A 27 year old man in noted to have blood pressure of 170/100 mmHg. He has prominent aoic ejection click and murmurs heard over the ribs on the both sides anteriorly and over the back posteriory. In addition, the pulses in the lower extremities are feeble and he complains of mild claudication with exeion. The most likely diagnosis is-

**Core Concept**
The patient's presentation suggests a condition involving the aorta, characterized by aortic stenosis, aortic regurgitation, and coarctation of the aorta. This condition is likely a congenital anomaly that has presented in adulthood due to the patient's age.

**Why the Correct Answer is Right**
The patient's symptoms are consistent with a diagnosis of **Coarctation of the Aorta**. Coarctation of the aorta is a narrowing of the aorta, typically occurring at the junction of the aortic arch and the descending aorta. This narrowing leads to increased resistance to blood flow, resulting in hypertension, aortic ejection click, and murmurs due to aortic stenosis and regurgitation. The feeble pulses in the lower extremities and mild claudication with exercise are due to decreased blood flow to the lower limbs.

**Why Each Wrong Option is Incorrect**
**Option A:** This option is not relevant to the patient's presentation, as it does not explain the aortic ejection click, murmurs, or lower extremity symptoms.

**Option B:** This option is not consistent with the patient's symptoms, as it does not account for the aortic ejection click, murmurs, or coarctation of the aorta.

**Option C:** This option is not relevant to the patient's presentation, as it does not explain the aortic ejection click, murmurs, or lower extremity symptoms.

**Clinical Pearl / High-Yield Fact**
Coarctation of the aorta is often associated with other congenital anomalies, such as bicuspid aortic valve, which can increase the risk of aortic stenosis and regurgitation.

**Correct Answer:** D. Coarctation of the Aorta

✓ Correct Answer: C. Coarctation of the aoa