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3002 > 13 History taking: GU > Flashcards

13 History taking: GU Flashcards

1
Q

History taking steps (GU)

A
  • Introductions
  • Presenting Complaint
  • History of Presenting Complaint :
  1. Obstetric History
  2. Menstrual History
  3. Psycho-sexual History
  • Past Medical History
  • Drug History
  • Family History
  • Social History
  • Systems Enquiry
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2
Q

SOCRATES - mnemonic for pain in HPC

A
  • Site
  • Onset
  • Character
  • Radiation
  • Associated symptoms
  • Timing
  • Exacerbators/relievers
  • Severity
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3
Q

What does uria mean?

A

Pertaining to urinary system

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4
Q

What does the prefix -Dys mean?

A

Pain

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5
Q

What does the prefix - Oli mean?

A

Little/ small

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6
Q

What does the prefix - An mean?

A

None/ absent

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7
Q

What does dysuria mean?

A

Pain passing urine

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8
Q

What does nocturia mean?

A

Get up at night to pass urine

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9
Q

What does haematuria (macroscopic) mean?

A

Blood in urine

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10
Q

What does polyuria mean?

A

Passing more urine than normal (large volumes)

• > 2.5 - 3 L in 24 hours

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11
Q

What does oliguria mean?

A

Passing smaller amounts of urine than normal (small volumes)

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12
Q

What does anuria mean?

A

Stopped passing urine

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13
Q

Factors to consider regarding dysuria

A
  1. Inflammation involving urethra - urethritis
  2. Inflammation of bladder - cystitis

• Consider SOCRATES

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14
Q

Factors to consider regarding haematuria

A
  • Amount (pink tinge vs clots)

* Check definitely per urethra (not PV/ PR)

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15
Q

Factors to consider regarding oliguria and anuria

A
  • Consider obstruction - suprapubic pain with intense desire to micturate
  • Consider hypovolaemia - dry/ dehydrated
  • Consider AKI/ failure
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16
Q

History of presenting complaint (urinary)

A 
• 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)
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17
Q

Name incontinence causes

A
  1. Stress
  2. Urge
  3. Overflow
  4. Neurological
  5. Mixed
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18
Q

Incontinence - stress

A
  • Result of sphincter weakness
  • Small leak of urine when intra-abdominal pressure rises
  • E.g. coughing, laughing, sneezing, standing up
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19
Q

Incontinence - urge

A
  • Usual cause is detrusor instability
  • Strong desire to void and rush to go
  • “Didn’t get there in time”
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20
Q

Incontinence - overflow

A
  • usually due to outflow obstruction
  • Leakage of small amounts
  • Distended bladder palpable
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21
Q

Incontinence - neurological

A
  • Different types - depends on cause and accompanying neurological deficits
  • E.g:
  1. Distended atonic bladder, with large residual volume (autonomic neuropathy)
  2. Loss of sensation and unexpected lack of control (spinal cord injury)
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22
Q

What are the symptoms of urinary tract obstruction - upper?

A 
• Dull ache in flank / loin
• Polyuria → Anuria
• Causes, e.g:
– Tumour (renal, ureter)
– Stricture 
– Calculi
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23
Q

What are the symptoms of urinary tract obstruction - bladder outlet?

A 
• Hesitancy
• Poor stream
• Terminal dribbling
• Sense of incomplete emptying 
• Possible retention (+ overflow) • Infection
• Causes, e.g:
– Benignprostatichypertrophy
– Prostate cancer
– Pelvictumour (gynae)
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24
Q

What are the associated symptoms in urinary?

A
  • Vomiting
  • Fever
  • Malaise
  • Anorexia
  • Weight loss
  • Fatigue / lack of energy
25
Q

Key urinary symptoms

A
  • 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
26
Q

History of presenting complaint (reproductive organs) - Men

A 
• 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
27
Q

Key male reproductive symptoms

A
  • 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?
28
Q

History of presenting complaint (reproductive organs) - Women

A 
• 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?

29
Q

Key female reproductive symptoms

A
  • 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?
30
Q

What does dyspareunia mean?

A

Painful intercourse

31
Q

What does dysmenorrhoea mean?

A

Painful periods

32
Q

What does menorrhagia mean?

A

Heavy periods

33
Q

What does IMB mean?

A

Inter menstrual bleeding - bleeding between periods

34
Q

What does PMB mean?

A

Post menopausal bleeding - bleeding after menopause (occurring after 12 months of amenorrhoea)

35
Q

What does amenorrhoea mean?

A

Abnormal absence of menstruation

36
Q

What does PCB mean?

A

Post coital bleeding - bleeding after intercourse

37
Q

What does age at menarche mean?

A

1st occurrence of menstruation

38
Q

What is the average age at menarche in UK?

A

12 years 11 months

39
Q

When is primary amenorrhoea considered?

A
  • If no period by age 12 years - in absence of secondary sexual characteristics
  • 16 - if other features are developing normally
40
Q

What does secondary amenorrhoea mean?

A

Had periods but now stopped for 6 consecutive months

41
Q

When does menopause occur and average age?

A
  • Occurs between 45 - 55 years of age

* Average age = 51

42
Q

Menopause before 40 years of age = ?

A

Premature menopause or premature ovarian insufficiency

43
Q

Menstrual history

A

• 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.)
44
Q

What does Gravida mean?

A

Number of times a woman has been pregnant

45
Q

What does Para mean?

A

Number of times that woman has given birth to a foetus with a gestational age of 24 weeks or more

46
Q

If pregnant 3 times, 1 delivery at term, 1 early TOP and 1 early miscarriage:
• What is Gravid and Para?

A

Gravida 3 Para 1 ^(+2)

47
Q

Obstetric history

A
  • Para and gravida
  • Any difficulties getting pregnant; any fertility treatment
  • Pregnancy complications
  • Mode of delivery - NVD
  • Postnatal complications (in self and baby)
48
Q

What does NVD mean?

A

Normal vaginal delivery

49
Q

Psycho sexual history

A 
• Ask what is relevant to the consultation: 
– Relationship details
– Impotence / erectile dysfunction
– Intercourse and sexual practices
– Libido
– Orgasm
– Associated symptoms

• Contraception

50
Q

What are the types of contraception?

A
  • 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
51
Q

Key obstetric and psycho sexual symptoms

A
  • Menarche
  • Menopause
  • LMP and cycle
  • Para
  • Gravida
  • Complications (pre/ post natal)
  • Mode of delivery
  • Psycho sexual history
  • Contraception
52
Q

Past medical history

A
  • 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)
53
Q

Drug history

A
  • Consider names of contraceptive pills
  • Consider drugs that cause renal impairment
  • Consider drugs associated with sexual dysfunction
54
Q

Family history

A
  • Kidney failure
  • Polycystic Kidney Disease

can be particularly relevant

55
Q

Social history

A
  • 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
56
Q

Past medical history

A
  • 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)
57
Q

Drug history

A
  • Consider names of contraceptive pills
  • Consider drugs that cause renal impairment
  • Consider drugs associated with sexual dysfunction
58
Q

Family history

A
  • Kidney failure
  • Polycystic Kidney Disease

can be particularly relevant

59
Q

Social history

A
  • 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

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