Strokes, Hemorrhages, and Aneurysms

Strokes

Strokes and TIAs will 100% for sure be on your PANCE/PANRE/PACKRAT, you name it. While historically, the PANCE and PACKRAT are only 6% Neurology questions, these are a few that you shouldn’t miss. After completing my general neurology rotation, I quickly learned that the answers to these complex puzzles was definitely time-dependent. Can you think on your feet and generate a differential diagnosis? Attention to tiny details was crucial for Neurology because that’s how you can tell what part of the brain the ischemia/infarction is coming from.

I hope this review helps you regardless of which avenue you find it useful. Good luck and make sure to check out TrueLearn’s free sample questions below! The vignette style questions are exactly what you need to prepare yourself for PANCE related questions. Good luck!

Transient Ischemic Attack, Cerebrovascular Accidents (CVA) or Stroke, Bell’s Palsy

• Evolving stroke: worsening
• Completed stroke: maximal deficit has occurred
• Duration of symptoms is the determining difference
• Transient Ischemic Attacks (TIA)
• Neurologic deficit that lasts few mins to <24 hours (N: 30 mins)
• Symptoms transient because reperfusion occurs due to collateral circulation or breaking up of embolus
• Blockage in blood flow does not last long enough to cause permanent infarction
• Clinical Pearls
• Triptans are contraindicated in patients with coronary artery disease or peripheral vascular disease and should be avoided in all patients with an increased risk for stroke
• Contraindications to thrombolytic therapy: previous hemorrhagic stroke, stroke within 1 year, a known intracranial neoplasm, active internal bleeding, suspected aortic dissection. Relative contraindications: severe uncontrolled hypertension, use of anticoagulation, active peptic ulcer disease.
• Hypertension is the most common and most important stroke risk factor

Antibiotics for PAs - Part I

Antibiotics for Physician Assistants - Part I

Updated: 08/07/2016

• Empiric therapy is defined as the initiation of treatment prior to firm diagnosis, and knowing the specific organism causing the infection
• Started only after cultures have been obtained
• Targets likely pathogens and must use local antibiogram
• Broad spectrum means covering both gram positive and gram negative bacteria
• Pharmacokinetics: what the body does to a drug
• Absorption: described in terms of bioavailability (F)
• 100% bioavailable drugs (PO = IV): Linezolid, Fluoroquinolones, Tetracyclines, Azithromycin, Metronidazole, Trimethoprim/Sulfamethoxazole (Bactrim), Rifampin
• Distribution: affected by protein binding, blood flow, molecular size, lipophilicity, inflammation, and fluid status
• Metabolism: occurs primarily in the liver via multiple mechanisms
• Phase I: oxidation/reduction (CYP 450), hydrolysis
• Phase II: glucuronidation, sulfonation, methylation, acetylation, glutathione
• Elimination: primarily renal (glomerular filtration and tubular secretion)
• Most antibiotics require dose adjustment for creatinine clearance (CrCl) <50 mL/min

Cell Wall Synthesis Inhibitors

Sixth Semester at UTSW

Sixth Semester at UTSW

Updated: 08/07/2016

Below is a schedule taken from our program website detailing the clinical rotation schedule. Each student’s rotations are already set up for them (a huge plus), as I learned at the PAEA conference this year that not all PA programs do this. Some programs require that you setup your own rotations. Additionally, I appreciated an increased level of security that our rotations were quality - something not all programs ensure. Our rotations have been vetted before, dropping sites and preceptors who do not meet a high enough standard for our students. Our clinical coordinators have also done a great job of ensuring preceptors provide feedback to our students and that we get the most experience on each rotation, never being left in the shadows.

This year our class also joined the many PA programs utilizing PAEAs end-of-rotation (EOR) examinations, streamlining the examination process and unifying rotation evaluation with an enhanced & secure online experience mirroring the PANCE. After each 120-question exam we received feedback about our performance, including a topic list of each type of question we missed and the task area. The content of the exams is provided by PAEA in a blueprint style and topic list format.

During the spring of 2016, I went through internal and family medicine, which were both 8 week long rotations. I was at Parkland and Zale-Lipshy hospital for my internal medicine rotation and I was in Bridgeport, Texas for my rural family medicine rotation. Both presented great opportunities for learning and included lots of 1-on-1 time with my preceptors as well as lots of procedural learning opportunities. Of note, since I was about 1 hour away from home during family medicine, my PA program located, secured, and paid for housing for all 8 weeks. This is something UT Southwestern does for all of its rural family medicine rotations - we are all very fortunate to have this provided for us.