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CMN 568 Exam 1: Questions With Detailed Answers
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CMN 568 Exam 1: Questions With Detailed Answers
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CMN 568 Exam 1: Questions With Detailed AnswersProper otoscopic technique Right Ans - Proper technique:
Note that he is bracing his finger against the child's cheek, if patient moves, so
does otoscope
OTITIS EXTERNA Right Ans - Cellulitis of the soft tissues of the external
auditory canal
-AKA swimmers ear
Otitis externa pathogens Right Ans - Pseudomonas aeruginosa
Staphylococcus aureus
Aspergillus or other fungi (especially diabetics)
Risk Factors otitis externa Right Ans - Moisture in the ear from swimming,
showering, etc
Trauma to the external canal from Q-tips, ear plugs, hearing aids, or scratching
Keeping ears too clean removes protective cerumen and increases pH which
promotes bacterial growth
s/s of otitis externa Right Ans - Edema and erythema of external canal, may
be swollen
shut
Severe ear pain, made worse by movement of the pinna or tragus
Purulent discharge from the external canal, canal may be filled with debris,
making visualization of the TM difficult or impossible
May have periauricular or cervical lymphadenopathy
Differential Dx of otitis externa Right Ans - Acute Otitis Media with TM
rupture or patent PE tubes
• Furunculosis of the ear canal, Mastoiditis
treatment of otitis externa Right Ans - Careful exam to see if the TM is
intact. If you can not visualize the TM due to swelling or debris, you MUST
assume perforation and manage accordingly.
-Gentle removal of debris from canal if possible. If TM is intact, gently irrigate
with NS and a bulb syringe. Do NOT irrigate if TM not visualized.
Pain control: Tylenol or Ibuprofen for mild pain, may need narcotic analgesic
for severe pain.
,Antibiotics for otitis externa Right Ans - -Topical eardrums unless signs of
system infection
-Fluoroquinolone drops are first line
-Neomycin/polymyxin b/hydrocortisone cream
-oral atnitibiotcs for systemic
Fluoroquinolone drops Right Ans - • Covers pseudomonas and Staph
• Safe to use if TM is perforated or PE tubes are in place
Ciprofloxacin/dexamethasone (Ciprodex) contain cipro and a
steroid for inflammation. (4g gtts BID x 7 days)
Ciprofloxacin otic alone (.25ml BID x 7days)
Ciprofloxicin otic liquid to gel (Otiprio): 0.2ml in ear x 1
Ciprofloxacin/dexamethasone (Ciprodex) Right Ans - contain cipro and a
steroid for inflammation. (4g gtts BID x 7 days)
Ciprofloxacin otic alone Right Ans - (.25ml BID x 7days)
Ciprofloxicin otic liquid to gel (Otiprio) Right Ans - 0.2ml in ear x 1
Neomycin/ Polymyxin B/ Hydrocortisone (Cortisporin otic) Right Ans - •
3-4 gtts TID-QID for 7-10 days• Do NOT use if TM is perforated or PE tubes in
place
Use of an ear wick Right Ans - -If canal is swollen, insert a Pope ear wick to
allow antibiotic drops to get deep into canal.
-Insert dry wick, then moisten with ear drops to expand
-Wick will fall out when swelling decreases
Prevention of otitis externa Right Ans - • Avoid vigorous ear cleaning
which removes protective cerumen and changes pH
• Avoid use of Q-tips which can damage ear canal
• Use drying agents after swimming:• 2-3 gtts of 1:1 solution of white vinegar/
70% ethyl alcohol • Commercial products such as Swim Ear drops• Acidify
and dry canal to inhibit bacterial growth
Acute otitis media (AOM) Right Ans - • Acute infection of the middle ear
space with inflammation and effusion
, • 2 things must be present to diagnose:
A bulging TM
Middle ear effusion (MEE) as demonstrated by pneumatic otoscopy or
tympanometry
Pathogens of AOM Right Ans - • Streptococcus pneumoniae (35-40%) •
Haemophilus influenzae (30-35%)• Moraxella catarrhalis (15-25%)•
Streptococcus pyogene
Risk Factors for AOM Right Ans - Eustachian tube dysfunction: equalizes
pressure and allows drainage from middle ear. Tubes in infants are shorter,
wider, floppier and more horizontal that in adults, making them prone to
dysfunction.
Bacterial colonization of the nasopharynx with AOM pathogens
Viral URI: inflammation of eustachian tubes impairs function leading to
middle ear effusion
Smoke exposure: inflames eustachian tubes, impeds drainage, and increases
pathogen colonization
Clinical Manifestations of AOM Right Ans - • Symptoms:• Ear pain: pulling
or tugging on ear in young infant • Fever
Signs:
-Bulging, inflamed (erythematous) TM
Signs of effusion: decreased mobility of TM on insufflation with pneumatic
otoscope or flat tympanometry wave
-Loss of bony landmarks and light reflex on otoscopic exam
-Yellow or white effusion behind TM (pus)
-Purulent drainage (otorrhea) if TM is ruptured or patent PE tubes in place
Treatment of AOM Right Ans - Pain management: ---AOM is painful.
Remember to advise use of acetaminophen or ibuprofen for pain relief
-Observation Option: A period of "watchful waiting" is appropriate in
otherwise healthy children > 6mo with the ability to be closely followed and
antibiotics provided if symptoms worsen or fail to improve in 48-72 hour
Antibiotic Selection AOM first line Right Ans - -Amoxicillin:
80-90mg/kg/day divided BID, max 1000mg/dose, 2000mg/day
• Child weighs >40 kg, 500-875mg po q12 h (adult dose)
Duration: < 2yr or any age with severe symptoms: 10 days
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