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Common shock exam questions for medical finals, OSCEs and MRCP PACES

 

Question 1.

Define the term ‘circulatory shock’

  • Shock is an abnormality of the circulatory system that results in reduced organ perfusion and tissue oxygenation.

 

Question 2.

What are the six categories of shock?

  • Hypovolaemic shock
  • Cardiogenic shock
  • Obstructive shock
  • Septic shock
  • Anaphylactic shock
  • Neurogenic shock

 

Question 3.

What is the equation to express the relationship between blood pressure (BP), cardiac output (CO) & systemic vascular resistance (SVR)?

  • BP = CO x SVR

 

Question 4.

What is the equation to express the relationship between CO, HR & SV?

  • CO = HR x SV

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Question 5.

What are the three determinants of stroke volume?

  • Preload
  • Myocardial contractility
  • Afterload

 

Question 6.

What is the Frank-Starling mechanism?

  • Increased myocardial muscle fibre length initially leads to an increased SV but above a certain point, the fibres become overstretched and further filling results in a decreased SV, as is the case in cardiac failure

 

Question 7.

Why does shock cause a lactic acidosis?

  • Inadequate organ perfusion and tissue oxygenation results in cells switching from aerobic to anaerobic metabolism
  • This generates a lactic acidosis that disrupts the cellular environment and causes myocardial depression

 

Question 8.

How do you classify haemorrhagic shock into type 1-4 (what are the parameters)?

  • Volume of blood loss (ml)
  • Percentage blood loss (%)
  • Heart rate (beats/min)
  • Blood pressure
  • Pulse pressure
  • Respiratory rate (breaths/min)
  • Urine output (ml/hour)
  • Mental state

 

Question 9.

What are the four main strategies for the ward-based management of shock?

  • Give oxygen 15 L/min via reservoir mask
    • Titrate to sats 94-98%
  • IV fluid resuscitation
  • Monitor lactate and urine output
  • Identify and treat the cause

Question 10.

What are three further strategies for HDU/ICU-based management of shock?

  • Central line insertion with central venous pressure (CVP) and central venous oxygen saturation (ScvO2) monitoring
  • Arterial line insertion and invasive arterial BP monitoring
  • Vasopressor and/or inotrope infusion