ENT

Question 1

Group A Strep Pharyngitis (GAS)

Answer 1

TX:
(adult) Penicillin VK 500mg po bid x 10 days OR amoxicillin 500mg po bid x 10 days

Complications/No TX:
Nonsuppurative complications of GAS pharyngitis include acute rheumatic fever, poststreptococcal glomerulonephritis, and reactive arthritis.

Question 2

Viral Conjunctivitis

Answer 2

Most common cause: Adenovirus
Spread: highly contagious and spread via direct contact

Viral conjunctivitis typically presents as injection; watery or mucoserous discharge; and a burning, sandy, or gritty feeling in one eye. Patients may report “pus” in the eye, but on further questioning they have morning crusting followed by watery discharge, perhaps with some scanty mucus throughout the day. The second eye usually becomes involved within 24 to 48 hours, although unilateral signs and symptoms do not rule out a viral process.

Usually self limiting. Can use oral decongestants, flonase, lubricating otc eye drops. ABX are not effective.

Question 3

Bacterial Conjunctivitis

Answer 3

Cause: Bacterial conjunctivitis is commonly caused by Staphylococcus aureus, Streptococcus pneumoniae, Haemophilus influenzae, and Moraxella catarrhalis. S. aureus

Presentation: usually unilateral but can be bilateral, crusted shut in the morning, injection, PURULENT DISCHARGE present.

Erythromycin ophthalmic ointment OR trimethoprim-polymyxin B drops. The dose is 0.5 inch (1.25 cm) of ointment deposited inside the lower lid or 1 to 2 drops instilled four times daily for five to seven days.

Alternative therapies include bacitracin ointment, sulfacetamide ointment, bacitracin-polymyxin B ointment, fluoroquinolone drops, or azithromycin drops (table 1).

Patients should respond to treatment within one to two days by showing a decrease in discharge, redness, and irritation. Patients who do not respond should be referred to an ophthalmologist.

Question 4

Corneal abrasion/foreign body

Answer 4

C/O severe eye pain with photophobia or foreign body feeling could have this.

Dx: fluorescence staying and Woods Lamp evaluation

TX:
For patients who wear contact lenses, select an ointment or drop that covers for Pseudomonas species (eg, ciprofloxacin, ofloxacin, or, if fluoroquinolones are not available, tobramycin or gentamicin).

For patients who are not contact lens wearers, erythromycin ointment (Ilotycin, Diomycin, Erocin) is a good choice, used four times daily for three to five days.