MRCS Part B Revision · Physical examination
Breast Lump — MRCS Part B Physical examination
By Dr Richard Miller, MBChB FRCS · Reviewed
Breast Lump is a physical examination station. Three of the seventeen examined stations in the MRCS Part B OSCE are physical examination. The physical examination stations ask you to examine a real patient or a simulated one to a clear sequence, interpret what you find, and present it.
What you need to know for the Breast Lump station
Wash Your Hands
Ensure that you are seen by the examiners to wash your hands using alcohol gel provided.
Introduce
Explain and inspect from the end of the bed. The patient should be chaperoned if possible.
Ask "where is the area of concern?"
Inspection
The patient should be positioned sitting on the edge of the bed with her arms by her side, with the upper half of her body exposed.
Reposition with hands on head, and hands on her hip whilst contracting the pectoralis muscles
Look for asymmetry, masses, dimpling (tethering to deep muscles, indicating cancer), scars, nipple inversion, Paget's disease (eczematous changes of the nipple as a result of cancer.
Palpation
Position the patient at 45 degrees, rolled slightly to the contralateral side being examined. Start examining the normal breast first. The hand of the side being examined should be behind her head.
Palpate the 4 quadrants and the central nipple (ask first, because it is sensitive). The most common site for malignancies is the upper, outer quadrant.
To palpate the axillae, relax her pectoral muscles by taking the weight of her arm in yours. Insert your fingers in to the axillae and move her arm closer to her side before feeling for lymph nodes.
Palpate the contralateral side.
Feel for infra and supraclavicular lymph nodes.
Tell the examiner you would like to:
Percuss the spine for tenderness (bone mets)
Listen to the lung bases (lung mets)
Examine the abdomen for hepatomegaly (liver mets)
Cover up the patient and thank her.
Top Tips
Always ensure a chaperone is asked for prior to starting the examination
Ensure dignity of the patient throughout
Don’t forget to palpate for areas of breast metastasis at the end of the examination
What are you asked at the Breast Lump station?
The station runs to 11 questions over nine minutes. These are the questions as they are put to you; the model answers are in the question bank.
- Examination: Breast
- Explain how you would introduce yourself
- Explain how you would begin your examination
- On contraction of the pectoralis muscle when sitting, this lady has a prominent lump in the right breast. On inspection the lump appears to be in the right upper outer quadrant On the left side, the nipple is absent; there is a scar over the left breast and at the back of the patient over the inferior boarder of the left scapula. What would you do next?
- How would you manage this patient?
- Why is an ultrasound more useful than a mammogram in younger patients?
- What are the complications of a mastectomy?
- What are the levels associated with axillary node clearance?
- What is the surface anatomy of the breast?
- What are the borders of the axilla?
- What are the reconstruction options for a patient post-mastectomy?
How is the physical examination station marked in MRCS Part B?
A physical examination station is marked out of 20: 8 marks for clinical and technical skill, and 4 each for clinical knowledge and its application, communication and professionalism. More than half the marks therefore sit outside your knowledge of the condition, so a silent but technically correct examination scores poorly. You are signalled at six minutes of the nine to present your findings.
FAQ
What does the Breast Lump station ask?
It opens with "Examination: Breast" and runs to 11 questions over nine minutes. A physical examination station is marked out of 20: 8 marks for clinical and technical skill, and 4 each for clinical knowledge and its application, communication and professionalism. More than half the marks therefore sit outside your knowledge of the condition, so a silent but technically correct examination scores poorly. You are signalled at six minutes of the nine to present your findings.
How many examination stations are there in MRCS Part B?
Three of the seventeen examined stations are physical examination. The number was reduced from four when the exam moved from eighteen stations to seventeen, implemented from the October 2020 diet.
How is a physical examination station marked?
Out of 20, with 8 marks for clinical and technical skill and 4 each for knowledge, communication and professionalism. The station also receives a global rating of pass, borderline or fail.
When do I present my findings?
At six minutes of the nine you are signalled to present. Rehearse the examination to finish inside six minutes, because the presentation carries marks that a rushed or truncated one will not earn.
How many stations are in the MRCS Part B OSCE?
Seventeen examined stations of nine minutes each, with a minute to read the task before each one. Two preparation stations and at least one rest station bring the circuit to about twenty, and the exam takes about three and a half hours.
What is the pass mark for MRCS Part B?
There is no published pass mark. The cut score is set separately for Applied Knowledge and Applied Skills, for each circuit, by borderline regression. Published pass rates across the 2024/25 diets ranged from 51% to 66%.
Can I fail a station and still pass?
Yes. There is no rule about how many stations you may fail: the cut score applies to your total mark in each component, so a weak station costs the marks you lost on it and strong stations elsewhere can make them back. Applied Knowledge and Applied Skills are passed separately and must both be passed at the same sitting, so a strong anatomy performance cannot rescue a weak communication one.
Dr Richard Miller, MBChB FRCS
Station summaries are reviewed against the current intercollegiate MRCS syllabus and the published marking blueprint. Guidance changes between diets: check the royal colleges' own pages before relying on a date, a fee or a threshold.
Practise this station
The question bank carries the model answer to every question above, with the rest of the physical examination stations.
More physical examination stations