Thu7October1232PM 3

An 82-year-old lady was admitted to hospital with fever and confusion. She had been found collapsed at home by her son, who reported that she was usually fit and well and coped well on her own at home.

She had a past history of angina, which was well-controlled on a beta blocker and oral nitrate and she also suffered from osteoarthritis.

On examination she looked pale and unwell and smelled strongly of stale urine. Her temperature was 38.1°C. She was disoriented in time, place and person. Her blood pressure was 80/45 mmHg with pulse 110 beats per minute and regular.

There were widespread petechiae on the limbs. Her respiratory rate was measured at 28 breaths per minute. Her heart sounds were normal and the chest clear. Her abdomen was soft, but she was very tender in the suprapubic region and a mass was felt rising from the pelvic brim.

After taking blood, it was noted that there was continued bleeding from the venous puncture site. A urinary catheter was inserted and yielded 1500 ml of cloudy yellow offensive-smelling urine.

Which of the following statements is true?

(Please select 1 option)

Levels of fibrin degradation products (FDPs) will be reduced

Circulating levels of activated protein C (aPC) will be reduced Correct

Levels of D-dimer will be reduced

The activated partial thromboplastin time (APTT) will be below the normal range

The platelet count is likely to be elevated

Explanation

The patient has disseminated intravascular coagulation (DIC) secondary to sepsis. Given the history, the most likely source is the urinary tract.

Several coagulation abnormalities which may be seen in severe sepsis include:

APTT - elevated

PT - elevated

FDPs - elevated

D-dimers - elevated

Platelets - reduced

Fibrinogen - reduced

Protein C - reduced

Antithrombin - reduced.

Answer Statistics

1

14%

2

68%

3

3%

4

6%

5

11%

Times answered: 318