Test Bank For Sepsis, An Issue of Clinics in Chest
Medicine, 1st Edition
Author: John P. Reilly
,Defining Sepsis: Past, Present, and Future
A. Theory-Based Questions (1–20)
Question 1
Which statement best reflects the Sepsis-3 definition of sepsis?
A. Presence of infection with ≥2 SIRS criteria
B. Infection causing hypotension requiring fluids
C. Life-threatening organ dysfunction caused by a dysregulated host response to infection
D. Positive blood cultures with systemic inflammation
Correct Answer: C
Explanation:
Sepsis-3 defines sepsis as “life-threatening organ dysfunction caused by a dysregulated
host response to infection.” Organ dysfunction is operationalized as an increase in SOFA
score ≥2 points. This definition emphasizes maladaptive host response rather than
inflammation alone.
• A is wrong: SIRS lacks specificity and may occur in noninfectious states.
• B is wrong: Hypotension alone does not define sepsis.
• D is wrong: Blood cultures may be negative in sepsis.
Critical Care Reasoning:
Modern sepsis definitions focus on organ dysfunction and biologic dysregulation rather
than inflammatory criteria alone.
Question 2
Which cytokine is considered a principal early mediator of septic inflammation?
A. IL-10
B. TNF-α
,C. TGF-β
D. Interferon-β
Correct Answer: B
Explanation:
TNF-α is rapidly released by activated macrophages and monocytes after pathogen
recognition. It drives endothelial activation, vasodilation, fever, leukocyte recruitment, and
capillary leak.
• A is wrong: IL-10 is anti-inflammatory.
• C is wrong: TGF-β is primarily regulatory.
• D is wrong: Interferon-β is more relevant in antiviral responses.
Hemodynamic Interpretation:
TNF-α contributes to vasoplegia and distributive shock through nitric oxide induction.
Question 3
The pathophysiologic hallmark of septic shock is:
A. Cardiogenic pulmonary edema
B. Fixed reduction in preload
C. Profound vasodilation with impaired oxygen utilization
D. Isolated adrenal insufficiency
Correct Answer: C
Explanation:
Septic shock involves vasoplegia, endothelial dysfunction, mitochondrial dysfunction, and
impaired oxygen extraction despite preserved or elevated cardiac output.
• A is wrong: Pulmonary edema may occur but is not the hallmark.
• B is wrong: Septic shock is not purely preload dependent.
• D is wrong: Adrenal dysfunction may contribute but is not primary.
Critical Care Reasoning:
Persistent tissue hypoxia despite macrocirculatory restoration explains ongoing organ
failure.
, Question 4
Which mechanism most contributes to microcirculatory dysfunction in sepsis?
A. Increased erythropoietin production
B. Endothelial injury with heterogeneous capillary flow
C. Excessive systemic vascular resistance
D. Reduced nitric oxide synthesis
Correct Answer: B
Explanation:
Endothelial dysfunction causes capillary leak, leukocyte adhesion, microthrombi, and
heterogeneous perfusion.
• A is wrong: Erythropoietin is not central.
• C is wrong: SVR is typically reduced.
• D is wrong: Nitric oxide production is increased.
Hemodynamic Interpretation:
Normal blood pressure does not guarantee adequate microvascular oxygen delivery.
Question 5
Which biomarker is most closely associated with tissue hypoperfusion in sepsis?
A. Ferritin
B. Lactate
C. ESR
D. Troponin
Correct Answer: B
Explanation:
Elevated lactate reflects impaired oxygen utilization, anaerobic metabolism, adrenergic
stimulation, and reduced clearance.
Medicine, 1st Edition
Author: John P. Reilly
,Defining Sepsis: Past, Present, and Future
A. Theory-Based Questions (1–20)
Question 1
Which statement best reflects the Sepsis-3 definition of sepsis?
A. Presence of infection with ≥2 SIRS criteria
B. Infection causing hypotension requiring fluids
C. Life-threatening organ dysfunction caused by a dysregulated host response to infection
D. Positive blood cultures with systemic inflammation
Correct Answer: C
Explanation:
Sepsis-3 defines sepsis as “life-threatening organ dysfunction caused by a dysregulated
host response to infection.” Organ dysfunction is operationalized as an increase in SOFA
score ≥2 points. This definition emphasizes maladaptive host response rather than
inflammation alone.
• A is wrong: SIRS lacks specificity and may occur in noninfectious states.
• B is wrong: Hypotension alone does not define sepsis.
• D is wrong: Blood cultures may be negative in sepsis.
Critical Care Reasoning:
Modern sepsis definitions focus on organ dysfunction and biologic dysregulation rather
than inflammatory criteria alone.
Question 2
Which cytokine is considered a principal early mediator of septic inflammation?
A. IL-10
B. TNF-α
,C. TGF-β
D. Interferon-β
Correct Answer: B
Explanation:
TNF-α is rapidly released by activated macrophages and monocytes after pathogen
recognition. It drives endothelial activation, vasodilation, fever, leukocyte recruitment, and
capillary leak.
• A is wrong: IL-10 is anti-inflammatory.
• C is wrong: TGF-β is primarily regulatory.
• D is wrong: Interferon-β is more relevant in antiviral responses.
Hemodynamic Interpretation:
TNF-α contributes to vasoplegia and distributive shock through nitric oxide induction.
Question 3
The pathophysiologic hallmark of septic shock is:
A. Cardiogenic pulmonary edema
B. Fixed reduction in preload
C. Profound vasodilation with impaired oxygen utilization
D. Isolated adrenal insufficiency
Correct Answer: C
Explanation:
Septic shock involves vasoplegia, endothelial dysfunction, mitochondrial dysfunction, and
impaired oxygen extraction despite preserved or elevated cardiac output.
• A is wrong: Pulmonary edema may occur but is not the hallmark.
• B is wrong: Septic shock is not purely preload dependent.
• D is wrong: Adrenal dysfunction may contribute but is not primary.
Critical Care Reasoning:
Persistent tissue hypoxia despite macrocirculatory restoration explains ongoing organ
failure.
, Question 4
Which mechanism most contributes to microcirculatory dysfunction in sepsis?
A. Increased erythropoietin production
B. Endothelial injury with heterogeneous capillary flow
C. Excessive systemic vascular resistance
D. Reduced nitric oxide synthesis
Correct Answer: B
Explanation:
Endothelial dysfunction causes capillary leak, leukocyte adhesion, microthrombi, and
heterogeneous perfusion.
• A is wrong: Erythropoietin is not central.
• C is wrong: SVR is typically reduced.
• D is wrong: Nitric oxide production is increased.
Hemodynamic Interpretation:
Normal blood pressure does not guarantee adequate microvascular oxygen delivery.
Question 5
Which biomarker is most closely associated with tissue hypoperfusion in sepsis?
A. Ferritin
B. Lactate
C. ESR
D. Troponin
Correct Answer: B
Explanation:
Elevated lactate reflects impaired oxygen utilization, anaerobic metabolism, adrenergic
stimulation, and reduced clearance.
