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Acute mesenteric ischaemia — RCPSC EM MCQ

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HardGI/Abdominal emergenciesAcute mesenteric ischaemiaRCPSC EM

A 79-year-old woman with atrial fibrillation presents CTAS 2 with sudden severe abdominal pain out of proportion to examination. BP is 102/64, HR 118, lactate is 5.6 mmol/L, WBC is 18, and creatinine is 128 µmol/L. Plain abdominal radiograph is non-specific. What is the most appropriate next step?

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Correct answer: C — Obtain urgent CT angiography of the abdomen and call general surgery

Pain out of proportion, atrial fibrillation and lactic acidosis strongly suggest acute mesenteric ischaemia. CTA and early surgical/vascular involvement are time-critical.

Reference: Royal College Emergency Medicine exam format and training experiences