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Aortic dissection — USMLE Step 3 MCQ

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HardEmergency MedicineAortic dissectionUSMLE Step 3

A 58-year-old man with hypertension has abrupt tearing chest pain radiating to the back. Blood pressure is 188/96 mm Hg in the right arm and 162/88 mm Hg in the left. He has a new diastolic murmur. ECG shows no ST elevation. Which of the following is the most likely diagnosis?

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

Reveal the answer and explanation

Correct answer: E — Acute aortic dissection

Sudden tearing chest/back pain, pulse or blood pressure differential, and aortic regurgitation suggest aortic dissection.

Reference: ACC/AHA aortic disease guideline: https://www.acc.org/