NR 511 ACUTE OTITIS EXTERNA CPG
PRACTICE QUESTIONS WITH SOLUTIONS 2026
◉ otitis externa (swimmers ear). Answer: -Pseudomonas (copious
green exudate). Staph (yellow crusting with purulent exudate)
-risk: summer months, immunocompromised, environmental
changes highly chlorinated water, excess moisture, not enough ear
wax
-S: acute, severe, pain, may be bilateral, may be worse at night, may
be itchy
-O: worse when pulling the pinna or lobe or pressure on tragus. Red,
swollen canal preventing full visualization of the TM, purulent
drainage
-dx: Usually not needed. May culture exudate. CT scan to assess soft
tissue or bone involvement.
-tx:heat/ice, APAP, NSAIDs, (Cipro/dexameth otic & oflox safe for
perf TM), (Chlor/pramo/hydrocort & cortisporin- not safe for
ruptured TM), PO Cipro
-edu: keep ear dry & avoid swimming x4-6 weeks (shower caps, ear
plugs), prophylactic acetic acid solution
◉ Otitis media. Answer: -risk:children, allergies, sinusitis, rhinitis,
pharyngitis, recurrent URI, influenza, RSV, differences in child
anatomy, downs syndrome, perforation of TM, child in daycare,
smoking in the house, living where s. pneumoniae are endemic
,-S: OME-stuffiness, fullness, loss of auditory acuity. Pain is rare.
popping, crackling when chewing, yawning, or blowing nose. AOM-
deep pain, fever. dizziness, vertigo, tinnitus, n/v
-O:
-dx:none-
-tx:no daycare= Amox 45 mg/kg/day. daycare=90 mg/kg/day OR
cefuroxime, clarithromycin
-edu:avoid swimming, no cotton swabs, avoid blowing nose, stop
smoking at home, avoid "sweet oil", OM not contagious
◉ Mononucleosis. Answer: -Epstein-Barr virus or CMV
-Risk: teens/young adults, kissing, crowded living conditions
-S: prolonged malaise, fatigue, fever, sore throat, tender cervical
lymph nodes, n/v, HA
-O: mpost cervical, axillary and inguinal adenopathy, nuchal
stiffness, enlarged tonsils, splenomegaly, enlarged liver
-Dx: CBC, serum chemistries, heterophile antibody test (monospot),
transaminase levels elevated, thrombocytopenia and neutropenia
-Tx: supportive care, NSAIDs, APAP, fluids, throat lozenges
-Edu: symptoms of splenic rupture, no contact sports x4 weeks,
avoid ETOH x3 months
◉ presbycusis. Answer: -Age-related hearing loss. > 50yo
- affect high frequency sounds
, - Bilateral
- no tx, but prevent further damage, hearing aids
◉ Rhinosinusitis- Bacterial or viral. Answer: -risk: bacterial
infections- streptococcus pneumoniae OR URI, rhinovirus, winter,
spring, fall
-S: recurrent, dull, constant sinus pain. then, throbbing pain, goes to
cheeks and upper teeth, worse when coughing, nasal congestion,
rhinorrhea, pressure, cough, fatigue, maxillary toothache
-O:total opacification of affected sinuses on transillumination, red,
swollen, mucosa, tender sinuses,
-dx:none- exam
-tx: NS flushes 2+ x/day, APAP, ibuprofen, phenylephrine spray only
3-4 days, sudafed, guaifenesin, flonase, no oral antihistamines. BACT:
augmentin, clarithromycin
-edu: call if periorbital swelling
◉ Nasal polyps. Answer: -Risk:poorly controlled rhinitis
-Gray-blue to yellow-tan polyps present with perennial rhinitis
- Cause mechanical obstruction
-tx: treat all respiratory infections, surgery -to remove polyps
◉ Streptococcus. Answer: -May lead to scarlet fever if not treated
-risk: usually <25 yo, winter & spring
PRACTICE QUESTIONS WITH SOLUTIONS 2026
◉ otitis externa (swimmers ear). Answer: -Pseudomonas (copious
green exudate). Staph (yellow crusting with purulent exudate)
-risk: summer months, immunocompromised, environmental
changes highly chlorinated water, excess moisture, not enough ear
wax
-S: acute, severe, pain, may be bilateral, may be worse at night, may
be itchy
-O: worse when pulling the pinna or lobe or pressure on tragus. Red,
swollen canal preventing full visualization of the TM, purulent
drainage
-dx: Usually not needed. May culture exudate. CT scan to assess soft
tissue or bone involvement.
-tx:heat/ice, APAP, NSAIDs, (Cipro/dexameth otic & oflox safe for
perf TM), (Chlor/pramo/hydrocort & cortisporin- not safe for
ruptured TM), PO Cipro
-edu: keep ear dry & avoid swimming x4-6 weeks (shower caps, ear
plugs), prophylactic acetic acid solution
◉ Otitis media. Answer: -risk:children, allergies, sinusitis, rhinitis,
pharyngitis, recurrent URI, influenza, RSV, differences in child
anatomy, downs syndrome, perforation of TM, child in daycare,
smoking in the house, living where s. pneumoniae are endemic
,-S: OME-stuffiness, fullness, loss of auditory acuity. Pain is rare.
popping, crackling when chewing, yawning, or blowing nose. AOM-
deep pain, fever. dizziness, vertigo, tinnitus, n/v
-O:
-dx:none-
-tx:no daycare= Amox 45 mg/kg/day. daycare=90 mg/kg/day OR
cefuroxime, clarithromycin
-edu:avoid swimming, no cotton swabs, avoid blowing nose, stop
smoking at home, avoid "sweet oil", OM not contagious
◉ Mononucleosis. Answer: -Epstein-Barr virus or CMV
-Risk: teens/young adults, kissing, crowded living conditions
-S: prolonged malaise, fatigue, fever, sore throat, tender cervical
lymph nodes, n/v, HA
-O: mpost cervical, axillary and inguinal adenopathy, nuchal
stiffness, enlarged tonsils, splenomegaly, enlarged liver
-Dx: CBC, serum chemistries, heterophile antibody test (monospot),
transaminase levels elevated, thrombocytopenia and neutropenia
-Tx: supportive care, NSAIDs, APAP, fluids, throat lozenges
-Edu: symptoms of splenic rupture, no contact sports x4 weeks,
avoid ETOH x3 months
◉ presbycusis. Answer: -Age-related hearing loss. > 50yo
- affect high frequency sounds
, - Bilateral
- no tx, but prevent further damage, hearing aids
◉ Rhinosinusitis- Bacterial or viral. Answer: -risk: bacterial
infections- streptococcus pneumoniae OR URI, rhinovirus, winter,
spring, fall
-S: recurrent, dull, constant sinus pain. then, throbbing pain, goes to
cheeks and upper teeth, worse when coughing, nasal congestion,
rhinorrhea, pressure, cough, fatigue, maxillary toothache
-O:total opacification of affected sinuses on transillumination, red,
swollen, mucosa, tender sinuses,
-dx:none- exam
-tx: NS flushes 2+ x/day, APAP, ibuprofen, phenylephrine spray only
3-4 days, sudafed, guaifenesin, flonase, no oral antihistamines. BACT:
augmentin, clarithromycin
-edu: call if periorbital swelling
◉ Nasal polyps. Answer: -Risk:poorly controlled rhinitis
-Gray-blue to yellow-tan polyps present with perennial rhinitis
- Cause mechanical obstruction
-tx: treat all respiratory infections, surgery -to remove polyps
◉ Streptococcus. Answer: -May lead to scarlet fever if not treated
-risk: usually <25 yo, winter & spring
