c) Start IV antibiotics

d) Perform intubation
Situational Questions
7. A post-operative patient develops
These are scenario-based questions where
tachycardia, hypotension, and oliguria
the student needs to analyze the situation
with no signs of external bleeding.
and pick the best answer.
What shock should be suspected?
1. A 68-year-old patient presents with a) Cardiogenic
chest pain, shortness of breath, and a b) Septic
weak pulse. Blood pressure is 85/50 c) Hypovolemic
mmHg, and there are crackles in the d) Anaphylactic
lungs. Which type of shock is most
8. A patient in septic shock remains
likely?
hypotensive despite IV fluid
a) Cardiogenic
resuscitation. Which treatment is most
b) Hypovolemic
appropriate next?
c) Anaphylactic
a) Vasopressors
d) Septic
b) Blood transfusion
2. A patient with a history of peanut c) Antihistamines
allergy suddenly develops wheezing, d) Beta-blockers
hypotension, and a widespread rash
9. A young man with a stab wound to the
after eating at a restaurant. What is
leg is hypotensive and tachycardic but
the most appropriate first step in
does not appear confused. What is the
management?
initial step?
a) Administer epinephrine
a) Control bleeding
b) Provide IV fluids
b) Administer antibiotics
c) Perform CPR
c) Provide oxygen
d) Start antibiotics
d) Insert a central line
3. A 24-year-old woman involved in a car
10.A child with meningitis has sudden
accident has rapid breathing, a weak
hypotension and cold extremities.
pulse, and is pale. Her abdomen is
Which type of shock is this most likely?
distended, and BP is 90/60 mmHg.
a) Septic shock
What type of shock is she most likely
b) Cardiogenic shock
experiencing?
c) Hypovolemic shock
a) Neurologic
d) Neurologic shock
b) Hypovolemic
c) Cardiogenic
d) Anaphylactic
Objective Questions
4. A 45-year-old man with a high fever,
These test knowledge about
confusion, low blood pressure (75/40
pathophysiology, diagnosis, and
mmHg), and warm, flushed skin is
management.
brought to the ER. Blood cultures are
pending. What is the likely diagnosis? 11.What is the hallmark feature of
a) Septic shock hypovolemic shock?
b) Cardiogenic shock a) Increased cardiac output
c) Hypovolemic shock b) Decreased circulating blood volume
d) Neurologic shock c) Vasodilation
d) Allergic reaction
5. A 55-year-old man develops sudden
bradycardia and hypotension after a 12.Which of the following is NOT a
cervical spine injury. What is the most common cause of cardiogenic shock?
likely type of shock? a) Myocardial infarction
a) Anaphylactic b) Cardiac tamponade
b) Neurologic c) Anaphylaxis
c) Hypovolemic d) Ventricular arrhythmia
d) Septic
13.What is the primary treatment for
6. After a severe allergic reaction, a anaphylactic shock?
patient continues to deteriorate a) Diphenhydramine
despite receiving one dose of b) Epinephrine
epinephrine. What is the next step? c) Corticosteroids
a) Give a second dose of epinephrine d) IV fluids
b) Administer corticosteroids
14.Which type of shock involves 23.What distinguishes anaphylactic shock
decreased systemic vascular from other types?
resistance and increased cardiac a) Cold extremities
output in the early stages? b) Tachycardia
a) Septic c) Urticaria and airway obstruction
b) Hypovolemic d) Oliguria
c) Cardiogenic
24.What is the most common source of
d) Anaphylactic
infection in septic shock?
15.In neurologic shock, which of the a) Skin infections
following is typically present? b) Gastrointestinal infections
a) Tachycardia c) Respiratory infections
b) Bradycardia d) Urinary tract infections
c) Pulmonary edema
25.Which type of shock is least likely to
d) Widespread rash
present with tachycardia?
16.Which laboratory marker is commonly a) Hypovolemic
elevated in septic shock? b) Cardiogenic
a) Troponin c) Neurologic
b) Lactate d) Septic
c) Hemoglobin
26.Which of the following is a key feature
d) Platelets
of cardiogenic shock?
17.What is the typical skin presentation in a) Increased cardiac output
hypovolemic shock? b) Decreased left ventricular ejection
a) Warm and flushed fraction
b) Cool and clammy c) Peripheral vasodilation
c) Cyanotic and dry d) High urine output
d) Rash-covered
27.Neurologic shock occurs due to:
18.Which shock is caused by inadequate a) Infection
heart function? b) Loss of sympathetic tone
a) Septic c) Myocardial dysfunction
b) Cardiogenic d) Blood loss
c) Hypovolemic
28.Anaphylactic shock results from:
d) Anaphylactic
a) Infection
19.What is the best indicator of tissue b) Vasodilation due to spinal cord
perfusion in shock? injury
a) Blood pressure c) Immunoglobulin E (IgE) mediated
b) Urine output reaction
c) Heart rate d) Low blood volume
d) Oxygen saturation
29.The primary goal of fluid resuscitation
20.Which medication is first-line for septic in hypovolemic shock is to:
shock with persistent hypotension? a) Improve oxygenation
a) Epinephrine b) Restore circulating volume
b) Norepinephrine c) Treat infection
c) Dopamine d) Increase heart rate
d) Dobutamine
30.Which of these is a potential late
21.A characteristic feature of septic shock complication of septic shock?
includes: a) Pulmonary edema
a) Low cardiac output b) Multiorgan failure
b) High systemic vascular resistance c) Spinal cord ischemia
c) Vasodilation and hypotension d) Myocardial infarction
d) Bradycardia
22.Hypovolemic shock is most commonly
caused by:
a) Myocardial infarction
b) Hemorrhage
c) Spinal cord injury
d) Allergic reaction
Situational Questions o Sudden hypotension and cold
extremities in meningitis
1. a) Cardiogenic
suggest septic shock due to
o Crackles in the lungs suggest overwhelming infection.
pulmonary congestion, a
hallmark of cardiogenic shock
due to heart failure (e.g., after Objective Questions
myocardial infarction).
11.b) Decreased circulating blood
2. a) Administer epinephrine volume
o Epinephrine is the first-line o Hypovolemic shock results from
treatment for anaphylaxis, as it inadequate intravascular
reverses airway obstruction and volume, often due to bleeding
vasodilation. or fluid loss.
3. b) Hypovolemic 12.c) Anaphylaxis
o Pale skin, rapid breathing, and o Anaphylaxis causes distributive
abdominal distension point to shock, not cardiogenic shock,
internal bleeding and which is linked to heart
hypovolemic shock. dysfunction like MI or
tamponade.
4. a) Septic shock
13.b) Epinephrine
o Fever, confusion, and warm,
flushed skin with hypotension o Epinephrine is the gold standard
are classic for septic shock due for treating anaphylaxis as it
to systemic inflammation and counteracts severe hypotension
vasodilation. and airway swelling.
5. b) Neurologic 14.a) Septic
o Cervical spine injuries can cause o Early septic shock is
loss of sympathetic tone, characterized by increased
leading to hypotension and cardiac output and reduced
bradycardia (neurologic shock). systemic vascular resistance
due to vasodilation.
6. a) Give a second dose of
epinephrine 15.b) Bradycardia
o If symptoms persist after the o Neurologic shock is unique in
first dose, repeat dosing of often presenting with
epinephrine is recommended to bradycardia due to loss of
restore stability in anaphylaxis. sympathetic nervous system
activity.
7. b) Septic
16.b) Lactate
o Hypotension and oliguria
without bleeding post-surgery o Elevated lactate is a marker of
suggest septic shock, likely from tissue hypoperfusion and
an undetected infection. anaerobic metabolism in septic
shock.
8. a) Vasopressors
17.b) Cool and clammy
o If fluid resuscitation fails to
restore BP in septic shock, o Hypovolemic shock triggers
vasopressors like vasoconstriction, making the
norepinephrine are indicated. skin cold and clammy.
9. a) Control bleeding 18.b) Cardiogenic
o In trauma, controlling the o Cardiogenic shock occurs when
source of bleeding is the first the heart fails to pump
priority in hypovolemic shock. effectively, reducing cardiac
output.
10.a) Septic shock
19.b) Urine output
 o Low urine output reflects poor vasodilation and airway
renal perfusion and tissue constriction.
hypoperfusion in shock.
29.b) Restore circulating volume
20.b) Norepinephrine
o Fluid resuscitation aims to
o Norepinephrine is the first-line replace lost volume in
vasopressor for septic shock hypovolemic shock, improving
with persistent hypotension perfusion.
after fluid resuscitation.
30.b) Multiorgan failure
21.c) Vasodilation and hypotension
o In septic shock, prolonged
o Septic shock is caused by hypotension and inflammation
systemic inflammation and can lead to organ failure.
vasodilation, leading to
profound hypotension.
22.b) Hemorrhage
o Hemorrhage is the most
common cause of hypovolemic
shock, as blood loss reduces
circulating volume.
23.c) Urticaria and airway
obstruction
o These symptoms are hallmark
signs of anaphylactic shock,
distinguishing it from other
forms.
24.c) Respiratory infections
o Respiratory infections (e.g.,
pneumonia) are a common
source of sepsis leading to
septic shock.
25.c) Neurologic
o Neurologic shock often presents
with bradycardia rather than the
tachycardia seen in other
shocks.
26.b) Decreased left ventricular
ejection fraction
o Cardiogenic shock typically
results from left ventricular
failure, reducing ejection
fraction.
27.b) Loss of sympathetic tone
o Neurologic shock occurs when
spinal cord injury leads to loss
of sympathetic nervous system
tone, causing vasodilation.
28.c) Immunoglobulin E (IgE)
mediated reaction
o Anaphylactic shock is an IgE-
mediated hypersensitivity
reaction causing widespread