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Let's just give her maybe two more minutes and then we can get her up. I know we've already got some people in um for those already watching. Um If you have a minute, if you don't mind scanning that QR Code, um, it takes you to a quick survey that we're doing on medical education at the moment. So we really appreciate it if you guys could fill that out and then we'll get started in a few minutes. All right, I think, let's get it started. So my name is Milly. I'm one of the F one doctors. I'm working in London and I'm gonna be running the first part of the session, um which is called a morning GP. So we're gonna go over some questions um and some scans and some cases that you likely encounter if you are working in GP practice or also if you write an exam, that's about GP start questions. And I've also got Sophia with me at the moment. Sophia's gonna have a look on the chat and um answer any questions and then as, as our session goes on, we're gonna have Aaron as well with us. He's one of our colleagues as well and we're gonna take turns and so we're running into sessions. Um Yeah, let's get started. So we have split this into three things. So um just very broad, any, anything that would really happen in GP anything you would see we're gonna cover today. Um So we have I created a family. So this is family. Um I've got a few cases based on the family members of this family. Um And let's meet our first patient. So um we've got Molly Molly t there on the rise. Um Molly is at this moment, she's 22. Um She's got a past medical history of epilepsy, um takes some antiepileptic drugs for it. Um But she doesn't have any drug allergies. Um She's a student. Um She lives in a, in a flat. Um She goes out on a weekend, she drinks but she doesn't really smoke. Um And yeah, now Molly comes to you. So this is question one, Molly comes to you and she has some vaginal discharge. Um sort of thin, white gray, thin, gray and it smells quite offensively the PS five. What diagnosis do you think is most likely? I'll give you guys a minute to think about that and answer the poll. Ok. I can see some answer. That's great to keep answering if you haven't already. Ok. Ok. Right. I think I've got a good number of answers in now. So I'm gonna skip ahead. So that we don't um get too bored. So we've got mostly A's and one B. So the correct answer is indeed A. So we'll answer the majority of people that got that right. Um And we're gonna talk about why it is a and not any of the other options. So BV, bacterial vaginosis. So this is as a lot of, you probably know it's not an STD, it's merely an overgrowth of some anaerobic organisms. So often the most common one you'll see in textbook is something called Gardnerella vaginalis. Um Essentially that overgrowth of bacteria decreases the number of lactobacillus. So lactobacilli is the bacteria that's usually found in the vaginal flora. Um And by the decreased number of d you get some symptoms. Um So you get this discharge, the discharge been usually described as quite fishy in smell, even though some women will say it's a bit different in smell. But so I've heard garlic before as well. Um It's originally quite thin and white. Um PH is higher because we get a decreased number of those um acidy bacteria. So PH is gonna rise um if you do microscopy, you're gonna see clue cells. Um And then there's also a positive rif test if you add um chemicals, it's very, very rarely done. Now, I think in sexual health practices, but um you reproduce essentially as fishy smell. Um Also it's asymptomatic in a lot of women. Um Yeah. So um management. So if someone is asymptomatic. Um, generally speaking, in a normal population, we wouldn't recommend any treatment. So, if a woman comes to you and what I've seen in practice is that they've had a private, a private screening, they've had a test and they tested positive for Gardnerella, but they're completely asymptomatic. You wouldn't necessarily treat them unless they're pregnant. Um, if they are symptomatic, um you want to treat them with metroNIDAZOLE, that's only your first line. Um, you can give a 2 g stat dose. So that's five tablets all at one. Generally speaking, or you can give sort of a lower dose for 5 to 7 days. Um, they're both pretty much equally effective. So generally speaking, um, what is preferred by a lot of people who work in sexual health is just a stat dose because metroNIDAZOLE can make you feel quite nauseous and sick. So it's usually better if you just get that over done within sort of one dose as opposed to a five day course. Um Also remember that you should not try not to drink any alcohol while you, while you drink metroNIDAZOLE as well. If you counsel your patient, um, if someone is pregnant, um, you can consider treating it even if they're asymptomatic, the treatment's the same. Um Just because, um, it's been sort of shown that there is a slight increased risk for preterm labor and low birth rate and miscarriages and things like that. Um So you would go back to your obgyn and, and see what they would advise to do and go, go into guidelines. Um Also make sure you counsel the women on sort of um risk factors and hygiene. So the most common one that you would counsel on would be things like um hygiene or not washing too much. So usually BV happens when women um use any th fresh products down there, for example, or when they um start cleaning inside your vagina when they use soap, um or dishing or anything like that because that gets rid of the good bacteria. Um So just tell them just to use water, um loose clothing if they can, um sometimes sex can trigger it as well and sometimes we just don't know. Um So good counseling is really key to make sure that they don't get this again. Um Yeah, that's it. I hope that was very clear. Um We'll move on to the next question. Oh, no, no, one more slide. Um So sometimes there's a bit of overlap between trichomonas and BB. Um To be honest, so TB trichomonas is a sexually transmitted infection. Um and it causes similar symptoms. So they both have this, this discharge and also PH S above. But luckily for us, they both treated with metroNIDAZOLE um with trichomonas, you probably wanna lean more towards the five day course because it's more effective for trichomonas as opposed to stat dose. Um But if, and doubt so if you've got a woman and you're gonna send for the screens but you don't know.