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PANCE Advanced Practice Examination:
Comprehensive 150-Question Multiple-Choice
Review Exam With Answer Key & Detailed
Rationales
Target Audience: Physician Assistant students and graduates preparing for the Physician
Assistant National Certifying Examination (PANCE)
CARDIOVASCULAR SYSTEM (11% of Exam)
Question 1
A 68-year-old male with a history of hypertension and type 2 diabetes presents to the
emergency department with sudden onset of severe, tearing chest pain radiating to his back.
His blood pressure is 190/110 mmHg in the right arm and 140/85 mmHg in the left arm. Which
of the following is the most appropriate initial diagnostic study?
A) Transthoracic echocardiogram
B) CT angiography of the chest
C) Cardiac catheterization
D) Standard chest radiograph
,2
CorreCt Answer: B
Rationale: The presentation of acute, tearing chest pain radiating to the back with asymmetric
blood pressures is classic for aortic dissection. CT angiography is the diagnostic modality of
choice for aortic dissection due to its high sensitivity and specificity. Transthoracic
echocardiography may miss distal dissections, and cardiac catheterization is invasive and not
first-line. Chest radiograph may show a widened mediastinum but is neither sensitive nor
specific.
Question 2
A 72-year-old woman with a history of heart failure with reduced ejection fraction presents with
worsening dyspnea, orthopnea, and lower extremity edema. Her medications include lisinopril,
carvedilol, and furosemide. Her serum potassium is 5.8 mEq/L and creatinine is 2.4 mg/dL.
Which of the following medication adjustments is most appropriate?
A) Increase furosemide
B) Discontinue lisinopril
C) Increase carvedilol
D) Add spironolactone
,3
CorreCt Answer: B
Rationale: The patient has hyperkalemia (K+ > 5.5 mEq/L) and worsening renal function
(creatinine 2.4 mg/dL), which are contraindications to continued ACE inhibitor therapy.
Lisinopril should be discontinued. Increasing furosemide may worsen electrolyte imbalances,
adding spironolactone would further elevate potassium, and increasing carvedilol does not
address the hyperkalemia or renal dysfunction.
Question 3
A 55-year-old male presents with palpitations, lightheadedness, and dyspnea on exertion. ECG
demonstrates an irregularly irregular rhythm with absent P waves and a ventricular rate of 140
bpm. Which of the following is the most appropriate initial management strategy for this
patient?
A) Immediate synchronized cardioversion
B) Rate control with a beta-blocker
C) Anticoagulation with warfarin
D) Electrophysiology study
, 4
CorreCt Answer: B
Rationale: The ECG findings are diagnostic of atrial fibrillation with rapid ventricular response.
Rate control with a beta-blocker or calcium channel blocker is the appropriate initial
management for hemodynamically stable patients. Immediate cardioversion is indicated only if
the patient is unstable. While anticoagulation is important, it is not the immediate first step, and
electrophysiology study is reserved for refractory cases.
Question 4
A 45-year-old woman with no significant past medical history presents with intermittent chest
pressure that occurs with exertion and resolves with rest. She reports that her symptoms have
been worsening over the past month. An exercise stress test reveals 2 mm ST-segment
depression in the inferior leads. Which of the following is the most appropriate next step?
A) Start aspirin and nitroglycerin
B) Cardiac catheterization
C) Stress echocardiogram
D) CT coronary angiography
PANCE Advanced Practice Examination:
Comprehensive 150-Question Multiple-Choice
Review Exam With Answer Key & Detailed
Rationales
Target Audience: Physician Assistant students and graduates preparing for the Physician
Assistant National Certifying Examination (PANCE)
CARDIOVASCULAR SYSTEM (11% of Exam)
Question 1
A 68-year-old male with a history of hypertension and type 2 diabetes presents to the
emergency department with sudden onset of severe, tearing chest pain radiating to his back.
His blood pressure is 190/110 mmHg in the right arm and 140/85 mmHg in the left arm. Which
of the following is the most appropriate initial diagnostic study?
A) Transthoracic echocardiogram
B) CT angiography of the chest
C) Cardiac catheterization
D) Standard chest radiograph
,2
CorreCt Answer: B
Rationale: The presentation of acute, tearing chest pain radiating to the back with asymmetric
blood pressures is classic for aortic dissection. CT angiography is the diagnostic modality of
choice for aortic dissection due to its high sensitivity and specificity. Transthoracic
echocardiography may miss distal dissections, and cardiac catheterization is invasive and not
first-line. Chest radiograph may show a widened mediastinum but is neither sensitive nor
specific.
Question 2
A 72-year-old woman with a history of heart failure with reduced ejection fraction presents with
worsening dyspnea, orthopnea, and lower extremity edema. Her medications include lisinopril,
carvedilol, and furosemide. Her serum potassium is 5.8 mEq/L and creatinine is 2.4 mg/dL.
Which of the following medication adjustments is most appropriate?
A) Increase furosemide
B) Discontinue lisinopril
C) Increase carvedilol
D) Add spironolactone
,3
CorreCt Answer: B
Rationale: The patient has hyperkalemia (K+ > 5.5 mEq/L) and worsening renal function
(creatinine 2.4 mg/dL), which are contraindications to continued ACE inhibitor therapy.
Lisinopril should be discontinued. Increasing furosemide may worsen electrolyte imbalances,
adding spironolactone would further elevate potassium, and increasing carvedilol does not
address the hyperkalemia or renal dysfunction.
Question 3
A 55-year-old male presents with palpitations, lightheadedness, and dyspnea on exertion. ECG
demonstrates an irregularly irregular rhythm with absent P waves and a ventricular rate of 140
bpm. Which of the following is the most appropriate initial management strategy for this
patient?
A) Immediate synchronized cardioversion
B) Rate control with a beta-blocker
C) Anticoagulation with warfarin
D) Electrophysiology study
, 4
CorreCt Answer: B
Rationale: The ECG findings are diagnostic of atrial fibrillation with rapid ventricular response.
Rate control with a beta-blocker or calcium channel blocker is the appropriate initial
management for hemodynamically stable patients. Immediate cardioversion is indicated only if
the patient is unstable. While anticoagulation is important, it is not the immediate first step, and
electrophysiology study is reserved for refractory cases.
Question 4
A 45-year-old woman with no significant past medical history presents with intermittent chest
pressure that occurs with exertion and resolves with rest. She reports that her symptoms have
been worsening over the past month. An exercise stress test reveals 2 mm ST-segment
depression in the inferior leads. Which of the following is the most appropriate next step?
A) Start aspirin and nitroglycerin
B) Cardiac catheterization
C) Stress echocardiogram
D) CT coronary angiography
