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22 Cards in this Set

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Cataract
Early nuclear cataract-change in prescription of glasses
Small central opacities-pupillary dilation may improve vision
Surgical removal of lens with replacement using intraocular lens implant
Cataract surgery is not performed with lasers
Laser used for “after cataract”
Thyroid eye disease
Mild cases- artificial tears
Moderate to severe-
Elevate head of bed –reduce congestion
Oral prednisone
Orbital radiation
Orbital decompression
Diabetic retinopathy
The diabetic control and complications trial has shown that tight glycemic control decreases the progression of diabetic retinopathy, nephropathy, and neuropathy

Prompt referral indicated
Laser photocoagulation
Diabetic macular degeneration
Tight glycemic control
Refer
Laser photocoagulation to decrease further decline in visual acuity by reducing amount of macular edema (ETDRS)
Hypertensive retinopathy
Treat the underlying hypertension
Treat the systemic vascular disease or renal disorders
Chronic does not require specific ophthalmic treatment
Retinal Vein occlusion
Mandatory ophthalmic exam within 48-72 hours of diagnosis
BRVO with macular edema may result in decreased vision-laser photocoagulation
Follow up- crvo assessed every month for 6 months by the eye doc
Visual prognosis depends on severity
age related macular degeneration
Acute vision changes-refer within 24 hours
Laser photocoagulation
Subretinal surgery experimental
Low vision aids-magnification
Preservision vitamins have been shown to improve patients with moderate to severe AMD
Visudyne – a new procedure for wet AMD
Otitis Externa
Treatment: remove debris, antibiotic and steroid drops, keep dry
Acidifying agent +/- hydrocortisone
Neomycin/polymyxin-B/hydrocortisone
Fluoroquinolone +/- dexamethasone
Perforated TM: Floxin otic + PO quinolone
Wick insertion
Acute otitis media
Treatment:
Antibiotics:
Moderate to severe otalgia
Fever > 39c (102.2f)
Less than 2 years of age
Observation:
Improvement: 61% in 24h, 75% in 1 week

Antibiotics:
First line: amoxicillin (macrolide)
Second line: amox/clavulanate, ceph2
PCN allergic: macrolide
Auralgan: benzocaine drops
Tympanocentesis
Otitis media with effusion
Treatment options:
Antibiotics: first line, limited benefit
Antihistamines/decongestants: no benefit
Steroids: not recommended
Ventilating tubes: initial benefit, limited by one year. No proven effects on language
Adenoidectomy: older than 4 y.o.
Chronic Otitis media
Treatment:
Antibiotics: fluoroquinolones
Surgery
Presbyacusis
Hearing aid, cochlear implant
Acoustic neuroma
Treatment: surgery, radiotherapy
Menieres disease
Treatment:
Low salt diet, limit alcohol and caffeine
Diuretics, antiemetics, anxiolytics (alprazolam)
Surgery
Tinnitus
Treatment:
Reverse underlying cause
Treat associated insomnia and depression
Vertigo
anticholinergics, antiemetics, benzodiazepines
Viral URI
Treatment:
Antihistamines, decongestants, guaifenesin
Antitussives
Ipratropium, cromolyn
Zinc
Vitamin C: no benefit, may help prevent
Echinacea: no benefit
Acute Sinusitis
Treatment
First line antibiotics: 7-10 days
Amoxicillin
Amoxicillin-clavulanate
Trimethoprim-sulfamethoxasole
Clarithromycin
Doxycycline
Second line antibiotics: 7-28 days
2nd generation cephalosporin (cefuroxime)
Fluoroquinolone (levofloxacin)

Treatment:
Intranasal steroids: no data
Surgery: endoscopic
Chronic sinusitis
Treatment:
Medications:
Antibiotics (3-6 weeks)
Intranasal steroid sprays
Guaifenesin
Antihistamines
Nasal irrigation

Antibiotics:
First line: amox-clavulanate, ceph2
PCN allergic: clarithromycin, clindamycin
Second line: levofloxacin, moxifloxacin
Functional endoscopic surgery (FESS)
Allergic Rhinitis
Treatment
Avoidance: dust, mold, dander, pollen
Medications:
Intranasal steroids (fluticasone)
Antihistamines (first and second generation)
Decongestants
Leukotriene inhibitors (montelukast)
Mast cell stabilizer sprays (nedrocromil)
Ipratropium bromide nasal spray: rhinorrhea
Allergen injection immunotherapy
Rhinitis medicomentosa
intranasal steroids
Epistaxis
balloon tamponade