CPEN Sepsis and Infectious Disease Emergencies 3

Question 1

A 6-week-old presents with paroxysmal coughing episodes, post-tussive vomiting, and an apneic episode. The infant was born to an incompletely vaccinated mother. Which diagnosis is MOST likely?

Accepted Answer

Pertussis (whooping cough)

Answer

Respiratory syncytial virus bronchiolitis

Answer

Viral croup (laryngotracheobronchitis)

Answer

Bacterial pneumonia from S. pneumoniae

Question 2

A child presents sitting upright and leaning forward in the 'sniffing position' with high fever, drooling, and severe respiratory distress. Epiglottitis is suspected. What is the MOST important immediate action?

Accepted Answer

Minimize agitation, prepare for definitive airway management, and call for anesthesia/ENT backup

Answer

Perform oral examination with a tongue depressor to visualize the epiglottis

Answer

Administer racemic epinephrine via nebulizer as first-line treatment

Answer

Obtain a lateral neck X-ray before any airway intervention

Question 3

Which radiographic finding on a lateral neck X-ray is MOST consistent with epiglottitis?

Accepted Answer

Thumb sign representing an enlarged, rounded epiglottis

Answer

Steeple sign representing subglottic narrowing

Answer

Retropharyngeal widening at the C2 level

Answer

Prevertebral soft tissue swelling below the C4 level

Question 4

A 4-year-old presents with fever, headache, and a rash that began on the wrists and ankles 3 days ago and has now spread to the trunk. There is a history of tick exposure. Which infection is MOST likely?

Accepted Answer

Rocky Mountain Spotted Fever (RMSF)

Answer

Lyme disease (erythema migrans)

Answer

Ehrlichiosis

Answer

Tularemia

Question 5

What is the drug of choice for Rocky Mountain Spotted Fever in a 5-year-old child, despite typical age-related concerns?

Accepted Answer

Doxycycline

Answer

Amoxicillin-clavulanate

Answer

Azithromycin

Answer

Ceftriaxone

Question 6

Which clinical features BEST differentiate septic arthritis from transient synovitis in a child with a painful hip?

Accepted Answer

Fever, significantly elevated ESR/CRP/WBC, and refusal to bear any weight

Answer

Mild limp with low-grade fever and normal ESR and WBC

Answer

Resolution of hip pain with NSAIDs within 24 hours

Answer

Bilateral hip discomfort occurring after a recent viral illness

Question 7

A 10-year-old receiving chemotherapy presents with a fever of 38.6°C. His absolute neutrophil count (ANC) is 320/mm³. What is the MOST appropriate management?

Accepted Answer

Admit and initiate IV broad-spectrum antibiotics immediately

Answer

Discharge with oral ciprofloxacin and follow-up in 24 hours

Answer

Observe in the ED for 6 hours and recheck the CBC

Answer

Administer G-CSF (filgrastim) subcutaneously and reassess in 2 hours