CLIPP 14 Flashcards
18 month olds should be saying a minimum of __ words
6
recommendation regarding OTC cough/cold/decongestant/antihistamine products in kids <2yo
not recommended
persistent URI sx >10 d w/ day and night cough
pediatic sinusitis
development of AOM
often 3-5 days post URI, w ear tugging or fever, anorexia, irritability, v/d
rhinitis can sometimes be a sx of ___ and having __ on exam makes ___ less likely
allergies, fever, allergic rhinitis
viral pna course
moderate fver, non productive cough, then gradual onset of upper resp tract sx
URI is not considered ____
a definite source of fever
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___
UTI
at what part of the examination should you look at the eyes and conjunctiva
early on in case they cry later
non infection related things that can make TM erythematous
crying, fever
normal middle ear generally has a __ tympanic membrane (TM) that is in a __ position.
It has __ mobility.
translucent
neutral or retracted
normal
OME vs AOM
OME has fluid w/o other signs or sx of acute inflammation (bulging, fullness, otalgia/tugging, fever)
otitis externa aka
swimmers ear includes pain w traction on ear lobe and edematous auditory canal
two most common causes of AOM - in kids for bacteria, and virally
bacterially are SP, HI non tapeable and virally are rsv, influenza, rhinovirus
first line tx for AOM
amoxicillin 80-90 mg/kg/day
if AOM + concurrent purulent conjunctivitis, tx w
augmetnin (amox+clav)
tx recommendations for AOM for 6mon-2yo child vs child>2yo
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.
can AOM resolve spontaneously w/o abx?
yes, 50-80% of the time.
AOM RF
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
amber, non- or poorly mobile, opaque and retracted tympanic membrane
OME - middle ear effusions can persist for several weeks after AOM, most often for a month(?)
do hearing test if
language delay, learning issue, or hearing loss
problem w/ OME
can cause conductive hearing loss–>language,learning and hearing issues
denver interpretation
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.
denver is used in what ages and what 4 areas does it asses
0-6yo
social ,fine motor, lang, gross motor
- screen reports the percentage (25%-90%) of children who successfully perform a specific task (C)
An objective method for evaluation of the mobility of the tympanic membrane.
tympanogram
ehavioral test measuring auditory thresholds in response to speech and frequency-specific stimuli presented through earphones.
-age
conventioan audiometry - tpyiclaly not possible before age 4yo
Behavioral test measuring response of the child to speech and frequency-specific stimuli presented through speakers in a sound-treated room.
-age
visual reinforcement audiometry
- 6 m to 2.5yo
- only assesses hearing in better ear
Physiologic test measuring cochlear function in response to presentation of a stimulus. Primarily used in newborn assessments
otoacoustic emissions
what is a rare cause of pharyngitis in kids<3
strep (GAS) and does not typically cause the rheumatic heart dz sequelueae in younger kids as it can in older
common cause of congestion, inflamed turbinates, fever,
rhinovirus
what can be indistinguishable from common cold
catarrhal phase of pertusiss
coughing fits w/ post tussive emesis and typically no fever
paroxysmal phase of pertusissi
when to use augmenting (amox clav)
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.
diagnostic measure to confirm a bacterial etiology after a patient has failed repeated courses of antibiotics or if an unusually resistant organism is suspected.
tympanocentesis
is strep pyo or strep pneumo a common cause of AOM
strep PNEUMO
why can immunized kid get HIB AOM
Although the child has been vaccinated against H. influenzae type B, this does not cover the unencapsulated strains of H. influenzae that cause AOM.
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.
OM w/ Effusion
ages for maxillary, sphenoid, ethmoid, frontal
max eth = infancy
sphen - 3-5yo
frontal - 6-10yo
nocturnal cough is common sx assoc w/ these two thigns
asthma, allergies…also gerd
