skip to main content

Preeclampsia prevention in high-risk pregnancy — USMLE Step 3 MCQ

Instant feedback + full explanation. One question, done properly.

HardOB/GYNPreeclampsia prevention in high-risk pregnancyUSMLE Step 3

A 67-year-old man has sudden interscapular pain. CT angiography shows an acute dissection beginning distal to the left subclavian artery. Esmolol lowers his heart rate to 58/min and nicardipine lowers systolic pressure to 112 mm Hg, but urine output falls and repeat imaging shows dynamic obstruction of the right renal artery with worsening creatinine. There is no ascending-aortic involvement. Which next step is most appropriate?

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

Reveal the answer and explanation

Correct answer: B — Perform thoracic endovascular aortic repair and continue anti-impulse therapy

The best answer is “Perform thoracic endovascular aortic repair and continue anti-impulse therapy”. A type B dissection is initially treated medically only when uncomplicated. New renal malperfusion despite effective anti-impulse therapy makes this a complicated type B dissection and creates an indication for urgent intervention. When anatomy is suitable, thoracic endovascular repair covers the entry tear and restores true-lumen perfusion with lower early morbidity than open repair.

Reference: 2022 ACC/AHA Guideline for Aortic Disease: https://www.ahajournals.org/doi/10.1161/CIR.0000000000001106