AOBOO Ophthalmology & Otolaryngology-HNS cheat sheet

Corneal abrasion: treat with topical antibiotic, consider cycloplegic for pain; avoid patching for contact lens-related abrasions due to Pseudomonas risk.

Bacterial keratitis: risk factors include contact lens wear, trauma, ocular surface disease; treat with topical fluoroquinolone monotherapy (e.g., ciprofloxacin 0.3%) hourly around the clock initially.

Fungal keratitis: suspect in agricultural trauma or contact lens wear with feathery infiltrates; treat with topical natamycin 5% for filamentous fungi, voriconazole for yeasts.

Acanthamoeba keratitis: severe pain out of proportion, ring infiltrate, contact lens wear with homemade saline; treat with biguanides (polyhexamethylene biguanide) and diamidines (propamidine).

Herpes simplex keratitis: dendritic ulcer with terminal bulbs; stain with fluorescein; treat with topical ganciclovir or oral acyclovir; avoid topical steroids alone.

Corneal ulcer with hypopyon: obtain scrapings for culture before treatment; if perforation imminent, consider cyanoacrylate glue and bandage contact lens.

Anterior uveitis: cells and flare in anterior chamber; treat with topical steroid and cycloplegic; if granulomatous or recurrent, workup for sarcoidosis, syphilis, HLA-B27.

Pterygium: fibrovascular growth from conjunctiva onto cornea; indications for surgery include visual axis obstruction, astigmatism, chronic irritation; adjunct mitomycin C or conjunctival autograft reduces recurrence.

Central retinal artery occlusion: sudden painless vision loss, cherry-red spot, boxcarring; treat with ocular massage, anterior chamber paracentesis, topical beta-blocker; workup for embolic source (carotid, cardiac).

Central retinal vein occlusion: blood and thunder fundus, disc edema, macular edema; treat macular edema with anti-VEGF or steroid implant; monitor for neovascular glaucoma.

Diabetic retinopathy: nonproliferative shows microaneurysms, dot-blot hemorrhages, hard exudates; proliferative shows neovascularization; treat with panretinal photocoagulation for high-risk PDR.

Retinal detachment: symptoms of flashes, floaters, visual field defect; fundus shows elevated retina with corrugated folds; rhegmatogenous treated with scleral buckle or vitrectomy.

Age-related macular degeneration: dry type with drusen and geographic atrophy; wet type with choroidal neovascularization; treat wet with anti-VEGF injections.

Vitreous hemorrhage: causes include diabetic retinopathy, retinal tear, trauma; if no view of retina, perform B-scan ultrasound to rule out detachment.

Retinitis pigmentosa: progressive night blindness, bone spicule pigmentation, ring scotoma, attenuated vessels; electroretinogram shows reduced a- and b-waves.

Posterior vitreous detachment: common after age 50, flashes and floaters; risk of retinal tear if symptoms acute; perform dilated fundus exam with scleral depression.

Primary open-angle glaucoma: optic disc cupping, visual field defects (arcuate scotoma, nasal step); treat with prostaglandin analogs first-line, then beta-blockers, alpha-agonists, carbonic anhydrase inhibitors.

Acute angle-closure glaucoma: severe eye pain, headache, nausea, mid-dilated fixed pupil, corneal edema; treat with topical beta-blocker, pilocarpine, IV acetazolamide, hyperosmotic agents, then laser peripheral iridotomy.

Optic neuritis: painful vision loss, afferent pupillary defect, dyschromatopsia; associated with multiple sclerosis; treat with IV corticosteroids for severe cases.

Papilledema: bilateral disc edema from increased intracranial pressure; symptoms include transient visual obscurations, headache; workup with neuroimaging and lumbar puncture.

Third nerve palsy: ptosis, diplopia, eye down and out; pupil involvement suggests compressive lesion (e.g., aneurysm); urgent neuroimaging.

Chalazion: granulomatous inflammation of meibomian gland; treat with warm compresses, incision and curettage if persistent; unlike hordeolum, not infectious.

Basal cell carcinoma: most common eyelid malignancy; pearly nodule with telangiectasia; treat with surgical excision with margin control.

Dacryocystitis: infection of lacrimal sac; presents with medial canthal swelling, tearing; treat with antibiotics and warm compresses; dacryocystorhinostomy for chronic obstruction.

Acute otitis media: bulging tympanic membrane, otalgia, fever; common pathogens Streptococcus pneumoniae, Haemophilus influenzae, Moraxella catarrhalis; first-line amoxicillin or amoxicillin-clavulanate.

Chronic suppurative otitis media: persistent otorrhea through perforated TM; treat with topical fluoroquinolone drops; avoid aminoglycosides if perforation.

Cholesteatoma: keratinizing squamous epithelium in middle ear; presents with painless otorrhea, conductive hearing loss; treat with surgical excision (tympanomastoidectomy).

Otosclerosis: conductive hearing loss with normal TM, progressive; stapes fixation; treat with hearing aid or stapedectomy.

Meniere disease: episodic vertigo, fluctuating hearing loss, tinnitus, aural fullness; treat with low-salt diet, diuretics, intratympanic steroids or gentamicin.

Benign paroxysmal positional vertigo: brief vertigo with head position changes; Dix-Hallpike maneuver positive; treat with Epley canalith repositioning.

Vestibular schwannoma: unilateral sensorineural hearing loss, tinnitus, imbalance; MRI with gadolinium shows enhancing mass in cerebellopontine angle; treat with observation, surgery, or radiation.

Sudden sensorineural hearing loss: >30 dB loss over 3 contiguous frequencies within 72 hours; treat with high-dose oral corticosteroids; urgent MRI to rule out retrocochlear lesion.

Acute bacterial rhinosinusitis: symptoms >10 days or worsening after 5 days; treat with amoxicillin-clavulanate; avoid antibiotics for viral rhinosinusitis.

Chronic rhinosinusitis: >12 weeks of symptoms; treat with saline irrigation, intranasal corticosteroids; if polyps, consider oral steroids or surgery.

Allergic rhinitis: sneezing, rhinorrhea, nasal congestion, itchy eyes; first-line intranasal corticosteroids and oral antihistamines; immunotherapy for refractory cases.

Epistaxis: anterior bleeding from Kiesselbach plexus; apply pressure, topical vasoconstrictor, cautery; posterior bleeding requires packing and ENT consult.

Nasal septal hematoma: presents as bilateral nasal obstruction after trauma; must drain to prevent septal necrosis and saddle nose deformity.

Orbital complications of sinusitis: preseptal cellulitis vs orbital cellulitis (proptosis, ophthalmoplegia, vision loss); orbital cellulitis requires IV antibiotics and possible surgical drainage.

Inverted papilloma: benign but locally aggressive sinonasal tumor; unilateral nasal obstruction, epistaxis; treat with endoscopic resection due to recurrence and malignant potential.

Laryngeal cancer: hoarseness >2 weeks, smoking history; diagnosis by laryngoscopy and biopsy; treat with radiation or surgery depending on stage.

Vocal cord paralysis: unilateral causes hoarseness, aspiration; bilateral causes stridor; workup for recurrent laryngeal nerve injury (thyroid surgery, malignancy).

Thyroid nodule: evaluate with TSH, ultrasound, and fine-needle aspiration if >1 cm or suspicious features; Bethesda category guides management.

Papillary thyroid carcinoma: most common thyroid cancer; lymphatic spread; treat with total thyroidectomy and possible radioactive iodine.

Parathyroid adenoma: primary hyperparathyroidism with elevated calcium, low phosphate, elevated PTH; treat with surgical excision of adenoma.

Deep neck space infection: presents with fever, neck swelling, pain, dysphagia; airway compromise risk; treat with IV antibiotics and surgical drainage.

Ludwig angina: bilateral submandibular cellulitis; board-like neck, tongue elevation; secure airway and IV antibiotics.

Tonsillectomy indications: recurrent tonsillitis (7 episodes in 1 year, 5 per year for 2 years, 3 per year for 3 years), obstructive sleep apnea; post-tonsillectomy bleeding is an emergency.

Croup: barking cough, inspiratory stridor, hoarseness; treat with dexamethasone and nebulized epinephrine for severe cases.

Epiglottitis: drooling, dysphagia, distress, tripod position; do not examine throat; secure airway in OR; caused by Haemophilus influenzae type b (vaccine-preventable).

Foreign body aspiration: sudden choking, unilateral wheeze; rigid bronchoscopy for removal; avoid blind finger sweep.

Cleft lip and palate: cleft lip repair at 3-6 months, palate repair at 9-12 months; monitor for feeding difficulties, otitis media, speech issues.

Skin cancer reconstruction: basal cell carcinoma most common; Mohs micrographic surgery for high-risk areas; reconstruction with local flaps or grafts.

Facial nerve paralysis: if incomplete, treat with corticosteroids and antivirals; if complete and acute, same; if gradual or progressive, workup for malignancy.

Osteopathic manipulative treatment: lymphatic pump technique improves lymphatic flow; used for otitis media and sinusitis adjunctively.

Perioperative antibiotic prophylaxis: administer within 60 minutes before incision; re-dose if surgery >4 hours or blood loss >1500 mL.

Venous thromboembolism prophylaxis: use Caprini risk assessment; early ambulation, compression devices, or pharmacologic prophylaxis based on risk.

Informed consent: must include diagnosis, nature of procedure, risks, benefits, alternatives, and consequences of no treatment; document discussion.

OSHA bloodborne pathogens standard: require universal precautions, hepatitis B vaccination, post-exposure prophylaxis, and sharps disposal.

Medical coding: ICD-10 for diagnosis, CPT for procedures; documentation must support level of service and medical necessity.

Quality improvement: use Plan-Do-Study-Act (PDSA) cycle; measure outcomes, implement changes, and reassess.