Course Content
🔬 Station 1 — Identification of Tuberculous Osteomyelitis
Learning Outcomes Identify tuberculous osteomyelitis from a provided gross specimen or histopathology image/slide. Identify the key gross and microscopic morphological features supporting the diagnosis. Differentiate the lesion from common pyogenic osteomyelitis when provided with relevant findings.
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Identification of Tuberculous Osteomyelitis
🔬 Station 2 — Identification of Common Bone Tumours
Learning Outcomes Identify the provided bone tumour from a gross specimen, image or histopathology slide. Identify the key morphological features supporting the diagnosis. Differentiate osteosarcoma, osteoclastoma and chondrosarcoma using characteristic morphological findings.
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Identification of Common Bone Tumours
🧪 Station 3 — ASO Test by Latex Agglutination
Learning Outcomes Prepare the specimen and reagents required for the ASO latex agglutination test. Demonstrate the correct steps of the latex agglutination technique. Interpret visible agglutination and report the test as positive or negative.
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ASO Test by Latex Agglutination
🔬 Station 4 — Identification of Squamous Cell Carcinoma and Basal Cell Carcinoma of Skin
Learning Outcomes Identify SCC or BCC from a provided gross specimen/image or histopathology slide. Identify the important morphological features supporting the diagnosis. Differentiate squamous cell carcinoma from basal cell carcinoma on morphological grounds.
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Topic: 🔬 Station 4 — Identification of Squamous Cell Carcinoma and Basal Cell Carcinoma of Skin
💊 Station 5 — Prescription Writing for Gout and Rheumatoid Arthritis
Learning Outcomes Write a complete and rational prescription for a patient with gout or rheumatoid arthritis based on the supplied clinical scenario. Select an appropriate drug, dose, route, frequency and duration. Demonstrate the essential components of safe prescription writing.
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Prescription Writing for Gout and Rheumatoid Arthritis
💊 Station 6 — Prescription Writing for Common Dermatological Disorders
Learning Outcomes Write an appropriate prescription for a supplied case of scabies or psoriasis. Select the appropriate preparation, route, dose/frequency and duration. Include essential patient instructions relevant to safe and effective treatment.
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Prescription Writing for Common Dermatological Disorders
⚖️ Station 7 — Identification of Mechanical Wounds and Causative Weapon
Learning Outcomes Identify the type of mechanical wound from a provided model, image or injury photograph. Recognize abrasion, bruise, laceration, incised wound or stab wound from its characteristic features. Identify the probable causative weapon/mechanism and relevant medico-legal significance.
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Identification of Mechanical Wounds and Causative Weapon
🔫 Station 8 — Examination of Firearm Injury and Identification of Bullet/Ammunition
Learning Outcomes Identify a firearm entry or exit wound from the provided image/model and describe its important features. Interpret features relevant to the probable range or mechanism of firing when demonstrated. Identify a supplied bullet/ammunition specimen and document the important medico-legal findings.
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Examination of Firearm Injury and Identification of Bullet/Ammunition
🩺 Station 9 — Focused Musculoskeletal History and Examination
Learning Outcomes Obtain a focused history relevant to a common musculoskeletal complaint. Perform an appropriate focused general and musculoskeletal examination. Present the relevant positive and negative findings in an organized manner.
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Focused Musculoskeletal History and Examination
🦴 Station 10 — X-Ray Interpretation of Fracture/Dislocation and Initial Limb Management
Learning Outcomes Identify a fracture or dislocation on a provided X-ray. Describe the site, type, displacement and/or angulation of the injury systematically. Demonstrate or describe appropriate immediate immobilization and initial management of the injured limb.
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X-Ray Interpretation of Fracture/Dislocation and Initial Limb Management
AIM OSPE/OSCE Lab — MSK-II Module | 3rd Year MBBS
AIM OSCE / OSPE • MBBS

🔬 Station 1 — Identification of Tuberculous Osteomyelitis

Rapid Revision • Practical Pathology • Viva

🎯 Task

Candidate Task

You are provided with a gross bone specimen and/or an H&E-stained histopathology image from a case of osteomyelitis. Identify the lesion, state the key morphological features supporting your diagnosis, and distinguish it from common pyogenic osteomyelitis.

⚡ Model Station Answer — What to say in the exam

Identification: This is tuberculous osteomyelitis.
Gross: Destructive bone lesion with pale yellow-white caseous necrotic material and granulation tissue.
Microscopy: Caseating epithelioid granulomas with Langhans-type giant cells, surrounding lymphocytes and areas of necrotic bone.
Differentiation: Tuberculous osteomyelitis is predominantly granulomatous with caseation, whereas pyogenic osteomyelitis shows prominent neutrophilic suppuration and abscess formation.

🔎 Stepwise Procedure / Approach

Identify the tissue. Confirm that the specimen or slide represents bone and look for areas of destruction or necrosis.

  1. Assess the gross pattern. Look for irregular bone destruction, granulation tissue and pale yellow-white caseous material when visible.
  2. Scan the slide at low power. Look for a granulomatous inflammatory pattern involving or surrounding bone trabeculae.
  3. Identify the granuloma. Look for collections of epithelioid histiocytes with central caseous necrosis.
  4. Confirm supporting cells. Identify Langhans-type multinucleated giant cells and a surrounding rim of lymphocytes.
  5. Look for bone involvement. Note necrotic or damaged bone trabeculae associated with the inflammatory lesion.
  6. Differentiate from pyogenic osteomyelitis. Predominant caseating granulomas favor tuberculosis; sheets of neutrophils, pus and suppurative abscesses favor pyogenic infection.
  7. State the diagnosis clearly. Correlate the dominant morphological features and conclude: tuberculous osteomyelitis.

🖼️ Visual Learning

VISUAL 1

Tuberculous Osteomyelitis — Gross, Microscopy & Pyogenic Comparison

🎥 Practical Video

🎥 Practical Demonstration — Osteomyelitis Pathology

Source: Pathology Master

This MBBS-focused pathology demonstration reviews the gross and microscopic morphology of osteomyelitis and directly compares pyogenic and tuberculous osteomyelitis, helping reinforce the identifying features required at this station.

▶ Watch Practical Video

📝 Important Viva Questions

Q1. What is the characteristic microscopic lesion in tuberculous osteomyelitis?

Answer: A caseating epithelioid cell granuloma containing Langhans-type giant cells and surrounded by lymphocytes.

Q2. What is caseous necrosis?

Answer: It is a form of necrosis producing soft, amorphous, cheese-like material, classically associated with tuberculosis.

Q3. How do you recognize a Langhans-type giant cell?

Answer: It is a multinucleated giant cell in which the nuclei are typically arranged toward the periphery in a horseshoe or arc-like pattern.

Q4. What is the major microscopic difference between tuberculous and pyogenic osteomyelitis?

Answer: Tuberculous osteomyelitis shows predominantly caseating granulomatous inflammation, whereas pyogenic osteomyelitis shows prominent neutrophilic suppuration and abscess formation.

Q5. Which organism causes tuberculous osteomyelitis?

Answer: It is caused by Mycobacterium tuberculosis.

Q6. Which stain can demonstrate acid-fast bacilli in tissue?

Answer: Ziehl–Neelsen stain can demonstrate acid-fast bacilli, although organisms may be sparse in osteoarticular tuberculosis.

Q7. What bone change may accompany the granulomatous inflammation?

Answer: Destruction and necrosis of bone trabeculae may occur, with surrounding granulation tissue and chronic inflammatory changes.

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