Physician Assistant Practice Test PDF (Free Printable 2026)

Physician Assistant Practice Test PDF

Prepare for the PANCE with Printable PA-C Exam Questions

The Physician Assistant National Certifying Examination (PANCE) is one of the most comprehensive board exams in healthcare. Administered by the NCCPA — the National Commission on Certification of Physician Assistants — the PANCE determines whether a PA school graduate is ready to practice medicine independently as a certified physician assistant. Passing it is required before you can use the PA-C credential and begin seeing patients. This page gives you a free printable practice test PDF so you can study offline, on paper, or wherever you learn best.

The PANCE consists of 300 questions spread across five blocks of 60 questions each. You have five hours to complete the full examination, working through timed blocks that mirror the pace and pressure of an actual clinical shift. Questions are multiple-choice and test your ability to evaluate patient presentations, order appropriate diagnostics, identify the correct diagnosis, and choose evidence-based treatment. The exam is scored on a scale of 300 to 800, with a passing threshold that typically sits near 350, though the exact cut score is re-evaluated periodically by the NCCPA.

Because the PANCE covers such a wide breadth of clinical medicine, it rewards candidates who study systematically across organ systems rather than focusing too narrowly on one specialty. The content blueprint published by the NCCPA is your roadmap. It divides tested material into organ-system content areas — cardiovascular, pulmonary, gastrointestinal, musculoskeletal, neurological, dermatology, endocrine, psychiatry, and reproductive — and into physician assistant task areas that cut across all of those systems. A printed practice test PDF lets you work through representative questions from each domain without a screen in front of you, which many candidates find reduces fatigue and improves retention during long study sessions.

Before your exam day, aim to review the full NCCPA content blueprint at least twice, complete multiple timed practice blocks, and use active recall on high-yield diagnoses. Flashcards, PDF practice tests, and spaced repetition are all effective tools. The physician assistant certification hub on this site has additional practice questions, quizzes by organ system, and study resources you can use alongside this printable PDF.

Downloading and printing this PDF takes less than a minute. Work through it with a timer set to the per-question pace of the PANCE (roughly one minute per question), then review every answer explanation carefully — both the ones you got wrong and the ones you got right by guessing. Understanding why an answer is correct is more valuable than the answer itself, and that depth of understanding is what separates high scorers from those who barely pass.

PANCE Content Areas: What You Need to Know

The PANCE content blueprint is organized around organ-system categories. Each category carries a different percentage weight on the exam, so understanding which areas receive the most emphasis helps you allocate study time strategically. The single largest category is cardiovascular disease, reflecting how central cardiac medicine is to PA clinical practice across virtually every setting from primary care to urgent care to hospital medicine.

Cardiovascular System

Expect questions on heart failure (systolic vs. diastolic, stages A–D, treatment ladders including ACE inhibitors, beta-blockers, and diuretics), arrhythmias (atrial fibrillation, ventricular tachycardia, heart block classifications, treatment with rate control vs. rhythm control), hypertension (JNC classifications, first-line agents by comorbidity, hypertensive urgency vs. emergency), coronary artery disease (stable angina, unstable angina, NSTEMI, STEMI — differentiating by troponin, EKG changes, and management), valvular heart disease (aortic stenosis vs. regurgitation, mitral stenosis vs. regurgitation — distinguishing murmurs by timing, location, and radiation), and cardiomyopathy (dilated, hypertrophic obstructive, and restrictive types and their respective management approaches).

Pulmonary System

Pulmonary questions test asthma (stepwise management by severity, controller vs. rescue medications, spirometry findings), COPD (GOLD staging, exacerbation management, indications for supplemental oxygen and pulmonary rehab), pneumonia (community-acquired, hospital-acquired, aspiration — pathogens by setting, empiric antibiotics, severity scoring with CURB-65 or PSI), pulmonary embolism (Wells criteria, D-dimer interpretation, CT-PA findings, anticoagulation protocols), pleural effusion (transudates vs. exudates by Light's criteria, causes, diagnostic thoracentesis), and lung cancer (cell types, staging principles, paraneoplastic syndromes, screening criteria for high-risk patients).

Gastrointestinal and Hepatology

GI questions span GERD (Barrett's esophagus surveillance, proton pump inhibitor dosing), peptic ulcer disease (H. pylori testing and eradication regimens, NSAID-related injury, alarm features requiring endoscopy), inflammatory bowel disease (Crohn's vs. ulcerative colitis — distribution, histology, extraintestinal manifestations, treatment with 5-ASA, steroids, biologics), irritable bowel syndrome (Rome IV criteria, management), liver disease (cirrhosis complications including ascites, spontaneous bacterial peritonitis, hepatic encephalopathy, varices, and hepatorenal syndrome), appendicitis (Alvarado score, imaging choices, surgical management), and small bowel obstruction (closed-loop vs. partial, conservative vs. operative management).

Musculoskeletal System

The musculoskeletal section includes fractures (growth plate injuries using Salter-Harris classification in pediatric patients, stress fractures in athletes, compartment syndrome recognition), osteoarthritis (clinical features, management with NSAIDs, intra-articular injections, joint replacement criteria), rheumatoid arthritis (serologic markers — RF, anti-CCP; disease-modifying agents starting with methotrexate; extra-articular manifestations), gout (uric acid crystal arthritis, acute treatment with colchicine or indomethacin, prophylaxis with allopurinol, foods to avoid), low back pain (red flags for serious pathology, conservative management, indications for imaging), and rotator cuff disorders (impingement syndrome, partial vs. full-thickness tears, physical exam tests — Hawkins, Neer, drop arm).

PA Task Areas and Clinical Reasoning on the PANCE

Beyond organ-system content, the PANCE tests five physician assistant task areas that reflect the real workflow of clinical practice. These task areas are threaded throughout every organ-system question — you will rarely encounter a question that tests only factual recall without also demanding some element of clinical judgment. Understanding how the task areas work helps you approach questions more systematically.

History-taking and physical examination questions ask you to identify the most important finding from a list of patient complaints, vital signs, or exam results. These questions reward knowing which physical exam tests are specific to which conditions, and which elements of history distinguish serious diagnoses from benign ones. A patient presenting with chest pain, for example, requires you to extract the features that differentiate stable angina from ACS from aortic dissection from musculoskeletal pain.

Diagnostic workup questions present a clinical scenario and ask which test to order next, or how to interpret a result that has already been returned. Knowing not just what tests exist but when they are indicated — and when ordering them is premature, redundant, or potentially harmful — is the skill being evaluated. These questions are where mastery of sensitivity vs. specificity, likelihood ratios, and sequential diagnostic algorithms pays off. Practicing with a printed question set helps you sharpen this decision-making process without time pressure so you build the underlying pattern recognition before you add the clock.

Treatment task questions present a confirmed diagnosis and ask for the appropriate management step. Many of these questions turn on knowing first-line therapy vs. second-line therapy, dosing thresholds, contraindications, and monitoring requirements. Health maintenance questions test screening guidelines (mammography, colonoscopy, bone density, lipid panels, immunization schedules) and preventive counseling. These are high-yield and frequently overlooked by candidates who focus exclusively on acute disease management.

Working through this PDF and reviewing the answer explanations gives you practice with all five task areas simultaneously, exactly as you will encounter them on exam day. After you finish the printed set, bring your weakest content areas back to the online quiz platform for additional targeted drilling.