Nutritional Rickets and Bone Health – Board-Style Questions

What this deck covers

nutritional rickets and bone health in 18 board-style clinical cases with worked explanations. Each case gives you a clinical vignette, four options, the correct answer, and an explanation of why each of the other three is wrong, with the guideline or textbook it follows named on the answer.

Board-style teaching questions for paediatricians and trainees preparing for paediatric board, MRCPCH and licensing examinations. Written from published guidelines and standard paediatric textbooks, with the source named on every answer.

The 18 cases, in order

1. No drops at all
2. Who needs the drops
3. Covered and indoors
4. No dairy at all
5. Lumps and knobs
6. Late on his feet
7. A springy skull
8. Only six weeks old
9. What to eat
10. Through the window
11. Still bandy at two
12. On tablets for years
13. Still rickety on treatment
14. The rest of the household
15. What goes with it
16. A white band appears
17. A litre a day
18. Hard to remember

Diagnoses and management options tested

Across the 18 cases you are asked to choose between options such as: An early weaning diet that included eggs, oily fish and fortified cereal, Any baby not taking at least 500 mL of fortified formula each day, Her age, since nutritional rickets is commonest between five and ten years of age, An inherited failure to make the active form of the vitamin, Widened wrists with a row of beads felt along the front of the ribs, Sudden collapse with a seizure and no other abnormal physical signs at all, Raised pressure inside the skull from an obstructed ventricle, The seizure has used up the calcium stored in the baby’s bones, Oily fish, egg yolk and fortified cereal, since few foods carry it, An hour at the window each day makes any supplement unnecessary, The bowing will worsen steadily despite the treatment being given, Rapid growth at this age, which always produces bowed legs and pain, Untreated coeliac disease, with fat malabsorption blocking uptake, No action, since the problem belongs to this child alone.

Clinical pearls from this deck

• Breastfed and unsupplemented is the classic story.
• Breastfed, or under half a litre of formula: supplement.
• Dark skin, high latitude and cover: no synthesis.
• Rickets can come from calcium, not the vitamin.
• Broad wrists and beaded ribs: growing ends flare.
• Bowing appears when the soft bone is loaded.

Work through the deck once for recognition, then again a week later to test yourself — each question gives the answer and explains why every other option fails.

More from this system: all MSK and orthopaedics case decks · pediatric reference values.