PANCE / PANRE PreTest 2023 (Review Question Answer): National Commission on Certification of Physician Assistants (NCCPA) administered the Physician Assistant National Certifying Examination (PANCE). The entry-level examination (PANCE) consists of 120 questions addressing all aspects of physician assistant education, including basic science concepts, history taking, physical examination, laboratory and radiographic interpretation, as well as treatment modalities. Tips for improving your score on the examination are provided.
Currently, the recertification (PANRE) examination consists of 240 questions constructed in a similar format as the entry-level examination. For the PANRE, candidates may choose alternate forms for the examination. Sixty percent of the examination will be a generalist focus.
PANCE / PANRE PreTest 2023 (Review Question Answer)
Test For | Physician Assistant Exam Prep |
Total Questions | 25 |
Question Type | multiple-choice questions |
Test Type | Sample PANCE / PANRE PreTest |
This type of question presents a problem or asks a question and is followed by four to five choices, only one of which is entirely correct. The directions preceding this type of question will generally appear as below:
DIRECTIONS: Each of the numbered items or incomplete statements in this section is followed by answers or by completion of the statement. Select the ONE-lettered answer or completion that is BEST in each case.
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Question 1 of 25
1. Question
1 pointsFor the past three weeks, a 47-year-old man has had the feeling of heaviness in his chest while pushing his lawn mower. He says he has never been treated for similar symptoms and has no symptoms now. He smoked one pack of cigarettes daily for 20 years but quit smoking seven years ago. Findings on physical examination are normal. Electrocardiography shows no abnormalities. Which of the following is the most appropriate initial diagnostic study?
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Option (C), exercise stress test, is correct because it is the most appropriate initial step in the workup of a patient with recent chest pain because the test is noninvasive, inexpensive, convenient, and sensitive in this type of patient.
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Question 2 of 25
2. Question
1 pointsA 32-year-old woman has had a rash on her legs for the past three weeks. There are no known infectious contacts. One month ago, she had a bladder infection and was treated with trimethoprim-sulfamethoxazole. Physical examination shows a diffuse rash on the shins, the left medial ankle, and the right medial calf. The rash is tender, diffuse, and recurs in the same areas. A few of the lesions have the appearance of bruising. Which of the following is the most likely diagnosis?
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he correct answer is Option (B), erythema nodosum, because this type of rash may be antibiotic-related, occurs on the lower extremities below the knees, and has the appearance of bruising. All of these symptoms are present in this clinical scenario.
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Question 3 of 25
3. Question
1 pointsA 41-year-old woman has a nine-month history of nausea, constipation, dyspepsia, general fatigue, arthralgia, and increasing memory loss. She has no history of illness other than her present complaints, and her menses have been regular. Physical examination shows no abnormalities. Laboratory findings include the following levels
Serum
Albumin 4.9 g/dL
Calcium 13.0 mg/dL
Chloride 111 mEq/L
Creatinine 1.0 mg/dL
Phosphate 0.3 mg/dL
Blood urea nitrogen 17 mg/dLWhich of the following is the most likely diagnosis?
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Option (B), hyperparathyroidism, is the correct answer. The patient has the classic signs of this condition, which include gastrointestinal, musculoskeletal, and neurologic abnormalities. Additionally, the laboratory values clearly show hypercalcemia and hypophosphatemia, both of which indicate hyperparathyroidism
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Question 4 of 25
4. Question
1 pointsA 40-year-old man is being examined because he feels weak and tired and has had symptoms of sexual dysfunction. His blood pressure is 100/60 mmHg. Physical examination shows decreased facial, axillary, and pubic hair. Laboratory studies show decreased serum levels of luteinizing and follicle-stimulating hormones, thyroxine, and testosterone; serum thyroid- stimulating hormone level is within normal limits. Which of the following is the most likely diagnosis?
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The correct answer is Option (D), hypopituitarism, based on the common symptoms of gonadotropin deficiency, weakness, fatigue, and sexual dysfunction. The decreased levels of luteinizing and follicle-stimulating hormones indicate hypogonadism. These laboratory findings, in addition to the decreased levels of testosterone, indicate hypopituitarism.
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Question 5 of 25
5. Question
1 pointsA previously healthy 15-month-old boy becomes anxious and begins crying and drooling copiously. A few minutes earlier he had been calmly playing with his toys. Temperature is 36.7°C (98.1°F), pulse rate is 84/min, and respirations are 18/min. On physical examination, the posterior pharynx is mildly injected but otherwise clear. The lungs are clear to auscultation and percussion. Findings on chest x-ray study are normal. Within an hour he is calmer, but he continues to drool heavily. Which of the following is the most appropriate next step?
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The correct answer is Option (D), esophagogastroduodenoscopy, which is the appropriate step to confirm a diagnosis and provide therapeutic treatment.
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Question 6 of 25
6. Question
1 pointsSix days ago, a 2-year-old boy had a temperature of 40.0°C (104.0°F). No specific cause was found. His fever has persisted, and he now has injected conjunctivae, strawberry tongue, dry fissured lips, erythema and desquamation of his hands and feet, and bilateral cervical adenopathy. Which of the following is the most likely complication of this condition?
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The correct answer is Option (C), coronary artery aneurysm. The clinical scenario described includes the characteristic presentation of Kawasaki syndrome: fever, age younger than 5 years, conjunctivitis, mucous membrane abnormalities, peripheral extremity abnormalities, polymorphous rash, and cervical lymphadenopathy. Coronary artery aneurysm is the most common complication of Kawasaki syndrome, occurring in about 25% of untreated patients.
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Question 7 of 25
7. Question
1 pointsA 22-year-old woman is brought to the emergency department for evaluation three hours after falling backward out of a chair and striking her head on a carpeted floor. She has tenderness over the back of her head but does not report loss of consciousness. Physical examination, including neurologic and musculoskeletal evaluation, shows no abnormalities except a 2-cm area of swelling and minimal abrasion overlying the left occiput. Which of the following is the most appropriate next step?
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The correct answer is Option (C), discharge and observation by family or friends. Patients with minor head injuries can be discharged with observation instructions in the care of a reliable adult
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Question 8 of 25
8. Question
1 pointsA 46-year-old woman wanders into the clinic, rambling incoherently. When questioned, she has some difficulty remembering what she was asked. She exhibits some perceptual disturbances and is not oriented to time. Which of the following is the most likely diagnosis?
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The correct answer is Option (B), delirium. This patient exhibits the classic signs of this disorder, which include an acute confusional state or an inability to concentrate or maintain attention. Orientation problems and a marked decrease in short-term memory and recall are also indicators of delirium.
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Question 9 of 25
9. Question
1 pointsA 31-year-old African American woman has had worsening malaise, dyspnea, and low-grade fever for the past four weeks. She was recently treated for iritis. On physical examination, red nodules over the anterior lower legs and mild hepatomegaly are noted. Chest x-ray study shows bilateral hilar adenopathy. Which of the following is the most likely diagnosis?
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The correct answer is Option (C), sarcoidosis. The age, gender, and race of the patient, in addition to the insidious onset of symptoms and x-ray study findings, are all characteristics of this disease.
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Question 10 of 25
10. Question
1 pointsA 33-year-old woman at 35 weeks’ gestation has constant pelvic pain. She says that she had a small amount of dark red vaginal bleeding after sexual intercourse. Her blood pressure is 80/50 mmHg, and she has tachycardia. The uterus is firm and tender to palpation. Which of the following is the most likely diagnosis?
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The correct answer is Option (A), abruptio placentae. In addition to the tachycardia and severe
hypotension, this patient has also had a small amount of dark red vaginal bleeding. -
Question 11 of 25
11. Question
1 pointsIn a randomized, double-blind, placebo-controlled clinical trial, which of the following assists the reader of the study in determining whether the results are statistically significant?
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The correct answer is Option (C), P value. P value is used to determine statistical significance by indicating the probability that an outcome occurred by chance if the null hypothesis were true. A low P value suggests that that the results are not likely due to random chance, indicating statistical significance.
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Question 12 of 25
12. Question
1 pointsA 39-year-old woman has been undergoing in vitro fertilization treatments using her extracted eggs and sperm from her husband. The patient has a 15% chance of successful conception. While reviewing the patient’s records, the physician assistant discovers that the patient was inadvertently implanted with a fertilized embryo from another couple 24 hours ago. Which of the following is the most appropriate course of action for the physician assistant?
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The correct answer is Option (B), immediately inform the patient of the error. It is the ethical
responsibility of the physician assistant to immediately disclose serious medical errors, such as
the one described in the scenario. -
Question 13 of 25
13. Question
1 pointsThe supervising physician examines a patient who had just been examined by the physician assistant because of pain in the knees. The physician instructs the physician assistant to add findings on McMurray test to the patient’s chart, and the physician assistant realizes that this pertinent part of the physical examination had been missed. The patient has not yet left the examination room. Which of the following is the most appropriate next step by the physician assistant?
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The correct answer is Option (C), complete the physical examination personally. In the scenario, the supervising physician asks the physician assistant to document a test that had not been performed. Because the patient is still in the examination room and the test is a simple physical maneuver, the most appropriate next step by the physician assistant is to complete the physical examination by performing the test personally
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Question 14 of 25
14. Question
1 pointsA 55-year-old man comes to the emergency department because he has had pressure-like pain in the substernal region of his chest for the past 20 minutes. The patient says the pain radiates to his left arm. He is nauseated and sweating profusely. Medical history includes long-standing hypertension that is well controlled with diuretics. On the basis of this patient’s history and symptoms, which of the following pathologic processes is most likely to have occurred first?
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The correct answer is Option (D), adhesion of platelets. The patient described in the scenario has characteristic symptoms of acute myocardial infarction, including pain in the substernal region of the chest that radiates to the left arm as well as diaphoresis. After disruption of the atherosclerotic plaque, platelets attach to the area due to the increase in turbulence as well as the exposed plaque and collagen. This results in aggregation of platelets and increased thrombi in the vasculature.
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Question 15 of 25
15. Question
1 pointsA 67-year-old woman comes to the clinic for routine physical examination. Medical history includes hypertension, type 2 diabetes mellitus, and dyslipidemia, which are well managed with medications. As the patient walks into the examination room, she describes an aching pain behind her sternum that radiates to her left breast. She says she has never had this type of pain before, and the pain does not worsen when she changes positions. The patient has shortness of breath and is slightly diaphoretic. Pulse rate is 105/min and regular, respirations are 24/min, and blood pressure is 146/91 mmHg. Oxygen saturation is 97% on room air. Which of the following is the most likely cause of this patient’s symptoms?
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The correct answer is Option (E), plaque rupture with platelet aggregation. The patient described in the scenario has characteristic symptoms of myocardial infarction, including chest pain, shortness of breath, and diaphoresis. The underlying pathologic process of myocardial infarction is plaque rupture with platelet aggregation.
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Question 16 of 25
16. Question
1 pointsA 57-year-old woman comes to the office because she has had pain in the left side of her chest for the past hour. The patient says the pain worsened as she crossed the parking lot to the office. During the past three months, she has had pain in her left shoulder and breast that worsens with exertion and is relieved with rest. She also has had fatigue during this time. Medical history includes hypertension and chronic obstructive pulmonary disease, which are well controlled. The patient smokes one pack of cigarettes daily. Height is 170.2 cm (5 ft 7 in), and weight is 99.8 kg (220 lb). Pulse rate is 112/min, respirations are 24/min, and blood pressure is 180/76 mmHg. Oxygen saturation is 96% on room air. On physical examination, palpation of the chest does not worsen the pain. Which of the following is the most appropriate next step?
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The correct answer is Option (E), send the patient to the emergency department. The patient described in the scenario has multiple risk factors for myocardial infarction, including older age, history of hypertension and chronic obstructive pulmonary disease, history of cigarette smoking, and obesity. In addition, the patient’s history of chest pain on exertion suggests that her myocardial oxygen needs are not being met. On the basis of these findings, evaluation in the emergency department for myocardial infarction is the most appropriate next step.
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Question 17 of 25
17. Question
1 pointsA 22-year-old woman presents with abdominal pain and fever of 2 days’ duration. During the digital pelvic examination, she experiences exquisite pain when the cervix is moved. This suggests a diagnosis of
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The item least likely to cause pain, (E), is eliminated. Any of the remaining four are possibilities, but peritonitis of any etiology is usually a safe diagnostic consideration. Do not get bogged down considering the unlikely diagnostic possibilities when an obvious choice is present. The oversimplification in this case is the correct answer, (C).
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Question 18 of 25
18. Question
1 pointsA painless testicular mass is found in an otherwise normal 29-year-old. Which of the following diagnoses should be pursued?
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Choices (C), (D), and (E) are ruled out because they usually are painful. (A) and (B), however, usually are painless. Because of its prognosis if left untreated, a testicular mass should be considered cancer until proven otherwise. Not to do so would be considered a life-threatening omission. The correct choice is (B)
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Question 19 of 25
19. Question
1 pointsThe diagnosis of congenital hip dislocation is made
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The term congenital means “present at birth.” This is when the diagnosis of congenital hip dislocation is made. The correct choice is (B).
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Question 20 of 25
20. Question
1 pointsAn obese 45-year-old woman presents with acute genital pain. Upon examination, a 2- to 3-cm soft mass is found in the right labia majora. This is most likely
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If the mass were located in the scrotum of an obese man, you would probably not miss the common diagnosis of inguinal hernia. Remembering from developmental anatomy that the labia majora and scrotum are corresponding tissues, (B) would be selected as the correct response, even if the test taker had minimal knowledge about surgical emergencies.
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Question 21 of 25
21. Question
1 pointsWhich of the following is NOT a sign of major depressive disorder?
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Major depressive disorder has many signs associated with it; all of them have to result in dysfunction in patient’s daily activities. Additionally, they
cannot meet criteria for other mood disorders, e.g., bipolar, dysthymia, cyclothymia. Each choice except (C) implies depressive symptoms—anhedonia,
hypersomnia, fatigue, weight loss. The odd choice, (C), however, is most likely associated with bipoloar or cyclothymia and is the correct response. -
Question 22 of 25
22. Question
1 pointsA 19-year-old unconscious motorcycle accident victim with suspected multiple trauma is brought to the emergency department. The most significant physical findings usually will result from
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Choices (C) and (D) can be excluded because they refer to historical, not physical, findings. This also excludes foil (E). Although indicated, at this point of presentation, the neurological examination is too focused. A more general, overall assessment provides the best clinical information. Therefore, critical, life-saving information across organ systems may be gained from observing the patient. Choice (A) is correct. Similarly, choice (E), blood gases, in the previous example was eliminated because it was inconsistent with the information asked for in the stem.
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Question 23 of 25
23. Question
1 pointsA 71-year-old female with long history of heavy tobacco use and COPD presents with increasing dyspnea on exertion, abdominal fullness, and lower extremity edema. The physical examination reveals elevated jugular venous pressure, a right ventricular heave, S3 gallop, holosystolic murmur at the lower LSB, RUQ tenderness with hepatomegaly, and bilateral peripheral edema. ECG demonstrates right axis deviation, right ventricular hypertrophy without significant ST-T abnormalities, and peaked P waves. What is her likely diagnosis?
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Question 24 of 25
24. Question
1 points27-year-old male with remote history of endocarditis secondary to intravenous drug use presents with complaints of abdominal fullness and edema. On examination, he has jugular venous distention, hepatic congestion, and peripheral edema. A blowing holosystolic murmur is heard along the lower left sternal border than is intensified with inspiration. What is this murmur?
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Question 25 of 25
25. Question
1 pointsA 68-year-old man presents to the emergency department with fatigue, dyspnea, and generalized weakness that has been getting worse over the past month or so. He has faint heart sounds with weak pulses and bradycardia on physical examination. His ECG demonstrates sinus bradycardia with low-voltage QRS and T wave flattening. His chest x-ray demonstrates enlarged cardiac silhouette with a globular appearance and pleural effusions. What is his most likely underlying diagnosis?
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