Question

A 56-year-old man is brought to the emergency room for severe chest pain over the past hour. He reports 10/10, burning pain that is retrosternal and concentrated around the mid-chest region. His wife claims that he has been throwing up for the past several hours from what seems like a ""stomach bug,"" with the latest 2 episodes of emesis being bright red. The patient denies trauma, fever, recent infections, urinary changes or diarrhea but endorses lightheadedness and shortness of breath. His past medical history is significant for hypertension and diabetes. A computed tomography (CT) with IV and oral contrast of the chest and abdomen is obtained and its results are shown in Figure A. What is the most specific physical examination findings for this patient's diagnosis?

a. Crepitus on palpation of the chest
b. Diminished breath sounds
c. Friction rub
d. Pulsus paradoxus
e. Unequal blood pressure in both arms

Answer 1

The most specific physical examination finding for a diagnosis in a patient with severe retrosternal pain and associated symptoms, with a history of hypertension and diabetes, would be unequal blood pressure in both arms, indicative of aortic dissection. The correct answer is option E

Step-by-step explanation:

The question pertains to identifying the most specific physical examination findings for a 56-year-old man with severe chest pain and other symptoms suggestive of an acute medical condition. Based on the given symptoms of severe, burning retrosternal pain, vomiting, lightheadedness, and shortness of breath, along with significant medical history of hypertension and diabetes, the most specific physical examination finding that could point towards the patient's diagnosis in this scenario would likely be unequal blood pressure in both arms. This could indicate aortic dissection, which is a serious condition requiring prompt medical attention.

Acute myocardial infarction (MI) is also ruled into differential diagnosis due to the presentation of severe chest pain. However, the physical examination finding of unequal blood pressure is more specific to aortic dissection than to MI.