UTHSC PA Program Podcast

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

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. Klein AL, Abbara S, Agler DA, et al. Evaluation and management of pericardial disease. JAMA. 2021;325(10):1022–1036.
3. Imazio M, Adler Y. Management of pericardial effusion. Nature Reviews Cardiology. 2020;17(11):698–7123
4. 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

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. 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
3. Benitz WE. Patent ductus arteriosus in preterm infants. Pediatrics. 2020;146(2):e20201209
4. 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

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. 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.
3. 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

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. Nappi F. Native Infective Endocarditis: A State-of-the-Art-Review Microorganisms. 2024; 12(7):1481-.
3. 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

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. Theodore S, Xia T, Saillant N. Intestinal Ischemia — Etiology and Foundational Concepts NEJM Evidence. 2024; 3(3).
3. Theodore S, Xia T, Saillant N. The Evaluation and Management of Intestinal Ischemia NEJM Evidence. 2024; 3(4).
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

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. 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).
3. Bonaca MP, Bauersachs RM, Anand SS, et al. Rivaroxaban in Peripheral Artery Disease after Revascularization N Engl J Med. 2020; 382(21):1994-2004.
4. 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

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. 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).
3. 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.
4. 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

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. Stevens SM, Woller SC, Kreuziger LB, et al. Antithrombotic Therapy for VTE Disease Chest. 2021; 160(6):e545-e608.
3. 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

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. 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/
3. 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

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. 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.
3. 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/