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Pediatric > Rickets > Flashcards

Rickets Flashcards

1
Q

what is the requirement of vitamin D of full term and when to start?

A

400IU\10ug\at birth

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2
Q

requirement of preterm , twins and low birth weight of vitmain D and when ?

A

400-800IU\at the age of 1 month

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3
Q

what is the normal serum calcium

A

9-11mg\dl

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4
Q

normal serum of phosphate

A

4.5-5.5 mg\dl

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5
Q

what is the structure of normal bone

A

matrix osteoid and minerals

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6
Q

what are the bone layers

A

zone of resting cartilage :1layer
zone of profilerating cartilage:6-8
zone of degenerating cartilage:deposition of Ca and ph
zone fo calcification: invasion by BV and osteoblasts with minerlaization

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7
Q

define rickets

A

Defective minerlaization of the growing bone so disease of childhood

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8
Q

pathophysiology of rickets

A
  1. proliferation without ossification
  2. epiphysis : failure of ca and ph depostion in the cartilage cells leading fo excess cartilage that invade the metaphysis(broadening and fraying
  3. diaphysis : bone rarefaction and fracture
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9
Q

types of rickets 4

A
  1. vitamin D deficiency rickets with 2ry ++parathyroidism:
    a. –intake of vitD b.malabsorption(small, large, liver, panceras
    c. hepatic disease(activation d. renal osteodystrophy(activation
  2. primary PO4 deficiency no 2ry ++parathyroid:
    a. X-linked hypophosphatemic rickets a. Fanconi syndrom: PCT dysfunction(gluco, phosphato, amino, uria
  3. end organ resistance to vit D
  4. hypophosphatasis
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10
Q

types of rickets according to nutrition : and compare

A

nutritional vitamin D deficiency rickets : more common , 6month -2years , response to vitD good
Non-nutritional vit D de ric: less common , any age , poor

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11
Q

etiology of nutritional vit D D rickets

A

a. inadequate intake of vit D : prolonged exclusive breast milk
cow milk: non optimum ca\ph ratio
b. inadequate sun exposure:
Wrapping Winter Windows Dark skinned people

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12
Q

what is the rachitogenic diet

A

deficient in vit D ,, deficient in Ca and PO4
non optimum ca:p ratio +++ content of phytate or oxalates

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13
Q

what is the first sign to appear in rickets

A

craniotabes

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14
Q

what is the first sign to appear in rickets

A

craniotabes

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15
Q

what are the CP of the head in the skeletal rickets 5

A
  1. crainotabes: ping-pong ball sensation on pressing over the occiput=thinning
  2. frontal bossing
  3. macrocephaly
    4, delayed closure of AF
  4. delayed dentition
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16
Q

CP of limbs in rickets4

A

1.broadening of the ends of long bones
2.marfan sign: transverse groove across medial malleolus
3. deformities of the UL: convexity of the forearm if crawling
4. deformities of the LL:
genu varum: bow legs
genu valgum: knock knees
genu recurvatum: overextension of the knees

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17
Q

CP of chest in rickets 4

A
  1. rosary beads: cartilage proliferation at the costochondral junctions
  2. pigeon chest: ++AP diameter of the chest : protrusion of the sternum+rib flaring
  3. harrison sulcus:horizontal groove along the costal insertion of the diaphragm
  4. longitudinal sulcus: vertical groove behind rosary beads
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18
Q

cp of spine in rickets 4
due to laxity of ligament

A

kyphosis:correctable:DD of pott disease
scoliosis
kyphoscoliosis
lumber lordosis

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19
Q

CP of pelvis in rickest

A

contracted plevis important in females

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20
Q

CP of muscles and ligaments in rickets 3
hypotonia due to hypophosphatemia leading to

A

Delayed Downward Distension
1. delayed motor milestones;sitting , crawling , standing, walking
2. downward displacement of liver and spleen(visceroptosis)
3. abdominal distension dueto: hypotonia, visceroptosis not enlargement, constipation

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21
Q

why ca is usually normal in rickets

A

due to 2ry hyperparathyroidism

22
Q

neurological manifestion in rikcets 2

A
  1. anorexia, irritability , sweating
  2. hypocalcemic tetany
23
Q

causes of hypocalcemia in rickets

A

parathyriod gland exhaustion
bone depletion: prolonged untreated
vit D:IM massive dose ; due to rapid mobilization of ca from blood to bone

24
Q

massive dose of vit D lead to hypocalciema

A

rapid mobilization of ca from blood to bone

25
Q

latent tetany:serum, signs

A

Ca=7-9mg
asymptomatic, only elicited by provocation

26
Q

signs of latent tetany

A

chvostek sign: tapping of the facial nerve=twitches fo facial muscles
trousseau sign:constriction of the UL by sphygmomanometer:carpal spasm
peroneal sign: tapping of the peroneal nerve: pedal spasm

27
Q

manifest tetay :serum

A

Ca;less than 7gm
carpopedal spasm
laryngospasm
convulsions

28
Q

manifest tetay :serum

A

Ca;less than 7gm
carpopedal spasm
laryngospasm
convulsions

29
Q

DD of rickets

A
  1. delayed closure of AF
  2. delayed dentition:rickets, ostogenesis imperfecta, down syndrom, hypothyroidism
    intracranial causes of macrocephaly(in AF only)
  3. delayed walking
30
Q

causes of delayed walking :neuro, bone, traing

A
  1. neurological(central,periphral:
    cerebral palsy
    mental retardation
    hydrocephalus
    neuromusclar disorders
    2.bone:rickets, trauma, fractures
  2. training : by exclusion
31
Q

causes of chest infection in rickets

A

hyptonia:weak cough
chest deformities

32
Q

causes of chest infection in rickets

A

hyptonia:weak cough
chest deformities

33
Q

complications of rickets 7

A
  1. respiratory; chest infection, atelectasis
  2. neurological: tetany, convulsions, laryngospasm
  3. short stature:disproportionate
    4.bone fractures and deformities
    5.iron deficiency anemia: breast milk
  4. contracted pelvis:obstructed labor in female
  5. complications of treatment:++vit D
34
Q

what is the type of short stature in rickets

A

disproportional

35
Q

investigations in rickets

A

1.laboratory:
serum Ca: usually normal ex in bone depletion, parp exuation, high dose of vit D
serum phosphorus:–decreased
serum alkaline phosphatase:++ increases Earliest manifestation
2. imaging:radiological improvment after 2 wks of vit D therapy

36
Q

what is the earliest laboratory manifestation in rickets

A

++ alkaline phosphtase

37
Q

when the improvment start to appear after ttt with D

A

2 weeks

38
Q

see table in 67 rickets

A
39
Q

prevention of rickets

A

nutritional education : breast, weaning, diet rich in D, avoid rachitogenic diet
vit D supplementation
sun exposure

40
Q

dose and duration of vit D oral

A

3000-5000IU\day
2-4 weeks

41
Q

dose and duration of vit D oral

A

3000-5000IU\day
2-4 weeks

42
Q

dose duration advantages and dis of parenteral vit D3

A

600.000IU shock therapy
duration:single IM dose
adv:rapid, need no compliance, diagnosis of non vitamin D deficiency rickets
dis:tetany, ++D

43
Q

ttt of complication:tetany, deformities

A

iv Ca gluconate 10% 1ml\kg slowly
orthopedic care after complete bone healing

44
Q

CP of hypervitaminosis of vit D

A

Git:anorexia, nausea, vomiting, constipation
renal: polyuria, polydipsia, renal stones

45
Q

ttt of vit D ++

A

stop fluid steroids

46
Q

calssification of non nutritional vit D D rickets

A

renal malabsorpstion hepatic

47
Q

renal rickets

A

a. glomerular:renal osteodystrophy:
defective activation by 1 a
chronic kideny disease
b. tubular:
x-linked hypophosphatemic rickets
fanconi syndrom
cystinosis: fanconi+ corneal cystine crystal
lowe syndrome: oculo- cerebro- renal:glucoma and cataract-MR-fanconi

48
Q

malabsorption in rickets

A

cystic fibrosis
celiac disease
cholestasis

49
Q

hepatic rickets

A

chronic liver disease:defective 25 hydr

50
Q

hepatic rickets

A

chronic liver disease:defective 25 hydr

Pediatric (6 decks)

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