A 70-Year-Old Man Comes to the Emergency Department Due to Severe

question 20

Multiple Choice

A 70-year-old man comes to the emergency department due to severe midback pain that started several hours ago.  He describes the pain as excruciating and wants immediate relief.  The patient also has nausea, diaphoresis, and lightheadedness.  He has a history of hypertension and chronic kidney disease.  His medication compliance has been poor.  He is an active smoker with a 40-pack-year history.  His blood pressure on the right arm is 220/105 mm Hg.  ECG shows sinus tachycardia and voltage criteria for left ventricular hypertrophy with secondary ST-segment and T wave changes.  After initial evaluation, a transesophageal echocardiogram shows a dissection flap in the descending aorta but no evidence of dissection in the ascending aorta.  The dissection flap in this patient most likely originates near which of the following points?

• A)Brachiocephalic trunk
• B)Celiac trunk
• C)Intercostal arteries
• D)Left subclavian artery
• E)Renal arteries

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Definitions:

Rational Choice Theories

Rational choice theories are based on the premise that individuals make decisions by calculating the costs and benefits of various actions to maximize their personal advantage.

Coterminous

means sharing the same boundaries or extent in space, time, or meaning.

Exchange Theory

A theoretical framework suggesting that social behavior is the result of an exchange process aiming to maximize benefits and minimize costs to individuals.

Rational Choice Theory

A framework for understanding and often formally modeling social and economic behavior based on the assumption that individuals act on rational self-interest.