Cardiovascular examination in a breathless man
PLAB 2 practice station

The task

You are a doctor in a medical outpatient clinic. Mr Alan Fraser, aged 66, has had breathlessness on exertion and two near-faints on climbing stairs. He is sitting on the couch. Perform a cardiovascular examination. Say aloud what you are doing at each step. The examiner will report the findings when you say what you are doing, so describe each step as you go. At the end, summarise your findings and say what you think is going on and what you would do next.

What this station tests

• Palpate carotid pulses one at a time, never both together.
• A slow-rising pulse, narrow pulse pressure and ejection systolic murmur radiating to the carotids point to aortic stenosis.
• Exertional syncope and chest pain in aortic stenosis are red flags that need prompt specialist review.
• Say what you are doing at each step, check for pain and obtain consent.
• Close the examination with a clear presentation, a differential and a plan.

Sources for the clinical content

• NICE NG208: Heart valve disease presenting in adults: investigation and management
• NICE CG109: Transient loss of consciousness ('blackouts') in over 16s

An original practice scenario with invented patients. Not an exam question.

Practise next

• Respiratory examination in a woman with cough and fever
• Abdominal examination with a painful groin lump
• Neurological examination of the legs after back pain
• Examination of a swollen painful knee
• Thyroid examination in a woman with weight loss