MRCS Part B Revision · Physical examination
Foot Drop — MRCS Part B Physical examination
By Dr Richard Miller, MBChB FRCS · Reviewed
Foot Drop 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 Foot Drop station
Motor
Inspect
Look at skin, muscles and look for wasting and fasciculations.
Tone
‘I’d like you to relax your legs.’ Shake/roll leg. Let leg go floppy and drop from the knee.
Test clonus by revolving ankle and then rapidly dorsiflex to elicit beats. (Gastronemius muscle, >5 beats pathological)
Power
Hip (L1,2) – ‘I’d like you to raise your left leg off he bed. And stop me from moving it.’ Compare sides.
Knee (L3,4,5) – ‘I’d like you to bend your knees. And stop me from moving them.
Ankle (L4,S1,2) – ‘I’d like you to flex your ankle up towards you. And stop me from moving it.’
Toe (L5) – ‘I’d like you to move your big toes towards you. And stop me from moving it.’
Reflexes
Knee (L3, L4)– Place hand underneath knees to take some of the weight. Use tendon hammer to elicit reflex.
Ankle (L5, S1) – relax by slightly flexing knee and slightly dorsiflexing ankle. Reinforce if necessary by asking patient to grasp and pull hands.
Plantar reflex (L5, S1) – Run finger along the lateral border of the sole of the foot from the heel to the toe. Normally produces plantar flexion of toes. In UMN lesion causes dorsiflexion – Babinski’s sign.
Sensory
Pain (Spinothalamic)
Use neurotip. . ‘I’m going to press this onto your leg. I’d like you to close your eyes and say ‘Yes’ when you can feel it.’
Compare legs. ‘Was it the same on both sides?’
Proprioception (Dorsal Column)
With patient’s eyes closed move big toe up and down. ‘Tell me whether I’m moving your toe up or down.’ Hold sides of toe between finger and immobilise foot.
Vibration (Dorsal Column)
Use tuning fork on medial maleolus. ‘Say ‘Yes’ when you can feel the tuning fork. Now tell me when it stops.’
Light touch (Spinothalamic)
Use cotton wool. ‘I’m going to press this onto your leg. I’d like you to say ‘Yes’ when you can feel it.’
Test dermatomes moving up from big toe and then little toe sides. ‘Was it the same feeling on both sides?’
Coordination
‘I’d like you to touch your left knee with your right heel. Now run your heel down your leg to your foot and do this as quickly as you can.’ Then other leg.
Gait - Ask the patient to walk if appropriate.
What are you asked at the Foot Drop station?
The station runs to 12 questions over nine minutes. These are the questions as they are put to you; the model answers are in the question bank.
- The patient is comfortable, you have washed your hands, introduced yourself and explained what you are going to do. Given the history above, please examine the lower limb. Examination: Foot Drop
- Explain how you would introduce yourself
- Explain how you would begin your examination
- On inspection you find bruising and swelling over the proximal aspect of the fibula on the left leg. The skin is intact, but there is an area of compromised skin over the head of the fibula. There is no obvious deformity of the lower limb. What would you do next?
- What differentials could cause the symptoms described in the scenario?
- What would you look for when testing reflexes?
- What investigations might help you narrow your diagnosis?
- What is the cutaneous sensation of the deep and superficial peroneal nerves?
- How can you classify nerve damage?
- How does the prognosis differ with each?
- What muscles does the common peroneal nerve innervate?
- From which nerve is the common peroneal a continuation? What are the nerve root values for this nerve?
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 Foot Drop station ask?
It opens with "The patient is comfortable, you have washed your hands, introduced yourself and explained what you are going to do. Given the history above, please examine the lower limb. Examination: Foot Drop" and runs to 12 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