Deck 44: Shock, Multiple Organ Dysfunction Syndrome, and Burns in Adults

Question 1

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.

Answer 1

lysosomal enzyme release.

Question 2

Without oxygen,cells shift from anaerobic to aerobic metabolism.

Answer 2

False

Question 3

Second-degree burns can be full-thickness burns.

Answer 3

False

Question 4

The gastrointestinal system is very sensitive to ischemic and inflammatory injury.

Question 5

The renin-angiotensin 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 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 6

With reperfusion in multiple organ dysfunction syndrome (MOSD),oxygen radicals are formed from oxygen by the action of xanthine oxidase that attack the already damaged tissue.

Question 7

The level of interleukin 1 (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 8

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 9

The clinical manifestations of failure of individual organs in multiple organ dysfunction syndrome (MODS)are caused only by inflammatory mediator damage,tissue hypoxia,and hypermetabolism.

Question 10

Secondary multiple organ dysfunction syndrome (MODS)results from excessive inflammatory reaction.

Question 11

In multiple organ dysfunction syndrome (MOSD),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.

Question 12

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 13

Burn shock is a form of hemorrhagic shock.

Question 14

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

Question 15

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

Question 16

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

Question 17

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

Question 18

A clinical infection is necessary for the development of septic shock.

Question 19

What parameter of stroke volume is affected by cardiogenic shock?

A) Preload is increased.
B) Preload is decreased.
C) Contractility is increased.
D) Afterload is increased.
E) Afterload is decreased.

Question 20

In multiple organ dysfunction syndrome (MODS),organs that show signs of failure are those involved in the initial injury.

Question 21

In secondary multiple organ dysfunction syndrome (MOSD),what stimulates the normal endothelial cells to change to proinflammatory state?

A) Interleukin 4 (IL-4)and interleukin 13 (IL-13)
B) Interleukin 1 (IL-1),interleukin 6 (IL-6),and tumor necrosis factor alpha (TNF-)
C) Interferon gamma and granulocyte cell-stimulating factor
D) Prostaglandin,leukotrienes,histamine,and bradykinin

Question 22

What type of shock develops when there is an 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 23

Blistering of the skin occurs in __________ burns.

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

Question 24

Burn injury induces almost immediate:

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

Question 25

What is the action of vasopressin (antidiuretic hormone)administration in the treatment of shock?

A) Vasopressin counteracts the chemical mediators that cause vasodilation.
B) Vasopressin stimulates ß₁ adrenergic receptors to increase heart rate.
C) Vasopressin retains sodium to increase fluid volume.
D) Vasopressin constricts arterioles to increase systemic vascular resistance.

Question 26

The end point 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 27

In multiple organ dysfunction syndrome (MOSD),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 28

A clinical syndrome involving a deleterious host response to an infection is the definition of:

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

Question 29

What mechanism causes organ injury in primary multiple organ dysfunction syndrome (MOSD)?

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

Question 30

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 31

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 32

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

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

Question 33

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

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

Question 34

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

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

Question 35

What type of shock results from decreased systemic vascular resistance?

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

Question 36

What type of shock results from endotoxins,release of chemical mediators,and activation of the complement cascade?

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

Question 37

In septic shock,which mediators are anti-inflammatory?

A) Interleukin 4 (IL-4),interleukin 10 (IL-10),and interleukin 13 (IL-13)
B) Tumor necrosis factor alpha (TNF-)and granulocyte cell-stimulating factor
C) Interleukin 1 (IL-1),interleukin 2 (IL-2),and interleukin 6 (IL-6).
D) Prostaglandin,leukotrienes,and bradykinin.

Question 38

What stimulates the "respiratory burst" and production of highly toxic free radicals in multiple organ dysfunction syndrome (MOSD)?

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 39

What effect does fatal burn injury have on interleukins?

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

Question 40

Acute burn injury results in _____ shock.

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

Question 41

MATCHING
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

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

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

Question 43

MATCHING
Match the types of shock with the corresponding descriptions.Terms can be used more than once.
Begins as an allergic reaction

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

Question 44

MATCHING
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 45

MATCHING
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 46

MATCHING
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