Case #32
Directions:
Click here to open your browser's e-mail system. This is where you
will record your answers to questions plus any comments you want to
pass along to your instructor. After entering your answers, you can
check your response by clicking "Faculty Comments". In the
subject line of the e-mail form, enter your name and the name of the
case being submitted, i.e., "Case #32." When you finish your session
with Family Medicine On-line, click the Send button in the e-mail
window to forward your answers to your instructor. If you end your
session before completing the case, click the Send button to submit
your answers, and then exit your browser.
To complete the case during another session, go to the first page
of the case and click the link above and then advance to the page
where you left off. When finished with this session, click the Send
button in the e-mail window. All materials copyrighted 2003 by Penn
State University.
Chief Complaint
|
HPI (per mom): Cooper is a 3 year old male who presents with 2 day history of increase fussiness and interrupted sleep. He was sent home from daycare today with a temperature of 38.5. Tylenol reduced temperature and irratibility. Cooper told his mother that his right ear hurt before coming in for his appointment, but he is now refusing to answer questions.
|
- What is the differential for a child presenting with pain in the ear?
|
Medical History
 |
Past Medical History
- 1 previous ear infection 3 mos ago, treated with amoxicillen
-
Multiple URIs since November (it is now March).
-
Recovering from most recent URI at the onset of current symptoms
- Normal cesarean birth
-
No other significant medical history
Social History
- Attends daycare 5 days a week since 18 months
- Only child
- Mother and Father smokers
Family History
Current Medication
- Children’s Tylenol 15 mg/kg for fever
- Children’s Sudafed for URI symptoms
|
- What are the most common risk factors of AOM?
- Based on Cooper's history so far, what risk factors apply to him?
|
Physical Exam
- What are the three elements required in order to diagnose Acute Otitis Media (AOM)?
- What are the most common signs and symptoms of AOM?
- What are the characteristics of the tympanic membrane which we should be looking for?
- What is considered the gold standard for diagnosing AOM?
- How does AOM differ from Otitis Media with Effusion (OME)?
|
Management Plan
Based on your findings, you tell mom that it looks like her son has another ear infection. She states that her son did not tolerate the last course of aomxicillin well, although his symptoms did resolve once he completed his course of medication.
- What is the most common side effect of amoxicillin unrelated to hypersensitivity?
- What are the hypersensitivity reactions seen with the penicillins?
- What are the common pathogens associated with AOM?
- What are the mechanisms of resistance for the above pathogens?
- Should you decide to prescribe medication at this time, what is the first line antibiotic of choice and recommended dose for the treatment of AOM?
- What would be your choice for medication if the child has severe disease?
- How would you treat a patient who had a previous type I allergic reaction (IgE mediated immediate reaction) to penicillin?
- At what point should a second line antibiotic treatment be considered?
- What would be you antibiotics of choice for second line treatment.
- Would your initial treatment choice change if the child had been treated with antibiotics within the past month?
- In Cooper’s case, what would be your treatment choice?
- Mom is concerned that this is her son’s second ear infection in three months and asks you whether or not he needs tubes. What can you tell her? Is this recurrent AOM?
|
| Normal tympanostomy tube |
Infection with tube (AOMT) |
 |
 |
- Consider this case in a child who already has tympanostomy tubes in place. How might treatment differ?
|
