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.
Polyuria may indicate
Diabetes insipidus.
Anuria may indicate
Acute kidney injury (e.g., post MI).
Loin pain may indicate
Pylonephritis.
Renal colic may indicate
Kidney stone.
Dysuria may indicate
UTI.
Hyperventilation may indicate
Underlying metabolic acidosis due to renal failure.
Hiccups may indicate
Advanced uraemia.
‘Fishy’ smell/fetor may indicate
Advanced uraemia.
Keton-elike smell may indicate
UTI.
Sallow complexion may indicate
CKD.
What renal pathology causes anaemia/jaundice?
Reduced EPO production via diseased kidneys -> reduced no. Hb -> anaemia.
Hearing aids on general inspection may indicate
Alport’s syndrome.
Drowsiness or confusion on general inspection may indicate
Terminal renal failure, UTI, over-vigorous correction of acidosis.
What is leukonychia and what may it indicate?
Nail bed opacification -> only a rim of pink nail bed present at the top of the nail may indicate hypoalbuminaemia (this could be caused by chronic kidney disease).
What are Muehrcke’s lines and what may they indicate?
Paired white transverse lines @ end of nails may indicate hypoalbuminaemia (e.g., nephrotic syndrome).
What are Mee’s lines and what may they indicate?
Single transverse white band may indicate arsenic poisoning or renal failure.
1/2 1/2 discoloration of the nail beds may indicate
CKD.
Pale creases of the palm may indicate
Anaemia.
Hepatic flap/asterixis may indicate
Terminal CKD.
Why is Phalen’s test performed during a GENURI exam?
CTS may be caused via CKD.
What renal-associated pathology causes easy bruising and what may this indicate?
Due to platelet dysfunction caused by nitrogen retention. May indicate CKD.
Scratch marks may indicate
May indicate uraemic pruritis, hyperphosphataemia.
Yellow discoloration of the sclera may indicate and what renal-associated pathology may be the cause of this?
Jaundice (which may suggest retention of nitrogenous wastes).
Pale conjunctiva may indicate
Anaemia.
Band keratopathy may indicate
Ca2+ deposition beneath the corneal epithelium in line with the interpalpebral fissure - often due to secondary or tertiary hyperparathyroidism, or excessive replacement of Ca2+ in pts w CKD.
What is gingival hyperplasia and what may it indicate?
Thickening of the gums due to calcineurin inhibitors administered to transplant pts.
Carotid bruits may indicate
General atherosclerotic disease (which can cause renal artery disease or CKD).
What renal-associated pathology may cause distension and what may this indicate?
May indicate large polycystic kidneys or ascites (due to nephrotic syndrome or peritoneal dialysis fluid).
If both kidneys are palpable upon balloting, what may this indicate?
Polycystic kidney disease -> CKD.
Hepatomegaly/splenomegaly may indicate
Kidney disease which has developed to R sided heart failure to trigger organomegaly.
Bladder enlargement may indicate
Uterine mass, prostrate obstruction, pregnancy.
What is the normal resonance of percussion from umbilicus -> pubic symphysis?
Resonant.
Sacral oedema may indicate
Nephrotic syndrome or congestive cardiac failure.
Tenderness over the vertebral column upon palpation may indicate
Strike pt’s vertebral column gently with the base of your fist to elicit bony tenderness. This may be due to renal osteodystrophy from osteomalacia, secondary hyperparathyroidism, multiple myeloma. Back pain in the context of renal failure may indicate underlying paraproteinaemia.
Osteoporosis causing spinal fractures may be due to reduced Ca2+ deposition due to CKD.
Tenderness upon performing Murphy’s kidney punch may indicate
May elicit tenderness in pts w renal infection, pyelonephritis.
What is the appearance of livedo reticularis?
Red-blue reticular pattern from vasculitis or atheroembolic disease.
What 3 x urinalysis findings are most suggestive of a UTI?
Blood, leucocytes, nitrates.
