PANCE / PANRE PreTest 2024 (Review Question Answer)

PANCE / PANRE PreTest 2024 (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.

Table of Contents

PANCE / PANRE PreTest 2024 (Review Question Answer)

Test For	Physician Assistant Exam Prep
Total Questions	30
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.

1.

A patient with systemic lupus erythematosus (SLE) very much wants to become pregnant. What should her health care provider tell her regarding pregnancy?

A. There is no increased risk to the fetus
B. There is an increased risk for cardiovascular malformations
C. There is an increased risk for nervous system malformations
D. There is an increased risk for renal malformations
E. There is an increased risk for spontaneous abortions and prematurity

Answer: E. There is an increased risk for spontaneous abortions and prematurity

Explanation: Patients with SLE have a higher risk of pregnancy complications, including spontaneous abortions, preterm birth, and intrauterine growth restriction.

2.

A 54-year-old woman comes to the emergency department with severe left-sided flank pain that is referred to the left labia majora. She is very uncomfortable lying still on the stretcher and is continuously shifting, trying to find a comfortable position. A nonenhanced helical CT scan shows a 10-mm ureteral stone at the ureteropelvic junction. She has a normal coagulation profile. Which of the following would most likely be the best therapy in this case?

A. Plenty of fluids and analgesics and await spontaneous passage
B. Extracorporeal shock wave lithotripsy (ESWL)
C. Endoscopic retrograde basket extraction
D. Endoscopic retrograde laser vaporization of the stone
E. Open surgical removal

Answer: B. Extracorporeal shock wave lithotripsy (ESWL)

Explanation: For a 10-mm ureteral stone, ESWL is a non-invasive and effective treatment option. Spontaneous passage is less likely for stones of this size.

3.

A 69-year-old woman comes to the health care provider for a periodic health maintenance examination. She has no complaints. She takes 1,500 mg of calcium daily, a multivitamin, and daily aspirin. She exercises regularly, eats a fairly healthy diet, and does not smoke cigarettes. She drinks a couple of glasses of wine with dinner each evening and smokes marijuana occasionally with a friend who has glaucoma. She is concerned about her risks for breast, ovarian, and colon cancer because she has friends with each of these diseases. Breast and pelvic examination are unremarkable. A mammogram is normal. Findings from a barium enema are shown. Which of the following is the most common presenting symptom of this condition?

A. Anemia
B. Blumer shelf
C. Constipation
D. Virchow node
E. Weight loss

Answer: C. Constipation

Explanation: Colorectal cancer, indicated by the barium enema findings, often presents with a change in bowel habits, particularly constipation.

4.

A patient who is being treated for hypertension related to a myocardial infarction that occurred 2 hours ago is medicated with IV nitroprusside (Nipride). Which of the following is the expected action of this drug?

A. Constriction of arterioles alone
B. Constriction of both arterioles and venules
C. Constriction of venules alone
D. Dilatation of arterioles alone
E. Dilatation of arterioles and venules

Answer: E. Dilatation of arterioles and venules

Explanation: Nitroprusside is a potent vasodilator that acts on both arterioles and venules, reducing both preload and afterload, making it effective for the management of hypertensive emergencies and acute heart failure.

5.

A 49-year-old man is recuperating in a hospital after having sustained a recent cerebrovascular accident that damaged part of his right temporal lobe. His wife and children are at his bedside day and night. They want to actively participate in his rehabilitation but specifically ask the health care provider what they can expect from him in the future. Once the patient has recuperated from the immediate effects of his stroke, to which of the following psychiatric disorders will he be most predisposed?

A. Conversion disorder
B. Narcolepsy
C. Major depressive disorder
D. Schizophrenia
E. Substance abuse

Answer: C. Major depressive disorder

Explanation: Stroke patients, particularly those with damage to the right hemisphere including the temporal lobe, are at increased risk of developing major depressive disorder due to the psychological and neurological impacts of the stroke.

6.

**A 63-year-old woman comes to the emergency department with severe abdominal pain. She reports the pain is epigastric and worse with eating. There is some radiation to the back. There is associated diarrhea that is described as “fatty.” Symptoms have been present for 3 to 4 months. Her medical history is significant for 2 episodes of acute pancreatitis, hypertension, and hyperlipidemia, but she takes no medications for these disorders. Her temperature is 38.3ºC (100.9ºF), blood pressure 160/90 mm Hg, pulse 143/min, and respirations 16/min. Physical examination shows epigastric tenderness, mild distention, and decreased bowel sounds. She appears uncomfortable and in moderate distress. An obstruction series reveals only scattered pancreatic calcifications. Laboratory studies show:

Amylase: 45 U/L (normal 23-140 U/L)
Lipase: 10 U/L (normal <160 U/L)
Albumin: 2.8 g/dL (normal 3.4-5.4 g/dL)
AST: 98 IU/L (normal <40 IU/L)
ALT: 45 IU/L (normal <40 IU/L)
Total bilirubin: 1.1 mg/dL (normal <1.9 mg/dL)

Which of the following is the most likely underlying etiology for this patient’s symptoms?

A. Alcohol
B. Elevated triglycerides
C. Gallstones
D. Hypercalcemia
E. Idiopathic

Answer: A. Alcohol

Explanation: The history of acute pancreatitis, combined with chronic symptoms and pancreatic calcifications, strongly suggests chronic pancreatitis. Alcohol abuse is the most common cause of chronic pancreatitis in adults.

7.

A 20-year-old woman comes to the health care provider because of left lower quadrant pain for 2 months. She states that she first noticed the pain 2 months ago but now it seems to be getting worse. She has had no changes in bowel or bladder function. She has no fever or chills and no nausea, vomiting, or diarrhea. The pain is intermittent and sometimes feels like a dull pressure. Pelvic examination is significant for a left adnexal mass that is mildly tender. Urine hCG is negative. Pelvic ultrasound shows a 7-cm complex left adnexal mass with features consistent with a benign cystic teratoma. Which of the following is the most appropriate next step in management?

A. Repeat pelvic examination in 1 year
B. Repeat pelvic ultrasound in 6 weeks
C. Prescribe the oral contraceptive pill
D. Perform hysteroscopy
E. Perform laparotomy

Answer: E. Perform laparotomy

Explanation: A 7-cm complex adnexal mass that is suspected to be a benign cystic teratoma requires surgical intervention due to its size and the potential risk of torsion or other complications. Laparotomy is the appropriate next step for definitive diagnosis and management.

8.

A 30-year-old woman with a history of tonic-clonic seizures complains of double vision, thickened gums, and growth of facial hair since starting a new medication. Which of the following anticonvulsant medications is most likely responsible for her symptoms?

A. Carbamazepine (Tegretol)
B. Ethosuximide (Zarontin)
C. Phenobarbital (Phenobarb)
D. Phenytoin (Dilantin)
E. Valproic acid (Depakene)

Answer: D. Phenytoin (Dilantin)

Explanation: Phenytoin is known to cause side effects such as gingival hyperplasia (thickened gums), hirsutism (growth of facial hair), and diplopia (double vision). These are well-documented adverse effects associated with this medication.

9.

A young mother brings her 6-month-old firstborn son for a health supervision visit. She states that the baby has been doing well and she has not noticed any abnormalities in his development, though her experience is really not very significant, she says. The boy is breastfeeding and is increasing the number of solid foods he eats with each passing day. He sleeps almost through the night and stopped having colic 2 months earlier. On physical examination the boy appears to be in no distress. He is in the 50th percentile for weight and length and his vital signs are normal. The health care provider performs a thorough neurologic exam in front of the mother, who is very curious about everything the health care provider is doing. On extension of the head, the boy flexes his arms and legs. When a finger is put in his palm, he flexes his hand, elbow and shoulder ipsilaterally. Tactile stimulation of the cheek prompts him to turn his mouth to that side, and touching the dorsum of his foot leads to a step-up movement. During a simulated fall, the baby reacts by extending his arms. The mother asks about each and every one of the newborn reflexes and when they are supposed to disappear.

Which of the following is likely to be the one reflex that persists throughout life?

A. Extension of the head leads to flexion of the arms and legs
B. Finger in palm leads to flexion of the hand, elbow, and shoulder ipsilaterally
C. Stimulation of a fall leads to extension of arms
D. Stimulation of the cheek prompts turning of mouth to that side
E. Stimulation of the dorsum of the foot leads to a step-up movement

Answer: C. Stimulation of a fall leads to extension of arms

Explanation: The reflex that persists throughout life is the parachute reflex, which involves the extension of the arms when a baby is stimulated as if they are falling. This reflex appears at around 6-9 months of age and continues into adulthood as a protective response to prevent injury during falls.

10.

A 25-year-old woman presents with amenorrhea, hirsutism, and obesity. Laboratory findings show elevated testosterone and LH levels. Which of the following is the most likely diagnosis?

A. Polycystic ovary syndrome (PCOS)
B. Cushing’s syndrome
C. Hypothyroidism
D. Hyperprolactinemia
E. Adrenal hyperplasia

Answer: A. Polycystic ovary syndrome (PCOS)

Explanation: PCOS is characterized by amenorrhea, hirsutism, obesity, and elevated levels of testosterone and LH.

11.

A 32-year-old woman presents with fatigue, cold intolerance, and weight gain. Physical examination reveals a diffusely enlarged thyroid gland. Laboratory findings show low T4 and elevated TSH levels. Which of the following is the most likely diagnosis?

A. Graves’ disease
B. Hashimoto’s thyroiditis
C. Subacute thyroiditis
D. Iodine deficiency
E. Thyroid cancer

Answer: B. Hashimoto’s thyroiditis

Explanation: Hashimoto’s thyroiditis is an autoimmune condition that results in hypothyroidism, characterized by low T4, elevated TSH, and an enlarged thyroid gland.

12.

A 28-year-old man presents with severe pain and swelling in the right knee following a basketball game. Which of the following is the most likely diagnosis?

A. Osteoarthritis
B. Gout
C. Septic arthritis
D. Meniscal tear
E. Patellar tendinitis

Answer: D. Meniscal tear

Explanation: A meniscal tear is a common sports injury that presents with pain and swelling in the knee following trauma or activity.

13.

A 70-year-old woman presents with progressive memory loss and difficulty performing daily activities. Which of the following is the most likely diagnosis?

A. Delirium
B. Vascular dementia
C. Alzheimer’s disease
D. Depression
E. Lewy body dementia

Answer: C. Alzheimer’s disease

Explanation: Alzheimer’s disease is characterized by progressive memory loss and cognitive decline, affecting daily activities.

14.

A 25-year-old man presents with recurrent episodes of hematuria, particularly after upper respiratory infections. Which of the following is the most likely diagnosis?

A. Polycystic kidney disease
B. IgA nephropathy
C. Post-streptococcal glomerulonephritis
D. Goodpasture syndrome
E. Alport syndrome

Answer: B. IgA nephropathy

Explanation: IgA nephropathy is characterized by recurrent hematuria, often triggered by upper respiratory infections.

15.

A 65-year-old man presents with urinary hesitancy, weak stream, and nocturia. Which of the following is the most likely diagnosis?

A. Prostate cancer
B. Bladder cancer
C. Benign prostatic hyperplasia (BPH)
D. Urinary tract infection
E. Chronic prostatitis

Answer: C. Benign prostatic hyperplasia (BPH)

Explanation: BPH is a common condition in older men, characterized by urinary hesitancy, weak stream, and nocturia due to the enlargement of the prostate gland.

16.

A 45-year-old woman presents with a butterfly-shaped rash on her face, joint pain, and photosensitivity. Which of the following is the most likely diagnosis?

A. Rheumatoid arthritis
B. Systemic lupus erythematosus (SLE)
C. Dermatomyositis
D. Psoriasis
E. Rosacea

Answer: B. Systemic lupus erythematosus (SLE)

Explanation: SLE is an autoimmune disorder characterized by a butterfly-shaped facial rash, joint pain, and photosensitivity among other systemic symptoms.

17.

A 50-year-old man with chronic alcoholism presents with confusion, ataxia, and ophthalmoplegia. Which of the following is the most likely diagnosis?

A. Korsakoff syndrome
B. Hepatic encephalopathy
C. Wernicke encephalopathy
D. Alcoholic neuropathy
E. Delirium tremens

Answer: C. Wernicke encephalopathy

Explanation: Wernicke encephalopathy, caused by thiamine deficiency in chronic alcoholism, presents with confusion, ataxia, and ophthalmoplegia.

18.

A 40-year-old woman presents with a history of multiple episodes of passing out without warning. She describes these episodes as sudden and occurring without any preceding symptoms. Which of the following is the most likely diagnosis?

A. Vasovagal syncope
B. Cardiac arrhythmia
C. Hypoglycemia
D. Orthostatic hypotension
E. Seizure

Answer: B. Cardiac arrhythmia

Explanation: Sudden episodes of syncope without warning are suggestive of a cardiac arrhythmia, which can cause sudden changes in cardiac output and lead to fainting.

19.

A 55-year-old woman presents with episodic severe headache, palpitations, and sweating. Which of the following is the most likely diagnosis?

A. Migraine
B. Pheochromocytoma
C. Hyperthyroidism
D. Panic disorder
E. Cluster headache

Answer: B. Pheochromocytoma

Explanation: Pheochromocytoma is a tumor of the adrenal gland that secretes catecholamines, causing episodic headaches, palpitations, and sweating.

20.

A 70-year-old man with a history of chronic obstructive pulmonary disease (COPD) presents with increased shortness of breath and a productive cough with purulent sputum. Which of the following is the most appropriate initial treatment?

A. Inhaled corticosteroids
B. Long-acting beta-agonists
C. Antibiotics and corticosteroids
D. Oxygen therapy
E. Anticholinergic agents

Answer: C. Antibiotics and corticosteroids

Explanation: An acute exacerbation of COPD with purulent sputum suggests a bacterial infection; thus, antibiotics and corticosteroids are the appropriate initial treatment.

21.

A 35-year-old man presents with fatigue, weight loss, and abdominal pain. Physical examination reveals hyperpigmentation of the skin. Laboratory findings show hyponatremia and hyperkalemia. Which of the following is the most likely diagnosis?

A. Addison’s disease
B. Cushing’s syndrome
C. Hyperthyroidism
D. Hypoparathyroidism
E. Pheochromocytoma

Answer: A. Addison’s disease

Explanation: Addison’s disease is characterized by adrenal insufficiency, leading to symptoms such as fatigue, weight loss, abdominal pain, hyperpigmentation, hyponatremia, and hyperkalemia.

22.

A 50-year-old woman presents with chronic diarrhea, weight loss, and a pruritic, blistering rash on her elbows and knees. Which of the following is the most likely diagnosis?

A. Crohn’s disease
B. Ulcerative colitis
C. Celiac disease
D. Irritable bowel syndrome
E. Dermatitis herpetiformis

Answer: C. Celiac disease

Explanation: Celiac disease is associated with chronic diarrhea, weight loss, and dermatitis herpetiformis, a pruritic, blistering rash often found on the elbows and knees.

23.

A 65-year-old man with a history of hypertension and diabetes presents with sudden, painless loss of vision in his right eye. Fundoscopic examination reveals a pale retina with a cherry-red spot at the fovea. Which of the following is the most likely diagnosis?

A. Retinal detachment
B. Central retinal artery occlusion
C. Central retinal vein occlusion
D. Diabetic retinopathy
E. Acute angle-closure glaucoma

Answer: B. Central retinal artery occlusion

Explanation: Central retinal artery occlusion presents with sudden, painless loss of vision and a characteristic fundoscopic finding of a pale retina with a cherry-red spot at the fovea.

24.

A 45-year-old man presents with chronic cough and weight loss. He has a 30-pack-year smoking history. Chest X-ray shows a centrally located mass. Which of the following is the most likely diagnosis?

A. Adenocarcinoma
B. Squamous cell carcinoma
C. Small cell lung cancer
D. Large cell carcinoma
E. Bronchioalveolar carcinoma

Answer: C. Small cell lung cancer

Explanation: Small cell lung cancer is often centrally located and associated with smoking history. It presents with rapid progression and significant weight loss.

25.

A 30-year-old woman presents with heat intolerance, weight loss, and palpitations. Physical examination reveals a diffusely enlarged thyroid gland. Which of the following is the most likely diagnosis?

A. Hashimoto’s thyroiditis
B. Subacute thyroiditis
C. Graves’ disease
D. Toxic multinodular goiter
E. Thyroid carcinoma

Answer: C. Graves’ disease

Explanation: Graves’ disease is an autoimmune disorder that leads to hyperthyroidism, characterized by a diffusely enlarged thyroid, heat intolerance, and palpitations.

26.

A 65-year-old woman with a history of osteoporosis presents with acute lower back pain after a minor fall. Which of the following is the most likely diagnosis?

A. Lumbar strain
B. Herniated disc
C. Vertebral compression fracture
D. Spinal stenosis
E. Sciatica

Answer: C. Vertebral compression fracture

Explanation: Osteoporosis increases the risk of vertebral compression fractures, often caused by minor trauma or falls, resulting in acute lower back pain.

27.

A 70-year-old man with atrial fibrillation presents with sudden onset of unilateral leg pain and pallor. Which of the following is the most likely diagnosis?

A. Deep vein thrombosis
B. Peripheral artery disease
C. Acute arterial occlusion
D. Cellulitis
E. Chronic venous insufficiency

Answer: C. Acute arterial occlusion

Explanation: Acute arterial occlusion often presents with sudden onset of pain, pallor, and other signs of ischemia in the affected limb, particularly in patients with atrial fibrillation.

28.

A 35-year-old man presents with a rash on his palms and soles, fever, and generalized lymphadenopathy. He admits to unprotected sexual encounters. Which of the following is the most likely diagnosis?

A. Syphilis
B. Gonorrhea
C. HIV infection
D. Herpes simplex
E. Chlamydia

Answer: A. Syphilis

Explanation: Secondary syphilis presents with a rash on the palms and soles, fever, and generalized lymphadenopathy, often following unprotected sexual encounters.

29.

A 50-year-old woman presents with episodic vertigo, tinnitus, and hearing loss. Which of the following is the most likely diagnosis?

A. Benign paroxysmal positional vertigo (BPPV)
B. Meniere’s disease
C. Vestibular neuritis
D. Acoustic neuroma
E. Labyrinthitis

Answer: B. Meniere’s disease

Explanation: Meniere’s disease is characterized by episodic vertigo, tinnitus, and hearing loss, typically affecting one ear.

30.

A 40-year-old woman presents with fatigue, muscle weakness, and difficulty climbing stairs. Physical examination reveals ptosis and a flattened smile. Laboratory findings show antibodies against acetylcholine receptors. Which of the following is the most likely diagnosis?

A. Multiple sclerosis
B. Amyotrophic lateral sclerosis (ALS)
C. Myasthenia gravis
D. Lambert-Eaton myasthenic syndrome
E. Guillain-Barre syndrome

Answer: C. Myasthenia gravis

Explanation: Myasthenia gravis is characterized by muscle weakness, ptosis, and antibodies against acetylcholine receptors, causing fatigable weakness and difficulty with repetitive movements.

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