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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. Pulmonary diagnostics (1)
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])
Persistent or relapse of infection - chronic sinusitis - fungal infection - extension in CNS (meningitis - orbital cellulitis - osteitis)
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

2. Whispered pectoriloguy
Increased loudness of whispering during auscultation. Indicative of consolidation.
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

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

4. Pulmonary tests
3 months to 3 years old
Pulse ox; Peak expiratory flow; spirometry
Oflaxicin 0.3% solution BID
Rhinovirus - influenza - parainfluenza

5. Spirometry
>12 weeks
Measures speed of exhalation; results measure by age and weight
Ear ache - dullness - hearing loss - fever - N/V/D
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

6. Rx nasal congestion?
Decongestants (oxymetazoline); glucocorticoids (e.g. fluticasone); mucolytics (e.g. guaifensin)
Oflaxicin 0.3% solution BID
Persistent or relapse of infection - chronic sinusitis - fungal infection - extension in CNS (meningitis - orbital cellulitis - osteitis)
Rebound congestion 3-5 days

7. Common cold pathogens
Bacterial infection
Afebrile viral infection of the the nose - paranasal sinuses - throat - larynx - trachea - and and bronchi.
Rhinovirus - influenza - and 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

8. Common cold symptoms
Abnormal high pitched caused by blockage in upper airway; usually heard with with inspiration
Abrupt onset - burning nose or throat - sneezing - rhinorrhea
Pulse ox; Peak expiratory flow; spirometry
Nasal congestion - HA - sinus pain - fever - sore throat - cough

9. Proxysmal nocturnal dyspnea
Severe dyspnea when lying supine with associated wheezing and coughing - need to sit up abruptly due to severe dyspnea
Rhinovirus - influenza - parainfluenza
Inflammation of the nasal cavity
24-72 hrs

10. Acute otitis media
Bacterial or viral infection of the middle ear (secondary to URI [e.g. eustachian tube dysfunction])
TM erythmatous - bulging - light reflex displaced - exudate
Augementin 2000/124 mg bid for 5-7 days - Peds: 90 mg/kg/day po in divided doses
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

11. What sinusitis symptoms would warrant image studies?
High pitched sounds; can occur during inspiration or expiration; indicates narrow airways; can occur with asthma - COPD - pneumonia - CHF
Aspirin: increases viral shedding
Persistent; recurrent x4/yr; severe HA; altered mental status
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. Tx for adult AOM?
92-100%
Amoxicillin 1000 mg TID x7 days; Augmentin 2000/125mg BID x7 days
Oflaxicin 0.3% solution BID
Inflammation of the paranasal sinuses

13. Acute viral rhino-sinusitis (AVRS) pathogens?
Persistent or relapse of infection - chronic sinusitis - fungal infection - extension in CNS (meningitis - orbital cellulitis - osteitis)
Afebrile viral infection of the the nose - paranasal sinuses - throat - larynx - trachea - and and bronchi.
Clubbing - Use of accessory muscles - barrel chest
Rhinovirus - influenza - parainfluenza

14. 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
Rebound congestion 3-5 days
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
Severe dyspnea when lying supine with associated wheezing and coughing - need to sit up abruptly due to severe dyspnea

15. Orthopnea
HEENT: rhinoscopy - sinus tenderness - lymphnodes - transillumination of sinuses - CV and PULM.
Nasal congestion - HA - sinus pain - fever - sore throat - cough
Rhinovirus - influenza - parainfluenza
Dyspnea when supine - relived by sitting or standing

16. Rhinitis
Viral inoculation > viral rhinitis > infection of paranasal sinuses > inflammation & edema > mucosal edema - copious secretions - ciliary dyskinesia > sinus congestions and/or obstruction
Inflammation of the nasal cavity
Augementin 2000/124 mg bid for 5-7 days - Peds: 90 mg/kg/day po in divided doses
Ear ache - dullness - hearing loss - fever - N/V/D

17. Alternative rx for bacterial sinusitis?
Apena alternating with hyperpnea;
Clubbing - Use of accessory muscles - barrel chest
Rhinovirus - influenza - parainfluenza
Macrolides (azithormycin); Doxycycline; TMZ-SMZ

18. Sinusitis
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)
Inflammation of the paranasal sinuses
Warm - humid environment; rest;

19. What is the common side effect of sympathomimetics?
Rebound congestion 3-5 days
Hardher and more turbulent
Labs: CBC - blood gas - d-dimer - CMP - BNP - Chest CT - MRI
Step. pneumoniae; Haemophilus influenzae; group B-strep

20. Tx for adult AOE?
Aspirin: increases viral shedding
Inflammation of the nasal cavity
Oflaxicin 0.3% solution BID
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

21. Respiratory Examination (Observation)
Rhinovirus - influenza - parainfluenza
Clubbing - Use of accessory muscles - barrel chest
Aspirin: Reye's Syndrome
Rate; pattern (regular or irregular); effort (labored - accessory muscles)

22. Kussmal's respiration
Purulent discharge - post nasal draiange; cough; sinus pressure - tooth pain; halitosis (changes in taste); alterations of smell
Deep - rapid - labored - breathing
Nasal polyps - deviated septum - hx of trauma - surgery - foreign bodies or recent altitude changes
Inflammation of the paranasal sinuses

23. Peak Expiratory Flow (PEF)
Measures speed of exhalation; results measure by age and weight
Bacterial or viral infection of the middle ear (secondary to URI [e.g. eustachian tube dysfunction])
Amoxicillin 1000 mg TID x7 days; Augmentin 2000/125mg BID x7 days
Ipratroprium bromide (e.g. Atrovent); Antihistamines (Cargeul not to overly dry out muscos)

24. Respiratory Illness Key Points (3)
Dyspnea when supine - relived by sitting or standing
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
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;

25. Bronchial breath sounds...
Augementin 2000/124 mg bid for 5-7 days - Peds: 90 mg/kg/day po in divided doses
Aspirin: increases viral shedding
Measures speed of exhalation; results measure by age and weight
Hardher and more turbulent

26. What is the most common pahtogen for otitis media?
Rhinovirus - influenza - and parainfluenza
Soft sounds in and out
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

27. Bronchophony
Augementin 2000/124 mg bid for 5-7 days - Peds: 90 mg/kg/day po in divided doses
>12 weeks
Increased breath sounds or voice remains loud at the periphery during auscultation. Indicative of consolidation.
Ear ache - dullness - hearing loss - fever - N/V/D

28. What are physical exam findings of AOE?
Abrupt onset - burning nose or throat - sneezing - rhinorrhea
Ipratroprium bromide (e.g. Atrovent); Antihistamines (Cargeul not to overly dry out muscos)
Erythmatous auditory canal - crusting
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

29. 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;
Inflammation of the paranasal sinuses
Bacterial or viral infection of the middle ear (secondary to URI [e.g. eustachian tube dysfunction])
Nasal congestion - HA - sinus pain - fever - sore throat - cough

30. 1st line treatment for bacterial sinusitis?
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
Deep - rapid - labored - breathing
4-12 weeks

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
3 months to 3 years old
Increased breath sounds or voice remains loud at the periphery during auscultation. Indicative of consolidation.
Measures speed of exhalation; results measure by age and weight

32. Stridor
Abnormal high pitched caused by blockage in upper airway; usually heard with with inspiration
Amoxicillin 1000 mg TID x7 days; Augmentin 2000/125mg BID x7 days
Inflammation of the nasal cavity
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;

33. Nonpharmacological tx for viral URI
Oflaxicin 0.3% solution BID
Apena alternating with hyperpnea;
Ear ache - dullness - hearing loss - fever - N/V/D
Warm - humid environment; rest;

34. Rhinosinusitis physical exam?
HEENT: rhinoscopy - sinus tenderness - lymphnodes - transillumination of sinuses - CV and PULM.
Rebound congestion 3-5 days
Deep - snoring sound; indicates fluid or narrowing of airways; common in bronchitis and COPD
Persistent or relapse of infection - chronic sinusitis - fungal infection - extension in CNS (meningitis - orbital cellulitis - osteitis)

35. What does mucopurulent indications not indicate?
Oflaxicin 0.3% solution BID
Bacterial infection
HEENT: rhinoscopy - sinus tenderness - lymphnodes - transillumination of sinuses - CV and PULM.
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;

36. Rhinosinusitis risk factors?
Afebrile viral infection of the the nose - paranasal sinuses - throat - larynx - trachea - and and bronchi.
Oflaxicin 0.3% solution BID
Nasal polyps - deviated septum - hx of trauma - surgery - foreign bodies or recent altitude changes
Abnormal high pitched caused by blockage in upper airway; usually heard with with inspiration

37. Rhonchi
Oflaxicin 0.3% solution BID
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
Fine or courses; secretions or aveolar collapse; normal if resovle with cough; abnormal: pneumonia; CHF; COPD; pilmonary fibrosis
Deep - snoring sound; indicates fluid or narrowing of airways; common in bronchitis and COPD

38. Which Rx should not be used for viral URI?
Aspirin: increases viral shedding
Persistent; recurrent x4/yr; severe HA; altered mental status
Ear ache - dullness - hearing loss - fever - N/V/D
Apena alternating with hyperpnea;

39. Cold incubation period
Rhinovirus - influenza - parainfluenza
Symptomatic (steam; nasal irrigation); APAP for pain.
24-72 hrs
Rebound congestion 3-5 days

40. Special cases of sinusitis?
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
Amoxicillin 1000 mg TID x7 days; Augmentin 2000/125mg BID x7 days
Decongestants (oxymetazoline); glucocorticoids (e.g. fluticasone); mucolytics (e.g. guaifensin)
Persistent or relapse of infection - chronic sinusitis - fungal infection - extension in CNS (meningitis - orbital cellulitis - osteitis)

41. Rx for rhinorrhea and/or allergies?
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
Aspirin: increases viral shedding
Ipratroprium bromide (e.g. Atrovent); Antihistamines (Cargeul not to overly dry out muscos)
Abrupt onset - burning nose or throat - sneezing - rhinorrhea

42. Crackles (rales)
Fine or courses; secretions or aveolar collapse; normal if resovle with cough; abnormal: pneumonia; CHF; COPD; pilmonary fibrosis
Amoxicillin 1000 mg TID x7 days; Augmentin 2000/125mg BID x7 days
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
Clubbing - Use of accessory muscles - barrel chest

43. Diagnostics of sinusitis?
PE: rhinoscopy with otoscope
Dyspnea when supine - relived by sitting or standing
Clubbing - Use of accessory muscles - barrel chest
Severe dyspnea when lying supine with associated wheezing and coughing - need to sit up abruptly due to severe dyspnea

44. Egophany (vocal resonance)
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
E. coli
High pitched voice sound due to transmission of noise across fluid. Indicative of effusion.

45. Subacute rhino-sinusitis duration of symptoms?
Deep - snoring sound; indicates fluid or narrowing of airways; common in bronchitis and COPD
Bacterial or viral infection of the middle ear (secondary to URI [e.g. eustachian tube dysfunction])
Erythmatous auditory canal - crusting
4-12 weeks

46. Rx for viral URI?
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
Decongestants (oxymetazoline); glucocorticoids (e.g. fluticasone); mucolytics (e.g. guaifensin)
Aspirin: increases viral shedding
NSAIDs for aches - fever; Sympathomimetics: pseudophedrine or phenylephrine

47. What are physical exam findings of AOM?
Abrupt onset - burning nose or throat - sneezing - rhinorrhea
TM erythmatous - bulging - light reflex displaced - exudate
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

48. Vesicular breath sounds...
Soft sounds in and out
Rebound congestion 3-5 days
Bacterial infection
Deep - rapid - labored - breathing

49. What is the most common pathogen for otitis in newborns?
Rate; pattern (regular or irregular); effort (labored - accessory muscles)
Amoxicillin 1000 mg TID x7 days; Augmentin 2000/125mg BID x7 days
E. coli
4-12 weeks

50. Tx of sinusitis symptoms <10 days
Symptomatic (steam; nasal irrigation); APAP for pain.
Rhinovirus - influenza - parainfluenza
Increased loudness of whispering during auscultation. Indicative of consolidation.
3 months to 3 years old