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

The standard cardiovascular examination sequence: inspect generally (comfortable at rest, dyspnoea, cyanosis), inspect peripherally (hands — clubbing, splinter haemorrhages; face — malar flush; JVP; carotid pulse), then cardiac palpation (apex position, heaves, thrills), then auscultation (four areas, radiation, dynamic manoeuvres).

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

The apex beat is normally in the 5th intercostal space, midclavicular line. Lateral displacement (to the anterior axillary line or beyond) indicates cardiomegaly, caused by left ventricular dilation (dilated cardiomyopathy, severe MR, volume overload). A thrusting apex is volume overloaded; a heaving apex is pressure overloaded (hypertension, AS).

Question 3

During abdominal examination, what is the correct sequence?

Accepted Answer

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

Answer

Abdominal examination sequence: Inspect (scars, distension, movement with respiration, visible pulsation, stomas), Auscultate (before palpation to avoid artificially altering bowel sounds), Lightly palpate (tenderness, guarding, rigidity), Deeply palpate (organomegaly), Percuss (liver, spleen, shifting dullness), Special tests (hernial orifices, rectal exam if indicated).

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

Hepatic (hepatocellular) jaundice is associated with stigmata of chronic liver disease: spider naevi (>5 is significant), palmar erythema, leukonychia, Dupuytren's contracture, caput medusae, gynaecomastia, testicular atrophy, asterixis, ascites, splenomegaly. Obstructive jaundice features pale stools, dark urine, and often a palpable gallbladder (Courvoisier's sign if non-tender).

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

Clonus is a series of rhythmic involuntary muscle contractions triggered by sudden passive dorsiflexion of the ankle (or other joint). Sustained clonus (>5 beats) is pathological and indicates an upper motor neurone lesion (e.g., stroke, cord compression), reflecting loss of descending inhibitory control on stretch reflexes.

PLAB 2 Practice Test

PLAB 2 Practice Test

PLAB 2 Physical Examination Skills