Questions about shock, liver below costal margin

[ItsAboutThePatient]

Hello student doctor world,
I'm getting ready to take step 2. I am having a hard time answering questions about shock. Mainly, what is the significance of cool or mottled extremities in the setting of shock vs warm or flushed? Isn't it something to do with peripheral vascular resistance? Like, if PVR is high then the extremities are warm? I missed a question with cool and mottled extremities because I put neurogenic shock, but the answer was actually hypovolemic shock (wouldn't hypovolemic shock cause elevated peripheral vascular resistance as vessels compensate by compressing?)

My other question is about all of this stuff about the "liver can be palpated 3 cm below the costal margin." I pretty much ignore these parts of the question stem and there is very little information about it in uworld, even though this information is in tons of question stems. How can I use this information? Thanks SDN

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[1badvette]

The reason you get cool extremities in Hypo/Cardio shock is because the body vasoconstrict " increase SVR" in order to increase/shift blood flow to vital organs .. So blood flow to the extremities is sacrificed in order to perfuse vital organs .

In Neurogenic Shock .. You lose the ability to clap down/vasoconstrict on vessels because of an impaired ANS response .

In Septic Shock ... You have a major inflammatory mediator response causing systemic vasodilation .

 

[ItsAboutThePatient]

Got it! Thanks. Any thoughts on interpreting the liver/costal margin findings