Domande di esercitazione PANCE
Le domande del test restano in inglese.
Questo è un assaggio gratuito da 15 domande per chi studia da assistente medico e si prepara al PANCE, scritto dal team di StudyPDF a partire dal blueprint pubblicato dell'NCCPA. Si distribuisce tra gli apparati e tra le aree di compito che il blueprint usa, così ottieni un mix di reperti classici, prossimo passo diagnostico migliore, domande di screening e meccanismi delle classi di farmaci. Rispondi a tutte e 15 le domande, poi guarda il punteggio e leggi la spiegazione di ognuna.
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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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
Mostra risposta e spiegazione
Risposta: 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
Mostra risposta e spiegazione
Risposta: 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 _____.
Opzioni per lo spazio 1: central, above the facial nucleus, peripheral, at or distal to the facial nucleus, in the cerebellum
Opzioni per lo spazio 2: a cortical stroke, Bell palsy, trigeminal neuralgia
Mostra risposta e spiegazione
Risposta: 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
Mostra risposta e spiegazione
Risposta: 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?
Seleziona tutte le risposte corrette.
- 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
Mostra risposta e spiegazione
Risposta: 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
Mostra risposta e spiegazione
Risposta: 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 _____.
Opzioni per lo spazio 1: erythema multiforme, erythema migrans, erythema nodosum
Opzioni per lo spazio 2: Rickettsia rickettsii, Borrelia burgdorferi, Babesia microti
Mostra risposta e spiegazione
Risposta: 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
Mostra risposta e spiegazione
Risposta: 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?
Seleziona tutte le risposte corrette.
- 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
Mostra risposta e spiegazione
Risposta: 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
Mostra risposta e spiegazione
Risposta: 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
Mostra risposta e spiegazione
Risposta: 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?
Seleziona tutte le risposte corrette.
- 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
Mostra risposta e spiegazione
Risposta: 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
Mostra risposta e spiegazione
Risposta: 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.
Opzioni per lo spazio 1: microcytic and hypochromic, macrocytic, normocytic and normochromic
Opzioni per lo spazio 2: high, normal, low
Mostra risposta e spiegazione
Risposta: 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
Mostra risposta e spiegazione
Risposta: 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.
Cosa verifica davvero il PANCE
Il Physician Assistant National Certifying Exam è somministrato dall'NCCPA, ed è l'esame che devi superare negli Stati Uniti per usare il titolo PA-C. È un esame a scelta multipla al computer erogato in blocchi a tempo. Il numero esatto di domande, il tempo consentito per blocco, l'intervallo del punteggio in scala e lo standard di superamento li fissa e li pubblica l'NCCPA, e negli anni sono cambiati, quindi leggi le pagine d'esame aggiornate su nccpa.net e il tuo manuale per i candidati invece di fidarti di un numero visto su un forum. Vale lo stesso per quanti tentativi hai e per quanto resta aperta la tua finestra di idoneità.
Il contenuto invece è pubblico. Il blueprint dell'NCCPA ha due dimensioni. La prima è il contenuto medico per apparato, che costituisce il 94 percento dell'esame: cardiovascolare 11 percento, polmonare 9 percento, gastrointestinale e nutrizione 8 percento, muscoloscheletrico 8 percento, malattie infettive 7 percento, neurologico 7 percento, psichiatria e scienze del comportamento 7 percento, riproduttivo 7 percento, endocrino 6 percento, occhi orecchie naso e gola 6 percento, ematologico 5 percento, renale 5 percento, dermatologico 4 percento e genitourinario 4 percento. La professional practice costituisce il restante 6 percento.
La seconda dimensione è l'area di compito, cioè quello che la domanda ti chiede di fare con quel contenuto. Quei compiti comprendono raccogliere l'anamnesi ed eseguire l'esame obiettivo, richiedere e interpretare indagini diagnostiche e di laboratorio, formulare la diagnosi più probabile, mantenimento della salute e prevenzione, intervento clinico, terapia farmacologica, applicazione dei concetti di scienze di base e pratica professionale. Ogni domanda sta all'incrocio tra un apparato e un compito, ed è per questo che studiare solo per apparati lascia dei buchi.
Come usare questo assaggio
Queste 15 domande sono sparse di proposito su tutto il blueprint invece che ammucchiate su un solo apparato. Trovi una valvulopatia, un quadro spirometrico, una lesione del nervo facciale, una prima scelta di imaging, esami tiroidei, una regola decisionale per l'imaging, un esantema da zecca, una definizione psichiatrica, uno screening dell'adulto, il meccanismo di una classe di farmaci, il sedimento urinario, una lesione cutanea, i test con il diapason, gli studi del ferro e una definizione in ambito gravidico. Lo scopo è trovare gli apparati in cui il tuo ragionamento è debole, non simulare un esame intero.
Fallo tutto d'un fiato senza appunti, poi leggi ogni spiegazione, comprese quelle delle domande a cui hai risposto giusto per il motivo sbagliato. Considera ogni errore un argomento e non un dettaglio. Se la domanda sul diapason e quella sul sedimento urinario sono andate male entrambe, di solito è il segno che stai memorizzando reperti invece di imparare cosa li produce, e il rimedio è tornare al meccanismo.
Un limite dichiarato. Queste domande riguardano il ragionamento, i meccanismi, le associazioni classiche e il monitoraggio, non i dosaggi o i protocolli di gestione. È voluto. Niente qui è un'indicazione medica, niente qui va usato per curare un paziente, e nulla di tutto ciò è un quesito dell'NCCPA. È esercitazione per l'esame scritta dal team di StudyPDF a partire dal blueprint pubblicato, e StudyPDF non è affiliata in alcun modo all'NCCPA. Le decisioni cliniche spettano alle linee guida aggiornate e al tuo medico supervisore.
Come StudyPDF crea test completi dal tuo materiale
Quindici domande possono mostrarti dove sei fragile. Non bastano a prepararti per un blueprint così ampio, e una banca dati generica raramente corrisponde a ciò su cui insiste il tuo programma, ai tuoi appunti di tirocinio o al manuale di ripasso che hai comprato davvero.
StudyPDF parte invece dal tuo materiale. Carichi il tuo manuale di ripasso per il PANCE, le slide dell'anno teorico, i fascicoli di tirocinio o gli appunti che hai preso su un argomento di rotazione, e Bo, l'agente di studio, crea test completi da quelle pagine esatte. Ogni domanda nasce dal tuo materiale e ogni spiegazione indica da dove viene la risposta, così quando qualcosa non ti torna puoi andare subito alla fonte e controllare. Puoi generare test nuovi quante volte vuoi, restringerli a un solo apparato come il cardiovascolare o l'endocrino, oppure a un solo compito come le indagini diagnostiche, e tenere traccia dei concetti che continui a sbagliare.
Per iniziare non serve un documento. Se non hai niente da caricare, nomina invece un argomento, per esempio i soffi cardiaci, i disturbi dell'equilibrio acido base o i calendari vaccinali dell'adulto, e Bo ci scrive sopra un test partendo solo da quello. Inizi gratis.
Scritto dal team di StudyPDF. Ultimo aggiornamento 2026-08-19.