new_n_lost
Politically InCorrect
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| | 05/15/07 - 09:58 AM
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| #1 |
A 26-year-old man presents to his physician with a chronic cough. The man is a smoker, and states that he also gets frequent headaches and aches in his legs when he exercises. Chest x-ray demonstrates notching of his ribs.
Which of the following undiagnosed congenital defects may be responsible for these findings?
A. Coarctation of the aorta
B. Eisenmenger's syndrome
C. Tetralogy of Fallot
D. Transposition of great vessels
E. Ventricular septal defect
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| mytime
Kick my butt!
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A
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| Addicudo
Forum Guru
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A. Coarctation of the aorta
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| Luckyall
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easy Qs but conceptual one 
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| keepgoing
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yes a...
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| rock
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A
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| new_n_lost
Politically InCorrect
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FORUM RULES-- Those who believe in telekinesis, raise my hand. I get enough exercise just by pushing my luck --P4U World.." The pure and simple truth is rarely pure and never simple."
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| new_n_lost
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The correct answer is A.
Coarctation of the aorta occurs in two patterns. In the infantile type, the stenosis is proximal to the insertion of the ductus arteriosus (preductal); this pattern is associated with Turner's syndrome. In the adult form, the stenosis is distal to the ductus arteriosus (postductal) and is associated with notching of the ribs (secondary to continued pressure from the aorta on them), hypertension in the upper extremities, and weak pulses in the lower extremities. Headache, cold extremities, and lower extremity claudication with exercise are typical if the patient is symptomatic (many adults with mild distal coarctation may remain asymptomatic for years). Upper extremity hypertension with weak pulses in the lower extremities, and a midsystolic (or continuous) murmur over the chest or back may be the only obvious signs in some. Note that the chronic cough is probably related to the man's smoking, and is not caused by the coarctation.
Eisenmenger's syndrome (choice B) is a shift from a left-to-right shunt to a right-to-left shunt secondary to pulmonary hypertension.
Tetralogy of Fallot (choice C) and transposition of great arteries (choice D) cause cyanosis and are usually diagnosed in infancy.
Ventricular septal defect (choice E) might remain undiagnosed until adulthood, but would not cause notching of the ribs.
___________________
FORUM RULES-- Those who believe in telekinesis, raise my hand. I get enough exercise just by pushing my luck --P4U World.." The pure and simple truth is rarely pure and never simple."
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