ANSWER: (B) Increased acid phosphataseREF: Nelson Textbook of Paediatrics 17th edition page 186-187"Alkaline phosphatase not acid phosphatase is increased in rickets"RICKETS 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 II)Congenital 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-like)Increased tendency for fractures (easily broken bones), especially greenstick fracturesSkeletal deformityToddlers: Bowed legs (genu varum)Older children: Knock-knees (genu valgum) or "windswept knees"Cranial, pelvic, and spinal deformities (such as lumbar lordosis)Growth disturbanceHypocalcaemia (lowT level of calcium in the blood)Tetany (uncontrolled muscle spasms all over the body)Craniotabes (soft skull)Costochondral swelling (aka "rickety rosary" or "rachitic rosary")Harrison's 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.