Deck 46: Shock, Multiple Organ Dysfunction Syndrome, and Burns in Adult

Question 1

In MODS, injured endothelial cells become more permeable, allowing fluid and protein to leak into interstitial spaces and they lose much of the ability to prevent blood clotting, allowing microvascular thrombi to develop.

Answer 1

True

Question 2

The gastrointestinal system is very sensitive to inflammatory injury resulting from mediators released by macrophages.

Answer 2

True

Question 3

Without oxygen, cells shift from anaerobic to aerobic metabolism.

Answer 3

False

Question 4

Hypovolemic shock begins to develop when intravascular volume has decreased by ____%.

A)5
B)10
C)15
D)20

Question 5

To compensate for hypovolemic shock, the liver and spleen add to the blood volume by disgorging stored red blood cells and plasma.

Question 6

In MODS, organs that show signs of failure are those involved in the initial injury.

Question 7

The cause of organ failure in shock is depletion of protein.

Question 8

When proteins are broken down anaerobically, ammonia and urea are produced.

Question 9

Secondary MODS results from excessive inflammatory reaction.

Question 10

Burn shock is a form of hemorrhagic shock.

Question 11

With reperfusion in MODS, oxygen radicals are formed from oxygen by the action of xanthine oxidase that attack the already damaged tissue.

Question 12

A clinical infection is necessary for the development of MODS.

Question 13

How does any type of shock cause oliguria?

A)By stimulating the renin-angiotensin system
B)By decreasing the perfusion to the kidneys
C)By stimulating carotid and baroreceptors
D)By decreasing the parasympathetic nervous system stimulation

Question 14

The final common pathway in all shock is:

A)cellular alterations in the heart and brain.
B)impairment of cellular metabolism.
C)cellular alterations in the vasculature and kidneys.
D)impairment of urine excretion.

Question 15

In primary multiple organ dysfunction syndrome (MODS), organ injury is directly associated with impaired perfusion.

Question 16

Positive-feedback loops that impair oxygen use in all types of shock include:

A)activation of the fibrinolytic cascade.
B)increased circulating volume.
C)hypermetabolic state.
D)lysosomal enzyme release.

Question 17

The clinical manifestations of failure of individual organs in MODS are caused only by inflammatory mediator damage, tissue hypoxia, and hypermetabolism.

Question 18

Second-degree burns can be full-thickness burns.

Question 19

The renin-angiotensin-aldosterone system compensates for hypovolemic shock by stimulating:

A)antidiuretic hormone from the posterior pituitary to retain potassium and excrete sodium to improve myocardial contractility.
B)ß1-adrenergic receptors to increase myocardial contractility, heart rate, and conduction through the atrioventricular node.
C)aldosterone release, which retains sodium and hence water to increase the blood volume.
D)movement of calcium into vascular smooth muscle, causing vasoconstriction and increasing systemic vascular resistance.

Question 20

The level of IL-1 detected in the serum of a burned individual correlates directly with the burn survival; high levels are associated with a higher mortality.

Question 21

What type of shock results from decreased systemic vascular resistance (SVR)?

A)Septic
B)Cardiogenic
C)Hypovolemic
D)Heart failure

Question 22

Blistering of the skin occurs in _____ burns.

A)first-degree
B)superficial second-degree
C)deep second-degree
D)third-degree

Question 23

The fluid most often used in fluid resuscitation following a major burn injury is:

A)saline.
B)albumin.
C)lactated Ringer.
D)dextrose in water.

Question 24

In MODS, the gut hypothesis attempts to explain:

A)paralytic ileus.
B)translocation of bacteria.
C)maldistribution of blood flow.
D)massive diarrhea accompanying septic shock.

Question 25

Daily evaporative water loss following burn injury is approximately _____ times normal.

A)5
B)10
C)15
D)20

Question 26

Match the types of shock with the corresponding descriptions. Terms can be used more than once.
Follows infection

A)Cardiogenic shock
B)Hypovolemic shock
C)Neurogenic shock
D)Anaphylactic shock
E)Septic shock

Question 27

What mechanism causes organ injury in primary MODS?

A)Impaired immune response
B)Impaired glucose use
C)Impaired perfusion
D)Impaired ventilation

Question 28

What type of shock develops with overstimulation of the parasympathetic nervous system or understimulation of the sympathetic nervous system?

A)Septic shock
B)Cardiogenic shock
C)Anaphylactic shock
D)Vasogenic shock

Question 29

A clinical syndrome involving a systemic response to infection, which is manifested by two or more of the systemic inflammatory response syndrome (SIRS) criteria is the definition of:

A)bacteremia.
B)sepsis.
C)severe sepsis.
D)septic shock.

Question 30

What is the clinical hallmark of neurogenic shock due to overstimulation of the parasympathetic nervous system?

A)Heart rate greater than 100 beats/minute
B)Heart rate less than 60 beats/minute
C)Systolic blood pressure less than 100 mmHg
D)Diastolic blood pressure less than 60 mmHg
E)Fever greater than 38.8° C (102° F)

Question 31

In septic shock, which mediators are anti-inflammatory?

A)IL-4, IL-10, and IL-13
B)TNF-a and granulocyte cell-stimulating factor
C)IL-1, IL-2, and IL-6
D)Prostaglandin, leukotrienes, and bradykinin

Question 32

For which type of shock would antihistamines and corticosteroids be prescribed?

A)Septic
B)Anaphylactic
C)Hypovolemic
D)Cardiogenic

Question 33

Acute burn injury results in _____ shock.

A)hypovolemic
B)septic
C)cardiogenic
D)vasogenic

Question 34

The endpoint of burn shock is defined as the time when the individual is able to:

A)maintain adequate blood pressure for 4 hours.
B)maintain adequate urine output for 2 hours.
C)manage pain without narcotics.
D)manage pain during dressing changes.

Question 35

_____ shock is often more severe than other forms because of its sudden, rapid systemic vasodilation.

A)Septic
B)Hypovolemic
C)Anaphylactic
D)Neurogenic

Question 36

Burn injury induces almost immediate:

A)hypervolemia.
B)hypermetabolism.
C)hyponatremia.
D)hypotension.

Question 37

In secondary MODS, what stimulates the normal endothelial cells to change to a proinflammatory state?

A)IL-4 and IL-13
B)IL-1, IL-6, and TNF-a
C)IFN-g and granulocyte cell-stimulating factor
D)Prostaglandin, leukotrienes, histamine, and bradykinin

Question 38

What effect does fatal burn injury have on interleukins?

A)Decreases levels of IL-2, which may decrease T helper 1 (Th1) lymphocytes
B)Decreases levels of IL-4, which causes a shift in production from Th1 to Th2 lymphocytes
C)Decreases levels of IL-6, which produces cytokines
D)Decreases levels of IL-12, which stimulates the production of immunoglobulins

Question 39

What stimulates the "respiratory burst" and production of highly toxic free radicals in MODS?

A)Neutrophils adhering to the endothelium
B)Activation of the complement cascade
C)Release of prostaglandins, thromboxanes, and leukotrienes
D)Activation of the fibrinolytic system

Question 40

The most reliable criterion of adequate fluid resuscitation following a major burn injury is:

A)blood pressure.
B)pulse rate.
C)respiratory rate.
D)urine output.

Question 41

Match the types of shock with the corresponding descriptions. Terms can be used more than once.
Follows major burns

A)Cardiogenic shock
B)Hypovolemic shock
C)Neurogenic shock
D)Anaphylactic shock
E)Septic shock

Question 42

Match the types of shock with the corresponding descriptions. Terms can be used more than once.
Follows myocardial infarction

A)Cardiogenic shock
B)Hypovolemic shock
C)Neurogenic shock
D)Anaphylactic shock
E)Septic shock

Question 43

Match the types of shock with the corresponding descriptions. Terms can be used more than once.
Follows widespread hypersensitivity reaction

A)Cardiogenic shock
B)Hypovolemic shock
C)Neurogenic shock
D)Anaphylactic shock
E)Septic shock

Question 44

Match the types of shock with the corresponding descriptions. Terms can be used more than once.
Follows parasympathetic stimulation

A)Cardiogenic shock
B)Hypovolemic shock
C)Neurogenic shock
D)Anaphylactic shock
E)Septic shock