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Free PANCE Practice Questions

10 free, exam-style Physician Assistant National Certifying Examination (PANCE) practice questions with answers and explanations. No signup required. Work through them below, then take the full free PANCE practice test to study every exam domain.

Question 1

A 62-year-old man with a history of hypertension and type 2 diabetes presents to the emergency department with 90 minutes of crushing substernal chest pain radiating to his left jaw. He is diaphoretic and nauseated. ECG shows 3 mm ST elevation in leads II, III, and aVF with reciprocal ST depression in leads I and aVL. Troponin I is pending. Which of the following is the MOST appropriate next step in management?

  1. Administer IV metoprolol and await troponin results before further intervention
  2. Activate the cardiac catheterization lab for emergent percutaneous coronary intervention
  3. Administer thrombolytics immediately in the emergency department
  4. Obtain a CT coronary angiogram to confirm the diagnosis before treatment
Show answer & explanation

Correct answer: B - Activate the cardiac catheterization lab for emergent percutaneous coronary intervention

Question 2

A 29-year-old woman taking oral contraceptives presents with acute-onset pleuritic chest pain and dyspnea. Her heart rate is 112 bpm and respiratory rate is 24 breaths/min. Oxygen saturation is 93% on room air. A Wells score is calculated at 6 points. Which of the following is the MOST appropriate diagnostic study to order NEXT?

  1. D-dimer assay
  2. CT pulmonary angiography
  3. Ventilation-perfusion scan
  4. Bilateral lower extremity venous duplex ultrasonography
Show answer & explanation

Correct answer: B - CT pulmonary angiography

Question 3

A 34-year-old woman presents with 6 weeks of bloody diarrhea, crampy abdominal pain, and urgency. Colonoscopy reveals continuous inflammation extending from the rectum to the splenic flexure with pseudopolyps and friable mucosa. Biopsies show crypt abscesses limited to the mucosa. Which finding, if present, would be MOST consistent with a change in diagnosis to Crohn disease rather than ulcerative colitis?

  1. Presence of p-ANCA antibodies on serologic testing
  2. Noncaseating granulomas on transmural biopsy of the terminal ileum
  3. Elevated fecal calprotectin level above 250 mcg/g
  4. Development of primary sclerosing cholangitis on MRCP
Show answer & explanation

Correct answer: B - Noncaseating granulomas on transmural biopsy of the terminal ileum

Question 4

A 71-year-old man with atrial fibrillation and hypertension presents with sudden-onset right-sided weakness and expressive aphasia. Symptoms began 2 hours ago. CT of the head without contrast shows no hemorrhage. Blood pressure is 178/96 mmHg. Which of the following is a contraindication to administration of IV alteplase in this patient?

  1. Blood pressure of 178/96 mmHg at the time of presentation
  2. Use of apixaban with the last dose taken 8 hours ago
  3. Patient age greater than 70 years
  4. History of well-controlled hypertension on amlodipine
Show answer & explanation

Correct answer: B - Use of apixaban with the last dose taken 8 hours ago

Question 5

A 38-year-old man who is HIV-positive with a CD4 count of 87 cells/mm³ and not on antiretroviral therapy presents with 2 weeks of progressive headache, fever, and neck stiffness. A lumbar puncture reveals an elevated opening pressure of 32 cm H₂O, lymphocytic pleocytosis, elevated protein, and low glucose. India ink preparation of the CSF is positive. Which of the following is the MOST likely causative organism?

  1. Toxoplasma gondii
  2. Cryptococcus neoformans
  3. Mycobacterium tuberculosis
  4. JC virus
Show answer & explanation

Correct answer: B - Cryptococcus neoformans

Question 6

A 26-year-old woman is started on olanzapine for a first episode of psychosis. At a follow-up visit 10 months later, her caregiver reports she has developed involuntary repetitive lip-smacking and tongue-protrusion movements that worsen with stress. The patient appears unaware of these movements. Which of the following is the MOST appropriate management?

  1. Add benztropine to her current medication regimen
  2. Switch the antipsychotic to clozapine and consider adding valbenazine
  3. Increase the dose of olanzapine to better control psychotic symptoms
  4. Prescribe diphenhydramine as needed for the involuntary movements
Show answer & explanation

Correct answer: B - Switch the antipsychotic to clozapine and consider adding valbenazine

Question 7

A 30-year-old woman, gravida 1 para 0, at 35 weeks gestation presents to labor and delivery with a persistent headache and blurred vision. Blood pressure is 164/108 mmHg on two readings 15 minutes apart. Laboratory studies show platelets of 82,000/µL, AST 312 U/L, ALT 278 U/L, and LDH 650 U/L. A peripheral blood smear reveals schistocytes. Which of the following is the MOST appropriate IMMEDIATE management?

  1. Administer IV magnesium sulfate and proceed with delivery
  2. Begin IV labetalol and recheck laboratory values in 6 hours
  3. Start oral nifedipine and administer betamethasone for fetal lung maturity, delaying delivery for 48 hours
  4. Transfuse platelets to above 100,000/µL before any intervention
Show answer & explanation

Correct answer: A - Administer IV magnesium sulfate and proceed with delivery

Question 8

A 54-year-old man with type 2 diabetes and a history of myocardial infarction is currently taking metformin 1,000 mg twice daily. His HbA1c is 8.4%. Serum creatinine is 1.1 mg/dL and eGFR is 72 mL/min. Which of the following is the MOST appropriate medication to ADD to his regimen based on current guidelines?

  1. Glipizide, a sulfonylurea, for its potent glucose-lowering effect
  2. Semaglutide, a GLP-1 receptor agonist, for its cardiovascular benefit
  3. Pioglitazone, a thiazolidinedione, for its insulin-sensitizing properties
  4. Sitagliptin, a DPP-4 inhibitor, for its favorable side effect profile
Show answer & explanation

Correct answer: B - Semaglutide, a GLP-1 receptor agonist, for its cardiovascular benefit

Question 9

A 45-year-old woman presents with 3 months of symmetric joint pain and swelling involving her metacarpophalangeal joints, proximal interphalangeal joints, and wrists bilaterally. She reports morning stiffness lasting approximately 2 hours each day. Laboratory studies show a positive anti-cyclic citrullinated peptide (anti-CCP) antibody, elevated ESR, and elevated CRP. Radiographs of the hands show periarticular osteopenia without erosions. Which of the following is the MOST appropriate initial disease-modifying therapy?

  1. Hydroxychloroquine
  2. Methotrexate
  3. Infliximab
  4. Prednisone taper over 6 weeks
Show answer & explanation

Correct answer: B - Methotrexate

Question 10

A 22-year-old man is brought to the emergency department after being found unresponsive following a building collapse. He was trapped under concrete debris for approximately 8 hours before rescue. On arrival, he is alert and complaining of severe bilateral leg pain. Urine is dark brown. Laboratory studies reveal: potassium 6.8 mEq/L, creatinine 3.4 mg/dL, creatine kinase 48,000 U/L, calcium 6.9 mg/dL, phosphorus 7.2 mg/dL. Urine dipstick is positive for blood, but microscopy shows no red blood cells. Which of the following is the MOST critical initial intervention?

  1. Emergent bilateral lower extremity fasciotomy
  2. Aggressive intravenous normal saline resuscitation targeting urine output of 200-300 mL/hr
  3. Immediate hemodialysis for the elevated potassium and creatinine
  4. Administration of IV calcium gluconate followed by sodium bicarbonate infusion
Show answer & explanation

Correct answer: B - Aggressive intravenous normal saline resuscitation targeting urine output of 200-300 mL/hr

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