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Self-Assessment Questions

Pulmonary Disease

Sepsis: Review Questions

Zaka U. Khan, MD, and Gary A. Salzman, MD, FCCP

Dr. Khan is a fellow in pulmonary and critical care medicine, and Dr. Salzman is a professor and chair; both are at the Department of Pulmonary and Critical Care Medicine, University of Missouri at Kansas City, Kansas City, MO.

Choose the single best answer for each question.

Questions 1 and 2 refer to the following case.

A 70-year-old man presents to the emergency department with a 2-day history of fever, chills, cough, and right-sided pleuritic chest pain. On the day of admission, the patient’s family noted that he was more lethargic and dizzy and was falling frequently. The patient’s vital signs are: temperature, 101.5°F; heart rate, 120 bpm; respiratory rate, 30 breaths/min; blood pressure, 70/35 mm Hg; and oxygen saturation as measured by pulse oximetry, 80% without oxygen supplementation. A chest radiograph shows a right lower lobe infiltrate.

1. This patient’s condition can best be defined as which of the following?
  1. Multi-organ dysfunction syndrome (MODS)
  2. Sepsis
  3. Septic shock
  4. Severe sepsis
  5. Systemic inflammatory response syndrome (SIRS)
Click here to compare your answer.

2. What is the first step in the initial management of this patient?

  1. Antibiotic therapy
  2. ß-Blocker therapy to control heart rate
  3. Intravenous (IV) fluid resuscitation
  4. Supplemental oxygen and airway management
  5. Vasopressor therapy with dopamine
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3. A 40-year-old man with a history of IV drug use presents with cellulitis with multiple abscesses of the right upper extremity. His current weight is 70 kg (lean body weight). He rapidly develops worsening respiratory distress and hypotension and ultimately requires intubation and mechanical ventilation. Blood gas analysis shows a pH of 7.23, Paco2 of 58 torr, Pao2 of 60 torr, and an oxygen saturation of 88%. His ventilator settings are assist-control mode with a tidal volume of 420 mL, respiratory rate of 16 breaths/min, positive end-expiratory pressure (PEEP) of 5 cm H2O, and Fio2 of 70%. His plateau pressure on the ventilator is 29 cm H2O. A chest radiograph shows bilateral interstitial infiltrates, and a 2-dimensional echocardiogram demonstrates normal left ventricular function. What ventilator adjustments should be made?
  1. Change the ventilator mode to synchronized intermittent mandatory ventilation
  2. Increase PEEP
  3. Increase respiratory rate to 24 breaths/min
  4. Increase tidal volume to 600 mL
  5. Leave the ventilator settings unchanged
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4. Which of the following patients is an ideal candidate for noninvasive positive pressure ventilation (NIPPV)?

  1. A 30-year-old comatose woman suspected of drug overdose
  2. A 55-year-old man with acute anterior wall myocardial infarction with cardiogenic shock and recurrent ventricular arrhythmias
  3. A 60-year-old man with peritonitis requiring 2 vasopressors
  4. A 65-year-old patient with a massive stroke and inability to protect airway
  5. A 70-year-old alert patient with respiratory failure due to chronic obstructive pulmonary disease exacerbation
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5. Which of the following is an indication for using corticosteroids in septic shock?

  1. Acute respiratory distress syndrome (ARDS)
  2. Necrotizing pneumonia
  3. Peritonitis
  4. Sepsis responding well to fluid resuscitation
  5. Vasopressor-dependent septic shock
Click here to compare your answer.

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