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Ectopic pregnancy — USMLE Step 3 MCQ

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HardOB/GYN (prenatal care, contraception, screening)Ectopic pregnancyUSMLE Step 3

A 72-year-old man with pyelonephritis remains hypotensive at 78/42 mm Hg after receiving 30 mL/kg of balanced crystalloid. Lactate is 5.2 mmol/L, bedside echocardiography shows no tamponade or severe ventricular failure, and a central venous catheter is being placed. Which hemodynamic intervention is most appropriate next?

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

Reveal the answer and explanation

Correct answer: A — Start norepinephrine and target an initial mean arterial pressure of 65 mm Hg

The best answer is “Start norepinephrine and target an initial mean arterial pressure of 65 mm Hg”. Persistent hypotension after an appropriate initial crystalloid bolus defines septic shock requiring vasopressor support. Norepinephrine is first-line and an initial MAP target of 65 mm Hg is appropriate for most adults. Dopamine causes more arrhythmias, phenylephrine is not routine first-line monotherapy, and rigid pressure targets or unlimited fluid loading risk harm without restoring vascular tone.

Reference: Surviving Sepsis Campaign 2021: https://pmc.ncbi.nlm.nih.gov/articles/PMC8486643/