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NBME 24 Answers

nbme24/Block 1/Question#10 (35.9 difficulty score)
A 75-year-old man is brought unconscious to ...

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hope this helps everyone, even the ones that just "like" everything

 +3  upvote downvote
submitted by andro(115),

Abdominal Vs Thoracic Aneurysm

Abdominal :typically infrarenal

Etiology -smoking ( most important risk factor )

Clinical features pulsatile abdominal mass bruit on auscultation * lower back pain

Recall: All men above 65 who have smoked or are still smokers always screened for AAA

Thoracic aneurysm : typically in ascending aorta

Etiology : - arterial hypertension - connective tissue disorders - syphillis

Clinical features : * thoracic back pain * feeling of pressure in the chest * may lead to compression of local structures like recurrent laryngeal nerve and esophagus

NOT MARFAN: True abdominal aortic aneurysm (AAA) in patients with Marfan syndrome is relatively rare because most aortic aneurysms in this disease are dissecting aneurysms in the thoracic area.

Given the diagnosis of AAA, why did he have syncope? I was first thinking it was from rupture, but his blood pressure is not hypotensive, so how could he get syncope from that.

Or maybe the AAA was compressing the inferior vena cava, causing syncope?

obgynnycstep1 worth taking a look +  

 -1  upvote downvote
submitted by keycompany(268),
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geamI hsosw etrCcnes Sgni, a ocnmmo dgiinnf ni adlniombA rctiAo snerymuAs edu to mulra ohsrtbmu occ.suioln

happysingh  crescent sign is a finding on radiographs that is associated with avascular necrosis, NOT aneurysms !!! what you're seeing is Calcification of wall of the aortic aneurysm +11  
sabistonsurgery  @happysingh - Thank you. You are correct indeed. +  
suckitnbme  Adding on, this patient is a >65 yo Male with a 120 pack year smoking history. Both are significant risk factors for AAA. +