101: Fungal infections, Test Questions and The 33 Days Program

Hello, and welcome to season two, episode 101 of the Physician Assistant Exam Review Podcast. This week, we’re going to be continuing with infectious disease, talking about different fungal infections.

All right. My name is Brian Wallace. I’m the founder and creator here at Physician Assistant Exam Review, where we teach core medical content and how to dominate school and ultimately pass the PANCE. Those are not the same thing, right? There are two different skill sets and we’re going to get to that in a little bit. If you’d like to get every single episode of the podcast, everyone that’s ever been recorded, you can do that at physicianassistantexamreview.com/podcast. That will prompt you to download the Physician Assistant Exam Review app where I have put every single over 200 episodes of the show are in there at physicianassistantexamreview.com/podcast.

And that’ll get you every single episode in a really nice format, right on your phone. Super easy to listen to and carry along with you. All the way back to episode number one, if you’re interested in hearing what I sounded like there, it’s atrocious, but it’s in there for you.

Now, next, let me tell you a story before we begin with the fungal issues that we’re going to talk about today. In early 2022, I found a large percentage of students were failing the exam, were failing the PANCE more than usual. I was getting emails at a more consistent pace than what I normally get. And normally I get a handful of people reaching out to me because they didn’t pass the test, asking for advice, asking for help. At the beginning of 2022, it was happening much more frequently. It’s a very obvious increase. And what I found when I reached out to some people was that it was a real number.

It wasn’t just me seeing it, but the percentages had changed. And there’s a few reasons for that. We’re not going to go into those here, but certainly COVID and homeschooling, Zoom school, right, may have played a part in that. There’s a couple other factors, But regardless, the problem was that there were people who were struggling, who would put a lot of time and effort into school, a lot of money into school, and were having trouble passing the exam once, maybe twice, three, maybe even four times. And they were reaching out to me for help. And I thought to myself, what can I do to help people more than what I’m doing, right? I’ve got the podcast.

I’ve got all the content that I put out. I have The Final Step. I have these things designed to help people to get through school and get through the exam. I have Physician Assistant Exam Review newsletter, all of these places where I teach all this stuff. But people needed more than that, right? So what was I going to do? The number one request and the most obvious choice would be to do one-on-one tutoring, right?

Can I do one-on-one tutoring? Can I help people that way? Well, I never liked the idea of one-on-one tutoring. It’s not terrible, but it has a couple of major drawbacks that I just couldn’t figure out a way to get past. Number one is I could only help a handful of people, right? So if I picked two or three people to help, then that doesn’t help anybody else. And that idea sounded terrible to me.

Number two is the cost would be exorbitant, right? I was talking with a friend who has an SAT tutor for his kid that he pays over $1,200 to. I know what I charged when I used to tutor high school chemistry 20 years ago in high school biology. And it just seemed like completely out of whack with what would be reasonable to make it work as a model, either for me or for the students. It just didn’t seem like a system that I could get to work. So there was a lot of limiting factors to tutoring. And so I sat and thought, well, what can I offer?

What could I do? And I keep giving back to the idea that I’m not that smart, right? I’m just, I’m not. I have a lot of talents and I have some brains, but certainly I’m not as smart as a lot of people in this community. A lot of people I went to PA school with, a lot of the people I work with. It’s just the way things are. But what I do have is strategy.

What I can do is pass a test. What I can do is study for a particular exam and figure out how to get through it. That’s basically how I got through school all the way from middle school through PA school was what people thought were brains weren’t brains. They were strategy. They were a system. They were knowing how to prepare myself to take tests. It’s one of the reasons, main reasons I went into science was one, I liked it.

But two, I didn’t want to write reports. I didn’t want to do bulletin boards and projects because I knew that when push came to shove, I could pass a test and something that I could do. And it’s a skill I’ve been working on, like I said, since middle school. And then since creating Physician Assistant Exam Review over 11 years ago, it’s a skill I’ve been really working on even more and learning about the reasons why the things I do have been successful. And then also learning about new things that I can add in to the things I do to make things easier, better, and even more successful. So I thought to myself, what if I could show people exactly what I do and what I’ve learned over the past 11 years? What if we could do it as a group?

Because one of the questions I kept getting was it’s very lonely. I had students who were doing rotations on their own all over the country. I had students who had failed, whose classmates had moved on, and the whole thing just seemed very, very lonely. So I thought, how could we do this not as individuals, but as a group? Wouldn’t that be more interesting? The other thing I kept running into that, especially early on, people would talk about the self-defeating intrusive thoughts they would get during the exam or as they were studying. And I thought, what if we could put together a system, a program to help with those intrusive thoughts, to help break those up, to help remove those thoughts?

Now, in addition to that, I thought, what if I could hand them the schedule and the methods that I’ve used to prepare for my exams, the way that I do it? What if I could show you exactly what I do and the time frames I use and how I work through to get ready for my exams? I’ve taken the PANCE once, and I’ve taken the PANRE twice now. And what if I could get people to the very top of their mental game? Get them into the best mental shape they’ve been in after this long drudge through PA school. And get them in the best shape they could be in for test day so that they could get the information that they know out of their brains and onto the exams and get the scores they deserve. And as I spent some time thinking about this, that’s when the 33 Days to Pass Your PANCE program was born, was created.

Way back in March of 2022. As a way that I could think of how to help people who are struggling and take people who are doing well and make them do really well and give them everything that they could need to pass the PANCE. In April and then again in June, I took a group of students through the program with those questions in mind, and the results were outstanding. I was really impressed with how people did.

Now, are there people who haven’t moved their scores and haven’t passed who have gone through the program? Absolutely. Of course there are. But I’ve had loads of people dramatically improve their numbers. Literally yesterday, I was emailing with a student who went from a 349 to a 434.

Now, this student only needed a handful of points to get to passing. But they went up almost 100 points. And I’ve had a bunch of people do that. Again, not everyone, but enough to make me really confident in the program and really confident in what I can do. I’m teaching new techniques and mental tools that take time to learn. That’s part of why this is a 33 Days program and not a five-day cram course, because what I do is I create a system within you to improve your test scores. But that system takes some time to install.

It takes practice. It takes work. You can’t just sit in the back of the room and listen and expect your scores to move. That’s not going to happen, especially with this program. You have to participate. You have to be part of it because the things I teach have to become part of you. And especially for people who have struggled on standardized tests in the past, past, what I find is you have to change your approach.

You have to change what you’re doing because too often I get emails like this. Actually just this morning at midnight last night, and I guess it wasn’t, it was very early in the morning. I got an email from someone who said, unfortunately, I took my PANCE back in April and I got a 342. And then I took it again in July and got a 345. Now look at those numbers, right? A 342 and a 345. That is, from what I’ve seen, the majority of people who take the PANCE a second or third time, their scores don’t move very much.

I know that’s surprising, but they don’t. In fact, I remember a long time ago having heard a, read through a study comparing students’ PANCE scores to their PANRE scores. And let’s say that they worked in infectious disease, as a PA, what they found is on their PANRE, their score on their infectious disease section of the test pretty much matched their score in the PAN section of their test. And my takeaway from that is it has a lot to do with your question reading, with your test-taking skills, with how you study for a particular exam, and less to do with the medical content. We’re going to assume those people had very good infectious disease medical content, knowledge, right? I mean, that seems pretty obvious. But it wasn’t necessarily about that.

It’s partially about that or mostly about that, but not entirely about that. There’s a big part of it that’s about how you approach the exams, how you take your tests, how you understand and see the questions, how you don’t get distracted and lose focus, how you maintain your stamina throughout the five hours it takes to take this test. There’s a lot that goes into it. So anyway, that’s a little bit about what the 33 Days to Pass Your PANCE program is. And it covers all of this stuff and more so that you’re ready to deliver everything that you know on exam day. So that you’re ready to perform at your absolute best as if you’re in the World Series, as if you’re in the Super Bowl and you are ready to go. I want to make sure that you’re not throwing points away and that you’re picking up free points wherever they are.

So I’m hosting the next cohort beginning September 1st. That’s going to do 33 Days, so it’s going to take us through October 3rd. So if you’re taking your exam anywhere near the end of this year, this would be an excellent match for you. I do not think I’m going to do another cohort this year. I will be doing several next year, probably three. Again, one probably in April, one probably in July, and one probably in September. I may move that a little bit, but that’s kind of what I’m thinking at the moment.

So for the September cohort, we’ll begin on the 1st, but the last day to register is the 27th of August because it takes me a couple of days to get everything set up. There’s some technological stuff on the back end to get you into the private group, which is something like a private Facebook group, but on a completely different platform. It’s not zero distractions, much easier to work in. I need to get you set up in the Physician Assistant Exam Review app and have everything up and running and working. So I want to make sure, and you’re going to want a couple of days to play around and go through the pre-work material. So I want to make sure you have all of that. So I’m not going to accept people right up to the very, very last day because I find that they fall behind.

I did that in the past. It isn’t good for them. It’s not good for me. It’s not good for the rest of the group to have people behind right from the start. So if you’d like to learn more and register for the September cohort, we’d love to have you. You can find out more at physicianassistantexamreview.com/33, just the numbers 33. And you can get a lot more information there.

Also, tonight, if you listen to this on August 9th of 2022, I’m going to be hosting a live discussion just to talk a little bit through some of the ideas of what the 33 Days to Pass Your PANCE program is all about, some of the structure, some of the details. So, if you’d like to get some more information, that’ll be tonight at 8 p.m. Eastern. And you can find out more at I’m sorry. You can. I’m going to put the Zoom link in, and you can get there through physicianassistantexamreview.com/live, L-I-V-E. That will take you right there.

And again, that’s going to be at 8 p.m. Eastern time on August 9th, 2022. Now for the last part of this, if you just want to get some more information and stay tuned as to what’s coming, I want to be aware of when it closes out. If you’re on the email list, you will get all of that information. And then some I send out daily emails with tips, tricks, techniques, methods, and all sorts of things to help you get through your, the through PA school or your rotations through the PANCE, through finding a job, all of that goes out through the email list on a daily basis. And in particular, I’ll be sending out during the month of August information about the 33 Days program. And if you just head over to the website, you will absolutely be able to find a way to get on the email, email list over there.

Good. All right. So I want to get through all of that right up front. I wanted to talk about that program because I think it’s, it’s helped a lot of people. And I really, really, if you’re in a position to be taking your exam before the end of the year, I’d love to have you involved. I’d love to have you as part of the group. I think it can make a big difference and I have seen where it’s made a big difference and really helped a lot of people.

So I want one more place that it’s easy to find some more information is if you go back to the May 17th episode in this feed. What I did was I posted a call with a few of the people from the April cohort after they had taken their exams and gone through the process. And we talked a little bit more about what the program is, how it works. And sometimes it’s a lot easier to hear from people in your position than it is for me to describe it to you. So again, if you just go back to the May 17th episode in the podcast feed, you’ll be able to see all that there.

All right. After all that, let’s get into our discussion of fungal infections.

All right. With our priming questions for today. Priming questions. Curd-like discharge should make you think of what type of infection? A curd-like discharge should make you think of what type of infection? How would you treat a vaginal candida infection? How would you treat a vaginal candida infection?

What component of Bactrim are patients often allergic to? What medication would you use to treat a severe cryptococcus infection? What medication would you use to treat a severe cryptococcus infection? Which pathogenic fungus should you think of if the question talks about birds or bats as pets? Which pathogenic fungus should you think of if the question talks about birds or bats as pets? List three reasons for a patient to be immunocompromised. List three reasons for a patient to be immunocompromised.

All right, candidiasis. This is a very common fungus that you may be familiar with. This may affect the skin and or the mucous membranes of the mouth, the intestine, or the vagina. Risk factors, poor hygiene, hot and humid environment, immunosuppression, and antibiotic therapy. So antibiotic therapy is a problem because you wipe out the normal flora, right? So you can get, especially in women, you can get vaginal candidiasis following a treatment of antibiotics for a completely different problem, right? So there can be harm in prescribing standard antibiotics, and this is one of the issues that can come up.

Clinical presentation, you can get oropharyngeal candidiasis, which is more colloquially known as thrush, which just means you get this fungal infection, this white fungal infection in your mouth. So it’s sore and painful mouth, burning mouth or tongue, dysphagia. You get these thick whitish patches on the oral mucosa. It’s very obvious. You can get diffuse erythema and white patches that appear on the surface of the buccal mucosa, throat, tongue, and gums. The problem is this stuff is painful and kind of gross, right? You can see it.

It makes it difficult to eat. You can also get esophageal candidiasis, which is obviously a little bit deeper. You often have a normal oral mucosa, but the patient has dysphagia, odynophagia. They can get retrosternal pain, epigastric pain, right? Think about if the esophagus is seeded with this fungus. They can get nausea and vomiting.

Now, this candida is kind of everywhere, right? This is almost like a staph infection. It is all over the place. But it’s usually kept in check, both by your immune system and by bacteria, so that it doesn’t grow out of control. It doesn’t form these giant colonies. But if for some reason the tables are turned a little bit, and you’re immunosuppressed, and your immune system doesn’t fight this off, it starts to gain the upper hand. If you’re in a super hot, humid environment, you give this fungus a nice growing environment as opposed to a difficult growing environment, and it will grow more.

You give it sort of an advantage, right? So genitourinary tract candidiasis, you can get vulvovaginal candidiasis, you get an erythema, vagina, and labia, burning dyspareunia, thick curd-like discharge, or cottage cheese discharge from the vagina. Dermatitis would be another way, most commonly found where the skin touches skin is the way that I like to think about it. So in the axilla is a great place to develop candida. Beneath the breasts, beneath the pannus, we see this a lot in plastic surgery. We have patients with either very large breasts or with a pannus that hangs down and where that’s rubbing right underneath. You can definitely, you know, it’s obviously moist.

It’s obviously skin rubbing on skin. You can develop a pretty good candida infection in those areas. In the groin, and then of course we have diaper rash, which is where this a lot of times will come up and will come up on your exams. You see these white pustules, vesicles, and papules with what they call satellite lesions. That’s sort of the key term here is that they develop these satellite lesions.

Now, again, when I say key term, it doesn’t mean they’re going to say satellite lesion on your test. They probably will. In fact, they probably won’t. They’ll probably try their best to avoid that term. But that’s the term that should make it stick in your mind, the term that you should use to picture what this looks like. And what the descriptions will be like. Satellite lesions just mean they’re lesions out away from the main area.

Labs and studies. For a wet mount, you’re going to do scrapings or smears examined under a microscope. The standard here is a KOH prep, right? You find pseudohyphae in budding yeast cells. That should be a pretty obvious one if you’re gifted with that sort of a question. And if you suspect gastrointestinal candidiasis, you can do an endoscopy to take a look with or without biopsy.

Now, how do we treat this?

Now, the standard is good hygiene, right? We want to avoid it in the first place, and if we can create a situation where the, I keep wanting to say bacteria, where the fungus doesn’t grow as well, if we can create that drying environment, we can slow it down that way. So good hygiene is a place to start. Breathable clothing is a great place to start. Then we can move into medication. So you have topical agents and oral agents, and then you have IV medications, right? When we talk about fungus, fungal infections, you need to think about them as far as treatments go, as staging.

We pretty much use very much the same medications throughout this section, the changes are based on severity in most cases. So in your question, you have to read how severe the infection is, how sick the patient is. All of those things have to come into play. And that’s where you get your, is this the best choice type questions is from judging how the patient is appearing, judging how bad the infection is. Where would you begin? Or what medication do you need? So we have topical, we have oral, we have IV.

Obviously, topical would be the least invasive for minor issues. Oral would be a little bit more invasive for a little bit worse disease. And then IV would be for somebody who’s really in some trouble. So we have the topical agents are itraconazole, ketoconazole, miconazole, and fluconazole, and then also nystatin. Again, you can use all of those orally. And then IV, we have amphotericin B, which we do reserve because it does have some nasty side effects, but it’s very powerful. As far as clearing fungal infections.

Cryptococcus is next. This is better known as our… Its name is Cryptococcus neoformans. It’s an encapsulated yeast. This can be found in the soil or dust contaminated with bird droppings. And again, it usually affects immunocompromised patients. We can have this in wounds, so we can get a cutaneous cryptococcus.

We can get a pulmonary version, or in a really bad scenario, it can cause meningitis. Clinical presentation. So it depends on where it is, right? Just like we’ve talked about before with staph and some other bugs. The presentation is going to be different. If it infects a wound, it’s going to be different than if you get a pulmonary infection. And I know that sounds easy, but sometimes it’s hard to get your brain around the fact that these different organisms can cause different diseases, that these different, depending on where they’re located, depending on what they do.

Just like our candidiasis, if you get candida in the groin, it’s a little different than if you have it in the esophagus. This is just if you get this cryptococcus in your lungs versus in your cerebral spinal fluid, it’s a lot different, right? So for a pulmonary infection, This is going to look kind of like a pneumonia. You’re going to get a cough with some sputum. You’re going to get pleuritic chest pain. You can get a low-grade fever, dyspnea, weight loss, and malaise. With meningitis, a lot of the symptoms are going to be caused by cerebral edema.

So there’ll be sort of vague neural symptoms like headache, confusion, lethargy. You can get to nausea and vomiting. In a more severe case, you can get to fever and stiff neck, blurred vision, photophobia, seizures, ataxia, aphasia, and eventually a coma. Labs and studies, if this is a wound infection, obviously we’re going to biopsy and get fungal stains and cultures. We can do blood cultures and a cryptococcal antigen test. If you do a lumbar puncture and get spinal fluid, you can do an India ink smear. The ink does not enter the capsule.

It’s how it helps to stand out. You can do a fungal culture there. For a CAT scan of the brain, you can get large focal brain lesions, and this has gotten to a very bad point if you see those. And then on chest x-ray, if we have a pulmonary infection, you can get a lung consolidation, so it can look like a pneumonia. Treatment, again, we have our antifungal therapy. So, we have, if we just we’re talking about like a pneumonia situation, we can use fluconazole. And if we’re talking more like a meningitis, we’re going to be leading more toward amphotericin B, right?

And maybe some combination of adding in fluconazole to that. Because that’s sort of obviously a worse situation. Histoplasmosis is next. This is inhaled spores often found in soil, contaminated with bird and bat droppings. Typically patients have literally no symptoms if they’re not immunocompromised. So again, what’s our main thing here? If a patient is immunocompromised, these become much more difficult to handle, right?

They become much harder to treat. They become much more infectious. Because again, realize that a lot of these things, this a little less than candida, are omnipresent. They’re always around. And your body’s doing a good job of constantly fighting them off without you knowing it, right? That’s the part that’s hard, at least it was hard for me to get my brain around. That your body’s in a constant state of battling the world around you.

It’s constantly fighting off bacteria. It’s constantly fighting off fungus. It’s constantly fighting off viruses. This is an ongoing battle throughout your entire life. That’s why when you get stressed and run down, you increase your odds of getting sick. That’s why when your diet stinks or you’re not drinking enough fluids, you increase your odds of getting sick because you have a constant battle going on between your body, your immune system, and the outside environment. If you remove some of the tools from your immune system, it doesn’t do as good a job fighting back.

Right? Clinical presentation for histoplasmosis, chest pain, chills, cough, fever, joint pain, and stiffness, muscle aches and stiffness, and extreme weakness. So again, this tends to be a pulmonary infection that we get. We’re talking about inhaled spores. So what are we going to do here? Medical and travel history can be very important. Laboratory tests.

We can do blood and urine antigen detection to diagnose systemic disease. A CBC may present mild anemia, pancytopenia. An alk phos and a lactate dehydrogenase can be elevated. You’re going to want to do a culture of the sputum. You may need to do a bronchial lavage. Chest x-ray may show miliary infiltrates. And you’re going to want to get a CT scan of the lungs.

Treatment. Symptoms typically resolve on their own. And again, your immune system usually will do a good job fighting this off, unless it doesn’t. So if we’re going to be treating a severe histoplasmosis in the lungs or a chronic state or a disseminated histoplasmosis, we’re going to use antifungal medications, just like before. So we’re going to do something like itraconazole for several months and maybe add in amphotericin B, depending on what we’re looking at. If you have a patient who is in acute respiratory distress, you’re going to add in steroids, right? To help calm everything down.

And our last one today is pneumocystis. Pneumocystis jirovecii pneumonia, PJP, was previously known as pneumocystis carinii pneumonia, PCP. It probably doesn’t matter to you anymore. And this was always, in my mind, the most common opportunistic infection in HIV and AIDS. So this was the one that just sort of, yes, everything goes with immunocompromised state, but for whatever reason, not for whatever, this one in my mind was taught and was linked as very, I don’t want to say very common, but common with an HIV or an AIDS infection. Clinical presentation is fever, mild and dry cough or wheezing, shortness of breath, especially with activity, rapid breathing fatigue, major weight loss, chest pain with respiration. Chest x-ray shows diffuse interstitial infiltrates.

That may be a separator for you. Patients will have hypoxia. Again, that shortness of breath, that wheezing. Again, you’re going to want to test the sputum. You may have to do a bronchial bronchial alveolar lavage, easy for me to say. Bronchoscopy to extract some fluid and maybe that sputum if you can’t get at it. And a biopsy will confirm the diagnosis.

These thickened alveolar septa with fluffy eosinophilic exudate in the alveoli will confirm your diagnosis. Thickened alveolar septa with fluffy eosinophilic exudate in the alveoli. Treatment. Treatment here is going to be with Bactrim. And it’s pretty much given empirically right away for all immunocompromised patients who present with a cough because it works against this bug and you don’t necessarily want to wait around to see what you’ve got while it gets a little bit better foothold. You can also use steroids just like we talked about before if necessary.

All right, those are our major fungal infections that I wanted to talk about as far as your test goes as are on the blueprint for ID under fungal infections. Our study tip for today is going to come right out of the 33 Days program. It’s something that I talk about a lot with the people inside of that program. And it’s the idea of doing practice questions with a purpose. And the way I see it, there are two specific ways to do practice questions as you get ready for your PANCE or you’re going through medicine. Probably be better if you did this earlier on in your career as a student. Rather than waiting before your PANCE, because hopefully your medicine tests, your EORs are all set up like the PANCE.

So there’s a couple of ways you can do practice questions. One is the standard way, right? You set out, so you sit down, you do a whole bunch of questions. I would add to that, and hopefully you have this by now, a clock, a timer. So if you’re going to do 30 questions, you do them in 30 minutes, just like the PANCE would be. You got one minute per question, right? So, you do blocks of 60 in 60 minutes.

That helps to keep you moving. It helps to keep the pressure on. It helps to make sure that your time is good. I can’t have you running out of time. It’s a disaster. I also don’t want you finishing in 30 minutes. Something new I’m learning a lot about, in particular right now, those of us who go too fast on exams and how we’re thinking and how we’re missing things.

It’s just as much as a problem as people who are going too slowly. We’ve got to find some balance there. And like I said, I’ve developed some, been learning some things and working on some structure to help define what type of test taker you are and help you get back to the middle. But regardless, that’s not really what I want to talk about here. What I wanted to talk about was using that clock to judge where you’re at, to feel like you’re in the right place. If you’re taking two, three, four minutes a question, that’s going to be too long. If you’re taking 30 seconds per question, that’s going to be too short.

I think that’s kind of obvious.

Now, that’s the way that most people would go through their material. And again, using that clock to help you. I would add in another piece to that. And this you should do maybe, I don’t know, 20% of the time you’re doing questions. Is not do a one minute to one minute, but do a double the amount of time you spend per question. Maybe even triple it, depending on where you fall in here. And what I mean is in this case, I would say do 10 questions in 20 minutes or maybe in 30 minutes initially.

Now, why do I say that? The point of this part of your practice is not the medicine. It’s not the pace. It’s not the questions. It’s really diving in and understanding how the questions are structured. It’s taking some extra time, double or even triple the time, to go through the questions, to get a better feeling for how they’re written, to get a better feeling for the distractors that they put in the questions. To get a better feeling for the answer choices that match up.

Meaning the things you see in the answer choices that will pull you away from the right answer or make it difficult or force you to come down to the difficult choice between two very good answers. And you can sort of start to pick apart the, I want to say tricks, but that’s kind of got a bad connotation to it. You can pick apart how they write the questions to make them not easy. Not necessarily tricks, but the way that they have to be written. The things that you’ll be doing in the clinic, right? You’ll be in the clinic trying to tell the difference between ulcerative colitis and Crohn’s disease. It’s not a trick.

That’s what you’re going to be doing. So on your exams, they’re going to put ulcerative colitis and Crohn’s disease as answer choices. You need to take some time and start seeing how those questions are written, what things get paired together. What terms in the question help you to differentiate your diagnosis, to differentiate how sick a patient is, like we talked about as we go through the fungal section. So don’t just go through questions to cover the medical content to see if you can answer the questions. Don’t feel good when you rip through a bunch of questions, you get them all right, right? That can help your ego, but you’re not learning much.

You’re not gaining much ground. Unfortunately, you have to get some things wrong and be challenged in order to gain ground, right? So as part of your practice, take some time, some extra time, and slowly go through and read and do some questions from the perspective of learning how to do questions, learning how they’re put together, learning how to pick them apart, learning how to read them. Initially, it may seem kind of slow and annoying, or it may seem like you know it all, and you might. But I think with some practice, you can improve your scores by having a better understanding of how these questions work, how they’re written, and the areas that you, personally, are most likely to be affected by. Like I said, some people move too fast, some people move too slow. There are a whole host of reasons for that.

Everybody does things a little bit differently. So, if you spend some time with the test questions, and you can sort of feel out how they affect you, where you might be losing time, where you might be going too fast and not seeing. But I would recommend that you spend some time with the questions in that fashion.

All right. Let’s answer our priming questions. Curd-like discharge should make you think of what type of infection? A curd-like discharge should make you think of what type of infection? Vaginal candida. How would you treat a vaginal candida infection? Fluconazole, one-time dose of 150 milligrams.

What component of Bactrim are patients often allergic to? Sulfa. What medication would you use to treat a severe cryptococcus infection? IV amphotericin B. Which pathogenic fungus should you think of if the question talks about birds or bats as pets? Histoplasmosis. And then last one: list three reasons for a patient to be immunocompromised.

They may not say in your question that the patient’s immunocompromised. You may not see those terms. So what are you looking for for things that might go associated with a patient being immunocompromised? HIV or AIDS is certainly one. Lymphoma is another. Long-term steroid use is another. Why would a patient, and then you may have to infer long-term steroid use.

Something like a patient who’s had asthma since they were little, over 60 years, has had lung issues like that and needed, or a sarcoid patient, right? What about an organ transplant patient? They’re also immunocompromised. You have to read a little bit into the questions to get where they’re going. You can’t just rely. You use key terms to paint pictures for your brain to hold on to things, but you can’t expect to see those key terms necessarily in the questions, right? You have to think through and take that next step.

And I think that’s where a lot of people get to get dropped is they’re looking for the very specific key terms, but you may not see immunocompromised. You may see a patient who has recently had an organ transplant or something along those lines, and you have to take that next step.

All right, thank you so much for tuning in today. Today’s show in particular has been a ton of fun for me. Hopefully you got a lot out of it. Hopefully, if you have your tests coming up, I will see you in the September cohort of the 33 Days to Pass Your PANCE program. Again, you can register for that at physicianassistantexamreview.com/33. And if you’d like to learn a little bit more and you’re around tonight on August 9th, 2022, physicianassistantexamreview.com/live, and I’ll be there at 8 p.m. Eastern time.

And of course, anything else you want to find out, if you want to sign up for the email list, get more information. If you want to see all the notes from today’s show, you can do all of that over at the website, physicianassistantexamreview.com. And I look forward to talking to you again soon. Take care. If you have your test coming up before September, good luck on your exams. And please let me know how you’re doing. I’m always happy to hear good news or bad news and to share that with you.

Really appreciate you tuning in today. Again, thank you so much and take care. Thank you.