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Exam Review

Key Facts: PANCE Exam

91.5%

First-Time Pass Rate

NCCPA 2025

300

Total Questions

5 blocks of 60

350

Passing Score

Scaled 200-800

$135,880

Median PA Salary

BLS May 2025

11%

Cardiovascular

Largest section

21%

Job Growth

BLS 2025-2035

NCCPA reports a 91.5% first-time PANCE pass rate for 2025. The exam contains 300 multiple-choice questions in five 60-question blocks over 5 hours. Content follows the NCCPA blueprint effective January 2025, with cardiovascular (11%), pulmonary (9%), and GI/nutrition and musculoskeletal (8% each) as the largest sections. Physician assistants earned a median wage of $135,880 in May 2025, and BLS projects 21% job growth from 2025 to 2035.

Sample PANCE Practice Questions

Try these sample questions to review concepts for the PANCE exam. Each question includes a detailed explanation. Start the interactive quiz above for the full 200+ question experience with AI tutoring.

1A 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?
A.Aspirin and nitroglycerin only
B.Emergency cardiac catheterization within 90 minutes
C.Heparin drip and observation
D.Cardiac stress test the next day
Explanation: This patient presents with an ST-elevation myocardial infarction (STEMI) involving the anterior wall (ST elevation in V1-V4). The standard of care is emergency reperfusion therapy via percutaneous coronary intervention (PCI) within 90 minutes of first medical contact. Aspirin and nitroglycerin are important adjuncts but do not replace reperfusion therapy.
2A 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?
A.Chronic obstructive pulmonary disease
B.Congestive heart failure
C.Pulmonary embolism
D.Acute coronary syndrome
Explanation: The triad of dyspnea on exertion, orthopnea, and lower extremity edema, combined with an S3 gallop (indicative of volume overload and ventricular dysfunction), strongly suggests congestive heart failure. The S3 sound occurs during early diastole when blood flows into a ventricle that is already volume-overloaded.
3A 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?
A.Immediate thrombolysis if within 4.5 hours of symptom onset
B.Aspirin 325 mg only
C.Heparin drip with immediate anticoagulation
D.Warfarin initiation
Explanation: This patient presents with acute ischemic stroke secondary to cardioembolism from atrial fibrillation. If within the therapeutic window (typically 4.5 hours from symptom onset), IV thrombolysis with alteplase is indicated for eligible patients after ruling out hemorrhage. Anticoagulation for stroke prevention is started later, not immediately after acute stroke.
4On 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?
A.Mitral regurgitation
B.Aortic stenosis
C.Mitral stenosis
D.Tricuspid regurgitation
Explanation: A harsh, crescendo-decrescendo systolic murmur at the right upper sternal border radiating to the carotids is characteristic of aortic stenosis. This is the classic description of the murmur caused by turbulent flow across a stenotic aortic valve. The radiation to the carotids occurs because the stenotic valve creates a high-velocity jet that follows the direction of blood flow.
5A 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?
A.Less than 120/80 mmHg
B.Less than 130/80 mmHg
C.Less than 140/90 mmHg
D.Less than 150/90 mmHg
Explanation: According to JNC 8 guidelines, the blood pressure goal for patients under 60 years of age is less than 140/90 mmHg. For patients 60 years or older, the goal is less than 150/90 mmHg. This patient is 45 years old, so the target is less than 140/90 mmHg.
6A 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?
A.Acute myocardial infarction
B.Cardiac tamponade
C.Aortic dissection
D.Pulmonary embolism
Explanation: The triad of hypotension, jugular venous distension, and muffled heart sounds (Beck's triad) is characteristic of cardiac tamponade. This is a life-threatening condition where fluid accumulation in the pericardium compresses the heart, impairing ventricular filling and reducing cardiac output.
7A 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?
A.Add inhaled corticosteroid and discharge home
B.Oral corticosteroids and reassess
C.Systemic corticosteroids and consider hospitalization
D.Antibiotics for presumed pneumonia
Explanation: This patient has moderate to severe asthma exacerbation (PEF 60% of predicted, poor response to initial bronchodilator). Guidelines recommend systemic corticosteroids and hospitalization for monitoring. Oral steroids alone would be insufficient, and antibiotics are not indicated unless there is evidence of bacterial infection.
8A 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?
A.Asthma
B.Chronic obstructive pulmonary disease
C.Congestive heart failure
D.Interstitial lung disease
Explanation: The diagnosis is chronic obstructive pulmonary disease (COPD). Key findings include smoking history, irreversible airflow obstruction (FEV1/FVC < 0.70, FEV1 reduced), and chronic symptoms. The non-reversibility with bronchodilators differentiates COPD from asthma.
9A 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?
A.Chest X-ray
B.CT pulmonary angiography
C.D-dimer test
D.Arterial blood gas
Explanation: This patient presents with classic symptoms and risk factors for pulmonary embolism. The appropriate initial diagnostic approach is to assess clinical probability (using a validated score like Wells or Geneva) and then obtain D-dimer testing for patients with low to intermediate probability. A negative D-dimer effectively rules out PE in these patients.
10A 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?
A.Vancomycin and piperacillin-tazobactam
B.Azithromycin or doxycycline
C.Ceftriaxone and azithromycin
D.Oseltamivir
Explanation: This patient has community-acquired pneumonia (CAP) with low severity. For outpatient CAP without comorbidities, guidelines recommend monotherapy with a macrolide (azithromycin) or doxycycline. The combination therapy (ceftriaxone + macrolide) is reserved for hospitalized patients or those with comorbidities.

About the PANCE Exam

The PANCE is the national certification examination for physician assistants. The exam covers medical content across all organ systems including cardiovascular, pulmonary, GI/nutrition, musculoskeletal, neurologic, psychiatry, infectious diseases, reproductive, endocrine, EENT, and professional practice.

Exam sponsor: NCCPA. The requirements and fees below concern the certification or admission exam, separate from our free practice resources.

Questions

300 questions

Time Limit

5 hours

Passing Score

350 (scaled score)

Exam / Certification Fees

$550

Exam sponsor website

Reported exam pass rate: 91.5%. first-time pass rate (NCCPA 2025) This describes exam candidates, not OpenExamPrep users or results from using our resources. Exam sponsor website

Fees, eligibility, and exam policies can change. Confirm them with the exam sponsor before applying or paying.

Our practice resources: topics covered

We aim to reflect publicly available exam outlines and topic information in our study resources. Coverage, format, and difficulty may differ from the actual exam, and we cannot guarantee that every detail is accurate or current. Confirm exam requirements, fees, and policies with the official exam sponsor.

11%

Cardiovascular System

Hypertension, coronary artery disease, heart failure, arrhythmias, valvular disease, peripheral vascular disease

9%

Pulmonary System

Asthma, COPD, pneumonia, pulmonary embolism, sleep apnea, lung cancer, interstitial lung disease

8%

GI/Nutrition

GERD, peptic ulcer disease, hepatitis, pancreatitis, inflammatory bowel disease, gallbladder disease

8%

Musculoskeletal

Osteoarthritis, rheumatoid arthritis, fractures, low back pain, osteoporosis, gout, fibromyalgia

7%

Neurologic System

Stroke, seizure disorders, headache, dementia, multiple sclerosis, Parkinson disease

7%

Psychiatry/Behavioral

Depression, anxiety disorders, bipolar disorder, schizophrenia, substance use disorders, personality disorders

7%

Infectious Diseases

HIV/AIDS, hepatitis, bacterial infections, viral infections, tick-borne diseases, STIs, tuberculosis

7%

Reproductive System

Contraception, pregnancy complications, menstrual disorders, menopause, pelvic inflammatory disease, breast disorders

6%

Endocrine System

Diabetes mellitus, thyroid disorders, adrenal disorders, pituitary disorders, metabolic syndrome

6%

EENT (Eyes/Ears/Nose/Throat)

Conjunctivitis, glaucoma, hearing loss, sinusitis, otitis media/externa, pharyngitis

6%

Professional Practice

Ethics, legal issues, patient safety, evidence-based medicine, cultural competence, health disparities

5%

Hematologic System

Anemia, clotting disorders, leukemia, lymphoma, transfusion reaction

5%

Renal System

Acute kidney injury, chronic kidney disease, acid-base, fluid and electrolyte disorders, renovascular disease, rhabdomyolysis

4%

Dermatologic System

Acne, eczema, psoriasis, skin infections, melanoma, dermatitis, wound care

4%

Genitourinary System

UTIs, BPH, erectile dysfunction, incontinence, STIs, renal calculi

Preparing for the PANCE Exam

What You Need to Know

  • Passing score: 350 (scaled score)
  • Exam length: 300 questions
  • Time limit: 5 hours
  • Exam / certification fees: $550 Official sources

Using Our Practice Resources

  • Work through all 200 available questions
  • Review every answer and explanation
  • Track weak areas and revisit them
  • Use our AI tutor for tough concepts

PANCE: Suggested Study Strategy

1Focus on high-yield organ systems: cardiovascular (11%), pulmonary (9%), GI/nutrition (8%), and musculoskeletal (8%) account for 36% of the exam
2Practice with timed blocks of 60 questions to simulate exam conditions and build stamina for the 5-hour test
3Master common presentations: know the classic presentations, diagnostic workup, and first-line treatments for the most common conditions
4Review professional practice topics: ethics, patient safety, and evidence-based medicine questions can be high-yield
5Understand pharmacology: medication mechanisms, side effects, contraindications, and drug interactions are heavily tested

Frequently Asked Questions

What is the PANCE pass rate?

NCCPA reports a 91.5% pass rate for first-time PANCE takers in 2025 (13,145 candidates) and an 88.4% pass rate across all 14,669 exams administered that year. The 2024 first-time pass rate was 92.4%.

How many questions are on the PANCE?

The PANCE consists of 300 multiple-choice questions administered over 5 hours in five 60-minute blocks of 60 questions each. There is a 15-minute tutorial and 45 minutes of scheduled break time.

How long should I study for the PANCE?

Most PA students study for 4-6 weeks before the PANCE, completing 1,500-2,500 practice questions. Create a study schedule covering all organ systems, with more time allocated to high-yield areas like cardiovascular, pulmonary, and GI. Use our practice questions to identify weak areas.

What is the PANCE passing score?

The PANCE uses a scaled scoring system with a passing score of 350. Scores range from 200-800. You will receive your score report within 2 weeks of testing, showing your total score and relative performance in each content area.

How much do Physician Assistants earn?

BLS reports a median annual wage of $135,880 for physician assistants in May 2025; the highest 10 percent earned more than $190,280. BLS projects employment of physician assistants to grow 21 percent from 2025 to 2035, much faster than the average for all occupations.

What are the largest content areas on the PANCE?

Cardiovascular System (11%) is the largest content area, followed by Pulmonary System (9%), then Gastrointestinal System/Nutrition and Musculoskeletal System (8% each). Infectious Diseases, Neurologic System, Psychiatry/Behavioral Science and Reproductive System follow at 7% each.