This document contains a marking key for a clinical methods and skills exam consisting of two sections - Section A with short answer questions and Section B of true/false statements. Section A covers topics like components of history taking, calculating pack-years smoked, measuring vital signs, and demonstrating skills like blood pressure measurement. Section B evaluates understanding of clinical conditions and procedures. The marking key provides the answers or ranges of acceptable answers for each question to guide exam scoring.

1. UNIVERSITY OF ZAMBIA
SCHOOL OF MEDICINE
DEPARTMENT OF MEDICAL EDUCATION
CLINICAL METHOD AND SKILLS
DME 4115
CONTINUOS ASSESSMENT-THEORY TEST 1 – MARKING KEY
DURATION: 2 HOURS
COMPUTER NUMBER: _____________________________
SKILLS GROUP: ___________________________________
INSTRUCTIONS
1. There are 2 sections in this paper. Answer all the questions in the question paper itself.
2. There is no negative marking in Section A, however marks will be deducted for illegible
handwriting and incorrect spellings. Section B has -1/2 mark for wrong answer.
3. All UNZA Examination rules apply.

2. SECTION A – SHORT NOTES
MAXIMUM TOTAL – 132 MARKS
1. List 10 components of history taking [10 marks]
DEMOGRAPHICS [1 mark]
CHIEF COMPLAINT [1 mark]
HISTORY OF PRESENTING COMPLAINT [1 mark]
REVIEW OF SYSTEMS [1 mark]
PAST MEDICAL HISTORY [1 mark]
PAST SURGICAL HISTORY [1 mark]
DRUG HISTORY [1 mark]
FAMILY HISTORY [1 mark]
SOCIOECONOMIC HISTORY [1 mark]
SUMMARY [1 mark]
2. What does the term RVD-R and RVD-NR stand for? [2 marks]
RETROVIRAL DISEASE REACTIVE [1 mark]
RETROVIRAL DISEASE NON REACTIVE [1 mark]
3. List the disease components abbreviated in the term DEATHS. [3 marks]
DIABETES MELLITUS [1/2 marks]
EPILEPSY [1/2 marks]
ASTHMA [1/2 marks]
TUBERCULOSIS [1/2 marks]
HYPERTENSION/ HIV [1/2 marks]
SICKLE CELL DISEASE [1/2 marks]
4. A patient tells you they are HIV positive. List 4 questions you will ask this patient about
his HIV status. [4 marks]
 WHEN DIAGNOSED?
 WHERE AND HOW DIAGNOSED?
 ON TREATMENT? WHICH TREATMENT?
 LAST VIRAL LOAD?
 LAST CD4+ COUNT?

3. **pick any 4 out of the following and award 1 mark for each. If answer provided is
not as above, judge whether sensible or not and award maximum ½ marks.
5. A patient tells you they have been smoking an average of 15 cigarettes per day for the
past 12 years.
Calculate the number pack-years smoked by this patient. [3 marks]
Formula – No. of packs smoked per day x No. of years smoked
(No. cigarretes smoked per day / 20) x No, years smoked [1 mark]
= 15/20 * 12 [1 mark]
= 9 PACK-YEARS [1 mark]
Are these significantly harmful to the patient’s health (yes/no)? [1 mark]
YES [1 mark]
6. List the four (4) characters of a pulse [4 marks]
RATE, RHYTHM, VOLUME AND SYNCHRONICITY [4 MARKS]
7. You receive a patient that you suspect is obese. Your consultant doctor asks you to
calculate his BMI.
What is BMI? [1 mark]
BODY MASS INDEX [1 MARK]
How do you calculate it? And what are its units. [5 marks]
WEIGHT (KG)/HEIGHT (M2) [2.5 marks]
UNITS – KG/ M2 [2.5 marks]
What range of BMI values would qualify this patient being obese? [2 marks]
>/= 30 KG/M2 [2 marks]

4. 8. Name the instrument [1 mark]. Label it’s different parts [4 marks]
Name of instrument –
ANEROID [1 mark] SPHYGMOMANOMETER [1 mark]
Labels;
A – BULB/ INFLATION BULB [1 mark]
B – CUFF [1 mark]
C – GAUGE/ MANOMETER GAUGE/ DIAL [1 mark]
D – BLADDER/ INFLATABLE BLADDER [1 mark]
9. How do you determine right cuff size for checking blood pressure? (2 marks)
 WIDTH OF THE INFLATABLE BLADDER SHOULD BE 40% OF THE
CIRCUMFERENCE OF THE UPPER ARM.
 LENGTH OF THE INFLATABLE BLADDER SHOULD BE 80% OF UPPER ARM
CIRCUMFERENCE.
OR MID UPPER ARM CIRCUMFERENCE COINCIDES WITH LABEL ON
SPHYGMOMANOMETER.

5. 10. When measuring Blood Pressure, the pressure at which the radial pulse disappears is
important. Give 2 reasons why it is important. [2 MARKS]
 TO PREVENT DISCOMFORT BY EXCESS INFLATION.
 TO PREVENT ERRORS CAUSED BY THE ASCULTATORY GAP.
11. Fill the spaces in the table below. [4 marks]
 AXILLARY TEMPERATURE ACCEPT ANY RANGE OF AT LEAST 1°C
BETWEEN 35°C TO 37.5°C.
 NORMAL PULSE RATE 60-100 BEATS PER MINUTE.
 OPTIMAL BLOOD PRESSURE IS <120MMHG SYSTOLIC AND < 80MMHG
DIASTOLIC.
 NORMAL RESPIRATORY RATE IS 12-20 BREATHES PER MINUTE.
**accept slight variation.
**1 mark for each correct range
**do not give marks if units are not clearly indicated
12. List the sites for intra-muscular injection [3 marks].
DELTOID REGION [1 mark]
LATERAL THIGH [1 mark]
UPPER – OUTER QUADRANT OF BUTTOCK [1 mark]
13. Explain the 7 rights of injection [7 marks]
 RIGHT PATIENT
 RIGHT TIME
 RIGHT DRUG/VACCINE
 RIGHT DOSAGE
 RIGHT ROUTE/NEEDLE/TECHNIQUE
 RIGHT SITE
 RIGHT DOCUMENTATION
**1 mark each

6. 14. How do you get a clean catch urine? Explain. [2 marks]
 ADEQUATE CLEANING OF GENITALIA [1 mark]
 OBTAIN MID – STREAM URINE [1 mark]
15. List any 2 causes of glucose in urine? [2 marks]
 DIABETES [1/2 mark] MELLTIUS [1/2 mark]
 PREGNANCY [1 mark]
 DRUGS [1 mark]
 RENAL TUBULAR DISORDERS [1 mark]
** If answer not indicated above, consult medical literature to check if correct
16. i. What is the normal Capillary Refill Time? [1 mark]
< 2 SECONDS [1 mark]
ii. List 5 signs that may be observed on a patient’s hand with ANY cardiac underlying
conditions. [5 marks]
** accept any of the above, 1 mark each
** if not above, consult medical literature to check if correct and award mark accordingly.
17. You are doing a cardiac examination on a patient, and you elicit grade 3 finger clubbing.
 What sign indicates grade 3 of finger clubbing? [1 mark]
ACCENTUATED CONVEXITY/CURVATURE OF NAIL
 Mention any 3 congenital heart diseases that can cause finger clubbing. [3 marks]
** accept any of the above, 1 mark each
** if not above, consult medical literature to check if correct and award mark accordingly.

7. 18. What is the normal Jugular Venous Pressure from the right atrium? (in cm) [1 mark]
LESS THAN 8/9CM
19. Define an apex beat. What is the normal location of the of the apex beat? [2 marks]
DEFINITION – LOWER-MOST AND OUT-MOST P.M.I OF CARDIAC IMPULSE [1
mark]
**accept similar logical answers
NORMAL LOCATION – 5TH
ICS, LEFT MID CLAVICULARLINE [1 mark]
20. State the sites at which the following areas are best auscultated (e.g. 6th
intercostal space,
mid clavicular line): [4 marks]
 Aortic – 2ND
ICS, RIGHT PARASTERNAL
 Pulmonic -2ND
ICS, LEFT PARASTERNAL
 Mitral – 5TH
ICS, LEFT MID CLAVICULAR LINE
 Tricuspid – 4TH
ICS, LEFT PARASTERNAL
17. List 5 signs of respiratory distress [5 marks]
INCREASED RR, NASAL FLARING, INTERCOSTAL AND SUBCOSTAL
RECESSIONS, USE OF ACCESSORY MUSCLES, GRUNTING RESPIRATIONS,
DIAPHORESIS
** accept any of the above, 1 mark each
** if not above, consult medical literature to check if correct and award mark accordingly
18. What are the signs of Horner’s syndrome? [3 marks]
 MIOSIS [1 mark]
 PARTIAL PTOSIS [1 mark]
 ANIHYDROSIS [1 mark]
19. What are the landmarks for the McBurney’s point? [4 marks]
2/3 FROM UMBILICUS [2 marks]
1/3 FROM ASIS [2 marks]
20. What is the order of examination of the abdomen? [4 marks]
INSPECTION>PALPATION>PERCUSSION>AUSCULTATION [4 MARKS]

8. 21. Study the diagram below and answer the questions that follow;
(i) In which region the spleen is located? [1 mark]
LEFT HYPOCHONDRIUM
(ii) Which region is the site for the Rovsing sign test? [1 mark]
LEFT ILIAC FOSSA
What is Basic Life Support? [1 mark]
THE IMMEDIATE, LIFE SAVING MEDICAL AID (INCLUDING CARDIO –
PULMONARY RESCUSCITATION) GIVEN TO AN INDIVIDUAL, WITH USE
OF NO OR MINIMAL MEDICAL EQUIPMENT/DRUGS AND LARGELY
THE SKILLS OF THE RESCUSCITATOR
22. Mention any 2 factors that improve the effectiveness of Basic Life Support? [2 marks]
EARLY RECOGNITION
EARLY INITIATION
MINIMAL BREAKS
COORDINATED ACTION/ TEAM WORK
EFFECTIVE CHEST COMPRESSIONS (DEPTH/RATE/TECHNIQUE)
** accept any of the above, 1 mark each
** if not above, consult medical literature to check if correct and award mark accordingly

9. 23. In resuscitation, what is the ratio of compressions to breaths in adults and neonates?
[2marks].
Adult – 30 COMPRESSIONS: 2 BREATHS [1 mark]
Neonates – 3 COMPRESSIONS: 1 BREATH [1 mark]
24. From superficial to deep, List the 10 Layers penetrated by a spinal needle during a
lumbar puncture. (5 marks)
SKIN,
SUBCUTANEOUS TISSUE,
SUPRASPINOUS LIGAMENT,
INTERSPINOUS LIGAMENT,
LIGAMENTUM FLAVUM,
EPIDURAL SPACE
DURA MATER,
SUB-DURAL SPACE
ARACHNOID MATER
SUBARACHNOID SPACE
**1/2 mark each
**subtract 1 mark for incorrect order
25. What is the instrument below called and what is it used for? [2 marks]
Name – 3 – WAY STOP COCK [1 mark]
Use – ATTACHMENT OF MANOMETER TO MEASURE CSF PRESSURE [1 mark]

10. 26. Mention 3 methods of confirming correct placement of a naso-gastric tube insertion [3
marks]
MEASUREMENT OF NG ASPIRATE PH USING PH INDICATOR PAPER
CHEST X-RAY
AUSCULTATION OF AIR INSUFFLATED THROUGH THE FEEDING TUBE
COLORIMETRIC CAPNOGRAPHY
MANOMETRY
** accept any of the above, 1 mark each
** if not above, consult medical literature to check if correct and award mark accordingly
27. The following patient was suspeted to have meningitis. What sign is being ilicitated
below? [2 marks]
 KERNIGS SIGN
28. What does the term OTPP stand for? [2 marks]
ORIENTED TO TIME PLACE PERSON
29. List the 12 cranial nerves, in their order. [6 marks]
**1/2 mark each
**subtract 2 marks for incorrect order

11. 30. What do the letters APGAR stand for? [5 marks]
A-APPEARANCE/ACTIVITY
P-PULSE
G-GRIMACE
A-ACTIVITY/APPEARANCE
R-RESPIRATION [5 MARKS]
31. What do the letters GCS stand for? [1 mark]
GLASGOW COMA SCALE
Name the 3 parameters assessed in GCS. [3 marks]
MOTOR
VISION
VERBAL
Give its highest and lowest possible scores. [1 mark]
LOWEST – 3/15 [1/2 mark]
HIGHEST – 15/15 [1/2 mark]
SECTION B – TRUE OR FALSE
MAXIMUM TOTAL – 10 MARKS
CLEARLY INDICATE EITHER TRUE OR FALSE AT THE END OF EACH STATEMENT.
DO NOT USE “T” OR “F.
Each statement carries 1 mark.
-1/2 mark for a wrong answer
1. Tuberculosis is considered as a familial disease F
2. Janeway lesions are tender, small erythematous macular/nodular lesions on the
palms/soles that are indicative of infective endocarditis. F
3. It is not safe to smoke 1 pack year T
4. A naso-gastric tube can safely be inserted in a patient that underwent nasal septoplasty
(surgical procedure to fix a deviated nasal septum). F
5. Blood tinged CSF is a sign of sub-arachnoid haemorrhage T

12. 6. Lung cancer can cause finger clubbing T
7. An intramuscular injection must be administered at 90◦ to the skin T
8. A chaperone is not required for a general exam on an opposite sex. F
9. The Alvarado score is for appendicitis T
10. The corneal reflex is a test for both CNVII and CNV. T