Medicine
Critical Care & Sepsis
Which physical finding favors cardiogenic rather than hypovolemic shock?
A. Flat neck veins
B. Dry mucous membranes
C. Raised jugular venous pressure
D. History of profuse diarrhea
Correct Answer: C
Elevated venous filling pressure supports pump failure or obstructive physiology rather than simple volume depletion.
Medicine
Critical Care & Sepsis
Which complication or major adverse outcome is particularly associated with Cardiogenic shock?
A. Hypoxic cardiac arrest
B. Progressive multiorgan hypoperfusion
C. Ventricular arrhythmia or asystole
D. Simultaneous microvascular thrombosis and major bleeding
Correct Answer: B
Low cardiac output can lead to renal, hepatic, neurologic and other organ failure.
Medicine
Critical Care & Sepsis
A patient is diagnosed with Cardiogenic shock. Which is the most appropriate management principle?
A. Urgently treat the cardiac cause, support perfusion and arrange reperfusion when acute coronary occlusion is responsible
B. Use lung-protective mechanical ventilation with low tidal volumes when invasive ventilation is required
C. Call for expert airway support and secure a definitive airway before complete obstruction occurs
D. Give intravenous calcium to stabilize the myocardium, then use measures that shift potassium intracellularly and remove potassium
Correct Answer: A
Definitive treatment targets the pump-failure cause; acute MI-associated shock requires urgent revascularization evaluation.
Medicine
Critical Care & Sepsis
In a patient with suspected Cardiogenic shock, which investigation or diagnostic approach is most appropriate at this stage?
A. Clinical diagnosis; do not delay emergency treatment for laboratory confirmation
B. Arterial blood gas plus chest imaging and evaluation for a noncardiogenic cause
C. Rapid airway assessment while preparing definitive airway management
D. Urgent ECG and bedside echocardiography
Correct Answer: D
ECG identifies ischemia and echocardiography assesses ventricular function and mechanical complications.
Medicine
Critical Care & Sepsis
A patient is hypotensive after a large myocardial infarction, with cool clammy skin, raised JVP and pulmonary crackles. What is the most likely diagnosis?
A. Hypovolemic shock
B. Anaphylactic shock
C. Cardiogenic shock
D. Acute respiratory distress syndrome (ARDS)
Correct Answer: C
Shock with evidence of pump failure, elevated filling pressures and pulmonary congestion indicates cardiogenic shock.
Medicine
Critical Care & Sepsis
Which hemodynamic feature is most expected in uncomplicated hypovolemic shock?
A. Markedly increased preload
B. Reduced preload
C. Primary bradycardia
D. High-output state with bounding pulses
Correct Answer: B
Loss of circulating volume reduces venous return and ventricular preload.
Medicine
Critical Care & Sepsis
Which complication or major adverse outcome is particularly associated with Hypovolemic shock?
A. Acute kidney injury from prolonged renal hypoperfusion
B. Simultaneous microvascular thrombosis and major bleeding
C. Multiple-organ dysfunction syndrome
D. Progressive multiorgan hypoperfusion
Correct Answer: A
Sustained hypoperfusion can cause ischemic kidney injury and other organ dysfunction.
Medicine
Critical Care & Sepsis
A patient is diagnosed with Hypovolemic shock. Which is the most appropriate management principle?
A. Give intravenous calcium to stabilize the myocardium, then use measures that shift potassium intracellularly and remove potassium
B. Treat the underlying cause and provide blood-component support when clinically indicated
C. Give prompt broad-spectrum antimicrobials, balanced crystalloid resuscitation and norepinephrine if hypotension persists
D. Control the source and restore intravascular volume, using blood products early when major hemorrhage is present
Correct Answer: D
Definitive control of ongoing loss and appropriate volume or blood replacement are the priorities.
Medicine
Critical Care & Sepsis
In a patient with suspected Hypovolemic shock, which investigation or diagnostic approach is most appropriate at this stage?
A. Rapid airway assessment while preparing definitive airway management
B. Immediate potassium assessment with continuous ECG monitoring
C. Rapid bedside assessment for the source of volume loss with serial perfusion markers
D. Platelet count, PT/INR, aPTT, fibrinogen and D-dimer
Correct Answer: C
Diagnosis is primarily clinical; investigations should rapidly identify hemorrhage or other causes while resuscitation proceeds.
Medicine
Critical Care & Sepsis
A patient is tachycardic and hypotensive after major fluid or blood loss, with cool extremities and a low jugular venous pressure. What is the most likely diagnosis?
A. Acute respiratory distress syndrome (ARDS)
B. Hypovolemic shock
C. Impending upper-airway failure
D. Life-threatening hyperkalemia
Correct Answer: B
Low preload after volume loss produces hypotension, tachycardia, cool skin and low venous filling pressure.
Medicine
Critical Care & Sepsis
Which vasopressor is generally first-line for septic shock when hypotension persists after appropriate fluid resuscitation?
A. Norepinephrine
B. Dopamine for every patient
C. Phenylephrine as routine first-line therapy
D. Oral midodrine as initial resuscitation
Correct Answer: A
Norepinephrine is generally preferred as the first-line vasopressor in septic shock.
Medicine
Critical Care & Sepsis
Which complication or major adverse outcome is particularly associated with Septic shock?
A. Progressive multiorgan hypoperfusion
B. Upper-airway obstruction
C. Ventilator-associated lung injury
D. Multiple-organ dysfunction syndrome
Correct Answer: D
Persistent dysregulated infection and shock can lead to progressive failure of multiple organs.
Medicine
Critical Care & Sepsis
A patient is diagnosed with Septic shock. Which is the most appropriate management principle?
A. Control the source and restore intravascular volume, using blood products early when major hemorrhage is present
B. Urgently treat the cardiac cause, support perfusion and arrange reperfusion when acute coronary occlusion is responsible
C. Give prompt broad-spectrum antimicrobials, balanced crystalloid resuscitation and norepinephrine if hypotension persists
D. Give intramuscular epinephrine promptly and repeat as clinically required while supporting airway and circulation
Correct Answer: C
Early antimicrobials, judicious crystalloid resuscitation and norepinephrine as first-line vasopressor are core septic-shock measures.
Medicine
Critical Care & Sepsis
In a patient with suspected Septic shock, which investigation or diagnostic approach is most appropriate at this stage?
A. Platelet count, PT/INR, aPTT, fibrinogen and D-dimer
B. Measure serum lactate and obtain appropriate cultures without delaying treatment
C. Rapid bedside assessment for the source of volume loss with serial perfusion markers
D. Urgent ECG and bedside echocardiography
Correct Answer: B
Lactate helps assess tissue hypoperfusion; cultures should be collected promptly but must not meaningfully delay antimicrobial therapy.
Medicine
Critical Care & Sepsis
A patient has suspected infection, altered mentation, elevated lactate and persistent hypotension despite initial fluid resuscitation. What is the most likely diagnosis?
A. Septic shock
B. Life-threatening hyperkalemia
C. Disseminated intravascular coagulation (DIC)
D. Hypovolemic shock
Correct Answer: A
Infection with circulatory and metabolic abnormalities causing persistent hypotension is consistent with septic shock.