medicine question nbme 6

[Doc2b82]

18 yo with hypertension in for routine exam....upper ext more muscular than lower. Radial pulses good...femoral post tibial, dorsalis pedis pulses decreased. 2/6 systolic murmur over precordium, ant chest and back. ECG-LVH. Most appropriate next step?

A) limit physical act
B) repeat bp in 1 month
c)initate low sodium
d)pharm management
e) surgery

Correct answer- E....anyone wanna explain why? I picked D because I figured that would be most "appropriate NEXT" and see how the patient does.

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[The Chemist]

he has aortic coarctation. are you going to send him home with a beta blocker or send him to a vascular surgeon?
this is primarily a surgically managed diagnosis. giving him sympathomimetics would increase his brain and UE hypertension. giving him sympatholytics would decrease pressure in lower extremities even further. you could use medications after surgery if the hypertension persists.

 

[Doc2b82]

he has aortic coarctation. are you going to send him home with a beta blocker or send him to a vascular surgeon?
this is primarily a surgically managed diagnosis. giving him sympathomimetics would increase his brain and UE hypertension. giving him sympatholytics would decrease pressure in lower extremities even further. you could use medications after surgery if the hypertension persists.

ok got it....I guess I over thought it. Appreciate your input