<prompt> In rickets all are seen EXCEPT:CraniotabesIncreased acid phosphataseBow legsIncrease alkaline phosphatase  <response>: ANSWER: B Increased acid phosphataseREF: Nelson Textbook of Paediatrics 17th edition page 186-187Alkaline phosphatase not acid phosphatase is increased in ricketsRICKETS is a softening of bones in children due to deficiency or impaired metabolism of vitamin D, magnesium, phosphorus or calcium, potentially leading to fractures and deformity.TypesNutritional RicketsVitamin D Resistant RicketsVitamin D Dependent Rickets Type I 8c Type IICongenital Rickets Signs and symptoms:Bone pain or tendernessDental problemsMuscle weakness rickety myopathy or floppy baby syndrome or slinky baby such that the baby is floppy or slinky-likeIncreased tendency for fractures easily broken bones, especially greenstick fracturesSkeletal deformityToddlers: Bowed legs genu varumOlder children: Knock-knees genu valgum or windswept kneesCranial, pelvic, and spinal deformities such as lumbar lordosisGrowth disturbanceHypocalcaemia lowT level of calcium in the bloodTetany uncontrolled muscle spasms all over the bodyCraniotabes soft skullCostochondral swelling aka rickety rosary or rachitic rosaryHarrisons grooveDouble malleoli sign due to metaphyseal hyperplasiaWidening of wrist raises early suspicion, it is due to metaphyseal cartilage hyperplasia.Diagnosis:Blood tests:Serum calcium may show low levels of calcium, serum phosphorus may be low, and serum alkaline phosphatase may be high.Arterial blood gases may reveal metabolic acidosisAn X-ray or radiograph of an advanced sufferer from rickets tends to present in a classic way:bow legs outward curve of long bone of the legs and a deformed chest. Changes in the skull also occur causing a distinctive square headed appearance. These deformities persist into adult life if not treated. Long-term consequences include permanent bends or disfiguration of the long bones, and a curved back. 