Treatment - EENT

Question 1

entropion or ectropion

Answer 1

lubricating eye drops for sx, surgical correct if needed

Question 2

dry macular degeneration

Answer 2

amsler grid to monitor stability

-zinc, vit A,C,E may slow progression

Question 3

wet macular degeneration

Answer 3

intravitreal anti-angiogenics (bevacizumab) to reduce neovascularization

Question 4

corneal abrasion or foreign bodies

Answer 4

topical erythromycin, polymyxin/trimethoprim, fulfacetamide, ciprofloxacin

Question 5

acute narrow angle-closure glaucoma

Answer 5

ACETAZOLAMIDE 1st line - dec aq humor production (but given IV so immediately BB)

Emperic:
Timolol (topical BB)
Apraclonidine (topical a-agonist)
Pilocarpine (topical miotic)

Systemic:
acetazolamide (carbonic anhydrase inhib)
mannitol (osmotic diuretic)

Peripheral iridotomy definitive treatment; avoid anticholingerics, sympathomimetics (dilate pupil and close angle)

Question 6

chronic (open angle) glaucoma

Answer 6

prostaglandin analog 1st line - latanoprost
-alternatives: BB, a-2 agonist, acetazolamide

laser tx or surgery if meds fail

Question 7

otitis externa

Answer 7

ciprofloxacin/dexamethasone drops (Ofloxacin) - safe if TM perforation too
-alt: aminoglycoside combo (neomycin/polytrim-b/hydrocortisone) but not if TM peroration suspected bc ototoxic

Question 8

mastoiditis

Answer 8

IV abx +/- middle ear/mastoid drainage (myringotomy) +/- t-tube placement

• amox, cefixime in children, augmentin
• if PCN allergy - erythromycin-sulfisoxazole

-refractory or complicated –> mastoidectomy

Question 9

AOM

Answer 9

amoxicillin, cefixime in children

• augmentin 2nd line
• PCN allergy - erythromycin-sulfisoxazole, azithro, bactrim

Question 10

eustachian tube dysfunction

Answer 10

1. decongestants (dec edema) - pseudoephedrine, phenylephrine
2. autoinsufflation (swallow, chew, yawn)
3. intranasal corticosteroids

Question 11

cerumen impaction

Answer 11

hydrogen peroxide 3%
carbamide peroxide (debrox)
-water at body temp to prevent vertigo

Question 12

N/V in vertigo

Answer 12

ANTIHISTIMINES 1st line, Meclizine
-blocks emetic response, most anticholinergic properties

Dopamine blockers (metoclopramide, prochlorperazine, IV promethazine/phenergan)
-often give benadryl to prevent dystonic rx

Anticholinergics (scopolamine)

Benzodiazepines

Question 13

vestibular neuritis & labyrinthitis

Answer 13

CORTICOSTEROIDS (for inflam of CN8)

antihistamines (meclizine) for symptoms

Question 14

mucormycosis

Answer 14

chronic sinusitis caused by fungus (immunocomp)

IV AMPHOTERICIN B 1st line

Question 15

acute sinusitis

Answer 15

sx therapy if <7 days

abx if ?10-14 days or facial swelling, F
AMOXICILLIN x 10-14 days
2nd line: doxy, bactrim
FQ or augmentin if recent abx use or refractory

too early for abx –> analgesics

Question 16

epistaxis

Answer 16

DIRECT PRESSURE 1st line

topical decongestants/vasoconstrictors (phenylephrine, oxymetazoline/affrin)

cauterization w/ silver nitrate

nasal packing +/- augmentin to prevent TSS

*septal hematoma associated w/ loss of cartilage if hematoma is not removed

Posterior bleeding: packing (foley, gauze pack, intranasal balloon device) Admit patients with posterior packing to a monitored bed

Question 17

strep pharyngitis

Answer 17

PCN, amoxicillin, augmentin

if allergy - erythromycin or clindamycin, azithro, clarithro, cephalexin

Question 18

oral candidiasis / thrush

Answer 18

NYSTATIN LIQUID tx of choice

oral fluconazole

Question 19

periorbital cellulitis

Answer 19

cover for staph/mrsa

Question 20

abscess from cartilage piercing

Answer 20

cipro

Question 21

sialoadenitis

Answer 21

Oral dicloxacillin or cephalexin 500 mg four times a day for 7 to 10 days
(if not infected: hard candies, massage, ibuprofen)