#1
THE ANSWER IS A.
A tympanic membrane with distinctly impaired mobility has an adjusted likelihood ratio of 31. A tympanic membrane with slightly impaired mobility has an adjusted likelihood ratio of 4. A tympanic membrane with normal mobility is unlikely to be acute otitis media.
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A distinctly red tympanic membrane (B) has an adjusted likelihood ratio of 8.4. A retracted tympanic membrane (C) has an adjusted likelihood ratio of 3.5. A ruptured tympanic membrane is nonspecific for acute otitis media. Another sign that suggests acute otitis media is a cloudy tympanic membrane with an adjusted likelihood ratio of 34.
Rothman R, Owens T, Simel D: Does this child have acute otitis media?. JAMA 2003; 290:1633.
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