WBR0675

Author	[[PageAuthor::Rim Halaby, M.D. [1]]]
Exam Type	ExamType::USMLE Step 1
Main Category	MainCategory::Pathophysiology
Sub Category	SubCategory::Cardiology
Prompt	[[Prompt::An 82 year old man, with a past medical history of myocardial infarction and heart failure, is brought to the emergency department (ED) with severe shortness of breath, sweating, and altered state of consciousness. He has cold hands and feet. The patient is diagnosed with cardiogenic shock. Which of the following additional findings is consistent with the patient's condition?]]
Answer A	AnswerA::Decrease in total peripheral resistance
Answer A Explanation	AnswerAExp::Total peripheral resistance increases in cardiogenic shock.
Answer B	AnswerB::High-output failure
Answer B Explanation	AnswerBExp::Cardiogenic shock is defined as low-output failure.
Answer C	AnswerC::Tachycardia
Answer C Explanation	AnswerCExp::Patients with cardiogenic shock often have tachycardia.
Answer D	AnswerD::Strong radial pulse
Answer D Explanation	AnswerDExp::Patients with cardiogenic shock often have absent pulse due to tachyarrhythmias.
Answer E	AnswerE::Polyuria
Answer E Explanation	AnswerEExp::Patients with cardiogenic shock often have oliguria due to decreased perfusion to the kidneys.
Right Answer	RightAnswer::C
Explanation	[[Explanation::The patient is diagnosed with cardiogenic shock, which is defined as low-output failure. The patient has symptoms and a past medical history consistent with the diagnosis. Cardiogenic shock is characterized by increased total peripheral resistance, which explains the patient's cold extremities. Also, the patient often has a very weak and maybe absent radial pulse due to the presence of tachyarrhythmias in cardiogenic shock. Due to decreased perfusion to the kidneys and given its definition as a low-output state, patients with cardiogenic shock often have oliguria or even anuria that might complicate the patient's condition with renal involvement. Although considered a state of shock, it is always important to note that cardiogenic shock is associated with tachycardia and tachyarrhythmias, not bradycardia, in attempt to compensate for the low-output. Educational Objective: Patients with cardiogenic shock, a state of low-output failure, usually have tachycardia Educational Objective: References: ]]
Approved	Approved::No
Keyword	WBRKeyword::cardiogenic, WBRKeyword::shock, WBRKeyword::tachycardia, WBRKeyword::bradycardia, WBRKeyword::low, WBRKeyword::output, WBRKeyword::high, WBRKeyword::total, WBRKeyword::peripheral, WBRKeyword::resistance, WBRKeyword::heart, WBRKeyword::failure, WBRKeyword::decompensated, WBRKeyword::cardiac, WBRKeyword::output
Linked Question	Linked::
Order in Linked Questions	LinkedOrder::