Question 1

Question

A 55-year-old man presents to the emergency department with sudden-onset tearing chest pain radiating to the interscapular region. He has a history of poorly controlled hypertension. BP is 178/96 mmHg in the right arm and 142/80 mmHg in the left arm. He is diaphoretic and in moderate distress. A CT angiogram of the chest is obtained. The image demonstrates an intimal flap originating 3 cm distal to the left subclavian artery with the false lumen extending through the descending thoracic aorta to the level of the renal arteries; the ascending aorta and aortic root appear normal. Which of the following is the most appropriate management?

Accepted Answer

Initiate IV labetalol to achieve a target heart rate below 60 bpm and systolic BP below 120 mmHg, and admit to the ICU

Answer

Arrange emergent cardiopulmonary bypass and open surgical repair of the aorta

Answer

Perform urgent thoracic endovascular aortic repair (TEVAR) in the interventional suite

Answer

Administer IV thrombolytics and obtain repeat CT angiography in 24 hours to assess progression

Answer

Perform emergent bedside transesophageal echocardiography and prepare for pericardiocentesis

Gastrointestinal Surgery — MCQs

Gastrointestinal Surgery — MCQs

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