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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. Spirometry
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;
Ipratroprium bromide (e.g. Atrovent); Antihistamines (Cargeul not to overly dry out muscos)
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
Pulse ox; Peak expiratory flow; spirometry

2. Tx for pediatric AOM?
Amoxicillin 80-90mg/kg/day x7 days; Augmentin 90/6.4 mg/kg/day x7 days
Persistent; recurrent x4/yr; severe HA; altered mental status
Step. pneumoniae; Haemophilus influenzae; group B-strep
Persistent or relapse of infection - chronic sinusitis - fungal infection - extension in CNS (meningitis - orbital cellulitis - osteitis)

3. Diagnostics of sinusitis?
PE: rhinoscopy with otoscope
Inflammation of the paranasal sinuses
Rhinovirus - influenza - and parainfluenza
Deep - rapid - labored - breathing

4. Rx for viral URI?
Soft sounds in and out
PE: rhinoscopy with otoscope
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

5. Wheezes
Dyspnea when supine - relived by sitting or standing
Labs: CBC - blood gas - d-dimer - CMP - BNP - Chest CT - MRI
High pitched sounds; can occur during inspiration or expiration; indicates narrow airways; can occur with asthma - COPD - pneumonia - CHF
Augementin 2000/124 mg bid for 5-7 days - Peds: 90 mg/kg/day po in divided doses

6. What are physical exam findings of AOM?
<4 weeks
Severe dyspnea when lying supine with associated wheezing and coughing - need to sit up abruptly due to severe dyspnea
Measures speed of exhalation; results measure by age and weight
TM erythmatous - bulging - light reflex displaced - exudate

7. Crackles (rales)
HEENT: rhinoscopy - sinus tenderness - lymphnodes - transillumination of sinuses - CV and PULM.
Fine or courses; secretions or aveolar collapse; normal if resovle with cough; abnormal: pneumonia; CHF; COPD; pilmonary fibrosis
E. coli
TM erythmatous - bulging - light reflex displaced - exudate

8. Rhinosinusitis physical exam?
Bacterial or viral infection of the middle ear (secondary to URI [e.g. eustachian tube dysfunction])
Deep - rapid - labored - breathing
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

9. What is most common age range for otitis?
High pitched voice sound due to transmission of noise across fluid. Indicative of effusion.
Fine or courses; secretions or aveolar collapse; normal if resovle with cough; abnormal: pneumonia; CHF; COPD; pilmonary fibrosis
3 months to 3 years old
Deep - rapid - labored - breathing

10. Subacute rhino-sinusitis duration of symptoms?
4-12 weeks
<4 weeks
Apena alternating with hyperpnea;
Nasal congestion - HA - sinus pain - fever - sore throat - cough

11. Acute rhino-sinusitis duration of symptoms?
E. coli
Macrolides (azithormycin); Doxycycline; TMZ-SMZ
Increased breath sounds or voice remains loud at the periphery during auscultation. Indicative of consolidation.
<4 weeks

12. Pulmonary tests
Pulse ox; Peak expiratory flow; spirometry
Afebrile viral infection of the the nose - paranasal sinuses - throat - larynx - trachea - and and bronchi.
Decongestants (oxymetazoline); glucocorticoids (e.g. fluticasone); mucolytics (e.g. guaifensin)
Persistent; recurrent x4/yr; severe HA; altered mental status

13. Common cold symptoms
Viral inoculation > viral rhinitis > infection of paranasal sinuses > inflammation & edema > mucosal edema - copious secretions - ciliary dyskinesia > sinus congestions and/or obstruction
Abrupt onset - burning nose or throat - sneezing - rhinorrhea
NSAIDs for aches - fever; Sympathomimetics: pseudophedrine or phenylephrine
Increased breath sounds or voice remains loud at the periphery during auscultation. Indicative of consolidation.

14. Rx for rhinorrhea and/or allergies?
Apena alternating with hyperpnea;
Ipratroprium bromide (e.g. Atrovent); Antihistamines (Cargeul not to overly dry out muscos)
High pitched sounds; can occur during inspiration or expiration; indicates narrow airways; can occur with asthma - COPD - pneumonia - CHF
Step. pneumoniae; Haemophilus influenzae; group B-strep

15. Chronic rhino-sinusitis duration of symptoms?
Amoxicillin 80-90mg/kg/day x7 days; Augmentin 90/6.4 mg/kg/day x7 days
Abrupt onset - burning nose or throat - sneezing - rhinorrhea
>12 weeks
PE: rhinoscopy with otoscope

16. 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
Increased breath sounds or voice remains loud at the periphery during auscultation. Indicative of consolidation.
Rhinovirus - influenza - and parainfluenza
Rhinovirus - influenza - parainfluenza

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

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18. Rhinosinusitis risk factors?
High pitched voice sound due to transmission of noise across fluid. Indicative of effusion.
Rate; pattern (regular or irregular); effort (labored - accessory muscles)
Soft sounds in and out
Nasal polyps - deviated septum - hx of trauma - surgery - foreign bodies or recent altitude changes

19. What is the most common pathogen for otitis in newborns?
High pitched sounds; can occur during inspiration or expiration; indicates narrow airways; can occur with asthma - COPD - pneumonia - CHF
>12 weeks
E. coli
Fine or courses; secretions or aveolar collapse; normal if resovle with cough; abnormal: pneumonia; CHF; COPD; pilmonary fibrosis

20. Abnormal pulmonary findings?
Apena alternating with hyperpnea;
Pulse ox; Peak expiratory flow; spirometry
Nasal polyps - deviated septum - hx of trauma - surgery - foreign bodies or recent altitude changes
Clubbing - Use of accessory muscles - barrel chest

21. Bronchophony
Increased breath sounds or voice remains loud at the periphery during auscultation. Indicative of consolidation.
Step. pneumoniae; Haemophilus influenzae; group B-strep
Inflammation of the nasal cavity
Inflammation of the paranasal sinuses

22. What is the most common pahtogen for otitis media?
Step. pneumoniae; Haemophilus influenzae; group B-strep
Abnormal high pitched caused by blockage in upper airway; usually heard with with inspiration
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

23. Cold incubation period
Increased loudness of whispering during auscultation. Indicative of consolidation.
24-72 hrs
Step. pneumoniae; Haemophilus influenzae; group B-strep
Aspirin: increases viral shedding

24. Kussmal's respiration
Deep - rapid - labored - breathing
Fine or courses; secretions or aveolar collapse; normal if resovle with cough; abnormal: pneumonia; CHF; COPD; pilmonary fibrosis
Bacterial or viral infection of the middle ear (secondary to URI [e.g. eustachian tube dysfunction])
Aspirin: increases viral shedding

25. Common Cold (URI - Acute Coryza)
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
Afebrile viral infection of the the nose - paranasal sinuses - throat - larynx - trachea - and and bronchi.
Inflammation of the nasal cavity
Oflaxicin 0.3% solution BID

26. Acute otitis media
Decongestants (oxymetazoline); glucocorticoids (e.g. fluticasone); mucolytics (e.g. guaifensin)
Increased breath sounds or voice remains loud at the periphery during auscultation. Indicative of consolidation.
Aspirin: increases viral shedding
Bacterial or viral infection of the middle ear (secondary to URI [e.g. eustachian tube dysfunction])

27. Respiratory Examination (Observation)
Rate; pattern (regular or irregular); effort (labored - accessory muscles)
Amoxicillin 80-90mg/kg/day x7 days; Augmentin 90/6.4 mg/kg/day x7 days
92-100%
4-12 weeks

28. Special cases of sinusitis?
Persistent or relapse of infection - chronic sinusitis - fungal infection - extension in CNS (meningitis - orbital cellulitis - osteitis)
Apena alternating with hyperpnea;
Rhinovirus - influenza - and parainfluenza
Increased loudness of whispering during auscultation. Indicative of consolidation.

29. Rx nasal congestion?
Decongestants (oxymetazoline); glucocorticoids (e.g. fluticasone); mucolytics (e.g. guaifensin)
Afebrile viral infection of the the nose - paranasal sinuses - throat - larynx - trachea - and and bronchi.
Severe dyspnea when lying supine with associated wheezing and coughing - need to sit up abruptly due to severe dyspnea
Deep - rapid - labored - breathing

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

31. Tx of sinusitis symptoms <10 days
Bacterial infection
Symptomatic (steam; nasal irrigation); APAP for pain.
Aspirin: Reye's Syndrome
NSAIDs for aches - fever; Sympathomimetics: pseudophedrine or phenylephrine

32. Symptoms of viral rhinosinusitis
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;
3 months to 3 years old
Nasal polyps - deviated septum - hx of trauma - surgery - foreign bodies or recent altitude changes
Decongestants (oxymetazoline); glucocorticoids (e.g. fluticasone); mucolytics (e.g. guaifensin)

33. Tx for adult AOM?
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
Decongestants (oxymetazoline); glucocorticoids (e.g. fluticasone); mucolytics (e.g. guaifensin)
Amoxicillin 1000 mg TID x7 days; Augmentin 2000/125mg BID x7 days

34. Physical exam of chest
Aspirin: Reye's Syndrome
Purulent discharge - post nasal draiange; cough; sinus pressure - tooth pain; halitosis (changes in taste); alterations of smell
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
Inflammation of the nasal cavity

35. Respiratory Illness Key Points (3)
High pitched voice sound due to transmission of noise across fluid. Indicative of effusion.
TM erythmatous - bulging - light reflex displaced - exudate
Afebrile viral infection of the the nose - paranasal sinuses - throat - larynx - trachea - and and bronchi.
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

36. Alternative rx for bacterial sinusitis?
High pitched voice sound due to transmission of noise across fluid. Indicative of effusion.
Aspirin: Reye's Syndrome
Bacterial infection
Macrolides (azithormycin); Doxycycline; TMZ-SMZ

37. Bronchial breath sounds...
Nasal congestion - HA - sinus pain - fever - sore throat - cough
Soft sounds in and out
Hardher and more turbulent
Abrupt onset - burning nose or throat - sneezing - rhinorrhea

38. Egophany (vocal resonance)
Fine or courses; secretions or aveolar collapse; normal if resovle with cough; abnormal: pneumonia; CHF; COPD; pilmonary fibrosis
Oflaxicin 0.3% solution BID
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;

39. Peak Expiratory Flow (PEF)
Measures speed of exhalation; results measure by age and weight
Rhinovirus - influenza - 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
Apena alternating with hyperpnea;

40. Normal pulse ox
Deep - snoring sound; indicates fluid or narrowing of airways; common in bronchitis and COPD
Rebound congestion 3-5 days
Measures speed of exhalation; results measure by age and weight
92-100%

41. Rhinitis
Inflammation of the nasal cavity
92-100%
Purulent discharge - post nasal draiange; cough; sinus pressure - tooth pain; halitosis (changes in taste); alterations of smell
Rebound congestion 3-5 days

42. Cheyne-stokes
92-100%
24-72 hrs
Bacterial infection
Apena alternating with hyperpnea;

43. Which Rx should not be used for viral URI?
Apena alternating with hyperpnea;
Rhinovirus - influenza - parainfluenza
High pitched voice sound due to transmission of noise across fluid. Indicative of effusion.
Aspirin: increases viral shedding

44. Proxysmal nocturnal dyspnea
NSAIDs for aches - fever; Sympathomimetics: pseudophedrine or phenylephrine
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
Rhinovirus - influenza - parainfluenza

45. Symptoms of acute bacterial rhino-sinusitis (ABRS)?
High pitched sounds; can occur during inspiration or expiration; indicates narrow airways; can occur with asthma - COPD - pneumonia - CHF
Purulent discharge - post nasal draiange; cough; sinus pressure - tooth pain; halitosis (changes in taste); alterations of smell
Deep - rapid - labored - breathing
4-12 weeks

46. What is the common side effect of sympathomimetics?
Macrolides (azithormycin); Doxycycline; TMZ-SMZ
Rebound congestion 3-5 days
Abnormal high pitched caused by blockage in upper airway; usually heard with with inspiration
3 months to 3 years old

47. Stridor
Decongestants (oxymetazoline); glucocorticoids (e.g. fluticasone); mucolytics (e.g. guaifensin)
Abnormal high pitched caused by blockage in upper airway; usually heard with with inspiration
Labs: CBC - blood gas - d-dimer - CMP - BNP - Chest CT - MRI
Nasal congestion - HA - sinus pain - fever - sore throat - cough

48. Orthopnea
Clubbing - Use of accessory muscles - barrel chest
Dyspnea when supine - relived by sitting or standing
Rebound congestion 3-5 days
Purulent discharge - post nasal draiange; cough; sinus pressure - tooth pain; halitosis (changes in taste); alterations of smell

49. What does mucopurulent indications not indicate?
Fine or courses; secretions or aveolar collapse; normal if resovle with cough; abnormal: pneumonia; CHF; COPD; pilmonary fibrosis
Aspirin: increases viral shedding
Bacterial infection
>12 weeks

50. 1st line treatment for bacterial sinusitis?
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
Deep - snoring sound; indicates fluid or narrowing of airways; common in bronchitis and COPD
Increased loudness of whispering during auscultation. Indicative of consolidation.
Augementin 2000/124 mg bid for 5-7 days - Peds: 90 mg/kg/day po in divided doses