Hello and welcome to episode 136 of the Physician Assistant Exam Review Podcast. Today we’re going to be doing neurodevelopmental, conduct, and eating disorders. So ADHD, autism spectrum disorder, disruptive impulse control and conduct disorder, and then we’re going to hit eating disorders with anorexia, bulimia, and binge eating. My name is Brian Wallace. I’m the host and creator here at Physician Assistant Exam Review where I’ve been at this desk for almost 15 years now amazingly helping PA students get through school, get the most out of school, and pass their PANCE with as much confidence and, let’s call it, ease as possible. That’s really the goal here. With that in mind, this weekend over Labor Day, I built a test-taking rescue kit, 100% free.

It’s set up so that you can learn to work on your pacing, to learn about taking micro-rests throughout your exam, to make it so that you can actually blink and get a break so you can hold up during that exam. What I think about flagging in particular, why I think it’s a trap and a mistake for 99.9% of the time. And then I go into the two the two types of test takers and which one are you and helping you figure that out so you can apply some of these tools. And lastly, we wrap it up with the five mistakes you absolutely can’t make. This is designed to help you get more points on your next exam without any more studying. You can pick that up at physicianassistantexamreview.com/testtakingkit. You just drop in your email there and real quick, it’ll turn around and give you access to the test taking rescue kit.

Anyway, moving forward, we are working on, we’re going to start with ADHD. We’re going to move into autism spectrum. We’re going to move into disruptive impulse control and conduct disorders. Then we’re going to hit eating disorders.

Let’s get started with our priming questions. These to me are good setups for how questions are going to come. We’re going to do our priming questions. We’re going to go through our content. We’re going to answer our priming questions. And then we’re going to do some PANCE questions like we’ve been doing. I think that’s been going really well.

And it’ll help you to see how all this ties together for the thing you have to do, which is take a test on this subject material. So many people inside the 33 Days September cohort are talking to me about how they are fantastic with their patients, loved by their preceptors, but are just struggling to get the game of test taking. So it’s one of the reasons I put that kit together and one of the reasons why I do this show the way that I do.

All right, so what age must symptoms begin for a diagnosis of attention deficit hyperactivity disorder? What age must symptoms begin for a diagnosis of attention deficit hyperactivity disorder? What behavior is required for a diagnosis of autism spectrum disorder? What behavior is required for a diagnosis of autism spectrum disorder? Which disorder involves aggression and theft? Oppositional defiant disorder or conduct disorder? Which disorder involves aggression and theft?

Oppositional defiant disorder or conduct disorder? If aggression and rights violations occur at age 18 or older, what’s the diagnosis? Which eating disorder has the highest mortality rate of all psychiatric conditions? Which eating disorder has the highest mortality rate of all psychiatric conditions? A patient of normal weight who has recurrent binge purge behavior most likely has which disorder? A patient of normal weight who has recurrent binge purge behavior most likely has which disorder? I tried to make more of these priming questions because I’m trying to make the content slightly longer.

I know I did a couple short shows, so I’m trying to balance that out a little bit. The problem is that’s a lot of questions to hold on to in your head as we move through this, but hopefully you’ll pick them up as we go.

All right, we’re going to begin with attention deficit hyperactivity disorder, ADD or ADHD. This is a neurodevelopmental disorder characterized by inattention, hyperactivity, and impulsivity. Again, I feel like this is one that we can sort of hang on to. I don’t think this is a tough one to wrap your brain around. Most of us know people like this, see people like this, are people like this. I’m hearing more and more from students who have some of these issues. I think it, well, we’ll get into what I think in a little bit.

This must have an onset before age 12. There must be an onset before age 12. So I was looking into this, and even if you’re going to diagnose this as an adult, they have to have stories. They have to have something that says, you know what, this has always been a problem. This is not something that just crept up at 45 years old. Symptoms must be present in greater than two settings, so school, home, and work. This is where you get a kid who is misbehaving at school, but is perfectly fine outside of school.

Well, that isn’t going to do it, right? That’s not going to count. Or if they’re misbehaving at home or having some attention issues at home, but they’re fine everywhere else, that doesn’t count. You have to have a minimum of two settings. More common in boys than girls, and about half persistent to adulthood. There’s also a strong genetic component to this. Clinical presentation, which would be for inattention, would be six symptoms or greater if less than 16, five symptoms or greater if over 17.

Man, that would be tough if they ask you those kind of questions. I don’t I don’t see that coming. Difficulty sustaining attention, careless mistakes in school work or regular work, poor organizational skills, loses items, forgetful, easily distracted. Those are just some of the those symptoms. Hyperactivity and impulsivity, same thing. More than six symptoms if they’re under 16. More than five symptoms if they’re over 17.

17 or over. This is the hyperactivity part, which is if they fidget, leave their seat when expected to remain seated, run, climb inappropriately, talks excessively, blurts out answers, interrupts, difficulty waiting their turn, on the go, like a motor’s always driving them. And the key to this is you have functional impairment, right? They are struggling to survive academically, socially, or at their job because of these issues. That’s a big part when we talk about psych, right? It interferes with your daily living. Lab studies and physical exam findings.

It’s obviously a clinical diagnosis. You might want to rule out thyroid disease or hearing or vision problems or sleep disorders or that kind of thing. There’s a Vanderbilt assessment scale and a Conners rating scale that you could look at this for to assess it. Treatments. First line here is going to be stimulants. This is the most effective. So Ritalin and Concerta are very popular, right?

And then you move on to amphetamines. So Adderall would be the one there. Non-stimulant alternatives. So you can do SNRIs. If there’s a substance abuse risk potential out there, that might be something to try. Alpha-2 agonists may help with hyperactivity and impulsivity. And then you get to the non-pharmacological, the behavioral therapy, parent training, exercise, structured routines.

This is where, especially when it comes to PA students, when I talk with students, a good percentage of struggling students have some of these issues. A good percentage of all students have these issues. And what I found to be most valuable for me, for my children, for the students I work with, fall into this non-pharmacological candidate. It doesn’t mean that the pharmacological stuff can’t help. It absolutely does. But I also feel like some of this can be helped with adjusting our framing and adjusting the way that we think about how we work and maybe not trying to fit into such the same structure as other people and presenting that as an option to those who are struggling with this. So what I mean by that is if you struggle with switching tasks, let’s say easily being distracted.

Well, one of the things I talk about is in today’s day and age, it’s so hard to not be distracted, right? So if you take a break and you check your email and you check your Instagram, then you go back to work. Well, you’re going to be distracted by the things you just checked. So, one line I love for this is if you don’t want to struggle with additional tasks in there, don’t add additional tasks in there, right? Don’t add things that are going to make you more distracted. On your breaks, go for a walk. Don’t check your email.

That’s hard, but those are things that are going to distract you more. Using timers, both starting timers and stopping timers seem to help a lot. That sort of thing. Blocking out other distractions. There are lots of apps that’ll turn your phone off. And again, we’re blurring the line here between a true diagnosis and the issues that all of us face with a world full of distractions, but it’s kind of similar. And I think a lot of it can be overcome with some behavior changes, but also with the things we consume.

You know, I see a drastic difference in my children when they get on a kick of certain video games or certain, let’s just say YouTube creators where they, I don’t want to say mimic behaviors, but you get caught up in this rapid fire thinking and you become very impulsive and very interruptive. And I see that in people all over the place. So be cautious and more in your patients and yourselves about what you’re consuming and how it’s affecting your brain and changing those cycles. Anyway, that’s a whole lot of, that’s a whole different story. So the key for you guys, the key for your exams, and what I’ve been trying to do more and more of is look at these key differentiators. So what is ADHD versus normal childhood behavior, right? So this is one of the hard parts, is how do we discern normal childhood behavior?

So rambunctious boys, young rambunctious children from actual ADHD. Well, here’s the deal. This is pervasive and it’s impairing across two or more settings. So, kids may be distractible, but not functionally impaired. That’s the difference. Oppositional defiant disorder would be more like a hostility toward authority, not inattention. Conduct disorder would be a violation of rights and social norms, aggression, theft, cruelty.

So, that’s pretty far off the base here. As far as autism, this would be a deficit in social communication. We’ll get to in a second. Not primarily inattention or impulsivity. One of the big ones here is that that diagnosis of ADHD requires evidence before age 12. So, if you have a 28 year old with new onset inattention after losing his job, he does not have ADHD. He probably has depression or anxiety or adjustment disorder.

So, that’s how it’s going to come on your test, right? You’re going to be looking for those kind of things. There’s an event in that case. So, I think I went over that a little too quick. If you had a question where it’s a 28-year-old with a new onset inattention, after losing a job, that person does not have ADHD. It’s more likely they have an adjustment disorder or depression or anxiety. They have an event, right?

They don’t have a lifetime of this behavior. So again, we’re framing this in how is this going to look on your exam?

All right, let’s talk about autism spectrum disorder. This is a neurodevelopmental disorder with deficits in social communication and restricted repetitive behaviors. These symptoms present in early childhood, often seen around age two or three. Again, more common in boys and a strong genetic component here. Clinical presentation. So this is deficits in social communication and interaction. So poor eye contact.

Difficulty forming relationships or peer interactions. Limited or absent speech or echolalia. Impaired in understanding of social cues. Then you get into the restrictive repetitive behavior pattern. So you get motor movements like hand flapping and rocking, insistence on routines and sameness, so doing things exactly the same way every time, following rules, intense fixated interests, hypo or hyper reactivity to sensory input. That tends to be one that you hear a lot about, is that hypersensitive to sensory input. Things you may see along with this are intellectual disability so common but not required.

Language delays, seizures, but they also may have strengths in specific areas like math, music, or memorization. I think most of us have heard stories like that as well. So, that’s not too tough. Again, I don’t think that’s a concept that’s tough to wrap your head around. Clinical diagnosis. So, obviously, this is there’s no lab test for this. This is a screening at 18 and 24 months.

But also, you want to make sure that you’re keeping an eye out when you have these sort of issues that you’re considering hearing or vision issues, because that can obviously impair social interactions, right? Treatment is early intervention, which improves long-term outcomes. You can get speech therapy, you can get occupational therapy and behavior therapies, educational support. And then for pharmacy, what we’re really doing is targeting symptoms, right? So, risperidone might help with irritability and aggression. Stimulants may help with the ADHD part, like we just talked about. If they have anxiety or OCD-type features, SSRIs may be helpful.

So, here, let’s talk again about our key differentiators. How is this different? So, autism spectrum disorder versus ADD. ADD gets that inattention impulsivity. Autism spectrum has impaired social issues and restricted interests. Autism versus intellectual disability, there’s a global cognitive delay for intellectual disability. For autism, there’s an uneven profile for specific deficits in communication and social issues, right?

So it’s more of a social problem than a global cognitive problem.

All right, so restrictive repetitive behaviors are required for diagnosis. A child with delayed language, but no repetitive interest or stereotyped behaviors does not meet the criteria for autism spectrum disorder. I shouldn’t have abbreviated that because I keep trying to struggle with what that abbreviation means in my notes. Disruptive impulse control and conduct disorders. So we did ADD. We did autism disorders. We’re comparing the two to make sure we understand how they’re going to look different on exam.

Then we’re going to get something we’re also going to see, and the reason why I’m pairing these up, right, is because you’re going to see them next to each other on exam. So, disruptive impulse control and conduct disorder. So, these are behavioral disorders marked by problems with self-control, defiance, or violation of social norms, or the rights of others. This is typically diagnosed in childhood. Again, more common in males. This whole section is associated with family conflict, inconsistent parenting, and comorbid ADHD. So, we have three types.

We have oppositional defiant disorder. We have conduct disorder, and we have intermittent explosive disorder. So for oppositional defiant disorder, we have a pattern of angry, irritable, argumentative, defiant, vindictiveness. This targets authority, like parents or teachers, does not involve aggression toward people or animals, theft, vandalism, or serious violations of rights. And the symptoms have to last greater than six months. Those timing things for psych are big, right? That’s how you’re going to pull these apart in questions.

Conduct disorder. This is more severe than oppositional defiant disorder. This is repetitive, persistent behavior violating basic rights or societal norms. This is aggression toward people or animals. Fighting and cruelty. Destruction of property. Setting things on fire.

Vandalism. Deceitfulness. Theft. Serious rule violations. With a childhood onset, we have a worse prognosis here, which may progress to antisocial personality disorder in adulthood. This is that destructive, violent individual. So this is a step up from oppositional defiant disorder.

Intermittent explosive disorder. This is recurrent episodes of verbal or physical aggression out of proportion to the stressor. Impulsive, not premeditated. So this is just explosions, just like it says, right? This may be what my 14 year old has. There’s a few holes in our wall, so it’s not too bad, but we’re getting better. So those are our different variations on the theme.

There’s obviously, this is a clinical diagnosis. We’re going to rule out ADHD, mood disorders, like depression and things that can certainly be masked in all of these, right? And obviously, there’s no specific labs. Treatments. All of these are going to begin with parent management training. Parents play a huge role here, consistent discipline strategies, and then cognitive behavioral therapy, family therapy, especially for oppositional defiant disorder. Conduct disorder.

This is going to be family intervention, behavioral therapy, look into treating ADHD with stimulants, which can help to reduce the aggression. And then you may need something a little bit stronger, like an atypical antipsychotic like risperidone, as far as the medication goes, that might help with this. For intermittent explosive disorder, again, it’s going to be cognitive behavior therapy and then maybe mood stabilizers or SSRIs to help. Here, you’re going to want to find those things, again, differentiate these on test questions. So oppositional defiant disorder versus conduct disorder, what’s the difference? How are we separating that? Well, conduct disorder is going to be much worse, right?

Serious aggression, property destruction, theft. What about conduct disorder versus antisocial personality disorder? I didn’t say this outright, but what’s the difference there? Well, conduct disorder is less than 18. Same symptoms, same patterns. Over 18 is antisocial personality disorder. What about conduct disorder versus intermittent explosive disorder how are you going to tell those apart?

Both… Intermittent explosive disorder, it’s impulsive. It’s completely out of proportion to what’s going on around them. Conduct disorder is planned, repetitive, right? So it’s premeditated.

All right, let’s do our eating disorders. And then I think we’re going to be just about done with the content. We’ll move into answering our questions and going through our PANCE questions. Eating disorders. These are psychiatric disorders characterized by disturbed eating behaviors and body image. So peak onset is adolescence to early childhood. These are more common in females.

These are associated with perfectionism, family conflict, history of trauma, psychiatric comorbidities include depression, anxiety, and OCD. We’ll do anorexia, bulimia, and then binge eating disorder. Anorexia is a restriction of energy intake, significantly low body weight. Intense fear of gaining weight or becoming fat. Distorted body image, they perceive themselves as overweight despite being underweight. That’s a clue. Two subtypes, you get restricted type, which is diet, fasting, and excessive exercise.

And then the other type is binging and purging type. So the person eats a lot and then vomits it back up. Physical findings, amenorrhea, bradycardia, hypotension, hypothermia, lanugo hair, and osteoporosis. Bulimia nervosa, this is recurrent binge eating episodes plus inappropriate compensatory behavior. So vomiting, laxatives, diuretics, excessive exercise, and so on occurs at least once a week for three months. That’s another major key. Patients usually are normal or overweight.

So that’s going to be a separator from anorexia where you have severely underweight patients. Here, these patients are going to be normal to overweight. Physical findings. These can have dental enamel erosions, right, from vomiting and having that stomach acid on the teeth, parotid gland enlargement, the Russell’s sign, which is the calluses on the knuckles from forcing yourself to vomit. And then they can have electrolyte disturbances. So hypokalemia and metabolic alkalosis. Binge eating disorder.

So this is recurrent binge eating episodes without compensatory behavior. So this is associated with obesity, right? Because we’re going to binge without purging. So loss of control, distress about binging, physical findings of zero obesity-related complications. So hypertension, diabetes, hyperlipidemia, all the things that would go along with that. Lab studies and physical exam findings. So for anorexia, you’re going to have a low BMI.

You may have a hypokalemia. A metabolic alkalosis, a high BUN, creatinine, a low estrogen, and osteoporosis. Those are things that may go along with it depending on the severity of the disease. For bulimics, you can have an electrolyte imbalance. Same thing, hypokalemia, and metabolic alkalosis. For binge eaters, you get the labs that show obesity-related metabolic syndrome, elevated glucose, elevated cholesterol, elevated triglycerides, all the things that go along with obesity.

Now, how do we treat these? So for anorexia, we’re going to start with nutritional rehab. This is priority number one. They need to be consuming calories. We’re going to do psychotherapy, so family-based therapy in adolescents, cognitive behavioral therapy. Pharmacotherapy may be helpful here, so SSRIs, especially if this is comorbid with depression or anxiety. But nutrition is really the main thing.

These patients will need to become hospitalized if malnutrition becomes incredibly severe. They have significant electrolyte imbalances, bradycardia, or suicidal ideations. For bulimia, your first line is going to be cognitive behavioral therapy and SSRIs. So fluoxetine is FDA approved for this. You want nutritional counseling, and you’re going to avoid bupropion. This is important because bupropion or Wellbutrin is used commonly for psych issues. So you have to be careful, especially with bulimia, because it has increased seizure risk with purging.

So I would highlight that. Mark it down. That seems like an easy stumbling block or an easy question. Binge eating disorder. First line here is going to be cognitive behavioral therapy. Then we’re going to follow that up with SSRIs. So how do we differentiate these?

These are pretty straightforward. Anorexia is underweight. Bulimia is normal or overweight. Binge eating is going to be overweight. So if you have a, let’s just run through some possible ways this is going to show up on an exam. An underweight patient with electrolyte abnormalities, that’s going to be anorexia nervosa. A patient with binge purge cycle but normal weight, that’s going to be bulimia.

A patient with binge eating and obesity without purging, that’s going to be binge eating disorder. So we can like take these big complicated ideas and sort of squeeze them down into these tiny boxes that are probably going to show up on your exam. Not always that way, sure, but it makes it a little bit easier.

All right, fantastic. Okay, so that brings us to the end of the content that I wanted to cover today.

Perfect. What I wanted to get to next is our study tip for today. And the study tip for today is to play with intent. I’m at a baseball tournament this summer, and the coach kept yelling, play with intent. And it really struck me that how many students I think struggle with studying and struggle on exam day because they’re not present. They’re not leaning in. They’re not participating.

They’re showing up and they’re sitting there in their chairs, but they’re not actually there. They’re more like NPCs. We’ve all been there. I’ve done it. Sat through a class, had no idea what we covered. Sat down and did to do some writing or to study something and spend an hour doing nothing and not realizing I was doing nothing. And one of the biggest places I find this is that we’re practicing it.

What I mean is students are coming to me and they’re doing telling me they’re doing 60 or 100 test questions per day. And I can’t imagine you can do 60 or 100 test questions per day with intention, with energy, with leaning into them, with really focus and working hard. I know I couldn’t. It sounds incredibly taxing and incredibly difficult. I could do 20. I could do 30. But depending on what else I had going on that day, I couldn’t play with intent for every question.

So then what happens is you start to fade. You start to zone out. And when you fade and zone out, when you’re practicing, it makes it so that you practiced fading and zoning out. You practiced not giving your full effort. So then when you get to your exam, you’re not you’ve already practiced not giving your full effort. So your eyes kind of glaze over and you’re not really paying attention. And you’re misreading and you’re stumbling over easy things.

Your anxiety is high, but you’ve trained not to play hard. One of the things that used to kill me when I coached Little League and my my travel team, they were we would always do batting practice, right? And what you would do is you’d have a field full of kids. You’d have one kid hitting and he’d get like 10 pitches. And on the last one, you’d say, okay, on the last one, you’re going to run just to give the fielder something to do, right? So if he hits the ball, they can pick it up and throw it somewhere versus if he’s just standing at the plate, it’s kind of boring for the fielder. So it’s a way to get the fielders involved and get the kid involved at the plate and make it a little more interesting.

But here’s the problem with the drill. If a kid hit a weak ground ball, the coach on the mound would say, oh, don’t run now. We’ll do another one. Or if he hit a little dinker between the first baseman and the second baseman, oh, don’t run, don’t run. We’ll do another one. So what you’ve now done is you’ve trained kids to do the opposite of what you want them to do. You want them to run hard every single time out of the box.

When they put that ball in play, you want them running hard because you don’t know who’s going to make a mistake, who’s going to screw up, what’s going to happen next. So you want them doing that. You want them trained to do that. But instead, we’re training them the opposite way. We’re training them to not run on those weak hits, on the weak contact. So we’re teaching them to do something we don’t want them to do. And I think that’s what’s happening when we do too many test questions.

We’re teaching ourselves to not play with intention. I hope that makes sense, and I hope you take it to heart and look at your practice and what you’re doing. Which is also one of the reasons, by the way, that I put together that test-taking rescue kit, was to go through some simple things you can be doing during your exam to pick up points fast without having to add any more studying. There’s so many things, so many different options that people just don’t even realize. Things that affect how you are that day, things that affect how it is when you’re sitting there, that all build in. So playing with intent is one of them, but there’s so many. So if you want to just get a start into that, you can pick that up at physicianassistantexamreview.com/testtakingkit, and you’ll get just instant access to that testing rescue kit.

physicianassistantexamreview.com/testtakingkit. All right, let’s go in and answer our priming questions. What age must symptoms begin for a diagnosis of attention deficit hyperactivity disorder? We hit on this a few times. What age must symptoms begin for a diagnosis of attention deficit hyperactivity disorder? Well, before age 12. What behavior is required for a diagnosis of autism spectrum disorder?

I mentioned this specifically, but you may have missed it. It’s going to be restricted or repetitive behaviors. Which disorder involves aggression and theft? Oppositional defiant disorder or conduct disorder? This is just straight memorization one. Conduct disorder. If aggression and rights violations occur at age 18 or older, what is the diagnosis?

I didn’t technically cover this today, but you got the idea. Antisocial personality disorder. Which eating disorder has the highest mortality rate of all psychiatric conditions? Anorexia nervosa. And a patient with normal weight and has recurrent binge purge behavior is most likely which disorder? This will be bulimia nervosa.

All right, let’s hit on some practice PANCE questions and see if we can use this stuff here.

Now, one thing I want you to realize as we do these questions, they can often come across as easy because we just covered the topics and we’re only on three different diagnoses, three different sections here. So it’s obvious what’s coming, right? There’s not a whole lot of questions. This gets hard two months from now, three months from now, when you haven’t looked at this stuff and it’s mixed in with a hundred other topics. And that’s when it’s difficult. So right now it should look a little bit easy because we’re just hitting off the things we just talked about. But this is how you build your foundation of understanding how questions get written, how they get worked through, and how you answer them.

So here we go. A 17-year-old girl is brought to the clinic by her parents for the evaluation of weight loss. So immediately I’m thinking, I’ve got a girl, I’ve got weight loss, I’m thinking anorexia. She has a BMI of 16 and reports restricting her food intake because she’s afraid of gaining weight. This is pushing me more towards that. On exam, she has lanugo hair, bradycardia, and amenorrhea. Laboratory studies show hypokalemia, elevated BUN.

Which of the following is the most likely diagnosis? Bulimia nervosa, binge eating disorder, anorexia nervosa, persistent depressive disorder, or body dysmorphic disorder. And this one’s pretty straightforward, right? It gives us every single clue you could ask for. The answer is anorexia. But what I want you to do, too, is just look at what else is there. You know, for bulimia, you’d want to see binge eating.

And you don’t, with vomiting or laxatives. For binge eating, you’d want to say binge eating, right? But you don’t. So those clues need to be in there. Don’t just look at this and say, oh, I got it. Look at it as a teaching option, a teaching potential of these types of questions. The next one.

A six-year-old boy is brought in by his parents for evaluation of school difficulties. His teacher reports he is easily distracted, leaves his seat frequently, and interrupts other classes. Parents says he is very social, has many friends, and enjoys imaginative play. Developmental milestones were normal, which of the following is the most likely diagnosis. A is autism spectrum disorder. B is oppositional defiant disorder. C is attention deficit hyperactivity disorder.

Then we have social communication disorder and intellectual disability. The correct answer here is going to be C, ADHD. But again, think about why, right? So here we have distractibility, we have hyperactivity, we have impulsivity, and functional impairment in school fits ADHD. ADHD. The only thing is, as I’m looking at this, it doesn’t give me a second site, which makes me sort of leery, but it doesn’t rule it out immediately, right? I mean, it says, which is the most likely diagnosis.

It doesn’t say that you have to diagnose it. So it’s a little bit of a question there, a little bit of a line that you may consider. But when you look at the other things, what would it have to be for autism? Well, you’d have to have some social communication and restricted repetitive type behaviors. I don’t see that at all here. For oppositional defiant disorder, you’d expect to see some oppositional defiant patterns, right? So irritability, hostility towards authority.

You don’t have that here. For social communication disorder, which we didn’t cover today, but you’d expect to see difficulty with social use of verbal and nonverbal communication. We don’t have that. And for a global intellectual disability, you’d have cognitive impairment, which we’re not showing. So although it doesn’t have that second site and maybe you want to reach for that, none of the other ones make any sense. So you wind up there.

All right, we’ve got one more. A 14-year-old boy is referred for behavior problems. His parents report is frequently lying and has stolen from neighbors and was recently suspended for fighting at school. He shows little remorse for his actions. Symptoms have been present for over a year, which of the following is the most likely diagnosis? A, oppositional defiant disorder. B, conduct disorder.

C, intermittent explosive disorder. D, antisocial personality disorder. E, attention deficit hyperactivity disorder. And their answer is B, conduct disorder. And again, pretty straightforward stuff. Repetitive violation of social norms and aggression, theft, no remorse, et cetera. If it’s oppositional defiant disorder, we’re not going to have that fighting.

We’re not going to have the theft and the vandalism, right? For intermittent explosive, obviously, that’s going to be that unprovoked, just random kind of occurrence. Antisocial personality disorder is going to be over 18. And this goes well beyond the means of ADHD, as we’ve talked about. So these become kind of obvious, but if you know these points, it becomes sort of structured and how they come. It’s just keeping them all straight two, three months from now when you have to do it mixed in with everything else.

Now, again, I’m just going to wrap up by reminding you over the weekend, I created that free test taking rescue kit where it’s going to help you get more points without studying more, without having to, some of these things you’re going to forget, right? But some of these techniques are going to help you to hold onto things and make it so it’s easier to pull them up out of your brain during the exam. You can go to physicianassistantexamreview.com/testtakingkit to pick that up instantly and get a look at that.

All right, so that’s it for today. I want to thank you guys so much for showing up, for being part of this community. Really absolutely enjoy being able to put this together. It’s an absolute blast to hear from you about your progress throughout PA school, how you’re using it, how you’re getting your scores, how things are going. Absolutely love to hear from you guys.

All right, that’s it for this week. Take care, and I look forward to talking to you again next week. We’ll see you next time.