ATLS Neurogenic Shock Recognition
Questions And Correct Answers
(Verified Answers) Plus Rationales
2026 Q&A | Instant Download Pdf
1. A 28-year-old patient sustains a cervical spinal cord injury after a
diving accident. He is hypotensive with a blood pressure of 78/46
mm Hg, heart rate of 48/min, warm dry skin, and no obvious
external hemorrhage. Which diagnosis is most likely?
A. Hemorrhagic shock
B. Neurogenic shock
C. Obstructive shock
D. Cardiogenic shock
Answer: B. Neurogenic shock
Rationale: Neurogenic shock results from loss of sympathetic vascular
tone after significant spinal cord injury, particularly cervical or high
thoracic injury. Hypotension accompanied by bradycardia, warm skin,
and relative peripheral vasodilation strongly supports neurogenic
shock rather than hemorrhagic shock.
2. Which physiologic abnormality is most characteristic of
neurogenic shock?
A. Increased systemic vascular resistance
B. Severe tachycardia
C. Loss of sympathetic vascular tone
D. Increased venous return
,Answer: C. Loss of sympathetic vascular tone
Rationale: Neurogenic shock occurs when sympathetic pathways are
disrupted, producing arterial and venous dilation. The resulting
reduction in systemic vascular resistance and venous return can cause
significant hypotension.
3. A trauma patient with suspected spinal cord injury has hypotension
and a heart rate of 42/min. His skin is warm rather than cool and
clammy. Which finding most strongly supports neurogenic shock?
A. Bradycardia with hypotension
B. Severe external bleeding
C. Narrow pulse pressure
D. Marked peripheral vasoconstriction
Answer: A. Bradycardia with hypotension
Rationale: Bradycardia in a hypotensive trauma patient is an
important clue to neurogenic shock. Loss of sympathetic stimulation
leaves parasympathetic cardiac influence relatively unopposed,
producing bradycardia while vascular tone is simultaneously reduced.
4. Neurogenic shock is most commonly associated with spinal cord
injury involving which region?
A. Sacral cord only
B. Low lumbar cord only
C. Cervical or upper thoracic cord
D. Coccygeal nerves
Answer: C. Cervical or upper thoracic cord
Rationale: Disruption of sympathetic pathways above the major
splanchnic sympathetic outflow can cause profound loss of vascular
,tone. Cervical and high thoracic injuries therefore carry the greatest
risk for clinically significant neurogenic shock.
5. Which mechanism best explains hypotension in neurogenic shock?
A. Acute loss of circulating blood volume
B. Massive myocardial infarction
C. Systemic vasodilation from sympathetic denervation
D. Mechanical obstruction of the pulmonary artery
Answer: C. Systemic vasodilation from sympathetic denervation
Rationale: The defining hemodynamic problem is loss of sympathetic-
mediated vasoconstriction. Arterial and venous dilation decrease
systemic vascular resistance and venous return, producing
hypotension even when blood volume has not been substantially lost.
6. A trauma patient with spinal cord injury is hypotensive and
bradycardic. Which additional finding would be most consistent
with neurogenic shock?
A. Cool, pale skin
B. Warm extremities
C. Profuse external hemorrhage
D. Severe jugular venous distention with pulmonary edema
Answer: B. Warm extremities
Rationale: Peripheral vasodilation in neurogenic shock often produces
warm, relatively dry skin. This contrasts with the cool, pale, clammy
appearance commonly associated with hypovolemic shock caused by
hemorrhage.
7. Which statement best distinguishes neurogenic shock from
hemorrhagic shock?
, A. Both typically cause profound bradycardia
B. Neurogenic shock commonly produces hypotension with relative
bradycardia
C. Hemorrhagic shock usually causes warm flushed skin
D. Neurogenic shock always causes external bleeding
Answer: B. Neurogenic shock commonly produces hypotension with
relative bradycardia
Rationale: Hemorrhage generally activates the sympathetic nervous
system and therefore causes tachycardia and peripheral
vasoconstriction. Neurogenic shock involves loss of sympathetic
activity, producing the characteristic combination of hypotension and
bradycardia.
8. What is the primary vascular consequence of sympathetic
denervation after a high spinal cord injury?
A. Generalized vasoconstriction
B. Generalized vasodilation
C. Increased pulmonary vascular resistance only
D. Increased capillary oncotic pressure
Answer: B. Generalized vasodilation
Rationale: Sympathetic denervation reduces arterial and venous
vascular tone. The resulting vasodilation lowers systemic vascular
resistance and venous return, contributing substantially to
hypotension.
9. A patient with a cervical spinal cord injury develops hypotension
without evidence of major bleeding. Which type of shock should
be considered?
Questions And Correct Answers
(Verified Answers) Plus Rationales
2026 Q&A | Instant Download Pdf
1. A 28-year-old patient sustains a cervical spinal cord injury after a
diving accident. He is hypotensive with a blood pressure of 78/46
mm Hg, heart rate of 48/min, warm dry skin, and no obvious
external hemorrhage. Which diagnosis is most likely?
A. Hemorrhagic shock
B. Neurogenic shock
C. Obstructive shock
D. Cardiogenic shock
Answer: B. Neurogenic shock
Rationale: Neurogenic shock results from loss of sympathetic vascular
tone after significant spinal cord injury, particularly cervical or high
thoracic injury. Hypotension accompanied by bradycardia, warm skin,
and relative peripheral vasodilation strongly supports neurogenic
shock rather than hemorrhagic shock.
2. Which physiologic abnormality is most characteristic of
neurogenic shock?
A. Increased systemic vascular resistance
B. Severe tachycardia
C. Loss of sympathetic vascular tone
D. Increased venous return
,Answer: C. Loss of sympathetic vascular tone
Rationale: Neurogenic shock occurs when sympathetic pathways are
disrupted, producing arterial and venous dilation. The resulting
reduction in systemic vascular resistance and venous return can cause
significant hypotension.
3. A trauma patient with suspected spinal cord injury has hypotension
and a heart rate of 42/min. His skin is warm rather than cool and
clammy. Which finding most strongly supports neurogenic shock?
A. Bradycardia with hypotension
B. Severe external bleeding
C. Narrow pulse pressure
D. Marked peripheral vasoconstriction
Answer: A. Bradycardia with hypotension
Rationale: Bradycardia in a hypotensive trauma patient is an
important clue to neurogenic shock. Loss of sympathetic stimulation
leaves parasympathetic cardiac influence relatively unopposed,
producing bradycardia while vascular tone is simultaneously reduced.
4. Neurogenic shock is most commonly associated with spinal cord
injury involving which region?
A. Sacral cord only
B. Low lumbar cord only
C. Cervical or upper thoracic cord
D. Coccygeal nerves
Answer: C. Cervical or upper thoracic cord
Rationale: Disruption of sympathetic pathways above the major
splanchnic sympathetic outflow can cause profound loss of vascular
,tone. Cervical and high thoracic injuries therefore carry the greatest
risk for clinically significant neurogenic shock.
5. Which mechanism best explains hypotension in neurogenic shock?
A. Acute loss of circulating blood volume
B. Massive myocardial infarction
C. Systemic vasodilation from sympathetic denervation
D. Mechanical obstruction of the pulmonary artery
Answer: C. Systemic vasodilation from sympathetic denervation
Rationale: The defining hemodynamic problem is loss of sympathetic-
mediated vasoconstriction. Arterial and venous dilation decrease
systemic vascular resistance and venous return, producing
hypotension even when blood volume has not been substantially lost.
6. A trauma patient with spinal cord injury is hypotensive and
bradycardic. Which additional finding would be most consistent
with neurogenic shock?
A. Cool, pale skin
B. Warm extremities
C. Profuse external hemorrhage
D. Severe jugular venous distention with pulmonary edema
Answer: B. Warm extremities
Rationale: Peripheral vasodilation in neurogenic shock often produces
warm, relatively dry skin. This contrasts with the cool, pale, clammy
appearance commonly associated with hypovolemic shock caused by
hemorrhage.
7. Which statement best distinguishes neurogenic shock from
hemorrhagic shock?
, A. Both typically cause profound bradycardia
B. Neurogenic shock commonly produces hypotension with relative
bradycardia
C. Hemorrhagic shock usually causes warm flushed skin
D. Neurogenic shock always causes external bleeding
Answer: B. Neurogenic shock commonly produces hypotension with
relative bradycardia
Rationale: Hemorrhage generally activates the sympathetic nervous
system and therefore causes tachycardia and peripheral
vasoconstriction. Neurogenic shock involves loss of sympathetic
activity, producing the characteristic combination of hypotension and
bradycardia.
8. What is the primary vascular consequence of sympathetic
denervation after a high spinal cord injury?
A. Generalized vasoconstriction
B. Generalized vasodilation
C. Increased pulmonary vascular resistance only
D. Increased capillary oncotic pressure
Answer: B. Generalized vasodilation
Rationale: Sympathetic denervation reduces arterial and venous
vascular tone. The resulting vasodilation lowers systemic vascular
resistance and venous return, contributing substantially to
hypotension.
9. A patient with a cervical spinal cord injury develops hypotension
without evidence of major bleeding. Which type of shock should
be considered?
