Quiz Answers and Rationale

1. All of the below are the most common causes of septic shock except: 

    1. Gram-negative bacteria
    2. Gram-positive bacteria
    3. Viruses
    4. Cancer

Rationale: The answer is 4. Most common causes of septic shock are gram positive bacteria, gram negative bacteria, viruses and fungi. Septic shock is caused by an infectious source. Although, untreated cancer can cause infectious complications, it is not a direct cause of septic shock.

2. Which of the following criteria would you expect to see from a patient with septic shock?

    1. Elevated lactate level
    2. 30 ml/hr of urine output
    3. Respiration of 18 rate per minute
    4. Patient is alert and oriented 

Rationale: The answer is 1. An elevated lactic acid level is expected because of decreased tissue perfusion leading to tissue hypoxia. The lack of oxygen shifts energy production from aerobic to anaerobic, which will lead to increased production of lactic acid. 2, 3 and 4 are normal signs of symptoms of healthy individual.

3. Which of the following are measurable components of the quick SOFA? Select all that apply.

    1. Respiration rate
    2. Temperature
    3. Heart rate
    4. Systolic blood pressure 
    5. Mentation 

Rationale: The answers are 1, 4, and 5. The quick SOFA criteria includes: respiratory rate, altered mentation and systolic blood pressure. Although temperature and heart rate are important parts of the assessment and evaluation of patient with septic shock, they are not parts of the quick SOFA scoring.

4. The patient wants to know more about sepsis asking if he or any of his family members would be at higher risk for sepsis. You tell the patient that most vulnerable patients for this problem would be: (Select all that apply)

    1. Children younger than one
    2. Patients who have received recommended vaccinations
    3. Adults 65 years old and older
    4. People with weakened immune systems
    5. People with chronic diseases
    6. People who have traveled outside of the United States

Rationale: The answers are 1, 3, 4, and 5. The most vulnerable patients would be children younger than one, adults 65 years and older, patients with weakened immune systems, and patients with chronic diseases. These patients are at a higher risk because their immune systems are not strong enough to fight off infections which can lead to sepsis and septic shock. Patients who have received recommended vaccinations would have developed acquired immunity to fight off potential infections; thus, reducing their chance to develop septic shock. Patient who have traveled outside of the US might be exposed to different types of infections; however, a non-compromised immune system should be able to fight these off.  

5. Septic shock is one of the leading causes of death in the intensive care units.

    1. True
    2. False

Rationale: The answer is true. Sepsis is associated with a high morbidity and mortality. As sepsis becomes more severe, it leads to septic shock which affects the cellular, metabolic, inflammatory and circular systems and, ultimately, can lead to dysfunction of multiple organs and eventually death.