Respiratory

The MRCP PACES respiratory station offers an opportunity to demonstrate a slick examination technique that is performed on practically all patients. Respiratory diseases, after cardiovascular and musculoskeletal complaints, are the third most common cause for presentation to either the Emergency Department or the general practitioner (GP) and remains proof of the concept that ‘common things are common’. Respiratory disease can be generally divided into 3 major categories: airways, parenchymal and pleural disease. We have aimed to structure the following chapter to reflect this. Certain ‘high-yield’ or ‘favourites’ that recur in the PACES examination are covered in this section. During PACES, examiners assess your ability to both elicit and then correctly interpret physical signs. A general sense exists that a decision to pass or fail a candidate rests on an aura of competence (or incompetence!) during the clinical performance. In essence, the examiners are looking for you to demonstrate correct techniques whilst eliciting the signs and logical thinking when interpreting them. Therefore, eliciting the physical signs is only the first step; the interpretation and presentation are equally, if not more, important. With this in mind, the following useful general points should be considered: • The respiratory examination does not need to be a lengthy one. Start at the peripheries with the hands and then move to the back (unless specifically advised otherwise by your examiners). Traditionally the physical examination starts with the anterior chest but it is perfectly acceptable to do the back first then return to the front (most signs and clues to the diagnosis e.g. scars, will be detected by examining the posterior chest). • A 6-minute period is allowed for the examination portion of the station and it is our advice to spend the first 2 minutes examining the patient from a general perspective (including full inspection, hands and face) then the second 2 minutes on the posterior chest and the final 2 minutes on the anterior chest. As time is limited, palpate for features of pulmonary hypertension or right-sided heart failure at the anterior chest, before moving to the respiratory signs.