Aortic dissection — MCCQE Part 1 MCQ

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ModerateChest PainAortic dissectionMCCQE Part 1

A 66-year-old woman with longstanding hypertension has abrupt tearing chest pain radiating to the back, a 32 mmHg inter-arm blood pressure difference and a new early diastolic murmur. Which of the following is the most likely diagnosis?

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Correct answer: D — Aortic dissection

Aortic dissection is the single best answer because the age, timing, examination findings and investigations in the vignette fit Aortic dissection better than the alternatives. The most tempting distractor is less appropriate because it either treats a neighbouring presentation, delays a time-critical intervention, or ignores a key discriminator in the stem. The remaining options are suboptimal because they would miss the diagnosis, use an investigation or treatment in the wrong sequence, or fail to address safety and follow-up. Canadian practice should be anchored to CCS emergency cardiovascular care guidance, with attention to acuity, safety-netting and local provincial pathways.

Reference: CCS emergency cardiovascular care guidance