HY lecture notes:
Tx of otitis media (OM) = simple amoxicillin or penicillin. Augmentin (amoxicillin + clavulanate) is the wrong answer for first-time OM on the USMLE.
Augmentin is used for recurrent OM or Hx of Abx within the past month; Hx of recent hospitalization; immunocompromised state; or for patients over age 65.
Tympanostomy tube (grommet) is the answer when the child has had three OM occurrences within the past 6 months, or four OM occurrences within the past year.
For otitis externa (OE), Tx = topical ciprofloxacin + hydrocortisone drops.
If the question asks about prevention of OE recurrence, the best answer is avoid the water exposure (if patient is a swimmer, etc.). If the Q doesn’t give this as an option, the answer is “acetic acid-alcohol drops.” This is an answer on one of the FM forms where they mention a guy who does crew + has frequent water exposure. Answers such as “use of ear plugs” are wrong.
Carbamide peroxide is the answer for softening and loosening ear wax in someone with cerumen (ear wax) buildup.
Tx of Strep pharyngitis = amoxicillin or penicillin, not Augmentin initially.
Tx of sinusitis = go straight to Augmentin. Sinusitis requires broader coverage.
Otitis media with effusion (serous otitis media) = fluid behind the tympanic membrane in child who recently had one or more OM. Answer = observe. Most spontaneously resolve within 8 weeks.
UTI antibiotic Tx –> simple trimethoprim; or trimethoprim/sulfamethoxazole (TMP/SMX; Bactrim); or amoxicillin; or nitrofurantoin.
Nitrofurantoin is classically used for cystitis in pregnant women, however this is an answer on the NBME for both UTI as well as cystitis in non-pregnant women.
If the Q asks for the best way to prevent recurrent UTI, the answer is “postcoital voiding,” since sexual activity is the biggest risk factor.
If postcoital voiding has already been attempted, the next best answer is “postcoital nitrofurantoin prophylaxis.”
If postcoital nitrofurantoin prophylaxis fails, the answer is daily TMP/SMX prophylaxis. This sounds absurdly wrong but is the correct answer on one of the obgyn forms. Everyone gets this Q wrong because it sounds incredibly overkill, but it’s on the obgyn CMS form.
If postcoital voiding has already been attempted + postcoital nitrofurantoin prophylaxis is not listed as an answer + they mention in the vignette that TMP/SMX was used successfully in the past for Tx of UTI, go straight to “daily TMP/SMX prophylaxis” as the answer.
Chronic interstitial cystitis = dysuria +/- bladder pain for at least 6 weeks with no evidence of infection or pathology. The question might also mention that there’s anterior vaginal wall pain, which sounds a bit strange, but this refers to the bladder. Tx is conservative at first – i.e., patient education, stress management, physiotherapy. Steroids are not recommended anymore.
If the question tells you a girl has UTI-like Sx + urine WBCs + no organisms grow; answer = check for Chlamydia.
