Cardiovascular Examination for MRCS Part B: Sequence, Signs and Presentation

The cardiovascular examination at MRCS Part B runs from the end of the bed to the hands, pulse, blood pressure, JVP, face and praecordium, then auscultation in four areas with the carotid palpated, and finishes with the peripheral pulses and oedema. Structure earns more marks than rare signs.

Key takeaways

• Position the patient at 45 degrees, exposed to the waist, and keep them covered between steps.
• The jugular venous pressure is read as a vertical height above the sternal angle, which sits about 5 cm above the mid right atrium.
• Palpate the carotid while you auscultate so you can time every sound you hear.
• Murmur intensity is graded 1 to 6 on the Levine scale, and a palpable thrill makes it at least grade 4.
• The Intercollegiate candidate briefing says you get a signal at six minutes of the nine-minute station, and that is when you present.

How is this station marked in MRCS Part B?

A physical examination station is marked out of 20 across four domains: clinical and technical skill carries 8 marks, and clinical knowledge and its application, communication, and professionalism carry 4 marks each. The examiner also gives the station a separate global rating of pass, borderline or fail.

Two things follow from that split. More than half the marks sit outside your knowledge of the condition, so a silent, technically correct examination scores poorly. And you are signalled at six minutes of the nine to present your findings, so the sequence has to finish inside six.

How do I start the cardiovascular examination?

Wash your hands in front of the examiners, introduce yourself, gain consent and ask about pain. The Intercollegiate guidance requires hand gel at clinical bays and arms bare below the elbow, so this is marked, not decorative.

• Stand at the end of the bed and look at the patient: well or breathless, cachectic, cyanosed, any recognisable syndrome.
• Scan the bedside for oxygen, medication, a glyceryl trinitrate spray, cardiac monitoring leads or walking aids.
• Position the patient sitting at 45 degrees and expose the chest, offering a sheet to preserve dignity.

What am I looking for in the hands and at the pulse?

You are looking for the peripheral stigmata of endocarditis, hyperlipidaemia and chronic disease, then characterising the pulse.

• Hands: temperature, capillary refill, clubbing, tar staining, palmar erythema, xanthomata, and the endocarditis signs of splinter haemorrhages, Osler's nodes and Janeway lesions.
• Nails: koilonychia in iron deficiency, and nailbed pulsation as Quincke's sign in aortic regurgitation.
• Radial pulse: rate over 15 seconds multiplied by four, rhythm, and radio-radial delay.
• Raise the arm while gripping the wrist to feel for a collapsing pulse, asking first about shoulder pain.
• Offer to measure the blood pressure with an appropriately sized cuff at the level of the heart.

How is the JVP measured and what is normal?

Turn the head slightly to the left with the patient at 45 degrees, and read the vertical height of the top of the venous column above the sternal angle.

Clinical Methods explains the arithmetic: the mid right atrium sits a fixed 5 cm below the sternal angle, so you add 5 cm to your reading. A normal mean jugular venous pressure is 6 to 8 cm of water, which is only a few centimetres of visible column.

Distinguish the JVP from the carotid by pressing on the right upper quadrant. The Stanford Medicine 25 teaching is that the JVP rises with that manoeuvre and a carotid pulsation does not.

What is the order of praecordial examination?

• Inspect for scars, including in the axilla and along the sternum, implanted devices and chest wall deformity, and ask the patient what any scar is from.
• Palpate the apex beat: flat hand first, then localise it to an intercostal space and a line, and describe its character.
• Feel for a left parasternal heave with the heel of the hand, which suggests right ventricular hypertrophy.
• Feel for thrills over the aortic and pulmonary areas with the flat of the hand.

Where do I listen, and how do I describe a murmur?

Keep a finger on the carotid throughout so that you can time what you hear against systole.

• Mitral area at the apex with the diaphragm, then the bell, then with the patient rolled into the left lateral position.
• Tricuspid area at the left sternal edge in the fifth intercostal space.
• Pulmonary area in the second left intercostal space and aortic area in the second right intercostal space.
• Carotids with the bell, asking the patient to hold their breath in expiration.

A murmur is described by timing, character, intensity, site of maximal intensity and radiation. StatPearls gives the Levine grades from 1, barely audible, to 6, audible with the stethoscope off the chest, with a palpable thrill from grade 4 upwards. Aortic stenosis radiates to the carotids and mitral regurgitation to the axilla.

How do I complete the cardiovascular examination?

Sit the patient forward, listen at the lung bases and feel for sacral oedema, then palpate the femoral, popliteal, posterior tibial and dorsalis pedis pulses and check for pitting ankle oedema. Offer a full set of observations, an ECG and a urine dipstick.

How do I present my findings to the examiner?

Lead with the headline, then the evidence. Say who the patient is, what the dominant finding is, the positive signs that support it, the relevant negatives, and what you would do next.

What is the examiner marking at this station?

Each MRCS Part B station carries 20 marks and a global rating of pass, borderline or fail, and the clinical and procedural skills stations sit inside the Applied Skills group that you must pass in its own right.

The Intercollegiate guidance marks four domains across the circuit, so your communication and professionalism are being scored here as well as your technique.

What are the most common mistakes at this station?

• Running out of time because the sequence was not rehearsed, and being cut off at the six-minute signal mid-auscultation.
• Auscultating without a finger on the carotid, then being unable to say whether a murmur was systolic or diastolic.
• Reporting the JVP without saying where it was measured from.
• Exposing the patient and leaving them exposed for the rest of the station.
• Listing every nail sign in the textbook instead of reporting the ones actually present.

The MRCS Part B Questions bank at mrcspartbquestions.com has a cardiovascular examination station with a marked checklist at /Sample-Questions. Reviewed and updated 15 September 2026.