# PANCE exam guide > Study the Physician Assistant National Certifying Examination by organ system, task area, and official blueprint weight. - Canonical page: https://www.arcadesacademy.com/exams/pance - Markdown source: https://www.arcadesacademy.com/exams/pance/llms.txt - Exam family: Medical exams - Governing body: National Commission on Certification of Physician Assistants (NCCPA) - Official exam information: https://www.nccpa.net/become-certified/pance-blueprint/ - Who takes it: Physician assistant students and graduates preparing for initial NCCPA certification. - Follows the 2025 PANCE content blueprint, from 1 Jan 2025 - Guide structure last checked against official sources: August 30, 2026 ## Overview The Physician Assistant National Certifying Examination (PANCE) is the certification exam physician assistant graduates take to become certified. It samples clinical knowledge across fifteen organ-system and professional content areas, each with a published blueprint weight, crossed with task areas such as forming the most likely diagnosis and selecting pharmaceutical therapy. Because the blueprint publishes exact percentages, the PANCE rewards proportional studying: high-weight systems such as cardiovascular and pulmonary medicine deserve more scheduled review time than low-weight areas. Arcade Academy's blueprint navigator turns those percentages into an exact weekly time allocation, and every content area below links the topics students most often review. Arcade Academy is an independent study workspace. Use the official NCCPA blueprint as the authoritative statement of exam content, and treat everything here as exam preparation support rather than medical guidance. ## Exam format - **Questions:** 300 multiple-choice questions - **Structure:** 5 blocks of 60 questions - **Timing:** 60 minutes per block, 45 minutes of total break time - **Delivery:** Computer-based at Pearson VUE test centers - **Score range:** Scaled 200 to 800; passing score 350 ## Scoring The PANCE reports a scaled score from 200 to 800, and the passing standard is a scaled score of 350. Only scored questions count toward the result; unscored pilot questions are mixed in without being identified. ## Content areas PANCE is organized into 15 content areas. Each one below lists its published weighting where the governing body publishes one, the topics it covers, and study tips specific to it. ### 1. Cardiovascular System - Position: 1 of 15 - Published weighting: 11% - Page: https://www.arcadesacademy.com/exams/pance/cardiovascular-system The cardiovascular system is the single highest-weighted PANCE content area, covering disease of the heart, conduction system, and vasculature. Questions range from recognizing acute coronary syndromes and interpreting classic murmur findings to managing chronic conditions such as heart failure, hypertension, and lipid disorders. #### Topics - **Coronary artery disease and acute coronary syndromes** — Stable angina through STEMI: risk factors, ECG patterns, biomarkers, and initial management priorities. - **Heart failure and cardiomyopathies** — Reduced versus preserved ejection fraction, dilated, hypertrophic, and restrictive patterns, and staged therapy. - **Conduction disorders and dysrhythmias** — Atrial fibrillation, blocks, supraventricular and ventricular rhythms, and rate versus rhythm decisions. - **Valvular disease** — Classic murmur descriptions, maneuvers, and the natural history of stenotic and regurgitant lesions. - **Hypertension and lipid disorders** — Diagnosis thresholds, first-line agents, compelling indications, and secondary-cause red flags. - **Vascular disease** — Aortic aneurysm and dissection, peripheral arterial disease, venous thromboembolism, and vasculitis patterns. - **Congenital heart disease** — High-yield shunt and obstruction lesions with their characteristic exam and diagnostic findings. - **Hypotension and shock** — Distinguishing cardiogenic, hypovolemic, distributive, and obstructive physiology from vitals and history. #### Study tips - Drill murmur-to-lesion pairings with flashcards until recognition is automatic; they are classic single-step questions. - Practice reading rhythm strips daily in short sessions rather than in one long block. - Anchor heart-failure pharmacology to physiology so guideline updates stay easy to absorb. - Give this system the largest share of weekly review time; the blueprint weights it highest. ### 2. Pulmonary System - Position: 2 of 15 - Published weighting: 9% - Page: https://www.arcadesacademy.com/exams/pance/pulmonary-system Pulmonary medicine is the second-highest weighted clinical system, spanning obstructive and restrictive disease, infections, malignancy, pleural disorders, and pulmonary vascular disease. Expect questions that hinge on pulmonary function patterns, imaging descriptions, and stepwise therapy. #### Topics - **Asthma and COPD** — Stepwise controller therapy, exacerbation management, and spirometry patterns that separate the two. - **Pulmonary infections** — Community and hospital pneumonia, tuberculosis screening and treatment, and pertussis and bronchiolitis patterns. - **Pulmonary embolism and pulmonary hypertension** — Pretest probability tools, diagnostic pathways, and anticoagulation decisions. - **Pleural disease** — Effusion transudate versus exudate criteria, pneumothorax types, and management thresholds. - **Restrictive and interstitial disease** — Fibrosis, pneumoconioses, and sarcoidosis presentations with their imaging vocabulary. - **Pulmonary neoplasms** — Solitary nodules, primary lung cancer types, and paraneoplastic associations. - **Sleep-disordered breathing** — Obstructive sleep apnea risk factors, screening, and first-line therapy. #### Study tips - Build one comparison table for obstructive versus restrictive spirometry and review it weekly. - Tie each pneumonia setting to its typical organisms and empiric choices with active recall rather than rereading. - Rehearse the pulmonary embolism diagnostic pathway aloud until the branching feels automatic. ### 3. Gastrointestinal System and Nutrition - Position: 3 of 15 - Published weighting: 8% - Page: https://www.arcadesacademy.com/exams/pance/gastrointestinal-system-nutrition This content area covers the alimentary tract, liver, biliary tree, and pancreas, along with nutritional and metabolic disorders. Questions frequently test classic presentations, alarm features, and first-line diagnostic studies. #### Topics - **Esophageal and gastric disorders** — GERD, esophagitis, motility disorders, peptic ulcer disease, and gastritis with their diagnostic triggers. - **Hepatic disease** — Viral hepatitis serologies, cirrhosis complications, and patterns of liver-enzyme elevation. - **Biliary and pancreatic disease** — Cholelithiasis through cholangitis, plus acute and chronic pancreatitis criteria and management. - **Small and large bowel disorders** — Inflammatory bowel disease, irritable bowel syndrome, diverticular disease, obstruction, and ischemia. - **Infectious diarrhea** — Organism-specific clues, stool-study interpretation, and when antibiotics help or harm. - **Anorectal disorders and hernias** — Hemorrhoids, fissures, abscesses, and hernia types with incarceration warning signs. - **Nutritional and metabolic disorders** — Vitamin deficiency syndromes, malabsorption workups, and obesity-related metabolic disease. - **GI neoplasms and screening** — Colorectal screening intervals, esophageal and gastric cancer risk factors, and pancreatic cancer presentations. #### Study tips - Memorize hepatitis B serology patterns with a small matrix and quiz yourself both directions. - Group abdominal-pain presentations by quadrant and quality; most stems reward location-first reasoning. - Keep one running list of alarm symptoms that force endoscopy or imaging instead of empiric therapy. ### 4. Musculoskeletal System - Position: 4 of 15 - Published weighting: 8% - Page: https://www.arcadesacademy.com/exams/pance/musculoskeletal-system Musculoskeletal questions cover fractures, joint and spine disorders, rheumatologic disease, and orthopedic emergencies. Physical-examination maneuvers and radiographic buzz-phrases carry many of the points in this content area. #### Topics - **Fractures and dislocations** — Named fracture patterns, neurovascular checks, and reduction or referral thresholds. - **Sprains, strains, and overuse injuries** — Ligament grading, tendinopathies, and return-to-activity guidance by joint. - **Degenerative and crystal arthropathies** — Osteoarthritis versus gout and pseudogout, including synovial-fluid findings. - **Autoimmune rheumatologic disease** — Rheumatoid arthritis, lupus, spondyloarthropathies, and their serologic signatures. - **Bone and joint infections** — Septic arthritis and osteomyelitis: organisms, diagnostics, and urgency of intervention. - **Spinal disorders** — Radiculopathy levels, stenosis, cauda equina red flags, and conservative-care windows. - **Osteoporosis and metabolic bone disease** — Screening criteria, DEXA interpretation, and fracture-prevention therapy. - **Compartment syndrome and orthopedic emergencies** — The pressure-related and vascular emergencies that cannot wait for imaging. #### Study tips - Pair every special test with the structure it stresses; test-to-structure pairs are frequent one-liners. - Learn nerve and artery injuries by fracture site as a single combined card, not separate facts. - Use image-based flashcards for classic radiographs so recognition survives exam-day pressure. ### 5. Infectious Diseases - Position: 5 of 15 - Published weighting: 7% - Page: https://www.arcadesacademy.com/exams/pance/infectious-diseases This cross-cutting content area tests organism recognition, empiric and targeted therapy, and prevention across bacterial, viral, fungal, and parasitic disease. Vaccination schedules and reportable-disease awareness also appear here. #### Topics - **Bacterial infections** — High-yield gram-positive and gram-negative syndromes with first-line antimicrobial choices. - **Viral infections** — HIV staging and prophylaxis, herpesviruses, influenza, and hepatitis-virus distinctions. - **Fungal and parasitic infections** — Endemic mycoses by geography plus the common protozoal and helminthic presentations. - **Sexually transmitted infections** — Diagnostic testing, current first-line regimens, and partner-treatment principles. - **Sepsis and systemic infection** — Recognition criteria, early management priorities, and source-control logic. - **Immunization and prevention** — Routine schedules, special-population vaccines, and post-exposure prophylaxis rules. #### Study tips - Organize antimicrobials by bug-and-drug pairs rather than drug classes alone. - Review geographic and exposure clues; stems often hide the organism in a travel or hobby detail. - Rehearse vaccine timing rules with spaced repetition since they decay quickly. ### 6. Neurologic System - Position: 6 of 15 - Published weighting: 7% - Page: https://www.arcadesacademy.com/exams/pance/neurologic-system Neurology questions test localization, time-critical stroke and seizure management, and chronic neurodegenerative and demyelinating disease. Expect vignettes where the physical examination localizes the lesion before imaging is offered. #### Topics - **Cerebrovascular disease** — Ischemic and hemorrhagic stroke syndromes, TIA risk stratification, and treatment windows. - **Headache disorders** — Migraine, tension, and cluster patterns plus the red flags that force urgent imaging. - **Seizure disorders** — Focal versus generalized classification, first-line agents, and status epilepticus response. - **Movement disorders and dementia** — Parkinson disease, essential tremor, and the differentiating features of the major dementias. - **Demyelinating and neuromuscular disease** — Multiple sclerosis, Guillain-Barré, myasthenia gravis, and their diagnostic studies. - **CNS infections** — Meningitis and encephalitis CSF patterns and empiric coverage by age group. - **Peripheral neuropathies and cranial nerve disorders** — Entrapment syndromes, Bell palsy, and the diabetic neuropathy spectrum. #### Study tips - Practice CSF-pattern interpretation as a table you can reproduce from memory. - Learn stroke syndromes by artery with one sentence of deficit each. - Use games or rapid-fire rounds for cranial-nerve findings; speed builds durable recognition. ### 7. Psychiatry and Behavioral Science - Position: 7 of 15 - Published weighting: 7% - Page: https://www.arcadesacademy.com/exams/pance/psychiatry-behavioral-science Behavioral-science questions cover mood, anxiety, psychotic, personality, substance-use, and developmental disorders along with safety assessment. Diagnostic criteria details, first-line therapy, and medication safety profiles are the recurring themes. #### Topics - **Mood disorders** — Major depression and bipolar spectrum criteria, screening tools, and treatment selection. - **Anxiety, trauma, and obsessive-compulsive disorders** — Distinguishing features, duration criteria, and psychotherapy-first options. - **Psychotic disorders** — Schizophrenia spectrum timing thresholds and antipsychotic side-effect profiles. - **Substance use disorders** — Intoxication and withdrawal syndromes with their specific management steps. - **Personality, eating, and somatic disorders** — Cluster patterns, refeeding cautions, and the somatic-symptom differential. - **Child and adolescent disorders** — ADHD, autism spectrum, and behavioral disorders with age-anchored criteria. - **Risk assessment and abuse** — Suicide risk factors, duty-to-report situations, and intimate-partner violence screening. #### Study tips - Anchor each disorder to its duration criterion; timing separates many look-alike diagnoses. - Make side-effect flashcards for psychotropics; safety profiles are tested more than mechanisms. - Rehearse withdrawal timelines for alcohol, opioids, and benzodiazepines as a comparative chart. ### 8. Reproductive System - Position: 8 of 15 - Published weighting: 7% - Page: https://www.arcadesacademy.com/exams/pance/reproductive-system This content area covers female and male reproductive health, including menstrual and menopausal disorders, breast disease, pregnancy and its complications, contraception, and reproductive-tract infection. Prenatal-care logic and screening intervals are commonly tested. #### Topics - **Menstrual and ovulatory disorders** — Abnormal uterine bleeding workups, polycystic ovary syndrome, and amenorrhea algorithms. - **Breast disorders** — Benign versus concerning masses, imaging pathways, and screening recommendations. - **Cervical, uterine, and ovarian disease** — Cervical-cancer screening rules, fibroids, endometriosis, and ovarian-mass triage. - **Uncomplicated pregnancy and prenatal care** — Visit cadence, trimester-specific screening, and normal physiologic changes. - **Complicated pregnancy** — Ectopic pregnancy, hypertensive disorders, bleeding in each trimester, and gestational diabetes. - **Contraception and infertility** — Method selection, contraindications, and the initial infertility evaluation. - **Menopause and male reproductive disorders** — Vasomotor-symptom management plus testicular, erectile, and infertility presentations. #### Study tips - Learn cervical screening and prenatal lab timing as schedules, then convert them into recall prompts. - Practice bleeding-in-pregnancy differentials by trimester with one distinguishing feature each. - Tie contraception contraindications to the underlying physiology instead of memorizing lists cold. ### 9. Endocrine System - Position: 9 of 15 - Published weighting: 6% - Page: https://www.arcadesacademy.com/exams/pance/endocrine-system Endocrine questions concentrate on diabetes, thyroid, adrenal, pituitary, and parathyroid disease. Laboratory-pattern interpretation carries most of the weight, so axis-based reasoning pays off quickly. #### Topics - **Diabetes mellitus** — Diagnostic thresholds, therapy escalation, hypoglycemia response, and acute crises. - **Thyroid disorders** — Hyper- and hypothyroidism patterns, nodules and cancer workup, and thyroiditis timelines. - **Adrenal disorders** — Cushing syndrome, adrenal insufficiency, and hyperaldosteronism testing sequences. - **Pituitary disorders** — Prolactinoma, acromegaly, and the panhypopituitarism pattern. - **Parathyroid and calcium disorders** — Hyper- and hypocalcemia causes with their PTH-based differentials. - **Endocrine neoplasms** — MEN syndromes and the malignancies each axis can produce. #### Study tips - Interpret every thyroid or adrenal case from the lab pattern first, then confirm with the story. - Drill diabetic emergency management steps in order; sequencing is what gets tested. - Draw each hormonal axis once from memory weekly; feedback loops answer many stems by themselves. ### 10. Eyes, Ears, Nose, and Throat - Position: 10 of 15 - Published weighting: 6% - Page: https://www.arcadesacademy.com/exams/pance/eyes-ears-nose-throat EENT covers ophthalmologic, otologic, nasal, and oropharyngeal disease, mixing urgent presentations such as acute angle-closure glaucoma with everyday primary-care complaints. Visual recognition and referral thresholds are frequent question targets. #### Topics - **Eye disorders** — Red-eye differentials, vision-threatening emergencies, and retinal-finding vocabulary. - **Ear disorders** — Otitis media and externa, hearing-loss patterns, and vertigo syndromes with their maneuvers. - **Nose and sinus disorders** — Rhinitis types, sinusitis criteria, and epistaxis management steps. - **Throat and oropharyngeal disorders** — Pharyngitis scoring, peritonsillar abscess recognition, and airway red flags. - **Oral and dental conditions** — Common oral lesions, candidiasis, and conditions requiring urgent dental referral. #### Study tips - Sort red-eye causes into painful versus painless and vision-threatening versus benign. - Learn the Weber and Rinne combinations as a two-by-two grid you can reproduce quickly. - Keep a can't-miss list for airway and vision emergencies and review it before the exam. ### 11. Professional Practice - Position: 11 of 15 - Published weighting: 6% - Page: https://www.arcadesacademy.com/exams/pance/professional-practice Professional practice tests legal and ethical reasoning, patient safety, quality improvement, risk management, communication, and public-health responsibilities. These questions reward calm, principle-based judgment more than memorized detail. #### Topics - **Medical ethics and informed consent** — Autonomy, capacity, consent exceptions, and minors' consent rules. - **Legal and regulatory issues** — Scope of practice, documentation duties, and mandatory-reporting obligations. - **Patient safety and quality improvement** — Error disclosure, root-cause thinking, and systems-level prevention. - **Communication and cultural humility** — Difficult conversations, interpreter use, and shared decision-making. - **Public health and epidemiology basics** — Screening-test statistics, study-design vocabulary, and reportable-disease duties. - **Billing, coding, and practice management basics** — The documentation and reimbursement concepts a new PA is expected to know. #### Study tips - Answer ethics questions with the least paternalistic safe option; that heuristic matches most keys. - Practice sensitivity, specificity, and predictive-value calculations until they take seconds. - Read these questions slowly; the testable principle usually sits in one sentence of the stem. ### 12. Hematologic System - Position: 12 of 15 - Published weighting: 5% - Page: https://www.arcadesacademy.com/exams/pance/hematologic-system Hematology covers anemias, coagulation disorders, hemoglobinopathies, and hematologic malignancies. Index-based anemia classification and clotting-cascade logic solve a large share of these questions. #### Topics - **Microcytic, normocytic, and macrocytic anemias** — Iron studies, B12 and folate patterns, and hemolysis markers as sorting tools. - **Hemoglobinopathies** — Sickle cell disease and thalassemias with their electrophoresis patterns. - **Coagulation disorders** — Hemophilias, von Willebrand disease, and platelet versus factor bleeding patterns. - **Thrombotic disorders and anticoagulation** — Inherited thrombophilias and monitoring rules for each anticoagulant class. - **Hematologic malignancies** — Leukemias, lymphomas, and myeloma with their marker and smear buzzwords. - **Transfusion medicine** — Product selection and recognition of transfusion reactions. #### Study tips - Classify every anemia stem by MCV before reading the answer choices. - Contrast platelet-type versus factor-type bleeding with two example diseases each. - Keep smear findings on image cards; visual recall is what the exam samples. ### 13. Renal System - Position: 13 of 15 - Published weighting: 5% - Page: https://www.arcadesacademy.com/exams/pance/renal-system Renal questions test acute kidney injury categories, chronic kidney disease staging, glomerular disease patterns, stones, and the fluid, electrolyte, and acid-base problems that accompany them. Urinalysis interpretation is the recurring skill. #### Topics - **Acute kidney injury** — Prerenal, intrinsic, and postrenal patterns with the urine studies that separate them. - **Chronic kidney disease** — Staging, progression control, and complication management. - **Glomerular disease** — Nephritic versus nephrotic presentations and their classic associations. - **Nephrolithiasis** — Stone types, imaging choice, and size-based management thresholds. - **Fluid, electrolyte, and acid-base disorders** — Sodium and potassium emergencies plus a reliable blood-gas method. - **Cystic and hereditary kidney disease** — Polycystic kidney disease features and screening implications. #### Study tips - Adopt one acid-base algorithm and apply it to every practice gas without shortcuts. - Sort AKI cases with the fractional excretion of sodium and the clinical story together. - Summarize nephritic versus nephrotic findings in a two-column table you rebuild from memory. ### 14. Dermatologic System - Position: 14 of 15 - Published weighting: 4% - Page: https://www.arcadesacademy.com/exams/pance/dermatologic-system Dermatology rewards precise lesion vocabulary and pattern recognition across inflammatory, infectious, and neoplastic skin disease. Descriptions substitute for photographs, so translating morphology words into diagnoses is the core skill. #### Topics - **Eczematous and papulosquamous disease** — Atopic dermatitis, contact dermatitis, psoriasis, and lichen planus patterns. - **Skin infections and infestations** — Bacterial, viral, fungal, and parasitic presentations with first-line therapy. - **Acneiform and follicular disorders** — Acne severity staging, rosacea, and hidradenitis basics. - **Skin neoplasms** — Melanoma warning criteria and the classic looks of basal cell and squamous cell carcinoma. - **Drug eruptions and severe cutaneous reactions** — Morbilliform rashes through SJS/TEN with their triggers and urgency. - **Burns, bites, and environmental injury** — Burn depth and surface-area estimation plus bite-wound care rules. #### Study tips - Memorize primary-lesion vocabulary first; every stem is written in that language. - Use image flashcards for neoplasm look-alikes and rate yourself honestly. - Keep the severe drug-reaction red flags on one card you review often. ### 15. Genitourinary System - Position: 15 of 15 - Published weighting: 4% - Page: https://www.arcadesacademy.com/exams/pance/genitourinary-system Genitourinary questions cover urinary-tract infection, prostate disease, scrotal emergencies, incontinence, and urologic malignancy in patients of all sexes. Torsion-versus-epididymitis discrimination is a perennial favorite. #### Topics - **Urinary tract infections** — Cystitis versus pyelonephritis, complicated-infection criteria, and therapy duration. - **Prostate disorders** — BPH management ladder, prostatitis categories, and screening discussions. - **Scrotal and testicular disorders** — Torsion timing, epididymitis, hydrocele and varicocele findings, and mass workup. - **Urinary incontinence** — Stress, urge, overflow, and functional types with first-line management. - **Urologic malignancies** — Bladder, renal, prostate, and testicular cancer presentations and initial tests. - **Urethral and structural disorders** — Strictures, congenital anomalies, and obstructive uropathy patterns. #### Study tips - Contrast torsion and epididymitis on one card: onset, cremasteric reflex, and next step. - Learn incontinence types through their one-line mechanism rather than symptom lists. - Attach painless hematuria to its cancer workup automatically. ## Study strategies - Allocate weekly study minutes proportionally to blueprint weights; the built-in blueprint navigator computes exact splits for your available time. - Cross every content area with the task dimension: for each disease, rehearse the presentation, the diagnostic study, the intervention, and the drug, because the PANCE samples all four. - Front-load spaced-repetition flashcards early so intervals lengthen before exam day instead of piling reviews into the final weeks. - Use active-recall games for recognition-speed topics such as murmurs, rashes, and ECG patterns. - Track below-70% topics in your progress view weekly and route the next day's first session at your weakest system. - Simulate full 60-question blocks under time pressure at least a few times to build stamina for the five-block format. ## Frequently asked questions ### How is the PANCE structured? The PANCE contains 300 multiple-choice questions delivered in five blocks of 60 questions, with 60 minutes per block and 45 minutes of total break time to divide between blocks. ### What score do I need to pass the PANCE? The PANCE reports scaled scores from 200 to 800, and the passing standard is 350. The NCCPA publishes current scoring policies, so confirm details there before your exam window. ### Which PANCE content areas carry the most weight? The cardiovascular system is weighted highest at 11%, followed by pulmonary at 9%, with gastrointestinal/nutrition and musculoskeletal at 8% each. Weighting your study time to match the blueprint is one of the highest-leverage planning moves. ### How should I split study time across systems? A proportional plan works well: multiply your weekly available minutes by each content area's blueprint percentage. Arcade Academy's blueprint navigator performs that allocation exactly and updates as your available time changes. ### Is Arcade Academy affiliated with the NCCPA? No. Arcade Academy is an independent educational resource, is not affiliated with or endorsed by the NCCPA, and does not provide medical advice. Use official NCCPA publications as the authoritative source on the exam itself. ## Related exam guides - [MCAT](https://www.arcadesacademy.com/exams/mcat): Study the Medical College Admission Test section by section, with official question counts, section timing, and the foundational concepts behind each set of passages. ## Independence and trademark notice Arcade Academy is an independent educational resource and is not affiliated with or endorsed by the NCCPA. PANCE is a service of the NCCPA. Always confirm exam structure, eligibility, and policies with the NCCPA directly. Arcade Academy is an independent educational resource. It is not affiliated with or endorsed by the NCCPA, the AAMC, the NCSBN, or any medical certifying body, and it does not provide medical advice.