Q31: High Yield PLAB- UKMLA Exam Style Question
A 61-year-old male was taken to the emergency department following a sudden onset, severe chest pain at rest. He complains that the pain is radiating into his back and down his arms. He has a past medical history of hypertension, angina and had a deep vein thrombosis four years ago. His current medications include ramipril, glyceryl trinitrate spray and simvastatin. Hs is a non-smoker and does not drink alcohol and has not had any recent travel abroad. A chest x-ray reveals a widened mediastinum and ECG shows sinus tachycardia. He thinks he found some relief from the pain 20 minutes after using his GTN spray. What is the single most likely diagnosis?
A. Pneumothorax
B. Unstable angina
C. Pulmonary embolism
D. ST elevation myocardial infarction
E. Aortic dissection
Try to answer this question in 50 seconds. Comment your answer below. The answer to this question is given below.
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The correct answer is E
Aortic dissection presents very likewise to myocardial infarction, nevertheless, the pain is classically described as tearing in nature and radiates into the back. An ECG can show ST elevation in the inferior leads if it involves the right coronary artery. In this case, the ECG did not show any ST elevation, hence, it is not an ST-elevation myocardial infarction.
Note that, a GTN spray should provide relief within a few minutes, hence taking 20 minutes to provide light relief is unlikely in genuine vasodilatation relieving angina.
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