A 20-year-old woman with poorly controlled diabetes mellitus is scheduled for urgent drainage of an abdominal abscess. She received an initial dose of regular insulin 10 units followed by regular insulin 5 units/hr for the past five hours. Laboratory studies show serum sodium concentration 128 mEq/L, potassium 5.4 mEq/L, chloride 80 mEq/L, and glucose 750 mg/dl. The most appropriate perioperative management is
(A) addition of subcutaneous NPH insulin
(B) administration of sodium bicarbonate to correct metabolic acidosis
(C) administration of normal saline solution to correct the presumed hypovolemia
(D) administration of furosemide to correct hyponatremia
(E) infusion of 5% dextrose in 0.2% saline solution to prevent hypoglycemia
A 66-year-old woman with essential hypertension has a preoperative blood pressure of 160/95 mmHg despite receiving the usual dose of labetalol on the morning of surgery. Following endotracheal intubation, blood pressure increases to 220/120 mmHg. Which of the following is the most likely explanation?
(A) Decreased arteriolar compliance
(B) Increased circulating blood volume
(C) Increased receptor sensitivity to norepinephrine
An asymptomatic 38-year-old woman is scheduled for elective cesarean delivery. The preoperative EKG shows left axis deviation that was not present one year ago. The most appropriate next step is to
(A) postpone the procedure and consult a cardiologist
(B) postpone the procedure and obtain an echocardiogram
(C) proceed with the procedure after administration of digitalis
(D) proceed with the procedure but avoid inhalational agents
(E) proceed without intervention since this is a normal finding
The primary mechanism for respiratory arrest following a spinal anesthetic to T2 is
(A) block of carotid chemoreceptors
(B) direct effect of local anesthetic on the medulla
(C) ischemia of respiratory centers in the medulla
(D) paralysis of the diaphragm by neural block
(E) paralysis of intercostal muscles
C
Which of the following findings on the left is most likely to be associated with an increased risk of complications with cannulation of the left internal jugular vein compared with cannulation of the right internal jugular vein?
(A) Longer recurrent laryngeal nerve
(B) Lower location of the cupola of the pleura
(C) More acute angle between the internal jugular and innominate veins