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Fever in Young Infant — USMLE Step 2 CK MCQ

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HardPediatricsFever in Young InfantUSMLE Step 2 CK

A well-appearing, term 16-day-old infant has a rectal temperature of 38.0°C and no focal findings. Urinalysis is normal and a respiratory viral PCR is positive for rhinovirus. Which next step is most appropriate?

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Correct answer: D — Obtain blood, urine and CSF cultures; give parenteral antibiotics and admit

An infant aged 8-21 days with documented fever remains in the highest-risk AAP group even when well appearing and viral testing is positive. Blood, urine, and CSF evaluation, parenteral antimicrobial therapy, and hospital monitoring are indicated. A viral result lowers but does not eliminate invasive bacterial infection risk and cannot justify discharge. Neither a higher fever threshold, a chest radiograph, nor partial cultures substitute for the neonatal pathway.

Reference: AAP Clinical Practice Guideline: Evaluation and Management of Well-Appearing Febrile Infants 8 to 60 Days Old. https://publications.aap.org/pediatrics/article/148/2/e2021052228/179783/Evaluation-and-Management-of-Well-Appearing