NCCPA Physician Assistant National Certifying Examination (PANCE) — Questions and Answers

Question 1: A 5-year-old with nephrotic syndrome presents with fever, abdominal pain, and peritoneal signs. Blood culture grows Streptococcus pneumoniae. Which underlying mechanism predisposes to this complication?

Urinary loss of immunoglobulins and complement factors (Correct answer)
Protein malnutrition impairing T-cell function
Splenic sequestration of white blood cells
Immunosuppressive medications only

Correct answer: Urinary loss of immunoglobulins and complement factors

Nephrotic syndrome causes urinary loss of IgG and complement components (factor B, properdin), predisposing to encapsulated organism infections such as spontaneous bacterial peritonitis.

Question 2: An IRB (Institutional Review Board) is required to review research primarily to:

Approve research funding applications
Ensure statistical validity of research methods
Protect the rights and welfare of human research subjects (Correct answer)
Verify researcher credentials and licensure

Correct answer: Protect the rights and welfare of human research subjects

IRBs exist to protect human subjects by reviewing research protocols for ethical compliance, risk minimization, and informed consent adequacy.

Question 3: Under what circumstance may a PA prescribe a Schedule II controlled substance?

Never — Schedule II prescribing is prohibited for PAs in all states
When authorized by state law and within the collaborative agreement (Correct answer)
Only in hospital inpatient settings
Only with verbal authorization from the supervising physician

Correct answer: When authorized by state law and within the collaborative agreement

Many states permit PAs to prescribe Schedule II substances when state law allows and the collaborative agreement with the supervising physician permits it.

Question 4: Which opioid analgesic is contraindicated in patients with renal failure due to accumulation of a toxic metabolite?

Fentanyl
Methadone
Meperidine (Correct answer)
Hydromorphone

Correct answer: Meperidine

Meperidine's metabolite normeperidine accumulates in renal failure and can cause seizures and CNS excitation.

Question 5: What is HIPAA?

A medical diagnosis code
Health Insurance Portability and Accountability Act — protects patient privacy (Correct answer)
A type of insurance plan
A hospital ranking system

Correct answer: Health Insurance Portability and Accountability Act — protects patient privacy

HIPAA establishes national standards for protecting patient health information, ensuring privacy and security of medical records.

Question 6: A PA who disagrees with a physician's treatment plan should:

Contact the patient directly to recommend an alternative
Communicate concerns professionally to the supervising physician (Correct answer)
Implement the plan silently and document personal disagreement only
Refuse all further involvement with the patient's care

Correct answer: Communicate concerns professionally to the supervising physician

Professional communication of clinical concerns to the supervising physician is the appropriate and ethical response to treatment disagreements.

Question 7: A 45-year-old male presents with chest pain. ECG shows ST elevation in leads V1-V4. Which additional diagnostic test is most appropriate FIRST?

Troponin I level (Correct answer)
Echocardiogram
Chest X-ray
CT pulmonary angiography

Correct answer: Troponin I level

Troponin I is the preferred biomarker for myocardial injury and should be drawn immediately alongside ECG in suspected STEMI.

Question 8: A patient's ABG shows pH 7.28, PaCO2 52 mmHg, HCO3 24 mEq/L. What is the primary acid-base disorder?

Respiratory alkalosis
Metabolic alkalosis
Respiratory acidosis (Correct answer)
Metabolic acidosis

Correct answer: Respiratory acidosis

Elevated PaCO2 with acidic pH and normal bicarbonate indicates acute respiratory acidosis without metabolic compensation.

Question 9: A 40-year-old woman presents with painless jaundice, weight loss, and a palpable, non-tender gallbladder. CT shows a mass in the head of the pancreas. This clinical scenario is best described by which eponym?

Charcot's triad
Murphy's sign
McBurney's sign
Courvoisier's sign (Correct answer)

Correct answer: Courvoisier's sign

Courvoisier's sign refers to a palpable, non-tender gallbladder in the setting of painless jaundice, suggesting malignant biliary obstruction rather than gallstones.

Question 10: A chest X-ray shows a 'sail sign' in a pediatric patient. What does this indicate?

Thymic shadow (Correct answer)
Pleural effusion
Lobar consolidation
Pneumothorax

Correct answer: Thymic shadow

The 'sail sign' on chest X-ray in children represents a normal thymic shadow, which can be mistaken for pathology.

Question 11: A PA joins a coalition advocating for expanded Medicaid coverage. This represents advocacy at which level?

Individual
Institutional
Community/systems (Correct answer)
International

Correct answer: Community/systems

Coalition work to expand public insurance programs represents systems-level community advocacy targeting broader population health.

Question 12: What is the difference between generic and brand-name drugs?

Brand names are always better
There is no difference
Generic drugs have the same active ingredient but different name and typically lower cost (Correct answer)
Generic drugs are less effective

Correct answer: Generic drugs have the same active ingredient but different name and typically lower cost

Generic drugs contain the same active ingredients, dosage, and route as brand-name drugs but are marketed under their chemical name at lower cost after patent expiration.

Question 13: In research ethics, the Belmont Report established three core principles. Which is NOT one of them?

Respect for persons
Fidelity (Correct answer)
Justice
Beneficence

Correct answer: Fidelity

The Belmont Report's three principles are respect for persons, beneficence, and justice; fidelity is not among them.

Question 14: The NCCPA issues specialty Certificates of Added Qualifications (CAQ). How many CAQ specialties are currently available?

7
9 (Correct answer)
12
4

Correct answer: 9

NCCPA offers CAQ credentials in 9 specialties, including cardiovascular/thoracic surgery, emergency medicine, and others.

Question 15: A 68-year-old presents with painless gross hematuria. He is a former smoker with a 40 pack-year history. What is the most concerning diagnosis to rule out?

Bladder cancer (Correct answer)
Nephrolithiasis
Benign prostatic hyperplasia
Urinary tract infection

Correct answer: Bladder cancer

Painless gross hematuria in an older smoker is bladder cancer until proven otherwise; smoking is the strongest risk factor for urothelial carcinoma.

Question 16: A 50-year-old man with alcohol use disorder presents with acute severe epigastric pain radiating to the back, nausea, and serum lipase 1,200 U/L. Which initial management is most appropriate?

Urgent ERCP
Broad-spectrum antibiotics
Aggressive IV fluid resuscitation and NPO (Correct answer)
Emergency surgery

Correct answer: Aggressive IV fluid resuscitation and NPO

Aggressive early IV fluid resuscitation (preferably with Lactated Ringer's) and bowel rest are the cornerstones of acute pancreatitis management.

Question 17: A 68-year-old woman with osteoporosis is started on alendronate. Which instruction is most critical to prevent the most serious adverse effect of this medication?

Take at bedtime with a full glass of water
Avoid dairy products for 2 hours after taking
Take with food to avoid GI upset
Remain upright for at least 30 minutes after taking (Correct answer)

Correct answer: Remain upright for at least 30 minutes after taking

Bisphosphonates must be taken with a full glass of water while remaining upright for ≥30 minutes to prevent esophageal ulceration and stricture.

Question 18: What does informed consent require?

Family approval only
Verbal agreement only
Explaining the procedure, risks, benefits, and alternatives to the patient (Correct answer)
Getting any signature on a form

Correct answer: Explaining the procedure, risks, benefits, and alternatives to the patient

Informed consent requires that patients understand the proposed procedure, its risks and benefits, alternatives, and have the opportunity to ask questions before agreeing.

Question 19: According to USPSTF guidelines, women with average risk should begin mammography breast cancer screening at what age?

40 years (Correct answer)
45 years
50 years
35 years

Correct answer: 40 years

The 2024 USPSTF recommendation states that average-risk women should begin biennial mammography screening at age 40 to reduce breast cancer mortality.

Question 20: Which of the following BEST describes the principle of a tension-free anastomosis?

Ensuring adequate blood supply and no tension at the anastomotic site (Correct answer)
Using large bites of tissue to prevent leakage
Performing hand-sewn rather than stapled technique
Using absorbable suture only

Correct answer: Ensuring adequate blood supply and no tension at the anastomotic site

Adequate blood supply and absence of tension at the anastomosis are the two most critical factors preventing anastomotic leak.

Question 21: A PA wants to advocate for a vulnerable patient who cannot afford medications. The most immediate action is to:

Report the issue to the state health department
Publish a case report about the patient's situation
Contact the patient's insurance company on their behalf
Connect the patient with pharmaceutical assistance programs and social work (Correct answer)

Correct answer: Connect the patient with pharmaceutical assistance programs and social work

Direct patient advocacy involves immediately connecting patients to available resources such as medication assistance programs and social services.

Question 22: According to professional standards, a PA who develops a personal romantic interest in a current patient should:

Disclose the interest in the medical record and continue care
Terminate the professional relationship and transfer care before pursuing any relationship (Correct answer)
Consult the patient about their interest before making any decision
Pursue the relationship discreetly outside of clinical hours

Correct answer: Terminate the professional relationship and transfer care before pursuing any relationship

Professional ethics require ending the therapeutic relationship and ensuring continuity of care before any personal relationship can be considered.

Question 23: A 45-year-old male presents with sudden onset severe headache described as 'the worst headache of his life.' CT head is negative. What is the next best step?

Lumbar puncture for xanthochromia (Correct answer)
Neurology consult only
Discharge with ibuprofen
MRI brain with contrast

Correct answer: Lumbar puncture for xanthochromia

A negative CT with thunderclap headache requires lumbar puncture to rule out subarachnoid hemorrhage via xanthochromia detection.

Question 24: Which of the following activities qualifies as Category 2 CME under NCCPA guidelines?

Precepting a PA student in clinical rotations (Correct answer)
Attending an AAPA-accredited conference
Presenting at an ACCME-accredited grand rounds
Completing an AMA PRA Category 1 online module

Correct answer: Precepting a PA student in clinical rotations

Precepting PA students is recognized as a self-directed learning activity and qualifies as Category 2 CME.

Question 25: A 72-year-old man is found to have a PSA of 28 ng/mL. Biopsy reveals Gleason score 9 prostate adenocarcinoma. Bone scan shows multiple metastases. Which is the most appropriate initial treatment?

Radical prostatectomy
Watchful waiting
Androgen deprivation therapy (Correct answer)
External beam radiation alone

Correct answer: Androgen deprivation therapy

Androgen deprivation therapy (ADT) is the standard first-line treatment for metastatic prostate cancer, as prostate cancer growth depends on androgens.

Question 26: A patient with gout is started on allopurinol. What is its mechanism of action?

Inhibits xanthine oxidase, reducing uric acid synthesis (Correct answer)
Blocks urate reabsorption in the proximal tubule
Neutralizes uric acid crystals in joints
Increases uric acid excretion by the kidney

Correct answer: Inhibits xanthine oxidase, reducing uric acid synthesis

Allopurinol inhibits xanthine oxidase, the enzyme that converts hypoxanthine and xanthine to uric acid, thereby reducing uric acid production.

Question 27: A 2-year-old presents with a barky cough, stridor at rest, and low-grade fever. Which treatment is first-line for moderate croup?

IV methylprednisolone
Oral amoxicillin
Nebulized albuterol
Oral dexamethasone 0.6 mg/kg (Correct answer)

Correct answer: Oral dexamethasone 0.6 mg/kg

Oral dexamethasone 0.6 mg/kg is first-line for moderate-to-severe croup due to its anti-inflammatory effect on subglottic edema.

Question 28: When a PA provides care in a telemedicine setting, professional standards require that the PA:

Be licensed in the state where the patient is located at the time of the visit (Correct answer)
Only follow the laws of the state where the PA is physically located
Obtain a federal telehealth license that supersedes state requirements
Treat telemedicine visits as informal consultations not subject to standard documentation rules

Correct answer: Be licensed in the state where the patient is located at the time of the visit

PAs providing telemedicine must be licensed in the state where the patient is located, as the practice of medicine occurs where the patient resides.

Question 29: Dumping syndrome after gastric surgery is BEST managed initially with:

Prokinetic agents like metoclopramide
Small frequent meals low in simple sugars with avoidance of liquids with meals (Correct answer)
Proton pump inhibitors
High-carbohydrate, low-fat diet

Correct answer: Small frequent meals low in simple sugars with avoidance of liquids with meals

Dietary modification with small frequent meals, reduced simple sugars, and separating solids from liquids is first-line management for dumping syndrome.

Question 30: Which of the following best defines 'absolute risk reduction' (ARR)?

The difference in event rates between the control and treatment groups (Correct answer)
The ratio of event rates between treatment and control groups
The proportion of risk explained by the intervention
The inverse of the number needed to harm

Correct answer: The difference in event rates between the control and treatment groups

ARR is the arithmetic difference between the control group event rate and the treatment group event rate.

Question 31: A 70-year-old man on warfarin for atrial fibrillation presents with sudden-onset severe headache and altered consciousness. CT shows hyperdense blood in ventricles. INR is 3.8. What is the most urgent reversal agent?

Protamine sulfate
Fresh frozen plasma (FFP)
4-factor prothrombin complex concentrate (PCC) (Correct answer)
Vitamin K alone

Correct answer: 4-factor prothrombin complex concentrate (PCC)

4-factor PCC provides the fastest and most complete reversal of warfarin in life-threatening bleeding and is superior to FFP for this indication.

NCCPA Physician Assistant National Certifying Examination (PANCE)

The PANCE is the entry-level certification exam administered by the NCCPA that all physician assistant graduates must pass to practice. It tests clinical knowledge across 14 organ systems and professional practice competencies required for safe, entry-level PA practice.

Questions

35 min

Time Limit

70%

To Pass

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