PANCE (Physician Assistant National Certifying Exam) Practice Test
Practice stays free. The full PANCE — Physician Assistant National Certifying Examination (NCCPA) study guide is the material itself, taught start to finish — a downloadable PDF + EPUB you keep.
| Administering body | National Commission on Certification of Physician Assistants (NCCPA) — exam delivered by Pearson VUE |
|---|---|
| Questions | 300 questions |
| Time limit | 300 minutes |
| Passing score | Scaled score of 350 on a 200–800 scale |
| Fees |
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| Languages offered | Not published by NCCPA What we read and found nothing in: NCCPA — Become Certified (About PANCE) |
Frequently asked questions
How many PANCE (Physician Assistant National Certifying Exam) practice questions are here?+
A full bank of original PANCE (Physician Assistant National Certifying Exam) practice questions across the official content areas, weighted like the real exam, with explanations. Free, no signup.
What is the PANCE (Physician Assistant National Certifying Exam) exam like?+
About 300 questions, 300 minutes. Practice by topic here, then take the full timed mock exam to gauge readiness.
Are these the real exam questions?+
No. Every question is 100% original, written from public primary sources with explanations. We never copy real exam questions or paid prep material.
Can I study in Chinese or Spanish?+
PrepPass practice is in English, 中文 and Español. The official exam is in English — switch the question language to English any time to rehearse the exact terminology you'll see on test day.
Is there a study guide for the PANCE (Physician Assistant National Certifying Exam)?+
Yes. PrepPass sells PANCE Study Guide — 2026 Edition, a PDF + EPUB download, $24.99 one-time; the practice on this page stays free without it. See the study guide →
Sample practice questions
A few real questions from this free bank, with full explanations. Use the practice tool above for the whole set.
- 1. Cardiovascular System
A 34-year-old man has 3 days of sharp substernal chest pain that worsens when he lies flat or breathes deeply and eases when he sits up and leans forward. A scratchy sound is heard at the left sternal border. ECG shows diffuse ST elevation with PR depression. Which diagnosis is most likely?
- a.Inferior ST-elevation myocardial infarction
- b.Stable angina pectoris
- c.Acute pulmonary embolism
- d.Acute pericarditis
Answer: d
Explanation: Pain relieved by sitting up and leaning forward, a friction rub, and diffuse ST elevation with PR depression are the classic findings of acute pericarditis. An inferior STEMI produces regional ST elevation in II, III and aVF with reciprocal change, not a diffuse pattern with PR depression. Pulmonary embolism causes pleuritic pain and dyspnea but not a positional rub with diffuse ST elevation, and stable angina is exertional pressure that settles with rest.
- 2. Cardiovascular System
A 31-year-old woman with chronic hypertension controlled on lisinopril tells you she is 6 weeks pregnant. Which change to her antihypertensive regimen is most appropriate?
- a.Continue lisinopril and also add losartan
- b.Continue lisinopril at the same dose
- c.Stop lisinopril and switch to labetalol
- d.Stop all antihypertensives until delivery
Answer: c
Explanation: ACE inhibitors and angiotensin receptor blockers are contraindicated in pregnancy because of fetal renal toxicity, so lisinopril should be stopped and replaced with a pregnancy-compatible agent such as labetalol. Adding losartan combines two contraindicated drugs. Continuing lisinopril exposes the fetus, and stopping all treatment leaves chronic hypertension uncontrolled.
- 3. Endocrine System
A 38-year-old man has episodes of pounding headache, sweating and palpitations with blood pressure up to 230/120 mm Hg. Plasma free metanephrines are markedly elevated and CT shows a 4-cm adrenal mass. Before surgery, how should his blood pressure be managed?
- a.Alpha-blockade first, then a beta-blocker
- b.A beta-blocker first, then alpha-blockade
- c.A beta-blocker alone
- d.A thiazide diuretic alone
Answer: a
Explanation: In pheochromocytoma, alpha-adrenergic blockade (for example phenoxybenzamine or doxazosin) is started first, and a beta-blocker is added only afterward to control tachycardia. Starting a beta-blocker first leaves alpha-mediated vasoconstriction unopposed and can precipitate a hypertensive crisis. Diuretics worsen the volume contraction these patients already have.
- 4. Gastrointestinal System/Nutrition
A 50-year-old man has severe epigastric pain radiating to the back and vomiting after a weekend of heavy drinking. Serum lipase is 5 times the upper limit of normal. Which statement about confirming the diagnosis is correct?
- a.Lipase must be above 10 times normal to qualify
- b.Pain plus lipase above 3 times normal is sufficient
- c.An elevated amylase is also needed with the lipase
- d.Contrast CT is needed to confirm it in each patient
Answer: b
Explanation: Acute pancreatitis is diagnosed when at least two of three criteria are met: characteristic abdominal pain, amylase or lipase above three times the upper limit of normal, and characteristic imaging findings. With typical pain and a lipase five times normal, imaging is not needed for diagnosis. Amylase adds nothing when lipase already qualifies, and the threshold is three times normal, not ten.
- 5. Genitourinary System
A 55-year-old man has fever, chills, dysuria, perineal pain and difficulty voiding. On gentle digital rectal exam the prostate is exquisitely tender, warm and boggy. Which diagnosis is most likely?
- a.Chronic pelvic pain syndrome
- b.Benign prostatic hyperplasia
- c.Acute bacterial prostatitis
- d.Prostate adenocarcinoma
Answer: c
Explanation: Systemic symptoms with urinary symptoms and an exquisitely tender, boggy prostate indicate acute bacterial prostatitis, treated with antibiotics. Benign prostatic hyperplasia produces a smooth, enlarged, nontender gland without fever. Prostate cancer is typically a hard nodule without fever, and chronic pelvic pain syndrome causes long-standing pain without systemic infection.
- 6. Infectious Diseases
A 34-year-old man with HIV started antiretroviral therapy a year ago for a CD4 count of 90 cells/µL and has taken trimethoprim-sulfamethoxazole since. His viral load is now suppressed and his CD4 count has stayed above 200 cells/µL for 4 months. What is appropriate regarding Pneumocystis prophylaxis?
- a.It must continue for life
- b.Switch it to inhaled pentamidine
- c.Double the trimethoprim-sulfamethoxazole dose
- d.It can be discontinued
Answer: d
Explanation: Pneumocystis prophylaxis can be stopped once antiretroviral therapy raises the CD4 count to 200 cells/µL or more for at least 3 months. Lifelong prophylaxis is not required after immune recovery. Switching to pentamidine is for intolerance of trimethoprim-sulfamethoxazole, and increasing the dose has no role in prophylaxis.
- 7. Musculoskeletal System
A 13-year-old soccer player has anterior knee pain that worsens with running and kneeling. There is a tender, prominent bump over the tibial tubercle, and the knee joint is otherwise normal. What is the usual treatment?
- a.Surgical excision of the tubercle
- b.Rest, activity modification and analgesics
- c.IV antibiotics for osteomyelitis
- d.Long leg cast for 8 weeks
Answer: b
Explanation: Painful swelling of the tibial tubercle in an active adolescent is Osgood-Schlatter disease, which is managed with analgesics, rest and activity modification and is usually self-limited as the growth plate closes. Surgery is rarely needed, casting is not routine, and osteomyelitis would present with fever and systemic signs.
- 8. Psychiatry/Behavioral Science
A 50-year-old man who drinks a fifth of vodka daily is admitted for a hip fracture. On hospital day 2 he is tremulous, sweating, anxious and tachycardic, with a CIWA-Ar score of 18. Which is the first-line medication class?
- a.Benzodiazepines
- b.Haloperidol alone
- c.Beta-blockers alone
- d.Naltrexone
Answer: a
Explanation: Benzodiazepines are first-line for alcohol withdrawal because they are cross-tolerant with alcohol and prevent progression to seizures and delirium tremens; symptom-triggered dosing is guided by the CIWA-Ar. Haloperidol can lower the seizure threshold and does not treat withdrawal, beta-blockers only mask autonomic signs, and naltrexone is for relapse prevention after withdrawal.
- 9. Pulmonary System
A 50-year-old man with obesity has loud snoring, witnessed apneas, morning headaches and daytime sleepiness. Which test is used to confirm the diagnosis?
- a.Polysomnography
- b.Pulmonary function testing
- c.Overnight pulse oximetry alone
- d.Arterial blood gas at rest
Answer: a
Explanation: Suspected obstructive sleep apnea is confirmed by a sleep study, either laboratory polysomnography or a qualifying home sleep apnea test, which measures the apnea-hypopnea index; positive airway pressure is the main treatment. Oximetry alone is not sufficient for diagnosis, and pulmonary function tests and a resting blood gas do not measure sleep-related breathing events.
- 10. Reproductive System
Fifteen minutes after a vaginal delivery of a 4.3-kg infant, a woman has heavy bleeding. The placenta was delivered intact and no lacerations are seen. The uterus feels soft and boggy above the umbilicus. What are the most appropriate first measures?
- a.Packing the vagina and observing
- b.Uterine massage and IV oxytocin
- c.IV tranexamic acid as the only treatment
- d.Immediate hysterectomy
Answer: b
Explanation: A soft, boggy uterus after delivery of a large infant points to uterine atony, the most common cause of postpartum hemorrhage, treated first with uterine massage, uterotonics such as oxytocin, and fluid resuscitation. Hysterectomy is a last resort. Vaginal packing does not contract the uterus, and tranexamic acid is an adjunct rather than a substitute for treating atony.