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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. Pulmonary tests
Nasal polyps - deviated septum - hx of trauma - surgery - foreign bodies or recent altitude changes
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;
Aspirin: Reye's Syndrome
Pulse ox; Peak expiratory flow; spirometry

2. Wheezes
High pitched sounds; can occur during inspiration or expiration; indicates narrow airways; can occur with asthma - COPD - pneumonia - CHF
Macrolides (azithormycin); Doxycycline; TMZ-SMZ
Increased loudness of whispering during auscultation. Indicative of consolidation.
Measures speed of exhalation; results measure by age and weight

3. Symptoms of acute bacterial rhino-sinusitis (ABRS)?
Pulse ox; Peak expiratory flow; spirometry
Purulent discharge - post nasal draiange; cough; sinus pressure - tooth pain; halitosis (changes in taste); alterations of smell
Ipratroprium bromide (e.g. Atrovent); Antihistamines (Cargeul not to overly dry out muscos)
Rate; pattern (regular or irregular); effort (labored - accessory muscles)

4. What are physical exam findings of AOE?
Erythmatous auditory canal - crusting
E. coli
Labs: CBC - blood gas - d-dimer - CMP - BNP - Chest CT - MRI
High pitched voice sound due to transmission of noise across fluid. Indicative of effusion.

5. Tx for adult AOE?
Augementin 2000/124 mg bid for 5-7 days - Peds: 90 mg/kg/day po in divided doses
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
Decongestants (oxymetazoline); glucocorticoids (e.g. fluticasone); mucolytics (e.g. guaifensin)
Oflaxicin 0.3% solution BID

6. Proxysmal nocturnal dyspnea
Augementin 2000/124 mg bid for 5-7 days - Peds: 90 mg/kg/day po in divided doses
HEENT: rhinoscopy - sinus tenderness - lymphnodes - transillumination of sinuses - CV and PULM.
Severe dyspnea when lying supine with associated wheezing and coughing - need to sit up abruptly due to severe dyspnea
Hardher and more turbulent

7. Rhinitis
Increased loudness of whispering during auscultation. Indicative of consolidation.
Bacterial or viral infection of the middle ear (secondary to URI [e.g. eustachian tube dysfunction])
Deep - snoring sound; indicates fluid or narrowing of airways; common in bronchitis and COPD
Inflammation of the nasal cavity

8. Orthopnea
Dyspnea when supine - relived by sitting or standing
Amoxicillin 1000 mg TID x7 days; Augmentin 2000/125mg BID x7 days
4-12 weeks
Increased loudness of whispering during auscultation. Indicative of consolidation.

9. Kussmal's respiration
Erythmatous auditory canal - crusting
Bacterial infection
Deep - rapid - labored - breathing
Bacterial or viral infection of the middle ear (secondary to URI [e.g. eustachian tube dysfunction])

10. Bronchophony
Afebrile viral infection of the the nose - paranasal sinuses - throat - larynx - trachea - and and bronchi.
Pulse ox; Peak expiratory flow; spirometry
Increased breath sounds or voice remains loud at the periphery during auscultation. Indicative of consolidation.
Dyspnea when supine - relived by sitting or standing

11. Rx nasal congestion?
Soft sounds in and out
Augementin 2000/124 mg bid for 5-7 days - Peds: 90 mg/kg/day po in divided doses
Decongestants (oxymetazoline); glucocorticoids (e.g. fluticasone); mucolytics (e.g. guaifensin)
Rebound congestion 3-5 days

12. Rx for rhinorrhea and/or allergies?
4-12 weeks
Labs: CBC - blood gas - d-dimer - CMP - BNP - Chest CT - MRI
Ipratroprium bromide (e.g. Atrovent); Antihistamines (Cargeul not to overly dry out muscos)
3 months to 3 years old

13. Abnormal pulmonary findings?
Amoxicillin 80-90mg/kg/day x7 days; Augmentin 90/6.4 mg/kg/day x7 days
Clubbing - Use of accessory muscles - barrel chest
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)

14. Rhinosinusitis History?
Nasal congestion - HA - sinus pain - fever - sore throat - cough
Step. pneumoniae; Haemophilus influenzae; group B-strep
Deep - rapid - labored - breathing
Erythmatous auditory canal - crusting

15. What are physical exam findings of AOM?
Purulent discharge - post nasal draiange; cough; sinus pressure - tooth pain; halitosis (changes in taste); alterations of smell
TM erythmatous - bulging - light reflex displaced - exudate
Aspirin: increases viral shedding
Soft sounds in and out

16. Which Rx should not be used for viral URI?
Ear ache - dullness - hearing loss - fever - N/V/D
High pitched sounds; can occur during inspiration or expiration; indicates narrow airways; can occur with asthma - COPD - pneumonia - CHF
Aspirin: increases viral shedding
Oflaxicin 0.3% solution BID

17. Sinusitis
Amoxicillin 1000 mg TID x7 days; Augmentin 2000/125mg BID x7 days
Inflammation of the paranasal sinuses
Measures speed of exhalation; results measure by age and weight
92-100%

18. Tx of sinusitis symptoms <10 days
Amoxicillin 80-90mg/kg/day x7 days; Augmentin 90/6.4 mg/kg/day x7 days
TM erythmatous - bulging - light reflex displaced - exudate
Symptomatic (steam; nasal irrigation); APAP for pain.
Fine or courses; secretions or aveolar collapse; normal if resovle with cough; abnormal: pneumonia; CHF; COPD; pilmonary fibrosis

19. Rhinosinusitis risk factors?
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 polyps - deviated septum - hx of trauma - surgery - foreign bodies or recent altitude changes
<4 weeks
Macrolides (azithormycin); Doxycycline; TMZ-SMZ

20. What are the symptoms of otitis?
Increased loudness of whispering during auscultation. Indicative of consolidation.
Ear ache - dullness - hearing loss - fever - N/V/D
24-72 hrs
Severe dyspnea when lying supine with associated wheezing and coughing - need to sit up abruptly due to severe dyspnea

21. What is the most common pathogen for otitis in newborns?
Ear ache - dullness - hearing loss - fever - N/V/D
E. coli
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
Clubbing - Use of accessory muscles - barrel chest

22. Special cases of sinusitis?
Symptomatic (steam; nasal irrigation); APAP for pain.
Persistent or relapse of infection - chronic sinusitis - fungal infection - extension in CNS (meningitis - orbital cellulitis - osteitis)
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

23. Subacute rhino-sinusitis duration of symptoms?
Rate; pattern (regular or irregular); effort (labored - accessory muscles)
3 months to 3 years old
4-12 weeks
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;

24. Alternative rx for bacterial sinusitis?
Macrolides (azithormycin); Doxycycline; TMZ-SMZ
Rhinovirus - influenza - parainfluenza
Amoxicillin 1000 mg TID x7 days; Augmentin 2000/125mg BID x7 days
Inflammation of the nasal cavity

25. Chronic rhino-sinusitis duration of symptoms?
Rhinovirus - influenza - and parainfluenza
Apena alternating with hyperpnea;
Amoxicillin 80-90mg/kg/day x7 days; Augmentin 90/6.4 mg/kg/day x7 days
>12 weeks

26. Spirometry
E. coli
High pitched voice sound due to transmission of noise across fluid. Indicative of effusion.
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
Ipratroprium bromide (e.g. Atrovent); Antihistamines (Cargeul not to overly dry out muscos)

27. Whispered pectoriloguy
Bacterial or viral infection of the middle ear (secondary to URI [e.g. eustachian tube dysfunction])
Pulse ox; Peak expiratory flow; spirometry
Warm - humid environment; rest;
Increased loudness of whispering during auscultation. Indicative of consolidation.

28. Additional pulmonary diagnostics
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
Clubbing - Use of accessory muscles - barrel chest
Labs: CBC - blood gas - d-dimer - CMP - BNP - Chest CT - MRI

29. What is the most common pahtogen for otitis media?
TM erythmatous - bulging - light reflex displaced - exudate
Rate; pattern (regular or irregular); effort (labored - accessory muscles)
High pitched voice sound due to transmission of noise across fluid. Indicative of effusion.
Step. pneumoniae; Haemophilus influenzae; group B-strep

30. Tx for adult AOM?
Fine or courses; secretions or aveolar collapse; normal if resovle with cough; abnormal: pneumonia; CHF; COPD; pilmonary fibrosis
Amoxicillin 1000 mg TID x7 days; Augmentin 2000/125mg BID x7 days
Deep - rapid - labored - breathing
Clubbing - Use of accessory muscles - barrel chest

31. What is the common side effect of sympathomimetics?
Clubbing - Use of accessory muscles - barrel chest
Rebound congestion 3-5 days
Increased breath sounds or voice remains loud at the periphery during auscultation. Indicative of consolidation.
Dyspnea when supine - relived by sitting or standing

32. Respiratory Illness Key Points (3)
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
Pulse ox; Peak expiratory flow; spirometry
Rhinovirus - influenza - and parainfluenza

33. Peak Expiratory Flow (PEF)
Rhinovirus - influenza - parainfluenza
Measures speed of exhalation; results measure by age and weight
Symptomatic (steam; nasal irrigation); APAP for pain.
Oflaxicin 0.3% solution BID

34. What sinusitis symptoms would warrant image studies?
Inflammation of the paranasal sinuses
Rebound congestion 3-5 days
Persistent; recurrent x4/yr; severe HA; altered mental status
Purulent discharge - post nasal draiange; cough; sinus pressure - tooth pain; halitosis (changes in taste); alterations of smell

35. Respiratory Examination (Observation)
Decongestants (oxymetazoline); glucocorticoids (e.g. fluticasone); mucolytics (e.g. guaifensin)
Rate; pattern (regular or irregular); effort (labored - accessory muscles)
TM erythmatous - bulging - light reflex displaced - exudate
Rebound congestion 3-5 days

36. Normal pulse ox
Macrolides (azithormycin); Doxycycline; TMZ-SMZ
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
92-100%
Clubbing - Use of accessory muscles - barrel chest

37. Stridor
Abnormal high pitched caused by blockage in upper airway; usually heard with with inspiration
Aspirin: Reye's Syndrome
Abrupt onset - burning nose or throat - sneezing - rhinorrhea
Nasal polyps - deviated septum - hx of trauma - surgery - foreign bodies or recent altitude changes

38. Pulmonary diagnostics (1)
Oflaxicin 0.3% solution BID
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
Ipratroprium bromide (e.g. Atrovent); Antihistamines (Cargeul not to overly dry out muscos)

39. Cheyne-stokes
Apena alternating with hyperpnea;
Afebrile viral infection of the the nose - paranasal sinuses - throat - larynx - trachea - and and bronchi.
Pulse ox; Peak expiratory flow; spirometry
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

40. Rhonchi
92-100%
Deep - snoring sound; indicates fluid or narrowing of airways; common in bronchitis and COPD
3 months to 3 years old
Afebrile viral infection of the the nose - paranasal sinuses - throat - larynx - trachea - and and bronchi.

41. Crackles (rales)
Fine or courses; secretions or aveolar collapse; normal if resovle with cough; abnormal: pneumonia; CHF; COPD; pilmonary fibrosis
Viral inoculation > viral rhinitis > infection of paranasal sinuses > inflammation & edema > mucosal edema - copious secretions - ciliary dyskinesia > sinus congestions and/or obstruction
Nasal polyps - deviated septum - hx of trauma - surgery - foreign bodies or recent altitude changes
Clubbing - Use of accessory muscles - barrel chest

42. Rhinosinusitis physical exam?
Viral inoculation > viral rhinitis > infection of paranasal sinuses > inflammation & edema > mucosal edema - copious secretions - ciliary dyskinesia > sinus congestions and/or obstruction
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;
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.

43. Bronchial breath sounds...
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
Macrolides (azithormycin); Doxycycline; TMZ-SMZ
Hardher and more turbulent

44. What does mucopurulent indications not indicate?
Fine or courses; secretions or aveolar collapse; normal if resovle with cough; abnormal: pneumonia; CHF; COPD; pilmonary fibrosis
Persistent or relapse of infection - chronic sinusitis - fungal infection - extension in CNS (meningitis - orbital cellulitis - osteitis)
Bacterial infection
Bacterial or viral infection of the middle ear (secondary to URI [e.g. eustachian tube dysfunction])

45. 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
Ipratroprium bromide (e.g. Atrovent); Antihistamines (Cargeul not to overly dry out muscos)
Step. pneumoniae; Haemophilus influenzae; group B-strep
Rhinovirus - influenza - parainfluenza

46. Common Cold (URI - Acute Coryza)
Clubbing - Use of accessory muscles - barrel chest
Rhinovirus - influenza - parainfluenza
Abnormal high pitched caused by blockage in upper airway; usually heard with with inspiration
Afebrile viral infection of the the nose - paranasal sinuses - throat - larynx - trachea - and and bronchi.

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

48. Nonpharmacological tx for viral URI
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;
Warm - humid environment; rest;
Inflammation of the nasal cavity
Rhinovirus - influenza - parainfluenza

49. 1st line treatment for bacterial sinusitis?
Augementin 2000/124 mg bid for 5-7 days - Peds: 90 mg/kg/day po in divided doses
Abnormal high pitched caused by blockage in upper airway; usually heard with with inspiration
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
Severe dyspnea when lying supine with associated wheezing and coughing - need to sit up abruptly due to severe dyspnea

50. Rx for viral URI?
Rate; pattern (regular or irregular); effort (labored - accessory muscles)
NSAIDs for aches - fever; Sympathomimetics: pseudophedrine or phenylephrine
Rhinovirus - influenza - parainfluenza
Hardher and more turbulent