Kaplan PANCE – Comprehensive Physician Assistant
Exam Questions and Answers with Detailed Rationales
2026/2027 | 300+ Questions Verified
1.
A 64-year-old man presents with substernal chest pressure that occurs while
climbing stairs and resolves after several minutes of rest. ECG is normal at rest.
What is the most likely diagnosis?
A. Unstable angina
B. Stable angina
C. Acute pericarditis
D. Aortic dissection
E. Pulmonary embolism
Answer: B. Stable angina
Rationale: Stable angina results from fixed coronary atherosclerotic narrowing
that causes myocardial oxygen supply-demand mismatch during exertion.
Symptoms characteristically improve with rest or nitroglycerin.
2.A patient presents with crushing substernal chest pain and ST-segment elevation
in leads II, III, and aVF. Which coronary artery is most likely occluded?
A. Left anterior descending
B. Left circumflex
C. Right coronary artery
D. Left main coronary artery
E. Posterior descending artery only
Answer: C. Right coronary artery
Rationale: An inferior STEMI involving leads II, III, and aVF is most commonly
caused by right coronary artery occlusion. The RCA frequently supplies the
inferior wall and AV node.
,3.
A 72-year-old patient has exertional syncope, angina, and dyspnea. Examination
reveals a harsh crescendo-decrescendo systolic murmur radiating to the carotids.
What is the most likely diagnosis?
A. Mitral regurgitation
B. Aortic stenosis
C. Aortic regurgitation
D. Mitral stenosis
E. Tricuspid regurgitation
Answer: B. Aortic stenosis
Rationale: The classic triad of severe aortic stenosis is angina, syncope, and
dyspnea. The murmur is a systolic crescendo-decrescendo sound that typically
radiates to the carotids.
4.
Which maneuver typically increases the intensity of the murmur associated with
hypertrophic obstructive cardiomyopathy?
A. Squatting
B. Passive leg elevation
C. Handgrip
D. Standing
E. Increased afterload
Answer: D. Standing
Rationale: Standing decreases venous return and ventricular preload, reducing LV
chamber size and worsening dynamic outflow obstruction in hypertrophic
obstructive cardiomyopathy. Squatting generally decreases the murmur.
,5.
A patient develops acute dyspnea several days after an MI and has a new
holosystolic murmur at the apex radiating toward the axilla. What complication
should be suspected?
A. Ventricular septal rupture
B. Papillary muscle rupture
C. Free-wall rupture
D. Dressler syndrome
E. Ventricular aneurysm
Answer: B. Papillary muscle rupture
Rationale: Papillary muscle rupture causes acute severe mitral regurgitation,
producing pulmonary edema and a new holosystolic apical murmur. The
posteromedial papillary muscle is particularly vulnerable because it often has a
single arterial supply.
6.
A patient with chronic hypertension develops concentric left ventricular
hypertrophy. What is the primary hemodynamic stimulus?
A. Increased preload
B. Increased afterload
C. Reduced venous return
D. Decreased systemic vascular resistance
E. Increased pulmonary compliance
Answer: B. Increased afterload
Rationale: Chronic systemic hypertension increases left ventricular afterload,
producing concentric hypertrophy through addition of sarcomeres in parallel.
7.
, A patient presents with hypotension, muffled heart sounds, and jugular venous
distention. What condition is most likely?
A. Tension pneumothorax
B. Cardiac tamponade
C. Massive pulmonary embolism
D. Acute MI
E. Aortic stenosis
Answer: B. Cardiac tamponade
Rationale: Beck triad consists of hypotension, muffled heart sounds, and
elevated jugular venous pressure. Cardiac tamponade results from accumulation
of pericardial fluid that restricts cardiac filling.
8.
A 28-year-old woman has palpitations and an ECG showing a narrow-complex
tachycardia at 180/min. Vagal maneuvers fail. Which medication is commonly
used for stable AV nodal reentrant tachycardia?
A. Adenosine
B. Lidocaine
C. Atropine
D. Digoxin immune Fab
E. Amiodarone only
Answer: A. Adenosine
Rationale: Adenosine transiently blocks AV nodal conduction and can terminate
AV node-dependent supraventricular tachycardias. It is used in stable patients after
appropriate initial maneuvers.
9.
A patient with atrial fibrillation has an irregularly irregular rhythm and no distinct
P waves. Which complication is the major long-term concern?
Exam Questions and Answers with Detailed Rationales
2026/2027 | 300+ Questions Verified
1.
A 64-year-old man presents with substernal chest pressure that occurs while
climbing stairs and resolves after several minutes of rest. ECG is normal at rest.
What is the most likely diagnosis?
A. Unstable angina
B. Stable angina
C. Acute pericarditis
D. Aortic dissection
E. Pulmonary embolism
Answer: B. Stable angina
Rationale: Stable angina results from fixed coronary atherosclerotic narrowing
that causes myocardial oxygen supply-demand mismatch during exertion.
Symptoms characteristically improve with rest or nitroglycerin.
2.A patient presents with crushing substernal chest pain and ST-segment elevation
in leads II, III, and aVF. Which coronary artery is most likely occluded?
A. Left anterior descending
B. Left circumflex
C. Right coronary artery
D. Left main coronary artery
E. Posterior descending artery only
Answer: C. Right coronary artery
Rationale: An inferior STEMI involving leads II, III, and aVF is most commonly
caused by right coronary artery occlusion. The RCA frequently supplies the
inferior wall and AV node.
,3.
A 72-year-old patient has exertional syncope, angina, and dyspnea. Examination
reveals a harsh crescendo-decrescendo systolic murmur radiating to the carotids.
What is the most likely diagnosis?
A. Mitral regurgitation
B. Aortic stenosis
C. Aortic regurgitation
D. Mitral stenosis
E. Tricuspid regurgitation
Answer: B. Aortic stenosis
Rationale: The classic triad of severe aortic stenosis is angina, syncope, and
dyspnea. The murmur is a systolic crescendo-decrescendo sound that typically
radiates to the carotids.
4.
Which maneuver typically increases the intensity of the murmur associated with
hypertrophic obstructive cardiomyopathy?
A. Squatting
B. Passive leg elevation
C. Handgrip
D. Standing
E. Increased afterload
Answer: D. Standing
Rationale: Standing decreases venous return and ventricular preload, reducing LV
chamber size and worsening dynamic outflow obstruction in hypertrophic
obstructive cardiomyopathy. Squatting generally decreases the murmur.
,5.
A patient develops acute dyspnea several days after an MI and has a new
holosystolic murmur at the apex radiating toward the axilla. What complication
should be suspected?
A. Ventricular septal rupture
B. Papillary muscle rupture
C. Free-wall rupture
D. Dressler syndrome
E. Ventricular aneurysm
Answer: B. Papillary muscle rupture
Rationale: Papillary muscle rupture causes acute severe mitral regurgitation,
producing pulmonary edema and a new holosystolic apical murmur. The
posteromedial papillary muscle is particularly vulnerable because it often has a
single arterial supply.
6.
A patient with chronic hypertension develops concentric left ventricular
hypertrophy. What is the primary hemodynamic stimulus?
A. Increased preload
B. Increased afterload
C. Reduced venous return
D. Decreased systemic vascular resistance
E. Increased pulmonary compliance
Answer: B. Increased afterload
Rationale: Chronic systemic hypertension increases left ventricular afterload,
producing concentric hypertrophy through addition of sarcomeres in parallel.
7.
, A patient presents with hypotension, muffled heart sounds, and jugular venous
distention. What condition is most likely?
A. Tension pneumothorax
B. Cardiac tamponade
C. Massive pulmonary embolism
D. Acute MI
E. Aortic stenosis
Answer: B. Cardiac tamponade
Rationale: Beck triad consists of hypotension, muffled heart sounds, and
elevated jugular venous pressure. Cardiac tamponade results from accumulation
of pericardial fluid that restricts cardiac filling.
8.
A 28-year-old woman has palpitations and an ECG showing a narrow-complex
tachycardia at 180/min. Vagal maneuvers fail. Which medication is commonly
used for stable AV nodal reentrant tachycardia?
A. Adenosine
B. Lidocaine
C. Atropine
D. Digoxin immune Fab
E. Amiodarone only
Answer: A. Adenosine
Rationale: Adenosine transiently blocks AV nodal conduction and can terminate
AV node-dependent supraventricular tachycardias. It is used in stable patients after
appropriate initial maneuvers.
9.
A patient with atrial fibrillation has an irregularly irregular rhythm and no distinct
P waves. Which complication is the major long-term concern?
