USMLE Step 3 - Question 43

A 55 year old male with a history of hypertension presents to the emergency room with acute onset chest pains. His temperature is 37.0, blood pressure 190/70 in the left arm and 150/70 in the right arm, heart rate 110, respirations 22, and oxygen saturation 94% on room air. Physical examination reveals normal lung sounds, elevated jugular venous pressures and a II/IV early diastolic murmur at the right upper sternal border. ECG shows normal sinus rhythm and left ventricular hypertrophy. Which of the following is the most likely diagnosis?

A. Pulmonary embolus

B. Mitral valve stenosis

C. Aortic dissection

D. Ascending aortic aneurysm

E. Myocardial ischemia