PANP360 Videos

Hair loss can’t be evaluated well from the scalp alone. In this hair and scalp exam video, Garland James, PA-C, walks through a practical approach to evaluating hair loss in clinic, from taking a focused history and asking about styling practices to looking for signs of inflammatory and noninflammatory alopecia. She also emphasizes the parts of the exam that can easily be missed: asking permission before touching the hair, photographing the scalp for comparison, recognizing when biopsy may be needed, and building a treatment plan with the patient instead of around them. Use the accompanying Hair and Scalp Exam: A Practical Clinical Guide for PAs and NPs as a quick reference for assessing hair practices, tension patterns, density and distribution, dermoscopic clues, and care considerations in textured hair. Question: In the video, James emphasizes that the clinical history can help guide the hair loss exam. Which of the following is most relevant to ask before examining the scalp? Whether the patient prefers prescription or over-the-counter treatment Current and recent hair care practices, including protective styles and duration of wear Whether the patient has used cosmetic hair coloring in the past 10 years Whether the patient is willing to stop all styling during treatment Rationale: Rationale: Hair practices can help explain the pattern of hair loss and should be discussed before the exam. The accompanying guide also notes that hair practices often explain the pattern and recommends asking about recent styling changes, current routine, symptoms, and prior treatments. document.querySelectorAll('.mcq-block').forEach(function(block) { const correct = block.getAttribute('data-correct'); const form = block.querySelector('.mcq-form'); const feedback = block.querySelector('.mcq-feedback'); const resultText = block.querySelector('.mcq-result'); form.addEventListener('change', function(e) { const selected = e.target.value; // Log to console (optional) console.log("Selected answer:", selected); // Show feedback feedback.style.display = 'block'; if (selected === correct) { resultText.textContent = "Correct!"; resultText.style.color = "green"; } else { resultText.textContent = "Incorrect"; resultText.style.color = "red"; } }); }); .mcq-block { padding: 1rem; border: 1px solid #ddd; border-radius: 10px; margin: 1.5rem 0; background: #fafafa; } .mcq-question { margin-bottom: 0.75rem; } .mcq-feedback p { margin: 0.3rem 0; } Question: During the exam, which finding would most strongly support considering biopsy for possible inflammatory or scarring alopecia? Diffuse shedding without scalp symptoms Mixed hair shaft diameters consistent with miniaturization Perifollicular erythema or scaling with concern for scarring disease Mild dandruff without tenderness or visible inflammation Rationale: In the video, James notes that if the exam raises concern for an inflammatory component that could lead to scarring, biopsy should be strongly considered. She also cautions that biopsy location matters; avoid areas that are already fully scarred and sample near active inflammation when possible. document.querySelectorAll('.mcq-block').forEach(function(block) { const correct = block.getAttribute('data-correct'); const form = block.querySelector('.mcq-form'); const feedback = block.querySelector('.mcq-feedback'); const resultText = block.querySelector('.mcq-result'); form.addEventListener('change', function(e) { const selected = e.target.value; // Log to console (optional) console.log("Selected answer:", selected); // Show feedback feedback.style.display = 'block'; if (selected === correct) { resultText.textContent = "Correct!"; resultText.style.color = "green"; } else { resultText.textContent = "Incorrect"; resultText.style.color = "red"; } }); }); .mcq-block { padding: 1rem; border: 1px solid #ddd; border-radius: 10px; margin: 1.5rem 0; background: #fafafa; } .mcq-question { margin-bottom: 0.75rem; } .mcq-feedback p { margin: 0.3rem 0; }

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Download the Psoriasis Epidemiology Screening Tool (PEST) to use in your practice:A Practical Screening Tool for Psoriatic Arthritis Psoriatic arthritis is common, disabling, and still widely underdiagnosed. For patients with psoriasis, missing it can mean irreversible joint damage and loss of function. For PAs and NPs, it represents both a challenge and a unique opportunity. In this video, Henry Yu, PA-C walks through how he uses the Psoriasis Epidemiology Screening Tool (PEST) as part of routine psoriasis care. Not as a rheumatology workup, but as a focused, efficient screening approach that fits seamlessly into busy days in the clinic. Simple by design, the PEST exam is a brief five-question questionnaire paired with a targeted physical exam. But when used intentionally, and documented clearly, it becomes a powerful bridge from observation to strategic action. (Henry Yu likes to use the Group for Research and Assessment of Psoriasis and Psoriatic Arthritis (GRAPPA) app to administer the PEST exam) Why the PEST Exam Matters As Yu explains, managing psoriasis without understanding a patient’s PsA status is incomplete care. Psoriatic arthritis can be present regardless of skin severity, and many patients see their dermatology provider more consistently than any other clinician. Used correctly, the PEST exam helps clinicians: Identify patients at higher risk for PsA earlierDistinguish inflammatory joint symptoms from common misdiagnoses like plantar fasciitisPrompt timely referral or treatment escalationInitiate therapies that protect both skin and joints before permanent damage occurs What the Exam Includes Five yes/no questions that address joint swelling, arthritis history, nail changes, heel pain, and dactylitis. A score of three or more signals the need to move forward with further evaluation.A focused, systematic physical assessment of:MCP, PIP, and DIP jointsFingernails (pitting, onycholysis)Toes and signs of dactylitisAchilles insertion points and plantar fascia He emphasizes specific documentation not just for accuracy, but because clear documentation forces a treatment decision and supports a shift toward dual-action systemic therapy when indicated. The full PEST exam takes less than five minutes. But, as Yu notes, it can change the entire trajectory of a patient’s life, allowing dermatology clinicians to intercept psoriatic arthritis years earlier than might otherwise occur. Editorial note: A substantial proportion of patients with psoriasis have undiagnosed psoriatic arthritis; meta-analysis suggests approximately 15% of psoriasis patients may have unrecognized PsA, with reported prevalence across studies ranging widely and, in some cohorts, approaching 30% or higher, depending on diagnostic criteria and screening methods.¹,² Villani AP, Rouzaud M, Sevrain M, et al. Prevalence of undiagnosed psoriatic arthritis among psoriasis patients: a systematic review and meta-analysis. J Am Acad Dermatol. 2015;73(2):242-248.Alinaghi F, Calov M, Kristensen LE, et al. Prevalence of psoriatic arthritis in patients with psoriasis: a systematic review and meta-analysis of observational and clinical studies. J Am Acad Dermatol. 2019;80(1):251-265.e19.

What do PASI, EASI, SALT, and ACR actually do for us in everyday practice? Here, Jill Cowan, NP, breaks down the role of validated scoring tools—not as numbers to memorize but as frameworks that help us communicate treatment expectations, evaluate response, and bring clinical trial results into meaningful patient discussions. This teaser leads into our upcoming full breakdown on applying scoring tools at the point of care. Question: Which of the following best describes the purpose of using validated clinical trial scales such as SALT, PASI, EASI, or ACR in dermatology practice? They are primarily designed to simplify documentation for insurance paperwork. They standardize how disease severity and treatment response are measured, enabling consistent, objective interpretation of clinical and research findings. They eliminate the need for clinical assessment by replacing it with numerical scoring. They are only useful in clinical trials and should not inform patient counseling in practice. Rationale: Jill explains that validated scoring tools provide standardized, reliable, and responsive measures of disease severity and treatment response, enabling reproducible evaluation and helping clinicians translate trial results into clear, meaningful expectations for patients. document.querySelectorAll('.mcq-block').forEach(function(block) { const correct = block.getAttribute('data-correct'); const form = block.querySelector('.mcq-form'); const feedback = block.querySelector('.mcq-feedback'); const resultText = block.querySelector('.mcq-result'); form.addEventListener('change', function(e) { const selected = e.target.value; // Log to console (optional) console.log("Selected answer:", selected); // Show feedback feedback.style.display = 'block'; if (selected === correct) { resultText.textContent = "Correct!"; resultText.style.color = "green"; } else { resultText.textContent = "Incorrect"; resultText.style.color = "red"; } }); }); .mcq-block { padding: 1rem; border: 1px solid #ddd; border-radius: 10px; margin: 1.5rem 0; background: #fafafa; } .mcq-question { margin-bottom: 0.75rem; } .mcq-feedback p { margin: 0.3rem 0; }

Nail disease isn’t cosmetic; it’s a clinical signal. NP Nasslynne Lenz discusses how standardized nail scoring can improve consistency in documentation and communication, and how certain nail findings may serve as early clues of psoriatic arthritis. She also highlights how nail assessment can support when to consider PEST screening or rheumatology collaboration. Watch for a briefing on what to look for during nail checks, and why nail evaluation belongs in every psoriasis visit. Question: When evaluating nail involvement in a patient with psoriasis, which of the following best explains why using a standardized nail scoring tool (such as N-NAIL) can meaningfully influence clinical decision-making? It allows clinicians to automatically determine whether the patient meets diagnostic criteria for psoriatic arthritis. It ensures insurance approval for systemic therapies in patients with mild psoriasis. It replaces the need for clinical examination by providing a numeric score that can be tracked over time. It creates a consistent and validated way to capture the extent of nail disease, which may help identify patients at higher risk for psoriatic arthritis and guide when to escalate evaluation or collaborate with rheumatology. Rationale: Nasslynne notes that standardized nail tools bring consistency and clarity to how nail disease is documented, improving communication across clinicians and helping surface clues that may indicate underlying or emerging psoriatic arthritis, even before joint symptoms are obvious. The scoring does not diagnose PsA on its own, but it does support earlier recognition and informed referral or co-management. document.querySelectorAll('.mcq-block').forEach(function(block) { const correct = block.getAttribute('data-correct'); const form = block.querySelector('.mcq-form'); const feedback = block.querySelector('.mcq-feedback'); const resultText = block.querySelector('.mcq-result'); form.addEventListener('change', function(e) { const selected = e.target.value; // Log to console (optional) console.log("Selected answer:", selected); // Show feedback feedback.style.display = 'block'; if (selected === correct) { resultText.textContent = "Correct!"; resultText.style.color = "green"; } else { resultText.textContent = "Incorrect"; resultText.style.color = "red"; } }); }); .mcq-block { padding: 1rem; border: 1px solid #ddd; border-radius: 10px; margin: 1.5rem 0; background: #fafafa; } .mcq-question { margin-bottom: 0.75rem; } .mcq-feedback p { margin: 0.3rem 0; }

If you’ve ever felt buried in acronyms (PASI, DLQI, ACR… and now PEST?), you’re not alone. In this teaser, Henry Yu, PA-C, reflects on the quiet clues we sometimes overlook and why speaking a shared language across specialties matters. This is the start of a full-circle look at psoriasis, psoriatic arthritis, and the tools that help us catch what’s easy to miss