Answer to Question 1
ANS: C
Neomycin is ototoxic and can cause local swelling and erythema in about 15 of patients.
Most infections begin to improve in 3 days and resolve completely by 10 days. No substantial information points to worsening of the otitis externa.
An allergy to the nonantibiotic component of the drops is not a feasible option, because hydrocortisone reduces inflammation and edema.
Development of necrotizing otitis externa is highly unlikely. It is almost exclusive to two groups of high-risk individuals, the elderly with diabetes and the immunocompromised, especially those infected with the human immunodeficiency virus (HIV). None of the information given supports the likelihood that the child is immunocompromised.
Answer to Question 2
ANS: C
As a rule, otomycosis can be managed with thorough cleansing and application of acidifying drops (2 acetic acid solution applied three to four times a day for 7 days.) If that does not work, an antifungal drug solution can be tried. If the infection fails to respond to the drug, oral antifungal therapy may be needed.
Neither antibiotic ear drops nor oral antibiotics are indicated as the first course of treatment.
IV antifungal agents are not indicated at all.
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