Otitis Media
Common pathogen
Streptococcus pneumoniae
Centor criteria
Fever, Lymphadenopathy, Exudate, Absence of cough (Centor Criteria)
Allergic facies
Allergic shiners, nasal crease, mouth breathing
Duration for bacterial dx
>10 days of symptoms or worsening after initial improvement
Pneumatic otoscopy use
Detects middle ear effusion by assessing TM mobility
First-line antibiotic
Amoxicillin
Strep vs viral signs
Viral: cough, rhinorrhea, conjunctivitis; Strep: sudden onset, no cough, exudate
First-line treatment
Intranasal corticosteroids
Monospot test use
Detects heterophile antibodies for EBV
Tympanometry curve meaning
Flat curve indicates fluid or poor compliance in middle ear
Watchful waiting criteria
Child >2 years with mild symptoms and reliable follow-up
Tonsillectomy indication
≥7 episodes in 1 year, ≥5/year for 2 years, or sleep apnea
Allergen avoidance tip
Use HEPA filters, wash bedding weekly in hot water, avoid pets in bedroom
Sinusitis red flag
Periorbital swelling, vision changes, high fever
Monospot detects what
Monospot detects heterophile antibodies for EBV
TM appearance
Bulging, erythematous, immobile tympanic membrane
Antibiotic for allergy
Azithromycin or cephalexin (if non-anaphylactic penicillin allergy)
Immunotherapy indication
Persistent symptoms despite maximal therapy or impact on quality of life
Mono sports restriction
Avoid contact sports for 3–4 weeks due to splenic rupture risk
Rapid strep test accuracy
Rapid strep test is fast but less sensitive than culture
Referral criteria
≥3 episodes in 6 months or ≥4 in 12 months with effusion
Complication to avoid
Rheumatic fever
Associated comorbidity
Asthma
Antibiotic to avoid in mono
Amoxicillin (causes rash in EBV)
Nasal endoscopy purpose
Visualizes nasal anatomy to detect polyps or structural abnormalities