ENT

Question 1

Tx of Sinusitis

Answer 1

Amox-clavulanic acid

Doxy

Bactrim

+ decongestant

Question 2

How does a cavernous sinus thrombosis present? How do you treat it?

Answer 2

Sinusitis + ocular cranial nerve involvement (run through sinus)

Tx = vancomycin + ceftriaxone + anaerobe coverage + steroids for dec inflammation

Question 3

Anterior v. Posterior Epistaxis Tx

Answer 3

Anterior (90%) - blow, nose, hold for 5 min, silver nitrate, phenylephrine or oxymetazoline

Posterior (5-10%) - SERIOUS ARTERIAL BLEED; pack it then give cephalexin for staph coverage / prevent toxic shock

Question 4

Tx of OM v. OE v. Malignant OE

Answer 4

OM - oral abx (amoxicillin)

OE - topical abx (polymyxin, quinolones, gentamicin) + topical hydrocortisone

Malignant OE - IV abx (pseudomonas coverage- esp cipro)

Question 5

What is the most sensitive physical exam finding for OM?

Answer 5

Immobility of TM

Question 6

Perilymph Fistula

Answer 6

Vertigo associated w/ barotrauma

Tx is surgical exploration, close the oval window

Question 7

Lemierre Syndrome

Answer 7

Fusobacterium necrophorum spreads from pharynx/parotids/mastoids –> neuromuscular bundle around jugular vein –> bacteremia

Dx = CT neck

Tx = amp sulbactam or piperacillin-tazo + beta lactase inhibitor

Question 8

Ludwig Angina

Answer 8

Cellulitis of floor of mouth

From spread of oral flora / dental infection

Present w/ tongue swelling that can block airway

Dx = CT neck

Tx = same as Lemierre (amp sulbactam or piperacillin-tazo + beta lactase inhibitor)