A 60-year-old man with type II diabetes mellitus requires emergency incision and drainage of a perirectal abscess. Laboratory studies show a serum glucose concentration of 850 mg/dl and a pHa of 7.30. The most appropriate management is administration of regular insulin and which of the following infusions?
(A) 5% Dextrose in water
(B) 5% Dextrose in 0.45% saline solution with potassium chloride
(C) 5% Dextrose in 0.45% saline solution with potassium chloride and mannitol
(D) Normal saline solution
(E) Normal saline solution and sodium bicarbonate
D
During postoperative indirect laryngoscopy, the vocal cords appear symmetric during quiet breathing and approximate to the left of midline during phonation. The most likely cause is
(A) pure abductor paralysis of the left cord
(B) pure abductor paralysis of the right cord
(C) abductor and adductor paralysis of the left cord
(D) abductor and adductor paralysis of the right cord
A 40-year-old woman is undergoing a posterior fossa craniotomy in the sitting position for clipping of a basilar artery aneurysm. Nitroprusside is being used to maintain mean arterial pressure at 50 mmHg, measured at head level. During dissection, over the course of one minute, the mean blood pressure decreases to 30 mmHg. Simultaneously, end-tidal carbon dioxide and pulmonary artery pressures decrease and heart rate increases. The most likely cause of these changes is
(A) progressive hypoxemia
(B) nitroprusside bolus
(C) junctional rhythm
(D) brain stem manipulation
(E) venous air embolism
B
Which of the following statements concerning use of temperature-corrected blood gas measurement (pH-stat) during hypothermic cardiopulmonary bypass is true?
(A) Blood gas analysis is performed at the patient's temperature
(B) Carbon dioxide should not be added to the bypass circuit
(C) The carbon dioxide content of the patient's blood is greater than it would be without temperature correction
(D) The incidence of postoperative neurologic deficits is increased compared with the alpha-stat method
(E) The patient's temperature should be maintained above 25°C
An anesthetized patient in the sitting position has a mean arterial pressure of 80 mmHg measured with a transducer placed at the level of the heart. Mean cerebral arterial pressure 20 cm above the transducer is
(A) 100 mmHg
(B) 80 mmHg
(C) 65 mmHg
(D) 60 mmHg
(E) 50 mmHg
C
Following protamine administration, profound pulmonary hypertension is most likely initiated by release of