Ophthalmology and ENT together make up about 6% of NRE Step I, roughly 12 of 200 items. PM&DC's blueprint gives ophthalmology 6 and ENT 6, and we present them on one page because they are revised together. The syllabus text for these two disciplines was not readable in the copy we reviewed, so the topic list follows the standard Pakistani MBBS final-year scope. Both are small, well-bounded subjects where a few days of focused work reliably earns marks, and each has one OSCE station in Step II.
Weight and expected item count
Six eye and six ENT items are worth about 12 minutes of paper time. These are some of the most efficient marks in the exam because the topics are repeated across textbooks and the clinical pictures are distinctive. They are also the domains that candidates from busy medicine-and-surgery curricula tend to leave until the last week, which is risky.
What is tested
| Discipline | Topics |
|---|---|
| Ophthalmology: the red eye | Conjunctivitis, uveitis, acute angle-closure glaucoma, corneal ulcer |
| Ophthalmology: lens and glaucoma | Cataract and refractive errors; glaucoma; diabetic and hypertensive retinopathy |
| Ophthalmology: other | Trachoma and vitamin A deficiency; retinal detachment and sudden visual loss; squint, amblyopia and neuro-ophthalmology; ocular trauma and orbital disorders |
| ENT: ear | Otitis media, mastoiditis and cholesteatoma; hearing loss and vertigo |
| ENT: nose and throat | Epistaxis, nasal polyps and sinusitis; tonsillitis, adenoids and peritonsillar abscess |
| ENT: larynx and neck | Laryngeal disorders, airway obstruction and tracheostomy; head and neck tumours and neck swellings; deep neck space infections and foreign bodies |
Local guideline points
- Trachoma and vitamin A deficiency: these belong to the nutrition and public-health story in South Asia and are listed in the standard scope. Know the WHO trachoma grading idea and the clinical features of xerophthalmia.
- Diabetic retinopathy: diabetes is common in Pakistan, so retinopathy staging and screening intervals are a good bet for a stem.
- Chronic suppurative otitis media: a common ENT presentation in South Asian practice, with cholesteatoma as the dangerous variant.
- Foreign bodies and airway emergencies in children: see paediatrics for the overlap with croup and the child with stridor.
- Organophosphate and other poisonings with eye signs: miosis is a clue in toxicology stems.
Three typical traps
- Confusing the painful red eye with the painless red eye. A painful red eye with a hazy cornea, fixed mid-dilated pupil and halos suggests acute angle closure, which needs urgent pressure-lowering treatment. A red eye with discharge and no pain is more likely conjunctivitis. Check pain, vision and pupil before the options.
- Treating sudden visual loss as one problem. Painless sudden loss may be retinal detachment, retinal vessel occlusion or vitreous haemorrhage, each with its own sign and urgency. Match the described fundus or field finding to the cause.
- Missing a complication of a common ENT infection. Otitis media with mastoid tenderness, tonsillitis with trismus and a deviated uvula, and sinusitis with periorbital swelling each point to a complication that changes the management. The common disease is the setting; the complication is the question.
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How to revise it
| Day | Focus |
|---|---|
| 1 | Red eye: a one-page comparison of conjunctivitis, keratitis, uveitis, acute glaucoma; 15 questions |
| 2 | Cataract, glaucoma types, refractive errors; diabetic and hypertensive retinopathy grading |
| 3 | Sudden visual loss, retinal detachment, squint and amblyopia, trachoma, vitamin A deficiency, ocular trauma |
| 4 | Ear: otitis media, mastoiditis, cholesteatoma, hearing loss tests (Rinne, Weber), vertigo causes |
| 5 | Nose and throat: epistaxis, sinusitis, polyps, tonsils, adenoids, peritonsillar abscess |
| 6 | Larynx, airway, tracheostomy, neck swellings, deep neck infections, foreign bodies; mixed block of 40 |
Learn tuning-fork results as a small table (conductive versus sensorineural) and practise reading a simple audiogram description. See the study plan for where to slot this domain; most plans place it in the second half.
Core facts to state without notes
- Acute angle-closure glaucoma: a painful red eye with a hazy cornea, a mid-dilated fixed pupil, halos and vomiting. It is an emergency treated by lowering the pressure at once.
- Retinal detachment: flashes, floaters and a curtain across the vision. Central retinal artery occlusion presents as sudden painless loss with a cherry-red spot.
- Trachoma: WHO's SAFE strategy stands for surgery for trichiasis, antibiotics, facial cleanliness and environmental improvement.
- Vitamin A deficiency: night blindness, then xerophthalmia and Bitot's spots; it ties to the paediatric nutrition programme.
- Hearing tests: in conductive loss Rinne is negative on the affected side and Weber lateralises to the affected ear; in sensorineural loss Rinne is positive and Weber lateralises to the better ear.
- Epistaxis: most arises from Little's area; first aid is to lean forward and pinch the soft part of the nose for 10 to 15 minutes.
- Peritonsillar abscess: severe sore throat, trismus, a deviated uvula and a muffled voice; treatment is drainage and antibiotics.
Self-check list
| Can you say, in one sentence each... | Mark |
|---|---|
| How you separate the main causes of a red eye by pain, vision and pupil | red, amber or green |
| How diabetic retinopathy is staged and what each stage needs | red, amber or green |
| Which ear findings suggest cholesteatoma or intracranial spread | red, amber or green |
| How you manage an airway foreign body in a child | red, amber or green |
Links to other domains
Eye and ENT draw on applied anatomy (cranial nerves, head and neck), medicine (diabetes, hypertension, neurology) and physiology (special senses). The Step II OSCE has one station in each discipline; see the Step II guide.
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Frequently asked questions
How many eye and ENT questions are in NRE Step I?
PM&DC's blueprint gives ophthalmology 6 and ENT 6 items, so about 12 of 200, or 6% of the paper.
Are ophthalmology and ENT separate in the NRE?
They are listed as separate disciplines in the blueprint. We present them on one page because they are revised together and each carries six items.
Which eye topics are most likely to be tested?
The red eye, glaucoma, cataract, diabetic and hypertensive retinopathy, trachoma, retinal detachment and sudden visual loss are the core topics in the standard scope. PM&DC publishes no topic frequency.
Which ENT topics should I know?
Otitis media and its complications, hearing loss and vertigo, epistaxis, sinusitis, tonsillitis and peritonsillar abscess, airway obstruction and tracheostomy, neck swellings and deep neck space infections.
Is there an eye station and an ENT station in Step II?
Yes. The Step II OSCE includes one ophthalmology station and one ENT station among its 20 stations.
Is the eye and ENT syllabus published in full?
Not in the copy of the 2024 PM&DC document that we read, so our topic list follows the standard Pakistani MBBS scope. Check the PDF on pmdc.pk.