This is a real-world medical entrance exam question, please give the true answer based on the question and selection. Topic name: None, Subject name: Pediatrics
[{'content': "A six month old infant fed totally on cow's milk has been brought with bleeding spots, anaemia, fever and generalised tenderness. On examination, there were swelling in both the lower extremities and the blood count was normal. The most likely diagnosis is – \nSelect and explain. \nA. Arthritis, B. Poliomyelities, C. Osteomyelities, D. Scurvy", 'role': 'user'}, {'content': "Answer: D \nExplanation: Exclusive feeding on Cow's milk in a 6 months infant with anemia, bleeding, fever and generalized tenderness suggest the diagnosis of scurvy.\nCow's milk does not contain sufficient amount of Vitamin C. On the other hand breast milk contains sufficient Vitamin C.\nClinical manifestations of scurvy \n\nThe usual age of manifestations of scurvy is 6-18 months.\nThe manifestions are -\n\n\nGeneral symptoms -f Low grade fever, irritability, tachypnea, digestive disturbances, loss of appetite.\nBleeding --> Subperiosteal, gingival and conjuctival hemorrhage, purpura & ecchymoses, petechiae, perifollicular hemorrhage, epistaxis.\nDefective dentition —> Bluish purple, spongy swellings of mucous membrane (due to hemorrhage), especially over the upper incisors.\nGeneralized tenderness and pseudoparalysis --> child is difficult to handle due to pain and generalized tenderness. The pain results in pseudoparalysis with the hips and knees in semi-flexed position and the feet rotated externally.\nScorbutic rosary --> Due to epiphyseal sepration, costochondral junction is disrupted and sternum is displaced backward with attached costal cartilages. The end of ribs becomes prominent —> rosary.\nAnemia Due to defect in utilization of iron & folic acid.\nBones are brittle and easily fractured.\nIrritability and other psychologic symptoms.\nOthers —f Arthralgia, muscle weakness, degenration of skeletal muscles, cardiac hypertrophy, adrenal atrophy and bone marrow depletion.\n\nDifferences between rachitic and scorbutic rosary\nRachitic Rosary\xa0\xa0\xa0\xa0\xa0\xa0\xa0\xa0\xa0\xa0\xa0\xa0\xa0\xa0\xa0\xa0\xa0\xa0\xa0\xa0\xa0\xa0\xa0\xa0\xa0\xa0\xa0\xa0\xa0\xa0\xa0\xa0\xa0\xa0\xa0\xa0\xa0\xa0\xa0\xa0\xa0\xa0\xa0\xa0\xa0\xa0\xa0\xa0\xa0\xa0\xa0\xa0\xa0\xa0\xa0\xa0\xa0\xa0\xa0\xa0\xa0\xa0\xa0 Scorbutic Rosary\n\nDue to metaphyseal widening\xa0\xa0\xa0\xa0\xa0\xa0\xa0\xa0\xa0\xa0\xa0\xa0\xa0\xa0\xa0\xa0\xa0\xa0\xa0\xa0\xa0\xa0\xa0\xa0\xa0\xa0\xa0\xa0\xa0\xa0\xa0\xa0\xa0\xa0 o Due to epiphyseal separation\nNon-tender\xa0\xa0\xa0\xa0\xa0\xa0\xa0\xa0\xa0\xa0\xa0\xa0\xa0\xa0\xa0\xa0\xa0\xa0\xa0\xa0\xa0\xa0\xa0\xa0\xa0\xa0\xa0\xa0\xa0\xa0\xa0\xa0\xa0\xa0\xa0\xa0\xa0\xa0\xa0\xa0\xa0\xa0\xa0\xa0\xa0\xa0\xa0\xa0\xa0\xa0\xa0\xa0\xa0\xa0\xa0\xa0\xa0\xa0\xa0\xa0\xa0\xa0\xa0\xa0\xa0\xa0\xa0 o Tender\nRounded\xa0\xa0\xa0\xa0\xa0\xa0\xa0\xa0\xa0\xa0\xa0\xa0\xa0\xa0\xa0\xa0\xa0\xa0\xa0\xa0\xa0\xa0\xa0\xa0\xa0\xa0\xa0\xa0\xa0\xa0\xa0\xa0\xa0\xa0\xa0\xa0\xa0\xa0\xa0\xa0\xa0\xa0\xa0\xa0\xa0\xa0\xa0\xa0\xa0\xa0\xa0\xa0\xa0\xa0\xa0\xa0\xa0\xa0\xa0\xa0\xa0\xa0\xa0\xa0\xa0\xa0\xa0\xa0\xa0\xa0 o Angular\n\n\nRemember\n\nVitamin C is not stored in the body, but is taken up by all tissues, the highest levels are found in the pituitary and adrenal glands.", 'role': 'assistant'}]