How to Prepare for MRCS Part B After Passing Part A

FREEMEDSITE MRCS ACADEMY · ARTICLE 24 · PART B OSCE

How to Prepare for MRCS Part B After Passing Part A: Complete Beginner OSCE Guide

A practical guide to 17 assessed OSCE stations, safe examination and procedural skills, structured communication, anatomy and critical care. Includes 17 original practice station briefs, a six-week plan, 52 saved study objectives and 40 original five-option revision SBAs.

17Original OSCE stations

52Saved objectives

40Supplementary SBAs

Start here: Part B is not an MCQ examination. Practise speaking and performing stations with another person. This page contains original teaching scenarios, not actual confidential examination stations.

Exam-format references checked October 2026. Always consult the College and your specific admission letter for current station arrangements.

On this page

Official station format 12 practical teaching modules Six-week OSCE plan 17 original practice OSCE stations 52-topic saved checklist 40 supplementary SBAs Frequently asked questions Official references and published lessons

Official MRCS Part B format

Applied Knowledge

Anatomy, pathology, applied surgical science and critical care. Stations may use images, models, clinical charts and specimens.

Applied Skills

Communication, clinical history, physical examination and procedural skills using models or simulated patients.

Count the circuit correctly: RCS England currently describes 19 nine-minute circuit stations: 17 examined and 2 preparation, plus rest stations. Intercollegiate guidance describes 17 examined stations; prep/pilot arrangements may differ by diet. This is an in-person OSCE; check official candidate instructions rather than treating all 19 as scored.

Pass standards apply separately to Knowledge and Skills. Candidates must pass both broad components in the same sitting. Part A should have been passed within the preceding seven years according to the regulations in force in 2026. Part B is not passed by achieving a website percentage.

Original learning schematic: how Part B content is organised.

12 teaching modules: from Part A to Part B

MODULE 01

Understand the MRCS Part B OSCE

MRCS Part B is a live, in-person objective structured clinical examination, not another written SBA paper. Contemporary Royal College of Surgeons of England guidance describes 17 assessed nine-minute stations, with two additional preparation stations and rest stations; consult the admission letter for your sitting's circuit arrangements. Stations test safe core surgical competence: applied anatomy and pathology, critical care, history, examination, procedures and communication.

The RCS England page describes a 19-station circuit as 17 assessed stations plus two preparation stations. The Intercollegiate regulations describe 17 examined stations, with additional preparation and possible pilot stations. These statements count different components of the circuit rather than contradicting the 17 assessed-station principle.

Exam pearl: The number to prepare around is 17 assessed stations; always check current candidate instructions.

MODULE 02

Know the pass rules and entry requirements

A pass in Part A is required before applying for Part B. The 2024 MRCS regulations set a seven-year period from passing Part A to complete Part B, subject to current rules. Candidates must reach the standard in both Knowledge and Skills in the same sitting; a high performance in one does not compensate for a failure in the other. Stations receive structured marks and examiner judgements; a website practice score is not the college pass mark.

Check personal eligibility, photo ID, examination dates, entry fees and reasonable-adjustment requirements on the chosen Royal College's current page, not a cached price in an old article.

Exam pearl: Pass both Knowledge and Skills; do not interpret a good mock overall score as a guaranteed pass.

MODULE 03

Build a Part B station map

Organise revision into applied knowledge and applied skills rather than reading one textbook cover to cover. Prepare image/prop-based anatomy and pathology, physiological interpretation and emergencies, examination sequences, common technical tasks, clinical histories, consent and difficult conversations.

Create a station sheet for each theme with five lines: opening, key discriminators, patient-safety actions, clear summary and response to an examiner challenge. Rotate stations so that previously practised areas return at increasing intervals.

Exam pearl: Practise speaking, demonstrating and prioritising; silent reading is insufficient.

MODULE 04

Make anatomy and pathology clinical

For each region, locate the anatomy, identify neurovascular relationships, connect the finding to a clinical deficit and explain what structure is vulnerable during surgery. With a pathology specimen or image, describe what you see before naming the likely diagnosis, then connect it to staging, treatment or a complication.

Good candidates can identify the nerve after a dislocation, explain the lost action, demonstrate the bedside test and discuss a safe examination or operative principle—not merely recite a list of structures.

Exam pearl: Describe image findings first, then interpret; anatomy without clinical consequences is incomplete.

MODULE 05

Use an ABCDE structure for critical care

The examiner may offer observations, charts, blood gases or an unstable postoperative vignette. Introduce an immediate structured assessment: call for help, address catastrophic haemorrhage when relevant, assess airway, breathing, circulation, disability and exposure, and reassess after interventions. Name investigations only after explaining actions that stabilise a threatened patient.

Examples include hypoxia, shock, chest pain, sepsis, bleeding, fluid imbalance and drug effects. Escalate early and use local protocols for medication doses and advanced procedures.

Exam pearl: An unsafe delay while waiting for imaging is a common OSCE error.

MODULE 06

Perform a focused examination safely

A clear performance begins with washing hands, introduction, confirming identity, explaining, obtaining consent and checking pain. Expose only as necessary, offer a chaperone where appropriate, inspect then palpate then move and test, and assess neurovascular function when relevant. Finish with a focused summary, differential, further examination and investigations.

Time is limited: adapt the sequence to the station's exact request. State what you would not perform because of pain, instability or another contraindication. Do not repeatedly manipulate a suspected unstable injury.

Exam pearl: A memorised ritual loses value if it ignores the patient’s comfort and station prompt.

Original station framework. Adapt to patient and examiner instructions.

MODULE 07

Rehearse suturing and procedural skills

Explain the indication, consent, allergies, asepsis, local anaesthetic safety, correct instruments, tissue handling and sharps disposal. For simple interrupted sutures, place appropriate symmetric bites, achieve edge eversion without strangulation, secure knots and describe dressing and follow-up. If a model or station requests a different procedure, adapt accordingly.

Use simulation equipment under appropriate supervision. Never practise invasive procedures on an unsupervised patient for exam preparation.

Exam pearl: Examiners assess safe preparation and handling, not just the final knot.

MODULE 08

Take a surgical history with prioritised questions

Start openly; clarify the presenting problem and timeline, then ask targeted discriminators, red flags, relevant comorbidities, medications and anticoagulants, allergies, previous procedures, social context and concerns. Summarise in clinical terms, offer an appropriate differential and propose initial assessment and tests.

For chest pain, a painful swollen leg, urinary obstruction or acute abdominal pain, the sequence changes according to danger signs. High-quality history taking requires listening as well as asking.

Exam pearl: Always recognise and escalate clinical instability during a history station.

MODULE 09

Communicate with empathy and clarity

Use plain language and avoid jargon. Establish what the patient knows and wants to know, acknowledge emotion, explain the decision in manageable chunks and check understanding. For consent, cover the intended procedure, benefits, material risks, reasonable alternatives and the option of no treatment; do not assume a signed form proves valid consent.

In difficult conversations, allow silence and questions. Maintain confidentiality, recognise impaired capacity and seek senior/legal support where needed. Exact consent/capacity law varies across UK jurisdictions.

Exam pearl: Explain uncertainty without evasion and check what matters to the individual patient.

MODULE 10

Train with a realistic six-week schedule

Weeks 1–2: anatomy, pathology and critical care foundations. Weeks 3–4: examination sequences, suturing, surgical history and communication with a partner. Week 5: mixed timed stations, targeted feedback and repairs. Week 6: complete mock circuits, weak-station repair, exam logistics and sleep protection.

For busy trainees, target 60–90 minutes on routine workdays and a longer supervised weekend practice session. This schedule is an educational suggestion, not an official requirement.

Exam pearl: Several short observed practices usually outperform one passive reading marathon.

MODULE 11

Score yourself and use actionable feedback

After each rehearsal, rate opening/safety, clinical reasoning, communication, practical execution and time. Record one strength and two specific changes for the next attempt. A practice partner should mark observed behaviours, not just whether you guessed the diagnosis.

Repeat an altered station a few days later to test understanding rather than memorisation. Always make a separate note of any major patient-safety lapse, even if the overall performance seemed fluent.

Exam pearl: A mock only helps when its feedback changes the next rehearsal.

MODULE 12

Your final seven days and exam morning

Day 7: mixed knowledge circuit. Day 6: procedural models and sterile technique. Day 5: examination and neurovascular assessment. Day 4: critical care with charts/ABGs. Day 3: difficult conversations and consent. Day 2: a short mixed rehearsal and equipment/ID checks. Day 1: light recall and rest.

On examination day, read the station instructions before entering, keep the opening crisp, listen to the examiner, prioritise safety and reset attention between stations. Follow the admission instructions for arrival, ID, clothing and personal items.

Exam pearl: Do not let one difficult station impair the rest of the circuit.

Six-week OSCE preparation plan

Suggested six-week revision sequence, not an official college study prescription.

Weeks 1–2: Build knowledge

Rehearse anatomy and pathology with diagrams, specimens and models; use short critical-care chart interpretation daily.

Weeks 3–4: Practise skills

Run focussed examination, suturing, history and consent stations with an observed colleague; use real nine-minute rehearsals.

Week 5: Mix and repair

Practise random station order. Use a red/amber/green log for safety, clarity, examination technique and time.

Week 6: Mock and consolidate

Simulate a longer circuit, address weak stations, and protect rest and travel planning. Avoid cramming unfamiliar procedures.

17 original timed OSCE practice stations

Each case is an original educational exercise. Read the brief, perform or speak aloud for up to nine minutes, then open the checklist and mark what you actually demonstrated. Ask a colleague to observe. These are not official station scripts or proprietary exam material.

Station 01 · Shoulder dislocation and axillary nerve (Applied anatomy)

Applied anatomy

Candidate brief: A patient has reduced a shoulder dislocation. On a model, identify relevant nerve anatomy and demonstrate the neurovascular examination.

Practice checklist

• Outline course of axillary nerve around surgical neck
• Demonstrate deltoid motor assessment with pain limitation
• Locate regimental-badge sensory area
• Check distal perfusion and other peripheral nerves
• Explain documentation before and after reduction
• Describe escalation for persistent deficit

Examiner follow-up: What movement might be limited by a rotator cuff tear? Abduction can be reduced; pain and weakness patterns differ from isolated axillary sensory loss.

Self-rate: safe opening · clear reasoning · patient-centred performance · timely summary. Seek supervisor feedback for clinical or procedural details.

Station 02 · Groin and femoral triangle (Applied anatomy)

Applied anatomy

Candidate brief: Show femoral triangle boundaries and distinguish a femoral from an inguinal hernia on a model.

Practice checklist

• Identify inguinal ligament, sartorius and adductor longus
• Locate nerve artery vein from lateral to medial
• Recognise femoral canal medial to femoral vein
• Describe inferior epigastric relationship to inguinal hernias
• Identify signs of strangulation
• State urgent referral for tender irreducible groin swelling

Examiner follow-up: What lies lateral to a femoral hernia neck? The femoral vein.

Self-rate: safe opening · clear reasoning · patient-centred performance · timely summary. Seek supervisor feedback for clinical or procedural details.

Station 03 · Neck surgery and laryngeal nerves (Applied anatomy)

Applied anatomy

Candidate brief: A singer loses high-pitched notes after thyroidectomy. Localise the neural deficit and nearby vessel.

Practice checklist

• Identify external branch of superior laryngeal nerve
• Name cricothyroid as motor target
• Relate nerve to superior thyroid pedicle
• Distinguish RLN injury causing vocal cord dysfunction
• Explain bilateral RLN injury airway risk
• Describe escalation for postoperative stridor

Examiner follow-up: What is the main mechanism of pitch reduction? Impaired cord tension from cricothyroid weakness.

Self-rate: safe opening · clear reasoning · patient-centred performance · timely summary. Seek supervisor feedback for clinical or procedural details.

Station 04 · Colon cancer specimen (Applied pathology)

Applied pathology

Candidate brief: Describe a photographed colorectal specimen with an ulcerated annular lesion and discuss confirmation and staging.

Practice checklist

• Describe macroscopic appearance without guessing
• Explain histology confirms type/grade
• Discuss regional nodes and margins
• Mention CT staging in appropriate pathway
• Distinguish obstruction/perforation requiring urgent action
• Outline MDT-based planning

Examiner follow-up: What does staging describe? Extent of disease; grade reflects differentiation.

Self-rate: safe opening · clear reasoning · patient-centred performance · timely summary. Seek supervisor feedback for clinical or procedural details.

Station 05 · Breast mass triple assessment (Applied pathology)

Applied pathology

Candidate brief: Interpret a simulated patient with a suspicious breast lump, clinical images and biopsy report.

Practice checklist

• Take focused cancer red flags
• Use examination, imaging, tissue sampling framework
• Explain histopathology is definitive
• Consider age-appropriate imaging approach
• Identify nodes and skin changes
• Summarise MDT referral and clear communication

Examiner follow-up: Can a normal ultrasound alone exclude breast malignancy? No; interpret all three assessment components.

Self-rate: safe opening · clear reasoning · patient-centred performance · timely summary. Seek supervisor feedback for clinical or procedural details.

Station 06 · Hypoxic postoperative patient (Critical care)

Critical care

Candidate brief: An adult becomes hypoxic and tachycardic shortly after abdominal surgery. Give your immediate approach.

Practice checklist

• Call for senior and critical-care assistance
• Apply ABCDE and oxygen as indicated
• Assess chest and haemodynamic signs
• Consider atelectasis, aspiration, PE, pneumothorax and bleeding
• Request investigations after initial stabilisation
• Reassess and give structured handover

Examiner follow-up: What is the first priority? Recognise and treat immediately threatened airway/breathing.

Self-rate: safe opening · clear reasoning · patient-centred performance · timely summary. Seek supervisor feedback for clinical or procedural details.

Station 07 · Haemorrhagic shock (Critical care)

Critical care

Candidate brief: A trauma patient is hypotensive with pelvic pain. Talk through immediate management.

Practice checklist

• Call trauma team and control external bleeding
• Use cABCDE and pelvic binder over greater trochanters if indicated
• Gain resuscitation access and activate haemorrhage protocol
• Avoid delays for unstable imaging
• Arrange urgent definitive haemorrhage control
• Reassess physiology and communicate

Examiner follow-up: What is the binder goal? Reduce pelvic motion and support tamponade as part of haemorrhage control.

Self-rate: safe opening · clear reasoning · patient-centred performance · timely summary. Seek supervisor feedback for clinical or procedural details.

Station 08 · Sepsis after surgery (Critical care)

Critical care

Candidate brief: An adult is febrile, confused and hypotensive on postoperative day three. Prioritise actions.

Practice checklist

• Acknowledge potential sepsis/shock and call for help
• Assess ABCDE and oxygenation
• Obtain cultures promptly if no harmful delay
• Use local sepsis pathway for antimicrobials and fluids
• Seek surgical source control
• Trend lactate, urine output and reassess

Examiner follow-up: Can normal temperature exclude sepsis? No; context and organ dysfunction determine risk.

Self-rate: safe opening · clear reasoning · patient-centred performance · timely summary. Seek supervisor feedback for clinical or procedural details.

Station 09 · Acute abdomen examination (Clinical examination)

Clinical examination

Candidate brief: Demonstrate a concise examination on a patient with abdominal pain.

Practice checklist

• Consent and appropriate positioning
• Review vital signs and appearance
• Inspect and gently palpate away from pain
• Seek guarding/rebound only when safe and appropriate
• Check hernial orifices and additional exams as indicated
• Summarise differential and need for escalation

Examiner follow-up: What matters more than eliciting every sign in peritonitis? Early recognition and safe escalation.

Self-rate: safe opening · clear reasoning · patient-centred performance · timely summary. Seek supervisor feedback for clinical or procedural details.

Station 10 · Knee assessment (Clinical examination)

Clinical examination

Candidate brief: Examine an acutely painful knee and explain whether you would stress test it.

Practice checklist

• Introduce, gain consent and check pain
• Inspect effusion, warmth and deformity
• Assess active and passive ROM gently
• Document neurovascular status
• Avoid forceful tests if fracture/sepsis suspected
• Recommend aspiration/referral where septic arthritis possible

Examiner follow-up: What is the emergency? A hot swollen joint with systemic features may be septic arthritis.

Self-rate: safe opening · clear reasoning · patient-centred performance · timely summary. Seek supervisor feedback for clinical or procedural details.

Station 11 · Lower limb vascular examination (Clinical examination)

Clinical examination

Candidate brief: Examine an adult with leg pain and a cold foot.

Practice checklist

• Check skin colour/temp, wounds and capillary refill
• Palpate bilateral pulses and Doppler if available
• Assess sensorimotor loss and pain
• Recognise features of threatened limb
• Consider ABPI only in stable chronic PAD context
• Escalate urgent vascular assessment

Examiner follow-up: Does a palpable pulse exclude compartment syndrome? No.

Self-rate: safe opening · clear reasoning · patient-centred performance · timely summary. Seek supervisor feedback for clinical or procedural details.

Station 12 · Simple interrupted suture (Procedural skills)

Procedural skills

Candidate brief: Demonstrate closure on a skin model while explaining the safety steps.

Practice checklist

• Confirm indication and consent
• Check allergies and prepare sterile field
• Handle needle in instrument correctly
• Place symmetrical bites with edge eversion
• Avoid excessive tension and discard sharps safely
• Explain dressing, infection advice and follow-up

Examiner follow-up: When not to close primarily? Consider heavily contaminated or infected wounds depending on assessment.

Self-rate: safe opening · clear reasoning · patient-centred performance · timely summary. Seek supervisor feedback for clinical or procedural details.

Station 13 · Aseptic preparation and sharps safety (Procedural skills)

Procedural skills

Candidate brief: Prepare for minor surgery using the provided equipment.

Practice checklist

• Confirm patient/procedure/site
• Perform appropriate hand hygiene
• Use appropriate PPE and field setup
• Identify contaminated item and replace it
• Maintain sharps visibility and disposal
• Describe how to stop if sterile field compromised

Examiner follow-up: What happens after glove contamination? Stop and replace glove before continuing.

Self-rate: safe opening · clear reasoning · patient-centred performance · timely summary. Seek supervisor feedback for clinical or procedural details.

Station 14 · Consent for laparoscopic surgery (Communication)

Communication

Candidate brief: Explain laparoscopic cholecystectomy to a simulated patient anxious about risks.

Practice checklist

• Elicit understanding and concerns
• Explain reason/expected benefits in plain language
• Discuss material risks including bile duct injury
• Describe alternatives including no operation as applicable
• Check capacity and voluntary choice
• Invite questions and confirm informed decision

Examiner follow-up: Does signing the form alone confer valid consent? No.

Self-rate: safe opening · clear reasoning · patient-centred performance · timely summary. Seek supervisor feedback for clinical or procedural details.

Station 15 · Breaking bad news compassionately (Communication)

Communication

Candidate brief: A biopsy has confirmed malignancy. The patient is distressed.

Practice checklist

• Set private environment and ascertain support needs
• Ask what they know and how much they want
• Deliver information clearly and in chunks
• Respond to emotion and allow silence
• Avoid premature certainty about stage/prognosis
• Offer next steps and written/support resources

Examiner follow-up: Why avoid detailed prognosis before staging? Uncertainty should be acknowledged and verified.

Self-rate: safe opening · clear reasoning · patient-centred performance · timely summary. Seek supervisor feedback for clinical or procedural details.

Station 16 · Duty of candour following complication (Communication)

Communication

Candidate brief: A patient has an unexpected postoperative complication potentially related to care.

Practice checklist

• Ensure urgent clinical care
• Explain known facts openly and without blaming
• Apologise and acknowledge impact
• Distinguish verified events from uncertain causes
• Arrange reporting, documentation and support
• Explain investigation and follow-up

Examiner follow-up: Does apologising automatically admit legal liability? Not necessarily; follow applicable local guidance.

Self-rate: safe opening · clear reasoning · patient-centred performance · timely summary. Seek supervisor feedback for clinical or procedural details.

Station 17 · Chest pain after surgery (History and communication)

History and communication

Candidate brief: Take a focused history from a simulated postoperative patient with chest pain.

Practice checklist

• Recognise distress and escalate if unstable
• Clarify onset, character, associated dyspnoea/syncope
• Check risk factors for PE, ACS, infection
• Ask meds and anticoagulants
• Summarise differential and next actions
• Communicate immediate safety priorities

Examiner follow-up: What is the trap? Prolonged questioning while ignoring hypoxia or hypotension.

Self-rate: safe opening · clear reasoning · patient-centred performance · timely summary. Seek supervisor feedback for clinical or procedural details.

52-topic revision checklist — saved in your browser

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Orientation

Distinguish Part A from Part B format Confirm 17 assessed stations and 9-minute timing Check preparation and rest station instructions Recognise Knowledge and Skills pass requirements Confirm eligibility and seven-year window Distinguish official pass standards from website practice scores

Anatomy and pathology

Upper-limb nerve localisation Lower-limb neurovascular anatomy Head/neck operative landmarks Thoracic pleural and mediastinal relations Abdominal groin anatomy Pelvic relationships and ureter risk Recognise and describe pathology images

Critical care

Structured ABCDE and escalation Respiratory deterioration and postoperative hypoxia Recognition of shock/major haemorrhage Sepsis and source control priorities Acid–base and chart interpretation Electrolyte emergencies and ECG danger Head injury and major trauma red flags

History and examination

Safe patient introduction and consent Present a focused abdominal history Present a focused vascular history Perform a knee examination safely Perform shoulder neurovascular assessment Assess acute abdomen without harm Summarise findings and safe next steps

Procedures

Hand hygiene and aseptic field Choice of suture and needle handling Simple interrupted sutures and eversion Safe sharps disposal Identify local-anaesthetic risk Explain procedure aftercare and red flags

Communication

Shared decision-making and material risks Capacity and treatment refusal Explain uncertainty and alternatives Respond to distress and bad news Duty of candour and open disclosure Use teach-back and check understanding Confidentiality and appropriate chaperone

Mock preparation

Arrange a study partner and simulation kit Record clear station-by-station feedback Practise 9-minute station pacing Repeat incorrect or unsafe stations Perform a full mixed mock circuit Test the final seven-day plan

Exam day

Confirm admission and exact ID requirements Check venue and travel logistics Read station instructions before entry Maintain professionalism between stations Reset attention after a difficult station Know the next revision goal after feedback

40-question supplementary knowledge quiz (original A–E SBAs)

Important: The real MRCS Part B examination is an OSCE—not a multiple-choice paper. These 40 original SBAs reinforce knowledge for discussions and practical stations. They do not simulate Part B marking or a full 17-station circuit.

0 / 40Marked

0Correct

N/AAccuracy

Question 1 of 40

Question 01 of 40 · Anatomy: shoulder

Q01. Following shoulder dislocation, a patient has deltoid weakness and loss of sensation over the lateral shoulder. What nerve must be examined and documented?

A. Radial nerve B. Axillary nerve C. Musculocutaneous nerve D. Long thoracic nerve E. Ulnar nerve

View detailed explanation, examiner trap and viva

Correct answer: B. Axillary nerve

Why correct: The axillary nerve supplies deltoid and the superior lateral cutaneous territory; it is vulnerable at the surgical neck.

Why the other options are incorrect:

• A. Radial nerve: Radial deficits favour wrist or finger extension weakness.
• C. Musculocutaneous nerve: This predominantly weakens elbow flexion and lateral forearm sensation.
• D. Long thoracic nerve: This causes scapular winging from serratus anterior weakness.
• E. Ulnar nerve: This affects intrinsic hand function and ulnar digit sensation.

Exam pearl: Check and document axillary function before and after reduction.

Examiner trap: Do not select a plausible alternative that contradicts the key clinical or safety finding in the stem.

Viva extension: How is deltoid motor function assessed? Ask for resisted abduction when safe, accounting for pain.

Question 02 of 40 · Anatomy: wrist

Q02. A fall on the outstretched hand causes anatomical snuffbox tenderness despite initially normal radiographs. What should be suspected?

A. Distal ulna fracture B. Lunate dislocation C. Occult scaphoid fracture D. De Quervain tenosynovitis E. Carpal tunnel syndrome

View detailed explanation, examiner trap and viva

Correct answer: C. Occult scaphoid fracture

Why correct: Scaphoid fractures may be radiographically occult initially; immobilise and arrange appropriate follow-up imaging according to the local pathway.

Why the other options are incorrect:

• A. Distal ulna fracture: Pain would usually localise towards the ulnar wrist.
• B. Lunate dislocation: Usually has different carpal alignment findings and may affect the median nerve.
• D. De Quervain tenosynovitis: Tendon pain does not best fit an acute fall with snuffbox tenderness.
• E. Carpal tunnel syndrome: Median nerve symptoms do not explain focal snuffbox bony tenderness.

Exam pearl: A normal initial wrist X-ray does not exclude scaphoid fracture.

Examiner trap: Do not select a plausible alternative that contradicts the key clinical or safety finding in the stem.

Viva extension: Why is proximal scaphoid important? Retrograde blood supply creates risk of osteonecrosis.

Question 03 of 40 · Anatomy: thyroid

Q03. After thyroidectomy, a singer cannot reach high-pitched notes but normal conversation is mostly retained. Which nerve is most likely involved?

A. External branch of the superior laryngeal nerve B. Recurrent laryngeal nerve C. Hypoglossal nerve D. Internal superior laryngeal nerve E. Glossopharyngeal nerve

View detailed explanation, examiner trap and viva

Correct answer: A. External branch of the superior laryngeal nerve

Why correct: It supplies cricothyroid, which tenses the vocal folds for higher pitch.

Why the other options are incorrect:

• B. Recurrent laryngeal nerve: This primarily affects intrinsic laryngeal muscles and vocal-fold motion.
• C. Hypoglossal nerve: This innervates most tongue muscles rather than cricothyroid.
• D. Internal superior laryngeal nerve: This mainly carries supraglottic sensation.
• E. Glossopharyngeal nerve: This has pharyngeal sensory and stylopharyngeus motor roles.

Exam pearl: High pitch after thyroid surgery points to external superior laryngeal nerve.

Examiner trap: Do not select a plausible alternative that contradicts the key clinical or safety finding in the stem.

Viva extension: What vessel is nearby? The superior thyroid artery pedicle.

Question 04 of 40 · Anatomy: thorax

Q04. An examiner asks what nerve carries sensation from costal parietal pleura during chest drain insertion. Which is best?

A. Axillary nerve B. Phrenic nerve C. Vagus nerve D. Long thoracic nerve E. Intercostal nerve

View detailed explanation, examiner trap and viva

Correct answer: E. Intercostal nerve

Why correct: Costal parietal pleura and chest wall receive segmental somatic supply from intercostal nerves.

Why the other options are incorrect:

• A. Axillary nerve: This innervates deltoid/teres minor and a shoulder cutaneous region.
• B. Phrenic nerve: This supplies central diaphragmatic and mediastinal pleura.
• C. Vagus nerve: This supplies visceral autonomic fibres and is not the segmental costal pleural sensory supply.
• D. Long thoracic nerve: This is motor to serratus anterior.

Exam pearl: Pleural sensory supply depends on the parietal pleural region.

Examiner trap: Do not select a plausible alternative that contradicts the key clinical or safety finding in the stem.

Viva extension: What supplies central diaphragmatic pleura? The phrenic nerve.

Question 05 of 40 · Anatomy: leg

Q05. After a fibular-neck injury, a patient cannot dorsiflex or evert the foot. Which nerve lesion fits best?

A. Superficial fibular nerve B. Deep fibular nerve C. Common fibular nerve D. Tibial nerve E. Saphenous nerve

View detailed explanation, examiner trap and viva

Correct answer: C. Common fibular nerve

Why correct: The common fibular nerve divides into deep and superficial branches; combined deficits explain dorsiflexion and eversion weakness.

Why the other options are incorrect:

• A. Superficial fibular nerve: Isolated superficial injury affects eversion but generally spares dorsiflexion.
• B. Deep fibular nerve: Isolated deep injury weakens dorsiflexion but generally spares eversion.
• D. Tibial nerve: Tibial lesions impair plantarflexion/inversion rather than producing the whole pattern.
• E. Saphenous nerve: This is sensory only to the medial leg/foot.

Exam pearl: Fibular-neck trauma warrants foot motor and sensory mapping.

Examiner trap: Do not select a plausible alternative that contradicts the key clinical or safety finding in the stem.

Viva extension: Where is deep fibular sensation? First dorsal web space.

Question 06 of 40 · Critical care

Q06. A postoperative patient is suddenly hypoxic and unable to speak in full sentences. What is the best immediate approach?

A. Reassure without examination B. Wait for a CT pulmonary angiogram C. Review the routine discharge summary D. Request outpatient spirometry E. Call for help and perform ABCDE assessment

View detailed explanation, examiner trap and viva

Correct answer: E. Call for help and perform ABCDE assessment

Why correct: Recognise life-threatening deterioration and initiate airway/breathing assessment with parallel escalation.

Why the other options are incorrect:

• A. Reassure without examination: This ignores critical physiological instability.
• B. Wait for a CT pulmonary angiogram: Imaging must not delay treatment of immediate airway or breathing danger.
• C. Review the routine discharge summary: Administrative information does not stabilise an acutely unwell patient.
• D. Request outpatient spirometry: This has no role as the first step in acute severe hypoxia.

Exam pearl: Escalate and reassess: ABCDE is an action framework.

Examiner trap: Do not select a plausible alternative that contradicts the key clinical or safety finding in the stem.

Viva extension: What follows intervention? Repeat observations and reassess response.

Question 07 of 40 · Critical care

Q07. A blunt trauma patient becomes hypotensive with an unstable pelvis. What initial device is appropriate alongside resuscitation?

A. Compression above the iliac crests B. Pelvic binder over the greater trochanters C. Immediate traction of both legs without assessment D. Circumferential abdominal binder only E. No support until CT confirms injury

View detailed explanation, examiner trap and viva

Correct answer: B. Pelvic binder over the greater trochanters

Why correct: An appropriately applied binder can reduce pelvic motion and support bleeding control while definitive management is arranged.

Why the other options are incorrect:

• A. Compression above the iliac crests: High placement is less effective for pelvic ring stabilisation.
• C. Immediate traction of both legs without assessment: Traction is not a routine substitute for pelvic stabilisation and resuscitation.
• D. Circumferential abdominal binder only: Abdominal compression does not target unstable pelvic ring mechanics.
• E. No support until CT confirms injury: Unsafe in an unstable patient with suspected pelvic haemorrhage.

Exam pearl: Pelvic binders belong over greater trochanters, not the waist.

Examiner trap: Do not select a plausible alternative that contradicts the key clinical or safety finding in the stem.

Viva extension: What else is critical? Activate the major haemorrhage pathway.

Question 08 of 40 · Critical care

Q08. A patient becomes febrile, confused and hypotensive following bowel surgery. What should accompany immediate resuscitation?

A. Routine outpatient follow-up B. Early source-control assessment and sepsis pathway C. Antipyretic alone D. Wait 48 hours for cultures E. Isolated wound dressing change

View detailed explanation, examiner trap and viva

Correct answer: B. Early source-control assessment and sepsis pathway

Why correct: Treat suspected sepsis with organ dysfunction and search for a reversible source such as leak or abscess while resuscitating.

Why the other options are incorrect:

• A. Routine outpatient follow-up: Unstable physiological signs demand immediate care.
• C. Antipyretic alone: Temperature reduction does not address organ dysfunction or source.
• D. Wait 48 hours for cultures: Cultures help but should not create harmful treatment delays.
• E. Isolated wound dressing change: The source may be intra-abdominal or systemic.

Exam pearl: Think sepsis plus source control in postoperative shock.

Examiner trap: Do not select a plausible alternative that contradicts the key clinical or safety finding in the stem.

Viva extension: Which measurements help? Lactate, urine output, serial physiology and cultures.

Question 09 of 40 · Critical care

Q09. An adult has acute pleuritic pain, severe hypoxia, hypotension and unilateral absent breath sounds after trauma. What is the priority when tension pneumothorax is suspected?

A. Oral analgesia and observation B. Chest CT before any intervention C. Immediate decompression by a trained clinician D. Pulmonary function testing E. Begin rehabilitation exercises

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Correct answer: C. Immediate decompression by a trained clinician

Why correct: Unstable tension physiology is a clinical emergency; decompression should not wait for imaging.

Why the other options are incorrect:

• A. Oral analgesia and observation: This does not treat obstructive shock.
• B. Chest CT before any intervention: Imaging can dangerously delay life-saving decompression.
• D. Pulmonary function testing: There is no diagnostic role in immediate trauma collapse.
• E. Begin rehabilitation exercises: Irrelevant and unsafe in unstable chest trauma.

Exam pearl: Treat tension pneumothorax based on clinical instability.

Examiner trap: Do not select a plausible alternative that contradicts the key clinical or safety finding in the stem.

Viva extension: What follows decompression? Definitive chest drain and reassessment per local guidance.

Question 10 of 40 · Critical care

Q10. A patient has potassium 6.9 mmol/L and a widening QRS complex on ECG. Which treatment most rapidly reduces immediate cardiac membrane risk?

A. Intravenous calcium according to emergency protocol B. Oral potassium binder alone C. Insulin and glucose alone D. Routine IV crystalloid only E. Loop diuretic alone

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Correct answer: A. Intravenous calcium according to emergency protocol

Why correct: IV calcium stabilises the myocardium in severe hyperkalaemia with dangerous ECG changes; it does not lower potassium concentration.

Why the other options are incorrect:

• B. Oral potassium binder alone: Too slow to address immediate arrhythmia risk.
• C. Insulin and glucose alone: This shifts potassium but does not directly stabilise cardiac membrane effects.
• D. Routine IV crystalloid only: Fluid alone does not protect against hyperkalaemic arrhythmia.
• E. Loop diuretic alone: Not the fastest immediate cardiac protection and depends on renal function.

Exam pearl: Calcium protects the heart; insulin/glucose shifts potassium.

Examiner trap: Do not select a plausible alternative that contradicts the key clinical or safety finding in the stem.

Viva extension: What definitive issue remains? Remove excess potassium and correct its cause.

Question 11 of 40 · Examination

Q11. During a suspected septic knee station, what is the most important immediate clinical principle?

A. Perform vigorous anterior drawer testing B. Avoid forceful movement and arrange urgent assessment C. Provide reassurance without vital signs D. Defer assessment until next month E. Apply a tight tourniquet

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Correct answer: B. Avoid forceful movement and arrange urgent assessment

Why correct: A hot painful joint may contain infection; avoid harming the patient and expedite appropriate aspiration/specialist assessment.

Why the other options are incorrect:

• A. Perform vigorous anterior drawer testing: Not the priority and may cause unnecessary pain.
• C. Provide reassurance without vital signs: Systemic illness must be assessed.
• D. Defer assessment until next month: Septic arthritis may rapidly damage a joint.
• E. Apply a tight tourniquet: This neither diagnoses nor treats septic arthritis.

Exam pearl: Hot swollen joint: septic arthritis is a time-critical differential.

Examiner trap: Do not select a plausible alternative that contradicts the key clinical or safety finding in the stem.

Viva extension: What confirms diagnosis? Appropriate synovial sampling/culture with clinical context.

Question 12 of 40 · Examination

Q12. A patient has severe leg pain out of proportion after tibial fracture, pain on passive toe movement and a palpable pedal pulse. What must you consider?

A. Stable chronic venous insufficiency B. Simple delayed-onset muscle soreness C. Acute compartment syndrome D. Isolated superficial cellulitis E. Asymptomatic peripheral arterial disease

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Correct answer: C. Acute compartment syndrome

Why correct: Pulse presence does not rule out intracompartmental pressure sufficient to cause muscle and nerve ischaemia.

Why the other options are incorrect:

• A. Stable chronic venous insufficiency: This is not an acute limb-threatening trauma pattern.
• B. Simple delayed-onset muscle soreness: Does not fit marked pain out of proportion after a fracture.
• D. Isolated superficial cellulitis: The mechanism and passive-stretch pain raise concern for compartment syndrome.
• E. Asymptomatic peripheral arterial disease: No compatible chronic claudication pattern is supplied.

Exam pearl: Palpable pulses do not exclude compartment syndrome.

Examiner trap: Do not select a plausible alternative that contradicts the key clinical or safety finding in the stem.

Viva extension: What is definitive treatment? Emergency fasciotomy when clinically indicated.

Question 13 of 40 · Examination

Q13. During a vascular examination of a painful cold leg, which additional feature indicates a more threatened limb?

A. Mild longstanding ankle oedema B. New motor weakness C. Stable varicose veins D. Normal symmetrical sensation E. Chronic skin hyperpigmentation

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Correct answer: B. New motor weakness

Why correct: Motor deficit alongside ischaemic signs indicates more severe threatened limb and mandates urgent escalation.

Why the other options are incorrect:

• A. Mild longstanding ankle oedema: Oedema alone is nonspecific for acute ischaemia severity.
• C. Stable varicose veins: Not a defining motor-threatening arterial sign.
• D. Normal symmetrical sensation: Less concerning than new deficit in this setting.
• E. Chronic skin hyperpigmentation: May reflect chronic venous disease rather than acute motor threat.

Exam pearl: Motor or sensory deficits raise acute limb-ischaemia urgency.

Examiner trap: Do not select a plausible alternative that contradicts the key clinical or safety finding in the stem.

Viva extension: What is first action? Immediate vascular escalation with concurrent assessment.

Question 14 of 40 · Examination

Q14. A patient with suspected acute peritonitis is tachycardic and rigid. Which approach is best?

A. Perform elective colonoscopy before stabilising B. Repeated deep palpation until the patient withdraws C. Send the patient home with analgesia only D. Brief gentle examination and urgent resuscitation/escalation E. Wait for a routine clinic slot

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Correct answer: D. Brief gentle examination and urgent resuscitation/escalation

Why correct: The patient is potentially unstable; avoid painful repeated manoeuvres and initiate appropriate urgent care.

Why the other options are incorrect:

• A. Perform elective colonoscopy before stabilising: Inappropriate first step in acute peritonitis.
• B. Repeated deep palpation until the patient withdraws: Adds pain and may delay action.
• C. Send the patient home with analgesia only: Ignores possible perforation/sepsis.
• E. Wait for a routine clinic slot: Cannot defer a threatened acute abdomen.

Exam pearl: Examine enough to recognise danger; do not delay treatment.

Examiner trap: Do not select a plausible alternative that contradicts the key clinical or safety finding in the stem.

Viva extension: Name initial steps: ABCDE, IV access, resuscitation and senior assessment.

Question 15 of 40 · Examination

Q15. A patient with a painless breast lump is being assessed. Which diagnostic strategy is most appropriate?

A. Empirical antibiotics in every case B. Physical examination alone C. Immediate mastectomy without diagnosis D. Clinical assessment, imaging and tissue diagnosis as indicated E. Only serum tumour markers

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Correct answer: D. Clinical assessment, imaging and tissue diagnosis as indicated

Why correct: Triple assessment aligns examination, imaging and tissue sampling for suspected breast pathology.

Why the other options are incorrect:

• A. Empirical antibiotics in every case: Not all lumps are infectious.
• B. Physical examination alone: Cannot reliably exclude malignancy.
• C. Immediate mastectomy without diagnosis: Definitive surgery requires appropriate assessment.
• E. Only serum tumour markers: These do not replace breast imaging and pathology.

Exam pearl: Suspected breast lesion: triple assessment.

Examiner trap: Do not select a plausible alternative that contradicts the key clinical or safety finding in the stem.

Viva extension: What influences imaging modality? Age, symptoms and local breast pathway.

Question 16 of 40 · Procedure

Q16. A suture pad station asks you to repair a clean laceration. What is essential before first needle placement?

A. Adding maximal suture tension B. Starting immediately to save time C. Choosing the smallest needle without examining tissue D. Consent, allergy check and aseptic preparation E. Leaving used needles on the table

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Correct answer: D. Consent, allergy check and aseptic preparation

Why correct: Safe minor procedures require indication, consent, patient assessment and sterile technique before stitching.

Why the other options are incorrect:

• A. Adding maximal suture tension: This risks tissue necrosis and poor healing.
• B. Starting immediately to save time: Skipping safety steps can cause preventable harm.
• C. Choosing the smallest needle without examining tissue: Equipment selection must match anatomy and wound.
• E. Leaving used needles on the table: Sharps must be controlled and disposed safely.

Exam pearl: A tidy stitch does not compensate for unsafe preparation.

Examiner trap: Do not select a plausible alternative that contradicts the key clinical or safety finding in the stem.

Viva extension: What are closing steps? Haemostasis, dressing, sharps, aftercare and documentation.

Question 17 of 40 · Procedure

Q17. During suturing, the wound edges are tightly inverted and blanching. What is the better technique?

A. Use a larger needle without reconsidering technique B. Tighten every knot further C. Leave large gaps regardless of tension D. Adjust bite placement and tension to approximate/evert edges E. Ignore tissue perfusion

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Correct answer: D. Adjust bite placement and tension to approximate/evert edges

Why correct: Excessive tension compromises perfusion; gentle approximation and edge eversion support healing.

Why the other options are incorrect:

• A. Use a larger needle without reconsidering technique: Instrument size alone does not fix tissue eversion.
• B. Tighten every knot further: Worsens strangulation and inversion.
• C. Leave large gaps regardless of tension: Does not accomplish suitable approximation.
• E. Ignore tissue perfusion: Blanching signals potentially excessive pressure.

Exam pearl: Aim for secure approximation, not strangulation.

Examiner trap: Do not select a plausible alternative that contradicts the key clinical or safety finding in the stem.

Viva extension: How should knots sit? Secure and not directly over the wound line when possible.

Question 18 of 40 · Procedure

Q18. A sterile glove contacts an unprepared table during a demonstration. What should you do?

A. Use the same glove but work faster B. Continue because the glove looks clean C. Wipe it with a dry swab D. Ask the patient to ignore it E. Stop and replace the contaminated glove

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Correct answer: E. Stop and replace the contaminated glove

Why correct: Asepsis requires recognising and correcting a field breach before proceeding.

Why the other options are incorrect:

• A. Use the same glove but work faster: Speed cannot correct contamination.
• B. Continue because the glove looks clean: Visual appearance does not establish sterility.
• C. Wipe it with a dry swab: A dry swab does not restore a sterile glove.
• D. Ask the patient to ignore it: Patient reassurance does not reverse contamination.

Exam pearl: Recognise and correct contamination immediately.

Examiner trap: Do not select a plausible alternative that contradicts the key clinical or safety finding in the stem.

Viva extension: Who else can help? Ask an assistant for safe replacement while maintaining field.

Question 19 of 40 · Procedure

Q19. A candidate finishes suturing and hands an exposed used needle to the examiner. What is the safer action?

A. Dispose of the needle directly into the designated sharps container B. Recap the needle with both hands C. Place it under used gauze D. Leave it on the trolley edge E. Put it in ordinary clinical waste

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Correct answer: A. Dispose of the needle directly into the designated sharps container

Why correct: The used sharp must be controlled and disposed in a suitable container, avoiding dangerous hand-to-hand transfer.

Why the other options are incorrect:

• B. Recap the needle with both hands: This increases needlestick risk.
• C. Place it under used gauze: Concealed sharps endanger staff.
• D. Leave it on the trolley edge: Creates an avoidable sharps hazard.
• E. Put it in ordinary clinical waste: Needles require sharps segregation.

Exam pearl: Sharps handling is part of procedural assessment.

Examiner trap: Do not select a plausible alternative that contradicts the key clinical or safety finding in the stem.

Viva extension: What if needlestick occurs? Follow immediate first-aid, incident and occupational-health protocol.

Question 20 of 40 · Procedure

Q20. A simulated patient requests a chaperone before a sensitive examination. What is appropriate?

A. Perform the examination despite refusal B. Insist the exam must proceed without one C. Proceed without explaining the examination D. Respect the request and arrange a suitable chaperone E. Invite an unrelated observer without consent

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Correct answer: D. Respect the request and arrange a suitable chaperone

Why correct: Patient dignity, choice and informed consent are essential for intimate examinations.

Why the other options are incorrect:

• A. Perform the examination despite refusal: Consent can be withheld or withdrawn.
• B. Insist the exam must proceed without one: Disregards the patient’s preference.
• C. Proceed without explaining the examination: Undermines valid consent.
• E. Invite an unrelated observer without consent: Privacy and confidentiality still apply.

Exam pearl: Offer and document appropriate chaperone arrangements.

Examiner trap: Do not select a plausible alternative that contradicts the key clinical or safety finding in the stem.

Viva extension: What if no chaperone is available? Defer if clinically safe or follow local policy.

Question 21 of 40 · Communication

Q21. An adult with capacity declines recommended surgery after hearing the material risks. What is the correct next step?

A. Assume capacity is absent because the decision is unwise B. Operate anyway because you believe it is best C. Ask relatives to override the refusal D. Withhold all further care E. Respect the refusal while confirming understanding and discussing alternatives

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Correct answer: E. Respect the refusal while confirming understanding and discussing alternatives

Why correct: An adult with capacity may decline even life-saving treatment; communicate risks, alternatives and document the decision.

Why the other options are incorrect:

• A. Assume capacity is absent because the decision is unwise: Unwise decisions alone do not demonstrate incapacity.
• B. Operate anyway because you believe it is best: This violates the capable patient’s autonomy.
• C. Ask relatives to override the refusal: Family cannot generally override a capable adult’s decision.
• D. Withhold all further care: Continue appropriate alternatives and supportive care.

Exam pearl: Capacity is decision- and time-specific; an unwise decision is not incapacity.

Examiner trap: Do not select a plausible alternative that contradicts the key clinical or safety finding in the stem.

Viva extension: What do you document? Information shared, understanding, wishes and plan.

Question 22 of 40 · Communication

Q22. You are explaining laparoscopic cholecystectomy. Which omission most seriously undermines consent?

A. Failing to discuss material risks and reasonable alternatives B. Using plain language C. Checking the patient’s questions D. Allowing time for a decision E. Providing a written information leaflet

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Correct answer: A. Failing to discuss material risks and reasonable alternatives

Why correct: Patient-specific material risks, options and the choice of no procedure belong in shared decision-making.

Why the other options are incorrect:

• B. Using plain language: This is desirable and supports understanding.
• C. Checking the patient’s questions: This is part of good informed consent.
• D. Allowing time for a decision: This promotes voluntariness.
• E. Providing a written information leaflet: Useful adjunct but not sole measure of consent.

Exam pearl: A signed form alone does not prove informed consent.

Examiner trap: Do not select a plausible alternative that contradicts the key clinical or safety finding in the stem.

Viva extension: What is a material risk? One a reasonable patient in that position would likely attach significance to.

Question 23 of 40 · Communication

Q23. A patient cries after being told that biopsy shows malignancy. What is the best immediate response?

A. Discuss prognosis in the corridor B. Explain every staging detail immediately C. Change subject to avoid upsetting the patient D. Promise cure before staging E. Acknowledge emotion, pause and allow questions

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Correct answer: E. Acknowledge emotion, pause and allow questions

Why correct: Empathic response and listening should precede a dense information dump.

Why the other options are incorrect:

• A. Discuss prognosis in the corridor: Inadequate privacy for sensitive information.
• B. Explain every staging detail immediately: Information overload can impair understanding in distress.
• C. Change subject to avoid upsetting the patient: This is dismissive and unhelpful.
• D. Promise cure before staging: Unjustified certainty is misleading.

Exam pearl: Silence, acknowledgement and checking understanding are clinical skills.

Examiner trap: Do not select a plausible alternative that contradicts the key clinical or safety finding in the stem.

Viva extension: What next? Ask what the patient has understood and what support they want.

Question 24 of 40 · Communication

Q24. A family member asks you not to tell a competent patient their histology result. What is most appropriate?

A. Assume all patients want maximal detail B. Agree to conceal everything permanently C. Inform the whole ward team in public D. Tell the family all results without patient permission E. Explore concerns, then assess the patient’s own information preferences

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Correct answer: E. Explore concerns, then assess the patient’s own information preferences

Why correct: The patient’s autonomy and wishes determine disclosure to them; family requests do not automatically control the conversation.

Why the other options are incorrect:

• A. Assume all patients want maximal detail: Ask the individual what they wish to know.
• B. Agree to conceal everything permanently: This may conflict with patient preferences and professional duties.
• C. Inform the whole ward team in public: Violates privacy.
• D. Tell the family all results without patient permission: Disclosure requires an appropriate basis.

Exam pearl: Ask what the patient wants to know and who they want involved.

Examiner trap: Do not select a plausible alternative that contradicts the key clinical or safety finding in the stem.

Viva extension: What if the patient declines details? Respect preferences while explaining options.

Question 25 of 40 · Communication

Q25. After an avoidable postoperative delay, the patient asks what went wrong. What reflects duty of candour?

A. Tell the patient to search online B. Deny any problem until litigation begins C. Blame a junior colleague without evidence D. Offer an open factual explanation, apology and next-step plan E. Promise no further errors will ever occur

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Correct answer: D. Offer an open factual explanation, apology and next-step plan

Why correct: Be honest about known events, uncertainties and what is being done; document and follow local incident procedures.

Why the other options are incorrect:

• A. Tell the patient to search online: Does not meet communication duties.
• B. Deny any problem until litigation begins: Fails candour obligations.
• C. Blame a junior colleague without evidence: Unfair and speculative.
• E. Promise no further errors will ever occur: Guarantee cannot be supported.

Exam pearl: Apology and transparent follow-up are central to candour.

Examiner trap: Do not select a plausible alternative that contradicts the key clinical or safety finding in the stem.

Viva extension: What should be escalated? Clinical harm, reporting, investigation and support needs.

Question 26 of 40 · Communication

Q26. A patient repeats medical jargon without accurately understanding a major operation. What best checks comprehension?

A. Speak faster to fit all risks B. Ask only “Do you understand?” C. Ask the patient to explain the plan in their own words D. Give more technical details without checking E. Conclude that silence means informed consent

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Correct answer: C. Ask the patient to explain the plan in their own words

Why correct: Teach-back reveals misunderstanding and supports informed choices.

Why the other options are incorrect:

• A. Speak faster to fit all risks: This reduces comprehension.
• B. Ask only “Do you understand?”: Yes/no questions may miss confusion.
• D. Give more technical details without checking: Jargon can worsen confusion.
• E. Conclude that silence means informed consent: Silence is not evidence of understanding.

Exam pearl: Use teach-back for complex consent.

Examiner trap: Do not select a plausible alternative that contradicts the key clinical or safety finding in the stem.

Viva extension: What if confusion remains? Explain again using simpler language and reassess.

Question 27 of 40 · Emergency care

Q27. An intubated trauma patient is hypotensive and has unilateral reduced breath sounds. What life-threatening diagnosis must be considered?

A. Chronic venous disease B. Simple ankle sprain C. Asymptomatic pulmonary nodule D. Tension pneumothorax E. Uncomplicated gastritis

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Correct answer: D. Tension pneumothorax

Why correct: Thoracic obstructive shock can be rapidly fatal and needs emergency assessment/decompression when clinically indicated.

Why the other options are incorrect:

• A. Chronic venous disease: Does not fit unilateral chest findings.
• B. Simple ankle sprain: Does not explain thoracic compromise.
• C. Asymptomatic pulmonary nodule: Cannot produce sudden obstructive shock presentation.
• E. Uncomplicated gastritis: Does not explain hypoxia and absent breath sounds.

Exam pearl: Treat the patient’s physiology, not only the diagnosis label.

Examiner trap: Do not select a plausible alternative that contradicts the key clinical or safety finding in the stem.

Viva extension: What immediate framework? ABCDE with early escalation.

Question 28 of 40 · Emergency care

Q28. A postoperative patient is confused with SpO2 82% and shallow breathing after IV opioids. What is an immediate priority?

A. Administer further opioid immediately B. Airway and ventilatory support with opioid toxicity assessment C. Delay until next routine observations D. Order only an outpatient sleep study E. Dismiss confusion as normal recovery

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Correct answer: B. Airway and ventilatory support with opioid toxicity assessment

Why correct: Potential opioid-induced hypoventilation threatens oxygenation; support airway/breathing, escalate and consider reversal per protocol.

Why the other options are incorrect:

• A. Administer further opioid immediately: May worsen respiratory depression.
• C. Delay until next routine observations: Severe hypoxaemia is an emergency.
• D. Order only an outpatient sleep study: Irrelevant to immediate deterioration.
• E. Dismiss confusion as normal recovery: Cannot ignore physiological instability.

Exam pearl: Opioid toxicity requires assessment of ventilation, not just oxygen saturation.

Examiner trap: Do not select a plausible alternative that contradicts the key clinical or safety finding in the stem.

Viva extension: What treatment may be indicated? Titrated naloxone with airway support per protocol.

Question 29 of 40 · Emergency care

Q29. A patient after major surgery becomes oliguric and hypotensive. What is the first principle?

A. Give loop diuretic to every patient B. Give large fluid boluses without assessment C. Assess perfusion, volume status, obstruction and causes of AKI D. Assume laboratory artefact without examination E. Ignore urine output if creatinine is normal

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Correct answer: C. Assess perfusion, volume status, obstruction and causes of AKI

Why correct: Oliguria requires review of haemodynamics and reversible causes, not reflexive administration of fluids or diuretics.

Why the other options are incorrect:

• A. Give loop diuretic to every patient: Not the routine treatment for all AKI or hypotension.
• B. Give large fluid boluses without assessment: May harm fluid-overloaded or cardiogenic patients.
• D. Assume laboratory artefact without examination: Clinical assessment is essential.
• E. Ignore urine output if creatinine is normal: Creatinine can lag acute deterioration.

Exam pearl: Assess and correct the cause of oliguria; creatinine may lag.

Examiner trap: Do not select a plausible alternative that contradicts the key clinical or safety finding in the stem.

Viva extension: What monitoring? Fluid balance, renal profile, urine output, vital signs.

Question 30 of 40 · Emergency care

Q30. A post-splenectomy patient develops fever and rigors. Why is prompt assessment especially important?

A. Risk of overwhelming infection due to impaired encapsulated-organism clearance B. Asplenia eliminates need for vaccines C. Only fungal infections occur after splenectomy D. Splenectomy prevents bloodstream infection E. Fever can always be managed with observation alone

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Correct answer: A. Risk of overwhelming infection due to impaired encapsulated-organism clearance

Why correct: Asplenia increases vulnerability to rapidly progressive infection, particularly from encapsulated bacteria.

Why the other options are incorrect:

• B. Asplenia eliminates need for vaccines: Vaccines and preventive plans remain important.
• C. Only fungal infections occur after splenectomy: Bacterial infection remains a key concern.
• D. Splenectomy prevents bloodstream infection: It increases risk for selected infections.
• E. Fever can always be managed with observation alone: Rapid assessment and treatment may be necessary.

Exam pearl: Asplenic fever is potentially urgent.

Examiner trap: Do not select a plausible alternative that contradicts the key clinical or safety finding in the stem.

Viva extension: What prevention? Vaccination, education and local prophylaxis guidance.

Question 31 of 40 · Applied anatomy

Q31. In the femoral triangle just distal to the inguinal ligament, which structure is outside the femoral sheath?

A. Femoral vein B. Femoral artery C. Femoral nerve D. Femoral canal E. Femoral branch of genitofemoral nerve as sole answer

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Correct answer: C. Femoral nerve

Why correct: Femoral sheath surrounds artery, vein and canal but not the femoral nerve, which lies laterally.

Why the other options are incorrect:

• A. Femoral vein: The vein is within the sheath medial to the artery.
• B. Femoral artery: This occupies the lateral compartment of the sheath.
• D. Femoral canal: This is the medial compartment of the sheath.
• E. Femoral branch of genitofemoral nerve as sole answer: Its course differs and the principal tested excluded structure is the femoral nerve.

Exam pearl: Femoral nerve lies outside the sheath.

Examiner trap: Do not select a plausible alternative that contradicts the key clinical or safety finding in the stem.

Viva extension: What is lateral-to-medial? Nerve, artery, vein, lymphatic/canal.

Question 32 of 40 · Applied anatomy

Q32. Following superficial parotidectomy, a patient cannot fully close the ipsilateral eye. What structure may be injured?

A. Facial nerve branch to orbicularis oculi B. Trigeminal motor root C. Hypoglossal nerve D. Glossopharyngeal nerve E. Accessory nerve

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Correct answer: A. Facial nerve branch to orbicularis oculi

Why correct: Facial motor fibres traverse the gland and supply muscles of facial expression including eye closure.

Why the other options are incorrect:

• B. Trigeminal motor root: Trigeminal motor supplies muscles of mastication.
• C. Hypoglossal nerve: Supplies most tongue muscles.
• D. Glossopharyngeal nerve: Provides stylopharyngeus motor and oropharyngeal sensation.
• E. Accessory nerve: Supplies sternocleidomastoid and trapezius.

Exam pearl: Facial nerve runs through parotid; it does not innervate the gland’s secretion.

Examiner trap: Do not select a plausible alternative that contradicts the key clinical or safety finding in the stem.

Viva extension: What is parotid secretomotor supply? Parasympathetic CN IX via otic ganglion and auriculotemporal nerve.

Question 33 of 40 · Applied anatomy

Q33. Loss of thumb-index OK-sign pinch with preserved skin sensation suggests which motor neuropathy?

A. Anterior interosseous nerve palsy B. Ulnar neuropathy at elbow C. Radial neuropathy in spiral groove D. Axillary neuropathy E. Superficial radial nerve injury

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Correct answer: A. Anterior interosseous nerve palsy

Why correct: AIN is a motor branch of median nerve; FPL and index FDP weakness impairs tip-to-tip pinch without cutaneous loss.

Why the other options are incorrect:

• B. Ulnar neuropathy at elbow: This alters interossei and ulnar cutaneous sensation.
• C. Radial neuropathy in spiral groove: This causes wrist or finger extension deficits.
• D. Axillary neuropathy: This weakens deltoid and may affect shoulder sensation.
• E. Superficial radial nerve injury: This is sensory and does not impair pinch motors.

Exam pearl: AIN palsy is motor-only; sensory loss suggests another lesion.

Examiner trap: Do not select a plausible alternative that contradicts the key clinical or safety finding in the stem.

Viva extension: What other muscle? Pronator quadratus may be weak.

Question 34 of 40 · Professionalism

Q34. A patient with capacity refuses a blood transfusion. What is the best response?

A. Discharge without other treatment B. Transfuse secretly for the patient’s benefit C. Assume all religious choices imply incapacity D. Ask the spouse to give overriding consent E. Respect refusal, explore alternatives and document

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Correct answer: E. Respect refusal, explore alternatives and document

Why correct: Capable adults can refuse treatment; revisit understanding, explain risk and explore acceptable alternatives.

Why the other options are incorrect:

• A. Discharge without other treatment: Continue appropriate supportive options.
• B. Transfuse secretly for the patient’s benefit: Would violate refusal and consent.
• C. Assume all religious choices imply incapacity: Personal beliefs do not indicate incapacity.
• D. Ask the spouse to give overriding consent: Spouse does not override a capable adult’s refusal.

Exam pearl: Respect autonomy even in high-stakes decisions.

Examiner trap: Do not select a plausible alternative that contradicts the key clinical or safety finding in the stem.

Viva extension: What if capacity is uncertain? Assess decision-specific capacity and seek help.

Question 35 of 40 · Professionalism

Q35. You discover a new unrelated lesion during routine surgery that is not an emergency. What is the general consent principle?

A. Assume relatives gave blanket permission B. Proceed because anaesthesia has already begun C. Avoid an unconsented additional procedure and seek appropriate discussion later D. Record that the patient probably would agree E. Never disclose the finding

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Correct answer: C. Avoid an unconsented additional procedure and seek appropriate discussion later

Why correct: Consent normally covers the agreed procedure; new elective work should not be performed without informed authorisation.

Why the other options are incorrect:

• A. Assume relatives gave blanket permission: No evidence for valid authority.
• B. Proceed because anaesthesia has already begun: Convenience does not justify unconsented intervention.
• D. Record that the patient probably would agree: Speculation does not replace consent.
• E. Never disclose the finding: Patient must receive appropriate information.

Exam pearl: Consent is procedure-specific; emergencies have separate legal considerations.

Examiner trap: Do not select a plausible alternative that contradicts the key clinical or safety finding in the stem.

Viva extension: What if immediately life-saving action is necessary? Apply emergency legal/clinical standards.

Question 36 of 40 · Professionalism

Q36. In an OSCE, a patient describes thoughts of self-harm while discussing surgery. What is safest?

A. Continue to the next examination manoeuvre B. Ignore because not the listed topic C. Promise absolute secrecy D. Dismiss as attention seeking E. Explore immediate risk and seek appropriate senior/mental-health support

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Correct answer: E. Explore immediate risk and seek appropriate senior/mental-health support

Why correct: Patient safety supersedes rigid station checklist flow; respond to immediate risk.

Why the other options are incorrect:

• A. Continue to the next examination manoeuvre: Does not assess immediate risk.
• B. Ignore because not the listed topic: Misses a potentially urgent safety issue.
• C. Promise absolute secrecy: Confidentiality has safety-related limitations.
• D. Dismiss as attention seeking: Inappropriate and unsafe.

Exam pearl: Safety signals alter the consultation priority.

Examiner trap: Do not select a plausible alternative that contradicts the key clinical or safety finding in the stem.

Viva extension: What to document? Risk assessment, advice, escalation and safeguards.

Question 37 of 40 · OSCE technique

Q37. You enter a clinical examination station. What is the best opening?

A. Skip identity check because actor is present B. Start palpation before speaking C. Ask the examiner to skip communication D. Introduce yourself, confirm identity, explain, seek consent and check comfort E. Deliver your full differential before examining

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Correct answer: D. Introduce yourself, confirm identity, explain, seek consent and check comfort

Why correct: A professional opening establishes consent, rapport and safety before touching the patient.

Why the other options are incorrect:

• A. Skip identity check because actor is present: Patient safety routines still matter.
• B. Start palpation before speaking: No consent, dignity or pain assessment.
• C. Ask the examiner to skip communication: Patient interaction is part of skills assessment.
• E. Deliver your full differential before examining: You have not collected the requested findings.

Exam pearl: Opening routine should be consistent and quick.

Examiner trap: Do not select a plausible alternative that contradicts the key clinical or safety finding in the stem.

Viva extension: What closes the station? Summary, differential, next steps and thanks.

Question 38 of 40 · OSCE technique

Q38. During a timed station you cannot answer a detailed anatomy follow-up. What is the most appropriate strategy?

A. State what is known, acknowledge uncertainty and reason safely B. Invent a confident anatomical relationship C. Go silent for the rest of the station D. Challenge the examiner about the question E. Speak continuously without addressing the question

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Correct answer: A. State what is known, acknowledge uncertainty and reason safely

Why correct: Clear concise reasoning and intellectual honesty are safer than fabricated detail.

Why the other options are incorrect:

• B. Invent a confident anatomical relationship: May be wrong and unsafe.
• C. Go silent for the rest of the station: Does not demonstrate remaining knowledge.
• D. Challenge the examiner about the question: Unprofessional and does not resolve uncertainty.
• E. Speak continuously without addressing the question: Wastes limited time.

Exam pearl: Do not bluff uncertain anatomy or management.

Examiner trap: Do not select a plausible alternative that contradicts the key clinical or safety finding in the stem.

Viva extension: What can improve next attempt? Targeted review and rehearsal.

Question 39 of 40 · OSCE technique

Q39. A patient repeatedly reports severe pain during an examination. What should the candidate do?

A. Continue because station time is short B. Stop the painful manoeuvre and adapt examination C. Hold the limb forcibly D. Claim the patient has no pain E. Perform all provocative tests in rapid succession

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Correct answer: B. Stop the painful manoeuvre and adapt examination

Why correct: Pain and consent govern what can safely be performed; describe deferred components and alternatives.

Why the other options are incorrect:

• A. Continue because station time is short: Patient welfare is not secondary to timing.
• C. Hold the limb forcibly: Unsafe and violates consent.
• D. Claim the patient has no pain: Dismisses patient report.
• E. Perform all provocative tests in rapid succession: Can worsen suspected injuries.

Exam pearl: Examination is adapted to the patient, not just the mark sheet.

Examiner trap: Do not select a plausible alternative that contradicts the key clinical or safety finding in the stem.

Viva extension: What can be stated? Deferred tests and further imaging when appropriate.

Question 40 of 40 · OSCE technique

Q40. You have 30 seconds remaining in a station. Which closing approach adds most value?

A. Repeat the complete history B. Summarise positive findings, likely diagnosis and immediate plan C. Start a new nonessential examination sequence D. Read textbook definitions aloud E. Walk away without thanking the patient

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Correct answer: B. Summarise positive findings, likely diagnosis and immediate plan

Why correct: Concise synthesis demonstrates clinical interpretation and safe next steps.

Why the other options are incorrect:

• A. Repeat the complete history: Uses time without synthesis.
• C. Start a new nonessential examination sequence: May leave the station without conclusion.
• D. Read textbook definitions aloud: Does not synthesise the patient findings.
• E. Walk away without thanking the patient: Misses courtesy and clear closure.

Exam pearl: End with a brief summary and safe next steps.

Examiner trap: Do not select a plausible alternative that contradicts the key clinical or safety finding in the stem.

Viva extension: Which structure works? Findings, differential, investigation/management, thanks.

Frequently asked questions

Does Part B contain 40 MCQs?

No. Part B is a practical, in-person OSCE. The questions above are optional original revision material to support knowledge for stations.

How many stations are assessed?

Contemporary official guidance describes 17 examined stations of nine minutes each. RCS England also lists two preparation stations and additional rest stations; read your candidate instructions.

Do I need to pass both Knowledge and Skills?

Yes. The current examination regulations require both broad components to meet their passing standards in a single sitting.

How long after Part A can I take Part B?

The published 2024 regulations and current RCS England eligibility page specify within seven years of passing Part A; always check your own application eligibility.

Should I practise alone?

Solo verbal rehearsal is useful, but observing a colleague, using simulated patients and getting structured feedback is important for communication and examination skills.

Can I use recalled confidential exam stations?

Do not reproduce or distribute confidential examination content. Use public syllabus objectives and original practice exercises.

Does saved progress move between devices?

No. Browser-local saving stays on the same browser/site unless its data is cleared.

Will Part B study replace revision for Part A?

No. Both assess overlapping knowledge but in different formats. Keep Part A foundations while prioritising speaking, examination, safe technique and real-time decisions for Part B.

Official references and further FreeMedSite lessons

Exam format and eligibility checked against official sources in October 2026. Medical cases here are original educational simulations and do not constitute individual patient advice.

1. Official RCS England Part B exam format and eligibility
2. Intercollegiate MRCS candidate guidance
3. 2024 intercollegiate MRCS regulations (PDF)
4. RCS England MRCS preparation resources
5. RCS England communication OSCE practice
6. Official MRCS content guide (syllabus)

Published MRCS Academy lessons

Article 01Start MRCS Here Article 02Complete Syllabus Article 03Books and Resources Article 0412-Week Study Plan Article 05SBA Question Strategy Article 06Common Preparation Mistakes Article 07Surgical Anatomy Overview Article 08Upper Limb Anatomy Article 09Inguinal & Abdominal Wall Article 10Head & Neck Surgical Anatomy Article 11Cardiovascular & Respiratory Physiology Article 12Renal & Acid–Base Physiology Article 13GI, Endocrine & Neurophysiology Article 14Lower Limb Surgical Anatomy Made Easy for MRCS Part A Article 15Thoracic, Pelvic and Visceral Surgical Anatomy Article 16Surgical Pathology, Inflammation and Wound Healing Made Easy for MRCS Part A Article 17Surgical Pharmacology and Microbiology Made Easy for MRCS Part A Article 18Perioperative Care, Anaesthesia and Surgical Complications Made Easy for MRCS Part A Article 19Trauma, Shock and Burns Made Easy for MRCS Part A Article 20Acute Abdomen and Emergency Surgical Conditions Made Easy for MRCS Part A Article 21Common Surgical Specialty Presentations Made Easy for MRCS Part A Article 22Ethics, Medical Statistics and Clinical Audit Made Easy for MRCS Part A Article 23MRCS Part A Mock Exams and Final Revision Strategy

Previous: Article 23 — MRCS Part A Mock Exams and Final Revision

Next: Extended OSCE station-by-station masterclass and post-launch syllabus expansion (future series; no unpublished link inserted).

FreeMedSite MRCS Academy. This article completes the first 24-part beginner-to-exam launch series. Updated October 2026.