PANCE Blueprint EENT (7%)

TX: viscous lidocaine 2–5% applied to ulcer QID after meals until healed

• Painful, white fluffy patches that can be scraped off and may bleed when scraped (candidiasis can "come off") leaving an erythematous, friable base
• Potassium Hydroxide (KOH) prep for diagnosis

TX: Antifungals, which are available in several forms (i.e., ketoconazole or fluconazole orally, clotrimazole troches, nystatin liquid rinses)

• Classic manifestations of these infections include high fever, systemic toxicity, and local signs of erythema, edema, and fluctuance
• Computed tomography (CT) is the imaging modality of choice for the diagnosis of deep neck space infection
• The most common organisms isolated from deep neck space infections are viridans streptococci

TX: Antibiotics, aspiration or surgical drainage should be performed

• H. influenza type B (Hib)
• Lateral radiograph: Thumbprint sign

TX: Secure airway, admit, IV Ceftriaxone, and IV fluids

TX: Symptomatic treatment with antipyretics and analgesia is recommended. IV hydration is sometimes needed in cases of decreased oral intake

• Oral acyclovir (15 mg/kg/dose five times per day for 7–10 days; max 200 mg per dose) may decrease the duration of illness if started within 72 hours at the onset of symptoms

• M.cat, H.flu
• Consider squamous cell carcinoma if hoarseness persists > 2 weeks, history of ETOH and or smoking, laryngoscopy is required for symptoms persisting > 3 weeks
• Absence of pain or sore throat

TX: Relax voice (vocal rest), supportive therapy

• Oral or IM corticosteroids may also hasten recovery for performers but requires vocal fold evaluation before starting therapy
• Bacterial → erythromycin, cefuroxime, or Augmentin for cough or hoarseness

• Hot potato (muffled) voice and deviation of the uvula to one side
• + Streptococcus pyogenes

TX: Aspiration, incision and drainage, and/or antibiotics

• Parenteral amoxicillin, amoxicillin-sulbactam, and clindamycin
• In less severe cases, oral antibiotics can be used for 7 to 10 days (i.e., amoxicillin, amoxicillin-clavulanate, clindamycin)
• Tonsillectomy may also be considered in about 10% of patients

• Mononucleosis: Epstein Barr virus, fever, sore throat, lymphadenopathy, splenomegaly, atypical lymphocytes, + heterophile agglutination test (monospot)
• Consider gonorrhea pharyngitis in patients with recent sexual encounters, or with non-resolving pharyngitis
• Fungal in patients using inhaled steroids

Strep pharyngitis

• Group A B-hemolytic streptococci (GABHS)
• Centor criteria: 1. Absence of a cough, 2. exudates, 3. fever (> 100.4 F), 4. cervical lymphadenopathy
• Not suggestive of strep - coryza, hoarseness, and cough
• If  3 out of 4 Centor criteria are met get a rapid streptococcal test (sensitivity > 90%)
• If negative → throat culture is the gold standard

TX:

• Group A Strep: Penicillin is first line, azithromycin if penicillin allergic. Complications: Rheumatic fever and post-strep glomerulonephritis
• Viral: supportive
• Mononucleosis: Symptomatic and avoid contact sports, antibiotics such as amoxicillin or ampicillin may cause a rash
• Fungal: clotrimazole, miconazole, or nystatin
• Gonorrhea pharyngitis: follows the same principles for the approach to therapy of uncomplicated urogenital gonococcal infections, with a preferred regimen of intramuscular ceftriaxone (250 mg) and azithromycin as a second agent