Which symptoms require urgent evaluation in a patient with an aneurysm?

• A. Severe abdominal/back pain; Syncope; Hypotension; Cool clammy skin.
• B. Headache relieved by sleep.
• C. Mild chest discomfort after exertion.
• D. Rash on the chest.

Answer: (A)

Rupture of an aneurysm is a surgical emergency because it causes internal bleeding and rapid loss of blood pressure. The most concerning signs are those that indicate this bleed and resulting shock: sudden severe abdominal or back pain from the ruptured vessel, fainting or syncope from drop in blood pressure, hypotension, and cool, clammy skin due to reduced perfusion. These signs together point to a life-threatening rupture that needs urgent evaluation and intervention.

The other options don’t point to rupture: a headache that goes away with sleep isn’t consistent with acute hemorrhage; mild chest discomfort after exertion could be angina or another benign issue; a rash on the chest is unrelated to aneurysm rupture.