MBBS OSCE · General Medicine
OSCE — Osteomyelitis
Eight-minute OSCE station on Osteomyelitis: 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 Osteomyelitis.
You have 8 minutes to take a focused history, outline examination, investigations, and management including red flags.
Clinical context
Osteomyelitis is an infection of bone and bone marrow (myelo = marrow) by microbes (usually bacteria), producing inflammation, bone destruction (osteolysis), necrosis and reactive new bone formation. By pathogenesis (Lew-Waldvogel): haematogenous (bloodstream seeding — children: long-bone metaphysis; adults: vertebrae), contiguous-focus (adjacent wound, ulcer, diabetic foot, surgery) and chronic (sequestrum, involucrum, sinus tract, biofilm). Staphylococcus aureus is the commonest organism across all ages and types. Acute disease presents with localised bone pain, tenderness, swelling and fever; chronic disease with a draining sinus tract and relapsing pain. X-ray may be normal for the first
Candidate tasks
- Clarify onset, severity, associated features, and red-flag symptoms.
- 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 | Localised bone pain with fever and tenderness in a child or adult - acute osteom |
| Safety | Back pain with fever and raised inflammatory markers in an adult - vertebral ost |
| Safety | New neurological deficit with back pain and fever - spinal epidural abscess; urg |
| 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. Document escalation criteria and follow-up. A safe candidate is specific, structured, and never delays critical care for non-urgent imaging.