AND SOLUTIONS RATED A+
✔✔MOSTLY viral (15-44%)
Strep pneumo (20-35%)
H. flu (20-30%)
M. cat (15%) - ✔✔AOM causes
✔✔Cover mycoplasma pneumo & strep pneumo - ✔✔Bullous AOM
✔✔Amoxicillin- 1st line
Augmentin- if severe or previous AOM w/in 1mo
Clarithromycin- PCN allergy - ✔✔Tx for AOM
✔✔Believed to be cause by free floating calcium debris in the semicircular canal
Pt changes position, debris settles & signals brainstem, stimulating vertigo & nausea -
✔✔Benign paroxysmal positional vertigo (BPPV)
✔✔Severe vertigo seconds after changing position
Lasts seconds to minutes - ✔✔S/s BPPV
✔✔Epley maneuvers
Habituating exercises
Vestibular rehab
**Self-limiting - ✔✔Tx BPPV
✔✔Labyrinthitis
*Infection of inner ear (most likely viral) often following URI
*Affects vestibular portion of CN VIII - ✔✔Vestibular neuritis
✔✔Ages BPPV and vestibular neuritis? - ✔✔BPPV: most common over 60
VN: any age, usually after a URI
✔✔Disabling vertigo with N/V, gait impairment, possible hearing loss
*NO TINNITUS
*Lasts hrs to days - ✔✔S/s vestibular neuritis
✔✔Vestibular rehab
Usually resolves in several days
*Steroid acutely (pred taper), antihistamines, anti-emetics, anticholinergic x1st 24-48hrs
- ✔✔Tx vestibular neuritis
✔✔Peripheral vestibular disorder resulting from excess endolymphatic pressure
, Tears in membrane separating endolymph & perilymph allow mixing & distention
Causing vertigo - ✔✔Meniere's dx
✔✔Meniere's dx ages - ✔✔Between 40-70
✔✔Sudden episodes of vertigo associated w/ TINNITUS & DIMINISHED HEARING
*Lasts minutes to hrs
Asymptomatic bt episodes
POSITIVE NYSTAGMUS - ✔✔S/s Meniere's dx
✔✔Limit salt, caffeine, ETOH
Rest, fluids if necessary
Hearing aids, vestibular rehab, surgery
*Vestibular suppressant + anti-emetics Diuretic - ✔✔Tx Meniere's dx
✔✔*Hard red eye, ciliary flush, steamy cornea, dilated pupil
Halos around eyes - ✔✔Acute closed-angle glaucoma (ACG)
✔✔Onset of ACG? - ✔✔ACUTE w/ severe pain, ha, nausea
✔✔ACG more common in what ethnicity - ✔✔Asian-American & Intuits
✔✔Gold standard for ACG - ✔✔Gonioscopy
✔✔Bed rest, laser peripheral iridotomy - ✔✔Tx ACD
✔✔What to do if >1hr before pt can see opthalmologist w/ ACG - ✔✔If high suspicion,
consider pressure lowering drops & systemic meds to control IOP
✔✔90% of glaucoma cases - ✔✔Open-angle glaucoma (OAG)
✔✔6x more common in blacks (leading cause of blindness) - ✔✔OAG
✔✔IOP in OAG - ✔✔up to 22mmHg
✔✔Insidious onset, no early s/s
PAINLESS
Progressive loss of peripheral vision
Optic nerve head pale w/ increased cup-to-disk ratio - ✔✔S/s OAG
✔✔OAG tx - ✔✔Laser- trabeculoplasty
Surgery- possible shunt if advanced dx