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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. Tx of sinusitis symptoms <10 days
Abnormal high pitched caused by blockage in upper airway; usually heard with with inspiration
Bacterial or viral infection of the middle ear (secondary to URI [e.g. eustachian tube dysfunction])
Symptomatic (steam; nasal irrigation); APAP for pain.
Step. pneumoniae; Haemophilus influenzae; group B-strep

2. What are the symptoms of otitis?
Labs: CBC - blood gas - d-dimer - CMP - BNP - Chest CT - MRI
Ear ache - dullness - hearing loss - fever - N/V/D
Abrupt onset - burning nose or throat - sneezing - rhinorrhea
Rhinovirus - influenza - and parainfluenza

3. Crackles (rales)
Fine or courses; secretions or aveolar collapse; normal if resovle with cough; abnormal: pneumonia; CHF; COPD; pilmonary fibrosis
Nasal polyps - deviated septum - hx of trauma - surgery - foreign bodies or recent altitude changes
Rebound congestion 3-5 days
Inflammation of the nasal cavity

4. Rhinosinusitis History?
Nasal congestion - HA - sinus pain - fever - sore throat - cough
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
Symptomatic (steam; nasal irrigation); APAP for pain.
Inflammation of the nasal cavity

5. Nonpharmacological tx for viral URI
>12 weeks
Warm - humid environment; rest;
Bacterial or viral infection of the middle ear (secondary to URI [e.g. eustachian tube dysfunction])
High pitched voice sound due to transmission of noise across fluid. Indicative of effusion.

6. Cheyne-stokes
Apena alternating with hyperpnea;
Rhinovirus - influenza - parainfluenza
Amoxicillin 1000 mg TID x7 days; Augmentin 2000/125mg BID x7 days
Rate; pattern (regular or irregular); effort (labored - accessory muscles)

7. Vesicular breath sounds...
Dyspnea when supine - relived by sitting or standing
Oflaxicin 0.3% solution BID
High pitched sounds; can occur during inspiration or expiration; indicates narrow airways; can occur with asthma - COPD - pneumonia - CHF
Soft sounds in and out

8. What is the most common pahtogen for otitis media?
Increased breath sounds or voice remains loud at the periphery during auscultation. Indicative of consolidation.
Oflaxicin 0.3% solution BID
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

9. Peak Expiratory Flow (PEF)
Abnormal high pitched caused by blockage in upper airway; usually heard with with inspiration
Ipratroprium bromide (e.g. Atrovent); Antihistamines (Cargeul not to overly dry out muscos)
>12 weeks
Measures speed of exhalation; results measure by age and weight

10. Rhinosinusitis risk factors?
Nasal polyps - deviated septum - hx of trauma - surgery - foreign bodies or recent altitude changes
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
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;
Pulse ox; Peak expiratory flow; spirometry

11. What does mucopurulent indications not indicate?
Pulse ox; Peak expiratory flow; spirometry
Bacterial infection
Macrolides (azithormycin); Doxycycline; TMZ-SMZ
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

12. 1st line treatment for bacterial sinusitis?
Augementin 2000/124 mg bid for 5-7 days - Peds: 90 mg/kg/day po in divided doses
Amoxicillin 1000 mg TID x7 days; Augmentin 2000/125mg BID x7 days
Dyspnea when supine - relived by sitting or standing
Amoxicillin 80-90mg/kg/day x7 days; Augmentin 90/6.4 mg/kg/day x7 days

13. Spirometry
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
Ear ache - dullness - hearing loss - fever - N/V/D
Dyspnea when supine - relived by sitting or standing
Increased breath sounds or voice remains loud at the periphery during auscultation. Indicative of consolidation.

14. Chronic rhino-sinusitis duration of symptoms?
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
92-100%
Warm - humid environment; rest;
>12 weeks

15. Bronchial breath sounds...
Macrolides (azithormycin); Doxycycline; TMZ-SMZ
>12 weeks
Bacterial or viral infection of the middle ear (secondary to URI [e.g. eustachian tube dysfunction])
Hardher and more turbulent

16. Pulmonary tests
Rebound congestion 3-5 days
Pulse ox; Peak expiratory flow; spirometry
Deep - snoring sound; indicates fluid or narrowing of airways; common in bronchitis and COPD
Nasal polyps - deviated septum - hx of trauma - surgery - foreign bodies or recent altitude changes

17. Wheezes
4-12 weeks
High pitched sounds; can occur during inspiration or expiration; indicates narrow airways; can occur with asthma - COPD - pneumonia - CHF
Warm - humid environment; rest;
Rebound congestion 3-5 days

18. Normal pulse ox
Purulent discharge - post nasal draiange; cough; sinus pressure - tooth pain; halitosis (changes in taste); alterations of smell
92-100%
Dyspnea when supine - relived by sitting or standing
Amoxicillin 80-90mg/kg/day x7 days; Augmentin 90/6.4 mg/kg/day x7 days

19. Special cases of sinusitis?
Persistent or relapse of infection - chronic sinusitis - fungal infection - extension in CNS (meningitis - orbital cellulitis - osteitis)
Deep - rapid - labored - breathing
PE: rhinoscopy with otoscope
HEENT: rhinoscopy - sinus tenderness - lymphnodes - transillumination of sinuses - CV and PULM.

20. Alternative rx for bacterial sinusitis?
Viral inoculation > viral rhinitis > infection of paranasal sinuses > inflammation & edema > mucosal edema - copious secretions - ciliary dyskinesia > sinus congestions and/or obstruction
<4 weeks
Macrolides (azithormycin); Doxycycline; TMZ-SMZ
Erythmatous auditory canal - crusting

21. Pulmonary diagnostics (1)
Rate; pattern (regular or irregular); effort (labored - accessory muscles)
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
High pitched voice sound due to transmission of noise across fluid. Indicative of effusion.

22. Additional pulmonary diagnostics
Bacterial infection
Warm - humid environment; rest;
Soft sounds in and out
Labs: CBC - blood gas - d-dimer - CMP - BNP - Chest CT - MRI

23. Subacute rhino-sinusitis duration of symptoms?
Increased breath sounds or voice remains loud at the periphery during auscultation. Indicative of consolidation.
Ear ache - dullness - hearing loss - fever - N/V/D
Dyspnea when supine - relived by sitting or standing
4-12 weeks

24. Stridor
Abnormal high pitched caused by blockage in upper airway; usually heard with with inspiration
Step. pneumoniae; Haemophilus influenzae; group B-strep
PE: rhinoscopy with otoscope
Rhinovirus - influenza - and parainfluenza

25. Tx for pediatric AOM?
Amoxicillin 80-90mg/kg/day x7 days; Augmentin 90/6.4 mg/kg/day x7 days
High pitched voice sound due to transmission of noise across fluid. Indicative of effusion.
TM erythmatous - bulging - light reflex displaced - exudate
Decongestants (oxymetazoline); glucocorticoids (e.g. fluticasone); mucolytics (e.g. guaifensin)

26. Abnormal pulmonary findings?
Clubbing - Use of accessory muscles - barrel chest
Hardher and more turbulent
Fine or courses; secretions or aveolar collapse; normal if resovle with cough; abnormal: pneumonia; CHF; COPD; pilmonary fibrosis
Increased loudness of whispering during auscultation. Indicative of consolidation.

27. Bronchophony
Aspirin: increases viral shedding
Rhinovirus - influenza - parainfluenza
Bacterial or viral infection of the middle ear (secondary to URI [e.g. eustachian tube dysfunction])
Increased breath sounds or voice remains loud at the periphery during auscultation. Indicative of consolidation.

28. Rx for rhinorrhea and/or allergies?
>12 weeks
Ipratroprium bromide (e.g. Atrovent); Antihistamines (Cargeul not to overly dry out muscos)
Erythmatous auditory canal - crusting
Fine or courses; secretions or aveolar collapse; normal if resovle with cough; abnormal: pneumonia; CHF; COPD; pilmonary fibrosis

29. Whispered pectoriloguy
Fine or courses; secretions or aveolar collapse; normal if resovle with cough; abnormal: pneumonia; CHF; COPD; pilmonary fibrosis
<4 weeks
Increased loudness of whispering during auscultation. Indicative of consolidation.
Aspirin: increases viral shedding

30. What is most common age range for otitis?
Warm - humid environment; rest;
3 months to 3 years old
Increased loudness of whispering during auscultation. Indicative of consolidation.
Ear ache - dullness - hearing loss - fever - N/V/D

31. What is the common side effect of sympathomimetics?
Amoxicillin 80-90mg/kg/day x7 days; Augmentin 90/6.4 mg/kg/day x7 days
Abrupt onset - burning nose or throat - sneezing - rhinorrhea
Erythmatous auditory canal - crusting
Rebound congestion 3-5 days

32. Acute otitis media
Bacterial or viral infection of the middle ear (secondary to URI [e.g. eustachian tube dysfunction])
Fine or courses; secretions or aveolar collapse; normal if resovle with cough; abnormal: pneumonia; CHF; COPD; pilmonary fibrosis
Hardher and more turbulent
Aspirin: increases viral shedding

33. Physical exam of chest
Pulse ox; Peak expiratory flow; spirometry
Clubbing - Use of accessory muscles - barrel chest
Symptomatic (steam; nasal irrigation); APAP for pain.
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. Common Cold (URI - Acute Coryza)
Amoxicillin 1000 mg TID x7 days; Augmentin 2000/125mg BID x7 days
Afebrile viral infection of the the nose - paranasal sinuses - throat - larynx - trachea - and and bronchi.
Viral inoculation > viral rhinitis > infection of paranasal sinuses > inflammation & edema > mucosal edema - copious secretions - ciliary dyskinesia > sinus congestions and/or obstruction
Deep - rapid - labored - breathing

35. What are physical exam findings of AOM?
24-72 hrs
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])
TM erythmatous - bulging - light reflex displaced - exudate

36. Kussmal's respiration
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])
Deep - rapid - labored - breathing
4-12 weeks

37. Respiratory Examination (Observation)
Ipratroprium bromide (e.g. Atrovent); Antihistamines (Cargeul not to overly dry out muscos)
Rate; pattern (regular or irregular); effort (labored - accessory muscles)
Erythmatous auditory canal - crusting
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;

38. What sinusitis symptoms would warrant image studies?
Persistent; recurrent x4/yr; severe HA; altered mental status
Symptomatic (steam; nasal irrigation); APAP for pain.
NSAIDs for aches - fever; Sympathomimetics: pseudophedrine or phenylephrine
Ear ache - dullness - hearing loss - fever - N/V/D

39. Egophany (vocal resonance)
Rhinovirus - influenza - and parainfluenza
Oflaxicin 0.3% solution BID
Macrolides (azithormycin); Doxycycline; TMZ-SMZ
High pitched voice sound due to transmission of noise across fluid. Indicative of effusion.

40. Rhinosinusitis physical exam?
High pitched sounds; can occur during inspiration or expiration; indicates narrow airways; can occur with asthma - COPD - pneumonia - CHF
<4 weeks
HEENT: rhinoscopy - sinus tenderness - lymphnodes - transillumination of sinuses - CV and PULM.
Warm - humid environment; rest;

41. Which Rx should not be used for viral URI?
Aspirin: increases viral shedding
Rhinovirus - influenza - parainfluenza
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;
TM erythmatous - bulging - light reflex displaced - exudate

42. Rhonchi
Ear ache - dullness - hearing loss - fever - N/V/D
Deep - snoring sound; indicates fluid or narrowing of airways; common in bronchitis and COPD
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

43. Rx nasal congestion?
Decongestants (oxymetazoline); glucocorticoids (e.g. fluticasone); mucolytics (e.g. guaifensin)
Ipratroprium bromide (e.g. Atrovent); Antihistamines (Cargeul not to overly dry out muscos)
Persistent; recurrent x4/yr; severe HA; altered mental status
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

44. Tx for adult AOE?
Oflaxicin 0.3% solution BID
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
24-72 hrs
Persistent or relapse of infection - chronic sinusitis - fungal infection - extension in CNS (meningitis - orbital cellulitis - osteitis)

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

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46. Acute viral rhino-sinusitis (AVRS) pathogens?
Rhinovirus - influenza - parainfluenza
4-12 weeks
Deep - snoring sound; indicates fluid or narrowing of airways; common in bronchitis and COPD
Aspirin: Reye's Syndrome

47. Diagnostics of sinusitis?
PE: rhinoscopy with otoscope
4-12 weeks
Abnormal high pitched caused by blockage in upper airway; usually heard with with inspiration
3 months to 3 years old

48. Common cold pathogens
Rhinovirus - influenza - parainfluenza
Afebrile viral infection of the the nose - paranasal sinuses - throat - larynx - trachea - and and bronchi.
Rhinovirus - influenza - and parainfluenza
HEENT: rhinoscopy - sinus tenderness - lymphnodes - transillumination of sinuses - CV and PULM.

49. Pathophysiology of rhino sinusitis?
High pitched voice sound due to transmission of noise across fluid. Indicative of effusion.
Increased loudness of whispering during auscultation. Indicative of consolidation.
Viral inoculation > viral rhinitis > infection of paranasal sinuses > inflammation & edema > mucosal edema - copious secretions - ciliary dyskinesia > sinus congestions and/or obstruction
Aspirin: increases viral shedding

50. Orthopnea
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
Rate; pattern (regular or irregular); effort (labored - accessory muscles)
Increased loudness of whispering during auscultation. Indicative of consolidation.
Dyspnea when supine - relived by sitting or standing