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MD3002 > Genitourinary History > Flashcards

Genitourinary History Flashcards

1
Q

Define what the following means:

  • Dysuria
  • Haematuria
  • Nocturia
  • Anuria
  • Oliuria
  • Polyuria
A
  • Dysuria: pain when urinating
  • Haematuria: blood in urine
  • Nocturia: frequent urinating at night
  • Anuria: no urinating
  • Oliguria: low output of urine
  • Polyuria: excessive or abnormally large passage of urine
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2
Q

What are symptoms to ask about with respect to urination ? (i.e. which questions would you ask)

A

♦ Do you ever have pain passing urine (i.e. dysuria) ?
♦ Do you frequently wake up at night to pass urine (i.e. nocturia) ?
♦ Have you noticed any blood in your urine (haematuria) ?
♦ Are you passing more urine than usual (polyuria) ?
♦ Are you passing less urine than usual (oliguria) ?
♦ Have you stopped passing urine ? (anuria)
♦ Frequency of urination ?
♦ Any terminal dribbling ? (i.e. prostatic phenomenon, once finish urinating, more pee comes out that they were not expecting)
♦ Any hesitancy ? (delay before being able to pass urine)
♦ Any pain ? (dysuria is pain when passing urine, but can be other pain e.g. suprapubic, flank/loin pain)
♦ Incontinence ?
♦ Urgency ?
♦ Incomplete emptying ? (retention)
♦ Any changes in stream flow ? (e.g. when they were younger strong flow, now poorer)
♦ Any other symptoms (fatigue, nausea, malaise…)

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3
Q

Distinguish between microscopic and macroscopic haematuria.

A

Micro= patients won’t know, need to pick it up with urine dip stick test
Macro (i.e. frank)= patients notice it

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4
Q

What is polyuria defined that in terms of liters ?

A

Greater than 2.5-3 L in 24 hours

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5
Q

Identify possible causes of anuria and oliguria.

A
  • Obstruction (if suprapubic pain with intense desire to micturate)
  • HypoV (if dry/dehydrated)
  • Acute Kidney Injury/Renal failure
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6
Q

What must a doctor do next if a patient mentions they have been feeling pain ?

A

Ask SOCRATES questions

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7
Q

Identify and describe the main types of incontinence.

A

1) Stress
- Result of sphincter weakness
- Small leak of urine when intra-abdominal P rises (e.g. coughing, sneezing, laughing)

2) Urge
- Usually due to detrusor instability
- Strong desire/rush to void (didn’t get there in time)

3) Overflow
- Usually due to outflow obstruction
- Leakage of small amounts only, with palpable distended bladder

4) Neurological
- Different types, depending on cause and accompanying neurological deficit
- E.g. distended atonic bladder with large residual V (due to autonomic neuropathy), loss of sensation and unexpected lack of control (due to spinal cord injury)

5) Mixed

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8
Q

Explain the importance of asking about catheters as part of the GU medical history.

A

Risk of infection is significant

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9
Q

Define intermittent self catheterisation.

A

Patient puts it in when need to pass urine

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10
Q

True or false: urine dip will always be + for infection with a catheter (without it meaning there necessarily is an infection).

A

True.

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11
Q

What are possible associated symptoms in addition to the GU symptoms mentioned ?

A 
Vomiting
Nausea
Fatigue
Malaise
Anorexia
Weight Loss
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12
Q

Identify common/ serious presentations of urinary problems, and what they indicate.

A

Dysuria, with frequency, urgency, and suprapubic discomfort: UTI, cystitis

Systemic upset, fever, rigors, vomiting, flank pain: pyelonephritis

Slow flow, hesitancy, terminal dribbling, incomplete emptying, nocturia: enlarged prostate (Benign Prostatic Hypertrophy, prostate cancer)

Painless frank haematuria: consider bladder cancer

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13
Q

Identify symptoms of upper urinary tract obstruction, as well as potential causes for it.

A
  • Dull ache in flank/loin
  • Polyuria → Anuria

-Causes: tumour (renal, ureter), stricture, calci

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14
Q

Identify symptoms of bladder outlet obstruction, as well as potential causes for it.

A
  • Hesitancy
  • Poor stream
  • Terminal dribbling
  • Sense of incomplete emptying
  • Possible retention (+overflow)
  • Infection

-Causes: benign prostatic hypertrophy, prostate cancer, pelvic tumor (gynae)

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15
Q

Identify possible symptoms to enquire about in a man’s reproductive system medical history.

A
  • Urethral discharge
  • Testicular pain
  • Testicular lumps
  • Joint, eye, GI symptoms
  • Rash/ulcers
  • Itch
  • Smell
  • Infertility/Fertility problems
  • Urinary symptoms
  • Abdominal pain
  • Systemic upset
  • Partner affected ?
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16
Q

Identify possible questions about urethral discharge in men.

A

Amount, smell, boody ?

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17
Q

Identify possible questions about testicular pain.

A

Any link to trauma ?
Link to other illness ?
Speed of onset/severity ?
Associated swelling/redness/tenderness ?

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18
Q

Identify possible questions about testicular lumps.

A
  • Unilateral/bilateral
  • Location
  • Associated symptoms ?
  • Hard/soft
  • Regular/irregular
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19
Q

What is a possible diagnosis with testicular lumps ?

A

Testicular cancer

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20
Q

What is a possible diagnosis with joint/eye/GI symptoms for men ?

A

If associated with urethral discharge, consider Reiter’s syndrome

21
Q

What is a possible diagnosis with genital rash/ulcers ?

A

Consider genital herpes (HSV)/genital warts (HPV, vesicular rash)

22
Q

Identify possible questions about itches as a reproductive issue for men ?

A

Associated rash ?

Discharge ?

23
Q

Identify possible questions to ask about infertility/fertility problems ?

A

> 12 months ?

Any children with previous partners ?

24
Q

Identify any common/serious presentations of reproductive problems, stating what each indicates.

A
  • Pelvic, perineal or scrotal pain, fever, systemic upset: acute prostatitis
  • Chronic pelvic/perineal/scrotal pain and urinary symptoms: chronic prostatitis
  • Discharge, dysuria, other urinary symptoms: urethritis (either STI or UTI)
  • Painless hard swelling of body or testis: consider testicular cancer
  • Acutely painful swollen unilateral testicle: consider testicular torsion
25
Q

Identify possible symptoms to enquire about in a woman’s reproductive system medical history.

A
  • Dyspareunia = painful intercourse
  • Dysmenorrhea = painful periods
  • Menorrhagia = heavy periods
  • Inter Menstrual Bleeding (IMB) = bleeding between periods
  • Post Menopausal Bleeding (PMB) = bleeding after the menopause (occurring after 12 months of amenorrohea)
  • Post coital bleeding = bleeding after coitus
  • Vaginal dryness
  • Itch
  • Smelly
  • Rash
  • Infertility/fertility problems
  • Urinary symptoms
  • Abdominal/pelvic pain, or pain around perineum
  • Any possibility of pregnancy ? (ask for last menstrual period)
  • Systemic upset (including fever)
  • Partner affected ?
  • Smear history
26
Q

Identify the main types of dyspareunia.

A
  • Deep

- Superficial

27
Q

Identify possible questions to ask about menorrhagia.

A

Passing clots ?

Any flooding ?

28
Q

Identify possible questions to ask about itches in women (reproductive system presenting complaint).

A

Any associated rash ?

Discharge ?

29
Q

Give an example of a disease causing poor vaginal smell.

A

Bacterial vaginosis (fishy)

30
Q

What is the importance of smear history in the history of presenting complaint of the reproductive system in women ?

A

Missed smears, can result in missed pathologies

31
Q

Identify possible questions to enquire about in a woman’s menstrual history.

A
  • Age at menarche
  • Age at menopause (if relevant)
  • Last menstrual period (LMP)
32
Q

What is the average age of menarche ?

A

12 years and 11 months

33
Q

What are possible abnormalities in the age of menarche, and what may each indicate ?

A

Primary amenorrhea if absence of periods at:

  • 14 with absence of secondary sexual characteristics
  • 16 with presence of secondary sexual characteristics

Secondary amenorrhea if had periods but now stopped for 6 consecutive months

34
Q

What is the average age of menopause ?

A

51 (usually between 45 and 55)

35
Q

What is a possible abnormality in the age of menopause, and what may each indicate ?

A

Menopause before 40 = premature menopause or premature ovarian insufficiency

36
Q

When establishing usual menstrual cycle, how is this usually expressed ? Give average values for this.

A

Expressed as x/y, where:
x = usually length of each period
y = number of days from the start of one period, to the start of the next (usually 21 to 35, average is 28)
Average x / y is 5 / 28

37
Q

What is a normal amount of blood loss per period occurrence ?

A

50-200 mL, average is 70 mL

38
Q

Identify a possible sign that a woman has been experiencing heavy loss in her periods.

A
  • Use of pads/tampon

- Presence of clots

39
Q

Identify possible questions to enquire about in a woman’s obstetric history.

A
  • Para ? (number of times that she has given birth to a foetus with a gestational age of 24 weeks or more)
  • Gravida ? (number of times a woman has been pregnant)
  • Difficulties getting pregnant ?
  • Any fertility treatment
  • Pregnancy complications ?
  • Mode of delivery ?
  • Post-natal complications (in self and baby)
40
Q

State what is meant by NVD.

A

Normal vaginal delivery

41
Q

State the para and gravida for the following:

Pregnant 3 times, 1 delivery at term, 1 early TOP and 1 early miscarriage.

A

Gravida 3 Para 1 (^+2)

42
Q

Identify any common/serious presentations of obstetric problems, stating what each indicates.

A
  • Unexpected bleeding = related to endometrial or cervical pathology
  • Post menopausal bleeding could be endometrial cancer
  • Bleeding in early pregnancy with right/left iliac fossa pain could be ectopic pregnancy
  • Cream PV discharge + itch + otherwise well, could be thrush
43
Q

Identify possible questions to ask as part of the psychosocial history.

A
  • Relationship details
  • Impotence/erectile dysfunction
  • Intercourse and sexual practices
  • Libido
  • Orgasms
  • Associated symptoms
  • Contraception
44
Q

Identify examples of types of contraception..

A
  • Male condom
  • Female condom
  • Intrauterine device (IUD)
  • Combined oral contraceptive
  • Sterilisation
  • Coitus interruptus
45
Q

In the context of a GU patient history taking, what questions can be asked in the past medical history ?

A
  • Vascular disease, inflammatory diseases
  • Urinary tract stones
  • Previous STIs
  • Previous ectopic injury
  • Recurrent UTIs
  • Renal disease (dialysis, transplant)
  • Cancer/chemo treatment (can affect fertility)
46
Q

What are drugs which one should pay particular attention to in the drug history as part of GU history taking ?

A
  • Drugs that cause renal impairment
  • Drugs associated with sexual dysfunction
  • Contraceptive pills
  • Hormone replacement therapy
47
Q

What are illness which one should pay particular attention to in the family history as part of GU history taking ?

A
  • Renal disease (e.g. kidney failure, polycystic kidney disease)
  • GU malignancies
48
Q

What are aspects which one should pay particular attention to in the social history as part of GU history taking ?

A
  • Exposure to chemical carcinogens (bladder cancer)
  • Foreign travel (schistosomiasis)
  • Dehydration during a travel in hot climate (impact on kidneys)
  • Non prescription drugs (e.g. effect of cannabis on sexual function)
  • Working in hot environment (e.g. kitchens, and effect on male fertility)

MD3002 (95 decks)

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