PAEA PEDIATRICS EOR EXAM 8 SCRIPT 2026
QUESTIONS AND SOLUTIONS
COMPREHENSIVE STUDY SHEET FULL
PRACTICE SET
◉ what is the most common sinus infection (90%) that causes
secondary orbital cellulitis? what organisms are the cause?
Answer: ethmoid; S. aureus, Strep. pneumo, GABHS (Strep.
pyogenes), H. influenzae
◉ work up/Dx? decreased vision, pain w/ ocular movement,
proptosis (bulging eye), eyelid erythema and edema; tx?
Answer: dx: orbital cellulitis
work up: CT scan (showing infxn of fat & ocular muscles) or MRI
tx: IV antibiotics (Vanc, Clinda, Cefotaxime, Ampicillin/Sulbactam)
◉ what is the difference b/t orbital (septal) cellulitis and preseptal
cellulitis?
Answer: preseptal may still have ocular pain, redness and swelling
but NO visual changes or pain w/ ocular mvmt (hasn't affected the
muscles)
,◉ misalignment of the eyes is aka? when does stable ocular
alignment present in infants?
Answer: strabismus; 2-3 mos
◉ convergent strabismus is aka? divergent strabismus is aka?
Answer: convergent: esotropia (deviated inward "cross eyed")
divergent: exotropia (deviated ouward)
◉ a + Hirschberg corneal light reflex test, diplopia, scotomas (blind
spots), or amblyopia (lazy eye) are clinical manifestations of what
condition? what other tests can be performed?
Answer: strabismus; cover-uncover test to determine the angle of
strabismus, cover test, convergence testing
◉ how can strabismus be treated?
Answer: -patch therapy: normal eye is covered to stimulate and
strengthen the affected eye
-eyeglasses
-corrective therapy: if severe or unresponsive to conservative
therapy
if not treated before 2 y/o, amblyopia may occur and cause
decreased visual acuity that is not correctable
,◉ Dx? 1-2 days of ear pain, pruritis in the ear canal, auricular
discharge, pressure/fullness, hearing usually preserved, pain with
tug test and tragus pressure, auditory canal
erythema/edema/debris, recent swimming pool use; MC organisms?
Tx?
Answer: Dx: otitis externa
MC organisms: *pseudomonas*, proteus, s. aureus, s. epidermis,
GABHS, anaerobes (peptostreptococcus), aspergillus
Tx: 1. protect ear against moisture (isopropyl alcohol and acetic
acid) 2. ciprofloxacin/dexamethasone (ofloxacin safe if there is an
associated TM perf) 3. Aminoglycoside combo (neomycin/polytrim-
B/hydrocortisone -BUT not used if perf suspected bc ototoxic 4.
amphotericin B if fungal
◉ malignant otitis externa is osteomyelitis at the skull base
secondary to ___________ infxn; MC seen in what pt populations; Tx?
Answer: pseudomonas; MC in DM and immunocompromised pts; Tx
w/ IV Ceftazidime or Piperacillin + FQ or Aminoglycoside
◉ acute otitis media is an infection of the middle ear, temporal bone
and mastoid air cells that is MC preceded by
Answer: a viral URI that causes edema of eustachian tube, negative
pressure, transudation of fluid and mucus in middle ear that allows
for bacterial growth
, ◉ what are the 4 MC organisms seen in acute otitis media?
Answer: *Strep pneumo*, H. influenza, Moraxella catarrhalis, Strep
pyogenes (same as seen in acute sinusitis)
◉ Dx: fever, otalgia, ear tugging in infants, conductive hearing loss,
stuffiness, possible drainage from ear, bulging/erythematous TM w/
effusion, dec TM mobility on pneumatic otoscopy; Tx?
Answer: dx: acute otitis media
tx: 1st line- amoxicillin, 2nd line- augmentin (amoxicillin-clavulate);
if PCN allergy- azithromycin, clarithromycin, erythromycin-
sulfisoxazole, trimethoprim/sulfamethoxazole, if PCN adverse effect
but not allergy- ceftriaxone, cefdinir, cefixine
don't forget to treat pain as well (ibuprofen or tylenol); can also
perform myringotomy (surgical drainage) to relieve pain
tympanostomy if recurrent >4 times in 1 yr
◉ if bullae are seen on the TM of a pt with AOM what should you
suspect?
Answer: mycoplasma pneumoniae
◉ Dx? deep ear pain (worse at night), fever, mastoid tenderness and
possibly fluctuance (abscess), following AOM infxn; complications?
QUESTIONS AND SOLUTIONS
COMPREHENSIVE STUDY SHEET FULL
PRACTICE SET
◉ what is the most common sinus infection (90%) that causes
secondary orbital cellulitis? what organisms are the cause?
Answer: ethmoid; S. aureus, Strep. pneumo, GABHS (Strep.
pyogenes), H. influenzae
◉ work up/Dx? decreased vision, pain w/ ocular movement,
proptosis (bulging eye), eyelid erythema and edema; tx?
Answer: dx: orbital cellulitis
work up: CT scan (showing infxn of fat & ocular muscles) or MRI
tx: IV antibiotics (Vanc, Clinda, Cefotaxime, Ampicillin/Sulbactam)
◉ what is the difference b/t orbital (septal) cellulitis and preseptal
cellulitis?
Answer: preseptal may still have ocular pain, redness and swelling
but NO visual changes or pain w/ ocular mvmt (hasn't affected the
muscles)
,◉ misalignment of the eyes is aka? when does stable ocular
alignment present in infants?
Answer: strabismus; 2-3 mos
◉ convergent strabismus is aka? divergent strabismus is aka?
Answer: convergent: esotropia (deviated inward "cross eyed")
divergent: exotropia (deviated ouward)
◉ a + Hirschberg corneal light reflex test, diplopia, scotomas (blind
spots), or amblyopia (lazy eye) are clinical manifestations of what
condition? what other tests can be performed?
Answer: strabismus; cover-uncover test to determine the angle of
strabismus, cover test, convergence testing
◉ how can strabismus be treated?
Answer: -patch therapy: normal eye is covered to stimulate and
strengthen the affected eye
-eyeglasses
-corrective therapy: if severe or unresponsive to conservative
therapy
if not treated before 2 y/o, amblyopia may occur and cause
decreased visual acuity that is not correctable
,◉ Dx? 1-2 days of ear pain, pruritis in the ear canal, auricular
discharge, pressure/fullness, hearing usually preserved, pain with
tug test and tragus pressure, auditory canal
erythema/edema/debris, recent swimming pool use; MC organisms?
Tx?
Answer: Dx: otitis externa
MC organisms: *pseudomonas*, proteus, s. aureus, s. epidermis,
GABHS, anaerobes (peptostreptococcus), aspergillus
Tx: 1. protect ear against moisture (isopropyl alcohol and acetic
acid) 2. ciprofloxacin/dexamethasone (ofloxacin safe if there is an
associated TM perf) 3. Aminoglycoside combo (neomycin/polytrim-
B/hydrocortisone -BUT not used if perf suspected bc ototoxic 4.
amphotericin B if fungal
◉ malignant otitis externa is osteomyelitis at the skull base
secondary to ___________ infxn; MC seen in what pt populations; Tx?
Answer: pseudomonas; MC in DM and immunocompromised pts; Tx
w/ IV Ceftazidime or Piperacillin + FQ or Aminoglycoside
◉ acute otitis media is an infection of the middle ear, temporal bone
and mastoid air cells that is MC preceded by
Answer: a viral URI that causes edema of eustachian tube, negative
pressure, transudation of fluid and mucus in middle ear that allows
for bacterial growth
, ◉ what are the 4 MC organisms seen in acute otitis media?
Answer: *Strep pneumo*, H. influenza, Moraxella catarrhalis, Strep
pyogenes (same as seen in acute sinusitis)
◉ Dx: fever, otalgia, ear tugging in infants, conductive hearing loss,
stuffiness, possible drainage from ear, bulging/erythematous TM w/
effusion, dec TM mobility on pneumatic otoscopy; Tx?
Answer: dx: acute otitis media
tx: 1st line- amoxicillin, 2nd line- augmentin (amoxicillin-clavulate);
if PCN allergy- azithromycin, clarithromycin, erythromycin-
sulfisoxazole, trimethoprim/sulfamethoxazole, if PCN adverse effect
but not allergy- ceftriaxone, cefdinir, cefixine
don't forget to treat pain as well (ibuprofen or tylenol); can also
perform myringotomy (surgical drainage) to relieve pain
tympanostomy if recurrent >4 times in 1 yr
◉ if bullae are seen on the TM of a pt with AOM what should you
suspect?
Answer: mycoplasma pneumoniae
◉ Dx? deep ear pain (worse at night), fever, mastoid tenderness and
possibly fluctuance (abscess), following AOM infxn; complications?
