I'm rebuilding this site in a simpler format. Sorry that some of the pages are still unformatted.

Videos

This should be videos and maybe images

The Rheumatologist website has an article entitled "Know Your Labs" with a follow up part 2.

Here are some great notes for your surgery rotation from the University of Louisville. It is for their medical students, but I think it all applies to PAs as well.

How to Shine: This is the most hands-on rotation you will have, and it’s important that you take advantage of it. Always bewilling and prepared to jump in and help. In the OR this means anticipating where you can be most useful, such as using thesuction to grab smoke at they use the Bovi, asking for the scissors as they begin to close, and transferring the patient to andfrom the bed. Outside the OR this means running errands, putting on gloves when doing a bedside procedure, changingdressings, etc. When in doubt, put on gloves so you are available for assistance should it be needed. In addition, confidence iskey. Always speak with confidence when you present or answer a question, even if you aren’t entirely sure of yourself. A fewother ways to shine –

Before the OR: There should be a student present in every case. Before surgeries begin each day, divide thescheduled cases between you and the other students on your team and decide who is scrubbing in on what. Read upon your patient, the surgeries you are scrubbing in on, and know the anatomy involved. Know your patient and knowwhy they are having surgery. Some surgeons ask—what’s the most important question of the day? The answer: Whyare we here? Read the HPI and look at any imaging the patient may have had. In addition, it may be helpful to get toknow the scrub team, the anesthesia team, and the other ancillary staff members that could make your life easier.This is team- and location-dependent, but if you get to know the anesthesia resident well, and stay with your patientfrom pre-op to the OR, they may be willing to teach you techniques like inserting IVs, induction, and intubation.

In the OR: Keep tabs on when your patient arrives to the OR. Pick out your gloves, and your resident’s gloves if youknow their size, and introduce yourself to the OR tech well before surgery. Also, write your name and year in medicalschool on the dry erase board—it helps the staff identify who you are and your role immediately. Help the OR staffwith moving the patient to the table, positioning the patient, shaving body hair, applying betadine to the area beingoperated on, etc. Always pay attention and be prepared to do your part during surgery. If you hear the attending orresident ask for the retractor, be ready to hold it. If they begin to close, ask for the scissors and be ready to cut. Aftersurgery, help the OR staff transfer the patient back to the bed. Stay with the patient until they are delivered to thePACU. The OR is like a dance—a lot goes unsaid and it’s up to you to anticipate the pace, tone, and next move; predicttheir needs, as well as when it is an appropriate time to ask questions or, arguably more important, when to stayquiet. This finesse comes with time and close observation, but the keen student will catch on quickly as the rotationprogresses.Note

Rotations, general

ISU's PA program (Idaho State) has 8 rotations of 5 weeks each. Most people end up with orthopedics or dermatology for their elective.

Outpatient

Internal Medicine

Psychology

Elective - Orthopedics

Elective - Derm

Pediatrics

OBGYN

Emergency

Surgery

Tips for studying for an emergency medicine rotation

I would recommend studying the Tintinalli's Emergency Medicine Manual. It was the gold standard while I was in school and I still reference the smaller pocket version from time to time. You could also check out the Society of Emergency Medicine Physician Assistants (SEMPA) and see what resources they recommend.
Have fun in the ER. It is a great place to work!

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DT, PA-C
Remote Physician Assistant
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Essentials of Musculoskeletal Care has info on reductions, joint injections, etc

Roberts and Hedges’ Clinical Procedures in Emergency Medicine has info on LPs, central lines, paracentesis, and a host of other invasive procedures.

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EH, PA-C, DHSc, DFAAPA
Doctor of Health Science & Global Health
Portland, OR
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Some great active resources to quickly look simple things up on the go, are PEPID {$} and also WikiEM and its app. As far as learning tools, em:rap {$} is very good for emergency medicine. If there are specific areas you need a better knowledge base of, just pick up a Current Diagnosis and Treatment book and start going through it. I use current from time to time when I need a refresher on a topic and I think it's the ultimate resource.

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DB PA-C
Emergency Medicine
Scottsdale AZ
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Depending on the way you learn, you might consider asynchronous learning with the use of FOAMed. foamcast.org, embasic.org. They will actually summarize the information in Rosens and Tintinalli into "RosenAlli" and provide you the most up to date information available, in a form you can load on your phone and listen to it during your commute.

Load the podcast up and re-listen if there is a concept you don't understand.... the best part, it's free.

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FN PA-C
Emergency Medicine
Scottsdale AZ
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How to Present the Patient

Pharmacology was my greatest torment in school. This page will never compete with other pharm resources, but I need a place to consolidate pharm items.

A viral infection followed by infection of the thyroid gland, causing subacute thyroiditis, is known as de Quervain's syndrome, or, more properly, de Quervian's Thyroiditis*. Neck pain and a tender mass in the neck anteriorly indicate thyroid inflammation. Sometimes, the swollen thyroid may cause obstructive symptoms. Sudden release of thyroid hormone may cause transient hyperthyroidism.

*De Quervain syndrome, more commonly refers to de Quervian's Tenosynovitis, an inflammation of the sheath or tunnel that surrounds the two tendons that control movement of the thumb.

Not to be confused with "D-Qwon's Dance Grooves" the fictional VCR dance instruction tape Napoleon Dynamite finds in a thrift store.

There isn't much research on Marijuana and cannabinoids in medicine. There seems to clearly be some great use-cases for glaucoma, improving appetite in cancer, cachectic, and other anorexic patients, as well as some pain relief in certain cases. Beyond that, I'm not so sure. Here is a solid set of papers in one place. Although they might not provide a lot of useful information.

Consumer reports has drug reports designed for consumers that are pretty well made. CR: Does Medical Marijuana Work? (2016)

Not part of the PANCE/PANRE Blueprint

Headache, palpitations, and diaphoresis together make up the “classic triad” in patients with a pheochromocytoma. A pheochromocytoma is a catecholamine-producing tumor that is most commonly found in the adrenal gland superior to the kidney. It is commonly diagnosed due to hypertension, but it causes less than 1% of hypertension cases. The symptom triad listed above has been found to have a specificity of almost 94% and a sensitivity of almost 91% for patients with pheochromocytomas. Patients may also experience other symptoms, including constipation, weight loss, flushing, and dizziness. Since the tumor produces catecholamines, excess production is usually measured by determining the levels of excreted metabolites during a 24-hour period by a 24-hour urine. Abdominal MRI can then be used to confirm the presence of the adrenal tumor.

Kernig's sign is a sign of meningeal irritation. The patient lies on his back, and his leg is raised and knee bent at a 90-degree angle. If there is pain or resistance to further extension when the examiner straightens the knee, Kernig's sign is said to be positive. This patient has signs and symptoms of cryptococcal meningitis. Cryptococcus neoformans is a yeast with a capsule made of polysaccharides.

India ink exam is positive for Cryptococcus neoformans. When visualized on high dry magnification, encapsulated organisms (Cryptococcus neoformans) have capsules that look like halos because they exclude the India ink. Cryptococcus neoformans can cause meningitis, and there is an increased risk of Cryptococcus neoformans meningitis in immunosuppressed individuals.

Babinski's sign is an abnormal response to stimulation on the sole of the foot that results in dorsiflexion of the big toe and fanning of the other toes. Babinski's sign is seen with pyramidal disease.

Kussmaul's sign is an increase in venous pressure during inspiration; it can be seen with cardiac tamponade.

Quincke's sign is also called Quincke's pulse. This sign is seen in the nails. It consists of whitening and reddening of the nail bed coinciding with each heartbeat. Quincke's sign can be seen with aortic insufficiency.

Chvostek's sign can be seen with tetany. When tapping on the facial nerve produces contraction on that side of the face, it is called Chvostek's sign.

Meningococcemia is an acute onset disease caused by the organism Neisseria meningitidis, which is an encapsulated, Gram-negative, aerobic, nonmotile diplococcus. When the organism enters the bloodstream and is disseminated, the result is meningococcemia. Patients with acute meningococcal infection may present with meningitis, meningitis with meningococcemia, or meningococcemia. Humans transmit the bacteria via aerosols or secretions from the nasopharynx. Infection is preceded by colonization of the nasopharynx. The bacteria may then enter the bloodstream and spread to areas, such as the meninges or joints, or disseminate throughout the body.

The infection may begin with sore throat, cough, and headache. Later, the patient experiences a rapid onset of fever with chills, myalgias, and arthralgias. The progression can be quite rapid, which makes early diagnosis extremely important. Fulminant meningococcemia may develop within a few hours, with rapid enlargement of petechiae, hypotension, cardiac depression, and purpuric lesions. In patients with meningitis, headache, neck stiffness, lethargy, altered mental status, seizures, and drowsiness may develop.

On physical exam, patient may have tachycardia, hypotension, and moderate fever. The fever increases with fulminant meningococcemia. A petechial/purpuric rash is present in approximately 55-80% of patients. It frequently involves the axillae, trunk, flanks, and ankles. Petechiae are often located in the center of lighter-colored macules. Serious complications include congestive heart failure, pulmonary edema, renal failure, and other end-organ damage.

Laboratory analysis shows the presence of meningococci from blood, spinal fluid, or joint fluid. About 50-80% of skin scrapings yield N.meningitidis if the skin chosen is over petechiae or a pustule. More research is being done on this to find a rapid method for diagnosis. Polymorphonuclear leukocyte levels are usually elevated, and thrombocytopenia may be evident.

Rocky Mountain spotted fever is a tick-borne disease caused by the organism Rickettsia rickettsii. It is the most fatal tick-borne disease in the United States. It is most common in rural and suburban areas of the Southeastern U.S. Patients may present with fever, myalgias, headache, and a maculopapular rash that usually appears about 2 to 6 days after infection. It begins on the wrists and ankles and then spreads to the rest of the body. It also spreads to the palms and soles of the feet. The rash is usually diagnostic.

Inhalant intoxication is characterized by behavioral changes that include apathy, assaultiveness, and impaired judgment. Physiological changes include nystagmus, slurred speech, psychomotor retardation, and movement abnormalities (e.g., incoordination, depressed reflexes, ataxic gait, and tremor). Mood presentation can range from euphoria to stupor.

Opioid intoxication is characterized by behavioral changes that include euphoria followed by apathy, shortened attention span and memory dysfunction, psychomotor agitation or retardation, and poor judgment. Physiological changes that may present include slurred speech, drowsiness, and pupillary constriction.

Phencyclidine intoxication is characterized by disinhibition, aggressive behavior, anxiety, panic, rage, and impaired judgment. Physiological changes can include hyperthermia, elevated blood pressure, tachycardia, hyperacusis, nystagmus, diminished pain responsiveness, dysarthria, and seizures.

Sedative, hypnotic, or anxiolytic intoxication is characterized by disinhibition, mood lability, and impaired judgment. Physiological symptoms may include slurred speech, poor coordination, nystagmus, impaired memory, and coma.

Cocaine intoxication is characterized by behavioral changes that include euphoria, hypervigilance, paranoia, interpersonal sensitivity, anxiety, and poor judgment. There are also possible physiological changes that include pupillary dilation, tachycardia or bradycardia, elevated or lowered blood pressure, psychomotor agitation, cardiac arrhythmias, seizures, and diaphoresis.

Lyme disease can happen without the typical target lesion, and that can make it very difficult to diagnose. Chronic Lyme Disease also seems to be somewhat of a catch-all title for certain chronic fatigue symptom sets by naturopaths and self-diagnosers. A lot of the latter group seem to refer to it as "Lyme's Disease" which makes me wonder if there will be a point when we can call Lyme disease the infection by the spirochete Borrelia burgdorferi, and Lyme's disease, an alternative medicine chronic fatigue syndrome. The NEJM put out this article that discusses the various pathologies that fall under the Chronic Lyme Disease umbrella.

EmCrit published this great paper on HyperK treatment titled: Management of severe hyperkalemia (pdf). I particularly liked how each treatment was categorized by its functional purpose: Membrane stabilization, Redistribution, and Elimination

Membrane stabilization

Redistribution

Elimination

NLMEB - Never Let Monkeys Eat Bananas

The results of a White Count differential indicate the percentage of each type of white blood cell that is present in a sample of blood. This mnemonic helps you remember the cell types in descending order of presentation.

If the Lymphocyte count is greater than the neutrophil count, be suspicious of an acute viral infection.

APETM - All Pigs Eat Too Much

Spanish

English-Spanish Dictionary of Health Terms made for volunteers at the UConn Migrant Farmworkers’ Clinics. Well done, succinct, and prints nicely into a compact booklet.