Shock

Question 2

Types of Shock (4 main)

Answer 2

1. Hypovolemic (e.g., hemorrhage)<br></br>2. Cardiogenic (e.g., MI)<br></br>3. Distributive (septic, anaphylactic, neurogenic)<br></br>4. Obstructive (e.g., PE, tamponade)

Question 3

Immediate Compensatory Mechanisms

Answer 3

• Sympathetic surge (↑HR, vasoconstriction)<br></br>• Tachycardia (↑CO)<br></br>• RAAS activation (↑Na+/H2O retention)<br></br>• ADH release (↑blood volume)

Question 4

Long-Term Compensations

Answer 4

• Erythropoiesis (↑RBCs)<br></br>• Renal Na+ retention (aldosterone)<br></br>• Protein shift (Starling forces)<br></br>• Liver glycogenolysis (↑glucose)

Question 5

USMLE Case: 65M with chest pain, BP 80/50, JVD

Answer 5

Diagnosis: Cardiogenic shock<br></br>Key Features:<br></br>- ↓CO, ↑PCWP<br></br>- JVD (RV failure)<br></br>Management:<br></br>- Inotropes (dobutamine)<br></br>- Avoid fluids!

Question 6

PLAB Case: 30F post-trauma, pale, HR 120

Answer 6

Diagnosis: Hypovolemic shock<br></br>Key Features:<br></br>- ↓CVP, ↓PAWP<br></br>Management:<br></br>- IV crystalloids<br></br>- Blood transfusion

Question 7

NEET-PG Case: 50M fever, BP 70/40, warm

Answer 7

Diagnosis: Septic shock<br></br>Key Features:<br></br>- ↓SVR, warm extremities<br></br>Management:<br></br>- Antibiotics<br></br>- Norepinephrine

Question 8

Shock Triad

Answer 8

1. Hypotension<br></br>2. Tachycardia<br></br>3. Oliguria<br></br>(Late sign: Altered mental status)

Question 9

Neurogenic vs Spinal Shock

Answer 9

Neurogenic:<br></br>- ↓BP + ↓HR (loss of SNS tone)<br></br>Spinal Shock:<br></br>- Flaccid paralysis (temp loss of reflexes)

Question 10

Obstructive Shock ECG Clue

Answer 10

• PE: Right heart strain (S1Q3T3)<br></br>• Tamponade: Electrical alternans<br></br>• Tension PTX: ↓QRS voltage

Question 11

Labs in Shock

Answer 11

• ↑Lactate (>2 mmol/L)<br></br>• Metabolic acidosis (↓pH, ↓HCO3-)<br></br>• ↑Creatinine (AKI)

Question 12

Front

Answer 12

Back

Question 13

22F with bee sting, urticaria, stridor, BP 70/40. Diagnosis?

Answer 13

Anaphylactic shock (Distributive). Key: Epinephrine IM + fluids

Question 14

68M post-STEMI, crackles, JVD, cold limbs, BP 85/50. Pathophysiology?

Answer 14

Cardiogenic shock. LV failure → ↓CO, ↑PCWP. Rx: Dobutamine, limit fluids

Question 15

Trauma patient: distended neck veins, muffled heart sounds. Bedside test?

Answer 15

Cardiac tamponade (obstructive). Echo for pericardial effusion. Rx: Pericardiocentesis

Question 16

Septic patient on norepinephrine: lactate 5.2, ScvO2 60%. Interpretation?

Answer 16

Tissue hypoxia (lactate >2, ScvO2 <70%). Optimize fluids, consider inotropes

Question 17

Post-op patient: MAP 55, oliguria, mottled skin. Failed compensation?

Answer 17

RAAS failure → ↓renal perfusion. Rx: Vasopressors, avoid renal-dose dopamine