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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. What are physical exam findings of AOE?
Erythmatous auditory canal - crusting
Decongestants (oxymetazoline); glucocorticoids (e.g. fluticasone); mucolytics (e.g. guaifensin)
Rebound congestion 3-5 days
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

2. Stridor
Labs: CBC - blood gas - d-dimer - CMP - BNP - Chest CT - MRI
Inflammation of the paranasal sinuses
Inflammation of the nasal cavity
Abnormal high pitched caused by blockage in upper airway; usually heard with with inspiration

3. Which Rx should not be used for viral URI?
E. coli
Aspirin: increases viral shedding
Purulent discharge - post nasal draiange; cough; sinus pressure - tooth pain; halitosis (changes in taste); alterations of smell
Symptomatic (steam; nasal irrigation); APAP for pain.

4. Diagnostics of sinusitis?
PE: rhinoscopy with otoscope
Nasal congestion - HA - sinus pain - fever - sore throat - cough
High pitched voice sound due to transmission of noise across fluid. Indicative of effusion.
92-100%

5. Normal pulse ox
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
Bacterial infection
Amoxicillin 1000 mg TID x7 days; Augmentin 2000/125mg BID x7 days

6. Bronchial breath sounds...
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
Hardher and more turbulent
Ipratroprium bromide (e.g. Atrovent); Antihistamines (Cargeul not to overly dry out muscos)

7. Special cases of sinusitis?
>12 weeks
Clubbing - Use of accessory muscles - barrel chest
Persistent or relapse of infection - chronic sinusitis - fungal infection - extension in CNS (meningitis - orbital cellulitis - osteitis)
Dyspnea when supine - relived by sitting or standing

8. Whispered pectoriloguy
Increased loudness of whispering during auscultation. Indicative of consolidation.
92-100%
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

9. 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
Nasal polyps - deviated septum - hx of trauma - surgery - foreign bodies or recent altitude changes
Aspirin: Reye's Syndrome

10. Vesicular breath sounds...
Deep - snoring sound; indicates fluid or narrowing of airways; common in bronchitis and COPD
Inflammation of the nasal cavity
Soft sounds in and out
Deep - rapid - labored - breathing

11. Rhinosinusitis physical exam?
Amoxicillin 80-90mg/kg/day x7 days; Augmentin 90/6.4 mg/kg/day x7 days
Increased loudness of whispering during auscultation. Indicative of consolidation.
Rhinovirus - influenza - parainfluenza
HEENT: rhinoscopy - sinus tenderness - lymphnodes - transillumination of sinuses - CV and PULM.

12. Rhinosinusitis History?
Nasal congestion - HA - sinus pain - fever - sore throat - cough
TM erythmatous - bulging - light reflex displaced - exudate
High pitched sounds; can occur during inspiration or expiration; indicates narrow airways; can occur with asthma - COPD - pneumonia - CHF
Fine or courses; secretions or aveolar collapse; normal if resovle with cough; abnormal: pneumonia; CHF; COPD; pilmonary fibrosis

13. Acute rhino-sinusitis duration of symptoms?
Aspirin: Reye's Syndrome
<4 weeks
Aspirin: increases viral shedding
Deep - snoring sound; indicates fluid or narrowing of airways; common in bronchitis and COPD

14. Pulmonary tests
HEENT: rhinoscopy - sinus tenderness - lymphnodes - transillumination of sinuses - CV and PULM.
High pitched sounds; can occur during inspiration or expiration; indicates narrow airways; can occur with asthma - COPD - pneumonia - CHF
Pulse ox; Peak expiratory flow; spirometry
Afebrile viral infection of the the nose - paranasal sinuses - throat - larynx - trachea - and and bronchi.

15. Proxysmal nocturnal dyspnea
Afebrile viral infection of the the nose - paranasal sinuses - throat - larynx - trachea - and and bronchi.
4-12 weeks
Severe dyspnea when lying supine with associated wheezing and coughing - need to sit up abruptly due to severe dyspnea
Aspirin: Reye's Syndrome

16. Rhinitis
>12 weeks
NSAIDs for aches - fever; Sympathomimetics: pseudophedrine or phenylephrine
Decongestants (oxymetazoline); glucocorticoids (e.g. fluticasone); mucolytics (e.g. guaifensin)
Inflammation of the nasal cavity

17. Abnormal pulmonary findings?
Augementin 2000/124 mg bid for 5-7 days - Peds: 90 mg/kg/day po in divided doses
Clubbing - Use of accessory muscles - barrel chest
Oflaxicin 0.3% solution BID
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

18. Symptoms of viral rhinosinusitis
Amoxicillin 1000 mg TID x7 days; Augmentin 2000/125mg BID x7 days
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;
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

19. Rx nasal congestion?
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
Decongestants (oxymetazoline); glucocorticoids (e.g. fluticasone); mucolytics (e.g. guaifensin)
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;
Apena alternating with hyperpnea;

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

21. Cold incubation period
Deep - snoring sound; indicates fluid or narrowing of airways; common in bronchitis and COPD
24-72 hrs
Warm - humid environment; rest;
Oflaxicin 0.3% solution BID

22. Rhonchi
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
Severe dyspnea when lying supine with associated wheezing and coughing - need to sit up abruptly due to severe dyspnea
Deep - snoring sound; indicates fluid or narrowing of airways; common in bronchitis and COPD

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

24. Tx for pediatric AOM?
Amoxicillin 80-90mg/kg/day x7 days; Augmentin 90/6.4 mg/kg/day x7 days
3 months to 3 years old
Soft sounds in and out
Rebound congestion 3-5 days

25. What does mucopurulent indications not indicate?
Erythmatous auditory canal - crusting
Bacterial infection
Amoxicillin 1000 mg TID x7 days; Augmentin 2000/125mg BID x7 days
Purulent discharge - post nasal draiange; cough; sinus pressure - tooth pain; halitosis (changes in taste); alterations of smell

26. Tx for adult AOE?
Inflammation of the paranasal sinuses
Pulse ox; Peak expiratory flow; spirometry
Hardher and more turbulent
Oflaxicin 0.3% solution BID

27. What is the most common pahtogen for otitis media?
Step. pneumoniae; Haemophilus influenzae; group B-strep
Nasal congestion - HA - sinus pain - fever - sore throat - cough
E. coli
NSAIDs for aches - fever; Sympathomimetics: pseudophedrine or phenylephrine

28. Common Cold (URI - Acute Coryza)
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.
TM erythmatous - bulging - light reflex displaced - exudate
Clubbing - Use of accessory muscles - barrel chest

29. Acute otitis media
Increased loudness of whispering during auscultation. Indicative of consolidation.
Bacterial or viral infection of the middle ear (secondary to URI [e.g. eustachian tube dysfunction])
Deep - snoring sound; indicates fluid or narrowing of airways; common in bronchitis and COPD
Nasal congestion - HA - sinus pain - fever - sore throat - cough

30. Crackles (rales)
Rate; pattern (regular or irregular); effort (labored - accessory muscles)
Fine or courses; secretions or aveolar collapse; normal if resovle with cough; abnormal: pneumonia; CHF; COPD; pilmonary fibrosis
Ipratroprium bromide (e.g. Atrovent); Antihistamines (Cargeul not to overly dry out muscos)
Apena alternating with hyperpnea;

31. Rhinosinusitis risk factors?
Labs: CBC - blood gas - d-dimer - CMP - BNP - Chest CT - MRI
Nasal polyps - deviated septum - hx of trauma - surgery - foreign bodies or recent altitude changes
Apena alternating with hyperpnea;
Purulent discharge - post nasal draiange; cough; sinus pressure - tooth pain; halitosis (changes in taste); alterations of smell

32. Chronic rhino-sinusitis duration of symptoms?
Viral inoculation > viral rhinitis > infection of paranasal sinuses > inflammation & edema > mucosal edema - copious secretions - ciliary dyskinesia > sinus congestions and/or obstruction
>12 weeks
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

33. What are physical exam findings of AOM?
Abrupt onset - burning nose or throat - sneezing - rhinorrhea
TM erythmatous - bulging - light reflex displaced - exudate
Macrolides (azithormycin); Doxycycline; TMZ-SMZ
Abnormal high pitched caused by blockage in upper airway; usually heard with with inspiration

34. Physical exam of chest
Afebrile viral infection of the the nose - paranasal sinuses - throat - larynx - trachea - and and bronchi.
Bacterial infection
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.

35. What are the symptoms of otitis?
Ear ache - dullness - hearing loss - fever - N/V/D
Aspirin: increases viral shedding
Dyspnea when supine - relived by sitting or standing
Abrupt onset - burning nose or throat - sneezing - rhinorrhea

36. Orthopnea
Dyspnea when supine - relived by sitting or standing
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
Measures speed of exhalation; results measure by age and weight
Aspirin: increases viral shedding

37. Subacute rhino-sinusitis duration of symptoms?
4-12 weeks
Rhinovirus - influenza - and parainfluenza
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;
Ipratroprium bromide (e.g. Atrovent); Antihistamines (Cargeul not to overly dry out muscos)

38. Common cold symptoms
Symptomatic (steam; nasal irrigation); APAP for pain.
Abrupt onset - burning nose or throat - sneezing - rhinorrhea
Inflammation of the paranasal sinuses
Clubbing - Use of accessory muscles - barrel chest

39. Spirometry
Measures speed of exhalation; results measure by age and weight
<4 weeks
Deep - snoring sound; indicates fluid or narrowing of airways; common in bronchitis and COPD
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

40. Bronchophony
Pulse ox; Peak expiratory flow; spirometry
Bacterial or viral infection of the middle ear (secondary to URI [e.g. eustachian tube dysfunction])
Warm - humid environment; rest;
Increased breath sounds or voice remains loud at the periphery during auscultation. Indicative of consolidation.

41. Tx for adult AOM?
Viral inoculation > viral rhinitis > infection of paranasal sinuses > inflammation & edema > mucosal edema - copious secretions - ciliary dyskinesia > sinus congestions and/or obstruction
High pitched sounds; can occur during inspiration or expiration; indicates narrow airways; can occur with asthma - COPD - pneumonia - CHF
Amoxicillin 1000 mg TID x7 days; Augmentin 2000/125mg BID x7 days
Aspirin: increases viral shedding

42. What is most common age range for otitis?
3 months to 3 years old
Deep - snoring sound; indicates fluid or narrowing of airways; common in bronchitis and COPD
<4 weeks
Erythmatous auditory canal - crusting

43. Rx for rhinorrhea and/or allergies?
NSAIDs for aches - fever; Sympathomimetics: pseudophedrine or phenylephrine
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
Ipratroprium bromide (e.g. Atrovent); Antihistamines (Cargeul not to overly dry out muscos)
Persistent; recurrent x4/yr; severe HA; altered mental status

44. Symptoms of acute bacterial rhino-sinusitis (ABRS)?
Deep - rapid - labored - breathing
Warm - humid environment; rest;
PE: rhinoscopy with otoscope
Purulent discharge - post nasal draiange; cough; sinus pressure - tooth pain; halitosis (changes in taste); alterations of smell

45. Egophany (vocal resonance)
Fine or courses; secretions or aveolar collapse; normal if resovle with cough; abnormal: pneumonia; CHF; COPD; pilmonary fibrosis
Nasal polyps - deviated septum - hx of trauma - surgery - foreign bodies or recent altitude changes
Viral inoculation > viral rhinitis > infection of paranasal sinuses > inflammation & edema > mucosal edema - copious secretions - ciliary dyskinesia > sinus congestions and/or obstruction
High pitched voice sound due to transmission of noise across fluid. Indicative of effusion.

46. 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
Rebound congestion 3-5 days
3 months to 3 years old
>12 weeks

47. Pathophysiology of rhino sinusitis?
High pitched sounds; can occur during inspiration or expiration; indicates narrow airways; can occur with asthma - COPD - pneumonia - CHF
Viral inoculation > viral rhinitis > infection of paranasal sinuses > inflammation & edema > mucosal edema - copious secretions - ciliary dyskinesia > sinus congestions and/or obstruction
Amoxicillin 1000 mg TID x7 days; Augmentin 2000/125mg BID x7 days
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;

48. Sinusitis
Step. pneumoniae; Haemophilus influenzae; group B-strep
Deep - snoring sound; indicates fluid or narrowing of airways; common in bronchitis and COPD
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

49. Nonpharmacological tx for viral URI
Warm - humid environment; rest;
Inflammation of the nasal cavity
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
Rebound congestion 3-5 days

50. Tx of sinusitis symptoms <10 days
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
Symptomatic (steam; nasal irrigation); APAP for pain.
Bacterial or viral infection of the middle ear (secondary to URI [e.g. eustachian tube dysfunction])
PE: rhinoscopy with otoscope