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Orthopaedics · Spine: spinal dysraphism with tethered cord
Sample itemA 6-year-old has a tuft of hair over the lumbar spine, a progressive cavovarus deformity of one foot and urinary urgency. What is the most likely diagnosis?
Original practice item, not a recalled exam question. Nothing here is recorded.
The answer and the reasoning
A. Tethered cord from spinal dysraphism
A cutaneous marker such as a hairy patch with progressive foot deformity and bladder symptoms points to a low-lying tethered cord, for example from a split cord malformation. MRI confirms it and early untethering prevents further loss.
Option by option
A. Tethered cord from spinal dysraphism (correct)
Correct. Skin marker, progressive foot deformity and bladder symptoms indicate a tethered cord.
B. Cerebral palsy of spastic type
Cerebral palsy is non-progressive and does not come with a lumbar skin marker.
C. Charcot-Marie-Tooth disease
Hereditary neuropathy can cause cavus feet but has no hair patch and no urinary dysfunction in a child.
D. Spina bifida occulta without neural involvement
Spina bifida occulta alone is asymptomatic and does not cause progressive deformity.
Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.
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