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ENT/Respiratory

Instructions:

Answer 50 questions in 15 minutes.
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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. Crackles (rales)
Fine or courses; secretions or aveolar collapse; normal if resovle with cough; abnormal: pneumonia; CHF; COPD; pilmonary fibrosis
Deep - rapid - labored - breathing
Abnormal high pitched caused by blockage in upper airway; usually heard with with inspiration
Persistent or relapse of infection - chronic sinusitis - fungal infection - extension in CNS (meningitis - orbital cellulitis - osteitis)

2. Nonpharmacological tx for viral URI
Deep - snoring sound; indicates fluid or narrowing of airways; common in bronchitis and COPD
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
Warm - humid environment; rest;

3. Respiratory Illness Key Points (3)
High pitched sounds; can occur during inspiration or expiration; indicates narrow airways; can occur with asthma - COPD - pneumonia - CHF
>12 weeks
Nasal polyps - deviated septum - hx of trauma - surgery - foreign bodies or recent altitude changes
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

4. Respiratory Examination (Observation)
<4 weeks
Symptomatic (steam; nasal irrigation); APAP for pain.
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

5. Symptoms of viral rhinosinusitis
Dyspnea when supine - relived by sitting or standing
92-100%
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;

6. Rx for viral URI?
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.
Measures speed of exhalation; results measure by age and weight
NSAIDs for aches - fever; Sympathomimetics: pseudophedrine or phenylephrine

7. Acute otitis media
Apena alternating with hyperpnea;
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;
Bacterial or viral infection of the middle ear (secondary to URI [e.g. eustachian tube dysfunction])
Fine or courses; secretions or aveolar collapse; normal if resovle with cough; abnormal: pneumonia; CHF; COPD; pilmonary fibrosis

8. What are the symptoms of otitis?
Fine or courses; secretions or aveolar collapse; normal if resovle with cough; abnormal: pneumonia; CHF; COPD; pilmonary fibrosis
Rhinovirus - influenza - parainfluenza
Deep - snoring sound; indicates fluid or narrowing of airways; common in bronchitis and COPD
Ear ache - dullness - hearing loss - fever - N/V/D

9. Tx of sinusitis symptoms <10 days
Decongestants (oxymetazoline); glucocorticoids (e.g. fluticasone); mucolytics (e.g. guaifensin)
Augementin 2000/124 mg bid for 5-7 days - Peds: 90 mg/kg/day po in divided doses
Symptomatic (steam; nasal irrigation); APAP for pain.
Amoxicillin 1000 mg TID x7 days; Augmentin 2000/125mg BID x7 days

10. Normal pulse ox
Abnormal high pitched caused by blockage in upper airway; usually heard with with inspiration
92-100%
Augementin 2000/124 mg bid for 5-7 days - Peds: 90 mg/kg/day po in divided doses
Labs: CBC - blood gas - d-dimer - CMP - BNP - Chest CT - MRI

11. Subacute rhino-sinusitis duration of symptoms?
Decongestants (oxymetazoline); glucocorticoids (e.g. fluticasone); mucolytics (e.g. guaifensin)
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
Fine or courses; secretions or aveolar collapse; normal if resovle with cough; abnormal: pneumonia; CHF; COPD; pilmonary fibrosis
4-12 weeks

12. Common cold symptoms
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
Abrupt onset - burning nose or throat - sneezing - rhinorrhea
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
Amoxicillin 1000 mg TID x7 days; Augmentin 2000/125mg BID x7 days

13. What are physical exam findings of AOE?
4-12 weeks
Increased loudness of whispering during auscultation. Indicative of consolidation.
High pitched voice sound due to transmission of noise across fluid. Indicative of effusion.
Erythmatous auditory canal - crusting

14. Rx nasal congestion?
Decongestants (oxymetazoline); glucocorticoids (e.g. fluticasone); mucolytics (e.g. guaifensin)
Clubbing - Use of accessory muscles - barrel chest
Measures speed of exhalation; results measure by age and weight
Step. pneumoniae; Haemophilus influenzae; group B-strep

15. Tx for pediatric AOM?
Amoxicillin 80-90mg/kg/day x7 days; Augmentin 90/6.4 mg/kg/day x7 days
Apena alternating with hyperpnea;
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
Warm - humid environment; rest;

16. Cold incubation period
Persistent; recurrent x4/yr; severe HA; altered mental status
Severe dyspnea when lying supine with associated wheezing and coughing - need to sit up abruptly due to severe dyspnea
24-72 hrs
Inflammation of the nasal cavity

17. 1st line treatment for bacterial sinusitis?
Bacterial infection
Augementin 2000/124 mg bid for 5-7 days - Peds: 90 mg/kg/day po in divided doses
Rate; pattern (regular or irregular); effort (labored - accessory muscles)
Dyspnea when supine - relived by sitting or standing

18. Rx for rhinorrhea and/or allergies?
Rhinovirus - influenza - and parainfluenza
Ipratroprium bromide (e.g. Atrovent); Antihistamines (Cargeul not to overly dry out muscos)
3 months to 3 years old
Augementin 2000/124 mg bid for 5-7 days - Peds: 90 mg/kg/day po in divided doses

19. What are physical exam findings of AOM?
Apena alternating with hyperpnea;
Deep - snoring sound; indicates fluid or narrowing of airways; common in bronchitis and COPD
TM erythmatous - bulging - light reflex displaced - exudate
<4 weeks

20. What does mucopurulent indications not indicate?
Warm - humid environment; rest;
Bacterial infection
Fine or courses; secretions or aveolar collapse; normal if resovle with cough; abnormal: pneumonia; CHF; COPD; pilmonary fibrosis
>12 weeks

21. Rhinosinusitis risk factors?
Pulse ox; Peak expiratory flow; spirometry
Increased breath sounds or voice remains loud at the periphery during auscultation. Indicative of consolidation.
Nasal polyps - deviated septum - hx of trauma - surgery - foreign bodies or recent altitude changes
Inflammation of the nasal cavity

22. Rhinosinusitis History?
Labs: CBC - blood gas - d-dimer - CMP - BNP - Chest CT - MRI
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;
Nasal congestion - HA - sinus pain - fever - sore throat - cough
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

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

24. Physical exam of chest
High pitched voice sound due to transmission of noise across fluid. Indicative of effusion.
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
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
Pulse ox; Peak expiratory flow; spirometry

25. Orthopnea
Deep - rapid - labored - breathing
Dyspnea when supine - relived by sitting or standing
High pitched voice sound due to transmission of noise across fluid. Indicative of effusion.
Deep - snoring sound; indicates fluid or narrowing of airways; common in bronchitis and COPD

26. Pulmonary tests
92-100%
Pulse ox; Peak expiratory flow; spirometry
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
Increased breath sounds or voice remains loud at the periphery during auscultation. Indicative of consolidation.

27. Vesicular breath sounds...
Soft sounds in and out
Aspirin: increases viral shedding
Labs: CBC - blood gas - d-dimer - CMP - BNP - Chest CT - MRI
Rate; pattern (regular or irregular); effort (labored - accessory muscles)

28. What is the most common pathogen for otitis in newborns?
E. coli
Rebound congestion 3-5 days
Inflammation of the nasal cavity
Fine or courses; secretions or aveolar collapse; normal if resovle with cough; abnormal: pneumonia; CHF; COPD; pilmonary fibrosis

29. Spirometry
Abnormal high pitched caused by blockage in upper airway; usually heard with with inspiration
Dyspnea when supine - relived by sitting or standing
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 or relapse of infection - chronic sinusitis - fungal infection - extension in CNS (meningitis - orbital cellulitis - osteitis)

30. What is the common side effect of sympathomimetics?
PE: rhinoscopy with otoscope
Rebound congestion 3-5 days
Rhinovirus - influenza - parainfluenza
High pitched sounds; can occur during inspiration or expiration; indicates narrow airways; can occur with asthma - COPD - pneumonia - CHF

31. Whispered pectoriloguy
Increased loudness of whispering during auscultation. Indicative of consolidation.
HEENT: rhinoscopy - sinus tenderness - lymphnodes - transillumination of sinuses - CV and PULM.
Nasal congestion - HA - sinus pain - fever - sore throat - cough
Bacterial infection

32. What is the most common pahtogen for otitis media?
Inflammation of the nasal cavity
Viral inoculation > viral rhinitis > infection of paranasal sinuses > inflammation & edema > mucosal edema - copious secretions - ciliary dyskinesia > sinus congestions and/or obstruction
Step. pneumoniae; Haemophilus influenzae; group B-strep
Amoxicillin 1000 mg TID x7 days; Augmentin 2000/125mg BID x7 days

33. Chronic rhino-sinusitis duration of symptoms?
Abnormal high pitched caused by blockage in upper airway; usually heard with with inspiration
Deep - rapid - labored - breathing
Inflammation of the paranasal sinuses
>12 weeks

34. Common Cold (URI - Acute Coryza)
Afebrile viral infection of the the nose - paranasal sinuses - throat - larynx - trachea - and and bronchi.
Increased loudness of whispering during auscultation. Indicative of consolidation.
Fine or courses; secretions or aveolar collapse; normal if resovle with cough; abnormal: pneumonia; CHF; COPD; pilmonary fibrosis
Severe dyspnea when lying supine with associated wheezing and coughing - need to sit up abruptly due to severe dyspnea

35. Abnormal pulmonary findings?
Clubbing - Use of accessory muscles - barrel chest
Nasal congestion - HA - sinus pain - fever - sore throat - cough
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

36. Rhonchi
>12 weeks
NSAIDs for aches - fever; Sympathomimetics: pseudophedrine or phenylephrine
Deep - snoring sound; indicates fluid or narrowing of airways; common in bronchitis and COPD
Ipratroprium bromide (e.g. Atrovent); Antihistamines (Cargeul not to overly dry out muscos)

37. Peak Expiratory Flow (PEF)
Fine or courses; secretions or aveolar collapse; normal if resovle with cough; abnormal: pneumonia; CHF; COPD; pilmonary fibrosis
92-100%
Measures speed of exhalation; results measure by age and weight
E. coli

38. Pathophysiology of rhino sinusitis?
Amoxicillin 80-90mg/kg/day x7 days; Augmentin 90/6.4 mg/kg/day x7 days
Viral inoculation > viral rhinitis > infection of paranasal sinuses > inflammation & edema > mucosal edema - copious secretions - ciliary dyskinesia > sinus congestions and/or obstruction
Rhinovirus - influenza - and parainfluenza
Clubbing - Use of accessory muscles - barrel chest

39. Egophany (vocal resonance)
High pitched voice sound due to transmission of noise across fluid. Indicative of effusion.
Inflammation of the paranasal sinuses
4-12 weeks
Increased breath sounds or voice remains loud at the periphery during auscultation. Indicative of consolidation.

40. What sinusitis symptoms would warrant image studies?
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
Abrupt onset - burning nose or throat - sneezing - rhinorrhea
Persistent; recurrent x4/yr; severe HA; altered mental status
Bacterial infection

41. Special cases of sinusitis?
Amoxicillin 80-90mg/kg/day x7 days; Augmentin 90/6.4 mg/kg/day x7 days
Erythmatous auditory canal - crusting
Rhinovirus - influenza - and parainfluenza
Persistent or relapse of infection - chronic sinusitis - fungal infection - extension in CNS (meningitis - orbital cellulitis - osteitis)

42. What is most common age range for otitis?
Rate; pattern (regular or irregular); effort (labored - accessory muscles)
Purulent discharge - post nasal draiange; cough; sinus pressure - tooth pain; halitosis (changes in taste); alterations of smell
Clubbing - Use of accessory muscles - barrel chest
3 months to 3 years old

43. Tx for adult AOE?
Warm - humid environment; rest;
NSAIDs for aches - fever; Sympathomimetics: pseudophedrine or phenylephrine
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
Oflaxicin 0.3% solution BID

44. Pulmonary diagnostics (1)
Soft sounds in and out
Aspirin: increases viral shedding
92-100%
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. Rhinosinusitis physical exam?
Symptomatic (steam; nasal irrigation); APAP for pain.
Rebound congestion 3-5 days
HEENT: rhinoscopy - sinus tenderness - lymphnodes - transillumination of sinuses - CV and PULM.
Warm - humid environment; rest;

46. Wheezes
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;
HEENT: rhinoscopy - sinus tenderness - lymphnodes - transillumination of sinuses - CV and PULM.
Persistent; recurrent x4/yr; severe HA; altered mental status
High pitched sounds; can occur during inspiration or expiration; indicates narrow airways; can occur with asthma - COPD - pneumonia - CHF

47. Tx for adult AOM?
Increased breath sounds or voice remains loud at the periphery during auscultation. Indicative of consolidation.
Inflammation of the paranasal sinuses
Aspirin: increases viral shedding
Amoxicillin 1000 mg TID x7 days; Augmentin 2000/125mg BID x7 days

48. Sinusitis
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
Ear ache - dullness - hearing loss - fever - N/V/D
Inflammation of the paranasal sinuses

49. Proxysmal nocturnal dyspnea
High pitched sounds; can occur during inspiration or expiration; indicates narrow airways; can occur with asthma - COPD - pneumonia - CHF
Inflammation of the nasal cavity
Severe dyspnea when lying supine with associated wheezing and coughing - need to sit up abruptly due to severe dyspnea
Amoxicillin 1000 mg TID x7 days; Augmentin 2000/125mg BID x7 days

50. Kussmal's respiration
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;
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