Emergency vascular surgery: a free FRCS (Gen Surg) Section 1 question

This is a ruptured or symptomatic abdominal aortic aneurysm until proved otherwise: new abdominal or loin pain in an older smoker with a large aneurysm on bedside ultrasound. NICE advises immediate bedside aortic ultrasound and, once an aneurysm is shown, immediate discussion with the regional vascular service, because survival depends on time to a centre that can repair it. CT angiography is valuable for planning but must not delay referral, and many patients are best scanned at the receiving unit. Ultrasound cannot exclude retroperitoneal rupture, so a formal scan adds nothing. Renal colic is the classic misdiagnosis. Observation in a hospital that cannot operate risks unheralded collapse. Reference: NICE NG156, Abdominal aortic aneurysm: diagnosis and management (2020).