A 32-Year-Old Man Comes to the Emergency Department with Intense

question 138

Multiple Choice

A 32-year-old man comes to the emergency department with intense, midline chest pain and diaphoresis of 4 hours duration.  Prior to the onset of pain, he developed nausea and recurrent vomiting after returning from a party.  His medical conditions include HIV infection, alcohol use disorder, and alcoholic hepatitis.  The patient uses cocaine regularly and does not take his medications regularly.  Temperature is 38.3 C (101 F) , blood pressure is 100/60 mm Hg, pulse is 120/min, and respirations are 28/min.  Examination shows injected conjunctivae and bilateral dilated pupils.  Breath sounds are present on the right but diminished on the left.  Heart sounds are normal.  Chest x-ray demonstrates a widened mediastinum and moderate left-sided pleural effusion.  ECG shows sinus tachycardia.  The pleural fluid is found to be a yellow exudate with high amylase content.  Which of the following is the most likely diagnosis in this patient?

• A)Acute pancreatitis
• B)Aortic dissection
• C)Aspiration pneumonia
• D)Esophageal perforation
• E)Myocardial infarction

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