Rickets

Question 1

Bone consists of…..

Answer 1

A protein matrix called osteoid and a mineral phase, principally composed of calcium and phosphate, mostly in the form of hydroxyapatite.

Question 2

Osteomalacia……..?

Answer 2

Occurs with inadequate mineralization of bone osteoid in children and adults.

Question 3

Rickets is ……..?

Answer 3

A disease of growing bone caused by unmineralized matrix at the growth plates in children only before fusion of the epiphyses.

Question 4

Why there is a classic clinical manifestations, such as widening of the wrists and ankles…..?

Answer 4

Because growth plate cartilage and osteoid continue to expand but mineralization is inadequate, the growth plate thickens. Circumference of the growth plate and metaphysis is also greater, increasing bone width at the growth plates

Question 5

Reason for bony deformity in Rickets……?

Answer 5

The general softening of the bones causes them to bend easily when subject to forces such as weight bearing or muscle pull.

This softening leads to a variety of bone deformities

Question 6

Principle etiology for rickets…..?

Answer 6

Vitamin D deficiency.

May be secondary to nutritional vitamin D deficiency and inadequate intake of calcium

Question 7

Main etiological factor for Rickets…..?

Answer 7

Vitamin D disorders,
calcium deficiency,
phosphorus deficiency, and
distal renal tubular acidosis

Question 8

Most common manifestation of Rickets…..?

Answer 8

Skeletal changes.

Question 9

What is craniotabes……..?

Answer 9

Craniotabes is a softening of the cranial bones and can be detected by applying pressure at the occiput or over the parietal bones.

The sensation is similar to the feel of pressing into a Ping-Pong ball and then releasing

Question 10

Other causes of craniotabes….?

Answer 10

osteogenesis imperfecta,

hydrocephalus, and

syphilis

Question 11

Richetic rosary……?

Answer 11

Widening of the costochondral junctions results in a rachitic “rosary,” which feels like the beads of a rosary as the examiner’s fingers move along the costochondral junctions from rib to rib

Question 12

Reason for enlargement of wrist and ankle …..?

Answer 12

Growth plate widening

Question 13

Harrison grove….?

Answer 13

The horizontal depression along the lower anterior chest known as Harrison groove occurs from pulling of the softened ribs by the diaphragm during inspiration.

Question 14

The dominant feature in X-linked hypophosphatemic rickets …….?

Answer 14

Changes in the lower extremities

Question 15

Richitic changes in PA view …….

Answer 15

Fraying

Cuffing

Question 16

Children with increased skin pigmentation are at increased risk for vitamin D deficiency because of ……

Answer 16

Decreased cutaneous synthesis

Question 17

Rationale of dietary fibre in calcium absorption…?

Answer 17

Interfere with absorption.

Question 18

Rationale of AED leading to Rickets…..

Answer 18

phenobarbital and phenytoin, increase degradation of vitamin D, and

phosphate binders or aluminum-containing antacids interfere with the absorption of phosphate

Question 19

The initial laboratory tests in a child with rickets should include…..?

Answer 19

serum calcium, 
phosphorus, 
alkaline phosphatase (ALP), 
parathyroid hormone (PTH), 
25-hydroxyvitamin D, 
1,25-dihydroxyvitamin D (1,25-D), 
creatinine, and electrolytes