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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. Acute rhino-sinusitis duration of symptoms?
>12 weeks
Ear ache - dullness - hearing loss - fever - N/V/D
<4 weeks
High pitched sounds; can occur during inspiration or expiration; indicates narrow airways; can occur with asthma - COPD - pneumonia - CHF

2. Tx for adult AOE?
Oflaxicin 0.3% solution BID
Nasal congestion - HA - sinus pain - fever - sore throat - cough
Symptomatic (steam; nasal irrigation); APAP for pain.
Rebound congestion 3-5 days

3. Diagnostics of sinusitis?
Increased loudness of whispering during auscultation. Indicative of consolidation.
PE: rhinoscopy with otoscope
Inflammation of the nasal cavity
Bacterial or viral infection of the middle ear (secondary to URI [e.g. eustachian tube dysfunction])

4. What does mucopurulent indications not indicate?
Bacterial infection
4-12 weeks
Aspirin: increases viral shedding
Increased breath sounds or voice remains loud at the periphery during auscultation. Indicative of consolidation.

5. Whispered pectoriloguy
Increased loudness of whispering during auscultation. Indicative of consolidation.
NSAIDs for aches - fever; Sympathomimetics: pseudophedrine or phenylephrine
Deep - rapid - labored - breathing
High pitched voice sound due to transmission of noise across fluid. Indicative of effusion.

6. Rx nasal congestion?
Severe dyspnea when lying supine with associated wheezing and coughing - need to sit up abruptly due to severe dyspnea
Decongestants (oxymetazoline); glucocorticoids (e.g. fluticasone); mucolytics (e.g. guaifensin)
Bacterial infection
Ear ache - dullness - hearing loss - fever - N/V/D

7. Pulmonary tests
3 months to 3 years old
24-72 hrs
Ear ache - dullness - hearing loss - fever - N/V/D
Pulse ox; Peak expiratory flow; spirometry

8. Proxysmal nocturnal dyspnea
Soft sounds in and out
4-12 weeks
Severe dyspnea when lying supine with associated wheezing and coughing - need to sit up abruptly due to severe dyspnea
Amoxicillin 80-90mg/kg/day x7 days; Augmentin 90/6.4 mg/kg/day x7 days

9. Nonpharmacological tx for viral URI
Inflammation of the paranasal sinuses
E. coli
Warm - humid environment; rest;
Pulse ox; Peak expiratory flow; spirometry

10. Respiratory Illness Key Points (3)
4-12 weeks
Aspirin: increases viral shedding
3 months to 3 years old
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

11. Orthopnea
Macrolides (azithormycin); Doxycycline; TMZ-SMZ
3 months to 3 years old
Dyspnea when supine - relived by sitting or standing
Augementin 2000/124 mg bid for 5-7 days - Peds: 90 mg/kg/day po in divided doses

12. Subacute rhino-sinusitis duration of symptoms?
NSAIDs for aches - fever; Sympathomimetics: pseudophedrine or phenylephrine
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
4-12 weeks
Increased breath sounds or voice remains loud at the periphery during auscultation. Indicative of consolidation.

13. Abnormal pulmonary findings?
Amoxicillin 1000 mg TID x7 days; Augmentin 2000/125mg BID x7 days
Hardher and more turbulent
Clubbing - Use of accessory muscles - barrel chest
Nasal congestion - HA - sinus pain - fever - sore throat - cough

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
Clubbing - Use of accessory muscles - barrel chest
Labs: CBC - blood gas - d-dimer - CMP - BNP - Chest CT - MRI
3 months to 3 years old

15. Kussmal's respiration
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.
Labs: CBC - blood gas - d-dimer - CMP - BNP - Chest CT - MRI
Deep - rapid - labored - breathing

16. Wheezes
Amoxicillin 1000 mg TID x7 days; Augmentin 2000/125mg BID x7 days
Rate; pattern (regular or irregular); effort (labored - accessory muscles)
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

17. Cold incubation period
HEENT: rhinoscopy - sinus tenderness - lymphnodes - transillumination of sinuses - CV and PULM.
Dyspnea when supine - relived by sitting or standing
24-72 hrs
Augementin 2000/124 mg bid for 5-7 days - Peds: 90 mg/kg/day po in divided doses

18. Rx for rhinorrhea and/or allergies?
Purulent discharge - post nasal draiange; cough; sinus pressure - tooth pain; halitosis (changes in taste); alterations of smell
Ipratroprium bromide (e.g. Atrovent); Antihistamines (Cargeul not to overly dry out muscos)
HEENT: rhinoscopy - sinus tenderness - lymphnodes - transillumination of sinuses - CV and PULM.
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

19. What is the most common pahtogen for otitis media?
24-72 hrs
Augementin 2000/124 mg bid for 5-7 days - Peds: 90 mg/kg/day po in divided doses
Step. pneumoniae; Haemophilus influenzae; group B-strep
Increased breath sounds or voice remains loud at the periphery during auscultation. Indicative of consolidation.

20. Egophany (vocal resonance)
Persistent; recurrent x4/yr; severe HA; altered mental status
High pitched voice sound due to transmission of noise across fluid. Indicative of effusion.
Abnormal high pitched caused by blockage in upper airway; usually heard with with inspiration
Soft sounds in and out

21. What is most common age range for otitis?
Bacterial or viral infection of the middle ear (secondary to URI [e.g. eustachian tube dysfunction])
Severe dyspnea when lying supine with associated wheezing and coughing - need to sit up abruptly due to severe dyspnea
3 months to 3 years old
Inflammation of the paranasal sinuses

22. What sinusitis symptoms would warrant image studies?
Deep - snoring sound; indicates fluid or narrowing of airways; common in bronchitis and COPD
Measures speed of exhalation; results measure by age and weight
Persistent; recurrent x4/yr; severe HA; altered mental status
Increased breath sounds or voice remains loud at the periphery during auscultation. Indicative of consolidation.

23. What are physical exam findings of AOE?
Rhinovirus - influenza - parainfluenza
24-72 hrs
Erythmatous auditory canal - crusting
Ear ache - dullness - hearing loss - fever - N/V/D

24. Physical exam of chest
24-72 hrs
Soft sounds in and out
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

25. Common cold pathogens
Erythmatous auditory canal - crusting
Abnormal high pitched caused by blockage in upper airway; usually heard with with inspiration
Persistent or relapse of infection - chronic sinusitis - fungal infection - extension in CNS (meningitis - orbital cellulitis - osteitis)
Rhinovirus - influenza - and parainfluenza

26. Rx for viral URI?
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;
Labs: CBC - blood gas - d-dimer - CMP - BNP - Chest CT - MRI
Ear ache - dullness - hearing loss - fever - N/V/D
NSAIDs for aches - fever; Sympathomimetics: pseudophedrine or phenylephrine

27. Rhonchi
Fine or courses; secretions or aveolar collapse; normal if resovle with cough; abnormal: pneumonia; CHF; COPD; pilmonary fibrosis
Decongestants (oxymetazoline); glucocorticoids (e.g. fluticasone); mucolytics (e.g. guaifensin)
Deep - snoring sound; indicates fluid or narrowing of airways; common in bronchitis and COPD
PE: rhinoscopy with otoscope

28. Vesicular breath sounds...
Oflaxicin 0.3% solution BID
Viral inoculation > viral rhinitis > infection of paranasal sinuses > inflammation & edema > mucosal edema - copious secretions - ciliary dyskinesia > sinus congestions and/or obstruction
Soft sounds in and out
<4 weeks

29. Pathophysiology of rhino sinusitis?
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
Viral inoculation > viral rhinitis > infection of paranasal sinuses > inflammation & edema > mucosal edema - copious secretions - ciliary dyskinesia > sinus congestions and/or obstruction
92-100%

30. What is the most common pathogen for otitis in newborns?
Augementin 2000/124 mg bid for 5-7 days - Peds: 90 mg/kg/day po in divided doses
E. coli
Nasal polyps - deviated septum - hx of trauma - surgery - foreign bodies or recent altitude changes
Soft sounds in and out

31. Pulmonary diagnostics (1)
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
Abrupt onset - burning nose or throat - sneezing - rhinorrhea
PE: rhinoscopy with otoscope
Afebrile viral infection of the the nose - paranasal sinuses - throat - larynx - trachea - and and bronchi.

32. Acute viral rhino-sinusitis (AVRS) pathogens?
Rhinovirus - influenza - and parainfluenza
Step. pneumoniae; Haemophilus influenzae; group B-strep
Rhinovirus - influenza - parainfluenza
92-100%

33. Additional pulmonary diagnostics
Labs: CBC - blood gas - d-dimer - CMP - BNP - Chest CT - MRI
Oflaxicin 0.3% solution BID
Macrolides (azithormycin); Doxycycline; TMZ-SMZ
Dyspnea when supine - relived by sitting or standing

34. Common Cold (URI - Acute Coryza)
Afebrile viral infection of the the nose - paranasal sinuses - throat - larynx - trachea - and and bronchi.
Rate; pattern (regular or irregular); effort (labored - accessory muscles)
Abnormal high pitched caused by blockage in upper airway; usually heard with with inspiration
Persistent or relapse of infection - chronic sinusitis - fungal infection - extension in CNS (meningitis - orbital cellulitis - osteitis)

35. What is the common side effect of sympathomimetics?
Rebound congestion 3-5 days
Aspirin: increases viral shedding
Purulent discharge - post nasal draiange; cough; sinus pressure - tooth pain; halitosis (changes in taste); alterations of smell
Inflammation of the paranasal sinuses

36. Chronic rhino-sinusitis duration of symptoms?
High pitched voice sound due to transmission of noise across fluid. Indicative of effusion.
High pitched sounds; can occur during inspiration or expiration; indicates narrow airways; can occur with asthma - COPD - pneumonia - CHF
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
>12 weeks

37. What are physical exam findings of AOM?
Apena alternating with hyperpnea;
TM erythmatous - bulging - light reflex displaced - exudate
92-100%
E. coli

38. Tx of sinusitis symptoms <10 days
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
Viral inoculation > viral rhinitis > infection of paranasal sinuses > inflammation & edema > mucosal edema - copious secretions - ciliary dyskinesia > sinus congestions and/or obstruction
Symptomatic (steam; nasal irrigation); APAP for pain.
Aspirin: Reye's Syndrome

39. Sinusitis
Abrupt onset - burning nose or throat - sneezing - rhinorrhea
Severe dyspnea when lying supine with associated wheezing and coughing - need to sit up abruptly due to severe dyspnea
Deep - snoring sound; indicates fluid or narrowing of airways; common in bronchitis and COPD
Inflammation of the paranasal sinuses

40. Stridor
Afebrile viral infection of the the nose - paranasal sinuses - throat - larynx - trachea - and and bronchi.
Deep - snoring sound; indicates fluid or narrowing of airways; common in bronchitis and COPD
Abnormal high pitched caused by blockage in upper airway; usually heard with with inspiration
Rate; pattern (regular or irregular); effort (labored - accessory muscles)

41. Which Rx should not be used for viral URI?
Aspirin: increases viral shedding
Aspirin: Reye's Syndrome
Ipratroprium bromide (e.g. Atrovent); Antihistamines (Cargeul not to overly dry out muscos)
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;

42. Spirometry
Symptomatic (steam; nasal irrigation); APAP for pain.
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
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

43. Alternative rx for bacterial sinusitis?
Abrupt onset - burning nose or throat - sneezing - rhinorrhea
Macrolides (azithormycin); Doxycycline; TMZ-SMZ
Nasal polyps - deviated septum - hx of trauma - surgery - foreign bodies or recent altitude changes
Step. pneumoniae; Haemophilus influenzae; group B-strep

44. Common cold symptoms
Increased breath sounds or voice remains loud at the periphery during auscultation. Indicative of consolidation.
Deep - snoring sound; indicates fluid or narrowing of airways; common in bronchitis and COPD
Abnormal high pitched caused by blockage in upper airway; usually heard with with inspiration
Abrupt onset - burning nose or throat - sneezing - rhinorrhea

45. Rhinosinusitis physical exam?
Deep - rapid - labored - breathing
Decongestants (oxymetazoline); glucocorticoids (e.g. fluticasone); mucolytics (e.g. guaifensin)
4-12 weeks
HEENT: rhinoscopy - sinus tenderness - lymphnodes - transillumination of sinuses - CV and PULM.

46. Acute otitis media
E. coli
Purulent discharge - post nasal draiange; cough; sinus pressure - tooth pain; halitosis (changes in taste); alterations of smell
>12 weeks
Bacterial or viral infection of the middle ear (secondary to URI [e.g. eustachian tube dysfunction])

47. Rhinitis
Pulse ox; Peak expiratory flow; spirometry
Amoxicillin 80-90mg/kg/day x7 days; Augmentin 90/6.4 mg/kg/day x7 days
Inflammation of the nasal cavity
Afebrile viral infection of the the nose - paranasal sinuses - throat - larynx - trachea - and and bronchi.

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

49. Respiratory Examination (Observation)
Persistent; recurrent x4/yr; severe HA; altered mental status
E. coli
Rate; pattern (regular or irregular); effort (labored - accessory muscles)
High pitched sounds; can occur during inspiration or expiration; indicates narrow airways; can occur with asthma - COPD - pneumonia - CHF

50. 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;
Increased breath sounds or voice remains loud at the periphery during auscultation. Indicative of consolidation.
Aspirin: Reye's Syndrome
Persistent or relapse of infection - chronic sinusitis - fungal infection - extension in CNS (meningitis - orbital cellulitis - osteitis)