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United States · Certification exam

PANCE study guide: the official content blueprint

The official guide to what’s on the PANCE is NCCPA’s content blueprint, in use since January 2025. It’s free, and it lists every organ system and task area with its share of the exam. There’s no official PANCE textbook. Review books like PANCE Prep Pearls are written by other authors, so use the blueprint as your checklist and pick a book that covers it.

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Updated October 2026 · Written from official sources, listed at the bottom of this page

Organ systems and how much they count

Content categoryShare of the exam
Cardiovascular11%
Pulmonary9%
Gastrointestinal/nutrition8%
Musculoskeletal8%
Infectious diseases7%
Neurologic7%
Psychiatry/behavioral science7%
Reproductive7%
Endocrine6%
Eyes, ears, nose and throat6%
Professional practice6%
Hematologic5%
Renal5%
Dermatologic4%
Genitourinary4%

NCCPA says the exact percentages can vary slightly between exams. Across all systems, 8% to 10% of questions involve surgical topics and 12% to 15% focus on children.

Task areas

Task areaShare of the exam
Formulating the most likely diagnosis18%
History taking and performing physical examination16%
Clinical intervention16%
Pharmaceutical therapeutics15%
Health maintenance, patient education and preventive measures11%
Using diagnostic and laboratory studies10%
Applying foundational scientific concepts8%
Professional practice6%

Each medical question is also coded to a task, which tells you what kind of thinking it tests.

Other free NCCPA materials

NCCPA also sells practice exams for $50 each: 120 retired PANCE questions in two 60-question sections, with access for 180 days. They don’t include the answers or explanations.

  • Sample PANCE questions with explanations, so you can see the official style
  • The adult laboratory values table used on the exam
  • What to Expect on Test Day, which covers breaks, ID and the testing room
  • The PANCE tutorial on Pearson VUE’s NCCPA page

Choosing a review book

PANCE Prep Pearls by Dwayne A. Williams is one of the best-known PANCE review books. Its website lists the 6th edition at $55 and a companion PANCE/PANRE question book with 600 questions at $36, as of October 2026.

Whatever book you use, check it against the blueprint. A book is good for organized review, but most people also use a question bank to practice the vignette style.

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Everything else, in one place

OverviewPANCE: the PA national certifying examQuestions and passingHow many questions are on the PANCE, and what’s the passing score?BookingHow to apply for and schedule the PANCECostHow much does the PANCE cost?Practice testFree PANCE practice questionsWhere to learnWhere to study for the PANCE
Sources: NCCPA, PANCE Prep Pearls and 3 more. Checked October 2026.

Rules and fees can change, so check the official site before your test.