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ENT/Respiratory

Instructions:

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. Common cold pathogens
Rhinovirus - influenza - and parainfluenza
Persistent; recurrent x4/yr; severe HA; altered mental status
Rate; pattern (regular or irregular); effort (labored - accessory muscles)
Amoxicillin 1000 mg TID x7 days; Augmentin 2000/125mg BID x7 days

2. Egophany (vocal resonance)
Oflaxicin 0.3% solution BID
High pitched voice sound due to transmission of noise across fluid. Indicative of effusion.
Nasal congestion - HA - sinus pain - fever - sore throat - cough
Rhinovirus - influenza - and parainfluenza

3. Common Cold (URI - Acute Coryza)
Clubbing - Use of accessory muscles - barrel chest
Rebound congestion 3-5 days
Afebrile viral infection of the the nose - paranasal sinuses - throat - larynx - trachea - and and bronchi.
<4 weeks

4. Chronic rhino-sinusitis duration of symptoms?
High pitched voice sound due to transmission of noise across fluid. Indicative of effusion.
Rhinovirus - influenza - parainfluenza
Rate; pattern (regular or irregular); effort (labored - accessory muscles)
>12 weeks

5. Rx for rhinorrhea and/or allergies?
92-100%
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
Ipratroprium bromide (e.g. Atrovent); Antihistamines (Cargeul not to overly dry out muscos)

6. Bronchial breath sounds...
Hardher and more turbulent
Step. pneumoniae; Haemophilus influenzae; group B-strep
Deep - rapid - labored - breathing
Oflaxicin 0.3% solution BID

7. Rhinosinusitis History?
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)
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
Nasal congestion - HA - sinus pain - fever - sore throat - cough

8. Rhinosinusitis physical exam?
Labs: CBC - blood gas - d-dimer - CMP - BNP - Chest CT - MRI
Increased breath sounds or voice remains loud at the periphery during auscultation. Indicative of consolidation.
Soft sounds in and out
HEENT: rhinoscopy - sinus tenderness - lymphnodes - transillumination of sinuses - CV and PULM.

9. Wheezes
High pitched sounds; can occur during inspiration or expiration; indicates narrow airways; can occur with asthma - COPD - pneumonia - CHF
Rate; pattern (regular or irregular); effort (labored - accessory muscles)
<4 weeks
Increased loudness of whispering during auscultation. Indicative of consolidation.

10. Subacute rhino-sinusitis duration of symptoms?
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
Step. pneumoniae; Haemophilus influenzae; group B-strep
24-72 hrs
4-12 weeks

11. Pulmonary tests
92-100%
NSAIDs for aches - fever; Sympathomimetics: pseudophedrine or phenylephrine
E. coli
Pulse ox; Peak expiratory flow; spirometry

12. Kussmal's respiration
Bacterial infection
Deep - rapid - labored - breathing
TM erythmatous - bulging - light reflex displaced - exudate
Severe dyspnea when lying supine with associated wheezing and coughing - need to sit up abruptly due to severe dyspnea

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

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14. Acute rhino-sinusitis duration of symptoms?
Nasal polyps - deviated septum - hx of trauma - surgery - foreign bodies or recent altitude changes
Ipratroprium bromide (e.g. Atrovent); Antihistamines (Cargeul not to overly dry out muscos)
24-72 hrs
<4 weeks

15. Stridor
Afebrile viral infection of the the nose - paranasal sinuses - throat - larynx - trachea - and and bronchi.
Rate; pattern (regular or irregular); effort (labored - accessory muscles)
Abnormal high pitched caused by blockage in upper airway; usually heard with with inspiration
NSAIDs for aches - fever; Sympathomimetics: pseudophedrine or phenylephrine

16. Special cases of sinusitis?
Decongestants (oxymetazoline); glucocorticoids (e.g. fluticasone); mucolytics (e.g. guaifensin)
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
Persistent or relapse of infection - chronic sinusitis - fungal infection - extension in CNS (meningitis - orbital cellulitis - osteitis)

17. Nonpharmacological tx for viral URI
Inflammation of the paranasal sinuses
Warm - humid environment; rest;
Aspirin: Reye's Syndrome
Dyspnea when supine - relived by sitting or standing

18. Rhinosinusitis risk factors?
Rebound congestion 3-5 days
Measures speed of exhalation; results measure by age and weight
Nasal polyps - deviated septum - hx of trauma - surgery - foreign bodies or recent altitude changes
High pitched sounds; can occur during inspiration or expiration; indicates narrow airways; can occur with asthma - COPD - pneumonia - CHF

19. Alternative rx for bacterial sinusitis?
Macrolides (azithormycin); Doxycycline; TMZ-SMZ
Hardher and more turbulent
Amoxicillin 1000 mg TID x7 days; Augmentin 2000/125mg BID x7 days
High pitched voice sound due to transmission of noise across fluid. Indicative of effusion.

20. Proxysmal nocturnal dyspnea
Severe dyspnea when lying supine with associated wheezing and coughing - need to sit up abruptly due to severe dyspnea
Afebrile viral infection of the the nose - paranasal sinuses - throat - larynx - trachea - and and bronchi.
Deep - rapid - labored - breathing
Persistent; recurrent x4/yr; severe HA; altered mental status

21. What are the symptoms of otitis?
Viral inoculation > viral rhinitis > infection of paranasal sinuses > inflammation & edema > mucosal edema - copious secretions - ciliary dyskinesia > sinus congestions and/or obstruction
PE: rhinoscopy with otoscope
High pitched voice sound due to transmission of noise across fluid. Indicative of effusion.
Ear ache - dullness - hearing loss - fever - N/V/D

22. What is the common side effect of sympathomimetics?
Rebound congestion 3-5 days
3 months to 3 years old
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
Purulent discharge - post nasal draiange; cough; sinus pressure - tooth pain; halitosis (changes in taste); alterations of smell

23. Orthopnea
TM erythmatous - bulging - light reflex displaced - exudate
PE: rhinoscopy with otoscope
Dyspnea when supine - relived by sitting or standing
Rebound congestion 3-5 days

24. Abnormal pulmonary findings?
Rhinovirus - influenza - parainfluenza
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
Bacterial infection

25. 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
Fine or courses; secretions or aveolar collapse; normal if resovle with cough; abnormal: pneumonia; CHF; COPD; pilmonary fibrosis
Afebrile viral infection of the the nose - paranasal sinuses - throat - larynx - trachea - and and bronchi.
Apena alternating with hyperpnea;

26. Pathophysiology of rhino sinusitis?
Viral inoculation > viral rhinitis > infection of paranasal sinuses > inflammation & edema > mucosal edema - copious secretions - ciliary dyskinesia > sinus congestions and/or obstruction
Dyspnea when supine - relived by sitting or standing
Warm - humid environment; rest;
PE: rhinoscopy with otoscope

27. Acute otitis media
Increased loudness of whispering during auscultation. Indicative of consolidation.
Step. pneumoniae; Haemophilus influenzae; group B-strep
Bacterial or viral infection of the middle ear (secondary to URI [e.g. eustachian tube dysfunction])
Symptomatic (steam; nasal irrigation); APAP for pain.

28. Respiratory Illness Key Points (3)
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
Dyspnea when supine - relived by sitting or standing
Warm - humid environment; rest;

29. Respiratory Examination (Observation)
Rate; pattern (regular or irregular); effort (labored - accessory muscles)
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
Inflammation of the paranasal sinuses
Hardher and more turbulent

30. 1st line treatment for bacterial sinusitis?
Augementin 2000/124 mg bid for 5-7 days - Peds: 90 mg/kg/day po in divided doses
Erythmatous auditory canal - crusting
Decongestants (oxymetazoline); glucocorticoids (e.g. fluticasone); mucolytics (e.g. guaifensin)
3 months to 3 years old

31. What sinusitis symptoms would warrant image studies?
Persistent; recurrent x4/yr; severe HA; altered mental status
Rebound congestion 3-5 days
Ear ache - dullness - hearing loss - fever - N/V/D
Oflaxicin 0.3% solution BID

32. Cheyne-stokes
Amoxicillin 1000 mg TID x7 days; Augmentin 2000/125mg BID x7 days
Erythmatous auditory canal - crusting
3 months to 3 years old
Apena alternating with hyperpnea;

33. Additional pulmonary diagnostics
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.
Labs: CBC - blood gas - d-dimer - CMP - BNP - Chest CT - MRI
Warm - humid environment; rest;

34. Crackles (rales)
Measures speed of exhalation; results measure by age and weight
Fine or courses; secretions or aveolar collapse; normal if resovle with cough; abnormal: pneumonia; CHF; COPD; pilmonary fibrosis
HEENT: rhinoscopy - sinus tenderness - lymphnodes - transillumination of sinuses - CV and PULM.
Aspirin: increases viral shedding

35. Tx for pediatric AOM?
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
Abrupt onset - burning nose or throat - sneezing - rhinorrhea
Rhinovirus - influenza - parainfluenza
Amoxicillin 80-90mg/kg/day x7 days; Augmentin 90/6.4 mg/kg/day x7 days

36. Rhinitis
Decongestants (oxymetazoline); glucocorticoids (e.g. fluticasone); mucolytics (e.g. guaifensin)
Clubbing - Use of accessory muscles - barrel chest
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;

37. Diagnostics of sinusitis?
PE: rhinoscopy with otoscope
Macrolides (azithormycin); Doxycycline; TMZ-SMZ
Rhinovirus - influenza - parainfluenza
High pitched sounds; can occur during inspiration or expiration; indicates narrow airways; can occur with asthma - COPD - pneumonia - CHF

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
Aspirin: increases viral shedding
3 months to 3 years old
Ear ache - dullness - hearing loss - fever - N/V/D

39. Rx for viral URI?
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.
NSAIDs for aches - fever; Sympathomimetics: pseudophedrine or phenylephrine

40. Rx nasal congestion?
Decongestants (oxymetazoline); glucocorticoids (e.g. fluticasone); mucolytics (e.g. guaifensin)
Rebound congestion 3-5 days
Afebrile viral infection of the the nose - paranasal sinuses - throat - larynx - trachea - and and bronchi.
<4 weeks

41. What are physical exam findings of AOE?
4-12 weeks
Measures speed of exhalation; results measure by age and weight
Erythmatous auditory canal - crusting
Severe dyspnea when lying supine with associated wheezing and coughing - need to sit up abruptly due to severe dyspnea

42. Tx for adult AOM?
Macrolides (azithormycin); Doxycycline; TMZ-SMZ
HEENT: rhinoscopy - sinus tenderness - lymphnodes - transillumination of sinuses - CV and PULM.
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

43. Rhonchi
Deep - snoring sound; indicates fluid or narrowing of airways; common in bronchitis and COPD
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
Apena alternating with hyperpnea;

44. What is the most common pathogen for otitis in newborns?
Severe dyspnea when lying supine with associated wheezing and coughing - need to sit up abruptly due to severe dyspnea
E. coli
Rebound congestion 3-5 days
Macrolides (azithormycin); Doxycycline; TMZ-SMZ

45. Common cold symptoms
Abrupt onset - burning nose or throat - sneezing - rhinorrhea
Oflaxicin 0.3% solution BID
HEENT: rhinoscopy - sinus tenderness - lymphnodes - transillumination of sinuses - CV and PULM.
Symptomatic (steam; nasal irrigation); APAP for pain.

46. Acute viral rhino-sinusitis (AVRS) pathogens?
Augementin 2000/124 mg bid for 5-7 days - Peds: 90 mg/kg/day po in divided doses
Apena alternating with hyperpnea;
Inflammation of the paranasal sinuses
Rhinovirus - influenza - parainfluenza

47. Symptoms of acute bacterial rhino-sinusitis (ABRS)?
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.
E. coli
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

48. Spirometry
Augementin 2000/124 mg bid for 5-7 days - Peds: 90 mg/kg/day po in divided doses
Measures speed of exhalation; results measure by age and weight
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

49. Tx of sinusitis symptoms <10 days
Amoxicillin 1000 mg TID x7 days; Augmentin 2000/125mg BID x7 days
Symptomatic (steam; nasal irrigation); APAP for pain.
Measures speed of exhalation; results measure by age and weight
Step. pneumoniae; Haemophilus influenzae; group B-strep

50. Bronchophony
Increased breath sounds or voice remains loud at the periphery during auscultation. Indicative of consolidation.
3 months to 3 years old
Aspirin: increases viral shedding
Viral inoculation > viral rhinitis > infection of paranasal sinuses > inflammation & edema > mucosal edema - copious secretions - ciliary dyskinesia > sinus congestions and/or obstruction