CMN 568 Final Exam/ 412 Questions with Definitive Solutions.
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Course
CMN 568
Institution
CMN 568
CMN 568 Final Exam/ 412 Questions with Definitive Solutions.
Ear Wick use - Answer: If canal is swolled, insert a pope ear wick to allow antibiotic drops to get deep into the caancal
Insert dry wick, then moisten with ear drops to expand
Wick will fall out when swelling decreases
Otitis Ex...
CMN 568 Final Exam/ 412 Questions with
Definitive Solutions.
Ear Wick use - Answer: If canal is swolled, insert a pope ear wick to allow
antibiotic drops to get deep into the caancal
Insert dry wick, then moisten with ear drops to expand
Wick will fall out when swelling decreases
Otitis Externa - Prevention - Answer: avoid vigorous ear cleaning
Avoid using q-Tips
Use drying agents after swimming - 2-3 gtt of 1:1 vinegar:alcohol or commercial
ear drops
Page 1 of 100
,Acute Otitis Media (AOM) - Answer: Acute infection of the middle ear space with
inflammation and effusion
AOM Diagnosis - Answer: 2 things MUST be present: A bulging TM and Middle ear
effusion as demonstrated by pneumatic otoscopy or tympanometry
AOM Risk factors #1 - Answer: Eustachian tube dysfunction: meant to equalize
pressure and allow drainage from middle ear. Tubes in infants are shorter, wider,
floppier and horizontal than in adults making them more 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, impedes drainage, and increases
pathogen colonization.
AOM Risk factors #2 - Answer: Impaired immune defense: children with disorders
that cause immunocompromise are at increased risk.
Bottle feeding: Breastfeeding shown to reduce risk
Craniofacial disorders: T21 and cleft palate
Daycare attendance
Page 2 of 100
,Time of year: more prevalent in winter months along with viral URI
AOM: Clinical manifestations - Answer: Symptoms: ear pain (tugging in young
infant), Fever
Signs: Bulging TM, red TM; Effusion (decreased mobility of TM), loss of bony
landmarks and light reflex, yellow or white effusion behind TM, Purulent otorrhea
AOM: Treatment - Answer: Pain management
Observation option: 6Mo-2yr Unilateral w/o otorrhea or >2yr unilateral or
bilateral w/o otorrhea. (Must be able to be closely followed and antibiotics
provided if worsens or no improvement in 48-72 hours)
AOM: Treatment Antibiotics - Answer: First line - Amoxicillin 80-90mg/gk/d
divided BID (Max 1000mg/dose, 2000mg/day) If child weighs >40kg 500-875mg
PO Q12H which is adult dose.
Duration:
<2yrs or any age with severe symptoms =10d
2-6yrs mild-mod symptoms = 7d
>6yrs mild-mod symptoms = 5d
Alternative (if PCN causes papular rash): Cephlosporin-cefdnir, cefuroxime,
cefpodoxime, or ceftriaxone 50mg/kg IM 1-3d if unable to take PO meds
Severe PCN allergy: Trimethoprim-sulfamethoxozole, Macrolides (azithromycin,
Erythromycin), clindamycin.
SNAP-safety net antibiotic prescription
Page 3 of 100
, AOM: First line treatment failure - Answer: If patient has taken amoxicillin in the
past 30 days or who fail to improve in 48-72hrs on amoxicillin or have otitis-
conjunctivitis syndrome:
Amoxicllin-clavulanate, use formulation with 90mg/kg/day divided BID or
Ceftriazone 50mg/kg/day x3d
Alternatives: Clindamycin w or w/o 3rd generation cephalosprin, tympanocentisis
by ENT, Refer
AOM: Treatment in presence of PE tubes - Answer: Treatment of child with PE
tubes and otorrhea but no systemic syptoms such as pain or fever:
flouroquinolone drops.
AOM: recurrence >4 weeks - Answer: Likely a new pathogen, start over with
amoxicillin or other first line treatment.
AOM: Reasons for antibiotic failure - Answer: Do not use macrolides such as
azithromycin or clarithromycin after failure of amoxicillin due to high resistance of
H flu and S. pneumoniae
Non-compliance, may need IM ceftriaxone
Vomiting of medication/medication refusal
AOM: Prevention - Answer: Avoid second hand smoke
Encourage breastfeeding
Discourage bottle propping
Discourage pacifier use after 6Mo
Page 4 of 100
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