Paediatric orthopaedics: bilateral Perthes-like disease: practice question

A Orthopaedics 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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Orthopaedics · Paediatric orthopaedics: bilateral Perthes-like disease

Sample item

A 6-year-old has bilateral hip pain and symmetrical flattened femoral epiphyses on radiographs. He is also short for his age. What is the most appropriate next step?

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

The answer and the reasoning

B. Skeletal survey and thyroid function tests

Perthes disease is bilateral in about 10 to 15 percent, but then the changes are usually asynchronous. Symmetrical bilateral involvement with short stature suggests multiple epiphyseal dysplasia or hypothyroidism, so a skeletal survey and thyroid tests are needed. Surgery is premature before the cause is clear.

Option by option

  • A. Start antituberculous treatment

    Nothing here suggests tuberculosis.

  • B. Skeletal survey and thyroid function tests (correct)

    Correct. Symmetrical bilateral epiphyseal change calls for a search for a systemic cause.

  • C. Bilateral osteotomies immediately

    Osteotomy without a diagnosis is inappropriate.

  • D. Hip aspiration only

    Aspiration does not distinguish a skeletal dysplasia.

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.

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Questions about this Orthopaedics question

What is the answer to this Orthopaedics question?

The best answer is B, Skeletal survey and thyroid function tests. Perthes disease is bilateral in about 10 to 15 percent, but then the changes are usually asynchronous.

Why is "Start antituberculous treatment" not the answer?

Nothing here suggests tuberculosis.

Why is "Bilateral osteotomies immediately" not the answer?

Osteotomy without a diagnosis is inappropriate.

Why is "Hip aspiration only" not the answer?

Aspiration does not distinguish a skeletal dysplasia.

What concept does this question test?

It tests Paediatric orthopaedics: bilateral Perthes-like disease in Orthopaedics. Symmetrical bilateral involvement with short stature suggests multiple epiphyseal dysplasia or hypothyroidism, so a skeletal survey and thyroid tests are needed. Surgery is premature before the cause is clear.

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 Paediatric orthopaedics: bilateral Perthes-like disease?

Pair each fracture with its classic complication and nerve injured. Then use the flashcards and the other Orthopaedics 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.