AANP Family Nurse Practitioner (FNP) Certification ExamAssessmentHard
A 58-year-old male presents with sudden onset of excruciating, tearing chest pain radiating to his back. He reports a history of uncontrolled hypertension. On examination, his blood pressure is 180/100 mmHg in the right arm and 140/80 mmHg in the left arm. His pulses are palpable but diminished in the left arm compared to the right. Which of the following diagnostic tests is the most appropriate initial imaging study?
- ATransthoracic echocardiogram (TTE).
- BComputed Tomography Angiography (CTA) of the chest.
- CElectrocardiogram (ECG).
- DChest X-ray.
Show answer & explanationAnswer & explanation
Correct answer: B. Computed Tomography Angiography (CTA) of the chest.
The patient's presentation with sudden, tearing chest pain radiating to the back, a history of uncontrolled hypertension, and a significant blood pressure differential between arms strongly suggests acute aortic dissection. CTA of the chest is the most appropriate initial imaging study as it provides rapid, detailed visualization of the aorta, confirming the dissection and its extent, which is critical for immediate management.
Why the other options are wrong
- A. Transthoracic echocardiogram can sometimes visualize proximal aortic dissection but is often limited by acoustic windows and is less comprehensive than CTA for evaluating the entire aorta.
- C. An ECG is essential to rule out myocardial infarction but will not diagnose aortic dissection.
- D. A chest X-ray may show a widened mediastinum but is not sensitive or specific enough to diagnose aortic dissection definitively and rapidly.
Acute Aortic Dissection Diagnosis
Acute aortic dissection is a life-threatening condition where the inner layer of the aorta tears, leading to blood flow between the layers. Diagnosis requires rapid imaging.
- Classic symptoms: sudden, tearing chest/back pain.
- Physical signs: pulse/BP differential, new murmur.
- CTA of chest is the diagnostic imaging of choice.
Memory trick: Dissection's Danger: CT Angiography Confirms the Tear