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1. Surgery FIRST PART > Shock > Flashcards

Shock Flashcards

1
Q

Shock caused by a large tension pneumothorax is categorized as

A. Trauma shock
B. Vasodilatory shock
C. Cardiogenic shock
D. Obstructive shock

A

D. Obstructive shock

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2
Q

What is true about baroreceptors?

A. Volume receptors can be activated in hemorrhage with reduction in left atrial pressure.
B. Receptors in the aortic arch and carotid bodies inhibit the autonomic nervous system (ANS) when stretched.
C. When baroreceptors are stretched, they induced increased ANS output and produce constriction of peripheral vessels.
D. None of the above.

A

B. Receptors in the aortic arch and carotid bodies inhibit the autonomic nervous system (ANS) when stretched.

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3
Q 
Chemoreceptors in the aorta and carotid bodies do NOT sense which of the following?
A. Changes in O2 tension
B. H+ ion concentration
C. HCO3– concentration
D. Carbon dioxide (CO2) levels
A

C. HCO3– concentration

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4
Q

Neurogenic shock is characterized by the presence of
A. Cool, moist skin
B. Increased cardiac output
C. Decreased peripheral vascular resistance
D. Decreased blood volume

A

C. Decreased peripheral vascular resistance

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5
Q

When a patient with hemorrhagic shock is resuscitated using an intravenous colloid solution rather than lactated Ringer solution, all of the following statements are true EXCEPT

A. Circulating levels of immunoglobulins are decreased.
B. Colloid solutions may bind to the ionized fraction of serum calcium.
C. Endogenous production of albumin is decreased.
D. Extracellular fluid volume deficit is restored.

A

D. Extracellular fluid volume deficit is restored.

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6
Q

In hemorrhage, larger arterioles vasoconstrict in response to the sympathetic nervous system. Which categories of shock are associated with vasodilation of larger arterioles?

A. Septic shock
B. Cardiogenic shock
C. Neurogenic shock
D. A & C

A

D. A & C

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7
Q

Which of the following is true about antidiuretic hormone (ADH) production in injured patients?

A. ADH acts as a potent mesenteric vasoconstrictor.
B. ADH levels all to normal within 2 to 3 days of the initial insult.
C. ADH decreases hepatic gluconeogenesis.
D. ADH secretion is mediated by the renin-angiotensin system.

A

A. ADH acts as a potent mesenteric vasoconstrictor.

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8
Q

Which of the following occur as a result of epinephrine and norepinephrine?

A. Hepatic glycogenolysis
B. Hypoglycemia
C. Insulin sensitivity
D. Lipogenesis

A

A. Hepatic glycogenolysis

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9
Q

A patient has a blood pressure of 70/50 mmHg and a serum lactate level of 30 mg/100 mL (normal: 6–16). His cardiac output is 1.9 L/min, and his central venous pressure is 2 cm H2O. The most likely diagnosis is

A. Congestive heart failure
B. Cardiac tamponade
C. Hypovolemic shock
D. Septic shock

A

C. Hypovolemic shock

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10
Q

Which cytokine is anti-inflammatory and increases after shock and trauma?

A. Interleukin (IL)-1
B. IL-2
C. IL-6
D. IL-10

A

D. IL-10

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11
Q

Tumor necrosis factor-alpha (TNF-α)

A. Can be released as a response to bacteria or endotoxin
B. Increased more in trauma than septic patients
C. Induces procoagulant activity and peripheral vasoconstriction
D. Contributes to anemia of chronic illness

A

A. Can be released as a response to bacteria or endotoxin

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12
Q

A 70-kg male patient presents to ED following a stab wound to the abdomen. He is hypotensive, markedly tachycardic, and appears confused. What percent of blood volume has he lost?

A. 5%
B. 15%
C. 35%
D. 55%

A

D. 55%

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13
Q

Vasodilatory shock

A. Is characterized by failure of vascular smooth muscle to constrict due to low levels o catecholamines
B. Leads to suppression of the renin-angiotensin system
C. Can also be caused by carbon monoxide poisoning
D. Is similar to early cardiogenic shock

A

C. Can also be caused by carbon monoxide poisoning

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14
Q

A patient in septic shock remains hypotensive despite adequate fluid resuscitation and initiation o norepinephrine. What is often given to patients with hypotension refractory to norepinephrine?

A. Dopamine
B. Arginine vasopressin
C. Dobutamine
D. Milrinone

A

B. Arginine vasopressin

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15
Q

Tight glucose management in critically ill and septic patients

A. Requires insulin to keep serum glucose <140
B. Has no effect on mortality
C. Has no effect on ventilator support
D. Decreases length of antibiotic therapy

A

D. Decreases length of antibiotic therapy

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16
Q

Cardiogenic shock

A. Is most commonly caused by exacerbation of congestive heart failure.
B. Cardiogenic shock following an acute myocardial infarction is typically present on admission.
C. Cardiogenic shock occurs in 5 to 10% of acute MIs.
D. Is characterized by hypotension, reduced cardiac index, and reduced pulmonary artery wedge pressure.

A

C. Cardiogenic shock occurs in 5 to 10% of acute MIs.

17
Q

All of the following result from the placement of an intra-aortic balloon pump in a patient with acute myocardial failure EXCEPT

A. Reduction of systolic afterload
B. Increased cardiac output
C. Increased myocardial O2 demand
D. Increased diastolic perfusion pressure

A

C. Increased myocardial O2 demand

18
Q

Which constellation o clinical findings is suggestive of cardiac tamponade?

A. Hypotension, wide pulse pressure, tachycardia
B. Tachycardia, hypotension, jugular venous distension
C. Hypotension, wide pulse pressure, jugular venous distension
D. Hypotension, muffled heart tones, jugular venous distension

A

D. Hypotension, muffled heart tones, jugular venous distension

19
Q

A 43-year-old man is struck by a motor vehicle while crossing the street; he arrives in the ED hypotensive, bra-dycardic, and unable to move his extremities. What is the most likely cause of his hypotension?

A. Hypovolemic shock
B. Obstructive shock
C. Neurogenic shock
D. Vasodilatory shock

A

A. Hypovolemic shock

20
Q

Corticosteroids in the treatment of septic shock

A. Improves rates of shock reversal in patients requiring vasopressors
B. Improves mortality in patients with relative adrenal insufficiency
C. Is contraindicated in patients with positive bacterial blood cultures
D. None of the above

A

B. Improves mortality in patients with relative adrenal insufficiency

21
Q

What is FALSE about serum lactate?

A. Generated from pyruvate in the setting of insufficient O2.
B. Metabolized by the liver and kidneys.
C. Is an indirect measure of the magnitude and severity of shock.
D. The time to peak lactate from admission predicts rates of survival.

A

D. The time to peak lactate from admission predicts rates of survival.

1. Surgery FIRST PART (7 decks)

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