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Pharmacology — MRCGP AKT MCQ

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EasyPharmacologyMRCGP AKTUKMLAPARAPSA

A 5-month-old boy is treated for his first febrile urinary tract infection. Urine culture grows Escherichia coli sensitive to treatment. He has normal urine flow and renal function, but fever and systemic symptoms persist until 50 hours after effective antibiotics are started. Which initial imaging action is recommended?

Educational content. Not a substitute for clinical judgement or local policy.

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Correct answer: A — Arrange urinary-tract ultrasonography during the acute infection

Explanation lettering: E = shown as B · B = shown as C · C = shown as D · D = shown as E

A is correct because failure to respond within 48 hours makes this an atypical UTI, despite the E. coli culture and absence of other atypical features. Atypical UTI requires ultrasonography during the acute infection. B would be the correct schedule for a baby younger than six months whose first UTI responded within 48 hours, but the response here occurred at 50 hours. C is incorrect because DMSA scintigraphy is not the initial acute anatomical test. D concerns later assessment rather than the required initial investigation. E is incorrect because MCUG is not the first imaging response to delayed clinical improvement.

Reference: NICE NG224, recommendations 1.3.2–1.3.7 and table 4: https://www.nice.org.uk/guidance/ng224/chapter/Recommendations#imaging-tests