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Ruptured abdominal aortic aneurysm — MCCQE Part 1 MCQ

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ModerateAbdominal PainRuptured abdominal aortic aneurysmMCCQE Part 1

A 73-year-old male smoker presents with sudden severe abdominal and back pain, syncope and hypotension. Examination reveals a tender pulsatile abdominal mass. Which of the following is the most appropriate next step?

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Correct answer: D — Activate vascular surgery, begin balanced resuscitation and proceed to emergency repair

Hypotension, back pain and a pulsatile mass indicate ruptured AAA until proven otherwise. This is a surgical emergency requiring resuscitation and vascular repair, not outpatient imaging. Endoscopy or discharge would be dangerous delays.

Reference: https://emergencycarebc.ca/clinical_resource/clinical-summary/abdominal-aortic-aneurysm/; https://www.cmaj.ca/content/193/5/E160