Physician Assistant National Recertifying
Examination (PANRE) Practice Question Bank
v2.0 Comprehensive 150-Question Review for
the NCCPA PANRE Blueprint (Effective January
2023) a well detailed one written
and graded A+ upgraded.
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 72-year-old man with a history of hypertension and type 2 diabetes presents to the
emergency department with severe substernal chest pressure that started 2 hours ago while
shoveling snow. The pain radiates to his jaw and left arm. He is diaphoretic and nauseated. ECG
,reveals 3-mm ST-segment elevations in leads V1–V4 with reciprocal depression in leads II, III,
and aVF. His blood pressure is 100/65 mm Hg, heart rate 110 bpm, and oxygen saturation 94%
on room air. Emergent cardiac catheterization is not available for 120 minutes. Which of the
following is the most appropriate immediate management?
A. Administer aspirin and sublingual nitroglycerin and observe
B. Administer fibrinolytic therapy
C. Transfer to a facility capable of percutaneous coronary intervention
D. Initiate heparin and glycoprotein IIb/IIIa inhibitor therapy
E. Perform immediate coronary artery bypass grafting
Correct Answer: B
Rationale: This patient has an acute anteroseptal STEMI. When PCI cannot be performed within
90-120 minutes of first medical contact, fibrinolytic therapy is indicated within 30 minutes of
arrival. Aspirin and nitroglycerin (Choice A) are adjunctive but not definitive. Transfer for PCI
(Choice C) is appropriate if the delay is acceptable, but here it exceeds the recommended
timeframe. Heparin and GP IIb/IIIa inhibitors (Choice D) are adjunctive therapies. CABG (Choice
E) is not indicated for acute STEMI.
Question 2
A 62-year-old woman with a history of hypertension presents with progressive dyspnea on
exertion, orthopnea, and paroxysmal nocturnal dyspnea over the past 2 months. Physical
examination reveals jugular venous distension at 12 cm H₂O, a laterally displaced point of
maximal impulse, and an S3 gallop. Echocardiogram shows a left ventricular ejection fraction of
28% with severe global hypokinesis. She is currently on lisinopril 20 mg daily. Which of the
following is the most appropriate addition to her medication regimen for mortality benefit?
A. Carvedilol
B. Amlodipine
C. Digoxin
D. Hydralazine and isosorbide dinitrate
E. Diltiazem
Correct Answer: A
Rationale: This patient has heart failure with reduced ejection fraction (HFrEF). Beta-blockers
with proven mortality benefit in HFrEF include carvedilol, metoprolol succinate, and bisoprolol.
Amlodipine (Choice B) is not recommended for HFrEF. Digoxin (Choice C) improves symptoms
but does not reduce mortality. Hydralazine and isosorbide dinitrate (Choice D) are indicated in
,African American patients with HFrEF as adjunctive therapy. Diltiazem (Choice E) is
contraindicated in HFrEF.
Question 3
A 78-year-old man with a history of hypertension and coronary artery disease presents with
acute onset of severe, sharp chest pain that is worse with deep inspiration and improves when
leaning forward. He reports a low-grade fever and malaise. ECG shows diffuse PR-segment
depression and diffuse ST-segment elevation. Which of the following is the most likely
diagnosis?
A. Acute myocardial infarction
B. Acute pericarditis
C. Pulmonary embolism
D. Aortic dissection
E. Costochondritis
Correct Answer: B
Rationale: This patient has acute pericarditis, characterized by sharp chest pain that worsens
with inspiration and improves with leaning forward, fever, and diffuse ST elevations with PR
depression. Acute MI (Choice A) typically has localized ST elevations with reciprocal changes.
Pulmonary embolism (Choice C) presents with dyspnea and hypoxia. Aortic dissection (Choice
D) presents with tearing pain radiating to the back. Costochondritis (Choice E) presents with
localized chest wall tenderness.
Question 4
A 45-year-old woman presents with palpitations, lightheadedness, and chest discomfort. Her
heart rate is 175 bpm and regular, blood pressure 110/70 mm Hg. ECG shows a regular, narrow-
complex tachycardia at 180 bpm with no discernible P waves. Vagal maneuvers are
unsuccessful. Which of the following is the most appropriate next step?
A. Electrical cardioversion
B. Intravenous adenosine
C. Oral metoprolol
D. Intravenous amiodarone
E. Intravenous verapamil
Correct Answer: B
, Rationale: This patient has paroxysmal supraventricular tachycardia (PSVT) that is
hemodynamically stable. Intravenous adenosine is the drug of choice for acute conversion of
PSVT after failed vagal maneuvers. Electrical cardioversion (Choice A) is for unstable patients.
Oral metoprolol (Choice C) is for chronic rate control. IV amiodarone (Choice D) and IV
verapamil (Choice E) are alternatives but not first-line for PSVT.
Question 5
A 65-year-old man with a history of non-ST-elevation myocardial infarction 2 months ago
presents for routine follow-up. He is status post two drug-eluting stents to the left anterior
descending artery and currently takes aspirin, ticagrelor, atorvastatin 80 mg, metoprolol
succinate, and lisinopril. He reports adherence to all medications and no symptoms. His LDL
cholesterol is 62 mg/dL. Which of the following is the most appropriate recommendation
regarding his antiplatelet therapy?
A. Continue aspirin and ticagrelor for at least 12 months
B. Discontinue ticagrelor and continue aspirin alone
C. Switch from ticagrelor to clopidogrel
D. Discontinue aspirin and continue ticagrelor alone
E. Continue dual antiplatelet therapy for 6 months and reassess
Correct Answer: A
Rationale: Following drug-eluting stent placement, dual antiplatelet therapy (DAPT) with aspirin
and a P2Y12 inhibitor (ticagrelor, prasugrel, or clopidogrel) is recommended for at least 12
months in patients with acute coronary syndrome. Ticagrelor is preferred over clopidogrel in
ACS patients. Discontinuing ticagrelor (Choice B) before 12 months increases the risk of stent
thrombosis. Switching to clopidogrel (Choice C) is not indicated. Aspirin alone (Choice D) is
insufficient. Shorter DAPT duration (Choice E) is not recommended in ACS patients.
Question 6
A 55-year-old woman presents with a 3-month history of progressive dyspnea on exertion,
fatigue, and lower extremity edema. Echocardiogram reveals severe mitral stenosis with a valve
area of 1.0 cm² and a mean gradient of 12 mm Hg. She is in sinus rhythm. Which of the
following is the most appropriate management?
A. Medical management with diuretics and beta-blockers
B. Percutaneous mitral balloon valvuloplasty
C. Mitral valve replacement
Examination (PANRE) Practice Question Bank
v2.0 Comprehensive 150-Question Review for
the NCCPA PANRE Blueprint (Effective January
2023) a well detailed one written
and graded A+ upgraded.
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 72-year-old man with a history of hypertension and type 2 diabetes presents to the
emergency department with severe substernal chest pressure that started 2 hours ago while
shoveling snow. The pain radiates to his jaw and left arm. He is diaphoretic and nauseated. ECG
,reveals 3-mm ST-segment elevations in leads V1–V4 with reciprocal depression in leads II, III,
and aVF. His blood pressure is 100/65 mm Hg, heart rate 110 bpm, and oxygen saturation 94%
on room air. Emergent cardiac catheterization is not available for 120 minutes. Which of the
following is the most appropriate immediate management?
A. Administer aspirin and sublingual nitroglycerin and observe
B. Administer fibrinolytic therapy
C. Transfer to a facility capable of percutaneous coronary intervention
D. Initiate heparin and glycoprotein IIb/IIIa inhibitor therapy
E. Perform immediate coronary artery bypass grafting
Correct Answer: B
Rationale: This patient has an acute anteroseptal STEMI. When PCI cannot be performed within
90-120 minutes of first medical contact, fibrinolytic therapy is indicated within 30 minutes of
arrival. Aspirin and nitroglycerin (Choice A) are adjunctive but not definitive. Transfer for PCI
(Choice C) is appropriate if the delay is acceptable, but here it exceeds the recommended
timeframe. Heparin and GP IIb/IIIa inhibitors (Choice D) are adjunctive therapies. CABG (Choice
E) is not indicated for acute STEMI.
Question 2
A 62-year-old woman with a history of hypertension presents with progressive dyspnea on
exertion, orthopnea, and paroxysmal nocturnal dyspnea over the past 2 months. Physical
examination reveals jugular venous distension at 12 cm H₂O, a laterally displaced point of
maximal impulse, and an S3 gallop. Echocardiogram shows a left ventricular ejection fraction of
28% with severe global hypokinesis. She is currently on lisinopril 20 mg daily. Which of the
following is the most appropriate addition to her medication regimen for mortality benefit?
A. Carvedilol
B. Amlodipine
C. Digoxin
D. Hydralazine and isosorbide dinitrate
E. Diltiazem
Correct Answer: A
Rationale: This patient has heart failure with reduced ejection fraction (HFrEF). Beta-blockers
with proven mortality benefit in HFrEF include carvedilol, metoprolol succinate, and bisoprolol.
Amlodipine (Choice B) is not recommended for HFrEF. Digoxin (Choice C) improves symptoms
but does not reduce mortality. Hydralazine and isosorbide dinitrate (Choice D) are indicated in
,African American patients with HFrEF as adjunctive therapy. Diltiazem (Choice E) is
contraindicated in HFrEF.
Question 3
A 78-year-old man with a history of hypertension and coronary artery disease presents with
acute onset of severe, sharp chest pain that is worse with deep inspiration and improves when
leaning forward. He reports a low-grade fever and malaise. ECG shows diffuse PR-segment
depression and diffuse ST-segment elevation. Which of the following is the most likely
diagnosis?
A. Acute myocardial infarction
B. Acute pericarditis
C. Pulmonary embolism
D. Aortic dissection
E. Costochondritis
Correct Answer: B
Rationale: This patient has acute pericarditis, characterized by sharp chest pain that worsens
with inspiration and improves with leaning forward, fever, and diffuse ST elevations with PR
depression. Acute MI (Choice A) typically has localized ST elevations with reciprocal changes.
Pulmonary embolism (Choice C) presents with dyspnea and hypoxia. Aortic dissection (Choice
D) presents with tearing pain radiating to the back. Costochondritis (Choice E) presents with
localized chest wall tenderness.
Question 4
A 45-year-old woman presents with palpitations, lightheadedness, and chest discomfort. Her
heart rate is 175 bpm and regular, blood pressure 110/70 mm Hg. ECG shows a regular, narrow-
complex tachycardia at 180 bpm with no discernible P waves. Vagal maneuvers are
unsuccessful. Which of the following is the most appropriate next step?
A. Electrical cardioversion
B. Intravenous adenosine
C. Oral metoprolol
D. Intravenous amiodarone
E. Intravenous verapamil
Correct Answer: B
, Rationale: This patient has paroxysmal supraventricular tachycardia (PSVT) that is
hemodynamically stable. Intravenous adenosine is the drug of choice for acute conversion of
PSVT after failed vagal maneuvers. Electrical cardioversion (Choice A) is for unstable patients.
Oral metoprolol (Choice C) is for chronic rate control. IV amiodarone (Choice D) and IV
verapamil (Choice E) are alternatives but not first-line for PSVT.
Question 5
A 65-year-old man with a history of non-ST-elevation myocardial infarction 2 months ago
presents for routine follow-up. He is status post two drug-eluting stents to the left anterior
descending artery and currently takes aspirin, ticagrelor, atorvastatin 80 mg, metoprolol
succinate, and lisinopril. He reports adherence to all medications and no symptoms. His LDL
cholesterol is 62 mg/dL. Which of the following is the most appropriate recommendation
regarding his antiplatelet therapy?
A. Continue aspirin and ticagrelor for at least 12 months
B. Discontinue ticagrelor and continue aspirin alone
C. Switch from ticagrelor to clopidogrel
D. Discontinue aspirin and continue ticagrelor alone
E. Continue dual antiplatelet therapy for 6 months and reassess
Correct Answer: A
Rationale: Following drug-eluting stent placement, dual antiplatelet therapy (DAPT) with aspirin
and a P2Y12 inhibitor (ticagrelor, prasugrel, or clopidogrel) is recommended for at least 12
months in patients with acute coronary syndrome. Ticagrelor is preferred over clopidogrel in
ACS patients. Discontinuing ticagrelor (Choice B) before 12 months increases the risk of stent
thrombosis. Switching to clopidogrel (Choice C) is not indicated. Aspirin alone (Choice D) is
insufficient. Shorter DAPT duration (Choice E) is not recommended in ACS patients.
Question 6
A 55-year-old woman presents with a 3-month history of progressive dyspnea on exertion,
fatigue, and lower extremity edema. Echocardiogram reveals severe mitral stenosis with a valve
area of 1.0 cm² and a mean gradient of 12 mm Hg. She is in sinus rhythm. Which of the
following is the most appropriate management?
A. Medical management with diuretics and beta-blockers
B. Percutaneous mitral balloon valvuloplasty
C. Mitral valve replacement
