Rosh Pediatrics Practice Exam

In a 2-year-old girl with right ear pain and fever, which additional physical exam finding would support a diagnosis of acute otitis media?

1. Bulging tympanic membrane

2. Erythematous external auditory canal

3. Middle ear effusion

4. Posterior auricular lymph node enlargement

The correct answer is: Bulging tympanic membrane

A bulging tympanic membrane is a key physical exam finding that supports the diagnosis of acute otitis media in a child with symptoms such as ear pain and fever. This finding is indicative of fluid accumulation behind the tympanic membrane due to infection and inflammation in the middle ear. In acute otitis media, the tympanic membrane often appears convex and tense because of the pressure from the fluid, which can also lead to a reduction in mobility during pneumatic otoscopy. This bulging is typically associated with acute infections and helps differentiate acute otitis media from other ear pathologies. While other findings, such as an erythematous external auditory canal, middle ear effusion, and enlargement of the posterior auricular lymph nodes, can be associated with various ear conditions, they are not as definitive for acute otitis media. Erythema of the external canal may indicate external otitis, while middle ear effusion by itself does not confirm infection. The enlargement of lymph nodes may suggest a systemic response but is not specific for acute otitis media. Hence, the presence of a bulging tympanic membrane is the most direct indicator of the condition in this scenario.