PHYSICIAN ASSISTANT – PANCE
PRACTICE
EXAMINATIONQUESTIONS WITH
CORRECT ANSWERS PLUS
RATIONALES 2026/2027 EDITION
WITH INSTANT PDF DOWNLOAD
Question 1
A 62-year-old man presents with crushing substernal chest pain
radiating to his left arm for 45 minutes. ECG shows ST-segment
elevations in leads II, III, and aVF. Which coronary artery is most
likely occluded?
A. Left anterior descending artery
B. Left circumflex artery
C. Right coronary artery
D. Left main coronary artery
Rationale: ST-segment elevation in leads II, III, and aVF indicates
an inferior-wall myocardial infarction. The right coronary artery
most commonly supplies the inferior wall of the left ventricle. It
also frequently supplies the sinoatrial and atrioventricular nodes,
making bradyarrhythmias possible in inferior infarction.
Question 2
,A 28-year-old woman presents with fatigue, weight gain,
constipation, and cold intolerance. Examination reveals dry skin
and delayed relaxation of the deep tendon reflexes. Laboratory
testing shows an elevated TSH and decreased free T4. What is the
most likely diagnosis?
A. Graves disease
B. Subacute thyroiditis
C. Primary hypothyroidism
D. Secondary hypothyroidism
Rationale: Primary hypothyroidism results from dysfunction of the
thyroid gland itself and is characterized by low free T4 with
compensatory elevation of TSH. Common symptoms include
fatigue, weight gain, constipation, cold intolerance, dry skin, and
bradycardia.
Question 3
A 45-year-old woman develops sudden, severe pain and swelling
in the first metatarsophalangeal joint. Joint aspiration
demonstrates needle-shaped, negatively birefringent crystals.
Which substance is responsible?
A. Calcium pyrophosphate
B. Monosodium urate
C. Calcium oxalate
D. Basic calcium phosphate
Rationale: Gout is caused by deposition of monosodium urate
crystals. These crystals are needle-shaped and demonstrate
strong negative birefringence under polarized light. The first
metatarsophalangeal joint is a classic site of acute gout.
,Question 4
A 67-year-old woman with hypertension develops sudden right-
sided weakness and expressive aphasia. CT of the head shows no
hemorrhage. Symptoms began 90 minutes ago. Which treatment
is potentially indicated if there are no contraindications?
A. Aspirin only
B. Intravenous alteplase
C. Warfarin
D. Mannitol
Rationale: This patient has an acute ischemic stroke within the
therapeutic window for intravenous thrombolysis. After
intracranial hemorrhage is excluded by CT, alteplase may be
administered to eligible patients when treatment begins within the
appropriate time window and contraindications are absent.
Question 5
A 34-year-old woman presents with episodic palpitations,
diaphoresis, headache, and severe hypertension. A
pheochromocytoma is suspected. Which laboratory test is most
appropriate for initial biochemical evaluation?
A. Serum aldosterone
B. Serum cortisol
C. Plasma free metanephrines
D. Serum renin activity
Rationale: Plasma free metanephrines are highly sensitive for
detecting catecholamine-producing tumors such as
, pheochromocytoma. Alternatively, 24-hour urinary fractionated
metanephrines may be used. Episodic headache, sweating,
palpitations, and hypertension are classic features.
Question 6
A 19-year-old college student presents with fever, severe
headache, photophobia, and neck stiffness. Lumbar puncture
reveals elevated opening pressure, high neutrophil count,
elevated protein, and low glucose. What is the most likely
diagnosis?
A. Viral meningitis
B. Bacterial meningitis
C. Fungal meningitis
D. Migraine
Rationale: Bacterial meningitis classically produces neutrophilic
pleocytosis, elevated protein, decreased CSF glucose, and
increased opening pressure. This clinical presentation requires
immediate empiric antimicrobial therapy after appropriate
cultures are obtained when this can be done without delaying
treatment.
Question 7
A 72-year-old man with atrial fibrillation develops sudden severe
abdominal pain that appears disproportionate to the physical
examination. What is the most likely diagnosis?
A. Acute pancreatitis
B. Diverticulitis
PRACTICE
EXAMINATIONQUESTIONS WITH
CORRECT ANSWERS PLUS
RATIONALES 2026/2027 EDITION
WITH INSTANT PDF DOWNLOAD
Question 1
A 62-year-old man presents with crushing substernal chest pain
radiating to his left arm for 45 minutes. ECG shows ST-segment
elevations in leads II, III, and aVF. Which coronary artery is most
likely occluded?
A. Left anterior descending artery
B. Left circumflex artery
C. Right coronary artery
D. Left main coronary artery
Rationale: ST-segment elevation in leads II, III, and aVF indicates
an inferior-wall myocardial infarction. The right coronary artery
most commonly supplies the inferior wall of the left ventricle. It
also frequently supplies the sinoatrial and atrioventricular nodes,
making bradyarrhythmias possible in inferior infarction.
Question 2
,A 28-year-old woman presents with fatigue, weight gain,
constipation, and cold intolerance. Examination reveals dry skin
and delayed relaxation of the deep tendon reflexes. Laboratory
testing shows an elevated TSH and decreased free T4. What is the
most likely diagnosis?
A. Graves disease
B. Subacute thyroiditis
C. Primary hypothyroidism
D. Secondary hypothyroidism
Rationale: Primary hypothyroidism results from dysfunction of the
thyroid gland itself and is characterized by low free T4 with
compensatory elevation of TSH. Common symptoms include
fatigue, weight gain, constipation, cold intolerance, dry skin, and
bradycardia.
Question 3
A 45-year-old woman develops sudden, severe pain and swelling
in the first metatarsophalangeal joint. Joint aspiration
demonstrates needle-shaped, negatively birefringent crystals.
Which substance is responsible?
A. Calcium pyrophosphate
B. Monosodium urate
C. Calcium oxalate
D. Basic calcium phosphate
Rationale: Gout is caused by deposition of monosodium urate
crystals. These crystals are needle-shaped and demonstrate
strong negative birefringence under polarized light. The first
metatarsophalangeal joint is a classic site of acute gout.
,Question 4
A 67-year-old woman with hypertension develops sudden right-
sided weakness and expressive aphasia. CT of the head shows no
hemorrhage. Symptoms began 90 minutes ago. Which treatment
is potentially indicated if there are no contraindications?
A. Aspirin only
B. Intravenous alteplase
C. Warfarin
D. Mannitol
Rationale: This patient has an acute ischemic stroke within the
therapeutic window for intravenous thrombolysis. After
intracranial hemorrhage is excluded by CT, alteplase may be
administered to eligible patients when treatment begins within the
appropriate time window and contraindications are absent.
Question 5
A 34-year-old woman presents with episodic palpitations,
diaphoresis, headache, and severe hypertension. A
pheochromocytoma is suspected. Which laboratory test is most
appropriate for initial biochemical evaluation?
A. Serum aldosterone
B. Serum cortisol
C. Plasma free metanephrines
D. Serum renin activity
Rationale: Plasma free metanephrines are highly sensitive for
detecting catecholamine-producing tumors such as
, pheochromocytoma. Alternatively, 24-hour urinary fractionated
metanephrines may be used. Episodic headache, sweating,
palpitations, and hypertension are classic features.
Question 6
A 19-year-old college student presents with fever, severe
headache, photophobia, and neck stiffness. Lumbar puncture
reveals elevated opening pressure, high neutrophil count,
elevated protein, and low glucose. What is the most likely
diagnosis?
A. Viral meningitis
B. Bacterial meningitis
C. Fungal meningitis
D. Migraine
Rationale: Bacterial meningitis classically produces neutrophilic
pleocytosis, elevated protein, decreased CSF glucose, and
increased opening pressure. This clinical presentation requires
immediate empiric antimicrobial therapy after appropriate
cultures are obtained when this can be done without delaying
treatment.
Question 7
A 72-year-old man with atrial fibrillation develops sudden severe
abdominal pain that appears disproportionate to the physical
examination. What is the most likely diagnosis?
A. Acute pancreatitis
B. Diverticulitis
