A 13-year-old male has a blood pressure of 150/95. His body mass index is normal. He is a well-adjusted child who behaves appropriately and does well in school. On examination he has no abdominal bruits, but his femoral pulse arrives later than his radial pulse. Of the following conditions, which is the most likely cause of his hypertension?

Question

Quizplus · Accepted Answer

This patient has a physical finding (a radiofemoral pulse delay) characteristic of coarctation of the aorta. He has no renal artery bruits that might suggest renal artery stenosis, and in most cases, renal artery stenosis is a disease affecting young woman (caused by fibromuscular dysplasia of the renal arteries), or older men and women with diffuse atherosclerosis. Essential hypertension is usually found in individuals who have increased body mass index. Excessive ethanol use in unlikely in a child of this age who "behaves appropriately and does well in school." Children who are alcoholics will usually demonstrate significant psychopathology.

A 13-Year-Old Male Has a Blood Pressure of 150/95