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OSCE Flashcards

1
Q

Haematuria history HPC

A

HPC == CLots

  • CLarify exactly when, colour, beetroot?
  • Onset when did you first notice it
  • Timing always there or come and go
  • Severity do you pass any clots
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2
Q

Haematuria history associated symptoms

A

Associated symptoms

  • Pain == SOCRATES
  • Frequency , has this changed do you have sudden urge
  • Nocturia
  • Urinary stream
  • Constitutional , any general unwellness
  • Renal failure , gained weight, swollen ankles
  • Glomerulonephritides, sore throat, rashes, joint ache
  • Pulmonary- renal conditions , coughed up blood
  • Trauma , stomach, groin trauma

ICE

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3
Q

Haematuria history SHX, PMH, DHX etc

A

PMH

  • UTI, prostate renal bladder cancer
  • BPH
  • Diabetes
  • HTN
  • Catheter

Drug history

  • Any regular meds
  • Allergies

Family history

  • Renal disease
  • PKD
  • Haematuria

SHX

  • Smoke
  • Worked with industrial chemicals or dyes
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4
Q

Important points haematuria

A

Always clarify colour
Clots = unlikely to be glomerular cause
Always clarify timing (initial, middle, terminal)
Poor stream suggests obstruction

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5
Q

Haematuria DDX considerations

A

Gross or microscopic

Gross- tends to be lower lesion higher likelihood of malignancy so investigated more vigorously

Microscopic is more common and only warrants further investigation if recurring or associated with UTI symptoms

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6
Q

Haematuria DDX Carcinoma

A

Renal cell carcinoma

  • triad of flank pain, haematuria and abdominal mass
  • constitutional symptoms
  • May present with paraneoplastic syndrome excess renin, parathyroid hormone and EPO

TCC

  • Painless intermittent haematuria in older males, worrying sign
  • Working with industrial dyes, smoking
  • Schistosomiasis
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7
Q

Haematuria DDX renal calculi

A

Renal calculi

  • Classic acute excruciating pain radiates from loin to groin, with N&V
  • Men in 30’s- 50’s
  • Pain is more constant than biliary colic, but can have period of dull ache
  • Most cases are actually found asymptomatically
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8
Q

Haematuria DDX UTI

A

Cystitis

  • typically urinary frequency, urgency and pain
  • fever
  • urethral discharge
  • Cloudy and foul odour urine
  • More common in women and elderly, may just have delirium
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9
Q

Haematuria DDX glomerulonephritis

A 
Many different causes 
may have preceding URTI, streptococcal nephropathy
IgA nephropathy 
Haemoptysis - Goodpastures
Rash and systemic features- vasculitis
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10
Q

Management haematuria

A

frank haematuria requires urgent referral to urology

bladder cancer = transurethral resection for superficial tumours

RCC- nephrectomy

Renal calculi - < 5mm usually pass on own, extracoporeal lithotripsy or endoscopic removal for medium stones

Nephrotic syndrome- treat cause eg furosemide, acei ccb to control fluid retention

Rapidly progressive glomerulonephritis, high dose steroids and cyclophosphamide

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11
Q

Dysuria HPC and urinary history

A

o’ SOCRATES

Frequency - and volume passed
Urgency 
Colour, blood
Discharge, colour, volume, smelly= sexual history 
Fever
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12
Q

Urological history men and women

A

Men

  • Urinary stream , start, power, dribbling
  • Nocturia
  • Prostatitis- ejaculation painful?

Women

  • Menopause?
  • Dysmenorrhoea
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13
Q

Dysuria abdo history

A

Abdo pain - socrates
Calculi - stones?
Painful bowel motions
Diarrhoea

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14
Q

Dysuria PMH, SHX, DH etc

A

PMH

  • UTI, STI, renal calculi
  • arthritis and conjuctivitis
  • Catheter

DH

  • Medications
  • allergies

SHX

  • does your partner have any similar symptoms
  • Occupation
  • Smoking and drinking
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15
Q

Dysuria overview

A 
o SOCRATES
urinary history
male/female
abdo
PMH etc
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16
Q

Haematuria overview

A

HPC clots
Associated symptoms
PMH etc

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17
Q

Dysuria important points

A

Always tailor history to the individual eg 20 yo vs 60 yo
Pain at start suggests urethritis
Pain at the end suggests cystitis

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18
Q

DDX dysuria UTI

A

Cystitis

  • typically urinary frequency, urgency and pain
  • fever
  • urethral discharge
  • Cloudy and foul odour urine
  • More common in women and elderly, may just have delirium
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19
Q

DDX dysuria pyelonephritis

A

Very unwell, fever rigors nausea and vomiting flank pain radiates to the back
Dysuria, frequency, urgency etc may be present

20
Q

DDX dysuria STI

A

discharge common
history of new partner or unprotected sex
history of painful sex, painful ejaculation, prostatitis
Symptoms of reactive arthritis

21
Q

DDX dysuria endometriosis

A

Cyclical pelvic pain which crescendos before menstruation and then dissipates
Dyspareunia, dysmenorrhoea, subfertility

22
Q

DDX dysuria renal calculi

A

Renal calculi

  • Classic acute excruciating pain radiates from loin to groin, with N&V
  • Men in 30’s- 50’s
  • Pain is more constant than biliary colic, but can have period of dull ache
  • Most cases are actually found asymptomatically
23
Q

DDX dysuria BPH

A

Urinary frequency and nocturia with obstructive symptoms = hesitancy, weak stream and dribbling
Incomplete bladder emptying causes continuous urge to go
Dysuria secondary to UTI due to urinary stasis

24
Q

Dysuria management

A

UTI - trimethoprim
Pyelonephritis - antibiotics
STI - refer to GUM give one off AB and start contact tracing
BPH - alpha blockers to relax sphincters and 5 alpha reductase inhibitor (reduce androgen ADT)

25
Q

Polyuria HPC

A

Urinary history

  • Onset
  • frequency
  • Nocturia
  • Amount
  • Thirst
  • Dysuria
  • Haematuria and discharge
  • Urge incontinence
26
Q

Polyuria urological history men and women

A

Men

  • urinary stream
  • prostatitis ejaculation and defaecation pain

Women

  • Prolapse, dropping sensation from pelvis, anything protruding
  • Obstetric history complicated, large?
  • Menopause
27
Q

Polyuria endo history

A

Abdo pain if so SOCRATES

Constitutional, weight loss, appetite, fever etc

28
Q

Polyuria PHM etc

A

PMH
- diabetes

DH

  • diuretics
  • allergies

FH

  • diabetes
  • renal conditions

SHX

  • smoke
  • drink
  • alcohol
29
Q

Polyuria overview

A

Urinary history
Urological history men/women
endo
PMH etc

30
Q

Polyuria important points

A

Polyuria is defined clinically as production of more than 3L urine in 24 hours this is very difficult to measure so may be best using a voiding diary

31
Q

Polyuria DDX UTI

A

dysuria, frequency and urgency
fever and discharge
may be frothy with foul odour, may contain blood
often in women and elderly with only delirium as presenting complaint

32
Q

Polyuria DDX hyperactive bladder

A

severe urgency, nocturia, incontinence and frequency

Past history of neurological disease, eg Parkinsons, stroke, spinal cord disease

33
Q

Genitourinary prolapse

A

older women
multiple vaginal deliveries
hysterectomy
frequency, recurrent UTIs, stress incontinence, fullness sensation in vagina

34
Q

Polyuria DDX BPH

A

frequency, nocturia and hesitancy = ( weak stream, trouble starting and terminal dribbling)
incomplete bladder emptying gives continuous urge to go

35
Q

Polyuria DDX Diabetes mellitus

A

Polydipsia, polyuria, abdominal pain, nausea and vomiting, pear drop breath in DKA
Often family history

36
Q

Polyuria DDX Diabets insipidus

A

Polydipsia and polyuria
Huge quantities of very dilute urine
Nocturia often present and bothersome
No signs of infection, irritative disorder

37
Q

Polyuria DDX

A 
UTI
vaginal prolapse
Diabetes M
Diabetes I
Hyperactive bladder
BPH
38
Q

Haematuria DDX

A 
Renal cell carcinoma
Transitional cell carcinoma 
Renal calculi
UTI
Glomerulonephritis
39
Q

Dysuria DDX

A 
UTI
Pyelonephritis
BPH
STI
Endometriosis 
Renal calculi
40
Q

Polyuria Management

A

Diabetes M- diet or insulin
Diabetes I - careful regular fluids, step up to exogenous ADH
DKA- fluid and electrolyte resus insulin until glucose level is controlled
Genitourinary prolapse - vaginal pessaries, surgery to tighten up ligaments
Hyperactive bladder- pelvic floor exercises, cut out caffeine and alcohol, botox if refractory
Diuretics- take in morning if have to

41
Q

Male genital exam steps

A

General inspection

  • skin, eyes, joints
  • lower abdomen, femoral and inguinal (bear down), scrotum bear down.

Palpation standing
- scrotum bear down and lumps swellings

Palpation supine

  • testicle size, surface, mobility
  • epididymis
  • vas deferens
  • lumps/mass, palpate, tender, impulse, transillumabillity, cough impulse
  • penis
  • foreskin
  • meatus
  • frenulum
  • corona

Lymph nodes
- inguinal, sub inguinal, medial thigh

Femoral pulses

42
Q

Gyanecological exam steps

A

Intro

  • ask allergies, emptied bladder
  • position light, use latex free gloves

Inspection

  • warts, ulcers, masses
  • vulvitis
  • prolapse, ask to bear down, and for stress incontinence
  • discharge
  • swelling

Bimanual palpation

  • Lubricant
  • behind cervix and push up while pushing down on abdomen, size, shape and position, mobility
  • adnexae, masses and tenderness
  • cervix, tenderness, polyps, masses, consistency, closed/open os
43
Q

Speculum examination steps

A

Warm speculum
water/lubricant gel to speculum

Inspect vagina
- masses, swellings, warts, discharge

Cervix

  • nulliparous, ectropion, masses, polyps
  • nabothian cysts (ecto growing over endo)
  • discharge
  • bleeding

Swabs - take from endocervical and high vaginal
Smear test ALWAYS WARN ABOUT SPOTTING / SLIGHT BLEEDING AFTERWARDS

44
Q

Male catheterisation equipment

A 
apron 
sterile gloves
catheter pack
catheter
collection bag
50ml syringe
10ml water
Instillagel
antiseptic fluid

Have smaller catheter nearby
2x bins

45
Q

Male catheterisation steps

A

Intro
clean hands
position patient
put on apron
unpack catheter pack
put in catheter, syringe, water, collecting bag into sterile field
pour in antiseptic gel
wash hands
put on sterile gloves
Prepare equipment caps
Expose patient
put on sterile drape over penis hold penis with dirty hand, retract foreskin and clean with wipe
Insert anaesthetic instillagel and wait 5 mins
Introduce catheter tip and move in gradually with non touch technique
Once fully in check urine outflow push on bladder and use syringe if necessary
Inflate balloon
Attach catheter bag
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