Fractures, Joints, Skin Cancer and Anaemia: Musculoskeletal, Dermatology and Haematology

Scope and time budget

About thirteen questions is thirteen minutes. Because this domain gathers several specialities, it feels less coherent than the others, and that makes it easy to under-revise. The questions are mostly short and recognition-based. A good photograph description, a joint history or a blood count is followed by a diagnosis or the next step.

What is tested

• Trauma and fractures. Neck of femur, wrist, scaphoid and open fractures, compartment syndrome and fracture complications, hip, knee, shoulder and ankle injuries including the Ottawa rules.
• Joints and connective tissue. Septic arthritis, osteomyelitis and the hot swollen joint, osteoarthritis, rheumatoid arthritis, gout and pseudogout, spondyloarthropathies and connective tissue diseases, polymyalgia rheumatica, vasculitis and fibromyalgia.
• Back and bone in children. Back pain red flags, and paediatric orthopaedics: DDH, SUFE, Perthes' disease and the limping child.
• Skin. Melanoma, basal cell and squamous cell carcinoma and the two-week-wait pathway, eczema, psoriasis and acne, skin infections including cellulitis, impetigo, scabies and necrotising fasciitis, severe drug reactions and urticaria, pressure ulcers and wound care.
• Blood. Anaemias (iron deficiency, B12 and folate, haemolytic), sickle cell disease and thalassaemia, bleeding and clotting disorders, DIC and anticoagulant reversal, leukaemias, lymphomas and myeloma, neutropenic sepsis, and VTE prophylaxis and thrombophilia.

UK points to anchor your answers

• Screening for haemoglobin disorders: antenatal screening covers sickle cell and thalassaemia, and newborn screening includes a blood spot test.
• Cancer pathways: NICE sets the suspected cancer referral criteria for skin cancer and haematological malignancy. Learn the current wording from the source, because we could not read it for this page.
• Prescribing: the BNF is the authority for anticoagulant reversal, antibiotics and topical steroids. Doses are in micrograms and milligrams as written in the BNF.
• Safeguarding: unexplained injuries in a child, or in a vulnerable adult, link to the professional domain and the GMC 0-18 years guidance.

How the questions are framed

Orthopaedic stems describe the mechanism and the examination, and ask for the likely fracture, the first investigation or the immediate treatment. A hot swollen joint question asks you to preserve the joint: aspirate and treat as infection until proved otherwise. Rheumatology stems ask you to match a pattern to a disease and to know the first-line drug and the monitoring. Dermatology stems usually describe a lesion in words, so practise turning a description into a diagnosis. Haematology stems give a count and a film description, and ask for the type of anaemia, the cause or the treatment.

What examiners ask about each group

• Fractures. Identify the fracture, treat pain, check neurovascular status, and recognise the complication that needs urgent action, such as compartment syndrome or an open fracture.
• The hot joint. Aspirate, culture and start antibiotics according to guidance, and avoid steroids or anti-inflammatory drugs until infection is excluded.
• Back pain. Separate mechanical pain from red flags: cancer, infection, fracture and cord compression.
• Skin lesions. Apply the features that trigger an urgent cancer referral. Treat cellulitis according to severity and recognise the signs of necrotising infection.
• Anaemia. Interpret size and iron studies, find the cause (especially in older adults, where the bowel must be considered) and treat.
• Haematological emergencies. Neutropenic sepsis needs immediate antibiotics, and anticoagulant overdose needs the correct reversal.

Time and exam technique

With many small topics in one domain, speed comes from pattern cards. For fractures, learn the site, the usual mechanism, the nerve or vessel at risk and the first treatment. For arthritis, learn the joint pattern, the key test and the first-line drug. For skin lesions, learn the three or four features that raise urgency. For blood, learn the sequence from count to cause. Cards turn a thirteen-question domain into a set of quick recognitions.

Avoid spending long on any single item. A skin description you cannot name may cost two minutes and still leave you uncertain, so choose the safest option, such as referral for a suspicious lesion, and move on. The same applies to rare blood disorders: pick the answer that protects the patient and returns to the question if time allows.

Three typical traps

1. Waiting for results in neutropenic sepsis. It is an emergency. The exam expects early broad-spectrum treatment according to local and national guidance, not a delay for cultures.
2. Missing red flags in back pain. Age, cancer history, fever, neurological signs or bladder and bowel disturbance move the patient from reassurance to urgent investigation.
3. Forgetting the limping child. In a child, hip pain can come from the hip, knee referral or infection. Age decides the likely diagnosis, and a febrile child who will not bear weight is an emergency.

How to revise it

1. Make a red flag card for back pain, the hot joint, the limping child, suspicious skin lesions and anaemia in older adults.
2. Learn fractures by site and complication. Pair each with its first action.
3. Build an anaemia flowchart from size to cause to treatment.
4. Look at skin descriptions daily from a trusted atlas until you can name the lesion from the words.
5. Do 20-question timed blocks and review.

Link this domain to infection and cancer, child health and acute care.