MEDICINE: SEPSIS & SEPTIC SHOCK 1.2 (AB)

Question 1

What is the primary support goal in sepsis treatment?

Answer 1

Improve delivery of O2.

Question 2

What type of fluid is used for initial resuscitation in sepsis?

Answer 2

Crystalloids.

Question 3

What clinical signs indicate successful fluid resuscitation in sepsis?

Answer 3

Resolution of hypotension. oliguria. altered mentation. and hyperlactemia.

Question 4

Why is dopamine avoided in patients with heart conditions during septic shock?

Answer 4

Because dopamine increases the risk of arrhythmias.

Question 5

What inotropic agent is preferred first-line in septic shock?

Answer 5

Norepinephrine.

Question 6

What serious complication can vasopressin cause?

Answer 6

Limb ischemia.

Question 7

What should you monitor when using vasopressin?

Answer 7

Color changes or capillary refill of the lower extremities.

Question 8

When should antibiotic de-escalation be performed in sepsis management?

Answer 8

When bacterial sensitivities are known and narrow-spectrum antibiotics can be used.

Question 9

What is the prognosis for patients surviving sepsis?

Answer 9

Increased risk of death within months or years.

Question 10

Within what timeframe is mortality highest after surviving sepsis?

Answer 10

Within 3 months.

Question 11

What complications commonly occur in sepsis survivors?

Answer 11

Neurocognitive dysfunction. mood disorders. and low quality of life.

Question 12

What is the hospital readmission rate within 90 days after sepsis?

Answer 12

Exceeds 40%.

Question 13

What is the definition of sepsis according to the 2021 Surviving Sepsis Campaign?

Answer 13

Life-threatening organ dysfunction caused by a dysregulated host response to infection.

Question 14

How much fluid should be given within 3 hours for sepsis-induced hypoperfusion?

Answer 14

At least 30 mL/kg of IV crystalloid.

Question 15

What dynamic measures can guide fluid resuscitation in sepsis?

Answer 15

Response to passive leg raise. fluid bolus. stroke volume variation. pulse pressure variation. echocardiography.

Question 16

What does a qSOFA score greater than 2 suggest?

Answer 16

Investigation for organ dysfunction and need for escalated therapy.

Question 17

What are the three qSOFA criteria?

Answer 17

Glasgow Coma Scale <15. respiratory rate >22. systolic BP <100 mmHg.

Question 18

What is the role of NEWS2 in sepsis?

Answer 18

Standardized scoring to detect deterioration in acutely ill patients.

Question 19

At what NEWS2 score should urgent clinical response be initiated?

Answer 19

Score of 5 or 6.

Question 20

What is the predictive value of NEWS2 score >6?

Answer 20

80.0% sensitivity and 84.3% specificity for severe disease.

Question 21

What is the blood lactate level cutoff that suggests elevated lactate in sepsis?

Answer 21

1.6-2.5 mmol/L.

Question 22

Does an elevated lactate confirm sepsis diagnosis?

Answer 22

No. lactate alone is neither sensitive nor specific enough.

Question 23

When should treatment and resuscitation begin in suspected sepsis?

Answer 23

Immediately.

Question 24

What happens if crystalloid fluid therapy is delayed beyond 3 hours in sepsis?

Answer 24

Increased mortality. delayed hypotension resolution. increased ICU stay.

Question 25

What initial target MAP should be maintained in septic shock?

Answer 25

65 mmHg.

Question 26

Why is maintaining a MAP >65 mmHg important in septic shock?

Answer 26

To ensure adequate organ perfusion and venous return.

Question 27

Within how many hours should a septic patient requiring ICU care be admitted?

Answer 27

Within 6 hours.

Question 28

If infection is unconfirmed in sepsis. what is the recommended approach?

Answer 28

Continuously re-evaluate and discontinue empiric antimicrobials if another cause is found.

Question 29

When should antimicrobials ideally be administered in septic shock?

Answer 29

Within 1 hour of recognition.

Question 30

What are risks of unnecessary antimicrobial use?

Answer 30

Allergic reactions. kidney injury. thrombocytopenia. C difficile infection. antimicrobial resistance.

Question 31

By when should antimicrobials be started in possible sepsis without shock if diagnosis remains likely?

Answer 31

Within 3 hours.

Question 32

Should procalcitonin be used alone to decide when to start antimicrobials?

Answer 32

No. clinical evaluation should remain primary.

Question 33

What is a normal procalcitonin level in sepsis assessment?

Answer 33

Less than 0.5.

Question 34

What procalcitonin level strongly discourages antibiotic therapy?

Answer 34

<0.1.

Question 35

At what procalcitonin range is antibiotic therapy encouraged?

Answer 35

0.25 to <0.5.

Question 36

When is antibiotic therapy strongly encouraged based on procalcitonin?

Answer 36

>0.5.

Question 37

What does a significant drop in procalcitonin after antibiotics suggest?

Answer 37

Bacterial eradication and possible antibiotic de-escalation.

Question 38

Why is procalcitonin useful in antibiotic de-escalation?

Answer 38

It helps decide when to switch from broad to narrow-spectrum antibiotics.

Question 39

What should be done before starting antibiotics in suspected sepsis if no major delay occurs?

Answer 39

Obtain appropriate microbiological cultures including blood.

Question 40

What is the sensitivity and specificity of procalcitonin for sepsis diagnosis?

Answer 40

77% sensitivity and 79% specificity.

Question 41

For septic patients at high risk of MRSA. what is recommended?

Answer 41

Use empiric antimicrobials with MRSA coverage.

Question 42

For septic patients at low risk of MRSA. what is recommended?

Answer 42

Avoid empiric MRSA coverage.

Question 43

What are dynamic clinical signs to assess tissue perfusion in sepsis?

Answer 43

Extremity temperature. skin mottling. capillary refill time.

Question 44

How is skin mottling scored in sepsis?

Answer 44

0 to 5 based on severity and extent.

Question 45

What does a mottling score of 5 indicate?

Answer 45

Grave mottling exceeding beyond the groin.

Question 46

What are patient-related risk factors for MRSA?

Answer 46

Prior history of MRSA infection or colonization. recent IV antibiotics. history of recurrent skin infections or chronic wounds. presence of invasive devices. hemodialysis. recent hospital admissions and severity of illness

Question 47

What is the impact of delaying antibiotic administration for >24-48 hours in MRSA infections?

Answer 47

Associated with increased mortality

Question 48

What antibiotics should be used during the empiric phase of infection management?

Answer 48

Broad-spectrum antibiotics

Question 49

When is sustained double gram-negative coverage rarely necessary?

Answer 49

Once causative agents and susceptibilities are known

Question 50

What factors guide empiric antibiotic decisions?

Answer 50

Proven infection or colonization with resistant organisms within the preceding year. local prevalence of resistant organisms. hospital-acquired or healthcare-associated infection. broad-spectrum antibiotic use within preceding 90 days. concurrent use of SDD. travel to endemic country within preceding 90 days. hospitalization abroad within preceding 90 days

Question 51

What is the antibiotic strategy for patients at high risk for MDR organisms?

Answer 51

Use two gram-negative agents for empiric treatment

Question 52

What is the antibiotic strategy for patients at low risk for MDR organisms?

Answer 52

Use a single agent for empiric treatment

Question 53

What patient group requires empiric antifungal therapy if febrile neutropenia persists after 4-7 days of broad-spectrum antibiotics?

Answer 53

Patients with febrile neutropenia

Question 54

Which viral infections are immunocompromised patients particularly vulnerable to?

Answer 54

HSV. EBV. CMV. respiratory viruses like adenovirus

Question 55

Which zoonotic viral infections can present like sepsis in tropical and subtropical regions?

Answer 55

Dengue. Ebola. Lassa. Marburg. Sin Nombre. Chikungunya

Question 56

What is the treatment for dengue viral infection?

Answer 56

Fluid management

Question 57

What is the recommended method of beta-lactam antibiotic delivery in sepsis?

Answer 57

Prolonged infusion after an initial bolus

Question 58

Why is prolonged infusion of beta-lactams used?

Answer 58

To maintain minimum inhibitory concentration for optimal bacterial killing

Question 59

What are examples of source control in infection management?

Answer 59

Drainage of abscess. debridement of infected necrotic tissue. removal of infected devices. definitive control of contamination source

Question 60

Why is source control crucial in treating abscesses?

Answer 60

Antibiotics cannot penetrate abscesses effectively

Question 61

What infections are amenable to source control?

Answer 61

Intra-abdominal abscess. GI perforation. ischemic bowel or volvulus. cholangitis. cholecystitis. pyelonephritis with obstruction. necrotizing soft tissue infection. empyema. septic arthritis. implanted device infections

Question 62

What biomarker can help guide antibiotic de-escalation?

Answer 62

Procalcitonin

Question 63

What does a decrease of 80% in procalcitonin suggest?

Answer 63

Shift antibiotic treatment to oral or narrower-spectrum antibiotics

Question 64

What is the recommendation regarding intravascular devices in sepsis?

Answer 64

Prompt removal after establishing other vascular access

Question 65

How often should antimicrobial therapy be reassessed for de-escalation in sepsis?

Answer 65

Daily

Question 66

What is the first-line fluid for resuscitation in sepsis or septic shock?

Answer 66

Crystalloids

Question 67

What type of crystalloid is preferred over normal saline for resuscitation?

Answer 67

Balanced crystalloids

Question 68

When is albumin suggested in sepsis resuscitation?

Answer 68

After receiving large volumes of crystalloids

Question 69

Which fluids are not recommended for resuscitation in sepsis?

Answer 69

Starches and gelatin

Question 70

What are potential adverse effects of normal saline administration?

Answer 70

Hyperchloremic metabolic acidosis. renal vasoconstriction. increased cytokine secretion. risk of acute kidney injury

Question 71

Which vasopressor is preferred for septic shock?

Answer 71

Norepinephrine

Question 72

Why is norepinephrine preferred over dopamine?

Answer 72

More potent vasoconstrictor with minimal effect on heart rate

Question 73

What are the adverse effects of epinephrine?

Answer 73

Arrhythmias. impaired splanchnic circulation. increased aerobic lactate production

Question 74

What inotropes are suggested for cardiac dysfunction in septic shock?

Answer 74

Dobutamine added to norepinephrine or epinephrine alone

Question 75

Which inotrope should be avoided in septic shock?

Answer 75

Levosimendan

Question 76

What ventilation strategy is recommended for sepsis-induced ARDS?

Answer 76

Low tidal volume ventilation (6 mL/kg)

Question 77

What is the definition of moderate ARDS according to the Berlin criteria?

Answer 77

PaO2/FiO2 ≤ 200 mmHg

Question 78

What PEEP strategy is suggested in moderate to severe sepsis-induced ARDS?

Answer 78

Higher PEEP

Question 79

What ventilation strategy is suggested for sepsis-induced respiratory failure without ARDS?

Answer 79

Low tidal volume

Question 80

Are recruitment maneuvers recommended for moderate-severe ARDS?

Answer 80

Yes. traditional recruitment maneuvers

Question 81

Is incremental PEEP titration recommended?

Answer 81

No

Question 82

What ventilation position is recommended for moderate-severe ARDS?

Answer 82

Prone ventilation for >12 hours daily

Question 83

What corticosteroid is used in septic shock requiring vasopressors?

Answer 83

IV hydrocortisone 200 mg/day

Question 84

When should corticosteroids be considered in septic shock?

Answer 84

When norepinephrine or epinephrine dose is ≥ 0.25 mcg/kg/min after 4 hours

Question 85

What is the recommendation for stress ulcer prophylaxis in sepsis?

Answer 85

Use PPI in patients with GI bleeding risk factors

Question 86

What is the recommendation for VTE prophylaxis in sepsis?

Answer 86

Use pharmacologic prophylaxis unless contraindicated

Question 87

Which VTE prophylactic agent is preferred in sepsis?

Answer 87

Low molecular weight heparin

Question 88

Is mechanical VTE prophylaxis recommended alongside pharmacologic prophylaxis?

Answer 88

No

Question 89

At what glucose level should insulin therapy be initiated in sepsis?

Answer 89

≥ 180 mg/dL

Question 90

What is the target blood glucose range after insulin therapy initiation?

Answer 90

144-180 mg/dL

Question 91

What are consequences of hyperglycemia and hypoglycemia in sepsis?

Answer 91

Increased mortality

Question 92

When should enteral nutrition be initiated in sepsis?

Answer 92

Within 48 to 72 hours if feasible