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1 A 65-year-old man presents with massive gastrointestinal bleeding. BP is 70/40 mmHg, HR 140/min, cold clammy extremities, and collapsed neck veins. Lactate is elevated. What is the primary pathophysiologic mechanism responsible for shock in this patient?

Reduced systemic vascular resistance due to cytokine release Decreased preload causing reduced cardiac output Primary myocardial pump failure with pulmonary congestion Mechanical obstruction of venous return to the heart

2 A trauma patient remains hypotensive despite receiving 2 liters of crystalloids. He has persistent tachycardia, rising lactate, and worsening mental status. What is the most appropriate next management step?

Administer norepinephrine immediately without further evaluation Activate massive transfusion protocol and control hemorrhage Restrict fluids completely and observe Start high-dose corticosteroids

3 A 58-year-old man develops hypotension, pulmonary edema, raised JVP, and cool extremities following an acute anterior STEMI. Which shock type is most consistent with these findings?

Hypovolemic shock Cardiogenic shock Septic shock Neurogenic shock

4 A patient in cardiogenic shock receives aggressive IV fluids and rapidly develops severe respiratory distress with crackles bilaterally. Why are excessive fluids harmful in cardiogenic shock?

They reduce oxygen delivery by diluting hemoglobin They worsen pulmonary edema due to increased preload They cause systemic vasodilation worsening hypotension They suppress catecholamine release

5 A septic patient has warm flushed skin, bounding pulses, BP 80/45 mmHg, and lactate 6 mmol/L. What is the key pathophysiologic mechanism causing hypotension?

Increased SVR from catecholamine surge Systemic vasodilation mediated by nitric oxide Acute blood loss causing reduced preload Mechanical obstruction of cardiac filling

6 A patient with septic shock remains hypotensive after receiving 30 mL/kg IV fluids. MAP is 55 mmHg. Which vasopressor is first-line therapy?

Dopamine Norepinephrine Nitroglycerin Propranolol

7 A 22-year-old develops hypotension, wheezing, urticaria, and facial swelling immediately after receiving IV penicillin. What is the most immediate life-saving intervention?

IV antihistamines only IM epinephrine High-dose IV steroids only Broad-spectrum antibiotics

8 A spinal cord injury patient presents with hypotension, bradycardia, and warm dry skin. What is the mechanism causing shock?

Loss of sympathetic tone leading to vasodilation Massive intravascular volume loss Primary left ventricular failure Pulmonary vascular obstruction

9 A patient develops sudden hypotension, raised JVP, and muffled heart sounds after coronary intervention. What shock type is present?

Cardiogenic shock Obstructive shock due to cardiac tamponade Hypovolemic shock Septic shock

10 A trauma patient has absent breath sounds on the right, tracheal deviation, hypotension, and distended neck veins. What is the immediate management?

IV antibiotics Needle decompression for tension pneumothorax Aggressive diuresis Thrombolytic therapy

11 A patient in shock has persistent lactic acidosis despite restoration of blood pressure. What does this indicate?

Adequate perfusion has been achieved Ongoing microcirculatory failure and tissue hypoxia Pure respiratory alkalosis Hypervolemic shock state

12 A hemorrhagic shock patient has tachycardia but maintains normal blood pressure initially. This represents which stage of shock?

Compensated shock Progressive shock Irreversible shock Terminal shock

13 A septic shock patient is on norepinephrine but develops low cardiac output due to myocardial depression. Which additional agent is most appropriate?

Dobutamine Furosemide Atenolol Amlodipine

14 A patient with massive pulmonary embolism develops hypotension, raised JVP, and clear lung fields. What is the mechanism of shock?

Severe vasodilation causing low SVR Mechanical obstruction of pulmonary circulation reducing LV preload Loss of intravascular volume from bleeding Primary myocardial infarction

15 A patient in irreversible shock has refractory hypotension despite vasopressors. What cellular event defines irreversible shock?

Increased ATP production Severe mitochondrial dysfunction and membrane failure Excess catecholamine release Pure hyperventilation-induced alkalosis

16 A 68-year-old man presents with massive GI bleeding. BP is 70/40 mmHg, HR 150/min, cold clammy extremities, and altered sensorium. After securing airway and oxygen, what is the most appropriate immediate circulatory management?

Start norepinephrine before fluids Rapid infusion of isotonic crystalloids and activate blood transfusion protocol Give diuretics to prevent pulmonary edema Delay fluids until laboratory confirmation

17 A trauma patient remains hypotensive despite 2 liters of IV fluids. FAST ultrasound suggests intra-abdominal bleeding. What is the next definitive step?

Continue crystalloids only Immediate surgical source control with massive transfusion Start beta-blockers for tachycardia Administer antibiotics only

18 A 60-year-old man in cardiogenic shock after MI has BP 80/50 mmHg, pulmonary edema, and raised JVP. Which treatment strategy is most appropriate?

Aggressive fluid boluses until BP normalizes Inotropes with urgent reperfusion therapy High-dose steroids immediately Restrict oxygen therapy

19 A septic shock patient remains hypotensive after receiving 30 mL/kg crystalloid. MAP is 55 mmHg. What is the first-line vasopressor?

Norepinephrine Nitroglycerin Furosemide Verapamil

20 A septic shock patient has persistent low cardiac output despite norepinephrine. Which agent is best added to improve myocardial contractility?

Dobutamine Amlodipine Hydrochlorothiazide Atenolol

21 A patient develops hypotension, wheezing, urticaria, and facial swelling immediately after IV contrast administration. What is the immediate life-saving drug?

IM epinephrine Oral antihistamines only IV warfarin IV beta-blockers

22 After epinephrine administration in anaphylactic shock, which adjunct therapy helps prevent biphasic or prolonged reactions?

Hydrocortisone Digoxin Mannitol Thrombolytics

23 A spinal cord injury patient has hypotension with bradycardia and warm extremities. Which is the most appropriate vasopressor choice?

Phenylephrine or norepinephrine to restore sympathetic tone Nitroglycerin infusion High-dose diuretics No treatment is required

24 A trauma patient develops hypotension, distended neck veins, and absent breath sounds with tracheal deviation. What is the immediate management?

Needle decompression followed by chest tube Large-dose IV morphine only Delay intervention until chest X-ray Aggressive diuretics

25 A patient in obstructive shock due to cardiac tamponade has hypotension, raised JVP, and muffled heart sounds. What is definitive treatment?

Pericardiocentesis High-dose antibiotics only Aggressive fluid restriction Long-term beta-blockers

26 A septic shock patient develops ARDS after excessive fluid resuscitation. What is the best supportive ventilatory strategy?

Low tidal volume ventilation with adequate PEEP High tidal volume ventilation to improve oxygenation No mechanical ventilation required Pure oxygen without airway support

27 During shock resuscitation, which clinical endpoint best indicates adequate renal perfusion?

Urine output ≥0.5 mL/kg/hr Skin rash resolution Heart rate below 50/min Presence of fever

28 A patient in septic shock has persistent hypotension despite norepinephrine. What is the next recommended vasopressor adjunct?

Vasopressin Nitroglycerin Furosemide Atenolol

29 A cardiogenic shock patient remains unstable despite inotropes. Which advanced mechanical support may be required?

Intra-aortic balloon pump or ECMO Oral antihistamines Long-term corticosteroids Fluid restriction alone

30 A patient with shock has rising lactate despite normal blood pressure after resuscitation. What is the best interpretation?

Shock has completely resolved Ongoing microcirculatory failure requiring continued optimization Pure respiratory alkalosis Excessive oxygen delivery

31 A 70-year-old man presents with massive hematemesis. BP is 75/40 mmHg, HR 145/min, cold clammy skin, and collapsed jugular veins. Which primary hemodynamic abnormality explains his shock state?

Decreased systemic vascular resistance due to nitric oxide release Decreased preload leading to reduced cardiac output Increased preload with pump failure Obstruction of right ventricular outflow tract

32 A patient with septic shock has warm flushed extremities, bounding pulses, BP 85/50 mmHg, and high cardiac output early in the course. What is the dominant pathophysiologic mechanism?

Primary myocardial infarction reducing contractility Systemic vasodilation causing low SVR Massive blood loss causing low preload Cardiac tamponade preventing ventricular filling

33 A 60-year-old man develops hypotension, pulmonary edema, raised JVP, and cool extremities after acute MI. Which shock type is most consistent with these findings?

Hypovolemic shock Cardiogenic shock Neurogenic shock Anaphylactic shock

34 A trauma patient has hypotension, distended neck veins, tracheal deviation, and absent breath sounds on one side. Which shock type is present?

Hypovolemic shock Obstructive shock due to tension pneumothorax Septic shock Cardiogenic shock

35 A patient develops hypotension, bradycardia, and warm dry skin after spinal cord injury. What mechanism causes this shock state?

Loss of sympathetic tone causing vasodilation Severe blood loss causing reduced preload Myocardial pump failure Systemic inflammatory cytokine storm

36 A patient in shock shows elevated lactate, metabolic acidosis, and altered mental status. What does elevated lactate primarily indicate?

Increased aerobic metabolism Anaerobic metabolism due to tissue hypoperfusion Pure respiratory alkalosis Excess renal clearance of bicarbonate

37 A patient has hypotension, raised JVP, muffled heart sounds, and pulsus paradoxus after cardiac surgery. What type of shock is this?

Cardiogenic shock Obstructive shock due to cardiac tamponade Hypovolemic shock Septic shock

38 In hypovolemic shock, which compensatory response occurs first to maintain blood pressure?

Systemic vasodilation Tachycardia and peripheral vasoconstriction Bradycardia with warm extremities Immediate myocardial hypertrophy

39 A patient with distributive shock has low SVR and high cardiac output initially. Which shock subtype best fits?

Septic shock Cardiogenic shock Hypovolemic shock Obstructive shock

40 A patient develops urticaria, wheezing, hypotension, and facial edema after eating peanuts. Which shock type is present?

Neurogenic shock Anaphylactic shock Cardiogenic shock Hypovolemic shock

41 A massive pulmonary embolism leads to hypotension, raised JVP, and clear lungs. What is the mechanism of shock?

Loss of circulating blood volume Mechanical obstruction of pulmonary blood flow reducing LV preload Primary systemic vasodilation Left ventricular pump failure from MI

42 Which hemodynamic profile is most typical of cardiogenic shock?

Low CVP, low SVR, high CO High CVP, high SVR, low CO Low CVP, high CO, low SVR Normal CVP, low CO, low SVR

43 Which stage of shock is characterized by hypotension, worsening organ dysfunction, and failure of compensatory mechanisms?

Compensated stage Progressive stage Early reversible stage Physiologic adaptation stage

44 A patient remains hypotensive despite restoration of blood pressure with vasopressors, and multi-organ failure develops. What defines irreversible shock?

Increased oxygen delivery Severe mitochondrial dysfunction with ATP depletion Pure hyperventilation-induced alkalosis Excessive catecholamine production

45 A patient with septic shock has persistent hypotension and lactate elevation despite fluids. Which pathophysiologic feature explains refractory shock?

Microcirculatory dysfunction and capillary leak Excessive preload with hypertension Pure hypovolemia from hemorrhage only Primary valvular stenosis