In each blank, try to type in the
word that is missing. If you've
typed in the correct word, the
blank will turn green.
If your not sure what answer should be entered, press the space bar and the next missing letter will be displayed. When you are all done, you should look back over all your answers and review the ones in red. These ones in red are the ones which you needed help on. Question: OM clinical Answer: Pain, , fever, irritability, URI signs & symptoms, night awakenings Question: OM exam Answer: Full/ bulging tympanic membrane, decreased or mobility on insufflation, opaque tympanic membrane, otorrhea, (erythema of TM is not diagnostic) Question: Laboratory Findings of Answer: Tympanocentesis of fluid id of causative organisms indicated 1) fail abx tx , suspected or confirmed complication, OM in neonate, sick neonate, immulogically pt, Question: organismsAnswer: Strep pneumonia (40-50%), H flu (40%), catarrhalis, ALSO Group A Beta hemolytic strep, Staph aureus, anerobic bacteria, viruses Question: Reason for reduction in incidence o Answer: HIB , & prevnair (pneumococcal) vaccine Question: RX for OM Answer: therapy
Amoxicillin 80-90mg/kg/day
Augmentin 40mg/kg/day
Cephlasporins
Ceftin
Omnicef
Cefzil
Zithromax
Biaxcin
Question: Management of Answer: not improved in 48-72 reevaluate, if no other pathology found, cover Beta Lactamase organism (augmentin)
Supportive: antipyretics and analgesics Auralgan and Otocain topical pain meeds reevaluated after 3-4 weeks with an acute otitis media
Question: OM with / serous otitiusAnswer: Defined as a chronic bacterial infection persisting more than 2 weeks
Terms used synonymously
Secretory otitis
Serous purulent otitis
Question: OM with Answer: Clinical findings
Usually asymptomatic
Physical findings
Opaque TM
Translucent with bluish effusion
Retracted TM with decreased fluid levels or bubbles
Laboratory
Hearing loss is frequently present
Tapanogram – flat
Mostly tempory
Question: Causative of OM with effusion Answer: Thirty-Fifty percent of effusions will grow pathogens (generally don’t cx)
H. influenza
B. catarrahalis
S. pneumoniae
S. epidermidis
Question: Management of OM with Answer: Majority will clear spontaneously within 2 months
Treatment if complications associated with chronic middle ear effusions- if kid already has hearing speech delay
Investigate underlying etiology
Sinusitis
Allergy
Immune cleft pa Question: of OM with effusion Answer: -watch & wait: reexamine 3 mth, at 6. Nonsurgical- abx = acute OM. Surgical: myringotomy with aspiration of fluid, PE tubes. Question: of Recurrent Acute Otitis MediaAnswer: acute episodes interspaced by periods of complete resolution- these are kids that need PE tubes
Question: for Recurrent AOM (7)Answer: First episode at age less than 6 in home
Patient is male
Formula fed
Day care attendance
Cigarette smoke in home
Cold weather months of the year
Question: Rx for recurrent Answer: Antibiotic prophylaxis
Single dose
3 weeks-3 months
Minimizing risk factors
Immunizations status
Prevnar
Myringotomy/Tympanostomy Tubes
Adenoidectomy
Question: When to refer AOMAnswer: Referral means surgery
4-5 episodes of acute OM in a season
Refractory disease
Mastoiditis
Speech/language loss
Question: ExernaAnswer: ear. Etiology: common in summer
Water causes breakdown of protective lining, bacteria multiply Acute= localized. Chronic = Secondary infection from tympanic cavity discharge, multiple pathogens
Malignant = Occurs in immunocompromised patients
Question: manifestations of Otitis ExternaAnswer: >2 years of age
Swelling of ear canal
Erythema and purulent exudate
Mild to severe otalgia, especially with movement of the pinna
Can be with concomitant acute otitis media, hearing loss, ear fullness, pressure, pruritis, and severe deep pa Question: Causative pathogens of ostitis Answer: Pseudomonas (60%)
Staph aureus (10%)
Other pathogens (30%)
Group A strep
Enterobacteriaceae
Proteus
Question: & tx of otitis externa Answer: Topical antibiotics
Cortisporin suspension
Fluoroquinolones
Ciprofloxacin
Ofloxacin
Fluoroquinolones with Question: of OE Answer: Solutions of half alcohol and vinegar instilled into ear after swimming
Molded ear for PE tubes
Referral
Draining ear that persists for greater than 2 weeks with treatment
Question: CholesteotomaAnswer: Cholesteotoma: Destructive and expanding keratinizing squamous epithelium in the middle ear and/or mastoid process
Untreated can eat into the malleus, incus and stapes, which can result in nerve deterioration, deafness, imbalance and
Question: Complications of OM & Answer: Cholesteotoma, hearing loss, speech delay, mastoiditis, perforation, |
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