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Tricky MKSAP quesiton

July 3, 2013

A 72-year-old man is evaluated in the emergency department for a severe headache, nausea, vomiting, and change in consciousness of 1 hour’s duration that developed after he fell earlier today. He has atrial fibrillation for which he takes warfarin and metoprolol.

On physical examination, temperature is normal, blood pressure is 160/90 mm Hg, pulse rate is 50/min, and respiration rate is 26/min. The patient is obtunded but responds to verbal commands and is able to follow simple instructions and swallow. No focal neurologic findings are present.

The INR is 12.

A CT scan of the head shows a subdural hematoma with a mass effect.

Which of the following is the most appropriate treatment?

A Fresh frozen plasma
B Intravenous vitamin K
C Intravenous vitamin K and prothrombin complex concentrate
D Oral vitamin K
E No additional treatment
Please choose the answer and respond in the comments.
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2 Comments leave one →
  1. dfytr permalink
    July 7, 2013 10:22 pm

    A.FFP for bleeds due to warfarin

    • July 7, 2013 11:22 pm

      That was my answer, at least that what we usually do in the Hospital. Tricky question indeed. Any other ideas? However, I still don’t know how relevant for the real practice this question is.

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