PANRE Exam Flashcards

Q: How many questions are on the PANRE?

The PANRE contains 240 multiple-choice questions delivered in four blocks of 60 questions, with about 4 hours of testing time within a roughly 5-hour appointment. It uses scaled scoring with a passing score of 379 on a 200-800 scale.

Q: What does the PANRE content blueprint cover?

The NCCPA blueprint spans organ-system categories weighted by clinical prevalence: Cardiovascular (12%), Pulmonary (10%), GI/Nutrition (10%), EENT (8%), Endocrine (8%), Musculoskeletal (8%), Psychiatry (7%), Infectious Disease (7%), Reproductive (5%), Dermatology (5%), Genitourinary (5%), Neurology (5%), Hematology (4%), Renal (4%), and Emergent/Professional Topics (2%).

Q: When can a PA take the PANRE?

Certified PAs maintain certification on a 10-year cycle and can take the PANRE in defined recertification years. Alternatively, eligible PAs may choose the PANRE Longitudinal Assessment (PANRE-LA), answering questions over time instead of in a single sitting.

Q: What is the PANRE Longitudinal Assessment (PANRE-LA)?

PANRE-LA is an alternative to the single-day PANRE. PAs answer a set number of questions per quarter over several years, may use references, and have a few minutes per question. Meeting the performance standard satisfies the recertification exam requirement without a one-time proctored exam.

Q: How should I prepare for the PANRE?

Prioritize the highest-weight categories—Cardiovascular, Pulmonary, and GI/Nutrition—which together approach a third of the exam. Refresh first-line treatments, drug adverse effects, USPSTF screening guidelines, and adult immunization schedules, and complete timed practice blocks to match exam pacing.

Question 1

First-Line Treatment for Stable Heart Failure with Reduced EF

Accepted Answer

Guideline-directed therapy combines an ARNI (or ACE inhibitor/ARB), an evidence-based beta blocker, a mineralocorticoid receptor antagonist, and an SGLT2 inhibitor. These four pillars reduce mortality; loop diuretics relieve congestion but do not improve survival.

Question 2

Atrial Fibrillation Stroke Risk Stratification

Accepted Answer

CHA2DS2-VASc scores stroke risk in nonvalvular atrial fibrillation. Higher scores favor anticoagulation; the decision weighs thromboembolic risk against bleeding risk (estimated with tools like HAS-BLED), not the rhythm pattern alone.

Question 3

ACE Inhibitor Class Effects

Accepted Answer

Lower blood pressure and provide renal and cardiac protection. Key adverse effects: dry cough, hyperkalemia, angioedema, and acute kidney injury in bilateral renal artery stenosis. Contraindicated in pregnancy.

Question 4

Hypertension Treatment Thresholds

Accepted Answer

Lifestyle modification is foundational. Pharmacologic therapy is recommended when blood pressure exceeds guideline thresholds, especially with elevated cardiovascular risk; first-line agents include thiazide diuretics, ACE inhibitors/ARBs, and calcium channel blockers.

Question 5

Statin Indication Categories

Accepted Answer

High-intensity statins are indicated for clinical atherosclerotic cardiovascular disease, LDL ≥190 mg/dL, and diabetes with high risk. The decision is risk-based using estimated 10-year ASCVD risk rather than LDL level alone.

Question 6

COPD vs. Asthma Reversibility

Accepted Answer

Asthma airflow obstruction is largely reversible with bronchodilators; COPD obstruction is persistent and only partially reversible. Spirometry showing a reduced FEV1/FVC ratio that does not normalize supports COPD.

Question 7

Asthma Step-Up Therapy

Accepted Answer

Treatment escalates from as-needed bronchodilator/ICS to scheduled inhaled corticosteroids and then add-on long-acting bronchodilators based on symptom control and exacerbation frequency. Frequent rescue inhaler use signals inadequate control.

Question 8

Community-Acquired Pneumonia Severity

Accepted Answer

Severity tools such as CURB-65 (confusion, urea, respiratory rate, blood pressure, age ≥65) guide outpatient versus inpatient decisions. Empiric antibiotics are chosen by setting and risk for resistant organisms.

Question 9

Pulmonary Embolism Risk Assessment

Accepted Answer

In low-probability patients, a negative D-dimer can exclude PE without imaging. In higher-probability patients, proceed directly to CT pulmonary angiography; anticoagulation is started promptly when PE is likely and bleeding risk is acceptable.

Question 10

GERD Initial Management

Accepted Answer

Lifestyle changes plus a trial of acid suppression (proton pump inhibitor) is first-line. Alarm features—dysphagia, weight loss, GI bleeding, anemia, persistent vomiting—warrant endoscopy rather than empiric therapy alone.

Question 11

Peptic Ulcer Disease Causes

Accepted Answer

The two leading causes are Helicobacter pylori infection and NSAID use. H. pylori testing and eradication is indicated for confirmed ulcers; stopping NSAIDs and starting a PPI addresses NSAID-related ulcers.

Question 12

Colorectal Cancer Screening

Accepted Answer

Average-risk screening is recommended starting at the guideline-defined age using colonoscopy or stool-based tests. A positive noninvasive test requires follow-up colonoscopy; family history may move the start age earlier.

Question 13

Acute Pancreatitis Diagnosis

Accepted Answer

Diagnosis requires two of three: characteristic epigastric pain radiating to the back, lipase or amylase elevated more than three times the upper limit, and confirmatory imaging. Gallstones and alcohol are the most common causes.

Question 14

Acute Otitis Media vs. Otitis Externa

Accepted Answer

Acute otitis media is a middle-ear infection with a bulging, immobile tympanic membrane. Otitis externa is an outer-canal infection with pain on tragus manipulation; treatment differs (systemic vs. topical antibiotics).

Question 15

Conjunctivitis Differentiation

Accepted Answer

Viral: watery discharge, often bilateral, highly contagious. Bacterial: purulent discharge. Allergic: itching with bilateral watery eyes. Pain, photophobia, or vision change suggests a more serious process needing referral.

Question 16

Acute Bacterial Sinusitis Criteria

Accepted Answer

Suspect bacterial sinusitis when symptoms persist beyond about 10 days, are severe at onset, or worsen after initial improvement (double sickening). Most acute rhinosinusitis is viral and resolves without antibiotics.

Question 17

Type 2 Diabetes First-Line Therapy

Accepted Answer

Metformin plus lifestyle modification is typically first-line. Agents with proven cardiovascular or renal benefit (GLP-1 receptor agonists, SGLT2 inhibitors) are prioritized when those comorbidities are present, regardless of A1c.

Question 18

Hypothyroidism Lab Pattern

Accepted Answer

Primary hypothyroidism shows elevated TSH with low free T4. Treatment is levothyroxine titrated to normalize TSH. Subclinical hypothyroidism has elevated TSH with normal free T4 and is treated selectively.

Question 19

Diabetic Ketoacidosis vs. HHS

Accepted Answer

DKA features ketosis and metabolic acidosis, more common in type 1 diabetes. Hyperosmolar hyperglycemic state has severe hyperglycemia and hyperosmolarity with minimal ketosis, typically in type 2 diabetes. Both require fluids and insulin with potassium monitoring.

Question 20

Adrenal Insufficiency Presentation

Accepted Answer

Fatigue, hypotension, hyponatremia, hyperkalemia, and hyperpigmentation (in primary disease). Adrenal crisis is life-threatening and treated with immediate stress-dose glucocorticoids and fluids before confirmatory testing.

Question 21

Gout Acute vs. Long-Term Therapy

Accepted Answer

Acute flares are treated with NSAIDs, colchicine, or corticosteroids. Urate-lowering therapy (e.g., allopurinol) is for long-term prevention and is not started to treat an acute flare, though established therapy is continued through one.

Question 22

Rheumatoid Arthritis vs. Osteoarthritis

Accepted Answer

Rheumatoid arthritis is symmetric, inflammatory, with prolonged morning stiffness and systemic features. Osteoarthritis is degenerative with brief stiffness and activity-related pain. Early RA requires DMARD therapy to prevent joint damage.

Question 23

Acute Low Back Pain Red Flags

Accepted Answer

Most acute low back pain is self-limited and managed conservatively. Imaging is reserved for red flags: significant trauma, neurologic deficit, suspected infection or malignancy, or cauda equina signs (saddle anesthesia, bladder/bowel dysfunction).

Question 24

Major Depressive Disorder First-Line Treatment

Accepted Answer

SSRIs are typically first-line, with onset of benefit taking several weeks. Assess suicide risk at baseline and follow-up, monitor for activation early in treatment, and combine pharmacotherapy with psychotherapy when feasible.

Question 25

Bipolar Disorder Treatment Caution

Accepted Answer

Antidepressant monotherapy can precipitate mania in bipolar disorder. Mood stabilizers or atypical antipsychotics are foundational, so screening for prior manic or hypomanic episodes before treating depression is essential.

Question 26

Serotonin Syndrome

Accepted Answer

Excess serotonergic activity, often from drug combinations, causing autonomic instability, neuromuscular hyperactivity (clonus, hyperreflexia), and altered mental status. Treatment is stopping the offending agents and supportive care.

Question 27

Latent Tuberculosis Treatment Goal

Accepted Answer

A positive screening test (TST or IGRA) with no active disease indicates latent TB. Treatment with an approved regimen prevents progression to active disease; active TB must be excluded before starting latent treatment.

Question 28

Sepsis Recognition and Bundle

Accepted Answer

Suspect sepsis with infection plus organ dysfunction or hypoperfusion. Early management includes obtaining cultures, lactate, prompt broad-spectrum antibiotics, and fluid resuscitation—time to antibiotics affects outcomes.

Question 29

Antibiotic Stewardship Principle

Accepted Answer

Use the narrowest effective agent for the shortest appropriate duration, guided by likely pathogen and local resistance. Avoiding antibiotics for viral infections reduces resistance and adverse effects such as C. difficile colitis.

Question 30

Uncomplicated UTI Management

Accepted Answer

Uncomplicated cystitis in healthy nonpregnant women is treated empirically with a short course of a first-line agent based on local resistance. Urine culture is reserved for complicated, recurrent, or treatment-failure cases.

Question 31

Benign Prostatic Hyperplasia Therapy

Accepted Answer

Alpha-blockers relieve obstructive symptoms quickly; 5-alpha-reductase inhibitors shrink the prostate over months and are useful for larger glands. Acute urinary retention requires catheterization and evaluation.

Question 32

Acute Stroke Time Sensitivity

Accepted Answer

Establishing last-known-well time determines eligibility for time-dependent reperfusion therapy. Sudden focal deficit prompts urgent neuroimaging to distinguish ischemic from hemorrhagic stroke before treatment.

Question 33

Primary Headache Red Flags

Accepted Answer

Most headaches are primary (migraine, tension, cluster). Warning features—thunderclap onset, neurologic deficit, fever with neck stiffness, new headache after age 50, or headache with immunosuppression—require urgent workup.

Question 34

Seizure vs. Syncope

Accepted Answer

Postictal confusion, tongue biting (lateral), and prolonged recovery favor seizure. Rapid full recovery with a clear trigger favors syncope. First unprovoked seizure warrants neuroimaging and evaluation for an underlying cause.

Question 35

Iron Deficiency Anemia Workup

Accepted Answer

Microcytic anemia with low ferritin indicates iron deficiency. In adults, especially older men and postmenopausal women, occult GI blood loss must be evaluated rather than treating with iron alone.

Question 36

Anticoagulant Reversal

Accepted Answer

Vitamin K (with prothrombin complex concentrate for urgent reversal) counters warfarin. Specific reversal agents exist for certain direct oral anticoagulants. Knowing the agent and indication guides safe reversal during bleeding.

Question 37

Acute Kidney Injury Categories

Accepted Answer

Prerenal (hypoperfusion), intrinsic (tubular, glomerular, interstitial), and postrenal (obstruction). Differentiating them—using volume status, urine studies, and imaging—directs management; relieving obstruction is key in postrenal AKI.

Question 38

Chronic Kidney Disease Staging

Accepted Answer

Staged by estimated GFR and albuminuria. Management focuses on slowing progression—blood pressure control, RAAS blockade, SGLT2 inhibitors, and avoiding nephrotoxins—and preparing for renal replacement in advanced disease.

Question 39

Hyperkalemia Emergency Treatment

Accepted Answer

When ECG changes or severe elevation are present, IV calcium stabilizes the myocardium first; insulin with glucose and beta-agonists shift potassium intracellularly; and removal therapies lower total body potassium.

Question 40

Skin Cancer ABCDE Criteria

Accepted Answer

Melanoma warning signs: Asymmetry, Border irregularity, Color variation, Diameter, and Evolving lesion. A suspicious pigmented lesion warrants biopsy rather than observation alone.

Question 41

Cellulitis vs. Abscess

Accepted Answer

Cellulitis is a spreading soft-tissue infection treated with antibiotics. A fluctuant abscess requires incision and drainage as primary treatment; antibiotics are adjunctive. Distinguishing them changes management.

Question 42

Contraception and Estrogen Risk

Accepted Answer

Combined hormonal contraceptives are contraindicated with significant venous thromboembolism risk, such as smoking over age 35 or migraine with aura. Progestin-only methods are preferred alternatives in these patients.

Question 43

Cervical Cancer Screening

Accepted Answer

Screening combines cytology and/or HPV testing at guideline-defined intervals based on age and prior results. Routine screening generally stops at an upper age limit with adequate prior negative screening.

Question 44

Adult Immunization Updates

Accepted Answer

Recertification commonly tests current adult schedules—influenza, Tdap, pneumococcal, shingles, and others by age and risk. Recommendations change, so review the latest schedule rather than relying on memory.

Question 45

USPSTF Recommendation Grades

Accepted Answer

Grade A and B recommendations indicate net benefit and are generally offered; D recommendations advise against a service; I indicates insufficient evidence. Knowing grade-based screening guidance is high-yield for recertification.

Question 46

Informed Consent Elements

Accepted Answer

Valid consent requires capacity, disclosure of the nature, risks, benefits, and alternatives, voluntariness, and patient understanding. Documentation supports but does not replace the conversation.

Question 47

Duty to Warn / Protect

Accepted Answer

When a patient poses a serious, identifiable threat to another person, clinicians may have a legal and ethical duty to take protective action, which can override usual confidentiality. Specific obligations vary by jurisdiction.

Question 48

Anaphylaxis First-Line Treatment

Accepted Answer

Intramuscular epinephrine is the first-line, time-critical treatment for anaphylaxis. Antihistamines and corticosteroids are adjuncts and do not replace epinephrine; delay in epinephrine is associated with worse outcomes.

Question 49

Number Needed to Treat (NNT)

Accepted Answer

The number of patients who must receive an intervention for one to benefit; it is the reciprocal of the absolute risk reduction. A lower NNT indicates a more effective intervention for that outcome.

Question 50

Sensitivity vs. Specificity

Accepted Answer

Sensitivity is the ability to correctly identify those with disease (few false negatives, good for ruling out). Specificity is the ability to correctly identify those without disease (few false positives, good for ruling in).

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