19.     Congenital dislocation of the hip.  

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MCQ Paper 1

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a. is more common in those with an affected 1st. degree relative True
b. is more common in North American Indians True
c. is less common in Africa True
d. is more common with face presentation False
e. is sought using Orsiniís test False
f. the definitive diagnosis in the neonate is by X-ray False
g. is associated with limited adduction of the hip False
h. clinical screening is effective in preventing late diagnosis False

The incidence is higher in groups who swaddle their infants with the hips extended, such as N. American Indians.

And lower in those who cart the baby about on the motherís hip or back, so that the hips are abducted, such as Africans.

The incidence is quoted as 1 per 500 births and is higher in breech presentation by a factor of 10  compared with vertex presentations.

Girls are six times more likely to be affected than boys.

It is more common if there are problems leading to muscular problems such as spina bifida.

The inheritance is multifactorial with a risk of recurrence of about 3%.

Ortolaniís test is used for screening.

Limitation of abduction and evidence of easy dislocation are the key clinical features.

The prognosis is best if the condition is diagnosed early, but clinical screening is not 100% effective in detecting all cases in the neonatal period.

It is mandatory that subsequent checks on the baby should include hip examination.

X-rays are a waste of time under three months.

Ultrasound defines the shape of the acetabulum and overall hip anatomy.

Some have advocated its routine use for all babies but this has not been generally adopted.

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