New PANCE Blueprint 2025: How to Prepare for the Updated Exam

The PANCE Blueprint, a.k.a. the true North for PA school students and those preparing for the PANCE exam, is the holy grail of PANCE preparation documents. In essence, if you know the topics on the blueprint, you will be well prepared for exam day.

Over the years, the PANCE blueprint has evolved, reflecting advancements in medical education and practice. The current blueprint, which has been in effect since 2019, will remain valid until December 2024. If you’re taking the PANCE before this date, you'll follow the 2019-2024 blueprint. However, for those graduating after January 2025, the updated 2025 blueprint will be your guide.

PANCE Blueprint History

• Initial Blueprint: The original blueprint was established when the PANCE was first introduced.
• 1997 Update: Comprehensive revision to reflect changes in medical education and practice.
  • Milestone - In 1999, the PANCE was administered for the first time as a computerized-based test at multiple sites nationwide!
• 2004 Update: Further adjustments and updates to content areas.
  • Milestone: In 2011, the recertification cycle was extended from six to ten years, with a rolling implementation that began in 2014 and completed the transition in 2020.
• 2012 Update: Significant changes were made to reflect the evolving practice of medicine. NCCPA certifies its 100,000th PA.
• 2019 Update: This is the latest major update (effective through December 2024), which includes new categories and content reorganization.
  • Milestone: In 2019, two distinct content blueprints for PANCE and PANRE have begun utilization.
• 2025 Update: Scheduled to become effective in 2025, this update will incorporate minor revisions based on the most recent practice analysis studies.

What's New on the New 2025 PANCE Blueprint

Here at Smarty PANCE, we take updates to the blueprint seriously. Given that Smarty PANCE is built on the blueprint topics, we want to ensure you have all the necessary resources to prepare effectively: Every topic covered, with nothing less and nothing more!

The good news is that the 2025 update sees mostly minor changes, many of which are organizational, along with some new topics.

In this blog post, I will cover the new content blueprint percentages for both the medical content and topic categories, then detail all the changes taking place within each organ system.

Rest assured, we have been actively updating Smarty PANCE to cover every new topic. These new additions will be hyperlinked on our main PANCE blueprint page and within the organ system courses.

2019-2024 and 2025 PANCE Blueprint Medical Content Categories Comparison

2019-2024 PANCE Blueprint (ordered by percentage)	2025 Blueprint (ordered by percentage)
There are 14 organ systems » with 121 sections and 23 subsections (within each organ system) » and approximately 616 diseases/disorders ​Cardiology 13%​  » 10 sections » 2 subsections » 49 disorders ​Pulmonary 10%​ » 7 sections » 31 disorders ​GI and Nutrition 9%​ » 11 sections » 46 disorders ​Musculoskeletal 8%​ » 8 sections » 98 disorders ​EENT 7%​ » 4 sections »  17 subsections » 65 disorders ​Reproductive 7%​ » 11 sections » 51 disorders ​Neurology 7%​ » 10 sections » 34 disorders ​Endocrinology 7%​ » 6 sections » 19 disorders ​Infectious Disease 6%​ » 7 sections » 44 disorders ​Psychiatry/Behavioral Science 6%​ » 15 sections » 67 disorders ​Genitourinary 5%​ » 8 sections » 27 disorders ​Renal 5%​ » 4 sections » 17 disorders ​Dermatology 5%​ » 13 sections » 4 subsections » 52 disorders ​Hematology 5%​ » 7 sections » 16 disorders	There are 14 organ systems » with 110 sections and 25 subsections (within each organ system) » and approximately 681 diseases/disorders Cardiology 11%​ » 10 sections » 2 subsections » 60 disorders ​Pulmonary 9%​ » 5 sections » 32 disorders ​GI and Nutrition 8%​ » 10 sections » 55 disorders ​Musculoskeletal 8%​ » 8 sections » 98 disorders Infectious Disease 7%​ » 7 sections » 54 disorders ​Reproductive 7%​ » 8 sections » 52 disorders ​Neurology 7%​ » 11 sections » 41 disorders ​Psychiatry/Behavioral Science 7%​ » 15 sections » 67 disorders ​EENT 6%​ » 3 sections  » 19 subsections » 73 disorders ​Endocrinology 6%​ » 6 sections » 24 disorders ​Renal 5%​ » 3 sections » 23 disorders ​Hematology 5%​ » 5 sections » 18 disorders Dermatology 4%​ » 12 sections » 4 subsections » 56 disorders ​Genitourinary 4%​ » 7 sections » 28 disorders

Cardiology, Pulmonary, GI and Nutrition, and Musculoskeletal continue to comprise the lion's share of the PANCE exam (40% and 36%, respectively). Mastering these areas can significantly boost your overall performance!

Medical Content Categories	Percentage (2019-2024)	Percentage (2025)
Cardiovascular System	13%	11%
Dermatologic System	5%	4%
Endocrine System	7%	6%
Eyes, Ears, Nose, and Throat	7%	6%
Gastrointestinal System/Nutrition	9%	8%
Genitourinary System (Male and Female)	5%	4%
Hematologic System	5%	5%
Infectious Diseases	6%	7%
Musculoskeletal System	8%	8%
Neurologic System	7%	7%
Psychiatry/Behavioral Science	6%	7%
Pulmonary System	10%	9%
Renal System	5%	5%
Reproductive System (Male and Female)	7%	7%
Professional Practice	5%	6%
		👉 2025 Blueprint (click here)

2019 and 2025 PANCE Blueprint Task Category Comparison

Medical content comprises 95% of the 2019-2024 blueprint and 94% of the new 2025 blueprint. All medical content questions are also coded to one of the following task areas, with the exception of the Professional Practice category. Questions related to professional practice issues comprise 5% and 6%, respectively.

In the 2019-2024 blueprint, 20% of the exam was related to general surgical topics. In the new 2025 Blueprint, a percentage has been allocated to pediatrics. Some questions on the exam will cover surgical topics (8% to 10%), and some will focus on conditions in pediatric patients (12% to 15%). The specific percentage allocations may vary slightly on exams.

Task Categories	Percentage 2019-2024	Percent 2025
History Taking and Performing Physical Examination	17%	16%
Using Diagnostic and Laboratory Studies	12%	10%
Formulating Most Likely Diagnosis	18%	18%
Managing Patients
Health Maintenance, Patient Education, and Preventive Measures	10%	11%
Clinical Intervention	14%	16%
Pharmaceutical Therapeutics	14%	15%
Applying Basic Scientific Concepts	10%	8%
Professional Practice	5%	6%

Medical Content Category Updates for the New 2025 PANCE Blueprint

Here is a detailed look at all the updates new to the 2025 PANCE Blueprint. We have each blueprint hyperlinked to the corresponding disease/disorder on the Medical Content Category page. Here you can see a detailed comparison and access the content for the version of the blueprint you will be tested on.

We are actively updating Smarty PANCE to reflect the upcoming changes. Topics that don't contain links are being updated and added weekly including new test questions and flashcard sets. We will be releasing new exams to cover all the new topics in the forthcoming 2025 blueprint.

PANCE Cardiovascular System Blueprint Updates for 2025

Here is a summary of the new additions/updates to the PANCE Cardiovascular System Blueprint that will take effect in 2025.

The percentage has decreased from 13% → 11% Cardiomyopathy now includes a new topic of stress cardiomyopathy Under the category of conduction disorders/dysrhythmias Atrial flutter has finally separated from its friend, atrial fibrillation, and become its own topic (Yay, atrial flutter!) New topics include Atrial tachycardia Bradycardia Idioventricular rhythm Junctional rhythms Premature contractions QT prolongation Unser congenital heart disease New topic of Patent foramen ovale Transposition of great vessels Under coronary artery disease New topic of acute coronary syndrome and atherosclerosis Removed prinzmetal variant and stable angina

Essential hypertension has been reclassified as primary hypertension Cardiogenic shock has been removed from the category of hypotension and given its own category now with four shock subtypes: Cardiogenic Distributive Hypovolemic Obstructive Under traumatic, infectious, and inflammatory heart conditions: No longer acute and subacute bacterial endocarditis but now simply infective endocarditis New topic of myocarditis Under the category of vascular disease, venous thrombosis is now deep venous thrombosis

PANCE Dermatology Blueprint Updates for 2025

Here is a summary of the new additions/updates to the PANCE Dermatology Blueprint that will take effect in 2025.

The percentage has decreased from 5% → 4% Acneiform eruptions → New topic of perioral dermatitis Diseases/disorders of the hair and nails → New topic of felon Atopic dermatitis and seborrheic dermatitis have been added to the category of papulosquamous disorders Vascular abnormalities → New topic of hemangioma and purpura. Stasis dermatitis has been moved here from skin integrity

PANCE Endocrine System Blueprint Updates for 2025

Here is a summary of the new additions/updates to the PANCE Endocrine System Blueprint that will take effect in 2025.

The percentage has decreased from 7% → 6% Adrenal disorders → New topic of pheochromocytoma (previously covered as part of adrenal neoplastic disease) Metabolic syndrome has its own category in the endocrinology blueprint → previously partnered with obesity in the GI Blueprint SIADH → has been relocated from neoplasms to the category of pituitary disorders Pituitary disorders → New topic of prolactinoma and Cushing disease Thyroid disorders → New topic of goiter and thyroid nodules

PANCE EENT Blueprint Updates for 2025

Here is a summary of the new additions/updates to the PANCE EENT System Blueprint that will take effect in 2025.

The percentage has decreased from 7% → 6% Scleritis has been moved to a new category of inflammatory eye disorders, along with the creation of two new topics, iritis, and uveitis, in this category New topics of dacryostenosis and keratoconjunctivitis sicca under lacrimal disorders New topic of periorbital cellulitis under orbital disorders Removal of vascular disorders as a category replaced by the topic of retinal vascular occlusion New topic of presbyopia Removal of trauma from the category of external ear disorders New topic of otosclerosis was added to the middle ear The category of hearing impairment has been updated with two new subtopics of conductive and sensorineural hearing loss Barotrauma moved from inner ear disorders to trauma of the eyes, ears, nose, and throat Oropharyngeal disorders see the addition of dental abscesses, dental caries, and gingivitis. Angioedema has been relocated to his category

PANCE GI and Nutrition Blueprint Updates for 2025

Here is a summary of the new additions/updates to the PANCE GI/Nutrition Content Blueprint that will take effect in 2025.

GI system percentage reduced from 9% → 8% Colorectal disorders New section on fecal incontinence New section on ileus The topic of rectocele moved from OBGYN and reclassified as rectal prolapse Esophageal disorders New lesson on Zenker diverticulum New lesson on gastroparesis New PANCE section on gastrointestinal bleeding Hepatic disorders New section on Fatty liver (is part of PANRE) New section on Portal hypertension

New section on Hyperemesis Metabolic disorders Removal of G6PD deficiency Relocation of Paget disease to MSS blueprint The category of nutrition has been added → changed from nutrition and vitamin disorders Food allergies and food sensitivities moved to the new nutrition section along with the elimination of these three previously nested categories (Gluten intolerance, Lactose intolerance, and Nut allergies) New lesson on malabsorption New lesson on refeeding syndrome Obesity now has its own section (moved from Nutritional and vitamin disorders) Acute and chronic pancreatitis have been separated

PANCE Genitourinary System Blueprint Updates for 2025

Here is a summary of the new additions/updates to the PANCE Genitourinary System Blueprint that will take effect in 2025.

The percentage has decreased from 5% → 4% Prostate disorders have been removed, and BPH was moved to its own category Human sexuality has been removed from the GU blueprint. You will find it in the Reproductive System Blueprint and the Psychiatry Blueprint Infectious disorders → New topic of Fournier gangrene Penile disorders → New topic of priapism

PANCE Hematologic System Blueprint Updates for 2025

Here is a summary of the new additions/updates to the PANCE Hematologic System Blueprint that will take effect in 2025.

The percentage remains unchanged (5%) The category of hemoglobinopathies has been removed, and a new category of hereditary disorders has been added New topic of G6PD deficiency Immunologic disorders → moved the subcategory of transfusion reactions to its own topic

PANCE Infectious Diseases Blueprint Updates for 2025

Here is a summary of the new additions/updates to the PANCE Infectious Diseases System Blueprint that will take effect in 2025.

Increased percentage from 6% → 7% Bacterial diseases → New topics of Bartonella, Chancroid, and C Diff infections Fungal diseases → New topics of Blastomycosis and Coccidioidomycosis Parasitic diseases → New topics of Amebiasis and Giardiasis Prenatal transmission of disorders → New topic of Group B Streptococcus New category of Prion disease Viral diseases → New topic of Polio

PANCE Musculoskeletal System Blueprint Updates for 2025

Here is a summary of the new additions/updates to the PANCE Musculoskeletal System Blueprint that will take effect in 2025.

The MSS system percentage remains unchanged (8%) New topic of extensor mechanism injuries added to lower extremity disorders Paget disease of bone has been moved here (previously in GI and Nutrition) New topic of connective tissue diseases has been added to rheumatologic disorders Cauda equina syndrome has been moved to the neurology blueprint New topic of spondylolisthesis and spondylolysis added to spinal disorders Thoracic outlet syndrome has been moved to its own category

PANCE Neurologic System Blueprint Updates for 2025

Here is a summary of the new additions/updates to the PANCE Neurologic System Blueprint that will take effect in 2025.

The percentage remains unchanged at (7%) Vascular disorders have been renamed cerebrovascular disorders and moved to the beginning of the blueprint. Two new categories—coma and hydrocephalus (on the PANRE blueprint)—have been added Movement disorders → added two new categories: restless legs syndrome and tardive dyskinesia The category of "peripheral nerve disorders" has been changed to "nerve disorders," along with the removal of carpal tunnel syndrome and the addition of the topic of mononeuropathies Within the category of neurocognitive disorders → major/mild neurocognitive disorders have been replaced with "cognitive impairment" A new category of spinal cord syndromes has been created, covering three topics that are new to the neurologic system blueprint: Cauda equina syndrome (formerly part of the MSS system blueprint) Epidural abscess Spinal cord injuries

PANCE Psychiatry/Behavioral Science Blueprint Updates for 2025

Here is a summary of the new additions/updates to the PANCE Psychiatry/Behavioral Science Blueprint that will take effect in 2025.

The percentage has increased from 6% → 7% Abuse and neglect have been updated with new topics of intimate partner violence, physical abuse, and psychological abuse. Domestic abuse is now classified as intimate partner violence The subtopics of narcolepsy and parasomnias have been removed from the category of sleep-wake disorders Human sexuality now includes gender dysphoria Conduct disorder has been removed as a distinct subtopic of Disruptive, impulse-control, and conduct disorders New topic of Psychogenic nonepileptic seizure Bereavement (a topic included in the PANRE Blueprint) has now been added to the PANCE Blueprint

Pulmonary System Blueprint Updates for 2025

Here is a summary of the new additions/updates to the PANCE Pulmonary System Blueprint that will take effect in 2025.

The percentage has been reduced from 10% → 9% The category of "other pulmonary disorders' has been removed, and acute respiratory distress syndrome (ARDS), foreign body aspiration, and hyaline membrane disease are now their own categories New topic of empyema added to infectious disorders The category of neoplasms has been updated to the more general classification of benign and malignant, carcinoid tumors remains, and pulmonary nodules as a topic have been removed Sleep apnea/obesity hypoventilation syndrome has been broken into its two component parts, forming two separate topics Emphysema and chronic bronchitis no longer have separate categories and are under the singular topic of chronic obstructive pulmonary disease. Cystic fibrosis now resides in the category of obstructive pulmonary diseases Pleural effusion and pneumothorax have been removed as subtopics of pleural diseases New topic of pulmonary edema has been added to the category of pulmonary circulation

PANCE Renal System Blueprint Updates for 2025

Here is a summary of the new additions/updates to the PANCE Renal System Blueprint that will take effect in 2025.

The renal system has received some much-needed updates and reorganization for 2025! The percentage remains unchanged at (5%) Gone is the confusing category of "acute disorders," which included the somewhat redundant subtopics of nephrotic syndrome and glomerulonephritis Pyelonephritis has been moved to the GU System Blueprint under infectious disorders Acute kidney injury and acute renal failure are now better categorized as intrinsic, prerenal, and postrenal. The topics of glomerulonephritis and nephrotic syndrome will be covered as part of this topic The category of fluid and electrolyte disorders and its subtopics have been disassembled into two new topics: "electrolyte disorders" and "fluid imbalances." Gone are the separate topics of dehydration, hyperkalemia/hypokalemia, hypervolemia, and hyponatremia Renal vascular disease is now its own category New category of rhabdomyolysis

PANCE Reproductive System Blueprint Updates for 2025

Here is a summary of the new additions/updates to the PANCE Reproductive System Blueprint that will take effect in 2025.

The percentage remains unchanged at (7%) Removed (Male and Female) from the System title The topic of human sexuality now includes gender identity Pelvic inflammatory disease is no longer grouped with sexually transmitted infections Sexually transmitted infections have been removed from the PANCE blueprint. They are covered as individual topics in the infectious disease blueprint Pregnancy is a singular topic and is no longer divided into uncomplicated and complicated subtypes New topics within the category of pregnancy include: Postpartum pituitary disorders Postpartum psychiatric disorders Cervical insufficiency (previously "incompetent cervix") Prelabor rupture of membranes (previously "premature rupture of membranes") Umbilical cord prolapse (previously "cord prolapse) Trauma in pregnancy category updated with the addition of "psychological" trauma New topic of Bartholian gland cysts added to vaginal/vulvar disorders

Navigating the New NCCPA 2025 PANCE Blueprint for Success

As I mentioned at the beginning of this post, the NCCPA PANCE blueprint remains the most important document in your PANCE prep arsenal. The NCCPA test question writers create exam questions from the diseases and disorders in this document, and PA school administrators use this as the scaffolding from which to construct your course curriculum. By understanding the evolution and the upcoming changes in the 2025 blueprint, you can tailor your study strategies to ensure you are covering all the required topics.

While there have been some shifts in the weightage of various systems, many of the core areas have remained consistent. Here is a brief summary:

Systems with Unchanged Percentages

Certain systems have retained their importance and continue to hold the same percentage in the blueprint, emphasizing their critical role in PA education:

1. Musculoskeletal System: Remains at 8%, though the PANCE blueprint remains somewhat vague regarding covered materials. It is important to identify the high-yield topics in broad categories like "soft-tissue injuries" and "fractures/dislocations."
2. Neurologic System: Maintains a 7% focus
3. Renal System: Steady at 5%, but don't let that fool you. Renal used to be combined with GU. It's a category that includes heavy hitters and everyday exam topics such as the beloved Acid-Base Disorders! You will likely see questions from every disorder in this medical content category.
4. Hematologic System: It remains at 5%, and like the renal system above, it is a treasure trove of thorny subjects that has led to much hair pulling (see dermatology for more on hair loss 😀).

Systems with Changed Percentages

Several systems have seen changes in their percentage allocations, reflecting shifts in medical education priorities and practice:

1. Cardiovascular System: Decreased from 13% to 11%, yet remains the highest single system.
2. Pulmonary System: Reduced from 10% to 9%, still a significant portion due to the prevalence of respiratory conditions.
3. Gastrointestinal System/Nutrition: Slightly decreased from 9% to 8% with only minor changes in the blueprint.
4. Dermatologic System: Decreased from 5% to 4%, yet (like others on this list) saw an increase in the number of covered disorders.
5. Endocrine System: Reduced from 7% to 6%
6. Infectious Diseases: Increased from 6% to 7%, highlighting the growing importance of infectious disease management in contemporary healthcare.
7. Psychiatry/Behavioral Science: Increased from 6% to 7%, recognizing the rising importance of mental health in overall patient care.
8. Professional Practice: Increased from 5% to 6%, emphasizing the need for proficiency in professional and ethical standards.

Systems with High Disorder Counts but Lower Percentages

It's also essential to note that some organ systems have numerous disorders to master despite having a lower percentage allocation. This indicates the complexity and breadth of these systems:

1. Musculoskeletal System: Although it remains at 8%, it encompasses 98 disorders, reflecting its broad scope.
2. Psychiatry/Behavioral Science: Maintains a 7% focus but includes 67 disorders, underscoring the diversity within mental health.
3. EENT (Eyes, Ears, Nose, and Throat): With only a 6% allocation, it covers 73 disorders, indicating a wide range of conditions that you must be familiar with.
4. Dermatology: Even though its percentage is reduced to 4%, it includes 56 disorders, showing the extensive nature of skin-related conditions.

Enhancing Your PANCE Preparation

At Smarty PANCE, we are committed to providing the most current and relevant resources to help you excel. Our updates reflect the latest blueprint changes, ensuring that you have access to everything you need to succeed. Whether it's mastering the cardiovascular system or staying updated on new infectious disease topics, our resources are designed to cover every aspect of the blueprint.

Additional Insights

• Test-Taking Strategies: Beyond content knowledge, effective test-taking strategies are essential. Utilize resources that help you develop these skills, as they can significantly enhance your performance.
• Interactive Learning: Engage with interactive materials such as quizzes, flashcards, and practice exams. These tools can help reinforce knowledge and improve recall.
• Community Support: Leverage community support, study groups, and online forums. Sharing experiences and tips with peers can provide valuable insights and motivation.

Incorporate these insights into your study plan. Focus on high-yield areas and practice with updated materials. By doing so, you will be well-equipped to tackle the PANCE and embark on a successful career as a PA. Keep pushing forward, stay diligent in your studies, and trust in your preparation. You've got this!

For more detailed comparisons and updates, explore our interactive blueprints, Trello Boards, and resources linked throughout this post. And remember, the Smarty PANCE Community is here to support you every step of the way—feel free to share your experiences and questions as you navigate your PANCE preparation journey​​​​​.