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NBME 20 Answers

nbme20/Block 3/Question#29 (27.2 difficulty score)
An 83-year-old man is brought to the ...
Early septic shockπŸ”
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 +7 
submitted by hayayah(1056),
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smc213  Septic shock can also present with hypothermia <36C +3  
bethune  Why is it not gastrointestinal bleeding? +3  
beanie368  GI bleeding would present with increased SVR as a response to hypovolemia +5  
mysteriousmantyping  Why would this not be pulmonary embolism? +  
step1passfail  Pulmonary embolism would cause a decrease in cardiac output. There is increased pressure in the high compliant RV which can bulge and compress the LV, decreasing its preload. CO=Heart rate x stroke volume and stroke volume is partially determined by preload. If the pulmonary embolism is large enough, it can also obstruct the pulmonary vessels and subsequently not have enough blood going to the LA and LV, ultimately making the cardiac output near 0. +1  



 +0 
submitted by spaceboy98(17),

The way i look at this is the temperature.

A hypothermic patient will almost always present with septic shock because septic shock can present as both hyperthermia or hypothermia