PAEA Internal Medicine EOR Questions with Complete Solutions 2024.

PAEA Internal Medicine EOR Questions with Complete Solutions 2024. Bell's Palsy causes cranial nerve 7 dysfunction S/S of Bell's Palsy Has forehead involvement (whereas a stroke does not affect forehead movement), facial weakness, inability to keep one eye closed Treatment for Bell's palsy Prednisone 60mg x 5 days, Valcyclovir 1000mg TID x 7 days, artificial tears, lacri lube at night When can I use tPA? ischemic stroke presenting within <3 hrs and CT head negative How do you treat high BP with stroke? Nitroprusside (short half life, easy to titrate) or IV labetalol What do you use for anticoagulation/antiplatelet therapy in stroke? ASA (not in hemorrhagic), heparin for thrombosis What do you do differently to treat hemorrhagic stroke? Give prophylactic anticonvulsant like phenytoin because of increased seizure risk, antiplatelet therapy contraindicated Types of Hemorrhagic Stroke 1. Intracerebral (10%): results from rupture of small arterioles 2. Subarachnoid (3%): rupture of arterial aneurysms (hemorrhage into subarachnoid space) Causes of Intracerebral hemorrhagic stroke are what? HTN, amyloidosis, iatrogenic anticoagulation, vascular malformations, cocaine use Causes of Subarachnoid hemorrhagic stroke are what? berry aneurysm rupture, vascular malformation rupture PAEA Internal Medicine EOR Questions with Complete Solutions 2024 Signs and symptoms of Intracerebral hemorrhagic stroke are what? ICP rises, vasoconstriction-sweating Signs and symptoms of Subarachnoid hemorrhagic stroke are what? may be preceded by warning headache, neck/back pain, "worst headache of my life," thunderclap, may have loss of consciousness Treatment of Subarachnoid hemorrhage surgery, control hypertension, analgesics What is Complex regional pain syndrome (CRPS) Chronic arm or leg pain developing after injury, surgery, stroke, or heart attack. Signs and symptoms of complex regional pain syndrome are what? Pain out of proportion to injury. ANS sx: swelling, extremity color changes, increased nail and hair growth. Treatment for complex regional pain syndrome Amitriptyline, nortriptyline, gabapentin, pregabalin, lamotrigine; NSAIDs; Calcitonin to reduce pain as adjunctive therapy; Bisphosphonates, IVIG, regional nerve blocks, dorsal column stimulation Vit C prophylaxis after fx Imaging modality used to diagnose Subarachnoid Hemorrhage? CT without contrast. If CT negative but still suspect SAH, do LP to look for RBC or xanthochromia (will not develop until 12hrs after onset) Delirium transient disorder characterized by impaired attention, perception, memory and cognition. Sleep wake cycles interrupted ("sundowning"). Reduced alertness, activity levels change rapidly. Treatment of Delirium treat underlying cause, Haloperidol 5-10mg for agitation, Lorazepam 0.5-2 mg Dementia Loss of mental capacity. Psychosocial level and cognitive abilities deteriorate and behavioral problems develop. Largest categories are Alzheimer dz and vascular dementia. Hallucinations, delusion, depression, repetitive behavior are common. Treatment of Dementia Antipsychotics to manage psychosis Essential tremor does not occur at rest, occurs bilaterally, and has no indication of other neuro signs. How do you treat essential tremor? Propranolol, Primidone (can combine these 2 if needed) Guillian Barre Syndrome Idiopathic polyneuropathy often following minor infections, immunizations or surgical procedures. Most times no cause is identified. How long does Guillian Barre Syndrome last? worst at 2-4 weeks after onset, plateaus next 2-4 weeks, remits weeks-moats Signs and symptoms of Guillian Barre Syndrome ascending symmetric weakness and loss of DTR's, proximal muscles affected more than distal. Sensory abnormalities, pain, tachycardia, sweating, impaired pulmonary function, paralytic ileus How do you diagnose Guillian Barre? no fever at onset, CSF protein >45 and low WBC, MRI shows selective enhancement of anterior spinal nerve roots Treatment of Guillian Barre Syndrome IVIG or plasmapheresis, may need intubation. Hospitalized pt with close monitoring. Recovery is slow but approximately 60% make full recovery within 1 year. What disease is a systemic inflammatory condition of medium and large vessels affecting people over 50 years old, coexists with polymyalgia rheumatica and can cause blindness if not treated appropriately? Giant cell arteritis Signs and symptoms of Giant Cell Arteritis headache, scalp tenderness, jaw claudication, throat pain, diplopia Symptoms of polymyalgia rheumatica: pain of shoulder/pelvis Giant Cell Arteritis Treatment Steroids immediately, do not wait for biopsy results. Give low dose aspirin too. Describe a Migraine Headache? unilateral location, pulsatile quality, moderate to severe intensity, aggravated by movement, nausea, vomiting, photophobia, phonophobia lasting 4-72 hours Migraine treatment NSAIDs, Triptans, antiemetics What is a Cluster Headache? severe, unilateral headache localized to periorbital/temporal area accompanied by lacrimation, rhinorrhea, ptosis, myosis, nasal congestion, eyelid edema -Occurs in clusters meaning 1-8 daily attacks lasting 15-90 minutes for 4-6 weeks... followed by pain free interval 3-6 months Cluster headache treatment Oxygen, Sumatriptan 6mg SQ, start preventive therapy as soon as headache onset to suppress attacks over expected duration of cluster period Preventive therapies for cluster headache lasting more than 2 months Verapamil 240- 960mg given in 3 daily doses What is a Tension Headache? mild to moderate intensity, located bilateral-frontal areas, dull band like pain, lasting for hours, associated with stress. No nausea, vomiting, neuro deficits. Tension HA treatment NSAIDs or ASA combined with caffeine. APAP less effective but preferred in pregnancy. 2nd line therapies are antidepressants (amitriptyline) Huntington Disease inherited disorder, develops after 30 years old, progressive chorea and dementia, usually fatal within 15-20 years Signs and symptoms of Huntington Disease mental changes, restless, dystonic posturing, severe choreiform movements Empiric treatment for bacterial meningitis Ceftriaxone 2g IV and Vancomycin =/- Acyclovifr, Dexamethasone 10 mg IV; spupportive care Bacterial meningitis opening pressure of LP >300mm Viral meningitis opening pressure of LP <300mm Bacterial and Viral meningitis WBC in CSF from lumbar puncture Bacterial: >1000 Viral: <1000 Bacterial and Viral meningitis glucose in CSF from lumbar puncture Bacterial: <40 Viral: >40 Bacterial and Viral meningitis protein in CSF from lumbar puncture Bacterial: >200 Viral: <200.