MEDICINE: SEPSIS & SEPTIC SHOCK 1.1 (AB)

Question 1

What is the definition of sepsis according to Sepsis-3?

Answer 1

Life-threatening organ dysfunction resulting from infection due to a deregulated host response.

Question 2

What defines septic shock under Sepsis-3?

Answer 2

Sepsis plus vasopressor therapy needed to maintain MAP ≥65 mmHg and serum lactate >2 mmol/L despite adequate fluid resuscitation.

Question 3

What is bacteremia?

Answer 3

Presence of bacteria actively dividing in the blood.

Question 4

What is septicemia?

Answer 4

Blood poisoning. Sepsis with blood infection.

Question 5

What ancient Greek word is “sepsis” derived from?

Answer 5

Sepo meaning rotten or putrid.

Question 6

Who introduced the word “septicemia” in 1856?

Answer 6

Rudolf Virchow.

Question 7

What are the criteria for SIRS?

Answer 7

Temperature <36°C or >38°C. HR >90 bpm. RR >20/min or PaCO₂ <32 mmHg. WBC <4000/mm³ or >12000/mm³ or >10% bands.

Question 8

How is sepsis diagnosed using SIRS criteria?

Answer 8

SIRS criteria plus confirmed or presumed infection.

Question 9

What defines severe sepsis?

Answer 9

Sepsis plus organ dysfunction.

Question 10

What defines septic shock?

Answer 10

Severe sepsis plus refractory hypotension.

Question 11

What defines multiple organ dysfunction syndrome (MODS)?

Answer 11

Evidence of dysfunction in two or more organs.

Question 12

What are common causes of sepsis?

Answer 12

Pneumonia (most common). Intra-abdominal infections. Gut infections.

Question 13

What are the two most common gram-positive bacteria causing sepsis?

Answer 13

Staphylococcus aureus and Streptococcus pneumoniae.

Question 14

What are the three main gram-negative bacteria associated with septic shock?

Answer 14

Escherichia coli. Klebsiella pneumoniae. Pseudomonas aeruginosa.

Question 15

What is the most common cause of sepsis among all age groups globally?

Answer 15

Diarrheal diseases.

Question 16

What is the most common cause of sepsis in the extremes of age?

Answer 16

Pneumonia.

Question 17

What is the significance of blood cultures in diagnosing sepsis?

Answer 17

Only about ⅓ are positive. ⅔ are negative due to difficulty in isolating organisms.

Question 18

What does a positive blood culture typically require?

Answer 18

At least 2 bottles for aerobic microorganisms from different sites.

Question 19

What are risk factors for progression from infection to organ dysfunction?

Answer 19

Underlying comorbidities. Pre-existing organ dysfunction. Delay in treatment. Extremes of age.

Question 20

What are common comorbidities that increase the risk of sepsis?

Answer 20

HIV. COPD. Cancers.

Question 21

What is the annual incidence of sepsis cases in the US?

Answer 21

2 million cases.

Question 22

What percentage of hospitalized encounters involve septic shock?

Answer 22

19 per 1000 hospitalized encounters.

Question 23

What percentage of global deaths are sepsis-related?

Answer 23

19.7%.

Question 24

Where do 85% of sepsis-related deaths occur?

Answer 24

Low- and middle-income countries.

Question 25

What happens to the endothelium during sepsis pathogenesis?

Answer 25

Increased permeability leads to plasma leakage and tissue edema.

Question 26

What metabolic change causes elevated lactate levels in sepsis?

Answer 26

Increased glycolysis due to mitochondrial dysfunction.

Question 27

What is the main vascular abnormality in sepsis?

Answer 27

Vasodilation leading to hypotension and shock.

Question 28

How does mitochondrial dysfunction contribute to organ failure in sepsis?

Answer 28

By releasing reactive oxygen species (ROS) causing cellular injury.

Question 29

What are the key features of sepsis-related coagulation abnormalities?

Answer 29

Endothelial damage. Platelet aggregation. Thrombosis. Risk of DIC.

Question 30

What role does meningococcemia play in sepsis?

Answer 30

It causes endothelial damage leading to purpuric lesions and high mortality.

Question 31

What is the function of coagulation proteases in sepsis?

Answer 31

Enhance inflammation via protease-activated receptors.

Question 32

What immune system changes occur during sepsis?

Answer 32

Initial hyperinflammation followed by immune suppression.

Question 33

How do phagocytes contribute to anti-inflammatory responses in sepsis?

Answer 33

By switching to an anti-inflammatory phenotype promoting tissue repair.

Question 34

What neural pathway reduces pro-inflammatory cytokine release in sepsis?

Answer 34

Vagus nerve stimulation leading to acetylcholine release by CD4+ T cells.

Question 35

Why do some sepsis patients fail to respond to antibiotics despite appropriate therapy?

Answer 35

Due to sepsis-induced immune suppression.

Question 36

Which organs show increased T-cell inhibitory receptor ligand expression in sepsis?

Answer 36

Lungs and spleen.

Question 37

What cells are most affected by apoptotic death during sepsis-induced immune suppression?

Answer 37

B cells. CD4+ T cells. Follicular dendritic cells.

Question 38

What clinical clue suggests immune suppression in a patient with sepsis?

Answer 38

Persistent infection despite normal WBC counts and unresponsive fever.

Question 39

What is the consensus criteria for sepsis

Answer 39

Organ dysfunction brought about by a dysregulated immune response.

Question 40

What elements are involved in diagnosing sepsis

Answer 40

Documented infection.Acute life-threatening organ dysfunction.Clinician’s acumen.

Question 41

What SOFA score indicates sepsis

Answer 41

2 or higher.

Question 42

What is crucial for immediate point-of-care lab assessment in sepsis

Answer 42

White blood cell count.

Question 43

What causes ARDS in sepsis

Answer 43

Hypoxemia and bilateral infiltrates of non-cardiac origin within 7 days of infection.

Question 44

What are the new 2023 criteria for ARDS time to installation

Answer 44

Up to seven days with known risk factors for mild moderate and severe.

Question 45

How is pulmonary edema described in the new ARDS definition

Answer 45

Not explained by cardiogenic edema or intravascular volume overload.

Question 46

What radiologic feature is seen in ARDS

Answer 46

Bilateral infiltrates not explained by nodules pleural effusion or atelectasis.

Question 47

What is the PaO₂/FiO₂ range for mild ARDS

Answer 47

201–300 with NIV or CPAP with PEEP ≥5 or HFNO >30 L/min.

Question 48

What is the PaO₂/FiO₂ range for moderate ARDS

Answer 48

101–200 with PEEP ≥5.

Question 49

What is the PaO₂/FiO₂ value for severe ARDS

Answer 49

≤100 with PEEP ≥5.

Question 50

How does early septic shock affect cardiac output and SVR

Answer 50

Low cardiac output with high systemic vascular resistance.

Question 51

How much fluid should be given during resuscitation in early septic shock

Answer 51

At least 30cc per kg fast drip.

Question 52

What causes acute kidney injury in sepsis

Answer 52

Decreased blood flow due to plasma leak and hypotension.

Question 53

How much does AKI increase mortality in sepsis

Answer 53

6-8 fold.

Question 54

Can AKI occur without overt hypotension

Answer 54

Yes in 25% of cases.

Question 55

What are the mechanisms causing AKI in sepsis

Answer 55

Diffuse microvascular blood flow abnormalities.Inflammation.Reactive oxygen species.Organ ischemia.

Question 56

What neurologic complication is common in sepsis

Answer 56

Delirium.

Question 57

What is critical-illness polyneuropathy and myopathy associated with

Answer 57

Prolonged critical illness.

Question 58

What is post-sepsis syndrome

Answer 58

Long term cognitive impairment and functional disability affecting 25-50% of survivors.

Question 59

What gastrointestinal complication must be checked in sepsis

Answer 59

Ileus.

Question 60

What liver enzyme alteration suggests alcoholic liver disease

Answer 60

AST greater than ALT.

Question 61

What does thrombocytopenia in sepsis suggest

Answer 61

DIC.

Question 62

What skin finding is associated with DIC

Answer 62

Petechial rashes.

Question 63

What is sick euthyroid syndrome

Answer 63

Low thyroid hormone levels during infection without hypothyroidism.

Question 64

What are the qSOFA criteria for sepsis screening

Answer 64

Hypotension with systolic BP <100 mmHg.Altered mental status.GCS ≤13.Tachypnea RR >22/min.

Question 65

What qSOFA score suggests greater risk for poor outcome

Answer 65

2 or higher.

Question 66

What defines septic shock

Answer 66

Sepsis plus vasopressor need and serum lactate >2.0 mmol/L after fluids.

Question 67

What conditions may cause lactic acidosis

Answer 67

Alcohol intoxication.Liver disease.DM.TPN administration.ARV treatment.

Question 68

What does elevated lactate signify

Answer 68

Impaired clearance.

Question 69

What is the first step in septic shock resuscitation

Answer 69

IV crystalloid 30 mL per kg within first 3 hours.

Question 70

What fluids are recommended for initial resuscitation

Answer 70

Normal saline or balanced crystalloids.

Question 71

What is the vasopressor of choice for septic shock

Answer 71

Norepinephrine.

Question 72

When is vasopressin used in septic shock

Answer 72

To decrease norepinephrine dose.

Question 73

When is dopamine used in septic shock

Answer 73

If high risk for tachyarrhythmias or relative bradycardia.

Question 74

When is dobutamine suggested in septic shock

Answer 74

When there is hypoperfusion despite fluid resuscitation and vasopressor use.

Question 75

When is RBC transfusion indicated in sepsis

Answer 75

Hemoglobin <7.0 g/dL.

Question 76

When should cultures be taken in sepsis

Answer 76

Before antibiotics.

Question 77

When should broad-spectrum antibiotics be given in sepsis

Answer 77

Within 1 hour.

Question 78

What should be done once antibiotic sensitivity results are available

Answer 78

Deescalate antibiotics.

Question 79

What tidal volume is targeted for sepsis-induced ARDS

Answer 79

6 mL per kg of predicted body weight.

Question 80

What is the purpose of increasing PEEP in ARDS

Answer 80

To prevent alveolar collapse.

Question 81

What interventions are recommended for severe ARDS

Answer 81

Proning.Recruitment maneuvers.Neuromuscular blocking agents for <48 hours.

Question 82

Why is conservative fluid strategy recommended after resuscitation

Answer 82

To avoid lung crackles and fluid overload.

Question 83

Is routine pulmonary catheter use recommended in ARDS

Answer 83

No.

Question 84

What is prone positioning used for

Answer 84

Improving breathing in patients with ARDS.

Question 85

Name one benefit of prone positioning

Answer 85

Reduced risk of ventilator-induced lung injury.

Question 86

What type of lung compression occurs less in prone position

Answer 86

Less lung compression allowing more efficient gas exchange.

Question 87

What heart benefit is achieved with prone positioning

Answer 87

Improved heart function and oxygen delivery.

Question 88

What initial antibiotics are used in immunocompetent adults with severe sepsis

Answer 88

Piperacillin-tazobactam.Imipenem-cilastatin.Meropenem.Cefepime.

Question 89

What antibiotic is added if indwelling catheter is present

Answer 89

Vancomycin.

Question 90

What additional treatment is needed if broad-spectrum antibiotics are already being given

Answer 90

Antifungal therapy like Amphotericin.

Question 91

What antibiotics are used for neutropenic sepsis

Answer 91

Imipenem.Piperacillin-tazobactam plus tobramycin.

Question 92

When is vancomycin added in neutropenic sepsis

Answer 92

If indwelling vascular catheter or MRSA risk factors are present.

Question 93

What antibiotic is used for post-splenectomy sepsis

Answer 93

Cefotaxime or ceftriaxone.

Question 94

What antibiotic is used for IV drug users with sepsis

Answer 94

Vancomycin.

Question 95

What regimen is used for AIDS patients with severe sepsis

Answer 95

Cefepime or piperacillin-tazobactam plus tobramycin.

Question 96

What are the five components of the sepsis bundle

Answer 96

Measure serum lactate.Blood cultures before antibiotics.Broad spectrum antibiotics.30 mL/kg crystalloid for hypotension or lactate ≥4 mmol/L.Vasopressors.

Question 97

What is done if initial lactate is more than 2 mmol/L

Answer 97

Remeasure serum lactate.