NURS 621 Midterm Exam 2026/2027 ACCURATE
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Dx: Acute otitis media H&P:
• Ear pain (typical)
• Decreased hearing (typical)
• Fever (sometimes)
• Recent URI or exacerbation of seasonal allergic
rhinitis (can be)
• Unilateral (usual)
• Bulging tympanic membrane (needed to
distinguish from otitis media with effusion). Can
also be erythematous or opacified. Tympanic
membrane can rupture (feels relief of ear pain,
may then have purulent otorrhea)
• Dysequilibrium (not common)
• Conductive hearing loss (usually transient)
• High fever, severe pain behind ear, facial
paralysis (unusual complications)
,DDx Otitis Media • Otitis externa
o More painful, normal-appearing ear drum
• Eustachian tube dysfunction
o Check if recurrent unilateral AOM (>2 over 6
months). Do fiberoptic nasopharyngoscopy
and/or contrast MRI of skull base to rule out
malignant process
• Herpes zoster infection
o Development of dermatomal vesicular rash that
evolves into crusted lesions. Pain may precede
rash. Ramsay Hunt syndrome presents with triad
of ipsilateral facial paralysis, ear pain, and vesicles
involving auditory canal and auricle. Can cause
vertigo
Lab/diagnostics Otitis Media • Common organism: strep pneumoniae, H.
influenza. Group A beta-hemolytic strep, staph
aureus, M. catarrhalis less frequently
• Otoscopic exam (standard)
o Redness, opacification, bulging TM
o Otitis media with effusion: TM cloudy, yellowish
or opaque when fluid in middle ear
• Pneumatoscopy (allows eval of tympanic
membrane motion)
• Weber (demonstrates conductive hearing loss)
o Perceived louder in infected ear (common)
o If sensorineural loss, sound may lateralize in
noninfected ear (rare)
, Txt Plan Otitis Media • Amoxicillin: 500 mg Q12 hours or 250 mg Q 8
hours 10 days...if severe: 875 mg Q12 hours or 500
mg TID 5-7 days
• Augmentin (if amoxicillin fails. Tx for another 10
days)
• PCN allergy:
o Cefdinir (3rd gen cephalosporin): 300 mg BID
or 600 mg once daily
o Cefpodoxime 200 mg BIC
o Cefuroxime (2nd gen): 500 mg Q12 hours
o Ceftriaxone (3rd gen): 2 g IM or IV once
• Severe allergy to beta-lactam:
o Macrolide: erythromycin, azithromycin,
clarithromycin
F/U Otitis Media • Should start to improve within 48 to 72 hours - if
no improvement should be re-examined
Edu Otitis Media • If TM ruptures, it will heal in most cases. Tx with
oral and topical abx (ofloxacin)
• Most effusions will resolve over 12 weeks - use
oral decongestants
Viral Conjunctivitis o Viral:
Injection, watery discharge during the day, scant,
stringy that is mucus rather than pus. Burning,
sandy, or gritty feelin gin one eye. Morning
crusting with scant mucus throughout the day.
Second eye usually becomes involved within 24-
48 hours
Usually gets worse for the 1st 3-5 days, with
gradual resolution over the following 1 or 2 weeks
for total course of 2-3 weeks.
QUESTIONS WITH CORRECT DETAILED
SOLUTIONS || 100% GUARANTEED PASS
NEWEST VERSION
Save
Terms in this set (83)
Dx: Acute otitis media H&P:
• Ear pain (typical)
• Decreased hearing (typical)
• Fever (sometimes)
• Recent URI or exacerbation of seasonal allergic
rhinitis (can be)
• Unilateral (usual)
• Bulging tympanic membrane (needed to
distinguish from otitis media with effusion). Can
also be erythematous or opacified. Tympanic
membrane can rupture (feels relief of ear pain,
may then have purulent otorrhea)
• Dysequilibrium (not common)
• Conductive hearing loss (usually transient)
• High fever, severe pain behind ear, facial
paralysis (unusual complications)
,DDx Otitis Media • Otitis externa
o More painful, normal-appearing ear drum
• Eustachian tube dysfunction
o Check if recurrent unilateral AOM (>2 over 6
months). Do fiberoptic nasopharyngoscopy
and/or contrast MRI of skull base to rule out
malignant process
• Herpes zoster infection
o Development of dermatomal vesicular rash that
evolves into crusted lesions. Pain may precede
rash. Ramsay Hunt syndrome presents with triad
of ipsilateral facial paralysis, ear pain, and vesicles
involving auditory canal and auricle. Can cause
vertigo
Lab/diagnostics Otitis Media • Common organism: strep pneumoniae, H.
influenza. Group A beta-hemolytic strep, staph
aureus, M. catarrhalis less frequently
• Otoscopic exam (standard)
o Redness, opacification, bulging TM
o Otitis media with effusion: TM cloudy, yellowish
or opaque when fluid in middle ear
• Pneumatoscopy (allows eval of tympanic
membrane motion)
• Weber (demonstrates conductive hearing loss)
o Perceived louder in infected ear (common)
o If sensorineural loss, sound may lateralize in
noninfected ear (rare)
, Txt Plan Otitis Media • Amoxicillin: 500 mg Q12 hours or 250 mg Q 8
hours 10 days...if severe: 875 mg Q12 hours or 500
mg TID 5-7 days
• Augmentin (if amoxicillin fails. Tx for another 10
days)
• PCN allergy:
o Cefdinir (3rd gen cephalosporin): 300 mg BID
or 600 mg once daily
o Cefpodoxime 200 mg BIC
o Cefuroxime (2nd gen): 500 mg Q12 hours
o Ceftriaxone (3rd gen): 2 g IM or IV once
• Severe allergy to beta-lactam:
o Macrolide: erythromycin, azithromycin,
clarithromycin
F/U Otitis Media • Should start to improve within 48 to 72 hours - if
no improvement should be re-examined
Edu Otitis Media • If TM ruptures, it will heal in most cases. Tx with
oral and topical abx (ofloxacin)
• Most effusions will resolve over 12 weeks - use
oral decongestants
Viral Conjunctivitis o Viral:
Injection, watery discharge during the day, scant,
stringy that is mucus rather than pus. Burning,
sandy, or gritty feelin gin one eye. Morning
crusting with scant mucus throughout the day.
Second eye usually becomes involved within 24-
48 hours
Usually gets worse for the 1st 3-5 days, with
gradual resolution over the following 1 or 2 weeks
for total course of 2-3 weeks.
