ENT

Question 1

Symptoms of blepharitis

Answer 1

irritated red eyes (typically a burning sensation)
Increases in tearing, blinking, and photophobia
eyelid sticking or contact lens intolerance

Question 2

Seborrheic blepharitis

Answer 2

eyelid deposits are matted and scaly

rarely exhibit eyelash loss or misdirection

Question 3

staphylococcus blepharitis

Answer 3

Eyelash loss or misdirection

eyelid deposits are oily and greasy

Question 4

MGD blepharitis

Answer 4

thickening of eyelid margin and formation of chalazia
eyelid deposits are fatty and sometimes foamy
plugging of meibomian orifices that may lead to atrophy

Question 5

nonpharmacologic treatment for all types of blepharitis

Answer 5

strict eyelid hygiene and warm compress

Question 6

when should you refer a patient to an eye care specialist r/t blepharitis

Answer 6

suspected new cases of seborrheic or MGD blepharitis

Question 7

pharmacologic treatment of blepharitis

Answer 7

bacitracin or erythromycin ointment is first line

if a solution is preferred a fluoroquinolone would be appropriate

Question 8

types of conjunctivitis

Answer 8

viral
bacterial
allergic

Question 9

when would you refer to an eye specialist r/t conjunctivitis

Answer 9

moderate to severe pain
light sensitivity
blurred vision that does not improve with blinking

Question 10

symptoms of bacterial conjunctivitis

Answer 10

eyelids stuck together upon waking (d/t purulent drainage)

usually starts in one eye and become bilat in a few days

Question 11

symptoms of viral conjunctivitis

Answer 11

profuse watery discharge
usually starts in one eye and becomes bilat a few days later
examination may reveal tender preauricular

Question 12

symptoms of allergic conjunctivitis

Answer 12

itching is hallmark symptom

Question 13

what should you suspect with copious purulent eye drainage

Answer 13

N. gonorrhea

Question 14

abts for conjunctivitis

Answer 14

decision is often empirical

5-7 days therapy with erythromycin or bacitracin-polymyxin B ointment/solution is usually effective

Question 15

drug therapy for conjunctivitis

Answer 15

antibiotics
antihistamines
mast cell stabilizers
antihistamine/mast cell stabilizer
ophthalmic NSAIDs
vasoconstrictors (decongestants)
topical corticosteroids

Question 16

tx for gonococcal eye infection

Answer 16

must be treated immediately d/t risk of permanent eye damage

ceftriaxone plus azithromycin

Question 17

when should you refer to eye specialist r/t dry eye syndrome

Answer 17

if patient reports moderate to severe pain, vision loss, corneal infiltration or ulceration, or no response to therapy

Question 18

Treatment for dry eye syndrome

Answer 18

artificial tears and lubricants
cholinergic agonists
topical cyclosporine
topical corticosteroids

Question 19

types of glaucoma

Answer 19

primary open-angle
acute closed-angle
normal-tension
narrow-angle

Question 20

how is glaucoma diagnosis made

Answer 20

by eye care professional

Question 21

pharmacologic treatment for glaucoma

Answer 21

beta-blockers
prostaglandins
carbonic anhydrase inhibitors (CAI)
adrenergic agonists
cholinergic agonists
combo products

Question 22

side effect of prostaglandins used for glaucoma tx

Answer 22

darkening of eyelid skin

usually reverses 3-6mo after therapy is dc’d

Question 23

1st line therapy for glaucoma

Answer 23

prostaglandins because they have the best balance between efficacy, safety, and ease of dosing

Question 24

2nd line therapy for glaucoma

Answer 24

addition of beta-blockers if IOP has decreased with prostaglandin but fails to meet goal
switch to beta-blocker if prostaglandin ineffective

Question 25

3rd line therapy for glaucoma

Answer 25

topical CAI

if this fails dc dorzolamide for brimonidine

Question 26

most common bacterial respiratory tract infection in children and predominately affects infants and children 6mo-2yrs

Answer 26

acute otitis media

Question 27

typical cause of AOM

Answer 27

typically follows URI in which eustachian tube closes due to inflamed mucus membranes

Question 28

presentation of acute otitis media (AOM)

Answer 28

abrupt onset of symptoms (less than 48h)(fever, otalgia, irritability, tugging on ear)
tympanic membrane appears bulging, erythematous, and immobile on otoscopy

Question 29

Otitis media with effusion

Answer 29

absence of inflammatory s/s

typically asymptomatic except for c/o full sensation in ear and hearing loss

Question 30

when would AOM be treated observationally

Answer 30

> 2yr with bilat AOM w/o otorrhea or severe symptoms

Question 31

1st line therapy for AOM

Answer 31

Amoxicillin if no amoxicillin in previous 30 days otherwise Augmentin. If PCN allergy a second or third-generation cephalosporin

Question 32

2nd line therapy for AOM

Answer 32

Augmentin if amoxicillin fails. If Augmentin fails, a cephalosporin or 1 dose ceftriaxone IM or 3 day course IV ceftriaxone

Question 33

standard course of treatment of AOM

Answer 33

<2y = 10 days to manage severe
>2y = 7 days
>6y may benefit from 5 days

Question 34

Tx for OE

Answer 34

topical abt preferred over systemic to achieve high concentration at the site of infection

Question 35

when would you use systemic abt for tx of OE

Answer 35

infection that extends beyond the ear canal
uncontrolled DM
immunocompromised
hx of radiotherapy
inability to deliver topical antibiotics

Question 36

1st line therapy for OE

Answer 36

fluoroquinolone abt (ciprofloxacin or ofloxacin)

Question 37

2nd line therapy for OE

Answer 37

neomycin/polymyxin B combos

Question 38

3rd line therapy for OE

Answer 38

AF can be considered if patient fails to respond to topical abt therapy

Question 39

symptom resolution after tx initiation for OE

Answer 39

improvement with 48-72h

complete resolution of symptoms may take 2 weeks