MRCS Part B Revision · Physical examination
Skin Lump A — MRCS Part B Physical examination
By Dr Richard Miller, MBChB FRCS · Reviewed
Skin Lump A 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 Skin Lump A station
With all potentially malignant skin conditions first expose the patient, then inspect the lesion itself before going on to comment on important additional points such as skin type, other lesions and scars. Examine the lesion systematically starting with simple palpation, before going on to test for fixity/fluctuance etc. Take care to examine the relevant lymphatic drainage site(s). Thank the patient, and offer the help them get dressed.
Introduction
Begin by washing your hands and introducing yourself to the patient
Explain that you would like to examine the lump, gain verbal consent and ensure he is not in any pain.
Expose the area appropriately
If the lump or bump is not obvious ask the patient to show you the ‘area of concern’
Inspection
Stand back so that the examiner knows that you are inspecting the area. Be systematic and follow the below scheme that can be applied to any lump or swelling:
• Site: most accurately measured with respect to a fixed landmark such as a bony prominence or an underlying muscle
• Size: give an approximate size in centimetres
• Shape
• Symmetry
• Scars
• Skin: is the skin tented, discoloured, breached?
• Transillumination: place a pen-torch (ask the examiner for one if it is not obviously laid out on the station) next to the lump and observe from the opposite side to see if the lump transilluminates
Palpation
Check again that the lump is not tender before gently palpating following the below scheme:
• Temperature: use the back of your hand to assess temperature
• Tenderness
• Surface: is the lump smooth or irregular
• Edge: is the lump well or poorly defined
• Consistency: is the lump soft, firm or hard. Is it fluctuant suggesting it is fluid filled? To assess fluctuant and look for fluid place two fingers either side of the lump and tap/press the centre feeling for fluid movement.
• Pulsatility: place a finger either side of the lump. If the lump is expansile your fingers will be pushed apart. If the lump is transmitting a pulsation your fingers will both be pushed upward.
• Compressibility: press firmly on the lump and release. A compressible lump disappears on compression and then spontaneously reappears. A reducible lump remains reduced following compression until a further force is applied to it.
• Fixity: move the skin away from the lump and then over the lump to see if the lump is fixed to the skin. Hold the lump more firmly between two fingers and move it to feel whether it is attached to deeper structures. Ask the patient to contract the relevant muscle and feel whether the lump moves with it.
Percussion / Auscultation
Tap across the lump and surrounding area to assess whether the lump is dull or resonant.
Place a stethoscope over the lump to listen for bruits as might be present in an AVM.
Lymph Nodes
At this point assess the lymph nodes to where the structure is likely to drain.
Closing
Thank the patient and inform them they can now get dressed. Present your findings.
Top Tips
Lumps and bumps come up frequently in OSCE examination. It is seen as a relatively straightforward station, but don’t be lured into a false sense of security. Show the examiner you have a clear structure and work through this methodically.
Demonstrate knowledge by commenting on the patients skin type, examining for lymphadenopathy and looking for other lesions particularly in sun-exposed sites.
Further Reading:
Telfer NR, Colver GB, Morton C a. Guidelines for the management of basal cell carcinoma. Br J Dermatol. 2008;159(1):35–48.
What are you asked at the Skin Lump A station?
The station runs to 13 questions over nine minutes. A prompt the station repeats — against each marker on a specimen, for instance — is listed once here; 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. Please examine this lump Examination: Skin Lump A
- Explain how you would introduce yourself
- Explain how you would expose this gentleman and how you would begin your examination
- Describe the lump
- What would you do after inspection?
- What do you understand about Mohs micrographically controlled excision?
- What is the most likely diagnosis?
- Are you aware of any pre-malignant skin conditions?
- What are the risk factors for developing a BCC?
- What are the management options?
- What are the layers of the skin?
- With reference to Malignant melanoma, what staging systems are you aware of
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 Skin Lump A station ask?
It opens with "The patient is comfortable, you have washed your hands, introduced yourself and explained what you are going to do. Please examine this lump Examination: Skin Lump 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