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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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1. Additional pulmonary diagnostics
Erythmatous auditory canal - crusting
Labs: CBC - blood gas - d-dimer - CMP - BNP - Chest CT - MRI
Amoxicillin 80-90mg/kg/day x7 days; Augmentin 90/6.4 mg/kg/day x7 days
Abrupt onset - burning nose or throat - sneezing - rhinorrhea

2. Which Rx should not be used for viral URI?
Inflammation of the nasal cavity
<4 weeks
Abrupt onset - burning nose or throat - sneezing - rhinorrhea
Aspirin: increases viral shedding

3. Sinusitis
Fine or courses; secretions or aveolar collapse; normal if resovle with cough; abnormal: pneumonia; CHF; COPD; pilmonary fibrosis
Abnormal high pitched caused by blockage in upper airway; usually heard with with inspiration
Labs: CBC - blood gas - d-dimer - CMP - BNP - Chest CT - MRI
Inflammation of the paranasal sinuses

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

5. Tx for pediatric AOM?
Increased loudness of whispering during auscultation. Indicative of consolidation.
Amoxicillin 80-90mg/kg/day x7 days; Augmentin 90/6.4 mg/kg/day x7 days
Rhinovirus - influenza - parainfluenza
3 months to 3 years old

6. Chronic rhino-sinusitis duration of symptoms?
NSAIDs for aches - fever; Sympathomimetics: pseudophedrine or phenylephrine
>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
Abnormal high pitched caused by blockage in upper airway; usually heard with with inspiration

7. What are physical exam findings of AOE?
Erythmatous auditory canal - crusting
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
HEENT: rhinoscopy - sinus tenderness - lymphnodes - transillumination of sinuses - CV and PULM.

8. Tx for adult AOM?
Macrolides (azithormycin); Doxycycline; TMZ-SMZ
Rhinovirus - influenza - and parainfluenza
Labs: CBC - blood gas - d-dimer - CMP - BNP - Chest CT - MRI
Amoxicillin 1000 mg TID x7 days; Augmentin 2000/125mg BID x7 days

9. Common cold symptoms
Viral inoculation > viral rhinitis > infection of paranasal sinuses > inflammation & edema > mucosal edema - copious secretions - ciliary dyskinesia > sinus congestions and/or obstruction
Abrupt onset - burning nose or throat - sneezing - rhinorrhea
Ear ache - dullness - hearing loss - fever - N/V/D
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

10. What are physical exam findings of AOM?
HEENT: rhinoscopy - sinus tenderness - lymphnodes - transillumination of sinuses - CV and PULM.
Step. pneumoniae; Haemophilus influenzae; group B-strep
Symptomatic (steam; nasal irrigation); APAP for pain.
TM erythmatous - bulging - light reflex displaced - exudate

11. Vesicular breath sounds...
Hardher and more turbulent
Soft sounds in and out
3 months to 3 years old
Persistent; recurrent x4/yr; severe HA; altered mental status

12. Acute otitis media
Abrupt onset - burning nose or throat - sneezing - rhinorrhea
Macrolides (azithormycin); Doxycycline; TMZ-SMZ
Bacterial or viral infection of the middle ear (secondary to URI [e.g. eustachian tube dysfunction])
Dyspnea when supine - relived by sitting or standing

13. Acute viral rhino-sinusitis (AVRS) pathogens?
Fine or courses; secretions or aveolar collapse; normal if resovle with cough; abnormal: pneumonia; CHF; COPD; pilmonary fibrosis
Step. pneumoniae; Haemophilus influenzae; group B-strep
Rhinovirus - influenza - parainfluenza
Severe dyspnea when lying supine with associated wheezing and coughing - need to sit up abruptly due to severe dyspnea

14. Cheyne-stokes
Hardher and more turbulent
Apena alternating with hyperpnea;
Warm - humid environment; rest;
Purulent discharge - post nasal draiange; cough; sinus pressure - tooth pain; halitosis (changes in taste); alterations of smell

15. Rhinitis
Inflammation of the nasal cavity
PE: rhinoscopy with otoscope
Nasal polyps - deviated septum - hx of trauma - surgery - foreign bodies or recent altitude changes
Persistent; recurrent x4/yr; severe HA; altered mental status

16. Rhonchi
E. coli
Viral inoculation > viral rhinitis > infection of paranasal sinuses > inflammation & edema > mucosal edema - copious secretions - ciliary dyskinesia > sinus congestions and/or obstruction
Deep - snoring sound; indicates fluid or narrowing of airways; common in bronchitis and COPD
Increased loudness of whispering during auscultation. Indicative of consolidation.

17. Rhinosinusitis risk factors?
Clubbing - Use of accessory muscles - barrel chest
Deep - rapid - labored - breathing
Nasal polyps - deviated septum - hx of trauma - surgery - foreign bodies or recent altitude changes
Deep - snoring sound; indicates fluid or narrowing of airways; common in bronchitis and COPD

18. Respiratory Illness Key Points (3)
Clubbing - Use of accessory muscles - barrel chest
Increased loudness of whispering during auscultation. Indicative of consolidation.
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
Rhinovirus - influenza - parainfluenza

19. Rhinosinusitis physical exam?
Inflammation of the nasal cavity
HEENT: rhinoscopy - sinus tenderness - lymphnodes - transillumination of sinuses - CV and PULM.
Rhinovirus - influenza - parainfluenza
Aspirin: Reye's Syndrome

20. Tx for adult AOE?
Rebound congestion 3-5 days
Inflammation of the nasal cavity
Persistent or relapse of infection - chronic sinusitis - fungal infection - extension in CNS (meningitis - orbital cellulitis - osteitis)
Oflaxicin 0.3% solution BID

21. Physical exam of chest
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
Increased loudness of whispering during auscultation. Indicative of consolidation.
Inflammation of the nasal cavity
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. Proxysmal nocturnal dyspnea
Persistent; recurrent x4/yr; severe HA; altered mental status
Nasal polyps - deviated septum - hx of trauma - surgery - foreign bodies or recent altitude changes
Severe dyspnea when lying supine with associated wheezing and coughing - need to sit up abruptly due to severe dyspnea
Inflammation of the nasal cavity

23. 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.
Measures speed of exhalation; results measure by age and weight
PE: rhinoscopy with otoscope

24. Bronchophony
Purulent discharge - post nasal draiange; cough; sinus pressure - tooth pain; halitosis (changes in taste); alterations of smell
Severe dyspnea when lying supine with associated wheezing and coughing - need to sit up abruptly due to severe dyspnea
Rate; pattern (regular or irregular); effort (labored - accessory muscles)
Increased breath sounds or voice remains loud at the periphery during auscultation. Indicative of consolidation.

25. What sinusitis symptoms would warrant image studies?
Fine or courses; secretions or aveolar collapse; normal if resovle with cough; abnormal: pneumonia; CHF; COPD; pilmonary fibrosis
Aspirin: increases viral shedding
Erythmatous auditory canal - crusting
Persistent; recurrent x4/yr; severe HA; altered mental status

26. Diagnostics of sinusitis?
PE: rhinoscopy with otoscope
TM erythmatous - bulging - light reflex displaced - exudate
Rhinovirus - influenza - and parainfluenza
Purulent discharge - post nasal draiange; cough; sinus pressure - tooth pain; halitosis (changes in taste); alterations of smell

27. Kussmal's respiration
PE: rhinoscopy with otoscope
Amoxicillin 1000 mg TID x7 days; Augmentin 2000/125mg BID x7 days
Deep - rapid - labored - breathing
Amoxicillin 80-90mg/kg/day x7 days; Augmentin 90/6.4 mg/kg/day x7 days

28. Abnormal pulmonary findings?
Persistent; recurrent x4/yr; severe HA; altered mental status
Macrolides (azithormycin); Doxycycline; TMZ-SMZ
Clubbing - Use of accessory muscles - barrel chest
Rate; pattern (regular or irregular); effort (labored - accessory muscles)

29. Nonpharmacological tx for viral URI
Apena alternating with hyperpnea;
Afebrile viral infection of the the nose - paranasal sinuses - throat - larynx - trachea - and and bronchi.
Warm - humid environment; rest;
Step. pneumoniae; Haemophilus influenzae; group B-strep

30. Spirometry
4-12 weeks
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
Apena alternating with hyperpnea;
Ear ache - dullness - hearing loss - fever - N/V/D

31. Acute rhino-sinusitis duration of symptoms?
High pitched voice sound due to transmission of noise across fluid. Indicative of effusion.
Afebrile viral infection of the the nose - paranasal sinuses - throat - larynx - trachea - and and bronchi.
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 weeks

32. Cold incubation period
Deep - rapid - labored - breathing
Rebound congestion 3-5 days
24-72 hrs
Ipratroprium bromide (e.g. Atrovent); Antihistamines (Cargeul not to overly dry out muscos)

33. Rx for viral URI?
92-100%
NSAIDs for aches - fever; Sympathomimetics: pseudophedrine or phenylephrine
Bacterial infection
Aspirin: Reye's Syndrome

34. Normal pulse ox
92-100%
Nasal polyps - deviated septum - hx of trauma - surgery - foreign bodies or recent altitude changes
Bacterial infection
Ear ache - dullness - hearing loss - fever - N/V/D

35. Symptoms of acute bacterial rhino-sinusitis (ABRS)?
Purulent discharge - post nasal draiange; cough; sinus pressure - tooth pain; halitosis (changes in taste); alterations of smell
24-72 hrs
Abnormal high pitched caused by blockage in upper airway; usually heard with with inspiration
Increased loudness of whispering during auscultation. Indicative of consolidation.

36. Whispered pectoriloguy
HEENT: rhinoscopy - sinus tenderness - lymphnodes - transillumination of sinuses - CV and PULM.
Clubbing - Use of accessory muscles - barrel chest
Increased loudness of whispering during auscultation. Indicative of consolidation.
Abrupt onset - burning nose or throat - sneezing - rhinorrhea

37. Rhinosinusitis History?
Decongestants (oxymetazoline); glucocorticoids (e.g. fluticasone); mucolytics (e.g. guaifensin)
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
Nasal congestion - HA - sinus pain - fever - sore throat - cough
Rate; pattern (regular or irregular); effort (labored - accessory muscles)

38. Special cases of sinusitis?
Afebrile viral infection of the the nose - paranasal sinuses - throat - larynx - trachea - and and bronchi.
Persistent or relapse of infection - chronic sinusitis - fungal infection - extension in CNS (meningitis - orbital cellulitis - osteitis)
E. coli
92-100%

39. Wheezes
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.
Apena alternating with hyperpnea;
High pitched sounds; can occur during inspiration or expiration; indicates narrow airways; can occur with asthma - COPD - pneumonia - CHF

40. 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;
Aspirin: increases viral shedding
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
4-12 weeks

41. What is most common age range for otitis?
<4 weeks
3 months to 3 years old
E. coli
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

42. Stridor
Clubbing - Use of accessory muscles - barrel chest
Increased breath sounds or voice remains loud at the periphery during auscultation. Indicative of consolidation.
Abnormal high pitched caused by blockage in upper airway; usually heard with with inspiration
Bacterial or viral infection of the middle ear (secondary to URI [e.g. eustachian tube dysfunction])

43. Rx nasal congestion?
Decongestants (oxymetazoline); glucocorticoids (e.g. fluticasone); mucolytics (e.g. guaifensin)
Rhinovirus - influenza - 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
Bacterial infection

44. Pulmonary tests
Increased loudness of whispering during auscultation. Indicative of consolidation.
Nasal polyps - deviated septum - hx of trauma - surgery - foreign bodies or recent altitude changes
Pulse ox; Peak expiratory flow; spirometry
Purulent discharge - post nasal draiange; cough; sinus pressure - tooth pain; halitosis (changes in taste); alterations of smell

45. Orthopnea
Dyspnea when supine - relived by sitting or standing
Pulse ox; Peak expiratory flow; spirometry
Oflaxicin 0.3% solution BID
NSAIDs for aches - fever; Sympathomimetics: pseudophedrine or phenylephrine

46. What is the most common pahtogen for otitis media?
PE: rhinoscopy with otoscope
Pulse ox; Peak expiratory flow; spirometry
Step. pneumoniae; Haemophilus influenzae; group B-strep
Symptomatic (steam; nasal irrigation); APAP for pain.

47. Subacute 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
Step. pneumoniae; Haemophilus influenzae; group B-strep
Ear ache - dullness - hearing loss - fever - N/V/D
4-12 weeks

48. Egophany (vocal resonance)
Abnormal high pitched caused by blockage in upper airway; usually heard with with inspiration
Labs: CBC - blood gas - d-dimer - CMP - BNP - Chest CT - MRI
High pitched voice sound due to transmission of noise across fluid. Indicative of effusion.
Fine or courses; secretions or aveolar collapse; normal if resovle with cough; abnormal: pneumonia; CHF; COPD; pilmonary fibrosis

49. Rx for rhinorrhea and/or allergies?
Ipratroprium bromide (e.g. Atrovent); Antihistamines (Cargeul not to overly dry out muscos)
Inflammation of the paranasal sinuses
Bacterial or viral infection of the middle ear (secondary to URI [e.g. eustachian tube dysfunction])
Abrupt onset - burning nose or throat - sneezing - rhinorrhea

50. Crackles (rales)
Viral inoculation > viral rhinitis > infection of paranasal sinuses > inflammation & edema > mucosal edema - copious secretions - ciliary dyskinesia > sinus congestions and/or obstruction
Fine or courses; secretions or aveolar collapse; normal if resovle with cough; abnormal: pneumonia; CHF; COPD; pilmonary fibrosis
Hardher and more turbulent
Dyspnea when supine - relived by sitting or standing