Cardiology: aortic dissection: practice question

A General Medicine question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

Try it

General Medicine · Cardiology: aortic dissection

Sample item

A 58-year-old hypertensive man has sudden tearing chest pain radiating to the back. Blood pressure is 190/110 mmHg in the right arm and 150/90 mmHg in the left, and the chest radiograph shows a widened mediastinum. He is haemodynamically stable. What is the most appropriate initial drug therapy?

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

B. Intravenous esmolol or labetalol to lower heart rate and blood pressure

In suspected aortic dissection the aim is to reduce shear stress on the aortic wall by lowering heart rate (target below 60 per minute) and systolic pressure (100 to 120 mmHg). An intravenous beta-blocker is given first; a vasodilator alone causes reflex tachycardia that increases shear. Type A dissection needs emergency surgery. Thrombolysis and anticoagulation are dangerous.

Option by option

  • A. Intravenous alteplase

    Thrombolysis could cause fatal haemorrhage into the pericardium or aortic wall.

  • B. Intravenous esmolol or labetalol to lower heart rate and blood pressure (correct)

    Correct. A short-acting beta-blocker reduces the force and rate of ventricular ejection first.

  • C. Intravenous hydralazine alone

    A vasodilator alone causes reflex tachycardia and raises aortic wall stress.

  • D. Aspirin and heparin infusion

    Antiplatelet and anticoagulant drugs are contraindicated and could worsen bleeding.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

More General Medicine questions

Questions about this General Medicine question

What is the answer to this General Medicine question?

The best answer is B, Intravenous esmolol or labetalol to lower heart rate and blood pressure. In suspected aortic dissection the aim is to reduce shear stress on the aortic wall by lowering heart rate (target below 60 per minute) and systolic pressure (100 to 120 mmHg).

Why is "Intravenous alteplase" not the answer?

Thrombolysis could cause fatal haemorrhage into the pericardium or aortic wall.

Why is "Intravenous hydralazine alone" not the answer?

A vasodilator alone causes reflex tachycardia and raises aortic wall stress.

Why is "Aspirin and heparin infusion" not the answer?

Antiplatelet and anticoagulant drugs are contraindicated and could worsen bleeding.

What concept does this question test?

It tests Cardiology: aortic dissection in General Medicine. An intravenous beta-blocker is given first; a vasodilator alone causes reflex tachycardia that increases shear. Type A dissection needs emergency surgery. Thrombolysis and anticoagulation are dangerous.

How hard is this question?

We tag it as a multi-step question: it asks you to combine more than one idea. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Cardiology: aortic dissection?

For each disease know the classic presentation, the best test, and the first-line treatment. Then use the flashcards and the other General Medicine questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.