Urology E78

Question 1

General examination of urological pt involves?

Answer 1

Brief examination of cardiovascular, respiratory, GIT, nervous systems. MUST TAKE BP

Question 2

Abdominal inspection involves?

Answer 2

Start w/ UUT
Skin changes, bulging, bruising, trauma,
Building in upper abdomen suggestion of hydronephrosis or kidney tumour

Inspection of suprapubic region for congenital anomalies like bladder exstrophy. Swelling in the region may be due to bladder distention

Question 3

Externa Genitalia inspection involves?

Answer 3

Scrotal exam while standing can help show varicocele
Redness of scrotum: epididymitis
Swelling (hydrocele, epididymo-orchitis)

Penis, foreskin, glans and external urethral meatus inspection can show phimosis, glans penis can show balanitis or tumour, stenosis of urethral meatus or congenital anomlaies such as hypospadias

Question 4

Pelvic inspection in women involves?

Answer 4

Urethra and vaginal opening should be inspected for abnormalities or atrophic changes.
Vaginal discharge should be swabbed for culture possible cervical smear.
Cystocele or rectocele may be obvious in inspection if pt coughs

Question 5

Abdominal palpation involves\shows?

Answer 5

Peritoneal irritation, bimanual palpation of kidney for enlargement

Question 6

Kidney palpation involves\shows?

Answer 6

Bimanual palpation of kidney: enlarged kidney can be felt in subcostal region on deep inspiration. Enlarged kidney could indicate: hydronephrosis, tumors of kidney(would feel firm or hard) and cystic kidney
(remember that lower pole of normal right kidney is often palpable)

Question 7

Urinary bladder palpation involves\shows?

Answer 7

One finger DRE and one hand on suprapubic region pressing to feel for swelling or irregularity. Bladder distention can be due to acute or chronic retention

Question 8

Rectal palpation shows?

Answer 8

Rectal tumour as 70% can be reached by examining finger. Pt is in left lateral position

Question 9

Prostate palpation involves\shows?

Answer 9

Normal prostate is about 15g and 3cm, smooth and bouncy.

Used to check for BPH, inflammation, Ca.
Firm prostate is query prostate Ca

Question 10

What can give a false impression of enlarged prostate, what can be done to get more accurate prostate size?

Answer 10

Urine retention can cause bladder to press prostate down giving false impression of enlargement. Can be more accurate if DRE done after catheterisation and drainage of bladder

Question 11

Palpation of external genitalia involves\shows?

Answer 11

Examine each structure; cord, vas deferens, epididymis, testes) for shape, size, consistency. Start with healthy teste.

Scrotal swellings can be described as inflammatory, solid or cystic
Transillumination of scrotal swelling is sign of fluid=filled scrotal leions
Positions of testes could be altred such as ectopic testis or cryptorchidism
Decreased size of testes can be due to: mumps, orchitis, hypogonadism
Increased size of testes can be due to: hydrocele, epididymo-orchitis, inguino-scrotal hernia

Question 12

Palpation of pelvis in women involves\shows?

Answer 12

The uterus and vaginal fornices should be examined bimanually for masses and tenderness

Question 13

Percussion in urology?

Answer 13

Secussio renalis (percussion at costovertebral angle) causing pain in kidney inflamm

Abdominal percussion: tenderness shows peritoneal irritation

Bladder percussion: can help identify enlarged bladder in obese pt

Question 14

Auscultatoin in urology?

Answer 14

both anteriorly above the umbilicus and in the loin for a vascular bruit which may be associated with renal artery stenosis with hypertension or an arteriovenous malformation in the kidney. Arteriovenous fistula or hypernephroma will also give rise to bruits