Physician Assistant National Certifying Examination (PANCE): Questions Answers
DSM recognizes a wide range of mental disorders in its Diagnostic Classification. For the purpose of billing and data collection, each diagnosis has a diagnostic code, which may be used by individual providers, institutions, or agencies.For the purpose of billing and data collection, each diagnosis has a diagnostic code, which may be used by individual providers, institutions, or agencies.
The topics covered on the Physician Assistant National Certifying Examination (PANCE) are based on the knowledge and skills that are necessary for entry-level physician assistants (PAs) to provide general medical care to patients. The exam covers a wide range of medical and surgical specialties, including: Cardiology Dermatology Emergency medicine Gastroenterology Geriatric medicine Hematology and oncology Infectious disease Medical ethics Neurology Orthopedic surgery Pediatrics Physical diagnosis Psychiatry Pulmonary medicine Radiology Rheumatology Urology In addition to these specialties, the PANCE also includes questions on pharmacology, pathology, and patient management. The exam is designed to assess the competencies that are necessary for PAs to provide general medical care to patients, including the ability to gather and interpret patient information, diagnose and manage common medical conditions, and work effectively with other members of the healthcare team.
Medical Content Categories Percent Allocation*
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 Percent Allocation*
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%
Part - 2: Practice Test
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1. 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?
2. Which one of the following represents a manifestation of measles?
3. Which of the following medications is approved for the treatment of pain associated with fibromyalgia syndrome (FMS)?
4. You’re evaluating a 4-month-old infant who presents with a fever of 39.4°C (103°F) and tonic-clonic seizure. There’s no prior history of seizures or epilepsy. A lumbar puncture is unrevealing. Which one of the following is the likely cause of this infant’s seizures?
5. Which one of the following is true concerning the evaluation and management of lipomas?
6. You’re evaluating a 43-year-old man who presents to the ER with an abnormal complete blood count (CBC). The white blood cell count is 6.3 mg/dL, the hemoglobin is 7.4 mg/dL, and the platelet count is 40 mg/dL. You order a peripheral smear, and there are schistocytes. The LDH level is 2,500. Plasmapheresis isn’t available at your hospital facility. What would be your next immediate step?
7. Which one of the following statements concerning post-streptococcal glomerulonephritis is true?
8. You’re evaluating a patient with anemia. During the course of your examination, you note that the patient has a positive monoclonal spike on a serum protein electrophoresis. You’re not sure of the significance of this. Which one of the following tests would you order next?
9. You are evaluating a 23-year-old woman who presents with recurrent epistaxis. She also experiences some bleeding from her gums when she brushes her teeth. Other past medical history is unremarkable, and the patient denies taking any medications, including NSAIDs. On examination, there is no splenomegaly. The CBC shows a WBC of 7.4 mg/dL, hemoglobin of 11.3 mg/dL, and a platelet count of 220,000. What would be your next step?
10. Which one of the following is the treatment for a heparin overdose?
11. A 55-year-old female comes to the ED complaining of moderate right eye pain, headache, and acute onset of blurry vision, which she describes as colored halos around lights. She was watching a movie at home with her husband about an hour ago when the pain began. On the physical exam of her right eye, her pupil is mid-dilated and unresponsive to light. Her right eyeball is firm to pressure. Intraocular pressure (IOP) measured with a tonometer is elevated at 36mmHg. Which of the following is the most appropriate emergency treatment?
12. Which one of the following tumor markers and its association is correct?
13. Which one of the following would be used to treat tetanus?
14. You’re evaluating a 55-year-old man with advanced HIV who presents with significant diarrhea. He has a CD4 count of 100. What is the likely cause of his diarrhea?
15. Which of the following conditions causes left lower-quadrant pain?
16.Which of the following is recommended for treating a Chlamydia trachomatis infection?
17. Which of the following is an example of a macrocytic anemia?
18. Which one of the following is recommended for treating Rocky Mountain spotted fever?
19. You’re treating a 74-year-old male nursing home resident who was admitted with shortness of breath and fever. His temperature on admission was 38.3°C (101°F). On physical exam, the gentleman is toxic looking and has decreased lung sounds at the right base. The chest radiograph shows an infiltrate at the right lower lobe. What’s the most likely causative organism?
20. You’re seeing a 25-year-old man in the ER who was recently started on metoclopramide (Reglan). He presents with a very high fever and a change in mental status. On physical examination, his muscles are rigid. His body temperature is 40.0°C (104°F). You obtain a stat CPK level, and it is 50,000. This man is in severe trouble. What is the most likely diagnosis?
21. A 35-year-old man develops worsening dyspnea on exertion, occurring over the last few weeks. He has no cardiac risk factors. A chest radiograph reveals bilateral hilar adenopathy. Labs show an elevated erythrocyte sedimentation rate and an elevated angiotensin converting enzyme (ACE) level. What is this person’s likely diagnosis?
22. What is the treatment of choice for mild persistent asthma?
23. Steroids are used in treating severe asthma and COPD exacerbations. Side effects of long-term steroid use include which of the following?
24. A 17-year-old female presents to her physician’s office after noticing a round lump in her left breast 2 months ago. She reports that the lump seemed to enlarge and became tender just preceding her last 2 menses. It is otherwise painless, and the patient denies any discharge or skin changes. She has no past medical history but her grandmother, age 72, was just diagnosed with invasive ductal carcinoma of the breast. The patient is an avid softball player at her high school and denies alcohol, smoking, or illicit drug use. On exam, the breasts appear symmetric and normal. A 3-cm round, mobile mass is palpated in the upper outer quadrant of the left breast. There is slight tenderness to deep palpation of the mass. There is no axillary lymphadenopathy on either side. Which of the following is the most likely outcome of this patient’s condition?
25. Which one of the following statements about acute respiratory distress syndrome (ARDS) is false?
26. Which of the following medications has been used in the treatment of hepatitis B?
27. A 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?
28. Which of the following tests would you order for someone in whom you suspect celiac disease?
29. Which one of the following conditions can present with fever, tachycardia, heat intolerance, and hyperdefecation?
30. Which one of the following medications would you give to treat someone with cytomegalovirus esophagitis?
31. A 68-year-old woman presents to your office for her annual check-up. Her vitals are HR 85, T 98.8 F, RR 16, BP 125/70. She has a history of smoking 1 pack a day for 35 years but states she quit five years ago. She had her last pap smear at age 64 and states all of her pap smears have been normal. She had her last colonoscopy at age 62, which was also normal. Which is the following is the next best test for this patient?
32. Which of the following muscles is not part of the rotator cuff?
33. A radiograph showing chondrocalcinosis would be suggestive of which of the following conditions?
34. Which one of the following statements concerning deep venous thrombosis prophylaxis is true?
35. Which medical condition is associated with Grey-Turner’s sign?
36. What is the most common cause of a hypercoagulable state?
37. You’re seeing a 65-year-old man in the primary care office who presents with worsening lower extremity edema. He has a history of Type 2 diabetes. On physical exam, he has a blood pressure of 150/86 mm Hg. His albumin/creatinine ratio is 160. His creatinine is 1.2 mg/dL. Which of the following medications would you prescribe for treating this patient?
38. You’re evaluating a 34-year-old woman who presents with dizziness, vertigo, and tinnitus in the right ear. She is also complaining of drainage in the right ear. She denies any prior cold, upper respiratory infection, or focal weakness. Which one of the following is her likely diagnosis?
39. A healthy 29-year-old woman at 30-weeks gestational age has gained 35lbs since becoming pregnant. She complains of several weeks of bilateral numbness and tingling of her palms, thumbs, index, and middle fingers that is worse at night. She also notes weakness gripping objects at the office. Which nerve is most likely affected?
40. Which of the following medications is ototoxic?
41. You are asked to see a 40-year-old man in the emergency room because of fever and altered mental status. He was recently started on fluphenazine (Prolixin). He is agitated and his temperature is 39.4°C (103°F). His blood pressure is 160/100 mmHg. A CPK level is 50,000. What is the most appropriate treatment at this time?
42. Which of the following muscles is innervated by cranial nerve IV?
43. Which one of the following would be a cause of sensorineural hearing loss?
44. A 15-year-old female with no medical history presents to the ER with altered mental status. She is tachycardic. Labs reveal a glucose level of 900 mg/dL and elevated beta-hydroxybutyric acid. Which of the following acid-base issues would you expect to see?
45. A 52-year-old female with a history of mitral valve regurgitation presents with exertional dyspnea. On physical exam, you notice abdominal swelling and lower extremity edema. You suspect pulmonary hypertension (PH). Which of the following is the gold standard for diagnosing PH?
46. A 72-year-old female smoker with a history of atrial fibrillation presents to the ER with severe abdominal pain for a few hours. Vitals are unremarkable. Physical exam reveals nothing significant. Which of the following is the gold standard diagnostic modality for the most likely diagnosis?
47. A 45-year old woman being managed for ulcerative colitis, developed abdominal pain, vomiting, diarrhea, the passage of blood and mucus per rectum, and fever. On examination, she was pale, febrile (temp: 102.2 C), moderately dehydrated, heart rate: 124bpm. There was abdominal distention and tenderness, bowel sounds were hypoactive. Lab results showed Hb: 9g/dl, WBC: 14 x 109/L, elevated CRP. Stool was negative for C. difficile. HIV status was negative. Abdominal radiograph showed dilated transverse colon of about 11 cm. What is the most likely diagnosis of this patient?
48. A 37-year-old female with no past medical history is brought in by EMS. She is hypotensive. On physical exam, you notice muffled heart sounds and jugular vein distention. What is the most appropriate initial treatment for this condition?
49. Which of the following should be avoided in patients who have an acute kidney injury?
50. A 67-year-old man with a long history of constipation presents with steady left lower quadrant pain. Physical exam reveals low-grade fever, mid abdominal distention, and lower left quadrant tenderness. Stool guaiac is negative. An absolute neutrophilic leukocytosis and a shift to the left are noted on the CBC. Which of the following is the most accurate test for this patient's condition?
51. A 21-year-old male presents to the ED with increasing dyspnea and pleuritic chest pain of sudden onset after getting hit in the left side of the chest during a bar fight. Examination reveals moderate respiratory distress with an absence of breath sounds and hyperresonance to percussion on the left, with tracheal deviation to the right. Which of the following is the most appropriate next step?
52. A 55-year-old woman with a history of ulcerative colitis presents to the emergency department with a severe flare. The patient reports numerous bloody loose stools and has been febrile for two days. Vital signs are T 102.0 HR 98 BP 131/86 RR 17 Sat 100%. The abdominal exam is notable for markedly distended abdomen with tympani and tenderness to palpation without guarding or rebound. A CT scan shows a markedly dilated descending and sigmoid colon with no perforations. What is the next best step in management for this patient?
53. A 56-year-old woman came to the clinic complaining of a lump protruding from her anal opening. It was initially reducible, but it now irreducible. There is associated pain and itching. She also noticed bright red blood on her stool when she defecates. There is an associated history of chronic constipation. Examination of the perianal area revealed skin tags and a tender perianal mass covered with mucosa. Inspection of the anal mucosa showed no fissure. What is the grade of the condition?
54. A 65-year old man who is being managed for lung cancer on the ward makes a complaint of a 2-day history of the passage of nonbloody watery stool up to 4 times per day, anorexia, cramping abdominal pain, and fever. Meanwhile, he had a 10-day course of antibiotics 4 weeks ago on account of a lung infection. Which of the following is the most likely cause of his diarrhea:
55. A 37-year-old male with a history of daily NSAID use complains of epigastric pain, nausea, and vomiting, all worsened by eating. On physical examination, he is tender to palpation in the epigastrium. He admits to drinking approximately two beers per day. He was prescribed a course of ranitidine followed by omeprazole after his symptoms did not resolve. He was referred for endoscopy, with findings consistent with a gastric ulcer. Biopsy with silver staining is positive for H-Pylori. Which of the following is the most effective regimen for the treatment of this condition?
56. A 34-year-old female presents to her ophthalmologist with 6 hours of blurry vision in her right eye. She reports severe pain with eye movement that has not been relieved with NSAIDs. She feels that she has been generally healthy all her life, although she does note one week of right arm weakness during the previous year that resolved without treatment. On exam, she has no noted ocular secretions. On her fundal exam, you note blurred borders on the optic disc. Which of the following additional findings is likely to be present in this patient?
57. A 68-year-old woman presents to your office for her annual check-up. Her vitals are HR 85, T 98.8 F, RR 16, BP 125/70. She has a history of smoking 1 pack a day for 35 years but states she quit five years ago. She had her last pap smear at age 64 and states all of her pap smears have been normal. She had her last colonoscopy at age 62, which was also normal. Which is the following is the next best test for this patient?
58. A 62-year-old woman follows up for a recent hospitalization for a severe urinary tract infection. Since returning home 100 days ago, she has developed swelling and pain in her left calf and, over the past 24 hours, she has become winded on minimal activity. She has a history of hypertension for which she takes levofloxacin. She has no history of peptic ulcer disease or malignancy. She reports that she refused low-molecular weight heparin prophylaxis while an inpatient because she dislikes needles. Physical examination findings include a pulse of 95 beats/minute, blood pressure of 100/60 mmHg, and oxygen saturation of 92%. The lungs are clear. There are no cardiac abnormalities, Chest x-ray and EKG are normal. The most appropriate next step is:
59. A 16-year-old otherwise healthy boy weighing 132 pounds (60 kg) presents following a motorcycle accident. His heart rate is 125 beats/minute with age appropriate normal blood pressure and pulse oximetry. He is speaking normally and has no external signs of bleeding. Physical examination reveals a grossly dislocated right ankle with absence of dorsalis pedis pulses. What single procedural sedation agent and dose is most appropriate?
1. 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?
1. A 34-year-old female presents to her ophthalmologist with 6 hours of blurry vision in her right eye. She reports severe pain with eye movement that has not been relieved with NSAIDs. She feels that she has been generally healthy all her life, although she does note one week of right arm weakness during the previous year that resolved without treatment. On exam, she has no noted ocular secretions. On her fundal exam, you note blurred borders on the optic disc. Which of the following additional findings is likely to be present in this patient?
62. 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?
63. 6. Which of the following is the likely etiology of a paronychia?