6-year-old boy is brought in my his mother to the office for evaluation of a 3-day history of irritability, fever, and ear pain.  She also says that his older sister has had a cold the past week, but it doesn’t seem to be that bad.  He is up to date on his immunizations.  She also report she has had an intermittent, non-productive cough, but denies any decrease in eating/drinking, diarrhea, or vomiting.


Vital signs show a BP-117/72, HR-94, RR-16, O2-100%, and T-99.2.  Physical exam reveals:

  • General – Non-toxic appearing, NAD, WN/WD
  • Skin – no rash
  • Eye – sclera white, conjunctiva clear
  • Ear – (below)


  • Throat – OP clear, no erythema or tonsillar swelling
  • Neck – no LAD
  • Heart – RRR without M/G/R
  • Lung – CTA without adventitial sounds
  • Abdomen – S/NT/ND
  • PV – 2+ pulses throughout, BCR < 2s
  • Neuro – No focal deficits


Mother is wanting an antibiotic because the holiday season is here and she can’t afford to have him sick.



  1. What is your diagnosis?
  2. What is your treatment?
  3. What do you tell the mother?


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