Physician Assistant National Certifying Examination (PANCE): Questions Answers
The Physician Assistant National Certifying Examination (PANCE) is a standardized exam that assesses the knowledge and skills of physician assistants (PAs) in the United States. The exam is administered by the National Commission on Certification of Physician Assistants (NCCPA). PAs who pass the PANCE are granted the Physician Assistant-Certified (PA-C) credential, which is a national certification recognized by all U.S. states and territories. The PANCE is typically taken after completing a PA education program and clinical experience. It consists of 300 multiple-choice questions that cover a wide range of medical and surgical specialties, including pharmacology, pathology, and medical ethics. The exam is designed to evaluate the competencies necessary for entry-level PAs to provide general medical care to patients.
Starting in 2019, the Physician Assistant National Certifying Examination content outline has been revised. In the content blueprint, the topics that will be evaluated on the Physician Assistant National Certifying Examination are outlined To comply with DSM-5 classifications and diagnostic criteria, the NCCPA modified content blueprints, disease and disorder lists, as well as psychiatry-related terms within test questions. PANCE content is updated and modified by certified PAs in consultation with NCCPA the practice of medicine changes and new guidelines are introduced.
Here are 50 questions and answers to assess one's knowledge
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1. Which of the following medications is approved for the treatment of pain associated with fibromyalgia syndrome (FMS)?
2. Boxer’s fracture is caused by an injury to which area of the hand or wrist?
3. Which one of the following can develop into squamous cell carcinoma over time?
4. Which class of medications would you recommend for a young man with a history of high blood pressure who also has significant anxiety and panic disorder?
5. You’re evaluating a 50-year-old man who presents with a headache. He says that he notices that before his headaches, like now, he sees “funny squiggly things.” He asks if you can turn off the light as you come into the room, because the bright light is “driving him nuts.” Which one of the following would you give to help with his headache?
6. You have been studying Condition X for five years. You have identified a number of people who have Condition X. You have also identified a blood test that can identify that Condition X is present when the blood test is positive. What term describes the ability of the blood test to detect those in the population who indeed have Condition X?
7. Which of the following muscles is not part of the rotator cuff?
8. Which one of the following would be used in the treatment of peripheral arterial disease (PAD)?
9. You’re evaluating a 35-year-old man who presents to your office with a headache. On physical examination, his blood pressure is 240/120 mmHg. On fundoscopic examination, you note the presence of papilledema. What’s this person’s underlying diagnosis?
10. You’re evaluating a 25-year-old woman who presents with a rash on her face. She states she may be having a reaction to some food that she ate, but she isn’t sure. The rash is reddened and macular on both cheeks, and there is no sparing of the nasolabial fold. Which one of the following would you order at this point?
11. You’re evaluating a 44-year-old man who presents with a new rash. He takes off his shirt and raises his arms to show you. In the left axillary area, you see a new hyperpigmented, macular rash. Which one of the following medical conditions could be associated with this skin lesion?
12. Which one of the following is a cause of a respiratory alkalosis?
13. Which one of the following statements concerning colon cancer screening is correct?
14. You’re evaluating a 40-year-old woman who has a history of worsening morning stiffness and swelling of the fingers and hands. No facial rash is present. Which of the following labs is most specific for diagnosing this rheumatologic condition?
15. Which one of the following would be used in treating a peripheral neuropathy secondary to heavy metal toxicity?
16. You’re evaluating a 65-year-old man with advanced colon cancer for a possibility of recurrence. Which of the following laboratory studies would you order at this time?
17. Which of the following is a potential side effect of colchicine?
18. A 32-year-old male presents with acute ascending symmetrical paralysis and diminished reflexes in his bilateral lower extremities. He has a history of bloody diarrhea a few days ago. What did he likely eat that led to his symptoms?
Which of the following is not transmitted by blood?
20. . A 25-year old female presents to the clinic with an 8-month history of intermittent crampy lower abdominal pain, with the passage of loose stools 4 times a day. Pain is usually worse during her menstrual period and is relieved by defecation. She also feels bloated. She says she has been undergoing work-related stress for months. There are no ALARM symptoms and there are no significant findings on physical examination. Which of the following is associated with this patient's condition?
21. A 6-year-old boy is admitted with a one-week history of diarrhea, which was sometimes bloody and originally began after a birthday party. He has become lethargic and has not been eating or drinking. His vital signs are as follows: T 38.5 C, HR 135, BP 82/54. Physical examination is significant for petechiae on his legs and diffuse abdominal tenderness to palpation. Lab-work shows BUN 72 mg/dL, creatinine 8.1 mg/dL, and platelet count < 10,000. PT and PTT are within normal limits. Which of the following would be expected on a peripheral blood smear?
22. Which of the following is the first-line treatment for nasal polyps in patients with chronic rhinosinusitis?
23. You’re preparing a patient to go into surgery for emergent cholecystectomy. The patient presented with a fever of 38.9°C (102°F) and acute right upper-quadrant pain. Ultrasound demonstrates ductal dilatation, thickening of the gallbladder wall, and pericholecystic fluid. The patient is made NPO and started on intravenous fluids. Which antibiotic would be appropriate to administer?
24. Which of the following is the most common cause of postpartum hemorrhage?
25. A 42-year-old homeless man presents to the emergency department with fever, painful muscle spasms in his arms and legs, and difficulty eating because of painful spasms in his jaw muscles. Until a week ago, he was wandering around the city looking for food and work and taking shelter in a commercial construction site. He reports not having seen a medical professional in more than 15 years. Examination of his feet reveals shoes with holes in the soles and a small, puncture-type wound on the bottom of the right foot. It is surrounded by erythema and somewhat tender to touch. The patient is uncertain what he may have stepped on. X-ray is negative for any radiopaque foreign body. In addition to hospital admission, which of the following is the first-line therapy for this patient?
26. A 21-year-old male with hematemesis. He is brought by his girlfriend who reports that he and his buddies have been out drinking every night last week in celebration of his 21st birthday. He reports having vomited each night, but tonight when he started vomiting, he noticed that there was streaking of blood. Concerned, he decided to come to the emergency department. Which of the following best describes the most likely diagnosis?
27. A 22-year-old man presents to the emergency room complaining of pain upon urination and a watery discharge from his penis. It started a few days ago and has been getting progressively worse. His temperature is 98.0°F (36.7°C), blood pressure is 122/74 mmHg, pulse is 83/min, respirations are 14/min, and oxygen saturation is 98% on room air. Physical exam is notable for a tender urethra with discharge. Gram stain of the discharge is negative for bacteria but shows many neutrophils. Which of the following is the most likely infectious etiology of this patient's symptoms?
28. You’re evaluating a 40-year-old woman who has a history of worsening morning stiffness and swelling of the fingers and hands. No facial rash is present. Which of the following labs is most specific for diagnosing this rheumatologic condition?
29. . A 43-year-old man is brought to the emergency department after having a seizure. His wife states that the patient has been struggling with alcohol abuse and has recently decided to "quit once and for all". Physical exam is notable for a malnourished patient responsive to verbal stimuli. He has moderate extremity weakness, occasional palpitations, and brisk deep tendon reflexes (DTRs). EKG demonstrates normal sinus rhythm and a prolonged QT interval. What nutritional deficiency most likely contributed to these findings?
30. 73. You’re examining a 35-year-old man who is exhibiting acute psychotic behavior. He also has delusions and hallucinations. He has a history of a hypertrophic cardiomyopathy as well. Which of the following medications would you be very hesitant to give this man?
31. A 14-hour-old boy has failed to pass stool and is vomiting greenish fluid. He was born at 40 weeks gestation with no complications during delivery or pregnancy. His temperature is 97.6°F (36.4°C), blood pressure is 64/34 mmHg, pulse is 140/min, respirations are 33/min, and oxygen saturation is 98% on room air. The child is currently breastfeeding and appears irritable. Physical exam is notable for a distended and non-tender abdomen. The rectal exam is unremarkable. An abdominal radiograph demonstrates distended loops of bowel. What is the most likely diagnosis?
32. A 45-year-old male presents with complaints of heartburn, belching, and epigastric pain for the past six months. He reports that symptoms occur within an hour of eating a meal and are aggravated by drinking coffee, eating fatty foods, and lying down. He has tried eating smaller meals and avoiding spicy food to no avail. He denies vomiting, difficulty swallowing, recent weight loss, or changes in stool color. His temperature is 98.9 °F, blood pressure is 147/82 mmHg, pulse is 86/min, respirations are 18/min, and BMI is 32 kg/m^2. His abdomen is soft, non-tender, and bowel sounds are auscultated in all quadrants. His laboratories are unremarkable and his fecal occult blood test (FOBT) is negative. What is the next best step in this patient's management?
33. Orbital cellulitis most commonly occurs when an infection spreads into the orbit from which sinus?
34. The definition of amblyopia is _________
35. You’re evaluating a 65-year-old woman who presents with fever and acute lower left-quadrant pain. She states that it began last night and won’t let up. She says that it began in the back and radiates to the lower left-quadrant area. She denies nausea, vomiting, or diarrhea. She has no history of diverticulosis. Her temperature is 38.9°C (102°F). There is lower left-quadrant tenderness and left costovertebral tenderness. She admits to dysuria and urinary frequency. The urinalysis is pending. What is the most likely diagnosis?
36. Which one of the following is a risk factor for developing testicular cancer?
37. Which of the following best represents values you would expect in a patient with SIADH?
38. Which of the following is the most common cause of death in hemochromatosis?
39. Which one of the following is a criterion for rheumatic fever?
40. When is PKU testing performed?
41. A 20-year-old female with a history of type 1 diabetes presents to the clinic complaining of weight loss, increased flatulence, foul-smelling stools, and a pruritic rash. You notice multiple papules and vesicles on the extensor surfaces of the elbows. Which of the following is most likely to be positive?
42. A 38-year-old male presents to the ER with acute onset of dyspnea, dizziness, chest pain, and diaphoresis, He has had 4 episodes similar in the past. Vital signs are remarkable for mild tachycardia (103 bpm). Lab and imaging studies are insignificant. Which of the following is the best long-term medical treatment for the likely diagnosis?
43. Which of the following is an example of a physiologic function of the pancreas?
44. 73. Boxer’s fracture is caused by an injury to which area of the hand or wrist?
45. Untreated hyperglycemia during pregnancy increases the risk of which one of the following?
46. You’re treating a 62-year-old man for benign prostatic hyperplasia (BPH). He has an American Urological Association (AUA) symptom score of 7, denoting mild BPH symptoms. He also has hypertension, so you elect to start terazosin (Hytrin). What would you advise this patient concerning potential side effects of this medication?
47. Which of the following is a risk factor for the development of Down syndrome?
48. TA 26-year-old monogamous female presents with cyclic pelvic pain that has been increasing over the last 6 months. She complains of significant dysmenorrhea and dyspareunia. She uses condoms for birth control. On physical examination, her uterus is retroverted and non-mobile, and she has a palpable adnexal mass on the left side. Her serum pregnancy test is negative. Which of the following is the most likely diagnosis?
49. Which one of the following conditions is a complication of acute otitis media?
50. Which of the following conditions causes left lower-quadrant pain?
1. Which of the following medications is approved for the treatment of pain associated with fibromyalgia syndrome (FMS)?
2. Boxer’s fracture is caused by an injury to which area of the hand or wrist?
3. Which one of the following can develop into squamous cell carcinoma over time?
4. Which class of medications would you recommend for a young man with a history of high blood pressure who also has significant anxiety and panic disorder?
5. You’re evaluating a 50-year-old man who presents with a headache. He says that he notices that before his headaches, like now, he sees “funny squiggly things.” He asks if you can turn off the light as you come into the room, because the bright light is “driving him nuts.” Which one of the following would you give to help with his headache?
6. You have been studying Condition X for five years. You have identified a number of people who have Condition X. You have also identified a blood test that can identify that Condition X is present when the blood test is positive. What term describes the ability of the blood test to detect those in the population who indeed have Condition X?
7. Which of the following muscles is not part of the rotator cuff?
8. Which one of the following would be used in the treatment of peripheral arterial disease (PAD)?
9. You’re evaluating a 35-year-old man who presents to your office with a headache. On physical examination, his blood pressure is 240/120 mmHg. On fundoscopic examination, you note the presence of papilledema. What’s this person’s underlying diagnosis?
10. You’re evaluating a 25-year-old woman who presents with a rash on her face. She states she may be having a reaction to some food that she ate, but she isn’t sure. The rash is reddened and macular on both cheeks, and there is no sparing of the nasolabial fold. Which one of the following would you order at this point?
11. You’re evaluating a 44-year-old man who presents with a new rash. He takes off his shirt and raises his arms to show you. In the left axillary area, you see a new hyperpigmented, macular rash. Which one of the following medical conditions could be associated with this skin lesion?
12. Which one of the following is a cause of a respiratory alkalosis?
13. Which one of the following statements concerning colon cancer screening is correct?
14. You’re evaluating a 40-year-old woman who has a history of worsening morning stiffness and swelling of the fingers and hands. No facial rash is present. Which of the following labs is most specific for diagnosing this rheumatologic condition?
15. Which one of the following would be used in treating a peripheral neuropathy secondary to heavy metal toxicity?
16. You’re evaluating a 65-year-old man with advanced colon cancer for a possibility of recurrence. Which of the following laboratory studies would you order at this time?
17. Which of the following is a potential side effect of colchicine?
18. A 32-year-old male presents with acute ascending symmetrical paralysis and diminished reflexes in his bilateral lower extremities. He has a history of bloody diarrhea a few days ago. What did he likely eat that led to his symptoms?
Which of the following is not transmitted by blood?
20. . A 25-year old female presents to the clinic with an 8-month history of intermittent crampy lower abdominal pain, with the passage of loose stools 4 times a day. Pain is usually worse during her menstrual period and is relieved by defecation. She also feels bloated. She says she has been undergoing work-related stress for months. There are no ALARM symptoms and there are no significant findings on physical examination. Which of the following is associated with this patient's condition?
21. A 6-year-old boy is admitted with a one-week history of diarrhea, which was sometimes bloody and originally began after a birthday party. He has become lethargic and has not been eating or drinking. His vital signs are as follows: T 38.5 C, HR 135, BP 82/54. Physical examination is significant for petechiae on his legs and diffuse abdominal tenderness to palpation. Lab-work shows BUN 72 mg/dL, creatinine 8.1 mg/dL, and platelet count < 10,000. PT and PTT are within normal limits. Which of the following would be expected on a peripheral blood smear?
22. Which of the following is the first-line treatment for nasal polyps in patients with chronic rhinosinusitis?
23. You’re preparing a patient to go into surgery for emergent cholecystectomy. The patient presented with a fever of 38.9°C (102°F) and acute right upper-quadrant pain. Ultrasound demonstrates ductal dilatation, thickening of the gallbladder wall, and pericholecystic fluid. The patient is made NPO and started on intravenous fluids. Which antibiotic would be appropriate to administer?
24. Which of the following is the most common cause of postpartum hemorrhage?
25. A 42-year-old homeless man presents to the emergency department with fever, painful muscle spasms in his arms and legs, and difficulty eating because of painful spasms in his jaw muscles. Until a week ago, he was wandering around the city looking for food and work and taking shelter in a commercial construction site. He reports not having seen a medical professional in more than 15 years. Examination of his feet reveals shoes with holes in the soles and a small, puncture-type wound on the bottom of the right foot. It is surrounded by erythema and somewhat tender to touch. The patient is uncertain what he may have stepped on. X-ray is negative for any radiopaque foreign body. In addition to hospital admission, which of the following is the first-line therapy for this patient?
26. A 21-year-old male with hematemesis. He is brought by his girlfriend who reports that he and his buddies have been out drinking every night last week in celebration of his 21st birthday. He reports having vomited each night, but tonight when he started vomiting, he noticed that there was streaking of blood. Concerned, he decided to come to the emergency department. Which of the following best describes the most likely diagnosis?
27. A 22-year-old man presents to the emergency room complaining of pain upon urination and a watery discharge from his penis. It started a few days ago and has been getting progressively worse. His temperature is 98.0°F (36.7°C), blood pressure is 122/74 mmHg, pulse is 83/min, respirations are 14/min, and oxygen saturation is 98% on room air. Physical exam is notable for a tender urethra with discharge. Gram stain of the discharge is negative for bacteria but shows many neutrophils. Which of the following is the most likely infectious etiology of this patient's symptoms?
28. You’re evaluating a 40-year-old woman who has a history of worsening morning stiffness and swelling of the fingers and hands. No facial rash is present. Which of the following labs is most specific for diagnosing this rheumatologic condition?
29. . A 43-year-old man is brought to the emergency department after having a seizure. His wife states that the patient has been struggling with alcohol abuse and has recently decided to "quit once and for all". Physical exam is notable for a malnourished patient responsive to verbal stimuli. He has moderate extremity weakness, occasional palpitations, and brisk deep tendon reflexes (DTRs). EKG demonstrates normal sinus rhythm and a prolonged QT interval. What nutritional deficiency most likely contributed to these findings?
30. 73. You’re examining a 35-year-old man who is exhibiting acute psychotic behavior. He also has delusions and hallucinations. He has a history of a hypertrophic cardiomyopathy as well. Which of the following medications would you be very hesitant to give this man?
31. A 14-hour-old boy has failed to pass stool and is vomiting greenish fluid. He was born at 40 weeks gestation with no complications during delivery or pregnancy. His temperature is 97.6°F (36.4°C), blood pressure is 64/34 mmHg, pulse is 140/min, respirations are 33/min, and oxygen saturation is 98% on room air. The child is currently breastfeeding and appears irritable. Physical exam is notable for a distended and non-tender abdomen. The rectal exam is unremarkable. An abdominal radiograph demonstrates distended loops of bowel. What is the most likely diagnosis?
32. A 45-year-old male presents with complaints of heartburn, belching, and epigastric pain for the past six months. He reports that symptoms occur within an hour of eating a meal and are aggravated by drinking coffee, eating fatty foods, and lying down. He has tried eating smaller meals and avoiding spicy food to no avail. He denies vomiting, difficulty swallowing, recent weight loss, or changes in stool color. His temperature is 98.9 °F, blood pressure is 147/82 mmHg, pulse is 86/min, respirations are 18/min, and BMI is 32 kg/m^2. His abdomen is soft, non-tender, and bowel sounds are auscultated in all quadrants. His laboratories are unremarkable and his fecal occult blood test (FOBT) is negative. What is the next best step in this patient's management?
33. Orbital cellulitis most commonly occurs when an infection spreads into the orbit from which sinus?
34. The definition of amblyopia is _________
35. You’re evaluating a 65-year-old woman who presents with fever and acute lower left-quadrant pain. She states that it began last night and won’t let up. She says that it began in the back and radiates to the lower left-quadrant area. She denies nausea, vomiting, or diarrhea. She has no history of diverticulosis. Her temperature is 38.9°C (102°F). There is lower left-quadrant tenderness and left costovertebral tenderness. She admits to dysuria and urinary frequency. The urinalysis is pending. What is the most likely diagnosis?
36. Which one of the following is a risk factor for developing testicular cancer?
37. Which of the following best represents values you would expect in a patient with SIADH?
38. Which of the following is the most common cause of death in hemochromatosis?
39. Which one of the following is a criterion for rheumatic fever?
40. When is PKU testing performed?
41. A 20-year-old female with a history of type 1 diabetes presents to the clinic complaining of weight loss, increased flatulence, foul-smelling stools, and a pruritic rash. You notice multiple papules and vesicles on the extensor surfaces of the elbows. Which of the following is most likely to be positive?
42. A 38-year-old male presents to the ER with acute onset of dyspnea, dizziness, chest pain, and diaphoresis, He has had 4 episodes similar in the past. Vital signs are remarkable for mild tachycardia (103 bpm). Lab and imaging studies are insignificant. Which of the following is the best long-term medical treatment for the likely diagnosis?
43. Which of the following is an example of a physiologic function of the pancreas?
44. 73. Boxer’s fracture is caused by an injury to which area of the hand or wrist?
45. Untreated hyperglycemia during pregnancy increases the risk of which one of the following?
46. You’re treating a 62-year-old man for benign prostatic hyperplasia (BPH). He has an American Urological Association (AUA) symptom score of 7, denoting mild BPH symptoms. He also has hypertension, so you elect to start terazosin (Hytrin). What would you advise this patient concerning potential side effects of this medication?
47. Which of the following is a risk factor for the development of Down syndrome?
48. TA 26-year-old monogamous female presents with cyclic pelvic pain that has been increasing over the last 6 months. She complains of significant dysmenorrhea and dyspareunia. She uses condoms for birth control. On physical examination, her uterus is retroverted and non-mobile, and she has a palpable adnexal mass on the left side. Her serum pregnancy test is negative. Which of the following is the most likely diagnosis?
49. Which one of the following conditions is a complication of acute otitis media?
50. Which of the following conditions causes left lower-quadrant pain?