Paediatric emergencies: febrile neutropenia: practice question

A Pediatrics question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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Pediatrics · Paediatric emergencies: febrile neutropenia

Sample item

A 5-year-old on induction chemotherapy for acute lymphoblastic leukaemia has a temperature of 38.7 degrees C and an absolute neutrophil count of 200 per microlitre. She looks well with normal vitals. What is the most appropriate step?

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

C. Cultures, then empirical intravenous antipseudomonal beta-lactam within the hour

Fever with severe neutropenia is an emergency because sepsis can progress rapidly. After blood cultures, give an empirical broad-spectrum antipseudomonal beta-lactam intravenously without delay, regardless of how well the child looks. Antifungals are added for persistent fever after several days.

Option by option

  • A. Wait for culture results before giving antibiotics

    Waiting for cultures delays treatment, and results take at least 24 to 48 hours.

  • B. Oral paracetamol with review after 24 hours at home

    Observation at home risks rapid deterioration in a neutropenic child.

  • C. Cultures, then empirical intravenous antipseudomonal beta-lactam within the hour (correct)

    Correct. Prompt empirical antipseudomonal antibiotics after cultures reduce mortality in neutropenic sepsis.

  • D. Start empirical antifungal therapy first

    Antifungal therapy is considered only if fever persists despite several days of antibiotics.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

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Questions about this Pediatrics question

What is the answer to this Pediatrics question?

The best answer is C, Cultures, then empirical intravenous antipseudomonal beta-lactam within the hour. Fever with severe neutropenia is an emergency because sepsis can progress rapidly.

Why is "Wait for culture results before giving antibiotics" not the answer?

Waiting for cultures delays treatment, and results take at least 24 to 48 hours.

Why is "Oral paracetamol with review after 24 hours at home" not the answer?

Observation at home risks rapid deterioration in a neutropenic child.

Why is "Start empirical antifungal therapy first" not the answer?

Antifungal therapy is considered only if fever persists despite several days of antibiotics.

What concept does this question test?

It tests Paediatric emergencies: febrile neutropenia in Pediatrics. After blood cultures, give an empirical broad-spectrum antipseudomonal beta-lactam intravenously without delay, regardless of how well the child looks. Antifungals are added for persistent fever after several days.

How hard is this question?

We tag it as an application question: it asks you to use a fact on a patient or a finding. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Paediatric emergencies: febrile neutropenia?

Memorise milestones and the vaccine schedule as tables and revise them often. Then use the flashcards and the other Pediatrics questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.