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Chapter 22. Upper Respiratory Tract Infections

Select the upper respiratory tract condition that is defined as the presence of fluid in the middle ear without symptoms of acute illness.

a. OME

b. Sinusitis

c. Pharyngitis

d. Laryngitis

e. Rhinitis

Answer a is correct. OME is the presence of fluid in the middle ear without symptoms of acute illness. It is important to differentiate between OME and AOM because antimicrobials are only useful for AOM. AOM is a symptomatic middle ear infection that occurs rapidly with effusion.

Answer b is incorrect. Sinusitis is an inflammation and/or infection of the paranasal sinus mucosa.

Answer c is incorrect. Pharyngitis is an acute throat infection caused by viruses or bacteria.

Answer d is incorrect. Laryngitis is a common and acute inflammation of the larynx that is usually caused by acute vocal strain, irritation of the mucosal surface of the larynx, or an URTI.

Answer e is incorrect. Rhinitis is the presence of any one of the following: sneezing, nasal congestion, rhinorrhea, or nasal itching.

JH is a 4-year-old patient that is brought to his pediatrician with a 36-hour history of rhinorrhea, nasal congestion, cough, and mild otalgia. He does not have any concurrent purulent conjunctivitis. His current temperature is 38°C (100.4°F). He has no known drug allergies and no known past medical conditions. He has not received amoxicillin in the previous 30 days. He is 36 lb. Which of the following would be the most appropriate option for JH?

a. Acetaminophen 10 mg/kg po qid prn

b. Amoxicillin 30 mg/kg po tid

c. Pseudoephedrine HCl 15 mg po qid

d. Diphenhydramine 6.25 mg po qid

e. Levofloxacin 10 mg/kg po bid

Answer a is correct. The most appropriate option for JH currently would be to watch and wait and provide adequate pain control. The patient is >2 years old; he had ear pain for <48 hours, and only has mild ear pain. Antimicrobials are not indicated at this time. The signs of rhinorrhea, nasal congestion and cough would also be consistent with viral etiology.

Answer b is incorrect. Antimicrobials are not indicated at this time.

Answer c is incorrect. There is limited literature to support efficacy in using decongestions for AOM. The potential risks outweigh the potential benefits and should not be recommended.

Answer d ...

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