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Home / Station 14: Fever in an eight-week-old infant

NAC OSCE preparation

Station 14: Fever in an eight-week-old infant

Complete the task in 11 minutes. Reveal the full standardized-patient script, examiner prompts and structured debrief only after your attempt.

Station time

11:00

Ready for an 11-minute attempt.

Candidate instructions

Fever in an eight-week-old infant

11 minutes

Discipline: Pediatrics
Station type: Caregiver history + urgent plan
Setting: Emergency department

Your task

Take a focused history from the parent. Explain immediate assessment, investigations and disposition.

Information available at entry

HR 168/minBP 76/44 mm HgRR 46/minSpO₂ 97%Rectal T 38.2°CWeight 4.7 kg

Coach prompt: Use an age-specific febrile-infant pathway and assess invasive bacterial infection.

In Exam Mode, coaching cues are hidden. Ask a partner to use the standardized-patient script after you start the timer.

Finished your attempt?Reveal the full station only after completing or stopping the timer.

Complete station package

Standardized-patient script and structured debrief

Station 14 of 30

Standardized-patient profile

NameBaby Maya

Age8 weeks

Pronounsshe/her

RoleMother provides history

Demeanour: Parent worried; infant sleepy but arousable.

Opening statement: “Her rectal temperature was 38.3. She is feeding less and seems sleepier.”

History and standardized-patient responses

Fever/appearance

Candidate explores	Standardized-patient response
Measurement	Rectal 38.3°C two hours ago.
Duration	Started today.
Behaviour	Sleepier but wakes and is consolable.
Breathing	No apnea, cyanosis or marked distress.

Feeding/output

Candidate explores	Standardized-patient response
Feeding	About half usual feeds.
Urine	Three wet diapers instead of six.
GI	No bilious vomiting or diarrhea.

Risk/source

Candidate explores	Standardized-patient response
Symptoms	Mild nasal congestion; no rash.
Birth	Term uncomplicated birth; no maternal fever/prolonged rupture.
History	No prior admission or antibiotics.
Contact	Sibling has a cold.

Physical findings

Less interactive than usual but not toxic.
No focal bacterial source.
Fontanelle soft; perfusion and breathing require repeated assessment.

Examiner prompts

Fever definition?

Documented rectal temperature at least 38.0°C.

Required evaluation?

Age/risk-stratified assessment including sterile urine, inflammatory markers and blood culture; LP and empiric antibiotics depend on exact age, appearance and pathway.

Does a viral contact end assessment?

No; it does not remove UTI or invasive bacterial infection risk.

Differential diagnosis

UTI
Bacteremia/meningitis
Viral infection
Pneumonia
Skin infection
HSV or other serious infection depending on features

Investigations

Sterile urinalysis/culture
CBC/inflammatory markers and blood culture
LP by age/appearance/risk pathway
Viral testing when it changes care
Other tests by suspected source

Management

Immediate pediatric assessment and reassessment
Empiric parenteral antibiotics when high risk/ill appearing/pathway requires
Support hydration
Admit when high risk or follow-up unreliable
Explicit culture-result/follow-up plan for low risk

Communication behaviours

Validate parent for seeking care
Explain serious infection can occur despite mild appearance
Avoid blame

Critical safety actions

Use an age-specific pathway
Urine testing is essential
Ill appearance overrides low-risk algorithms

Model closing summary

This eight-week-old has documented rectal fever and reduced feeding. Even with a sick contact and no toxic appearance, she needs urgent age-specific assessment for invasive bacterial infection. I would repeatedly assess appearance/perfusion, obtain sterile urine for UA/culture, blood culture and inflammatory markers, and decide on LP, empiric antibiotics and admission using the current pediatric pathway and clinical appearance.

Common pitfalls

Calling it viral and discharging without urine testing
Bag urine culture
Ignoring exact age/temperature method
Antipyretic advice without follow-up

Reference starting points

Verify current recommendations and local protocols before clinical use.

Continue practising

Choose another complete 11-minute station

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