ENT/Respiratory

Instructions:

• Answer 50 questions in 15 minutes.
• If you are not ready to take this test, you can study here.
• Match each statement with the correct term.
• Don't refresh. All questions and answers are randomly picked and ordered every time you load a test.

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. Tx for adult AOE?
Dyspnea when supine - relived by sitting or standing
HEENT: rhinoscopy - sinus tenderness - lymphnodes - transillumination of sinuses - CV and PULM.
High pitched voice sound due to transmission of noise across fluid. Indicative of effusion.
Oflaxicin 0.3% solution BID


2. Acute otitis media
Bacterial or viral infection of the middle ear (secondary to URI [e.g. eustachian tube dysfunction])
Aspirin: increases viral shedding
Erythmatous auditory canal - crusting
Severe dyspnea when lying supine with associated wheezing and coughing - need to sit up abruptly due to severe dyspnea


3. Rhinosinusitis History?
Bacterial infection
Amoxicillin 80-90mg/kg/day x7 days; Augmentin 90/6.4 mg/kg/day x7 days
Decongestants (oxymetazoline); glucocorticoids (e.g. fluticasone); mucolytics (e.g. guaifensin)
Nasal congestion - HA - sinus pain - fever - sore throat - cough


4. Stridor
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
Fine or courses; secretions or aveolar collapse; normal if resovle with cough; abnormal: pneumonia; CHF; COPD; pilmonary fibrosis
Abnormal high pitched caused by blockage in upper airway; usually heard with with inspiration


5. Rhinitis
Inflammation of the nasal cavity
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;
Inflammation of the paranasal sinuses


6. Diagnostics of sinusitis?
PE: rhinoscopy with otoscope
Augementin 2000/124 mg bid for 5-7 days - Peds: 90 mg/kg/day po in divided doses
Afebrile viral infection of the the nose - paranasal sinuses - throat - larynx - trachea - and and bronchi.
HEENT: rhinoscopy - sinus tenderness - lymphnodes - transillumination of sinuses - CV and PULM.


7. Common cold symptoms
High pitched voice sound due to transmission of noise across fluid. Indicative of effusion.
Aspirin: Reye's Syndrome
Abrupt onset - burning nose or throat - sneezing - rhinorrhea
92-100%


8. Sinusitis
Viral inoculation > viral rhinitis > infection of paranasal sinuses > inflammation & edema > mucosal edema - copious secretions - ciliary dyskinesia > sinus congestions and/or obstruction
Nasal polyps - deviated septum - hx of trauma - surgery - foreign bodies or recent altitude changes
Nasal congestion - HA - sinus pain - fever - sore throat - cough
Inflammation of the paranasal sinuses


9. Kussmal's respiration
Deep - snoring sound; indicates fluid or narrowing of airways; common in bronchitis and COPD
Deep - rapid - labored - breathing
Bacterial or viral infection of the middle ear (secondary to URI [e.g. eustachian tube dysfunction])
Aspirin: Reye's Syndrome


10. Respiratory Examination (Observation)
E. coli
Dyspnea when supine - relived by sitting or standing
Rate; pattern (regular or irregular); effort (labored - accessory muscles)
Amoxicillin 1000 mg TID x7 days; Augmentin 2000/125mg BID x7 days


11. Common cold pathogens
Deep - rapid - labored - breathing
Rhinovirus - influenza - and parainfluenza
Aspirin: increases viral shedding
Afebrile viral infection of the the nose - paranasal sinuses - throat - larynx - trachea - and and bronchi.


12. Rhinosinusitis risk factors?
Nasal polyps - deviated septum - hx of trauma - surgery - foreign bodies or recent altitude changes
Deep - rapid - labored - breathing
Oflaxicin 0.3% solution BID
Viral inoculation > viral rhinitis > infection of paranasal sinuses > inflammation & edema > mucosal edema - copious secretions - ciliary dyskinesia > sinus congestions and/or obstruction


13. What is the most common pathogen for otitis in newborns?
Ear ache - dullness - hearing loss - fever - N/V/D
Step. pneumoniae; Haemophilus influenzae; group B-strep
E. coli
3 months to 3 years old


14. Rx for viral URI?
NSAIDs for aches - fever; Sympathomimetics: pseudophedrine or phenylephrine
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
Labs: CBC - blood gas - d-dimer - CMP - BNP - Chest CT - MRI


15. Respiratory Illness Key Points (3)
Nasal congestion - HA - sinus pain - fever - sore throat - cough
NSAIDs for aches - fever; Sympathomimetics: pseudophedrine or phenylephrine
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
TM erythmatous - bulging - light reflex displaced - exudate


16. Additional pulmonary diagnostics
<4 weeks
Labs: CBC - blood gas - d-dimer - CMP - BNP - Chest CT - MRI
Purulent discharge - post nasal draiange; cough; sinus pressure - tooth pain; halitosis (changes in taste); alterations of smell
Persistent; recurrent x4/yr; severe HA; altered mental status


17. Symptoms of acute bacterial rhino-sinusitis (ABRS)?
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
Aspirin: Reye's Syndrome
Purulent discharge - post nasal draiange; cough; sinus pressure - tooth pain; halitosis (changes in taste); alterations of smell
Persistent; recurrent x4/yr; severe HA; altered mental status


18. Peak Expiratory Flow (PEF)
Measures speed of exhalation; results measure by age and weight
Nasal polyps - deviated septum - hx of trauma - surgery - foreign bodies or recent altitude changes
Fine or courses; secretions or aveolar collapse; normal if resovle with cough; abnormal: pneumonia; CHF; COPD; pilmonary fibrosis
Abrupt onset - burning nose or throat - sneezing - rhinorrhea


19. Cheyne-stokes
Apena alternating with hyperpnea;
Oflaxicin 0.3% solution BID
High pitched sounds; can occur during inspiration or expiration; indicates narrow airways; can occur with asthma - COPD - pneumonia - CHF
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


20. Bronchophony
Labs: CBC - blood gas - d-dimer - CMP - BNP - Chest CT - MRI
Abnormal high pitched caused by blockage in upper airway; usually heard with with inspiration
PE: rhinoscopy with otoscope
Increased breath sounds or voice remains loud at the periphery during auscultation. Indicative of consolidation.


21. Alternative rx for bacterial sinusitis?
Warm - humid environment; rest;
HEENT: rhinoscopy - sinus tenderness - lymphnodes - transillumination of sinuses - CV and PULM.
E. coli
Macrolides (azithormycin); Doxycycline; TMZ-SMZ


22. Which Rx should not be used for viral URI?
Abrupt onset - burning nose or throat - sneezing - rhinorrhea
Macrolides (azithormycin); Doxycycline; TMZ-SMZ
Aspirin: increases viral shedding
Rhinovirus - influenza - parainfluenza


23. Tx for adult AOM?
Amoxicillin 1000 mg TID x7 days; Augmentin 2000/125mg BID x7 days
Afebrile viral infection of the the nose - paranasal sinuses - throat - larynx - trachea - and and bronchi.
Oflaxicin 0.3% solution BID
Macrolides (azithormycin); Doxycycline; TMZ-SMZ


24. What sinusitis symptoms would warrant image studies?
Rate; pattern (regular or irregular); effort (labored - accessory muscles)
Abrupt onset - burning nose or throat - sneezing - rhinorrhea
Persistent; recurrent x4/yr; severe HA; altered mental status
Rhinovirus - influenza - parainfluenza


25. 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
Nasal congestion - HA - sinus pain - fever - sore throat - cough
Oflaxicin 0.3% solution BID


26. Rx for rhinorrhea and/or allergies?
Rhinovirus - influenza - parainfluenza
Ipratroprium bromide (e.g. Atrovent); Antihistamines (Cargeul not to overly dry out muscos)
4-12 weeks
Bacterial infection


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


28. Normal pulse ox
92-100%
<4 weeks
High pitched voice sound due to transmission of noise across fluid. Indicative of effusion.
HEENT: rhinoscopy - sinus tenderness - lymphnodes - transillumination of sinuses - CV and PULM.


29. What is the common side effect of sympathomimetics?
>12 weeks
Apena alternating with hyperpnea;
Rhinovirus - influenza - parainfluenza
Rebound congestion 3-5 days


30. Special cases of sinusitis?
Abrupt onset - burning nose or throat - sneezing - rhinorrhea
Viral inoculation > viral rhinitis > infection of paranasal sinuses > inflammation & edema > mucosal edema - copious secretions - ciliary dyskinesia > sinus congestions and/or obstruction
Persistent or relapse of infection - chronic sinusitis - fungal infection - extension in CNS (meningitis - orbital cellulitis - osteitis)
Purulent discharge - post nasal draiange; cough; sinus pressure - tooth pain; halitosis (changes in taste); alterations of smell


31. Acute rhino-sinusitis duration of symptoms?
Increased breath sounds or voice remains loud at the periphery during auscultation. Indicative of consolidation.
Persistent or relapse of infection - chronic sinusitis - fungal infection - extension in CNS (meningitis - orbital cellulitis - osteitis)
<4 weeks
Augementin 2000/124 mg bid for 5-7 days - Peds: 90 mg/kg/day po in divided doses


32. Physical exam of chest
Rhinovirus - influenza - parainfluenza
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
Decongestants (oxymetazoline); glucocorticoids (e.g. fluticasone); mucolytics (e.g. guaifensin)
Deep - snoring sound; indicates fluid or narrowing of airways; common in bronchitis and COPD


33. What is the most common pahtogen for otitis media?
Erythmatous auditory canal - crusting
Symptomatic (steam; nasal irrigation); APAP for pain.
Step. pneumoniae; Haemophilus influenzae; group B-strep
Abrupt onset - burning nose or throat - sneezing - rhinorrhea


34. What does mucopurulent indications not indicate?
Aspirin: Reye's Syndrome
Fine or courses; secretions or aveolar collapse; normal if resovle with cough; abnormal: pneumonia; CHF; COPD; pilmonary fibrosis
Bacterial infection
Deep - snoring sound; indicates fluid or narrowing of airways; common in bronchitis and COPD


35. Nonpharmacological tx for viral URI
Nasal polyps - deviated septum - hx of trauma - surgery - foreign bodies or recent altitude changes
Warm - humid environment; rest;
Pulse ox; Peak expiratory flow; spirometry
3 months to 3 years old


36. Wheezes
Deep - snoring sound; indicates fluid or narrowing of airways; common in bronchitis and COPD
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
Ear ache - dullness - hearing loss - fever - N/V/D


37. Tx of sinusitis symptoms <10 days
Amoxicillin 80-90mg/kg/day x7 days; Augmentin 90/6.4 mg/kg/day x7 days
Increased loudness of whispering during auscultation. Indicative of consolidation.
Deep - rapid - labored - breathing
Symptomatic (steam; nasal irrigation); APAP for pain.


38. Egophany (vocal resonance)
High pitched voice sound due to transmission of noise across fluid. Indicative of effusion.
Ear ache - dullness - hearing loss - fever - N/V/D
Soft sounds in and out
Amoxicillin 1000 mg TID x7 days; Augmentin 2000/125mg BID x7 days


39. Orthopnea
<4 weeks
Bacterial or viral infection of the middle ear (secondary to URI [e.g. eustachian tube dysfunction])
Aspirin: increases viral shedding
Dyspnea when supine - relived by sitting or standing


40. Whispered pectoriloguy
NSAIDs for aches - fever; Sympathomimetics: pseudophedrine or phenylephrine
Increased loudness of whispering during auscultation. Indicative of consolidation.
Soft sounds in and out
4-12 weeks


41. Vesicular breath sounds...
Aspirin: Reye's Syndrome
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
Soft sounds in and out


42. Rhinosinusitis physical exam?
Viral inoculation > viral rhinitis > infection of paranasal sinuses > inflammation & edema > mucosal edema - copious secretions - ciliary dyskinesia > sinus congestions and/or obstruction
Ipratroprium bromide (e.g. Atrovent); Antihistamines (Cargeul not to overly dry out muscos)
HEENT: rhinoscopy - sinus tenderness - lymphnodes - transillumination of sinuses - CV and PULM.
Rate; pattern (regular or irregular); effort (labored - accessory muscles)


43. Pulmonary diagnostics (1)
Rebound congestion 3-5 days
Dyspnea when supine - relived by sitting or standing
Amoxicillin 80-90mg/kg/day x7 days; Augmentin 90/6.4 mg/kg/day x7 days
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. What are physical exam findings of AOE?
Step. pneumoniae; Haemophilus influenzae; group B-strep
Erythmatous auditory canal - crusting
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
Severe dyspnea when lying supine with associated wheezing and coughing - need to sit up abruptly due to severe dyspnea


45. Spirometry
Symptomatic (steam; nasal irrigation); APAP for pain.
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
Rebound congestion 3-5 days
Purulent discharge - post nasal draiange; cough; sinus pressure - tooth pain; halitosis (changes in taste); alterations of smell


46. Acute viral rhino-sinusitis (AVRS) pathogens?
Rhinovirus - influenza - parainfluenza
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
Aspirin: increases viral shedding
Rhinovirus - influenza - and parainfluenza


47. Subacute rhino-sinusitis duration of symptoms?
4-12 weeks
TM erythmatous - bulging - light reflex displaced - exudate
Abnormal high pitched caused by blockage in upper airway; usually heard with with inspiration
Warm - humid environment; rest;


48. What is most common age range for otitis?
PE: rhinoscopy with otoscope
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
3 months to 3 years old


49. Chronic rhino-sinusitis duration of symptoms?
Rebound congestion 3-5 days
4-12 weeks
>12 weeks
24-72 hrs


50. What are physical exam findings of AOM?
Soft sounds in and out
Abnormal high pitched caused by blockage in upper airway; usually heard with with inspiration
TM erythmatous - bulging - light reflex displaced - exudate
Step. pneumoniae; Haemophilus influenzae; group B-strep