A 48-year-old woman maintained on Warfarin for a history of cardiac valvular replacement and a history of recent upper respiratory infection presents with severe abdominal pain exacerbated by movement. Her physical examination shows tenderness in the right paramedian area with voluntary guarding but no peritoneal signs. The following statement(s) is/are true concerning the diagnosis and management of this patient.
A.	Urgent laparotomy should be performed because of concern for arterial mesenteric embolus
B.	The correct diagnosis could likely be made by CT scan and operation avoided
C.	The status of her anticoagulation should be checked and if her prothrombin time is excessively prolonged, correction is necessary
D.	If untreated, hemodynamic instability is common
Answer:B
A 48-year-old woman maintained on Warfarin for a history of cardiac valvular replacement and a history of recent upper respiratory infection presents with severe abdominal pain exacerbated by movement. Her physical examination shows tenderness in the right paramedian area with voluntary guarding but no peritoneal signs. The following statement(s) is/are true concerning the diagnosis and management of this patient.
A.	Urgent laparotomy should be performed because of concern for arterial mesenteric embolus B.	The correct diagnosis could likely be made by CT scan and operation avoided C.	The status of her anticoagulation should be checked and if her prothrombin time is excessively prolonged, correction is necessary D.	If untreated, hemodynamic instability is common