from reportlab.lib.pagesizes import A4
from reportlab.lib import colors
from reportlab.lib.styles import getSampleStyleSheet, ParagraphStyle
from reportlab.lib.units import cm, mm
from reportlab.platypus import (
    SimpleDocTemplate, Paragraph, Spacer, Table, TableStyle,
    HRFlowable, KeepTogether
)
from reportlab.lib.enums import TA_CENTER, TA_LEFT, TA_JUSTIFY
from reportlab.pdfbase import pdfmetrics

OUTPUT = "/home/daytona/workspace/rda-summary/RDA_Quick_Reference.pdf"

doc = SimpleDocTemplate(
    OUTPUT,
    pagesize=A4,
    rightMargin=1.5*cm,
    leftMargin=1.5*cm,
    topMargin=1.5*cm,
    bottomMargin=1.5*cm,
)

W, H = A4
styles = getSampleStyleSheet()

# ── Custom styles ─────────────────────────────────────────────────────────────
BLUE       = colors.HexColor("#1565C0")
DARK_BLUE  = colors.HexColor("#0D47A1")
LIGHT_BLUE = colors.HexColor("#E3F2FD")
GREEN      = colors.HexColor("#1B5E20")
LIGHT_GREEN= colors.HexColor("#E8F5E9")
ORANGE     = colors.HexColor("#E65100")
ORANGE_BG  = colors.HexColor("#FFF3E0")
RED        = colors.HexColor("#B71C1C")
RED_BG     = colors.HexColor("#FFEBEE")
GREY_BG    = colors.HexColor("#F5F5F5")
HEADER_BG  = colors.HexColor("#1565C0")
ALT_ROW    = colors.HexColor("#EEF4FF")

title_style = ParagraphStyle(
    "Title", parent=styles["Normal"],
    fontSize=20, fontName="Helvetica-Bold",
    textColor=colors.white, alignment=TA_CENTER,
    spaceAfter=2,
)
subtitle_style = ParagraphStyle(
    "Subtitle", parent=styles["Normal"],
    fontSize=10, fontName="Helvetica",
    textColor=colors.HexColor("#BBDEFB"), alignment=TA_CENTER,
    spaceAfter=0,
)
section_style = ParagraphStyle(
    "Section", parent=styles["Normal"],
    fontSize=11, fontName="Helvetica-Bold",
    textColor=colors.white, alignment=TA_LEFT,
    spaceAfter=0, spaceBefore=0,
    leftIndent=6,
)
body_style = ParagraphStyle(
    "Body", parent=styles["Normal"],
    fontSize=8.5, fontName="Helvetica",
    textColor=colors.HexColor("#212121"),
    spaceAfter=2, leading=12,
)
bold_style = ParagraphStyle(
    "Bold", parent=styles["Normal"],
    fontSize=8.5, fontName="Helvetica-Bold",
    textColor=colors.HexColor("#212121"),
    spaceAfter=2,
)
formula_style = ParagraphStyle(
    "Formula", parent=styles["Normal"],
    fontSize=10, fontName="Helvetica-Bold",
    textColor=ORANGE, alignment=TA_CENTER,
    spaceAfter=4, spaceBefore=4,
    borderPad=4,
)
note_style = ParagraphStyle(
    "Note", parent=styles["Normal"],
    fontSize=7.5, fontName="Helvetica-Oblique",
    textColor=colors.HexColor("#555555"),
    spaceAfter=2, leftIndent=4,
)
footer_style = ParagraphStyle(
    "Footer", parent=styles["Normal"],
    fontSize=7, fontName="Helvetica",
    textColor=colors.HexColor("#9E9E9E"), alignment=TA_CENTER,
)
tip_style = ParagraphStyle(
    "Tip", parent=styles["Normal"],
    fontSize=8, fontName="Helvetica-Bold",
    textColor=GREEN, spaceAfter=1,
)

def section_header(text, bg=HEADER_BG):
    t = Table([[Paragraph(text, section_style)]], colWidths=[doc.width])
    t.setStyle(TableStyle([
        ("BACKGROUND", (0,0), (-1,-1), bg),
        ("ROWBACKGROUNDS", (0,0), (-1,-1), [bg]),
        ("TOPPADDING",  (0,0), (-1,-1), 5),
        ("BOTTOMPADDING",(0,0),(-1,-1), 5),
        ("LEFTPADDING", (0,0), (-1,-1), 8),
        ("ROUNDEDCORNERS", [4,4,4,4]),
    ]))
    return t

def make_table(headers, rows, col_widths, alt=True):
    header_row = [Paragraph(f"<b>{h}</b>", ParagraphStyle(
        "TH", parent=styles["Normal"], fontSize=8, fontName="Helvetica-Bold",
        textColor=colors.white, alignment=TA_CENTER
    )) for h in headers]

    data = [header_row]
    for i, row in enumerate(rows):
        styled = []
        for j, cell in enumerate(row):
            align = TA_CENTER if j > 0 else TA_LEFT
            styled.append(Paragraph(str(cell), ParagraphStyle(
                "TD", parent=styles["Normal"], fontSize=8, fontName="Helvetica",
                textColor=colors.HexColor("#212121"), alignment=align
            )))
        data.append(styled)

    row_bgs = []
    for i in range(1, len(data)):
        bg = ALT_ROW if (alt and i % 2 == 0) else colors.white
        row_bgs.append(bg)

    t = Table(data, colWidths=col_widths)
    ts = TableStyle([
        ("BACKGROUND",   (0,0), (-1,0), DARK_BLUE),
        ("GRID",         (0,0), (-1,-1), 0.4, colors.HexColor("#BDBDBD")),
        ("TOPPADDING",   (0,0), (-1,-1), 4),
        ("BOTTOMPADDING",(0,0), (-1,-1), 4),
        ("LEFTPADDING",  (0,0), (-1,-1), 5),
        ("RIGHTPADDING", (0,0), (-1,-1), 5),
        ("VALIGN",       (0,0), (-1,-1), "MIDDLE"),
    ])
    for i, bg in enumerate(row_bgs, start=1):
        ts.add("ROWBACKGROUNDS", (0,i), (-1,i), [bg])
    t.setStyle(ts)
    return t

# ── Title Banner ───────────────────────────────────────────────────────────────
def title_banner():
    banner_data = [[
        Paragraph("RDA - Quick Reference Sheet", title_style),
    ],[
        Paragraph("PSM Practical Exam | MBBS 2nd Year | ICMR-NIN 2020 Guidelines", subtitle_style),
    ]]
    t = Table(banner_data, colWidths=[doc.width])
    t.setStyle(TableStyle([
        ("BACKGROUND", (0,0), (-1,-1), DARK_BLUE),
        ("TOPPADDING",    (0,0), (-1,-1), 8),
        ("BOTTOMPADDING", (0,0), (-1,-1), 8),
        ("LEFTPADDING",   (0,0), (-1,-1), 10),
        ("ROUNDEDCORNERS", [6,6,6,6]),
    ]))
    return t

# ─────────────────────────────────────────────────────────────────────────────
story = []

# TITLE
story.append(title_banner())
story.append(Spacer(1, 6))

# ── SECTION 1: Definition & DRI Family ───────────────────────────────────────
story.append(section_header("1. DEFINITION"))
story.append(Spacer(1, 4))

def_box_data = [[Paragraph(
    "<b>RDA</b> = The average daily dietary intake level sufficient to meet the nutritional "
    "requirements of <b>nearly all (97–98%)</b> healthy individuals of a specific age, sex, "
    "and physiological state.",
    ParagraphStyle("Def", parent=styles["Normal"], fontSize=9, fontName="Helvetica",
                   textColor=DARK_BLUE, leading=13)
)]]
def_box = Table(def_box_data, colWidths=[doc.width])
def_box.setStyle(TableStyle([
    ("BACKGROUND",    (0,0), (-1,-1), LIGHT_BLUE),
    ("TOPPADDING",    (0,0), (-1,-1), 7),
    ("BOTTOMPADDING", (0,0), (-1,-1), 7),
    ("LEFTPADDING",   (0,0), (-1,-1), 10),
    ("RIGHTPADDING",  (0,0), (-1,-1), 10),
    ("BOX",           (0,0), (-1,-1), 1, BLUE),
]))
story.append(def_box)
story.append(Spacer(1, 5))

# Formula box
formula_data = [[Paragraph("RDA = EAR + 2 SD  (covers 97–98% of population)", formula_style)]]
fbox = Table(formula_data, colWidths=[doc.width])
fbox.setStyle(TableStyle([
    ("BACKGROUND",   (0,0), (-1,-1), ORANGE_BG),
    ("BOX",          (0,0), (-1,-1), 1.5, ORANGE),
    ("TOPPADDING",   (0,0), (-1,-1), 6),
    ("BOTTOMPADDING",(0,0), (-1,-1), 6),
]))
story.append(fbox)
story.append(Spacer(1, 5))

# ── DRI Table ─────────────────────────────────────────────────────────────────
story.append(section_header("2. DRI FAMILY — 4 COMPONENTS (Remember: EAR → RDA → AI → UL)"))
story.append(Spacer(1, 4))

dri_rows = [
    ["EAR", "Estimated Average Requirement", "Meets needs of 50% of healthy people", "Assess population groups"],
    ["RDA", "Recommended Dietary Allowance", "Meets needs of 97–98% of healthy people", "Plan individual diets"],
    ["AI",  "Adequate Intake",               "Used when EAR/RDA cannot be calculated", "Infants, nutrients with insufficient data"],
    ["UL",  "Tolerable Upper Intake Level",  "Highest safe average daily intake", "Avoid toxicity from supplements"],
]
story.append(make_table(
    ["Term", "Full Form", "Covers", "Use"],
    dri_rows,
    [1.2*cm, 4.5*cm, 6*cm, 5.1*cm],
))
story.append(Spacer(1, 3))
story.append(Paragraph(
    "* EAR is set first → RDA is derived from EAR.  "
    "If EAR cannot be set → use AI instead of RDA.  "
    "Above UL → risk of adverse effects increases.",
    note_style
))
story.append(Spacer(1, 6))

# ── SECTION 3: Energy & Protein ──────────────────────────────────────────────
story.append(section_header("3. ENERGY & PROTEIN RDA  (ICMR-NIN 2020)"))
story.append(Spacer(1, 4))

# Energy table
story.append(Paragraph("<b>ENERGY</b>", bold_style))
energy_rows = [
    ["Adult Man",   "Sedentary",  "2110", "—", "—"],
    ["Adult Man",   "Moderate ★", "2710", "—", "—"],
    ["Adult Man",   "Heavy",      "3470", "—", "—"],
    ["Adult Woman", "Sedentary",  "1660", "—", "—"],
    ["Adult Woman", "Moderate ★", "2130", "—", "—"],
    ["Adult Woman", "Heavy",      "2720", "—", "—"],
    ["Pregnant",    "2nd Trimester", "+350", "—", "—"],
    ["Pregnant",    "3rd Trimester", "+350", "—", "—"],
    ["Lactating",   "0–6 months", "+600", "—", "—"],
    ["Lactating",   "7–12 months","+ 520","—", "—"],
]
# Simpler energy table
e_rows = [
    ["Adult Man",   "Sedentary / Moderate ★ / Heavy",  "2110 / 2710 / 3470 kcal"],
    ["Adult Woman", "Sedentary / Moderate ★ / Heavy",  "1660 / 2130 / 2720 kcal"],
    ["Pregnant",    "Extra (2nd / 3rd trimester)",      "+350 / +350 kcal"],
    ["Lactating",   "Extra (0–6 m / 7–12 m)",          "+600 / +520 kcal"],
    ["Children 1–3 y","—",                              "1010 kcal"],
    ["Children 4–6 y","—",                              "1360 kcal"],
    ["Children 7–9 y","—",                              "1700 kcal"],
]
story.append(make_table(
    ["Group", "Activity Level", "Energy (kcal/day)"],
    e_rows,
    [4*cm, 5.5*cm, 7.3*cm],
))
story.append(Spacer(1, 4))

# Protein table
story.append(Paragraph("<b>PROTEIN</b>  (RDA = 0.83 g/kg/day — revised down from 1.0 g/kg in 2010)", bold_style))
p_rows = [
    ["Adult Man (60 kg)",   "54 g/day"],
    ["Adult Woman (55 kg)", "46 g/day"],
    ["Pregnant — 2nd trimester extra", "+9.5 g/day"],
    ["Pregnant — 3rd trimester extra", "+22 g/day"],
    ["Lactating 0–6 months extra",     "+17 g/day"],
    ["Lactating 7–12 months extra",    "+13 g/day"],
    ["Infants 0–6 months",             "8.0 g/day"],
    ["Children 1–3 y",                 "12.5 g/day"],
    ["Children 4–6 y",                 "16.0 g/day"],
]
story.append(make_table(
    ["Group", "Protein RDA"],
    p_rows,
    [10*cm, 6.8*cm],
))
story.append(Spacer(1, 3))
story.append(Paragraph(
    "★ = Moderate work is the standard reference. ICMR 2020 uses DIAAS (Digestible Indispensable Amino Acid Score) "
    "instead of PDCAAS, and a cereal:legume:milk ratio of 3:1:2.5.",
    note_style
))
story.append(Spacer(1, 6))

# ── SECTION 4: Key Minerals ───────────────────────────────────────────────────
story.append(section_header("4. KEY MINERALS  (ICMR-NIN 2020)", bg=colors.HexColor("#1B5E20")))
story.append(Spacer(1, 4))

min_rows = [
    ["Calcium (mg)",  "1000", "1000", "1000", "1200", "300 (infant)"],
    ["Iron (mg)",     "19",   "29 ★", "35",   "—",    "—"],
    ["Zinc (mg)",     "17",   "13",   "14.5", "14",   "2.5 (6–12 m)"],
    ["Iodine (µg)",   "150",  "150",  "200",  "200",  "90"],
    ["Magnesium (mg)","440",  "370",  "—",    "—",    "—"],
    ["Phosphorus (mg)","1000","1000", "1000", "1000", "450 (infant)"],
    ["Sodium (mg)",   "2000", "2000", "2000", "2000", "—"],
]
story.append(make_table(
    ["Mineral", "Man", "Woman ★", "Pregnant", "Lactating", "Child/Infant"],
    min_rows,
    [3.5*cm, 2*cm, 2.5*cm, 2.5*cm, 2.5*cm, 3.8*cm],
))
story.append(Spacer(1, 3))
story.append(Paragraph(
    "★ Iron for women is higher (29 mg) than men (19 mg) due to menstrual losses — frequently asked in viva!",
    note_style
))
story.append(Spacer(1, 6))

# ── SECTION 5: Key Vitamins ───────────────────────────────────────────────────
story.append(section_header("5. KEY VITAMINS  (ICMR-NIN 2020)", bg=colors.HexColor("#4A148C")))
story.append(Spacer(1, 4))

vit_rows = [
    ["Vitamin A (µg)",    "1000",  "840",   "1000", "1950"],
    ["Vitamin D (IU)",    "600",   "600",   "600",  "600"],
    ["Vitamin C (mg)",    "80",    "65",    "80",   "95"],
    ["Folate (µg DFE)",   "300",   "220",   "500",  "300"],
    ["Vitamin B12 (µg)",  "2.2",   "2.2",   "2.2",  "2.2"],
    ["Thiamine (mg)",     "1.8",   "1.7",   "2.0",  "1.9"],
    ["Riboflavin (mg)",   "2.5",   "2.4",   "2.5",  "2.5"],
    ["Niacin (mg)",       "18",    "14",    "18",   "17"],
    ["Vitamin B6 (mg)",   "2.4",   "1.9",   "2.5",  "2.5"],
    ["Vitamin E (mg)",    "10",    "8",     "10",   "12"],
    ["Vitamin K (µg)",    "55",    "55",    "55",   "55"],
]
story.append(make_table(
    ["Vitamin", "Man", "Woman", "Pregnant", "Lactating"],
    vit_rows,
    [4*cm, 2.5*cm, 2.5*cm, 3*cm, 3*cm],  # adjusted for margins
))
story.append(Spacer(1, 3))
story.append(Paragraph(
    "Note: Vitamin D 600 IU for all adults; >70 years = 800 IU. "
    "Folate 500 µg in pregnancy (prevents neural tube defects).",
    note_style
))
story.append(Spacer(1, 6))

# ── SECTION 6: Who Sets RDA ───────────────────────────────────────────────────
story.append(section_header("6. WHO SETS RDA?", bg=colors.HexColor("#37474F")))
story.append(Spacer(1, 4))

who_rows = [
    ["India / Nepal", "ICMR-NIN", "2020 (latest)"],
    ["USA",           "National Academies of Medicine (IOM)", "2010–2019 (varies by nutrient)"],
    ["International", "WHO / FAO", "Ongoing updates"],
    ["Europe",        "EFSA (European Food Safety Authority)", "Ongoing updates"],
]
story.append(make_table(
    ["Country/Region", "Body", "Latest Version"],
    who_rows,
    [3.5*cm, 8*cm, 5.3*cm],
))
story.append(Spacer(1, 6))

# ── SECTION 7: Determinants ───────────────────────────────────────────────────
story.append(section_header("7. FACTORS AFFECTING RDA (Determinants)", bg=colors.HexColor("#BF360C")))
story.append(Spacer(1, 4))

det_rows = [
    ["Age",               "Infants, adolescents, elderly have different needs"],
    ["Sex",               "Men vs women differ (e.g., iron, calcium)"],
    ["Pregnancy",         "Increased requirements for almost ALL nutrients"],
    ["Lactation",         "Extra energy, protein, calcium, vitamins"],
    ["Physical Activity", "More activity = more energy needed"],
    ["Bioavailability",   "Plant iron (non-haem) absorbed less → higher RDA"],
    ["Disease State",     "Illness/malabsorption may alter requirements"],
    ["Nutrient Interactions", "E.g., Vitamin C enhances iron absorption"],
]
story.append(make_table(
    ["Factor", "Explanation"],
    det_rows,
    [4*cm, 12.8*cm],
))
story.append(Spacer(1, 6))

# ── SECTION 8: Uses of RDA ────────────────────────────────────────────────────
story.append(section_header("8. USES / IMPORTANCE OF RDA", bg=DARK_BLUE))
story.append(Spacer(1, 4))

uses_data = [
    [
        Paragraph("1. Plan individual diets\n2. Evaluate dietary adequacy\n3. National nutrition policy", body_style),
        Paragraph("4. Food labeling (% daily values)\n5. Supplementation programs\n6. Research baseline", body_style),
        Paragraph("7. School / hospital meal planning\n8. Targeting vulnerable groups\n9. Fortification programs", body_style),
    ]
]
uses_table = Table(uses_data, colWidths=[doc.width/3]*3)
uses_table.setStyle(TableStyle([
    ("BACKGROUND",   (0,0), (-1,-1), LIGHT_BLUE),
    ("BOX",          (0,0), (-1,-1), 0.5, BLUE),
    ("INNERGRID",    (0,0), (-1,-1), 0.5, colors.HexColor("#BDBDBD")),
    ("TOPPADDING",   (0,0), (-1,-1), 6),
    ("BOTTOMPADDING",(0,0), (-1,-1), 6),
    ("LEFTPADDING",  (0,0), (-1,-1), 8),
    ("VALIGN",       (0,0), (-1,-1), "TOP"),
]))
story.append(uses_table)
story.append(Spacer(1, 6))

# ── SECTION 9: Exam Tips ──────────────────────────────────────────────────────
story.append(section_header("9. EXAM TIPS — SAY THESE TO IMPRESS THE EXAMINER!", bg=colors.HexColor("#1B5E20")))
story.append(Spacer(1, 4))

tips_data = [[Paragraph(
    "✔  <b>\"RDA = EAR + 2 SD\"</b> — most students don't know this formula!\n"
    "✔  <b>\"ICMR 2020 revised protein RDA from 1.0 g/kg to 0.83 g/kg using DIAAS\"</b> — shows you're updated.\n"
    "✔  <b>\"Iron RDA for women (29 mg) is higher than men (19 mg) due to menstrual losses.\"</b>\n"
    "✔  <b>\"AI is used instead of RDA when sufficient data is unavailable — e.g., infants &lt;6 months.\"</b>\n"
    "✔  <b>\"Folate RDA doubles in pregnancy (220→500 µg) to prevent neural tube defects.\"</b>\n"
    "✔  <b>\"RDA is NOT the minimum requirement — it has a built-in safety margin above EAR.\"</b>",
    ParagraphStyle("Tips", parent=styles["Normal"], fontSize=8.5, fontName="Helvetica",
                   textColor=colors.HexColor("#1B5E20"), leading=14)
)]]
tips_box = Table(tips_data, colWidths=[doc.width])
tips_box.setStyle(TableStyle([
    ("BACKGROUND",   (0,0), (-1,-1), LIGHT_GREEN),
    ("BOX",          (0,0), (-1,-1), 1.5, GREEN),
    ("TOPPADDING",   (0,0), (-1,-1), 8),
    ("BOTTOMPADDING",(0,0), (-1,-1), 8),
    ("LEFTPADDING",  (0,0), (-1,-1), 10),
    ("RIGHTPADDING", (0,0), (-1,-1), 10),
]))
story.append(tips_box)
story.append(Spacer(1, 8))

# ── SECTION 10: Quick Memory Card ─────────────────────────────────────────────
story.append(section_header("10. RAPID RECALL CARD", bg=ORANGE))
story.append(Spacer(1, 4))

recall_data = [[Paragraph(
    "<b>RDA</b> = 97–98% healthy individuals | <b>EAR</b> = 50% | <b>AI</b> = when no EAR | <b>UL</b> = max safe\n\n"
    "<b>Key Values (Adult, Moderate Work):</b>\n"
    "Energy: Man 2710 kcal | Woman 2130 kcal\n"
    "Protein: Man 54 g | Woman 46 g  (0.83 g/kg/day)\n"
    "Ca: 1000 mg | Fe: Man 19 mg, Woman 29 mg | Zn: Man 17 mg, Woman 13 mg\n"
    "Vit A: Man 1000 µg, Woman 840 µg | Vit D: 600 IU | Vit C: Man 80 mg, Woman 65 mg\n"
    "Folate: 220 µg (→500 µg in pregnancy) | B12: 2.2 µg | Iodine: 150 µg\n\n"
    "<b>Formula:</b> RDA = EAR + 2 SD    |    <b>Set by:</b> ICMR-NIN (India/Nepal), latest 2020",
    ParagraphStyle("Recall", parent=styles["Normal"], fontSize=8.5, fontName="Helvetica",
                   textColor=colors.HexColor("#212121"), leading=13)
)]]
recall_box = Table(recall_data, colWidths=[doc.width])
recall_box.setStyle(TableStyle([
    ("BACKGROUND",   (0,0), (-1,-1), ORANGE_BG),
    ("BOX",          (0,0), (-1,-1), 2, ORANGE),
    ("TOPPADDING",   (0,0), (-1,-1), 8),
    ("BOTTOMPADDING",(0,0), (-1,-1), 8),
    ("LEFTPADDING",  (0,0), (-1,-1), 10),
    ("RIGHTPADDING", (0,0), (-1,-1), 10),
]))
story.append(recall_box)
story.append(Spacer(1, 8))

# Footer
story.append(HRFlowable(width=doc.width, thickness=0.5, color=colors.HexColor("#BDBDBD")))
story.append(Spacer(1, 3))
story.append(Paragraph(
    "PSM Practical Quick Reference | MBBS 2nd Year | ICMR-NIN 2020 | "
    "Source: Lippincott Biochemistry 8e, ICMR-NIN 2020 Report | Generated by Orris",
    footer_style
))

# BUILD
doc.build(story)
print(f"PDF saved to: {OUTPUT}")

<!DOCTYPE html>
<html lang="en">
<head>
<meta charset="UTF-8">
<meta name="viewport" content="width=device-width, initial-scale=1.0">
<title>RDA Quick Reference Sheet</title>
<style>
  * { margin: 0; padding: 0; box-sizing: border-box; }
  body {
    font-family: Arial, Helvetica, sans-serif;
    font-size: 10px;
    color: #212121;
    background: #fff;
    padding: 14px;
  }

  /* TITLE BANNER */
  .title-banner {
    background: #0D47A1;
    color: white;
    text-align: center;
    padding: 10px 8px 8px;
    border-radius: 6px;
    margin-bottom: 8px;
  }
  .title-banner h1 { font-size: 18px; font-weight: bold; margin-bottom: 3px; }
  .title-banner p  { font-size: 9px; color: #BBDEFB; }

  /* SECTION HEADERS */
  .sec-header {
    color: white;
    font-size: 10px;
    font-weight: bold;
    padding: 5px 8px;
    border-radius: 4px;
    margin: 8px 0 5px;
  }
  .blue   { background: #1565C0; }
  .green  { background: #1B5E20; }
  .purple { background: #4A148C; }
  .grey   { background: #37474F; }
  .red    { background: #BF360C; }
  .orange { background: #E65100; }

  /* DEFINITION BOX */
  .def-box {
    background: #E3F2FD;
    border: 1px solid #1565C0;
    padding: 7px 10px;
    border-radius: 4px;
    font-size: 9.5px;
    color: #0D47A1;
    margin-bottom: 5px;
    line-height: 1.5;
  }

  /* FORMULA BOX */
  .formula-box {
    background: #FFF3E0;
    border: 2px solid #E65100;
    padding: 6px;
    text-align: center;
    font-size: 12px;
    font-weight: bold;
    color: #E65100;
    border-radius: 4px;
    margin-bottom: 5px;
  }

  /* TABLES */
  table {
    width: 100%;
    border-collapse: collapse;
    margin-bottom: 4px;
    font-size: 8.5px;
  }
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<!-- TITLE -->
<div class="title-banner">
  <h1>RDA — Quick Reference Sheet</h1>
  <p>PSM Practical Exam &nbsp;|&nbsp; MBBS 2nd Year &nbsp;|&nbsp; ICMR-NIN 2020 Guidelines</p>
</div>

<!-- SECTION 1 -->
<div class="sec-header blue">1. DEFINITION</div>
<div class="def-box">
  <b>RDA (Recommended Dietary Allowance)</b> = The average daily dietary intake level sufficient to meet the nutritional requirements of <b>nearly all (97–98%)</b> healthy individuals of a specific age, sex, and physiological state.
</div>
<div class="formula-box">RDA = EAR + 2 SD &nbsp;&nbsp;(covers 97–98% of population)</div>

<!-- SECTION 2 -->
<div class="sec-header blue">2. DRI FAMILY — 4 COMPONENTS &nbsp; (Remember: EAR → RDA → AI → UL)</div>
<table>
  <thead><tr><th>Term</th><th>Full Form</th><th>Covers</th><th>Use For</th></tr></thead>
  <tbody>
    <tr><td><b>EAR</b></td><td>Estimated Average Requirement</td><td>50% of healthy people</td><td>Assess population groups</td></tr>
    <tr><td><b>RDA</b></td><td>Recommended Dietary Allowance</td><td>97–98% of healthy people</td><td>Plan individual diets</td></tr>
    <tr><td><b>AI</b></td><td>Adequate Intake</td><td>Used when EAR/RDA cannot be calculated</td><td>Infants; nutrients with insufficient data</td></tr>
    <tr><td><b>UL</b></td><td>Tolerable Upper Intake Level</td><td>Max safe average daily intake</td><td>Avoid toxicity from supplements</td></tr>
  </tbody>
</table>
<p class="note">* EAR is set first → RDA derived from EAR. &nbsp;If EAR cannot be set → use AI. &nbsp;Above UL → risk of adverse effects increases.</p>

<!-- SECTION 3 -->
<div class="sec-header blue">3. ENERGY &amp; PROTEIN RDA &nbsp; (ICMR-NIN 2020)</div>

<div class="two-col">
<div class="col-block">
  <p class="bold-label">ENERGY</p>
  <table>
    <thead><tr><th>Group</th><th>Activity</th><th>kcal/day</th></tr></thead>
    <tbody>
      <tr><td>Adult Man</td><td>Sedentary</td><td>2110</td></tr>
      <tr><td>Adult Man</td><td><b>Moderate ★</b></td><td><b>2710</b></td></tr>
      <tr><td>Adult Man</td><td>Heavy</td><td>3470</td></tr>
      <tr><td>Adult Woman</td><td>Sedentary</td><td>1660</td></tr>
      <tr><td>Adult Woman</td><td><b>Moderate ★</b></td><td><b>2130</b></td></tr>
      <tr><td>Adult Woman</td><td>Heavy</td><td>2720</td></tr>
      <tr><td>Pregnant</td><td>2nd / 3rd trim.</td><td>+350 / +350</td></tr>
      <tr><td>Lactating</td><td>0–6 / 7–12 m</td><td>+600 / +520</td></tr>
      <tr><td>Children 1–3 y</td><td>—</td><td>1010</td></tr>
      <tr><td>Children 4–6 y</td><td>—</td><td>1360</td></tr>
      <tr><td>Children 7–9 y</td><td>—</td><td>1700</td></tr>
    </tbody>
  </table>
</div>
<div class="col-block">
  <p class="bold-label">PROTEIN &nbsp;<span style="font-weight:normal;font-size:7.5px;">(RDA = 0.83 g/kg/day; revised from 1.0 g/kg in 2010)</span></p>
  <table>
    <thead><tr><th>Group</th><th>Protein RDA</th></tr></thead>
    <tbody>
      <tr><td><b>Adult Man (60 kg)</b></td><td><b>54 g/day</b></td></tr>
      <tr><td><b>Adult Woman (55 kg)</b></td><td><b>46 g/day</b></td></tr>
      <tr><td>Pregnant — 2nd trimester extra</td><td>+9.5 g/day</td></tr>
      <tr><td>Pregnant — 3rd trimester extra</td><td>+22 g/day</td></tr>
      <tr><td>Lactating 0–6 m extra</td><td>+17 g/day</td></tr>
      <tr><td>Lactating 7–12 m extra</td><td>+13 g/day</td></tr>
      <tr><td>Infants 0–6 m</td><td>8.0 g/day</td></tr>
      <tr><td>Children 1–3 y</td><td>12.5 g/day</td></tr>
      <tr><td>Children 4–6 y</td><td>16.0 g/day</td></tr>
      <tr><td>Boys 16–18 y</td><td>55 g/day</td></tr>
      <tr><td>Girls 16–18 y</td><td>46 g/day</td></tr>
    </tbody>
  </table>
  <p class="note">★ Moderate work is the standard reference. ICMR 2020 uses DIAAS (Digestible Indispensable Amino Acid Score).</p>
</div>
</div>

<!-- SECTION 4 -->
<div class="sec-header green">4. KEY MINERALS &nbsp; (ICMR-NIN 2020)</div>
<table>
  <thead><tr><th>Mineral</th><th>Adult Man</th><th>Adult Woman</th><th>Pregnant</th><th>Lactating</th><th>Child / Infant</th></tr></thead>
  <tbody>
    <tr><td>Calcium (mg)</td><td>1000</td><td>1000</td><td>1000</td><td>1200</td><td>300–850 mg</td></tr>
    <tr><td><b>Iron (mg) ★</b></td><td><b>19</b></td><td><b>29</b></td><td>35</td><td>—</td><td>5–18 mg</td></tr>
    <tr><td>Zinc (mg)</td><td>17</td><td>13</td><td>14.5</td><td>14</td><td>2.5–14 mg</td></tr>
    <tr><td>Iodine (µg)</td><td>150</td><td>150</td><td>200</td><td>200</td><td>90 µg</td></tr>
    <tr><td>Magnesium (mg)</td><td>440</td><td>370</td><td>—</td><td>—</td><td>80–350 mg</td></tr>
    <tr><td>Phosphorus (mg)</td><td>1000</td><td>1000</td><td>1000</td><td>1000</td><td>450 (infant)</td></tr>
    <tr><td>Sodium (mg)</td><td>2000</td><td>2000</td><td>2000</td><td>2000</td><td>—</td></tr>
    <tr><td>Fluoride (mg)</td><td>3.5</td><td>3.0</td><td>—</td><td>—</td><td>0.1–2 mg</td></tr>
  </tbody>
</table>
<p class="note">★ Iron for women (29 mg) &gt; men (19 mg) due to menstrual losses — very commonly asked in viva!</p>

<!-- SECTION 5 -->
<div class="sec-header purple">5. KEY VITAMINS &nbsp; (ICMR-NIN 2020)</div>
<table>
  <thead><tr><th>Vitamin</th><th>Adult Man</th><th>Adult Woman</th><th>Pregnant</th><th>Lactating</th></tr></thead>
  <tbody>
    <tr><td>Vitamin A (µg)</td><td>1000</td><td>840</td><td>1000</td><td>1950</td></tr>
    <tr><td><b>Vitamin D (IU)</b></td><td><b>600</b></td><td><b>600</b></td><td>600</td><td>600</td></tr>
    <tr><td>Vitamin C (mg)</td><td>80</td><td>65</td><td>80</td><td>95</td></tr>
    <tr><td><b>Folate (µg DFE) ★</b></td><td><b>300</b></td><td><b>220</b></td><td><b>500</b></td><td>300</td></tr>
    <tr><td>Vitamin B12 (µg)</td><td>2.2</td><td>2.2</td><td>2.2</td><td>2.2</td></tr>
    <tr><td>Thiamine B1 (mg)</td><td>1.8</td><td>1.7</td><td>2.0</td><td>1.9</td></tr>
    <tr><td>Riboflavin B2 (mg)</td><td>2.5</td><td>2.4</td><td>2.5</td><td>2.5</td></tr>
    <tr><td>Niacin B3 (mg)</td><td>18</td><td>14</td><td>18</td><td>17</td></tr>
    <tr><td>Pyridoxine B6 (mg)</td><td>2.4</td><td>1.9</td><td>2.5</td><td>2.5</td></tr>
    <tr><td>Vitamin E (mg)</td><td>10</td><td>8</td><td>10</td><td>12</td></tr>
    <tr><td>Vitamin K (µg)</td><td>55</td><td>55</td><td>55</td><td>55</td></tr>
  </tbody>
</table>
<p class="note">★ Folate doubles in pregnancy (220→500 µg) to prevent Neural Tube Defects. Vit D 800 IU for age &gt;70 years.</p>

<!-- SECTION 6 + 7 side by side -->
<div class="two-col">
<div>
  <div class="sec-header grey">6. WHO SETS RDA?</div>
  <table>
    <thead><tr><th>Country/Region</th><th>Body</th><th>Year</th></tr></thead>
    <tbody>
      <tr><td><b>India / Nepal</b></td><td><b>ICMR-NIN</b></td><td><b>2020</b></td></tr>
      <tr><td>USA</td><td>National Academies (IOM)</td><td>2010–2019</td></tr>
      <tr><td>International</td><td>WHO / FAO</td><td>Ongoing</td></tr>
      <tr><td>Europe</td><td>EFSA</td><td>Ongoing</td></tr>
    </tbody>
  </table>
</div>
<div>
  <div class="sec-header red">7. FACTORS AFFECTING RDA</div>
  <table>
    <thead><tr><th>Factor</th><th>Effect</th></tr></thead>
    <tbody>
      <tr><td>Age</td><td>Different values per life stage</td></tr>
      <tr><td>Sex</td><td>Men vs women differ (e.g., iron)</td></tr>
      <tr><td>Pregnancy</td><td>Increased for almost all nutrients</td></tr>
      <tr><td>Lactation</td><td>Extra energy, protein, Ca</td></tr>
      <tr><td>Physical Activity</td><td>More activity = more energy</td></tr>
      <tr><td>Bioavailability</td><td>Plant iron absorbed less → higher RDA</td></tr>
      <tr><td>Disease/Malabsorption</td><td>May alter requirements</td></tr>
    </tbody>
  </table>
</div>
</div>

<!-- SECTION 8 -->
<div class="sec-header blue">8. USES / IMPORTANCE OF RDA</div>
<div class="uses-grid">
  <div class="uses-col">
    1. Plan individual diets<br>
    2. Evaluate dietary adequacy<br>
    3. National nutrition policy
  </div>
  <div class="uses-col">
    4. Food labeling (% daily values)<br>
    5. Supplementation programs<br>
    6. Research baseline
  </div>
  <div class="uses-col">
    7. School/hospital meal planning<br>
    8. Targeting vulnerable groups<br>
    9. Food fortification programs
  </div>
</div>

<!-- SECTION 9 -->
<div class="sec-header green">9. EXAM TIPS — SAY THESE TO IMPRESS THE EXAMINER!</div>
<div class="tips-box">
  ✔ &nbsp;<b>"RDA = EAR + 2 SD"</b> — most students don't know this formula!<br>
  ✔ &nbsp;<b>"ICMR 2020 revised protein RDA from 1.0 g/kg to 0.83 g/kg using DIAAS"</b> — shows you're updated.<br>
  ✔ &nbsp;<b>"Iron RDA for women (29 mg) &gt; men (19 mg) due to menstrual losses."</b><br>
  ✔ &nbsp;<b>"AI is used when sufficient data is unavailable — e.g., infants under 6 months."</b><br>
  ✔ &nbsp;<b>"Folate RDA doubles in pregnancy (220→500 µg) to prevent neural tube defects."</b><br>
  ✔ &nbsp;<b>"RDA is NOT the minimum requirement — it has a built-in safety margin above EAR."</b>
</div>

<!-- SECTION 10 -->
<div class="sec-header orange">10. RAPID RECALL CARD</div>
<div class="recall-box">
  <b>RDA</b> = 97–98% healthy individuals &nbsp;|&nbsp; <b>EAR</b> = 50% &nbsp;|&nbsp; <b>AI</b> = when no EAR &nbsp;|&nbsp; <b>UL</b> = max safe &nbsp;|&nbsp; Formula: <b>RDA = EAR + 2 SD</b><br><br>
  <b>Key Values (Adult, Moderate Work):</b><br>
  Energy: Man <b>2710</b> kcal &nbsp;|&nbsp; Woman <b>2130</b> kcal &nbsp;|&nbsp;
  Protein: Man <b>54 g</b> &nbsp;|&nbsp; Woman <b>46 g</b> (0.83 g/kg/day)<br>
  Ca: <b>1000 mg</b> &nbsp;|&nbsp; Fe: Man <b>19</b> mg, Woman <b>29</b> mg &nbsp;|&nbsp; Zn: Man <b>17</b> mg, Woman <b>13</b> mg &nbsp;|&nbsp; Iodine: <b>150</b> µg<br>
  Vit A: Man <b>1000</b> µg, Woman <b>840</b> µg &nbsp;|&nbsp; Vit D: <b>600</b> IU &nbsp;|&nbsp; Vit C: Man <b>80</b> mg, Woman <b>65</b> mg<br>
  Folate: <b>220</b> µg (→<b>500</b> µg pregnancy) &nbsp;|&nbsp; B12: <b>2.2</b> µg &nbsp;|&nbsp; Protein pregnancy 3rd trim extra: <b>+22 g</b><br><br>
  <b>Set by:</b> ICMR-NIN (India/Nepal), latest revision <b>2020</b>
</div>

<div class="footer">
  PSM Practical Quick Reference &nbsp;|&nbsp; MBBS 2nd Year &nbsp;|&nbsp; ICMR-NIN 2020 &nbsp;|&nbsp; Source: Lippincott Biochemistry 8e, ICMR-NIN 2020 Report &nbsp;|&nbsp; Generated by Orris
</div>

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<!-- BANNER -->
<div class="banner">
  <h1>🦠 RUBELLA &amp; MUMPS — PSM Quick Reference</h1>
  <p>MBBS 2nd Year | PSM Practical Exam | Based on Dr. Narendra Kumar Yadav's Slides | Harrison's 22e | ICMR Guidelines</p>
</div>

<!-- ROW 1: RUBELLA + MUMPS BASICS -->
<div class="two-col">

  <!-- ── RUBELLA CARD ── -->
  <div>
    <div class="card">
      <div class="card-header r-hdr">🔴 RUBELLA (German Measles / जर्मन दादुरा)</div>
      <div class="card-body">

        <span class="sub-label r-lbl">BASICS</span>
        <table class="r-thead">
          <thead><tr><th>Feature</th><th>Detail</th></tr></thead>
          <tbody>
            <tr><td>Virus</td><td>RNA virus — Togavirus family</td></tr>
            <tr><td>Reservoir</td><td>Humans ONLY</td></tr>
            <tr><td>Transmission</td><td>Droplet infection</td></tr>
            <tr><td>Incubation</td><td><b>14–21 days (avg 18 days)</b> ★ NOT &lt;10 days!</td></tr>
            <tr><td>Communicability</td><td>7 days before → 7 days after rash</td></tr>
            <tr><td>Age group</td><td>Children 5–15 yrs; adults susceptible</td></tr>
            <tr><td>Seasonality</td><td>Late winter – early spring</td></tr>
          </tbody>
        </table>

        <span class="sub-label r-lbl">CLINICAL FEATURES (Post-natal)</span>
        <ul>
          <li><b>Rash:</b> Maculopapular, face→trunk→limbs, lasts <b>3 days</b> only</li>
          <li><b>Lymphadenopathy:</b> Occipital + <b>post-auricular</b> (TENDER) ★ Hallmark!</li>
          <li><b>Low-grade fever</b> (or absent); no Koplik spots</li>
          <li>Arthralgia/arthritis in adult women (common)</li>
          <li><b>50% cases are SUBCLINICAL</b> — no rash, no symptoms!</li>
        </ul>

        <span class="sub-label r-lbl">WHY CALLED "3-DAY MEASLES"?</span>
        <div class="box box-red" style="font-size:8px;">
          Rash lasts only <b>3 days</b> (vs measles = 4–7 days). Milder than measles but DANGEROUS in pregnancy!
        </div>

        <span class="sub-label r-lbl">DIAGNOSIS</span>
        <table>
          <tbody>
            <tr><td>Acquired rubella</td><td><b>IgM antibodies</b> in acute phase OR 4× rise in IgG</td></tr>
            <tr><td>CRS at birth</td><td><b>IgM antibodies</b> (IgM does NOT cross placenta → baby made it!)</td></tr>
            <tr><td>CRS confirm later</td><td>IgG persists <b>&gt;6 months</b> (maternal IgG disappears by 6 m)</td></tr>
          </tbody>
        </table>

      </div>
    </div>
  </div>

  <!-- ── MUMPS CARD ── -->
  <div>
    <div class="card">
      <div class="card-header m-hdr">🔵 MUMPS (Gulphulia / गुल्फुलिया)</div>
      <div class="card-body">

        <span class="sub-label m-lbl">BASICS</span>
        <table class="m-thead">
          <thead><tr><th>Feature</th><th>Detail</th></tr></thead>
          <tbody>
            <tr><td>Virus</td><td>RNA virus — Paramyxovirus (Rubulavirus genus)</td></tr>
            <tr><td>Reservoir</td><td>Humans ONLY</td></tr>
            <tr><td>Transmission</td><td>Droplet + direct contact with saliva</td></tr>
            <tr><td>Incubation</td><td><b>16–18 days (avg 18 days)</b> ★ MCQ = 18 days!</td></tr>
            <tr><td>Communicability</td><td>2 days before → 9 days after parotitis</td></tr>
            <tr><td>Age group</td><td>School-age children 5–14 yrs</td></tr>
            <tr><td>Immunity</td><td>Lifelong after natural infection</td></tr>
          </tbody>
        </table>

        <span class="sub-label m-lbl">CLINICAL FEATURES</span>
        <ul>
          <li><b>Parotitis:</b> Painful swelling of parotid gland (in front + below ear)</li>
          <li>Usually <b>bilateral</b> (may start unilateral)</li>
          <li>Earlobe pushed upward &amp; outward — angle of jaw obliterated</li>
          <li>Stensen's duct orifice: red &amp; swollen</li>
          <li>Prodrome: fever, malaise, headache, anorexia (1–2 days before)</li>
          <li>Swelling lasts ~7–10 days</li>
        </ul>

        <span class="sub-label m-lbl">MANAGEMENT</span>
        <div class="box box-blue" style="font-size:8px;">
          <b>NO specific antiviral.</b> Symptomatic only: paracetamol, soft diet, warm/cold compress, rest, hydration. Orchitis: scrotal support + analgesics.
        </div>

        <span class="sub-label m-lbl">DIAGNOSIS</span>
        <table>
          <tbody>
            <tr><td>Serology</td><td><b>IgM antibodies</b> in acute phase (confirmatory)</td></tr>
            <tr><td>Parotitis vs pancreatitis</td><td>Both ↑ amylase; <b>↑ lipase = pancreatitis</b></td></tr>
            <tr><td>CSF pleocytosis</td><td>Up to 55% subclinical CNS involvement</td></tr>
          </tbody>
        </table>

      </div>
    </div>
  </div>

</div><!-- end two-col -->

<!-- ROW 2: CRS + COMPLICATIONS -->
<div class="two-col">

  <!-- CRS -->
  <div>
    <div class="card">
      <div class="card-header r-hdr">⭐ CONGENITAL RUBELLA SYNDROME (CRS) — MOST IMPORTANT!</div>
      <div class="card-body">

        <div class="box box-red">
          <span class="title">GREGG'S TRIAD (Classic CRS = "CCC")</span>
          <b>C</b>ataract &nbsp;+&nbsp; <b>C</b>ardiac defect (PDA) &nbsp;+&nbsp; <b>C</b>ochlear deafness (sensorineural)
        </div>

        <span class="sub-label r-lbl">RISK BY TRIMESTER</span>
        <table class="r-thead">
          <thead><tr><th>Trimester</th><th>Risk of CRS</th><th>Note</th></tr></thead>
          <tbody>
            <tr><td><b>1st (1–12 wks) ★</b></td><td><b>Up to 90%</b></td><td><b>MOST DISASTROUS!</b></td></tr>
            <tr><td>2nd (13–24 wks)</td><td>10–20%</td><td>Moderate risk</td></tr>
            <tr><td><b>After 16 wks ★</b></td><td><b>RARE</b></td><td><b>No major defects (MCQ!)</b></td></tr>
          </tbody>
        </table>

        <span class="sub-label r-lbl">CRS DEFECTS</span>
        <table>
          <tbody>
            <tr><td><b>Eyes</b></td><td>Cataract, glaucoma, retinopathy, microphthalmia</td></tr>
            <tr><td><b>Heart</b></td><td>PDA, VSD, pulmonary artery stenosis</td></tr>
            <tr><td><b>Ears</b></td><td>Sensorineural deafness (most common single defect)</td></tr>
            <tr><td><b>Brain</b></td><td>Microcephaly, intellectual disability</td></tr>
            <tr><td><b>Transient</b></td><td>Hepatosplenomegaly, thrombocytopenic purpura ("Blueberry muffin baby")</td></tr>
          </tbody>
        </table>

        <div class="box box-orange" style="margin-top:4px;">
          <span class="title">IgM vs IgG LOGIC (Exam favourite!)</span>
          IgM does <b>NOT</b> cross placenta → <b>IgM in newborn = CRS confirmed</b> (baby made it)<br>
          IgG <b>DOES</b> cross placenta → maternal IgG disappears by 6 months → <b>IgG persisting &gt;6 m = CRS</b>
        </div>

      </div>
    </div>
  </div>

  <!-- MUMPS COMPLICATIONS -->
  <div>
    <div class="card">
      <div class="card-header m-hdr">⚡ MUMPS COMPLICATIONS (Very Frequently Asked!)</div>
      <div class="card-body">

        <div class="box box-blue">
          <span class="title">KEY MCQ RULE:</span>
          Most common in <b>CHILDREN</b> = <b>Aseptic Meningitis</b> <span class="badge badge-blue">★ MCQ</span><br>
          Most common overall = <b>Orchitis</b> (only in post-pubertal males)
        </div>

        <span class="sub-label m-lbl">COMPLICATION TABLE</span>
        <table class="m-thead">
          <thead><tr><th>Complication</th><th>Freq (unvax)</th><th>Key Points</th></tr></thead>
          <tbody>
            <tr><td><b>Aseptic meningitis ★</b></td><td>Up to 10%</td><td>Most common in children; self-limiting</td></tr>
            <tr><td><b>Orchitis ★</b></td><td><b>30%</b> post-pubertal ♂</td><td>30–50% testicular atrophy; rarely permanent infertility</td></tr>
            <tr><td>Oophoritis</td><td>7% post-pubertal ♀</td><td>Ovarian inflammation</td></tr>
            <tr><td>Pancreatitis</td><td>~4%</td><td>↑ amylase + ↑ lipase</td></tr>
            <tr><td>Encephalitis</td><td>&lt;1%</td><td>Mortality 1.5%</td></tr>
            <tr><td>Hearing loss</td><td>Up to 4%</td><td>Usually unilateral, transient</td></tr>
            <tr><td>Mastitis</td><td>30% ♀</td><td>Post-pubertal females</td></tr>
          </tbody>
        </table>

        <span class="sub-label m-lbl">ORCHITIS FACTS (Examiners love this!)</span>
        <ul>
          <li>Occurs in <b>30% unvaccinated</b> post-pubertal males (6% if vaccinated)</li>
          <li>Develops in <b>1st week of parotitis</b> (up to 6 weeks after)</li>
          <li>Bilateral in 10–30% of cases</li>
          <li>Testicular atrophy in <b>30–50%</b> of affected testes</li>
          <li><b>Permanent infertility is RARE</b> despite atrophy</li>
        </ul>

      </div>
    </div>
  </div>

</div><!-- end two-col -->

<!-- ROW 3: VACCINE + COMPARISON -->
<div class="two-col">

  <!-- VACCINE + PREVENTION -->
  <div>
    <div class="card">
      <div class="card-header" style="background:#2e7d32;">💉 MMR VACCINE &amp; PREVENTION (Both diseases)</div>
      <div class="card-body">

        <span class="sub-label g-lbl">MMR VACCINE</span>
        <table class="g-thead">
          <thead><tr><th>Feature</th><th>Detail</th></tr></thead>
          <tbody>
            <tr><td>Type</td><td><b>Live attenuated</b> (M + M + R combined)</td></tr>
            <tr><td>Schedule</td><td><b>9 months + 15 months</b> (Nepal/India)</td></tr>
            <tr><td>Route</td><td>Subcutaneous (SC)</td></tr>
            <tr><td>Efficacy</td><td>~95% single dose; two-dose reduces mumps by 97–99%</td></tr>
            <tr><td>Mumps strain</td><td>Jeryl Lynn strain (genotype A)</td></tr>
            <tr><td>Rubella strain</td><td>RA 27/3 strain (grown in human diploid cells)</td></tr>
          </tbody>
        </table>

        <span class="sub-label g-lbl">CONTRAINDICATIONS (Both MMR)</span>
        <ul>
          <li><b>Pregnancy</b> — delay conception 1 month after MMR!</li>
          <li>Severe immunocompromise (HIV with severe immunosuppression)</li>
          <li>Severe febrile illness</li>
          <li>Note: egg allergy is NOT a contraindication (grown in human cells)</li>
        </ul>

        <span class="sub-label g-lbl">RUBELLA VACCINATION STRATEGY</span>
        <div class="box box-green">
          <b>During rubella outbreak → vaccinate NON-PREGNANT WOMEN aged 15–49 years on PRIORITY</b><br>
          (Goal = prevent CRS; NOT to protect women themselves)
        </div>

        <span class="sub-label g-lbl">MUMPS ISOLATION</span>
        <div class="box box-blue" style="font-size:8px;">
          Isolate for <b>9 days</b> after onset of parotitis. Avoid schools/crowded places during infectious period.
        </div>

      </div>
    </div>
  </div>

  <!-- MEASLES VS RUBELLA -->
  <div>
    <div class="card">
      <div class="card-header" style="background:#37474f;">⚖️ MEASLES vs RUBELLA (Comparison — Examiners Always Ask!)</div>
      <div class="card-body">
        <table style="font-size:7.8px;">
          <thead>
            <tr>
              <th style="background:#37474f; color:white; text-align:left; padding:3px 4px;">Feature</th>
              <th style="background:#c62828; color:white; padding:3px 4px;">Measles</th>
              <th style="background:#e53935; color:white; padding:3px 4px;">Rubella</th>
            </tr>
          </thead>
          <tbody>
            <tr><td>Other name</td><td>Hard measles</td><td>German measles / 3-day measles</td></tr>
            <tr><td>Virus</td><td>Paramyxovirus (Morbillivirus)</td><td>Togavirus</td></tr>
            <tr><td>Incubation</td><td>10–12 days</td><td><b>14–21 days (avg 18)</b></td></tr>
            <tr><td>Rash duration</td><td><b>4–7 days</b></td><td><b>3 days only</b></td></tr>
            <tr><td>Koplik spots</td><td><b>Present ★</b></td><td><b>ABSENT</b></td></tr>
            <tr><td>LN enlarged</td><td>Cervical</td><td><b>Occipital + post-auricular</b></td></tr>
            <tr><td>Fever</td><td>High (3C's prodrome)</td><td>Low grade / absent</td></tr>
            <tr><td>Severity</td><td><b>More severe</b></td><td>Milder</td></tr>
            <tr><td>3C's prodrome</td><td><b>Yes</b> (Cough, Coryza, Conjunctivitis)</td><td>No</td></tr>
            <tr><td>Subclinical cases</td><td>Rare</td><td><b>50%!</b></td></tr>
            <tr><td>Danger in pregnancy</td><td>Less</td><td><b>EXTREMELY DANGEROUS → CRS</b></td></tr>
            <tr><td>Arthritis in adults</td><td>Rare</td><td><b>Common (esp. women)</b></td></tr>
            <tr><td>Vaccine</td><td colspan="2" style="text-align:center;"><b>Both in MMR (live attenuated)</b></td></tr>
          </tbody>
        </table>
      </div>
    </div>
  </div>

</div><!-- end two-col -->

<!-- MCQ BANK -->
<div style="margin-bottom:6px;">
  <div class="mcq-banner">📝 MCQ ANSWERS (Directly from Your Slides)</div>
  <div class="mcq-grid">
    <div class="mcq-item">
      <span class="mcq-q">Q. Vaccination priority in rubella outbreak?</span><br>
      <span class="mcq-a">✔ Women 15–49 years (NON-PREGNANT)</span>
    </div>
    <div class="mcq-item">
      <span class="mcq-q">Q. Max fetal damage from maternal rubella?</span><br>
      <span class="mcq-a">✔ 6–12 weeks (1st trimester)</span>
    </div>
    <div class="mcq-item">
      <span class="mcq-q">Q. Rubella incubation period?</span><br>
      <span class="mcq-a">✔ 14–21 days avg 18 days (NOT &lt;10 days!)</span>
    </div>
    <div class="mcq-item">
      <span class="mcq-q">Q. Rubella infection after 16 weeks?</span><br>
      <span class="mcq-a">✔ No major congenital abnormalities</span>
    </div>
    <div class="mcq-item">
      <span class="mcq-q">Q. How to diagnose CRS at birth?</span><br>
      <span class="mcq-a">✔ IgM at birth OR IgG persisting &gt;6 months</span>
    </div>
    <div class="mcq-item">
      <span class="mcq-q">Q. Rubella caused by which type of virus?</span><br>
      <span class="mcq-a">✔ RNA virus (Togavirus) — NOT DNA!</span>
    </div>
    <div class="mcq-item">
      <span class="mcq-q">Q. Most common mumps complication in CHILDREN?</span><br>
      <span class="mcq-a">✔ Aseptic meningitis (NOT orchitis!)</span>
    </div>
    <div class="mcq-item">
      <span class="mcq-q">Q. Incubation period of mumps?</span><br>
      <span class="mcq-a">✔ 18 days (range 12–25 days)</span>
    </div>
  </div>
</div>

<!-- EXAM TIPS -->
<div style="margin-bottom:5px;">
  <div class="tips-banner">🌟 IMPRESS THE EXAMINER — SAY THESE LINES!</div>
  <div class="tips-grid">
    <div class="tip-item">
      ✔ <b>"50% of rubella cases are subclinical — this is why pregnant women don't know they're infected, making CRS prevention so critical."</b>
    </div>
    <div class="tip-item">
      ✔ <b>"IgM cannot cross the placenta — so IgM in a newborn confirms CRS regardless of the mother's history."</b>
    </div>
    <div class="tip-item">
      ✔ <b>"Gregg's triad = Cataract + Cardiac defect (PDA) + Cochlear deafness — the three C's of CRS."</b>
    </div>
    <div class="tip-item">
      ✔ <b>"During a rubella outbreak, we vaccinate non-pregnant women 15–49 years NOT to protect them, but to prevent CRS in future pregnancies."</b>
    </div>
    <div class="tip-item">
      ✔ <b>"Most common mumps complication in CHILDREN is aseptic meningitis — orchitis only occurs in post-pubertal males, so it cannot be the answer for children."</b>
    </div>
    <div class="tip-item">
      ✔ <b>"Mumps orchitis causes testicular atrophy in 30–50% but permanent infertility is rare — so patients should be reassured."</b>
    </div>
  </div>
</div>

<!-- FOOTER -->
<div class="footer">
  PSM Practical Quick Reference &nbsp;|&nbsp; MBBS 2nd Year &nbsp;|&nbsp;
  Based on: Dr. Narendra Kumar Yadav's Slides + Harrison's Principles of Internal Medicine 22e + ICMR Guidelines &nbsp;|&nbsp;
  Generated by Orris — Good luck on your exam! 🎓
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<!-- BANNER -->
<div class="banner">
  <h1>🐔 CHICKENPOX &amp; SMALLPOX — PSM Quick Reference (K. Park)</h1>
  <p>MBBS 2nd Year | PSM Practical Exam | Park's Textbook of PSM | Red Book 2021 | Harrison's 22e</p>
</div>

<!-- ROW 1: CHICKENPOX + SMALLPOX BASICS -->
<div class="two-col">

  <!-- CHICKENPOX -->
  <div class="card">
    <div class="card-header cp-hdr">🐔 CHICKENPOX (Varicella)</div>
    <div class="card-body">

      <span class="sub-label cp-lbl">BASICS</span>
      <table class="cp-thead">
        <thead><tr><th>Feature</th><th>Detail</th></tr></thead>
        <tbody>
          <tr><td>Causative agent</td><td><b>Varicella-Zoster Virus (VZV)</b> — also called Human (alpha) Herpesvirus 3</td></tr>
          <tr><td>Type</td><td>DNA virus (Herpesvirus family)</td></tr>
          <tr><td>Reservoir</td><td>Humans only</td></tr>
          <tr><td>Source</td><td>Cases of chickenpox; rarely herpes zoster patients</td></tr>
          <tr><td>Transmission</td><td>Droplet + <b>direct contact</b> with lesions + <b>airborne</b> (most contagious)</td></tr>
          <tr><td>Incubation</td><td><b>15 days (range: 7–21 days)</b></td></tr>
          <tr><td>Communicability</td><td><b>1–2 days before rash → 4–5 days after rash</b> (until lesions crust)</td></tr>
          <tr><td>Secondary attack rate</td><td><b>~85%</b> in susceptible household contacts</td></tr>
          <tr><td>Immunity</td><td>One attack = <b>lifelong immunity</b>; second attacks rare</td></tr>
          <tr><td>Infectivity of scabs</td><td><b>Scabs are NOT infective</b> ★</td></tr>
        </tbody>
      </table>

      <span class="sub-label cp-lbl">CLINICAL FEATURES</span>
      <div class="box cp-box">
        <span class="title">PRODROMAL STAGE (1–2 days before rash)</span>
        Mild fever, malaise. Children often have NO prodrome — rash is the 1st sign.
      </div>
      <div class="box cp-box">
        <span class="title">ERUPTIVE STAGE — 4 KEY FEATURES</span>
        <b>(1) Distribution (CENTRIPETAL):</b> Trunk first (abundant) → face, arms, legs (less). Axilla affected. <b>Palms &amp; soles usually SPARED.</b> Mucous membranes involved.<br>
        <b>(2) Rapid evolution:</b> Macule → Papule → Vesicle ("dew-drop on skin") → Scab in 4–7 days. Vesicles are <b>superficial, unilocular, easily ruptured</b>. Area of inflammation around vesicles.<br>
        <b>(3) PLEOMORPHISM ★:</b> All stages (papules, vesicles, crusts) present simultaneously in same area — because rash comes in successive crops over 4–5 days.<br>
        <b>(4) Fever:</b> Low-grade; rises with each new crop of rash.
      </div>

      <span class="sub-label cp-lbl">COMPLICATIONS</span>
      <ul>
        <li><b>Secondary bacterial infection</b> (Group A Strep, Staph aureus) — most common</li>
        <li>Cellulitis, erysipelas, osteomyelitis</li>
        <li><b>Pneumonia</b> (adults especially)</li>
        <li><b>Encephalitis / Cerebellar ataxia</b> (neurological)</li>
        <li><b>Reye's syndrome</b> (if aspirin given to children!)</li>
        <li><b>Herpes Zoster</b> — virus stays latent in dorsal root ganglia; reactivates later</li>
        <li>Immunocompromised: disseminated disease, DIC (rapidly fatal)</li>
        <li>Pitted scars (frequent sequelae)</li>
      </ul>

    </div>
  </div>

  <!-- SMALLPOX -->
  <div class="card">
    <div class="card-header sp-hdr">☠️ SMALLPOX (Variola) — ERADICATED!</div>
    <div class="card-body">

      <span class="sub-label sp-lbl">BASICS</span>
      <table class="sp-thead">
        <thead><tr><th>Feature</th><th>Detail</th></tr></thead>
        <tbody>
          <tr><td>Causative agent</td><td><b>Variola virus</b> (DNA virus, Poxvirus family — Orthopoxvirus)</td></tr>
          <tr><td>Types</td><td><b>Variola major</b> (CFR ~30%) and <b>Variola minor</b> (CFR ~1%)</td></tr>
          <tr><td>Reservoir</td><td><b>Humans only</b> (no animal reservoir — key for eradication)</td></tr>
          <tr><td>Transmission</td><td>Droplet + direct contact; scabs also infective (unlike chickenpox)</td></tr>
          <tr><td>Incubation</td><td><b>12 days (range: 7–17 days)</b></td></tr>
          <tr><td>Communicability</td><td>From onset of oral lesions until all crusts fall off (~3–4 weeks)</td></tr>
          <tr><td>Status</td><td><b>GLOBALLY ERADICATED — 1980 (WHO confirmed)</b></td></tr>
        </tbody>
      </table>

      <span class="sub-label sp-lbl">CLINICAL FEATURES</span>
      <div class="box sp-box">
        <span class="title">PRODROMAL STAGE (2–4 days) — SEVERE</span>
        High fever (38.9–40°C), severe headache, <b>backache</b> (characteristic!), malaise, prostration. Children: vomiting, seizures. Patient is <b>bedridden</b>.
      </div>
      <div class="box sp-box">
        <span class="title">ERUPTIVE STAGE — KEY FEATURES</span>
        <b>(1) Distribution (CENTRIFUGAL):</b> Face first → forearms → trunk → legs. <b>Palms &amp; soles involved. Axilla usually free.</b><br>
        <b>(2) Slow, deliberate, "majestic" evolution:</b> Macule → Papule → Vesicle → Pustule → Scab. Each stage 1–2 days. Scabs form in 10–14 days.<br>
        <b>(3) MONOMORPHISM ★:</b> All lesions at same stage in same area at same time.<br>
        <b>(4) Vesicles deep-seated, multilocular, umbilicated, hard ("pearls of pus").</b> No area of inflammation around lesions.<br>
        <b>(5) Fever:</b> Falls with rash; may rise again in pustular stage (secondary rise).
      </div>

      <span class="sub-label sp-lbl">ERADICATION STORY (Park's) ★ Impress!</span>
      <ul>
        <li>WHO campaign began <b>1967</b> (surveillance &amp; containment strategy)</li>
        <li>Last case in <b>India: 24 May 1975</b>; India declared free: <b>5 July 1975</b></li>
        <li>Last natural case worldwide: <b>Somalia, 1977</b></li>
        <li>WHO declared global eradication: <b>May 1980</b></li>
        <li>Virus still kept in 2 labs: <b>USA (CDC Atlanta)</b> &amp; <b>Russia (Novosibirsk)</b></li>
        <li>Bioterrorism concern: vaccination restarted for military (2002) &amp; first responders (2003)</li>
      </ul>

    </div>
  </div>

</div><!-- end two-col -->

<!-- ROW 2: TREATMENT/VACCINE + HERPES ZOSTER -->
<div class="two-col">

  <!-- CHICKENPOX TREATMENT + VACCINE -->
  <div class="card">
    <div class="card-header" style="background:#bf360c;">💊 TREATMENT &amp; PREVENTION — CHICKENPOX</div>
    <div class="card-body">

      <span class="sub-label cp-lbl">TREATMENT</span>
      <div class="box box-orange">
        <b>Antiviral of choice: ACYCLOVIR</b> (also valacyclovir, famciclovir, foscarnet)<br>
        Used in: immunocompromised, adults, severe disease, pneumonia.<br>
        Prevents disseminated disease in immunosuppressed patients.
      </div>
      <div class="box box-red">
        <b>⚠️ ASPIRIN (Salicylates) CONTRAINDICATED</b> in children with chickenpox!<br>
        Risk of <b>Reye's syndrome</b> (hepatic encephalopathy). Avoid salicylates for 6 weeks post-vaccination too.
      </div>

      <span class="sub-label cp-lbl">VARICELLA VACCINE (Active Immunization)</span>
      <table>
        <tbody>
          <tr><td>Type</td><td><b>Live attenuated</b> varicella vaccine (Oka strain)</td></tr>
          <tr><td>Schedule</td><td>2 doses: <b>12–15 months + 4–6 years</b></td></tr>
          <tr><td>Route</td><td>Subcutaneous (SC)</td></tr>
          <tr><td>Efficacy</td><td>~85–90% against disease; ~100% against severe disease</td></tr>
          <tr><td>Contraindications</td><td>Pregnancy (delay 4 weeks post-vaccine), severe immunocompromise</td></tr>
          <tr><td>Post-exposure use</td><td>Within <b>5 days</b> of exposure; &gt;90% efficacy if within 3 days</td></tr>
        </tbody>
      </table>

      <span class="sub-label cp-lbl">VZIG (Passive Immunization)</span>
      <div class="box box-blue" style="font-size:8px;">
        <b>Varicella-Zoster Immunoglobulin (VZIG)</b> — given within <b>72 hours</b> of exposure.<br>
        For: pregnant women, immunocompromised, neonates exposed perinatally, premature infants.
      </div>

      <span class="sub-label cp-lbl">CONTROL MEASURES</span>
      <ul>
        <li>Notification to health authorities</li>
        <li><b>Isolation</b> for 6 days after onset of rash</li>
        <li>Disinfection of articles soiled by secretions</li>
        <li>PCR of vesicular fluid for laboratory confirmation</li>
      </ul>

    </div>
  </div>

  <!-- HERPES ZOSTER + SMALLPOX VACCINE -->
  <div class="card">
    <div class="card-header" style="background:#37474f;">🔥 HERPES ZOSTER + SMALLPOX VACCINE</div>
    <div class="card-body">

      <span class="sub-label" style="color:#37474f; border-color:#90a4ae;">HERPES ZOSTER (Shingles) — Same VZV Virus!</span>
      <div class="box box-yellow">
        <span class="title">The VZV Link: Chickenpox → Herpes Zoster</span>
        After chickenpox, VZV stays <b>LATENT</b> in cranial nerve sensory ganglia &amp; dorsal root ganglia. When cell-mediated immunity <b>wanes</b> (old age, steroids, HIV) → virus reactivates → <b>Herpes Zoster</b>.
      </div>
      <ul>
        <li>Affects ~10–30% of chickenpox survivors</li>
        <li>Risk increases sharply after <b>50 years</b></li>
        <li>~50% of people reaching age 85 will have had at least 1 zoster episode</li>
        <li>Painful vesicular eruption along <b>1 dermatome</b> distribution</li>
        <li>Complication: <b>Post-herpetic neuralgia</b> (acyclovir does NOT prevent this!)</li>
        <li>Contact with zoster rash → <b>VARICELLA</b> (not zoster) in susceptible person</li>
        <li>Zoster is ~20% as infectious as chickenpox</li>
      </ul>

      <span class="sub-label sp-lbl" style="margin-top:5px;">SMALLPOX VACCINE (Vaccinia Virus)</span>
      <table>
        <tbody>
          <tr><td>Type</td><td><b>Live vaccinia virus</b> (not variola — a related poxvirus)</td></tr>
          <tr><td>Route</td><td>Intradermal — <b>bifurcated needle</b> technique</td></tr>
          <tr><td>Efficacy</td><td>~95%; protects against variola major &amp; minor</td></tr>
          <tr><td>Immunity duration</td><td>3–5 years (wanes; no routine boosters now)</td></tr>
          <tr><td>Status now</td><td><b>Routine vaccination DISCONTINUED worldwide after 1980</b></td></tr>
          <tr><td>Stockpiles</td><td>WHO maintains reserve for &gt;200 million people</td></tr>
          <tr><td>Strategy used</td><td><b>Ring vaccination / Surveillance &amp; Containment</b> (not mass vaccination)</td></tr>
        </tbody>
      </table>

      <div class="box box-purple" style="margin-top:4px;font-size:7.8px;">
        <b>Why was smallpox eradicated (but not polio/measles yet)?</b><br>
        ✔ No animal reservoir &nbsp;✔ No subclinical infectious cases &nbsp;✔ Effective vaccine available &nbsp;✔ Visible rash (easy to identify cases) &nbsp;✔ Single stable serotype
      </div>

    </div>
  </div>

</div><!-- end two-col -->

<!-- BIG COMPARISON TABLE -->
<div class="comp-wrap">
  <div class="comp-banner">⚖️ CHICKENPOX vs SMALLPOX — PARK'S COMPARISON TABLE (Most Frequently Asked!)</div>
  <table class="comp-table">
    <thead>
      <tr>
        <th class="th-f">Feature</th>
        <th class="th-cp">🐔 CHICKENPOX (Varicella)</th>
        <th class="th-sp">☠️ SMALLPOX (Variola)</th>
      </tr>
    </thead>
    <tbody>
      <tr><td>Causative agent</td><td>VZV (Herpesvirus) — DNA virus</td><td>Variola virus (Poxvirus) — DNA virus</td></tr>
      <tr><td>Incubation period</td><td><b>15 days (7–21 days)</b></td><td><b>12 days (7–17 days)</b></td></tr>
      <tr><td>Prodromal symptoms</td><td><b>Usually mild</b> (often no prodrome in children)</td><td><b>Severe</b> — high fever, backache, prostration, bedridden</td></tr>
      <tr><td>Distribution of rash</td><td><b>CENTRIPETAL</b> — trunk first, then limbs</td><td><b>CENTRIFUGAL</b> — face first, then trunk, limbs</td></tr>
      <tr><td>Palms &amp; soles</td><td><b>Seldom affected</b></td><td><b>Frequently involved</b> ★</td></tr>
      <tr><td>Axilla</td><td><b>Affected</b></td><td><b>Usually FREE</b></td></tr>
      <tr><td>Rash surface</td><td>Mostly <b>flexor surfaces</b></td><td>Mostly <b>extensor surfaces and bony prominences</b></td></tr>
      <tr><td>Vesicle character</td><td><b>Superficial, unilocular</b>, dew-drop appearance, easily ruptured, area of inflammation around</td><td><b>Deep-seated, multilocular, umbilicated</b>, "pearls of pus", NO area of inflammation around</td></tr>
      <tr><td>Rash stages</td><td><b>PLEOMORPHIC</b> — all stages simultaneously (crops)</td><td><b>MONOMORPHIC</b> — all lesions at same stage</td></tr>
      <tr><td>Evolution of rash</td><td><b>Very rapid</b></td><td><b>Slow, deliberate, "majestic"</b></td></tr>
      <tr><td>Scabbing begins</td><td><b>4–7 days</b> after rash</td><td><b>10–14 days</b> after rash</td></tr>
      <tr><td>Fever pattern</td><td>Rises with each <b>new crop</b> of rash</td><td>Falls with rash; <b>secondary rise in pustular stage</b></td></tr>
      <tr><td>Infectivity of scabs</td><td><b>Scabs NOT infective</b> ★</td><td><b>Scabs ARE infective</b></td></tr>
      <tr><td>Scarring</td><td>Less (pitted scars if scratched)</td><td><b>Severe scarring</b></td></tr>
      <tr><td>Case fatality rate</td><td><b>~3 per 100,000</b> (very low)</td><td>Variola major: <b>~30%</b>; Minor: ~1%</td></tr>
      <tr><td>Treatment</td><td><b>Acyclovir</b> (symptomatic + antiviral)</td><td><b>No specific treatment</b> (supportive only)</td></tr>
      <tr><td>Vaccine</td><td>Live attenuated <b>varicella (Oka strain)</b></td><td>Live <b>vaccinia virus</b> — discontinued after eradication</td></tr>
      <tr><td>Current status</td><td>Still occurring worldwide</td><td><b>GLOBALLY ERADICATED (1980)</b></td></tr>
    </tbody>
  </table>
</div>

<!-- MCQ BANK -->
<div style="margin-bottom:5px;">
  <div class="mcq-banner">📝 EXPECTED MCQs &amp; VIVA QUESTIONS WITH ANSWERS</div>
  <div class="mcq-grid">
    <div class="mcq-item">
      <span class="mcq-q">Q. Rash in chickenpox is?</span><br>
      <span class="mcq-a">✔ PLEOMORPHIC (all stages at once)</span><br>
      Rash in smallpox = MONOMORPHIC
    </div>
    <div class="mcq-item">
      <span class="mcq-q">Q. Distribution of rash in chickenpox?</span><br>
      <span class="mcq-a">✔ CENTRIPETAL (trunk first)</span><br>
      Smallpox = CENTRIFUGAL (face first)
    </div>
    <div class="mcq-item">
      <span class="mcq-q">Q. Global eradication of smallpox confirmed by?</span><br>
      <span class="mcq-a">✔ WHO, May 1980</span><br>
      Last natural case: Somalia 1977
    </div>
    <div class="mcq-item">
      <span class="mcq-q">Q. India declared smallpox-free when?</span><br>
      <span class="mcq-a">✔ 5th July 1975</span><br>
      Last case in India: 24 May 1975
    </div>
    <div class="mcq-item">
      <span class="mcq-q">Q. Scabs in chickenpox are infective? True/False?</span><br>
      <span class="mcq-a">✔ FALSE — scabs are NOT infective</span><br>
      But smallpox scabs ARE infective!
    </div>
    <div class="mcq-item">
      <span class="mcq-q">Q. Secondary attack rate of varicella?</span><br>
      <span class="mcq-a">✔ ~85% in household contacts</span><br>
      Highly contagious disease
    </div>
    <div class="mcq-item">
      <span class="mcq-q">Q. Drug CONTRAINDICATED in childhood chickenpox?</span><br>
      <span class="mcq-a">✔ ASPIRIN (causes Reye's syndrome)</span><br>
      Use paracetamol instead!
    </div>
    <div class="mcq-item">
      <span class="mcq-q">Q. Eradication strategy used for smallpox?</span><br>
      <span class="mcq-a">✔ Surveillance &amp; Containment (Ring vaccination)</span><br>
      NOT mass vaccination!
    </div>
    <div class="mcq-item">
      <span class="mcq-q">Q. Where is smallpox virus still stored?</span><br>
      <span class="mcq-a">✔ CDC (USA) &amp; VECTOR Institute (Russia)</span><br>
      Only 2 labs in world
    </div>
  </div>
</div>

<!-- EXAM TIPS -->
<div style="margin-bottom:5px;">
  <div class="tips-banner">🌟 IMPRESS THE EXAMINER — SAY THESE EXACT LINES!</div>
  <div class="tips-grid">
    <div class="tip-item">
      ✔ <b>"Chickenpox rash is pleomorphic — all stages seen simultaneously because it appears in successive crops. Smallpox is monomorphic — all lesions at the same stage."</b>
    </div>
    <div class="tip-item">
      ✔ <b>"Chickenpox scabs are not infective — the virus dies out before the pustular stage. But smallpox scabs ARE infective until they fall off."</b>
    </div>
    <div class="tip-item">
      ✔ <b>"Aspirin must never be given to children with chickenpox because it causes Reye's syndrome — a potentially fatal hepatic encephalopathy."</b>
    </div>
    <div class="tip-item">
      ✔ <b>"Smallpox was eradicated because it had no animal reservoir, no subclinical infectious cases, a visible rash for easy detection, and an effective vaccine — unique combination."</b>
    </div>
    <div class="tip-item">
      ✔ <b>"After chickenpox, VZV lies latent in dorsal root ganglia for decades. When cell-mediated immunity wanes — with age or immunosuppression — it reactivates as Herpes Zoster."</b>
    </div>
    <div class="tip-item">
      ✔ <b>"India was declared smallpox-free on 5th July 1975. WHO confirmed global eradication in May 1980 — the first and only human disease to be eradicated."</b>
    </div>
  </div>
</div>

<div class="footer">
  PSM Quick Reference | MBBS 2nd Year | Source: Park's Textbook of Preventive &amp; Social Medicine | Red Book 2021 | Harrison's 22e | Generated by Orris — Good luck! 🎓
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<title>Measles vs Rubella vs Chickenpox vs Smallpox</title>
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</head>
<body>

<!-- BANNER -->
<div class="banner">
  <h1>🔴 MEASLES &nbsp;&nbsp;vs&nbsp;&nbsp; 🟢 RUBELLA &nbsp;&nbsp;vs&nbsp;&nbsp; 🟠 CHICKENPOX &nbsp;&nbsp;vs&nbsp;&nbsp; 🟣 SMALLPOX — PSM Comparison Card</h1>
  <p>MBBS 2nd Year | PSM Practical Exam | K. Park's Textbook of PSM | Harrison's 22e | Source: Park's PSM, Red Book 2021, ICMR Guidelines</p>
</div>

<!-- MAIN COMPARISON TABLE -->
<table class="main-table">
  <thead>
    <tr>
      <th class="th-feat">FEATURE</th>
      <th class="th-measles">🔴 MEASLES<br><span style="font-size:7.5px;font-weight:400;">(Rubeola / Hard Measles)</span></th>
      <th class="th-rubella">🟢 RUBELLA<br><span style="font-size:7.5px;font-weight:400;">(German / 3-Day Measles)</span></th>
      <th class="th-varic">🟠 CHICKENPOX<br><span style="font-size:7.5px;font-weight:400;">(Varicella)</span></th>
      <th class="th-small">🟣 SMALLPOX<br><span style="font-size:7.5px;font-weight:400;">(Variola — ERADICATED)</span></th>
    </tr>
  </thead>
  <tbody>

    <!-- AETIOLOGY -->
    <tr class="cat-row"><td colspan="5">⚗️ AETIOLOGY &amp; BASICS</td></tr>
    <tr>
      <td class="feat-col">Causative virus</td>
      <td class="col-m">Measles virus<br><span class="hl hl-m">Paramyxovirus (Morbillivirus)</span></td>
      <td class="col-r">Rubella virus<br><span class="hl hl-r">Togavirus (Rubivirus)</span></td>
      <td class="col-v">Varicella-Zoster Virus<br><span class="hl hl-v">Herpesvirus — Human α-HV3</span></td>
      <td class="col-s">Variola virus<br><span class="hl hl-s">Poxvirus (Orthopoxvirus)</span></td>
    </tr>
    <tr>
      <td class="feat-col">Nucleic acid</td>
      <td class="col-m"><span class="hl hl-m">RNA virus</span></td>
      <td class="col-r"><span class="hl hl-r">RNA virus</span></td>
      <td class="col-v"><span class="hl hl-v">DNA virus</span></td>
      <td class="col-s"><span class="hl hl-s">DNA virus</span></td>
    </tr>
    <tr>
      <td class="feat-col">Reservoir</td>
      <td class="col-m">Humans only</td>
      <td class="col-r">Humans only</td>
      <td class="col-v">Humans only</td>
      <td class="col-s">Humans only</td>
    </tr>
    <tr>
      <td class="feat-col">Transmission</td>
      <td class="col-m">Droplet + airborne<br><span class="hl hl-m">Most contagious of all!</span></td>
      <td class="col-r">Droplet infection</td>
      <td class="col-v">Droplet + contact + <span class="hl hl-v">airborne</span></td>
      <td class="col-s">Droplet + direct contact</td>
    </tr>
    <tr>
      <td class="feat-col">Incubation period</td>
      <td class="col-m"><span class="hl hl-m">10–12 days</span></td>
      <td class="col-r"><span class="hl hl-r">14–21 days (avg 18)</span></td>
      <td class="col-v"><span class="hl hl-v">15 days (7–21)</span></td>
      <td class="col-s"><span class="hl hl-s">12 days (7–17)</span></td>
    </tr>
    <tr>
      <td class="feat-col">Communicability</td>
      <td class="col-m">4 days before → 4 days after rash</td>
      <td class="col-r">7 days before → 7 days after rash</td>
      <td class="col-v">1–2 days before → 4–5 days after rash (till crusted)</td>
      <td class="col-s">Onset of oral lesions → all crusts fall off (~3–4 wks)</td>
    </tr>
    <tr>
      <td class="feat-col">Secondary attack rate</td>
      <td class="col-m"><span class="hl hl-m">90–95%</span> (highest!)</td>
      <td class="col-r">~10–30%</td>
      <td class="col-v"><span class="hl hl-v">~85%</span> household contacts</td>
      <td class="col-s">Variable; lower than measles</td>
    </tr>

    <!-- PRODROME -->
    <tr class="cat-row"><td colspan="5">🌡️ PRODROME (Before Rash)</td></tr>
    <tr>
      <td class="feat-col">Severity of prodrome</td>
      <td class="col-m"><span class="hl hl-m">3–4 days, severe</span><br>High fever</td>
      <td class="col-r"><span class="hl hl-r">1–5 days, mild</span><br>Low fever, malaise</td>
      <td class="col-v"><span class="hl hl-v">1–2 days, mild</span><br>Often absent in children</td>
      <td class="col-s"><span class="hl hl-s">2–4 days, VERY severe</span><br>Bedridden</td>
    </tr>
    <tr>
      <td class="feat-col">3 C's (Catarrhal stage)</td>
      <td class="col-m"><span class="hl hl-m">Present! ★</span><br>Cough, Coryza, Conjunctivitis</td>
      <td class="col-r">Absent</td>
      <td class="col-v">Absent</td>
      <td class="col-s">Absent</td>
    </tr>
    <tr>
      <td class="feat-col">Koplik's spots</td>
      <td class="col-m"><span class="hl hl-m">PRESENT ★ (Pathognomonic)</span><br>White spots on buccal mucosa</td>
      <td class="col-r">Absent</td>
      <td class="col-v">Absent</td>
      <td class="col-s">Absent</td>
    </tr>
    <tr>
      <td class="feat-col">Backache</td>
      <td class="col-m">Mild</td>
      <td class="col-r">Absent / mild</td>
      <td class="col-v">Absent</td>
      <td class="col-s"><span class="hl hl-s">SEVERE, characteristic ★</span></td>
    </tr>

    <!-- RASH -->
    <tr class="cat-row"><td colspan="5">🌺 RASH CHARACTERISTICS (Most Asked!)</td></tr>
    <tr>
      <td class="feat-col">Distribution</td>
      <td class="col-m"><span class="hl hl-m">Centrifugal</span><br>Face → neck → trunk → limbs</td>
      <td class="col-r"><span class="hl hl-r">Centrifugal</span><br>Face → trunk → limbs</td>
      <td class="col-v"><span class="hl hl-v">CENTRIPETAL ★</span><br>Trunk → face → limbs</td>
      <td class="col-s"><span class="hl hl-s">Centrifugal ★</span><br>Face → arms → trunk → legs</td>
    </tr>
    <tr>
      <td class="feat-col">Palms &amp; soles</td>
      <td class="col-m">Not typically affected</td>
      <td class="col-r">Not typically affected</td>
      <td class="col-v"><span class="hl hl-v">Usually SPARED ★</span></td>
      <td class="col-s"><span class="hl hl-s">FREQUENTLY involved ★</span></td>
    </tr>
    <tr>
      <td class="feat-col">Rash type</td>
      <td class="col-m">Maculopapular<br><span class="hl hl-m">coalescent, blotchy</span></td>
      <td class="col-r">Maculopapular<br><span class="hl hl-r">discrete, fine, faint</span></td>
      <td class="col-v"><span class="hl hl-v">Vesicular</span><br>"Dew-drops on skin"</td>
      <td class="col-s"><span class="hl hl-s">Vesiculopustular</span><br>"Pearls of pus"</td>
    </tr>
    <tr>
      <td class="feat-col">Vesicle depth</td>
      <td class="col-m">No vesicles</td>
      <td class="col-r">No vesicles</td>
      <td class="col-v"><span class="hl hl-v">SUPERFICIAL, unilocular</span><br>easily ruptured</td>
      <td class="col-s"><span class="hl hl-s">DEEP, multilocular</span><br>hard, umbilicated</td>
    </tr>
    <tr>
      <td class="feat-col">Inflammation around lesion</td>
      <td class="col-m">—</td>
      <td class="col-r">—</td>
      <td class="col-v"><span class="hl hl-v">PRESENT (erythematous halo)</span></td>
      <td class="col-s"><span class="hl hl-s">ABSENT</span></td>
    </tr>
    <tr>
      <td class="feat-col">Stages of rash (Park's)</td>
      <td class="col-m">MONOMORPHIC<br>Macular → papular (coalesce)</td>
      <td class="col-r">MONOMORPHIC<br>Maculopapular only (3 days)</td>
      <td class="col-v"><span class="hl hl-v">PLEOMORPHIC ★</span><br>All stages simultaneously (crops)</td>
      <td class="col-s"><span class="hl hl-s">MONOMORPHIC ★</span><br>One stage at a time</td>
    </tr>
    <tr>
      <td class="feat-col">Rash duration</td>
      <td class="col-m"><span class="hl hl-m">4–7 days</span></td>
      <td class="col-r"><span class="hl hl-r">3 days only</span></td>
      <td class="col-v">Scabs in <span class="hl hl-v">4–7 days</span></td>
      <td class="col-s">Scabs in <span class="hl hl-s">10–14 days</span> (slow!)</td>
    </tr>
    <tr>
      <td class="feat-col">Axilla involvement</td>
      <td class="col-m">—</td>
      <td class="col-r">—</td>
      <td class="col-v"><span class="hl hl-v">Affected</span></td>
      <td class="col-s"><span class="hl hl-s">Usually FREE</span></td>
    </tr>
    <tr>
      <td class="feat-col">Scarring</td>
      <td class="col-m">Minimal</td>
      <td class="col-r">None</td>
      <td class="col-v">Pitted scars if scratched</td>
      <td class="col-s"><span class="hl hl-s">SEVERE, permanent ★</span></td>
    </tr>

    <!-- LYMPH NODES -->
    <tr class="cat-row"><td colspan="5">🫁 LYMPHADENOPATHY &amp; FEVER</td></tr>
    <tr>
      <td class="feat-col">Lymphadenopathy</td>
      <td class="col-m">Cervical lymph nodes<br>+ generalised</td>
      <td class="col-r"><span class="hl hl-r">Occipital + post-auricular ★</span><br>TENDER — hallmark!</td>
      <td class="col-v">—</td>
      <td class="col-s">—</td>
    </tr>
    <tr>
      <td class="feat-col">Fever pattern</td>
      <td class="col-m">High fever; falls at rash onset</td>
      <td class="col-r">Low grade or absent</td>
      <td class="col-v">Rises with each <span class="hl hl-v">new crop</span></td>
      <td class="col-s">Falls with rash; <span class="hl hl-s">secondary rise</span> in pustular stage</td>
    </tr>
    <tr>
      <td class="feat-col">Infectivity of scabs</td>
      <td class="col-m">No scabs formed</td>
      <td class="col-r">No scabs formed</td>
      <td class="col-v"><span class="hl hl-v">Scabs NOT infective ★</span></td>
      <td class="col-s"><span class="hl hl-s">Scabs ARE infective ★</span></td>
    </tr>

    <!-- SPECIAL FEATURES -->
    <tr class="cat-row"><td colspan="5">⭐ SPECIAL / UNIQUE FEATURES</td></tr>
    <tr>
      <td class="feat-col">Pathognomonic sign</td>
      <td class="col-m"><span class="hl hl-m">Koplik's spots</span></td>
      <td class="col-r"><span class="hl hl-r">Occipital LN + 3-day rash</span></td>
      <td class="col-v"><span class="hl hl-v">Pleomorphic vesicles (dew-drop)</span></td>
      <td class="col-s"><span class="hl hl-s">Deep umbilicated pustules on face</span></td>
    </tr>
    <tr>
      <td class="feat-col">Subclinical cases</td>
      <td class="col-m">Rare</td>
      <td class="col-r"><span class="hl hl-r">50% subclinical! ★</span></td>
      <td class="col-v">Rare</td>
      <td class="col-s"><span class="hl hl-s">None (all visible)</span></td>
    </tr>
    <tr>
      <td class="feat-col">Mucosal involvement</td>
      <td class="col-m">Oral (Koplik's), conjunctiva</td>
      <td class="col-r">Mild oral</td>
      <td class="col-v">Buccal, pharyngeal mucosa</td>
      <td class="col-s">Oral/pharyngeal — patient becomes <span class="hl hl-s">infectious</span></td>
    </tr>
    <tr>
      <td class="feat-col">Pregnancy danger</td>
      <td class="col-m">Pneumonia, preterm birth</td>
      <td class="col-r"><span class="hl hl-r">CRITICAL → CRS ★</span><br>CCC: Cataract+Cardiac+Cochlear</td>
      <td class="col-v">Neonatal varicella, pneumonia</td>
      <td class="col-s">CFR highest in pregnancy (~30%)</td>
    </tr>
    <tr>
      <td class="feat-col">Arthritis in adults</td>
      <td class="col-m">Uncommon</td>
      <td class="col-r"><span class="hl hl-r">Common (esp. women) ★</span></td>
      <td class="col-v">Uncommon</td>
      <td class="col-s">—</td>
    </tr>
    <tr>
      <td class="feat-col">Latency / Reactivation</td>
      <td class="col-m">None</td>
      <td class="col-r">None</td>
      <td class="col-v"><span class="hl hl-v">Herpes Zoster ★</span><br>Reactivates from dorsal root ganglia</td>
      <td class="col-s">None</td>
    </tr>

    <!-- COMPLICATIONS -->
    <tr class="cat-row"><td colspan="5">⚡ KEY COMPLICATIONS</td></tr>
    <tr>
      <td class="feat-col">Most feared complication</td>
      <td class="col-m">Pneumonia, Encephalitis<br>Subacute sclerosing panencephalitis (SSPE)</td>
      <td class="col-r"><span class="hl hl-r">CRS (Congenital Rubella Syndrome)</span></td>
      <td class="col-v">Secondary bacterial infection<br>Pneumonia (adults), Reye's syndrome</td>
      <td class="col-s"><span class="hl hl-s">Death (CFR 30%)</span><br>Hemorrhagic type CFR ~100%</td>
    </tr>
    <tr>
      <td class="feat-col">Drug contraindication</td>
      <td class="col-m">—</td>
      <td class="col-r">—</td>
      <td class="col-v"><span class="hl hl-v">ASPIRIN → Reye's syndrome ★</span></td>
      <td class="col-s">—</td>
    </tr>

    <!-- TREATMENT & VACCINE -->
    <tr class="cat-row"><td colspan="5">💊 TREATMENT &amp; VACCINE</td></tr>
    <tr>
      <td class="feat-col">Specific treatment</td>
      <td class="col-m">Vitamin A + supportive<br>(Vit A reduces mortality!)</td>
      <td class="col-r">Supportive only<br>No antiviral</td>
      <td class="col-v"><span class="hl hl-v">ACYCLOVIR ★</span><br>(esp. immunocompromised)</td>
      <td class="col-s">No specific antiviral<br>Supportive only</td>
    </tr>
    <tr>
      <td class="feat-col">Vaccine type</td>
      <td class="col-m">Live attenuated<br>(MMR)</td>
      <td class="col-r">Live attenuated<br>(MMR)</td>
      <td class="col-v">Live attenuated<br>(Oka strain; separate or MMRV)</td>
      <td class="col-s"><span class="hl hl-s">Live vaccinia virus ★</span><br>DISCONTINUED after 1980</td>
    </tr>
    <tr>
      <td class="feat-col">Vaccine schedule (Nepal/India)</td>
      <td class="col-m">MMR: 9 m + 15 m</td>
      <td class="col-r">MMR: 9 m + 15 m</td>
      <td class="col-v">12–15 m + 4–6 yr</td>
      <td class="col-s">No routine vaccination<br>(since 1980)</td>
    </tr>
    <tr>
      <td class="feat-col">Post-exposure prophylaxis</td>
      <td class="col-m">Vaccine within 72 h OR<br>Normal IG within 6 days</td>
      <td class="col-r">Vaccine (non-pregnant)<br>No benefit post-exposure in pregnancy</td>
      <td class="col-v"><span class="hl hl-v">Vaccine within 5 days</span><br>VZIG within 72 h (high-risk)</td>
      <td class="col-s">Ring vaccination</td>
    </tr>
    <tr>
      <td class="feat-col">Vaccine contraindication</td>
      <td class="col-m">Pregnancy, severe immunocomp.</td>
      <td class="col-r">Pregnancy (delay 1 month)</td>
      <td class="col-v">Pregnancy (delay 4 weeks)</td>
      <td class="col-s">N/A (routine not given)</td>
    </tr>

    <!-- STATUS -->
    <tr class="cat-row"><td colspan="5">🌍 CURRENT STATUS &amp; ERADICATION</td></tr>
    <tr>
      <td class="feat-col">Current status</td>
      <td class="col-m">Ongoing; elimination target<br>WHO target: eliminate regionally</td>
      <td class="col-r">Ongoing; CRS prevention priority</td>
      <td class="col-v">Ongoing worldwide<br>~4.2 M hospitalisations/yr</td>
      <td class="col-s"><span class="hl hl-s">GLOBALLY ERADICATED 1980 ★</span><br>First human disease eradicated!</td>
    </tr>
    <tr>
      <td class="feat-col">CFR (unvaccinated)</td>
      <td class="col-m">1–3 per 1000</td>
      <td class="col-r">Very low<br>(&lt;1 per 1000)</td>
      <td class="col-v">~3 per 100,000</td>
      <td class="col-s"><span class="hl hl-s">~30% (Variola major)</span></td>
    </tr>

  </tbody>
</table>

<!-- BOTTOM 3-PANEL ROW -->
<div class="bottom-row">

  <!-- MEMORY TRICKS -->
  <div class="panel">
    <div class="panel-hdr green-hdr">🧠 MEMORY TRICKS — NEVER FORGET!</div>
    <div class="panel-body">
      <b>"MERK" = Measles, EaR (rubella), Koplik's (measles only)</b><br><br>
      <b>Rash distribution:</b><br>
      &nbsp; <span style="color:#c62828;">●</span> Measles = face→trunk (centri<b>F</b>ugal = <b>F</b>ace first)<br>
      &nbsp; <span style="color:#00695c;">●</span> Rubella = face→trunk (centri<b>F</b>ugal = <b>F</b>ace first)<br>
      &nbsp; <span style="color:#e65100;">●</span> Chickenpox = trunk→limbs (centri<b>P</b>etal = <b>P</b>ericentral/trunk first)<br>
      &nbsp; <span style="color:#4a148c;">●</span> Smallpox = face→trunk (<b>F</b>ace = <b>F</b>earful severity)<br><br>
      <b>Rash type trick:</b><br>
      &nbsp; Chickenpox = <b>P</b>leomorphic = <b>P</b>lenty of stages at once<br>
      &nbsp; Smallpox = <b>M</b>onomorphic = <b>M</b>arching one stage at a time<br><br>
      <b>Vesicle depth:</b><br>
      &nbsp; Chickenpox = <b>S</b>uperficial = <b>S</b>afe (low CFR)<br>
      &nbsp; Smallpox = <b>D</b>eep = <b>D</b>eadly (30% CFR)<br><br>
      <b>CRS = "3 C's":</b> Cataract + Cardiac + Cochlear deafness<br>
      <b>Measles 3C's:</b> Cough + Coryza + Conjunctivitis (prodrome)<br><br>
      <b>Incubation (shortest→longest):</b><br>
      Measles (10–12) &lt; Smallpox (12) &lt; Chickenpox (15) &lt; Rubella (18 avg)
    </div>
  </div>

  <!-- MCQ BANK -->
  <div class="panel">
    <div class="panel-hdr blue-hdr">📝 HIGH-YIELD MCQs</div>
    <div class="panel-body">
      <table class="mini-table">
        <tr><td><b>Only disease with Koplik's spots?</b></td><td><span class="hl hl-m">Measles</span></td></tr>
        <tr><td><b>Rash lasts only 3 days?</b></td><td><span class="hl hl-r">Rubella</span></td></tr>
        <tr><td><b>Rash centripetal (trunk first)?</b></td><td><span class="hl hl-v">Chickenpox</span></td></tr>
        <tr><td><b>Palms &amp; soles always involved?</b></td><td><span class="hl hl-s">Smallpox</span></td></tr>
        <tr><td><b>Pleomorphic rash?</b></td><td><span class="hl hl-v">Chickenpox</span></td></tr>
        <tr><td><b>Monomorphic rash?</b></td><td><span class="hl hl-s">Smallpox</span></td></tr>
        <tr><td><b>50% subclinical cases?</b></td><td><span class="hl hl-r">Rubella</span></td></tr>
        <tr><td><b>Scabs NOT infective?</b></td><td><span class="hl hl-v">Chickenpox</span></td></tr>
        <tr><td><b>Aspirin contraindicated?</b></td><td><span class="hl hl-v">Chickenpox (Reye's)</span></td></tr>
        <tr><td><b>Post-auricular LN tender?</b></td><td><span class="hl hl-r">Rubella</span></td></tr>
        <tr><td><b>Arthritis common in adult women?</b></td><td><span class="hl hl-r">Rubella</span></td></tr>
        <tr><td><b>CRS triad (Gregg's)?</b></td><td><span class="hl hl-r">Rubella: Cat+Card+Coch</span></td></tr>
        <tr><td><b>Herpes zoster reactivation?</b></td><td><span class="hl hl-v">Chickenpox (VZV)</span></td></tr>
        <tr><td><b>Globally eradicated 1980?</b></td><td><span class="hl hl-s">Smallpox</span></td></tr>
        <tr><td><b>CFR ~30%?</b></td><td><span class="hl hl-s">Smallpox (Variola major)</span></td></tr>
        <tr><td><b>Vaccine = live vaccinia virus?</b></td><td><span class="hl hl-s">Smallpox (discontinued)</span></td></tr>
        <tr><td><b>Vitamin A reduces mortality?</b></td><td><span class="hl hl-m">Measles</span></td></tr>
        <tr><td><b>India declared free: 5 Jul 1975?</b></td><td><span class="hl hl-s">Smallpox</span></td></tr>
      </table>
    </div>
  </div>

  <!-- COLOUR-CODED RECAP -->
  <div class="panel">
    <div class="panel-hdr amber-hdr">⚡ RAPID RECALL — ONE GLANCE!</div>
    <div class="panel-body">
      <table class="mini-table">
        <tr><td colspan="2" style="background:#c62828;color:white;font-weight:900;text-align:center;">🔴 MEASLES (Paramyxovirus, RNA)</td></tr>
        <tr><td>Incubation</td><td>10–12 days</td></tr>
        <tr><td>Prodrome</td><td>3C's + Koplik's ★</td></tr>
        <tr><td>Rash</td><td>Maculopapular, centrifugal, 4–7 days</td></tr>
        <tr><td>Treatment</td><td>Vitamin A + supportive</td></tr>
        <tr><td>Vaccine</td><td>MMR (9 m + 15 m)</td></tr>
      </table>
      <br>
      <table class="mini-table">
        <tr><td colspan="2" style="background:#00695c;color:white;font-weight:900;text-align:center;">🟢 RUBELLA (Togavirus, RNA)</td></tr>
        <tr><td>Incubation</td><td>14–21 days (avg 18)</td></tr>
        <tr><td>Hallmark</td><td>Occipital/post-auricular LN ★</td></tr>
        <tr><td>Rash</td><td>Fine maculopapular, 3 days only</td></tr>
        <tr><td>Danger</td><td>CRS (Cataract+Cardiac+Cochlear)</td></tr>
        <tr><td>Vaccine</td><td>MMR (9 m + 15 m)</td></tr>
      </table>
      <br>
      <table class="mini-table">
        <tr><td colspan="2" style="background:#e65100;color:white;font-weight:900;text-align:center;">🟠 CHICKENPOX (VZV, DNA)</td></tr>
        <tr><td>Incubation</td><td>15 days (7–21)</td></tr>
        <tr><td>Rash</td><td>CENTRIPETAL; PLEOMORPHIC; dew-drop ★</td></tr>
        <tr><td>No aspirin!</td><td>Reye's syndrome risk ★</td></tr>
        <tr><td>Treatment</td><td>Acyclovir</td></tr>
        <tr><td>Latency</td><td>→ Herpes Zoster later in life</td></tr>
      </table>
      <br>
      <table class="mini-table">
        <tr><td colspan="2" style="background:#4a148c;color:white;font-weight:900;text-align:center;">🟣 SMALLPOX (Variola, DNA) — ERADICATED</td></tr>
        <tr><td>Incubation</td><td>12 days (7–17)</td></tr>
        <tr><td>Rash</td><td>CENTRIFUGAL; MONOMORPHIC; deep pustules ★</td></tr>
        <tr><td>CFR</td><td>~30% (Variola major)</td></tr>
        <tr><td>Eradicated</td><td>WHO May 1980 (India free: 5 Jul 1975)</td></tr>
        <tr><td>Vaccine</td><td>Live vaccinia — discontinued!</td></tr>
      </table>
    </div>
  </div>

</div><!-- end bottom-row -->

<!-- EXAMINER TIPS -->
<div>
  <div class="tips-banner">🌟 LINES TO IMPRESS THE EXAMINER</div>
  <div class="tips-grid">
    <div class="tip">
      ✔ <b>"Measles is the MOST contagious of all four — secondary attack rate 90–95%. Koplik's spots are pathognomonic and appear before the rash."</b>
    </div>
    <div class="tip">
      ✔ <b>"50% of rubella cases are subclinical — this is why pregnant women unknowingly get infected and transmit CRS. Gregg's triad = Cataract + Cardiac (PDA) + Cochlear deafness."</b>
    </div>
    <div class="tip">
      ✔ <b>"Chickenpox rash is pleomorphic (successive crops) and centripetal (trunk first). Smallpox is monomorphic (one stage at a time) and centrifugal (face first) — the most important clinical distinction."</b>
    </div>
    <div class="tip">
      ✔ <b>"Smallpox was eradicated because no animal reservoir, no subclinical cases, visible rash, effective vaccine — the 1967 WHO surveillance &amp; containment strategy worked perfectly. India was declared free on 5 July 1975; WHO confirmed global eradication May 1980."</b>
    </div>
  </div>
</div>

<div class="footer">
  PSM Comparison Card | MBBS 2nd Year | Source: Park's Textbook of PSM (K. Park) | Harrison's Principles of Internal Medicine 22e | Red Book 2021 | ICMR-NIN 2020 | Generated by Orris — All the best for your exam! 🎓
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<!-- BANNER -->
<div class="banner">
  <h1>👁️ BLINDNESS — PSM Quick Reference (K. Park)</h1>
  <p>MBBS 2nd Year | PSM Practical Exam | Park's Textbook of PSM | WHO ICD-11 | Vision 2020 | NPCB India</p>
</div>

<!-- ROW 1: DEFINITION + CLASSIFICATION + MAGNITUDE -->
<div class="two-col">

  <!-- DEFINITION & CLASSIFICATION -->
  <div class="card">
    <div class="card-header navy">📖 DEFINITION &amp; CLASSIFICATION (WHO / ICD-11)</div>
    <div class="card-body">

      <div class="box box-b">
        <span class="title">WHO DEFINITION OF BLINDNESS (Park's)</span>
        <b>"Visual acuity of less than 3/60 (Snellen) or its equivalent"</b><br>
        — Proposed by WHO; adopted at 25th World Health Assembly, 1972<br>
        (Earlier, 65 different definitions of blindness existed worldwide!)
      </div>

      <span class="sub sub-b">ICD-11 (2018): DISTANCE VISION IMPAIRMENT CATEGORIES</span>
      <table class="th-b">
        <thead><tr><th>Category</th><th>Visual Acuity</th><th>Memory Aid</th></tr></thead>
        <tbody>
          <tr><td>Mild impairment</td><td>Worse than <b>6/12</b></td><td>Can't read newspaper</td></tr>
          <tr><td>Moderate impairment</td><td>Worse than <b>6/18</b></td><td>Low vision</td></tr>
          <tr><td>Severe impairment</td><td>Worse than <b>6/60</b></td><td>Finger counting</td></tr>
          <tr><td><b>BLINDNESS ★</b></td><td>Worse than <b>3/60</b></td><td>Perception of light only</td></tr>
        </tbody>
      </table>

      <div class="box box-a" style="margin-top:4px;">
        <span class="title">NEAR VISION IMPAIRMENT</span>
        Worse than <b>N6 or M0.8 at 40 cm</b> with existing correction (presbyopia main cause — 826 million affected!)
      </div>

      <span class="sub sub-b">OLD TERMINOLOGY (Still asked in exams)</span>
      <table>
        <tbody>
          <tr><td><b>Economic blindness</b></td><td>VA &lt; 6/60 (cannot earn a living)</td></tr>
          <tr><td><b>Social blindness</b></td><td>VA &lt; 3/60 (needs social support)</td></tr>
          <tr><td><b>Total blindness</b></td><td>No light perception at all</td></tr>
        </tbody>
      </table>

      <span class="sub sub-b">TYPES: AVOIDABLE vs UNAVOIDABLE</span>
      <div class="box box-g">
        <b>~80% of all blindness is AVOIDABLE</b> (preventable OR treatable)<br>
        Only ~20% is unavoidable (congenital anomalies, hereditary, etc.)<br>
        This is the most important PSM concept about blindness!
      </div>

    </div>
  </div>

  <!-- GLOBAL MAGNITUDE -->
  <div class="card">
    <div class="card-header blue">🌍 MAGNITUDE OF THE PROBLEM (Park's)</div>
    <div class="card-body">

      <span class="sub sub-b">GLOBAL FIGURES</span>
      <div class="box box-b">
        <b>1 billion people</b> have vision impairment that could be prevented/treated.<br>
        82% of all visually impaired are <b>aged ≥50 years</b>.<br>
        19 million children are visually impaired; 1.4 million irreversibly blind for life.
      </div>

      <span class="sub sub-b">GLOBAL CAUSES OF BLINDNESS (Park's Table)</span>
      <table class="th-b">
        <thead><tr><th>Cause</th><th>% of Blindness</th></tr></thead>
        <tbody>
          <tr><td><b>1. Un-operated Cataract ★</b></td><td><b>35%</b> — #1 cause of blindness!</td></tr>
          <tr><td><b>2. Uncorrected Refractive Error</b></td><td><b>21%</b></td></tr>
          <tr><td><b>3. Glaucoma</b></td><td><b>8%</b></td></tr>
          <tr><td>4. Age-related Macular Degeneration</td><td>~5%</td></tr>
          <tr><td>5. Corneal opacities</td><td>~4%</td></tr>
          <tr><td>6. Diabetic Retinopathy</td><td>~3%</td></tr>
          <tr><td>7. Trachoma</td><td>~2%</td></tr>
        </tbody>
      </table>

      <span class="sub sub-b">CAUSES OF MODERATE-SEVERE VISION IMPAIRMENT</span>
      <table class="th-b">
        <thead><tr><th>Cause</th><th>%</th></tr></thead>
        <tbody>
          <tr><td><b>1. Uncorrected Refractive Errors ★</b></td><td><b>53%</b> — #1 cause of visual impairment!</td></tr>
          <tr><td><b>2. Un-operated Cataract</b></td><td><b>25%</b></td></tr>
          <tr><td>3. Age-related Macular Degeneration</td><td>4%</td></tr>
          <tr><td>4. Glaucoma</td><td>2%</td></tr>
          <tr><td>5. Diabetic Retinopathy</td><td>1%</td></tr>
        </tbody>
      </table>

      <div class="box box-r" style="margin-top:3px;font-size:7.8px;">
        <b>KEY DISTINCTION (Examiners love this!):</b><br>
        #1 cause of <b>BLINDNESS</b> = <b>Cataract (35%)</b><br>
        #1 cause of <b>VISUAL IMPAIRMENT</b> = <b>Refractive Error (53%)</b>
      </div>

      <span class="sub sub-b">SOUTH-EAST ASIA REGION (SEAR) / INDIA</span>
      <ul>
        <li>Cataract = <b>50–80%</b> of all blindness in SEAR</li>
        <li>India: ~1.2 crore (12 million) blind people</li>
        <li>Cataract alone accounts for <b>62.6%</b> of blindness in India</li>
        <li>Childhood blindness main cause: <b>Xerophthalmia</b> (Vit A deficiency)</li>
        <li>Emerging: glaucoma, diabetic retinopathy, corneal ulcer, trauma</li>
      </ul>

    </div>
  </div>

</div>

<!-- ROW 2: CAUSES IN DETAIL + TRACHOMA -->
<div class="two-col">

  <!-- MAJOR CAUSES IN DETAIL -->
  <div class="card">
    <div class="card-header green">🔍 MAJOR CAUSES OF BLINDNESS — DETAILS</div>
    <div class="card-body">

      <span class="sub sub-g">1. CATARACT (Most Common Cause of Blindness)</span>
      <ul>
        <li>Opacity of the lens — causes gradual painless loss of vision</li>
        <li>Age-related (senile cataract) = most common type</li>
        <li>Also: congenital, traumatic, diabetic, radiation-induced</li>
        <li><b>Treatment: Surgical removal</b> (ECCE + IOL implant)</li>
        <li>Fully treatable — most important reason to prevent avoidable blindness</li>
        <li>Key strategy: Cataract Surgical Rate (CSR) — India target: 6 million/year</li>
      </ul>

      <span class="sub sub-g">2. REFRACTIVE ERRORS (#1 Visual Impairment)</span>
      <ul>
        <li>Myopia, hypermetropia, astigmatism, presbyopia</li>
        <li>Presbyopia = loss of near vision with age (826 million affected globally!)</li>
        <li><b>Treatment: Spectacles / contact lenses / refractive surgery</b></li>
        <li>Cheapest, most effective intervention for visual impairment</li>
      </ul>

      <span class="sub sub-g">3. GLAUCOMA (#3 Cause of Blindness)</span>
      <ul>
        <li>Increased intraocular pressure → optic nerve damage</li>
        <li>"Silent thief of sight" — often no symptoms until late</li>
        <li>Open angle most common; closed angle = acute emergency</li>
        <li><b>Treatment:</b> Eye drops (beta-blockers), laser, surgery</li>
        <li>Irreversible blindness if untreated — early detection crucial</li>
      </ul>

      <span class="sub sub-g">4. VITAMIN A DEFICIENCY / XEROPHTHALMIA</span>
      <ul>
        <li>Leading cause of <b>childhood blindness</b> in developing countries</li>
        <li>Stages: Night blindness → Bitot's spots → Corneal xerosis → Keratomalacia (corneal melting) → Blindness</li>
        <li><b>Treatment/Prevention:</b> Vitamin A supplementation</li>
        <li>National programme: Vit A given at 9 months, 16 months, then every 6 months till 5 years</li>
        <li>Now under control due to immunization programme distribution</li>
      </ul>

      <span class="sub sub-g">5. DIABETIC RETINOPATHY (Emerging Cause)</span>
      <ul>
        <li>Microangiopathy of retinal vessels due to diabetes</li>
        <li>Globally 3 million moderate-severe visual impairment cases</li>
        <li>Prevention: Good glycaemic control; annual retinal screening</li>
        <li>Treatment: Laser photocoagulation, anti-VEGF injections, vitrectomy</li>
      </ul>

      <span class="sub sub-g">6. CORNEAL BLINDNESS</span>
      <ul>
        <li>Causes: trachoma, xerophthalmia, trauma, infections (HSV), ulcers</li>
        <li>3–4 million persons blind due to corneal opacity</li>
        <li>Treatment: Corneal transplantation (keratoplasty)</li>
        <li>Prevention: Eye banking, eye donation awareness</li>
      </ul>

    </div>
  </div>

  <!-- TRACHOMA -->
  <div class="card">
    <div class="card-header teal">🦠 TRACHOMA — Infectious Cause of Blindness</div>
    <div class="card-body">

      <div class="box box-t">
        <span class="title">DEFINITION (Park's)</span>
        Chronic infectious disease of conjunctiva &amp; cornea caused by <b>Chlamydia trachomatis</b>. Leads to conjunctival scarring → trichiasis/entropion → corneal ulceration → blindness.
      </div>

      <span class="sub sub-t">DISEASE PROCESS (How blindness occurs)</span>
      <div class="box box-t" style="font-size:7.8px;">
        Infection → Follicles on conjunctiva → <b>Scarring</b> → <b>Trichiasis</b> (inward eyelashes) / <b>Entropion</b> (inward lid) → Eyelashes scratch cornea → <b>Corneal ulcer → Scar → Blindness</b>
      </div>

      <span class="sub sub-t">DIAGNOSIS (Field criteria — need ≥2 of 4)</span>
      <table class="th-t">
        <thead><tr><th>#</th><th>Criterion</th></tr></thead>
        <tbody>
          <tr><td>a</td><td>Follicles on upper tarsal conjunctiva</td></tr>
          <tr><td>b</td><td>Limbal follicles or Herbert's pits (their sequelae) ★</td></tr>
          <tr><td>c</td><td>Typical conjunctival scarring (trichiasis, entropion)</td></tr>
          <tr><td>d</td><td>Vascular pannus at superior limbus</td></tr>
        </tbody>
      </table>

      <span class="sub sub-t">SAFE STRATEGY (WHO — Key for Exams!) ★</span>
      <div class="box box-t">
        <b>S</b> — Surgery (for trichiasis/entropion to prevent corneal damage)<br>
        <b>A</b> — Antibiotics (tetracycline 1% ointment / oral azithromycin)<br>
        <b>F</b> — Facial cleanliness (wash face, reduce fly contact)<br>
        <b>E</b> — Environmental improvement (safe water, sanitation, hygiene)
      </div>

      <span class="sub sub-t">MAGNITUDE</span>
      <ul>
        <li>41 endemic countries affected</li>
        <li>~1.9 million visual impairment; 1.2 million irreversibly blind</li>
        <li>~190 million at risk of infection</li>
        <li>Most affected: poor communities with poor water/sanitation</li>
      </ul>

      <span class="sub sub-t">CHEMOTHERAPY (Park's)</span>
      <ul>
        <li><b>Mass treatment</b>: if &gt;5% severe/moderate trachoma in children &lt;10 yr</li>
        <li>Tetracycline 1% ointment twice daily × 5 days/month × 6 months</li>
        <li>Alternatively: Azithromycin single oral dose (now preferred)</li>
        <li><b>Selective treatment</b>: for low/medium prevalence areas — screen first, treat cases</li>
        <li>Surgical correction of trichiasis/entropion: immediate impact on preventing blindness</li>
      </ul>

    </div>
  </div>

</div>

<!-- ROW 3: PREVENTION + VISION 2020 + NPCB -->
<div class="three-col">

  <!-- PREVENTION STRATEGIES -->
  <div class="card">
    <div class="card-header red">🛡️ PREVENTION OF BLINDNESS (Park's)</div>
    <div class="card-body">

      <div class="box box-r">
        <b>"Avoidable blindness" = preventable + treatable</b><br>
        About 80% of blindness is avoidable. Major opportunity for public health action!
      </div>

      <span class="sub sub-r">COMPONENTS OF NATIONAL PROGRAMME (Park's)</span>
      <ol style="padding-left:12px; font-size:8px;">
        <li style="margin-bottom:2px;"><b>Initial Assessment</b> — prevalence survey to identify causes &amp; priorities</li>
        <li style="margin-bottom:2px;"><b>Methods of Intervention:</b>
          <ul>
            <li>(a) Primary eye care — at PHC level</li>
            <li>(b) Mass surgery campaigns — eye camps</li>
            <li>(c) Treatment of individual patients</li>
            <li>(d) Rehabilitation of the blind</li>
          </ul>
        </li>
        <li style="margin-bottom:2px;"><b>Training of Personnel</b> — eye surgeons, assistants, PHC workers</li>
        <li style="margin-bottom:2px;"><b>Health Education</b> — public awareness</li>
        <li style="margin-bottom:2px;"><b>Evaluation</b> — monitoring outcomes</li>
      </ol>

      <span class="sub sub-r">LEVELS OF PREVENTION</span>
      <table class="th-r">
        <thead><tr><th>Level</th><th>Action</th></tr></thead>
        <tbody>
          <tr><td><b>Primordial</b></td><td>Reduce poverty, malnutrition, improve water/sanitation</td></tr>
          <tr><td><b>Primary</b></td><td>Vit A supplementation, immunization, eye safety at work</td></tr>
          <tr><td><b>Secondary</b></td><td>Early detection &amp; treatment — screening camps, refraction</td></tr>
          <tr><td><b>Tertiary</b></td><td>Surgery (cataract, glaucoma), corneal transplant, rehabilitation</td></tr>
        </tbody>
      </table>

    </div>
  </div>

  <!-- VISION 2020 -->
  <div class="card">
    <div class="card-header amber">🎯 VISION 2020 &amp; GLOBAL EYE HEALTH</div>
    <div class="card-body">

      <div class="box box-a">
        <span class="title">VISION 2020: "The Right to Sight"</span>
        Joint initiative of <b>WHO + IAPB (International Agency for Prevention of Blindness)</b><br>
        Launched: <b>1999</b><br>
        Goal: Eliminate avoidable blindness by the year <b>2020</b>
      </div>

      <span class="sub sub-a">5 PRIORITY DISEASES (Vision 2020)</span>
      <ol style="padding-left:12px; font-size:8px;">
        <li style="margin-bottom:2px;"><b>Cataract</b> — surgical intervention</li>
        <li style="margin-bottom:2px;"><b>Refractive errors</b> — glasses, correction</li>
        <li style="margin-bottom:2px;"><b>Trachoma</b> — SAFE strategy</li>
        <li style="margin-bottom:2px;"><b>Onchocerciasis</b> (river blindness) — ivermectin</li>
        <li style="margin-bottom:2px;"><b>Childhood blindness</b> — Vit A, Rubella vaccine, retinopathy care</li>
      </ol>

      <span class="sub sub-a">3 CORE STRATEGIES (Vision 2020)</span>
      <div class="box box-a">
        <b>1. Disease Control</b> — target priority diseases<br>
        <b>2. Human Resource Development</b> — train eye care workers<br>
        <b>3. Infrastructure Development</b> — equip facilities
      </div>

      <span class="sub sub-a">GLOBAL EYE HEALTH ACTION PLAN 2014–2019 (WHO)</span>
      <ul>
        <li>Target: 25% reduction in avoidable visual impairment by 2019 vs 2010 baseline</li>
        <li>Universal eye health coverage goal</li>
        <li>Integrate eye care into primary health care</li>
        <li>National eye health plans for all countries</li>
      </ul>

      <span class="sub sub-a">CHANGING CONCEPTS IN EYE CARE (Park's)</span>
      <ol style="padding-left:12px; font-size:8px;">
        <li style="margin-bottom:1px;"><b>Primary eye care</b> at PHC level</li>
        <li style="margin-bottom:1px;"><b>Epidemiological approach</b> — population surveys</li>
        <li style="margin-bottom:1px;"><b>Team concept</b> — auxiliary workers (ophthalmic assistants)</li>
        <li style="margin-bottom:1px;"><b>National programmes</b> — comprehensive, not disease-specific</li>
      </ol>

    </div>
  </div>

  <!-- NPCB + INDIA -->
  <div class="card">
    <div class="card-header purple">🇮🇳 INDIA — NPCB &amp; KEY DATA</div>
    <div class="card-body">

      <div class="box box-p">
        <span class="title">NATIONAL PROGRAMME FOR CONTROL OF BLINDNESS (NPCB) — India</span>
        Launched: <b>1976</b> (during 5th Five-Year Plan)<br>
        Revised as: <b>NPCBVI</b> (National Programme for Control of Blindness and Visual Impairment) in 2017
      </div>

      <span class="sub sub-p">INDIA'S BLINDNESS BURDEN</span>
      <ul>
        <li>~<b>1.2 crore (12 million)</b> blind persons in India</li>
        <li><b>Cataract: 62.6%</b> of blindness in India</li>
        <li>Refractive error: ~19.7%</li>
        <li>Corneal blindness: ~0.9%</li>
        <li>Glaucoma: ~5.8%</li>
        <li>Surgical backlog: India performs millions of cataract operations/year</li>
      </ul>

      <span class="sub sub-p">NPCB KEY ACTIVITIES</span>
      <ul>
        <li>Free cataract surgeries at district hospitals</li>
        <li>Eye donation &amp; eye bank strengthening</li>
        <li>School eye screening programmes</li>
        <li>District Mobile Ophthalmic Units</li>
        <li>Training of ophthalmic assistants at PHC level</li>
        <li>Vitamin A supplementation programme for children</li>
      </ul>

      <span class="sub sub-p">VITAMIN A SUPPLEMENTATION PROGRAMME</span>
      <table class="th-r">
        <thead><tr><th>Age</th><th>Dose</th></tr></thead>
        <tbody>
          <tr><td>9 months (with measles vaccine)</td><td>1 lakh IU (1,00,000 IU)</td></tr>
          <tr><td>16 months</td><td>2 lakh IU (2,00,000 IU)</td></tr>
          <tr><td>Every 6 months till 5 years</td><td>2 lakh IU (2,00,000 IU)</td></tr>
        </tbody>
      </table>

      <span class="sub sub-p">WHO SET BLINDNESS THRESHOLD</span>
      <div class="box box-r" style="font-size:7.8px;">
        Blindness rate <b>&gt;0.5%</b> of population = public health problem requiring urgent action (community with blinding trachoma)
      </div>

    </div>
  </div>

</div>

<!-- MCQ BANK -->
<div style="margin-bottom:5px;">
  <div class="mcq-banner">📝 HIGH-YIELD MCQs &amp; VIVA QUESTIONS</div>
  <div class="mcq-grid">
    <div class="mcq-item">
      <span class="mcq-q">Q. WHO definition of blindness?</span><br>
      <span class="mcq-a">✔ VA &lt; 3/60 (Snellen)</span><br>
      Adopted at 25th WHA, 1972
    </div>
    <div class="mcq-item">
      <span class="mcq-q">Q. #1 cause of blindness globally?</span><br>
      <span class="mcq-a">✔ Un-operated Cataract (35%)</span><br>
      #1 visual impairment = Refractive error (53%)
    </div>
    <div class="mcq-item">
      <span class="mcq-q">Q. % of avoidable blindness?</span><br>
      <span class="mcq-a">✔ About 80% is avoidable</span><br>
      (preventable or treatable)
    </div>
    <div class="mcq-item">
      <span class="mcq-q">Q. SAFE strategy is for?</span><br>
      <span class="mcq-a">✔ Trachoma control</span><br>
      S-Surgery A-Antibiotics F-Face E-Environment
    </div>
    <div class="mcq-item">
      <span class="mcq-q">Q. Vision 2020 launched by?</span><br>
      <span class="mcq-a">✔ WHO + IAPB, in 1999</span><br>
      Goal: eliminate avoidable blindness by 2020
    </div>
    <div class="mcq-item">
      <span class="mcq-q">Q. Cause of trachoma?</span><br>
      <span class="mcq-a">✔ Chlamydia trachomatis</span><br>
      Chronic conjunctival &amp; corneal disease
    </div>
    <div class="mcq-item">
      <span class="mcq-q">Q. NPCB launched in India?</span><br>
      <span class="mcq-a">✔ 1976 (5th Five Year Plan)</span><br>
      Now NPCBVI (2017)
    </div>
    <div class="mcq-item">
      <span class="mcq-q">Q. Leading cause of childhood blindness?</span><br>
      <span class="mcq-a">✔ Xerophthalmia (Vit A deficiency)</span><br>
      Also: congenital cataract, glaucoma
    </div>
    <div class="mcq-item">
      <span class="mcq-q">Q. Herbert's pits are seen in?</span><br>
      <span class="mcq-a">✔ Trachoma (healed limbal follicles)</span><br>
      Pathognomonic of old trachoma!
    </div>
  </div>
</div>

<!-- EXAM TIPS -->
<div style="margin-bottom:5px;">
  <div class="tips-banner">🌟 LINES TO IMPRESS THE EXAMINER</div>
  <div class="tips-grid">
    <div class="tip-item">
      ✔ <b>"The #1 cause of blindness is cataract (35%) but the #1 cause of visual impairment is uncorrected refractive error (53%) — these are different, and this distinction is very commonly asked."</b>
    </div>
    <div class="tip-item">
      ✔ <b>"About 80% of all blindness is avoidable — either preventable or treatable. Cataract alone causes 35% of blindness but is completely curable with a simple surgical procedure."</b>
    </div>
    <div class="tip-item">
      ✔ <b>"Trachoma is controlled by the WHO SAFE strategy: Surgery for trichiasis, Antibiotics (azithromycin/tetracycline), Facial cleanliness, and Environmental improvement."</b>
    </div>
    <div class="tip-item">
      ✔ <b>"Vision 2020 — The Right to Sight was launched in 1999 by WHO and IAPB with the goal to eliminate avoidable blindness by 2020, focusing on 5 priority diseases: cataract, refractive errors, trachoma, onchocerciasis, and childhood blindness."</b>
    </div>
    <div class="tip-item">
      ✔ <b>"The WHO definition of blindness is visual acuity less than 3/60. Before 1972, there were 65 different definitions of blindness worldwide — the 25th World Health Assembly standardized this."</b>
    </div>
    <div class="tip-item">
      ✔ <b>"In India, cataract accounts for 62.6% of blindness. The NPCB was launched in 1976 during the 5th Five Year Plan to address this through free cataract surgeries, school screening, and Vitamin A supplementation."</b>
    </div>
  </div>
</div>

<div class="footer">
  PSM Quick Reference — Blindness | MBBS 2nd Year | Source: Park's Textbook of PSM | WHO ICD-11 2018 | Vision 2020 | NPCB India | Generated by Orris — Good luck on your exam! 🎓
</div>

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