MRCS Part B Revision · Physical examination
Incisional Hernia — MRCS Part B Physical examination
By Dr Richard Miller, MBChB FRCS · Reviewed
Incisional Hernia 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 Incisional Hernia station
• Wash your hands and introduce yourself to the patient gaining consent for examination.
• Position, expose and inspect the patient from the end of the bed. Ask the patient to cough.
o Do this with the patient standing and then supine.
• Palpate assessing the characteristics of the abdominal lump/hernia. Palpate for a cough impulse.
• Assess if the hernia is reducible.
• Percuss.
• Auscultate.
• Thank the patient, cover them up, turn to the examiner and explain how you would like to complete your exam and give your findings.
Top Tips
• When examining a hernia always initially examine with the patient standing.
• Ask the patient to reduce the hernia before you attempt reduction.
• Remember that abdominal scars can become discrete in time and can be hidden in skin creases.
What are you asked at the Incisional Hernia station?
The station runs to 13 questions over nine minutes. These are the questions as they are put to you; the model answers are in the question bank.
- You have washed your hands, introduced yourself and explained what you are going to do. Please exam this lady’s abdominal lump. Examination: Hernia A
- Explain how you would introduce yourself
- Explain how you would expose this patient and how you would begin your examination
- The patient has increased body habitus and smells of cigarette smoke. She has a visible mass at the lateral aspect of her Kochers incision site. There are no visible skin changes. The swelling is more prominent on coughing. She is comfortable and not distended. Describe what you would do next
- There is a reducible non-tender mass over the lateral aspect of the scar site. There is a palpable cough impulse. There are no skin changes. Bowel sounds are present over the mass. It does not trans-illuminate. There are no stigmata of obstruction. How would you close the examination?
- What is your differential and most likely diagnosis?
- How would you manage this patient?
- What is the definition of a hernia?
- What other types of herniae do you know?
- What are the risk factors for developing a hernia?
- What are the potential complications of a hernia?
- What is the difference between incarceration and strangulation?
And 1 more at this station.
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 Incisional Hernia station ask?
It opens with "You have washed your hands, introduced yourself and explained what you are going to do. Please exam this lady’s abdominal lump. Examination: Hernia A" and runs to 13 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