A 64-year-old hypertensive man has an acute sharp midsternal chest pain that is intermittent and radiates to his back between his shoulder blades. Blood pressure is 170/110 mmHg in his right arm and 90/60 mmHg in his left arm. Heart auscultation reveals a diastolic murmur. ECG is normal. Chest radiograph reveals a widened mediastinum. Which of the following is the most likely diagnosis?
سؤال مجاني 6 من 10 اليوم · اشترك وكمّل بدون حد
اعرض الإجابة
الإجابة والشرح
ادخل لحسابك عشان نحفظ إجاباتك ونوريك أخطاءك.
الإجابة: A. Aortic dissection
A hypertensive man with acute sharp chest pain radiating between the shoulder blades, a big inter-arm BP difference, a diastolic murmur (AR) and a widened mediastinum = aortic dissection. Coarctation also causes BP differences, but it is chronic and congenital and doesn't cause acute tearing pain. A normal ECG argues against MI.
ليش كل خيار صح أو غلط
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A
ليش صح
Sudden severe pain in the interscapular area or retrosternum, asymmetrical BP between the arms and an aortic regurgitation (diastolic) murmur is the classic presentation of a proximal dissection.
✓ Dr. Al-Ahmadi - Dyslipidemia and Aortic Dissection✅.pdf · p. 7 -
B
ليش غلط
Coarctation is a narrowing of the aorta that raises BP in the upper extremities and lowers it in the lower ones, with weak lower-limb pulses. It is not described as causing acute tearing pain or a diastolic murmur.
✓ (Y4)-(M B) Hypertension.pdf · p. 4 -
C
ليش غلط
An MI shows an abnormal ECG: ST elevation in STEMI, or ST depression/T-wave inversion in NSTEMI, with raised troponin. A normal ECG in this patient argues against it.
✓ (Y4)-(M B) Ischemic Heart and Acute coronary syndrome.pdf · p. 8 -
D
ليش غلط
PE causes pleuritic chest pain (pain on inspiration) and dyspnea from pulmonary artery occlusion. It does not explain a large BP difference between the arms or a diastolic murmur.
✓ 12• Venous Thromboembolism [Notes].pdf · p. 3 -
E
ليش غلط
Esophageal perforation lets air and contents escape into the mediastinum, causing subcutaneous emphysema with crepitations and pneumomediastinum, and a risk of mediastinitis and sepsis. It does not cause an arm BP gap or a diastolic murmur.
✓ 2• Esophagitis [Notes].pdf · p. 2
- المصدر
- Dr. Al-Ahmadi - Dyslipidemia and Aortic Dissection✅.pdf · p. 7
Dr. Al-Ahmadi - Dyslipidemia and Aortic Dissection✅.pdf · p. 5 - المحاضرة
- Hypertensive Crisis & Aortic Dissection · Cardiology · Module B
- ظهر في
- Cardio bank