A three year old old boy with known renal failure presents

Question Number 0003


A three year old old boy with known renal failure presents is brought to Casualty after a seizure. He is noted to have marked bowing of the long bones of his lower limbs. An xray of the lower limbs shows cupping, fraying and irregularity of the metaphyses. These manifestations are most likely secondary to deficiency of
a) Vitamin A
b) Vitamin D2
c) alpha-Tocopherol
d) Vitamin K
e) Vitamin C


Correct Answer: B

These clinical and radiographic features are characteristic of rickets.Metaphyseal cupping and fraying in the distal radius

Rickets is associated with abnormalities of growth. These include skeletal deformity, bone fractures and slipped epiphyses. Hypocalcemia may be severe enough to produce tetany, seizures, and laryngeal spasm though the commoner manifestations are listlessness and irritability.Children often are unable to walk without support as the disease progresses and muscle weakness is present. The classical skeletal deformities start by 6 months of age with frontal bossing. Later chest deformities include a lateral collapse of both chest walls (Harrison's sulcus) and rachitic rosary.If it goes untreated, progressive bony deformities result in bowing particularly in the tibia, femur, radius, and ulna. Fractures may also result.

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