Legg-Calvé-Perthes Disease — MCQs
Severe disability in primary osteoarthritis of hip is best managed by -
A 6-year-old boy presents with a painful limp, tenderness in the femoral triangle, and some limitation of hip movements. The X-ray is normal. What is the next investigation?
X-ray spine of a child is shown. What is the probable diagnosis?
Osteonecrosis is seen in all except
Which of the following is most Likely to be fatal?
A child 10 yrs of age presents with a mass on his left thigh. The mass seems to be arising from the diaphysis of the femur and involving the soft tissue of the thigh. The child is having fever also. Give your most probable diagnosis -
Avascular necrosis of bone is LEAST likely to be associated with?
Which of the following movements is typically restricted in Perthes disease?
All the following are causes of a painful limp, except which of the following?
Identify the condition shown in the given X-ray: 
Legg-Calvé-Perthes Disease Indian Medical PG Practice Questions and MCQs
Question 1: Severe disability in primary osteoarthritis of hip is best managed by -
- A. Arthroplasty (Correct Answer)
- B. Arthrodesis
- C. Mc Murray's osteotomy
- D. Intra-articular hydrocortisone and physiotherapy
Explanation: ***Arthroplasty*** - **Total hip arthroplasty (THA)** is the most effective treatment for severe osteoarthritis of the hip, providing significant pain relief and functional improvement. - It involves replacing the damaged joint surfaces with **prosthetic components**, addressing advanced cartilage loss and structural damage. *Arthrodesis* - **Arthrodesis (joint fusion)** is an older technique that fixes the joint in a permanent position, eliminating pain but sacrificing all motion in that joint. - While it relieves pain, the severe loss of motion makes it generally less desirable than arthroplasty for the hip, especially in active patients. *Mc Murray's osteotomy* - **McMurray's osteotomy** is a surgical procedure primarily used for some types of **femoral neck fractures** or a specific type of **avascular necrosis** of the femoral head, not for severe osteoarthritis affecting the entire joint. - It involves cutting and realigning the bone, but it does not address advanced, widespread articular cartilage degeneration seen in severe osteoarthritis. *Intra-articular hydrocortisone and physiotherapy* - **Intra-articular hydrocortisone injections** and **physiotherapy** are conservative treatments used for mild to moderate hip osteoarthritis to manage pain and improve function. - These methods do not resolve severe structural damage and are typically insufficient for managing severe disability due to advanced osteoarthritis.
Question 2: A 6-year-old boy presents with a painful limp, tenderness in the femoral triangle, and some limitation of hip movements. The X-ray is normal. What is the next investigation?
- A. MRI (Correct Answer)
- B. CT scan
- C. Arthroscopy
- D. Bone scan
Explanation: ***MRI*** - An **MRI** is the most sensitive imaging modality for detecting early changes in bone marrow and soft tissues, such as **avascular necrosis of the femoral head** (Legg-Calvé-Perthes disease), which can present with a painful limp and normal initial X-rays. - It can visualize bone edema, cartilage irregularities, and effusions that are not apparent on plain radiographs. *CT scan* - While useful for detailed bone anatomy, a **CT scan** exposes the child to significant **radiation** and is less effective than MRI for detecting early soft tissue and bone marrow changes in conditions like Perthes disease. - It is often reserved for complex fracture assessments or when MRI is contraindicated. *Arthroscopy* - **Arthroscopy** is an **invasive surgical procedure** used for direct visualization, diagnosis, and treatment of joint problems. - It is not a primary diagnostic investigation for a painful limp with a normal X-ray, as less invasive imaging like MRI should be performed first. *Bone scan* - A **bone scan** (scintigraphy) is sensitive for detecting increased **metabolic activity** in bone, such as in infections or tumors, but it is less specific than MRI for detailed anatomical changes in early Perthes disease. - It involves radiation exposure and may not provide the detailed soft tissue information needed to differentiate various causes of a painful hip.
Question 3: X-ray spine of a child is shown. What is the probable diagnosis?
- A. Bamboo spine
- B. Normal spine
- C. Ivory spine
- D. Rugger Jersey spine (Correct Answer)
Explanation: ***Rugger Jersey spine*** - This X-ray image shows alternating bands of **increased density (sclerosis) at the superior and inferior endplates** with **central lucency** in the vertebral bodies, creating the characteristic "Rugger Jersey spine" appearance. - This pattern is commonly associated with **secondary hyperparathyroidism**, most often seen in patients with **chronic renal failure**. - The alternating bands resemble the horizontal stripes on a rugby jersey, hence the name. *Bamboo spine* - **Bamboo spine** is a characteristic finding in advanced **ankylosing spondylitis**, where ossification of the annulus fibrosus and anterior longitudinal ligament leads to **syndesmophytes** bridging adjacent vertebral bodies. - This creates a smooth, continuous appearance resembling bamboo, which is not the pattern seen in this image. *Normal spine* - A **normal spine** would show **uniform bone density** throughout the vertebral bodies without the alternating lucent and sclerotic bands seen in this image. - Normal vertebral bodies have homogeneous trabecular bone density without endplate sclerosis. *Ivory spine* - An **ivory vertebra** refers to a **homogeneously dense and enlarged** vertebral body, typically observed in conditions like **metastatic prostate cancer** (blastic metastases), **Paget's disease**, or **lymphoma**. - This is typically a **localized finding** in a single or few vertebrae, distinct from the **generalized alternating band pattern** seen in Rugger Jersey spine.
Question 4: Osteonecrosis is seen in all except
- A. Fracture neck femur
- B. Paget's disease (Correct Answer)
- C. Perthe's disease
- D. Sickle cell anemia
Explanation: ***Paget's disease*** - **Paget's disease of bone (osteitis deformans)** is a localized disorder of bone remodeling, characterized by excessive and disorganized bone formation, leading to enlarged, softened, and misshapen bones, but not directly causing osteonecrosis. - While complications like **pathological fractures** and **osteosarcoma** can occur, primary osteonecrosis is not a typical feature of Paget's disease itself. *Fracture neck femur* - **Fractures of the femoral neck** can disrupt the blood supply to the femoral head, particularly the medial circumflex femoral artery, leading to **avascular necrosis** (osteonecrosis) of the femoral head. - This is a well-known and common complication, especially in displaced fractures. *Sickle cell anemia* - **Sickle cell anemia** causes sickling of red blood cells, leading to **vaso-occlusion** and impaired blood flow to bones, resulting in **bone infarcts** (osteonecrosis). - This can affect various bones, including the femoral head, humeral head, and vertebrae. *Perthe's disease* - **Perthe's disease** (Legg-Calvé-Perthes disease) is a childhood condition characterized by **idiopathic osteonecrosis** of the femoral head. - It involves the collapse and subsequent re-ossification of the femoral epiphysis due to an interruption of its blood supply.
Question 5: Which of the following is most Likely to be fatal?
- A. Osteochondroma
- B. Paget's disease
- C. Multiple myeloma (Correct Answer)
- D. Giant cell tumour
Explanation: No changes made because no provided references reached the relevance threshold of 7. The provided text fragments discuss coagulation factor deficiency (Waldenström macroglobulinemia), physiology of taste, and Lambert-Eaton Myasthenic Syndrome, which do not directly support the clinical descriptions of Multiple Myeloma, Osteochondroma, Paget's disease, or Giant Cell Tumour as presented in the explanation.
Question 6: A child 10 yrs of age presents with a mass on his left thigh. The mass seems to be arising from the diaphysis of the femur and involving the soft tissue of the thigh. The child is having fever also. Give your most probable diagnosis -
- A. Osteosarcoma
- B. Chondrosarcoma
- C. Ewing's sarcoma (Correct Answer)
- D. Malignant fibrous histiocytoma
Explanation: ***Ewing's sarcoma*** - **Ewing's sarcoma** commonly presents in children and adolescents, often involving the **diaphysis of long bones** like the femur. - The presence of a **soft tissue mass** and **fever** are characteristic systemic symptoms due to its aggressive nature and rapid growth. *Osteosarcoma* - While it is a common pediatric bone tumor, **osteosarcoma** typically arises in the **metaphysis** of long bones, not the diaphysis. - Systemic symptoms like fever are less common at presentation compared to Ewing's sarcoma unless there's significant metastatic disease. *Chondrosarcoma* - **Chondrosarcoma** is a malignant tumor of cartilage that usually affects older adults and rarely occurs in children. - It typically affects the **pelvis, shoulder, or long bones**, but a fever and involvement of the soft tissue with a diaphyseal origin are less classic presentation. *Malignant fibrous histiocytoma* - **Malignant fibrous histiocytoma** (now often termed undifferentiated pleomorphic sarcoma) is a tumor of adulthood, primarily affecting individuals over 40 years of age. - While it can involve deep soft tissues and bone, it is an extremely rare diagnosis in a 10-year-old child.
Question 7: Avascular necrosis of bone is LEAST likely to be associated with?
- A. Osgood -Schlatter disease (Correct Answer)
- B. Long-term use of corticosteroids
- C. Sickle-cell disease
- D. Legg-Perthes disease
Explanation: ***Osgood-Schlatter disease*** - This condition is characterized by **inflammation of the patellar ligament** at its insertion into the tibial tuberosity, primarily due to repetitive stress in adolescents. - While it involves pain and swelling around the knee, it is a **traction apophysitis** and not a form of avascular necrosis. *Long-term use of corticosteroids* - **Corticosteroids** are a well-established risk factor for avascular necrosis, particularly in the femoral head, by affecting lipid metabolism and blood flow. - They can lead to **fat embolism** and increased intraosseous pressure, compromising blood supply to the bone. *Sickle-cell disease* - **Sickle cell disease** significantly increases the risk of avascular necrosis due to **vaso-occlusive crises**, where sickled red blood cells block small blood vessels. - This leads to **ischemia and infarction** in bone marrow, commonly affecting the femoral and humeral heads. *Legg-Perthes disease* - This is a specific type of **avascular necrosis of the femoral head** in children, causing a temporary interruption of blood supply to the epiphysis. - It results in the collapse of the femoral head and subsequent repair processes, consistent with the pathology of avascular necrosis.
Question 8: Which of the following movements is typically restricted in Perthes disease?
- A. Abduction & internal rotation (Correct Answer)
- B. Abduction & external rotation
- C. Adduction & internal rotation
- D. Adduction & external rotation
Explanation: ***Abduction & internal rotation*** - **Perthes disease** affects the femoral head, leading to pain and stiffness that most commonly restricts **abduction** and **internal rotation** of the hip. - This restriction is an early and consistent clinical finding, often accompanied by a ** Trendelenburg gait** due to gluteal muscle weakness or pain avoidance. *Abduction & external rotation* - While abduction can be restricted, a primary restriction in **external rotation** is less typical in early Perthes disease. - Reduced external rotation is more characteristic of conditions like **slipped capital femoral epiphysis (SCFE)**, especially in older children. *Adduction & internal rotation* - **Adduction** is generally preserved or even increased in Perthes disease as the hip seeks a position of comfort due to pain, making it an unlikely primary restriction. - While internal rotation is restricted, the combination with adduction restriction is not the classical presentation. *Adduction & external rotation* - Neither **adduction** nor **external rotation** are typically the primary hip movements restricted in Perthes disease. - Restriction in adduction is rare, and external rotation is often compensatory or less affected than internal rotation.
Question 9: All the following are causes of a painful limp, except which of the following?
- A. Slipped femoral epiphysis (SCFE)
- B. Tuberculosis (TB) of the hip
- C. Perthes disease (Legg-Calvé-Perthes disease)
- D. Infantile Coxa Vara (Coxa Vara) (Correct Answer)
Explanation: ***Infantile Coxa Vara (Coxa Vara)*** - **Infantile coxa vara** is a developmental condition characterized by a **reduced femoral neck-shaft angle**, often leading to a painless waddling gait or limp. - While it causes a limp, the limp itself is typically **painless**, distinguishing it from the other conditions listed. *Slipped femoral epiphysis (SCFE)* - **SCFE** involves displacement of the **femoral head** from the neck through the growth plate and is a classic cause of a **painful limp** in adolescents, often associated with obesity. - Patients typically experience **hip, groin, thigh, or knee pain** and may present with a shortened leg with external rotation. *Tuberculosis (TB) of the hip* - **TB of the hip** is a chronic infectious arthritis that causes significant **pain**, swelling, and reduced range of motion, leading to a **painful limp**. - It often presents insidiously with **constitutional symptoms** like fever and weight loss, in addition to localized pain. *Perthes disease (Legg-Calvé-Perthes disease)* - **Perthes disease** is characterized by avascular necrosis of the **femoral head** in children, causing a **painful limp** and restricted hip movement. - The pain typically worsens with activity and improves with rest, and may be referred to the knee or thigh.
Question 10: Identify the condition shown in the given X-ray: 
- A. Lateral epicondyle of femur
- B. Osgood-Schlatter disease (Correct Answer)
- C. Tibial tuberosity fracture
- D. Gerdy's tubercle fracture
Explanation: ***Osgood-Schlatter disease*** - The X-ray shows fragmentation and irregularity of the **tibial tuberosity**, which is characteristic of Osgood-Schlatter disease. - This condition typically affects adolescents undergoing rapid growth spurts and presents with **pain and swelling** at the tibial tuberosity. *Tibial tuberosity fracture* - This usually involves a **clear fracture line** and displacement of the tibial tuberosity. - It is typically caused by a **sudden, forceful contraction** of the quadriceps muscle. *Lateral epicondyle of femur* - The X-ray shows changes at the **tibial tuberosity**, not the lateral epicondyle of the femur. - The lateral epicondyle is located at the **distal end of the femur**, near the knee joint. *Gerdy's tubercle fracture* - Gerdy's tubercle is the insertion point of the **iliotibial band** on the lateral aspect of the proximal tibia. - Fractures here are **rare** and would present differently on X-ray compared to the observed tibial tuberosity changes.
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