Physician Assistant National Certifying Examination (PANCE) Reproductive System and Women's Health Syllabus

Reproductive System and Women's Health syllabus — full chapter and topic list

Expand any chapter to see its topics and sub-topics. This is the whole examinable outline for Reproductive System and Women's Health in Physician Assistant National Certifying Examination (PANCE), not a summary of it.

1. 1

   Menstrual and Gynecologic Disorders

   4 topics

   • Abnormal uterine bleeding
   • Amenorrhea and dysmenorrhea
   • Endometriosis and adenomyosis
   • PCOS and menopause
2. 2

   Pelvic and Reproductive Pathology

   4 topics

   • Uterine fibroids and polyps
   • Ovarian cysts and cancer
   • Cervical dysplasia and cancer
     • Pap smear and HPV screening
   • Pelvic inflammatory disease
3. 3

   Obstetrics and Prenatal Care

   5 topics

   • Normal pregnancy and prenatal screening
   • Hypertensive disorders of pregnancy
     • Preeclampsia and eclampsia
   • Gestational diabetes
   • Ectopic pregnancy and spontaneous abortion
   • Labor, delivery, and postpartum complications
4. 4

   Breast and Sexual Health

   4 topics

   • Breast disorders and breast cancer
     • Mammography screening guidelines
   • Contraception methods
   • Sexually transmitted infections
   • Infertility evaluation

Reproductive System and Women's Health flashcards for Physician Assistant National Certifying Examination (PANCE)

21 of 52 cards from the Reproductive System and Women's Health deck — real questions with worked answers.

1. What is the PALM-COEIN classification system used for, and what do the two halves represent?

   It classifies causes of abnormal uterine bleeding (AUB) in nonpregnant reproductive-age women. PALM = structural causes (Polyp, Adenomyosis, Leiomyoma, Malignancy/hyperplasia); COEIN = nonstructural causes (Coagulopathy, Ovulatory dysfunction, Endometrial, Iatrogenic, Not otherwise classified).

2. In a woman over 45 (or younger with risk factors) presenting with abnormal uterine bleeding, what is the key test to rule out malignancy?

   Endometrial biopsy to exclude endometrial hyperplasia or carcinoma. Transvaginal ultrasound (assessing endometrial thickness) is often the initial imaging.

3. Define primary versus secondary amenorrhea.

   Primary amenorrhea: no menses by age 15 with normal secondary sexual characteristics (or by 13 with no secondary characteristics). Secondary amenorrhea: absence of menses for $\geq 3$ months in a previously regular woman, or $\geq 6$ months if previously oligomenorrheic.

4. What is the single most common cause of secondary amenorrhea, and what is the first test to order?

   Pregnancy is the most common cause. The first test is a urine or serum $\beta$-hCG.

5. What distinguishes primary from secondary dysmenorrhea?

   Primary dysmenorrhea is painful menses without underlying pathology, caused by excess prostaglandins (PGF2$\alpha$); it typically begins in adolescence. Secondary dysmenorrhea results from pelvic pathology (e.g., endometriosis, fibroids, adenomyosis, PID) and usually appears later in life.

6. What is the first-line treatment for primary dysmenorrhea?

   NSAIDs (prostaglandin synthesis inhibitors), with combined hormonal contraceptives as an effective second option.

7. Define endometriosis and name its classic symptom triad.

   Endometriosis is the presence of functional endometrial tissue outside the uterine cavity. Classic triad: dysmenorrhea, dyspareunia, and infertility (often with chronic pelvic pain).

8. What is the gold-standard method for definitively diagnosing endometriosis?

   Laparoscopy with visualization and biopsy of lesions (classic 'powder-burn' implants or chocolate cyst/endometrioma on the ovary).

9. How does adenomyosis differ from endometriosis, and what is its classic presentation?

   Adenomyosis is endometrial glands within the myometrium (uterine wall). It classically presents in multiparous women over 35 with menorrhagia, dysmenorrhea, and a diffusely enlarged, boggy, tender uterus.

10. What are the Rotterdam criteria for diagnosing polycystic ovary syndrome (PCOS)?

    At least 2 of 3: (1) oligo-/anovulation, (2) clinical or biochemical hyperandrogenism, (3) polycystic ovaries on ultrasound ($\geq 12$ follicles or ovarian volume $> 10$ mL), after excluding other causes.

11. What is the first-line medication to induce ovulation for fertility in a woman with PCOS?

    Letrozole (an aromatase inhibitor) is now first-line; clomiphene citrate is an alternative. Metformin helps with insulin resistance.

12. How is menopause defined clinically, and what hormonal change confirms it?

    Menopause is 12 consecutive months of amenorrhea due to loss of ovarian follicular activity (mean age ~51). It is confirmed by an elevated FSH (typically $> 30$ mIU/mL) with low estradiol.

13. What are the main long-term health risks of estrogen deficiency after menopause?

    Osteoporosis (accelerated bone loss), increased cardiovascular disease risk, and genitourinary syndrome of menopause (vaginal atrophy, dyspareunia, urinary symptoms).

14. What is the most common benign solid tumor of the uterus, and from what tissue does it arise?

    Uterine leiomyoma (fibroid), arising from smooth muscle of the myometrium. It is estrogen-sensitive and tends to regress after menopause.

15. How do submucosal versus subserosal uterine fibroids differ in their clinical effects?

    Submucosal fibroids (projecting into the endometrial cavity) most often cause heavy menstrual bleeding and infertility. Subserosal fibroids (projecting outward) more often cause bulk/pressure symptoms on adjacent organs.

16. What is the most common cause of postmenopausal intermenstrual bleeding from an endometrial source, and how is it characterized?

    Endometrial polyps — focal overgrowths of endometrial glands/stroma that commonly cause intermenstrual or postmenopausal bleeding; usually benign but may harbor malignancy and are diagnosed/removed by hysteroscopy.

17. What is the most common type of benign ovarian cyst in reproductive-age women, and how is it typically managed?

    Functional (follicular or corpus luteum) cysts. Most are asymptomatic and resolve spontaneously within 1–2 menstrual cycles; observation with repeat ultrasound is usual management.

18. What classic triad suggests ovarian torsion, and what is the diagnostic imaging study?

    Sudden severe unilateral pelvic pain, a palpable adnexal mass, and nausea/vomiting. Doppler transvaginal ultrasound (showing decreased/absent ovarian blood flow) is the imaging study; it is a surgical emergency.

19. What is the most common type of ovarian cancer, and which tumor marker is used to monitor it?

    Epithelial ovarian carcinoma (most commonly serous type) is the most common ovarian cancer. CA-125 is used for monitoring (most useful in postmenopausal women, as it is nonspecific in premenopausal women).

20. Why does ovarian cancer typically present at an advanced stage, and what are common late symptoms?

    There is no effective screening and early disease is asymptomatic. Late symptoms include abdominal bloating/distension, early satiety, pelvic pain, and an adnexal mass; ascites is common at presentation.

21. Which virus causes the majority of cervical dysplasia and cervical cancer, and which serotypes are highest-risk?

    Human papillomavirus (HPV); high-risk types 16 and 18 cause about 70% of cervical cancers.

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