Hernia Examination

MRCS Part B OSCE Revision

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Hernia Examination

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Wash Your Hands
Ensure that you are seen by the examiners to wash your hands using alcohol gel provided.

Introduce, Explain, Expose and Inspect
Begin by introducing yourself, explain what you are going to do and check that this is ok with the patient and that he/she is not in any pain.
For herniae examination the patient should ideally be bare from 'nipples to knees'.

Patient Standing
Ask the patient to stand and observe for any obvious swelling in the groin.

Inspect
For previous hernia or abdominal scars. Ask the patient to cough and observe for any swellings.
Palpate
If there is a palpable lump assess the lump for fluctuance, size, shape, mobility/tethering, whether it is reducible and whether you can get above it. Also try to ascertain where the lump originates from in comparison to the femoral pulse and whether it extends to the scrotum.
Palpate both inguinal regions and compare both sides.
Ask the patient to cough while palpating the inguinal regions to check for a cough impulse.

Patient Supine
Ask the patient to lie on the examination couch.
Inspect and palpate both inguinal regions again and ask the patient to cough to again test for a cough impulse.
Offer to examine the abdomen to look for signs of intraabdominal pressure that might predispose to a hernia.
Offer to examine the external genitalia.

Closing
Thank the patient. Inform them that they may now get dressed or ensure they are adequately covered.
Present your findings to the examiner.

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