Peds 14 Flashcards
What is the typical expected speech/language development of an 18 month old?
- Identify 2 body parts
- Name 5 familiar objects
Rebecca is a fully immunized 18-month-old girl with acute onset of fever and ear tugging following three days of URI symptoms who has a history of language delay, past otitis media, daycare, and smoke exposure. Physical exam is pertinent for TMs that are white/red, poorly mobile, bulging, and opaque. What is your top differential? How would you treat this?
- Bilateral AOM
- Amoxicillin 80-90mg/kg/day
Which two pathogens are the most prevalent causes of AOM?
Haemophilus influenzae, nontypeable
Streptococcus pneumoniae
If a child has language delays, hx of multiple AOMs, and chronic middle ear effusions, what would appropriate next steps to take?
- Assess her language development
- Order a hearing assessment
An 18-month-old girl presents to the clinic with nasal congestion and fever for three days. She is previously healthy. She is receiving acetaminophen for fever. Temperature is 101.2 F (38.4 C), pulse is 100 beats/minute, respirations are 24 breaths per minute. Oxygen saturations are 98% on room air. She is alert and well perfused with clear mucus coming from both nostrils and no increased work of breathing. Both turbinates show erythema. Her oropharynx is erythematous. No crackles or wheezing are heard. Her immunizations are up to date. Which of the following infectious organisms is most likely cause of this patient’s presentation?
A. Group A Strep B. Haemophilus Influenzae type B C. Pertussis D. Rhinovirus E. Strep pneumoniae
D. Rhinovirus
Rhinovirus causes the common cold and is the most reasonable diagnosis for this patient. Rhinovirus is a very common cause of congestion and other cold-like symptoms. She presents with slightly elevated temperature, slight tachypnea, and inflamed turbinates, and oral mucosa. Her symptoms all correlate with the common cold.
A 14-month-old female presents to the clinic with a fever of 39.2 C and irritability. According to mom, the patient was initially sick one week ago with a runny nose and cough, but these symptoms had resolved. She started pulling at her ear and becoming increasingly irritable last night. She has had several prior ear infections and was most recently treated one month ago with amoxicillin. She is up to date on immunizations. Physical examination reveals a red, opaque, bulging tympanic membrane with bubbles and limited mobility of her left ear. The exam of the right ear is normal. Which of the following is the next step in the management of this patient?
A. Amoxicillin/clavulanate B. Decongestants C. High-dose amoxicillin D. Observation E. Tympanocentesis
A. Amoxicillin/clavulanate
An 18-month-old girl is brought to her pediatrician by her mother who notes that she has been fussy for the past three days and has been pulling on her ears. The child is up to date with her vaccines. Her temperature is 39 C (102.2 F). Otoscopic exam of her left ear shows a yellow, opaque, and bulging tympanic membrane. Which of the following organisms is the most likely cause of the child’s condition?
A. Candida albicans B. Haemophilus influenzae C. Moraxella catarrhalis D. Rhinovirus E. Streptococcus pyogenes
B. Haemophilus influenzae
H. influenzae is the most frequent cause of AOM (50-60%% of cases). Although the child has been vaccinated against H. influenzae type B, this does not cover the unencapsulated strains of H. influenzae that cause AOM.
An 18-month-old presents with yellow and poorly mobile tympanic membranes. Four months prior he presented then with several days of nasal congestion, cough, decreased eating, and ear tugging. His exam then revealed a red, nonmobile tympanic membrane and he was treated with amoxicillin. Based on the history and physical exam, what is the most likely diagnosis now?
A. Acute otitis media B. Mastoiditis C. Otitis externa D. Otitis media with effusion E. Viral encephalitis
D. Otitis media with effusion
An 8-year-old girl comes to the clinic with two weeks of nasal congestion. Three days ago, she developed a fever of 38.7°C, purulent nasal secretions, malodorous breath, and a nocturnal cough. Examination of the nose reveals bilateral purulent nasal drainage and mild facial tenderness. Which of the following is the most likely diagnosis?
A. Allergic rhinitis B. Asthma C. URI D. Sinusitis E. Middle ear infection
D. Sinusitis
The maxillary and ethmoid sinuses are large enough to harbor infection in infancy. The sphenoid sinuses do not become large enough until the third to fifth year of life, and the frontal sinuses are rarely large enough until the sixth to tenth year of life. Sinusitis is characterized by the findings in the question stem and is often preceded by a URI.
How would you diagnose a tympanic membrane that is amber, non- or poorly mobile, opaque and retracted?
Otitis media effusion
