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ENT/Respiratory

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1. Pulmonary tests
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
NSAIDs for aches - fever; Sympathomimetics: pseudophedrine or phenylephrine
Pulse ox; Peak expiratory flow; spirometry
Persistent or relapse of infection - chronic sinusitis - fungal infection - extension in CNS (meningitis - orbital cellulitis - osteitis)

2. Vesicular breath sounds...
E. coli
Soft sounds in and out
Hardher and more turbulent
92-100%

3. Whispered pectoriloguy
Pulse ox; Peak expiratory flow; spirometry
Ear ache - dullness - hearing loss - fever - N/V/D
Increased loudness of whispering during auscultation. Indicative of consolidation.
Bacterial infection

4. Common cold symptoms
Fine or courses; secretions or aveolar collapse; normal if resovle with cough; abnormal: pneumonia; CHF; COPD; pilmonary fibrosis
Abrupt onset - burning nose or throat - sneezing - rhinorrhea
Symptomatic (steam; nasal irrigation); APAP for pain.
Pulse ox; Peak expiratory flow; spirometry

5. Additional pulmonary diagnostics
HEENT: rhinoscopy - sinus tenderness - lymphnodes - transillumination of sinuses - CV and PULM.
<4 weeks
Labs: CBC - blood gas - d-dimer - CMP - BNP - Chest CT - MRI
>12 weeks

6. Cold incubation period
Rhinovirus - influenza - and parainfluenza
24-72 hrs
Clubbing - Use of accessory muscles - barrel chest
Augementin 2000/124 mg bid for 5-7 days - Peds: 90 mg/kg/day po in divided doses

7. What does mucopurulent indications not indicate?
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
Bacterial infection
Amoxicillin 1000 mg TID x7 days; Augmentin 2000/125mg BID x7 days
Dyspnea when supine - relived by sitting or standing

8. Tx for adult AOM?
3 months to 3 years old
High pitched sounds; can occur during inspiration or expiration; indicates narrow airways; can occur with asthma - COPD - pneumonia - CHF
Macrolides (azithormycin); Doxycycline; TMZ-SMZ
Amoxicillin 1000 mg TID x7 days; Augmentin 2000/125mg BID x7 days

9. Tx of sinusitis symptoms <10 days
Increased breath sounds or voice remains loud at the periphery during auscultation. Indicative of consolidation.
Inflammation of the nasal cavity
Symptomatic (steam; nasal irrigation); APAP for pain.
Labs: CBC - blood gas - d-dimer - CMP - BNP - Chest CT - MRI

10. What are the symptoms of otitis?
Macrolides (azithormycin); Doxycycline; TMZ-SMZ
Ear ache - dullness - hearing loss - fever - N/V/D
Warm - humid environment; rest;
Severe dyspnea when lying supine with associated wheezing and coughing - need to sit up abruptly due to severe dyspnea

11. Rhinosinusitis History?
Soft sounds in and out
Decongestants (oxymetazoline); glucocorticoids (e.g. fluticasone); mucolytics (e.g. guaifensin)
Nasal congestion - HA - sinus pain - fever - sore throat - cough
Persistent; recurrent x4/yr; severe HA; altered mental status

12. Cheyne-stokes
Apena alternating with hyperpnea;
TM erythmatous - bulging - light reflex displaced - exudate
Purulent discharge - post nasal draiange; cough; sinus pressure - tooth pain; halitosis (changes in taste); alterations of smell
Dyspnea when supine - relived by sitting or standing

13. Orthopnea
Increased breath sounds or voice remains loud at the periphery during auscultation. Indicative of consolidation.
Dyspnea when supine - relived by sitting or standing
Aspirin: increases viral shedding
92-100%

14. What is the most common pathogen for otitis in newborns?
HEENT: rhinoscopy - sinus tenderness - lymphnodes - transillumination of sinuses - CV and PULM.
E. coli
Decongestants (oxymetazoline); glucocorticoids (e.g. fluticasone); mucolytics (e.g. guaifensin)
Nasal polyps - deviated septum - hx of trauma - surgery - foreign bodies or recent altitude changes

15. Nonpharmacological tx for viral URI
Viral inoculation > viral rhinitis > infection of paranasal sinuses > inflammation & edema > mucosal edema - copious secretions - ciliary dyskinesia > sinus congestions and/or obstruction
Rhinovirus - influenza - parainfluenza
Warm - humid environment; rest;
High pitched voice sound due to transmission of noise across fluid. Indicative of effusion.

16. What is most common age range for otitis?
3 months to 3 years old
TM erythmatous - bulging - light reflex displaced - exudate
Pulse ox; Peak expiratory flow; spirometry
NSAIDs for aches - fever; Sympathomimetics: pseudophedrine or phenylephrine

17. Special cases of sinusitis?
4-12 weeks
High pitched sounds; can occur during inspiration or expiration; indicates narrow airways; can occur with asthma - COPD - pneumonia - CHF
Soft sounds in and out
Persistent or relapse of infection - chronic sinusitis - fungal infection - extension in CNS (meningitis - orbital cellulitis - osteitis)

18. Alternative rx for bacterial sinusitis?
Aspirin: increases viral shedding
PE: rhinoscopy with otoscope
Macrolides (azithormycin); Doxycycline; TMZ-SMZ
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

19. Symptoms of acute bacterial rhino-sinusitis (ABRS)?
Fine or courses; secretions or aveolar collapse; normal if resovle with cough; abnormal: pneumonia; CHF; COPD; pilmonary fibrosis
Measures speed of exhalation; results measure by age and weight
Purulent discharge - post nasal draiange; cough; sinus pressure - tooth pain; halitosis (changes in taste); alterations of smell
Bacterial infection

20. Rhinitis
Soft sounds in and out
Inflammation of the nasal cavity
HEENT: rhinoscopy - sinus tenderness - lymphnodes - transillumination of sinuses - CV and PULM.
Nasal polyps - deviated septum - hx of trauma - surgery - foreign bodies or recent altitude changes

21. 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
Erythmatous auditory canal - crusting
Persistent; recurrent x4/yr; severe HA; altered mental status
Aspirin: Reye's Syndrome

22. Tx for adult AOE?
Oflaxicin 0.3% solution BID
Nasal congestion - HA - sinus pain - fever - sore throat - cough
Bacterial infection
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

23. Subacute rhino-sinusitis duration of symptoms?
4-12 weeks
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
Ear ache - dullness - hearing loss - fever - N/V/D

24. Which Rx should not be used for viral URI?
92-100%
Aspirin: increases viral shedding
4-12 weeks
Dyspnea when supine - relived by sitting or standing

25. Symptoms of viral rhinosinusitis
TM erythmatous - bulging - light reflex displaced - exudate
Persistent; recurrent x4/yr; severe HA; altered mental status
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;
Pulse ox; Peak expiratory flow; spirometry

26. Sinusitis
Inflammation of the paranasal sinuses
PE: rhinoscopy with otoscope
Decongestants (oxymetazoline); glucocorticoids (e.g. fluticasone); mucolytics (e.g. guaifensin)
Soft sounds in and out

27. 1st line treatment for bacterial sinusitis?
TM erythmatous - bulging - light reflex displaced - exudate
Ear ache - dullness - hearing loss - fever - N/V/D
Augementin 2000/124 mg bid for 5-7 days - Peds: 90 mg/kg/day po in divided doses
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;

28. What is the most common pahtogen for otitis media?
Step. pneumoniae; Haemophilus influenzae; group B-strep
Amoxicillin 80-90mg/kg/day x7 days; Augmentin 90/6.4 mg/kg/day x7 days
>12 weeks
Deep - snoring sound; indicates fluid or narrowing of airways; common in bronchitis and COPD

29. Respiratory Examination (Observation)
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
Abrupt onset - burning nose or throat - sneezing - rhinorrhea
Rate; pattern (regular or irregular); effort (labored - accessory muscles)

30. Peak Expiratory Flow (PEF)
Erythmatous auditory canal - crusting
Soft sounds in and out
Measures speed of exhalation; results measure by age and weight
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;

31. What sinusitis symptoms would warrant image studies?
Clubbing - Use of accessory muscles - barrel 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
Persistent; recurrent x4/yr; severe HA; altered mental status
Ipratroprium bromide (e.g. Atrovent); Antihistamines (Cargeul not to overly dry out muscos)

32. Rhonchi
Soft sounds in and out
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
Deep - snoring sound; indicates fluid or narrowing of airways; common in bronchitis and COPD
<4 weeks

33. Common cold pathogens
Abrupt onset - burning nose or throat - sneezing - rhinorrhea
Rate; pattern (regular or irregular); effort (labored - accessory muscles)
Rhinovirus - influenza - and parainfluenza
Persistent; recurrent x4/yr; severe HA; altered mental status

34. What are physical exam findings of AOE?
Rate; pattern (regular or irregular); effort (labored - accessory muscles)
Erythmatous auditory canal - crusting
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;
Augementin 2000/124 mg bid for 5-7 days - Peds: 90 mg/kg/day po in divided doses

35. Bronchial breath sounds...
Persistent or relapse of infection - chronic sinusitis - fungal infection - extension in CNS (meningitis - orbital cellulitis - osteitis)
Hardher and more turbulent
Nasal congestion - HA - sinus pain - fever - sore throat - cough
Rhinovirus - influenza - and parainfluenza

36. What are physical exam findings of AOM?
Dyspnea when supine - relived by sitting or standing
Rhinovirus - influenza - parainfluenza
Increased breath sounds or voice remains loud at the periphery during auscultation. Indicative of consolidation.
TM erythmatous - bulging - light reflex displaced - exudate

37. Acute otitis media
Bacterial or viral infection of the middle ear (secondary to URI [e.g. eustachian tube dysfunction])
Inflammation of the paranasal sinuses
Persistent or relapse of infection - chronic sinusitis - fungal infection - extension in CNS (meningitis - orbital cellulitis - osteitis)
TM erythmatous - bulging - light reflex displaced - exudate

38. Rx for rhinorrhea and/or allergies?
Ipratroprium bromide (e.g. Atrovent); Antihistamines (Cargeul not to overly dry out muscos)
4-12 weeks
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
Rhinovirus - influenza - parainfluenza

39. Diagnostics of sinusitis?
PE: rhinoscopy with otoscope
Rebound congestion 3-5 days
Viral inoculation > viral rhinitis > infection of paranasal sinuses > inflammation & edema > mucosal edema - copious secretions - ciliary dyskinesia > sinus congestions and/or obstruction
Labs: CBC - blood gas - d-dimer - CMP - BNP - Chest CT - MRI

40. Pathophysiology of rhino sinusitis?
Rhinovirus - influenza - parainfluenza
High pitched sounds; can occur during inspiration or expiration; indicates narrow airways; can occur with asthma - COPD - pneumonia - CHF
Ipratroprium bromide (e.g. Atrovent); Antihistamines (Cargeul not to overly dry out muscos)
Viral inoculation > viral rhinitis > infection of paranasal sinuses > inflammation & edema > mucosal edema - copious secretions - ciliary dyskinesia > sinus congestions and/or obstruction

41. Proxysmal nocturnal dyspnea
Rhinovirus - influenza - parainfluenza
Step. pneumoniae; Haemophilus influenzae; group B-strep
Ear ache - dullness - hearing loss - fever - N/V/D
Severe dyspnea when lying supine with associated wheezing and coughing - need to sit up abruptly due to severe dyspnea

42. Pulmonary diagnostics (1)
Pulse ox; Peak expiratory flow; spirometry
Amoxicillin 1000 mg TID x7 days; Augmentin 2000/125mg BID x7 days
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
Aspirin: Reye's Syndrome

43. Common Cold (URI - Acute Coryza)
Decongestants (oxymetazoline); glucocorticoids (e.g. fluticasone); mucolytics (e.g. guaifensin)
Inflammation of the nasal cavity
92-100%
Afebrile viral infection of the the nose - paranasal sinuses - throat - larynx - trachea - and and bronchi.

44. Rhinosinusitis physical exam?
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)
HEENT: rhinoscopy - sinus tenderness - lymphnodes - transillumination of sinuses - CV and PULM.
Purulent discharge - post nasal draiange; cough; sinus pressure - tooth pain; halitosis (changes in taste); alterations of smell

45. Rx for viral URI?
NSAIDs for aches - fever; Sympathomimetics: pseudophedrine or phenylephrine
Soft sounds in and out
Purulent discharge - post nasal draiange; cough; sinus pressure - tooth pain; halitosis (changes in taste); alterations of smell
Inflammation of the paranasal sinuses

46. Crackles (rales)
Ipratroprium bromide (e.g. Atrovent); Antihistamines (Cargeul not to overly dry out muscos)
Bacterial or viral infection of the middle ear (secondary to URI [e.g. eustachian tube dysfunction])
PE: rhinoscopy with otoscope
Fine or courses; secretions or aveolar collapse; normal if resovle with cough; abnormal: pneumonia; CHF; COPD; pilmonary fibrosis

47. Egophany (vocal resonance)
Erythmatous auditory canal - crusting
High pitched voice sound due to transmission of noise across fluid. Indicative of effusion.
Abnormal high pitched caused by blockage in upper airway; usually heard with with inspiration
HEENT: rhinoscopy - sinus tenderness - lymphnodes - transillumination of sinuses - CV and PULM.

48. Tx for pediatric AOM?
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 voice sound due to transmission of noise across fluid. Indicative of effusion.
Dyspnea when supine - relived by sitting or standing
Amoxicillin 80-90mg/kg/day x7 days; Augmentin 90/6.4 mg/kg/day x7 days

49. Kussmal's respiration
Dyspnea when supine - relived by sitting or standing
Deep - rapid - labored - breathing
>12 weeks
TM erythmatous - bulging - light reflex displaced - exudate

50. Spirometry
Amoxicillin 80-90mg/kg/day x7 days; Augmentin 90/6.4 mg/kg/day x7 days
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
HEENT: rhinoscopy - sinus tenderness - lymphnodes - transillumination of sinuses - CV and PULM.
Erythmatous auditory canal - crusting