Terminology

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: 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. 

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.

Public Health England (PHE) ceased to exist in late 2021.

Since 1 October 2021, PHE's health protection functions have been delivered by the UK Health Security Agency (UKHSA), while its health improvement functions have been delivered by the Office for Health Improvement and Disparities (OHID, DHSC), NHS England, and NHS Digital.

Pelvic inflammatory disease/disorder (PID) is an infection of the female upper genital tract, including the uterus, Fallopian tubes and ovaries. In about 1 in 4 cases, STI is the cause.

PID can lead to a number of complications including infertility and ectopic pregnancy. 

Prompt and effective treatment with antibiotics is important (after STI screening), of both the affected female ± recent sexual partner(s). 

NICE CKS - PID

Polymyalgia rheumatica (PMR) is an inflammatory condition which presents with aching and morning stiffness in the neck, shoulders, and/or pelvic girdle (hips and thighs) in people older than 50 years of age.

PMR is frequently associated with GCA.

NICE CKS - PMR

Point-of-Care Ultrasound (PoCUS) refers to USS performed at the patient's bedside (or wherever they are - in the ED, in a GP practice, or in an ambulance, for example), as opposed to in a dedicated radiology department.

Radiopaedia - PoCUS Curriculum

Personal protective equipment

Proton-pump inhibitors (PPIs) are a group of medications which reduce stomach acid production.

PPIs are used in the management of PUD and GORD.

Physiotherapy (preferred UK terminology) and physical therapy (preferred US terminology) help to restore movement and function when someone is affected by injury, illness or disability.

Post-traumatic stress disorder (PTSD) is an anxiety disorder caused by very stressful or distressing events.

People with PTSD often relive the traumatic event through nightmares and intrusive thoughts or images when awake (flashbacks). Symptoms last for at least one month after the traumatic event.

Other anxiety disorders include OCD and GAD.

NICE CKS - PTSD

PUD is peptic ulcer disease.

BMJ Best Practice - Peptic ulcer disease

PUO is pyrexia (fever) of unknown origin.

Patient.info - Pyrexia of Unknown Origin