PANCE: 3-year-old Boy with Persistent Fever and Worsening Ear Pain
Über den Vortrag
Der Vortrag „PANCE: 3-year-old Boy with Persistent Fever and Worsening Ear Pain“ von John Albanese, DMSc, MPA, PA-C ist Bestandteil des Kurses „PANCE Question Walkthroughs“.
Quiz zum Vortrag
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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Dozent des Vortrages PANCE: 3-year-old Boy with Persistent Fever and Worsening Ear Pain
John Albanese, DMSc, MPA, PA-C
Dr. John Albanese is a Clinical Assistant Professor of Physician Assistant Education at Fairleigh Dickinson University and Coordinator of Assessment & Remediation. He is the course director for various courses including Emergency Medicine, Technical Skills, Health Law & Professional Practice, and Clinical Reasoning & Problem Solving.
Prior to his academic career, Dr. Albanese served as a firefighter and EMT before transitioning to clinical practice as a physician assistant. He held diverse clinical positions in emergency medicine, urgent care, trauma/surgical critical care, rapid response, and internal medicine at Hackensack University Medical Center. During his tenure in the emergency department, Dr. Albanese served as the lead preceptor for Seton Hall PA students. His clinical excellence was recognized when he received the New Jersey Physician Assistant of the Year award in 2016. Dr. Albanese has also contributed to professional leadership, serving as both a member and later as Vice President of the New Jersey State Society of Physician Assistants (NJSSPA).
Within Lecturio, Dr. Albanese provides instruction to current PA students preparing for the PANCE examination.
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