AMLS Shock and Hemodynamic Instability 1 — Questions and Answers
Question 1: Which type of shock is characterized by decreased SVR (systemic vascular resistance) and increased cardiac output?
- Distributive shock (Correct answer)
- Cardiogenic shock
- Obstructive shock
- Hypovolemic shock
Correct answer: Distributive shock
Distributive shock (e.g., septic, anaphylactic, neurogenic) causes massive vasodilation, reducing SVR while initially increasing cardiac output.
Question 2: A patient presents with hypotension, JVD, and absent breath sounds on the left. What is the most likely diagnosis?
- Tension pneumothorax (Correct answer)
- Massive hemothorax
- Cardiac tamponade
- Open pneumothorax
Correct answer: Tension pneumothorax
Tension pneumothorax presents with hypotension, JVD, tracheal deviation, and absent breath sounds on the affected side.
Question 3: Which is the most sensitive early indicator of hypovolemic shock in adults?
- Tachycardia (Correct answer)
- Hypotension
- Altered mental status
- Decreased urine output
Correct answer: Tachycardia
Tachycardia is the earliest compensatory response to hypovolemia, occurring before hypotension develops.
Question 4: In anaphylactic shock, which is the first-line treatment?
- Epinephrine 0.3 mg IM in the anterolateral thigh (Correct answer)
- Diphenhydramine 50 mg IV
- Normal saline 2 L IV bolus
- Methylprednisolone 125 mg IV
Correct answer: Epinephrine 0.3 mg IM in the anterolateral thigh
Epinephrine IM is the cornerstone of anaphylaxis treatment, reversing bronchospasm and vasodilation while blocking mediator release.
Question 5: What hemodynamic profile characterizes neurogenic shock following spinal cord injury?
- Hypotension with bradycardia and warm skin (Correct answer)
- Hypotension with tachycardia and cool skin
- Hypertension with bradycardia
- Hypotension with normal heart rate
Correct answer: Hypotension with bradycardia and warm skin
Neurogenic shock causes loss of sympathetic tone leading to hypotension and paradoxical bradycardia with warm, dry, flushed skin.
Question 6: Which crystalloid is considered the preferred initial resuscitation fluid in hemorrhagic shock?
- Normal saline (0.9% NaCl) (Correct answer)
- 5% dextrose in water (D5W)
- Half-normal saline (0.45% NaCl)
- 3% hypertonic saline
Correct answer: Normal saline (0.9% NaCl)
Normal saline or lactated Ringer's (isotonic crystalloids) are standard initial resuscitation fluids in hemorrhagic shock.
AMLS Shock and Hemodynamic Instability 1
Which type of shock is characterized by decreased SVR (systemic vascular resistance) and increased cardiac output?