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Top 5 Cases for each PACES Station

By Hannah Brown in MRCP PACES on Thursday, June 16, 2011 @ 12:17

Scenarios for PACES

PasTest collects feedback from every PACES sitting. We use this information to keep abreast of what sort of cases

are coming up across the country. We have candidates from all over the UK reporting back to us on what they saw.

Here are the top 5 cases for each of the core clinical stations:


1. Aortic valve replacement

2. Mitral valve replacement

3. Aortic stenosis
4. Mitral regurgitation

5. Congenital heart disease (mostly VSD)

Notes: Unlike some of the other stations, there was no one diagnosis that appeared far more frequently than any

other. Aortic and mitral valve replacements were reported with very similar frequency. If we had extended this list

further there would have been few surprises. Mitral stenosis is perhaps one case that is appearing less frequently

than in the past (reflecting the gradual decline in patients in the UK with this condition).


1. Interstitial lung disease (most frequent by a long way!)

2. Bronchiectasis

3. Pneumonectomy/lobectomy

4. Pleural effusion

5. Chronic obstructive airways disease

Notes: Interstitial lung disease (ILD) was reported twice as frequently as the next case on the list (bronchiectasis) so

you would be wise to know your approach to ILD inside and out! It is worth being aware that many of the ILD patients

had another diagnosis to pick up upon as well (systemic sclerosis, rheumatoid etc.). Chronic obstructive airways

disease has always been an important case to prepare for. Candidates are reporting that many of the questions

relating to this case revolved around management of exacerbations (who to admit, when to use non-invasive



1. Splenomegaly
2. Patient on dialysis
3. Polycystic kidney disease

4. Renal transplant

5. Chronic liver disease

Notes: Splenomegaly just took the lead as the most frequently seen case. However it is clear that the nephrologists

around the country are helping supply patients for this exam in large numbers! Any PACES candidate should

definitely be planning to spend several hours (maybe even days) on renal wards and dialysis units learning to master

this popular topic. After the renal scenarios the next on the list was chronic liver disease (closely followed by isolated



1. Peripheral neuropathy

2. Parkinsonism

3. Muscular dystrophy

4. Multiple sclerosis

5. Eye findings (III, IV, VI, palsies, INO, ptosis)

Notes: Coding the neurology cases remains challenging, as many candidates remain unsure about the diagnosis

even after the exam! For those of you who have not done a neurology post, this remains one of the toughest stations

to excel in. The frequency of peripheral neuropathy remains very high. Every candidate should be ready to give a

detailed overview of causes and appropriate investigations of sensory or motor neuropathies. It is slightly surprising

to see Parkinsonism appearing so high on the list as this has not been reported previously as occurring so frequently.

Parkinsonism is of course an excellent case to demonstrate your knowledge of a common (and often misdiagnosed)

neurological disease. No doubt the top candidates will enjoy identifying the drug induced or vascular cases!

Station 5

Station 5 consists of two patients, and so we have included the top ten:

1. Rheumatoid arthritis

2. Systemic sclerosis

3. Hemianopia

4. Acromegaly

5. Ankylosing spondylitis

6. HIV related problems

7. Diabetic retinopathy

8. Neck lump
9. Retinitis pigmentosa

10. Thyroid eye disease

Notes: Candidates and examiners alike have met the introduction of the new station 5 with some apprehension.

However, as the dust is settling, it is clear that the new format is a success. The cases are reflecting our clinical

practice better and although some rarities are still coming up, these are much less frequent. The range of cases

reported was wide and presenting the top ten only barely does the station justice. However, if we had presented the

next ten as well, there would not have been many surprises. HIV is a newcomer to the exam and definitely a

condition to be familiar with (it was also a frequent contender in the history and communications stations). Obstructive

sleep apneoa was the main surprise in the next ten.