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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. Rx for rhinorrhea and/or allergies?
E. coli
Pulse ox; Peak expiratory flow; spirometry
Bacterial or viral infection of the middle ear (secondary to URI [e.g. eustachian tube dysfunction])
Ipratroprium bromide (e.g. Atrovent); Antihistamines (Cargeul not to overly dry out muscos)

2. What are physical exam findings of AOE?
Inflammation of the nasal cavity
Abnormal high pitched caused by blockage in upper airway; usually heard with with inspiration
Erythmatous auditory canal - crusting
PE: rhinoscopy with otoscope

3. Common cold symptoms
Erythmatous auditory canal - crusting
Afebrile viral infection of the the nose - paranasal sinuses - throat - larynx - trachea - and and bronchi.
Abrupt onset - burning nose or throat - sneezing - rhinorrhea
Macrolides (azithormycin); Doxycycline; TMZ-SMZ

4. What sinusitis symptoms would warrant image studies?
Bacterial or viral infection of the middle ear (secondary to URI [e.g. eustachian tube dysfunction])
Erythmatous auditory canal - crusting
Bacterial infection
Persistent; recurrent x4/yr; severe HA; altered mental status

5. Rhinitis
Persistent or relapse of infection - chronic sinusitis - fungal infection - extension in CNS (meningitis - orbital cellulitis - osteitis)
92-100%
Labs: CBC - blood gas - d-dimer - CMP - BNP - Chest CT - MRI
Inflammation of the nasal cavity

6. Symptoms of acute bacterial rhino-sinusitis (ABRS)?
Purulent discharge - post nasal draiange; cough; sinus pressure - tooth pain; halitosis (changes in taste); alterations of smell
3 months to 3 years old
Dyspnea when supine - relived by sitting or standing
Persistent or relapse of infection - chronic sinusitis - fungal infection - extension in CNS (meningitis - orbital cellulitis - osteitis)

7. Acute otitis media
Rhinovirus - influenza - and parainfluenza
Nasal congestion - HA - sinus pain - fever - sore throat - cough
Fine or courses; secretions or aveolar collapse; normal if resovle with cough; abnormal: pneumonia; CHF; COPD; pilmonary fibrosis
Bacterial or viral infection of the middle ear (secondary to URI [e.g. eustachian tube dysfunction])

8. Special cases of sinusitis?
92-100%
Macrolides (azithormycin); Doxycycline; TMZ-SMZ
Persistent or relapse of infection - chronic sinusitis - fungal infection - extension in CNS (meningitis - orbital cellulitis - osteitis)
Soft sounds in and out

9. Vesicular breath sounds...
Rhinovirus - influenza - parainfluenza
Deep - snoring sound; indicates fluid or narrowing of airways; common in bronchitis and COPD
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
Soft sounds in and out

10. Crackles (rales)
High pitched voice sound due to transmission of noise across fluid. Indicative of effusion.
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)
TM erythmatous - bulging - light reflex displaced - exudate

11. Tx for adult AOE?
Oflaxicin 0.3% solution BID
Increased breath sounds or voice remains loud at the periphery during auscultation. Indicative of consolidation.
Abrupt onset - burning nose or throat - sneezing - rhinorrhea
Rhinovirus - influenza - and parainfluenza

12. Rx nasal congestion?
Amoxicillin 1000 mg TID x7 days; Augmentin 2000/125mg BID x7 days
Abnormal high pitched caused by blockage in upper airway; usually heard with with inspiration
Decongestants (oxymetazoline); glucocorticoids (e.g. fluticasone); mucolytics (e.g. guaifensin)
4-12 weeks

13. What is the common side effect of sympathomimetics?
Inflammation of the paranasal sinuses
Severe dyspnea when lying supine with associated wheezing and coughing - need to sit up abruptly due to severe dyspnea
Dyspnea when supine - relived by sitting or standing
Rebound congestion 3-5 days

14. Subacute rhino-sinusitis duration of symptoms?
Fine or courses; secretions or aveolar collapse; normal if resovle with cough; abnormal: pneumonia; CHF; COPD; pilmonary fibrosis
Rhinovirus - influenza - and parainfluenza
4-12 weeks
Purulent discharge - post nasal draiange; cough; sinus pressure - tooth pain; halitosis (changes in taste); alterations of smell

15. Acute viral rhino-sinusitis (AVRS) pathogens?
Increased breath sounds or voice remains loud at the periphery during auscultation. Indicative of consolidation.
Deep - rapid - labored - breathing
Rhinovirus - influenza - parainfluenza
Inflammation of the paranasal sinuses

16. What is the most common pathogen for otitis in newborns?
Apena alternating with hyperpnea;
E. coli
Ipratroprium bromide (e.g. Atrovent); Antihistamines (Cargeul not to overly dry out muscos)
3 months to 3 years old

17. 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
Macrolides (azithormycin); Doxycycline; TMZ-SMZ
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
Increased loudness of whispering during auscultation. Indicative of consolidation.

18. Cold incubation period
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
24-72 hrs
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

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

20. Proxysmal nocturnal dyspnea
Dyspnea when supine - relived by sitting or standing
Increased loudness of whispering during auscultation. Indicative of consolidation.
Rhinovirus - influenza - and parainfluenza
Severe dyspnea when lying supine with associated wheezing and coughing - need to sit up abruptly due to severe dyspnea

21. Common cold pathogens
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
Hardher and more turbulent
Rhinovirus - influenza - and parainfluenza
Nasal polyps - deviated septum - hx of trauma - surgery - foreign bodies or recent altitude changes

22. Rx for viral URI?
<4 weeks
Measures speed of exhalation; results measure by age and weight
NSAIDs for aches - fever; Sympathomimetics: pseudophedrine or phenylephrine
Macrolides (azithormycin); Doxycycline; TMZ-SMZ

23. Spirometry
Inflammation of the nasal cavity
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;
Nasal congestion - HA - sinus pain - fever - sore throat - cough
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. Normal pulse ox
92-100%
Rate; pattern (regular or irregular); effort (labored - accessory muscles)
Augementin 2000/124 mg bid for 5-7 days - Peds: 90 mg/kg/day po in divided doses
Warm - humid environment; rest;

25. Peak Expiratory Flow (PEF)
Oflaxicin 0.3% solution BID
Bacterial infection
Measures speed of exhalation; results measure by age and weight
Step. pneumoniae; Haemophilus influenzae; group B-strep

26. Tx for pediatric AOM?
Amoxicillin 80-90mg/kg/day x7 days; Augmentin 90/6.4 mg/kg/day x7 days
Amoxicillin 1000 mg TID x7 days; Augmentin 2000/125mg BID x7 days
Labs: CBC - blood gas - d-dimer - CMP - BNP - Chest CT - MRI
PE: rhinoscopy with otoscope

27. Common Cold (URI - Acute Coryza)
Step. pneumoniae; Haemophilus influenzae; group B-strep
Afebrile viral infection of the the nose - paranasal sinuses - throat - larynx - trachea - and and bronchi.
92-100%
Nasal congestion - HA - sinus pain - fever - sore throat - cough

28. Abnormal pulmonary findings?
Clubbing - Use of accessory muscles - barrel chest
Rate; pattern (regular or irregular); effort (labored - accessory muscles)
>12 weeks
High pitched sounds; can occur during inspiration or expiration; indicates narrow airways; can occur with asthma - COPD - pneumonia - CHF

29. Pulmonary tests
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
Pulse ox; Peak expiratory flow; spirometry
Oflaxicin 0.3% solution BID
Rebound congestion 3-5 days

30. Wheezes
Aspirin: increases viral shedding
Erythmatous auditory canal - crusting
24-72 hrs
High pitched sounds; can occur during inspiration or expiration; indicates narrow airways; can occur with asthma - COPD - pneumonia - CHF

31. 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
Deep - rapid - labored - breathing
Abrupt onset - burning nose or throat - sneezing - rhinorrhea
Rhinovirus - influenza - parainfluenza

32. Rhinosinusitis risk factors?
Severe dyspnea when lying supine with associated wheezing and coughing - need to sit up abruptly due to severe dyspnea
Nasal polyps - deviated septum - hx of trauma - surgery - foreign bodies or recent altitude changes
Inflammation of the paranasal sinuses
Pulse ox; Peak expiratory flow; spirometry

33. Rhinosinusitis physical exam?
4-12 weeks
HEENT: rhinoscopy - sinus tenderness - lymphnodes - transillumination of sinuses - CV and PULM.
Dyspnea when supine - relived by sitting or standing
Pulse ox; Peak expiratory flow; spirometry

34. Rhonchi
Ipratroprium bromide (e.g. Atrovent); Antihistamines (Cargeul not to overly dry out muscos)
Deep - snoring sound; indicates fluid or narrowing of airways; common in bronchitis and COPD
Clubbing - Use of accessory muscles - barrel chest
Aspirin: Reye's Syndrome

35. Egophany (vocal resonance)
High pitched sounds; can occur during inspiration or expiration; indicates narrow airways; can occur with asthma - COPD - pneumonia - CHF
High pitched voice sound due to transmission of noise across fluid. Indicative of effusion.
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;

36. What are physical exam findings of AOM?
TM erythmatous - bulging - light reflex displaced - exudate
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
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;

37. What does mucopurulent indications not indicate?
Afebrile viral infection of the the nose - paranasal sinuses - throat - larynx - trachea - and and bronchi.
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;
Bacterial infection
Abnormal high pitched caused by blockage in upper airway; usually heard with with inspiration

38. Pulmonary diagnostics (1)
Nasal polyps - deviated septum - hx of trauma - surgery - foreign bodies or recent altitude changes
High pitched voice sound due to transmission of noise across fluid. Indicative of effusion.
Decongestants (oxymetazoline); glucocorticoids (e.g. fluticasone); mucolytics (e.g. guaifensin)
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

39. Tx of sinusitis symptoms <10 days
Rebound congestion 3-5 days
Symptomatic (steam; nasal irrigation); APAP for pain.
Nasal polyps - deviated septum - hx of trauma - surgery - foreign bodies or recent altitude changes
Amoxicillin 80-90mg/kg/day x7 days; Augmentin 90/6.4 mg/kg/day x7 days

40. Acute rhino-sinusitis duration of symptoms?
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.
Amoxicillin 1000 mg TID x7 days; Augmentin 2000/125mg BID x7 days
<4 weeks

41. Respiratory Examination (Observation)
Apena alternating with hyperpnea;
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
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)

42. What are the symptoms of otitis?
Ear ache - dullness - hearing loss - fever - N/V/D
Deep - rapid - labored - breathing
Rhinovirus - influenza - parainfluenza
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

43. Alternative rx for bacterial sinusitis?
Oflaxicin 0.3% solution BID
Macrolides (azithormycin); Doxycycline; TMZ-SMZ
Deep - rapid - labored - breathing
Persistent or relapse of infection - chronic sinusitis - fungal infection - extension in CNS (meningitis - orbital cellulitis - osteitis)

44. Orthopnea
Inflammation of the paranasal sinuses
Decongestants (oxymetazoline); glucocorticoids (e.g. fluticasone); mucolytics (e.g. guaifensin)
Dyspnea when supine - relived by sitting or standing
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

45. Pathophysiology of rhino sinusitis?
Afebrile viral infection of the the nose - paranasal sinuses - throat - larynx - trachea - and and bronchi.
Viral inoculation > viral rhinitis > infection of paranasal sinuses > inflammation & edema > mucosal edema - copious secretions - ciliary dyskinesia > sinus congestions and/or obstruction
Decongestants (oxymetazoline); glucocorticoids (e.g. fluticasone); mucolytics (e.g. guaifensin)
3 months to 3 years old

46. What is most common age range for otitis?
3 months to 3 years old
Deep - rapid - labored - breathing
Purulent discharge - post nasal draiange; cough; sinus pressure - tooth pain; halitosis (changes in taste); alterations of smell
Oflaxicin 0.3% solution BID

47. Rhinosinusitis History?
3 months to 3 years old
Inflammation of the paranasal sinuses
Nasal congestion - HA - sinus pain - fever - sore throat - cough
Increased breath sounds or voice remains loud at the periphery during auscultation. Indicative of consolidation.

48. Which Rx should not be used for viral URI?
Aspirin: increases viral shedding
Ear ache - dullness - hearing loss - fever - N/V/D
Hardher and more turbulent
Aspirin: Reye's Syndrome

49. Cheyne-stokes
Augementin 2000/124 mg bid for 5-7 days - Peds: 90 mg/kg/day po in divided doses
Bacterial or viral infection of the middle ear (secondary to URI [e.g. eustachian tube dysfunction])
Apena alternating with hyperpnea;
Purulent discharge - post nasal draiange; cough; sinus pressure - tooth pain; halitosis (changes in taste); alterations of smell

50. Stridor
E. coli
Hardher and more turbulent
Macrolides (azithormycin); Doxycycline; TMZ-SMZ
Abnormal high pitched caused by blockage in upper airway; usually heard with with inspiration