AANP Family Nurse Practitioner (FNP) Certification ExamDiagnosisHard
A 58-year-old male presents to the emergency department with sudden onset of severe, tearing chest pain radiating to his back. He reports the pain started abruptly and is the worst pain he has ever experienced. His blood pressure is 180/100 mmHg in the right arm and 140/80 mmHg in the left arm. Peripheral pulses are diminished in the left arm. Electrocardiogram shows no ischemic changes. What is the most critical diagnosis to consider?
- APericarditis
- BAcute Myocardial Infarction (AMI)
- CAcute Aortic Dissection
- DPulmonary Embolism (PE)
Show answer & explanationAnswer & explanation
Correct answer: C. Acute Aortic Dissection
The sudden onset of severe, tearing chest pain radiating to the back, combined with a significant blood pressure differential between arms and diminished peripheral pulses, are classic highly concerning signs for acute aortic dissection. The absence of EKG changes further supports this over AMI.
Why the other options are wrong
- A. Pericarditis pain is typically sharp, pleuritic, relieved by leaning forward, and does not cause a blood pressure differential or diminished pulses.
- B. While chest pain is present, the 'tearing' quality, radiation to the back, BP differential, and normal EKG make AMI less likely as a primary diagnosis.
- D. PE typically causes sudden dyspnea, pleuritic chest pain, and sometimes hemoptysis, but not usually 'tearing' pain, BP differentials, or diminished pulses.
Acute Aortic Dissection
A life-threatening condition where the inner layer of the aorta tears, allowing blood to surge between the layers, separating them and potentially causing organ ischemia.
- Sudden onset of severe, 'tearing' or 'ripping' chest or back pain.
- May present with blood pressure differentials between arms or pulse deficits.
- High mortality if not rapidly diagnosed and treated.
Memory trick: Aortic Dissection: A 'Tear'ing pain, different 'Pressures', and 'Diminished' pulses.