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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?
Nasal congestion - HA - sinus pain - fever - sore throat - cough
<4 weeks
Erythmatous auditory canal - crusting
Rhinovirus - influenza - parainfluenza

2. Cold incubation period
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
Amoxicillin 1000 mg TID x7 days; Augmentin 2000/125mg BID x7 days
24-72 hrs
3 months to 3 years old

3. Common cold symptoms
PE: rhinoscopy with otoscope
Abrupt onset - burning nose or throat - sneezing - rhinorrhea
Step. pneumoniae; Haemophilus influenzae; group B-strep
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

4. Kussmal's respiration
3 months to 3 years old
Deep - rapid - labored - breathing
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
Labs: CBC - blood gas - d-dimer - CMP - BNP - Chest CT - MRI

5. Pathophysiology of rhino sinusitis?
Nasal congestion - HA - sinus pain - fever - sore throat - cough
Rate; pattern (regular or irregular); effort (labored - accessory muscles)
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

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

7. What does mucopurulent indications not indicate?
Bacterial infection
High pitched voice sound due to transmission of noise across fluid. Indicative of effusion.
Inflammation of the nasal cavity
Rhinovirus - influenza - and parainfluenza

8. Tx for adult AOM?
Afebrile viral infection of the the nose - paranasal sinuses - throat - larynx - trachea - and and bronchi.
Soft sounds in and out
High pitched voice sound due to transmission of noise across fluid. Indicative of effusion.
Amoxicillin 1000 mg TID x7 days; Augmentin 2000/125mg BID x7 days

9. What sinusitis symptoms would warrant image studies?
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
Persistent; recurrent x4/yr; severe HA; altered mental status
Labs: CBC - blood gas - d-dimer - CMP - BNP - Chest CT - MRI

10. Crackles (rales)
Fine or courses; secretions or aveolar collapse; normal if resovle with cough; abnormal: pneumonia; CHF; COPD; pilmonary fibrosis
92-100%
Viral inoculation > viral rhinitis > infection of paranasal sinuses > inflammation & edema > mucosal edema - copious secretions - ciliary dyskinesia > sinus congestions and/or obstruction
>12 weeks

11. Cheyne-stokes
Purulent discharge - post nasal draiange; cough; sinus pressure - tooth pain; halitosis (changes in taste); alterations of smell
Apena alternating with hyperpnea;
Clubbing - Use of accessory muscles - barrel chest
Bacterial infection

12. Common Cold (URI - Acute Coryza)
24-72 hrs
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;
Afebrile viral infection of the the nose - paranasal sinuses - throat - larynx - trachea - and and bronchi.
Erythmatous auditory canal - crusting

13. Abnormal pulmonary findings?
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
Clubbing - Use of accessory muscles - barrel chest
4-12 weeks
Soft sounds in and out

14. Stridor
Hardher and more turbulent
Ipratroprium bromide (e.g. Atrovent); Antihistamines (Cargeul not to overly dry out muscos)
Abnormal high pitched caused by blockage in upper airway; usually heard with with inspiration
Aspirin: increases viral shedding

15. Tx of sinusitis symptoms <10 days
Decongestants (oxymetazoline); glucocorticoids (e.g. fluticasone); mucolytics (e.g. guaifensin)
Step. pneumoniae; Haemophilus influenzae; group B-strep
Warm - humid environment; rest;
Symptomatic (steam; nasal irrigation); APAP for pain.

16. Bronchophony
Inflammation of the nasal cavity
4-12 weeks
Amoxicillin 1000 mg TID x7 days; Augmentin 2000/125mg BID x7 days
Increased breath sounds or voice remains loud at the periphery during auscultation. Indicative of consolidation.

17. Sinusitis
TM erythmatous - bulging - light reflex displaced - exudate
Inflammation of the paranasal sinuses
Increased loudness of whispering during auscultation. Indicative of consolidation.
Nasal congestion - HA - sinus pain - fever - sore throat - cough

18. Rhinitis
Deep - rapid - labored - breathing
Inflammation of the nasal cavity
Symptomatic (steam; nasal irrigation); APAP for pain.
Erythmatous auditory canal - crusting

19. Symptoms of viral rhinosinusitis
<4 weeks
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;
Abnormal high pitched caused by blockage in upper airway; usually heard with with inspiration
Rate; pattern (regular or irregular); effort (labored - accessory muscles)

20. Rhinosinusitis physical exam?
High pitched sounds; can occur during inspiration or expiration; indicates narrow airways; can occur with asthma - COPD - pneumonia - CHF
HEENT: rhinoscopy - sinus tenderness - lymphnodes - transillumination of sinuses - CV and PULM.
Deep - snoring sound; indicates fluid or narrowing of airways; common in bronchitis and COPD
Bacterial or viral infection of the middle ear (secondary to URI [e.g. eustachian tube dysfunction])

21. Additional pulmonary diagnostics
Labs: CBC - blood gas - d-dimer - CMP - BNP - Chest CT - MRI
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
NSAIDs for aches - fever; Sympathomimetics: pseudophedrine or phenylephrine
Bacterial or viral infection of the middle ear (secondary to URI [e.g. eustachian tube dysfunction])

22. Acute otitis media
Ear ache - dullness - hearing loss - fever - N/V/D
Hardher and more turbulent
24-72 hrs
Bacterial or viral infection of the middle ear (secondary to URI [e.g. eustachian tube dysfunction])

23. What are the symptoms of otitis?
Apena alternating with hyperpnea;
Rhinovirus - influenza - parainfluenza
Ear ache - dullness - hearing loss - fever - N/V/D
Aspirin: Reye's Syndrome

24. Acute viral rhino-sinusitis (AVRS) pathogens?
Rhinovirus - influenza - parainfluenza
Aspirin: Reye's Syndrome
Bacterial or viral infection of the middle ear (secondary to URI [e.g. eustachian tube dysfunction])
Aspirin: increases viral shedding

25. Peak Expiratory Flow (PEF)
Amoxicillin 80-90mg/kg/day x7 days; Augmentin 90/6.4 mg/kg/day x7 days
Measures speed of exhalation; results measure by age and weight
Macrolides (azithormycin); Doxycycline; TMZ-SMZ
>12 weeks

26. Rhonchi
Abrupt onset - burning nose or throat - sneezing - rhinorrhea
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
HEENT: rhinoscopy - sinus tenderness - lymphnodes - transillumination of sinuses - CV and PULM.

27. What is most common age range for otitis?
3 months to 3 years old
Hardher and more turbulent
Apena alternating with hyperpnea;
Inflammation of the nasal cavity

28. Rhinosinusitis History?
Increased loudness of whispering during auscultation. Indicative of consolidation.
Abrupt onset - burning nose or throat - sneezing - rhinorrhea
Decongestants (oxymetazoline); glucocorticoids (e.g. fluticasone); mucolytics (e.g. guaifensin)
Nasal congestion - HA - sinus pain - fever - sore throat - cough

29. Vesicular breath sounds...
Soft sounds in and out
Measures speed of exhalation; results measure by age and weight
HEENT: rhinoscopy - sinus tenderness - lymphnodes - transillumination of sinuses - CV and PULM.
Aspirin: Reye's Syndrome

30. Nonpharmacological tx for viral URI
>12 weeks
Rebound congestion 3-5 days
Persistent; recurrent x4/yr; severe HA; altered mental status
Warm - humid environment; rest;

31. Acute rhino-sinusitis duration of symptoms?
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.
<4 weeks
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

32. Special cases of sinusitis?
Hardher and more turbulent
Rate; pattern (regular or irregular); effort (labored - accessory muscles)
Persistent or relapse of infection - chronic sinusitis - fungal infection - extension in CNS (meningitis - orbital cellulitis - osteitis)
Rhinovirus - influenza - parainfluenza

33. Subacute rhino-sinusitis duration of symptoms?
E. coli
4-12 weeks
NSAIDs for aches - fever; Sympathomimetics: pseudophedrine or phenylephrine
Soft sounds in and out

34. Wheezes
Step. pneumoniae; Haemophilus influenzae; group B-strep
High pitched sounds; can occur during inspiration or expiration; indicates narrow airways; can occur with asthma - COPD - pneumonia - CHF
Decongestants (oxymetazoline); glucocorticoids (e.g. fluticasone); mucolytics (e.g. guaifensin)
Oflaxicin 0.3% solution BID

35. Alternative rx for bacterial sinusitis?
Amoxicillin 1000 mg TID x7 days; Augmentin 2000/125mg BID x7 days
Macrolides (azithormycin); Doxycycline; TMZ-SMZ
Bacterial infection
Nasal polyps - deviated septum - hx of trauma - surgery - foreign bodies or recent altitude changes

36. Normal pulse ox
E. coli
92-100%
Ipratroprium bromide (e.g. Atrovent); Antihistamines (Cargeul not to overly dry out muscos)
Warm - humid environment; rest;

37. Egophany (vocal resonance)
24-72 hrs
High pitched voice sound due to transmission of noise across fluid. Indicative of effusion.
3 months to 3 years old
Pulse ox; Peak expiratory flow; spirometry

38. Tx for pediatric AOM?
Amoxicillin 80-90mg/kg/day x7 days; Augmentin 90/6.4 mg/kg/day x7 days
<4 weeks
Persistent or relapse of infection - chronic sinusitis - fungal infection - extension in CNS (meningitis - orbital cellulitis - osteitis)
Increased loudness of whispering during auscultation. Indicative of consolidation.

39. 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
High pitched sounds; can occur during inspiration or expiration; indicates narrow airways; can occur with asthma - COPD - pneumonia - CHF
Clubbing - Use of accessory muscles - barrel chest
Step. pneumoniae; Haemophilus influenzae; group B-strep

40. What is the most common pahtogen for otitis media?
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
Ipratroprium bromide (e.g. Atrovent); Antihistamines (Cargeul not to overly dry out muscos)
Step. pneumoniae; Haemophilus influenzae; group B-strep
>12 weeks

41. Proxysmal nocturnal dyspnea
Decongestants (oxymetazoline); glucocorticoids (e.g. fluticasone); mucolytics (e.g. guaifensin)
Dyspnea when supine - relived by sitting or standing
Severe dyspnea when lying supine with associated wheezing and coughing - need to sit up abruptly due to severe dyspnea
High pitched voice sound due to transmission of noise across fluid. Indicative of effusion.

42. Common cold pathogens
Nasal congestion - HA - sinus pain - fever - sore throat - cough
Measures speed of exhalation; results measure by age and weight
Aspirin: increases viral shedding
Rhinovirus - influenza - and parainfluenza

43. Which Rx should not be used for viral URI?
Aspirin: increases viral shedding
High pitched voice sound due to transmission of noise across fluid. Indicative of effusion.
<4 weeks
Clubbing - Use of accessory muscles - barrel chest

44. Tx for adult AOE?
Increased loudness of whispering during auscultation. Indicative of consolidation.
Abrupt onset - burning nose or throat - sneezing - rhinorrhea
Oflaxicin 0.3% solution BID
HEENT: rhinoscopy - sinus tenderness - lymphnodes - transillumination of sinuses - CV and PULM.

45. Bronchial breath sounds...
<4 weeks
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
Rhinovirus - influenza - and parainfluenza
Hardher and more turbulent

46. Orthopnea
Step. pneumoniae; Haemophilus influenzae; group B-strep
High pitched sounds; can occur during inspiration or expiration; indicates narrow airways; can occur with asthma - COPD - pneumonia - CHF
Dyspnea when supine - relived by sitting or standing
Symptomatic (steam; nasal irrigation); APAP for pain.

47. Respiratory Illness Key Points (3)
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
<4 weeks
Rebound congestion 3-5 days
Hardher and more turbulent

48. Rx nasal congestion?
Decongestants (oxymetazoline); glucocorticoids (e.g. fluticasone); mucolytics (e.g. guaifensin)
24-72 hrs
Pulse ox; Peak expiratory flow; spirometry
92-100%

49. Whispered pectoriloguy
Increased loudness of whispering during auscultation. Indicative of consolidation.
92-100%
TM erythmatous - bulging - light reflex displaced - exudate
NSAIDs for aches - fever; Sympathomimetics: pseudophedrine or phenylephrine

50. Physical exam of chest
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
Bacterial or viral infection of the middle ear (secondary to URI [e.g. eustachian tube dysfunction])
Nasal congestion - HA - sinus pain - fever - sore throat - cough
Aspirin: Reye's Syndrome