When to begin studying?  Where to start?

If you’re unsure of  where to begin or how to get started follow along as we cover the NCCPA blueprint.

Viral Exanthems and More

by Brian Wallace PA-C on April 14, 2015


Exanthem – widespread rashRash_of_rubella_on_skin_of_child's_back

  • 6 childhood exanthems and 4 of them are viral
    • 1st disease – Rubeola
    • 2nd disease – Scarlet fever
    • 3rd disease – Rubella
    • 4th disease – Exfoliative Staph infections
    • 5th disease – Erythema infectiosum
    • 6th disease – Roseola

Rubeola (Measles)

Things you should know

  • Highly contagious
  • Respiratory droplet transmission

I came in to see my physician assistant today because of…

  • Fever greater than 104.0
  • Cough
  • Runny nose – rhinitis, coryza
  • Red eyes
  •  Red, flat maculopapular pruritic rash beginning on the face and then spreading

Labs, Studies and Physical Exam Findings

  • Koplik’s spots are pathognomonic and are seen 2-3 days after onset
    • Small white spots inside the mouth
    • There are tests for serum IgM and salivary IgA


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Spirochetal Disease

by Brian Wallace PA-C on March 31, 2015


Erythema migrans

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Lyme Disease

Things you should know

  • Borrelia burgdorferi
  • Transmitted by a deer tick bite – it takes between 36 and 48 hours to transfer the bacteria.
  • The deer tick is found in high grass or wooded areas

Signs and Symptoms

  • Early localized stage (about 1 week after the bite)
    • Erythema Migrans – Bull’s eye rash (about 1 week after bite)
    • Fever
    • Malaise
    • Flu like symptoms
  • Early disseminated stage (weeks)
    • Muscle and joint pain
    • Facial or Bell’s palsy
    • Severe headaches and neck stiffness – due to inflammation of the spinal cord (meningitis)
    • Pain and swelling in the large joints (such as knees)
    • Pericarditis, arrhythmias
    • Shooting pains that may interfere with sleep
  • Late disseminated stage (months)
    • Arthritis most commonly in the large joints
    • Shooting pains
    • Polyneuropathy
      • numbness and tingling in the hands or feet
    • Mood changes and memory loss
    • Fatigue
    • Untreated disease can have significant cognitive and psychological manifestations

Physical exam findings

  • Erythema Migrans – A small, red bump may appear at the site of the tick bite, which later the redness expands forming a rash in a bull’seye pattern, with a red outer ring surrounding a clear area.


  • Clinical exam and history
  • A history possible exposure to a tick.  Most patients will not have any memory of a tick bite.
  • Blood tests (there are many cross reactive disease processes)
    • Enzyme-linked immunosorbent assay (ELISA) test.
      • Detects antibodies to B. burgdorferi.
      • False negatives in the early stage of Lyme disease
    • Western blot test.
      • Done following a positive ELISA test
      • detects antibodies to several proteins of B. burgdorferi.
    • Polymerase chain reaction (PCR)
      • This has been most helpful in joint fluid


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Episode 100 – This week we go through over 50 review questions

We cover over 50 review questions this week, come take a listen

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Mycobacteria and Parasites

We continue ID with mycobacteria and parasites for the PANCE or the PANRE

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