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Graded
Section 1: Hemodynamics, Shock & Resuscitation (Questions 1-
12)
Q1. A 28-year-old male involved in a motorcycle crash has a heart rate of 128 bpm,
blood pressure of 96/68 mmHg, and respiratory rate of 24. What is his shock index
(SI), and what does it indicate?
A. 0.75; normal perfusion
B. 1.33; probable compensated shock with significant hypovolemia
C. 1.50; severe decompensated shock
D. 0.96; borderline but within normal limits
Rationale: Shock Index = HR/SBP = 128/96 = 1.33. An SI >0.9 in adults indicates
shock, even with a "normal" SBP. At 1.33, this patient is in compensated shock with
significant volume loss. Option A miscalculates. Option C overestimates severity
(decompensated would show hypotension). Option D incorrectly states normal limits.
Correct Answer: B
Q2. A trauma patient presents with cool, clammy skin; tachycardia (HR 118);
narrowed pulse pressure (BP 110/88); and anxiety. Urine output is 25 mL/hr. Which
stage of shock is MOST likely?
A. Irreversible shock
B. Compensated (non-progressive) shock
,C. Decompensated (progressive) shock
D. Neurogenic shock
Rationale: Compensated shock is characterized by tachycardia, vasoconstriction
(cool/clammy skin, narrowed pulse pressure), maintained SBP, and decreased urine
output (25 mL/hr is low). The body is compensating but showing signs of inadequate
perfusion. Irreversible shock (Option A) shows profound hypotension and organ
failure. Decompensated shock (Option C) shows falling BP and worsening perfusion.
Neurogenic shock (Option D) presents with warm, dry skin and bradycardia.
Correct Answer: B
Q3. A patient in hemorrhagic shock has a base deficit of -8 mEq/L and lactate of 4.5
mmol/L. Which statement about these values is MOST accurate?
A. Both values indicate adequate tissue perfusion and oxygenation
B. The base deficit and elevated lactate indicate anaerobic metabolism and
inadequate tissue perfusion, guiding resuscitation needs
C. These values are normal in trauma patients and require no intervention
D. Only the lactate is relevant; base deficit is an outdated measurement
Rationale: Base deficit <-6 and lactate >4 indicate significant metabolic acidosis
from anaerobic metabolism, reflecting inadequate tissue perfusion and ongoing
shock. These values guide resuscitation volume and blood product needs. Options A,
C, and D are incorrect—both markers are clinically relevant and abnormal.
Correct Answer: B
Q4. A patient presents with hypotension (BP 78/52), tachycardia (HR 134), warm
flushed skin, and clear lung sounds. JVD is absent. Which type of shock is MOST
likely?
A. Cardiogenic shock
B. Hypovolemic shock
, C. Neurogenic shock
D. Septic shock
Rationale: Warm, flushed skin with hypotension and tachycardia in the absence of
JVD suggests neurogenic shock (loss of sympathetic tone from spinal cord injury) or
septic shock (distributive). However, in the trauma context with clear lungs and
absent JVD, neurogenic shock is most likely. Cardiogenic shock (Option A) shows
JVD and pulmonary edema. Hypovolemic shock (Option B) presents with cool,
clammy skin. Septic shock (Option D) is less likely in acute trauma without infection
source.
Correct Answer: C
Q5. A patient with suspected hemorrhagic shock has the following: HR 110, BP
118/76, RR 20, SpO2 97%, skin warm and dry. Which statement is TRUE?
A. The patient is not in shock because blood pressure is normal
B. The patient may be in early compensated shock; normal vital signs do not exclude
significant blood loss in young, healthy patients
C. The patient is in irreversible shock
D. The patient requires no further assessment or monitoring
Rationale: Young, healthy patients can maintain normal BP despite losing 15-20%
of blood volume through compensatory mechanisms (tachycardia, vasoconstriction).
A HR of 110 with trauma history warrants concern. Normal BP (Option A) does not
rule out shock. Irreversible shock (Option C) shows profound hypotension. Option D
is dangerous—continued monitoring is essential.
Correct Answer: B
Q6. Which of the following is a sign of irreversible (terminal) shock?
A. Tachycardia with maintained systolic blood pressure
B. Bradycardia, profound hypotension, fixed and dilated pupils, and unresponsiveness