B3.054 - Big Case Otitis Media

Question 1

what is the most common condition for which antimicrobials are prescribed for children in the US

Answer 1

otitis media

Question 2

Otitis media usually occurs coincident with or following what

Answer 2

viral upper respiratory infection

Question 3

what occurs in 75% of children with a viral URI to contribute to otitis media

Answer 3

eustatian tube dysfunction, organisms can get transmitted from nasopharynx to the ear

Question 4

describe the nature of bacterial infections and which are most common

Answer 4

66% bacteria and viruses together 27% bacteria alone 4% viruses alone

Question 5

what are the 4 most common causes of bacterial Otitis media

Answer 5

strep pneumo non typable H. influenzae strep pyogens moraxella vatarrhalis

Question 6

what is usually responsible for otitis conjuctivitis

Answer 6

NTHi

Question 7

whats the difference between prevnar 7 and 13

Answer 7

7 has 7 serotypes and 13 has 13 serotypes

Question 8

what are factors that increase risk of otitis media

Answer 8

attending daycare white race having siblings family history

Question 9

what effect does breastfeeding have on AOM

Answer 9

protective

Question 10

what does “strong recommendation” mean?

Answer 10

you should probably do it

Question 11

what does it mean if a treatment is an “option”

Answer 11

it should be discussed with patient, hasn’t been definitively proven to be better

Question 12

what has the greatest specificity and positive predictive value for otitis media

Answer 12

bulging tympanic membrane

Question 13

most appropriate treatment for otitis media

Answer 13

amoxicillin

Question 14

what is amoxicillin/clavulonate used for

Answer 14

otitis media thats resistant to penicillins

Question 15

do you treat otitis media with effusion with antibiotics

Answer 15

no

Question 16

what do you do for pts with otitis media with effusion

Answer 16

observation

Question 17

symptoms of AOM

Answer 17

rapid onset ear pain in preverbal children rubbing/tugging ear changes in childs sleep or behavior

Question 18

best predictor of AOM

Answer 18

cloudy, bulging TM with impaired mobility

Question 19

which sign of AOM had the highest sensitivity and specificity

Answer 19

impaired mobility

Question 20

which sign of AOM had the highest specificity but lower sensitivity

Answer 20

bulging

Question 21

do you use antibiotics for OME

Answer 21

no it doesnt benefit from it

Question 22

clinicians should not diagnose AOM in children who do not have what

Answer 22

Middle ear effusion

Question 23

what do you need to make sure you have when doing a tympanometry

Answer 23

a seal

Question 24

what indicates a presence of MEE

Answer 24

bulging of tympanic membrane limited or absent mobility of the tympanic membrane air-fluid level behind membrane otorrhea

Question 25

Answer 25

normal tympanic membrane

Question 26

Answer 26

retracted tympanic membrane

Question 27

Answer 27

retracted tympanic membrane with air bubbles

Question 28

what is considered an option for uncomplicated AOM based on age, illness severity, assurance of follow up

Answer 28

observation without use of antimibrobial agents

Question 29

when do you use a safety net antibiotic

Answer 29

use of safety net antibiotic prescription if not improved at 48 to 72 hours

Question 30

what is the antibiotic prescribed for most children for AOM

Answer 30

amoxicillin

Question 31

when do you prescribe an antibiotic with additional beta lactamase coverage

Answer 31

if the child has received amoxicillin in the past 30 days or has purulent conjuctivitis, or is unresponsive to amoxicillin

Question 32

what do you do for a pneumococcal infection

Answer 32

increase dose, dont need a beta lactamase

Question 33

if a patient has a penicillin allergy what do you prescribe

Answer 33

ceftriaxone or

cefdiner or

cefpodoxime or

cefuroxime

Question 34

how is OME defined

Answer 34

presence of fluid in the middle ear without signs or symptoms of acute ear infection

Question 35

how does peristent OME affect the pt

Answer 35

decreased mobility of the tympanic membrane and serves as a barrier to sound conduction

Question 36

when do you use pneumatic otoscopy

Answer 36

should be used to document OME

in a child with otalgia, hearing loss, both

suspected OME

Question 37

when should clinicians get a hearing test

Answer 37

if OME persists over 3 months

Question 38

what population is more likely to have risk factors for OME

Answer 38

developmental difficulties