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65 Cards in this Set
- Front
- Back
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definition of acute otitis media
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infection a/w middle ear effusion and or ottorhea
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definition of effusion
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collection of fluid in the mid ear space
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definition of ottorhea
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discharge through perforated TM
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what are the cardinal symptoms/signs of AOM
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1. rapid onset
2. systemic signs and symptoms: fever otalgia emesis irritability anorexia + effusion and/or otorrhea |
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What are the 3 main bugs implicated in AOM
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1. STREP - Streptococcus pneumonia
2. HIB - Haemophilus influenzae 3. MORAXELLA - Moraxella catarrhalis |
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What are the clinical signs of AOM
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MIDDLE EAR EFFUSION
bulging TM decreased or no mobility of TM air/fluid level behind TM ottorrhea MIDDLE EAR INFLAMATION erythema of TM |
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What are the symptoms of AOM
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otalgia
acute onset (may be a/w systemic symptoms) |
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What distinguishes AOM from Otitis Media with Effusion?
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AOM has signs of inflammation of the TM and acute onset symptoms of an infection. AOM is also a/w bulging TM, distortion of landmarks, yellow/white/bright red TM, dull TM, exudate in the ear canal.
OME is a/w NONbulging TM - may be retracted or neutral, TM always with decreased mobility, TM may be dull, may be white or amber colored. Note that kids with OME may get a superimposed acute infx, which will then present like AOM. |
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What is used to dx AOM
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pneumatic otoscopy
tympanometry |
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Risk factors for AOM
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bacterial colonization
URI --> decreased tube function ETS exposure eustacian tube dysfunction immunocompromised (IgA deficient) not breastfed did not receive vaccines |
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Def of otitis externa
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inflammation of the skin lining the ear canal
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etiology of otitis externa
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loss of protective cerumen leads to maceration of the skin
- trauma from Q-tips or ear plugs - contact dermatitis - secondary infxn - OM with open TM (Staph, pseudomonas) |
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what are the presenting symptoms of otitis externa
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pain and itching (espec w/ chewing or pressure)
normal hearing (unless canal completely occluded) |
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what are the presenting signs of otitis externa
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drainage (may be minimal)
canal is swollen resist speculum exam pain with movement of tragus or pinna debris in the canal, unable to visualize TM |
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what is the treatment for otitis externa
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topical - fluoroquinolone drops or corticosporin drops or others
systemic - abx |
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when to use systemic treatment for otitis externa
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s/s of systemic infection, such as fever cellulitis of the auricles, tender post-auricular lymph nodes)
or if the TM is perforated |
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how do you treat otitis externa if the TM is perforated or you don't know.
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(1) topical - only certain ones ok, ie corticosporin drops (Otic drops)
(2) systemic abx if you don't know, treat as if it is perforated |
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how long does OME take to heal?
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can take 3 wks minimum
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if there is another ear infection within 2-3 months of a previous one, what do you do? refer or just treat?
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just treat and watch
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when is it important to refer for recurrent ear infections
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if there is any concern for speech delay, refer to ENT
(may be other reasons as well...?) |
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what are the components of treatment of AOM
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1. pain mgt
2. watchful waiting vs. antibiotic treatment |
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when is it a good idea to use watchful waiting before abx in AOM
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in a child 6mo-2yo: when you're not sure it's AOM (because of obstruction of visibility of the TM) & the disease is NOT severe
child over 2yo: NONsevere disease less than 48-72hrs since onset ALSO The parent needs to agree and F/U needs to be assured **severe disease = severe pain or high fever** |
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when do you switch from watchful waiting to antibiotic treatement
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after 48-72 hrs.
if there are s/s of severe disease |
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What is the 1st line treatment for AOM
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amoxicillin 40-50 or 90mg/kg/day divided BID
child <2yo -- 10 days child >2yo -- 5 days |
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what med is used if there is treatment failure to amoxicillin for AOM after 48-72hrs? why?
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at 48-72hrs, if treatment not effective, switch to augmentin at same amox dose.
likely Hib. |
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What medication is used for AOM if Amoxicillin causes a rash?
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Cephalosporins:
- Cefuroxime (Ceftin) - Cefdinir (Omnicef) - Cefpodoxime (Vantin) |
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What medication is used for AOM that recurs in LESS THAN 1 month after treatment
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Cephalosporins:
- Cefuroxime (Ceftin) - Cefdinir (Omnicef) - Cefpodoxime (Vantin) |
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What medication is used for AOM if amoxicillin causes a SERIOUS reaction
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Bactrim or Azithromycin
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How can AOM be prevented?
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Breastfeeding
Take away the pacifier No ETS Day care.... Antibiotic prophylaxis (unusual - for kids with recurrent infections in late spring) TM tubes |
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what is the role of allergies in AOM?
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none
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what is the association of AOM and immunocompromise
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in a child who is not known to be immunocompromised, recurrent AOM is not a likely reason to think they might be. However, the association is unknown and IgA deficiency is a possibility, among other things.
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what is the assoc of vaccines and AOM?
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Hib and PCV7 have significantly decreased amt of AOM
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what/when is the intervention for a perforated TM
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should spontaneously heal
if not healed in 3 months --> surgery |
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What is the criteria for fever of unknown origin?
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(1) a temperature greater than 38.3°C (101°F) on several occasions,
(2) more than 3 weeks' duration of illness, and (3) failure to reach a diagnosis despite one week of inpatient investigation. |
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what is the workup for a fever of unknown origin -important hx and pe exam components
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History:
duration Tmax Associated symptoms chronic conditions meds at home I/O's exposure PE: neuro - hydration - toxic apearing? |
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what to do with a kid with fver of unknown orgin who is :
<28 days. 29d-3mo |
< 28days - admit
29days -3mo - if toxic appearing or high risk of toxicity- admit if not toxic appearing & low risk - don't have to admit 3-36mo - low temp - home temp >39 -- urine culture, blood culture, chest x-ray **low risk = healthy, no focal infection, CBC ok, normal UA |
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up to what temperature is safe? (for brain damage control)
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<41.7 is OK
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when do you use Tylenol for fever and how is it dosed
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<2mo
39C+ uncomfortable use 15mg/kg/dose |
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when to use Ibuprofen
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only after 2mo
10mg/kg/dose - longer lasting (Q6-8hrs) |
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What do the EBV titers mean?
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IgG - have they EVER had it?
IgM - Acute illness |
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what are the bacterial causes of pharyngitis? viral?
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mycoplasma
GABHS Chlamydia Strep C & G viral: mono herpangina hand foot mouth disease |
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what are the characteristics of mono
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exudative tonsilitis
cervical adenitis fever usually >5yo may also have: palpable spleen axillary adenopathy test results: atypical lymphs +mono spot + EBV serology |
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what are the characteristics of herpangina
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ulcers (~3mm) with a halo
ulcers are at the anterior pillars, soft palate, and uvula ulcers are NOT on the tonsils or anterior mouth |
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what causes herpangina
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coxsackie virus
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what is the natural hx of herpangina
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after ulcers, the disease is self-limited
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what are the characteristics of hand foot mouth disease?
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ulcers that can be anywhere in the mouth
rash at the palms, soles, interdigitally, buttocks rash is: vessicles, papules, pustules |
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what is the cause of hand foot mouth
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enterovirus
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How do you manage mild - moderate pharyngitis
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symptomatic treatment only if afebrile and URI s/s
for symptoms (febrile, tonsilar exudate, S pyogenes, FHx), rapid Strep |
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In a child 3mo-3yo with a fever, when would you get a urine culture?
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temp >39C
+ male and less than 6mo or female and less than 2yo |
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In a child 3mo-3yo with a fever, when would you get a blood culture
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temp >39C
+ any medical history appearance of toxicity or sepsis, etc |
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In a child 3mo-3yo with a fever, when would you get a chest x-ray
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temp >39C
+ dyspnea and or shift of CBC |
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what are the cardinal signs of peritonsilar abscess or tonsilitis?
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fever
sore throat severe URI |
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What are the cardinal URI-like s/s of Acute primary HIV infxn
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fever
fatigue flu s/s |
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what are the cardinal signs of diptheria
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fever
extremely sore throat |
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what tests would you do if the child had pharyngitis with bilateral tonsilitis and severe s/s of infection (what would be the next steps?)
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throat culture
mono testing CBC **refer to ENT **likely admit to hospital |
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How do you manage a child with pharyngitis with unilateral tonsilitis and severe s/s of infection
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** refer to ENT
(they will likely drain and/or treat with abx) |
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How do you manage a child with pharyngitis with airway compromise and severe s/s of disease?
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Refer to ENT
they will likely get a CT scan and admit to ICU for steroids |
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What should you always consider in a child who presents with ear and throat pain?
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Strep - can cause ear and throat pain.
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How to manage a child with pharyngitis and mild to moderate illness who is afebrile & has URI s/s?
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Symptomatic treatment b/c it's likely viral
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How to manage a child with pharyngitis and significant symptoms - febrile, tonsilar exudate - &/or FHx Rheumatic fever &/or Strep pyogenes exposure?
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Rapid Strep test:
- if NEG --> culture - if both are NEG --> symptomatic treatment - if either is POS --> Pen VK 50-500mg/kg/day divided BID x10days (generally use 500mg/kg) |
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When do kids with strep stop being contagious
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3-4 days after abx started
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How do you manage a kid with POS strep who fails treatment or relapses in 1 wk?
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culture and do a Mono test
If the cx shows persistent Strep pyogenes --> give either (1) IM PCN OR (2) B-lactam Abx |
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In a child w Mono, how long before they can play sports
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No splenic involvement - 3-4 wks
+ splenic involvement - 6-8 wks |
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In a child who has AOM, when do you switch from 1st to second line Abx (after how long without response)? What if they are still unresponsive?
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72 hrs without response --> switch to 2nd line, like Augmentin
If still unresponsive, diagnostic tympanocentesis then retreat w/ appropriate abx |
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when do you f/u with a child w/ AOM who was treated & responsive?
What if this child has residual effusion? (what do you do?) |
reexamine in 3-6 wks
If residual effusion, reevaluate monthly. If there are no episodes of AOM but the effusion lasts >3mo send to speech/audiology If there ARE superimposed AOM infxns --> ENT referral. |
