PANCE Content
Blueprint
The Physician Assistant National Certifying Examination (PANCE) is developed and managed by the National Commission on Certification of Physician Assistants (NCCPA). Every couple of years, the PANCE undergoes content updates published in a revised NCCPA blueprint. The most recent PANCE blueprint went into effect in January 2019, reflecting feedback on current PA practices from certified physician assistants.
What Are the PANCE Blueprint Categories?
The PANCE blueprint breaks down the exam into medical content and task categories defined as follows:
- Medical Content Categories: Knowledge of the diseases and disorders physician assistants encounter.
- Task Categories: Knowledge and skills related to tasks physician assistants perform when treating patients.
Because the medical field is constantly changing to address improved practices and technologies, the NCCPA leans on certified PAs to provide industry information through profession-wide practice analysis studies. Certified PAs are also involved in updating the exam by reviewing the results of the practice analyses, creating new questions, critiquing the exam prior to it being administered, reviewing exam-question performance data, and offering suggestions for the passing standard. While PANCE blueprint updates do not occur annually, certified PAs continuously work with the NCCPA to ensure the PANCE is relevant.
PANCE medical content categories
As defined above, the medical content categories on the PANCE assess candidates’ knowledge of the diseases and disorders PAs encounter. Below are the contents of each category and how each category is allocated on the exam:
| Categories | % Allocation |
|---|
Cardiomyopathy
- Dilated
- Hypertrophic
- Restrictive
Conduction disorders/dysrhythmias
- Atrial fibrillation/flutter
- Atrioventricular block
- Bundle branch block
- Paroxysmal supraventricular tachycardia
- Premature beats
- Sick sinus syndrome
- Sinus arrhythmia
- Torsades de pointes
- Ventricular fibrillation
- Ventricular tachycardia
Congenital heart disease
- Atrial septal defect
- Coarctation of aorta
- Patent ductus arteriosus
- Tetralogy of Fallot
- Ventricular septal defect
Coronary artery disease
- Acute myocardial infarction
- Non–ST-segment elevation
- ST-segment elevation
- Angina pectoris
- Prinzmetal variant
- Stable
- Unstable
Heart failure
Hypertension
- Essential hypertension
- Hypertensive emergencies
- Secondary hypertension
Hypotension
- Cardiogenic shock
- Orthostatic hypotension
- Vasovagal hypotension
Lipid disorders
- Hypercholesterolemia
- Hypertriglyceridemia
Traumatic, infectious, and inflammatory heart conditions
- Acute and subacute bacterial endocarditis
- Acute pericarditis
- Cardiac tamponade
- Pericardial effusion
Valvular disorders
- Aortic
- Mitral
- Pulmonary
- Tricuspid
Vascular disease
- Aortic aneurysm/dissection
- Arterial embolism/thrombosis
- Arteriovenous malformation
- Giant cell arteritis
- Peripheral artery disease
- Phlebitis/thrombophlebitis
- Varicose veins
- Venous insufficiency
- Venous thrombosis
Acneiform eruptions
- Acne vulgaris
- Folliculitis
- Rosacea
Desquamation
- Erythema multiforme
- Stevens-Johnson syndrome
- Toxic epidermal necrolysis
Diseases/disorders of the hair and nails
- Alopecia
- Onychomycosis
- Paronychia
Envenomations and arthropod bite reactions
Exanthems
- Erythema infectiosum (fifth disease)
- Hand-foot-and-mouth disease
- Measles
Infectious diseases
- Bacterial
- Cellulitis
- Erysipelas
- Impetigo
- Fungal
- Candidiasis
- Dermatophyte infections
- Parasitic
- Lice
- Scabies
- Viral
- Condyloma acuminatum
- Herpes simplex
- Molluscum contagiosum
- Varicella-zoster virus infections
- Verrucae
Keratotic disorders
- Actinic keratosis
- Seborrheic keratosis
Neoplasms
- Benign
- Malignant
- Premalignant
Papulosquamous disorders
- Contact dermatitis
- Drug eruptions
- Eczema
- Lichen planus
- Pityriasis rosea
- Psoriasis
Pigment disorders
- Melasma
- Vitiligo
Skin integrity
- Burns
- Lacerations
- Pressure ulcers
- Stasis dermatitis
Vascular abnormalities
- Cherry angioma
- Telangiectasia
Vesiculobullous disease
- Pemphigoid
- Pemphigus
Other dermatologic disorders
- Acanthosis nigricans
- Hidradenitis suppurativa
- Lipomas/epidermal inclusion cysts
- Photosensitivity reactions
- Pilonidal disease
- Urticaria
Adrenal disorders
- Primary adrenal insufficiency
- Cushing syndrome
Diabetes mellitus
- Type 1
- Type 2
Hypogonadism
Neoplasms
- Multiple endocrine neoplasia
- Neoplastic syndrome
- Primary endocrine malignancy
- Syndrome of inappropriate antidiuretic hormone secretion (SIADH)
Parathyroid disorders
- Hyperparathyroidism
- Hypoparathyroidism
Pituitary disorders
- Acromegaly/gigantism
- Diabetes insipidus
- Dwarfism
- Pituitary adenoma
Thyroid disorders
- Hyperthyroidism
- Hypothyroidism
- Thyroiditis
Eye disorders
- Conjunctival disorders
- Conjunctivitis
- Corneal disorders
- Cataract
- Corneal ulcer
- Infectious
- Keratitis
- Pterygium
- Lacrimal disorders
- Dacryocystitis
- Lid disorders
- Blepharitis
- Chalazion
- Ectropion
- Entropion
- Hordeolum
- Neuro-ophthalmologic disorders
- Nystagmus
- Optic neuritis
- Papilledema
- Orbital disorders
- Orbital cellulitis
- Retinal disorders
- Macular degeneration
- Retinal detachment
- Retinopathy
- Traumatic disorders
- Blowout fracture
- Corneal abrasion
- Globe rupture
- Hyphema
- Vascular disorders
- Retinal vascular occlusion
- Vision abnormalities
- Amaurosis fugax
- Amblyopia
- Glaucoma
- Scleritis
- Strabismus
Ear disorders
- External ear
- Cerumen impaction
- Otitis externa
- Trauma
Inner ear
- Acoustic neuroma
- Barotrauma
- Dysfunction of eustachian tube
- Labyrinthitis
- Vertigo
Middle ear
- Cholesteatoma
- Otitis media
- Tympanic membrane perforation
Hearing impairment
Other abnormalities of the ear
- Mastoiditis
- Meniere disease
- Tinnitus
Foreign bodies
Neoplasms
- Benign
- Malignant
Nose/sinus disorders
- Epistaxis
- Nasal polyps
- Rhinitis
- Sinusitis
- Trauma
Oropharyngeal disorders
- Diseases of the teeth/gums
- Infectious/inflammatory disorders
- Aphthous ulcers
- Candidiasis
- Deep neck infection
- Epiglottitis
- Herpes simplex
- Laryngitis
- Peritonsillar abscess
- Pharyngitis
- Salivary disorders
- Sialadenitis
- Parotitis
- Trauma
- Other oropharyngeal disorders
- Leukoplakia
Biliary disorders
- Acute/chronic cholecystitis
- Cholangitis
- Cholelithiasis
Colorectal disorders
- Abscess/fistula
- Anal fissure
- Constipation
- Diverticulitis
- Fecal impaction
- Hemorrhoids
- Inflammatory bowel disease
- Irritable bowel syndrome
- Ischemic bowel disease
- Obstruction
- Polyps
- Toxic megacolon
Esophageal disorders
- Esophagitis
- Gastroesophageal reflux disease
- Mallory-Weiss tear
- Motility disorders
- Strictures
- Varices
Food allergies and food sensitivities
- Gluten intolerance
- Lactose intolerance
- Nut allergies
Gastric disorders
- Gastritis
- Peptic ulcer disease
- Pyloric stenosis
Hepatic disorders
- Acute/chronic hepatitis
- Cirrhosis
Hernias
Infectious diarrhea
Ingestion of toxic substances or foreign bodies
Metabolic disorders
- G6PD deficiency
- Paget disease
- Phenylketonuria
- Rickets
Neoplasms
- Benign
- Malignant
Nutritional and vitamin disorders
- Hypervitaminosis/hypovitaminosis
- Obesity
Pancreatic disorders
- Acute/chronic pancreatitis
Small intestine disorders
- Appendicitis
- Celiac disease
- Intussusception
- Obstruction
- Polyps
Bladder disorders
- Incontinence
- Overactive bladder
- Prolapse
Congenital and acquired abnormalities
- Cryptorchidism
- Peyronie disease
- Trauma
- Vesicoureteral reflux
Human sexuality
Infectious disorders
- Cystitis
- Epididymitis
- Orchitis
- Prostatitis
- Pyelonephritis
- Urethritis
Neoplasms
- Bladder cancer
- Penile cancer
- Prostate cancer
- Testicular cancer
Nephrolithiasis/urolithiasis
Penile disorders
- Erectile dysfunction
- Hypospadias/epispadias
- Paraphimosis/phimosis
Prostate disorders
- Benign prostatic hyperplasia
Testicular disorders
- Hydrocele/varicocele
- Testicular torsion
Urethral disorders
- Prolapse
- Stricture
Autoimmune disorders
Coagulation disorders
- Clotting factor disorders
- Thrombocytopenias
Cytopenias
- Anemia
- Leukopenia
Cytoses
- Polycythemia
- Thrombocytosis
Hemoglobinopathies
- Hemochromatosis
- Sickle cell disease
- Thalassemia
Immunologic disorders
- Transfusion reaction
Neoplasms, premalignancies, and malignancies
- Acute/chronic lymphocytic leukemia
- Acute/chronic myelogenous leukemia
- Lymphoma
- Multiple myeloma
- Myelodysplasia
Bacterial diseases
- Botulism
- Campylobacter jejuni infection
- Chlamydia
- Cholera
- Diphtheria
- Gonococcal infections
- Gonorrhea
- Methicillin-resistant Staphylococcus aureus infection
- Rheumatic fever
- Rocky Mountain spotted fever
- Salmonellosis
- Shigellosis
- Tetanus
Fungal diseases
- Candidiasis
- Cryptococcosis
- Histoplasmosis
- Pneumocystis
Mycobacterial diseases
- Atypical mycobacterial disease
- Tuberculosis
Parasitic diseases
- Helminth infestations
- Malaria
- Pinworms
- Toxoplasmosis
- Trichomoniasis
Prenatal transmission of disorders
- Congenital varicella
- Herpes simplex virus
- Human papillomavirus
- Zika virus
Sepsis/systemic inflammatory response syndrome
Spirochetal diseases
- Lyme disease
- Syphilis
Viral diseases
- Cytomegalovirus infections
- Epstein-Barr virus infections
- Erythema infectiosum
- Herpes simplex virus infections
- HIV infection
- Human papillomavirus infections
- Influenza
- Measles
- Mumps
- Rabies
- Roseola
- Rubella
- Varicella-zoster virus infections
Chest/rib disorders
- Deformities
- Fractures
Compartment syndrome
Degenerative diseases
- Osteoarthritis
Infectious diseases
- Osteomyelitis
- Septic arthritis
Lower extremity disorders
- Avascular necrosis
- Developmental dysplasia
- Fractures/dislocations
- Osgood-Schlatter disease
- Slipped capital femoral epiphysis
- Soft-tissue injuries
Neoplasms
- Benign
- Malignant
Rheumatologic disorders
- Fibromyalgia
- Gout/pseudogout
- Juvenile rheumatoid arthritis
- Osteoporosis
- Polyarteritis nodosa
- Polymyalgia rheumatica
- Polymyositis
- Reactive arthritis
- Rheumatoid arthritis
- Sjögren syndrome
- Systemic lupus erythematosus
- Systemic sclerosis (Scleroderma)
Spinal disorders
- Ankylosing spondylitis
- Cauda equina syndrome
- Herniated nucleus pulposus
- Kyphosis
- Scoliosis
- Spinal stenosis
- Sprain/strain
- Thoracic outlet syndrome
- Torticollis
- Trauma
Upper extremity disorders
- Fractures/dislocations
- Soft-tissue injuries
Closed head injuries
- Concussion
- Postconcussion syndrome
- Traumatic brain injury
Cranial nerve palsies
Encephalopathic disorders
Headaches
- Cluster headache
- Migraine
- Tension headache
Infectious disorders
- Encephalitis
- Meningitis
Movement disorders
- Essential tremor
- Huntington disease
- Parkinson disease
- Tourette disorder
Neoplasms
- Benign
- Malignant
Neurocognitive disorders
- Delirium
- Major/mild neurocognitive disorders
Neuromuscular disorders
- Cerebral palsy
- Multiple sclerosis
- Myasthenia gravis
Peripheral nerve disorders
- Carpal tunnel syndrome
- Complex regional pain syndrome
- Guillain-Barré syndrome
- Peripheral neuropathy
Seizure disorders
- Focal seizures
- Generalized seizures
- Status epilepticus
Vascular disorders
- Arteriovenous malformation
- Cerebral aneurysm
- Intracranial hemorrhage
- Stroke
- Syncope
- Transient ischemic attack
Abuse and neglect
- Child abuse
- Domestic violence
- Elder abuse
- Sexual abuse
Anxiety disorders
- Generalized anxiety disorder
- Panic disorder
- Phobias
Bipolar and related disorders
Depressive disorders
- Major depressive disorder
- Persistent depressive disorder (dysthymia)
- Premenstrual dysphoric disorder
- Suicidal/homicidal behaviors
Disruptive, impulse-control, and conduct disorders
- Conduct disorder
Dissociative disorders
Feeding and eating disorders
Human sexuality
Obsessive-compulsive and related disorders
Neurodevelopmental disorders
- Attention-deficit/hyperactivity disorder
- Autism spectrum disorder
Personality disorders
Schizophrenia spectrum and other psychotic disorders
Sleep-wake disorders
- Narcolepsy
- Parasomnias
Somatic symptom and related disorders
Substance-related and addictive disorders
Trauma- and stressor-related disorders
- Adjustment disorders
- Post-traumatic stress disorder
Chronic obstructive pulmonary diseases
- Chronic bronchitis
- Emphysema
Infectious disorders
- Acute bronchiolitis
- Acute bronchitis
- Acute epiglottitis
- Croup
- Influenza
- Pertussis
- Pneumonias
- Bacterial
- Fungal
- HIV-related
- Viral
- Respiratory syncytial virus infection
- Tuberculosis
Neoplasms
- Carcinoid tumors
- Lung cancer
- Pulmonary nodules
Pleural diseases
- Pleural effusion
- Pneumothorax
Pulmonary circulation
- Cor pulmonale
- Pulmonary embolism
- Pulmonary hypertension
Restrictive pulmonary diseases
- Idiopathic pulmonary fibrosis
- Pneumoconiosis
- Sarcoidosis
Sleep apnea/Obesity hypoventilation syndrome
Other pulmonary disorders
- Acute respiratory distress syndrome
- Asthma
- Cystic fibrosis
- Foreign body aspiration
- Hyaline membrane disease
Acute disorders
- Glomerulonephritis
- Nephrotic syndrome
- Pyelonephritis
Acute kidney injury (acute renal failure)
Chronic kidney disease
Congenital or structural renal disorders
- Horseshoe kidney
- Hydronephrosis
- Polycystic kidney disease
- Renal vascular disease
End-stage renal disease
Fluid and electrolyte disorders
- Acid-base disorders
- Dehydration
- Hyperkalemia/hypokalemia
- Hypervolemia
- Hyponatremia
Neoplasms
- Renal cell carcinoma
- Wilms tumor
Breast disorders
- Abscess
- Fibroadenoma
- Fibrocystic changes
- Galactorrhea
- Gynecomastia
- Mastitis
Cervical disorders
- Cervicitis
- Dysplasia
Complicated pregnancy
- Abortion
- Abruptio placentae
- Breech presentation
- Cesarean delivery
- Cord prolapse
- Dystocia
- Ectopic pregnancy
- Fetal distress
- Gestational diabetes
- Gestational trophoblastic disease
- Hypertension disorders in pregnancy
- Incompetent cervix
- Multiple gestation
- Placenta previa
- Postpartum hemorrhage
- Premature rupture of membranes
- Rh incompatibility
- Shoulder dystocia
Contraceptive methods
Human sexuality
Infertility
Menopause
Menstrual disorders
Neoplasms of the breast and reproductive tract
- Benign
- Malignant
Ovarian disorders
- Cysts
- Polycystic ovarian syndrome
- Torsion
Sexually transmitted infections/Pelvic inflammatory disease
Trauma
- Physical assault
- Sexual assault
- Trauma in pregnancy
Uncomplicated pregnancy
- Normal labor/delivery
- Postnatal/postpartum care
- Preconception/prenatal care
Uterine disorders
- Endometriosis
- Leiomyoma
- Prolapse
Vaginal/vulvar disorders
- Cystocele
- Prolapse
- Rectocele
- Vaginitis
PANCE task categories
The task categories on the PANCE assess candidates’ knowledge and skills related to tasks PAs perform when treating patients. Below are the contents of each category and how each category is allocated on the exam:
| Categories | % Allocation |
|---|
Knowledge of:
- General physical examination components and techniques
- Pertinent historical information
- Risk factors for development of significant medical conditions
- Significant physical examination findings
- Signs and symptoms of significant medical conditions
Skill in:
- Conducting comprehensive and/or problem-based interviews and physical examinations
- Eliciting patient information from other sources
- Identifying conditions requiring referral to or consultation with specialists
- Identifying pertinent patient and family historical information from patients and caregivers
- Identifying pertinent physical examination information
- Triaging of patients based on recognition of abnormal vital signs, examination findings, and/or general observations
Knowledge of:
- Appropriate patient education relating to diagnostic and laboratory studies
- Indications for initial and subsequent diagnostic and laboratory studies
- Indications for preventive screening tests
- Risks associated with diagnostic and laboratory studies
Skill in:
- Collecting diagnostic and laboratory specimens
- Communicating risks, benefits, and results effectively to other members of the healthcare team
- Communicating risks, benefits, and results effectively to patients, families, and caregivers
- Reviewing and interpreting results of diagnostic and laboratory studies, and correlating the results with history and physical examination findings
- Selecting appropriate diagnostic and/or laboratory studies
- Using diagnostic equipment safely and appropriately
Knowledge of:
- Significance of diagnostic and laboratory studies as they relate to diagnosis
- Significance of history as it relates to the differential diagnosis
- Significance of physical examination findings as they relate to diagnosis
Skill in:
- Developing multiple differential diagnoses for complicated and/or multisystem cases
- Formulating most likely differential diagnoses
- Incorporating history, physical examination findings, and diagnostic data into medical decision-making
- Recognizing the need for referral to a specialist
- Selecting the most likely diagnosis in light of presented data
Knowledge of:
- Appropriate patient education regarding preventable conditions and lifestyle modifications
- Early detection and prevention of medical conditions
- Effects of aging and changing family roles
- Genetic testing and counseling
- Human growth and development
- Human sexuality and gender identity, gender transition, and associated medical issues
- Immunization schedules and recommendations for infants, children, adults, and foreign travelers/adoptions
- Impact of patient demographics on risks for medical conditions
- Prevention of communicable diseases
- Preventive screening recommendations
- Psychosocial effects of illness, stress, and injury as well as related healthy coping strategies
- Signs of abuse and neglect
Skill in:
- Adapting health maintenance to an individual patient’s context
- Communicating effectively with and educating patients, family members, and caregivers regarding medical conditions
- Conducting education on modifiable risk factors with an emphasis on primary and secondary prevention
- Using counseling techniques
Knowledge of:
- Clinical procedures and their indications, contraindications, complications, risks, benefits, and techniques
- Conditions that constitute medical emergencies
- Criteria for admission to or discharge from the hospital or other facilities
- Management, treatment, and follow-up of medical conditions
- Palliative care and end-of-life issues
- Roles of other health professionals
- Sterile technique
- Therapeutic regimens
- Universal precautions and special isolation conditions
Skill in:
- Demonstrating technical expertise related to performing specific procedures
- Evaluating patient response to treatment/intervention
- Facilitating patient/caregiver adherence to and active participation in treatment
- Formulating and implementing treatment plans in accordance with applicable practice guidelines
- Interfacing in multidisciplinary teams, including education of other health care professionals
- Making appropriate dispositions
- Monitoring and managing nutritional status
- Prioritizing tasks
- Recognizing and initiating treatment for life-threatening conditions
- Using community resources to meet the needs of patients/caregivers
Knowledge of:
- Adverse effects, reactions, and toxicities
- Common alternative/complementary therapies and their interactions and toxicities
- Contraindications
- Drug interactions, including presentation and treatment
- Indications for use
- Mechanism of action
- Methods to reduce medication errors
- Monitoring and follow-up of pharmacologic regimens
- Presentation and treatment of allergic reactions
- Regulation of controlled substances
- Special populations requiring drug/dose modification
- Substances of abuse
Skill in:
- Assessing patient adherence to drug regimens
- Drafting a prescription
- Evaluating, treating, and reporting adverse drug reactions and/or adverse effects
- Identifying and managing medication misuse
- Interacting with pharmacists to address medication issues
- Maintaining knowledge of relevant pharmacologic agents
- Monitoring pharmacologic regimens and adjusting as appropriate
- Prescribing controlled substances appropriately
- Selecting appropriate pharmacologic therapy and dosing
Knowledge of:
- Basic biochemistry
- Basic genetics
- Human anatomy and physiology
- Microbiology
- Pathophysiology and immunology
Skill in:
- Evaluating emerging medical trends critically as they relate to patient care
- Maintaining awareness of trends in infectious disease
- Relating pathophysiologic principles to specific disease processes
Legal/medical ethics
Knowledge of:
- Cultural and religious beliefs related to health care
- Informed consent and refusal process
- Living will, advance directives, organ donation, code status, do not resuscitate, do not
intubate, medical power of attorney, etc. - Medicolegal issues
- Patient/provider rights and responsibilities
- Privacy, security, and responsibility related to medical record documentation and management
Skill in:
- Caring for patients with cognitive impairment
Medical informatics
Knowledge of:
- Billing/coding to maintain accuracy and completeness for reimbursement and administrative
purposes
Skill in:
- Demonstrating appropriate medical record documentation
- Using appropriate medical informatics sources
Patient care and communication (individual patients)
Knowledge of:
- Affordable and effective health care that is patient specific
- Cultural and religious diversity
- Stewardship of patient and community resources
Skill in:
- Acknowledging and applying patient/provider rights and responsibilities
- Ensuring patient satisfaction
- Providing patient advice and education regarding the informed consent and refusal process
- Providing patient advice and education related to end-of-life decisions
Physician/PA relationship
Knowledge of:
- Professional and clinical limitations, scope of practice, etc.
- Supervision parameters: malpractice, mandated reporting, conflict of interest, impaired
provider, ethical principles
Skill in:
- Communicating and consulting with the supervising physician and/or other specialists/consultants
Professional development
Knowledge of:
- Continuing medical education resources
Skill in:
- Critically analyzing evidence-based medicine
- Identifying and interpreting data from medical informatics sources and identifying appropriate
reference sources - Using epidemiologic techniques to evaluate the spread of disease
Public health (population/society)
Knowledge of:
- Basic disaster preparedness
- Infection control measures and response to outbreaks
- Occupational health issues as they pertain to health care as well as non–health care workers
- Population health, travel health, and epidemiology of disease states
Skill in:
- Protecting vulnerable populations and recognizing disparities in provision of and access to
health
care
Risk management
Knowledge of:
- Quality improvement and patient safety
- Resource stewardship
Skill in:
- Ensuring patient safety and avoiding medical errors
How medical content and task categories are tested
As you might have noticed, the percent allocation on each table equals 100%. This is because the medical content questions are coded to task areas (with the exception of the “Professional Practice” task category, totaling 5% allocation). As a result, medical content makes up 95% of the exam. Additionally, up to 20% of tested content may be related to general surgical topics. This percent allocation varies by exam.
PANCE Practice Questions Based on the NCCPA Blueprint
The UWorld PA QBank is written by practicing physician assistants to put aspiring PAs on a path to success. Our PANCE sample questions and industry-leading rationales are based on the latest NCCPA blueprints to ensure you know everything you’re expected to know on exam day. To see how our active-learning methodology can help you achieve PANCE success, try our example problems below. Submit your answers to view our award-winning explanations.
A 1-month-old boy is brought to the office for a routine visit. His prenatal and birth histories are unremarkable. His vital signs and pulse oximetry are normal. Examination shows a harsh, 3/6 holosystolic murmur over the left lower sternal border. Palpation indicates no thrill over the precordial region. Brachial and femoral pulses are 2+ and equal. The skin is pink and well perfused. ECG is normal. Which of the following is the best next step in management of this patient?
- Digoxin and diuretic therapy
- Echocardiography
- Oxygen administration
- Prostaglandin E1 therapy
- Reassurance and no further workup
A 78-year-old resident of an extended care facility is brought to the emergency department due to lethargy, fevers, and poor oral intake for the last day. Temperature is 39 C (102 F), blood pressure is 70/40 mm Hg, and pulse is 120/min and regular. On examination, the patient is lethargic but arousable. His extremities are warm. A Foley catheter is inserted into the bladder and drains 500 mL of cloudy urine consistent with urinary tract infection. Five hours after admission, the patient begins to bleed from the nose and venipuncture sites, and the Foley catheter begins to drain blood-tinged urine. Which of the following laboratory findings would most likely to be seen in this patient?
- Increased fibrinogen
- Normal D-dimer
- Normal partial thromboplastin time
- Normal prothrombin time
- Thrombocytopenia
A 45-year-old woman comes to the emergency department for acute onset of low back pain radiating down her left leg after lifting heavy boxes at home. She has had no muscle weakness and has no concerns with bowel or bladder function. The back pain worsens with coughing or bearing down. Neurologic examination reveals 5/5 muscle strength in all 4 extremities with 2+ reflexes. Straight-leg raise sign is positive on the left. Sensory examination reveals reduced pinprick and temperature sensation along the posterolateral region of the left leg. X-ray of the lumbar spine reveals only degenerative changes. Which of the following is the best next step in management of this patient?
- Bone density testing
- Gabapentin and tramadol
- Light exercise and a nonsteroidal anti-inflammatory drug
- MRI of the lumbar
- Physical therapy
Read More About the PANCE
Discover how the PANCE is scored, when you can see your score, and historical pass rates.
Understand PANCE eligibility requirements, how to register for the exam, and associated fees.