Chapter 1 - Shock: pathophysiology, diagnosis, tx Flashcards
Which of the following best describes the fundamental cause of shock?
A) Excessive oxygen in the bloodstream
B) Inadequate tissue perfusion
C) Overactive immune response
D) Excessive nutrient supply to cells
B) Inadequate tissue perfusion –> leads to energy and oxygen deprivation, release of cellular enzymes and accumulation of calcium and reactive oxygen species (ROS) (cellular injury and death) - leads to activation of inflammatory, coagulation and complement cascadesc - cellular injury and microvascular thrombosis + increased absorption of endotoxin and bacteria = SIRS
Hypovolemic shock is primarily caused by
A) Loss of vasomotor tone
B) Volume deficit due to blood loss or dehydration
C) Cardiac muscle failure
D) Obstruction of blood flow
B) Volume deficit due to blood loss or dehydration
Which of the following is NOT a common cause of distributive shock?
A) Septic shock
B) Neurogenic shock
C) Cardiogenic shock
D) Anaphylactic shock
C) Cardiogenic shock
Distributive shock or vasodilatory shock is a medical emergency where your body can’t get enough blood to your heart, brain and kidneys.
In compensated shock, which are mechanisms involved in restoring homeostasis?
1) Increased sympathetic tone
2) Vasoconstriction
3) Enhanced renal water reabsorptio
The primary goal in treating hypovolemic shock is to:*
A) Increase heart rate
B) Restore tissue perfusion and oxygen delivery C) Decrease blood lactate levels
D) Increase blood viscosity
B) Restore tissue perfusion and oxygen delivery
What is the main reason for the rapid diffusion of isotonic crystalloids out of the vascular space?
A) High glucose content
B) High oxygen content
C) Low viscosity
D) Low oncotic pressure
D) Low oncotic pressure
Which of the following is NOT a benefit of hypertonic saline solution (HSS) in shock treatment?
A) Rapid expansion of intravascular volume
B) Prolonged intravascular retention
C) Reduction of endothelial cell volume
D) Blunting neutrophil activation
B) Prolonged intravascular retention
When assessing shock progression, capillary refill time (CRT) is:
A) Only prolonged in hypovolemic shock
B) Unaffected by vascular permeability
C) Useful if assessed over time
D) Always shortened in septic shock
C) Useful if assessed over time
Hypotensive resuscitation in shock is primarily aimed at:
A) Maximizing oxygen delivery
B) Preventing further blood loss in uncontrolled bleeding
C) Increasing the blood volume rapidly
D) Restoring blood pressure to normal values immediately
B) Preventing further blood loss in uncontrolled bleeding
Which of the following is NOT a clinical sign of early, hyperdynamic shock?
A) Tachycardia
B) Decreased pulse pressure
C) Mental agitation
D) Tachypnea
B) Decreased pulse pressure
What does shock result from?
A. Muscular distress
B. Physical injury
C. Inadequate tissue perfusion
D. Excessive blood loss
C. Inadequate tissue perfusion
What are the major factors affecting blood flow?
A. Brain function, liver function, kidney function
B. Circulating volume, cardiac pump function, vasomotor tone
C. Respiratory rate, blood pressure, temperature
D. Muscle strength, bone density, skin integrity
B.Circulating volume, cardiac pump function, vasomotor tone
What is cardiac output (CO) determined by?
Stroke volume (SV)
What is myocardial contractility?
The rate of cross-bridge cycling between actin and myosin filaments within cardiomyocytes
Which of the following is a component of stroke volume?
A. Ventricular afterload
B. Blood plasma
C. White blood cell count
D. Platelet aggregatio
A. Ventricular afterload
What is the primary goal in treating shock?
To restore and maintain cardiac output
What is hypovolemic shock primarily caused by?
A volume deficit
What is the cause of cardiogenic shock?
Pump failure of the heart
What is a common cause of distributive shock?
Loss of vasomotor tone
What is the response of baroreceptors to a fall in blood pressure?
They increase sympathetic tone
How is obstructive shock primarily caused?
By obstruction of ventilation or cardiac output
How does renal perfusion decrease affect the body?
It stimulates production of renin
What happens during decompensated shock?
Ischemia and failure of compensatory mechanisms
What are the signs of Class I blood loss according to the American College of Surgeons?
No change in physical findings