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ENT/Respiratory

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Answer 50 questions in 15 minutes.
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Match each statement with the correct term.
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1. Additional pulmonary diagnostics
Nasal polyps - deviated septum - hx of trauma - surgery - foreign bodies or recent altitude changes
Labs: CBC - blood gas - d-dimer - CMP - BNP - Chest CT - MRI
Aspirin: increases viral shedding
Sore throat; nasal congestion; sections mucopurulent/clear; fullness in sinuses and ears; low grade fever; peaks 3-5 days; occasional cough; itchy nose - eyes - throat;

2. Acute viral rhino-sinusitis (AVRS) pathogens?
Viral inoculation > viral rhinitis > infection of paranasal sinuses > inflammation & edema > mucosal edema - copious secretions - ciliary dyskinesia > sinus congestions and/or obstruction
Rhinovirus - influenza - parainfluenza
Amoxicillin 80-90mg/kg/day x7 days; Augmentin 90/6.4 mg/kg/day x7 days
Amoxicillin 1000 mg TID x7 days; Augmentin 2000/125mg BID x7 days

3. Common cold pathogens
Rhinovirus - influenza - and parainfluenza
PE: rhinoscopy with otoscope
Hardher and more turbulent
Abnormal high pitched caused by blockage in upper airway; usually heard with with inspiration

4. Respiratory Examination (Observation)
High pitched voice sound due to transmission of noise across fluid. Indicative of effusion.
Rate; pattern (regular or irregular); effort (labored - accessory muscles)
Assess how fast a patient can expire in a second (FEV1) - FEV is the amount of air that normal lung can hold - FEV1 is reduced in asthma and COPD - FEV is reduced when there is restriction of the chest wall
Severe dyspnea when lying supine with associated wheezing and coughing - need to sit up abruptly due to severe dyspnea

5. Rx for viral URI?
24-72 hrs
Amoxicillin 1000 mg TID x7 days; Augmentin 2000/125mg BID x7 days
Aspirin: increases viral shedding
NSAIDs for aches - fever; Sympathomimetics: pseudophedrine or phenylephrine

6. Common Cold (URI - Acute Coryza)
Hardher and more turbulent
Afebrile viral infection of the the nose - paranasal sinuses - throat - larynx - trachea - and and bronchi.
Purulent discharge - post nasal draiange; cough; sinus pressure - tooth pain; halitosis (changes in taste); alterations of smell
Chest-X-Ray: (ABCDEFG) Airways and lung fields; bone and soft tissue - cardiac contour and mediastinum; diaphragms and costophrenic angles; exam technique; foreign bodies - tubes - and wires; gastric air bubble

7. Chronic rhino-sinusitis duration of symptoms?
Ear ache - dullness - hearing loss - fever - N/V/D
>12 weeks
Decongestants (oxymetazoline); glucocorticoids (e.g. fluticasone); mucolytics (e.g. guaifensin)
Warm - humid environment; rest;

8. Which Rx should not be used for viral URI?
Afebrile viral infection of the the nose - paranasal sinuses - throat - larynx - trachea - and and bronchi.
Clubbing - Use of accessory muscles - barrel chest
<4 weeks
Aspirin: increases viral shedding

9. Subacute rhino-sinusitis duration of symptoms?
Sore throat; nasal congestion; sections mucopurulent/clear; fullness in sinuses and ears; low grade fever; peaks 3-5 days; occasional cough; itchy nose - eyes - throat;
Augementin 2000/124 mg bid for 5-7 days - Peds: 90 mg/kg/day po in divided doses
4-12 weeks
Inflammation of the nasal cavity

10. Diagnostics of sinusitis?
Augementin 2000/124 mg bid for 5-7 days - Peds: 90 mg/kg/day po in divided doses
PE: rhinoscopy with otoscope
NSAIDs for aches - fever; Sympathomimetics: pseudophedrine or phenylephrine
Soft sounds in and out

11. Rhonchi
Severe dyspnea when lying supine with associated wheezing and coughing - need to sit up abruptly due to severe dyspnea
Deep - snoring sound; indicates fluid or narrowing of airways; common in bronchitis and COPD
24-72 hrs
Fine or courses; secretions or aveolar collapse; normal if resovle with cough; abnormal: pneumonia; CHF; COPD; pilmonary fibrosis

12. What is the most common pathogen for otitis in newborns?
Bacterial infection
E. coli
3 months to 3 years old
Fine or courses; secretions or aveolar collapse; normal if resovle with cough; abnormal: pneumonia; CHF; COPD; pilmonary fibrosis

13. Tx for adult AOE?
Warm - humid environment; rest;
Augementin 2000/124 mg bid for 5-7 days - Peds: 90 mg/kg/day po in divided doses
Oflaxicin 0.3% solution BID
4-12 weeks

14. Whispered pectoriloguy
Deep - rapid - labored - breathing
Increased loudness of whispering during auscultation. Indicative of consolidation.
Chest-X-Ray: (ABCDEFG) Airways and lung fields; bone and soft tissue - cardiac contour and mediastinum; diaphragms and costophrenic angles; exam technique; foreign bodies - tubes - and wires; gastric air bubble
Palpation: chest wall for tenderness; tactile fremitus - asymmetric chest wall expansion; Percussion: resonant vs. tympany vs dullness; Auscultation: cough or adventious sounds - lung sounds - pleural friction rubs

15. Acute rhino-sinusitis duration of symptoms?
Macrolides (azithormycin); Doxycycline; TMZ-SMZ
<4 weeks
Labs: CBC - blood gas - d-dimer - CMP - BNP - Chest CT - MRI
Afebrile viral infection of the the nose - paranasal sinuses - throat - larynx - trachea - and and bronchi.

16. Acute otitis media
Clubbing - Use of accessory muscles - barrel chest
Fine or courses; secretions or aveolar collapse; normal if resovle with cough; abnormal: pneumonia; CHF; COPD; pilmonary fibrosis
Bacterial or viral infection of the middle ear (secondary to URI [e.g. eustachian tube dysfunction])
Persistent or relapse of infection - chronic sinusitis - fungal infection - extension in CNS (meningitis - orbital cellulitis - osteitis)

17. Bronchophony
Amoxicillin 80-90mg/kg/day x7 days; Augmentin 90/6.4 mg/kg/day x7 days
Dyspnea when supine - relived by sitting or standing
Increased breath sounds or voice remains loud at the periphery during auscultation. Indicative of consolidation.
Rhinovirus - influenza - and parainfluenza

18. What is the most common pahtogen for otitis media?
TM erythmatous - bulging - light reflex displaced - exudate
Assess how fast a patient can expire in a second (FEV1) - FEV is the amount of air that normal lung can hold - FEV1 is reduced in asthma and COPD - FEV is reduced when there is restriction of the chest wall
Deep - snoring sound; indicates fluid or narrowing of airways; common in bronchitis and COPD
Step. pneumoniae; Haemophilus influenzae; group B-strep

19. Peak Expiratory Flow (PEF)
Hardher and more turbulent
Amoxicillin 80-90mg/kg/day x7 days; Augmentin 90/6.4 mg/kg/day x7 days
Measures speed of exhalation; results measure by age and weight
Pulse ox; Peak expiratory flow; spirometry

20. 1st line treatment for bacterial sinusitis?
Macrolides (azithormycin); Doxycycline; TMZ-SMZ
Ear ache - dullness - hearing loss - fever - N/V/D
Augementin 2000/124 mg bid for 5-7 days - Peds: 90 mg/kg/day po in divided doses
TM erythmatous - bulging - light reflex displaced - exudate

21. Tx of sinusitis symptoms <10 days
Viral inoculation > viral rhinitis > infection of paranasal sinuses > inflammation & edema > mucosal edema - copious secretions - ciliary dyskinesia > sinus congestions and/or obstruction
Rebound congestion 3-5 days
Symptomatic (steam; nasal irrigation); APAP for pain.
Inflammation of the nasal cavity

22. Sinusitis
Rhinovirus - influenza - and parainfluenza
Soft sounds in and out
Severe dyspnea when lying supine with associated wheezing and coughing - need to sit up abruptly due to severe dyspnea
Inflammation of the paranasal sinuses

23. Kussmal's respiration
Step. pneumoniae; Haemophilus influenzae; group B-strep
Abrupt onset - burning nose or throat - sneezing - rhinorrhea
Deep - rapid - labored - breathing
Rate; pattern (regular or irregular); effort (labored - accessory muscles)

24. Crackles (rales)
Severe dyspnea when lying supine with associated wheezing and coughing - need to sit up abruptly due to severe dyspnea
Clubbing - Use of accessory muscles - barrel chest
Amoxicillin 80-90mg/kg/day x7 days; Augmentin 90/6.4 mg/kg/day x7 days
Fine or courses; secretions or aveolar collapse; normal if resovle with cough; abnormal: pneumonia; CHF; COPD; pilmonary fibrosis

25. Rx nasal congestion?
Dyspnea when supine - relived by sitting or standing
Decongestants (oxymetazoline); glucocorticoids (e.g. fluticasone); mucolytics (e.g. guaifensin)
Increased loudness of whispering during auscultation. Indicative of consolidation.
NSAIDs for aches - fever; Sympathomimetics: pseudophedrine or phenylephrine

26. What sinusitis symptoms would warrant image studies?
Bacterial infection
Persistent; recurrent x4/yr; severe HA; altered mental status
Measures speed of exhalation; results measure by age and weight
High pitched voice sound due to transmission of noise across fluid. Indicative of effusion.

27. Alternative rx for bacterial sinusitis?
Macrolides (azithormycin); Doxycycline; TMZ-SMZ
92-100%
Nasal congestion - HA - sinus pain - fever - sore throat - cough
High pitched voice sound due to transmission of noise across fluid. Indicative of effusion.

28. Rhinosinusitis risk factors?
Ear ache - dullness - hearing loss - fever - N/V/D
Clubbing - Use of accessory muscles - barrel chest
High pitched voice sound due to transmission of noise across fluid. Indicative of effusion.
Nasal polyps - deviated septum - hx of trauma - surgery - foreign bodies or recent altitude changes

29. Rhinosinusitis History?
Fine or courses; secretions or aveolar collapse; normal if resovle with cough; abnormal: pneumonia; CHF; COPD; pilmonary fibrosis
<4 weeks
92-100%
Nasal congestion - HA - sinus pain - fever - sore throat - cough

30. Proxysmal nocturnal dyspnea
NSAIDs for aches - fever; Sympathomimetics: pseudophedrine or phenylephrine
Severe dyspnea when lying supine with associated wheezing and coughing - need to sit up abruptly due to severe dyspnea
Fine or courses; secretions or aveolar collapse; normal if resovle with cough; abnormal: pneumonia; CHF; COPD; pilmonary fibrosis
PE: rhinoscopy with otoscope

31. What are physical exam findings of AOE?
Aspirin: Reye's Syndrome
Abrupt onset - burning nose or throat - sneezing - rhinorrhea
Symptomatic (steam; nasal irrigation); APAP for pain.
Erythmatous auditory canal - crusting

32. Symptoms of viral rhinosinusitis
Ear ache - dullness - hearing loss - fever - N/V/D
Increased loudness of whispering during auscultation. Indicative of consolidation.
Sore throat; nasal congestion; sections mucopurulent/clear; fullness in sinuses and ears; low grade fever; peaks 3-5 days; occasional cough; itchy nose - eyes - throat;
Oflaxicin 0.3% solution BID

33. Common cold symptoms
Inflammation of the nasal cavity
3 months to 3 years old
Abrupt onset - burning nose or throat - sneezing - rhinorrhea
Sore throat; nasal congestion; sections mucopurulent/clear; fullness in sinuses and ears; low grade fever; peaks 3-5 days; occasional cough; itchy nose - eyes - throat;

34. What are physical exam findings of AOM?
TM erythmatous - bulging - light reflex displaced - exudate
High pitched voice sound due to transmission of noise across fluid. Indicative of effusion.
Step. pneumoniae; Haemophilus influenzae; group B-strep
Severe dyspnea when lying supine with associated wheezing and coughing - need to sit up abruptly due to severe dyspnea

35. Spirometry
Assess how fast a patient can expire in a second (FEV1) - FEV is the amount of air that normal lung can hold - FEV1 is reduced in asthma and COPD - FEV is reduced when there is restriction of the chest wall
Bacterial infection
>12 weeks
Labs: CBC - blood gas - d-dimer - CMP - BNP - Chest CT - MRI

36. Which Rx should not be used for viral URI pecs?

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37. Vesicular breath sounds...
E. coli
Bacterial infection
Ear ache - dullness - hearing loss - fever - N/V/D
Soft sounds in and out

38. Pathophysiology of rhino sinusitis?
Decongestants (oxymetazoline); glucocorticoids (e.g. fluticasone); mucolytics (e.g. guaifensin)
Viral inoculation > viral rhinitis > infection of paranasal sinuses > inflammation & edema > mucosal edema - copious secretions - ciliary dyskinesia > sinus congestions and/or obstruction
3 months to 3 years old
Step. pneumoniae; Haemophilus influenzae; group B-strep

39. What is most common age range for otitis?
Ipratroprium bromide (e.g. Atrovent); Antihistamines (Cargeul not to overly dry out muscos)
Afebrile viral infection of the the nose - paranasal sinuses - throat - larynx - trachea - and and bronchi.
3 months to 3 years old
Sore throat; nasal congestion; sections mucopurulent/clear; fullness in sinuses and ears; low grade fever; peaks 3-5 days; occasional cough; itchy nose - eyes - throat;

40. Nonpharmacological tx for viral URI
Deep - rapid - labored - breathing
Warm - humid environment; rest;
>12 weeks
<4 weeks

41. What does mucopurulent indications not indicate?
Aspirin: Reye's Syndrome
Bacterial infection
Aspirin: increases viral shedding
Rebound congestion 3-5 days

42. What are the symptoms of otitis?
3 months to 3 years old
Ear ache - dullness - hearing loss - fever - N/V/D
Warm - humid environment; rest;
>12 weeks

43. Egophany (vocal resonance)
Increased breath sounds or voice remains loud at the periphery during auscultation. Indicative of consolidation.
Rate; pattern (regular or irregular); effort (labored - accessory muscles)
High pitched voice sound due to transmission of noise across fluid. Indicative of effusion.
Chest-X-Ray: (ABCDEFG) Airways and lung fields; bone and soft tissue - cardiac contour and mediastinum; diaphragms and costophrenic angles; exam technique; foreign bodies - tubes - and wires; gastric air bubble

44. Bronchial breath sounds...
Rate; pattern (regular or irregular); effort (labored - accessory muscles)
Hardher and more turbulent
NSAIDs for aches - fever; Sympathomimetics: pseudophedrine or phenylephrine
HEENT: rhinoscopy - sinus tenderness - lymphnodes - transillumination of sinuses - CV and PULM.

45. Stridor
Nasal polyps - deviated septum - hx of trauma - surgery - foreign bodies or recent altitude changes
Rebound congestion 3-5 days
TM erythmatous - bulging - light reflex displaced - exudate
Abnormal high pitched caused by blockage in upper airway; usually heard with with inspiration

46. What is the common side effect of sympathomimetics?
Is the process upper or lower respiratory system - or both? Is the diagnostic workup necessary or can you initiate empiric treatment? Are antibiotics indicated?If so which ones and for how long? Can this patient be treated in the outpatients setting
Amoxicillin 80-90mg/kg/day x7 days; Augmentin 90/6.4 mg/kg/day x7 days
Deep - snoring sound; indicates fluid or narrowing of airways; common in bronchitis and COPD
Rebound congestion 3-5 days

47. Pulmonary diagnostics (1)
Rebound congestion 3-5 days
E. coli
Chest-X-Ray: (ABCDEFG) Airways and lung fields; bone and soft tissue - cardiac contour and mediastinum; diaphragms and costophrenic angles; exam technique; foreign bodies - tubes - and wires; gastric air bubble
Persistent or relapse of infection - chronic sinusitis - fungal infection - extension in CNS (meningitis - orbital cellulitis - osteitis)

48. Rx for rhinorrhea and/or allergies?
Ipratroprium bromide (e.g. Atrovent); Antihistamines (Cargeul not to overly dry out muscos)
Abrupt onset - burning nose or throat - sneezing - rhinorrhea
Amoxicillin 80-90mg/kg/day x7 days; Augmentin 90/6.4 mg/kg/day x7 days
Deep - snoring sound; indicates fluid or narrowing of airways; common in bronchitis and COPD

49. Cheyne-stokes
Erythmatous auditory canal - crusting
Inflammation of the paranasal sinuses
Apena alternating with hyperpnea;
HEENT: rhinoscopy - sinus tenderness - lymphnodes - transillumination of sinuses - CV and PULM.

50. Orthopnea
Amoxicillin 80-90mg/kg/day x7 days; Augmentin 90/6.4 mg/kg/day x7 days
Deep - rapid - labored - breathing
Macrolides (azithormycin); Doxycycline; TMZ-SMZ
Dyspnea when supine - relived by sitting or standing