Ch. 40 - Management and Resuscitation of the Critical Patient

A 40 y/o male had a syncopal episode after receiving news of the death of a loved one. He complains of a headache and is unable to walk without becoming dizzy. You should be the MOST suspicious for:
A) hypovolemia
B) dysrhythmia
C) a head injury
D) hypoglycemia

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C) a head injury

Systemic vascular resistance is:
A) the force of blood flow through the arteries
B) represented by blood pressure
C) the resistance to blood flow in all vessels except the pulmonary vessels
D) the product of HR x SV

C) the resistance to blood flow in all vessels except the pulmonary vessels

Decompensation in shock is characterized by:
A) increased catecholamine release
B) increased PSNS activity
C) multiple organ failure
D) progressive hypoperfusion

D) progressive hypoperfusion

You are providing care for a 37 y/o female patient with internal bleeding. On assessment, the patient is slightly lethargic and hypotensive. It is difficult to find peripheral radial pulses and her skin is ashen. Based on this information, the patient is most likely in:
A) compensated shock
B) decompensated shock
C) terminal shock
D) MODS

B) decompensated shock

You are providing care to a 63 y/o female complaining of extreme weakness. The patient has been too weak to get out of bed all day. On assessment, her skin is flushed and hot to the touch. Her BP is low and her pulse and respirations are fast. Based on this information, the patient is MOST likely experiencing:
A) cardiogenic shock
B) neurogenic shock
C) septic shock
D) anaphylactic shock

C) septic shock

You are providing care for a 54 y/o male who was struck in the chest with a baseball bat. The patient is complaining of diffuse pain in his chest. He is hypotensive but has pronounced JVD. On auscultation, there is clear air entry but you are having trouble hearing heart sounds. The ECG shows a sinus tachycardia but the QRS complexes are quite small. Based on this information, the patient is most likely in:
A) hypovolemic shock
B) cardiogenic shock
C) distributive shock
D) obstructive shock

D) obstructive shock

Which of the following is an example of a peri-arrest condition?
A) VT and an SBP of 60 mmHg
B) sinus tachycardia secondary to fever and a mild infection
C) VF that has persisted for 6 minutes
D) bradycardia in the absence of chest pain or other symptoms

A) VT and an SBP of 60 mmHg

Infection, hypertensive crisis, and medication noncompliance are differential diagnoses that should be considered when treating a patient who presents with:
A) acute chest pain
B) unilateral weakness
C) AMS
D) vomiting and diarrhea

C) AMS

Cardiac output is dependent on:
A) SV and HR
B) BP and HR
C) afterload and peripheral resistance
D) peripheral resistance and HR

A) SV and HR

Which of the following components represent the perfusion triangle?
A) RBCs and oxygen
B) heart, blood, blood vessels
C) oxygen, lungs, RBCs
D) organs, oxygen, CO2

B) heart, blood, blood vessels

Which of the following is the BEST indicator of tissue perfusion during compensated shock? A) SBP B) pulse rate and quality C) skin color and condition D) level of responsivenessD) level of responsivenessWhich of the following hemodynamic parameters decreases, regardless of the etiology of the shock? A) pulse rate B) MAP C) central venous pressure D) peripheral vascular resistanceB) MAPWhat effect would the restoration of normotension have on a patient with internal bleeding and a BP of 70/54? A) increased hemostasis and improved cerebral perfusion B) acute pulmonary edema secondary to volume overload C) facilitation of clotting mechanisms that stop bleeding D) formed clot dislodgment and worsened internal bleedingD) formed clot dislodgment and worsened internal bleedingWhich of the following injuries or conditions would cause obstructive shock? A) severe burns B) massive sepsis C) pelvic fracture D) cardiac tamponadeD) cardiac tamponadeWhich of the following assessment findings should increase your index of suspicion for obstructive shock? A) low BP B) JVD C) increased lung compliance D) generalized edemaB) JVDYou and your team are treating an unresponsive trauma patient. Which of the following questions would be MOST relevant to ask your team when evaluating for the presence of a tension PTX? A) what is the patient's SBP? B) are the patient's heart tones becoming affected? C) is the patient becoming difficult to ventilate? D) does the patient's pulse weaken during inhalation?C) is the patient becoming difficult to ventilate?You are responding to a patient who collapsed while running a marathon. Assessment of her breathing reveals a RR of 28/min, and slightly labored. She has a radial pulse that is tachycardic at 120 bpm, and her skin is mottled, cool, and dry. There are no obvious signs of trauma, but there are positive signs and symptoms of dehydration, including sunken eyes and poor skin turgor, as well as syncope, nausea, and vomiting. Which form of shock is this patient experiencing? A) hypovolemic B) neurogenic C) septic D) cardiogenicA) hypovolemicWhich of the following signs and symptoms are NOT consistent with those of shock due to dehydration? A) anxiety B) thirst C) pale, cool, moist skin D) elevated temperatureD) elevated temperatureTension PTX and cardiac tamponade are examples of which types of shock? A) obstructive B) cardiogenic C) hypovolemic D) distributiveA) obstructiveWhat is the best indicator of tissue perfusion in compensated shock? A) decreased cardiac output B) level of responsiveness C) widened pulse pressure D) drop in BPB) level of responsivenessAnaphylaxis is what kind of shock? A) obstructive B) distributive C) cardiogenic D) hypovolemicB) distributiveWhich of the following is a late sign of fluid loss? A) restlessness/anxiety B) drop in BP C) postural syncope D) tachycardiaB) drop in BPWhich of the following would you expect to see in a shock patient? A) decreased pulse, decreased respirations B) increased pulse, increased respirations C) increased pulse, decreased respirations D) decreased pulse, increased respirationsB) increased pulse, increased respirationsWhich condition would lead you to suspect obstructive shock over hypovolemic shock? A) increased SBP B) closed head injury C) distended neck veins D) abdominal injuryC) distended neck veinsYou are responding to a frequent flyer complaining of SOB. You assume that she is simply having an anxiety attack since your past dealings with her have shown no significant morbidities. What is this an example of? A) egocentric bias B) confirmation bias C) overconfidence D) anchoring biasD) anchoring biasWhat is the role of baroreceptors in perfusion? A) regulate respiratory rate (chemoreceptors) B) increase BP C) increase cardiac contraction (epinephrine and norepinephrine) D) narrow pulse pressureB) increase BPWhich medication is the first-line treatment of choice for anaphylaxis? A) epinephrine B) Benadryl C) corticosteroids D) atropineA) epinephrineAnaerobic metabolism is the process in which: A) adequate amounts of oxygen reach the cell level B) the adrenal glands fail to release catecholamines C) inefficient cellular metabolism produces lactic acid D) the cells produce carbon dioxide and waterC) inefficient cellular metabolism produces lactic acidDIC is defined as a(n): A) pathological condition in which the proteins that normally control blood clotting become inappropriately active B) abnormal process in which disease or injury causes hemostasis due to platelet aggregation C) decrease in WBC count, which results in decreased resistance to infection D) pathophysiologic reaction that occurs when cellular ischemia leads to anaerobic metabolismA) pathological condition in which the proteins that normally control blood clotting become inappropriately activeBy which of the following mechanisms do patients with septic shock become hypovolemic? A) spontaneous destruction of RBCs B) fluid leakage out of the vascular space C) frequent and severe vomiting and diarrhea D) sustained systemic vascular dilationA) spontaneous destruction of RBCsIntrinsic causes of cardiogenic shock include: A) PE B) cardiomyopathy C) pleural effusion D) tension PTXB) cardiomyopathyAdequately perfused kidneys put out at least ___ to ___ mL of urine per hour. A) 50, 70 B) 100, 110 C) 30, 50 D) 70, 100C) 30, 50Carbonic acid is formed by the combination of: A) water and bicarbonate B) lactate and pyruvic acid C) water and CO2 D) water and HGBC) water and CO2Accumulating acids and other waste products in the blood: A) cause a marked increase in the production of RBCs B) inhibit HGB from binding with and carrying oxygen C) act as potent vasoconstrictors, which worsens ischemia D) cause a left shift in the oxyhemoglobin dissociation curveB) inhibit HGB from binding with and carrying oxygenWhat is the MAP of a person who has a BP of 140/90? A) 97 B) 82 C) 101 D) 107D) 107Incomplete glucose breakdown leads to an accumulation of: A) pyruvic acid B) bicarbonate C) lactic acid D) carbonic acidA) pyruvic acidDuring MODS, the release of ____, a potent vasodilator, leads to tissue hypoperfusion and may contribute to hypotension. A) renin B) angiotensin C) bradykinin D) epinephrineC) bradykininIf the LV fills with 85 mL of blood and ejects 60 mL during a contraction, the EF is approximately _____%. A) 70 B) 60 C) 55 D) 65A) 70The vasodilation that accompanies distributive shock creates: A) increased afterload B) increased preload C) decreased cardiac contractility D) relative hypothermiaD) relative hypothermiaWhat is formed when CO binds to the hemoglobin molecule? A) methemoglobin B) oxyhemoglobin C) carboxyhemoglobin D) myoglobinC) carboxyhemoglobinA young woman experiences a sudden nervous system reaction that produces a temporary, generalized vasodilation and causes her to faint. This is MOST descriptive of _____ shock. A) neurogenic B) obstructive C) hypovolemic D) psychogenicD) psychogenicSigns and symptoms of MODS may include: A) marked hyperglycemia B) uncontrollable bleeding C) severe polyuria D) warm, flushed skinB) uncontrollable bleedingWhen administering IV fluid boluses to an elderly patient in shock, it is especially important to monitor their: A) lung sounds B) blood pressure C) pulse rate D) mental statusA) lung soundsA patient with suspected internal bleeding has a systolic BP of 104. What is the appropriate fluid management? A) fluid challenge is not necessary B) 250 mL, repeated twice C) 5-10 mL/kg, repeated once D) 500 mL, repeated onceA) fluid challenge is not necessaryHypotension during anaphylactic shock is caused primarily by: A) capillary leakage B) vascular damage C) relative hypovolemia D) cardiac muscle injuryC) relative hypovolemiaWhich of the following is a disadvantage of using a crystalloid solution when treating a patient with hemorrhagic shock? A) they increase the viscosity of the blood B) they cause platelets to clump together C) they do not expand the circulating volume D) they do not have oxygen-carrying capacityD) they do not have oxygen-carrying capacityWhich of the following premorbid conditions would MOST likely occur in an otherwise healthy adult? A) CHF B) renal failure C) CAD D) drug toxicityD) drug toxicityIn medicine, intuition would MOST likely be used to: A) rule out a particular diagnosis B) downgrade the transport status C) triage a patient to a higher category D) justify not transporting a patientC) triage a patient to a higher categoryRelative bradycardia during neurogenic shock occurs because: A) systemic venous pooling of the blood overstimulates the vagus nerve B) the PSNS does not release ACh C) the SNS is not stimulated to release catecholamines D) the brainstem does not receive messages to increase the HRC) the SNS is not stimulated to release catecholaminesWhich of the following is the MOST accurate definition of MODS? A) progressive failure of two or more organs or systems that were directly affected by the acute disorder or injury that caused the patient's initial illness B) combined failure of two or more organs or systems that were initially unharmed by the acute disorder or injury that caused the patient's initial illness C) acute and predictable failure of the kidneys, liver, lungs, and heart that resulted from any disorder or injury that directly affected these organs D) sequential failure of two or more organs or systems caused by an acute injury or illness affecting any part of the patient's CNSB) combined failure of two or more organs or systems that were initially unharmed by the acute disorder or injury that caused the patient's initial illnessThe negative target-organ effects of anaphylactic shock are reversed with: A) low-dose dopamine B) diphenhydramine C) epinephrine D) methylprednisoloneC) epinephrineThe MOST immediate treatment for the patient with a tension PTX is to: A) establish a large-bore IV line B) evacuate air from the pleural space C) ventilate with a BVM D) apply high-flow oxygenB) evacuate air from the pleural spaceWhich of the following is an element of the Fick principle? A) a relatively constant EtCO2 B) an adequate number of RBCs C) adequate production of pyruvic acid D) consistent WBC productionB) an adequate number of RBCsBaroreceptors function by: A) constricting the blood vessels when systemic vascular resistance is high B) dilating the blood vessels when systemic vascular resistance is low C) measuring subtle shifts in arterial oxygen and carbon dioxide levels D) sensing decreased blood flow and activating the vasomotor centerD) sensing decreased blood flow and activating the vasomotor centerWhen an adult patient with hemorrhagic shock loses more than 40% of their blood volume: A) blood flow is diverted away from the skin to the liver, kidneys, and lungs B) immediate IV fluid replacement can rapidly restore adequate tissue perfusion C) vital organ damage can be repaired if a blood transfusion is started promptly D) cardiovascular deterioration cannot be reversed by compensatory mechanismsD) cardiovascular deterioration cannot be reversed by compensatory mechanismsAfterload is increased following alpha-1 stimulation because of: A) arteriolar constriction B) widespread vasodilation C) increased contractility D) decreased preloadA) arteriolar constrictionA patient with severe dehydration is found to be hypotensive during your assessment. The MOST important intervention in this case is: A) applying blankets to keep the pt warm B) immediate fluid resuscitation at the scene C) high-flow oxygen via NRB D) transport with fluid resuscitation en routeD) transport with fluid resuscitation en routeClinical indicators of SNS discharge include: A) increased salivation B) pupillary dilation C) diffuse wheezing D) hypoventilationB) pupillary dilationWhich of the following BPs is MOST c/w pericardial tamponade? A) 90/70 B) 100/60 C) 110/80 D) 80/50A) 90/70Shock in the trauma pt should be considered ______ until proven otherwise. A) obstructive B) distributive C) neurogenic D) hemorrhagicD) hemorrhagicThe MOST common cause of cardiogenic shock is: A) papillary muscle rupture B) myocardial infarction C) a sudden dysrhythmia D) ventricular aneurysmB) myocardial infarctionWhich of the following clinical signs would differentiate septic shock from hypovolemic shock? A) warm or hot skin B) weak, thready pulse C) AMS D) severe hypotensionA) warm or hot skinIf you can feel a pulse over the femoral artery of an adult, but are unable to feel a pulse over the radial artery, their SBP is likely between ____ and ____ mmHg. A) 90, 100 B) 70, 80 C) 60, 70 D) 80, 90B) 70, 80Which of the following volume expanders has been shown to interfere with platelet function and cause clotting problems? A) Plasmanate B) LR C) Hespan D) DextranD) DextranThe capillary washout phase occurs when: A) cellular ischemia causes the post-capillary sphincters to remain constricted, causing the capillaries to become engorged with fluid B) anaerobic metabolism causes the postcapillary sphincters to remain constricted, causing capillary fluid engorgement C) post-capillary sphincters relax, releasing accumulated hydrogen, potassium, CO2, and thrombosed RBCs D) precapillary sphincters constrict in response to the buildup of lactic acid, vasomotor failure, and increased CO2C) post-capillary sphincters relax, releasing accumulated hydrogen, potassium, CO2, and thrombosed RBCsDuring anaerobic metabolism, the precapillary sphincters ______ in response to _____. A) constrict, capillary engorgement B) relax, systemic vasoconstriction C) constrict, decreased CO2 D) relax, lactic acid buildupD) relax, lactic acid buildup

Ch. 40 - Management and Resuscitation of the Critical Patient

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