Cardiovascular drugs: acute aortic dissection: practice question

A Pharmacology question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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Pharmacology · Cardiovascular drugs: acute aortic dissection

Sample item

A man with a tearing chest pain and a blood pressure of 200/110 mm Hg is diagnosed with acute aortic dissection. Which initial drug is chosen to reduce shear stress on the aortic wall?

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

A. Intravenous esmolol

The aim is to lower heart rate and the rate of rise of ventricular pressure. An intravenous beta blocker such as esmolol is given first. A vasodilator is added only afterwards, because used alone it causes reflex tachycardia that increases shear stress.

Option by option

  • A. Intravenous esmolol (correct)

    Correct. It lowers heart rate and the force of ejection, reducing aortic wall stress.

  • B. Intravenous hydralazine

    Hydralazine causes reflex tachycardia and increases wall stress.

  • C. Intravenous nitroprusside alone

    Nitroprusside alone causes reflex tachycardia, so a beta blocker must come first.

  • D. Oral nifedipine

    Short-acting nifedipine causes reflex tachycardia and unpredictable falls.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

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Questions about this Pharmacology question

What is the answer to this Pharmacology question?

The best answer is A, Intravenous esmolol. The aim is to lower heart rate and the rate of rise of ventricular pressure.

Why is "Intravenous hydralazine" not the answer?

Hydralazine causes reflex tachycardia and increases wall stress.

Why is "Intravenous nitroprusside alone" not the answer?

Nitroprusside alone causes reflex tachycardia, so a beta blocker must come first.

Why is "Oral nifedipine" not the answer?

Short-acting nifedipine causes reflex tachycardia and unpredictable falls.

What concept does this question test?

It tests Cardiovascular drugs: acute aortic dissection in Pharmacology. An intravenous beta blocker such as esmolol is given first. A vasodilator is added only afterwards, because used alone it causes reflex tachycardia that increases shear stress.

How hard is this question?

We tag it as a multi-step question: it asks you to combine more than one idea. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Cardiovascular drugs: acute aortic dissection?

Learn drugs as classes, then the exception in each class that an examiner would pick. Then use the flashcards and the other Pharmacology questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.