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NR511-Midterm iStudyguide
Week iOne
- Define idiagnostic ireasoning: iprocess iof idata igeneration iand iclustering, ihypothesis igeneration, iprobabilistic ireasoning, ipattern imatching, iplanning, iproblem-solving, iand icritical ireflection. o i i i iDiagnostic ireasoning ithen iincludes ia isystematic iway iof ithinking ithat ievaluates ieach inew ipiece iof idata ias iit ieither isupports isome idiagnostic ihypothesis ior ireduces ithe ilikelihood iof iothers. iBased ion iexperience. iCritical ithinking OR A iscientific iprocess iin iwhich ipractitioners isuspect ithe icause iof isymptoms iand isignsibased ion iprevious iknowledge.
- Identify isubjective i& iobjective idata. subjective: ithing ithe ipt ireports o objective: ithings iI iobserve, ixrays, ilabs, ivitals OR A: iSubjective idata iis ianything ithe ipatient itells ithe ipractitioner. iObjective idata iis ianything ithe ipractitioner ihears, isees, ifeels ior ismells iduring ithe ipatient;s iexamination.
- Identify ithe icomponents iof ithe iHPI. Chief icomplaint iand irelated iissues; iOLDCART
- Develop ian iappropriate idifferential. a. things ithat iare icommon iand ithings ithat ican ikill ilist b. about i 3 OR : iA idifferential idiagnosis ilist iis ia ilist iof ipossible idiagnoses iin iorder iof ipriority. iIn ideveloping ian iappropriate idifferential, iconsider i“skin iin”, iafter icomplaint iis igiven ithe iclinician ibegins ito iconsider iall ithe ipossible icauses ibeginning iwith ithe iskin ilevel iand ivisualizing iall istructures iin ithat iarea iinward. i(Dunphy, ip55)
- Accurately idescribe iwhy ievery iprocedure icode imust ihave ia icorresponding idiagnosis icode.
CPT i(procedure) icodes iare irecognized iuniversally iand ialso iprovide ia ilogical imeans ito ibe iable ito track ihealthcare idata, itrends, iand ioutcomes. iEach iservice ior iprocedure iis irepresented iby ia ifive-digit code ithat iis ipresented iin isix isections, iincluding ievaluation iand imanagement; ianesthesiology; isurgery; radiology; iand ipathology. ICD- 10 icodes iare ishorthand ifor ithe ipatient’s idiagnoses, iwhich iare iused ito iprovide ithe ipayer information ion ithe inecessity iof ithe ivisit ior iprocedure iperformed. iThis imeans ithat ievery iCPT icode imust have ia idiagnosis icode ithat icorresponds. iThe itakeaway imessage ihere iis ithat ievery iprocedure icode ineeds a idiagnosis ito iexplain ithe inecessity iwhether ithe icode irepresents ian iactual iprocedure iperformed ior ia nonprocedural iencounter ilike ian ioffice ivisit. iFrom ilesson iBilling iand iCoding iin iLesson i 1
- Identify ithe ithree icomponents irequired iin idetermining ian ioutpatient, ioffice ivisit iE&M icode. - Plan iof iservice - Type iof iservice - Patient istatus
- Describe ithe idifferences ibetween imedical ibilling iand imedical icoding. Medical iBilling: iThe iprocess iof isubmitting iand ifollowing iup ion iclaims imade ito ia ipayer iin iorder ito ireceive ipayment ifor imedical iservices irendered iby ihealthcare iprovider. Medical iCoding: iThe iuse iof icodes ito icommunicate iwith ipayers iabout iwhich iprocedures iwere iperformed iand iwhy.
- Compare iand icontrast ithe itwo icoding iclassification isystems ithat iare icurrently iused iin ithe iU.S. ihealthcare isystem. a. CPT i= iProcedures i. Office iprocedural icoding ii. Legal imeans ito itrack ihealth icare idata, itrends, iand ioutcomes iii. Every iCPT icode imust ihave ia icorresponding iICD icode. b. ICD- 10 icodes i= iDiagnosis
- Describe ithe icomponents iof imedical idecision imaking iin iE&M icoding.
- Correctly iorder ithe iE&M ioffice ivisit icodes ibased ion icomplexity ifrom ileast ito imost icomplex. As iyou ishould irecall, ithe ihigher ithe ilevel iof icode, ithe ihigher ithe icomplexity New Established Minimal/RN ivisit 99201 99211 Problem ifocused 99202 99212 Exp. iproblem ifocused 99203 99213 Detailed 99204 99214 Comprehensive 99205 99215
- Define ithe icomponents iof ia iSOAP inote.
- Subjective i(CC, iHPI, iPMH, iFam iHx, iSocial iHx, iand iROS)
- Objective i(What iyou isee, ihear, ifeel iof iexam)- iphysical ifindings, ivital isigns, igeneral isurvey iHEENT ietc
- Assessment i(Global iassessment iof ipatient iincluding idifferentials iin iorder ifrom most ilikely ito ileast ilikely. iCombination iof isubjective iand iobjective iinformation. iList iof idx iaddressed iand ibilled ifor iat ivisit.
- Plan i(What iyou iwill itreat, iwhen ito icome iback, idiagnostic itests iand iPt. iEducation).
- Discuss ia iminimum iof ithree ipurposes iof ithe iwritten ihistory iand iphysical iin irelation ito ithe iimportance iof idocumentation.
- It iis ian iimportant ireference idocument ithat igives iconcise iinformation iabout ia ipatient's ihistory iand iexam ifindings.
- It ioutlines ia iplan ifor iaddressing ithe iissues ithat iprompted ithe ivisit. iThis iinformation ishould ibe ipresented iin ia ilogical ifashion ithat iprominently ifeatures iall idata iimmediately irelevant ito ithe ipatient's icondition.
- It iis ia imeans iof icommunicating iinformation ito iall iproviders iwho iare iinvolved iin ithe icare iofia iparticular ipatient.
- It iis ian iimportant imedical-legal idocument.
- It iis iessential iin iorder ito iaccurately icode iand ibill ifor iservices.
- Correctly iidentify ia ipatient ias inew ior iestablished igiven ithe ihistorical iinformation. i Patient istatus i refers ito iwhether ior inot ithe ipatient iis ia inew ipatient ior ian iestablished ipatient iof iyour ipractice. i By idefinition, ia inew ipatient iis ione iwho ihas inot ireceived iprofessional iservice ifromia iprovider ifrom ithe isame igroup ipractice iwithin ithe ipast i 3 iyears. iConversely, ian iestablished ipatient ihas ireceived iprofessional iservice ifrom ia iprovider iof iyour ioffice iwithin ithe ilast i 3 iyears. iRetrieved ifrom iBilling iand iCoding ilesson
- Correctly iidentify ithe imost ispecific iICD- 10 icode iwith ithe iinformation igiven
- Explain iwhat ia i"well irounded" iclinical iexperience imeans. Infant ifrom ibirth ito iyoung iadult ivisits ifor iwell ichild iand iacute ivisits, iadults ifor iwellnessior iacute/routine ivisits 15% ipeds iand i15% iwomen’s ihealth
- Discuss ithe imaximum inumber iof ihours ithat itime ican ibe ispent i"rounding" iin ia ifacility. No imore ithan i25% iof itotal ipracticum ihours iin ithe iprogram
- Discuss inine ithings ithat imust ibe idocumented iwhen iinputting idata iinto iclinical iencounter ilogs. (Patient iInfo) iPatient iinitials, iage, igender, ichief icompliant Type iof ivisit i(acute/chronic iillness, iwell ivisit, ihealth ipromotion) Level iof iinvolvement-estimated ipercentage iof iyour ilevel iof iindependence. iHistory i& iphysical iexam iareas icovered Diagnostics iand iProcedures iDiagnosis iand iICD i 10 icode iMedications Education iand/or iother itherapeutic iinterventions iReferrals iand ifollow iup
- Explain ieach ipart iof ithe iacronym ithe iSNAPPS ipresentation. iS—Briefly isummarizing ithe irelative ihistory iand ifindings N—Narrowing ithe idifferential ito ithree irelevant ipossibilities iusing ithe ipertinent ipositive iand inegative ifindings; A—Analyzing ithe idifferential iby icomparing iand icontrasting ithe ipossibilities;
- Discuss icolon icancer iscreening irecommendations irelative ito icertain ipopulations.
- Describe ian iintervention ifor ia ipatient iwith igastroenteritis.
- Discuss ian iappropriate itreatment ifor iprophylaxis ior itreatment iof itraveler's idiarrhea.
- Identify iat ileast ione ieffective itreatment ifor iIrritable iBowel iSyndrome i(IBS). Dietary itherapy Potential itriggers ito iavoid: ilactose, icaffeine, ilegumes, iand iartificial iSweeteners Lower-fat idiet iwith iincreased iprotein High ifiber i(introduced islowly ito iprevent ibloating) iBulk iproducing iagents 8 - 8 iounce iglasses iof iwater idaily Pharmacological iTherapy i(for imoderate ito isevere isymptoms ionly) iAntidiarrheals imay ibe iused itemporarily: iImmodium ior iLomotil iLaxatives imay ibe iused iintermittently: ilactulose, imagnesium ihydroxide iAntispasmodic i(for ipostprandial ipain inot iresponsive ito idiet itherapy): Dicyclomine ior ihyoscyamine Avoid ianticholinergics iin ipts iwith iglaucoma iand iBPH iand iin ithe ielderly iTricyclic iantidepressants Supportive iTreatments Support igroups iCounseling Refractory iIBS, iconsider: ipsychotherapy ithat iteaches ibehavior iModification, ibiofeedback, ior ihypnosis
- Identify iat ileast ione iprescription imedication ifor ithe itreatment iof ichronic iconstipation. Prescription iPharmacologic iTreatments ifor iConstipation
- Osmotic iagents i(Lactulose i( iKristalose, iCephulac)
- Serotonin iagonists i(tegaserod, iprucalopride, iand ivelusetrag)
- Secretagogues i(lubiprostone, ilinaclotide, iand iplecanatide)
- Bile iacid—modifying iagents i(chenodeoxycholate iand ielobixibat) ihttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC4836568/
- Describe ithe icomponent iof ithe iH&P ithat ishould ibe idone ifor ia ipatient iwith iabdominal ipain If ithere iis icomplaint iof iabdominal ipain, iask ithe ipatient ito idescribe ithe ipain.iAsk ithe ipatient ito ipoint ito ithe ilocation iof ithe ipain. Upper iabdominal ipain i- iask iabout ichronic ior irecurrent iand irelated isymptoms i(bloating,ifullness,heartburn, inausea, ivomiting) Lower iabdominal ipain- iif iacute- iis ithe ipain isharp, iintermittent iof icontinuous If ichronic- iIs ithere ia ichange iin ibowel ihabits? i(Alternating idiarrhea iand iconstipation?)
- Does ithe ipatient iuse ia isingle ifinger ior ispread ithe ifingers iand imove ithe ipalm iover imuch iof ithe iabdomen?
- What iis ithe inature iof ithe ipain? iNote ibody ilanguage. iA iburning ipain iis ioften idescribed iwith ian iopen ihand imoving iupwards ibut ia iclenched ifist iis iused ito idescribe icolic.
- Are ithere iany iaggravating ior irelieving ifactors? iThe iformer imay iinclude ifatty ifood. iThe ilatter imay iinclude isitting iforward ior itaking imedication.
- How ioften iis ithe ipain ifelt iand ihow ilong idoes iit ilast?
- Is ithere iradiation ielsewhere?
- Elicit isymptoms iassociated iwith ithe ipain- i chills, ifever iOther iGI isymptoms ito iinclude: Anorexia iDysphagia iOdynophagi aiDiarrhea iConstipation Recent iuse iof iantibiotics iMelena ior iblack istool Jaundice ifrom iincreased i levels iof ibilirubin
- Describe ithe iclinical icharacteristics iand itreatment ioptions ifor iGERD iand iAGE GERD Acute igastroenteritis Etiology Backward^ iflow^ iof istomach ior iduodenal icontents iinto ithe iesophagus iwithout iretching ior ivomiting.
- inflammation iof ithe istomach iand iintestine ithat icauses ianorexia, inausea, ivomiting, iand idiarrhea. Any iage iaffected Primary icause iof iGERD: iinappropriate, ispontaneous, itransient irelaxation iof ithe ilower iesophageal isphincter i(LES) ior iincompetence iLES ipressure i(<10mmHg; inormal iis i 10 - 30mmHg)
- AGE ican ibe iacute ior ichronic, iand ican ibe icaused iby ibacteria, iviruses, iparasites, iinjury ito ibowel imucosa, iinorganic ipoisons i(sodium i nitrate), i organic ipoisons i(mushroom ior ishellfish), iand idrug. AGE imost ioften iresult ifrom iinfectious iagents Mode iof itransmission:
hoarseness, iwheezing iusually iat inight. Substernal ior iretrosternal ichest ipain i(need ito iask ipt ifurther iquestion ito irule iout icardiac iissue isuch ias ipain iwith iactivity iis icardiac) What imakes iit iworse? iReclining iafter ieating, ieating ilarge imeal, iingesting ialcohol, ichocolate, icaffeine, ifatty ior ispicy ifoods, ior inicotine, iwearing iconstrictive iclothing; ioccupation ithat irequires iheavy ilifting, istraining, ior ibent iover imay ialso ipart iof ithe icause iof iGERD What imakes iit ibetter? iTaking iantacid, isitting iupright iafter ia imeal, ieating ismall imeals Severe idehydration Objective Patient iwith iGERD iusually ihas inormal ifinding Diarrhea, iDehydration, ifever, iincrease iheart irate, idizziness, imaybe iedema iresulting ifrom ihypoalbuminemia Diagnostic - Accurate^ imethod: iambulatory iesophageal ipH imonitoring. ipH i<4.0 iis Stool icheck ifor iblood, ileukocyte, ibacteria, iova, iparasite
positive i+ iCC iof iGERD isymptoms i= i+ iGERD Routine istool iculture ishould iidentify ithese ipathogens iShigella, iSalmonella, iCampylobacter, iAeromonas
- Upper iendoscopy iwith ibiopsy — is ialso iused ito iidentify ithe itype iand iextent iof itissue idamage iin ithe iesophagus If ipatient ihas idiarrhea imore ithan i 2 iweeks, iand istool inegative ifor ifecal ileukocytes ------ need ito check ifor istool iparasite. Flexible isigmoidoscopy: ifor ipatient inot irespond ito iantibiotic itreatment, iand ifor ipersistent idiarrhea iundiagnosed iby ilab iwork. Differential idiagnosis GERD iis isimilar ito ipeptic iulcer idisease. iSo iwe ineed ito idifferentiate ithem. IBD, ismall ibowel idiverticulosis, iischemic ibowel idisease, ipartial ibowel iobstruction, ipelvic iabscess, ichronic ipancreatitis GERD: iepigastric ipain, iburning, ithat iworse ishortly iafter ieating PUD: iepigastric ipain, iburning ior ignawing i(hunger) isensation ithat ioften irelieved iby ifood ior iantacid. Gallbladder idisease: iepigastric, iright isubcostal ipain Cholelithiasis iand icholecystitis: iepigastric ipain iwith inausea,
- dietary iand ilife imodification choice ifor iafebrile, inondysenteric icases iof iacute idiarrhea.
- antacid
- OTC iH2-RA: icimetidine i(Tagamet), iranitidine i(Zantac), iPepcid, inizatidine i(Axid) Lomotil: iprescription ionly, iused iin iafebrile, inondysentery iof iacute idiarrhea, ihas icentral iopiate ieffects. Step iup i(trial ifor i 6 iweeks, iif inot iworking imove ito itroublesome isymptom istep i+ irefer ito iGI) Antiviral/antibiotic itreatments: iBacterial:
- continue idietary iand ilife imodification
- H2-RA iprescription idosase C-diff: imetronidazole i(Flagyl) i250mg ix4 idaily ifor i 10 idays; ivancomycin i 125 img ix4 idaily ifor i 10 idays. Cimetidine i 800 img itid, ior Ranitidine i 150 img itid ior iNizatidine i 150 img itid ior Vibrio icholerae: itetracycline i 500 img iPO iq i 5 ihours ifor i 2 idays; iBactrim iDS iq i 12 ihours ifor i 2 idays. Famotidine i 20 img itid OR PPI: iomeprazole i 20 img, irabeprazole i 20 img, ilansoprazole i30mg, iesomeprazole i 20 img, ior ipantoprazole i 40 img idaily Yersinia ienterocolitica: itetracycline i 250 - 500 img iq i 6 ihours ifor i 7 - 10 idays; iciprofloxacin i 500 img i 2 ix idaily; itobramycin i 3 - 5mg/kg iq i 8 ihrs Troublesome isymptoms: itrial ifor i 8 iweek, iif inot iworking imove ito iunresponsive idisease istep Salmonella: iBactrim iDS, ior iquinoline, inorfloxin i400mg ior iofloxin i 400 img ix2 idaily ifor i 7 - 10 idays.
- dietary iand ilifestyle imodifications Shigella: iBactrim iDS i 2 ix idaily
- PPI iincrease ito i 40 img idaily i(omeprazole i 40 img, iesomeprazole i 40 img idaily) Unresponsive idisease istep
- dietary iand ilifestyles imodification
- surgical iintervention Note: iEvidence isuggests ithat iPPI iis imore ieffective ithan iH2-RA iin iall icases iof iGERD for i 3 idays Viral: Rotavirus, iNorwalk ivirus: ino itreatment, itreat isymptoms Protozoal Giardia ilamblia: iquinacrine ihydrochloride i(Atabrine) i 100 img ix i 3 idaily iafter imeals ifor i 5 - 7 idays; imetronidazole i(Flagyl) i 250 img ix3 idaily ifor i 5 - 7 idays. Entamoeba ihistolytica: iFlagyl i 750 img ix3 idaily ifor i 7 - 10 idays. Cryptosporidium:iparomomycin i(Humatin) i 500 img ix4 idaily ifor i 14 - 28 idays, ithen i 500 img ix2 idaily iindefinitely. iIf itreatment ifails Azithromycin i(Zithromax) i2. grams ion iday i1, i1.2 igrams ifor i 27 idays, iand ithen i 600 img/day ifor imaintenance iindefinitely.
- Discuss ithe idifference ibetween isensorineural iand iconductive ihearing iloss. iSensorineural: iThis icondition iresults ifrom ideterioration iof icochlea idue ito iloss iof ihair icells ifrom iorgan iof iCorti. iIt iis ivery icommon iin iadults. Gradual, iprogressive, ipredominantly ihigh-frequency iloss iw/advanced iaging i(presbyacusis). Other icauses iof isensorinural ihearing iloss iinclude: iototoxic idrugs, iloud inoises, ihead itrauma, iautoimmune idiseases, imetabolic idiseases, iacoustic ineuroma. Genetic imakeup ican iinfluence.
NOSE iAND iBLOW iMAY iPOP iTM. iTympanostomy itubes iplaced isometimes ito iequalize ipressure
- Identify iwhich iconditions iwarrant ian iENT ireferral Difficulty iremoving ian iinsect, iforeign ibody, ior icerumen ifrom ithe iear, iotitis iexterna inot iresolved iwith itopical iantibiotics i(needing iIV) iwith iaurical icellulitis ior irefractory ito iinitial itherapy Chronic iEustachian iTube iDisorder ithat idoes inot iresolve iwith iabove itreatmentiIf ia imetabolic icause icannot ibe iidentified ifor iTinnitis Meniere’s idisease ifurther iwork iideology Reoccurring iOtitis iMedia, imore ithan i 3 iepisodes iin i 6 imonths ior i 4 iepisodes iin i 12 imonths imanaged iby iplacement iof itympanostomy itubes ior iprophylactic iantibiotics iAcute ibacterial iSinusitis: isymptoms i>4 iweeks, ior iorbital icellulitis, iosteomyelitis. Cholesteoma iTM:if iperforation iis ipresent, ias iwell ias iin icases iof idamage ito ithe iossicles, itympanosclerosis, iotosclerosis, itumor, iand itemporal ibone iinjury If ihoarseness ipersists ifor imore ithan i 2 iweeks, ifurther ievaluation iby ian iENT ispecialist iis iwarranted.Tonsillectomy ior iAdenoidectomy
- Compare iand icontrast iotitis imedia iand iotitis iexterna Otitis iExterna Otitis iMedia Definition Inflammation^ iof imembranous ilining iof iauditory icanal iand/or icontiguous istructures iof ithe iouter iear Inflammation iof istructures iwithin ithe imiddle iear Epidemiology/Cause 10 - 20 itimes imore Incidence iincreases s likely ito ioccur iduring in iwinter imonths; warmer, isummer most icommon iin months ithan iin icooler very iyoung seasons; iadults i>50 iat children; ielderly greatest irisk; ino also iat ihigh irisk; ethnic ior igender Native iAmericans predispositions; (esp iNavajos) iand immunocompromised Native iAlaskans people iat igreater irisk have ihigher (especially iof iinvasive prevalence; iMen disease); iexcess and iwomen iequally moisture ifrom iany at irisk, imore irare iin
cause iincreases irisk i(humidity, i “swimmer’s i ear”); iseborrheic idermatitis, ihearing iaids, iear iplugs, i or icotton iswabs i all i increase irisk i with i extended iuse adults; irisk ifactors: iallergies, isinusitis, irhinitis, iand ipharangytis; irecent ior irecurrent iURI; iperforation iof ithe ieardrum; iactive iand ipassive ismoking Pathophysiology Compromised inormal ifunctions iincluding: inatural isloughing iof ikeratinizing isquamous iepithelia iof ithe iear icanal, ihair ifollicles iin iouter ithird iof ithe icanal, iproduction iof iviscous,ihydrophobic icerumenithat ihas iacidic ipH iand irepels imoisture, iand ipresence iof inonpathogenic iendogenous imicrobialiflora; ilocal iskin imaceration, itraumatic iinjury, iexcessive icleaning iof ithe iear, iand iexcessive imoisture Obstruction iof iisthmus i by ibacterial iinfection ifrom inasopharyngeal imicroorganisms; iinflammation icauses imiddle iear iabscess; ipressure ifrom ibuild iup iof ipus iimpinges ion iblood ivessels isupplying iTM iwhich ieventually icauses iperforation ior irupture iof ieardrum; iwill iheal ispontaneously iwith inormal iimmune isystem; i Otitis imedia iwith ieffusion icause iby itransudation iof iplasma ifluid iwhich iblocks ie-tubes; iviral iURIs ior iacute iallergy iattacks imost icommonly icause iswelling iof ithe imucosa Pathogens Pseudomonas iaeruginosa i (most icommon icause iof idiffuse iinfection), Streptococcus ipneumoniae i (mostifrequent icause iin iadults),
exam; iaccumulation or iobscured ibony of ipurulent idrainage landmarks iand may ibe ipresent iwith cone ilight ireflux; bacterial iinfection; discharge iwill ibe diffuse icases imay present iif iTM ihas have ilocalized perforated; pustules ior ifuruncles Otorrhea imay ibe in icanal ior iexternal purulent ior processes; igreen mucoid; ichronic exudate iwith OM ihas iperforated, Pseudomonas , iyellow draining iTM iand crusting iin imidst iof possibly iinvasive purulent idrainage granulation itissue; occurs iwith lymphadenopathy Staphylococcus; of ipreauricular iand fungal iinfections ihave posterior icervical fluffy iwhite ior iblack nodes iis icommon; iif malodorus icarpet iof OM ialong iwith growth; iallergic acute imastoiditis reactions iscaly, tenderness iover cracked, iand/or mastoid iwill ibe weepy itissue; present lymphadenopathy typically inot involved; iTMJ tenderness imay ibe present iin iinvasive disease Diagnostics Lab itests inot Rarely ineeded; indicated iusually; pneumatic iotoscopy may iculture ifluid may ibe iused; from icanal; iMRI ior tympanometry imay CT ifor iconfirming be iused; ipure-tone soft itissue audiometry ican ibe involvement performed ibefore and iafter itreatment Management Localized iapplication Uncomplicated iis of iheat ior iice ifor ipain, often iself-limiting; nonprescription ipain Treatment iis reliever ifor imild ito recommended ifor moderate ipain, chronic ior Tylenol i#3 ifor isevere recurrent iOM; pain, ikeep iear idry supportive
Treatment: igentle icleaning iof iear icanal, ievaluation iof iotic idischarge iand iedema iof iauditory icanal iand itympanic imembrane, iand iselection iof ilocal imedication iappropriate ifor ietiology; May ineed ito iperform iI&D iof ipustules ior ifuruncles; idiffuse iinfection imay ibe itreated iempirically; itopical iotic ipreparations treatment iindicated ifor iacceptance iof i pt’s iauditory ihearing ilosses irelated ito ichronic idisease; iif isymptoms ipersist ifor igreater ithan i 12 iweeks, i 10 iday iantibiotic icourse iis iwarranted; iAntibiotics: iamoxicillin, iAugmentin, isecond ior ithird igeneration icephalosporin. Steroids inot irecommended ifor ichildren. Antibiotics iof ichoice: ifirst igeneration icephalosporins ior ipenicillins, isecond igeneration icephalosporins, fluroquinolones, iceftazidime
- State ithe iclinical ifeatures iand itreatments ifor ieach icondition inoted iabove. Otitis iMedia- iFirst iline itreatment- ipain icontrol iand iAmoxicillin ior Amoxicillin/clavulanate. iSecondary itx icefdinir
- Inflamed iTM
- Bulging iTM iand iscalded iappearance iof isuperficial iepithelium
- Opaque iserum ilike iexudate ioozing ithrough ithe ientire iTM i(appear iwhite, iyellow, ipink, ior ired)
- fever
- Ear ipain iespecially iat inight iwhen ilying idown
- Irritability
- Decreased imobility iof iTM Otitis iExterna i– iFirst iline itreatment- iantibiotic iear idrops iwith ior iwithout icorticosteroids
