CPEN Sepsis and Infectious Disease Emergencies 2 — Questions and Answers
Question 1: A 3-year-old presents with high fever, severe headache, neck stiffness, and a non-blanching petechial rash spreading rapidly. What is the PRIORITY intervention?
- Perform lumbar puncture before starting antibiotics
- Administer IV ceftriaxone immediately without waiting for LP (Correct answer)
- Obtain a head CT scan before any other intervention
- Start IV acyclovir as first-line empiric treatment
Correct answer: Administer IV ceftriaxone immediately without waiting for LP
Suspected meningococcemia requires immediate IV antibiotics (ceftriaxone) without delay, as each hour of treatment delay significantly increases mortality.
Question 2: Which CSF analysis result is MOST consistent with bacterial meningitis?
- Clear fluid, low protein, normal glucose, predominantly lymphocytes
- Turbid fluid, elevated protein, decreased glucose, neutrophilic pleocytosis (Correct answer)
- Xanthochromic fluid with elevated RBCs and normal protein
- Clear fluid with normal protein, glucose, and no white cells
Correct answer: Turbid fluid, elevated protein, decreased glucose, neutrophilic pleocytosis
Bacterial meningitis typically shows turbid CSF with elevated protein, decreased glucose relative to serum, and neutrophilic pleocytosis due to bacterial invasion.
Question 3: A 2-year-old has had fever for 6 days with bilateral non-purulent conjunctival injection, erythematous cracked lips, strawberry tongue, and a diffuse macular rash. Which diagnosis BEST fits this presentation?
- Scarlet fever from Group A Streptococcus
- Kawasaki disease (Correct answer)
- Toxic shock syndrome
- Stevens-Johnson syndrome
Correct answer: Kawasaki disease
Kawasaki disease requires fever for 5 or more days plus at least 4 of 5 criteria: bilateral non-exudative conjunctivitis, oral mucosal changes, rash, extremity changes, and cervical lymphadenopathy.
Question 4: What is the standard first-line treatment for Kawasaki disease?
- IV methylprednisolone and oral azithromycin
- IV immunoglobulin (IVIG) and high-dose aspirin (Correct answer)
- IV ceftriaxone and low-dose aspirin
- Oral prednisone and ibuprofen
Correct answer: IV immunoglobulin (IVIG) and high-dose aspirin
IVIG (2 g/kg single infusion) and high-dose aspirin are the standard treatment for Kawasaki disease to reduce inflammation and prevent coronary artery aneurysms.
Question 5: A 5-year-old develops fever, sore throat, and a diffuse 'sandpaper-like' rash after a positive rapid strep test. What is the MOST appropriate antibiotic treatment?
- Azithromycin for 5 days
- Amoxicillin for 10 days (Correct answer)
- Cephalexin for 7 days
- Clindamycin for 14 days
Correct answer: Amoxicillin for 10 days
Amoxicillin for 10 days (or penicillin) is first-line treatment for Group A Streptococcal pharyngitis/scarlet fever to eradicate the organism and prevent rheumatic fever.
Question 6: Which clinical triad BEST distinguishes peritonsillar abscess from severe tonsillitis in a child?
- High fever, bilateral tonsillar enlargement, and odynophagia
- Uvular deviation, trismus, and muffled 'hot potato' voice (Correct answer)
- Unilateral otalgia, drooling, and neck rigidity
- Drooling, stridor, and the sniffing position
Correct answer: Uvular deviation, trismus, and muffled 'hot potato' voice
Peritonsillar abscess classically presents with uvular deviation toward the unaffected side, trismus from pterygoid muscle spasm, and a muffled 'hot potato' voice.
Question 7: An 18-month-old presents with 3 days of fever and irritability. Examination reveals a bulging, erythematous tympanic membrane with loss of the light reflex. Which antibiotic is FIRST-LINE per AAP guidelines?
- Azithromycin
- Amoxicillin (Correct answer)
- Trimethoprim-sulfamethoxazole
- Cephalexin
Correct answer: Amoxicillin
Amoxicillin is the first-line antibiotic for acute otitis media per AAP guidelines due to its efficacy against S. pneumoniae, the most common causative organism.
CPEN Sepsis and Infectious Disease Emergencies 2
A 3-year-old presents with high fever, severe headache, neck stiffness, and a non-blanching petechial rash spreading rapidly.
What is the PRIORITY intervention?