Nose/Mouth/Throat Flashcards
Rhinitis Medicamentosa: tx
- avoid decongestant use for >3-4 days
- flunisolide (steroid)
- ipratropium (bronchodilator)
Acute Bacterial Rhinosinusitis: tx
-Abx:
1st- Amoxicillin or Augmentin
PCN Allergy or 2nd line: Doxycycline, Levofloxacin, or Moxifloxacin
Non- anaphylactic PCN allergy or 2nd line: Clindamycin +
Cefixime or Cefpodoxime
- Topical steroid: nasonex, nasocort
- Sinus rinse
- PO steroid: MDP (medrol dosepak)
- Sudaphed
- Mucolytic (mucinex)
- If fail initial tx, extend course 2-3 weeks or change abx
- If fail x2 abx, refer to ENT/obtain culture
- Surgical intervention: FESS (functional endoscopic sinus surgery)
Chronic Sinusitis: tx
augmentin
Allergic Rhinitis: tx
- limit exposure
- nasal irrigation
- intranasal steroid: (beclomethasone, fluticasone)
- antihistamines: (PO loratadine or cetirizine, intranasal azelastine)
- immunotherapy
Nasal Polyps: tx
- Topical Steroids
- PO Steroids (Prednisone)
- Surgical Resection
Epistaxis: tx
Anterior:
- Direct Pressure
- Afrin spray (decongestant)
- Cautery (silver nitrate, electric)
- surgicel/gelfoam
- nasal tamponade (Bacitracin/Petroleum + )
- Topical Cocaine
Posterior:
- Epistat (double balloon pack)
- surgery
- embolization
- if packing in: antistaph abx (cephalexin or clinda) → reduces risk of toxic shock syndrome
Other tx:
- nasal packing
- rhino rocket
tx
Sinonasal Inflammatory Disease:
-Granulomatosis (Wegner’s)
-Sarcoidosis
- Steroids
- Immunomodulators (methotrexate)
Bacterial Pharyngitis (GABHS): tx
- Penicillin V Potassium
- If PCN allergy: erythromycin
- If fail, 2nd course tx w/ same drug
- Alternatives to PCN: cefuroxime, dicloxacillin, Augmentin
- Analgesics: (chloraseptic spray, lidocaine swish/spit), gargle salt water, anesthetic gargles/lozenges
- Anti-inflammatory agents (ASA, APAP, steroids)
Infectious Mononucleosis
Avoid sports due to enlarged spleen
Secondary infx could require abx: same for bacterial pharyngitis but avoid PCN (could cause diffuse maculopapular rash)
Gonococcal Pharyngitis
IM ceftriaxone + PO azithromycin
Thrush: tx
Oral antifungals: clotrimazole troches, miconazole, fluconazole
Gunville: ketoconazole
Infants: Nystatin rinse → not absorbed through GI tract
Gentian Violet- home remedy (recurrent thrush in neonates)
Diptheria: etiology
Corynebacterium diphtheriae
Diptheria: tx
Isolation until no longer contagious (48 hrs)
PCN or erythromycin
Humidity
Diphtheria antitoxin
Peritonsillar Abscess (quincy): tx
I&D
Tonsillectomy
IV abx: amoxicillin, amoxicillin-sulbactam, or clindamycin
If tolerating PO abx: amoxicillin, augmentin, or clindamycin
Retropharyngeal Abscess: tx
Surgery: Transoral/ Transcervical/ Combined Drainage
IV Abx: Clindamycin, Ampicillin-Sulbactam (Unasyn)
Ludwig’s angina: tx
Intubate/secure airway if tongue compromises airway
If immunocompetent:
- ampicillin-sulbactam
- PCN + metronidazole
- clindamycin
PCN allergy:
-clindamycin
OR (submental incision for I+D)
Epiglottitis: tx
Observe Airway
IV Abx
-Ceftizoxime
-Cefuroxime + dexamethasone
PO Abx to finish tx
Obstructive Sleep Apnea (OSA): tx
- Weight loss
- CPAP
- Oral dental appliance
- Uvulopalatopharyngoplasty
- Transoral Robotic -Surgery (TORS)
- Hypoglossal nerve stimulator
Laryngopharyngeal Reflux (LPR): tx
- proton pump inhibitor (PPI): Omeprazole
- reassess 3 months later
Recurrent Respiratory Papillomas: tx
- Laser vaporizations
- Cold knife resection via operative laryngoscopy
-Severe cases may require treatment as often as Q6 weeks to maintain airway patency
Vocal Fold Paralysis: tx
- Injection (fat, collagen, hyaluronic acid)
- Thyroplasty
- Tracheostomy +/- arytenoidectomy
- Sometimes paralysis resolves overtime» be conservative
Branchial Cleft Cyst: tx
to prevent recurrent infx or CA, must completely excise along with fistulous tracts
Thyroglossal Duct Cyst: tx
Surgical excision (Fistula + middle Hyoid Bone)
Laryngeal SCCa: tx
Early: radiation therapy, surgical resection
Advanced: chemotherapy, laryngectomy
