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SU2.1-3 | Shock and Resuscitation — Graded Quiz
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A 60-year-old man with crushing chest pain develops shock. He is cold and clammy with hypotension, raised jugular venous pressure and bilateral basal crepitations; an ECG shows an extensive anterior myocardial infarction. Which type of shock is this, and what is the underlying mechanism?
Correct. A large myocardial infarction causing hypotension with a raised JVP and pulmonary oedema is cardiogenic shock — failure of the heart as a pump. The raised filling pressures and pulmonary congestion distinguish it from hypovolaemia (low filling pressures) and from obstructive causes such as tamponade or PE.
Cardiogenic shock = intrinsic pump failure (e.g. large MI): hypotension with raised filling pressures and pulmonary congestion, contrasting with the low filling pressures of hypovolaemia.
Pump failure after a large MI, with a raised JVP and pulmonary oedema, is cardiogenic shock. Hypovolaemia gives low filling pressures; distributive shock is warm/vasodilated; obstructive shock is mechanical obstruction (tamponade, tension pneumothorax, PE).
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Which sequence of bedside signs best reflects the EARLY recognition of haemorrhagic shock, before hypotension develops?
Correct. Early haemorrhagic shock shows tachycardia and a narrowed pulse pressure (rising diastolic from vasoconstriction), cool clammy oliguric peripheries and altered mentation — all before the systolic pressure falls. Hypotension is a late sign, which is why it must never be awaited before treating.
Read early haemorrhagic shock from tachycardia, narrowed pulse pressure, cool clammy oliguric peripheries and altered mentation; hypotension is a late sign.
The early signs are tachycardia, a narrowed pulse pressure, cool clammy peripheries, oliguria and altered mentation — hypotension comes LAST. Bradycardia, warmth and isolated fever do not describe early haemorrhagic shock.
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A patient in undifferentiated shock is being assessed and resuscitated in the emergency department. Which principle BEST describes the relationship between assessment and treatment in shock?
Correct. In shock, assessment and resuscitation proceed together: the ABCDE primary survey structures simultaneous identification and correction of life threats, restoring tissue perfusion while the underlying cause is sought and treated. Sequential 'assess-then-treat' or 'wait for imaging' approaches cost lives.
Shock is managed by simultaneous assessment and resuscitation via the ABCDE primary survey: restore perfusion and treat the cause together.
Assessment and treatment in shock are simultaneous, structured by the ABCDE primary survey — you restore perfusion and hunt the cause at the same time, not one after the other and not after definitive imaging.
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During resuscitation, which finding is the MOST useful single indicator that tissue perfusion is being restored adequately over time?
Correct. Adequacy of resuscitation is judged by end-organ perfusion over time: a rising urine output, a falling (clearing) lactate, improving conscious level and warming, well-perfused peripheries. These dynamic markers are far more reliable than a single blood-pressure reading, which can be normal in compensated shock.
Monitor resuscitation by end-organ perfusion trends: urine output, lactate clearance, mentation and peripheral warmth — not a single blood-pressure snapshot.
Judge resuscitation by trends in end-organ perfusion — urine output, lactate clearance, mentation and peripheral warmth — not by a single BP reading. A rising heart rate suggests ongoing shock.
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A young adult develops shock within minutes of a wasp sting, with widespread urticaria, wheeze, facial swelling and hypotension. What is the immediate first-line drug treatment?
Correct. Anaphylaxis — a form of distributive shock — is treated first and foremost with prompt intramuscular adrenaline, alongside oxygen, fluids and removal of the trigger. Antihistamines and corticosteroids are adjuncts, never the first-line life-saving treatment, and diuretics have no role.
Anaphylaxis is distributive shock; the immediate first-line treatment is intramuscular adrenaline, with oxygen, fluids and trigger removal — antihistamines and steroids are adjuncts.
Anaphylactic (distributive) shock is treated first with intramuscular adrenaline, plus oxygen and fluids. Antihistamines and steroids are adjuncts only; furosemide is not indicated.
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You must counsel the anxious family of a patient in septic shock whose prognosis is guarded. Which approach BEST reflects empathic, structured prognosis communication using frameworks such as SPIKES and NURSE?
Correct. Good prognosis counselling is honest but kind: arrange privacy, establish the family's perception and invitation (SPIKES), deliver information in plain language calibrated to what they can absorb, and respond to emotion by naming, understanding and acknowledging it (NURSE). False reassurance, an information dump, and deflecting the hard question all fail the family.
Empathic prognosis counselling (SPIKES/NURSE): truthful, calibrated information delivered privately with active acknowledgement of emotion; honesty with compassion, not false reassurance or deflection.
Empathic prognosis communication means privacy, finding out what the family understands, honest calibrated information, and responding to emotion (SPIKES/NURSE) — not false reassurance, not an unbuffered technical dump, and not deflecting the direct question.
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