PLAB 2 Clinical Examination

Question 1

During a cardiovascular examination station in PLAB 2, you auscultate a pansystolic murmur best heard at the apex radiating to the axilla. What is the most likely valve lesion?

Accepted Answer

Mitral regurgitation

Answer

A pansystolic murmur heard best at the apex (mitral area) with radiation to the axilla is characteristic of mitral regurgitation. Aortic stenosis produces an ejection systolic murmur at the aortic area radiating to the carotids. Aortic regurgitation causes an early diastolic murmur.

Question 2

You are performing an abdominal examination and find hepatomegaly with a pulsatile liver. What is the most likely underlying cardiac condition?

Accepted Answer

Tricuspid regurgitation

Answer

A pulsatile liver is caused by tricuspid regurgitation, where blood regurgitates into the right atrium during systole, causing pulsatile venous congestion transmitted to the liver via the hepatic veins. Other signs include a raised JVP with prominent v waves and peripheral oedema.

Question 3

During a respiratory examination station, you find reduced breath sounds, dullness to percussion, and reduced vocal resonance at the right base. What is the most likely finding?

Accepted Answer

Right pleural effusion

Answer

Pleural effusion produces the classic triad of reduced breath sounds, stony dullness to percussion, and reduced vocal resonance/fremitus at the affected area. Consolidation causes dullness but with increased vocal resonance (bronchial breathing). Pneumothorax causes hyper-resonance.

Question 4

You are asked to examine the cranial nerves in a PLAB 2 station. A patient cannot close their right eye, has drooping of the right side of their mouth, and cannot raise their right eyebrow. The forehead is affected. What is the most likely diagnosis?

Accepted Answer

Right lower motor neuron facial nerve palsy (Bell's palsy)

Answer

Involvement of the forehead (inability to raise the eyebrow) indicates a lower motor neuron lesion of the facial nerve (CN VII). In upper motor neuron lesions (e.g., stroke), the forehead is spared because it has bilateral upper motor neuron innervation. Bell's palsy is the commonest cause of LMN facial palsy.

Question 5

During a thyroid examination station, you find a diffusely enlarged, non-tender thyroid gland with a bruit. The patient has exophthalmos and lid lag. What is the most likely diagnosis?

Accepted Answer

Graves' disease

Answer

A diffusely enlarged thyroid with a bruit (due to increased vascularity) combined with eye signs (exophthalmos, lid lag) is diagnostic of Graves' disease — an autoimmune condition caused by TSH receptor antibodies. Eye signs are specific to Graves' and do not occur in other causes of thyrotoxicosis.

PLAB 2 Practice Test

PLAB 2 Practice Test

PLAB 2 Clinical Examination