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ENT/Respiratory

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1. What are physical exam findings of AOM?
TM erythmatous - bulging - light reflex displaced - exudate
Bacterial or viral infection of the middle ear (secondary to URI [e.g. eustachian tube dysfunction])
Ipratroprium bromide (e.g. Atrovent); Antihistamines (Cargeul not to overly dry out muscos)
Bacterial infection

2. Tx for adult AOE?
Rhinovirus - influenza - parainfluenza
3 months to 3 years old
Oflaxicin 0.3% solution BID
TM erythmatous - bulging - light reflex displaced - exudate

3. 1st line treatment for bacterial sinusitis?
Fine or courses; secretions or aveolar collapse; normal if resovle with cough; abnormal: pneumonia; CHF; COPD; pilmonary fibrosis
Erythmatous auditory canal - crusting
HEENT: rhinoscopy - sinus tenderness - lymphnodes - transillumination of sinuses - CV and PULM.
Augementin 2000/124 mg bid for 5-7 days - Peds: 90 mg/kg/day po in divided doses

4. Cheyne-stokes
Ipratroprium bromide (e.g. Atrovent); Antihistamines (Cargeul not to overly dry out muscos)
Apena alternating with hyperpnea;
Aspirin: increases viral shedding
Bacterial or viral infection of the middle ear (secondary to URI [e.g. eustachian tube dysfunction])

5. Rhinitis
Soft sounds in and out
Inflammation of the nasal cavity
Nasal polyps - deviated septum - hx of trauma - surgery - foreign bodies or recent altitude changes
Clubbing - Use of accessory muscles - barrel chest

6. Acute viral rhino-sinusitis (AVRS) pathogens?
Rhinovirus - influenza - parainfluenza
24-72 hrs
Warm - humid environment; rest;
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

7. Rhonchi
Measures speed of exhalation; results measure by age and weight
HEENT: rhinoscopy - sinus tenderness - lymphnodes - transillumination of sinuses - CV and PULM.
Decongestants (oxymetazoline); glucocorticoids (e.g. fluticasone); mucolytics (e.g. guaifensin)
Deep - snoring sound; indicates fluid or narrowing of airways; common in bronchitis and COPD

8. Kussmal's respiration
Inflammation of the nasal cavity
Apena alternating with hyperpnea;
Deep - rapid - labored - breathing
Warm - humid environment; rest;

9. What sinusitis symptoms would warrant image studies?
Persistent; recurrent x4/yr; severe HA; altered mental status
Labs: CBC - blood gas - d-dimer - CMP - BNP - Chest CT - MRI
Deep - rapid - labored - breathing
Macrolides (azithormycin); Doxycycline; TMZ-SMZ

10. Tx for pediatric AOM?
Hardher and more turbulent
Amoxicillin 80-90mg/kg/day x7 days; Augmentin 90/6.4 mg/kg/day x7 days
High pitched sounds; can occur during inspiration or expiration; indicates narrow airways; can occur with asthma - COPD - pneumonia - CHF
Persistent or relapse of infection - chronic sinusitis - fungal infection - extension in CNS (meningitis - orbital cellulitis - osteitis)

11. What are the symptoms of otitis?
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
Ear ache - dullness - hearing loss - fever - N/V/D
Clubbing - Use of accessory muscles - barrel chest

12. Sinusitis
Bacterial infection
Measures speed of exhalation; results measure by age and weight
4-12 weeks
Inflammation of the paranasal sinuses

13. Abnormal pulmonary findings?
Macrolides (azithormycin); Doxycycline; TMZ-SMZ
HEENT: rhinoscopy - sinus tenderness - lymphnodes - transillumination of sinuses - CV and PULM.
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;
Clubbing - Use of accessory muscles - barrel chest

14. Rhinosinusitis physical exam?
Dyspnea when supine - relived by sitting or standing
Oflaxicin 0.3% solution BID
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.

15. Peak Expiratory Flow (PEF)
Erythmatous auditory canal - crusting
High pitched voice sound due to transmission of noise across fluid. Indicative of effusion.
Severe dyspnea when lying supine with associated wheezing and coughing - need to sit up abruptly due to severe dyspnea
Measures speed of exhalation; results measure by age and weight

16. Spirometry
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
E. coli
Abrupt onset - burning nose or throat - sneezing - rhinorrhea
Deep - snoring sound; indicates fluid or narrowing of airways; common in bronchitis and COPD

17. Wheezes
Amoxicillin 80-90mg/kg/day x7 days; Augmentin 90/6.4 mg/kg/day x7 days
High pitched sounds; can occur during inspiration or expiration; indicates narrow airways; can occur with asthma - COPD - pneumonia - CHF
Macrolides (azithormycin); Doxycycline; TMZ-SMZ
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

18. What is the most common pathogen for otitis in newborns?
High pitched voice sound due to transmission of noise across fluid. Indicative of effusion.
Labs: CBC - blood gas - d-dimer - CMP - BNP - Chest CT - MRI
Erythmatous auditory canal - crusting
E. coli

19. Pulmonary tests
Measures speed of exhalation; results measure by age and weight
Pulse ox; Peak expiratory flow; spirometry
Ear ache - dullness - hearing loss - fever - N/V/D
E. coli

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

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21. Orthopnea
Aspirin: Reye's Syndrome
Dyspnea when supine - relived by sitting or standing
Bacterial or viral infection of the middle ear (secondary to URI [e.g. eustachian tube dysfunction])
Amoxicillin 80-90mg/kg/day x7 days; Augmentin 90/6.4 mg/kg/day x7 days

22. Special cases of sinusitis?
Deep - snoring sound; indicates fluid or narrowing of airways; common in bronchitis and COPD
Persistent or relapse of infection - chronic sinusitis - fungal infection - extension in CNS (meningitis - orbital cellulitis - osteitis)
Viral inoculation > viral rhinitis > infection of paranasal sinuses > inflammation & edema > mucosal edema - copious secretions - ciliary dyskinesia > sinus congestions and/or obstruction
E. coli

23. Rhinosinusitis History?
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
Soft sounds in and out
Symptomatic (steam; nasal irrigation); APAP for pain.

24. Alternative rx for bacterial sinusitis?
Macrolides (azithormycin); Doxycycline; TMZ-SMZ
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;
Persistent; recurrent x4/yr; severe HA; altered mental status
Apena alternating with hyperpnea;

25. Acute otitis media
Bacterial or viral infection of the middle ear (secondary to URI [e.g. eustachian tube dysfunction])
Oflaxicin 0.3% solution BID
Rhinovirus - influenza - and parainfluenza
Step. pneumoniae; Haemophilus influenzae; group B-strep

26. Normal pulse ox
Ipratroprium bromide (e.g. Atrovent); Antihistamines (Cargeul not to overly dry out muscos)
92-100%
Oflaxicin 0.3% solution BID
PE: rhinoscopy with otoscope

27. Additional pulmonary diagnostics
Labs: CBC - blood gas - d-dimer - CMP - BNP - Chest CT - MRI
PE: rhinoscopy with otoscope
Hardher and more turbulent
Apena alternating with hyperpnea;

28. Egophany (vocal resonance)
3 months to 3 years old
92-100%
High pitched voice sound due to transmission of noise across fluid. Indicative of effusion.
Erythmatous auditory canal - crusting

29. Respiratory Examination (Observation)
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 or relapse of infection - chronic sinusitis - fungal infection - extension in CNS (meningitis - orbital cellulitis - osteitis)
Rate; pattern (regular or irregular); effort (labored - accessory muscles)

30. Pulmonary diagnostics (1)
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
TM erythmatous - bulging - light reflex displaced - exudate
Bacterial infection
3 months to 3 years old

31. Bronchial breath sounds...
24-72 hrs
Erythmatous auditory canal - crusting
Hardher and more turbulent
Increased loudness of whispering during auscultation. Indicative of consolidation.

32. Whispered pectoriloguy
Symptomatic (steam; nasal irrigation); APAP for pain.
Increased loudness of whispering during auscultation. Indicative of consolidation.
Inflammation of the paranasal sinuses
92-100%

33. Subacute rhino-sinusitis duration of symptoms?
Rebound congestion 3-5 days
Purulent discharge - post nasal draiange; cough; sinus pressure - tooth pain; halitosis (changes in taste); alterations of smell
Afebrile viral infection of the the nose - paranasal sinuses - throat - larynx - trachea - and and bronchi.
4-12 weeks

34. Rx nasal congestion?
Increased loudness of whispering during auscultation. Indicative of consolidation.
Step. pneumoniae; Haemophilus influenzae; group B-strep
Decongestants (oxymetazoline); glucocorticoids (e.g. fluticasone); mucolytics (e.g. guaifensin)
Ipratroprium bromide (e.g. Atrovent); Antihistamines (Cargeul not to overly dry out muscos)

35. Tx of sinusitis symptoms <10 days
Dyspnea when supine - relived by sitting or standing
Symptomatic (steam; nasal irrigation); APAP for pain.
Severe dyspnea when lying supine with associated wheezing and coughing - need to sit up abruptly due to severe dyspnea
Deep - rapid - labored - breathing

36. Chronic rhino-sinusitis duration of symptoms?
<4 weeks
Ipratroprium bromide (e.g. Atrovent); Antihistamines (Cargeul not to overly dry out muscos)
92-100%
>12 weeks

37. Pathophysiology of rhino sinusitis?
Rhinovirus - influenza - and parainfluenza
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
24-72 hrs

38. Bronchophony
Rhinovirus - influenza - parainfluenza
3 months to 3 years old
Clubbing - Use of accessory muscles - barrel chest
Increased breath sounds or voice remains loud at the periphery during auscultation. Indicative of consolidation.

39. What is the common side effect of sympathomimetics?
Afebrile viral infection of the the nose - paranasal sinuses - throat - larynx - trachea - and and bronchi.
Inflammation of the paranasal sinuses
Dyspnea when supine - relived by sitting or standing
Rebound congestion 3-5 days

40. Cold incubation period
Inflammation of the paranasal sinuses
Abrupt onset - burning nose or throat - sneezing - rhinorrhea
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

41. Rx for viral URI?
Rebound congestion 3-5 days
>12 weeks
NSAIDs for aches - fever; Sympathomimetics: pseudophedrine or phenylephrine
Purulent discharge - post nasal draiange; cough; sinus pressure - tooth pain; halitosis (changes in taste); alterations of smell

42. Respiratory Illness Key Points (3)
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
Fine or courses; secretions or aveolar collapse; normal if resovle with cough; abnormal: pneumonia; CHF; COPD; pilmonary fibrosis
24-72 hrs

43. What is the most common pahtogen for otitis media?
24-72 hrs
Step. pneumoniae; Haemophilus influenzae; group B-strep
Aspirin: Reye's Syndrome
Apena alternating with hyperpnea;

44. Vesicular breath sounds...
NSAIDs for aches - fever; Sympathomimetics: pseudophedrine or phenylephrine
Inflammation of the paranasal sinuses
Erythmatous auditory canal - crusting
Soft sounds in and out

45. Acute rhino-sinusitis duration of symptoms?
3 months to 3 years old
Rhinovirus - influenza - parainfluenza
Erythmatous auditory canal - crusting
<4 weeks

46. What are physical exam findings of AOE?
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
Erythmatous auditory canal - crusting
Persistent or relapse of infection - chronic sinusitis - fungal infection - extension in CNS (meningitis - orbital cellulitis - osteitis)
Viral inoculation > viral rhinitis > infection of paranasal sinuses > inflammation & edema > mucosal edema - copious secretions - ciliary dyskinesia > sinus congestions and/or obstruction

47. What does mucopurulent indications not indicate?
Amoxicillin 1000 mg TID x7 days; Augmentin 2000/125mg BID x7 days
Bacterial infection
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
>12 weeks

48. Crackles (rales)
Fine or courses; secretions or aveolar collapse; normal if resovle with cough; abnormal: pneumonia; CHF; COPD; pilmonary fibrosis
Purulent discharge - post nasal draiange; cough; sinus pressure - tooth pain; halitosis (changes in taste); alterations of smell
Abnormal high pitched caused by blockage in upper airway; usually heard with with inspiration
E. coli

49. Tx for adult AOM?
Augementin 2000/124 mg bid for 5-7 days - Peds: 90 mg/kg/day po in divided doses
Measures speed of exhalation; results measure by age and weight
Macrolides (azithormycin); Doxycycline; TMZ-SMZ
Amoxicillin 1000 mg TID x7 days; Augmentin 2000/125mg BID x7 days

50. Diagnostics of sinusitis?
PE: rhinoscopy with otoscope
Symptomatic (steam; nasal irrigation); APAP for pain.
Measures speed of exhalation; results measure by age and weight
Abnormal high pitched caused by blockage in upper airway; usually heard with with inspiration

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