Rosh Pediatrics Practice Exam

What is the likely etiology for hip pain in a boy with a history of leukemia and current difficulty bearing weight?

1. Chronic glucocorticoid use

2. Infection

3. Obesity

4. Untreated developmental dysplasia of the hip

The correct answer is: Chronic glucocorticoid use

The presence of hip pain in a boy with a history of leukemia, especially when accompanied by difficulty bearing weight, suggests the influence of chronic glucocorticoid use as a probable etiology. Children with leukemia often receive glucocorticoids as part of their treatment regimen to manage their disease. Long-term use of these medications can lead to various side effects, one of which is avascular necrosis of the bone, particularly in weight-bearing joints, including the hip. Avascular necrosis occurs when the blood supply to the bone is compromised, leading to bone death and subsequent joint pain. The symptoms of hip pain and difficulty bearing weight align with this condition, making it a likely consequence of the chronic glucocorticoid therapy that the child may have been receiving. Other options, while they may be relevant in different contexts, are less likely to be the primary cause in this scenario. An infection could also result in similar symptoms; however, the history of leukemia and glucocorticoid use makes avascular necrosis a more fitting diagnosis. Obesity can contribute to hip and joint pain but is not specifically linked to the patient's cancer history. Lastly, untreated developmental dysplasia of the hip would typically present earlier in life and not