Tx only for Opthal/Ear

Question 1

Bacterial Conjunctivitis

Answer 1

• Mild-mod (and no contacts) : Erythromycin ophthalmic ointment or trimethoprim-polymyxin B drops (Polytrim)
• Severe or pseudo (contacts): Topical FQs: Vigamox or Moxeza (Moxifloxacin) Ofloxacin ophthalmic (Ocuflox/Floxin) Ciprofloxacin Ophthalmic
• Gonococcal: Rocephin 1g IM x 1 dose +/- erythromycin or Bacitracin
• Ophthalmologic emergency

mild red polytrim

Question 2

Viral Conjunctivitis

Answer 2

Supportive tx Cold compresse

Junk invites cold viruses

Question 3

Allergic Conjunctivitis

Answer 3

Mild-mod: Topical antihistamines - 1st line Alaway (ketotifen), Patanol or Pataday (olopatadine)
Bepotastine, Emedastine
Topical NSAIDs: Disclofenac (Voltaren), Ketorolac

Tx: Mast cell stabilizers (prophylaxis) Cromolyn, Lodoxamine, Nedocromil, Pemirolast
Severe: topical corticosteroids → Loteprednol (Alrex)
NO corticosteroids if hx of or suspected HSV → can exacerbate it

1st key tone paladin dashing to allergic junk
Tropical said

Prophylaxis - Necro Crone Load premeir to junk
Severe tropical Lotto

Question 4

Uveitis

Answer 4

Anterior: Topical corticosteroids - 1st line
Dilation of pupil to relieve discomfort

Posterior:
Req systemic, periocular or intravitreal coricosteroid tx
Pupil dilation not necessary

In first you’ve topped steroids, dilate.

Behind you’ve chosen real steroids, since you didn’t dilate.

Question 5

Viral Keratitis

Answer 5

Urgent referral to ophthalmologist Topical and/or oral antivirals - treat until 1 wk after lesions heal Acyclovir PO or ointment
Prophylaxis for recurrence: Valacyclovir

Urgent vital corn to the doctor. A sick corn 1 week later. Preventative valor

Question 6

Fungal Keratitis

Answer 6

Natamycin 5%, Amphotericin 0.1-0.5%,Voriconazole 1% for 6m

Mushroom corn
not a mouse inside a amphieater, very blue

Question 7

Acanthamoeba Keratitis

Answer 7

Long term 6m-1yr (org may encyst w/i corneal stroma)

Antiseptics: Topical biguanide (Polyhexamethylene or chrolohexidine)

The host invades from 6 mo to 1 year.Start in the tropics of guam # 6

Question 8

Subconjunctival hemorrhage

Answer 8

Self limiting (2 weeks)
treat underlying causes like HTN

2 week fountain subterfuge

subterfuge for 2 weeks by a fountain

Question 9

Dacryoadenitis

Answer 9

Autoimmune: tx underlying cause/steroids

Viral: supportive care

Bacterial: systemic abx; I&D if necessary

Vital support for ‘roided duck
bacterial abx- I indeed (I&D) the duck for B

Question 10

Dacryocystitis

Answer 10

Acute: lacrimal sac massage
Mucopurulent discharge w/o s/s of inf:
Topical abx - tobramycin sulfate or moxifloxacin

-purulent discharge w/ s/s of infection: (erythema/swelling) → systemic abx:
amoxicillin/clavulanic acid (Augmentin)
Sx - elective or emergent

Chronic: can be kept latent w/ abx
**Sx - only cure **
Dacryocystorhinostomy - explore lacrimal sac and form fistula in nasal canal

A cute massage for a clean duck w/ moxi’s bra No massage for a messy duck. maybe Augment surgery.

A chronic surgery removes the bag

Question 11

Blepharitis anterior

Answer 11

Anterior:
Remove scales w/ hot washcloth and baby shampoo
Anti-staph ointment w/ acute exacerbations
Bacitracin or erythromycin

A cute dragon keeps their staff appointment (ointment) while bathing, until back is red

Question 12

Blepharitis Posterior

Answer 12

Posterior:
Reg meibomian gland expression
Hot washcloth
Lid massage

A gliding baker’s expression during a hot massage

Question 13

Blepharitis inflam of conjunctiva and cornea-

Answer 13

Inflam of conjunctuve and cornea:
Long-term low dose PO abx (2-4wks):
Tetracycline, doxy, or minocycline

Short-term topical corticosteroids:
Prednisone

corn + junk yard together

Four long docks mine while short packnsow

Question 14

Hordeolum

Answer 14

Warm compress - 1st line
5-10x/day → 3-5x/wk
d/c eye makeup

I&D if does not improve w/i 1 wk

Abx ointment - bacitracin or erythro applied to lid Q3 hrs during acute phase if ind

warm horde 1st week, Indeed the second week, Red back

Question 15

Chalazion

Answer 15

Self-limiting; warm compress and massage
Baby shampoo → lid scrub

Refractory: refer to ophth; I&D, corticosteroid injection

Cha ‘ lazy warm massage & bath

Unbroken lazy steroids indeed

Question 16

Orbital Cellulitis

Answer 16

IV abx - prevent optic nerve damage
Initial empiric tx: IV vanco + ceftriaxone or cefotaxime

+/- anaerobic cov: metronidazole or clinda

Vanco and ceftriaxone MC in children

Can switch to PO abv after 2-3wks
Bactrim + Augmentin (or FQ if PCN allergy

Around the sun, Ivy van + axe/tax prevent broken wires
Clean metro in the dark places of space
Kid’s IV van axe
After 2 weeks, augment trim, unless flowers

Question 17

Preseptal Cellulitis

Answer 17

PO abx:

Augmentin (or cefdinir (omniceph) if PCN allergy)
+ Bactrim (or clinda if sulfa allergy)

Augmented omnicient (dinner) high priest, BC

Question 18

Corneal ulcers - pseudomonas

Answer 18

TX: abx eyedrops
Moxifloxacin, gatifloxacin, ciprofloxacin, tobramycin, or gentamycin

sipping money statue w/ bra & moxi’s gait Drops gentlemen

Question 19

Group A strep corneal ulcer

Answer 19

Gram + cocci in chains. corneal stroma infiltrate, edematous, and LARGE hypopyon

Tx: abx eyedrops
Moxifloxacin, Gatifloxacin or Cefazolin

“A+” statue in chains
ants follow Moxi’s gait (ancef)

Question 20

Corneal ulcer s. aureus or s. epidermidis

Answer 20

Hypopyon and corneal infiltration
Often superficial
Firm ulcer bed - like the hard rocks of alaska

Dx: scrapings show Gram (+) cocci

Tx: cefazolin, Moxiffloxacin, gatifloxacin
MRSA - Vanco

Northern lights
Ants & van follow moxi’s gait,

Question 21

Corneal ulcer fungal

also whats the other S/S, dx

Answer 21

indolent, gray infiltrate w/ irregular edges
Marked inflam of the globe
Superficial ulcer, satellite lesions

Tx: Amphotericin B, Voriconazole, Posaconazole

mushroom statue posiing in a Blue amphieater

Question 22

Corneal Ulcer viral (herpes)

also whats the other S/S, Dx

Answer 22

**MCC of corneal ulcer and blindness **
Irritation, photophobia, tearing, ↓ vision
Hx of fever blisters or other herpetic inf
**Dendritic ulcers in corneal epithelium
Branching, linear pattern w/ feathery edges
Terminal bulbs at ends

Tx: PO antiviral - acyclovir
Topical antiviral - Idoxuridine, Gangciclovir

Vital uridine statue, for a sick Herpes gang

Question 23

Pterygium

Answer 23

Artificial tears
NSAIDS
Sx if severe or visual imp
recurrance is aggressive

Artificial Terry said surgery if severe

Question 24

Ptosis

Answer 24

Nonsurgical - oxymetazoline eye drops

MOA: stimulates ɑ-adrenergic-R in superior tarsal muscle (Muller’s muscle)

Surgery - ind: pts w/ obscured visual fields
Muller muscle resection
Levator muscle resection or advancement

Oxy drops the superior curtain.
If oxy can’t see, Miller Light

Question 25

Dry eye

Answer 25

Artificial tears - 1st line 3-4x/d OTC
Ointment - 1st line (prolonged lubrication) - ex: sleeping

Rx - Cyclosporine (Restasis) - drops
MOA: Polycyclic peptide that inhib cellular and humoral immune rsp by inhib IL-2 ↑ tear prod d/t inflam reduction (prevents organ rejection after transplant)

Environmental - humidifiers, moister chamber glasses, swim goggles Insertion of punctual plugs to retain lacrimal secretions → blocks drainage and ↑ eyes’ tear films and retains moisture

fake sleep for the 1st dry appointment

Then psychos spar in the environment (link to heart broken tears)

Question 26

Cataracts

Answer 26

Refer to ophthalmologist Sx - ind: in pts w/ visual impairment

Doctor cat can’t see for surgery

Question 27

Macular Degeneration

Answer 27

Refer to ophthalmologist

Inhibitors of VEGF - (wet MD) Reverses choroidal

neovascularization - stabilization of vision in neovascular degen

Adm into vitreous; monitor BP

No specific tx for atrophic degen

Antioxidants: vit. C and E, zinc, copper, carotenoids

Wet fountain vegetables for dracula’s vitreous
CCCEZ - antiox

Question 28

Acute/narrow angle glaucoma

Answer 28

Acetazolamide -
1st line 500mg PO or IV MOA: ↓ prod of aqueous humor

When IOP drops: Pilocarpine 2% - 1 drop q15min for 1 hr then QID
MOA: ↑ outflow of aqueous humor, ↓ resistance causes miosis (constriction)
Others: Latanoprost, Timolol, Apraclonidine
Recheck IOP every 30-60min

Reduction of IOP (incr aq. outflow or dec inflow)
place pt supine
analgesia, antiemetic if needed

Laser peripheral iridotomy is definitive tx

1st Ace
carpenter drops supine 30-60m , then uses lazer
(narrow/hard for carpenter to get in)

Question 29

What does laser peripheral iridotomy do

Answer 29

Laser peripheral iridotomy is definitive tx

Laser creates hole in peripheral iris to relieve pupillary block →

widened angle → tubular meshwork exposed and fluid outflow is enhanced

Aqueous humor goes from posterior to anterior chamber

hollow iris into pipes

Question 30

Open angle glaucoma - all drugs and MoAs

Answer 30

Topical Prostaglandin -
1st line MOA: selective agonist of PG-R;
↑ outflow of aqueous humor → ↓ IOP
Initial tx for open-angle; well-tolerated SE: conjunctival hyperemia, irritation, ↑ number and length of eyelashes, changes in iris and lash pigmentation, foreign body sensation

• Latanoprost (Xalatan) - genetic
• Tafluprost (Zioptan) - no preservatives
• Bimatoprost (Latisse) - lengthens eyelashes

Topical Beta Blockers MOA: ↓ IOP by inferring w/ cAMP (which is used to prod aqueous humor in ciliary process)
SE: systemic- MC w/ non-selective BB: Timoptic (timolol) - brady, hypotension (Long-term use - bronchospasm)
Ocular - burning

Topical α-2 adrenergic agonists - Apraclonidine

MOA: causes iris to dilate (mydriasis), ↓ congestion in blood vessels of conjunctiva leading to ↓ IOP by ↓ prod of aqueous humor SE: allergic conjunctivitis, hyperemia, ocular pruritus
DIs: MAOIs, tricyclics, CNS depressant, alc, BB, cardiac glycosides, antihypertensives

Topical carbonic anhydrase inhib - Acetazolamide (Diamox)
- not as effective
- MOA: slows action of enzyme carbonic anhydrase (directly inhib prod) → ↓ prod of aqueous humor and ↓ IOP CI: sulfa allergy

Cholinergic agonists - pilocarpine
- Mitotic - causes pupil constriction → ciliary muscles attache to trabecular meshwork and contract → open up Schlemm’s canal → ↑ outflow of aqueous humor and ↓ IOP
Deactivates cholinesterase and allows ACh to continue miosis for ~4-6hrs
SE: abd cramps, D, watery mouth, sweat, fixed small pupils, myopia, visual disturbance, HA

first tropical prost ~ frost
time camp slows heart
tropical apples
Ace eggs
Carpeter dilates

Question 31

Open angle glaucoma shortened version

Answer 31

Topical PGs - 1st line
Topical beta blockers
Topical a-2 adrenergic agonists (lots of DI’s, can’t rx BB)
Acetazolamade (not as effective)
pilocarpine
Laser peripheral iridotomy

first tropical prost
time camp slows heart
tropical apples
Ace eggs
Carpeter dilates

Question 32

Corneal Abrasion

Answer 32

+/- topical anesthetic drops - prior to staining are Proparacaine, Tetracaine
Topical abx: bacitracin-polymyxin ointment/drops - 1st line
Short-acting cycloplegic if needed - pain relief d/t ciliary spasm Cyclopentolate 1% or Homatropine 5%
NSAID eye drops: Diclofenac or Ketorolac
Other: Oral opioid analogies, tetanus prophylaxis; Don’t smoke!

Fluroescent green back drop
Pentagram Home (ciliary)

Opiates
Tetanus to prevent

Question 33

Chemical Keratitis

Answer 33

Alkaline (worse) vs acidic burns
Topical anesthetics or abx
Irrigation ASAP - Morgan lens: irrigate until pH of 7 Slit lamp exam w/ lid eversion, Measure IOP
Cycloplegic-decrease pain iris-ciliary spasm and dilate (Cyclopentolate 1% drops)
Steroids or narcotics if severe

Pentagram chemicals
Steriods for worse chemicals

Question 34

UV keratitis

Answer 34

Binocular patching
1-2 drops Cyclopentolate → dilates pupil and relieves pain

Patch pentagram

Question 35

Corneal Foreign Body

Answer 35

• Check visual acuity
• Topical anesthetic drops If superficial - remove it via saline flush, sterile cotton swab, sterile eye spud, small 25-gauge needle
• Topical abx drops or ointment - Bacitracin-polymyxin ointment
• Tetanus prophylaxis Short-acting cycloplegic “Rust ring” - iron foreign body → refer for removal if no improvement in 2-3d

flush 25 objects back to tropical
short rust ring
3 d referally

Question 36

Hyphema

Answer 36

Prevent of further hemorrhage (most re-bleeding w/i 72hrs d/t clot lysis/retraction; more severe)
Keep pt supine position w/ HOB @ 45°
Hard eye shield
NO NSAIDs, ASA
Oral or parenteral pain meds; antiemetics

stop the bleed in 72 hrs
Supine w head 45, hard eye shield
No talking (no said)

Question 37

Orbital Blowout Fracture

Answer 37

Refer!
Tetanus prophylaxis/pain mgmt
Avoid valsava maneuvers, give antiemetics (no sneezing/blowing nose)
+/- systemic abx to cover for sinus pathogens (Augmentin or doxy)
+/- systemic steroids for swelling of eye adnexa and ↓ diplopia
Long-term tx - possible sx

Orb blowing - no blow
Augment Doxy with roid and tetanus (doxin? the dog?)
long surgery

Question 38

Penetrating Trauma or Ruptured Globe

Answer 38

Protective eye shield
HOB @ 45° Vanco + Ceftazidime (or FQ) - IV
Tetanus updates, sedation
antiemetic
Pt NPO d/t Sx
CT of orbit

Ivy van dime penetrates @ 45 degrees
Tetanus
Antiemetic
Panther, surgery

Question 39

Sudden Vision Loss

Answer 39

Consult!

Question 40

CRAO

Answer 40

Consult!
Early presentation: lay pt flat, ocular massage, high [ ] of O2, IV acetazolamide or mannitol,
VDs Thrombolysis - may induce hemorrhage (generally w/i 4.5hrs)
Giant cell arteritis - high dose corticosteroids

Man Vampire supine for massage, O2, Ace!
Watch Thrombolysis 4.5 hrs
High Giants on steroids blocking arteries

Question 41

CRVO

Answer 41

• anti-VEGF - 1st line (↓ macular edema and vascular permeability)
• Intravitreal corticosteroids - 2nd line
• Laser photocoagulation - for sig hemorrhages and neovascularization (seal leaky vessels and prevent formation of VEGF)

1st Veggie tales injecting steroids for baddie lazer

Question 42

Retinal Detachment

Answer 42

Sx - close all retinal holes/tears w/ permanent adhesion via laser photocoagulation (pneumatic retinopexy)
Worse prognosis if macula is detached or detachment is of long duration

Question 43

Optic Neuritis

Answer 43

Acute demyelinating optic neuritis
- IV methylprednisone x 3d then taper w/ PO prednisone
Other causes: more prolonged corticosteroid tx (poorer prognosis)
Most visual acuity improves w/i 2-3wks

metal ivy purse for 3 days
Pac n’ sow after
see clearly after 2 weeks

Question 44

Papilledema

Answer 44

Refer to ophthalmology
Treat underlying causes
Do NOT perform LP on pt w/ papilledema - can worse IC

MRI is Dx

Question 45

Ischemic Optic Neuropathy

Answer 45

Systemic high-dose corticosteroids and refer!

Question 46

Vertigo

Answer 46

Gait instability, Romberg test, CN and EOM
Pursuit/saccades - not a test but a result of the head impulse test. Abnormal is when eyes can’t follow target. or there’s a delay. abn can ind cerebral patho
Nystagmus
Head impulse test (move head back and forth)
Hearing eval - whisper, Webber, Rinne test
Dix-Hallpike Maneuver (BPPV)

Question 47

Vertigo all the different special testing

Answer 47

Audiometry - comorbidities, hearing acuity, various tones and pitches

Caloric testing - cold/warm water or air into ear (COWS)

CT/MRI

Electronystagmography (ENG) - trace eye movements, records nystagmus
or videonystagmography (VNG) - video images of eyes

Vestibular-evoked myogenic potentials (VEMPS)- repetitive sound stimulus to one ear and avg rxn time of muscle activitiy in rsp to each soundcheck or pulse

Question 48

how to assess otolith fxn

Answer 48

Cervical VEMP - saccule (loud sound in one ear triggers reflex to ipsi SCM muscle)
Ocular VEMP - utricle (records EOM potentials during head vibration)
-look for asymmetrical or absent response

Question 49

BPPV

Answer 49

Repositioning otoliths:

The Epley maneuver - most effective
Deconditioning exercises:

Brandt-Daroff Maneuver or Exposure tx
Sermount Maneuver
Recurrence is common

Question 50

Vestibular Neuronitis/ Labyrinthitis

Answer 50

Corticosteroids - methylprednisone or prednisone (shorten s/s duration, improve vestibular fxn and hearing recovery)
Give w/i 3 days of onset

Antimicrobials - not as effective
Valacyclovir if viral etiology

Abx if febrile or bacterial inf

Symptomatic:
Vertigo suppression:
Antihistamines - meclizine (Antivert)
Benzos - diazepam (Valium), lorazepam (Ativan)

N/V:
Promethazine (Phenergan)
Ondansetron (Zofrna)

Vestibular rehab tx

Question 51

Meniere’s Disease

Answer 51

Goal - ↓ freq of attacks, preserve hearing, alleviate imbalance

Lifestyle mod:
Low salt diet
Restrict alc and caffeine
Acute - vestibular suppressants:
Meclizine, diazepam, promethazine

Chronie - diuretics:
acetazolamide, HCTZ

Supportive:
Vestibular rehab, hearing aid Refractory - nondestructive interventions:
Intratympanic corticosteroids injections
Positive pressure pulse generator (Meniett)
Deliver pressure to inner ear
Endolymphatic shunt

Refractory - destructive interventions:
Intratympanic gentamicin injections
Surgical labyrinthectomy
Vestibular nerve resection

Mermaids can’t have salt, coffee or alcohol.
A cutely MMD (depressed b/c can’t drink alcohol)
Chronic Ace Fountain

Interventions: conch shell steriods, endolymph shunt, + pressure
Refractory - drummer gentlemen, surgical labrinth, vestibular nerve resection

Question 52

Perilymphatic Fistula

Answer 52

Prompt ENT referral
BR → Head elevation, avoid straining
Symptomatic meds PRN
Refractory - surgical patch

Question 53

Barotrauma

Answer 53

Symptomatic - analgesics

Refractory - Sx (myringotomy, tympanoplasty)

Question 54

Tinnitus subtype

Answer 54

Paraganglioma - Sx
Patulous Eustachian Tube- Sx, estrogen drops
Sensorineural hearing loss - hearing aids

Question 55

Tinnitus for all of the types

Answer 55

Underlying dz:
Hearing loss → hearing aids

Control HTN, review meds
Exacerbating factors: depression, insomnia (white noise) Behavioral tx:
Tinnitus Retraining tx (TRT)
Noise-inducing generators + counseling (habituates pt to tinnitus and diverts attention away from it)
Stress reduction programs, CBT

Meds - BZDs, intra-TM steroid shots, misoprostol

Masking devices

Transcranial magnetic stimulation

Question 56

Screening older children:

Answer 56

Tuning fork

Whisper test

Audiometric screening: use headphones

Question 57

What if a hearing loss screening is abnormal in kids/babies

Answer 57

Abn or failed screen → obtain full hearing eval ASAP, before 3mo
Children at risk for acquired hearing loss should repeat hearing test by 2.5yrs

Question 58

Ototoxic drugs

Answer 58

Salicylates - Aspirin
Quinine
Loop diuretics - Furosemide or Torsemide
Aminoglycosides - Gentamicin or Tobramycin
Macrolides - Erythromycin
Anti-neoplastic drugs - Cisplntin and Carboplantin
Heavy metal - Mercury and Lead
+ NSAIDs, vanco, vincristine, ethacrynic acid

dmg cochlea or CN 8, cause tinnitis or hearing loss

Question 59

Otosclerosis

Answer 59

Sx w/ stapedectomy

Sensorineural damage → amplification (hearing aid)

Question 60

Presbycusis

Answer 60

Hearing aids (MC) or cochlea implants (severe)

OTC CoQ10 - antioxidant vital to healthy hair cells - helps w/ sudden sensorineural hearing loss

Question 61

Acoustic Neuroma

Answer 61

May just req monitoring

RT or Sx

Question 62

Noise Induced Hearing Loss

Answer 62

Refer to audiologist
Routine audiologic screening rec for adults w/ prior exposure to high noise levels or 65+y/o

Question 63

Hearing Aids

Answer 63

Gold standard for auditory rehab of advanced sensorineural hearing loss (SNHL) and poor speech perception for adults and children

Restores partial hearing w/ advanced hearing loss

External mic and speech processor worn on ear and receiver implanted under temporalis muscle → internal receiver attached to electrode that is surgically placed in cochlea

Completely in canal (smallest)
Behind the ear (largest)