Pediatrics 14: 18-month-old female with congestion

Based on what you know about the patient so far, write a one-to-three sentence summary statement to communicate your understanding of the patient to other providers.

Rebecca is a fully immunized 18-month-old girl with acute onset of fever and ear tugging following three days of URI symptoms who has a history of language delay, past otitis media, daycare, and smoke exposure. Epidemiology and risk factors: Rebecca is an 18-month-old girl Attends daycare Smoke exposure History of otitis media History of language delay Key clinical findings about the present illness using qualifying adjectives and transformative language: Acute onset fever and ear pain Three days of URI symptoms previously

How would you describe and diagnose her right ear? Choose the single best answer. A. Amber, nonmobile, retracted position, opaque (OME) B. Clear, normal mobility, neutral position (normal) C. Yellow, reduced mobility, bulging (AOM)

The correct answer is A

Considering Rebecca's signs, symptoms, and physical exam findings, now select the most appropriate diagnosis. Choose the single best answer. A. Bilateral acute otitis media (AOM) B. Bilateral normal middle ears C. Bilateral otitis externa D. Bilateral otitis media with effusion (OME)

The correct answer is A.

Of the following, which treatment option would be best for Rebecca? Choose the single best answer. A. Amoxicillin B. Amoxicillin/clavulanate C. Ceftriaxone single intramuscular injection D. "Watch and wait": no antibiotics unless symptoms worsen or persist SUBMIT

The correct answer is A.

Based on the history you have gathered so far, is it appropriate for Rebecca to be receiving antihistamines/decongestants for her symptoms? Choose the single best answer. A. Yes B. No SUBMIT

The correct answer is B.

Is this typical speech development for an 18-month-old? Choose the single best answer. A. Yes B. No

The correct answer is B.

Think about the order in which you will conduct your examination of Rebecca to achieve the best results. Which of the following will be the last step in your exam sequence? Choose the single best answer. A. Eyes B. Ears/oral cavity C. General observation D. Lungs/cardiac/abdomen

The correct answer is B.

Of the descriptions below, which best describes Rebecca's left ear? Choose the single best answer. A. Amber/red, non-mobile, retracted position, opaque B. Gray, normal mobility, neutral position, translucent C. Gray, normal mobility, retracted position, translucent D. White/red, reduced mobility, bulging, opaque SUBMIT CONTINUE

The correct answer is D.

\You find similar findings for Rebecca's left ear, consistent with bilateral OME. You explain to her mother that the fluid in her middle ear has most likely persisted since her episode of bilateral AOM four months before. Which of the following are appropriate options at this point? Select all that apply. A. Assess her language development B. Order a hearing assessment C. Provide reassurance with a plan for observation over time D. Refer for tympanostomy tube placement

The correct answers are A and B.

You begin to think about treatment options. Which two of the pathogens below are the most prevalent causes of AOM? Choose the two best answers. A. Haemophilus influenzae, nontypeable B. Moraxella catarrhalis C. Streptococcus pneumoniae D. Streptococcus pyogenes

The correct answers are A and C.

In which position(s) could the child rest while you examine her ears? Select all that apply. A. On mother's chest B. On mother's lap C. On the exam table SUBMIT CONTINUE

The correct answers are A, B, C.

Of the following factors that you discovered while taking Rebecca's medical history, which are considered risk factors for developing acute otitis media? Select all that apply. A. Daycare attendance B. Exposure to cigarette smoke C. Maternal perinatal Group B Streptococcus carriage D. Possible allergies E. Use of antihistamines/decongestants

The correct answers are A, B, and D.

Considering the key findings in the history, which of the following would you include in your differential diagnosis at this point? Select all that apply. A. Allergic rhinitis B. Gastroenteritis C. Otitis media D. Pneumonia E. Sinusitis F. Upper respiratory infection (URI) G. Urinary tract infection (UTI) SUBMIT

The correct answers are C, D, E, F.