 you only have to do two things as a PA student. You have to get through school and you have to graduate from an ARC accredited PA program and you have to pass the pants, otherwise you can't practice as a physician assistant in the United States. So I thought it might be valuable to do some pants review. What is the Beck triad of cardiac tamponade? What are some characteristics of an anti-cholinergic overdose? Okay. Elijah, describe gamekeeper's thumb or ski pole thumb injury. Elijah, hello. Hey boys. So what is the purpose of getting through PA school? Like, what is the main thing you have to accomplish by becoming a PA student and by being a PA student? What's like the number one thing you have to do? Pass your classes. No. No. Pass the pants. Pass the pants. Pass your classes so you can take the pants. That's okay. Fine. Two things. So you have to go to school. Fine. Elijah totally just like corrected me. Which is totally true. So two things. You only have to do two things as a PA student. You have to get through school. So you have to pass and get your diploma in physician assistant study. You have to graduate from an ARC accredited PA program and you have to pass the pants, otherwise you can't practice as a physician assistant in the United States. So I thought it might be valuable to do some pants review. And what better way to do that than to pull out my stack of note cards that I personally used to study for the pants, which I passed on the first try. Where's the PA.com? Where's the PA.com? I have the book. Byte, it's good. I swear. Elijah, how big do you think the stack of note cards is? Oh, God, like huge, right? That is, that is a book. It's Lorge. That is a book. It's not smooth. I've never seen a physical set of flashcards in a long time. You must be old school. It's Lorge. I'm definitely going to need something like that. This is going to be the thumbnail. Do it again. Do it again. Okay. You look terrified. Yeah. So we could put this next to like Mount Rushmore or something. But yeah, so I don't know how many are in here. Definitely several hundreds. And this is basically condensing everything I didn't know like off the top of my head from the, from the rush review. Essentially all I used for pants prep was rush review and a few other resources, but that was mainly it, which Elijah will definitely want to know about in like two years when he's, but for those of you that might be taking the pants shortly in the fall because you're graduating, why don't we do three note cards? You know, we'll do three today. So good. I can't guarantee I'll know this yet. I'm barely a month in. I would be very surprised if you knew most of these or any of these because this took literally two years of learning plus review, but why not? You know, maybe this will ring a bell in Elijah's head when he's doing cardiology or whatever. And for those of you taking the pants, this might be helpful. So what is the Beck triad of cardiac tamponade? Oh my gosh, I think I know this. Yeah. Am I allowed, am I allowed to see the multiple choice like or do you just want me to say like off the top of your head? What is the Beck triad of cardiac tamponade? Beck's triad. Is it JVD? And these are just symptoms, right? JVD hypotension and one more, one more. It's something about blood pressure. That's hypotension. Oh, hypotension. Yep. JVD hypotension. I'm missing the third one. It's always the third one. You know what? I promise you can figure it out because you already know the other two. Good job on that, by the way. Holy crap. So what is cardiac tamponade? Cardiac tamponade is when I think that that sac around the heart is like the pericardial sac is filled, right? And then it causes, it doesn't allow like your heart to contract fully or something like that. Kind of. Yeah. So the pericardium, it surrounds the heart. And I'm doing spitballing this. I totally have not studied this, but in a while, but basically the pericardium, it's this very thick fibrous sac that surrounds the heart protects it. And it fills with blood for whatever reason. It's bleeding for some reason or something's leaking. Either way, it fills with blood and it puts pressure on the heart. So what does that do? It makes it so the heart cannot fully expand and contract. So you get hypotension, your blood pressure drops because the heart's not pumping as strongly as it should. You get JVD, which is a jugular venous distension because your venous system is backed up because the heart is not like, not only is it not able to pump, but it's also not able to clear blood coming into it. So you get a backup of venous blood. And what else would you possibly get if the heart sac is filled with blood and you're trying to auscultate? What might be different there? Would the heart sounds be louder or quieter? It'd be quieter, but full heart sounds? Boom. Holy crap. Two weeks. He's been in PA school for two weeks and he already knows the first note card that I pulled out at random. That was not from PA school. That's from my PCE. Solid. Solid. Like I promise we didn't stage this. I was such a nerd before PA school. Like everything I found out, like how to do like ED thoracotomies to like, yeah, to like Bex try out. Like I made sure, like I looked it up afterwards because I wanted to know. Out of this huge stack of note cards, someone who's been in PA school for two weeks knew the answer because of his clinical experience prior to PA school. So awesome. Awesome job. And just one more time, the Beck triad of cardiac tamponade, which is when the pericardium fills with blood, is hypotension, your blood pressure goes down, JVD, jugular venous distention, and muffled heart sounds. So the way that it might present on exam is patient comes in with two hours of chest pain after blunt force trauma to the chest and a motor vehicle accident. Heart rate is slightly elevated at 110. Rhythm is regular. However, provider notes muffled heart sounds on exam or difficulty hearing due to quiet heart sounds. Their blood pressure is 90 over 40. And what other finding might you find on physical exam? And it would be like multiple choice, dilated pupils, testicular, you know, hypertrophy, or like in JVD and you would choose JVD because you would know the Beck's triad of cardiac tamponade. Boom. Boom. Now I'm for sure going to get that one now. I'll remember that. Okay. Oh, this one's funny. Okay. Okay. What are some characteristics of an anticholinergic overdose? Oh, God, anticholinergic. What are some symptoms? Yeah, some findings, some symptoms, some physical findings, some, you know, physical exam findings, whatever, just some characteristics of anticholinergic overdose. I even forgot what anticholinergic means. So anticholinergic, like a straight up anticholinergic might be for like excess, like salivation or whatever. A lot of things have anticholinergic properties such as SSRIs, psych drugs, fricking overactive bladder drugs. A lot of things do have anticholinergic side effects. So I'm not sure if my pharmacology. Yeah, it is pharmacology. So I'm not sure professor made this up, but I thought it was funny. So anticholinergic overdose findings, hot as hell, blind as a bat, dry as a cactus, red as a cherry, mad as a hatter. Oh my gosh, I've heard that. I've heard that in the morning before. Probably in my ED wear work. Yeah. So you get dilated pupils, decreased bowel sounds, urine retention, sinus tachycardia, wide complex tachycardia or ventricular dysrhythmia. The person is hot. They have vision changes. They're very dry. They're not sweating. They get flush. They get red and they have psychiatric overtones. So I don't know, maybe they're a manic, maybe I don't know what mad as a hatter is, but they're just not acting right. And the treatment that's a side effect of SSRIs of anticholinergic. So I know SSRIs have anticholinergic properties, but I'm not going to go further than that just because I'm not certain right now. But anticholinergic overdose, hot as hell, blind as a bat, dry as a red as a cherry, mad as a hatter. And the treatment is benzos for agitation or seizures, lidocaine or amiodarone for dysrhythmias and magnesium for any torsades. I can't say it, torsades. Let's go with that. Oh, and by the way, here's the medications that cause this for anticholinergic overdose, atropine, antidepressants, antihistamines and antipsychotics. So psych drugs, atropine and antihistamines. Oh, wow. That is a lot of info. Yep. All on one little note card. Oh, man, that's something I'm going to need to remember. It's a pretty, it's a pretty common one as far as overdoses go because a lot of people are on antidepressants, antihistamines. So the situation might be like a 68 year old lady who has a history of chronic sinusitis, allergic rhinitis, sinusitis, whatever. And she's depressed and anxious. So she's on an antipsychotic. She's on an antidepressant. She's on an antihistamine. And she's taken all of them chronically. And she took them all without having a lot of water and is very dehydrated. And now she's got this, you know, slew of side effects. So, yeah. Last one, we have four minutes. All right. Okay. Elijah described Gamekeeper's thumb or Ski pole thumb injury. Can you repeat that? Gamekeeper's thumb or Ski pole thumb. It's a thumb injury. Gamekeeper's thumb. I've never heard that term before in my life. It's much simpler than it sounds. It's basically your thumb gets pulled that way. I know because it happened to me twice on both hands. And you tear this ligament, which of course I can't remember, but I bet you the back of the no card has it. So it's forced abduction, abduction of the thumb, which causes injury to the ulnar collateral ligament, the UCL, ulnar collateral ligament, forcible abduction. This is abduction. This is abduction. So forcible abduction to the thumb causing a tear in the ulnar collateral ligament, which is right here. Ulnar collateral ligament. Okay. And you get pain and swelling on the ulnar side of the MCP, metacarpofilangeal joint of the thumb is a thumb spica and or surgery depending on how bad it is. Thumb spica. I know that kind of cast or that kind of split. Yeah. It just kind of keeps your thumb like this. Yeah. So Gamekeeper's thumb or Ski pole thumb. Ski pole because like that's basically injuries are all named after like things that happen frequently. So ski poles and skiing and then they get their ski stuck in the snow and it like goes back on their thumb and you know, just yanks it this way. Gamekeeper's thumb is, this is disgusting, but it's because gamekeepers like Hagrid and Harry Potter, what real people did was they took care of like the lands and the farm animals and stuff. And so what they did a lot, a lot of their job entailed ripping heads off chickens. Oh, a lot. So it would be like constantly putting that same stress on the thumb and they would have this in there. Gamekeeper's thumb or Ski pole thumb, whichever one applies to you more. So you could think Hagrid from Harry Potter ripping the head off a giant chicken like Buckbeak. Or you could think ski pole thumb because like you're skiing. Yay. This is so fun. Ah, that hurts. Yeah. It's the tearing or injury to the ulnar collateral ligament due to forcible abduction of the thumb. Treatment is thumb spica and or surgery.