Infectious diseases: septic shock: practice question

A General Medicine 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.

Try it

General Medicine · Infectious diseases: septic shock

Sample item

A 58-year-old man with urosepsis has a blood pressure of 78/40 mmHg and lactate 5.2 mmol/L. After 30 mL/kg of crystalloid and antibiotics, his mean arterial pressure remains 55 mmHg. Which vasopressor should be started first?

APhenylephrineBDopamineCNoradrenalineDDobutamine

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

The answer and the reasoning

C. Noradrenaline

Noradrenaline is the first-line vasopressor in septic shock, targeting a mean arterial pressure of at least 65 mmHg. It raises MAP through alpha-1 vasoconstriction with modest beta-1 effect. Vasopressin is added if needed, and adrenaline is a further option. Dopamine causes more arrhythmias and has been associated with higher mortality.

Option by option

A. Phenylephrine
Phenylephrine is a pure alpha agonist and is not a first-line agent.
B. Dopamine
Dopamine is inferior due to tachyarrhythmias and is reserved for selected patients.
C. Noradrenaline (correct)
Correct. Noradrenaline is recommended first-line as it restores vascular tone with a safer profile.
D. Dobutamine
Dobutamine is an inotrope and does not correct vasodilatory hypotension.

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.

Questions about this General Medicine question

What is the answer to this General Medicine question?

The best answer is C, Noradrenaline. Noradrenaline is the first-line vasopressor in septic shock, targeting a mean arterial pressure of at least 65 mmHg.

Why is "Phenylephrine" not the answer?

Phenylephrine is a pure alpha agonist and is not a first-line agent.

Why is "Dopamine" not the answer?

Dopamine is inferior due to tachyarrhythmias and is reserved for selected patients.

Why is "Dobutamine" not the answer?

Dobutamine is an inotrope and does not correct vasodilatory hypotension.

What concept does this question test?

It tests Infectious diseases: septic shock in General Medicine. It raises MAP through alpha-1 vasoconstriction with modest beta-1 effect. Vasopressin is added if needed, and adrenaline is a further option. Dopamine causes more arrhythmias and has been associated with higher mortality.

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 Infectious diseases: septic shock?

For each disease know the classic presentation, the best test, and the first-line treatment. Then use the flashcards and the other General Medicine 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.