EENT Clin Med

Difference between the presentation of CMV and Mono

Mono has lymphadenopathy and pharyngitis, CMV usually does not

At risk populations for CMV

Immunocompromised patients (organ transplant)

Neonates (C of TORCH)

Risks of CMV

Other organ system involvement

CMV treatment

Ganciclovir (or another -ciclovir)

Fever+Lymphadenopathy+pharyngitis

Epstein-Barr virus/ Mono

Patient presenting with a maculopapular rash after taking antibiotics

Likely Epstein-Barr Virus (Mono)

(patient was likely prescribed them for suspected strep throat)

Pathogen of EBV/Mono

Herpes 4

Risk of EBV/Mono, and counseling

Splenic rupture (from enlargement→trauma)

limit activity

Treatment of EBV/Mono

None; it’s self-limiting

Testing options for EBV/Mono

CBC with a smear (shows atypical lymphs)

Monospot (finger poke rapid test, high rate of false negatives)

gray membrane in throat. Low fever, cervical lymphadenopathy ("Bull neck")

Diptheria

Pathogen of diptheria

Diptheria (gram+)

Risks of diptheria

Chronic skin ulcers

Testing of diptheria

Cultures from the grey membrane or skin ulcers (PCR to determine if its toxigenic or not)

Treatment of Diptheria

Macrolide or PCN (along with antitoxin, if it's toxigenic)

Antibiotics if it’s solely cutaneous

Treatment of the close contacts of a diptheria patient

Erythromycin

Dysphagia, Drooling, Distress. Sore throat with pain out of proportion to exam

Epiglottitis

Epiglottitis pathogen

Haemophilus influ B (HIB vaccine)

Epiglottitis testing

Neck x-ray or CT (usually not done, out of urgency, though)

Epiglottitis treatments

SECURE AIRWAY

Ceftriax or Vanco (± Antipyretics)

no steroids (not useful)

Cough, rhinorrhea, pink eye, headache, rash. Condition and pathogen

Viral acute pharyngitis

acute, fever, tonsil exudate, scarlet fevers. No cough, no rhinorrhea. Condition and pathogen

Group A strep Acute pharyngitis

Risks of Group A strep Acute Pharyngitis

Post strep glomerulonephritis

Treatment for Acute Pharyngitis

Viral: fluids and rest

Strep: Penicillin (erythro as back-up)

Testing of Acute Pharyngitis

McIsaac score to determine whether to test

RADT or NAAT (both POC tests),

and in kids, culture if the POC is negative

Notable DDx of acute pharyngitis

Gonorrhea

3-7 days of sore throat and hoarseness

Laryngitis

Can’t-miss DDX of Laryngitis

Laryngeal cancer (Esp in smoking)

Sore throat/swallowing, drooling, trismus, "hot potato" voice, bilateral pain that then worsens and becomes unilateral. Uvular deviation on exam

Peritonsillar abscess

Causes/pathogens of peritonsillar abscess

Acute tonsillitis, Mono, or Group A Strep

Peritonsillar abscess testing

X-ray, CT, intraoral Ultrasound, culture if aspirate is purulent

Treatment of peritonsillar abscess

Drain with needle aspiration (make needle short; could puncture carotid)

Antibiotics (augmentin or Clinda, cover anaerobes), Dexamethasone

Trismus, swelling below mandible, bulging of pharyngeal wall, systemic sx (fever or rigors)

Deep neck space infections

Potential spaces of Deep Neck Space infections

Superficial, pretrachial, or prevertebral spaces

Risks of Deep Neck Space Infections

Sepsis traveling into the chest

Deep neck space infection treatments

Aspiration or surgical drainage, broad spectrum antibiotics (Vanco)

Purulent discharge, facial pain/pressure (especially with sinus percussion), congestion

Sinusitis

Difference between viral and bacterial Sinusitis

Viral resolves within 10d

vs

Bacterial lasts longer than 10d, double-worsening pattern (start to feel better, then feel worse), high fever, or facial pain at the very start

Acute bacterial sinusitis pathogens

strep, H Flu, Moraxella

Risks of sinusitis

Preseptal cellulitis, orbital cellulitis, subperiosteal or intracranial abscess, meningitis, septic cavernous sinus thrombosis, osteomyelitis

Treatment of viral or bacterial sinusitis

Viral: supportive (rinses, flonase/inhaled steroids, anticholinergic, oral decongestant)

Bacterial: after a few days of watchful waiting, amoxicillin, augmentin, or cef or doxy

No macrolide, no bactrim

BOTH are often self-limiting; watch for improvement after diagnosis before prescribing antibiotics

What does Rinne positive mean?

AC>BC (normal)

Swelling (hematoma) of the auricle after trauma

Traumatic aricular hematoma

Traumatic aricular hematoma treatment

incision&drainage with compression dressing

Painful red ear, often around a cut/scrape/piercing

Perichondritis

Perichondritis tx

antibiotics, maybe incision and drainage

Cerumen impaction tx

Debrox (detergent ear drops) and irrigation

Foreign bodies in ear tx

Mechanical removal or aqueous irrigation

Mineral oil to dislodge insect grip

erythema and edema of the ear canal, purulent exudate
tragus and pinna tender

Otitis externa

Otitis externa pathogens

Pseudomonas or fungi (no purulence)

risks of otitis externa

Osteomyelitis of skull base (malignant otitis externa)

diabetic/immunocompromised patients

Otitis externa treatment

ofloxacin drops (for pseudomonas or staph)

Malignant otitis externa treatment

ciprofloxacin, surgical skull debridement

Edematous, persistent foul aural discharge, granulations in ear canal, deep otalgia, progressive palsies of the cranial nerves
Osteomyelitis of the base of the skull (seen on CT)

Malignant otitis externa

TM retraction, aural "fullness", fluctuating hearing, popping with swallowing/yawning

Eustachian tube dysfunction

risks of Eustachian tube dysfunction

serous otitis media, barotrauma

treatments for eustachian tube dysfunction

decongestants, and if allergic, nasal corticosteroids

TM perforation treatment to AVOID

-mycins as ear drops

new otorrhea without otitis externa (through perforation)

moderate-to-severe TM bulging

mild TM bulging+recent onset pain or intense erythema

otalgia, hearing loss, otorrhea, pruritis, fever, nausea, URI

Acute Otitis media (purulent)

pathogens of Acute Otitis media (purulent)

Bacterial (strep pneuminae, h flu, moraxella)
Nonbacterial (viral)

Treatment of purulent acute otitis media

over 6mo& at risk, or over 2yo with severe sx: 10d amoxicillin or augmentin (+ probiotics to prevent GI sfx)
If TM tubes, use fluoroquinolone
if more than 4 infections in a year, ENT referral

Tx of serous acute otitis media

Decongestants (treat eustachian tube dysfunction

asymptomatic, maybe hearing loss, no inflammation, serous middle ear fluid

serous acute otitis media

Can be asymptomatic
Tenderness, erythema, swelling, fluctuation behind the ear
Ear discharge, pain, hearing loss
Lethargy, fever, and nausea
Bulging TM, middle ear effusion, perforation; Normal appearing TM generally excludes this condition

mastoiditis

Common pathogen of mastoiditis

Pseudomonas

Epitympanic retraction pocket or a marginal

tympanic membrane perforation that exudes keratin debris or

granulation tissue

Cholesteatoma

crusty, dusty lid margins

Blepharitis

Stye-acute tender localized eyelid lesion

Hordeolum

Hordeolum pathogen

Staph

Firm chronic eyelid nodule (may result from a stye)

Chalazion

Eyelid turned in

Entropion

Eyelid turned out

Ectropion

Inflammation of lacrimal glad (swelling of upper outer eyelid)

Dacryoadenitis

Infection/inflammation of the lacrimal sac (lower, inner side of eye)

Dacryocystitis

Dacryoadenitis vs Dacryocystitis

Adenitis-gland (right under eyebrow)

Cystitis-sac (next to nose)

Treatment for Dacrocystitis

Antibiotics

Obstruction of tear drainage system (tear overflow, mucoid discharge)

Dacryostenosis

Dacryocystosis vs Dacryostenosis

cystosis: swelling, etc

stenosis: tear overflow

Dry eye (leading to red, inflamed eye)

Keratoconjunctivitis Sicca

Most common cause of Keratoconjunctivitis Sicca

autoimmune disease

Benign triangular growth extending towards the cornea

Pterygium

Pterygium risk factors

UV exposure, wind, dust, dryness

Infection of the cornea (corneal clouding, photophobia, red eye)

Infectious keratosis

Diagnosis of Infectious Keratitis

Slit-lamp, fluorescin, ±corneal scraping for culture

Most common pathogen of infectious keratosis+ treatment

HSV; -ciclovir

Treatments for infectious keratitis

Bacterial: Fluoroquinolone

HSV: -ciclovir

Fungal: Natamycin

Contact lens user with a painful red eye. Corneal infiltrate/opacity

Bacterial infectious keratitis

Pathogen of herpetic keratitis

Herpes Simplex Virus in trigeminal nerve

Corneal opacity or scarring, dendritic corneal ulcer, unilateral eye pain/redness

Herpetic Keratitis

Photophobia, small or irregular pupil, cells/flare on slit lamp

Anterior Uveitis/Iritis

Treatment of Anterior Uveitis/Iritis

Corticosteroids

Very painful red eye; severe, deep pain worsened when eye moves

Scleritis

Gradual loss of peripheral vision

Chronic Open-angle Glaucoma

Nausea/headaches, halos around light, abnormal pupil, cloudy cornea, high IOP

acute closed-angle glaucoma

Diagnosis and treatment of acute closed-angle glaucoma

Elevated IOP

topical beta-blockers or alpha-2 agonists

laser peripheral iridotomy, once possible

Painless peripheral vision loss with optic-disk cupping

Chronic open-angle glaucoma

Chronic open-angle glaucoma treatments

Prostaglandin-analog eye drops

Selective laser trabeculoplasty

Recent eye surgery+vision loss+hypopyon

Endopthalmitis

White area in iris; WBC in anterior chamber

Hypopyon

Endopthalmitis treatments

intravitreal antibiotics (vanco+ceftrazidime)