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Aortic dissection — RCPSC EM MCQ

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HardCardiovascular emergenciesAortic dissectionRCPSC EM

A 72-year-old with hypertension develops tearing chest pain radiating to the back while shovelling snow. BP is 196/104 mmHg in the right arm and 166/88 mmHg in the left; a new diastolic murmur is heard. Chest radiograph shows mediastinal widening and creatinine is normal. What is the most appropriate investigation?

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

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Correct answer: A — CT angiography of the chest, abdomen, and pelvis

CT angiography of the chest, abdomen, and pelvis is correct: the clues indicate Aortic dissection and this option addresses the immediate ED priority. The distractors delay care, target a less likely problem, or are unsafe in this physiology.

Reference: Canadian EM vascular emergency practice; Rosen's Emergency Medicine