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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. What sinusitis symptoms would warrant image studies?
Oflaxicin 0.3% solution BID
Persistent; recurrent x4/yr; severe HA; altered mental status
Rhinovirus - influenza - parainfluenza
92-100%

2. Tx of sinusitis symptoms <10 days
Inflammation of the nasal cavity
<4 weeks
3 months to 3 years old
Symptomatic (steam; nasal irrigation); APAP for pain.

3. Rx for rhinorrhea and/or allergies?
Warm - humid environment; rest;
Ipratroprium bromide (e.g. Atrovent); Antihistamines (Cargeul not to overly dry out muscos)
Labs: CBC - blood gas - d-dimer - CMP - BNP - Chest CT - MRI
Rhinovirus - influenza - parainfluenza

4. Common cold pathogens
High pitched voice sound due to transmission of noise across fluid. Indicative of effusion.
92-100%
HEENT: rhinoscopy - sinus tenderness - lymphnodes - transillumination of sinuses - CV and PULM.
Rhinovirus - influenza - and parainfluenza

5. Stridor
Nasal congestion - HA - sinus pain - fever - sore throat - cough
Erythmatous auditory canal - crusting
3 months to 3 years old
Abnormal high pitched caused by blockage in upper airway; usually heard with with inspiration

6. Acute rhino-sinusitis duration of symptoms?
Clubbing - Use of accessory muscles - barrel chest
Severe dyspnea when lying supine with associated wheezing and coughing - need to sit up abruptly due to severe dyspnea
<4 weeks
HEENT: rhinoscopy - sinus tenderness - lymphnodes - transillumination of sinuses - CV and PULM.

7. Bronchial breath sounds...
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)
Nasal polyps - deviated septum - hx of trauma - surgery - foreign bodies or recent altitude changes
Hardher and more turbulent

8. Egophany (vocal resonance)
Amoxicillin 1000 mg TID x7 days; Augmentin 2000/125mg BID x7 days
Symptomatic (steam; nasal irrigation); APAP for pain.
High pitched voice sound due to transmission of noise across fluid. Indicative of effusion.
High pitched sounds; can occur during inspiration or expiration; indicates narrow airways; can occur with asthma - COPD - pneumonia - CHF

9. 1st line treatment for bacterial sinusitis?
TM erythmatous - bulging - light reflex displaced - exudate
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.
Nasal polyps - deviated septum - hx of trauma - surgery - foreign bodies or recent altitude changes

10. Cheyne-stokes
Purulent discharge - post nasal draiange; cough; sinus pressure - tooth pain; halitosis (changes in taste); alterations of smell
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
Apena alternating with hyperpnea;

11. Pulmonary diagnostics (1)
Aspirin: increases viral shedding
Hardher and more turbulent
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
Step. pneumoniae; Haemophilus influenzae; group B-strep

12. Common Cold (URI - Acute Coryza)
>12 weeks
Dyspnea when supine - relived by sitting or standing
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.

13. Rhinitis
92-100%
Nasal polyps - deviated septum - hx of trauma - surgery - foreign bodies or recent altitude changes
Inflammation of the nasal cavity
Warm - humid environment; rest;

14. Tx for adult AOE?
Bacterial infection
Rebound congestion 3-5 days
Oflaxicin 0.3% solution BID
Decongestants (oxymetazoline); glucocorticoids (e.g. fluticasone); mucolytics (e.g. guaifensin)

15. What is the most common pahtogen for otitis media?
Step. pneumoniae; Haemophilus influenzae; group B-strep
Severe dyspnea when lying supine with associated wheezing and coughing - need to sit up abruptly due to severe dyspnea
Increased breath sounds or voice remains loud at the periphery during auscultation. Indicative of consolidation.
Symptomatic (steam; nasal irrigation); APAP for pain.

16. Bronchophony
Aspirin: Reye's Syndrome
Increased breath sounds or voice remains loud at the periphery during auscultation. Indicative of consolidation.
Amoxicillin 80-90mg/kg/day x7 days; Augmentin 90/6.4 mg/kg/day x7 days
Rhinovirus - influenza - parainfluenza

17. Chronic rhino-sinusitis duration of symptoms?
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
Augementin 2000/124 mg bid for 5-7 days - Peds: 90 mg/kg/day po in divided doses
>12 weeks
Aspirin: Reye's Syndrome

18. Acute viral rhino-sinusitis (AVRS) pathogens?
Ipratroprium bromide (e.g. Atrovent); Antihistamines (Cargeul not to overly dry out muscos)
Rhinovirus - influenza - parainfluenza
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;
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

19. Peak Expiratory Flow (PEF)
Measures speed of exhalation; results measure by age and weight
Persistent; recurrent x4/yr; severe HA; altered mental status
Bacterial infection
Inflammation of the nasal cavity

20. Tx for adult AOM?
Bacterial infection
Amoxicillin 1000 mg TID x7 days; Augmentin 2000/125mg BID x7 days
Rhinovirus - influenza - and parainfluenza
Persistent; recurrent x4/yr; severe HA; altered mental status

21. Nonpharmacological tx for viral URI
Symptomatic (steam; nasal irrigation); APAP for pain.
Abrupt onset - burning nose or throat - sneezing - rhinorrhea
Increased loudness of whispering during auscultation. Indicative of consolidation.
Warm - humid environment; rest;

22. Which Rx should not be used for viral URI?
Abrupt onset - burning nose or throat - sneezing - rhinorrhea
PE: rhinoscopy with otoscope
Aspirin: increases viral shedding
Deep - snoring sound; indicates fluid or narrowing of airways; common in bronchitis and COPD

23. Pathophysiology of rhino sinusitis?
Decongestants (oxymetazoline); glucocorticoids (e.g. fluticasone); mucolytics (e.g. guaifensin)
Nasal congestion - HA - sinus pain - fever - sore throat - cough
Viral inoculation > viral rhinitis > infection of paranasal sinuses > inflammation & edema > mucosal edema - copious secretions - ciliary dyskinesia > sinus congestions and/or obstruction
Amoxicillin 1000 mg TID x7 days; Augmentin 2000/125mg BID x7 days

24. Pulmonary tests
Decongestants (oxymetazoline); glucocorticoids (e.g. fluticasone); mucolytics (e.g. guaifensin)
Severe dyspnea when lying supine with associated wheezing and coughing - need to sit up abruptly due to severe dyspnea
Augementin 2000/124 mg bid for 5-7 days - Peds: 90 mg/kg/day po in divided doses
Pulse ox; Peak expiratory flow; spirometry

25. Subacute rhino-sinusitis duration of symptoms?
Ear ache - dullness - hearing loss - fever - N/V/D
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
High pitched sounds; can occur during inspiration or expiration; indicates narrow airways; can occur with asthma - COPD - pneumonia - CHF

26. Physical exam of chest
NSAIDs for aches - fever; Sympathomimetics: pseudophedrine or phenylephrine
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
Deep - snoring sound; indicates fluid or narrowing of airways; common in bronchitis and COPD

27. Common cold symptoms
Warm - humid environment; rest;
Afebrile viral infection of the the nose - paranasal sinuses - throat - larynx - trachea - and and bronchi.
Dyspnea when supine - relived by sitting or standing
Abrupt onset - burning nose or throat - sneezing - rhinorrhea

28. Symptoms of viral rhinosinusitis
Rate; pattern (regular or irregular); effort (labored - accessory muscles)
Symptomatic (steam; nasal irrigation); APAP for pain.
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;
Bacterial or viral infection of the middle ear (secondary to URI [e.g. eustachian tube dysfunction])

29. What are physical exam findings of AOM?
Rate; pattern (regular or irregular); effort (labored - accessory muscles)
TM erythmatous - bulging - light reflex displaced - exudate
Bacterial infection
Decongestants (oxymetazoline); glucocorticoids (e.g. fluticasone); mucolytics (e.g. guaifensin)

30. Rhinosinusitis History?
High pitched voice sound due to transmission of noise across fluid. Indicative of effusion.
Nasal congestion - HA - sinus pain - fever - sore throat - cough
24-72 hrs
Persistent; recurrent x4/yr; severe HA; altered mental status

31. Sinusitis
Aspirin: Reye's Syndrome
Soft sounds in and out
Inflammation of the paranasal sinuses
Severe dyspnea when lying supine with associated wheezing and coughing - need to sit up abruptly due to severe dyspnea

32. Alternative rx for bacterial sinusitis?
Macrolides (azithormycin); Doxycycline; TMZ-SMZ
Pulse ox; Peak expiratory flow; spirometry
Symptomatic (steam; nasal irrigation); APAP for pain.
Rebound congestion 3-5 days

33. What is most common age range for otitis?
TM erythmatous - bulging - light reflex displaced - exudate
3 months to 3 years old
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.

34. Crackles (rales)
Aspirin: Reye's Syndrome
Severe dyspnea when lying supine with associated wheezing and coughing - need to sit up abruptly due to severe dyspnea
HEENT: rhinoscopy - sinus tenderness - lymphnodes - transillumination of sinuses - CV and PULM.
Fine or courses; secretions or aveolar collapse; normal if resovle with cough; abnormal: pneumonia; CHF; COPD; pilmonary fibrosis

35. Acute otitis media
Clubbing - Use of accessory muscles - barrel chest
Inflammation of the nasal cavity
Bacterial or viral infection of the middle ear (secondary to URI [e.g. eustachian tube dysfunction])
>12 weeks

36. Spirometry
Amoxicillin 1000 mg TID x7 days; Augmentin 2000/125mg BID x7 days
Inflammation of the paranasal sinuses
Rhinovirus - influenza - and parainfluenza
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

37. Respiratory Illness Key Points (3)
Rhinovirus - influenza - parainfluenza
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
TM erythmatous - bulging - light reflex displaced - exudate
Bacterial or viral infection of the middle ear (secondary to URI [e.g. eustachian tube dysfunction])

38. Proxysmal nocturnal dyspnea
Bacterial infection
NSAIDs for aches - fever; Sympathomimetics: pseudophedrine or phenylephrine
Severe dyspnea when lying supine with associated wheezing and coughing - need to sit up abruptly due to severe dyspnea
Warm - humid environment; rest;

39. Rhonchi
Deep - rapid - labored - breathing
Warm - humid environment; rest;
Inflammation of the paranasal sinuses
Deep - snoring sound; indicates fluid or narrowing of airways; common in bronchitis and COPD

40. Vesicular breath sounds...
Soft sounds in and out
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
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

41. Orthopnea
Persistent or relapse of infection - chronic sinusitis - fungal infection - extension in CNS (meningitis - orbital cellulitis - osteitis)
Dyspnea when supine - relived by sitting or standing
4-12 weeks
Fine or courses; secretions or aveolar collapse; normal if resovle with cough; abnormal: pneumonia; CHF; COPD; pilmonary fibrosis

42. What does mucopurulent indications not indicate?
Bacterial infection
Warm - humid environment; rest;
Erythmatous auditory canal - crusting
Step. pneumoniae; Haemophilus influenzae; group B-strep

43. Symptoms of acute bacterial rhino-sinusitis (ABRS)?
Purulent discharge - post nasal draiange; cough; sinus pressure - tooth pain; halitosis (changes in taste); alterations of smell
Inflammation of the nasal cavity
<4 weeks
Abrupt onset - burning nose or throat - sneezing - rhinorrhea

44. 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
Deep - snoring sound; indicates fluid or narrowing of airways; common in bronchitis and COPD
Deep - rapid - labored - breathing
Apena alternating with hyperpnea;

45. Additional pulmonary diagnostics
Rhinovirus - influenza - parainfluenza
Labs: CBC - blood gas - d-dimer - CMP - BNP - Chest CT - MRI
3 months to 3 years old
Rhinovirus - influenza - and parainfluenza

46. What are physical exam findings of AOE?
Clubbing - Use of accessory muscles - barrel chest
Pulse ox; Peak expiratory flow; spirometry
TM erythmatous - bulging - light reflex displaced - exudate
Erythmatous auditory canal - crusting

47. Rx nasal congestion?
Decongestants (oxymetazoline); glucocorticoids (e.g. fluticasone); mucolytics (e.g. guaifensin)
Persistent or relapse of infection - chronic sinusitis - fungal infection - extension in CNS (meningitis - orbital cellulitis - osteitis)
Ipratroprium bromide (e.g. Atrovent); Antihistamines (Cargeul not to overly dry out muscos)
4-12 weeks

48. Special cases of sinusitis?
Clubbing - Use of accessory muscles - barrel chest
Ear ache - dullness - hearing loss - fever - N/V/D
Persistent or relapse of infection - chronic sinusitis - fungal infection - extension in CNS (meningitis - orbital cellulitis - osteitis)
Labs: CBC - blood gas - d-dimer - CMP - BNP - Chest CT - MRI

49. What is the most common pathogen for otitis in newborns?
Increased loudness of whispering during auscultation. Indicative of consolidation.
E. coli
Oflaxicin 0.3% solution BID
NSAIDs for aches - fever; Sympathomimetics: pseudophedrine or phenylephrine

50. Normal pulse ox
Rhinovirus - influenza - and parainfluenza
Dyspnea when supine - relived by sitting or standing
92-100%
Bacterial or viral infection of the middle ear (secondary to URI [e.g. eustachian tube dysfunction])