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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. Wheezes
Purulent discharge - post nasal draiange; cough; sinus pressure - tooth pain; halitosis (changes in taste); alterations of smell
High pitched sounds; can occur during inspiration or expiration; indicates narrow airways; can occur with asthma - COPD - pneumonia - CHF
Dyspnea when supine - relived by sitting or standing
High pitched voice sound due to transmission of noise across fluid. Indicative of effusion.

2. Symptoms of acute bacterial rhino-sinusitis (ABRS)?
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
4-12 weeks
Increased breath sounds or voice remains loud at the periphery during auscultation. Indicative of consolidation.
Purulent discharge - post nasal draiange; cough; sinus pressure - tooth pain; halitosis (changes in taste); alterations of smell

3. Peak Expiratory Flow (PEF)
PE: rhinoscopy with otoscope
4-12 weeks
24-72 hrs
Measures speed of exhalation; results measure by age and weight

4. Tx for adult AOE?
Apena alternating with hyperpnea;
PE: rhinoscopy with otoscope
Oflaxicin 0.3% solution BID
Rhinovirus - influenza - and parainfluenza

5. Rhonchi
<4 weeks
Deep - snoring sound; indicates fluid or narrowing of airways; common in bronchitis and COPD
24-72 hrs
Bacterial or viral infection of the middle ear (secondary to URI [e.g. eustachian tube dysfunction])

6. Nonpharmacological tx for viral URI
3 months to 3 years old
Rhinovirus - influenza - and parainfluenza
Measures speed of exhalation; results measure by age and weight
Warm - humid environment; rest;

7. Common cold symptoms
Aspirin: increases viral shedding
Abrupt onset - burning nose or throat - sneezing - rhinorrhea
Symptomatic (steam; nasal irrigation); APAP for pain.
Ipratroprium bromide (e.g. Atrovent); Antihistamines (Cargeul not to overly dry out muscos)

8. Which Rx should not be used for viral URI?
Aspirin: increases viral shedding
Rebound congestion 3-5 days
3 months to 3 years old
Deep - rapid - labored - breathing

9. Rx for viral URI?
NSAIDs for aches - fever; Sympathomimetics: pseudophedrine or phenylephrine
Aspirin: increases viral shedding
HEENT: rhinoscopy - sinus tenderness - lymphnodes - transillumination of sinuses - CV and PULM.
3 months to 3 years old

10. Alternative rx for bacterial sinusitis?
Macrolides (azithormycin); Doxycycline; TMZ-SMZ
Erythmatous auditory canal - crusting
<4 weeks
TM erythmatous - bulging - light reflex displaced - exudate

11. Common Cold (URI - Acute Coryza)
Augementin 2000/124 mg bid for 5-7 days - Peds: 90 mg/kg/day po in divided doses
Nasal polyps - deviated septum - hx of trauma - surgery - foreign bodies or recent altitude changes
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
Afebrile viral infection of the the nose - paranasal sinuses - throat - larynx - trachea - and and bronchi.

12. Subacute rhino-sinusitis duration of symptoms?
Hardher and more turbulent
PE: rhinoscopy with otoscope
Decongestants (oxymetazoline); glucocorticoids (e.g. fluticasone); mucolytics (e.g. guaifensin)
4-12 weeks

13. Sinusitis
Ear ache - dullness - hearing loss - fever - N/V/D
High pitched voice sound due to transmission of noise across fluid. Indicative of effusion.
Inflammation of the paranasal sinuses
Inflammation of the nasal cavity

14. Physical exam of chest
Step. pneumoniae; Haemophilus influenzae; group B-strep
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
Inflammation of the paranasal sinuses

15. Special cases of sinusitis?
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)
Soft sounds in and out
Abnormal high pitched caused by blockage in upper airway; usually heard with with inspiration

16. Rhinosinusitis risk factors?
Nasal polyps - deviated septum - hx of trauma - surgery - foreign bodies or recent altitude changes
Oflaxicin 0.3% solution BID
NSAIDs for aches - fever; Sympathomimetics: pseudophedrine or phenylephrine
HEENT: rhinoscopy - sinus tenderness - lymphnodes - transillumination of sinuses - CV and PULM.

17. Bronchial breath sounds...
Hardher and more turbulent
Nasal congestion - HA - sinus pain - fever - sore throat - cough
92-100%
Aspirin: Reye's Syndrome

18. Pulmonary tests
Amoxicillin 80-90mg/kg/day x7 days; Augmentin 90/6.4 mg/kg/day x7 days
Fine or courses; secretions or aveolar collapse; normal if resovle with cough; abnormal: pneumonia; CHF; COPD; pilmonary fibrosis
<4 weeks
Pulse ox; Peak expiratory flow; spirometry

19. What is the most common pathogen for otitis in newborns?
Bacterial infection
E. coli
Pulse ox; Peak expiratory flow; spirometry
Severe dyspnea when lying supine with associated wheezing and coughing - need to sit up abruptly due to severe dyspnea

20. What is the common side effect of sympathomimetics?
92-100%
Rebound congestion 3-5 days
Bacterial or viral infection of the middle ear (secondary to URI [e.g. eustachian tube dysfunction])
TM erythmatous - bulging - light reflex displaced - exudate

21. Orthopnea
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
Dyspnea when supine - relived by sitting or standing
Hardher and more turbulent

22. What is the most common pahtogen for otitis media?
Erythmatous auditory canal - crusting
Aspirin: Reye's Syndrome
Step. pneumoniae; Haemophilus influenzae; group B-strep
Increased breath sounds or voice remains loud at the periphery during auscultation. Indicative of consolidation.

23. Normal pulse ox
HEENT: rhinoscopy - sinus tenderness - lymphnodes - transillumination of sinuses - CV and PULM.
Aspirin: Reye's Syndrome
Measures speed of exhalation; results measure by age and weight
92-100%

24. Bronchophony
Increased breath sounds or voice remains loud at the periphery during auscultation. Indicative of consolidation.
Deep - rapid - labored - breathing
Severe dyspnea when lying supine with associated wheezing and coughing - need to sit up abruptly due to severe dyspnea
Oflaxicin 0.3% solution BID

25. Acute viral rhino-sinusitis (AVRS) pathogens?
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
24-72 hrs
Rhinovirus - influenza - parainfluenza
Aspirin: Reye's Syndrome

26. Acute otitis media
Warm - humid environment; rest;
Symptomatic (steam; nasal irrigation); APAP for pain.
Bacterial or viral infection of the middle ear (secondary to URI [e.g. eustachian tube dysfunction])
Nasal polyps - deviated septum - hx of trauma - surgery - foreign bodies or recent altitude changes

27. Egophany (vocal resonance)
Dyspnea when supine - relived by sitting or standing
High pitched voice sound due to transmission of noise across fluid. Indicative of effusion.
24-72 hrs
Inflammation of the paranasal sinuses

28. Crackles (rales)
<4 weeks
Fine or courses; secretions or aveolar collapse; normal if resovle with cough; abnormal: pneumonia; CHF; COPD; pilmonary fibrosis
Soft sounds in and out
E. coli

29. Tx for pediatric AOM?
High pitched voice sound due to transmission of noise across fluid. Indicative of effusion.
Amoxicillin 80-90mg/kg/day x7 days; Augmentin 90/6.4 mg/kg/day x7 days
Amoxicillin 1000 mg TID x7 days; Augmentin 2000/125mg BID x7 days
Inflammation of the nasal cavity

30. Symptoms of viral rhinosinusitis
Clubbing - Use of accessory muscles - barrel chest
92-100%
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;
Fine or courses; secretions or aveolar collapse; normal if resovle with cough; abnormal: pneumonia; CHF; COPD; pilmonary fibrosis

31. What are physical exam findings of AOE?
Erythmatous auditory canal - crusting
Oflaxicin 0.3% solution BID
Increased breath sounds or voice remains loud at the periphery during auscultation. Indicative of consolidation.
Aspirin: increases viral shedding

32. Pulmonary diagnostics (1)
High pitched voice sound due to transmission of noise across fluid. Indicative of effusion.
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
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
Rhinovirus - influenza - parainfluenza

33. Cheyne-stokes
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;
Dyspnea when supine - relived by sitting or standing
NSAIDs for aches - fever; Sympathomimetics: pseudophedrine or phenylephrine
Apena alternating with hyperpnea;

34. What does mucopurulent indications not indicate?
Amoxicillin 80-90mg/kg/day x7 days; Augmentin 90/6.4 mg/kg/day x7 days
Bacterial infection
Ear ache - dullness - hearing loss - fever - N/V/D
Fine or courses; secretions or aveolar collapse; normal if resovle with cough; abnormal: pneumonia; CHF; COPD; pilmonary fibrosis

35. Spirometry
Macrolides (azithormycin); Doxycycline; TMZ-SMZ
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
Rhinovirus - influenza - parainfluenza
Increased loudness of whispering during auscultation. Indicative of consolidation.

36. Kussmal's respiration
Deep - rapid - labored - breathing
Severe dyspnea when lying supine with associated wheezing and coughing - need to sit up abruptly due to severe dyspnea
92-100%
Ear ache - dullness - hearing loss - fever - N/V/D

37. Vesicular breath sounds...
HEENT: rhinoscopy - sinus tenderness - lymphnodes - transillumination of sinuses - CV and PULM.
Amoxicillin 1000 mg TID x7 days; Augmentin 2000/125mg BID x7 days
Soft sounds in and out
Increased loudness of whispering during auscultation. Indicative of consolidation.

38. Tx of sinusitis symptoms <10 days
Symptomatic (steam; nasal irrigation); APAP for pain.
PE: rhinoscopy with otoscope
Ipratroprium bromide (e.g. Atrovent); Antihistamines (Cargeul not to overly dry out muscos)
Deep - rapid - labored - breathing

39. Respiratory Examination (Observation)
Rate; pattern (regular or irregular); effort (labored - accessory muscles)
Ipratroprium bromide (e.g. Atrovent); Antihistamines (Cargeul not to overly dry out muscos)
Augementin 2000/124 mg bid for 5-7 days - Peds: 90 mg/kg/day po in divided doses
Nasal polyps - deviated septum - hx of trauma - surgery - foreign bodies or recent altitude changes

40. Rhinitis
Inflammation of the nasal cavity
24-72 hrs
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
Oflaxicin 0.3% solution BID

41. What sinusitis symptoms would warrant image studies?
High pitched sounds; can occur during inspiration or expiration; indicates narrow airways; can occur with asthma - COPD - pneumonia - CHF
Erythmatous auditory canal - crusting
Persistent; recurrent x4/yr; severe HA; altered mental status
Clubbing - Use of accessory muscles - barrel chest

42. Rx nasal congestion?
E. coli
Hardher and more turbulent
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

43. What is most common age range for otitis?
Bacterial or viral infection of the middle ear (secondary to URI [e.g. eustachian tube dysfunction])
Abnormal high pitched caused by blockage in upper airway; usually heard with with inspiration
3 months to 3 years old
Ipratroprium bromide (e.g. Atrovent); Antihistamines (Cargeul not to overly dry out muscos)

44. Respiratory Illness Key Points (3)
Rhinovirus - influenza - parainfluenza
Step. pneumoniae; Haemophilus influenzae; group B-strep
Bacterial infection
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

45. Whispered pectoriloguy
Increased loudness of whispering during auscultation. Indicative of consolidation.
Hardher and more turbulent
Warm - humid environment; rest;
PE: rhinoscopy with otoscope

46. Cold incubation period
Increased loudness of whispering during auscultation. Indicative of consolidation.
Clubbing - Use of accessory muscles - barrel chest
24-72 hrs
Measures speed of exhalation; results measure by age and weight

47. Rhinosinusitis History?
Soft sounds in and out
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
Fine or courses; secretions or aveolar collapse; normal if resovle with cough; abnormal: pneumonia; CHF; COPD; pilmonary fibrosis
Nasal congestion - HA - sinus pain - fever - sore throat - cough

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

49. What are the symptoms of otitis?
Ear ache - dullness - hearing loss - fever - N/V/D
Rhinovirus - influenza - and parainfluenza
Nasal polyps - deviated septum - hx of trauma - surgery - foreign bodies or recent altitude changes
Apena alternating with hyperpnea;

50. Abnormal pulmonary findings?
Increased loudness of whispering during auscultation. Indicative of consolidation.
Decongestants (oxymetazoline); glucocorticoids (e.g. fluticasone); mucolytics (e.g. guaifensin)
Clubbing - Use of accessory muscles - barrel chest
Amoxicillin 1000 mg TID x7 days; Augmentin 2000/125mg BID x7 days