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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. Pulmonary tests
Clubbing - Use of accessory muscles - barrel chest
Pulse ox; Peak expiratory flow; spirometry
NSAIDs for aches - fever; Sympathomimetics: pseudophedrine or phenylephrine
TM erythmatous - bulging - light reflex displaced - exudate

2. Stridor
Abnormal high pitched caused by blockage in upper airway; usually heard with with inspiration
E. coli
Deep - snoring sound; indicates fluid or narrowing of airways; common in bronchitis and COPD
NSAIDs for aches - fever; Sympathomimetics: pseudophedrine or phenylephrine

3. Rhonchi
3 months to 3 years old
Severe dyspnea when lying supine with associated wheezing and coughing - need to sit up abruptly due to severe dyspnea
Aspirin: Reye's Syndrome
Deep - snoring sound; indicates fluid or narrowing of airways; common in bronchitis and COPD

4. Bronchial breath sounds...
Persistent or relapse of infection - chronic sinusitis - fungal infection - extension in CNS (meningitis - orbital cellulitis - osteitis)
Persistent; recurrent x4/yr; severe HA; altered mental status
Hardher and more turbulent
Deep - snoring sound; indicates fluid or narrowing of airways; common in bronchitis and COPD

5. Alternative rx for bacterial sinusitis?
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 voice sound due to transmission of noise across fluid. Indicative of effusion.
Macrolides (azithormycin); Doxycycline; TMZ-SMZ
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

6. Additional pulmonary diagnostics
Clubbing - Use of accessory muscles - barrel chest
Labs: CBC - blood gas - d-dimer - CMP - BNP - Chest CT - MRI
Symptomatic (steam; nasal irrigation); APAP for pain.
Rhinovirus - influenza - parainfluenza

7. Crackles (rales)
Step. pneumoniae; Haemophilus influenzae; group B-strep
E. coli
Fine or courses; secretions or aveolar collapse; normal if resovle with cough; abnormal: pneumonia; CHF; COPD; pilmonary fibrosis
3 months to 3 years old

8. Nonpharmacological tx for viral URI
Warm - humid environment; rest;
Amoxicillin 80-90mg/kg/day x7 days; Augmentin 90/6.4 mg/kg/day x7 days
Hardher and more turbulent
Rhinovirus - influenza - parainfluenza

9. Bronchophony
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.
Decongestants (oxymetazoline); glucocorticoids (e.g. fluticasone); mucolytics (e.g. guaifensin)
Ear ache - dullness - hearing loss - fever - N/V/D

10. Normal pulse ox
HEENT: rhinoscopy - sinus tenderness - lymphnodes - transillumination of sinuses - CV and PULM.
92-100%
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;
Macrolides (azithormycin); Doxycycline; TMZ-SMZ

11. What sinusitis symptoms would warrant image studies?
>12 weeks
TM erythmatous - bulging - light reflex displaced - exudate
Persistent; recurrent x4/yr; severe HA; altered mental status
Bacterial infection

12. Rhinosinusitis risk factors?
Nasal polyps - deviated septum - hx of trauma - surgery - foreign bodies or recent altitude changes
High pitched sounds; can occur during inspiration or expiration; indicates narrow airways; can occur with asthma - COPD - pneumonia - CHF
TM erythmatous - bulging - light reflex displaced - exudate
Ear ache - dullness - hearing loss - fever - N/V/D

13. Kussmal's respiration
Fine or courses; secretions or aveolar collapse; normal if resovle with cough; abnormal: pneumonia; CHF; COPD; pilmonary fibrosis
Deep - rapid - labored - breathing
NSAIDs for aches - fever; Sympathomimetics: pseudophedrine or phenylephrine
Apena alternating with hyperpnea;

14. 1st line treatment for bacterial sinusitis?
Augementin 2000/124 mg bid for 5-7 days - Peds: 90 mg/kg/day po in divided doses
Pulse ox; Peak expiratory flow; spirometry
3 months to 3 years old
Persistent or relapse of infection - chronic sinusitis - fungal infection - extension in CNS (meningitis - orbital cellulitis - osteitis)

15. What is the common side effect of sympathomimetics?
Pulse ox; Peak expiratory flow; spirometry
Rebound congestion 3-5 days
Ipratroprium bromide (e.g. Atrovent); Antihistamines (Cargeul not to overly dry out muscos)
Measures speed of exhalation; results measure by age and weight

16. Proxysmal nocturnal 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
Severe dyspnea when lying supine with associated wheezing and coughing - need to sit up abruptly due to severe dyspnea
HEENT: rhinoscopy - sinus tenderness - lymphnodes - transillumination of sinuses - CV and PULM.
Soft sounds in and out

17. Which Rx should not be used for viral URI?
Amoxicillin 1000 mg TID x7 days; Augmentin 2000/125mg BID x7 days
Aspirin: increases viral shedding
Clubbing - Use of accessory muscles - barrel chest
Amoxicillin 80-90mg/kg/day x7 days; Augmentin 90/6.4 mg/kg/day x7 days

18. Respiratory Examination (Observation)
High pitched voice sound due to transmission of noise across fluid. Indicative of effusion.
4-12 weeks
Rate; pattern (regular or irregular); effort (labored - accessory muscles)
TM erythmatous - bulging - light reflex displaced - exudate

19. Common cold pathogens
Fine or courses; secretions or aveolar collapse; normal if resovle with cough; abnormal: pneumonia; CHF; COPD; pilmonary fibrosis
Rhinovirus - influenza - and parainfluenza
Deep - rapid - labored - breathing
Increased breath sounds or voice remains loud at the periphery during auscultation. Indicative of consolidation.

20. What is the most common pahtogen for otitis media?
Step. pneumoniae; Haemophilus influenzae; group B-strep
Macrolides (azithormycin); Doxycycline; TMZ-SMZ
Ipratroprium bromide (e.g. Atrovent); Antihistamines (Cargeul not to overly dry out muscos)
Decongestants (oxymetazoline); glucocorticoids (e.g. fluticasone); mucolytics (e.g. guaifensin)

21. Rx for viral URI?
Inflammation of the nasal cavity
Decongestants (oxymetazoline); glucocorticoids (e.g. fluticasone); mucolytics (e.g. guaifensin)
Macrolides (azithormycin); Doxycycline; TMZ-SMZ
NSAIDs for aches - fever; Sympathomimetics: pseudophedrine or phenylephrine

22. Pulmonary diagnostics (1)
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
Aspirin: increases viral shedding
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

23. Common Cold (URI - Acute Coryza)
Afebrile viral infection of the the nose - paranasal sinuses - throat - larynx - trachea - and and bronchi.
92-100%
Deep - rapid - labored - breathing
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

24. Peak Expiratory Flow (PEF)
Measures speed of exhalation; results measure by age and weight
Ipratroprium bromide (e.g. Atrovent); Antihistamines (Cargeul not to overly dry out muscos)
Nasal congestion - HA - sinus pain - fever - sore throat - cough
Bacterial infection

25. Rhinosinusitis physical exam?
HEENT: rhinoscopy - sinus tenderness - lymphnodes - transillumination of sinuses - CV and PULM.
4-12 weeks
Soft sounds in and out
Rhinovirus - influenza - and parainfluenza

26. Rx nasal congestion?
<4 weeks
Pulse ox; Peak expiratory flow; spirometry
Decongestants (oxymetazoline); glucocorticoids (e.g. fluticasone); mucolytics (e.g. guaifensin)
Ipratroprium bromide (e.g. Atrovent); Antihistamines (Cargeul not to overly dry out muscos)

27. Diagnostics of sinusitis?
Aspirin: increases viral shedding
PE: rhinoscopy with otoscope
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;
Increased loudness of whispering during auscultation. Indicative of consolidation.

28. Tx for adult AOE?
Deep - rapid - labored - breathing
High pitched sounds; can occur during inspiration or expiration; indicates narrow airways; can occur with asthma - COPD - pneumonia - CHF
Oflaxicin 0.3% solution BID
Rhinovirus - influenza - and parainfluenza

29. Sinusitis
High pitched voice sound due to transmission of noise across fluid. Indicative of effusion.
E. coli
Macrolides (azithormycin); Doxycycline; TMZ-SMZ
Inflammation of the paranasal sinuses

30. What is most common age range for otitis?
Apena alternating with hyperpnea;
Decongestants (oxymetazoline); glucocorticoids (e.g. fluticasone); mucolytics (e.g. guaifensin)
3 months to 3 years old
Inflammation of the paranasal sinuses

31. Subacute rhino-sinusitis duration of symptoms?
Deep - snoring sound; indicates fluid or narrowing of airways; common in bronchitis and COPD
4-12 weeks
TM erythmatous - bulging - light reflex displaced - exudate
Fine or courses; secretions or aveolar collapse; normal if resovle with cough; abnormal: pneumonia; CHF; COPD; pilmonary fibrosis

32. Acute otitis media
Decongestants (oxymetazoline); glucocorticoids (e.g. fluticasone); mucolytics (e.g. guaifensin)
Bacterial or viral infection of the middle ear (secondary to URI [e.g. eustachian tube dysfunction])
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
PE: rhinoscopy with otoscope

33. Physical exam of chest
24-72 hrs
Apena alternating with hyperpnea;
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;
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

34. Vesicular breath sounds...
Aspirin: increases viral shedding
Rebound congestion 3-5 days
Soft sounds in and out
Augementin 2000/124 mg bid for 5-7 days - Peds: 90 mg/kg/day po in divided doses

35. Cold incubation period
Bacterial infection
Rhinovirus - influenza - and parainfluenza
Bacterial or viral infection of the middle ear (secondary to URI [e.g. eustachian tube dysfunction])
24-72 hrs

36. Tx for adult AOM?
Erythmatous auditory canal - crusting
Increased breath sounds or voice remains loud at the periphery during auscultation. Indicative of consolidation.
Purulent discharge - post nasal draiange; cough; sinus pressure - tooth pain; halitosis (changes in taste); alterations of smell
Amoxicillin 1000 mg TID x7 days; Augmentin 2000/125mg BID x7 days

37. What are the symptoms of otitis?
Purulent discharge - post nasal draiange; cough; sinus pressure - tooth pain; halitosis (changes in taste); alterations of smell
Ear ache - dullness - hearing loss - fever - N/V/D
NSAIDs for aches - fever; Sympathomimetics: pseudophedrine or phenylephrine
Rhinovirus - influenza - and parainfluenza

38. Rhinitis
Inflammation of the nasal cavity
Ear ache - dullness - hearing loss - fever - N/V/D
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

39. Acute rhino-sinusitis duration of symptoms?
Soft sounds in and out
<4 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
Aspirin: increases viral shedding

40. Rhinosinusitis History?
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
Nasal congestion - HA - sinus pain - fever - sore throat - cough
Aspirin: increases viral shedding

41. Orthopnea
Ipratroprium bromide (e.g. Atrovent); Antihistamines (Cargeul not to overly dry out muscos)
Nasal congestion - HA - sinus pain - fever - sore throat - cough
92-100%
Dyspnea when supine - relived by sitting or standing

42. Respiratory Illness Key Points (3)
Fine or courses; secretions or aveolar collapse; normal if resovle with cough; abnormal: pneumonia; CHF; COPD; pilmonary fibrosis
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
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 or relapse of infection - chronic sinusitis - fungal infection - extension in CNS (meningitis - orbital cellulitis - osteitis)

43. Wheezes
Labs: CBC - blood gas - d-dimer - CMP - BNP - Chest CT - MRI
Increased loudness of whispering during auscultation. Indicative of consolidation.
Rhinovirus - influenza - parainfluenza
High pitched sounds; can occur during inspiration or expiration; indicates narrow airways; can occur with asthma - COPD - pneumonia - CHF

44. Symptoms of acute bacterial rhino-sinusitis (ABRS)?
Clubbing - Use of accessory muscles - barrel chest
Bacterial infection
Measures speed of exhalation; results measure by age and weight
Purulent discharge - post nasal draiange; cough; sinus pressure - tooth pain; halitosis (changes in taste); alterations of smell

45. Egophany (vocal resonance)
High pitched voice sound due to transmission of noise across fluid. Indicative of effusion.
3 months to 3 years old
Deep - snoring sound; indicates fluid or narrowing of airways; common in bronchitis and COPD
Decongestants (oxymetazoline); glucocorticoids (e.g. fluticasone); mucolytics (e.g. guaifensin)

46. Chronic rhino-sinusitis duration of symptoms?
Macrolides (azithormycin); Doxycycline; TMZ-SMZ
>12 weeks
Inflammation of the paranasal sinuses
Rebound congestion 3-5 days

47. Abnormal pulmonary findings?
Rhinovirus - influenza - and parainfluenza
TM erythmatous - bulging - light reflex displaced - exudate
Clubbing - Use of accessory muscles - barrel chest
Abrupt onset - burning nose or throat - sneezing - rhinorrhea

48. What are physical exam findings of AOM?
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.
Rhinovirus - influenza - and parainfluenza
TM erythmatous - bulging - light reflex displaced - exudate

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

50. Common cold symptoms
Bacterial or viral infection of the middle ear (secondary to URI [e.g. eustachian tube dysfunction])
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
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;