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paediatric

Rickets (Nutritional and Metabolic)

advanced
6 min
28 marks
6 questions
Clinical Scenario
A 2-year-old girl of African descent is brought in by her parents who are concerned about her bowed legs. They have been living in the UK for 3 years. She was exclusively breastfed until 18 months. Her diet is limited and she spends most time indoors. On examination, she has frontal bossing and a rachitic rosary (palpable costochondral junctions). There is genu varum bilaterally with widened wrists and ankles. She has delayed motor milestones.
AP radiographs of the wrist and knee in a 2-year-old child with nutritional rickets. The distal radius and ulna show classic physeal widening with cupping and fraying of the metaphyses. The zone of provisional calcification is indistinct. Similar changes are visible at the knee with widened, irregular growth plates. There is genu varum deformity. Generalized osteopenia is present.
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AP radiographs of the wrist and knee in a 2-year-old child with nutritional rickets. The distal radius and ulna show classic physeal widening with cupping and fraying of the metaphyses. The zone of provisional calcification is indistinct. Similar changes are visible at the knee with widened, irregular growth plates. There is genu varum deformity. Generalized osteopenia is present.

Image source: Open Access medical literature (NIH/PubMed Central) • CC-BY License

Questions

Question 1 (4 marks)

Describe the radiographic features and clinical presentation of rickets.

Question 2 (5 marks)

What are the different types of rickets and their causes?

Question 3 (6 marks)

Describe the pathophysiology and biochemical abnormalities.

Question 4 (5 marks)

What is the medical treatment for different types of rickets?

Question 5 (4 marks)

When is surgical intervention indicated and what are the options?

Question 6 (4 marks)

How do you differentiate rickets from Blount's disease?

Exam Day Cheat Sheet

Must Mention

  • •Classic triad: widened physis, cupping/fraying, indistinct ZPC
  • •Types: Nutritional (low 25-OH-D), XLH (low PO4, normal D)
  • •Clinical: rosary, craniotabes, Harrison sulcus, bowing
  • •Biochemistry patterns (high ALP in all)
  • •Medical treatment first, surgery if persistent
  • •Differentiate from Blount's (wrists, biochemistry)

Common Pitfalls

  • •Missing biochemistry patterns
  • •Wrong treatment by type
  • •Surgery before medical
  • •Confusing with Blount's
  • •Missing clinical signs
  • •Not knowing XLH specifics