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Ruptured abdominal aortic aneurysm — MCCQE Part 1 MCQ

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HardAbdominal PainRuptured abdominal aortic aneurysmMCCQE Part 1

A 73-year-old man with a smoking history presents with sudden severe abdominal and back pain. He is pale and diaphoretic, blood pressure is 84/50 mmHg, and a pulsatile abdominal mass is palpable. Bedside ultrasound shows a 7.2 cm abdominal aortic aneurysm. What is the most appropriate next step in management?

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Correct answer: C — Immediate vascular surgery activation with permissive resuscitation

Shock, back or abdominal pain and a pulsatile mass with aneurysm on ultrasound indicate ruptured AAA, requiring immediate vascular surgery and controlled resuscitation. CT may be useful if stable, but it should not delay operative management in shock. Excessive fluids before haemorrhage control can worsen bleeding.

Reference: Canadian Society for Vascular Surgery resources