mkdir -p /home/daytona/workspace/md-exam-notes && ls /home/daytona/workspace/md-…

pandoc --track-changes=all "/home/daytona/workspace/attachments/712f1f6c-6a0c-47…

You are preparing comprehensive MD Medicine Final Year exam answers for a Word document (.docx). The exam topics are from Cardiology and CNS sections. You must: 1. Search the medical library database for each topic using `query_library_db` and `read_file` 2. Compile full, detailed answers with flowcharts (as ASCII/text diagrams), tables, and clinical examples 3. Write a JavaScript file using the `docx` npm package to generate a Word document 4. Execute the JS file to produce the .docx output at `/home/daytona/workspace/md-exam-notes/MD_Medicine_Cardiology_CNS_Notes.docx` 5. Validate with `python /home/daytona/skills/docx/scripts/office/validate.py` ## TOPICS TO COVER (all must be included): ### CARDIOLOGY (20-mark questions): 1. **CHF** - Etiopathogenesis, classification (NYHA, ACC/AHA stages), clinical features, investigations, treatment (including HFrEF vs HFpEF management) 2. **CAD** - Recent advances in investigation (high-sensitivity troponin, CT angiography, FFR, IVUS, OCT) and treatment (PCSK9 inhibitors, SGLT2i, PCI vs CABG, stents) 3. **MI** - Blood supply of heart, classification (STEMI/NSTEMI, types 1-5), clinical features, diagnosis (ECG changes by territory), management (STEMI protocol, thrombolysis criteria, PCI) 4. **HOCM** - Pathophysiology (dynamic obstruction, SAM), clinical features (Brockenbrough sign, spike-and-dome pulse), management; plus classification of cardiomyopathies (dilated, hypertrophic, restrictive, arrhythmogenic, unclassified) 5. **Infective Endocarditis** - Etiology, Duke criteria (modified), diagnosis, treatment (antibiotic regimens), complications (embolic, cardiac, renal, neurological) 6. **Pulmonary Arterial Hypertension** - Definition (mPAP >20 mmHg), WHO classification (5 groups), pathophysiology, diagnosis (right heart catheterization), management (ERA, PDE5i, prostacyclins, combination therapy) 7. **Atrial Fibrillation** - Etiopathogenesis, classification (paroxysmal/persistent/permanent), management (rate vs rhythm control, CHA2DS2-VASc score, anticoagulation, cardioversion, ablation) 8. **Acute Rheumatic Fever** - Jones criteria (revised 2015), clinical features, diagnosis, treatment (benzathine penicillin), prophylaxis 9. **Constrictive Pericarditis vs Restrictive Cardiomyopathy** - Differentiation table (clinical, echo, catheter findings), Kussmaul's sign, pericardial knock, septal bounce 10. **Hypertension** - Mechanism (RAAS, SNS, endothelial dysfunction, salt-water retention), WHO classification, JNC 8/ACC-AHA 2017 targets, management algorithm (lifestyle + stepwise drug therapy) 11. **Broad QRS Tachycardia** - Approach (Brugada criteria, Vereckei aVR criteria), differential diagnosis (VT vs SVT with aberrancy vs pre-excited AF), management (stable vs unstable) 12. **SVT** - Physiology of cardiac conduction (SA node, AV node, His-Purkinje), AV node physiology, pathophysiology of SVT (AVNRT, AVRT, AT), management (vagal maneuvers, adenosine, ablation) 13. **ACS Pathophysiology + Coagulation** - Plaque rupture/erosion, platelet activation, coagulation cascade (intrinsic/extrinsic/common pathway), thrombus formation, myocardial ischemia cascade ### SHORT QUESTIONS (6-mark): 14. **HFpEF** - Definition, pathophysiology, diagnosis (E/e' ratio >14), treatment 15. **Narrow QRS Tachycardia** - Classification, ECG features, management 16. **Recent diagnostic modifications for IHD** - High-sensitivity troponin 0/1h algorithm, HEART score, CT-FFR, PET perfusion imaging 17. **Masked Hypertension** - Definition, causes, ABPM diagnosis, significance 18. **WPW Syndrome** - Accessory pathway, delta wave, classification, management (ablation), danger of AV nodal blockers in pre-excited AF 19. **Digoxin** - Mechanism (Na/K ATPase inhibition), indications, toxicity, interactions, ECG changes 20. **ARNI (Sacubitril/Valsartan)** - Mechanism (neprilysin inhibition + ARB), PARADIGM-HF trial, indications, contraindications 21. **Neprilysin inhibitor** - Same as ARNI 22. **Destination therapy in heart failure** - LVAD (HeartMate 3), indications, outcomes 23. **Antiarrhythmic drugs in ventricular arrhythmias** - Vaughan Williams classification, specific drugs (amiodarone, lidocaine, mexiletine, sotalol, flecainide), ICD indications ## LIBRARY SEARCH STRATEGY: Use these SQL queries to find content: ```sql -- For headings SELECT title, book_title, '/textbooks/' || block_file_path AS file_path, line_number, para_line_ranges FROM headings_fts WHERE headings_fts MATCH 'heart failure' ORDER BY rank LIMIT 5 -- For paragraphs SELECT book_title, section_heading, '/textbooks/' || block_file_path AS file_path, line_start, line_end, snippet(paragraphs_fts, 0, '>>>', '<<<', '...', 30) as snippet FROM paragraphs_fts WHERE paragraphs_fts MATCH 'ventricular tachycardia brugada criteria' ORDER BY rank LIMIT 5 ``` Prioritize Goldman-Cecil Medicine, Harrison's, Braunwald's Heart Disease, and Guyton & Hall for content. ## DOCUMENT REQUIREMENTS: - Title page: "MD Medicine Final Year Examination - Complete Notes" - Subtitle: "Cardiology & CNS - Comprehensive Exam Answers" - Date: July 2026 - For each topic: - Heading 1: Question number and title - Marks indicator (20 marks / 6 marks) - Full structured answer with subheadings - At least one ASCII flowchart or table per major topic - Clinical examples/mnemonics where helpful - Key points box at the end of each answer - Reference: Harrison's 22nd Edition / Goldman-Cecil / Braunwald's ## ASCII FLOWCHART FORMAT (use this style): ``` ┌─────────────────────────────────┐ │ WIDE COMPLEX TACHYCARDIA │ │ (QRS > 120 ms) │ └────────────────┬────────────────┘ │ ▼ ┌─────────────────────────────────┐ │ Hemodynamically UNSTABLE? │ │ (BP<90, AMS, chest pain, HF) │ └───────┬─────────────────┬───────┘ │ YES │ NO ▼ ▼ ┌──────────────┐ ┌──────────────────┐ │ SYNCHRONIZED │ │ 12-lead ECG │ │CARDIOVERSION │ │ Analysis │ │ 100-200 J │ └──────┬───────────┘ └──────────────┘ │ ``` ## JAVASCRIPT DOCX GENERATION: Use the docx npm package. Key imports: ```javascript const { Document, Packer, Paragraph, TextRun, Table, TableRow, TableCell, HeadingLevel, AlignmentType, BorderStyle, WidthType, ShadingType, VerticalAlign, PageBreak, PageNumber } = require('docx'); const fs = require('fs'); ``` Create sections with: - Proper heading hierarchy (Heading1 for questions, Heading2 for subsections, Heading3 for sub-subsections) - Tables for comparisons (e.g., constrictive pericarditis vs restrictive cardiomyopathy) - Styled boxes for key points (use shading) - ASCII flowcharts in monospace font (Courier New) - Page breaks between major questions Save to: `/home/daytona/workspace/md-exam-notes/MD_Medicine_Cardiology_CNS_Notes.docx` ## IMPORTANT NOTES: - Each 20-mark answer should be thorough (equivalent to ~4-6 printed pages) - Each 6-mark answer should be concise but complete (~1-2 printed pages) - Include clinical pearls, mnemonics, and exam tips - Use tables for drug comparisons, classification systems, and diagnostic criteria - The flowcharts must be in ASCII/box-drawing characters (not images) so they render in Word - After generating, validate the file and report the output path Return: The absolute path to the generated .docx file and confirmation it validated successfully.

mkdir -p /home/daytona/workspace/md-exam-notes && echo "Directory created"