Pancreatitis and Pancreatic Cancer

Pancreatitis and Pancreatic Cancer

I can’t even stress to you how frequently PA students are tested over pancreatitis (acute and chronic) and pancreatic cancer. It seems to be one of those vague presentations that test writers take advantage of by placing in distractors (answers that seem right, but are in fact incorrect). This is meant to be a short, but hopefully helpful review of each of them, so that you are better prepared to tackle questions on these topics regardless of if they’re your in house exams during didactic, rotation exams, the PACKRAT, the PANCE, or the PANRE. I hope this helps you regardless of which avenue you find it useful. Good luck and make sure to check out TrueLearn’s free sample questions below! I’ll say, I loved their gastroenterology section the most. The vignettes were on point and difficulty wise - they were spot on with the rotation exams and PANCE-style questions.

Acute and Chronic Pancreatitis

Introduction to Behavioral Health

Introduction to Behavioral Health

Updated: 04/22/2016

The Multiaxial System - used previously in DSM 4 (now DSM 5 is used, but we should still understand and recognize the importance of these axes).

1. Axis I – serious mental illnesses (mood, anxiety, eating, sleep, impulse-control, adjustment)
2. Axis II – personality disorders +/- mental retardation
3. Axis II – general medical conditions (neoplasms, injury, poisoning)
4. Axis IV – psychosocial and environmental problems (educational problems, economic, housing, access to healthcare)
5. Axis V – GAF (1-100) = global assessment of functioning

Terminology

AFFECT - The patient’s present emotional responsiveness, inferred from patient’s facial expression, including amount and range of expressive behavior [objective: what you observe about pt]

Appropriate	Inappropriate	Congruent	Incongruent
Appropriate amount of eye contact, facial expression, responsiveness, etc.	Incongruent with content or social norms	Psychotic content consistent with patient's mood	Psychotic content inappropriate to patient's mood

Restricted	Constricted	Blunted
Reduced intensity of affect – lesser degree than blunted	Restricted affect	Severe reduction in intensity of affect

Flat	Exaggerated	Labile
Virtually no signs of affective expression, no facial expression, monotonous voice	Dramatic, overly expressive	Fluctuating, rapid changes in emotion unrelated to external stimuli

Seizures, Headaches, and Migraines

Seizures, Headaches, and Migraines

Updated: 04/18/2016

Seizures, headaches and migraines are some of the most commonly occurring questions on the PACKRAT, rotation exams, PANCE, and PANRE. Since they also occur commonly in practice, you’ll definitely want to cover these topics thoroughly. Knowing the subtleties between each and the questions to ask is important not only for your understanding, but so you can treat the patient accordingly with the most appropriate therapy.

While Neurology only makes up 6% of the PANCE, knowing topics like this well can mean the difference between passing and not passing. As I have stated before, one of the best ways to prepare for your exams is through quality question banks and study guides. TrueLearn has introduced an incredible opportunity to work with the PA-student and PA community to help us excel in our didactic education and clinicals, and on our boards. See below for our second post discussing Seizure Disorders and Headaches and Migraines.

Remember from last month that TrueLearn’s SmartBanks include specialized medical content crafted to mirror rotation exams, the PACKRAT, the PANCE and the PANRE. This means that the best test writers have come together to write questions that not only get your juices flowing, but challenge you to think critically - the most important characteristic of great PAs.

Visit TrueLearn.com/Physician-Assistant/ today to learn more about their physician assistant products.  

Disclosure: I am not an employee of TrueLearn.

Seizure Disorders - sudden abnormal discharge of electrical activity

• Epilepsy - syndrome of recurrent, idiopathic seizures

• In seizures, duration of unconsciousness tends to be longer than in syncope (momentary)
• In syncope, bladder control is retained, but lost in seizures
• Causes: four Ms and four Is
• Metabolic and electrolyte disturbances - hyponatremia, water intoxication, hypoglycemia and hyperglycemia, hypocalcemia, uremia, thyroid storm, hyperthermia
• Mass lesions - brain mets, primary brain tumors, hemorrhage
• Missing drugs
• Non-compliance with anticonvulsants (most common reason)
• Acute withdrawal from alcohol, benzos, barbituates
• Miscellaneous
• Pseudoseizures - psychiatric in origin
• Eclampsia
• Hypertensive encephalopathy
• Intoxication - cocaine, lithium
• Infection - septic shock, bacterial or viral meningitis, brain abscess
• Ischemia - stroke, TIA (common in elderly)
• Increased ICP due to trauma
• Diagnosis
• If known epileptic → check anticonvulsant levels
• If first seizure
• CBC, CMP (LFTs), blood glucose, renal function tests, serum calcium, urinalysis
• EEG: most helpful diagnostic test, abnormal pattern is not diagnostic alone
• CT scan of head: r/o structural lesions
• MRI of brain with and without gadolinium: more sensitive than CT for structural changes
• LP/blood cultures if febrile
• Pregnancy test - before initiating anticonvulsants!!!
• Treatment
• ABCs first, secure airway and roll patient to side
• Known epileptics
• Check for non-compliance of anticonvulsant, check levels
• If persistent with monotherapy, increase dose of first anticonvulsant until signs of toxicity appear → add second drug if seizures uncontrolled
• If controlled → continue regimen x 2 years, then taper
• First seizure
• EEG with neurology consult
• Anticonvulsant therapy
• If normal EEG, recurrence low (15%) compared to abnormal EEG (41%)
• Do not treat patients with single seizure - start antiepileptics if EEG abnormal, MRI abnormal or status epilepticus

Introduction to Medically Important Bacteria

Introduction to Medically Important Bacteria

Updated: 08/07/2016

Types of Therapy

• Prophylactic Therapy – treatment initiated to prevent an infection that has not yet developed
• Ex. Antibiotic “prophy” to prevent opportunistic bacterial infections
• Ex. Antibiotics while on a trip to Mexico
• Ex. Antibiotics before surgery or dental procedures to prevent bacterial endocarditis
• Empiric Therapy
• Empiric – relies solely on observation or practical experience.
• Therapy initiated to treat serious infections until test results are available; or therapy for minor infections (URI’s, UTI’s) because causative organisms are predictable and their susceptibility to available antibiotics is known
• Definitive Therapy
• Start broad spectrum antibiotics before the culture and sensitivity results are reported. When they become reported, you know what will kill the bug in vitro and can tailor the therapy making it less broad and more definitive.
• The hospital antibiogram can assist with empiric or definitive therapies.
• Antibiogram
• The cumulative results of hospital performed bacterial susceptibility testing organized into a summary table which may be used by clinicians, pharmacists, infection control personnel and microbiologists as a reference guide to community or hospital-specific resistance patterns.

TrueLearn's SmartBanks

Introducing TrueLearn

Updated: 03/17/2016

At the PAEA Summit I recently attended in Washington D.C. I learned that PA students and practicing PAs should understand that even once we graduate, we will always be a student. Continuous learning is an expectation not just of our peers or NCCPA, but of our employers as well, and our colleagues (physicians and NPs). Collectively, we must work to ensure we are practicing at the top of our career, implementing the best practices and presenting the most up-to-date information to our patients. One colleague put it plainly, “either be at the table, or be on it.” This can be interpreted in many ways, but I believe that regular review of content keeps us competitive.

Over the next 3 months, I will be selecting topics that are most commonly tested by the NCCPA and PAEA for exam preparation. TrueLearn, which provides next generation question banks (called SmartBanks), will provide free practice questions on these topics to provide insight into their test preparation expertise. One of the best ways to prepare for your exams is through quality question banks. TrueLearn has introduced an incredible opportunity to work with the PA-student and PA community to help us excel in our didactic education and clinicals, and on our boards. Moving forward, I am pleased to announce TrueLearn to the table of exam preparation for PAs from the start of your education. See below for our first post discussing Heart Murmurs. This topic is important as Cardiology makes up 16% of the PANCE and PANRE exams.

SmartBanks, brought to you by TrueLearn, the nation’s most trusted test preparation, provide the highest level of test readiness available today.Their products have served up over 39 million practice questions in 2015 alone, achieving an 11% score improvement after using their SmartBanks. TrueLearn’s SmartBanks have been utilized for USMLE, COMLEX, and specialty board exams in general surgery, anesthesiology, emergency medicine, family medicine, pediatrics, OB/GYN, internal medicine, and psychiatry. These exams are written by the nation's leading specialists and are used by most medical students and residents in preparation for shelf (clinicals) and board exams.

TrueLearn’s SmartBanks include specialized medical content crafted to mirror rotation exams, the PACKRAT, the PANCE and the PANRE. Why stop there? Use these exams to help you prepare for Certificates of Added Qualification (CAQ) - the limits are endless!

Visit TrueLearn.com/Physician-Assistant/ today to learn more about their physician assistant products.  

Career Advancement for PAs

Career Advancement for PAs

Updated: 01/17/2018

About 1.9% of PAs have obtained a doctoral degree of some sort (PhD, EdD, DHSc, DPH “public
health”, PsyD, PharmD, DHEd, DHA “healthcare administration”, DGH “global health”,
DPA “public administration” etc.) according to the 2014 Statistical Profile of Certified PAs
released by the NCCPA in 2016. PAEA’s 2014 Faculty and Program Director’s Report showed
174 faculty held doctoral degrees, with 30 DHSc, 15 EdD, 56 PhD, 12 PharmD, and other (JD, etc.).
Of the 48 program directors who responded, 19 held a PhD, 10 DHSc, 7 EdD. Degree creep is upon
our profession as it has affected many of our colleagues in the healthcare workforce. With increased
competition from our peers, we are continually being challenged to step up to the educational demands
of our employers and address the deficit in leadership and education nationwide. Doctoral degrees,
while not the be-all-end-all of expertise, can offer physician assistants an opportunity for career
advancement in many areas, including public healthy policy, education, and administration. This
is why so many physician assistants have chosen to seek higher education - to open up new
opportunities. While some may argue that doctoral degrees are unnecessary to obtain these
potentials, not every PA will be offered the same experiences in the same amount of time with
the same amount of experience.

Many PAs wonder about the incentives for pursuing a doctoral degree. Some include:

• Most PA programs require a doctoral degree for tenure status, which can make you
• more marketable if you are considering education (Dean or program director)
• Recommended: DHEd (higher education), EdD (education), DHSc (health science)
• or PhD (philosophy)
• Governmental jobs pay higher based on degree attainment
• Some private sector jobs offer higher financial incentives for higher degrees, most do not
• Competition faced against DNPs
• International opportunities to work in global health
• Administration and organizational management gateway
• Recommended: MBA, MPA, MHA
• Feasibility of conducting research as the primary investigator and applying for grants
• Recommended: PhD
• Managing public health departments or providers
• Recommended: DrPH

In as many as 27 states, nurse practitioners are allowed to practice independently of their
supervising physician (full autonomy), which has created lots of competition to hiring PAs for
those same positions. Qualified individuals are not receiving adequate compensation for lacking the “proper credentials.” There are many fields in which a doctoral degree is already required, such as physical therapy, pharmacy, audiology, psychology, and advanced nurse practitioners. Arguably, some PAs feel this is a major threat to our profession and that PAs need to develop a degree specific to our profession or as an entry level degree. Unfortunately, there are few degree programs that allow PAs to pursue an advanced route in medicine to enhance their careers especially in a cost-effective manner.

Click here to read the Clinical Doctorate Summit (used to be available for free) which highlights
many of the opinions centered around the doctoral degree, degree-creep, and deciding what the
terminal degree should be for physician assistants.

Some of the more difficult questions you might ask yourself if you are considering a doctoral degree:

• What are my plans after I obtain the degree and how long will it take me to obtain the degree?
• How time consuming will this be, can I afford it, and how invested in it am I?

• How do PAs work toward advancing their career in leadership within the larger administration they work within?
• What programs or training are available beyond pursuing an MBA, MHA or PhD?
• Should I get a doctoral degree in healthcare sciences? Beyond education, what new career opportunities justify the expense of obtaining a DHS? Same question applies to DHed and EdD.

Doctor of Health Science (DHSc) Programs

Currently, there are 2 DHSc programs that are well attended and known by PAs,
although MCPHS and many other universities have also started programs. Both programs are academic instead of clinical doctorates. Both are doctorate degrees in the health sciences, so each degree will allow you to do similar work as with a MPH. PAs have a great opportunity for lateral movement in medicine, but the struggle remains to move up vertically in any hierarchy. The DHSc has brought forth administrative opportunity and responsibility. Obtaining a doctoral degree can make any candidate more marketable, but keep in mind that a DHSc may not improve what you are already capable of clinically. Patients may be better served by a doctoral degree that offers a different area of expertise, such as public or global health, hospital administration, or leadership/organizational behavior. These specialty areas can make PAs more of an asset.

• AT Still University Mesa, Arizona
• Outcomes: prepare students to better understand, effectively manage and evaluate solutions to ongoing challenges of healthcare access, cost, and quality
• Knowledge and skills to excel in project management, decision-making, organizational leadership, establishing evidence-based standards and gaining competencies to apply research to professional practice
• 64 credit hours of distance education + 1 week residency in AZ
• 8 quarters long, may start in any quarter, take 1-2 classes per quarter
• No on campus requirement except graduation
• Admission Requirements: master’s degree, 2 years experience, 3.0 GPA
• 70 credit hours total
• Cost: $34,370
• Nova Southeastern Ft. Lauderdale, Florida
• Outcomes: provide evidence based knowledge in health sciences, including health professions education, epidemiology, global health, health policy, clinical professionalism and ethics, and effective delivery of culturally competent services to populations and individuals in U.S. and internationally
• Online course delivery with an internship and practicum, doctoral analysis, two 1-week on-campus institutes
• No dissertation required, complete the program in as little as 2 years (or up to 3.5 years), 1-2 classes per semester
• 61 credit hours at $628/semester hour = $38,308
• Admission Requirements: Master’s degree, 3.0 GPA, prior healthcare experience
• MCPHS Boston, Massachusetts
• Outcomes: pursue educational opportunities in teaching in higher education or leadership in healthcare delivery organizations, advanced managerial and administrative positions within private care facilities, government agencies, pharmaceutical industries, clinical and research settings, etc.
• Part-time option available, two-1 week Boston residencies in January and July
• Dissertation required
• Two concentrations:
• 1) healthcare administration
• 2) academic health sciences
• Admission requirements: master’s degree, 3.0 GPA, 3-5 years of health related work experience
• 54 semester hours at $870/credit hour = $46,980
• Jefferson College of Health Sciences - Roanoke, Virginia
• Admission requirements: master’s degree, GPA 3.0+, master’s level statistics course and master/doctoral level research methods course, 4+ years experience as a professional clinician, public health examiner, educator in health-related field or HCA, healthcare manager/administrator
• Keiser University -
• Admission requirements: graduate degree, 2+ years full-time managerial or professional experience in healthcare, 2 letters of recommendation, interview

Doctor of Physician Assistant Studies Programs

In February of 2014, Lynchburg College in Virginia announced its plans to develop a doctoral PA program to suit the needs of the future of health care and PA students. They have notified the Southern Association of Colleges and Schools (SACS) of their decision. Director and Founding Chair, Jeremy Welsh, DHSc, PA-C, says that a degree beyond a master's would be beneficial to those seeking leadership positions such as a program director or chair. It would also allow PAs in emergency medicine to gain expertise in the specialty. The program will consist of a fellowship, advanced didactic training in leadership, and a commitment to student research. This training could also prepare someone for teaching PA education as some PA educators lack a doctoral degree. Students wishing to enter this degree program would first graduate from Lynchburg College's Master of PA Medicine (MPAM) program and pass the PANCE. The first graduates will be in May 2018.

• Outcomes: leadership and organizational behavior, healthcare management and law, disaster medicine, and global health
• Clinical fellowship in any area of medicine
• 9-12 months of academic and clinical preparation
• Admission requirements: master’s degree

MCPHS also offers a Doctor of Science in Physician Assistant Studies (DScPAS)

• Admission requirements: GPA 3.2+, state licensure and current NCCPA certification, work experience (preferred), MPAS or equivalent
• 23 total credits over 5 semesters

Physician Assistant to Doctor of Osteopathic Medicine

• Lake Erie College of Osteopathic Medicine Accelerated Physician Assistant Pathway - WI
• Fast tracked, 3-year medical school curriculum leading to Doctor of Osteopathic Medicine degree
• Curriculum
• 1st year of didactic instruction
• 2 primary care focused clinical clerkships: 1 family medicine, other in general IM, pediatrics, family medicine, or OB/GYN
• 2nd year of didactic instruction
• 48 additional weeks of clinical clerkships
• 12 students accepted annually: 6 undeclared (students take residency of their choice), 6 primary care (commit to 5 years in family practice, internal medicine, pediatrics or OB/GYN)
• Admission requirements: PA-C, GPA 2.7+, at least one physics/organic chemistry course with lab, minimum 23 on MCAT, U.S. citizen or permanent residency
• LECOM Academic Index Score - alternative for applicants who have no taken MCAT (undergraduate/graduate GPAs + ACT/SAT scores)
• Oceania University of Medicine - Samoas

Doctor of Public Health

• University of Illinois at Chicago
• Outcomes: lead practice-based research, influence public health policy, effect change in health systems and institutions, and assume key roles in the public health community at local, national, and international levels
• Distance based learning with a one time 3-day summer institute
• Dissertation required
• 28 semester hours

Dual-Degree Programs

Master of Physician Assistant Studies (MPAS)/Master of Public Health (MPH/MSPH)

• Pros
• Cost of dual program can be cheaper than getting MPH by itself
• Less time than if you were to get both degrees separately
• Requires less coursework than separate programs
• Do not have to author two theses
• Access to global or public health careers
• Access to hospital or administrative roles (health policy/management)
• Access to academia
• Access to more jobs, internationally
• Government jobs pay more with an MPH
• Some employers will pay for your tuition
• Cons
• Increases overall program length
• Costs at private institutions can be expensive
• Less ability to specialize with your public health degree (most are general)
• Ones that are focused (research methods, policy, epidemiology) - can influence your future employment options
• Some PA programs do not have accredited MPH programs, which matters if you are seeking government jobs
• Schools Offering
• George Washington University
• Yale University
• Emory University
• Touro University California
• Campbell University
• Arcadia University
• MEDEX Northwest
• University of Nebraska Medical Center
• University of North Texas
• Des Moines University
• Rutgers University

Master of Physician Assistant Studies (MPAS)/Master of Healthcare Administration(MHA)

If you’re looking to become an administrator of a hospital or health care education, you’ll probably want to look into dual programs that offer MPAS/MHA degrees. Other PAs who move into administrative positions also have Master of Business Administration degrees, in which case you could also look into doing a MPH/MHA or MPH/MBA degree before PA school as well. If you’re looking into management after PA school, you could apply to become an operations manager (junior administrator) and eventually be promoted to operations administrator (hospital administrator). It is highly advised that if you’re looking into health care administration, you go with a program offering a dual MHA program.

• Schools Offering
• Pacific University
• Des Moines University
• Philadelphia University (MBA/MPAS)
• Marywood University (MPAS/Master of Health Services Administration)
• The Mayo Clinic also offers an Administrative Fellowship Program for graduates wishing to commit to careers in health care administration.

MMs-PhD Program for Physician Assistants

• Wake Forest School of Medicine - a 5-7 year program that combines a Master of Medical Science in PA Studies with a PhD in Molecular Medicine and Translational Science (MMTS)
• This program primarily targets students interested in clinical research, community research and translation of knowledge into improved human health
• Lab research is supervised by physician scientists and molecular medicine pathway is clinically oriented, and after research and dissertation are complete, the PA facet begins with connections to population and translational research applications.
• PhD candidates also gain mentored experiences in teaching.

Also, you might like, International Physician Assistants and International Volunteer Opportunities.

Check out Certificates of Added Qualifications (CAQs).