Medicine and Health Sciences Commons^™

Herniated Nucleus Pulposus Radiculopathy In Athletes, Elizabeth G. Massel

Capstone Showcase

Herniated nucleus pulposus (HNP), commonly referred to as intervertebral disc (IVD) herniation, is the second most common cause of neck and back pain, and most common cause of radiculopathy. The purpose of this CME article is to provide guidance on the medical management and secondary prevention of HNP in athletic populations, and highlight the pathophysiological process of mechanical overload putting athletes at a proportionately higher risk of the disease. It will address the unique pathophysiology of overuse-related HNP, as opposed to underuse, with the mechanical overload on vertebral discs associated with many sports. It will also review, with more emphasis …

A Thoughtful Approach To Weight Loss Management, Zachary Brock

Capstone Showcase

As a student preparing to graduate PA school, one of the areas I hope to improve upon is my ability to educate patients in a comfortable, caring, encouraging, and effective manner. In my experience, the topic of weight-loss is often handled in ways that are insensitive, making patients feel shameful about their condition and less inspired to change. The goal of this article will be to address the current literature on how to medically manage obesity in patients and combine resources that offer more effective, encouraging, and subtle approaches that will help lead to a more effective, shame-free treatment of …

Early Onset Colorectal Cancer: Research, Trends & Challenges, Sarah E. Smith

Capstone Showcase

Early onset colorectal cancer (EOCRC) incidence and mortality are rising in a global trend, contrasting with improvements seen in late-onset colorectal cancer (LOCRC). EOCRC appears to differ in presentation, histology, and pathology from LOCRC painting concerns of a more aggressive tumor profile. With incidence steadily climbing, there is still lacking awareness and guidance on screening for EOCRC. This article aims to provide background on EOCRC including epidemiology, risk factors, and traits, as well as to explore methods for adjusting provider screening criteria to combat this concerning trend.

Evaluating Causes Of Sinus Tachycardia In The Pediatrics Population And Managing In A Primary Care Setting, Guillemette Calderwood

Capstone Showcase

This article’s goal is to fill a gap in research that compares causes of tachycardia in children by appropriately addressing epidemiology, what is physiologically happening with tachycardia, symptoms that may be associated with it, as well as a differential diagnosis. This review specifically discusses positional orthostatic tachycardia syndrome, anxiety, hyperthyroidism, as well as infection. This is important and needed in order to help providers in diagnosing the cause for this common arrhythmia.

Impact Of Sleep Deprivation On Stress And Performance In Students: Best Interventions, Brianna Crowley

Capstone Showcase

Sleep is an essential part of physical and mental well-being, yet, many individuals underestimate its importance.^1,2,4 Sleep deprivation can lead to a variety of detriments including memory loss, disorganized thinking, and mood changes.^3,6,7 Because of this, academic performance can be directly impaired as well, which further perpetuates a vicious cycle of sleep deprivation and increasing stress.⁸ Interventions to help improve sleep include adequate sleep hygiene, appropriate physical exercise, lifestyle changes, practicing mindfulness, and using pharmaceutical aids. Providers must continue to address this common issue among patients as it truly impacts various aspects of life and follow good …

Migraine Treatment In Primary Care, Vivian Tran

Capstone Showcase

Migraines are a common problem that medical providers encounter, especially in primary care, neurology, and the emergency department. Given that 15% of the population suffers from migraines annually, it is important for providers to know how to diagnose migraines. Migraines may also present as a symptom of another disorder, so being able to recognize whether symptoms are alarming is crucial to start the correct workup. The mainstay abortive therapy for migraines is ibuprofen, and for prophylactic therapy is topiramate. However, CGRP targeted medications like gepants and CGRP mAbs may be the new treatment of choice for abortive and prophylactic treatment …

Examining The Efficacy Of Treatments For Complex Regional Pain Syndrome, Michael Podcasy

Capstone Showcase

Complex Regional Pain Syndrome (CRPS) is a disease that affects the sensory, motor, sudomotor, vasomotor and trophic systems of patients. The pathophysiology is currently unknown and the diagnostic criteria that is used, the Budapest criteria, has its own shortcomings. This had led to hurdles in the research of the disease and well as a lack of high-quality studies on the efficacy of the many treatments currently being used to treat CRPS today. This poster explores those concepts.

Cme: Pcos Diagnostic Criteria, Lindsay R. Phillips

Capstone Showcase

Polycystic Ovarian Syndrome, or PCOS, is a hormonal imbalance that can affect females of reproductive ages and is described as women having high androgen levels, irregular menstrual cycles, and small cysts on one or both ovaries. PCOS is difficult to accurately diagnose since the diagnostic criteria are vague and the disease falls on a wide spectrum of symptoms, leaving women underdiagnosed. Previous research has shown marked improvement in the diagnostic criteria for PCOS over the years. However, due to the vagueness in symptoms, most of the criteria has been created through expert opinion based on subjective data vs objective data. …

Emerging Unconventional Therapies For Glioblastoma Multiforme, Danielle Morang

Capstone Showcase

Glioblastoma multiforme (GBM) is the most prevalent and aggressive primary malignant brain tumor occurring in adults with a median survival of less than two years. It is a highly invasive tumor characterized by genetic heterogeneity, angiogenesis, and rapid proliferation. Patients undergo a multimodal treatment regimen consisting of surgical resection and chemoradiation therapy, yet GBM tumors almost always recur with a worsening prognosis. The molecular and genetic complexities of GBM pose a significant challenge for developing effective therapeutics. Thus, it is imperative to identify new therapeutic targets and explore novel treatment strategies to improve patients’ overall survival time and quality of …

Diagnosis And Management Of Cyclic Vomiting Syndrome, Sara Read

Capstone Showcase

Cyclic vomiting syndrome (CVS) is a chronic and debilitating condition that can be encountered in a multitude of clinical settings. It is classified as a functional gastrointestinal disorder and is often misdiagnosed. Proper identification and management of this condition are crucial to patient care and quality of life. This article reviews the hypothesized etiologies, clinical presentation, and diagnosis of CVS as well as recommendations for management in a variety of settings. As an understudied and underdiagnosed condition, it is important that clinicians have a basic understanding of this disorder.

Considerations In The Management Of Juvenile Absence Epilepsy In Pregnancy And In Females Of Childbearing Age, Casey Brew

Capstone Showcase

JAE is an epilepsy syndrome that typically requires lifelong AED treatment, and valproic acid or lamotrigine is considered first line to manage the spectrum of associated seizures. In females with JAE who become pregnant, there exist risks both from having uncontrolled seizures and from taking AEDs during the pregnancy. Valproic acid carries the highest risks to the fetus but is the most effective in controlling the seizure types seen with JAE. Folic acid supplementation has shown to mitigate some but not all of the fetal risks from valproic acid. Limited guidance from professional organizations exists for management of females of …

Management Of Opioid Use Disorder In Primary Care, Carolyn Jeffries

Capstone Showcase

The prevalence of opioid use disorder (OUD) in the United States, and worldwide, has drastically increased in the span of 2-3 years. OUD is considered chronic condition and as such requires routine care over a lifetime. This makes OUD patients excellent candidates to be managed by primary care providers (PCPs). This article discusses the various barriers to treatment of OUD in a primary care setting as well methods and models that aim to mitigate these barriers. We will also review how to take a detailed assessment of an OUD patient, mainstays of medication assisted treatment (MAT), and management of side …

Non-Pharmaceutical Symptom Management In Patients With Pcos, Allison Stern

Capstone Showcase

Polycystic Ovarian Syndrome (PCOS) is a relatively common diagnosis among biological females. There are many variations of presentations among patients with PCOS that require an individualized and tailored treatment plan for symptom management. Although there are pharmaceutical medications that can be used for PCOS symptoms, some patients’ symptoms might not be fully managed, or they might prefer to focus on non-pharmaceutical options for their symptoms instead. Therefore, it is important for clinicians to be familiar with alternatives to the mainstay of pharmaceutical treatment.

Exploring Factors Contributing To Compassion Fatigue In Emergency Departments And Possible Interventions, Neggin Assadi

Capstone Showcase

The ED is a fast paced, busy, and unpredictable environment. Increased exposures to death, suffering, and trauma can make the ED a stressful environment and makes providers more susceptible to a phenomenon called compassion fatigue (CF), a diminished ability to feel compassion towards those they are tasked to care for. Three main contributors to CF in the ED are a poor workplace environment, workplace aggression/violence, and traumatic events. Exploring what contributes to these stressors and proposing ways to reduce them can help ED providers combat CF.

Acute Otitis Media: Management And Recurrence In The Pediatric Population, Sydney Klaiman

Capstone Showcase

Acute otitis media (AOM) is one the the most common condition that affects the pediatric population. AOM place burden on affected children, caregivers, the healthcare system, and also contributes to antibiotic resistance. In many cases, AOM is not just a one-time occurrence and is the most common reason that kids receive oral antibiotics and undergo surgery. Relative to the number of articles available, there is a large gap in the research that does not thoroughly address recurrent AOM (rAOM) and the importance of its management and prevention. Therefore, the goal of this poster is to discuss different modalities used to …

Choosing The Route Of Delivery: A Discussion Of Vaginal And Cesarean Births, Camille Green

Capstone Showcase

The percentage of cesarean deliveries in the United States has increased to a rate of 32.1%, double what the World Health Organization recommends as an ideal rate for maternal and fetal benefits. The majority of cesarean sections are performed on women who have never had the procedure before and this increases the risk for subsequent cesarean deliveries. Half of the indications for primary cesarean delivery were found to be non-reassuring fetal heart tracings and arrest of labor, both of which are subject to obstetric provider judgment and comfort level. Among these there is also an increasing incidence of elective primary …

Diagnostic Imaging Read By Ai-Assisted Technology Within The Emergency Department, Joshua Leland

Capstone Showcase

Introduction: The emergency department (ED) has had an appreciable increase in volume over the past two decades with more individuals utilizing the ED now than a decade ago which has placed a strain on healthcare resources. Specifically adding to the rising costs in healthcare are diagnostics including chest x-rays. To combat this, institutions across the nation are developing deep-learning and artificial intelligence (AI) programs to assist in reading these diagnostics. Therefore, this systematic review analyzes the use of AI programs by clinicians in the ED to read diagnostic imaging compared to those who do not use these algorithms.

Methods: This …

Treatment Of Hypothyroidism: Desiccated Thyroid Extract, Aimee Fong

Capstone Showcase

The treatment of hypothyroidism with Levothyroxine (T4) has been well studied and FDA approved. However, many patients continue to have signs and symptoms of hypothyroidism while on Levothyroxine treatment despite reaching appropriate thyroid levels. An additional thyroid treatment known as desiccated thyroid extract (DTE) is made from dried pig thyroid glands and is advertised as a “natural” alternative to Levothyroxine. Despite lack of FDA approval and studies surrounding DTE, clinicians have prescribed DTE to patients, many of whom reported relief of their symptoms. The following poster highlights the approach to the treatment of hypothyroidism with Levothyroxine and DTE and outlines …

Continuing Medical Education On Immunothombosis In Sepsis, Vivienne Van Nguyen

Capstone Showcase

In the past decades, the incidence of sepsis complicated by immunothrombosis has increased in critically ill patients, especially those with sepsis and septic shock. Despite intensive surveillance and prevention of the underlying causes, these disease syndromes are frequently fatal. The increased incidence of immunothrombosis in sepsis has been accompanied by many critical issues and concerns regarding current diagnostic and treatment protocols. This paper offers a concise critical assessment of the current state of knowledge about sepsis and immunothrombosis among clinicians in the ICU as well as problem concerning the recognition of sepsis and immunothrombosis and their management.

Quality Of Life Before And After Cosmetic Surgery: Should Body Dysmorphic Disorder Be Considered An Absolute Or Relative Contraindication For Cosmetic Surgery?, Lindsay Conlisk

Capstone Showcase

Body Dysmorphic Disorder (BDD) has historically been regarded as a strong contraindication for cosmetic plastic surgery. New research now suggests that the contraindications to cosmetic surgery in patients with BDD may not be so absolute. This paper reviews diagnostic criteria, diagnostic challenges, and current standard of treatment of BDD. It then presents the idea of insight analysis in the BDD patient as a significant factor in determining if patients with BDD may or may not benefit from cosmetic surgery or procedures.

Case Of Acute Onset Cerebral Ischemia Involving The Subcortical Region: Corona Radiata, Devin Nichols

Capstone Showcase

Corona radiata cerebral infarcts have the capability of leaving detrimental residual deficits if not recognized and treated promptly. This article describes the presentation and management of a 43-year-old woman who was transferred from a local community hospital to a larger institution’s emergency department. Initially presenting with nausea, vomiting, and dysarthria and examined global left sided extremity weakness and dysarthria, leading to a confirmed diagnosis via magnetic resonance imaging (MRI) of a corona radiata infarction.

Cme: Ischemic Stroke Recognition And Management, Mae Missana

Capstone Showcase

Stroke is defined as a sudden onset of neurologic deficit caused by interrupted blood flow. Stroke is divided into two subtypes: ischemic and hemorrhagic. Roughly 87% of all strokes are ischemic with infarcts caused by obstruction to carotid artery circulation or vertebrobasilar artery circulation. Symptoms of ischemic and hemorrhagic stroke are similar on physical exam;therefore use of imaging is essential to determine treatment pathway. Asstroke is one of the leading causes of death in the United States, it is important to recognize the signs and symptoms, employ the necessary tools to evaluate and identity stroke, and deliver timely treatment to …

Initial Antihyperglycemic Options For Populations With Type 2 Diabetes Who Cannot Take Metformin, Rena Ogino

Capstone Showcase

Type 2 diabetes is a common disease in the United States that can result in life-threatening cardiac, vascular, and/or renal complications. The treatment of type 2 diabetes includes but is not limited to exercise, diet, multi-disciplinary approaches, and pharmaceuticals. Metformin is the first line pharmaceutical for newly diagnosed type 2 diabetes, however patients may be unable to tolerate metformin. With more than seven different antihyperglycemic drug classes and over twenty antihyperglycemic drugs, clinicians may have difficulty choosing the best agent for patients when metformin is not tolerated. This article compares common anti-hyperglycemic pharmaceutical agents and their drug classes, focusing on …

Clinical Pearls To Diagnosing Lyme Arthritis, Chandelle Keller

Capstone Showcase

Arthritis is one of the most common long term sequelae of Lyme disease infection in humans. Although the pathophysiology for Lyme arthritis is not concretely understood, there are several key features that are helpful in diagnosing Lyme disease as the culprit for the arthritic symptoms that an individual is experiencing. With a thorough history of an individuals’ age, geographic location, recent travel history and common outdoor recreational activities engaged in, a differential can be narrowed down. With the knowledge of how various arthritides present in the body, along with the use of diagnostic testing with ELISA and Western immunoblot, any …

The Benefit Of Bdnf Modification In The Treatment Of Post-Stroke Depression, Christine Gordynskiy-Ageyev

Capstone Showcase

Neuroplasticity has been a rapidly expanding area of research, and its findings have elucidated the potential of taking advantage of some of its components for the treatment of various neural pathologies. Stroke is the most common cause of long-term disability, and it is a disease process that affects many people. There are many rehabilitation programs that seek to restore a patient’s motor and cognitive functions after stroke; if not fully, then at least partially. Unfortunately, mental health changes contribute in large part to the overall disability of a patient, but these changes are not always targeted in these programs. In …

Vulvodynia: Making The Diagnosis And Improving Treatment Outcomes, Sophia Campbell

Capstone Showcase

Vulvodynia is an underdiagnosed condition that affects about 25% of women1. Patients report frustration and a lack of knowledge in the medical community regarding their symptoms of vulvar pain. Painful penetration makes performing an internal pelvic exam difficult, and patients may avoid annual gynecological appointments due to fear. It is imperative for providers to understand and implement the correct approach for accurate diagnosis. Once the diagnosis of vulvodynia has been identified, the multimodal treatment plan should be implemented to include pharmacological therapy, referral to physical therapy, and psychotherapy. With continued research and the use of evidence-based practice, the gap in …

Conditions That Mimic Attention Deficit Hyperactivity Disorder In A Pediatric Population: A Diagnostic Guide For Primary Care Providers, Elena Schatell

Capstone Showcase

This article outlines common neurobiological, developmental, psychological, and other medical diagnoses and conditions that symptomatically mimic attention deficit hyperactivity disorder (ADHD) in the pediatric population. Many of these disorders are comorbid with ADHD, but they may also be misdiagnosed as ADHD. Due to the similarity in presentation, these conditions must be included when formulating a differential diagnosis. Accurately diagnosing a child with ADHD requires a thorough evaluation and work up to rule out diagnoses on the differential.

Case Report: Fournier's Gangrene, Abigail Groos

Capstone Showcase

•Fournier’s gangrene is a rare manifestation of the already sparse skin infection known as necrotizing fasciitis, specifically of the scrotal and perineal region. This case illustrates a patient in the emergency department with a severe necrotizing skin infection who quickly progressed to sepsis and multiorgan damage. It is important to understand the common presentation, complications, and ideal management of patients with necrotizing fasciitis.

Altitude Illness, Kali Hepner

Capstone Showcase

With an increasing number of individuals traveling to high altitudes, it is important to address the risk these individuals face of developing altitude related illnesses. An example of high altitude related illness might be the elevation transition of travelers flying into Denver, Colorado (1,673 m) with the intention to then drive up to Rocky Mountain National Park’s Alpine Visitor Center (3,595 m) in the same day. This poses increased risk of unacclimatized visitors experiencing altitude illness in remote areas of the national park. This poster summarizes the diagnosis, prevention, and treatment of altitude illnesses so that clinicians and travelers may …

Detecting Multiple Myeloma In The Primary Care Setting, Anna Schweidler

Capstone Showcase

Multiple myeloma (MM) is a hematological malignancy arising from differentiated B-lymphocyte white blood cells called plasma cells. Hematological malignancies are the fourth most diagnosed cancers, composing approximately 9% of all cancer diagnoses. Specifically, multiple myeloma attributes to approximately 2% of cancer diagnoses in the United States². MM incidence has increased significantly over the past years, increasing 40% in the United States and 126% globally from 1990-2016 ². Affecting 7.0 out of every 100,000 people², multiple myeloma is considered a rare form of blood cancer. Many strides have been made in the treatment of multiple myeloma …