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Septic shock — ABIM Board MCQ

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ModeratePulmonary/Critical CareSeptic shockABIM Board

A 58-year-old with pyelonephritis has septic shock. After appropriate antibiotics and initial balanced crystalloid, blood pressure is 78/46 mm Hg and lactate is 5.1 mmol/L. Which vasoactive treatment should be started first?

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

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Correct answer: E — Start norepinephrine and titrate toward a mean arterial pressure of 65 mm Hg

The best answer is “Start norepinephrine and titrate toward a mean arterial pressure of 65 mm Hg”. Persistent hypotension after initial resuscitation requires prompt norepinephrine, the preferred first-line vasopressor, while fluids, perfusion and source control are reassessed. Dopamine causes more arrhythmias, a fixed central venous pressure target should not delay support, bicarbonate does not reverse distributive shock, and source control proceeds concurrently.

Reference: Surviving Sepsis Campaign 2026 Adult Guideline: https://www.sccm.org/survivingsepsiscampaign/guidelines-and-resources/surviving-sepsis-campaign-adult-guidelines