9th May 2025

You are working with paediatric ED as part of an emergency medicine rotation.

You are working with paediatric ED as part of an emergency medicine rotation. You are asked to see a 6-year-old male with a sore throat and malaise. His clinical observations are T38.7, HR 130bpm, and Sp02 98%. He has purulent swollen tonsils bilaterally, and he is diagnosed with tonsillitis and given an appropriate course of antibiotics and safety netting advice.

However, his mother states that he has a history of a “heart condition”. An audible ejection systolic murmur is heard over the back, and his femoral pulses are delayed. 

Which underlying abnormality may explain his clinical findings? 

Select the SINGLE most appropriate option from the list below. Select ONE option only.