Module 3, General Medical Level

A six year old, otherwise healthy girl presents with the parents complaint that she has a funny gait. They specifically note that she has a waddling gait and has a shorter left leg. She has never complained of pain and has never had any recognized fractures. The parents had not noticed this until a grandmother visited them from out of the country. The grandmother brought this to the parents attention.

Question 3A

A physical examination should focus primarily on an complete neurological examination of the lower extremity.

Question 3B

Developmental dislocation of the hip(DDH) is one of the primary concerns on the list of differential diagnosis, therefore an ultrasound should be ordered to rule out DDH.

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Question 3C

When you see the child standing in the examination room you notice no abnormality and the child has a full range of hip motion, therefore you can reassure the parents that the grandmother is just being overly critical and that this is nothing to worry about.

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Question 3D

Because the parents are very anxious you order an x-ray which has the above appearance. You reassure them this is a minor deformity due to a previously unrecognized fracture.

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Question 3E

The above history is not consistent with a previously unrecognized fracture but more consistent with a congenital deformity.

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