IGNOU PB. Bsc. Nsg. Entrance-2025
Child Health Nursing (Pediatrics)
Easy
A child suffering from red or blue spot on the skin muscle and joint pain and X-ray revealing Frenkel's lines is :
Appeared in: IGNOU PB. Bsc. Nsg. Entrance-2025
Explanation
- The correct diagnosis is Scurvy, caused by a deficiency in Vitamin C.
- This condition impairs collagen synthesis, leading to fragile blood vessels and causing the red or blue spots on the skin (petechiae and ecchymoses).
- Bleeding under the bone's surface (subperiosteal hemorrhage) results in severe muscle and joint pain.
- Frenkel's line is a specific radiological finding representing a dense line of calcification at the metaphysis, which is a hallmark of scurvy.
Why Other Options Were Wrong
- Option A: Achondroplasia is a genetic disorder affecting bone growth, leading to dwarfism. It does not cause the hemorrhagic signs or the specific X-ray findings seen in scurvy.
- Option C: Rickets is due to Vitamin D deficiency and affects bone mineralization. Its classic X-ray signs are metaphyseal cupping, fraying, and widening, not the dense Frenkel's line.
- Option D: While leukemia can cause bone pain and petechiae (due to thrombocytopenia), its radiological findings are different (e.g., lytic lesions, metaphyseal bands) and do not include Frenkel's line.
Related Visual
Clinical Relevance
- Nursing practice connection: This is primarily an exam-oriented knowledge point with limited direct bedside application, so retain Diagnosis of Scurvy based on clinical and radiological findings as background academic context rather than a clinical decision trigger.
- A thorough dietary history is crucial in pediatric patients presenting with musculoskeletal pain or failure to thrive, as scurvy often occurs in children on highly restrictive diets (e.g., due to autism spectrum disorders or food fads).
- Scurvy is known as a 'great mimicker' because its symptoms can resemble those of child abuse (bruising, fractures), infections (osteomyelitis), or cancer (leukemia), requiring a high index of suspicion.
- The diagnosis is confirmed by a rapid clinical improvement within days of starting Vitamin C supplementation (100-200 mg/day).
How to Approach the Question
- First, analyze the clinical presentation described in the question stem. Identify the key signs and symptoms: 1) skin manifestations (red/blue spots), 2) musculoskeletal symptoms (muscle/joint pain), and 3) a specific investigation finding (X-ray showing Frenkel's lines).
- Recognize that 'Frenkel's line' is a highly specific, pathognomonic term. Your primary task is to recall or determine which condition is associated with this sign.
- Evaluate each option against the full clinical picture.
- Scurvy is directly linked to all three findings: bleeding (skin spots), subperiosteal hemorrhage (pain), and Frenkel's line on X-ray.
- Rule out the other options by identifying their key features. Achondroplasia is a growth disorder. Rickets has different X-ray findings (cupping/fraying). Leukemia can cause pain and spots but not Frenkel's line.
- Conclude that the unique combination of symptoms, especially the specific X-ray sign, points directly to Scurvy.
Concept Tested & Keywords
- Concept Tested: Diagnosis of Scurvy based on clinical and radiological findings.
- Stem keywords: child, red or blue spot on the skin, muscle and joint pain, X-ray, Frenkel's lines
- Lead-in keywords: is
- Clinical cues: The presence of Frenkel's lines on an X-ray is a pathognomonic (specifically characteristic) sign for scurvy.
- Negative lead-in flag: false
Question ID
QSFC5WloLB1FPnzIKwrxxF
Reference Book
E6 Nelson Textbook of Pediatrics(2024) — Volume 1 pp. 513-515, 1491-1493
Practise the full IGNOU PB. Bsc. Nsg. Entrance-2025
Attempt every question from this paper in a timed mock, then review the full solution for each one.
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