INESSS AOM Ped

Question 1

History taking for AOM. (8)

Answer 1

1- Daycare?
2- Recent ATB tx? (Resistance?
3- How many AOM in the past? (Could refer to ORL PRN)
3- Onset? (Recently abrupt?)
4- Immunizations UTD?
5- Other health problems? (Immunodeficiency, chronic cardiac or pulm disease, head or neck abnormalities)
6- How high was fever at home? (If over 39, would be considered severe symptoms)
7- Does pain seem to interfere with sleep or normal activities? (Criterea for diagnosis)
8- Known allergies?

Question 2

Name 4 preventive measures for AOM:

Answer 2

1- Breastfeeding exclusively until 6mo age.
2- Smoke free
3- Nasal hygiene for child’s age
4- follow immunization schedule

Question 3

3 features that need to be present for AOM diagnosis.

Answer 3

1- Recent abrupt onset of signs and symptoms
2- Mucupurulent effusion in middle ear
3- Middle-ear inflammation

Question 4

Name 4 physical findings what would indicate mucopurulent effusion of middle ear.

Answer 4

1- Bulging of tympanic membrane
2- Tympanic membrane coloured or opaque
3- Otorrhea not d/t external otitis
4- Mobility of tympanic membrane absent or limited.

Question 5

Name 2 findings that would indicate middle-ear inflammation. (1 physical, 1 historical)

Answer 5

1- Marked erythema of tympanic membrane
2- Otalgia (evidence of pain in ear that interferes with normal activities or sleep)

Question 6

Name 3 complications of AOM:

Answer 6

1- Central nervous system change
2- Facial paralysis
3- Retroauricular swelling

Question 7

Name 3 red flags for AOM:

Answer 7

1- Infant under 3mo of age with fever 38
2- Suspicion of meningitis or mastoiditis
3- Toxicity or impairment of general condition

Question 8

Name signs of mastoiditis.

Answer 8

1- Postauricular tenderness, erythema, swelling, fluctuance or mass.
2- Protrusion of the auricle.

Question 9

Name signs of meningitis in children. (2)

Answer 9

1- Signs of meningeal inflammation (Nuchal rigidity/neck stiffness, altered mental status, headache, photophobia, N, V)
2- Bulging fontanel

Question 10

Name severe symptoms of AOM (3)
Only need to present 1 to be considered severe

Answer 10

1- moderate to severe otalgia x more than 48hrs.
2- Temps over 39C
3- Perforation of tympanic membrane

Question 11

Mild symptoms of AOM (3)
Need all three to be considered mild

Answer 11

1- Mild otalgia for less than 48hrs
2- Temp less than 39C
3- No perforation of tympanic membrane

Question 12

Treatment or observation fo ra 3-6 month old with severe or mild symptoms.

Answer 12

ATB treatment for both cases.
Amoxicillin 90mg/kg/day PO divided BID x 10 days.

Question 13

6 months and up with severe AOM symptoms. ATB tx or observe?

Answer 13

ATB treatment.
Amoxicillin 90mg/kg/day PO divided BID x 10 days.
(Max 2 000 mg PO BID)

Question 14

Mild AOM symptoms for 6 months and up, 2 options.
Define both options

Answer 14

1-Close observation if ATB can be started in 48hrs if symptoms persist or worsen. And parents collaborate.
2- ATB tx: Amoxicillin 90 mg/kg/day divided BID x 10 days if under 2 years old OR 5 to 7 days if older than 2 years old.

Question 15

When should parents come back after starting AOM Tx?

Answer 15

48 to 72 hours if no response.

Question 16

2nd line treatment of AOM (peds)

Answer 16

Amoxicillin-clavulanate 90mg/kg/day PO divided BID x 10 days.

Question 17

When to refer to ORL in the case of AOM? (3)

Answer 17

1- Resists 2nd line antibiotic treatment
2- More than 4 episodes in 6 months or 6 episodes per year
4- Perforation of tympanic membrane not resolved after 6 weeks.

Question 18

Name some of the physical exam for AOM (4)

Answer 18

1- Look inside ear canal for: erythema, coloration of tympanic membrane, bulging tympanic membrane.
2- Look outside of ear for otorrhea that would indicate perforation.
3- Look for stiff neck to r/o meningitis
4- Look for erythema or swelling retroauricular area.