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.