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Give crisp and concise answer from latest edition of Harrison's medicine
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Here are complete, crisp answers from Harrison's Principles of Internal Medicine 22nd Edition (2025):
SECTION A - MCQs (Answers with Rationale)
| Q | Answer | Key Rationale (Harrison's) |
|---|---|---|
| 1 | (c) Mycoplasma pneumoniae | Most common cause of atypical (walking) pneumonia; extrapulmonary features include cold agglutinin-mediated hemolytic anemia, Stevens-Johnson syndrome, and neurologic manifestations |
| 2 | (a) Decreased FEV1/FVC ratio with bronchodilator reversibility | Asthma = obstructive pattern; FEV1/FVC <0.70, with ≥12% reversibility after bronchodilator |
| 3 | (d) Lichen Planus | Classic "5 P's": Purple, Polygonal, Planar, Pruritic, Papules on flexor wrists; Wickham's striae seen |
| 4 | (b) Erythema Chronicum Migrans | Pathognomonic of Lyme disease (Borrelia burgdorferi); expanding bull's-eye rash at tick bite site |
| 5 | (d) Pityriasis Rosea | Herald patch precedes "Christmas tree" distribution of lesions along Langer's lines on the trunk |
| 6 | (c) Auditory Hallucinations | Positive symptoms = added phenomena (hallucinations, delusions, disorganized speech). Social withdrawal, anhedonia, alogia = negative symptoms |
| 7 | (b) Lithium | Drug of choice for acute mania and long-term maintenance; also has anti-suicidal properties |
| 8 | (a) IgE | Type I hypersensitivity (anaphylactic/allergic) is mediated by IgE bound to mast cells and basophils |
| 9 | (b) Inhibition of acetylcholinesterase | Organophosphates irreversibly inhibit AChE → ACh accumulation → muscarinic effects including miosis |
| 10 | (d) Naloxone | Competitive opioid receptor antagonist; dose 0.4-2 mg IV; reverses respiratory depression, miosis, and coma |
| 11 | (b) Bamboo Spine | Ankylosing Spondylitis: ossification of annulus fibrosus + anterior longitudinal ligament → "bamboo spine" on X-ray |
| 12 | (a) Reactive Arthritis | Reiter's syndrome (urethritis + conjunctivitis + arthritis) = Reactive Arthritis; triggered by Chlamydia, Salmonella, Shigella, Campylobacter |
| 13 | (c) Trisomy 21 | Down Syndrome = three copies of chromosome 21; most commonly due to meiotic non-disjunction |
| 14 | (d) Marfan Syndrome | Autosomal dominant (fibrillin-1 gene, chromosome 15); Thalassemia = AR; PKU = AR; Cystic Fibrosis = AR |
| 15 | (b) Enteric Fever (Typhoid) | Widal test detects agglutinating antibodies against O and H antigens of Salmonella typhi |
| 16 | (c) Arsenic | Chronic arsenic poisoning: Mees' lines on nails, raindrop pigmentation (alternating hyperpigmentation/depigmentation), arsenical keratosis |
| 17 | (a) Aedes aegypti | Primary vector of Dengue, Zika, Chikungunya, Yellow Fever; breeds in stagnant clean water |
| 18 | (b) Primaquine | Radical cure of P. vivax/P. ovale (kills liver hypnozoites); must test for G6PD deficiency first |
| 19 | (b) Rifampicin, Dapsone, and Clofazimine | Paucibacillary: Rifampicin + Dapsone × 6 months. Multibacillary: Rifampicin + Dapsone + Clofazimine × 12 months |
| 20 | (a) Respiratory Failure | Elapid (cobra, krait) venom → neurotoxic → neuromuscular blockade → respiratory muscle paralysis → death |
SECTION B
Q1 - Lobar Pneumonia (35-year-old with rusty sputum, bronchial breathing)
(a) Diagnosis
Community-Acquired Pneumonia (Pneumococcal/Lobar Pneumonia) caused by Streptococcus pneumoniae. Rusty sputum, bronchial breathing, and increased vocal fremitus in a lobar distribution are classic.
(b) Pathogenesis and Pathological Stages
Pathogenesis: S. pneumoniae colonizes nasopharynx → aspirated into lungs → evades mucociliary clearance → polysaccharide capsule inhibits phagocytosis → alveolar inflammation.
4 Classic Stages (Laennec):
- Congestion (24h): Vascular engorgement, serous exudate; lung heavy and red
- Red Hepatization (2-3 days): Alveoli filled with RBCs, fibrin, neutrophils; lung firm, red, liver-like
- Grey Hepatization (4-8 days): RBC lysis; neutrophils and fibrin persist; lung grey
- Resolution (8+ days): Macrophages clear debris; normal architecture restored
(c) Investigations and CURB-65 Score
Investigations:
- CXR: lobar/segmental consolidation
- Sputum Gram stain and culture
- CBC: leukocytosis (WBC >12,000)
- Blood cultures (2 sets)
- ABG if SpO2 <94%
- Urine pneumococcal antigen
- Serum electrolytes, BUN, creatinine
CURB-65 Score (1 point each):
| C | Confusion (new onset) |
| U | Urea >7 mmol/L (BUN >19 mg/dL) |
| R | Respiratory rate ≥30/min |
| B | Blood pressure: systolic <90 or diastolic ≤60 mmHg |
| 65 | Age ≥65 years |
- Score 0-1: Outpatient
- Score 2: Consider hospitalization
- Score 3-5: Hospitalize; ICU if score 4-5
(d) Management for Hospitalized Patient
- Beta-lactam (IV amoxicillin-clavulanate or ceftriaxone 1g IV OD) PLUS macrolide (azithromycin 500 mg OD) - Harrison's preferred empiric regimen
- OR Respiratory fluoroquinolone monotherapy (levofloxacin 750 mg IV/OD)
- ICU patients: beta-lactam + azithromycin or anti-pneumococcal fluoroquinolone
- Supplemental O2 to maintain SpO2 >94%
- IV fluids if hypotensive
- Antipyretics
- Thromboprophylaxis (low-molecular-weight heparin)
- Duration: 5 days (if clinically stable); de-escalate to oral when afebrile ×48h
Q2a - Falciparum Malaria: Clinical Features and Complications
Clinical Features:
- Fever (may be irregular, not classic tertian)
- Headache, myalgia, nausea, vomiting
- Splenomegaly, hepatomegaly
- Anemia, thrombocytopenia
Severe/Complications (WHO criteria):
| Complication | Mechanism |
|---|---|
| Cerebral malaria | Sequestration of parasitized RBCs in brain microvasculature → coma, seizures |
| Blackwater fever | Massive intravascular hemolysis → hemoglobinuria, renal failure |
| Acute Renal Failure | Hemoglobinuria + cytokine damage |
| ARDS/Pulmonary edema | Capillary leak |
| Hypoglycemia | Glucose consumption by parasites + quinine-induced hyperinsulinism |
| Algid malaria | Circulatory collapse, cold skin |
| DIC | Coagulation cascade activation |
| Hyperparasitemia | >5% parasitized RBCs = severe malaria marker |
Treatment of severe falciparum: IV Artesunate (2.4 mg/kg at 0, 12, 24h, then daily) - drug of choice.
Q2b - Leprosy: Diagnosis and WHO Classification
Diagnosis:
- Clinical: hypopigmented/erythematous skin patches with loss of sensation + thickened peripheral nerves
- Slit-skin smear: acid-fast bacilli (AFB) from ear lobe/lesion - assessed as Bacterial Index (BI)
- Skin biopsy: gold standard - granulomas with AFB
- Lepromin test: measures CMI (positive in tuberculoid, negative in lepromatous)
- PCR for M. leprae DNA
WHO Field Classification (for MDT purposes):
| Type | Skin Lesions | Nerve | Smear | Treatment |
|---|---|---|---|---|
| Paucibacillary (PB) | 1-5 lesions | ≤1 nerve | Negative | Rifampicin + Dapsone × 6 months |
| Multibacillary (MB) | >5 lesions | >1 nerve | Positive | Rifampicin + Dapsone + Clofazimine × 12 months |
Ridley-Jopling Classification: TT → BT → BB → BL → LL (tuberculoid to lepromatous spectrum)
Q2c - Management of Acute Methanol Poisoning
Mechanism: Methanol → (alcohol dehydrogenase) → Formaldehyde → Formic acid → severe metabolic acidosis + optic nerve toxicity (blindness)
Clinical features: Nausea, vomiting, headache, visual disturbance ("snowstorm vision"), high anion gap metabolic acidosis, elevated osmol gap
Management:
- ABC - airway, breathing, circulation
- Fomepizole (4-methylpyrazole) 15 mg/kg IV loading - ADH inhibitor, drug of choice (or ethanol 10% IV if fomepizole unavailable)
- Sodium bicarbonate - correct metabolic acidosis (pH <7.3)
- Folinic acid (Leucovorin) 50 mg IV q4-6h - enhances formate metabolism
- Hemodialysis - indicated if: pH <7.25, severe visual impairment, methanol level >25 mg/dL, renal failure
- Supportive care; monitor visual acuity
Q2d - HIV/AIDS: Clinical Features and WHO Clinical Staging
Clinical Features by Stage:
WHO Stage 1 (Asymptomatic):
- Asymptomatic
- Persistent generalized lymphadenopathy (PGL)
- CD4 usually >500
WHO Stage 2 (Mild):
- Weight loss <10%, minor mucocutaneous manifestations
- Recurrent oral ulcers, seborrheic dermatitis, herpes zoster, recurrent URTIs
WHO Stage 3 (Advanced):
- Weight loss >10%, chronic diarrhea >1 month
- Oral candidiasis, oral hairy leukoplakia
- Pulmonary TB, severe bacterial pneumonia
- CD4 typically <350
WHO Stage 4 (Severe/AIDS-defining):
- PCP pneumonia (Pneumocystis jirovecii)
- Cerebral toxoplasmosis, CNS cryptococcosis
- CMV retinitis
- Kaposi's sarcoma, lymphoma
- HIV wasting syndrome
- CD4 <200 defines AIDS
Antiretroviral Therapy: Start in ALL patients regardless of CD4 count. Preferred first-line: TDF + 3TC + DTG (Tenofovir + Lamivudine + Dolutegravir)
SECTION B - Q3
(a) Primary Chancre in Syphilis
- Single (occasionally multiple), painless, clean-based ulcer
- Well-demarcated, indurated (hard) edges - "cartilaginous feel"
- Appears 10-90 days (mean 3 weeks) after inoculation with Treponema pallidum
- Size: 0.5-2 cm
- Located at site of inoculation (glans, prepuce, vulva, cervix, anus)
- Associated with painless, non-tender regional lymphadenopathy (inguinal)
- Heals spontaneously in 3-6 weeks without treatment
- Highly infectious - dark-field microscopy shows spirochetes
(b) Vitamin A Deficiency - Ocular Manifestations
In order of progression (WHO grading):
- Night blindness (Nyctalopia) - earliest; rhodopsin synthesis impaired
- Conjunctival xerosis (X1A) - dry, non-wettable conjunctiva
- Bitot's spots (X1B) - foamy, cheese-like plaques on temporal conjunctiva (triangular, can't be wiped off)
- Corneal xerosis (X2) - dry, hazy cornea
- Corneal ulceration/keratomalacia (X3A/X3B) - colliquative necrosis; irreversible blindness
- Corneal scar (XS) - leucoma
Treatment: Vitamin A capsule 200,000 IU orally on days 1, 2, and 14.
(c) Koebner Phenomenon
Definition: Appearance of skin lesions characteristic of a disease at sites of trauma or injury to previously normal skin.
3 Classic Examples:
- Psoriasis - most classic; new plaques form at scratch/trauma sites
- Lichen Planus - purple papules appear along scratch lines
- Vitiligo - depigmented patches at sites of injury
Other examples: warts (viral koebnerization), molluscum contagiosum
(d) Bipolar I vs. Bipolar II Disorder
| Feature | Bipolar I | Bipolar II |
|---|---|---|
| Manic episodes | Full mania (≥7 days, hospitalization may be needed) | Absent |
| Hypomanic episodes | May occur | Present (≥4 days, not requiring hospitalization) |
| Depressive episodes | Usually present | Prominent/required for diagnosis |
| Psychosis | Can occur during mania | Does not occur in hypomania |
| Severity | More severe | Less severe overall, but depression can be disabling |
| Hospitalization | May be required for mania | Not required for hypomania |
| Key point | Mania alone = Bipolar I | No full mania ever = Bipolar II |
(e) Post-Exposure Prophylaxis (PEP) for Rabies
Wound Management (immediate, most important):
- Wash wound with soap and water for ≥15 min
- Apply povidone-iodine or 70% alcohol
Rabies Immunoglobulin (RIG): 20 IU/kg (human RIG) or 40 IU/kg (equine RIG)
- Inject as much as possible into and around the wound
- Remainder given IM at distant site
- Given only on Day 0 (only if not previously vaccinated)
Rabies Vaccine (Essen regimen - WHO recommended):
- Days 0, 3, 7, 14 (4-dose IM schedule) - for previously unvaccinated
- Previously vaccinated: Days 0 and 3 only (no RIG needed)
Category of exposure:
- Cat I (touching, feeding, licking intact skin): No PEP
- Cat II (nibbling, minor scratches): Vaccine only
- Cat III (transdermal bite, bat exposure, mucosal lick): Vaccine + RIG
SECTION C
Q1 - Ankylosing Spondylitis
(a) Diagnosis
Ankylosing Spondylitis (AS) - a seronegative spondyloarthropathy. Classic presentation: young male <45 years, insidious-onset low back pain >3 months, morning stiffness improving with exercise (not rest), anterior uveitis, reduced spinal flexion.
(b) Significance of HLA-B27
- HLA-B27 is a class I MHC molecule; present in 90-95% of AS patients (vs. 8% in general population)
- Relative risk of AS with HLA-B27 positivity: ~100x
- Mechanism: molecular mimicry between HLA-B27 and bacterial antigens (Klebsiella), misfolded protein theory, free heavy chain theory
- Not diagnostic alone - 8% of HLA-B27 positive individuals develop AS
- Also associated with other spondyloarthropathies: Reactive arthritis, psoriatic arthritis, IBD-associated arthritis
- Useful for supporting diagnosis when clinical features and X-ray are equivocal
- HLA-B27 positive children with arthritis + uveitis = high-risk group
(c) Schober's Test
Purpose: Objectively measures lumbar spinal flexion (detects reduced mobility in AS)
Technique:
- Patient stands erect; mark a point at L5 (lumbosacral junction)
- Mark a second point 10 cm above and another 5 cm below this mark (15 cm total span)
- Patient asked to bend forward maximally
- Remeasure the distance between the two outer marks
Interpretation:
- Normal: distance increases by ≥5 cm (from 15 cm to ≥20 cm)
- Abnormal (<5 cm increase): suggests reduced lumbar flexion as seen in AS
(d) Management including TNF Inhibitors
Non-pharmacological:
- Exercise, physiotherapy, hydrotherapy
- Posture training to prevent kyphosis
- Smoking cessation
Pharmacological:
NSAIDs (first-line):
- Indomethacin, diclofenac, naproxen - continuous use preferred over PRN
- If first NSAID fails, try second NSAID before escalating
Second-line - Biologics (TNF inhibitors):
- Indicated when: inadequate response to 2 NSAIDs over 4 weeks each
- Agents: Etanercept, Adalimumab, Infliximab, Certolizumab, Golimumab
- Reduce inflammation, improve function, slow radiographic progression
- Screen for latent TB before starting (with tuberculin test/IGRA)
IL-17 inhibitors (alternative biologics):
- Secukinumab, Ixekizumab - particularly effective for skin and joint disease
Surgical: Total hip replacement for advanced hip involvement; spinal osteotomy for severe kyphosis
Q2a - Neurotoxic vs. Vasculotoxic Snake Bite
| Feature | Neurotoxic (Elapid) | Vasculotoxic (Viper) |
|---|---|---|
| Snakes | Cobra, Krait, Mamba | Russell's viper, Saw-scaled viper, Pit viper |
| Mechanism | Pre-synaptic (krait): blocks ACh release; Post-synaptic (cobra): blocks nAChR | Proteases, hyaluronidase, phospholipases → local tissue destruction, coagulopathy |
| Local effects | Minimal swelling | Severe swelling, necrosis, blister formation |
| Systemic features | Ptosis (earliest sign), diplopia, dysphagia, respiratory paralysis, areflexia | Bleeding (hemotoxin): ecchymosis, hematuria, hematemesis, DIC |
| Pupils | Dilated (cobra) | Normal |
| Death cause | Respiratory failure | Hemorrhage, ARF |
| 20WBCT test | Normal | Abnormal (blood doesn't clot in 20 min) |
| Treatment | Polyvalent ASV + neostigmine (for post-synaptic) + atropine; ventilatory support | Polyvalent ASV; FFP, platelets; manage ARF with dialysis |
Anti-snake venom (ASV):
- Polyvalent ASV given IV (preferred over IM)
- Dose: 10 vials initial; repeat if no improvement in 1-2 hours
- Indications: coagulopathy, neurotoxicity, hemoglobinuria, local necrosis
Q2b - Status Asthmaticus Management (Emergency Department)
Definition: Severe asthma attack not responding to initial bronchodilator therapy.
Initial Assessment: SpO2, PEFR/FEV1, ABG, RR, use of accessory muscles, ability to speak.
Step-by-step ED Management:
-
Oxygen: 40-60% to maintain SpO2 93-95% (not high-flow routinely)
-
SABA (first-line): Salbutamol (albuterol) 2.5-5 mg nebulized q20min × 3 doses in first hour, then q1-4h; or MDI 4-8 puffs q20min
-
Ipratropium bromide: 0.5 mg nebulized q20min × 3 (add to SABA for severe attacks)
-
Systemic corticosteroids (mandatory): Prednisolone 40-60 mg oral or Hydrocortisone 100-200 mg IV; continue 5-7 days
-
IV Magnesium sulfate: 2g IV over 20 min - for severe/life-threatening attacks not responding to above (bronchosmolytics via calcium channel mechanism)
-
IV aminophylline: No longer recommended as first-line; use only if no response to above
-
Heliox (helium-oxygen mixture): Consider if failing
-
NIV/BiPAP: In impending respiratory failure
-
Intubation/Mechanical ventilation: Last resort; aim for permissive hypercapnia, low PEEP
Discharge criteria: PEFR >75% predicted, SpO2 >94% on room air, sustained for 1 hour
Q2c - Scleroderma: Clinical Manifestations and CREST Syndrome
Two Main Forms:
- Diffuse cutaneous SSc (dcSSc): Rapid skin involvement proximally + internal organs
- Limited cutaneous SSc (lcSSc): Skin confined to distal extremities/face = CREST syndrome
CREST Syndrome (lcSSc):
| Letter | Feature | Detail |
|---|---|---|
| C | Calcinosis cutis | Calcium deposits in skin/soft tissues, especially fingers |
| R | Raynaud's phenomenon | Episodic digital vasospasm (white → blue → red with cold/stress) |
| E | Esophageal dysmotility | Dysphagia, GERD; lower 2/3 of esophagus affected |
| S | Sclerodactyly | Tight, shiny skin of fingers; "sausage fingers" |
| T | Telangiectasia | Dilated capillaries on face, lips, hands |
Anti-centromere antibody is the hallmark of lcSSc/CREST (>90% sensitive).
Other systemic features: Pulmonary arterial hypertension (leading cause of death in lcSSc), interstitial lung disease, renal crisis (in dcSSc), Sjogren's overlap.
Q2d - Genetic Counseling: Ethical Considerations and Steps
Steps:
- Referral and indication - family history, advanced maternal age, abnormal prenatal screening
- Information gathering - 3-generation pedigree, medical records
- Risk estimation - calculate recurrence risk using Mendelian principles
- Education - explain disease, inheritance pattern, variability, penetrance
- Discussion of options - prenatal diagnosis (amniocentesis, CVS, FISH/microarray), preimplantation genetic diagnosis, adoption, childlessness
- Decision support (non-directive counseling)
- Follow-up - psychological support, referral to support groups
Ethical Principles:
- Autonomy: Non-directive counseling; patient decides freely without coercion
- Beneficence: Provide accurate information for informed decisions
- Non-maleficence: Avoid unnecessary anxiety; disclose information responsibly
- Confidentiality: Genetic information is private; duty to warn at-risk relatives (conflict)
- Justice: Equal access to genetic services
- Informed consent: Voluntary, capacity-based, with full disclosure
- Disclosure to third parties (insurers, employers) is generally prohibited
SECTION C - Q3
(a) Laboratory Diagnosis of Kala-azar (Visceral Leishmaniasis)
-
Definitive: Demonstration of Leishmania donovani (LD bodies/amastigotes)
- Splenic aspirate - most sensitive (>95%) but risky
- Bone marrow aspirate - safer, 70-80% sensitive
- Liver biopsy, lymph node aspirate
-
Serological (used in endemic areas):
- rK39 immunochromatographic test (ICT) - rapid, highly sensitive and specific; point-of-care test of choice
- DAT (Direct Agglutination Test)
- ELISA for anti-leishmanial antibodies
-
Molecular: PCR - highly sensitive, not routine
-
Blood: CBC shows pancytopenia (anemia, leucopenia, thrombocytopenia), elevated ESR, hypergammaglobulinemia, hypoalbuminemia
(b) Anaphylaxis Management - Drug and Dose
Epinephrine (Adrenaline) = cornerstone - give FIRST and immediately
| Drug | Dose | Route | Timing |
|---|---|---|---|
| Epinephrine | 0.3-0.5 mg (adult); 0.01 mg/kg in children (max 0.5mg) of 1:1000 solution | IM (anterolateral thigh) | Immediately |
| Oxygen | 100%, 15 L/min via non-rebreather mask | Inhalation | Immediately |
| IV Fluids | 1-2 L normal saline bolus | IV | If hypotensive |
| Diphenhydramine (H1 blocker) | 25-50 mg IV/IM | IV/IM | After epi |
| Ranitidine/Famotidine (H2 blocker) | 50 mg IV | IV | After epi |
| Hydrocortisone | 200 mg IV | IV | After epi (prevents biphasic) |
| Salbutamol nebulization | 2.5-5 mg | Inhaled | If bronchospasm |
Biphasic anaphylaxis (second reaction 8-72h later): observe for minimum 6 hours before discharge.
(c) Obsessive-Compulsive Disorder (OCD) - Clinical Features
Obsessions (intrusive, unwanted, ego-dystonic thoughts/images/urges):
- Contamination (dirt, germs)
- Harm (fear of hurting self/others)
- Symmetry, exactness
- Religious/sexual thoughts
Compulsions (repetitive behaviors/mental acts to neutralize obsessions):
- Washing/cleaning (most common)
- Checking (locks, appliances)
- Counting, arranging
- Hoarding
Diagnostic criteria (DSM-5):
- Obsessions and/or compulsions that are time-consuming (>1h/day) and cause significant distress/impairment
- Ego-dystonic (recognized as excessive/unreasonable)
- Not attributable to substances or medical condition
Y-BOCS (Yale-Brown) scale used to assess severity.
Treatment: First-line: SSRIs (fluoxetine, fluvoxamine, sertraline) + CBT with Exposure and Response Prevention (ERP)
(d) Dermatological Features of Scabies and the Burrow
Causative agent: Sarcoptes scabiei var. hominis (mite)
Burrow:
- Pathognomonic of scabies
- A tortuous, grayish-white or skin-colored linear track (5-15 mm long)
- Created by the female mite tunneling into stratum corneum to lay eggs
- Found characteristically in: finger webs (earliest and most common), flexor wrists, genitalia, buttocks, areola, umbilicus
- Dermoscopy: shows "delta-wing jet" sign (mite at end of burrow)
Other features:
- Intense pruritus (worse at night - hallmark)
- Papules, vesicles, excoriations from scratching
- Burrows are pathognomonic
- Secondary bacterial infection (impetigo)
- Norwegian (crusted) scabies: hyperkeratotic plaques; thousands of mites; in immunocompromised
Treatment: Permethrin 5% cream (drug of choice) - apply to entire body from neck down, wash off after 8-12 hours; repeat after 1 week. Oral ivermectin 200 mcg/kg alternative.
(e) Difference between Delirium and Dementia
| Feature | Delirium | Dementia |
|---|---|---|
| Onset | Acute (hours to days) | Insidious (months to years) |
| Course | Fluctuating, worse at night | Progressive, gradually worsening |
| Consciousness | Impaired (clouded) | Clear until late stages |
| Attention | Markedly impaired | Relatively preserved early |
| Orientation | Disoriented | Preserved early |
| Memory | Short-term impaired acutely | Short-term first, then long-term |
| Sleep-wake cycle | Severely disrupted | Mildly disrupted |
| Hallucinations | Common (visual > auditory) | Less common (visual in LBD) |
| Reversibility | Usually reversible (treat cause) | Irreversible (progressive) |
| EEG | Diffuse slowing | Normal early (except prion disease) |
| Duration | Days to weeks | Years |
| Common causes | Infection, drugs, metabolic, post-op | Alzheimer's, vascular, LBD, FTD |
| Treatment | Treat underlying cause; haloperidol for agitation | Cholinesterase inhibitors (donepezil), memantine |
Key distinction: Delirium = acute, fluctuating, impaired consciousness; Dementia = chronic, progressive, clear consciousness until late.
All answers based on Harrison's Principles of Internal Medicine, 22nd Edition (2025, McGraw Hill).
Generate a flashcard presentation on Harrison's diagnostic criteria for these conditions
Reading File
Reading File
Running Command
ls /home/daytona/workspace/ 2>/dev/null || mkdir -p /home/daytona/workspace/flashcards
Running Command
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const conditions = [
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{
qNum: 1,
condition: "Bronchial Asthma",
category: "Respiratory",
accentColor: C.accentTeal,
bgColor: "0A2540",
tagColor: C.accentTeal,
criteria: [
"FEV1/FVC ratio < 0.70 (obstructive pattern)",
"Reversibility: ≥12% AND ≥200 mL increase in FEV1 after bronchodilator",
"FEV1 < 80% predicted (variability on serial measurements)",
"PC20 < 8 mg/mL on methacholine challenge (hyperresponsiveness)",
"Peak Expiratory Flow (PEF) variability > 10% (diurnal variation)",
"Symptoms: wheeze, cough, chest tightness, shortness of breath",
],
mnemonic: "ROVER\nReversibility\nObstruction\nVariability\nEosinophilia\nResponse to steroids",
keyFact: "Spirometry is KEY:\nFEV1/FVC < 0.70 +\n≥12% reversibility\n= Asthma until proven otherwise",
},
{
qNum: 2,
condition: "Community-Acquired Pneumonia (CURB-65)",
category: "Infectious Disease / Respiratory",
accentColor: C.accentOran,
bgColor: "1A1200",
tagColor: C.accentOran,
criteria: [
"C – Confusion (new onset, AMT ≤8)",
"U – Urea > 7 mmol/L (BUN > 19 mg/dL)",
"R – Respiratory rate ≥ 30/min",
"B – Blood pressure: SBP < 90 or DBP ≤ 60 mmHg",
"65 – Age ≥ 65 years",
"Score 0-1: Outpatient | 2: Hospital ward | 3-5: ICU/HDU",
],
mnemonic: "CURB-65\nConfusion\nUrea\nRespiratory rate\nBlood pressure\n65 years",
keyFact: "Score ≥ 3 = SEVERE\nMortality doubles\nwith each added point\n\n'Rusty sputum' = S. pneumoniae",
},
{
qNum: 3,
condition: "Lichen Planus",
category: "Dermatology",
accentColor: C.accentPurp,
bgColor: "120A2A",
tagColor: C.accentPurp,
criteria: [
"Clinical: 5 P's - Purple, Polygonal, Planar, Pruritic, Papules",
"Location: flexor wrists, ankles, lower back, buccal mucosa",
"Wickham's striae: white lacy network on surface of papules",
"Koebner phenomenon: lesions appear at sites of trauma",
"Biopsy: saw-tooth rete ridges, band-like lymphocytic infiltrate at DEJ",
"Civatte bodies (apoptotic keratinocytes) at DEJ - pathognomonic",
],
mnemonic: "5 P's of LP:\nPurple\nPolygonal\nPlanar\nPruritic\nPapules",
keyFact: "Oral LP on buccal\nmucosa = risk of SCC\n\nWickham's striae\n= pathognomonic sign",
},
{
qNum: 4,
condition: "Atypical Pneumonia (Mycoplasma)",
category: "Infectious Disease",
accentColor: C.accentGreen,
bgColor: "021A0E",
tagColor: C.accentGreen,
criteria: [
"Insidious onset: gradual fever, headache, malaise (prodrome)",
"Dry (non-productive) cough - hallmark",
"Chest X-ray worse than clinical findings ('walking pneumonia')",
"Extrapulmonary: cold agglutinin hemolytic anemia, Stevens-Johnson",
"Cold agglutinin titer > 1:64 (suggestive)",
"PCR for M. pneumoniae or serology (4-fold rise in IgG titers)",
],
mnemonic: "MAC-WE:\nMycoplasma\nAtypical\nCold agglutinins\nWalking pneumonia\nExtrapulmonary features",
keyFact: "Most common cause\nof atypical CAP\n\nTreat: Azithromycin\nor Doxycycline\n(no cell wall = no β-lactam)",
},
{
qNum: 5,
condition: "Ankylosing Spondylitis (modified NY criteria)",
category: "Rheumatology",
accentColor: C.accentGold,
bgColor: "1A1200",
tagColor: "D97706",
criteria: [
"Clinical: Low back pain > 3 months, improves with exercise, not rest",
"Clinical: Limitation of lumbar spine motion (sagittal & frontal planes)",
"Clinical: Limited chest expansion relative to age/sex normal values",
"Radiological: Sacroiliitis grade ≥2 bilateral OR grade 3-4 unilateral",
"Definite AS: radiological criterion + ≥1 clinical criterion",
"HLA-B27 present in 90-95%; Schober's test < 5 cm increase",
],
mnemonic: "SPINE:\nSacroiliitis (X-ray)\nPain improves with activity\nInflammatory back pain\nNight pain/stiffness\nEarly morning stiffness",
keyFact: "Bamboo spine =\ncomplete ankylosis\n\nFirst-line: NSAIDs\nBiologics: TNF-α inhibitors\n(Etanercept, Adalimumab)",
},
{
qNum: 6,
condition: "Schizophrenia (DSM-5)",
category: "Psychiatry",
accentColor: C.accentRed,
bgColor: "1A0505",
tagColor: C.accentRed,
criteria: [
"≥2 of: delusions, hallucinations, disorganized speech, disorganized behavior, negative symptoms (≥1 must be from first 3)",
"Duration: continuous signs for ≥6 months (including ≥1 month active phase)",
"Significant functional decline (work, social, self-care)",
"Rule out: schizoaffective, mood disorder, substance, medical cause",
"POSITIVE symptoms: hallucinations (auditory > visual), delusions",
"NEGATIVE symptoms: avolition, alogia, anhedonia, flat affect",
],
mnemonic: "DDHDB:\nDelusions\nDisorganized speech\nHallucinations\nDisorganized behavior\n(negative) Blunted affect",
keyFact: "Auditory hallucinations\n= most common positive symptom\n\nNegative symptoms:\n4 A's - Alogia, Anhedonia,\nAvolition, Affect flat",
},
{
qNum: 7,
condition: "OCD (DSM-5)",
category: "Psychiatry",
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"Obsessions: recurrent, persistent, intrusive thoughts/urges/images",
"Obsessions: attempts to ignore/suppress or neutralize with compulsions",
"Compulsions: repetitive behaviors/mental acts aimed at reducing distress",
"Compulsions: not realistically connected to feared event (excessive)",
"Time-consuming: > 1 hour/day OR causes significant distress/impairment",
"Not attributable to substances, medical condition, or better explained by another disorder",
],
mnemonic: "OCD = EGO-DYSTONIC\nPerson recognizes\nobsessions as\nexcessive/unreasonable\n\nERP (CBT) + SSRI",
keyFact: "Y-BOCS scale\n= severity assessment\n\nFirst-line Rx:\nSSRI + ERP therapy\n(Fluvoxamine preferred)",
},
{
qNum: 8,
condition: "Bipolar I vs. Bipolar II",
category: "Psychiatry",
accentColor: C.accentPurp,
bgColor: "0D0520",
tagColor: C.accentPurp,
criteria: [
"BIPOLAR I: ≥1 manic episode (≥7 days, hospitalizable, with/without psychosis)",
"BIPOLAR I: Mania may occur alone (depression NOT required for diagnosis)",
"BIPOLAR II: ≥1 hypomanic episode (≥4 days, NO hospitalization, NO psychosis)",
"BIPOLAR II: ≥1 major depressive episode (REQUIRED for diagnosis)",
"BIPOLAR II: NEVER had a full manic episode",
"Both: Rule out substances, medical causes, other psychiatric disorders",
],
mnemonic: "I = full MANIA\n(hospitalize, psychosis ok)\n\nII = HYPOMANIA +\nDEPRESSION\n(never full mania)",
keyFact: "Bipolar II is NOT\n'milder' than Bipolar I —\ndepression is more\npredominant and disabling\n\nRx: Lithium (gold standard)",
},
{
qNum: 9,
condition: "Reactive Arthritis (Reiter's Syndrome)",
category: "Rheumatology",
accentColor: C.accentOran,
bgColor: "1A0900",
tagColor: C.accentOran,
criteria: [
"Triad: Urethritis + Conjunctivitis + Arthritis",
"Triggered by preceding infection (1-4 weeks before): Chlamydia (STI) or enteric (Salmonella, Shigella, Campylobacter, Yersinia)",
"Asymmetric oligoarthritis (lower limb predominant)",
"HLA-B27 positive in ~75% of cases",
"Extra-articular: circinate balanitis, keratoderma blennorrhagicum, oral ulcers",
"Classification: ASAS criteria for reactive arthritis in spondyloarthritis spectrum",
],
mnemonic: "Can't SEE, can't PEE,\ncan't climb a TREE\n(Conjunctivitis,\nUrethritis, Arthritis)",
keyFact: "Seronegative arthritis\n(RF negative)\n\nMost common in\nyoung males 20-40 yrs\n\nRx: NSAIDs ± antibiotics",
},
{
qNum: 10,
condition: "Scleroderma CREST Syndrome",
category: "Rheumatology / Dermatology",
accentColor: C.accentGreen,
bgColor: "011A08",
tagColor: C.accentGreen,
criteria: [
"C – Calcinosis cutis (calcium deposits in skin/fingers)",
"R – Raynaud's phenomenon (white → blue → red triphasic color change)",
"E – Esophageal dysmotility (lower 2/3, GERD, dysphagia)",
"S – Sclerodactyly (tight, shiny skin of fingers)",
"T – Telangiectasia (dilated capillaries: face, hands, lips)",
"Antibody: Anti-centromere antibody (ACA) >90% sensitive for lcSSc",
],
mnemonic: "CREST:\nCalcinosis\nRaynaud's\nEsophageal dysmotility\nSclerodactyly\nTelangiectasia",
keyFact: "Limited cutaneous SSc\n= lcSSc = CREST\n\nAnti-centromere Ab\n= hallmark\n\nPAH = leading\ncause of death in CREST",
},
{
qNum: 11,
condition: "HIV/AIDS — WHO Clinical Staging",
category: "Infectious Disease",
accentColor: C.accentRed,
bgColor: "150005",
tagColor: C.accentRed,
criteria: [
"Stage 1: Asymptomatic / Persistent generalized lymphadenopathy (PGL)",
"Stage 2: Minor weight loss <10%, herpes zoster, recurrent oral ulcers, seborrheic dermatitis",
"Stage 3: Weight loss >10%, oral candidiasis, hairy leukoplakia, pulmonary TB, severe bacterial pneumonia",
"Stage 4 (AIDS): PCP, cerebral toxoplasmosis, CMV retinitis, Kaposi's sarcoma, cryptococcal meningitis, HIV wasting",
"CD4 < 200 cells/μL = AIDS (US CDC definition)",
"ART: Start ALL patients regardless of CD4. 1st line: TDF + 3TC + DTG",
],
mnemonic: "1: Asymptomatic\n2: Minor (skin/mucosa)\n3: Advanced (TB, oral)\n4: Severe/AIDS-defining\n\nCD4 < 200 = AIDS",
keyFact: "Opportunistic infections\nby CD4 count:\n<500: PGL, candida\n<200: PCP, Toxo\n<50: CMV, MAC, Crypto",
},
{
qNum: 12,
condition: "Kala-azar (Visceral Leishmaniasis)",
category: "Infectious Disease / Tropical",
accentColor: C.accentGold,
bgColor: "0D0A00",
tagColor: "B45309",
criteria: [
"Clinical: Prolonged fever + massive splenomegaly + weight loss in endemic area",
"Pancytopenia: anemia, leukopenia, thrombocytopenia + hypoalbuminemia",
"Definitive: LD bodies (amastigotes) in splenic aspirate (>95%) or BM aspirate (70-80%)",
"Serological: rK39 immunochromatographic test (ICT) - rapid POC test of choice",
"DAT (Direct Agglutination Test) - high sensitivity in field settings",
"PCR: highly sensitive; Aldehyde (formol-gel) test: obsolete but historically used",
],
mnemonic: "FESP:\nFever (prolonged)\nEnormouss Splenomegaly\nSkin darkening (kala=black)\nPancytopenia",
keyFact: "rK39 ICT strip =\nbest rapid field test\n\nTreatment:\nLiposomal Amphotericin B\n(drug of choice)\nor Miltefosine (oral)",
},
{
qNum: 13,
condition: "Anaphylaxis (WAO/NIAID criteria)",
category: "Emergency Medicine / Immunology",
accentColor: C.accentRed,
bgColor: "180000",
tagColor: C.accentRed,
criteria: [
"Criterion 1: Acute onset of illness with skin/mucosal involvement (urticaria, angioedema, flushing) PLUS respiratory compromise OR hypotension/end-organ dysfunction",
"Criterion 2: ≥2 of following after exposure to likely allergen: skin/mucosa, respiratory, hypotension, persistent GI symptoms",
"Criterion 3: Reduced BP after exposure to KNOWN allergen for that patient",
"Tryptase elevation (>11.4 ng/mL) - confirms mast cell activation",
"Epinephrine 1:1000, 0.3-0.5 mg IM anterolateral thigh = FIRST treatment",
"Biphasic reaction can occur 8-72 hours later; observe for ≥6 hours",
],
mnemonic: "SHART:\nSkin (urticaria, flush)\nHypotension\nAirway (wheeze, stridor)\nRespiratory distress\nTachycardia",
keyFact: "EPINEPHRINE FIRST!\n0.3-0.5 mg IM (1:1000)\nAnterolateral thigh\n\nDO NOT delay for\nantihistamines or steroids",
},
{
qNum: 14,
condition: "Down Syndrome (Trisomy 21)",
category: "Genetics",
accentColor: C.accentTeal,
bgColor: "001518",
tagColor: C.accentTeal,
criteria: [
"Genetic: Trisomy 21 in 95% (non-disjunction), Translocation 4%, Mosaic 1%",
"Facial: flat facies, upslanting palpebral fissures, Brushfield spots in iris",
"Facial: small ears, flat nasal bridge, protruding tongue, short neck",
"Hands: single palmar crease (simian crease), clinodactyly of 5th finger",
"Hypotonia at birth, intellectual disability (mild-moderate)",
"Associations: ASD/VSD (40-50%), Hirschsprung disease, duodenal atresia, ALL risk",
],
mnemonic: "Trisomy 21:\nFlat face\nUpslanting eyes\nSingle palmar crease\nHypotonia\nIntellectual disability",
keyFact: "Most common\nchromosomal disorder\n\nMostly due to\nmaternal non-disjunction\n\nRisk ↑ with\nmaternal age > 35",
},
];
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// ─── FINAL SLIDE: QUICK REFERENCE TABLE ──────────────────────────────────────
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["Asthma", "FEV1/FVC <0.70 + ≥12% reversibility", "Inhaled SABA + ICS"],
["Pneumonia (CURB-65)", "Score ≥3 = ICU admission", "Ceftriaxone + Azithromycin"],
["Ankylosing Spondylitis", "Sacroiliitis grade ≥2 bilateral", "NSAIDs → TNF-α inhibitors"],
["HIV/AIDS", "CD4 <200 = AIDS (CDC)", "TDF + 3TC + DTG"],
["Kala-azar", "rK39 ICT + LD bodies in BM/spleen", "Liposomal Ampho B"],
["Anaphylaxis", "Acute onset: skin + respiratory/hypotension", "Epinephrine 0.3mg IM (1:1000)"],
["OCD (DSM-5)", ">1 hour/day, ego-dystonic", "SSRI + ERP (CBT)"],
["Bipolar I", "≥1 manic episode ≥7 days", "Lithium"],
["Scleroderma CREST", "Anti-centromere Ab (>90%)", "CCBs (Raynaud's)"],
["Reactive Arthritis", "Urethritis + Conjunctivitis + Arthritis", "NSAIDs"],
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// ─── WRITE FILE ───────────────────────────────────────────────────────────────
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Running Command
cd /home/daytona/workspace/flashcards && node generate_flashcards.js 2>&1
Running Command
ls -lh /home/daytona/workspace/flashcards/Harrisons_Diagnostic_Criteria_Flashcards.pptx
Your flashcard presentation is ready!
Harrisons Diagnostic Criteria Flashcards
Presentation · PPTX
What's inside (16 slides total):
| Slides | Content |
|---|---|
| Slide 1 | Title slide with all 14 condition chips |
| Slides 2-15 | One flashcard per condition (see below) |
| Slide 16 | Quick reference table - key thresholds + drugs |
14 Flashcards covering:
- Bronchial Asthma (FEV1/FVC criteria + reversibility)
- Community-Acquired Pneumonia (CURB-65 scoring)
- Lichen Planus (5 P's + Wickham's striae)
- Atypical Pneumonia - Mycoplasma
- Ankylosing Spondylitis (modified NY criteria)
- Schizophrenia (DSM-5 positive/negative)
- OCD (DSM-5 + Y-BOCS)
- Bipolar I vs. Bipolar II (side-by-side)
- Reactive Arthritis (Reiter's triad)
- Scleroderma CREST syndrome
- HIV/AIDS WHO Clinical Staging
- Kala-azar / Visceral Leishmaniasis
- Anaphylaxis (WAO criteria + Epinephrine dose)
- Down Syndrome (Trisomy 21)
Each card has: Diagnostic criteria bullets + a mnemonic box + a key fact box, all color-coded by specialty (Respiratory = teal, Psychiatry = red/purple, Rheumatology = gold, Infectious Disease = green/orange).
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