urogenital

Question 1

what can cause increased urinary frequency?

Answer 1

irritable bladder: infection, inflammation, chemical irritation
less compliant: fibrosis, tumour infiltration
bladder outflow obstruction

Question 2

what are the different types of urinary incontinence?

Answer 2

urge: urgency and frequency, due to detrusor instability. motor or sensory
stress: increased abdo pressure e.g. coughing

Question 3

what does the location of the pain say about the potential cause?

Answer 3

rena angles: plus urinary symptoms and systemic illness=pyelonephritis
loin pain=renal stones
colicky pain from loin to groin: also N+V, sweeating=ureteric stones.
dull suprapubic discomfort: also dysuria and freq=bladder stones

Question 4

what past medical hx is relevant to urological hx?

Answer 4

UTIs, gout, diabetes, htn (damages kidneys), cv or cerebrovascular disease

Question 5

what medications need to be considered in urological hx?

Answer 5

analgesic abuse=renal failure
tetracycline, aminoglycoside abx and nsaids worsen renal function
rifampicin=red urine
tricyclic antidepressants and lithium=incontinence

Question 6

why is it important to ask about pain with haematuria?

Answer 6

painless=bladder malignancy
loin or ureteric colic=stone or clot
suprapubic pain=bladder stone

Question 7

why is bloods place in the stream important?

Answer 7

end=prostate or bladder base
throughout=bladder or above
start then clear=urethral lesion

Question 8

what is the commonest cause of multiple painful genital ulcers?

Answer 8

herpes simplex infection

Question 9

what can cause dyspareunia (painful intercourse)?

Answer 9

infection, endometriosis, vaginal dryness, psychological factors

Question 10

what causes and increased in vaginal discharge?

Answer 10

physiological=puberty, pregnancy, ovulation, combined oral contraceptive
pathological=infection, foreign body, ectropion, polyp, maligancy

Question 11

why is the colour of vaginal discharge important?

Answer 11

thick white=candida
thin grey=bacterial vaginosis
green frothy=trichomonas
ehite/yellow=gonorrhoea
watery/non=chlamydia
bloody=ectropion, endocervical polyp

Question 12

what are the common features of a fibroadenoma?

Answer 12

highly mobile, rarely painful, smooth, rubbery, small, sometimes multiple

Question 13

what are the features of a breast carcinoma?

Answer 13

rarely painful, irregular, hard, tethering of skin, nipple changes, bloody discharge, lymphadenopathy, fhx, >55, wt loss

Question 14

what are the features of breast fibroadenosis?

Answer 14

cyclical breast pain, smooth, firm, nipple disk white, single/multiple lumps or generally nodular

Question 15

what are some causes of gynaecomastia?

Answer 15

genetic, oestrogen, cirrhosis, CCB, marijuana, alcoholism, spironolactone, testicular/adrenal tumour, isoniazid, antineoplastics
physiological: neonate, puberty, old age

Question 16

what are some lower urinary tract sx?

Answer 16

Filling: urgency, frequency, nocturia
Voiding: dysuria (pain), hesitancy, poor flow, incomplete emptying, dribbling (terminal/postmicturition), straining to urinate, spraying of urine
Incontinence: stress, urge, overflow, continuous, enuresis (nocturnal bedwetting)

Question 17

what is important in a hx of haematuria?

Answer 17

Duration,
Timing within the stream (initial/continual/terminal),
Presence of clots
Pain (painful haematuria may suggest a renal calculus or infection; painless
haematuria, may suggest a carcinoma of the kidney or bladder, or prostatic
bleeding)
Fever and rigors
Trauma / exercise

Question 18

what are some sx of uti?

Answer 18

Dysuria
Frequency
Urgency
Strangury - Painful passage of small quantities of urine which are expelled slowly by
straining with severe urgency; it is usually accompanied with the sensation of
incomplete micturition.
Fever
Acute confusion (especially in the elderly

Question 19

give sx of chronic renal failure.

Answer 19

Oliguria
Nocturia
Polyuria (increased volume of urine production secondary to the urea solute load)
Anorexia
Insomnia
Metallic taste in the mouth
Vomiting
Anaemia (due to erythropoietin deficiency)
Fatigue
Pruritis
Oedema
Bruising and bleeding due to abnormal platelet function
Sallow complexion (yellow-grey tinge)
Uraemic fetor

Question 20

what drug hx is important?

Answer 20

Certain medication can affect the colour of the urine (e.g. rifampicin).
Enquire about allergies to iodine if contrast is to be used for investigations

Question 21

what social hx is important?

Answer 21

Smoking, alcohol, travel, occupation (full history as certain industries e.g. rubber and dyes
may lead to renal and/or bladder cancer), sexual history.
Enquire about diet. Does the patient eat excessive beetroot as it can colour the urine red

Question 22

what fhx is important?

Answer 22

As any medical history however do focus on any familial renal or urological condition for
example Polycystic kidney disease is familial