Special Populations>Therapy Selection Practice Test

An 18-month-old boy (weight 11 kg) is brought to the clinic with 2 days of fever ( Tmax 102.6 F ), irritability, and tugging at his right ear. He attends daycare and has had no recent antibiotic exposure. Otoscopic exam shows a bulging, erythematous right tympanic membrane with decreased mobility; the left ear is normal. He is drinking less but making wet diapers; no vomiting or diarrhea. Vitals: HR 132, RR 26, BP 90/58, SpO2 99% on room air. No conjunctivitis or purulent rhinorrhea. Medications: acetaminophen as needed, cholecalciferol drops daily, and cetirizine as needed for seasonal allergies. Allergies: no known drug allergies. Basic labs were not obtained. He has no history of recurrent otitis media or tympanostomy tubes. The parent asks about starting an antibiotic today.

A 12-year-old boy with moderate persistent asthma presents within 24 hours of fever (101.8 F), myalgias, sore throat, and cough; his sister was diagnosed with influenza A yesterday. Medications: albuterol HFA as needed, fluticasone inhaler twice daily, and loratadine daily. Allergies: penicillin (hives). Vitals: BP 108/64, HR 110, RR 20, SpO2 98% on room air. Nasopharyngeal PCR is positive for influenza A; lungs are clear without wheeze. He has no bacterial signs such as focal consolidation or purulent sinusitis. He can take oral medications and has normal renal function on prior labs.