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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. Rhinosinusitis History?
Amoxicillin 80-90mg/kg/day x7 days; Augmentin 90/6.4 mg/kg/day x7 days
Nasal congestion - HA - sinus pain - fever - sore throat - cough
Apena alternating with hyperpnea;
Increased breath sounds or voice remains loud at the periphery during auscultation. Indicative of consolidation.

2. Egophany (vocal resonance)
HEENT: rhinoscopy - sinus tenderness - lymphnodes - transillumination of sinuses - CV and PULM.
Afebrile viral infection of the the nose - paranasal sinuses - throat - larynx - trachea - and and bronchi.
High pitched voice sound due to transmission of noise across fluid. Indicative of effusion.
<4 weeks

3. Pulmonary tests
Rhinovirus - influenza - parainfluenza
Warm - humid environment; rest;
Pulse ox; Peak expiratory flow; spirometry
24-72 hrs

4. Special cases of sinusitis?
Persistent or relapse of infection - chronic sinusitis - fungal infection - extension in CNS (meningitis - orbital cellulitis - osteitis)
Nasal congestion - HA - sinus pain - fever - sore throat - cough
Decongestants (oxymetazoline); glucocorticoids (e.g. fluticasone); mucolytics (e.g. guaifensin)
TM erythmatous - bulging - light reflex displaced - exudate

5. Pulmonary diagnostics (1)
Macrolides (azithormycin); Doxycycline; TMZ-SMZ
>12 weeks
High pitched voice sound due to transmission of noise across fluid. Indicative of effusion.
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

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

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7. What does mucopurulent indications not indicate?
Step. pneumoniae; Haemophilus influenzae; group B-strep
Bacterial infection
TM erythmatous - bulging - light reflex displaced - exudate
Warm - humid environment; rest;

8. Respiratory Examination (Observation)
Measures speed of exhalation; results measure by age and weight
Soft sounds in and out
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)

9. Common cold pathogens
Macrolides (azithormycin); Doxycycline; TMZ-SMZ
Nasal polyps - deviated septum - hx of trauma - surgery - foreign bodies or recent altitude changes
Rhinovirus - influenza - and parainfluenza
Decongestants (oxymetazoline); glucocorticoids (e.g. fluticasone); mucolytics (e.g. guaifensin)

10. Sinusitis
Inflammation of the paranasal sinuses
Symptomatic (steam; nasal irrigation); APAP for pain.
Amoxicillin 1000 mg TID x7 days; Augmentin 2000/125mg BID x7 days
Oflaxicin 0.3% solution BID

11. Bronchophony
Erythmatous auditory canal - crusting
Deep - snoring sound; indicates fluid or narrowing of airways; common in bronchitis and COPD
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.

12. What are the symptoms of otitis?
Severe dyspnea when lying supine with associated wheezing and coughing - need to sit up abruptly due to severe dyspnea
Ear ache - dullness - hearing loss - fever - N/V/D
Inflammation of the nasal cavity
>12 weeks

13. What are physical exam findings of AOM?
Warm - humid environment; rest;
Rebound congestion 3-5 days
Augementin 2000/124 mg bid for 5-7 days - Peds: 90 mg/kg/day po in divided doses
TM erythmatous - bulging - light reflex displaced - exudate

14. Peak Expiratory Flow (PEF)
Rhinovirus - influenza - and parainfluenza
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
Soft sounds in and out
Measures speed of exhalation; results measure by age and weight

15. Rx nasal congestion?
Deep - snoring sound; indicates fluid or narrowing of airways; common in bronchitis and COPD
Nasal congestion - HA - sinus pain - fever - sore throat - cough
Decongestants (oxymetazoline); glucocorticoids (e.g. fluticasone); mucolytics (e.g. guaifensin)
Measures speed of exhalation; results measure by age and weight

16. Normal pulse ox
Inflammation of the paranasal sinuses
E. coli
92-100%
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

17. Additional pulmonary diagnostics
Ear ache - dullness - hearing loss - fever - N/V/D
High pitched voice sound due to transmission of noise across fluid. Indicative of effusion.
Labs: CBC - blood gas - d-dimer - CMP - BNP - Chest CT - MRI
24-72 hrs

18. Respiratory Illness Key Points (3)
<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
Pulse ox; Peak expiratory flow; spirometry
Step. pneumoniae; Haemophilus influenzae; group B-strep

19. Rhinosinusitis physical exam?
HEENT: rhinoscopy - sinus tenderness - lymphnodes - transillumination of sinuses - CV and PULM.
Erythmatous auditory canal - crusting
Purulent discharge - post nasal draiange; cough; sinus pressure - tooth pain; halitosis (changes in taste); alterations of smell
Increased loudness of whispering during auscultation. Indicative of consolidation.

20. Tx of sinusitis symptoms <10 days
High pitched sounds; can occur during inspiration or expiration; indicates narrow airways; can occur with asthma - COPD - pneumonia - CHF
E. coli
Dyspnea when supine - relived by sitting or standing
Symptomatic (steam; nasal irrigation); APAP for pain.

21. Spirometry
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
Increased breath sounds or voice remains loud at the periphery during auscultation. Indicative of consolidation.
Purulent discharge - post nasal draiange; cough; sinus pressure - tooth pain; halitosis (changes in taste); alterations of smell
Aspirin: Reye's Syndrome

22. Symptoms of acute bacterial rhino-sinusitis (ABRS)?
Ear ache - dullness - hearing loss - fever - N/V/D
Purulent discharge - post nasal draiange; cough; sinus pressure - tooth pain; halitosis (changes in taste); alterations of smell
Deep - rapid - labored - breathing
Inflammation of the nasal cavity

23. Rhinitis
Rate; pattern (regular or irregular); effort (labored - accessory muscles)
Inflammation of the nasal cavity
High pitched voice sound due to transmission of noise across fluid. Indicative of effusion.
Hardher and more turbulent

24. What sinusitis symptoms would warrant image studies?
Rhinovirus - influenza - parainfluenza
Persistent; recurrent x4/yr; severe HA; altered mental status
Amoxicillin 80-90mg/kg/day x7 days; Augmentin 90/6.4 mg/kg/day x7 days
Hardher and more turbulent

25. Cold incubation period
24-72 hrs
3 months to 3 years old
Step. pneumoniae; Haemophilus influenzae; group B-strep
NSAIDs for aches - fever; Sympathomimetics: pseudophedrine or phenylephrine

26. Vesicular breath sounds...
24-72 hrs
Rhinovirus - influenza - parainfluenza
Persistent; recurrent x4/yr; severe HA; altered mental status
Soft sounds in and out

27. Tx for pediatric AOM?
Amoxicillin 80-90mg/kg/day x7 days; Augmentin 90/6.4 mg/kg/day x7 days
Dyspnea when supine - relived by sitting or standing
PE: rhinoscopy with otoscope
Inflammation of the paranasal sinuses

28. Tx for adult AOM?
Amoxicillin 1000 mg TID x7 days; Augmentin 2000/125mg BID x7 days
Ipratroprium bromide (e.g. Atrovent); Antihistamines (Cargeul not to overly dry out muscos)
Bacterial infection
E. coli

29. Symptoms of viral rhinosinusitis
Hardher and more turbulent
Deep - rapid - labored - breathing
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;
Viral inoculation > viral rhinitis > infection of paranasal sinuses > inflammation & edema > mucosal edema - copious secretions - ciliary dyskinesia > sinus congestions and/or obstruction

30. Rhonchi
>12 weeks
4-12 weeks
Inflammation of the nasal cavity
Deep - snoring sound; indicates fluid or narrowing of airways; common in bronchitis and COPD

31. Rhinosinusitis risk factors?
Nasal polyps - deviated septum - hx of trauma - surgery - foreign bodies or recent altitude changes
Nasal congestion - HA - sinus pain - fever - sore throat - cough
Persistent or relapse of infection - chronic sinusitis - fungal infection - extension in CNS (meningitis - orbital cellulitis - osteitis)
Afebrile viral infection of the the nose - paranasal sinuses - throat - larynx - trachea - and and bronchi.

32. 1st line treatment for bacterial sinusitis?
Augementin 2000/124 mg bid for 5-7 days - Peds: 90 mg/kg/day po in divided doses
Ipratroprium bromide (e.g. Atrovent); Antihistamines (Cargeul not to overly dry out muscos)
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
Erythmatous auditory canal - crusting

33. Rx for rhinorrhea and/or allergies?
>12 weeks
Ipratroprium bromide (e.g. Atrovent); Antihistamines (Cargeul not to overly dry out muscos)
Decongestants (oxymetazoline); glucocorticoids (e.g. fluticasone); mucolytics (e.g. guaifensin)
Rate; pattern (regular or irregular); effort (labored - accessory muscles)

34. What is the most common pahtogen for otitis media?
Step. pneumoniae; Haemophilus influenzae; group B-strep
Amoxicillin 1000 mg TID x7 days; Augmentin 2000/125mg BID x7 days
Labs: CBC - blood gas - d-dimer - CMP - BNP - Chest CT - MRI
Measures speed of exhalation; results measure by age and weight

35. Crackles (rales)
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
Fine or courses; secretions or aveolar collapse; normal if resovle with cough; abnormal: pneumonia; CHF; COPD; pilmonary fibrosis
Purulent discharge - post nasal draiange; cough; sinus pressure - tooth pain; halitosis (changes in taste); alterations of smell
Persistent or relapse of infection - chronic sinusitis - fungal infection - extension in CNS (meningitis - orbital cellulitis - osteitis)

36. What is the common side effect of sympathomimetics?
High pitched voice sound due to transmission of noise across fluid. Indicative of effusion.
4-12 weeks
Deep - rapid - labored - breathing
Rebound congestion 3-5 days

37. Nonpharmacological tx for viral URI
HEENT: rhinoscopy - sinus tenderness - lymphnodes - transillumination of sinuses - CV and PULM.
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
Warm - humid environment; rest;

38. What are physical exam findings of AOE?
Rate; pattern (regular or irregular); effort (labored - accessory muscles)
Erythmatous auditory canal - crusting
Bacterial or viral infection of the middle ear (secondary to URI [e.g. eustachian tube dysfunction])
Amoxicillin 1000 mg TID x7 days; Augmentin 2000/125mg BID x7 days

39. Cheyne-stokes
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
Apena alternating with hyperpnea;
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.

40. Proxysmal nocturnal dyspnea
PE: rhinoscopy with otoscope
Severe dyspnea when lying supine with associated wheezing and coughing - need to sit up abruptly due to severe dyspnea
HEENT: rhinoscopy - sinus tenderness - lymphnodes - transillumination of sinuses - CV and PULM.
Hardher and more turbulent

41. Wheezes
High pitched sounds; can occur during inspiration or expiration; indicates narrow airways; can occur with asthma - COPD - pneumonia - CHF
Increased loudness of whispering during auscultation. Indicative of consolidation.
Fine or courses; secretions or aveolar collapse; normal if resovle with cough; abnormal: pneumonia; CHF; COPD; pilmonary fibrosis
Deep - snoring sound; indicates fluid or narrowing of airways; common in bronchitis and COPD

42. Acute otitis media
Ear ache - dullness - hearing loss - fever - N/V/D
Rebound congestion 3-5 days
Bacterial or viral infection of the middle ear (secondary to URI [e.g. eustachian tube dysfunction])
Amoxicillin 1000 mg TID x7 days; Augmentin 2000/125mg BID x7 days

43. Bronchial breath sounds...
Decongestants (oxymetazoline); glucocorticoids (e.g. fluticasone); mucolytics (e.g. guaifensin)
Hardher and more turbulent
Deep - snoring sound; indicates fluid or narrowing of airways; common in bronchitis and COPD
>12 weeks

44. Rx for viral URI?
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
NSAIDs for aches - fever; Sympathomimetics: pseudophedrine or phenylephrine
Rate; pattern (regular or irregular); effort (labored - accessory muscles)

45. Common cold symptoms
Rebound congestion 3-5 days
Abrupt onset - burning nose or throat - sneezing - rhinorrhea
Purulent discharge - post nasal draiange; cough; sinus pressure - tooth pain; halitosis (changes in taste); alterations of smell
Viral inoculation > viral rhinitis > infection of paranasal sinuses > inflammation & edema > mucosal edema - copious secretions - ciliary dyskinesia > sinus congestions and/or obstruction

46. Acute rhino-sinusitis duration of symptoms?
TM erythmatous - bulging - light reflex displaced - exudate
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
Decongestants (oxymetazoline); glucocorticoids (e.g. fluticasone); mucolytics (e.g. guaifensin)

47. Acute viral rhino-sinusitis (AVRS) pathogens?
TM erythmatous - bulging - light reflex displaced - exudate
Rhinovirus - influenza - parainfluenza
Soft sounds in and out
Erythmatous auditory canal - crusting

48. Chronic rhino-sinusitis duration of symptoms?
Increased breath sounds or voice remains loud at the periphery during auscultation. Indicative of consolidation.
>12 weeks
Fine or courses; secretions or aveolar collapse; normal if resovle with cough; abnormal: pneumonia; CHF; COPD; pilmonary fibrosis
Soft sounds in and out

49. Alternative rx for bacterial sinusitis?
Oflaxicin 0.3% solution BID
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
Macrolides (azithormycin); Doxycycline; TMZ-SMZ
92-100%

50. Kussmal's respiration
Deep - rapid - labored - breathing
Bacterial infection
Oflaxicin 0.3% solution BID
Macrolides (azithormycin); Doxycycline; TMZ-SMZ