General Surgery
Core concepts
Understand the principles of wound healing, including primary, secondary, and tertiary intention, and the factors that impair healing (diabetes, steroids, ischemia, infection). Know the basics of fluid and electrolyte management, particularly perioperative sodium and potassium disturbances. Be familiar with the approach to acute abdomen, hernia, and thyroid surgery complications. Understand the principles of asepsis and surgical site infection prevention.
Traps
A frequent trap is attributing postoperative fever to infection on the first day; early fever is more often due to atelectasis or a drug reaction, while infection typically appears later. Another is confusing hypovolemic and septic shock in the postoperative patient. Questions on thyroid surgery often test postoperative hypocalcemia from parathyroid injury and recurrent laryngeal nerve injury. Do not forget that a tension pneumothorax is a clinical diagnosis requiring immediate decompression.
Worked rule
For postoperative fever, use the timing to guide the differential: day 1–2 atelectasis, day 3–5 urinary or line infection, day 5–7 wound infection or abscess.
Medicine
Core concepts
Know the medical conditions that affect ENT patients: diabetes and its impact on infection and wound healing, hypertension and epistaxis, anticoagulation and bleeding risk, and autoimmune diseases such as granulomatosis with polyangiitis and sarcoidosis that can present with sinonasal or laryngeal disease. Understand the basics of acid-base and electrolyte disorders and the recognition of sepsis. Be familiar with the pharmacology of common ENT medications, including corticosteroids, antihistamines, and antibiotics.
Traps
A common trap is missing a systemic disease presenting in the head and neck, such as GPA with crusting epistaxis and septal perforation. Another is attributing all dizziness to a vestibular cause when it may be orthostatic or cardiac. Questions on anticoagulation often test the need to balance bleeding risk against thrombotic risk before surgery. Do not forget that steroids can mask infection and impair wound healing.
Worked example
A patient with epistaxis and a septal perforation plus renal impairment should raise suspicion for granulomatosis with polyangiitis; the next step is ANCA testing and urgent rheumatology referral rather than repeated cautery.
Critical Care
Core concepts
Understand the recognition and management of the airway in the critically ill, including the difficult airway algorithm, rapid sequence intubation, and the role of surgical airway. Know the principles of mechanical ventilation and the recognition of ventilator-associated pneumonia. Be familiar with the management of sepsis, shock, and acute respiratory distress syndrome. Understand the postoperative care of the head and neck patient, including tracheostomy care and monitoring for airway compromise.
Traps
A frequent trap is delaying a surgical airway in a cannot-intubate, cannot-ventilate situation; cricothyrotomy is the rescue. Another is missing airway compromise after neck surgery because stridor is a late sign. Questions on tracheostomy often test the difference between early and late complications, and the management of accidental decannulation. Do not forget that a patient with a fresh tracheostomy who decannulates should have the stoma covered and be ventilated by mask while help arrives.
Worked rule
For any postoperative head and neck patient with increasing neck swelling, stridor, or respiratory distress, assume airway compromise and prepare for immediate airway control rather than waiting for imaging.