Eye and Ear disorders

What is the most common pathogen causing blepharitis?

Staphylococcus aureus.

What is the first-line treatment for blepharitis?

Warm compresses and lid hygiene; erythromycin ophthalmic ointment if bacterial.

What is the mechanism of action of erythromycin ophthalmic ointment?

Inhibits bacterial protein synthesis by targeting the 50S ribosomal subunit.

What is a common side effect of erythromycin ointment?

Temporary blurred vision, mild irritation, and burning.

What hallmark symptom indicates allergic conjunctivitis?

Itching.

What is the first-line treatment for allergic conjunctivitis?

Olopatadine (Pataday), an antihistamine + mast cell stabilizer.

What should be considered when treating conjunctivitis if the stem states 'itching'?

Think allergic conjunctivitis.

What discharge is associated with viral conjunctivitis?

Watery discharge.

What is the treatment approach for viral conjunctivitis?

Supportive care with artificial tears, cold compresses, and lubricants.

What is the first-line treatment for bacterial conjunctivitis?

Erythromycin ointment or trimethoprim-polymyxin B drops.

What common pathogens cause bacterial conjunctivitis in adults?

Staphylococcus aureus, Streptococcus pneumoniae, Haemophilus influenzae.

What should contact lens wearers use first-line for bacterial conjunctivitis?

Fluoroquinolone drops (e.g., ciprofloxacin, ofloxacin, moxifloxacin).

What is the mechanism of action of fluoroquinolone drops?

Inhibits DNA gyrase and topoisomerase IV.

What are the common side effects of fluoroquinolone drops?

Burning, stinging, and bad taste.

What is a contraindication for fluoroquinolone drops?

Hypersensitivity.

What patient education is important for contact lens wearers with bacterial conjunctivitis?

Stop wearing contacts immediately and discard lenses, cases, and eye makeup.

What is the first-line treatment for dry eye disease?

Artificial tears.

What is a second-line treatment for chronic dry eye?

Cyclosporine ophthalmic (Restasis), a calcineurin inhibitor.

What is the mechanism of action of prostaglandin analogs in glaucoma treatment?

Increase uveoscleral outflow to decrease intraocular pressure.

What are common side effects of prostaglandin analogs for glaucoma?

Increased iris pigmentation, eyelash growth, red eyes, and blurred vision.

What is a key contraindication for using timolol for glaucoma?

Asthma or COPD.

What is the first-line antibiotic for acute otitis media in children?

High-dose Amoxicillin (80–90 mg/kg/day).

What is the mechanism of action of amoxicillin?

Inhibits bacterial cell wall synthesis.

What is the common side effect of high-dose amoxicillin?

Diarrhea.

What is the second-line antibiotic for acute otitis media?

Amoxicillin-clavulanate.

Why is clavulanate used with amoxicillin?

It inhibits beta-lactamase and extends the spectrum of amoxicillin.

What is a major complication to avoid in otitis externa with tympanostomy tubes?

Use of aminoglycosides due to ototoxicity.

What is the first-line treatment for otitis externa?

Fluoroquinolone drops, often combined with a steroid.

Why is a steroid often used with fluoroquinolone drops for otitis externa?

It decreases canal swelling and improves penetration.

What is an important instruction for patients with severe swelling in otitis externa?

Insert an ear wick to allow drops to reach infected tissue.

What should be avoided in cases of perforated tympanic membrane?

Aminoglycosides (e.g., neomycin, gentamicin).

What is an exam pearl regarding conjunctivitis with purulent discharge?

It indicates bacterial conjunctivitis.

What condition does redness and discharge in contact lens wearers often suggest?

Pseudomonas infection.

What are common side effects of cyclosporine in eye treatments?

Burning and delayed onset of action.

What is a critical warning regarding steroid eye drops in primary care?

They can worsen glaucoma and herpetic eye disease.

What should be done with eye makeup after resolving conjunctivitis?

It should be replaced.

What type of drops should be used for a patient with dry eye symptoms?

Artificial tears.

How does Restasis (cyclosporine) help in dry eye disease?

It increases tear production by inhibiting T-cell activation.

What are the primary symptoms of allergic conjunctivitis?

Bilateral itching and stringy/clear discharge.

What is the main symptom of viral conjunctivitis that distinguishes it from bacterial?

Watery discharge.

What is an additional important aspect of managing patients with chronic inflammatory dry eye?

Monitoring the delayed onset of action of cyclosporine.

What should patients expect regarding pain improvement when treated for acute otitis media?

Pain improvement should occur within 48–72 hours after starting antibiotics.

What are the implications of prescribing timolol in patients with a history of asthma?

It can cause bronchospasm.