Clinical Scenario

[bharat]

ok here is just a simple question which can be faced in our near life so give a try......i know for some it is easy question but if u don't know it might be difficult. try.

You are a general internist working in a hospital paged to the emergency department to evaluate
A 58 year-old man with new-onset pain in his chest and back.
In emergency, the patient describes to you the sudden onset of severe pain in the center of his chest radiating to his neck and mid-back. He has longstanding hypertension, for which he takes a diuretic. You find a normal thoracic wall, clear lungs, equal pulses, a diastolic murmur of aortic regurgitation, and diastolic hypotension with blood pressure of 162/56 mm Hg. The electrocardiogram shows left ventricular hypertrophy but no signs of ischemia or infarction. The first set of cardiac enzymes is normal. The portable chest radiograph shows widening of the mediastinum. An arterial blood gas shows mild respiratory alkalosis and normal oxygenation.

Then what is the most possible diagnosis you can draw from above facts?

[bharat]

well so far no body replied and my vacation is going to finish so before i begin my last busy sem.
here is the answer
the most possible diagnosis is :-Aortic dissection
how? look certain fact
A 58 year-old man with new-onset pain in his chest and back.
On the way to emergency, [you may first think of myocardial ischemia as your leading hypothesis and you wonder whether aortic dissection should be actively considered in this patient].

In emergency, the patient describes to you the sudden onset of severe pain in the center of his chest radiating to his neck and mid-back. He has longstanding hypertension, for which he takes a diuretic. You find a normal thoracic wall, clear lungs, equal pulses, a diastolic murmur of aortic regurgitation, and diastolic hypotension with blood pressure of 162/56 mm Hg. The electrocardiogram shows left ventricular hypertrophy but no signs of ischemia or infarction. The first set of cardiac enzymes is normal. The portable chest radiograph shows widening of the mediastinum. An arterial blood gas shows mild respiratory alkalosis and normal oxygenation.

why i gave it here is about few month ago during Forensic exam there was Fill in Blank question and it was asked "------- is the most commonest cause of Aortic dissection" and so far i remember pregnancy and cocaine use that i remember studying in slides some friend told me about Longstanding HTN but i didn't write it and as i was out of exam hall i know i made mistake so i don't want to make same again so best wishes fellas..

[prachandra]

hey bharat, i am MBBS first year first sem first week ,student in China, tell me something, how tough a exam is in Bir Hospital for applying Internship??? is it similar to that of NMLE licensing exam??Can i get Question bank in the market, nepal ???? help me!!