PANCE Practice Questions
This is a free 15-question sampler for physician assistant students preparing for the PANCE, written by the StudyPDF team from the published NCCPA blueprint. It spreads across organ systems and across the task areas the blueprint uses, so you get a mix of classic findings, next best diagnostic step, screening questions and drug class mechanisms. Answer all 15, then check your score and read the explanation for every question.
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?
All Medicine & Pharmacy quizzes
- Practice test · 15 questions
USMLE Step 2 CK Practice Questions
- Practice test · 15 questions
NAPLEX Practice Questions
- Practice test · 15 questions
MCAT Practice Test
Now make your own
Upload your prep book, slides or notes, or just tell Bo what you want to learn. You do not need a document to start.
All 15 questions at a glance
Prefer to read before you play? Every question in the sampler is listed below. Answers and explanations stay collapsed until you open them.
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
Show answer and explanation
Answer: 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
Show answer and explanation
Answer: 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 _____.
Options for blank 1: central, above the facial nucleus, peripheral, at or distal to the facial nucleus, in the cerebellum
Options for blank 2: a cortical stroke, Bell palsy, trigeminal neuralgia
Show answer and explanation
Answer: 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
Show answer and explanation
Answer: 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?
Select all that apply.
- 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
Show answer and explanation
Answer: 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
Show answer and explanation
Answer: 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 _____.
Options for blank 1: erythema multiforme, erythema migrans, erythema nodosum
Options for blank 2: Rickettsia rickettsii, Borrelia burgdorferi, Babesia microti
Show answer and explanation
Answer: 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
Show answer and explanation
Answer: 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?
Select all that apply.
- 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
Show answer and explanation
Answer: 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
Show answer and explanation
Answer: 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
Show answer and explanation
Answer: 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?
Select all that apply.
- 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
Show answer and explanation
Answer: 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
Show answer and explanation
Answer: 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.
Options for blank 1: microcytic and hypochromic, macrocytic, normocytic and normochromic
Options for blank 2: high, normal, low
Show answer and explanation
Answer: 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
Show answer and explanation
Answer: 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.
What the PANCE actually tests
The Physician Assistant National Certifying Exam is given by the NCCPA, and it is the exam you have to pass to use the PA-C credential. It is a computer based multiple choice exam delivered in timed blocks. The exact number of questions, the time allowed per block, the scaled score range and the passing standard are set and published by the NCCPA, and they have changed over the years, so read the current exam pages at nccpa.net and your own candidate handbook rather than trusting a number you saw on a forum. The same goes for how many attempts you get and how long your eligibility window stays open.
The content itself is public. The NCCPA blueprint has two dimensions. The first is medical content by organ system, which makes up 94 percent of the exam: cardiovascular 11 percent, pulmonary 9 percent, gastrointestinal and nutrition 8 percent, musculoskeletal 8 percent, infectious diseases 7 percent, neurologic 7 percent, psychiatry and behavioral science 7 percent, reproductive 7 percent, endocrine 6 percent, eyes ears nose and throat 6 percent, hematologic 5 percent, renal 5 percent, dermatologic 4 percent and genitourinary 4 percent. Professional practice makes up the remaining 6 percent.
The second dimension is the task area, which is what the question asks you to do with that content. Those tasks include taking a history and doing a physical exam, ordering and interpreting diagnostic and laboratory studies, formulating the most likely diagnosis, health maintenance and prevention, clinical intervention, pharmaceutical therapeutics, applying basic science concepts and professional practice. Every question sits at the crossing of one system and one task, which is why studying by system alone leaves gaps.
How to use this sampler
These 15 questions are spread deliberately thin across the blueprint rather than stacked on one system. You get a valve lesion, a spirometry pattern, a facial nerve lesion, a first imaging choice, thyroid labs, an imaging decision rule, a tick borne rash, a psychiatric definition, adult screening, a drug class mechanism, urinary sediment, a skin lesion, tuning fork tests, iron studies and a pregnancy definition. The point is to find the systems where your reasoning is thin, not to simulate a full exam.
Take it in one sitting with no notes, then read every explanation, including the ones you got right for the wrong reason. Treat each miss as a topic rather than a fact. If the tuning fork question and the urinary sediment question both went wrong, that is usually a sign you are memorizing findings instead of learning what produces them, and the fix is to go back to the mechanism.
One honest limit. These questions ask about reasoning, mechanisms, classic associations and monitoring, not about dosing or management protocols. That is on purpose. Nothing here is medical guidance, nothing here should be used to treat a patient, and none of it is an NCCPA item. It is exam practice written by the StudyPDF team from the published blueprint, and StudyPDF is not affiliated with the NCCPA in any way. Clinical decisions belong with current guidelines and your supervising physician.
How StudyPDF builds full practice tests from your own material
Fifteen questions can show you where you are shaky. They cannot get you ready for a blueprint this wide, and a generic bank rarely matches the emphasis of your own program, your rotation notes or the review book you actually bought.
StudyPDF works from your material instead. You upload your PANCE review book, your didactic year slides, your rotation packets or the notes you took on a shelf topic, and Bo, the study agent, builds full length practice tests from those exact pages. Every question is grounded in your material, and every explanation cites where the answer came from, so when something looks wrong you can go straight to the source and check. You can regenerate fresh tests as often as you like, narrow them to a single system such as cardiovascular or endocrine, or to a single task such as diagnostic studies, and track which concepts keep coming back wrong.
You do not need a document to start. If you have nothing to upload, name a topic instead, for example murmurs, acid base disorders or adult vaccination schedules, and Bo writes a practice test from that alone. Starting is free.
Written by the StudyPDF team. Last updated 2026-08-19.