Rosh Pediatrics Practice Exam

What condition is indicated by the presence of a bulging tympanic membrane in a pediatric patient?

1. Chronic otitis media

2. Acute otitis media

3. External otitis

4. Middle ear effusion

The correct answer is: Acute otitis media

The presence of a bulging tympanic membrane in a pediatric patient is typically indicative of acute otitis media. This condition occurs when there is an infection in the middle ear, often resulting in inflammation and the accumulation of pus or fluid. The bulging tympanic membrane is a crucial clinical finding that suggests increased pressure within the middle ear, a direct result of this infection. In acute otitis media, the bulging is usually accompanied by other symptoms such as ear pain, fever, irritability, and sometimes discharge if the membrane perforates. The diagnosis is primarily based on the clinical presentation and the characteristic appearance of the tympanic membrane during otoscopic examination. While other conditions like chronic otitis media or middle ear effusion can also lead to changes in the tympanic membrane, they typically present differently. Chronic otitis media may show a more retracted or altered tympanic membrane due to ongoing issues, while middle ear effusion can lead to a fluid level but not necessarily a bulging appearance unless an infection is present. External otitis, or swimmer's ear, affects the external ear canal and does not cause a bulging tympanic membrane. Thus, the clinical presentation associated with a bulging tympanic membrane strongly points to acute otitis media