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Aortic dissection — SCE Acute Medicine MCQ

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HardAcute Cardiac PresentationsAortic dissectionSCE Acute Medicine

A 61-year-old man is assessed on the acute medical unit. He has abrupt tearing chest pain radiating to the back, right arm blood pressure 182/96 mmHg and left arm 142/84 mmHg. There is a new early diastolic murmur. Initial assessment includes relevant observations, bedside tests and urgent blood results. What is the most appropriate investigation?

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Correct answer: E — CT angiography of the aorta

CT angiography of the aorta is the best answer because the pain character, pulse or pressure differential and murmur suggest acute aortic syndrome needing CT angiography if stable enough. Urgent transthoracic echocardiography is plausible, but it is less appropriate for the physiology or timing described in this stem. The other distractors either fit a neighbouring presentation, delay definitive treatment, or miss the key immediate risk. Clinical pearl: Anticoagulation before excluding dissection can be catastrophic.

Reference: https://cks.nice.org.uk/#acute-medicine-order-67-1