Which of the following predisposes infants to chronic otitis media?
Correct Answer C:
Chronic otitis media is a long-standing infection of the middle ear. Some factors that increase a child's risk for middle ear infections include crowded living or daycare conditions, exposure to second-hand smoke, respiratory illnesses, close contact with siblings who have colds or ear infections, having a cleft palate, allergies that cause congestion on a chronic basis.
A 4-year-old child returns to your clinic after 3 days of treatment for acute otitis media. She had been taking amoxicillin, 40 mg/kg/day, and using acetaminophen and ibuprofen for pain and fever. On examination, the child still has a bulging red tympanic membrane on the left, with a flat tympanogram. She has continued to have a fever.
Which one of the following would be contraindicated?
Correct Answer D:
All of these medications listed are indicated for second-line treatment of acute otitis media.
Ciprofloxacin, however, is not approved for patients under age 18.
Which one of the following is the most common cause of recurrent and persistent acute otitis media in children?
Streptococcus pneumoniae, Haemophilus influenzae, and Moraxella catarrhalis are the most common bacterial isolates from the middle ear fluid of children with acute otitis media. Penicillin-resistant S. pneumoniae is the most common cause of recurrent and persistent acute otitis media.
A 4-month-old child has been noticed to have episodes where he tenses his arms and leans his head forward. He has also had poor feeding and a history of upper respiratory infections.
What is the most likely diagnosis?
Correct Answer B:
Infantile spasms are characterized by sudden flexion of the arms, forward flexion of the trunk, and extension of the legs. Seizures last a few seconds and recur many times a day. They occur only in the 1st 5 years of life, then are replaced by other types of seizures. Developmental defects are usually present.
Absence seizures do not present until age 1-8 years. Febrile seizures would occur when the child has a fever.
What is the most suggestive sign of selective mutism in a child?
Selective Mutism (SM) is a complex childhood anxiety disorder characterized by a child’s inability to speak in select social settings, such as school. These children understand language and are able to talk normally in settings where they are comfortable, secure and relaxed.
Over 90% of children with SM also have social phobia or social anxiety, and some experts view SM as a symptom of social anxiety. What is clear is that children and adolescents with SM have an actual fear of speaking and of social interactions where there is an expectation to talk.
A child meets the criteria for selective mutism if the following are true:
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