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200+ Free PANRE Practice Questions

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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?

A
B
C
D
to track
2026 Statistics

Key Facts: PANRE Exam

240

Total Questions

NCCPA

4h

Exam Time

NCCPA

379+

Passing Score

Scaled scoring

90-95%

Pass Rate

First-time takers

$350

Exam Fee

NCCPA 2026

10 years

Recertification Cycle

NCCPA

The PANRE is a 240-question exam administered over 4 hours with a passing score of 379+ on a scaled scoring system. First-time pass rates are approximately 90-95% for well-prepared candidates. The exam covers 14 organ system categories weighted by prevalence in clinical practice. PAs must pass PANRE every 10 years (or complete the PANRE Longitudinal Assessment) to maintain NCCPA certification.

Sample PANRE Practice Questions

Try these sample questions to test your PANRE exam readiness. Each question includes a detailed explanation. Start the interactive quiz above for the full 200+ question experience with AI tutoring.

1A 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?
A.Start heparin drip and admit for observation
B.Administer aspirin, nitroglycerin, and activate the cath lab immediately
C.Order troponin levels and repeat ECG in 2 hours
D.Give morphine only and monitor pain resolution
Explanation: This patient presents with an acute ST-elevation myocardial infarction (STEMI) based on symptoms and ECG findings (ST elevation in V1-V4 indicating anterior wall involvement). The standard of care is immediate reperfusion therapy. Aspirin (antiplatelet), nitroglycerin (afterload reduction), and immediate activation of the cardiac catheterization lab for primary PCI are the correct interventions. Delaying with observation or serial troponins would worsen outcomes.
2A 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?
A.Increase lisinopril to 20mg daily
B.Add hydrochlorothiazide 25mg daily
C.Continue current regimen and recheck in 3 months
D.Switch to losartan 50mg daily
Explanation: The patient has uncontrolled hypertension (goal <130/80 for most adults per ACC/AHA guidelines). She is on an ACE inhibitor at a suboptimal dose. Given her dizziness on standing (possible orthostatic hypotension), increasing the ACE inhibitor may worsen this. Adding a thiazide diuretic is an appropriate combination therapy that works synergistically with ACE inhibitors. The dizziness should be monitored but does not preclude adding a second agent.
3A 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?
A.Increase furosemide to 80mg daily and provide dietary counseling
B.Add metoprolol succinate 25mg daily
C.Start spironolactone 25mg daily
D.Add hydralazine-isosorbide dinitrate
Explanation: This patient presents with acute decompensated heart failure, likely due to dietary indiscretion. The appropriate initial management is diuretic optimization. Increasing the loop diuretic dose and addressing the dietary non-adherence with education is the most direct approach. While beta-blockers and aldosterone antagonists are important in chronic HF management, they should not be started or adjusted during acute decompensation. The vasodilator combination is reserved for African American patients with persistent symptoms on standard therapy.
4A 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?
A.Start unfractionated heparin IV and transition to warfarin
B.Start apixaban 10mg twice daily for 7 days, then 5mg twice daily
C.Perform urgent thrombectomy
D.Start aspirin 325mg daily
Explanation: For hemodynamically stable patients with pulmonary embolism, direct oral anticoagulants (DOACs) like apixaban are now preferred over warfarin-based therapy due to similar efficacy without the need for monitoring. Apixaban can be initiated without initial parenteral anticoagulation (unlike rivaroxaban, it requires a higher dose for the first week). Thrombectomy is reserved for massive PE with hemodynamic instability. Aspirin is not appropriate for VTE treatment.
5A 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?
A.Hold warfarin and administer vitamin K 10mg IV
B.Hold warfarin and administer 4-factor PCC
C.Hold next 1-2 warfarin doses and recheck INR in 2-3 days
D.Continue warfarin at reduced dose
Explanation: For an elevated INR (4.5-10) without bleeding, the recommended management is to hold 1-2 doses of warfarin and monitor. Vitamin K is reserved for INR >10 or serious bleeding. PCC is used for life-threatening bleeding. Continuing warfarin or reducing the dose would not appropriately address the supratherapeutic INR.
6A 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?
A.Optimal medical therapy with aspirin, statin, and beta-blocker
B.PCI with drug-eluting stent placement
C.Coronary artery bypass grafting
D.Referral for cardiac transplantation evaluation
Explanation: For stable coronary artery disease with significant stenosis (>70%) and evidence of ischemia on stress testing, percutaneous coronary intervention (PCI) with stenting plus optimal medical therapy reduces angina and improves outcomes compared to medical therapy alone. CABG would be considered for left main disease, triple vessel disease, or complex anatomy. Transplantation is not indicated for stable CAD.
7A 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?
A.Increase albuterol to every 4 hours as needed
B.Add low-dose inhaled corticosteroid (fluticasone)
C.Start oral prednisone 40mg daily
D.Refer for bronchial thermoplasty
Explanation: This patient has persistent asthma (daily symptoms, nighttime awakenings, reduced FEV1) and is only using a short-acting bronchodilator. According to GINA and NAEPP guidelines, the preferred initial controller therapy for persistent asthma is a daily inhaled corticosteroid. Using SABA alone increases risk of exacerbations. Oral steroids are for acute exacerbations, not maintenance. Bronchial thermoplasty is reserved for severe refractory asthma.
8A 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?
A.Azithromycin 500mg day 1, then 250mg daily for 4 days
B.Levofloxacin 750mg daily for 5 days
C.Amoxicillin-clavulanate 875/125mg twice daily for 5-7 days
D.All of the above are appropriate depending on patient factors
Explanation: Antibiotic selection for COPD exacerbations depends on local resistance patterns, patient risk factors, and severity. Options include macrolides (azithromycin), respiratory fluoroquinolones (levofloxacin), or amoxicillin-clavulanate. All are appropriate choices depending on the clinical scenario, allergies, and local antibiograms. Recent guidelines suggest shorter 5-day courses are often sufficient.
9A 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?
A.Azithromycin 500mg day 1, then 250mg daily
B.Amoxicillin 1g three times daily
C.Levofloxacin 750mg daily
D.Doxycycline 100mg twice daily
Explanation: For healthy adults with community-acquired pneumonia (CAP) without comorbidities or risk factors for MRSA/Pseudomonas, high-dose amoxicillin is the preferred empiric therapy per IDSA/ATS guidelines. Macrolides are alternatives but resistance is increasing. Respiratory fluoroquinolones are reserved for patients with comorbidities or beta-lactam allergy. Doxycycline is an alternative but has inferior pneumococcal coverage.
10A 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?
A.Overnight polysomnography
B.Home sleep apnea testing
C.Arterial blood gas
D.Pulmonary function tests
Explanation: For patients with a high pretest probability of obstructive sleep apnea (symptoms plus risk factors like obesity), home sleep apnea testing (HSAT) is an appropriate initial diagnostic test. It is more convenient and less expensive than polysomnography. Polysomnography is indicated if HSAT is negative but suspicion remains high, or for patients with significant comorbidities. ABG and PFTs are not diagnostic for OSA.

About the PANRE Exam

The PANRE is a recertification examination for certified Physician Assistants. It assesses clinical knowledge and skills across all organ systems with content based on the NCCPA Content Blueprint: 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 Topics (2%).

Questions

240 scored questions

Time Limit

4 hours

Passing Score

379+ (scaled)

Exam Fee

$350 (NCCPA (National Commission on Certification of Physician Assistants))

PANRE Exam Content Outline

12%

Cardiovascular

Coronary artery disease, heart failure, arrhythmias, hypertension, valvular disease, peripheral vascular disease

10%

Pulmonary

COPD, asthma, pneumonia, pulmonary embolism, lung cancer, sleep apnea

10%

GI/Nutrition

GERD, PUD, IBD, liver disease, pancreatitis, gallbladder disease, nutritional deficiencies

8%

EENT

Otitis media/externa, sinusitis, pharyngitis, conjunctivitis, vision/hearing loss, oral diseases

8%

Endocrine

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

8%

Musculoskeletal

Osteoarthritis, rheumatoid arthritis, gout, low back pain, fractures, sprains/strains

7%

Psychiatry

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

7%

Infectious Disease

HIV/AIDS, hepatitis, TB, sepsis, meningitis, pneumonia, tick-borne diseases, endocarditis

5%

Reproductive

Contraception, STIs, pregnancy complications, menopause, infertility, sexual dysfunction

5%

Dermatology

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

5%

Genitourinary

UTIs, renal failure, kidney stones, BPH, erectile dysfunction, incontinence

5%

Neurology

Stroke, seizures, headaches, dementia, multiple sclerosis, Parkinson disease, neuropathy

4%

Hematology

Anemia, coagulation disorders, DVT/PE, leukemia, lymphoma, blood transfusion

4%

Renal

Acute kidney injury, chronic kidney disease, electrolyte disorders, acid-base imbalance

2%

Emergent Topics

Emergency care principles, legal/ethical issues, professional practice, patient safety

How to Pass the PANRE Exam

What You Need to Know

  • Passing score: 379+ (scaled)
  • Exam length: 240 questions
  • Time limit: 4 hours
  • Exam fee: $350

Keys to Passing

  • Complete 500+ practice questions
  • Score 80%+ consistently before scheduling
  • Focus on highest-weighted sections
  • Use our AI tutor for tough concepts

PANRE Study Tips from Top Performers

1Focus on high-weight categories: Cardiovascular (12%), Pulmonary (10%), and GI/Nutrition (10%) account for nearly one-third of the exam
2Master first-line treatments and pharmacology for common conditions in each organ system
3Know screening guidelines: USPSTF recommendations for cancer, cardiovascular disease, and preventive care
4Review vaccine schedules: adult immunizations are frequently tested across multiple categories
5Understand emergency management: ABCs, ACLS protocols, and first-line treatments for acute presentations
6Practice with timed blocks: 60 questions in 60 minutes to simulate exam pacing
7Study contraindications and adverse effects of common medications

Frequently Asked Questions

What is the PANRE pass rate?

The PANRE first-time pass rate is approximately 90-95% for well-prepared candidates who have maintained their medical knowledge through clinical practice and continuing education. Pass rates may vary based on years of clinical experience and preparation.

How many questions are on the PANRE?

The PANRE contains 240 multiple-choice questions administered over 4 hours in four blocks of 60 questions each. The exam uses a scaled scoring system with a passing score of 379 or higher.

What is the PANRE content blueprint?

The NCCPA PANRE Content Blueprint includes 14 organ system categories: 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 Topics including Professional Practice (2%).

When should I take PANRE?

Certified PAs must pass PANRE every 10 years. You can take it in the 5th or 6th year of your certification maintenance cycle, or in the 9th or 10th year. Alternatively, you may participate in the PANRE Longitudinal Assessment, which allows you to answer questions over time rather than in a single exam session.

What is the PANRE Longitudinal Assessment?

The PANRE Longitudinal Assessment is an alternative to the traditional PANRE exam. It allows PAs to answer 25 questions per quarter over 12 quarters (3 years). You can use references and have 5 minutes per question. Passing 8 of 12 quarters meets the certification requirement. This option is available starting in the 7th year of your certification cycle.

How should I prepare for PANRE?

Preparation should include: 1) Reviewing the NCCPA Content Blueprint to understand category weights, 2) Using practice questions covering all organ systems, 3) Focusing on high-weight categories (Cardiovascular, Pulmonary, GI), 4) Reviewing pharmacology and first-line treatments, 5) Studying screening guidelines and preventive care, 6) Completing at least 200 practice questions with detailed rationales.