GU examination

Question 1

Steps in hernia examination (Standing)

Answer 1

Ask about pain

Expose and inspect swelling whilst STANDING
Ask patient to cough

Now palpate and repeat the cough

Examine the scrotum (you can’t get above hernia but you can get above lumps)

Question 2

Examining hernia (lying down)

Answer 2

Ask patient to lie flat

identify pubic tubercle and relation to hernia

attempt to reduce (ask patient) and then apply pressure on deep ring (mid way between ASIS and pubic tubercle) a direct hernia will still bulge through abdo defect but not indirect hernia

Question 3

Inguinal Vs Femoral hernia position

Answer 3

inguinal hernias enter scrotum above and medial to tubercle

femoral hernias pass under the inguinal ligament entering below and lateral to pubic tubercle

Question 4

Direct Versus Indirect

Answer 4

Control through pressure on deep ring

Inferior epigastric is medial to indirect and lateral to direct hernia

Question 5

Key point in scrotal examination:

Answer 5

Is there a cough impulse?
Can you get above swelling?
Can testis and epididymis be identified separately?
Does the swelling transluminate?
Is the swelling tender?

Question 6

Ddx scrotal lumps

Answer 6

Testicle: tumours, torsion (pain), cysts

hydrocele (fluid filled, transluminates)

epididymal cyst (may transluminate)

Pampiform plexus (Varicocele)

Question 7

Urological history: Pain

Answer 7

SOCRATES

ureteric stone pain loin to groin & assoc with N&V

PKD assoc with intermittent pain due to cyst rupture

Question 8

LUTS

Answer 8

Filling
- urgency, frequency, nocturia

Voiding
- dysuria, hesitancy, poor flow, incomplete empty, straining

Incontinence
- stress, urge, overflow, continuous

Question 9

Haematuria Hx

Answer 9

Duration of symptoms

Timing within stream (initial, continuous, terminal)

Presence of clots

Pain (infection/calculus if painful, painless suggests Ca Kidney/Bladder/Prostate)

Fever & rigors

Trauma / Exercise

Question 10

UTI symptoms

Answer 10

Dysuria
Frequency
Urgency
Fever
Acute confusion (esp elderly)

Question 11

CKD / renal failure symptoms

Answer 11

Oliguria
Nocturia
Polyuria (increased volume of urine production secondary to the urea solute load) Anorexia
Insomnia
Metallic taste in the mouth
Vomiting
Anaemia (due to erythropoietin deficiency)
Fatigue
Pruritis
Oedema
Bruising and bleeding due to abnormal platelet function
Sallow complexion (yellow-grey tinge)
Uraemic fetor

Question 12

Completing Urological HPC

Answer 12

Past episodes (UTI, calculi etc) onset and duration

Sexual hx (STIs etc)

Obstetric history

Diabetes?

Question 13

Drug Hx

Answer 13

Rifampicin can affect colour of urine

Allergies: esp iodine which is used for contrast

Question 14

SH

Answer 14

Smoking
Alcohol
Travel
Occupation (rubber and dye industry may give renal/bladder Ca)

Eat beetroot?

Question 15

FH

Answer 15

all relevant FH

Focus also on urological conditions (CKD, PKD etc)