ENT Flashcards
A 34-year-old woman presents with facial pain, discolored nasal discharge, bad taste in her mouth, and fever. On physical examination she has facial tenderness.
Which of the following is the most accurate diagnostic test?
a. Sinus biopsy or aspirate
b. CT Scan
c. X-Ray
d. Culture of the discharge
e. Transillumination
A. Remember that in infectious diseases, the radiologic test is never “the most accurate test.” Only a biopsy or aspirate can give you a precise microbiological diagnosis. There is a difference between a question that says, “What is the most accurate test?” and one that asks, “What will you do?” CT Scan is the most common wrong answer to this question. You cannot stain or culture a CT scan.
A 34-year-old woman presents with facial pain, discolored nasal discharge, bad taste in her mouth, and fever. On physical examination she has facial tenderness.
What is the most appropriate next step OR action OR management?
a. Linezolid
b. CT Scan
c. X-Ray
d. Amoxicillin/clavulanic acid and a decongestant
e. Erythromycin and a decongestant
D. When the diagnosis is as clear as in this case, radiologic testing is unnecessary. Amoxicillin/clavulanic acid, doxycycline, and trimethoprim/sulfamethoxazole remain first-line therapy for both otitis and sinusitis. The efficacy of these agents is the same as newer or more “broad spectrum” agents such as quinolones. Imaging is done if the diagnosis is equivocal. A decongestant is used in all cases to promote sinus drainage.
Erythromycin is inadequate because of poorer coverage for Streptococcus pneumoniae. Linezolid, although excellent for resistant gram-positive organisms, would not cover Haemophilus. Antibiotics are rarely needed, because most cases are viral in etiology. Antibiotics are used with fever and discolored nasal discharge.
This is a venous drainage system that receives venous drainage from the face, nose, orbits, and tonsils.
Cavernous sinus
Patient presents with a history of sinusitis and diplopia with the inability to move the eyes normally on examination. What is the most likely diagnosis?
Cavernous Sinus Thrombosis
What is the best initial test for Cavernous Sinus Thrombosis?
CT or MRI with contrast showing the thrombosis
What is your best treatment option for Cavernous Sinus Thrombosis?
Ampicillin/Sulbactam with Vancomycin
This is a granulomatous inflammation of the cavernous sinus with ophthalmoplegia. Patient presents with eye pain and paralysis of the same cranial nerves (III,IV, and VI).
Tolosa-Hunt Syndrome
These are the cranial nerves affected in cavernous sinus thrombosis.
CN III, IV, VI
How would you diagnose Tolosa-Hunt Syndrome?
MRI
How would you treat Tolosa-Hunt Syndrome?
Steroids
90-95% of epistaxis are anterior, venous bleeds of the ________.
Kiesselbach venous plexus.
This presents with redness, immobility, bulging, and a decreases light reflex of the tympanitic membrane. Pain is common. Decreased hearinf and fever also occur.
Otitis Media
Which of the following is the most sensitive physical finding for otitis media?
a. Redness
b. Immobility
c. Bulging
d. Decreased light reflex
e. Decreased hearing
B. Immobility is so sensitive a physical finding that a fully mobile tympanitic membrane essentially excludes otitis media
This is the most accurate diagnostic test for otitis media.
Tympanocentesis for a sample of fluid for culture
This is the best initial therapy for otitis media.
Amoxicillin
This is a cellulitis of the skin of the external auditory canal, also known as “swimmer’s ear.” Exposure to water raises the pH of the canal, facilitating bacterial growth. Maceration of the canal with cotton swabs also promotes bacterial growth. There is pain in moving the tragus.
Otitis Externa
How would you treat Otitis Externa?
- Topical neomycin-polymyxin, topical quinolones, or gentamicin
- Hydrocortisone ear drops to decrease inflammation and relieve pain
- Removing desquamated skin and cerumen will make it easier to disinfect the ear canal
