NREMT Paramedic Cognitive ExamMedicalMedium
A 35-year-old female presents with sudden onset of severe, tearing chest pain radiating to her back. She is diaphoretic and anxious. Her blood pressure is 190/110 mmHg in the right arm and 140/90 mmHg in the left arm. Heart rate is 104 bpm, and respirations are 20 breaths/min. Distal pulses are palpable but diminished in the left arm. What is the MOST likely underlying condition?
- AAortic dissection
- BPulmonary embolism
- CAcute myocardial infarction
- DSpontaneous pneumothorax
Show answer & explanationAnswer & explanation
Correct answer: A. Aortic dissection
The sudden onset of severe, tearing chest pain radiating to the back, combined with a significant blood pressure differential between the upper extremities and diminished pulses, is highly indicative of an aortic dissection. This is a life-threatening emergency.
Why the other options are wrong
- B. Pulmonary embolism typically presents with sudden onset of dyspnea, pleuritic chest pain, and sometimes hemoptysis, but not usually with tearing pain or BP differentials.
- C. While chest pain is present, the tearing quality and BP differential are not typical for MI. MI pain is often crushing or pressure-like.
- D. Spontaneous pneumothorax causes sudden pleuritic chest pain and dyspnea, often with diminished breath sounds on the affected side, but not tearing pain or BP differentials.
Aortic Dissection
Aortic dissection is a life-threatening condition where the inner layer of the aorta tears, allowing blood to surge between the layers, forcing them apart.
- Sudden, severe 'tearing' or 'ripping' pain.
- Pain often radiates to the back.
- May present with blood pressure or pulse deficits between limbs.
Memory trick: Tearing pain plus unequal pulses means run to the ER!