A 66-year-old male is brought to your office by his wife with complaint of productive cough, fever, and chills for the past 2 days. The patient lives with his wife and is retired. PMH is significant for DM, for which he takes insulin; CHF, with an ejection fraction of 40%; and a history of renal insufficiency. He is alert and oriented. There is no history of smoking or alcohol use. On examination, the patient is lethargic. He has crackles over the left lower lung. CVS examination is normal. Vitals: Temperature = 39.61°C, BP = 82/54, HR = 128, RR = 24. O2 saturation on room air is 97%. CXR shows infiltrates and consolidation in the left lower lobe of the lung. Lab results show WBC 15, hematocrit 36, Na 142, glucose 167, BUN 36, creatinine 1.5. Lactate is elevated. What is the likely diagnosis in this patient?
سؤال مجاني 3 من 10 اليوم · اشترك وكمّل بدون حد
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الإجابة والشرح
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الإجابة: D. Severe sepsis
Using the SIRS-based definitions taught in the course: he has SIRS (T 39.6, HR 128, RR 24, WBC 15) + a source (LLL pneumonia) = sepsis, plus organ dysfunction/hypoperfusion (hypotension, raised lactate, lethargy, raised creatinine) = severe sepsis. Septic shock requires refractory hypotension that persists despite adequate fluid resuscitation – no fluids have been given yet, so it cannot be labelled shock. Cardiogenic shock is unlikely with a clear infective source and EF 40%.
ليش كل خيار صح أو غلط
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A
ليش غلط
Cardiogenic shock occurs when the heart cannot generate enough cardiac output (most often after acute MI) and brings a raised JVP and pulmonary congestion. This man has fever, a high WBC and a lobar consolidation, and his CVS examination is normal.
✓ Step Up To Medicine 6th (Shock).pdf · p. 3 -
B
ليش غلط
Septic shock is hypotension from sepsis that persists despite adequate fluid resuscitation. No fluids have been given yet, so his BP of 82/54 cannot yet be labelled septic shock.
✓ Step Up To Medicine 6th (Shock).pdf · p. 6 -
C
ليش غلط
Sepsis is only SIRS plus a confirmed or presumed infection. He also has organ dysfunction (hypotension, lethargy), which moves him up to severe sepsis.
✓ Inefctious Diseases 🦠.pdf · p. 14 -
D
ليش صح
He has SIRS with a pneumonia source plus organ dysfunction (hypotension, altered mental status), which defines severe sepsis. Refractory hypotension, needed for shock, is not yet shown.
✓ Inefctious Diseases 🦠.pdf · p. 14
- المصدر
- Inefctious Diseases 🦠.pdf · p. 14
Step Up To Medicine 6th (Shock).pdf · p. 6 - المحاضرة
- Sepsis & Septic Shock · Infectious Diseases · Module B
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- ID bank