Rosh Pediatrics Practice Exam

What is the recommended treatment for a 15-year-old with ear pain and a fluctuant nodule after trauma?

1. Incision and drainage

2. Levofloxacin without drainage

3. Needle aspiration

4. Referral to surgical subspecialty for debridement

The correct answer is: Needle aspiration

In a case involving a 15-year-old with ear pain and a fluctuating nodule following trauma, the recommended treatment focuses on addressing the accumulation of fluid or pus that has likely formed due to the injury. Needle aspiration is an effective initial treatment method in such scenarios. It allows for the removal of any localized fluid collection, which often alleviates discomfort and can also help to clarify the nature of the nodule via the analysis of the aspirated material. Needle aspiration is particularly useful because it is minimally invasive and can be performed in an outpatient setting. By using this technique, healthcare providers can manage the condition promptly, which can prevent complications such as infection or the development of a more complicated abscess. For this specific age group and presentation, quick relief of symptoms and potential pathologic evaluation of the fluid are priorities in management. While incision and drainage is a more invasive procedure that may also be considered, it is generally reserved for more extensive abscesses or where needle aspiration has failed to provide adequate relief. Referral to a surgical subspecialist would typically be considered if there are signs of significant complications or if the lesion remains unresolved after initial attempts at management. Thus, needle aspiration stands out as the most appropriate first-line approach in this