Musculoskeletal, Dermatology, ENT and Eye Care for the MCCQE Part I

Weight and scope

Eighteen questions is about twenty-five minutes. The domain looks like four separate subjects, but the question pattern is the same: a presentation, an image or description, and a request for the diagnosis or the first step. The marks lie in recognizing the sight-threatening, limb-threatening or life-threatening problem among many benign ones. Photographs and diagrams are most likely here, since the MCC says items may include photographs, diagrams and radiographs.

The MCC publishes no discipline weights. The 8% figure is our editorial estimate from the MCC Examination Objectives and clinical presentations, and the count is rounded because some items in each section are unscored. Questions from this domain are also spread across the four dimensions of care and the four physician activities.

What is tested

• Fractures and injury. Hip, wrist, scaphoid and open fractures; compartment syndrome; joint and soft-tissue injury with clinical decision rules.
• Joint disease. Septic arthritis, osteomyelitis, osteoarthritis, rheumatoid arthritis, gout and pseudogout, spondyloarthropathies, connective tissue disease, polymyalgia rheumatica and vasculitis.
• Spine and pediatric orthopedics. Low back pain and red flags; developmental dysplasia of the hip, slipped capital femoral epiphysis, Perthes disease and the limping child.
• Skin. Melanoma, basal cell and squamous cell carcinoma; eczema, psoriasis and acne; skin and soft-tissue infection, scabies and necrotizing fasciitis; severe cutaneous drug reactions and urticaria.
• Ear, nose and throat. Otitis media and externa, hearing loss, epistaxis, tonsillitis, peritonsillar abscess and airway obstruction.
• Eye. Red eye including conjunctivitis, uveitis and acute angle-closure glaucoma; sudden vision loss; glaucoma, cataract, macular degeneration and diabetic eye disease; orbital cellulitis, trauma and chemical injury.
• Head and neck. Neck and head and neck lumps.

Canadian points to anchor your answers

• Ottawa rules. The Ottawa ankle and knee rules are Canadian decision rules. Learn the idea and the inclusion criteria, and check the numerical details in the original papers.
• Canadian C-Spine Rule. Use it as a named rule in trauma and neck injury. State the criteria in your reasoning rather than relying on memorized numbers.
• Vision screening. The task force published a statement on impaired vision in adults in 2018. Check its direction in the source.
• Skin cancer and sun safety. Counselling sits in the prevention dimension. Learn the features that prompt urgent referral.
• Osteoporosis. The task force published fragility fracture guidance in 2023. This sits in the endocrine domain, and the check applies there too.
• Reporting. Necrotizing infection and some skin infections need urgent surgical referral. Reportable infections follow provincial lists.

How the questions are framed

Stems in this domain are often short and visual. A swollen joint in a feverish patient, a child with a limp, a red painful eye, a patch of skin with an irregular border. The question asks for the diagnosis or the next step. Recognize the emergency first: a hot joint needs urgent aspiration, compartment syndrome needs urgent release, acute angle-closure glaucoma needs urgent treatment, and necrotizing infection needs urgent surgery.

Communication items include explaining a skin cancer diagnosis, a visual loss, hearing loss or a chronic pain plan. Professional-behaviour items include opioid prescribing for musculoskeletal pain and the duty to report.

Three typical traps

1. Treating a hot joint as inflammatory without excluding infection. A single acutely swollen joint with fever is septic arthritis until shown otherwise. The expected step is aspiration and cultures, not anti-inflammatory treatment alone.
2. Using imaging when a clinical rule applies. Decision rules exist to avoid unnecessary films. If the stem gives the criteria, use them.
3. Missing the sight-threatening cause of a red eye. Pain, reduced vision, a fixed pupil or photophobia point away from simple conjunctivitis and toward urgent referral.

How to revise it

1. Create a can't-miss list for each specialty: the presentation, the first step and the referral.
2. Practise image recognition for skin lesions, radiographs and eye photographs, ten a day.
3. Learn the clinical decision rules by name, with the idea behind each.
4. Review the pediatric limp by age group.
5. Revise opioid and non-opioid pain principles from the 2017 Canadian guideline.

Pair this domain with the emergency and critical care, pediatrics and infection, hematology and oncology pages.

Subtopic checklist

Our blueprint lists these 20 subtopics for this domain. Tick each one only when you can state the presentation, the first investigation and the first management step without notes.

• Fractures: hip, wrist, scaphoid and open fractures
• Compartment syndrome and fracture complications
• Joint and soft-tissue injuries (Ottawa rules, knee, shoulder, ankle)
• Septic arthritis, osteomyelitis and the acute hot joint
• Osteoarthritis, rheumatoid arthritis, gout and pseudogout
• Spondyloarthropathies and connective tissue diseases
• Low back pain: red flags and management
• Pediatric orthopedics: DDH, SCFE, Perthes and the limping child
• Polymyalgia rheumatica and vasculitis
• Skin cancer: melanoma, BCC and SCC
• Eczema, psoriasis and acne
• Skin and soft-tissue infections, scabies and necrotizing fasciitis
• Severe cutaneous drug reactions and urticaria
• Otitis media, otitis externa and hearing loss
• Epistaxis, tonsillitis, peritonsillar abscess and airway obstruction
• Red eye: conjunctivitis, uveitis and acute angle-closure glaucoma
• Sudden vision loss: retinal artery or vein occlusion and retinal detachment
• Glaucoma, cataract, macular degeneration and diabetic eye disease
• Orbital cellulitis, eye trauma and chemical injury
• Head and neck lumps

How the four dimensions of care show up

Every question in this domain is classified under one dimension of care, so revise musculoskeletal, skin, ENT and eye in four ways, not one.

• Health promotion and illness prevention. Prevention: sun protection, osteoporosis prevention, falls prevention and vision screening in older adults.
• Acute care. Acute: fractures, septic joint, compartment syndrome, acute angle-closure glaucoma, retinal artery occlusion and necrotizing infection.
• Chronic care. Chronic: osteoarthritis, rheumatoid arthritis, gout, psoriasis, eczema and glaucoma.
• Psychosocial aspects. Psychosocial: chronic pain and function, work and disability, body image in skin disease and the impact of hearing or vision loss.

When you review a wrong answer, note which dimension the question belonged to as well as the topic. A pattern, such as repeated errors on the prevention items, tells you more than a topic score.