A 1-month-old boy is referred for failure to thrive. On examination, he shows feature of congestive failure. The femoral pulses are feeble as compared to branchial pulses. The most likely clinical diagnosis is -

Ans. is b i.e., Coarctation of aoa Feeble femoral pulsations compared to strong brachial pulsations suggests the diagnosis of coarctation of aoa. Hypeension and strong pulsations in the upper extremities and absence, marked dimunition or delay in pulsations in the femoral aery are characteristic in coarctation. Also failure to thrive and congestive hea failure are consistent with the diagnosis of congestive hea failure. Remember: o Differential cyanosis is a manifestation of PDA o Differential pulses/Blood pressure is a manifestation of Coarctation