PACES for the MRCP,
Edition 3 with 250 Clinical Cases

Publication Date: 19 Jun 2013

The 3rd edition of PACES for the MRCP has been fully revised and updated throughout to retain its pole position as the textbook to accompany core medical training (CMT) and prepare candidates for success in the Practical Assessment of Clinical Examination Skills and a future specialty career.


  • Fully revised for the new Station 5 and completely updated throughout.

  • Promotes understanding and deeper learning of modern medicine applicable to PACES and the specialist registrar.

  • Emphasis on clinical assessment – history-taking, examination and communication skills – equipping candidates with appropriate differential diagnoses from which to develop the right diagnosis.

  • Encourages candidates to question why a diagnosis has arisen and consider its consequences. For example, ‘Heat failure’ is a not a diagnosis until a candidate has considered the differential diagnoses of breathlessness and decided why heart failure is most likely, and then considered its cause (not always ischaemic heart disease), its presentation (acute, chronic, left or right ventricular or both) and, most importantly, the effects of it and its treatments on a patient’s life.

This 3rd edition of PACES for the MRCP continues to provide fully revised, up-to-date, evidence-based coverage of investigations and treatments. Whilst the emphasis of PACES is on clinical skills, candidates who understand when, for example, a patient with rheumatoid arthritis might benefit from a biologic agent and how this will influence inflammatory disease, is better equipped for success.

From reviews of the previous edition:

‘Hall's PACES for the MRCP is excellent. It is easy to follow, carefully laid out and covers all conditions likely to appear in each station of the exam. The author not only explains examination techniques and clinical signs, but also goes that step further to ensure the reader really understands each topic, using clinical examples, question and answer/discussion sections as well as detailed illustrations. Where this text also outshines the others is with the inclusion of chapters covering the History Taking and Communication/Ethics stations of the exam. The scenarios are "spot on" and give the reader plenty of examples to work through. The Neurology section is brilliant.’ Overall: An excellent and up-to-date text, this is the new MRCP "Bible" - don't sit your exam without it.

‘Looking through the book is a visual delight and there is lots of excellent information there.’

‘Well laid out, easy to read and utterly relevant. Also serves as a useful reference tool post-membership too. Buy it!’

Really good book. The clinical stations are well covered - in particular this book is worth buying just for the neuro section alone which is really easy to read and understand and gives you a great framework for approaching clinical cases (this is also what countless colleagues of mine have cited as the book's main selling point!)

‘This is an excellent book. It is very well-written, clear, factually correct and actually means that you know enough to hold a conversation with the examiners. Apparently most people assume they will pass the Hx and comm stations but commonly fail them and this book is excellent for those with lots of information and cases to practice. I really feel that this book has transformed the paces market as it is so much better than the others.’

‘Hall's refreshingly relevant and readable textbook is vital to successful PACES preparation and covers all sections faced in the exam with good detail.’

Key Features

  • A one-volume text giving candidates complete preparation for the PACES exam within one portable volume
  • 250 cases organised into the 5 stations of the PACES exam – respiratory and abdominal system, history taking, cardiovascular and nervous system, communication and ethics and skin, locomotion, eyes and endocrine systems
  • Engaging question-and-answer approach at the end of each case – excellent preparation for the exam
  • Boxed tips highlight vital information – helps identify what is most important to remember

New Features

    • Fully revised for the new Station 5 and completely updated throughout.
    About the author
    By Tim Hall, MB ChB FRCP MRCGP DipClinEd FHEA, Consultant in Geriatric Medicine and Acute and General (Internal) Medicine and Geriatric Medicine, Plymouth Hospitals NHS Trust, South West Peninsula Deanery, Plymouth, UK
    Table of Contents



    Examination of the respiratory system


    1.1 Chronic obstructive pulmonary disease
    1.2 Consolidation
    1.3 Dullness at the lung base
    1.4 Pneumonia
    1.5 Lung cancer
    1.6 Pancoast’s syndrome
    1.7 Superior vena cava obstruction
    1.8 Collapse/pneumonectomy/lobectomy
    1.9 Bronchiectasis
    1.10 Cystic fibrosis
    1.11 Kartagener’s syndrome
    1.12 Tuberculosis
    1.13 Idiopathic pulmonary fibrosis and diffuse parenchymal lung disease

    1.14 Rheumatoid lung

    1.15 Extrinsic allergic alveolitis

    1.16 Asbestos-related lung disease and pneumoconiosis

    1.17 Pulmonary sarcoidosis
    1.18 Pulmonary hypertension
    1.19 Cor pulmonale
    1.20 Pulmonary embolism
    1.21 Pleural effusion
    1.22 Pleural rub
    1.23 Pneumothorax
    1.24 Obstructive sleep apnoea-hypopnoea syndrome

    1.25 Lung transplant


    Examination of the abdominal system


    1.26 Chronic liver disease
    1.27 Jaundice
    1.28 Ascites
    1.29 Alcoholic liver disease
    1.30 Viral hepatitis
    1.31 Autoimmune hepatitis
    1.32 Primary biliary cirrhosis
    1.33 Hereditary haemochromatosis
    1.34 Wilson’s disease
    1.35 Hepatomegaly
    1.36 Splenomegaly

    1.37 Hepatosplenomegaly
    1.38 Felty’s syndrome
    1.39 Abdominal mass
    1.40 Crohn’s disease
    1.41 Ulcerative colitis
    1.42 Carcinoid syndrome
    1.43 Enteric and urinary stomas
    1.44 Chronic myeloid leukaemia
    1.45 Polycythaemia vera, myeloproliferative disorders and myelodysplasia
    1.46 Chronic lymphocytic leukaemia
    1.47 Lymphadenopathy and lymphoma
    1.48 Polycystic kidney disease
    1.49 Nephrotic syndrome
    1.50 Renal transplant


    Introduction to history-taking skills

    Clinical reasoning

    The traditional medical history model

    Incorporating the patient's perspective - ideas, concerns and expectations

    History-taking skills - the communication skills that make history-taking effective

    The traditional model and communication skills - putting these two together


    Respiratory problems

    2.1 Breathlessness
    2.2 Asthma

    Abdominal problems

    2.3 Dyspepsia
    2.4 Dysphagia
    2.5 Abdominal pain
    2.6 Altered bowel habit

    Cardiovascular problems

    2.7 Prevention of cardiovascular disease and weight gain
    2.8 Chest pain and angina
    2.9 Acute coronary syndrome
    2.10 Heart failure
    2.11 Palpitations
    2.12 Atrial fibrillation
    2.13 Dyslipidaemia

    Neurological problems

    2.15 Headache
    2.16 Transient ischaemic attack
    2.17 Weakness and wasting
    2.18 TMultiple sclerosis
    2.19 Tremor

    Locomotor problems

    2.20 Back pain
    2.21 Joint pain

    Eye problems

    2.22 Visual loss

    Endocrine problems

    2.23 Type 1 diabetes mellitus
    2.24 Type 2 diabetes mellitus

    Renal and metabolic problems

    2.25 Acute renal failure
    2.26 Chronic kidney disease and renal replacement therapy
    2.27 Glomerulonephritis
    2.28 Systemic vasculitis
    2.29 Hypercalcaemia
    2.30 Hyponatraemia
    2.31 Poisoning and metabolic disturbance

    Haematological problems

    2.32 Anaemia
    2.33 Sickle cell disease and thalassaemia
    2.34 Purpura
    2.35 Haemophilia
    2.36 Deep vein thrombosis
    2.37 Thrombophilic tendency
    2.38 Myeloma

    Infectious disease

    2.39 Human immunodeficiency virus infection

    Other general internal medicine and elderly care problems

    2.40 Falls and rehabilitation
    2.41 Syncope
    2.42 Seizures
    2.43 Acute confusion
    2.44 Mild cognitive impairment and dementia
    2.45 Incontinence
    2.46 Raised inflammatory markers
    2.47 Polymyalgia and giant cell arteritis
    2.48 Pyrexia and sepsis
    2.49 Weight loss
    2.50 Tiredness



    Examination of the cardiovascular system


    3.1 Mitral stenosis
    3.2 Mitral regurgitation
    3.3 Aortic stenosis
    3.4 Aortic regurgitation
    3.5 Tricuspid regurgitation and Ebstein’s anomaly
    3.6 Other right-sided heart murmurs
    3.7 Mixed valve disease
    3.8 Mitral valve prolapse
    3.9 Prosthetic valves
    3.10 Permanent pacemaker
    3.11 Infective endocarditis
    3.12 Congenital heart disease
    3.13 Cyanotic heart disease
    3.14 Hypertrophic (obstructive) cardiomyopathy
    3.15 Pericardial rub and pericardial disease


    Examination of the nervous system

    - Overview of the organisation of the nervous system and how to examine it
    - Cranial nerves
    - Higher cortical function and specific lobes
    - Speech and language
    - Power and sensation
    - Upper limbs
    - Lower limbs
    - Gait


    3.16 Visual field defects
    3.17 Ocular nerve lesions
    3.18 Internuclear ophthalmoplegia
    3.19 Nystagmus
    3.20 Ptosis
    3.21 Large pupil
    3.22 Small pupil
    3.23 Horner’s syndrome
    3.24 Cerebellopontine angle syndrome
    3.25 Facial nerve palsy
    3.26 Bulbar palsy
    3.27 Anterior circulation stroke syndromes
    3.28 Dysphasia and dysarthria
    3.29 Pseudobulbar palsy
    3.30 Agnosias and apraxias
    3.31 Posterior circulation stroke syndromes
    3.32 Parkinson’s disease
    3.33 Cerebellar disease
    3.34 Spastic paraparesis and Brown Sequard syndrome
    3.35 Syringomyelia
    3.36 Absent ankle jerks and extensor plantars
    3.37 Motor neurone disease
    3.38 Cervical myeloradiculopathy
    3.39 Cauda equina syndrome
    3.40 Carpal tunnel syndrome (median nerve lesion)
    3.41 Ulnar nerve lesion
    3.42 Radial nerve lesion
    3.43 Wasting of the small (intrinsic) muscles of the hand
    3.44 Common peroneal nerve lesion
    3.45 Peripheral neuropathy
    3.46 Charcot-Marie-Tooth disease and hereditary neuropathies
    3.47 Guillain-Barre syndrome
    3.48 Myasthenia gravis
    3.49 Myotonic dystrophy



    Introduction to communication skills and ethics


    Discussing clinical management

    4.1 Explaining a diagnosis
    4.2 Explaining an investigation
    4.3 Discussing a treatment
    4.4 Discussing management, prognosis and possible complications in a patient with multiple problems
    4.5 Discussing diagnostic uncertainty
    4.6 Discussing risk and treatment effect
    4.7 Negotiating a management plan for a chronic disease/long-term condition
    4.8 Encouraging concordance with treatment and prevention

    Communication in special circumstances

    4.9 Cross-cultural communication
    4.10 Communicating with angry patients or relatives
    4.11 Communicating with upset and distressed relatives
    4.12 Discharge against medical advice
    4.13 Delayed discharge

    Breaking bad news

    4.14 Cancer – potentially curable
    4.15 Cancer – likely incurable
    4.16 Cancer – patient not fit for active treatment
    4.17 Chronic disease
    4.18 Discussing an acutely terminal situation with relatives

    Confidentiality, consent and capacity

    4.19 Legal points in confidentiality
    4.20 Breaching confidentiality when a third party may be at risk
    4.21 Breaching confidentiality in the public interest
    4.22 Confidentiality when talking with relatives and other third parties
    4.23 Consent for investigation or treatment
    4.24 Consent and capacity
    4.25 Refusal to consent
    4.26 Deliberate self-harm

    End of life issues

    4.27 Resuscitation-status decision-making discussion with patient
    4.28 Resuscitation status decision-making discussion with relative
    4.29 Appropriateness of intensive therapy unit transfer
    4.30 Withholding and withdrawing life-prolonging treatments - Artificial hydration and nutrition
    4.31 Withholding and withdrawing life-prolonging treatments - antibiotics and drugs
    4.32 Percutaneous endoscopic gastrostromy feeding
    4.33 Palliative care
    4.34 Advance directives/decisions
    4.35 Persistent vegetative state
    4.36 Brainstem death
    4.37 Discussing live organ donation
    4.38 Requesting an autopsy (post-mortem)

    Clinical Governance

    4.39 Critical incident
    4.40 Managing a complaint and the question of negligence
    4.41 Fitness to practice - poor peformance in a colleague
    4.42 Fitness to practice - misconduct in a colleague
    4.43 Fitness to practice - health problems in a colleague
    4.44 Recruitment to a randomised controlled trial

    Other communication, ethical and legal scenarios

    4.45 Genetic testing
    4.46 HIV testing
    4.47 Needlestick injury
    4.48 Medical opinion on fitness for anaesthesia
    4.49 Fitness to drive
    4.50 Industrial injury benefits



    Examination of the skin


    5.1 Psoriasis
    5.2 Dermatitis
    5.3 Lichen planus
    5.4 Blistering skin condititions
    5.5 Facial rash
    5.6 Scleroderma, vitiligo and autoimmune skin disease
    5.7 Oral lesions
    5.8 Nail lesions
    5.9 Shin lesions
    5.10 Neurofibromatosis
    5.11 Tuberose sclerosis
    5.12 Neoplastic skin lesions
    5.13 Skin vasculitis
    5.14 Xanthomata and xanthelasmata
    5.15 Skin and soft tissue infection


    Examination of the joints

    Examination of the hands and arms

    Examination of the legs

    Examination of the spine


    5.16 Rheumatoid hands and rheumatoid arthritis
    5.17 Ankylosing spondylitis and spondyloarthropathies
    5.18 Systemic lupus erythematosus
    5.19 Scleroderma
    5.20 Crystal arthropathy
    5.21 Osteoarthritis
    5.22 Paget’s disease
    5.23 Marfan’s syndrome
    5.24 Ehlers-Danlos syndrome
    5.25 Osteogenesis imperfecta


    Examination of the eyes


    5.26 Diabetic retinopathy
    5.27 Hypertensive retinopathy
    5.28 Swollen optic disc and papilloedema
    5.29 Optic atrophy
    5.30 Chorioretinitis
    5.31 Retinitis pigmentosa
    5.32 Central retinal vein occlusion
    5.33 Central retinal artery occlusion
    5.34 Retinal detachment and vitreous haemorrhage
    5.35 Drusen and age-related macula degeneration (asteroids)
    5.36 Angioid streaks
    5.37 Myelinated nerve fibres
    5.38 Glaucoma
    5.39 Cataracts
    5.40 Uveitis and red eye


    Examination of the thyroid


    5.41 Hyperthyroidism and Grave’s disease
    5.42 Hypothyroidism
    5.43 Goitre and neck lumps
    5.44 Acromegaly
    5.45 Hypopituitarism
    5.46 Cushing’s syndrome
    5.47 Hypoadrenalism and Addison’s disease
    5.48 Hirsutism and polycystic ovarian syndrome
    5.49 Hypogonadism and gynaecomastia
    5.50 Pseudohypoparathyroidism

    APPENDIX 100 tips for passing PACES

    Book Reviews

    Comments from candidates' reviews:

    "The book is an excellently designed companion to PACES preparation. It is portable enough to be carried around with you (unlike some other texts!), and removes some of the fear factor that can hamper preparation. I certainly used this book as my main text whilst on the wards and have recommended it ever since. I feel it is the best PACES text."

    "The book's format follows the format of the exam and helps to focus and get an idea what one needs to prepare for. It focuses not only on signs related to certain diseases, but also how to recognise and interpret these. As a second step it includes treatment/management to discuss the disease/case in the exam."

    "One of the greatest assets of this text is the positioning of relevant (and often asked!) questions at the end of this case. Even if studying alone it is possible to see a real patient and then test oneself on the questions practicing for the real exam experience. The close proximity of the answers (directly following the questions) aids readability, as some texts require you to seek out other pages. The competition lacks the questions which help you get good pass marks."

    "The miscellaneous section of 100 tips is motivating and all-encompassing! I often flicked to the back of the book throughout my preparation. It is also excellent for the night before the exam."

    "Hall’s PACES for MRCP has comprehensive and up-to-date information presented in a very easy-to-read format. It quotes up-to-date studies. The content appears to be more comprehensive than any of the other PACES books out in the market that I have seen."
    BMA Book Awards 2009 - judges comments







    Book details
    ISBN: 9780702051418
    Page Count: 960
    Retail Price : £59.99
    • MRCP candidates preparing for PACES exam

    • Medical students preparing for postgraduate exams in medicine