phuluong2k
Forum Fanatic
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I have a some NBME qs for discussion
A 3-year-old boy is brought for a follow-up examination. He just completed a 10-day course of amoxicillin that has not resolved his right ear pain. He appears irritable. His temperature is 38.9 C (102 F). Examination shows downward and lateral displacement of the right auricle with tenderness to palpation of the posterior auricular area; his neck is supple. Which of the following is the most appropriate next step in diagnosis?
A) Bone scan
B) CT scan of the head
C) Tympanometry
D) Lumbar puncture
E) Tympanocentesis
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| DrS
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B) CT scan of the head
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| mani
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B) CT scan of the head
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| kmp
Forum Elite
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B) CT scan of the head: Mastoiditis
A few points for CT scan
- A fine-cut CT scan of the temporal bones will evaluate the integrity of the bone of the tegmen, otic capsule, posterior fossa, and facial canal. It will show soft tissue causing coalescence of mastoid air cells in mastoiditis, and may show destruction of the overlying cortex with overlying postauricular abscess formation. A frank subperiosteal abscess is found in only 48-49% of acute mastoiditis cases.
- A contrasted CT scan will detect abscess formation or sigmoid sinus thromobosis. The delta sign is a triangular enhancement of the wall of the sigmoid sinus suggestive of thrombosis.
- Meningitis, facial paralysis, brain abscess, otitic hydrocephalus, sigmoid sinus thrombophlebitis, and intracranial abscess may also occur without evidence of bone destruction as observed on CT scan.
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