CMN 568 FINAL QUESTIONS And Answers
Verified 100% Correct
Normal Otoscope View - ANSWER Malleus, Umbo, Cone of light
Cone of light at 7 o'clock in left and 5 o'clock on right
Cone of light disappears when there is fluid
Otitis Externa - ANSWER Cellulitis of the soft tissues of the external
auditory canal
Hallmark - tragus pain (doesn't hurt with middle ear infection)
Pathogens: Otitis Externa - ANSWER Pseudomonas aeruginosa
Staphylococcus aureus
Aspergillis or other fungi (esp. Diabetes)
Risk factors for Otitis External - ANSWER Moisture in ear from
swimming, showering, ect.
Trauma to the external ear canal form q-tips, ear plugs, hearing
aids, scratching
Keeping ears too clean removes protective cerumen and
increases pH with promotes bacterial growth
Otitis External: signs and symptoms - ANSWER Edema and erythema of
the external canal, may be swollen shut.
Sever ear pain, made worse by movement of the pinna or tragus Purulent
discharge from the external canal, canal may be filled wih debris, making
visualization of the TM difficult or impossible
May have periauricular or cervical lymphadenopathy
Otitis externa: differential diagnosis - ANSWER AOM with TM
rupture or patent PE tubes
Furunculosis(pimple/boil) of the ear canal, mastoidisis
,Otitis Externa: Treatment - ANSWER Careful exam to see if the TM is
intact, if you cannot see TM you MUST assume perforation and manage
accordingly.
Gentle removal of debris from canal if possible. If TM is intact, gently
irrigate with NS and bulb syringe. DO NOT irrigate if TM not visualized. Use
warm water, not cold (will cause vestibular response). Do not use "water
pik"
Pain control: Tylenol or ibuprofen for mild pain, ma need narcotic analgesic
for severe pain.
Otitis externa: Antibiotics - ANSWER Topical eardrops are recommended
unless there are signs of systemic symptoms
Fluoroquinolone drops are first line- 4gtt BID x7d
Neomycin/Polymyxin B/Hydrocortisone - 3-4gtt QID for 7-10d (Do not use if
TM is perforated or PE tubes in place!)
Ear Wick use - ANSWER If canal is swolled, insert a pope ear
wick to allow antibiotic drops to get deep into the caancal
Insert dry wick, then moisten with ear drops to expand
Wick will fall out when swelling decreases
Otitis Externa - Prevention - ANSWER avoid vigorous ear cleaning
Avoid using q-Tips
Use drying agents after swimming - 2-3 gtt of 1:1 vinegar:alcohol or
commercial ear drops
Acute Otitis Media (AOM) - ANSWER Acute infection of the
middle ear space with inflammation and effusion
AOM Diagnosis - ANSWER 2 things MUST be present: A bulging
TM and Middle ear effusion as demonstrated by pneumatic
otoscopy or tympanometry
AOM Pathogens - ANSWER Streptococcus pneumoniae Haemophilus
influenzae
Moraxella catarrhalis
,Streptococcus pyogenes
AOM Risk factors #1 - ANSWER Eustachian tube dysfunction: meant to
equalize pressure and allow drainage from middle ear. Tubes in infants are
shorter, wider, floppier and horizontal than in adults making them more
prone to dysfunction.
Bacterial colonization of the nasopharynx with AOM pathogens Viral URI:
inflammation of Eustachian tubes impairs function leading to middle ear
effusion
Smoke exposure: inflames Eustachian tubes, impedes drainage, and
increases pathogen colonization.
AOM Risk factors #2 - ANSWER Impaired immune defense: t
children with disorders that cause immunocompromise are a
increased risk.
Bottle feeding: Breastfeeding shown to reduce risk
Craniofacial disorders: T21 and cleft palate
Daycare attendance
Time of year: more prevalent in winter months along with viral URI
AOM: Clinical manifestations - ANSWER Symptoms: ear pain
(tugging in young infant), Fever
Signs: Bulging TM, red TM; Effusion (decreased mobility of TM), loss of
bony landmarks and light reflex, yellow or white effusion behind TM,
Purulent otorrhea
AOM: Treatment - ANSWER Pain management
Observation option: 6Mo-2yr Unilateral w/o otorrhea or >2yr unilateral or
bilateral w/o otorrhea. (Must be able to be closely followed and antibiotics
provided if worsens or no improvement in
48-72 hours)
AOM: Treatment Antibiotics - ANSWER First line - Amoxicillin
8090mg/gk/d divided BID (Max 1000mg/dose, 2000mg/day) If child weighs
>40kg 500-875mg PO Q12H which is adult dose.
Duration:
, <2yrs or any age with severe symptoms =10d
2-6yrs mild-mod symptoms = 7d
>6yrs mild-mod symptoms = 5d
Alternative (if PCN causes papular rash): Cephlosporin-cefdnir, cefuroxime,
cefpodoxime, or ceftriaxone 50mg/kg IM 1-3d if unable to take PO meds
Severe PCN allergy: Trimethoprim-sulfamethoxozole, Macrolides
(azithromycin, Erythromycin), clindamycin.
SNAP-safety net antibiotic prescription
AOM: First line treatment failure - ANSWER If patient has taken amoxicillin
in the past 30 days or who fail to improve in 48-72hrs on amoxicillin or have
otitis-conjunctivitis syndrome:
Amoxicllin-clavulanate, use formulation with 90mg/kg/day divided
BID or Ceftriazone 50mg/kg/day x3d
Alternatives: Clindamycin w or w/o 3rd generation cephalosprin,
tympanocentisis by ENT, Refer
AOM: Treatment in presence of PE tubes - ANSWER Treatment of child
with PE tubes and otorrhea but no systemic syptoms such as pain or fever:
flouroquinolone drops.
AOM: recurrence >4 weeks - ANSWER Likely a new pathogen,
start over with amoxicillin or other first line treatment.
AOM: Reasons for antibiotic failure - ANSWER Do not use macrolides
such as azithromycin or clarithromycin after failure of amoxicillin due to
high resistance of H flu and S. pneumoniae
Non-compliance, may need IM ceftriaxone
Vomiting of medication/medication refusal
AOM: Prevention - ANSWER Avoid second hand smoke
Encourage breastfeeding
Discourage bottle propping
Discourage pacifier use after 6Mo
Find child care with fewer children
Antibiotic prophalxysis is NOT recommended Vaccines!
Verified 100% Correct
Normal Otoscope View - ANSWER Malleus, Umbo, Cone of light
Cone of light at 7 o'clock in left and 5 o'clock on right
Cone of light disappears when there is fluid
Otitis Externa - ANSWER Cellulitis of the soft tissues of the external
auditory canal
Hallmark - tragus pain (doesn't hurt with middle ear infection)
Pathogens: Otitis Externa - ANSWER Pseudomonas aeruginosa
Staphylococcus aureus
Aspergillis or other fungi (esp. Diabetes)
Risk factors for Otitis External - ANSWER Moisture in ear from
swimming, showering, ect.
Trauma to the external ear canal form q-tips, ear plugs, hearing
aids, scratching
Keeping ears too clean removes protective cerumen and
increases pH with promotes bacterial growth
Otitis External: signs and symptoms - ANSWER Edema and erythema of
the external canal, may be swollen shut.
Sever ear pain, made worse by movement of the pinna or tragus Purulent
discharge from the external canal, canal may be filled wih debris, making
visualization of the TM difficult or impossible
May have periauricular or cervical lymphadenopathy
Otitis externa: differential diagnosis - ANSWER AOM with TM
rupture or patent PE tubes
Furunculosis(pimple/boil) of the ear canal, mastoidisis
,Otitis Externa: Treatment - ANSWER Careful exam to see if the TM is
intact, if you cannot see TM you MUST assume perforation and manage
accordingly.
Gentle removal of debris from canal if possible. If TM is intact, gently
irrigate with NS and bulb syringe. DO NOT irrigate if TM not visualized. Use
warm water, not cold (will cause vestibular response). Do not use "water
pik"
Pain control: Tylenol or ibuprofen for mild pain, ma need narcotic analgesic
for severe pain.
Otitis externa: Antibiotics - ANSWER Topical eardrops are recommended
unless there are signs of systemic symptoms
Fluoroquinolone drops are first line- 4gtt BID x7d
Neomycin/Polymyxin B/Hydrocortisone - 3-4gtt QID for 7-10d (Do not use if
TM is perforated or PE tubes in place!)
Ear Wick use - ANSWER If canal is swolled, insert a pope ear
wick to allow antibiotic drops to get deep into the caancal
Insert dry wick, then moisten with ear drops to expand
Wick will fall out when swelling decreases
Otitis Externa - Prevention - ANSWER avoid vigorous ear cleaning
Avoid using q-Tips
Use drying agents after swimming - 2-3 gtt of 1:1 vinegar:alcohol or
commercial ear drops
Acute Otitis Media (AOM) - ANSWER Acute infection of the
middle ear space with inflammation and effusion
AOM Diagnosis - ANSWER 2 things MUST be present: A bulging
TM and Middle ear effusion as demonstrated by pneumatic
otoscopy or tympanometry
AOM Pathogens - ANSWER Streptococcus pneumoniae Haemophilus
influenzae
Moraxella catarrhalis
,Streptococcus pyogenes
AOM Risk factors #1 - ANSWER Eustachian tube dysfunction: meant to
equalize pressure and allow drainage from middle ear. Tubes in infants are
shorter, wider, floppier and horizontal than in adults making them more
prone to dysfunction.
Bacterial colonization of the nasopharynx with AOM pathogens Viral URI:
inflammation of Eustachian tubes impairs function leading to middle ear
effusion
Smoke exposure: inflames Eustachian tubes, impedes drainage, and
increases pathogen colonization.
AOM Risk factors #2 - ANSWER Impaired immune defense: t
children with disorders that cause immunocompromise are a
increased risk.
Bottle feeding: Breastfeeding shown to reduce risk
Craniofacial disorders: T21 and cleft palate
Daycare attendance
Time of year: more prevalent in winter months along with viral URI
AOM: Clinical manifestations - ANSWER Symptoms: ear pain
(tugging in young infant), Fever
Signs: Bulging TM, red TM; Effusion (decreased mobility of TM), loss of
bony landmarks and light reflex, yellow or white effusion behind TM,
Purulent otorrhea
AOM: Treatment - ANSWER Pain management
Observation option: 6Mo-2yr Unilateral w/o otorrhea or >2yr unilateral or
bilateral w/o otorrhea. (Must be able to be closely followed and antibiotics
provided if worsens or no improvement in
48-72 hours)
AOM: Treatment Antibiotics - ANSWER First line - Amoxicillin
8090mg/gk/d divided BID (Max 1000mg/dose, 2000mg/day) If child weighs
>40kg 500-875mg PO Q12H which is adult dose.
Duration:
, <2yrs or any age with severe symptoms =10d
2-6yrs mild-mod symptoms = 7d
>6yrs mild-mod symptoms = 5d
Alternative (if PCN causes papular rash): Cephlosporin-cefdnir, cefuroxime,
cefpodoxime, or ceftriaxone 50mg/kg IM 1-3d if unable to take PO meds
Severe PCN allergy: Trimethoprim-sulfamethoxozole, Macrolides
(azithromycin, Erythromycin), clindamycin.
SNAP-safety net antibiotic prescription
AOM: First line treatment failure - ANSWER If patient has taken amoxicillin
in the past 30 days or who fail to improve in 48-72hrs on amoxicillin or have
otitis-conjunctivitis syndrome:
Amoxicllin-clavulanate, use formulation with 90mg/kg/day divided
BID or Ceftriazone 50mg/kg/day x3d
Alternatives: Clindamycin w or w/o 3rd generation cephalosprin,
tympanocentisis by ENT, Refer
AOM: Treatment in presence of PE tubes - ANSWER Treatment of child
with PE tubes and otorrhea but no systemic syptoms such as pain or fever:
flouroquinolone drops.
AOM: recurrence >4 weeks - ANSWER Likely a new pathogen,
start over with amoxicillin or other first line treatment.
AOM: Reasons for antibiotic failure - ANSWER Do not use macrolides
such as azithromycin or clarithromycin after failure of amoxicillin due to
high resistance of H flu and S. pneumoniae
Non-compliance, may need IM ceftriaxone
Vomiting of medication/medication refusal
AOM: Prevention - ANSWER Avoid second hand smoke
Encourage breastfeeding
Discourage bottle propping
Discourage pacifier use after 6Mo
Find child care with fewer children
Antibiotic prophalxysis is NOT recommended Vaccines!
