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Question 1

Define the term acute sepsis

Answer 1

A systemic inflammatory response with documented or presumed infection

Question 2

What causes acute sepsis?

Answer 2

Is causes by the immune systems response to an insult such as an infection

Question 3

What are some common infections that can lead to sepsis?

Answer 3

PneumoniaAbdominal infectionKidney infectionBacteraemia

Question 4

What are the stages that sepsis can be viewed in?

Answer 4

SepsisSevers SepsisSeptic Shock

Question 5

What is the Glasgow Coma Scale?

Answer 5

A test of mental alertness/consciousness- value between 0 and 15

Question 6

What are the four characteristics of Systemic Inflammatory Response Syndrome?

Answer 6

1. Temp below 36 or above 382. Increased HR, above 90 bpm3. Increased respiratory rate, above 20/min4. WBC above 12x10^9/L or below 4x10^9/L

Question 7

What is bacteraemia?

Answer 7

The presence of bacteria in the blood

Question 8

What is septicaemia?

Answer 8

Generalised sepsis

Question 9

Define severe sepsis

Answer 9

SIRS with organ dysfunction of organ hypoperfusion.

Question 10

What are some features of severe sepsis?

Answer 10

HypotensionDecreased urine outputAbrupt changes in mental statusDecreased platelet countDifficulty breathingAbnormal heart pumping functionAbdominal pain

Question 11

Define septic shock

Answer 11

Severe sepsis with persistently low blood pressure, despite the administration of IV fluids PLUS the other symptoms of severe sepsis

Question 12

Describe the mechanism by which micro-organisms trigger the inflammatory cascade

Answer 12

Infection attaches to the host by endotoxins which bind to macrophages and trigger the release of cytokines.

Question 13

What are the cytokines released in the inflammatory cascade?

Answer 13

TNF-alpha Interleukiene-1

Question 14

What does cytokine release promote?

Answer 14

Promotes wound repairInitiates thrombin productionInhibits fibrinolysisStimulate growth factor, macrophages and platelets

Question 15

What is the main cause of shock?

Answer 15

Disseminated intravascular coagulation

Question 16

What are the urgent investigations that should be carried out in order to review progress/

Answer 16

FBC, Urea and electrolytesBlood glucoseLFTsCRPClotting studiesBlood gases

Question 17

What are some of the complications of SIRS?

Answer 17

Irreversible hypotensionRespiratory FailureAcute kidney injury/kidney failureRaised intracranial pressureIschaemic necrosis of the hands and feet

Question 18

What are the treatments for sepsis?

Answer 18

1. High flow oxygen2. Blood cultures and consider control of the source of the infection3. Administer empirical IV antibiotics4. Measure serum lactate5. Start IV fluid resuscitation6. Commence accurate urine output measurement

Question 19

Why do you deliver high flow oxygen?

Answer 19

Increases perfusion to organs

Question 20

Why do you take blood cultures and consider control of the source of the infection?

Answer 20

Drain any abscesses or infected peritoneal fluid. Helps to identify bacteria/virus to make treatment more specific

Question 21

Why do you administer empirical IV antibiotics?

Answer 21

Give supportive treatment ASAP to give time for investigations for specific treatment

Question 22

Why do you measure serum lactate?

Answer 22

Elevated lactate levels is a maker for poor tissue perfusion.

Question 23

Why do you start IV fluid resuscitation?

Answer 23

Increases blood pressure

Question 24

Why do you start to measure an accurate urine output?

Answer 24

Indicates kidney function

Question 25

How do you choose which antibiotic to use?

Answer 25

What agent is the most likely cause of infection in that group of people?Do you need to penetrate the CSF?

Question 26

How do you confirm a diagnosis?

Answer 26

-- Blood culture before antibiotics are administered-- PCR of blood-- Lumbar puncture if safe then culture and PCR the CSF

Question 27

Give some specific treatments

Answer 27

Surgical debridementAmtimicrobials

Question 28

Give some supportive treatments

Answer 28

VasopressersIV fluidsBloos transfusionMechanical ventilationDialysis-- TREAT THE SYMPTOMS

Question 29

Give some physical characteristics of neisseria meningitidis

Answer 29

Gram negative diplococusHas numerous serogroupsIs highly anti-phagocyticOuter membrane acts as an endotoxin and triggers inflammationPili are present which enhance attachement to organism

Question 30

How is neisseria meningitidis spread?

Answer 30

By direct contact through respiratory secretions

Question 31

How are meningococcal infections spread?

Answer 31

By aerosols and nasopharyngeal secretions

Question 32

What are the different types of meningococcal disease and where are the most commonly present?

Answer 32

Type A and B are the most common in the UK. Type A is predominant in Africa in the "meningitis belt"

Question 33

What is a notifiable disease?

Answer 33

A disease which you must report to the local Health Protection Unit of Public Health England. People in close contact are given and antiprophylactic.

Question 34

What happens once someone has been infected with the organism?

Answer 34

You either clear the infection or become a carrier depending on the individual immune system.

Question 35

What happens in meningitis?

Answer 35

The bacteria which has invaded the blood stream invade the meninges surrounding the brain where they multiply, release toxins and cause inflammation of the meninges and of the brain.

Question 36

What are the characteristics of meningitis?

Answer 36

Is rapidly progressive. Can fatal if not treated properly

Question 37

What are the symptoms of meningitis?

Answer 37

HeadacheStiff neckPhotophobiaDrowsinessConfusionDeliriousnessSeizuresUnconciousnessPurpuric, non-blanching rash

Question 38

Give some characteristics of Streptococcue pneumoniae

Answer 38

Gram positiveEncapsulated cocciNon-motileHas pili for attachment to host cells in the upper respiratory tract

Question 39

What does streptococcus pneumoniae mainly cause?

Answer 39

Bacterial pneumonia which occurs after an upper or middle respiratory tract infection.

Question 40

What are the symptoms of bacterial pneumonia?

Answer 40

Crackling in the lungsYellow SputumFeverHigh temperatureIncrease respiratory rateLow blood pressure