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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. Egophany (vocal resonance)
92-100%
Abrupt onset - burning nose or throat - sneezing - rhinorrhea
High pitched voice sound due to transmission of noise across fluid. Indicative of effusion.
Oflaxicin 0.3% solution BID

2. What are physical exam findings of AOM?
TM erythmatous - bulging - light reflex displaced - exudate
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.
Bacterial infection

3. Symptoms of viral rhinosinusitis
Bacterial infection
Ipratroprium bromide (e.g. Atrovent); Antihistamines (Cargeul not to overly dry out muscos)
NSAIDs for aches - fever; Sympathomimetics: pseudophedrine or phenylephrine
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;

4. Pulmonary tests
Pulse ox; Peak expiratory flow; spirometry
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
Hardher and more turbulent
Dyspnea when supine - relived by sitting or standing

5. Abnormal pulmonary findings?
Dyspnea when supine - relived by sitting or standing
Persistent; recurrent x4/yr; severe HA; altered mental status
Aspirin: Reye's Syndrome
Clubbing - Use of accessory muscles - barrel chest

6. Orthopnea
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
Dyspnea when supine - relived by sitting or standing
Augementin 2000/124 mg bid for 5-7 days - Peds: 90 mg/kg/day po in divided doses
PE: rhinoscopy with otoscope

7. Rx for rhinorrhea and/or allergies?
3 months to 3 years old
Abrupt onset - burning nose or throat - sneezing - rhinorrhea
Pulse ox; Peak expiratory flow; spirometry
Ipratroprium bromide (e.g. Atrovent); Antihistamines (Cargeul not to overly dry out muscos)

8. Peak Expiratory Flow (PEF)
Pulse ox; Peak expiratory flow; spirometry
Labs: CBC - blood gas - d-dimer - CMP - BNP - Chest CT - MRI
Measures speed of exhalation; results measure by age and weight
4-12 weeks

9. Wheezes
Increased loudness of whispering during auscultation. Indicative of consolidation.
Pulse ox; Peak expiratory flow; spirometry
High pitched sounds; can occur during inspiration or expiration; indicates narrow airways; can occur with asthma - COPD - pneumonia - CHF
Rate; pattern (regular or irregular); effort (labored - accessory muscles)

10. Cold incubation period
Rate; pattern (regular or irregular); effort (labored - accessory muscles)
Pulse ox; Peak expiratory flow; spirometry
24-72 hrs
Afebrile viral infection of the the nose - paranasal sinuses - throat - larynx - trachea - and and bronchi.

11. Pathophysiology of rhino sinusitis?
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
Warm - humid environment; rest;
<4 weeks
Viral inoculation > viral rhinitis > infection of paranasal sinuses > inflammation & edema > mucosal edema - copious secretions - ciliary dyskinesia > sinus congestions and/or obstruction

12. Acute viral rhino-sinusitis (AVRS) pathogens?
Viral inoculation > viral rhinitis > infection of paranasal sinuses > inflammation & edema > mucosal edema - copious secretions - ciliary dyskinesia > sinus congestions and/or obstruction
Rhinovirus - influenza - parainfluenza
Symptomatic (steam; nasal irrigation); APAP for pain.
92-100%

13. Special cases of sinusitis?
Macrolides (azithormycin); Doxycycline; TMZ-SMZ
Hardher and more turbulent
E. coli
Persistent or relapse of infection - chronic sinusitis - fungal infection - extension in CNS (meningitis - orbital cellulitis - osteitis)

14. What is most common age range for otitis?
Step. pneumoniae; Haemophilus influenzae; group B-strep
3 months to 3 years old
Abrupt onset - burning nose or throat - sneezing - rhinorrhea
<4 weeks

15. Stridor
Decongestants (oxymetazoline); glucocorticoids (e.g. fluticasone); mucolytics (e.g. guaifensin)
Soft sounds in and out
Abnormal high pitched caused by blockage in upper airway; usually heard with with inspiration
Increased breath sounds or voice remains loud at the periphery during auscultation. Indicative of consolidation.

16. Whispered pectoriloguy
Ear ache - dullness - hearing loss - fever - N/V/D
Soft sounds in and out
Fine or courses; secretions or aveolar collapse; normal if resovle with cough; abnormal: pneumonia; CHF; COPD; pilmonary fibrosis
Increased loudness of whispering during auscultation. Indicative of consolidation.

17. Rx for viral URI?
NSAIDs for aches - fever; Sympathomimetics: pseudophedrine or phenylephrine
High pitched sounds; can occur during inspiration or expiration; indicates narrow airways; can occur with asthma - COPD - pneumonia - CHF
Rebound congestion 3-5 days
Purulent discharge - post nasal draiange; cough; sinus pressure - tooth pain; halitosis (changes in taste); alterations of smell

18. What sinusitis symptoms would warrant image studies?
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
Rate; pattern (regular or irregular); effort (labored - accessory muscles)
Persistent; recurrent x4/yr; severe HA; altered mental status

19. Diagnostics of sinusitis?
Augementin 2000/124 mg bid for 5-7 days - Peds: 90 mg/kg/day po in divided doses
PE: rhinoscopy with otoscope
Ear ache - dullness - hearing loss - fever - N/V/D
Purulent discharge - post nasal draiange; cough; sinus pressure - tooth pain; halitosis (changes in taste); alterations of smell

20. Rhinitis
Afebrile viral infection of the the nose - paranasal sinuses - throat - larynx - trachea - and and bronchi.
Inflammation of the nasal cavity
Oflaxicin 0.3% solution BID
PE: rhinoscopy with otoscope

21. What are physical exam findings of AOE?
Erythmatous auditory canal - crusting
4-12 weeks
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

22. Rhinosinusitis risk factors?
Nasal polyps - deviated septum - hx of trauma - surgery - foreign bodies or recent altitude changes
Measures speed of exhalation; results measure by age and weight
Rhinovirus - influenza - and parainfluenza
Apena alternating with hyperpnea;

23. Symptoms of acute bacterial rhino-sinusitis (ABRS)?
Aspirin: increases viral shedding
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
Purulent discharge - post nasal draiange; cough; sinus pressure - tooth pain; halitosis (changes in taste); alterations of smell
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

24. Bronchial breath sounds...
High pitched voice sound due to transmission of noise across fluid. Indicative of effusion.
Viral inoculation > viral rhinitis > infection of paranasal sinuses > inflammation & edema > mucosal edema - copious secretions - ciliary dyskinesia > sinus congestions and/or obstruction
Bacterial infection
Hardher and more turbulent

25. Acute rhino-sinusitis duration of symptoms?
4-12 weeks
Measures speed of exhalation; results measure by age and weight
Hardher and more turbulent
<4 weeks

26. Respiratory Examination (Observation)
High pitched sounds; can occur during inspiration or expiration; indicates narrow airways; can occur with asthma - COPD - pneumonia - CHF
Warm - humid environment; rest;
Rate; pattern (regular or irregular); effort (labored - accessory muscles)
Dyspnea when supine - relived by sitting or standing

27. Cheyne-stokes
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.
Aspirin: Reye's Syndrome
Apena alternating with hyperpnea;

28. Subacute rhino-sinusitis duration of symptoms?
Apena alternating with hyperpnea;
Nasal congestion - HA - sinus pain - fever - sore throat - cough
4-12 weeks
TM erythmatous - bulging - light reflex displaced - exudate

29. Common cold symptoms
Warm - humid environment; rest;
E. coli
Macrolides (azithormycin); Doxycycline; TMZ-SMZ
Abrupt onset - burning nose or throat - sneezing - rhinorrhea

30. Spirometry
Increased loudness of whispering 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
Nasal congestion - HA - sinus pain - fever - sore throat - cough
Severe dyspnea when lying supine with associated wheezing and coughing - need to sit up abruptly due to severe dyspnea

31. Common Cold (URI - Acute Coryza)
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
Hardher and more turbulent
Increased breath sounds or voice remains loud at the periphery during auscultation. Indicative of consolidation.
Afebrile viral infection of the the nose - paranasal sinuses - throat - larynx - trachea - and and bronchi.

32. Tx of sinusitis symptoms <10 days
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;
Erythmatous auditory canal - crusting
Symptomatic (steam; nasal irrigation); APAP for pain.
24-72 hrs

33. Common cold pathogens
Nasal congestion - HA - sinus pain - fever - sore throat - cough
Soft sounds in and out
Rhinovirus - influenza - and parainfluenza
Pulse ox; Peak expiratory flow; spirometry

34. What is the most common pathogen for otitis in newborns?
Ear ache - dullness - hearing loss - fever - N/V/D
Increased loudness of whispering during auscultation. Indicative of consolidation.
E. coli
3 months to 3 years old

35. What is the common side effect of sympathomimetics?
Rebound congestion 3-5 days
High pitched voice sound due to transmission of noise across fluid. Indicative of effusion.
Aspirin: increases viral shedding
Nasal congestion - HA - sinus pain - fever - sore throat - cough

36. Rhinosinusitis physical exam?
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
24-72 hrs
HEENT: rhinoscopy - sinus tenderness - lymphnodes - transillumination of sinuses - CV and PULM.
Nasal polyps - deviated septum - hx of trauma - surgery - foreign bodies or recent altitude changes

37. Rx nasal congestion?
PE: rhinoscopy with otoscope
Decongestants (oxymetazoline); glucocorticoids (e.g. fluticasone); mucolytics (e.g. guaifensin)
Warm - humid environment; rest;
Increased loudness of whispering during auscultation. Indicative of consolidation.

38. Acute otitis media
Purulent discharge - post nasal draiange; cough; sinus pressure - tooth pain; halitosis (changes in taste); alterations of smell
Bacterial or viral infection of the middle ear (secondary to URI [e.g. eustachian tube dysfunction])
Nasal congestion - HA - sinus pain - fever - sore throat - cough
92-100%

39. Tx for adult AOM?
Pulse ox; Peak expiratory flow; spirometry
Rhinovirus - influenza - and parainfluenza
Amoxicillin 1000 mg TID x7 days; Augmentin 2000/125mg BID x7 days
Deep - snoring sound; indicates fluid or narrowing of airways; common in bronchitis and COPD

40. What does mucopurulent indications not indicate?
Afebrile viral infection of the the nose - paranasal sinuses - throat - larynx - trachea - and and bronchi.
>12 weeks
Bacterial infection
Bacterial or viral infection of the middle ear (secondary to URI [e.g. eustachian tube dysfunction])

41. Nonpharmacological tx for viral URI
Aspirin: Reye's Syndrome
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
Warm - humid environment; rest;
4-12 weeks

42. Tx for adult AOE?
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
Persistent; recurrent x4/yr; severe HA; altered mental status
Deep - rapid - labored - breathing
Oflaxicin 0.3% solution BID

43. Respiratory Illness Key Points (3)
Deep - snoring sound; indicates fluid or narrowing of airways; common in bronchitis and COPD
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
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
3 months to 3 years old

44. 1st line treatment for bacterial sinusitis?
Inflammation of the paranasal sinuses
Soft sounds in and out
Nasal polyps - deviated septum - hx of trauma - surgery - foreign bodies or recent altitude changes
Augementin 2000/124 mg bid for 5-7 days - Peds: 90 mg/kg/day po in divided doses

45. Crackles (rales)
Fine or courses; secretions or aveolar collapse; normal if resovle with cough; abnormal: pneumonia; CHF; COPD; pilmonary fibrosis
Aspirin: increases viral shedding
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

46. Tx for pediatric AOM?
>12 weeks
Amoxicillin 80-90mg/kg/day x7 days; Augmentin 90/6.4 mg/kg/day x7 days
Aspirin: Reye's Syndrome
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

47. Normal pulse ox
92-100%
>12 weeks
24-72 hrs
Purulent discharge - post nasal draiange; cough; sinus pressure - tooth pain; halitosis (changes in taste); alterations of smell

48. Rhinosinusitis History?
4-12 weeks
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
Labs: CBC - blood gas - d-dimer - CMP - BNP - Chest CT - MRI

49. Additional pulmonary diagnostics
Abrupt onset - burning nose or throat - sneezing - rhinorrhea
Fine or courses; secretions or aveolar collapse; normal if resovle with cough; abnormal: pneumonia; CHF; COPD; pilmonary fibrosis
Labs: CBC - blood gas - d-dimer - CMP - BNP - Chest CT - MRI
Decongestants (oxymetazoline); glucocorticoids (e.g. fluticasone); mucolytics (e.g. guaifensin)

50. Pulmonary diagnostics (1)
High pitched voice sound due to transmission of noise across fluid. Indicative of effusion.
Severe dyspnea when lying supine with associated wheezing and coughing - need to sit up abruptly due to severe dyspnea
>12 weeks
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