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Physician Assistant Course Information

Physician Assistant Review Course Information

Post-Rotation Exams

Post-Rotation Exam - Allergy/Immunology
Post-Rotation Exam - Cardiology
Post-Rotation Exam - Dermatology
Post-Rotation Exam - EENT
Post-Rotation Exam - Emergency Medicine
Post-Rotation Exam - Family Medicine
Post-Rotation Exam - Geriatrics
Post-Rotation Exam - Internal Medicine
Post-Rotation Exam - OBGYN
Post-Rotation Exam - Orthopedics
Post-Rotation Exam - Pediatrics
Post-Rotation Exam - Psychiatry
Post-Rotation Exam - Surgery
Post-Rotation Exam - Underserved Care
Post-Rotation Exam - Urgent Care

CME Bank - Signs, Symptoms, and Presentations (AAPA Credit)

Abdominal Pain
Acute Pelvic Pain in Women
Acute Vaginal Bleeding
Back Pain
Chest Pain
Confusion
Constipation
Cyanosis
Depressed Consciousness and Coma
Diarrhea
Dizziness and Vertigo
Dyspnea
Fever in the Adult Patient
Gastrointestinal Bleeding
Headache: Initial Approach
Hemoptysis
Jaundice
Nausea and Vomiting
Seizures: Initial Approach
Syncope
Weakness

CME Bank - Allergy/Immunology

Auto-Immune Collagen Vascular Disorders
Drug Allergy
Food Allergy
Hypersensitivity Reactions
Pediatric Allergy and Immunology
Primary Immunodeficiency Disorders
The Immunocompromised / Solid-Organ Transplant Patient

CME Bank - Cardiovascular System

Congenital Heart Disease in the Adult
Congestive Heart Failure
Dysrhythmias/Conduction Defects
Endocarditis
Hypertension
Ischemic Heart Disease
Myocardial Disease
Pediatric Cardiovascular Disease
Pericardial Disease
Valvular Heart Disease
Vascular Disease

CME Bank - Dermatology

Acne/Rosacea
Cancers of the Skin
Cutaneous Infections
Dermatitis (non-infectious)
Maculopapular Lesions
Papular/Nodular Lesions
Pediatric Dermatology
Ulcerative Lesions
Vesicular / Bullous Lesions

CME Bank - EENT (Eyes, Ears, Nose and Throat) System

Eye: Assessment
Eye: Glaucoma
Eye: Inflammation and Infection
Eye: Pharmacology
Eye: Vascular Disorders
Nose: Infection and Inflammation
Oral Cavity: Medical Disorders
Otologic Infections
Otologic Signs, Symptoms, Presentations
Pediatric Eye, Ear, Nose and Throat Disorders
Throat and Soft Tissue Neck: Medical Disorders

CME Bank - Endocrinology, Metabolism, and Nutrition

Adrenal Disorders
Diabetes Mellitus
Disorders of Calcium Metabolism and Bone
Hypoglycemia
Lipid Disorders
Obesity
Thyroid Disorders
Pediatric Endocrine Disorders

CME Bank - Gastroenterology/Nutritional System

Biliary Tract Disease
Colonic and Anorectal Disease
Esophageal Disorders
Liver Disease
Pancreatic Disease
Pediatric Gastrointestinal Disorders
Small Intestinal Disease
Stomach or Duodenum

CME Bank - Genitourinary System

Acute Renal Failure
Chronic Kidney Disease
Glomerular Disorders
Nephrolithiasis
Pediatric Nephrology and Urology
Penile Disorders
Prostate Disorders
Sexually Transmitted Infections - Male
Testicular Disorders
Urinary Incontinence
Urinary Tract Infections
Water and Electrolyte Balance

CME Bank - Hematology and Oncology

Anemia
Bone Tumors
Breast Cancer
Coagulopathies
Disseminated Intravascular Coagulation
Gastrointestinal or Hepatic Cancer
Gynecologic Cancer
Hematologic Malignancies
Lung Cancer
Management of Malignant Pain
Neoplasms of the Head and Neck
Oncologic Emergencies
Pediatric Hematology and Oncology
Sickle Cell Disease
Transfusion Medicine (Principles and Complications)
Urological Cancer

CME Bank - Infectious Diseases

Coronavirus (SARS-COV-2, COVID-19)
COVID-19 During Pregnancy
Diphtheria, Pertussis, Tetanus
Meningococcemia, Pneumococcemia
MRSA, VRE, ESBL
Tuberculosis
Parasitic Infections
Pediatric Infectious Diseases
Sepsis Syndromes
Systemic Fungal Infections
Tick-Borne Illnesses
Hantavirus HIV and AIDS
Influenza, Mononucleosis, Herpes
Rabies

CME Bank - Musculoskeletal System

Bone and Joint Infections
Crystal-Induced Arthropathy
Deep Soft Tissue Infections
Disorders of Muscles
Infectious, Inflammatory, and Reactive Arthritis
Neck and Back Pain
Osteoarthritis Rheumatoid Arthritis
Sports Injuries / Trauma
Systemic Lupus Erythematosus
Systemic Sclerosis Vasculitis
Pediatric Rheumatology and Musculoskeletal Disorders

CME Bank - Neurological System

Central Nervous System Disorders: Delirium and Dementia
Central Nervous System Disorders: Demyelinating/Inflammatory Diseases
Central Nervous System Disorders: Diseases of Movement Control
Central Nervous System Disorders: Seizures
Central Nervous System Disorders: Spinal Cord Syndromes
Central Nervous System Infections
Cerebrovascular Accidents: Epidemiology and Presentation
Cerebrovascular Accidents: Initial Work-Up
Cerebrovascular Accidents: Preventive Care
Cerebrovascular Accidents: Treatment
Headache: Cervical Neck Vessels, Subarachnoid, and Venous Emergencies
Headache: Cluster, Migraine, and Tension
Headache: Less Common Etiologies
Neurologic Assessment
Pediatric Neurologic Disorders
Peripheral Nervous System Disorders: Neuromuscular Junction Disease
Peripheral Nervous System Disorders: Neuropathies
Selected Cranial Nerve Disorders

CME Bank - Psychiatry/Behavioral System

Affective Disorders
Antidepressants
Anxiety Disorders
Anxiolytics
Dissociative Disorders
Eating Disorders
Factitious Disorders and Malingering
Geriatric Psychology
Obsessive-Compulsive Disorder
Pediatric Psychiatric Disorders
Personality Disorders
Psychiatric Assessment
Psychological Factors Affecting Medical Disorders
Schizophrenia
Somatoform Disorders
Substance Abuse
Suicidal Behavior
Thought Disorders

CME Bank - Pulmonary System

Asthma and Other Obstructive Lung Disease
Interstitial Lung Disease
Lower Respiratory Tract Infections
Occupational and Environmental Lung Disease
Pediatric Respiratory Disorders
Pleural Disease
Pulmonary Vascular Disease
Sleep Medicine
Upper Respiratory Tract Infections

CME Bank - Reproductive System

Acute Complications of Pregnancy
Chronic Medical Illness During Pregnancy
Contraception
General Approach to the Pregnant Patient
Gynecological Assessment
Menopause and Hormonal Therapy
Screening and Regular Health Care in Adult Women
Sexual Assault Sexually Transmitted Infections: Female

Sample Question 1

A 37-year-old man presents with scrapes, bruises, and a broken arm after falling off a ladder. His clothes are dirty and he does not seem to have washed or bathed for at least several days. In the clinical interview, you note that the patient abruptly shifts topic for no apparent reason and without noticing. What other symptoms would help cement the diagnosis of schizophrenia, particularly if present for a month or more?

hypersomnia
anhedonia
pressured speech
no additional symptoms needed
Auditory hallucinations

To make the diagnosis of schizophrenia requires the presence of 2 or more characteristic symptoms. These include: i. Delusions   ii. Hallucinations iii. Disorganized speech (e.g., frequent derailment or incoherence, present in the example) iv. Grossly disorganized or catatonic behavior v. Negative symptoms, i.e., affective flattening, alogia, or avolition

References:

American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 5th ed., 2013.

Andreasen NC, Olsen S. Negative v positive schizophrenia. Definition and validation. Arch Gen Psychiatry. 1982;39(7):789-794

Sample Question 2

A 52-year-old woman presents to you asking about the potential benefits of hormone therapy (HT), which she is considering to help with her hot flashes. She has a strong family history of colon cancer. Which of the following statements is true?

HT is recommended as long-term chemoprophylaxis for the prevention of colon cancer.
The role of estrogen in the development of colon cancer is well understood.
Colon cancer is the second leading cause of cancer death in women.
Although colon cancer is less common in women on HT, the incidence of fatal cancers has not been shown to be decreased in women taking HT.
Progesterone clearly has a protective effect on the development of colon cancer.

Colon cancer is the third leading cause of cancer death in women after breast and lung cancers. Several studies have shown a decrease in colon cancer diagnosis associated with the use of HT. However, the risk of advanced tumors does not appear to be reduced. Long-term follow-up of the Women's Health Initiative showed a small and non-significant increase in colon cancer-related mortality among women treated with HT. HT is not recommended as long-term chemoprophylaxis due to the risks associated with long-term therapy as well as the doubt about the effect on mortality. The role of estrogen in colon cancer is unclear, and it is also unclear how much of this effect is due to estrogen only or if progesterone is also protective.

References:

Brändstedt J, Wangefjord S, Nodin B, et al. Associations of hormone replacement therapy and oral contraceptives with risk of colorectal cancer defined by clinicopathological factors, beta-catenin alterations, expression of cyclin D1, p53, and microsatellite-instability. BMC Cancer. 2014;14:371.

Delellis Henderson K, Duan L, Sullivan-Halley J, et al. Menopausal hormone therapy use and risk of invasive colon cancer: the California Teachers Study. Am J Epidemiol. 2010;171(4):415-425.

Mørch LS, Lidegaard Ø, Keiding N, et al. The influence of hormone therapies on colon and rectal cancer. Eur J Epidemiol. 2016;31(5):481-489.

Simon MS, Chlebowski RT, Wactawski-Wende J, Johnson KC, et al. Estrogen plus progestin and colorectal cancer incidence and mortality. J Clin Oncol. 2012;30(32):3983-3990.

Sample Question 3

Which of the following is true when distinguishing between a neuropathy and a myopathy?

EMG are not sensitive enough to distinguish between myopathies and neuropathies.
Leukocytosis with elevated erythrocyte sedimentation rate and muscle enzymes usually occur with neuropathy.
Deep tendon reflexes (DTRs) remain intact in neuropathies.
Weakness tends to begin distally with neuropathy and is often accompanied by sensory disturbances, while myopathies tend to present with more proximal weakness.
Neuropathy causes muscle pain, swelling, and tenderness.

Neuropathies begin distally and have sensory disturbances. In addition, the DTR’s are often absent. EMG is a very sensitive test that can not only distinguish between neuropathies and myopathies, but can often localize the location of the pathology.

Myopathies retain their DTR’s. Myopathies can, but do not always result in muscle pain and tenderness, and elevated muscle enzymes and sedimentation rate (ESR) upon blood testing.

References:

Losman ED. Weakness, in Rosen’s Emergency Medicine, 7th edition, Concepts and Clinical Practice. Marx JA editor. 2009, Mosby (Elsevier); volume 1, part I, section 2, chapter 11.

Bethel CA. Myopathies; last updated Dec 30, 2009.

Sample Question 4

This child abruptly developed large purpuric plaques, hypotension, gastrointestinal hemorrhage and renal failure. Which of the following is the most likely diagnosis?

cellulitis
traumatic purpura
purpura fulminans
staphylococcal scalded skin syndrome

This patient has purpura fulminans, the sudden onset of symmetric purpuric lesions in association with vascular collapse, hypotensive shock, fever, gastrointestinal hemorrhage, and renal failure. Purpura fulminans usually follows some acute infectious process such as meningococcemia, varicella or Group A beta-hemolytic streptococcal septicemia. Cellulitis appears as painful red to violaceous indurated skin, not purpuric plaques. Traumatic purpura often occurs on the forearms of elderly patients and represents extravasated blood produced by trauma to fragile, aged cutaneous vessels; it is noninflammatory.

Staphylococcal scalded skin syndrome presents with widespread red skin that subsequently peels superficially.

Sample Question 5

A 45-year-old man presents to you with a chief complaint of "coughing up blood." During your physical examination of the patient, you remember that there are certain priorities to consider in a patient with hemoptysis.

Which of the following statements is true regarding the role of the physical examination in the evaluation of such a patient?

The physical examination localizes the site of bleeding in a surprisingly large number of cases.
The physical examination is more reliable in determining the site than the cause of bleeding.
Cardiac examination is usually noncontributory and is a lower priority in the evaluation of the patient with hemoptysis.
The nasal cavity and oropharynx should be examined for signs of bleeding.

Educational Objective:

Recall the physical exam approach to a patient with hemoptysis.

Key Point:

The nasal cavity and oropharynx should be examined for evidence of bleeding, which may mimic hemoptysis.

Explanation:

There are several priorities in the examination of the patient with hemoptysis. 

The top priority is assessment of hemodynamic stability as well as adequacy of airway patency, oxygenation, and ventilation. In addition to vital signs and pulmonary examination, this entails auscultation of the heart for signs of valvular or congestive heart disease (possible alternate or additional sources of hemodynamic instability). 

After assessment of the patient’s cardiovascular stability (top priority), the second priority is to rule out an alternate source of bleeding, such as the naso- or oropharynx. The physical examination generally does not determine the site or the cause of bleeding.

Reference:

Brown III CA., Raja AS. Hemoptysis. (Chapter 21) In: Walls RMarx JA, et al. Rosen’s Emergency Medicine: Concepts and Clinical Practice. 98th ed., 201814: 190203-194205.e1.

Target Audience

Med-Challenger Physician Assistant is intended for practitioners of acute and primary care or clinicians otherwise involved in the diagnosis and treatment of acute, emergent, or chronic medical problems.

Educational Objectives

The objective of the Challenger academic continuing medical education programs is to provide an interactive review of the knowledge base of acute care and primary care medicine as appropriate by medical specialty. After completing this course, the participating clinician should be better equipped to:

Confidently manage the broad spectrum of acute and chronic medical problems encountered in the practice of medicine.
Formulate appropriate differential diagnoses for patients presenting with acute medical problems of uncertain etiology.
Efficiently initiate therapeutic and diagnostic procedures for patients presenting with acute and chronic medical disorders.
Cope effectively with the uncertainty that is inherent in the initial treatment of acute and chronic disorders.
Handle efficiently the spectrum of common disorders involving all organ systems. In particular, the physician will be better equipped to diagnose and treat acute and chronic: cardiovascular disorders; diseases of the eye, ear, nose, throat, skin and soft tissues; endocrinologic disorders; traumatic and environmental injuries; gastrointestinal diseases; gynecologic and obstetric disorders; hematologic and oncologic problems; immunologic, allergic and rheumatologic diseases; infectious diseases; life-threatening signs and symptoms; musculoskeletal disorders; pulmonary diseases; and intoxications and poisonings.
Demonstrate mastery of the knowledge and cognitive skills required to achieve objectives 1-5 by scoring at least 80% on all topics studied for CME credit.

Faculty

Mark W. Perdue, PA-C
Clinical Assistant Professor
University of Oklahoma (Tulsa)
Tulsa, OK

Joint Accreditation Statement

This activity has been planned and implemented in accordance with the accreditation requirements and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint providership of National Association for Continuing Education and Challenger Corporation.

The National Association for Continuing Education is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.

Designation Statement

AMA Credit - The National Association for Continuing Education designates this enduring activity for a maximum of 215.0 AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

AAPA Credit - Earn up to 20 AAPA-approved CME credits (annual requirements)

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