Urogenital System Male - Systemic Exam

Examination - Urogenital System Physical Examination - Male

Systemic Examination
Environment

• Dialysis tubes in flesh.
• Dialysis bags.
• Catheter.

General appearance

• Hydration level: under (ARF).
• Skin pigmentation (kidney excretion problems).
• Hyperventilation (acidosis).
• Hiccupping (uremia).
• Twitching, spasms (hypocalcemia, N2 retention).

Hands

• Nails: leuconychia [white transverse bands], Muehrcke's nails [white paired lines near fingernail tip] (nephrotic syndrome's hypoalbuminemia).
• Nails: others (do later).
• Palmar creases: pallor (anemia).
• Wrists: shunts from prior dialysis.

Arms

• Scratch marks (2° hyperparathyroid).
• Uremic frost [white powder on skin] (chronic renal failure).
• Peripheral neuropathy (chronic renal failure 2° to diabetes).
• Bone tenderness (low vit D).
• Blood pressure (HTN 2° to chronic renal failure).
• Postural hypotension if applicable (ARF).

Face, neck

• Eyes: jaundice, anemia.
• Eyes: fundi (diabetes).
• Mouth: fetor.
• Mouth: ulcers, infections.
• Face: rash (SLE, systemic sclerosis).

Chest

• Heart: CHF.
• Heart: hypertension.
• Heart pericarditis.
• Lung: pulmonary edema.

Abdomen

• Scars: nephrectomy [may need to roll pt. on side], kidney transplant.
• Distension (APKD/ Wilm's tumor [young], nephrotic syndrome, ascities, dialysis).
• Palpate kidneys.
• Palpate enlarged bladder.
• Palpate hepatomegaly, splenomegaly (APKD).
• Palpate AAA, so can DDx from renal stenosis on auscultation.
• Assess ascites. See Ascites ( find this in STEP - 3 )
• Percuss enlarged bladder.
• Auscultate renal bruit: above umbilicus 2cm lateral to midline, then in flanks (renal artery stenosis).
• Urinary Catheter ( find this in step - 3 )

Back

• Ask if tenderness in back.
• Sacral edema (CHF, nephrotic syndrome).
• Gently strike base of spine with fist for tenderness (renal osteomalacia, 2° hyperparathyroidism).
• Gently do Murphy's kidney punch in renal angle for tenderness (kidney infection).

Legs

• Edema.
• Peripheral vascular dz (chronic renal failure 2° to diabetes).
• Injured toes from diabetes (chronic renal failure 2° to diabetes).
• Purpura.
• Toes: tophi (gout).

Urine

• See Urinalysis reference ( find this in step - 3 )