CPEN Sepsis and Infectious Disease Emergencies 5 — Questions and Answers
Question 1: A 5-year-old presents with high fever, drooling, stridor, and tripod positioning. The child appears toxic. Which action is MOST appropriate?
- Perform throat examination with a tongue depressor immediately
- Obtain lateral neck X-ray in the radiology department
- Keep the child calm, call anesthesia/ENT, prepare for emergency airway (Correct answer)
- Administer nebulized racemic epinephrine and observe
Correct answer: Keep the child calm, call anesthesia/ENT, prepare for emergency airway
In suspected epiglottitis, airway stability is paramount; agitating the child or attempting examination can precipitate complete obstruction — immediate expert airway management is required.
Question 2: Which antibiotic combination is recommended as empiric therapy for a neonate (< 28 days) with suspected sepsis without a focal source?
- Ceftriaxone and vancomycin
- Ampicillin and gentamicin (Correct answer)
- Azithromycin and cefazolin
- Piperacillin-tazobactam alone
Correct answer: Ampicillin and gentamicin
Ampicillin plus gentamicin provides coverage for GBS, Listeria monocytogenes, and gram-negative organisms that are the most common neonatal pathogens.
Question 3: A 9-year-old with septic shock is on norepinephrine and epinephrine infusions but remains hypotensive. Bedside echocardiography shows severely depressed LV function. Which additional agent is MOST appropriate?
- Increase norepinephrine dose
- Add vasopressin
- Add milrinone (Correct answer)
- Start phenylephrine
Correct answer: Add milrinone
Milrinone, a phosphodiesterase-3 inhibitor, improves cardiac contractility and reduces afterload, making it appropriate for septic shock with significant myocardial dysfunction.
Question 4: Which clinical feature BEST distinguishes Kawasaki disease from sepsis in a febrile child?
- Fever lasting more than 5 days with conjunctivitis, oral changes, rash, and extremity changes (Correct answer)
- Elevated CRP and ESR
- Tachycardia disproportionate to fever
- Absolute neutrophilia on CBC
Correct answer: Fever lasting more than 5 days with conjunctivitis, oral changes, rash, and extremity changes
Kawasaki disease is defined by fever ≥5 days plus at least 4 of 5 classic features (conjunctivitis, oral changes, rash, extremity changes, cervical lymphadenopathy), differentiating it from sepsis.
Question 5: A 12-year-old returns from a camping trip with fever, headache, myalgias, and a macular rash starting on the wrists and ankles spreading centrally. Which treatment should be initiated IMMEDIATELY?
- Amoxicillin-clavulanate
- Doxycycline (Correct answer)
- Azithromycin
- Ciprofloxacin
Correct answer: Doxycycline
Rocky Mountain Spotted Fever (RMSF) is treated with doxycycline in all age groups, including children, and delay in treatment significantly increases mortality.
Question 6: A 2-year-old with sepsis has a serum glucose of 38 mg/dL. Which dextrose concentration and dose is MOST appropriate for IV correction?
- D50W 1 mL/kg IV push
- D25W 2 mL/kg IV
- D10W 5 mL/kg IV (Correct answer)
- D5W 10 mL/kg IV
Correct answer: D10W 5 mL/kg IV
D10W at 5 mL/kg (providing 0.5 g/kg glucose) is the standard pediatric hypoglycemia correction dose; higher concentrations risk vascular injury and osmotic shifts.
Question 7: During the management of a child with meningococcal sepsis, the nurse notes new onset of unequal pupils and posturing. The MOST immediate intervention is:
- Administer mannitol 0.5-1 g/kg IV and prepare for possible intubation (Correct answer)
- Perform lumbar puncture to check opening pressure
- Increase the rate of IV fluid bolus
- Administer lorazepam 0.1 mg/kg IV
Correct answer: Administer mannitol 0.5-1 g/kg IV and prepare for possible intubation
Unequal pupils and posturing indicate herniation or impending herniation; hyperosmolar therapy with mannitol and preparation for intubation to control ICP are the priority responses.
CPEN Sepsis and Infectious Disease Emergencies 5
A 5-year-old presents with high fever, drooling, stridor, and tripod positioning.
The child appears toxic.
Which action is MOST appropriate?