NCCPA PANRE Longitudinal Assessment Practice Test
The PANRE Longitudinal Assessment practice bank samples physician assistant clinical reasoning across internal medicine, emergency presentations, and care during pregnancy. Its cases call for interpreting symptoms, examination findings, and laboratory or imaging results to identify likely diagnoses and choose appropriate evaluation or treatment steps.
Exam overview
About the NCCPA PANRE Longitudinal Assessment Exam
Clinical scenarios in this question bank include cholestatic liver disease, hematuria evaluation, hypertensive disorders of pregnancy, acute ischemic stroke, and acute angle-closure glaucoma. Other cases test recognition of macrocytic anemia, management of reflux symptoms, empiric treatment when meningitis evaluation is delayed, preoperative medication sequencing for pheochromocytoma, and valve involvement in infective endocarditis. Work through each vignette by identifying time-sensitive threats, distinguishing findings that support competing diagnoses, and selecting the next step that fits the patient’s presentation. These decisions reflect practical PA tasks such as interpreting a blood smear, using imaging and vital signs in context, and prioritizing treatment without overlooking contraindications or urgent stabilization.
Sample Practice Questions
Review a selection from this exam's published US Practice Tests practice bank.
A 43-year-old with a history of ulcerative colitis develops progressive jaundice and itching. Alkaline phosphatase is elevated, and cholangiography shows multifocal strictures with intervening dilation of the intrahepatic and extrahepatic bile ducts. Which diagnosis is most likely?
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Correct answer: APrimary sclerosing cholangitis causes chronic inflammation and fibrosis of bile ducts, producing multifocal strictures and a beaded appearance on cholangiography. It is strongly associated with inflammatory bowel disease, particularly ulcerative colitis.
A 65-year-old with a history of smoking has painless visible blood in the urine. Urinalysis confirms hematuria, and urine culture is negative. Which diagnosis must be considered and evaluated for?
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Correct answer: APainless visible hematuria, particularly in an older adult with a smoking history, is concerning for urothelial malignancy, including bladder cancer. A negative urine culture does not explain the bleeding, so appropriate urologic evaluation is warranted.
A 34-year-old at 24 weeks of pregnancy has a blood pressure of 148/94 mm Hg on two measurements four hours apart. She has no proteinuria, severe-range pressure, or symptoms of end-organ involvement. Which diagnosis is most appropriate?
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Correct answer: ANew hypertension after 20 weeks of pregnancy without proteinuria or evidence of end-organ dysfunction is classified as gestational hypertension. Chronic hypertension predates pregnancy or is identified before 20 weeks; severe features and seizures are absent here.
A 71-year-old develops sudden right facial droop and arm weakness 45 minutes ago. Point-of-care glucose is normal, and noncontrast head CT shows no hemorrhage. What is the most appropriate immediate next step in evaluating eligibility for reperfusion treatment?
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Correct answer: AAcute ischemic stroke is time-sensitive. After excluding intracranial hemorrhage, clinicians should rapidly assess eligibility for intravenous thrombolysis and avoid unnecessary delays, while also evaluating for endovascular treatment when appropriate.
A 72-year-old develops sudden severe pain in one eye with blurred vision, halos around lights, nausea, and a mid-dilated poorly reactive pupil. Which action is most appropriate?
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Correct answer: AThe combination of abrupt eye pain, visual disturbance, halos, nausea, and a mid-dilated pupil is characteristic of acute angle-closure glaucoma. This is a vision-threatening emergency requiring immediate pressure-lowering treatment and ophthalmology involvement.
A 31-year-old has fatigue and exertional dyspnea. Laboratory testing shows hemoglobin 9.8 g/dL, mean corpuscular volume 112 fL, and a low reticulocyte count. The blood smear shows macro-ovalocytes and hypersegmented neutrophils. Which deficiency is most consistent with these findings?
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Correct answer: AMacro-ovalocytes and hypersegmented neutrophils with macrocytosis are characteristic of megaloblastic anemia, most commonly due to vitamin B12 or folate deficiency. Further testing distinguishes the specific deficiency.
A 48-year-old has chronic heartburn and regurgitation despite lifestyle measures. Endoscopy shows no erosive esophagitis or other alarm finding. Which is an appropriate initial medication strategy?
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Correct answer: AFor typical gastroesophageal reflux symptoms without alarm features, an empiric once-daily proton pump inhibitor trial is an accepted initial approach. Persistent symptoms despite appropriate use warrant reassessment and possible further evaluation.
How to use this practice test
Access is free. The bank contains 50 questions; each practice session presents up to 20 randomly selected questions and displays results afterward. Use a session to test clinical reasoning, then review missed items by tracing which finding or decision point you misinterpreted.
Preparation tips
- For acute stroke cases, organize the sequence around last-known-well time, hemorrhage exclusion on noncontrast CT, and assessment for reperfusion eligibility.
- Compare hepatobiliary patterns by relating alkaline phosphatase elevation and cholangiographic strictures to the patient’s history of inflammatory bowel disease.
- Practice distinguishing pregnancy-related hypertension diagnoses using gestational age, repeated blood pressure measurements, proteinuria, and severe features.
- For treatment questions, identify whether the scenario asks for immediate stabilization, diagnostic testing, empiric therapy, or preoperative preparation before choosing an action.
- Review common pattern recognition in anemia, eye emergencies, endocarditis, and catecholamine-secreting tumors, including the findings that change urgency or medication sequence.