What do PANCE Questions Look Like?

By the time PA students sit for the PANCE, they have answered thousands of test questions and logged hundreds of hours of board prep. Despite this, many leave the testing center feeling like the questions were different than expected.

The reason is writers of standardized tests use specific style guides to write their questions. The language, order of information, and other formatting is consistent for every question. A similar question asking for the same clinical answer, but written using a different style guide or no guide at all, will feel very different. 

It is important for PA students to study for the PANCE using questions that follow the same formatting the PANCE uses. Test-takers need 100% of their brain power focused on analyzing the question at hand and identifying the correct answer. Energy spent trying to interpret confusing language or word order distracts the brain from the task at hand. 

NCCPA formatting

I was fortunate enough to attend an NCCPA workshop several years ago. Their highly trained psychometricians discussed how the PANCE is developed – PAs and physicians from a variety of backgrounds are selected to write questions, and each question undergoes intense review by content experts and medical editors. Some questions identified to meet all standards then make it to the “pre-test” phase (the block of questions on the PANCE that is not scored).

After this, experts analyze questions to determine how well they perform and if they meet standards for inclusion as a scored-question on the PANCE. A question may run through the entire process only to be edited and submitted through the process again. Or it may get cut completely.

In addition to learning how the PANCE is designed, administered and its results interpreted, I was also given insight into the format and framework of PANCE questions and the general rules of thumb used in their style guide. 

It has become the format we use at All Things PA-C when writing questions, and one of the reasons we receive consistent feedback about how similar our questions feel to PANCE questions. 

The PANCE question framework

Second and third-order questions are most common

Test questions are categorized into first, second and third-order questions. First-order questions are straight forward. Second and third-order questions require additional steps and application to identify the correct answer.

An example of a first-order question is “Which medication has an adverse effect of hypotension?” A second-order question might say “A patient has shortness of breath, tachycardia, and hypoxia. He recently returned home on a transcontinental flight. Which test is considered the gold standard to confirm the suspected diagnosis?”

Most questions on the PANCE are second and third-order questions which require a deeper understanding of the application as well as how to apply knowledge of the subject. 

Questions and answer choices will follow the same formatting

For most questions on the PANCE, there is a question stem, followed by five multiple choice options. One is the correct answer, and the other four are distractors

The question stem includes a vignette and a lead in question. The vignette is the patient presentation, and the lead in question is what they ask you to figure out. 

Every vignette on the PANCE will include the age, gender, site of care (clinic, hospital, ED, etc), presenting symptoms, and duration. This is almost without exception. If pertinent, the stem will also include personal or family history, vital signs, exam findings, and image/lab/study results. Questions will NOT include irrelevant information. If it is there, it is important. So pay attention to everything! 

If the information is pertinent, it is included

Do not assume information if it is not given. An example is assuming an age, race or condition that is not provided, but leads you to choose one answer over another. For example, the question might ask “Which medication is the best first line therapy for a UTI?” The answer choices are trimethoprim-sulfamethoxazole, azithromycin, or amoxicillin. You choose amoxicillin because the patient could be pregnant, in which case you would not prescribe trimethoprim-sulfamethoxasole. However amoxicillin is not the best answer choice, the question never stated the patient was pregnant. 

Everything you need to know to answer the question correctly is present. If you are relying on other details not given, you may miss the question. 

There are no “made up” answer choices. You will not see non-existent disease names as a distracting answer choice.  

Every distractor could potentially be correct, but only one can definitively be the answer. They are able to do this by stating “which one is the mostor “the bestchoiceIn addition, phrases like “of the following answer choices” defines that one of the answer choices is correct, although it is possible there is an unlisted choice that could also be correct. 

Do not forget the details! Remember, vital signs are vital. Lab results are given for a reason. Often these details will help you distinguish between the correct answer and an almost correct distractor. 

The answer choices on the PANCE are always in alphabetical order. While the question order is randomized, the answer choice order will always be the same. 

Some questions you will not see

Exam writers are NOT trying to test what you DO NOT know.

You rarely, if ever anymore, see a negative question. Examples of negative questions are “Which of the following is NOT….” or “All of the following EXCEPT…” These questions are no longer used on the PANCE (but still exist abundantly in PANCE prep materials). In addition, there are no K-type questions. Examples of K-type questions include answer choices A, B, C, A & B, and A & C. 

Go to the source

NCCPA is very open about how their tests are written. They have a PDF available of sample questions and explanations that explains why the correct answer is correct, and why the distractors are incorrect. Review this for an even better understanding of the PANCE format!

Our resources

Our resources and practice questions follow the same formatting and style guide used on the PANCE. Resources including an affordable comprehensive Qbank are available on our website. 

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