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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. Rx nasal congestion?
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
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
Decongestants (oxymetazoline); glucocorticoids (e.g. fluticasone); mucolytics (e.g. guaifensin)

2. Egophany (vocal resonance)
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.
Amoxicillin 1000 mg TID x7 days; Augmentin 2000/125mg BID x7 days
High pitched sounds; can occur during inspiration or expiration; indicates narrow airways; can occur with asthma - COPD - pneumonia - CHF

3. What is the common side effect of sympathomimetics?
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
Rebound congestion 3-5 days
Rhinovirus - influenza - and parainfluenza
Persistent or relapse of infection - chronic sinusitis - fungal infection - extension in CNS (meningitis - orbital cellulitis - osteitis)

4. Whispered pectoriloguy
Warm - humid environment; rest;
>12 weeks
Measures speed of exhalation; results measure by age and weight
Increased loudness of whispering during auscultation. Indicative of consolidation.

5. Kussmal's respiration
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
Deep - rapid - labored - breathing
Afebrile viral infection of the the nose - paranasal sinuses - throat - larynx - trachea - and and bronchi.

6. Orthopnea
Nasal polyps - deviated septum - hx of trauma - surgery - foreign bodies or recent altitude changes
Abrupt onset - burning nose or throat - sneezing - rhinorrhea
Dyspnea when supine - relived by sitting or standing
Symptomatic (steam; nasal irrigation); APAP for pain.

7. What are physical exam findings of AOM?
TM erythmatous - bulging - light reflex displaced - exudate
Fine or courses; secretions or aveolar collapse; normal if resovle with cough; abnormal: pneumonia; CHF; COPD; pilmonary fibrosis
High pitched voice sound due to transmission of noise across fluid. Indicative of effusion.
Inflammation of the paranasal sinuses

8. Stridor
Ipratroprium bromide (e.g. Atrovent); Antihistamines (Cargeul not to overly dry out muscos)
Dyspnea when supine - relived by sitting or standing
Increased loudness of whispering during auscultation. Indicative of consolidation.
Abnormal high pitched caused by blockage in upper airway; usually heard with with inspiration

9. Alternative rx for bacterial sinusitis?
Pulse ox; Peak expiratory flow; spirometry
Nasal congestion - HA - sinus pain - fever - sore throat - cough
Increased loudness of whispering during auscultation. Indicative of consolidation.
Macrolides (azithormycin); Doxycycline; TMZ-SMZ

10. Tx for adult AOE?
Rhinovirus - influenza - and parainfluenza
Augementin 2000/124 mg bid for 5-7 days - Peds: 90 mg/kg/day po in divided doses
3 months to 3 years old
Oflaxicin 0.3% solution BID

11. Additional pulmonary diagnostics
Fine or courses; secretions or aveolar collapse; normal if resovle with cough; abnormal: pneumonia; CHF; COPD; pilmonary fibrosis
High pitched sounds; can occur during inspiration or expiration; indicates narrow airways; can occur with asthma - COPD - pneumonia - CHF
Symptomatic (steam; nasal irrigation); APAP for pain.
Labs: CBC - blood gas - d-dimer - CMP - BNP - Chest CT - MRI

12. 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
Augementin 2000/124 mg bid for 5-7 days - Peds: 90 mg/kg/day po in divided doses
Dyspnea when supine - relived by sitting or standing
Apena alternating with hyperpnea;

13. Common Cold (URI - Acute Coryza)
<4 weeks
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.
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

14. Proxysmal nocturnal dyspnea
Severe dyspnea when lying supine with associated wheezing and coughing - need to sit up abruptly due to severe dyspnea
>12 weeks
<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

15. What are physical exam findings of AOE?
Viral inoculation > viral rhinitis > infection of paranasal sinuses > inflammation & edema > mucosal edema - copious secretions - ciliary dyskinesia > sinus congestions and/or obstruction
Ear ache - dullness - hearing loss - fever - N/V/D
Aspirin: increases viral shedding
Erythmatous auditory canal - crusting

16. What does mucopurulent indications not indicate?
Increased loudness of whispering during auscultation. Indicative of consolidation.
Soft sounds in and out
Bacterial infection
Fine or courses; secretions or aveolar collapse; normal if resovle with cough; abnormal: pneumonia; CHF; COPD; pilmonary fibrosis

17. Nonpharmacological tx for viral URI
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
Hardher and more turbulent
Inflammation of the paranasal sinuses
Warm - humid environment; rest;

18. Acute viral rhino-sinusitis (AVRS) pathogens?
Abrupt onset - burning nose or throat - sneezing - rhinorrhea
Rhinovirus - influenza - parainfluenza
Rate; pattern (regular or irregular); effort (labored - accessory muscles)
Increased breath sounds or voice remains loud at the periphery during auscultation. Indicative of consolidation.

19. Tx of sinusitis symptoms <10 days
Symptomatic (steam; nasal irrigation); APAP for pain.
4-12 weeks
Apena alternating with hyperpnea;
Dyspnea when supine - relived by sitting or standing

20. Symptoms of acute bacterial rhino-sinusitis (ABRS)?
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
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
Fine or courses; secretions or aveolar collapse; normal if resovle with cough; abnormal: pneumonia; CHF; COPD; pilmonary fibrosis

21. Sinusitis
Inflammation of the paranasal sinuses
Severe dyspnea when lying supine with associated wheezing and coughing - need to sit up abruptly due to severe dyspnea
Abnormal high pitched caused by blockage in upper airway; usually heard with with inspiration
Erythmatous auditory canal - crusting

22. Rhinosinusitis risk factors?
Ear ache - dullness - hearing loss - fever - N/V/D
Nasal polyps - deviated septum - hx of trauma - surgery - foreign bodies or recent altitude changes
Nasal congestion - HA - sinus pain - fever - sore throat - cough
Abrupt onset - burning nose or throat - sneezing - rhinorrhea

23. Rhinitis
PE: rhinoscopy with otoscope
Rhinovirus - influenza - parainfluenza
Inflammation of the nasal cavity
NSAIDs for aches - fever; Sympathomimetics: pseudophedrine or phenylephrine

24. Rhinosinusitis physical exam?
TM erythmatous - bulging - light reflex displaced - exudate
Apena alternating with hyperpnea;
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.

25. Rhonchi
Macrolides (azithormycin); Doxycycline; TMZ-SMZ
Deep - snoring sound; indicates fluid or narrowing of airways; common in bronchitis and COPD
Purulent discharge - post nasal draiange; cough; sinus pressure - tooth pain; halitosis (changes in taste); alterations of smell
Inflammation of the paranasal sinuses

26. Normal pulse ox
Warm - humid environment; rest;
Abnormal high pitched caused by blockage in upper airway; usually heard with with inspiration
92-100%
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

27. Subacute rhino-sinusitis duration of symptoms?
Macrolides (azithormycin); Doxycycline; TMZ-SMZ
4-12 weeks
Aspirin: increases viral shedding
Deep - snoring sound; indicates fluid or narrowing of airways; common in bronchitis and COPD

28. Symptoms of viral rhinosinusitis
24-72 hrs
Soft sounds in and out
3 months to 3 years old
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;

29. What is the most common pathogen for otitis in newborns?
3 months to 3 years old
Step. pneumoniae; Haemophilus influenzae; group B-strep
E. coli
Afebrile viral infection of the the nose - paranasal sinuses - throat - larynx - trachea - and and bronchi.

30. Special cases of sinusitis?
TM erythmatous - bulging - light reflex displaced - exudate
Dyspnea when supine - relived by sitting or standing
Persistent or relapse of infection - chronic sinusitis - fungal infection - extension in CNS (meningitis - orbital cellulitis - osteitis)
High pitched sounds; can occur during inspiration or expiration; indicates narrow airways; can occur with asthma - COPD - pneumonia - CHF

31. 1st line treatment for bacterial sinusitis?
Inflammation of the paranasal sinuses
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;
Increased breath sounds or voice remains loud at the periphery during auscultation. Indicative of consolidation.

32. Acute rhino-sinusitis duration of symptoms?
<4 weeks
Increased loudness of whispering during auscultation. Indicative of consolidation.
Abrupt onset - burning nose or throat - sneezing - rhinorrhea
Pulse ox; Peak expiratory flow; spirometry

33. Wheezes
Inflammation of the nasal cavity
High pitched sounds; can occur during inspiration or expiration; indicates narrow airways; can occur with asthma - COPD - pneumonia - CHF
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
Warm - humid environment; rest;

34. Cheyne-stokes
Ipratroprium bromide (e.g. Atrovent); Antihistamines (Cargeul not to overly dry out muscos)
Oflaxicin 0.3% solution BID
Apena alternating with hyperpnea;
Deep - rapid - labored - breathing

35. What are the symptoms of otitis?
92-100%
Ear ache - dullness - hearing loss - fever - N/V/D
Dyspnea when supine - relived by sitting or standing
HEENT: rhinoscopy - sinus tenderness - lymphnodes - transillumination of sinuses - CV and PULM.

36. What is most common age range for otitis?
3 months to 3 years old
Decongestants (oxymetazoline); glucocorticoids (e.g. fluticasone); mucolytics (e.g. guaifensin)
24-72 hrs
Oflaxicin 0.3% solution BID

37. Bronchial breath sounds...
Afebrile viral infection of the the nose - paranasal sinuses - throat - larynx - trachea - and and bronchi.
Hardher and more turbulent
Nasal congestion - HA - sinus pain - fever - sore throat - cough
TM erythmatous - bulging - light reflex displaced - exudate

38. Crackles (rales)
TM erythmatous - bulging - light reflex displaced - exudate
Fine or courses; secretions or aveolar collapse; normal if resovle with cough; abnormal: pneumonia; CHF; COPD; pilmonary fibrosis
Erythmatous auditory canal - crusting
Warm - humid environment; rest;

39. Tx for adult AOM?
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
Ear ache - dullness - hearing loss - fever - N/V/D
Amoxicillin 1000 mg TID x7 days; Augmentin 2000/125mg BID x7 days

40. Which Rx should not be used for viral URI?
Aspirin: increases viral shedding
Rhinovirus - influenza - parainfluenza
Rate; pattern (regular or irregular); effort (labored - accessory muscles)
E. coli

41. Rx for viral URI?
Fine or courses; secretions or aveolar collapse; normal if resovle with cough; abnormal: pneumonia; CHF; COPD; pilmonary fibrosis
High pitched voice sound due to transmission of noise across fluid. Indicative of effusion.
NSAIDs for aches - fever; Sympathomimetics: pseudophedrine or phenylephrine
4-12 weeks

42. Pulmonary tests
Augementin 2000/124 mg bid for 5-7 days - Peds: 90 mg/kg/day po in divided doses
High pitched voice sound due to transmission of noise across fluid. Indicative of effusion.
Rebound congestion 3-5 days
Pulse ox; Peak expiratory flow; spirometry

43. Bronchophony
Increased breath sounds or voice remains loud at the periphery during auscultation. Indicative of consolidation.
Macrolides (azithormycin); Doxycycline; TMZ-SMZ
High pitched voice sound due to transmission of noise across fluid. Indicative of effusion.
3 months to 3 years old

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

45. What sinusitis symptoms would warrant image studies?
Bacterial or viral infection of the middle ear (secondary to URI [e.g. eustachian tube dysfunction])
Fine or courses; secretions or aveolar collapse; normal if resovle with cough; abnormal: pneumonia; CHF; COPD; pilmonary fibrosis
Step. pneumoniae; Haemophilus influenzae; group B-strep
Persistent; recurrent x4/yr; severe HA; altered mental status

46. Common cold pathogens
Increased loudness of whispering during auscultation. Indicative of consolidation.
Hardher and more turbulent
Rhinovirus - influenza - and parainfluenza
Rebound congestion 3-5 days

47. Common cold symptoms
Abrupt onset - burning nose or throat - sneezing - rhinorrhea
Ipratroprium bromide (e.g. Atrovent); Antihistamines (Cargeul not to overly dry out muscos)
24-72 hrs
Decongestants (oxymetazoline); glucocorticoids (e.g. fluticasone); mucolytics (e.g. guaifensin)

48. Acute otitis media
High pitched voice sound due to transmission of noise across fluid. Indicative of effusion.
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;
Soft sounds in and out
Bacterial or viral infection of the middle ear (secondary to URI [e.g. eustachian tube dysfunction])

49. Chronic rhino-sinusitis duration of symptoms?
>12 weeks
PE: rhinoscopy with otoscope
4-12 weeks
Nasal polyps - deviated septum - hx of trauma - surgery - foreign bodies or recent altitude changes

50. Diagnostics of sinusitis?
Dyspnea when supine - relived by sitting or standing
PE: rhinoscopy with otoscope
Aspirin: increases viral shedding
>12 weeks