The 10 most common PACES cases by station

Every PACES sitting draws on a huge range of possible conditions, and there’s no way to predict the exact patient that will be waiting for you on the day. But cases are not selected at random: they have to work within the time available and allow the examiners to assess the skills being tested. This means that certain presentations tend to come up again and again. 

Broad clinical knowledge is, of course, essential for passing PACES. However, familiarising yourself with the cases that appear most frequently can help you decide where to prioritise your revision, especially in the final few weeks before the exam. 

In this guide, we’ll cover the 10 most common PACES cases and scenarios likely to appear in each station, along with what examiners are typically looking for.

How PACES cases are chosen

PACES is divided into five stations, each designed to assess different combinations of clinical skills:

• Station 1: respiratory examination and communication

• Station 2: clinical consultation

• Station 3: cardiovascular and neurology examinations

• Station 4: abdominal examination and communication

• Station 5: clinical consultation

In the examination encounters, you’ll perform a focused examination, identify and interpret the relevant clinical signs and discuss your findings. The communication encounters assess your ability to communicate clearly and appropriately in clinical situations. The consultation encounters require you to assess a patient more holistically, including history-taking and examination, and explain investigations and management.

The cases chosen must allow the examiner to assess the relevant skills for each station. The patient also needs to be clinically stable and likely to turn up on the day. That’s why certain conditions and presentations appear more frequently than others. 

There is no fixed list of cases, however, so these should be viewed as high-yield areas for revision rather than a list of cases you can definitely expect to see.

Station 1: respiratory examination

The respiratory examination tests your ability to perform a systematic, clinically appropriate examination of the respiratory system. This examination takes up 10 minutes of Station 1 (alongside a separate communication task).

The most likely cases to come up at this station include:

1. Interstitial lung disease

2. Lobectomy

3. Bronchiectasis

4. COPD (chronic obstructive pulmonary disease)

5. Pleural effusion

6. Pneumonectomy

7. Kyphoscoliosis

8. Asthma

9. Rheumatoid lung

10. Lung transplant

These remain among the most frequently seen cases because they represent common respiratory conditions and, importantly for PACES, each has a recognisable pattern of clinical signs that you should be able to identify and interpret confidently. 

Station 3: cardiovascular and neurological examinations

Station 3 is the only station that brings together two different clinical examination encounters: a cardiovascular examination and a neurological examination. Each lasts 10 minutes. The most common cases that crop up at these examinations include:

Cardiovascular examination 

1. Prosthetic aortic valve

2. Aortic stenosis

3. Mitral regurgitation

4. Aortic regurgitation

5. Mitral valve replacement

6. Mitral stenosis

7. Atrial fibrillation

8. Mitral prolapse

9. Mixed aortic valve disease

10. Ventricular septal defect

Neurological examination

1. Peripheral neuropathy

2. Parkinson’s disease

3. Charcot-Marie-Tooth disease

4. Abnormal gait

5. Spastic paraparesis

6. Cerebellar syndrome

7. Myotonic dystrophy

8. Myasthenia gravis

9. Post-polio syndrome

10. Acromegaly

The cardiovascular and neurology examinations, while both part of Station 3, are distinct exams that are assessed separately. Your PACES revision strategy should dedicate adequate time to each examination in its own right. 

Station 4: abdominal examination

The abdominal examination in Station 4 covers a mixture of hepatobiliary, gastrointestinal and renal conditions. You will have 10 minutes for the examination, alongside a separate communication encounter.

Here are 10 of the most common abdominal PACES cases you’re likely to face:

1. Transplanted kidney

2. Chronic liver disease

3. Hepatosplenomegaly

4. Hepatomegaly

5. Splenomegaly

6. Transplanted liver

7. Polycystic kidney disease

8. Ascites

9. Inflammatory bowel disease

10. Abdominal mass

A number of these cases rely on being able to recognise relatively subtle abdominal findings, so it’s worth building familiarity with the most common signs associated with these conditions as part of your PACES preparation.

Stations 2 and 5: clinical consultation

Stations 2 and 5 are the two PACES clinical consultation stations. Each lasts 20 minutes. For each one, you’ll take a detailed history, carry out an appropriate examination, communicate your findings and recommendations with the patient and address their concerns. One station will feature a patient with an acute presentation while the other will be non-acute. 

The range of possible PACES topics that can come up at stations 2 and 5 is much broader than in the clinical examination stations. However, some of the most commonly seen cases include:

1. Rheumatoid hands

2. Thyroid eye disease

3. Erythema nodosum

4. Cushing syndrome

5. Goitre

6. Pyoderma gangrenosum

7. Acromegaly

8. Neurofibromatosis

9. Scleroderma

10. Osler-Weber-Rendu
    
    

PACES consultation scenarios often revolve around systemic, rheumatological, endocrine, ophthalmological or dermatological conditions, but they can involve almost any medical problem that allows the required skills to be assessed. 

Communication encounters

Stations 1 and 4 each include a 10-minute communication encounter alongside a clinical examination. Each communication encounter follows the same format, and there is no meaningful difference in the types of scenarios that appear in either station. 

Some MRCP PACES communication scenarios that come up regularly include: 

1. Breaking bad news or explaining a serious diagnosis

2. Explaining investigation results

3. Discussing prognosis

4. Explaining treatment and its benefits or risks

5. Addressing difficulties with treatment adherence

6. Dealing with an angry, upset or distressed patient or relative

7. Explaining and responding to a medical error

8. Discussing end-of-life care and treatment decisions

9. Addressing ethical issues, including patient autonomy and best interests

10. Exploring and addressing a patient's or relative's concerns about their care

Unlike the clinical examinations, these encounters are not really about the symptoms or diagnosis itself. The examiners are looking for more than simply giving the “right” information: you need to demonstrate clear and structured communication, empathy, active listening and an ability to respond to the patient's individual concerns.

For a full overview of how PACES is structured and assessed, see The Pastest Guide to the MRCP PACES Exam. 

Preparing for PACES with Pastest

The cases in this guide are best used as a starting point for your revision, rather than a list to memorise. For each case, practise running through the examination or history routine out loud, summarising your findings and communicating with the patient, as you would in the exam.

Looking for resources to help you get exam-ready? Pastest’s online PACES revision course includes over 140 patient examination videos, flashcards and spot diagnoses to test your knowledge, while our MRCP PACES strategy guide provides station-specific strategies and study techniques. And when you’re getting closer to exam day, our PACES In-Person Course helps you put your knowledge and skills together under realistic conditions. 

Frequently asked questions

Are the same PACES cases repeated across sittings?

The specific patients and scenarios change between sittings, but certain conditions come up repeatedly because they're reliably examinable and lend themselves to clear discussion, such as murmurs, chronic liver disease and common neurological signs. Recognising these patterns is more useful than trying to predict exact cases.

How should I revise the most common PACES cases?

Start by learning the examination or consultation approach for each high-yield case, then practise identifying the key clinical signs, forming a diagnosis or differential diagnosis, and presenting your findings clearly. It is also important to practise explaining your findings and answering follow-up questions.

How many MRCP PACES sample scenarios should I revise?

Rather than aiming to memorise a fixed number of cases, it's more effective to build broad familiarity across common presentations in each station, then apply the same examination and presentation structure to less familiar conditions. The cases in this guide are a starting point, not an exhaustive list.

How do I know which PACES cases to prioritise?

Prioritise cases that are common, have distinctive clinical signs and are relevant to the station you are preparing for. You should also consider your own weaker areas and spend more time practising cases where you are less confident.

Should I revise rare PACES cases as well as common cases?

Yes. Common cases are useful for prioritising your revision, but you still need broad clinical knowledge. Once you are confident with the high-yield cases, use your remaining revision time to cover less common conditions and practise applying your examination and consultation skills to unfamiliar presentations.