NREMT Paramedic Cognitive ExamMedicalHard
A 45-year-old female presents with acute severe abdominal pain, described as a 'tearing' sensation radiating to her back. She has a history of poorly controlled hypertension. Her vital signs are BP 190/110 mmHg, HR 120 bpm, RR 20 bpm, SpO2 97%. Her skin is cool and clammy. Upon palpation, her abdomen is diffusely tender but soft. Distal pulses are palpable but weak. What is the most likely diagnosis?
- AMyocardial infarction
- BAcute pancreatitis
- CPerforated gastric ulcer
- DAbdominal aortic aneurysm (AAA) dissection
Show answer & explanationAnswer & explanation
Correct answer: D. Abdominal aortic aneurysm (AAA) dissection
The sudden onset of severe 'tearing' abdominal pain radiating to the back in a patient with a history of hypertension, combined with signs of shock (tachycardia, cool/clammy skin) and differential/weak peripheral pulses, is classic for an abdominal aortic aneurysm (AAA) dissection or rupture. Prompt recognition and transport are critical.
Why the other options are wrong
- A. Myocardial infarction can cause referred abdominal pain, but a 'tearing' sensation radiating to the back with differential pulses points away from a primary cardiac event and strongly towards a vascular catastrophe.
- B. Acute pancreatitis causes severe epigastric pain radiating to the back, often with nausea/vomiting, but less commonly described as 'tearing' and rarely causes differential pulses or signs of shock this rapidly without other complications.
- C. A perforated gastric ulcer causes sudden, severe, diffuse abdominal pain, often described as 'knife-like,' with a rigid, board-like abdomen, not typically 'tearing' pain radiating to the back or differential pulses.
Abdominal Aortic Aneurysm (AAA) Dissection/Rupture
A life-threatening condition involving a tear in the inner layer of the aorta (dissection) or a full rupture, causing severe pain and rapid blood loss.
- Classic presentation: sudden, severe 'tearing' or 'ripping' pain in the chest, back, or abdomen.
- Often associated with hypertension.
- Can cause pulse deficits or signs of shock; high mortality.
Memory trick: TEARING BACK PAIN + HTN = AAA ATTACK!