Viva 5

A 76-year-old male has presented 4 hours after onset of acute, severe chest and back pain. He is
awake and responsive with a BP of 80/50 mmHg. His past history includes hypertension and 40-pack
year smoking.

 What are the life-threatening causes for this presentation and what clinical examination findings would you seek to differentiate between these causes?

(This viva dealt with the diagnosis, management and complications of thoracic aortic dissection.)

Disclaimer: the viva stem above may be an original CICM stem, acquired from their publicly available past papers. Or, perhaps it is a slightly altered version of the original CICM stem. Or, it is a completely original viva stem, concocted by the monstrously amoral author of Deranged Physiology for nothing more than his own personal amusement. In either case, because the college do not make the main viva text or marking criteria available, almost everything here has been confabulated. It might sound like a plausible viva and it could be used for the purpose of practice, but all should be aware that it does not represent the "true" canonical CICM viva station.