Internal Medicine_Infectious Diseases_14

Question 1

What describes an extreme systemic response to an infection leading to hypotension, tissue damage, organ failure, and potentially death?

Answer 1

Sepsis.

Question 2

What triggers sepsis?

Answer 2

Another infection elsewhere in the body.

Question 3

What are the four infections most commonly linked to sepsis?

Answer 3

Pneumonia, urinary tract infections (most common in elderly patients), skin infections, gastrointestinal (GI) infections.

Question 4

What are the most common organisms causing sepsis?

Answer 4

Staphylococcus aureus, Escherichia coli (E. coli), certain strains of Streptococcus.

Question 5

Which patient populations are at increased risk for sepsis?

Answer 5

Adults aged 65 years or older, infants under one year, patients with chronic diseases (diabetes, kidney failure, cancer, lung disease), malnourished or immunosuppressed individuals.

Question 6

What are the key symptoms of sepsis?

Answer 6

Dyspnea, delirium, tachycardia, fever or hypothermia, cold, clammy skin, extreme pain.

Question 7

How is sepsis diagnosed?

Answer 7

Clinical diagnosis based on symptoms. Cultures of catheter tips (urinary and IV), sputum, urine, blood.

Question 8

What is the key initial treatment for sepsis?

Answer 8

Immediate parenteral antibiotics.

This still falls secondary to fluids on exams.

Question 9

Why is early antibiotic therapy crucial in sepsis?

Answer 9

Delays increase mortality by 8% per hour.

Question 10

What other treatments are commonly used after antibiotics?

Answer 10

Oxygen therapy, intravenous (IV) fluids, vasopressors, dialysis.

Question 11

A 72-year-old man with a history of diabetes presents with fever, tachycardia, dyspnea, and altered mental status. His blood pressure is 85/50 mmHg. Blood cultures grow E. coli. What is the most likely source of his infection?

A) Pneumonia
B) Skin infection
C) Urinary tract infection
D) Gastrointestinal infection

Answer 11

C) Urinary tract infection.

Question 12

Which of the following symptoms would you not expect in a patient with sepsis?

A) Hypothermia.
B) Tachycardia.
C) Hypertension.
D) Dyspnea.

Answer 12

C) Hypertension.

Question 13

A 1-month-old infant is diagnosed with sepsis. What is the most common pathogen likely to be involved?
A) Escherichia coli.
B) Group B Streptococcus.
C) Staphylococcus aureus.
D) Klebsiella pneumoniae

Answer 13

B) Group B Streptococcus.

Question 14

Which culture type provides the best yield for diagnosing sepsis?

A) Blood cultures.
B) Sputum cultures.
C) Urinary catheter tip cultures.
D) IV catheter tip cultures.

Answer 14

A) Blood cultures.

Question 15

A 65-year-old immunosuppressed woman develops sepsis. What initial treatment is the most critical to reduce her risk of death?

A) IV fluids.
B) Antibiotics.
C) Oxygen.
D) Vasopressors.

Answer 15

B) Antibiotics.

Question 16

A patient presents with fever, cold clammy skin, and hypotension. What clinical test would confirm the suspected diagnosis of sepsis?

A) Lactate levels.
B) Complete blood count.
C) Blood cultures.
D) Arterial blood gas.

Answer 16

C) Blood cultures.

Question 17

Which of the following patients is at the highest risk for developing sepsis?

A) A 35-year-old with well-controlled asthma.
B) A 2-month-old infant with a urinary tract infection.
C) A 40-year-old man with pneumonia.
D) A 70-year-old diabetic woman with skin cellulitis.

Answer 17

D) A 70-year-old diabetic woman with skin cellulitis.

Question 18

What additional treatment is indicated for a sepsis patient whose blood pressure remains low despite IV fluids?

A) Antibiotics.
B) Vasopressors.
C) Antipyretics.
D) Corticosteroids.

Answer 18

B) Vasopressors.

Question 19

A malnourished cancer patient develops sepsis after chemotherapy. Which of the following pathogens is the most likely cause?

A) Staphylococcus aureus.
B) Pseudomonas aeruginosa.
C) Escherichia coli.
D) Candida albicans.

Answer 19

A) Staphylococcus aureus.

Question 20

What is the first-line management for suspected sepsis?

Answer 20

First:
0.9% saline

Second:
Administer broad-spectrum antibiotics
(e.g., vancomycin + ceftriaxone).
Usually obtain microbiological cultures before antibiotics.

Third:
Norepinephrine

Question 21

What vital sign is most strongly associated with increased mortality in sepsis?

Answer 21

Temperature

Especially hypothermia.

Question 22

What is the most reliable global marker of tissue hypoperfusion in sepsis?

Answer 22

Serum lactate levels: Elevated in anaerobic metabolism due to hypoperfusion.

Question 23

What is the normal range for lactate, and when is it concerning in sepsis?

Answer 23

Normal lactate: <2 mmol/L.

Concerning: ≥4 mmol/L indicates severe sepsis or shock.

Question 24

What is the target lactate clearance in sepsis management?

Answer 24

≥10% reduction in lactate levels within 2-6 hours indicates improved tissue perfusion.