skip to main content

Febrile Infant — MRCPCH AKP MCQ

Instant feedback + full explanation. One question, done properly.

ModeratePediatricsFebrile InfantMRCPCH AKP

A 3-week-old term infant presents to a UK emergency department with an axillary temperature of 38.8°C. The infant appears well, and examination identifies no source of infection. Which is the most appropriate management?

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

Reveal the answer and explanation

Correct answer: C — Obtain blood and urine investigations, perform lumbar puncture unless contraindicated, and give parenteral antibiotics

The correct answer is C. NICE classifies a temperature of 38°C or higher in an infant younger than 3 months as high risk. In infants younger than 1 month, well appearance does not remove the need for investigation and treatment. Recommended investigations include full blood count, C-reactive protein, blood culture and urine testing. Lumbar puncture should be performed unless contraindicated, preferably before antibiotics, and parenteral antibiotics should be given. Therefore, outpatient observation or a partial investigation without antibiotics is inappropriate. Urine testing alone may miss bacteraemia or meningitis. Chest radiography is not routine and is reserved for infants with respiratory signs.

Reference: National Institute for Health and Care Excellence. NG143, Fever in under 5s: assessment and initial management, recommendations 1.5.3–1.5.7. 2019, updated 2021 and reviewed 2025. https://www.nice.org.uk/guidance/ng143/chapter/recommendations