Sepsis And Severe Infection Practice Test

History: A 46-year-old man presents with severe epigastric pain radiating to the back and fever. He has a history of gallstones.

Vital signs: T 38.7°C (101.7°F), HR 120/min, BP 92/58 mm Hg, RR 24/min.

Physical exam: He is ill-appearing. Abdomen is tender in the epigastrium with guarding.

Labs: WBC 18,300/mm³, lactate 3.6 mmol/L, total bilirubin 4.2 mg/dL, alkaline phosphatase 320 U/L.

Imaging: Right upper quadrant ultrasound shows dilated common bile duct with a stone.

Clinical decision point: He has suspected ascending cholangitis with sepsis.

Question: Which intervention is crucial for source control in this scenario?

History: A 56-year-old man with pancreatitis 3 weeks ago presents with fever and worsening abdominal pain. He has early satiety and nausea.

Vital signs: T 38.6°C (101.5°F), HR 118/min, BP 90/58 mm Hg, RR 22/min.

Physical exam: Abdomen is tender in the epigastrium.

Labs: WBC 17,400/mm³, lactate 3.4 mmol/L.

Imaging: Computed tomography of the abdomen shows a 9-cm walled-off fluid collection with gas bubbles consistent with infected pancreatic necrosis.

Clinical decision point: He has sepsis from an infected pancreatic collection.

Question: Which intervention is crucial for source control in this scenario?