Otitis media Pharyngitis Tonsillectomy Upper Airway Illnesses

Question 1

Acute Otitis Media vs. Otitis Media with Effusion

Answer 1

Acute Otitis Media= structures in inner ear infected

Otitis Media with Effusion= collection of fluid in the middle ear but NO INFECTION

Question 2

what role does Eustachian tube play in otitis media?

Answer 2

• majority of infections are related to eustachian tube
◦ Eustachian tube – shorter and more horizontal in child = at greater risk for middle ear infections
‣ adult is longer and more vertical

Question 3

will otitis media infections clear up on their own or require meds?

Answer 3

clear up on their own

Question 4

when are ear infections most common?

Answer 4

◦ Common first 24 months of life and entering school

◦ infrequent after age 7

Question 5

triggers for otitis media?

Answer 5

◦ Bacterial infection
◦ Viral infection
◦ Allergies/ enlarged adenoids

Question 6

things that can affect frequency of occurrence of otitis media (4)

Answer 6

◦ Less in breastfed infants
◦ Higher in winter and spring
◦ Higher in daycare
◦ Higher in exposure to second-hand smoke

Question 7

admin in ear <3 vs >3

Answer 7

◦ Children < 3, auricle should be pulled down and back to open the ear canal

◦ Children > 3, auricle should be pulled up and back to open the ear canal

Question 8

when do we give ABX for otitis media

Answer 8

◦ if very severe case of otitis media ( fever >102 >2 days OR bilateral ears <2 years) do ABX

Question 9

how should parents bottlefeed to prevent otitis media

Answer 9

Feed in an upright position- not horizontally

Question 10

what vaccination do we need to keep up to date related to otitis media?

Answer 10

HIB / all of them

Question 11

what does this word mean and what does it have to do with ear aches : Myringotomy

Answer 11

create a hole in the eardrum

- place tubes in the ears to Equalize pressure and minimize effusion

Question 12

education related to myringotomy and placement of tympanoplasty

Answer 12

• outpatient/ tubes come out on their own

* teach them to avoid getting water in ear

Question 13

is Myringotomy and placement of tympanoplasty tubes for ostitis media with effusion or acute otitis media?

Answer 13

otitis media with effusion

Question 14

what will tympanic membrane look like with acute otitis media vs otitis media with effusion

Answer 14

AOM = Bulging yellow or red tympanic membrane

Otitis Media with Effusion (OME)= Orange discoloration of tympanic membrane and decreased movement

Question 15

acute ear pain =

Answer 15

otalgia

Question 16

Purulent drainage and Lymphadenopathy AOM or OME?

Answer 16

AOM

Question 17

risks with chronic ear infections?

Answer 17

= hearing issues = speech delays

Question 18

ringing in ears =

Answer 18

tinnitus

Question 19

otisis externa

Answer 19

= Swimmers ear/trauma

Question 20

s/s of Swimmers ear/trauma (otitis externa)

Answer 20

• pain when move earlobe

* redness and swelling in outer canal

Question 21

s/s of AOM

Answer 21

• Fever, crying, irritability, loss of appetite, nausea 
- Otalgia
- yellow/red tympanic membrane 
Purulent drainage
• Lymphadenopathy

Question 22

what causes Streptococcal pharyngitis

Answer 22

• Group A beta hemolytic strep

Question 23

onset of Streptococcal pharyngitis

Answer 23

abrupt

Question 24

s/s of Streptococcal pharyngitis

Answer 24

• Pharyngitis, headache, fever, abdominal pain, anorexia, nausea, diarrhea, pain with swallowing
• Tonsils red and white patches and pharynx inflamed, white exudate (2nd day of illness)

Question 25

how do we test for Streptococcal pharyngitis

Answer 25

• Throat culture, rapid antigen testing

Question 26

treatment for Streptococcal pharyngitis

Answer 26

• Antibiotics, Antipyretics

penicillin preferred

Question 27

when can kid return to school after strep throat?

Answer 27

◦ isolate child until complete full 24 hour of ABX and fever free –> return to school

Question 28

what should parents do at home to prevent reinfection after strep throat?

Answer 28

clean toothbrush

Question 29

what kind of compress can help with strep throat for comfort?

Answer 29

warm or cool - kid choice

Question 30

examples of how to provide atraumatic care prior to tonsillectomy?

Answer 30

tell them you will use a flashlight to look at throat, voice may sound funny right after surgery, may put collar with ice on neck afterwards, doll, let them see scrubs and masks, let them know they will have medicine to help if hurting

Question 31

things to avoid post op tonscillectomy?

Answer 31

• brown/red liquids
• citrus/acidic
• dairy
• straws / objects in mouth

Question 32

when can give clear liquids to child after tonsillectomy?

Answer 32

after return of gag reflex

Question 33

3 hemorrhage indications for tonsillectomy?

Answer 33

◦ Frequent swallowing
◦ Frequent clearing of throat
◦ Bright red blood

Question 34

is rheumatic fever systemic or local? what causes it?

Answer 34

◦ Systemic inflammatory disease

◦ Develops after a streptococcus bacterial infection

Question 35

how quickly will rheumatic fever develop after strep infection?

Answer 35

2-6 weeks

Question 36

questions to ask when suspect rheumatic fever?

Answer 36

• Has child had a sore throat recently? anyone in family?

Question 37

4 systems rheumatic fever affects?

Answer 37

heart, joints, skin, brain

◦ Damages the heart valves – assess for tachycardia and murmur
◦ Joint pain
◦ Erythematous rash

Question 38

how do we test for rheumatic fever?

Answer 38

• No specific test for rheumatic fever, have to rest for strep
◦ ASO, anti-streptolysin O, titer

Question 39

what is ASO ( anti-streptolysin O) titer test for?

Answer 39

tells if you had strep throat recently –> rheumatic fever