CLIN GENURI Exam - Week 7 Flashcards
GENURI Systems Review Qs
- Urine appearance
o Have you noticed any changes to the appearance of your urine? Blood in the urine ? Change in colour ? Frothy appearance? Offensive smell? - Urine volume/stream & frequency
o Have you noticed any changes in urine volume or stream?
Nocturia - Do you have to get up at night to pass urine?
Polyuria - Have you been passing abnormally large amounts of urine? Do you have to pass more than 2L/day?
Anuria - Have you been unable to pass any urine or have you passed between 0-50ml/day?
Oligouria - Have you been passing <400ml of urine/day ?
- Pain
o Have you experienced any pain?
Loin pain - Do you have any lower back pain?
Renal colic - Do you have any pain in your back, side or flanks which radiates to your groin and comes and goes in waves?
Dysuria - Do you experience pain/burning when urinating?
- Urination character
o Have you noticed any changes to your control or how it feels when urinating?
Retention
Hesitancy
Pis-en-deux - Do you feel like you have not completely emptied your bladder after urinating? Do you feel like you have to urinate very soon after initially trying to empty your bladder?
Dribbling
Incontinence
Urgency - Fever/chills
o Do you have a fever? Have you had a fever? - Chronic kidney disease - oligouria, nocturia, polyuria, dyspnoea, oedema, anorexia, fatigue, pruritis, bruising, hiccups, vomiting?
o Have you been passing <400ml of urine/day? Do you have to get up at night to pass urine? Have you been passing more urine than normal? Breathlessness? Have you noticed any swelling? Have you noticed any loss of appetite? Fatigue? Itch? Vomiting? Bruising? Hiccups all the time?
Haematuria.
Blood in the urine.
PPMHx of gout, diabetes mellitus may increase the risk of
Renal complications (e.g., kidney stones).
FHx of deafness, renal failure may indicate
Alport’s syndrome.
FHx of any form of kidney disease places pts at increased risk of what renal condition
CKD.
MHx of analgesic abuse may increase the risk of
Renal failure.
MHx of high NSAID use may place pts at risk of what
Worsened renal failure or CKD.
MHx of Bex/Vincent’s powders may increase the risk of
Analgesic nephropathy -> urothelial malignancy.
MHx of smoking, alcohol consumption, toxin exposure may increase pt’s risk of developing
Bladder cancer.
GENURI Exam GI
a. Pain/discomfort
b. Hyperventilation
c. Hiccups
d. ‘Fishy’ smell
e. Ketone-like smell
f. Sallow complexion
g. Pallor - Anaemia/jaundice
h. Hydration status
i. Hearing aids
13. Vital signs
14. Mental state
GENURI Exam Skin
a. Look
i. Skin pigmentation
ii. Uraemic frost
iii. Vasculitis
iv. Subcutaneous nodules
GENRUI Exam Hands, Wrists
- Palmar creases
a. Look
i. Erythema
ii. Pale creases - Hands
a. Look
i. Hepatic flap /asterixis - Wrists
a. Palpate
i. Phalen’s Test.
GENURI Exam Arms
a. Look
i. Bruising
ii. Scratch marks /excoriations
iii. AV Fistula
b. Palpate
i. Thrill.
GENURI Exam Eyes
a. Look
i. Sclera
ii. Conjuctiva
iii. Band keratopathy
iv. Fundus.
GENURI Exam Mouth
a. Look
i. Breath
ii. Gingival hyperplasia
iii. Thrush
iv. Mouth ulcers.
GENURI Exam Neck & Chest
- Neck
a. Look
i. JVP
b. Auscultate
i. Carotid artery - Bruits
- Chest
a. Examine
i. Heart
ii. Lungs.
GENURI Exam Abdomen
a. Inspection
i. Symmetry
ii. Scars
iii. Tenckhoff catheter/peritoneal dialysis catheter
iv. Distension
v. Scrotal masses
vi. Genital oedema
b. Palpation (light -> deep pressure) – over 9 regions
Ensure that you perform this part of the examination whilst looking at the pt’s face.
i. Ask pt to point to any area that is tender & leave this region until last to examine
ii. Reassure pt & have warm hands
iii. Observe for:
1. Areas of guarding/rigidity
2. Cross tenderness
3. Rebound tenderness
4. Pain on coughing
iv. Comment on presence/absence of above
c. Palpate
i. Kidneys (normally, not palpable/felt on balloting )
1. Curl one hand under pts and firmly grip posterior ribs
2. Apply pressure directly above other hand on ant abdo wall
3. Ask pt to inspire and make flapping motion w posterior hand
ii. Bladder
iii. AAA
d. Palpate
i. Liver
ii. Spleen
e. Percussion
i. Abdomen
ii. Liver
iii. Spleen
iv. Bladder
1. From umbilicus -> pubic symphysis
v. Ascites
1. If region of the abdomen is dull on percussion, test for:
a. Roll pt & wait 30sec
b. Repercuss to check whether percussion is more resonant &
c. Assess for fluid thrill
i. Ask pt to place hand perpendicular along midline @ umbilicus level
ii. Place L hand on L side of pt’s hand and apply light pressure
iii. Flick ant abdo wall on R side of pt’s hand
f. Auscultation
i. Bruits
1. Aortic
2. Renal
a. Listen 2-2.5cm above & lateral from umbilicus.
GENURI Exam Back
a. Look
i. Sacral oedema
b. Palpate
i. Vertebral column
ii. Murphy’s kidney punch @ renal angle
1. Strike pt in renal angle w clenched fist.
GENURI Exam Legs
a. Look
i. Oedema
ii. Purpura
iii. Livedo reticularis
iv. Pigmentation
v. Scratch marks
vi. Peripheral vascular disease
vii. Peripheral neuropathy
viii. Gouty tophi.
If urine changes colour upon standing, then this may indicate
Porphyria.
Foamy, tea-colored or brown urine may indicate
Nephrosis or kidney failure.
Frothy urine may indicate
Protein presence.
Normal urination frequency.
3-4 times/24.
Nocturia may indicate
Inability of the kidneys to concentration urine normally - CKD, benign prostate hypertrophy, pregnancy.