Preguntas de práctica PANCE
Las preguntas del test siguen en inglés.
Esta es una muestra gratis de 15 preguntas para estudiantes de physician assistant que preparan el PANCE, escrita por el equipo de StudyPDF a partir del blueprint publicado por la NCCPA. Se reparte entre sistemas orgánicos y entre las áreas de tarea que usa el blueprint, así que tienes una mezcla de hallazgos clásicos, siguiente mejor paso diagnóstico, preguntas de cribado y mecanismos de grupos de fármacos. Responde las 15, después mira tu puntuación y lee la explicación de cada pregunta.
A 72-year-old has a harsh crescendo-decrescendo systolic murmur heard best at the right second intercostal space that radiates to both carotids. The carotid upstroke is slow and weak. Which valve lesion does this describe?
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Las 15 preguntas de un vistazo
¿Prefieres leer antes de jugar? Abajo están todas las preguntas de la muestra. Las respuestas y explicaciones quedan plegadas hasta que las abras.
1. A 72-year-old has a harsh crescendo-decrescendo systolic murmur heard best at the right second intercostal space that radiates to both carotids. The carotid upstroke is slow and weak. Which valve lesion does this describe?
- A. Mitral regurgitation
- B. Aortic stenosis
- C. Aortic regurgitation
- D. Mitral stenosis
Ver respuesta y explicación
Respuesta: B. Aortic stenosis
Aortic stenosis forces blood through a narrowed outflow tract during systole, so the murmur is systolic, loudest at the right upper sternal border, and carried along the aortic arch to the carotids. The slow, low volume carotid upstroke, often called pulsus parvus et tardus, comes from the same fixed obstruction. Mitral regurgitation is also systolic but blows toward the axilla, while aortic regurgitation and mitral stenosis are diastolic.
2. Which spirometry pattern defines an obstructive ventilatory defect?
- A. A normal FEV1/FVC ratio with a reduced total lung capacity
- B. A reduced FVC with a preserved FEV1/FVC ratio
- C. An increased FEV1 with a normal FVC
- D. A reduced FEV1/FVC ratio
Ver respuesta y explicación
Respuesta: D. A reduced FEV1/FVC ratio
Obstruction means air leaves slowly, so the volume exhaled in the first second falls more than the total volume does and the ratio drops. Restriction is the opposite problem, small lungs, so both FEV1 and FVC fall together and the ratio stays normal or even rises while total lung capacity falls. Whether the obstruction improves substantially after a bronchodilator is what separates asthma from fixed disease.
3. Complete the sentence.
A patient cannot wrinkle the forehead on the affected side, cannot fully close that eye, and cannot lift that corner of the mouth. Because the forehead is involved, the lesion is _____, and the picture fits _____.
Opciones para el hueco 1: central, above the facial nucleus, peripheral, at or distal to the facial nucleus, in the cerebellum
Opciones para el hueco 2: a cortical stroke, Bell palsy, trigeminal neuralgia
Ver respuesta y explicación
Respuesta: peripheral, at or distal to the facial nucleus, Bell palsy
The forehead muscles receive input from both cerebral hemispheres, so a lesion above the facial nucleus spares them and the patient can still wrinkle the brow. Once the forehead goes weak with the rest of the side, the problem is the nerve itself or its nucleus, which is the peripheral pattern seen in Bell palsy. Trigeminal neuralgia is a pain syndrome in the fifth cranial nerve and causes no facial weakness.
4. A patient reports right upper quadrant pain after fatty meals and now has fever and arrest of inspiration when you palpate under the right costal margin. Which imaging study is the best first test?
- A. Upper endoscopy
- B. Plain abdominal radiographs
- C. Right upper quadrant ultrasound
- D. Barium swallow
Ver respuesta y explicación
Respuesta: C. Right upper quadrant ultrasound
That inspiratory arrest is a positive Murphy sign and points at acute cholecystitis. Ultrasound is first because it is quick, needs no radiation or contrast, and shows the things that matter here: stones, a thickened gallbladder wall and pericholecystic fluid. Most gallstones are not visible on plain films, and endoscopy and barium studies look at the lumen of the gut rather than the biliary tree.
5. Which findings are consistent with primary hypothyroidism?
Marca todas las que correspondan.
- A. An elevated TSH
- B. A low free T4
- C. A delayed relaxation phase of the deep tendon reflexes
- D. A suppressed TSH with an elevated free T4
- E. Lid lag and a fine resting tremor
Ver respuesta y explicación
Respuesta: A. An elevated TSH, B. A low free T4, C. A delayed relaxation phase of the deep tendon reflexes
In primary hypothyroidism the thyroid gland itself is failing, so free T4 falls and the pituitary responds by driving TSH up. The slowed metabolic state shows up on exam as the delayed, hung up relaxation phase of the reflexes, along with cold intolerance, constipation and weight gain. A suppressed TSH with a high free T4, lid lag and tremor are the hyperthyroid picture, and TSH is high in the primary form because the feedback loop is intact.
6. Under the Ottawa ankle rules, which finding makes an ankle radiograph series indicated after an acute injury?
- A. Bone tenderness along the posterior edge or tip of either malleolus
- B. Any swelling over the lateral ankle
- C. Pain reproduced by passive inversion of the ankle
- D. A visible bruise within 24 hours of the injury
Ver respuesta y explicación
Respuesta: A. Bone tenderness along the posterior edge or tip of either malleolus
The Ottawa rules key on bone tenderness at the posterior edge or tip of the medial or lateral malleolus, or an inability to bear weight for four steps both right after the injury and at the time of evaluation. They were built to be highly sensitive, meaning a negative rule is good at ruling a fracture out, so their job is to safely skip films rather than to confirm a fracture. Swelling, bruising and pain with inversion are common in ordinary sprains and do not decide imaging on their own.
7. Complete the sentence.
An expanding red rash with central clearing at the site of a tick bite is called _____, and it is the classic early sign of infection with _____.
Opciones para el hueco 1: erythema multiforme, erythema migrans, erythema nodosum
Opciones para el hueco 2: Rickettsia rickettsii, Borrelia burgdorferi, Babesia microti
Ver respuesta y explicación
Respuesta: erythema migrans, Borrelia burgdorferi
Erythema migrans is the early localized stage of Lyme disease, which spreads through Ixodes ticks in endemic parts of the country. It matters that the diagnosis at this stage is clinical, because antibodies often have not developed yet and early serology can be falsely negative. Rickettsia rickettsii causes Rocky Mountain spotted fever, whose rash typically starts on the wrists and ankles and moves inward.
8. What distinguishes bipolar I disorder from bipolar II disorder?
- A. Bipolar I requires psychotic features in every mood episode
- B. Bipolar II requires a mixed episode
- C. Bipolar I requires at least one full manic episode
- D. Bipolar II requires a longer depressive episode
Ver respuesta y explicación
Respuesta: C. Bipolar I requires at least one full manic episode
Bipolar I is defined by a manic episode, meaning elevated or irritable mood with increased energy that causes marked impairment, needs hospitalization or includes psychosis. Bipolar II requires a hypomanic episode plus at least one major depressive episode, and hypomania is shorter and does not cause that level of impairment. Psychosis can occur in bipolar I but is not required in every episode, and a single manic episode is enough for the bipolar I diagnosis even without a documented depression.
9. Which of the following match current United States Preventive Services Task Force recommendations for average-risk adults?
Marca todas las que correspondan.
- A. Colorectal cancer screening starting at age 45
- B. A one-time ultrasound for abdominal aortic aneurysm in men aged 65 to 75 who have ever smoked
- C. Annual low-dose CT of the chest for adults aged 50 to 80 with a 20 pack-year history who still smoke or quit within the past 15 years
- D. An annual PSA test for every man starting at age 40
- E. A routine annual chest radiograph for every adult
Ver respuesta y explicación
Respuesta: A. Colorectal cancer screening starting at age 45, B. A one-time ultrasound for abdominal aortic aneurysm in men aged 65 to 75 who have ever smoked, C. Annual low-dose CT of the chest for adults aged 50 to 80 with a 20 pack-year history who still smoke or quit within the past 15 years
Colorectal screening was moved down to 45 for average-risk adults, AAA screening is a single ultrasound in men 65 to 75 with any smoking history, and lung cancer screening is annual low-dose CT for the 50 to 80 group with a 20 pack-year history. Prostate screening is not a blanket annual test, it is a shared decision with the patient in a defined age band. Routine chest films as general screening have never been supported, because they find little and generate harm through false positives. Task Force recommendations get revised, so check the current version before you quote an age.
10. Why do ACE inhibitors cause a dry cough in some patients?
- A. They block the breakdown of bradykinin, which then accumulates
- B. They block angiotensin II at its receptor
- C. They reduce aldosterone, which raises serum potassium
- D. They dilate the efferent arteriole in the kidney
Ver respuesta y explicación
Respuesta: A. They block the breakdown of bradykinin, which then accumulates
Angiotensin converting enzyme also acts as kininase II, the enzyme that degrades bradykinin, so blocking it lets bradykinin and substance P build up in the airway and trigger the cough. The same accumulation explains the rarer but far more dangerous angioedema. Angiotensin receptor blockers act downstream at the receptor and leave bradykinin breakdown intact, which is why cough is much less common with them. The potassium rise and the efferent arteriolar dilation are real effects of the class, but they are not what causes the cough.
11. Which urinary sediment finding points to glomerular bleeding rather than bleeding from lower in the urinary tract?
- A. Muddy brown granular casts
- B. White blood cell casts
- C. Calcium oxalate crystals
- D. Red blood cell casts with dysmorphic red cells
Ver respuesta y explicación
Respuesta: D. Red blood cell casts with dysmorphic red cells
Casts are molded in the renal tubules, so a cast packed with red cells proves the blood entered upstream at the glomerulus rather than from the bladder or ureter. Red cells that squeezed through a damaged glomerular basement membrane come out misshapen, which is the dysmorphic part. Muddy brown granular casts suggest acute tubular necrosis, white cell casts suggest pyelonephritis or interstitial nephritis, and calcium oxalate crystals are common and nonspecific.
12. Which features of a pigmented skin lesion raise concern for melanoma?
Marca todas las que correspondan.
- A. Asymmetry, so that one half does not mirror the other
- B. An irregular, notched or poorly defined border
- C. A change in size, shape or color over recent months
- D. A single uniform tan color throughout the lesion
- E. A 2 mm diameter that has been stable for years
Ver respuesta y explicación
Respuesta: A. Asymmetry, so that one half does not mirror the other, B. An irregular, notched or poorly defined border, C. A change in size, shape or color over recent months
The ABCDE list is asymmetry, border irregularity, color variation, diameter greater than about 6 mm, and evolution over time. Evolution carries the most weight in practice, because a lesion that is changing deserves attention even when it does not tick the other boxes. Uniform color and a small, stable size are reassuring features rather than warning signs, and a lesion that simply looks different from all the others on that patient is the ugly duckling sign.
13. A patient reports hearing loss in the left ear. The Weber tuning fork test lateralizes to the left, and on the left the Rinne test shows bone conduction greater than air conduction. What does this pattern indicate?
- A. Sensorineural hearing loss on the left
- B. Conductive hearing loss on the left
- C. Sensorineural hearing loss on the right
- D. Normal hearing in both ears
Ver respuesta y explicación
Respuesta: B. Conductive hearing loss on the left
Normally air conduction beats bone conduction, so a Rinne with bone greater than air means something is blocking sound on its way in, such as cerumen, fluid or otosclerosis. Weber lateralizes toward the affected ear in conductive loss, because the blocked ear is shielded from room noise and picks up the bone conducted tone better. In sensorineural loss the pattern flips: Weber lateralizes away from the bad ear and air conduction still beats bone conduction on both sides.
14. Complete the sentence.
In uncomplicated iron deficiency anemia the red cells are typically _____, the serum ferritin is _____, and the total iron binding capacity is high.
Opciones para el hueco 1: microcytic and hypochromic, macrocytic, normocytic and normochromic
Opciones para el hueco 2: high, normal, low
Ver respuesta y explicación
Respuesta: microcytic and hypochromic, low
Without enough iron the marrow cannot fill cells with hemoglobin, so it makes small, pale cells, and ferritin, which reflects stored iron, drops. Transferrin production rises as the body reaches for iron, which is why total iron binding capacity goes up. Anemia of chronic disease can also be microcytic but sits at the other end: ferritin is normal or high because it is an acute phase reactant, and the binding capacity is low.
15. New onset hypertension after 20 weeks of gestation, together with proteinuria or evidence of end organ dysfunction, defines which condition?
- A. Chronic hypertension
- B. Gestational diabetes
- C. Gestational hypertension
- D. Preeclampsia
Ver respuesta y explicación
Respuesta: D. Preeclampsia
The 20 week line is what separates pregnancy related hypertension from chronic hypertension that was present before pregnancy or appeared early. Gestational hypertension is the same new hypertension without proteinuria and without end organ features, so it becomes preeclampsia the moment those appear. End organ signs include a low platelet count, rising creatinine, elevated liver enzymes, pulmonary edema and new visual or cerebral symptoms, which is why preeclampsia can be diagnosed even when the urine protein is negative.
Qué evalúa de verdad el PANCE
El Physician Assistant National Certifying Exam lo pone la NCCPA, y es el examen que tienes que aprobar para usar la credencial PA-C en Estados Unidos. Es un examen por ordenador de opción múltiple que se hace en bloques cronometrados. El número exacto de preguntas, el tiempo por bloque, el rango de puntuación de escala y el estándar de aprobado los fija y los publica la NCCPA, y han cambiado con los años, así que lee las páginas del examen vigentes en nccpa.net y tu propio manual del candidato en vez de fiarte de un número que hayas visto en un foro. Lo mismo vale para cuántos intentos tienes y cuánto tiempo sigue abierta tu ventana de elegibilidad.
El contenido en sí es público. El blueprint de la NCCPA tiene dos dimensiones. La primera es el contenido médico por sistema orgánico, que supone el 94 por ciento del examen: cardiovascular 11 por ciento, pulmonar 9 por ciento, gastrointestinal y nutrición 8 por ciento, musculoesquelético 8 por ciento, enfermedades infecciosas 7 por ciento, neurológico 7 por ciento, psiquiatría y ciencias del comportamiento 7 por ciento, reproductor 7 por ciento, endocrino 6 por ciento, ojos, oídos, nariz y garganta 6 por ciento, hematológico 5 por ciento, renal 5 por ciento, dermatológico 4 por ciento y genitourinario 4 por ciento. La práctica profesional supone el 6 por ciento restante.
La segunda dimensión es el área de tarea, que es lo que la pregunta te pide hacer con ese contenido. Esas tareas incluyen hacer la anamnesis y la exploración física, pedir e interpretar pruebas diagnósticas y de laboratorio, formular el diagnóstico más probable, el mantenimiento de la salud y la prevención, la intervención clínica, la terapéutica farmacológica, aplicar conceptos de ciencias básicas y la práctica profesional. Cada pregunta está en el cruce de un sistema y una tarea, y por eso estudiar solo por sistemas deja lagunas.
Cómo usar esta muestra
Estas 15 preguntas están repartidas a propósito por todo el blueprint en vez de amontonadas en un solo sistema. Tienes una lesión valvular, un patrón de espirometría, una lesión del nervio facial, una primera elección de imagen, analítica tiroidea, una regla de decisión de imagen, un exantema por picadura de garrapata, una definición psiquiátrica, cribado en adultos, el mecanismo de un grupo de fármacos, sedimento urinario, una lesión cutánea, pruebas con diapasón, estudio del hierro y una definición del embarazo. La idea es encontrar los sistemas donde tienes flojo el razonamiento, no simular un examen completo.
Hazla de una sentada y sin apuntes, después lee todas las explicaciones, también las de las que acertaste por el motivo equivocado. Trata cada fallo como un tema, no como un dato. Si la pregunta del diapasón y la del sedimento urinario fueron mal las dos, suele ser señal de que estás memorizando hallazgos en vez de aprender qué los produce, y la solución es volver al mecanismo.
Un límite honesto. Estas preguntas van sobre razonamiento, mecanismos, asociaciones clásicas y monitorización, no sobre dosis ni protocolos de manejo. Es a propósito. Nada de aquí es orientación médica, nada de aquí debería usarse para tratar a un paciente, y nada de esto es un ítem de la NCCPA. Es práctica de examen escrita por el equipo de StudyPDF a partir del blueprint publicado, y StudyPDF no está afiliada a la NCCPA de ninguna manera. Las decisiones clínicas corresponden a las guías vigentes y a tu médico supervisor.
Cómo StudyPDF crea tests completos con tu material
Quince preguntas te enseñan dónde flojeas. No pueden prepararte para un blueprint tan ancho, y un banco genérico rara vez coincide con lo que subrayan tu propio programa, tus apuntes de rotación o el libro de repaso que compraste de verdad.
StudyPDF va por otro camino y trabaja con tu material. Subes tu libro de repaso del PANCE, tus diapositivas del año teórico, tus dosieres de rotación o los apuntes que tomaste sobre un tema de shelf, y Bo, el agente de estudio, crea tests de práctica completos con esas páginas exactas. Cada pregunta sale de tu material, y cada explicación cita de dónde viene la respuesta, así que cuando algo parezca raro puedes ir directo a la fuente y comprobarlo. Puedes generar tests nuevos tantas veces como quieras, centrarlos en un solo sistema como el cardiovascular o el endocrino, o en una sola tarea como las pruebas diagnósticas, y seguir qué conceptos sigues fallando.
No necesitas un documento para empezar. Si no tienes nada que subir, di solo un tema, por ejemplo los soplos, los trastornos del equilibrio ácido base o los calendarios de vacunación del adulto, y Bo escribe un test de práctica solo con eso. Empezar es gratis.
Escrito por el equipo de StudyPDF. Actualizado el 2026-08-19.