CPEN Sepsis and Infectious Disease Emergencies 4 — Questions and Answers
Question 1: A 6-week-old infant presents with fever, bulging fontanelle, and high-pitched cry. Which pathogen is the MOST common cause of bacterial meningitis in this age group?
- Neisseria meningitidis
- Group B Streptococcus (Correct answer)
- Haemophilus influenzae
- Streptococcus pneumoniae
Correct answer: Group B Streptococcus
Group B Streptococcus (GBS) is the leading cause of bacterial meningitis in neonates and young infants under 3 months.
Question 2: A 4-year-old with septic shock remains hypotensive after 60 mL/kg of isotonic crystalloid. Which vasoactive agent is the FIRST-LINE choice for fluid-refractory septic shock in children?
- Vasopressin
- Epinephrine
- Norepinephrine (Correct answer)
- Dopamine
Correct answer: Norepinephrine
Current PALS and Surviving Sepsis Campaign guidelines recommend norepinephrine as the first-line vasopressor for fluid-refractory septic shock in children.
Question 3: Which finding is MOST consistent with toxic shock syndrome (TSS) caused by Staphylococcus aureus in a pediatric patient?
- Petechial rash beginning on the trunk
- Desquamation of palms and soles 1-2 weeks after illness onset (Correct answer)
- Vesicular lesions on palms and soles
- Painless ulcer at the primary inoculation site
Correct answer: Desquamation of palms and soles 1-2 weeks after illness onset
Desquamation of the palms and soles occurring 1–2 weeks after the acute illness is a hallmark feature of staphylococcal toxic shock syndrome.
Question 4: A 10-year-old presents with fever, severe headache, neck stiffness, and a petechial rash rapidly spreading to purpura. What is the priority intervention?
- Obtain blood cultures, then administer IV ceftriaxone immediately (Correct answer)
- Perform lumbar puncture before starting antibiotics
- Administer oral amoxicillin and arrange outpatient follow-up
- Start IV vancomycin only and await culture results
Correct answer: Obtain blood cultures, then administer IV ceftriaxone immediately
Blood cultures should be drawn and IV ceftriaxone given immediately in suspected meningococcemia; lumbar puncture should not delay antibiotic therapy.
Question 5: When calculating the PELOD-2 score in a pediatric patient with suspected sepsis, which parameter is included?
- Serum procalcitonin level
- Glasgow Coma Scale score (Correct answer)
- Erythrocyte sedimentation rate
- Body surface area involvement
Correct answer: Glasgow Coma Scale score
The PELOD-2 (Pediatric Logistic Organ Dysfunction-2) score includes Glasgow Coma Scale score as part of its neurological domain assessment.
Question 6: A 7-year-old with a recent varicella infection presents with fever, exquisite leg pain, and refusal to bear weight. Blood cultures grow Group A Streptococcus. What is the MOST likely diagnosis?
- Septic arthritis
- Osteomyelitis
- Necrotizing fasciitis (Correct answer)
- Transient synovitis
Correct answer: Necrotizing fasciitis
Varicella infection predisposes children to invasive GAS infections including necrotizing fasciitis, presenting with severe pain disproportionate to skin findings.
Question 7: A 3-month-old appears ill with fever, tachycardia, and mottled skin. Point-of-care lactate is 4.2 mmol/L. According to the Surviving Sepsis Campaign pediatric guidelines, this lactate level indicates:
- Normal perfusion; reassess in 1 hour
- Mild hypoperfusion; oral rehydration appropriate
- Hyperlactatemia associated with increased mortality risk requiring aggressive resuscitation (Correct answer)
- Benign elevation secondary to crying
Correct answer: Hyperlactatemia associated with increased mortality risk requiring aggressive resuscitation
A lactate ≥2 mmol/L is associated with increased mortality in pediatric sepsis, and a level of 4.2 mmol/L indicates significant tissue hypoperfusion requiring urgent intervention.
CPEN Sepsis and Infectious Disease Emergencies 4
A 6-week-old infant presents with fever, bulging fontanelle, and high-pitched cry.
Which pathogen is the MOST common cause of bacterial meningitis in this age group?