AANP Family Nurse Practitioner (FNP) Certification ExamDiagnosisHard
A 58-year-old male presents with sudden onset of severe, tearing chest pain radiating to his back. He reports a history of poorly controlled hypertension. On examination, his blood pressure is 180/100 mmHg in the right arm and 160/90 mmHg in the left arm. He has a new diastolic murmur. Which of the following is the most critical immediate diagnostic consideration?
- AAortic dissection
- BAcute myocardial infarction (AMI)
- CPericarditis
- DPulmonary embolism (PE)
Show answer & explanationAnswer & explanation
Correct answer: A. Aortic dissection
The patient's sudden, severe, tearing chest pain radiating to the back, history of hypertension, differential blood pressures between arms (aortic dissection often causes pulse/BP deficits), and a new diastolic murmur (suggesting aortic regurgitation) are classic signs of acute aortic dissection, a life-threatening emergency.
Why the other options are wrong
- B. AMI typically presents with crushing chest pain, often radiating to the arm or jaw, but less commonly tearing pain radiating to the back, and rarely differential blood pressures or a new diastolic murmur.
- C. Pericarditis causes sharp, pleuritic chest pain, often relieved by leaning forward, and may have a pericardial friction rub, but not the tearing quality, differential blood pressures, or new diastolic murmur.
- D. PE causes sudden pleuritic chest pain, dyspnea, and tachycardia, but not typically tearing pain, differential blood pressures, or a new diastolic murmur.
Acute Aortic Dissection
A life-threatening condition caused by a tear in the inner layer of the aorta, allowing blood to flow between the layers of the aortic wall.
- Sudden onset, severe, 'tearing' or 'ripping' chest or back pain.
- Risk factors: uncontrolled hypertension, Marfan syndrome.
- Physical exam: pulse or blood pressure differential between arms, new aortic regurgitation murmur.
- Requires urgent imaging (CT angiography) and surgical intervention.
Memory trick: Dissection is a 'Devastating' 'Differential' in BP, 'Tearing' through the chest.