AANP Family Nurse Practitioner (FNP) Certification ExamAssessmentHard
A 58-year-old male with a history of hypertension and hyperlipidemia presents with sudden onset of excruciating, tearing chest pain radiating to his back. He appears pale and diaphoretic. His blood pressure is 180/100 mmHg in the right arm and 140/80 mmHg in the left arm. Which of the following is the most concerning finding on physical examination?
- ADiaphoresis
- BHypertension
- CBlood pressure differential between arms
- DTearing chest pain radiating to the back
Show answer & explanationAnswer & explanation
Correct answer: C. Blood pressure differential between arms
The patient's presentation of sudden, excruciating, tearing chest pain radiating to the back, especially with a history of hypertension, is highly suggestive of acute aortic dissection. The significant blood pressure differential between the two arms (40 mmHg systolic difference) is a classic and highly concerning physical finding that indicates possible involvement of the subclavian artery by the dissection, making it the most crucial finding among the options.
Why the other options are wrong
- A. Diaphoresis is a general sign of severe pain or shock, but not specific to aortic dissection.
- B. Hypertension is a risk factor for aortic dissection and often present, but a differential in BP is more specific for dissection.
- D. Tearing chest pain radiating to the back is a classic symptom, but the BP differential is a more objective and specific physical sign of the extent of dissection.
Acute Aortic Dissection Diagnosis
Rapid identification of a tear in the inner layer of the aorta, leading to blood flow between the layers of the aortic wall.
- Sudden, severe, tearing chest/back pain.
- Risk factors: hypertension, Marfan syndrome.
- Key physical finding: pulse or blood pressure differential between limbs.
Memory trick: Dissection's 'D'anger: 'D'ifferent 'D'igital Pressures.