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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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1. Cold incubation period
24-72 hrs
Ipratroprium bromide (e.g. Atrovent); Antihistamines (Cargeul not to overly dry out muscos)
Persistent or relapse of infection - chronic sinusitis - fungal infection - extension in CNS (meningitis - orbital cellulitis - osteitis)
Aspirin: increases viral shedding

2. Special cases of sinusitis?
Pulse ox; Peak expiratory flow; spirometry
Persistent or relapse of infection - chronic sinusitis - fungal infection - extension in CNS (meningitis - orbital cellulitis - osteitis)
Macrolides (azithormycin); Doxycycline; TMZ-SMZ
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

3. Pathophysiology of rhino sinusitis?
Apena alternating with hyperpnea;
TM erythmatous - bulging - light reflex displaced - exudate
Viral inoculation > viral rhinitis > infection of paranasal sinuses > inflammation & edema > mucosal edema - copious secretions - ciliary dyskinesia > sinus congestions and/or obstruction
PE: rhinoscopy with otoscope

4. What are the symptoms of otitis?
E. coli
Abrupt onset - burning nose or throat - sneezing - rhinorrhea
Augementin 2000/124 mg bid for 5-7 days - Peds: 90 mg/kg/day po in divided doses
Ear ache - dullness - hearing loss - fever - N/V/D

5. Acute otitis media
Aspirin: Reye's Syndrome
Bacterial or viral infection of the middle ear (secondary to URI [e.g. eustachian tube dysfunction])
Severe dyspnea when lying supine with associated wheezing and coughing - need to sit up abruptly due to severe dyspnea
Purulent discharge - post nasal draiange; cough; sinus pressure - tooth pain; halitosis (changes in taste); alterations of smell

6. Whispered pectoriloguy
Inflammation of the nasal cavity
Increased loudness of whispering during auscultation. Indicative of consolidation.
<4 weeks
Persistent; recurrent x4/yr; severe HA; altered mental status

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

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8. Rx for rhinorrhea and/or allergies?
Apena alternating with hyperpnea;
Ipratroprium bromide (e.g. Atrovent); Antihistamines (Cargeul not to overly dry out muscos)
TM erythmatous - bulging - light reflex displaced - exudate
NSAIDs for aches - fever; Sympathomimetics: pseudophedrine or phenylephrine

9. Rx for viral URI?
E. coli
Bacterial or viral infection of the middle ear (secondary to URI [e.g. eustachian tube dysfunction])
NSAIDs for aches - fever; Sympathomimetics: pseudophedrine or phenylephrine
Inflammation of the nasal cavity

10. What sinusitis symptoms would warrant image studies?
NSAIDs for aches - fever; Sympathomimetics: pseudophedrine or phenylephrine
Rebound congestion 3-5 days
Persistent; recurrent x4/yr; severe HA; altered mental status
24-72 hrs

11. Common cold pathogens
Persistent or relapse of infection - chronic sinusitis - fungal infection - extension in CNS (meningitis - orbital cellulitis - osteitis)
Abnormal high pitched caused by blockage in upper airway; usually heard with with inspiration
3 months to 3 years old
Rhinovirus - influenza - and parainfluenza

12. Common cold symptoms
Abrupt onset - burning nose or throat - sneezing - rhinorrhea
Rhinovirus - influenza - and parainfluenza
Deep - snoring sound; indicates fluid or narrowing of airways; common in bronchitis and COPD
E. coli

13. Tx of sinusitis symptoms <10 days
Symptomatic (steam; nasal irrigation); APAP for pain.
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
Amoxicillin 1000 mg TID x7 days; Augmentin 2000/125mg BID x7 days
Abnormal high pitched caused by blockage in upper airway; usually heard with with inspiration

14. Peak Expiratory Flow (PEF)
Measures speed of exhalation; results measure by age and weight
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
HEENT: rhinoscopy - sinus tenderness - lymphnodes - transillumination of sinuses - CV and PULM.
Rate; pattern (regular or irregular); effort (labored - accessory muscles)

15. What is most common age range for otitis?
3 months to 3 years old
HEENT: rhinoscopy - sinus tenderness - lymphnodes - transillumination of sinuses - CV and PULM.
Bacterial infection
Ipratroprium bromide (e.g. Atrovent); Antihistamines (Cargeul not to overly dry out muscos)

16. Proxysmal nocturnal dyspnea
Severe dyspnea when lying supine with associated wheezing and coughing - need to sit up abruptly due to severe dyspnea
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
Augementin 2000/124 mg bid for 5-7 days - Peds: 90 mg/kg/day po in divided doses
Ear ache - dullness - hearing loss - fever - N/V/D

17. What does mucopurulent indications not indicate?
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
Bacterial infection
3 months to 3 years old

18. Pulmonary tests
Increased loudness of whispering during auscultation. Indicative of consolidation.
Persistent; recurrent x4/yr; severe HA; altered mental status
Pulse ox; Peak expiratory flow; spirometry
Viral inoculation > viral rhinitis > infection of paranasal sinuses > inflammation & edema > mucosal edema - copious secretions - ciliary dyskinesia > sinus congestions and/or obstruction

19. Tx for adult AOE?
Deep - snoring sound; indicates fluid or narrowing of airways; common in bronchitis and COPD
Oflaxicin 0.3% solution BID
Abrupt onset - burning nose or throat - sneezing - rhinorrhea
92-100%

20. Cheyne-stokes
Apena alternating with hyperpnea;
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
Deep - snoring sound; indicates fluid or narrowing of airways; common in bronchitis and COPD
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;

21. Pulmonary diagnostics (1)
Erythmatous auditory canal - crusting
PE: rhinoscopy with otoscope
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
Deep - snoring sound; indicates fluid or narrowing of airways; common in bronchitis and COPD

22. Tx for adult AOM?
Amoxicillin 1000 mg TID x7 days; Augmentin 2000/125mg BID x7 days
Viral inoculation > viral rhinitis > infection of paranasal sinuses > inflammation & edema > mucosal edema - copious secretions - ciliary dyskinesia > sinus congestions and/or obstruction
Increased loudness of whispering during auscultation. Indicative of consolidation.
Aspirin: Reye's Syndrome

23. Kussmal's respiration
Warm - humid environment; rest;
Increased breath sounds or voice remains loud at the periphery during auscultation. Indicative of consolidation.
Rhinovirus - influenza - parainfluenza
Deep - rapid - labored - breathing

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;
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
24-72 hrs

25. Crackles (rales)
High pitched sounds; can occur during inspiration or expiration; indicates narrow airways; can occur with asthma - COPD - pneumonia - CHF
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.
Fine or courses; secretions or aveolar collapse; normal if resovle with cough; abnormal: pneumonia; CHF; COPD; pilmonary fibrosis

26. Spirometry
Aspirin: Reye's Syndrome
Inflammation of the nasal cavity
Amoxicillin 1000 mg TID x7 days; Augmentin 2000/125mg BID x7 days
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

27. What are physical exam findings of AOM?
Viral inoculation > viral rhinitis > infection of paranasal sinuses > inflammation & edema > mucosal edema - copious secretions - ciliary dyskinesia > sinus congestions and/or obstruction
Severe dyspnea when lying supine with associated wheezing and coughing - need to sit up abruptly due to severe dyspnea
TM erythmatous - bulging - light reflex displaced - exudate
Rebound congestion 3-5 days

28. Physical exam of chest
Inflammation of the nasal cavity
Decongestants (oxymetazoline); glucocorticoids (e.g. fluticasone); mucolytics (e.g. guaifensin)
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
Pulse ox; Peak expiratory flow; spirometry

29. Rhinosinusitis History?
<4 weeks
Nasal congestion - HA - sinus pain - fever - sore throat - cough
HEENT: rhinoscopy - sinus tenderness - lymphnodes - transillumination of sinuses - CV and PULM.
Persistent; recurrent x4/yr; severe HA; altered mental status

30. Respiratory Examination (Observation)
Erythmatous auditory canal - crusting
Rate; pattern (regular or irregular); effort (labored - accessory muscles)
High pitched voice sound due to transmission of noise across fluid. Indicative of effusion.
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;

31. Rhinosinusitis physical exam?
Labs: CBC - blood gas - d-dimer - CMP - BNP - Chest CT - MRI
Abrupt onset - burning nose or throat - sneezing - rhinorrhea
HEENT: rhinoscopy - sinus tenderness - lymphnodes - transillumination of sinuses - CV and PULM.
Pulse ox; Peak expiratory flow; spirometry

32. Rhinitis
Bacterial infection
Inflammation of the nasal cavity
Augementin 2000/124 mg bid for 5-7 days - Peds: 90 mg/kg/day po in divided doses
Macrolides (azithormycin); Doxycycline; TMZ-SMZ

33. Alternative rx for bacterial sinusitis?
Amoxicillin 80-90mg/kg/day x7 days; Augmentin 90/6.4 mg/kg/day x7 days
Pulse ox; Peak expiratory flow; spirometry
Macrolides (azithormycin); Doxycycline; TMZ-SMZ
PE: rhinoscopy with otoscope

34. Tx for pediatric AOM?
Decongestants (oxymetazoline); glucocorticoids (e.g. fluticasone); mucolytics (e.g. guaifensin)
Amoxicillin 80-90mg/kg/day x7 days; Augmentin 90/6.4 mg/kg/day x7 days
Abrupt onset - burning nose or throat - sneezing - rhinorrhea
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

35. Rx nasal congestion?
<4 weeks
Aspirin: increases viral shedding
Decongestants (oxymetazoline); glucocorticoids (e.g. fluticasone); mucolytics (e.g. guaifensin)
Ipratroprium bromide (e.g. Atrovent); Antihistamines (Cargeul not to overly dry out muscos)

36. Stridor
Abnormal high pitched caused by blockage in upper airway; usually heard with with inspiration
High pitched voice sound due to transmission of noise across fluid. Indicative of effusion.
Hardher and more turbulent
Erythmatous auditory canal - crusting

37. Rhonchi
Deep - snoring sound; indicates fluid or narrowing of airways; common in bronchitis and COPD
Severe dyspnea when lying supine with associated wheezing and coughing - need to sit up abruptly due to severe dyspnea
Ear ache - dullness - hearing loss - fever - N/V/D
Measures speed of exhalation; results measure by age and weight

38. Additional pulmonary diagnostics
Rhinovirus - influenza - and parainfluenza
Afebrile viral infection of the the nose - paranasal sinuses - throat - larynx - trachea - and and bronchi.
Oflaxicin 0.3% solution BID
Labs: CBC - blood gas - d-dimer - CMP - BNP - Chest CT - MRI

39. Subacute rhino-sinusitis duration of symptoms?
4-12 weeks
Decongestants (oxymetazoline); glucocorticoids (e.g. fluticasone); mucolytics (e.g. guaifensin)
Persistent; recurrent x4/yr; severe HA; altered mental status
HEENT: rhinoscopy - sinus tenderness - lymphnodes - transillumination of sinuses - CV and PULM.

40. 1st line treatment for bacterial sinusitis?
Erythmatous auditory canal - crusting
Abrupt onset - burning nose or throat - sneezing - rhinorrhea
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

41. Which Rx should not be used for viral URI?
Aspirin: increases viral shedding
High pitched voice sound due to transmission of noise across fluid. Indicative of effusion.
Amoxicillin 1000 mg TID x7 days; Augmentin 2000/125mg BID x7 days
Purulent discharge - post nasal draiange; cough; sinus pressure - tooth pain; halitosis (changes in taste); alterations of smell

42. Diagnostics of sinusitis?
Symptomatic (steam; nasal irrigation); APAP for pain.
Amoxicillin 80-90mg/kg/day x7 days; Augmentin 90/6.4 mg/kg/day x7 days
Erythmatous auditory canal - crusting
PE: rhinoscopy with otoscope

43. Vesicular breath sounds...
Soft sounds in and out
Ipratroprium bromide (e.g. Atrovent); Antihistamines (Cargeul not to overly dry out muscos)
>12 weeks
Nasal polyps - deviated septum - hx of trauma - surgery - foreign bodies or recent altitude changes

44. Sinusitis
Pulse ox; Peak expiratory flow; spirometry
Inflammation of the paranasal sinuses
<4 weeks
Ipratroprium bromide (e.g. Atrovent); Antihistamines (Cargeul not to overly dry out muscos)

45. Symptoms of acute bacterial rhino-sinusitis (ABRS)?
Abnormal high pitched caused by blockage in upper airway; usually heard with with inspiration
Fine or courses; secretions or aveolar collapse; normal if resovle with cough; abnormal: pneumonia; CHF; COPD; pilmonary fibrosis
Purulent discharge - post nasal draiange; cough; sinus pressure - tooth pain; halitosis (changes in taste); alterations of smell
Erythmatous auditory canal - crusting

46. What is the common side effect of sympathomimetics?
Symptomatic (steam; nasal irrigation); APAP for pain.
Clubbing - Use of accessory muscles - barrel chest
Rebound congestion 3-5 days
E. coli

47. Wheezes
92-100%
>12 weeks
High pitched sounds; can occur during inspiration or expiration; indicates narrow airways; can occur with asthma - COPD - pneumonia - CHF
Increased breath sounds or voice remains loud at the periphery during auscultation. Indicative of consolidation.

48. Acute rhino-sinusitis duration of symptoms?
<4 weeks
TM erythmatous - bulging - light reflex displaced - exudate
Warm - humid environment; rest;
Fine or courses; secretions or aveolar collapse; normal if resovle with cough; abnormal: pneumonia; CHF; COPD; pilmonary fibrosis

49. Egophany (vocal resonance)
Abnormal high pitched caused by blockage in upper airway; usually heard with with inspiration
High pitched voice sound due to transmission of noise across fluid. Indicative of effusion.
PE: rhinoscopy with otoscope
Macrolides (azithormycin); Doxycycline; TMZ-SMZ

50. Common Cold (URI - Acute Coryza)
Nasal polyps - deviated septum - hx of trauma - surgery - foreign bodies or recent altitude changes
Aspirin: increases viral shedding
Afebrile viral infection of the the nose - paranasal sinuses - throat - larynx - trachea - and and bronchi.
E. coli