13 History taking: GU Flashcards
History taking steps (GU)
- Introductions
- Presenting Complaint
- History of Presenting Complaint :
- Obstetric History
- Menstrual History
- Psycho-sexual History
- Past Medical History
- Drug History
- Family History
- Social History
- Systems Enquiry
SOCRATES - mnemonic for pain in HPC
- Site
- Onset
- Character
- Radiation
- Associated symptoms
- Timing
- Exacerbators/relievers
- Severity
What does uria mean?
Pertaining to urinary system
What does the prefix -Dys mean?
Pain
What does the prefix - Oli mean?
Little/ small
What does the prefix - An mean?
None/ absent
What does dysuria mean?
Pain passing urine
What does nocturia mean?
Get up at night to pass urine
What does haematuria (macroscopic) mean?
Blood in urine
What does polyuria mean?
Passing more urine than normal (large volumes)
• > 2.5 - 3 L in 24 hours
What does oliguria mean?
Passing smaller amounts of urine than normal (small volumes)
What does anuria mean?
Stopped passing urine
Factors to consider regarding dysuria
- Inflammation involving urethra - urethritis
- Inflammation of bladder - cystitis
• Consider SOCRATES
Factors to consider regarding haematuria
- Amount (pink tinge vs clots)
* Check definitely per urethra (not PV/ PR)
Factors to consider regarding oliguria and anuria
- Consider obstruction - suprapubic pain with intense desire to micturate
- Consider hypovolaemia - dry/ dehydrated
- Consider AKI/ failure
History of presenting complaint (urinary)
• Urinary frequency – What’s normal for them – Has this changed – Quantify • Urinary urgency • Urinary incontinence (type) • Urinary flow / stream • Abdominal pain – Suprapubic or flank (SOCRATES)
Name incontinence causes
- Stress
- Urge
- Overflow
- Neurological
- Mixed
Incontinence - stress
- Result of sphincter weakness
- Small leak of urine when intra-abdominal pressure rises
- E.g. coughing, laughing, sneezing, standing up
Incontinence - urge
- Usual cause is detrusor instability
- Strong desire to void and rush to go
- “Didn’t get there in time”
Incontinence - overflow
- usually due to outflow obstruction
- Leakage of small amounts
- Distended bladder palpable
Incontinence - neurological
- Different types - depends on cause and accompanying neurological deficits
- E.g:
- Distended atonic bladder, with large residual volume (autonomic neuropathy)
- Loss of sensation and unexpected lack of control (spinal cord injury)
What are the symptoms of urinary tract obstruction - upper?
• Dull ache in flank / loin • Polyuria → Anuria • Causes, e.g: – Tumour (renal, ureter) – Stricture – Calculi
What are the symptoms of urinary tract obstruction - bladder outlet?
• Hesitancy • Poor stream • Terminal dribbling • Sense of incomplete emptying • Possible retention (+ overflow) • Infection • Causes, e.g: – Benignprostatichypertrophy – Prostate cancer – Pelvictumour (gynae)
What are the associated symptoms in urinary?
- Vomiting
- Fever
- Malaise
- Anorexia
- Weight loss
- Fatigue / lack of energy
Key urinary symptoms
- Dysuria
- Nocturia
- Haematuria
- Polyuria
- Oliguria
- Anuria
- Frequency
- Urgency
- Incontinence
- Flow/ stream
- Abdominal pain
- Hesitancy
- Terminal dribbling
- Sense of incomplete emptying
- Retention
- Systemic upset/ associated symptoms
History of presenting complaint (reproductive organs) - Men
• Urethral discharge – Amount – Smell – Bloody – Associated symptoms
• Testicular pain
– Any link to trauma?
– Link to other illness / symptoms (e.g. mumps)
– Speed of onset and severity
– Associated swelling / redness / tenderness / discharge
• Testicular lumps – Unilateral / bilateral – Location – Associated symptoms – Hard / soft – Regular / irregular – Consider testicular cancer, occurs in young men too (mainly between 15 and 49 years of age)
• Joint, eye or GI symptoms
– If associated with urethral discharge, consider Reiter’s
syndrome
• Rash / ulcers
– Consider herpes / genital warts
• Itch
– Associated rash, discharge?
• Smell
• Infertility / fertility problems
– >12mths
– Any children with previous partners?
- Urinary symptoms
- Abdominal pain
- Systemic upset
- ?Partner affected
Key male reproductive symptoms
- Urinary symptoms
- Abdominal pain
- Systemic upset
- Urethral discharge
- Testicular pian
- Testicular lumps
- Joint, eye or GI symptoms
- Rash/ ulcers
- Itch
- Smell
- Rash
- Fertility problems
- Partner affected?
History of presenting complaint (reproductive organs) - Women
• Dyspareunia (painful intercourse) – Deep – Superficial • Dysmenorrhoea (painful periods) – When and for how long • Menorrhagia (heavy periods) – clots flooding • Inter Menstrual Bleeding (IMB) – bleeding between periods • Post Menopausal Bleeding (PMB) – bleeding after the menopause (occurring after 12 months of amenorrhoea) • Post Coital Bleeding (PCB) – bleeding after intercourse • Vaginal dryness – Common, especially post menopausal • Itch – Associated rash, discharge? • Smell – E.g. fishy (bacterial vaginosis), offensive • Rash – E.g. Herpes (vesicular), Genital warts • Infertility / fertility problems – Trying for > 12months • Urinary symptoms (see earlier) • Abdominal / pelvic pain (see earlier); or pain around perineum itself • Systemic upset; including fever (see earlier) • Partner affected?
• POSSIBILITY OF PREGNANCY?
Key female reproductive symptoms
- Urinary symptoms
- Abdominal/ pelvic/ perineal pain
- Systemic upset
- Dyspareunia
- Dysmenorrhoea
- Menorrhagia
- IMB
- PMB
- PCB
- Vaginal dryness
- Itch
- Smell
- Rash
- Fertility problems
- Possibility of pregnancy
- Partner affected?
What does dyspareunia mean?
Painful intercourse
What does dysmenorrhoea mean?
Painful periods
What does menorrhagia mean?
Heavy periods
What does IMB mean?
Inter menstrual bleeding - bleeding between periods
What does PMB mean?
Post menopausal bleeding - bleeding after menopause (occurring after 12 months of amenorrhoea)
What does amenorrhoea mean?
Abnormal absence of menstruation
What does PCB mean?
Post coital bleeding - bleeding after intercourse
What does age at menarche mean?
1st occurrence of menstruation
What is the average age at menarche in UK?
12 years 11 months
When is primary amenorrhoea considered?
- If no period by age 12 years - in absence of secondary sexual characteristics
- 16 - if other features are developing normally
What does secondary amenorrhoea mean?
Had periods but now stopped for 6 consecutive months
When does menopause occur and average age?
- Occurs between 45 - 55 years of age
* Average age = 51
Menopause before 40 years of age = ?
Premature menopause or premature ovarian insufficiency
Menstrual history
• Always establish LMP and give usual cycle expressed as x/y, where:
X = usual length of each period Y = number of days from the start of 1 period to the start of the next
i.e. 5/28 = each period lasts 5 days and 28days from the 1st day of one period to the first day of the next
- Usual range of “Y” is 21 to 35 days; average is 28
- Blood loss is 50-200 mls and averages 70 mls
- Guide to loss / heaviness is use of pads and tampons; presence of clots
- Ties in with HPC (dysmenorrhoea etc.)
What does Gravida mean?
Number of times a woman has been pregnant
What does Para mean?
Number of times that woman has given birth to a foetus with a gestational age of 24 weeks or more
If pregnant 3 times, 1 delivery at term, 1 early TOP and 1 early miscarriage:
• What is Gravid and Para?
Gravida 3 Para 1 ^(+2)
Obstetric history
- Para and gravida
- Any difficulties getting pregnant; any fertility treatment
- Pregnancy complications
- Mode of delivery - NVD
- Postnatal complications (in self and baby)
What does NVD mean?
Normal vaginal delivery
Psycho sexual history
• Ask what is relevant to the consultation: – Relationship details – Impotence / erectile dysfunction – Intercourse and sexual practices – Libido – Orgasm – Associated symptoms
• Contraception
What are the types of contraception?
- Male condom
- Female condom
- Intra Uterine Device (IUD)
- Intra Uterine System (IUS)
- Diaphragm
- Progesterone Only Pill
- Combined Oral Contraceptive
- Implant
- Injection
- Patch
- Sterilisation
- Calendar rhythm method • Coitus interruptus
- Vaginal hormonal ring
Key obstetric and psycho sexual symptoms
- Menarche
- Menopause
- LMP and cycle
- Para
- Gravida
- Complications (pre/ post natal)
- Mode of delivery
- Psycho sexual history
- Contraception
Past medical history
- Any previous GU illness
- Previous STIs
- Previous Pelvic Inflammatory Disease
- Previous ectopic pregnancy
- Previous testicular problems; such as torsion, tumour, undescended testes
- Recurrent UTIs
- Renal disease
- Previous surgery
- Neurological disease
- Cancer / chemo treatment (can affect fertility)
Drug history
- Consider names of contraceptive pills
- Consider drugs that cause renal impairment
- Consider drugs associated with sexual dysfunction
Family history
- Kidney failure
- Polycystic Kidney Disease
can be particularly relevant
Social history
- Exposure to chemical carcinogens (bladder ca)
- Foreign travel (schistosomiasis)
- Dehydration during a holiday in a hot climate (impact on kidneys)
- Non prescription drugs; effects of cannabis on sexual function
- Working in hot environments, e.g. kitchens, and effect on male fertility
Past medical history
- Any previous GU illness
- Previous STIs
- Previous Pelvic Inflammatory Disease
- Previous ectopic pregnancy
- Previous testicular problems; such as torsion, tumour, undescended testes
- Recurrent UTIs
- Renal disease
- Previous surgery
- Neurological disease
- Cancer / chemo treatment (can affect fertility)
Drug history
- Consider names of contraceptive pills
- Consider drugs that cause renal impairment
- Consider drugs associated with sexual dysfunction
Family history
- Kidney failure
- Polycystic Kidney Disease
can be particularly relevant
Social history
- Exposure to chemical carcinogens (bladder ca)
- Foreign travel (schistosomiasis)
- Dehydration during a holiday in a hot climate (impact on kidneys)
- Non prescription drugs; effects of cannabis on sexual function
- Working in hot environments, e.g. kitchens, and effect on male fertility
