Acute Otitis Media

Question 1

Decongestants in kids under 2

Answer 1

NOT RECOMMENDED because there is lack of evidence that it helps and there is possibility of FATAL overdose

Question 2

DDx for fever and cough

Answer 2

Allergic Rhinitis
AOM
PNA
URI
Sinusitis

Question 3

Allergic Rhinitis

Answer 3

corresponds to seasonal allergens –> most common presenting sign is rhinitis

Question 4

Acute Otitis Media

Answer 4

S. pneumo, Hib (nontypable), moraxella
typically develops 3-5 days after URI symptoms
- specific sign = otalgia (ear pain)
- fever, irritability, cough, anorexia, N/V

Question 5

Sinusitis

Answer 5

begin with URI and progress to superinfection from same organism (same as AOM)
- persistent URI symptoms with day and night cough

Question 6

URI

Answer 6

common cold –> quite variable depending on virus

- throat irritation, coughing, sneezing, nasal stuffiness, rhinorrhea, fever, irritability

Question 7

PNA

Answer 7

abrupt onset of fever, cough, pleuritic chest pain, ill appearing

• dyspnea and tachypnea
• viral pneumonias = less severe

Question 8

Examining a toddler

Answer 8

1. General observations first, noting interactions
2. Brief look at eyes/conjunctiva for discharge
3. Auscultate heart, lungs, abdomen
4. Ears and oral cavity

Question 9

Ear exam

Answer 9

QUITE CHALLENGING

• have them sit on parents lap and help hold in place
• pull pinna of ear up and back to see past “anterior bend”
• use 5th finger to brace otoscope against head so you don’t jam tip into their canal if they move

Question 10

Describing Ear Exam

Answer 10

Otitis media - effusion present, inflammation, redness, bulging?
Otitis Externa - edematous canal, pain with retraction of ear, discharge?

Question 11

Bacterial Causes of AOM

Answer 11

1. S. pneumo (decreasing because of vaccine)
2. H flu (nontypeable)
3. Moraxella

Question 12

Viral Causes of AOM

Answer 12

RSV, influenza, rhinovirus

• alter mucosal lining –> increasing bacterial colonization
• can be less responsive to ABx

Question 13

Treatment of AOM

Answer 13

1st line - AMOXICILLIN (80-90 mg/kg split BID)

- inexpensive, tastes good, safe, narrow spectrum

Question 14

Resolution of AOM without treatment

Answer 14

50-80% of time the AOM will self-resolve

Question 15

Risk factors for AOM

Answer 15

Daycare attendance
Smoke Exposure
Seasonal Allergies
Pacifier Use
Fam Hx of AOM

Question 16

Persistent Otitis Media with Effusion

Answer 16

assess hearing and speech development –> if normal –> follow clinically
- if they keep getting infected or they have hearing loss –> myringotomy

Question 17

Developmental Screening tool

Answer 17

Assesses the following:
Gross motor
Fine motor
Social/communication
Congitive/language

Question 18

Visual Reinforcement Audiometry

Answer 18

for kids 6 months - 2.5 years

- measures response to speech and frequency-specific stimuli