stethoscope

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

  • I took my PANRE June 7th and I PASSED!!!!
  • A new podcast is released every two weeks packed with only the most important information.

Enter your email address below to join our community and receive my top 54 study tips!

Rheumatologic Conditions Part 1

by Brian Wallace PA-C on April 8, 2014

Play

300px Joint pain 2Fibromyalgia 

Things you should know

  • Muscle and connective tissue pain
  • Frequently associated with depression, anxiety and posttraumatic stress disorder

I came in to see my physician assistant because of…

  • Widespread pain
  • Bowel and bladder issues
  • Fatigue
  • Weakness
  • Palpitations
  • Sleep issues

Labs, studies and physical exam studies

  • This is a diagnosis of exclusion
  • Widespread pain in all four quadrants of the body
  • Trigger points

Treatment

  • Cognitive behavioural therapy
  • Antidepressants
  • Excercise

Gout (Podagra)

Things you should know

  • Uric acid crystallizes in the joints
  • Occurs in men more than women

I came in to see my physician assistant because of…

  • I woke up with a really really painful, hot, red joint.

Labs, studies and physical exam studies

  • Red, hot, tender joint with decreased ROM
  • Most commonly this affects the metatarsal phalangeal joint of the great toe
  • It may be found in any joint but the feet, ankles and knees are most common
  • Hyperuricemia or uric acid levels > 8 is diagnostic however half of patients with gout will have levels below this
  • X-rays will be negative until end stage arthritis
  • Joint fluid – showing negatively birefringent crystals

Treatment

  • Prevention
    • Diet
      • Limit alcohol
      • Limit organ meats
      • Limit animal protein
      • Drink lots of water
  • NSAIDS – indomethacin is the drug of choice
  • Steroid injection to reduce inflammation
  • Colchicine – decrease inflammation in acute attacks
  • Allopurinol – decreases production of uric acid and is used for long term treatment

Pseudogout 

Things you should know

  • Due to deposits of calcium pyrophosphate into the joint
  • May be acute or chronic

I came in to see my physician assistant because of…

  • Joint pain

Labs, studies and physical exam studies

  • Most often affects large joints
  • X-ray may show fine linear calcifications
  • Joint fluid – calcium pyrophosphate crystals in the joint.

Treatment

  • NSAIDS
  • Steroid injection
  • Surgical joint replacement

Juvenile rheumatoid arthritis 

Things you should know

  • Girls more often than boys
  • Age of onset is before 16
  • Systemic JRA may include
    • Rash
    • Hepatosplenomegaly
    • Hepatitis
  • Oligoarticular or pauciarticular
    • Involves fewer than 5 joints
    • Typically involves larger joints
    • Eye issues are most common with this subtype
  • Polyarticular
    • More than 5 joints are involved

I came in to see my physician assistant because of…

  • Poor appetite
  • Fatigue
  • Lethargy
  • Fever
  • Limping
  • Pain
  • Morning stiffness
  • Systemic JRA has a characteristic rash and fever which come an go

Labs, studies and physical exam studies

  • Joint pain
  • Rash fever
  • X-rays will likely be negative
  • There is no specific blood work that is diagnostic
    • ESR is elevated
    • Rheumatoid factor may be positive

Treatment

  • NSAIDS
  • Physical Therapy
  • Occupational therapy

Polyarteritis nodosa 

Things you should know

  • Vasculitis of medium and small vessels
  • Affects males are  3x more likely to get this disease
  • Typically occurs between 40 and 60 year old

I came in to see my physician assistant because of…

  • Constitutional symptoms -fever, weight loss, fatigue
  • Abdominal pain
  • Neuropathy
  • Skin issues
    • Rashes
    • Ulcers
    • Livedo reticularis – a mottled purple skin discoloration

Labs, studies and physical exam studies

  • Skin issues
    • Rashes
    • Ulcers
    • Livedo reticularis
  • Kidney issues
    • Hypertension
    • Edemia
    • Oliguria
    • Elevated BUN
    • Creatinine Elevated
  • WBCs may be elevated
  • Erythrocyte sedimentation rate may be elevated
  • C-reactive protein may be elevated
  • Tissue biopsy will show vasculitis
  • Angiography

Treatment

  • High dose steroids

Polymyositis

Things you should know

  • Inflammation of the muscle – most frequently affecting the proximal limbs and neck
  • Women are affected more frequently than men

I came in to see my physician assistant because of…

  • Insidious onset of proximal muscle weakness
    • Difficulty going up stairs
    • Difficulty getting up from a chair
  • Dysphagia
  • Butterfly facial rash

Labs, studies and physical exam studies

  • Enzymes that may be elevated but are not specific
    • Creatinine phosphokinase (CPK)
    • Aspartate aminotransferase (AST)
    • Alanine aminotransferase (ALT)
    • Lactate dehydrogenase (LSH)
    • Myoglobin
  • Muscle biopsy

Treatment

  • High dose steroids

Polymyalgia rheumatica (PMR)

Things you should know

  • Pain in many muscles
  • Women are more commonly affected
  • Typically occurs in people older than 50.
  • Associated with temporal arteritis
    • 15% of patients with PMR will have temporal arteritis
    • 50% of patients with temporal arteritis will have PMR

I came in to see my physician assistant because of…

  • My muscles hurt and ar are stiff when I wake up in the morning
  • Muscle pain most commonly in the neck, shoulders and hips.
  • Symptoms tend to be symmetrical
  • Fatigue
  • Fever
  • Weightloss

Labs, studies and physical exam studies

  • Erythrocyte sedimentation rate is elevated

Treatment

  • Low dose corticosteroids (10-20 mg of oral prednisone) for several years
  • Excercise

Key terms and Ideas

  • A question includes the term negatively birefringent crystals.  What disease must be in your differential?
    • Gout
  • What medication do you use to control uric acid in a patient with a history of gout?
    • Allopurinol
  • Aside from lupus what is another disease which may have a butterfly facial rash?
    • Polymyositis
  • Which is used to treat polyarteritis nodosa, high or low dose steroids?
    • High

Study Tips

  • Discuss your study schedule with the people it will affect.  Be sure that before you begin study session that everyone else understands what you are planning to do and how long you will be.

If you are preparing for the PANRE or PANCE check back for weekly updates and PA review questions which are typically posted on Thursdays.   Bookmark this site or add it to your feed reader and never miss an update.   You can also subscribe by clicking here and receive my top 54 Study Tips!  Spend a few minutes a week with us and never have to cram again.

{ 0 comments }

Orthopedics osteoarthritis, tumors and more.

by Brian Wallace PA-C on March 25, 2014

Play

Knee replacementAcute/chronic osteomyelitis

Things you should know

  • An infection in the bone
  • Hematogenous- spread through the blood. 90% of these cases are found in children and long bones are most commonly affected
  • Exogenous – Typically from an open wound or surgery
  • Staph Aureus the most common pathogen
  • Salmonella is the most common cause of osteomyelitis in a patient with sickle cell anemia
  • Chronic osteo comes and goes. It is treated with antibiotics and then it comes back months or years later.

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

  • Pain, warm, red, tender
  • Open oozing wound
  • Foul smelling wound
  • Difficulty using limb

Labs, Studies and Physical Exam Findings

  • Warm, red, tender area
  • Swelling
  • X-ray will only show advance stages
  • MRI
  • Bone scan
  • Bone biopsy

Treatment

  • At least 6 weeks of antibiotics
  • Surgical debridement
  • Remove hardware if there is any. (plates, screws etc)

[Click here to finish this topic…]

{ 3 comments }

The Lower Extremity

In this podcast we discuss issues involving the hip, knee, foot and ankle. As always we stick to the most important things for your PANRE or PANCE

Read the full article →

Disorders of the back and spine

In today’s podcast we are covering disorders of the back and spine. As always we are sure to review the key term and ideas for your PANRE

Read the full article →

Upper Extremity

Problems of the upper extremity. Musculoskeletal makes up 10% of the PANCE or PANRE. We start covering it today.

Read the full article →

Leukemia, Lymphoma and Multiple Myeloma

In today’s podcast we cover leukemia, lymphoma and multiple myeloma. We cover just we you need to know for you PANCE or your PANRE

Read the full article →

Bleeding Disorders

Today’s session covers bleeding disorders including hemophilia, clotting disorders and platelet issues.

Read the full article →

Macrocytic and Normocytic Anemia

In today’s session we discuss macrocytic and normocytic anemias

Read the full article →

An Intro to Anemia Beginning with Microcytic Anemias

In today’s session we cover basic vocabulary for anemia. We also cover iron deficiency anemia, thalassemia and sideroblastic anemias

Read the full article →

Finishing Pulmonology A Review of Circulation, Cancer and a Few Other Issues

In this today’s podcast we cover pulmonary circulation issues, lung cancer and few other miscellaneous issues to wrap up pulmonology

Read the full article →