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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. Rhonchi
Rate; pattern (regular or irregular); effort (labored - accessory muscles)
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
PE: rhinoscopy with otoscope
Deep - snoring sound; indicates fluid or narrowing of airways; common in bronchitis and COPD

2. What is most common age range for otitis?
HEENT: rhinoscopy - sinus tenderness - lymphnodes - transillumination of sinuses - CV and PULM.
Increased breath sounds or voice remains loud at the periphery during auscultation. Indicative of consolidation.
3 months to 3 years old
Viral inoculation > viral rhinitis > infection of paranasal sinuses > inflammation & edema > mucosal edema - copious secretions - ciliary dyskinesia > sinus congestions and/or obstruction

3. Additional pulmonary diagnostics
Rate; pattern (regular or irregular); effort (labored - accessory muscles)
Labs: CBC - blood gas - d-dimer - CMP - BNP - Chest CT - MRI
Step. pneumoniae; Haemophilus influenzae; group B-strep
Abnormal high pitched caused by blockage in upper airway; usually heard with with inspiration

4. Rhinosinusitis physical exam?
Macrolides (azithormycin); Doxycycline; TMZ-SMZ
Persistent; recurrent x4/yr; severe HA; altered mental status
HEENT: rhinoscopy - sinus tenderness - lymphnodes - transillumination of sinuses - CV and PULM.
Severe dyspnea when lying supine with associated wheezing and coughing - need to sit up abruptly due to severe dyspnea

5. Cheyne-stokes
Afebrile viral infection of the the nose - paranasal sinuses - throat - larynx - trachea - and and bronchi.
Erythmatous auditory canal - crusting
Apena alternating with hyperpnea;
Deep - rapid - labored - breathing

6. Symptoms of viral rhinosinusitis
High pitched voice sound due to transmission of noise across fluid. Indicative of effusion.
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;
NSAIDs for aches - fever; Sympathomimetics: pseudophedrine or phenylephrine
Macrolides (azithormycin); Doxycycline; TMZ-SMZ

7. What are physical exam findings of AOE?
Erythmatous auditory canal - crusting
Rhinovirus - influenza - and parainfluenza
Severe dyspnea when lying supine with associated wheezing and coughing - need to sit up abruptly due to severe dyspnea
Symptomatic (steam; nasal irrigation); APAP for pain.

8. Common cold pathogens
Rhinovirus - influenza - and parainfluenza
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
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
Decongestants (oxymetazoline); glucocorticoids (e.g. fluticasone); mucolytics (e.g. guaifensin)

9. Proxysmal nocturnal dyspnea
24-72 hrs
Severe dyspnea when lying supine with associated wheezing and coughing - need to sit up abruptly due to severe dyspnea
High pitched sounds; can occur during inspiration or expiration; indicates narrow airways; can occur with asthma - COPD - pneumonia - CHF
Labs: CBC - blood gas - d-dimer - CMP - BNP - Chest CT - MRI

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

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11. Nonpharmacological tx for viral URI
High pitched sounds; can occur during inspiration or expiration; indicates narrow airways; can occur with asthma - COPD - pneumonia - CHF
Increased loudness of whispering during auscultation. Indicative of consolidation.
Warm - humid environment; rest;
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

12. Sinusitis
HEENT: rhinoscopy - sinus tenderness - lymphnodes - transillumination of sinuses - CV and PULM.
4-12 weeks
Abrupt onset - burning nose or throat - sneezing - rhinorrhea
Inflammation of the paranasal sinuses

13. Bronchial breath sounds...
Persistent or relapse of infection - chronic sinusitis - fungal infection - extension in CNS (meningitis - orbital cellulitis - osteitis)
Persistent; recurrent x4/yr; severe HA; altered mental status
Viral inoculation > viral rhinitis > infection of paranasal sinuses > inflammation & edema > mucosal edema - copious secretions - ciliary dyskinesia > sinus congestions and/or obstruction
Hardher and more turbulent

14. Common Cold (URI - Acute Coryza)
Oflaxicin 0.3% solution BID
Increased breath sounds or voice remains loud at the periphery during auscultation. Indicative of consolidation.
TM erythmatous - bulging - light reflex displaced - exudate
Afebrile viral infection of the the nose - paranasal sinuses - throat - larynx - trachea - and and bronchi.

15. Common cold symptoms
24-72 hrs
Abrupt onset - burning nose or throat - sneezing - rhinorrhea
PE: rhinoscopy with otoscope
Dyspnea when supine - relived by sitting or standing

16. Peak Expiratory Flow (PEF)
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;
>12 weeks
Measures speed of exhalation; results measure by age and weight
92-100%

17. Tx of sinusitis symptoms <10 days
Macrolides (azithormycin); Doxycycline; TMZ-SMZ
Symptomatic (steam; nasal irrigation); APAP for pain.
Inflammation of the paranasal sinuses
Severe dyspnea when lying supine with associated wheezing and coughing - need to sit up abruptly due to severe dyspnea

18. Bronchophony
Ear ache - dullness - hearing loss - fever - N/V/D
<4 weeks
Rhinovirus - influenza - parainfluenza
Increased breath sounds or voice remains loud at the periphery during auscultation. Indicative of consolidation.

19. Spirometry
Amoxicillin 80-90mg/kg/day x7 days; Augmentin 90/6.4 mg/kg/day x7 days
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
Ear ache - dullness - hearing loss - fever - N/V/D
92-100%

20. What are physical exam findings of AOM?
Severe dyspnea when lying supine with associated wheezing and coughing - need to sit up abruptly due to severe dyspnea
Warm - humid environment; rest;
Dyspnea when supine - relived by sitting or standing
TM erythmatous - bulging - light reflex displaced - exudate

21. What sinusitis symptoms would warrant image studies?
Dyspnea when supine - relived by sitting or standing
Labs: CBC - blood gas - d-dimer - CMP - BNP - Chest CT - MRI
Apena alternating with hyperpnea;
Persistent; recurrent x4/yr; severe HA; altered mental status

22. Egophany (vocal resonance)
Nasal congestion - HA - sinus pain - fever - sore throat - cough
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)
High pitched voice sound due to transmission of noise across fluid. Indicative of effusion.

23. Acute viral rhino-sinusitis (AVRS) pathogens?
High pitched sounds; can occur during inspiration or expiration; indicates narrow airways; can occur with asthma - COPD - pneumonia - CHF
Apena alternating with hyperpnea;
Inflammation of the paranasal sinuses
Rhinovirus - influenza - parainfluenza

24. Pulmonary tests
Step. pneumoniae; Haemophilus influenzae; group B-strep
Purulent discharge - post nasal draiange; cough; sinus pressure - tooth pain; halitosis (changes in taste); alterations of smell
Severe dyspnea when lying supine with associated wheezing and coughing - need to sit up abruptly due to severe dyspnea
Pulse ox; Peak expiratory flow; spirometry

25. Rx for rhinorrhea and/or allergies?
<4 weeks
>12 weeks
Apena alternating with hyperpnea;
Ipratroprium bromide (e.g. Atrovent); Antihistamines (Cargeul not to overly dry out muscos)

26. Tx for adult AOM?
Ipratroprium bromide (e.g. Atrovent); Antihistamines (Cargeul not to overly dry out muscos)
Amoxicillin 1000 mg TID x7 days; Augmentin 2000/125mg BID x7 days
Warm - humid environment; rest;
Abnormal high pitched caused by blockage in upper airway; usually heard with with inspiration

27. Abnormal pulmonary findings?
Nasal polyps - deviated septum - hx of trauma - surgery - foreign bodies or recent altitude changes
Ear ache - dullness - hearing loss - fever - N/V/D
Rhinovirus - influenza - parainfluenza
Clubbing - Use of accessory muscles - barrel chest

28. Rx for viral URI?
Amoxicillin 1000 mg TID x7 days; Augmentin 2000/125mg BID x7 days
NSAIDs for aches - fever; Sympathomimetics: pseudophedrine or phenylephrine
Pulse ox; Peak expiratory flow; spirometry
Measures speed of exhalation; results measure by age and weight

29. Stridor
Increased loudness of whispering during auscultation. Indicative of consolidation.
Abnormal high pitched caused by blockage in upper airway; usually heard with with inspiration
Abrupt onset - burning nose or throat - sneezing - rhinorrhea
NSAIDs for aches - fever; Sympathomimetics: pseudophedrine or phenylephrine

30. Wheezes
Measures speed of exhalation; results measure by age and weight
High pitched sounds; can occur during inspiration or expiration; indicates narrow airways; can occur with asthma - COPD - pneumonia - CHF
92-100%
Nasal congestion - HA - sinus pain - fever - sore throat - cough

31. Crackles (rales)
Aspirin: Reye's Syndrome
Bacterial infection
Rate; pattern (regular or irregular); effort (labored - accessory muscles)
Fine or courses; secretions or aveolar collapse; normal if resovle with cough; abnormal: pneumonia; CHF; COPD; pilmonary fibrosis

32. Whispered pectoriloguy
Oflaxicin 0.3% solution BID
92-100%
Increased loudness of whispering during auscultation. Indicative of consolidation.
Macrolides (azithormycin); Doxycycline; TMZ-SMZ

33. Diagnostics of sinusitis?
Measures speed of exhalation; results measure by age and weight
Deep - rapid - labored - breathing
Hardher and more turbulent
PE: rhinoscopy with otoscope

34. Subacute rhino-sinusitis duration of symptoms?
PE: rhinoscopy with otoscope
Nasal polyps - deviated septum - hx of trauma - surgery - foreign bodies or recent altitude changes
Dyspnea when supine - relived by sitting or standing
4-12 weeks

35. Tx for pediatric AOM?
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
Aspirin: Reye's Syndrome

36. Alternative rx for bacterial sinusitis?
Nasal congestion - HA - sinus pain - fever - sore throat - cough
Viral inoculation > viral rhinitis > infection of paranasal sinuses > inflammation & edema > mucosal edema - copious secretions - ciliary dyskinesia > sinus congestions and/or obstruction
Macrolides (azithormycin); Doxycycline; TMZ-SMZ
Oflaxicin 0.3% solution BID

37. Kussmal's respiration
Purulent discharge - post nasal draiange; cough; sinus pressure - tooth pain; halitosis (changes in taste); alterations of smell
Deep - rapid - labored - breathing
Nasal congestion - HA - sinus pain - fever - sore throat - cough
Ear ache - dullness - hearing loss - fever - N/V/D

38. 1st line treatment for bacterial sinusitis?
Warm - humid environment; rest;
Augementin 2000/124 mg bid for 5-7 days - Peds: 90 mg/kg/day po in divided doses
Persistent or relapse of infection - chronic sinusitis - fungal infection - extension in CNS (meningitis - orbital cellulitis - osteitis)
Aspirin: Reye's Syndrome

39. Respiratory Examination (Observation)
Rate; pattern (regular or irregular); effort (labored - accessory muscles)
Soft sounds in and out
Macrolides (azithormycin); Doxycycline; TMZ-SMZ
Increased loudness of whispering during auscultation. Indicative of consolidation.

40. Acute rhino-sinusitis duration of symptoms?
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
<4 weeks
HEENT: rhinoscopy - sinus tenderness - lymphnodes - transillumination of sinuses - CV and PULM.

41. Tx for adult AOE?
Oflaxicin 0.3% solution BID
Bacterial infection
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
Labs: CBC - blood gas - d-dimer - CMP - BNP - Chest CT - MRI

42. Pathophysiology of rhino sinusitis?
Hardher and more turbulent
Viral inoculation > viral rhinitis > infection of paranasal sinuses > inflammation & edema > mucosal edema - copious secretions - ciliary dyskinesia > sinus congestions and/or obstruction
>12 weeks
TM erythmatous - bulging - light reflex displaced - exudate

43. Special cases of sinusitis?
Persistent or relapse of infection - chronic sinusitis - fungal infection - extension in CNS (meningitis - orbital cellulitis - osteitis)
Augementin 2000/124 mg bid for 5-7 days - Peds: 90 mg/kg/day po in divided doses
Aspirin: increases viral shedding
Soft sounds in and out

44. Acute otitis media
Bacterial or viral infection of the middle ear (secondary to URI [e.g. eustachian tube dysfunction])
Persistent; recurrent x4/yr; severe HA; altered mental status
Deep - rapid - labored - breathing
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;

45. Respiratory Illness Key Points (3)
HEENT: rhinoscopy - sinus tenderness - lymphnodes - transillumination of sinuses - CV and PULM.
Abnormal high pitched caused by blockage in upper airway; usually heard with with inspiration
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
E. coli

46. Which Rx should not be used for viral URI?
Aspirin: increases viral shedding
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
PE: rhinoscopy with otoscope
Viral inoculation > viral rhinitis > infection of paranasal sinuses > inflammation & edema > mucosal edema - copious secretions - ciliary dyskinesia > sinus congestions and/or obstruction

47. What is the most common pahtogen for otitis media?
Oflaxicin 0.3% solution BID
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
Step. pneumoniae; Haemophilus influenzae; group B-strep

48. Symptoms of acute bacterial rhino-sinusitis (ABRS)?
Purulent discharge - post nasal draiange; cough; sinus pressure - tooth pain; halitosis (changes in taste); alterations of smell
Persistent or relapse of infection - chronic sinusitis - fungal infection - extension in CNS (meningitis - orbital cellulitis - osteitis)
Aspirin: Reye's Syndrome
Fine or courses; secretions or aveolar collapse; normal if resovle with cough; abnormal: pneumonia; CHF; COPD; pilmonary fibrosis

49. Rhinosinusitis risk factors?
Soft sounds in and out
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
Nasal polyps - deviated septum - hx of trauma - surgery - foreign bodies or recent altitude changes
Increased loudness of whispering during auscultation. Indicative of consolidation.

50. Orthopnea
Dyspnea when supine - relived by sitting or standing
Apena alternating with hyperpnea;
Increased loudness of whispering during auscultation. Indicative of consolidation.
Bacterial or viral infection of the middle ear (secondary to URI [e.g. eustachian tube dysfunction])