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Jennifer is a 2-year-old female who presents with her mother. Mom is concerned because Jennifer

has been “running a temperature” for the last 3 days. Mom says that Jennifer is usually healthy

and has no significant medical history. She was in her usual state of good health until 3 days ago

when she started to get fussy, would not eat her breakfast, and would not sit still for her favorite

television cartoon. Since then she has had a fever off and on, anywhere between 101oF and

today’s high of 103.2oF. Mom has been giving her ibuprofen, but when the fever went up to

103.2oF today, she felt that she should come in for evaluation. A physical examination reveals a

height and weight appropriate 2-year-old female who appears acutely unwell. Her skin is hot and

dry. The tympanic membranes are slightly reddened on the periphery, but otherwise normal in

appearance. The throat is erythematous with 4+ tonsils and diffuse exudates. Anterior cervical

nodes are readily palpable and clearly tender to touch on the left side. The child indicates that her

throat hurts “a lot” and it is painful to swallow. Vital signs reveal a temperature of 102.8oF, a pulse

of 128 beats per minute, and a respiratory rate of 24 beats per minute.