ATLS Neurogenic Shock Recognition
Practice Questions And Correct Answers
(Verified Answers) Plus Rationales 2026
Q&A Instant Download Pdf
1. A 24-year-old patient sustains a cervical spinal cord injury after a diving
accident. He is hypotensive, bradycardic, and has warm, dry skin. Which
diagnosis best explains these findings?
A. Hemorrhagic shock
B. Obstructive shock
C. Neurogenic shock
D. Cardiogenic shock
Answer: Neurogenic shock
Rationale: Neurogenic shock results from loss of sympathetic vascular tone after
significant spinal cord injury, producing hypotension, bradycardia, and
peripheral vasodilation with warm skin.
2. Which pathophysiologic mechanism is primarily responsible for neurogenic
shock?
A. Acute myocardial infarction
B. Loss of sympathetic nervous system tone
C. Massive blood loss
D. Increased pulmonary vascular resistance
,Answer: Loss of sympathetic nervous system tone
Rationale: Neurogenic shock occurs when sympathetic outflow is disrupted,
particularly after cervical or high thoracic spinal cord injury, causing vasodilation
and impaired cardiac chronotropic responses.
3. Neurogenic shock is most commonly associated with spinal cord injuries
occurring at which level?
A. Sacral spinal cord
B. Lumbar spinal cord
C. Low thoracic spinal cord
D. Cervical or high thoracic spinal cord
Answer: Cervical or high thoracic spinal cord
Rationale: Injuries above the thoracolumbar sympathetic outflow, especially
cervical and upper thoracic injuries, can interrupt sympathetic control
sufficiently to produce neurogenic shock.
4. Which combination is most characteristic of neurogenic shock?
A. Hypertension, tachycardia, and cool skin
B. Hypotension, tachycardia, and diaphoresis
C. Hypotension, bradycardia, and warm skin
D. Hypotension, narrow pulse pressure, and cool skin
Answer: Hypotension, bradycardia, and warm skin
Rationale: Loss of sympathetic tone causes arterial and venous dilation,
resulting in hypotension, while interruption of sympathetic cardiac stimulation
can cause bradycardia.
5. A trauma patient with a cervical spinal cord injury has a blood pressure of
78/44 mm Hg and a heart rate of 48/min. There is no obvious external
bleeding. Which diagnosis should be strongly considered?
A. Hypovolemic shock
B. Neurogenic shock
,C. Septic shock
D. Tension pneumothorax
Answer: Neurogenic shock
Rationale: Severe hypotension accompanied by inappropriate bradycardia after
cervical spinal cord injury strongly suggests neurogenic shock, although
hemorrhage and other causes must still be excluded.
6. What happens to systemic vascular resistance during neurogenic shock?
A. It increases substantially
B. It remains unchanged
C. It fluctuates because of hypovolemia
D. It decreases because of vasodilation
Answer: It decreases because of vasodilation
Rationale: Loss of sympathetic vasoconstrictor activity causes arterial and
venous dilation, reducing systemic vascular resistance and venous return.
7. Which physical finding most strongly supports neurogenic shock rather than
hemorrhagic shock?
A. Altered mental status
B. Hypotension
C. Warm, dry extremities
D. Tachypnea
Answer: Warm, dry extremities
Rationale: Peripheral vasodilation in neurogenic shock produces warm, often dry
skin, whereas hemorrhagic shock usually produces cool, pale, clammy skin
because of sympathetic vasoconstriction.
8. Why does bradycardia occur in neurogenic shock?
A. Increased vagal inhibition from hypoxia
B. Direct myocardial injury
C. Reduced circulating catecholamines from hemorrhage
, D. Unopposed parasympathetic activity after loss of sympathetic cardiac
stimulation
Answer: Unopposed parasympathetic activity after loss of sympathetic cardiac
stimulation
Rationale: High spinal cord injury can interrupt sympathetic pathways to the
heart while parasympathetic influence remains intact, resulting in relative or
marked bradycardia.
9. A patient with suspected neurogenic shock is hypotensive and bradycardic.
What should be the initial priority?
A. Assume blood loss is absent
B. Immediately administer antibiotics
C. Continue systematic trauma assessment while supporting airway, breathing,
and circulation
D. Remove spinal precautions
Answer: Continue systematic trauma assessment while supporting airway,
breathing, and circulation
Rationale: Neurogenic shock is a diagnosis of exclusion in trauma. Life-
threatening hemorrhage and other causes of shock must be actively assessed
while ABC management and spinal protection continue.
10.Which finding would make hemorrhagic shock more likely than isolated
neurogenic shock?
A. Warm skin
B. Bradycardia
C. High spinal cord injury
D. Cool, clammy skin with ongoing blood loss
Answer: Cool, clammy skin with ongoing blood loss
Practice Questions And Correct Answers
(Verified Answers) Plus Rationales 2026
Q&A Instant Download Pdf
1. A 24-year-old patient sustains a cervical spinal cord injury after a diving
accident. He is hypotensive, bradycardic, and has warm, dry skin. Which
diagnosis best explains these findings?
A. Hemorrhagic shock
B. Obstructive shock
C. Neurogenic shock
D. Cardiogenic shock
Answer: Neurogenic shock
Rationale: Neurogenic shock results from loss of sympathetic vascular tone after
significant spinal cord injury, producing hypotension, bradycardia, and
peripheral vasodilation with warm skin.
2. Which pathophysiologic mechanism is primarily responsible for neurogenic
shock?
A. Acute myocardial infarction
B. Loss of sympathetic nervous system tone
C. Massive blood loss
D. Increased pulmonary vascular resistance
,Answer: Loss of sympathetic nervous system tone
Rationale: Neurogenic shock occurs when sympathetic outflow is disrupted,
particularly after cervical or high thoracic spinal cord injury, causing vasodilation
and impaired cardiac chronotropic responses.
3. Neurogenic shock is most commonly associated with spinal cord injuries
occurring at which level?
A. Sacral spinal cord
B. Lumbar spinal cord
C. Low thoracic spinal cord
D. Cervical or high thoracic spinal cord
Answer: Cervical or high thoracic spinal cord
Rationale: Injuries above the thoracolumbar sympathetic outflow, especially
cervical and upper thoracic injuries, can interrupt sympathetic control
sufficiently to produce neurogenic shock.
4. Which combination is most characteristic of neurogenic shock?
A. Hypertension, tachycardia, and cool skin
B. Hypotension, tachycardia, and diaphoresis
C. Hypotension, bradycardia, and warm skin
D. Hypotension, narrow pulse pressure, and cool skin
Answer: Hypotension, bradycardia, and warm skin
Rationale: Loss of sympathetic tone causes arterial and venous dilation,
resulting in hypotension, while interruption of sympathetic cardiac stimulation
can cause bradycardia.
5. A trauma patient with a cervical spinal cord injury has a blood pressure of
78/44 mm Hg and a heart rate of 48/min. There is no obvious external
bleeding. Which diagnosis should be strongly considered?
A. Hypovolemic shock
B. Neurogenic shock
,C. Septic shock
D. Tension pneumothorax
Answer: Neurogenic shock
Rationale: Severe hypotension accompanied by inappropriate bradycardia after
cervical spinal cord injury strongly suggests neurogenic shock, although
hemorrhage and other causes must still be excluded.
6. What happens to systemic vascular resistance during neurogenic shock?
A. It increases substantially
B. It remains unchanged
C. It fluctuates because of hypovolemia
D. It decreases because of vasodilation
Answer: It decreases because of vasodilation
Rationale: Loss of sympathetic vasoconstrictor activity causes arterial and
venous dilation, reducing systemic vascular resistance and venous return.
7. Which physical finding most strongly supports neurogenic shock rather than
hemorrhagic shock?
A. Altered mental status
B. Hypotension
C. Warm, dry extremities
D. Tachypnea
Answer: Warm, dry extremities
Rationale: Peripheral vasodilation in neurogenic shock produces warm, often dry
skin, whereas hemorrhagic shock usually produces cool, pale, clammy skin
because of sympathetic vasoconstriction.
8. Why does bradycardia occur in neurogenic shock?
A. Increased vagal inhibition from hypoxia
B. Direct myocardial injury
C. Reduced circulating catecholamines from hemorrhage
, D. Unopposed parasympathetic activity after loss of sympathetic cardiac
stimulation
Answer: Unopposed parasympathetic activity after loss of sympathetic cardiac
stimulation
Rationale: High spinal cord injury can interrupt sympathetic pathways to the
heart while parasympathetic influence remains intact, resulting in relative or
marked bradycardia.
9. A patient with suspected neurogenic shock is hypotensive and bradycardic.
What should be the initial priority?
A. Assume blood loss is absent
B. Immediately administer antibiotics
C. Continue systematic trauma assessment while supporting airway, breathing,
and circulation
D. Remove spinal precautions
Answer: Continue systematic trauma assessment while supporting airway,
breathing, and circulation
Rationale: Neurogenic shock is a diagnosis of exclusion in trauma. Life-
threatening hemorrhage and other causes of shock must be actively assessed
while ABC management and spinal protection continue.
10.Which finding would make hemorrhagic shock more likely than isolated
neurogenic shock?
A. Warm skin
B. Bradycardia
C. High spinal cord injury
D. Cool, clammy skin with ongoing blood loss
Answer: Cool, clammy skin with ongoing blood loss
