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Ophthamology/ENT > Treatments > Flashcards

Treatments Flashcards

1
Q

Hordeolum

A

warm compresses, usually self-limited. Topical antibiotics if doesn’t improve within 48 hours

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2
Q

Granulomatous inflammation of meibomian gland, non-tender, hard swelling

A

Cosmetic unless it’s injecting the conjunctiva or obstructing vision. I&C or corticosteroid injections.

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3
Q

Anterior Blepharitis

A

Staph infection - treat with Bacitracin/erythromycin, lid hygiene, warm cloth

Seborrheic - lid hygiene, warm washcloth with baby shampoo

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4
Q

Posterior blepharitis

A

Regular meibomian gland massage. If cornea or conjunctiva are irritated - low dose antibiotics (tetracycline, doxycycline, minocycline). Topical with ciproflaxin.

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5
Q

Dacryostenosis

A

Clear mattering and drainage from in to out. Massage the nasolacrimal duct. Patience.

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6
Q

Dacryocystitis

A

Acute - Systemic AB (don’t want progression to preseptal/orbital cellulitis), probing.
Chronic - Kept latent with AB, need surgery to cure

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7
Q

Preseptal Cellulitis

A

Systemic AB, cool compresses, hospitalize child if

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8
Q

Orbital Cellulits

A

Systemic AB (IV), sinus irrigation, hospitaliztion (CT scans, blood cultures), if due to trauma give cephalosporin

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9
Q

Unilateral red conjunctiva with mucoprurulent (greenish-yellow) discharge all day.

A

Bacterial conjunctivitis. Topical sulfonamide or oral AB.

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10
Q

Bilateral red conjunctiva with watery-serous discharge, enlarged and tender preauricular lymph nodes.

A

Self-limited, cold compresses.

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11
Q

Gonococcal conjunctivitis

A

EMERGENCY - could perforate cornea. Culture and stain smear to confirm. Single dose 1g IM ceftriaxone (with possible addition of topical AB - bacitracin, erythromycin)

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12
Q

Neonatal conjunctivitis

A

Scrape for gram stain. Hospitalize to combat. Systemic + topical AB

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13
Q

Chlamydial Conjunctivitis

A

1g oral azithromycin, improve hygiene and living conditions

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14
Q

Inclusion Conjunctivitis

A

same as chlamydial conjucntivitis

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15
Q

Keratoconjunctivitis sicca

A

artificial tears, mucomimetics for mucin deficiency, increased Omega-3 fatty acids

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16
Q

Allergic conjunctivitis

A

Topical antihistamines, topical mast cell stabilizers (prophylaxis), and topical corticosteroids for acute exacerbations. Treat the allergies underlying the reactions.

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17
Q

Pinguecula

A

Artificial tears or topical NSAIDS (short term)

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18
Q

Pterygium

A

Surgery with induced astigmatism, vision obstruction, or sever irritation.

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19
Q

Episcleritis/Scleritis

A

Refer to an Ophthalmologist. Usually treated with systemic steroids.

20
Q

Corneal abrasion

A

Fluorescene stain. Test visual acuity. Control pain with cytoplegic (mydriatic analgesics) drops. Topical antibiotics (bacitracin). May need a pressure patch (esp children).

21
Q

Lacerations

A

MRI contraindicated in case there are metalic foreign bodies in the eye. Cover eye with metal plate. Systemic AB. Suture the lids.

22
Q

Bacterial Keratitis

A

Scrape ulcer for gram stain. High concentration topical AB (fluoroquinolone) qh for 48 hours first line. Otherwise,
Gram + = cephalosporin
MRSA = vancomycin
Gram - aminoglycoside (tobramycin).

23
Q

Herpes Simplex Keratitis

A

Fluorescein and blue light exam. Debridement and patching. Topical antiviral a (trifluridine drops), PO antivirals (acyclovir).
Corneal grafting for severe stromal scarring

24
Q

Herpes Zoster Ophthalmicus

A

Immediate Referral! Ocular emergency.
Acyclovir, valacyclovir, famicyclovir.
Ant uveitis - topical corticosteroids and cycloplegics

25
Q

Fungal Keratitis

A

Corneal scraping - culture.
Natamycin, amphotericin, and voriconazole (topical agents).
Systemic imidazoles helpful.

26
Q

Acanthamoeba Keratitis

A

Confocal microscopy. Specialized culture.
Long-term treatment because the organism can embed in the corneal stroma. Topical biguanide, diamidine + triazole.
Most likely will need corneal grafting to restore lost vision.

27
Q

Hyphema

A

Refer to Ophthalmologist STAT.

Risk for secondary hemorrhage, therefore advise to rest until it resolves, stop anticoagulant meds.

28
Q

Anterior uveitis (non-granulomatous and granulomatous)

A

Topical, injected or systemic corticosteroids.

Dilate pupil to relieve discomfort - prevent posterior synechiae.

29
Q

Posterior uveitis

A

Systemic, peri ocular, or intravitreal corticosteroid therapy. No dilation.

30
Q

Dry AMD treatment - early

A

Daily Amsler grid and regular (yearly) eye exams

31
Q

Intermediate - Advanced Dry AMD

A

AREDSII supplementation, daily Amsler grid, checking for changes in vision. 6-24mo FU

32
Q

Wet AMD

A

Photocoagulation (not curative - nor progression slowing)
Photodynamic therapy
Anti-VEGF (ranibizumab, pegatanib) injections into the eye.
UNMC - Lampalizumab

33
Q

Giant Cell Arteritis (Temporal Arteritis)

A

Check ESR/CRP
IMMEDIATE high dose steroids to save fellow eye
Consider TA biopsy

34
Q

Transient Monocular Visual Loss

A

Immediate administration of oral aspirin.
Angioplasty/carotid endarterectomy (could be carotid stenosis)
Admit if have had crescendoing episodes

35
Q

NP Diabetic Retinopathy

A

Manage diabetes.
Refer with any vision loss, macular involvement, PR, or retinal detachment.

Laser photo coagulation, Anti-VEGF (ranibizumab), Fluocinolone implant

36
Q

Proliferative Diabetic Retinopathy

A

Pan-retinal photocoagulation (PRP) - need to do fluorescein angiopathy to diagnose if this will be helpful
Possible vitrectomy if uncontrolled vitreous hemorrhage
Anti-VEGF

37
Q

Acute-Angle Glaucoma

A

Refer! Ocular emergency!
Single IV dose of acetazolamide, followed by daily doses 4q.i.d.
Topical pilocarpine q 15min for 1 hour then 4q.i.d.
Definitive treatment is laser iridotomy or surgical peripheral iridecotmy. Prophylactic iridotomy of fellow eye.

38
Q

Chronic glaucoma

A 
Prostaglandin analogs ("prost" in name)
topical beta-adrenergic blocking agents (timolol, carteolol) - block production of an humor

Surgery: laser trabeculoplasty

39
Q

Retinal detachment

A

Laser photocoagulation of retina, RPE and choroid to the retina
In fibroproliferative tissues developed on the retinal surface, need to do pars plant vitrectomy, direct manipulation of retina, internal tomponade of retina

40
Q

Vitreous hemorrhage

A

Refer

41
Q

Sudden monocular loss of vision, painless, no redness, widespread retinal hemorrhages, cotton wool spots, optic disc swelling

A

Central &/or Branch Retinal Vein Occlusion - prophylactic PRP
Anti-VEGF (ranibizumab)

42
Q

Sudden monocular vision loss, no pain or redness, pallid swelling of retina with cherry-red spot at fovea

A

Central &/or Branch Retinal Artery Occlusion
Check ESR, CRP, diabetes, hyperlipidemia

Tx: Lay pt flat, ocular massage, check for carotid stenosis (pt at risk of stroke), pt at risk of having giant cell arteritis

43
Q

Giant cell arteritis

A

Immediate high dose steroids (prednisone) to save eyes, especially fellow eye.
Consider temporal artery biopsy

44
Q

Optic neuritis

A

IV methylprednisolone - accelerate visual recovery (2-3 weeks)

MS will develop within 15 years

45
Q

Thyroid eye disease

A

Mechanical closure of eyes at night.

Treating hyperthyroidism - IV/oral pulse methylprednisolone, radiotherapy, surgery

46
Q

Ultraviolet keratitis

A

binocular patching, cyclopentolate to relax ciliary spasm

47
Q

Medical Rx for Orbital Fractures

A

Anitbiotics, nasal decongestants, corticosteroids, postural damage, Abstinence (Aspirin, NSAIDS, and nose-blowing), physical protection of eye.

Ophthamology/ENT (2 decks)

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