#august2020mccqe1
A 64-year-old man is brought to the emergency department because of sudden onset of tearing chest pain that seems to originate in the anterior chest and radiate to the back in the interscapular region. A few weeks ago, he had a dental abscess, which resolved with extraction followed by a full course of ampicillin. On examination, he is oriented to person, place, and time; however, he appears in acute distress, is diaphoretic, and is breathing with difficulty. His temperature is 37.1 C (98.8 F), blood pressure is 174/68 mm Hg, pulse is 206/min, and respirations are 25/min. There is no jugular vein distention or hepatomegaly. Auscultation reveals a diastolic murmur along the left sternal border. The lungs are clear to auscultation. The ECG shows no signs of myocardial ischemia. A chest x-ray film demonstrates widening of the mediastinum. Which of the following is the most likely diagnosis?
(A) Aortic dissection
(B) Acute mediastinitis
(C) Acute pericarditis
(D) Cardiac tamponade
(E) Myocardial infarction
A 64-year-old man is brought to the emergency department because of sudden onset of tearing chest pain that seems to originate in the anterior chest and radiate to the back in the interscapular region. A few weeks ago, he had a dental abscess, which resolved with extraction followed by a full course of ampicillin. On examination, he is oriented to person, place, and time; however, he appears in acute distress, is diaphoretic, and is breathing with difficulty. His temperature is 37.1 C (98.8 F), blood pressure is 174/68 mm Hg, pulse is 206/min, and respirations are 25/min. There is no jugular vein distention or hepatomegaly. Auscultation reveals a diastolic murmur along the left sternal border. The lungs are clear to auscultation. The ECG shows no signs of myocardial ischemia. A chest x-ray film demonstrates widening of the mediastinum. Which of the following is the most likely diagnosis?
(A) Aortic dissection
(B) Acute mediastinitis
(C) Acute pericarditis
(D) Cardiac tamponade
(E) Myocardial infarction
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