Diagnosis- Urogenital Flashcards
What is the most common causative organism of an uncomplicated UTI?
Klebsiella
Human Papilloma Virus
E. coli
Proteus
E.coli
E. coli, Klebsiella and Proteus bacterial species are all found in the lower GI tract of normal, healthy individuals and do not usually cause issues whilst they remain in the bowel. However, since the anatomical proximity of the urethral opening and the anus, it is common for bacteria to migrate and cause a UTI.
What is the most common type of bladder cancer?
Small cell bladder cancer
Adenocarcinoma
Pilocytic Astrocytoma
Transitional Cell Carcinoma
Transitional Cell Carcinoma
58-year-old man presents to the GP with worsening symptoms of increased urinary frequency, hesitancy and urgency as well as a weak flow. He has continued with these symptoms for the best part of 18 months and has not presented with this problem before. During the consultation a DRE is carried out by the doctor where he finds unilateral smooth enlargement of one of the peripheral lobes. What is the most likely working diagnosis?
- Prostate Cancer
- UTI
- Balanitis
- BPH
BPH
78-year-old male presents to the GP with a large scrotal mass that he states has a diameter of around 5cm; he is extremely worried about this. He noticed this around 2 weeks ago and has only just plucked up the courage to come to see the GP. He also mentions that he can only ever feel it when he is stood for long periods or in the shower. He can never feel it when he is in bed. On examination the doctor is unable to palpate above the mass. It is non-transluminal, and he has a family history of testicular cancer. What is the most likely diagnosis?
- Testicular Cancer
- Scrotal Cancer
- Inguinal Hernia
- Spermatocele
Inguinal Hernia
Although the man has a family history of cancer this is not the most likely diagnosis due to the key facts of being unable to palpate above the mass and it is disappearing when he lies down
A 28-year-old woman presents to A+E with a sudden onset, severe headache which she claims is 11/10 on the pain scale. The headache came on whilst she was reading. She has a past medical history of severe hypertension and chronic loin pain. The A&E doctor requested a head CT which confirmed his diagnosis of a sub-arachnoid haemorrhage secondary to a ruptured berry aneurysm. What underlying pathology links these symptoms?
- Pyelonephritis
- Meniere’s disease
- Polycystic Kidney Disease
- Congenital Adrenal Hyperplasia
Polycystic Kidney Disease
PKD can also present with severe abdominal pain, hypertension, UTIs, macroscopic (visible) haematuria and urolithiasis.
A sexually active 19-year-old female presents to the GP with a thin, white discharge which she describes as ‘fishy smelling’ and burning when she urinates. This has been getting slowly worse for the past 2/3 days. She has very little amounts of soreness and isn’t particularly irritated by the problem. What is your working diagnosis?
- Chlamydia
- Bacterial Vaginosis
- UTI
- Reactive Arthritis
Bacterial Vaginosis
All these have slightly different presentations, but this is something common to women in their reproductive years. The causative organisms are also those found naturally in the vagina (lactobacilli and Gardnerella vaginalis) but in BV, there is vaginal inflammation and bacterial overgrowth.
35-year-old woman gravida 2 para 2 presents to the GP with a feeling of urinary urgency whenever she carries out manual tasks, as she is a personal trainer at a local gym. This upsets her greatly and she feels embarrassed as it happens frequently when she is at work. What is her most likely diagnosis?
- Stress Urinary Incontinence
- Bladder Cancer
- UTI
- Overactive bladder
Stress Urinary Incontinence
In this scenario, the woman in question has given birth twice during her life which predisposes her to SUI risk as this can cause pelvic floor weakness and reduce her ability to control urinary flow. This cannot be overactive bladder as there is no warning signs or urgency of urination. It just happens without warning.
- A 72-year-old nulliparous woman presents to her GP with a non-specific 12-month history of bloating and general abdominal discomfort. Upon examination the GP discovers a large abdominal mass. She refers the lady to her general hospital under the 2-week rule for suspected ovarian cancer. What blood test would be most suitable to confirm this diagnosis?
PSA test
FSH/LH blood test
Ca-125
CRP
Ca-125
To the right is an Ultrasound of the hypogastric region of a 38-year-old female. She has had dyspareunia and some difficulty emptying her bowels fully. What does the film show?
- Transitional Cell Bladder Cancer
- Endometriosis
- Ovarian Cysts
- Normal (No Pathology)
Ovarian Cysts
Ovarian Cysts often do not present until rupture, although you can get the above symptoms as well as a feeling of fullness, pelvic pain and increased urinary frequency. USS is the correct and only diagnostic technique.
- A 29-year-old woman with a past medical history of a complete molar pregnancy is admitted through A&E 9 day’s after she’s had a miscarriage. She has noticed marked vaginal bleeding and more recently a cough accompanied by chest pain and occasionaly haemoptysis. The doctor in A&E ran routine blood test and found her b-hCG to be extremely raised at 495,000 mlU/mL. (normal <10 mlU/mL) What is causing her symptoms?
Pregnancy
Placenta previa
Placenta accreta
Choriocarcinoma
Choriocarcinoma
Choriocarcinoma is the correct answer as it is an aggressive cancer originating from the placenta. It is heavily associated with molar pregnancy miscarriage. It typically presents with early metastasis to the lungs, causing pulmonary symptoms and extremely elevated b-HCG (more so than pregnancy).
