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Sepsis exam questions for medical finals, OSCEs and MRCP PACES

 

Question 1.

Define the term ‘systemic inflammatory response syndrome’ (SIRS)

  • Systemic response to various insults including infection, trauma, surgery, burns; includes two or more of the following:
    • Respiratory rate (RR) >20 or PaCO2 <4.3 kPa
    • Heart rate (HR) >90
    • Temperature >38.3 oC or <36 oC
    • White cell count (WCC) >12 or <4 x 109/L

 

Question 2.

Define the term sepsis

  •  Life-threatening organ dysfunction caused by a dysregulated host response to infection

 

Question 3.

Define the term severe sepsis

  • Classically this was defined as “Sepsis + organ dysfunction or tissue hypoperfusion”
  • However, this term has been largely subsumed under the broader definition of sepsis itself (as per Sepsis-3) which focused on life-threatening organ dysfunction due to a dysregulated response to infection

 

Question 4.

Define the term septic shock

  • Sepsis with persisting hypotension requiring vasopressors to maintain a MAP of 65 mmHg plus lactate over 2 mmol/L despite adequate volume resuscitation

 

Question 5.

List three broad categories of risk factors for sepsis

  • Immunocompromised
  • In-dwelling devices
  • Recurrent antibiotic therapy

 

Question 6.

What six steps should be taken on recognition of sepsis?

  • Oxygen titrated to achieve SpO2 94-98% or 88-92% if known to have COPD
  • Check lactate
  • Take blood cultures
  • Give IV antibiotics
  • Commence IV fluid resuscitation
  • Monitor urine output

 

Question 7.

What is the purpose of checking lactate levels?

  • Hyperlactataemia acts as a marker of tissue hypoperfusion suggesting severe sepsis (>2 mM) or septic shock (>4 mM)
  • In addition, the resulting high anion gap metabolic acidosis has negative effects on cellular and organ function

 

Question 8.

What antibiotics should be commenced on recognition of sepsis?

  • If the source is known, give the appropriate empirical IV antibiotic(s) as per local guidelines
  • For sepsis of unknown origin, give the appropriate broad-spectrum IV antibiotic(s) as per local guidelines e.g. piperacillin + tazobactam (tazocin) + gentamicin; once the source has been identified, switch to the appropriate empirical IV antibiotic(s) as per local guidelines

 

Question 9.

In addition to antibiotics, what action may also be required to target the underlying infection?

  • Source control

 

Question 10.

What approach should be taken to fluid resuscitation in sepsis?

  • Guided by clinical context
  • Give boluses of crystalloid 500-1000 ml IV and re-assess after each
  • Patients with severe sepsis should receive a minimum of 20 ml/kg
  • Patients with septic shock often require up to 60 ml/kg

 

Question 11.

What medication can be given to control fever in sepsis?

  • Anti-pyretics e.g. paracetamol 1 g PO +/- ibuprofen 400 mg PO if no contraindications

 

Question 12.

List the three aims of EGDT in sepsis.

  • 1: CVP >8 mmHg
  • 2: MAP >65 mmHg or SBP >90 mmHg
  • 3: ScvO2 >70%

 

Question 13.

Outline the possible complications of sepsis.

  • Respiratory failure
  • Cardiac failure
  • Renal failure
  • Hepatic failure
  • Shock
  • DIC
  • Death