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Vitamin D Deficiency Counseling Case: A PLAB 2 Mock

Summary:

This is a counseling station where the candidate needs to explain abnormal blood results, especially low vitamin D and calcium levels, and provide a structured management plan covering medical treatment, lifestyle advice, safety netting, and follow-up.


Key Points:


System Involved: Endocrine & Metabolic (Vitamin D and Calcium Deficiency)

  • Data Gathering:

    • Focused questions on symptoms of deficiency (bone pain, muscle cramps, tiredness).

    • Screen for risk factors affecting vitamin D absorption (diet, sunlight exposure, gastrointestinal malabsorption).

    • Avoid repeated questions to save time.

    • Quickly transition to management once diagnosis is clear.

  • Explanation of Results:

    • Specify which tests are normal (e.g. thyroid) and which are abnormal (vitamin D, calcium).

    • Avoid general statements like “all your blood tests are normal” if not true.

    • Explain the role of vitamin D in calcium absorption and bone health to contextualise the deficiency.


Management Plan:

  • Medical Management:

    • Prescribe vitamin D supplements as first-line treatment.

    • Consider calcium supplementation if indicated.

  • Lifestyle Advice:

    • Encourage safe sunlight exposure.

    • Recommend dietary sources rich in vitamin D and calcium.

  • Safety Netting:

    • Advise on signs and symptoms warranting urgent medical review (e.g. worsening bone pains, muscle weakness).

  • Information Leaflets:

    • Provide patient information leaflets on vitamin D deficiency for patient education.

  • Follow-up:

    • Arrange follow-up to review symptoms and blood levels after treatment initiation.


Important Considerations:

  • Time management is crucial in counseling stations to cover all management components.

  • Always cover medical treatment, lifestyle modification, safety netting, patient education (leaflets), and follow-up to secure full marks.

  • Structuring management like a teaching station (briefly outlining all components upfront) helps when time is limited.

  • Avoid rehearsed stock phrases; communication must remain natural and patient-centred.

  • Demonstrate confidence in explaining results and management plans without overpromising.


Diagnostic Approach:

  1. Confirm Diagnosis:

    • Review presenting symptoms (tiredness, bone pain, muscle cramps).

    • Correlate with blood test results showing low vitamin D and calcium.

  2. Assess Cause:

    • Enquire about dietary intake, sun exposure, gastrointestinal symptoms suggestive of malabsorption.

  3. Exclude Differentials:

    • Thyroid disorders

    • Anaemia


Management:

  1. Explain Diagnosis and Results Clearly

  2. Outline Management Plan:

    • Vitamin D supplementation (specify dose if required).

    • Dietary advice for calcium and vitamin D-rich foods.

    • Sunlight exposure recommendations.

    • Safety net for worsening symptoms.

    • Provision of information leaflets.

    • Arrange follow-up to assess treatment response.


Communication Skills:

  • Avoid repeating questions.

  • Maintain patient-centred language and structure.

  • Involve patient in deciding priorities for discussion.

  • Check patient understanding throughout.

  • Use empathetic, supportive communication to build rapport.


Ethical Considerations:

  • Maintain honesty in explaining abnormal results (do not generalise “all tests are normal” if not true).

  • Respect patient autonomy by involving them in management decisions.

  • Provide clear safety netting to uphold duty of care.


Additional Resources:

  • NICE Guidelines: Vitamin D deficiency in adults – treatment and prevention

  • GMC Good Medical Practice: Communication and partnership with patients

  • PLAB Examiner Tips: Time management and avoiding rehearsed responses

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