PANCE Blueprint PDF

Content Blueprint for the Physician Assistant National Certifying Examination (PANCE) (effective beginning January 2019 for all PANCE administrations) The PANCE content blueprint provides information on how exam questions are allocated to the different medical con...

Content Blueprint for the Physician Assistant National Certifying Examination (PANCE) (effective beginning January 2019 for all PANCE administrations) The PANCE content blueprint provides information on how exam questions are allocated to the different medical content and task categories that have been deemed important for entry-level practice as a certified physician assistant. These exam specifications are based on the results of the most recent profession-wide practice analysis. The examples provided for each medical content and task category are indicative of the types of information that will be included on the exam. It is not possible to include all topics on a single exam, and it may be possible that some questions on the exam cover content that is not listed in the examples. Medical Content Categories Percentage* Cardiovascular System 13% Dermatologic System 5% Endocrine System 7% Eyes, Ears, Nose, and Throat 7% Gastrointestinal System/Nutrition 9% Genitourinary System (Male and Female) 5% Hematologic System 5% Infectious Diseases 6% Musculoskeletal System 8% Neurologic System 7% Psychiatry/Behavioral Science 6% Pulmonary System 10% Renal System 5% Reproductive System (Male and Female) 7% Task Categories Percentage* History Taking and Performing Physical Examination 17% Using Diagnostic and Laboratory Studies 12% Formulating Most Likely Diagnosis 18% Managing Patients Health Maintenance, Patient Education, and Preventive Measures 10% Clinical Intervention 14% Pharmaceutical Therapeutics 14% Applying Basic Scientific Concepts 10% Professional Practice 5% *Medical content comprises 95% of the exam. All medical content questions are also coded to one of the task areas, with the exception of the professional practice task category. Questions related to professional practice issues comprise 5% of the exam. In addition, up to 20% of the exam may be related to general surgical topics. The specific percentage allocations may vary slightly on exams. PANCE Content Blueprint – effective January 2019 Page 1 of 20  Medical Content Categories Cardiovascular System (13%) Cardiomyopathy Hypotension Dilated Cardiogenic shock Hypertrophic Orthostatic hypotension Restrictive Vasovagal hypotension Conduction disorders/dysrhythmias Lipid disorders Atrial fibrillation/flutter Hypercholesterolemia Atrioventricular block Hypertriglyceridemia Bundle branch block Paroxysmal supraventricular tachycardia Traumatic, infectious, and inflammatory heart Premature beats conditions Sick sinus syndrome Acute and subacute bacterial endocarditis Sinus arrhythmia Acute pericarditis Torsades de pointes Cardiac tamponade Ventricular fibrillation Pericardial effusion Ventricular tachycardia Valvular disorders Congenital heart disease Aortic Atrial septal defect Mitral Coarctation of aorta Pulmonary Patent ductus arteriosus Tricuspid Tetralogy of Fallot Ventricular septal defect Vascular disease Aortic aneurysm/dissection Coronary artery disease Arterial embolism/thrombosis Acute myocardial infarction Arteriovenous malformation o Non–ST-segment elevation Giant cell arteritis o ST-segment elevation Peripheral artery disease Angina pectoris Phlebitis/thrombophlebitis o Prinzmetal variant Varicose veins o Stable Venous insufficiency o Unstable Venous thrombosis Heart failure Hypertension Essential hypertension Hypertensive emergencies Secondary hypertension PANCE Content Blueprint – effective January 2019 Page 2 of 20 Dermatologic System (5%) Acneiform eruptions Neoplasms Acne vulgaris Benign Folliculitis Malignant Rosacea Premalignant Desquamation Papulosquamous disorders Erythema multiforme Contact dermatitis Stevens-Johnson syndrome Drug eruptions Toxic epidermal necrolysis Eczema Lichen planus Diseases/disorders of the hair and nails Pityriasis rosea Alopecia Psoriasis Onychomycosis Paronychia Pigment disorders Melasma Envenomations and arthropod bite reactions Vitiligo Exanthems Skin integrity Erythema infectiosum (fifth disease) Burns Hand-foot-and-mouth disease Lacerations Measles Pressure ulcers Stasis dermatitis Infectious diseases Bacterial Vascular abnormalities o Cellulitis Cherry angioma o Erysipelas Telangiectasia o Impetigo Fungal Vesiculobullous disease o Candidiasis Pemphigoid o Dermatophyte infections Pemphigus Parasitic o Lice Other dermatologic disorders o Scabies Acanthosis nigricans Viral Hidradenitis suppurativa o Condyloma acuminatum Lipomas/epidermal inclusion cysts o Herpes simplex Photosensitivity reactions o Molluscum contagiosum Pilonidal disease o Varicella-zoster virus infections Urticaria o Verrucae Keratotic disorders Actinic keratosis Seborrheic keratosis PANCE Content Blueprint – effective January 2019 Page 3 of 20 Endocrine System (7%) Adrenal disorders Primary adrenal insufficiency Cushing syndrome Diabetes mellitus Type 1 Type 2 Hypogonadism Neoplasms Multiple endocrine neoplasia Neoplastic syndrome Primary endocrine malignancy Syndrome of inappropriate antidiuretic hormone secretion (SIADH) Parathyroid disorders Hyperparathyroidism Hypoparathyroidism Pituitary disorders Acromegaly/gigantism Diabetes insipidus Dwarfism Pituitary adenoma Thyroid disorders Hyperthyroidism Hypothyroidism Thyroiditis PANCE Content Blueprint – effective January 2019 Page 4 of 20 Eyes, Ears, Nose, and Throat (7%) Eye disorders Inner ear Conjunctival disorders o Acoustic neuroma o Conjunctivitis o Barotrauma Corneal disorders o Dysfunction of eustachian tube o Cataract o Labyrinthitis o Corneal ulcer o Vertigo o Infectious Middle ear o Keratitis o Cholesteatoma o Pterygium o Otitis media Lacrimal disorders o Tympanic membrane perforation o Dacryocystitis Hearing impairment Lid disorders Other abnormalities of the ear o Blepharitis o Mastoiditis o Chalazion o Meniere disease o Ectropion o Tinnitus o Entropion o Hordeolum Foreign bodies Neuro-ophthalmologic disorders o Nystagmus Neoplasms o Optic neuritis Benign o Papilledema Malignant Orbital disorders o Orbital cellulitis Nose/sinus disorders Retinal disorders Epistaxis o Macular degeneration Nasal polyps o Retinal detachment Rhinitis o Retinopathy Sinusitis Traumatic disorders Trauma o Blowout fracture o Corneal abrasion Oropharyngeal disorders o Globe rupture Diseases of the teeth/gums o Hyphema Infectious/inflammatory disorders Vascular disorders o Aphthous ulcers o Retinal vascular occlusion o Candidiasis Vision abnormalities o Deep neck infection o Amaurosis fugax o Epiglottitis o Amblyopia o Herpes simplex o Glaucoma o Laryngitis o Scleritis o Peritonsillar abscess o Strabismus o Pharyngitis Salivary disorders Ear disorders o Sialadenitis External ear o Parotitis o Cerumen impaction Trauma o Otitis externa Other oropharyngeal disorders o Trauma o Leukoplakia PANCE Content Blueprint – effective January 2019 Page 5 of 20 Gastrointestinal System/Nutrition (9%) Biliary disorders Metabolic disorders Acute/chronic cholecystitis G6PD deficiency Cholangitis Paget disease Cholelithiasis Phenylketonuria Rickets Colorectal disorders Abscess/fistula Neoplasms Anal fissure Benign Constipation Malignant Diverticulitis Fecal impaction Nutritional and vitamin disorders Hemorrhoids Hypervitaminosis/hypovitaminosis Inflammatory bowel disease Obesity Irritable bowel syndrome Ischemic bowel disease Pancreatic disorders Obstruction Acute/chronic pancreatitis Polyps Small intestine disorders Toxic megacolon Appendicitis Esophageal disorders Celiac disease Esophagitis Intussusception Gastroesophageal reflux disease Obstruction Mallory-Weiss tear Polyps Motility disorders Strictures Varices Food allergies and food sensitivities Gluten intolerance Lactose intolerance Nut allergies Gastric disorders Gastritis Peptic ulcer disease Pyloric stenosis Hepatic disorders Acute/chronic hepatitis Cirrhosis Hernias Infectious diarrhea Ingestion of toxic substances or foreign bodies PANCE Content Blueprint – effective January 2019 Page 6 of 20 Genitourinary System (Male and Female) (5%) Bladder disorders Incontinence Overactive bladder Prolapse Congenital and acquired abnormalities Cryptorchidism Peyronie disease Trauma Vesicoureteral reflux Human sexuality Infectious disorders Cystitis Epididymitis Orchitis Prostatitis Pyelonephritis Urethritis Neoplasms Bladder cancer Penile cancer Prostate cancer Testicular cancer Nephrolithiasis/urolithiasis Penile disorders Erectile dysfunction Hypospadias/epispadias Paraphimosis/phimosis Prostate disorders Benign prostatic hyperplasia Testicular disorders Hydrocele/varicocele Testicular torsion Urethral disorders Prolapse Stricture PANCE Content Blueprint – effective January 2019 Page 7 of 20 Hematologic System (5%) Autoimmune disorders Coagulation disorders Clotting factor disorders Thrombocytopenias Cytopenias Anemia Leukopenia Cytoses Polycythemia Thrombocytosis Hemoglobinopathies Hemochromatosis Sickle cell disease Thalassemia Immunologic disorders Transfusion reaction Neoplasms, premalignancies, and malignancies Acute/chronic lymphocytic leukemia Acute/chronic myelogenous leukemia Lymphoma Multiple myeloma Myelodysplasia PANCE Content Blueprint – effective January 2019 Page 8 of 20 Infectious Diseases (6%) Bacterial diseases Viral diseases Botulism Cytomegalovirus infections Campylobacter jejuni infection Epstein-Barr virus infections Chlamydia Erythema infectiosum Cholera Herpes simplex virus infections Diphtheria HIV infection Gonococcal infections Human papillomavirus infections Gonorrhea Influenza Methicillin-resistant Staphylococcus aureus Measles infection Mumps Rheumatic fever Rabies Rocky Mountain spotted fever Roseola Salmonellosis Rubella Shigellosis Varicella-zoster virus infections Tetanus Fungal diseases Candidiasis Cryptococcosis Histoplasmosis Pneumocystis Mycobacterial diseases Atypical mycobacterial disease Tuberculosis Parasitic diseases Helminth infestations Malaria Pinworms Toxoplasmosis Trichomoniasis Prenatal transmission of disorders Congenital varicella Herpes simplex virus Human papillomavirus Zika virus Sepsis/systemic inflammatory response syndrome Spirochetal diseases Lyme disease Syphilis PANCE Content Blueprint – effective January 2019 Page 9 of 20 Musculoskeletal System (8%) Chest/rib disorders Spinal disorders Deformities Ankylosing spondylitis Fractures Cauda equina syndrome Herniated nucleus pulposus Compartment syndrome Kyphosis Scoliosis Degenerative diseases Spinal stenosis Osteoarthritis Sprain/strain Thoracic outlet syndrome Infectious diseases Torticollis Osteomyelitis Trauma Septic arthritis Upper extremity disorders Lower extremity disorders Fractures/dislocations Avascular necrosis Soft-tissue injuries Developmental dysplasia Fractures/dislocations Osgood-Schlatter disease Slipped capital femoral epiphysis Soft-tissue injuries Neoplasms Benign Malignant Rheumatologic disorders Fibromyalgia Gout/pseudogout Juvenile rheumatoid arthritis Osteoporosis Polyarteritis nodosa Polymyalgia rheumatica Polymyositis Reactive arthritis Rheumatoid arthritis Sjögren syndrome Systemic lupus erythematosus Systemic sclerosis (Scleroderma) PANCE Content Blueprint – effective January 2019 Page 10 of 20 Neurologic System (7%) Closed head injuries Vascular disorders Concussion Arteriovenous malformation Postconcussion syndrome Cerebral aneurysm Traumatic brain injury Intracranial hemorrhage Stroke Cranial nerve palsies Syncope Transient ischemic attack Encephalopathic disorders Headaches Cluster headache Migraine Tension headache Infectious disorders Encephalitis Meningitis Movement disorders Essential tremor Huntington disease Parkinson disease Tourette disorder Neoplasms Benign Malignant Neurocognitive disorders Delirium Major/mild neurocognitive disorders Neuromuscular disorders Cerebral palsy Multiple sclerosis Myasthenia gravis Peripheral nerve disorders Carpal tunnel syndrome Complex regional pain syndrome Guillain-Barré syndrome Peripheral neuropathy Seizure disorders Focal seizures Generalized seizures Status epilepticus PANCE Content Blueprint – effective January 2019 Page 11 of 20 Psychiatry/Behavioral Science (6%) Abuse and neglect Child abuse Domestic violence Elder abuse Sexual abuse Anxiety disorders Generalized anxiety disorder Panic disorder Phobias Bipolar and related disorders Depressive disorders Major depressive disorder Persistent depressive disorder (dysthymia) Premenstrual dysphoric disorder Suicidal/homicidal behaviors Disruptive, impulse-control, and conduct disorders Conduct disorder Dissociative disorders Feeding and eating disorders Human sexuality Obsessive-compulsive and related disorders Neurodevelopmental disorders Attention-deficit/hyperactivity disorder Autism spectrum disorder Personality disorders Schizophrenia spectrum and other psychotic disorders Sleep-wake disorders Narcolepsy Parasomnias Somatic symptom and related disorders Substance-related and addictive disorders Trauma- and stressor-related disorders Adjustment disorders Post-traumatic stress disorder PANCE Content Blueprint – effective January 2019 Page 12 of 20 Pulmonary System (10%) Chronic obstructive pulmonary diseases Chronic bronchitis Emphysema Infectious disorders Acute bronchiolitis Acute bronchitis Acute epiglottitis Croup Influenza Pertussis Pneumonias o Bacterial o Fungal o HIV-related o Viral Respiratory syncytial virus infection Tuberculosis Neoplasms Carcinoid tumors Lung cancer Pulmonary nodules Pleural diseases Pleural effusion Pneumothorax Pulmonary circulation Cor pulmonale Pulmonary embolism Pulmonary hypertension Restrictive pulmonary diseases Idiopathic pulmonary fibrosis Pneumoconiosis Sarcoidosis Sleep apnea/Obesity hypoventilation syndrome Other pulmonary disorders Acute respiratory distress syndrome Asthma Cystic fibrosis Foreign body aspiration Hyaline membrane disease PANCE Content Blueprint – effective January 2019 Page 13 of 20 Renal System (5%) Acute disorders Glomerulonephritis Nephrotic syndrome Pyelonephritis Acute kidney injury (acute renal failure) Chronic kidney disease Congenital or structural renal disorders Horseshoe kidney Hydronephrosis Polycystic kidney disease Renal vascular disease End-stage renal disease Fluid and electrolyte disorders Acid-base disorders Dehydration Hyperkalemia/hypokalemia Hypervolemia Hyponatremia Neoplasms Renal cell carcinoma Wilms tumor PANCE Content Blueprint – effective January 2019 Page 14 of 20 Reproductive System (Male and Female) (7%) Breast disorders Menopause Abscess Fibroadenoma Menstrual disorders Fibrocystic changes Galactorrhea Neoplasms of the breast and reproductive tract Gynecomastia Benign Mastitis Malignant Cervical disorders Ovarian disorders Cervicitis Cysts Dysplasia Polycystic ovarian syndrome Torsion Complicated pregnancy Abortion Sexually transmitted infections/Pelvic inflammatory Abruptio placentae disease Breech presentation Cesarean delivery Trauma Cord prolapse Physical assault Dystocia Sexual assault Ectopic pregnancy Trauma in pregnancy Fetal distress Gestational diabetes Uncomplicated pregnancy Gestational trophoblastic disease Normal labor/delivery Hypertension disorders in pregnancy Postnatal/postpartum care Incompetent cervix Preconception/prenatal care Multiple gestation Uterine disorders Placenta previa Endometriosis Postpartum hemorrhage Leiomyoma Premature rupture of membranes Prolapse Rh incompatibility Shoulder dystocia Vaginal/vulvar disorders Cystocele Contraceptive methods Prolapse Human sexuality Rectocele Vaginitis Infertility PANCE Content Blueprint – effective January 2019 Page 15 of 20  Task Categories History Taking and Performing Physical Examination (17%) Knowledge of: General physical examination components and techniques Pertinent historical information Risk factors for development of significant medical conditions Significant physical examination findings Signs and symptoms of significant medical conditions Skill in: Conducting comprehensive and/or problem-based interviews and physical examinations Eliciting patient information from other sources Identifying conditions requiring referral to or consultation with specialists Identifying pertinent patient and family historical information from patients and caregivers Identifying pertinent physical examination information Triaging of patients based on recognition of abnormal vital signs, examination findings, and/or general observations Using Diagnostic and Laboratory Studies (12%) Knowledge of: Appropriate patient education relating to diagnostic and laboratory studies Indications for initial and subsequent diagnostic and laboratory studies Indications for preventive screening tests Risks associated with diagnostic and laboratory studies Skill in: Collecting diagnostic and laboratory specimens Communicating risks, benefits, and results effectively to other members of the health care team Communicating risks, benefits, and results effectively to patients, families, and caregivers Reviewing and interpreting results of diagnostic and laboratory studies, and correlating the results with history and physical examination findings Selecting appropriate diagnostic and/or laboratory studies Using diagnostic equipment safely and appropriately Formulating Most Likely Diagnosis (18%) Knowledge of: Significance of diagnostic and laboratory studies as they relate to diagnosis Significance of history as it relates to the differential diagnosis Significance of physical examination findings as they relate to diagnosis Skill in: Developing multiple differential diagnoses for complicated and/or multisystem cases Formulating most likely differential diagnoses Incorporating history, physical examination findings, and diagnostic data into medical decision-making Recognizing the need for referral to a specialist Selecting the most likely diagnosis in light of presented data PANCE Content Blueprint – effective January 2019 Page 16 of 20 Managing Patients - Health Maintenance, Patient Education, and Preventive Measures (10%) Knowledge of: Appropriate patient education regarding preventable conditions and lifestyle modifications Early detection and prevention of medical conditions Effects of aging and changing family roles Genetic testing and counseling Human growth and development Human sexuality and gender identity, gender transition, and associated medical issues Immunization schedules and recommendations for infants, children, adults, and foreign travelers/adoptions Impact of patient demographics on risks for medical conditions Prevention of communicable diseases Preventive screening recommendations Psychosocial effects of illness, stress, and injury as well as related healthy coping strategies Signs of abuse and neglect Skill in: Adapting health maintenance to an individual patient’s context Communicating effectively with and educating patients, family members, and caregivers regarding medical conditions Conducting education on modifiable risk factors with an emphasis on primary and secondary prevention Using counseling techniques Managing Patients - Clinical Intervention (14%) Knowledge of: Clinical procedures and their indications, contraindications, complications, risks, benefits, and techniques Conditions that constitute medical emergencies Criteria for admission to or discharge from the hospital or other facilities Management, treatment, and follow-up of medical conditions Palliative care and end-of-life issues Roles of other health professionals Sterile technique Therapeutic regimens Universal precautions and special isolation conditions Skill in: Demonstrating technical expertise related to performing specific procedures Evaluating patient response to treatment/intervention Facilitating patient/caregiver adherence to and active participation in treatment Formulating and implementing treatment plans in accordance with applicable practice guidelines Interfacing in multidisciplinary teams, including education of other health care professionals Making appropriate dispositions Monitoring and managing nutritional status Prioritizing tasks Recognizing and initiating treatment for life-threatening conditions Using community resources to meet the needs of patients/caregivers PANCE Content Blueprint – effective January 2019 Page 17 of 20 Managing Patients - Pharmaceutical Therapeutics (14%) Knowledge of: Adverse effects, reactions, and toxicities Common alternative/complementary therapies and their interactions and toxicities Contraindications Drug interactions, including presentation and treatment Indications for use Mechanism of action Methods to reduce medication errors Monitoring and follow-up of pharmacologic regimens Presentation and treatment of allergic reactions Regulation of controlled substances Special populations requiring drug/dose modification Substances of abuse Skill in: Assessing patient adherence to drug regimens Drafting a prescription Evaluating, treating, and reporting adverse drug reactions and/or adverse effects Identifying and managing medication misuse Interacting with pharmacists to address medication issues Maintaining knowledge of relevant pharmacologic agents Monitoring pharmacologic regimens and adjusting as appropriate Prescribing controlled substances appropriately Selecting appropriate pharmacologic therapy and dosing Applying Basic Scientific Concepts (10%) Knowledge of: Basic biochemistry Basic genetics Human anatomy and physiology Microbiology Pathophysiology and immunology Skill in: Evaluating emerging medical trends critically as they relate to patient care Maintaining awareness of trends in infectious disease Relating pathophysiologic principles to specific disease processes PANCE Content Blueprint – effective January 2019 Page 18 of 20 Professional Practice (5%) Legal/medical ethics Knowledge of: Cultural and religious beliefs related to health care Informed consent and refusal process Living will, advance directives, organ donation, code status, do not resuscitate, do not intubate, medical power of attorney, etc. Medicolegal issues Patient/provider rights and responsibilities Privacy, security, and responsibility related to medical record documentation and management Skill in: Caring for patients with cognitive impairment Medical informatics Knowledge of: Billing/coding to maintain accuracy and completeness for reimbursement and administrative purposes Skill in: Demonstrating appropriate medical record documentation Using appropriate medical informatics sources Patient care and communication (individual patients) Knowledge of: Affordable and effective health care that is patient specific Cultural and religious diversity Stewardship of patient and community resources Skill in: Acknowledging and applying patient/provider rights and responsibilities Ensuring patient satisfaction Providing patient advice and education regarding the informed consent and refusal process Providing patient advice and education related to end-of-life decisions Physician/PA relationship Knowledge of: Professional and clinical limitations, scope of practice, etc. Supervision parameters: malpractice, mandated reporting, conflict of interest, impaired provider, ethical principles Skill in: Communicating and consulting with the supervising physician and/or other specialists/consultants PANCE Content Blueprint – effective January 2019 Page 19 of 20 Professional development Knowledge of: Continuing medical education resources Skill in: Critically analyzing evidence-based medicine Identifying and interpreting data from medical informatics sources and identifying appropriate reference sources Using epidemiologic techniques to evaluate the spread of disease Public health (population/society) Knowledge of: Basic disaster preparedness Infection control measures and response to outbreaks Occupational health issues as they pertain to health care as well as non–health care workers Population health, travel health, and epidemiology of disease states Skill in: Protecting vulnerable populations and recognizing disparities in provision of and access to health care Risk management Knowledge of: Quality improvement and patient safety Resource stewardship Skill in: Ensuring patient safety and avoiding medical errors PANCE Content Blueprint – effective January 2019 Page 20 of 20