Unit 3: Eye and Ear

Question 1

Blepharitis

Answer 1

Eyelid margin infection

Question 2

Causes of blepharitis

Answer 2

Usually due to staphylococcus infections, inflammation or hypersecretion of sebaceous glands or meibomian gland dysfunction

Question 3

S/S blepharitis

Answer 3

Irritated red eyes, burning sensation, increase in tearing, blinking and phototobia

Question 4

First line tx for blepharitis

Answer 4

Erythromycin 0.5% ointment, bacitracin 500U/g ointment or opthalmic fluoroquinolone (besifloxacin, gatifloxacin, levofloxacin, moxifloxacin)

Question 5

Conjunctivitis

Answer 5

External surface ocular infection

Eye inflammation of bulbar conjunctiva

Question 6

Most common organisms causing bacterial conjunctivitis

Answer 6

Staph, Strep, Moraxella + Haemophilus

Question 7

most common cause of conjunctivitis in neonates

Answer 7

N. Gonorrhoeae + C. Trachomatis

Question 8

Viral conjunctivitis

Answer 8

Most common
Usually adenovirus
Very contagious

Question 9

S/S conjunctivitis

Answer 9

Itching, burning sensation of eye, discharge, sensation of foreign body

Question 10

S/S bacterial conjunctivitis

Answer 10

Eyelids stuck together in morning

Question 11

S/S N. Gonorrhoeae conjunctivitis

Answer 11

Copious purulent discharge

Question 12

S/S viral conjunctivitis

Answer 12

Profuse watery discharge

Question 13

S/S allergic conjunctivitis

Answer 13

Itching is hallmark

Question 14

Antibiotics for bacterial conjunctivitis

Answer 14

Erythromycin or bacitracin/polymyxin B ointment usually most effective
Some fluoroquinolones have good coverage (besifloxacin, gatifloxacin, levofloxacin, moxifloxacin)

Question 15

Antibiotic for gonoccocal conjunctivitis

Answer 15

immediate IM injection of ceftriaxone and single dose oral azithromycin

Question 16

Antibiotic for chalmydial conjunctivitis

Answer 16

Single dose azithromycin or 7 days doxycyline

Question 17

Antihistamine for conjunctivitis

Answer 17

Alcaftadine + Emedastine

Useful for allergic conjunctivitis

Question 18

Mast cell stabilizers for conjunctivitis

Answer 18

Bepotastine, cromolyn, lodoxamide, nedocromil

For allergic conjunctivitis

Question 19

NSAID ophthalmic drug

Answer 19

Ketorolac

Treatment of itch with allergic conjunctivitis

Question 20

First line tx for bacterial conjunctivitis

Answer 20

Erythromycin ointment of bacitracin/polymyxin B ointment

Question 21

Second line tx for bacterial conjunctivitis

Answer 21

Ophthalmic fluoroquinolones

Question 22

First line tx for seasonal conjunctivitis

Answer 22

Topical antihistamines

Question 23

Second line tx for seasonal conjunctivitis

Answer 23

Topical antihistamines + low potency topical corticosteroid

Question 24

First line tx for viral conjunctivitis

Answer 24

Topical antihistamines or artificial tears

Question 25

Second line tx for viral conjunctivitis

Answer 25

Low potency topical corticosteroid <2 weeks

Question 26

Dry eye syndrome

Answer 26

Keratoconjunctivitis Bilateral disruption of tear film on ocular surface Can be due to decreased tear production, increased tear evaporation, or combination

Question 27

when to refer to ophthalmologist for dry eye syndrome

Answer 27

If moderate to severe pain, vision loss, corneal infiltration/ulceration

Question 28

Cholinergic agonists for dry eye syndrome

Answer 28

Pilocarpine + Cevimeline Increases secretions May cause excess sweating

Question 29

Topical cyclosporine for dry eye syndrome

Answer 29

Increases aqueous tear production and decreases ocular irritation

Question 30

First line tx for dry eye syndrome

Answer 30

Artificial tears 4x a day

Question 31

Second line tx for dry eye syndrome

Answer 31

Cyclosporine emulsion 2x a day

Question 32

Glaucoma

Answer 32

Irreversible damage to optic nerve and retinal ganglion cells Results in loss of visual sensitivity and field Due to increased IOP due to decrease in outflow of aqueous humor

Question 33

Beta blockers for glaucoma

Answer 33

Topical Decreases adenylyl cyclase activity which decreases production of aqueous humor in ciliary body Timolol, levobunolol, carteolol, metipranolol, betaxolol

Question 34

Prostaglandins for glaucoma

Answer 34

Bimatoprost, latanoprost, tafluprost, travoprost Decrease IOP by increasing aqueous outflow More effective at bedtime May cause irreversible iris discoloration

Question 35

Topical Carbonic anhydrase inhibitors for glaucoma

Answer 35

Brinzolamide + Dorzolamide Decrease bicarbonate formation so decreases movement of fluid into posterior chamber of eye and decreases production of aqueous humor Less effective but less systemic SE

Question 36

Systemic carbonic anhydrase inhibitors for glaucoma

Answer 36

Acetazolamide, methazolamide, dichlorphenamide | More potent but more severe SE- paresthesias, GI distress, metallic taste, renal calculi

Question 37

Adrenergic agonists for glaucoma

Answer 37

Apraclonidine + Bromonidine | Activate alpha 2, inhibiting release of NE which decreases aqueous humor production

Question 38

Cholinergic agonists for glaucoma

Answer 38

Pilocarpine Stimulates parasympathetic muscarinic receptor site to increase aqueous outflow May cause eye pain, brow ache, blurred vision, decreased night vision

Question 39

First line agent for glaucoma

Answer 39

Prostaglandin ophthalmic solution

Question 40

Second line agent for glaucoma

Answer 40

Ophthalmic beta blocker or addition of beta blocker to prostaglandin solution

Question 41

Third line agent for glaucoma

Answer 41

Addition of carbonic anhydrase inhibitor or brimonidine

Question 42

Most common infection in children requiring antibiotics

Answer 42

otitis media

Question 43

Most frequent bacteria present in middle ear fluid

Answer 43

Strep pneumoniae, H. Influenzae, moraxella catarrhalis | Less common: GAS and Staph aureus

Question 44

Most cases of Acute otitis media

Answer 44

Follow viral URI since it facilitates bacteria

Question 45

Most otitis externa caused by

Answer 45

Pseudomonas and Staph aureus

Question 46

Dx criteria for AOM

Answer 46

Abrupt fever, otalgia, irritability, tugging on ear, tympanic membrane is red, bulging and immobile

Question 47

OTC therapy for OM

Answer 47

NSAIDs and acetaminophen to decrease pain

Question 48

First line therapy for AOM

Answer 48

High dose amoxicillin | Can use augmentin if bacteria is penicillin resistant

Question 49

2nd line therapy for AOM

Answer 49

Use if penicillin allergy 2nd generation cephalosporin: cefuroxime 3rd generation cephalosporin: cefdinir + cefpodoxime

Question 50

Otitis externa S/S

Answer 50

ear pain, itching, fullness, tenderness | Rapid onset of s/s within 48 hours in past 3 weeks

Question 51

Mainstay OE tx

Answer 51

Topical antibiotics

Question 52

Antibiotics that can be used for OE

Answer 52

Fluoroquinolones: ciprofloxacin and ofloxacin Aminoglycosides: Neomycin

Question 53

First line tx for OE

Answer 53

Fluoroquinolone drops

Question 54

Second line tx for OE

Answer 54

Neomycin/polymyxin B combos

Question 55

Third line tx for OE

Answer 55

Antifungal drops | Systemic antipseudomonal/antistaph agent