Critical care: types of shock: practice question

A General Medicine question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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General Medicine · Critical care: types of shock

Sample item

A 64-year-old man with a large anterior myocardial infarction has cool clammy skin, blood pressure 80/50 mmHg, heart rate 120 per minute, basal crepitations, a raised JVP and oliguria. Which haemodynamic profile would a pulmonary artery catheter show?

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

B. Low cardiac index, high wedge pressure and high systemic vascular resistance

Pump failure after a large infarct causes cardiogenic shock: cardiac output is low, ventricular filling pressures are high so the wedge pressure is raised and pulmonary oedema develops, and vasoconstriction raises systemic vascular resistance. Distributive shock gives the opposite pattern, hypovolaemia gives low filling pressures, and obstructive shock gives raised right-sided pressures with a low wedge pressure.

Option by option

  • A. High cardiac index, low wedge pressure and low systemic vascular resistance

    This warm, high-output, low-resistance pattern is typical of early septic or distributive shock.

  • B. Low cardiac index, high wedge pressure and high systemic vascular resistance (correct)

    Correct. A failing pump gives low output, congested lungs and compensatory vasoconstriction.

  • C. Low cardiac index, low wedge pressure and high systemic vascular resistance

    Low filling pressure with high resistance describes hypovolaemic shock, and this man has pulmonary congestion.

  • D. Low cardiac index, raised right-sided pressure with a normal or low wedge pressure

    This is the pattern in obstructive shock such as massive pulmonary embolism.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

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Questions about this General Medicine question

What is the answer to this General Medicine question?

The best answer is B, Low cardiac index, high wedge pressure and high systemic vascular resistance. Pump failure after a large infarct causes cardiogenic shock: cardiac output is low, ventricular filling pressures are high so the wedge pressure is raised and pulmonary oedema develops, and vasoconstriction raises systemic vascular resistance.

Why is "High cardiac index, low wedge pressure and low systemic vascular resi…" not the answer?

This warm, high-output, low-resistance pattern is typical of early septic or distributive shock.

Why is "Low cardiac index, low wedge pressure and high systemic vascular resi…" not the answer?

Low filling pressure with high resistance describes hypovolaemic shock, and this man has pulmonary congestion.

Why is "Low cardiac index, raised right-sided pressure with a normal or low w…" not the answer?

This is the pattern in obstructive shock such as massive pulmonary embolism.

What concept does this question test?

It tests Critical care: types of shock in General Medicine. Distributive shock gives the opposite pattern, hypovolaemia gives low filling pressures, and obstructive shock gives raised right-sided pressures with a low wedge pressure.

How hard is this question?

We tag it as a multi-step question: it asks you to combine more than one idea. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Critical care: types of shock?

For each disease know the classic presentation, the best test, and the first-line treatment. Then use the flashcards and the other General Medicine questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.