Question 1

A 72-year-old woman reports feeling dizzy and nearly fainting when she stands up quickly in the morning. Her blood pressure drops from 130/80 mm Hg while lying down to 105/68 mm Hg upon standing. Which of the following best defines orthostatic hypotension?

Accepted Answer

A decrease in systolic blood pressure of $$\geq 20 mm Hg or $$diastolic blood pressure of $$\geq 10 mm Hg $$upon standing

Question 2

Which of the following mechanisms is primarily responsible for the rapid compensation of blood pressure when a healthy person stands up from a supine position?

Accepted Answer

Baroreceptor-mediated increase in sympathetic nervous system output

Question 3

A patient with Parkinson’s disease experiences frequent episodes of dizziness upon standing. Which of the following best explains the pathophysiology of his orthostatic hypotension?

Accepted Answer

Impaired autonomic nervous system function leading to reduced baroreflex-mediated sympathetic output

Question 4

Which of the following medications is most likely to cause orthostatic hypotension by reducing blood volume?

Accepted Answer

Loop diuretics

Question 5

A patient presents with syncope, blurred vision, and chest pain after standing up quickly. Which of the following symptoms is most likely due to decreased perfusion of the occipital lobe?

Accepted Answer

Blurred vision

Question 6

Which of the following is a common non-neurogenic cause of orthostatic hypotension?

Accepted Answer

Dehydration due to excessive gastrointestinal losses

Question 7

A 65-year-old man with a history of heart failure and recent gastrointestinal bleeding is at increased risk for orthostatic hypotension. Which of the following best explains why?

Accepted Answer

Decreased intravascular volume leads to reduced venous return and cardiac output upon standing

Question 8

Which of the following is the most appropriate initial management strategy for a patient with orthostatic hypotension due to dehydration?

Accepted Answer

Encourage oral fluid intake and correct underlying volume depletion

Question 9

Which of the following shock syndromes is primarily characterized by impaired cardiac contractility leading to decreased cardiac output ($$CO$$)?

Accepted Answer

Cardiogenic shock

Question 10

A patient in the ICU develops hypotension, warm extremities, and evidence of infection. Which of the following best describes the primary hemodynamic abnormality in septic shock?

Accepted Answer

Decreased systemic vascular resistance ($$SVR) $$due to proinflammatory cytokine-induced vasodilation

Question 11

Which of the following best explains why elderly patients are at increased risk for orthostatic hypotension?

Accepted Answer

Impaired compensatory mechanisms of the autonomic nervous system and increased medication use

Question 12

A patient with diabetes develops orthostatic hypotension. Which of the following is the most likely mechanism?

Accepted Answer

Peripheral neuropathy leading to impaired autonomic regulation

Question 13

Which of the following is a distinguishing feature of neurogenic shock compared to other forms of shock?

Accepted Answer

Loss of sympathetic outflow resulting in decreased systemic vascular resistance ($$SVR)$$

Question 14

A patient is prescribed midodrine for orthostatic hypotension. What is the primary mechanism of action of this medication?

Accepted Answer

Alpha-1 adrenergic receptor agonist causing vasoconstriction

Question 15

A 60-year-old man with a history of hypertension and recent use of tricyclic antidepressants presents with dizziness upon standing. Which of the following best explains his symptoms?

Accepted Answer

Drug-induced impairment of autonomic regulation leading to orthostatic hypotension

Question 16

Which of the following is a common clinical sign of orthostatic hypotension that is more prominent in the setting of hypovolemia?

Accepted Answer

Presyncope (feeling faint) upon standing

Question 17

A patient with orthostatic hypotension is advised to rise slowly from bed and move their legs before standing. What is the physiological rationale for this advice?

Accepted Answer

To increase venous return and reduce blood pooling in the lower extremities

Question 18

Which of the following best describes the metabolic consequence of shock syndromes when tissue perfusion is inadequate?

Accepted Answer

Shift from aerobic to anaerobic metabolism due to lack of sufficient oxygen

Question 19

A patient with a history of cirrhosis develops orthostatic hypotension. Which of the following best explains the pathophysiology?

Accepted Answer

Decreased effective circulating blood volume due to fluid sequestration

Question 20

Which of the following shock syndromes is most likely to present with hypotension and bronchospasm following exposure to an allergen?

Accepted Answer

Anaphylactic shock

Disorders of Low Blood Pressure: Orthostatic Hypotension and Shock Syndromes

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