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Senoir paeds > Rickets > Flashcards

Rickets Flashcards

1
Q

Rickets – word’s orginin is unknown
– Maybe Rucket – to _________________ , Dorset word
– Or Rhakhis – _________
Rhachitis ‘’ ________________________ ’’

A

breath with difficulty

Spine; inflammation of spine

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2
Q

Rickets

Definition: A deficiency disease resulting from a lack of __________ or _________ and from insufficient ______________ , characterized by defective _____________ and occurring chiefly in _________. Also called rachitis.

A

vitamin D or calcium

exposure to sunlight

bone growth ; children

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3
Q

Normal Bone Processes

•Calcium and Phosphate
-Constitutes the ________ component of bone
–Deficiency leads to disease (i.e., _______ and/or ___________)

A

crystalline; Rickets; osteomalacia

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4
Q

•Rickets:
-Deficient _________ at ______________

•Osteomalacia:
–impaired ____________ of the __________.

A

mineralization; growth plate

mineralization; bone matrix

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5
Q

Open plates: Occur in ____________________.

Closed plates: Happens in ____________________

A

Osteomalacia and rickets

osteomalacia only!

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6
Q

Mineralization Defects
Classified according to Predominant mineral deficiency:
– 1)______________ (hypophosphatemic) rickets
Primarily caused by _________ deficiency

– 2)_____________ (hypocalcemic) rickets
Primarily caused by ___________ deficiency

Associated with decrease levels of phosphorus or calcium, respectively.

A

Phosphopenic ; phosphate

Calcipenic; calcium

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7
Q

Pathogensis of Rickets

Growth Plate thickens:

•_______________ grow and ____________

• _________ invasion of growth plate into ____________
-this requires __________ of the growth plate cartilage
-Can be _________ or prevent by deficiency of calcium or phosphorous
-In such circumstances ___________________ accumulates and ____________ . In addition, the _____________ of the growth plate becomes _____________, losing their regular _________________ orientation.

A

Chondrocytes; hypertrophy

Vascular; primary bone; mineralization

delayed; growth plate cartilage

thickens; chondrocytes; disorganised

straight columned

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8
Q

The Pathogenic processes of Rickets (2)

_______ Accumulation in __________
Decreased ______________________ of the invovled skeletal sites

 2nd-ary increase in _________ of the growth plate. Compensatory mechanism due to ________________ by increase size

Bone __________ is compromised - if such condition does not improve, _________ occurs.

A

Osteoid ; metaphysis

biochemical resistance ; diameter

decrease strenght ; stability

bowing

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9
Q

Zones of the normal bone

From A-E

A

Reserve zone
Maturation zone
Proliferative zone
Hypertrophic zone
Primary Spongiosa

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10
Q

Clinical manifestation of rickets

Usually @ _________,________, and _____________ junctions.

Typically @Sites of (slow or rapid?) bone growth, where ____________________________________ are required for mineralization.

A

distal forearm, knee, and costochondral

Rapid

large quantities of calcium and phosphorus

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11
Q

Clinical Manifestations of rickets (Skeletal)

Delay in closure of the _________
Parietal & frontal _________ (due to excess osteoid)
_________ ( soft skull bones)
_________ of the costochondral junction (_____________)

A

fontanelles; bossing

Craniotabes ; Enlargement

rachitic rosary

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12
Q

Skeletal clinical manifestations of Rickets

The development of __________ sulcus ( caused by pull of the __________ to the __________)

__________ chest deformity (The weakened ribs bend inwards due to the pull of respiratory muscles, causing __________ of __________)

A

Harrison sulcus ; diaphragmatic attachments

lower ribs ; Pigeon chest

anterior protrusion of sternum

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13
Q

Skeletal clinical manifestations of rickets

______________ of the wrist + ankle & bowing of the ______________ & __________

Genus _________ (knocked), Genus ________ (bowleg), or __________ deformity (combination of valgus deformity of 1 leg with varus deformity of the other leg)

A

Enlargement ; distal radius & ulna

Valgus ; Verus ; Windswept

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14
Q

Clinical Manifestations (Extra-Skeletal)

Depends upon the type of ricket
___________ of the ___________ is typical for hypocalcemic rickets, whereas ___________ of the ________ occur more often in phosphopenic rickets.

Hypocalcemic _________, _____eased muscle tone leading to delayed ___________, recurrent infections, increased ___________

A

Hypoplasia of the dental enamel

abscesses of the teeth

seizures ; decreased

motor milestones; sweating

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15
Q

Clinical Manifestations of rickets

GENERAL Failure to thrive; _______ abdomen; Muscle __________ (especially (proximal or distal?) ); Fractures

HEAD: ___________ ; Frontal ___________; Delayed ___________; Delayed ___________; caries

CHEST : ___________; ___________ groove; or Respiratory infections

A

Protuding ; weakness ; proximal

Craniotabes; bossing; fontanelle closure

dentition ; Rachitic rosary; Harrison

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16
Q

Clinical manifestations of Rickets

BACK: __________ , __________ , __________

EXTREMITIES Enlargement of _______ and _______; _______ or ______ deformities; __________ deformity ; __________ of the tibia and femur; Leg pain.

HYPOCALCEMIC SYMPTOMS : __________, __________; Stridor due to laryngeal spasm

A

Scoliosis ; Kyphosis ; Lordosis

wrists ; ankles

Valgus ;? varus ; Windswept

Anterior bowing ; Tetany

Seizures

17
Q

Radiography in rickets

Best visualised @ growth plate of rapidly growing bones.
– Upper limb  __________
– Knee  ___________ above and below

A

distal Ulna

Metaphyses

18
Q

As disease progresses:

Disorganization of the growth plate becomes more apparent:
with __________ ,
__________,
formation of __________
__________.

A

cupping,
splaying,
formation of cortical spurs
stippling.

19
Q

Biochemical Findings in Rickets

Alkaline phosphatase: ____ in all forms of rickets
Serum phosphorus: ____ in both hypocalcemic and phosphopenic rickets

Serum Ca+2: ___ in hypocalcemic rickets (normal 9-11mg/dl)

Serum PTH: _____ in hypocalcemic rickets, but ________ in hypophosphatemic rickets

25-OH vitamin D reflect the amount of vitamin D stored in the body, and is ______ in vitamin D deficiency.

1,25-OH2 vitamin D can be ___________ in hypocalcemic rickets and usually is _____________ in phosphopenic rickets

A

↑; ↓; ↓; ↑; normal

↓

↓, N or ↑

N or slightly ↑

20
Q

A child with clinical signs of rickets should include _______ history with particular attention to given ________ and _________ intake

Medication history

Measurement of serum ________ and live enzymes

A

dietary

calcium and vitamin D

creatinine

21
Q

PREVENTION of rickets

1.Exposure to ________________
__________ and __________ ———- per day
2. Lactating mothers should receive supplemention with ______ or _________ to ensure prevention of rickets in their babies.
3. _______ exposure to mothers

A

sunlight (ultraviolet light)

Early morning and evening 15 minutes

milk or vitamin D

Sun

22
Q

Prevention of rickets

  1. Vitamin D supplementation (careful of _________ ): In prematures, twins and weak babies, give Vitamin D _____IU per day
    For term babies and infants the demand of Vitamin D is _____IU per day
A

toxicity

800; 400

23
Q

Prevention of rickets
5. Calcium supplementation:
________gm/day, for premature, and weak babies

A

0.5-1

24
Q

Treatment of Rickets

EITHER: _______________ therapy: 300,000-600,000 IU orally or IM in 2-4 divided doses over one day
OR: High dose vit D 2000-5000 IU orally for 4-6wks followed by 400 IU daily orally as maintenance
OR: (5000-10,000 U) is given daily for 2-3 months until healing and alkaline phosphatase concentration is approaching to the normal

Adequate dietary ________ and __________ provided by milk, formula & other dairy products
Symptomatic hypocalcaemia need ____________ as 20mg/kg or ______________ as 100mg/kg as a bolus, followed by ___________ tapered over 2- 6 weeks

A

Vitamin D. stoss

Calcium & phosphorus

IV CaCl ; Calcium gluconate

oral calcium

Senoir paeds (15 decks)

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