ACCS ACCS Infection Control and Sepsis Management 2 — Questions and Answers
Question 1: In a patient with septic shock refractory to fluid resuscitation, which vasopressor is recommended as the first-line agent?
- Epinephrine
- Vasopressin
- Norepinephrine (Correct answer)
- Dopamine
Correct answer: Norepinephrine
Norepinephrine is the first-line vasopressor for septic shock due to its potent vasoconstrictive effect with limited tachycardia.
Question 2: Which isolation precaution is required for a patient with confirmed Clostridioides difficile infection in the ICU?
- Airborne precautions with N95 respirator
- Droplet precautions
- Contact precautions with soap and water handwashing (Correct answer)
- Standard precautions only
Correct answer: Contact precautions with soap and water handwashing
C. difficile requires contact precautions, and soap and water must be used for hand hygiene because alcohol-based sanitizers do not kill spores.
Question 3: A patient develops fever, purulent tracheal secretions, and a new infiltrate on CXR after 5 days of mechanical ventilation. What is the most appropriate next step?
- Start empiric antifungal therapy
- Obtain a bronchoalveolar lavage (BAL) and start empiric antibiotics for VAP (Correct answer)
- Remove the endotracheal tube immediately
- Order a high-resolution chest CT
Correct answer: Obtain a bronchoalveolar lavage (BAL) and start empiric antibiotics for VAP
BAL sampling followed by empiric broad-spectrum antibiotics targeting VAP pathogens is the recommended approach for suspected VAP.
Question 4: Which serum lactate level is used to define occult tissue hypoperfusion (cryptic shock) in sepsis?
- ≥1 mmol/L
- ≥2 mmol/L (Correct answer)
- ≥4 mmol/L
- ≥6 mmol/L
Correct answer: ≥2 mmol/L
A lactate ≥2 mmol/L despite normal blood pressure defines occult or cryptic septic shock and warrants aggressive resuscitation.
Question 5: Which antifungal agent is recommended as first-line empiric therapy for suspected candidemia in a critically ill ICU patient?
- Fluconazole
- Voriconazole
- An echinocandin (caspofungin, micafungin, or anidulafungin) (Correct answer)
- Amphotericin B liposomal
Correct answer: An echinocandin (caspofungin, micafungin, or anidulafungin)
Echinocandins are first-line for suspected candidemia because they cover fluconazole-resistant Candida species with excellent tolerability.
Question 6: What is the primary mechanism by which endotoxin (lipopolysaccharide) triggers the systemic inflammatory response in gram-negative sepsis?
- Direct cytotoxic damage to endothelial cells
- Activation of Toll-like receptor 4 (TLR4) on innate immune cells (Correct answer)
- Inhibition of the complement cascade
- Cross-linking of T-cell receptors
Correct answer: Activation of Toll-like receptor 4 (TLR4) on innate immune cells
LPS binds to TLR4 on macrophages and monocytes, triggering a massive pro-inflammatory cytokine cascade that drives septic shock.
ACCS ACCS Infection Control and Sepsis Management 2
In a patient with septic shock refractory to fluid resuscitation, which vasopressor is recommended as the first-line agent?