A 20-year-old man is evaluated for hypertension. On physical examination, BP 180/80 in both arm, HR 60/min regular, normal S1, S2, S4 in noted at the apex, soft systolic murmur over left posterior chest. An abdominal bruit is audible. Femoral pulses are difficult to palpate, and there is radial artery to femoral artery pulse delay. Which of the following is the most likely diagnosis?
سؤال مجاني 5 من 10 اليوم · اشترك وكمّل بدون حد
اعرض الإجابة
الإجابة والشرح
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الإجابة: A. Aortic coarctation
A young man with high upper-limb BP, weak/delayed femoral pulses (radio-femoral delay) and a systolic murmur over the posterior chest (collaterals/coarctation site) has coarctation of the aorta. The narrowing raises pressure proximal to the lesion and lowers it distally. Renovascular hypertension gives an abdominal bruit but normal femoral pulses; essential HTN is unlikely at 20 with these signs.
ليش كل خيار صح أو غلط
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A
ليش صح
Coarctation: upper-limb BP is higher than lower-limb BP, with a brachial-femoral delay (femoral pulse comes late), and rib notching on chest x-ray.
✓ (Y4)-(M B) Hypertension.pdf · p. 10 -
B
ليش غلط
Secondary hypertension is suspected in young patients and severe cases; a 20-year-old with weak femoral pulses and a radio-femoral delay points to a secondary cause.
✓ (Y4)-(M B) Hypertension.pdf · p. 10 -
C
ليش غلط
HCM causes a crescendo-decrescendo systolic murmur from LV outflow obstruction, heard at Erb's point; the delayed femoral pulses and upper-limb hypertension belong to coarctation.
✓ 8• Heart Sounds & Murmurs [Notes].pdf · p. 5 -
D
ليش غلط
Renovascular disease is suggested by an abdominal bruit and reduced renal blood flow; the arm-leg BP difference and femoral delay point to coarctation instead.
✓ (Y4)-(M B) Hypertension.pdf · p. 10
- المصدر
- (Y4)-(M B) Hypertension.pdf · p. 10
11• Hypertension [Notes].pdf · p. 2 - المحاضرة
- Hypertension · Cardiology · Module B
- ظهر في
- Cardio bank · MED42 ♂ EOM B