RICKETS

Question 1

DEFINE

Answer 1

METABOLIC DISEASE OF CHILDHOOD OCCURING DUE TO INADEQUATE MINERALIZATION OF OSTEOID , MOSTLY AFFECTING THE GROWTH PLATE RESULTING IN SOFTENING OF BONES AND CAUSING DEFORMITIES OF ENDOCHONDRAL SKELETON.

Question 2

TYPE

Answer 2

TYPE 1 -DUE TO DEFICIENCY OR DEFECT IN METABOLISM OF VITAMIN D

A. DUE TO DEFICIENCY - DECREASE INTAKE , LACK OF EXPOSURE TO SUNLIGHT, DECREASE ABSORPTION
B. DUE TO DEFECT IN METABOLISM -
HEPATIC FACTORS - LACK OF 25 HYDROXYLATION OF VIT D
RENAL FACTORS - LACK OF 1 HYDROXYLATION

TYPE 2 - DUE TO LOW SERUM PHOSPHATE
A. DUE TO DECREASE INTAKE
B. DUE TO DEFECTIVE TUBULAR ABSORPTION OF RICKETS

Question 3

CHANGES IN BONE - SKULL

Answer 3

SKULL -
FRONTAL AND PARIETAL BOSSING
CRANIOTABES
CAPUT QUADRATUM
DELAYED CLOSURE OF FONTANELS
BROAD FOREHEAD

Question 4

CLINICAL FEATURES

Answer 4

IN OLDER CHILDREN MAY BE DUE TO MALABSORPTION
IN LESS THAN 1 YEAR DUE TO NUTRITIONAL RICKETS
INFANT - CHOVSTEK SIGN , TETANY
OLDER - WADDLING GAIT , FAILURE TO GROW
MUSCULAR HYPOTONIA- POT BELLY
CHANGES IN BONE

Question 5

CHANGES IN BONE - TEETH

Answer 5

ENAMEL HYPOPLASIA
DELAYED TEETH ERUPTION

Question 6

CHANGES IN BONE - CHEST

Answer 6

PIGEON CHEST DEFORMITY
RICKETY ROSARY
HARRISONS SULCUS

Question 7

CHANGES IN BONE - VERTEBRAE

Answer 7

EXAGGERATED CURVATURE

Question 8

CHANGES IN LONG BONES

Answer 8

KNOCK KNESS , BOW LEGS
COXA VARA
BROADENING OF ENDS

Question 9

INVESTIGATION

Answer 9

X RAY
BIOCHEMISTRY
BIOPSY

Question 10

X RAY

Answer 10

CUPPING OF METAPHYSIS
SPLAYING OF METAPHYSIS
WIDENING OF EPIPHYSEAL PLATE
DELAYED APPEARANCE OF EPIPHYSIS
RAREFRACTION OF BONES
KNOCK KNEES
BOW LEGS
COXA VARA

Question 11

BIOCHEMISTRY

Answer 11

SERUM CALCIUM AND PHOSPHATE - LOW
ALP - HIGH
PTH - HIGH
SERUM CALCIUM * PHOSPHATE < 2.4 MMOL / L DIAGNOSTIC OF RICKETS

Question 12

BIOPSY

Answer 12

WIDER AND EXTENSIVE OSTEOID SEAMS
DEFECTIVE MINERALISATION

Question 13

TREATMENT

Answer 13

MEDICAL
PREVENTION OF DEFORMITY
ORTHOPEDIC
VIT D RESISTANT RICKETS

Question 14

MEDICAL

Answer 14

SINGLE ORAL DOSE OF VIT. D 6 LAKH IU
INDUCES RAPID HEALING
IF NO SIGNS OF HEALING
REPEAT DOSE
IF SIGNS OF HEALING SEEN THEN GIVE MAINTAINANCE DOSE OF 400 IU PER DAY WITH CALCIUM SUPPLEMNTATION
IF STILL NO SIGNS OF HEALING
THEN MUST BE REFRACTORY RICKETS

Question 15

PREVENTION OF DEFORMITY

Answer 15

ABSOLUTE BED REST
RICKETS SPLINT

Question 16

ORTHOPAEDIC TT

Answer 16

CONSERVATIVE - MERMAID SPLINTS
OPERATIVE - CORRECTIVE OSTEOTOMY AFTER 6 MONTHS OF STARTING MEDICAL TT

Question 17

VITAMIN D RESISTANT RICKETS

Answer 17

THESE DONT RESPOND TO PHYSILOGICAL DOSES OF CALCIUM
1. IF CAUSE IS HEPATIC FACTOR: THEN GIVE VERY LARGE DOSES OF VIT D
2.IF CAUSE IS RENAL FACTOR - THEN VERY LARGE DOSE OF VITAMIN D ( VIATMIN D DEPENDENT RICKETS -
TYPE 1 - GIVE LIFE LONG TT WITH 1 (OH) D
TYPE 2 - LONG TERM PARENTERAL CALCIUM
3. HYPOPHOSPHATAEMIC RICKETS
GIVE PHOSPHATE AND VERY LARE DOSE OF VIT D