American Board of Internal Medicine (ABIM) Certification Practice Exam

What does a brachial-femoral pulse delay indicate?

1. Normal blood flow

2. Coarctation of the aorta

3. Aortic regurgitation

4. Increased cardiac output

The correct answer is: Coarctation of the aorta

A brachial-femoral pulse delay suggests the potential presence of coarctation of the aorta, which is a congenital heart defect characterized by a narrowing of the aorta. This condition can lead to differential blood flow and pressure differences in the upper and lower parts of the body. In cases of coarctation, the blood supply to the lower extremities (femoral pulse) is reduced compared to the upper body (brachial pulse), resulting in a noticeable delay when assessing the pulses in these locations. Detecting this delay is clinically significant because it can indicate systemic issues related to blood flow, leading physicians to further evaluate the possibility of coarctation, especially in patients presenting with symptoms of hypertension, diminished lower extremity perfusion, or in those with a history of congenital heart disease. Other options provided do not directly relate to the concept of a pulse delay; aortic regurgitation and increased cardiac output do not typically present with this specific clinical finding, and normal blood flow would reflect equal timing of pulse detection. Thus, the association of a brachial-femoral pulse delay with coarctation is critical for accurate diagnosis and management.