NURS 629 Exam 3 | Real Exam Questions
and Answers | 100% Verified
Reason for OM -✓✓■ Eustachian tube is shorter. By the ages 7-12 the eustachian tube
resembles that of an adult
■ Adenoids can be enlarged. If the adenoid that is enlarged d/t smaller nasal canals &
respiratory tract, that can easily block the eustachian tube & not allow for drainage
Common bacterial causes for OM? -✓✓● S. pneumoniae: most common
● H. influenzae: child presents with conjunctivitis with OM, treat with Augmentin and
topical antibiotic for conjunctivitis
● M. catarrhalis
Symptoms of OM? -✓✓■ Fever, pain, discharge from the ear, tugging or batting at the
ear, irritability, crying, lethargy, decreased appetite, decreased sleep, recent URI
Clinical Signs of OM? -✓✓■ Red, bulging TM, retracted with pus, decreased
translucency of TM, no movement of the TM, inability to see normal landmarks,
occasionally: hole in the TM
Diagnosis of OM requirements? -✓✓■ History of acute onset
■ Identify presence of middle ear effusion: bulging TM, decreased or absent mobility of
TM, amber fluid or appearance of TM, otorrhea
■ Identify signs of middle ear inflammation: erythematous TM, otalgia (which interferes
with function/sleep)
Tx of OM? ages:
>6m
6m-2yrs
>2yrs -✓✓<6m: abx if certain or not
6-12m: abx if : fever >102, bilateral infection, severe otalgia, longer than 7 days
(observe if not severe)
>2 yrs: abx if severe ^ observe if not
Symptoms relief for OM? (non-abx) -✓✓● Acetaminophen or ibuprofen: mild to
moderate pain
● Benzocaine (Auralgan, Amerciaine otic): mild to moderate pain
● Warm compress
ABX tx for OM? -✓✓● Clinically defined treatment failure at 48-72 hours after initial
management with observation or at diagnosis for patients being initially with
antibacterial agents
ABX:
Amoxicillin 80-90 mg/kg/day BID for 10 days
,OR IF PCN ALLERGY:
Non-Type 1: Cefdinir, cefuroxime
Type 1: Azithromycin, clarithromycin
OR: SEVERE OM:
Augmentin (Amoxicillin-clavulanate) 80-90 mg/kg/day for 10 days or
PCN alg: Ceftriaxone 1 or 3 days
Signs of bacterial AOM? -✓✓• Bulging TM with decreased mobility, acute onset pain
and fever
when do you not 'watch and wait' on AOM? -✓✓o Kids younger than 6 months
o \Children 6 mo - 2 years with moderate to severe pain (concerned bc of speech
development during this time)
o 2 and older with high fever
o All children with comorbidities such as heart disease etc
How do you treat AOM in kid who has ear tubes? -✓✓Ofloxacin/cipro gtt
If pt develops rash after taking amox for ear infection what do you do? -✓✓stop and
start cephalosporin
What are the predisposing factors for otitis externa? -✓✓■ Frequent exposure to
moisture of the ear
■ Aggressive cleaning of the ear canal (do not use Q-tips because that can cause little
micro tears in the skin which can lead to inflammation and infection)
■ Local trauma to the ear
■ Allergies & skin conditions
■ Eczema
t/f otitis externa is typically bilateral? -✓✓F usually unilateral
symptoms of otitis externa? -✓✓■ Discharge from the ear (especially if the TM has
rupture), low grade fever, recent history of swimming or placing something in ear, pain
with movement of the tragus, redness around ear, decreased hearing
tx of otitis externa? -✓✓■ Topical antimicrobial for initial therapy of diffuse AOE should
be based upon efficacy, low incidence of adverse events, likelihood of adherence to
therapy, and cost.
■ Pain management: analgesic treatment based on the severity of pain
■ Therapeutic
● Warm compresses, NSAIDs/Tylenol, prednisone, auralgan, OTC benzocaine drops
and then wicking
, when should pt with otitis externa return if therapy has failed? -✓✓■ If the patient fails to
respond to the initial therapeutic option within 48-72 hours, the clinician should reassess
the patient to confirm the diagnosis of diffuse AOE and to exclude other causes of
illness
what are red flag symptoms of throat pain? -✓✓drooling, stridor, or trouble breathing
Do NOT examine
What type of rash is associated with strep? -✓✓sandpaper rash
what are common complications of pharyngitis? -✓✓peritonsillar abscesses, rheumatic
fever, post-streptococcal, glomerulonephritis
What are the common signs/symptoms of Group AB strep? -✓✓■ Symptoms: rapid
onset of sore throat, fever 103-104, swollen glands, children often complain of
abdominal pain, usually no URI symptoms, headache, decreased appetite, dysphagia,
irritability
■ Signs: exudate tonsils, anterior cervical lymphadenopathy, strawberry tongue, rash
Diagnostic for strep? -✓✓■ Throat culture: 24 hr is the gold standard, must swab both
tonsils for best results
■ Remember 50% of kids with mono also have strep
what is the common abx for strep? -✓✓■ Amoxicillin (50-80 mg/kg/day) x 10 days (PCN
allergy: cephalosporin or macrolide)
■ Warm water gargles
■ Tylenol/NSAIDs
What causes Mono? -✓✓Epstein-Barr virus
what is the classic mono triad? -✓✓: fever, exudative pharyngitis, adenopathy (posterior
cervical)
What is the incubation time of Mono>? -✓✓2-5 weeks
what are common symptoms of mono? -✓✓● Fever, severe sore throat, and
lymphadenopathy
● Less common symptoms
○ Rash that is erythematous, petechial, erythema multiform rash, periorbital edema
● Abnormal LFTs and enlarged spleen
● Typically lasts 3-4 weeks but can be longer (2-3 months)
Diagnostic tests of Mono? -✓✓● CBC with diff: lymphocytosis with atypical cells is
common
and Answers | 100% Verified
Reason for OM -✓✓■ Eustachian tube is shorter. By the ages 7-12 the eustachian tube
resembles that of an adult
■ Adenoids can be enlarged. If the adenoid that is enlarged d/t smaller nasal canals &
respiratory tract, that can easily block the eustachian tube & not allow for drainage
Common bacterial causes for OM? -✓✓● S. pneumoniae: most common
● H. influenzae: child presents with conjunctivitis with OM, treat with Augmentin and
topical antibiotic for conjunctivitis
● M. catarrhalis
Symptoms of OM? -✓✓■ Fever, pain, discharge from the ear, tugging or batting at the
ear, irritability, crying, lethargy, decreased appetite, decreased sleep, recent URI
Clinical Signs of OM? -✓✓■ Red, bulging TM, retracted with pus, decreased
translucency of TM, no movement of the TM, inability to see normal landmarks,
occasionally: hole in the TM
Diagnosis of OM requirements? -✓✓■ History of acute onset
■ Identify presence of middle ear effusion: bulging TM, decreased or absent mobility of
TM, amber fluid or appearance of TM, otorrhea
■ Identify signs of middle ear inflammation: erythematous TM, otalgia (which interferes
with function/sleep)
Tx of OM? ages:
>6m
6m-2yrs
>2yrs -✓✓<6m: abx if certain or not
6-12m: abx if : fever >102, bilateral infection, severe otalgia, longer than 7 days
(observe if not severe)
>2 yrs: abx if severe ^ observe if not
Symptoms relief for OM? (non-abx) -✓✓● Acetaminophen or ibuprofen: mild to
moderate pain
● Benzocaine (Auralgan, Amerciaine otic): mild to moderate pain
● Warm compress
ABX tx for OM? -✓✓● Clinically defined treatment failure at 48-72 hours after initial
management with observation or at diagnosis for patients being initially with
antibacterial agents
ABX:
Amoxicillin 80-90 mg/kg/day BID for 10 days
,OR IF PCN ALLERGY:
Non-Type 1: Cefdinir, cefuroxime
Type 1: Azithromycin, clarithromycin
OR: SEVERE OM:
Augmentin (Amoxicillin-clavulanate) 80-90 mg/kg/day for 10 days or
PCN alg: Ceftriaxone 1 or 3 days
Signs of bacterial AOM? -✓✓• Bulging TM with decreased mobility, acute onset pain
and fever
when do you not 'watch and wait' on AOM? -✓✓o Kids younger than 6 months
o \Children 6 mo - 2 years with moderate to severe pain (concerned bc of speech
development during this time)
o 2 and older with high fever
o All children with comorbidities such as heart disease etc
How do you treat AOM in kid who has ear tubes? -✓✓Ofloxacin/cipro gtt
If pt develops rash after taking amox for ear infection what do you do? -✓✓stop and
start cephalosporin
What are the predisposing factors for otitis externa? -✓✓■ Frequent exposure to
moisture of the ear
■ Aggressive cleaning of the ear canal (do not use Q-tips because that can cause little
micro tears in the skin which can lead to inflammation and infection)
■ Local trauma to the ear
■ Allergies & skin conditions
■ Eczema
t/f otitis externa is typically bilateral? -✓✓F usually unilateral
symptoms of otitis externa? -✓✓■ Discharge from the ear (especially if the TM has
rupture), low grade fever, recent history of swimming or placing something in ear, pain
with movement of the tragus, redness around ear, decreased hearing
tx of otitis externa? -✓✓■ Topical antimicrobial for initial therapy of diffuse AOE should
be based upon efficacy, low incidence of adverse events, likelihood of adherence to
therapy, and cost.
■ Pain management: analgesic treatment based on the severity of pain
■ Therapeutic
● Warm compresses, NSAIDs/Tylenol, prednisone, auralgan, OTC benzocaine drops
and then wicking
, when should pt with otitis externa return if therapy has failed? -✓✓■ If the patient fails to
respond to the initial therapeutic option within 48-72 hours, the clinician should reassess
the patient to confirm the diagnosis of diffuse AOE and to exclude other causes of
illness
what are red flag symptoms of throat pain? -✓✓drooling, stridor, or trouble breathing
Do NOT examine
What type of rash is associated with strep? -✓✓sandpaper rash
what are common complications of pharyngitis? -✓✓peritonsillar abscesses, rheumatic
fever, post-streptococcal, glomerulonephritis
What are the common signs/symptoms of Group AB strep? -✓✓■ Symptoms: rapid
onset of sore throat, fever 103-104, swollen glands, children often complain of
abdominal pain, usually no URI symptoms, headache, decreased appetite, dysphagia,
irritability
■ Signs: exudate tonsils, anterior cervical lymphadenopathy, strawberry tongue, rash
Diagnostic for strep? -✓✓■ Throat culture: 24 hr is the gold standard, must swab both
tonsils for best results
■ Remember 50% of kids with mono also have strep
what is the common abx for strep? -✓✓■ Amoxicillin (50-80 mg/kg/day) x 10 days (PCN
allergy: cephalosporin or macrolide)
■ Warm water gargles
■ Tylenol/NSAIDs
What causes Mono? -✓✓Epstein-Barr virus
what is the classic mono triad? -✓✓: fever, exudative pharyngitis, adenopathy (posterior
cervical)
What is the incubation time of Mono>? -✓✓2-5 weeks
what are common symptoms of mono? -✓✓● Fever, severe sore throat, and
lymphadenopathy
● Less common symptoms
○ Rash that is erythematous, petechial, erythema multiform rash, periorbital edema
● Abnormal LFTs and enlarged spleen
● Typically lasts 3-4 weeks but can be longer (2-3 months)
Diagnostic tests of Mono? -✓✓● CBC with diff: lymphocytosis with atypical cells is
common
