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Aortic dissection — DipIMC MCQ

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HardMedical EmergenciesAortic dissectionDipIMC

A 71-year-old man develops sudden tearing interscapular pain while gardening. Blood pressure is 210/110 in the right arm and 160/90 in the left; he is pale and nauseated. What is the most appropriate transport decision?

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

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Correct answer: D — Transport urgently to an emergency department with vascular and imaging access

Acute aortic syndrome is suggested by tearing pain and inter-arm blood pressure difference, requiring urgent imaging and specialist pathways. Thrombolysis for presumed MI could be catastrophic if dissection is present. Analgesic response does not exclude life-threatening vascular disease. The pearl is that chest pain pathways need active consideration of diagnoses where antithrombotic treatment may harm.

Reference: JRCALC Guidelines 2025; NICE Acute Coronary Syndromes NG185