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ENT/Respiratory

Instructions:

Answer 50 questions in 15 minutes.
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Match each statement with the correct term.
Don't refresh. All questions and answers are randomly picked and ordered every time you load a test.

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. Abnormal pulmonary findings?
Clubbing - Use of accessory muscles - barrel chest
Ear ache - dullness - hearing loss - fever - N/V/D
Aspirin: Reye's Syndrome
Nasal polyps - deviated septum - hx of trauma - surgery - foreign bodies or recent altitude changes

2. Tx of sinusitis symptoms <10 days
NSAIDs for aches - fever; Sympathomimetics: pseudophedrine or phenylephrine
Viral inoculation > viral rhinitis > infection of paranasal sinuses > inflammation & edema > mucosal edema - copious secretions - ciliary dyskinesia > sinus congestions and/or obstruction
Symptomatic (steam; nasal irrigation); APAP for pain.
Bacterial infection

3. Pathophysiology of rhino sinusitis?
Symptomatic (steam; nasal irrigation); APAP for pain.
Viral inoculation > viral rhinitis > infection of paranasal sinuses > inflammation & edema > mucosal edema - copious secretions - ciliary dyskinesia > sinus congestions and/or obstruction
Increased breath sounds or voice remains loud at the periphery during auscultation. Indicative of consolidation.
Aspirin: Reye's Syndrome

4. Peak Expiratory Flow (PEF)
Measures speed of exhalation; results measure by age and weight
Inflammation of the nasal cavity
Viral inoculation > viral rhinitis > infection of paranasal sinuses > inflammation & edema > mucosal edema - copious secretions - ciliary dyskinesia > sinus congestions and/or obstruction
TM erythmatous - bulging - light reflex displaced - exudate

5. What is the most common pathogen for otitis in newborns?
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
Afebrile viral infection of the the nose - paranasal sinuses - throat - larynx - trachea - and and bronchi.
E. coli
Dyspnea when supine - relived by sitting or standing

6. Respiratory Examination (Observation)
24-72 hrs
Rate; pattern (regular or irregular); effort (labored - accessory muscles)
Aspirin: increases viral shedding
Abnormal high pitched caused by blockage in upper airway; usually heard with with inspiration

7. Common cold symptoms
TM erythmatous - bulging - light reflex displaced - exudate
Rate; pattern (regular or irregular); effort (labored - accessory muscles)
Abrupt onset - burning nose or throat - sneezing - rhinorrhea
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;

8. Symptoms of acute bacterial rhino-sinusitis (ABRS)?
Rhinovirus - influenza - and parainfluenza
Symptomatic (steam; nasal irrigation); APAP for pain.
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

9. Spirometry
Bacterial infection
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
Rate; pattern (regular or irregular); effort (labored - accessory muscles)
Measures speed of exhalation; results measure by age and weight

10. Cold incubation period
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
24-72 hrs
Deep - rapid - labored - breathing

11. Kussmal's respiration
Deep - rapid - labored - breathing
Rhinovirus - influenza - and parainfluenza
<4 weeks
Abnormal high pitched caused by blockage in upper airway; usually heard with with inspiration

12. Orthopnea
Soft sounds in and out
Increased breath sounds or voice remains loud at the periphery during auscultation. Indicative of consolidation.
Persistent or relapse of infection - chronic sinusitis - fungal infection - extension in CNS (meningitis - orbital cellulitis - osteitis)
Dyspnea when supine - relived by sitting or standing

13. Subacute rhino-sinusitis duration of symptoms?
Persistent; recurrent x4/yr; severe HA; altered mental status
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])
4-12 weeks

14. Sinusitis
92-100%
Pulse ox; Peak expiratory flow; spirometry
Inflammation of the paranasal sinuses
Rhinovirus - influenza - parainfluenza

15. Rhinitis
Ear ache - dullness - hearing loss - fever - N/V/D
Inflammation of the nasal cavity
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

16. What are physical exam findings of AOE?
Ear ache - dullness - hearing loss - fever - N/V/D
Erythmatous auditory canal - crusting
Severe dyspnea when lying supine with associated wheezing and coughing - need to sit up abruptly due to severe dyspnea
Oflaxicin 0.3% solution BID

17. Diagnostics of sinusitis?
<4 weeks
PE: rhinoscopy with otoscope
Nasal polyps - deviated septum - hx of trauma - surgery - foreign bodies or recent altitude changes
TM erythmatous - bulging - light reflex displaced - exudate

18. Pulmonary diagnostics (1)
Apena alternating with hyperpnea;
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
NSAIDs for aches - fever; Sympathomimetics: pseudophedrine or phenylephrine

19. Rhinosinusitis physical exam?
Erythmatous auditory canal - crusting
3 months to 3 years old
Step. pneumoniae; Haemophilus influenzae; group B-strep
HEENT: rhinoscopy - sinus tenderness - lymphnodes - transillumination of sinuses - CV and PULM.

20. Acute otitis media
Bacterial or viral infection of the middle ear (secondary to URI [e.g. eustachian tube dysfunction])
HEENT: rhinoscopy - sinus tenderness - lymphnodes - transillumination of sinuses - CV and PULM.
24-72 hrs
Soft sounds in and out

21. Rx nasal congestion?
Decongestants (oxymetazoline); glucocorticoids (e.g. fluticasone); mucolytics (e.g. guaifensin)
High pitched sounds; can occur during inspiration or expiration; indicates narrow airways; can occur with asthma - COPD - pneumonia - CHF
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
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;

22. Crackles (rales)
TM erythmatous - bulging - light reflex displaced - exudate
Rate; pattern (regular or irregular); effort (labored - accessory muscles)
Inflammation of the nasal cavity
Fine or courses; secretions or aveolar collapse; normal if resovle with cough; abnormal: pneumonia; CHF; COPD; pilmonary fibrosis

23. Acute rhino-sinusitis duration of symptoms?
Symptomatic (steam; nasal irrigation); APAP for pain.
Decongestants (oxymetazoline); glucocorticoids (e.g. fluticasone); mucolytics (e.g. guaifensin)
<4 weeks
NSAIDs for aches - fever; Sympathomimetics: pseudophedrine or phenylephrine

24. Bronchophony
Increased breath sounds or voice remains loud at the periphery during auscultation. Indicative of consolidation.
Viral inoculation > viral rhinitis > infection of paranasal sinuses > inflammation & edema > mucosal edema - copious secretions - ciliary dyskinesia > sinus congestions and/or obstruction
Clubbing - Use of accessory muscles - barrel chest
Erythmatous auditory canal - crusting

25. Pulmonary tests
Deep - snoring sound; indicates fluid or narrowing of airways; common in bronchitis and COPD
Deep - rapid - labored - breathing
Pulse ox; Peak expiratory flow; spirometry
Rebound congestion 3-5 days

26. What are physical exam findings of AOM?
Nasal congestion - HA - sinus pain - fever - sore throat - cough
E. coli
<4 weeks
TM erythmatous - bulging - light reflex displaced - exudate

27. Bronchial breath sounds...
Hardher and more turbulent
Labs: CBC - blood gas - d-dimer - CMP - BNP - Chest CT - MRI
Measures speed of exhalation; results measure by age and weight
Rhinovirus - influenza - and parainfluenza

28. Cheyne-stokes
Apena alternating with hyperpnea;
Rebound congestion 3-5 days
Decongestants (oxymetazoline); glucocorticoids (e.g. fluticasone); mucolytics (e.g. guaifensin)
3 months to 3 years old

29. Which Rx should not be used for viral URI?
Rhinovirus - influenza - and parainfluenza
Increased loudness of whispering during auscultation. Indicative of consolidation.
Macrolides (azithormycin); Doxycycline; TMZ-SMZ
Aspirin: increases viral shedding

30. What is the common side effect of sympathomimetics?
Viral inoculation > viral rhinitis > infection of paranasal sinuses > inflammation & edema > mucosal edema - copious secretions - ciliary dyskinesia > sinus congestions and/or obstruction
Aspirin: increases viral shedding
Amoxicillin 80-90mg/kg/day x7 days; Augmentin 90/6.4 mg/kg/day x7 days
Rebound congestion 3-5 days

31. Common cold pathogens
Clubbing - Use of accessory muscles - barrel chest
Nasal polyps - deviated septum - hx of trauma - surgery - foreign bodies or recent altitude changes
Rhinovirus - influenza - and parainfluenza
Amoxicillin 80-90mg/kg/day x7 days; Augmentin 90/6.4 mg/kg/day x7 days

32. Respiratory Illness Key Points (3)
Erythmatous auditory canal - crusting
Rebound congestion 3-5 days
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
Symptomatic (steam; nasal irrigation); APAP for pain.

33. Stridor
Abnormal high pitched caused by blockage in upper airway; usually heard with with inspiration
<4 weeks
3 months to 3 years old
NSAIDs for aches - fever; Sympathomimetics: pseudophedrine or phenylephrine

34. Proxysmal nocturnal dyspnea
Severe dyspnea when lying supine with associated wheezing and coughing - need to sit up abruptly due to severe dyspnea
Amoxicillin 80-90mg/kg/day x7 days; Augmentin 90/6.4 mg/kg/day x7 days
24-72 hrs
Ipratroprium bromide (e.g. Atrovent); Antihistamines (Cargeul not to overly dry out muscos)

35. What is the most common pahtogen for otitis media?
Pulse ox; Peak expiratory flow; spirometry
Clubbing - Use of accessory muscles - barrel chest
Viral inoculation > viral rhinitis > infection of paranasal sinuses > inflammation & edema > mucosal edema - copious secretions - ciliary dyskinesia > sinus congestions and/or obstruction
Step. pneumoniae; Haemophilus influenzae; group B-strep

36. Rhonchi
Increased loudness of whispering during auscultation. Indicative of consolidation.
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
Ipratroprium bromide (e.g. Atrovent); Antihistamines (Cargeul not to overly dry out muscos)

37. Physical exam of chest
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
Nasal polyps - deviated septum - hx of trauma - surgery - foreign bodies or recent altitude changes
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
Soft sounds in and out

38. What is most common age range for otitis?
Purulent discharge - post nasal draiange; cough; sinus pressure - tooth pain; halitosis (changes in taste); alterations of smell
3 months to 3 years old
Hardher and more turbulent
Aspirin: increases viral shedding

39. What are the symptoms of otitis?
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
Measures speed of exhalation; results measure by age and weight
Ear ache - dullness - hearing loss - fever - N/V/D
Pulse ox; Peak expiratory flow; spirometry

40. Special cases of sinusitis?
4-12 weeks
Inflammation of the nasal cavity
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)

41. Tx for pediatric AOM?
Abnormal high pitched caused by blockage in upper airway; usually heard with with inspiration
Purulent discharge - post nasal draiange; cough; sinus pressure - tooth pain; halitosis (changes in taste); alterations of smell
Fine or courses; secretions or aveolar collapse; normal if resovle with cough; abnormal: pneumonia; CHF; COPD; pilmonary fibrosis
Amoxicillin 80-90mg/kg/day x7 days; Augmentin 90/6.4 mg/kg/day x7 days

42. Alternative rx for bacterial sinusitis?
Deep - snoring sound; indicates fluid or narrowing of airways; common in bronchitis and COPD
Macrolides (azithormycin); Doxycycline; TMZ-SMZ
Apena alternating with hyperpnea;
4-12 weeks

43. Whispered pectoriloguy
Ipratroprium bromide (e.g. Atrovent); Antihistamines (Cargeul not to overly dry out muscos)
92-100%
Increased loudness of whispering during auscultation. Indicative of consolidation.
High pitched voice sound due to transmission of noise across fluid. Indicative of effusion.

44. What sinusitis symptoms would warrant image studies?
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
Persistent; recurrent x4/yr; severe HA; altered mental status
E. coli

45. Acute viral rhino-sinusitis (AVRS) pathogens?
Rhinovirus - influenza - parainfluenza
Afebrile viral infection of the the nose - paranasal sinuses - throat - larynx - trachea - and and bronchi.
Nasal polyps - deviated septum - hx of trauma - surgery - foreign bodies or recent altitude changes
Inflammation of the paranasal sinuses

46. Egophany (vocal resonance)
Rate; pattern (regular or irregular); effort (labored - accessory muscles)
Aspirin: increases viral shedding
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.

47. Tx for adult AOM?
Amoxicillin 1000 mg TID x7 days; Augmentin 2000/125mg BID x7 days
Oflaxicin 0.3% solution BID
Viral inoculation > viral rhinitis > infection of paranasal sinuses > inflammation & edema > mucosal edema - copious secretions - ciliary dyskinesia > sinus congestions and/or obstruction
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

48. Common Cold (URI - Acute Coryza)
Clubbing - Use of accessory muscles - barrel chest
Nasal congestion - HA - sinus pain - fever - sore throat - cough
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
Afebrile viral infection of the the nose - paranasal sinuses - throat - larynx - trachea - and and bronchi.

49. Symptoms of viral rhinosinusitis
Decongestants (oxymetazoline); glucocorticoids (e.g. fluticasone); mucolytics (e.g. guaifensin)
NSAIDs for aches - fever; Sympathomimetics: pseudophedrine or phenylephrine
TM erythmatous - bulging - light reflex displaced - exudate
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;

50. Nonpharmacological tx for viral URI
Measures speed of exhalation; results measure by age and weight
Warm - humid environment; rest;
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;
High pitched voice sound due to transmission of noise across fluid. Indicative of effusion.