Eyes Ears Nose And Throat

Question 1

Ophthalmic Anti-infectives

Answer 1

Agents are either bacteriostatic or bactericidal

Minimal systemic effects

Look for decreased redness, discharge or irritation in 1-2 days

Watch for: superinfection with prolonged use, sulfa allergies

Question 2

Bacterial conjunctivitis

Answer 2

Children 3m to 8 yrs: staph, strepto or Haemophilus

Elderly : staph or pseudomonas ( contacts)

Tx: erythromycin (Ilotycin) or Polytrim drops, to PA w/ Fluoroquinolone drops ( in cipro or oflaxacin form)

Clinical PEARLS: ointment preferred over drops , Ointment will blur vision for 20 min

Question 3

Viral Conjunctivitis

Answer 3

No specific agent
Viral organism : adenovirus ( highly contagious )

Symptomatic relief only with topical antihistamines /decongestants

Consider contagious for 2 weeks after infection in second eyelid present

Question 4

Conjunctivitis - Otitis Syndrome

Answer 4

Children < 6 H. Influenza - organism

Tx: high dose amoxicillin (80-90mg )

Question 5

Allergic Conjunctivitis

Answer 5

Mast cell stabilizers : Alomide and Crolom

Antihistamine: Vasocon A, Zaditor, NaphconA

Pt ed: proper administeration, may have stinging and burning, QID, can use intranasal corticosteroids and decongestants

Question 6

Dry eye syndrome

Answer 6

Artificial tears ( TID or QID) ( systane )

Help maintain the ocular toxicity,
buffers and preservatives

Question 7

Temporary relief of eye redness due to irritation or allergic conjunctivitis

Answer 7

Opthalmic Vasoconstrictors

Watch for increased IOP

(VISINE)

Question 8

Blepharitis

Answer 8

Acute or chronic inflammation of the eyelash follicles and Melbomian glands of the eye

Tx: scrubbing the eyelash with gently no tear shampoo or applying erythromycin ointment

Question 9

Hordeolum

Answer 9

“Sty” caused by s. aureus

Burning, stinging tenderness to one eyelid

Tx: warm compress, antibiotic eye drops or ointment

Question 10

Anti-Glaucoma Agents

Answer 10

Only treated by an eye MD

Normal IOP 8-21 IOP w/ Glaucoma over 30

Question 11

Acute Otitis Media (AOM)

Answer 11

Most common in children
Tx: systemic and local s/s resolve in 24 hours , give pain control

Do not use decongestants or antihistamines

Antibitoic therapy:

• pain control + 2 strategies
  - immediate tx with antibitoics or watching waiting then start antibiotics therapy after 48-72 hours
• first line:
  • amoxicillin
    - only give if low risk of beta-lactam resistence ( no beta lactam < 30 days no conjunctivitis or recurrent AOM)
  • Augmentin ( next line if at risk for beta -lactam resistance)

With pencillin allergy (w/o anaphylaxis ) - cefdinir

If pencillin allergy w/ anaphaysis - macrolid ( Azithromycin)

Question 12

Otitis Externa

Answer 12

Painful inflammation of the external auditory canal

Tx: combined corticosteroid with antibiotic ( cortisporin and tobraDex) , hydrocortisone reduces inflammation or alcohol drops

Watch for: Perforated TM ( will cause superinfection)

• classified as swimmers ear ( use topical acid or alcohol solution ) or chronic otitis externa ( use mineral oil)

Question 13

Cerumenolytics

Answer 13

Ear wax important b/c it prevents bacteria, germs and dirt from getting into you

To soften: Carbamide peroxide ( Debrox, Murine ear wax removal) 1-5 drops BID for up to 4 days - once cerúmen softened ear canal can be irrigated with warm water

Question 14

Acute Sinusitis

Answer 14

Symptomatic inflammation of the nasal cavity and paranasal sinuses lasting < 4 weeks

Tx for Acute Viral : symptomatic management; typically resolves w/in 7-10days

Tx for acute bacterial : self limited , may be treated with antibitoics

Symptoms can be relieved with , saline irrigation, intranasal glucocorticoids, mucolytics, antihistamines,

Question 15

Allergic Rhinitis in pediatrics

Answer 15

Young children ( < 2) = allergy development requires repeated exposure to inhaled allergens and is uncommon at this age

Tx options: cromolyn nasal spray,

• Second generation antihistamine ( certrizine, fexofendadine ) approved for kids over 6
• kids over 2 when cromolyn nasal spay doesnt work
  
  • nasonex, Flonase, nasacort,
• watch for HA, growth suppression

Question 16

Allergic rhinitis - older children and adult

Answer 16

Mild or episodic = second generation oral antihistamine , antihistamine spray ( azelastine ) , glucocorticoid nasal spray ( two days before - two days after exposure ) , Cromolyn nasal spray

Peristent or moderate-severe= glucocorticoid spray , second generation oral antihistamine

W/ people with asthma = leukotriene-modifying agent ( singulair)

Question 17

Allergic Rhinitis - preg /lactation

Answer 17

Intermittent congestant ( < 4 days per week ) = topical decongestant

Mild persistent ( >4 days a week and more than 4 weeks a year) = intranasal Budesonide or comolyn supplemented with cetirizine or loratidine

Moderate-severe = Budesonide or immunotherapy injections along with cetirisine or loratadine

Question 18

Strep throat ( pharyngitis)

Answer 18

Caused by streptococcus

Symptoms: red tonsillar, enlarged tonsillar, vomiting , palatal petechiae

Tx: Penicillin V - 10 days child: 250mg BID
Amoxicillin - 50 mg once daily 10 days

Question 19

Proper saline irrigation method

Answer 19

Do not use table water must use sterile water