Question of the week # 302

302) A 16 year old girl is evaluated in your office for one day duration of fever, cough and left pleuritic chest pain. On examination, her temperature is 100.5F, respiratory rate is 18/min, pulse 100/min and blood pressure 120/60 mm hg. Breath sounds are decreased in the left lower lobe. A Chest x-ray is obtained which reveals left lower lobe infiltrate. Incidentally, a 7 ° lateral curvature is seen on the chest x-ray. The patient is started oral azithromycin for her pneumonia and is discharged home. Which of the following is the most appropriate management for her  incidentally discovered scoliosis?

A) Clinical follow up  alone

B) Repeat x-rays every 6 months

C) Refer to orthopedic surgery

D) Bracing

E) No follow up required

11 Responses

  1. A

  2. a only

  3. A; Clinical follow up alone

  4. aaa

  5. is the answer A or E.

    Do we even make a diagnosis of scoliosis if the cob’s angle is < 10 degree ?

    need help here . thanks

  6. E
    teenages spatially girl have some degree of scoliosis that will go way
    with time

  7. ~E

    Diagnosis of scoliosis
    1. 10y or more age
    2. A Cob’s angle 10 or >10degree
    3. Exclude other etiologies (neuromuscular, congenital etc)

  8. Answer A: If a curve measures less than 10 degrees on X-ray it is not very likely to progress. These children can be followed with repeated school screening, exams by the family physician and if things appear to be worsening the child can be sent to an orthopaedist for further evaluation or X-rays. Some orthopaedists will follow these children in their office with clinical exams and scoliometer readings yearly until growth slows or ceases, only taking X-rays if the measurements worsen.
    If a child has a curve of 10 degrees or more, they should be followed by clinical and X-ray exam every 3 to 6 months to check for progression

    Source: Scoliosis – Department of Orthopaedics at University of Maryland Medicine | University of Maryland Medical Center
    University of Maryland Medical Center
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