Q1. Sepsis is best defined as: A. Any infection with a fever above 38°C B. Infection with organ dysfunction C. A positive blood culture D. Infection requiring intravenous antibiotics ANSWER: B — infection with organ dysfunction. Why: sepsis is defined by the dysregulated host response causing organ dysfunction, not by temperature or by bacteraemia. C: many septic patients have negative cultures, and many positive cultures are not sepsis. LEARNING POINT: look for the failing organ, not the fever.

Q2. Which pattern fits SEPTIC shock? A. Cold peripheries, high SVR, low cardiac output B. Warm peripheries, low SVR, high cardiac output C. Raised JVP with pulmonary oedema D. Bradycardia with warm dry skin ANSWER: B — warm, low SVR, high output. Why: septic shock is distributive. Inflammatory vasodilation lowers systemic vascular resistance while cardiac output rises. A: hypovolaemic or cardiogenic shock. D: neurogenic shock. LEARNING POINT: feel the peripheries — it categorises the shock before any test returns.

Q3. An 82-year-old is newly confused. Temperature 35.7°C, BP 100/56, creatinine risen from 85 to 170, lactate 3.4, urine dipstick positive. The correct interpretation is: A. Not infection — there is no fever B. Sepsis with organ dysfunction; treat urgently C. Simple urinary tract infection for oral antibiotics D. Delirium of unknown cause; observe ANSWER: B — sepsis. Why: confusion, renal impairment and a raised lactate are organ dysfunction in a patient with a likely urinary source. Hypothermia does not exclude infection and is a worse prognostic sign than fever. LEARNING POINT: "no fever, so not infection" is the sentence that precedes preventable deaths.

Q4. A patient in septic shock needs a CT to locate the source. The scanner is 45 minutes away. Regarding antibiotics: A. Wait for the CT so the antibiotic can be targeted B. Give broad-spectrum antibiotics immediately after taking cultures C. Give oral antibiotics while waiting D. Withhold until cultures are reported ANSWER: B — antibiotics immediately. Why: mortality rises with every hour of delay. Broad cover can be started now and narrowed once cultures return; the CT guides source control, not the decision to treat. C: absorption is unreliable in shock. LEARNING POINT: imaging never delays the first dose.

Q5. A patient with pyelonephritis and an obstructing stone remains septic after 48 hours of appropriate antibiotics. The most appropriate next step is: A. Broaden the antibiotic further B. Urgent decompression of the obstructed kidney C. Add an antifungal D. Continue and reassess in 48 hours ANSWER: B — decompress. Why: an infected obstructed system is undrained pus. Antibiotics cannot sterilise it while obstruction persists. Source control is the treatment. LEARNING POINT: failure to respond to correct antibiotics usually means an uncontrolled source, not the wrong drug.

Q6. A patient on chemotherapy has a temperature of 38.4°C. Neutrophil count is pending and no source is apparent. The correct action is: A. Wait for the neutrophil count before treating B. Take cultures and give broad-spectrum intravenous antibiotics immediately C. Oral antibiotics and review tomorrow D. Paracetamol and observation ANSWER: B — immediate broad-spectrum IV antibiotics. Why: neutropenic sepsis is a medical emergency. These patients deteriorate rapidly and often have no localising signs because they cannot mount an inflammatory response. Treatment precedes both the count and the source. LEARNING POINT: fever on chemotherapy means antibiotics now.

Q7. A 45-year-old with pneumonia has BP 120/76, pulse 110, confusion and lactate 4.2. Regarding shock: A. Shock is excluded by the normal blood pressure B. Tissue hypoperfusion is present despite a normal pressure — treat urgently C. The lactate is unrelated to the infection D. Repeat the lactate in 12 hours ANSWER: B. Why: lactate reflects tissue-level perfusion and can rise while compensation maintains blood pressure. Confusion is organ dysfunction. Waiting for hypotension means waiting for compensation to fail, which happens abruptly. LEARNING POINT: the same principle as the shock chapter — a normal blood pressure never excludes inadequate perfusion.