Physician Assistant National Certifying Examination (PANCE): Questions Answers
The National Commission on Certification of Physician Assistants (NCCPA) is the only certifying organization for PAs in the United States. Established as a not-for-profit organization in 1974, NCCPA is dedicated to providing certification programs that reflect standards for clinical knowledge, clinical reasoning, and other medical skills and professional behaviours required upon entry into practice and throughout the careers of PAs. All U.S. states, the District of Columbia, and the U.S. Territories have decided to rely on NCCPA certification as one of the criteria for initial licensure or regulation of PAs. More than 185,000 PAs have been certified by NCCPA since 1975.
In the United States, physician assistants (PAs) are licensed health professionals who practice medicine as part of a team with physicians. PAs are educated in the medical model and trained to diagnose and treat illnesses, prescribe medications, and provide a range of other medical services. They work in a variety of settings, including hospitals, clinics, private practices, and other healthcare facilities.
PAs must complete a formal education program that includes classroom instruction and clinical training. These programs are typically around two years in length and lead to a master's degree in physician assistant studies. To be accepted into a PA program, students typically need to have a bachelor's degree and have completed prerequisites in areas such as biology, chemistry, and psychology.
PAs must pass a national certification exam in order to practice in the United States. This exam, known as the Physician Assistant National Certifying Exam (PANCE), is administered by the National Commission on Certification of Physician Assistants (NCCPA). To maintain their certification, PAs must complete ongoing medical education and demonstrate their continued competency through the recertification process.
In their practice, PAs work under the supervision of a physician and are responsible for taking medical histories, performing physical exams, ordering and interpreting diagnostic tests, making diagnoses, and developing treatment plans. They may also prescribe medications, assist in surgeries, and provide counseling and education to patients.
Practice Questions Part-3
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1. You’re evaluating a 35-year-old man who presents with arthritis, fever, urethritis, and conjunctivitis. This has been occurring a few days. He states that about a week ago, he came down with what felt like a viral bug that went away. What is the likely cause of this person’s symptoms?
2. You’re evaluating a 65-year-old woman who presents with abdominal distention and bloating. An abdominal ultrasound confirms the presence of ascites. Which one of the following is she most likely to have?
3. Chronic gastroesophageal reflux disease can put patients at risk for which of the following diseases?
4. The use of tamoxifen increases the risk of which type of cancer?
5. Which of the following is a risk factor for vulvar cancer?
6. You are evaluating a 55-year-old man who comes to the clinic complaining of a fever. You take his temperature, and it is 39.4°C (103°F). You find out that this person may have somehow heated the thermometer with a lighter to induce a false reading. This behavior could be an example of what psychiatric condition?
7. A 50-year-old female presents to the office with elevated alkaline phosphatase levels. She denies abdominal pain. The history is negative for medications of any kind, and she denies alcohol use. Surgical history is negative. Which of the following is the most likely diagnosis?
8. You’re evaluating a 32-year-old man who was found on the ground after a drug overdose. It’s not known how long he was there, but from the history, you suspect it may have been several hours. On admission, his creatinine level is 4.5 mg/dL. Urinalysis is strongly positive for blood, but the microscopic evaluation reveals only 0–2 RBC/HPF. Which of the following is the likely cause of hematuria and acute renal failure in this patient?
9. You’re seeing a patient who will be undergoing a cardiac catheterization in the next 24 hours. He has Stage III chronic kidney disease (CKD) with a creatinine level of 1.5 mg/dL. Which of the following interventions should be instituted at this time?
10. Which one of the following is a risk factor for sudden infant death syndrome (SIDS)?
11. Your patient has an acute onset of left lower quadrant pain without fever or other complicating findings, and you suspect that she has mild diverticulitis. You decide to treat her on an outpatient basis with oral antibiotics while you do further studies. Which of the following antibiotics offers the best treatment when combined with metronidazole?
12. Which one of the following is true concerning the characteristics of childhood autism?
13. In addition to physical examination, which one of the following is most useful in diagnosing congenital hip dysplasia in the newborn?
14. Which one of the following is true concerning the evaluation of ovarian cysts?
15. A patient has developed a carrier state of salmonellosis which is not responding to chemotherapy, which is the most likely site of colonization?
16.Your patient is a 19-year-old woman who has been sexually active for the past two years. At what age would you recommend that she receive a Pap smear?
17. Which of the following has the lowest evidence of study bias?
18. Which of the following would be on indication for surgical treatment of hyperparathyroidism?
19. A patient presents with splenomegaly, Coombs-negative hemolytic anemia, portal hypertension, neurologic/psychiatric abnormalities, and moderately elevated AST and ALT liver enzymes. During the HEENT portion of the physical examination, Kayser–Fleischer rings are present. What laboratory finding is expected if the patient has Wilson’s disease?
20. Which condition does the Haemophilus influenzae B vaccine prevent?
21. A 25-year-old woman presents wearing sunglasses. She’s sporting a huge black eye. When you question her, she states that she “ran into a door.” You suspect spousal abuse. What do you do next?
22. You’re seeing a 35-year-old woman for evaluation of major depressive disorder. You want to begin treatment with an antidepressant. Which of the following conditions do you need to exclude before you treat her?
23. Which symptom would not be a typical finding and be considered a red flag finding in a patient who has irritable bowel syndrome?
24. You’re going to school with a colleague who swears that he has every medical condition you are studying. In school, you’re currently studying the GI system. He’s having some diarrhea and fears he may have colon cancer. He beseeches the physicians to allow him to have a colonoscopy. This behavior could be an example of what psychiatric condition?
25. What’s the most immediate treatment needed in a patient suffering from neuroleptic malignant syndrome?
26. You are evaluating a 35-year-old woman who presents with an acute lithium overdose. Which one of the following statements concerning lithium is true?
27. Which of the following hernias is most common in women and will typically be palpated below the inguinal ligament?
28. Which one of the following antidotes matches the underlying toxicity?
29. A patient is hepatitis C positive. What should be included in educating them and their family about this disease?
30. Which one of the following statements concerning digoxin is true?
31. Which of the following can be used in the evaluation of Addison’s disease?
32. A 14-year-old boy presents for evaluation of diarrhea, bloating, flatulence, nausea, and anorexia for the past 2 weeks. He has four to five loosely formed stools per day. He thinks that his symptoms may have started after returning from a camping trip about 1 month ago. He denies fever, or blood in the stools. Which of the following tests should be ordered to confirm the diagnosis?
33. 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?
34. You are seeing a 50-year-old man who has been treated with a diuretic for hypertension and edema. You do routine lab work and discover a potassium level of 3.4 mg/dL and a calcium level of 10.8 mg/dL. Which medication is this patient likely taking?
35. A patient who presents with hematemesis is most likely having problems with which of the following disorders?
36. You are evaluating a 35-year-old man with no significant past medical problems. You obtained a lipid panel, and it shows an LDL level of 130 mg/dL. Based on National Cholesterol Education Program (NCEP) guidelines, which of the following would you recommend?
37. A patient describes multiple episodes of forceful vomiting with hematemesis. After evaluation, the report comes back as a nonpenetrating mucosal tear at the gastroesophageal junction. What is this finding called?
38. A 35-year-old woman with a history of manic depression presents to the clinic with excessive thirst. She doesn’t remember her medication list but recalls one was abruptly stopped. She also states she is urinating a lot more than usual. Her vitals, including blood pressure, are stable. You order some lab work, and the sodium level is 141 mEq/L, the creatinine level is 1.2 mg/dL, the blood glucose level is 100 mg/dL, and the calcium level is 9.5 mg/dL. Which test would you order next?
39. You are seeing a 68-year-old man with type 2 diabetes in your office. His last Hgb A1c, done one month ago, was 9.2. In the last three weeks, you made some adjustments in his medication. Which test could you order to see whether there has been any change in his condition?
40. In which one of the following disorders would you see choreiform movements?
41. You’re evaluating a 67-year-old man who was involved in a motor vehicle accident. On physical examination, you notice a significant restriction of right eye movement. Which of the following would you order next?
42. Among different ethnic groups, cholesterol cholelithiasis is unusually common in which group?
43. Which one of the following signs is associated with meningitis?
44. You’re evaluating a 45-year-old woman with a history of a solid organ transplant. She’s on immunosuppression and presents with a fever and a change in mental status. She isn’t arousable and has become very lethargic. There’s a question as to whether she had a seizure at home. An MRI showed hemorrhagic changes and increased enhancement in the temporal lobe. Which one of the following does she need at this point?
45. Which of the following could be seen with the chronic use of phenytoin (Dilantin)?
46. A patient with suspected acute appendicitis complains of abdominal pain in the right lower quadrant region when he walks and strikes his heel to the ground. What diagnostic sign is he demonstrating?
47. You’re evaluating a 78-year-old man who presents to the emergency room with a heart rate of about 140–150 beats per minute. On the monitor, you see a narrow-complex tachycardia, but it’s impossible to determine the underlying rhythm. You apply carotid massage, and the patient breaks into a normal sinus rhythm. What’s the likely original rhythm?
48. You’re evaluating a 25-year-old woman who presents with palpitations. On examination, you hear a midsystolic click. Which one of the following would you recommend concerning evaluation of her heart condition?
49. Which of the following is more likely to be associated with Crohn disease versus ulcerative colitis?
50. Which of the following disorders is characterized by a scaly, rough erythematous patch that appears on sun-exposed areas?
51. A 42-year-old male is admitted for typical pneumonia. He is given IV azithromycin and ceftriaxone. His QT interval becomes prolonged and he develops a polymorphic ventricular tachycardia. Which of the following is the most appropriate pharmacological management?
52. Which of the following is true about an indirect inguinal hernia?
53. 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?
54. 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?
55. Which of the following vitamins help increase the absorption of calcium in the GI tract?
56. Which of the following is the likely etiology of a paronychia?
57. 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?
58. An older gentleman with a history of alcoholism and chronic pancreatitis presents with pain radiating to the back. He states the pain is much worse than before. He has a mild fever. His white blood cell count is normal, but you note that his hemoglobin level is 8.5 mg/dL. You look at the lab values in his medical record and note that it was 10.5 on a prior hospitalization. Lab values, including liver function tests, amylase, and lipase, are normal. What is your next step?
59. Hepatocellular carcinoma has a higher incidence of occurrence when associated with which of the listed disorders?
60. Mrs. James was referred for screening colonoscopy at the age of 50. She has no personal or family history of colorectal cancer. No polyps or lesions were found during the examination. She should be advised that a colonoscopy should be repeated in how many years?
61.A patient’s esophageal biopsy was positive for Barrett esophagus. Of the following, which is a complication of this disease?
62. A diet high in nitrates or salt and low in vitamin C is a significant risk factor for cancer of which of the following?
63. A patient has cancer in the ascending (right side) colon. What findings are typically found in this situation?