PANCE practice questions: the prompt for ChatGPT, Claude and Gemini

You are writing exam-style multiple-choice practice questions for me. I am preparing for PANCE, set by NCCPA. Write questions that match the real exam's content, difficulty and style, drawn from the current official syllabus.

Write 20 questions. Each must be a standalone multiple-choice question that can be answered from its own stem and options, with exactly the right answer(s) marked and nothing ambiguous.

Set each question's `topic` to one of these names, copied exactly (same words, same capitalization; these are the only topic names the import accepts):
- Cardiovascular System (subtopics: Cardiomyopathy; Conduction disorders/dysrhythmias; Congenital heart disease; Coronary artery disease; Heart failure; Hypertension; Hypotension; Lipid disorders; Shock; Traumatic, infectious, and inflammatory heart conditions; Valvular disorders; Vascular disease)
- Dermatologic System (subtopics: Acneiform eruptions; Desquamation; Diseases/disorders of the hair and nails; Envenomations and arthropod bite reactions; Infectious diseases; Keratotic disorders; Neoplasms; Papulosquamous disorders; Pigment disorders; Skin integrity; Vascular abnormalities; Vesiculobullous disease; Other dermatologic disorders)
- Endocrine System (subtopics: Adrenal disorders; Diabetes mellitus; Hypogonadism; Metabolic syndrome; Neoplasms; Parathyroid disorders; Pituitary disorders; Thyroid disorders)
- Eyes, Ears, Nose, and Throat (subtopics: Eye disorders; Ear disorders; Foreign bodies of the eyes, ears, nose, and throat; Trauma of the eyes, ears, nose, and throat; Neoplasms; Nose/sinus disorders; Oropharyngeal disorders)
- Gastrointestinal System/Nutrition (subtopics: Biliary disorders; Colorectal disorders; Diarrhea; Esophageal disorders; Gastric disorders; Gastrointestinal bleeding; Hepatic disorders; Hernias; Hyperemesis; Ingestion of toxic substances or foreign bodies; Metabolic disorders; Neoplasms; Nutrition; Obesity; Pancreatic disorders; Small intestine disorders)
- Genitourinary System (subtopics: Benign prostatic hyperplasia; Bladder disorders; Congenital and acquired abnormalities; Infectious disorders; Neoplasms; Nephrolithiasis/urolithiasis; Penile disorders; Testicular disorders; Urethral disorders)
- Hematologic System (subtopics: Autoimmune disorders; Coagulation disorders; Cytopenias; Cytoses; Hereditary disorders; Immunologic disorders; Neoplasms, premalignancies, and malignancies; Transfusion reaction)
- Infectious Diseases (subtopics: Bacterial diseases; Fungal diseases; Mycobacterial diseases; Parasitic diseases; Perinatal transmission of disorders; Prion diseases; Sepsis/systemic inflammatory response syndrome; Spirochetal diseases; Viral diseases)
- Musculoskeletal System (subtopics: Chest/rib disorders; Compartment syndrome; Degenerative diseases; Infectious diseases; Lower extremity disorders; Neoplasms; Rheumatologic disorders; Spinal disorders; Thoracic outlet syndrome; Upper extremity disorders)
- Neurologic System (subtopics: Cerebrovascular disorders; Closed head injuries; Cranial nerve palsies; Encephalopathic disorders; Headaches; Infectious disorders; Movement disorders; Neoplasms; Nerve disorders; Neurocognitive disorders; Neuromuscular disorders; Seizure disorders; Spinal cord syndromes)
- Psychiatry/Behavioral Science (subtopics: Abuse and neglect; Anxiety disorders; Bipolar and related disorders; Depressive disorders; Disruptive, impulse-control, and conduct disorders; Dissociative disorders; Feeding and eating disorders; Human sexuality and gender dysphoria; Neurodevelopmental disorders; Obsessive-compulsive and related disorders; Personality disorders; Psychogenic nonepileptic seizure; Schizophrenia spectrum and other psychotic disorders; Sleep-wake disorders; Somatic symptom and related disorders; Substance-related and addictive disorders; Trauma- and stressor-related disorders)
- Pulmonary System (subtopics: Acute respiratory distress syndrome; Foreign body aspiration; Hyaline membrane disease; Infectious disorders; Neoplasms; Obesity hypoventilation syndrome; Obstructive pulmonary diseases; Pleural diseases; Pulmonary circulation; Restrictive pulmonary diseases; Sleep apnea)
- Renal System (subtopics: Acid-base disorders; Acute kidney injury and acute renal failure; Chronic kidney disease/end-stage renal disease; Congenital or structural renal disorders; Electrolyte disorders; Fluid imbalances; Neoplasms; Renovascular disease; Rhabdomyolysis)
- Reproductive System (subtopics: Breast disorders; Cervical disorders; Contraceptive methods; Human sexuality and gender identity; Infertility; Menopause; Menstrual disorders; Neoplasms of the breast and reproductive tract; Ovarian disorders; Pelvic inflammatory disease; Pregnancy; Trauma in pregnancy; Uterine disorders; Vaginal/vulvar disorders)
- Professional Practice (subtopics: Legal/medical ethics; Medical informatics; Patient care and communication (individual patients); PA role in professional practice; Professional development; Public health (population/society); Risk management)
Where subtopics are listed, set `subtopic` to one of them; otherwise choose a short, specific `subtopic` of your own or leave it out.

Spread the questions across the topics in the real exam's proportions, about:
- Cardiovascular System: 2 (11% of the real exam)
- Dermatologic System: 1 (4% of the real exam)
- Endocrine System: 1 (6% of the real exam)
- Eyes, Ears, Nose, and Throat: 1 (6% of the real exam)
- Gastrointestinal System/Nutrition: 2 (8% of the real exam)
- Genitourinary System: 1 (4% of the real exam)
- Hematologic System: 1 (5% of the real exam)
- Infectious Diseases: 2 (7% of the real exam)
- Musculoskeletal System: 2 (8% of the real exam)
- Neurologic System: 1 (7% of the real exam)
- Psychiatry/Behavioral Science: 1 (7% of the real exam)
- Pulmonary System: 2 (9% of the real exam)
- Renal System: 1 (5% of the real exam)
- Reproductive System: 1 (7% of the real exam)
- Professional Practice: 1 (6% of the real exam)

Give each question between 4 and 5 options. Options are plain text without letter prefixes (DoMcq labels them A, B, C… by position); make them similar in length and form so the right one does not stand out.
Give almost every question exactly 5 options, as NCCPA's own sample PANCE questions do; use 4 options only now and then, never fewer.
Every question has exactly one correct option; `answer` is a single letter.
Never use these as an option: "all of the above", "none of the above". Avoid "both A and B" style options too.

Write stems the way the real exam does, for example: "Which of the following is the most likely diagnosis?"; "Which of the following is the most appropriate next step?"; "Which of the following is the most appropriate initial diagnostic study?"; "Which of the following is the most appropriate course of action for the physician assistant?".
Keep each stem self-contained (any scenario the question needs is in the stem), concrete and free of trick wording. Do not refer to other questions, images, tables or exhibits.

Mix the difficulty: about 6 easy, 10 medium and 4 hard, and set each question's `difficulty` to "easy", "medium" or "hard" accordingly.

In `explanation`, say in two to four sentences why the correct answer is correct, in a way that teaches the underlying point, not just restates the option.

In `source`, give a short reference I can check in my own study materials (a syllabus topic, a chapter or section name, a learning objective, or a standard's clause), at most 200 characters; never invent a page number or a quotation.

Leave out `rationales` and `id`.

Before you answer, check your own work: no two questions ask the same thing; no question gives away another's answer; the correct option sits in a different position from one question to the next (never always the same letter); every `answer` letter exists for that question; the correct option is correct according to the current official material, not folklore; facts are accurate. Fix anything you find.

Output the whole set as one JSON object in the `domcq/1` format (schema: https://domcq.com/schema/v1; this is the import format of https://domcq.com):

```json
{
  "format": "domcq/1",
  "exam": "pance",
  "set": "PANCE practice – [a short name for this set]",
  "questions": [
    {
      "stem": "[the question, 10–2000 characters]",
      "options": [
        "[option 1]",
        "[option 2]",
        "[option 3]",
        "[option 4]"
      ],
      "answer": "B",
      "explanation": "[why the correct answer is correct, 1–3000 characters]",
      "topic": "Cardiovascular System",
      "subtopic": "[optional, more specific]",
      "difficulty": "medium",
      "source": "[a reference I can check]"
    }
  ]
}
```

Rules the import enforces: `format` is exactly "domcq/1"; `set` is 1–120 characters; `questions` holds all 20; each question has exactly the fields shown (no others); `stem` is 10–2000 characters and each option 1–500; `options` are all different; `answer` uses capital letters A–F naming options by position, in ascending order, never every option; `explanation` (1–3000 characters) and `topic` are required; `subtopic` (up to 120 characters), `difficulty` ("easy", "medium" or "hard") and `source` (up to 200 characters) are optional. Use plain double quotes in JSON strings (escape any inside text as \"), no trailing commas, no comments.

Reply with the JSON object inside a single ```json code fence and nothing else: no introduction, no commentary, no notes after it. If the set is long, keep going until every question is written and the JSON is complete and closed.