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Chapter 72. Upper Respiratory Tract Infections

ML is a 14-month-old girl diagnosed with acute otitis media. She presented to the pediatric clinic today with a fever of 102.4°F (39.1°C) and tugging of her right ear for the past 24 hours. She developed rhinorrhea, nasal congestion, and sneezing approximately 3 days ago, but those symptoms have improved. She attends daycare 3 days a week and has a 4-year-old brother who attends preschool. This is her first episode of acute otitis media. She had a urinary tract infection when she was 10 months old, which was treated with amoxicillin successfully. What risk factor(s) for otitis media is/are present in ML?

A. Female sex

B. Daycare attendance

C. Young sibling

D. Antibiotic therapy 4 months ago

E. B and C are both risk factors

ML has been vaccinated appropriately according to recommended childhood immunization schedules. The most likely bacterial pathogen causing her infection is:

A. Streptococcus pneumoniae

B. Streptococcus pyogenes

C. Moraxella catarrhalis

D. Staphylococcus aureus

E. Influenza

Acute otitis media should be diagnosed in a child with which of the following signs/symptoms?

A. Middle ear effusion only

B. Middle ear effusion and mild erythema of the tympanic membrane

C. Moderate bulging of the tympanic membrane and otalgia

D. Mild erythema of the tympanic membrane, middle ear effusion, and hearing impairment for at least 72 hours

E. None of these signs/symptoms are consistent with acute otitis media

JJ is a 13-month-old boy with bilateral acute otitis media that is not severe. He was treated for a similar episode 4 months ago with amoxicillin and developed a nonurticarial rash. Which of the following is the most appropriate treatment approach for JJ?

A. Amoxicillin-clavulanate

B. Azithromycin

C. Cefdinir

D. Clindamycin

E. Observation option

Adjunctive therapies for acute otitis media that are effective for reducing symptoms include:

A. Analgesics


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