Rickets forMRCPCH clinical

By

Dr / Mohammed Ayad

Where could it be? 1 -MSK station

2 -others station

How could I suspect it? Bow legs – large head – myopathic gait

How could I proceed to such case?Really this depends totally on the opening statement.

1 -look to this child and till me what else would you like to examine?

In this scenario the examiner wants to see how brilliant you are in suspecting rickets from the first

look. If you suspect it , till him I see some rachitic features and I’d like t search for other signs . Then proceed as I

will mention soon.

This child shows difficult walking , please examine him?

This statement is frankly a MSK opening. First do PGALS of lower limb , then inform the examiner that you have noticed some features

of rickets and I will search for the other signs. Then do the scheme I will mention later.

This child looks short , please examine him

Measurement. Maneuvers .

Specific examination of rickets as I will mention later.

Approach to examination

1 -generalShort statureHypotonia and myopathic gait ( rare )

2 -handsBroad epiphysisCurved UL bonesScars of previous fractures

3 -head and neckLarge head ( offer to measure and put on curve )Opened or wide fontanelleFrontal bossingCraniotabes ( with cautious )Teeth problems

4 -chestPectusRosary beadsHarison sulcus

5 -abdomenProtruded abdomenPtosed liver

6 -backKyphoscoliosisExaggerated lumbar lordosis

7 -lower limbs Knock keesBow legsTibial deformitiesMarfan sign

causes

investigations

1 first lineCa – phosphorus – ALP – PTH – Vit D – creatinineBone x ray

ThenUrine for Ca and phosphorus

management

management of specific types

Thank you