A pregnant woman at 28 weeks says she fell. She has bruises of different ages on her abdomen, and her partner answers every question for her. Four days after delivery, a new mom cries easily but is still caring for her baby. A week after delivery, another mother says her baby is evil.

Each of these is a classic PANCE setup, and each one has a wrong answer that sounds reasonable.

In Episode 177, we cover trauma in pregnancy and postpartum psychiatric disorders, including:

• Why a minor fall still matters, and how long you watch the baby afterward
• Getting the imaging the mother needs, and how much radiation actually worries you
• What to do when a pregnant patient is hypotensive lying flat on her back
• The red flags for abuse, and how to ask about it
• Postpartum blues vs postpartum depression: the timeline that separates them
• Which SSRI to pick for a breastfeeding mother
• Postpartum psychosis: the strongest risk factor, and why an SSRI alone is the wrong move

The study strategy for this episode: get into the sun. About 10 minutes of bright light early in the morning, and more later in the day, sets your body clock. Better sleep is one of the biggest things you can do for your studying.

Visit physicianassistantexamreview.com/177 for the episode notes.

Coming in November: a free Master Class on getting the most out of the question bank you already have, Nov 10 and 12. Register at physicianassistantexamreview.com/masterclass.

Think different. Work different. Score different.

A new mom is bleeding heavily minutes after delivery, and her uterus feels soft and boggy above the umbilicus. Six weeks later, another mother still can't breastfeed and her period hasn't come back. Two days after a C-section, a third has a fever, a tender uterus, and foul-smelling lochia.

Each of these is a classic PANCE setup, and each one has a wrong answer that sounds reasonable.

In Episode 176, we cover postpartum complications, including:

• What counts as postpartum hemorrhage, and why blood pressure is a late sign
• The 4 T's: tone, trauma, tissue, and thrombin
• Placenta accreta vs placenta previa, and why they get mixed up
• The first steps for hemorrhage, and how to pick a second-line uterotonic by what the patient can't take
• Where tranexamic acid fits, and its time window
• Sheehan syndrome: the hormones that drop and the order you replace them
• Postpartum endometritis: the risk factors, the antibiotic of choice, and what to do when the fever won't break

The study strategy for this episode: go back to material you've already covered. Pull a few cards from an old pile, or reread one section from a month ago. A little, often, is how you interrupt the forgetting curve.

Visit physicianassistantexamreview.com/176 for the episode notes.

The December 33 Days cohort is coming soon. Join the waitlist at physicianassistantexamreview.com/33.

Think different. Work different. Score different.

A breastfeeding mom asks for contraception at her two-week postpartum visit. A patient with gestational diabetes returns six weeks after delivery. A new mother on postpartum day six has a severe headache and blood pressure of 164/112.

These cases contain the common wrong answers that sound reasonable but can cost you points on the PANCE.

In Episode 175, we cover postpartum contraception and follow-up, including:

• The three requirements for the lactational amenorrhea method
• When progestin-only contraception can be started
• The day 21 rule for estrogen-containing contraception
• When breastfeeding changes the timing
• IUD placement after delivery
• RhoGAM, MMR, varicella, and Tdap before discharge
• Follow-up after gestational diabetes and why the 2-hour glucose tolerance test beats hemoglobin A1C
• Postpartum hypertension, preeclampsia, and magnesium sulfate
• Blood pressure medications compatible with breastfeeding
• Why the recommended interpregnancy interval is 18 months

The study strategy for this episode is simple: for every topic, identify the trap before you see the answer choices. Ask yourself, "What would sound reasonable but be wrong here?"

Visit physicianassistantexamreview.com/175 for the episode notes.

The December 33 Days cohort is coming soon. Join the waitlist at physicianassistantexamreview.com/33.

Think different. Work different. Score different.

Fifteen PANCE-style questions, mixed systems, the way the exam mixes them. Pause after each one, say your answer out loud, then check yourself. Keep count.

This is Rapid Rounds, a short set of practice questions between the regular episodes of the Physician Assistant Exam Review Podcast. About 16 minutes.

What's in this one:

• A firefighter with a pulse ox of 99% who isn't fine
• The toddler who won't use the arm after being pulled up by the wrist
• Chest pain that gets better leaning forward
• Resistant hypertension with a potassium of 2.9
• Back pain, saddle anesthesia, and urinary retention
• A platelet count that drops by half on day 5 of heparin
• Blisters that shear off with a little pressure
• The worst headache of her life and a negative head CT
• Restlessness three days after starting risperidone
• A sodium of 125 on an SSRI
• Abdominal pain out of proportion to the exam in a patient with AFib
• Milky nipple discharge and a prolactin of 95
• A rusty nail in an unvaccinated patient
• Sudden painless vision loss with hemorrhages in all four quadrants
• A new apical murmur a few days after an inferior MI

Every question comes out of the new edition of The Final Step.

It's PA Week, and I'm giving away a seat in 33 Days, a Stop Guessing Session with me, and the new Final Step before anyone can buy it. Enter by Friday night: https://physicianassistantexamreview.com/giveaway

Full episode notes: https://physicianassistantexamreview.com/rapid-rounds-01/

Think different. Work different. Score different.

A white count of 20,000 the day after delivery. A temperature of 38 in the first 24 hours. Cramping every time she breastfeeds. Each one looks like trouble, and each one is normal. In this episode of the Physician Assistant Exam Review Podcast, we cover the six weeks after delivery when nothing is going wrong, who shouldn't breastfeed, and how to tell engorgement from mastitis.

Five priming questions open the episode. Sit with them while you listen, then check yourself at the end.

What's covered:

• Uterine involution: where the fundus sits after delivery and how fast it comes down
• Afterpains, and why breastfeeding makes them worse
• Lochia: red to pink-brown to yellow-white, and the foul odor plus fever that means endometritis
• Postpartum diuresis and the hypercoagulable weeks after delivery
• The 24-hour line for fever, and the white count that's normal
• Pain control, perineal care, and early ambulation
• Prolactin vs oxytocin, colostrum, and vitamin D for the breastfed infant
• Sheehan syndrome: when the first sign is a mother who can't make milk
• Who shouldn't breastfeed, and the infections that don't stop it
• Engorgement vs mastitis vs breast abscess
• Why she keeps breastfeeding through mastitis

Study tip in this episode: win the day. Decide the minimum you're going to get done today, then get it done. Stack those days and you won't need to cram on the weekend.

It's PA Week, and I'm giving away a seat in 33 Days, a Stop Guessing Session with me, and The Final Step 3.0 before anyone can buy it. Enter by Friday: https://physicianassistantexamreview.com/giveaway

Full episode notes: https://physicianassistantexamreview.com/174

Think different. Work different. Score different.

The water breaks at 30 weeks with no infection: you buy time. At 34 weeks: you deliver. A breech baby at 37 weeks gets turned, and twins get delivered on a schedule set by how many placentas they share. In this episode of the Physician Assistant Exam Review Podcast, we cover the setups that change the delivery plan before labor even starts, and the one number that decides each one.

Five priming questions open the episode. Sit with them while you listen, then check yourself at the end.

What's covered:

• PROM vs PPROM: premature means before labor, not before term
• Risk factors for ruptured membranes, and the look-alikes that fool people
• The sterile speculum exam: pooling, nitrazine, ferning, and why nobody puts a finger in
• 34 weeks is the line: deliver after, steroids and antibiotics before
• Magnesium under 32 weeks, and why it's not a tocolytic
• Chorioamnionitis: the diagnosis, ampicillin plus gentamicin, and why you still deliver
• Frank, complete and footling breech, and which one sets up cord prolapse
• External cephalic version at 37 weeks, and when you never try it
• Chorionicity: why the number of placentas drives the risk
• The lambda sign and the T sign
• Twin-twin transfusion syndrome: the donor twin vs the recipient twin
• Delivery timing and route for twins, and why twin A decides

Study tip in this episode: you can't study everything, and trying to is a fool's game. Some things are more important to learn than other things. Decide what you're going to study.

The new edition of The Final Step is coming at the end of October: 2,000 questions, only the most important stuff. The first run is 50 copies. Get on the list: https://physicianassistantexamreview.com/newbook

Full episode notes: https://physicianassistantexamreview.com/173

Think different. Work different. Score different.

The water breaks and the heart rate drops. The head delivers and pulls back. A scarred uterus loses station. Three of today's four emergencies announce themselves the same way, and what separates them is what happened right before. This episode covers fetal distress, umbilical cord prolapse, shoulder dystocia, and operative delivery, boiled down to what the PANCE actually tests.

A Bishop score of 8 or higher means skip the ripening and go straight to oxytocin. Misoprostol and a prior uterine scar don't mix. And the APGAR never decides when resuscitation starts. In this episode of the Physician Assistant Exam Review Podcast, we finish labor: how to start it when it won't start, how to restart it when it stalls, and everything from the epidural to the baby's first assessment, taught the way it actually gets tested.

Five priming questions open the episode. Sit with them while you listen, then check yourself at the end.

What's covered:

• Induction vs augmentation, and why the cervix picks the method
• Who gets induced: offer at 41 weeks, deliver by 42, and no elective induction before 39
• Contraindications to induction: placenta previa, vasa previa, transverse lie, prior classical incision
• The Bishop score: 8 or higher is favorable, 6 or lower means ripen first
• Cervical ripening: misoprostol, dinoprostone, the Foley balloon, and which one a prior cesarean rules out
• Oxytocin, tachysystole, and why amniotomy waits for an engaged head
• Labor analgesia: epidural hypotension, the post-dural puncture headache, pudendal block, IV opioids
• Delayed cord clamping and the three signs of placental separation
• Active management of the third stage, the main prevention of postpartum hemorrhage
• The APGAR score and what it doesn't tell you
• First- through fourth-degree perineal lacerations

Study tip in this episode: it doesn't have to be a ton. It has to be thoughtful. You don't need to study longer. You need to study better.

Free Live Master Class on Passing the PANCE: Find the One Thing Quietly Costing You 5-10% on Every Exam. Two live sessions, Tuesday September 15 and Thursday September 17, both at 8 PM ET: https://physicianassistantexamreview.com/masterclass

Registration for the October cohort of 33 Days to Pass the PANCE opens Thursday, September 17: https://physicianassistantexamreview.com/33

Full episode notes: https://physicianassistantexamreview.com/171

Think different. Work different. Score different.