Question 1

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

Accepted Answer

Clinical manifestations of septic shock are persistent low arterial pressure, low SVR from vasodilation, and an alteration in oxygen extraction by all cells.

Question 2

Blistering of the skin occurs in _____ burns.

Accepted Answer

The hallmark of superficial partial-thickness injury is the appearance of thin-walled, fluid-filled blisters that develop within just a few minutes after injury.

Question 3

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

Accepted Answer

Lactated Ringer solution is used because it closely approximates extracellular fluid, the repository of fluid leaving the circulatory system during this phase of extensive edema formation (Table 46-4).

Question 4

In MODS, the gut hypothesis attempts to explain:

Accepted Answer

The loss of intestinal barrier function leads to the systemic spread of bacteria and/or endotoxin from the gut (systemic endotoxemia). This phenomenon is called translocation of bacteria. The gut hypothesis provides a possible explanation for the fact that an infectious focus is not always found in individuals with MODS.

Question 5

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

Accepted Answer

Moncrief and Mason attempted to determine the magnitude of such a loss and determined that daily evaporative water loss was in the range of 20 times normal in the early phase of injury, with gradual decreases as wound closure is achieved.

Question 6

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

Accepted Answer

Septic shock is a type of shock that follows an infection, leading to a systemic inflammatory response and potentially resulting in organ dysfunction and low blood pressure.

Question 7

What mechanism causes organ injury in primary MODS?

Accepted Answer

In primary MODS the organ injury is directly associated with a specific insult, most often ischemia or impaired perfusion from an episode of shock or trauma, thermal injury, soft tissue necrosis, or invasive infection.

Question 8

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

Accepted Answer

Neurogenic shock is sometimes called vasogenic shock. Both terms refer to a widespread and massive vasodilation that result from an imbalance between parasympathetic and sympathetic stimulation of vascular smooth muscle .

Question 9

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:

Accepted Answer

Sepsis is a systemic response to infection that is manifested by two or more of the SIRS criteria.

Question 10

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

Accepted Answer

Neurogenic shock is sometimes called vasogenic shock. Both terms refer to a widespread and massive vasodilation that results from an imbalance between parasympathetic and sympathetic stimulation of vascular smooth muscle .

Question 11

In septic shock, which mediators are anti-inflammatory?

Accepted Answer

Anti-inflammatory mediators released include lipopolysaccharide binding protein; IL-1 receptor antagonist; soluble CD-14; type 2 IL-1 receptor; leukotriene b4 receptor antagonist; IL-4, IL-10, and IL-13; and soluble tumor necrosis factor.

Question 12

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

Accepted Answer

Epinephrine is administered to decrease mast cell and basophil degranulation, cause vasoconstriction, and reverse airway constriction. Volume expanders (e.g., lactated Ringer solution) are given intravenously to reverse the relative hypovolemia, and antihistamines and steroids are given to stop the inflammatory reaction.

Question 13

Acute burn injury results in _____ shock.

Accepted Answer

Burn shock consists of a hypovolemic cardiovascular component and a cellular component. Hypovolemia associated with burn shock results from massive fluid losses from the circulating blood volume.

Question 14

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

Accepted Answer

The endpoint of burn shock is defined as the state in which the individual is able to maintain adequate urine output for 2 hours with the intravenous fluid administration rate equal to the individual's calculated maintenance rate (Box 46-4).

Question 15

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

Accepted Answer

Anaphylactic shock is often more severe than other types of normovolemic shock because the hypersensitivity reaction that triggers vasodilation has other pathophysiologic effects that rapidly involve the entire body.

Question 16

Burn injury induces almost immediate:

Accepted Answer

Burn injury induces a hypermetabolic state that persists until wound closure.

Question 17

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

Accepted Answer

Normal endothelial cells have little interaction with leukocytes except when stimulated by TNF, IL-1, IL-6.

Question 18

What effect does fatal burn injury have on interleukins?

Accepted Answer

Fatal burn injury has often shown decreased levels of IL-2, which may result in decreased Th1 lymphocytes.

Question 19

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

Accepted Answer

The accumulation of activated neutrophils in organs is thought to play a key role in the pathogenesis of MODS. When neutrophils adhere to the endothelium, they undergo a "respiratory burst" (oxidative burst) and release oxygen radicals. The respiratory burst occurs as the activated neutrophil experiences a sudden increase in oxidative metabolism, producing large quantities of highly toxic oxygen free radicals.

Question 20

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

Accepted Answer

The most reliable criterion for adequate resuscitation of burn shock is urine output.

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

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