PANCE Question Overview

PANCE Question Overview

PANCE can be challenging. For you aspiring physician assistants out there, it’s the culmination of years of study. Understandably, the pressure can feel intense! So, how can you best tackle this task? Well, sometimes the best way to tackle your problems is to dissect them into parts.


PANCE question overview
Bianca Villanueva


February 22, 2024

This article will answer some commonly-asked questions about the PANCE content and provide an overview. We’ll also go over common formats used in the exam and how to approach them. But first, let’s have a quick explanation of what the PANCE is.

What is PANCE? Definition

The Physician Assistant National Certifying Exam (PANCE) is an exam that physician assistant (PA) graduates must take to start practicing in the United States (US). It is computer-based and administered by the National Commission on Certification of Physician Assistants (NCCPA).

The exam consists of medical and surgical questions about common diseases encountered by physician assistants. The specific topic distribution of subject content will be discussed later in the article.

What’s on the PANCE & the PANCE Blueprints

It can feel like a big ask to cram years of study into one exam. It feels like any topic could come up, and how can one person possibly remember everything? Luckily, the NCCPA releases blueprints for the exam. These blueprints outline the percentage distribution of each topic so that you know which subjects to prioritize. That isn’t to say that other subjects aren’t important; it’s simply that these topics will be the ones you’ll most commonly encounter in practice.

The blueprint is created by practicing physician assistants to ensure the questions cover the competencies a PA needs. These professionals write and review the questions included in the exam and even recommend the passing standard. The exam is constantly being reviewed and updated by PAs to ensure relevancy and accuracy.

For medical content, the percentage allocation in the 2019 version (which is currently in use) is:

  • Cardiovascular System (13%)
  • Pulmonary System (10%)
  • Gastrointestinal System/Nutrition (9%)
  • Musculoskeletal System (8%)
  • Endocrine System (7%)
  • Eyes, Ears, Nose, and Throat (7%)
  • Neurologic System (7%)
  • Reproductive System (Male and Female) (7%)
  • Infectious Diseases (6%)
  • Psychiatry/Behavioral Science (6%)
  • Dermatologic System (5%)
  • Genitourinary System (Male and Female) (5%)
  • Renal System (5%)
  • Hematologic System (5%)

Ninety-five percent of the exam consists of the medical content mentioned above. The other 5% are about professional practice issues. Additionally, up to 20% of the exam can be about surgery.

The exam will also test your competency in common tasks performed by PAs. Every question in the exam is categorized under a type of task. The distribution of these tasks is:

  • History Taking and PE (17%)
  • Diagnostic and Laboratory Studies (12%)
  • Formulating the Most Likely Diagnosis (18%)
  • Managing Patients
    • Health Maintenance, Patient Education, and Preventive Measures (10%)
    • Clinical Intervention (14%)
    • Pharmaceutical Therapeutics (14%)
  • Applying Basic Scientific Concepts (10%)
  • Professional Practice (5%)

How Long is the PANCE?

The PANCE is composed of 5 blocks. Each block is allotted 60 minutes to complete with 45-minute breaks in between. This makes the total duration of the exam 5 hours, plus the 15-minute tutorial at the beginning of the exam.

Make sure to arrive 30 minutes before your testing time, as you may not be allowed to enter if you’re late. This would result in the forfeiture of the fee you paid. You would then have to reapply for the exam.

Make sure to be responsible about your breaks as well. If you go over-time, that extra time can be deducted from the time allotted for a block during the actual exam. So, use your breaks wisely.

How Many Questions are on the PANCE?

The exam itself consists of 300 questions total, in multiple choice format. Each block has 60 questions. Hence, you’ll have to answer at the (arguably) comfy pace of one question per minute.

What Kind of Questions are on the PANCE?

Some years ago, the exam used to contain K-type questions, which were series of true or false questions with more than one option being correct. For example, the answers could be, “Both A and B are true” or “Two of the above are true”. Don’t worry about running into this type of question, as these question types have been phased out.

The exam also no longer contains negative questions. These types of questions usually begin with phrasing like, “Which of the answers is NOT…” or “The following are true EXCEPT…”

Currently, the PANCE exam features mostly second- or third-order questions. What does this mean? First-order questions are straightforward questions such as “What is the drug of choice for URTI (Upper Respiratory Tract Infections)?”

Second- and third-order questions require a few extra steps to come up with the right answer. For example, “A patient comes in one-sided weakness and has a history of loss of consciousness prior to arrival. He has trouble explaining what happened due to slurring of speech. What is the gold standard diagnostic imaging tool for this patient?” These questions require you to think about a diagnosis. Then, based on that diagnosis, you then have to recall the gold standard for diagnosing it.

Is There a Specific PANCE Question Format?

There’s no set question format. However, if you’ve read through the sample questions on the NCCPA site, you’ll notice a recurring pattern in the questions. It mentions the age, sex, race, onset, symptoms leading up to consultation, physical exam, lab work done, and other pertinent details.

Make sure to read every clue provided, as all you need to know about the case is given in the question. There’s no need to assume anything that isn’t explicitly stated. So make sure to study all the information given, even if it looks like a long case! Even though you may already have a diagnosis in mind while reading about the presenting symptoms, you still need to read through the lab work to confirm your suspicions.

The questions are mostly in paragraph form, so be prepared to read a lot. It can be mentally taxing, but it’s not impossible.

How are the Answers Stated?

Almost every question, if not all the questions, have 5 choices: one correct answer and four distractors (wrong or less likely answers). While some answers may be plausible and are not necessarily wrong, always go for the BEST or MOST LIKELY answer.

The distractors (the incorrect or least likely answers) will always be real diseases. You won’t find anything made-up in there. However, the distractors will try to throw you off by presenting choices that either sound correct but may not be the best answer, directly harm the patient, or have nothing to do with the case. So, try to think about why your answer is correct and why the other choices are wrong.

Practice Exams

One of the best ways to review for an exam is using practice tests. It helps to familiarize yourself with the question format of the PANCE. That way, you’ll be able to answer each question in 60 seconds or less when the test day arrives without getting too exhausted.

Learning path pance learning path

Ace your PANCE with Lecturio

NCCPA has practice questions that you can use to check your performance. Unfortunately, you have to pay a fee for it and it’s not meant to act as a predictor for your actual performance on the PANCE. Still, it helps to get a feel of what the exam is like. Each exam costs $50 and you only have 180 days to complete it, otherwise you’ll have to repurchase it.

What Types of Questions are Asked On the PANCE?

In addition to questions like “What’s the most likely diagnosis?,” the PANCE will feature various other types of questions. Of course, it’s still important to know how to formulate the most likely diagnosis, because that’s the basis for your next steps in managing the patient. Either way, be also prepared for other types of questions, such as:

“What is the next appropriate step/management?”

For questions like these, imagine yourself being the PA on the case in real life. Be practical. If the case is about an emergency patient, remember to stabilize the patient first and leave diagnostic exams for later. Try to rule out the most life-threatening conditions before investigating more benign ones.

Eliminate answer choices that you’re certain will harm the patient. For example, if a patient comes in with tachycardia, chest pain radiating to the left shoulder, and difficulty breathing, you don’t want to pick the choice that says “Watch and wait” or “Observe” (These are common distractors used for these types of questions).

“Which of the following patients…?”

An example for this type of question is “Which of the following patients is a candidate for percutaneous coronary intervention (PCI)?” The answer choices will be a list of different patients with varying presentations. In questions like this one, some distractors will have the absolute contraindications to the procedure. Eliminate those immediately to narrow down your choices. In other words, get the obviously wrong distractors out of the way first.

“What is the gold standard/drug of choice?”

This type of question is more knowledge- and recall-based than application-based. Many diseases have their own gold standard tests and treatments. I suggest you list those down as you study. Of course, these questions will not be that straightforward. The question will usually give a case and you’ll have to formulate your own diagnosis before identifying the gold standard test or treatment. So, if your initial diagnosis is wrong, you’ll definitely get the question wrong.

“What is the most common etiology?”

Similar to the gold standard questions, these are also more knowledge- and recall-based questions that require you to have a diagnosis in mind. What makes these questions tricky is that etiology can change depending on your patient’s age, background, or presenting symptoms. For example, bacterial meningitis in children can have different etiologies, depending on their age. So, keep your patient’s profile in mind for questions like this.

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