KAMPALA INTERNATIONAL UNIVERSITY – WESTERN CAMPUS

DEPARTMENT OF PAEDIATRICS AND CHILD HEALTH

CLINICAL EXAMINATION GUIDE
History Taking

No Skill Do Not Not

ne done done
wel well
l
Opening the consultation
1 Wash your hands and don PPE if appropriate
2 Introduce yourself including your name and role
3 Greet the child, their parents or carers and any other siblings who are present
4 Confirm the child’s name and date of birth
5 Explain that you'd like to take a history
6 Gain consent to proceed with taking a history
Presenting complaint
7 Use open questioning to explore the presenting complaint
History of presenting complaint
8 Explore the presenting complaint in more detail using a range of questions (e.g. when
did it start, how has it changed, has there been similar episodes in the past, does
anything make it better or worse etc)
9 Explore the child’s and parent’s/carer’s ideas, concerns and expectations
10 Summarise the presenting complaint
Systemic enquiry
11 Screen for relevant symptoms in other body systems
Past medical and surgical history
12 Ask if the child has any medical conditions
13 Ask if the child has undergone any relevant surgical procedures
14 Ask if the child has any allergies and if so, clarify what kind of reaction they had to the
substance
15 Explore the child’s prenatal, birth and neonatal history if relevant to the presenting
complaint
16 Ask if the child is currently meeting their developmental and growth milestones if
relevant
17 Ask if the child is up to date with their immunisations
Drug history
18 Ask if the child is currently taking any prescribed medications or over-the-counter
remedies
Family history
19 Start by drawing a family tree or genogram which you can then annotate with key
details about the child's family members
20 Ask if any family members or friends have recently experienced similar symptoms to
those the child is presenting with
21 Ask about conditions which appear to run in the family and clarify who has been
affected
Social history
22 Clarify who lives with the child and the type of accommodation
23 Ask about the relationship status of the parents/carers
24 Ask about the child’s play or leisure activities
25 Ask if the child is happy at home and at school/nursery
26 Clarify the smoking status of the parents and others living with the child
27 Ask if the child is currently under the care of social services, subject to a child
protection plan or has previously had social services involvement
Closing the consultation
29 Summarise the key points back to the child and parents/carers and ask if they feel
anything has been missed
30 Thank the child and parents/carers for their time
31 Dispose of PPE appropriately and wash your hands
Key communication skills
32 Active listening
33 Summarizing
KAMPALA INTERNATIONAL UNIVERSITY – WESTERN CAMPUS

DEPARTMENT OF PAEDIATRICS AND CHILD HEALTH

CLINICAL EXAMINATION GUIDE

General examination

Not
Done done Not
No Skill well well done
1 Creates rapport with the patient
Greets mother, introduces self, explains purpose of the
examination, asks for permission to examine the patient,
positions and exposes the patient appropriately
2 Comments on general condition of the patient (2)
General appearance/ general condition
Measures temperature/ assesses for fever (correct technique &
interpretation)
3 Assesses for anaemia (2)
Examines the conjunctiva, mucous membranes, palms and soles
of feet
Describes the level of anemia
4 Assesses for Cyanosis (2)
Checks for central cyanosis
Checks for peripheral cyanosis
5 Examines the tongue and oral mucous membranes (2)
Comments on texture of the tongue
Comments on other lesions on the tongue and oral mucosa
6 Asseses for Jaundice (2)
Checks the sclera in good light
Comments on the level of jaundice
7 Examines for Lymph nodes (3)
Examines/ palpates for L/nodes
Looks for all groups (cervical, axillary, inguinal…)
Describes the palpable nodes (site, size, mobility, tenderness)
8 Examines for Digital clubbing (2)
Uses correct technique
Correct interpretation
9 The skin and hands (3)
Examines the hands and nails
Examines the skin for any lesions
Checks for bleeds in the skin (petechie, ecchymosis, purpura)
10 Other signs (6)
 Examines/ palpates for bone tenderness
Comments on long bone and flat bone tenderness
Examines for oedema
Examines hydration status
Assesses for capillary refill
Comments on any other obvious signs (growth, dysmorphism
etc)
11 Summary (1)
Summarizes the significant findings
12 Diagnosis (4)
Most likely diagnoses & reasons
Differential diagnoses & reasons

13 Investigations (3)
Investigations& reasons
KAMPALA INTERNATIONAL UNIVERSITY – WESTERN CAMPUS

DEPARTMENT OF PAEDIATRICS AND CHILD HEALTH

CLINICAL EXAMINATION MARKING GUIDE

ABDOMEN

Serial no Skill Done Not done Not

well well done
1 Creates rapport with the patient (1)
Greets mother, introduces self, explains purpose of
the examination, asks for permission to examine
the patient, positions and exposes the patient
appropriately
2 General examination relevant to the abdomen (3)
Comments on general condition (sick, wasted etc)
Carries out a quick general exam
– fever, anaemia,
- jaundice, mouth exam,
-lymphadenopathy, digital clubbing,
-oedema, hydration status
3 Inspection of abdomen (2)
Inspects the abdomen (uses correct maneuvers-
inspects from side & foot of bed))
Comments on relevant features (shape, fullness,
movement, collaterals, scars, umbilicus)
4 Palpation (4)
Superficial palpation (in all relevant areas)
Comments on tenderness, masses
Deep palpation (correct technique)
Comments on tenderness, masses
Examination of the liver (3)
Palpates for the liver
Description of consistency, liver surface, edge,
tenderness
Identifies upper boarder & measures size of the
liver
 Examination of the spleen (4)
Palpates for the spleen
Description of consistency, surface, tenderness
Looks for other features of a spleen e.g medial
notch, cannot go above it etc.
Measures size of the spleen

5 Examination of kidneys (2)

Palpates for the kidneys
Looks for renal angle tenderness (Murphy punch)
6 Percussion
Percusses all appropriate areas
Uses correct technique
Examines for ascites (shifting dullness, fluid thrill)
6 Others (2)
Examines for other masses in the abdomen

Examination of inguinal orifices

Examination of genitalia
Perianal and rectal examination (digital exam if
indicated)
7 Auscultation (2)
Bowel sounds (3 – 10/min)
Auscultate for vascular bruit

8 Technique (2)
Is systematic
Uses appropriate technique
9 Summary (1)
Summarize the relevant findings
10 Diagnosis (4)
Most likely diagnoses & reasons

Differential diagnoses & reasons

11 Investigations

Investigations & reasons

KAMPALA INTERNATIONAL UNIVERSITY – WESTERN CAMPUS

DEPARTMENT OF PAEDIATRICS AND CHILD HEALTH

CLINICAL EXAMINATION GUIDE

RESPIRATORY SYSTEM

Seria Skill Done Not done Not

l no well well done
1 Creates rapport with the patient (applies to all
stations) (1)
Greets mother, introduces self, explains purpose of
the examination, asks for permission to examine the
patient, positions and exposes the patient
appropriately
2 General examination relevant to respiratory system
(3)
Comments on general condition (sick, wasted etc)
Carries out a quick general exam
– fever, anaemia,
- cyanosis ,
-lymphadenopathy, ,
-digital clubbing

3 Inspection (3)
Counts respiratory rate (for 1 minute)
Comments on chest wall (symmetry, deformities,
movement)
Comments on other key features (eg tubes for Oxy or
UWSDT)
Features of respiratory distress ( nasal flaring, chest in-
drawing, supra-sternal and sternal recession)
4 Examines the ears, nose and throat (3)
Inspects nostrils
Examines ears (otoscopy) /(intention to do so)
Examines the throat using a tongue depressor
(depending on the condition of the patient) /intention
to do so
5 Palpation (4)
Locates position of trachea & apex beat
Palpates for chest tenderness
Palpates for chest expansion
Examines for tactile fremitus (if appropriate for age)

5 Percussion (3)
Percusses all the appropriate areas on the chest
Comments on the percussion note
Compares L versus R as s/he percusses
6 Auscultation (5)
Places the stethoscope on all appropriate areas on
chest
Comments on air entry
Comments on nature of breath sounds
Comments on presence/absence of added sounds
Examines for vocal fremitus/ resonance
7 Technique (2)
Is systematic
Uses appropriate technique
8 Summary (1)
Summarize the relevant findings
10 Diagnosis (3)
Most likely diagnoses & reasons
Differential diagnoses & reasons

11 Investigations (3)
Investigations 1 & reasons
KAMPALA INTERNATIONAL UNIVERSITY – WESTERN CAMPUS

DEPARTMENT OF PAEDIATRICS AND CHILD HEALTH

CLINICAL EXAMINATION GUIDE

CARDIOVSCULAR SYSTEM

Serial Skill Done Not Not

no well done done
well
1 Creates rapport with the patient (1)
Greets mother, introduces self, explains purpose of the
examination, asks for permission to examine the patient,
positions and exposes the patient appropriately
2 General examination relevant to CVS (5.5)
Comments on general condition (sick, wasted etc)
Carries out a quick general exam
– fever, anaemia,
- jaundice, cyanosis ,
-lymphadenopathy,
-digital clubbing
-capillary refill
-splinter haemorrhages
-osler’s nodes
-oedema
-Joint swelling
3 Pulse (5)
Counts rate for a full minute
Describes the volume (thin, weak, full volume, large
volume)/ if large volume checks for collapsing
Describes character (regular, irregular…)
Checks for other pulses & describes synchronicity
Checks for radial-femoral delay
4 Blood pressure (3)/ Intention to do so in appropriate
patient
Uses appropriate calf
Appropriate technique
Correct interpretation
5 Jugular venous pressure (4)/ Intention to do so in
appropriate patient
Correctly positions the patient at 45oC
Identifies the internal jugular vein
Correctly measures the JVP
Comments on JVP (raised, not raised, engorged neck
veins)

6 Precordium (6)
Inspects & comments on the activity of the
precordium
Localizes the apex beat
Describes the apex beat (heaving, tapping, diffuse etc)
Palpates for the other relevant areas (Tricuspid, Pul &
aorta, carotids)
Palpates for heaves (apical heave, left parasternal
heave)
Palpates for thrills in all relevant areas
7 Auscultation (3)
Places the stethoscope and listens in all auscultatory
areas
Comments on heart sounds I & II and any added
sounds (in appropriate areas)
Comments on presence or absence of murmurs

8 Other relevant examination (4)

Palpates and localizes the liver
Assess whether the liver is tender
Auscultates lung bases
Describes findings in the lung bases
9 Summarizes significant findings (2)

10 Technique (2)
Is systematic
Uses appropriate technique
11 Does the child have a normal CVS? (1)
Appropriate answer
12 List reasons to support your answer (3)
Reasons
KAMPALA INTERNATIONAL UNIVERSITY – WESTERN CAMPUS

DEPARTMENT OF PAEDIATRICS AND CHILD HEALTH

CLINICAL EXAMINATION GUIDE

NUTRITIONAL ASSESSMENT

Seria Skill Done Not done Not

l no well well done
1 Creates rapport with the patient (1)
Greets mother, introduces self, explains purpose of
the examination, asks for permission to examine the
patient, positions and exposes the patient
appropriately
2 General examination relevant to nutrition (11)
Comments on general condition (sick, wasted)
Takes temperature
Assesses for pallor, jaundice
Examines eyes for vit A deficiency
Examines L/nodes
Examines mouth & mucous membranes & comments
on the tongue
Examines the skin for skin lesions
, Comments on hair changes
Signs of dehydration
Looks for oedema
3 Nutritional assessment (4)
Examines muscle bulk of large muscles
Examines for evidence of wasting – skin thickness
Looks for baggy pants sign, bony prominences,
Looks for signs of vit D deficiency (Rachitic rosary,
wide wrists)
4 Anthropometric measurements (5)
Measures MUAC (and correct interpretation)
Measures weight (and correct interpretation)
Measures height/ length (and correct interpretation)
Determines WHZ score using growth charts &
interpretation
 Determines HAZ score using growth charts &
interpretation
Determines WAZ score using growth charts &
interpretation
5 Summarize the relevant clinical signs (3)
Problem 1
Problem 2
Problem 3
Diagnosis
6 What is the nutritional diagnosis? 2
Correct diagnosis
7 Treatment plan (3)
Dietary treatment, specify which one
Treatment of complications
KAMPALA INTERNATIONAL UNIVERSITY – WESTERN CAMPUS

DEPARTMENT OF PAEDIATRICS AND CHILD HEALTH

CLINICAL EXAMINATION GUIDE

CENTRAL NERVOUS SYSTEM: MOTOR EXAMINATION

Seria Skill Done Not done Not

l no well well done
1 Creates rapport with the patient (1)
Greets mother, introduces self, explains purpose of
the examination, asks for permission to examine the
patient, positions and exposes the patient
appropriately
2 General examination relevant to CNS (2)
Comments on general condition (sick, wasted, alert,
posture, abnormal movements, etc)
3 Inspection of the limbs (3)
Inspects the lower limbs – symmetrical
Describes the posture of the lower limbs
Comments on presence/ absence of abnormal
movements
4 Palpation (5)
Assesses muscle bulk
Correct technique for muscle bulk
Assesses power in both limbs
Uses correct technique
Correctly states the power in both limbs

5 Assessment of tone (3)

Assesses tone of the small joints
Assesses tone of the large joints
Correctly states the tone in the joints
6 Assessment of reflexes (4)
Performs the knee jerk- compares both sides
Performs the ankle jerk- compares both sides
Correctly states reflexes in the limbs
Examines for superficial reflex (Babinsky)
7 Assesses coordination (2)/ If appropriate for age
Assesses coordination in both limbs if possible (heel to
sheen test)
Appropriate technique
8 Assesses gait (2)
Assesses gait if possible (mentions the intention)
Correct assessment
9 Summarizes the findings (2)
Summarizes significant positive findings
10 Does the child have a motor deficit? (4)
Gives an appropriate answer
Reasons to support the answer
KAMPALA INTERNATIONAL UNIVERSITY – WESTERN CAMPUS

DEPARTMENT OF PAEDIATRICS AND CHILD HEALTH

CLINICAL EXAMINATION GUIDE

CENTRAL NERVOUS SYSTEM: CRANIAL NERVES

Seria Skill Done Not done Not

l no well well done
1 Creates rapport with the patient (1)
Establishes rapport and makes the patient
comfortable
2 General examination relevant to CNS (2)
Comments on general condition (sick, wasted, alert,
posture, abnormal movements, etc)
3 Olfactory nerve (1)
Tests for sense of smell using a test substance
4 Optic nerve 3
Examines visual fields
Examines visual acuity
Correct interpretation
4 Oculomotor (3)
Examines for appropriate eye movements
Correct interpretation
Examines the pupils for pupillary reflex
5 Trochlear nerve (2)
Examines for appropriate eye movements
Correct interpretation
6 Trigeminal nerve (3)
Assesses sensory function
Assesses motor function
Assesses corneal reflex and jaw reflex
7 Abducent nerve (2)
Assesses appropriate eye movements
Correct interpretation
8 Facial nerve (3)
Examines muscles of facial expression
Comments on taste sensation of anterior 2/3
Correct interpretation
9 Vestibulocochlear nerve (2)
Assesses hearing
Doll’s eye manouvre
10 Glossopharyngeal nerve (2 marks)
Assesses gag reflex
Comments on taste sensation posterior 1/3 of tongue
11 Vagus nerve (1)
Asseses position of ovula by asking the patient to say
‘aaaaa’
12 Accessory nerve 1
Assesses functionality of muscles around the shoulder
13 Hypoglossal nerve (1)
Observe movement of tongue side by side (1)
14 Summarizes the findings (2)
Summarizes significant positive findings
15 Conclusion (does the child have a craniopathy?) 2
Correct answer
16 Explain the possible causes. 3
Explanations
KAMPALA INTERNATIONAL UNIVERSITY – WESTERN CAMPUS

DEPARTMENT OF PAEDIATRICS AND CHILD HEALTH

CLINICAL EXAMINATION MARKING GUIDE

CANDIDATES’S REG NO ------------------------------------------------------------------------------

STATION: Newborn assessment

Not
Done done Not
well well done
No Skill (1) (1/2) (0)
1 Creates rapport with the patient (1)

Greets mother, introduces self, explains purpose of the examination, asks for
permission to examine the patient, positions and exposes the patient appropriately
2 Comments on general condition of the patient (3)
1. Cry( normal, feeble, absent)
2. Color (cyanosis, pallor, cyanosis, rashes/petechiae, etc.)
3. Activity, Posturing, tone and movements (hemiparesis, opistothonos,
hypertonicity, myoclonus, etc)
3. Examines the head(4)
1. Fontanelles (size, bulge)
2. Sutures (split, overriding)
3. Shape (molding)
4. Birth trauma (cephalohematoma, caput succedaneum, forceps marks,)
4 Checks dysmorphic features(4)
1. Facial dysmorphic features (eye shape and position, philtrum, etc)
2. Ears: low set, deformity(Downs)
3.Mouths: cleft lip, cleft palate, micrognathia (Pierre Robin syndrome),
ankyloglossia
4. Distal extremities: number of digits, clinodactyly, palmar creases, clubfeet)
5 Examines the eyes(3)
1. Comments about Red reflex
2. Sub-conjunctival hemorrhages
3. Presence of discharge
6 Examines the neck and shoulders(2)
1. Neck evaluation (masses, abnormalities, range of motion)
2. Shoulders: checks if aligned, feels clavicles
7 Examines the lungs(4)
1. Respiratory rate,
2. work of breathing (retractions, nasal flaring, head bobbing, accessory
muscle use)
3. Auscultates anterior
3. Auscultates and posterior
8 Cardiovascular examination(5)
1 Heart rate
2Auscultates 4 points on chest
3. Auscultates back
4. Femoral pulses
5. Peripheral pulses
9 Abdomen examination(4)
1.Inspects for distension(obstruction), scaphoid abdomen(diaphragmatic
hernia)
2.Umbilical cord (bleeding, discharge)
3. Palpates for liver and spleen size and checks masses
4. Auscultation of abdomen
10 Genito urinary examination(3)
Male Female
1. Scrotum (testes present, 1. Hymen and labia (hymenal tags and
hydrocele, hernia) discharge)
2. Penis: size, location of meatus 2. Clitoris and urethra (clitoromegaly)

3. Anus: patency and location 3. Anus: patency and location

11 Extremities including hips (4)

1. Barlow and Ortolani: (done correctly)
2. Examines feet (clubfeet)
4. Palmar creases(Downs), extra digits, fused digits
4. Obvious deformities
12 Back and spine examination(2)
1. Sacral dimple or hair tuft
2. Scoliosis
13 Neurological examination(4)
1. Level of alertness
2. Tone
3. 4 newborn reflexes (rooting, sucking, Moro, grasp)
4. Moves 4 extremities
14 Skin examination(1)
 Vernix, Milia, Mongolian spots, Hemangiomas, Salmon patch, Café au lait
spot, Petichae or bruising
15. Summarizes the findings and gives conclusions (2)

1.Summary

2. Conclusions