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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. What does mucopurulent indications not indicate?
NSAIDs for aches - fever; Sympathomimetics: pseudophedrine or phenylephrine
Bacterial infection
Abnormal high pitched caused by blockage in upper airway; usually heard with with inspiration
Aspirin: increases viral shedding

2. 1st line treatment for bacterial sinusitis?
Augementin 2000/124 mg bid for 5-7 days - Peds: 90 mg/kg/day po in divided doses
>12 weeks
Persistent or relapse of infection - chronic sinusitis - fungal infection - extension in CNS (meningitis - orbital cellulitis - osteitis)
Deep - snoring sound; indicates fluid or narrowing of airways; common in bronchitis and COPD

3. Peak Expiratory Flow (PEF)
Measures speed of exhalation; results measure by age and weight
Clubbing - Use of accessory muscles - barrel chest
PE: rhinoscopy with otoscope
Amoxicillin 80-90mg/kg/day x7 days; Augmentin 90/6.4 mg/kg/day x7 days

4. Proxysmal nocturnal dyspnea
Amoxicillin 80-90mg/kg/day x7 days; Augmentin 90/6.4 mg/kg/day x7 days
Decongestants (oxymetazoline); glucocorticoids (e.g. fluticasone); mucolytics (e.g. guaifensin)
Severe dyspnea when lying supine with associated wheezing and coughing - need to sit up abruptly due to severe dyspnea
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;

5. What are physical exam findings of AOM?
Bacterial infection
TM erythmatous - bulging - light reflex displaced - exudate
Nasal congestion - HA - sinus pain - fever - sore throat - cough
Dyspnea when supine - relived by sitting or standing

6. Special cases of sinusitis?
Symptomatic (steam; nasal irrigation); APAP for pain.
Persistent or relapse of infection - chronic sinusitis - fungal infection - extension in CNS (meningitis - orbital cellulitis - osteitis)
3 months to 3 years old
Erythmatous auditory canal - crusting

7. Alternative rx for bacterial sinusitis?
Rebound congestion 3-5 days
Symptomatic (steam; nasal irrigation); APAP for pain.
Deep - snoring sound; indicates fluid or narrowing of airways; common in bronchitis and COPD
Macrolides (azithormycin); Doxycycline; TMZ-SMZ

8. Common Cold (URI - Acute Coryza)
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.
92-100%
E. coli

9. Stridor
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)
3 months to 3 years old
TM erythmatous - bulging - light reflex displaced - exudate

10. Tx for pediatric AOM?
Amoxicillin 1000 mg TID x7 days; Augmentin 2000/125mg BID x7 days
Amoxicillin 80-90mg/kg/day x7 days; Augmentin 90/6.4 mg/kg/day x7 days
TM erythmatous - bulging - light reflex displaced - exudate
Increased loudness of whispering during auscultation. Indicative of consolidation.

11. Chronic rhino-sinusitis duration of symptoms?
Inflammation of the paranasal sinuses
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
Deep - rapid - labored - breathing
>12 weeks

12. Common cold pathogens
PE: rhinoscopy with otoscope
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
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

13. What is most common age range for otitis?
Step. pneumoniae; Haemophilus influenzae; group B-strep
Symptomatic (steam; nasal irrigation); APAP for pain.
3 months to 3 years old
Hardher and more turbulent

14. Rhinosinusitis risk factors?
Nasal polyps - deviated septum - hx of trauma - surgery - foreign bodies or recent altitude changes
Increased loudness of whispering during auscultation. Indicative of consolidation.
Increased breath sounds or voice remains loud at the periphery during auscultation. Indicative of consolidation.
Soft sounds in and out

15. Bronchial breath sounds...
Aspirin: Reye's Syndrome
Increased breath sounds or voice remains loud at the periphery during auscultation. Indicative of consolidation.
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
Hardher and more turbulent

16. Respiratory Examination (Observation)
Afebrile viral infection of the the nose - paranasal sinuses - throat - larynx - trachea - and and bronchi.
Warm - humid environment; rest;
Rate; pattern (regular or irregular); effort (labored - accessory muscles)
Clubbing - Use of accessory muscles - barrel chest

17. Orthopnea
Abnormal high pitched caused by blockage in upper airway; usually heard with with inspiration
Oflaxicin 0.3% solution BID
Hardher and more turbulent
Dyspnea when supine - relived by sitting or standing

18. Whispered pectoriloguy
Increased loudness of whispering during auscultation. Indicative of consolidation.
Afebrile viral infection of the the nose - paranasal sinuses - throat - larynx - trachea - and and bronchi.
Abrupt onset - burning nose or throat - sneezing - rhinorrhea
Severe dyspnea when lying supine with associated wheezing and coughing - need to sit up abruptly due to severe dyspnea

19. What is the most common pathogen for otitis in newborns?
E. coli
Bacterial or viral infection of the middle ear (secondary to URI [e.g. eustachian tube dysfunction])
Augementin 2000/124 mg bid for 5-7 days - Peds: 90 mg/kg/day po in divided doses
Abrupt onset - burning nose or throat - sneezing - rhinorrhea

20. Sinusitis
Nasal congestion - HA - sinus pain - fever - sore throat - cough
Decongestants (oxymetazoline); glucocorticoids (e.g. fluticasone); mucolytics (e.g. guaifensin)
92-100%
Inflammation of the paranasal sinuses

21. Spirometry
Amoxicillin 80-90mg/kg/day x7 days; Augmentin 90/6.4 mg/kg/day x7 days
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
24-72 hrs
Ipratroprium bromide (e.g. Atrovent); Antihistamines (Cargeul not to overly dry out muscos)

22. Symptoms of acute bacterial rhino-sinusitis (ABRS)?
Rate; pattern (regular or irregular); effort (labored - accessory muscles)
Aspirin: Reye's Syndrome
Purulent discharge - post nasal draiange; cough; sinus pressure - tooth pain; halitosis (changes in taste); alterations of smell
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

23. Subacute rhino-sinusitis duration of symptoms?
Erythmatous auditory canal - crusting
4-12 weeks
Augementin 2000/124 mg bid for 5-7 days - Peds: 90 mg/kg/day po in divided doses
Oflaxicin 0.3% solution BID

24. Additional pulmonary diagnostics
Labs: CBC - blood gas - d-dimer - CMP - BNP - Chest CT - MRI
Bacterial infection
Amoxicillin 80-90mg/kg/day x7 days; Augmentin 90/6.4 mg/kg/day x7 days
Deep - snoring sound; indicates fluid or narrowing of airways; common in bronchitis and COPD

25. Rx nasal congestion?
Symptomatic (steam; nasal irrigation); APAP for pain.
NSAIDs for aches - fever; Sympathomimetics: pseudophedrine or phenylephrine
Decongestants (oxymetazoline); glucocorticoids (e.g. fluticasone); mucolytics (e.g. guaifensin)
Abnormal high pitched caused by blockage in upper airway; usually heard with with inspiration

26. Respiratory Illness Key Points (3)
Soft sounds in and out
Symptomatic (steam; nasal irrigation); APAP for pain.
3 months to 3 years old
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

27. Symptoms of viral rhinosinusitis
NSAIDs for aches - fever; Sympathomimetics: pseudophedrine or phenylephrine
Nasal congestion - HA - sinus pain - fever - sore throat - cough
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;

28. Acute rhino-sinusitis duration of symptoms?
Ear ache - dullness - hearing loss - fever - N/V/D
Inflammation of the paranasal sinuses
<4 weeks
Clubbing - Use of accessory muscles - barrel chest

29. What sinusitis symptoms would warrant image studies?
Ear ache - dullness - hearing loss - fever - N/V/D
Persistent; recurrent x4/yr; severe HA; altered mental status
Macrolides (azithormycin); Doxycycline; TMZ-SMZ
92-100%

30. Diagnostics of sinusitis?
PE: rhinoscopy with otoscope
E. coli
Rhinovirus - influenza - and parainfluenza
Decongestants (oxymetazoline); glucocorticoids (e.g. fluticasone); mucolytics (e.g. guaifensin)

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

32. Bronchophony
Amoxicillin 1000 mg TID x7 days; Augmentin 2000/125mg BID x7 days
Macrolides (azithormycin); Doxycycline; TMZ-SMZ
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

33. Cold incubation period
E. coli
24-72 hrs
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

34. What is the most common pahtogen for otitis media?
Inflammation of the nasal cavity
Rhinovirus - influenza - parainfluenza
Fine or courses; secretions or aveolar collapse; normal if resovle with cough; abnormal: pneumonia; CHF; COPD; pilmonary fibrosis
Step. pneumoniae; Haemophilus influenzae; group B-strep

35. Pathophysiology of rhino sinusitis?
HEENT: rhinoscopy - sinus tenderness - lymphnodes - transillumination of sinuses - CV and PULM.
Deep - rapid - labored - breathing
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.

36. Rhinosinusitis physical exam?
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
Measures speed of exhalation; results measure by age and weight
NSAIDs for aches - fever; Sympathomimetics: pseudophedrine or phenylephrine

37. Nonpharmacological tx for viral URI
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
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
Warm - humid environment; rest;

38. Wheezes
PE: rhinoscopy with otoscope
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)
Dyspnea when supine - relived by sitting or standing

39. Kussmal's respiration
Increased breath sounds or voice remains loud at the periphery during auscultation. Indicative of consolidation.
Clubbing - Use of accessory muscles - barrel chest
Deep - rapid - labored - breathing
>12 weeks

40. Tx for adult AOM?
Rebound congestion 3-5 days
Dyspnea when supine - relived by sitting or standing
Amoxicillin 1000 mg TID x7 days; Augmentin 2000/125mg BID x7 days
Ear ache - dullness - hearing loss - fever - N/V/D

41. Cheyne-stokes
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)
Abrupt onset - burning nose or throat - sneezing - rhinorrhea
Apena alternating with hyperpnea;

42. Tx of sinusitis symptoms <10 days
NSAIDs for aches - fever; Sympathomimetics: pseudophedrine or phenylephrine
Step. pneumoniae; Haemophilus influenzae; group B-strep
Aspirin: increases viral shedding
Symptomatic (steam; nasal irrigation); APAP for pain.

43. What are physical exam findings of AOE?
Soft sounds in and out
Erythmatous auditory canal - crusting
Macrolides (azithormycin); Doxycycline; TMZ-SMZ
High pitched voice sound due to transmission of noise across fluid. Indicative of effusion.

44. Rx for viral URI?
Oflaxicin 0.3% solution BID
Ipratroprium bromide (e.g. Atrovent); Antihistamines (Cargeul not to overly dry out muscos)
Nasal congestion - HA - sinus pain - fever - sore throat - cough
NSAIDs for aches - fever; Sympathomimetics: pseudophedrine or phenylephrine

45. Pulmonary tests
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
Pulse ox; Peak expiratory flow; spirometry
Oflaxicin 0.3% solution BID
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;

46. Crackles (rales)
Dyspnea when supine - relived by sitting or standing
Increased loudness of whispering during auscultation. Indicative of consolidation.
Soft sounds in and out
Fine or courses; secretions or aveolar collapse; normal if resovle with cough; abnormal: pneumonia; CHF; COPD; pilmonary fibrosis

47. Which Rx should not be used for viral URI?
Hardher and more turbulent
Symptomatic (steam; nasal irrigation); APAP for pain.
Aspirin: increases viral shedding
<4 weeks

48. Tx for adult AOE?
Rhinovirus - influenza - and parainfluenza
HEENT: rhinoscopy - sinus tenderness - lymphnodes - transillumination of sinuses - CV and PULM.
Oflaxicin 0.3% solution BID
Labs: CBC - blood gas - d-dimer - CMP - BNP - Chest CT - MRI

49. What is the common side effect of sympathomimetics?
Rebound congestion 3-5 days
Rhinovirus - influenza - and parainfluenza
Symptomatic (steam; nasal irrigation); APAP for pain.
Abrupt onset - burning nose or throat - sneezing - rhinorrhea

50. Rhinosinusitis History?
Nasal congestion - HA - sinus pain - fever - sore throat - cough
Amoxicillin 1000 mg TID x7 days; Augmentin 2000/125mg BID x7 days
Deep - snoring sound; indicates fluid or narrowing of airways; common in bronchitis and COPD
Rhinovirus - influenza - parainfluenza