Vascular surgery: drug treatment in acute aortic dissection: practice question

A General Surgery 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.

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General Surgery · Vascular surgery: drug treatment in acute aortic dissection

Sample item

A 58-year-old man has sudden tearing interscapular pain. CT confirms an acute aortic dissection. His blood pressure is 190/105 mmHg and his heart rate is 110 per minute. Which initial drug therapy is best?

ASublingual nifedipineBIntravenous hydralazine bolusCSodium nitroprusside infusion as the only agentDIntravenous beta-blocker such as esmolol or labetalol

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

The answer and the reasoning

D. Intravenous beta-blocker such as esmolol or labetalol

The aim is to lower heart rate and blood pressure to reduce aortic wall shear (dP/dt). An intravenous beta-blocker is given first. A vasodilator can be added afterwards, because vasodilator alone causes reflex tachycardia that increases shear stress.

Option by option

A. Sublingual nifedipine
Sublingual nifedipine causes abrupt unpredictable hypotension and reflex tachycardia.
B. Intravenous hydralazine bolus
Hydralazine produces reflex tachycardia and an uncontrolled fall in pressure, so it is unsuitable.
C. Sodium nitroprusside infusion as the only agent
Nitroprusside without prior beta-blockade causes reflex tachycardia that worsens the dissection.
D. Intravenous beta-blocker such as esmolol or labetalol (correct)
Correct. A beta-blocker reduces heart rate and the force of ejection, limiting propagation of the dissection.

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.

Questions about this General Surgery question

What is the answer to this General Surgery question?

The best answer is D, Intravenous beta-blocker such as esmolol or labetalol. The aim is to lower heart rate and blood pressure to reduce aortic wall shear (dP/dt).

Why is "Sublingual nifedipine" not the answer?

Sublingual nifedipine causes abrupt unpredictable hypotension and reflex tachycardia.

Why is "Intravenous hydralazine bolus" not the answer?

Hydralazine produces reflex tachycardia and an uncontrolled fall in pressure, so it is unsuitable.

Why is "Sodium nitroprusside infusion as the only agent" not the answer?

Nitroprusside without prior beta-blockade causes reflex tachycardia that worsens the dissection.

What concept does this question test?

It tests Vascular surgery: drug treatment in acute aortic dissection in General Surgery. An intravenous beta-blocker is given first. A vasodilator can be added afterwards, because vasodilator alone causes reflex tachycardia that increases shear stress.

How hard is this question?

We tag it as an application question: it asks you to use a fact on a patient or a finding. 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 Vascular surgery: drug treatment in acute aortic dissection?

Learn classic signs and eponyms alongside what they diagnose. Then use the flashcards and the other General Surgery 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.