ENT/Ophthalmology Flashcards
A 4-day-old neonate born at 38 weeks gestation following an uncomplicated pregnancy and delivery presents to the emergency department with his father due to bilateral eye redness and discharge. On exam, the patient has bilateral conjunctivitis and copious amounts of purulent discharge from both eyes. What is the treatment for the most likely diagnosis?
A) Ceftriaxone
B) Cephalexin
C) Ciprofloxacin
D) Erythromycin
What is the disposition of this patient?
Ceftriaxone
Admit to hospital
Gonococcal conjuctivitis typically presents on DOL 2-5. Prevention is with erythromycin at birth. Treatment is with IM or IV ceftriaxone.
What is the hallmark physical exam finding for acute otitis media?
What is the most common bacterial cause?
Bulging, erythematous tympanic membrane with decreased mobility
Streptococcus pneumoniae
What is the first-line antibiotic treatment for acute otitis media in children?
Amoxicillin
What is the alternative antibiotic for penicillin-allergic patients with acute otitis media?
Cefdinir or azithromycin
A 3-year-old girl with a history of untreated acute otitis media presents with postauricular swelling, erythema, and fever. She has tenderness behind her ear, and her ear is displaced downward and forward. What is the most likely diagnosis?
A. Otitis externa
B. Mastoiditis
C. Temporal bone fracture
D. Peritonsillar abscess
Mastoiditis
Postauricular swelling and displacement of the ear are classic signs of mastoiditis, a complication of untreated AOM
A 6-year-old boy with a history of AOM presents with high fever, ear pain, and otorrhea. His tympanic membrane is perforated with purulent drainage. What is the most appropriate treatment?
A. Amoxicillin
B. Amoxicillin-clavulanate
C. Topical ciprofloxacin drops
D. Observation
Amoxicillin-clavulanate
Perforated AOM with purulent drainage often requires broader coverage with amoxicillin-clavulanate
A 4-year-old child with a history of severe penicillin allergy presents with acute otitis media. What is the best antibiotic option?
A. Amoxicillin
B. Cephalixin
C. Clindamycin
D. Azithromycin
Azithromycin
For children with severe penicillin allergies, macrolides such as azithromycin or cefdinir are appropriate alternatives
An 8-year old child presents to the ED with fever and right ear pain for several days, now his ear is protruding up and out more than usual. Today, his mother is concerned because the right side of his face is drooping and “not working.” On exam, the child has post-auricular erythema and tenderness to palpation. He is also noted to have a peripheral CN VII palsy. What is the next best step in management for this patient?
A) Head CT
B) Intravenous antibiotics
C) Lumbar puncture
D) Incision and drainage
Intravenous antibiotics
Mastoiditis is a complication of AOM and will present with fever, otalgia, protruding pina, post-auricular erythema, tenderness, and swelling. This diagnosis warrants urgent intravenous antibiotics and ENT consult. Head CT can be helpful in management but antibtiocs should not be delayed.
What is the most common bacterial pathogen isolated in otitis externa?
Pseudomonas
