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Question 1

what is bacteraemia

Answer 1

presence of viable bacteria in the blood

Question 2

what is SIRs

Answer 2

systemic inflammatory response to infection - marked by haemodynamic disturbance and organic disfunction

Question 3

what must be present to qualify for SIRS

Answer 3

2 or more:

1. oral temp >38 or 20 PaCO2 90
2. WBC >120000 or <4000

Question 4

what happens in SIRs

Answer 4

• cytokine storm (TNF, IL-1, IL-6)
• Complement activation
• Coagulation activation
• Microvascular damage
• Neuroendocrine disturbance
• Hypotension

Question 5

what are the signs of organ dysfunction in severe sepsis

Answer 5

Cardiovascular failure:
o hypoperfusion
o hypotension: systolic <90 or 40 less than baseline
Respiratory failure
o Hypoxaemia
Renal failure
o Oliguria
o Azotemia (blood urea nitrates)
Haematologic failure by coagulopathy : thrombocytopaenia or DIC
organ dysfunction: metabolic acidosis, acute alteration in mental status

Question 6

what is septic shock

Answer 6

sepsis with refractory hypotension and impaired end organ perfusion despite adequate fluid resus

Question 7

what is multiple organ dysfunction syndrome

Answer 7

Dysfunction of more than one organ requiring intervention to maintain homeostasis

Question 8

what are the sources of infection in sepsis

Answer 8

20% resp
20% intra-abdominal
20% urinary

Question 9

what are the cardiac complications of sepsis

Answer 9

• reduced myocardial function : ventricular dilation permits a normal stoke volume
• increased cardiac output with decreased peripheral vascular resistance : reduced BP -> warm shock

Question 10

what are the pulmonary complication of sepsis

Answer 10

• increased alveolar capillary permeability : increased pulmonary water content : decreased compliance and oxygen exchange : ARDS
• ARDS in 20-50% of pts with sepsis

Question 11

what is the mortality from septic shock

Answer 11

50-70%

Question 12

what triggers mast cell degranulation

Answer 12

cross linking of antigen with mast cell bound IgE

Question 13

what does prior sensitisation to antigens allow in anaphylaxis

Answer 13

bonding of IgE to mast cells

Question 14

what would you monitor in the case of septic shock

Answer 14

urine output
temperature
SATS

Question 15

what is released when mast cells degranulate

Answer 15

histamine
proteases
chemotactic factors

Question 16

what happens when the antigen is picked up by the dendritic cell

Answer 16

activates Th2 cell

Question 17

which type of reaction causes anaphylaxis

Answer 17

severe type 1 hypersensitivity reaction

Question 18

what does the activation of Th2 cells cause

Answer 18

activation of B cell to produce IgE antibody

Question 19

what results from degranulation of mast cells

Answer 19

smooth muscle spasm
dilation of blood vessels
chemotaxis
mucous secretion
tissue damage

Question 20

where do IgE bind

Answer 20

Fc receptors on mast cell surface, priming mast cells