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Short & Sweet PANCE/PANRE Review

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    Small & Large Intestine Part II: Immune Disorders, Ischemia, Infection

    We're here to provide you short & sweet PANCE review to help you PASS your exam. Today we'll be covering symptoms, diagnosis, and management of inflammatory bowel disease, appendicitis, diverticular disease, IBS, and more. For a complete copy of the show notes including today's take away points, please visit https://pastudysesh.blubrry.net/bowelpart2

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    Small & Large Intestine Part 1: Obstruction

    We're here to provide you short & sweet PANCE review to help you PASS your exam. Today we'll be covering symptoms, diagnosis, and management of bowel obstruction, intussusception, colon cancer, and Hirschsprung Disease. For a complete copy of the show notes including today's take away points, please visit https://pastudysesh.blubrry.net/bowelobstruction

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    Disorders of the Stomach

    We're here to provide you short & sweet PANCE review to help you PASS your exam. Today we'll be covering symptoms, diagnosis, and management PUD, gastritis, gastric neoplasms, and pyloric stenosis. For a complete copy of the show notes including today's take away points, please visit https://pastudysesh.blubrry.net/stomach

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    Disorders of the Esophagus

    As always, we're here to provide you with the key blueprint information to help you PASS your PANCE. For full show notes, including my mnemonics and Take Away Points, please visit: https://pastudysesh.blubrry.net/esophagus

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    Beyond the Boards: My New Grad Job Search Experience

    So you're procrastinating studying for the PANCE by scrolling through your Facebook Feed and there it is, another "Happy to announce that I'll be working for ______ as a PA!" post. As graduation inches closer, it seems to be all there is. You want to be happy for your classmates, but what you're really thinking is: why can't I find a job?. I want to share with you my experiencing in finding my first job after graduation and assure you that you are not alone in this feeling and that everything will be ok. https://pastudysesh.blubrry.net/?p=185&preview=true

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    Cardio Conglomeration

    As always, we're here to provide you with the key blueprint information to help you PASS your PANCE. For full show notes, including my mnemonics and Take Away Points, please visit: https://pastudysesh.blubrry.net/carditis

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    Hypertension & Hyperlipidemia

    Disclaimer: new guidelines as of late 2017 Unlikely to be reflected on PANCE yet. New BP Guidelines: Elevated: 120-129/ 80 Stage 1: 130-139/80-89 Stage 2: 140+/90+ Hypertensive crisis: 180+/120+ with patients needing prompt changes in medication if there are no other indications of problems, or immediate hospitalization if there are signs of organ damage. Medication for Stage 1 only if high ASCVD risk (same calculator used in prescribing statins)   Now Back to the PANCE: Hypertension *  Definition * Prehypertension 120-139/80-89 * Stage 1 140-159/90-99 * Stage 2 160+/100+ * Urgency 180+/120+ & NO end organ damage * Emergency 180+/120+ & end organ damage (HERB) * ON 2 DIFFERENT READINGS * Symptoms * Primary Hypertension is typically asymptomatic * Hypertensive emergency * Encephalopathy * Intracranial hemorrhage * Nephropathy * Unstable angina/MI * Papilledema=malignant hypertension * Treatment (non-urgent/emergent) * Lifestyle Modifications 1stALWAYS (Including those with Pre-HTN) * DASH Diet * Lower Sodium * Exercise * Healthy weight * Smoking Cessation * Medication Therapy * Begin at 140/90 (this is also BP goal) * Unless * Over age 60 * Normal Kidneys * No Diabetes * Then 150/90 * Which med? * 4 Main Classes to Choose From * ACE Inhibitor * Angiotensin converting Enzyme * -“pril” * Side Effects: * Cough * Hyperkalemia * Angioedema * Contraindications: * Renal artery stenosis * Pregnancy * ARB * Angiotensin II Receptor Blocker * -“sartan” * Side Effects: * Hyperkalemia * Angioedema * Contraindications: * Renal Artery Stenosis * Pregnancy * Calcium Channel Blocker * -“dipine” * More effective as vasodilators than verapamil and diltiazem * Side Effects: * Cardiac depression * Still have some cardiac effects * Thiazide Diuretic (HCTZ) * Side Effects: * Hypokalemia * Gout * Dyslipidemia * Contraindication: * Sulfa Allergy * How to choose? * If they have CKD or DM * ACE/ARB (Renal Protective) * African American * TZD or CCB * None of the above? * Then just pick one! * You can max out the dose before adding a 2ndor add a 2ndif goal isn’t met, doesn’t matter * NEVER MIX AN ACE AND AN ARB * Both inhibit the RAAS * Renin angiotensin aldosterone system * So at most, they’ll be on ACT * Other possible additions * Beta blockers “olols” * fib * Post MI * Stable Angina * Heart failure * Alpha blockers “zosin” * Pts with BPH * Pregnant? Use Methyldopa * Resistant to medication? Consider secondary hypertension * Renal artery stenosis * Coarctation of the Aorta (think Peds) * Sleep Apnea * Pheochromocytoma * Primary Hyperaldosteronism * Thyroid disease * Treatment * Urgency * Decrease by 25% over 24-48 hours * Rest in a quiet room

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    Back to Basics: EKG Interpretation

    This episode is less about boards, more about being thorough and thinking about how to process an EKG systemically in order to not miss something. For boards, it’s ok to jump to what is glaring at you. No questions or take away points associated with this podcast. As promised, here is my EKG Cheatsheet! Evidence of a pacemaker? * Failure to capture * Heart doesn’t “capture” signal * Pacemaker spike, but no P wave * Failure to Pace/Oversensing * Pacemaker is over sensing electrical activity * HR is slow, pacemaker isn’t initiating beats * Failure to sense * Pacemaker ISN’T sensing natural heart activity * sends unnecessary spikes EKG Interpretation 1 box=0.04s wide x 1mm high * Rate=how fast * 6 second strip*10 * can be used for regular or irregular rhythms * May also use 300-150-100-75-60-50 method * Refers to # of large boxes in between R waves * 1 large box=300bpm, 2 large boxes=150bpm * Rhythm MUST be regular * Tachycardia is ALWAYS tachycardia (>100bpm) * regardless of sinus, junctional, or ventricular tachycardia * Sinus * Bradycardia >60 * Normal 60-100bpm * Junctional * Escape 40-60bpm * Accelerated Junctional 60-100bpm * Ventricular * Idioventricular 20-40bpm * Accelerated Ventricular 40-100bpm * Rhythm=pattern * normal=atria, junction, ventricals * 1. Should be able to march caliper along R-R intervals without adjustments * If no, we already know the rhythm is irregular * 2.  Do we have distinct P waves? * No? * Junctional rhythm? * inverted or absent p waves * normal QRS complex * non-compensatory pause * Ventricular rhythm? * absent p waves * wide-bizarre complex * pre-mature ventricular contraction with compensatory pause * A fib? * Yes? Does each P have a QRS? * No? * A flutter * 2nd/3rd degree heart blocks * 3. Determine if regularly irregular or irregularly irregular. * P wave * Normal=2.5×2.5 boxes * Represents atrial depolarization * Too wide? (3 boxes) * Left atrial enlargement * May also be M shaped * Left is LONG * Too tall? (3 boxes) * Right atrial enlargement * PR Interval * Normal= 0.12-0.2s (3-5 boxes) * Too long? * Consistent=1st degree heart block * Inconsistent= 2nd degree heart block (Type 1 or 2) * Too short? = Pre-Excitation Disorder * Wolf-Parkinson-White * Also has delta wave * Lown-Ganong-Levine * QRS Complex * Normal = less than 0.12s (3 boxes) * Too wide? * Bundle branch block * Left * Deep S in V1 (carrot) * Broad R in v6 * Right * RsR’ in v1 (rabbit ears) * Wide S in v6 * Ventricular rhythm * Wide, bizarre complex with no p wave * Height? * Right ventricular hypertrophy

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Short & Sweet PANCE/PANRE Review

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