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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. What are physical exam findings of AOM?
Symptomatic (steam; nasal irrigation); APAP for pain.
TM erythmatous - bulging - light reflex displaced - exudate
Increased breath sounds or voice remains loud at the periphery during auscultation. Indicative of consolidation.
Augementin 2000/124 mg bid for 5-7 days - Peds: 90 mg/kg/day po in divided doses

2. Acute otitis media
Bacterial or viral infection of the middle ear (secondary to URI [e.g. eustachian tube dysfunction])
Pulse ox; Peak expiratory flow; spirometry
Rate; pattern (regular or irregular); effort (labored - accessory muscles)
Clubbing - Use of accessory muscles - barrel chest

3. Kussmal's respiration
Amoxicillin 80-90mg/kg/day x7 days; Augmentin 90/6.4 mg/kg/day x7 days
Deep - rapid - labored - breathing
Fine or courses; secretions or aveolar collapse; normal if resovle with cough; abnormal: pneumonia; CHF; COPD; pilmonary fibrosis
Erythmatous auditory canal - crusting

4. Bronchial breath sounds...
Hardher and more turbulent
<4 weeks
Rhinovirus - influenza - parainfluenza
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

5. Chronic rhino-sinusitis duration of symptoms?
High pitched sounds; can occur during inspiration or expiration; indicates narrow airways; can occur with asthma - COPD - pneumonia - CHF
>12 weeks
Macrolides (azithormycin); Doxycycline; TMZ-SMZ
Hardher and more turbulent

6. Symptoms of acute bacterial rhino-sinusitis (ABRS)?
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
Purulent discharge - post nasal draiange; cough; sinus pressure - tooth pain; halitosis (changes in taste); alterations of smell
Step. pneumoniae; Haemophilus influenzae; group B-strep

7. What is the most common pathogen for otitis in newborns?
E. coli
Afebrile viral infection of the the nose - paranasal sinuses - throat - larynx - trachea - and and bronchi.
Bacterial infection
Apena alternating with hyperpnea;

8. Rhinosinusitis risk factors?
Nasal polyps - deviated septum - hx of trauma - surgery - foreign bodies or recent altitude changes
Bacterial infection
Nasal congestion - HA - sinus pain - fever - sore throat - cough
Rhinovirus - influenza - and parainfluenza

9. Common cold pathogens
Step. pneumoniae; Haemophilus influenzae; group B-strep
Rhinovirus - influenza - and parainfluenza
Fine or courses; secretions or aveolar collapse; normal if resovle with cough; abnormal: pneumonia; CHF; COPD; pilmonary fibrosis
Nasal polyps - deviated septum - hx of trauma - surgery - foreign bodies or recent altitude changes

10. Nonpharmacological tx for viral URI
Step. pneumoniae; Haemophilus influenzae; group B-strep
Ipratroprium bromide (e.g. Atrovent); Antihistamines (Cargeul not to overly dry out muscos)
High pitched voice sound due to transmission of noise across fluid. Indicative of effusion.
Warm - humid environment; rest;

11. Proxysmal nocturnal dyspnea
>12 weeks
<4 weeks
Severe dyspnea when lying supine with associated wheezing and coughing - need to sit up abruptly due to severe dyspnea
4-12 weeks

12. 1st line treatment for bacterial sinusitis?
Measures speed of exhalation; results measure by age and weight
Augementin 2000/124 mg bid for 5-7 days - Peds: 90 mg/kg/day po in divided doses
Rhinovirus - influenza - and parainfluenza
Deep - rapid - labored - breathing

13. Physical exam of chest
Aspirin: increases viral shedding
Amoxicillin 80-90mg/kg/day x7 days; Augmentin 90/6.4 mg/kg/day x7 days
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
Erythmatous auditory canal - crusting

14. What is most common age range for otitis?
Nasal congestion - HA - sinus pain - fever - sore throat - cough
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
E. coli
3 months to 3 years old

15. Rx for viral URI?
Viral inoculation > viral rhinitis > infection of paranasal sinuses > inflammation & edema > mucosal edema - copious secretions - ciliary dyskinesia > sinus congestions and/or obstruction
Pulse ox; Peak expiratory flow; spirometry
NSAIDs for aches - fever; Sympathomimetics: pseudophedrine or phenylephrine
Bacterial or viral infection of the middle ear (secondary to URI [e.g. eustachian tube dysfunction])

16. Normal pulse ox
E. coli
92-100%
Soft sounds in and out
3 months to 3 years old

17. Symptoms of viral rhinosinusitis
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;
Amoxicillin 1000 mg TID x7 days; Augmentin 2000/125mg BID x7 days
Fine or courses; secretions or aveolar collapse; normal if resovle with cough; abnormal: pneumonia; CHF; COPD; pilmonary fibrosis

18. Orthopnea
Rhinovirus - influenza - parainfluenza
Rate; pattern (regular or irregular); effort (labored - accessory muscles)
Dyspnea when supine - relived by sitting or standing
Symptomatic (steam; nasal irrigation); APAP for pain.

19. Tx of sinusitis symptoms <10 days
Erythmatous auditory canal - crusting
Dyspnea when supine - relived by sitting or standing
Symptomatic (steam; nasal irrigation); APAP for pain.
Soft sounds in and out

20. Which Rx should not be used for viral URI?
Macrolides (azithormycin); Doxycycline; TMZ-SMZ
Aspirin: increases viral shedding
PE: rhinoscopy with otoscope
>12 weeks

21. What are physical exam findings of AOE?
Symptomatic (steam; nasal irrigation); APAP for pain.
Step. pneumoniae; Haemophilus influenzae; group B-strep
Rhinovirus - influenza - and parainfluenza
Erythmatous auditory canal - crusting

22. Egophany (vocal resonance)
Measures speed of exhalation; results measure by age and weight
High pitched voice sound due to transmission of noise across fluid. Indicative of effusion.
NSAIDs for aches - fever; Sympathomimetics: pseudophedrine or phenylephrine
Inflammation of the paranasal sinuses

23. Alternative rx for bacterial sinusitis?
Inflammation of the paranasal sinuses
Macrolides (azithormycin); Doxycycline; TMZ-SMZ
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 loudness of whispering during auscultation. Indicative of consolidation.

24. Cheyne-stokes
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
Apena alternating with hyperpnea;
3 months to 3 years old
Erythmatous auditory canal - crusting

25. Vesicular breath sounds...
Fine or courses; secretions or aveolar collapse; normal if resovle with cough; abnormal: pneumonia; CHF; COPD; pilmonary fibrosis
Ear ache - dullness - hearing loss - fever - N/V/D
Rate; pattern (regular or irregular); effort (labored - accessory muscles)
Soft sounds in and out

26. Special cases of sinusitis?
Ipratroprium bromide (e.g. Atrovent); Antihistamines (Cargeul not to overly dry out muscos)
Amoxicillin 80-90mg/kg/day x7 days; Augmentin 90/6.4 mg/kg/day x7 days
Persistent or relapse of infection - chronic sinusitis - fungal infection - extension in CNS (meningitis - orbital cellulitis - osteitis)
Amoxicillin 1000 mg TID x7 days; Augmentin 2000/125mg BID x7 days

27. Bronchophony
Increased loudness of whispering during auscultation. Indicative of consolidation.
High pitched voice sound due to transmission of noise across fluid. Indicative of effusion.
Increased breath sounds or voice remains loud at the periphery during auscultation. Indicative of consolidation.
Inflammation of the paranasal sinuses

28. What sinusitis symptoms would warrant image studies?
Inflammation of the paranasal sinuses
Persistent; recurrent x4/yr; severe HA; altered mental status
Labs: CBC - blood gas - d-dimer - CMP - BNP - Chest CT - MRI
E. coli

29. Rhinosinusitis History?
Nasal congestion - HA - sinus pain - fever - sore throat - cough
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
TM erythmatous - bulging - light reflex displaced - exudate
Afebrile viral infection of the the nose - paranasal sinuses - throat - larynx - trachea - and and bronchi.

30. Common cold symptoms
Step. pneumoniae; Haemophilus influenzae; group B-strep
Measures speed of exhalation; results measure by age and weight
Abrupt onset - burning nose or throat - sneezing - rhinorrhea
Pulse ox; Peak expiratory flow; spirometry

31. Rhinosinusitis physical exam?
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
HEENT: rhinoscopy - sinus tenderness - lymphnodes - transillumination of sinuses - CV and PULM.
Measures speed of exhalation; results measure by age and weight
Rhinovirus - influenza - and parainfluenza

32. Crackles (rales)
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)
Dyspnea when supine - relived by sitting or standing
Rhinovirus - influenza - and parainfluenza

33. What does mucopurulent indications not indicate?
Bacterial infection
E. coli
Nasal polyps - deviated septum - hx of trauma - surgery - foreign bodies or recent altitude changes
Warm - humid environment; rest;

34. Acute rhino-sinusitis duration of symptoms?
Increased breath sounds or voice remains loud at the periphery during auscultation. Indicative of consolidation.
<4 weeks
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
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

35. Sinusitis
4-12 weeks
Amoxicillin 1000 mg TID x7 days; Augmentin 2000/125mg BID x7 days
Rhinovirus - influenza - and parainfluenza
Inflammation of the paranasal sinuses

36. Pulmonary tests
Persistent or relapse of infection - chronic sinusitis - fungal infection - extension in CNS (meningitis - orbital cellulitis - osteitis)
Nasal congestion - HA - sinus pain - fever - sore throat - cough
Pulse ox; Peak expiratory flow; spirometry
Apena alternating with hyperpnea;

37. Diagnostics of sinusitis?
Dyspnea when supine - relived by sitting or standing
Deep - rapid - labored - breathing
Warm - humid environment; rest;
PE: rhinoscopy with otoscope

38. Tx for pediatric AOM?
Oflaxicin 0.3% solution BID
Amoxicillin 80-90mg/kg/day x7 days; Augmentin 90/6.4 mg/kg/day x7 days
Rate; pattern (regular or irregular); effort (labored - accessory muscles)
Labs: CBC - blood gas - d-dimer - CMP - BNP - Chest CT - MRI

39. Cold incubation period
Bacterial infection
24-72 hrs
Abrupt onset - burning nose or throat - sneezing - rhinorrhea
Rhinovirus - influenza - and parainfluenza

40. Pathophysiology of rhino sinusitis?
Nasal polyps - deviated septum - hx of trauma - surgery - foreign bodies or recent altitude changes
Viral inoculation > viral rhinitis > infection of paranasal sinuses > inflammation & edema > mucosal edema - copious secretions - ciliary dyskinesia > sinus congestions and/or obstruction
Purulent discharge - post nasal draiange; cough; sinus pressure - tooth pain; halitosis (changes in taste); alterations of smell
Nasal congestion - HA - sinus pain - fever - sore throat - cough

41. Rhonchi
Erythmatous auditory canal - crusting
Deep - snoring sound; indicates fluid or narrowing of airways; common in bronchitis and COPD
Warm - humid environment; rest;
4-12 weeks

42. Tx for adult AOE?
Decongestants (oxymetazoline); glucocorticoids (e.g. fluticasone); mucolytics (e.g. guaifensin)
Deep - snoring sound; indicates fluid or narrowing of airways; common in bronchitis and COPD
Viral inoculation > viral rhinitis > infection of paranasal sinuses > inflammation & edema > mucosal edema - copious secretions - ciliary dyskinesia > sinus congestions and/or obstruction
Oflaxicin 0.3% solution BID

43. Acute viral rhino-sinusitis (AVRS) pathogens?
E. coli
Rhinovirus - influenza - parainfluenza
Aspirin: increases viral shedding
High pitched sounds; can occur during inspiration or expiration; indicates narrow airways; can occur with asthma - COPD - pneumonia - CHF

44. Pulmonary diagnostics (1)
Nasal polyps - deviated septum - hx of trauma - surgery - foreign bodies or recent altitude changes
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
Erythmatous auditory canal - crusting
Amoxicillin 1000 mg TID x7 days; Augmentin 2000/125mg BID x7 days

45. Common Cold (URI - Acute Coryza)
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
Afebrile viral infection of the the nose - paranasal sinuses - throat - larynx - trachea - and and bronchi.
3 months to 3 years old

46. Rhinitis
Ear ache - dullness - hearing loss - fever - N/V/D
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
Inflammation of the nasal cavity
Pulse ox; Peak expiratory flow; spirometry

47. Rx for rhinorrhea and/or allergies?
Hardher and more turbulent
Measures speed of exhalation; results measure by age and weight
Ipratroprium bromide (e.g. Atrovent); Antihistamines (Cargeul not to overly dry out muscos)
HEENT: rhinoscopy - sinus tenderness - lymphnodes - transillumination of sinuses - CV and PULM.

48. Additional pulmonary diagnostics
Bacterial infection
High pitched sounds; can occur during inspiration or expiration; indicates narrow airways; can occur with asthma - COPD - pneumonia - CHF
Aspirin: increases viral shedding
Labs: CBC - blood gas - d-dimer - CMP - BNP - Chest CT - MRI

49. Wheezes
Deep - snoring sound; indicates fluid or narrowing of airways; common in bronchitis and COPD
Ipratroprium bromide (e.g. Atrovent); Antihistamines (Cargeul not to overly dry out muscos)
High pitched sounds; can occur during inspiration or expiration; indicates narrow airways; can occur with asthma - COPD - pneumonia - CHF
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

50. 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
Deep - rapid - labored - breathing
Symptomatic (steam; nasal irrigation); APAP for pain.
Abrupt onset - burning nose or throat - sneezing - rhinorrhea