PA Student - Clinical Year

PANCE Qbank

It’s time to get that “C” with 3,800 NCCPA-formatted questions with thorough explanations following the updated NCCPA Blueprint.

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Questions

Just like the actual exam

Aligned with the NCCPA format and updated blueprint. Authored & peer-reviewed by PA-Cs who excelled on the PANCE.

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

Question

A 66-year-old woman presents with a sensation of pulsation in her neck and abdomen. The patient reports she has also had progressively worsening dyspnea on exertion and peripheral edema that began 2 months ago. She had a pacemaker placement 9 months ago for a chronic bifascicular block. Physical exam is significant for distended, pulsatile neck veins, hepatomegaly, and 1+ generalized pitting edema. Palpation of the liver results in increased distension of the neck veins. Which of the following findings on physical exam would most likely correlate with the patient’s condition?

A Harsh midsystolic crescendo-decrescendo murmur radiating to the left shoulder

B Loud midsystolic murmur best heard with the patient sitting and leaning forward

C Pansystolic murmur that becomes louder with inspiration

D Pansystolic murmur with prolonged apical impulse

Correct Answer Distractors

Tricuspid regurgitation is a valvular disorder that occurs when there is retrograde blood flow from the right ventricle to the right atrium during systole. The underlying pathophysiology is a right-sided pressure overload leading to right-sided heart failure. Common causes of tricuspid regurgitation include congenital abnormalities of the tricuspid valve, structural abnormalities resulting from infection, and chronic pulmonary hypertension. Pacemaker lead placement is an increasingly common iatrogenic cause of tricuspid regurgitation. As tricuspid regurgitation persists, right-sided cardiomegaly, systemic venous congestion, and eventually right-sided heart failure ensue. Signs of severe tricuspid regurgitation are associated with systemic venous congestion and include distended, pulsating neck veins, a pulsatile enlarged liver, and anasarca. On cardiac auscultation, tricuspid regurgitation is a pansystolic murmur that becomes louder with inspiration and reduced with expiration or Valsalva maneuver. It is best heard at the left lower sternal border and radiates to the right lower sternal border. Chest radiography may show an enlarged right heart border. ECG findings include right-axis deviation, P wave changes indicating right atrial enlargement, and R and S wave changes indicating right ventricular hypertrophy. Definitive diagnostic methods for tricuspid regurgitation include echocardiography and cardiac catheterization. Valvular regurgitations are classified as mild, moderate, or severe based on a variety of measurements obtained from diagnostic measures. Since most cases of tricuspid regurgitation are secondary, treatment of the underlying cause should be considered first. Patients with mild or moderate tricuspid regurgitation may be managed with oral diuretics (e.g., furosemide). Moderate tricuspid regurgitation warrants a cardiology consult. Severe tricuspid regurgitation may require IV diuretics such as torsemide. Spironolactone may be used if ascites is present along with severe tricuspid regurgitation. Severe cases require regular monitoring by a cardiologist. Valvular repair may be indicated in patients with tricuspid valve endocarditis. Patients with refractory symptoms due to inherent defects may need a tricuspid valve replacement.

Explanations

Written with a purpose

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.

Created for optimal learning and recall
Help reinforce your knowledge
Focus on the essential information

Illustrations

Created to enhance learning

Custom illustrations and tables help further clarify the core concepts. When information is presented visually, you can focus on meaning, easily reorganize and group similar ideas, and make better use of your memory.

Powerful Analytics

Track progress, performance, & predictions

Your personal analytics allow you to see your progress at all times, so you can create an efficient and effective learning strategy and stay on pace with your plan.

Focus your learning

Deep insights to determine your strengths and weaknesses so you can spend your time on the subjects that matter

Compare with your peers

Discover how your answer choices align with those selected by learners across the country.

Find out your probability of passing

Using data generated by previous users, your Qbank gives a prediction of how likely you are to pass your exam.

One Step Further

Taking your learning to the next level

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

Strengthens your knowledge
Stands alone from the main explanation so you’re not rereading content

Question

What is the Carvallo sign?

Reveal Answer

Tricuspid Regurgitation

Causes: tricuspid ring stretching > pulmonary HTN, endocarditis, rheumatic heart disease
Pansystolic murmur at left (or right) sternal border
JVP: giant c-v wave
Atrial fibrillation

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

FAQs

Get a little more clarification

When can I take the PANCE?: You must graduate from an accredited program to qualify for the PANCE, and you can apply for the exam anytime within 180 days before your program completion date. The soonest you can take the exam is 7 days after your program completion date.

For more information, read Everything You Need to Know for the PANCE Exam and the Top Questions about Qbanks for PA Students, the PANCE, & Rotation Exams.

How hard is the PANCE?: That’s a subjective question—everyone’s experience is different!

In January 2019, the NCCPA updated the Content Blueprint, which resulted in lower pass rates for first-time test takers. This doesn’t mean the test is harder (just different), so keep studying, and remember that you’ve been preparing since day 1 of PA school.

How many questions are on the PANCE?: There are 300 multiple-choice questions, which you will take in 5 blocks of 60 questions each. You have 60 minutes to complete each block.

The PANCE Qbank contains thousands of questions covering the topics you need to know, so you'll get plenty of practice!

How should I study for the PANCE?

If you found a study routine that worked well during your rotation exams, stick with it! If you're still trying to find your optimal strategy, check out these resources:

How to Boost Your PANCE Score, which teaches you how to determine your "unknown unknowns" and what kinds of grammatical mistakes to look for on the exam
The Pummel the PANCE series, which includes four articles by PA-Cs detailing their PANCE study plans, favorite resources, and strategies
The PANCE Study Plan They Don't Teach You in PA School, which covers the tips Adam Rosh gave a PA student who didn't pass the PANCE four times (and she passed after using this strategy!)
The Rosh Reveal vodcast, where Adam Rosh teaches you the thought process behind answering board exam questions
Adam Rosh’s interview by Jessica Veale, PA-S, on her podcast The PA Process discussing test-taking strategies, overcoming failure, and building confidence

Which PA Qbanks should I compare?

These are the companies we suggest trying to make sure you find the Qbank that's right for you. Compare them by signing up for a free trial:

BoardVitals
Exam Master
Hippo Education
Kaplan
NEJM Knowledge+
PAEasy
Rosh Review
UWorld

How to Select the Best PANCE Review Qbank breaks down the selection criteria you can use.

What forms of payment do you accept?: Visa, Mastercard, American Express, and gold bars (just kidding—please don’t try this. It sounds heavy.

What is the pass guarantee?: We believe in you, and if you use Rosh Review, we're confident you will pass your board exam.

If you complete 100% of the questions in your package and don't pass, you will be refunded the full amount of your subscription costs. Guaranteed. Your score report with your name and numerical score must be emailed Rosh Review at refund@roshreview.com within 60 days of the score report being published.

If you haven't completed all the questions or if you want to prepare to retake your exam, your subscription can be extended through the next exam date free of charge.

Who writes the questions and explanations?: The finest people around! Question writers are board-certified clinicians who have all performed well on their certification exams. Answer explanations are derived from the specialty’s authoritative resources with some personal input to simplify the material and synthesize it for greatest comprehension and recall.

If you’re interested in becoming a question writer, tell us a bit about yourself and we'll be in touch.

Can I use my subscription from multiple devices and locations?: Phone...laptop...tablet...yep! You can access your subscription from as many locations and as many devices as you want and have. However, we recommend starting and completing exams on a single device.

Keep in mind that sharing accounts is not allowed, so simultaneous logins are not allowed. Any abuse of the Terms & Conditions will result in cancellation of your account.

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“I just received comfortably above passing score on the Initial Certification Exam! When I started using Rosh Review last year for the In-Service, my scores started rising considerably. Thanks again!”

Matthew DeAugustinis, MD

Attending Physician

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