Pediatrics List of Most Commons for Physician Assistant Students

Most Commons in Pediatrics

• Most Common Congenital Heart Lesions
• Left-to-Right Shunts (Breathless)
• VSD (Ventricular septal defect) - 30%
• Right-to-Left Shunt (Blue)
• Tetralogy of Fallot - 5%
• Most common cyanotic heart anomaly with R-L shunt
• Common Mixing (Breathless and blue)
• Atrioventricular septal defect (complete) - 2%
• Coarctation of the Aorta - most common site is ligamentum arteriosum
• More common in males than females (3:1)
• Pathognomonic signs: rib notching on CXR, “three sign” on CTA

Orthopaedics List of Most Commons for Physician Assistant Students

Most Commons in Orthopaedics

• Compartment Syndrome
• Most commonly occurs in lower leg following tibia fractures or crash injuries
• Anterior Cruciate Ligament (ACL) Injury - most commonly injured knee ligament
• Osgood Schlatter’s Syndrome - most common in adolescents that are overactive (too many sports)
• Patellofemoral Pain: most commonly caused by anterior knee pain syndrome, chondromalacia patella, patellofemoral osteoarthritis
• Fibromyalgia - most common cause of chronic, widespread pain in the US

Neurology List of Most Commons for Physician Assistant Students

Most Commons in Neurology

• Tension Headache - most common type of headache
• Episodic Tension-Type Headache - most common headache subtype (<15 days monthly)
• Migraine - most common recurrent headache disorder
• Medication Overuse Headache (Analgesic Rebound) - most common cause of migraine-like and “mixed” headaches that occur > 15 days per month
• Epilepsy - most common in childhood due to perinatal injury, infection and genetic factors and old age due to stroke, tumors, or dementia
• Seizures
• Most common toxic causes of seizures: drugs, alcohol, and medications
• Most common metabolic causes of seizures: hypocalcemia, hypoglycemia, hyponatremia, hypoxia

Gastroenterology List of Most Commons for Physician Assistant Students

Esophageal adenocarcinoma is the fastest growing cancer in the United States. In total, it affects about 1.5 million people per year worldwide and 38,000 in the US alone. There has been a 6-fold increase in the last 3 decades, accounting for 60% of esophageal cancers. This is one puppy you don’t want to mess with; don’t even get me started on colorectal cancer!

Gastroenterology accounts for 10% of the PANCE, so make sure you pay attention during this part of your didactic phase! Knowing that, you had better take a step into gastroenterology with your thinking cap on ready to learn about new disease and therapy that can affect the way you provide care everyday.

Most Commons in Gastroenterology

• Heartburn (pyrosis) - most common symptom of esophageal disease
• GERD (Gastroesophageal reflux disease) - most common disorder of the esophagus
• Ulcerative Colitis - most commonly affects young adults in 2nd and 3rd decade of life, but 2nd peak in 7th decade
• Most common in N. America, England, N. Europe, and Australia
• More common in industrialized countries
• More common in higher socioeconomic status
• Important: Ulcerative colitis increases the risk of colorectal cancer
• Crohn’s Disease - most common between 15-30 years of age, though can present at any age
• More common in industrialized countries
• More common in higher economic status
• Most common in N. America, England, N. Europe, and Australia
• Skip areas common: The most common distribution pattern of Crohn’s disease is ileocecal, which involves the distal portion of the small intestine (terminal ileum) and the proximal large bowel (40% of patients)
• Most common skin lesions in IBD: pyoderma gangrenosum and erythema nodosum

Pulmonology List of Most Commons for Physician Assistant Students

This topic deserves an introduction. Why? Because it is Lung Cancer Awareness Month. How many of you have ever heard of Lung Cancer Awareness Month? Exactly. That’s probably because Breast Cancer Awareness Month probably stole its light in October. Unfortunately, breast cancer does not cause the most mortality in the United States, lung cancer does; that goes for men and for women. Why is this? Probably because there is not a unified and inexpensive diagnostic screening method for lung cancer as there is for breast cancer. Lung cancer causes almost double the number of deaths per year as breast, colon/rectal, and prostate cancers. Nonsmokers living with smokers have more than a 30% increased risk for developing lung cancer, regardless of whether or not the smoker is physically smoking around the nonsmoker or not. A diet rich in fruits and vegetables may protect against the development of lung cancer in smokers. However, high dose supplements of beta-carotene (also found in carrots) has been shown to increase the risk for lung cancer and is not recommended. So there you go. I have increased your knowledge about lung cancer in a matter of a few minutes. Hopefully now you will remember that every november is Lung Cancer Awareness Month and that you will remember to include lung cancer in your differential and to screen folks for it when necessary.

Most Commons in Pulmonology

• Cough - Most common complaint seen in outpatient setting
• Dyspnea (difficulty breathing) - common complain at emergency department
• COPD - most common respiratory disease; 3rd leading cause of death in US
• More prevalent in males
• Most common cause of COPD - cigarette smoking
• Most common bacterial pathogens in COPD are: Streptococcus pneumoniae, Haemophilus influenzae, and Moraxella catarrhalis
• Asthma - most common in children
• More common in male children
• Prevalence changes to adult women after puberty
• Most common in Caucasians
• Most are categorized as moderate persistent
• More common in obese individuals
• Most common Interstitial Lung Diseases
• (1) Usual Interstitial Pneumonia (idiopathic pulmonary fibrosis) - idiopathic interstitial pneumonia (IIP)
• (2) Sarcoidosis - idiopathic, granulomatous
• (3) Hypersensitivity Pneumonitis (HP) - known cause, granulomatous

Cardiology List of Most Commons for Physician Assistant Students

Dear Readers,

Below are the most commons in cardiology that I’ve put together from this block. I’m sure once I enter rotations I will be adding many more. Can I just say that one of my biggest pet-peeves right now is the incorrect pronunciation of medical terms? For example, angina. This word has been produced in two ways by various professors, but there must be a correct way to pronounce it, so naturally, I looked it up. “An-jen-uh” is the correct pronunciation, while “an-jine-ah” is colloquially used, but incorrect.

Cardiology Most Commons

• Most common pathologic process of the pericardium - Pericarditis
• Most common etiology of Acute Pericarditis - coxsackievirus A and B
• Most common cause of death in the U.S. - Coronary Artery Disease (CAD)
• Coronary microcirculation disease more common in women - this is why CAD affects more women than men annually
• Exercise electrocardiography less accurate in women
• More women die each year of CAD
• Most common cause of sudden cardiac death: ventricular fibrillation
• Most common cause of sudden cardiac death in young athletes: hypertrophic obstructive cardiomyopathy (HOCM)
• Hypertension
• More common in women as age increases
• More common in men in young and middle aged people
• More common in African Americans and lower socioeconomic groups
• African Americans develop at earlier age compared to other races
• Secondary HTN - more common in children
• White coat HTN - affects more treated women than men
• HTN is the SECOND most common cause of CKD

Dermatology List of Most Commons for Physician Assistant Students

Most PA programs teach in a systems-based style of learning with “block” style approaches to navigating through the mounds of medical factoids we must learn and know. It’s often talked about how PA students should start their own lists of “most commons” in medicine for each block or system in preparation for course examinations and the PANCE. It has come to my attention that this is most definitely the case. As such, I’ve decided to create a list of most commons for each block we cover, the first being Dermatology!

Most Commons in Dermatology:

1. Most common treatment for keloids: triamcinolone acetonide (corticosteroid) in concentrations of 10-40 mg/mL at 4-6 week intervals
2. Most common cutaneous cyst: epidermal inclusion cyst (EIC), also known as cutaneous cysts
3. One of Top 3 Skin problems in children: verruca vulgaris
1. Most common primary treatment: cryotherapy and salicylic acid (cure rate improved by combining both therapies)
4. Human Papilloma Virus (HPV) is one of the most common STIs causing Condylomata Acuminate, also known as External Genital Warts (EGW)
5. Most common type of psoriasis: Plaque Psoriasis (affects 80-90% of patients).
6. Most common clinical pattern seen in Psoriatic Arthritis:
1. Oligoarthritis - swelling and tenosynovitis of one/few hand joints.
7. The “Butterfly Rash”
1. Many facial rashes are described as malar or “butterfly” rashes
2. Most commonly, they are either: seborrheic dermatitis or rosacea, NOT systemic lupus erythematosus (SLE)
8. Most common dermatologic condition in infants: Diaper Rash (diaper candidiasis)

Anatomy Tips and Tricks for Physician Assistant Students

Anatomy can be a doosey for everyone, so don't let it get you down if you're having trouble. A few mnemonics and acronyms can be your savior if you are really struggling. Just make sure you have them straight and practice saying them out loud. Remember that sometimes, the most silly or inappropriate mnemonics or acronyms can help you recall the toughest things! Be creative and have fun with anatomy, it will help it stick. Some of my acronyms and mnemonics may not be helpful or useful to you if you don't understand them, so try making your own. When in doubt, draw it out! Drawing vasculature or nerves from beginning to end can take some time, but can be worth it in the long run. Typically, I would draw out sections of vasculature or nerves and then go to the lab to identify them. It really helped me solidify relationships.

When I was in anatomy, I would read the lab manual the night before, taking notes on things I thought were important for the lecture test. To my surprise, much of what I originally thought were minor details, were actually very helpful in locating structures for the lab exam. Knowing relationships between structures can aid your learning in anatomy, because if you can find landmarks like nerves, vessels, or bony structures, you can often figure out what something is.

For your practical, if your school offers any old exams, you might make a list of all of the terms that have been tested on in the past and their occurrence. You and your classmates might also join Quizlet and start your own flashcard deck. Our class created decks for each exam that helped to quiz when the lab was closed. Creating tables with muscle origins, insertions, and actions will also help reinforce your learning. Remember, teamwork makes the dream work!

If you have anything to add to this list, please leave it in the comments section below. Thank you all for reading! Much thanks to the UT Southwestern PA Class of 2015 for their help.

Helpful Links

• Free Online Anatomy Practicals
• Virtual Cadaver Lab
• BioDigital Human
• The Skeleton Dance - for help with bony landmarks
• Shoulder Articulations
• Brachial Plexus Parody
• Drawing the Brachial Plexus in 37.6 Seconds

Upper Body

• Suprascapular nerve/artery with the superior transverse scapular ligament (bridge)
• Army goes over the bridge, Navy goes under it
• = Artery superior to ligament, Nerve inferior to ligament

First Semester at UT Southwestern

Dear Readers,

I sincerely apologize for not having been as active as I was previously. Today I completed summer I at UT Southwestern. I can tell you all that it was no easy task. All of the rumors are true! While I definitely enjoyed my first semester here in Dallas, I have to say, it was probably the most difficult semester I've ever endured. Here is a snapshot into each course and my overall experience thus far. I hope you future PA's enjoy this post!

A look at a typical week in the first semester of PA school. This is Summer I at UTSW.

International Volunteer Opportunities and Missionaries for Physician Assistants

International Volunteer Opportunities and Missionaries for Physician Assistants

Whether you’re a pre-PA, a PA student, or a professional PA looking for international volunteer opportunities or mission trips to enhance your global impact, look no further! In this post, you’ll find a variety of resources to get you started on planning your trip and even links to places you may have never heard of before. If you have any resources or comments to contribute to this posting, please leave them in the comments section below and I’d be happy to include any and all changes or additions.

First off, I’ll start by directing your attention to AAPAs “Before You Go--Preparing for International Practice.” This is not only useful, but essential on so many levels! You’ll find links for researching the country you’ll visit, passport information, visa information, insurance, immunizations, physician supervision, guidelines for working internationally, and much more!

Now, let me direct your attention to AAPAs International Volunteer Opportunities page, where you’ll find out:

• What you need to know before making a trip
• The “Before You Go” checklist of travel information and questions to ask before accepting a volunteer position - found above
• A list of volunteer databases (given by AAPA) known to accept physician assistants including, but not limited to:
• International Medical Volunteers Association - contains resources for international volunteering
• International Healthcare Opportunities Clearinghouse - a list of more opportunities
• Omni Med - database of global health service opportunities

In addition, the International Practice guide lists guidelines for international licensure, liability coverage, and transporting medical supplies that may be helpful.

A list of International PA Caucuses involved in the delivery of international healthcare are:

• Physician Assistants for Global Health
• Fellowship of Christian Physician Assistants

Physician Assistants and Medical Scribes

Physician Assistants and Medical Scribes

The word scribe is Latin for scribere, which means "to write." A scribe has been known historically for recording events, making written copies of documents, and more recently, "transcribing" word for word. Medical scribes have emerged most recently in response to the extensive use of EMR into clinical practice from widely used handwritten and dictation methods. 

What Role do Medical Scribes Have in Healthcare?

Medical practices, hospitals, and typically lots of emergency departments hire medical scribes to relieve the providers unequipped with rapid typing skills or who cannot simply find their way around on EMR software. A medical scribe serves to record the actions and words spoken as they occur. Scribes cannot implement their own observations into the medical record. The scribe documents the activities of the provider as they occur and must include the name and signature of the provider who performed the encounter. The provider is required to attest of his/her presence during the encounter, verifying they have reviewed the scribe's documentation and the accuracy. The provider must also sign and date the encounter. 

What are the Benefits of Medical Scribes? 

The Affordable Care Act and Physician Assistants

How is the ACA going to affect me as a PA? How is the ACA going to affect my patients?

By: Paul Gonzales

These two questions were posed in an article written in the september issue of PA professional. I think they're both very important questions for pre-PA students, current students, and practicing PA's. If you don't know what the ACA is - the Affordable Care Act is what people are calling ObamaCare. The terms are interchangeable, incase you were wondering. Signed into law March 23, 2010, the ACA quickly implemented changes such as the following below. In addition, the grand impact of the ACA was to decrease the number of uninsured Americans by as many as 32 million people. Highlighted in red are a few impacts that relate heavily to PA practice. I encourage you to read through all of them.

• Cover children younger than 19 regardless of pre-existing conditions (2010)
• Young adults can now stay on their parents insurance until they are 26 (2010)
• Access to insurance for uninsured individuals with pre-existing conditions (2010) - some people who have be uninsured for 6+ months have trouble finding insurance because of existing conditions
• Scholarships and loan repayment plans (2010) - primary care practitioners have access to repayment or loan forgiveness programs to increase the primary care workforce
• Increased federal payments to providers in rural areas (2010)- this includes PA's who work in rural areas; examples are Medicare, Medicaid, Children's Health Insurance Program