Quick revise Flashcards
Glycolysis
Occurs int he cytosol of cells
Glucose (C6) – > Pyruvate (2 x C3)
–> Acetyl-coA which can enter the citric acid cycle.
Net ATP gain = 2 ATP (4 produced, 2 used).
NADH plus H+ produced = 2 molecules per glucose.
pelvic floor muscles
coccygeus (back)
levator ani (lat to med)
iliococcygeus
pubococcygeus
puborectalis
Obesity and EC
LNG-EC – double dose if BMI>26 or >70kg
Bosentan
used to treat pulmonary arterial hypertension
ERA – endothelial receptor antagonist
decreases prog and eostro levels in contra
VTE risk and progesterones
Doubles the risk (9-10 in 10,000)
Baseline VTE risk = 2 in 10,000
Pregnancy & puerperium = 20 in 10,000
Lower risk progestogens (6 in 10,000)
Levonogestrel
Norethisterone
Norgestimate
Moderate risk progestogens (8 in 10,000)
Etonogestrel
Norelgestromin
Higher risk progestogens (10 in 10,000)
Desogestrel
Gestodene
Drospirenone
What oestrogen does zoely and qlaria use
oestradiol valerate
Zeoly: Nomegestrol acetate progestin
Qlaria: Dienogest progestin
First line COCP
A monophasic COC containing
20 - 35 micrograms of ethinylestradiol
norethisterone or levonorgestrel
Dianette components
Ethinylestradiol 35
Cyproterone acetate 2000
UKMEC Known BRCA1/2 mutation
CHC: UKMEC 3
All other hormonal forms UKMEC 2
Filshie clip
Titanium clip lined with silicone
UKMEC Hx of bariatric surgery
All 1 other than CHC
BMI <30 = 1
BMI 30-34 =2
BMI >34 = 3
UKMEC Organ transplant
a) Complicated: graft failure (acute or
chronic), rejection, cardiac allograft vasculopathy
Coils UKMEC 3 initiation/ 2 continuation
CHC UKMEC 3
b) Uncomplicated
UKMEC 2 for all
UKMEC CVD
RFs
Known dislipidaemia
Cardiomyopathy
AF
QT
RF multiple:
DMPA and CHC: UKMEC 3
All other methods (other than copper):UKMEC 2
Known dislipidaemia
UKMEC 2 (other than copper)
Cardiomyopathy
Normal cardiac fx: CHC UKMEC 2, all UKMEC 1
Impaired cardiac fx: CHC UKMEC 4, all UKMEC 2
AF
CHC UKMEC 4, Copper UKMEC 1, rest UKMEC 2
Known long QT
Coils UKMEC 3 initiation/ 1 continuation
DMPA and CHC UKMEC 2
IIH UKMEC
CHC 2, rest 1
GC VS CT infectivity
Single episode of UPSI
M->F spread
GC: 60-80% (40% with condom) 40/60/80
CT: 10% transmission rate (75% concordance within partners, condoms reduce by 40%)
F->M spread
GC: 20% (5% with condom)
CT: 10% same as above
Men symptoms and complications GC
Only 5-10% asymptomatic
Typical incubation of 2-5 days (up to 14)
Urethral discharge in 80%, typically profuse and purulent; dysuria in 50%
Complications are rare
(1) Infection of the median raphe (line down middle of scrotum -> perineum)
(2) Tysonitis – swollen parafrenal gland/s
(3) Meatal gland abscess / peri-urethral cellulitis/ abscess -> strictures and fistulae if left
(4) Epididymitis in <1%
Note: MSM: FVU, pharyngeal and rectal swabs all recommended even if no history of RAI
Women symptoms and complications GC
Women ~50% symptomatic vs asymptomatic
When present, symptoms usually appear within 10 days
Increased vaginal discharge, which again may be purulent, most common symptom
Dysuria without frequency, lower abdominal discomfort and less often IMB/ menorrhagia
Complications are rare
(1) Inflamed paraurethral (Skene) glands
(2) Bartholin’s abscess
(3) PID may develop in 10-20% of cases if left untreated
GC rectal
usually asymptomatic but can cause discharge (12%), pain or itching
In women: + rectal GC, + correlation with length of infection suggests transmucosal spread to rectal infection, with anal intercourse thought to be attributable in only ~10%
GC pharyngeal
asymptomatic in >90% of cases with almost 100% spontaneous clearance in 3 /12
Strongest association with disseminated infection
GC Conjunctival infection
Conjunctival infection in adults is rare and can present with purulent discharge and -> keratitis and blindness
GC disseminated infection
Occurs in <1%
4 x more likely in women, especially if recent menstruation, in pregnancy, and pharyngeal infection (which is likely to have been asymptomatic)
Skin signs in 67% - ‘gonococcal dermatitis’ – petechiae, necrotic pustules usually at extremities
Tenosynovitis in ~ 1/3 of cases -> migratory arthralgia
Rarely: endocarditis, hepatitis, meningitis
GC microscopy endocervical vs urethral vs proctoscopic
Endocervical microscopy sensitivity of only 45% - not routinely recommended for asymptomatic but should be performed if symptoms
Microscopy of urethral smears has good sensitivity for those with symptoms (95%) so is recommended -> POC diagnosis and treatment facilitation
Sensitivity less good for asymptomatic (65%) therefore not recommended here
Proctoscopy and microscopy 75% sensitivity»_space;> blind swab microscopy only 40% sensitivity
Listeria
non-spore forming Facultative anaerobe
GRAM POSITIVE bacilli
obligate anaerobes
If you are asked about obligate anaerobes you are likely dealing with either:
Clostridium gram positive
Bacteroides (also called Prevotella) gram negative
Actinomyces not appropriately classified : Actinomyces mostly facultative, one strain is an obligate anaerobe