13th August 2024

You are referred an 83-year-old lady with a reduced conscious level. She is previously known

You are referred an 83-year-old lady with a reduced conscious level. She is previously known to have a good functional baseline, being independent of her activities of daily living, and having an exercise tolerance of 2 km on the flat, with a stick. Her past medical history includes hypertension, chronic kidney disease stage 2, and urge incontinence. She usually takes amlodipine 5 mg, ramipril 2.5 mg, and oxybutynin 2.5 mg twice daily.

Her daughter reports that she last saw her being her normal self 48 hours ago, at which time she had complained of some non-specific abdominal pain.

Her observations demonstrate a heart rate of 110-120 bpm in fast AF, with a blood pressure of 103/45 mmHg and a temperature of 38.7℃. Examination of the abdomen elicits groans and localisation to the area palpated, but she does not open her eyes.

Which single investigation finding is most likely to explain this presentation?

Select the SINGLE most appropriate option from the list below. Select ONE option only.