PANCE review
1. Centor Criteria: Used to ID streptococcal pharyngitis, need 3/4:
1. fever,
2. tonsillar exudate,
3. tender anterior cervical LAD,
4. lack of cough
Add 1 if child, subtract 1 if over 45
2. 1st line treatment strep: Penicillins
(Macrolide and cephalosporin are 2nd)
3. strep complications: rheumatic fever and glomerulonephritis and pharygneal abscess
4. Rheumatic fever rash: Risk of epiglottis and managment
5. patho of peritonsillar abscess: Tonsillar infection spreading to surrounding tissue
tonsillititis—> peritonsillar cellulitis—> PTA
6. Deviated uvula, hot potato voice, unilateral sore throat: Peritonsillar abscess
7. peritonsillar abscess tx: ID and ABX= Unasyn or Clindamycin
8. Cellulitis vs PTA can been visualized by: CT
9. Ludwig's angina/risk: Submandibular space infection Can arise
from molar infection
Risk of airway compromise
10.Ludwig angina presentation: Fever, tender neck, palpable crepitus NO lym- phadenopathy
11.Mono triad: Fever, pharyngitis, and posterior cervical LAD
12.Tripoding, drooling, stridor, muffled voice think: Epiglottitis
13.The Hib vaccine prevents .: Epiglottitis
14.: Respiratory distress—> airway management ICU
admission
Nebulized epinephrine IV
abx (cephalosporin)
15."Thumb sign" on lateral neck x-ray: Epiglottitis
16.seal bark cough think: Laryngotracheitis croup
17.AP "steeple sign": Croup
18.Croup treatment: Supportive, dexamethasone,
19.Epistaxis treatment steps: 1) pressure (DO NOT TILT)
2) afrin
3) packing or cautery (if bleeding is seen)
4) referral/ if posterior will need referral
20.Rhinosinusitis treatment (bacterial): Augmentin first line (bacterial infection)
, PANCE review
21.septal hematoma: Bruise/swelling of septum (sign of a nose fracture), refer to ENT within 3-5
days for possible correction
22.auricular erysipelas vs perichondritis: Entire ear involved in auricular erysipelas
unlike perichondritis spares the lobe
-pseudomonas in perichondritis
-strep/staph in erysipelas
23.Perichondritis causes, and complications: Trauma, burn, piercing Necrosis of
cartilage/deformity
24.1st step in auricular hematoma: Drainage
25.If otitis media is associated with eye symptoms think: H influenza
26.Treat OM if 1) tm 2) or erythema: Buldging TM, pain or erythema
27.first line medication acute otitis media: Amoxicillin @90 mg/kg per day for 10 days
28.If amoxicillin allergy what abx for OME?: Ceftiraxone
29.acute mastoiditis tx: CT scan temporal bone, IV antibiotics, admission
30.Chronic otitis media mgmt: 1) ent referral 2) aural toilet 3) surgery
31.TM perforation mgmt: Abx -infection concern Recheck
in 4 weeks to assure healing
ENT referral if hearing loss
32.Vertical vertigo or nystagmus: Cerebellar stroke or MS
33.Most common cause vertigo, test and treatment: benign paroxysmal posi- tional vertigo
-did hallpike & epeley
34.Vertigo with hearing loss post viral infection think: Labyrinthitis
35.Ménière's disease treatment: Audiology, avoid triggers (salt), diuretics, PT, nausea meds,
and antihistamines
36.acoustic neuroma: benign tumor on the auditory nerve (8th cranial nerve) that causes
vertigo, tinnitus, facial paralysis and hearing loss
MRI is study of choice
37.Bacterial vs viral parotitis: Bacterial-unilateral, fever, pain trismus
Viral is less severe symptomatically, bacterial parotitis requires IV abx and IV rehydration
38.Triamicinolone topical: Treats apthous ulcers
39.oral leukoplakia: Will not scrape off, possible progression to SCC, consider biopsy
40.Corneal abrasion dx: fluoroscein staining
41.corneal abrasion tx: polymyxin/bacitracin or erythromycin ointment for contact
wearers > concern for pseudomonas > use ofloxacin or cipro
, PANCE review
DO NOT PATCH
42.Seidel sign: If fluorescein stain applied to eye, stained virtuous fluid will be seen leaking
from eye —-> indicates penetrating globe injury
43.keratitis and corneal ulcer: Break in the epithelium
44.Limbic flush: iritis/uveitis—-> indicates inflammation of the uvea
45.Hyphema: blood in the anterior chamber of the eye, seen in trauma
46.Hyphema management: ASAP Optho referral
-pupil dilation, bedrest, daily pressure managements Substantial risk of
glaucoma/vision loss
47.blepharitis tx: warm compress, hygiene, and topical antibiotics (Chronic
inflammation of eyelids)
48.Horedulum vs Chalazion: Stye acute Vs
chalazion is chronic and NOT painful
49.Preorbital cellulitis tx: Oral clindamycin/ Bactrim + amoxicillin If not
improving consider cellutits
50.Orbital cellulitis involves: Infection behind the septum including orbital fat and muscle
-pain with eye movement/limited movement
51.Orbital cellulitis treatment: Consult, CT imaging w & w/o contrast, admit with broad spectrum
IV antibiotics
52.Most common autoimmune cause of scleritis: Rheumatoid arthritis
53.scleritis: physical exam: Redness with a bluish hue
54.Scleritis diagnosis: B scan ultrasound- see sclera thickening
55.scleritis tx: control inflammation (oral NSAIDS, glucocorticoids)
56.acute angle closure glaucoma presentation: Pain, injection, blurred vision, vomiting, HA,
visual field defects, dilated pupil IOP > 40
57.Acute angle closure glaucoma treatment: Refer to ED, azetazolamide
58.open angle glaucoma
common
Blocks
Asymptomatic until
not characteristic
cup-disc ratio: Most common, risks HTN DM AA race Blocks
aqueous humor reabsorption
Asymptomatic until vision loss Pain
is NOT common Increased Disc to
Cup ratio
1. Centor Criteria: Used to ID streptococcal pharyngitis, need 3/4:
1. fever,
2. tonsillar exudate,
3. tender anterior cervical LAD,
4. lack of cough
Add 1 if child, subtract 1 if over 45
2. 1st line treatment strep: Penicillins
(Macrolide and cephalosporin are 2nd)
3. strep complications: rheumatic fever and glomerulonephritis and pharygneal abscess
4. Rheumatic fever rash: Risk of epiglottis and managment
5. patho of peritonsillar abscess: Tonsillar infection spreading to surrounding tissue
tonsillititis—> peritonsillar cellulitis—> PTA
6. Deviated uvula, hot potato voice, unilateral sore throat: Peritonsillar abscess
7. peritonsillar abscess tx: ID and ABX= Unasyn or Clindamycin
8. Cellulitis vs PTA can been visualized by: CT
9. Ludwig's angina/risk: Submandibular space infection Can arise
from molar infection
Risk of airway compromise
10.Ludwig angina presentation: Fever, tender neck, palpable crepitus NO lym- phadenopathy
11.Mono triad: Fever, pharyngitis, and posterior cervical LAD
12.Tripoding, drooling, stridor, muffled voice think: Epiglottitis
13.The Hib vaccine prevents .: Epiglottitis
14.: Respiratory distress—> airway management ICU
admission
Nebulized epinephrine IV
abx (cephalosporin)
15."Thumb sign" on lateral neck x-ray: Epiglottitis
16.seal bark cough think: Laryngotracheitis croup
17.AP "steeple sign": Croup
18.Croup treatment: Supportive, dexamethasone,
19.Epistaxis treatment steps: 1) pressure (DO NOT TILT)
2) afrin
3) packing or cautery (if bleeding is seen)
4) referral/ if posterior will need referral
20.Rhinosinusitis treatment (bacterial): Augmentin first line (bacterial infection)
, PANCE review
21.septal hematoma: Bruise/swelling of septum (sign of a nose fracture), refer to ENT within 3-5
days for possible correction
22.auricular erysipelas vs perichondritis: Entire ear involved in auricular erysipelas
unlike perichondritis spares the lobe
-pseudomonas in perichondritis
-strep/staph in erysipelas
23.Perichondritis causes, and complications: Trauma, burn, piercing Necrosis of
cartilage/deformity
24.1st step in auricular hematoma: Drainage
25.If otitis media is associated with eye symptoms think: H influenza
26.Treat OM if 1) tm 2) or erythema: Buldging TM, pain or erythema
27.first line medication acute otitis media: Amoxicillin @90 mg/kg per day for 10 days
28.If amoxicillin allergy what abx for OME?: Ceftiraxone
29.acute mastoiditis tx: CT scan temporal bone, IV antibiotics, admission
30.Chronic otitis media mgmt: 1) ent referral 2) aural toilet 3) surgery
31.TM perforation mgmt: Abx -infection concern Recheck
in 4 weeks to assure healing
ENT referral if hearing loss
32.Vertical vertigo or nystagmus: Cerebellar stroke or MS
33.Most common cause vertigo, test and treatment: benign paroxysmal posi- tional vertigo
-did hallpike & epeley
34.Vertigo with hearing loss post viral infection think: Labyrinthitis
35.Ménière's disease treatment: Audiology, avoid triggers (salt), diuretics, PT, nausea meds,
and antihistamines
36.acoustic neuroma: benign tumor on the auditory nerve (8th cranial nerve) that causes
vertigo, tinnitus, facial paralysis and hearing loss
MRI is study of choice
37.Bacterial vs viral parotitis: Bacterial-unilateral, fever, pain trismus
Viral is less severe symptomatically, bacterial parotitis requires IV abx and IV rehydration
38.Triamicinolone topical: Treats apthous ulcers
39.oral leukoplakia: Will not scrape off, possible progression to SCC, consider biopsy
40.Corneal abrasion dx: fluoroscein staining
41.corneal abrasion tx: polymyxin/bacitracin or erythromycin ointment for contact
wearers > concern for pseudomonas > use ofloxacin or cipro
, PANCE review
DO NOT PATCH
42.Seidel sign: If fluorescein stain applied to eye, stained virtuous fluid will be seen leaking
from eye —-> indicates penetrating globe injury
43.keratitis and corneal ulcer: Break in the epithelium
44.Limbic flush: iritis/uveitis—-> indicates inflammation of the uvea
45.Hyphema: blood in the anterior chamber of the eye, seen in trauma
46.Hyphema management: ASAP Optho referral
-pupil dilation, bedrest, daily pressure managements Substantial risk of
glaucoma/vision loss
47.blepharitis tx: warm compress, hygiene, and topical antibiotics (Chronic
inflammation of eyelids)
48.Horedulum vs Chalazion: Stye acute Vs
chalazion is chronic and NOT painful
49.Preorbital cellulitis tx: Oral clindamycin/ Bactrim + amoxicillin If not
improving consider cellutits
50.Orbital cellulitis involves: Infection behind the septum including orbital fat and muscle
-pain with eye movement/limited movement
51.Orbital cellulitis treatment: Consult, CT imaging w & w/o contrast, admit with broad spectrum
IV antibiotics
52.Most common autoimmune cause of scleritis: Rheumatoid arthritis
53.scleritis: physical exam: Redness with a bluish hue
54.Scleritis diagnosis: B scan ultrasound- see sclera thickening
55.scleritis tx: control inflammation (oral NSAIDS, glucocorticoids)
56.acute angle closure glaucoma presentation: Pain, injection, blurred vision, vomiting, HA,
visual field defects, dilated pupil IOP > 40
57.Acute angle closure glaucoma treatment: Refer to ED, azetazolamide
58.open angle glaucoma
common
Blocks
Asymptomatic until
not characteristic
cup-disc ratio: Most common, risks HTN DM AA race Blocks
aqueous humor reabsorption
Asymptomatic until vision loss Pain
is NOT common Increased Disc to
Cup ratio
