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SECTION OF EDUCATION
OSCE MARK SCHEME
MODULE: CHILD AND FAMILY HEALTH WITH DERMATOLOGY
Station: Neonatal Examination
You are the FY2 on a busy postnatal ward. Baby Smith was born by uncomplicated spontaneous
vaginal delivery 6 hours ago. His APGAR scores and initial observations have been normal and he
has been feeding well. Please perform a neonatal examination on him to aid discharge.
Action
P
Introduction
Check baby details – Name, DOB, gestational age, type of delivery, birthweight
Washes hands
Introduces self to parents with name and grade
Explains purpose of examination and gains consent
Adequately exposes baby and ensures good lighting
Repositions if necessary
General – inspection, observation and listening
Ask parents – feeding, urinating, bowel movements, any concerns
Overall appearance of baby – general condition and activity, tone, drowsy, crying,
responsiveness, size, posture
Skin inspection – colour and texture, jaundice, rashes, birthmarks
Listen – note sound of cry, audible breath sounds, wheeze
Weigh baby and plot on growth chart
Head
Note head shape – any trauma from birth
Palpate fontanelles and sutures – presence, shape, consistency (bulging,
depressed)
Facial appearance and position of eyes, nose and mouth
Any asymmetry or deformities of head and facial features
Measure head circumference and plot on growth chart
Eyes
Shape and appearance
Check red reflex
Look for cataracts or signs of infection
Corneal opacity
© UCLU Medical Society 2013
BL
F
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SECTION OF EDUCATION
Ears
Check shape and size
Check level of setting – normal or ‘low-set’
Check patency of external auditory meatus
Mouth
Observe palate (use finger and torch) – colour of mucous membranes (cyanosis)
Check posteriorly - exclude posterior cleft lip and palate, submucous cleft, natal
teeth
Suckling reflex – insert clean little finger inside mouth
Upper limb
Assess proportions, symmetry, mobility and tone
Check neck, clavicles and shoulders for signs of traction birth injury
Inspect hand shape and size – count fingers (clinodactyly – incurving of fingers)
Inspect palmar creases – double or single
Check baby’s grip
Cardiovascular
Palpate position and feel for heaves/thrills
Auscultate heart sounds – rate (110-160), rhythm, added sounds
Peripheral pulses
Brachial, radial and femoral for rate, rhythm and volume
Check for radio-femoral delay
Respiratory
Inspect chest – deformities
Observe breathing effort - chest expansion, rate (30-60) and depth
Look for signs of resp. distress – intercostal recession, tracheal tug, stridor
Auscultate lung fields
Abdo
Observe abdominal girth and shape
Inspect umbilical stump for infection or hernia
Palpate abdomen for organomegaly, masses or hernia – liver, spleen, kidneys,
bladder
Genitalia and anus
Inspect external genitalia
Palpate testicles in boys (undescended)
© UCLU Medical Society 2013
uclumedicalsociety
SECTION OF EDUCATION
Inspect for vaginal prolapse in girls (small prolapse + discharge/blood is normal)
Inspect anus (ask parents if meconium has been passed) – check completeness
Back
Inspect spinal curvature/symmetry (spina bifida, pilonidal sinus)
Inspect skin over spine – check integrity
Palpate bony structures
Lower limb
Assess proportions, symmetry, mobility and tone – including skin folds
Check for dislocation of hip – Barlow and Ortolani manouvres
Watch movements at each joint
Check for talipes equinovarus
Count toes and check normal anatomy
CNS
Observe tone, behaviour, movements and posture
Elicit reflexes only if cause for concern – morrow, rooting, grasp, stepping
Finishing off
Record findings in postnatal care plan and personal child health record
Offer info on newborn screening tests (heel prick, repeat neonatal exam, hearing)
Investigate further any abnormalities
Global Score (for borderline candidates):
A – Clear Pass
B – Pass
C – Borderline
D – Fail
E – Clear fail
If you have any serious concerns about this candidate’s fitness to practice, please complete a separate
Report Form.
© UCLU Medical Society 2013