Urological

Question 1

What do you look for on general inspection?

Answer 1

Build
State of hydration
Oedema
Pain
Sallow complexion (uraemia)
Pallor (anaemia)
IV fluids, fistulae, catheter, dialysis

Question 2

What obs would you do?

Answer 2

Pulse
BP (dehydration, HTN)
RR (hyperventilation in metabolic acidosis)

Question 3

What do you look for on inspection of the abdomen / kidneys?

Answer 3

Large kidney / renal mass may be visible
Loin scars
Urostomy, nephrostomy, catheter for peritoneal dialysis

Question 4

What do you assess on palpation of the kidney?

Answer 4

supine
Renal angle = between lateral border of erector spinal and 12th rib
Causes of palpable kidneys = hydronephrosis, polycystic kidney disease, large cyst, carcinoma

Question 5

What do you assess on percussion of the kidney?

Answer 5

Anterior resonance due to presence of colon and small intestine

Question 6

What do you assess on auscultation of the kidney?

Answer 6

Auscultate the epigastrium, flank and costovertebral angle for bruits:

• AV fistula
• Renal artery stenosis
• Vascular tumour

Question 7

What do you assess from the back?

Answer 7

Palpate for renal angle tenderness:

• Acute pyelonephritis
• Renal abscess
• Acute hydronephrosis

Question 8

How do you assess the bladder?

Answer 8

Look for a midline mass in suprapubic area
Palpate SP area - urge to void with gentle pressure and elastic feel –> distended bladder
Palpate for a mass (ovarian cyst, uterine tumour, colonic tumour, pregnancy)
Percuss - distended –> dull, distended bowel loops –> tympanic

Question 9

What could cause a distended bladder?

Answer 9

Outlet obstruction - urethral valves, prostatic hypertrophy / carcinoma, urethral stricture
Decreased bladder tone - neurogenic bladder (spinal cord injury), detrusor failure (chronic retention)

Question 10

What else would you do? (end pieces)

Answer 10

Examine external genitalia
Examine for inguinal herniae
Rectal exam
Temperature
Urinalysis