2 y/o ear pain and fever iHuman – 2 year old otherwise healthy female on day 3 of runny nose and cough, and day 2 of fever. She is drinking liquids well, has a reduced appetite but normal number of wet diapers and normal stools. Physical exam is notable for tympanic temperature of 101.1 F, bilateral severe bulging of her tympanic membranes and erythema and exudates of her pharynx. Risks include lack of flu vaccine this season, exposure to other sick children at daycare and second hand smoke at home.