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“Increased irritability and right ear pain.”
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History of Present Illness
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JL is a 22-month-old female who presents to her primary care provider (PCP) with a 2-day history of rhinorrhea and a 1-day history of increased irritability, fever (to 101.5°F per Mom), and right-ear tugging. Mom denies that JL has had any nausea, vomiting, or diarrhea.
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Full-term birth via spontaneous vaginal delivery. Hospitalized at 9 months of age for respiratory syncytial virus–associated bronchiolitis. Two episodes of acute otitis media (AOM), with last episode about 6 months earlier.
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Lives with mother, father, and her 5-year-old brother who attends kindergarten. JL attends daycare 2 d/wk, and stays at home with maternal grandmother 3 d/wk.
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Vital Signs (while crying)
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Temp 100.7°F, P 140 bpm, RR 35, BP 100/57 mm Hg, Ht 81 cm, Wt 23.7 kg
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Fussy, but consolable by Mom; well-appearing
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Normocephalic, atraumatic, moist mucous membranes, normal conjunctiva, clear rhinorrhea, moderate bulging and erythema of right tympanic membrane with middle-ear effusion
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Good air movement throughout, clear breath sounds bilaterally
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Normal rate and rhythm, no murmur, rub or gallop
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Soft, non-distended, non-tender, active bowel sounds
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Normal female genitalia, no dysuria or hematuria
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Alert and appropriate for age
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1. Which of the following clinical criteria is not part of the diagnostic evaluation or staging of acute otitis media (AOM) for this patient?
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D. Contour of the tympanic membrane
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2. Which of the following is a risk factor for AOM?
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