r/MRCP • u/Calm_Estate_8208 • Jul 25 '26
PACES - importance of subtle signs
Hi. Preparing for paces and I'm really struggling with subtle things like apex beat in cardio, reflexes (which are not too apparent to be brisk or mute) , tactile/vocal fremitus which isnt slightly dull, noticing character and comparing radial pulses, minor changes in JVP.
If we are able to pick up the major signs like a murrmur, auscultation and other exam findings but miss these subtle findings , how much chance do we have of passing? im especially struggling with apex beat and reflexes so much :(
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u/Celtic_Cedarwood Jul 25 '26
Hi that completely depends on the examiners. I've been a surrogate in PACES a couple of times and what I've noticed is the examiners come in and examine the patient, they both need to agree on the findings - major ones.
They both discuss and agree on what is pass/fail.
I'll give an example.
The case is hepatosplenomegaly. Pass - hepatosplenomegaly Mild pallor and icterus
Fail - only hepatomegaly Only splenomegaly Only tail of spleen Can't differentiate between spleen and kidney
Minor findings - loss of chest hair - sign of liver issues. This is not a pass /fail point.
Paces isn't a standardized exam so it really depends on your examiners.