PANCE study guide
PANCE · Work through your exam, one topic at a time.
The Physician Assistant National Certifying Examination (PANCE) is the multiple-choice certifying exam that physician assistants must pass to earn the PA-C credential and, in most states, to begin practicing. It is administered by the National Commission on Certification of Physician Assistants (NCCPA), an independent body with no affiliation with this study platform. The PANCE study guide has 12 sections and about 3,643 words.
01Cardiovascular System
Organize cardiovascular questions into four buckets: ischemia, pump failure, rhythm, and vascular catastrophe. Ischemia: troponin rises within hours and peaks near 24 hours, so a single early normal value never excludes myocardial infarction.
309 words, about 2 min02Pulmonary System
Separate obstructive from restrictive physiology first. Obstruction (asthma, COPD, bronchiectasis) shows a reduced FEV1/FVC ratio below 0.70; restriction shows a reduced FVC with a normal or increased ratio.
315 words, about 2 min03Musculoskeletal System
Approach joint complaints by pattern: monoarticular versus polyarticular, acute versus chronic, inflammatory versus mechanical. Osteoarthritis affects weight-bearing joints with brief morning stiffness and bony nodes; rheumatoid arthritis is symmetric, involves the metacarpophalangeal and proximal interphalangeal joints, causes prolonged morning stiffness, and is supported by anti-cyclic citrullinated peptide antibodies.
305 words, about 2 min04Gastrointestinal System and Nutrition
Sort abdominal pain by location, onset, and associated symptoms. Epigastric pain radiating to the back with lipase greater than three times the upper limit of normal is acute pancreatitis; treat with aggressive fluids, analgesia, and early enteral feeding.
310 words, about 2 min05Genitourinary and Renal Systems
Classify acute kidney injury before treating it. Prerenal injury shows a blood urea nitrogen to creatinine ratio above 20, urine sodium under 20, and a fractional excretion of sodium below 1 percent.
308 words, about 2 min06Reproductive System
Pregnancy status changes every abdominal pain algorithm: any reproductive-age woman with abdominal or pelvic pain gets a pregnancy test. A positive test with pain or bleeding means ectopic until localized.
305 words, about 2 min07Endocrine System
Diabetes emergencies: diabetic ketoacidosis shows glucose above 250, arterial pH below 7.3, bicarbonate below 18, an elevated anion gap, and ketones; total body potassium is depleted even when the serum value looks normal, so replace potassium once it falls below 5.3 and add dextrose when glucose reaches roughly 200 to 250. Hyperosmolar hyperglycemic state shows glucose above 600 with minimal ketosis and profound dehydration.
298 words, about 1 min08Neurologic System
Stroke: thrombolysis is considered up to 4.5 hours from onset after noncontrast head CT excludes hemorrhage, and thrombectomy extends later for selected large-vessel occlusions. Check glucose first because hypoglycemia mimics stroke.
287 words, about 1 min09Psychiatry and Behavioral Medicine
Major depression requires five or more symptoms for at least two weeks, including depressed mood or anhedonia. Before starting an antidepressant, screen for bipolar disorder: treating bipolar depression with an antidepressant alone can trigger mania or rapid cycling.
287 words, about 1 min10Hematologic System
Start anemia with mean corpuscular volume and the reticulocyte count. A low reticulocyte count means a production problem; a high one means loss or destruction.
308 words, about 2 min11Dermatologic System and Eyes, Ears, Nose, and Throat
Skin: learn to separate the common rashes by morphology and distribution. Psoriasis has well-demarcated silvery scale on extensor surfaces; atopic dermatitis is flexural and intensely pruritic; tinea is annular with central clearing; pityriasis rosea follows a herald patch in a Christmas-tree distribution; erythema migrans is the expanding target lesion of early Lyme disease.
313 words, about 2 min12Infectious Diseases
Sepsis is infection plus organ dysfunction. Obtain cultures, measure lactate, give broad-spectrum antibiotics within an hour, and resuscitate with crystalloid.
298 words, about 1 min