Shock is about as scary as it is common. There are several different types and so here at MedGuide we have written two sets of questions to quiz you on the presentation and schema of shock. Good luck.
Second Author: Daniel Mercer
Reviewed by: awaiting review
Approach to the Patient with Shock
Stem 1 of 5
A 35YOF painter fell 8m from her ladder whilst working. She landed on her left side and presents with an open fracture of the anterior middle thigh. Her observations were: HR130, BP 95/60, RR24, T37.5ºC, sats 93% on air and 7.0mmol/L glucose reading. She is visibly distressed, unable to move her limb and there is a pool of blood from the open wound.
Which of the following structures, within the thigh, is most likely impinged given the mechanism of injury?
Common peroneal nerve
Great saphenous vein
Superficial fibular nerve
Stem 2 of 5The patient opened her eyes when asked, she is upset but able to follow and contribute to a conversation. She can squeeze fingers and raise hands above the head appropriately. Calculate the patient’s Glasgow Coma Scale:
Stem 3 of 5What is the best-matched finding on physical examination?
Diminished dorsalis pedis pulse
Flushed, red skin of the lower limb
Grey-Turner and Cullen signs
Jugular venous pressure 6cm
Kussmaul breathing rate
Stem 4 of 5What is the most likely ABG finding for this patient?
Bicarbonate > 15 mmol/L
Glucose >4 mmol/L
K+ > 5.5 mmol/L
Lactate >2 mmol/L
Na+ > 140 mmol/L
Stem 5 of 5What is the next best step if a bolus of IV 0.9% saline increases the patient’s blood pressure to 105/75?
Administer cross-matched blood
Give a intravenous beta blocker
Halt further fluid administration
Put the patient under general anesthetic
Repeat saline dosage
Stem 1 of 5
A 72YOF is admitted to the ward with ?urosepsis. Her obs are RR25, HR120, BP 90/60, 92% on air, T38.5ºC. On examination the patient is found confused, and combative beyond her baseline, as reported by collateral history with her carer.
Which of the following anatomical facts predispose this demography to the diagnosis?
A 4cm urethra
Benign prostatic hyperplasia
Horseshoe kidney abnormality
Overactive detrusor muscle
Renal artery stenosis
Stem 2 of 524 hours later the patient presents with back pain, her temperature has increased to 39.5ºC with nausea and vomiting. What is the most appropriate investigation?
KUB CT scan
Renal artery angiogram
Stem 3 of 5Which of the following examination findings would most likely reinforce the diagnosis?
Further elevation of temperature
Palpable spleen in left iliac fossa
Passage of renal calculi (calcium oxalate)
Referred pain to the T5 dermatome
Tenderness of the costovertebral angle
Stem 4 of 5Which of the following organisms is more likely to be cultured in this patient?
Stem 5 of 5The patient is given a two-week course of ceftriaxone. Which of the following side-effects are more likely given this course of treatment?