PLAB 2 Clinical Examination — Questions and Answers
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?
- Aortic stenosis
- Mitral regurgitation (Correct answer)
- Aortic regurgitation
- Tricuspid stenosis
Correct answer: Mitral regurgitation
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?
- Aortic stenosis
- Tricuspid regurgitation (Correct answer)
- Mitral stenosis
- Pulmonary stenosis
Correct answer: Tricuspid regurgitation
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?
- Right pneumothorax
- Right pleural effusion (Correct answer)
- Right lower lobe consolidation
- Right upper lobe collapse
Correct answer: Right pleural effusion
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?
- Right upper motor neuron facial nerve palsy (stroke)
- Right lower motor neuron facial nerve palsy (Bell's palsy) (Correct answer)
- Left upper motor neuron facial nerve palsy
- Trigeminal nerve palsy
Correct answer: Right lower motor neuron facial nerve palsy (Bell's palsy)
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?
- Multinodular goitre
- Graves' disease (Correct answer)
- Hashimoto's thyroiditis
- Thyroid carcinoma
Correct answer: Graves' disease
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.
Question 6: You are performing a knee examination in a PLAB 2 station. You perform the anterior drawer test and find excessive anterior translation of the tibia on the femur. Which structure is most likely damaged?
- Posterior cruciate ligament
- Anterior cruciate ligament (ACL) (Correct answer)
- Medial meniscus
- Lateral collateral ligament
Correct answer: Anterior cruciate ligament (ACL)
The anterior drawer test assesses the integrity of the anterior cruciate ligament (ACL). Excessive forward movement of the tibia relative to the femur indicates ACL rupture. Lachman's test is more sensitive for ACL injuries. The posterior drawer test assesses the posterior cruciate ligament.
PLAB 2 Clinical Examination
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?