Sepsis is defined as an inappropriate inflammatory response syndrome with concomintant infection. The definitions are changing all the time, and thus it is difficult to make standardised questions – particularly ones that will not require immediate revision – so effort has been made to tailor this quiz to Kumar and Clark’s current guidelines – though note in 2016, the notions of Severe Sepsis were redefined. Watch this space for more changes!   In the meantime, test your knowledge on some fundamental clinical scenarios of the septic patient.

Reviewed by: awaiting review

Edited on: September 2020

Introduction to Sepsis MCQ

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Question 1
Which of the following is the best matched definition of SIRS?
A
An acquired infective state
B
Pyrexia, leuocytosis and tachycardia/pnoea
C
Oliguria and increased INR
D
Hypovolaemic state evidenced post-Hartmann bolus resuscitative attempts
Question 2
To manage shock, the initial loading dose of alpha-1-adrenoceptor agonism causes ...
A
Polyuria
B
Decreased GFR
C
Decreased respiratory rate
D
Systemic vasodilation
Question 3
Noradrenaline will be most useful in which form of shock?
A
Distributive
B
Cardiogenic
C
Ischaemic
D
Hypovolaemic
Question 4
Which of the following best outlines alpha1 adrenoreceptors?
A
Principally increase chronotrophy and inotrophy of the cardiomyocyte
B
located in the vascular wall and heart
C
Cause vasodilaton of peripheral vessels
D
Mediate vasodilation of mesenteric, renal, coronary and cerebral circulation
Question 5
Administration of dopamine to a patient with shock should be ...
A
As first line medication
B
In patients at risk of bradyarrhythmia
C
To decrease SVR
D
Only when the patient is haemodynamically stable
Question 5 Explanation: 
DA is a catecholamine that will increase SVR and contractility of the heart. As a vasomotor regulator (D1R agonist), it should only be administrated when fluid bolus resuscitation is successful in the shocked patient. It is no longer indicated as a first line drug (cf noradrenaline) for shock treatment.
Question 6
A synthetic analogue of a hormone synthesised in the paraventricular hypothalamic nucleus is used to increase SVR in hypovolaemic shock.  What is the name of this neuroendocrine hormone?
A
Oxytocin
B
Vasopressin
C
Prolactin
D
Human growth hormone (hGH)
Question 7
Using your knowledge of septic shock, postulate at which phase it would be most appropriate to administer hydrocortisone in "low dose".
A
As a first line medication
B
Concomitantly with dopamine
C
Concomitantly with vasopressin
D
In cases of ADH-resistant resuscitation
Question 7 Explanation: 
In instance where distributive shock is such that inflammatory mediators have caused the degree of vasodilation - and extravasation - that causes hypovolaemia, ADH may not be effective to increase SVR. Low-dose glucocorticosteroids may, therefore, be indicated.
Question 8
Which of the following is the least clinically relevant to guide uncomplicated treatment of septic shock patients?
A
Skin temperature
B
Radiala and carotid pulses
C
Urine output
D
Respiratory rate
Question 8 Explanation: 
The patient's skin perfusion, pulse, BP, JVP and urine output should be adequate to guide treatment - though CVP and pulmonary arterial catheters may be useful also.
Question 9
A patient has been in severe sepsis for some time and the family ask about his prognosis.  What is the mortality rate of severe sepsis?
A
10%
B
35%
C
55%
D
50%
Question 10
Inotropic agents are given to patients who qualify as "severely septic". Which of the following patient vignettes suggest inotrophy administration?
A
Tachyarrhythmic cardiogenic shock
B
Low volume sepsis
C
Hartmann-resistant sepsis
D
Septicaemia
Question 10 Explanation: 
Severe sepsis, with 50% mortality, is defined as sepsis that is resistant to fluid-bolus challenge (one such bolus is Hartmann solution).
Question 11

Stem 1 of 4

The following is an "SBAR" handover from an Advanced Paramedic to the F1 on-call in ED
Mr Jones, 65YO male, found short of breath, warm and clammy to touch with a decreased LOC.  He has stable angina and controlled type 2 diabetes.  He has a normal BM, sats on oxygen of 95%, heart rate of 100 and resp rate of 27.  His temperature is 38.5º and he is 100 SBP. I'm concerned the patient is septic and so began with high flow oxygen, broad spectrum antibiotic IV and IV bolus of Hartmann solution pre-hospitally.
How many septic red flags does this patient have?
A
1
B
2
C
4
D
5
Question 12

Stem 2 of 4

The patient has a confirmed infection. What score does the patient get on qSOFA?
A
3
B
4
C
5
D
6
Question 12 Explanation: 
qSOFA consists of confirmed infection and SBP ≤100, RR≥22 and decreased level of consciousness - the patient has all of the above.
Question 13

Stem 3 of 4

Which of the following are you not taking from the patient for investigation immediately?
A
UO
B
MCS
C
FBC
D
GFR
Question 14

Stem 4 of 4

How do you anticipate the sCreat to be in the patient?
A
Unchanged
B
Increased due to afferent arteriolar vasodilation
C
Decreased due to hypoxaemic acidaemia of organs
D
Increased due to efferent arteriolar vasoconstriction
E
Increased due to AKI
Question 15
FBC reveals a patient in distributive shock is thrombocytopenic. Postulate why.
A
Splenic infarct
B
Osteological medulla ischaemia
C
Overload of the cardiovascular system
D
Perfusion failure of hepatocytes
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