The lumps and bumps station gives you an unknown lump and marks whether you have a system. Use one order every time: site, size, shape, surface, edge, colour, temperature, tenderness, consistency, then the special tests of fluctuance, transillumination, pulsatility, compressibility and fixity, then the regional nodes.

Key takeaways

  • Measure the site against a fixed bony landmark, not against a soft tissue one.
  • **Fluctuance** is the movement of fluid within a lump when you press its centre with two fingers placed either side of it.
  • An expansile pulsation pushes your fingers apart; a transmitted pulsation pushes them both upwards.
  • A compressible lump disappears on pressure and refills; a reducible lump stays reduced until a force returns it.
  • Always examine the regional lymph nodes and say that you would examine the rest of the skin.

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 lumps and bumps station?

Gel your hands where the examiners can see, introduce yourself, gain consent and ask about pain. Expose the area fully and look at the surrounding skin before you touch anything.

Ask the patient three questions while you inspect: how long has it been there, has it changed, and is it painful.

What do I record on inspection?

  • Site, described against a bony prominence or an underlying muscle.
  • Size in two or three dimensions, measured rather than estimated where a ruler is provided.
  • Shape and symmetry, and whether it is single or multiple.
  • Surface: smooth, irregular, lobulated or ulcerated.
  • Edge: well defined or ill defined.
  • Colour of the overlying skin, any punctum, discharge, scar or dilated vessels.

What do I feel for on palpation?

Warm your hands and start at the edge, working towards the centre, watching the patient's face.

  • Temperature, using the back of your hand and comparing with adjacent skin.
  • Tenderness.
  • Consistency: soft, firm, hard, rubbery or bony.
  • Whether the lump is tethered to the skin, mobile within the subcutaneous tissue, or fixed to deeper structures.

How do I test for fluctuance?

Place a finger of one hand either side of the lump and press the centre of the lump with a finger of the other hand. If fluid moves, your outer fingers are displaced outwards.

Test in two planes at right angles, because a soft solid lump can appear fluctuant in one plane only. Fluctuance in both planes suggests a fluid-filled swelling such as a cyst, an abscess or a hydrocele.

What is transillumination and what does it mean?

Hold a pen torch against one side of the lump, shield the area from the room light, and look from the other side. Ask the examiner for a torch if one is not laid out.

A lump that glows contains clear fluid, which points to a cyst, a hydrocele or a cystic hygroma. A solid or blood-filled lump does not transilluminate.

How do I test pulsatility, compressibility and fixity?

  • Pulsatility: place a finger either side of the lump. If they are pushed apart the lump is expansile, which suggests an aneurysm. If both are pushed upwards the pulsation is transmitted from a vessel beneath.
  • Compressibility: press firmly and release. A compressible lump, such as a vascular malformation or a lymphangioma, disappears on pressure and refills spontaneously.
  • Reducibility: a reducible lump, such as a hernia, stays reduced until a force such as a cough returns it.
  • Fixity to skin: move the skin over the lump and then the lump under the skin.
  • Fixity to deep structures: hold the lump between two fingers and ask the patient to contract the relevant muscle. A lump within or beneath the muscle becomes less mobile when the muscle tenses.

How do I complete the examination?

  • Auscultate the lump if it is pulsatile or compressible, listening for a bruit.
  • Examine the regional lymph nodes that drain the area.
  • Test sensation and distal neurovascular function if the lump lies near a nerve or vessel.
  • Say that you would examine the rest of the skin for similar lesions and take a full history.
  • Cover the patient, thank them and present your findings.

How do I present an unknown lump?

Describe before you diagnose. Give the site, size and the three or four features that define the lump, then offer a most likely diagnosis and one or two differentials, then say what you would do next.

A candidate who describes a lump precisely and offers a sensible differential scores better than one who names a diagnosis immediately and cannot justify it.

What are the most common mistakes at this station?

  • Naming a lipoma or sebaceous cyst in the first ten seconds and then examining to fit the guess.
  • Testing fluctuance in one plane only.
  • Forgetting the regional lymph nodes, which is often where the mark is.
  • Describing the site vaguely instead of against a bony landmark.
  • Missing the punctum of an epidermoid cyst because the skin was never inspected closely.

MRCS Part B Questions has a lumps and bumps station with a marked checklist at /Sample-Questions. Reviewed and updated 15 September 2026.