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HEENT Flashcards

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1
Q

What are the first line treatments for bacterial conjunctivitis?

A

Gramicidin- polymyxin B drops (Polysporin), erythromycin 0.5% ointment, fusidic acid 1% drops (>2 years), tobramycin 0.3% drops/ointment, trimethoprim-polymyxin B drops

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2
Q

How long should treatment be for bacterial conjunctivitis?

A

5-7 days

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3
Q

What are some counselling techniques for conjunctivitis?

A

Advise re: self-limiting nature, highly contagious for 48-72 hours (restrict contact for people for 24-48 hours after tx), cleanse eye from inner canthus to outer canthus, clean eyelashes with no-tears shampoo/warm water, cold compresses for comfort

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4
Q

What tx to use for serious conjunctivitis (ex: corneal involvement, contact lenses, tx failure)?

A

Besifloxacin 0.6% drops, ciprofloxacin 0.3% drops/ointment, moxifloxacin 0.5% drops

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5
Q

What is the management of seborrheic blepharitis?

A

LID hygiene BID/TID until improved (then once daily), anti-seborrheic shampoo

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6
Q

What is the management for bacterial blepharitis?

A

ABX ointment, lid hygiene, tear supplements PRN

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7
Q

What is the management for mixed bacterial/seborrheic blepharitis?

A

Lid hygiene, antibiotics

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8
Q

What is the tx for meibomian gland dysfunction?

A

Lid hygiene up to TID, scalp shampoo daily, Meibomian massage/expression, antibiotic/corticosteroid drops QHS or TID

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9
Q

What is the lid hygiene management for blepharitis?

A

Warm wash cloth with baby shampoo, artificial tears 4-8x/day PRN, hot compresses to loosen

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10
Q

What is first line antibiotic tx for blepharitis?

A

Erythromycin 0.5 ointment 1/2 inch QHS

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11
Q

What is the tx for keratosis/ keratoconjunctivitis caused by HSV?

A

Consult optho! Tx usually an antiviral opthalmic solution (ex: trifluridine 1 drop q2h)

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12
Q

What is the treatment for otitis externa?

A

Ciprodex 4 drops BID x7 days–can be used for both ruptured tympanic membrane and non-ruptured

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13
Q

What is the treatment for otomycosis?

A

Consider referral, can use topical antifungal cream (clotrimazole 1% cream applied to area BID x21 d)

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14
Q

What is the first-line treatment for adult otitis media?

A

Amoxicillin 500 mg BID x5 days

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15
Q

What is the tx for adults with a severe penicillin allergy?

A

Clarithromycin 500 mg BID x5 days

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16
Q

What is an appropriate tx option for adults with a non-severe penicillin allergy?

A

Cefprozil 500 mg BID x5 days

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17
Q

If the tympanic membrane is ruptured in those with otitis media, what is the appropriate tx?

A

Ciprodex 4 drops BID x5 days

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18
Q

What is the first management consideration for children presenting with otitis media?

A

Watchful waiting (if >6 mo) and not unwell/ have the capabilities to do so

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19
Q

In a child without TM rupture, what is the first-line tx for otitis media?

A

Amoxicillin 80 mg/kg/d BID or TID x10 days (if those <2) or 5 days (>2)

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20
Q

What is the tx for children with a non-severe penicillin allergy with otitis media?

A

Cefprozil 30 mg/kg/d BID x5 or 10 days (max 1 g/d)

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21
Q

What is the tx option for otitis media if child has a severe penicillin allergy?

A

Clarithromycin 15 mg/kg/d BID x5 or 10 days (max: 1 g/d)

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22
Q

What is the typical tx for chronic suppurative otitis media? (Safe or dangerous)

A

Ciprodex 4 drops BID x10 days

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23
Q

What are tx options for recurrent otitis media infection?

A

High dose amoxicillin (90 mg/kg/d) x 10 days if no antibiotics within past MONTH AND A HALF or change to amoxicillin-clav 45 mg/kg/d TID x10 days

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24
Q

What is a chalazion?

A

Chronic inflammation of Meibomian gland, blockage that results in stagnation of sebaceous secretions

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25
How to differentiate b/t a stye and chalazion?
Chalazion usually not painful and inflammed
26
What are tx options for a chalazion?
WARM compresses several times a day with gentle massage
27
What are treatment options for dry eye?
Changing environmental/lifestyle factors (depending on cause), lubricating eye drops/ artificial tears PRN, can consider opthlamic corticosteroids for short-term (should be prescribed by optho)
28
What is first-line tx for mild allergic rhinitis?
Second generation ORAL antihistamine or intranasal antihistamine
29
What is first-line tx for moderate to severe allergic rhinitis?
Intranasal corticosteroids
30
What are some second generation oral anti-histamines to prescribe?
Adult: 10 mg reactine PO daily (max 20 mg) Children 6 mo-5 y: 2.5 mg daily PO (syrup 1 mg/ml)
31
For mild-moderate allergic rhinitis, prescribe an intranasal corticosteroid
Mometasone (Nasonex) Adults: 2 spray each nostril (50 mcg/spray) daily Children 3-11 years: 1 spray each nostril daily
32
What are common adverse effects of intranasal corticosteroids?
Epistaxis, burning, nasal irritation Rare: mucosal membrane ulceration
33
What allergic rhinitis medication has the most effect on eye symptoms?
Intranasal antihistamines (also have good effect for sneezing)
34
In terms of allergic rhinitis, what medication is most effective for sneezing/congestion/rhinorrhea?
Intranasal corticosteroids
35
Using the throat score, what would you do if pt had a score of 2?
Complete a rapid test
36
Using the throat score, what would you do if patient had a score of 1?
No tx needed
37
Using the throat score, what would you do if pt scored a 3?
Treat if rapid +
38
What is the first-line tx for an adult with bacterial pharyngitis?
Amoxicillin 500 mg BID x10 days
39
What is the tx for an adult with bacterial pharyngitis with a severe allergy to penicillin?
Clarithromycin 250 mg BID x10 days
40
What is the tx for an adult with bacterial pharyngitis with a non-severe allergy to penicillin?
Ceprozil 250 mg BID x10 days
41
What is the dosing for amoxicillin for a child with bacterial pharyngitis?
40 mg/kg/d BID x10 days (max 4g/d)
42
If allergy to penicillin, what would be the tx option for child with GAS?
Clarithromycin 15 mg/kg/d (max 500mg/d)
43
What is the priority treatment for epiglotitis?
Airway establishment! Then IV antibiotics
44
What are treatment options for laryngitis?
Viral infection, recommended to rest vocal chords and avoid smoking or throat clearing, symptomatic management
45
What is the treatment for croup?
0.6 mg/kg/dose of dexamethasone (usually one time dose)
46
Who should antivirals be considered in with seasonal influenza?
Not healthy individuals- would consider in those at risk of complications with exposure, HCP/LTC workers/residents, immunoscompromised
47
What are the two antivirals that can be used for seasonal influenza post-exposure prophylaxis?
Oseltamivir and zanamivir
48
When should post-exposure prophylaxis be given for seasonal influenza?
Within 48 hours for oseltamivir, within 36 hours for zanamivir
49
What is one adverse event for zanamivir?
Can cause bronchospasm, would avoid in asthmatics
50
Can zanamivir and oseltamivir be used in pregnancy?
Yes- oseltamivir preferred, both safe for breastfeeding
51
What is suggested non-pharm tx for sinusitis?
Nasal irrigation/rinses/sprays
52
What is not recommended for sinusitis?
Topical decongestants and anti-histamines
53
What is first line tx for sinusitis in children?
Amoxicillin 80 mg/kg/d TID x10-14 days
54
Sinusitis tx in children with severe penicillin allergy?
Clarithromycin 15 mg/kg/d BID x 14 days (max 1 g)
55
Sinusitis tx in children with non-severe penicillin allergy?
Cefprozil 30 mg/kg/d BID x14 days (max 1 g)
56
First line bacterial sinusitis tx for adult?
Amoxicillin 500 mg TID x10 days
57
Sinusitis tx in adult with severe penicillin allergy?
Clarithromycin 500 mg BID x10 days
58
What is the most effective tx for pertussis?
Vaccination=prevention
59
What to consider with pertussis?
Can spontaneously clear from nasopharynx within 3 to 4 weeks of cough--ABX no benefit in this case
60
What is first-line tx for pertussis for adults?
Clarithromycin 250 mg BID x7 days
61
First-line tx for children with pertussis?
Clarithromycin 15 mg/kg/d BID x 7 days (max 1 g)
62
Second-line tx for pertussis?
TMP/SMX 2 tabs BID x7 days, children: 10 mg/kg/d BID x 7 days
63
Which of the following options is recommended for the treatment of Upper Airway Cough Syndrome (UACS) characterized by post-nasal drip, nasal discharge and throat clearing?
Decongestant and antihistamine
64

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