12 year old boy came with fever, sorethroat and cervical lymph node enlargement. Throat swab positive for group A beta hemolytic streptococci and started on penicillin. But he came back with worsening of symptoms even while on treatment. Next step is:
Start azithromycin Blood monospot test and CBC IgE for IMN Presume it as EBV and start acyclovir and prednisolone