Physical Examination and Laboratory Tests general: Patient lying supine; WDWN yo

Question

Physical Examination and Laboratory Tests

general:

Patient lying supine; WDWN young female; Now crying with intermittent screaming

Vital signs:

BP= 105/65; RR= 35; WT= 20 lbs; HR= 145; T= 102 degrees F with ibuprofen; HT= 30 in

Head, eyes, ears, nose, and throat

pupils equal at 3 mm, round, responsive to light and accommodation; (+) tears; both TMs bulging with no mobility; left TM is yellow and opaque and there appears to be some purulent fluid behind it; right TM is erythematous; no otorrhea present; nares patent with no discharge; throat shows significant erythema

neck/lymph nodes

neck supple with no apparent pain or stiffness with movement; no lymphadenopathy

chest

clear to auscultation bilaterally without crackles or wheezes; chest wall rise is symmetric

cardiac

regular rate and rhythm with no murmurs, rubs, or gallops

abdomen

soft, non-tender, and non-distended; (+) bowl sounds; (-) hepatosplenomegaly and masses

genitalia

normal-appearing external genitalia

extremities

20 digits; no cyanosis, clubbing, or edema; brachial pulses palpable; capliiary refill WNL; moves all extremities well; skin is warm and pink with no rashes or lesions

neurologic

responsive to stimulation; depp tendon reflexes 2+ throughout; cranial nerves intact; hearing appears intact; motor exam shows normal muscle tone and bulk; facial strength appears symmetric and normal

lab blood test results

WBC= 12,100/mm^3; lymphs= 21%; Eos= 1%; Plt= 270,000/mm^3; Neutros= 75%; Monos= 3%; RBC= 5.0 million/mm^3; ESR= 18 mm/hr

Question: Would prophylactic antibiotics be appropriate for this patient?

Explanation / Answer

Physical examination reveals normal except changes in TM (both TMs bulging with no mobility; left TM is yellow and opaque and there appears to be some purulent fluid behind it; right TM is erythematous; no otorrhea present; nares patent with no discharge; throat shows significant erythema).

Vital signs shows the child is febrile (T= 102 degrees F with ibuprofen).the other parameters were normal.

The blood investigations were normal.

This shows a suspection of acute otitis media.But this cannot be accepted as a complete diagnosis in a febrile child.

As acute otitis media is very common in childhood.75% of children will have atleast one episode in their .

school age.

So, using prophylactic antibiotics is not recommended.

Prophylactic antibiotics wouldnt be appropriate for this patient.

Symptomatic treatment woould be beneficial for this patient.

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