Urogenital: Examination (M)
- Environment, general appearance
- Hands, arms, face,
neck, chest
- Abdomen, back, legs
- Urine
- Penis
- Scrotum: insp,
palp, translucency
- Spermatic cord
- Dialysis tubes in flesh.
- Dialysis bags.
- Catheter.
- Hydration level: under (ARF).
- Skin pigmentation (kidney excretion problems).
- Hyperventilation (acidosis).
- Hiccupping (uremia).
- Twitching, spasms (hypocalcemia, N2 retention).
- Nails: leuconychia [white transverse bands], Muehrcke's nails [white
paired lines near fingernail tip] (nephrotic syndrome's hypoalbuminemia).
- Nails: others (do later).
- Palmar creases: pallor (anemia).
- Wrists: shunts from prior dialysis.
- Scratch marks (2° hyperparathyroid).
- Uremic frost [white powder on skin] (chronic renal failure).
- Peripheral neuropathy (chronic renal failure 2° to diabetes).
- Bone tenderness (low vit D).
- Blood pressure (HTN 2° to chronic renal failure).
- Postural hypotension if applicable (ARF).
- Eyes: jaundice, anemia.
- Eyes: fundi (diabetes). See Fundi
Examination.
- Mouth: fetor.
- Mouth: ulcers, infections.
- Face: rash (SLE, systemic sclerosis).
- Heart: CHF.
- Heart: hypertension.
- Heart pericarditis.
- Lung: pulmonary edema.
- Scars: nephrectomy [may need to roll pt. on side], kidney transplant.
- Distension (APKD/ Wilm's tumor [young], nephrotic syndrome, ascities,
dialysis).
- Palpate kidneys.
- Palpate enlarged bladder.
- Palpate hepatomegaly, splenomegaly (APKD).
- Palpate AAA, so can DDx from renal stenosis on auscultation.
- Assess ascites. See Ascites.
- Percuss enlarged bladder.
- Auscultate renal bruit: above umbilicus 2cm lateral to midline, then in
flanks (renal artery stenosis).
- Ask if tenderness in back.
- Sacral edema (CHF, nephrotic syndrome).
- Gently strike base of spine with fist for tenderness (renal osteomalacia,
2° hyperparathyroidism).
- Gently do Murphy's kidney punch in renal angle for tenderness (kidney
infection).
- Edema.
- Peripheral vascular dz (chronic renal failure 2° to diabetes).
- Injured toes from diabetes (chronic renal failure 2° to diabetes).
- Purpura.
- Toes: tophi (gout).
- Gloves on.
- Retract foreskin if indicated.
- Rashes, ulcerations, swellings, lesions, warts.
- Urethral meatus:
• Meatus is patent
• Meatus is in normal location.
• No extra openings (hypospadias).
- Look for discharge:
• Bloody.
• Purulent.
• Smegma [cheese-like substance] under foreskin.
- If discharge, compress penis to excrete some into jar for analysis.
- Tell pt. to cough (stress incontinence).
- Pt. standing up.
- Asymmetry is normal: L lower than R.
- Note size (mumps), position.
- Rashes, ulcerations, swellings, lesions.
- Look for discharge:
• Bloody.
• Purulent.
- Tell pt. to cough (stress incontinence).
- Similar size, consistency for R and L.
- Smoothness, firmness.
- Absent testicle causes:
• Undescended [look in inguinal canal].
• Surgical removal.
- Masses. See Testicular Masses
Reference.
- If mass palpated, Dr tries to get above it. If unable, likely an inguinal
hernia.
- Perform if a mass was palpated.
- Turn off lights.
- Hold light up to posterior of swelling, and test for translucency:
• Opaque: solid mass.
• Translucent: cystic.
- Examine whether separate from the testis.
- See Testicular Masses Reference.
- Palpate from epididymis to superficial inguinal ring.
- Locate both R and L ductus deferens within scrotum.