Clin Med - Eent Tx

Front 1

Tx acoustic neuroma

Back 1

refer for surgical excision

Front 2

Tx cholesteatoma

Back 2

surgical excision

Front 3

Tx hematoma of external ear

Back 3

needle aspiration, I & D,

compression & dressing

Front 4

Tx labyrinthitis

Back 4

symptomatic: Antivert;

Hallpike maneuver

(S/Sx may persist for several wks)

Front 5

Tx mastoiditis

Back 5

IV abx for 21 days (Ceftriaxone)

Surgical - myringotomy or mastoidectomy

Front 6

Tx Meniere disease

Back 6

acute: diazepam IV, atropine IV

maintenance: diuretics (hctz), low salt diet, less caffeine, stop smoking

other: ablate hair cells, section vestibular n.

Front 7

Tx otitis externa

Back 7

clean canal, Tx inflammation & infection;

control pain

if bacterial: quinolone (cipro) drops (7-10d)

+/- steroid, acetic acid

Front 8

Pt has otitis media. When do you decide to NOT follow the observation protocol?

Back 8

<6 mo

<2 yo w/ severe symptoms (>39C, bilat, pain)

recent use of abx

otorrhea, vomiting

Front 9

observation protocol for otitis media

Back 9

Tx symptomatically x2-3 d;

if S/Sx still, start abx (Amoxicillin)

>6 y/o: 5-7 days

<6 y/o: 10 days

Front 10

Tx for benign paroxysmal positional vertigo

Back 10

Epley maneuver

Front 11

Tx TM perforation

Back 11

wait; heals spontaneously 4-6 wks

If large, may need surgery

Front 12

Tx allergic rhinitis

Back 12

Tx symptomatically

Antihistamine (Zyrtec)

Intranasal steroid (fluticasone)

avoid exposure; consider allergy testing

Front 13

Mgmt of nasal polyps

Back 13

antihistamine +/- decongestant;

topical steroids;

surgical resection (polypectomy)

Front 14

Tx sinusitis

Back 14

symptomatic: warm compresses, NSAIDs, saline irrigation, mucolytics, decongestants

+/- intranasal steroids

If bacterial: Amoxicillin (10 days)

If no improvement - CT scan, culture

Front 15

Tx acute pharyngitis

Back 15

symptomatic: NSAIDs, salt gargle, herbal tea

If severe pain, codeine PRN

If Group A strep:

pen VK or amoxicillin x10 days

Augmentin x5 days

If recurrent = Keflex

Front 16

If you suspect eustachian tube dysfunction -> serous otitis media...

Back 16

Tx w/ steroids

Front 17

Tx mononucleosis

Back 17

symptomatic: rest, salt gargle, NSAIDs

Avoid aspirin (Reye's) & contact sports;

No abx unless coexisting Strep infx

Front 18

Tx aphthous ulcer

Back 18

topical abx (tetracycline, Keflex),

topical corticosteroids

If severe/recurrent:

systemic corticosteroids,

Colchicine

Front 19

Tx epiglottitis

Back 19

manage airways,

IV Ceftriaxone, IV Vancomycin,

systemic corticosteroids (Dexamethasone)

culture if possible

Front 20

Tx laryngitis

Back 20

rest voice, humidify, hydrate,

analgesics

abx not needed

if hoarse >2 wks, refer to ENT (cancer)

Front 21

Tx laryngeal cancer

Back 21

surgical excision +/- radiation

Front 22

Tx oral candidiasis

Back 22

Nystatin (antifungal macrolide),

Miconazole, Clotrimazole, Fluconazole

Front 23

Tx oral herpes simplex

Back 23

mouthwash w/ analgesic

If recurrent, acyclovir

Front 24

Tx peritonsillar abscess

Back 24

surgical drainage (needle aspiration);

kids: hospitalize, IV abx (Pen G + metronidazole)

adults: outpt abx; clindamycin x10-14 days

Front 25

Tx for parotitis

Back 25

abx for S. aureus coverage (Augmentin, Dicloxacillin, etc.) then empiric

If severe, inpt abx (Nafcillin + metronidazole)

Symptomatic: analgesics, warm compress

Front 26

Tx for blepharitis

Back 26

warm compresses, eyelid scrubs

Ant: erythromycin/bacitracin ointment

Post: oral doxycycline

Front 27

Tx chalazion

Back 27

warm compresses, lid scrubs;

if refractory/recurrent,

refer for incision & curettage

Front 28

Tx hordeolum

Back 28

warm compresses, lid scrubs, massage;

if draining, abx ointment

(bacitracin, erythromycin)

If no improv. after 3-4 wks,

refer for curettage & drainage

Front 29

Tx dacryocystitis

Back 29

Most commonly Staph aureus;

Tx w/ cephalexin

If severe, multiple drugs (Vanco + ceftriaxone);

sometimes need I&D

Front 30

Tx ectropion

Back 30

artificial tears, warm compresses,

bacitracin or erythromycin ointment

tape lid, refer for surgery

Front 31

Tx entropion

Back 31

artificial tears

refer for surgery

Front 32

Tx pterygium

Back 32

protect from sun & wind,

topical steroid drops,

refer for surgical excision

Front 33

Tx conjunctivitis

Back 33

viral: artificial tears, cool compresses

bacterial: self-limiting; can use broad spec abx drops (sulfonamides)

Gonorrheal = IM ceftriaxone

Chlamydial = tetracycline, doxycycline

Allergic = antihistamine drops, steroid drops

Front 34

Tx corneal abrasion

Back 34

anesthetic drops, remove FB;

NSAIDs (diclofenac),

abx drops (tobramycin, polymyxin-bacitracin)

if contact user = ciprofloxacin

& no lenses for at least 7 days

if deep, patent FB, rust ring = f/u in 1-2 days

Front 35

Tx cataracts

Back 35

prescription glasses,

refer for evaluation/surgery

(intraocular lens implant)

Front 36

Tx glaucoma

Back 36

B-adrenergic drops,

A-adrenergic agonists,

steroid drops,

carbonic anhydrase inhibitor

If from topiramate or sulfonamide,

d/c contributing med & refer ASAP

(cycloplegia, atropine, IV steroids)

Front 37

Tx diabetic retinopathy

Back 37

manage glucose, BP, lipids;

yearly dilated eye exam;

photocoag. laser for neovascularization;

anti-VEGF injection

Front 38

Tx macular degeneration

Back 38

AREDS vitamins, monitor w/ Amsler grid,

stop smoking

photocoag. laser, intraocular anti-VEGF

end stage = implantable microscope

Front 39

Tx temporal arteritis

Back 39

oral prednisone ASAP;

(don't wait for bx)

if vision loss, IV methylprednisone

Front 40

Tx nystagmus

Back 40

if acquired, Tx underlying cause

If periodic alternating = baclofen

(contraindicated in kids)

If congenital, glasses +/- prism, Tx amblyopia, may need muscle surgery

Front 41

Tx optic neuritis

Back 41

one lesion = IV methylprednisone x3d, then oral prednisone x11d + antiulcer meds

3+ lesions = steroids & refer to neuro for possible interferon Tx

Front 42

Tx papilledema

Back 42

tailored to cause;

diuretics, wt reduction, corticosteroids,

medical adjustments

Front 43

Tx strabismus

Back 43

correct refraction,

Tx amblyopia or diplopia,

extraocular muscle surgery

maybe chemo-denervation

if paralytic/restrictive = botox injections

Front 44

Tx HSV keratitis

Back 44

topical antivirals,

+/- debridement

NO TOPICAL STEROIDS (make it worse)

Front 45

Tx orbital cellulitis

Back 45

hospitalize;

abx x3 wks

Front 46

Tx preseptal cellulitis

(aka periorbital cellulitis)

Back 46

consider hospitalization;

abx x10 days (Cephalexin)

Front 47

Tx iritis

Back 47

ASAP ophthalmology referral

Front 48

Tx subconjunctival hemorrhage

Back 48

reassurance (resolves 2-3 wks),

consider checking BP

Front 49

Tx hyphema

Back 49

acetaminophen, rest

(NO SAIDs - make worse)

Others: cycloplegics, miotics, +/- patch

Front 50

Tx orbital blowout fracture

Back 50

surgical

Front 51

Tx retinal detachment

Back 51

ASAP ophtho referral for surgery

Front 52

tx central retinal artery or vein occlusion

Back 52

ASAP ophtho referral

Front 53

Tx dacryoadenitis

Back 53

inflammatory condition: refer

viral: cool compresses, acetaminophen

bacterial: Augmentin or cephalexin

(if severe, hospitalize - Tx empirically)