Module 66, General Orthopaedist Level

A 2 year and 6 month old girl was recently adopted and brought for a medical evaluation. The available history was that the child was born to a mother who suffered from alcohol abuse. She was born prematurely (gestational age not available) at 2000 gms, 44 cm, with an apgar of 5/6. Furthermore, she had previously been diagnosed with encephalopathy, anemia, fetal alcohol syndrome and rickets. The adopted mother states that the child began walking recently at the age of 27 months. Laboratory tests included: Ca: 9.7(normal), Phosphorus 6.2(mildly increased), Alk Phos: 401(mildly increased) and Vit D 1 25: 92( mildly increased).

Question 66A

Based on this information you feel that this is likely nutritional based rickets however the laboratory tests are not consistent.

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Question 66B

The primary treatment of nutritional rickets is to increase the amount of calcium in the diet.

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Question 66C

This case does not demonstrate Looser's lines on the xray which suggests that this may be a primary metabolic bone disorder.

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Question 66D

On further history the adopted mother noted that the child has frequent diarrhea and has multiple food intolerances. All these symptoms may be due to a primary gastrointestinal problem.

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Question 66E

The adopted mother asks if the bone problems and the diagnosed static encephalopathy are possibly caused by the same problem. You tell her that is very likely the case.

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