American Board of Internal Medicine (ABIM) Certification Practice Exam

Which initial treatment is recommended for uncomplicated type B acute aortic injury?

1. Immediate surgery

2. β-blockade followed by a parenteral arterial vasodilator

3. Antihypertensive medication only

4. Selective embolization

The correct answer is: β-blockade followed by a parenteral arterial vasodilator

For uncomplicated type B acute aortic injury, the recommended initial treatment is β-blockade followed by a parenteral arterial vasodilator. This approach focuses on controlling the blood pressure and minimizing shear stress on the aorta, which are crucial factors in managing this condition. Type B acute aortic injuries involve a tear in the aorta that does not involve the ascending aorta. These cases are usually less critical than type A injuries but still necessitate prompt management to prevent complications such as aortic rupture, dissection extension, or organ ischemia. The use of β-blockers is important as they help to lower heart rate and blood pressure, subsequently reducing the stress on the aortic wall. Following this, incorporating a parenteral arterial vasodilator can further decrease systemic vascular resistance, aiding in more effective management of the blood pressure. Immediate surgery is not typically warranted for uncomplicated type B injuries unless there are signs of complications or rapid deterioration. While antihypertensive medication is necessary, relying solely on it without the combination of β-blockade may not sufficiently reduce the heart rate and shear stress. Selective embolization is not appropriate for managing aortic injuries since it targets different pathologies commonly related to vascular issues rather than the structural concerns of