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PANCE

PANCE practice questions, PANCE practice exams, PANCE sample questions and a full PANCE practice test

You have to pass the PANCE to be a certified PA, and a fail means a 90-day wait plus one of only six lifetime attempts gone. What separates people who pass comfortably is not the brand of their prep. It is the number of board-style questions they work through, with every answer choice explained, across the full NCCPA blueprint.

  • Unlimited PANCE-style questions across the current 2025 NCCPA blueprint
  • Every answer choice explained, so you learn the reasoning, not an answer key
  • Organ systems and task areas in the same proportions the real exam uses
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The short answer

The PANCE (Physician Assistant National Certifying Examination) is 300 multiple-choice questions split into five 60-minute blocks of 60 questions each, so it is 5 hours of testing in a roughly 6-hour appointment at a Pearson VUE center. It is scored on a 200 to 800 scale and you need 350 to pass. The national first-time pass rate is about 92 percent (91.5 percent in 2025, per NCCPA). The best PANCE prep is high-volume board-style questions with a real explanation for every answer choice, which is exactly what Aspirants.ai generates, unlimited, for $9 a month.

Last updated July 2026

Work the questions

PANCE sample questions with answers and explanations

Eight board-style PANCE practice questions drawn from the heaviest-weighted areas of the current NCCPA blueprint. Read every rationale, including why the wrong answers are wrong. That is the habit that passes this exam.

Question 1 · Cardiovascular

A 62-year-old man presents with 45 minutes of crushing substernal chest pain, nausea and diaphoresis. Blood pressure is 88/56 mm Hg and heart rate is 52/min. ECG shows ST elevation in leads II, III and aVF. Which of the following is the most appropriate next step?

  1. A. Administer sublingual nitroglycerin
  2. B. Obtain a right-sided ECG before giving nitrates
  3. C. Start an intravenous beta blocker
  4. D. Give a fluid bolus and discharge on aspirin
Show the answer and explanation

B. Obtain a right-sided ECG before giving nitrates

ST elevation in II, III and aVF is an inferior wall MI, usually from the right coronary artery. Up to 40 percent of inferior MIs involve the right ventricle, and an RV infarct is preload dependent, which is exactly what the hypotension and bradycardia here are warning you about. Nitroglycerin (A) drops preload and can cause profound hypotension in these patients. A right-sided ECG showing ST elevation in V4R confirms RV involvement, and those patients need fluids rather than nitrates. Beta blockers (C) are contraindicated with hypotension and possible cardiogenic shock, and (D) ignores an acute STEMI that needs reperfusion.

Question 2 · Pulmonary

A 28-year-old woman taking a combined oral contraceptive presents with sudden pleuritic chest pain and shortness of breath that began 3 hours ago. She is afebrile, heart rate is 112/min, respiratory rate 24/min, and oxygen saturation is 92 percent on room air. Lungs are clear and the chest radiograph is normal. Which of the following is the most appropriate diagnostic study?

  1. A. D-dimer
  2. B. CT pulmonary angiography
  3. C. Repeat chest radiograph in 24 hours
  4. D. Transthoracic echocardiography
Show the answer and explanation

B. CT pulmonary angiography

Estrogen-containing contraception, abrupt pleuritic pain, tachycardia, hypoxemia and a clear chest film put her in a high pretest probability group for pulmonary embolism. When pretest probability is high you go straight to definitive imaging, and CT pulmonary angiography is the study of choice. D-dimer (A) is used to rule PE out in low or intermediate probability patients, because only a negative result is informative and a positive one here would not change management. Echocardiography (D) may show right heart strain but is neither sensitive nor specific enough to diagnose PE. Waiting (C) risks a fatal second embolism.

Question 3 · Gastrointestinal

A 45-year-old man reports 3 months of gnawing epigastric pain that wakes him at night and improves after eating. He takes no NSAIDs. Upper endoscopy shows a 1 cm duodenal ulcer and biopsy urease testing is positive for Helicobacter pylori. Which of the following is the most appropriate treatment?

  1. A. Proton pump inhibitor alone for 8 weeks
  2. B. Proton pump inhibitor, clarithromycin and amoxicillin for 14 days
  3. C. Histamine-2 receptor antagonist and dietary modification
  4. D. Sucralfate for 6 weeks
Show the answer and explanation

B. Proton pump inhibitor, clarithromycin and amoxicillin for 14 days

Pain relieved by food that wakes the patient at night is the classic duodenal ulcer pattern, and a positive urease test confirms H. pylori. Eradication is required: acid suppression alone (A, C and D) heals the ulcer but leaves recurrence rates high. Standard clarithromycin triple therapy is a PPI plus clarithromycin plus amoxicillin for 14 days, with metronidazole substituted for amoxicillin in penicillin allergy, and bismuth quadruple therapy preferred where clarithromycin resistance is high. Confirm eradication afterward with a urea breath test or stool antigen test, taken off the PPI.

Question 4 · Musculoskeletal

A 20-year-old man falls on an outstretched arm playing basketball. He holds the arm slightly abducted and externally rotated, and the shoulder has lost its normal rounded contour with a palpable fullness anteriorly. Which of the following should be assessed both before and after reduction?

  1. A. Radial nerve function at the wrist
  2. B. Sensation over the lateral deltoid and deltoid motor function
  3. C. Ulnar nerve sensation in the small finger
  4. D. Grip strength
Show the answer and explanation

B. Sensation over the lateral deltoid and deltoid motor function

This is an anterior shoulder dislocation, the most common type, and the axillary nerve is the structure most often injured. The axillary nerve supplies sensation over the lateral deltoid, the so-called regimental badge area, and motor supply to the deltoid, so documenting both before and after reduction is standard practice and matters medicolegally. The radial nerve (A) is the one at risk in humeral shaft fractures, and the ulnar nerve (C) in medial epicondyle injuries and elbow dislocations. Grip strength (D) does not localize this injury.

Question 5 · Infectious disease

A 24-year-old sexually active man presents with 3 days of dysuria and a purulent urethral discharge. Nucleic acid amplification testing is positive for Neisseria gonorrhoeae and negative for Chlamydia trachomatis. Which of the following is the recommended treatment?

  1. A. Ceftriaxone 500 mg intramuscularly as a single dose
  2. B. Azithromycin 1 g orally as a single dose
  3. C. Ciprofloxacin 500 mg orally twice daily for 7 days
  4. D. Oral cefixime plus doxycycline for 14 days
Show the answer and explanation

A. Ceftriaxone 500 mg intramuscularly as a single dose

CDC guidance treats uncomplicated urogenital gonorrhea with a single 500 mg intramuscular dose of ceftriaxone, increased to 1 g in patients weighing 150 kg or more. Because chlamydia has been excluded here, doxycycline is not added; when chlamydia has not been ruled out, doxycycline 100 mg twice daily for 7 days is given alongside. Azithromycin monotherapy (B) is no longer recommended because of rising macrolide resistance, and fluoroquinolones (C) were abandoned for gonorrhea years ago on resistance grounds. Partners from the previous 60 days should be evaluated and treated.

Question 6 · Neurologic

A 72-year-old woman reports 2 weeks of a new right-sided temporal headache, pain in the jaw when chewing, and one episode of transient vision loss in the right eye. The erythrocyte sedimentation rate is 88 mm/hr. Which of the following is the most appropriate next step?

  1. A. Order a temporal artery biopsy and begin treatment when results return
  2. B. Start high-dose corticosteroids immediately and arrange temporal artery biopsy
  3. C. Obtain MRI of the brain before any treatment
  4. D. Prescribe sumatriptan and follow up in 2 weeks
Show the answer and explanation

B. Start high-dose corticosteroids immediately and arrange temporal artery biopsy

A new headache after age 50 with jaw claudication, transient monocular vision loss and a markedly elevated ESR is giant cell arteritis until proven otherwise. The threat is permanent, irreversible blindness from anterior ischemic optic neuropathy, so treatment is never delayed for diagnostic confirmation. Steroids do not meaningfully change biopsy findings for one to two weeks, so the biopsy stays useful after therapy starts, which is why option (A) trades an eye for a tidier workup. Imaging (C) does not make this diagnosis, and a triptan (D) treats the wrong disease entirely.

Question 7 · Psychiatry and behavioral science

A 26-year-old man is started on fluoxetine for depression. Three weeks later he presents with 5 days of decreased need for sleep, pressured speech, grandiose business plans and impulsive spending. He has no history of substance use. Which of the following best explains this presentation?

  1. A. Serotonin syndrome
  2. B. An unmasked bipolar I disorder
  3. C. Fluoxetine discontinuation syndrome
  4. D. Generalized anxiety disorder
Show the answer and explanation

B. An unmasked bipolar I disorder

Decreased need for sleep together with pressured speech, grandiosity and impulsive spending is a manic episode, and an antidepressant started without a mood stabilizer is a classic precipitant in a patient whose bipolar disorder had not yet declared itself. This is precisely why you screen for prior manic or hypomanic episodes before prescribing an antidepressant. Serotonin syndrome (A) presents with autonomic instability, clonus, hyperreflexia and hyperthermia, typically within hours to a day and usually on combined serotonergic agents. Discontinuation syndrome (C) follows stopping a drug rather than starting one, and fluoxetine has the longest half-life of the SSRIs, making it the least likely to cause it.

Question 8 · Endocrinology

A 19-year-old woman with type 1 diabetes presents with vomiting and abdominal pain. Glucose is 512 mg/dL, arterial pH is 7.15, bicarbonate is 8 mEq/L, and serum potassium is 3.1 mEq/L. Which of the following is the most appropriate next step?

  1. A. Begin an intravenous insulin infusion immediately
  2. B. Give intravenous fluids and replace potassium before starting insulin
  3. C. Administer intravenous sodium bicarbonate
  4. D. Give subcutaneous long-acting insulin and observe
Show the answer and explanation

B. Give intravenous fluids and replace potassium before starting insulin

In diabetic ketoacidosis, total body potassium is depleted even when the serum value looks reassuring, because acidosis shifts potassium out of cells. A serum potassium below 3.3 mEq/L is the specific situation in which insulin must be held: insulin drives potassium back into cells and can precipitate a fatal arrhythmia. Fluid resuscitation and potassium repletion come first, and the insulin infusion starts once potassium is above 3.3. Starting insulin now (A) is the trap this question is built around. Bicarbonate (C) is reserved for a pH below roughly 6.9 and does not improve outcomes otherwise, and subcutaneous long-acting insulin (D) is inadequate for active DKA.

These eight are a sample. Inside Aspirants.ai you can generate unlimited PANCE practice questions on any blueprint area, with the same depth of explanation on every answer choice.

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What the PANCE looks like

The PANCE is 300 multiple-choice questions delivered in five blocks of 60 questions, with 60 minutes for each block. That is 5 hours of actual testing time, and with the tutorial and the 45 minutes of total break time you can split between blocks, you should plan for a roughly 6-hour appointment. It is computer-based and given year-round at Pearson VUE test centers. You cannot go back to a block once you leave it, so pace yourself at about a minute per question and flag the ones you want to revisit before the block ends.

  • 300 questions, five blocks of 60, 60 minutes per block
  • 5 hours of testing, about a 6-hour total appointment
  • Computer-based at Pearson VUE, offered throughout the year
  • No returning to a block once it is submitted

How the PANCE is scored and what you need to pass

The PANCE is scored on a 200 to 800 scale, and the passing standard is 350. It is pass or fail: there is no percentile ranking that programs or employers see, so a 351 and a 750 both simply say "certified." Because the score is scaled through a standard-setting process, the exact number of questions you need right varies a little by test form, but the practical target is clear. The national first-time pass rate has held around 92 percent (91.5 percent for 2025 per NCCPA), which sounds comfortable until you remember that the roughly 8 percent who do not pass studied too, usually on too few practice questions.

  • Scored 200 to 800, passing score is 350
  • Pass or fail only, no percentile shown to programs
  • First-time pass rate about 92 percent (91.5 percent in 2025)
  • Scaled scoring, so the raw number to pass shifts slightly by form

What is actually on the PANCE: the 2025 blueprint

The current NCCPA blueprint took effect in January 2025 and splits the exam into medical content (94 percent) and professional practice (6 percent). By organ system, the biggest weightings are cardiovascular (11 percent), pulmonary (9 percent), then gastrointestinal and nutrition, musculoskeletal, infectious diseases, neurologic, psychiatry and behavioral science, and reproductive. The exam also tests eight task areas: formulating the most likely diagnosis is the largest at 18 percent, followed by history taking and physical exam and health maintenance at 16 percent each, then clinical intervention, managing patients, using diagnostic studies, pharmaceutical therapeutics, and applying foundational scientific concepts. Practicing questions in those same proportions, rather than by whatever topic feels comfortable, is how you stop your weak systems from sinking the score.

  • Cardiovascular 11 percent and pulmonary 9 percent lead the organ systems
  • Formulating the most likely diagnosis is the largest task area at 18 percent
  • Medical content is 94 percent, professional practice 6 percent
  • Practice weighted to the blueprint, not to your comfort zone

How to study for the PANCE

PA students who pass comfortably almost all do the same thing: thousands of board-style questions with the rationale read on every one, right and wrong. Reading a review book front to back feels productive and mostly is not, because the PANCE tests whether you can apply knowledge to a vignette under time, not whether you can recognize a fact. Build your prep around a question bank, review every answer choice including the distractors, track which organ systems and task areas you miss, and drill those. An AI tutor fits here: it generates unlimited PANCE-style questions on the exact blueprint areas you are weak in, explains the reasoning, and answers your follow-up questions at midnight when the qbank cannot.

How many times you can take the PANCE

NCCPA gives you a six-year window from when you complete your program requirements, and within it you may sit the PANCE a maximum of six times. Whichever limit you hit first, six attempts or six years, ends your eligibility. There is also a frequency cap: no more than once in any 90-day period and no more than three times in a calendar year. After you apply you get a 180-day window to schedule and take the exam. In plain terms, treat every attempt as scarce. That is another argument for walking in only when your practice scores say you are ready, rather than testing to "see how it goes."

  • Up to six attempts within a six-year eligibility window
  • No more than once per 90 days or three times per calendar year
  • A 180-day window to test after you apply
  • Eligibility ends at six attempts or six years, whichever comes first

Compare the options

Best PANCE question bank: the main options compared

What each PANCE question bank costs and what it actually gets you. Prices change and vendors discount often, so verify current pricing before you buy.

Option Typical US cost What you get Best for
Rosh Review (now Blueprint Prep) about $270 to $600 The most-recommended PANCE qbank, detailed rationales, readiness analytics The default board qbank most students use
UWorld about $199 to $299 A rising qbank with strong explanations and images Students who want a second question style
Kaplan about $99 to $500+ Qbank alone or bundled with lectures Learners who want video plus questions
PANCE Prep Pearls review book, roughly $60 to $90 The canonical PANCE review text Building or refreshing content knowledge
Aspirants.ai from $9/mo Unlimited PANCE-style questions on the current blueprint, every answer explained Adding high-volume practice to any qbank above

Rosh Review is now part of Blueprint Prep. Competitor prices are approximate and change often. The NCCPA exam fee itself is $550 and is separate from any prep course. Verify current pricing with each provider before you buy.

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Rosh Review, now part of Blueprint Prep, is the PANCE question bank most PA students use and the one programs most often recommend, at roughly $270 to $600. UWorld is the strongest second option. The honest answer is that question volume matters more than brand: students who work several thousand board-style questions and read every rationale pass, whatever qbank they bought.

You need a scaled score of 350 to pass the PANCE, on a scale that runs from 200 to 800. It is pass or fail, so nothing above 350 gives you any advantage that programs or employers see. Because scoring is scaled through a standard-setting process, the exact number of questions you must answer correctly varies slightly from one test form to another.

The PANCE has 300 multiple-choice questions, delivered in five blocks of 60 questions each with 60 minutes per block. That is 5 hours of testing time. With the tutorial and 45 minutes of total break time between blocks, you should plan for a roughly 6-hour appointment at the Pearson VUE test center.

The national first-time pass rate for the PANCE is about 92 percent, with NCCPA reporting 91.5 percent for 2025. The rate for all takers, including repeats, is lower at around 88 percent. A high first-time rate is reassuring, but the roughly 8 percent who do not pass also studied, usually on too few practice questions.

NCCPA allows up to six attempts within a six-year eligibility window that starts when you complete your program requirements. Your eligibility ends when you hit six attempts or six years, whichever comes first. There is also a cap of once per 90-day period and no more than three times in a calendar year.

The PANCE is challenging but passable: about 92 percent of first-time takers pass. The difficulty is less about obscure facts and more about applying knowledge to clinical vignettes across every organ system under time pressure. Students who struggle almost always did too little board-style question practice, which is the single best predictor of how you will do.

The NCCPA fee to sit the PANCE is $550. That is separate from prep: most PA students also spend somewhere between $200 and $600 on a board question bank and practice exams. Because a retake means a 90-day wait and burns one of only six lifetime attempts, thorough prep is cheaper than a second $550 fee.

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