OnlineMedEd: Pediatrics - "Ear, Nose, and Throat"

Question 1

The best clinical diagnostic of otitis media is __________________.

Answer 1

immobility to insufflation

Question 2

Go through the three tiers of treatment for otitis media.

Answer 2

• 1st occurrence: amoxicillin
• Recurrences: Augmentin
• Multiple recurrences (greater than 4 in one year): tympanostomy

Question 3

Otitis externa can arise from two common sources: _________________.

Answer 3

• Swimmer’s ear: Pseudomonas

* Digital trauma (such as from aggressive cleaning): Staph aureus

Question 4

Otitis externa and otitis media both present with unilateral ear pain. How can you differentiate the two by symptom history?

Answer 4

Otitis media often leads kids to pull on their ears. When they do this it doesn’t hurt. Otitis externa, on the other hand, will cause extreme pain when the pinna is pulled.

Question 5

Both AOM and AOE can cause ___________, a surgical emergency. Those with tympanostomy are at increased risk.

Answer 5

mastoiditis

Look for a swollen mastoid with anterior displacement of the ear.

Question 6

Discuss how to differentiate bacterial vs. viral sinusitis.

Answer 6

• Bacterial:

• bilateral, thick, purulent discharge
• facial pain with tapping
• ** lasting longer than 10 days
• ** fever
• ** getting markedly worse

•Viral:
- think, watery discharge

Question 7

A “cold” (rhinitis) is diagnosed by _____________.

Answer 7

clinical picture –bilateral rhinorrhea with copious watery discharge

PCR, immunofluorescence, x-ray, and CT should not be used.

Question 8

What are the CENTOR criteria?

Answer 8

The CENTOR criteria are used to guide treatment for pharyngitis:
• (An absent) Cough: +1
•Exudates: +1
•Nodes (lymphadenopathy): +1
•Temperature greater than 38º C: +1
• Age less than 14: +1 OR Age greater than 44: -1

• One or less: do nothing
• Two to three: do an RST
• Four or greater: treat for Strep

Question 9

_____________ often present with unilateral bacterial infection.

Answer 9

Foreign body insertions

Question 10

What should you not do in retrieving an insect from the ear?

Answer 10

Do not shine your light. Insects often run from light and may damage the tympanic membrane.

Question 11

ENTs recommend that you lean __________ to stop epistaxis.

Answer 11

forward

Question 12

True or false: you can pack anterior bleeds to stem epistaxis.

Answer 12

False. You should cauterize a refractory anterior bleed and pack a refractory posterior bleed.

Question 13

In _____________, the communication between the nose and the mouth is blocked.

Answer 13

choanal atresia

This is diagnosed by babies that turn blue with feeds (because they’re obligate mouth breathers) and pink with crying.