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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. Diagnostics of sinusitis?
PE: rhinoscopy with otoscope
Nasal polyps - deviated septum - hx of trauma - surgery - foreign bodies or recent altitude changes
Hardher and more turbulent
Purulent discharge - post nasal draiange; cough; sinus pressure - tooth pain; halitosis (changes in taste); alterations of smell

2. Pathophysiology of rhino sinusitis?
Macrolides (azithormycin); Doxycycline; TMZ-SMZ
Abnormal high pitched caused by blockage in upper airway; usually heard with with inspiration
NSAIDs for aches - fever; Sympathomimetics: pseudophedrine or phenylephrine
Viral inoculation > viral rhinitis > infection of paranasal sinuses > inflammation & edema > mucosal edema - copious secretions - ciliary dyskinesia > sinus congestions and/or obstruction

3. Whispered pectoriloguy
>12 weeks
Abnormal high pitched caused by blockage in upper airway; usually heard with with inspiration
Increased loudness of whispering during auscultation. Indicative of consolidation.
Hardher and more turbulent

4. What is the most common pathogen for otitis in newborns?
Rate; pattern (regular or irregular); effort (labored - accessory muscles)
E. coli
<4 weeks
Aspirin: Reye's Syndrome

5. Spirometry
Deep - rapid - labored - breathing
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
Inflammation of the paranasal sinuses

6. Tx for pediatric AOM?
HEENT: rhinoscopy - sinus tenderness - lymphnodes - transillumination of sinuses - CV and PULM.
Amoxicillin 80-90mg/kg/day x7 days; Augmentin 90/6.4 mg/kg/day x7 days
Soft sounds in and out
Nasal congestion - HA - sinus pain - fever - sore throat - cough

7. Tx for adult AOM?
TM erythmatous - bulging - light reflex displaced - exudate
Rhinovirus - influenza - parainfluenza
Apena alternating with hyperpnea;
Amoxicillin 1000 mg TID x7 days; Augmentin 2000/125mg BID x7 days

8. Nonpharmacological tx for viral URI
Increased loudness of whispering during auscultation. Indicative of consolidation.
Pulse ox; Peak expiratory flow; spirometry
Warm - humid environment; rest;
Macrolides (azithormycin); Doxycycline; TMZ-SMZ

9. 1st line treatment for bacterial sinusitis?
Inflammation of the nasal cavity
Ear ache - dullness - hearing loss - fever - N/V/D
Augementin 2000/124 mg bid for 5-7 days - Peds: 90 mg/kg/day po in divided doses
Oflaxicin 0.3% solution BID

10. Alternative rx for bacterial sinusitis?
Dyspnea when supine - relived by sitting or standing
TM erythmatous - bulging - light reflex displaced - exudate
Macrolides (azithormycin); Doxycycline; TMZ-SMZ
Deep - snoring sound; indicates fluid or narrowing of airways; common in bronchitis and COPD

11. Acute rhino-sinusitis duration of symptoms?
Step. pneumoniae; Haemophilus influenzae; group B-strep
Amoxicillin 80-90mg/kg/day x7 days; Augmentin 90/6.4 mg/kg/day x7 days
<4 weeks
Rate; pattern (regular or irregular); effort (labored - accessory muscles)

12. Special cases of sinusitis?
Warm - humid environment; rest;
Persistent or relapse of infection - chronic sinusitis - fungal infection - extension in CNS (meningitis - orbital cellulitis - osteitis)
Ipratroprium bromide (e.g. Atrovent); Antihistamines (Cargeul not to overly dry out muscos)
Rhinovirus - influenza - parainfluenza

13. Rhinosinusitis History?
Deep - rapid - labored - breathing
Nasal congestion - HA - sinus pain - fever - sore throat - cough
Inflammation of the nasal cavity
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

14. What are physical exam findings of AOM?
Labs: CBC - blood gas - d-dimer - CMP - BNP - Chest CT - MRI
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
Rebound congestion 3-5 days
TM erythmatous - bulging - light reflex displaced - exudate

15. Respiratory Illness Key Points (3)
Warm - humid environment; rest;
Amoxicillin 1000 mg TID x7 days; Augmentin 2000/125mg BID x7 days
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

16. What is most common age range for otitis?
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
>12 weeks
Erythmatous auditory canal - crusting
3 months to 3 years old

17. Rhinosinusitis risk factors?
Inflammation of the nasal cavity
Nasal polyps - deviated septum - hx of trauma - surgery - foreign bodies or recent altitude changes
Bacterial or viral infection of the middle ear (secondary to URI [e.g. eustachian tube dysfunction])
92-100%

18. Symptoms of viral rhinosinusitis
Measures speed of exhalation; results measure by age and weight
High pitched voice sound due to transmission of noise across fluid. Indicative of effusion.
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 weeks

19. Crackles (rales)
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
Ipratroprium bromide (e.g. Atrovent); Antihistamines (Cargeul not to overly dry out muscos)
Nasal congestion - HA - sinus pain - fever - sore throat - cough

20. What does mucopurulent indications not indicate?
Bacterial infection
Oflaxicin 0.3% solution BID
Step. pneumoniae; Haemophilus influenzae; group B-strep
Persistent or relapse of infection - chronic sinusitis - fungal infection - extension in CNS (meningitis - orbital cellulitis - osteitis)

21. Wheezes
Labs: CBC - blood gas - d-dimer - CMP - BNP - Chest CT - MRI
Clubbing - Use of accessory muscles - barrel chest
Deep - rapid - labored - breathing
High pitched sounds; can occur during inspiration or expiration; indicates narrow airways; can occur with asthma - COPD - pneumonia - CHF

22. What is the most common pahtogen for otitis media?
Increased loudness of whispering during auscultation. Indicative of consolidation.
Dyspnea when supine - relived by sitting or standing
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

23. Which Rx should not be used for viral URI?
E. coli
Symptomatic (steam; nasal irrigation); APAP for pain.
Amoxicillin 80-90mg/kg/day x7 days; Augmentin 90/6.4 mg/kg/day x7 days
Aspirin: increases viral shedding

24. Rhinitis
Oflaxicin 0.3% solution BID
Purulent discharge - post nasal draiange; cough; sinus pressure - tooth pain; halitosis (changes in taste); alterations of smell
Inflammation of the nasal cavity
E. coli

25. Proxysmal nocturnal dyspnea
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.
Measures speed of exhalation; results measure by age and weight
High pitched sounds; can occur during inspiration or expiration; indicates narrow airways; can occur with asthma - COPD - pneumonia - CHF

26. Rhonchi
4-12 weeks
Abnormal high pitched caused by blockage in upper airway; usually heard with with inspiration
Aspirin: Reye's Syndrome
Deep - snoring sound; indicates fluid or narrowing of airways; common in bronchitis and COPD

27. Normal pulse ox
Labs: CBC - blood gas - d-dimer - CMP - BNP - Chest CT - MRI
92-100%
Abnormal high pitched caused by blockage in upper airway; usually heard with with inspiration
Purulent discharge - post nasal draiange; cough; sinus pressure - tooth pain; halitosis (changes in taste); alterations of smell

28. Chronic rhino-sinusitis duration of symptoms?
>12 weeks
PE: rhinoscopy with otoscope
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])

29. Physical exam of chest
Aspirin: increases viral shedding
High pitched voice sound due to transmission of noise across fluid. Indicative of effusion.
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
Ear ache - dullness - hearing loss - fever - N/V/D

30. Acute otitis media
Bacterial or viral infection of the middle ear (secondary to URI [e.g. eustachian tube dysfunction])
Purulent discharge - post nasal draiange; cough; sinus pressure - tooth pain; halitosis (changes in taste); alterations of smell
Clubbing - Use of accessory muscles - barrel chest
Fine or courses; secretions or aveolar collapse; normal if resovle with cough; abnormal: pneumonia; CHF; COPD; pilmonary fibrosis

31. Sinusitis
Amoxicillin 80-90mg/kg/day x7 days; Augmentin 90/6.4 mg/kg/day x7 days
Inflammation of the paranasal sinuses
Augementin 2000/124 mg bid for 5-7 days - Peds: 90 mg/kg/day po in divided doses
Erythmatous auditory canal - crusting

32. Stridor
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;
92-100%
Clubbing - Use of accessory muscles - barrel chest
Abnormal high pitched caused by blockage in upper airway; usually heard with with inspiration

33. What sinusitis symptoms would warrant image studies?
Persistent; recurrent x4/yr; severe HA; altered mental status
Apena alternating with hyperpnea;
Measures speed of exhalation; results measure by age and weight
Persistent or relapse of infection - chronic sinusitis - fungal infection - extension in CNS (meningitis - orbital cellulitis - osteitis)

34. Common cold symptoms
Step. pneumoniae; Haemophilus influenzae; group B-strep
Abrupt onset - burning nose or throat - sneezing - rhinorrhea
24-72 hrs
Viral inoculation > viral rhinitis > infection of paranasal sinuses > inflammation & edema > mucosal edema - copious secretions - ciliary dyskinesia > sinus congestions and/or obstruction

35. Tx of sinusitis symptoms <10 days
Ipratroprium bromide (e.g. Atrovent); Antihistamines (Cargeul not to overly dry out muscos)
Symptomatic (steam; nasal irrigation); APAP for pain.
Augementin 2000/124 mg bid for 5-7 days - Peds: 90 mg/kg/day po in divided doses
Abnormal high pitched caused by blockage in upper airway; usually heard with with inspiration

36. Symptoms of acute bacterial rhino-sinusitis (ABRS)?
Purulent discharge - post nasal draiange; cough; sinus pressure - tooth pain; halitosis (changes in taste); alterations of smell
4-12 weeks
Clubbing - Use of accessory muscles - barrel chest
Abnormal high pitched caused by blockage in upper airway; usually heard with with inspiration

37. Tx for adult AOE?
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
Viral inoculation > viral rhinitis > infection of paranasal sinuses > inflammation & edema > mucosal edema - copious secretions - ciliary dyskinesia > sinus congestions and/or obstruction
Oflaxicin 0.3% solution BID
Deep - rapid - labored - breathing

38. Pulmonary diagnostics (1)
Persistent; recurrent x4/yr; severe HA; altered mental status
Warm - humid environment; rest;
4-12 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

39. Acute viral rhino-sinusitis (AVRS) pathogens?
Rhinovirus - influenza - parainfluenza
Symptomatic (steam; nasal irrigation); APAP for pain.
Apena alternating with hyperpnea;
>12 weeks

40. Subacute rhino-sinusitis duration of symptoms?
Amoxicillin 80-90mg/kg/day x7 days; Augmentin 90/6.4 mg/kg/day x7 days
4-12 weeks
HEENT: rhinoscopy - sinus tenderness - lymphnodes - transillumination of sinuses - CV and PULM.
TM erythmatous - bulging - light reflex displaced - exudate

41. Vesicular breath sounds...
Step. pneumoniae; Haemophilus influenzae; group B-strep
Abnormal high pitched caused by blockage in upper airway; usually heard with with inspiration
Pulse ox; Peak expiratory flow; spirometry
Soft sounds in and out

42. Bronchophony
24-72 hrs
Increased breath sounds or voice remains loud at the periphery during auscultation. Indicative of consolidation.
Aspirin: increases viral shedding
PE: rhinoscopy with otoscope

43. Respiratory Examination (Observation)
>12 weeks
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
Abnormal high pitched caused by blockage in upper airway; usually heard with with inspiration
Rate; pattern (regular or irregular); effort (labored - accessory muscles)

44. Bronchial breath sounds...
Hardher and more turbulent
24-72 hrs
Step. pneumoniae; Haemophilus influenzae; group B-strep
Dyspnea when supine - relived by sitting or standing

45. Rhinosinusitis physical exam?
Macrolides (azithormycin); Doxycycline; TMZ-SMZ
HEENT: rhinoscopy - sinus tenderness - lymphnodes - transillumination of sinuses - CV and PULM.
NSAIDs for aches - fever; Sympathomimetics: pseudophedrine or phenylephrine
Abnormal high pitched caused by blockage in upper airway; usually heard with with inspiration

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

47. Egophany (vocal resonance)
Pulse ox; Peak expiratory flow; spirometry
High pitched voice sound due to transmission of noise across fluid. Indicative of effusion.
Dyspnea when supine - relived by sitting or standing
4-12 weeks

48. Common Cold (URI - Acute Coryza)
HEENT: rhinoscopy - sinus tenderness - lymphnodes - transillumination of sinuses - CV and PULM.
Step. pneumoniae; Haemophilus influenzae; group B-strep
Soft sounds in and out
Afebrile viral infection of the the nose - paranasal sinuses - throat - larynx - trachea - and and bronchi.

49. Orthopnea
Dyspnea when supine - relived by sitting or standing
NSAIDs for aches - fever; Sympathomimetics: pseudophedrine or phenylephrine
Ear ache - dullness - hearing loss - fever - N/V/D
Augementin 2000/124 mg bid for 5-7 days - Peds: 90 mg/kg/day po in divided doses

50. Cheyne-stokes
Fine or courses; secretions or aveolar collapse; normal if resovle with cough; abnormal: pneumonia; CHF; COPD; pilmonary fibrosis
Hardher and more turbulent
Apena alternating with hyperpnea;
Rebound congestion 3-5 days