A positive Ortolani Sign indicates?

Appeared in: NHM UP Staff Nurse - 2019

Explanation

A positive Ortolani sign is a key diagnostic finding for Developmental Dysplasia of the Hip (DDH) in a newborn.
The maneuver involves flexing the infant's hips and knees to 90 degrees and then abducting the thigh.
A positive sign is a distinct 'clunk' that is felt (and sometimes heard) as the head of the femur, which was dislocated, slips back into the hip socket (acetabulum).
This 'clunk' of reduction confirms that the hip was dislocated at rest.

Option B: Cardiac anomalies are defects in the heart's structure. They are detected by methods like listening for heart murmurs, pulse oximetry, or echocardiograms, not by a hip maneuver.
Option C: Intestinal obstruction is a blockage in the intestines. It presents with gastrointestinal symptoms like bilious vomiting, abdominal distension, and failure to pass stool.
Option D: An imperforate anus is a congenital defect where the anal opening is missing or blocked. It is identified by a careful visual inspection of the infant's perineum after birth.

Clinical Relevance

Nursing practice connection: This is primarily an exam-oriented knowledge point with limited direct bedside application, so retain Neonatal musculoskeletal assessment for Developmental Dysplasia of the Hip (DDH) as background academic context rather than a clinical decision trigger.
Early detection of DDH through newborn screening (including the Ortolani test) is critical. If missed, it can lead to long-term complications like a limp, chronic pain, and early-onset arthritis.
Nurses play a vital role in performing newborn assessments and must be proficient in both the Ortolani and Barlow maneuvers to identify hip instability.
A positive finding requires prompt referral to a pediatric orthopedist. Early treatment, often with a Pavlik harness, is highly effective and non-invasive.

How to Approach the Question

This is a factual recall question testing knowledge of a specific clinical sign.
First, identify the key term in the question: 'Ortolani Sign'.
Recall the purpose of this physical examination maneuver. It is a standard part of the newborn assessment.
Evaluate the options based on the body system they relate to. 'Hip dislocation' is musculoskeletal. The other options are cardiovascular, gastrointestinal, and an anorectal malformation.
Connect the 'Ortolani' test to the correct body system. It is a specific orthopedic test for the infant hip.
Conclude that a positive Ortolani sign, which involves manipulating the hip joint, must indicate a problem with the hip, such as a dislocation.

Concept Tested & Keywords

Concept Tested: Neonatal musculoskeletal assessment for Developmental Dysplasia of the Hip (DDH).
Stem keywords: Ortolani Sign, positive
Lead-in keywords: indicates
Negative lead-in flag: false

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E6 Nelson Textbook of Pediatrics(2024) — Volume 2 pp. 2043-2045, 2044-2046

E6 Text Book Of Pediatric Nursing 3rd Panchali Pal — Part 3 (pp 477-702 of 713) p. 2

Practise the full NHM UP Staff Nurse - 2019

Attempt every question from this paper in a timed mock, then review the full solution for each one.