PLAB 2 Physical Examination Skills

Question 1

When performing a cardiovascular examination, in which order should you proceed?

Accepted Answer

Inspection (general + hands + face + JVP), palpation (apex beat, heaves, thrills), auscultation (heart sounds + murmurs), then peripheral findings and completion

Answer

Auscultation, palpation, percussion, inspection

Answer

Auscultation, inspection, percussion, palpation

Answer

Palpation, auscultation, inspection, percussion

Question 2

Where is the normal apex beat located and what does a displaced apex beat suggest?

Accepted Answer

5th intercostal space, midclavicular line; displacement laterally suggests cardiomegaly (e.g., dilated cardiomyopathy, left ventricular failure, mitral regurgitation)

Answer

5th intercostal space, midsternal line; displaced laterally suggests aortic stenosis

Answer

4th intercostal space, anterior axillary line; displacement indicates normal variant

Answer

6th intercostal space, midclavicular line; displacement suggests right heart failure

Question 3

During abdominal examination, what is the correct sequence?

Accepted Answer

Inspection, auscultation, light palpation, deep palpation, percussion, then special tests

Answer

Palpation, auscultation, percussion, inspection

Answer

Percussion, palpation, auscultation, inspection

Answer

Palpation, percussion, inspection, auscultation

Question 4

When examining a patient for jaundice, which additional examination findings would suggest a hepatic cause rather than post-hepatic (obstructive) jaundice?

Accepted Answer

Spider naevi, palmar erythema, leukonychia, caput medusae, hepatic encephalopathy, ascites, and splenomegaly — stigmata of chronic liver disease

Answer

Pale stools and dark urine

Answer

Right upper quadrant mass and rigors

Answer

Pruritus without other hepatic signs

Question 5

During a neurological examination of the lower limbs, what does 'clonus' indicate?

Accepted Answer

Rhythmic, involuntary muscle contractions elicited by sudden passive stretch, indicating upper motor neurone lesion with hyperreflexia

Answer

Reduced reflexes due to lower motor neurone lesion

Answer

Flaccid muscle tone

Answer

A cerebellar sign indicating ataxia

Question 6

When examining cranial nerve V (trigeminal nerve), what do you assess?

Accepted Answer

Facial sensation (three divisions: ophthalmic, maxillary, mandibular), muscles of mastication (masseter, temporalis — jaw clench), and the corneal reflex (afferent limb)

Answer

Eye movements and pupillary reactions

Answer

Facial expression and taste on anterior 2/3 of tongue

Answer

Hearing, balance, and the gag reflex