Rosh Emergency Medicine Practice Test 2025 - Free Emergency Medicine Practice Questions and Study Guide

When considering the symptoms of a ruptured abdominal aortic aneurysm (AAA), it is important to understand the typical presentation and the anatomy involved. One of the hallmark symptoms is sudden severe back pain. This type of pain occurs due to the aneurysm applying pressure on surrounding nerves or due to bleeding from the aneurysm irritating the tissues around the aorta as it ruptures.

During a rupture, patients may also experience referred pain, which may manifest as flank pain that can be perceived to originate from the lower back or sides. This phenomenon occurs because the aorta is located near the spine and its branches supply blood to structures in the abdomen and pelvis. Pain signals can overlap, leading to confusion in the exact location of discomfort.

The distended abdomen may indicate internal bleeding or blood accumulation in the abdominal cavity, but it is not specific to AAA and can be seen in various other conditions. Neck pain does not relate to AAA and is more characteristic of cervical issues or other thoracic pathologies. Therefore, while flank pain may present, it is crucial to recognize sudden severe back pain as the most common and classic symptom associated with a ruptured abdominal aortic aneurysm. Understanding these presentations helps in the rapid identification and management of this potentially life-threatening condition.