PAEA PEDIATRICS EOR EXAM 2023-2024 ACTUAL
EXAM 313 QUESTIONS AND CORRECT DETAILED
ANSWERS WITH RATIONALES (VERIFIED ANSWERS)
|ALREADY GRADED A+
how can strabismus be treated? - ANSWER--patch therapy: normal eye is
covered to stimulate and strengthen the affected eye
-eyeglasses
-corrective therapy: if severe or unresponsive to conservative therapy
if not treated before 2 y/o, amblyopia may occur and cause decreased
visual acuity that is not correctable
Dx? 1-2 days of ear pain, pruritis in the ear canal, auricular discharge,
pressure/fullness, hearing usually preserved, pain with tug test and tragus
pressure, auditory canal erythema/edema/debris, recent swimming pool
use; MC organisms? Tx? - ANSWER-Dx: otitis externa
MC organisms: *pseudomonas*, proteus, s. aureus, s. epidermis, GABHS,
anaerobes (peptostreptococcus), aspergillus
Tx: 1. protect ear against moisture (isopropyl alcohol and acetic acid) 2.
ciprofloxacin/dexamethasone (ofloxacin safe if there is an associated TM
perf) 3. Aminoglycoside combo (neomycin/polytrim-B/hydrocortisone -BUT
not used if perf suspected bc ototoxic 4. amphotericin B if fungal
malignant otitis externa is osteomyelitis at the skull base secondary to
___________ infxn; MC seen in what pt populations; Tx? - ANSWER-
pseudomonas; MC in DM and immunocompromised pts; Tx w/ IV
Ceftazidime or Piperacillin + FQ or Aminoglycoside
acute otitis media is an infection of the middle ear, temporal bone and
mastoid air cells that is MC preceded by - ANSWER-a viral URI that causes
, PAEA PEDIATRICS EOR EXAM 2023-2024 ACTUAL
EXAM 313 QUESTIONS AND CORRECT DETAILED
ANSWERS WITH RATIONALES (VERIFIED ANSWERS)
|ALREADY GRADED A+
edema of eustachian tube, negative pressure, transudation of fluid and
mucus in middle ear that allows for bacterial growth
what are the 4 MC organisms seen in acute otitis media? - ANSWER-
*Strep pneumo*, H. influenza, Moraxella catarrhalis, Strep pyogenes (same
as seen in acute sinusitis)
Dx: fever, otalgia, ear tugging in infants, conductive hearing loss, stuffiness,
possible drainage from ear, bulging/erythematous TM w/ effusion, dec TM
mobility on pneumatic otoscopy; Tx? - ANSWER-dx: acute otitis media
tx: 1st line- amoxicillin, 2nd line- augmentin (amoxicillin-clavulate); if PCN
allergy- azithromycin, clarithromycin, erythromycin-sulfisoxazole,
trimethoprim/sulfamethoxazole, if PCN adverse effect but not allergy-
ceftriaxone, cefdinir, cefixine
don't forget to treat pain as well (ibuprofen or tylenol); can also perform
myringotomy (surgical drainage) to relieve pain
tympanostomy if recurrent >4 times in 1 yr
if bullae are seen on the TM of a pt with AOM what should you suspect? -
ANSWER-mycoplasma pneumoniae
Dx? deep ear pain (worse at night), fever, mastoid tenderness and possibly
fluctuance (abscess), following AOM infxn; complications? - ANSWER--dx:
mastoiditis (inflammation of the mastoid air cells of the temporal bone-
mastoid and middle ear are connected)
-complications: hearing loss, labyrinthitis, vertigo, CN VII paralysis, brain
abscess
, PAEA PEDIATRICS EOR EXAM 2023-2024 ACTUAL
EXAM 313 QUESTIONS AND CORRECT DETAILED
ANSWERS WITH RATIONALES (VERIFIED ANSWERS)
|ALREADY GRADED A+
how is mastoiditis diagnosed and treated? - ANSWER-dx: by CT scan is
1st line test
tx: IV abx (same as w/ AOM- amoxicillin 1st line, augmentin 2nd line,
azithromycin for allergy to PCN, ceftriaxone for ADR to PCN) + middle
ear/mastoid drainage (myringotomy +/- tympanostomy tube placement- can
obtain Cx)
if mastoiditis refractory to tx or complicated = mastoidectomy
what are the 2 auditory examination tests (and what order do you perform
them in)? - ANSWER-1st Weber (tuning fork placed on top of head)
2nd Rinne (tuning fork placed on mastoid bone by ear)
if a child has conductive hearing loss in their L ear what will the Weber and
Rinne tests show? - ANSWER-Weber: lateralizes to L ear
Rinne: BC > AC
if a child has sensorineural hearing loss in the R ear what will the Weber
and Rinne tests show? - ANSWER-Weber: lateralizes to L ear (the normal
one)
Rinne: AC > BC (shows normal L ear)
what are the causes of conductive vs sensorineural hearing loss? -
ANSWER-conductive: *cerumen impaction* MC, damage to ossicles
(otosclerosis, cholesteatoma), mastoiditis, otitis media
, PAEA PEDIATRICS EOR EXAM 2023-2024 ACTUAL
EXAM 313 QUESTIONS AND CORRECT DETAILED
ANSWERS WITH RATIONALES (VERIFIED ANSWERS)
|ALREADY GRADED A+
sensorineural: *presbyacusis* MC (age-related hearing loss), chronic loud
noise exposure, CNS lesions (acoustic neuroma), labyrinthitis, meniere
syndrome
how is cerumen impaction treated? - ANSWER-1. cerumen softening:
hydrogen peroxide 3% or carbamide peroxide (Debrox)
2. aural toilet: irrigation (as long as no TM perf- H2O must be at body temp
to prevent vertigo), curette removal, suction
Dx? acute ear pain, hearing loss, break in the tympanic membrane, +/-
conductive hearing loss, +/- bloody otorrhea, +/- tinnitus & vertigo; Tx? -
ANSWER-dx: tympanic membrane perforation
tx: observation (most heal spontaneously) but can do surgical repair; avoid
water/moisture/topical aminoglycoside (ototoxic) in ear
Dx: sneezing, nasal congestion/itching, clear rhinorrhea, worse in the
morning, pale/blue turbinates, +/- nasal polyps, +/- eye, ear, throat
involvement; Tx? - ANSWER-dx: allergic rhinitis
tx: 1st line intranasal steroids, oral antihistamines, mast cell stabilizers
(cromolyn, nedocromil)
what are the blood vessels involved in anterior vs posterior epistaxis?
which is MC involved? - ANSWER-anterior: Kiesselbach's plexus *MC type
of epistaxis*
posterior: palatine artery- this one may cause bleeding in both nares and
posterior pharynx
EXAM 313 QUESTIONS AND CORRECT DETAILED
ANSWERS WITH RATIONALES (VERIFIED ANSWERS)
|ALREADY GRADED A+
how can strabismus be treated? - ANSWER--patch therapy: normal eye is
covered to stimulate and strengthen the affected eye
-eyeglasses
-corrective therapy: if severe or unresponsive to conservative therapy
if not treated before 2 y/o, amblyopia may occur and cause decreased
visual acuity that is not correctable
Dx? 1-2 days of ear pain, pruritis in the ear canal, auricular discharge,
pressure/fullness, hearing usually preserved, pain with tug test and tragus
pressure, auditory canal erythema/edema/debris, recent swimming pool
use; MC organisms? Tx? - ANSWER-Dx: otitis externa
MC organisms: *pseudomonas*, proteus, s. aureus, s. epidermis, GABHS,
anaerobes (peptostreptococcus), aspergillus
Tx: 1. protect ear against moisture (isopropyl alcohol and acetic acid) 2.
ciprofloxacin/dexamethasone (ofloxacin safe if there is an associated TM
perf) 3. Aminoglycoside combo (neomycin/polytrim-B/hydrocortisone -BUT
not used if perf suspected bc ototoxic 4. amphotericin B if fungal
malignant otitis externa is osteomyelitis at the skull base secondary to
___________ infxn; MC seen in what pt populations; Tx? - ANSWER-
pseudomonas; MC in DM and immunocompromised pts; Tx w/ IV
Ceftazidime or Piperacillin + FQ or Aminoglycoside
acute otitis media is an infection of the middle ear, temporal bone and
mastoid air cells that is MC preceded by - ANSWER-a viral URI that causes
, PAEA PEDIATRICS EOR EXAM 2023-2024 ACTUAL
EXAM 313 QUESTIONS AND CORRECT DETAILED
ANSWERS WITH RATIONALES (VERIFIED ANSWERS)
|ALREADY GRADED A+
edema of eustachian tube, negative pressure, transudation of fluid and
mucus in middle ear that allows for bacterial growth
what are the 4 MC organisms seen in acute otitis media? - ANSWER-
*Strep pneumo*, H. influenza, Moraxella catarrhalis, Strep pyogenes (same
as seen in acute sinusitis)
Dx: fever, otalgia, ear tugging in infants, conductive hearing loss, stuffiness,
possible drainage from ear, bulging/erythematous TM w/ effusion, dec TM
mobility on pneumatic otoscopy; Tx? - ANSWER-dx: acute otitis media
tx: 1st line- amoxicillin, 2nd line- augmentin (amoxicillin-clavulate); if PCN
allergy- azithromycin, clarithromycin, erythromycin-sulfisoxazole,
trimethoprim/sulfamethoxazole, if PCN adverse effect but not allergy-
ceftriaxone, cefdinir, cefixine
don't forget to treat pain as well (ibuprofen or tylenol); can also perform
myringotomy (surgical drainage) to relieve pain
tympanostomy if recurrent >4 times in 1 yr
if bullae are seen on the TM of a pt with AOM what should you suspect? -
ANSWER-mycoplasma pneumoniae
Dx? deep ear pain (worse at night), fever, mastoid tenderness and possibly
fluctuance (abscess), following AOM infxn; complications? - ANSWER--dx:
mastoiditis (inflammation of the mastoid air cells of the temporal bone-
mastoid and middle ear are connected)
-complications: hearing loss, labyrinthitis, vertigo, CN VII paralysis, brain
abscess
, PAEA PEDIATRICS EOR EXAM 2023-2024 ACTUAL
EXAM 313 QUESTIONS AND CORRECT DETAILED
ANSWERS WITH RATIONALES (VERIFIED ANSWERS)
|ALREADY GRADED A+
how is mastoiditis diagnosed and treated? - ANSWER-dx: by CT scan is
1st line test
tx: IV abx (same as w/ AOM- amoxicillin 1st line, augmentin 2nd line,
azithromycin for allergy to PCN, ceftriaxone for ADR to PCN) + middle
ear/mastoid drainage (myringotomy +/- tympanostomy tube placement- can
obtain Cx)
if mastoiditis refractory to tx or complicated = mastoidectomy
what are the 2 auditory examination tests (and what order do you perform
them in)? - ANSWER-1st Weber (tuning fork placed on top of head)
2nd Rinne (tuning fork placed on mastoid bone by ear)
if a child has conductive hearing loss in their L ear what will the Weber and
Rinne tests show? - ANSWER-Weber: lateralizes to L ear
Rinne: BC > AC
if a child has sensorineural hearing loss in the R ear what will the Weber
and Rinne tests show? - ANSWER-Weber: lateralizes to L ear (the normal
one)
Rinne: AC > BC (shows normal L ear)
what are the causes of conductive vs sensorineural hearing loss? -
ANSWER-conductive: *cerumen impaction* MC, damage to ossicles
(otosclerosis, cholesteatoma), mastoiditis, otitis media
, PAEA PEDIATRICS EOR EXAM 2023-2024 ACTUAL
EXAM 313 QUESTIONS AND CORRECT DETAILED
ANSWERS WITH RATIONALES (VERIFIED ANSWERS)
|ALREADY GRADED A+
sensorineural: *presbyacusis* MC (age-related hearing loss), chronic loud
noise exposure, CNS lesions (acoustic neuroma), labyrinthitis, meniere
syndrome
how is cerumen impaction treated? - ANSWER-1. cerumen softening:
hydrogen peroxide 3% or carbamide peroxide (Debrox)
2. aural toilet: irrigation (as long as no TM perf- H2O must be at body temp
to prevent vertigo), curette removal, suction
Dx? acute ear pain, hearing loss, break in the tympanic membrane, +/-
conductive hearing loss, +/- bloody otorrhea, +/- tinnitus & vertigo; Tx? -
ANSWER-dx: tympanic membrane perforation
tx: observation (most heal spontaneously) but can do surgical repair; avoid
water/moisture/topical aminoglycoside (ototoxic) in ear
Dx: sneezing, nasal congestion/itching, clear rhinorrhea, worse in the
morning, pale/blue turbinates, +/- nasal polyps, +/- eye, ear, throat
involvement; Tx? - ANSWER-dx: allergic rhinitis
tx: 1st line intranasal steroids, oral antihistamines, mast cell stabilizers
(cromolyn, nedocromil)
what are the blood vessels involved in anterior vs posterior epistaxis?
which is MC involved? - ANSWER-anterior: Kiesselbach's plexus *MC type
of epistaxis*
posterior: palatine artery- this one may cause bleeding in both nares and
posterior pharynx
