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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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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. What are physical exam findings of AOE?
3 months to 3 years old
Abnormal high pitched caused by blockage in upper airway; usually heard with with inspiration
Viral inoculation > viral rhinitis > infection of paranasal sinuses > inflammation & edema > mucosal edema - copious secretions - ciliary dyskinesia > sinus congestions and/or obstruction
Erythmatous auditory canal - crusting

2. Acute viral rhino-sinusitis (AVRS) pathogens?
Rebound congestion 3-5 days
Inflammation of the nasal cavity
Rhinovirus - influenza - parainfluenza
Erythmatous auditory canal - crusting

3. Acute rhino-sinusitis duration of symptoms?
Persistent; recurrent x4/yr; severe HA; altered mental status
<4 weeks
PE: rhinoscopy with otoscope
E. coli

4. What is the most common pahtogen for otitis media?
Step. pneumoniae; Haemophilus influenzae; group B-strep
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
24-72 hrs
Symptomatic (steam; nasal irrigation); APAP for pain.

5. Respiratory Examination (Observation)
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
Rate; pattern (regular or irregular); effort (labored - accessory muscles)
Measures speed of exhalation; results measure by age and weight

6. Bronchial breath sounds...
TM erythmatous - bulging - light reflex displaced - exudate
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 or relapse of infection - chronic sinusitis - fungal infection - extension in CNS (meningitis - orbital cellulitis - osteitis)
Hardher and more turbulent

7. Pathophysiology of rhino sinusitis?
Bacterial infection
PE: rhinoscopy with otoscope
Viral inoculation > viral rhinitis > infection of paranasal sinuses > inflammation & edema > mucosal edema - copious secretions - ciliary dyskinesia > sinus congestions and/or obstruction
High pitched sounds; can occur during inspiration or expiration; indicates narrow airways; can occur with asthma - COPD - pneumonia - CHF

8. Rhonchi
Deep - rapid - labored - breathing
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
Dyspnea when supine - relived by sitting or standing

9. Common cold symptoms
High pitched voice sound due to transmission of noise across fluid. Indicative of effusion.
Abrupt onset - burning nose or throat - sneezing - rhinorrhea
Warm - humid environment; rest;
24-72 hrs

10. Special cases of sinusitis?
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
Augementin 2000/124 mg bid for 5-7 days - Peds: 90 mg/kg/day po in divided doses
Persistent or relapse of infection - chronic sinusitis - fungal infection - extension in CNS (meningitis - orbital cellulitis - osteitis)

11. Nonpharmacological tx for viral URI
3 months to 3 years old
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
Apena alternating with hyperpnea;
Warm - humid environment; rest;

12. Rx for rhinorrhea and/or allergies?
Clubbing - Use of accessory muscles - barrel chest
Inflammation of the nasal cavity
Bacterial or viral infection of the middle ear (secondary to URI [e.g. eustachian tube dysfunction])
Ipratroprium bromide (e.g. Atrovent); Antihistamines (Cargeul not to overly dry out muscos)

13. What is the common side effect of sympathomimetics?
High pitched sounds; can occur during inspiration or expiration; indicates narrow airways; can occur with asthma - COPD - pneumonia - CHF
Inflammation of the paranasal sinuses
Clubbing - Use of accessory muscles - barrel chest
Rebound congestion 3-5 days

14. Rhinosinusitis risk factors?
High pitched sounds; can occur during inspiration or expiration; indicates narrow airways; can occur with asthma - COPD - pneumonia - CHF
Nasal polyps - deviated septum - hx of trauma - surgery - foreign bodies or recent altitude changes
Ipratroprium bromide (e.g. Atrovent); Antihistamines (Cargeul not to overly dry out muscos)
Warm - humid environment; rest;

15. Symptoms of acute bacterial rhino-sinusitis (ABRS)?
Purulent discharge - post nasal draiange; cough; sinus pressure - tooth pain; halitosis (changes in taste); alterations of smell
92-100%
Soft sounds in and out
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;

16. Crackles (rales)
Abrupt onset - burning nose or throat - sneezing - rhinorrhea
Rhinovirus - influenza - parainfluenza
>12 weeks
Fine or courses; secretions or aveolar collapse; normal if resovle with cough; abnormal: pneumonia; CHF; COPD; pilmonary fibrosis

17. What is the most common pathogen for otitis in newborns?
Ipratroprium bromide (e.g. Atrovent); Antihistamines (Cargeul not to overly dry out muscos)
E. coli
Labs: CBC - blood gas - d-dimer - CMP - BNP - Chest CT - MRI
HEENT: rhinoscopy - sinus tenderness - lymphnodes - transillumination of sinuses - CV and PULM.

18. What are the symptoms of otitis?
Ipratroprium bromide (e.g. Atrovent); Antihistamines (Cargeul not to overly dry out muscos)
Dyspnea when supine - relived by sitting or standing
Ear ache - dullness - hearing loss - fever - N/V/D
Persistent or relapse of infection - chronic sinusitis - fungal infection - extension in CNS (meningitis - orbital cellulitis - osteitis)

19. Diagnostics of sinusitis?
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
Increased breath sounds or voice remains loud at the periphery during auscultation. Indicative of consolidation.
Bacterial or viral infection of the middle ear (secondary to URI [e.g. eustachian tube dysfunction])
PE: rhinoscopy with otoscope

20. Subacute rhino-sinusitis duration of symptoms?
4-12 weeks
Bacterial infection
Symptomatic (steam; nasal irrigation); APAP for pain.
Deep - rapid - labored - breathing

21. Rx for viral URI?
<4 weeks
NSAIDs for aches - fever; Sympathomimetics: pseudophedrine or phenylephrine
Bacterial infection
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

22. Vesicular breath sounds...
Soft sounds in and out
High pitched voice sound due to transmission of noise across fluid. Indicative of effusion.
Warm - humid environment; rest;
HEENT: rhinoscopy - sinus tenderness - lymphnodes - transillumination of sinuses - CV and PULM.

23. Stridor
Increased loudness of whispering during auscultation. Indicative of consolidation.
92-100%
Abnormal high pitched caused by blockage in upper airway; usually heard with with inspiration
Apena alternating with hyperpnea;

24. What are physical exam findings of AOM?
High pitched voice sound due to transmission of noise across fluid. Indicative of effusion.
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
24-72 hrs
TM erythmatous - bulging - light reflex displaced - exudate

25. Orthopnea
Persistent; recurrent x4/yr; severe HA; altered mental status
Bacterial or viral infection of the middle ear (secondary to URI [e.g. eustachian tube dysfunction])
Ipratroprium bromide (e.g. Atrovent); Antihistamines (Cargeul not to overly dry out muscos)
Dyspnea when supine - relived by sitting or standing

26. Whispered pectoriloguy
Increased loudness of whispering during auscultation. Indicative of consolidation.
Dyspnea when supine - relived by sitting or standing
Step. pneumoniae; Haemophilus influenzae; group B-strep
Increased breath sounds or voice remains loud at the periphery during auscultation. Indicative of consolidation.

27. Egophany (vocal resonance)
Decongestants (oxymetazoline); glucocorticoids (e.g. fluticasone); mucolytics (e.g. guaifensin)
Abnormal high pitched caused by blockage in upper airway; usually heard with with inspiration
Augementin 2000/124 mg bid for 5-7 days - Peds: 90 mg/kg/day po in divided doses
High pitched voice sound due to transmission of noise across fluid. Indicative of effusion.

28. Tx for adult AOM?
High pitched sounds; can occur during inspiration or expiration; indicates narrow airways; can occur with asthma - COPD - pneumonia - CHF
Increased loudness of whispering during auscultation. Indicative of consolidation.
Amoxicillin 1000 mg TID x7 days; Augmentin 2000/125mg BID x7 days
Afebrile viral infection of the the nose - paranasal sinuses - throat - larynx - trachea - and and bronchi.

29. Common cold pathogens
Severe dyspnea when lying supine with associated wheezing and coughing - need to sit up abruptly due to severe dyspnea
Rhinovirus - influenza - and parainfluenza
Abnormal high pitched caused by blockage in upper airway; usually heard with with inspiration
HEENT: rhinoscopy - sinus tenderness - lymphnodes - transillumination of sinuses - CV and PULM.

30. What does mucopurulent indications not indicate?
Bacterial infection
Increased breath sounds or voice remains loud at the periphery during auscultation. Indicative of consolidation.
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
Macrolides (azithormycin); Doxycycline; TMZ-SMZ

31. Rhinitis
Deep - rapid - labored - breathing
<4 weeks
Rhinovirus - influenza - parainfluenza
Inflammation of the nasal cavity

32. Physical exam of chest
Nasal polyps - deviated septum - hx of trauma - surgery - foreign bodies or recent altitude changes
NSAIDs for aches - fever; Sympathomimetics: pseudophedrine or phenylephrine
Symptomatic (steam; nasal irrigation); APAP for pain.
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

33. Normal pulse ox
Deep - snoring sound; indicates fluid or narrowing of airways; common in bronchitis and COPD
High pitched sounds; can occur during inspiration or expiration; indicates narrow airways; can occur with asthma - COPD - pneumonia - CHF
92-100%
Deep - rapid - labored - breathing

34. Pulmonary diagnostics (1)
Persistent or relapse of infection - chronic sinusitis - fungal infection - extension in CNS (meningitis - orbital cellulitis - osteitis)
92-100%
Labs: CBC - blood gas - d-dimer - CMP - BNP - Chest CT - MRI
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. Tx for adult AOE?
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
Oflaxicin 0.3% solution BID
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

36. Common Cold (URI - Acute Coryza)
Aspirin: increases viral shedding
Soft sounds in and out
Afebrile viral infection of the the nose - paranasal sinuses - throat - larynx - trachea - and and bronchi.
Labs: CBC - blood gas - d-dimer - CMP - BNP - Chest CT - MRI

37. Chronic rhino-sinusitis duration of symptoms?
Ipratroprium bromide (e.g. Atrovent); Antihistamines (Cargeul not to overly dry out muscos)
>12 weeks
Persistent or relapse of infection - chronic sinusitis - fungal infection - extension in CNS (meningitis - orbital cellulitis - osteitis)
Clubbing - Use of accessory muscles - barrel chest

38. Spirometry
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
92-100%
>12 weeks
Ipratroprium bromide (e.g. Atrovent); Antihistamines (Cargeul not to overly dry out muscos)

39. Rhinosinusitis History?
NSAIDs for aches - fever; Sympathomimetics: pseudophedrine or phenylephrine
Labs: CBC - blood gas - d-dimer - CMP - BNP - Chest CT - MRI
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

40. Additional pulmonary diagnostics
Clubbing - Use of accessory muscles - barrel chest
Decongestants (oxymetazoline); glucocorticoids (e.g. fluticasone); mucolytics (e.g. guaifensin)
Labs: CBC - blood gas - d-dimer - CMP - BNP - Chest CT - MRI
Increased loudness of whispering during auscultation. Indicative of consolidation.

41. Cold incubation period
24-72 hrs
Hardher and more turbulent
Aspirin: Reye's Syndrome
<4 weeks

42. Pulmonary tests
Ipratroprium bromide (e.g. Atrovent); Antihistamines (Cargeul not to overly dry out muscos)
Bacterial or viral infection of the middle ear (secondary to URI [e.g. eustachian tube dysfunction])
Pulse ox; Peak expiratory flow; spirometry
Erythmatous auditory canal - crusting

43. Wheezes
Rhinovirus - influenza - and parainfluenza
Amoxicillin 1000 mg TID x7 days; Augmentin 2000/125mg BID x7 days
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
High pitched sounds; can occur during inspiration or expiration; indicates narrow airways; can occur with asthma - COPD - pneumonia - CHF

44. What sinusitis symptoms would warrant image studies?
Persistent; recurrent x4/yr; severe HA; altered mental status
Ear ache - dullness - hearing loss - fever - N/V/D
Step. pneumoniae; Haemophilus influenzae; group B-strep
Deep - snoring sound; indicates fluid or narrowing of airways; common in bronchitis and COPD

45. Kussmal's respiration
High pitched voice sound due to transmission of noise across fluid. Indicative of effusion.
Persistent; recurrent x4/yr; severe HA; altered mental status
Increased loudness of whispering during auscultation. Indicative of consolidation.
Deep - rapid - labored - breathing

46. Cheyne-stokes
Apena alternating with hyperpnea;
HEENT: rhinoscopy - sinus tenderness - lymphnodes - transillumination of sinuses - CV and PULM.
Ear ache - dullness - hearing loss - fever - N/V/D
Bacterial infection

47. Abnormal pulmonary findings?
Clubbing - Use of accessory muscles - barrel chest
Persistent or relapse of infection - chronic sinusitis - fungal infection - extension in CNS (meningitis - orbital cellulitis - osteitis)
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;
Nasal congestion - HA - sinus pain - fever - sore throat - cough

48. What is most common age range for otitis?
Macrolides (azithormycin); Doxycycline; TMZ-SMZ
Pulse ox; Peak expiratory flow; spirometry
3 months to 3 years old
Deep - rapid - labored - breathing

49. Proxysmal nocturnal dyspnea
Labs: CBC - blood gas - d-dimer - CMP - BNP - Chest CT - MRI
Oflaxicin 0.3% solution BID
Severe dyspnea when lying supine with associated wheezing and coughing - need to sit up abruptly due to severe dyspnea
Hardher and more turbulent

50. Tx of sinusitis symptoms <10 days
3 months to 3 years old
High pitched voice sound due to transmission of noise across fluid. Indicative of effusion.
Symptomatic (steam; nasal irrigation); APAP for pain.
Measures speed of exhalation; results measure by age and weight