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Chapter 22. Upper Respiratory Tract Infections

Which upper respiratory tract condition is defined as the presence of fluid in the middle ear without symptoms of acute illness?

a. Otitis media with effusion (OME)

b. Rhinosinusitis

c. Acute pharyngitis

d. Laryngitis

e. Acute otitis media (AOM)

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 antibiotics are only useful for AOM. AOM is a symptomatic middle ear infection that occurs rapidly with effusion.

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

Answer c is incorrect. Acute pharyngitis is an acute throat infection caused by viruses or bacteria (group A β-hemolytic streptococci).

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 upper respiratory tract infection (URTI).

Answer e is incorrect. AOM is a symptomatic middle ear infection that occurs rapidly with inflammation and effusion.

JH is a 4-year-old patient (weight 36 lbs) who 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 past 30 days. Which of the following would be the most appropriate treatment 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. Antibiotics 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. Antibiotics are not indicated at this time.

Answer c is incorrect. There is limited literature to support efficacy in using decongestants for AOM. The potential risks ...

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