A 52-Year-Old Man Comes to the Emergency Department Due to Several

A 52-year-old man comes to the emergency department due to several days of vague chest pain and cough.  He immigrated to the United States from Taiwan 20 years ago.  Temperature is 37.1 C (98.8 F) .  Physical examination reveals a decrescendo-type diastolic murmur over the right sternal border.  Pulmonary auscultation reveals normal breath sounds with no wheezes or rales.  Abdominal examination shows no organomegaly.  Serum fluorescent treponemal antibody absorption testing is positive.  Chest x-ray reveals mediastinal widening.  The pathologic process most likely responsible for this patient's symptoms starts as which of the following?

A) Intimal streak
B) Intimal tear
C) Medial degeneration
D) Medial inflammation
E) Vasa vasorum obliteration

Correct Answer:

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