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ENT/Respiratory

Instructions:

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. Common cold symptoms
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
Deep - rapid - labored - breathing
Abrupt onset - burning nose or throat - sneezing - rhinorrhea

2. Tx for pediatric AOM?
Rhinovirus - influenza - parainfluenza
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
Purulent discharge - post nasal draiange; cough; sinus pressure - tooth pain; halitosis (changes in taste); alterations of smell
Amoxicillin 80-90mg/kg/day x7 days; Augmentin 90/6.4 mg/kg/day x7 days

3. Sinusitis
Inflammation of the paranasal sinuses
Step. pneumoniae; Haemophilus influenzae; group B-strep
Bacterial infection
4-12 weeks

4. Whispered pectoriloguy
Increased loudness of whispering during auscultation. Indicative of consolidation.
Apena alternating with hyperpnea;
HEENT: rhinoscopy - sinus tenderness - lymphnodes - transillumination of sinuses - CV and PULM.
PE: rhinoscopy with otoscope

5. Proxysmal nocturnal dyspnea
Rate; pattern (regular or irregular); effort (labored - accessory muscles)
Augementin 2000/124 mg bid for 5-7 days - Peds: 90 mg/kg/day po in divided doses
Severe dyspnea when lying supine with associated wheezing and coughing - need to sit up abruptly due to severe dyspnea
HEENT: rhinoscopy - sinus tenderness - lymphnodes - transillumination of sinuses - CV and PULM.

6. Spirometry
Pulse ox; Peak expiratory flow; spirometry
4-12 weeks
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
Macrolides (azithormycin); Doxycycline; TMZ-SMZ

7. Tx of sinusitis symptoms <10 days
E. coli
Purulent discharge - post nasal draiange; cough; sinus pressure - tooth pain; halitosis (changes in taste); alterations of smell
Symptomatic (steam; nasal irrigation); APAP for pain.
Dyspnea when supine - relived by sitting or standing

8. Pathophysiology of rhino sinusitis?
Viral inoculation > viral rhinitis > infection of paranasal sinuses > inflammation & edema > mucosal edema - copious secretions - ciliary dyskinesia > sinus congestions and/or obstruction
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
Persistent; recurrent x4/yr; severe HA; altered mental status
Abrupt onset - burning nose or throat - sneezing - rhinorrhea

9. Alternative rx for bacterial sinusitis?
Bacterial or viral infection of the middle ear (secondary to URI [e.g. eustachian tube dysfunction])
Macrolides (azithormycin); Doxycycline; TMZ-SMZ
<4 weeks
Symptomatic (steam; nasal irrigation); APAP for pain.

10. Acute rhino-sinusitis duration of symptoms?
Increased breath sounds or voice remains loud at the periphery during auscultation. Indicative of consolidation.
Afebrile viral infection of the the nose - paranasal sinuses - throat - larynx - trachea - and and bronchi.
Apena alternating with hyperpnea;
<4 weeks

11. Rhinosinusitis History?
Augementin 2000/124 mg bid for 5-7 days - Peds: 90 mg/kg/day po in divided doses
Nasal congestion - HA - sinus pain - fever - sore throat - cough
Measures speed of exhalation; results measure by age and weight
3 months to 3 years old

12. Additional pulmonary diagnostics
Labs: CBC - blood gas - d-dimer - CMP - BNP - Chest CT - MRI
Deep - rapid - labored - breathing
Increased breath sounds or voice remains loud at the periphery during auscultation. Indicative of consolidation.
Step. pneumoniae; Haemophilus influenzae; group B-strep

13. Special cases of sinusitis?
Increased loudness of whispering during auscultation. Indicative of consolidation.
TM erythmatous - bulging - light reflex displaced - exudate
Persistent or relapse of infection - chronic sinusitis - fungal infection - extension in CNS (meningitis - orbital cellulitis - osteitis)
Abrupt onset - burning nose or throat - sneezing - rhinorrhea

14. Which Rx should not be used for viral URI?
Macrolides (azithormycin); Doxycycline; TMZ-SMZ
Nasal polyps - deviated septum - hx of trauma - surgery - foreign bodies or recent altitude changes
Aspirin: increases viral shedding
HEENT: rhinoscopy - sinus tenderness - lymphnodes - transillumination of sinuses - CV and PULM.

15. What is the most common pathogen for otitis in newborns?
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;
Apena alternating with hyperpnea;
Aspirin: increases viral shedding
E. coli

16. Rx nasal congestion?
92-100%
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)
Decongestants (oxymetazoline); glucocorticoids (e.g. fluticasone); mucolytics (e.g. guaifensin)

17. What is the common side effect of sympathomimetics?
Viral inoculation > viral rhinitis > infection of paranasal sinuses > inflammation & edema > mucosal edema - copious secretions - ciliary dyskinesia > sinus congestions and/or obstruction
Augementin 2000/124 mg bid for 5-7 days - Peds: 90 mg/kg/day po in divided doses
Rebound congestion 3-5 days
Bacterial infection

18. Normal pulse ox
92-100%
Ear ache - dullness - hearing loss - fever - N/V/D
Rhinovirus - influenza - parainfluenza
Increased breath sounds or voice remains loud at the periphery during auscultation. Indicative of consolidation.

19. Rhinitis
Inflammation of the paranasal sinuses
3 months to 3 years old
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
Inflammation of the nasal cavity

20. Stridor
Deep - rapid - labored - breathing
>12 weeks
Abnormal high pitched caused by blockage in upper airway; usually heard with with inspiration
Symptomatic (steam; nasal irrigation); APAP for pain.

21. Abnormal pulmonary findings?
Clubbing - Use of accessory muscles - barrel chest
High pitched sounds; can occur during inspiration or expiration; indicates narrow airways; can occur with asthma - COPD - pneumonia - CHF
E. coli
Apena alternating with hyperpnea;

22. Rhonchi
>12 weeks
Soft sounds in and out
Deep - snoring sound; indicates fluid or narrowing of airways; common in bronchitis and COPD
Rate; pattern (regular or irregular); effort (labored - accessory muscles)

23. Rx for viral URI?
Increased loudness of whispering during auscultation. Indicative of consolidation.
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
Amoxicillin 1000 mg TID x7 days; Augmentin 2000/125mg BID x7 days

24. Acute viral rhino-sinusitis (AVRS) pathogens?
92-100%
E. coli
4-12 weeks
Rhinovirus - influenza - parainfluenza

25. Symptoms of acute bacterial rhino-sinusitis (ABRS)?
Nasal polyps - deviated septum - hx of trauma - surgery - foreign bodies or recent altitude changes
Abnormal high pitched caused by blockage in upper airway; usually heard with with inspiration
Purulent discharge - post nasal draiange; cough; sinus pressure - tooth pain; halitosis (changes in taste); alterations of smell
Step. pneumoniae; Haemophilus influenzae; group B-strep

26. Pulmonary diagnostics (1)
Inflammation of the nasal cavity
Dyspnea when supine - relived by sitting or standing
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

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

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28. Crackles (rales)
Viral inoculation > viral rhinitis > infection of paranasal sinuses > inflammation & edema > mucosal edema - copious secretions - ciliary dyskinesia > sinus congestions and/or obstruction
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
HEENT: rhinoscopy - sinus tenderness - lymphnodes - transillumination of sinuses - CV and PULM.
Fine or courses; secretions or aveolar collapse; normal if resovle with cough; abnormal: pneumonia; CHF; COPD; pilmonary fibrosis

29. Cold incubation period
24-72 hrs
Dyspnea when supine - relived by sitting or standing
Macrolides (azithormycin); Doxycycline; TMZ-SMZ
Abnormal high pitched caused by blockage in upper airway; usually heard with with inspiration

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

31. What does mucopurulent indications not indicate?
Increased breath sounds or voice remains loud at the periphery during auscultation. Indicative of consolidation.
Bacterial infection
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; recurrent x4/yr; severe HA; altered mental status

32. Tx for adult AOM?
Amoxicillin 1000 mg TID x7 days; Augmentin 2000/125mg BID x7 days
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
92-100%
Clubbing - Use of accessory muscles - barrel chest

33. Rhinosinusitis physical exam?
Amoxicillin 80-90mg/kg/day x7 days; Augmentin 90/6.4 mg/kg/day x7 days
4-12 weeks
Measures speed of exhalation; results measure by age and weight
HEENT: rhinoscopy - sinus tenderness - lymphnodes - transillumination of sinuses - CV and PULM.

34. Bronchophony
Bacterial or viral infection of the middle ear (secondary to URI [e.g. eustachian tube dysfunction])
Purulent discharge - post nasal draiange; cough; sinus pressure - tooth pain; halitosis (changes in taste); alterations of smell
High pitched voice sound due to transmission of noise across fluid. Indicative of effusion.
Increased breath sounds or voice remains loud at the periphery during auscultation. Indicative of consolidation.

35. Tx for adult AOE?
3 months to 3 years old
Oflaxicin 0.3% solution BID
Abrupt onset - burning nose or throat - sneezing - rhinorrhea
Rebound congestion 3-5 days

36. Nonpharmacological tx for viral URI
Rate; pattern (regular or irregular); effort (labored - accessory muscles)
Nasal polyps - deviated septum - hx of trauma - surgery - foreign bodies or recent altitude changes
>12 weeks
Warm - humid environment; rest;

37. Vesicular breath sounds...
Clubbing - Use of accessory muscles - barrel chest
Inflammation of the paranasal sinuses
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
Soft sounds in and out

38. Pulmonary tests
Rate; pattern (regular or irregular); effort (labored - accessory muscles)
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;
Increased breath sounds or voice remains loud at the periphery during auscultation. Indicative of consolidation.
Pulse ox; Peak expiratory flow; spirometry

39. 1st line treatment for bacterial sinusitis?
<4 weeks
Augementin 2000/124 mg bid for 5-7 days - Peds: 90 mg/kg/day po in divided doses
Persistent; recurrent x4/yr; severe HA; altered mental status
Deep - rapid - labored - breathing

40. What sinusitis symptoms would warrant image studies?
Warm - humid environment; rest;
92-100%
Amoxicillin 1000 mg TID x7 days; Augmentin 2000/125mg BID x7 days
Persistent; recurrent x4/yr; severe HA; altered mental status

41. Orthopnea
Rate; pattern (regular or irregular); effort (labored - accessory muscles)
Nasal polyps - deviated septum - hx of trauma - surgery - foreign bodies or recent altitude changes
PE: rhinoscopy with otoscope
Dyspnea when supine - relived by sitting or standing

42. Acute otitis media
Purulent discharge - post nasal draiange; cough; sinus pressure - tooth pain; halitosis (changes in taste); alterations of smell
Bacterial or viral infection of the middle ear (secondary to URI [e.g. eustachian tube dysfunction])
Measures speed of exhalation; results measure by age and weight
Soft sounds in and out

43. Subacute rhino-sinusitis duration of symptoms?
4-12 weeks
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
Rate; pattern (regular or irregular); effort (labored - accessory muscles)
High pitched sounds; can occur during inspiration or expiration; indicates narrow airways; can occur with asthma - COPD - pneumonia - CHF

44. Cheyne-stokes
Bacterial infection
Inflammation of the paranasal sinuses
Clubbing - Use of accessory muscles - barrel chest
Apena alternating with hyperpnea;

45. What are the symptoms of otitis?
Amoxicillin 80-90mg/kg/day x7 days; Augmentin 90/6.4 mg/kg/day x7 days
Augementin 2000/124 mg bid for 5-7 days - Peds: 90 mg/kg/day po in divided doses
Ear ache - dullness - hearing loss - fever - N/V/D
Amoxicillin 1000 mg TID x7 days; Augmentin 2000/125mg BID x7 days

46. Kussmal's respiration
Rhinovirus - influenza - parainfluenza
Deep - rapid - labored - breathing
Erythmatous auditory canal - crusting
Purulent discharge - post nasal draiange; cough; sinus pressure - tooth pain; halitosis (changes in taste); alterations of smell

47. Bronchial breath sounds...
Decongestants (oxymetazoline); glucocorticoids (e.g. fluticasone); mucolytics (e.g. guaifensin)
Hardher and more turbulent
Fine or courses; secretions or aveolar collapse; normal if resovle with cough; abnormal: pneumonia; CHF; COPD; pilmonary fibrosis
Deep - rapid - labored - breathing

48. Physical exam of chest
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
Ear ache - dullness - hearing loss - fever - N/V/D
Apena alternating with hyperpnea;
Bacterial infection

49. Respiratory Illness Key Points (3)
Oflaxicin 0.3% solution BID
Persistent; recurrent x4/yr; severe HA; altered mental status
Rate; pattern (regular or irregular); effort (labored - accessory muscles)
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

50. Symptoms of viral rhinosinusitis
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;
Deep - snoring sound; indicates fluid or narrowing of airways; common in bronchitis and COPD
Inflammation of the nasal cavity
Bacterial infection