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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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This is a study tool. The 3 wrong answers for each question are randomly chosen from answers to other questions. So, you might find at times the answers obvious, but you will see it re-enforces your understanding as you take the test each time.

1. What is most common age range for otitis?
3 months to 3 years old
Increased breath sounds or voice remains loud at the periphery during auscultation. Indicative of consolidation.
Abnormal high pitched caused by blockage in upper airway; usually heard with with inspiration
Symptomatic (steam; nasal irrigation); APAP for pain.

2. Which Rx should not be used for viral URI?
Nasal congestion - HA - sinus pain - fever - sore throat - cough
Purulent discharge - post nasal draiange; cough; sinus pressure - tooth pain; halitosis (changes in taste); alterations of smell
Aspirin: increases viral shedding
Increased breath sounds or voice remains loud at the periphery during auscultation. Indicative of consolidation.

3. Symptoms of viral rhinosinusitis
E. coli
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;
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
Nasal polyps - deviated septum - hx of trauma - surgery - foreign bodies or recent altitude changes

4. Special cases of sinusitis?
Abnormal high pitched caused by blockage in upper airway; usually heard with with inspiration
Rhinovirus - influenza - parainfluenza
Persistent or relapse of infection - chronic sinusitis - fungal infection - extension in CNS (meningitis - orbital cellulitis - osteitis)
Amoxicillin 80-90mg/kg/day x7 days; Augmentin 90/6.4 mg/kg/day x7 days

5. Crackles (rales)
Step. pneumoniae; Haemophilus influenzae; group B-strep
Fine or courses; secretions or aveolar collapse; normal if resovle with cough; abnormal: pneumonia; CHF; COPD; pilmonary fibrosis
Aspirin: increases viral shedding
>12 weeks

6. What is the common side effect of sympathomimetics?
Ear ache - dullness - hearing loss - fever - N/V/D
Warm - humid environment; rest;
Rebound congestion 3-5 days
NSAIDs for aches - fever; Sympathomimetics: pseudophedrine or phenylephrine

7. Rx nasal congestion?
<4 weeks
Decongestants (oxymetazoline); glucocorticoids (e.g. fluticasone); mucolytics (e.g. guaifensin)
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;
High pitched voice sound due to transmission of noise across fluid. Indicative of effusion.

8. Tx for pediatric AOM?
Abnormal high pitched caused by blockage in upper airway; usually heard with with inspiration
Augementin 2000/124 mg bid for 5-7 days - Peds: 90 mg/kg/day po in divided doses
Rebound congestion 3-5 days
Amoxicillin 80-90mg/kg/day x7 days; Augmentin 90/6.4 mg/kg/day x7 days

9. Sinusitis
Inflammation of the paranasal sinuses
Labs: CBC - blood gas - d-dimer - CMP - BNP - Chest CT - MRI
PE: rhinoscopy with otoscope
Decongestants (oxymetazoline); glucocorticoids (e.g. fluticasone); mucolytics (e.g. guaifensin)

10. What does mucopurulent indications not indicate?
Bacterial infection
TM erythmatous - bulging - light reflex displaced - exudate
Persistent or relapse of infection - chronic sinusitis - fungal infection - extension in CNS (meningitis - orbital cellulitis - osteitis)
Macrolides (azithormycin); Doxycycline; TMZ-SMZ

11. Tx for adult AOM?
Amoxicillin 1000 mg TID x7 days; Augmentin 2000/125mg BID x7 days
Rate; pattern (regular or irregular); effort (labored - accessory muscles)
Soft sounds in and out
Amoxicillin 80-90mg/kg/day x7 days; Augmentin 90/6.4 mg/kg/day x7 days

12. Tx of sinusitis symptoms <10 days
Severe dyspnea when lying supine with associated wheezing and coughing - need to sit up abruptly due to severe dyspnea
Rate; pattern (regular or irregular); effort (labored - accessory muscles)
Erythmatous auditory canal - crusting
Symptomatic (steam; nasal irrigation); APAP for pain.

13. Stridor
Abnormal high pitched caused by blockage in upper airway; usually heard with with inspiration
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;
Symptomatic (steam; nasal irrigation); APAP for pain.
High pitched voice sound due to transmission of noise across fluid. Indicative of effusion.

14. Rx for rhinorrhea and/or allergies?
Rebound congestion 3-5 days
NSAIDs for aches - fever; Sympathomimetics: pseudophedrine or phenylephrine
Afebrile viral infection of the the nose - paranasal sinuses - throat - larynx - trachea - and and bronchi.
Ipratroprium bromide (e.g. Atrovent); Antihistamines (Cargeul not to overly dry out muscos)

15. Common Cold (URI - Acute Coryza)
Inflammation of the paranasal sinuses
Afebrile viral infection of the the nose - paranasal sinuses - throat - larynx - trachea - and and bronchi.
PE: rhinoscopy with otoscope
>12 weeks

16. Acute rhino-sinusitis duration of symptoms?
<4 weeks
3 months to 3 years old
Increased loudness of whispering during auscultation. Indicative of consolidation.
4-12 weeks

17. Pulmonary tests
Inflammation of the paranasal sinuses
Pulse ox; Peak expiratory flow; spirometry
Persistent or relapse of infection - chronic sinusitis - fungal infection - extension in CNS (meningitis - orbital cellulitis - osteitis)
Macrolides (azithormycin); Doxycycline; TMZ-SMZ

18. Additional pulmonary diagnostics
Inflammation of the nasal cavity
Hardher and more turbulent
24-72 hrs
Labs: CBC - blood gas - d-dimer - CMP - BNP - Chest CT - MRI

19. Cold incubation period
Soft sounds in and out
Clubbing - Use of accessory muscles - barrel chest
Ipratroprium bromide (e.g. Atrovent); Antihistamines (Cargeul not to overly dry out muscos)
24-72 hrs

20. 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
Rate; pattern (regular or irregular); effort (labored - accessory muscles)
Nasal congestion - HA - sinus pain - fever - sore throat - cough
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

21. Proxysmal nocturnal dyspnea
Severe dyspnea when lying supine with associated wheezing and coughing - need to sit up abruptly due to severe dyspnea
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;
Clubbing - Use of accessory muscles - barrel chest
TM erythmatous - bulging - light reflex displaced - exudate

22. What is the most common pathogen for otitis in newborns?
E. coli
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
Severe dyspnea when lying supine with associated wheezing and coughing - need to sit up abruptly due to severe dyspnea
Rhinovirus - influenza - parainfluenza

23. Tx for adult AOE?
Oflaxicin 0.3% solution BID
Aspirin: Reye's Syndrome
Fine or courses; secretions or aveolar collapse; normal if resovle with cough; abnormal: pneumonia; CHF; COPD; pilmonary fibrosis
Purulent discharge - post nasal draiange; cough; sinus pressure - tooth pain; halitosis (changes in taste); alterations of smell

24. Egophany (vocal resonance)
92-100%
Aspirin: increases viral shedding
Macrolides (azithormycin); Doxycycline; TMZ-SMZ
High pitched voice sound due to transmission of noise across fluid. Indicative of effusion.

25. Bronchial breath sounds...
E. coli
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
Hardher and more turbulent
Severe dyspnea when lying supine with associated wheezing and coughing - need to sit up abruptly due to severe dyspnea

26. What sinusitis symptoms would warrant image studies?
Increased loudness of whispering during auscultation. Indicative of consolidation.
Nasal congestion - HA - sinus pain - fever - sore throat - cough
<4 weeks
Persistent; recurrent x4/yr; severe HA; altered mental status

27. Peak Expiratory Flow (PEF)
Severe dyspnea when lying supine with associated wheezing and coughing - need to sit up abruptly due to severe dyspnea
Measures speed of exhalation; results measure by age and weight
Ipratroprium bromide (e.g. Atrovent); Antihistamines (Cargeul not to overly dry out muscos)
Deep - rapid - labored - breathing

28. Whispered pectoriloguy
Increased loudness of whispering during auscultation. Indicative of consolidation.
Oflaxicin 0.3% solution BID
Persistent; recurrent x4/yr; severe HA; altered mental status
HEENT: rhinoscopy - sinus tenderness - lymphnodes - transillumination of sinuses - CV and PULM.

29. Rhinitis
High pitched sounds; can occur during inspiration or expiration; indicates narrow airways; can occur with asthma - COPD - pneumonia - CHF
Symptomatic (steam; nasal irrigation); APAP for pain.
Augementin 2000/124 mg bid for 5-7 days - Peds: 90 mg/kg/day po in divided doses
Inflammation of the nasal cavity

30. Pulmonary diagnostics (1)
TM erythmatous - bulging - light reflex displaced - exudate
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
Erythmatous auditory canal - crusting
3 months to 3 years old

31. Acute viral rhino-sinusitis (AVRS) pathogens?
3 months to 3 years old
Deep - rapid - labored - breathing
Rhinovirus - influenza - parainfluenza
Persistent; recurrent x4/yr; severe HA; altered mental status

32. Symptoms of acute bacterial rhino-sinusitis (ABRS)?
PE: rhinoscopy with otoscope
Augementin 2000/124 mg bid for 5-7 days - Peds: 90 mg/kg/day po in divided doses
Purulent discharge - post nasal draiange; cough; sinus pressure - tooth pain; halitosis (changes in taste); alterations of smell
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

33. Rx for viral URI?
Dyspnea when supine - relived by sitting or standing
Measures speed of exhalation; results measure by age and weight
NSAIDs for aches - fever; Sympathomimetics: pseudophedrine or phenylephrine
Warm - humid environment; rest;

34. 1st line treatment for bacterial sinusitis?
Augementin 2000/124 mg bid for 5-7 days - Peds: 90 mg/kg/day po in divided doses
Apena alternating with hyperpnea;
Nasal polyps - deviated septum - hx of trauma - surgery - foreign bodies or recent altitude changes
Ipratroprium bromide (e.g. Atrovent); Antihistamines (Cargeul not to overly dry out muscos)

35. Alternative rx for bacterial sinusitis?
>12 weeks
Hardher and more turbulent
Macrolides (azithormycin); Doxycycline; TMZ-SMZ
PE: rhinoscopy with otoscope

36. Kussmal's respiration
Fine or courses; secretions or aveolar collapse; normal if resovle with cough; abnormal: pneumonia; CHF; COPD; pilmonary fibrosis
NSAIDs for aches - fever; Sympathomimetics: pseudophedrine or phenylephrine
Deep - rapid - labored - breathing
Bacterial infection

37. Vesicular breath sounds...
Persistent or relapse of infection - chronic sinusitis - fungal infection - extension in CNS (meningitis - orbital cellulitis - osteitis)
Measures speed of exhalation; results measure by age and weight
Oflaxicin 0.3% solution BID
Soft sounds in and out

38. Cheyne-stokes
Apena alternating with hyperpnea;
Fine or courses; secretions or aveolar collapse; normal if resovle with cough; abnormal: pneumonia; CHF; COPD; pilmonary fibrosis
TM erythmatous - bulging - light reflex displaced - exudate
E. coli

39. Acute otitis media
Bacterial or viral infection of the middle ear (secondary to URI [e.g. eustachian tube dysfunction])
Increased breath sounds or voice remains loud at the periphery during auscultation. Indicative of consolidation.
Viral inoculation > viral rhinitis > infection of paranasal sinuses > inflammation & edema > mucosal edema - copious secretions - ciliary dyskinesia > sinus congestions and/or obstruction
Soft sounds in and out

40. Wheezes
Deep - snoring sound; indicates fluid or narrowing of airways; common in bronchitis and COPD
NSAIDs for aches - fever; Sympathomimetics: pseudophedrine or phenylephrine
High pitched sounds; can occur during inspiration or expiration; indicates narrow airways; can occur with asthma - COPD - pneumonia - CHF
Measures speed of exhalation; results measure by age and weight

41. Chronic rhino-sinusitis duration of symptoms?
Bacterial infection
>12 weeks
Warm - humid environment; rest;
4-12 weeks

42. Common cold symptoms
Aspirin: increases viral shedding
Labs: CBC - blood gas - d-dimer - CMP - BNP - Chest CT - MRI
Symptomatic (steam; nasal irrigation); APAP for pain.
Abrupt onset - burning nose or throat - sneezing - rhinorrhea

43. What are physical exam findings of AOM?
TM erythmatous - bulging - light reflex displaced - exudate
Abrupt onset - burning nose or throat - sneezing - rhinorrhea
4-12 weeks
Oflaxicin 0.3% solution BID

44. Rhinosinusitis History?
Dyspnea when supine - relived by sitting or standing
Decongestants (oxymetazoline); glucocorticoids (e.g. fluticasone); mucolytics (e.g. guaifensin)
Nasal congestion - HA - sinus pain - fever - sore throat - cough
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

45. Bronchophony
Amoxicillin 1000 mg TID x7 days; Augmentin 2000/125mg BID x7 days
Nasal congestion - HA - sinus pain - fever - sore throat - cough
Increased breath sounds or voice remains loud at the periphery during auscultation. Indicative of consolidation.
Aspirin: increases viral shedding

46. Respiratory Examination (Observation)
<4 weeks
Rate; pattern (regular or irregular); effort (labored - accessory muscles)
Rebound congestion 3-5 days
Severe dyspnea when lying supine with associated wheezing and coughing - need to sit up abruptly due to severe dyspnea

47. Abnormal pulmonary findings?
Clubbing - Use of accessory muscles - barrel chest
Viral inoculation > viral rhinitis > infection of paranasal sinuses > inflammation & edema > mucosal edema - copious secretions - ciliary dyskinesia > sinus congestions and/or obstruction
Dyspnea when supine - relived by sitting or standing
Rebound congestion 3-5 days

48. Pathophysiology of rhino sinusitis?
Labs: CBC - blood gas - d-dimer - CMP - BNP - Chest CT - MRI
Rhinovirus - influenza - and parainfluenza
Viral inoculation > viral rhinitis > infection of paranasal sinuses > inflammation & edema > mucosal edema - copious secretions - ciliary dyskinesia > sinus congestions and/or obstruction
Increased breath sounds or voice remains loud at the periphery during auscultation. Indicative of consolidation.

49. Physical exam of chest
Viral inoculation > viral rhinitis > infection of paranasal sinuses > inflammation & edema > mucosal edema - copious secretions - ciliary dyskinesia > sinus congestions and/or obstruction
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
Amoxicillin 80-90mg/kg/day x7 days; Augmentin 90/6.4 mg/kg/day x7 days
24-72 hrs

50. Nonpharmacological tx for viral URI
Warm - humid environment; rest;
Ear ache - dullness - hearing loss - fever - N/V/D
High pitched sounds; can occur during inspiration or expiration; indicates narrow airways; can occur with asthma - COPD - pneumonia - CHF
Viral inoculation > viral rhinitis > infection of paranasal sinuses > inflammation & edema > mucosal edema - copious secretions - ciliary dyskinesia > sinus congestions and/or obstruction