Exam 1 Flashcards
Pharmacological treatment for blepharitis
topical abx drops: bacitracin, macrolides- erythromycin, azithromycin
Indications for pharmacological treatment for blepharitis
signs of infection- red and inflamed
Other treatment options for blepharitis
warm compress
S&S of hordeolum
very sudden, tender, swollen, red eyelids
Treatment for hordeolum
warm compress, don’t pop it; if continued inflammation antibiotic drops are OK
Difference between hordeolum and chalazion
Hordeolon- sudden onset, very painful
Chalazion- slow onset, not painful
When to refer a patient to ophthalmology for chalazion
If persistent- may need incision and drainage
S&S of iritis/uveitis
severe pain, photophobia, constricted pupil with no response
Treatment for iritis/uveitis
immediate referral to opthalmology
Differenceinpresentation between bacterial/viral/allergic conjunctivitis
Bacterial- purulent discharge (wipe and comes back right away); unilateral at start
Viral- purulent discharge in AM, watery in PM; unilateral at start; gritty, burning sensation
Allergic- watery, stringy discharge; bilateral; INTENSE itching
Tx for bacterial conjunctivitis
Azithromycin drops (1 drop BID x 2 days, then 1 drop daily for 5 days)
Polymyxin-trimethoprim (polytrim)- 1-2 drops QID x5-7 days
Tx for bacterial conjunctivitis for contact lens wearers
NO POLYTRIM
Fluroquinolone drops- oxfloxacin or ciprofloxacin (1-2 drops QID x5-7 days)
What would you not want to give a patient with allergic conjunctivitis?
Do not give corticosteroids- can lead to keratitis
Tx recommendations for allergic conjunctivitis
Cold compress, lubricant drops, antihistamine, decongestants, mast cell stabilizer drops (ketorolac 1 drop QID, olopatadine 0.1-0.2% BID)
Treatment for viral conjunctivitis
antihistamine/decongestant drops, lubricants, cold compress
Tx for gonorrheal conjunctivitis
ceftriaxone and azithromycin
S&S for gonorrheal conjunctivitis
profuse discharge within 12 hours; SEVERE AND SIGHT THREATENING, preauricular adenopathy
Treatment for Herpes zoster conjunctivitis
refer to ophthalmologist for slit lamp evaluation; pyrimidine drops, acyclovir PO start within 72 hours
S&S Chlamydial conjunctivitis
Persistent eye infection lasting > 3 weeks despite treatment; preauricular adenopathy; may also have ear infection or rhinitis
Tx for chlamydial conjunctivitis
Doxycycline 100 mg BID x 7-10 days
Azithromycin 1 gm PO
AND ABX drops
Pharmacological treatment for corneal abrasion
Tobramycin or quinolones (NO POLYTRIM IF CONTACT LENS)
Assessments for corneal abrasion
visual acuity, penlight/fundoscopic exam, fluorescein stain with slit lamp (cobalt blue filter)
In relation to a corneal abrasion, what signs or symptoms would indicate need for immediate referral to opthalmologist?
Corneal infiltrate, white spots or opacities, inability to remove foreign body, pus, change in vision, not healed in 3-4 days
What diagnosis related to the eye require immediate ophthalmology referral?
Uveitis/Iritis, Keratitis, Glaucoma, Maculardegeneration, Retinal detachment
Difference between open-angle and closed-angle glaucoma
Open- slow onset, halo vision
Closed- SUDDEN, eye pain, N/V, HA, rainbow around lights; EMERGENCY
Tx for glaucoma
laser or surgery (if closed-angle); eye drops: timolol, pilocarpine, azeta
Risk factors for developing macular degeneration
> 60 years, female, fair skin, excessive sun exposure, tobacco use, HTN, vascular disease, family Hx, high intake of fats and cholesterol
Rx factors for otitis externa
Swimmer (swimmer’s ear)
Risk factors for otitis media
Hx of chronic allergies, down syndrome, cleft lip/palate, smokers, acid reflux, Hx of URI, immunodeficient
Triad of symptoms for otitis media
abrupt onset, effusion, inflammation of middle ear
Pharmacological treatment for otitis media
amoxicillin (1st choice), macrolide (azithromycin, clarithromycin), fluoroquinolone (cefdinir, bactrim)
When to treat AOM with antibiotics
bilateral infections, high fever, severe pain, Sx lasting > 48 hours
S&S of Meniere’s disease
tinnitus, vertigo, sensory hearing loss, + Romberg, N/V
Treatment for Meniere’s disease
Treatments for acute attacks only- meclizine, scopolamine, diphenhydramine
S&S of Benign Positional Vertigo (BPV)
vertigo in specific positions, episodic; Diagnosis: Dix hallpike test
Treatments for BPV
Epley maneuver, Meclizine, promethazine, dramamine, benzodiazepines
Describe the dix-hallpike maneuver
1, Patient sitting, turn head 45 degrees to one side
2. Lie the patient down the head overhanging the edge of the bed and look for nystagmus
3. Repeat on other side
POSITIVE if maneuver provokes paroxysmal vertigo and nystagmus
When to start ABX for acute bacterial rhinosinusitis
If symptoms don’t improve after 10 days, if they worsen after 7 days, fever over 102F, severe pain
Pharmacological treatment for acute bacterial rhinosinusitis
1st line: Augmentin (875/125) PO BID x10 days OR high dose augmentin (2000/125) if not effective; if PCN allergy then Doxycycline 100 mg BID x10 days, if can’t tolerate then clindamycin 150mg PO QID + cefixime 400 mg PO daily x10 days, then last line levofloxacin 500 mg PO daily x10days (avoid in elderly)
When should you refer a patient with acute rhinosinusitis to ENT?
Recurrent- more than 4 cases in 12 months, Chronic- symptoms greater than 12 weeks
S&S of EBV-Mononucleosis
Fever, exudative pharyngitis, POSTERIOR ADENOPATHY, HA, Fatigue, enlarged spleen, elevated LFTs
Treatment options for EBV mononucleosis
steroids for severe fatigue/swollen tonsils, avoid contact sports for 3-4 weeks d/t risk of spleen rupture
Treatment plan for Mono + concurrent strep
Macrolides- erythromycin BECAUSE of increased risk of rash with amoxicillin
S&S of acute strep pharyngitis
Acute onset, fever, headache, ANTERIOR cervical adenopathy, petechia, erythema, exudate, breath odor
Pharmacological treatment for Group A Strep Pharyngitis
First line: PCN V 500 mg BID x 10 days; if allergy to PCN than a macrolide (erythromycin), or cephalosporin (cephalexin)
S&S of tonsillar abscess
Fever, severe sore throat, hot potato muffled voice, drooling, tripod position, deviated uvula, peritonsillar edema, neck edema with lymphadenopathy
Tx for tonsillar abscess
Medical emergency if suspected airway restriction- needle aspiration or excision of abscess; Augmentin 875mg BID x 14 days, Clindamycin 300-450 mg QID x 14 days
What is the cause of epistaxis?
Anterior- trauma, dry mucosa rarely HTN or Co-ag problems
Posterior- carotid and sphenopalatine artery
Difference between otitis media, otitis media with effusion, and swimmer’s ear (otitis externa)
Otitis media- inflammation, fever, bulging inflamed TM
Otitis media with effusion- afebrile, fullness in ear, popping, cracking with yawning, dull TM but no bulging
Otitis externa- painful pinna & tragus, inflamed ear canal, white or green discharge
Risk factors for otitis externa
exposure to water or excessive use of headphones, earplugs, Q-tips
How to treat patients with otitis media + conjunctivitis
Augmentin- most likely cause is H. Influenzae
S&S of allergic rhinitis
allergic shiners, hypertrophic turbinate, COBBLESTONE THROAT, swollen eyelids
Difference in presentation between rhinosinusitis and allergic rhinitis
Allergic rhinitis- inflammation of lining of nose, runny nose, pale/edematous mucosa
Rhinosinusitis- nasal obstruction, facial pain, purulent discharge
Risk factors for rhinosinusitis
smoking, swimming, immunodeficient, dental disease, asthma, allergies
