Physician Assistant National Recertifying
Examination (PANRE) Practice Question Bank a
well detailed one written and
graded A+ upgraded Comprehensive 150-
Question Review for the NCCPA PANRE
Blueprint (Effective January 2023)
Instructions
This question bank contains 150 multiple-choice questions designed to reflect the content and
difficulty of the Physician Assistant National Recertifying Examination (PANRE). Questions are
organized by organ system and performance expectation level (History & Physical, Diagnosis,
Intervention Basic, Intervention Complex) as outlined in the NCCPA content blueprint. Each
question includes a single correct answer and a detailed rationale explaining both the correct
choice and the distractors.
Exam Format Reference: The PANRE consists of 240 multiple-choice questions administered
in four 60-minute blocks of 60 questions each. Content is distributed across 15 organ systems
with the following approximate allocations: Cardiovascular 12%, Pulmonary 10%,
Gastrointestinal 10%, Endocrine 8%, EENT 8%, Musculoskeletal 8%, Infectious Disease 7%,
Psychiatry/Behavioral Science 7%, Dermatologic 5%, Genitourinary 5%, Neurologic 5%,
Reproductive 5%, Hematologic 4%, Renal 4%, and Emergent Topics 2%.
Section 1: Cardiovascular System (12%)
Question 1
A 68-year-old man with a history of hypertension and type 2 diabetes mellitus presents to the
,emergency department with crushing substernal chest pain that began 45 minutes ago. The
pain radiates to his left arm and is associated with diaphoresis and nausea. ECG shows 2-mm ST-
segment elevations in leads V1–V4. His blood pressure is 142/88 mm Hg, heart rate 96 bpm,
and oxygen saturation 96% on room air. Which of the following is the most appropriate
immediate management?
A. Administer sublingual nitroglycerin and observe
B. Perform emergent percutaneous coronary intervention (PCI)
C. Administer intravenous thrombolytics and admit to ICU
D. Obtain serial troponin levels and admit for observation
E. Administer oral aspirin only and schedule stress testing
Correct Answer: B
Rationale: This patient presents with an acute ST-segment elevation myocardial infarction
(STEMI) as evidenced by ST elevations in the anterior leads (V1–V4) with classic anginal
symptoms. Emergent PCI is the preferred reperfusion strategy when it can be performed within
90 minutes of first medical contact. Thrombolytics (Choice C) are an alternative if PCI is not
available within the recommended timeframe. Sublingual nitroglycerin (Choice A) may provide
symptomatic relief but is not definitive reperfusion therapy. Observation alone (Choice D) or
outpatient stress testing (Choice E) would be inappropriate for an acute STEMI.
Question 2
A 55-year-old woman with a history of hypertension presents with progressive dyspnea on
exertion, orthopnea, and bilateral lower extremity edema over the past 3 weeks. Physical
examination reveals jugular venous distension, a third heart sound (S3), and 2+ pitting edema to
the knees. Echocardiogram shows an ejection fraction of 35% with global hypokinesis. Which of
the following is the most appropriate first-line pharmacologic therapy for this patient?
A. Digoxin and furosemide
B. Metoprolol succinate and lisinopril
C. Amlodipine and hydrochlorothiazide
D. Spironolactone and diltiazem
E. Dobutamine and dopamine
Correct Answer: B
Rationale: This patient has heart failure with reduced ejection fraction (HFrEF). Guideline-
directed medical therapy includes a beta-blocker (metoprolol succinate, carvedilol, or
bisoprolol) and an ACE inhibitor or ARB (lisinopril). These agents improve survival and reduce
,hospitalizations. Digoxin (Choice A) may be added for symptom control but is not first-line.
Amlodipine (Choice C) is a calcium channel blocker that is not recommended for HFrEF.
Diltiazem (Choice D) is contraindicated in HFrEF. Dobutamine (Choice E) is for acute
decompensated heart failure, not chronic management.
Question 3
A 72-year-old man presents with acute onset of severe, tearing chest pain that radiates to his
back. His blood pressure is 190/110 mm Hg in the right arm and 170/100 mm Hg in the left arm.
ECG shows no acute ischemic changes. Chest radiograph reveals a widened mediastinum. Which
of the following is the most likely diagnosis?
A. Acute myocardial infarction
B. Pulmonary embolism
C. Aortic dissection
D. Pericarditis
E. Esophageal rupture
Correct Answer: C
Rationale: This patient's presentation with acute tearing chest pain radiating to the back,
asymmetric blood pressures, and widened mediastinum on chest radiograph is classic for aortic
dissection. Acute myocardial infarction (Choice A) typically presents with ischemic ECG changes
and cardiac biomarker elevation. Pulmonary embolism (Choice B) presents with dyspnea,
tachycardia, and hypoxia. Pericarditis (Choice D) presents with positional chest pain and a
pericardial friction rub. Esophageal rupture (Choice E) typically presents with vomiting and
subcutaneous emphysema.
Question 4
A 48-year-old woman presents with palpitations, lightheadedness, and shortness of breath. ECG
shows an irregularly irregular rhythm with no discernible P waves and a ventricular rate of 145
bpm. She has a history of hypertension and is currently taking lisinopril and
hydrochlorothiazide. Which of the following is the most appropriate initial management?
A. Electrical cardioversion
B. Oral amiodarone
C. Rate control with a beta-blocker
D. Anticoagulation with warfarin and cardioversion
E. Immediate referral for catheter ablation
, Correct Answer: C
Rationale: This patient has atrial fibrillation with rapid ventricular response. The initial
management should focus on rate control with a beta-blocker or nondihydropyridine calcium
channel blocker. Electrical cardioversion (Choice A) may be considered if the patient is
hemodynamically unstable, which this patient is not (she is lightheaded but stable). Amiodarone
(Choice B) is a rhythm-control agent but is not first-line for rate control. Anticoagulation (Choice
D) is indicated for stroke prevention but should be initiated after considering the CHA₂DS₂-VASc
score and the timing of onset; cardioversion without anticoagulation carries stroke risk.
Catheter ablation (Choice E) is reserved for patients who fail medical therapy.
Question 5
A 62-year-old man with a history of coronary artery disease status post two drug-eluting stents
placed 6 months ago presents for routine follow-up. He reports adherence to aspirin and
clopidogrel and has been asymptomatic. His LDL cholesterol is 85 mg/dL on high-intensity statin
therapy. Which of the following is the most appropriate recommendation regarding his
antiplatelet therapy?
A. Continue aspirin and clopidogrel indefinitely
B. Discontinue clopidogrel and continue aspirin alone
C. Switch clopidogrel to ticagrelor
D. Discontinue both aspirin and clopidogrel
E. Continue dual antiplatelet therapy for at least 12 months
Correct Answer: E
Rationale: Following drug-eluting stent placement, dual antiplatelet therapy (DAPT) with aspirin
and a P2Y12 inhibitor (clopidogrel, ticagrelor, or prasugrel) is recommended for at least 6–12
months to prevent stent thrombosis. Given that this patient is only 6 months post-stenting,
DAPT should be continued for a minimum of 12 months. Discontinuing clopidogrel (Choice B)
too early increases the risk of stent thrombosis. Switching to ticagrelor (Choice C) may be
considered in some cases but is not indicated based on the information provided.
Question 6
A 75-year-old woman presents with sudden onset of severe shortness of breath, pleuritic chest
pain, and hemoptysis. She recently underwent total knee replacement surgery 10 days ago. Her
heart rate is 110 bpm, respiratory rate 28/min, blood pressure 100/70 mm Hg, and oxygen
Examination (PANRE) Practice Question Bank a
well detailed one written and
graded A+ upgraded Comprehensive 150-
Question Review for the NCCPA PANRE
Blueprint (Effective January 2023)
Instructions
This question bank contains 150 multiple-choice questions designed to reflect the content and
difficulty of the Physician Assistant National Recertifying Examination (PANRE). Questions are
organized by organ system and performance expectation level (History & Physical, Diagnosis,
Intervention Basic, Intervention Complex) as outlined in the NCCPA content blueprint. Each
question includes a single correct answer and a detailed rationale explaining both the correct
choice and the distractors.
Exam Format Reference: The PANRE consists of 240 multiple-choice questions administered
in four 60-minute blocks of 60 questions each. Content is distributed across 15 organ systems
with the following approximate allocations: Cardiovascular 12%, Pulmonary 10%,
Gastrointestinal 10%, Endocrine 8%, EENT 8%, Musculoskeletal 8%, Infectious Disease 7%,
Psychiatry/Behavioral Science 7%, Dermatologic 5%, Genitourinary 5%, Neurologic 5%,
Reproductive 5%, Hematologic 4%, Renal 4%, and Emergent Topics 2%.
Section 1: Cardiovascular System (12%)
Question 1
A 68-year-old man with a history of hypertension and type 2 diabetes mellitus presents to the
,emergency department with crushing substernal chest pain that began 45 minutes ago. The
pain radiates to his left arm and is associated with diaphoresis and nausea. ECG shows 2-mm ST-
segment elevations in leads V1–V4. His blood pressure is 142/88 mm Hg, heart rate 96 bpm,
and oxygen saturation 96% on room air. Which of the following is the most appropriate
immediate management?
A. Administer sublingual nitroglycerin and observe
B. Perform emergent percutaneous coronary intervention (PCI)
C. Administer intravenous thrombolytics and admit to ICU
D. Obtain serial troponin levels and admit for observation
E. Administer oral aspirin only and schedule stress testing
Correct Answer: B
Rationale: This patient presents with an acute ST-segment elevation myocardial infarction
(STEMI) as evidenced by ST elevations in the anterior leads (V1–V4) with classic anginal
symptoms. Emergent PCI is the preferred reperfusion strategy when it can be performed within
90 minutes of first medical contact. Thrombolytics (Choice C) are an alternative if PCI is not
available within the recommended timeframe. Sublingual nitroglycerin (Choice A) may provide
symptomatic relief but is not definitive reperfusion therapy. Observation alone (Choice D) or
outpatient stress testing (Choice E) would be inappropriate for an acute STEMI.
Question 2
A 55-year-old woman with a history of hypertension presents with progressive dyspnea on
exertion, orthopnea, and bilateral lower extremity edema over the past 3 weeks. Physical
examination reveals jugular venous distension, a third heart sound (S3), and 2+ pitting edema to
the knees. Echocardiogram shows an ejection fraction of 35% with global hypokinesis. Which of
the following is the most appropriate first-line pharmacologic therapy for this patient?
A. Digoxin and furosemide
B. Metoprolol succinate and lisinopril
C. Amlodipine and hydrochlorothiazide
D. Spironolactone and diltiazem
E. Dobutamine and dopamine
Correct Answer: B
Rationale: This patient has heart failure with reduced ejection fraction (HFrEF). Guideline-
directed medical therapy includes a beta-blocker (metoprolol succinate, carvedilol, or
bisoprolol) and an ACE inhibitor or ARB (lisinopril). These agents improve survival and reduce
,hospitalizations. Digoxin (Choice A) may be added for symptom control but is not first-line.
Amlodipine (Choice C) is a calcium channel blocker that is not recommended for HFrEF.
Diltiazem (Choice D) is contraindicated in HFrEF. Dobutamine (Choice E) is for acute
decompensated heart failure, not chronic management.
Question 3
A 72-year-old man presents with acute onset of severe, tearing chest pain that radiates to his
back. His blood pressure is 190/110 mm Hg in the right arm and 170/100 mm Hg in the left arm.
ECG shows no acute ischemic changes. Chest radiograph reveals a widened mediastinum. Which
of the following is the most likely diagnosis?
A. Acute myocardial infarction
B. Pulmonary embolism
C. Aortic dissection
D. Pericarditis
E. Esophageal rupture
Correct Answer: C
Rationale: This patient's presentation with acute tearing chest pain radiating to the back,
asymmetric blood pressures, and widened mediastinum on chest radiograph is classic for aortic
dissection. Acute myocardial infarction (Choice A) typically presents with ischemic ECG changes
and cardiac biomarker elevation. Pulmonary embolism (Choice B) presents with dyspnea,
tachycardia, and hypoxia. Pericarditis (Choice D) presents with positional chest pain and a
pericardial friction rub. Esophageal rupture (Choice E) typically presents with vomiting and
subcutaneous emphysema.
Question 4
A 48-year-old woman presents with palpitations, lightheadedness, and shortness of breath. ECG
shows an irregularly irregular rhythm with no discernible P waves and a ventricular rate of 145
bpm. She has a history of hypertension and is currently taking lisinopril and
hydrochlorothiazide. Which of the following is the most appropriate initial management?
A. Electrical cardioversion
B. Oral amiodarone
C. Rate control with a beta-blocker
D. Anticoagulation with warfarin and cardioversion
E. Immediate referral for catheter ablation
, Correct Answer: C
Rationale: This patient has atrial fibrillation with rapid ventricular response. The initial
management should focus on rate control with a beta-blocker or nondihydropyridine calcium
channel blocker. Electrical cardioversion (Choice A) may be considered if the patient is
hemodynamically unstable, which this patient is not (she is lightheaded but stable). Amiodarone
(Choice B) is a rhythm-control agent but is not first-line for rate control. Anticoagulation (Choice
D) is indicated for stroke prevention but should be initiated after considering the CHA₂DS₂-VASc
score and the timing of onset; cardioversion without anticoagulation carries stroke risk.
Catheter ablation (Choice E) is reserved for patients who fail medical therapy.
Question 5
A 62-year-old man with a history of coronary artery disease status post two drug-eluting stents
placed 6 months ago presents for routine follow-up. He reports adherence to aspirin and
clopidogrel and has been asymptomatic. His LDL cholesterol is 85 mg/dL on high-intensity statin
therapy. Which of the following is the most appropriate recommendation regarding his
antiplatelet therapy?
A. Continue aspirin and clopidogrel indefinitely
B. Discontinue clopidogrel and continue aspirin alone
C. Switch clopidogrel to ticagrelor
D. Discontinue both aspirin and clopidogrel
E. Continue dual antiplatelet therapy for at least 12 months
Correct Answer: E
Rationale: Following drug-eluting stent placement, dual antiplatelet therapy (DAPT) with aspirin
and a P2Y12 inhibitor (clopidogrel, ticagrelor, or prasugrel) is recommended for at least 6–12
months to prevent stent thrombosis. Given that this patient is only 6 months post-stenting,
DAPT should be continued for a minimum of 12 months. Discontinuing clopidogrel (Choice B)
too early increases the risk of stent thrombosis. Switching to ticagrelor (Choice C) may be
considered in some cases but is not indicated based on the information provided.
Question 6
A 75-year-old woman presents with sudden onset of severe shortness of breath, pleuritic chest
pain, and hemoptysis. She recently underwent total knee replacement surgery 10 days ago. Her
heart rate is 110 bpm, respiratory rate 28/min, blood pressure 100/70 mm Hg, and oxygen
