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Meningitis — MRCPCH FOP MCQ

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HardInfectious diseasesMeningitisMRCPCH FOP

A 10-year-old boy has fever, headache and photophobia. He is alert, has neck stiffness, normal blood pressure and no focal neurological signs or papilloedema after initial assessment. What is the most appropriate investigation?

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Correct answer: D — Lumbar puncture after blood cultures and empirical antibiotics if not delayed

In a stable child with suspected meningitis and no signs of raised intracranial pressure, lumbar puncture is appropriate, but antibiotics should not be delayed. CT is needed before lumbar puncture when there are contraindications such as focal signs or reduced consciousness, not routinely. Migraine does not cause fever and neck stiffness. The pearl is that treatment timing takes priority over perfect diagnostic sequencing.

Reference: NICE NG240 Meningitis bacterial and meningococcal disease; APLS