MBBS OSCE · General Medicine
OSCE — Vitamin D Deficiency (Rickets & Osteomalacia)
Eight-minute OSCE station on Vitamin D Deficiency (Rickets & Osteomalacia): focused history, examination priorities, investigations, emergency and definitive management.
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Brief (to candidate)
You will assess a patient with a presentation consistent with Vitamin D Deficiency (Rickets & Osteomalacia).
You have 8 minutes to take a focused history, outline examination, investigations, and management including red flags.[1]g red flags.
Clinical context
Vitamin D deficiency is the commonest nutritional deficiency worldwide, caused by inadequate UVB skin synthesis, dark skin, malabsorption, CKD, liver disease, obesity and enzyme-inducing drugs.[1]KD, liver disease, obesity and enzyme-inducing drugs. In the growing skeleton it causes nutritional rickets — craniotabes, rachitic rosary, Harrison sulcus, widened wrists, genu varum, delayed fontanelle closure and dental defects. In the mature skeleton it causes osteomalacia — diffuse bone pain, proximal muscle weakness, a waddling gait and Looser zones (pseudofractures). The diagnostic test is 25-hydroxyvitamin D (calcidiol): under 30 nmol/L (12 ng/mL) deficient, 30 to 50 nmol/L insufficient, 50 nmol/L or above sufficient, with the classical biochemic
Candidate tasks
- Clarify onset, severity, associated features, and red-flag symptoms.[1]
- State focused examination priorities.
- List first-line investigations and any named score/criteria.
- Give immediate resuscitation steps.
- Outline definitive management with doses/routes where standard.
- Name complications and disposition (ward / HDU / theatre / discharge safety-net).
- Mention one special-population modifier (pregnancy, child, elderly, CKD).
Examiner checklist
| Domain | Pass behaviours |
|---|---|
| Definition | Correct working diagnosis language |
| Assessment | Focused, prioritised, red flags sought |
| Investigations | Appropriate first-line + interpretation |
| Emergency care | ABC / time-critical actions first |
| Definitive care | Specific drugs/procedures, not generic phrases |
| Safety | Bone pain and proximal muscle weakness in an adult — check 25-hydroxyvitamin D f |
| Safety | Child with bowing legs, enlarged wrists, rachitic rosary or delayed walking — ri |
| Safety | Hypocalcaemic seizures, laryngeal stridor or dilated cardiomyopathy in an exclus |
| Communication | Clear plan and safety-netting |
Model outline
Lead with the working diagnosis and life threats. Resuscitate before definitive tests when unstable. Use guideline-standard therapy with named agents and doses.[1] Document escalation criteria and follow-up. A safe candidate is specific, structured, and never delays critical care for non-urgent imaging.
References2ShowHide
- [1]Munns CF, Shaw N, Kiely M, et al. Global Consensus Recommendations on Prevention and Management of Nutritional Rickets J Clin Endocrinol Metab, 2016.PMID 26745253
- [2]Hassan AB, Hozayen RF, Alotaibi RA, et al. Therapeutic and maintenance regimens of vitamin D3 supplementation in healthy adults: A systematic review Cell Mol Biol (Noisy-le-grand), 2018.PMID 30511630