, Question 1
A patient with septic shock has a CVP of 14 mm Hg, PAOP of 16 mm Hg, and
CI of 1.9 L/min/m². Which interpretation best explains these findings?
A. Hypovolemic shock with reduced preload
B. Cardiogenic shock with elevated filling pressures and low output
C. Obstructive shock from pulmonary embolism
D. Distributive shock with low SVR and high output
Correct Answer: B - Cardiogenic shock with elevated filling
pressures and low output
RATIONALE
Elevated CVP/PAOP with low CI indicates pump failure with
congestion, consistent with cardiogenic shock. Distributive shock
would show low SVR and normal/high CI, while hypovolemic and
obstructive patterns produce low filling pressures or specific
obstructive findings.
Question 2
During intra-arterial waveform analysis, the dicrotic notch is absent and the
upstroke is slurred. Which hemodynamic alteration does this most likely
reflect?
A. Increased systemic vascular resistance
B. Aortic regurgitation
C. Reduced left ventricular contractility
D. Hypovolemia with narrow pulse pressure
Correct Answer: C - Reduced left ventricular contractility
Page 2
, RATIONALE
Loss of the dicrotic notch with a slurred upstroke reflects reduced
ventricular contractility and damping of the arterial waveform. Aortic
regurgitation widens pulse pressure with a prominent notch, while
increased SVR and hypovolemia do not eliminate the notch in this
pattern.
Question 3
Which combination of hemodynamic parameters is most consistent with right
ventricular failure after an inferior myocardial infarction?
A. Elevated CVP, low PAOP, low CI
B. Low CVP, elevated PAOP, low CI
C. Elevated CVP, elevated PAOP, high CI
D. Low CVP, low PAOP, high CI
Correct Answer: A - Elevated CVP, low PAOP, low CI
RATIONALE
Right ventricular infarction impairs right-sided filling and output,
producing elevated CVP with low PAOP and reduced CI. Left-sided
failure would elevate PAOP, while high-output states would not show
low CI.
Question 4
A patient on norepinephrine has a MAP of 68 mm Hg, lactate rising, and
mottled extremities. Which additional parameter best guides escalation of
therapy?
A. Central venous oxygen saturation (ScvO)
B. Urine specific gravity
C. Serum sodium level
D. Respiratory rate
Correct Answer: A - Central venous oxygen saturation (ScvO)
Page 3
, RATIONALE
ScvO reflects the balance between oxygen delivery and consumption
and helps identify inadequate tissue perfusion despite a MAP target.
The other options are not direct perfusion or oxygen-delivery
indicators in this context.
Question 5
Which finding on a pulmonary artery waveform indicates the catheter has
migrated too far distally and requires immediate repositioning?
A. Loss of the dicrotic notch
B. Spontaneous wedging with a continuous PAOP tracing
C. Respiratory variation in the PA systolic upstroke
D. Presence of a small C wave
Correct Answer: B - Spontaneous wedging with a continuous
PAOP tracing
RATIONALE
Spontaneous wedging produces a continuous PAOP tracing and risks
pulmonary artery rupture or infarction, requiring immediate balloon
deflation and catheter withdrawal. The other findings are either normal
or nonspecific.
Question 6
Which statement best explains why stroke volume variation (SVV) is
unreliable in a patient with an open chest after cardiac surgery?
A. SVV requires a closed chest and controlled ventilation to reflect
preload responsiveness
B. SVV is unaffected by intrathoracic pressure changes
C. SVV measures right ventricular afterload directly
D. SVV correlates only with pulmonary vascular resistance
Correct Answer: A - SVV requires a closed chest and controlled
Page 4
A patient with septic shock has a CVP of 14 mm Hg, PAOP of 16 mm Hg, and
CI of 1.9 L/min/m². Which interpretation best explains these findings?
A. Hypovolemic shock with reduced preload
B. Cardiogenic shock with elevated filling pressures and low output
C. Obstructive shock from pulmonary embolism
D. Distributive shock with low SVR and high output
Correct Answer: B - Cardiogenic shock with elevated filling
pressures and low output
RATIONALE
Elevated CVP/PAOP with low CI indicates pump failure with
congestion, consistent with cardiogenic shock. Distributive shock
would show low SVR and normal/high CI, while hypovolemic and
obstructive patterns produce low filling pressures or specific
obstructive findings.
Question 2
During intra-arterial waveform analysis, the dicrotic notch is absent and the
upstroke is slurred. Which hemodynamic alteration does this most likely
reflect?
A. Increased systemic vascular resistance
B. Aortic regurgitation
C. Reduced left ventricular contractility
D. Hypovolemia with narrow pulse pressure
Correct Answer: C - Reduced left ventricular contractility
Page 2
, RATIONALE
Loss of the dicrotic notch with a slurred upstroke reflects reduced
ventricular contractility and damping of the arterial waveform. Aortic
regurgitation widens pulse pressure with a prominent notch, while
increased SVR and hypovolemia do not eliminate the notch in this
pattern.
Question 3
Which combination of hemodynamic parameters is most consistent with right
ventricular failure after an inferior myocardial infarction?
A. Elevated CVP, low PAOP, low CI
B. Low CVP, elevated PAOP, low CI
C. Elevated CVP, elevated PAOP, high CI
D. Low CVP, low PAOP, high CI
Correct Answer: A - Elevated CVP, low PAOP, low CI
RATIONALE
Right ventricular infarction impairs right-sided filling and output,
producing elevated CVP with low PAOP and reduced CI. Left-sided
failure would elevate PAOP, while high-output states would not show
low CI.
Question 4
A patient on norepinephrine has a MAP of 68 mm Hg, lactate rising, and
mottled extremities. Which additional parameter best guides escalation of
therapy?
A. Central venous oxygen saturation (ScvO)
B. Urine specific gravity
C. Serum sodium level
D. Respiratory rate
Correct Answer: A - Central venous oxygen saturation (ScvO)
Page 3
, RATIONALE
ScvO reflects the balance between oxygen delivery and consumption
and helps identify inadequate tissue perfusion despite a MAP target.
The other options are not direct perfusion or oxygen-delivery
indicators in this context.
Question 5
Which finding on a pulmonary artery waveform indicates the catheter has
migrated too far distally and requires immediate repositioning?
A. Loss of the dicrotic notch
B. Spontaneous wedging with a continuous PAOP tracing
C. Respiratory variation in the PA systolic upstroke
D. Presence of a small C wave
Correct Answer: B - Spontaneous wedging with a continuous
PAOP tracing
RATIONALE
Spontaneous wedging produces a continuous PAOP tracing and risks
pulmonary artery rupture or infarction, requiring immediate balloon
deflation and catheter withdrawal. The other findings are either normal
or nonspecific.
Question 6
Which statement best explains why stroke volume variation (SVV) is
unreliable in a patient with an open chest after cardiac surgery?
A. SVV requires a closed chest and controlled ventilation to reflect
preload responsiveness
B. SVV is unaffected by intrathoracic pressure changes
C. SVV measures right ventricular afterload directly
D. SVV correlates only with pulmonary vascular resistance
Correct Answer: A - SVV requires a closed chest and controlled
Page 4
