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Paeds Casesnephrology-urology-fluids-and-electrolytes

Paeds Cases · nephrology-urology-fluids-and-electrolytes

Calcium, magnesium and phosphate disorders — OSCE

OSCE communication and clinical reasoning station for the family of a child newly diagnosed with X-linked hypophosphataemic rickets presenting with short stature, leg bowing and a low phosphate, covering the diagnosis, the role of fibroblast growth factor 23, the burosumab treatment plan, and the safety-net.

osce communication and clinical reasoning station2 min readSource-verified ·

Target exams

MRCPCH ClinicalRACP DCE
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Study tools

Target exams

MRCPCH ClinicalRACP DCE
Prompt
You have 8 minutes with the parents of a 4-year-old boy who presented with short stature and progressive leg bowing. His blood tests showed a normal calcium with a low phosphate, a normal parathyroid hormone, a high alkaline phosphatase and a high fibroblast growth factor 23, confirming X-linked hypophosphataemic rickets, an inherited bone condition. He will start burosumab injections. Explain the diagnosis in plain language, why his phosphate is low, the treatment plan, and agree a safety-net for the future.

Candidate brief

You are the paediatric registrar. The child is 4 years old and has had bowing of the legs and slow growth for over a year. The team has confirmed X-linked hypophosphataemic rickets, an inherited condition. The parents want to understand what it is, whether it can be cured, why his phosphate is low when his other bones tests look normal, what the treatment involves, and what to watch for. Explain clearly, check understanding, and agree a plan. [9]

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References2ShowHide
  1. [9]Haffner D; Emma F; Eastwood DM; Biosse Duplan M Clinical practice recommendations for the diagnosis and management of X-linked hypophosphataemia. Nat Rev Nephrol, 2019.PMID 31068690
  2. [10]Ali DS; Carpenter TO; Imel EA; Ward LM X-Linked Hypophosphatemia Management in Children: An International Working Group Clinical Practice Guideline. J Clin Endocrinol Metab, 2025.PMID 39960858
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