Sepsis

Question 1

what is responsible for elevated plasma white cell count?

Answer 1

IL-6 and IL-1

TNF - Il1 and IL6 = leuokocyte production

Question 2

characteristic of IL17 and chemokines

Answer 2

more adaptive immune response and chemokines will modify the leukocyte trafficking

Question 3

is loss of blood volume associated with septic shock?

Answer 3

no - this is a part of hypoalemic shock

Question 4

septicemia

Answer 4

sepsis with positive blood culture (used to identify whether there is bacteria in the blood or not
blood poisoning - especially when caused by bacteria or their toxins

most of the time the blood culture is negative - even if have sepsis

Question 5

bacteremia

Answer 5

bacteria in blood

Question 6

TLR4

Answer 6

pattern recognition receptor - activation leads to activation of the innate immune system

Question 7

SOFA

Answer 7

*REQUIRE LAB TESTS
Sequential [sepsis-related] organ failure assessment score
0-4 (4 being severe)
organ dysfunctin represented by an increase in SOFA score of 2 points or more

Question 8

T/F sepsis is a syndrome shaped by pathogen factors and host factors (sex, race, age, co-morbitites, environment)

Answer 8

True

Question 9

qSOFA

aka

Answer 9

‘quick’ SOFA - ‘sepsis-3’ - looking at it in terms of three criteria
Respiratory rate of 22/min or greater
altered mentation (mental status)
systolic blood pressure of 100 mmHg or less
- quick because ‘bedside’ and do not need to run lab tests

Question 10

coagulation factor 5

Answer 10

co-factor for coagulation cascade - protein C patwhay acts on this by inhibiting it
- if mutation or deficeint -

Question 11

components of basic hemostatic plug

Answer 11

1. exposure of collagen and other extracellular matrix molecules
2. activated platelets
3. tissue factor and fibrin from coagulation cascade

Question 12

what does activated protein C target?

Answer 12

targets the coagulation co-factors

- make a bunch of fibrin if dont have the protein C???

Question 13

DIC

Answer 13

Disseminated Intravascular Coagulation = consumptive coagulation
COMPLICATION OF AN UNDERLYING ILLNESS - not a disease itself
- so much clotting occuring that patient actually at risk for too much bleeding - using up antithrombotic factors (protein C) and pro-thrombotic factors

Question 14

plasmin

Answer 14

activated by tPA - this is a ant-thrombotic factor

- inhibits the formation of clots

Question 15

petachiae

Answer 15

cutaneous hemmorrhage, thrombocytopenia, DIC

• frequent complication of severe sepsis
• small clots in the cutaneous microvasculature- often leading to amputation of limbs or digits

Question 16

PAI-1

Answer 16

PLASMINOGEN ACTIVATOR INHIBITOR
supresses fibrinolysis (breaking down clots- as plasmin is major component of breaking down clots) and promotes the formation of the fibrin clots through the fibrinolytic response to infection

Question 17

hemorrhage

Answer 17

blood outside the vessel

Question 18

hematoma

Answer 18

type of hemmorage (blood outside the vessel) but enclosed within a space like subdural (brain) and retroperitoneal (abdominal space)

Question 19

bruises

Answer 19

bleeding into the extracellular space

Question 20

petachiae, purpura, ecchymosis are all?

Answer 20

bruises - type of hematoma where the bleeding is occurring in the extracellular space
the order of these is smallest to largest

Question 21

generalizations of the protein C pathway

Answer 21

anti-thrombotic - CONTROLLING THROMBIN
anti-inflammatory
neuroprotective

*in DIC - there is A LOSS OF ANTI-THROMBOTIC CAPACITY OF PROTEIN C (usually it is inhibiting the coagulation co factors)

Question 22

Factor 5 Leiden

Answer 22

mutant - protein C pathway does not work now

change in allele where the protein C needs to bind to control the thrombin

Question 23

three ways compliment can become activated

Answer 23

1. alternative pathway - spontaneous C3 activation - MICROBE MEDIATED
2. classical pathway - Antigen/antibody complex - ANTIBODY MEDIATED
3. lectin pathway - CARBOHYDRATE MEDIATED serum lectins bind pathogen mannose

all will deposit c3b on the microbe

Question 24

Kinin system

Answer 24

resulting in bradykinin formation - very potent vasoactive peptide responsible for vasodilation, pain transmission, smooth muscle cell contraction