Shock
ORS is the preferred route, and IV fluids are for severe dehydration or shock.
What our notes say
- ORS is the preferred route, and IV fluids are for severe dehydration or shock. (Paediatrics end of 2nd semester exam (MBPE 4300): 5 October 2021, 50 MCQs)
- ICU: NIV or ventilation, vasopressors for septic shock. (Pneumonia)
- Parapneumonic effusion and empyema, lung abscess, sepsis and septic shock, respiratory failure and ARDS, pleurisy, pericarditis, lobar collapse, metastatic infection (meningitis, endocarditis, arthritis), bronchiectasis (long term). (Pneumonia)
- PE: sudden dyspnoea, pleuritic chest pain, cough, haemoptysis, tachycardia, tachypnoea, fever (low grade), syncope; massive PE: hypotension, shock, cyanosis, raised JVP, cardiac arrest. (DVT and Venous Thromboembolism (with Pulmonary Embolism))
- Massive PE (shock): thrombolysis (alteplase) unless contraindicated, or surgical/catheter embolectomy; supportive (oxygen, fluids with care, vasopressors). (DVT and Venous Thromboembolism (with Pulmonary Embolism))
- Shock out of proportion to visible bleeding, a woody hard uterus and a dead fetus point to concealed severe abruption. (Junior Clerkship in Reproductive Health (MBOG 4200): end of year examination, 4 )
Study material on Shock
- Sepsis and septic shock
- Pathology CAT 1: Cell Injury, Metaplasia & Hypoxia Q&A
- General Pathology I
- Medical Bacteriology And Parasitology End Year 2024/2025
- General Pathology I
- Blood Transfusion Contraindications & Acute Reactions
- Liver Histology & Physiology
- Liver Histology & Physiology
- Medical MCQs: Chemical Pathology & Haematology Exam Review
- Streptococcus Classification, S. pyogenes, Rheumatic Fever, AGN
- Cardiovascular Pathology MCQs
- Medical Bacteriology
Images
Practice questions on Shock
A man is examined 4 days after a large transmural anterolateral MI with cardiogenic shock. What is the most likely microscopic finding in the affected myocardium?
- Early coagulative necrosis with early neutrophil infiltration
- Extensive coagulative necrosis with established granulation tissue formation
- Myofibrillar lysis and early fibroblast proliferation
- Dense collagenous scar tissue with scattered chronic inflammatory cells
Answer: B. At 4 days post-MI, the necrotic myocardium would be well-established with significant neutrophil infiltration and the early stages of granulation tissue formation at the edges of the infarct.
63-year-old, known CAD, new harsh pansystolic murmur + cardiogenic shock 4 days after large inferior MI, severe MR on echo. MOST likely structural cause?
- Left ventricular free wall rupture with pseudoaneurysm
- Aortic root dilation causing aortic regurgitation
- Rupture of the interventricular septum creating an acquired VSD
- Dressler syndrome causing pericardial effusion
- Papillary muscle rupture causing acute mitral valve incompetence
Answer: E. - Inferior MIs (RCA territory) put the **posteromedial papillary muscle** (single blood supply) at high risk of rupture, causing acute severe MR — typically 3–7 days post-MI ---
A patient with septic shock shows elevated levels of multiple cytokines. Which combination is most directly responsible for the fever?
- IL-8 and MCP-1 acting on hypothalamic chemokine receptors
- IL-1 and TNF inducing COX-2 and PGE2 production in hypothalamus
- IL-6 stimulating acute phase protein synthesis in liver
- IL-17 recruiting neutrophils to create metabolic heat
- TGF-β causing endothelial activation and heat generation
Answer: B. Fever is caused by IL-1 and TNF (endogenous pyrogens) acting on hypothalamic vascular cells to upregulate cyclooxygenase (COX), which produces prostaglandins, especially PGE2. PGE2 then stimulates neurotransmitter production that resets the body's temperature set-point higher. This is why NSAIDs and aspirin (COX inhibitors) reduce fever by blocking prostaglandin synthesis. IL-8 and MCP-1 are chemokines for leukocyte
A man is examined 4 days after a large transmural anterolateral MI with cardiogenic shock. Most likely microscopic finding?
- Coagulative necrosis with early neutrophil infiltration
- Myocytolysis and early fibrosis
- Extensive granulation tissue formation
- Complete scar formation
Answer: A. At 4 days post-MI, the hallmark microscopic findings are coagulative necrosis of the cardiomyocytes and the initial inflammatory response, characterized by neutrophil infiltration. Myocytolysis starts around day 1, fibrosis begins later (around day 7-10), and scar formation is much later.
A man is examined 4 days after a large transmural anterolateral MI with cardiogenic shock. What is the most likely microscopic finding in the affected myocardium?
- Coagulative necrosis with early granulation tissue formation
- Early enzymatic degradation of myocardial cells
- Dense inflammatory infiltrate with neutrophils
- Myofibrillar lysis and hemorrhage
Answer: A. At 4 days post-MI, the microscopic picture is characterized by extensive coagulative necrosis of the myocardium. Early signs of healing, such as the influx of inflammatory cells and the beginnings of granulation tissue formation at the borders, would also be present. Enzymatic degradation is more prominent in the first 24-48 hours. Neutrophilic infiltration peaks around day 3-7.
A man is examined 4 days after a large transmural anterolateral MI with cardiogenic shock. Most likely microscopic finding?
- Coagulative necrosis with early granulation tissue formation
- Myocytolysis and early fibroblast infiltration
- Inflammatory cell infiltration and beginning of scar formation
- Complete scar formation with minimal inflammation
Answer: C. At 4 days post-MI, the myocardium typically shows significant inflammatory cell infiltration (neutrophils and macrophages) and the beginning of granulation tissue formation and scar development.