Haemodynamics: irreversible stage of shock: practice question

A Pathology 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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Pathology · Haemodynamics: irreversible stage of shock

Sample item

A man in haemorrhagic shock is resuscitated with fluids and blood, and his blood pressure returns to normal. Over the next day he develops oliguric renal failure, lung injury and worsening acidosis, and dies despite supportive care. What best explains the outcome?

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

The answer and the reasoning

C. Widespread ischaemic cell injury that persists after pressure is restored

In the irreversible stage of shock, prolonged hypoperfusion causes enough cell and tissue damage (acute tubular necrosis, diffuse alveolar damage, myocardial depression) that death follows even when haemodynamics are corrected. Lysosomal enzyme leakage and metabolic acidosis feed the cycle.

Option by option

  • A. Persistent loss of circulating volume that was never corrected

    Volume was replaced, so ongoing hypovolaemia does not explain this course.

  • B. Failure of the sympathetic reflex to constrict peripheral vessels

    Reflex vasoconstriction is a feature of the compensated early stage.

  • C. Widespread ischaemic cell injury that persists after pressure is restored (correct)

    Correct. Established multi-organ cellular injury continues even after the pressure is normal.

  • D. Isolated pump failure from an acute coronary occlusion

    Nothing in the history points to a coronary event or primary pump failure.

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 Pathology question

What is the answer to this Pathology question?

The best answer is C, Widespread ischaemic cell injury that persists after pressure is restored. In the irreversible stage of shock, prolonged hypoperfusion causes enough cell and tissue damage (acute tubular necrosis, diffuse alveolar damage, myocardial depression) that death follows even when haemodynamics are corrected.

Why is "Persistent loss of circulating volume that was never corrected" not the answer?

Volume was replaced, so ongoing hypovolaemia does not explain this course.

Why is "Failure of the sympathetic reflex to constrict peripheral vessels" not the answer?

Reflex vasoconstriction is a feature of the compensated early stage.

Why is "Isolated pump failure from an acute coronary occlusion" not the answer?

Nothing in the history points to a coronary event or primary pump failure.

What concept does this question test?

It tests Haemodynamics: irreversible stage of shock in Pathology. Lysosomal enzyme leakage and metabolic acidosis feed the cycle.

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 Haemodynamics: irreversible stage of shock?

Learn each disease as a bundle: cause, key histology, markers, and the clinical hallmark. Then use the flashcards and the other Pathology 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.