Makindo Medical Notes.com

Introduction (Use the acronym WIPER to prepare for the examination)

• W - Wash your hands
• I - Introduce yourself and confirm patient details
• P - Permission - gain consent to proceed with the examination, including explaining relevant details
• E - Expose the patient appropriately, gather Equipment
• R - Position the patient lying back at 45 degrees comfortably

• Inspect with patient standing - look for
  • Scars
  • Swellings
  • Lumps
  • Inspects scrotum
  • Inspects groin
  • Inspects abdomen
  • Asks patient to cough to exaggerate the hernia, observing for any impulse around groin and scrotum Palpation:
  • Identifies relevant anatomical landmarks:
  • Pubic tubercle
  • Anterior superior iliac spine
  • Mid-inguinal point
  • External (superficial) ring
  • Internal (deep) ring
  • Attempts to palpate external ring through scrotum (or states intent to do so)
  • Identifies any swelling/lump
  • Examines swelling/lump thoroughly:
  • 4 Ss
  • 4 Cs
  • 4 Ts
  • Attempts to get 'above' swelling
  • Attempts to manually reduce the hernia
  • Asks patient to cough to exaggerate the hernia and feel a 'cough impulse'
  • Uses finger to obstruct internal ring (at the mid-inguinal point) and asks patient to cough
  • Direct hernia appears
  • Indirect hernia does not appear Auscultates swelling for bowel sounds Examines both sides for comparison Tells examiner he or she would like to complete the examination by examining the scrotum Thanks patient Offers to help patient get dressed Washes hands Presents findings Offers appropriate differential diagnosis Suggests appropriate further investigations and management