Sepsis

Question 1

Major mechanism by which intravascular WBCs dilate blood vessels

Answer 1

Nitrous oxide production

(iNOS)

Question 2

P_blood equation

Answer 2

P_blood = R_systemic x CO

Where R_systemic is systemic vascular resistance and CO is cardiac output.

Question 3

Precise mechanisms of shock-induced hypoxia

Answer 3

1. Low systemic blood pressure
2. Poor diffusion of O₂ through systemic edematous fluid to reach extravascular tissues
3. Systemic damage of blood vessels (from vasculitis)
4. Depletion of coagulation factors from blood vessel damage, resulting in lack of ability to repair further vascular damage (dissemianted intravascular coagulation)
5. Microvascular thrombosis resultant from disseminated intravascular coagulation

Question 4

DIC summary

Answer 4

Question 5

For PAMPS, when gram positive think ___, when gram negative think ___.

Answer 5

For PAMPS, when gram positive think peptidoglycan, when gram negative think LPS..

Question 6

The hypothalamic-pituitary-adrenal axis is ___-inflammatory.

Answer 6

The hypothalamic-pituitary-adrenal axis is anti-inflammatory.

Question 7

In disseminated intravascular coagulation fibrin degradation products act to

Answer 7

Inhibit platelet aggregation

Question 8

Examples of phenomena which may cause sepsis

Answer 8

Vascular candidiasis (C. albicans)

Severe trauma or crash injury

Burns

Staphylococcus aureus-derived TSST-1 (a superantigen)

Question 9

Bacteremia is documented in ___% of septic shock cases.

Answer 9

Bacteremia is documented in 20-30% of septic shock cases.

Question 11

Vasopressors

Answer 11

α receptor agonists, increase blood pressure

Question 12

Bacterial abscesses may be ____.

Answer 12

Bacterial abscesses may be impenetrable to antibiotics.

Question 13

“Typical” pneumonia

Answer 13

One continuous lesion focused witihn a single lobe of the lung

Question 14

“Atypical” pneumonia

Answer 14

Diffuse material within multiple lobes of the lung and multiple foci

Question 15

Creatinine

Answer 15

A measure of kidney function

VERY sensitive, small differences in creatinine levels mean big changes in renal function

Question 16

Acute respiratory distress syndrome

Answer 16

aka ARDS

Pulmonary angioedema from pulmonary endothelium activation

Question 17

If you see diplococci on a blood gram stain and they are. . .

Gram +, ____.

Gram -, ____.

Answer 17

If you see diplococci on a blood gram stain and they are. . .

Gram +, Streptococci.

Gram -, Neisseria.

Question 18

Schistocytes

Answer 18

Sheered or damaged erythrocytes

Question 19

Following sepsis, there is almost always a phase of ____.

Answer 19

Following sepsis, there is almost always a phase of immunosuppression from immune exhaustion.