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Aortic dissection — SCE Acute Medicine MCQ

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ModerateAcute Cardiac PresentationsAortic dissectionSCE Acute Medicine

A 51-year-old woman presents with acute chest symptoms with haemodynamic concern. Relevant history includes cardiovascular risk factors or structural heart disease. On assessment, haemodynamic findings and ECG changes are present. Investigations show tearing chest pain, pulse deficit and widened mediastinum. What is the most appropriate investigation?

Educational content. Not a substitute for clinical judgement or local policy.

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Correct answer: A — Urgent CT angiography of the aorta

The key discriminator is that tearing chest pain, pulse deficit and widened mediastinum, which makes Urgent CT angiography of the aorta the single best answer. Urine microscopy and renal ultrasound is less appropriate because it does not address the dominant acute risk in the vignette; Lumbar puncture after safety assessment would fit a different presentation or later stage of care. Bedside echocardiography and MRI spine are suboptimal because they would either delay time-critical treatment or follow the wrong acute pathway. Teaching point: SCE-style acute medicine questions usually test prioritisation using physiology, timing and a guideline-defined threshold, rather than isolated factual recall.

Reference: ESC aortic disease guideline