英文试题-1.Apreviouslyhealthy55-year-oldmanundergoes.docVIP

1. A previously healthy 55-year-old man undergoes elective right hemicolectomy for a Dukes A cancer of the cecum. His postoperative ileus is somewhat prolonged, and on the fifth postoperative day his nasogastric tube is still in place. Physical examination reveals diminished skin turgor, dry mucous membranes, and orthostatic hypotention. Pertinent laboratory values are as follows: Arterial blood gases:PH7.56,Po2 85 kPa,Pco2 50kPa Serum electrolytes (meq/L):Na+132,K+3.1,Cl80,HCO3-42 Urine electrolytes (meq/L):Na+2,K-5,Cl-6 The values given above allow the descriptive diagosis of Uncompensated metabolic alkalosis Respiratory acidosis with metabolic compensation Combined metabolic and respiratory alkalosis Metabolic alkalosis with respiratory compensation “Paradoxical” metabolic respiratory alkalosis The most appropriate therapy for the patient described would be Infusion of 0.9% Nacl with supplemental Kcl until clinical signs of volume depletion are eliminated Infusion of isotonic (0.15 N)HCL via a central venous catheter Clamping the nasogastrics tube to prevent further acid losses Administration of acetazolamide to promote renal excretion of bicarbonate Intubation and controlled hypoventilation on a volumecycled ventilator to further increase Pco2 2. The response to shock includes which of the following metabolic effects? Increase in sodium and water excretion Increase in renal perfusion Decrease in cortisol levels Hyperkalemia Hypoglycemia 3. Animal and clinical studies have shown that administration of lactated Ringer’s solution to patients with hypovolemic shock may Increase serum lactate concentration Impair liver function Improve hemodynamics by alleviating the deficit in the interstitial fluid compartment Increase metabolic acidosis Increase the need for blood transfusion 4. Rapid fluid resuscitation of the hypovolemic patient after abdominal trauma is significantly enhanced by which of the following ? Placement of long 18-gauge subclavian vein catheters Pla