Author: Ahmed Sakr, Ahmed Shahin / Editor: Stephen Sheridan / Codes: IP1, ResC2, ResC7, ResP4, SLO5, SLO7 / Published: 06/11/2025
A 10-month-old boy is brought to the Emergency Department (ED) by his mother with a 3-day history of fever, cough, reduced feeding, and increased work of breathing. She reports no vomiting or diarrhoea but notes that he has been producing fewer wet nappies. He was recently admitted in Malta (his home country) for bronchiolitis for 2 days, two weeks ago. The family is currently on holiday in the UK. His immunizations are up to date.
On arrival, the infant appears alert but is crying continuously. Observations are within normal limits for his age, and PEWS is 0. Clinical examination reveals:
- A: Patient
- B: No crepitations or wheeze, Oxygen saturation 98% on room air
- C: capillary refill < 2 seconds
- D: alert, Crying
- E: No skin rashes, no fever
- H/N: No signs of tonsillitis or otitis media
His mother is concerned about his continuous crying over the past two days, which she says is very unusual for him.
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Question 1 of 3
1. Question
What feature in this case most strongly justified further investigation?
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Question 2 of 3
2. Question
Which of the following is the most appropriate next step after observing the child remains unsettled despite a normal PEWS?
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Question 3 of 3
3. Question
Investigations reveal:
- WBC: 29.3 × 10⁹/L
- Neutrophils: 23.25 × 10⁹/L
- CRP: 427 mg/L
- Chest X-ray: Right-sided lobar pneumonia (Fig.1)
Fig.1 Courtesy of the authors
What is the most appropriate initial antibiotic for infant pneumonia?
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3 responses
Good learning point, thanks!
Nice short case learning.
Great Revision