Station no……………….

Date…………………… Examination: HISTORY TAKING (malnutrition)

Student Name……………………………………………………………………….. Index no………………… Batch………………..
Examiner's name………………………………………………………………..
Please mark to the right of appropriate score. Please use only PENCIL

Station specific skills

Greet the parent - introduce self - take permission 012 
Personal data 012
Eliciting complains & duration 012
History of present illness 01 2
Systemic enquiry 012
Past history (diarrhea, infections, similar condition) 012
Breast feeding & weaning 01 2
Food intake (type, amount, frequency, feeding during diarrhea & taboos) 01 2
Immunization history 0 1 2
Developmental history and regression 012
Family history (similar condition, contact with chronic cough, inherited &
012
congenital diseases)
Social history (parents’ education, occupation, income & housing condition) 012
Drug history 012
Summary 0 12
Mention the life threatening conditions in the first 24 hours (dehydration, 012
hypoglycemia, hypothermia, infections, heart failure)
Discuss the management of ONE of the above complications 012
Student's Total Mark…………………………… Total Mark

…………………………………Examiner's Signature
 Station no………………. Date…………………… Examination: HISTORY TAKING (bleeding disorder)
Student Name……………………………………………………………………….. Index no………………… Batch………………..
Examiner's name………………………………………………………………..
Please mark to the right of appropriate score. Please use only PENCIL

Station specific skills

Greet the parent - introduce self 012 
Personal data 012 
Elicit complains & duration 012 
History of present illness
Site of bleeding(skin, mucosal, joints or muscles) 012 
Estimation of quantity of blood loss 012 
Date of onset, duration & when he acquired bruises 012
Provocative factors (spontaneous, traumatic, surgery) 012 
Symptoms of anemia (fatigability, palpitations, shortness of breath) 012 
Systemic enquiry 012 
Past history
Excessive bleeding after injury, surgical procedures, cephalohematoma,
012 
bleeding at the site of vaccination, circumcision
Blood transfusion 012 
Developmental, schooling, puberty 012 
Family & social history 012 
Drug history (aspirin, anticoagulants) 012 
Summary 012 
Differential diagnosis (VWB, thrombocytopenic purpura, platelets
dysfunction)
Investigations (CBC, BT, PT, APTT, factor viii, plt function test, cofactor assay,
Management (supportive, DDAVP, VW factor conc., cryoprecipitate)
Student's Total Mark…………………………… Total Mark

.……………………………………………………Examiner's Signature

Station no………………. Date…………………… Examination: Counseling (immunization)

Student Name……………………………………………………………………….. Index no………………… Batch………………..
Examiner's name………………………………………………………………..
Please mark to the right of appropriate score. Please use only PENCIL

Station specific skills

Greet the parent - introduce self 012 
Ask her what vaccines she knows and their
012 
advantages
Explain to her what vaccines for and their
012 
schedules
Tell her that vaccines are generally safe 012 
Seriousness of diseases which can be prevented by
012 
these vaccines
Ask if her baby was given BCG immediately after
01
delivery
Tell her about future vaccines needed and when to
be given ( primary vaccination, booster doses, oral 012 
vs injections, times to bring the child)
What is expected after vaccination (local pain,
012 
tenderness, swelling, fever, irritability)
Tell her about minor illnesses that will not prevent
012 
her to take the child to vaccination
Use simple words - no medical terms 0 1
Ask her if she has any questions 0 1
Tell her to come again for follow up 0 1

Student's Total Mark…………………………… Total Mark

.…………………………………………Examiner's Signature
Station no………………. Date…………………… Examination: Counseling (febrile convulsions)
Student Name……………………………………………………………………….. Index no………………… Batch………………..
Examiner's name………………………………………………………………..
Please mark to the right of appropriate score. Please use only PENCIL

Station specific skills

Greet the parent - introduce self 012 
Ask the mother about
What she knows about febrile convulsions 01
Detection of fever 01
Giving antipyretic, shower, sponging 01
Detection of convulsions 01
Awareness and reaction during the seizures 01
Praising, correcting wrong attitudes, giving
012 
instructions
Detect increase in temp. using the dorsum of the
hand, touching covered sites of the body, using 012 
thermometer
Give paracetamol suppositories or syrups 012 
Use tepid water or shower to reduce temp. 012 
Give diazepam syrup if indicated 012 
Stress on the importance of reducing temp. 012 
Reassure the mother about the
prognosis( recurrence, normal intelligence, rarely 012 
epilepsy)
Any questions 01
Tell her to come again for follow up 01
Use simple words - no medical terms 0 1

Student's Total Mark…………………………… Total Mark

………………………………………Examiner's Signature
Station no………………. Date…………………… Examination: Respiratory Examination
Student Name……………………………………………………………………….. Index no………………… Batch………………..
Examiner's name………………………………………………………………..
Please mark to the right of appropriate score. Please use only PENCIL

Station specific skills

012  Greet the parent & child- introduce self- take permission
01 Wash hands
012 Identify that the pt is in correct position, undressing
General look
Comment on the appearance (wellbeing, consciousness, distress,
012
pallor, cyanosis, dysmorphism..)
012  Anthropometric measurements
012  Vital signs
012  Inspection (alae nasi-chest shape-scars, recessions..)
012  Counting resp rate for a minimum of half a min
Moving to head or foot of the bed to determine which side is
012
moving less
Palpation
012 Checking correctly position of trachea (if applicable)
012  Palpates for chest movements at three sites (if applicable)
01 Correctly confirm the side which is moving less (if applicable)
012  Palpates for tactile vocal fremitus (if applicable)
Percussion: comparing two sides and correct findings (if
012 
applicable)
012  Auscultation in all areas
Correct sequence of reporting ( air entry-type of breath sounds-
012 
added sounds- Vocal resonance)
012  Offer to examine all of the above posteriorly
012  Cover the pt and thank the mother
012  Summarize findings appropriately
012  State reasonable differential diagnosis
01 The most likely diagnosis
012  Outline management plan briefly
Total Mark Student's Total Mark……………………………

.……………………………………………………Examiner's Signature
Station no………………. Date…………………… Examination: Abdominal Examination
Student Name……………………………………………………………………….. Index no………………… Batch………………..
Examiner's name………………………………………………………………..
Please mark to the right of appropriate score. Please use only PENCIL

Station specific skills

Greet the parent & child- introduce self- take permission 012 
Wash hands 01
Identify that the pt is in correct position, undressing 012
General look
Comment on the appearance (wellbeing, consciousness, distress,
012
pallor, cyanosis, dysmorphism..)
Anthropometric measurements 012 
Vital signs 012 
Inspection (contour-visible scars-veins-cautery marks-visible
012 
peristalsis - umbilicus)
Superficial palpation (ask about areas of tenderness), check for
012 
temp-tenderness-superficial masses)
Deep palpation for organomegaly, masses (starting from right iliac
012 
fossa)
Report examination of the spleen (size-consistency-tenderness-
012 
auscultaion)
Report examination of the liver (edge-size-consistency-surface-
012 
tenderness-auscultation-span)
Percussion for ascites 012 
Shifting dullness (if applicable) 012
Fluid thrill (if applicable) 012
Bimanual palpation for kidneys 012
Auscultation for bowel sounds in different areas 012
Check for hernial orifices 012
Inspect the genitalia 012 
Cover the pt and thank the mother 012 
Summarize findings appropriately 012 
State reasonable differential diagnosis 012 
List Relevant investigations (in logic sequence) 012 
Student's Total Mark…………………………… Total Mark

.……………………………………………………Examiner's Signature
 Station no………………. Date…………………… Examination: Cardiac Examination
Student Name……………………………………………………………………….. Index no………………… Batch………………..
Examiner's name………………………………………………………………..
Please mark to the right of appropriate score. Please use only PENCIL

Station specific skills

Greet the parent & child- introduce self- take permission 012 
Wash hands 01
Identify that the pt is in correct position, undressing 012
General look
Comment on the appearance (wellbeing, consciousness, distress, pallor,
012
cyanosis, dysmorphism..)
Anthropometric measurements 012 
Vital signs 012 
Hands (clubbing- features of endocarditis) 012
Check the pulse ( rate- rhythm- character- volume- synchronicity-
012 
radiofemoral delay- peripheral pulses)
Offer to measure the blood pressure 01
Check JVP (if applicable) 01
Eye and mouth (for pallor and cyanosis) 012 
Precordium Examination
Inspection (chest contour- scars - pulsations) 012 
Palpation
Apical impulse (site - character) 012 
Thrills (site - timing) 012 
Parasternal heave 012 
Palpable 2nd heart sound 012 
Auscultation: Heart sounds (1st - 2nd - added) 012 
Murmurs ( site - timing - radiation) 012 
Basal crepitations 012 
Abdomen (liver- spleen) 012 
Lower limb odema 012 
Cover the pt and thank the mother 012 
Summarize findings appropriately 012 
State reasonable differential diagnosis 012 
What is the most likely diagnosis 01
List Relevant investigations (in logic sequence) 012 
Student's Total Mark…………………………… Total Mark

.……………………………………………………Examiner's Signature
 Station no………………. Date…………………… Examination: (Assessment of Dehydration)
Student Name……………………………………………………………………….. Index no………………… Batch………………..
Examiner's name………………………………………………………………..
Please mark to the right of appropriate score. Please use only PENCIL

Station specific skills

Greet the parent & child- introduce self- take permission 012 
Wash hands 01
Identify that the pt is in correct position, undressing 012
General look
Comment on the appearance (wellbeing, consciousness, distress, pallor,
012
cyanosis, dysmorphism..)
Consciousness & Mood
Alert, drowsy, irritable, lethargic or shocked 012 
Anthropomertic measurements 012 
Vital signs 012 
Head
Fontanelles if not closed (depressed, flat, bulging) 012 
Eyes (sunken, normal) 012 
Eyes (dry, tears present on crying) 012 
Mouth (moist, dry) 012 
Drinking response (normal, eager, refusing) 012 
Skin pinch & circulation
Skin pinch (correct technique, goes back slowly or normally) 012 
Pulse ( rate, volume) 012 
Capillary refill 012 
Cover the pt and thank the mother 012 
Degree of dehydration 
State the degree of dehydration correctly 012 
Complications (of watery diarrhea)
Dehydration, metabolic acidosis, hypokalemia, CVS complications, renal
012 
complications, DIC, CNS (convulsions) and malnutrition
Plan of management (plan A, plan B, plan C) 012 
Student's Total Mark…………………………… Total Mark

……………………………………………………Examiner's Signature
 Station no………………. Date…………………… Examination: (Nervous System)
Student Name……………………………………………………………………….. Index no………………… Batch………………..
Examiner's name………………………………………………………………..
Please mark to the right of appropriate score. Please use only PENCIL

Station specific skills

Greet the parent & child- introduce self- take permission 012 
Wash hands 01
Identify that the pt is in correct position, undressing 012
General look
Comment on the appearance (wellbeing, consciousness, distress, pallor,
012
cyanosis, dysmorphism..)
Anthropometric measurements 012 
Vital signs 012 
Higher functions
Speech, intelligence, cooperation, interest in surroundings &
012 
orientation
Cranial nerves (if applicable)
Facial asymmetry, squint 012 
Vision & hearing ( hearing is tested by a rattle) 012 
Upper limbs
Position, deformities, fasciculations, wasting 012 
Tone, power, reflexes 012 
Sensory examination (if applicable) 012 
Coordination (if applicable) 012 
Lower limbs
Position, deformities, fasciculations, wasting 012 
Tone, power, reflexes 012 
Sensory examination (if applicable) 012 
Coordination (if applicable) 012 
Examination of the back 012 
Gait (if able to walk) 012
Cover the pt and thank the mother 012 
Most likely diagnosis 012 
Suggest investigations 012 
Management plan 012 
Student's Total Mark…………………………… Total Mark

.……………………………………………………Examiner's Signature
 Station no………………. Date…………………… Examination: (Malnutrition)
Student Name……………………………………………………………………….. Index no………………… Batch………………..
Examiner's name………………………………………………………………..
Please mark to the right of appropriate score. Please use only PENCIL

Station specific skills

Greet the parent & child- introduce self- take permission 012 
Wash hands 01
Identify that the pt is in correct position, undressing 012
General look
Comment on the appearance (wellbeing, consciousness, mood,
012
distress, cyanosis, dysmorphism..)
Anthropometric measurements (Wt, Ht, HC, MUAC) + centiles 012 
Vital signs (PR, RR, BP and T) 012 
Head
Fontanelles if not closed (depressed, flat, bulging), Hair(color,
012 
distribution)
Eyes (pallor, jaundice, sunken, signs of vit D def) 012 
Nose & Ears (discharge) 01
Mouth (dryness, cyanosis, signs of vit def, teething) 012 
Neck (lymph nodes, goiter) 012 
Chest (shape, movement, auscultation) 012 
Abdomen (shape, ascites, hepatomegaly) 012 
Assess wasting (buttocks, dryness, inner thighs, below scapula) 012 
Skin (hypo/hyperpigmentation, ulceration, skin pinch) 012 
Lower limb (oedema, tone) 012 
Cover the pt and thank the mother 012 
Student's Total Mark…………………………… Total Mark

.……………………………………………………Examiner's Signature
 Station no………………. Date…………………… Examination: HISTORY TAKING (Neonatal jaundice)
Student Name……………………………………………………………………….. Index no………………… Batch………………..
Examiner's name………………………………………………………………..
Please mark to the right of appropriate score. Please use only PENCIL

Station specific skills

Greet the parent - introduce self 012 
Personal data 012 
Elicit complains & duration 012 
History of present illness
Onset, duration, site, progression 012 
Color of urine and stool 012 
Symptoms of kernicterus 012
Blood group of mother and child 012
Systemic enquiry (fever, vomiting, constipation) 012 
Perinatal history
Pregnancy (fever and rash, gestation, single or multiple, complications-e.g
012 
DM
Birth wt, birth injuries, cry immediately 012 
Nutrition (breast feeding) 012 
Family history 012 
Drug history 012 
Summary 012 
Differential diagnosis 012 
Investigations 012 
Management 012 
Student's Total Mark…………………………… Total Mark

.……………………………………………………Examiner's Signature
Station no………………. Date…………………… Examination: Counseling (DM)
Student Name……………………………………………………………………….. Index no………………… Batch………………..
Examiner's name………………………………………………………………..
Please mark to the right of appropriate score. Please use only PENCIL

Station specific skills

Greet the parent - introduce self 012 
Ask what does she know about diabetes 012 
Explain the nature of the disease 012 
Tell her about the importance of insulin 012 
Tell her that the disease is common and can be
012 
controlled
Show her how and where to store insulin 012 
Show her how to give the injections 012 
Tell her to change the injection sites 012 
Tell her about symptoms of hypoglycemia 012 
Tell her about the importance of nutrition 012 
Tell her about activity and schooling 012 
Tell her how to deal with infections 012 
Ask her if there any questions 0 1
Tell her to come again for follow up 0 1
Use simple words - no medical terms 0 1

Student's Total Mark…………………………… Total Mark

.…………………………………………Examiner's Signature
 Station no………………. Date…………………… Examination: (Hydrocephalus)
Student Name……………………………………………………………………….. Index no………………… Batch………………..
Examiner's name………………………………………………………………..
Please mark to the right of appropriate score. Please use only PENCIL

Station specific skills

Greet the parent & child- introduce self- take permission 012 
Wash hands 01
Identify that the pt is in correct position, undressing 012
General look
Comment on the appearance (enlarged head, wellbeing, consciousness,
012
distress, dysmorphism..)
Anthropometric measurements (Wt, Ht, HC) + centiles 012 
Vital signs (PR, RR, BP and T) 012 
Head
Inspection (size, shape, dilated veins, fontanelles, presence of shunt) 012 
Palpation (HC, fontanelles and sutures, craniotabes, shunt function) 012 
Percussion (watermelon sign) 012 
Auscultation 012 
Offer to do Transillumination test 01
Eyes (sunken, sunsetting) 012 
Abdomen (scar of the shunt, percuss for bladder) 012 
Back for NTD 012 
Lower limbs (deformity, tone & reflexes) 012 
Cover the pt and thank the mother 012 
Student's Total Mark…………………………… Total Mark

.……………………………………………………Examiner's Signature
 Station no………………. Date…………………… Examination: HISTORY TAKING (cough)
Student Name……………………………………………………………………….. Index no………………… Batch………………..
Examiner's name………………………………………………………………..
Please mark to the right of appropriate score. Please use only PENCIL

Station specific skills

Greet the parent - introduce self 012 
Personal data: Name - age - residence 012 
History of present illness
Onset, severity, duration, triggering factors, dry or productive 012 
Other symptoms (SOB, wheeze, chest tightness, fever, night sweats, wt loss) 012 
Systemic enquiry 012 
Past history
If pt known asthmatic 012 
Similar attacks, severity and duration, hospital admission, response to
012 
treatment, contact with pt with chronic cough, condition between attacks
Developmental, schooling, puberty 012 
Family history
FH of allergic conditions, parental smoking 012 
Social history (housing conditions, contact with animals) 012 
Drug history 012 
Summary 012 
Differential
Management
Student's Total Mark…………………………… Total Mark

.……………………………………………………Examiner's Signature
 Station no………………. Date…………………… Examination: (Rickets)
Student Name……………………………………………………………………….. Index no………………… Batch………………..
Examiner's name………………………………………………………………..
Please mark to the right of appropriate score. Please use only PENCIL

Station specific skills

Greet the parent & child- introduce self- take permission 012 
Wash hands 01
Identify that the pt is in correct position, undressing 012
General look
Comment on the appearance (wellbeing, consciousness, distress,
012
dysmorphism..)
Anthropometric measurements (Wt, Ht, HC) + centiles 012 
Vital signs (PR, RR, BP and T) 012 
Head
Size, shape, fontanelles, craniotabes 012 
Eyes (pallor, jaundice, vit A def) 012 
Mouth (pallor, signs of vit def) 012 
Chest (deformity. Ricketic rosary, Harrison sulcus) 01
Abdomen (distension) 012 
Upper and lower limbs (deformity, tone) 012 
Back for kyphosis 012 
Cover the pt and thank the mother 012 
Student's Total Mark…………………………… Total Mark

.……………………………………………………Examiner's Signature
Station no………………. Date…………………… Examination: Counseling (Down syndrome)
Student Name……………………………………………………………………….. Index no………………… Batch………………..
Examiner's name………………………………………………………………..
Please mark to the right of appropriate score. Please use only PENCIL

Station specific skills

Greet the parent - introduce self 012 
Ask what does she know about Down syndrome 012 
Explain the nature of the syndrome and some of its
012 
features
Tell her that it’s not her fault 01
Tell her that children with this disorder may be
quite normal and few of them may have some 012 
complications
Tell her that we may have to do some
012 
investigations to exclude these complications
Explain the developmental delay 012 
Tell her about schooling 012 
Tell her that those children are lovely, friendly and
012 
don’t cause trouble
Ask her if there any questions 0 1
Tell her to come again for follow up 0 1
Use simple words - no medical terms 0 1

Student's Total Mark…………………………… Total Mark

.…………………………………………Examiner's Signature

Station no………………. Date…………………… Examination: (Neonatal Examination)

 Student Name……………………………………………………………………….. Index no………………… Batch………………..
Examiner's name………………………………………………………………..
Please mark to the right of appropriate score. Please use only PENCIL

Station specific skills

Greet the parent introduce self- take permission 012 
Wash hands 01
Identify that the pt is in correct position, undressing 012
General look
Comment on the appearance (wellbeing, consciousness, distress,
012
dysmorphism, activity, color…)
Anthropometric measurements (Wt, Ht, HC) + centiles 012 
Vital signs (PR, RR, BP and T) 012 
Head
Sutures, fontanelles, birth injury 012 
Eyes (pallor, jaundice, abnormality, red reflex, offer fundoscopy) 012 
Nose and Ear (congenital abnormality) 01
Mouth (pallor, cyanosis, teething, cleft lip & palate) 012 
Neck (obvious abnormality) 01
Chest (deformity, nipples, auscultation) 012 
Abdomen (shape, umbilicus, liver, spleen and kidneys) 012 
Genitalia (ambiguity), anal patency 012 
Hip examination (Barlow and Ortolani tests) 012 
Extremities (deformity, tone, reflexes) 012 
Skin (neonatal skin changes) 012 
Back (deformity) 012 
Neonatal reflexes 012 
Cover the pt and thank the mother 012 
Student's Total Mark…………………………… Total Mark

.……………………………………………………Examiner's Signature