A 58-year-old man is brought to the emergency department by his family because of severe upper back pain, which he describes as ripping. The pain started suddenly 1 hour ago while he was watching television. He has hypertension for 13 years, but he is not compliant with his medications. He denies the use of nicotine, alcohol or illicit drugs. His temperature is 36.5°C (97.7°F), the heart rate is 110/min and the blood pressure is 182/81 mm Hg in the right arm and 155/71 mm Hg in the left arm. CT scan of the chest shows an intimal flap limited to the descending aorta. Intravenous opioid analgesia is started. Which of the following is the best next step in the management of this patient condition?
AIntravascular ultrasound
BEmergency surgical intervention
CSublingual nitroglycerin
DIntravenous esmolol
EOral metoprolol and/or enalapril
A 68-year-old man presents for a screening ultrasound scan. He has been feeling well and is in his usual state of good health. His medical history is notable for mild hypertension and a 100-pack-year tobacco history. He has a blood pressure of 128/86 and heart rate of 62/min. Physical examination is clear lung sounds and regular heart sounds. On ultrasound, an infrarenal aortic aneurysm of 4 cm in diameter is identified. Which of the following is the best initial step for this patient?
AReassurance
BBeta-blockers
CUrgent repair
DSurveillance
EElective repair
A 75-year-old Caucasian man presents to the emergency department with abdominal pain. The patient states he was at home eating dinner when he began to experience severe abdominal pain. The patient has a past medical history of diabetes, hypertension, and atherosclerosis. He lives at home alone, smokes cigarettes, and drinks 1 to 2 alcoholic drinks per day. The patient is given IV morphine and an ultrasound is obtained demonstrating a dilated abdominal aorta. The patient states that his father died of a similar finding and is concerned about his prognosis. Which of the following is the greatest risk factor for this patient's presentation?
AMale gender and age
BCaucasian race
CCigarette smoking
DFamily history
EAtherosclerosis
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