A 28-year-old female patient, known case of Systemic Lupus Erythematosus (SLE), presented to the Emergency Department with a 2-hour history of progressive dyspnea and productive cough. Her current medications include Prednisolone and Azathioprine. Upon arrival, she received 2 liters of Normal Saline. Shortly after, the nursing staff called you because the patient became acutely distressed and unable to lie flat (orthopnea). Physical Examination & Vital Signs: BP: 80/45 mmHg HR: 140 bpm (Tachycardia) RR: … breaths/min Temperature: 38°C O2 Saturation: … % on 100% FiO2 General Appearance: The patient appears pale, clammy, and cold to the touch. Precordium: Soft S1 and S2 with a gallop (S3) heard at the apex. Chest Auscultation: Bronchial breathing over the posterior lower lobes with bilateral basal crepitations. Extremities: Bilateral pitting edema up to the mid-shin. Based on the clinical presentation, what is the most likely type of shock?
سؤال مجاني 4 من 10 اليوم · اشترك وكمّل بدون حد
اعرض الإجابة
الإجابة والشرح
ادخل لحسابك عشان نحفظ إجاباتك ونوريك أخطاءك.
الإجابة: A. Cardiogenic shock
Hypotension with cold, pale, clammy skin (low cardiac output with vasoconstriction), an S3 gallop, orthopnoea and basal crepitations that worsened after 2 L of saline, plus peripheral oedema, point to pump failure, i.e. cardiogenic shock (e.g. lupus myocarditis). Septic/distributive shock is classically warm and pink with low SVR and should improve with fluids, not develop pulmonary oedema. Hypovolaemic shock would not cause oedema, crepitations or an S3. Fever and bronchial breathing suggest an added chest infection, but the haemodynamic picture is cardiogenic.
ليش كل خيار صح أو غلط
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A
ليش صح
The listed complication of cardiogenic shock is pulmonary oedema; here saline led to orthopnoea, basal crepitations, S3 and oedema.
✓ CARDIOLOGY-HYPOTENSION AND SHOCK.pdf · p. 8 -
B
ليش غلط
Hypovolaemic shock comes from plasma or blood loss (vomiting, diarrhoea, burns, bleeding); nothing here suggests volume loss, and saline made her worse.
✓ 14• Shock [Notes].pdf · p. 1 -
C
ليش غلط
Distributive (septic) shock has low SVR with warm, pink extremities; this patient is cold, pale and clammy.
✓ 14• Shock [Notes].pdf · p. 5 -
D
ليش غلط
Obstructive shock comes from tamponade, tension pneumothorax or pulmonary embolism; the stem shows none of these but an S3 gallop with crepitations and oedema.
✓ 14• Shock [Notes].pdf · p. 2
- المصدر
- 14• Shock [Notes].pdf · p. 5
CARDIOLOGY-HYPOTENSION AND SHOCK.pdf · p. 8 - المحاضرة
- Heart Failure · Cardiology · Module B
- ظهر في
- MED43 ♀ Quiz B