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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. Cold incubation period
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
24-72 hrs
TM erythmatous - bulging - light reflex displaced - exudate

2. Crackles (rales)
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
Hardher and more turbulent
Warm - humid environment; rest;

3. What does mucopurulent indications not indicate?
Persistent or relapse of infection - chronic sinusitis - fungal infection - extension in CNS (meningitis - orbital cellulitis - osteitis)
Bacterial infection
Abnormal high pitched caused by blockage in upper airway; usually heard with with inspiration
Afebrile viral infection of the the nose - paranasal sinuses - throat - larynx - trachea - and and bronchi.

4. Abnormal pulmonary findings?
Symptomatic (steam; nasal irrigation); APAP for pain.
Clubbing - Use of accessory muscles - barrel chest
Pulse ox; Peak expiratory flow; spirometry
Decongestants (oxymetazoline); glucocorticoids (e.g. fluticasone); mucolytics (e.g. guaifensin)

5. Orthopnea
Fine or courses; secretions or aveolar collapse; normal if resovle with cough; abnormal: pneumonia; CHF; COPD; pilmonary fibrosis
Dyspnea when supine - relived by sitting or standing
Inflammation of the paranasal sinuses
Symptomatic (steam; nasal irrigation); APAP for pain.

6. What is the most common pathogen for otitis in newborns?
Rebound congestion 3-5 days
Inflammation of the paranasal sinuses
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

7. Diagnostics of sinusitis?
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
92-100%
PE: rhinoscopy with otoscope
Nasal polyps - deviated septum - hx of trauma - surgery - foreign bodies or recent altitude changes

8. Whispered pectoriloguy
Erythmatous auditory canal - crusting
Macrolides (azithormycin); Doxycycline; TMZ-SMZ
3 months to 3 years old
Increased loudness of whispering during auscultation. Indicative of consolidation.

9. What sinusitis symptoms would warrant image studies?
Viral inoculation > viral rhinitis > infection of paranasal sinuses > inflammation & edema > mucosal edema - copious secretions - ciliary dyskinesia > sinus congestions and/or obstruction
Afebrile viral infection of the the nose - paranasal sinuses - throat - larynx - trachea - and and bronchi.
Persistent; recurrent x4/yr; severe HA; altered mental status
Dyspnea when supine - relived by sitting or standing

10. Symptoms of acute bacterial rhino-sinusitis (ABRS)?
Aspirin: Reye's Syndrome
Purulent discharge - post nasal draiange; cough; sinus pressure - tooth pain; halitosis (changes in taste); alterations of smell
92-100%
Macrolides (azithormycin); Doxycycline; TMZ-SMZ

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

12. What is the common side effect of sympathomimetics?
Ipratroprium bromide (e.g. Atrovent); Antihistamines (Cargeul not to overly dry out muscos)
E. coli
Augementin 2000/124 mg bid for 5-7 days - Peds: 90 mg/kg/day po in divided doses
Rebound congestion 3-5 days

13. Rhinitis
Nasal congestion - HA - sinus pain - fever - sore throat - cough
Inflammation of the nasal cavity
High pitched voice sound due to transmission of noise across fluid. Indicative of effusion.
Afebrile viral infection of the the nose - paranasal sinuses - throat - larynx - trachea - and and bronchi.

14. Peak Expiratory Flow (PEF)
Measures speed of exhalation; results measure by age and weight
Bacterial or viral infection of the middle ear (secondary to URI [e.g. eustachian tube dysfunction])
Bacterial infection
Fine or courses; secretions or aveolar collapse; normal if resovle with cough; abnormal: pneumonia; CHF; COPD; pilmonary fibrosis

15. Stridor
3 months to 3 years old
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
Augementin 2000/124 mg bid for 5-7 days - Peds: 90 mg/kg/day po in divided doses
Abnormal high pitched caused by blockage in upper airway; usually heard with with inspiration

16. Spirometry
Deep - snoring sound; indicates fluid or narrowing of airways; common in bronchitis and COPD
Ear ache - dullness - hearing loss - fever - N/V/D
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
Step. pneumoniae; Haemophilus influenzae; group B-strep

17. Pulmonary tests
Increased loudness of whispering during auscultation. Indicative of consolidation.
Pulse ox; Peak expiratory flow; spirometry
Abrupt onset - burning nose or throat - sneezing - rhinorrhea
Rate; pattern (regular or irregular); effort (labored - accessory muscles)

18. Which Rx should not be used for viral URI?
Apena alternating with hyperpnea;
Symptomatic (steam; nasal irrigation); APAP for pain.
Soft sounds in and out
Aspirin: increases viral shedding

19. Vesicular breath sounds...
Bacterial infection
Soft sounds in and out
Rebound congestion 3-5 days
Abnormal high pitched caused by blockage in upper airway; usually heard with with inspiration

20. Tx for adult AOM?
HEENT: rhinoscopy - sinus tenderness - lymphnodes - transillumination of sinuses - CV and PULM.
Amoxicillin 1000 mg TID x7 days; Augmentin 2000/125mg BID x7 days
Bacterial or viral infection of the middle ear (secondary to URI [e.g. eustachian tube dysfunction])
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

21. Normal pulse ox
92-100%
3 months to 3 years old
E. coli
Step. pneumoniae; Haemophilus influenzae; group B-strep

22. Nonpharmacological tx for viral URI
24-72 hrs
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
Soft sounds in and out

23. Rhinosinusitis risk factors?
Nasal polyps - deviated septum - hx of trauma - surgery - foreign bodies or recent altitude changes
Inflammation of the nasal cavity
3 months to 3 years old
Persistent; recurrent x4/yr; severe HA; altered mental status

24. Tx of sinusitis symptoms <10 days
Labs: CBC - blood gas - d-dimer - CMP - BNP - Chest CT - MRI
Symptomatic (steam; nasal irrigation); APAP for pain.
Rhinovirus - influenza - and 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

25. Rx nasal congestion?
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 congestion - HA - sinus pain - fever - sore throat - cough
Decongestants (oxymetazoline); glucocorticoids (e.g. fluticasone); mucolytics (e.g. guaifensin)
24-72 hrs

26. Respiratory Illness Key Points (3)
Labs: CBC - blood gas - d-dimer - CMP - BNP - Chest CT - MRI
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
Amoxicillin 80-90mg/kg/day x7 days; Augmentin 90/6.4 mg/kg/day x7 days
Nasal polyps - deviated septum - hx of trauma - surgery - foreign bodies or recent altitude changes

27. What is the most common pahtogen for otitis media?
TM erythmatous - bulging - light reflex displaced - exudate
Step. pneumoniae; Haemophilus influenzae; group B-strep
Ipratroprium bromide (e.g. Atrovent); Antihistamines (Cargeul not to overly dry out muscos)
Persistent; recurrent x4/yr; severe HA; altered mental status

28. Tx for adult AOE?
Increased breath sounds or voice remains loud at the periphery during auscultation. Indicative of consolidation.
Inflammation of the paranasal sinuses
Abnormal high pitched caused by blockage in upper airway; usually heard with with inspiration
Oflaxicin 0.3% solution BID

29. Additional pulmonary diagnostics
Amoxicillin 1000 mg TID x7 days; Augmentin 2000/125mg BID x7 days
E. coli
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
Labs: CBC - blood gas - d-dimer - CMP - BNP - Chest CT - MRI

30. Common cold pathogens
Pulse ox; Peak expiratory flow; spirometry
Deep - snoring sound; indicates fluid or narrowing of airways; common in bronchitis and COPD
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
Rhinovirus - influenza - and parainfluenza

31. Rhinosinusitis History?
24-72 hrs
Persistent or relapse of infection - chronic sinusitis - fungal infection - extension in CNS (meningitis - orbital cellulitis - osteitis)
Nasal congestion - HA - sinus pain - fever - sore throat - cough
Aspirin: increases viral shedding

32. Rhinosinusitis physical exam?
HEENT: rhinoscopy - sinus tenderness - lymphnodes - transillumination of sinuses - CV and PULM.
Hardher and more turbulent
Abrupt onset - burning nose or throat - sneezing - rhinorrhea
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

33. Egophany (vocal resonance)
Increased loudness of whispering during auscultation. Indicative of consolidation.
Rebound congestion 3-5 days
Erythmatous auditory canal - crusting
High pitched voice sound due to transmission of noise across fluid. Indicative of effusion.

34. Bronchophony
Pulse ox; Peak expiratory flow; spirometry
Increased breath sounds or voice remains loud at the periphery during auscultation. Indicative of consolidation.
Bacterial infection
Apena alternating with hyperpnea;

35. Kussmal's respiration
Deep - rapid - labored - breathing
Rate; pattern (regular or irregular); effort (labored - accessory muscles)
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)

36. Chronic rhino-sinusitis duration of symptoms?
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
>12 weeks
Measures speed of exhalation; results measure by age and weight

37. Acute viral rhino-sinusitis (AVRS) pathogens?
Fine or courses; secretions or aveolar collapse; normal if resovle with cough; abnormal: pneumonia; CHF; COPD; pilmonary fibrosis
Rhinovirus - influenza - parainfluenza
Labs: CBC - blood gas - d-dimer - CMP - BNP - Chest CT - MRI
>12 weeks

38. 1st line treatment for bacterial sinusitis?
NSAIDs for aches - fever; Sympathomimetics: pseudophedrine or phenylephrine
TM erythmatous - bulging - light reflex displaced - exudate
Augementin 2000/124 mg bid for 5-7 days - Peds: 90 mg/kg/day po in divided doses
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

39. Cheyne-stokes
Dyspnea when supine - relived by sitting or standing
Apena alternating with hyperpnea;
Inflammation of the paranasal sinuses
Ear ache - dullness - hearing loss - fever - N/V/D

40. Rx for rhinorrhea and/or allergies?
Decongestants (oxymetazoline); glucocorticoids (e.g. fluticasone); mucolytics (e.g. guaifensin)
Increased loudness of whispering during auscultation. Indicative of consolidation.
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

41. Common cold symptoms
Abrupt onset - burning nose or throat - sneezing - rhinorrhea
Deep - rapid - labored - breathing
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)

42. Pulmonary diagnostics (1)
Labs: CBC - blood gas - d-dimer - CMP - BNP - Chest CT - MRI
Aspirin: Reye's Syndrome
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

43. Sinusitis
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 paranasal sinuses
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

44. Symptoms of viral rhinosinusitis
Dyspnea when supine - relived by sitting or standing
Aspirin: increases viral shedding
Augementin 2000/124 mg bid for 5-7 days - Peds: 90 mg/kg/day po in divided doses
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. Pathophysiology of rhino sinusitis?
Fine or courses; secretions or aveolar collapse; normal if resovle with cough; abnormal: pneumonia; CHF; COPD; pilmonary fibrosis
Viral inoculation > viral rhinitis > infection of paranasal sinuses > inflammation & edema > mucosal edema - copious secretions - ciliary dyskinesia > sinus congestions and/or obstruction
Ear ache - dullness - hearing loss - fever - N/V/D
TM erythmatous - bulging - light reflex displaced - exudate

46. Physical exam of chest
Viral inoculation > viral rhinitis > infection of paranasal sinuses > inflammation & edema > mucosal edema - copious secretions - ciliary dyskinesia > sinus congestions and/or obstruction
Inflammation of the nasal cavity
High pitched sounds; can occur during inspiration or expiration; indicates narrow airways; can occur with asthma - COPD - pneumonia - CHF
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

47. Alternative rx for bacterial sinusitis?
3 months to 3 years old
Nasal congestion - HA - sinus pain - fever - sore throat - cough
Bacterial infection
Macrolides (azithormycin); Doxycycline; TMZ-SMZ

48. Bronchial breath sounds...
TM erythmatous - bulging - light reflex displaced - exudate
Hardher and more turbulent
HEENT: rhinoscopy - sinus tenderness - lymphnodes - transillumination of sinuses - CV and PULM.
Increased loudness of whispering during auscultation. Indicative of consolidation.

49. What is most common age range for otitis?
92-100%
Oflaxicin 0.3% solution BID
3 months to 3 years old
Erythmatous auditory canal - crusting

50. Acute rhino-sinusitis duration of symptoms?
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
Increased loudness of whispering during auscultation. Indicative of consolidation.
Erythmatous auditory canal - crusting
<4 weeks