Which of the following clinical features is not seen in shock?

Appeared in: NORCET 5 Prelims - Sept 2023 (Shift-1)

Explanation

Tremors are involuntary, rhythmic muscle contractions and are not a primary or characteristic sign of shock.
The pathophysiology of shock involves circulatory collapse, leading to hypoperfusion and hypoxia, which do not directly cause tremors.
Tremors are more commonly associated with conditions like hypoglycemia, electrolyte imbalances, fever, anxiety, or neurological disorders such as Parkinson's disease.

Option A: Hypotension (low blood pressure) is a classic, though sometimes late, sign of shock. It reflects the circulatory system's failure to maintain adequate pressure for tissue perfusion.
Option B: Decreased tissue perfusion is the fundamental definition of shock. All signs and symptoms of shock stem from the body's tissues not receiving enough blood flow.
Option C: Hypoxia, or inadequate oxygen at the cellular level, is the direct result of decreased tissue perfusion. It triggers anaerobic metabolism and leads to organ damage.

Clinical Relevance

Nursing practice connection: Prioritize focused assessment, early escalation, and real-time monitoring when managing Clinical features of shock in acute care settings.
Early recognition of shock's true signs (hypotension, poor perfusion, altered mental status) is a critical nursing responsibility to prevent progression to irreversible organ failure and death.
Nurses must differentiate between signs of shock and other symptoms. Attributing tremors to shock would be a diagnostic error and could delay the investigation of the true cause (e.g., hypoglycemia).
What if? If a patient in shock also presents with tremors, the nurse should immediately check blood glucose levels and assess for neurological changes, as these are more likely causes than the shock state itself.

How to Approach the Question

First, identify the negative keyword in the question: 'not'. This means you are looking for the option that is an exception.
Recall the definition of shock: a life-threatening condition of circulatory failure causing inadequate tissue perfusion.
Evaluate each option based on this definition.
Hypotension (low blood pressure), decreased tissue perfusion (poor blood flow), and hypoxia (low oxygen) are all direct consequences of circulatory failure.
Therefore, these three options are expected features of shock.
Tremors are not directly caused by the pathophysiology of shock. By elimination, this is the feature not seen in shock.

Concept Tested & Keywords

QITBHVnjqmhYHww-rX6-hi

E6 Nelson Textbook of Pediatrics(2024) — Volume 1 p. 650-652

E6 Medicine Harrison 22e Part 2 p. 216-218

E6 Ghai Essential Pediatrics(pp 26-904 of 913) p. 768-770

Practise the full NORCET 5 Prelims - Sept 2023 (Shift-1)

Attempt every question from this paper in a timed mock, then review the full solution for each one.