Question

A 4 and a half year old girl child always had to wear warm socks even in summer season. On physical examination, she was found to have high blood pressure and her femoral pulse was weak as compared to her radial and carotid pulse. A chest radiograph showed remarkable notching of the ribs along their lower borders. This was due to:

• A. Femoral artery thrombosis
• B. Coarctation of aorta
• C. Raynaud's disease
• D. Takayasu's arteritis

Hint:

Weak femoral pulse plus strong radial pulse plus rib notching is the classic triad for one specific congenital lesion.

Answer 1

The Correct Option is B

Step 1: Work from the pulses first.
A radial pulse that feels stronger than the femoral pulse tells us the lower body is getting less blood than the upper body. That single finding already points to a block somewhere in the aorta between the arm vessels and the leg vessels.

Step 2: Add the blood pressure and rib finding.
High blood pressure measured in the arms fits with blood being pushed hard into the upper body above a narrowing, while the body opens up small side channels through the intercostal arteries to feed the lower body around the block. Over years these enlarged vessels press on and erode the lower border of the ribs, which shows up as notching on X-ray.

Step 3: Name the lesion that fits all three findings.
A narrowing of the aorta itself, coarctation of the aorta, is the one condition that produces this exact trio: high upper limb pressure, weak delayed femoral pulse, and rib notching from collateral vessels.

Step 4: Check why the other choices fail.
Femoral thrombosis gives a sudden painful pulseless leg, not chronic cold feet with hypertension. Raynaud's disease affects fingers with cold triggered colour change and no rib notching. Takayasu's arteritis can weaken pulses but does not typically give this same rib notching pattern, and is an inflammatory large vessel disease rather than a fixed narrowing.

Step 5: Conclude.
\[ \boxed{\text{Coarctation of aorta}} \]