Septic Shock — FRCA Final MCQ

Instant feedback + full explanation. One question, done properly.

EasyIntensive Care MedicineSeptic ShockFRCA Final

A 58-year-old woman with community-acquired pneumonia is admitted to the ICU with septic shock. After initial crystalloid resuscitation, her mean arterial pressure remains 55 mmHg, and further fluid administration is not expected to improve her haemodynamics. Which vasopressor should be commenced first?

Educational content. Not a substitute for clinical judgement or local policy.

Reveal the answer and explanation

Correct answer: D — Noradrenaline

Noradrenaline is the first-line vasopressor for adult septic shock when hypotension persists despite adequate initial fluid resuscitation. Predominant α1-adrenoceptor-mediated vasoconstriction increases systemic vascular resistance and MAP, with modest β1 activity supporting cardiac performance. Vasopressin is usually added to noradrenaline when additional vasopressor support is required or to limit the noradrenaline dose; it is not the routine initial agent. Adrenaline may be used when shock remains inadequately responsive to noradrenaline. Dobutamine is principally an inotrope and is considered when myocardial dysfunction and persistent hypoperfusion are present despite adequate volume status and arterial pressure. Phenylephrine is a pure α1 agonist that may reduce stroke volume and is not routinely recommended as first-line treatment for septic shock.

Reference: Worcestershire Acute Hospitals NHS Trust, Guidelines for Management of Sepsis and Septic Shock in Adults, vasopressors section, approved 2025. https://apps.worcsacute.nhs.uk/KeyDocumentPortal/Home/DownloadFile/2807