Septic Shock
Septic shock is characterized by all of the following pathophysiologic changes EXCEPT:
What our notes say
- Septic shock is characterized by all of the following pathophysiologic changes EXCEPT: (Pathology CAT 1: Cell Injury, Metaplasia & Hypoxia Q&A)
- Septic shock carries the highest mortality among shock types, largely due to its complex, multifactorial pathophysiology (vasodilation, DIC, multi-organ dysfunction) that is often refractory to standard resuscitation. (Pathology CAT 1: Cell Injury, Metaplasia & Hypoxia Q&A)
- While this response is essential for fighting infections, excessive cytokine production can result in host toxicity and potentially contribute to septic shock. (Bacteria)
- ICU: NIV or ventilation, vasopressors for septic shock. (Pneumonia)
- Parapneumonic effusion and empyema, lung abscess, sepsis and septic shock, respiratory failure and ARDS, pleurisy, pericarditis, lobar collapse, metastatic infection (meningitis, endocarditis, arthritis), bronchiectasis (long term). (Pneumonia)
- Sepsis and septic shock — Year 4 Internal Medicine (Infectious Disease) Notes (Sepsis and septic shock)
Study material on Septic Shock
Practice questions on Septic Shock
A patient with septic shock shows elevated levels of multiple cytokines. Which combination is most directly responsible for the fever?
- IL-8 and MCP-1 acting on hypothalamic chemokine receptors
- IL-1 and TNF inducing COX-2 and PGE2 production in hypothalamus
- IL-6 stimulating acute phase protein synthesis in liver
- IL-17 recruiting neutrophils to create metabolic heat
- TGF-β causing endothelial activation and heat generation
Answer: B. Fever is caused by IL-1 and TNF (endogenous pyrogens) acting on hypothalamic vascular cells to upregulate cyclooxygenase (COX), which produces prostaglandins, especially PGE2. PGE2 then stimulates neurotransmitter production that resets the body's temperature set-point higher. This is why NSAIDs and aspirin (COX inhibitors) reduce fever by blocking prostaglandin synthesis. IL-8 and MCP-1 are chemokines for leukocyte
A 27-year-old man develops septic shock 3 days after tooth extraction. He has a split S2, a diastolic murmur, splinter hemorrhages, and splenomegaly. What cardiac condition predisposed him?
- Hypoplastic left heart syndrome
- Atrial septal defect
- Chagas disease
- Coronary atherosclerosis
Answer: B. A pre-existing ASD creates a structural abnormality that dental bacteremia can seed, causing infective endocarditis. The diastolic murmur and split S2 suggest this underlying defect. ---
A patient with septic shock has lactic acid of 7.0 mmol/L. What is the most likely acid-base disorder?
- Normal anion gap metabolic acidosis
- High anion gap metabolic acidosis
- Metabolic alkalosis
- Respiratory alkalosis Correct
Answer: B. Lactic acidosis produces organic acids, causing high anion gap metabolic acidosis in shock states. ---
A patient with lactic acidosis due to septic shock would most likely present with which type of acid-base disorder?
- Respiratory acidosis with normal anion gap
- Metabolic acidosis with increased anion gap
- Metabolic alkalosis
- Respiratory alkalosis
Answer: B. ** Lactic acidosis from tissue hypoperfusion in septic shock causes metabolic acidosis with increased anion gap due to accumulation of lactate, an unmeasured anion. ---