Emergency Medicine Final Exam Questions
and Answers Latest Versions 2025 A+
What are the 4 categories of shock?
Hypovolemic
Distributive
Cardiogenic
Obstructive
What maintains intravascular volume during shock?
a. Epi
b. Nor-epi
c. Cortisol
d. ADH
d. ADH
If hypoxia is not corrected a cascade of metabolic
degragements develop that result in:
-Loss of cellular integrity
-Development of hyperkalemia
-Hyponatremia
-Reduction in renal function
-Alterations in glucose
-Lactic acidosis
What are the manifestations of multi-organ system failure
Renal Failure
Respiratory Failure
Myocardial depression
Liver Failure
DIC
The progression from tissue hypoxia is determined by what 2
factors?
,-Degree of inadequate tissue perfusion
&
-Balance of anti-inflammatory vs. pro-inflammatory mediators
Draw The Metabolic Pathway of Progression for Shock:
Inadequate tissue perfusion--> Tissue Hypoxia --> Aerobic &
Anaerobic metabolism (Lactic Acidosis)-->Loss of cellular wall
integrity-->Cell Death--> Multi System Organ Failure
Decrease in intravascular fluid or blood volume
results in a decrease in
-preload
-stroke volume
-cardiac output
*Caused by blood loss can result in myocardial O2 delivery
that can cause a decrease in cardiac contractility and cardiac
output (CO)
Hypovolemic Shock
Occurs 31-36% of the time
What are non traumatic causes of hypovolemic shock?
GI losses
Burns
Insensible losses (evaporation from the skin)
What are the S&S of Hypovolemic Shock?
Tachycardia
Tachypnea
Normotensive early then..Hypotensive as fluid loss advances
AMS
Skin: Pale, cool, clammy
Delayed capillary refill
Thrist
Decreased urine output
What labs do you run in Hypovolemic shock?
,Hgb
Hct
CMP (electrolytes)
BUN
Urine (Spec grav/Ketones)
What charachteristic do you expect the vital signs to be for
someone in hypovolemic shock?
(+) Orthostatic vitals (they pass out when they stand up or a
change of 20mmHg or 20 BPM with position change)
In what order do you take orthostatic vitals?
a. Sitting-lying-standing
b. Lying-sitting-standing
c. Standing-sitting-lying
d. Lying-standing-sitting
b. Lying-sitting-standing
What signifies the changes between compensated and
decompensated shock?
Urine output decreased
Respiratory Rate Increase
Blood pressure dropping
How do you manage shock?
-1-2L Normal saline (unless elderly or they cannot tolerate it)
-Correct electrolyte imbalances
-Stop vomiting: Zofran
-Treat fever: Tylenol (?)
-Treat underlying cause
-Ensure patient can tolerate oral fluids prior to discharge
Intravascular volume depletion due to marker system
vasodilation. Results in reduction of afterload.
Distributive Shock
(33-50% of the time)
, What types of shock are commonly seen with Distrubutive
shock?
Septic Shock
Anaphylaxis
Neurogenic shock
IgE mediated response that results in systemic vasodilation
and is commonly caused by:
-Food
-Medications
-Insect stings
-Immunotherapy injections
Any sunstance or agent that can cause a sudden
degranulation of mast cells or basophils can cause
anaphylaxis
Anaphylaxis
What are the S & S of anaphylaxis?
-Pruritus
-Skin Flushing
-Hives or urticaria
-Fullness in the throat and -Hoarseness (laryngeal edema)
-Anxiety
-Chest tightness
What are the MAJOR symptoms of Distributive shock?
-Abdominal pain or cramps
-Nausea/Vomiting/Diarrhea
-Bronchospasm
-Rhinorrhea
-Conjunctivitis
-Hypotension
What is the cascade flow of Distributive shock if you had to
draw it as a diagram?
and Answers Latest Versions 2025 A+
What are the 4 categories of shock?
Hypovolemic
Distributive
Cardiogenic
Obstructive
What maintains intravascular volume during shock?
a. Epi
b. Nor-epi
c. Cortisol
d. ADH
d. ADH
If hypoxia is not corrected a cascade of metabolic
degragements develop that result in:
-Loss of cellular integrity
-Development of hyperkalemia
-Hyponatremia
-Reduction in renal function
-Alterations in glucose
-Lactic acidosis
What are the manifestations of multi-organ system failure
Renal Failure
Respiratory Failure
Myocardial depression
Liver Failure
DIC
The progression from tissue hypoxia is determined by what 2
factors?
,-Degree of inadequate tissue perfusion
&
-Balance of anti-inflammatory vs. pro-inflammatory mediators
Draw The Metabolic Pathway of Progression for Shock:
Inadequate tissue perfusion--> Tissue Hypoxia --> Aerobic &
Anaerobic metabolism (Lactic Acidosis)-->Loss of cellular wall
integrity-->Cell Death--> Multi System Organ Failure
Decrease in intravascular fluid or blood volume
results in a decrease in
-preload
-stroke volume
-cardiac output
*Caused by blood loss can result in myocardial O2 delivery
that can cause a decrease in cardiac contractility and cardiac
output (CO)
Hypovolemic Shock
Occurs 31-36% of the time
What are non traumatic causes of hypovolemic shock?
GI losses
Burns
Insensible losses (evaporation from the skin)
What are the S&S of Hypovolemic Shock?
Tachycardia
Tachypnea
Normotensive early then..Hypotensive as fluid loss advances
AMS
Skin: Pale, cool, clammy
Delayed capillary refill
Thrist
Decreased urine output
What labs do you run in Hypovolemic shock?
,Hgb
Hct
CMP (electrolytes)
BUN
Urine (Spec grav/Ketones)
What charachteristic do you expect the vital signs to be for
someone in hypovolemic shock?
(+) Orthostatic vitals (they pass out when they stand up or a
change of 20mmHg or 20 BPM with position change)
In what order do you take orthostatic vitals?
a. Sitting-lying-standing
b. Lying-sitting-standing
c. Standing-sitting-lying
d. Lying-standing-sitting
b. Lying-sitting-standing
What signifies the changes between compensated and
decompensated shock?
Urine output decreased
Respiratory Rate Increase
Blood pressure dropping
How do you manage shock?
-1-2L Normal saline (unless elderly or they cannot tolerate it)
-Correct electrolyte imbalances
-Stop vomiting: Zofran
-Treat fever: Tylenol (?)
-Treat underlying cause
-Ensure patient can tolerate oral fluids prior to discharge
Intravascular volume depletion due to marker system
vasodilation. Results in reduction of afterload.
Distributive Shock
(33-50% of the time)
, What types of shock are commonly seen with Distrubutive
shock?
Septic Shock
Anaphylaxis
Neurogenic shock
IgE mediated response that results in systemic vasodilation
and is commonly caused by:
-Food
-Medications
-Insect stings
-Immunotherapy injections
Any sunstance or agent that can cause a sudden
degranulation of mast cells or basophils can cause
anaphylaxis
Anaphylaxis
What are the S & S of anaphylaxis?
-Pruritus
-Skin Flushing
-Hives or urticaria
-Fullness in the throat and -Hoarseness (laryngeal edema)
-Anxiety
-Chest tightness
What are the MAJOR symptoms of Distributive shock?
-Abdominal pain or cramps
-Nausea/Vomiting/Diarrhea
-Bronchospasm
-Rhinorrhea
-Conjunctivitis
-Hypotension
What is the cascade flow of Distributive shock if you had to
draw it as a diagram?
