A 20-year-old man is referred for evaluation of hypertension. He states he has never had any health problem. On examination, he appears in no apparent distress. His height is 175 cm, and his weight is 70 kg. Blood pressure is 162/80 mmHg in the upper extremities and Ul5/77 mmHg in the lower extremities. There is no jugular venous distension or pitting deem of the legs. The lungs are clear to auscultation. A systolic murmur is appreciated at the base of the heart and particularly intense at the back. Femoral pulses are weaker than radial pulses The ECG shows signs of left ventricular hypertrophy. Chest x ray shows notching of the inferior margins of the ribs. Which of the following is most likely diagnosis?
سؤال مجاني 1 من 10 اليوم · اشترك وكمّل بدون حد
اعرض الإجابة
الإجابة والشرح
ادخل لحسابك عشان نحفظ إجاباتك ونوريك أخطاءك.
الإجابة: B. Cortication of the aorta
Young man with upper-limb BP higher than lower-limb, femoral pulses weaker than radial, a systolic murmur loudest at the back, LVH, and rib notching on CXR = coarctation of the aorta. Congenital aortic stenosis or HCM give an ejection murmur but no arm–leg BP gradient or rib notching.
ليش كل خيار صح أو غلط
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A
ليش غلط
AF is diagnosed on ECG by a variable R-R interval (irregular rhythm) and absent P waves. This patient has LVH on ECG, and AF would not explain the arm-to-leg BP gradient or rib notching.
✓ 3• Atrial Fibrillation [Notes].pdf · p. 5 -
B
ليش صح
Coarctation of the aorta: upper-limb BP exceeds lower-limb BP, the brachial pulse comes well before the femoral one, and chest X-ray can show rib notching. All are present here.
✓ (Y4)-(M B) Hypertension.pdf · p. 10 -
C
ليش غلط
HCM gives a crescendo-decrescendo murmur from LV outflow obstruction, with no ejection click and no carotid radiation. It is not described as causing an arm-to-leg BP gradient, weak femoral pulses or rib notching.
✓ 8• Heart Sounds & Murmurs [Notes].pdf · p. 5 -
D
ليش غلط
Aortic stenosis causes an ejection click and a crescendo-decrescendo murmur from difficulty ejecting blood from the LV, radiating to the carotids. It is not described as lowering lower-limb BP or notching the ribs.
✓ 8• Heart Sounds & Murmurs [Notes].pdf · p. 5 -
E
ليش غلط
A VSD gives a holosystolic murmur from LV-to-RV shunting, heard at the left 4th intercostal space. It is not described as causing an arm-to-leg BP gradient or rib notching.
✓ 8• Heart Sounds & Murmurs [Notes].pdf · p. 6
- المصدر
- (Y4)-(M B) Hypertension.pdf · p. 10
- المحاضرة
- Hypertension · Cardiology · Module B
- ظهر في
- Cardio bank