Master CPS - Dermatology/ENT/Eyes
for MSRA

What the MSRA Tests in CPS - Dermatology/ENT/Eyes

CPS - Dermatology/ENT/Eyes in the MSRA tests the ability to recognise common and serious presentations across these three specialties, with emphasis on initial management in primary care and urgent referral pathways. Candidates must differentiate between self-limiting conditions (e.g., viral exanthems, otitis media with effusion, conjunctivitis) and emergencies (e.g., anaphylaxis, necrotising fasciitis, acute angle closure glaucoma, epiglottitis). Knowledge of red-flag symptoms, diagnostic criteria (e.g., Fitzpatrick skin type for phototherapy, Centor criteria for tonsillitis), and first-line treatments (e.g., topical corticosteroids for eczema, chloramphenicol for bacterial conjunctivitis, amoxicillin for acute otitis media) is essential. The exam also tests appropriate use of scoring systems (e.g., Psoriasis Area Severity Index, Snellen chart interpretation) and when to refer to secondary care.

High-Yield Concepts

• Acute Otitis Media (AOM) Diagnosis and Management: Diagnose AOM in children with acute-onset ear pain, fever, and bulging tympanic membrane on otoscopy. First-line analgesia (paracetamol/ibuprofen); antibiotics (amoxicillin 5-7 days) only if bilateral in children <2 years, otorrhoea, or systemically unwell. Refer if complications (mastoiditis, facial nerve palsy) or recurrent AOM (>3 episodes in 6 months).
• Acute Angle Closure Glaucoma (AACG): Presents with sudden severe eye pain, red eye, blurred vision, halos around lights, fixed mid-dilated pupil, and raised intraocular pressure (IOP >40 mmHg). Emergency: immediate referral to ophthalmology; initial treatment includes acetazolamide 500 mg IV/PO, topical pilocarpine 2%, and topical beta-blocker (timolol). Do not dilate the pupil.
• Psoriasis: Assessment and First-Line Therapy: Use PASI (Psoriasis Area Severity Index) for severity. Mild-to-moderate: topical corticosteroids (e.g., betamethasone valerate) plus vitamin D analogue (calcipotriol). Moderate-to-severe: phototherapy (UVB) or systemic therapy (methotrexate, ciclosporin, or biologics like adalimumab). Refer if PASI >10 or DLQI >10.
• Centor Criteria for Streptococcal Pharyngitis: Score 1 each for: fever >38°C, tonsillar exudate, tender anterior cervical lymphadenopathy, absence of cough. Score 0-1: no antibiotic; 2-3: consider rapid antigen test or culture; 4: treat with penicillin V (phenoxymethylpenicillin) 500 mg QDS for 10 days or amoxicillin if compliance concern.
• Eczema (Atopic Dermatitis) Management: Mild: emollients (e.g., aqueous cream) and mild topical corticosteroid (hydrocortisone 1%) for flares. Moderate: potent corticosteroid (betamethasone valerate 0.1%) for short bursts. Severe: refer to dermatology for systemic therapy (ciclosporin, methotrexate, dupilumab). Avoid prolonged use of potent steroids on face/flexures.
• Epiglottitis Recognition and Management: Acute onset of stridor, drooling, tripod positioning, muffled voice, and high fever. Do NOT examine throat or lie patient flat (risk of airway obstruction). Immediate senior ENT and anaesthetic review; secure airway (intubation or tracheostomy). Antibiotics: ceftriaxone IV. Haemophilus influenzae type b vaccination has reduced incidence.
• Bacterial Conjunctivitis vs. Viral Conjunctivitis: Bacterial: purulent discharge, sticky eyelids, unilateral initially. Treat with chloramphenicol eye drops (first-line) or fusidic acid. Viral: watery discharge, bilateral, often with preauricular lymphadenopathy and upper respiratory tract infection. No antibiotics; supportive care (artificial tears, cold compresses). Refer if severe pain, photophobia, or vision loss (exclude keratitis).
• Necrotising Fasciitis (NF) Recognition: Pain out of proportion to skin changes, rapid progression, systemic toxicity, crepitus, skin blistering or necrosis. Immediate surgical debridement; IV antibiotics (piperacillin-tazobactam or meropenem plus clindamycin). LRINEC score (Laboratory Risk Indicator for Necrotising Fasciitis) >6 is suggestive; do not delay surgery for imaging.

Common Traps in CPS - Dermatology/ENT/Eyes Questions

• Confusing viral exanthem (e.g., measles) with drug eruption – check for prodromal symptoms and exposure history.
• Using topical corticosteroids on suspected fungal infections (e.g., tinea) – this can worsen the infection; confirm with skin scraping or KOH preparation.
• Treating all red eyes as conjunctivitis – always check for corneal involvement (fluorescein staining), uveitis (photophobia, ciliary flush), and acute glaucoma (fixed pupil, raised IOP).
• Missing epiglottitis in adults – it can present with dysphagia out of proportion to pharyngitis; do not perform throat examination.
• Prescribing antibiotics for acute otitis media in all cases – NICE recommends no antibiotics for most mild unilateral cases in children >2 years.
• Forgetting to check for red flags in headache with ENT symptoms (e.g., sinusitis) – consider intracranial complications if fever, focal neurology, or papilloeodema.

How to Revise CPS - Dermatology/ENT/Eyes for the MSRA

Focus on high-stakes, time-pressured decisions: differentiating emergencies (AACG, NF, epiglottitis) from benign conditions, and knowing exact first-line drugs and doses. Questions often present a clinical scenario with multiple choice options that test the next best step (e.g., 'What is the most appropriate management?'). Prioritise memorising referral criteria (e.g., PASI >10, Centor score 4, IOP >40 mmHg) and common prescribing (e.g., chloramphenicol, amoxicillin, topical corticosteroids). Practice interpreting otoscopy images, Snellen chart results, and skin lesion descriptions. Use the 'red-flag' approach: if a presentation has a serious differential, that is usually the answer. Revise NICE guidelines for common presentations (sore throat, otitis media, conjunctivitis, eczema) and the British Association of Dermatologists guidelines for psoriasis and eczema.

Practise it: MedLumen has 50 CPS - Dermatology/ENT/Eyes questions for the MSRA, each with a full explanation and references.