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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. Rhinosinusitis History?
Increased breath sounds or voice remains loud at the periphery during auscultation. Indicative of consolidation.
Nasal polyps - deviated septum - hx of trauma - surgery - foreign bodies or recent altitude changes
Rate; pattern (regular or irregular); effort (labored - accessory muscles)
Nasal congestion - HA - sinus pain - fever - sore throat - cough

2. Special cases of sinusitis?
Erythmatous auditory canal - crusting
E. coli
High pitched sounds; can occur during inspiration or expiration; indicates narrow airways; can occur with asthma - COPD - pneumonia - CHF
Persistent or relapse of infection - chronic sinusitis - fungal infection - extension in CNS (meningitis - orbital cellulitis - osteitis)

3. Rhinitis
4-12 weeks
Inflammation of the nasal cavity
Labs: CBC - blood gas - d-dimer - CMP - BNP - Chest CT - MRI
Warm - humid environment; rest;

4. Tx for adult AOE?
Oflaxicin 0.3% solution BID
3 months to 3 years old
Dyspnea when supine - relived by sitting or standing
Symptomatic (steam; nasal irrigation); APAP for pain.

5. Tx for adult AOM?
Rhinovirus - influenza - and parainfluenza
PE: rhinoscopy with otoscope
92-100%
Amoxicillin 1000 mg TID x7 days; Augmentin 2000/125mg BID x7 days

6. Sinusitis
Aspirin: Reye's Syndrome
Oflaxicin 0.3% solution BID
Inflammation of the paranasal sinuses
Apena alternating with hyperpnea;

7. Cheyne-stokes
Apena alternating with hyperpnea;
Afebrile viral infection of the the nose - paranasal sinuses - throat - larynx - trachea - and and bronchi.
Rhinovirus - influenza - and parainfluenza
Inflammation of the nasal cavity

8. Nonpharmacological tx for viral URI
Warm - humid environment; rest;
Rebound congestion 3-5 days
Bacterial or viral infection of the middle ear (secondary to URI [e.g. eustachian tube dysfunction])
Inflammation of the paranasal sinuses

9. Acute rhino-sinusitis duration of symptoms?
<4 weeks
Abnormal high pitched caused by blockage in upper airway; usually heard with with inspiration
Rate; pattern (regular or irregular); effort (labored - accessory muscles)
Deep - snoring sound; indicates fluid or narrowing of airways; common in bronchitis and COPD

10. 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
Bacterial infection
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;
High pitched sounds; can occur during inspiration or expiration; indicates narrow airways; can occur with asthma - COPD - pneumonia - CHF

11. Tx of sinusitis symptoms <10 days
24-72 hrs
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
PE: rhinoscopy with otoscope
Symptomatic (steam; nasal irrigation); APAP for pain.

12. Pulmonary diagnostics (1)
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
Persistent; recurrent x4/yr; severe HA; altered mental status
Rhinovirus - influenza - and parainfluenza

13. Proxysmal nocturnal dyspnea
Inflammation of the paranasal sinuses
Oflaxicin 0.3% solution BID
Severe dyspnea when lying supine with associated wheezing and coughing - need to sit up abruptly due to severe dyspnea
Measures speed of exhalation; results measure by age and weight

14. Rx nasal congestion?
Warm - humid environment; rest;
Bacterial infection
Soft sounds in and out
Decongestants (oxymetazoline); glucocorticoids (e.g. fluticasone); mucolytics (e.g. guaifensin)

15. Bronchophony
Labs: CBC - blood gas - d-dimer - CMP - BNP - Chest CT - MRI
Persistent or relapse of infection - chronic sinusitis - fungal infection - extension in CNS (meningitis - orbital cellulitis - osteitis)
Increased breath sounds or voice remains loud at the periphery during auscultation. Indicative of consolidation.
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

16. 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
Nasal polyps - deviated septum - hx of trauma - surgery - foreign bodies or recent altitude changes
Inflammation of the paranasal sinuses

17. Egophany (vocal resonance)
Step. pneumoniae; Haemophilus influenzae; group B-strep
Persistent; recurrent x4/yr; severe HA; altered mental status
Clubbing - Use of accessory muscles - barrel chest
High pitched voice sound due to transmission of noise across fluid. Indicative of effusion.

18. Cold incubation period
24-72 hrs
Oflaxicin 0.3% solution BID
4-12 weeks
Bacterial or viral infection of the middle ear (secondary to URI [e.g. eustachian tube dysfunction])

19. Bronchial breath sounds...
Apena alternating with hyperpnea;
Hardher and more turbulent
Rhinovirus - influenza - parainfluenza
Oflaxicin 0.3% solution BID

20. What is the common side effect of sympathomimetics?
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;
Rhinovirus - influenza - and parainfluenza
Nasal polyps - deviated septum - hx of trauma - surgery - foreign bodies or recent altitude changes
Rebound congestion 3-5 days

21. Acute otitis media
Symptomatic (steam; nasal irrigation); APAP for pain.
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
Bacterial or viral infection of the middle ear (secondary to URI [e.g. eustachian tube dysfunction])
Pulse ox; Peak expiratory flow; spirometry

22. Rx for viral URI?
PE: rhinoscopy with otoscope
Symptomatic (steam; nasal irrigation); APAP for pain.
<4 weeks
NSAIDs for aches - fever; Sympathomimetics: pseudophedrine or phenylephrine

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

24. Symptoms of viral rhinosinusitis
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 infection
Measures speed of exhalation; results measure by age and weight
>12 weeks

25. Subacute rhino-sinusitis duration of symptoms?
4-12 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
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

26. Whispered pectoriloguy
Clubbing - Use of accessory muscles - barrel chest
Bacterial infection
Pulse ox; Peak expiratory flow; spirometry
Increased loudness of whispering during auscultation. Indicative of consolidation.

27. Kussmal's respiration
Increased breath sounds or voice remains loud at the periphery during auscultation. Indicative of consolidation.
E. coli
Soft sounds in and out
Deep - rapid - labored - breathing

28. Normal pulse ox
Increased loudness of whispering during auscultation. Indicative of consolidation.
>12 weeks
92-100%
Symptomatic (steam; nasal irrigation); APAP for pain.

29. Rhinosinusitis physical exam?
Rate; pattern (regular or irregular); effort (labored - accessory muscles)
Pulse ox; Peak expiratory flow; spirometry
4-12 weeks
HEENT: rhinoscopy - sinus tenderness - lymphnodes - transillumination of sinuses - CV and PULM.

30. Pulmonary tests
Inflammation of the paranasal sinuses
Pulse ox; Peak expiratory flow; spirometry
Rate; pattern (regular or irregular); effort (labored - accessory muscles)
Augementin 2000/124 mg bid for 5-7 days - Peds: 90 mg/kg/day po in divided doses

31. Tx for pediatric AOM?
Bacterial infection
Deep - rapid - labored - breathing
Nasal polyps - deviated septum - hx of trauma - surgery - foreign bodies or recent altitude changes
Amoxicillin 80-90mg/kg/day x7 days; Augmentin 90/6.4 mg/kg/day x7 days

32. Pathophysiology of rhino sinusitis?
Step. pneumoniae; Haemophilus influenzae; group B-strep
Viral inoculation > viral rhinitis > infection of paranasal sinuses > inflammation & edema > mucosal edema - copious secretions - ciliary dyskinesia > sinus congestions and/or obstruction
Afebrile viral infection of the the nose - paranasal sinuses - throat - larynx - trachea - and and bronchi.
Rate; pattern (regular or irregular); effort (labored - accessory muscles)

33. What is the most common pahtogen for otitis media?
Deep - snoring sound; indicates fluid or narrowing of airways; common in bronchitis and COPD
Increased breath sounds or voice remains loud at the periphery during auscultation. Indicative of consolidation.
Step. pneumoniae; Haemophilus influenzae; group B-strep
Apena alternating with hyperpnea;

34. Acute viral rhino-sinusitis (AVRS) pathogens?
Symptomatic (steam; nasal irrigation); APAP for pain.
Rhinovirus - influenza - parainfluenza
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
PE: rhinoscopy with otoscope

35. Which Rx should not be used for viral URI?
Aspirin: increases viral shedding
Severe dyspnea when lying supine with associated wheezing and coughing - need to sit up abruptly due to severe dyspnea
Persistent; recurrent x4/yr; severe HA; altered mental status
Rebound congestion 3-5 days

36. Common cold symptoms
Dyspnea when supine - relived by sitting or standing
Abrupt onset - burning nose or throat - sneezing - rhinorrhea
Inflammation of the nasal cavity
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

37. Alternative rx for bacterial sinusitis?
Aspirin: increases viral shedding
Aspirin: Reye's Syndrome
Bacterial or viral infection of the middle ear (secondary to URI [e.g. eustachian tube dysfunction])
Macrolides (azithormycin); Doxycycline; TMZ-SMZ

38. 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
>12 weeks
Augementin 2000/124 mg bid for 5-7 days - Peds: 90 mg/kg/day po in divided doses
Rebound congestion 3-5 days

39. Common Cold (URI - Acute Coryza)
Afebrile viral infection of the the nose - paranasal sinuses - throat - larynx - trachea - and and bronchi.
Increased breath sounds or voice remains loud at the periphery during auscultation. Indicative of consolidation.
24-72 hrs
4-12 weeks

40. What is most common age range for otitis?
Ear ache - dullness - hearing loss - fever - N/V/D
Nasal congestion - HA - sinus pain - fever - sore throat - cough
PE: rhinoscopy with otoscope
3 months to 3 years old

41. Common cold pathogens
Labs: CBC - blood gas - d-dimer - CMP - BNP - Chest CT - MRI
Rhinovirus - influenza - and parainfluenza
NSAIDs for aches - fever; Sympathomimetics: pseudophedrine or phenylephrine
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

42. Symptoms of acute bacterial rhino-sinusitis (ABRS)?
Nasal congestion - HA - sinus pain - fever - sore throat - cough
Purulent discharge - post nasal draiange; cough; sinus pressure - tooth pain; halitosis (changes in taste); alterations of smell
E. coli
Increased loudness of whispering during auscultation. Indicative of consolidation.

43. Additional pulmonary diagnostics
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
Persistent; recurrent x4/yr; severe HA; altered mental status
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

44. What are physical exam findings of AOE?
Abrupt onset - burning nose or throat - sneezing - rhinorrhea
Erythmatous auditory canal - crusting
Hardher and more turbulent
E. coli

45. Respiratory Examination (Observation)
E. coli
Deep - rapid - labored - breathing
Bacterial infection
Rate; pattern (regular or irregular); effort (labored - accessory muscles)

46. What are the symptoms of otitis?
Ear ache - dullness - hearing loss - fever - N/V/D
4-12 weeks
Bacterial infection
Persistent; recurrent x4/yr; severe HA; altered mental status

47. Respiratory Illness Key Points (3)
4-12 weeks
Bacterial infection
92-100%
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

48. What sinusitis symptoms would warrant image studies?
High pitched voice sound due to transmission of noise across fluid. Indicative of effusion.
Persistent; recurrent x4/yr; severe HA; altered mental status
Ipratroprium bromide (e.g. Atrovent); Antihistamines (Cargeul not to overly dry out muscos)
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

49. Orthopnea
High pitched voice sound due to transmission of noise across fluid. Indicative of effusion.
E. coli
Dyspnea when supine - relived by sitting or standing
PE: rhinoscopy with otoscope

50. Diagnostics of sinusitis?
Oflaxicin 0.3% solution BID
Deep - rapid - labored - breathing
PE: rhinoscopy with otoscope
Inflammation of the paranasal sinuses