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Chapter 72. Upper Respiratory Tract Infections

Student Questions

A 2-year-old boy is appropriately diagnosed with acute otitis media. He has been vaccinated according to recommended childhood immunization schedules. The most likely pathogen causing his infection is:

A. Haemophilus influenzae

B. Streptococcus pyogenes

C. Moraxella catarrhalis

D. Influenza virus

Answer: A

Option A: Correct. The most common organism in a child who has received routine pneumococcal vaccines according to schedule is Haemophilus influenzae (up to 60% of bacterial cases).

Option B: Incorrect. Streptococcus pyogenes is an infrequent cause of AOM.

Option C: Incorrect. Moraxella catarrhalis is a less common cause of AOM than H. influenzae.

Option D: Incorrect. When diagnosed appropriately, AOM is usually caused by bacteria.

A 12-month-old girl is 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. 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 for otitis media is present in this child?

A. Female sex

B. Daycare attendance

C. Young sibling

D. Antibiotic therapy 2 months ago

Answer: B

Option A: Incorrect. Male sex is a risk factor for otitis media.

Option B: Correct. Daycare attendance is a risk factor for otitis media.

Option C: Incorrect. While having a young sibling is a risk factor, this child does not have a sibling.

Option D: Incorrect. Prior antibiotic use is not a risk factor for infection, but it can be a risk factor for antimicrobial resistance.

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. Middle ear effusion and hearing impairment for 72 hours

D. Moderate bulging of the tympanic membrane and otalgia

Answer: ...

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