Q.1 Which of the following is the most accurate method to measure cardiac output in critically ill patients?
Pulse oximetry
Pulmonary artery catheter
Electrocardiogram
Capnography
Explanation - Pulmonary artery catheterization (Swan-Ganz) provides direct measurement of cardiac output and pressures within the heart.
Correct answer is: Pulmonary artery catheter
Q.2 A patient in shock presents with hypotension and cold, clammy skin. What type of shock is most likely?
Hypovolemic shock
Cardiogenic shock
Distributive shock
Obstructive shock
Explanation - Hypovolemic shock is caused by loss of circulating volume, leading to hypotension, tachycardia, and cool, clammy skin.
Correct answer is: Hypovolemic shock
Q.3 Central venous pressure (CVP) monitoring primarily assesses which physiological parameter?
Left ventricular preload
Right ventricular preload
Systemic vascular resistance
Cardiac contractility
Explanation - CVP reflects the pressure in the thoracic vena cava near the right atrium and is an estimate of right ventricular preload.
Correct answer is: Right ventricular preload
Q.4 Which of the following is a hallmark of cardiogenic shock?
Low cardiac output with high systemic vascular resistance
High cardiac output with low systemic vascular resistance
Low cardiac output with low systemic vascular resistance
High cardiac output with high systemic vascular resistance
Explanation - Cardiogenic shock results from the heart's inability to pump effectively, leading to low cardiac output and compensatory vasoconstriction (high SVR).
Correct answer is: Low cardiac output with high systemic vascular resistance
Q.5 In septic shock, which hemodynamic change is typically observed initially?
Increased SVR and low cardiac output
Decreased SVR and high cardiac output
Decreased SVR and low cardiac output
Increased SVR and high cardiac output
Explanation - Early septic shock is characterized by vasodilation (low SVR) and compensatory high cardiac output (hyperdynamic state).
Correct answer is: Decreased SVR and high cardiac output
Q.6 Which monitoring method is most suitable for assessing dynamic fluid responsiveness?
Pulmonary artery catheter
Central venous pressure
Stroke volume variation via arterial line
Urine output measurement
Explanation - Stroke volume variation measured through an arterial line during mechanical ventilation helps predict fluid responsiveness more reliably than static measures like CVP.
Correct answer is: Stroke volume variation via arterial line
Q.7 Which type of shock is most commonly associated with anaphylaxis?
Hypovolemic shock
Cardiogenic shock
Distributive shock
Obstructive shock
Explanation - Anaphylactic shock is a form of distributive shock caused by massive vasodilation and increased vascular permeability.
Correct answer is: Distributive shock
Q.8 Mean arterial pressure (MAP) is considered a critical parameter in shock management. What is the minimum MAP usually targeted to ensure adequate tissue perfusion?
50 mmHg
60 mmHg
65 mmHg
80 mmHg
Explanation - A MAP of at least 65 mmHg is generally recommended in critically ill patients to maintain adequate organ perfusion.
Correct answer is: 65 mmHg
Q.9 Which lab value is most indicative of tissue hypoperfusion in shock?
Serum lactate
Serum sodium
Serum creatinine
Hemoglobin
Explanation - Elevated serum lactate reflects anaerobic metabolism due to tissue hypoxia and is a key marker of shock severity.
Correct answer is: Serum lactate
Q.10 In obstructive shock, which of the following conditions is a common cause?
Massive pulmonary embolism
Severe dehydration
Myocardial infarction
Sepsis
Explanation - Obstructive shock results from physical obstruction to blood flow, such as tension pneumothorax or massive pulmonary embolism.
Correct answer is: Massive pulmonary embolism
Q.11 Which drug is commonly used as a first-line vasopressor in septic shock?
Dopamine
Norepinephrine
Epinephrine
Phenylephrine
Explanation - Norepinephrine is the first-line vasopressor in septic shock due to its strong alpha-adrenergic vasoconstrictive effect and relatively safe profile.
Correct answer is: Norepinephrine
Q.12 A patient with hypovolemic shock is best managed initially with which intervention?
Vasopressors
Fluid resuscitation
Inotropes
Mechanical ventilation
Explanation - Hypovolemic shock is primarily due to decreased circulating volume, and rapid fluid resuscitation is the initial treatment of choice.
Correct answer is: Fluid resuscitation
Q.13 Pulmonary artery wedge pressure (PAWP) helps assess:
Left ventricular preload
Right ventricular preload
Cardiac output
Systemic vascular resistance
Explanation - PAWP (obtained via a pulmonary artery catheter) reflects left atrial pressure, serving as an estimate of left ventricular preload.
Correct answer is: Left ventricular preload
Q.14 Which of the following signs is an early indicator of shock in a patient?
Tachycardia
Bradycardia
Peripheral cyanosis
Pulmonary edema
Explanation - Tachycardia is one of the earliest compensatory responses to reduced perfusion in shock.
Correct answer is: Tachycardia
Q.15 Which parameter is used to guide fluid therapy in patients with septic shock?
Mean arterial pressure and urine output
Heart rate alone
Respiratory rate
Body temperature
Explanation - MAP and urine output are critical indicators for assessing tissue perfusion and guiding fluid resuscitation.
Correct answer is: Mean arterial pressure and urine output
Q.16 Which type of shock is associated with spinal cord injury?
Hypovolemic shock
Neurogenic shock
Cardiogenic shock
Septic shock
Explanation - Neurogenic shock results from loss of sympathetic tone after spinal cord injury, leading to hypotension and bradycardia.
Correct answer is: Neurogenic shock
Q.17 What is the main goal of hemodynamic monitoring in critically ill patients?
Assessing organ perfusion and guiding therapy
Measuring blood glucose
Detecting infection
Monitoring oxygen saturation only
Explanation - Hemodynamic monitoring provides real-time data on cardiac output, vascular resistance, and perfusion, guiding interventions to maintain tissue oxygenation.
Correct answer is: Assessing organ perfusion and guiding therapy
Q.18 In distributive shock, what hemodynamic pattern is typically observed?
Low SVR, high cardiac output
High SVR, low cardiac output
Low SVR, low cardiac output
High SVR, high cardiac output
Explanation - Distributive shock, such as septic shock, leads to vasodilation (low SVR) and often a hyperdynamic circulation with high cardiac output.
Correct answer is: Low SVR, high cardiac output
Q.19 Which invasive monitoring is considered the gold standard for measuring pulmonary artery pressures?
Central venous catheter
Arterial line
Pulmonary artery catheter
Pulse oximeter
Explanation - Pulmonary artery catheterization directly measures pulmonary artery pressures and cardiac output, making it the gold standard for detailed hemodynamic assessment.
Correct answer is: Pulmonary artery catheter
Q.20 A patient presents with shock and muffled heart sounds, distended neck veins, and hypotension. What is the likely type of shock?
Hypovolemic shock
Cardiogenic shock
Obstructive shock
Distributive shock
Explanation - These are Beck’s triad signs of cardiac tamponade, an example of obstructive shock.
Correct answer is: Obstructive shock
Q.21 Which of the following interventions is priority in managing anaphylactic shock?
Intravenous fluids and epinephrine
Beta-blockers
Diuretics
Antibiotics
Explanation - Epinephrine is the drug of choice in anaphylactic shock, along with fluids to counteract vasodilation and hypovolemia.
Correct answer is: Intravenous fluids and epinephrine
Q.22 Which hemodynamic parameter helps differentiate between cardiogenic and hypovolemic shock?
CVP
Heart rate
Respiratory rate
Blood glucose
Explanation - In cardiogenic shock, CVP is often elevated due to impaired cardiac function, whereas in hypovolemic shock CVP is low due to volume loss.
Correct answer is: CVP
Q.23 Which of the following is a late sign of shock?
Tachycardia
Hypotension
Cold extremities
Altered mental status
Explanation - Hypotension is a late and ominous sign of shock, often appearing after compensatory mechanisms fail.
Correct answer is: Hypotension
Q.24 Which type of fluid is preferred initially in hypovolemic shock due to hemorrhage?
Crystalloids
Colloids
Albumin only
Dextrose 5% solution
Explanation - Isotonic crystalloids like normal saline or Ringer’s lactate are the first choice for rapid volume replacement in hypovolemic shock.
Correct answer is: Crystalloids
Q.25 Which parameter is most useful in assessing tissue perfusion non-invasively?
Serum lactate
Urine output
Capillary refill time
Blood pressure
Explanation - Capillary refill time is a simple bedside indicator of peripheral perfusion, reflecting early circulatory compromise.
Correct answer is: Capillary refill time