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Daniel Eshetu
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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”
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Diagnostic evaluation will point to the nature of
the disease:
Congenital
Infections and infestations
Metabolic problems
Traumatic
Neoplastic
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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
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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
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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
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Physical examination for signs of enlarged kidneys
by bimanual palpation
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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)
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Normal bladder can not be palpated or percussed
Distended bladder becomes visible in patients
It is a palpable subumblical midline abdominal
mass
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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
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Abnormal findings are:
Over distended bladder noticeable and palpable
Bladder outlet obstruction (BOO)
Neurogenic conditions
Large bladder tumors or calculi
Tenderness - cystitis
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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
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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
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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
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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
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Abnormal findings
Acute prostatitis
Benign prostatic hyperplasia (BPH)
Prostatic carcinoma
Female Pelvic Examination
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Neurological abnormalities assessed by:
- the pattern of sensory deficit
- testing reflexes in the genital area
(bulbocavernous reflex :BCR)
- cremasteric reflex
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infrasacralperipheral
supraspinale
suprasacral spinale
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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!