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PANRE/PANRE-LA Question Banks


Just like the actual exam

Satisfies NCCPA Certification Maintenance requirement. Authored & peer-reviewed by PA-Cs.

Each question is written to resemble the format and topics on the exam, meaning you won’t see any negatively phrased questions, no “all of the following except,” no “A and B”…you know what we mean. Most importantly, all questions include selective distractors (incorrect answer choices), which will help you think critically.

  • Must address important content
  • Must be well structured


A 75-year-old woman with a history of hypertension presents to the emergency department with right upper quadrant pain that has been gradually worsening over the past day. Her vital signs are T 103°F (39.4°C), BP 100/60 mm Hg, HR 100 bpm, RR 22/min, and SaO2 97% on room air. Physical exam reveals scleral icterus and right upper quadrant tenderness without rebound or guarding. A bedside right upper quadrant ultrasound demonstrates a common bile duct measuring 1 cm. Laboratory results are pending. What is the definitive management of this condition?
A Broad spectrum antibiotics
B Cholecystectomy
C Endoscopic retrograde cholangiopancreatography
D Percutaneous transhepatic cholangiography
Correct Answer Distractors
The patient presents with severe (suppurative) ascending cholangitis and requires biliary decompression with endoscopic retrograde cholangiopancreatography (ERCP). Ascending (or acute) cholangitis is a bacterial infection of the biliary system and is most frequently associated with common bile duct stones and obstruction. The disease classically presents with the Charcot triad (fever, jaundice, and right upper quadrant pain). However, only 50–75% of patients present classically, so clinicians must maintain a high index of suspicion for this life-threatening condition. While administration of broad-spectrum antibiotics is appropriate, those with signs of severe disease, including persistent abdominal pain, hypotension despite adequate fluid resuscitation, fever greater than 102°F (38.9°C), and confusion, warrant urgent ERCP.


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Understanding why an answer choice is incorrect is just as important as knowing why one is correct. That’s why every Rosh Review question includes detailed explanations for the correct and incorrect answer choices. These comprehensive summaries link the most important components of a topic—from risk factors to diagnostics and treatment—giving you the context to build relationships between them.

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One Step Further

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After each explanation is a straightforward question with a simple, memorizable answer that reinforces the corresponding topic.

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What is the recommended initial therapy for patients with primary biliary cholangitis?

Reveal Answer

Acute Cholangitis

  • Patient presents with right upper quadrant pain, jaundice, fever (Charcot triad)
  • Diagnosis is made by RUQ ultrasound, CT scan, or ERCP (gold standard)
  • Most commonly caused by choledocholithiasis that leads to bacterial infection, E. coli
  • Definitive treatment is ERCP with antibiotics, typically an adjunct
  • Charcot triad + hypotension and AMS = Reynolds pentad, acute obstruction

Rapid Review

Keeping things simple

These bulleted reviews focus on condensed, high-yield concepts about the main topic, from patient presentation to preferred management.

  • Cover the fundamentals in one list
  • Allow you to quickly scan the must-know information


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