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Anyone seeking a career as a physician assistant will need to pass the Physician Assistant National Certifying Exam (PANCE) in order to be certified to practice. The test is developed and administered by the National Commission on Certification of Physician Assistants (NCCPA), and covers two broad areas. The first category is questions concerning organs and systems in the human body, and the most common medical ailments a PA is likely to encounter. The second category concerns what a PA's responses and actions to these ailments should be. The PANCE consists of 300 questions, in five separate blocks of 60 questions. It's pretty much a day long undertaking; a candidate is given five hours total to complete the test (with breaks in between sessions, totaling 45 additional minutes).

Candidates must first graduate from a PA training program that has been accredited by the Accreditation Review Committee on Education for the Physician Assistant (ARC-PA). After graduation, the Six Years/Six Attempts Rule takes effect: a person must pass the PANCE within six years after graduating, and they are allowed a maximum of six attempts. If six years elapse, or if the candidate fails the exam six times, he is ineligible to take the test again. The only way to regain eligibility is to graduate from another ARC-PA accredited PA training program. (These are the rules for those people graduating from PA training programs on or after January 1, 2003; the rules are more complex for those who graduated before this day, and for people in those situations it's best to consult the NCCPA website. )

The earliest a person may apply is 90 days prior to graduation from their PA education program, and the earliest date to actually take the test is seven days after graduation. Once an application is approved, the applicant has a window of 180 days in which to take the tests. If a person wants to retake the exam, they must wait at least 90 days to do so. No one is allowed to take the test more than three times in a calendar year. Currently the fee to take the PANCE is $475, and it must be paid every time a person takes the test, not just the initial attempt. As the PANCE is a very difficult exam to pass, and because the consequences of failure can be so high, many candidates rely on test prep aids before tackling the exam. These are not officially endorsed by the NCCPA, but there is no doubt that they have been the difference between passing and failing for thousands.

PANCE Test Breakdown

PANCE Self-Assessment Modules:

Practice Questions

1. A P.A. has just started on the 7PM surgical shift rotation. Which of the following patients should the P.A. check on first?

A: A 75 year-old female who is scheduled for an EGD in 10 hours.
B: A 34 year-old male who is complaining of low back pain following back surgery and has an onset of urinary incontinence in the last hour.
C: A 21 year-old male who had a lower extremity BKA yesterday, following a MVA and has phantom pain.
D: A 27 year-old female who has received 1.5 units of RBC's. via transfusion the previous day.

2. A 13 year old girl is admitted to the hospital with lower right abdominal discomfort. The P.A. should take which the following measures first?

A: Administer Loritab to the patient for pain relief.
B: Place the patient in right sidelying position for pressure relief.
C: Start a Central Line.
D: Provide pain reduction techniques without administering medication.

3. A fifty-five year-old man suffered a left frontal lobe CVA. The patient's family is not present in the room. Which of the following should the P.A. watch most closely for?

A: Changes in emotion and behavior
B: Monitor loss of hearing
C: Observe appetite and vision deficits
D: Changes in facial muscle control

4. A central venous pressure reading of 11cm/H20 of an IV of normal saline is determined by the P.A. caring for the patient. The patient has a diagnosis of pericarditis. Which of the following is the most applicable:

A: The patient has a condition of hypovolemia.
B: Not enough fluid has been given to the patient.
C: Pericarditis may cause pressures greater than 10cm/H20 with testing of CVP.
D: The patient may have a condition of arteriosclerosis.

5. A physician is instructing a patient on the order of sensations with the application of an ice water bath for a swollen right ankle. Which of the following is the correct order of sensations experienced with an ice water bath?

A: cold, burning, aching, and numbness
B: burning, aching, cold, and numbness
C: aching, cold, burning and numbness
D: cold, aching, burning and numbness

Answer Key

1. (B) The new onset of urinary incontinence may require additional medical assessment.
2. (D) Do not administer pain medication or start a central line without MD orders.
3. (A) The frontal lobe is responsible for behavior and emotions.
4. (C) >10cm/H20 may indicate a condition of pericarditis
5. (A) CBAN, cold, burn, ache, numbness

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Last Updated: 07/25/2014

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