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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. Cold incubation period
>12 weeks
Rate; pattern (regular or irregular); effort (labored - accessory muscles)
Dyspnea when supine - relived by sitting or standing
24-72 hrs

2. Chronic rhino-sinusitis duration of symptoms?
Aspirin: increases viral shedding
>12 weeks
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;
Rhinovirus - influenza - parainfluenza

3. Alternative rx for bacterial sinusitis?
Augementin 2000/124 mg bid for 5-7 days - Peds: 90 mg/kg/day po in divided doses
Purulent discharge - post nasal draiange; cough; sinus pressure - tooth pain; halitosis (changes in taste); alterations of smell
Macrolides (azithormycin); Doxycycline; TMZ-SMZ
Ear ache - dullness - hearing loss - fever - N/V/D

4. Physical exam of chest
Clubbing - Use of accessory muscles - barrel chest
PE: rhinoscopy with otoscope
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

5. Tx for pediatric AOM?
Amoxicillin 80-90mg/kg/day x7 days; Augmentin 90/6.4 mg/kg/day x7 days
Nasal polyps - deviated septum - hx of trauma - surgery - foreign bodies or recent altitude changes
Warm - humid environment; rest;
Viral inoculation > viral rhinitis > infection of paranasal sinuses > inflammation & edema > mucosal edema - copious secretions - ciliary dyskinesia > sinus congestions and/or obstruction

6. Proxysmal nocturnal dyspnea
>12 weeks
Amoxicillin 1000 mg TID x7 days; Augmentin 2000/125mg BID x7 days
Severe dyspnea when lying supine with associated wheezing and coughing - need to sit up abruptly due to severe dyspnea
Ipratroprium bromide (e.g. Atrovent); Antihistamines (Cargeul not to overly dry out muscos)

7. What is most common age range for otitis?
Afebrile viral infection of the the nose - paranasal sinuses - throat - larynx - trachea - and and bronchi.
Apena alternating with hyperpnea;
Amoxicillin 80-90mg/kg/day x7 days; Augmentin 90/6.4 mg/kg/day x7 days
3 months to 3 years old

8. Special cases of sinusitis?
Amoxicillin 80-90mg/kg/day x7 days; Augmentin 90/6.4 mg/kg/day x7 days
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)

9. 1st line treatment for bacterial sinusitis?
Pulse ox; Peak expiratory flow; spirometry
Augementin 2000/124 mg bid for 5-7 days - Peds: 90 mg/kg/day po in divided doses
24-72 hrs
Nasal congestion - HA - sinus pain - fever - sore throat - cough

10. 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
Afebrile viral infection of the the nose - paranasal sinuses - throat - larynx - trachea - and and bronchi.
Increased loudness of whispering during auscultation. Indicative of consolidation.

11. Stridor
Fine or courses; secretions or aveolar collapse; normal if resovle with cough; abnormal: pneumonia; CHF; COPD; pilmonary fibrosis
Abnormal high pitched caused by blockage in upper airway; usually heard with with inspiration
Deep - rapid - labored - breathing
Aspirin: increases viral shedding

12. Subacute rhino-sinusitis duration of symptoms?
4-12 weeks
Nasal polyps - deviated septum - hx of trauma - surgery - foreign bodies or recent altitude changes
Severe dyspnea when lying supine with associated wheezing and coughing - need to sit up abruptly due to severe dyspnea
Macrolides (azithormycin); Doxycycline; TMZ-SMZ

13. Common cold symptoms
HEENT: rhinoscopy - sinus tenderness - lymphnodes - transillumination of sinuses - CV and PULM.
NSAIDs for aches - fever; Sympathomimetics: pseudophedrine or phenylephrine
Persistent or relapse of infection - chronic sinusitis - fungal infection - extension in CNS (meningitis - orbital cellulitis - osteitis)
Abrupt onset - burning nose or throat - sneezing - rhinorrhea

14. Rhinosinusitis risk factors?
Inflammation of the nasal cavity
Nasal congestion - HA - sinus pain - fever - sore throat - cough
Aspirin: Reye's Syndrome
Nasal polyps - deviated septum - hx of trauma - surgery - foreign bodies or recent altitude changes

15. Tx of sinusitis symptoms <10 days
Symptomatic (steam; nasal irrigation); APAP for pain.
4-12 weeks
Step. pneumoniae; Haemophilus influenzae; group B-strep
Aspirin: increases viral shedding

16. 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;
Persistent or relapse of infection - chronic sinusitis - fungal infection - extension in CNS (meningitis - orbital cellulitis - osteitis)
Amoxicillin 1000 mg TID x7 days; Augmentin 2000/125mg BID x7 days
3 months to 3 years old

17. What are physical exam findings of AOE?
Aspirin: Reye's Syndrome
Inflammation of the nasal cavity
Warm - humid environment; rest;
Erythmatous auditory canal - crusting

18. What are physical exam findings of AOM?
Nasal polyps - deviated septum - hx of trauma - surgery - foreign bodies or recent altitude changes
TM erythmatous - bulging - light reflex displaced - exudate
Ipratroprium bromide (e.g. Atrovent); Antihistamines (Cargeul not to overly dry out muscos)
Apena alternating with hyperpnea;

19. Bronchophony
Macrolides (azithormycin); Doxycycline; TMZ-SMZ
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
Increased breath sounds or voice remains loud at the periphery during auscultation. Indicative of consolidation.
Abnormal high pitched caused by blockage in upper airway; usually heard with with inspiration

20. Whispered pectoriloguy
Increased loudness of whispering during auscultation. Indicative of consolidation.
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
Hardher and more turbulent
Apena alternating with hyperpnea;

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

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22. Symptoms of acute bacterial rhino-sinusitis (ABRS)?
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
Hardher and more turbulent
E. coli

23. Normal pulse ox
<4 weeks
3 months to 3 years old
92-100%
Measures speed of exhalation; results measure by age and weight

24. Common Cold (URI - Acute Coryza)
Ear ache - dullness - hearing loss - fever - N/V/D
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
Rhinovirus - influenza - parainfluenza

25. Abnormal pulmonary findings?
Clubbing - Use of accessory muscles - barrel chest
Step. pneumoniae; Haemophilus influenzae; group B-strep
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;
PE: rhinoscopy with otoscope

26. Egophany (vocal resonance)
Bacterial infection
High pitched voice sound due to transmission of noise across fluid. Indicative of effusion.
Nasal congestion - HA - sinus pain - fever - sore throat - cough
Step. pneumoniae; Haemophilus influenzae; group B-strep

27. Rhinosinusitis physical exam?
HEENT: rhinoscopy - sinus tenderness - lymphnodes - transillumination of sinuses - CV and PULM.
Augementin 2000/124 mg bid for 5-7 days - Peds: 90 mg/kg/day po in divided doses
Erythmatous auditory canal - crusting
TM erythmatous - bulging - light reflex displaced - exudate

28. Wheezes
TM erythmatous - bulging - light reflex displaced - exudate
Deep - snoring sound; indicates fluid or narrowing of airways; common in bronchitis and COPD
High pitched sounds; can occur during inspiration or expiration; indicates narrow airways; can occur with asthma - COPD - pneumonia - CHF
Nasal congestion - HA - sinus pain - fever - sore throat - cough

29. Sinusitis
Nasal polyps - deviated septum - hx of trauma - surgery - foreign bodies or recent altitude changes
Soft sounds in and out
Inflammation of the paranasal sinuses
E. coli

30. Pathophysiology of rhino sinusitis?
92-100%
Amoxicillin 80-90mg/kg/day x7 days; Augmentin 90/6.4 mg/kg/day x7 days
Viral inoculation > viral rhinitis > infection of paranasal sinuses > inflammation & edema > mucosal edema - copious secretions - ciliary dyskinesia > sinus congestions and/or obstruction
Erythmatous auditory canal - crusting

31. Rhinitis
Purulent discharge - post nasal draiange; cough; sinus pressure - tooth pain; halitosis (changes in taste); alterations of smell
Inflammation of the nasal cavity
Measures speed of exhalation; results measure by age and weight
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

32. Pulmonary tests
Soft sounds in and out
3 months to 3 years old
Nasal congestion - HA - sinus pain - fever - sore throat - cough
Pulse ox; Peak expiratory flow; spirometry

33. What sinusitis symptoms would warrant image studies?
TM erythmatous - bulging - light reflex displaced - exudate
High pitched sounds; can occur during inspiration or expiration; indicates narrow airways; can occur with asthma - COPD - pneumonia - CHF
High pitched voice sound due to transmission of noise across fluid. Indicative of effusion.
Persistent; recurrent x4/yr; severe HA; altered mental status

34. Additional pulmonary diagnostics
Step. pneumoniae; Haemophilus influenzae; group B-strep
High pitched sounds; can occur during inspiration or expiration; indicates narrow airways; can occur with asthma - COPD - pneumonia - CHF
Labs: CBC - blood gas - d-dimer - CMP - BNP - Chest CT - MRI
Rebound congestion 3-5 days

35. Respiratory Examination (Observation)
Purulent discharge - post nasal draiange; cough; sinus pressure - tooth pain; halitosis (changes in taste); alterations of smell
Rate; pattern (regular or irregular); effort (labored - accessory muscles)
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

36. Acute otitis media
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])
Nasal polyps - deviated septum - hx of trauma - surgery - foreign bodies or recent altitude changes
Ipratroprium bromide (e.g. Atrovent); Antihistamines (Cargeul not to overly dry out muscos)

37. Nonpharmacological tx for viral URI
E. coli
3 months to 3 years old
Warm - humid environment; rest;
Clubbing - Use of accessory muscles - barrel chest

38. What is the most common pathogen for otitis in newborns?
Hardher and more turbulent
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
E. coli

39. Common cold pathogens
Rhinovirus - influenza - and parainfluenza
Pulse ox; Peak expiratory flow; spirometry
Macrolides (azithormycin); Doxycycline; TMZ-SMZ
Severe dyspnea when lying supine with associated wheezing and coughing - need to sit up abruptly due to severe dyspnea

40. Bronchial breath sounds...
Hardher and more turbulent
Measures speed of exhalation; results measure by age and weight
Abrupt onset - burning nose or throat - sneezing - rhinorrhea
Increased breath sounds or voice remains loud at the periphery during auscultation. Indicative of consolidation.

41. Orthopnea
Nasal polyps - deviated septum - hx of trauma - surgery - foreign bodies or recent altitude changes
Dyspnea when supine - relived by sitting or standing
Persistent or relapse of infection - chronic sinusitis - fungal infection - extension in CNS (meningitis - orbital cellulitis - osteitis)
Increased loudness of whispering during auscultation. Indicative of consolidation.

42. Rx for rhinorrhea and/or allergies?
Rhinovirus - influenza - and parainfluenza
Ipratroprium bromide (e.g. Atrovent); Antihistamines (Cargeul not to overly dry out muscos)
E. coli
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. Peak Expiratory Flow (PEF)
<4 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
Measures speed of exhalation; results measure by age and weight
Rhinovirus - influenza - and parainfluenza

44. Acute viral rhino-sinusitis (AVRS) pathogens?
Step. pneumoniae; Haemophilus influenzae; group B-strep
Ear ache - dullness - hearing loss - fever - N/V/D
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
Rhinovirus - influenza - parainfluenza

45. Cheyne-stokes
Rhinovirus - influenza - and parainfluenza
Increased loudness of whispering during auscultation. Indicative of consolidation.
Apena alternating with hyperpnea;
Symptomatic (steam; nasal irrigation); APAP for pain.

46. Rx for viral URI?
Decongestants (oxymetazoline); glucocorticoids (e.g. fluticasone); mucolytics (e.g. guaifensin)
NSAIDs for aches - fever; Sympathomimetics: pseudophedrine or phenylephrine
<4 weeks
Rhinovirus - influenza - and parainfluenza

47. Which Rx should not be used for viral URI?
Fine or courses; secretions or aveolar collapse; normal if resovle with cough; abnormal: pneumonia; CHF; COPD; pilmonary fibrosis
Aspirin: increases viral shedding
Persistent; recurrent x4/yr; severe HA; altered mental status
Severe dyspnea when lying supine with associated wheezing and coughing - need to sit up abruptly due to severe dyspnea

48. Rhonchi
Rhinovirus - influenza - and parainfluenza
Deep - snoring sound; indicates fluid or narrowing of airways; common in bronchitis and COPD
Rebound congestion 3-5 days
3 months to 3 years old

49. Crackles (rales)
Fine or courses; secretions or aveolar collapse; normal if resovle with cough; abnormal: pneumonia; CHF; COPD; pilmonary fibrosis
High pitched voice sound due to transmission of noise across fluid. Indicative of effusion.
Bacterial infection
Ipratroprium bromide (e.g. Atrovent); Antihistamines (Cargeul not to overly dry out muscos)

50. Kussmal's respiration
Aspirin: Reye's Syndrome
4-12 weeks
Deep - rapid - labored - breathing
Hardher and more turbulent