Basic Clinical Skills and Patient Assessment
This domain tests structured history-taking, correct measurement technique, triage and recognition of danger signs - the skills used at every Health and Wellness Centre visit.
Structured assessment
- History: presenting complaint with duration and character, associated symptoms, treatment already taken, past history, pregnancy or menstrual history, immunisation, family and social history.
- Use ABCDE for the sick patient, and triage before queue order: a convulsing child or a bleeding woman is seen first.
- GCS = eye (1–4) + verbal (1–5) + motor (1–6); maximum 15, and 8 or below needs airway protection.
Normal values to memorise
- Adult: pulse 60–100/min, respiratory rate 12–20/min, BP ideally under 120/80 mmHg, temperature 36.5–37.5 °C, SpO₂ 95% or above.
- IMNCI fast-breathing thresholds: under 2 months ≥60/min; 2–11 months ≥50/min; 12–59 months ≥40/min.
Worked example
A 24-month-old with cough has no chest indrawing, no stridor at rest, no danger signs, and a respiratory rate of 52/min counted over a full minute while calm. Because the child falls in the 12–59-month band, the threshold is 40/min. 52 exceeds it, so the classification is pneumonia, managed with oral amoxicillin at home - not "no pneumonia", and not severe pneumonia, because there is no indrawing or danger sign.
Traps
- Counting respiratory rate for 15 seconds and multiplying; count a full minute in a calm child.
- Wrong cuff size or an unsupported arm giving falsely high blood pressure.
- Missing IMNCI danger signs: unable to feed, convulsions, lethargy or unconsciousness, vomiting everything, stridor at rest, severe dehydration.
- Recording only one temperature site value without noting the site when it matters.