OVERVIEW
This page is dedicated to organizing various examples of standardized exam questions whose answer is aortic dissection. While this may seem a odd practice, it is useful to see multiple examples of how aortic dissection will be characterized on standardized exams (namely the boards and the shelf exams). This page is not meant to be used as a tradition question bank (as all of the answers will be the same), however seeing the classic “test” characterization for a disease is quite valuable.
QUESTION EXAMPLES
Question # 1
A 50 year old man comes to the emergency room because of a sudden onset of severe chest pain. He explains that the pain radiates down his left arm and also to his back. His past medical history is unremarkable and he does not smoke cigarettes or drink alcohol. His temperature is 98.5°F, pulse is 120/min, and blood pressure is 90/65 mm Hg. A grade 2/6 diastolic murmur is heard in the upper sternal area. An EKG is performed and shows nonspecific ST-T wave changes. An X-ray of the chest reveals the presence of a small right sided pleural effusion. What is the likely diagnosis in this patient?
Explanation: acute chest pain radiating to back + aortic regurgitation (murmur) + pleural effusion = aortic dissection
Question # 2
A 30 year old male is brought to the hospital after being involved in a head on traffic collision. He was wearing his seat belt during the crash and did not lose consciousness. He explains that his only symptom is mild chest tenderness. His workup in the ED is unremarkable except for a chest X-ray that shows a widened mediastinum. What diagnosis needs to be ruled out in this patient?
Question #3
A 75 year old male is seen in the ER for chest pain. He explains that it feels like a tearing chest pain that radiates to his back. His blood pressure is 220/115 mm Hg in the left arm, and 160/95 mm Hg in the right arm. He has a past medical history notable for a long history of poorly controlled hypertension. He also smokes and drinks alcohol regularly. A chest X-ray shows a widened mediastinum. ECG and cardiac enzymes are negative. What is the likely diagnosis in this patient?
Explanation: tearing chest pain that radiates to the back + different blood pressures in each arm = aortic dissection
Question # 4
A 70 year old man is brought to the hospital after being in a motor vehicle collision. He complains of chest pain that radiates to the back. His vitals show a heart rate of 135, blood pressure of 80/60 mm Hg, and his respirations are 30/min. A chest X-ray reveals a widened mediastinum, and there is loss of the aortic knob. An ECG is only notable for sinus tachycardia. What might be a suspected diagnosis in this patient?
Explanation: recent trauma + chest pain radiating to back + mediastinal widening on X-ray = aortic dissection
Question # 5
A 28 year old male presents to the ER with complaints of severe chest pain that began suddenly. The pain radiates to his upper back and has bee present for the past 2 hours. It feels like a “tearing sensation” in his back. He denies any fever or chills, but explains that he had an episode of syncope before he came to the hospital. His past medical history is unremarkable. His blood pressure is 145/55 mm Hg, and heart rate is 105/min. He is tall and thin, and has long arms, long fingers, and hyper mobile joints. His sternum has a concave deformity. A cardiac exam is notable for a regular rhythm with an early diastolic murmur at the left upper sternal border, as well as muffled heart sounds. Breath sounds are present across both lung fields, and there are no crackles. ECG shows nonspecific ST segment changes. Cardiac enzymes are within normal ranges. A chest X-ray shows a widened mediastinum. What is the likely diagnosis in this patient?
Explanation: suspected Marfans (long limbs/fingers) + chest pain radiating to back + mediastinal widening on X-ray = aortic dissection
Page Updated: 01.21.2017