Nichole got devastating news. A 222! She had a ton of ground to make up. More than I would have thought possible. But… She did it. She went up 137 points! Listen to her story.

We’ve got an interview this week with Heather. She was feeling a little lost. A little behind, and she wanted to share with you a few ways that helped her turn it around.

Mary’s story is AMAZING. She was the Valedictorian o her high school She graduated Cum laude in 3 years from undergrad while working 30-35 hours per week. Then she got to PA school and got her first 20 on 100 point test. That was followed promptly by her first 10 on a 100 point test. […]

Substance-Related and Addictive Disorders Alcohol Use Disorder Definition/Overview Clinical Presentation Labs, Studies, and Physical Exam Findings Treatment Key Differentiators Test Alert Opioid Use Disorder Definition/Overview Clinical Presentation Labs, Studies, and Physical Exam Findings Treatment Key Differentiators Test Alert Stimulant Use Disorder (Cocaine, Amphetamines) Definition/Overview Clinical Presentation Labs, Studies, and Physical Exam Findings Treatment Key Differentiators […]

Personality Disorders Definition/Overview Clusters High-Yield Management Principles Cluster A: Odd / Eccentric (Mad) Paranoid Personality Disorder Definition/Overview Clinical Presentation Labs, Studies, and Physical Exam Findings Treatment Key Differentiators Test Alert Schizoid Personality Disorder Definition/Overview Clinical Presentation Labs, Studies, and Physical Exam Findings Treatment Key Differentiators Test Alert Schizotypal Personality Disorder Definition/Overview Clinical Presentation Labs, Studies, […]

Priming Questions

A 23-year-old with hallucinations and social decline for 8 months. What’s the most likely diagnosis?

A man disappears after trauma, later found living under a new name with no memory of his past. What disorder does this suggest?

A student feels detached, like he’s outside his body, but knows it isn’t real. What condition fits best?

A woman has seizure-like episodes with eyes closed and a normal EEG. What’s the most likely diagnosis?

Schizophrenia Spectrum
Definition/Overview

• Disorders of distorted perception, thought, and behavior


• Core symptoms: delusions, hallucinations, disorganized speech/behavior, negative symptoms


• Exist along a time + mood spectrum

Clinical Presentation

• Positive symptoms: hallucinations (auditory > visual), delusions (persecutory, grandiose), disorganized speech/behavior


• Negative symptoms: flat affect, anhedonia, avolition, alogia, social withdrawal


• Cognitive: impaired attention, executive function


• Onset: late teens to mid-30s; earlier in men

Spectrum Breakdown (time + mood = key)

• 
  

  Brief psychotic disorder

  
  
  
  
  • Duration: <1 month
  
  
  • Sudden onset, often stress-related
  
  
  • Full recovery is common
  
  
  
  


• 
  

  Schizophreniform

  
  
  
  
  • Duration: 1–6 months
  
  
  • Same symptoms as schizophrenia
  
  
  • No functional decline required
  
  
  • ~⅓ recover, ~⅔ progress to schizophrenia or schizoaffective
  
  
  
  


• 
  

  Schizophrenia

  
  
  
  
  • Duration: ≥6 months (≥1 month active symptoms)
  
  
  • Requires functional decline (social/occupational)
  
  
  • Positive + negative symptoms
  
  
  • Chronic, worse prognosis
  
  
  
  


• 
  

  Schizoaffective disorder

  
  
  
  
  • Meets schizophrenia criteria + mood disorder (major depression or mania)
  
  
  • ≥2 weeks psychosis without mood symptoms
  
  
  • If psychosis only during mood episode → mood disorder with psychotic features (not schizoaffective)
  
  
  
  


• 
  

  Delusional disorder

  
  
  
  
  • ≥1 month fixed delusion
  
  
  • Functioning not markedly impaired
  
  
  • No other psychotic features
  
  
  
  

Labs, Studies, and Physical Exam Findings

• Clinical diagnosis (DSM-5 criteria)


• Labs/imaging to rule out medical/substance causes: CBC, CMP, TSH, urine tox, neuroimaging if focal neuro deficits

Treatment

• First-line: atypical antipsychotics (risperidone, olanzapine, quetiapine, aripiprazole, ziprasidone)


• Acute agitation: haloperidol, lorazepam


• Clozapine: treatment-resistant schizophrenia (monitor CBC → agranulocytosis risk)


• Psychosocial: CBT, social skills, family therapy


• Hospitalization if danger to self/others

Schizophrenia Spectrum Timeline



Disorder
Duration
Key Features
Functional Decline
Mood Symptoms




Brief psychotic disorder
<1 month
Sudden onset, stress-related, recovery likely
No
None


Schizophreniform disorder
1–6 months
Same symptoms as schizophrenia
Not required
None


Schizophrenia
≥6 months (≥1 mo active)
Positive + negative symptoms
Required
None


Schizoaffective disorder
≥6 months

Attention-Deficit/Hyperactivity Disorder (ADHD) Neurodevelopmental disorder characterized by inattention, hyperactivity, and impulsivity. Clinical Presentation Inattention (≥6 symptoms if ≤16; ≥5 if ≥17): Hyperactivity/Impulsivity (≥6 symptoms if ≤16; ≥5 if ≥17): Functional impairment required (academic, social, occupational). Labs, Studies, and Physical Exam Findings Treatment First-line: Stimulants (most effective) Non-stimulant alternatives Non-pharmacologic Key Differentiators Test Alert Autism Spectrum […]

Bipolar and Related Disorders Chronic mood disorder with episodes of mania/hypomania and depression.Onset typically late teens–20s. Equal in men/women. Strong genetic predisposition. Clinical Presentation Bipolar I Disorder Bipolar II Disorder Cyclothymic Disorder Hallmark exam clues Labs, Studies, and Physical Exam Findings Treatment First-line (mood stabilizers): Adjunctive / Antipsychotics: Antidepressants: Non-pharmacologic: Key Differentiators Bipolar I vs. […]

Generalized Anxiety Disorder (GAD) Clinical Presentation Labs, Studies & Imaging Treatment & Management Panic Disorder Clinical Presentation Labs, Studies & Imaging Treatment & Management Phobias Clinical Presentation Labs, Studies & Imaging Treatment & Management Obsessive-Compulsive Disorder (OCD) Clinical Presentation Labs, Studies & Imaging Treatment & Management High-Yield Facts

Abuse Disorders
Child Abuse

• Physical, sexual, emotional maltreatment or neglect of a child


• High prevalence across socioeconomic classes; vigilance essential


• High priority for prevention

Clinical Presentation

• Unexplained or suspicious injuries (e.g., spiral fractures, stocking-glove pattern burns)


• Retinal hemorrhages (Shaken Baby Syndrome)


• Hyphema (blood in anterior chamber of eye)


• Behavioral indicators: anxiety, PTSD symptoms, depression, failure to thrive, substance abuse, suicidal ideation

Labs, Studies & Imaging

• Skeletal survey


• Head CT/MRI for suspected trauma

Treatment & Management

• Mandatory reporting


• Immediate hospitalization for severe injuries


• Multidisciplinary involvement: social services, child protective services

High-Yield Facts

• Fractures at various healing stages strongly indicate abuse


• Always prioritize child safety and mandatory reporting

Elder Abuse

• Abuse of elderly individuals, especially frail, isolated, cognitively impaired


• Approximately 4% prevalence annually

Clinical Presentation

• Unexplained injuries, signs of neglect (poor hygiene, malnutrition)


• Emotional withdrawal, fearfulness

Labs, Studies & Imaging

• Thorough documentation of all injuries and conditions

Treatment & Management

• Mandatory reporting


• Coordination with social services


• Supportive care

High-Yield Facts

• Isolation significantly raises risk

Intimate Partner Violence (Domestic Violence)

• Pattern of violence or abuse between partners


• Prevalent across demographics


• Heightened risk during pregnancy

Clinical Presentation

• Frequent healthcare visits with nonspecific complaints


• Injuries inconsistent with history or in various healing stages


• Partner exhibits controlling/aggressive behavior during visits

Labs, Studies & Imaging

• Private, careful screening and documentation of injuries


• Consider neuroimaging if head trauma suspected (MRI/CT)

Treatment & Management

• Mandatory reporting according to local regulations


• Safety planning, counseling, referral to community resources

High-Yield Facts

• Always perform private interviews to accurately screen for domestic violence

Physical and Psychological Abuse

Clinical Presentation

• Fearful behavior


• Anxiety


• Unexplained somatic complaints


• Low self-esteem


• Depression

Labs, Studies & Imaging

• Private patient interviews


• Thorough documentation

Treatment & Management

• Counseling


• Psychotherapy


• Safety planning


• Community resources

Sexual Abuse

Clinical Presentation

• Genital trauma


• STIs


• Pregnancy in minors


• Behavioral regression

Labs, Studies & Imaging

• Sexual assault forensic exam

Neurologic Neoplasms
Benign Neurologic Neoplasms
Meningioma

• Most common benign intracranial tumor; originates from meninges (arachnoid cells)


• Slow-growing, frequently calcified

Clinical Presentation

• Often asymptomatic or gradual-onset headaches, seizures, focal deficits

Labs, Studies, and Physical Exam Findings

• MRI: extra-axial lesion with dural attachment (“dural tail sign”)


• CT: often calcified

Treatment

• Surgical resection if symptomatic; observation if incidental

Schwannoma (Acoustic Neuroma)

• Originates from Schwann cells, commonly affects CN VIII at cerebellopontine angle

Clinical Presentation

• Progressive unilateral hearing loss, tinnitus, balance issues


• Possible facial nerve involvement (CN VII)

Labs, Studies, and Physical Exam Findings

• MRI: enhancing lesion at cerebellopontine angle

Treatment

• Surgical resection, stereotactic radiosurgery, or observation if small

Pituitary Adenoma

• Benign anterior pituitary tumor; may be hormone-secreting or nonfunctional

Clinical Presentation

• Endocrine abnormalities (prolactinoma, acromegaly, Cushing’s disease)


• Bitemporal hemianopsia from optic chiasm compression

Labs, Studies, and Physical Exam Findings

• MRI: sellar mass compressing optic chiasm


• Hormone level assessment (prolactin, GH, ACTH)

Treatment

• Prolactinoma: Dopamine agonists (Cabergoline)


• Surgical resection if visual or hormonal disturbances

Malignant Neurologic Neoplasms
Glioblastoma Multiforme (GBM)

• Most common and aggressive primary CNS malignancy; Grade IV astrocytoma

Clinical Presentation

• Rapid onset and progression of headaches, seizures, focal deficits, cognitive changes


• Increased ICP: nausea/vomiting, papilledema

Labs, Studies, and Physical Exam Findings

• MRI: irregular, infiltrative lesion with central necrosis (“butterfly” glioma crossing corpus callosum) and extensive edema

Treatment

• Surgical debulking, radiation, chemotherapy (Temozolomide)


• Prognosis poor (median survival 12-15 months)

Medulloblastoma

• Malignant pediatric brain tumor located in cerebellum; commonly in posterior fossa

Clinical Presentation

• Symptoms due to obstructive hydrocephalus: headache, vomiting, ataxia, gait instability


• Increased ICP: papilledema, altered mental status

Labs, Studies, and Physical Exam Findings

• MRI: enhancing mass in posterior fossa; obstructive hydrocephalus

Treatment

• Surgical resection, radiation, chemotherapy


• Prognosis varies with subtype and resection completeness

CNS Lymphoma (Primary CNS Lymphoma)

• Aggressive malignancy primarily affecting immunocompromised patients (HIV/AIDS, post-transplant)

Clinical Presentation

• Rapid cognitive decline, focal neurological deficits, seizures


• May present with constitutional “B symptoms” (fever, weight loss, night sweats)

Cauda Equina Syndrome • Neurosurgical emergency due to compression of cauda equina nerve roots, usually from disc herniation, tumor, or trauma Clinical Presentation Labs, Studies, and Physical Exam Findings Treatment Key Differentiators Epidural Abscess • • Spinal epidural infection commonly caused by Staphylococcus aureus Clinical Presentation Labs, Studies, and Physical Exam Findings Treatment Key Differentiators […]

Over the past 14 years I’ve seen a lot of people make up A LOT of points, but I don’t think there’s anyone who’s done what this student did. Listen up. This is a good one.

Last time, we covered the detailed medical content on infectious neurologic disorders. (If you missed it, you can find it here: physicianassistantexamreview.com/130) This week is about action. We’re taking everything you learned and making it stick by applying it to questions, clues, and decision-making strategies you’ll need on test day. We’ll work through: Instead of memorizing facts, you’ll learn how to […]

Encephalitis Inflammation of the brain parenchyma, often viral in origin, presenting with altered mental status, seizures, and focal neurologic deficits. Can be life-threatening. Viral Encephalitis (Most Common) HSV-1 Encephalitis  Clinical Presentation: Labs & Imaging: Treatment:  Arboviral Encephalitis Clinical Presentation: Diagnosis: Treatment: Meningitis Acute Bacterial Meningitis Clinical Presentation: CSF Findings: Diagnosis: Empiric Treatment: Viral (Aseptic) Meningitis […]

Conditions Covered • Wernicke’s Encephalopathy • Hepatic Encephalopathy • Toxic & Metabolic Encephalopathy • Uremic Encephalopathy • Hypertensive Encephalopathy ⸻ Encephalopathy = Global brain dysfunction Encephalitis = Brain inflammation ⸻ Wernicke’s Encephalopathy Acute, reversible encephalopathy caused by thiamine (B1) deficiency. Key Differentiator: Confusion + Ataxia + Ophthalmoplegia in a malnourished or alcoholic patient. Essentials: • […]

Wernicke’s Encephalopathy Clinical Presentation Labs, Studies & Imaging Treatment & Management High-Yield Facts Hepatic Encephalopathy Clinical Presentation Labs, Studies & Imaging Treatment & Management High-Yield Facts Toxic & Metabolic Encephalopathy Clinical Presentation Labs, Studies & Imaging Treatment & Management High-Yield Facts Uremic Encephalopathy Clinical Presentation Labs, Studies & Imaging Treatment & Management High-Yield Facts Hypertensive […]

Cranial Nerve Review: Full Breakdown Cranial Nerves in Order 1. Olfactory (CN I) – Smell 2. Optic (CN II) – Vision 3. Oculomotor (CN III) – Eye movement (SR, IR, MR, IO), pupil constriction, eyelid elevation 4. Trochlear (CN IV) – Eye movement (SO – superior oblique) 5. Trigeminal (CN V) – Facial sensation, mastication […]

CN VI (Abducens Nerve Palsy) Definition/Overview Clinical Presentation Physical Exam Labs, Studies, and Imaging Common Causes Treatment Key Takeaways CN VII (Facial Nerve Palsy) Definition/Overview Clinical Presentation Physical Exam Labs, Studies, and Imaging Common Causes Treatment Key Takeaways CN VIII (Vestibulocochlear Nerve Palsy) Definition/Overview Clinical Presentation Physical Exam Labs, Studies, and Imaging Common Causes Treatment […]

Not a lot of notes for today. Look back to Episode 127 for the complete notes. https://www.physicianassistantexamreview.com/127