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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. Proxysmal nocturnal dyspnea
Severe dyspnea when lying supine with associated wheezing and coughing - need to sit up abruptly due to severe dyspnea
>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
Inflammation of the nasal cavity

2. Nonpharmacological tx for viral URI
Fine or courses; secretions or aveolar collapse; normal if resovle with cough; abnormal: pneumonia; CHF; COPD; pilmonary fibrosis
Warm - humid environment; rest;
Decongestants (oxymetazoline); glucocorticoids (e.g. fluticasone); mucolytics (e.g. guaifensin)
Amoxicillin 1000 mg TID x7 days; Augmentin 2000/125mg BID x7 days

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

4. Vesicular breath sounds...
Clubbing - Use of accessory muscles - barrel chest
Soft sounds in and out
Labs: CBC - blood gas - d-dimer - CMP - BNP - Chest CT - MRI
Macrolides (azithormycin); Doxycycline; TMZ-SMZ

5. Tx for adult AOE?
Amoxicillin 1000 mg TID x7 days; Augmentin 2000/125mg BID x7 days
Erythmatous auditory canal - crusting
24-72 hrs
Oflaxicin 0.3% solution BID

6. What is the common side effect of sympathomimetics?
Fine or courses; secretions or aveolar collapse; normal if resovle with cough; abnormal: pneumonia; CHF; COPD; pilmonary fibrosis
Increased loudness of whispering during auscultation. Indicative of consolidation.
Deep - snoring sound; indicates fluid or narrowing of airways; common in bronchitis and COPD
Rebound congestion 3-5 days

7. Normal pulse ox
92-100%
Persistent; recurrent x4/yr; severe HA; altered mental status
NSAIDs for aches - fever; Sympathomimetics: pseudophedrine or phenylephrine
Clubbing - Use of accessory muscles - barrel chest

8. Acute viral rhino-sinusitis (AVRS) pathogens?
Pulse ox; Peak expiratory flow; spirometry
Rhinovirus - influenza - parainfluenza
Ipratroprium bromide (e.g. Atrovent); Antihistamines (Cargeul not to overly dry out muscos)
Nasal polyps - deviated septum - hx of trauma - surgery - foreign bodies or recent altitude changes

9. Respiratory Illness Key Points (3)
Amoxicillin 80-90mg/kg/day x7 days; Augmentin 90/6.4 mg/kg/day 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
Persistent or relapse of infection - chronic sinusitis - fungal infection - extension in CNS (meningitis - orbital cellulitis - osteitis)
Increased loudness of whispering during auscultation. Indicative of consolidation.

10. What is most common age range for otitis?
>12 weeks
Deep - snoring sound; indicates fluid or narrowing of airways; common in bronchitis and COPD
3 months to 3 years old
Step. pneumoniae; Haemophilus influenzae; group B-strep

11. Pathophysiology of rhino sinusitis?
Augementin 2000/124 mg bid for 5-7 days - Peds: 90 mg/kg/day po in divided doses
Viral inoculation > viral rhinitis > infection of paranasal sinuses > inflammation & edema > mucosal edema - copious secretions - ciliary dyskinesia > sinus congestions and/or obstruction
Pulse ox; Peak expiratory flow; spirometry
3 months to 3 years old

12. Respiratory Examination (Observation)
High pitched voice sound due to transmission of noise across fluid. Indicative of effusion.
Rate; pattern (regular or irregular); effort (labored - accessory muscles)
E. coli
Erythmatous auditory canal - crusting

13. What does mucopurulent indications not indicate?
Warm - humid environment; rest;
Ipratroprium bromide (e.g. Atrovent); Antihistamines (Cargeul not to overly dry out muscos)
Deep - rapid - labored - breathing
Bacterial infection

14. Spirometry
NSAIDs for aches - fever; Sympathomimetics: pseudophedrine or phenylephrine
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
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

15. Tx for adult AOM?
PE: rhinoscopy with otoscope
Fine or courses; secretions or aveolar collapse; normal if resovle with cough; abnormal: pneumonia; CHF; COPD; pilmonary fibrosis
Amoxicillin 1000 mg TID x7 days; Augmentin 2000/125mg BID x7 days
Persistent or relapse of infection - chronic sinusitis - fungal infection - extension in CNS (meningitis - orbital cellulitis - osteitis)

16. Which Rx should not be used for viral URI?
Ipratroprium bromide (e.g. Atrovent); Antihistamines (Cargeul not to overly dry out muscos)
Warm - humid environment; rest;
Purulent discharge - post nasal draiange; cough; sinus pressure - tooth pain; halitosis (changes in taste); alterations of smell
Aspirin: increases viral shedding

17. What sinusitis symptoms would warrant image studies?
Persistent; recurrent x4/yr; severe HA; altered mental status
>12 weeks
Soft sounds in and out
Purulent discharge - post nasal draiange; cough; sinus pressure - tooth pain; halitosis (changes in taste); alterations of smell

18. What are physical exam findings of AOE?
Ear ache - dullness - hearing loss - fever - N/V/D
Erythmatous auditory canal - crusting
Apena alternating with hyperpnea;
Oflaxicin 0.3% solution BID

19. Kussmal's respiration
Hardher and more turbulent
Clubbing - Use of accessory muscles - barrel chest
Persistent or relapse of infection - chronic sinusitis - fungal infection - extension in CNS (meningitis - orbital cellulitis - osteitis)
Deep - rapid - labored - breathing

20. Physical exam of chest
PE: rhinoscopy with otoscope
Symptomatic (steam; nasal irrigation); APAP for pain.
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
High pitched voice sound due to transmission of noise across fluid. Indicative of effusion.

21. Whispered pectoriloguy
Rate; pattern (regular or irregular); effort (labored - accessory muscles)
Aspirin: increases viral shedding
Increased loudness of whispering during auscultation. Indicative of consolidation.
Bacterial infection

22. Common Cold (URI - Acute Coryza)
Fine or courses; secretions or aveolar collapse; normal if resovle with cough; abnormal: pneumonia; CHF; COPD; pilmonary fibrosis
Soft sounds in and out
Rate; pattern (regular or irregular); effort (labored - accessory muscles)
Afebrile viral infection of the the nose - paranasal sinuses - throat - larynx - trachea - and and bronchi.

23. Orthopnea
Dyspnea when supine - relived by sitting or standing
PE: rhinoscopy with otoscope
Measures speed of exhalation; results measure by age and weight
Amoxicillin 80-90mg/kg/day x7 days; Augmentin 90/6.4 mg/kg/day x7 days

24. Bronchial breath sounds...
>12 weeks
Hardher and more turbulent
E. coli
Rate; pattern (regular or irregular); effort (labored - accessory muscles)

25. What are the symptoms of otitis?
Symptomatic (steam; nasal irrigation); APAP for pain.
Viral inoculation > viral rhinitis > infection of paranasal sinuses > inflammation & edema > mucosal edema - copious secretions - ciliary dyskinesia > sinus congestions and/or obstruction
92-100%
Ear ache - dullness - hearing loss - fever - N/V/D

26. Cheyne-stokes
NSAIDs for aches - fever; Sympathomimetics: pseudophedrine or phenylephrine
Amoxicillin 80-90mg/kg/day x7 days; Augmentin 90/6.4 mg/kg/day x7 days
Apena alternating with hyperpnea;
Deep - snoring sound; indicates fluid or narrowing of airways; common in bronchitis and COPD

27. Rx for rhinorrhea and/or allergies?
HEENT: rhinoscopy - sinus tenderness - lymphnodes - transillumination of sinuses - CV and PULM.
Oflaxicin 0.3% solution BID
High pitched sounds; can occur during inspiration or expiration; indicates narrow airways; can occur with asthma - COPD - pneumonia - CHF
Ipratroprium bromide (e.g. Atrovent); Antihistamines (Cargeul not to overly dry out muscos)

28. Common cold symptoms
Abrupt onset - burning nose or throat - sneezing - rhinorrhea
Erythmatous auditory canal - crusting
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

29. Rhinosinusitis History?
Severe dyspnea when lying supine with associated wheezing and coughing - need to sit up abruptly due to severe dyspnea
Hardher and more turbulent
Nasal congestion - HA - sinus pain - fever - sore throat - cough
Clubbing - Use of accessory muscles - barrel chest

30. Tx for pediatric AOM?
Nasal congestion - HA - sinus pain - fever - sore throat - cough
Amoxicillin 80-90mg/kg/day x7 days; Augmentin 90/6.4 mg/kg/day x7 days
Afebrile viral infection of the the nose - paranasal sinuses - throat - larynx - trachea - and and bronchi.
Rhinovirus - influenza - and parainfluenza

31. What is the most common pahtogen for otitis media?
Step. pneumoniae; Haemophilus influenzae; group B-strep
Increased breath sounds or voice remains loud at the periphery during auscultation. Indicative of consolidation.
Bacterial or viral infection of the middle ear (secondary to URI [e.g. eustachian tube dysfunction])
Amoxicillin 1000 mg TID x7 days; Augmentin 2000/125mg BID x7 days

32. Sinusitis
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)
Erythmatous auditory canal - crusting
Inflammation of the paranasal sinuses

33. Rx for viral URI?
NSAIDs for aches - fever; Sympathomimetics: pseudophedrine or phenylephrine
Clubbing - Use of accessory muscles - barrel chest
Decongestants (oxymetazoline); glucocorticoids (e.g. fluticasone); mucolytics (e.g. guaifensin)
Abrupt onset - burning nose or throat - sneezing - rhinorrhea

34. Acute otitis media
E. coli
TM erythmatous - bulging - light reflex displaced - exudate
Bacterial or viral infection of the middle ear (secondary to URI [e.g. eustachian tube dysfunction])
Rhinovirus - influenza - parainfluenza

35. Rhinosinusitis physical exam?
HEENT: rhinoscopy - sinus tenderness - lymphnodes - transillumination of sinuses - CV and PULM.
Pulse ox; Peak expiratory flow; spirometry
Nasal polyps - deviated septum - hx of trauma - surgery - foreign bodies or recent altitude changes
Macrolides (azithormycin); Doxycycline; TMZ-SMZ

36. Pulmonary diagnostics (1)
24-72 hrs
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
Pulse ox; Peak expiratory flow; spirometry
Bacterial infection

37. Wheezes
Symptomatic (steam; nasal irrigation); APAP for pain.
High pitched sounds; can occur during inspiration or expiration; indicates narrow airways; can occur with asthma - COPD - pneumonia - CHF
Rhinovirus - influenza - 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

38. Crackles (rales)
Fine or courses; secretions or aveolar collapse; normal if resovle with cough; abnormal: pneumonia; CHF; COPD; pilmonary fibrosis
Aspirin: increases viral shedding
3 months to 3 years old
Increased breath sounds or voice remains loud at the periphery during auscultation. Indicative of consolidation.

39. Subacute rhino-sinusitis duration of symptoms?
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
4-12 weeks
E. coli
Erythmatous auditory canal - crusting

40. Rhinosinusitis risk factors?
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
Amoxicillin 80-90mg/kg/day x7 days; Augmentin 90/6.4 mg/kg/day x7 days
Bacterial infection

41. What is the most common pathogen for otitis in newborns?
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
Apena alternating with hyperpnea;
E. coli
Amoxicillin 80-90mg/kg/day x7 days; Augmentin 90/6.4 mg/kg/day x7 days

42. Rhonchi
Abnormal high pitched caused by blockage in upper airway; usually heard with with inspiration
Ipratroprium bromide (e.g. Atrovent); Antihistamines (Cargeul not to overly dry out muscos)
Deep - snoring sound; indicates fluid or narrowing of airways; common in bronchitis and COPD
High pitched voice sound due to transmission of noise across fluid. Indicative of effusion.

43. Pulmonary tests
Rebound congestion 3-5 days
Inflammation of the nasal cavity
Pulse ox; Peak expiratory flow; spirometry
Deep - rapid - labored - breathing

44. Peak Expiratory Flow (PEF)
Measures speed of exhalation; results measure by age and weight
E. coli
Severe dyspnea when lying supine with associated wheezing and coughing - need to sit up abruptly due to severe dyspnea
Dyspnea when supine - relived by sitting or standing

45. Symptoms of acute bacterial rhino-sinusitis (ABRS)?
Purulent discharge - post nasal draiange; cough; sinus pressure - tooth pain; halitosis (changes in taste); alterations of smell
Soft sounds in and out
Bacterial infection
Ear ache - dullness - hearing loss - fever - N/V/D

46. What are physical exam findings of AOM?
Dyspnea when supine - relived by sitting or standing
Amoxicillin 1000 mg TID x7 days; Augmentin 2000/125mg BID x7 days
Persistent; recurrent x4/yr; severe HA; altered mental status
TM erythmatous - bulging - light reflex displaced - exudate

47. 1st line treatment for bacterial sinusitis?
NSAIDs for aches - fever; Sympathomimetics: pseudophedrine or phenylephrine
Persistent; recurrent x4/yr; severe HA; altered mental status
24-72 hrs
Augementin 2000/124 mg bid for 5-7 days - Peds: 90 mg/kg/day po in divided doses

48. Bronchophony
Bacterial infection
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.
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

49. Stridor
Abnormal high pitched caused by blockage in upper airway; usually heard with with inspiration
Step. pneumoniae; Haemophilus influenzae; group B-strep
NSAIDs for aches - fever; Sympathomimetics: pseudophedrine or phenylephrine
4-12 weeks

50. Additional pulmonary diagnostics
Persistent or relapse of infection - chronic sinusitis - fungal infection - extension in CNS (meningitis - orbital cellulitis - osteitis)
Labs: CBC - blood gas - d-dimer - CMP - BNP - Chest CT - MRI
NSAIDs for aches - fever; Sympathomimetics: pseudophedrine or phenylephrine
Bacterial infection