What does circulatory shock mean?

A) Localized excess perfusion

B) Generalized inadequate tissue blood flow

C) Isolated hypertension crisis

D) Venous obstruction only

B. Generalized inadequate tissue blood flow

Tissue damage in circulatory shock occurs mainly because too little what reaches cells?

A) Oxygen and nutrients

B) Carbon dioxide and wastes

C) Lymph and proteins

D) Hormones and enzymes

A. Oxygen and nutrients

Two major categories can severely reduce cardiac output. One is cardiac abnormalities that:

A) Increase afterload only

B) Decrease pumping ability

C) Improve venous tone

D) Raise arterial oxygen

B. Decrease pumping ability

The other major category lowering cardiac output is factors that decrease:

A) Coronary pressure

B) Arterial compliance

C) Venous return

D) Pulmonary diffusion

C. Venous return

Why does reduced venous return lower cardiac output?

A) The heart cannot pump absent inflow

B) Arteries constrict too rapidly

C) Ventricles stop depolarizing

D) Capillaries become impermeable

A. The heart cannot pump absent inflow

The most common cause of decreased venous return is reduced:

A) Blood volume

B) Heart rate

C) Blood viscosity

D) Hematocrit

A. Blood volume

Venous return can fall because of decreased vascular:

A) Resistance

B) Elasticity

C) Tone

D) Frequency

C. Tone

Loss of venous tone is especially important in which vascular compartment?

A) Pulmonary capillaries

B) Venous reservoirs

C) Coronary arteries

D) Cerebral arterioles

B. Venous reservoirs

Another major cause of reduced venous return is:

A) Excess lymph flow

B) Valve calcification

C) Obstruction to flow

D) Elevated plasma proteins

C. Obstruction to flow

Obstruction causing shock is especially dangerous when it lies in the pathway of venous return to the:

A) Kidneys

B) Brain

C) Heart

D) Lungs

C. Heart

A patient may be in shock despite normal or increased cardiac output if metabolic rate is:

A) Excessively low

B) Excessively high

C) Completely absent

D) Equal to resting

B. Excessively high

Normal or high cardiac output can still be inadequate in shock if tissue perfusion patterns are:

A) Abnormally distributed

B) Fully autoregulated

C) Excessively venous

D) Entirely coronary

A. Abnormally distributed

In distributive perfusion failure, much of the cardiac output passes through vessels that do not:

A) Return blood to veins

B) Remove clot burden

C) Supply local tissue nutrition

D) Contain smooth muscle

C. Supply local tissue nutrition

All cases of shock lead to inadequate delivery of what to critical tissues?

A) Nutrients

B) Catecholamines

C) Bicarbonate

D) Platelets

A. Nutrients

Shock also impairs removal of cellular:

A) Hormones

B) Waste products

C) Growth factors

D) Clotting factors

B. Waste products

A patient may be in severe shock and still have nearly normal arterial pressure because of powerful:

A) Renal hormones

B) Nervous reflexes

C) Plasma proteins

D) Coronary shunts

B. Nervous reflexes

In most types of shock, especially severe blood loss, arterial pressure usually:

A) Rises as output falls

B) Falls with cardiac output

C) Stays fully unchanged

D) Exceeds baseline markedly

B. Falls with cardiac output

During hemorrhagic shock, arterial pressure usually decreases:

A) More than cardiac output

B) Less than cardiac output

C) Before blood loss begins

D) Only after therapy

B. Less than cardiac output

Once shock reaches a critical severity, the shock itself tends to produce:

A) Automatic recovery

B) More shock

C) Isolated hypertension

D) Pure bradycardia

B. More shock

The earliest major stage of shock is the:

A) Irreversible stage

B) Progressive stage

C) Nonprogressive stage

D) Terminal fibrillation

C. Nonprogressive stage

The nonprogressive stage of shock is also called the:

A) Compensated stage

B) Decompensated stage

C) Obstructive stage

D) Cardiogenic stage

A. Compensated stage

In compensated shock, normal compensatory mechanisms can eventually produce:

A) Renal failure

B) Full recovery

C) Pulmonary edema

D) Irreversible ischemia

B. Full recovery

The second major stage of shock is the:

A) Compensated stage

B) Progressive stage

C) Reversible stage

D) Hypertrophic stage

B. Progressive stage

Without what does progressive shock steadily worsen toward death?

A) Sleep

B) Therapy

C) Nutrition

D) Ventilation

B. Therapy

The final major stage of shock is the:

A) Hyperdynamic stage

B) Irreversible stage

C) Prodromal stage

D) Vasodilated stage

B. Irreversible stage

Hypovolemia means diminished:

A) Vascular resistance

B) Blood volume

C) Plasma sodium

D) Cardiac contractility

B. Blood volume

The most common cause of hypovolemic shock is:

A) Burns

B) Diarrhea

C) Hemorrhage

D) Sepsis

C. Hemorrhage

Hemorrhage lowers venous return primarily by decreasing the circulatory:

A) Filling mean systemic filling pressure

B) Arterial oxygen content

C) Ventricular compliance

D) Coronary resistance

A) Filling mean systemic filling pressure

After hemorrhage, both cardiac output and arterial pressure generally:

A) Increase together

B) Decrease together

C) Remain unchanged

D) Diverge opposite ways

B. Decrease together

The fall in arterial pressure after hemorrhage, along with reduced thoracic vascular pressures, triggers strong:

A) Parasympathetic reflexes

B) Sympathetic reflexes

C) Metabolic reflexes

D) Cushing reflexes

B. Sympathetic reflexes

Which pairing is correct for shock with normal cardiac output?

A) High output plus perfect nutrition

B) High metabolism or maldistributed perfusion

C) Low metabolism and high preload

D) Bradycardia and hypertension

B. High metabolism or maldistributed perfusion

Which factor below is a venous-return problem rather than a primary pump problem?

A) Myocardial infarction

B) Cardiac tamponade

C) Diminished blood volume

D) Ventricular fibrillation

C. Diminished blood volume

After hemorrhage, sympathetic reflexes increase total peripheral resistance primarily by causing systemic arterioles to:

A) Dilate widely

B) Constrict

C) Collapse completely

D) Lose tone

B. Constrict

The major hemodynamic result of widespread arteriolar constriction during hemorrhage is:

A) Decreased venous return

B) Increased total peripheral resistance

C) Decreased arterial pressure

D) Increased capillary filtration

B. Increased total peripheral resistance

A second major sympathetic response to blood loss is constriction of the:

A) Coronary arteries only

B) Pulmonary capillaries

C) Veins and venous reservoirs

D) Cerebral arterioles

C. Veins and venous reservoirs

Why is venoconstriction especially important during hemorrhage?

A) It lowers arterial stiffness

B) It preserves venous return

C) It abolishes afterload

D) It reduces heart rate

B. It preserves venous return

The third major effect of sympathetic reflex activation in hemorrhage is a marked increase in:

A) Lymphatic flow

B) Heart activity

C) Coronary sinus pressure

D) Atrial compliance

B. Heart activity

Sympathetic reflexes during hemorrhage are geared more toward maintaining:

A) Cardiac output

B) Arterial pressure

C) Plasma osmolarity

D) Coronary flow

B. Arterial pressure

Which compensatory change most directly helps keep cardiac output from falling too much after blood loss?

A) Arteriolar constriction

B) Venous constriction

C) Capillary filtration

D) Bradycardia

B. Venous constriction

Recovery from moderate shock depends largely on circulatory negative feedback mechanisms that attempt to restore:

A) Coronary flow and preload

B) Heart rate and renin

C) Cardiac output and arterial pressure

D) Capillary pressure and hematocrit

C. Cardiac output and arterial pressure

Which reflex is an early negative feedback mechanism that strongly stimulates the sympathetic circulation after hemorrhage?

A) Bainbridge reflex

B) Baroreceptor reflex

C) Cushing reflex

D) Bezold-Jarisch reflex

B. Baroreceptor reflex

The baroreceptor reflex helps recovery from shock mainly by producing:

A) Parasympathetic withdrawal

B) Powerful sympathetic stimulation

C) Coronary venodilation

D) Decreased vascular tone

B. Powerful sympathetic stimulation

Compared with the baroreceptor reflex, the CNS ischemic response produces:

A) Less sympathetic output

B) No vascular effect

C) Even more powerful sympathetic stimulation

D) Pure vagal discharge

C. Even more powerful sympathetic stimulation

The CNS ischemic response is usually not activated significantly until:

A) Cardiac output doubles

B) Arterial pressure is very low

C) Venous tone is normal

D) Renin secretion ceases

B. Arterial pressure is very low

Reverse stress-relaxation helps recover from blood loss by causing vessels to:

A) Dilate around low volume

B) Contract around low volume

C) Lose smooth muscle tone

D) Open capillary beds widely

B. Contract around low volume

The functional purpose of reverse stress-relaxation in shock is to allow the available blood volume to:

A) More adequately fill the circulation

B) Preferentially enter the lungs

C) Bypass venous reservoirs

D) Increase tissue edema

A. More adequately fill the circulation

Reverse stress-relaxation just means blood vessels constrict/tighten around the smaller blood volume.

A renal compensatory response in hemorrhagic shock is increased secretion of:

A) Nitric Oxide

B) ANP

C) Renin

D) Erythropoietin

C. Renin

Increased renin secretion during shock promotes formation of:

A) Bradykinin

B) Angiotensin II

C) Nitric oxide

D) Endothelin

B. Angiotensin II

Angiotensin II helps compensate for shock primarily by:

A) Dilating peripheral arterioles

B) Constricting peripheral arterioles

C) Lowering venous tone

D) Increasing capillary leak

B. Constricting peripheral arterioles

A second major benefit of angiotensin II in shock is that it promotes:

A) Increased renal water and salt loss

B) Decreased renal water and salt output

C) Immediate plasma protein synthesis

D) Pulmonary vasodilation

B. Decreased renal water and salt output

Compensation prioritizes:

A) Cardiac output over pressure

B) Pressure over cardiac output

C) Coronary flow over pressure

D) Oxygen extraction over tone

B. Pressure over cardiac output

Which statement best explains why arterial pressure can be preserved despite substantial blood loss?

A) Sympathetic reflexes strongly defend pressure

B) Coronary arteries autoregulate fully

C) Blood viscosity rises immediately

D) The kidneys replace volume instantly

A. Sympathetic reflexes strongly defend pressure

If venous constriction failed during hemorrhage, the most immediate consequence would be a larger fall in:

A) Venous return

B) Total peripheral resistance

C) Pulmonary diffusion

D) Coronary oxygen extraction

A. Venous return

Which of the following is not one of the three immediate major effects of sympathetic reflexes in hemorrhage?

A) Arteriolar constriction

B) Venous constriction

C) Marked tachycardia

D) Capillary protein synthesis

D. Capillary protein synthesis

Which posterior pituitary hormone helps compensate for shock?

A) Oxytocin

B) Vasopressin

C) Aldosterone

D) Renin

B. Vasopressin

Vasopressin helps restore circulation in shock mainly by:

A) Dilating arteries only

B) Constricting veins only

C) Constricting arterioles and veins

D) Lowering renal water reabsorption

C. Constricting arterioles and veins

A major renal effect of vasopressin in shock is:

A) Increased water retention

B) Increased sodium wasting

C) Increased bicarbonate loss

D) Decreased thirst

A. Increased water retention

In shock, increased secretion of epinephrine and norepinephrine comes primarily from the:

A) Adrenal cortex

B) Adrenal medullae

C) Posterior pituitary

D) Juxtaglomerular cells

B. Adrenal medullae

Adrenal medullary catecholamines help compensate for shock by causing peripheral vessels to:

A) Dilate and pool blood

B) Constrict and support pressure

C) Collapse and clot

D) Leak and swell

B. Constrict and support pressure

A second major compensatory effect of adrenal medullary catecholamine release in shock is increased:

A) Heart rate

B) Capillary permeability

C) Plasma potassium

D) Coronary thrombosis

A. Heart rate

Which is a mechanism that helps restore blood volume during shock?

A) Decreased thirst

B) Intestinal fluid absorption

C) Increased urine output

D) Reduced salt appetite

B. Intestinal fluid absorption

Shock compensation includes movement of fluid into the blood from the:

A) Alveoli

B) Interstitial spaces

C) Lymph nodes

D) Pericardium

B. Interstitial spaces

The kidneys help restore blood volume in shock mainly by:

A) Excreting more salt

B) Conserving water and salt

C) Producing more glucose

D) Lowering renin

B. Conserving water and salt

Behavioral compensation for shock includes increased:

A) Thirst and salt appetite

B) Hunger for sugar

C) Need for sleep

D) Sweating and urination

A. Thirst and salt appetite

Which of the following is not part of blood-volume restoration in shock?

A) Intestinal absorption

B) Fluid shift into capillaries

C) Renal conservation

D) Coronary vasospasm

D. Coronary vasospasm

When arterial pressure falls sufficiently low in shock, nutrition of the myocardium becomes inadequate because:

A) Cerebral flow rises too high

B) Coronary blood flow falls

C) Pulmonary veins collapse first

D) Aortic oxygen content doubles

B. Coronary blood flow falls

A major feature of progressive shock, regardless of cause, is progressive:

A) Cardiac improvement

B) Cardiac deterioration

C) Renal hypertrophy

D) Arterial dilation

B. Cardiac deterioration

After about 10 to 15 minutes of markedly diminished brain blood flow, the vasomotor center becomes:

A) Hyperactive

B) Depressed

C) Hypertrophied

D) Insensitive to CO2

B. Depressed

Once the vasomotor center is severely depressed in shock, there is:

A) More sympathetic discharge

B) No further sympathetic evidence

C) Selective vagal arrest

D) Immediate recovery

B. No further sympathetic evidence

As progressive shock continues, many very small vessels develop:

A) Aneurysms

B) Blockage

C) Vasodilation

D) Elastic recoil

B. Blockage

Local tissue metabolism during low-flow shock causes accumulation of which two major acids?

A) Sulfuric and phosphoric

B) Carbonic and lactic

C) Uric and hydrochloric

D) Acetic and pyruvic

B. Carbonic and lactic

The rising local acidity in shock is mainly due to ongoing tissue metabolism despite:

A) High blood flow

B) Low blood flow

C) Hyperoxia

D) High pH

B. Low blood flow

Acid buildup and ischemic breakdown products promote local blood:

A) Hemolysis

B) Agglutination

C) Oxygenation

D) Dilution

B. Agglutination

Local blood agglutination in shock leads directly to formation of:

A) Large emboli

B) Minute clots

C) Coronary aneurysms

D) Lymphatic plugs

B. Minute clots

The term for blood that becomes difficult to move through the microvasculature because cells stick together is:

A) Foamy blood

B) Sludged blood

C) Deoxygenated blood

D) Viscous plasma

B. Sludged blood

After many hours of capillary hypoxia, capillary permeability typically:

A) Decreases

B) Increases

C) Normalizes

D) Oscillates unpredictably

B. Increases

In late shock, increased capillary permeability causes fluid to:

A) Enter arteries

B) Transude into tissues

C) Remain intravascular

D) Enter lymph only

B. Transude into tissues

Shock may trigger release of toxic mediators such as histamine, serotonin, and:

A) Tissue enzymes

B) Platelet factor IV

C) Immunoglobulins

D) Bile acids

A. Tissue enzymes

A toxic factor released from dead gram-negative bacteria in the intestines is:

A) Exotoxin

B) Endotoxin

C) Enteropeptidase

D) Hemolysin

B. Endotoxin

Circulating endotoxin in shock causes cellular metabolism to:

A) Decrease appropriately

B) Increase despite poor nutrition

C) Stop completely

D) Shift only to fat oxidation

B. Increase despite poor nutrition

A particularly important effect of endotoxin in shock is:

A) Coronary dilation

B) Cardiac depression

C) Increased renal filtration

D) Decreased lactate production

B. Cardiac depression

As shock becomes severe, generalized cellular deterioration is especially prominent in the:

A) Liver

B) Spleen

C) Thyroid

D) Pancreas

A. Liver

In severe shock, which ions accumulate inside cells?

A) Potassium and bicarbonate

B) Sodium and chloride

C) Calcium and magnesium

D) Hydrogen and phosphate

B. Sodium and chloride

In severe shock, cells do not get enough oxygen.

↓ oxygen → ↓ ATP production
↓ ATP → Na⁺/K⁺ pump fails
→ sodium builds up inside cells
→ chloride follows sodium
→ water enters cells
→ cell swelling/injury

During cellular deterioration in shock, which ion is lost from cells?

A) Sodium

B) Chloride

C) Potassium

D) Calcium

C. Potassium

The ionic shifts of shock cause cells to:

A) Shrink

B) Swell

C) Divide

D) Calcify

B. Swell

In shock, which organelle’s activity becomes severely depressed in liver cells and many other tissues? This organelle doesn't rupture, however:

A) Ribosomal

B) Golgi

C) Lysosomal

D) Mitochondrial

D. Mitochondrial

Widespread intracellular deterioration in shock is worsened when which organelles rupture?

A) Peroxisomes

B) Lysosomes

C) Nuclei

D) Centrioles

B. Lysosomes

When lysosomes break open in shock, they release intracellular:

A) Hydrolases

B) Catecholamines

C) Lipoproteins

D) Hemoglobin

A. Hydrolases

Which process best explains progression of shock despite initial compensation?

A) Positive feedback worsening perfusion

B) Complete restoration of preload

C) Permanent baroreceptor activation

D) Selective cerebral vasodilation

A. Positive feedback worsening perfusion

Which event most directly links severe hypotension to later myocardial failure in progressive shock?

A) Increased coronary flow

B) Decreased coronary nutrition

C) Renal sodium excretion

D) Increased AV nodal firing

B. Decreased coronary nutrition

Shock lowers BP → low BP starves the heart → weak heart pumps less → shock gets worse.

In the last stages of shock, cellular metabolism of which nutrient becomes greatly depressed?

A) Lactate

B) Glucose

C) Ketones

D) Creatine

B. Glucose

Around which end of capillaries does the greatest nutritive deficiency occur in shock?

A) Arterial end

B) Venous end

C) Midcapillary zone

D) Lymphatic end

B. Venous end

Progressive pulmonary deterioration after shock causing respiratory distress days later is called:

A) COPD

B) Shock lung syndrome

C) Blue bloater lung

D) Flash edema

B. Shock lung syndrome

In irreversible shock, essentially all cellular stores of what high-energy compound are depleted?

A) Creatine phosphate

B) Glycogen

C) NADH

D) Lactate

A. Creatine phosphate

In irreversible shock, ATP is progressively degraded to ADP, AMP, and eventually:

A) Inosine

B) Creatine

C) Adenosine

D) Pyruvate

C. Adenosine

Why are depleted cellular high-energy phosphate stores hard to restore in irreversible shock?

A) New adenosine is slow to make

B) Mitochondria overproduce acids

C) Cells lose all glucose

D) Kidneys waste all phosphate

A) New adenosine is slow to make

Intestinal obstruction can cause severe shock mainly by reducing:

A) Cardiac contractility

B) Plasma volume

C) Coronary flow

D) Arterial compliance

B. Plasma volume

Intestinal obstruction triggers plasma volume loss through the leakage of fluid into the gut (third-spacing), resulting in hypovolemic shock.

In intestinal obstruction, bowel distention partly blocks venous flow in the intestinal:

A) Lumen

B) Walls

C) Arteries

D) Lymphatics

B. Walls

Venous blockage in intestinal obstruction increases intestinal capillary:

A) Oncotic pressure

B) Pressure

C) Osmolality

D) Filtration fraction

B. Pressure

Elevated intestinal capillary pressure causes fluid to leak into the intestinal walls and the:

A) Pleural cavity

B) Intestinal lumen

C) Pericardium

D) Portal vein

B. Intestinal lumen

Because leaked intestinal fluid is protein-rich, intestinal obstruction reduces total plasma:

A) Sodium

B) Bicarbonate

C) Protein

D) Chloride

C. Protein

The protein-rich fluid loss of intestinal obstruction ultimately reduces plasma:

A) Osmolarity

B) Volume

C) Potassium

D) Glucose

B. Volume

Severe burns can precipitate hypovolemic shock chiefly by causing loss of:

A) Whole blood

B) Plasma through skin

C) Lymph through nodes

D) CSF through wounds

B. Plasma through skin

Compared with hemorrhagic shock, hypovolemic shock is especially characterized by increased blood:

A) Oxygen content

B) Viscosity

C) Sodium

D) pH

B. Viscosity

The increased blood viscosity of hypovolemic shock results mainly from increased red cell:

A) Production

B) Destruction

C) Concentration

D) Deformability

C. Concentration

Shock from dehydration can result from excessive:

A) Sweating

B) Hemolysis

C) Insulin

D) Salivation

A. Sweating

Shock from dehydration can result from severe diarrhea or:

A) Constipation

B) Vomiting

C) Aspiration

D) Flatulence

B. Vomiting

Shock from dehydration can also result from excess fluid loss by the:

A) Skin

B) Kidneys

C) Lungs

D) Spleen

B. Kidneys

Inadequate intake of fluid and what else can lead to dehydration shock?

A) Proteins

B) Electrolytes

C) Lipids

D) Vitamins

B. Electrolytes

Destruction of the adrenal cortices predisposes to dehydration shock because of loss of:

A) Cortisol

B) Aldosterone

C) Epinephrine

D) ADH

B. Aldosterone

Sudden loss of vasomotor tone causing massive venous dilation is called:

A) Cardiogenic shock

B) Neurogenic shock

C) Septic shock

D) Obstructive shock

B. Neurogenic shock

Which can cause neurogenic shock by loss of vasomotor tone?

A) Deep general anesthesia

B) Hyperthyroidism

C) Mitral stenosis

D) Polycythemia

A. Deep general anesthesia

Which can cause neurogenic shock by interrupting sympathetic tone?

A) Portal hypertension

B) Spinal anesthesia

C) Asthma

D) Renal failure

B. Spinal anesthesia

Which central cause may precipitate neurogenic shock?

A) Brain damage

B) Liver rupture

C) Pleural fibrosis

D) GI bleeding

A. Brain damage

In severe allergic reactions, which mediator can sharply reduce venous return and cause rapid shock?

A) Bradykinin

B) Histamine

C) Dopamine

D) Acetylcholine

B. Histamine

Bacterial infection spread through the bloodstream to many tissues causing extensive damage is called:

A) Neurogenic shock

B) Septic shock

C) Cardiogenic shock

D) Anaphylactic shock

B. Septic shock

Most cases of septic shock are caused first by Gram-___ organisms.

A) Negative

B) Positive

C) Variable

D) Neutral

B. Positive

After Gram-positive bacteria, septic shock is commonly caused by endotoxin-producing Gram-___ bacteria.

A) Positive

B) Negative

C) Variable

D) Acid-fast

B. Negative

A classic cause of septic shock is peritonitis from spread of infection from the uterus and:

A) Ovaries

B) Fallopian tubes

C) Cervix

D) Vagina

B. Fallopian tubes

Peritonitis leading to septic shock may follow rupture of the:

A) Gastrointestinal system

B) Pulmonary tree

C) Coronary sinus

D) Biliary duct

A. Gastrointestinal system

Generalized septic shock may arise from spread of which type of peripheral infection?

A) Skin infection

B) Joint infection

C) Retinal infection

D) Thyroid infection

A. Skin infection

A common skin-source organism leading to septic shock is:

A) Candida or staph

B) Strep or staph

C) E. histolytica

D) Mycoplasma

B. Strep or staph

Generalized gangrenous infection causing septic shock is classically due to:

A) Tetanus bacilli

B) Gas gangrene bacilli

C) Tubercle bacilli

D) Diphtheria bacilli

B. Gas gangrene bacilli

Gas gangrene infection spreads first through peripheral tissues and then to internal organs, especially the:

A) Pancreas

B) Liver

C) Brain

D) Spleen

B. Liver

Another important source of septic shock is infection entering the blood from the:

A) kidney or urinary tract

B) liver or upper airway

C) kidney or bone marrow

D) liver or small bowel

A) kidney or urinary tract

Infection spreading from the urinary tract and causing septic shock is often due to:

A) Pneumococcus

B) Colon bacilli

C) Staphylococci

D) Clostridia

B. Colon bacilli

Which mechanism best explains hypovolemia in intestinal obstruction?

A) Fluid shifts into bowel

B) Myocardial depression

C) Arterial rupture

D) Renal vasodilation

A. Fluid shifts into bowel

The best therapy for shock caused by hemorrhage is usually:

A) Plasma only

B) Electrolyte solution

C) Whole blood transfusion

D) Dextran alone

C. Whole blood transfusion

If shock is caused primarily by plasma loss, the best therapy is administration of:

A) Whole blood

B) Plasma

C) Heparin

D) Streptokinase

B. Plasma

When dehydration is the cause of shock, the most appropriate treatment is an:

A) Appropriate electrolyte solution

B) Immediate plasma exchange

C) Whole blood transfusion

D) Pure glucose infusion

A. Appropriate electrolyte solution

If cardiac output remains adequate, the body can usually tolerate a hematocrit decrease to about:

A) Three fourths normal

B) Half normal

C) One fourth normal

D) One tenth normal

B. Half normal

A plasma substitute must contain molecules large enough to exert:

A) Hydrostatic pressure

B) Colloid osmotic pressure

C) Pulse pressure

D) Filtration pressure

B. Colloid osmotic pressure

Why are dextrans useful as plasma substitutes?

A) They increase hematocrit and provide colloid osmotic effect

B) They remain intravascular and provide colloid osmotic effect

C) They stimulate erythropoiesis and provide colloid osmotic effect

D) They directly constrict arterioles and provide colloid osmotic effect

B. They remain intravascular and provide colloid osmotic effect

Dextrans can replace plasma proteins mainly because they do not pass through:

A) Glomerular slits

B) AV valves

C) Capillary pores

D) Coronary sinuses

C. Capillary pores

Sympathomimetic drugs such as epinephrine and norepinephrine are most useful in which two shock states?

A) Hemorrhagic and cardiogenic

B) Septic and hypovolemic

C) Neurogenic and anaphylactic

D) Obstructive and cardiogenic

C. Neurogenic and anaphylactic

You should put patients in a head-down position beacuse it improves shock by increasing:

A) Coronary resistance

B) Venous return

C) Capillary leakage

D) Pulmonary pressure

B. Venous return

The first essential maneuver in treatment of many types of shock is the:

A) Upright position

B) Head-down position

C) Left lateral position

D) Reverse Trendelenburg

B. Head-down position

Glucocorticoids are often given in severe shock because they may increase late-stage cardiac:

A) Compliance

B) Strength

C) Automaticity

D) Oxygen extraction

B. Strength

A second reason glucocorticoids are used in severe shock is that they stabilize:

A) Mitochondria

B) Ribosomes

C) Lysosomes

D) Nuclei

C. Lysosomes

By stabilizing lysosomes, glucocorticoids help prevent further cellular:

A) Deterioration

B) Hypertrophy

C) Vasodilation

D) Oxygenation

A. Deterioration

A third proposed benefit of glucocorticoids in severe shock is support of cellular metabolism of:

A) Ketones

B) Glucose

C) Lactate

D) Creatine

B. Glucose

Administration of what anticoagulant before cardiac arrest has been shown to increase brain survivability?

A) Warfarin

B) Heparin

C) Aspirin

D) Clopidogrel

B. Heparin

Which fibrinolytic agent, if given before cardiac arrest, may also prolong brain survivability?

A) Alteplase

B) Urokinase

C) Tenecteplase

D) Streptokinase

D. Streptokinase

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Why is an adequate cardiac output important when hematocrit falls?

A) It compensates for lower oxygen carrying capacity

B) It prevents capillary protein loss

C) It raises colloid osmotic pressure

D) It eliminates need for plasma

A. It compensates for lower oxygen carrying capacity

Which statement about early septic shock is most accurate?

A) Collapse is always immediate

B) Infection signs may predominate first

C) Hemorrhage is the cause

D) Bradycardia is universal

B. Infection signs may predominate first

Which statement about plasma substitutes is most accurate?

A) They work best when freely filtered

B) They must supply colloid osmotic force

C) They should lower oncotic pressure

D) They replace leukocytes

B. They must supply colloid osmotic force

Which agent class is especially useful for anaphylactic shock?

A) Sympathomimetics

B) Plasma substitutes

C) Anticoagulants

D) Pure crystalloids only

A. Sympathomimetics

Which outcome is most feared after prolonged total circulatory arrest?

A) Aortic stenosis

B) Permanent brain damage

C) Mitral regurgitation

D) Polycythemia

B. Permanent brain damage