Answers & Examiner Commentary

Q1. Summarize the current clinical issues in this patient.

  • Post-op septic shock with hypotension, lactate 4.1, oliguria, and acidosis
  • Possible under-resuscitation and/or ongoing bleeding (high drain, low Hb)
  • Early multi-organ dysfunction: AKI, thrombocytopenia, coagulopathy
  • Respiratory distress: Tachypnea with CXR infiltrates → likely early ARDS or aspiration
  • Background risk: COPD, NSAID use, peritonitis

Examiner Commentary:
A good candidate highlights sepsis physiology, perfusion deficits, and early organ dysfunction. Avoid vague generalizations — be systematic.

Q2. What are your top 2 immediate concerns and next 2 steps in 15 minutes?

Concerns:

  1. Inadequate perfusion (MAP <65, high lactate)
  2. Uncontrolled source/bleeding

Next Steps:

  1. Perform PLR with echo/VTI to assess fluid responsiveness
  2. Start norepinephrine if MAP remains <65 or non-responsive to fluids

Examiner Commentary:
Top answers identify real-time action and rationale — assessing response before blindly giving fluids. EDIC likes candidates who personalize care dynamically.



Q3. Based on data, what is your working diagnosis for shock? Justify.

Diagnosis: Septic shock with distributive and hypovolemic features.

Justification:

  • Infection (WBC↑, post-peritonitis), lactate 4.1
  • Low MAP, warm extremities, preserved echo → distributive
  • Surgical blood loss, ongoing drain, low Hb → possible volume depletion
  • ABG: HAGMA from lactate

Examiner Commentary:
Differentiating components of shock (distributive vs hypovolemic) shows mature thinking. Always use labs + vitals to build a pattern.


Q4. Would you give fluids, vasopressors, or both? Explain rationale and tests to guide.

Likely both.

  • Start fluid bolus (500 mL crystalloid), assess with PLR + VTI/PPV
  • If non-responsive or hypotensive: start norepinephrine (0.05–0.1 mcg/kg/min)
  • Monitor lactate, UO, MAP, Vitals as endpoints

Examiner Commentary:
They don’t want “give fluids” or “start pressor” without context. Mentioning a test like PLR or echo shows clinical realism and safety awareness.

Complete and Continue