Head and Neck Surgery, Laryngology, and Thyroid/Parathyroid
Core concepts
For head and neck oncology, know that squamous cell carcinoma is the dominant histology and that HPV status changes prognosis in oropharyngeal cancer (HPV-positive has better outcomes). Understand the neck lymph node levels and their drainage patterns to predict metastasis. In laryngology, distinguish benign from malignant vocal fold lesions and know that persistent hoarseness beyond a few weeks warrants laryngoscopy. Understand airway emergencies: stridor indicates upper airway obstruction and requires immediate assessment. For thyroid, know that most nodules are benign, that fine-needle aspiration is the diagnostic step, and that medullary carcinoma arises from parafollicular C cells and secretes calcitonin. Parathyroid disease: primary hyperparathyroidism causes hypercalcemia with elevated or inappropriately normal PTH.
Traps
Questions often confuse recurrent laryngeal nerve injury (hoarseness, aspiration) with superior laryngeal nerve injury (voice fatigue, pitch changes). Another trap is assuming all thyroid nodules need surgery-most require evaluation, not immediate resection. Also beware of attributing hypercalcemia to malignancy when primary hyperparathyroidism is the more common outpatient cause.
Worked example
A patient has a thyroid nodule and elevated calcitonin. This suggests medullary thyroid carcinoma. Rule of thumb: calcitonin elevation points to medullary carcinoma, not papillary or follicular.