UTHSC PA Program Podcast

In this episode, we cover torsades de pointes, a life-threatening form of polymorphic ventricular tachycardia associated with a prolonged QT interval. We break down the electrophysiology behind delayed ventricular repolarization and early afterdepolarizations, which set the stage for this distinctive "twisting" QRS pattern on EKG. High-yield risk factors—including electrolyte abnormalities (low potassium, magnesium, calcium), QT-prolonging medications, bradycardia, and female sex—are emphasized to help with rapid clinical recognition. We walk through classic presentations such as palpitations, syncope, and sudden collapse, and outline the diagnostic approach with EKG confirmation and targeted lab evaluation. Management focuses on immediate IV magnesium sulfate, correction of underlying causes, and escalation to defibrillation or pacing in unstable or refractory cases. References Bushardt RL, Colomb-Lippa DM, Klinger AM, Reed H. The JAAPA QRS Review for PAs: Study Plan and Guide for PANCE and PANRE. 1st ed. LWW; 2021. ISBN: 9781975143817 Al-Khatib SM, Stevenson WG, Ackerman MJ, et al. 2017 AHA/ACC/HRS guideline for management of ventricular arrhythmias. Circulation. 2018;138(13):e272–e391 Drew BJ, Ackerman MJ, Funk M, et al. Prevention of torsade de pointes in hospital settings. Circulation. 2010;121(8):1047–1060

In this episode, we dive into stress (Takotsubo) cardiomyopathy, a reversible form of acute left ventricular systolic dysfunction that often mimics acute coronary syndrome but occurs without obstructive coronary artery disease. We unpack the proposed mechanism of a catecholamine surge leading to myocardial stunning, producing the classic apical ballooning pattern on imaging. The discussion highlights key risk groups—especially postmenopausal women following emotional or physical stressors—and the typical presentation of chest pain, dyspnea, and EKG changes resembling STEMI. We walk through the diagnostic approach, emphasizing the role of echocardiography and coronary angiography in distinguishing this condition from true ischemic disease. Management focuses on supportive heart failure therapy, with most patients experiencing full recovery within weeks. References Bushardt RL, Colomb-Lippa DM, Klinger AM, Reed H. The JAAPA QRS Review for PAs: Study Plan and Guide for PANCE and PANRE. 1st ed. LWW; 2021. ISBN: 9781975143817 Templin C, Ghadri JR, Diekmann J, et al.Clinical features and outcomes of Takotsubo cardiomyopathy. New England Journal of Medicine. 2015;373(10):929–938 Pelliccia F, Kaski JC, Crea F, Camici PG.Takotsubo syndrome: pathophysiology and treatment. JAMA Cardiology. 2023;8(3):273–282

In this episode, we cover pericardial effusion, the accumulation of fluid within the pericardial sac, and its progression to cardiac tamponade, a life-threatening emergency. We break down the pathophysiology of increased intrapericardial pressure impairing ventricular filling, emphasizing how the rate of fluid accumulation is just as critical as volume. Common etiologies—including infection, malignancy, autoimmune disease, uremia, and post-MI syndromes—are reviewed alongside key clinical presentations such as dyspnea, chest pain, and fatigue. We highlight classic exam findings of tamponade, including Beck's triad (hypotension, JVD, muffled heart sounds) and pulsus paradoxus. Diagnostic strategies focus on echocardiography as the gold standard, with supportive EKG and imaging findings. Management ranges from treating underlying causes in stable cases to emergent pericardiocentesis in tamponade. High-yield pearls emphasize rapid recognition to prevent hemodynamic collapse and death. References Bushardt RL, Colomb-Lippa DM, Klinger AM, Reed H. The JAAPA QRS Review for PAs: Study Plan and Guide for PANCE and PANRE. 1st ed. LWW; 2021. ISBN: 9781975143817 Klein AL, Abbara S, Agler DA, et al. Evaluation and management of pericardial disease. JAMA. 2021;325(10):1022–1036. Imazio M, Adler Y. Management of pericardial effusion. Nature Reviews Cardiology. 2020;17(11):698–7123 Adler Y, Charron P, Imazio M, et al. 2015 ESC guidelines for the diagnosis and management of pericardial diseases. European Heart Journal. 2015;36(42):2921–2964.

In this episode, we review patent ductus arteriosus (PDA), a common congenital heart defect characterized by persistent connection between the aorta and pulmonary artery, resulting in a left-to-right shunt and pulmonary overcirculation. We break down the underlying physiology of failed ductal closure after birth, including the roles of oxygen tension and prostaglandins, and discuss why premature infants are at highest risk. Clinically, we highlight presentations ranging from asymptomatic small PDAs to larger defects causing tachypnea, poor feeding, failure to thrive, and signs of heart failure. Classic exam findings—especially the continuous "machinery" murmur and bounding pulses—are emphasized alongside diagnostic confirmation with echocardiography. Management strategies include NSAID therapy (indomethacin or ibuprofen) in preterm infants and catheter-based or surgical closure for persistent or symptomatic cases. Key pearls focus on early recognition to prevent complications such as pulmonary hypertension, Eisenmenger syndrome, and heart failure. References Bushardt RL, Colomb-Lippa DM, Klinger AM, Reed H. The JAAPA QRS Review for PAs: Study Plan and Guide for PANCE and PANRE. 1st ed. LWW; 2021. ISBN: 9781975143817. Sathanandam S, Gutfinger D, O'Brien L, et al. Patent ductus arteriosus: current management strategies. Journal of the American College of Cardiology. 2020;75(22):2927–2938 Benitz WE. Patent ductus arteriosus in preterm infants. Pediatrics. 2020;146(2):e20201209 Backes CH, Rivera BK, Bridge JA, et al. Contemporary management of patent ductus arteriosus. Journal of Perinatology. 2021;41(2):273–282.

In this episode, we explore hypertrophic cardiomyopathy (HCM)—a common inherited cardiac disorder defined by unexplained left ventricular hypertrophy, most often involving the interventricular septum. We break down the underlying genetics of autosomal dominant sarcomere mutations and how they lead to myocyte disarray, diastolic dysfunction, and dynamic left ventricular outflow tract obstruction. Clinically, we highlight hallmark features such as exertional dyspnea, chest pain, syncope, and the classic systolic murmur that increases with Valsalva and decreases with squatting. The episode also reviews diagnostic strategies with echocardiography as the gold standard, along with EKG and cardiac MRI for further evaluation. Management focuses on beta-blockers as first-line therapy, risk stratification for implantable cardioverter-defibrillator (ICD) placement, and key medication considerations. High-yield pearls emphasize HCM as the leading cause of sudden cardiac death in young athletes, the importance of family screening, and avoiding therapies that reduce preload. References Bushardt RL, Colomb-Lippa DM, Klinger AM, Reed H. The JAAPA QRS Review for PAs: Study Plan and Guide for PANCE and PANRE. 1st ed. LWW; 2021. ISBN: 9781975143817. Ommen SR, Mital S, Burke MA, et al. 2020 AHA/ACC guideline for the diagnosis and treatment of hypertrophic cardiomyopathy. Circulation. 2020;142(25):e558–e631. Maron BJ, Desai MY, Nishimura RA, et al. Hypertrophic cardiomyopathy: a review. New England Journal of Medicine. 2018;379(7):655–668

In this episode, we break down infective endocarditis, a serious infection of the endocardial surface and heart valves that can lead to destructive vegetations and life-threatening complications. We walk through the underlying pathophysiology—from endothelial injury and platelet-fibrin deposition to bacteremia and vegetation formation—and highlight common pathogens such as Staphylococcus aureus and viridans streptococci. The episode emphasizes high-risk populations, including patients with prosthetic valves, prior endocarditis, IV drug use, and recent dental procedures. Clinically, we focus on key findings like fever, new or changing murmur, and classic embolic or immunologic signs (Osler nodes, Janeway lesions, splinter hemorrhages). We also review a practical diagnostic approach using blood cultures, echocardiography, and Duke criteria, along with management strategies centered on prompt, targeted IV antibiotics and surgical intervention when indicated. High-yield pearls reinforce early recognition and the importance of preventing devastating complications such as stroke, heart failure, and sepsis. References Bushardt RL, Colomb-Lippa DM, Klinger AM, Reed H. The JAAPA QRS Review for PAs: Study Plan and Guide for PANCE and PANRE. 1st ed. LWW; 2021. ISBN: 9781975143817. Nappi F. Native Infective Endocarditis: A State-of-the-Art-Review Microorganisms. 2024; 12(7):1481-. McDonald EG, Aggrey G, Aslan AT, et al. Guidelines for Diagnosis and Management of Infective Endocarditis in Adults JAMA Netw Open. 2023; 6(7):e2326366-.

In this episode, we cover intestinal (mesenteric) ischemia, a high-acuity vascular emergency characterized by reduced blood flow to the intestines leading to ischemia, necrosis, and potential perforation. We break down the four primary mechanisms—arterial embolism, arterial thrombosis, nonocclusive low-flow states, and venous thrombosis—and highlight key risk factors such as atrial fibrillation, atherosclerosis, shock states, and hypercoagulability. Clinically, we emphasize the classic presentation of severe abdominal pain out of proportion to physical exam findings, along with differences between acute and chronic mesenteric ischemia. The episode reviews a targeted diagnostic approach, focusing on CT angiography as the test of choice, and outlines time-sensitive management including hemodynamic stabilization, anticoagulation, and urgent revascularization. Key pearls reinforce early recognition and rapid intervention to prevent bowel infarction, sepsis, and death. References Bushardt RL, Colomb-Lippa DM, Klinger AM, Reed H. The JAAPA QRS Review for PAs: Study Plan and Guide for PANCE and PANRE. 1st ed. LWW; 2021. ISBN: 9781975143817. Theodore S, Xia T, Saillant N. Intestinal Ischemia — Etiology and Foundational Concepts NEJM Evidence. 2024; 3(3). Theodore S, Xia T, Saillant N. The Evaluation and Management of Intestinal Ischemia NEJM Evidence. 2024; 3(4). Deranged Physiology. Mesenteric ischaemia. Deranged Physiology. Accessed April 28, 2026. https://derangedphysiology.com/main/required-reading/gastrointestinal-intensive-care/Chapter-26/mesenteric-ischaemia

In this episode, we cover peripheral artery disease (PAD)—a chronic atherosclerotic condition that leads to reduced blood flow and limb ischemia, most commonly in the lower extremities. We break down the underlying pathophysiology of progressive arterial narrowing and impaired oxygen delivery, and highlight major risk factors such as smoking (the strongest contributor), diabetes, hypertension, and hyperlipidemia. Clinically, we focus on recognizing intermittent claudication as the hallmark presentation, along with advanced findings like rest pain, nonhealing ulcers, and gangrene. Diagnostic strategies are reviewed with emphasis on the ankle-brachial index (ABI) as the first-line test, followed by vascular imaging when indicated. Management includes aggressive risk factor modification, structured exercise therapy, antiplatelet and statin therapy, and revascularization for severe disease. Key pearls reinforce that PAD is not just a limb disease—but a marker of systemic atherosclerosis with significant cardiovascular risk. References Bushardt RL, Colomb-Lippa DM, Klinger AM, Reed H. The JAAPA QRS Review for PAs: Study Plan and Guide for PANCE and PANRE. 1st ed. LWW; 2021. ISBN: 9781975143817. Gerhard-Herman MD, Gornik HL, Barrett C, et al. 2016 AHA/ACC Guideline on the Management of Patients With Lower Extremity Peripheral Artery Disease: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines Circulation. 2017; 135(12). Bonaca MP, Bauersachs RM, Anand SS, et al. Rivaroxaban in Peripheral Artery Disease after Revascularization N Engl J Med. 2020; 382(21):1994-2004. McDermott MM. Peripheral Artery Disease in the Legs N Engl J Med. 2026; 394(5):486-496.

In this episode, we review carotid artery disease, a major cause of ischemic stroke resulting from atherosclerotic narrowing of the carotid arteries. We break down the pathophysiology of plaque buildup, luminal stenosis, and embolization, and discuss key risk factors including hypertension, hyperlipidemia, smoking, diabetes, and advanced age. The episode highlights the often silent progression of disease and classic warning signs such as transient ischemic attacks (TIAs), amaurosis fugax, and focal neurologic deficits. We also cover essential diagnostic approaches, including carotid duplex ultrasound as the first-line test, and review management strategies ranging from aggressive medical therapy to procedural interventions like carotid endarterectomy and stenting for high-risk patients. References Bushardt RL, Colomb-Lippa DM, Klinger AM, Reed H. The JAAPA QRS Review for PAs: Study Plan and Guide for PANCE and PANRE. 1st ed. LWW; 2021. ISBN: 9781975143817. Kleindorfer DO, Towfighi A, Chaturvedi S, et al. 2021 Guideline for the Prevention of Stroke in Patients With Stroke and Transient Ischemic Attack: A Guideline From the American Heart Association/American Stroke Association Stroke. 2021; 52(7). Naylor AR. Time to rethink management strategies in asymptomatic carotid artery disease. Nat Rev Cardiol. 2011 Oct 11;9(2):116-24. doi: 10.1038/nrcardio.2011.151. PMID: 21989048. Brott TG, Howard G, Lal BK, et al. Medical Management and Revascularization for Asymptomatic Carotid Stenosis N Engl J Med. 2026; 394(3):219-231.

In this episode, we review deep vein thrombosis (DVT), a critical condition within the spectrum of venous thromboembolism and a major cause of preventable morbidity and mortality. We break down the underlying pathophysiology using Virchow's triad—venous stasis, endothelial injury, and hypercoagulability—and discuss common risk factors including immobility, surgery, malignancy, pregnancy, and inherited thrombophilias. The episode highlights classic clinical features such as unilateral leg swelling, pain, warmth, and erythema, while emphasizing that presentations can be subtle or even asymptomatic. We also review a practical diagnostic approach using the Wells score, D-dimer testing, and compression ultrasound, along with first-line treatment strategies centered on anticoagulation to prevent progression and pulmonary embolism. References Bushardt RL, Colomb-Lippa DM, Klinger AM, Reed H. The JAAPA QRS Review for PAs: Study Plan and Guide for PANCE and PANRE. 1st ed. LWW; 2021. ISBN: 9781975143817. Stevens SM, Woller SC, Kreuziger LB, et al. Antithrombotic Therapy for VTE Disease Chest. 2021; 160(6):e545-e608. Ortel TL, Neumann I, Ageno W, et al. American Society of Hematology 2020 Guidelines for Management of Venous Thromboembolism: Treatment of Deep Vein Thrombosis and Pulmonary Embolism . 2020; 4(19):4693-4738.

Kyphosis is characterized by an excessive forward curvature of the thoracic spine along the sagittal plane, often developing gradually over time. In this episode, we review the common causes and risk factors—including aging, osteoporosis, spinal injury, and degenerative disease—along with typical signs and symptoms such as back pain, fatigue, and a rounded back posture. We discuss key diagnostic approaches, including lateral spine X-ray and Cobb angle measurement, as well as management strategies ranging from conservative therapy and bracing to surgical intervention in severe cases. Tune in for a concise clinical overview of recognizing, evaluating, and managing kyphosis and its potential complications. References Bushardt RL, Colomb-Lippa DM, Klinger AM, Reed H. The JAAPA QRS Review for PAs: Study Plan and Guide for PANCE and PANRE. 1st ed. LWW; 2021. ISBN: 9781975143817. Lam JC, Mukhdomi T. Kyphosis. [Updated 2023 Aug 8]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2026 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK558945/ Koelé MC, Lems WF, Willems HC. The Clinical Relevance of Hyperkyphosis: A Narrative Review Front. Endocrinol.. 2020; 11.

Scoliosis is a common spinal condition characterized by a lateral curvature of the spine greater than 10 degrees with associated vertebral rotation. In this episode, we review the key clinical features of scoliosis, including risk factors, epidemiology, and typical physical exam findings such as uneven shoulders or hips. We also discuss the diagnostic role of spinal X-rays, current management strategies based on Cobb angle severity—from observation to bracing and surgical fusion—and the potential complications associated with untreated disease. This concise review provides practical clinical insights for recognizing, evaluating, and managing scoliosis in practice. References Bushardt RL, Colomb-Lippa DM, Klinger AM, Reed H. The JAAPA QRS Review for PAs: Study Plan and Guide for PANCE and PANRE. 1st ed. LWW; 2021. ISBN: 9781975143817. Janicki JA, Alman B. Scoliosis: Review of diagnosis and treatment. Paediatr Child Health. 2007 Nov;12(9):771-6. doi: 10.1093/pch/12.9.771. PMID: 19030463; PMCID: PMC2532872. Menger RP, Sin AH. Adolescent Idiopathic Scoliosis. [Updated 2023 Apr 3]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2026 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK499908/

In this episode, we review nursemaid's elbow, also known as radial head subluxation, a common upper extremity injury in young children. We discuss the typical mechanism—sudden traction on an extended arm, such as when a child is lifted or swung by the hand—which causes displacement of the annular ligament around the radial head. The episode highlights classic clinical findings including a child holding the arm slightly flexed and pronated while avoiding movement due to pain. We also review the primarily clinical diagnosis, when imaging may be necessary, and the simple but effective treatment of closed reduction, after which most children regain normal arm use within minutes. Key clinical pearls include the high recurrence rate and the importance of prevention, particularly avoiding pulling or lifting young children by the arms. References Bushardt RL, Colomb-Lippa DM, Klinger AM, Reed H. The JAAPA QRS Review for PAs: Study Plan and Guide for PANCE and PANRE. 1st ed. LWW; 2021. ISBN: 9781975143817. Nardi NM, Schaefer TJ. Nursemaid Elbow. [Updated 2023 Aug 14]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2026 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK430777/ Shaath K, Shirley E. Nursemaid's elbow. Orthobullets. Updated August 21, 2022. Accessed March 9, 2026. https://www.orthobullets.com/pediatrics/4012/nursemaids-elbow

In this episode, we review osteoporosis, a common metabolic bone disease characterized by decreased bone density and increased fracture risk due to an imbalance between bone resorption by osteoclasts and bone formation by osteoblasts. We discuss key risk factors such as aging, postmenopausal estrogen loss, low BMI, smoking, and sedentary lifestyle, along with the epidemiology showing that 1 in 2 women and 1 in 5 men over age 50 will experience an osteoporosis-related fracture. The episode highlights the often silent progression of the disease until fractures occur, as well as classic clinical findings such as height loss, kyphosis, and fragility fractures. We also review diagnostic tools including DEXA scans, T-scores, and FRAX fracture risk assessment, and discuss treatment options such as bisphosphonates, denosumab, and anabolic therapies like teriparatide. Finally, we cover prevention strategies including weight-bearing exercise, adequate calcium and vitamin D intake, and routine screening to reduce fracture risk and maintain bone health. References Bushardt RL, Colomb-Lippa DM, Klinger AM, Reed H. The JAAPA QRS Review for PAs: Study Plan and Guide for PANCE and PANRE. 1st ed. LWW; 2021. ISBN: 9781975143817. Ye C, Ebeling P, Kline G. Osteoporosis The Lancet. 2025; 406(10514):2003-2016. Morin SN, Leslie WD, Schousboe JT. Osteoporosis: A Review. JAMA. 2025 Sep 9;334(10):894-907. doi: 10.1001/jama.2025.6003. PMID: 40587168

In this episode, we review compartment syndrome, a limb-threatening orthopedic emergency caused by increased pressure within a closed muscle compartment that compromises tissue perfusion. We discuss the underlying pathophysiology of rising intracompartmental pressure leading to ischemia, cellular hypoxia, and potential muscle and nerve damage. The episode highlights common causes such as fractures, crush injuries, burns, vascular trauma, and reperfusion injuries, along with nontraumatic triggers like intense physical exertion or prolonged immobilization. Key clinical features—including severe pain out of proportion to exam, pain with passive stretch, paresthesias, and tense compartments—are emphasized to aid early recognition. We also review diagnostic considerations, the role of compartment pressure measurement, and the urgent treatment of emergent fasciotomy to prevent devastating complications such as permanent nerve damage, rhabdomyolysis, amputation, or death. References Bushardt RL, Colomb-Lippa DM, Klinger AM, Reed H. The JAAPA QRS Review for PAs: Study Plan and Guide for PANCE and PANRE. 1st ed. LWW; 2021. ISBN: 9781975143817. Torlincasi AM, Lopez RA, Waseem M. Acute Compartment Syndrome. [Updated 2023 Jan 16]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2026 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK448124/ Novak M, Penhaker M, Raska P, Pleva L, Schmidt M. Extremity compartment syndrome: A review with a focus on non-invasive methods of diagnosis Front. Bioeng. Biotechnol.. 2022; 10.

In this episode, we review spinal trauma, focusing on rapid recognition, evaluation, and early management of potential spinal instability and neurologic injury. We discuss common mechanisms such as motor vehicle collisions, falls, and diving injuries, and emphasize the importance of spinal motion restriction when trauma patients present with risk factors like midline tenderness, neurologic deficits, altered mental status, or distracting injuries. The episode also covers key clinical decision tools including the NEXUS criteria and Canadian C-spine rule, along with appropriate imaging strategies—highlighting CT as the preferred modality for fractures and MRI for ligamentous or spinal cord injuries. We review vertebral fracture classifications, the TLICS scoring system, and critical complications such as spinal cord injury and neurogenic shock. Finally, we outline essential management principles, including maintaining adequate spinal cord perfusion and preventing hypotension, to help reduce secondary neurologic injury. References Bushardt RL, Colomb-Lippa DM, Klinger AM, Reed H. The JAAPA QRS Review for PAs: Study Plan and Guide for PANCE and PANRE. 1st ed. LWW; 2021. ISBN: 9781975143817. Alizadeh A, Dyck SM, Karimi-Abdolrezaee S. Traumatic Spinal Cord Injury: An Overview of Pathophysiology, Models and Acute Injury Mechanisms Front. Neurol.. 2019; 10. Mensah EO, Chalif JI, Johnston BR, et al. Traumatic spinal cord injury: a review of the current state of art and future directions – what do we know and where are we going? North American Spine Society Journal (NASSJ). 2025; 22:100601-. van Den Hauwe L, Sundgren PC, Flanders AE. Spinal Trauma and Spinal Cord Injury (SCI) 2020 Feb 15. In: Hodler J, Kubik-Huch RA, von Schulthess GK, editors. Diseases of the Brain, Head and Neck, Spine 2020–2023: Diagnostic Imaging [Internet]. Cham (CH): Springer; 2020. Chapter 19. Available from: https://www.ncbi.nlm.nih.gov/books/NBK554330/ doi: 10.1007/978-3-030-38490-6_19  

In this episode, we review systemic lupus erythematosus (SLE), a chronic multisystem autoimmune disease driven by immune complex deposition and widespread inflammation. We discuss the epidemiology—most commonly affecting women of childbearing age—and the classic clinical presentation including fatigue, photosensitive rash, symmetric inflammatory arthritis, and constitutional symptoms. The episode highlights hallmark findings such as the malar ("butterfly") rash, cytopenias, and potential renal involvement leading to lupus nephritis. We also review key diagnostic laboratory markers including ANA, anti–double-stranded DNA, and anti-Smith antibodies, as well as important complications like avascular necrosis related to corticosteroid therapy. Finally, we outline treatment strategies centered on hydroxychloroquine, with escalation to corticosteroids or immunosuppressive therapy for more severe disease, and discuss clinical features that help differentiate SLE from rheumatoid arthritis. References Bushardt RL, Colomb-Lippa DM, Klinger AM, Reed H. The JAAPA QRS Review for PAs: Study Plan and Guide for PANCE and PANRE. 1st ed. LWW; 2021. ISBN: 9781975143817. Siegel CH, Sammaritano LR. Systemic Lupus Erythematosus JAMA. 2024; 331(17):1480-. Justiz Vaillant AA, Goyal A, Varacallo MA. Systemic Lupus Erythematosus. [Updated 2023 Aug 4]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2026 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK535405/ Hoi A, Igel T, Mok CC, Arnaud L. Systemic lupus erythematosus The Lancet. 2024; 403(10441):2326-2338.

In this episode, we review key genetic connective tissue disorders that commonly appear in clinical practice and board-style exams: Ehlers-Danlos syndrome, Marfan syndrome, and osteogenesis imperfecta. We discuss how defects in connective tissue proteins lead to systemic structural weakness affecting the joints, bones, skin, and cardiovascular system. The episode highlights distinguishing clinical features such as joint hypermobility and skin fragility in Ehlers-Danlos syndrome, tall stature with aortic root dilation in Marfan syndrome, and recurrent fractures with blue sclera in osteogenesis imperfecta. We also review major complications, including vascular rupture in EDS, life-threatening aortic disease in Marfan syndrome, and severe bone fragility in OI, along with key management strategies and diagnostic clues to help differentiate these disorders in both clinical practice and exam scenarios. References Bushardt RL, Colomb-Lippa DM, Klinger AM, Reed H. The JAAPA QRS Review for PAs: Study Plan and Guide for PANCE and PANRE. 1st ed. LWW; 2021. ISBN: 9781975143817. Marwa K, Anjum F. Undifferentiated Connective Tissue Disease. [Updated 2023 Apr 27]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2026 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK572061/ Ravi U, Sieg VC. Ehlers-Danlos Syndrome. [Updated 2023 May 29]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2026 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK549814/ Milewicz DM, Braverman AC, De Backer J, et al. Marfan syndrome Nat Rev Dis Primers. 2021; 7(1).

In this episode, we provide a high-yield orthopedic review of common lower extremity soft-tissue injuries, focusing on mechanisms of injury, key physical exam findings, and first-line management. We cover common conditions such as hamstring strains, knee ligament injuries (ACL, PCL, MCL, and LCL), extensor mechanism ruptures, ankle sprains, Achilles tendon rupture, shin splints, and plantar fasciitis. The discussion highlights classic diagnostic exam maneuvers including the Lachman test, posterior drawer test, squeeze test, and Thompson test, along with red-flag conditions like compartment syndrome, an orthopedic emergency requiring immediate intervention. References Bushardt RL, Colomb-Lippa DM, Klinger AM, Reed H. The JAAPA QRS Review for PAs: Study Plan and Guide for PANCE and PANRE. 1st ed. LWW; 2021. ISBN: 9781975143817. American Academy of Orthopaedic Surgeons. Diseases & conditions. OrthoInfo. Accessed March 9, 2026. https://orthoinfo.aaos.org/en/diseases--conditions/

In this episode, we review torticollis, a condition characterized by abnormal head and neck positioning caused by involuntary contraction or dysfunction of cervical muscles—most commonly the sternocleidomastoid. We discuss the various forms of torticollis, including congenital torticollis, cervical dystonia (spasmodic torticollis), ocular torticollis, and trauma-related cases, along with the neuromuscular mechanisms that lead to abnormal neck rotation and tilt. The episode highlights common clinical presentations, risk factors such as birth trauma, stress, or sudden neck movement, and key physical exam findings including lateral head tilt with contralateral rotation. We also review the role of imaging when structural or neurologic causes are suspected and discuss management strategies ranging from physical therapy and muscle relaxants to botulinum toxin injections and surgical intervention in select cases. Key clinical pearls help clinicians recognize the different types and underlying causes of this distinctive neck disorder. References Bushardt RL, Colomb-Lippa DM, Klinger AM, Reed H. The JAAPA QRS Review for PAs: Study Plan and Guide for PANCE and PANRE. 1st ed. LWW; 2021. ISBN: 9781975143817. Raucci U, Roversi M, Ferretti A, et al. Pediatric torticollis: clinical report and predictors of urgency of 1409 cases Ital J Pediatr. 2024; 50(1). Cunha B, Tadi P, Bragg BN. Torticollis. [Updated 2023 Aug 8]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2026 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK539857/ Gundrathi J, Cunha B, Tiwari V, et al. Congenital Torticollis. [Updated 2024 Mar 20]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2026 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK549778/  

In this episode, we review Sjögren syndrome, a systemic autoimmune disorder that primarily affects the exocrine glands, leading to dry eyes (keratoconjunctivitis sicca) and dry mouth (xerostomia). We explore the immune-mediated pathophysiology involving lymphocytic infiltration of salivary and lacrimal glands, the role of autoantibodies such as SSA/Ro and SSB/La, and the increased risk of B-cell lymphoma associated with chronic immune activation. The episode highlights common clinical features including ocular and oral dryness, parotid gland enlargement, fatigue, and a variety of extraglandular manifestations affecting the lungs, kidneys, nerves, and skin. We also discuss diagnostic evaluation with tests such as the Schirmer test, autoantibody panels, and salivary gland imaging or biopsy, along with supportive and systemic treatment options. High-yield clinical pearls reinforce how to recognize this frequently underdiagnosed autoimmune condition in both clinical practice and board-style scenarios. References Bushardt RL, Colomb-Lippa DM, Klinger AM, Reed H. The JAAPA QRS Review for PAs: Study Plan and Guide for PANCE and PANRE. 1st ed. LWW; 2021. ISBN: 9781975143817. Kuryata O, Lysunets T, Karavanska I, Semenov V. Duration till diagnosis and clinical profile of Sjögren's syndrome: Data from real clinical practice in a single-center cohort The Egyptian Rheumatologist. 2020; 42(1):41-46. Bunya VY, Maguire MG, Akpek EK, et al. A New Screening Questionnaire to Identify Patients With Dry Eye With a High Likelihood of Having Sjögren Syndrome . 2021; 40(2):179-187. Carsons SE, Blum MA. Sjogren Syndrome. [Updated 2025 Jul 6]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2026 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK431049/  

In this episode, we review reactive arthritis, an inflammatory arthritis that develops days to weeks after a gastrointestinal or genitourinary infection, most commonly associated with Chlamydia trachomatis, Shigella, Campylobacter, or other enteric pathogens. We discuss the immune-mediated pathophysiology involving molecular mimicry and T-cell activation, as well as the association with the HLA-B27 gene. The episode highlights the classic clinical presentation of asymmetric oligoarthritis of the lower extremities, often accompanied by extra-articular features such as conjunctivitis, urethritis, and enthesitis—remembered by the classic mnemonic "can't see, can't pee, can't climb a tree." We also review diagnostic evaluation, including testing for preceding infections and ruling out other inflammatory arthritides, and discuss treatment strategies focusing on NSAIDs, management of the triggering infection, and DMARDs for persistent disease. High-yield clinical pearls reinforce how to recognize this important seronegative spondyloarthropathy in both clinical practice and board-style exams. References Bushardt RL, Colomb-Lippa DM, Klinger AM, Reed H. The JAAPA QRS Review for PAs: Study Plan and Guide for PANCE and PANRE. 1st ed. LWW; 2021. ISBN: 9781975143817. Cheeti A, Chakraborty RK, Ramphul K. Reactive Arthritis. [Updated 2023 Jan 2]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2026 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK499831/ Denison HJ, Curtis EM, Clynes MA, Bromhead C, Dennison EM, Grainger R. The incidence of sexually acquired reactive arthritis: a systematic literature review Clin Rheumatol. 2016; 35(11):2639-2648. Ehrenfeld M. Spondyloarthropathies Best Practice & Research Clinical Rheumatology. 2012; 26(1):135-145.

In this episode, we review polymyalgia rheumatica (PMR), an inflammatory rheumatic condition that commonly affects adults over age 50 and presents with symmetrical pain and stiffness of the shoulders, neck, and hip girdle. We discuss the immune-mediated pathophysiology, including the role of IL-6–driven inflammation, and the strong association with giant cell arteritis (GCA). The episode highlights classic clinical features such as morning stiffness lasting more than 45 minutes, rapid onset of symptoms, and difficulty with everyday activities like rising from a chair or lifting the arms. We also review key diagnostic clues including elevated ESR and CRP with negative autoimmune serologies, supportive imaging findings, and the ACR/EULAR classification criteria. Finally, we cover treatment strategies—particularly glucocorticoids as first-line therapy, steroid tapering protocols, and monitoring for complications—along with high-yield clinical pearls for recognizing PMR in clinical practice and on board exams. References Bushardt RL, Colomb-Lippa DM, Klinger AM, Reed H. The JAAPA QRS Review for PAs: Study Plan and Guide for PANCE and PANRE. 1st ed. LWW; 2021. ISBN: 9781975143817. Lall M, Jackson CD. What Is Polymyalgia Rheumatica? JAMA. 2024; 332(6):514-. Acharya S, Musa R. Polymyalgia Rheumatica. [Updated 2025 Aug 16]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2026 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK537274/ Milchert M, Brzosko M. Diagnosis of polymyalgia rheumatica usually means a favourable outcome for your patient . 2017; 145(5):593-600.

In this episode, we review polyarteritis nodosa (PAN), a rare systemic necrotizing vasculitis of medium and small arteries that leads to vessel inflammation, narrowing, thrombosis, and aneurysm formation. We discuss the underlying pathophysiology, including vascular injury and ischemia affecting multiple organ systems—most commonly the renal, dermatologic, neurologic, gastrointestinal, and cardiovascular systems. The episode highlights key clinical features such as hypertension from renal involvement, painful skin nodules, abdominal pain from intestinal ischemia, and mononeuritis multiplex. We also review diagnostic evaluation, including laboratory studies to rule out other vasculitides, the role of angiography or tissue biopsy, and the association with hepatitis B infection. Finally, we cover treatment strategies ranging from glucocorticoids and immunosuppressive therapy to antiviral management in hepatitis-associated disease, along with important clinical pearls to help clinicians recognize this high-yield systemic vasculitis. References Bushardt RL, Colomb-Lippa DM, Klinger AM, Reed H. The JAAPA QRS Review for PAs: Study Plan and Guide for PANCE and PANRE. 1st ed. LWW; 2021. ISBN: 9781975143817. Stanton M, Tiwari V. Polyarteritis Nodosa. [Updated 2023 Feb 22]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2026 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK482157/ Pagnoux C, Seror R, Henegar C, et al. Clinical features and outcomes in 348 patients with polyarteritis nodosa: A systematic retrospective study of patients diagnosed between 1963 and 2005 and entered into the French vasculitis study group database Arthritis & Rheumatism. 2010; 62(2):616-626. Schnappauf O, Sampaio Moura N, Aksentijevich I, et al. Sequence‐Based Screening of Patients With Idiopathic Polyarteritis Nodosa, Granulomatosis With Polyangiitis, and Microscopic Polyangiitis for Deleterious Genetic Variants in Arthritis & Rheumatology. 2021; 73(3):512-519.

In this episode, we review lumbar spinal stenosis, a common degenerative condition characterized by narrowing of the spinal canal or neural foramina that compresses nerve roots of the cauda equina. We discuss the pathophysiology of age-related spinal changes—including disk degeneration, facet hypertrophy, ligamentum flavum thickening, and spondylolisthesis—that contribute to canal narrowing. The episode highlights the classic clinical presentation of neurogenic claudication, including leg pain with walking or standing that improves with sitting or forward flexion, often referred to as the "shopping cart sign." We also review key exam findings, diagnostic imaging with MRI, important differential diagnoses such as vascular claudication, and treatment strategies ranging from conservative therapy and physical therapy to decompressive laminectomy in refractory cases. References Bushardt RL, Colomb-Lippa DM, Klinger AM, Reed H. The JAAPA QRS Review for PAs: Study Plan and Guide for PANCE and PANRE. 1st ed. LWW; 2021. ISBN: 9781975143817. Katz JN, Zimmerman ZE, Mass H, Makhni MC. Diagnosis and Management of Lumbar Spinal Stenosis: A Review. JAMA. 2022;327(17):1688–1699. doi:10.1001/jama.2022.5921 Webb CW, Aguirre K, Seidenberg PH. Lumbar Spinal Stenosis: Diagnosis and Management. Am Fam Physician. 2024 Apr;109(4):350-359. PMID: 38648834. Hartvigsen J, Hancock MJ, Kongsted A, Louw Q, Ferreira ML, Genevay S, Hoy D, Karppinen J, Pransky G, Sieper J, Smeets RJ, Underwood M; Lancet Low Back Pain Series Working Group. What low back pain is and why we need to pay attention. Lancet. 2018 Jun 9;391(10137):2356-2367. doi: 10.1016/S0140-6736(18)30480-X. Epub 2018 Mar 21. PMID: 29573870. Knezevic NN, Candido KD, Vlaeyen JWS, Van Zundert J, Cohen SP. Low back pain. Lancet. 2021 Jul 3;398(10294):78-92. doi: 10.1016/S0140-6736(21)00733-9. Epub 2021 Jun 8. PMID: 34115979.

In this episode, we explore rheumatoid arthritis (RA), a chronic systemic autoimmune disease that primarily targets synovial joints and leads to progressive inflammation, cartilage destruction, and bone erosion. We review the underlying pathophysiology, including the formation of the inflammatory pannus and the role of immune-mediated cytokine activity that drives joint damage. The episode highlights key clinical features such as morning stiffness lasting more than 30 minutes, symmetric polyarthritis of the small joints of the hands and feet, and extra-articular manifestations affecting the eyes, lungs, and cardiovascular system. We also discuss the 2010 ACR/EULAR diagnostic criteria, important laboratory markers like rheumatoid factor and anti-CCP antibodies, and imaging findings. Finally, we emphasize the critical 3–6 month "window of opportunity" for early treatment with disease-modifying antirheumatic drugs—especially methotrexate—to prevent irreversible joint damage and long-term disability. References Bushardt RL, Colomb-Lippa DM, Klinger AM, Reed H. The JAAPA QRS Review for PAs: Study Plan and Guide for PANCE and PANRE. 1st ed. LWW; 2021. ISBN: 9781975143817. Aletaha D, Smolen JS. Diagnosis and Management of Rheumatoid Arthritis: A Review. JAMA. 2018;320(13):1360–1372. doi:10.1001/jama.2018.13103 Di Matteo A, Bathon JM, Emery P. Rheumatoid arthritis. Lancet. 2023 Nov 25;402(10416):2019-2033. doi: 10.1016/S0140-6736(23)01525-8. Epub 2023 Oct 27. PMID: 38240831. Peterson E, Gallagher MK, Wilbur J. Rheumatoid Arthritis: Diagnosis and Management for the Family Physician. Am Fam Physician. 2024 Nov;110(5):515-526. PMID: 39556634. Chauhan K, Jandu JS, Brent LH, et al. Rheumatoid Arthritis. [Updated 2023 May 25]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK441999/

In this episode, we review Paget's disease of bone, a chronic skeletal disorder characterized by abnormal bone remodeling that leads to structurally weak, enlarged, and deformed bone. We discuss the underlying pathophysiology of accelerated bone turnover, common risk factors such as age over 50, family history, and European ancestry, and the bones most frequently affected—including the pelvis, spine, skull, femur, and tibia. The episode also highlights key diagnostic clues such as elevated alkaline phosphatase levels and characteristic radiographic findings like the "cotton wool" appearance on X-ray. Finally, we cover treatment strategies—including bisphosphonates as first-line therapy, supportive management, and potential complications such as fractures, hearing loss, and rare malignant transformation to osteosarcoma. References Bushardt RL, Colomb-Lippa DM, Klinger AM, Reed H. The JAAPA QRS Review for PAs: Study Plan and Guide for PANCE and PANRE. 1st ed. LWW; 2021. ISBN: 9781975143817. Rendina, D., Falchetti, A., Diacinti, D., Bertoldo, F., Merlotti, D., Giannini, S., Cianferotti, L., Girasole, G., Di Monaco, M., Gonnelli, S., Malavolta, N., Minisola, S., Vescini, F., Rossini, M., Frediani, B., Chiodini, I., Asciutti, F., & Gennari, L. (2024). Diagnosis and treatment of Paget's disease of bone: position paper from the Italian Society of Osteoporosis, Mineral Metabolism and Skeletal Diseases (SIOMMMS). Journal of endocrinological investigation, 47(6), 1335–1360. https://doi.org/10.1007/s40618-024-02318-1 Bouchette P, Boktor SW. Paget Bone Disease. [Updated 2023 Nov 12]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2026 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK430805/  

In this episode, we review slipped capital femoral epiphysis (SCFE), the most common hip disorder in adolescents and an important orthopedic emergency. We discuss the pathophysiology of growth plate weakening that allows the femoral head to slip relative to the femoral neck, often during periods of rapid growth. The episode highlights classic risk factors such as childhood obesity and endocrine disorders, the typical presentation of hip or knee pain with a limp, and key physical exam findings including limited internal rotation and the Drehmann sign. We also review essential imaging findings—such as Klein's line (Trethowan sign)—and emphasize urgent management with non–weight-bearing status and orthopedic referral to prevent complications like avascular necrosis and long-term joint damage References Bushardt RL, Colomb-Lippa DM, Klinger AM, Reed H. The JAAPA QRS Review for PAs: Study Plan and Guide for PANCE and PANRE. 1st ed. LWW; 2021. ISBN: 9781975143817. Cotton EV, Fowler SC, Maday KR. A review of slipped capital femoral epiphysis. JAAPA. 2022 Dec 1;35(12):39-43. doi: 10.1097/01.JAA.0000892720.49955.c0. PMID: 36412940. Sarah E. Hampl, Sandra G. Hassink, Asheley C. Skinner, Sarah C. Armstrong, Sarah E. Barlow, Christopher F. Bolling, Kimberly C. Avila Edwards, Ihuoma Eneli, Robin Hamre, Madeline M. Joseph, Doug Lunsford, Eneida Mendonca, Marc P. Michalsky, Nazrat Mirza, Eduardo R. Ochoa, Mona Sharifi, Amanda E. Staiano, Ashley E. Weedn, Susan K. Flinn, Jeanne Lindros, Kymika Okechukwu; Clinical Practice Guideline for the Evaluation and Treatment of Children and Adolescents With Obesity. Pediatrics February 2023; 151 (2): e2022060640. 10.1542/peds.2022-060640  Webb CW, Liu R, Bouchereau-Lal N. Slipped Capital Femoral Epiphysis: Rapid Evidence Review. Am Fam Physician. 2025 Oct;112(4):414-423. PMID: 41118186.

In this episode, we review costochondritis, a common cause of noncardiac chest pain resulting from inflammation of the costochondral junctions of the anterior chest wall. We discuss the underlying pathophysiology, common risk factors such as repetitive upper-body activity and chest wall strain, and the typical presentation of localized chest pain that worsens with movement or deep breathing. The episode highlights the importance of a careful history and physical exam—particularly the reproduction of pain with palpation—and when additional testing like an EKG or chest imaging is needed to rule out cardiac causes. We also cover evidence-based management with conservative therapies such as NSAIDs, heat, and activity modification, along with key clinical pearls to help clinicians distinguish costochondritis from more serious causes of chest pain. References Bushardt RL, Colomb-Lippa DM, Klinger AM, Reed H. The JAAPA QRS Review for PAs: Study Plan and Guide for PANCE and PANRE. 1st ed. LWW; 2021. ISBN: 9781975143817. Mott T, Jones G, Roman K. Costochondritis: Rapid Evidence Review. Am Fam Physician. 2021 Jul 1;104(1):73-78. PMID: 34264599. Proulx AM, Zryd TW. Costochondritis: diagnosis and treatment. Am Fam Physician. 2009 Sep 15;80(6):617-20. PMID: 19817327. Expert Panel on Thoracic Imaging, Stowell, J. T., Walker, C. M., Chung, J. H., Bang, T. J., Carter, B. W., Christensen, J. D., Donnelly, E. F., Hanna, T. N., Hobbs, S. B., Johnson, B. D., Kandathil, A., Lo, B. M., Madan, R., Majercik, S., Moore, W. H., & Kanne, J. P. (2021). ACR Appropriateness Criteria® Nontraumatic Chest Wall Pain. Journal of the American College of Radiology : JACR, 18(11S), S394–S405. https://doi.org/10.1016/j.jacr.2021.08.004 Gulati, M, Levy, P. et al. 2021 AHA/ACC/ASE/CHEST/SAEM/SCCT/SCMR Guideline for the Evaluation and Diagnosis of Chest Pain: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. JACC. 2021 Nov, 78 (22) e187–e285. https://doi.org/10.1016/j.jacc.2021.07.053

In this episode, we review common fractures and dislocations of the upper extremity, focusing on key injury patterns, clinical presentation, diagnosis, and management. We discuss the mechanisms behind common injuries such as FOOSH-related fractures, shoulder dislocations, distal radius fractures, and pediatric growth plate injuries. High-yield conditions—including radial head fractures, Monteggia and Galeazzi injuries, Colles and Smith fractures, Boxer's fractures, Salter–Harris fractures, scaphoid fractures, and lunate dislocations—are highlighted with practical clinical insights. The episode also covers essential evaluation principles such as neurovascular assessment, imaging strategies, and indications for reduction or surgical referral. Key clinical pearls help clinicians recognize high-risk injuries and avoid commonly tested pitfalls in emergency and orthopedic care. References 1) Bushardt RL, Colomb-Lippa DM, Klinger AM, Reed H. The JAAPA QRS Review for PAs: Study Plan and Guide for PANCE and PANRE. 1st ed. LWW; 2021. ISBN: 9781975143817. 2) Basener, C. J., Mehlman, C. T., & DiPasquale, T. G. (2009). Growth disturbance after distal femoral physeal fracture. Journal of Pediatric Orthopaedics, 29(4), 356–361. https://doi.org/10.1097/BPO.0b013e3181a0c54c 3) Patel, D. S., Statuta, S. M., & Ahmed, N. (2021). Common fractures of the radius and ulna. American Family Physician, 103(6), 345–354. https://www.aafp.org/pubs/afp/issues/2021/0315/p345.html

In this episode, we review gout and pseudogout, two common crystal-induced arthropathies that frequently present with acute monoarticular arthritis. We discuss the underlying pathophysiology of monosodium urate crystal deposition in gout and calcium pyrophosphate crystal deposition in pseudogout, highlighting the key differences in risk factors, joint involvement, and disease progression. The episode covers classic clinical presentations—such as first metatarsophalangeal joint involvement in gout and knee involvement in pseudogout—along with the diagnostic gold standard of synovial fluid crystal analysis. We also review evidence-based management strategies for acute flares and long-term prevention, including NSAIDs, colchicine, corticosteroids, and appropriate use of urate-lowering therapy. Practical clinical pearls help clinicians differentiate these conditions and recognize when joint aspiration is critical to rule out septic arthritis. References 1) Bushardt RL, Colomb-Lippa DM, Klinger AM, Reed H. The JAAPA QRS Review for PAs: Study Plan and Guide for PANCE and PANRE. 1st ed. LWW; 2021. ISBN: 9781975143817. 2) Afzal M, Rednam M, Gujarathi R, et al. Gout. [Updated 2025 Jun 23]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK546606/ 3) Mikuls TR. Gout N Engl J Med. 2022; 387(20):1877-1887. 4) Azam A, Minalyan A, Naik R. Calcium Pyrophosphate Deposition Disease. [Updated 2025 Dec 13]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK540151/

In this episode, we review plantar fasciitis, the most common cause of heel pain in adults. We discuss the underlying pathophysiology of repetitive stress and degeneration of the plantar fascia at its calcaneal insertion, leading to the classic presentation of sharp heel pain with the first steps in the morning. The episode highlights key risk factors such as prolonged standing, obesity, foot biomechanics, and tight Achilles tendons, along with characteristic exam findings including focal calcaneal tenderness and a positive windlass test. We also review the primarily clinical diagnosis and evidence-based treatment strategies, emphasizing stretching, load modification, supportive footwear, and when advanced therapies may be considered. This concise review provides practical clinical pearls to help clinicians recognize and manage plantar fasciitis effectively. References 1) Bushardt RL, Colomb-Lippa DM, Klinger AM, Reed H. The JAAPA QRS Review for PAs: Study Plan and Guide for PANCE and PANRE. 1st ed. LWW; 2021. ISBN: 9781975143817. 2) Goff JD, Crawford R. Diagnosis and treatment of plantar fasciitis. Am Fam Physician. 2011 Sep 15;84(6):676-82. PMID: 21916393. 3) Nweke TC. Comprehensive Review and Evidence-Based Treatment Framework for Optimizing Plantar Fasciitis Diagnosis and Management. Cureus. 2025 Jul 25;17(7):e88745. doi: 10.7759/cureus.88745. PMID: 40717873; PMCID: PMC12294660. 4) Tseng WC, Chen YC, Lee TM, Chen WS. Plantar Fasciitis: An Updated Review. J Med Ultrasound. 2023 Oct 6;31(4):268-274. doi: 10.4103/jmu.jmu_2_23. PMID: 38264606; PMCID: PMC10802877.

In this episode, we review Osgood–Schlatter disease, a common cause of anterior knee pain in adolescents and young athletes. We discuss the pathophysiology of traction apophysitis at the tibial tubercle caused by repetitive quadriceps contraction during periods of rapid growth. Key clinical features—including localized tibial tubercle pain that worsens with running, jumping, and kneeling—are highlighted along with the typical physical exam findings that help distinguish this condition from intra-articular knee pathology. We also cover the primarily clinical diagnosis, when imaging may be helpful, and evidence-based conservative management such as activity modification, stretching, and physical therapy. The episode concludes with practical clinical pearls to help clinicians quickly recognize this self-limited condition in active adolescents. References 1) Bushardt RL, Colomb-Lippa DM, Klinger AM, Reed H. The JAAPA QRS Review for PAs: Study Plan and Guide for PANCE and PANRE. 1st ed. LWW; 2021. ISBN: 9781975143817. 2) Circi, E., Atalay, Y. & Beyzadeoglu, T. Treatment of Osgood–Schlatter disease: review of the literature. Musculoskelet Surg 101, 195–200 (2017). https://doi.org/10.1007/s12306-017-0479-7 3) Corbi, F., et al. (2022). Osgood–Schlatter Disease: Appearance, Diagnosis and Management. Healthcare, 10(6), 1011. https://www.mdpi.com/2227-9032/10/6/1011 4) Rathleff, M. S., Winiarski, L., Krommes, K., Graven-Nielsen, T., Hölmich, P., Olesen, J. L., & Holden, S. (2020). Activity modification and knee strengthening for Osgood–Schlatter disease: A prospective cohort study. Orthopaedic Journal of Sports Medicine, 8(10), 2325967120911106. https://doi.org/10.1177/2325967120911106

In this episode, we review osteoarthritis, the most common degenerative joint disease and a major cause of chronic pain and disability worldwide. We discuss the underlying pathophysiology of cartilage breakdown, osteophyte formation, and low-grade joint inflammation that leads to progressive joint dysfunction. Key clinical features such as activity-related joint pain, brief morning stiffness, crepitus, and characteristic hand findings—including Heberden and Bouchard nodes—are highlighted, along with the role of imaging in confirming the diagnosis. We also cover evidence-based management strategies, including lifestyle modification, exercise therapy, NSAIDs, intra-articular corticosteroid injections, and indications for joint replacement. This episode concludes with practical clinical pearls to help clinicians recognize osteoarthritis and differentiate it from inflammatory arthritis in everyday practice. References 1) Bushardt RL, Colomb-Lippa DM, Klinger AM, Reed H. The JAAPA QRS Review for PAs: Study Plan and Guide for PANCE and PANRE. 1st ed. LWW; 2021. ISBN: 9781975143817. 2) Duong V, Oo WM, Ding C, Culvenor AG, Hunter DJ. Evaluation and Treatment of Knee Pain: A Review. JAMA. 2023;330(16):1568–1580. doi:10.1001/jama.2023.19675 3) Kolasinski SL., et al. 2020 Feb;72(2):149-162. doi: 10.1002/acr.24131. Epub 2020 Jan 6. Erratum in: Arthritis Care Res (Hoboken). 2021 May;73(5):764. doi: 10.1002/acr.24615. PMID: 31908149; PMCID: PMC11488261. 4) Shtroblia, V., Petakh, P., Kamyshna, I., Halabitska, I., & Kamyshnyi, O. (2025). Recent advances in the management of knee osteoarthritis: A narrative review. Frontiers in Medicine, 12, Article 1523027. https://doi.org/10.3389/fmed.2025.1523027

In this episode, we review Zenker diverticulum, a posterior pharyngoesophageal outpouching that develops above the upper esophageal sphincter due to cricopharyngeal dysfunction. We break down the anatomy of the Killian triangle, the pathophysiology of increased intraluminal pressure leading to herniation, and the classic presentation of dysphagia, regurgitation of undigested food, and halitosis in older adults. The discussion highlights the diagnostic role of barium swallow imaging and reviews definitive management with endoscopic cricopharyngeal myotomy. References 1) Bushardt RL, Colomb-Lippa DM, Klinger AM, Reed H. The JAAPA QRS Review for PAs: Study Plan and Guide for PANCE and PANRE. 1st ed. LWW; 2021. ISBN: 9781975143817. 2) Law R, Katzka DA, Baron TH. Zenker's Diverticulum. Clin Gastroenterol Hepatol. 2014 Nov;12(11):1773-82; quiz e111-2. doi: 10.1016/j.cgh.2013.09.016. Epub 2013 Sep 18. PMID: 24055983. 3) Nesheiwat Z, Antunes C. Zenker Diverticulum. [Updated 2023 Aug 8]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK499996/

In this episode, we review Mallory–Weiss tears, a common cause of upper gastrointestinal bleeding characterized by a longitudinal mucosal tear at the gastroesophageal junction following forceful vomiting. We break down the pathophysiology of sudden increases in intra-abdominal pressure, key risk factors such as alcohol use and hiatal hernia, and the classic presentation of hematemesis after retching. The discussion highlights stabilization strategies, the diagnostic and therapeutic role of endoscopy, and how to differentiate this condition from more severe esophageal injuries like Boerhaave syndrome. References 1) Bushardt RL, Colomb-Lippa DM, Klinger AM, Reed H. The JAAPA QRS Review for PAs: Study Plan and Guide for PANCE and PANRE. 1st ed. LWW; 2021. ISBN: 9781975143817. 2) Kassama Z, Goosenberg E. Mallory-Weiss Syndrome. [Updated 2025 Dec 13]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan-. Available from: https://www.ncbi.nlm.nih.gov/sites/books/NBK538190/ 3) Mahvi DAS, Mahvi DM. Stomach: Mallory-Weiss Tears. In: Townsend CM Jr, Beauchamp RD, Evers BM, Mattox KL, eds. Sabiston Textbook of Surgery. 22nd ed. Elsevier; 2026

In this episode, we review esophageal strictures, an abnormal narrowing of the esophageal lumen most commonly caused by chronic GERD. We break down the pathophysiology of inflammation leading to fibrosis and luminal narrowing, along with other important causes including caustic ingestion, radiation, eosinophilic esophagitis, and malignancy. The discussion highlights the classic presentation of progressive dysphagia to solids, appropriate use of barium swallow and endoscopy, and evidence-based management with endoscopic dilation. We also review red flags for malignancy and complications such as perforation. References 1) Bushardt RL, Colomb-Lippa DM, Klinger AM, Reed H. The JAAPA QRS Review for PAs: Study Plan and Guide for PANCE and PANRE. 1st ed. LWW; 2021. ISBN: 9781975143817. 2) Pregun I, Hritz I, Tulassay Z, Herszényi L. Peptic esophageal stricture: medical treatment. Dig Dis. 2009;27(1):31-7. doi: 10.1159/000210101. Epub 2009 May 8. PMID: 19439958. 3) Yang F, Hu Y, Shi Z, Liu M, Hu K, Ye G, Pang Q, Hou R, Tang K, Zhu Y. The occurrence and development mechanisms of esophageal stricture: state of the art review. J Transl Med. 2024 Jan 31;22(1):123. doi: 10.1186/s12967-024-04932-2. PMID: 38297325; PMCID: PMC10832115. 4) Luedtke P, Levine MS, Rubesin SE, Weinstein DS, Laufer I. Radiologic diagnosis of benign esophageal strictures: a pattern approach. Radiographics. 2003 Jul-Aug;23(4):897-909. doi: 10.1148/rg.234025717. PMID: 12853664.

In this episode, we review diverticular disease, including the progression from diverticulosis to acute diverticulitis. We break down the pathophysiology of mucosal outpouchings in high-pressure zones of the sigmoid colon and how obstruction can lead to inflammation, abscess, perforation, or peritonitis. The discussion highlights classic left lower quadrant pain, the role of CT imaging for diagnosis and staging, and evidence-based management ranging from outpatient antibiotics to percutaneous drainage or surgical intervention. We also address prevention strategies, common complications such as fistula formation, and key clinical pearls to guide decision-making in both uncomplicated and complicated cases. References 1) Bushardt RL, Colomb-Lippa DM, Klinger AM, Reed H. The JAAPA QRS Review for PAs: Study Plan and Guide for PANCE and PANRE. 1st ed. LWW; 2021. ISBN: 9781975143817. 2) Tochigi T, Kosugi C, Shuto K, Mori M, Hirano A, Koda K. Management of complicated diverticulitis of the colon. Ann Gastroenterol Surg. 2017 Sep 28;2(1):22-27. doi: 10.1002/ags3.12035. PMID: 29863123; PMCID: PMC5868871. 3) Horesh N, Emile S, Wexner SD. Diverticular disease. In: Townsend CM Jr, Beauchamp RD, Evers BM, Mattox KL, eds. Sabiston Textbook of Surgery. 22nd ed. Elsevier  

In this episode, we review acute cholangitis, a life-threatening infection of the biliary tree that occurs in the setting of obstruction—most commonly from choledocholithiasis. We break down the pathophysiology of increased intrabiliary pressure leading to bacterial overgrowth and systemic infection, along with the classic presentation of Charcot triad: fever, jaundice, and right upper quadrant pain. The discussion highlights key laboratory and imaging findings, the urgency of ERCP for biliary decompression, and the role of broad-spectrum IV antibiotics.   References 1) Bushardt RL, Colomb-Lippa DM, Klinger AM, Reed H. The JAAPA QRS Review for PAs: Study Plan and Guide for PANCE and PANRE. 1st ed. LWW; 2021. ISBN: 9781975143817. 2) An Z, Braseth AL, Sahar N. Acute Cholangitis: Causes, Diagnosis, and Management. Gastroenterol Clin North Am. 2021 Jun;50(2):403-414. doi: 10.1016/j.gtc.2021.02.005. Epub 2021 Apr 23. PMID: 34024448. 3) Sulzer JK, Ocuin LM. Cholangitis: Causes, Diagnosis, and Management. Surg Clin North Am. 2019 Apr;99(2):175-184. doi: 10.1016/j.suc.2018.11.002. Epub 2019 Feb 10. PMID: 30846028. 4) Smith SE. Management of Acute Cholangitis and Choledocholithiasis. Surg Clin North Am. 2024 Dec;104(6):1175-1189. doi: 10.1016/j.suc.2024.03.007. Epub 2024 Apr 27. PMID: 39448120.

In this episode, we review endoscopic retrograde cholangiopancreatography (ERCP), a specialized procedure used to diagnose and treat biliary and pancreatic duct disorders. We break down the relevant anatomy of the ampulla of Vater and sphincter of Oddi, common indications such as choledocholithiasis and acute cholangitis, and key contraindications to consider before proceeding. The discussion walks through procedural steps, highlights complication risks—particularly post-ERCP pancreatitis—and emphasizes thoughtful patient selection. References 1) Bushardt RL, Colomb-Lippa DM, Klinger AM, Reed H. The JAAPA QRS Review for PAs: Study Plan and Guide for PANCE and PANRE. 1st ed. LWW; 2021. ISBN: 9781975143817. 2) Johnson KD, Perisetti A, Tharian B, Thandassery R, Jamidar P, Goyal H, Inamdar S. Endoscopic retrograde cholangiopancreatography-related complications and their management strategies: a scoping literature review. Dig Dis Sci. 2020;65(2):361-375. doi:10.1007/s10620-019-05970-3. 3) Meseeha M, Goosenberg E, Attia M. Endoscopic Retrograde Cholangiopancreatography. [Updated 2025 Oct 5]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK4931603)  4) Sanders DJ, Bomman S, Krishnamoorthi R, Kozarek RA. Endoscopic retrograde cholangiopancreatography: current practice and future research. World J Gastrointest Endosc. 2021;13(8):260-274. doi:10.4253/wjge.v13.i8.260.

In this episode, we review Hirschsprung disease, a congenital disorder caused by the absence of enteric ganglion cells in the distal colon, leading to functional obstruction and chronic constipation. We break down the embryologic failure of neural crest cell migration, classic neonatal findings such as delayed passage of meconium and bilious emesis, and the hallmark "squirt sign" on exam. The discussion highlights appropriate diagnostic strategies—including contrast enema and confirmatory rectal biopsy—and the role of surgical management. References 1) Bushardt RL, Colomb-Lippa DM, Klinger AM, Reed H. The JAAPA QRS Review for PAs: Study Plan and Guide for PANCE and PANRE. 1st ed. LWW; 2021. ISBN: 9781975143817. 2) Lotfollahzadeh S, Taherian M, Anand S. Hirschsprung Disease. [Updated 2023 Jun 3]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK562142/ 3) Zhang Y, Zhang X, Li C, Wei S, Tao J, Yang M. Risk factors for Hirschsprung's disease in infancy: a study from the NHANES database. Medicine (Baltimore). 2025;104(40):e44601. doi:10.1097/MD.0000000000044601.

In this episode, we review nonalcoholic fatty liver disease (NAFLD), a common and often silent condition driven primarily by insulin resistance and metabolic dysfunction. We break down the distinction between simple steatosis (NAFL) and nonalcoholic steatohepatitis (NASH), highlighting key pathophysiologic differences such as hepatocellular ballooning and fibrosis. The discussion covers risk factors including obesity, type 2 diabetes, and dyslipidemia, along with appropriate diagnostic evaluation and when to consider liver biopsy. We also emphasize lifestyle modification as the cornerstone of treatment and review the potential progression to cirrhosis and hepatocellular carcinoma. References 1) Bushardt RL, Colomb-Lippa DM, Klinger AM, Reed H. The JAAPA QRS Review for PAs: Study Plan and Guide for PANCE and PANRE. 1st ed. LWW; 2021. ISBN: 9781975143817. 2) Antunes C, Azadfard M, Hoilat GJ, et al. Fatty Liver. [Updated 2023 Jan 1]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK441992/ 3) Younossi ZM, Golabi P, Paik JM, Henry A, Van Dongen C, Henry L. The global epidemiology of nonalcoholic fatty liver disease (NAFLD) and nonalcoholic steatohepatitis (NASH): a systematic review. Hepatology. 2023;77(4):1335-1347. doi:10.1097/HEP.0000000000000004.

In this episode, we review gastroparesis, a chronic disorder of delayed gastric emptying without mechanical obstruction. We break down normal gastric motility, the role of the vagus nerve and interstitial cells of Cajal, and how dysfunction leads to impaired antral contraction and pyloric relaxation. The discussion highlights key risk factors—including diabetes, postsurgical vagal injury, and medications—along with classic symptoms such as nausea, early satiety, and postprandial fullness. We cover diagnostic strategies with gastric emptying studies and evidence-based management, from dietary modification and prokinetic therapy to advanced interventions for refractory cases. References 1) Bushardt RL, Colomb-Lippa DM, Klinger AM, Reed H. The JAAPA QRS Review for PAs: Study Plan and Guide for PANCE and PANRE. 1st ed. LWW; 2021. ISBN: 9781975143817. 2) Dilmaghani S, Zheng T, Camilleri M. Epidemiology and healthcare utilization in patients with gastroparesis: a systematic review. Clin Gastroenterol Hepatol. 2023;21(9):2239-2251.e2. doi:10.1016/j.cgh.2022.07.011. 3) Reddivari AKR, Mehta P. Gastroparesis. [Updated 2024 Feb 28]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK551528/ 4) Schol J, Wauters L, Dickman R, et al; ESNM Gastroparesis Consensus Group. United European Gastroenterology (UEG) and European Society for Neurogastroenterology and Motility (ESNM) consensus on gastroparesis. United European Gastroenterol J. 2021;9(3):287-306. doi:10.1002/ueg2.12060.

In this episode, we review ileus, a functional inhibition of gastrointestinal motility without mechanical obstruction, most commonly seen after surgery. We break down the neurogenic and inflammatory phases that suppress peristalsis, along with key risk factors such as opioid use, intra-abdominal infection, and electrolyte imbalances. The discussion highlights how to distinguish ileus from small bowel obstruction using imaging, clinical findings, and time course. We also cover supportive management, prevention strategies including ERAS protocols, and practical clinical pearls to reduce complications and hospital length of stay. References 1) Bushardt RL, Colomb-Lippa DM, Klinger AM, Reed H. The JAAPA QRS Review for PAs: Study Plan and Guide for PANCE and PANRE. 1st ed. LWW; 2021. ISBN: 9781975143817. 2) Beach EC, De Jesus O. Ileus. [Updated 2023 Aug 23]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK558937/ 3) Khawaja, Z. H., Gendia, A., Adnan, N., & Ahmed, J. (2022). Prevention and Management of Postoperative Ileus: A Review of Current Practice. Cureus, 14(2), e22652. https://doi.org/10.7759/cureus.22652  4) Weledji E. P. (2020). Perspectives on paralytic ileus. Acute medicine & surgery, 7(1), e573. https://doi.org/10.1002/ams2.573    

In this episode, we review acute appendicitis, a common yet time-sensitive surgical emergency. We break down the pathophysiology of luminal obstruction—most often from a fecalith—leading to infection, ischemia, and potential perforation within 24–48 hours if untreated. The discussion covers classic symptom progression from periumbilical pain to right lower quadrant tenderness, key physical exam maneuvers, appropriate imaging strategies, and current treatment standards including antibiotics and laparoscopic appendectomy. High-yield clinical pearls emphasize early recognition, risk of recurrence with nonoperative management, and the role of the Alvarado score alongside imaging to guide diagnosis. References 1) Bushardt RL, Colomb-Lippa DM, Klinger AM, Reed H. The JAAPA QRS Review for PAs: Study Plan and Guide for PANCE and PANRE. 1st ed. LWW; 2021. ISBN: 9781975143817. 2) Krzyzak M, Mulrooney SM. Acute Appendicitis Review: Background, Epidemiology, Diagnosis, and Treatment. Cureus. 2020 Jun 11;12(6):e8562. doi: 10.7759/cureus.8562. PMID: 32670699; PMCID: PMC7358958. 3) Moris D, Paulson EK, Pappas TN. Diagnosis and Management of Acute Appendicitis in Adults JAMA. 2021; 326(22):2299-. 4) Salminen, P., Haijanen, J., Minneci, P.C. et al. Appendicitis. Nat Rev Dis Primers 11, 79 (2025). https://doi.org/10.1038/s41572-025-00659-6

In this episode, we review abdominal and groin hernias, including inguinal (direct and indirect), femoral, umbilical, and incisional types. We break down the pathophysiology of fascial defects leading to organ protrusion, key risk factors such as heavy lifting and prior surgery, and the clinical distinction between reducible, incarcerated, and strangulated hernias. The discussion highlights hallmark exam findings, when imaging is helpful, and clear indications for urgent surgical referral. A high-yield, clinically focused review designed to help clinicians recognize complications early and manage hernias appropriately in both outpatient and emergent settings. References 1) Bushardt RL, Colomb-Lippa DM, Klinger AM, Reed H. The JAAPA QRS Review for PAs: Study Plan and Guide for PANCE and PANRE. 1st ed. LWW; 2021. ISBN: 9781975143817. 2) Nadia A Henriksen, Heather Bougard, Mário R Gonçalves, William Hope, Ritu Khare, Jenny Shao, Andrea C Quiroga-Centeno, Eva B Deerenberg, Primary ventral and incisional hernias: comprehensive review, BJS Open, Volume 9, Issue 1, February 2025, zrae145, https://doi.org/10.1093/bjsopen/zrae145 3) Joppin V, Masson C, Bendahan D, Bege T. A review of ventral hernia biomechanics Journal of the Mechanical Behavior of Biomedical Materials. 2026; 173:107159-. 4) McBee, Patrick J.; Walters, Ryan W.1; Fitzgibbons, Robert J.. Current status of inguinal hernia management: A review. International Journal of Abdominal Wall and Hernia Surgery 5(4):p 159-164, Oct–Dec 2022. | DOI: 10.4103/ijawhs.ijawhs_36_22

In this episode, we review gastritis, an inflammatory condition of the gastric mucosa commonly triggered by H. pylori infection, NSAID use, alcohol, or physiologic stress. We break down the pathophysiology of mucosal inflammation, key differences between acute and chronic gastritis, and the clinical features of epigastric pain, nausea, and possible GI bleeding. The discussion highlights appropriate diagnostic strategies—including when to pursue endoscopy—and evidence-based treatment such as PPI therapy and eradication of H. pylori. A focused, high-yield review emphasizing careful history-taking and differentiation from more life-threatening causes of upper GI bleeding. References 1) Bushardt RL, Colomb-Lippa DM, Klinger AM, Reed H. The JAAPA QRS Review for PAs: Study Plan and Guide for PANCE and PANRE. 1st ed. LWW; 2021. ISBN: 9781975143817. 2) Azer SA, Awosika AO, Akhondi H. Gastritis. [Updated 2024 Jun 22]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK544250/ 3) Rugge M, Savarino E, Sbaraglia M, Bricca L, Malfertheiner P. Gastritis: The clinico-pathological spectrum Digestive and Liver Disease. 2021; 53(10):1237-1246. 4) Provenza, Delaney MMS, PA-C; Provenza, John Michael MD. Vonoprazan: A novel agent used in eradicating Helicobacter pylori infection. JAAPA 37(12):p 13-17, December 2024. | DOI: 10.1097/01.JAA.0000000000000154

In this episode, we review esophageal varices, a life-threatening complication of portal hypertension most commonly seen in patients with cirrhosis. We break down the pathophysiology of increased portal venous pressure leading to fragile, dilated submucosal veins at high risk of rupture. The discussion highlights the dramatic presentation of upper GI bleeding, the critical role of emergent endoscopy, and evidence-based management including fluid resuscitation, band ligation, octreotide, antibiotics, and TIPS for refractory cases. A focused, high-yield review emphasizing early stabilization, prevention of rebleeding, and risk reduction strategies in patients with chronic liver disease. References 1) Bushardt RL, Colomb-Lippa DM, Klinger AM, Reed H. The JAAPA QRS Review for PAs: Study Plan and Guide for PANCE and PANRE. 1st ed. LWW; 2021. ISBN: 9781975143817. 2) Meseeha M, Attia M. Esophageal Varices. [Updated 2023 Aug 7]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK448078/ 3) Pallio S, Melita G, Shahini E, Vitello A, Sinagra E, Lattanzi B, Facciorusso A, Ramai D, Maida M. Diagnosis and Management of Esophagogastric Varices. Diagnostics (Basel). 2023 Mar 8;13(6):1031. doi: 10.3390/diagnostics13061031. PMID: 36980343; PMCID: PMC10047815.

In this episode, we review ischemic bowel disease, a life-threatening condition caused by insufficient blood flow to the intestines. We break down the spectrum of disease—including ischemic colitis, acute mesenteric ischemia, and chronic mesenteric ischemia—and discuss key risk factors such as vascular disease and atrial fibrillation. The episode highlights the classic presentation of severe abdominal pain out of proportion to exam, the critical role of CT angiography, and the need for emergent surgical consultation. References 1) Bushardt RL, Colomb-Lippa DM, Klinger AM, Reed H. The JAAPA QRS Review for PAs: Study Plan and Guide for PANCE and PANRE. 1st ed. LWW; 2021. ISBN: 9781975143817. 2) Amini A, Nagalli S. Bowel Ischemia. [Updated 2023 Jul 31]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK554527/ 3) Theodore S, Xia T, Saillant N. Intestinal Ischemia — Etiology and Foundational Concepts NEJM Evidence. 2024; 3(3). 4) Ahmed M. Ischemic bowel disease in 2021. World J Gastroenterol. 2021 Aug 7;27(29):4746-4762. doi: 10.3748/wjg.v27.i29.4746. PMID: 34447224; PMCID: PMC8371501.

In this episode, we review systemic sclerosis (scleroderma), a rare connective tissue disease characterized by autoimmune endothelial injury and progressive fibrosis of the skin and internal organs. We break down hallmark features such as Raynaud phenomenon, skin tightening, GERD, and dyspnea, along with key physical exam findings like sclerodactyly and telangiectasias. The discussion highlights important autoantibodies—including anti–Scl-70 and anticentromere antibodies—plus essential screening for pulmonary hypertension and interstitial lung disease. References 1) Bushardt RL, Colomb-Lippa DM, Klinger AM, Reed H. The JAAPA QRS Review for PAs: Study Plan and Guide for PANCE and PANRE. 1st ed. LWW; 2021. ISBN: 9781975143817. 2) Volkmann ER, Andréasson K, Smith V. Systemic sclerosis. Lancet. 2023 Jan 28;401(10373):304-318. doi: 10.1016/S0140-6736(22)01692-0. Epub 2022 Nov 25. PMID: 36442487; PMCID: PMC9892343. 3) Jerjen R, Nikpour M, Krieg T, Denton CP, Saracino AM. Systemic sclerosis in adults. Part I: Clinical features and pathogenesis. J Am Acad Dermatol. 2022;87(5):S0190-9622(22)00190-6. doi:10.1016/j.jaad.2021.10.065. 4) Jerjen R, Nikpour M, Krieg T, Denton CP, Saracino AM. Systemic sclerosis in adults. Part II: management and therapeutics. J Am Acad Dermatol. 2022 Nov;87(5):957-978. doi: 10.1016/j.jaad.2021.10.066. Epub 2022 Feb 4. PMID: 35131401.