<prompt> 8 yrs. old child presents with lethargy multiple epiphyseal breaks, wormian bones with growth retardation and mental retardation Diagnosis is?RicketsHypothyroidismScurvyHypoparathyroidism  <response>: Ans. is b Hypothyroidism Ref. : O.RGhai, 6e, p 482 5e, p447Presence of mental retardation, growth retardation and wormian bones clinch the diagnosis in favour of hypothyroidism.In Hypothyroidism both mental retardation and growth retardation are present andthe skull X-ray shows large fontanelle, wide sutures and wormian bones Rickets -Wormian bones are also present in rickets but mental retardation is not seen in ricketsScurvy and Hypoparathyroidism have a radically different symptomatic profile.Important causes of wormian boneHypothyroidism Hypophosphatasia Rickets Cleidocranial dysplasia Osteogenesis imperfecta 