ENT

Question 1

common cause of facial cellulitis

Answer 1

S aureus

S pyogenes

Question 2

how to tx facial cellulits

Answer 2

oral therapy( clindamycin, dicloxacillin, or cephalosporins) suspected MRSA(Bactrim, clindamycin, doxycycline, minocycline) IV(vancomycin, clindamycin)

Question 3

erysipelas

Answer 3

• Superficial form of cellulitis involving the epidermis, upper levels of the dermis and lymphatics(cellulitis can go as deep as the muscle)
• Red(fiery) raised, puffy appearance with sharp defined palpable borders

Question 4

how to tx erysipelas

Answer 4

PO penicillin, augmentin, Keflex, dicloxacillin,
Bullous erysipelas-Bactrim, clindamycin, doxycycline, or minocycline
IV vancomycin, nafcillin, clindamycin
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Question 5

how to tx bullous impetigo

non-bullous

Answer 5

• dicloxacin, augmentin, Keflex. If MRSA is suspected clindamycin or bactrim
• mupirocin

Question 6

what to do if you suspect pre/post septal cellulitis?

Answer 6

DX to r/o postseptal cellulitis is made with CT scan with* or without contrast

Question 7

how to tx otitis externa

Answer 7

Tx- analgesia; Oflacin drops, acetic acid/hydrocortisone drops(CANT HAVE PERF)or ciprofloxacin/hydrocortisone drops(CANT HAVE PERF)

Question 8

Life threating infection that occurs in the auditory canal with extension to the skull base. Most commonly effecting elgerly, diabetic and immunocompromised

Answer 8

malignant otitis externa, caused by P aeruginosa

Tombramycin IV and Piperacillin/ceftriaxone/ciprofloxacin IV

Question 9

MCC otitis media and its tx

Answer 9

S. Pneumo

Amoxicillin, azithromycin or cefuroxime

Question 10

lateral sinus thrombosis

Answer 10

When infection and inflammation extends to the lateral and sigmoid sinuses

Sxs- HA, papilledema, 6th nerve palsy, and vertigo

Question 11

bullous myringitis

Answer 11

• Bulla on the TM and deep EAC
• Viruses, mycoplasma pneumonaie, and chlamydia psittaci
• tx w/pain control

Question 12

most nose bleeds occur where?

Answer 12

M/C digital trauma  90 % are anterior usually from kiesselbachs plexus

Question 13

how to tx a nosebleed

Answer 13

Have patient blow their nose to dislodge any clots. Then instill oxymetazoline or phenylephrine 2 sprays. Inspect after.
Have patient apply external pressure for 15-20 mins CONTINUOUSLY. Re-examine and repeat if necessary

Question 14

if you pack a nose, what must you use?

Answer 14

antibiotics (augmentin)

Question 15

MC precipitating factors for sinusitis

Answer 15

Viral URI and allergic rhinitis

Question 16

hwo to tx sinusitis

Answer 16

nasal irrigation and nasal decongestants. Antibiotics are usually saved for patients who have symptoms for 7 days or more. 10days of Augmentin/Bactrim/erythromycin/levaquin

Question 17

fever, sore throat, odynophagia, trismus, dysphagia, and potentially muffled voice(hot potato voice

Answer 17

peritonsilar abscess

Dx- needle aspiration, CT** or US

Question 18

High fever, Sore throat, Drooling*, Stridor/respiratory distress, Cough maybe absent/muffled, MAY APPEAR IN A TRIPOD POSITION

Answer 18

epiglottitis

Question 19

how to tx epiglottitis

Answer 19

Tx-Keep patient seated upright and provide O2 , Intubation?, ADMINISTER NEBULIZED RACEMIC OR L-EPINEPHRINE for severe cases, Methlprednisolone every 6 hours or dexamethasone, ENT consult, ceftriaxone IV

Question 20

Sxs- sore throat, fever, torticollis, and dysphagia, muffled voice, cervical adenopathy, and respiratory distress. Stridor in children

Answer 20

retropharyngeal abscess

CT of neck is gold standard

start clinda or unasyn

Question 21

how to tx airway angioedema

Answer 21

Epinephrine IM, Benadryl, methylprednisone, Pepcid/ranitidine
If it is ACE inhibitor induced Berinert 20 units per kg and Ecallantide 30 mg sub q