The Physical Exam, How to be Better

As PA students we are taught a great deal of about the value of the physical exam. In addition, we spend significantly more time learning about it than most MD/DO programs.... but as with most things in PA school... too much information in too little time. It is much like drinking from a fire hose on full blast. Bates is a great resource to read, but I'm a visual learner. YouTube has tons of videos, but sometimes the hunt for a good video is tiring and often it doesn't paint the whole picture.

Luckily I came across The Stanford 25. The authors of this site came up with 25 bedside clinical evaluations that were important to them and came up with a video/text all about the subjects. Very helpful. Some videos are a little dated, but they have updated the pages with pertinent, newer videos.

All the links are on the right. Good luck.


Clinical Resource Online - FREE!

I just came across this clinical book online: Clinical Methods, 3rd edition: The History, Physical, and Laboratory Examinations, Edited by H Kenneth Walker, MD, W Dallas Hall, MD, and J Willis Hurst, MD

It has lots of short, straight to the point chapters and printable charts on a ton of generalized medical topics including (but not limited to):

1. The physical exam
2. Medical interviewing
3. Cardiovascular system
4. Hematology
5. Chest Pain
6. Syncope
7. Pulse, BP, Heart Sounds
8. Wheezing, asthma
10. Sleep disturbances
11. N/V
12. Abdominal Pain
13. Jaundice
14. Neurology
15. Headaches

There are 229 Chapters so LOTS of free information!


Pediatric Case Answers!

Answers from the cases in the prior post...

Pediatric Case 1: Answer = C
At 6 to 6.5 months of age, infants will be able to site along, leaning forward to support themselves with arms extended, in the so-called tripod position. They can reach for an object by changing the orientation of the torso. They can roll (on purpose) from prone to supine and visa versa. By 12 months, they can grasp a pellet between their thumb and forefinger w/out ulnar support. Motor development goes cephalo-caudal and central to peripheral - in other words, the babies can control their trunk before they can control finger dexterity.

Pediatric Case 2: Answer = D
Chlamydiae, sexually transmitted in adults, is spread to infants during birth from the genitally infected moms. The sites of infection in infants are the conjunctivae and the lungs, where chlamydiae cause inclusion conjunctivitis and afebrile pneumonia (usually in infants 2-12 wks). Diagnosis is confirmed by culture of secretions and by antibody titers. **Note: most common tx for this is macrolide antibx orally which clears both the nasopharyngeal secretions when a conjunctivitis is present and prevents the pneumonia that can occur later. Topical tx is not effective in clearing nasopharynx.

I'll try to throw out some more cases here and there... Thanks for the guesses!

Cases from PreTest Series, Pediatrics 10th Ed, Yetman and Hormann


Gearing Up for Clinical Rotations

Yesterday was a great day... the blog hit over 1,000 views! AND we received our rotations for the year. Nothing is written in stone (changes are possible due to preceptor maternity leaves, life changes, etc) but we now have a pretty good idea what life will be like for our last year in PA school. I couldn't be more excited... or nervous! I start out with more generalize medicine, then move into specialties, and finish up with emergency medicine and surgery. Each rotation is 5 weeks so we will finish up around mid-July 2012.

My first rotation starts in Sept and is in pediatrics at a great local practice. I used to work in pediatrics when I was in Orthotics and Prosthetics so its nice to start in a familiar setting. Kids are great, parents are difficult, and pediatric dosages are nearly impossible to remember...  stay tuned - I'll share my experiences.
This is one of my favorite pediatric practice tools! Love this kid.
As of now here are my rotations:
1. Peds
2. Internal Medicine
3. Family Medicine
5. Psychiatric
6. Ambulatory
7. Elective
8. Emergency Med
9. Surgery

In the spirit of each rotation I'll throw out a case study or two for each and then give the answer in a follow up entry. Feel free to post your guesses!

Pediatric Case 1:
An infant who sits with only minimal support, attempts to attain a toy beyond reach, and rolls over from the supine to the prone position, but does not have a pincer grasp, is at a development level of:

A. 2 months
B. 4 months
C. 6 months
D. 9 months
E. 1 year

Pediatric Case 2:
A 6 wk old child develops increased RR and a non-productive cough. Physical exam is significant for rales and rhonchi. The PMH for the child is positive for an eye discharge at 3 weeks of age, which was treated with a topical antibx. The most likely organism causing this child's condition is:

A. Neisseria gonorrhoeae
B. Staph. aureus
C. Group B streptococcus
D. Chlamydia trachomatis
E. Herpes virus

Good luck! Any words of wisdom to share?


Electronic STI Treatment Guideline - FREE!

The CDC has a 2010 STI Treatment book available on the iPhone/iPod/iPad. There is no fee associated with this and it is a great resource for students (or practicing PAs) trying to keep up with treatment protocols. It is not available in iTunes, so you'll have to follow the link below:


10 Things About PA Per Diem Work

Ever wonder about per diem work? I can tell you that I did. It sounds so appealing. The extra money would come in handy when all those student loan payments start rolling in and the chance to work in a completely different setting every once in a while sounds amazing! What's the catch? Is there a catch? What’s the average pay? Where could I work? How much or little would I need to work? All good questions that I didn't have the answers to ... so I asked. 

I spoke with Northeastern’s Clinical Coordinator, Erin Sharaf, PA-C to get her take on per diem work. Erin is currently a full time faculty member at Northeastern, but still continues to keep her clinical skills up by working per diem for the Department of Defense. Below are 10 pearls that I came away from our conversation with:

1.It is a great way to make extra money if you have the time and energy to do it.

2.Per diem work can be used to gain specialized clinical skills if you are a primary care PA and want to find per diem work with a specialty service. On the flip side, if you are going into a specialty service, you can use per diem work in primary care to keep up on all of your general clinical skills (don’t forget recertification exams are primary care based!)

3.You can find per diem work on PA recruiter sites, by word of mouth, or on the hospital or clinic website.

4.Be sure that you know how to contact your supervising physician because they may not be onsite on the days that you are working.

5.You do not usually receive benefits with per diem work.

6. You are typically paid via an hourly wage – the average for this area is about $50-70/hr. (This means that if you work one 10hr shift every other week... you are looking at an additional $15,600 per year before taxes at the rate of $60/hr.)

7.Some popular places to start looking for per diem work are: the Dept of Defense, prison systems, emergency rooms, urgent care, and sporting events (college or high school).

8.There are international per diem positions available. Check with PA recruiter sites.

9.You can work as much or as little as you want. There is not a minimum hr requirement.

10. Per diem can be used as a spring board to a new job or specialty.

A special thank you to Erin for taking the time to answer all of my questions. Hope this helps those who were curious about this subject. Feel free to continue to email me other subject matters that you would like more information on and I'll do my best to get the answers.


AAPA Conference Closing Remarks

At opening ceremony
last entry from the aapa11 blog.
I loved IMPACT. I was energized and inspired each and everyday by people in my profession. It all started with the enthusiasm of the opening ceremony. I was impressed with President Patrick Killeen’s heart felt speech and his passion for the profession. The video segments of the award winners played during the ceremony were also a great addition. The AOR meeting gave me the opportunity to meet some of the current and future student leaders as well as become part of the SAAPA Board. I loved the Leadership Conference that was put on by Josh Newton (soon-to-be past SAAPA VP). He was able to get great speakers such as President-elect Robert Wooten and Michelle DiBaise to share their advice on being an effective leader. The Challenge Bowl was thoroughly entertaining and I was also fortunate to meet so many PA pioneers and hear their words of wisdom. I must admit that one of the most impressive things about IMPACT was the accessibility and approachability of our leaders.  Thanks to the AAPA for a great week. See you in Toronto 2012.
Northeast Region AOR Representative - An Inspirational Bunch


The Stance of the AOR...

Another entry from the aapa11 blog!

Yesterday something interesting happened at the AOR meeting. The morning session was dedicated to voting on our “stance” or position if you will on some subjects to be voted on in the HOD. The topics included 1) Looking at the impact of paying PA preceptors, 2) Recommending further research on the MD/DO Bridge programs, 3) Changing the verbiage on the student protection protocol, and the one that surprisingly (to me) got the most dialogue…
AAPA supports legislature that bans the use of hand-held telecommunication devices while operating a moving vehicle except in emergency situations.
This seemed like a no-brainer to me, but to my surprise, there was objection. One argument stated that the AAPA should not have a stance on these types of subjects. The arguer stated, “Why shouldn’t the AAPA take a stance on tire pressure or other road safety issues?”
While I appreciate all arguments and courage to get up and speak at the microphone –I must beg to differ with the message. This issue directly impact us as health care providers. First, the time, money, and resources spent in the ED on collisions involving texting should satisfy the objective link between PAs and this subject. Second, although sometimes we forget because we operate so freely under the medical model (one patient, one provider) – we are all public health servants as well… preventionist.
Historically, medical organizations have had stances on many public safety issues such as bike/motorcycle helmet use, drinking and driving, and smoking in public places. I don’t think now is the time for the AAPA to fall silent.  Support the legislature.


Networking without Business Cards

This is a blog entry that I wrote for the aapa11 blog at the 2011 American Academy of Physician Assistants conference in Las Vegas! I will be tweeting my experiences and remain a guest on the aapa11 blog for the week. I will repost my entries here but if you get a chance check out their blog.  http://aapa11.blogspot.com/

Networking without Business Cards…(Welcome New AAPA11 Blogger Bianca Belcher!)

As a PA student, the opportunity to meet a future preceptor or co-worker is part of the appeal of attending the big show. Unfortunately, many PA programs do not provide their students with business cards.  So how can you still network effectively?
Well…You could try writing your email address on a napkin or scrap of paper and hope that it doesn’t get lost 15 minutes later, but there is a better way… The wireless business card.
First, add your own contact information to your cell phone’s contact list. Most smart phones have a very simple way to then share that contact information with someone else. With the iPhone for example, once you have clicked on a contact you can scroll to the bottom of the screen where you are given the option to “share contact”.
Second, simply ask your new network connection for their email address or their cell number, then you will be able to instantly share all of your information (email, phone numbers, website, blogs, etc).
Now, not only have you distributed your information to them, but you have also gotten their contact information as well. It is good practice to follow up after the conference with a brief thank you that will not only show appreciation for their time, but also serve as a little reminder of who you are and what you talked about. Happy networking!
twitter. @B_Belcher