Scoliosis: The Daily PANCE Blueprint

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Scoliosis: The Daily PANCE Blueprint

A 14-year-old female presents for a well-child visit. She has been complaining of more fatigue and dyspnea. On physical exam, you notice severe lateral curvature of her spine. You suspect scoliosis is causing a ventilatory defect leading to hypoxia and thus subsequent fatigue. Which of the following would you most likely expect on pulmonary function tests?

A. FEV1/FVC ratio < 0.70 with normal FVC
B. FEV1/FVC ratio > 0.70 with decreased FVC
C. FEV1/FVC ratio < 0.70 with decreased FVC
D. FEV1/FVC ratio > 0.70 with increased FVC
E. None of the above

Answer and topic summary

The answer is B. FEV1/FVC ratio > 0.70 with decreased FVC

Scoliosis represents lateral displacement or curvature of the spine. Severe scoliosis (radiographic Cobb angle > 40 degrees) is known to be associated with restrictive lung disease due to limitations in chest wall motion. The impaired chest wall mechanics prevent normal inflation of lungs leading to progressive atelectasis and air-trapping. With a Cobb angle > 70 degrees, patients can even have hypoxemia, especially with exertion. You would expect a restrictive pattern of pulmonary function, with decreased predicted forced vital capacity (<80%) and the forced expiratory volume in 1 s/forced vital capacity (FEV1/FVC) ratio to be > 0.70.

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Smarty PANCE Content Blueprint Review:

Covered under ⇒ PANCE Blueprint Musculoskeletal ⇒ Spinal Disorders (PEARLS) ⇒ Scoliosis

Also covered in the Pediatric PAEA EOR topic lists