NREMT Paramedic Cognitive ExamMedicalMedium
A 45-year-old male presents with sudden onset of severe, tearing pain in his back that radiates to his abdomen. He has a history of poorly controlled hypertension. On assessment, his blood pressure is 190/110 mmHg in the right arm and 140/90 mmHg in the left arm, and his pulse is 110 bpm. Distal pulses are diminished in the left lower extremity. Which of the following is the most likely diagnosis?
- ANephrolithiasis
- BAortic Dissection
- CAcute Pancreatitis
- DMyocardial Infarction
Show answer & explanationAnswer & explanation
Correct answer: B. Aortic Dissection
The patient's sudden onset of severe, tearing back pain radiating to the abdomen, coupled with a significant blood pressure differential between limbs and diminished distal pulses, strongly indicates an aortic dissection. This is a life-threatening condition requiring immediate recognition and intervention.
Why the other options are wrong
- A. Nephrolithiasis causes severe flank pain radiating to the groin, often colicky, and does not present with pulse or blood pressure differentials.
- C. Acute pancreatitis presents with severe epigastric pain radiating to the back, but does not typically cause pulse deficits or blood pressure differentials between limbs.
- D. Myocardial infarction typically presents with chest pain, often radiating to the arm or jaw, and is less likely to cause a significant pulse deficit or blood pressure differential between limbs.
Aortic Dissection
A serious condition in which the inner layer of the aorta, the body's main artery, tears, allowing blood to surge through the tear and split the layers of the aorta.
- Sudden onset of severe, tearing pain (chest, back, abdomen)
- Often associated with uncontrolled hypertension
- Can present with pulse and/or blood pressure differentials between limbs
Memory trick: Tearing Pain, Pressure Difference, Pulse Loss: Aortic Emergency!