CLIN SKILLS: Renal Exam

Question 1

general structure of renal exam

Answer 1

• introduction
• general inspection
• hands, arms, face
• palpate spine
• abdominal palpation + percussion (supine)
• auscultation
• legs
• conclusion

Question 2

renal general inspection

Answer 2

• pain, hyperventilation (acidosis), hiccups, fishy smell, pallor (anaemia), jaundice, drowsiness/confusion, dehydration

Question 3

hands inspection (renal)

Answer 3

• leukonychia - white clusters/spots on nails
• pallor - palmar creases (anaemia)

Question 4

arms inspection (renal)

Answer 4

• bruising
• AV fistula (bulging artery in cubital fossa) - indicates dialysis
• scratch marks - indicates itch due to toxin buildup
• asterixis - hold hands up in stop sign for 30s

Question 5

face inspection (renal)

Answer 5

• jaundice
• conjunctival pallor (anaemia)
• mouth ulcers

Question 6

legs inspection (renal)

Answer 6

• pitting oedema and sacral oedema

Question 7

auscultation (renal)

Answer 7

• renal bruits = 2cm either side of umbilicus
• aortic bruits = 2cm above umbilicus
• push really hard

Question 8

general structure of what to palpate/percuss in renal

Answer 8

• light and deep palpation
• kidneys
• bladder (both)
• liver (both)
• spleen (both)
• ascites

Question 9

how to palpate liver

Answer 9

• MAY be normally palpable: place L hand on R costal margin and R hand in RLQ
• ask Pt to take deep breaths in and out
• as they breathe out, move R hand closer to ribs until you reach liver edge or costal margin
• may be palpable on inspiration with side of R index finger

Question 10

how to percuss liver

Answer 10

• percuss superiorly from iliac fossa (midclavicular line) until dull = inferior liver border
• percuss inferiorly from clavicle until dull = superior liver border

Question 11

how to palpate spleen

Answer 11

• normally not palpable
• place L hand over L costal margin
• place R hand below umbilicus
• move R hand closer to L hand as they breathe in and out
• spleen should move towards R iliac fossa on inspiration

Question 12

how to percuss spleen

Answer 12

• ask Pt to take deep breaths
• percuss lowest IC space in L anterior axillary line - should be resonant
• if dull or becomes dull on inspiration - splenomegaly

Question 13

how to palpate kidneys

Answer 13

• not usually palpable but sometimes lower pole of R kidney can be felt in very thin ppl
• palpate flank (lumbar region) using bimanual ballottement - trapping kidney between hands anteriorly and posteriorly.
• push REALLY hard down w/ top hand, get them to take deep breath in and flick up with bottom hand on their back

Question 14

how to palpate bladder

Answer 14

• not normally palpable if empty, and even if full may only be just palpable in the suprapubic region
• can be palpable if: full bladder, small children, obstructed urethra

Question 15

how to percuss bladder

Answer 15

• percuss down umbilicus to see if dull
• if resonant = urethra obstruction

Question 16

how to feel for ascites

Answer 16

• percuss from umbilicus to lumbar region on both sides - should be normally resonant.
• if dull = fluid (mark the point), then roll Pt towards the fluid side and stay for 30-60 secs
• dull area should now be resonant = shifting dullness = ascites