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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. Subacute rhino-sinusitis duration of symptoms?
4-12 weeks
Amoxicillin 1000 mg TID x7 days; Augmentin 2000/125mg BID x7 days
Bacterial or viral infection of the middle ear (secondary to URI [e.g. eustachian tube dysfunction])
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;

2. Egophany (vocal resonance)
High pitched voice sound due to transmission of noise across fluid. Indicative of effusion.
Clubbing - Use of accessory muscles - barrel chest
Inflammation of the nasal cavity
E. coli

3. Stridor
Purulent discharge - post nasal draiange; cough; sinus pressure - tooth pain; halitosis (changes in taste); alterations of smell
Abnormal high pitched caused by blockage in upper airway; usually heard with with inspiration
Persistent; recurrent x4/yr; severe HA; altered mental status
PE: rhinoscopy with otoscope

4. Tx of sinusitis symptoms <10 days
Symptomatic (steam; nasal irrigation); APAP for pain.
Inflammation of the nasal cavity
<4 weeks
Pulse ox; Peak expiratory flow; spirometry

5. Kussmal's respiration
Increased breath sounds or voice remains loud at the periphery during auscultation. Indicative of consolidation.
Step. pneumoniae; Haemophilus influenzae; group B-strep
Persistent or relapse of infection - chronic sinusitis - fungal infection - extension in CNS (meningitis - orbital cellulitis - osteitis)
Deep - rapid - labored - breathing

6. Rhinosinusitis physical exam?
HEENT: rhinoscopy - sinus tenderness - lymphnodes - transillumination of sinuses - CV and PULM.
Inflammation of the paranasal sinuses
Ear ache - dullness - hearing loss - fever - N/V/D
24-72 hrs

7. What is the most common pathogen for otitis in newborns?
Aspirin: increases viral shedding
E. coli
Warm - humid environment; rest;
Abrupt onset - burning nose or throat - sneezing - rhinorrhea

8. Wheezes
>12 weeks
High pitched sounds; can occur during inspiration or expiration; indicates narrow airways; can occur with asthma - COPD - pneumonia - CHF
Aspirin: Reye's Syndrome
Inflammation of the nasal cavity

9. Acute otitis media
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])
High pitched voice sound due to transmission of noise across fluid. Indicative of effusion.
Dyspnea when supine - relived by sitting or standing

10. Pulmonary tests
Rate; pattern (regular or irregular); effort (labored - accessory muscles)
Severe dyspnea when lying supine with associated wheezing and coughing - need to sit up abruptly due to severe dyspnea
Pulse ox; Peak expiratory flow; spirometry
Ipratroprium bromide (e.g. Atrovent); Antihistamines (Cargeul not to overly dry out muscos)

11. Tx for adult AOM?
Bacterial infection
Amoxicillin 1000 mg TID x7 days; Augmentin 2000/125mg BID x7 days
Step. pneumoniae; Haemophilus influenzae; group B-strep
Severe dyspnea when lying supine with associated wheezing and coughing - need to sit up abruptly due to severe dyspnea

12. Rhinosinusitis risk factors?
E. coli
24-72 hrs
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

13. What are physical exam findings of AOE?
Macrolides (azithormycin); Doxycycline; TMZ-SMZ
E. coli
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
Erythmatous auditory canal - crusting

14. Tx for adult AOE?
Nasal polyps - deviated septum - hx of trauma - surgery - foreign bodies or recent altitude changes
Oflaxicin 0.3% solution BID
Deep - rapid - labored - breathing
4-12 weeks

15. Diagnostics of sinusitis?
PE: rhinoscopy with otoscope
Aspirin: Reye's Syndrome
Rhinovirus - influenza - parainfluenza
Severe dyspnea when lying supine with associated wheezing and coughing - need to sit up abruptly due to severe dyspnea

16. Peak Expiratory Flow (PEF)
Measures speed of exhalation; results measure by age and weight
Deep - snoring sound; indicates fluid or narrowing of airways; common in bronchitis and COPD
Dyspnea when supine - relived by sitting or standing
Macrolides (azithormycin); Doxycycline; TMZ-SMZ

17. Special cases of sinusitis?
Rhinovirus - influenza - parainfluenza
Persistent or relapse of infection - chronic sinusitis - fungal infection - extension in CNS (meningitis - orbital cellulitis - osteitis)
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

18. What is most common age range for otitis?
Clubbing - Use of accessory muscles - barrel chest
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
3 months to 3 years old

19. Additional pulmonary diagnostics
Oflaxicin 0.3% solution BID
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
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

20. Chronic rhino-sinusitis duration of symptoms?
>12 weeks
Augementin 2000/124 mg bid for 5-7 days - Peds: 90 mg/kg/day po in divided doses
Decongestants (oxymetazoline); glucocorticoids (e.g. fluticasone); mucolytics (e.g. guaifensin)
Nasal polyps - deviated septum - hx of trauma - surgery - foreign bodies or recent altitude changes

21. Alternative rx for bacterial sinusitis?
Erythmatous auditory canal - crusting
Nasal congestion - HA - sinus pain - fever - sore throat - cough
Macrolides (azithormycin); Doxycycline; TMZ-SMZ
Pulse ox; Peak expiratory flow; spirometry

22. Bronchophony
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
Measures speed of exhalation; results measure by age and weight
Increased breath sounds or voice remains loud at the periphery during auscultation. Indicative of consolidation.

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

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24. Rx for rhinorrhea and/or allergies?
Ipratroprium bromide (e.g. Atrovent); Antihistamines (Cargeul not to overly dry out muscos)
Aspirin: Reye's Syndrome
Dyspnea when supine - relived by sitting or standing
Nasal polyps - deviated septum - hx of trauma - surgery - foreign bodies or recent altitude changes

25. Respiratory Examination (Observation)
Warm - humid environment; rest;
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
Symptomatic (steam; nasal irrigation); APAP for pain.
Rate; pattern (regular or irregular); effort (labored - accessory muscles)

26. Acute viral rhino-sinusitis (AVRS) pathogens?
Rhinovirus - influenza - parainfluenza
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)
Bacterial or viral infection of the middle ear (secondary to URI [e.g. eustachian tube dysfunction])

27. Rhinitis
Viral inoculation > viral rhinitis > infection of paranasal sinuses > inflammation & edema > mucosal edema - copious secretions - ciliary dyskinesia > sinus congestions and/or obstruction
HEENT: rhinoscopy - sinus tenderness - lymphnodes - transillumination of sinuses - CV and PULM.
Inflammation of the nasal cavity
Measures speed of exhalation; results measure by age and weight

28. Cheyne-stokes
Persistent; recurrent x4/yr; severe HA; altered mental status
Apena alternating with hyperpnea;
Soft sounds in and out
92-100%

29. Pathophysiology of rhino sinusitis?
Viral inoculation > viral rhinitis > infection of paranasal sinuses > inflammation & edema > mucosal edema - copious secretions - ciliary dyskinesia > sinus congestions and/or obstruction
<4 weeks
Ear ache - dullness - hearing loss - fever - N/V/D
HEENT: rhinoscopy - sinus tenderness - lymphnodes - transillumination of sinuses - CV and PULM.

30. Whispered pectoriloguy
Rhinovirus - influenza - parainfluenza
Increased loudness of whispering during auscultation. Indicative of consolidation.
Ear ache - dullness - hearing loss - fever - N/V/D
Amoxicillin 1000 mg TID x7 days; Augmentin 2000/125mg BID x7 days

31. Symptoms of acute bacterial rhino-sinusitis (ABRS)?
Purulent discharge - post nasal draiange; cough; sinus pressure - tooth pain; halitosis (changes in taste); alterations of smell
Inflammation of the paranasal sinuses
Rhinovirus - influenza - parainfluenza
Ear ache - dullness - hearing loss - fever - N/V/D

32. Nonpharmacological tx for viral URI
Soft sounds in and out
Fine or courses; secretions or aveolar collapse; normal if resovle with cough; abnormal: pneumonia; CHF; COPD; pilmonary fibrosis
Warm - humid environment; rest;
92-100%

33. Proxysmal nocturnal dyspnea
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
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

34. Tx for pediatric AOM?
Step. pneumoniae; Haemophilus influenzae; group B-strep
Purulent discharge - post nasal draiange; cough; sinus pressure - tooth pain; halitosis (changes in taste); alterations of smell
Amoxicillin 80-90mg/kg/day x7 days; Augmentin 90/6.4 mg/kg/day x7 days
Soft sounds in and out

35. What sinusitis symptoms would warrant image studies?
Rhinovirus - influenza - and parainfluenza
Persistent; recurrent x4/yr; severe HA; altered mental status
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;
Clubbing - Use of accessory muscles - barrel chest

36. Vesicular breath sounds...
Nasal congestion - HA - sinus pain - fever - sore throat - cough
TM erythmatous - bulging - light reflex displaced - exudate
Soft sounds in and out
Macrolides (azithormycin); Doxycycline; TMZ-SMZ

37. Common cold symptoms
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
Abrupt onset - burning nose or throat - sneezing - rhinorrhea
Abnormal high pitched caused by blockage in upper airway; usually heard with with inspiration

38. 1st line treatment for bacterial sinusitis?
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;
Clubbing - Use of accessory muscles - barrel chest
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

39. Physical exam of chest
Aspirin: increases viral shedding
Clubbing - Use of accessory muscles - barrel chest
Increased loudness of whispering during auscultation. Indicative of consolidation.
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

40. What is the most common pahtogen for otitis media?
Inflammation of the paranasal sinuses
Increased loudness of whispering during auscultation. Indicative of consolidation.
Step. pneumoniae; Haemophilus influenzae; group B-strep
High pitched sounds; can occur during inspiration or expiration; indicates narrow airways; can occur with asthma - COPD - pneumonia - CHF

41. Which Rx should not be used for viral URI?
24-72 hrs
Afebrile viral infection of the the nose - paranasal sinuses - throat - larynx - trachea - and and bronchi.
Bacterial infection
Aspirin: increases viral shedding

42. What does mucopurulent indications not indicate?
Abnormal high pitched caused by blockage in upper airway; usually heard with with inspiration
High pitched sounds; can occur during inspiration or expiration; indicates narrow airways; can occur with asthma - COPD - pneumonia - CHF
Bacterial infection
NSAIDs for aches - fever; Sympathomimetics: pseudophedrine or phenylephrine

43. Crackles (rales)
Nasal polyps - deviated septum - hx of trauma - surgery - foreign bodies or recent altitude changes
Fine or courses; secretions or aveolar collapse; normal if resovle with cough; abnormal: pneumonia; CHF; COPD; pilmonary fibrosis
Aspirin: increases viral shedding
E. coli

44. Common Cold (URI - Acute Coryza)
Increased loudness of whispering during auscultation. Indicative of consolidation.
Deep - rapid - labored - breathing
Afebrile viral infection of the the nose - paranasal sinuses - throat - larynx - trachea - and and bronchi.
Rhinovirus - influenza - and parainfluenza

45. Rx 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
NSAIDs for aches - fever; Sympathomimetics: pseudophedrine or phenylephrine
Bacterial infection

46. Spirometry
HEENT: rhinoscopy - sinus tenderness - lymphnodes - transillumination of sinuses - CV and PULM.
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
Labs: CBC - blood gas - d-dimer - CMP - BNP - Chest CT - MRI
Rhinovirus - influenza - parainfluenza

47. Common cold pathogens
Rhinovirus - influenza - and parainfluenza
Increased loudness of whispering during auscultation. Indicative of consolidation.
Nasal polyps - deviated septum - hx of trauma - surgery - foreign bodies or recent altitude changes
TM erythmatous - bulging - light reflex displaced - exudate

48. Cold incubation period
Measures speed of exhalation; results measure by age and weight
Amoxicillin 1000 mg TID x7 days; Augmentin 2000/125mg BID x7 days
Rebound congestion 3-5 days
24-72 hrs

49. What are physical exam findings of AOM?
Nasal congestion - HA - sinus pain - fever - sore throat - cough
Rate; pattern (regular or irregular); effort (labored - accessory muscles)
Erythmatous auditory canal - crusting
TM erythmatous - bulging - light reflex displaced - exudate

50. Respiratory Illness Key Points (3)
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
Deep - rapid - labored - breathing
Symptomatic (steam; nasal irrigation); APAP for pain.
Nasal congestion - HA - sinus pain - fever - sore throat - cough