University of science & technology (UST) – Sudan – Omdurman

Internal Medicine Final Exam M.B.B.S Assessment sheet 2015.Exam.

Cardiovascular exam (12 minute)

Candidate name : .................................................................. ID : ........... Date................
Case diagnosis........................................................................

Examination system 0: Not done 1: Poor 2: Pass 3: Good 4: Excellent

Student mark
Task 0 1 2 3 4
Introduces yourself and asks for permission
Stand by right side of the patient and properly exposed the patient
1. General Inspection: general ill health, tachypnoeic
2. Pulse examination: rate rhythm, volume character (collapsing), synchrony,
radio-femoral delay, peripheral pulses vessel wall
3. Examination JVP/ Asks to check the Blood pressure
4. Correctness of Findings of Pulse and JVP examination
*Precordium examination:
5. Inspection: contour, pulsations, surgical scars, dilated veins, skin lesions-etc.
6. Palpation:
Apex heat. P2, A2, LPH, thrills
7. Auscultation: Using the bell (mitral area) then diaphragm (all areas) and in left
lateral & sitting positions. Comment on heart sounds. murmurs & added sounds
8. Correctness of findings of precordium Examination
9. Examination for anemia. cyanosis .evidence of infective endocarditis
- Examination for enlarged liver, pitting edema. Auscultate over the lung bases
Examiner – student interaction
10. Formulation clinical diagnosis: lesion (valvular…. etc.), possible aetiology,
Functional status rhythm, evidence of infective endocarditis
11. Suggest relevant investigation and management plan
Overall impression
Pass Borderline Fail

Comment: (please comment on performance, and conduct)

Observer................................................................................. Signature.........................
 University of science & technology (UST) – Sudan – Omdurman
Internal Medicine Final Exam M.B.B.S Assessment sheet 2015.Exam.

Chest exam (12 minute)

Candidate name : .................................................................. ID : ........... Date................
Case diagnosis........................................................................

Examination system 0: Not done 1: Poor 2: Pass 3: Good 4: Excellent

Student mark
Task 0 1 2 3 4
Introduces self to patient and asks for permission
Stands by the right side of the patient and properly expose the patient
1. Inspection: Chest contour (symmetry, deformity, skin lesions, sinuses, diluted
veins. *Respiration: rate, mode determines which side of the chest moves less,
cheek for sputum pot, chest lube/ others
2. Palpation: for Chest movement/expansion (Comparing both sides), palpate
trachea, locate cardiac apex, Examine for Tactile vocal fremitus
3. Correct now of finding of inspection and palpation
4. Percussion of anterior chest:
* proper technique/comparing both sides
5. Correctness of findings of Percussion
6. Auscultation:
For breath sounds, added sounds, Vocal refinance, whispering pectoralis
7. Correct of findings of Auscultation
8. further step of examination performing chest examination posteriorly
*General Examination for: anemia, cyanosis, lymph nodes, nail dubbin, nicotine
stain, and flapping tremor
Examiner – student interaction
9. Formulating clinical diagnosis:
Mention lung pathology, possible underling aetiology. functional status
10. Suggesting management plan including investigation and treatment
Overall impression
Pass Borderline Fail

Comment: (please comment on performance, and conduct)

Observer................................................................................. Signature.........................
 University of science & technology (UST) – Sudan – Omdurman
Internal Medicine Final Exam M.B.B.S Assessment sheet 2015.Exam.

Abdomen exam (12 minute)

Candidate name : .................................................................. ID : ........... Date................
Case diagnosis........................................................................

Examination system 0: Not done 1: Poor 2: Pass 3: Good 4: Excellent

Student mark
Task 0 1 2 3 4
Introduces self to patient and asks for permission
Stands by the right side of the patient and properly expose the patient
1. Inspection: (Contour, movement with breathing. umbilicus scar dilated veins.
direction of flow, hernial orifices, hair distribution etc.)
2. superficial palpitation (ask about area of pain, start at RIF moving anticlockwise)
check for: area of tenderness, and masses
3. Correction the finding of inspection and superficial palpitation
Deep palpitation/ ballottement in patient with ascites
4. Examine the spleen, confirming it (start from RIF, using edge of the palm)
5. Examine for the liver: determine (Size, surface, edge, consistency, tenderness)
*determine liver spam (tidal percussion)
6. Doing bimanual palpitation for Kidney, palpable for para aortic lymph node
 Ask to examine genital and ano-rectal
 Describe other palpable mass
7. Correction the finding of deep palpitation
8. Examine for ascites (percussion for shifting dullness /thrill)
9. Auscultation :
For bowel sound, venous hum, splenic/ hepatic rub, bruit
10. Correction the finding of percussion and auscultation
11. Perform general inspection for: anemia, jaundice, lymph node, other relevant
signs
*Check for: sign of chronic liver disease / Evidence of liver failure
Examiner – student interaction
12. Formulating clinical diagnosis:
Mention underlying pathology, possible aetiology, functional status
13. Suggesting management plan
Overall impression
Pass Borderline Fail

Comment: (please comment on performance, and conduct)

Observer................................................................................. Signature.........................
 University of science & technology (UST) – Sudan – Omdurman
Internal Medicine Final Exam M.B.B.S Assessment sheet 2015.Exam.

Neurology exam (12 minute)

Candidate name : .................................................................. ID : ........... Date................
Case diagnosis........................................................................

Examination system 0: Not done 1: Poor 2: Pass 3: Good 4: Excellent

Student mark
Task 0 1 2 3 4
Introduces self to patient and asks for permission
Stands by the right side of the patient and properly expose the patient
1. Inspection: {position, deformity, muscle bulk, fasciculation, abnormal
movement, skin change, indwelling catheter}
2. Tone examination: flexion, extension +/- rolling/ lifting
3. Power/ muscle strength: proximal/ distal muscle groups (grade 1-5)
4. Reflex: properly testing for
Tendon jerks/ examining for clonus, reinforcement as appreciate
5. Plantar response
6. correction of findings of reflexes
7. coordination: heel-shin test, finger-nose test
8. Sensation:
check for superficial & deep sensory modalities/ examine for sensory level
9. Doing further relevant examination (back, abdominal reflex, neck, cranial
nerves, limbs, gait, higher function)
Examiner – student interaction
10. Clinical problem identification :
Mono/ hemi/ para/ quadri/ plegi:paresis (U/ LMNL)
11. Identification site of lesion (brain, spinal cord, peripheral … etc.)
Suggest possible cause (differential diagnosis)
12. Suggesting management plan
Overall impression
Pass Borderline Fail

Comment: (please comment on performance, and conduct)

Observer................................................................................. Signature.........................
 University of science & technology (UST) – Sudan – Omdurman
Internal Medicine Final Exam M.B.B.S Assessment sheet 2015.Exam.

Locomotor/ endocrine/ skin (each 5minute)

Candidate name : .................................................................. ID : ........... Date................
Case diagnosis........................................................................

Examination system 0: Not done 1: Poor 2: Pass 3: Good 4: Excellent

Student mark
Task 0 1 2 3 4
Introduces self In patient and asks for permission
Thyroid case
Objective: examine this patient's neck and determine functional
status of his/ her thyroid
Technique: 1. General inspection
examine for characteristic faces, anxiety/irritability, somnolence...etc.
2. Neck: confirm goiter from anterior then examine from posterior, and properly
describe the thyroid swelling
3. Eyes: for exophthalmos, lid refraction, lid lag, ophthalmoplegia, chemosis,
periorbital edema, xanthelasma
4. Hands for: moisture (dryness), warmth, tremor, nail changes
5. Pulse for: tachy/ bradycardia, atrial fibrillation
6. Proximal muscle weakness/ abdominal reflexes
7. Skin for texture, vitiligo... pretibial myxoedema
8. Correctness of Findings with logical and proper interpretation
Examiner – student interaction
9. Diagnosis/ Functional status
Could give diagnosis determine functional status correctly
10. Management Plan: relevant investigations and treatment
Overall impression
Pass Borderline Fail

Comment: (please comment on performance, and conduct)

Observer................................................................................. Signature.........................
 University of science & technology (UST) – Sudan – Omdurman
Internal Medicine Final Exam M.B.B.S Assessment sheet 2015.Exam.

Locomotor/ endocrine/ skin (each 5minute)

Candidate name : .................................................................. ID : ........... Date................
Case diagnosis........................................................................

Examination system 0: Not done 1: Poor 2: Pass 3: Good 4: Excellent

Student mark
Task 0 1 2 3 4
Introduces self In patient and asks for permission
Locomotor case
Objective: examine this patient's with joint disease (Rheumatic arthritis, etc.)
Technique
1. Hand (examine dorsal and palmer aspect of the hand)
Look for nail change : pitting, onycholysis, splinter hemorrhage
2. Joint: *inspect for sign of inflammation, ulcer deviation, subluxation deformities,
muscle wasting
*Feel joint for: hotness, tenderness, effusion, crepitus (wrist… rtc.)
*Test for : movement of joint, carpal tunnel syndrome, (Tinel, phalen signs),
Determine functional status (hand grip, key grip, buttoning & unbuttoning,
opposition, writing … etc.)
3. Findings: could identified and describe abnormal physiological signs correctily
and give logical interpretation of the findings.
Examiner – student interaction
4. Mention relevant systemic abnormalities : eyes, lungs, CNS, … etc.
5. Diagnosis: could give appreciate diagnosis/ relevant differential diagnosis and
determine functional status, of affected joints
6. Investigation and treatment: mention appropriate investigation, and proper
management
Overall impression
Pass Borderline Fail

Comment: (p lease comment on performance, and conduct)

Observer................................................................................. Signature.........................