Systemic paediatrics: persistent rickets work-up: practice question

A Pediatrics question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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Pediatrics · Systemic paediatrics: persistent rickets work-up

Sample item

A 3-year-old with rickets and short stature has not improved after 3 months of adequate vitamin D and calcium. What is the most appropriate next step?

ADouble the vitamin D dose indefinitelyBRefer for endocrine and metabolic work-up including phosphate, PTH and renal functionCReassure and stop treatmentDStart growth hormone empirically

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

B. Refer for endocrine and metabolic work-up including phosphate, PTH and renal function

Rickets that fails to respond to standard nutritional therapy suggests a non-nutritional cause such as hypophosphataemic rickets, renal tubular disease, or vitamin D-dependent rickets. Serum phosphate, calcium, ALP, PTH, bicarbonate and creatinine guide referral to an endocrinologist or nephrologist.

Option by option

A. Double the vitamin D dose indefinitely
Indefinite high-dose vitamin D risks toxicity without addressing the cause.
B. Refer for endocrine and metabolic work-up including phosphate, PTH and renal function (correct)
Correct. Non-response needs a metabolic work-up.
C. Reassure and stop treatment
Stopping therapy leaves the disease untreated.
D. Start growth hormone empirically
Growth hormone does not treat rickets.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

Questions about this Pediatrics question

What is the answer to this Pediatrics question?

The best answer is B, Refer for endocrine and metabolic work-up including phosphate, PTH and renal function. Rickets that fails to respond to standard nutritional therapy suggests a non-nutritional cause such as hypophosphataemic rickets, renal tubular disease, or vitamin D-dependent rickets.

Why is "Double the vitamin D dose indefinitely" not the answer?

Indefinite high-dose vitamin D risks toxicity without addressing the cause.

Why is "Reassure and stop treatment" not the answer?

Stopping therapy leaves the disease untreated.

Why is "Start growth hormone empirically" not the answer?

Growth hormone does not treat rickets.

What concept does this question test?

It tests Systemic paediatrics: persistent rickets work-up in Pediatrics. Serum phosphate, calcium, ALP, PTH, bicarbonate and creatinine guide referral to an endocrinologist or nephrologist.

How hard is this question?

We tag it as a multi-step question: it asks you to combine more than one idea. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Systemic paediatrics: persistent rickets work-up?

Memorise milestones and the vaccine schedule as tables and revise them often. Then use the flashcards and the other Pediatrics questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.