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Practical Assessment of Clinical Examination Skills (PACES) is an exam designed to test the clinical knowledge and skills of trainee doctors who hope to enter higher specialty training.

This is the third of three MRCP(UK) exams required before you can start specialist internal medicine training in the UK.

RCPE information:Β Preparing for PACES exams



Peripheral arterial disease (PAD) occurs where a build-up of fatty deposits in the peripheral arteries causes narrowing or blockage, restricting blood supply to the lower limbs, particularly the leg muscles.

PAD classically causes intermittent claudication, leg pain when walking which resolves with rest.

PAD can be assessed using ABPI initially, and if abnormal, Doppler USS and angiography may be undertaken.


Pulmonary arterial hypertension (PAH) is a rare, progressive disorder characterised by high blood pressure in the arteries of the lungs, due to thickening and stiffening of the walls of the smaller branches of the pulmonary arteries. Over time, PAH damages the heart, which has to work harder to overcome this arterial resistance.

PAH can be associated with a number of conditions, including connective tissue diseases (such as scleroderma), portal hypertension, HIV, and certain medications/drugs. The cause may be unknown (idiopathic PAH).


Percutaneous coronary intervention (PCI, coronary angioplasty with stent insertion) is a non-surgical procedure used to treat narrowing or blockage of the coronary arteries, as found in CHD / MI.

Primary PCI is the urgent use of PCI in people with acute MI.


Proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors are a new type of cholesterol-lowering drug.


Parkinson's disease (PD) is a chronic, progressive neurodegenerative condition caused by lack of dopamine in the brain, due to loss of the dopamine-containing cells of the substantia nigra.

PD is a movement disorder with four core features: tremor (shaking), bradykinesia (slowness of movement), rigidity (muscle stiffness) and postural instability (difficulty with balance and coordination).

NICE CKS - Parkinson's disease



Pulmonary embolism/emboli (PE) occurs when a blood vessel in the lung(s) is blocked by a blood clot.

NICE CKS - Pulmonary embolism


PERLA means pupils equal and reactive to light and accommodation.

PEARL means pupils equal and reactive to light; PERRLA means pupils equal, round and reactive to light and accommodation.


Positron emission tomography (PET) is a non-invasive, nuclear medicine imaging technique (similar to SPECT), providing metabolic and functional information.

PET is often combined with CT or MRI.

Radiopaedia - PET

Radiopaedia - SPECT vs. PET


Patent foramen ovale (PFO) occurs if the foramen ovale, a hole between the heart's atria made in normal foetal development, does not close after birth as it should.

PFO is common, affecting about 1 in 4 people.Β 

PFO can increase risk of ischaemic stroke, because thrombi (blood clots) can pass from the right to the left side of the circulation and more easily reach the brain - normally small thrombi are filtered out by the lungs.

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