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OVERVIEW
This page is dedicated to organizing various examples of standardized exam questions whose topic is cardiogenic shock. While this may seem a odd practice, it is useful to see multiple examples of how cardiogenic shock will be characterized on standardized exams (namely the boards and the shelf exams). This page is not meant to be used as a traditional question bank (as all of the answers will be the same), however seeing the classic “test” characterization for a topic is quite valuable.
KEY CHARACTERISTICS OF THIS CONDITION (ON EXAMS)
When it comes to standardized exams, each topic has its own “code” marked by key buzzwords, lab findings, clues, etc. If you are well versed in this code you will be able to more quickly identify the condition that is being discussed, and get the right answer on the exam you are taking. Below is the “code” for cardiogenic shock.
Chief Complaints:
- Shortness of breath is a common chief complaints
- Loss of consciousness/collapse can be presenting issue/complaint as well
Patient History:
- Recent myocardial infarction: often times patients will have this as a component of their history/or will be diagnosed with an MI during the time frame of the vignette.
Clinical Workup:
- Hypotension: will be present on patient’s vitals
- Tachycardia: will often be present
- Jugular venous distention can be a an important physical exam finding (due to decreased cardiac output)
- Crackles in lung fields due to pulmonary edema
- Low cardiac index
QUESTION EXAMPLES
Question # 1
A 40 year old woman is brought to the ER after she is found on the floor unconscious by her husband. Her temperature is currently 96.7°F, heart rate is 130 bpm, and blood pressure is 70/40 mm Hg. A physical exam shows cool and visibly pale extremities. She also has jugular venous distention, weak pulses, and there are crackles over her lung fields bilaterally. Cardiac auscultation does not reveal any extra heart sounds and there are no murmurs. What type of shock is this patient most likely experiencing?
Explanation # 1
Unconscious patient + tachycardia + hypotension + jugular venous distension + lung crackles = cardiogenic shock
Question # 2
A week after having an emergency colon resection a 90 year old man feels the sudden onset of shortness of breath. His operation was scheduled for an obstruction malignant mass in the sigmoid colon. His past medical history is significant of a 20 year history of coronary artery disease. He is currently agitated and is also slightly confused. His temperature is 99.8°F, pulse 105/min, respirations are 28/min, and his blood pressure is 85/45 mm Hg. A physical exam is notable for crackles that are heard over the lung fields, and also jugular venous distention. There are no murmurs or rubs heard during cardiac auscultation. The abdominal exam is notable for distention and hepatomegaly. The patient’s oxygen saturation is 90% on room air. An EKG is order dan shows ST elevation in the anterior leads. What is the likely diagnosis in this patient?
Explanation # 2
Shortness of breath + tachycardia + hypotension + lung crackles + jugular venous distention + STEMI (seen on EKG) = cardiogenic shock
Question # 3
About 8 hours after the onset of chest pain, a 80 year old male collapses at home. He is brought to the ER where the diagnosis of an acute anterior wall MI is made. His puss is currently 110/min, and his blood pressure is 80 mm Hg over palpation. The patient has pale and clammy skin. Diffuse crackles are heard over the lung fields bilaterally. Cardiac auscultation reveals the presence of an S3 heart sound. What is the likely diagnosis in this patient?
Explanation # 3
Collapse at home + acute MI + tachycardia + hypotension + lung crackles = cardiogenic shock
Question # 4
About 4 hours after undergoing surgery for a leaking abdominal aortic aneurysm, a 75 year old female undergoes pulmonary artery catheterization. The results are shown below:
- Cardiac index: 1.1 L/min/m² (ref range = 2.5-4.2)
- Mean arterial pressure: 60 mm Hg (ref range = 80-90)
- Pulmonary capillary wedge pressure; 32 mm Hg (ref range = 5-16)
- Central venous pressure: 30 cm H20 (ref range = 5-8)
- Pulmonary arterial pressure: 60/40 mm Hg (ref range = 15-80/3-12)
IV dopamine was given to the patient during the operation, and continues to be given. The patient’s aneurysm operation lasted 4 hours, and was complicated by numerous episodes of hypotension, metabolic acidosis, and the patient had oliguria during the case. An EKG is performed and shows supraventricular and ventricular arrhythmias. What might explain the hemodynamic findings in this patient?
Explanation # 4
Low cardiac index = cardiogenic shock
TESTABLE FACTS ABOUT THIS TOPIC (BEYOND ITS IDENTIFICATION)
Many questions on standardized exams go beyond simply recognizing the underlying topic. Often there are specific testable facts regarding some aspect of the topic’s pathophysiology/management/clinical implications that are commonly asked. Some of these are listed below:
Treatment:
- Dopamine is used to increase a patient’s blood pressure
Page Updated: 10.07.2017