Shock
23 Questions
| Attempts: 2453
Questions and Answers
- 1.A 53-year-old woman is brought in by ambulance to the ER. The nurse calls you to the bedside because the patient is confused and hypertense. Which of the following would you do first?
- A.
Get a basic history
- B.
Basic clinical examination - vital signs
- C.
ABCs
- D.
Placement of foley catheter
- 2.Which of the following would you do during the AIRWAY portion of ABC?
- A.
Check for evidence of end-organ function
- B.
Check for adequate level of consciousness
- C.
Check for adequate cough
- D.
Check for adequate O2 saturation
- E.
Apply oxygen to the patient
- F.
Obtain IV access
- G.
Check for adequate gag reflex
- 3.Which of the following would you do during the BREATHING portion of ABC?
- A.
Check for evidence of end-organ function
- B.
Check for adequate level of consciousness
- C.
Check for adequate cough
- D.
Check for adequate O2 saturation
- E.
Apply oxygen to the patient
- F.
Obtain IV access
- G.
Check for adequate gag reflex
- 4.Which of the following would you do during the CIRCULATION) portion of ABC?
- A.
Check for evidence of end-organ function
- B.
Check for adequate level of consciousness
- C.
Check for adequate cough
- D.
Check for adequate O2 saturation
- E.
Apply oxygen to the patient
- F.
Obtain IV access
- G.
Check for adequate gag reflex
- 5.A 53-year-old woman is brought in by ambulance to the ER. The nurse calls you to the bedside because the patient is confused and hypertense. The patient had felt unwell today and had told her husband that she had vomited a 'small amount' of fresh blood six times today. After her last episode of vomiting, her husband had checked on her and found her unconscious on the bathroom floor, in a pool of blood, and called the ambulance. The paramedics tell you that there was obvious fresh blood in the toilet bowl, as well as evidence of fresh blood oozing from her rectum. Based on this history, what is the most likely diagnosis?
- A.
Upper GI bleed
- B.
Lower GI bleed
- C.
Bleeding from lungs
- D.
Aortic aneurism
- 6.A 53-year-old woman is brought in by ambulance to the ER. The nurse calls you to the bedside because the patient is confused and hypertense. The patient had felt unwell today and had told her husband that she had vomited a 'small amount' of fresh blood six times today. After her last episode of vomiting, her husband had checked on her and found her unconscious on the bathroom floor, in a pool of blood, and called the ambulance. The paramedics tell you that there was obvious fresh blood in the toilet bowl, as well as evidence of fresh blood oozing from her rectum. Her initial examination reveals a BP of 70/40 mmHg, HR 140 bpm, and RR 20. She is afebrile. She looks very pale, and her extremities are very cold and clammy. Her JVP and external jugular pulse are flat; she has a normal S1 and S2, and no extra heart sounds. She has normal breath sounds bilateral. She has decreased bowel sounds, with epigastric tenderness to palpation. Her level of consciousness is decreased, but she does rouse to painful stimuli (GCS 12). a Foley catheter is inserted: 15cc of concentrated urine returns. Is this patient in shock?
- A.
Yes
- B.
No
- C.
Maybe?
- D.
Where am I?
- 7.What signs and symptoms suggest that a patient is in shock?
- A.
Confusion
- B.
Asterixis
- C.
Tachycardia
- D.
Decreased capillary refill
- E.
Decreased breath sounds
- F.
Decreased bowel sounds
- G.
Decreased urinary output
- 8.Which of the four broad categories of shock is this patient's clinical presentation most in keeping with?
- A.
Cardiogenic
- B.
Hypovolemic
- C.
Distributive
- D.
Obstructive
- 9.At this point, two 14 gauge peripheral IVs are started, and she is immediately given a 2L bolus of normal saline. Her blood is sent for a CBC, electrolytes, INR, PTT, and type and cross-match for 6 units of packed red cells. After the bolus the patient remains somnolent. Her BP is 76/40, HR 120 bpm (regular), RR 24 and O2 sats on 4L NP are 95%. There is an additional 10 cc of concentrated urine in her foley catheter since it was inserted 30 minutes ago. Her blood work has now returned and shows: ABG 7.26/30/91/13, Hb 135, WBC 8.3, platelets normal, Na 135, Cl 102, K 4.2, creatinine 162, BUN 21.3, INR 1.1, aPTT normal, lactate 4.2, ScvO2 A+. Is this patient still in shock?
- A.
Yes
- B.
No
- C.
Maybe?
- D.
Who are you?
- 10.At this point, two 14 gauge peripheral IVs are started, and she is immediately given a 2L bolus of normal saline. Her blood is sent for a CBC, electrolytes, INR, PTT, and type and cross-match for 6 units of packed red cells. After the bolus the patient remains somnolent. Her BP is 76/40, HR 120 bpm (regular), RR 24 and O2 sats on 4L NP are 95%. There is an additional 10 cc of concentrated urine in her foley catheter since it was inserted 30 minutes ago. Her blood work has now returned and shows: ABG 7.26/30/91/13, Hb 135, WBC 8.3, platelets normal, Na 135, Cl 102, K 4.2, creatinine 162, BUN 21.3, INR 1.1, aPTT normal, lactate 4.2, ScvO2 A+. What is the significance of the patient's Hb?
- A.
Rules out massive bleed
- B.
Rules out hemorrhagic shock
- C.
Neither of the above
- 11.At this point, two 14 gauge peripheral IVs are started, and she is immediately given a 2L bolus of normal saline. Her blood is sent for a CBC, electrolytes, INR, PTT, and type and cross-match for 6 units of packed red cells. After the bolus the patient remains somnolent. Her BP is 76/40, HR 120 bpm (regular), RR 24 and O2 sats on 4L NP are 95%. There is an additional 10 cc of concentrated urine in her foley catheter since it was inserted 30 minutes ago. Her blood work has now returned and shows: ABG 7.26/30/91/13, Hb 135, WBC 8.3, platelets normal, Na 135, Cl 102, K 4.2, creatinine 162, BUN 21.3, INR 1.1, aPTT normal, lactate 4.2, ScvO2 A+. Interpret the ABG
- A.
Wide anion gap metabolic acidosis with resp compensation
- B.
Normal anion gap metabolic acidosis with resp compensation
- C.
Wide anion gap resp acidosis with metabolic compensation
- D.
Normal anion gap resp acidosis with metabolic compensation
- 12.What are the potentially modifiable variables for every patient in shock?
- A.
Blood content
- B.
Cardiac contractility
- C.
Heart rate
- D.
Heart rhythm
- E.
Afterload
- F.
Preload
- G.
Temperature
- 13.Based on the formula for oxygen delivery, what are the two factors that can be modified to optimize the amount of oxygen carried in the blood?
- A.
SaO2
- B.
PaO2
- C.
Hb
- D.
Hct
- 14.You are called urgently to the medical ward to assess a 54-year-old man who was admitted 2 days ago for investigation of recurrent abdominal pain. Upon your arrival you are told that the blood pressure that was just taken was 114/60 mmHg. The patient is moaning in bed, and looks unwell. This morning he had onset of epigastric burning that got progressively worse over the next few hours, despite Maalox and ranitidine. He has a past medical history significant for a previous gastric ulcer, tobacco use (30 pack-years), HTN, dyslipidemia and a recent diagnosis of DM type 2. Your initial PE demonstrates cold extremities and a JVP 9cm ASA. His blood pressure is 118/62 mm Hg, HR 102 bpm and regular, RR 30 and oxygen saturations of 93% on 10L/min by face mask. He is working very hard to breathe, prefers sitting upright, is diaphoretic, has a new S3, equal breath sounds bilaterally, with crackles to both bases and has not made any urine for the past 4 hours. He is able to give one to two word answers to your questions. Is this patient in shock?
- A.
Yes
- B.
No
- C.
Maybe?
- D.
How did I get here?
- 15.You are called urgently to the medical ward to assess a 54-year-old man who was admitted 2 days ago for investigation of recurrent abdominal pain. Upon your arrival you are told that the blood pressure that was just taken was 114/60 mmHg. The patient is moaning in bed, and looks unwell. This morning he had onset of epigastric burning that got progressively worse over the next few hours, despite Maalox and ranitidine. He has a past medical history significant for a previous gastric ulcer, tobacco use (30 pack-years), HTN, dyslipidemia and a recent diagnosis of DM type 2. Your initial PE demonstrates cold extremities and a JVP 9cm ASA. His blood pressure is 118/62 mm Hg, HR 102 bpm and regular, RR 30 and oxygen saturations of 93% on 10L/min by face mask. He is working very hard to breathe, prefers sitting upright, is diaphoretic, has a new S3, equal breath sounds bilaterally, with crackles to both bases and has not made any urine for the past 4 hours. He is able to give one to two word answers to your questions. With which broad categories of shock is this patient's presentation most in keeping?
- A.
Distributive
- B.
Cardiogenic
- C.
Obstructive
- D.
Hypovolemic
- 16.What is the significance of a mild elevation in lactate in this patient?
- A.
Impending respiratory failure
- B.
Previous MI
- C.
End-organ hypoperfusion
- D.
Anaerobic metabolism
- E.
C and D
- 17.You are called urgently to the medical ward to assess a 54-year-old man who was admitted 2 days ago for investigation of recurrent abdominal pain. Upon your arrival you are told that the blood pressure that was just taken was 114/60 mmHg. The patient is moaning in bed, and looks unwell. This morning he had onset of epigastric burning that got progressively worse over the next few hours, despite Maalox and ranitidine. He has a past medical history significant for a previous gastric ulcer, tobacco use (30 pack-years), HTN, dyslipidemia and a recent diagnosis of DM type 2. Your initial PE demonstrates cold extremities and a JVP 9cm ASA. His blood pressure is 118/62 mm Hg, HR 102 bpm and regular, RR 30 and oxygen saturations of 93% on 10L/min by face mask. He is working very hard to breathe, prefers sitting upright, is diaphoretic, has a new S3, equal breath sounds bilaterally, with crackles to both bases and has not made any urine for the past 4 hours. He is able to give one to two word answers to your questions. How will you manage this patient?
- A.
Identification of the underlying etiology of the shock state
- B.
Immediate resuscitation of the shock state
- C.
Initiation of specific therapies related to the underlying etiology
- D.
Identification and treatment of any complications related to the shock state
- E.
All of the above
- 18.You are completing a rotation in a rural hospital, and as the clinical clerk, you are first call to the ER. One night when you are on call, a 23 year old woman is brought in by her roommate because of a high fever. The nurse asks you to see the patient right away because she believes the patient is very ill. What would you do first?
- A.
Get a basic history
- B.
Basic clinical examination - vital signs
- C.
ABCs
- D.
Placement of foley catheter
- 19.The patient is unable to give a coherent history. The roommate states that the patient has been feeling unwell for the past two days, with increasing lethargy, fever, intermittent "shaking" and cough productive of yellow sputum. The patient has previously been very healthy, with the only sick contacts being her two nephews with whom she visited four days ago. Her initial vital signs include a BP 66/32, HR 132, RR 28, temp 39.8 and O2 sat 92% on 3L nasal prongs. Her extremities feel warm to the touch and her JVP is in the normal range. She has bounding pulses. Her GCS is 11. She has not urinated in 24 hours. Is this patient in shock?
- A.
Yes
- B.
No
- C.
Maybe?
- D.
Get me the hell out of here!?
- 20.The patient is unable to give a coherent history. The roommate states that the patient has been feeling unwell for the past two days, with increasing lethargy, fever, intermittent "shaking" and cough productive of yellow sputum. The patient has previously been very healthy, with the only sick contacts being her two nephews with whom she visited four days ago. Her initial vital signs include a BP 66/32, HR 132, RR 28, temp 39.8 and O2 sat 92% on 3L nasal prongs. Her extremities feel warm to the touch and her JVP is in the normal range. She has bounding pulses. Her GCS is 11. She has not urinated in 24 hours. With which broad category of shock is this patient's presentation most in keeping?
- A.
Hypovolemic
- B.
Obstructive
- C.
Distributive
- D.
Cardiogenic
- 21.The patient is unable to give a coherent history. The roommate states that the patient has been feeling unwell for the past two days, with increasing lethargy, fever, intermittent "shaking" and cough productive of yellow sputum. The patient has previously been very healthy, with the only sick contacts being her two nephews with whom she visited four days ago. Her initial vital signs include a BP 66/32, HR 132, RR 28, temp 39.8 and O2 sat 92% on 3L nasal prongs. Her extremities feel warm to the touch and her JVP is in the normal range. She has bounding pulses. Her GCS is 11. She has not urinated in 24 hours. Which type of distributive shock is the most likely possibility in this case?
- A.
Anaphylaxis
- B.
Fulminant hepatic failure
- C.
Adrenal insufficiency
- D.
Septic shock
- E.
Neurogenic
- 22.Chest x-ray shows a right upper-lobe infiltrate. How would you initially manage this patient?
- A.
Crystalloids 500-1000mL boluses every 15-30 minutes
- B.
Broad spectrum antibiotics
- C.
Find the source of infection
- D.
Draw cultures as soon as possible to maximize chances of isolating an organism
- E.
All of the above
- 23.After 2L of normal saline, the patient's BP rises to 72/50 mmHg. However, she continues to be somnolent, have no urine output and have a ScvO2 of 55%. Her JVP is 1cm ASA, and her SaO2 is 98% on a non-rebreather mask. All the following measures can be undertaken to help resuscitate this patient EXCEPT:
- A.
Increase the SaO2 by increasing FiO2 or intubation with mechanical ventilation
- B.
Give a vascoconstricting agent to increase afterload
- C.
Crystalloid administered to target a CVP of 8-12 mmHg
- D.
Agent to increase contractility
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