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Ruptured abdominal aortic aneurysm — MCCQE Part 1 MCQ

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HardAbdominal PainRuptured abdominal aortic aneurysmMCCQE Part 1

77-year-old man with smoking history presents with sudden abdominal and back pain with collapse. He is hypotensive and has a pulsatile abdominal mass. Which of the following is the most appropriate next step?

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Correct answer: A — Activate massive resuscitation and urgent vascular surgery pathway

Activate massive resuscitation and urgent vascular surgery pathway is best because hypotension, back pain and pulsatile mass suggest ruptured AAA. Discharge with oral analgesia only is suboptimal because analgesia alone may mask a surgical emergency; Delay surgical assessment until routine clinic is suboptimal because time-sensitive surgical presentations require urgent assessment; Treat with laxatives or antacids as sole therapy is suboptimal because a benign gastrointestinal explanation does not account for the red flags; Perform an invasive bedside procedure without imaging or senior input is suboptimal because invasive treatment can worsen outcomes when anatomy or diagnosis is uncertain. Do not delay transfer for extensive testing in an unstable rupture.

Reference: Canadian Society for Vascular Surgery guidance