Acute Aortic Dissection

A 65-year-old man presents with sudden thoracic pain and is suspected of having an acute aortic dissection.

Which of the following is the most common predisposing factor for this disease?

A 70-year-old man presents with an abrupt onset of anterior chest pain. You suspect aortic dissection.

Where in the aorta does the intimal tear occur most commonly?

A 68-year-old woman attends the emergency department (ED) complaining of thoracic pain.

Which of the following is the most common presenting symptom of acute aortic dissection?

A 78-year-old man collapsed at home and was brought to the ED with a suspected aortic dissection.

Which of the following findings on physical examination would be the least likely to be present?

An 85-year-old woman is found collapsed with sudden onset paraplegia with a sensory level at T4. A portable erect chest x-ray and an ECG is performed as part of the initial assessment in resus. You consider aortic dissection in your differential diagnosis of this patient.

Which one of the following chest X-ray features would not support this diagnosis?

A 65-year-old man presented with sudden onset chest pain and shock. Examination revealed a slightly obtunded conscious level, distended neck veins, no audible heart sounds and a blood pressure of 70/40. You suspect he has an aortic dissection complicated by haemopericardium with cardiac tamponade.

Which of the following procedures is absolutely contraindicated?

A 50-year-old woman is awaiting transfer to the regional cardiothoracic surgical centre with a Type A aortic dissection. Her blood pressure continues to be elevated at 180/110 despite opiate analgesia. She has a previous history of hypertension, but is otherwise fit and well normally.

Which one of the following antihypertensives would be the best to use for her?

A 67-year-old man with a Type B aortic dissection has continuous intractable chest and back pain. The cardiothoracic surgeons have decided that his dissection is not amenable to surgery.

Which one of the following is this patient’s most urgent need?

A 74-year-old man with longstanding hypertension presents with sudden, severe interscapular pain and was strongly considered to have an acute aortic dissection in the ED. No other diagnosis is evident from the CXR, 12 lead ECG or blood investigations, and CT scan of his aorta was reported as normal. The patient still has severe pain and unchanged ECG findings.

What should be done in such a case?