Musculoskeletal, Skin, Eye, Ear, Nose, Oropharynx and Anaesthesia

Scope and time budget

Low weighting is a reason to be efficient, not a reason to skip. Most questions here turn on a safety point or a red flag that you can learn quickly.

What is tested

• NSAIDs. Cardiovascular and gastro-intestinal risk.
• Rheumatoid arthritis. DMARD monitoring.
• Gout. Treatment and allopurinol initiation.
• Osteoarthritis. Topical analgesia.
• Eczema. Emollients and steroid potency.
• Psoriasis and acne. Treatment, including the isotretinoin pregnancy prevention programme.
• Skin infestations and infections. Fungal infections and sun protection.
• Eyes. Drops, glaucoma and conjunctivitis.
• Ear, nose and throat. Otitis externa, rhinitis and mouth ulcers.
• Anaesthesia. Local and general anaesthetics and peri-operative medicines.

UK guideline anchors

• NICE and BNF. Guidance for gout, arthritis, eczema and acne, and cautions for NSAIDs.
• MHRA. Isotretinoin pregnancy prevention programme and other safety updates.
• Pharmacy First (checked). Impetigo from 1 year, infected insect bites from 1 year, sinusitis from 12, sore throat from 5 and acute otitis media from 1 to 17 years.
• OTC rules. Supply conditions and red flags for common skin, eye and ENT requests.
• Children. Topical steroid strength and age limits.

NSAIDs and analgesia

NSAIDs sit in the framework's list of high-risk drugs. Know the cardiovascular, gastro-intestinal and renal risks, the groups who should avoid them, and the interactions with anticoagulants, antihypertensives, lithium and methotrexate. Topical NSAIDs have lower systemic exposure, which makes them a common first choice for localised osteoarthritis pain. Gout questions combine acute treatment with the rules for starting allopurinol, which is not started during an acute attack and is usually begun with cover against flares. Confirm details in current guidance.

Skin conditions and the eye

For eczema, learn the emollient first principle, the potency grades of topical corticosteroids, the amount to apply using fingertip units and the sites where potent products should be avoided. Isotretinoin is subject to a pregnancy prevention programme, so a female patient who could become pregnant needs contraception and monitoring. For eye conditions, know the difference between bacterial and viral conjunctivitis, the red flags that need urgent referral (pain, reduced vision, photophobia, contact lens wearers), the counselling points for eye drops, and the importance of adherence in glaucoma.

Ear, nose, mouth and anaesthesia

Otitis externa, mouth ulcers, rhinitis and sore throat are common minor-ailment topics. Know the red flags and the treatment options that are available over the counter. For anaesthesia, questions focus on peri-operative medicines: which long-term medicines to continue, which to stop and the particular risks, for example with anticoagulants, diabetes medicines and corticosteroids. Local anaesthetic safety, including maximum doses, links to the calculations page.

Counselling points that earn marks

• NSAIDs. Take with food, use the lowest dose for the shortest time, and stop and seek help for black stools or vomiting blood.
• DMARDs. Understand the monitoring schedule, report infection symptoms, and take methotrexate weekly, not daily.
• Emollients. Use generously and often, apply downwards in the direction of hair growth, and warn about fire risk with paraffin-based products on clothing and bedding.
• Topical steroids. Use the weakest effective strength for the shortest time, with fingertip units to guide the amount, and avoid the face and flexures unless advised.
• Eye drops. Wash hands, avoid touching the tip, wait between different drops, and record the date opened.

Sun protection and skin cancer awareness

Public health items include sun protection advice, the signs of a changing mole that need referral, and the effects of photosensitising medicines. Learn the advice on sun protection factor and star ratings, and the groups who need extra care, including young children and people on certain medicines.

Children

Paediatric skin conditions, such as eczema, impetigo and head lice, appear often. Know the age limits for products, the Pharmacy First eligibility for impetigo from 1 year and for insect bites from 1 year, and how topical steroid potency changes the advice for infants.

If you have only an hour

Spend 20 minutes on NSAID risks, interactions and alternatives. Spend 15 minutes on topical steroid potency and emollient advice. Spend 15 minutes on eye, ear and mouth red flags. Spend 10 minutes on gout, DMARDs and peri-operative medicine rules. Then do fifteen questions. Because the weighting is low, aim for accuracy on the safety points and accept that you will not know every detail.

Three typical traps

1. The NSAID trap. An NSAID in a patient with kidney disease, an anticoagulant or a history of ulcer is rarely the best answer.
2. The flare trap. Allopurinol is not started during an acute gout attack. Read the stage of the condition.
3. The red-flag trap. A red eye with pain or reduced vision is not a conjunctivitis for the shelf. It is a referral.

How to revise it

1. Cover the safety points first. One line per drug class.
2. Learn potency grades. Mild to very potent topical steroids and where to use each.
3. List eye and ENT red flags. One short list per complaint.
4. Pair with other domains. NSAIDs with cardiovascular, gastro-intestinal and renal risk.
5. Time-box it. Spend proportionally less time here than on high-weighted areas.

Return to the cardiovascular domain to see the NSAID interactions in context, or the clinical evaluation domain. Back to the hub.