Ear
A 2-year-old female presents with right ear pain and irritability after a recent upper respiratory infection. She had completed a course of amoxicillin for right otitis media prior to onset of her current symptoms. Examination shows an erythematous, bulging, and immobile right tympanic membrane.
What is the most appropriate next step in management for this patient?
Oral amoxicillin-clavulanate
While high-dose amoxicillin can be effective for many cases of acute otitis media, the child’s previous treatment with amoxicillin and recurrence suggests the possibility of resistant bacteria. Amoxicillin-clavulanate would be a better choice in this scenario due to its broader coverage.
You are seeing a 5-year-old for nosebleeds that occur several times a week. The patient has no other symptoms.
What do you recommend if he has a nose bleed?
Pinching the lower third of the nose against the septum for > 5 minutes.
If bleeding does not stop, try vasoconstrictor nose sprays or cautery of the bleeding site with silver nitrate.
If bleeding persists, refer the patient to an ENT for nasal packing and further monitoring.
A 9-year-old girl with a sore throat, fever, and difficulty swallowing comes to your office. Her oropharynx is red with pus, her uvula is slightly deviated to the right, and her left tonsil is larger than the right with swollen anterior cervical lymph nodes.
What is the diagnosis?
Peritonsillar abscess
ENT consult for surgical drainage
IV antibiotics (Ampicillin-sulbactam or Clindamycin)
What is the most common reason for the development of obstructive sleep apnea in children?
Tonsillar and adenoid hypertrophy
Diagnosis with overnight polysomnography
Removal of the tonsils and adenoids often corrects the OSA without further intervention.
What are the most common pathogens associated with acute otitis media?
Name 3 pathogens
Streptococcus pneumoniae
Nontypeable Haemophilus influenzae
Moraxella catarrhalis
A 4-month-old male infant presents to the clinic with his parents, who report that he appears to be tugging at his right ear for the past day. He has had no fever, irritability, change in feeding habits, or any other symptoms. On physical examination, the right tympanic membrane is red and slightly bulging, while the left tympanic membrane appears normal.
What is the most appropriate treatment for this infant?
Amoxicillin 90 mg/kg/day for 10 days is indicated for all infants with otitis media who are younger than 6 months regardless of symptoms.
A 5-year-old boy presents with a history of cough and unilateral purulent, bad odor nasal discharge for several weeks.
What is the most likely diagnosis in this patient?
Nasal foreign body
A7-year-old patient presents with fever and pharyngeal erythema, and exudates. She also has a runny nose and cough. Rapid strep test is pending. She is allergic to penicillin.
What is the treatment?
Reassurance
Viral pharyngitis
Clinical features that suggest a viral etiology include concurrent rhinorrhea, cough, conjunctivitis, hoarseness, oral ulcers, rash, and/or diarrhea.
What common cause of midline neck mass is often associated with an ectopic thyroid gland?
Thyroglossal duct cyst
A healthy 16-year-old male competitive swimmer presents with muffled hearing, pain with movement and drainage from his right ear
What organisms are the likely cause of these symptoms?
Name 2 pathogens?
Pseudomonas aeruginosa
Staph aureus
A 17-year-old boy presents to the emergency department after a motor vehicle collision. He hit his right ear on the car door. He complains of right ear pain. He denies loss of consciousness or other injuries. On exam, there is an auricular hematoma of the right ear.
What is the best next step in the management of this patient?
Immediate incision & drainage
Pressure dressing to prevent reaccumulation of the hematoma.
You are seeing a patient who presented with a nose injury. on physical examination, he has a swollen, fluctuant, and tender septum.
What is the most appropriate management for this patient?
Drainage, nasal packing, and antibiotics
Nasal septal hematoma can compromise the blood supply to the septum, resulting in septal perforation, saddle nose deformity, or abscess.
4-year-old boy presents with fever and inspiratory stridor is found to have markedly increased depth of the prevertebral space on a lateral neck XR.
What is your diagnosis and treatment of this patient?
Retropharyngeal abscess
Ampicillin-sulbactam
What is the usual age for cleft palate repair?
9-18 months
What is the most common infectious cause of congenital sensorineural hearing loss?
Cytomegalovirus (CMV)
A 4-year-old boy is seen in the pediatric clinic for a 5-week history of hearing difficulties. He has no pain, fever, or drainage from the ear. On examination, there’s a slight bulging of the tympanic membrane without erythema or mobility on otoscopy. Audiogram shows a mild conductive hearing loss in the affected ear.
What is the most appropriate initial management for this child?
Observation
The effusion usually resolves within 3 months; therefore, observation is the recommended management
Tympanostomy tube placement is recommended for patients with persistent OME > 3 months.
A newborn presents with intermittent cyanosis, especially with feeding. Several attempts to pass a small nasogastric tube are unsuccessful. Additional findings include a harsh 3/6 systolic murmur localized along the left lower sternal border and bilateral undescended testes.
What is the most likely finding on examination of this patient’s eyes?
CHARGE syndrome
- Coloboma
- Heart Defects
- Atresia choanae
- Retardation of growth/development
- Genito-urinary anomalies
- Ear abnormalities/deafness
A 9-year-old boy presents to your office with fever and sore throat for 1 day. He tests positive for group A Streptococcus on a throat swab. He is started on amoxicillin.
His mother asks when he may return to school?
He may return to school when he is afebrile and on antibiotics for at least 12 hours.
2-year-old boy is found to have a small cystic mass along the anterior margin of the right sternocleidomastoid muscle.
What is the most likely diagnosis in this patient?
Branchial cleft cyst
These cysts are most often located along the lower half of the anterior margin of the sternocleidomastoid muscle, although they may also be preauricular or located at the mandibular angle.
What is the most common organism associated with chronic rhinosinusitis?
Staph aureus
A 3-year-old girl presents with right ear pain for the past 24 hours. She has no fever, cough, runny nose, or other respiratory symptoms. On examination, her right tympanic membrane is bulging and red without any perforation or discharge. Light reflex is absent, and mobility is reduced on otoscopy.
What is the most appropriate initial treatment for this patient?
Observation without antibiotics is indicated for patients > 2 years of age with unilateral or bilateral acute otitis media (AOM), otalgia for < 48 hours, no otorrhea, and mild to no symptoms.
Begin antibiotics with worsening or failure to improve within 2-3 days.
2-year-old girl presents with failure to thrive is noted to have nasal polyps bilaterally.
For what illness should be evaluated?
Cystic fibrosis
It's essential to evaluate for CF in any child under 12 years of age with nasal polyps, even without other CF symptoms.
A 13-month-old girl presents with fever, rhinorrhea, thick purulent nasal discharge, poor appetite, and tender anterior cervical lymphadenopathy.
What is your diagnosis?
Streptococcosis
Toddlers with GABHS do not present with typical pharyngitis, but rather with thick purulent nasal discharge, low-grade fever, and tender anterior cervical lymphadenopathy.
A 16-year-old boy presents to the emergency department with mouth pain, stiff neck, difficulty swallowing, high temperature, inspiratory stridor, drooling, severe sore throat, and submandibular swelling. Physical exam showed a mandibular molar tooth infection.
What is your diagnosis?
Ludwig's angina
IV ampicillin-sulbactam
Patients who do not improve require incision and drainage.
Any tooth implicated as the source of infection should be extracted.
What organisms are usually responsible for acute unilateral cervical lymphadenopathy?
Staph aureus
strep pyogenes