History Taking: GU

Question 1

causes of oliguria and anuria

Answer 1

• consider obstruction: suprapubic pain with intense desire to urinate
• consider hypovolaemia: dry/dehydrated
• consider AKI/renal failure

Question 2

Dysuria, frequency, urgency, suprapubic discomfort: consider

Answer 2

UTI, cystitis

Question 3

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

Answer 3

pyelonephritis

Question 4

Slow flow, hesitancy, incomplete emptying, dribbling, nocturia: consider

Answer 4

enlarged prostate (Benign Prostatic Hypertrophy, prostate cancer)

Question 5

Painless frank haematuria

Answer 5

bladder cancer

Question 6

Symptoms of urinary tract obstruction - upper

Answer 6

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

Question 7

ymptoms of urinary tract obstruction - outlet

Answer 7

• Hesitancy
• Poor stream
• Terminal dribbling
• Sense of incomplete emptying 
• Possible retention (+ overflow) 
• Infection
• Causes, e.g:
– Benign prostatic hypertrophy
– Prostate cancer
– Pelvic tumour (gynae)

Question 8

Human Papilloma Virus

Answer 8

Genital warts

Question 9

Herpes Simplex Virus

Answer 9

Genital herpes (vesicular rash)

Question 10

Pelvic, perineal or scrotal pain, fever, systemic upset: consider

Answer 10

acute prostatitis

Question 11

Chronic pelvic/perineal/scrotal pain and urinary symptoms: consider

Answer 11

chronic prostatitis

Question 12

Discharge, dysuria, other urinary symptoms: consider

Answer 12

urethritis (either STI or UTI)

Question 13

Painless hard swelling of body of testis: consider

Answer 13

testicular tumour

Question 14

Acutely painful swollen unilateral testicle: consider

Answer 14

testicular torsion

Question 15

Ageatmenarche

Answer 15

– Average age in the UK is 12 years 11 months
– Consider primary amenorrhoea if no period by age 14 years (in the absence of secondary sexual characteristics), or 16 (if other features are developing normally)
– Secondary amenorrhoea; had periods but now stopped for 6 consecutive months

Question 16

• If relevant, age at menopause

Answer 16

– Usually occurs between 45 and 55 years of age; average
age is 51
– Menopause before 40 years of age = premature menopause or premature ovarian insufficiency

Question 17

Gravida

Answer 17

number of times a woman has been

pregnant

Question 18

Para

Answer 18

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

Question 19

Unexpected bleeding can be related to

Answer 19

endometrial or cervical pathology

Question 20

Bleeding in early pregnancy with RIF/LIF pain –

consider

Answer 20

ectopic

Question 21

Creamy PV discharge + itch, otherwise well – consider

Answer 21

thrush

Question 22

Psycho Sexual History

Answer 22

– Relationship details
– Impotence / erectile dysfunction
– Intercourse and sexual practices
– Libido
– Orgasm
– Associated symptoms\\

Contraception

Question 23

Past Medical History

Answer 23

• HT, DM, vascular disease, inflammatory diseases
• Any previous GU illness
• Urinary tract stones
• Previous STIs
• Previous Pelvic Inflammatory Disease
• Previous ectopic pregnancy
• Previous testicular problems; such as torsion, tumour, undescended testes
• Recurrent UTIs
• Renal disease; including ARF, CRF, dialysis and transplantation
• Previous surgery
• Neurological disease
• Cancer / chemo treatment (can affect fertility) and prior malignancy

Question 24

Drug History

Answer 24

• Long term meds
• Recent changes
• Names of contraceptive pills
• HRT
• Drugs that cause renal impairment
• Drugs associated with sexual dysfunction
• OTC meds
• NSAIDs

Question 25

Social History

Answer 25

• 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