Sepsis – Maternal medicine Module part2

Sepsis - Maternal medicine Module part2

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1) The incidence of breast abscess in untreated mastitis is approximately

A) 40%

B) 20%

C) 10%

D) 3%

E) 0.3%

2) Which of the following analgesia should be avoided in cases of sepsis?

A) Co-codamol

B) Codeine phosphate

C) Morphine

D) Paracetamol

E) Non-steroidal anti-inflammatory drugs (NSAIDS)

3) Which of these steps will you do first?

A) Chase microbiology results

B) Commense antipyretics

C) Give IV antibiotics

D) Give IV fluids/crysalloids

E) Give vasopressors

F) Liase with microbiologist

G) Take blood cultures, serum lactate levels

4) How many days does it normally take for surgical wound related abscess to develop?

A) 15-30 days

B) 10-20 days

C) 7-10 days

D) 1-5 days

E) 0-3 days

While choosing antibiotics which of these have the broadest range of cover in
treating sepsis?

A) Co-amoxiclav and metronidazole

B) Piperacillin/tazobactam with clindamycin

C) Cefuroxime and metronidazole

D) Clindamycin and metronidazole

E) Amoxicillin and metronidazole

7) Which of the following is NOT a common causative organism of postnatal sepsis?

A) Staphylococcus aureus

B) Streptococcus pneumoniae

C) GAS (aka Streptococcus pyogenes)

D) Mycoplasma pneumoniae

E) Escherichia coli

8) % of blood cultures positive in severe sepsis

A) 60-70%

B) 70-80%

C) 10-20%

D) 30-40%

E) 25-30%

9) Which of the following is NOT a risk factor of postnatal sepsis?

A) Prolonged SROM

B) Anaemia

C) Hypertension

D) Diabetes

E) Obesity

12)

Q13.A 22-year-old woman is referred by her GP 36 hours following a spontaneous vaginal
delivery. She had an uncomplicated pregnancy apart from a history of prolonged rupture of
membranes for which she was induced. She required epidural analgesia in labour. There were no
concerns in the immediate postpartum period and she was discharged home the following
morning.
On admission her temperature is 38.5°C. She has tachycardia 120 beats/minute and feeling
generally unwell.
What is the most important initial investigation?

A) Computed tomography scan

B) Epidural site swab

C) Serum lactate

D) Sputum culture

E) Throat swab

13) A 17-year-old primigravida undergoes surgical termination of pregnancy at 8 weeks gestation. What is the recommended antibiotic regimen to reduce post-operative infection?

A) 200 mg of Doxycycline or 500 mg of azithromycin within 2 hours of the procedure

B) Doxycycline 100mg BD and metronidazole 400mgBD for 14 days

C) Metronidazole 1g PR at time of termination, then doxycycline 100mg BD PO for 7 days

D) Metronidazole 1g PR at time of termination, then doxycycline 100mg BD PO for 14 days

E) No antibiotics required

A 35-year-old para 1 is 48-hours post emergency caesarean section and has a temperature
of 38.1°C. Her blood pressure is 110/78 mmHg, her respiratory rate is 26 breaths/min and her
pulse is 132 beats/minute. She feels generally unwell. She has a history of prolonged rupture of
membranes prior to delivery (32 hours). You take a venous blood gas, on which the lactate is
1.8. You activate the sepsis resuscitation bundle.

14) What is the most important initial management?

A) Broad spectrum antibiotics

B) Discuss with a consultant

C) Fluid resuscitation

D) Inotropic support

E) Referral to ITU outreach

A 35-year-old primigravid woman is in spontaneous labour at 38 weeks of gestation and
has a temperature of 38.1°C. Her blood pressure is 146/78 mmHg, her respiratory rate is 24
breaths/min and her pulse is 102 beats/minute. She feels generally unwell but has no specific
symptoms. She has a history of prolonged rupture of membranes (32 hours). You activate the
sepsis resuscitation care bundle.

15) What is a target for this?

A) Fluid resuscitation with crystalloid 50 ml/kg

B) If mixed venous oxygen saturation <80% consider supportive inotrope treatment

C) Keep glucose controlled at <10 mmol/l

D) Lactate of >2 mmol/l would suggest central venous pressure and oxygenation measurement

E) Maintain CVP at 6 mmHg

You are asked to review a wound 5 days following caesarean section. The woman has Type
1 diabetes and a BMI of 40kg/m2. The procedure was performed as an emergency for the
management of suspected intrapartum fetal distress and the woman received antibiotic
prophylaxis at the time of the procedure. The pain is described as agonising and is not relieved
by opiates. On examination the wound is blistered, tender and swollen.

16) What should you do as part of her management?

A) Arrange to transfer her to theatre for wound debridement and refashioning

B) Biopsy the wound for culture and antibiotic sensitivities

C) Contact the plastic surgery team

D) Prescribe antibiotics and plan for surgical management 48 hours later if the wound has not improved

E) Request a CT scan to assess depth of infection

17)

What will you do in septic shock if you fail to get satisfactory improvement in
the BP after sufficient fluid resuscitation with crystalloids?

A) Chase microbiology results

B) Commense antipyretics

C) Give IV antibiotics

D) Give IV fluids/crysalloids

E) Give vasopressors

F) Liase with microbiologist

G) Take blood cultures, serum lactate levels

18) According to WHO, preavalance of puerperal sepsis is ;

A) 4.4

B) 3.3

C) 5.4

D) 1.1

E) 2.2

19) The above patient was seen by the registrar who initiated the sepsis hour 1 bundle.

Which one of these measures is not part of the sepsis hour 1 bundle?

A) Starting IV fluids

B) Starting IV antibiotics

C) Checking lactate levels

D) Monitoring BP and maintaining MAP >65 mm of Hg

E) Administering oxygen

20) A-25-year old lady presented in A&E, 10 hours after normal vaginal delivery with symptoms of high fever, severe abdominal pain and purulent vaginal discharge. She had a temp of 38.9 degrees, tachycardia HR 120/min, RR of 26/min and based on clinical findings, a diagnosis of sepsis was made.

Which one of the following is likely to be causative organism?

A) Group B streptococcus

B) Group A streptococcus

C) E coli sepsis from previously undiagnosed UTI

D) Methicillin resistant staph aureus

E) Pseudomonas

21)

A 32 year old para two presents on day 7 post emergency caesarean section, with
erythema, pain and oozing around the wound site. She is alert and well, with BP 124/86, P 95,
Temp 37.5, RR 18 and sats 98% on room air. BMI is 38, she has no other past medical
history. You review the operative notes and discover that it was a challenging caesarean due to
adhesions, it was performed by a consultant and a drain was used, removed on day one postop. The wound was closed with a subcuticular absorbable monofilament suture. What is the
most important risk factor in her history for development of wound infection?

A) Age of 32

B) Caesarean section performed by consultant

C) Obesity

D) Use of drain at caesarean section

E) Use of subcuticular absorbable closure

22) The most common site of sepsis in peuperium is;

A) Uterus

B) Vagina

C) Urinary tract

D) Breast

E) Episiotomy wound

23)

What will you do if you fail to get clinical improvement after 24 hours of IV
antibiotics?
Which of the above is recommended to occur within the first hour of recognition
of sepsis in order to reduce mortality?

A) Chase microbiology results

B) Commense antipyretics

C) Give IV antibiotics

D) Give IV fluids/crysalloids

E) Give vasopressors

F) Liase with microbiologist

G) Take blood cultures, serum lactate levels

A woman who is 3 days postpartum presents with systemic sepsis. She had an SVD
following induction of labour at 41 weeks of gestation. Group A Streptococcus is identified in
maternal blood cultures.

25) With regards to her management...

A) All contacts need to be treated with prophylactic antibiotics

B) Clindamycin deactivates endotoxins

C) Prescribing both paracetamol and NSAIDs is important to control temperature

D) Staff members must wear surgical masks when in patient contact

E) The mother should be encouraged to continue with breastfeeding and the baby should be treated with antibiotics

A 35-year-old multigravid woman presents 10 days following an uncomplicated vaginal
delivery at term with a painful swelling in the upper, outer quadrant of the right breast. It has
progressed in size over the last two days, despite following advice from her midwife to
breastfeed regularly from the affected breast.
On examination she has a palpable mass in the right axilla which is firm, tender and
erythematous. There is no palpable fluctuance. Her observations are as follows: Pulse 76 BP
110/70, Temperature 37.4, RR 16, Sate 98% on air . She had a benign fibroadenoma excised five
years ago and is concerned about the recurrence of a more sinister pathology.

26) What is the most appropriate initial management in this patient?

A) Admission for IV antibiotics

B) Discharge with oral antibiotics and urgent 2 week wait referral to breast clinic

C) Oral antibiotics and advise not to breastfeed from the affected breast.

D) Oral antibiotics and advise regular breastfeeding from the affected breast

E) Urgent surgical review for incision and drainage

27) All are true regarding maternal sepsis management except;

A) RCOG recommands Initial fluid resuscitation should be at 30ml/kg

B) RCOG recommands Initial fluid resuscitation should be at 20ml/kg

C) A venous lactate of >2 mmol/l should prompt critical care input

D) a level of >4 mmol/l, despite intravenous fluid resuscitation and requiring the use of vasopressors, should lead to the initiation of central venous pressure (CVP) and oxygen saturation monitoring (aiming for a CVP ≥8 mmHg and central venous oxygen saturation [ScvO2] ≥70%).

E) Current RCOG guidelines do not consider steroid use for sepsis, but recommend cautious use in the context of promoting fetal lung maturity.

29)

A 37-year-old woman presents with a secondary postpartum haemorrhage six days
following a spontaneous vaginal delivery. On examination she is acutely tender over the
uterus and has a temperature of 38.2°C.

She is passing large fresh clots per vaginum. You check her delivery records and you note
that the placenta had 'ragged membranes'. All are true in her management options
except

A) She requires urgent admission and IV access with cross-matched blood

B) Vaginal swab should be sent

C) A baseline clotting result is useful in case she develops disseminated intravascular coagulopathy

D) She will need an examination under anaesthesia once she becomes hemodynamically stabilised

E) Evacuation of retained products can be performed under regional anaesthesia

30) The incidence of recurrent uti in pregnancy is

A) 1-2%

B) 4-5%

C) 10-15%

D) 15-18%

E) 20%

Your score is