A family doctor receives a visit from a 25yearold woman who

A family doctor receives a visit from a 25-year-old woman who brought her 18-month-old son in for examination. The mother said the boy was not showing any interest in walking and he could not sustain upright stature without assistance. You noted when the women placed the boy on his feet that he had extremely bowed legs – and when she released his arms he fell back into a half seated position and caught himself in her burka (full gown and head scarf associated with the Arab nations). He could not raise himself without her assistance.Upon palpation (physical examination by touching) all of the boys’ skeletal elements and joints were unremarkable (normal). However, it was noted that he lacked the necessary compensation curvature to support walking. Neurological reflex (knee-jerk reflex, elbow, etc.) tests proved unremarkable.

1. Name the vertebral curvature (by region) that the boy lacked to support walking.

2. List biochemical factors that might have influenced the malformation of his legs.

3. What test/s would you order to attain a formal diagnosis?

Choices are: x-ray, MRI, Bone density, blood chemistry, and/or liver enzyme

4. What results would you expect to confirm your diagnosis?

5. Would you order any tests for the mother? Why or why not – and if so which?

Solution

1.The boy may be lacking lumbar curvature. This curvature helps us to stand upright and lift objects.

3.Necessary tests for diagnosis would be MRI, Bone density and liver enzyme.

4. We would expect abnormal result of either MRI test or liver enzyme test