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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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1. 1st line treatment for bacterial sinusitis?
Augementin 2000/124 mg bid for 5-7 days - Peds: 90 mg/kg/day po in divided doses
Fine or courses; secretions or aveolar collapse; normal if resovle with cough; abnormal: pneumonia; CHF; COPD; pilmonary fibrosis
Ear ache - dullness - hearing loss - fever - N/V/D
High pitched voice sound due to transmission of noise across fluid. Indicative of effusion.

2. What does mucopurulent indications not indicate?
Macrolides (azithormycin); Doxycycline; TMZ-SMZ
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
Bacterial infection

3. What are physical exam findings of AOE?
Erythmatous auditory canal - crusting
Soft sounds in and out
Inflammation of the paranasal sinuses
Amoxicillin 80-90mg/kg/day x7 days; Augmentin 90/6.4 mg/kg/day x7 days

4. Whispered pectoriloguy
Increased loudness of whispering during auscultation. Indicative of consolidation.
Amoxicillin 1000 mg TID x7 days; Augmentin 2000/125mg BID x7 days
PE: rhinoscopy with otoscope
92-100%

5. Bronchophony
24-72 hrs
Rate; pattern (regular or irregular); effort (labored - accessory muscles)
Increased breath sounds or voice remains loud at the periphery during auscultation. Indicative of consolidation.
Severe dyspnea when lying supine with associated wheezing and coughing - need to sit up abruptly due to severe dyspnea

6. Crackles (rales)
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
Persistent or relapse of infection - chronic sinusitis - fungal infection - extension in CNS (meningitis - orbital cellulitis - osteitis)
Ipratroprium bromide (e.g. Atrovent); Antihistamines (Cargeul not to overly dry out muscos)

7. Cheyne-stokes
Aspirin: increases viral shedding
Ear ache - dullness - hearing loss - fever - N/V/D
Increased breath sounds or voice remains loud at the periphery during auscultation. Indicative of consolidation.
Apena alternating with hyperpnea;

8. Physical exam of chest
Aspirin: increases viral shedding
HEENT: rhinoscopy - sinus tenderness - lymphnodes - transillumination of sinuses - CV and PULM.
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

9. What is the most common pathogen for otitis in newborns?
Rate; pattern (regular or irregular); effort (labored - accessory muscles)
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
TM erythmatous - bulging - light reflex displaced - exudate

10. Common cold symptoms
High pitched sounds; can occur during inspiration or expiration; indicates narrow airways; can occur with asthma - COPD - pneumonia - CHF
Aspirin: Reye's Syndrome
Deep - snoring sound; indicates fluid or narrowing of airways; common in bronchitis and COPD
Abrupt onset - burning nose or throat - sneezing - rhinorrhea

11. Pulmonary tests
Erythmatous auditory canal - crusting
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
Increased breath sounds or voice remains loud at the periphery during auscultation. Indicative of consolidation.

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

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13. What is the common side effect of sympathomimetics?
Rebound congestion 3-5 days
Measures speed of exhalation; results measure by age and weight
Deep - rapid - labored - breathing
Aspirin: increases viral shedding

14. Orthopnea
Abnormal high pitched caused by blockage in upper airway; usually heard with with inspiration
Macrolides (azithormycin); Doxycycline; TMZ-SMZ
Dyspnea when supine - relived by sitting or standing
Increased breath sounds or voice remains loud at the periphery during auscultation. Indicative of consolidation.

15. Alternative rx for bacterial sinusitis?
Hardher and more turbulent
Macrolides (azithormycin); Doxycycline; TMZ-SMZ
Nasal polyps - deviated septum - hx of trauma - surgery - foreign bodies or recent altitude changes
Increased breath sounds or voice remains loud at the periphery during auscultation. Indicative of consolidation.

16. Acute viral rhino-sinusitis (AVRS) pathogens?
NSAIDs for aches - fever; Sympathomimetics: pseudophedrine or phenylephrine
Ipratroprium bromide (e.g. Atrovent); Antihistamines (Cargeul not to overly dry out muscos)
High pitched voice sound due to transmission of noise across fluid. Indicative of effusion.
Rhinovirus - influenza - parainfluenza

17. Additional pulmonary diagnostics
Ear ache - dullness - hearing loss - fever - N/V/D
Rhinovirus - influenza - and parainfluenza
Macrolides (azithormycin); Doxycycline; TMZ-SMZ
Labs: CBC - blood gas - d-dimer - CMP - BNP - Chest CT - MRI

18. Tx of sinusitis symptoms <10 days
Aspirin: increases viral shedding
Rhinovirus - influenza - parainfluenza
Symptomatic (steam; nasal irrigation); APAP for pain.
Abrupt onset - burning nose or throat - sneezing - rhinorrhea

19. Stridor
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
Abnormal high pitched caused by blockage in upper airway; usually heard with with inspiration
HEENT: rhinoscopy - sinus tenderness - lymphnodes - transillumination of sinuses - CV and PULM.
Nasal congestion - HA - sinus pain - fever - sore throat - cough

20. Tx for pediatric AOM?
Dyspnea when supine - relived by sitting or standing
Rebound congestion 3-5 days
Viral inoculation > viral rhinitis > infection of paranasal sinuses > inflammation & edema > mucosal edema - copious secretions - ciliary dyskinesia > sinus congestions and/or obstruction
Amoxicillin 80-90mg/kg/day x7 days; Augmentin 90/6.4 mg/kg/day x7 days

21. Common cold pathogens
Rhinovirus - influenza - and parainfluenza
Hardher and more turbulent
Warm - humid environment; rest;
PE: rhinoscopy with otoscope

22. Rhonchi
Step. pneumoniae; Haemophilus influenzae; group B-strep
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 breath sounds or voice remains loud at the periphery during auscultation. Indicative of consolidation.
Deep - snoring sound; indicates fluid or narrowing of airways; common in bronchitis and COPD

23. Acute rhino-sinusitis duration of symptoms?
92-100%
<4 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
Aspirin: increases viral shedding

24. Acute otitis media
Persistent or relapse of infection - chronic sinusitis - fungal infection - extension in CNS (meningitis - orbital cellulitis - osteitis)
Augementin 2000/124 mg bid for 5-7 days - Peds: 90 mg/kg/day po in divided doses
Bacterial or viral infection of the middle ear (secondary to URI [e.g. eustachian tube dysfunction])
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;

25. Proxysmal nocturnal dyspnea
Severe dyspnea when lying supine with associated wheezing and coughing - need to sit up abruptly due to severe dyspnea
Clubbing - Use of accessory muscles - barrel chest
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
PE: rhinoscopy with otoscope

26. Egophany (vocal resonance)
Labs: CBC - blood gas - d-dimer - CMP - BNP - Chest CT - MRI
Soft sounds in and out
Increased breath sounds or voice remains loud at the periphery during auscultation. Indicative of consolidation.
High pitched voice sound due to transmission of noise across fluid. Indicative of effusion.

27. Chronic rhino-sinusitis duration of symptoms?
>12 weeks
Bacterial infection
Augementin 2000/124 mg bid for 5-7 days - Peds: 90 mg/kg/day po in divided doses
Deep - rapid - labored - breathing

28. Common Cold (URI - Acute Coryza)
Afebrile viral infection of the the nose - paranasal sinuses - throat - larynx - trachea - and and bronchi.
Fine or courses; secretions or aveolar collapse; normal if resovle with cough; abnormal: pneumonia; CHF; COPD; pilmonary fibrosis
Bacterial or viral infection of the middle ear (secondary to URI [e.g. eustachian tube dysfunction])
4-12 weeks

29. Nonpharmacological tx for viral URI
Soft sounds in and out
High pitched voice sound due to transmission of noise across fluid. Indicative of effusion.
<4 weeks
Warm - humid environment; rest;

30. Special cases of sinusitis?
Decongestants (oxymetazoline); glucocorticoids (e.g. fluticasone); mucolytics (e.g. guaifensin)
TM erythmatous - bulging - light reflex displaced - exudate
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

31. Rx for viral URI?
Rhinovirus - influenza - parainfluenza
NSAIDs for aches - fever; Sympathomimetics: pseudophedrine or phenylephrine
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
Dyspnea when supine - relived by sitting or standing

32. Which Rx should not be used for viral URI?
Aspirin: increases viral shedding
Fine or courses; secretions or aveolar collapse; normal if resovle with cough; abnormal: pneumonia; CHF; COPD; pilmonary fibrosis
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;
Macrolides (azithormycin); Doxycycline; TMZ-SMZ

33. 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
Decongestants (oxymetazoline); glucocorticoids (e.g. fluticasone); mucolytics (e.g. guaifensin)
Bacterial or viral infection of the middle ear (secondary to URI [e.g. eustachian tube dysfunction])
Measures speed of exhalation; results measure by age and weight

34. Rx for rhinorrhea and/or allergies?
Rebound congestion 3-5 days
Ipratroprium bromide (e.g. Atrovent); Antihistamines (Cargeul not to overly dry out muscos)
HEENT: rhinoscopy - sinus tenderness - lymphnodes - transillumination of sinuses - CV and PULM.
E. coli

35. Rhinitis
Inflammation of the nasal cavity
Nasal polyps - deviated septum - hx of trauma - surgery - foreign bodies or recent altitude changes
PE: rhinoscopy with otoscope
3 months to 3 years old

36. Peak Expiratory Flow (PEF)
<4 weeks
Abrupt onset - burning nose or throat - sneezing - rhinorrhea
Measures speed of exhalation; results measure by age and weight
Step. pneumoniae; Haemophilus influenzae; group B-strep

37. 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
Persistent; recurrent x4/yr; severe HA; altered mental status
Increased loudness of whispering during auscultation. Indicative of consolidation.

38. Cold incubation period
Measures speed of exhalation; results measure by age and weight
24-72 hrs
92-100%
NSAIDs for aches - fever; Sympathomimetics: pseudophedrine or phenylephrine

39. 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
Abrupt onset - burning nose or throat - sneezing - rhinorrhea
PE: rhinoscopy with otoscope
Bacterial or viral infection of the middle ear (secondary to URI [e.g. eustachian tube dysfunction])

40. What is most common age range for otitis?
Rate; pattern (regular or irregular); effort (labored - accessory muscles)
3 months to 3 years old
Abrupt onset - burning nose or throat - sneezing - rhinorrhea
Rhinovirus - influenza - parainfluenza

41. Abnormal pulmonary findings?
Clubbing - Use of accessory muscles - barrel chest
Rebound congestion 3-5 days
Symptomatic (steam; nasal irrigation); APAP for pain.
3 months to 3 years old

42. Rhinosinusitis History?
Nasal congestion - HA - sinus pain - fever - sore throat - cough
Rate; pattern (regular or irregular); effort (labored - accessory muscles)
Aspirin: Reye's Syndrome
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

43. Tx for adult AOM?
NSAIDs for aches - fever; Sympathomimetics: pseudophedrine or phenylephrine
Amoxicillin 1000 mg TID x7 days; Augmentin 2000/125mg BID x7 days
Macrolides (azithormycin); Doxycycline; TMZ-SMZ
Inflammation of the paranasal sinuses

44. Subacute rhino-sinusitis duration of symptoms?
Nasal polyps - deviated septum - hx of trauma - surgery - foreign bodies or recent altitude changes
4-12 weeks
Purulent discharge - post nasal draiange; cough; sinus pressure - tooth pain; halitosis (changes in taste); alterations of smell
Deep - rapid - labored - breathing

45. Tx for adult AOE?
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
Nasal polyps - deviated septum - hx of trauma - surgery - foreign bodies or recent altitude changes
Decongestants (oxymetazoline); glucocorticoids (e.g. fluticasone); mucolytics (e.g. guaifensin)
Oflaxicin 0.3% solution BID

46. Respiratory Illness Key Points (3)
Measures speed of exhalation; results measure by age and weight
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
NSAIDs for aches - fever; Sympathomimetics: pseudophedrine or phenylephrine
Increased breath sounds or voice remains loud at the periphery during auscultation. Indicative of consolidation.

47. Spirometry
HEENT: rhinoscopy - sinus tenderness - lymphnodes - transillumination of sinuses - CV and PULM.
Hardher and more turbulent
Aspirin: increases viral shedding
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

48. Rhinosinusitis physical exam?
Clubbing - Use of accessory muscles - barrel chest
HEENT: rhinoscopy - sinus tenderness - lymphnodes - transillumination of sinuses - CV and PULM.
Nasal polyps - deviated septum - hx of trauma - surgery - foreign bodies or recent altitude changes
Aspirin: Reye's Syndrome

49. Rhinosinusitis risk factors?
Amoxicillin 80-90mg/kg/day x7 days; Augmentin 90/6.4 mg/kg/day x7 days
<4 weeks
Augementin 2000/124 mg bid for 5-7 days - Peds: 90 mg/kg/day po in divided doses
Nasal polyps - deviated septum - hx of trauma - surgery - foreign bodies or recent altitude changes

50. Bronchial breath sounds...
Inflammation of the paranasal sinuses
Deep - rapid - labored - breathing
Ipratroprium bromide (e.g. Atrovent); Antihistamines (Cargeul not to overly dry out muscos)
Hardher and more turbulent