12-03-2011, 05:56 AM
24-year-old male seeks medical attention for the recent onset of headaches. The headaches are described as "pounding" and occur during the day and night. He has had minimal relief with acetaminophen. Physical examination is notable for a blood pressure of 185/115 mmHg in the right arm, a heart rate of 70/min, arterioventricular (AV) nicking on funduscopic examination, normal jugular veins and carotid arteries, a pressure-loaded PMI with an apical S4, no abdominal bruits, and reduced pulses in both lower extremities. Review of symptoms is positive only for leg fatigue with exertion. Additional measurement of blood pressure reveals the following:
Right arm 185/115
Left arm 188/113
Right thigh 100/60
Left thigh 102/58
He is most likely to have which of the following associated cardiac abnormalities?
A. Bicuspid aortic valve
B. Mitral stenosis
C. Preexcitation syndrome
D. Right bundle branch block
E. Tricuspid atresia
Right arm 185/115
Left arm 188/113
Right thigh 100/60
Left thigh 102/58
He is most likely to have which of the following associated cardiac abnormalities?
A. Bicuspid aortic valve
B. Mitral stenosis
C. Preexcitation syndrome
D. Right bundle branch block
E. Tricuspid atresia