Module 12, General Medical Level

This is a newborn infant whose mother has insulin dependent diabetes. The infant is the product of an otherwise normal pregnancy and vaginal delivery. Marked atrophy of the buttocks showing gluteal dimples with a very short intergluteal fold and a horizontal anus were present. The lower limbs are in flexion, abduction, and external rotation contracture at the level of the hips, and a severe flexion contracture of the knees was also present giving infant the classic Buddha-like position.

Question 12A

Lumbar spine x-rays should be the first test to order in the work up.

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Question 12B

On further examination of the infants back, a slightly swollen cyst area is noted in the middle of the back. Your concerned that this may represent a severe associated deformity.

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Question 12C

The occurrence of this deformity is incidental to the mother's diabetes.

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Question 12D

An x-ray of the spine would provide information which would allow making some prognosis concerning this child's future motor function.

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Question 12E

In spite of the severe lower extremity deformities and gluteal atrophy you should reassure the mother that there are almost never major internal organ deformities or bowel or bladder problems.

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