spoiler: nbme 18 question about pt with stridor, etc

[dontwantaids]

hey guys, here's an nbme question that I'm confused with: a 68 y/o male with long-standing h/o htn, now presents with 3 days h/o of chest pain, visible pulsation around manibrium, a murmur in right second intercoastal space, horseness, stridor, dysphagia, nonproductive cough, bp 160/70, lungs clear, displacement of trachea to right. People in different forums are suggesting that it's aortic aneurysm. But isn't it aortic stenosis? Aortic aneurysm can cause a regurgitation murmur in left sternal border; I didn't know that a thoracic aortic aneurysm causes visible pulsation; aortic aneurysm without dissection doesn't cause chest pain (this patient doesn't have shock and thus no dissection); i'm thinking that aortic stenosis is causing dilation of left atrium and thus dysphagia, stridor; also explains the chest pain. What do you guys think

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[Iceandmedicine]

That widened pulse pressure is the big giveaway that it's aortic regurtitation

 

[dontwantaids]

That widened pulse pressure is the big giveaway that it's aortic regurtitation

that's right, thanks! btw, his bp is actually 160/94 (I made the mistake of saying 160/70). I also found in medscape that when AR is due to aortic dissection, it causes murmur in right 2nd intercoastal space (instead of the usual left parasternum).