A 42-Year-Old Man Comes to the Emergency Department Due to Severe

question 42

Multiple Choice

A 42-year-old man comes to the emergency department due to severe chest pain that started abruptly 2 hours ago.  The pain is midline, constant, and 10/10 in intensity.  He has had no fever, cough, or shortness of breath.  His only medical condition is hypertension.  On examination, the patient is diaphoretic and is in severe distress due to pain.  Temperature is 37 C (98.6 F) , pulse is 116/min, and respirations are 24/min.  Systolic blood pressure is 82 mm Hg in the right arm and 60 mm Hg in the left arm.  Jugular veins are distended with an estimated pressure of 13 cm H₂O.  The lungs are clear to auscultation.  The point of maximal impulse is not palpable.  The extremities are cold with no peripheral edema.  The patient develops cardiac arrest and dies soon after arrival.  Autopsy would most likely reveal which of the following findings?

• A)Air within the pleural space
• B)Blood in the pericardial space
• C)Ruptured posteromedial papillary muscle
• D)Thrombus at the pulmonary artery bifurcation
• E)Transmural necrosis of the anterolateral myocardium

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