Rickets

Question 1

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

Answer 1

400IU\10ug\at birth

Question 2

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

Answer 2

400-800IU\at the age of 1 month

Question 3

what is the normal serum calcium

Answer 3

9-11mg\dl

Question 4

normal serum of phosphate

Answer 4

4.5-5.5 mg\dl

Question 5

what is the structure of normal bone

Answer 5

matrix osteoid and minerals

Question 6

what are the bone layers

Answer 6

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

Question 7

define rickets

Answer 7

Defective minerlaization of the growing bone so disease of childhood

Question 8

pathophysiology of rickets

Answer 8

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

Question 9

types of rickets 4

Answer 9

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

Question 10

types of rickets according to nutrition : and compare

Answer 10

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

Question 11

etiology of nutritional vit D D rickets

Answer 11

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

Question 12

what is the rachitogenic diet

Answer 12

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

Question 13

what is the first sign to appear in rickets

Answer 13

craniotabes

Question 14

what is the first sign to appear in rickets

Answer 14

craniotabes

Question 15

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

Answer 15

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

Question 16

CP of limbs in rickets4

Answer 16

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

Question 17

CP of chest in rickets 4

Answer 17

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

Question 18

cp of spine in rickets 4
due to laxity of ligament

Answer 18

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

Question 19

CP of pelvis in rickest

Answer 19

contracted plevis important in females

Question 20

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

Answer 20

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

Question 21

why ca is usually normal in rickets

Answer 21

due to 2ry hyperparathyroidism

Question 22

neurological manifestion in rikcets 2

Answer 22

1. anorexia, irritability , sweating
2. hypocalcemic tetany

Question 23

causes of hypocalcemia in rickets

Answer 23

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

Question 24

massive dose of vit D lead to hypocalciema

Answer 24

rapid mobilization of ca from blood to bone

Question 25

latent tetany:serum, signs

Answer 25

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

Question 26

signs of latent tetany

Answer 26

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

Question 27

manifest tetay :serum

Answer 27

Ca;less than 7gm carpopedal spasm laryngospasm convulsions

Question 28

manifest tetay :serum

Answer 28

Ca;less than 7gm carpopedal spasm laryngospasm convulsions

Question 29

DD of rickets

Answer 29

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

Question 30

causes of delayed walking :neuro, bone, traing

Answer 30

1. neurological(central,periphral: cerebral palsy mental retardation hydrocephalus neuromusclar disorders 2.bone:rickets, trauma, fractures 3. training : by exclusion

Question 31

causes of chest infection in rickets

Answer 31

hyptonia:weak cough chest deformities

Question 32

causes of chest infection in rickets

Answer 32

hyptonia:weak cough chest deformities

Question 33

complications of rickets 7

Answer 33

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 6. contracted pelvis:obstructed labor in female 7. complications of treatment:++vit D

Question 34

what is the type of short stature in rickets

Answer 34

disproportional

Question 35

investigations in rickets

Answer 35

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

Question 36

what is the earliest laboratory manifestation in rickets

Answer 36

++ alkaline phosphtase

Question 37

when the improvment start to appear after ttt with D

Answer 37

2 weeks

Question 38

see table in 67 rickets

Question 39

prevention of rickets

Answer 39

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

Question 40

dose and duration of vit D oral

Answer 40

3000-5000IU\day 2-4 weeks

Question 41

dose and duration of vit D oral

Answer 41

3000-5000IU\day 2-4 weeks

Question 42

dose duration advantages and dis of parenteral vit D3

Answer 42

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

Question 43

ttt of complication:tetany, deformities

Answer 43

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

Question 44

CP of hypervitaminosis of vit D

Answer 44

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

Question 45

ttt of vit D ++

Answer 45

stop fluid steroids

Question 46

calssification of non nutritional vit D D rickets

Answer 46

renal malabsorpstion hepatic

Question 47

renal rickets

Answer 47

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

Question 48

malabsorption in rickets

Answer 48

cystic fibrosis celiac disease cholestasis

Question 49

hepatic rickets

Answer 49

chronic liver disease:defective 25 hydr

Question 50

hepatic rickets

Answer 50

chronic liver disease:defective 25 hydr