Pediatrics: Ear Infections and Fever

Question 1

What is Otitis Media

Answer 1

Acute of infection of the middle ear

Question 2

What usually precedes Otitis Media

Answer 2

Viral Upper Respiratory Infection

Question 3

What is the pathology of Otitis Media

Answer 3

Inflammatory edema obstructs Eustachian tube drainage

URT bacteria enters the middle ear

Microbial Growth occurs

Question 4

What Bugs are commonly associated with Otitis Media

Answer 4

Streptococcus Pneumoniae

Haemophilus Influenza Non-typeable

Moraxella Catarrhalis

Question 5

What is the #1 complaint in Otitis Media

Answer 5

Ear Pain

Question 6

How is Otitis Media Diagnosed

Answer 6

Clinically based on physical exam

Question 7

What is the most specific sign of acute inflammation in Otitis Media

Answer 7

Bulging of the Tympanic Membrane

Question 8

Physical exam findings that support Otitis Media

Answer 8

Middle Ear Effusion + signs of Middle ear inflammation

Bulging of the Tympanic membrane

Question 9

What are the treatment indications for Otitis Media

Answer 9

All Adults

Children <2

Children over 2 with specific features

Question 10

What are the indications to treat a child >2 with Otitis Media

Answer 10

Toxic appearance

Fever >102.2 F

More than 48 hours of ear pain

Question 11

First-line treatment for Otitis Media

Answer 11

Amoxicillin

Question 12

What is an alternative medication for Otitis Media

Answer 12

Amoxicillin-Clavulanate (Augementin)

Question 13

What are indications to treat otitis media with Augmentin

Answer 13

Hx of recurrent AOM

Recent use of a beta-lactam antibiotic

H. Influenza resistant to Amoxicillin

Question 14

What is a Myringotomy

Answer 14

Surgical incision of the TM

prevents (-) pressure in Eustaschian tube

Allows fluid to drain

Question 15

Complications of Otitis Media

Answer 15

TM Perforation

Mastoiditis

Labryinthitis

Intracranial Calcification

Conductive Hearing Loss

Question 16

What is Mastoiditis

Answer 16

Bacterial infection of mastoid air cells
-in mastoid of temporal bone

Question 17

What bugs are associated with Mastoiditis

Answer 17

S. Pneumo

S. Pyogenes

S. Aureus (MRSA)

Question 18

How do you diagnose Mastoiditis

Answer 18

Clinical + CT Scan

Question 19

How do you treat Mastoiditis

Answer 19

Abx

Myringotomy +/- Tympanostomy tube

Question 20

What Abx are used for Mastoiditis

Answer 20

Vancomycin or Linezolid to cover for MRSA

Question 21

What is Serous Otitis media

Answer 21

Otitis media with effusion

Middle ear serous effusion without evidence of infection

often develops after AOM

Question 22

What is the most common symptom of Serous Otitis Media

Answer 22

Hearing loss

Question 23

How is Serous Otitis Media Treated

Answer 23

Most resolve with observation

Question 24

What is Otitis Externa

Answer 24

Swimmer’s ear

infection and inflammation of the external auditory canal

Question 25

How does Otitis Externa Present

Answer 25

Ear pain with pruritus and discharge Tragus sign

Question 26

What is the tragus sign

Answer 26

Ear pain with pulling on the ear

Question 27

What are the most common bugs in Otitis Externa

Answer 27

Pseudomonas Aeruginosa S. Epidermidis S. Aureus

Question 28

How does the external ear canal appear in Otitis Externa

Answer 28

Edematous Erythematous White, patchy exudate

Question 29

How do you diagnose Otitis Externa

Answer 29

Clinically

Question 30

How do you treat Otitis Externa

Answer 30

Ear drops -Abx -Steroids -Antiseptics

Question 31

What Abx drops are used in Otitis Externa

Answer 31

Ciprofloxacin/Ofloxacin

Question 32

What timeline has a higher risk of sepsis in fever without a source (FWS)

Answer 32

<90 days has a higher sepsis risk

Question 33

What must you consider for FWS in a patient <7 days

Answer 33

Neonatal Sepsis Meningitis

Question 34

How to diagnose FWS in infant <7 days

Answer 34

Blood Cx Urine Cx CSF Cx

Question 35

How to treat FWS in infant <7 days

Answer 35

Empiric Abx -Ampicillin/Gentamycin

Question 36

What do ampicillin/Gentamycin cover in FWS

Answer 36

GBS Listeria Enterococcus E. Coli

Question 37

Workup for FWS in infants <60 days

Answer 37

Full sepsis workup Hospitalization common Empiric Abx

Question 38

Workup for FWS in older infants >60 days

Answer 38

Inpatient or outpatient management

Question 39

What do well-appearing children 3-36 months with FWS most commonly have

Answer 39

Self-limited viral illness

Question 40

What do ill-appearing children 3-36 months with FWS most common have

Answer 40

Occult bacterial infections -full-work up -hospitalize -empiric Abx

Question 41

What is the diagnostic criteria for Fever of unknown origin (FUO)

Answer 41

Fever >101F at least 9 days no apparent diagnosis