CPEN Sepsis and Infectious Disease Emergencies 1 — Questions and Answers
Question 1: According to current Surviving Sepsis Campaign guidelines for pediatrics, what is the recommended time frame for administering IV antibiotics after recognizing septic shock?
- Within 1 hour (Correct answer)
- Within 3 hours
- Within 6 hours
- Within 30 minutes
Correct answer: Within 1 hour
The Surviving Sepsis Campaign recommends IV antibiotics within 1 hour of recognizing pediatric septic shock to reduce mortality.
Question 2: A 6-month-old presents with temperature of 38.5°C, heart rate of 180 bpm, respiratory rate of 55, and appears lethargic. What is the MOST appropriate initial intervention?
- Obtain blood cultures and start broad-spectrum antibiotics (Correct answer)
- Perform a lumbar puncture immediately before any other action
- Administer antipyretics and observe for 30 minutes
- Order chest X-ray and urinalysis only before treatment
Correct answer: Obtain blood cultures and start broad-spectrum antibiotics
Blood cultures should be obtained immediately followed by empiric broad-spectrum antibiotics, as this toxic-appearing infant has a presentation highly concerning for sepsis.
Question 3: What is the recommended initial fluid bolus for a pediatric patient presenting in septic shock?
- 5 mL/kg of 0.9% normal saline
- 10 mL/kg of 5% dextrose in water
- 20 mL/kg of isotonic crystalloid (Correct answer)
- 40 mL/kg of 0.45% half-normal saline
Correct answer: 20 mL/kg of isotonic crystalloid
Current PALS guidelines recommend an initial fluid bolus of 20 mL/kg of isotonic crystalloid (normal saline or Lactated Ringer's) for pediatric septic shock.
Question 4: Which laboratory finding is MOST consistent with severe sepsis and tissue hypoperfusion?
- Elevated serum lactate level greater than 2 mmol/L (Correct answer)
- White blood cell count below 5,000/mm³ only
- Blood glucose above 200 mg/dL
- Normal C-reactive protein with elevated procalcitonin
Correct answer: Elevated serum lactate level greater than 2 mmol/L
Elevated lactate greater than 2 mmol/L indicates anaerobic metabolism from tissue hypoperfusion and is a key diagnostic and prognostic marker in severe sepsis.
Question 5: A 2-year-old with septic shock receives three fluid boluses totaling 60 mL/kg with minimal hemodynamic improvement. What is the NEXT most appropriate intervention?
- Administer a fourth fluid bolus of 20 mL/kg
- Initiate vasoactive medications such as epinephrine or norepinephrine (Correct answer)
- Perform immediate endotracheal intubation without other interventions
- Transfer without further intervention
Correct answer: Initiate vasoactive medications such as epinephrine or norepinephrine
After adequate fluid resuscitation without improvement, vasoactive/vasopressor support should be initiated for fluid-refractory septic shock.
Question 6: Which presentation BEST describes 'warm shock' (hyperdynamic septic shock) in a pediatric patient?
- Cool, mottled skin with weak thready pulses and delayed capillary refill
- Bounding pulses, flash capillary refill, and wide pulse pressure (Correct answer)
- Bradycardia with absent peripheral pulses and cold extremities
- Cyanosis with agonal respirations and pulseless rhythm
Correct answer: Bounding pulses, flash capillary refill, and wide pulse pressure
Warm (vasodilatory) shock presents with bounding pulses, flash capillary refill, and wide pulse pressure due to decreased systemic vascular resistance.
Question 7: A febrile neonate aged 18 days is brought to the emergency department. The infant appears well but has a rectal temperature of 38.1°C. What is the MOST appropriate management?
- Observe for 4 hours and discharge if remains well-appearing
- Perform full sepsis workup and admit for empiric IV antibiotics (Correct answer)
- Administer oral amoxicillin and recheck in 24 hours
- Obtain urinalysis and CBC only before making treatment decision
Correct answer: Perform full sepsis workup and admit for empiric IV antibiotics
All neonates younger than 28 days with fever require a full sepsis evaluation (CBC, blood culture, UA/urine culture, LP, CXR) and empiric IV antibiotics due to high risk of serious bacterial infection.
