The Physician Assistant National Recertifying Examination, commonly known as the PANRE, is a comprehensive and challenging examination for men and women who hope to enter this exciting field of health care. The content of this exam is divided into the following seven task areas: history taking and performing physical examinations (16% of the exam), using laboratory and diagnostic studies (14%), formulating most likely diagnosis (18%), health maintenance (10%), clinical intervention (14%), pharmaceutical therapeutics (18%), and applying basic science concepts (10%).
In the section on history taking and performing physical examinations, you must demonstrate knowledge of pertinent historical information, risk factors, signs, and symptoms. The following skills are covered in this task area of the PANRE: conducting interviews, identifying historical information, performing physical examinations, associating current complaint with presented history, and identifying physical examination information. In the section on using laboratory and diagnostic studies, you must demonstrate knowledge of indications, cost-effectiveness, relevance of common screening tests, normal and abnormal diagnostic ranges, risks, and appropriate patient education. The skills covered in this section of the PANRE include using diagnostic equipment, selecting specimens, and interpreting study results. In the section on formulating the most likely diagnosis, the following subjects are covered: significance of history, physical findings, and diagnostic and laboratory studies as they relate to diagnosis.
The skills required for success in this section include correlating normal and abnormal diagnostic data, formulating differential diagnoses, and selecting the most likely diagnosis in light of presented data. In the health maintenance task area of the PANRE, the required knowledge includes epidemiology, early detection and prevention, relative value of common screening tests, appropriate patient education regarding preventable conditions or lifestyle modifications, and healthy lifestyles. The skills required for this section include using counseling and patient education techniques, communicating with patients, adapting health maintenance to the patient’s context, and using the informational database.
Finally, the clinical intervention task area of the PANRE requires knowledge of the management and treatment of selected medical conditions and indications, contraindications, complications, risks, benefits, and techniques. The skills required for this section include formulating and implementing treatment plans, recognizing and initiating treatment for life-threatening emergencies, demonstrating technical expertise related to performing specific procedures, communicating effectively, facilitating patient adherence and active participation in treatment, and interacting effectively in multidisciplinary teams. The PANRE was developed by the National Commission on Certification of Physician Assistants.
PANRE Review Video
PANRE Practice Questions
1. A 45-year-old male comes to the emergency room after being involved in a head-on motor vehicle accident earlier in the day. The patient notes that he struck his head, but he did not experience any loss of consciousness. His blood pressure is 190/110, his respirations are irregular, and his electrocardiogram (EKG) shows sinus bradycardia with a heart rate of 42 beats per minute. The patient’s symptoms are part of which clinical triad?
A. Beck’s triad
B. Charcot’s triad
C. Cushing’s triad
D. Bergman’s triad
2. A 26-year-old female comes to the ER with complaints of white vaginal discharge and pelvic pain. She admits to having unprotected sex. On physical examination, she has an inflamed cervix and cervical motion tenderness. Which one of the following two-medication pairs should she receive prior to leaving the ER?
A. Ceftriaxone 250 mg IM and clindamycin 300 mg po
B. Clindamycin 300 mg po and azithromycin 1 gm po
C. Mefoxitin 2 gm IV and azithromycin 1 gm po
D. Ceftriaxone 250 mg IM and azithromycin 1 gm po
3. A 26-year-old man is rushed to the emergency room with chest pain and shortness of breath that developed suddenly. A family member notes that he has smoked a half a pack of cigarettes per day for five years, but he has no other known medical problems. On physical examination, there is no evidence of trauma. He has normal breath sounds on the left but decreased breath sounds on the right. A chest x-ray shows lung markings on the left, but not on the right. Based on his past medical history, presentation, and x-ray, what is the most likely diagnosis?
B. Secondary pneumothorax
C. Pulmonary carcinoma
D. Spontaneous pneumothorax
4. An 11-year-old male is brought to the ER by his mother with a one-day history of sudden, right-sided abdominal pain, nausea, and vomiting. These symptoms are not related to food intake. There is no history of trauma, recent travel, ingesting raw or rare foods, or diarrhea. His only medical problem is asthma. During his physical examination, he cries out in pain while you gently shake the bed. He displays moderate discomfort when you flex his right leg at his hip and his knee. What is the most likely diagnosis based on his medical history and examination findings?
5. A 56-year-old man comes to the ER with dull, nonradiating left-sided chest pain, nausea, and vomiting for the past four hours. The chest pain is not related to activity. He denies a history of similar symptoms. You notice that his blood pressure is 80/45 and that his electrocardiogram (EKG) shows sinus tachycardia with a rate of 123. His oxygen saturation is 99% on room air. During his physical examination, you notice that his neck veins are bulging. Auscultation of his heart reveals quiet systolic and diastolic sounds. His breath sounds are coarse bilaterally. Based on his symptoms and physical examination, what is the most likely diagnosis?
A. Pericardial tamponade
C. Aortic dissection
D. Stable angina
Answers & Explanations
1. C: Cushing’s triad is a clinical triad defined as hypertension, bradycardia, and irregular respirations. It suggests rising intracranial pressure due to intracranial pathology such as hemorrhage. Beck’s triad is the combination of distended jugular veins, hypotension, and muffled heart sounds. It occurs as a result of pericardial effusion. Charcot’s triad is the combination of jaundice, fever, and right-upper quadrant abdominal pain. It occurs as a result of ascending cholangitis. Bergman’s triad is the combination of dyspnea, petechiae, and mental status changes. It occurs when a patient has a fat embolism.
2. D: Ceftriaxone 250 mg IM injection in a single dose plus azithromycin 1 gm PO in a single dose or doxycycline 100 mg PO BID for seven days is the recommended regimen for treating gonorrhea (GC)/chlamydia infections. Clindamycin and Maxipime are not given as treatment for either gonorrhea or chlamydia. The patient should be treated in the ER for suspected GC/chlamydia infection to prevent the patient from potentially spreading the disease.
3. D: A primary, or spontaneous, pneumothorax occurs in the absence of underlying pulmonary pathology. The patient has no past medical history such as lung cancer or cystic fibrosis. A secondary, or complicated, pneumothorax occurs due to underlying pulmonary disease such as lung cancer, cystic fibrosis, chronic obstructive pulmonary disease (COPD), or other diseases. Trauma, such as a stab wound or a gunshot wound, can cause a pneumothorax, but there was no trauma noted in the physical examination or the medical history. Pneumonia may cause chest pain and shortness of breath, but there would not be an absence of lung markings on the chest x-ray. Lung cancer would show up as a radio-opaque mass or masses on chest x-ray.
4. B: The patient is displaying signs of acute appendicitis. Causing discomfort by shaking the bed or chair in which the patient is positioned is called the jar sign. Causing discomfort by flexing the right leg at the hip and the knee is called the psoas sign. The patient has discomfort during these maneuvers due to peritoneal irritation. These maneuvers help diagnose acute appendicitis and are not present in the other conditions listed.
5. A: The patient most likely has a pericardial tamponade. Pericardial tamponade is the abnormal collection of fluid that develops on the heart due to injury or prior disease, although the cause may be idiopathic. The patient’s symptoms are consistent with Beck’s triad. Beck’s triad is the combination of hypotension, muffled heart sounds, and distended jugular veins. A pneumothorax is much less likely. The patient is saturating 99% on room air, and his lungs sounds are equal bilaterally. An aortic dissection usually presents with sharp, tearing chest pain that radiates to the back. Auscultation of the heart usually reveals a blowing murmur, not quiet heart sounds. Stable angina is described as chest pain that is alleviated with rest.