General Pathology USMLE Step 1 Practice Question
A 68-year-old man with diabetes presents with pyelonephritis and gram-negative bacteremia. Despite ceftriaxone and gentamicin, he develops hypotension (BP 85/52), tachycardia (HR 118), tachypnea (RR 22), and warm erythematous skin. Laboratory studies show serum lactate 4.2 mg/dL and positive blood cultures for E. coli. Urinalysis reveals pyuria and bacteriuria. He denies chest pain. Which mechanism most directly accounts for his decreased systemic vascular resistance?
Answer choices
- ACoronary plaque rupture with pump failure
- BMassive vagal discharge causing bradycardia
- CRapid loss of intravascular volume from hemorrhage
- DAutoimmune destruction of adrenal cortex
- ENitric oxide mediated systemic vasodilation from inflammatory cytokinesCorrect answer
- FDirect bacterial endotoxin-induced myocardial depression with reduced cardiac output
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