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Health & emergency services

PANCE — Practice Questions, Part 1 flashcards

6 of 75 questions free to study here · 7 topics · the whole deck is built into Willys

Multiple-choice practice questions, one best answer each, on ACS, heart failure, valves, arrhythmias, diabetes, thyroid, GI, anemia, coagulation, infections, lung disease and kidney disease.

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Practice deck · part of PANCE (Physician Assistant boards) · written against: NCCPA PANCE content blueprint, effective January 2025 (organ systems); no dosing. Updated 2026-10-10.

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  1. A 58-year-old man has had crushing substernal chest pain for an hour. His ECG shows ST elevation in leads II, III and aVF with reciprocal ST depression in I and aVL. Which artery is most likely occluded?

    A) Left main coronary artery
    B) Left circumflex artery
    C) Right coronary artery
    D) Left anterior descending artery
    C) Right coronary artery

    Leads II, III and aVF face the inferior wall, which the right coronary artery supplies in most (right-dominant) hearts. The left circumflex supplies it mainly in a left-dominant or codominant circulation, so it is the less likely culprit.
    Cardiovascular › Coronary Disease and ECG
  2. An asymptomatic 47-year-old man has an A1c of 6.8% on routine labs. He has no prior glucose results. What is the most appropriate next step?

    A) Check C-peptide and islet antibodies
    B) Diagnose diabetes and start metformin
    C) Reassure him and rescreen in three years
    D) Confirm with a second abnormal test
    D) Confirm with a second abnormal test

    Without classic symptoms or unequivocal hyperglycemia, a single abnormal result must be confirmed by a repeat A1c or a fasting or 2-hour glucose. Antibody testing is for suspected autoimmune diabetes, not a routine screen.
    Endocrine › Diabetes
  3. A 42-year-old woman has had trouble swallowing both solids and liquids from the start, with regurgitation of undigested food. Barium swallow shows a dilated esophagus that tapers to a bird's beak. Which test is most accurate?

    A) Barium esophagram
    B) Upper endoscopy
    C) Esophageal manometry
    D) 24-hour pH monitoring
    C) Esophageal manometry

    Manometry confirms achalasia by showing incomplete lower esophageal sphincter relaxation and absent peristalsis. Endoscopy is still done to rule out a tumor mimicking it, but it cannot measure motility.
    Gastrointestinal › Esophagus and Stomach
  4. A 70-year-old woman develops frequent watery diarrhea and cramps after a course of clindamycin. A stool test for C. difficile toxin is positive. This is her first episode. Which treatment is preferred?

    A) Oral fidaxomicin
    B) Intravenous vancomycin
    C) Oral metronidazole
    D) Oral ciprofloxacin
    A) Oral fidaxomicin

    Oral fidaxomicin is preferred for an initial episode, with oral vancomycin as the alternative (IDSA/SHEA 2021); metronidazole is no longer first-line. IV vancomycin does not reach the colon.
    Infectious Disease › Bacterial Infections
  5. A 30-year-old woman has episodic wheezing and cough. Spirometry shows a reduced FEV1/FVC ratio. Which additional finding best supports asthma rather than COPD?

    A) Reduced diffusing capacity (DLCO)
    B) Persistent post-bronchodilator obstruction
    C) Reduced total lung capacity
    D) Large FEV1 gain after a bronchodilator
    D) Large FEV1 gain after a bronchodilator

    Asthma obstruction is largely reversible, so FEV1 improves substantially after a bronchodilator. A low DLCO points to emphysema, and obstruction that persists after a bronchodilator marks COPD.
    Pulmonary › Obstructive Disease
  6. A 78-year-old woman has had vomiting for three days and has dry mucous membranes. Her creatinine has doubled, the BUN-to-creatinine ratio is above 20, and the fractional excretion of sodium is 0.4%. What type of acute kidney injury is this?

    A) Postrenal obstruction
    B) Acute tubular necrosis
    C) Acute interstitial nephritis
    D) Prerenal azotemia
    D) Prerenal azotemia

    A FENa below 1% means intact tubules are avidly holding sodium in response to low perfusion, the pattern of prerenal injury. Acute tubular necrosis has a FENa above 2% because damaged tubules lose sodium.
    Renal › Kidney Injury and CKD

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More PANCE (Physician Assistant boards) decks

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About these cards

Review status: Second-reader reviewed, with corrections applied.

Checked against:

  • NCCPA PANCE content blueprint, effective January 2025 (topic outline only; no text copied)
  • Checked against standard internal-medicine references (reference only; no text copied)
  • Checked against the ADA Standards of Care in Diabetes—2026 (diagnosis), the 2023 ACC/AHA/ACCP/HRS atrial fibrillation guideline, the 2022 AHA/ACC/HFSA heart failure guideline, the 2021 IDSA/SHEA C. difficile focused update, the 2018 ASH heparin-induced thrombocytopenia guideline, the 2023 Pituitary Society prolactinoma consensus statement and the CDC December 2025 pertussis treatment and postexposure prophylaxis guidance (reference only; no text copied)

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