Rosh Pediatrics Practice Exam

For a 4-year-old with ear pain and a bulging tympanic membrane, what is the treatment of choice?

1. Antipyretics and analgesics

2. Oral amoxicillin

3. Referral to ENT for tympanostomy tubes

4. Topical ofloxacin drop

The correct answer is: Oral amoxicillin

When treating a 4-year-old with ear pain and a bulging tympanic membrane, the choice of oral amoxicillin is appropriate because it is the first-line antibiotic for acute otitis media (AOM). AOM frequently presents with symptoms like ear pain, fever, and the characteristic finding of a bulging tympanic membrane upon examination. Amoxicillin is effective against the most common bacterial pathogens causing AOM, including Streptococcus pneumoniae and Haemophilus influenzae. By prescribing amoxicillin, the treatment addresses the underlying bacterial infection, helping to alleviate symptoms and prevent potential complications such as mastoiditis or long-term hearing loss. While analgesics and antipyretics may provide symptomatic relief for pain and fever, they do not address the bacterial infection itself. Referral to an ENT for tympanostomy tubes is usually reserved for recurrent cases of AOM or when there are complications; it is not the immediate treatment for a first episode. Topical ofloxacin drops would be indicated in cases of external ear infections or cases where the tympanic membrane is not intact, but they are not used for treating AOM presenting with a bulging tympanic membrane. Thus, oral amoxicillin directly targets the infection, making it