PANCE Exam Guide 2026: Study by the 2025 NCCPA Blueprint
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A 58-year-old male presents with crushing chest pain radiating to his left arm and jaw. The pain started 45 minutes ago while he was at rest. He is diaphoretic and nauseated. ECG shows ST elevation in leads V1-V4. Which of the following is the most appropriate immediate management?
Pance Cardiovascular
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Doctor lie detector test
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A source-checked 2026 PANCE guide covering the active NCCPA blueprint, 300-question format, $550 fee, eligibility, scoring, retake rules, and a six-week study plan.
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STEMI versus NSTEMI: what separates them, and how does that change the first hour of care?
Cardiovascular System
Flashcard
A 67-year-old woman with hypertension presents with dyspnea on exertion, orthopnea, and lower extremity edema. On examination, an S3 gallop is heard. Which of the following is the most likely diagnosis?
Question · Easy
Most common medicine class used to treat high blood cholesterol, lowering it by reducing how much the liver makes.
Cardiovascular system
Guess the Term
Chapter 1: Cardiovascular System
1.1 Hypertension (Essential & Secondary)
Study guide
Cheat sheet
A 55-year-old man with a history of atrial fibrillation presents with sudden onset of right-sided weakness and aphasia. He is not anticoagulated. CT scan shows no hemorrhage. What is the most appropriate immediate management?
Read the clue and guess the term in 6 tries.
Game
Which four drug classes form guideline-directed therapy for heart failure with reduced ejection fraction, and which of them actually reduce mortality?
On cardiac examination, a patient has a harsh, crescendo-decrescendo systolic murmur heard best at the right upper sternal border that radiates to the carotid arteries. What is the most likely diagnosis?
Warning sign of coronary heart disease: chest pain or discomfort when part of the heart muscle does not get enough oxygen-rich blood.
A 45-year-old patient with newly diagnosed hypertension has blood pressure readings averaging 158/96 mmHg on three separate occasions. There are no other cardiovascular risk factors. According to JNC 8 guidelines, what is the target blood pressure for this patient?
At the bedside, how do you tell the murmur of aortic stenosis from mitral regurgitation?
A 72-year-old man with coronary artery disease develops sudden severe chest pain, hypotension, and jugular venous distension. Heart sounds are muffled. What is the most likely diagnosis?
Chronic condition in which the airways become inflamed and narrowed at times, making it hard to breathe out.
Pulmonary system
1.2 Coronary Artery Disease & Myocardial Infarction
A 25-year-old man with a history of asthma presents with wheezing, shortness of breath, and cough. Peak expiratory flow is 60% of predicted. He has used his albuterol inhaler twice without relief. What is the next best step in management?
Pance Pulmonary
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Term Match
What does the CHA2DS2-VASc score measure, and at what score do you anticoagulate in nonvalvular atrial fibrillation?
A 68-year-old smoker with a 40 pack-year history presents with worsening dyspnea and chronic cough. Spirometry shows FEV1/FVC ratio of 0.62 and FEV1 55% predicted that is not reversible with bronchodilators. What is the most likely diagnosis?
Condition caused by damage to the airways that makes breathing hard, usually from cigarette smoking.
A 35-year-old woman presents with acute onset of pleuritic chest pain and dyspnea. She recently returned from a long international flight. Physical examination reveals tachypnea and tachycardia. What is the most appropriate initial diagnostic test?
Hypertensive emergency versus hypertensive urgency: what defines each, and how fast should the pressure come down?
A 42-year-old man presents with fever, productive cough, and pleuritic chest pain for 3 days. Chest X-ray shows a right lower lobe infiltrate. His vital signs are stable. What is the most appropriate empiric antibiotic therapy for outpatient management?
___ disease, an immune disorder triggered by gluten that damages the small intestine.
Digestive system
1.3 Heart Failure & Cardiomyopathy
A 55-year-old man with a history of alcohol use presents with fever, night sweats, weight loss, and productive cough for 3 weeks. Chest X-ray shows cavitary lesions in the upper lobes. Sputum acid-fast bacilli smear is positive. What is the most likely diagnosis?
Flip two cards at a time to find matching terms.
Term Pairs
When does a D-dimer help in suspected pulmonary embolism, and when will it mislead you?
A 45-year-old man presents with epigastric pain that improves with eating. He denies weight loss or vomiting. The pain has been present for 2 weeks. What is the most appropriate initial test?
Pance Gi Nutrition
Growth on the lining of the colon or rectum that is usually not cancerous but can become cancer.
A 68-year-old man with cirrhosis presents with increasing abdominal girth and weight gain. Physical examination reveals shifting dullness and a fluid wave. Paracentesis shows SAAG greater than 1.1 g/dL. What is the most likely cause of his ascites?
Which spirometry findings separate asthma from COPD, and which point to restrictive disease instead?
Pulmonary System
A 35-year-old woman presents with severe epigastric pain radiating to her back, nausea, and vomiting for 24 hours. She has a history of gallstones. Laboratory studies show elevated lipase (850 U/L) and amylase (620 U/L). What is the most likely diagnosis?
Injury ranging from a stretch to a complete tear of the bands that join one bone to another at a joint.
Musculoskeletal system
1.4 Cardiac Arrhythmias & Conduction Disorders
A 60-year-old man with diverticulosis presents with left lower quadrant abdominal pain, fever, and leukocytosis. CT scan shows colonic wall thickening and pericolic fat stranding. What is the appropriate management?
Find five hidden terms in a grid of letters.
Term Search
A previously healthy adult with community-acquired pneumonia, no comorbidities and no recent antibiotics: what is first-line outpatient therapy?
A 28-year-old man presents with bloody diarrhea, abdominal cramping, and urgency for 2 weeks. Stool studies are negative for infection. Colonoscopy reveals continuous inflammation of the rectum and sigmoid colon with friable mucosa. What is the most likely diagnosis?
Injury that is a twist, pull, or tear of a muscle or the cord that attaches it to bone.
A 65-year-old woman presents with gradual onset of knee pain that worsens with activity and improves with rest. There is no redness or warmth. X-ray shows joint space narrowing and osteophytes. What is the most likely diagnosis?
Pance Musculoskeletal
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