Which of the following conditions can result in a hairy patch on the back of children?

AIIMS Patna NO - 2020

Child Health Nursing (Pediatrics)

Easy

Appeared in: AIIMS Patna NO - 2020

Explanation

The hairy patch, also known as a 'faun tail,' is a classic cutaneous marker for spina bifida occulta, as seen in the image.
Spina bifida occulta is the mildest form of a neural tube defect, where a small gap exists in the spine, but the spinal cord and nerves are typically unaffected.
This external sign is critical because it points to a hidden (occult) congenital anomaly of the vertebral column that might otherwise go undetected.
Other skin signs at the site can include a sacral dimple, a port-wine stain, or a subcutaneous lipoma.

Option A: Epilepsy is a neurological disorder characterized by recurrent, unprovoked seizures. It does not have any associated cutaneous manifestations like a hairy patch on the back.
Option B: Hydrocephalus is the buildup of excess cerebrospinal fluid (CSF) in the brain's ventricles, leading to increased intracranial pressure and an enlarged head. It does not cause a hairy patch on the back.
Option D: Rickets is a skeletal disorder in children caused by a deficiency of vitamin D, calcium, or phosphate. It leads to soft, weak bones and skeletal deformities like bowed legs, not skin changes on the back.

Clinical Relevance

Nursing practice connection: This is primarily an exam-oriented knowledge point with limited direct bedside application, so retain Cutaneous manifestations of neural tube defects as background academic context rather than a clinical decision trigger.
Nurses performing newborn assessments must meticulously inspect the entire spine for any cutaneous markers like hairy patches, dimples, or lipomas, as these can be the only external sign of an underlying spinal cord anomaly.
Early identification and referral for imaging (like an ultrasound or MRI) can lead to timely intervention if needed, potentially preventing future neurological problems such as bladder/bowel dysfunction or leg weakness.
What if? If the infant had a visible, fluid-filled sac on the back instead of just a hairy patch, the diagnosis would be a more severe form of spina bifida (meningocele or myelomeningocele), requiring immediate application of a sterile, moist dressing and urgent neurosurgical consultation to prevent infection and injury.

How to Approach the Question

First, identify the key clinical sign presented in the question and the accompanying image: a 'hairy patch on the back' of a child.
Recognize this as a specific cutaneous (skin) finding.
Systematically evaluate each option to determine which condition is associated with this specific sign.
Recall that Epilepsy is a seizure disorder, Hydrocephalus involves fluid in the brain, and Rickets is a bone disease. None of these are primarily associated with a hairy patch.
Remember that spina bifida occulta is a 'hidden' defect of the spine that is often marked by an overlying skin abnormality.
Conclude that the hairy patch is the classic sign pointing to spina bifida occulta, making it the correct answer.

Concept Tested & Keywords

Concept Tested: Cutaneous manifestations of neural tube defects
Stem keywords: hairy patch, back, children
Lead-in keywords: Which
Clinical cues: The presence of a hairy patch on the back is a specific clinical sign pointing towards a congenital anomaly.

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E6 Nelson Textbook of Pediatrics(2024) — Volume 2 pp. 1370-1372, 1093-1095