FREE NCCPA PANRE Guide 2026: Pass Recertification on First Try
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A 62-year-old male presents with chest pressure radiating to his left arm that began 30 minutes ago while walking. He is diaphoretic and nauseated. Vital signs: BP 148/92, HR 98, RR 18, SpO2 94% on room air. ECG shows ST-segment elevation in leads V1-V4. Which is the most appropriate immediate management?
Panre Cardiovascular
Question · Medium
Two exes, two antidotes
Short
Complete FREE 2026 NCCPA PANRE study guide covering the 240-question exam, PANRE-LA alternative, CME rules, blueprint percentages, fees, and test-day strategy.
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First-Line Treatment for Stable Heart Failure with Reduced EF
Cardiovascular
Flashcard
A 58-year-old female with a history of hypertension presents for follow-up. Her home BP readings average 145/88 mmHg. She is currently on lisinopril 10mg daily. She reports occasional dizziness on standing. What is the most appropriate next step?
Common sustained arrhythmia with irregular R-R intervals and no distinct P waves on ECG.
Cardiovascular System
Guess the Term
Introduction & PANRE Exam Overview
1.1 PANRE Exam Facts
Study guide
Cheat sheet
A 72-year-old male with heart failure presents with worsening dyspnea and peripheral edema. He has been non-adherent with his low-sodium diet. On exam: JVD at 8cm, crackles bilaterally, 2+ pitting edema. Current meds include furosemide 40mg daily. What is the most appropriate intervention?
Read the clue and guess the term in 6 tries.
Game
Atrial Fibrillation Stroke Risk Stratification
A 45-year-old female presents with sudden onset of pleuritic chest pain and dyspnea. She recently returned from a 12-hour flight. HR 110, RR 22, SpO2 90% on room air. D-dimer is elevated. CT pulmonary angiography confirms bilateral pulmonary emboli. What is the preferred initial treatment?
Most common type of VTE, forming in the lower leg, thigh or pelvis; a piece can break loose and travel to the lungs.
A 68-year-old male with atrial fibrillation on warfarin presents for follow-up. His INR is 6.2 (therapeutic range 2-3). He has no active bleeding. What is the most appropriate management?
Question · Easy
ACE Inhibitor Class Effects
A 55-year-old male presents with exertional chest pain that resolves with rest. He has a family history of premature CAD. Stress testing reveals reversible ischemia in the inferior wall. Cardiac catheterization shows 70% stenosis of the right coronary artery. What is the recommended management?
Condition confirmed when post-bronchodilator FEV1/FVC stays below 0.7 on spirometry; emphysema and bronchitis are its two main forms.
Pulmonary System
1.2 Maintaining Certification & Eligibility
A 35-year-old female with asthma presents with increased wheezing and shortness of breath. She uses her albuterol inhaler daily and has nighttime awakenings 2-3 times per week. Her FEV1 is 75% of predicted. What is the most appropriate next step?
Panre Pulmonary
Swap tiles to line up three of the same term.
Term Match
Hypertension Treatment Thresholds
A 68-year-old male with COPD presents with increased dyspnea and sputum production. He has been using his albuterol inhaler more frequently. On exam: diminished breath sounds, prolonged expiration. Which antibiotic regimen is most appropriate for this COPD exacerbation?
Repeated upper airway closure during the night, rated at least mild at an AHI of 5 with daytime drowsiness and moderate to severe at 15 or more.
A 42-year-old male presents with fever, productive cough, and pleuritic chest pain for 3 days. Vital signs: T 38.2°C, HR 102, RR 22, BP 128/78. Physical exam reveals crackles in the right lower lobe. Chest X-ray shows right lower lobe consolidation. What is the preferred empiric antibiotic for outpatient treatment?
Statin Indication Categories
A 55-year-old obese male presents with excessive daytime sleepiness and morning headaches. His wife reports loud snoring and witnessed apneas. What is the most appropriate initial diagnostic test?
Long-lasting condition that causes repeated heartburn, a burning feeling behind the breastbone, or other bothersome symptoms.
Gastrointestinal/Nutrition
1.3 Content Blueprint & Study Strategy
A 28-year-old male presents with sudden onset of sharp right-sided chest pain and shortness of breath. He has a history of spontaneous pneumothorax. Chest X-ray shows a 15% right-sided pneumothorax with no mediastinal shift. The patient is hemodynamically stable with SpO2 96% on room air. What is the most appropriate management?
Flip two cards at a time to find matching terms.
Term Pairs
COPD vs. Asthma Reversibility
Pulmonary
A 45-year-old male presents with heartburn occurring 3-4 times per week, especially after meals and when lying down. He denies dysphagia, weight loss, or melena. What is the most appropriate initial management?
Panre Gi Nutrition
Mucosal break in the stomach or duodenum, most often from H. pylori infection or NSAIDs.
A 28-year-old female presents with intermittent abdominal pain and diarrhea for 3 months. Stool studies are negative for infection. Colonoscopy reveals continuous inflammation from the rectum to the splenic flexure with friable mucosa and loss of vascular pattern. Biopsies confirm chronic active colitis. What is the diagnosis?
Asthma Step-Up Therapy
A 52-year-old male with a history of alcohol use presents with severe epigastric pain radiating to the back, nausea, and vomiting. Serum lipase is 1200 U/L (normal <160). CT abdomen shows peripancreatic fat stranding. What is the most important initial management priority?
Glaucoma treatment target, higher than normal for most people above 21 mm Hg, though some patients develop the disease at normal values.
Eyes, Ears, Nose, Throat
Cardiovascular & Pulmonary Systems
2.1 Cardiovascular I: Ischemic, Heart Failure & Vascular
A 35-year-old female presents with right upper quadrant pain after eating fatty meals. Ultrasound reveals gallstones and a thickened gallbladder wall. She has had 3 similar episodes in the past 2 months. What is the definitive treatment?
Find five hidden terms in a grid of letters.
Term Search
Community-Acquired Pneumonia Severity
A 58-year-old male presents with fatigue and is found to have microcytic anemia. Stool guaiac is positive. Colonoscopy reveals a 4cm mass in the sigmoid colon. Biopsy confirms adenocarcinoma. CT chest/abdomen/pelvis shows no metastatic disease. What is the next step?
Brief spinning spells triggered by rolling over in bed or tilting the head, caused by loose crystals in the inner ear.
A 6-year-old child presents with ear pain and fever. Otoscopy reveals a bulging, erythematous tympanic membrane with loss of light reflex. What is the most appropriate initial treatment?
Panre Eent
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