The highest-yield MRCP PACES topics are the presentations that let you score in more than one kind of encounter: breathlessness, chest pain, cough or haemoptysis, abdominal pain and jaundice, weight loss or anaemia, confusion or falls, fever or sepsis, acute kidney injury and electrolyte problems, and diabetes-related presentations. In the current MRCP(UK) Part 2 Clinical Examination (PACES), you move through five stations and eight encounters across communication, consultation and system examination, so the smartest revision topics are the ones that let you demonstrate focused history taking, examination, differential diagnosis, judgement and explanation in the same case.
These areas are not random. The Internal Medicine curriculum highlights common or serious presentations across cardiology, respiratory medicine, gastroenterology and hepatology, geriatrics, haematology, infectious diseases, neurology, renal medicine, endocrinology and rheumatology, and PACES marks you across seven clinical skills rather than simple recall.
Why these presentations matter to examiners
In the consultation stations, you are expected to take a relevant history, do a focused examination, explain your thinking, answer questions and agree a plan. Stations 2 and 5 each last 20 minutes, with 15 minutes for history, examination and discussion with the patient, followed by 5 minutes of examiner questions; one consultation is likely to be more acute and the other less acute.
In the system examination encounters, you are not being rewarded for a beautiful but empty routine. You have up to 6 minutes to examine, then at least 4 minutes to identify signs, offer a differential and suggest sensible investigation and treatment. That is why presentation-based revision beats memorising rare diagnoses.
High-Yield MRCP PACES Topics: Cardiorespiratory Presentations
Cardiorespiratory medicine stays near the top of the list because the curriculum explicitly includes breathlessness, chest pain, palpitations, syncope, oedema, cough, haemoptysis, wheeze and pleuritic pain, and the current exam still includes respiratory, cardiovascular and consultation encounters where those syndromes fit naturally.
The core cases to practise are progressive breathlessness with oedema, chest pain with palpitations or syncope, and cough with wheeze or haemoptysis. If you can handle those cleanly, you have already covered heart failure, valve disease, arrhythmia, pulmonary embolic disease, COPD, asthma, bronchiectasis, lung malignancy and infection at a useful PACES level.
When you answer, open with severity and stability: is the patient hypoxic, hypotensive, actively bleeding or in pain right now? Then move fast to tempo, exertional limitation, orthopnoea or PND, sputum or blood, risk factors and a focused examination. Examiners like candidates who can turn signs into a syndrome, not just recite a system.
One official sample consultation is a 63-year-old man with haemoptysis and suspected bronchiectasis. Another is a 64-year-old man on the medical assessment unit with worsening breathlessness and a previous myocardial infarction. Use those cases to rehearse a one-sentence synthesis such as: “This sounds most likely to be chronic cardiorespiratory disease with recent deterioration; my leading possibilities are heart failure, pulmonary pathology and less likely thromboembolic disease, and I would first check for immediate instability before arranging targeted tests.”
A useful frame for breathlessness
- Immediate risk: airway, oxygenation and haemodynamic compromise.
- Pattern: acute, subacute or chronic; exertional, orthopnoeic, pleuritic or wheezy.
- Focused exam: pulse, JVP, heart sounds or murmurs, crackles, wheeze and peripheral oedema.
- Close with: leading diagnosis, key differentials, first tests and first treatment steps.
That frame is short enough for the station and broad enough for heart failure, PE, COPD exacerbation, ILD and valve disease.
Gastroenterology, Hepatology and Nutrition
Do not under-revise abdominal and liver presentations. The curriculum includes abdominal pain, abdominal swelling, haematemesis and melaena, jaundice, nausea and vomiting, dysphagia, weight loss and iron-deficiency anaemia, and these are strong PACES cases because they combine diagnosis, examination, explanation and management.
The themes worth repeated practice are jaundice or abnormal liver tests, weight loss with nausea or anorexia, GI bleeding or iron-deficiency anaemia, and abdominal pain or swelling with a malignancy, inflammatory or hepatobiliary differential. Those themes also force you to talk clearly about urgency, cancer concern, nutrition and follow-up.
An official sample consultation uses a 45-year-old woman with nausea, anorexia and abnormal liver function tests. That is classic exam territory because it forces you to sort pattern recognition from rote history-taking: alcohol, drugs and supplements, viral risk, autoimmune clues, weight loss, obstructive symptoms, stigmata of chronic liver disease and what the patient fears this might mean.
Nutrition and best-interest discussions are also high yield. One official communication example is a conversation with a daughter about hydration and feeding in a 74-year-old woman with severe dementia. Even when the clinical content is nutritional or gastrointestinal, the marks come from explanation, ethics, judgement, emotional handling and patient welfare.
A useful frame for jaundice or abnormal liver tests
Start with pattern, not a shopping list. Tell yourself: hepatocellular, cholestatic or mixed? Then ask about time course, alcohol, drugs, viral risk, autoimmune disease, weight loss, pruritus, pale stool or dark urine, and decompensation. Finish with a focused abdominal exam and a clear first plan: repeat bloods, clotting, ultrasound, medication review and escalation if the patient is septic or encephalopathic.
Neurology, Frailty and Older-Patient Presentations
PACES still rewards candidates who can localise, prioritise safety and explain uncertainty calmly. The Internal Medicine curriculum includes acute confusion, weakness and paralysis, speech disturbance, swallowing difficulty, seizures, dizziness or vertigo, memory loss, unsteadiness, stroke or TIA, delirium, falls, frailty and deterioration in mobility.
These are high-yield because they cross stations. A weak or unsteady patient may become a neurological examination case, a consultation about stroke, seizure or delirium, or a communication encounter about prognosis, capacity or discharge planning.
Your language matters here. Say where the lesion might be, how quickly it evolved and what function has been lost. “This sounds like an acute focal neurological deficit until proved otherwise” is much stronger than “neurology review and CT head please.”
A useful frame for confusion, falls or weakness
- Establish time course and baseline function.
- Screen for immediately reversible causes: sepsis, hypoglycaemia, drugs, stroke, seizure, urinary retention, constipation and dehydration.
- Do a targeted neurological plus general examination.
- State whether you think this is delirium, focal neurology, frailty syndrome or mixed pathology.
- End with immediate safety steps, not just a referral.
Renal, Endocrine, Infection and Haematology Presentations
These topics are easy to leave for written revision, but they are common PACES material because they test judgement under pressure. The curriculum specifically includes acute kidney injury, raised creatinine, fluid and electrolyte problems, hyperglycaemia, hypoglycaemia, polyuria or polydipsia, fever, sepsis syndrome, weight loss, anaemia, lymphadenopathy, bruising or bleeding and neutropenic fever.
What examiners want is simple: can you recognise a sick patient, identify the likely syndrome, start safe first-line management and explain the plan clearly? A muddled answer on hyperkalaemia, DKA or HHS, sepsis, AKI or severe anaemia loses marks quickly because these are bread-and-butter internal medicine problems.
Build your practice around presentation clusters rather than specialties: AKI with electrolyte disturbance and fluid balance; fever with sepsis and immunocompromise; anaemia with weight loss and lymphadenopathy; polyuria or polydipsia with hyperglycaemia or hypoglycaemia. That is much closer to how cases feel in the station.
How to Turn Any Core Medical Presentation Into a PACES Answer
The consultation script
In Stations 2 and 5, aim to sound like a safe registrar, not a textbook. A reliable structure is: one opening line that identifies urgency; focused history around the syndrome; focused examination early, not as an afterthought; one-sentence summary; top two or three differentials with reasons; first investigations and immediate management; then the patient’s concerns, preferences and safety-netting.
A good closing sentence is often enough to show maturity: “My main concern is decompensated heart failure, but I would also consider PE and pneumonia; I would check observations, ECG and chest imaging urgently, start supportive treatment, and keep you updated as results come back.” That sounds organised. More importantly, it sounds believable.
The physical signs script
In respiratory, cardiovascular, neurological and abdominal encounters, move in the same order every time: inspection and position; hands and pulse; face and neck; the core system examination; one clean presentation of findings; differential diagnosis; then targeted next steps. Repetition matters because the physical examination encounters are scored for technique, sign detection, differential diagnosis, judgement and patient welfare.
Remember that official guidance specifically warns candidates about two common failures: poor examination technique and reporting signs that are not actually present. Honest, disciplined examination beats theatrical overcalling every time.
Common Mistakes
Most strong candidates do not lose marks because they forgot a rare disease. They lose them through timing, focus, sign interpretation and patient-centredness. The official preparation material is especially clear about technique, physical signs and maintaining patient welfare.
- Revising by rare diagnoses instead of common syndromes.
- Spending too long on history and leaving no room for examination or explanation.
- Giving a full clerking when the station needs a focused problem-solving approach.
- Missing severity markers at the start.
- Naming one diagnosis but not offering reasonable alternatives.
- Overcalling physical signs.
- Ignoring what the patient or relative is worried about.
- Ending without a clear plan, timeframe or safety-net.
Practice Workflow
Use the official sample scenarios and the current marksheets, then rehearse to the real station timings. That means 10 minutes for communication encounters, 20 minutes for consultations, and for physical examination encounters no more than 6 minutes examining before you practise the 4-minute discussion.
A practical weekly loop looks like this:
- Pick one presentation cluster, such as breathlessness or jaundice.
- Run it three ways: consultation, communication and physical signs discussion.
- Mark yourself against the PACES skills, not just factual knowledge.
- Debrief one missed safety point and one missed communication point.
- Repeat the same cluster 48 hours later with a different stem.
Add one non-diagnostic communication case each week as well. The official examples on feeding in advanced dementia and open disclosure after a medication error are worth using because they force you to practise candour, empathy and safe explanation under time pressure.
That is how topics become station performance.
Summary
- Revise the core presentation clusters that recur across stations: breathlessness, chest pain, cough or haemoptysis, jaundice or weight loss, confusion or falls, AKI or electrolyte disturbance, fever or sepsis, anaemia and diabetes-related syndromes.
- In the consultation stations, practise sounding like a safe registrar: focused history, focused exam, synthesis, plan, concerns.
- In the physical examination encounters, go from sign to syndrome to differential to management.
- Use official sample scenarios and official marksheets first. They are the best starting point for realistic practice.
References
- https://www.thefederation.uk/examinations/paces
- https://www.thefederation.uk/examinations/paces/format
- https://www.thefederation.uk/examinations/paces/preparation
- https://www.thefederation.uk/examinations/paces/sample-scenarios
- https://www.thefederation.uk/examinations/paces/marksheets
- https://www.thefederation.uk/sites/default/files/uploads/PACES23%20Communication%20encounter%20examples.pdf
- https://www.thefederation.uk/sites/default/files/uploads/PACES23%20Consultation%20example%201.pdf
- https://www.thefederation.uk/sites/default/files/uploads/PACES23%20Consultation%20example%202.pdf
- https://www.thefederation.uk/sites/default/files/uploads/PACES23%20Consultation%20example%203.pdf
- https://www.thefederation.uk/sites/default/files/uploads/IM_Curriculum_Sept2519_2.pdf