PANCE: 3-year-old Boy with Persistent Fever and Worsening Ear Pain
About the Lecture
The lecture PANCE: 3-year-old Boy with Persistent Fever and Worsening Ear Pain by John Albanese, DMSc, MPA, PA-C is from the course PANCE Question Walkthroughs.
Included Quiz Questions
What postauricular findings are classic for acute mastoiditis in AOM?
- Erythema, swelling, tenderness
- Cerumen impaction in canal
- Tragus pain on pressure
- Clear postauricular skin
- Isolated tympanic perforation
What auricular change strongly suggests acute mastoiditis?
- Protruding external ear
- Retracted external ear
- Flattened external ear
- Elevated external ear
- Rotated external ear
Which feature best differentiates acute mastoiditis from uncomplicated AOM?
- Postauricular edema and erythema
- Bulging tympanic membrane
- Middle ear effusion
- Mild intermittent otalgia
- Conductive hearing loss
After how long of no AOM improvement on amoxicillin should complications be suspected?
- 48–72 hours
- 6–12 hours
- 12–24 hours
- 5–7 days
- 10–14 days
What is the most appropriate initial procedure in suspected acute mastoiditis with failed AOM therapy?
- Tympanocentesis with culture
- Immediate mastoidectomy
- Myringotomy with tube placement
- CT temporal bone scan
- Serial audiometry testing
Tympanocentesis in acute mastoiditis is best described as:
- Diagnostic and therapeutic
- Purely diagnostic only
- Purely therapeutic only
- Screening and preventive
- Palliative and supportive
What is the recommended initial IV antibiotic approach for acute mastoiditis?
- Vancomycin plus third-gen cephalosporin
- Amoxicillin-clavulanate monotherapy
- Ciprofloxacin plus metronidazole
- Azithromycin monotherapy
- Penicillin G monotherapy
When should empiric IV antibiotics be started in relation to tympanocentesis cultures?
- Immediately after cultures drawn
- Before obtaining any cultures
- 24 hours after cultures
- After preliminary culture results
- Only if cultures are positive
When is mastoidectomy indicated in acute mastoiditis?
- Failure after 24–48h IV antibiotics
- Subperiosteal abscess on imaging
- Initial presentation of AOM
- Mild postauricular tenderness
- Negative imaging findings
When is CT of the temporal bones with contrast most appropriate in acute mastoiditis?
- Suspected intracranial complications
- All uncomplicated AOM cases
- Routine mastoiditis screening
- Before physical examination
- After symptom resolution
Which measures help prevent AOM and mastoiditis complications?
- PCV13 vaccination
- Annual influenza vaccination
- Reducing secondhand smoke exposure
- Avoiding all water activities
- Daily oral antibiotic prophylaxis
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Author of lecture PANCE: 3-year-old Boy with Persistent Fever and Worsening Ear Pain
John Albanese, DMSc, MPA, PA-C
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