urogenital Flashcards
what can cause increased urinary frequency?
irritable bladder: infection, inflammation, chemical irritation
less compliant: fibrosis, tumour infiltration
bladder outflow obstruction
what are the different types of urinary incontinence?
urge: urgency and frequency, due to detrusor instability. motor or sensory
stress: increased abdo pressure e.g. coughing
what does the location of the pain say about the potential cause?
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
what past medical hx is relevant to urological hx?
UTIs, gout, diabetes, htn (damages kidneys), cv or cerebrovascular disease
what medications need to be considered in urological hx?
analgesic abuse=renal failure
tetracycline, aminoglycoside abx and nsaids worsen renal function
rifampicin=red urine
tricyclic antidepressants and lithium=incontinence
why is it important to ask about pain with haematuria?
painless=bladder malignancy
loin or ureteric colic=stone or clot
suprapubic pain=bladder stone
why is bloods place in the stream important?
end=prostate or bladder base
throughout=bladder or above
start then clear=urethral lesion
what is the commonest cause of multiple painful genital ulcers?
herpes simplex infection
what can cause dyspareunia (painful intercourse)?
infection, endometriosis, vaginal dryness, psychological factors
what causes and increased in vaginal discharge?
physiological=puberty, pregnancy, ovulation, combined oral contraceptive
pathological=infection, foreign body, ectropion, polyp, maligancy
why is the colour of vaginal discharge important?
thick white=candida thin grey=bacterial vaginosis green frothy=trichomonas ehite/yellow=gonorrhoea watery/non=chlamydia bloody=ectropion, endocervical polyp
what are the common features of a fibroadenoma?
highly mobile, rarely painful, smooth, rubbery, small, sometimes multiple
what are the features of a breast carcinoma?
rarely painful, irregular, hard, tethering of skin, nipple changes, bloody discharge, lymphadenopathy, fhx, >55, wt loss
what are the features of breast fibroadenosis?
cyclical breast pain, smooth, firm, nipple disk white, single/multiple lumps or generally nodular
what are some causes of gynaecomastia?
genetic, oestrogen, cirrhosis, CCB, marijuana, alcoholism, spironolactone, testicular/adrenal tumour, isoniazid, antineoplastics
physiological: neonate, puberty, old age
what are some lower urinary tract sx?
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)
what is important in a hx of haematuria?
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
what are some sx of uti?
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
give sx of chronic renal failure.
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
what drug hx is important?
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
what social hx is important?
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
what fhx is important?
As any medical history however do focus on any familial renal or urological condition for
example Polycystic kidney disease is familial
