Clinical Examination: Renal

Question 1

Define urinary frequency

Answer 1

Abnormally frequent urination

Question 2

Define urinary urgency

Answer 2

A sudden, strong need to urinate

Question 3

Define nocturia

Answer 3

Need to urinate at night

Question 4

Define polyuria

Answer 4

Excessive or abnormally large production or passage of urine (>2.5 L/ 3L and over in 24 hrs)

Question 5

Define oliguria

Answer 5

Urine output of <0.5 ml/kg/hr

Question 6

Define haematuria

Answer 6

Presence of blood in urine

Question 7

Define Incontinence (Stress / Urge)

Question 8

Define Incomplete emptying of bladder

Question 9

Define acute urinary retention

Question 10

Define chronic urinary retention

Answer 10

a persistent inability to completely empty the bladder despite maintaining an ability to urinate

Question 11

Define fever

Answer 11

an elevation of body temperature above the normal daily variation

Question 12

Define hesitancy

Answer 12

Involuntary delay in initiating urination

Question 13

Define poor strem

Answer 13

Difficulty starting or maintaining a urine stream

Question 14

Define dribbling

Answer 14

Involuntary leakage of urine

Question 15

Define erectyle dysfunction

Answer 15

the inability to get and keep an erection firm enough for sex

Question 16

What is important to do when performing urinary exam in females?

Answer 16

Also take gynea Hx

Question 17

Define anuria

Answer 17

Absolute Anuria: no urine output
Relative Anuria: <100ml urine output in 24 hrs

Question 18

Define proteinuria

Question 19

In which patients is dialysis routine treatment?

Answer 19

Acute and chronic renal failure

Question 20

What is haemodialysis?

Answer 20

A dialyser filters electrolytes and fluid from the blood when the kidneys are not functioning enough to do this adequately.

Question 21

What is peritoneal dialysis (PD)?

Answer 21

Procedure in which peritoneum in a patient’s abdomen is used as the membrane through which fluid and dissolved substances are exchanged with the blood.

Question 22

If a renal transplant is performed, where is it places?

Answer 22

One of iliac fossae

Question 23

What must you not do in a patient with an atreovenous fistula

Answer 23

1. Never measure the blood pressure on the patient’s arm which has an arteriovenous fistula. You may damage the fistula!
2. Never take blood from the fistula arm or the arm protected for a fistula (usually the non- dominant arm).

Question 24

Initial observation

Go over initial observation/general assessment of urinary system

Answer 24

Question 25

Go over introduction of urinary examination

Answer 25

Question 26

Section 3: Examination | Go over examination of hands and nails

Answer 26

Question 27

What is brown nail pigmentation a sign of?

Answer 27

Advanced renal failure

Question 28

Section 3: Examination | Go over examination of both arms

Answer 28

Question 29

What is the purpose of an atreovenous fistula?

Answer 29

Surgically created fistula to allow vascular access for dialysis in pts with renal failure

Question 30

What are bruising and scratch marks a sign of?

Answer 30

Advanced renal failure (can be found on legs too)

Question 31

Section 3: Examination | Go over examination of face and neck

Answer 31

``` Yellow complexion Pallor Fundoscopy Smell of pts breath: uraemia retro Examination of JVP ```

Question 32

What does a yellow complexion indicate?

Answer 32

Renal failure

Question 33

What does pallor indicate?

Answer 33

Anaemia -> chronic renal failure

Question 34

Why is fundoscopy performed?

Answer 34

To check for hypertensive diabetic retinopathy

Question 35

Why is the patients breath examined?

Answer 35

Uraemia retro -> chronic renal failure

Question 36

Section 3: Examination | Go over examination of the chest

Answer 36

* Lung base crepitus | * Additional heart sounds

Question 37

Section 3: Examination | Go over examination of the abdomen

Answer 37

``` Inspect : Scars, Peritoneal dialysis Palpate : kidney/bladder palpable? Percussion: palpable bladder ( percussion from upper abdomen in midline towards symphysis pubis Auscultation: Renal artery bruits DRE ```

Question 38

When may a digital rectal examination be indicated in a urinary examination?

Answer 38

To examine the prostate as prostatic enlargement can cause urethral and bladder outflow obstruction

Question 39

Section 4: Closure | Go over closure of urinary exam

Answer 39

Question 40

What are some common causes of haematuria?

Answer 40

``` Glomerulonephritis • Urinary tract infection • Renal stones • Tumours of the kidney, ureter, bladder or prostate • Acute tubular necrosis • Distance running or severe exercise ```

Question 41

What are some causes of proteinuria?

Answer 41

* Diabetes mellitus * Glomerulonephritis * Infection * Severe hypertension * Burns * Drugs e.g. gold and penicillamine

Question 42

What are confusion and myoclonus signs of?

Answer 42

Uraemic encephalopathy

Question 43

What are excoriations a sign of?

Answer 43

Uraemic pruritus

Question 44

What is breathlessness a sign of? | Renbal cause

Answer 44

Fluid overload

Question 45

What may cause a postural tremor?

Answer 45

Calcineurin inhibitor side effects

Question 46

What is asterixis a sign of?

Answer 46

Flapping termor -> uraemic encephalopathy

Question 47

What are: a) Leukonychia b) Koilonychia Signs of?

Answer 47

a) Hypoalbuminaemia -> nephrotic syndrome b) Iron deficiency -> nephritic syndrome

Question 48

What may hlow pulse and high heart rate be caused by?

Answer 48

Blood loss

Question 49

What are some causes of proteinuria?

Answer 49

Diabetes Mellitus • Glomerulonephritis • Infection • Severe Hypertension • Burns • Drugs e.g. Gold & Penicillam