This is a real-world medical entrance exam question, please give the true answer based on the question and selection. Topic name: None, Subject name: Pediatrics
[{'content': 'All are true about septic shock in children except – \nSelect and explain. \nA. 1st response is ↑ C.O. due to vasodilatation, B. Hypotension is a late sign, C. Heart rate remains same, D. ↓ Peripheral vascular resistance', 'role': 'user'}, {'content': 'Answer: C \nExplanation: Septic shock in children\n\nSeptic shock is an inflammatory state resulting from a systemic response to bacterial infection.\nThe decrease in peripheral resistance (vasodilatation) is the hallmark of early (hyper dynamic) stage of septic shock, this feature distinguishes it from other types of shock. Decreased peripheral resistance (vasodilatation) leads to a compensatory increase in cardiac output; therefore, cardiac output is maintained or some time increased despite of shock.\nDecreased peripheral resistance and increased cardiac output lead to increased blood flow and total oxygen delivery to the tissue. But, still, the tissues lack O2 due to local microcirculatory changes produced as a result of sepsis which causes decrease tissue extraction of oxygen. So, increased blood flow and cardiac out are still inadequate to meet the total metabolic needs of the tissue which are increased in sepsis.\nAs sepsis progresses, hypo dynamic stage supervenes in which there is decreased cardiac output and increased peripheral resistance.\nSo, hemodynamic changes in septic shock occur in two characteristic patterns, Early hyperdynamic and late hypo dynamic shock\n\n1) Early hyperdynamic shock\n\nHypotension is a late feature of septic shock and early hyperdynamic stage is characterized by normal or increased BR\nOther features are : -\nTachycardia \xa0 \xa0 \xa0 \xa0 \xa0 \xa0 \xa0 \xa0 \xa0 \xa0 \xa0 \xa0 \xa0 \xa0 \xa0 \xa0 \xa0 \xa0 \xa0 \xa0 \xa0 \xa0 \xa0 \xa0 \xa0 \xa0 \xa0 \xa0 \xa0 \xa0 \xa0 \xa0\nNormal or increased cardiac output \xa0 \xa0 \xa0 \xa0 \xa0 \xa0 \xa0 \xa0 \xa0 \xa0 \xa0\xa0\nTachypnea\xa0\xa0\xa0\xa0\nWarm extremities\xa0\nDecreased systemic vascular resistance\xa0\xa0\xa0\nIncreased pulmonary vascular resistance\xa0 \xa0 \xa0 \xa0 \xa0 \xa0 \xa0 \xa0 \xa0 \xa0 \xa0 \xa0 \xa0 \xa0 \xa0 \xa0 \xa0\xa0\n\n2) Late hypo dynamic stage\n\nDecreased cardiac output \xa0 \xa0 \xa0 \xa0 \xa0 \xa0 \xa0 \xa0 \xa0 \xa0 \xa0 \xa0 \xa0 \xa0 \xa0 \xa0 \xa0 \xa0 \xa0 \xa0\xa0\nHypotension \xa0 \xa0 \xa0 \xa0 \xa0 \xa0 \xa0 \xa0 \xa0 \xa0 \xa0 \xa0 \xa0 \xa0 \xa0 \xa0 \xa0 \xa0 \xa0 \xa0 \xa0 \xa0 \xa0 \xa0 \xa0 \xa0 \xa0 \xa0 \xa0 \xa0\xa0\nIncreased vascular resistance\xa0\xa0\xa0\xa0\xa0\xa0\xa0\xa0\xa0\xa0\xa0\nCool, mottled and often cyanotic extremities\xa0\xa0\xa0\xa0\xa0\nOliguria, renal failure\xa0\xa0\xa0\nHypothermia', 'role': 'assistant'}]