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EENT & Neuro Flashcards

1
Q

Hordeolum (Management)

A

Hot Compress

Refer to ophthalmologist for I&D if not resolved in 2 days

Consider topical bacitracin or erythromycin ointment **(PEDS)

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2
Q

Chalazion (Management)

A

Warm Compress & Referral for surgical removal (I&D) (Adults & Peds)

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3
Q

Blepharitis (Management)

A
  1. Hot compress
  2. Topical ABX (Bacitracin/erythromycin)
  3. Vigorously scrub lashes & lid margins then rinse
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4
Q

Conjunctivitis (Chemical)- Management

A

Flush with normal saline

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5
Q

Conjunctivitis (Bacterial)- Management

A
  1. ABX ointment/drops solution
    - levofloxacin, ofloxacin, ciprofloxacin
    - tobramycin, gentamicin
  2. Refer to ophthalmologist (If recurrent)
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6
Q

Conjunctivitis (Gonococcal)-Management

A

Refer to Ophthalmologist

Ceftriaxone 1 gram IM + Azithromycin 1 gram PO

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7
Q

Conjunctivitis (Chlamydial)-Management

A

Doxycycline 100mg BID x10 days OR Azithromycin 1 gram single dose

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8
Q

Conjunctivitis (Allergic)-Management

A

Oral antihistamines
OR
**Refer to allergist/ophthalmologist **

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9
Q

Conjunctivitis (Viral)-Management

A

Symptomatic Care

  1. Preservative-free artificial tears
  2. Cool compress
  3. NSAIDS

No school until symptoms resolves

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10
Q

Conjunctivitis (Herpetic)-Management

A

REFER to ophthalmologist

Oral antiviral (Acyclovir) + LONG-term follow-up

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11
Q

Cataracts- Management

A
  1. Refer to ophthalmologist
  2. Sugery
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12
Q

Glaucoma (Open-Angle/Chronic)-Managment

A
  1. Prostaglandin analogs
    - latanoprost, bimatoprost, tafluprost,travoprost, & latanoprostene bound
  2. Alpha 2-adrenergic blockers
    - Brimonide, Alphagan
  3. Beta-adrenergic blockers
    - Timolol
  4. Miotic agent
    - Pilocarpine
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13
Q

Glaucoma (Closed-Angle/Acute)-Managment

A
  1. Carbonic anhydrase inhibitor
    - Acetazolamide (Diamox)
  2. Osmotic diuretics
    - Mannitol
  3. Surgery
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14
Q

Retinal Detachment-Management

A

Referral for Surgery

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15
Q

Otitis Externa (Swimmers Ear)-Management

A
  1. Cleansing & Debridement of ear
  2. Topical (optic)Drops
    - Hydrocortisone/neomycin,polymyxin (Cortisporin otic)
  3. Pain control
    -*NSAIDs & Topical corticosteroids *
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16
Q

Otitis Media & Serous Otitis Media-Management

A
  1. Spontaneous resolution (uncomplicated cases)

OR

  1. Hydration
  2. Avoidance of irritants
  3. Topical or oral decongestants, and cool mist humidifiers.

Bacterial cases(Suspected) TX: Amoxicillin-clavulanate or Cephalosporin (cefdinir, cefpodoxime, or cefuroxime)

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17
Q

Cholesteatoma- Management

A

Refer for Surgery

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18
Q

Vertigo-Management

A
  1. Diazepam (Valium)
  2. Meclinzine hydrochloride (Antivert)
  3. Diphenhydramine (Benadryl)
  4. Scopolamine transdermal patch
  5. Antiemetics
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19
Q

Hearing Loss (Conductive) - Management

A
  1. Clear canal
  2. Treat underlying cause
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20
Q

Hear Loss (Sensorineural)-Management

A

Refer

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21
Q

Common Cold-Management

A
  1. Supportive care
  2. Hydration, steam/humidifier
  3. Tylenol, Motrin, Advil (Fever /Pain)
  4. Warm salt-water gargles.
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22
Q

Pharyngitis/Tonsillitis-Management

A
  1. Fluids/hydration
  2. Salt water gargles
  3. Tylenol
  4. Streptococcal (ABX)
    - PCN V, Amoxicillin (PCN allergies: Cephalexin, Cefadroxil, Clindamycin, Azithromycin, Clarithromycin)
  5. Gonococcal (ABX)
    Cetriaxone
  6. Refer
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23
Q

Influenza-Management

A
  1. Supportive Care
  2. Neuraminidase inhibitors
    - Oseltamivir (Tamiflu): Oral, Zanamivir (Relenza): Inhaler Influenza A&B
  3. Polymerase acidic (PA) endonuclease inhibitor
    -Baloxavir marboxil (Xofluza): Single oral dose
24
Q

Mononucleosis- Management

A
  1. Supportive care (rest and hydration)
  2. Avoid contact sports (3 weeks to months) * Even without clinical detectable splenomegaly*

Severely enlarged tonsils give Prednisone/steroid taper

25
Q

Nose Bleeds- Management

A
  1. Sit upright
  2. Constant pressure to the nose
  3. Apply ice
26
Q

Sinusitis (Rhinosinusitis)-Management

A
  1. Hydration
  2. Intranasal saline irrigation
  3. Intranasal corticalsteroids.
  4. Analgesics
  5. Bacteria cases: ABX
    - Amoxicillin-clavulante (Augmentin)
    (Doxycycline for PCN allergies)
  6. Supportive care
27
Q

Tension Headache-Management

A
  1. Over-the-counter analgesics
  2. Relaxation
28
Q

Migraine Headaches- Management

A
  1. Avoidance of triggers
  2. Relaxation (stress management.)
  3. Prophylactic therapy
29
Q

ACUTE ATTACK: Migraine Headaches- Management

A
  1. Rest and dark & quiet room.
  2. Simple analgesic (ASA)
    -* Take right away to provide some relief*
  3. Sumatriptan (Imitrex) 6mg SQ at onset, may repeat in one hour (3x per day)
  4. Sumatriptan (Imitrex) 25mg orally at onset of headache
30
Q

Prophylactic daily therapy: Migraine Headaches- Management

A

Anticonvulsants:
Topiramate (Qudexy XR, Topamax), valproic acid (Depakene, Depakote)

Beta blockers:
Atenolol (Tenormin), metoprolol (Lopressor, Toprol XL), nadolol (Corgard), propranolol (Inderal, Inderal LA, Inderal XL, InnoPran), timolol

Botulinum toxin (Botox):
Injecting small amounts around the face and scalp every 3 months, only approved for patients with at least 15 headaches/month

Calcium channel blockers:
Diltiazem (Cardizem, Cartia, Tiazac) and verapamil (Calan, Covera HS, Verelan)

Tricyclic antidepressants (TCAs):
Amitriptyline (Elavil) or nortriptyline (Aventyl, Pamelor)

Calcitonin gene-related peptide (CGRP) inhibitors:
Eptinezumab (Vyepti), erenumab (Aimovig), fremanezumab (Ajovy), and galcanezumab (Emgality)

NSAIDs and certain triptans:
NSAIDs such as naproxen or certain triptans may be especially useful in treating women with migraines that occur in association with the menstrual cycle.

31
Q

Cluster Headaches-Management

A
  1. 100% Oxygen
  2. Sumatriptan (Imitrex)6mg SQ
32
Q

Transient Ischemic Attack (TIA)-Management

A
  1. Asprin
  2. Clopidogrel (Plavix) 75mg PO daily
  3. Carotid Endarterectomy 1st TX for:
    -* Symptomatic low rise surgical patients with 50% to 90% stenosis*
    - * Asymptomatic patients with > 70% to 99% stenosis*
33
Q

Seizures- Management

A
  1. Maintain open airway
  2. Protect patient from injuring
  3. Administer oxygen if needed
  4. Parenteral Benzodiazepines
    - Diazepam (Valium) or Lorazepam (Ativan) are used to acutely stop seizures
  5. Seizure Prevention Maintenance Drugs
34
Q

Parkinson’s Disease- Management

A
  1. Carbidopa-Levodopa (Sinemet)
  2. Dopamine agonists (mimic dopamine):
    - Pramipexole (Mirapex), Ropinirole (Requip), Rotigotine (Neupro)
  3. MAO-B inhibitors (help to prevent the breakdown of dopamine):
    - Selegiline (Eldepryl, Zelapar), Rasagiline (Azilect), Safinamide (Xadago)
35
Q

Alzheimer’s Disease- Management

A
  1. Neurological consult
  2. Cholinesterase inhibitors (increase the availability of acetylcholine):
    - Donepezil (Aricept), Galantamine (Razadyne), Rivastigmine (Exelon)
    - Cholinesterase inhibitors + NMDA receptor antagonists memantine (Namenda) to decrease symptoms.
  3. Refer patient/family for counseling as appropriate
36
Q

Myasthenia Gravis-Management

A
  1. Neurology referral
  2. Anticholinesterase drugs
    - * pyridostigmine bromide (Prostigmin)*
    Blockthe hydrolysis of acetylcholine and are used for symptomatic improvement
  3. Immunosuppressives
  4. Plasmapheresis
  5. Ventilator support may be needed during a crisis
37
Q

Multiple Sclerosis-Management

A
  1. Neurology referral
  2. Steroids
  3. Antispasmodics
  4. Interferon therapy
  5. Immunosuppressive therapy
  6. Plasmapheresis
38
Q

Bell’s Palsy-Management

A
  1. Prednisone 60 mg divided in 4 to 5 doses daily and tapered over 7 to 10 days
  2. Acyclovir [when facial palsy caused by varicella zoster infection (Ramsay Hunt syndrome)
  3. Lubricating eye drops and patch at night if unable to close
  4. Neurology referral as needed
39
Q

Trigeminal Neuralgia-Management

A
  1. Anti-seizure drugs
    - Carbamazepine (Tegretol)
  2. Muscle relaxants
    - Soma/Flexeril
  3. Tricyclic antidepressant
    - Elavil (Amitriptyline)
40
Q

Tic Disorders- Management (Peds)

A

Collaboration with Neurology

41
Q

Neurofibromatosis-Management (Peds)

A
  1. Refer to neurology
  2. Routine screening as directed by neurology (BP & Head circumference)
  3. Genetic counseling.
42
Q

Febrile Seizure-Management (Peds)

A

GOALis to ensure child SAFETYand decrease ASSOCIATED FEVER.

  1. Protect airway
  2. Place in side-lying position in a safe place
  3. Cooling measures (e.g., tepid bath, remove blankets or warm clothes)
  4. Antipyretics: Acetaminophen (15 mg/kg/dose) or ibuprofen (5-10 mg/kg/dose)
43
Q

Brain Tumor-Management (Peds)

A
  1. CT scan
  2. MRI
    preferred over CT scan when available
  3. Lumbar puncture (LP)
    Only after imaging has been done to show safety
44
Q

Seizures-Management (Peds)

A

Initial management is supportive as most seizures are self-limiting.

  1. Supportive Care
    Maintain airway, protect from injuries, administer oxygen if needed
  2. Parenteral Anticonvulsants (If IV access available)-Benzo’s 1st Line
    Lorazepam (Ativan), midazolam (Versed), or diazepam (Valium) If Benzo’s ineffective: fosphenytoin, levetiracetam, valproic acid, lacosamide If Benzo’s ineffective
  3. Consider referral for all unprovoked seizures or if the following occur
  4. Primary care follow-up
  5. Neurology consult
45
Q

Migraines & Tention HA-Management (Peds)

A
  1. Avoidance of trigger factors
  2. Create headache diary
  3. Headache hygiene
    Balanced diet, avoid skipping meals, proper hydration, aerobic exercise, regular sleep, limited screen time
  4. Relaxation/stress management techniques
    Counseling & biofeedback
  5. Consider massage therapy (Migraines)
  6. Limit/avoid caffeine intake
  7. Prophylactic therapy if attacks occur more than 4 times per month, or if headaches interfere with daily functioning or school
    Cyproheptadine (Periactin), Amitriptyline (Elavil),Topiramate (Topamax)
  8. Abortive therapy
    Rest & Naproxen sodium is preferred over acetaminophen or ibuprofen; taken at onset of headache
    Antiemtics & Triptans *(For Migraines)
46
Q

Infectious mononucleosis – Management (Peds)

A
  1. Supportive care
    NSAIDS & warm saline gargle etc.
  2. Oral cortical steroids
    * if enlarged lymph tissue threatens airway obstruction*
  3. Avoid contact sports (3wks to months)
    Even without clinically detectable splenomegaly
47
Q

Croup-Management (Peds)

A
  1. Outpatient supportive care (Mild disease)
  2. Hospitalize for respiratory support; IV fluids (Moderate disease)
  3. May require nebulized racemic epinephrine
  4. Short course of corticosteroids
48
Q

Epiglottitis – Management (Peds)

A

Do not perform a pharyngeal exam

  1. Immediate hospitalization + ABX TX
  2. Keep the child calm.
  3. Intubation capabilities as soon as possible
  4. IV third generation cephalosporin until pathogen identified
    (cefixime, cefdinir, ceftriaxone)
49
Q

Pharyngitis/Tonsillitis-Management (Peds)

A
  1. Supportive care
    Fluids/hydration, warm salt, water, gargles, antipyretics(Tylenol)
  2. Streptococcal infections ONLY
    Penicillin VK 250 mg orally 2-3 times daily X10 days (PCN allergies erythromycin succinate 20 mg/kg PO BID for 10 days)
    Return to school 12hrs post treatment
50
Q

Epistaxis (Nosebleed)-Management (Peds)

A
  1. Sit straight up
  2. Apply pressure at Kiesselbach’s plexus X10min.
  3. Apply ice
51
Q

Sinusitis (Rhinosinusitis)-Management (Peds)

A

Uncomplicated with mild symptoms, treat as outpatient

  1. Amoxicillin-clavulanate X10 days; change to broad-spectrum beta-lactam-stable antibiotic if no improvement in 3 days
  2. Decongestants and antihistamines are not useful in acute sinusitis but maybe used in chronic sinusitis.
  3. Pain managed with acetaminophen
  4. Nighttime humidification to reduce mucosal drying
  5. Supportive care

Chronic, refractory, or recurrent sinusitis: Refer to ENT/otolaryngology

52
Q

Common cold-management (Peds)

A
  1. Rest and hydration
  2. Nasal saline drops & humidifier
  3. OTC cold preparations
    Decongestants, antihistamines, antitussives, expectorants
  4. No antibiotics
  5. Pain and fever management.
    Tylenol or ibuprofen
53
Q

Allergic rhinitis-Management (Peds)

A
  1. Avoid allergens
  2. 2 gen. oral antihistamines
    Cetirizine, Loratadine, Fexofenadine
  3. Nasal cortical steroids
    Budesonide, Fluticasone
54
Q

Hearing Loss-Management (Peds)

A
  1. remove foreign body/cerumen
  2. Refer for audiogram
  3. Refer for further eval/hearing aid.
55
Q

Serous Otitis Media/OM with Effusion-Management (Peds)

A
  1. Watch for monitoring (3mths)
  2. Antibiotic therapy
  3. Antihistamines/congestions: Ineffective
  4. Re-evaluation in 3-6 months.
56
Q

Cataracts-Management (Peds)

A

Refer for surgical removal

57
Q

Strabismus-Management (Peds)

A

Refer to ophthalmology
* it fixed or continuous at six months or older*
Immediately for hypertropia and hypertropia
Signs of underlying causes present (neurological issues)

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