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Old 07-17-2012
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Default NBME 1 Q: Coarctation and HPT Mx?

An 18-year-old man comes to the physician 1 week after he had a blood pressure of 140/110 mm Hg during a routine precollege examination. His temperature is 37.1 C (98.7 F), blood pressure is 140/100 mm Hg, pulse is 92/min, and respirations are 12/min. The upper extremities appear to be more muscular than the lower extremities. Radial pulses are normal; femoral, posterior tibial, and dorsalis pedis pulses are decreased. A grade 2/6 systolic murmur is heard over the precordium, anterior chest, and back. An ECG shows left ventricular hypertrophy. Which of the following is the most appropriate next step in management?

A ) Limiting physical activity

B ) Repeat blood pressure measurement in 1 month

C ) Initiate a low-sodium diet and exercise program

D ) Pharmacologic management

E ) Operative treatment
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