Diagnosis of Shock

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Question 1 of 10

1. Question
Which of the following patients is most likely to be suffering from a type of distributive shock?
- A 32-year-old diabetic unwell following 2 days of diarrhoea and vomiting. HR 125, BP 90/54, RR 32
- An 18-year-old motorcyclist following a collision with a car. Unable to move arms and legs, evident priapism. HR 75, BP 90/54, RR 32
- A 62-year-old with metastatic cancer. Increasing shortness of breath for 2 weeks. Large globular heart on chest x-ray. HR 140, BP 90/54, RR 32
- A 48-year-old alcoholic. Admitted with 2-day history of frequent loose black tarry stools. HR 130, BP 90/54, RR 32
- A 78-year-old with ischaemic heart disease. Collapsed at bingo. Pale, cool and clammy. HR 35, BP 90/54, RR 32
Question 2 of 10

2. Question
From the five shocked patients below, which is most likely to be due to a type of obstructive shock?
- A 32-year-old man who has been trapped by the thighs between two cars
- A 26-year-old woman with pyrexia and a generalised erythaematous rash
- A 45-year-old woman with abdominal pain, diarrhoea and wheeze
- A 68-year-old man, clammy, grey, short of breath, aching central chest pain
- A 34-year-old woman, 38/40 pregnant, collapsed and pale
Question 3 of 10

3. Question
A 46-year-old man undergoing chemotherapy for acute myeloid leukaemia has suspected neutropenic sepsis.

His heart rate is 120/min, BP 95/50, his oxygen saturation is 91% on 4 l of oxygen, his haemoglobin is 6.8 g/dl, temperature 40.1oC.

Which of the following interventions will increase oxygen delivery to the tissues the most within the next 2 hours?
- Transfusing to an Hb of 9g/dl
- Titrating noradrenaline to a MAP of 65mmHg
- Reducing temp to <38oC with antipyretics
- Increasing oxygen saturation to >98%
- Commencing broad spectrum intravenous antibiotics
Question 4 of 10

4. Question
Which of the following statements regarding haemorrhagic shock in otherwise healthy adults is true?
- Blood pressure starts to fall after the loss of about 5-10% of circulating volume
- Conscious level will drop after the loss of about 20% circulating volume
- Pulse pressure will not decrease until loss of about 40% of circulating volume
- Systolic blood pressure usually increases until about 30% of circulating volume is lost
- Pulse pressure will decrease before systolic blood pressure
Question 5 of 10

5. Question
Which of the following pedestrians, hit by a car, is likely to be the most shocked?

All patients are on non-rebreathing mask at 15L/minutes O2.
- A 68-year-old male. BP 110/55, HR 65, CRT 5s, pO2 18kPa, pCO2 5.4kPA, pH 7.42
- An 8-year-old boy. BP 90/60, HR 130, CRT 3s, sats 97%
- A 26-year-old man. BP 120/60, HR 98, pO2 9.9kPa, pCO2 3.1kPa pH 7.34
- A 40-year-old woman. BP 110/ 60, HR 110, pO2 50kPa pCO2 3.3kPa, pH 7.47
- An 18-year-old man. BP 95/55, HR 120, pO2 36kPa, pCO2 4.0kPa, pH 7.37
Question 6 of 10

6. Question
A 34-year-old man sustains multiple injuries in a road traffic accident. On arrival at the emergency department (ED) he is tachycardic and hypotensive. A blood gas shows a lactate of 8.

Which of the following statements concerning the blood lactate is most accurate?
- The high blood lactate on arrival is a reliable marker of poor prognosis in this situation
- Serial measures of lactate can help guide resuscitation
- Worsening of the blood lactate in the first hour post arrival strongly suggests a poor outcome
- Blood lactate levels are irrelevant in trauma
- The elevated lactate suggests another pathology in addition to hypovolaemic shock
Question 7 of 10

7. Question
A 32-year-old woman presents with pyrexia and right loin pain. She is tachycardic and hypotensive. She responds poorly to initial fluid resuscitation and a central line is inserted. A junior asks if you are going to measure the central venous oxygen saturation.

What is the significance of central venous oxygen saturation in this situation?
- A normal or high CvO2 following resuscitation ensures good tissue perfusion
- A normal or high CvO2 is most likely to indicate inadequate oxygen delivery
- A low CvO2 suggests oxygen delivery is inadequate
- A low CvO2 necessitates higher supplemental oxygen delivery
- A low CvO2 necessitates urgent transfusion
Question 8 of 10

8. Question
Which of the following treatments is most appropriate for the patients listed below?
- One litre warmed Hartmann’s solution bolus in a 24-year-old male with single stab wound to the chest HR 120, BP 85/60, ongoing blood loss
- Hydrocortisone, 100 micrograms, in a previously well 36-year-old woman with presumed chest sepsis requiring noradrenaline infusion to maintain BP
- Two units of blood in a 43-year-old woman with bilateral femoral fractures from road traffic accident. Following crystalloid resuscitation: BP 130/70, pulse 70, Hb 8.0g/dl
- Intubation and ventilation of a 20kg boy with meningococcal sepsis after 1.2 l of fluid resuscitation. BP 100/60, HR 140, RR 60, SaO2 90%
- Crystalloid, 1L, over 2 hours in a 32-year-old diabetic with ketoacidosis. HR 130, BP 80/50
Question 9 of 10

9. Question
In which of the following patients is the instigation of inotropic support indicated?
- A 26-year-old thrown from horse. T4 sensory level and paraplegia. BP 75/40, HR 120
- A 36-year-old with a stab wound to the chest. BP 60/40, HR 140
- A 73-year-old with an inferior myocardial infarction. BP 90/60, HR 80
- A 36-year-old with sudden onset urticaria and abdominal pain. BP 70/40, HR 120
- A 68-year-old with a pulsatile abdominal mass and back pain. BP 80/50, HR 130
Question 10 of 10

10. Question
Which of the following statements regarding mortality in shock is correct?
- Severe sepsis has a mortality of about 60%
- Cardiogenic shock has a mortality of about 30%
- Worldwide, about 2 million children under 5 years die each year from hypovolaemic shock secondary to diarrhoea
- About 250 children under 5 years die each year in the UK as a result of diarrhoeal illness
- About 200 people die of anaphylactic shock in the UK each year

Diagnosis of Shock – Post Test

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