Makindo Medical Notes

Testicular Checklist P MP F HELP H: 'Hello' (introduction and gains consent) E: Exposure L: Lighting P: Positions correctly (supine), asks if the patient is in any pain Washes hands Requests CHAPERONE Inspection:

Comments on patient's general appearance (secondary sexual characteristics, gynaecomastia - if shirt has been removed)

Hair distribution (face, axilla, pubis)

Skin of pubic region and scrotum (scars, colour, rash, lumps, ulcers)

Examines penis from base to shaft

Prepuce (if present) is examined and retracted (phimosis, paraphimosis)

Asks patient for permission to retract foreskin

Meatus (hypospadias, epispadias, discharge)

Scrotum (front and back, size, shape, symmetry, height of testes - left usually lower than right)

Returns foreskin to normal position Palpation:

Testicles (number, size, consistency, other masses, epididymis, vas deferens) Checklist P MP F

Epididymis (location, swellings)

Spermatic cord

Uses correct technique, 'rolling' the testes between finger and thumb, and covering the entire surface area of the testes

Examines any swellings if present (size, shape,fluctuance, trans illuminable, cough impulse)

Tries to palpate 'above' swelling to determine where it originates from (testes,inguinal canal)

Examines inguinal lymph nodes

Asks patient to stand and comments on any changes (varicocele, hernia) Complete examination:

Examine abdomen

Hernial orifices

Rectal examination for prostate

If a lump was felt, offers to examine the lungs, liver and spine for bony tenderness Thanks patient Offers to help patient get dressed Washes hands Presents findings Offers appropriate differential diagnosis Suggests appropriate further investigations and management OVERALL IMPRESSION