Genitourinary History Flashcards
Define what the following means:
- Dysuria
- Haematuria
- Nocturia
- Anuria
- Oliuria
- Polyuria
- 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
What are symptoms to ask about with respect to urination ? (i.e. which questions would you ask)
♦ 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…)
Distinguish between microscopic and macroscopic haematuria.
Micro= patients won’t know, need to pick it up with urine dip stick test
Macro (i.e. frank)= patients notice it
What is polyuria defined that in terms of liters ?
Greater than 2.5-3 L in 24 hours
Identify possible causes of anuria and oliguria.
- Obstruction (if suprapubic pain with intense desire to micturate)
- HypoV (if dry/dehydrated)
- Acute Kidney Injury/Renal failure
What must a doctor do next if a patient mentions they have been feeling pain ?
Ask SOCRATES questions
Identify and describe the main types of incontinence.
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
Explain the importance of asking about catheters as part of the GU medical history.
Risk of infection is significant
Define intermittent self catheterisation.
Patient puts it in when need to pass urine
True or false: urine dip will always be + for infection with a catheter (without it meaning there necessarily is an infection).
True.
What are possible associated symptoms in addition to the GU symptoms mentioned ?
Vomiting Nausea Fatigue Malaise Anorexia Weight Loss
Identify common/ serious presentations of urinary problems, and what they indicate.
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
Identify symptoms of upper urinary tract obstruction, as well as potential causes for it.
- Dull ache in flank/loin
- Polyuria → Anuria
-Causes: tumour (renal, ureter), stricture, calci
Identify symptoms of bladder outlet obstruction, as well as potential causes for it.
- Hesitancy
- Poor stream
- Terminal dribbling
- Sense of incomplete emptying
- Possible retention (+overflow)
- Infection
-Causes: benign prostatic hypertrophy, prostate cancer, pelvic tumor (gynae)
Identify possible symptoms to enquire about in a man’s reproductive system medical history.
- 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 ?
Identify possible questions about urethral discharge in men.
Amount, smell, boody ?
Identify possible questions about testicular pain.
Any link to trauma ?
Link to other illness ?
Speed of onset/severity ?
Associated swelling/redness/tenderness ?
Identify possible questions about testicular lumps.
- Unilateral/bilateral
- Location
- Associated symptoms ?
- Hard/soft
- Regular/irregular
What is a possible diagnosis with testicular lumps ?
Testicular cancer
What is a possible diagnosis with joint/eye/GI symptoms for men ?
If associated with urethral discharge, consider Reiter’s syndrome
What is a possible diagnosis with genital rash/ulcers ?
Consider genital herpes (HSV)/genital warts (HPV, vesicular rash)
Identify possible questions about itches as a reproductive issue for men ?
Associated rash ?
Discharge ?
Identify possible questions to ask about infertility/fertility problems ?
> 12 months ?
Any children with previous partners ?
Identify any common/serious presentations of reproductive problems, stating what each indicates.
- 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
Identify possible symptoms to enquire about in a woman’s reproductive system medical history.
- 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
Identify the main types of dyspareunia.
- Deep
- Superficial
Identify possible questions to ask about menorrhagia.
Passing clots ?
Any flooding ?
Identify possible questions to ask about itches in women (reproductive system presenting complaint).
Any associated rash ?
Discharge ?
Give an example of a disease causing poor vaginal smell.
Bacterial vaginosis (fishy)
What is the importance of smear history in the history of presenting complaint of the reproductive system in women ?
Missed smears, can result in missed pathologies
Identify possible questions to enquire about in a woman’s menstrual history.
- Age at menarche
- Age at menopause (if relevant)
- Last menstrual period (LMP)
What is the average age of menarche ?
12 years and 11 months
What are possible abnormalities in the age of menarche, and what may each indicate ?
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
What is the average age of menopause ?
51 (usually between 45 and 55)
What is a possible abnormality in the age of menopause, and what may each indicate ?
Menopause before 40 = premature menopause or premature ovarian insufficiency
When establishing usual menstrual cycle, how is this usually expressed ? Give average values for this.
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
What is a normal amount of blood loss per period occurrence ?
50-200 mL, average is 70 mL
Identify a possible sign that a woman has been experiencing heavy loss in her periods.
- Use of pads/tampon
- Presence of clots
Identify possible questions to enquire about in a woman’s obstetric history.
- 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)
State what is meant by NVD.
Normal vaginal delivery
State the para and gravida for the following:
Pregnant 3 times, 1 delivery at term, 1 early TOP and 1 early miscarriage.
Gravida 3 Para 1 (^+2)
Identify any common/serious presentations of obstetric problems, stating what each indicates.
- 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
Identify possible questions to ask as part of the psychosocial history.
- Relationship details
- Impotence/erectile dysfunction
- Intercourse and sexual practices
- Libido
- Orgasms
- Associated symptoms
- Contraception
Identify examples of types of contraception..
- Male condom
- Female condom
- Intrauterine device (IUD)
- Combined oral contraceptive
- Sterilisation
- Coitus interruptus
In the context of a GU patient history taking, what questions can be asked in the past medical history ?
- Vascular disease, inflammatory diseases
- Urinary tract stones
- Previous STIs
- Previous ectopic injury
- Recurrent UTIs
- Renal disease (dialysis, transplant)
- Cancer/chemo treatment (can affect fertility)
What are drugs which one should pay particular attention to in the drug history as part of GU history taking ?
- Drugs that cause renal impairment
- Drugs associated with sexual dysfunction
- Contraceptive pills
- Hormone replacement therapy
What are illness which one should pay particular attention to in the family history as part of GU history taking ?
- Renal disease (e.g. kidney failure, polycystic kidney disease)
- GU malignancies
What are aspects which one should pay particular attention to in the social history as part of GU history taking ?
- 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)
