OAT HEENT Patient

Question 1

Chapman’s points associated with otitis media

Answer 1

Anterior: superior aspect of clavicle just lateral to 1st rib

Posterior: lateral edge of C1 posteriorly

Question 2

Chapman’s points associated with sinusitis

Answer 2

Anterior: 3.5 inches lateral to sternum on the superior aspect of 2nd rib

Posterior: midway b/w articular pillar and the spinous process of C2

Question 3

Chapman’s points associated with pharyngitis

Answer 3

Anterior: first rib 3/4 of an inch laterally from the sternum, where clavicle crosses rib

Posterior: midway between the articular pillar and the spinous process of C2

Question 4

Chapman’s points associated with nasal complaints

Answer 4

Anterior: 1st costochondral junction

Posterior: working backwards from the angle of the jaw and one finds tenderness on anterior part of C1

Question 5

Chapman’s points associated with sinuses

Answer 5

Anterior: inferomedial clavicle, lateral to SC junction (nasal sinuses); superior second rib at midclavicular line (all sinuses)

Posterior: mastoid process

Question 6

Chapman’s points associated with tonsils

Answer 6

Anterior: lateral manubrium

Question 7

Chapman’s points associated with middle ear

Answer 7

Anterior: superior clavicle, and 2-3cm lateral to SC junction

Posterior: base of occiput at OA joint

Question 8

Cranial considerations associated with acute otitis media

Answer 8

Dural tension around internal auditory meatus

Tension around jugular foramen — relieve Vagus and decrease N/V

The ear structures are provided sensory innervation by CNs V, VII, IX, and X, and by the cervical nerves 2 and 3. Although there is no role for CN VIII in carrying pain fibers, sensation mediated by this nerve can be felt by the pt as a “fullness” in the ear

Question 9

Drugs of choice when abx are indicated for OM

Answer 9

Amoxicillin (or)
Amoxicillin-clavulanate (or)
Ceftriaxone

Given for 10 days if severe or <2y/o, given for 7 days if age 2-5 w/ mild to moderate sx, 5-7 days for >6y/o w/ mild to moderate sx

Question 10

When is abx therapy recommended strongly in pts with OM?

Answer 10

Moderate or severe otalgia

Otalgia for >48 hrs

Temp >39 degrees C (102.2 F)

Age <24 months and bilateral AOM

[Either abx therapy OR observation with close f/u recommended for: Children aged 6-23 months w/ unilateral AOM without severe signs/sx; children >24 mo old with u/l or b/l AOM without severe signs/sx]