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Ruptured abdominal aortic aneurysm — USMLE Step 2 CK MCQ

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ModerateSurgeryRuptured abdominal aortic aneurysmUSMLE Step 2 CK

A 74-year-old Middle Eastern woman comes to the urgent care clinic because of abdominal pain or gastrointestinal symptoms. History and focused examination are notable for hypotension, abdominal pain, back pain, and pulsatile mass. Temperature is 101.5°F (38.6°C), blood pressure is 82/48 mmHg, pulse is 132/min, respirations are 28/min, and oxygen saturation is 90% on room air. Physical examination confirms the key finding and shows no unrelated abnormality that would better explain the presentation. Focused laboratory studies and imaging support an acute surgical process without suggesting a safer outpatient approach. Which of the following is the most likely diagnosis?

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Correct answer: E — Ruptured abdominal aortic aneurysm

The vignette describes Ruptured abdominal aortic aneurysm, supported by hypotension, abdominal pain, back pain, and pulsatile mass. Ruptured abdominal aortic aneurysm is the single best answer because it matches the diagnostic or management priority in this clinical setting. The other choices are plausible alternatives in related presentations, but they do not best fit the timing, findings, and guideline-directed approach described here.

Reference: https://www.ncbi.nlm.nih.gov/books/#stage-9-order-100