NBME 21 Answers ↦
there is another clue, the man has diminished pulses in just one arm, which means that the left subclavian artery must be involved somehow, and an aortic dissection would be the best answer explaining this.
please why is there where a diastolic mumur?
@temmy Aortic dissection especially near the root of aorta can lead to dilatation of the aortic valves, which can lead to Aortic regurgitation (diastoic murmur at left sternal border)
Does anyone know why is this patient's tepmerature elevated?
@garibay92, not important for this question I think but cocaine can cause malignant hyperthermia
judging by his heart murmur, he probably has marfan syndrome. that's the only place where FA talks about dissecting aneurysm
he's only 28 - another clue for marfan?
did anyone else think it was weird his only sx was SOB? I always think of radiating pain as being a good clue for dissection
@almondbreeze his heart murmur is at the LSB (aortic regurg) and not consistent with MVP plus no other sx/indication of Marfan. I think the only association of RF you should think about in this question is the cocaine use and consequent HTN.
@turtlepenlight I agree. I chose another answer because I was like, there's no way this guy doesn't hurt if he's got a dissection.
*same goes for saccular aneurysm, which also is usually 2/2 trauma
In the question stem there is no indication of trauma so it would be hard to just assume that
see my comment above for marfan syndrome. might help
This is because a pseudoaneurysm is between the media and adventitia, and is incited by trauma; a dissection is between the intima and the media and is a result of hypertension causing an intimal tear. The history points toward cocaine -> hypertension rather than penetrating trauma.