Question 1

Why is the initial blood pressure goal >65 mm Hg?

Accepted Answer

A large study showed that patients had significant renal and myocardial injury when than 65 mm Hg

Answer

Because it is a nice round number

Answer

A large study showed that it is more harmful the kidney and cardiac muscle when higher than 70 mm Hg

Answer

Dogs overall did better in a study

Question 2

What is the main goal in treating septic shock?

Accepted Answer

to have a balance between perfusing organs and cellular death

Answer

To perfuse the brain, and cardiac muscle

Answer

To allow / facilitate with antibiotic circulation

Answer

To get the MAP greater than 65 mm Hg

Question 3

Why is lactate produced during shock?

Accepted Answer

Combination of anerobic metabolism and epinephrine cause glycolysis

Answer

Kreb cycle malfunction due to ischemia

Answer

Purely due to anerobic metabolism of pyruvate to lactate from cell hypoxia

Answer

Mitochondrial increased demand from glycogen to glucose and glycolysis from beta 2 stimulation

Question 4

What is the equation for cardiac output?

Accepted Answer

Heart rate x Stroke Volume

Answer

(Preload – after load) X contractility

Answer

LOVT area X LVOT velocity

Answer

Stroke volume – peripheral vascular resistance

Question 5

What is the calculation of oxygen delivery?

Accepted Answer

[(1.32 x hemoglobin x SaO2) x cardiac output] + (0.003 X PaO2)

Answer

[(1.5 x hemoglobin x SaO2) x heart rate x (PVR-SVR)] + (0.03 X PaO2)

Answer

Heart rate x stroke volume x (1/ hematocrit)

Answer

cardiac output x (1/ hematocrit) X (SVR)] - (0.003 X PaO2)

Question 6

What are signs of poor perfusion?

Accepted Answer

Decrease in urine output, decreased capillary refill time, mottled extremities

Answer

Mottled extremities increase in heart rate, increase in lactic acid, decrease in urine output, increased capillary refill time

Answer

Mental status change, increase in lactic acid, increase in urine output, decreased capillary refill time, hemoconcentration

Answer

Mental status change, increase in heart rate, increase in lactic acid, decrease in urine output, increased capillary refill time

Question 7

Which medications are a pure vasopressors?

Accepted Answer

Phenylephrine, vasopressin

Answer

Norepinephrine, and epinephrine

Answer

Epinephrine, phenylephrine

Answer

Norepinephrine, vasopressin, epinephrine

Question 8

What does inotropic mean?

Accepted Answer

Increase contractility

Answer

Increase heart rate

Answer

Increase diastolic filling time

Answer

Increase conduction velocity

Question 9

What does chronotropic mean?

Accepted Answer

Increase heart rate

Answer

Increase contractility

Answer

Increase diastolic filling time

Answer

Increase conduction velocity

Question 10

What does inopressor mean?

Accepted Answer

increases cardiac contractility and induces vasoconstriction

Answer

induces venous vasoconstriction and arterial vasodilation

Answer

increases heart rate and causes arterial vasoconstriction

Answer

increases cardiac contractility and induces vasodilation

Question 11

What does inodilator mean?

Accepted Answer

increases cardiac contractility and induces vasodilation

Answer

increases heart rate and causes arterial vasoconstriction

Answer

increases cardiac contractility and induces vasoconstriction

Answer

induces venous vasoconstriction and arterial vasodilation

Question 12

Which medications are inodilators?

Accepted Answer

isoproterenol, dobutamine, milrinone

Answer

Dobutamine, milrinone, dopamine

Answer

Epinephrine, dopamine, milrinone

Answer

Milrinone, dobutamine, epinephrine

Question 13

What receptor causes free water reabsorption in the kidney?

Accepted Answer

V2

Answer

V1 + V2

Answer

V1

Question 14

Vasopressin works on which receptors?

Accepted Answer

V1 and V2

Answer

V2 at low doses and then V1>V2 at high doses

Answer

V1 at low doses and then V2>V1 at high doses

Answer

V1 only

Question 15

Which receptor causes smooth muscle vasoconstriction?

Accepted Answer

Alpha 1

Answer

Beta 1

Answer

Alpha 2

Answer

Beta 2

Question 16

Which receptor causes increased chronotropy and inotropy?

Accepted Answer

Beta 1

Answer

Alpha 2

Answer

Beta 2

Answer

Alpha 1

Question 17

Which receptor causes bronchodilation?

Accepted Answer

Beta 2

Answer

Beta 1

Answer

Alpha 1

Answer

Alpha 2

Question 18

What is vasopressin?

Accepted Answer

Hormone

Answer

Catecholamine

Answer

Catecholamine + Hormone

Question 19

What receptor(s) are activated by norepinephrine?

Accepted Answer

alpha 1 and beta 1

Answer

alpha 1 and alpha 2

Answer

alpha 1 and beta 2

Answer

Alpha 2 and beta 1

Question 20

Activation of this/these receptor(s) by norepinephrine can cause arrythmias?

Accepted Answer

Beta 1

Answer

Beta 2

Answer

Alpha 1

Answer

Alpha 1 + Beta 1

Question 21

Activation of this receptor is important in septic and obstructive shock by norepinephrine due to increased _______?

Accepted Answer

Beta 1- increased inotropy

Answer

Beta 2- bronchodilation

Answer

Alpha 1 – vasoconstriction

Answer

Alpha 2- vasodilation

Question 22

Which is better for cardiogenic shock: norepinephrine vs dopamine?

Accepted Answer

Norepinephrine

Answer

Dopamine

Question 23

At low doses, what receptor(s) are activated by epinephrine?

Accepted Answer

Beta 1

Answer

Alpha 1 + Beta 1

Answer

Alpha 1 + Beta 2

Answer

alpha 1

Question 24

What was the major unwanted effect by epinephrine in the SOAP II trial?

Accepted Answer

Hyperglycemia

Answer

ischemia

Answer

hyperthermia

Answer

tachycardia

Question 25

Which drug is best in pediatric septic shock?

Accepted Answer

Epinephrine

Answer

Vasopressin

Answer

Norepinephrine

Answer

Phenylephrine

Question 26

Which drug is best with anaphylactic shock?

Accepted Answer

Epinephrine

Answer

Phenylephrine

Answer

Vasopressin

Answer

Norepinephrine

Question 27

At 1 mg dose or greater, what receptor is more activated by epinephrine (alpha or beta) & which is more harmful?

Accepted Answer

Alpha 1 >  Beta 1;  Beta 1

Answer

Alpha 1 <  Beta 1; Alpha 1

Answer

Alpha 1 <  Beta 1; Beta 1

Answer

Alpha 1 >  Beta 1; Alpha 1

Question 28

Which pressor is more known to be the most arrhythmogenic?

Accepted Answer

Dopamine

Answer

Epinephrine

Answer

Norepinephrine

Answer

Dobutamine

Question 29

At 5-10 mcg/kg/min, what receptor(s) are primary activated by dopamine?

Accepted Answer

Beta 1

Answer

Alpha 1

Answer

Alpha 1 + Beta 1

Answer

Alpha 1 + Beta 2

Question 30

At >10 mcg/kg/min, what receptor(s) are more activated by dopamine?

Accepted Answer

Alpha 1 > Beta 1

Answer

Alpha 1 = Beta 1

Answer

Alpha 1 < Beta 2

Answer

Beta 1 > Beta 2

Question 31

What receptor(s) are activated by phenylephrine?

Accepted Answer

Alpha 1

Answer

Beta 1

Answer

Alpha 1 + Beta 1

Answer

Alpha 1 + Beta 2

Question 32

In which situation would phenylephrine be harmful to the patient?

Accepted Answer

Cardiogenic shock

Answer

Pediatric Septic Shock

Answer

Hemorrhagic shock

Answer

Adult Septic Shock

Question 33

What is the dose of push dose phenylephrine that should be administered to a patient?

Accepted Answer

80-200 mcg every 2- 4 minutes

Answer

100-200 mcg every 5-10 minutes

Answer

100-300 mcg every 5-10 minutes

Answer

150-200 mcg every 2-4 minutes

Question 34

What is the onset of push dose phenylephrine?

Accepted Answer

1 minute

Answer

10 seconds

Answer

30 seconds

Answer

2 minutes

Question 35

What is the dose of push dose epinephrine that should be administered to a patient?

Accepted Answer

10-20 mcg every 2-5 minutes

Answer

15-20 mcg every 5-10 minutes

Answer

8-20 mcg every 2- 5 minutes

Answer

5-10 mcg every 5-10 minutes

Question 36

What is the duration of push dose epinephrine?

Accepted Answer

5-10 minutes

Answer

<30 seconds

Answer

1-2 minutes

Answer

10-20 minutes

Question 37

Where does dobutamine work?

Accepted Answer

Beta 1 + Beta 2

Answer

Beta 1

Answer

Alpha 1 + Beta 2

Answer

Alpha 1

Question 38

Where do you mainly want dobutamine to work in cardiogenic shock?

Accepted Answer

Beta 2

Answer

Alpha 2

Answer

Alpha 1

Answer

Beta 1

Question 39

Can you use dobutamine a as first line agent in septic shock?

Accepted Answer

No

Answer

who knows

Answer

Yes

Question 40

Which medication is a phosphodiesterase 3 inhibitor?

Accepted Answer

Milrinone

Answer

Norepinephrine

Answer

Selepressin

Answer

Dobutamine

Question 41

What is lusitropy?

Accepted Answer

Diastolic relaxation

Answer

Increased ventricular filling

Answer

Increased heart rate

Answer

Contraction of the ventricles

Question 42

Are arrythmias common with milrinone?

Accepted Answer

No

Answer

Yes

Answer

who knows

Question 43

Why is milrinone good in obstructive shock?

Accepted Answer

Decreased pulmonary vascular resistance

Answer

Decreased afterload

Answer

Bronchodilator

Answer

Decrease preload

Question 44

Which drug is a hormone?

Accepted Answer

Vasopressin

Answer

Milrinone

Answer

Dobutamine

Answer

Norepinephrine

Question 45

How does vasopressin cause vasodilation?

Accepted Answer

Inhibits nitric oxide production

Answer

Inhibits alpha 1

Answer

Activates Beta 2

Answer

Activates alpha 1

Question 46

How does vasopressin help a patient with a pulmonary embolisms?

Accepted Answer

Restore mean arterial blood pressure, decrease pulmonary vascular resistance

Answer

Decrease preload, decrease cardiac afterload

Answer

Decrease preload, Restore mean arterial blood pressure

Answer

Decrease cardiac afterload, decrease pulmonary vascular resistance

Question 47

How do you titrate vasopressin?

Accepted Answer

it is not titrated

Answer

0.4-0.5 mcg/hour

Answer

1-3 mcg/kg/hour

Answer

0.03-0.05 mcg/kg/min

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