The patient is a 5-year-old boy who presents with a 2-day history of fever and severe right ear pain. The mother reports that the child has a history of frequent (1)___________ ear infections. He recently had an upper respiratory (2)__________ infection and over the past 2 days has developed fever and pain in his right ear. There is no drainage from the ear. The mother reports that the child has

Question

had a similar episode in the past, with development of ear drainage, which required treatment with antibiotics.

On examination, the child is not at all ill appearing. The examination of the left ear reveals that the external (3)__________ canal is clear, and the (4)__________ is retracted, with a small air-fluid level. Examination of the right ear reveals the external auditory canal to be clear. The right tympanic membrane is (5)__________ and bulging. (6)__________ cannot be visualized on the right tympanic membrane. The nose is without masses or purulence. The oropharynx and oral cavity are without erythema, masses, or (7)__________. The neck reveals multiple small, nontender nodes.

Audiogram reveals bilateral mild conductive hearing loss, with a flat (8)__________ on the right and a negative middle ear pressure on tympanometric testing of the left ear.

In summary, the patient has a right acute otitis media and an early left (9)__________ otitis media. He has been treated with Augmentin 200 mg/tsp 1 tsp p.o. b.i.d. and is to use Children’s Tylenol as needed for fever. He is to follow up in this office in 3 weeks. The mother is to call immediately if he develops any high fever, ear drainage, severe pain, or develops any (10)__________, or appears very ill.

Answer 1

1. intermittent
2. tract
3. auditory
4. TM
5. erythematous
6. Landmarks
7. exudate
8. tympanogram
9. serous
10. lethargy