STEP2 > ENT > Flashcards

ENT Flashcards

(17 cards)

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1
Q

Describe diagnostic testing used for sinusitis.

A
  • best initial test is CT if asked but rarely necessary

- most accurate test is biopsy but only needed if there are frequent recurrences or no response to empiric therapy

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2
Q

Describe the etiology, presentation, diagnosis, and treatment of cavernous sinus thrombosis.

A
  • most often due to Staph, Strep, or anaerobic organisms that spread from the adjacent sinus
  • presents with fever, headache, ptosis, proptosis, and abnormal ocular movements in someone with a history of recent sinusitis
  • best initial test is a CT or MRI with contrast
  • treat with vancomycin and ceftriaxone
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3
Q

What is Tolosa-Hunt syndrome and how is it diagnosed and treated?

A
  • it is granulomatous inflammation of the cavernous sinus
  • diagnosed with MRI
  • treated with steroids
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4
Q

What is the difference between an anterior and a posterior epistaxis?

A
  • anterior are far more common and bleeding is from Kiesselbach’s venous plexus
  • posterior are less common but more dangerous because they are arterial bleeds
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5
Q

How is a posterior epistaxis treated?

A
  • requires packing

- after bleeding is controlled, give cephalexin to prevent Staph toxic shock syndrome

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6
Q

Describe the presentation, diagnosis, and treatment of otitis media.

A
  • presents with redness, immobility, bulging, and a decreased light reflex of the tympanic membrane
  • in most cases it is a clinical diagnosis but tympanocentesis and culture is the most accurate for recurrent otitis media
  • treat with amoxicillin or azithromycin
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7
Q

Describe the pathogenesis, presentation, and treatment of otitis externa.

A
  • it is a cellulitis of the skin of the EAC caused by water exposure which raises the pH and facilitates bacterial growth
  • presents with pain on moving the tragus and erythema or discharge within the EAC
  • treat with topical neomycin-polymyxin, topical quinolones, or gentamicin; hydrocortisone drops will reduce pain
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8
Q

What is the treatment treatment for each fo the following ear infections:

  • otitis media
  • otitis externa
  • malignant external otitis
  • mastoiditis
A
  • otitis media: amoxicillin or azithromycin
  • otitis externa: topical neomycin-polymyxin, quinolones, or gentamicin
  • malignant external otitis: ciprofloxacin, cefepime, or anti-pseudomonal penicillins like piperacillin
  • mastoiditis: ceftriaxone or levofloxacin
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9
Q

What is the treatment for malignant external otitis?

A

it is typically due to pseudomonas so use ciprofloxacin, piperacillin, or cefepime

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10
Q

Describe the etiology, presentation, complications, diagnosis, and treatment of mastoiditis.

A
  • due to the same organisms as otitis media: Strep pneumo, Hib, and Moraxella
  • presents with mastoid tenderness
  • may be complicated by hearing loss and meningitis
  • initially diagnosis is with CT or MRI and it is treated with ceftriaxone or levofloxacin
  • for recurrent or chronic infection, get a biopsy and treat with vancomycin and piperacillin
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11
Q

Describe the presentation, diagnosis, and treatment of labyrinthitis.

A
  • presents with acute hearing loss, tinnitus, vertigo, and nystagmus in patients with a recent viral illness
  • there are no specific diagnostic tests but a head impulse test will be positive
  • treat with steroids and meclizine
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12
Q

Describe the presentation and treatment of Meniere disease.

A
  • presents with chronic hearing loss, tinnitus, vertigo, nystagmus, and a feeling of fullness in the ear
  • treat with sodium restriction and carbonic anhydrase inhibitors
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13
Q

Describe the pathophysiology, presentation, and treatment of perilymph fistula.

A
  • it is a leaking hole in the oval window of the inner ear
  • presents with nystagmus and vertigo in a patient with a history of barotrauma or exposure to explosions
  • treat surgically
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14
Q

Describe the etiology, presentation, diagnosis, and treatment of Lemierre syndrome.

A
  • it is an expansion of Fusobacterium necrophorum beyond the mouth to the neuromuscular bundle around the jugular vein
  • this contributes to sepsis in a patient with recent ENT infection
  • diagnosis is with CT of the neck
  • treat with ampicillin/sulbactam or piperacillin/tazobactam
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15
Q

Describe the presentation, diagnosis, and treatment of Ludwig angina.

A
  • it is a cellulitis of the floor of the mouth
  • best initial test is CT of the neck
  • treat with ampicillin/sulbactam or piperacillin/tazobactam
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16
Q

How is sialolithiasis treated?

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A

removal of the stone manually or with I&D, sialoendoscopy, or lithotripsy

17
Q

Describe the etiology, presentation, diagnosis, and treatment of sialadenitis.

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A
  • most commonly caused by S. aureus
  • presents with swelling, pain, and expulsion of pus which increase after meals
  • it is a clinical diagnosis supported by CT or US
  • treat with antibiotics, warm compresses, massage, and sour candy
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