Examl 3:l NU641/l NUl 641l (Latestl 2025/l
2026l Update)l Advancedl Clinicall
Pharmacologyl Review|l Questionsl &l
Answers|l Gradel A|l 100%l Correctl
(Verifiedl Solutions)-l Regis
Q:l acutel otitisl media
Answer:
causedl byl estachianl tubel dysfunctionl blockingl thel flowl ofl secretionsl froml thrl middlel
earl tol thel pharynxl andl negaativel pressurel causingl refluxl ofl bacterial intol middlel earl
-occursl primariyl nl childrenl underl 5l yearsl oldl (tubel isl narrowerl andl straghter,l andl
horizontal)
pathogens:l sl pneumoniae,l nontypeablel hl influenze,l ml catarrhalis
l microbiologyl isl changingl duel tol pneumococcall conjugatel vaccinel (PCV)l vaccine
-hl influenzael increasing,l sl pneuomonial decreasing
-respiratoryl virusesl accountl forl 40l tol 75%l ofl AOMl casesl inl children
Q:l AOMl treatmentl guidelines
Answer:
diagnosis
-moderatel tol severel bulgingl ofl thel TMl orl newl onsetl ofl otorrheal notl duel tol acutrel
otitisl externa
-mildl bulgingl ofl thel TMl andl recentl (lessl thanl 48l hours)l ofl onsetl ofl earl painl orl
intensel erythemal ofl thel TM
-nol diagnosisl ofl AOMl inl childrenl whol dol notl havel MEE
startingl antiboitcs:
Childrenl <6l monthsl ofl agel orl anyl childl immunocompromisedl -l immediatel therapyl >l
initiall observation
Optional:l Immediatel therapyl inl alll childrenl <2l yearsl ofl agel forl anyl severityl type
Childrenl ≥6l monthsl orl ≥2l years
Severel AOM:l moderatel tol severel otalgia,l otalgial >48l hours,l orl templ ≥102.2l F
Ifl initiall observation,l mayl bel prescribedl withl closel follow-upl withinl 48-72l hoursl basedl
onl jointl decisionl withl caregiver.
,Shouldl bel prescribedl ifl failsl tol improvel orl worsens
Q:l AOMl treatmentl guidelines
Answer:
Childrenl <6l monthsl ofl agel orl anyl childl immunocompromisedl -l immediatel therapyl >l
initiall observation
Optional:l Immediatel therapyl inl alll childrenl <2l yearsl ofl agel forl anyl severityl type
Childrenl ≥6l monthsl orl ≥2l years
Severel AOM:l moderatel tol severel otalgia,l otalgial >48l hours,l orl templ ≥102.2l F
Ifl initiall observation,l mayl bel prescribedl withl closel follow-upl withinl 48-72l hoursl basedl
onl jointl decisionl withl caregiver.
Shouldl bel prescribedl ifl failsl tol improvel orl worsens
Q:l antibioticl treatmentl forl AOMl treatmentl guidelines
Answer:
antibiotics
-amoaxillinl 90mg/kg/day
-PCNl allergy:l cefindir,l ceftriaxonel IMl etc
-amoxillinl inl thel pastl 30l days,l recurrentl AOM,l usel amoxillin/clavulanatel (augmentin)
treatmentl failure:
-treatedl withobservation:l startl antibiotics
-treatedl withl amoxcillin/clauvanate
-treatedl withl alternative:l changel antibiotics
course
-10l daysl forl kidsl underl 2,l TMl perfl orl recurrentl AOM
-l 5-7l daysl forl childrenl >l 2l ,l notl TMl andl nol recurrentl AOM
-forl ceftiazone;l 1-3l doses,l depednignl uponl persistancel ofl symptoms
preventionl ofl AOM:l recommendl pneuoumoccall vaccinel (PCV)l anl annuall influenzal
vaccinel tol alll children,l breastfeedingl forl thel firstl 6l monthsl ofl life,l andl reducingl
exposurel tol tobaccol smoke
Q:l lookl atl AOMl grid
Answer:
,Q:l AOMl painl managementl andl monitoring
Answer:
-l acetaminopenl 15mg/kgl perl dose
-ibuprofenl (5-10l mg/kgl perl dose)l -agel >l 6l mos
rexaminel patientsl afterl 48-72l hrsl isl symptomsl dol notl improve
patientsl <l 2:l reexaminel inl 8-12l weeks,l mayl stilll bel fluidl inl thel ears,l canl lastl upl tol 3l
months
Q:l First-linel treatmentl forl anl afebrilel 2-year-oldl withl otitisl medial wouldl include:
A.Azithromycinl (Zithromax)
B.Amoxicillinl (Amoxil)
C.Ceftriaxonel (Rocephin)
D.Sulfamethoxazole/Trimethopriml (Bactrim)
Answer:
b
Q:l Whetherl prescribingl anl antibioticl forl al childl withl acutel otitisl medial orl not,l thel
parentsl shouldl bel educatedl about:
A.Usingl decongestantsl tol providel fasterl symptoml relief
B.Providingl adequatel painl reliefl forl atl leastl thel firstl 24l hours
C.Usingl complementaryl treatmentsl forl acutel otitisl media,l suchl asl garlicl oil
D.Administeringl anl antihistamine/decongestantl combinationl (Dimetapp)l sol thel childl canl
sleepl better
Answer:
b
Q:l First-linel therapyl forl al patientl withl acutel otitisl external (swimmer'sl ear)l andl anl
intactl tympanicl membranel includes:
A.Swim-Earl drops
B.Ciprofloxacinl andl hydrocortisonel dropsl (Cipro-HC)
C.Amoxicillin
D.Gentamicinl ophthalmicl drops
, Answer:
b
Q:l basicl principlesl ofl topicall antiinfectives
Answer:
mostl commonl pathogens
-bacterial [mostl common]:l staphl aureusl [mostl peoplel arel colonizedl atl somel point],l strepl
pyogenes,l graml negl infectionsl arel morel rarel andl morel likelyl inl immunocompromisedl
person
-fungus:l candidal andl dermatophytel (causel tinea)
-viral:l HSVl
culturel ifl youl aren'tl sure
treatl emperically
followl progressl andl culture
watchl forl resistance
Q:l topicall antibacterials
Answer:
rxl only
-muprocinl (bactroban):l MRSAl coverage,l firstl linel forl impetigol inl milderl forml ****
-retapamulinl (Altabax)-l MSSAl (methicillin-susceptiblel Staphylococcusl aureus),l Sl pyogensl
coverage,l $,l fairlyl narrowl coverage,l nol genericl available
OTC
-bacitracin:l MSSA,l sl pyogenesl coverage
-doublel antibitoics:l bacitracin/polymyxinl Bl (polysporin),l graml -l coverage
-triplel antibitotic:l bacitracin/polymyxinl b/l neomycinl (neosporin)-l mayl havel somel
sensitivityl
polymyxinl bl expandsl tol coverl graml negl organismsl includingl pl aeroginosa,l el coli,l
klebsiella
Q:l monitoringl withl topicall antibacterials
Answer:
shouldl seel improvementl withinl 24-48l hours,l resolutionl inl 3-5l days
2026l Update)l Advancedl Clinicall
Pharmacologyl Review|l Questionsl &l
Answers|l Gradel A|l 100%l Correctl
(Verifiedl Solutions)-l Regis
Q:l acutel otitisl media
Answer:
causedl byl estachianl tubel dysfunctionl blockingl thel flowl ofl secretionsl froml thrl middlel
earl tol thel pharynxl andl negaativel pressurel causingl refluxl ofl bacterial intol middlel earl
-occursl primariyl nl childrenl underl 5l yearsl oldl (tubel isl narrowerl andl straghter,l andl
horizontal)
pathogens:l sl pneumoniae,l nontypeablel hl influenze,l ml catarrhalis
l microbiologyl isl changingl duel tol pneumococcall conjugatel vaccinel (PCV)l vaccine
-hl influenzael increasing,l sl pneuomonial decreasing
-respiratoryl virusesl accountl forl 40l tol 75%l ofl AOMl casesl inl children
Q:l AOMl treatmentl guidelines
Answer:
diagnosis
-moderatel tol severel bulgingl ofl thel TMl orl newl onsetl ofl otorrheal notl duel tol acutrel
otitisl externa
-mildl bulgingl ofl thel TMl andl recentl (lessl thanl 48l hours)l ofl onsetl ofl earl painl orl
intensel erythemal ofl thel TM
-nol diagnosisl ofl AOMl inl childrenl whol dol notl havel MEE
startingl antiboitcs:
Childrenl <6l monthsl ofl agel orl anyl childl immunocompromisedl -l immediatel therapyl >l
initiall observation
Optional:l Immediatel therapyl inl alll childrenl <2l yearsl ofl agel forl anyl severityl type
Childrenl ≥6l monthsl orl ≥2l years
Severel AOM:l moderatel tol severel otalgia,l otalgial >48l hours,l orl templ ≥102.2l F
Ifl initiall observation,l mayl bel prescribedl withl closel follow-upl withinl 48-72l hoursl basedl
onl jointl decisionl withl caregiver.
,Shouldl bel prescribedl ifl failsl tol improvel orl worsens
Q:l AOMl treatmentl guidelines
Answer:
Childrenl <6l monthsl ofl agel orl anyl childl immunocompromisedl -l immediatel therapyl >l
initiall observation
Optional:l Immediatel therapyl inl alll childrenl <2l yearsl ofl agel forl anyl severityl type
Childrenl ≥6l monthsl orl ≥2l years
Severel AOM:l moderatel tol severel otalgia,l otalgial >48l hours,l orl templ ≥102.2l F
Ifl initiall observation,l mayl bel prescribedl withl closel follow-upl withinl 48-72l hoursl basedl
onl jointl decisionl withl caregiver.
Shouldl bel prescribedl ifl failsl tol improvel orl worsens
Q:l antibioticl treatmentl forl AOMl treatmentl guidelines
Answer:
antibiotics
-amoaxillinl 90mg/kg/day
-PCNl allergy:l cefindir,l ceftriaxonel IMl etc
-amoxillinl inl thel pastl 30l days,l recurrentl AOM,l usel amoxillin/clavulanatel (augmentin)
treatmentl failure:
-treatedl withobservation:l startl antibiotics
-treatedl withl amoxcillin/clauvanate
-treatedl withl alternative:l changel antibiotics
course
-10l daysl forl kidsl underl 2,l TMl perfl orl recurrentl AOM
-l 5-7l daysl forl childrenl >l 2l ,l notl TMl andl nol recurrentl AOM
-forl ceftiazone;l 1-3l doses,l depednignl uponl persistancel ofl symptoms
preventionl ofl AOM:l recommendl pneuoumoccall vaccinel (PCV)l anl annuall influenzal
vaccinel tol alll children,l breastfeedingl forl thel firstl 6l monthsl ofl life,l andl reducingl
exposurel tol tobaccol smoke
Q:l lookl atl AOMl grid
Answer:
,Q:l AOMl painl managementl andl monitoring
Answer:
-l acetaminopenl 15mg/kgl perl dose
-ibuprofenl (5-10l mg/kgl perl dose)l -agel >l 6l mos
rexaminel patientsl afterl 48-72l hrsl isl symptomsl dol notl improve
patientsl <l 2:l reexaminel inl 8-12l weeks,l mayl stilll bel fluidl inl thel ears,l canl lastl upl tol 3l
months
Q:l First-linel treatmentl forl anl afebrilel 2-year-oldl withl otitisl medial wouldl include:
A.Azithromycinl (Zithromax)
B.Amoxicillinl (Amoxil)
C.Ceftriaxonel (Rocephin)
D.Sulfamethoxazole/Trimethopriml (Bactrim)
Answer:
b
Q:l Whetherl prescribingl anl antibioticl forl al childl withl acutel otitisl medial orl not,l thel
parentsl shouldl bel educatedl about:
A.Usingl decongestantsl tol providel fasterl symptoml relief
B.Providingl adequatel painl reliefl forl atl leastl thel firstl 24l hours
C.Usingl complementaryl treatmentsl forl acutel otitisl media,l suchl asl garlicl oil
D.Administeringl anl antihistamine/decongestantl combinationl (Dimetapp)l sol thel childl canl
sleepl better
Answer:
b
Q:l First-linel therapyl forl al patientl withl acutel otitisl external (swimmer'sl ear)l andl anl
intactl tympanicl membranel includes:
A.Swim-Earl drops
B.Ciprofloxacinl andl hydrocortisonel dropsl (Cipro-HC)
C.Amoxicillin
D.Gentamicinl ophthalmicl drops
, Answer:
b
Q:l basicl principlesl ofl topicall antiinfectives
Answer:
mostl commonl pathogens
-bacterial [mostl common]:l staphl aureusl [mostl peoplel arel colonizedl atl somel point],l strepl
pyogenes,l graml negl infectionsl arel morel rarel andl morel likelyl inl immunocompromisedl
person
-fungus:l candidal andl dermatophytel (causel tinea)
-viral:l HSVl
culturel ifl youl aren'tl sure
treatl emperically
followl progressl andl culture
watchl forl resistance
Q:l topicall antibacterials
Answer:
rxl only
-muprocinl (bactroban):l MRSAl coverage,l firstl linel forl impetigol inl milderl forml ****
-retapamulinl (Altabax)-l MSSAl (methicillin-susceptiblel Staphylococcusl aureus),l Sl pyogensl
coverage,l $,l fairlyl narrowl coverage,l nol genericl available
OTC
-bacitracin:l MSSA,l sl pyogenesl coverage
-doublel antibitoics:l bacitracin/polymyxinl Bl (polysporin),l graml -l coverage
-triplel antibitotic:l bacitracin/polymyxinl b/l neomycinl (neosporin)-l mayl havel somel
sensitivityl
polymyxinl bl expandsl tol coverl graml negl organismsl includingl pl aeroginosa,l el coli,l
klebsiella
Q:l monitoringl withl topicall antibacterials
Answer:
shouldl seel improvementl withinl 24-48l hours,l resolutionl inl 3-5l days
