PANCE Orthopedics Practice EXAM 2026-
2027 LATEST VERSION QUESTIONS AND
VERIFIED CORRECT ANSWERS
Exam
This document includes the most recent PANCE Orthopedics practice exam questions
for the 2026–2027 testing cycle, paired with verified correct answers. It covers core
orthopedic topics assessed on the PANCE, including musculoskeletal anatomy, fractures,
joint injuries, orthopedic diagnostics, management strategies, and evidence-based
treatment guidelines. The material reflects current NCCPA exam expectations and
provides a complete study resource for PA students focusing on orthopedic review.
A 66-year-old male presents to his primary care physician complaining of
increasing discharge from an ulcer on the plantar aspect of his right great
toe. He has a long history of poorly controlled diabetes with complications
including chronic renal failure and bilateral peripheral neuropathy to the
mid-calf. He denies any pain or fevers/chills. Examination confirms
warmth and erythema of the area surrounding the ulcer. A probe can be
passed into the ulcer; however, it is not readily apparent if bone can be
contacted with the probe. Laboratory evaluation is significant for a WBC
count of 17k/uL and an ESR of 116 mm/h. Which of the following would be
the most accurate diagnostic test for this patient's condition?
A) Three-phase bone scan of the foot
B) Ultrasound of the great toe
C) AP and lateral radiographs of the foot
D) MRI of the foot
E) CT scan of the foot - ,,,answers,,,..D) MRI of the foot
,This patient is suffering from osteomyelitis secondary to a diabetic foot
infection. MRI is the most accurate diagnostic imaging test for
osteomyelitis.
A 31-year-old male presents with sudden onset of pain and swelling in his
right ankle. On physical exam, you appreciate a warm, swollen, and
erythematous ankle. The joint was aspirated, and the synovial fluid shows
55,000 WBCs, 80% polymorphonuclear leukocytes, low glucose levels,
and no crystals. Cultures are pending at the time. Which of the following is
the most likely diagnosis based on the information above?
A. Osteoarthritis
B. Septic arthritis
C. Rheumatoid arthritis
D. Psoriatic arthritis
E. Gouty arthritis - ,,,answers,,,..B. Septic arthritis
Septic arthritis is an infection of the joint space due to bacteria. It can
occur at any age, although the incidence is higher in elderly and very
young people. Etiologies include Staphylococcus aureus, Streptococcus
spp., N. gonorrhoeae (in young, sexually active adults). Septic arthritis
either happens due to hematogenous spread or direct inoculation by
microorganisms s/t trauma or iatrogenesis (e.g., joint surgery). Clinical
features include joint pain/swelling, warmth, and decreased ROM. The
gold standard for diagnosis is synovial fluid analysis (Although make sure
to note WBC count alone is insufficient to rule in or out septic arthritis).
Patients should be given IV antibiotics (4-6-week course).
A 48-year-old nurse, with a body mass index of 31, presents for an
evaluation of back pain. She relates that historically, she had a positive
PPD test a year ago and did not follow-up as directed. She has recently
been experiencing night sweats and coughing. An x-ray of her lumbar
spine reveals osteopenia and cortical breakdown of vertebral bodies L4
and L5. Which of the following diagnosis is most suspect?
,A) compression fractures secondary to obesity
B) degenerative joint disease
C) Pott's disease
D) compression fractures secondary to osteoporosis
E) spondylolisthesis - ,,,answers,,,..Answer: C
Pott's disease
Pott's disease is TB of the spine. She could have any of the other diseases,
but the question states that she had a positive PPD and did not take
meds...that is the clue that she has active TB in the spine.
An 80-year-old woman arrives at the emergency room with severe right
shoulder pain and immobility. She fell down the steps outside her house
and landed on her right side two hours prior to presentation. On exam, her
right arm is abducted and externally rotated. She has decreased
sensation to touch over the lateral aspect of her right shoulder.
What do you think she has and what are you worried about? -
,,,answers,,,..Anterior Shoulder Dislocation
Axillary Nerve Injury
An 35-year-old man is brought into the emergency room by his wife. She
found him having a seizure on the floor and brought him in as he was
complaining about left shoulder pain and an inability to move his arm. On
exam, his left arm is adducted and internally rotated. On imaging, the
humerus shows a "Light Bulb Sign."
What is the diagnosis? - ,,,answers,,,..Posterior shoulder dislocation
Name 3 complications of an anterior shoulder dislocation. -
,,,answers,,,..1. Hill Sachs Lesion
2. Bankart Lesion
, 3. Axillary Nerve Injury
A 7-year-old girl who fell from a jungle gym and lands on her outstretched
left hand. She develops immediate-onset left elbow pain and swelling. On
exam, her arm is held in 30 degrees of extension and she is unable to
move her elbow due to pain. A radiographic imaging shows an anterior fat
pad sign and a disrupted anterior humeral line.
What is the diagnosis? - ,,,answers,,,..Supracondylar Fracture
An otherwise healthy 30-year-old woman states that she sustained a left
forearm injury as a result of a fall. Initial examination in the emergency
room reveals a clean 2-centimeter laceration over the volar forearm, pain
and swelling of the affected arm along with decreased active and passive
range of motion. Radial and ulnar pulses are intact. X-rays show an
isolated transverse fracture of the mid-diaphysis of the ulna.
What should you be worried about in this patient? - ,,,answers,,,..Violence
because its a nightstick fracture
A 13 year old boy comes in with pain and edema over the 5th metacarpal.
He states his sister threw a basketball at him and he punched it. X-ray
shows a fracture of the 5th metacarpal with significant angulation.
What is the name of this fracture?
What type of split would you use to immobilize it? - ,,,answers,,,..Boxer's
Fracture
Ulnar Gutter
A 15-year old with fall to an outstretched hand now presents with acute
onset of wrist swelling. On imaging, there is a distal radial fracture with
the distal segment protruding upward (dorsal angulation).
2027 LATEST VERSION QUESTIONS AND
VERIFIED CORRECT ANSWERS
Exam
This document includes the most recent PANCE Orthopedics practice exam questions
for the 2026–2027 testing cycle, paired with verified correct answers. It covers core
orthopedic topics assessed on the PANCE, including musculoskeletal anatomy, fractures,
joint injuries, orthopedic diagnostics, management strategies, and evidence-based
treatment guidelines. The material reflects current NCCPA exam expectations and
provides a complete study resource for PA students focusing on orthopedic review.
A 66-year-old male presents to his primary care physician complaining of
increasing discharge from an ulcer on the plantar aspect of his right great
toe. He has a long history of poorly controlled diabetes with complications
including chronic renal failure and bilateral peripheral neuropathy to the
mid-calf. He denies any pain or fevers/chills. Examination confirms
warmth and erythema of the area surrounding the ulcer. A probe can be
passed into the ulcer; however, it is not readily apparent if bone can be
contacted with the probe. Laboratory evaluation is significant for a WBC
count of 17k/uL and an ESR of 116 mm/h. Which of the following would be
the most accurate diagnostic test for this patient's condition?
A) Three-phase bone scan of the foot
B) Ultrasound of the great toe
C) AP and lateral radiographs of the foot
D) MRI of the foot
E) CT scan of the foot - ,,,answers,,,..D) MRI of the foot
,This patient is suffering from osteomyelitis secondary to a diabetic foot
infection. MRI is the most accurate diagnostic imaging test for
osteomyelitis.
A 31-year-old male presents with sudden onset of pain and swelling in his
right ankle. On physical exam, you appreciate a warm, swollen, and
erythematous ankle. The joint was aspirated, and the synovial fluid shows
55,000 WBCs, 80% polymorphonuclear leukocytes, low glucose levels,
and no crystals. Cultures are pending at the time. Which of the following is
the most likely diagnosis based on the information above?
A. Osteoarthritis
B. Septic arthritis
C. Rheumatoid arthritis
D. Psoriatic arthritis
E. Gouty arthritis - ,,,answers,,,..B. Septic arthritis
Septic arthritis is an infection of the joint space due to bacteria. It can
occur at any age, although the incidence is higher in elderly and very
young people. Etiologies include Staphylococcus aureus, Streptococcus
spp., N. gonorrhoeae (in young, sexually active adults). Septic arthritis
either happens due to hematogenous spread or direct inoculation by
microorganisms s/t trauma or iatrogenesis (e.g., joint surgery). Clinical
features include joint pain/swelling, warmth, and decreased ROM. The
gold standard for diagnosis is synovial fluid analysis (Although make sure
to note WBC count alone is insufficient to rule in or out septic arthritis).
Patients should be given IV antibiotics (4-6-week course).
A 48-year-old nurse, with a body mass index of 31, presents for an
evaluation of back pain. She relates that historically, she had a positive
PPD test a year ago and did not follow-up as directed. She has recently
been experiencing night sweats and coughing. An x-ray of her lumbar
spine reveals osteopenia and cortical breakdown of vertebral bodies L4
and L5. Which of the following diagnosis is most suspect?
,A) compression fractures secondary to obesity
B) degenerative joint disease
C) Pott's disease
D) compression fractures secondary to osteoporosis
E) spondylolisthesis - ,,,answers,,,..Answer: C
Pott's disease
Pott's disease is TB of the spine. She could have any of the other diseases,
but the question states that she had a positive PPD and did not take
meds...that is the clue that she has active TB in the spine.
An 80-year-old woman arrives at the emergency room with severe right
shoulder pain and immobility. She fell down the steps outside her house
and landed on her right side two hours prior to presentation. On exam, her
right arm is abducted and externally rotated. She has decreased
sensation to touch over the lateral aspect of her right shoulder.
What do you think she has and what are you worried about? -
,,,answers,,,..Anterior Shoulder Dislocation
Axillary Nerve Injury
An 35-year-old man is brought into the emergency room by his wife. She
found him having a seizure on the floor and brought him in as he was
complaining about left shoulder pain and an inability to move his arm. On
exam, his left arm is adducted and internally rotated. On imaging, the
humerus shows a "Light Bulb Sign."
What is the diagnosis? - ,,,answers,,,..Posterior shoulder dislocation
Name 3 complications of an anterior shoulder dislocation. -
,,,answers,,,..1. Hill Sachs Lesion
2. Bankart Lesion
, 3. Axillary Nerve Injury
A 7-year-old girl who fell from a jungle gym and lands on her outstretched
left hand. She develops immediate-onset left elbow pain and swelling. On
exam, her arm is held in 30 degrees of extension and she is unable to
move her elbow due to pain. A radiographic imaging shows an anterior fat
pad sign and a disrupted anterior humeral line.
What is the diagnosis? - ,,,answers,,,..Supracondylar Fracture
An otherwise healthy 30-year-old woman states that she sustained a left
forearm injury as a result of a fall. Initial examination in the emergency
room reveals a clean 2-centimeter laceration over the volar forearm, pain
and swelling of the affected arm along with decreased active and passive
range of motion. Radial and ulnar pulses are intact. X-rays show an
isolated transverse fracture of the mid-diaphysis of the ulna.
What should you be worried about in this patient? - ,,,answers,,,..Violence
because its a nightstick fracture
A 13 year old boy comes in with pain and edema over the 5th metacarpal.
He states his sister threw a basketball at him and he punched it. X-ray
shows a fracture of the 5th metacarpal with significant angulation.
What is the name of this fracture?
What type of split would you use to immobilize it? - ,,,answers,,,..Boxer's
Fracture
Ulnar Gutter
A 15-year old with fall to an outstretched hand now presents with acute
onset of wrist swelling. On imaging, there is a distal radial fracture with
the distal segment protruding upward (dorsal angulation).
