Sepsis Decoded: 165 Exam Questions on Pathophysiology, Shock & Critical Care Management

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Emma Sepsis Case Study Exam 2026-2027 BANK QUESTIONS
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Question 1:
A 68-year-old female named Emma presents to the emergency
department with a 3-day history of dysuria, fever, and flank pain. Her
past medical history includes type 2 diabetes mellitus and
hypertension. Which of the following is the most likely source of sepsis
in this patient?
A) Pneumonia
B) Urinary tract infection
C) Cellulitis
D) Meningitis
Answer: B) Urinary tract infection
Explanation: The symptoms of dysuria and flank pain, combined with
fever, are classic for pyelonephritis, which is a common source of gram-
negative sepsis, especially in diabetic patients.


Question 2:

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Emma's initial vital signs reveal a temperature of 38.9°C (102°F). Which
of the following cytokines is primarily responsible for mediating fever at
the hypothalamic level?
A) Tumor necrosis factor-alpha
B) Interleukin-1
C) Interleukin-10
D) Transforming growth factor-beta
Answer: B) Interleukin-1
Explanation: While TNF-alpha and IL-1 are both endogenous pyrogens,
IL-1 acts directly on the hypothalamus to elevate the thermoregulatory
set point via prostaglandin E2 synthesis.


Question 3:
Her blood pressure on arrival is 88/54 mmHg. According to the Sepsis-3
definition, what is the minimum mean arterial pressure (MAP) that
defines a systolic of 88 mmHg as hypotension, assuming a normal
diastolic, in the context of sepsis?
A) 60 mmHg
B) 65 mmHg
C) 70 mmHg
D) 75 mmHg
Answer: B) 65 mmHg
Explanation: The Sepsis-3 consensus defines septic shock as the
requirement for vasopressors to maintain a MAP of 65 mmHg or

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greater, in the setting of a serum lactate greater than 2 mmol/L despite
adequate fluid resuscitation.


Question 4:
Emma's heart rate is 112 beats per minute. This finding contributes to
the qSOFA score. What are the other two components of the qSOFA
score?
A) Temperature and white blood cell count
B) Glasgow Coma Scale and respiratory rate
C) Lactate level and mean arterial pressure
D) Creatinine and bilirubin
Answer: B) Glasgow Coma Scale and respiratory rate
Explanation: The qSOFA (quick Sequential Organ Failure Assessment)
score is positive if a patient has a respiratory rate of 22/min or greater,
altered mentation (GCS <15), and systolic blood pressure of 100 mmHg
or less. It is a rapid bedside tool.


Question 5:
Her respiratory rate is 24 breaths per minute. What acid-base
disturbance is most likely stimulating this tachypnea early in the course
of sepsis?
A) Metabolic alkalosis
B) Respiratory acidosis
C) Metabolic acidosis with respiratory compensation

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D) Respiratory alkalosis
Answer: D) Respiratory alkalosis
Explanation: In early sepsis, tachypnea is often driven by cytokine-
mediated central stimulation and pain, resulting in a primary
respiratory alkalosis. As tissue hypoperfusion worsens, lactic acidosis
and metabolic acidosis develop.


Question 6:
Emma's past medical history includes diabetes. How does chronic
hyperglycemia impair the immune response to infection?
A) Enhanced neutrophil chemotaxis
B) Increased leukocyte adhesion
C) Impaired phagocytosis and bactericidal activity
D) Upregulation of complement receptors
Answer: C) Impaired phagocytosis and bactericidal activity
Explanation: Hyperglycemia impairs multiple leukocyte functions,
including chemotaxis, phagocytosis, and intracellular killing, increasing
susceptibility to severe infections.


Question 7:
She is on lisinopril for hypertension. In the context of sepsis, the renin-
angiotensin-aldosterone system deregulation contributes to shock
primarily through which mechanism?
A) Relative vasopressin deficiency