CLIPP 14

Question 1

18 month olds should be saying a minimum of __ words

Answer 1

6

Question 2

recommendation regarding OTC cough/cold/decongestant/antihistamine products in kids <2yo

Answer 2

not recommended

Question 3

persistent URI sx >10 d w/ day and night cough

Answer 3

pediatic sinusitis

Question 4

development of AOM

Answer 4

often 3-5 days post URI, w ear tugging or fever, anorexia, irritability, v/d

Question 5

rhinitis can sometimes be a sx of ___ and having __ on exam makes ___ less likely

Answer 5

allergies, fever, allergic rhinitis

Question 6

viral pna course

Answer 6

moderate fver, non productive cough, then gradual onset of upper resp tract sx

Question 7

URI is not considered ____

Answer 7

a definite source of fever

Question 8

In other words, in the absence of a definitive source of fever, or in the face of persistent fever, you would need to reconsider the possibility of a___

Answer 8

UTI

Question 9

at what part of the examination should you look at the eyes and conjunctiva

Answer 9

early on in case they cry later

Question 10

non infection related things that can make TM erythematous

Answer 10

crying, fever

Question 11

normal middle ear generally has a __ tympanic membrane (TM) that is in a __ position.
It has __ mobility.

Answer 11

translucent
neutral or retracted
normal

Question 12

OME vs AOM

Answer 12

OME has fluid w/o other signs or sx of acute inflammation (bulging, fullness, otalgia/tugging, fever)

Question 13

otitis externa aka

Answer 13

swimmers ear includes pain w traction on ear lobe and edematous auditory canal

Question 14

two most common causes of AOM - in kids for bacteria, and virally

Answer 14

bacterially are SP, HI non tapeable and virally are rsv, influenza, rhinovirus

Question 15

first line tx for AOM

Answer 15

amoxicillin 80-90 mg/kg/day

Question 16

if AOM + concurrent purulent conjunctivitis, tx w

Answer 16

augmetnin (amox+clav)

Question 17

tx recommendations for AOM for 6mon-2yo child vs child>2yo

Answer 17

use abx in 6m-2yo if unilateral AOM w severe sx such as toxic appearing, OR persistent ear pain for 48h, OR fever >39 within past 48 h.. OR for bilateral AOM with mild or severe sx

use abx in >2yo if unilateral or bilateral AOM w/ severe sx such as toxic appearing OR, persistent ear pain for 48h OR fver>39 within past 48h

discuss obvs w/ fu vs abx tx in 6m-2yo if unilateral AOM mild sx such as mild ear pain AND temp 2yo if unilateral or bilat mild AOM w mild ear pain AND temps condition worsen or not improve in 48 to 72 hours.

Question 18

can AOM resolve spontaneously w/o abx?

Answer 18

yes, 50-80% of the time.

Question 19

AOM RF

Answer 19

Daycare attendance (A)
Tobacco exposure
Allergies (E)
Bottle propping at bedtime
Pacifier use
Drinking formula from a bottle rather than breastfeeding
Significant family history of AOM
Male gender
Lower socioeconomic status
Respiratory allergies
Onset of otitis in the first year of life.
plus, clefts, down syndrome, genetics, native americans

Question 20

amber, non- or poorly mobile, opaque and retracted tympanic membrane

Answer 20

OME - middle ear effusions can persist for several weeks after AOM, most often for a month(?)

Question 21

do hearing test if

Answer 21

language delay, learning issue, or hearing loss

Question 22

problem w/ OME

Answer 22

can cause conductive hearing loss–>language,learning and hearing issues

Question 23

denver interpretation

Answer 23

Normal: No delays and a maximum of 1 caution.
Suspect: Two or more cautions and/or one or more delays. Rescreen in 1-2 weeks.
Untestable: Refusal scores on one or more items completely to the left of the age line or on more than one item intersected by the age line in the 75%-90% area.

Question 24

denver is used in what ages and what 4 areas does it asses

Answer 24

0-6yo
social ,fine motor, lang, gross motor
- screen reports the percentage (25%-90%) of children who successfully perform a specific task (C)

Question 25

An objective method for evaluation of the mobility of the tympanic membrane.

Answer 25

tympanogram

Question 26

ehavioral test measuring auditory thresholds in response to speech and frequency-specific stimuli presented through earphones.
-age

Answer 26

conventioan audiometry - tpyiclaly not possible before age 4yo

Question 27

Behavioral test measuring response of the child to speech and frequency-specific stimuli presented through speakers in a sound-treated room.
-age

Answer 27

visual reinforcement audiometry

• 6 m to 2.5yo
• only assesses hearing in better ear

Question 28

Physiologic test measuring cochlear function in response to presentation of a stimulus. Primarily used in newborn assessments

Answer 28

otoacoustic emissions

Question 29

what is a rare cause of pharyngitis in kids<3

Answer 29

strep (GAS) and does not typically cause the rheumatic heart dz sequelueae in younger kids as it can in older

Question 30

common cause of congestion, inflamed turbinates, fever,

Answer 30

rhinovirus

Question 31

what can be indistinguishable from common cold

Answer 31

catarrhal phase of pertusiss

Question 32

coughing fits w/ post tussive emesis and typically no fever

Answer 32

paroxysmal phase of pertusissi

Question 33

when to use augmenting (amox clav)

Answer 33

our pt has high temperature greater than 39 C and also had recently been tx w amox. Amoxicillin/clavulanate is the treatment of choice for patients with moderate to severe otalgia or high fever, and is used for additional beta-lactamase coverage for Haemophilus influenzae and Moraxella catarrhalis, and when failure with amoxicillin is suspected.

Question 34

diagnostic measure to confirm a bacterial etiology after a patient has failed repeated courses of antibiotics or if an unusually resistant organism is suspected.

Answer 34

tympanocentesis

Question 35

is strep pyo or strep pneumo a common cause of AOM

Answer 35

strep PNEUMO

Question 36

why can immunized kid get HIB AOM

Answer 36

Although the child has been vaccinated against H. influenzae type B, this does not cover the unencapsulated strains of H. influenzae that cause AOM.

Question 37

earlier diagnosis of acute otitis media together with current findings of bilateral yellow and poorly mobile tympanic membranes on physical exam make this the most likely diagnosis.

Answer 37

OM w/ Effusion

Question 38

ages for maxillary, sphenoid, ethmoid, frontal

Answer 38

max eth = infancy
sphen - 3-5yo
frontal - 6-10yo

Question 39

nocturnal cough is common sx assoc w/ these two thigns

Answer 39

asthma, allergies…also gerd