Urethritis

• Inflammation or infection of the urethra, usually from a sexually transmitted infection (STI).


• Most common pathogens: Chlamydia trachomatis and Neisseria gonorrhoeae.


• Can also result from chemical irritation or catheter use.

Risk Factors

• Multiple or new sexual partners


• Unprotected intercourse


• Prior STI history


• Men under 35 years old

Clinical Presentation

• Dysuria, burning, or itching at urethral meatus


• Urethral discharge:
  
  
  
  • Clear or mucoid → Chlamydia
  
  
  • Thick yellow-green → Gonorrhea
  
  
  
  


• Urethral redness or irritation


• The question stem would likely describe a young sexually active man with dysuria and discharge after unprotected sex.

Diagnostics

• NAAT (nucleic acid amplification test): Urethral swab or first-catch urine → most sensitive for Chlamydia and Gonorrhea.


• Urinalysis: Pyuria without bacteriuria (“sterile pyuria”) — WBCs in urine but no bacterial growth due to intracellular organisms like Chlamydia.


• Consider Trichomonas vaginalis or Mycoplasma genitalium if persistent symptoms.


• Screen for HIV and syphilis.

Treatment

• Empiric therapy for both C. trachomatis and N. gonorrhoeae:
  
  
  
  • Ceftriaxone 500 mg IM single dose
  
  
  • plus Doxycycline 100 mg PO twice daily for 7 days
  
  
  
  


• If doxycycline contraindicated → Azithromycin 1 g PO single dose


• Treat all sexual partners.


• Abstain from sexual activity for 7 days after treatment.


• Retest at 3 months due to high reinfection rate.

Exam Keys

• Dysuria + urethral discharge = Urethritis (STI until proven otherwise).


• Gonorrhea: Purulent yellow-green discharge.


• Chlamydia: Clear or mucoid discharge.


• Sterile pyuria: WBCs present but no bacterial growth → Chlamydia.


• Always treat both pathogens empirically.

Urinary Tract Infection (Cystitis)

• Infection of the bladder (lower urinary tract) most often caused by Escherichia coli.


• Common in women due to short urethra and proximity to anus.


• Classified as uncomplicated (healthy, nonpregnant women) or complicated (men, pregnancy, diabetes, obstruction, catheters).

Risk Factors

• Female sex, sexual activity, diaphragm or spermicide use.


• Postmenopausal estrogen loss, pregnancy, diabetes.


• Indwelling catheters or urinary obstruction (BPH, stones).

Clinical Presentation

• Dysuria, frequency, urgency, suprapubic pain, hematuria, cloudy urine.


• No systemic symptoms (no fever, chills, or flank pain).


• If fever or costovertebral tenderness → think pyelonephritis.


• The question stem would likely describe a young woman with burning urination, frequency, and no fever.

Diagnostics

• Urinalysis: Pyuria, positive leukocyte esterase, and nitrites (Gram-negative organisms).


• Urine culture: >100,000 CFU/mL of a single organism confirms diagnosis.


• Urine dipstick: Often sufficient in uncomplicated cases.


• Men or recurrent infections: Consider ultrasound to assess for obstruction or stones.

Treatment

• Uncomplicated: Nitrofurantoin, Trimethoprim-Sulfamethoxazole (TMP-SMX), or Fosfomycin.

Urinary Incontinence

• Involuntary loss of urine due to dysfunction of bladder storage, outlet control, or both. Classified as stress, urge (overactive bladder), overflow, functional, or mixed types.


• Very common in women after menopause or childbirth. Overflow type occurs more often in men with benign prostatic hyperplasia or neurologic disease.

Clinical Presentation

• 
  

  Stress Incontinence: Leakage with increased intra-abdominal pressure (cough, sneeze, laugh); common postpartum or post-menopause.
  
  The question stem would likely describe a postmenopausal woman who reports urine leakage when she exercises, laughs, or coughs.

  
  


• 
  

  Urge Incontinence: Sudden, strong urge to void with inability to reach the toilet in time; caused by overactive detrusor muscle; nocturia is common.
  
  The question stem would likely describe a patient who feels an abrupt urge to urinate and cannot make it to the bathroom in time, often awakening several times at night.

  
  


• 
  

  Overflow Incontinence: Dribbling and incomplete emptying due to bladder outlet obstruction or detrusor underactivity; seen with benign prostatic hyperplasia, neurogenic bladder, or diabetes.
  
  The question stem would likely describe an older man with benign prostatic hyperplasia who reports dribbling urine and a sensation of incomplete emptying.

  
  


• 
  

  Functional Incontinence: Normal bladder function but impaired mobility or cognition (dementia, post-stroke).
  
  The question stem would likely describe an elderly nursing home resident with dementia who is unable to reach the bathroom before urinating.

  
  


• 
  

  Mixed Incontinence: Combination of stress and urge symptoms; common in older women.
  
  The question stem would likely describe an older woman with both leakage when coughing and episodes of urgency.

  
  

Diagnostics

• Urinalysis and urine culture: First step to rule out urinary tract infection.


• Serum BUN and creatinine: Assess renal function in chronic or severe cases.


• Post-void residual measurement:
  
  
  
  • Less than 50 mL is normal.
  
  
  • Greater than 200 mL suggests overflow incontinence.
  
  
  • In older adults, a residual up to about 100 mL can be normal.
  
  
  
  


• Bladder stress (cough) test: With a full bladder, immediate leakage after a single cough confirms stress incontinence.


• Voiding diary (48–72 hours) and medication review: Identify transient or medication-related causes (e.g., diuretics, anticholinergics, calcium-channel blockers, opioids, alpha-blockers).


• Urodynamic studies: A small catheter measures bladder pressure and urine flow during filling and emptying; used to identify detrusor overactivity, impaired contractility, or outlet obstruction when the diagnosis is uncertain or before surgery.


• Neurologic evaluation: Consider if diabetic neuropathy or spinal cord involvement is suspected.

Treatment

Step 1: Behavioral and Lifestyle Measures

• Bladder training: Scheduled voiding at gradually longer intervals to increase bladder capacity and reduce urgency episodes.


• Timed voiding and fluid management; limit caffeine, alcohol, and bladder irritants.


• Kegel (pelvic floor) exercises for stress incontinence.


• Weight loss and smoking cessation.


• Topical vaginal estrogen for postmenopausal atrophic urethritis or vaginitis contributing to symptoms.

Step 2: Pharmacologic Management (Type-Specific)

• Urge / Overactive bladder:
  
  
  
  • Antimuscarinic agents (oxybutynin,

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 […]

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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: • […]

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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 […]