100+ Free PANRE-LA Practice Questions

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A 52-year-old presents with painless jaundice, weight loss, and a palpable nontender gallbladder. What is the MOST likely diagnosis?

Choledocholithiasis

Acute cholecystitis

Primary biliary cholangitis

Pancreatic head adenocarcinoma

to track

Same family resources

More NCCPA Physician Assistant Exams Prep

Continue through related practice pages, study guides, comparisons, and articles from the same exam family.

Practice Pages

NCCPA PANCE Physician Assistant Practice200 questions NCCPA PANRE Physician Assistant Recertifying Exam Practice200 questions NCCPA CAQ Cardiovascular and Thoracic Surgery Practice100 questions NCCPA CAQ Dermatology Practice100 questions NCCPA CAQ Emergency Medicine Practice100 questions NCCPA CAQ Hospital Medicine Practice100 questions

FREE NCCPA PANRE Guide 2026: Pass Recertification on First Try15 min read PANCE Exam Guide 2026: Study by the 2025 NCCPA Blueprint9 min read

2026 Statistics

Key Facts: PANRE-LA Exam

~500

Total Items

25 q/quarter × 4 q/yr × 5 yr

5 min

Time per Item

NCCPA

$300

Cycle Fee

NCCPA (vs $350 PANRE)

Open

Resource Policy

Non-human references allowed

PANRE-LA is NCCPA's longitudinal recertification — 25 open-resource items per quarter for 5 years (~500 total), 5 minutes per question, $300 per cycle. Same 14-organ-system primary-care blueprint as PANRE. Performance threshold is cumulative across the cycle, not a single test day.

Sample PANRE-LA Practice Questions

Try these sample questions to test your PANRE-LA exam readiness. Each question includes a detailed explanation. Start the interactive quiz above for the full 100+ question experience with AI tutoring.

1A 58-year-old man with a history of HTN and T2DM presents with substernal chest pressure radiating to the left arm for 45 minutes. ECG shows 3-mm ST elevation in leads II, III, and aVF. Which artery is MOST likely occluded?

A.Left anterior descending

B.Left circumflex

C.Right coronary artery

D.Left main coronary artery

Explanation: ST elevation in inferior leads (II, III, aVF) indicates inferior wall MI, most commonly caused by RCA occlusion (~80% of cases). Right-sided ECG leads should be obtained to rule out RV infarction, which contraindicates nitrates due to preload dependence.

2According to 2017 ACC/AHA guidelines, what is the BP goal for a 65-year-old patient with established cardiovascular disease?

A.Less than 120/80 mm Hg

B.Less than 130/80 mm Hg

C.Less than 140/90 mm Hg

D.Less than 150/90 mm Hg

Explanation: The 2017 ACC/AHA guideline recommends a BP target of <130/80 mm Hg for adults with established CVD or 10-year ASCVD risk >=10%, based on SPRINT trial data showing reduced cardiovascular events.

3A 72-year-old man with new-onset atrial fibrillation has a CHA2DS2-VASc score of 4. He has no contraindications. What is the MOST appropriate stroke prevention strategy?

A.Aspirin 81 mg daily

B.Clopidogrel 75 mg daily

C.Apixaban 5 mg twice daily

D.Warfarin with INR goal 2.5-3.5

Explanation: DOACs (apixaban, rivaroxaban, dabigatran, edoxaban) are first-line for stroke prevention in non-valvular AFib with CHA2DS2-VASc >=2 in men or >=3 in women. They have lower intracranial hemorrhage risk than warfarin.

4A 65-year-old woman with HFrEF (EF 30%) on lisinopril, carvedilol, and furosemide remains NYHA class III. Which medication change has the STRONGEST mortality benefit?

A.Increase furosemide dose

B.Switch lisinopril to sacubitril/valsartan

C.Add digoxin

D.Add amlodipine

Explanation: PARADIGM-HF showed sacubitril/valsartan (ARNI) reduced cardiovascular mortality by 20% vs enalapril in HFrEF. ARNI replaces ACE-I/ARB (with 36-hour washout) in symptomatic HFrEF patients.

5A 50-year-old man with no prior CV events has LDL 165 mg/dL, HDL 40, BP 132/82, non-smoker, no diabetes. 10-year ASCVD risk is calculated at 8%. What is the MOST appropriate management?

A.No statin therapy; lifestyle changes only

B.Discuss starting moderate-intensity statin

C.Start high-intensity statin

D.Start ezetimibe monotherapy

Explanation: For ASCVD 10-year risk 7.5-19.9% (intermediate risk), 2018 ACC/AHA guidelines recommend a clinician-patient discussion about starting moderate-intensity statin, with risk enhancers and possibly CAC scoring to refine decision.

6A 45-year-old man presents with sudden tearing chest pain radiating to the back. BP is 180/100 in the right arm and 140/85 in the left arm. CT angiography reveals an ascending aortic dissection. What is the MOST appropriate next step?

A.IV nitroprusside alone

B.IV beta-blocker followed by vasodilator if needed; emergent cardiothoracic surgery consult

C.Thrombolytic therapy

D.Immediate cardiac catheterization

Explanation: Stanford type A (ascending) dissection is a surgical emergency. Management requires IV beta-blockade (esmolol/labetalol) FIRST to reduce dP/dt and HR <60, then vasodilators if BP remains >120 systolic, plus emergent surgery.

7A 68-year-old woman with COPD presents with palpitations. ECG shows irregular rhythm with at least 3 distinct P-wave morphologies and varying PR intervals at a rate of 110. What is the MOST likely diagnosis?

A.Atrial fibrillation

B.Atrial flutter

C.Multifocal atrial tachycardia

D.Wandering atrial pacemaker

Explanation: MAT is defined by >=3 distinct P-wave morphologies, varying PR intervals, and rate >100. It is strongly associated with COPD exacerbation, hypoxia, and theophylline toxicity. Treatment targets the underlying cause.

8A 22-year-old college basketball player collapses during practice. He has a family history of sudden cardiac death. Echocardiogram reveals asymmetric septal hypertrophy with LVOT gradient. Which medication is contraindicated?

A.Metoprolol

B.Disopyramide

C.Digoxin

D.Verapamil

Explanation: In hypertrophic cardiomyopathy with LVOT obstruction, positive inotropes like digoxin worsen outflow obstruction by enhancing contractility. Negative inotropes (beta-blockers, non-DHP CCBs, disopyramide) are preferred.

9A 60-year-old man presents with exertional chest pressure relieved by rest for 3 months. Resting ECG is normal. Which is the MOST appropriate initial diagnostic test?

A.Coronary CT angiography or exercise stress test

B.Immediate cardiac catheterization

C.Cardiac MRI

D.Holter monitor for 48 hours

Explanation: For stable angina with intermediate pretest probability, exercise treadmill testing or coronary CTA is the first-line noninvasive evaluation. CTA has high negative predictive value for excluding obstructive CAD.

10A 28-year-old IV drug user presents with fever, fatigue, and a new holosystolic murmur loudest at the lower sternal border increased with inspiration. Blood cultures grow Staphylococcus aureus. Which valve is MOST likely affected?

A.Mitral

B.Aortic

C.Tricuspid

D.Pulmonic

Explanation: Right-sided endocarditis (most often tricuspid) is characteristic of IV drug users, with S. aureus as the most common organism. The tricuspid regurgitation murmur increases with inspiration (Carvallo sign).

About the PANRE-LA Exam

PANRE-LA (Longitudinal Assessment) is NCCPA's open-resource alternative to the traditional one-day PANRE. PAs receive 25 questions each calendar quarter for 5 years (≈500 items total). Each item allows 5 minutes; PAs may use any non-human resource. Performance is measured against a cycle-based threshold rather than a single pass/fail score, with feedback after each question. Content follows the same primary-care PANRE blueprint: 14 organ-system task areas plus professional practice.

Questions

25 scored questions

Time Limit

Quarterly window

Passing Score

Performance threshold per item / cumulative across cycle

Exam Fee

$300 per cycle (NCCPA)

PANRE-LA Exam Content Outline

12%

Cardiovascular System

ACS, AFib, HF, hypertension, lipid management, valvular disease

10%

Pulmonary System

Asthma/COPD, PE, pneumonia, pleural disease, ILD

10%

Gastrointestinal/Nutrition

GERD, IBD, hepatitis, GIB, colorectal cancer screening

Musculoskeletal System

Common fractures, OA, RA/SpA, low-back pain, sports injuries

Neurologic System

Stroke/TIA, headache, seizure, neuropathies, dementia

Endocrine System

Diabetes, thyroid disease, adrenal disorders, dyslipidemia

EENT

Otitis, sinusitis, conjunctivitis, vertigo, oral pathology

Reproductive/Genitourinary

STIs, contraception, prostate disease, UTI, menstrual disorders

Infectious Disease

Antibiotic stewardship, TB, HIV, immunizations, sepsis recognition

Hematology / Dermatology / Psychiatry

Anemia, common skin conditions, mood/anxiety, substance use

Professional Practice

Ethics, scope, evidence-based practice, quality improvement

How to Pass the PANRE-LA Exam

What You Need to Know

Passing score: Performance threshold per item / cumulative across cycle
Exam length: 25 questions
Time limit: Quarterly window
Exam fee: $300 per cycle

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-LA Study Tips from Top Performers

1Treat each quarter like a graded study session — read the rationale even when you get it right

2Bookmark UpToDate, AAFP, and pharmacology references; have them open during the 5-minute window

3Use the immediate feedback to identify weak organ systems and review them between quarters

4Track the 14-organ-system blueprint — gaps in low-frequency areas (heme, derm, psych) cost the most points per question

5Do not procrastinate — quarterly windows close and persistent misses can disqualify you from the LA pathway

Frequently Asked Questions

What is PANRE-LA and how is it different from PANRE?

PANRE-LA (Longitudinal Assessment) is NCCPAs alternative to the traditional one-day PANRE. PAs receive 25 questions each calendar quarter for 5 years (~500 total). Each item allows 5 minutes and PAs may use any non-human resource (textbooks, UpToDate, Google) — but not other people. Feedback is given after each question. Performance is measured cumulatively, not on a single test day.

How much does PANRE-LA cost?

PANRE-LA costs $300 per certification maintenance cycle (paid up front), compared to $350 for the traditional PANRE. PAs choose between PANRE-LA or traditional PANRE during their recertification window.

Can I use UpToDate during PANRE-LA?

Yes — PANRE-LA is open-resource. You may use any non-human reference (UpToDate, textbooks, AAFP/NEJM articles, drug references, Google) during the 5-minute window per item. You may NOT consult other people, ask AI assistants on the actual exam interface, or copy answers from question banks.

What if I miss a quarterly window?

NCCPA assigns make-up windows for missed quarters, but persistent failure to complete quarterly items can disqualify you from PANRE-LA — forcing you back to traditional PANRE or risking certification lapse. Set calendar reminders.