An elderly woman presents after a coughing episode followed by spontaneous abdominal wall bruising that has worsened overnight. She had a syncopal episode at home and has significant left-sided abdominal pain.
Background includes atrial fibrillation and prior valve replacement (childhood rheumatic fever). Medications include metoprolol and warfarin; recent INR ~2.9.
Her observations are:
- T 35.1
- P 91
- BP 73/50
- RR 24
- SpO2 92% on room air
After 2 units of packed red cells, she is stable enough for CT abdomen/pelvis. A single axial slice is provided:
a. Describe the CT findings.
(Marked out of 3.0)
/3
b. If reversing anticoagulation, list two valve-related factors that influence prosthetic valve thrombosis risk.
(Marked out of 2.0)
/2
c. What is the approximate daily thrombosis risk?
(Marked out of 1.0)
/1
d. Outline your approach to full warfarin reversal.
(Marked out of 3.0)
/3
e. Name six laboratory targets during massive transfusion.
(Marked out of 6.0)
/6
f. Excluding resuscitation and reversal, outline your management plan.
(Marked out of 4.0)
/4
Total Score: 0 / 19
Percentage: 0%
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