Trevon is an 18-month-old with a 3-day history of upper-respiratory-type symptoms that have progressively worsened over the last 8 hours. His immunizations are up to date. Mom states he spiked a fever to 103.2°F this morning and he has become increasingly fussy. He vomited after drinking a cup of juice this afternoon and has refused PO fluids since then. Pertinent physical exam findings include negative abdominal exam, marked irritability with inconsolable crying, and he cries louder with pupil examination and fights head and neck assessment. You are unable to elicit Kernig’s or Brudzinski’s signs due to patient noncompliance. Case Study 3:
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