Shock can best be defined as: A. Hypotension. B. Hypoperfusion of tissues. C. Hypoxemia. D. All of the above.

Shock can best be defined as: A.  Hypotension. B.  Hypoperfusion of tissues. C.  Hypoxemia. D.  All of the above.
by

1 Answer

Answer :

Answer: B  DISCUSSION: Shock, no matter what the cause, is a syndrome associated with tissue hypoperfusion. Tissue hypoperfusion leads to tissue hypoxia, which may or may not be due to hypoxemia. Hypotension is a late sign of shock and, therefore, is not a good clinical indicator of the presence of tissue hypoperfusion
by
selected

Related questions

Which of the following statement(s) is/are true concerning tumor necrosis factor (TNF)? a. TNF is a product of activated macrophages secreted in response to contact with endotoxin or lipopolysaccharide, antibody complexes, or inflammatory stimuli b. The liver and gut appear to be a major source of TNF following hypoperfusion c. Circulating levels of TNF correlate well with severity of tissue injury in shock d. Recently completed clinical trials of anti-TNF antibody in septic patients shows a marked improvement in survival

Description : Which of the following statement(s) is/are true concerning tumor necrosis factor (TNF)? a. TNF is a product of activated macrophages secreted in response to contact with endotoxin or ... completed clinical trials of anti-TNF antibody in septic patients shows a marked improvement in survival

Last Answer : Answer: a, b Tumor necrosis factor (TNF), a protein product of activated macrophages, is secreted in response to contact with endotoxin or lipopolysaccharide, antibody complexes, or ... patients utilizing infusion of monoclonal antibodies to the TNF molecule have shown no overall survival benefit

Which of the following statements are true of elevated–anion gap metabolic acidosis? A. Hypoperfusion from the shock state rarely produces an elevated anion gap. B. Retention of sulfuric and phosphoric acids may lead to this form of acidosis. C. Copious diarrhea does not produce this condition. D. Rapid volume expansion may produce this form of acidosis. E. Use of lactated Ringer's solution is inappropriate in the treatment of lactic acidosis.

Description : Which of the following statements are true of elevated-anion gap metabolic acidosis? A. Hypoperfusion from the shock state rarely produces an elevated anion gap. B. Retention of sulfuric and phosphoric ... E. Use of lactated Ringer's solution is inappropriate in the treatment of lactic acidosis.

Last Answer : Answer: BC DISCUSSION: An elevated anion gap may be produced by lactic acidosis from shock or by retention of inorganic acids from uremia. Lactated Ringer's solution rapidly corrects the ... . Bicarbonate loss from diarrhea and dilutional acidosis are non-anion gap types of metabolic acidosis

Which of the following physical findings are associated with the various classes of hemorrhagic shock? a. Mild shock (< 20% blood volume): Pallor, cool extremities, diminished capillary refill and diaphoresis b. Moderate shock (20%–40% blood volume): All of the above plus tachycardia and hypotension c. Severe shock (> 40% blood volume): Systemic hypotension, changes in mental status, tachycardia, oliguria d. All of the above

Description : Which of the following physical findings are associated with the various classes of hemorrhagic shock? a. Mild shock (< 20% blood volume): Pallor, cool extremities, diminished capillary refill and ... ): Systemic hypotension, changes in mental status, tachycardia, oliguria d. All of the above

Last Answer : Answer: a, c PHYSICAL FINDINGS IN HEMORRHAGIC SHOCK* Moderate Mild (40% Blood Volume) Blood Volume) Blood Volume) Pallor Pallor Pallor Cool extremities Cool extremities Cool extremities ... hypotension Mental status changes * Alcohol or drug intoxication may alter physical findings

A 32-year-old man suffers a spinal cord injury with a resultant paraplegia in a motorcycle accident. He presents to the emergency room with hypotension. Which of the following statement(s) is/are true concerning his diagnosis and management? a. The low blood pressure can be assumed to be due to neurogenic shock b. The sole cause of hypotension is the loss of sympathetic input to the venous system c. Despite significant hypotension, secondary organ injury will be uncommon d. There is no role for pharmacologic intervention to maintain blood pressure

Description : A 32-year-old man suffers a spinal cord injury with a resultant paraplegia in a motorcycle accident. He presents to the emergency room with hypotension. Which of the following statement(s) is/ ... injury will be uncommon d. There is no role for pharmacologic intervention to maintain blood pressure

Last Answer : Answer: c Neurogenic shock results from interruption of sympathetic vasomotor input and develops after spinal cord injury, spinal anesthesia, and severe head injury. Under normal conditions, baseline ... the cause is not neurogenic and search for occult blood loss or cardiogenic causes of shock

A 22-year-old man sustains a single stab wound to the left chest and presents to the emergency room with hypotension. Which of the following statement(s) is/are true concerning his diagnosis and management? a. The patient likely is suffering from hypovolemic shock and should respond quickly to fluid resuscitation b. Beck’s triad will likely be an obvious indication of compressive cardiogenic shock due to pericardial tamponade c. Echocardiography is the most sensitive noninvasive approach for diagnosis of pericardial tamponade d. The placement of bilateral chest tubes will likely resolve the problem

Description : A 22-year-old man sustains a single stab wound to the left chest and presents to the emergency room with hypotension. Which of the following statement(s) is/are true concerning his ... diagnosis of pericardial tamponade d. The placement of bilateral chest tubes will likely resolve the problem

Last Answer : Answer: c Shock from cardiac compression occurs when external pressure on the heart impairs ventricular filling. Because ventricular filling is a function of venous return and myocardial compliance, ... sternotomy. Chest tube placement would not be appropriate as the sole treatment in this patient

All of the following are true about neurogenic shock except: A. There is a decrease in systemic vascular resistance and an increase in venous capacitance. B. Tachycardia or bradycardia may be observed, along with hypotension. C. The use of an alpha agonist such as phenylephrine is the mainstay of treatment. D. Severe head injury, spinal cord injury, and high spinal anesthesia may all cause neurogenic shock.

Description : All of the following are true about neurogenic shock except: A. There is a decrease in systemic vascular resistance and an increase in venous capacitance. B. Tachycardia or bradycardia may be ... Severe head injury, spinal cord injury, and high spinal anesthesia may all cause neurogenic shock.

Last Answer : Answer: C DISCUSSION: Neurogenic shock occurs when severe head injury, spinal cord injury, or pharmacologic sympathetic blockade leads to sympathetic denervation and loss of vasomotor tone. ... of treatment. The use of alpha-adrenergic agonist is infrequently necessary to treat neurogenic shock

True statements concerning hypoadrenal shock include which of the following? A. Adrenocortical insufficiency may manifest itself as severe shock refractory to volume and pressor therapy. B. The presence of hyperglycemia and hypotension may suggest the diagnosis of shock due to adrenocortical insufficiency. C. Hydrocortisone does not interfere with the serum cortisol assay and should be given to hemodynamically unstable patients suspected of having hypoadrenal shock. D. The rapid adrenocorticotropic hormone (ACTH) stimulation test should be performed to help establish the diagnosis of acute adrenocortical insufficiency.

Description : True statements concerning hypoadrenal shock include which of the following? A. Adrenocortical insufficiency may manifest itself as severe shock refractory to volume and pressor therapy. B. ... test should be performed to help establish the diagnosis of acute adrenocortical insufficiency.

Last Answer : Answer: AD DISCUSSION: Shock due to acute adrenocortical insufficiency is relatively uncommon but must be considered when shock refractory to volume replacement and pressor therapy is present. ... and it is the corticosteroid of choice while the ACTH stimulation test is being performed

Which of the following statement(s) is/are true concerning the multiorgan failure syndrome (MOFS)? a. Changes in the splanchnic and pulmonary microcirculation are critical to the development of MOFS b. Tissue fixed microphages, including the liver Kupffer cell, have little role in the development of MOFS c. MOFS represents systemic consequences of loss of homeostatic control of local inflammation and microcirculatory hypoperfusion d. The nature of MOFS is highly dependent upon the etiology of the underlying problem

Description : Which of the following statement(s) is/are true concerning the multiorgan failure syndrome (MOFS)? a. Changes in the splanchnic and pulmonary microcirculation are critical to the development of MOFS ... d. The nature of MOFS is highly dependent upon the etiology of the underlying problem

Last Answer : Answer: a, c The nature of multiorgan failure syndrome (MOFS) is that of a diffuse cellular injury, developing systemically as a consequence of losing homeostatic control of local ... of microorganism. In noninfectious cases, the response also appears independent of the specific underlying cause

All of the following statements about hemorrhagic shock are true except: A. Following hemorrhagic shock, there is an initial interstitial fluid volume contraction. B. Dopamine, or a similar inotropic agent, should be given immediately for resuscitation from hemorrhagic shock, to increase cardiac output and improve oxygen delivery to hypoperfused tissues. C. The use of colloid solutions or hypertonic saline solutions is contraindicated for treatment of hemorrhagic shock. D. In hemorrhagic shock, a narrowed pulse pressure is commonly seen before a fall in systolic blood pressure.

Description : All of the following statements about hemorrhagic shock are true except: A. Following hemorrhagic shock, there is an initial interstitial fluid volume contraction. B. Dopamine, or a similar inotropic ... shock, a narrowed pulse pressure is commonly seen before a fall in systolic blood pressure.

Last Answer : Answer: BC DISCUSSION: Hemorrhagic shock is associated with a contraction of the interstitial fluid compartment because of precapillary vasoconstriction and reabsorption of interstitial fluid ... definitive evidence that such solutions are better than standard crystalloid solutions is lacking

A 68-year-old male who underwent a repair of an abdominal aortic aneurysm 5 days ago, develops tachycardia, tachypnea, hypotension with cool, pale, mottled cyanotic extremities. He is agitated and complains of shortness of breath. Which of the following statement(s) is/ are correct concerning his diagnosis and management? a. Myocardial ischemia secondary to preexisting coronary artery disease is most likely the underlying cause of this problem b. Invasive hemodynamic monitoring with a Swan-Gantz catheter will demonstrate a low cardiac output, a high systemic vascular resistance, and elevated cardiac filling pressures c. The use of morphine sulphate and nitrates should be part of the initial management d. The primary pharmacologic treatment involves the use of moderate doses of inotropic ag

Description : A 68-year-old male who underwent a repair of an abdominal aortic aneurysm 5 days ago, develops tachycardia, tachypnea, hypotension with cool, pale, mottled cyanotic extremities. He ... use of moderate doses of inotropic agents e. Afterload reduction with nitroprusside is absolutely contraindicated

Last Answer : Answer: a, b, d Intrinsic cardiogenic shock results from failure of the heart as an effective pump. Coronary artery disease is the most common cause of myocardial ... hemodynamic monitoring. Infusion of afterload-reducing agents can be administered in conjunction with inotropic support

Which of the following is/are acceptable reasons for the transfusion of red blood cells based on currently available data? A. Rapid, acute blood loss with unstable vital signs but no available hematocrit or hemoglobin determination. B. Symptomatic anemia: orthostatic hypotension, severe tachycardia (greater than 120 beats per minute), evidence of myocardial ischemia, including angina. C. To increase wound healing. D. A hematocrit of 26% in an otherwise stable, asymptomatic patient.

Description : Which of the following is/are acceptable reasons for the transfusion of red blood cells based on currently available data? A. Rapid, acute blood loss with unstable vital signs but no available ... increase wound healing. D. A hematocrit of 26% in an otherwise stable, asymptomatic patient.

Last Answer : Answer: AB DISCUSSION: Currently accepted guidelines for the transfusion of packed red blood cells include acute ongoing blood loss, as might occur in an injured patient, and the development of ... not be given based solely or predominantly on a numerical value such as a hematocrit of 28%

A classic sign of cardiogenic shock is a) Tissue hypoperfusion Tissue hypoperfusion is manifested as cerebral hypoxia (restlessness, confusion, agitation). b) High blood pressure Low blood pressure is a classic sign of cardiogenic shock. c) Hyperactive bowel sounds Hypoactive bowel sounds are classic signs of cardiogenic shock. d) Increased urinary output Decreased urinary output is a classic sign of cardiogenic shock.

Description : A classic sign of cardiogenic shock is a) Tissue hypoperfusion Tissue hypoperfusion is manifested as cerebral hypoxia (restlessness, confusion, agitation). b) High blood pressure Low blood pressure is ... . d) Increased urinary output Decreased urinary output is a classic sign of cardiogenic shock.

Last Answer : a) Tissue hypoperfusion Tissue hypoperfusion is manifested as cerebral hypoxia (restlessness, confusion, agitation).

Which of the following statement(s) is/are true concerning pharmacologic agents used in the treatment of shock? a. The primary difference between dopamine and dobutamine is the absence of significant a adrenergic activity b. The renal and mesenteric vasoconstrictive effects of norepinephrine complicate and sometimes restrict its use c. The apparent paradoxical use of vasodilators, such as nitroprusside, in shock is indicated as a means to augment cardiac function d. Isoproterenol with its potent b-adrenergic effect, is a particularly useful agent in the treatment of all forms of shock

Description : Which of the following statement(s) is/are true concerning pharmacologic agents used in the treatment of shock? a. The primary difference between dopamine and dobutamine is the absence of significant a ... b-adrenergic effect, is a particularly useful agent in the treatment of all forms of shock

Last Answer : Answer: a, b, c Therapeutic adjustments of intravascular volume (preload) and systemic vascular resistance (afterload) form the basis of the treatment strategies for all ... careful constant monitoring of arterial pressure and repeated hemodynamic measurements with a pulmonary artery catheter

Which of the following statement(s) is/are correct concerning the cardiovascular response to shock? a. Changes in cardiac contractile function shift the Frank Starling curve up and down b. Venoconstriction from skeletal muscle is a significant contributor to the restoration of blood volume with shock c. Arterial vasoconstriction affects all vascular beds equally d. The total circulating blood volume is equally split between the arterial and venous system

Description : Which of the following statement(s) is/are correct concerning the cardiovascular response to shock? a. Changes in cardiac contractile function shift the Frank Starling curve up and down b. ... d. The total circulating blood volume is equally split between the arterial and venous system

Last Answer : Answer: a Central in the general cardiovascular response to shock is the action of the heart itself. The principle determinants of cardiac function in the normal heart are the volume of blood ... Blood flow to the skin is sacrificed early, followed by that to the kidneys and splanchnic viscera

Which of the following statement(s) is/are true concerning hypoadrenal shock? a. In the United States, idiopathic adrenal atrophy (Addison’s disease) is the most common cause b. Laboratory abnormalities include hyponatremia, hypochloremia, and hyperkalemia c. Fever may be seen with hypoadrenal shock d. ACTH stimulation test is the diagnostic test of choice to confirm hypoadrenal shock

Description : Which of the following statement(s) is/are true concerning hypoadrenal shock? a. In the United States, idiopathic adrenal atrophy (Addison's disease) is the most common cause b. Laboratory ... hypoadrenal shock d. ACTH stimulation test is the diagnostic test of choice to confirm hypoadrenal shock

Last Answer : Answer: b, c, d Shock of a dramatic nature, poorly responsive to resuscitation, may develop as a consequence of adrenal insufficiency. In this country, adrenal insufficiency most ... of an ACTH stimulation test. A significant major cortisol response should be elicited by ACTH administration

Which of the following statement(s) is/are correct concerning the immunoinflammatory response to shock? a. The anaphylactoxins, C3a and C5a, are products of activation of only the classical pathway of the compliment cascade b. Eicosanoids, such as prostaglandins are stored in platelets and endothelial cells and released in response to inflammatory stimuli c. Thromboxane and PGI2 have similar effects d. Platelet-activating factor can be released by both circulating and fixed tissue cells

Description : Which of the following statement(s) is/are correct concerning the immunoinflammatory response to shock? a. The anaphylactoxins, C3a and C5a, are products of activation of only the classical pathway ... effects d. Platelet-activating factor can be released by both circulating and fixed tissue cells

Last Answer : Answer: d Inflammatory mediators have recently been recognized as playing a significant role in the clinical manifestations and progression of shock and the development ... increased pulmonary vascular resistance, bronchoconstriction, peripheral vasodilatation, and increased vascular permeability

Which of the following statement(s) is/are true concerning septic shock? a. The clinical picture of gram negative septic shock is specifically different than shock associated with other infectious agents b. The circulatory derangements of septic shock precede the development of metabolic abnormalities c. Splanchnic vascular resistance falls in similar fashion to overall systemic vascular resistance d. Despite normal mechanisms of intrinsic expansion of the circulating blood volume, exogenous volume resuscitation is necessary

Description : Which of the following statement(s) is/are true concerning septic shock? a. The clinical picture of gram negative septic shock is specifically different than shock associated with ... mechanisms of intrinsic expansion of the circulating blood volume, exogenous volume resuscitation is necessary

Last Answer : Answer: d The clinical findings in sepsis and septic shock represent the host response to infection. Gram-positive and gram-negative bacteria, viruses, fungi, rickettsiae, and ... intravascular volume, exogenous volume resuscitation must be provided to restore venous return and ventricular filling

Which of the following statement(s) is/are true concerning the neuroendocrine responses to shock? a. Sympathetic nerve endings release epinephrine which is responsible for greater than 80% of systemic vascular resistance b. Endogenous epinephrine is the primary contributor to systemic vascular resistance c. Increased pancreatic secretion of glucagon contributes to glucose intolerance associated with injury and sepsis d. The renin-angiotensin axis further augments the sympathetic-mediated vasoconstriction

Description : Which of the following statement(s) is/are true concerning the neuroendocrine responses to shock? a. Sympathetic nerve endings release epinephrine which is responsible for greater than 80% ... injury and sepsis d. The renin-angiotensin axis further augments the sympathetic-mediated vasoconstriction

Last Answer : Answer: c, d The neuroendocrine response to shock attempts to achieve restoration of effective blood volume, mobilization of metabolic substrates, and maintenance of central ... . Angiotensin II is an extremely effective vasoconstrictor that further augments sympathetic-mediated vasoconstriction

Which of the following statement(s) is/are true concerning the diagnosis and management of hypovolemic shock? a. A fall in hematocrit or hemoglobin always accompanies hemorrhagic shock b. The treatment of shock is generic regardless of the etiology c. Pharmacologic intervention to increase myocardial contractility in hypovolemic shock is an important part the early management d. Complications are less frequent after treatment of hemorrhagic shock than septic or traumatic shock

Description : Which of the following statement(s) is/are true concerning the diagnosis and management of hypovolemic shock? a. A fall in hematocrit or hemoglobin always accompanies hemorrhagic shock b. The ... d. Complications are less frequent after treatment of hemorrhagic shock than septic or traumatic shock

Last Answer : Answer: d Hypovolemic shock is readily diagnosed when there is an obvious source of volume loss and overt signs of hemodynamic instability and increased adrenergic output are present. ... response systems and consequences of their disseminated, indiscriminate cellular injury can be quite profound

Which of the following statement(s) is/are true concerning the pulmonary response to shock? a. The acute pulmonary vascular response to shock differs markedly from that of systemic vasculature b. The pulmonary edema of ARDS occurs in the face of elevated left heart pressures c. The initial physiologic changes of ARDS involve the capillary endothelial cells and the type I pneumocyte d. Mechanisms proposed in the pathogenesis of ARDS include injury from mediators of inflammation elsewhere and from activated cellular elements e. A decrease in lung compliance may result from the loss of type I pneumocytes

Description : Which of the following statement(s) is/are true concerning the pulmonary response to shock? a. The acute pulmonary vascular response to shock differs markedly from that of systemic vasculature b. The ... elements e. A decrease in lung compliance may result from the loss of type I pneumocytes

Last Answer : Answer: c, d, e Contributing pathophysiologic processes to the pulmonary manifestations of shock include the pulmonary component of the cardiovascular response, disruption of the normal ... injury from mediators of inflammation elaborated elsewhere, and from activated cellular blood elements

Which of the following statement(s) is/are true concerning the microvascular and cellular response to shock? a. Osmodically induced mobilization of intracellular fluid is the initial response to restore intravascular volume b. With larger volume hemorrhagic shock deterioration of normal cellular transmembrane potential occurs resulting in an increase in extracellular sodium and water c. The accumulation of anaerobic metabolites override normal homeostatic vasomotor tone and contribute to the maladaptive vasodilatation d. Abnormal intracellular calcium homeostasis may contribute to the cellular dysfunction of shock

Description : Which of the following statement(s) is/are true concerning the microvascular and cellular response to shock? a. Osmodically induced mobilization of intracellular fluid is the initial ... d. Abnormal intracellular calcium homeostasis may contribute to the cellular dysfunction of shock

Last Answer : Answer: c, d Moderate hypovolemia results in a relatively rapid spontaneous restitution of intravascular volume through expansion of the plasma space. This plasma expansion by ... potassium pump. Cellular dysfunction also appears to be related to abnormal intracellular calcium homeostasis

Which of the following statement(s) is/are true concerning metabolic derangements in sepsis and the systemic inflammatory response syndrome which may follow progressive shock? a. Alterations in glucose metabolism lead to the development of efficient substrate utilization b. A progressive rise in serum triglyceride levels result from less efficient clearance and increased hepatic lipogenesis c. A net negative nitrogen balance occurs due to the oxidative metabolism of proteins to meet energy needs d. The serum aromatic amino acids fall rapidly as they are actively used in oxidative metabolism

Description : Which of the following statement(s) is/are true concerning metabolic derangements in sepsis and the systemic inflammatory response syndrome which may follow progressive shock? a. Alterations in glucose ... The serum aromatic amino acids fall rapidly as they are actively used in oxidative metabolism

Last Answer : Answer: b, c A broad spectrum of metabolic abnormalities become apparent in sepsis and the systemic inflammatory response syndrome following shock. Disruption of the normal cycles of carbohydrate, ... acetyl coenzyme A. This results in reduced serum level of leucine, isoleucine and valine

Which of the following statement(s) is/are true concerning the various types of shock? a. Traumatic shock is more commonly associated with subsequent organ injury and multiorgan failure syndrome than hemorrhagic shock b. Cardiogenic shock can be of either an intrinsic or compressive nature c. Hypodynamic septic shock is associated with a decreased mortality risk when compared with hyperdynamic septic shock d. Hypoadrenal shock usually responds quickly to resuscitation e. Neurogenic shock occurs with the absence of sympathetic activity

Description : Which of the following statement(s) is/are true concerning the various types of shock? a. Traumatic shock is more commonly associated with subsequent organ injury and multiorgan failure ... responds quickly to resuscitation e. Neurogenic shock occurs with the absence of sympathetic activity

Last Answer : Answer: a, b, d, e Classification schemes of shock based on cause have been developed for the seemingly dissimilar processes leading to circulatory collapse and the shock state. ... and pressor agents. The response to exogenous corticosteroids is usually dramatic and potentially life-saving

Most hormone receptors are localized on the cell membrane and transduce hormone binding into altered levels of intracellular messengers. A limited number of intracellular receptors do exist. Which of the following statement(s) is/are true concerning intracellular receptors? a. The messengers or hormones must by lipophilic b. These intracellular receptors generally regulate protein synthesis c. The intracellular receptors are located entirely in the nucleus of the cell d. A heat-shock protein serves as an inhibitor protein blocking the DNA-binding domain of the steroid receptor

Description : Most hormone receptors are localized on the cell membrane and transduce hormone binding into altered levels of intracellular messengers. A limited number of intracellular receptors do exist. Which of ... protein serves as an inhibitor protein blocking the DNA-binding domain of the steroid receptor

Last Answer : Answer: a, d Although most hormone and other messenger receptors are extracellular, intracellular receptors have been identified. The hormone messengers involved for these receptors are primarily ... DNA-binding domain of the receptor. Activation involves the dissociation of the inhibitor protein

Which of the following statements about the role of the gut in shock and sepsis are true? A. Selective decontamination of the digestive tract with the use of oral antibiotics has been shown to reduce nosocomial pneumonias and to improve mortality rates. B. Enteral nutrition, as compared with parenteral nutrition, preserves the villus architecture of the gut. C. Gut dysfunction may be an effect of shock, but it may also contribute to the development of MODS by the mechanism of bacterial translocation. D. As compared with parenteral nutrition, enteral nutrition is associated with a reduction in septic morbidity.

Description : Which of the following statements about the role of the gut in shock and sepsis are true? A. Selective decontamination of the digestive tract with the use of oral antibiotics has been ... As compared with parenteral nutrition, enteral nutrition is associated with a reduction in septic morbidity.

Last Answer : Answer: BCD DISCUSSION: The gut has a vital role in the pathophysiology of shock. The splanchnic circulation is very vulnerable to the circulatory redistribution that occurs in shock, thus, gut ... , enteral feeding is more cost effective and is associated with a lower rate of septic morbidity

Which of the following statements about septic shock are true? A. A circulating myocardial depressant factor may account for the cardiac dysfunction sometimes seen with shock due to sepsis or SIRS. B. A cardiac index (CI) of 6 liters per minute per square meter of body surface, a pulmonary capillary wedge pressure of 15 mm. Hg, and a systemic vascular resistance index (SVRI) of 800 dynes-sec/(cm 5-m 2) is a hemodynamic profile consistent with septic shock. C. An increase in SvO 2 in septic patients may be explained by the finding of anatomic arteriovenous shunts. D. Results of human trials employing antimediator therapy, such as antiendotoxin antibodies, IL-1 receptor antagonist, and tumor necrosis factor (TNF) antibodies, have confirmed animal studies that demonstrate a significant im

Description : Which of the following statements about septic shock are true? A. A circulating myocardial depressant factor may account for the cardiac dysfunction sometimes seen with shock due to sepsis or ... animal studies that demonstrate a significant improvement in survival with the use of such agents.

Last Answer : Answer: AB DISCUSSION: Shock due to sepsis or SIRS frequently manifests as a hyperdynamic cardiovascular response, consisting of an elevated CI and a decreased SVR or SVRI. Occasionally, ... been encouraging thus far in human clinical trials, despite the promising results from many animal studies

Which of the following statements are true of the multiple organ dysfunction syndrome (MODS)? A. The “two-hit” model proposes that secondary MODS may be produced when even a relatively minor second insult reactivates, in a more amplified form, the systemic inflammatory response that was primed by an initial insult to the host. B. The systemic inflammatory response syndrome (SIRS), shock due to sepsis or SIRS, and MODS may be regarded as a continuum of illness severity. C. Prolonged stimulation or activation of Kupffer cells in the liver is thought to be a critical factor in the sustained, uncontrolled release of inflammatory mediators. D. The incidence of MODS in intensive care units has decreased owing to increased awareness, prevention, and treatment of the syndrome.

Description : Which of the following statements are true of the multiple organ dysfunction syndrome (MODS)? A. The two-hit model proposes that secondary MODS may be produced when even a relatively ... intensive care units has decreased owing to increased awareness, prevention, and treatment of the syndrome.

Last Answer : Answer: ABC DISCUSSION: MODS is part of a clinical continuum that begins with the systemic inflammatory response syndrome, which is the host's stress response to any major insult such ... pathogenesis of MODS, the incidence of MODS continues to increase without a significant improvement in outcome

All of the following may be useful in the treatment of cardiogenic shock except: A. Dobutamine. B. Sodium nitroprusside. C. Pneumatic antishock garment. D. Intra-aortic balloon pump.

Description : All of the following may be useful in the treatment of cardiogenic shock except: A. Dobutamine. B. Sodium nitroprusside. C. Pneumatic antishock garment. D. Intra-aortic balloon pump.

Last Answer : Answer: C DISCUSSION: Cardiogenic shock occurs when the heart fails to generate adequate cardiac output to maintain tissue perfusion. Intrinsic causes such as myocardial dysfunction secondary ... ), which causes an increase in systemic vascular resistance, is contraindicated in cardiogenic shock

Which of the following statements about delivery-dependent oxygen consumption are true? A. Below the critical oxygen delivery (D(overdot)O 2crit), one would expect to see a decrease in the lactate-pyruvate ratio. B. D(overdot)O 2crit may be increased in patients with sepsis. C. A desirable goal in the treatment of shock is to achieve delivery-independent oxygen consumption. D. The oxygen extraction ratio remains constant as long as oxygen delivery remains above D(overdot)O 2crit.

Description : Which of the following statements about delivery-dependent oxygen consumption are true? A. Below the critical oxygen delivery (D(overdot)O 2crit), one would expect to see a decrease in the ... oxygen extraction ratio remains constant as long as oxygen delivery remains above D(overdot)O 2crit.

Last Answer : Answer: BC DISCUSSION: Oxygen consumption is said to be delivery dependent below a critical point, D(overdot)O 2crit, at which anaerobic metabolism supervenes. Above this point, oxygen ... the therapeutic benefit of trying to achieve supranormal oxygen delivery has not been firmly established

Cytokines are endogenous signals that stimulate: A. Local cell proliferation within the wound. B. The central nervous system to initiate fever. C. The production of “acute-phase proteins.” D. Hypoferremia. E. Septic shock.

Description : Cytokines are endogenous signals that stimulate: A. Local cell proliferation within the wound. B. The central nervous system to initiate fever. C. The production of “acute-phase proteins.” D. Hypoferremia. E. Septic shock.

Last Answer : Answer:ABCD DISCUSSION: Although cytokines exert primarily autocrine and paracrine effects, they may also cause systemic effects

Which of the following statement(s) is/are true concerning carbon dioxide kinetics? a. The amount of carbon dioxide produced is equivalent to the amount of oxygen consumed b. Carbon dioxide levels in blood, present mostly as a bicarbonate ion, can quickly change c. Normally the amount of carbon dioxide excreted through the lung is exactly equal to the amount of carbon dioxide produced in peripheral tissues d. The amount of carbon dioxide excreted is a function of ventilation of perfused alveoli

Description : Which of the following statement(s) is/are true concerning carbon dioxide kinetics? a. The amount of carbon dioxide produced is equivalent to the amount of oxygen consumed b. Carbon dioxide levels ... tissues d. The amount of carbon dioxide excreted is a function of ventilation of perfused alveoli

Last Answer : Answer: a, c, d The total amount of carbon dioxide produced by systemic metabolism is roughly equivalent to the amount of oxygen consumed (100-120 cc/m2/min, 200 cc/min in a typical ... carbon dioxide excreted is a function of ventilation of perfused alveoli (i.e. the alveolar ventilation/min).

Which of the following statement(s) is/are true concerning oxygen delivery? a. The amount of oxygen delivered to peripheral tissues is dependent upon the oxygen content in arterial blood and cardiac output b. Oxygen content is commonly measured in arterial blood c. The normal arterial-venous difference is 4 cc O2/dL d. Normal systemic oxygen delivery for a typical adult is approximately 1000 cc/min

Description : Which of the following statement(s) is/are true concerning oxygen delivery? a. The amount of oxygen delivered to peripheral tissues is dependent upon the oxygen content in arterial blood and cardiac ... O2/dL d. Normal systemic oxygen delivery for a typical adult is approximately 1000 cc/min

Last Answer : Answer: a, c, d The amount of oxygen that is delivered to peripheral tissues is the product of the oxygen content in arterial blood times the cardiac output. Normally, oxygen content of arterial blood is ... of venous blood is 16 cc/dL. Hence, the normal arterial-venous difference is 4 cc O2/dL

If a necrotizing soft tissue infection is considered, therapy mandates: a. Empiric administration of antibiotics active against gram-positive, gram-negative, and anaerobic bacteria b. Due to usually resistant species, penicillin is not indicated c. Immediate operative intervention and aggressive resection of all involved tissues is mandatory d. The use of hyperbaric oxygen has been demonstrated to be clearly advantageous

Description : If a necrotizing soft tissue infection is considered, therapy mandates: a. Empiric administration of antibiotics active against gram-positive, gram-negative, and anaerobic bacteria b. Due to usually ... is mandatory d. The use of hyperbaric oxygen has been demonstrated to be clearly advantageous

Last Answer : Answer: a, c Identification of a necrotizing, soft tissue infection mandates immediate operative intervention with aggressive resection of all involved tissues and empiric ... remains without controlled trials demonstrating any additional benefits derived from hyperbaric oxygen therapy

The following statement(s) is/are true concerning cellular defense mechanisms. a. Macrophages function solely as antigen processing cells in the initial reaction to exposure to an antigen b. Macrophages may become activated and secrete cytokines c. Macrophages serve as phagocytic cells in the tissues but not within the bloodstream d. Polymorphonucleocytes (PMNS) are normally present in only small numbers within the tissue and enter an area of infection through diapedesis

Description : The following statement(s) is/are true concerning cellular defense mechanisms. a. Macrophages function solely as antigen processing cells in the initial reaction to exposure to an antigen b. Macrophages ... in only small numbers within the tissue and enter an area of infection through diapedesis

Last Answer : Answer: b, d A wide variety of cell types serve to provide host defense at several levels. Macrophages act as the initial antigen processing cell that serves to ... through diapedesis after chemotactic stimuli are excluded by macrophages, bacterial breakdown products, and complement activation

Scar formation is part of the normal healing process following injury. Which of the following tissues has the ability to heal without scar formation? a. Liver b. Skin c. Bone d. Muscle

Description : Scar formation is part of the normal healing process following injury. Which of the following tissues has the ability to heal without scar formation? a. Liver b. Skin c. Bone d. Muscle

Last Answer : Answer: c Every tissue in the body undergoes reparative processes after injury. Bone has the unique ability to heal without scar and liver has the potential to regenerate parenchyma, the only organ ... scar (cirrhosis) as well. With these exceptions, all other mature human tissues heal with scar

Which of the following tissues contain significant collagen useful for placing sutures to allow the prolonged tension necessary to maintain tissue approximation? a. Dermis b. Intestinal submucosa c. Muscular fascia d. Blood vessel wall

Description : Which of the following tissues contain significant collagen useful for placing sutures to allow the prolonged tension necessary to maintain tissue approximation? a. Dermis b. Intestinal submucosa c. Muscular fascia d. Blood vessel wall

Last Answer : Answer: a, b, c, d It takes at least three weeks for collagen to undergo sufficient remodeling and cross linking to attain moderate strength. Since most skin sutures are removed at one to ... , Scarpa's fascia, and blood vessel wall represent a partial list of tissues with high collagen content

Which of the following is/are true? A. Because of its thickness, the tensile strength of a healing wound on the eyelid is much less than one on the thick skin of the back. B. By 2 days, the experimental burst strength of skin is minimal since collagen has been formed in the wound but has not yet cross-linked. C. Wound strength reaches a plateau by 3 weeks. D. Wounds rarely, if ever, regain the strength of intact tissues.

Description : Which of the following is/are true? A. Because of its thickness, the tensile strength of a healing wound on the eyelid is much less than one on the thick skin of the back. B. By 2 days, ... strength reaches a plateau by 3 weeks. D. Wounds rarely, if ever, regain the strength of intact tissues.

Last Answer : Answer: BD DISCUSSION: Tensile strength measures load per cross-section area at rupture, whereas burst strength measures load required to break a wound, regardless of dimension. Therefore, skin wounds have ... a slower rate for more than a year. Wounds do not regain the strength of normal tissue

The hormonal alterations that follow operation and injury favor accelerated gluconeogenesis. This new glucose is consumed by which of the following tissues? A. Central nervous system. B. Skeletal muscle. C. Bone. D. Kidney. E. Tissue in the healing wound.

Description : The hormonal alterations that follow operation and injury favor accelerated gluconeogenesis. This new glucose is consumed by which of the following tissues? A. Central nervous system. B. Skeletal muscle. C. Bone. D. Kidney. E. Tissue in the healing wound.

Last Answer : Answer: ADE DISCUSSION: Glucose is produced in increased amounts to satisfy the fuel requirements of the healing wound. In addition, nerve tissue and the renal medulla also utilize this substrate. Skeletal muscle primarily utilizes fatty acids, and bone utilizes mineral substrate

The use of antibiotics can be based on either the clinical course of a patient without the benefit of well-defined microbiologic data (empiric therapy), or targeted at specific identified pathogens once sensitivity reports are available (directed therapy). The following statement(s) is/are true concerning these therapies. a. The issue of toxic side effects of antibiotics is only important in dealing with emperic therapy b. Single agent therapy is generally inferior to specific multi-drug therapy (aminoglycoside plus an antianaerobic agent) for the treatment of secondary bacterial peritonitis due to appendicitis, diverticulitis, penetrating gastrointestinal injury, or anastomotic leak c. With the empiric use of antibiotics, a diligent search for the septic source should be undertaken and co

Description : The use of antibiotics can be based on either the clinical course of a patient without the benefit of well-defined microbiologic data (empiric therapy), or targeted at ... which polymicrobial infection is identified, specifically-directed treatment for the predominant organism is satisfactory

Last Answer : Answer: c The use of empiric therapy without the benefit of well-defined microbiologic data is appropriate when there is sufficient clinical evidence to support the diagnosis such that it would ... components of the infection if the body site is such that these microorganisms may be present

Cytokines with clearly defined actions in acute inflammation and early tissue injury include which of the following? a. Cysteine-X-Cysteine (C-X-C) chemokines b. Tumor Necrosis Factor (TNFa) c. Transforming Growth Factor-b (TGF-b) d. Interleukin-6 (IL-6) e. Platelet Derived Growth Factor (PDGF)

Description : Cytokines with clearly defined actions in acute inflammation and early tissue injury include which of the following? a. Cysteine-X-Cysteine (C-X-C) chemokines b. Tumor Necrosis Factor (TNFa) c. Transforming Growth Factor-b (TGF-b) d. Interleukin-6 (IL-6) e. Platelet Derived Growth Factor (PDGF)

Last Answer : Answer: a, b, c, d, e Polypeptide mediators, such as TNFa and IL-1, are considered early response cytokines and are actively involved in the initiation of the ... of tissue repair. Thus, coagulation and platelet activation provide the initial foundation for subsequent cellular recruitment

The neurohormonal arm of the stress response is well defined. Less is known about the inflammatory arm mediated primarily by cytokines. Which of the following statement(s) is/are true concerning this arm of the surgical stress response? a. Cytokines primarily work locally via direct cell-to-cell communication b. Cytokines are never detectable in the systemic bloodstream c. Cytokines are produced only by immune cells attracted to the site of injury d. Cytokine release may stimulate the release of other cytokines leading to an important cascade of events

Description : The neurohormonal arm of the stress response is well defined. Less is known about the inflammatory arm mediated primarily by cytokines. Which of the following statement(s) is/are true ... Cytokine release may stimulate the release of other cytokines leading to an important cascade of events

Last Answer : Answer: a, d Cytokines, which are produced at the site of injury by endothelial cells and by diverse immune cells throughout the body, also occupy a pivotal position in the stress response ... act as hormones and spill over into the systemic circulation and become detectable in the bloodstream

Vasoconstrictors should not be used in (a) Neurogenic shock (b) Haemorrhagic shock (c) Secondary shock (d) Hypotension due to spinal anaesthesia

Description : Vasoconstrictors should not be used in (a) Neurogenic shock (b) Haemorrhagic shock (c) Secondary shock (d) Hypotension due to spinal anaesthesia

Last Answer : Ans: C

Which of the following vasoactive drugs used in treating shock results in reduced preload and afterload, reducing oxygen demand of the heart? a) Nitroprusside (Nipride) A disadvantage of nitroprusside is that it causes hypotension. b) Dopamine (Intropin) Dopamine improves contractility, increases stroke volume, and increases cardiac output. c) Epinephrine (adrenaline) Epinephrine improves contractility, increases stroke volume, and increases cardiac output. d) Methoxamine (Vasoxyl) Methoxamine increases blood pressure by vasoconstriction.

Description : Which of the following vasoactive drugs used in treating shock results in reduced preload and afterload, reducing oxygen demand of the heart? a) Nitroprusside (Nipride) A disadvantage ... increases cardiac output. d) Methoxamine (Vasoxyl) Methoxamine increases blood pressure by vasoconstriction.

Last Answer : a) Nitroprusside (Nipride) A disadvantage of nitroprusside is that it causes hypotension.

Vasoconstrictors should not be used in: A. Neurogenic shock B. Haemorrhagic shock C. Secondary shock D. Hypotension due to spinal anaesthesia

Description : Vasoconstrictors should not be used in: A. Neurogenic shock B. Haemorrhagic shock C. Secondary shock D. Hypotension due to spinal anaesthesia

Last Answer : C. Secondary shock

Loss of water from tissues is called a. hypotension b. dehydration c. edema d. none of them

Description : Loss of water from tissues is called a. hypotension b. dehydration c. edema d. none of them

Last Answer : dehydration

Which of the following terms is used to describe inability to breathe easily except in an upright position? a) Orthopnea Patients with orthopnea are placed in a high Fowler’s position to facilitate breathing. b) Dyspnea Dyspnea refers to labored breathing or shortness of breath. c) Hemoptysis Hemoptysis refers to expectoration of blood from the respiratory tract. d) Hypoxemia Hypoxemia refers to low oxygen levels in the blood.

Description : Which of the following terms is used to describe inability to breathe easily except in an upright position? a) Orthopnea Patients with orthopnea are placed in a high Fowler's position to facilitate ... blood from the respiratory tract. d) Hypoxemia Hypoxemia refers to low oxygen levels in the blood.

Last Answer : a) Orthopnea Patients with orthopnea are placed in a high Fowler’s position to facilitate breathing.

Which of the following statement(s) is/are true concerning the outcome in patients with acute renal failure? a. Mortality for ischemic acute tubular necrosis without other organ failure is approximately 6% b. Multiple organ failure complicated with acute renal failure is associated with mortality ranging from 50% to 90% c. Recovery of renal function after six weeks is unlikely d. There is no difference in survival between oliguric and nonoliguric renal failure

Description : Which of the following statement(s) is/are true concerning the outcome in patients with acute renal failure? a. Mortality for ischemic acute tubular necrosis without other organ failure is ... is unlikely d. There is no difference in survival between oliguric and nonoliguric renal failure

Last Answer : Answer: a, b, c Survival of patients with acute renal failure is a function of the successful treatment of the primary disease from which the renal failure was derived. The mortality ... is unlikely. Nonoliguric renal failure is usually limited in its extent and is almost always reversible