Spinal cord injury: neurogenic shock: practice question

A Orthopaedics question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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Orthopaedics · Spinal cord injury: neurogenic shock

Sample item

A man with a T4 complete spinal cord injury has a blood pressure of 80/50 mmHg, a heart rate of 50 per minute and warm, dry peripheries. What is the diagnosis?

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

B. Neurogenic shock from loss of sympathetic tone

Injury above about T6 interrupts the sympathetic outflow, which causes vasodilatation, hypotension and bradycardia because vagal tone is unopposed. The skin is warm and dry, unlike hypovolaemic shock with tachycardia and cold peripheries. Treatment is fluids guided cautiously and vasopressors, after excluding bleeding.

Option by option

  • A. Cardiogenic shock

    Cardiogenic shock causes pulmonary oedema and cold peripheries.

  • B. Neurogenic shock from loss of sympathetic tone (correct)

    Correct. Hypotension with bradycardia and warm skin after a high cord injury is neurogenic shock.

  • C. Septic shock

    Septic shock causes fever and tachycardia.

  • D. Hypovolaemic shock from haemorrhage

    Haemorrhagic shock causes tachycardia and cold, pale skin.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

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Questions about this Orthopaedics question

What is the answer to this Orthopaedics question?

The best answer is B, Neurogenic shock from loss of sympathetic tone. Injury above about T6 interrupts the sympathetic outflow, which causes vasodilatation, hypotension and bradycardia because vagal tone is unopposed.

Why is "Cardiogenic shock" not the answer?

Cardiogenic shock causes pulmonary oedema and cold peripheries.

Why is "Septic shock" not the answer?

Septic shock causes fever and tachycardia.

Why is "Hypovolaemic shock from haemorrhage" not the answer?

Haemorrhagic shock causes tachycardia and cold, pale skin.

What concept does this question test?

It tests Spinal cord injury: neurogenic shock in Orthopaedics. The skin is warm and dry, unlike hypovolaemic shock with tachycardia and cold peripheries. Treatment is fluids guided cautiously and vasopressors, after excluding bleeding.

How hard is this question?

We tag it as an application question: it asks you to use a fact on a patient or a finding. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Spinal cord injury: neurogenic shock?

Pair each fracture with its classic complication and nerve injured. Then use the flashcards and the other Orthopaedics questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.