Undifferentiated fever and fever without a source in infants and children — formative viva

A MedVellum formative branching viva on the age-stratified evaluation of a febrile child without a localising source. Tests the candidate's ability to classify risk by age, choose investigations, apply prediction rules, select empiric antibiotics and construct a safe disposition. Not an official board format.

Prompt

A series of escalating clinical updates about a febrile infant, from initial presentation through risk-stratification, investigation, and disposition decisions.

Branching cross-examination

Name: Undifferentiated fever and fever without a source in infants and children — formative viva
Creator: MedVellum
Published: 2026-07-12

This is a MedVellum formative viva. It is not an official RACP, MRCPCH, ABP, ACGME or RCPSC station, mark scheme, duration or pass standard. Release each update only after the candidate states the risk category, immediate action and next step. [6] [13]

Candidate brief

You are the paediatric registrar in a regional emergency department. You will receive a series of escalating clinical updates about a febrile infant. For each update, state what you would do next and why. Treat each branch as a continuous case. [1] [6]

Paediatrics Fellowship Pro

You have read the opening of this viva. The complete unit — every section and its primary-source references — is part of the Paediatrics Fellowship fellowship atlas.

References7Show ledger

[1]Kuppermann N, Dayan PS, Levine DA, et al. A Clinical Prediction Rule to Identify Febrile Infants 60 Days and Younger at Low Risk for Serious Bacterial Infections. JAMA pediatrics, 2019.PMID 30776077
[2]Jaskiewicz JA, McCarthy CA, Richardson AC, et al. Febrile infants at low risk for serious bacterial infection--an appraisal of the Rochester criteria and implications for management. Pediatrics, 1994.PMID 8065869
[4]Nigrovic LE, Kuppermann N, Malley R Development and validation of a multivariable predictive model to distinguish bacterial from aseptic meningitis in children in the post-Haemophilus influenzae era. Pediatrics, 2002.PMID 12359784
[6]Ishimine P Fever without source in children 0 to 36 months of age. Pediatric clinics of North America, 2006.PMID 16574521
[9]Yo CH, Hsieh PS, Lee SH, et al. Comparison of the test characteristics of procalcitonin to C-reactive protein and leukocytosis for the detection of serious bacterial infections in children presenting with fever without source. Annals of emergency medicine, 2012.PMID 22921165
[13]Baraff LJ Management of infants and young children with fever without source. Pediatric annals, 2008.PMID 18972849
[15]Velasco R, Gomez B, Benito J, et al. Accuracy of PECARN rule for predicting serious bacterial infection in infants with fever without a source. Archives of disease in childhood, 2021.PMID 32816694

Undifferentiated fever and fever without a source in infants and children — formative viva

Candidate brief

Paediatrics Fellowship Pro

You have read the opening of this viva. The complete unit — every section and its primary-source references — is part of the Paediatrics Fellowship fellowship atlas.

References7Show ledger

[1]Kuppermann N, Dayan PS, Levine DA, et al. A Clinical Prediction Rule to Identify Febrile Infants 60 Days and Younger at Low Risk for Serious Bacterial Infections. JAMA pediatrics, 2019.PMID 30776077
[2]Jaskiewicz JA, McCarthy CA, Richardson AC, et al. Febrile infants at low risk for serious bacterial infection--an appraisal of the Rochester criteria and implications for management. Pediatrics, 1994.PMID 8065869
[4]Nigrovic LE, Kuppermann N, Malley R Development and validation of a multivariable predictive model to distinguish bacterial from aseptic meningitis in children in the post-Haemophilus influenzae era. Pediatrics, 2002.PMID 12359784
[6]Ishimine P Fever without source in children 0 to 36 months of age. Pediatric clinics of North America, 2006.PMID 16574521
[9]Yo CH, Hsieh PS, Lee SH, et al. Comparison of the test characteristics of procalcitonin to C-reactive protein and leukocytosis for the detection of serious bacterial infections in children presenting with fever without source. Annals of emergency medicine, 2012.PMID 22921165
[13]Baraff LJ Management of infants and young children with fever without source. Pediatric annals, 2008.PMID 18972849
[15]Velasco R, Gomez B, Benito J, et al. Accuracy of PECARN rule for predicting serious bacterial infection in infants with fever without a source. Archives of disease in childhood, 2021.PMID 32816694