INF1 - A. SEPSIS AND MENINGOCOCCAL DISEASE-COVERED

Question 1

what is sepsis

Answer 1

• body’s immune system has an extreme response to an infection
• the body’s reaction causes damage to it’s own tissues and organs

Question 2

high risk groups for sepsis

Answer 2

75 yrs>
babies <1
diabetics
weakened immune system
just given birth, miscarried, abortion

Question 3

physiological effects of sepsis on CVS

Answer 3

• hypotension - blood vessels dilate, and hence decreased oxygen to organs
• mottled skin and altered microcirculation
• increased lactate levels in septic shock

Question 4

physiological effects of sepsis on hepatic system

Answer 4

increased bilirubin levels and liver enzymes and hence decreased metabolism

Question 5

physiological effects of sepsis on renal system

Answer 5

• oliguria
• increased serum creatinine, blood urea nitrogen and biomarkers

Question 6

physiological effects of sepsis on neurological system

Answer 6

• altered mentation
• confusion
• disorientation

Question 7

physiological effects of sepsis on respiratory system

Answer 7

• decrease blood flow to heart and hence decreased oxygen levels in blood (hypoxaemia)
• decreased PaO2:FiO2 ratio

Question 8

physiological effects of sepsis on haematological system

Answer 8

• low platelet count
• disseminated intravascular coagulation (abnormal blood clotting)
• petechiae (rash)

Question 9

symptoms of sepsis in children

Answer 9

fast breathing
fit or convulsion
mottled, bluish, pale
rash that doesn’t fade
very tired/difficult to wake
feels abnormally cold

Question 10

symptoms of sepsis in adults

Answer 10

slurred speech or confusion
extreme shivering or muscle pain
passing no urine in a day
severe breathlessness
it feels like your going to die
skin mottled or discoloured

Question 11

what to use to identify sepsis at earliest stage

Answer 11

NEWS2 (is it 5 or more?)

Question 12

why give oxygen when sepsis detected

Answer 12

hypoxia kills, this prevents tissue damage
we want SpO2 94-98% or 88-92% in COPD

Question 13

why obtain IV access and take fluids

Answer 13

to identify pathogen causing infection
urine, sputum should also be cultured

Question 14

why give IV antibiotics

Answer 14

give in 1 hour of diagnosis
broad spectrum - targets gram -ve/+ve
start smart then focus toolkit

Question 15

why give IV fluids

Answer 15

adults - 500ml over less than 15 minutes
become dehydrated
leads to decreased reduced urine output

Question 16

why monitor patient

Answer 16

use NEWS2 to monitor urinary output
may need catheter
repeat lactate levels once per hour if initial lactate elevated or if clinical condition changes

Question 17

what is meningococcal disease

Answer 17

meningitis and septicaemia

Question 18

what is meningococcal meningitis

Answer 18

• meninges around lining of brain and spinal cord are infected
• this damages blood vessels, bacteria can leak in and infect cerebrospinal fluid
• meninges are inflamed and brain pressure is increased

Question 19

what is meningococcal septicaemia

Answer 19

• blood poisoning
• bacteria multiply uncontrollably in blood releasing endotoxins that damage blood vessels and hence stop supply of oxygen to organs

Question 20

what is the causative organism of meningococcus disease

Answer 20

neisseria meningitides (meningococcus) - anaerobic gram -ve bacterium
(polysaccharide capsule)

Question 21

how is meningococcus transmitted

Answer 21

aerosol
droplets from cough
direct contact with resp secretions

Question 22

risk factors of meningococcus disease

Answer 22

young age, adolescence and early adulthood
>65 years
winter
absent spleen
immunocompromised state (HIV, chemo)
incomplete immunisation
cancer
liver/kidney disease
smoking
living in overcrowded places
cranial anatomical defects - congenital or acquired
cochlear implants
contiguous infection
sickle cell disease

Question 23

signs and symptoms of meningococcal disease

Answer 23

fever
cold hands and feet
vomiting
drowsy
confusion
severe muscle pain
pale, blotchy skin / rash
severe headache
stiff neck
photophobia
convulsions/seizures

Question 24

how to diagnose meningococcal disease

Answer 24

• physical exam (glass test)
• blood tests (liver, kidney)
• lumbar puncture (extract fluid from spine)
• CT scan of brain

Question 25

how to treat meningococcal disease

Answer 25

• IV antibiotics (start smart then focus: broad to narrow)
• IV fluids to prevent dehydration and AKI
• oxygen
• steroid meds (help inflam)

Question 26

what prophylaxis should be used for meningococcal disease

Answer 26

• close prolonged contact, give within 24 hours
• 1st line ciprofloxacin (single dose)
• 2nd line rifampicin (inducer of CP50 so lots of interactions)

Question 27

long term complications of meningococcal meningitis

Answer 27

hearing loss
loss of sight
epilepsy
cognitive impairment
motor and coordination deficits
psychological disorders

Question 28

long term complications of meningococcal septicaemia

Answer 28

limb deformities
limb amputation
ongoing organ failure
severe scarring
tissue loss
psychological disorders

Question 29

what is the meningococcal NHS vaccination schedule

Answer 29

8wo - MenB vaccine
16wo - MenB vaccine
1yo - MenB vaccine
14yo - MenACWY vaccine
uni students (up to 25yo) - MenACWY vaccine