Daniel Eshetu

Properly taken medical history

Aim at performing a thorough and complete physical examination

Aim- to evaluate patients who present with medical problems

Why? Physical examination (P/E) remains to be the key component

of diagnostic evaluation along with properly taken history

What is expected? To perform conscientiously – “Take time”

Diagnostic evaluation will point to the nature of

the disease:

Congenital

Infections and infestations

Metabolic problems

Traumatic

Neoplastic

Diagnostic evaluation begins as the patient comes in or the physician/medical trainee comes in to evaluate the patient

General assessment of severity of the illness/medical condition – “visual inspection”

Evidence of pain

Nutritional status: weight loss/obesity

Gait

Abnormal body movements

Wetting

Fever

Edema

Pick features that draws attention to disorders in

another system and examine that system:

Edema – cardiac disease, renal failure etc.

Gynacomastia – alcoholism, endocrinologic diseases, post

chemotherapy (for example, for prostatic cancer)

Lymphadenopathy – metastatic genitourinary (GU)

neoplasms

During examination of the GU tract look for:

Enlargement of the kidneys

Enlargement of the bladder

Disorders of the inguinal region

Disorders of the genitalia

Pelvic disease detectable by internal examination (Digital

Rectal Examination-DRE and per vaginal examination - PV)

Neurological examination

Physical examination for signs of enlarged kidneys

by bimanual palpation

Normal sized kidneys may not be palpable

May be palpable in thin patients and in children

Enlarged kidney is a classical sign of a palpable

mass

Benign cysts/ hydronephrosis benign or malignant renal

tumors

Absence of colonic resonance

Costovertebral angle tenderness (CVAT)

Normal bladder can not be palpated or percussed

Distended bladder becomes visible in patients

It is a palpable subumblical midline abdominal

mass

Floppy bladder Cystic mass

May be more to one side

Bladder moves from side to side only

Gravid uterus moves from side to side and up and down

Bimanual Examination (BME) Suprapubic fluid filled bladder

Irregular mass

Cystic mass

BME under anesthesia (for better assessment of a bladder mass)

Bladder palpated between the abdomen and the rectum in males and between the abdomen and the vagina in females

Abnormal findings are:

Over distended bladder noticeable and palpable

Bladder outlet obstruction (BOO)

Neurogenic conditions

Large bladder tumors or calculi

Tenderness - cystitis

Loose sac

Scrotal wall made of skin and underlying thin,

elastic muscular layers

Contents: testis

epididymis

spermatic cord and contents namely

vas deference and testicular vessels

Abnormal findings:

Small testis

Normal adult testis = 6x4 cm in size and firm in consistency.

Hard area of the testis

Suspect testicular cancer

Tortuous

Hydrocele

Varicocele

Absent testis: ectopic or undescended testis

Inguinal masses: L.N,

Scrotal skin masses or nodules

Rectal and Prostate Examination in the Male:

Routine D.R.E should be performed in every male after the age of 40 years and in men of any age who present for urologic evaluation

Done at the end of the physical examination

Positions to be maintained by the patient: 1. Left lateral position or

2. Standing and bent over the examination table

3. Supine position or

4. Knee to chest position

The patient should be given enough time to attain the proper position – NO HURRY

The patient should be relaxed and reassured

Minimize friction by lubricating the gloved examining index finger

Inspect for any perennial pathologies – skin, hemorrhoids, anal cancers

Note the anal sphincter tone – flaccid or spastic = neurogenic disease

Entire posterior surface of the prostate is examined and the circumference of the whole rectum –withdrawal of finger:

1. Inspect the examining finger – color of stool

2. Test for blood in stool

Abnormal findings

Acute prostatitis

Benign prostatic hyperplasia (BPH)

Prostatic carcinoma

Female Pelvic Examination

Neurological abnormalities assessed by:

- the pattern of sensory deficit

- testing reflexes in the genital area

(bulbocavernous reflex :BCR)

- cremasteric reflex

infrasacralperipheral

supraspinale

suprasacral spinale

HEAR and YOU FORGET

WHAT I HEAR I FORGET

SEE and YOU REMEMBER

WHAT I SEE I REMEMBER

DO and YOU UNDERSTAND / KNOW

WHAT I DO I KNOW

THINK FAST and MOVE SLOW

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Wish you all the best in your

clinical career.

Good Luck!