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Colon cancer surveillance — USMLE Step 3 MCQ

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HardSurgery (Post-operative / Follow-up)Colon cancer surveillanceUSMLE Step 3

A 61-year-old man has abrupt tearing chest pain radiating to the back, pulse asymmetry, and CT angiography showing an ascending aortic dissection. Blood pressure is 198/116 mm Hg and heart rate is 112/min. He has no aortic regurgitation-induced shock. Which immediate management sequence is most appropriate?

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Correct answer: A — Start intravenous esmolol, add vasodilator after rate control, and arrange emergency surgery

The best answer is “Start intravenous esmolol, add vasodilator after rate control, and arrange emergency surgery”. Acute type A dissection requires simultaneous anti-impulse therapy and emergency operative management. An intravenous beta blocker first reduces heart rate and shear; a titratable vasodilator is added only if blood pressure remains elevated after rate control. Vasodilator-first therapy can increase reflex shear, anticoagulation may worsen bleeding, and delayed oral or outpatient strategies are unsafe.

Reference: 2022 ACC/AHA Guideline for Aortic Disease: https://pmc.ncbi.nlm.nih.gov/articles/PMC9876736/