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NBME 21 Answers

nbme21/Block 1/Question#25

A 28-year-old man is brought to the emergency ...

Dissecting aneurysm

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submitted by neonem(227),

Major risk factor for aortic dissection is hypertension, and in this case might be due to cocaine use, which causes marked hypertension. Dissections cause a tear in the tunica intima -- blood can flow backwards into the pericardium and cause tamponade. This manifests as crackles in the lung due to poor left ventricular function (filling/diastolic problem due to compression).

forerofore  there is another clue, the man has diminished pulses in just one arm, which means that the left subclavian artery must be involved somehow, and an aortic dissection would be the best answer explaining this. +3  
temmy  please why is there where a diastolic mumur? +1  
whoissaad  @temmy Aortic dissection especially near the root of aorta can lead to dilatation of the aortic valves, which can lead to Aortic regurgitation (diastoic murmur at left sternal border) +2  
garibay92  Does anyone know why is this patient's tepmerature elevated? +  
ratadecalle  @garibay92, not important for this question I think but cocaine can cause malignant hyperthermia +1