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ModuleI-HEENT Flashcards

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1
Q

True or false, otitis media with effusion (OME) is typically treated with amoxicillin?

A

False, otitis media with effusion (OME) is usually self-resolving and therefore not treated.

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2
Q

Which is not a causative organism of acute otitis media (OM)?

a) S. aureus
b) S. pneumoniae
c) H. influenzae
d) M. catarrhalis

A

Answer: a) S. aureus

The other three organisms are common causes of OM (they are also common causes of sinusitis so this bacteria can come from the pharynx and invade the tissue of the middle ear thus producing OM)

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3
Q

Which of the following are consistent with otitis media (choose all that apply):

a) bulging tympanic membrane
b) decreased movement of eardrum
c) fever
d) more visible landmarks
e) pain worsens with auricle manipulation

A

Answer: a,b,c

In OM: there is fever, ear pain, bulging tympanic membrane, decreased movement of the eardrum, less visible landmarks on the tympanic membrane, and dilated vessels within the ear

Note: auricle manipulation lessens the pain in OM but will worsen pain in acute otitis externa

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4
Q

Risk factors for otitis media include (choose all that apply):

a) immunizations
b) tobacco smoke
c) daycare
d) younger siblings in home
e) bottle feeds while laying down

A

Answer: b,c,d,e

Risks include choices b,c,d,e

Protective factors include: immunizations and breastfeeding

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5
Q

Watchful waiting for acute otitis media (AOM) is appropriate for what period of time?

A

48-72 hours (as 75% of cases will self resolve in 7 days)

Note: if symptoms worsen during that period–>treat with ABX

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6
Q

The first line treatment of acute otitis media (AOM) is what medication:

a) Amoxicillin/clavulanate otic drops
b) Cefuroxime orally
c) Amoxicillin orally
d) Cefpodoxime otic drops

A

Answer: c) Amoxicillin orally

Amoxicillin 80-90 mg/kg/day

2nd line therapy includes:

  • Amoxicillin/clavulanate
  • 2nd/3rd generation cephalosporins (Cefuroxime, Cefpodoxime, Cefdinir) [avoid 1st gen ceph drugs]

Treatment for ages <2= 10 days
Treatment for ages 2+=5-7 days

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7
Q

If your patient has an anaphylactic reaction to penicillin, what should you give them to treat acute otitis media?

a) Cefuroxime orally
b) Neomycin sulfate orally
c) Azithromycin orally
d) Ciprofloxacin orally

A

Answer: c) Azithromycin orally

In patients with anaphylaxis to PCN, give azithromycin or clindamycin

If reaction to PCN is rash you can use a 2nd/3rd generation cephalosporin

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8
Q

True or false, AOM has a high incidence of resistance to macrolide antibiotics such as azithromycin?

A

True. That is why they are only utilized in patients with a true anaphylactic allergy to PCN.

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9
Q

Myringotomy tubes and indicated in which patients (choose all that apply):

a) a patient with middle ear effusion 3+months
b) learning/speech delays
c) AOM with perforated tympanic membrane
d) AOM three times in 6 months

A

Answer: a,b,d

A perforated TM is not an indication for tube placement

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10
Q

One severe complication of acute otitis media is:

A

mastoiditis

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11
Q

True or false, a risk factor or drug resistant staphylococcus pneumoniae (DRSP) is recent antimicrobial use?

A

True.

If systemic antibiotics were used in last month, the patient should be treated with amoxicillin-clavulanate high dose.

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12
Q

True or false, acute otitis media can be caused by both bacteria and viruses?

A

True. Common viruses are RSV, influenza, rotavirus, and adenovirus

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13
Q

Which is not a causative organism of otitis externa?

a) pseudomonas
b) staphylococcus
c) streptococcus
d) moraxella

A

Answer: d) moraxella

Moraxella catarrhalis is a causative organism for otitis media.

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14
Q

Causes of otitis externa include the following (choose all that apply):

a) cerumen impaction
b) swimming/moisture in ear
c) trauma
d) pressure fluctuations (seen in someone who flies/travels by airplane frequently)

A

Answer: a,b,c

Causes include cerumen impaction, swimmer’s ear, and trauma (q-tips)

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15
Q

True or false, treatment of otitis externa is typically topical?

A

Answer: true.

Complicated cases may require oral/parenteral ABX

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16
Q

Which is not a treatment for otitis externa?

a) ciprofloxacin+hydrocortisone drops
b) neomycin sulfate drops + hydrocortisone
c) Tobramycin+dexamethasone
d) acetic acid+hydrocortisone drops

A

Answer: ALL are appropriate treatments

Treatment involves: FQ “floxacin” and aminoglycosides “mycins”; and a few others. All are used in tandem with a steroid.

Note: aminoglycosides can be oto/nephro toxic and should be avoided in those with a sulfa allergy

Will want to add something for analgesia too.

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17
Q

_______ (vertigo/dizziness) is the subjective perception of altered equilibrium, whereas ______ (vertigo/dizziness) is the perception that the person or the environment is moving.

A

Answer: Dizziness is the subjective perception of altered equilibrium, whereas vertigo is the perception that the person or the environment is moving.

*Vertigo involves an inner ear issue

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18
Q

Most vertigo is considered peripheral, which is broken down into which two categories?

a) central
b) otogenic
c) neurologic
d) toxic

A

Answer: b & d

Peripheral consists of otogenic (Meniere’s disease, infection) & toxic (ETOH, diuretics, ototoxic drugs)

*All other types will be referred out

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19
Q

Medications used to manage vertigo include (choose all that apply):

a) antihistamines (meclizine)
b) benzos
c) loop diuretics
d) systemic corticosteroids
e) anticholinergics

A

Answer: a,b,d,e

Antihistamines (meclizine, scopolamime) can help minimize overall symptoms; benzos can help with the anxiety; systemic corticosteroids can reduce inflammation of endolymph pressure; anticholinergics work centrally.

THIAZIDE diuretics are useful to decrease fluid in inner ear (will not treat acute attack but can prevent)

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20
Q

Benign paroxysomal positional vertigo (BPPV) is a common cause of vertigo due to sediment in the inner ear, treatment usually involves:

a) reposition maneuver (Epley)
b) diuretics
c) antiemetics
d) medication

A

Answer: a) reposition maneuver

Dix-Hallpike test is done and considered “abnormal” if nystagmus or vertigo are elicited. This is suggestive of an inner ear problem.

Note, BBPV is short lived usually ~60 seconds

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21
Q

Labyrinthitis causes vertigo due to:

a) free floating sediment in the inner ear
b) ETOH, or ototoxic drugs
c) autoimmune disease (RA)
d) inflammation

A

Answer: d) inflammation

Labyrinthitis is caused by inflammation secondary to a viral infection (URI) which affects the 8th CN in the inner ear

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22
Q

Labyrinthitis is usually _______ (30 min-4 hours/24-48 hours in duration) whereas Meniere’s disease usually lasts (30 min-4 hours/24-48 hours).

A

Answer: labyrinthitis lasts 24-48 hours whereas Meniere’s disease is 30 min-4 hours

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23
Q

Treatment for labyrinthitis includes:

a) antihistamines (meclizine)
b) antiemetics
c) steroids
d) analgesics

A

Answer: a,b,c

Analgesics are not usually needed because patients do not typically complain of pain.

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24
Q

Symptoms of Meniere’s include (choose all that apply):

a) vertigo
b) tinnitus
c) aural fullness
d) fluctuating hearing loss

A

Answer: all of the above

This differs from labyrinthitis where patients do not complain of hearing loss.

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25
Treatment for Meniere's includes: a) thiazide diuretics b) water restriction c) sodium restriction d) biologic drugs
Answer: a & c Thiazide diuretics and sodium restriction are both first line.
26
Weber test use a tuning fork placed _____ whereas the Rinne test places the tuning fork _______.
Weber-->top of head (sound should be distributed equally to both ears); Rinne placed on mastoid bone (air conduction>bone conduction)
27
Rhinitis associated with eating meals and a "confusion" within the neural pathways causes profuse drainage, this is commonly seen in which type of rhinitis? a) allergic b) non allergic c) vasomotor
Answer: c) vasomotor Treatment: ipratropium bromide or in office procedure Vasomotor rhinitis also involves dilation of vessels and can be triggered by various things. It comes and goes without any predictable pattern.
28
True or false, non allergic rhinitis has similar symptoms to allergic rhinitis, but it is not driven by immune mediated responses.
True. Non allergic rhinitis is due to exposures to irritants, viral infection, weather, hormones, etc. Symptoms are similar to allergic (runny nose, congestion, sneezing, postnasal drip) but do not include watery eyes, itchy nose, or scratchy throat.
29
Which is not a symptom of allergic rhinitis? a) nasal congestion b) rhinorrhea c) itchy nose d) sneezing
Answer: all of the above are symptoms
30
Assessment findings in allergic rhinitis do not include which of the following: a) erythematous nasal mucosa b) allergic shiners c) mouth breathing d) palpable lymph nodes
Answer: a) erythematous nasal mucosa The nasal mucosa in allergic rhinitis is usually pale and boggy
31
Allergic rhinitis "controllers" include which medications? a) intranasal steroids (Flonase) b) leukotriene receptor antagonist (Montelukast) c) mast cell stabilizers (Cromolyn) d) antihistamines
Answer: a,b,c Antihistamines are "relievers" for acute symptoms but the controllers are best used for prevention.
32
Allergic rhinitis "relievers" include which medications? a) antihistamines b) decongestants c) intranasal steroids d) oral steroids
Answer: a,b,d Intranasal steroids (Flonase) should be used preventatively as a controller since they can take up to 2 weeks to work. The other medications listed are for acute relief.
33
Allergy testing can be used in patients who ______ but RAST testing should be used in _______ patients.
Allergy testing-->patients unresponsive to empiric tx (stop antihistamines before tests) RAST (blood test) can be used in patients when a severe reaction is anticipated or when testing cannot be done (pregnant, take BB, take TCA, anaphylaxis)
34
Mainstays of allergic rhinitis management are:
avoid allergen, pharmacotherapy, immunotherapy
35
Preferred treatment for allergic rhinitis (preventatively) is:
intranasal steroids (Flonase)
36
True or false, decongestants should be used in caution in patients with CV disease.
True. There is a risk of HTN and tachycardia with decongestants
37
Which statement is NOT true regarding viral rhinosinusitis: a) causative organisms are usually rhinovirus, coronavirus, adenovirus b) congestion is often BIL and clear rhinorrhea c) it often precedes acute bacterial rhinosinusitis d) CT can differentiate between viral sinusitis and bacterial e) it is essentially the "common cold"
Answer: d) CT can differentiate between viral sinusitis and bacterial rhinosinusitis CT cannot differentiate and therefore it has limited use diagnostically
38
A patient presents with facial pressure, purulent nasal discharge, and ear pressure. The patient states they were sick with a cold for approximately 7-10 days, but have started feeling even worse than before. What is a likely diagnosis?
Acute bacterial rhinosinusitis Viral rhinosinusitis (a cold) typically precedes ABRS. ABRS symptoms which differ include (purulent nasal discharge, fever, maxillary tenderness/pain, etc). Additionally the symptoms lasting beyond the 7-10 day period are suggestive of ABRS.
39
Which organism is not a common cause of bacterial sinusitis? a) S. pneumoniae b) H. influenzae c) M. catarrhalis d) S. pyogenes
Answer: d) S. pyogenes S. pyogenes is more responsible for pharyngitis & strep throat The other organisms listed are commonly seen in bacterial sinusitis as well as acute otitis media
40
True or false, sinusitis is typically diagnosed with clinical symptoms?
True. CT scans are only done before surgery due to the inability to differentiate between bacterial and virus sinusitis. Transillumination has limited use. Culture and sensitivity should be done for resistant infections.
41
Treatment for viral sinusitis is typically: a) supportive b) antibiotics c) oral steroids d) intranasal steroids and topical decongestants
Answer: a) supportive
42
First line treatment for bacterial sinusitis is typically: a) amoxicillin-clavulanate b) levofloxacin c) cefixime d) azithromycin
Answer: a) amoxicillin-clavulanate
43
If your patient has bacterial sinusitis, but has a PCN allergy, you could prescribe which antibiotic (choose all that apply)? a) doxycycline b) levofloxacin c) cefixime d) azithromycin
Answer: a & b Appropriate alternatives are doxycyline, levofloxacin, moxifloxacin Cefixime (3rd gen Cephalosporin) should be avoided due to concerns of cross-reactivity in patients with a PCN allergy Macrolides (azithromycin) should be avoided due to high rates of resistance
44
True or false, montelukast (Singular) is a leuktriene modifier with a risk of mental health side effects in children.
True. These SE can include: agitation, depression, sleeping problems, and suicidal thoughts and actions.
45
True or false, nasal and oral corticosteroids are NOT helpful in acute bacterial rhinosinusitis?
True.
46
True or false, HPI is better in diagnosing acute bacterial rhinosinusitis (ABRS) than physical exam?
True. History paints a better picture especially if the patient complains of symptoms persisting beyond 7-10 days, or of the patient is likely experiencing double sickening. Symptoms of ABRS can be consistent with several diagnoses, again this reiterates the value in HPI.
47
True or false, the most common causative organism for both ABRS and AOM is S. pneumoniae?
True.
48
Anterior bleeding epistaxis is clinically obvious whereas posterior bleeding may be asymptomatic, and can present as which of the following: a) anemia b) nausea c) constipation d) pale nasal mucosa
Answer: a&b Posterior bleeding can cause nausea, hematemesis, anemia, hemoptysis, or melena
49
Which is not a common local cause of epistaxis? a) chronic sinusitis b) trauma c) topical medication d) irritants e) epistaxis digitorum
Answer: all of the above are common local causes of epistaxis
50
Systemic causes of epistaxis can include: a) liver disease b) platelet dysfunction c) medications d) hypotension
Answer: a,b,c HYPERtension can cause epistaxis. Other systemic causes can include hemophilia, leukemia, thrombocytopenia
51
Initial treatment of anterior epistaxis includes: a) pressure for 5-20 minutes b) ice c) tilting the head backward d) phenylephrine
Answer: a) pressure for 5-20 minutes Note: that is the initial management, but ice can be added as an adjunct The head should be tilted forward and phenylephrine should be reserved for nonresponsive bleeding.
52
Treatment for posterior epistaxis includes: a) pressure for 5-20 minutes b) ice c) tilting the head forward d) referral
Answer: d) referral Posterior epistaxis patients need to be referred.
53
True or false, most episodes of pharyngitis are viral.
True
54
The most common causative organism for bacterial pharyngitis is: a) Strep pyogenes b) Strep pneumoniae c) Haemophilus d) Moraxella
Answer: a) Strep pyogenes Strep pyogenes is a Group A beta-hemolytic streptococcus Note: GABHS does not produce beta-lactamase which is why they are susceptible (can be treated with) penicillin
55
True or false, common causative organisms for acute otitis media and bacterial sinusitis such as moraxella catarrhalis and haemophilus influenzae produce beta-lactamase which is why they are resistant to PCN treatment?
True. Note that the organism responsible for strep throat (strep pyogenes) does not produce beta-lactamase which is why penicillin is a treatment option for the diagnosis of strep throat. In order to use amoxicillin-clavulanate as the primary treatment for AOM and bacterial sinusitis it requires the addition of the "clavulanate."
56
What is the "CENTOR" criteria?
It is the criteria used to guide strep treatment and testing. ``` Cough (-1 point if cough present; +1 point if cough absent) Exudates +1 point Nodes +1 point Temperature 100.4+ (38 Celsius) +1 point OR age <15=+1 point and age >45=-1 point ``` 1 point total= strep unlikely so don't treat 2=test for strep (if negative rapid in kids, do a culture) 3-4=treat for strep empirically
57
True or false, GABHS pharyngitis always requires treatment.
False. It is self-limited usually. Treatment is done to avoid complications (rheumatic fever ,glomerular nephritis, abscesses), to shorten duration, reduce communicability, provide acute relief
58
Children can return to school within how many hours after treatment has been initiated for strep throat (GABHS)?
24 hours
59
First line treatment for GABHS pharyngitis includes: a) PenVeeK orally for 10 days b) amoxicillin orally for 10 days c) amoxicillin-clavulanate orally for 10 days d) Penicillin G benzathine IM once
Answer: a & b Primary treatment choices are oral PenVeeK and amoxicillin. Amoxicilin-clavulanate is not needed because GABHS doesn't produce beta-lactamase (so it doesn't render PCN ineffective) While Penicillin G IM is appropriate as first line (it should be reserved for patients where noncompliance is a concern)
60
Second-line treatment options for GABHS pharyngitis include: a) cephalexin b) cefadroxil c) TMP-SMZ d) doxycycline
Answer: a& b If patient has anaphylactic reaction to PCN, clindamycin, azithromycin, or clarithromycin can be used. Note: Clindamycin carries a risk of C. Diff
61
Symptoms of peritonsillar abscess include: a) contralateral uvular deviation b) erythematous swollen tonsil c) unilateral otalgia d) difficulty opening mouth (trismus)
Answer: all of the above This is a MEDICAL emergency and these paitents need to be referred out to the emergency department with an ENT consult
62
A 3 year old patient presents with stridor, tripod position, drooling, and a "thumb sign" on x-ray. The likely diagnosis is: a) peritonsillar abscess b) anaphylaxis c) choanal atresia d) epiglottitis
Answer: d) epiglottitis This is a medical emergency and these patients need to go to the ER as it can compromise the airway.
63
What places the patient at risk for acquiring epiglottitis? a) recent sinusitis b) missed H. influenzae (HiB) vaccine c) recurent tonsillitis d) Penicillin G injection to treat acute bacterial pharyngitis which caused a subsequent reaction
Answer: b) missed H. influenzae (HiB) vaccine The most common causative organism for epiglottits is HiB, thus, missing this vaccine places the child at risk.
64
Blepharitis (inflammation of the eyelid) is treated by which of the following nonpharm measures (choose all that apply): a) steroid injection b) warm moist compress c) lid massage/scrub d) disposal of contact lenses e) daily cleansing with astringent
Answer: b,c,d Treatments include warm moist compresses, lid massage/scrub, disposal of contact lenses.
65
The less common form of blepharitis is ______ (ulcerative/nonulcerative) and it is associated with ________ bacteria.
Answer: Ulcerative blepharitis is less common and associated with bacteria. Nonulcerative (seborrheic) is associated with dandriff and greasy scales are seen on the eyelid.
66
Nonulcerative blepharitis is seen more in people such as: a) trisomy 21 patients b) psoriasis c) allergies d) acne e) immunocompromised
Answer: all of the above
67
Blepharitis risk factors DO NOT include: a) frequent hordeola or chalazia b) immunocompromised state c) psoriasis d) recent conjunctivitis
Answer: d) recent conjunctivitis Other risks include: diabetes, acne, isotretinoin (accutane)
68
Which antibiotic is not appropriate for treating blepharitis? a) doxycycline orally b) bacitracin topically c) erythromycin topically d) quinolones topically e) ceftriaxone orally
Answer: e) ceftriaxone First line are: bacitracin, erythromycin, quinolone ointments. Resistant infections can be treated with doxycycline and tetracycline ORALLY*****
69
True or false, a common causative organism of hordeolum, chalazion, and blepharitis (eyelid disorders) is staphylococcus.
True.
70
A patient presents with a painful, erythematous lump on the eyelid. What is the most likely diagnosis? a) blepharitis b) hordeolum c) chalazion d) pterygium
Answer: b) hordeolum (aka a stye) Hordeolum are usually pus filled*
71
A patient presents with a painless, hard lump on the eyelid, and no erythema is present. What is the most likely diagnosis? a) blepharitis b) hordeolum c) chalazion d) pterygium
Answer: c) chalazion
72
True or false, management of both hordeolum and chalazion involves warm compresses, which are typically sufficient.
True. Warm compresses, lid massage/scrub. Chalazion can also be treated with a steroid injection of needed.
73
Which is a red flag in red eye (choose all that apply): a) vision changes b) blurred vision c) painless d) photophobia e) purulent discharge
Answer: a,b,d Red flags include: pain, vision changes (acuity), blurred vision, photophobia, fixed pupil, severe headache w/ nausea, corneal opacity, severe foreign body sensation
74
A patient presents with viral conjunctivitis and you notice dendrites on your fluorescin slide, what should you do?
Refer. This is likely HSV and can lead to blindness.
75
When evaluating a patient for conjunctivitis, what is the first test? a) red reflex b) cover/uncover c) fluorescin stain d) Snellen
Answer: d) Snellen To evaluate for changes in visual acuity which is a RED flag (if changes have occurred relative to the patient baseline).
76
First line treatment of bacterial conjunctivitis includes which medication: a) ofloxacin b) doxycycline c) amoxicillin d) olopatadine
Answer: a) ofloxacin Fluoroquinolones ("floxacins") are first line. While the macrolides (gentamicin, azithromycin) can be used, there is resistance emerging.
77
Allergic conjunctivitis can be treated with all of the following except: a) topical decongestant antihistamine combos (Naphazoline) b) oral antihistamines c) corticosteroid opthalmic drops d) mast cell stabilizers (Azelastine & Olopatadine)
Answer: c) corticosteroid opthalmic drops
78
True or false, if the patient has conjunctivitis due to chlamydia or gonococcal infection, they mus be treated topically and systemically?
True. Systemic tx: doxycyline (chlamydia) and PCN Ocular: managed by opthamology
79
True or false, while orbital or periorbital cellulitis is caused by the typical URI organisms, it should be referred out.
True. Due to the organisms responsible and potential for resistance to beta-lactam abx, the empiric treatment should include Ampicillin-clavulanate or cephalosporins
80
The best treatment for pingueculum and pterygium is: a) laster removal b) topical steroids c) lubricants d) prevention
Answer: d) prevention These are hyperplasia of the conjunctiva due to sun and irritants
81
A _______ (pingueculum/pterygium) is seen on the inner (nasal aspect) of the conjunctiva but spares the cornea, whereas a _______ (pingueculum/pterygium) is seen extending from the nasal aspect of the conjunctiva and extends onto the cornea.
Answer: Pingueculum-nasal aspect and spares cornea Pterygium- nasal aspect and covers part of cornea
82
What diagnostic tests are appropriate for a patient with a foreign body in the eye? a) CBC b) fluorescein stain c) cover/uncover test d) culture & sensitivity
Answer: b & d
83
Treatment for foreign body in the eye includes which of the following: a) tobramycin ointment b) ofloxacin drops c) loteprednol topically d) opthalmic lubricant drops
Answer: a&b The eye SHOULD NOT be patched, and patients should be referred if they do not heal within 1-2 days.
84
Level 1 treatment for dry eye includes education, environmental modification, and artificial tear substitutes. Level 2 treatment includes all of level 1 options plus: a) anti-inflammatory meds b) Restasis c) topical corticosteroids d) omega 3-FA
Answer: all of the above
85
Which is not an assessment finding of a patient with cataracts: a) diminished red reflex b) white reflex c) peripheral vision changes d) glare e) diminished night vision
Answer: c) peripheral vision changes are seen more with glaucoma
86
While cataracts are largely age related, prevention can include which of the following: a) avoiding unnecessary anticoagulant use b) control DM c) reduce ETOH and quit smoking d) UV eyewear usage
Answer: b,c,d Routine eye exams are beneficial as well
87
An obstruction of the nasolacrimal duct called dacrostenosis can be managed by: a) atropine eye drops b) vision therapy c) lacrimal massage BID d) immediate referral as this is an emergency
Answer: c) lacrimal massage BID If bacteria suspected, abx can be used. If persists you should refer.
88
A patient presents to the office reporting a minor car accident yesterday. They have blood in the anterior chamber and a visible fluid line in the pupil. You suspect: a) detached retina b) angle-closure glaucoma c) central renal artery occlusion d) hyphemia
Answer: d) hyphemia This is a medical emergency usually preceded by trauma. These patients need to be referred.
89
Which patient is NOT at risk for a hypemia? a) a patient on Warfarin b) a DM patient c) a patient with trisomy 21 d) a patient with hemophilia
Answer: c) a patient with trisomy 21 Risks include: anticoagulants, DM, hemophilia, and trauma
90
Risks for strabismus include: a) genetic issue b) prematurity c) tumors d) smoking during pregnancy e) anticoagulant use
Answer: a,b,c,d Other risks include family history, cataracts, DM, TBI, vision loss from any disease, TIA
91
Which is not an assessment finding for strabismus (eye misalignment or failure to look at same object simultaneously): a) abnormal cover/uncover b) vision loss c) white reflex d) abnormal visual acuity
Answer: c) white reflex White reflex is seen in cataracts
92
Diagnostic tests useful in evaluating strabismus include: a) corneal light reflex b) red reflex c) CT/MRI d) fluorescein dye
Answer: a,b,c Other tests include: visual acuity, pupillary response/accomodation, fundoscopic exam, extraocular muscle exam
93
Which is NOT an appropriate treatment option for strabismus? a) patching the affected eye b) atropine eye drops c) botox d) vision correction
Answer: a) patching the affected eye The UNaffected eye should be patched to allow the weak eye to become stronger. Referral is also appropriate.

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