Arrange the examination process for scoliosis screening from first to last.

• A. Ask the girl to remove her shirt but leave on her bra or swimsuit top; Look for asymmetry in the hip area; Instruct the girl to bend at the waist so back is parallel to the floor; Examine the scapular prominence
• B. Look for asymmetry in the hip area; Ask the girl to remove her shirt but leave on her bra or swimsuit top; Examine the scapular prominence; Instruct the girl to bend at the waist so back is parallel to the floor
• C. Instruct the girl to bend at the waist so back is parallel to the floor; Ask the girl to remove her shirt but leave on her bra or swimsuit top; Look for asymmetry in the hip area; Examine the scapular prominence
• D. Examine the scapular prominence; Ask the girl to remove her shirt but leave on her bra or swimsuit top; Look for asymmetry in the hip area; Instruct the girl to bend at the waist so back is parallel to the floor

Answer: (A)

The process starts with exposing the back to clearly observe trunk symmetry. Removing the shirt (while keeping a bra or swimsuit top on) allows you to see the spine, shoulders, and scapulae directly, which is essential for detecting asymmetry in the trunk early in the exam. Next, you look for asymmetry in the hip area to assess pelvic alignment and rule out pelvic tilting or leg-length discrepancies that might mimic or mask spinal deformity. Then the patient bends forward with the back kept straight to parallel the floor; this forward-bending step highlights a rib hump or trunk rotation that accompanies scoliosis, making the deformity more apparent. Finally, you examine scapular prominence as the spine rotates; the prominence of one scapula can reflect asymmetrical rib rotation and vertebral rotation characteristic of scoliosis. This order optimizes visibility of the key signs while maintaining modesty and a logical progression from neutral posture to rotated deformity.