A lump in or close to the midline suggests a thyroid lesion which moves with

swallowing.
- Skin ulcers or sinuses suggest T.B.
- Venous engorgement.

Palpation:
- Systematic palpation: anterior triangle ( swallowing), submental and
submandibular areas, posterior triangle and the supraclavicular fossae.
Atallah A. Shaaban Basic Urology 47

- Thyroid lumps. Is it unilateral or bilateral? Does it move with tongue protrusion?

- Carotid arteries. Are they normal, dilated or aneurysmal?
Supraclavicular Nodes: (See page 52) Atallah A. Shaaban Basic Urology 48

Vital Signs
Critical information about the state of health
Observation
- Anxious, in pain, upset
- Dress
- Hygiene
Temperature:
- Recording will depend on the site of measurement. Normal oral temperature is
37C (36.5-37.2C). Rectal temperature is 0.5 C higher, while axillary temperature
is 0.5 C lower.
- Fever is an increase in body temperature resulting from a cellular response to
inflammation, immunological disorders or malignancy.
Causes:
a) Inflammation: Acute infections of parenchymatous organs.
Kidney: Acute pyelonephritis, renal abscesses, pyonephrosis, infected
hydronephrosis and emphysematous pyelonephritis.
Prostate: Acute prostatitis and prostate abscess.
Testis: Epididymo-orchitis.
b) Malignancy: Kidney cancer will cause fever particularly when it is metastatic or
necrotic.
c) Central Nervous System: Head injury, cerebral hemorrhage.
d) Metabolic: Acute gout.
e) Drugs: Morphine, sulfonamides and hypersensitivity conditions.
f) Surgical and Post-traumatic: Patients with collection of pus have a high-grade
swinging fever with rigors. Infected collections of blood or urine will cause fever.
- Hypothermia: Shock states, starvation, prolonged unconsciousness, elderly
immobile patients during winter and severe hypothyroidism.
Respiratory Rate
12-20 breaths/ min
Pulse
- Quantity beats/min
- Regularity
- Volume

Atallah A. Shaaban Basic Urology 49

Hormonal hypertension of urologic importance:

A) High renin HTN:
1) Renovascular abnormalities.
2) Juxtaglomerular cell tumors.
3) Bilateral endocrine dysfunction of the kidney.
4) Renal tumors.
B) Low renin HTN:
1) Conn's syndrome (primary aldosteronism).
2) Cushing syndrome.
3) Congenital adrenal hyperplasia.
C) High catecholamines:
1) Pheochromocytoma.
2) Neuroblastoma.
Body Habitus:
A. Body mass index (BMI):
Normal 19-25
Overweight 25-30
Obesity 30-40
Morbid Obesity >40 kg/m2
- Information on waist circumference refines associated disease risks. A
circumference greater than 102 cm in men or 88 cm in women indicates increased
metabolic risk.
B. Obesity
- Obesity increases risk for almost all types of cancer, reproductive disorders,
hypertension, diabetes mellitus, cardiovascular disease, stroke, and gallbladder
disease.
- It obscures intra-abdominal physical signs, increases difficulties in many
operations and post-operative complications.
- Causes:
- Simple: overeating
- Endocrine: Atallah A. Shaaban Basic Urology 51
Cushing's syndrome