Dermatology, Otolaryngology and Ophthalmology
This domain tests pattern recognition and safe first-line treatment for the high-volume skin, ear, nose, throat and eye problems seen in clinics, plus recognition of the small number that are emergencies.
Core rules
- Describe skin lesions by site, morphology, colour, distribution, and involvement of nails and mucosae before deciding.
- Psoriasis: well-demarcated plaques with silvery scale on extensor surfaces; treat with topical corticosteroid plus a vitamin D analogue; check joints and cardiometabolic risk.
- Eczema: emollients and topical steroids stepped by severity; oral steroids are not routine.
- Scabies: permethrin to the whole body, repeated after 7 days, and treat all close contacts; itch can persist for weeks after successful treatment.
- Acne: topical retinoid plus benzoyl peroxide; avoid antibiotic monotherapy; isotretinoin requires pregnancy prevention.
- Suspected melanoma: use the ABCDE criteria and arrange excision biopsy with a narrow margin - never a shave biopsy.
- Red eye: pain, photophobia or reduced vision means a serious cause. Acute angle closure presents with severe pain, halos, nausea, a mid-dilated fixed pupil and a hard globe - urgent ophthalmology, acetazolamide and pilocarpine.
- Never prescribe a topical steroid for an undiagnosed red eye: herpes keratitis can be worsened catastrophically.
- Otitis externa: topical antibiotic with steroid; avoid aminoglycoside drops if the tympanic membrane is perforated.
- Hoarseness for more than 3 weeks needs ENT assessment to exclude laryngeal cancer.
Worked example
A 65-year-old has sudden painful loss of vision with halos and vomiting; the eye is hard and the pupil mid-dilated. Reasoning: acute angle closure glaucoma. Refer immediately, start intravenous acetazolamide and topical pilocarpine and a beta-blocker as directed, and do not give a mydriatic.
Traps that cost marks
Steroid drops in a red eye; treating the index scabies case only; missing giant cell arteritis with visual loss; shave biopsy of suspected melanoma.