USMLE Step 3 ENT Notes

  • Preseptal cellulitis: erythema/swelling of eyelid, chemosis, fever, leukocytosis  Tx with oral antibiotics  clindamycin, OR TMP-­‐SMX + either amoxicillin, augmentin, cefpodoxime, or
  • Orbital (postseptal cellulitis): Sx of preseptal cellulitis + ophthalmoplegia, change in visual acuity, diplopia, proptosis. Tx with intravenous antibiotics  vancomycin PLUS either ceftriaxone, cefotaxime, ampicillin/sulbactam, or pipericillin/tazobactam.
  • Complications of orbital cellulitis are 1) orbital abscess, 2) intracranial infection, and cavernous venous sinus thrombosis
  • Cavernous venous sinus thrombosis presents like orbital cellulitis, but there’s also papilledema + dilated tortuous retinal veins. Patients also frequently present with headache. If there is a patient who appears to have orbital cellulitis, but also has headache, bilateral eye involvement, and/or numbness in the area of CN V1/V2, think cavernous venous sinus thrombosis. The next best step in management to diagnose is magnetic resonance venography.
  • Tx for blepharospams (which can present as prolonged closure of an eye, especially upon stimulation) is botulinum toxin injection.
  • Three drugs can be used as alternatives to amoxicillin in acute otitis media (e.g., in persistent/recurrent infection): amoxicillin-­‐clavulanate, cefuroxime axetil, or intramuscular ceftriaxone.
  • After treatment for acute otitis media, effusion in the middle ear may persist for up to three months. Otitis media with effusion (OME) is an effusion without other signs of otitis media. Tx is “watchful waiting” as OME often self-­‐resolves in six weeks.