Provide evidence from the literature to support diagnostic tests that would be appropriate for each case.

Amy, a 3 year old girl is brought to your office by her mother because she has a fever and complains that her ear hurts. She has no significant medical history. The child is not pleased to be in the provider’s office and has been crying. Her mother explains that she developed a “cold” about 3 days ago with sniffles. As she cries she continues to cough and has yellowish nasal discharge.
Provide evidence from the literature to support diagnostic tests that would be appropriate for each case. List five different possible conditions for the patient’s differential diagnosis and justify why you selected each.
ANSWER
**Evidence from the literature to support diagnostic tests that would be appropriate for each case:**
* **Otitis media:**
* Pneumatic otoscopy: Pneumatic otoscopy is a noninvasive test that uses a pneumatic otoscope to examine the tympanic membrane. A pneumatic otoscope is a device that delivers a puff of air to the tympanic membrane. A normal tympanic membrane is mobile and will move in response to the puff of air. However, a tympanic membrane that is inflamed or infected will be less mobile.
* Tympanometry: Tympanometry is a noninvasive test that measures the middle ear pressure. A tympanometer is a device that places a probe in the ear canal and delivers a series of tones. The tympanometer then measures the response of the tympanic membrane to the tones. A normal tympanic membrane will produce a type A tympanogram. However, an inflamed or infected tympanic membrane will produce a type B or C tympanogram.
* **Acute sinusitis:**
* Nasal endoscopy: Nasal endoscopy is a minimally invasive test that uses a thin, flexible tube with a camera on the end (nasal endoscope) to examine the inside of the nose and sinuses. A nasal endoscope is inserted through one nostril and passed through the nasal cavity to the sinuses. A nasal endoscope can be used to visualize the sinuses and to identify any signs of inflammation or infection.
* Sinus computed tomography (CT) scan: A sinus CT scan is a type of X-ray that creates detailed images of the sinuses. A sinus CT scan can be used to identify any abnormalities in the sinuses, such as inflammation, infection, or tumors.
**Five different possible conditions for the patient’s differential diagnosis and justification for each:**
1. **Acute otitis media:** This is the most likely diagnosis, given the patient’s age, presentation, and medical history. Acute otitis media is an inflammation of the middle ear, which is the space behind the eardrum. It is most common in children under the age of 5. The usual symptoms are ear pain, fever, and drainage from the ear.
2. **Acute sinusitis:** Acute sinusitis is an inflammation of the sinuses, which are air-filled cavities in the skull. It is often caused by a viral infection, but it can also be caused by a bacterial infection. The usual symptoms are facial pain, congestion, and runny nose.
3. **Pharyngitis (strep throat):** Pharyngitis is an inflammation of the pharynx, which is the back of the throat. It is most commonly caused by a bacterial infection, such as Streptococcus pyogenes (strep throat). The usual symptoms are sore throat, fever, and difficulty swallowing.
4. **Influenza (flu):** Influenza is a respiratory infection caused by the influenza virus. The usual symptoms are fever, chills, muscle aches, headache, and cough.
5. **COVID-19:** COVID-19 is a respiratory infection caused by the SARS-CoV-2 virus. The usual symptoms are fever, cough, shortness of breath, and fatigue.
It is important to note that this is just a differential diagnosis, and the patient’s specific diagnosis can only be determined after performing a physical examination and ordering appropriate diagnostic tests.