Step 2

Cardiovascular 6

A 63-year-old man presents to the emergency department with 2 hours of severe back and abdominal pain. Past medical history includes hyperlipidemia and hypertension, both of which are well-controlled with medication. He reports a lifelong smoking history and only social alcohol consumption. He reports some nausea but denies any vomiting, diarrhea, melena, hemoptysis, chest pain, or shortness of breath. Vital signs are 37.0° C (98.6° F), pulse 123 beats/min, respirations 24/min, and blood pressure 88/65 mmHg. Physical examination reveals a diaphoretic man with diffuse abdominal and flank pain, as well as a palpable pulsatile abdominal mass. The remainder of the examination is normal, and resuscitation with intravenous (IV) fluids is started.

Which of the following is the most appropriate next step in management?

  • A) Abdominal computed tomography (CT)
  • B) Abdominal ultrasound
  • C) Chest X-ray
  • D) Electrocardiogram (ECG) and troponin levels
  • E) Emergency surgery


Dawid Karapuda


Dr. Raj Dasgupta