PATHO 370 Week 3 Pathophysiology Exam Edition 2: Advanced 150-Question Bank with Verified
Answers and Clinical Rationales for Hemodynamics, Shock, Hypertension, ACS, Heart Failure, and
Arrhythmias – 2026 Updated
Questions 1–150 (With Correct Answers & Explanations)
Section 1: Hemodynamics & Shock – Advanced Concepts (1–30)
1. A patient in hypovolemic shock has a pulse pressure of 20 mmHg. This indicates:
A) Increased stroke volume
B) Decreased stroke volume
C) Normal cardiac function
D) Increased aortic compliance
Correct Answer: B – Narrow pulse pressure reflects reduced stroke volume in hypovolemia.
2. Which finding is consistent with early decompensated shock?
A) Alert and oriented
B) Urine output 40 mL/hr
C) Serum lactate 6 mmol/L
D) Warm, dry skin
Correct Answer: C – Elevated lactate indicates tissue hypoxia despite compensatory mechanisms.
3. The primary pathophysiologic mechanism of warm shock in early sepsis is:
A) Increased systemic vascular resistance
B) Decreased cardiac output
C) Nitric oxide-mediated vasodilation
D) Myocardial depression only
Correct Answer: C – Inflammatory cytokines induce iNOS, producing excessive NO.
4. A patient with neurogenic shock has a heart rate of 55 bpm and blood pressure 80/50 mmHg.
The most appropriate initial vasopressor is:
A) Epinephrine
B) Norepinephrine
C) Phenylephrine
, D) Vasopressin
Correct Answer: C – Phenylephrine (pure alpha-1 agonist) is often used in neurogenic shock.
5. In obstructive shock due to massive PE, right ventricular pressure:
A) Decreases
B) Increases dramatically
C) Remains normal
D) Equals left ventricular pressure
Correct Answer: B – Acute pressure overload causes RV hypertension.
6. Which hemodynamic profile is typical of hypovolemic shock?
A) High PCWP, low CO
B) Low PCWP, low CO
C) High PCWP, high CO
D) Low PCWP, high CO
Correct Answer: B – Low preload (PCWP) and low cardiac output.
7. A patient with septic shock has a central venous oxygen saturation (ScvO₂) of 50% despite
adequate fluids. The next step is:
A) Increase norepinephrine
B) Transfuse red blood cells
C) Start dobutamine
D) Discontinue vasopressors
Correct Answer: C – Low ScvO₂ indicates inadequate oxygen delivery; dobutamine increases CO.
8. The earliest measurable marker of acute kidney injury in shock is:
A) Serum creatinine
B) Blood urea nitrogen
C) Urine output
D) Neutrophil gelatinase-associated lipocalin (NGAL)
Correct Answer: D – NGAL rises within hours of renal injury, before creatinine.
9. A patient with anaphylactic shock and severe bronchospasm has failed epinephrine. The next
best agent is:
A) Diphenhydramine
B) Continuous epinephrine infusion
, C) Methylprednisolone
D) Albuterol nebulizer
Correct Answer: B – Continuous epinephrine infusion is indicated for refractory anaphylaxis.
10. In cardiogenic shock, the use of mechanical circulatory support such as Impella:
A) Increases afterload
B) Unloads the left ventricle
C) Increases myocardial oxygen demand
D) Decreases coronary perfusion
Correct Answer: B – Impella pumps blood from LV to aorta, reducing ventricular work.
11. A patient with massive hemorrhage receives 6 units of packed red blood cells, 4 units of plasma,
and 1 unit of platelets. This ratio (1:1:1) is used to prevent:
A) Hyperkalemia
B) Trauma-induced coagulopathy
C) Transfusion reaction
D) Volume overload
Correct Answer: B – Balanced resuscitation prevents dilutional coagulopathy.
12. Which acid-base disorder is most common in early septic shock?
A) Metabolic acidosis with high anion gap
B) Metabolic alkalosis
C) Respiratory acidosis
D) Mixed metabolic and respiratory alkalosis
Correct Answer: A – Lactic acidosis causes high anion gap metabolic acidosis.
13. The “microcirculatory” dysfunction in septic shock is characterized by:
A) Increased capillary density
B) Heterogeneous perfusion with shunting
C) Uniform vasoconstriction
D) Increased RBC deformability
Correct Answer: B – Some capillaries are shut, others overperfused, causing shunting.
14. In hemorrhagic shock, the primary stimulus for increased heart rate is:
A) Increased vagal tone
B) Decreased baroreceptor firing
, C) Direct myocardial depression
D) Increased atrial stretch
Correct Answer: B – Low BP reduces baroreceptor firing, disinhibiting sympathetic outflow.
15. A patient with anaphylactic shock has stridor and hypotension. The FIRST medication to
administer is:
A) Diphenhydramine IV
B) Methylprednisolone IV
C) Epinephrine IM
D) Albuterol nebulizer
Correct Answer: C – IM epinephrine (0.3–0.5 mg) is first-line for anaphylaxis.
16. Which shock state is associated with bradycardia rather than tachycardia?
A) Hypovolemic
B) Cardiogenic
C) Neurogenic
D) Septic
Correct Answer: C – Loss of sympathetic tone causes bradycardia.
17. A patient with tension pneumothorax develops obstructive shock. Immediate treatment is:
A) Chest tube insertion
B) Needle decompression
C) Pericardiocentesis
D) Fluid bolus
Correct Answer: B – Needle decompression (second intercostal space, midclavicular line) relieves
tension.
18. The hallmark of irreversible shock is:
A) Responsiveness to fluids
B) Rebound hypertension
C) Progressive organ failure despite correcting hemodynamics
D) Normal lactate
Correct Answer: C – End-organ damage becomes self-perpetuating.
19. Which vasopressor has both alpha and beta effects and is often used in cardiogenic shock with
hypotension?
Answers and Clinical Rationales for Hemodynamics, Shock, Hypertension, ACS, Heart Failure, and
Arrhythmias – 2026 Updated
Questions 1–150 (With Correct Answers & Explanations)
Section 1: Hemodynamics & Shock – Advanced Concepts (1–30)
1. A patient in hypovolemic shock has a pulse pressure of 20 mmHg. This indicates:
A) Increased stroke volume
B) Decreased stroke volume
C) Normal cardiac function
D) Increased aortic compliance
Correct Answer: B – Narrow pulse pressure reflects reduced stroke volume in hypovolemia.
2. Which finding is consistent with early decompensated shock?
A) Alert and oriented
B) Urine output 40 mL/hr
C) Serum lactate 6 mmol/L
D) Warm, dry skin
Correct Answer: C – Elevated lactate indicates tissue hypoxia despite compensatory mechanisms.
3. The primary pathophysiologic mechanism of warm shock in early sepsis is:
A) Increased systemic vascular resistance
B) Decreased cardiac output
C) Nitric oxide-mediated vasodilation
D) Myocardial depression only
Correct Answer: C – Inflammatory cytokines induce iNOS, producing excessive NO.
4. A patient with neurogenic shock has a heart rate of 55 bpm and blood pressure 80/50 mmHg.
The most appropriate initial vasopressor is:
A) Epinephrine
B) Norepinephrine
C) Phenylephrine
, D) Vasopressin
Correct Answer: C – Phenylephrine (pure alpha-1 agonist) is often used in neurogenic shock.
5. In obstructive shock due to massive PE, right ventricular pressure:
A) Decreases
B) Increases dramatically
C) Remains normal
D) Equals left ventricular pressure
Correct Answer: B – Acute pressure overload causes RV hypertension.
6. Which hemodynamic profile is typical of hypovolemic shock?
A) High PCWP, low CO
B) Low PCWP, low CO
C) High PCWP, high CO
D) Low PCWP, high CO
Correct Answer: B – Low preload (PCWP) and low cardiac output.
7. A patient with septic shock has a central venous oxygen saturation (ScvO₂) of 50% despite
adequate fluids. The next step is:
A) Increase norepinephrine
B) Transfuse red blood cells
C) Start dobutamine
D) Discontinue vasopressors
Correct Answer: C – Low ScvO₂ indicates inadequate oxygen delivery; dobutamine increases CO.
8. The earliest measurable marker of acute kidney injury in shock is:
A) Serum creatinine
B) Blood urea nitrogen
C) Urine output
D) Neutrophil gelatinase-associated lipocalin (NGAL)
Correct Answer: D – NGAL rises within hours of renal injury, before creatinine.
9. A patient with anaphylactic shock and severe bronchospasm has failed epinephrine. The next
best agent is:
A) Diphenhydramine
B) Continuous epinephrine infusion
, C) Methylprednisolone
D) Albuterol nebulizer
Correct Answer: B – Continuous epinephrine infusion is indicated for refractory anaphylaxis.
10. In cardiogenic shock, the use of mechanical circulatory support such as Impella:
A) Increases afterload
B) Unloads the left ventricle
C) Increases myocardial oxygen demand
D) Decreases coronary perfusion
Correct Answer: B – Impella pumps blood from LV to aorta, reducing ventricular work.
11. A patient with massive hemorrhage receives 6 units of packed red blood cells, 4 units of plasma,
and 1 unit of platelets. This ratio (1:1:1) is used to prevent:
A) Hyperkalemia
B) Trauma-induced coagulopathy
C) Transfusion reaction
D) Volume overload
Correct Answer: B – Balanced resuscitation prevents dilutional coagulopathy.
12. Which acid-base disorder is most common in early septic shock?
A) Metabolic acidosis with high anion gap
B) Metabolic alkalosis
C) Respiratory acidosis
D) Mixed metabolic and respiratory alkalosis
Correct Answer: A – Lactic acidosis causes high anion gap metabolic acidosis.
13. The “microcirculatory” dysfunction in septic shock is characterized by:
A) Increased capillary density
B) Heterogeneous perfusion with shunting
C) Uniform vasoconstriction
D) Increased RBC deformability
Correct Answer: B – Some capillaries are shut, others overperfused, causing shunting.
14. In hemorrhagic shock, the primary stimulus for increased heart rate is:
A) Increased vagal tone
B) Decreased baroreceptor firing
, C) Direct myocardial depression
D) Increased atrial stretch
Correct Answer: B – Low BP reduces baroreceptor firing, disinhibiting sympathetic outflow.
15. A patient with anaphylactic shock has stridor and hypotension. The FIRST medication to
administer is:
A) Diphenhydramine IV
B) Methylprednisolone IV
C) Epinephrine IM
D) Albuterol nebulizer
Correct Answer: C – IM epinephrine (0.3–0.5 mg) is first-line for anaphylaxis.
16. Which shock state is associated with bradycardia rather than tachycardia?
A) Hypovolemic
B) Cardiogenic
C) Neurogenic
D) Septic
Correct Answer: C – Loss of sympathetic tone causes bradycardia.
17. A patient with tension pneumothorax develops obstructive shock. Immediate treatment is:
A) Chest tube insertion
B) Needle decompression
C) Pericardiocentesis
D) Fluid bolus
Correct Answer: B – Needle decompression (second intercostal space, midclavicular line) relieves
tension.
18. The hallmark of irreversible shock is:
A) Responsiveness to fluids
B) Rebound hypertension
C) Progressive organ failure despite correcting hemodynamics
D) Normal lactate
Correct Answer: C – End-organ damage becomes self-perpetuating.
19. Which vasopressor has both alpha and beta effects and is often used in cardiogenic shock with
hypotension?
