AANP Family Nurse Practitioner (FNP) Certification ExamAssessmentHard
A 62-year-old male with a history of hypertension and hyperlipidemia presents with sudden onset of severe, tearing chest pain radiating to his back. He reports associated shortness of breath and diaphoresis. On examination, his blood pressure is 180/100 mmHg in the right arm and 140/80 mmHg in the left arm. A faint diastolic murmur is appreciated. What is the most critical diagnostic test to perform immediately?
- ACT angiography of the chest
- BChest X-ray (CXR)
- CElectrocardiogram (ECG)
- DCardiac troponin levels
Show answer & explanationAnswer & explanation
Correct answer: A. CT angiography of the chest
The patient's symptoms (sudden, severe, tearing chest pain radiating to the back, associated with shortness of breath and diaphoresis, and importantly, a significant blood pressure differential between arms) are highly suggestive of acute aortic dissection. CT angiography of the chest is the gold standard for diagnosing aortic dissection, providing rapid and detailed imaging of the aorta.
Why the other options are wrong
- B. A CXR might show a widened mediastinum but is neither sensitive nor specific enough to rule in or rule out aortic dissection definitively and would delay definitive imaging.
- C. While an ECG is always done for chest pain, it would primarily rule out an MI and is not definitive for aortic dissection.
- D. Troponin levels would be elevated in myocardial infarction, which is a differential, but aortic dissection is the more immediate and life-threatening concern here, and troponins are often normal in dissection unless there is coronary involvement.
Acute Aortic Dissection
A life-threatening condition where a tear in the inner layer of the aorta allows blood to flow between the layers, causing them to separate.
- Sudden, severe, 'tearing' chest pain radiating to back.
- Key finding: Pulse/BP differential between extremities.
- CT angiography is the diagnostic gold standard.
Memory trick: Chest Pain: Rule Out the Deadly Ds