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Pediatric Crohn disease evaluation — USMLE Step 3 MCQ

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HardPediatricsPediatric Crohn disease evaluationUSMLE Step 3

A well-appearing 24-day-old term infant has a rectal temperature of 38.2°C. Urinalysis shows pyuria and leukocyte esterase; procalcitonin is elevated. Blood and urine cultures have been obtained. What is the most appropriate next step?

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Correct answer: C — Perform lumbar puncture, give parenteral antibiotics, and observe in the hospital

The best answer is “Perform lumbar puncture, give parenteral antibiotics, and observe in the hospital”. Uses the 22-to-28-day pathway: an abnormal inflammatory marker and positive urinalysis do not permit low-risk outpatient management. CSF should be obtained when feasible before empiric parenteral treatment, and hospital observation is appropriate while cultures are pending.

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