Exam Summary


1. Introduction

Introduce yourself and the examination.

a. Considerations

When introducing the examination consider the following:
  • Body Stance and positioning
  • Facial expression
  • Eye contact (1/3 at patient, 1/3 at breast, 1/3 away is preferable)
  • Dignity of patient
  • Give patients control over moving penis, scrotum and gown
  • Use of language (examine vs feel or look, lower gown vs get undressed)

b. 5 Steps of Consent

  • Explain procedure
  • Check for understanding
  • Ask if there are any questions
  • Mention STOP signal
  • Ask to proceed

c. Wash Hands

2. Inguinal Hernia

a. Inspection

  • With the patient standing, squat to observe the inguinal region.
  • Ask the patient to cough to look for protrusion
  • Check inguinal creases for rashes and swellings

b. Palpation

  • Find the landmarks for the internal and external inguinal ring and feel for a cough impulse
  • Repeat with the patient lying down

3. Scrotum

Wear gloves

a. Inspection

  • Ask patient to lift penis and scrotum
  • Inspect scrotal skin

b. Palpation

  • Palpate each testicle individually, looking for:
    • Size
    • Texture
    • Consistency
  • Palpate the Epididymis (Head, body and tail)
  • Palpate the spermatic cord
  • If there is a mass, assess:
    • If it arises from the testes
    • Size
    • Texture
    • Tenderness
    • Cough impulse

4. Penis

a. Inspection

  • Inspect skin of penis
  • Ask patient to lift penis to inspect underside
  • Ask patient to retract foreskin
  • Inspect Glans and Meatus

b. Palpation

  • Palpate penis for indurations/ thickenings
  • Ask patient to return foreskin

5. Digital Rectal Examination

a. Preparation

  • Position patient on their left side with hips and knees flexed
  • Put on gloves
  • Inspect anal area for:
    • Rashes
    • Ulcers
    • Vesicles
    • Haemorrhoids
    • Fissures
    • Fistulae
  • Put lubricant on right index finger
  • Remember to keep forearm straight

b. Process

  • Place finger across anus
  • Ask patient to take deep breaths in and out (to relax)
  • Slide finger inside
  • Check for anal tone by asking patient to squeeze finger
  • Move finger around posterior surface checking for:
    • Ulcers
    • Hard areas
  • Move finger to anterior surface (about 3 o'clock)
  • Palpate prostate, assessing for:
    • Size
    • Symmetry
    • Texture
    • Ability to get above median sulcus
  • Remove finger and check glove for blood and colour of faecal matter. Make sure the patient doesn't see.
  • Gently clean perianal area, offer patient extra tissues to clean themselves
  • Dispose of gloves and tissues

6. Conclude

Thank patient and allow privacy for getting dressed or offer assistance if needed.

See Also

Prostate Cancer
Hernia

References

Principles of Clinical Practice - Clinical Examinations Guide 2015 pp61-62

Introduce yourself and the examination.