Can you help me
Actually uk there is upsc cms exam on 2nd August
- Subject-wise notes - Medicine, Surgery, OBG, Pediatrics, Preventive & Social Medicine, etc.
- High-yield topics - Key areas frequently tested in UPSC CMS
- MCQ practice - Questions on specific topics
- Revision summaries - Quick recap of important concepts
- Doubt clearing - Explain any clinical or theoretical concept
Yess give me a 3 week study plan including high yield top notch notes including q bank explanation pyqs everything that if I do properly for 3 weeks then i can clear the exam
What is your current preparation level? · How many hours can you study per day? · Which subjects feel weakest to you? (select all that apply)
UPSC CMS 2025 2026 exam pattern syllabus high yield topics
UPSC CMS 2026 - 3 Week Cracker Plan
(6-8 hrs/day | Exam: August 2, 2026)
EXAM STRUCTURE (Know This Cold)
| Paper | Subjects | Marks | Questions |
|---|---|---|---|
| Paper 1 | General Medicine + allied (Derma, Psychiatry, Pharma) + Paediatrics | 250 | 96 Medicine + 24 Paeds = 120 |
| Paper 2 | Surgery (+ ENT, Ophtha, Ortho, Anaesthesia) + OBG + PSM | 250 | ~40 each = 120 |
TIME ALLOCATION STRATEGY
WEEK 1 (July 13-19): Medicine + Pre-clinical High Yields
- 7:00-10:00 AM - Medicine (core systems)
- 10:30 AM-1:00 PM - Pharmacology / Microbiology / Pathology (high yield only)
- 2:00-4:00 PM - PYQs from morning topics
- 4:30-6:30 PM - Revision + mnemonics
- 7:00-8:00 PM - 20 MCQs timed practice
Day 1-2: Medicine - Cardiology (highest yield in Medicine)
- Heart failure - types, NYHA grading, management (ACE-I, Beta blockers, Spironolactone, SGLT2i)
- Hypertension - JNC 8 targets, preferred drugs (DM→ACEi, CKD→ACEi, pregnancy→methyldopa/labetalol)
- MI - STEMI vs NSTEMI, Killip classification, thrombolytic criteria, complications
- Atrial fibrillation - rate vs rhythm control, CHA2DS2-VASc score, anticoagulation
- Rheumatic heart disease - Jones criteria, most common valve (MS), Carey-Coombs murmur
- Infective endocarditis - Duke criteria, organisms (Strep viridans #1, Staph in IV drug users)
- Congenital heart disease - ASD/VSD/PDA/TOF features
Day 3-4: Medicine - Respiratory + Neurology
- COPD - GOLD staging, inhalers (SABA→LABA→LABA+ICS), exacerbation management
- Asthma - stepwise management, drugs in pregnancy safe (SABA, ICS)
- Pneumonia - CURB-65 score, CAP vs HAP organisms, treatment
- TB - RNTCP/NTP regimens (2HRZE/4HR), MDR-TB, IRIS
- Pleural effusion - transudates vs exudates (Light's criteria)
- Lung cancer - types, paraneoplastic syndromes (SIADH→small cell, PTHrP→squamous)
- Stroke - NIHSS, thrombolysis window (4.5 hrs), hemorrhagic vs ischemic CT
- Meningitis - CSF findings (bacterial vs viral vs TB vs fungal)
- Epilepsy - drug of choice (focal→carbamazepine, absence→ethosuximide, pregnancy→lamotrigine)
- Parkinson's - dopamine deficiency, levodopa + carbidopa, MPTP toxicity
- GBS - ascending paralysis, cytoalbuminous dissociation in CSF
- Myasthenia Gravis - anti-AChR, edrophonium test, thymoma association
Day 5: Medicine - Gastroenterology + Hepatology
- Liver cirrhosis - Child-Pugh vs MELD score, complications (SBP, HRS, HE)
- Hepatitis - serology patterns (HBsAg, Anti-HBs, HBeAg meanings)
- IBD - Crohn's vs UC differences (skip lesions vs continuous, transmural vs mucosal)
- Peptic ulcer - H. pylori triple therapy, NSAID-induced management
- Pancreatitis - Ranson's criteria, complications, pseudocyst
- Jaundice - pre-hepatic/hepatic/post-hepatic differentiation
Day 6-7: Pharmacology High Yields (your weak area)
- Beta blockers: contraindications (asthma, COPD, heart block), cardioselective (metoprolol, atenolol, bisoprolol)
- ACE inhibitors: side effects (dry cough, angioedema), contraindicated in pregnancy
- Diuretics: site of action, K-sparing (spironolactone, amiloride), indications
- NSAIDs: mechanism, COX-2 selective drugs, contraindications
- Antibiotics: drug of choice for common infections - memorize a DOC table
- Drug of choice in pregnancy: safe drugs (penicillin, cephalosporins, metronidazole, methyldopa)
- Antiepileptics: DOC for each type, enzyme inducers/inhibitors
- Antihypertensives: drug choice in special populations
- Drugs to avoid: aminoglycosides (ototoxicity/nephrotoxicity), chloramphenicol (grey baby), tetracycline (pregnancy)
- Antimalarials: chloroquine, artemisinin, DOC for P. falciparum, G6PD considerations
- OCP pharmacology: estrogen vs progesterone effects, emergency contraception
- Organisms causing specific syndromes (Ghon complex→TB, Negri bodies→rabies, Cowdry A→HSV)
- Common staining (Ziehl-Neelsen, Gram stain, India ink for Cryptococcus)
- Opportunistic infections in HIV (CD4 count thresholds - PCP <200, MAC <50, CMV retinitis <50)
- Tumor markers (AFP→HCC/germ cell, CEA→colorectal, CA-125→ovarian, PSA→prostate)
- Oncogenes and cancer associations (H. pylori→gastric lymphoma/cancer, HBV/HCV→HCC, HPV→cervical)
WEEK 2 (July 20-26): Surgery + OBG + Paediatrics
- 7:00-10:00 AM - Surgery
- 10:30 AM-12:30 PM - OBG
- 1:30-3:30 PM - Paediatrics
- 4:00-6:00 PM - PYQs (all 3 subjects)
- 6:30-8:00 PM - Medicine revision (15 min/topic from Week 1)
Day 8-10: Surgery (your weak area - 3 full days)
- ATLS protocol - primary survey (ABCDE), secondary survey
- Tension pneumothorax vs open pneumothorax - immediate management
- Fluid resuscitation - Hartmann's solution, crystalloid vs colloid
- Abdominal compartment syndrome
- Damage control surgery concept
- Acute abdomen - causes by quadrant, Rovsing's sign, Murphy's sign, Cullen's/Grey Turner's signs
- Appendicitis - Alvarado score, management
- Intestinal obstruction - mechanical vs paralytic ileus, X-ray findings (ladder pattern, coffee bean)
- Hernia - types (inguinal direct vs indirect, femoral), Richter's hernia, Maydl's hernia
- Colorectal cancer - Dukes staging, screening, FAP, HNPCC
- Anorectal - piles (grades), fissure DOC, perianal abscess
- Carcinoma breast - BRCA1/2, triple assessment, staging, FNAC vs core biopsy
- Modified radical mastectomy vs BCS criteria
- Paget's disease of nipple vs eczema (Toker cells, CK7+)
- Goiter - endemic (iodine deficiency), MNG management
- Thyroid cancer types - papillary (most common, psammoma bodies), medullary (calcitonin, MEN2)
- Parathyroid - primary HPT (stones, bones, groans, psychic moans)
- BPH - IPSS score, medical (alpha blockers - tamsulosin, 5-ARIs - finasteride) vs surgical
- Renal cell carcinoma - triad, treatment
- Bladder cancer - TCC, smoking association, cystoscopy
- Fracture healing stages, complications (fat embolism, compartment syndrome, AVN)
- Common fractures - Colles' (dinner fork deformity), scaphoid (AVN risk), NOF fractures
- Osteomyelitis - acute vs chronic, organisms, Brodie's abscess
- Bone tumors - osteosarcoma (Codman's triangle, sunburst), Ewing's (onion peel)
- Otitis media - acute vs chronic, CSOM types (tubotympanic vs atticoantral), cholesteatoma
- Hearing loss types (conductive vs sensorineural - Rinne and Weber tests)
- Epistaxis - Kiesselbach's plexus (anterior), Little's area
- Tonsillitis - indications for tonsillectomy
- Glaucoma - open angle vs angle closure, normal IOP, drugs (timolol, latanoprost, pilocarpine)
- Cataract - types, surgical landmark (ECCE vs phaco)
- Diabetic retinopathy - NPDR vs PDR, laser photocoagulation
- Retinal detachment - flashes and floaters, emergency
Day 11-12: OBG
- Antenatal care - booking visit, investigations, schedule
- Hypertensive disorders - pre-eclampsia criteria (new: >140/90 + proteinuria or features), eclampsia, MgSO4 (Pritchard regimen)
- APH - placenta previa vs abruptio placentae (painless vs painful bleeding, soft vs woody hard uterus)
- Malpresentations - breech types, management
- Labour - stages and their durations, Bishop score, partogram
- PPH - causes (4 T's: Tone, Tissue, Trauma, Thrombin), management, Bakri balloon
- Caesarean section - indications, classical vs lower segment
- PCOS - Rotterdam criteria (2 of 3), insulin resistance, treatment (OCP, metformin, clomiphene)
- Endometriosis - chocolate cyst, CA-125, staging, treatment
- Fibroid - classification (FIGO/PALM-COEIN), submucous most symptomatic, myomectomy vs hysterectomy
- Cervical cancer - HPV 16/18, CIN grading, Pap smear, colposcopy, LLETZ
- Ovarian cancer - most common (serous cystadenocarcinoma), CA-125, BRCA
- Gestational trophoblastic disease - molar pregnancy (complete vs partial mole), beta-hCG levels, treatment (MTX)
Day 13-14: Paediatrics
- Growth and Development: Denver developmental milestones (social smile 6 weeks, sits without support 6 months, walks 12 months, 2-word sentences 2 years)
- Immunization schedule (NIS India 2026): BCG at birth, OPV 0 at birth, Penta + OPV at 6/10/14 weeks, MMR at 9 months + 15-18 months, Typhoid at 9-12 months
- Neonatal jaundice - physiological vs pathological, exchange transfusion criteria
- Neonatal sepsis - early vs late onset, organisms (GBS early, Klebsiella/E.coli late)
- Malnutrition - Wellcome classification, MUAC, SAM criteria (MUAC <11.5 cm), F-75 vs F-100
- Febrile seizures - simple vs complex, management (lorazepam, diazepam), prognosis
- Diarrhea management - ORS (WHO low osmolarity), zinc supplementation, Plan A/B/C
- Childhood TB - Mantoux test interpretation, primary complex (Ghon focus + lymph node)
- Common childhood exanthems - measles (Koplik's spots), chickenpox (centripetal), roseola infantum (fever then rash)
- Vitamin deficiencies - Vit D (rickets), Vit A (night blindness, Bitot spots), Vit C (scurvy - perifollicular hemorrhage), Vit K (HDN)
- Congenital heart diseases - cyanotic (TOF, TGA) vs acyanotic (ASD, VSD, PDA) - clinical features
WEEK 3 (July 27 - August 1): PSM + Revision + Mock Tests
- 7:00-9:30 AM - PSM (community medicine)
- 10:00 AM-12:00 PM - Full Mock Test (timed, 120 Qs in 2 hrs)
- 1:00-3:00 PM - Analyze mistakes + weak areas
- 3:30-6:00 PM - Rapid revision of flagged topics
- 6:30-8:00 PM - PYQ solving (last 5 years)
Day 15-17: PSM / Community Medicine
- Types of studies - RCT > cohort > case-control > cross-sectional (hierarchy of evidence)
- Sensitivity vs Specificity vs PPV vs NPV - formulas and interpretations
- Odds ratio vs Relative risk - when each is used
- Type 1 error (alpha) vs Type 2 error (beta), p-value interpretation
- Normal distribution, mean/median/mode in skewed distributions
- Attributable risk, NNT, NNH
- Incidence vs Prevalence - relationship (P = I × D)
- Attack rate, secondary attack rate
- Herd immunity threshold formula: 1 - 1/R0
- Epidemic curves - common source vs propagated
- Case definitions - suspected, probable, confirmed
- RNTCP/NTP - new TB treatment regimens, bedaquiline for MDR-TB
- National Immunization Schedule (memorize completely)
- RCH Program - ANC visits, institutional delivery targets
- NVBDCP - malaria, dengue, kala-azar, filariasis
- NPCDCS - hypertension, diabetes, cancer screening targets
- Ayushman Bharat - PMJAY coverage (Rs 5 lakh per family)
- NFHS-5 key data points (IMR, MMR, TFR for India)
- India IMR (NFHS-5): 35.2 per 1000 live births
- MMR (SRS 2018-20): 97 per 100,000 live births (target <70 by 2030)
- TFR: 2.0 (NFHS-5)
- Under-5 mortality: 41.9 per 1000
- Life expectancy: 69.7 years
- SDG targets: IMR <12, U5MR <25, MMR <70 by 2030
- PEM - Marasmus vs Kwashiorkor differences
- Recommended dietary allowances (RDA) - Indian standards (ICMR)
- IYCF guidelines - exclusive breastfeeding for 6 months
- Mid-Day Meal scheme, ICDS components
- Water purification - chlorination, BOD/COD, WHO water quality standards
- Air pollution - PM2.5 vs PM10, NAAQS standards
- Occupational diseases - silicosis, asbestosis, byssinosis, occupational asthma
- Notifiable diseases in India
Day 18-19: Full Mock Tests + PYQ Marathon
- Attempt 2 full-length mock papers (Paper 1 + Paper 2) each day
- Time yourself strictly (2 hours per paper)
- For EVERY wrong answer: read the concept, understand WHY the answer is correct
- Focus on accuracy over speed - CMS cutoff is typically around 55-60% (275-300/500)
Day 20-21: Final Revision + Exam Day Prep
- Go through your personal notes/mnemonics
- Revise only HIGH CONFIDENCE topics - don't start new topics
- Solve 30-40 PYQs to build momentum
- NO new topics
- Revise scores/criteria/numbers (these are easy marks if memorized)
- Sleep by 10 PM - at least 8 hours sleep
- Keep admit card, ID proof, stationery ready the night before
SCORES AND CRITERIA CHEAT SHEET (Memorize These)
| Score/Criteria | Used For | Key Numbers |
|---|---|---|
| CURB-65 | Pneumonia severity | Score ≥2 = hospitalize |
| Killip classification | MI prognosis | Class 4 = cardiogenic shock |
| Child-Pugh | Liver cirrhosis | A=5-6, B=7-9, C=10-15 |
| MELD | Liver transplant priority | >15 consider transplant |
| Ranson's criteria | Pancreatitis severity | ≥3 = severe |
| NYHA | Heart failure | Class I-IV by symptoms |
| GOLD | COPD | Stage I-IV by FEV1% |
| Alvarado | Appendicitis | ≥7 = likely appendicitis |
| Rotterdam | PCOS | 2 of 3 criteria needed |
| Bishop Score | Cervical ripening | ≥8 = favorable |
| Denver | Development | Memorize key milestones |
| CHA2DS2-VASc | AF anticoagulation | ≥2 in men = anticoagulate |
| Duke Criteria | Infective endocarditis | 2 major OR 1 major + 3 minor |
DRUG OF CHOICE MASTER LIST (High Yield for Pharma Questions)
| Condition | DOC |
|---|---|
| Pneumococcal meningitis | Ceftriaxone |
| TB meningitis | 2HRZE/7HR + dexamethasone |
| Malaria P. falciparum (uncomplicated) | Artemether-lumefantrine |
| Malaria P. vivax | Chloroquine + Primaquine |
| H. pylori | Clarithromycin triple therapy (PPI + Amoxy + Clarithro) |
| Eclampsia | MgSO4 (Pritchard regimen) |
| PCOS infertility | Clomiphene citrate |
| Thyroid storm | Propylthiouracil (PTU) + beta-blocker + iodine |
| Hypertension in pregnancy | Methyldopa (1st line), Labetalol, Nifedipine |
| Absence seizure | Ethosuximide |
| Status epilepticus | Lorazepam (IV) then phenytoin |
| Parkinson's disease | Levodopa + Carbidopa |
| Myasthenia crisis | Pyridostigmine; plasma exchange/IVIG for crisis |
| C. diff colitis | Oral vancomycin or fidaxomicin |
| Kala-azar (VL) | Liposomal amphotericin B (1st line in India) |
| Cryptococcal meningitis (HIV) | Amphotericin B + Flucytosine |
| ORS composition (WHO low osmolarity) | Na 75, Cl 65, Glucose 75, K 20, Citrate 10 (osmolarity 245) |
WHAT TO DO WITH PYQs
- Don't just read Q+A - read the explanation for EVERY option
- Mark topics that repeat - if a topic appears in 3+ PYQ years, it WILL come again
- Note the distractors - CMS often uses similar-sounding wrong options
- Negative marking strategy - attempt only when you can eliminate at least 2 options confidently
QUICK TIPS FOR EXAM DAY
- Paper 1 is tougher (Medicine is harder to score) - don't panic
- Attempt PSM and Paediatrics first in Paper 2 (easiest, fastest marks)
- In surgery, anatomy/signs questions are easy marks - don't skip
- If stuck between 2 options after 1 minute, mark and move on - revisit at end
- Target: 75-80 correct in each paper (out of 120) to be safe
As you described me all the imp topics can you please provide notes of everything whatever is needed for upsc cms in pdf format as I don’t have any content ready
mkdir -p /home/daytona/workspace/upsc-cms-notes && ls /home/daytona/workspace/upsc-cms-notes
Will it take more time ??
- ~80-100 pages of structured notes
- Medicine (Cardiology, Respiratory, Neuro, GI, Endocrine, Infectious diseases)
- Surgery (Trauma, GI Surgery, Breast, Thyroid, Urology, Ortho, ENT, Ophtha)
- OBG (Obstetrics + Gynaecology)
- Paediatrics
- PSM / Community Medicine + Biostatistics
- Pharmacology high yields
- Microbiology / Pathology high yields
- Scores & Criteria master table
- Drug of Choice master list
- PYQ pattern analysis
What do you think would be great a full comprehensive one or subjectwise
- One PDF per subject (7 files)
- You study Medicine today? Open only Medicine PDF - no scrolling through 100 pages
- Easy to carry/open on phone while commuting
- You can track "Medicine - Done ✓" subject by subject
- If one file fails to generate, others are still ready
- Easier to revise specific weak areas quickly
- Good for printing as one book
- But 100+ pages is heavy to navigate on a phone/laptop
- Hard to jump between subjects
- One big file = harder to manage
- Medicine + Pharmacology PDF
- Surgery PDF (incl. ENT, Ophtha, Ortho)
- OBG PDF
- Paediatrics PDF
- PSM + Biostatistics PDF
- Micro + Pathology PDF
- Master Quick Reference PDF (scores, DOC table, PYQs)
Start with medicine and pharmac after that continue to generate the rest too
Done with medicine pharmac pdf
mkdir -p /home/daytona/workspace/upsc-cms-notes && python3 -c "import reportlab; print('reportlab ok')" && python3 -c "from reportlab.lib.pagesizes import A4; print('A4 ok')"
~/upsc-cms-notes/generate_medicine_pharma.py
from reportlab.lib.pagesizes import A4
from reportlab.lib.styles import getSampleStyleSheet, ParagraphStyle
from reportlab.lib.units import cm
from reportlab.lib import colors
from reportlab.platypus import (SimpleDocTemplate, Paragraph, Spacer, Table,
TableStyle, PageBreak, HRFlowable)
from reportlab.lib.enums import TA_CENTER, TA_LEFT, TA_JUSTIFY
OUTPUT = "/home/daytona/workspace/upsc-cms-notes/01_Medicine_Pharmacology.pdf"
doc = SimpleDocTemplate(
OUTPUT, pagesize=A4,
rightMargin=1.8*cm, leftMargin=1.8*cm,
topMargin=2*cm, bottomMargin=2*cm
)
W = A4[0] - 3.6*cm # usable width
styles = getSampleStyleSheet()
# Custom styles
TITLE = ParagraphStyle('TITLE', parent=styles['Title'], fontSize=22, textColor=colors.HexColor('#1a237e'),
spaceAfter=6, alignment=TA_CENTER, fontName='Helvetica-Bold')
SUBTITLE = ParagraphStyle('SUBTITLE', parent=styles['Normal'], fontSize=12, textColor=colors.HexColor('#283593'),
spaceAfter=4, alignment=TA_CENTER, fontName='Helvetica')
H1 = ParagraphStyle('H1', parent=styles['Heading1'], fontSize=15, textColor=colors.white,
backColor=colors.HexColor('#1a237e'), spaceBefore=14, spaceAfter=6,
fontName='Helvetica-Bold', leftIndent=-4, rightIndent=-4, borderPad=5)
H2 = ParagraphStyle('H2', parent=styles['Heading2'], fontSize=12, textColor=colors.white,
backColor=colors.HexColor('#3949ab'), spaceBefore=10, spaceAfter=4,
fontName='Helvetica-Bold', leftIndent=-2, rightIndent=-2, borderPad=4)
H3 = ParagraphStyle('H3', parent=styles['Heading3'], fontSize=11, textColor=colors.HexColor('#1a237e'),
spaceBefore=8, spaceAfter=3, fontName='Helvetica-Bold')
BODY = ParagraphStyle('BODY', parent=styles['Normal'], fontSize=9.5, spaceAfter=3,
leading=14, fontName='Helvetica', alignment=TA_JUSTIFY)
BULLET = ParagraphStyle('BULLET', parent=styles['Normal'], fontSize=9.5, spaceAfter=2,
leading=13, fontName='Helvetica', leftIndent=14, bulletIndent=4)
IMPORTANT = ParagraphStyle('IMPORTANT', parent=styles['Normal'], fontSize=9.5, spaceAfter=3,
leading=13, fontName='Helvetica-Bold', textColor=colors.HexColor('#b71c1c'),
leftIndent=8)
NOTE = ParagraphStyle('NOTE', parent=styles['Normal'], fontSize=9, spaceAfter=3,
leading=12, fontName='Helvetica-Oblique', textColor=colors.HexColor('#4a148c'),
leftIndent=8)
def h1(text): return Paragraph(f" {text}", H1)
def h2(text): return Paragraph(f" {text}", H2)
def h3(text): return Paragraph(text, H3)
def body(text): return Paragraph(text, BODY)
def bullet(text): return Paragraph(f"• {text}", BULLET)
def imp(text): return Paragraph(f"★ {text}", IMPORTANT)
def note(text): return Paragraph(f"Note: {text}", NOTE)
def sp(n=1): return Spacer(1, n*0.3*cm)
def hr(): return HRFlowable(width="100%", thickness=0.5, color=colors.HexColor('#9fa8da'), spaceAfter=4)
def table(data, col_widths=None, header_bg=colors.HexColor('#3949ab')):
if col_widths is None:
col_widths = [W/len(data[0])]*len(data[0])
t = Table(data, colWidths=col_widths, repeatRows=1)
style = [
('BACKGROUND', (0,0), (-1,0), header_bg),
('TEXTCOLOR', (0,0), (-1,0), colors.white),
('FONTNAME', (0,0), (-1,0), 'Helvetica-Bold'),
('FONTSIZE', (0,0), (-1,0), 9),
('ALIGN', (0,0), (-1,-1), 'LEFT'),
('VALIGN', (0,0), (-1,-1), 'TOP'),
('FONTNAME', (0,1), (-1,-1), 'Helvetica'),
('FONTSIZE', (0,1), (-1,-1), 8.5),
('ROWBACKGROUNDS', (0,1), (-1,-1), [colors.white, colors.HexColor('#e8eaf6')]),
('GRID', (0,0), (-1,-1), 0.4, colors.HexColor('#9fa8da')),
('LEFTPADDING', (0,0), (-1,-1), 5),
('RIGHTPADDING', (0,0), (-1,-1), 5),
('TOPPADDING', (0,0), (-1,-1), 3),
('BOTTOMPADDING', (0,0), (-1,-1), 3),
]
t.setStyle(TableStyle(style))
return t
# ─────────────────────────────────────────────
story = []
# COVER
story += [
sp(3),
Paragraph("UPSC CMS 2026", TITLE),
Paragraph("HIGH-YIELD NOTES", ParagraphStyle('big', parent=styles['Title'], fontSize=28,
textColor=colors.HexColor('#b71c1c'), alignment=TA_CENTER, fontName='Helvetica-Bold')),
sp(1),
Paragraph("PAPER 1 — MODULE 1", ParagraphStyle('mod', parent=styles['Normal'], fontSize=16,
textColor=colors.HexColor('#283593'), alignment=TA_CENTER, fontName='Helvetica-Bold')),
sp(0.5),
Paragraph("General Medicine + Pharmacology", ParagraphStyle('sub2', parent=styles['Normal'], fontSize=14,
textColor=colors.HexColor('#1a237e'), alignment=TA_CENTER, fontName='Helvetica')),
sp(2),
HRFlowable(width="80%", thickness=2, color=colors.HexColor('#1a237e'), hAlign='CENTER'),
sp(1),
Paragraph("Exam Date: August 2, 2026", ParagraphStyle('ed', parent=styles['Normal'], fontSize=11,
textColor=colors.HexColor('#424242'), alignment=TA_CENTER)),
Paragraph("Covers: Cardiology | Respiratory | Neurology | GI/Hepatology |", ParagraphStyle('cov', parent=styles['Normal'], fontSize=10,
textColor=colors.HexColor('#616161'), alignment=TA_CENTER)),
Paragraph("Endocrinology | Infectious Diseases | Dermatology | Psychiatry | Pharmacology", ParagraphStyle('cov', parent=styles['Normal'], fontSize=10,
textColor=colors.HexColor('#616161'), alignment=TA_CENTER)),
sp(3),
PageBreak(),
]
# ═══════════════════════════════════════════
# SECTION 1: CARDIOLOGY
# ═══════════════════════════════════════════
story += [h1("SECTION 1: CARDIOLOGY"), sp()]
story += [h2("1.1 HEART FAILURE"), sp(0.5)]
story += [
body("Heart failure (HF) is inability of heart to pump sufficient blood to meet metabolic needs at normal filling pressures."),
h3("Classification:"),
table([
["Type","EF","Common Cause","Key Feature"],
["HFrEF (Systolic)","< 40%","IHD, Dilated CMP","Reduced contractility"],
["HFpEF (Diastolic)","> 50%","HTN, HCM, Restrictive","Impaired relaxation"],
["HFmrEF","40-49%","Mixed","Intermediate"],
], [3.5*cm, 2.5*cm, 5*cm, 5.5*cm]),
sp(),
h3("NYHA Classification (★ PYQ Favourite):"),
table([
["Class","Symptoms","6-Min Walk"],
["I","No symptoms with ordinary activity","≥ 450 m"],
["II","Symptoms with moderate exertion","300-450 m"],
["III","Symptoms with minimal exertion","150-300 m"],
["IV","Symptoms at rest","< 150 m"],
], [2*cm, 9*cm, 3.5*cm]),
sp(),
h3("Management of HFrEF (ABCDE of HF):"),
bullet("<b>A</b>CE inhibitor / ARB (Ramipril, Enalapril) — reduce mortality, first line"),
bullet("<b>B</b>eta-blocker (Carvedilol, Metoprolol succinate, Bisoprolol) — reduce mortality"),
bullet("<b>C</b>ardiac resynchronization (BiV pacemaker) — if QRS >150ms, LVEF <35%"),
bullet("<b>D</b>iuretics (Furosemide) — symptom relief, no mortality benefit"),
bullet("<b>E</b>plerenone/Spironolactone (MRA) — mortality benefit in HFrEF"),
bullet("SGLT2 inhibitors (Dapagliflozin, Empagliflozin) — NEW addition, mortality benefit"),
bullet("ARNI (Sacubitril + Valsartan / LCZ696) — superior to ACEi in symptomatic HFrEF"),
imp("Digoxin: reduces hospitalization but NO mortality benefit; used for rate control in AF+HF"),
imp("Hydralazine + Nitrate: alternative if ACEi/ARB not tolerated"),
sp(),
]
story += [h2("1.2 HYPERTENSION"), sp(0.5)]
story += [
table([
["Category","Systolic (mmHg)","Diastolic (mmHg)"],
["Normal","< 120","< 80"],
["Elevated (Pre-HTN)","120-129","< 80"],
["Stage 1 HTN","130-139","80-89"],
["Stage 2 HTN","≥ 140","≥ 90"],
["Hypertensive Crisis","≥ 180","≥ 120"],
], [4*cm, 5.5*cm, 5.5*cm]),
sp(),
h3("Drug Choice in Special Populations (★ Most PYQs):"),
table([
["Condition","Preferred Drug(s)","Drugs to Avoid"],
["Diabetes + HTN","ACEi / ARB (renoprotective)","—"],
["CKD + HTN","ACEi / ARB","NSAIDs"],
["Pregnancy","Methyldopa, Labetalol, Nifedipine","ACEi, ARB, Atenolol"],
["HF + HTN","ACEi, Beta-blocker, MRA","Verapamil, Diltiazem"],
["Angina + HTN","Beta-blocker, CCB","—"],
["Elderly / ISH","CCB (Amlodipine), Thiazide","—"],
["Asthma + HTN","CCB, ACEi","Beta-blockers"],
["BPH + HTN","Alpha-blocker (Prazosin, Doxazosin)","—"],
["Migraine + HTN","Beta-blocker, CCB","—"],
], [5*cm, 6*cm, 4.5*cm]),
sp(),
imp("Hypertensive Emergency: IV Labetalol, IV Nicardipine, IV Sodium Nitroprusside. Reduce MAP by max 25% in first hour."),
imp("Hypertensive Urgency (no end organ damage): Oral Amlodipine, oral Captopril — reduce BP over 24-48 hrs"),
sp(),
]
story += [h2("1.3 ISCHEMIC HEART DISEASE (IHD)"), sp(0.5)]
story += [
h3("Killip Classification (★ PYQ — always asked):"),
table([
["Class","Features","Mortality"],
["I","No HF signs","6%"],
["II","S3, basal crepitations / JVP raised","17%"],
["III","Frank pulmonary oedema","38%"],
["IV","Cardiogenic shock (BP<90, cold peripheries)","81%"],
], [2*cm, 9*cm, 4.5*cm]),
sp(),
h3("STEMI Management:"),
bullet("Reperfusion within 12 hours: Primary PCI (preferred) OR Thrombolysis (if PCI unavailable within 120 min)"),
bullet("Thrombolytics: Streptokinase, Alteplase, Tenecteplase"),
bullet("Dual antiplatelet: Aspirin + Clopidogrel/Ticagrelor"),
bullet("Anticoagulation: LMWH (Enoxaparin) or UFH"),
bullet("Beta-blocker: start within 24 hours if no contraindications"),
bullet("ACEi: start within 24 hours, especially if anterior MI or EF <40%"),
imp("Contraindications to thrombolysis: Prior ICH, ischemic stroke <3 months, active bleeding, severe HTN (>180/110), aortic dissection"),
sp(),
h3("NSTEMI / Unstable Angina:"),
bullet("Risk stratify with TIMI or GRACE score"),
bullet("Antiplatelet + anticoagulation + early invasive strategy within 24 hrs for high risk"),
bullet("No thrombolytics in NSTEMI"),
sp(),
h3("Complications of MI:"),
table([
["Timing","Complication","Notes"],
["Immediate (0-24h)","VF, VT, Heart block","Most common cause of early death"],
["1-3 days","Pericarditis (early)","Friction rub, pleuritic chest pain"],
["3-5 days","Papillary muscle rupture","Acute MR, flash pulmonary oedema"],
["3-5 days","Free wall rupture","Cardiac tamponade, sudden death"],
["5-7 days","VSD","New harsh pansystolic murmur"],
["2-8 weeks","Dressler's syndrome","Autoimmune pericarditis, fever, high ESR"],
["Weeks-months","LV aneurysm","Persistent ST elevation, mural thrombus"],
], [3.5*cm, 5*cm, 7*cm]),
sp(),
]
story += [h2("1.4 ATRIAL FIBRILLATION"), sp(0.5)]
story += [
h3("CHA2DS2-VASc Score (★ PYQ — know full form and scoring):"),
table([
["Factor","Points"],
["C — Congestive Heart Failure","1"],
["H — Hypertension","1"],
["A2 — Age ≥ 75 years","2"],
["D — Diabetes Mellitus","1"],
["S2 — Stroke/TIA/thromboembolism history","2"],
["V — Vascular disease (MI, PAD, aortic plaque)","1"],
["A — Age 65-74 years","1"],
["Sc — Sex category (female)","1"],
], [10*cm, 5.5*cm]),
imp("Anticoagulate if score ≥ 2 in men, ≥ 3 in women. Score of 1 in men: consider anticoagulation."),
sp(0.5),
h3("Rate vs Rhythm Control:"),
bullet("Rate control (beta-blocker, diltiazem, digoxin): first-line for most patients, target HR <110 bpm"),
bullet("Rhythm control (cardioversion, amiodarone, flecainide): for symptomatic patients, recent-onset AF (<48h), or younger patients"),
bullet("If AF >48h or unknown duration: anticoagulate for 3 weeks before cardioversion OR perform TOE to exclude LA clot"),
imp("Wolff-Parkinson-White + AF: DO NOT use AV nodal blockers (digoxin, verapamil, diltiazem) — risk of rapid conduction via accessory pathway → VF. Use Amiodarone or DC cardioversion."),
sp(),
]
story += [h2("1.5 RHEUMATIC FEVER & RHEUMATIC HEART DISEASE"), sp(0.5)]
story += [
h3("Jones Criteria (★ Most frequently asked PYQ in Medicine):"),
table([
["Major Criteria (CASPE)","Minor Criteria"],
["Carditis (pancarditis)","Fever (>38.5°C)"],
["Arthritis (migratory, large joints)","Elevated ESR/CRP"],
["Sydenham's chorea","Prolonged PR interval on ECG"],
["Polyarthralgia (only if no arthritis)","Arthralgia (only if no arthritis in major)"],
["Erythema marginatum","Previous rheumatic fever"],
["Subcutaneous nodules","—"],
], [8*cm, 7.5*cm]),
imp("Diagnosis: 2 Major OR 1 Major + 2 Minor + evidence of preceding strep infection (ASOT raised, positive throat culture)"),
imp("Most common valve affected: MITRAL (MS > MR > AS > AR in chronic RHD)"),
bullet("Carey-Coombs murmur: soft mid-diastolic murmur of active rheumatic carditis"),
bullet("Penicillin prophylaxis: monthly Benzathine Penicillin G 1.2 MU IM for prevention of recurrence"),
sp(),
]
story += [h2("1.6 INFECTIVE ENDOCARDITIS (IE)"), sp(0.5)]
story += [
h3("Duke Criteria (★ PYQ):"),
table([
["Major Criteria","Minor Criteria"],
["Positive blood cultures (2 separate, typical organisms)","Predisposing condition (valvular disease, IVDU)"],
["Evidence of endocardial involvement (echo: vegetation, abscess, new valvular regurgitation)","Fever > 38°C"],
["","Vascular phenomena (emboli, mycotic aneurysm, Janeway lesions)"],
["","Immunological phenomena (Osler nodes, Roth spots, RF positive, GN)"],
["","Positive blood cultures (not meeting major criteria)"],
], [8*cm, 7.5*cm]),
imp("Definite IE: 2 major OR 1 major + 3 minor OR 5 minor"),
sp(0.5),
table([
["Organism","Association"],
["Streptococcus viridans","Most common (native valve, dental procedures)"],
["Staphylococcus aureus","IVDU, prosthetic valve, acute/aggressive IE"],
["Enterococcus","GI/GU procedures"],
["HACEK organisms","Culture-negative IE, slow growing"],
["Strep bovis (S. gallolyticus)","Colon cancer — always do colonoscopy!"],
["Candida","Prosthetic valve, immunocompromised, IVDU"],
], [5.5*cm, 10*cm]),
sp(0.5),
bullet("Empirical treatment: Benzylpenicillin + Gentamicin (native valve); Vancomycin + Gentamicin (prosthetic valve)"),
bullet("MRSA: Vancomycin or Daptomycin"),
sp(),
]
story += [h2("1.7 CONGENITAL HEART DISEASE"), sp(0.5)]
story += [
table([
["Defect","Blood Flow","Murmur","Key Features"],
["ASD","L→R (usually)","Systolic ejection at pulmonary area","Fixed split S2; RVH on ECG"],
["VSD","L→R","Pansystolic at LSE","Most common CHD; may close spontaneously"],
["PDA","L→R","Continuous machinery murmur","Widened pulse pressure; Indomethacin closes it"],
["TOF","R→L (cyanotic)","Ejection systolic (pulmonic stenosis)","Boot-shaped heart on CXR; squatting relieves cyanosis"],
["TGA","Parallel circuits","Variable","Egg-on-side CXR; PGE1 to maintain PDA"],
["Coarctation of Aorta","—","Interscapular bruit","Radio-femoral delay; rib notching on CXR"],
["Eisenmenger syndrome","R→L (reversal)","Varies","Late cyanosis; irreversible; contraindication to surgery"],
], [3*cm, 3*cm, 4.5*cm, 5*cm]),
imp("Eisenmenger: irreversible pulmonary hypertension from longstanding L→R shunt. Pregnancy contraindicated (50% maternal mortality)."),
PageBreak(),
]
# ═══════════════════════════════════════════
# SECTION 2: RESPIRATORY
# ═══════════════════════════════════════════
story += [h1("SECTION 2: RESPIRATORY DISEASES"), sp()]
story += [h2("2.1 CHRONIC OBSTRUCTIVE PULMONARY DISEASE (COPD)"), sp(0.5)]
story += [
h3("GOLD Staging (★ PYQ):"),
table([
["Stage","FEV1 (% predicted)","Severity"],
["GOLD 1 (Mild)","≥ 80%","Mild — symptoms only"],
["GOLD 2 (Moderate)","50-79%","Moderate — exertional dyspnea"],
["GOLD 3 (Severe)","30-49%","Severe — frequent exacerbations"],
["GOLD 4 (Very Severe)","< 30%","Very severe — chronic respiratory failure"],
], [3.5*cm, 5*cm, 7*cm]),
imp("All COPD: FEV1/FVC < 0.70 post-bronchodilator (fixed ratio). This differentiates from restrictive disease."),
sp(0.5),
h3("Stepwise Management:"),
bullet("All stages: Smoking cessation (most important intervention), vaccinations (influenza, pneumococcal)"),
bullet("Mild (GOLD 1-2): SABA (Salbutamol) PRN → add LAMA (Tiotropium) or LABA (Salmeterol)"),
bullet("Moderate-Severe (GOLD 2-3): LAMA + LABA combination"),
bullet("Frequent exacerbations: add ICS (Fluticasone, Budesonide) → triple therapy (ICS+LABA+LAMA)"),
bullet("GOLD 4 + chronic hypoxia (PaO2 <55 mmHg): Long-Term Oxygen Therapy (LTOT) >15 hrs/day — only intervention that improves survival"),
imp("Roflumilast (PDE4 inhibitor): add-on for GOLD 3-4 with chronic bronchitis phenotype and frequent exacerbations"),
sp(0.5),
h3("COPD Exacerbation Management:"),
bullet("Controlled oxygen: target SpO2 88-92% (avoid hypercapnia)"),
bullet("Bronchodilators: SABA + SAMA nebulization"),
bullet("Systemic steroids: Prednisolone 30-40 mg for 5 days"),
bullet("Antibiotics (if purulent sputum): Amoxicillin/Doxycycline/Azithromycin"),
bullet("Non-invasive ventilation (NIV/BiPAP): if pH <7.35 and PaCO2 >45 mmHg"),
sp(),
]
story += [h2("2.2 BRONCHIAL ASTHMA"), sp(0.5)]
story += [
h3("BTS/GINA Stepwise Management:"),
table([
["Step","Treatment"],
["Step 1","SABA PRN (Salbutamol inhaler)"],
["Step 2","Low-dose ICS (Budesonide, Beclomethasone) + SABA PRN"],
["Step 3","Low-dose ICS + LABA (Formoterol/Salmeterol) OR medium ICS"],
["Step 4","Medium/high ICS + LABA; consider LAMA, LTRA (Montelukast)"],
["Step 5","High ICS + LABA + specialist referral; add-on: Tiotropium, Omalizumab (if allergic)"],
], [2.5*cm, 13*cm]),
sp(0.5),
imp("Safe in pregnancy: SABA, ICS, LABA, Montelukast — all safe. Avoid systemic steroids in 1st trimester if possible."),
h3("Status Asthmaticus Management:"),
bullet("High flow oxygen, SABA nebulization every 20 min x3, IV Magnesium Sulfate 2g over 20 min"),
bullet("IV Hydrocortisone 100mg, then oral Prednisolone"),
bullet("Heliox (He+O2) for severe bronchospasm"),
bullet("Intubation: if exhaustion, PaCO2 rising, SpO2 <90% despite max treatment"),
imp("Normal or rising PaCO2 in acute asthma = sign of impending respiratory failure — treat aggressively"),
sp(),
]
story += [h2("2.3 PNEUMONIA"), sp(0.5)]
story += [
h3("CURB-65 Score (★ PYQ — must memorize):"),
table([
["Parameter","Score"],
["C — Confusion (new onset)","1"],
["U — Urea > 7 mmol/L (BUN > 19 mg/dL)","1"],
["R — Respiratory rate ≥ 30/min","1"],
["B — Blood pressure (SBP <90 or DBP ≤60)","1"],
["65 — Age ≥ 65 years","1"],
], [10*cm, 5.5*cm]),
table([
["Score","Management","Mortality"],
["0-1","Outpatient treatment","< 3%"],
["2","Short inpatient or supervised outpatient","9%"],
["3-5","Hospitalize; ICU if score 4-5","15-40%"],
], [3*cm, 9*cm, 3.5*cm]),
sp(0.5),
h3("Organisms by Type:"),
table([
["Type","Common Organisms","Treatment"],
["CAP (Mild)","S. pneumoniae, H. influenzae, Mycoplasma","Amoxicillin OR Doxycycline"],
["CAP (Moderate-Severe)","S. pneumoniae, Legionella","Beta-lactam + Macrolide OR Respiratory FQ"],
["HAP/VAP","Gram negatives (Klebsiella, Pseudomonas), MRSA","Piperacillin-tazobactam ± Vancomycin"],
["Atypical","Mycoplasma, Chlamydophila, Legionella","Macrolide or Doxycycline"],
["Aspiration","Anaerobes, mixed","Amoxicillin-clavulanate, Clindamycin"],
], [3.5*cm, 6*cm, 6*cm]),
sp(0.5),
imp("Legionella: Pontiac fever (mild); Legionnaires' disease (severe). Hyponatremia is clue. Urine antigen test. Treat with Azithromycin/FQ."),
sp(),
]
story += [h2("2.4 TUBERCULOSIS"), sp(0.5)]
story += [
h3("India NTP Regimen (★ PYQ):"),
table([
["Category","Regimen","Notes"],
["New pulmonary/extrapulmonary TB","2HRZE / 4HR","H=INH, R=Rifampicin, Z=Pyrazinamide, E=Ethambutol"],
["Previously treated (Retreatment)","2HRZES / 1HRZE / 5HRE","Under PMDT now being phased to new drugs"],
["MDR-TB (RR-TB)","6-9 months shorter regimen (BPaLM)","Bedaquiline + Pretomanid + Linezolid + Moxifloxacin"],
["TB Meningitis","2HRZE / 10HR + Dexamethasone","Longer continuation phase; dexamethasone reduces mortality"],
], [4.5*cm, 5.5*cm, 5.5*cm]),
sp(0.5),
h3("Side Effects of Anti-TB Drugs:"),
table([
["Drug","Key Side Effect"],
["Isoniazid (H)","Peripheral neuropathy (give Pyridoxine/B6), hepatotoxicity, SLE-like syndrome"],
["Rifampicin (R)","Orange discoloration of body fluids, hepatotoxicity, enzyme inducer (reduces OCP efficacy)"],
["Pyrazinamide (Z)","Hyperuricemia/gout, hepatotoxicity"],
["Ethambutol (E)","Optic neuritis (red-green color vision loss) — check visual acuity before starting"],
["Streptomycin (S)","Ototoxicity (vestibular), nephrotoxicity"],
], [4*cm, 11.5*cm]),
sp(0.5),
imp("Immune Reconstitution Inflammatory Syndrome (IRIS): paradoxical worsening after starting ART in HIV-TB co-infection. Treat with steroids."),
bullet("Directly Observed Treatment Short-course (DOTS): cornerstone of NTP India"),
sp(),
]
story += [h2("2.5 PLEURAL EFFUSION"), sp(0.5)]
story += [
h3("Light's Criteria (★ PYQ — must know):"),
body("Exudate if ANY ONE of the following:"),
bullet("Pleural protein / serum protein > 0.5"),
bullet("Pleural LDH / serum LDH > 0.6"),
bullet("Pleural LDH > 2/3 upper limit of normal serum LDH"),
sp(0.5),
table([
["Transudate","Exudate"],
["Heart failure (most common)","Pneumonia / parapneumonic"],
["Cirrhosis (hepatic hydrothorax)","Tuberculosis"],
["Nephrotic syndrome","Malignancy"],
["Hypothyroidism","Pulmonary embolism"],
["Hypoalbuminemia","Rheumatoid arthritis, SLE"],
], [8*cm, 7.5*cm]),
sp(),
]
story += [h2("2.6 LUNG CANCER"), sp(0.5)]
story += [
table([
["Type","% of Cases","Location","Key Features","Paraneoplastic"],
["Squamous cell","25-30%","Central","Cavitation, Keratin pearls on histo","PTHrP → Hypercalcemia"],
["Adenocarcinoma","35-40%","Peripheral","Most common overall; EGFR mutation","Hypertrophic osteoarthropathy"],
["Small cell (SCLC)","15-20%","Central","Neuroendocrine, very aggressive","SIADH, ACTH (Cushing's), Lambert-Eaton"],
["Large cell","10%","Peripheral","Diagnosis of exclusion","Gynecomastia, hCG"],
], [3.5*cm, 2.5*cm, 3*cm, 4.5*cm, 4*cm]),
sp(0.5),
imp("SCLC: Chemotherapy (Cisplatin + Etoposide) is primary treatment. Surgery generally NOT done. Prophylactic cranial irradiation for complete responders."),
imp("NSCLC: Surgery if operable (Stage I-IIIa). EGFR mutation → Erlotinib/Gefitinib. ALK mutation → Crizotinib. PD-L1 → Pembrolizumab."),
bullet("Horner's syndrome (ptosis, miosis, anhidrosis): Pancoast (superior sulcus) tumor at lung apex"),
bullet("SVC syndrome: obstruction → face/neck swelling, 'collar of stokes'. Common in SCLC and lymphoma."),
PageBreak(),
]
# ═══════════════════════════════════════════
# SECTION 3: NEUROLOGY
# ═══════════════════════════════════════════
story += [h1("SECTION 3: NEUROLOGY"), sp()]
story += [h2("3.1 STROKE"), sp(0.5)]
story += [
h3("Ischemic vs Hemorrhagic:"),
table([
["Feature","Ischemic (85%)","Hemorrhagic (15%)"],
["Onset","Sudden, often on waking","Sudden during activity"],
["CT appearance","Hypodense (may be normal in first 6h)","Hyperdense (bright white immediately)"],
["Headache","Usually absent","Severe (ICH/SAH)"],
["Thrombolysis","YES (if criteria met)","CONTRAINDICATED"],
["BP management","Permissive HTN (up to 220/120) unless thrombolysis","Aggressive BP reduction (<140)"],
], [4.5*cm, 5.5*cm, 5.5*cm]),
sp(0.5),
h3("Thrombolysis Criteria (tPA/Alteplase):"),
bullet("Time window: Within 4.5 hours of symptom onset"),
bullet("BP must be <185/110 before giving tPA"),
bullet("No hemorrhage on CT"),
bullet("No recent surgery (14 days), no prior ICH, no active bleeding"),
imp("NIHSS: Stroke severity score 0-42. Score ≥ 6: consider thrombectomy. Mechanical thrombectomy window: up to 24 hours in selected patients."),
sp(),
]
story += [h2("3.2 MENINGITIS — CSF FINDINGS (★ PYQ)"), sp(0.5)]
story += [
table([
["Type","Appearance","Cells","Protein","Glucose","Other"],
["Normal","Clear","0-5 lymphocytes","15-45 mg/dL","50-75 mg/dL (>60% serum)","—"],
["Bacterial","Turbid/Purulent","100-10,000 PMNs","High (>100)","Very low (<40%)","Gram stain +ve"],
["Viral (Aseptic)","Clear","10-100 lymphocytes","Normal/slight increase","Normal","PCR diagnostic"],
["TB","Xanthochromic/Fibrin web","100-500 lymphocytes","Very high (100-500)","Very low","AFB smear/culture"],
["Fungal (Crypto)","Clear/turbid","5-100 lymphocytes","High","Low","India ink +ve; CrAg +ve"],
["SAH","Xanthochromic","RBCs (not clearing)","High","Normal","Xanthochromia after 2-4h"],
], [3*cm, 3*cm, 3.5*cm, 2.5*cm, 2.5*cm, 2*cm]),
sp(0.5),
imp("Bacterial meningitis triad: fever + neck stiffness + photophobia. LP contraindicated if papilledema/focal deficit → CT first."),
bullet("Treatment: IV Ceftriaxone + Dexamethasone (before or with first dose of antibiotic) — reduces hearing loss and mortality in bacterial meningitis"),
bullet("Meningococcal meningitis (N. meningitidis): give IV Benzylpenicillin immediately + isolate. Chemoprophylaxis: Rifampicin/Ciprofloxacin for contacts."),
sp(),
]
story += [h2("3.3 EPILEPSY — DRUG OF CHOICE"), sp(0.5)]
story += [
table([
["Epilepsy Type","Drug of Choice","Alternatives"],
["Focal (partial) seizures","Carbamazepine","Oxcarbazepine, Lamotrigine, Levetiracetam"],
["Absence seizures","Ethosuximide (or Valproate)","Lamotrigine"],
["Juvenile myoclonic epilepsy","Valproate","Levetiracetam, Lamotrigine"],
["Tonic-clonic (generalized)","Valproate","Lamotrigine, Levetiracetam"],
["Status epilepticus (acute)","IV Lorazepam (1st) → IV Phenytoin (2nd)","Levetiracetam, Valproate IV"],
["Febrile seizures (acute)","Diazepam (rectal/IV)","Lorazepam"],
["Epilepsy in pregnancy","Lamotrigine (safest)","Levetiracetam; AVOID Valproate (teratogenic)"],
["Neonatal seizures","Phenobarbitone (1st line)","Phenytoin, Levetiracetam"],
], [5*cm, 5.5*cm, 5*cm]),
imp("Valproate: major teratogen (neural tube defects, craniofacial abnormalities). AVOID in women of childbearing age if possible."),
imp("Carbamazepine: enzyme inducer, reduces OCP efficacy. Also causes SIADH."),
sp(),
]
story += [h2("3.4 PARKINSON'S DISEASE"), sp(0.5)]
story += [
bullet("Pathology: Loss of dopaminergic neurons in Substantia Nigra pars compacta. Lewy bodies (alpha-synuclein)"),
bullet("TRAP: Tremor (pill-rolling, 4-6 Hz, at rest), Rigidity (cogwheel), Akinesia/Bradykinesia, Postural instability"),
h3("Management:"),
bullet("Levodopa + Carbidopa (Sindopa, Sinemet): Gold standard; carbidopa prevents peripheral conversion of L-DOPA"),
bullet("Dopamine agonists (Pramipexole, Ropinirole): use first in young patients to delay L-DOPA"),
bullet("MAO-B inhibitors (Selegiline, Rasagiline): neuroprotective, mild symptomatic benefit"),
bullet("COMT inhibitors (Entacapone, Tolcapone): extend L-DOPA effect, used in 'wearing off'"),
bullet("Anticholinergics (Trihexyphenidyl/Benzhexol): for tremor only, avoid in elderly"),
imp("MPTP toxicity: causes parkinsonian syndrome. Mechanism: selective destruction of substantia nigra neurons."),
imp("Drug-induced parkinsonism: Haloperidol, Metoclopramide (dopamine blockers) → treat by stopping the drug"),
sp(),
]
story += [h2("3.5 MYASTHENIA GRAVIS"), sp(0.5)]
story += [
bullet("Autoimmune: Anti-AChR antibodies (85%); Anti-MuSK antibodies (10%)"),
bullet("Clinical: Fatigable muscle weakness — worsens with activity, improves with rest. Ptosis, diplopia most common presentation."),
bullet("Thymic abnormality: Thymoma (10-15%), thymic hyperplasia (65%)"),
h3("Tests:"),
bullet("Edrophonium (Tensilon) test: IV edrophonium → transient improvement of ptosis (AChE inhibitor, short acting)"),
bullet("Ice pack test: place ice on ptotic eyelid → improves (alternative to Tensilon)"),
bullet("Repetitive nerve stimulation: decremental response (>10% decrement at 3 Hz)"),
h3("Treatment:"),
bullet("Pyridostigmine (Mestinon): symptomatic, AChE inhibitor"),
bullet("Thymectomy: for thymoma (mandatory) and non-thymomatous generalized MG in young adults"),
bullet("Immunosuppression: Prednisolone, Azathioprine, Mycophenolate"),
bullet("Crisis: Plasmapheresis OR IVIg (both equally effective, work in 3-5 days)"),
imp("Myasthenic crisis vs Cholinergic crisis: Both cause weakness. Cholinergic crisis has SLUDGE (Salivation, Lacrimation, Urination, Defecation, GI distress, Emesis) + bradycardia. Stop pyridostigmine in cholinergic crisis."),
PageBreak(),
]
# ═══════════════════════════════════════════
# SECTION 4: GI AND HEPATOLOGY
# ═══════════════════════════════════════════
story += [h1("SECTION 4: GASTROENTEROLOGY & HEPATOLOGY"), sp()]
story += [h2("4.1 PEPTIC ULCER DISEASE"), sp(0.5)]
story += [
table([
["Feature","Gastric Ulcer","Duodenal Ulcer"],
["H. pylori association","70-80%","95%"],
["Pain","Worsens with food, relieved by vomiting","Relieved by food, worsens 2-3h after meal (hunger pain)"],
["Night pain","Less common","Common (wakes patient)"],
["Weight loss","Common","Less common"],
["Malignant potential","Yes (always biopsy gastric ulcers)","Very rare"],
], [4*cm, 6.5*cm, 6*cm]),
sp(0.5),
h3("H. pylori Triple Therapy:"),
bullet("PPI (Omeprazole 20mg BD) + Amoxicillin 1g BD + Clarithromycin 500mg BD — 7-14 days"),
bullet("If Clarithromycin resistance: PPI + Amoxicillin + Metronidazole (bismuth quadruple therapy)"),
bullet("Test of cure: Urea breath test (4 weeks after completing treatment)"),
imp("NSAID-induced ulcer prevention: use PPI in high-risk patients (elderly, prior ulcer, on anticoagulants)"),
sp(),
]
story += [h2("4.2 INFLAMMATORY BOWEL DISEASE (IBD)"), sp(0.5)]
story += [
table([
["Feature","Crohn's Disease","Ulcerative Colitis"],
["Location","Anywhere (mouth to anus); terminal ileum most common","Colon only; always involves rectum"],
["Distribution","Skip lesions (patchy)","Continuous (no skip lesions)"],
["Depth","Transmural","Mucosal + submucosal only"],
["Histology","Non-caseating granulomas","Crypt abscesses, goblet cell depletion"],
["Clinical","Diarrhea, abdominal pain, weight loss, fistulae","Bloody diarrhea, urgency, tenesmus"],
["Complications","Fistulae, strictures, abscesses","Toxic megacolon, colon cancer (UC>>Crohn's)"],
["Smoking","Worsens Crohn's","Protective in UC (controversial)"],
["Surgery","Resection not curative","Colectomy = curative"],
["ASCA","Positive (anti-S. cerevisiae)","pANCA positive"],
], [4.5*cm, 6*cm, 6*cm]),
sp(0.5),
bullet("Treatment: Aminosalicylates (5-ASA/Mesalamine) for UC; Corticosteroids for flares; Azathioprine for maintenance; Biologics (Infliximab, Adalimumab) for moderate-severe/refractory"),
imp("Toxic megacolon: medical emergency in UC. Colon >6 cm diameter. IV fluids, IV steroids, IV antibiotics, NG decompression. Surgery if not improving in 48-72 hrs."),
sp(),
]
story += [h2("4.3 LIVER DISEASE"), sp(0.5)]
story += [
h3("Child-Pugh Score (★ PYQ):"),
table([
["Parameter","1 point","2 points","3 points"],
["Bilirubin (mg/dL)","< 2","2-3","> 3"],
["Albumin (g/dL)","> 3.5","2.8-3.5","< 2.8"],
["PT prolongation (sec)","< 4","4-6","> 6"],
["Ascites","None","Controlled","Refractory"],
["Encephalopathy","None","Grade I-II","Grade III-IV"],
], [5.5*cm, 3.5*cm, 3.5*cm, 3*cm]),
table([
["Class","Score","1-year survival","2-year survival"],
["A (compensated)","5-6","100%","85%"],
["B (significant functional compromise)","7-9","81%","57%"],
["C (decompensated)","10-15","45%","35%"],
], [6*cm, 2.5*cm, 3.5*cm, 3.5*cm]),
sp(0.5),
h3("Hepatitis Serology (★ PYQ):"),
table([
["Marker","Meaning"],
["HBsAg","Active infection (acute or chronic)"],
["Anti-HBs","Immunity (vaccine OR recovered from infection)"],
["Anti-HBc IgM","Acute HBV infection"],
["Anti-HBc IgG","Past infection"],
["HBeAg","High infectivity, active replication"],
["Anti-HBe","Seroconversion, lower infectivity"],
["HBV DNA","Gold standard for viral load"],
["Window period (HBsAg –ve, Anti-HBs –ve)","Only Anti-HBc IgM positive"],
], [6*cm, 10*cm]),
sp(0.5),
h3("Complications of Cirrhosis:"),
bullet("Spontaneous Bacterial Peritonitis (SBP): ascitic fluid PMN >250/mm³. Treat: Cefotaxime 2g IV 8-hourly x 5 days. Prophylaxis: Norfloxacin/Ciprofloxacin."),
bullet("Hepatic Encephalopathy: elevated ammonia → asterixis, altered consciousness. Treat: Lactulose (reduces NH3 production), Rifaximin (non-absorbable antibiotic)"),
bullet("Hepatorenal Syndrome (HRS): renal failure in cirrhosis. Exclude other causes. Type 1 (rapid, <2 weeks); Type 2 (slower). Terlipressin + Albumin is treatment."),
bullet("Varices: beta-blockers (propranolol) for primary prophylaxis. Active bleed: Terlipressin + endoscopic band ligation + antibiotics (Ceftriaxone)"),
imp("TIPS (Transjugular Intrahepatic Portosystemic Shunt): for refractory ascites or recurrent variceal bleeding. Risk: worsening hepatic encephalopathy."),
sp(),
]
story += [h2("4.4 ACUTE PANCREATITIS"), sp(0.5)]
story += [
h3("Ranson's Criteria (★ PYQ — know all 11):"),
table([
["At Admission","During First 48 Hours"],
["Age > 55 years","Hematocrit drop > 10%"],
["WBC > 16,000/mm³","BUN rise > 5 mg/dL"],
["Blood glucose > 200 mg/dL","Serum Ca < 8 mg/dL"],
["Serum LDH > 350 IU/L","PaO2 < 60 mmHg"],
["AST > 250 IU/L","Base deficit > 4 mEq/L"],
["—","Fluid sequestration > 6L"],
], [8*cm, 7.5*cm]),
imp("Score ≥ 3 = Severe pancreatitis. Score 0-2 = mild (1% mortality). Score 3-4 = 15% mortality. Score ≥ 5 = 40% mortality."),
sp(0.5),
bullet("Common causes: Gallstones (most common in India), Alcohol (most common worldwide reported), Drugs (SAND: Steroids, Azathioprine, NSAIDs, Diuretics/furosemide/thiazides)"),
bullet("Management: NBM, aggressive IV fluids (Lactated Ringer's preferred), analgesia (Pethidine/Morphine), ERCP if gallstone pancreatitis"),
bullet("Pseudocyst: fluid collection >4 weeks. If symptomatic: endoscopic drainage. If infected (abscess): surgical/radiological drainage."),
PageBreak(),
]
# ═══════════════════════════════════════════
# SECTION 5: ENDOCRINOLOGY
# ═══════════════════════════════════════════
story += [h1("SECTION 5: ENDOCRINOLOGY"), sp()]
story += [h2("5.1 DIABETES MELLITUS"), sp(0.5)]
story += [
h3("Diagnostic Criteria (ADA):"),
table([
["Test","Diagnostic Value","Normal","Pre-diabetes"],
["Fasting glucose","≥ 126 mg/dL","< 100","100-125 (IFG)"],
["2-hr OGTT","≥ 200 mg/dL","< 140","140-199 (IGT)"],
["Random glucose + symptoms","≥ 200 mg/dL","—","—"],
["HbA1c","≥ 6.5%","< 5.7%","5.7-6.4%"],
], [4.5*cm, 4*cm, 3*cm, 4*cm]),
sp(0.5),
h3("Oral Hypoglycemic Agents:"),
table([
["Drug","Mechanism","Key Point"],
["Metformin","Decrease hepatic glucose output (activates AMPK)","1st line T2DM; C/I: eGFR <30, contrast, alcohol. Lactic acidosis (rare)."],
["Sulfonylureas (Glibenclamide, Gliclazide)","Stimulate insulin secretion (close K-ATP channels)","Risk of hypoglycemia; avoid in elderly, CKD"],
["GLP-1 agonists (Liraglutide, Semaglutide)","Stimulate insulin, inhibit glucagon","Weight loss, CV benefit; GI side effects"],
["SGLT2 inhibitors (Dapagliflozin)","Block glucose reabsorption in kidney","HF benefit, renoprotection, DKA risk (rare)"],
["DPP-4 inhibitors (Sitagliptin)","Prevent GLP-1 breakdown","Weight neutral, safe in CKD"],
["Thiazolidinediones (Pioglitazone)","PPAR-gamma agonist → insulin sensitizer","Weight gain, fluid retention, HF risk, fractures"],
["Acarbose","Alpha-glucosidase inhibitor","Reduces post-prandial glucose; GI side effects"],
["Insulin","Direct replacement","Essential in T1DM; used in T2DM when OHA fail"],
], [4*cm, 5.5*cm, 6*cm]),
sp(0.5),
h3("Diabetic Ketoacidosis (DKA) Management:"),
bullet("Diagnostic triad: glucose >200, metabolic acidosis (pH <7.3), ketonemia/ketonuria"),
bullet("IV normal saline 1L/hr initially, then 0.45% NaCl"),
bullet("IV regular insulin 0.1 units/kg/hr after K+ >3.5 mEq/L"),
bullet("Potassium replacement (add to fluids once K+ confirmed)"),
bullet("Bicarbonate only if pH <6.9"),
bullet("Identify and treat precipitating factor (infection, insulin omission, MI)"),
imp("HHS (Hyperosmolar Hyperglycemic State): glucose >600, osmolality >320, NO significant acidosis. Occurs in T2DM. Higher mortality than DKA. Slow rehydration."),
sp(),
]
story += [h2("5.2 THYROID DISORDERS"), sp(0.5)]
story += [
table([
["Condition","TSH","Free T4","Clinical Features"],
["Primary hypothyroidism","↑↑","↓","Fatigue, cold intolerance, constipation, bradycardia, myxedema"],
["Subclinical hypothyroidism","↑","Normal","Asymptomatic or mild symptoms"],
["Primary hyperthyroidism","↓↓","↑","Weight loss, heat intolerance, tremor, tachycardia, AF"],
["Subclinical hyperthyroidism","↓","Normal","Risk of AF, osteoporosis"],
["Secondary hypothyroidism (pituitary)","↓ or normal","↓","Pituitary/hypothalamic cause"],
["Sick euthyroid syndrome","Normal/↓","Normal/↓","Systemic illness; do not treat"],
], [4.5*cm, 2*cm, 2.5*cm, 6.5*cm]),
sp(0.5),
h3("Thyroid Storm (Thyrotoxic Crisis):"),
bullet("Precipitants: surgery, infection, contrast, iodine excess in already thyrotoxic patient"),
bullet("Features: fever >38.5°C, tachycardia, agitation, cardiac arrhythmia, high-output HF"),
bullet("Burch-Wartofsky score for diagnosis"),
h3("Treatment of Thyroid Storm (6 P's):"),
bullet("PTU 200-400mg 4-6 hourly (blocks synthesis AND peripheral conversion)"),
bullet("Propranolol 40-80mg 4-6 hourly (controls adrenergic symptoms)"),
bullet("Potassium iodide (SSKI) — give 1 hr AFTER PTU to block hormone release (Wolff-Chaikoff effect)"),
bullet("Prednisolone/hydrocortisone (blocks T4→T3 conversion, treats adrenal insufficiency)"),
bullet("Paracetamol (fever control; AVOID aspirin — displaces T4 from binding proteins)"),
bullet("Precipitant treatment (infection, etc.)"),
sp(),
]
story += [h2("5.3 ADRENAL DISORDERS"), sp(0.5)]
story += [
h3("Cushing's Syndrome:"),
bullet("Causes: Iatrogenic (most common) > Pituitary adenoma (Cushing's DISEASE, ACTH-dependent, 70%) > Adrenal adenoma > Ectopic ACTH (small cell lung cancer)"),
bullet("Features: Central obesity, buffalo hump, moon face, purple striae, HTN, DM, osteoporosis, proximal myopathy"),
bullet("Diagnosis: 24-hr urinary free cortisol, low-dose dexamethasone suppression test (1mg overnight)"),
bullet("High-dose DST: suppresses cortisol in pituitary Cushing's but NOT in ectopic/adrenal"),
imp("CRH test: ACTH rises in pituitary Cushing's, does NOT rise in ectopic ACTH or adrenal Cushing's"),
sp(0.5),
h3("Addison's Disease (Primary Adrenal Insufficiency):"),
bullet("Causes: Autoimmune (most common in developed world), TB (most common in India)"),
bullet("Features: Fatigue, postural hypotension, hyponatremia, hyperkalemia, hyperpigmentation (increased ACTH/MSH), hypoglycemia"),
bullet("Diagnosis: Short synacthen (ACTH stimulation) test — cortisol fails to rise"),
bullet("Treatment: Hydrocortisone (glucocorticoid) + Fludrocortisone (mineralocorticoid)"),
imp("Adrenal crisis: IV hydrocortisone 100mg STAT, IV normal saline. Do NOT delay treatment for tests."),
PageBreak(),
]
# ═══════════════════════════════════════════
# SECTION 6: INFECTIOUS DISEASES
# ═══════════════════════════════════════════
story += [h1("SECTION 6: INFECTIOUS DISEASES & TROPICAL MEDICINE"), sp()]
story += [h2("6.1 HIV/AIDS"), sp(0.5)]
story += [
h3("CD4 Count and Opportunistic Infections (★ PYQ — must memorize):"),
table([
["CD4 Count","Opportunistic Infection"],
["Any CD4 count","TB (can occur at any level, more aggressive as CD4 falls)"],
["< 500","Herpes zoster, oral candidiasis, hairy leukoplakia"],
["< 200","Pneumocystis jirovecii Pneumonia (PCP) — most common OI in HIV"],
["< 150","Disseminated histoplasmosis, Coccidioidomycosis"],
["< 100","Cerebral toxoplasmosis, Cryptosporidium, Microsporidiosis"],
["< 50","Cytomegalovirus (CMV) retinitis, Disseminated MAI/MAC, Cryptococcal meningitis, CNS lymphoma"],
], [4*cm, 11.5*cm]),
sp(0.5),
bullet("PCP Prophylaxis: Cotrimoxazole (TMP-SMX) when CD4 <200"),
bullet("MAC Prophylaxis: Azithromycin when CD4 <50"),
bullet("CMV: Ganciclovir/Valganciclovir"),
bullet("Cryptococcus: Amphotericin B + Flucytosine (induction) → Fluconazole (consolidation + maintenance)"),
imp("ART (Antiretroviral Therapy): Start ALL HIV patients regardless of CD4 count. 2 NRTIs + 1 NNRTI or Integrase inhibitor. India first line: TLE (Tenofovir + Lamivudine + Efavirenz)."),
sp(),
]
story += [h2("6.2 MALARIA"), sp(0.5)]
story += [
table([
["Feature","P. falciparum","P. vivax","P. malariae","P. ovale"],
["Fever cycle","36-48 hrs (irregular)","48 hrs (tertian)","72 hrs (quartan)","48 hrs (tertian)"],
["Severe malaria","Yes (most dangerous)","Rarely","No","No"],
["Relapse","No","Yes (hypnozoites)","Recrudescence","Yes (hypnozoites)"],
["Drug resistance","Common (CQ-resistant)","Emerging CQ-resistance","Rare","Rare"],
], [3.5*cm, 4*cm, 4*cm, 3*cm, 3*cm]),
sp(0.5),
h3("Treatment (★ PYQ):"),
table([
["Type","Treatment"],
["Uncomplicated P. falciparum","Artemether-Lumefantrine (AL) / Artesunate-Mefloquine; India: AS+SP (Artesunate + Sulfadoxine-Pyrimethamine)"],
["Severe/Complicated falciparum","IV Artesunate (preferred) or IV Quinine + Doxycycline"],
["P. vivax/ovale","Chloroquine (3 days) + Primaquine (14 days to eliminate hypnozoites)"],
["P. malariae","Chloroquine only (no hypnozoites)"],
["Prophylaxis","Doxycycline (most regions), Mefloquine, Atovaquone-Proguanil (Malarone)"],
], [4.5*cm, 11*cm]),
imp("Primaquine: CONTRAINDICATED in G6PD deficiency (causes hemolysis). Always test G6PD before giving."),
imp("Blackwater fever: massive intravascular hemolysis in P. falciparum → hemoglobinuria → acute renal failure."),
sp(),
]
story += [h2("6.3 OTHER TROPICAL DISEASES"), sp(0.5)]
story += [
table([
["Disease","Organism","Vector","Treatment","Key Points"],
["Kala-azar (VL)","Leishmania donovani","Sandfly (Phlebotomus)","Liposomal Ampho B (India 1st line); Miltefosine oral","Splenomegaly, pancytopenia, PKDL after treatment"],
["Dengue","Flavivirus (DENV 1-4)","Aedes aegypti","Supportive (no specific antiviral)","DHF: plasma leak; DSS: shock. Thrombocytopenia <100k."],
["Chikungunya","Alphavirus","Aedes aegypti/albopictus","NSAIDs for pain; supportive","Incapacitating joint pain; does NOT cause dengue shock"],
["Scrub typhus","Orientia tsutsugamushi","Trombiculid mite (chigger)","Doxycycline 1st line","Eschar at bite site; endemic NE India and Himalayas"],
["Filariasis","Wuchereria bancrofti","Culex mosquito","DEC (Diethylcarbamazine)","Elephantiasis; night blood smear for microfilariae"],
["Japanese Encephalitis","Flavivirus","Culex mosquito (pig reservoir)","Supportive; vaccine available (SA-14-14-2)","Most common viral encephalitis in India/Asia"],
], [2.5*cm, 3.5*cm, 3.5*cm, 4.5*cm, 4*cm]),
sp(),
]
story += [h2("6.4 DERMATOLOGY HIGH YIELDS"), sp(0.5)]
story += [
table([
["Condition","Key Features","Treatment"],
["Psoriasis","Silvery scales on extensor surfaces; Auspitz sign; nail pitting; Koebner phenomenon","Topical steroids, calcipotriol, methotrexate, biologics (anti-TNF)"],
["Pemphigus vulgaris","Flaccid bullae; positive Nikolsky sign; IgG anti-desmoglein 3; involves mucosa","High-dose steroids + Azathioprine/Rituximab"],
["Bullous pemphigoid","Tense bullae; negative Nikolsky; IgG anti-BP180; elderly","Topical/systemic steroids"],
["Dermatitis herpetiformis","Intensely itchy vesicles on extensors; associated with celiac disease; IgA anti-endomysial","Gluten-free diet + Dapsone"],
["Lichen planus","6 Ps: Purple, Pruritic, Polygonal, Planar, Papules, Plaques; Wickham's striae; Koebner","Topical steroids; systemic steroids for severe"],
["Acne vulgaris","Comedones, papules, pustules, nodules","Topical retinoids, benzoyl peroxide; severe: oral isotretinoin"],
["Scabies","Nocturnal pruritus, burrows, web spaces, genitalia; mite Sarcoptes scabiei","Permethrin 5% (DOC); Ivermectin oral for crusted scabies; treat all contacts"],
["Leprosy","M. leprae; TT (tuberculoid) vs LL (lepromatous)","PB leprosy: Rifampicin + Dapsone x 6 months. MB: + Clofazimine x 12 months"],
], [3.5*cm, 6.5*cm, 5.5*cm]),
PageBreak(),
]
# ═══════════════════════════════════════════
# SECTION 7: PHARMACOLOGY
# ═══════════════════════════════════════════
story += [h1("SECTION 7: PHARMACOLOGY HIGH YIELDS"), sp()]
story += [h2("7.1 AUTONOMIC PHARMACOLOGY"), sp(0.5)]
story += [
table([
["Drug Class","Examples","Key Uses","Key Side Effects"],
["Beta-1 selective blockers","Metoprolol, Atenolol, Bisoprolol","HTN, angina, HF, arrhythmias","Bradycardia, fatigue, cold extremities; SAFE in asthma (relatively)"],
["Non-selective beta-blockers","Propranolol, Carvedilol, Labetalol","HTN (propranolol), HF (carvedilol), thyroid storm (propranolol)","Bronchospasm (AVOID in asthma), mask hypoglycemia symptoms"],
["Alpha-1 blockers","Prazosin, Doxazosin, Tamsulosin","HTN, BPH","First-dose hypotension; retrograde ejaculation (tamsulosin)"],
["Alpha-2 agonists","Methyldopa, Clonidine","HTN in pregnancy (methyldopa); hypertensive urgency (clonidine)","Sedation, dry mouth, rebound HTN if stopped suddenly"],
["Muscarinic agonists","Pilocarpine, Bethanechol","Glaucoma (pilocarpine), urinary retention (bethanechol)","SLUDGE effects"],
["Anticholinergics","Atropine, Ipratropium, Tiotropium","Bradycardia (atropine), COPD (ipratropium, tiotropium)","Dry mouth, urinary retention, constipation, tachycardia, mydriasis"],
], [3.5*cm, 4.5*cm, 4.5*cm, 4*cm]),
sp(),
]
story += [h2("7.2 CARDIOVASCULAR PHARMACOLOGY"), sp(0.5)]
story += [
table([
["Drug","Class","Key Use","Important Notes"],
["Digoxin","Cardiac glycoside (Na/K ATPase inhibitor)","AF rate control, HF (not mortality benefit)","Narrow TI; toxicity: nausea, xanthopsia (yellow vision), arrhythmias. Hypokalemia increases toxicity."],
["Amiodarone","Class III antiarrhythmic (K channel blocker)","AF, VT, VF (drug of choice for shock-resistant VF)","Pulmonary fibrosis, hypothyroidism/hyperthyroidism, corneal microdeposits, blue-grey skin, hepatotoxicity. Longest T1/2 (40-55 days)."],
["Lignocaine","Class IB (Na channel blocker)","VT (IV), local anesthetic","Only IV use for arrhythmias"],
["Adenosine","Endogenous nucleoside","SVT termination (DOC)","Short-acting (10 sec); causes transient asystole; C/I in asthma (bronchoconstriction)"],
["Nitrates","NO → cGMP → vasodilation","Angina, HF, hypertensive emergency","Headache, tolerance (nitrate-free period needed); C/I with PDE5 inhibitors (sildenafil → severe hypotension)"],
["Hydralazine","Arteriolar vasodilator","HTN in pregnancy, HF (with nitrate)","Drug-induced lupus; reflex tachycardia"],
["Sodium Nitroprusside","Arterial + venous vasodilator","Hypertensive emergency (most potent)","Cyanide toxicity with prolonged use; give sodium thiosulfate as antidote"],
], [2.5*cm, 4*cm, 4*cm, 5*cm]),
sp(),
]
story += [h2("7.3 ANTIBIOTICS — DRUG OF CHOICE TABLE (★ HIGH YIELD PYQ)"), sp(0.5)]
story += [
table([
["Infection/Organism","Drug of Choice","Alternatives"],
["Streptococcal throat/Rheumatic fever prophylaxis","Benzathine Penicillin G IM monthly","Amoxicillin oral daily"],
["Pneumococcal meningitis","Ceftriaxone IV","Cefotaxime"],
["Meningococcal meningitis","Benzylpenicillin IV","Ceftriaxone; prophylaxis: Rifampicin/Cipro"],
["Listeria meningitis (neonates/elderly/immunocomp)","Ampicillin + Gentamicin","Co-trimoxazole"],
["Neurosyphilis","Benzylpenicillin IV 14 days","Procaine penicillin + Probenecid"],
["Legionella","Azithromycin or Levofloxacin","Doxycycline"],
["Mycoplasma/Chlamydophila pneumonia","Doxycycline or Azithromycin","Fluoroquinolone"],
["H. pylori","PPI + Amoxicillin + Clarithromycin","Quadruple with Bismuth"],
["C. difficile","Oral Vancomycin or Fidaxomicin","Metronidazole (less effective)"],
["MRSA","Vancomycin or Linezolid or Daptomycin","Teicoplanin"],
["VRE (Vancomycin-resistant Enterococcus)","Linezolid or Daptomycin","Quinupristin-dalfopristin"],
["Pseudomonas aeruginosa","Piperacillin-Tazobactam or Ceftazidime","Carbapenems, Ciprofloxacin"],
["Typhoid fever","Ceftriaxone or Azithromycin","Ciprofloxacin (increasing resistance)"],
["Leptospirosis","Penicillin G or Doxycycline","Ceftriaxone"],
["Rickettsia","Doxycycline","Chloramphenicol"],
["Cholera","Oral Rehydration + Doxycycline or Azithromycin","Tetracycline, Cipro"],
["Shigella (dysentery)","Ciprofloxacin or Azithromycin","Cotrimoxazole (if sensitive)"],
["Gonococcal infection","Ceftriaxone IM single dose","(+ Azithromycin if chlamydia co-infection)"],
["Chlamydia trachomatis","Doxycycline 7 days or Azithromycin 1g single dose","—"],
["BV (Bacterial vaginosis)","Metronidazole 400mg BD x 5-7 days","Clindamycin vaginal"],
], [5.5*cm, 5.5*cm, 4.5*cm]),
sp(),
]
story += [h2("7.4 DRUGS IN SPECIAL POPULATIONS (★ PYQ FAVOURITE)"), sp(0.5)]
story += [
h3("Safe Drugs in Pregnancy:"),
table([
["Category","Safe Drugs"],
["Antibiotics","Penicillins, Cephalosporins, Azithromycin, Nitrofurantoin (not near term), Metronidazole (avoid 1st trimester)"],
["Antihypertensives","Methyldopa, Labetalol, Nifedipine, Hydralazine"],
["Anticoagulants","Heparin/LMWH (warfarin C/I: fetal warfarin syndrome; DOAC: no data)"],
["Antiepileptics","Lamotrigine, Levetiracetam (avoid Valproate, Carbamazepine if possible)"],
["Antidepressants","SSRIs (generally safe; Sertraline preferred); avoid Lithium in 1st trimester"],
["Thyroid","PTU (1st trimester), Carbimazole/MMI (2nd-3rd trimester); both C/I: high dose near term"],
["Asthma","All inhaled drugs (SABA, ICS, LABA) safe; systemic steroids short courses acceptable"],
["Antiemetics","Metoclopramide, Ondansetron, Promethazine"],
], [4*cm, 12*cm]),
sp(0.5),
h3("Drugs to AVOID in Pregnancy (★ PYQ):"),
table([
["Drug","Problem"],
["ACE inhibitors / ARBs","Fetal renal agenesis, oligohydramnios, skull defects (2nd/3rd trimester)"],
["Tetracyclines","Dental discoloration, impaired bone growth"],
["Fluoroquinolones","Cartilage damage (theoretical)"],
["Aminoglycosides","Ototoxicity"],
["Chloramphenicol (near term)","Grey baby syndrome (cardiovascular collapse)"],
["Sulphonamides (near term)","Neonatal jaundice (displaces bilirubin from albumin)"],
["Warfarin","Fetal warfarin syndrome (1st trimester), hemorrhage"],
["Valproate","Neural tube defects, cognitive impairment (foetal valproate syndrome)"],
["Thalidomide","Phocomelia (limb defects)"],
["Isotretinoin","Severe teratogen (multiple defects); need two forms of contraception"],
["Misoprostol","Möbius sequence (facial nerve palsy, limb defects) — used medicinally for termination"],
["NSAIDs (3rd trimester)","Premature closure of ductus arteriosus, oligohydramnios"],
], [5*cm, 10.5*cm]),
sp(),
]
story += [h2("7.5 DRUG SIDE EFFECTS — QUICK REFERENCE (★ PYQ)"), sp(0.5)]
story += [
table([
["Side Effect","Drug(s)","Notes"],
["Dry cough","ACE inhibitors (ALL)","Bradykinin accumulation; switch to ARB"],
["Angioedema","ACE inhibitors","Bradykinin mediated; can be life-threatening"],
["Gingival hyperplasia","Phenytoin, Cyclosporine, Nifedipine, Amlodipine","PCN mnemonic"],
["Lupus-like syndrome","Hydralazine, Procainamide, Isoniazid, Methyldopa","Anti-histone antibodies"],
["Pulmonary fibrosis","Amiodarone, Bleomycin, Methotrexate, Nitrofurantoin","ABM → Alveoli Break Mercilessly"],
["Osteoporosis","Steroids (long-term), Heparin (long-term), Phenytoin","Give Ca + Vit D with steroids"],
["SJS/TEN","Allopurinol, Carbamazepine, Lamotrigine, Sulphonamides, Phenytoin","HLA-B*15:02 association with carbamazepine in Asians"],
["Agranulocytosis","Carbimazole, Clozapine, Ticlopidine, Carbamazepine","Monitor WBC"],
["Aplastic anemia","Chloramphenicol, Carbamazepine, Gold, NSAIDs","Rare but fatal"],
["Hepatotoxicity","INH, Rifampicin, Pyrazinamide, Paracetamol, Statins","LFT monitoring for anti-TB drugs"],
["Nephrotoxicity","Aminoglycosides, Cisplatin, NSAIDs, Amphotericin B, Vancomycin","ACNAV mnemonic"],
["Ototoxicity","Aminoglycosides (cochlear), Loop diuretics (Furosemide)","Synergistic when combined"],
["Peripheral neuropathy","INH, Metronidazole, Nitrofurantoin, Vincristine, ddI","Give B6 with INH"],
["Disulfiram-like reaction","Metronidazole, Chlorpropamide, Cephalosporins (some), Griseofulvin","Avoid alcohol"],
["Photosensitivity","Tetracyclines, Fluoroquinolones, Amiodarone, Chlorpromazine","TQAC mnemonic"],
["QT prolongation","Amiodarone, Sotalol, Haloperidol, Erythromycin, Methadone","Risk of Torsades de Pointes"],
["Gynecomastia","Spironolactone, Cimetidine, Digoxin, Ketoconazole, Estrogens","SCOKE"],
["SIADH","Carbamazepine, SSRIs, Cyclophosphamide, Vincristine, Chlorpropamide","Hyponatremia"],
["Hyperuricemia/Gout","Thiazides, Pyrazinamide, Ethambutol, Cyclosporine","TPEC"],
["Rhabdomyolysis","Statins (esp. with fibrates), Alcohol, Cocaine","Check CK, myoglobinuria"],
], [4.5*cm, 5.5*cm, 5.5*cm]),
PageBreak(),
]
story += [h2("7.6 ENZYME INDUCERS AND INHIBITORS"), sp(0.5)]
story += [
h3("CYP450 Inducers (REDUCE drug levels):"),
imp("Mnemonic: CRAP GPS — Carbamazepine, Rifampicin, Alcohol (chronic), Phenytoin, Griseofulvin, Phenobarbitone, St. John's Wort"),
bullet("Clinical impact: Reduce efficacy of OCPs, Warfarin, Antiretrovirals, Immunosuppressants"),
sp(0.5),
h3("CYP450 Inhibitors (INCREASE drug levels — toxicity risk):"),
imp("Mnemonic: DEVICES — Diltiazem, Erythromycin/clarithromycin, Verapamil, Isoniazid, Cimetidine, Erythromycin, Sodium valproate, (+ Grapefruit, Ketoconazole, Fluconazole, Fluoxetine)"),
bullet("Clinical impact: Increase toxicity of Warfarin (bleeding), Statins (rhabdomyolysis), Theophylline (seizures), Digoxin"),
sp(),
h3("Plasma Protein Binding Competition (Displacement reactions):"),
bullet("Drugs displacing bilirubin in neonates: Sulphonamides, Aspirin → neonatal jaundice"),
bullet("Drugs displaced by NSAIDs: Warfarin, Sulphonylureas → increased anticoagulation/hypoglycemia"),
sp(),
]
story += [h2("7.7 IMPORTANT DRUG ANTIDOTES (★ PYQ)"), sp(0.5)]
story += [
table([
["Poison/Drug","Antidote"],
["Paracetamol (acetaminophen)","N-acetylcysteine (NAC) — within 8-24 hrs"],
["Opioids (morphine, heroin)","Naloxone (IV/IM/intranasal) — repeat as short-acting"],
["Benzodiazepines","Flumazenil (short-acting — risk of re-sedation)"],
["Warfarin","Vitamin K (oral/IV); FFP (for urgent reversal); 4-factor PCC"],
["Heparin","Protamine sulfate"],
["Digoxin","Digoxin-specific antibody fragments (Digibind)"],
["Atropine (anticholinergic poisoning)","Physostigmine"],
["Organophosphates","Atropine (large doses) + Pralidoxime (2-PAM) if given early"],
["Carbon monoxide","100% O2; hyperbaric O2 for severe"],
["Cyanide","Hydroxocobalamin (1st line); Sodium thiosulfate + Sodium nitrite (older)"],
["Iron","Deferoxamine (IV/IM) — chelation"],
["Lead","DMSA (oral, preferred in children); EDTA (IV severe cases)"],
["Methanol/Ethylene glycol","Fomepizole (ADH inhibitor); Ethanol; Folate (methanol); Thiamine+Pyridoxine (EG)"],
["Tricyclic antidepressants","IV Sodium bicarbonate (for cardiac arrhythmias, hypotension)"],
["Beta-blocker overdose","Glucagon (1st line); Calcium gluconate; high-dose insulin + glucose"],
["CCB overdose","Calcium gluconate (10%) IV; high-dose insulin + glucose"],
["Methemoglobinemia","Methylene blue 1-2 mg/kg IV"],
["Nitroprusside toxicity (cyanide)","Sodium thiosulfate"],
], [5.5*cm, 10*cm]),
PageBreak(),
]
# PSYCHIATRY SECTION
story += [h1("SECTION 8: PSYCHIATRY HIGH YIELDS"), sp()]
story += [h2("8.1 PSYCHOTIC DISORDERS"), sp(0.5)]
story += [
h3("Schizophrenia:"),
bullet("Diagnostic criteria (DSM-5): 2 or more of — delusions, hallucinations, disorganized speech, disorganized behaviour, negative symptoms — for ≥ 1 month, with 6-month overall dysfunction"),
bullet("Most common hallucination: Auditory (3rd person voices commenting or arguing)"),
bullet("Positive symptoms: delusions, hallucinations, disorganized speech/behaviour"),
bullet("Negative symptoms: Flat affect, Alogia (poverty of speech), Avolition, Anhedonia, Asociality (5 A's)"),
h3("Antipsychotic Drugs:"),
table([
["Generation","Examples","Key SE","Indication"],
["Typical (1st gen)","Haloperidol, Chlorpromazine, Fluphenazine","EPS (tardive dyskinesia, akathisia, parkinsonism), NMS, hyperprolactinemia","Acute psychosis, agitation (IM haloperidol)"],
["Atypical (2nd gen)","Olanzapine, Clozapine, Risperidone, Quetiapine, Aripiprazole","Metabolic syndrome (weight gain, DM, dyslipidemia); Clozapine: agranulocytosis","Treatment-resistant schizophrenia: Clozapine (only drug proven effective)"],
], [3*cm, 5*cm, 5.5*cm, 4*cm]),
imp("Clozapine: ONLY antipsychotic for treatment-resistant schizophrenia. Requires weekly WBC monitoring due to agranulocytosis risk (1-2%)."),
imp("NMS (Neuroleptic Malignant Syndrome): FEVER + rigidity + autonomic instability + elevated CK. Treat: Stop antipsychotic, IV fluids, Dantrolene, Bromocriptine."),
sp(),
]
story += [h2("8.2 MOOD DISORDERS"), sp(0.5)]
story += [
h3("Depression treatment:"),
bullet("First line: SSRIs (Sertraline, Escitalopram, Fluoxetine)"),
bullet("SSRIs side effects: GI (nausea, diarrhea), sexual dysfunction, SIADH, serotonin syndrome, discontinuation syndrome"),
bullet("SNRIs (Venlafaxine, Duloxetine): good for pain + depression, HTN side effect"),
bullet("TCAs (Amitriptyline): sedating, good for neuropathic pain/migraine prevention; overdose → cardiac arrhythmias"),
bullet("MAOIs (Phenelzine): avoid tyramine-rich foods (cheese, wine) → hypertensive crisis"),
sp(0.5),
h3("Bipolar Disorder:"),
bullet("Mood stabilizers: Lithium (gold standard), Valproate, Carbamazepine, Lamotrigine (especially for bipolar depression)"),
imp("Lithium toxicity: tremor → ataxia → seizures → coma. Narrow TI. Monitor levels. Polyuria/polydipsia (nephrogenic DI). Hypothyroidism (25% on long-term). Teratogen (Ebstein anomaly). Toxicity increased by dehydration, NSAIDs, thiazide diuretics."),
sp(),
]
story += [h2("8.3 ANXIETY DISORDERS"), sp(0.5)]
story += [
table([
["Disorder","Key Feature","First-line Treatment"],
["Generalised Anxiety Disorder","Excessive worry >6 months","SSRIs/SNRIs; Buspirone; CBT"],
["Panic Disorder","Recurrent unexpected panic attacks, anticipatory anxiety","SSRIs (long-term); Benzodiazepines (short-term acute)"],
["PTSD","Re-experiencing, avoidance, hyperarousal after trauma, >1 month","SSRIs (Sertraline, Paroxetine — FDA approved); Prazosin for nightmares"],
["OCD","Obsessions + compulsions causing distress","SSRIs (high dose); Clomipramine (TCA); ERP therapy"],
["Social anxiety","Fear of social situations, scrutiny","SSRIs; Beta-blockers (performance anxiety); CBT"],
], [4.5*cm, 5.5*cm, 5.5*cm]),
sp(),
]
story += [h2("8.4 SUBSTANCE ABUSE"), sp(0.5)]
story += [
table([
["Substance","Withdrawal Features","Treatment of Withdrawal"],
["Alcohol","Tremors (6-12h), Seizures (12-24h), Delirium Tremens (24-72h): agitation, hallucinations, tachycardia, fever","Benzodiazepines (Diazepam/Chlordiazepoxide — CIWA protocol); Thiamine BEFORE glucose (prevent Wernicke's)"],
["Opioids","Lacrimation, rhinorrhoea, yawning, piloerection, diarrhea, insomnia, myalgia — NOT life-threatening","Methadone (substitution), Buprenorphine-Naloxone, Clonidine (symptomatic); Naltrexone for relapse prevention"],
["Benzodiazepines","Similar to alcohol — seizures, delirium — CAN be life-threatening","Long-acting BZD (Diazepam) taper"],
["Cocaine/Stimulants","Crash: depression, fatigue, hypersomnia — NOT medically dangerous","Supportive; Antidepressants for craving"],
["Nicotine","Irritability, craving, increased appetite, difficulty concentrating","NRT (patch, gum); Varenicline (Champix) 1st line; Bupropion"],
], [3.5*cm, 5.5*cm, 6.5*cm]),
]
story.append(PageBreak())
# LAST PAGE: IMPORTANT MNEMONICS
story += [h1("BONUS: MNEMONICS & QUICK REMINDERS"), sp()]
story += [
h2("Memory Aids for Common UPSC CMS Topics"),
sp(0.5),
h3("Jones Criteria Major (CASPE):"),
imp("C = Carditis, A = Arthritis (migratory), S = Sydenham's chorea, P = subcutaneous (Pea-sized) nodules, E = Erythema marginatum"),
sp(0.5),
h3("Heart Failure drugs that improve MORTALITY (ABCDS):"),
imp("ACEi/ARB, Beta-blockers, Cardiac resynchronization, Diuretics (NO), Spironolactone/Eplerenone, SGLT2i, Sacubitril-valsartan"),
sp(0.5),
h3("Ranson's Criteria On Admission (GA LAW):"),
imp("Glucose >200, Age >55, LDH >350, AST >250, WBC >16,000"),
sp(0.5),
h3("CURB-65: C-U-R-B-65"),
imp("Confusion, Urea >7, Respiratory rate ≥30, Blood pressure low (SBP<90), 65+ years"),
sp(0.5),
h3("CHA2DS2-VASc (Anti-coagulate AF if ≥2 men, ≥3 women):"),
imp("Congestive HF, Hypertension, Age≥75 (×2), Diabetes, Stroke (×2), Vascular disease, Age 65-74, Sex (female)"),
sp(0.5),
h3("Drugs causing SJS/TEN (CALPS):"),
imp("Carbamazepine, Allopurinol, Lamotrigine, Phenytoin, Sulphonamides"),
sp(0.5),
h3("Enzyme INDUCERS (CRAP GPS):"),
imp("Carbamazepine, Rifampicin, Alcohol (chronic), Phenytoin, Griseofulvin, Phenobarbitone, St. John's Wort"),
sp(0.5),
h3("Enzyme INHIBITORS (DEVICES):"),
imp("Diltiazem, Erythromycin, Verapamil, Isoniazid, Cimetidine, Erythromycin (macrolides), Sodium valproate"),
sp(0.5),
h3("Killip Classification (for MI):"),
imp("I = No HF (6% mortality), II = S3/crepitations (17%), III = Pulmonary oedema (38%), IV = Cardiogenic shock (81%)"),
sp(0.5),
h3("GOLD Staging COPD (FEV1%):"),
imp("G1 ≥80%, G2 50-79%, G3 30-49%, G4 <30% — all require FEV1/FVC <0.70"),
sp(2),
HRFlowable(width="100%", thickness=1, color=colors.HexColor('#1a237e')),
sp(0.5),
Paragraph("UPSC CMS 2026 | Medicine + Pharmacology Notes | Exam: August 2, 2026",
ParagraphStyle('footer', parent=styles['Normal'], fontSize=9,
textColor=colors.HexColor('#616161'), alignment=TA_CENTER)),
Paragraph("Study hard, stay consistent. You have 3 weeks — make every hour count.",
ParagraphStyle('footer2', parent=styles['Normal'], fontSize=9,
textColor=colors.HexColor('#1a237e'), alignment=TA_CENTER, fontName='Helvetica-Bold')),
]
doc.build(story)
print("PDF generated successfully:", OUTPUT)
cd /home/daytona/workspace/upsc-cms-notes && python3 generate_medicine_pharma.py
I think we should stop previous attempt and try new one
ls -lh /home/daytona/workspace/upsc-cms-notes/
01 Medicine Pharmacology
PDF Document · PDF
-
Continue as planned - I generate the remaining 6 PDFs one by one (Surgery → OBG → Paeds → PSM → Micro/Patho → Master Reference). The Medicine PDF is already done, no need to redo it.
-
Different format - Want the notes in a different style? (More MCQ-focused, more concise bullet points, more tables, etc.)
-
Different subjects first - Want me to prioritize a specific subject you're most worried about?
-
Single big PDF - Changed your mind and want everything in one file?
Not able to download
cd /home/daytona/workspace/upsc-cms-notes && python3 -c " import base64 with open('01_Medicine_Pharmacology.pdf', 'rb') as f: data = f.read() print(f'File size: {len(data)} bytes') b64 = base64.b64encode(data).decode() print(f'Base64 length: {len(b64)}') # Save base64 to text file for sharing with open('01_Medicine_Pharmacology_b64.txt', 'w') as f: f.write(b64) print('Base64 file saved.') "
Option 1 - I give you all notes as formatted text right here in chat
- Copy-paste into Word / Google Docs
- Print from there
- Convert to PDF yourself
Option 2 - I create an HTML file instead
Option 3 - I host it via a temporary link
Convert html file to pdf in mobile?
- Open the HTML file in Chrome
- Tap the 3 dots menu (top right)
- Tap Share → Print
- Select "Save as PDF"
- Done ✓
- Open the HTML file in Safari
- Tap the Share button (box with arrow)
- Scroll down → tap "Print"
- Pinch-zoom out on the preview → it saves as PDF
- Or tap "Save to Files" directly
- Generate all 7 subjects as HTML files (beautifully formatted, colored, tables)
- You open each in Chrome/Safari on your phone
- Print → Save as PDF
- Study!
- Medicine + Pharmacology
- Surgery
- OBG
- Paediatrics
- PSM + Biostatistics
- Micro + Pathology
- Master Quick Reference
Yes, generate all 7 HTML notes now
Generate a comprehensive HTML file for UPSC CMS 2026 exam - Medicine + Pharmacology notes. Save to /home/daytona/workspace/upsc-cms-notes/01_Medicine_Pharmacology.html The HTML must: - Be a single self-contained file (no external dependencies) - Have a beautiful, mobile-friendly design with: - Dark blue header (#1a237e) with white text - Colored section headers (alternating deep blue and indigo) - Tables with zebra striping - Important points highlighted in red bold - Bullet points for lists - Responsive layout (max-width 900px, centered) - Print-friendly CSS (@media print) - Cover page with title, subject, exam date Cover: "UPSC CMS 2026 | HIGH-YIELD NOTES | Paper 1 - Medicine + Pharmacology | Exam: August 2, 2026" Include ALL of the following content in full detail: SECTION 1: CARDIOLOGY - Heart Failure: HFrEF vs HFpEF, NYHA classification (all 4 classes with symptoms), Management (ACEi, Beta-blockers, MRA, SGLT2i, Sacubitril-valsartan, Digoxin role) - Hypertension: Stages, Drug choice in special populations table (DM, CKD, pregnancy, HF, asthma, elderly, BPH), Hypertensive emergency vs urgency management - IHD: Killip classification (all 4 classes with mortality %), STEMI management (primary PCI, thrombolytics, contraindications), NSTEMI management, MI complications table (timing, complication, notes) - Atrial Fibrillation: CHA2DS2-VASc score (full form + points), rate vs rhythm control, WPW warning - Rheumatic Fever: Full Jones Criteria (major CASPE + minor criteria), diagnostic rule, most common valve, Carey-Coombs murmur, prophylaxis - Infective Endocarditis: Duke Criteria (major + minor), organisms table (Strep viridans, Staph aureus, HACEK, Strep bovis + colonoscopy), treatment - Congenital Heart Disease: ASD, VSD, PDA, TOF, TGA, Coarctation, Eisenmenger table with murmur and key features SECTION 2: RESPIRATORY - COPD: GOLD staging (all 4 with FEV1%), stepwise management, exacerbation management, LTOT criteria - Asthma: BTS stepwise treatment, status asthmaticus management, safe drugs in pregnancy - Pneumonia: CURB-65 score (full form + scoring + management by score), organisms by type table, Legionella special features - TB: NTP regimens table, side effects of all anti-TB drugs, MDR-TB treatment (BPaLM), IRIS - Pleural Effusion: Light's criteria (all 3), transudate vs exudate causes table - Lung Cancer: Types table (%, location, paraneoplastic syndromes), SCLC vs NSCLC treatment, Pancoast tumor, SVC syndrome SECTION 3: NEUROLOGY - Stroke: Ischemic vs hemorrhagic comparison table, thrombolysis criteria, NIHSS, thrombectomy window - Meningitis: CSF findings table (normal, bacterial, viral, TB, fungal, SAH) - all parameters - Epilepsy: Drug of choice table for all seizure types including pregnancy - Parkinson's: TRAP features, all drug classes with mechanism, MPTP, drug-induced parkinsonism - Myasthenia Gravis: antibodies, thymic association, Tensilon test, treatment, crisis management, myasthenic vs cholinergic crisis SECTION 4: GASTROENTEROLOGY & HEPATOLOGY - PUD: Gastric vs duodenal ulcer table, H. pylori triple therapy - IBD: Crohn's vs UC comparison table (10+ features) - Liver: Child-Pugh score (full table with points), hepatitis serology meanings table, complications (SBP, HE, HRS, varices) with treatment - Pancreatitis: All 11 Ranson's criteria (admission + 48h), severity scoring, management SECTION 5: ENDOCRINOLOGY - Diabetes: Diagnostic criteria table, all OHA agents with mechanism and key points, DKA management steps, HHS features - Thyroid: Thyroid function test interpretation table, thyroid storm treatment (6 P's) - Adrenal: Cushing's (causes, features, DST interpretation), Addison's (causes, features, treatment, crisis management) SECTION 6: INFECTIOUS DISEASES - HIV/AIDS: CD4 count threshold OI table, ART first line India (TLE), prophylaxis - Malaria: Species comparison table, treatment table by type, Primaquine contraindication, blackwater fever - Tropical diseases: Kala-azar, Dengue, Chikungunya, Scrub typhus, Filariasis, JE table SECTION 7: DERMATOLOGY - Psoriasis, Pemphigus vulgaris, Bullous pemphigoid, Dermatitis herpetiformis, Lichen planus, Scabies, Leprosy table SECTION 8: PSYCHIATRY - Schizophrenia: diagnostic criteria, positive/negative symptoms, antipsychotic table (typical vs atypical), Clozapine special mention, NMS - Depression: SSRI side effects, SNRIs, TCAs - Bipolar: Mood stabilizers, Lithium toxicity signs and drug interactions - Anxiety disorders table - Substance abuse: Withdrawal features + treatment table SECTION 9: PHARMACOLOGY - Autonomic pharmacology table (beta-blockers selective/non-selective, alpha blockers, anticholinergics) - Cardiovascular pharmacology table (Digoxin, Amiodarone, Adenosine, Nitrates, Sodium Nitroprusside) - Antibiotics DOC table (20+ infections) - Drugs in pregnancy: safe drugs table + drugs to AVOID with reasons table (15+ entries) - Drug side effects quick reference table (20+ entries) - Enzyme inducers (CRAP GPS mnemonic) and inhibitors (DEVICES mnemonic) - Drug antidotes table (18+ entries) BONUS SECTION: Mnemonics summary page Write the complete HTML to the file. Make sure all tables are properly formatted with thead/tbody, all content is complete and detailed. The file should be comprehensive enough for exam preparation.
Generate a comprehensive HTML file for UPSC CMS 2026 exam - Surgery notes (including ENT, Ophthalmology, Orthopaedics, Anaesthesia). Save to /home/daytona/workspace/upsc-cms-notes/02_Surgery.html The HTML must: - Be a single self-contained file (no external dependencies) - Have a beautiful, mobile-friendly design with: - Dark green header (#1b5e20) with white text - Colored section headers (green shades) - Tables with zebra striping - Important points highlighted in red bold - Bullet points for lists - Responsive layout (max-width 900px, centered) - Print-friendly CSS (@media print) Cover: "UPSC CMS 2026 | HIGH-YIELD NOTES | Paper 2 - Surgery | Exam: August 2, 2026" Include ALL of the following content in full detail: SECTION 1: TRAUMA & EMERGENCY SURGERY - ATLS primary survey (ABCDE - full details of each step) - Tension pneumothorax: features, immediate treatment (needle decompression + chest tube) - Open pneumothorax: 3-sided dressing, then chest tube - Massive hemothorax: chest tube, if >1.5L immediate or >200ml/hr → thoracotomy - Cardiac tamponade: Beck's triad, pericardiocentesis, Kussmaul's sign - Fluid resuscitation: crystalloid vs colloid, Hartmann's solution, damage control resuscitation - Damage control surgery principles - Burns: Rule of nines (adults and children - Lund-Browder), Parkland formula (4ml/kg/% TBSA, first half in 8h, second half in 16h), Curling's ulcer SECTION 2: GI SURGERY - Acute abdomen: signs table (Murphy's, Rovsing's, Psoas, Obturator, Cullen's, Grey Turner's, Carnett's) with meaning - Appendicitis: Alvarado score (full table with points - MANTRELS mnemonic), management - Intestinal obstruction: mechanical vs paralytic ileus comparison, X-ray findings (ladder pattern, coffee bean sign in volvulus) - Hernia types: inguinal (direct vs indirect - Hesselbach's triangle), femoral, umbilical, incisional; Richter's hernia, Maydl's hernia, Littre's hernia; reducible/irreducible/obstructed/strangulated - Colorectal cancer: Dukes staging (A,B,C,D), Duke vs TNM, FAP (APC gene), HNPCC (MLH1, MSH2 genes), Lynch syndrome, screening - Anorectal: Haemorrhoids (grades I-IV with features and treatment), anal fissure (DOC: GTN ointment/Diltiazem, lateral internal sphincterotomy), perianal abscess and fistula - Gastric cancer: types, H. pylori association, Virchow's node, Sister Mary Joseph nodule, Krukenberg tumor - Esophageal cancer: squamous (upper 2/3) vs adenocarcinoma (lower 1/3, Barrett's), treatment SECTION 3: BREAST SURGERY - Breast carcinoma: Risk factors (BRCA1/2), triple assessment, FNAC vs core biopsy vs open biopsy - Staging and surgical options: BCS criteria vs MRM - Paget's disease of nipple: features, Toker cells, CK7 - Fibroadenoma vs fibrocystic disease vs carcinoma comparison - Gynecomastia: causes (SCOKED mnemonic) SECTION 4: THYROID AND PARATHYROID - Thyroid cancer: papillary (most common, psammoma bodies, BRAF mutation, excellent prognosis), follicular (vascular invasion, capsule), medullary (calcitonin marker, MEN2A and 2B), anaplastic (worst prognosis) - MEN syndromes: MEN1 (3 P's: Pituitary, Parathyroid, Pancreas), MEN2A (Medullary thyroid, Pheo, Parathyroid), MEN2B (Medullary thyroid, Pheo, Marfanoid, mucosal neuromas) - Primary hyperparathyroidism: stones, bones, groans, psychic moans - Hypercalcemia management SECTION 5: VASCULAR SURGERY - Peripheral artery disease: Fontaine classification (I-IV), ABI interpretation - Aortic aneurysm: AAA definition (>3cm), indications for surgery (>5.5cm symptomatic), complications - DVT and PE: Wells score, treatment (LMWH/DOAC), IVC filter indications SECTION 6: UROLOGY - BPH: IPSS score interpretation, medical (alpha-blockers: tamsulosin, 5-ARIs: finasteride) vs surgical (TURP) treatment - Renal cell carcinoma: classic triad, Grawitz tumor, paraneoplastic, radical nephrectomy - Bladder cancer: TCC, smoking association, painless hematuria, staging, TURBT - Urolithiasis: stone types (calcium oxalate most common, uric acid radiolucent, struvite staghorn - Proteus), ESWL vs ureteroscopy - Testicular tumors: seminoma vs NSGCT, tumor markers (AFP not raised in seminoma, beta-hCG) SECTION 7: ENT - Otitis media: AOM features and treatment, CSOM - tubotympanic (safe) vs atticoantral (unsafe - cholesteatoma) - Hearing loss: Conductive vs sensorineural - Rinne test (AC>BC normal; BC>AC = conductive), Weber test (lateralizes to affected ear in CHL, better ear in SNHL) - Cholesteatoma: definition, features, complications, surgery - Epistaxis: anterior (Kiesselbach's/Little's area) vs posterior, management - Tonsillitis: indications for tonsillectomy (Paradise criteria: 7 episodes/year for 1 year, or 5/year x 2 years, or 3/year x 3 years) - Laryngeal cancer: glottic (best prognosis, early hoarseness) vs supraglottic vs subglottic - Vertigo: BPPV (Dix-Hallpike test, Epley maneuver), Meniere's disease (triad: vertigo, tinnitus, SNHL), Labyrinthitis SECTION 8: OPHTHALMOLOGY - Glaucoma: Open angle (painless, gradual, cup:disc ratio >0.6) vs Angle closure (acute painful red eye, halos, mid-dilated pupil); Normal IOP 10-21 mmHg; Drugs: Timolol, Latanoprost, Brimonidine, Pilocarpine (pupil constriction = miosis = opens drainage angle) - Cataract: types (nuclear, cortical, posterior subcapsular), surgical: phacoemulsification (ECCE) - Diabetic retinopathy: NPDR (microaneurysms, hemorrhages, exudates) vs PDR (new vessels = neovascularization → tractional RD); Pan-retinal photocoagulation for PDR; Anti-VEGF for DME - Retinal detachment: rhegmatogenous (most common), flashes + floaters + curtain, emergency surgery - Age-related macular degeneration (AMD): dry (drusen, geographic atrophy) vs wet (CNVM, sudden vision loss); Anti-VEGF for wet AMD - Uveitis: anterior (iritis - red eye, photophobia, ciliary flush, keratic precipitates) vs posterior; HLA-B27 association - Corneal ulcer: bacterial (hypopyon), herpetic (dendritic - treat with Aciclovir), fungal (treat with Natamycin) - Squint (strabismus): types, Hirschberg test, cover test; amblyopia SECTION 9: ORTHOPAEDICS - Fracture healing: stages (hematoma → fibrocartilaginous callus → bony callus → remodeling), complications (malunion, non-union, AVN, infection, compartment syndrome, fat embolism) - Common fractures and features: - Colles' fracture: dinner fork deformity, FOOSH, radius 2.5cm from wrist - Smith's fracture: garden spade deformity, reverse Colles' - Scaphoid: anatomical snuffbox tenderness, AVN risk (proximal pole), treat with thumb spica - Neck of femur fracture: Garden classification (I-IV), treatment by type (conservative/DHS/hemiarthroplasty/THR) - Pott's fracture: bimalleolar ankle fracture - Monteggia: ulna fracture + radial head dislocation - Galeazzi: radial fracture + distal radioulnar dislocation - Compartment syndrome: 6 P's (Pain out of proportion, Pressure, Pallor, Paresthesia, Paralysis, Pulselessness), treatment = emergency fasciotomy - Osteomyelitis: acute (Staph aureus most common, Salmonella in sickle cell), chronic (Brodie's abscess, involucrum, sequestrum, cloaca), treatment - Bone tumors: - Osteosarcoma: adolescents, around knee, Codman's triangle + sunburst on X-ray, treat with chemo + surgery - Ewing's sarcoma: children, diaphysis, onion-peel appearance, small round blue cells - Giant cell tumor: epiphysis, soap bubble appearance, locally aggressive - Chondrosarcoma: adults, slow growing, chemotherapy resistant - Spine: PIVD (L4-L5 and L5-S1 most common), features, management; ankylosing spondylitis (HLA-B27, bamboo spine, sacroiliitis) SECTION 10: ANAESTHESIA HIGH YIELDS - General anaesthesia stages (Guedel's classification): I analgesia, II excitement, III surgical (planes 1-4), IV overdose - Induction agents: Propofol (most common, watch: hypotension, pain on injection), Thiopentone (decreases ICP), Ketamine (dissociative, increases ICP/BP - avoid in head injury, use in hemorrhagic shock) - Volatile agents: Halothane (hepatotoxicity, malignant hyperthermia trigger), Isoflurane (most commonly used), Sevoflurane (smooth induction), Desflurane (fastest recovery) - Muscle relaxants: Succinylcholine (depolarizing, fastest onset, suxamethonium apnea in pseudocholinesterase deficiency, hyperkalemia risk), Non-depolarizing (vecuronium, atracurium - reversed by neostigmine) - Malignant hyperthermia: trigger (volatile agents + succinylcholine), features (hyperthermia, muscle rigidity, rhabdomyolysis), treatment = Dantrolene - Spinal vs epidural anaesthesia comparison - Local anaesthetics: mechanism (Na channel block), toxic effects (CNS → CVS), adrenaline addition prolongs action, NOT added in ring block/digits/penis - Regional blocks: Brachial plexus (Interscalene, Supraclavicular, Axillary approaches) Write the complete HTML to the file. Make sure all tables are properly formatted. Comprehensive exam-ready content.
mkdir -p /home/daytona/workspace/upsc-cms-notes && echo "Directory ready"
mkdir -p /home/daytona/workspace/upsc-cms-notes && ls /home/daytona/workspace/upsc-cms-notes/
Proceed
mkdir -p /home/daytona/workspace/upsc-cms-notes && cat > /home/daytona/workspace/upsc-cms-notes/01_Medicine_Pharmacology.html << 'HTMLEOF' <!DOCTYPE html> <html lang="en"> <head> <meta charset="UTF-8"> <meta name="viewport" content="width=device-width, initial-scale=1.0"> <title>UPSC CMS 2026 - Medicine & Pharmacology</title> <style> body{font-family:'Segoe UI',Arial,sans-serif;margin:0;padding:0;background:#f5f5f5;color:#212121;font-size:14px;} .cover{background:linear-gradient(135deg,#1a237e,#283593);color:#fff;text-align:center;padding:60px 20px;min-height:200px;} .cover h1{font-size:2.2em;margin:0 0 10px;letter-spacing:1px;} .cover h2{font-size:1.5em;margin:0 0 8px;color:#c5cae9;} .cover p{font-size:1.1em;color:#9fa8da;margin:4px 0;} .container{max-width:900px;margin:0 auto;padding:16px;} .sec-header{background:#1a237e;color:#fff;padding:10px 16px;border-radius:6px;margin:24px 0 10px;font-size:1.2em;font-weight:bold;} .sub-header{background:#3949ab;color:#fff;padding:7px 14px;border-radius:4px;margin:16px 0 8px;font-size:1.05em;font-weight:bold;} .sub2{color:#1a237e;font-size:1em;font-weight:bold;margin:12px 0 4px;border-left:4px solid #3949ab;padding-left:8px;} table{width:100%;border-collapse:collapse;margin:10px 0;font-size:13px;} th{background:#3949ab;color:#fff;padding:7px 8px;text-align:left;font-size:12.5px;} td{padding:6px 8px;border:1px solid #c5cae9;vertical-align:top;} tr:nth-child(even) td{background:#e8eaf6;} tr:nth-child(odd) td{background:#fff;} ul{margin:4px 0 8px 18px;padding:0;} li{margin:3px 0;line-height:1.5;} .imp{color:#b71c1c;font-weight:bold;background:#fff8f8;border-left:4px solid #b71c1c;padding:5px 10px;margin:6px 0;border-radius:0 4px 4px 0;} .note{color:#4a148c;font-style:italic;background:#f3e5f5;border-left:4px solid #7b1fa2;padding:5px 10px;margin:6px 0;border-radius:0 4px 4px 0;} .tag{display:inline-block;background:#e8eaf6;color:#1a237e;border-radius:3px;padding:1px 6px;font-size:11px;font-weight:bold;margin-left:4px;} @media print{body{background:#fff;font-size:12px;} .cover{padding:30px;} .container{padding:8px;} th{-webkit-print-color-adjust:exact;print-color-adjust:exact;} .sec-header,.sub-header{-webkit-print-color-adjust:exact;print-color-adjust:exact;}} </style> </head> <body> <div class="cover"> <h1>UPSC CMS 2026</h1> <h2>HIGH-YIELD NOTES — PAPER 1</h2> <p style="font-size:1.3em;font-weight:bold;color:#fff;margin:12px 0;">General Medicine + Pharmacology</p> <p>Exam Date: <b>August 2, 2026</b></p> <p style="color:#9fa8da;font-size:0.95em;">Cardiology | Respiratory | Neurology | GI/Hepatology | Endocrinology | Infectious Diseases | Dermatology | Psychiatry | Pharmacology</p> </div> <div class="container"> <!-- CARDIOLOGY --> <div class="sec-header">SECTION 1: CARDIOLOGY</div> <div class="sub-header">1.1 HEART FAILURE</div> <table><tr><th>Type</th><th>EF</th><th>Cause</th><th>Key Feature</th></tr> <tr><td>HFrEF (Systolic)</td><td><40%</td><td>IHD, Dilated CMP</td><td>Reduced contractility</td></tr> <tr><td>HFpEF (Diastolic)</td><td>>50%</td><td>HTN, HCM, Restrictive</td><td>Impaired relaxation</td></tr> <tr><td>HFmrEF</td><td>40-49%</td><td>Mixed</td><td>Intermediate</td></tr></table> <div class="sub2">NYHA Classification <span class="tag">★ PYQ</span></div> <table><tr><th>Class</th><th>Symptoms</th><th>Mortality/Walk</th></tr> <tr><td>I</td><td>No symptoms with ordinary activity</td><td>Normal</td></tr> <tr><td>II</td><td>Symptoms with moderate exertion</td><td>Mild limitation</td></tr> <tr><td>III</td><td>Symptoms with minimal exertion</td><td>Marked limitation</td></tr> <tr><td>IV</td><td>Symptoms at rest</td><td>Severe, bedridden</td></tr></table> <div class="sub2">HFrEF Management (Drugs that REDUCE MORTALITY)</div> <ul> <li><b>ACE inhibitor/ARB</b> (Ramipril, Enalapril, Sacubitril-Valsartan) — 1st line</li> <li><b>Beta-blocker</b> (Carvedilol, Metoprolol succinate, Bisoprolol)</li> <li><b>MRA</b> Spironolactone/Eplerenone</li> <li><b>SGLT2 inhibitors</b> (Dapagliflozin, Empagliflozin) — newest addition</li> <li><b>ARNI</b> Sacubitril+Valsartan (LCZ696) — superior to ACEi alone</li> <li>Diuretics (Furosemide) — symptom relief ONLY, no mortality benefit</li> </ul> <div class="imp">Digoxin: reduces hospitalizations but NO mortality benefit. Use for rate control in AF+HF. Toxicity: nausea, xanthopsia (yellow vision), arrhythmias — worsened by hypokalemia.</div> <div class="sub-header">1.2 HYPERTENSION</div> <table><tr><th>Category</th><th>Systolic</th><th>Diastolic</th></tr> <tr><td>Normal</td><td><120</td><td><80</td></tr> <tr><td>Elevated</td><td>120-129</td><td><80</td></tr> <tr><td>Stage 1</td><td>130-139</td><td>80-89</td></tr> <tr><td>Stage 2</td><td>≥140</td><td>≥90</td></tr> <tr><td>Hypertensive Crisis</td><td>≥180</td><td>≥120</td></tr></table> <div class="sub2">Drug Choice in Special Populations <span class="tag">★ PYQ Favourite</span></div> <table><tr><th>Condition</th><th>Preferred Drug</th><th>Avoid</th></tr> <tr><td>Diabetes + HTN</td><td>ACEi / ARB (renoprotective)</td><td>—</td></tr> <tr><td>CKD + HTN</td><td>ACEi / ARB</td><td>NSAIDs</td></tr> <tr><td>Pregnancy</td><td>Methyldopa, Labetalol, Nifedipine</td><td>ACEi, ARB, Atenolol</td></tr> <tr><td>HF + HTN</td><td>ACEi, Beta-blocker, MRA</td><td>Verapamil, Diltiazem</td></tr> <tr><td>Asthma + HTN</td><td>CCB (Amlodipine), ACEi</td><td>Beta-blockers</td></tr> <tr><td>Elderly / ISH</td><td>CCB (Amlodipine), Thiazide</td><td>—</td></tr> <tr><td>BPH + HTN</td><td>Alpha-blocker (Prazosin, Doxazosin)</td><td>—</td></tr> <tr><td>Angina + HTN</td><td>Beta-blocker, CCB</td><td>—</td></tr></table> <div class="imp">Hypertensive Emergency: IV Labetalol, IV Nicardipine, IV Sodium Nitroprusside. Reduce MAP by max 25% in first hour. Hypertensive Urgency (no organ damage): Oral Amlodipine/Captopril — reduce over 24-48 hrs.</div> <div class="sub-header">1.3 ISCHEMIC HEART DISEASE</div> <div class="sub2">Killip Classification <span class="tag">★ PYQ</span></div> <table><tr><th>Class</th><th>Features</th><th>Mortality</th></tr> <tr><td>I</td><td>No heart failure signs</td><td>6%</td></tr> <tr><td>II</td><td>S3 gallop, basal crepitations, raised JVP</td><td>17%</td></tr> <tr><td>III</td><td>Frank pulmonary oedema</td><td>38%</td></tr> <tr><td>IV</td><td>Cardiogenic shock (BP<90, cold peripheries)</td><td>81%</td></tr></table> <div class="sub2">STEMI Management</div> <ul> <li>Reperfusion within 12 hours: Primary PCI (preferred) OR Thrombolysis (if PCI not available within 120 min)</li> <li>Thrombolytics: Streptokinase, Alteplase, Tenecteplase</li> <li>DAPT: Aspirin + Clopidogrel/Ticagrelor</li> <li>Anticoagulation: LMWH (Enoxaparin) or UFH</li> <li>Beta-blocker: within 24 hrs (if no contraindication)</li> <li>ACEi: within 24 hrs, especially anterior MI or EF <40%</li> </ul> <div class="imp">Contraindications to thrombolysis: Prior ICH, ischemic stroke <3 months, active bleeding, severe HTN (>180/110), aortic dissection, recent surgery (<14 days)</div> <div class="sub2">MI Complications</div> <table><tr><th>Timing</th><th>Complication</th><th>Notes</th></tr> <tr><td>0-24h</td><td>VF/VT, Heart block</td><td>Most common cause of early death</td></tr> <tr><td>1-3 days</td><td>Early pericarditis</td><td>Friction rub, pleuritic pain</td></tr> <tr><td>3-5 days</td><td>Papillary muscle rupture</td><td>Acute MR, flash pulmonary oedema</td></tr> <tr><td>3-5 days</td><td>Free wall rupture</td><td>Cardiac tamponade, sudden death</td></tr> <tr><td>5-7 days</td><td>VSD</td><td>New harsh pansystolic murmur</td></tr> <tr><td>2-8 weeks</td><td>Dressler's syndrome</td><td>Autoimmune pericarditis, fever, high ESR</td></tr> <tr><td>Weeks-months</td><td>LV aneurysm</td><td>Persistent ST elevation, mural thrombus</td></tr></table> <div class="sub-header">1.4 ATRIAL FIBRILLATION</div> <div class="sub2">CHA₂DS₂-VASc Score <span class="tag">★ PYQ</span></div> <table><tr><th>Factor</th><th>Points</th></tr> <tr><td>C — Congestive Heart Failure</td><td>1</td></tr> <tr><td>H — Hypertension</td><td>1</td></tr> <tr><td>A₂ — Age ≥75 years</td><td>2</td></tr> <tr><td>D — Diabetes Mellitus</td><td>1</td></tr> <tr><td>S₂ — Stroke/TIA history</td><td>2</td></tr> <tr><td>V — Vascular disease (MI, PAD)</td><td>1</td></tr> <tr><td>A — Age 65-74 years</td><td>1</td></tr> <tr><td>Sc — Sex (female)</td><td>1</td></tr></table> <div class="imp">Anticoagulate if score ≥2 in men, ≥3 in women. Score 1 in men: consider anticoagulation.</div> <ul> <li>Rate control: Beta-blocker, Diltiazem, Digoxin. Target HR <110 bpm</li> <li>Rhythm control: Amiodarone, DC cardioversion</li> <li>If AF >48h: anticoagulate 3 weeks before cardioversion OR TOE to exclude LA clot</li> </ul> <div class="imp">WPW + AF: DO NOT use AV nodal blockers (Digoxin, Verapamil, Diltiazem) — risk of VF. Use Amiodarone or DC cardioversion.</div> <div class="sub-header">1.5 RHEUMATIC FEVER — JONES CRITERIA <span class="tag">★ Most PYQs</span></div> <table><tr><th>Major Criteria (CASPE)</th><th>Minor Criteria</th></tr> <tr><td>Carditis (pancarditis)</td><td>Fever (>38.5°C)</td></tr> <tr><td>Arthritis (migratory, large joints)</td><td>Elevated ESR/CRP</td></tr> <tr><td>Sydenham's chorea</td><td>Prolonged PR interval on ECG</td></tr> <tr><td>Erythema marginatum</td><td>Arthralgia (only if arthritis absent)</td></tr> <tr><td>Subcutaneous nodules</td><td>Previous rheumatic fever</td></tr></table> <div class="imp">Diagnosis: 2 Major OR 1 Major + 2 Minor + evidence of preceding strep infection (ASOT raised / positive throat culture)</div> <ul> <li>Most common valve: MITRAL (MS > MR > AS > AR in chronic RHD)</li> <li>Carey-Coombs murmur: soft mid-diastolic murmur of active rheumatic carditis</li> <li>Prophylaxis: Benzathine Penicillin G 1.2 MU IM monthly</li> </ul> <div class="sub-header">1.6 INFECTIVE ENDOCARDITIS — DUKE CRITERIA</div> <table><tr><th>Major Criteria</th><th>Minor Criteria</th></tr> <tr><td>Positive blood cultures (2 separate, typical organisms)</td><td>Predisposing condition (valvular disease, IVDU)</td></tr> <tr><td>Evidence of endocardial involvement on echo (vegetation, abscess, new regurgitation)</td><td>Fever >38°C</td></tr> <tr><td></td><td>Vascular phenomena (emboli, Janeway lesions)</td></tr> <tr><td></td><td>Immunological (Osler nodes, Roth spots, RF+ve)</td></tr></table> <div class="imp">Definite IE: 2 major OR 1 major + 3 minor OR 5 minor</div> <table><tr><th>Organism</th><th>Association</th></tr> <tr><td>Strep viridans</td><td>Most common (native valve, dental procedures)</td></tr> <tr><td>Staph aureus</td><td>IVDU, prosthetic valve, acute aggressive IE</td></tr> <tr><td>Enterococcus</td><td>GI/GU procedures</td></tr> <tr><td>HACEK organisms</td><td>Culture-negative IE, slow growing</td></tr> <tr><td>Strep bovis (S. gallolyticus)</td><td>Colon cancer — always do colonoscopy!</td></tr> <tr><td>Candida</td><td>Prosthetic valve, immunocompromised, IVDU</td></tr></table> <div class="sub-header">1.7 CONGENITAL HEART DISEASE</div> <table><tr><th>Defect</th><th>Shunt</th><th>Murmur</th><th>Key Features</th></tr> <tr><td>ASD</td><td>L→R</td><td>Systolic ejection (pulmonary)</td><td>Fixed split S2; RVH on ECG</td></tr> <tr><td>VSD</td><td>L→R</td><td>Pansystolic at LSE</td><td>Most common CHD; may close spontaneously</td></tr> <tr><td>PDA</td><td>L→R</td><td>Continuous machinery murmur</td><td>Widened pulse pressure; Indomethacin closes it</td></tr> <tr><td>TOF</td><td>R→L</td><td>Ejection systolic (PS)</td><td>Boot-shaped heart CXR; squatting relieves cyanosis</td></tr> <tr><td>TGA</td><td>Parallel</td><td>Variable</td><td>Egg-on-side CXR; PGE1 to maintain PDA</td></tr> <tr><td>Coarctation of Aorta</td><td>—</td><td>Interscapular bruit</td><td>Radio-femoral delay; rib notching on CXR</td></tr> <tr><td>Eisenmenger syndrome</td><td>R→L (reversal)</td><td>Varies</td><td>Irreversible; pregnancy contraindicated (50% maternal mortality)</td></tr></table> <!-- RESPIRATORY --> <div class="sec-header">SECTION 2: RESPIRATORY DISEASES</div> <div class="sub-header">2.1 COPD</div> <div class="sub2">GOLD Staging <span class="tag">★ PYQ</span></div> <table><tr><th>Stage</th><th>FEV1 (% predicted)</th><th>Severity</th></tr> <tr><td>GOLD 1</td><td>≥80%</td><td>Mild</td></tr> <tr><td>GOLD 2</td><td>50-79%</td><td>Moderate</td></tr> <tr><td>GOLD 3</td><td>30-49%</td><td>Severe</td></tr> <tr><td>GOLD 4</td><td><30%</td><td>Very Severe</td></tr></table> <div class="imp">All COPD: FEV1/FVC <0.70 post-bronchodilator (fixed ratio)</div> <ul> <li>All stages: Smoking cessation (most important), vaccinations</li> <li>Mild: SABA PRN → add LAMA (Tiotropium) or LABA</li> <li>Moderate-Severe: LAMA + LABA combination</li> <li>Frequent exacerbations: add ICS → triple therapy (ICS+LABA+LAMA)</li> <li>GOLD 4 + PaO₂ <55 mmHg: LTOT >15 hrs/day — only intervention improving survival</li> <li>Roflumilast (PDE4 inhibitor): GOLD 3-4 with chronic bronchitis + frequent exacerbations</li> </ul> <div class="sub2">Exacerbation Management</div> <ul> <li>Controlled O₂: target SpO₂ 88-92%</li> <li>SABA + SAMA nebulization</li> <li>Prednisolone 30-40mg for 5 days</li> <li>Antibiotics if purulent sputum (Amoxicillin/Doxycycline)</li> <li>NIV/BiPAP if pH <7.35 and PaCO₂ >45 mmHg</li> </ul> <div class="sub-header">2.2 BRONCHIAL ASTHMA</div> <table><tr><th>Step</th><th>Treatment</th></tr> <tr><td>Step 1</td><td>SABA PRN (Salbutamol)</td></tr> <tr><td>Step 2</td><td>Low-dose ICS + SABA PRN</td></tr> <tr><td>Step 3</td><td>Low-dose ICS + LABA OR medium ICS</td></tr> <tr><td>Step 4</td><td>Medium/high ICS + LABA; add LAMA, LTRA (Montelukast)</td></tr> <tr><td>Step 5</td><td>High ICS + LABA + specialist; add-on Omalizumab (allergic asthma)</td></tr></table> <div class="imp">Safe in pregnancy: SABA, ICS, LABA, Montelukast — all safe. Normal pCO₂ or rising CO₂ in acute asthma = impending respiratory failure!</div> <div class="sub-header">2.3 PNEUMONIA — CURB-65 <span class="tag">★ PYQ</span></div> <table><tr><th>Parameter</th><th>Score</th></tr> <tr><td>C — Confusion (new onset)</td><td>1</td></tr> <tr><td>U — Urea >7 mmol/L (BUN >19 mg/dL)</td><td>1</td></tr> <tr><td>R — Respiratory rate ≥30/min</td><td>1</td></tr> <tr><td>B — BP: SBP <90 or DBP ≤60</td><td>1</td></tr> <tr><td>65 — Age ≥65 years</td><td>1</td></tr></table> <table><tr><th>Score</th><th>Management</th><th>Mortality</th></tr> <tr><td>0-1</td><td>Outpatient treatment</td><td><3%</td></tr> <tr><td>2</td><td>Short inpatient or supervised outpatient</td><td>9%</td></tr> <tr><td>3-5</td><td>Hospitalize; ICU if score 4-5</td><td>15-40%</td></tr></table> <table><tr><th>Type</th><th>Organisms</th><th>Treatment</th></tr> <tr><td>CAP (Mild)</td><td>S. pneumoniae, H. influenzae, Mycoplasma</td><td>Amoxicillin OR Doxycycline</td></tr> <tr><td>CAP (Severe)</td><td>S. pneumoniae, Legionella</td><td>Beta-lactam + Macrolide OR Respiratory FQ</td></tr> <tr><td>HAP/VAP</td><td>Gram negatives, MRSA</td><td>Pip-Tazo ± Vancomycin</td></tr> <tr><td>Atypical</td><td>Mycoplasma, Legionella, Chlamydophila</td><td>Macrolide or Doxycycline</td></tr></table> <div class="imp">Legionella: Hyponatremia is key clue. Urine antigen test. Treat with Azithromycin/Levofloxacin.</div> <div class="sub-header">2.4 TUBERCULOSIS</div> <table><tr><th>Category</th><th>Regimen</th><th>Notes</th></tr> <tr><td>New pulmonary/extrapulmonary TB</td><td>2HRZE / 4HR</td><td>H=INH, R=Rifampicin, Z=Pyrazinamide, E=Ethambutol</td></tr> <tr><td>TB Meningitis</td><td>2HRZE / 10HR + Dexamethasone</td><td>Dexamethasone reduces mortality</td></tr> <tr><td>MDR-TB (RR-TB)</td><td>BPaLM (6-9 months)</td><td>Bedaquiline + Pretomanid + Linezolid + Moxifloxacin</td></tr></table> <table><tr><th>Drug</th><th>Key Side Effect</th></tr> <tr><td>Isoniazid (H)</td><td>Peripheral neuropathy (give Pyridoxine/B6), hepatotoxicity, SLE-like syndrome</td></tr> <tr><td>Rifampicin (R)</td><td>Orange body fluids, hepatotoxicity, enzyme INDUCER (reduces OCP efficacy)</td></tr> <tr><td>Pyrazinamide (Z)</td><td>Hyperuricemia/gout, hepatotoxicity</td></tr> <tr><td>Ethambutol (E)</td><td>Optic neuritis (red-green color blindness) — check visual acuity before starting</td></tr> <tr><td>Streptomycin (S)</td><td>Ototoxicity (vestibular), nephrotoxicity</td></tr></table> <div class="sub-header">2.5 PLEURAL EFFUSION — LIGHT'S CRITERIA <span class="tag">★ PYQ</span></div> <p>Exudate if ANY ONE of:</p> <ul> <li>Pleural protein / serum protein >0.5</li> <li>Pleural LDH / serum LDH >0.6</li> <li>Pleural LDH >2/3 upper limit of normal serum LDH</li> </ul> <table><tr><th>Transudate</th><th>Exudate</th></tr> <tr><td>Heart failure (most common)</td><td>Pneumonia / parapneumonic</td></tr> <tr><td>Cirrhosis (hepatic hydrothorax)</td><td>Tuberculosis</td></tr> <tr><td>Nephrotic syndrome</td><td>Malignancy</td></tr> <tr><td>Hypothyroidism</td><td>Pulmonary embolism</td></tr></table> <div class="sub-header">2.6 LUNG CANCER</div> <table><tr><th>Type</th><th>Location</th><th>Key Feature</th><th>Paraneoplastic</th></tr> <tr><td>Squamous cell (25-30%)</td><td>Central</td><td>Cavitation, Keratin pearls</td><td>PTHrP → Hypercalcemia</td></tr> <tr><td>Adenocarcinoma (35-40%)</td><td>Peripheral</td><td>Most common; EGFR mutation</td><td>Hypertrophic osteoarthropathy</td></tr> <tr><td>Small cell (SCLC) (15-20%)</td><td>Central</td><td>Very aggressive</td><td>SIADH, ACTH (Cushing's), Lambert-Eaton</td></tr> <tr><td>Large cell (10%)</td><td>Peripheral</td><td>Diagnosis of exclusion</td><td>Gynecomastia, hCG</td></tr></table> <div class="imp">SCLC: Chemo (Cisplatin+Etoposide). NO surgery generally. NSCLC: EGFR→Erlotinib/Gefitinib. ALK→Crizotinib. PD-L1→Pembrolizumab. Pancoast tumor → Horner's syndrome (ptosis, miosis, anhidrosis).</div> <!-- NEUROLOGY --> <div class="sec-header">SECTION 3: NEUROLOGY</div> <div class="sub-header">3.1 STROKE</div> <table><tr><th>Feature</th><th>Ischemic (85%)</th><th>Hemorrhagic (15%)</th></tr> <tr><td>CT appearance</td><td>Hypodense (may be normal <6h)</td><td>Hyperdense (bright white immediately)</td></tr> <tr><td>Headache</td><td>Usually absent</td><td>Severe (ICH/SAH)</td></tr> <tr><td>Thrombolysis</td><td>YES (if criteria met)</td><td>CONTRAINDICATED</td></tr> <tr><td>BP management</td><td>Permissive HTN (up to 220/120 unless thrombolysis)</td><td>Aggressive (<140)</td></tr></table> <div class="imp">tPA/Alteplase window: within 4.5 hours. BP must be <185/110 before giving tPA. Mechanical thrombectomy: up to 24 hours in selected patients.</div> <div class="sub-header">3.2 MENINGITIS — CSF FINDINGS <span class="tag">★ PYQ</span></div> <table><tr><th>Type</th><th>Cells</th><th>Protein</th><th>Glucose</th><th>Other</th></tr> <tr><td>Normal</td><td>0-5 lymphocytes</td><td>15-45 mg/dL</td><td>>60% serum</td><td>Clear</td></tr> <tr><td>Bacterial</td><td>100-10,000 PMNs</td><td>Very high (>100)</td><td>Very low (<40%)</td><td>Gram stain +ve</td></tr> <tr><td>Viral (Aseptic)</td><td>10-100 lymphocytes</td><td>Normal/slight ↑</td><td>Normal</td><td>PCR diagnostic</td></tr> <tr><td>TB</td><td>100-500 lymphocytes</td><td>Very high (100-500)</td><td>Very low</td><td>AFB smear/culture</td></tr> <tr><td>Fungal (Crypto)</td><td>5-100 lymphocytes</td><td>High</td><td>Low</td><td>India ink +ve; CrAg +ve</td></tr> <tr><td>SAH</td><td>RBCs (not clearing)</td><td>High</td><td>Normal</td><td>Xanthochromia after 2-4h</td></tr></table> <div class="imp">Treatment: IV Ceftriaxone + Dexamethasone (before or WITH first antibiotic dose). Meningococcal: IV Benzylpenicillin + isolate. Contacts: Rifampicin/Ciprofloxacin prophylaxis.</div> <div class="sub-header">3.3 EPILEPSY — DRUG OF CHOICE <span class="tag">★ PYQ</span></div> <table><tr><th>Seizure Type</th><th>Drug of Choice</th><th>Alternatives</th></tr> <tr><td>Focal (partial) seizures</td><td>Carbamazepine</td><td>Oxcarbazepine, Lamotrigine, Levetiracetam</td></tr> <tr><td>Absence seizures</td><td>Ethosuximide</td><td>Valproate, Lamotrigine</td></tr> <tr><td>Juvenile myoclonic epilepsy</td><td>Valproate</td><td>Levetiracetam, Lamotrigine</td></tr> <tr><td>Generalized tonic-clonic</td><td>Valproate</td><td>Lamotrigine, Levetiracetam</td></tr> <tr><td>Status epilepticus (acute)</td><td>IV Lorazepam → IV Phenytoin/Levetiracetam</td><td>Valproate IV, Midazolam</td></tr> <tr><td>Febrile seizures (acute)</td><td>Diazepam (rectal/IV)</td><td>Lorazepam</td></tr> <tr><td>Epilepsy in PREGNANCY</td><td>Lamotrigine (safest)</td><td>Levetiracetam; AVOID Valproate</td></tr> <tr><td>Neonatal seizures</td><td>Phenobarbitone</td><td>Phenytoin, Levetiracetam</td></tr></table> <div class="imp">Valproate: Neural tube defects, foetal valproate syndrome. AVOID in women of childbearing age. Carbamazepine: enzyme inducer, reduces OCP efficacy, causes SIADH.</div> <div class="sub-header">3.4 PARKINSON'S DISEASE</div> <ul> <li>Pathology: Loss of dopaminergic neurons in Substantia Nigra pars compacta. Lewy bodies (alpha-synuclein).</li> <li>TRAP: Tremor (pill-rolling 4-6Hz at rest), Rigidity (cogwheel), Akinesia/Bradykinesia, Postural instability</li> </ul> <table><tr><th>Drug</th><th>Mechanism</th><th>Notes</th></tr> <tr><td>Levodopa + Carbidopa</td><td>DA precursor; carbidopa prevents peripheral conversion</td><td>Gold standard; wearing off, dyskinesias long-term</td></tr> <tr><td>Dopamine agonists (Pramipexole, Ropinirole)</td><td>DA receptor agonist</td><td>First choice in young patients to delay L-DOPA</td></tr> <tr><td>MAO-B inhibitors (Selegiline, Rasagiline)</td><td>Prevent DA breakdown</td><td>Neuroprotective, mild symptom benefit</td></tr> <tr><td>COMT inhibitors (Entacapone)</td><td>Prolong L-DOPA effect</td><td>For wearing-off phenomenon</td></tr> <tr><td>Anticholinergics (Trihexyphenidyl)</td><td>Block ACh</td><td>For tremor only; avoid in elderly (confusion)</td></tr></table> <div class="imp">MPTP → selective destruction of substantia nigra (drug-induced parkinsonism model). Drug-induced parkinsonism: Haloperidol, Metoclopramide → treat by stopping drug.</div> <div class="sub-header">3.5 MYASTHENIA GRAVIS</div> <ul> <li>Anti-AChR antibodies (85%); Anti-MuSK (10%)</li> <li>Fatigable weakness — ptosis, diplopia, worsens with activity</li> <li>Edrophonium (Tensilon) test: IV edrophonium → transient improvement of ptosis</li> <li>Repetitive nerve stimulation: decremental response at 3 Hz</li> <li>Thymoma in 10-15%; thymic hyperplasia in 65%</li> <li>Treatment: Pyridostigmine (symptomatic), Thymectomy (for thymoma + generalized MG in young), Prednisolone/Azathioprine</li> <li>Crisis: Plasmapheresis OR IVIg (equally effective, work in 3-5 days)</li> </ul> <div class="imp">Myasthenic crisis vs Cholinergic crisis: Cholinergic has SLUDGE + bradycardia → stop Pyridostigmine. Myasthenic crisis → increase Pyridostigmine + plasmapheresis/IVIg.</div> <!-- GI --> <div class="sec-header">SECTION 4: GASTROENTEROLOGY & HEPATOLOGY</div> <div class="sub-header">4.1 PEPTIC ULCER DISEASE</div> <table><tr><th>Feature</th><th>Gastric Ulcer</th><th>Duodenal Ulcer</th></tr> <tr><td>H. pylori</td><td>70-80%</td><td>95%</td></tr> <tr><td>Pain pattern</td><td>Worsens with food</td><td>Relieved by food, worsens 2-3h after (hunger pain)</td></tr> <tr><td>Night pain</td><td>Less common</td><td>Common (wakes patient)</td></tr> <tr><td>Malignant potential</td><td>Yes — always biopsy</td><td>Very rare</td></tr></table> <div class="imp">H. pylori Triple Therapy: PPI + Amoxicillin 1g BD + Clarithromycin 500mg BD for 7-14 days. Test of cure: Urea breath test 4 weeks after treatment.</div> <div class="sub-header">4.2 IBD — CROHN'S vs UC <span class="tag">★ PYQ</span></div> <table><tr><th>Feature</th><th>Crohn's Disease</th><th>Ulcerative Colitis</th></tr> <tr><td>Location</td><td>Anywhere (mouth to anus); terminal ileum most common</td><td>Colon only; ALWAYS involves rectum</td></tr> <tr><td>Distribution</td><td>Skip lesions (patchy)</td><td>Continuous (no skip lesions)</td></tr> <tr><td>Depth</td><td>Transmural</td><td>Mucosal + submucosal only</td></tr> <tr><td>Histology</td><td>Non-caseating granulomas</td><td>Crypt abscesses, goblet cell depletion</td></tr> <tr><td>Complications</td><td>Fistulae, strictures, abscesses</td><td>Toxic megacolon, colon cancer (UC > Crohn's)</td></tr> <tr><td>Smoking</td><td>Worsens Crohn's</td><td>Protective in UC</td></tr> <tr><td>Surgery</td><td>Resection NOT curative</td><td>Colectomy = CURATIVE</td></tr> <tr><td>Antibodies</td><td>ASCA positive</td><td>pANCA positive</td></tr></table> <div class="imp">Toxic megacolon: colon >6cm. Medical emergency. IV fluids, IV steroids, IV antibiotics, NG decompression. Surgery if not improving in 48-72 hrs.</div> <div class="sub-header">4.3 LIVER DISEASE</div> <div class="sub2">Child-Pugh Score <span class="tag">★ PYQ</span></div> <table><tr><th>Parameter</th><th>1 point</th><th>2 points</th><th>3 points</th></tr> <tr><td>Bilirubin (mg/dL)</td><td><2</td><td>2-3</td><td>>3</td></tr> <tr><td>Albumin (g/dL)</td><td>>3.5</td><td>2.8-3.5</td><td><2.8</td></tr> <tr><td>PT prolongation (sec)</td><td><4</td><td>4-6</td><td>>6</td></tr> <tr><td>Ascites</td><td>None</td><td>Controlled</td><td>Refractory</td></tr> <tr><td>Encephalopathy</td><td>None</td><td>Grade I-II</td><td>Grade III-IV</td></tr></table> <table><tr><th>Class</th><th>Score</th><th>1-yr survival</th><th>2-yr survival</th></tr> <tr><td>A (compensated)</td><td>5-6</td><td>100%</td><td>85%</td></tr> <tr><td>B</td><td>7-9</td><td>81%</td><td>57%</td></tr> <tr><td>C (decompensated)</td><td>10-15</td><td>45%</td><td>35%</td></tr></table> <div class="sub2">Hepatitis Serology <span class="tag">★ PYQ</span></div> <table><tr><th>Marker</th><th>Meaning</th></tr> <tr><td>HBsAg</td><td>Active infection (acute or chronic)</td></tr> <tr><td>Anti-HBs</td><td>Immunity (vaccine OR recovered)</td></tr> <tr><td>Anti-HBc IgM</td><td>Acute HBV infection</td></tr> <tr><td>Anti-HBc IgG</td><td>Past infection</td></tr> <tr><td>HBeAg</td><td>High infectivity, active replication</td></tr> <tr><td>Window period</td><td>HBsAg -ve, Anti-HBs -ve; ONLY Anti-HBc IgM positive</td></tr></table> <ul> <li>SBP: ascitic fluid PMN >250/mm³. Treat: IV Cefotaxime 5 days. Prophylaxis: Norfloxacin/Ciprofloxacin</li> <li>Hepatic Encephalopathy: Lactulose + Rifaximin. Precipitants: infection, constipation, GI bleed, sedatives</li> <li>HRS: Terlipressin + Albumin. Exclude other causes of renal failure</li> <li>Varices: Beta-blockers (propranolol) for prophylaxis. Active bleed: Terlipressin + band ligation + antibiotics</li> </ul> <div class="sub-header">4.4 ACUTE PANCREATITIS — RANSON'S CRITERIA <span class="tag">★ PYQ</span></div> <table><tr><th>At Admission (GA LAW)</th><th>At 48 Hours</th></tr> <tr><td>Glucose >200 mg/dL</td><td>Hematocrit drop >10%</td></tr> <tr><td>Age >55 years</td><td>BUN rise >5 mg/dL</td></tr> <tr><td>LDH >350 IU/L</td><td>Serum Ca <8 mg/dL</td></tr> <tr><td>AST >250 IU/L</td><td>PaO₂ <60 mmHg</td></tr> <tr><td>WBC >16,000</td><td>Base deficit >4 mEq/L</td></tr> <tr><td></td><td>Fluid sequestration >6L</td></tr></table> <div class="imp">Score ≥3 = Severe pancreatitis. Score 0-2: 1% mortality. Score 3-4: 15%. Score ≥5: 40% mortality. Causes: Gallstones (most common in India), Alcohol.</div> <!-- ENDOCRINOLOGY --> <div class="sec-header">SECTION 5: ENDOCRINOLOGY</div> <div class="sub-header">5.1 DIABETES MELLITUS</div> <table><tr><th>Test</th><th>Diagnostic</th><th>Normal</th><th>Pre-diabetes</th></tr> <tr><td>Fasting glucose</td><td>≥126 mg/dL</td><td><100</td><td>100-125 (IFG)</td></tr> <tr><td>2-hr OGTT</td><td>≥200 mg/dL</td><td><140</td><td>140-199 (IGT)</td></tr> <tr><td>Random + symptoms</td><td>≥200 mg/dL</td><td>—</td><td>—</td></tr> <tr><td>HbA1c</td><td>≥6.5%</td><td><5.7%</td><td>5.7-6.4%</td></tr></table> <table><tr><th>Drug</th><th>Mechanism</th><th>Key Point</th></tr> <tr><td>Metformin</td><td>Decrease hepatic glucose output</td><td>1st line T2DM; C/I eGFR<30. Lactic acidosis (rare).</td></tr> <tr><td>Sulfonylureas</td><td>Stimulate insulin secretion</td><td>Risk of hypoglycemia; avoid elderly, CKD</td></tr> <tr><td>GLP-1 agonists (Liraglutide)</td><td>Stimulate insulin, inhibit glucagon</td><td>Weight loss, CV benefit</td></tr> <tr><td>SGLT2 inhibitors (Dapagliflozin)</td><td>Block renal glucose reabsorption</td><td>HF benefit, renoprotection</td></tr> <tr><td>DPP-4 inhibitors (Sitagliptin)</td><td>Prevent GLP-1 breakdown</td><td>Weight neutral, safe in CKD</td></tr> <tr><td>Pioglitazone</td><td>PPAR-gamma agonist</td><td>Weight gain, fluid retention, HF risk, fractures</td></tr></table> <div class="imp">DKA triad: glucose>200, metabolic acidosis (pH<7.3), ketonemia. Treat: IV NS 1L/hr → 0.45% NaCl, IV regular insulin AFTER K+>3.5, K+ replacement. HHS: glucose>600, osmolality>320, NO significant acidosis (T2DM).</div> <div class="sub-header">5.2 THYROID DISORDERS</div> <table><tr><th>Condition</th><th>TSH</th><th>Free T4</th><th>Clinical Features</th></tr> <tr><td>Primary hypothyroidism</td><td>↑↑</td><td>↓</td><td>Fatigue, cold intolerance, bradycardia, myxedema</td></tr> <tr><td>Primary hyperthyroidism</td><td>↓↓</td><td>↑</td><td>Weight loss, heat intolerance, tachycardia, tremor</td></tr> <tr><td>Subclinical hypothyroidism</td><td>↑</td><td>Normal</td><td>Asymptomatic/mild</td></tr> <tr><td>Sick euthyroid</td><td>Normal/↓</td><td>Normal/↓</td><td>Systemic illness; DO NOT treat</td></tr></table> <div class="imp">Thyroid Storm Treatment (6 P's): PTU → Propranolol → Potassium iodide (1hr after PTU) → Prednisolone → Paracetamol (NOT aspirin) → Precipitant treatment</div> <div class="sub-header">5.3 ADRENAL DISORDERS</div> <ul> <li>Cushing's causes: Iatrogenic (most common) > Pituitary adenoma (Cushing's DISEASE, 70%) > Adrenal adenoma > Ectopic ACTH (SCLC)</li> <li>Features: Central obesity, buffalo hump, moon face, purple striae, HTN, DM, osteoporosis, proximal myopathy</li> <li>Diagnosis: 24-hr urinary free cortisol, low-dose DST (1mg overnight)</li> <li>High-dose DST: suppresses cortisol in pituitary Cushing's, NOT in ectopic/adrenal</li> </ul> <div class="imp">Addison's Disease (India: TB most common cause): Fatigue, postural hypotension, hyponatremia, hyperkalemia, hyperpigmentation. Crisis: IV hydrocortisone 100mg STAT + IV normal saline. Do NOT delay for tests.</div> <!-- INFECTIOUS DISEASES --> <div class="sec-header">SECTION 6: INFECTIOUS DISEASES & TROPICAL MEDICINE</div> <div class="sub-header">6.1 HIV/AIDS — CD4 COUNT THRESHOLDS <span class="tag">★ PYQ</span></div> <table><tr><th>CD4 Count</th><th>Opportunistic Infection</th></tr> <tr><td>Any count</td><td>TB (more aggressive as CD4 falls)</td></tr> <tr><td><500</td><td>Herpes zoster, oral candidiasis, hairy leukoplakia</td></tr> <tr><td><200</td><td>PCP (Pneumocystis jirovecii Pneumonia) — most common OI</td></tr> <tr><td><150</td><td>Disseminated histoplasmosis</td></tr> <tr><td><100</td><td>Cerebral toxoplasmosis, Cryptosporidium</td></tr> <tr><td><50</td><td>CMV retinitis, Disseminated MAC, Cryptococcal meningitis, CNS lymphoma</td></tr></table> <div class="imp">India 1st line ART: TLE (Tenofovir + Lamivudine + Efavirenz). PCP Prophylaxis: Co-trimoxazole when CD4 <200. MAC Prophylaxis: Azithromycin when CD4 <50.</div> <div class="sub-header">6.2 MALARIA</div> <table><tr><th>Feature</th><th>P. falciparum</th><th>P. vivax</th><th>P. malariae</th></tr> <tr><td>Fever cycle</td><td>36-48h (irregular)</td><td>48h (tertian)</td><td>72h (quartan)</td></tr> <tr><td>Severe malaria</td><td>Yes (most dangerous)</td><td>Rarely</td><td>No</td></tr> <tr><td>Relapse</td><td>No</td><td>Yes (hypnozoites)</td><td>Recrudescence</td></tr></table> <table><tr><th>Type</th><th>Treatment</th></tr> <tr><td>Uncomplicated P. falciparum</td><td>Artemether-Lumefantrine; India: Artesunate + Sulfadoxine-Pyrimethamine</td></tr> <tr><td>Severe/Complicated falciparum</td><td>IV Artesunate (preferred) or IV Quinine + Doxycycline</td></tr> <tr><td>P. vivax/ovale</td><td>Chloroquine (3 days) + Primaquine (14 days for hypnozoites)</td></tr> <tr><td>P. malariae</td><td>Chloroquine only (no hypnozoites)</td></tr></table> <div class="imp">Primaquine: CONTRAINDICATED in G6PD deficiency (hemolysis). Always test G6PD first. Blackwater fever: massive hemolysis in P. falciparum → hemoglobinuria → acute renal failure.</div> <div class="sub-header">6.3 TROPICAL DISEASES</div> <table><tr><th>Disease</th><th>Organism</th><th>Vector</th><th>Treatment</th><th>Key Points</th></tr> <tr><td>Kala-azar (VL)</td><td>Leishmania donovani</td><td>Sandfly (Phlebotomus)</td><td>Liposomal Ampho B (India 1st line); Miltefosine</td><td>Splenomegaly, pancytopenia, PKDL after treatment</td></tr> <tr><td>Dengue</td><td>Flavivirus (DENV 1-4)</td><td>Aedes aegypti</td><td>Supportive only</td><td>DHF: plasma leak; DSS: shock. Plt <100k.</td></tr> <tr><td>Scrub typhus</td><td>Orientia tsutsugamushi</td><td>Trombiculid mite</td><td>Doxycycline 1st line</td><td>Eschar at bite site; endemic NE India</td></tr> <tr><td>Filariasis</td><td>Wuchereria bancrofti</td><td>Culex mosquito</td><td>DEC (Diethylcarbamazine)</td><td>Elephantiasis; night blood smear</td></tr> <tr><td>JE</td><td>Flavivirus</td><td>Culex mosquito</td><td>Supportive; SA-14-14-2 vaccine</td><td>Most common viral encephalitis in Asia</td></tr></table> <div class="sub-header">6.4 DERMATOLOGY HIGH YIELDS</div> <table><tr><th>Condition</th><th>Key Features</th><th>Treatment</th></tr> <tr><td>Psoriasis</td><td>Silvery scales, extensor surfaces, Auspitz sign, nail pitting, Koebner phenomenon</td><td>Topical steroids, calcipotriol, methotrexate, anti-TNF biologics</td></tr> <tr><td>Pemphigus vulgaris</td><td>Flaccid bullae, Nikolsky sign +ve, IgG anti-desmoglein 3, involves mucosa</td><td>High-dose steroids + Azathioprine/Rituximab</td></tr> <tr><td>Bullous pemphigoid</td><td>Tense bullae, Nikolsky -ve, IgG anti-BP180, elderly</td><td>Topical/systemic steroids</td></tr> <tr><td>Dermatitis herpetiformis</td><td>Intensely itchy vesicles on extensors; celiac disease association; IgA anti-endomysial</td><td>Gluten-free diet + Dapsone</td></tr> <tr><td>Lichen planus</td><td>6 Ps: Purple, Pruritic, Polygonal, Planar, Papules, Plaques; Wickham's striae; Koebner</td><td>Topical steroids</td></tr> <tr><td>Scabies</td><td>Nocturnal pruritus, burrows, web spaces; Sarcoptes scabiei</td><td>Permethrin 5% (DOC); Ivermectin for crusted</td></tr> <tr><td>Leprosy</td><td>M. leprae; TT (tuberculoid) vs LL (lepromatous)</td><td>PB: Rifampicin+Dapsone x6m. MB: +Clofazimine x12m</td></tr></table> <!-- PSYCHIATRY --> <div class="sec-header">SECTION 7: PSYCHIATRY</div> <div class="sub-header">7.1 SCHIZOPHRENIA</div> <ul> <li>DSM-5: ≥2 of: delusions, hallucinations, disorganized speech, behaviour, negative symptoms — for ≥1 month, 6-month dysfunction</li> <li>Most common hallucination: Auditory (3rd person voices)</li> <li>Negative symptoms (5 A's): Flat Affect, Alogia, Avolition, Anhedonia, Asociality</li> </ul> <table><tr><th>Generation</th><th>Examples</th><th>Key Side Effects</th></tr> <tr><td>Typical (1st gen)</td><td>Haloperidol, Chlorpromazine, Fluphenazine</td><td>EPS (tardive dyskinesia, akathisia, parkinsonism), NMS, hyperprolactinemia</td></tr> <tr><td>Atypical (2nd gen)</td><td>Olanzapine, Clozapine, Risperidone, Quetiapine</td><td>Metabolic syndrome (weight gain, DM, dyslipidemia)</td></tr></table> <div class="imp">Clozapine: ONLY antipsychotic for treatment-resistant schizophrenia. Weekly WBC monitoring (agranulocytosis 1-2%). NMS: FEVER + rigidity + autonomic instability + elevated CK. Treat: Stop antipsychotic + Dantrolene + Bromocriptine.</div> <div class="sub-header">7.2 MOOD DISORDERS</div> <ul> <li>Depression 1st line: SSRIs (Sertraline, Escitalopram, Fluoxetine)</li> <li>SSRI side effects: GI, sexual dysfunction, SIADH, serotonin syndrome, discontinuation syndrome</li> <li>SNRIs (Venlafaxine, Duloxetine): good for pain + depression; HTN side effect</li> <li>TCAs (Amitriptyline): good for neuropathic pain, migraine prevention; overdose → cardiac arrhythmias</li> </ul> <div class="imp">Lithium toxicity: tremor → ataxia → seizures → coma. Polyuria/polydipsia (nephrogenic DI). Hypothyroidism. Ebstein anomaly (teratogen). Toxicity worsened by dehydration, NSAIDs, thiazides. Narrow therapeutic index.</div> <div class="sub-header">7.3 ANXIETY & SUBSTANCE ABUSE</div> <table><tr><th>Disorder</th><th>First-line Treatment</th></tr> <tr><td>GAD</td><td>SSRIs/SNRIs; Buspirone; CBT</td></tr> <tr><td>Panic Disorder</td><td>SSRIs (long-term); BZD (short-term acute)</td></tr> <tr><td>PTSD</td><td>SSRIs (Sertraline, Paroxetine — FDA approved); Prazosin for nightmares</td></tr> <tr><td>OCD</td><td>SSRIs (high dose); Clomipramine; ERP therapy</td></tr></table> <table><tr><th>Substance</th><th>Withdrawal Features</th><th>Treatment</th></tr> <tr><td>Alcohol</td><td>Tremors (6-12h), Seizures (12-24h), Delirium Tremens (24-72h)</td><td>Benzodiazepines (CIWA protocol); Thiamine BEFORE glucose</td></tr> <tr><td>Opioids</td><td>Lacrimation, piloerection, diarrhea, myalgia (not life-threatening)</td><td>Methadone/Buprenorphine substitution; Naltrexone for relapse</td></tr> <tr><td>Nicotine</td><td>Irritability, craving, increased appetite</td><td>Varenicline (Champix) 1st line; NRT; Bupropion</td></tr></table> <!-- PHARMACOLOGY --> <div class="sec-header">SECTION 8: PHARMACOLOGY HIGH YIELDS</div> <div class="sub-header">8.1 ANTIBIOTICS — DRUG OF CHOICE <span class="tag">★ PYQ</span></div> <table><tr><th>Infection/Organism</th><th>Drug of Choice</th><th>Alternative</th></tr> <tr><td>Streptococcal throat / RF prophylaxis</td><td>Benzathine Penicillin G IM monthly</td><td>Amoxicillin oral daily</td></tr> <tr><td>Pneumococcal meningitis</td><td>Ceftriaxone IV</td><td>Cefotaxime</td></tr> <tr><td>Meningococcal meningitis</td><td>Benzylpenicillin IV</td><td>Ceftriaxone</td></tr> <tr><td>Listeria meningitis</td><td>Ampicillin + Gentamicin</td><td>Co-trimoxazole</td></tr> <tr><td>Legionella</td><td>Azithromycin or Levofloxacin</td><td>Doxycycline</td></tr> <tr><td>Mycoplasma/Chlamydophila pneumonia</td><td>Doxycycline or Azithromycin</td><td>Fluoroquinolone</td></tr> <tr><td>H. pylori</td><td>PPI + Amoxicillin + Clarithromycin</td><td>Bismuth quadruple therapy</td></tr> <tr><td>C. difficile</td><td>Oral Vancomycin or Fidaxomicin</td><td>Metronidazole (less effective)</td></tr> <tr><td>MRSA</td><td>Vancomycin or Linezolid</td><td>Daptomycin, Teicoplanin</td></tr> <tr><td>Pseudomonas aeruginosa</td><td>Piperacillin-Tazobactam or Ceftazidime</td><td>Carbapenems, Ciprofloxacin</td></tr> <tr><td>Typhoid fever</td><td>Ceftriaxone or Azithromycin</td><td>Ciprofloxacin (resistance increasing)</td></tr> <tr><td>Leptospirosis</td><td>Penicillin G or Doxycycline</td><td>Ceftriaxone</td></tr> <tr><td>Rickettsia (Scrub typhus)</td><td>Doxycycline</td><td>Chloramphenicol</td></tr> <tr><td>Cholera</td><td>ORS + Doxycycline or Azithromycin</td><td>Tetracycline, Cipro</td></tr> <tr><td>Gonorrhoea</td><td>Ceftriaxone IM single dose</td><td>+ Azithromycin if co-infection</td></tr> <tr><td>Chlamydia trachomatis</td><td>Doxycycline 7 days or Azithromycin 1g single dose</td><td>—</td></tr> <tr><td>Bacterial vaginosis</td><td>Metronidazole 400mg BD x 5-7 days</td><td>Clindamycin vaginal</td></tr> <tr><td>Kala-azar (India)</td><td>Liposomal Amphotericin B</td><td>Miltefosine</td></tr> <tr><td>Cryptococcal meningitis (HIV)</td><td>Amphotericin B + Flucytosine (induction)</td><td>Fluconazole (consolidation)</td></tr></table> <div class="sub-header">8.2 DRUGS IN PREGNANCY <span class="tag">★ PYQ</span></div> <table><tr><th>Category</th><th>Safe Drugs</th></tr> <tr><td>Antibiotics</td><td>Penicillins, Cephalosporins, Azithromycin, Metronidazole (avoid 1st trimester)</td></tr> <tr><td>Antihypertensives</td><td>Methyldopa (1st line), Labetalol, Nifedipine, Hydralazine</td></tr> <tr><td>Anticoagulants</td><td>Heparin / LMWH (Warfarin CONTRAINDICATED)</td></tr> <tr><td>Antiepileptics</td><td>Lamotrigine, Levetiracetam (AVOID Valproate, Carbamazepine if possible)</td></tr> <tr><td>Asthma</td><td>All inhaled drugs (SABA, ICS, LABA) safe</td></tr> <tr><td>Thyroid</td><td>PTU (1st trimester), Carbimazole/MMI (2nd-3rd trimester)</td></tr></table> <table><tr><th>Drug to AVOID</th><th>Problem</th></tr> <tr><td>ACE inhibitors / ARBs</td><td>Fetal renal agenesis, oligohydramnios (2nd/3rd trimester)</td></tr> <tr><td>Tetracyclines</td><td>Dental discoloration, impaired bone growth</td></tr> <tr><td>Aminoglycosides</td><td>Ototoxicity</td></tr> <tr><td>Chloramphenicol (near term)</td><td>Grey baby syndrome (cardiovascular collapse)</td></tr> <tr><td>Sulphonamides (near term)</td><td>Neonatal jaundice (displaces bilirubin from albumin)</td></tr> <tr><td>Warfarin</td><td>Fetal warfarin syndrome (1st trimester), hemorrhage</td></tr> <tr><td>Valproate</td><td>Neural tube defects, foetal valproate syndrome, cognitive impairment</td></tr> <tr><td>Thalidomide</td><td>Phocomelia (limb defects)</td></tr> <tr><td>Isotretinoin</td><td>Severe teratogen — requires two forms of contraception</td></tr> <tr><td>NSAIDs (3rd trimester)</td><td>Premature closure of ductus arteriosus, oligohydramnios</td></tr></table> <div class="sub-header">8.3 DRUG SIDE EFFECTS QUICK REFERENCE <span class="tag">★ PYQ</span></div> <table><tr><th>Side Effect</th><th>Drug(s)</th><th>Notes</th></tr> <tr><td>Dry cough</td><td>ACE inhibitors (ALL)</td><td>Bradykinin accumulation; switch to ARB</td></tr> <tr><td>Angioedema</td><td>ACE inhibitors</td><td>Bradykinin mediated; can be life-threatening</td></tr> <tr><td>Gingival hyperplasia</td><td>Phenytoin, Cyclosporine, Nifedipine (PCN)</td><td>PCN mnemonic</td></tr> <tr><td>Lupus-like syndrome</td><td>Hydralazine, Procainamide, INH, Methyldopa</td><td>Anti-histone antibodies</td></tr> <tr><td>Pulmonary fibrosis</td><td>Amiodarone, Bleomycin, Methotrexate, Nitrofurantoin</td><td>ABMN</td></tr> <tr><td>Osteoporosis</td><td>Steroids (long-term), Heparin, Phenytoin</td><td>Give Ca + Vit D with steroids</td></tr> <tr><td>SJS/TEN</td><td>Allopurinol, Carbamazepine, Lamotrigine, Sulphonamides, Phenytoin</td><td>HLA-B*15:02 + carbamazepine in Asians</td></tr> <tr><td>Agranulocytosis</td><td>Carbimazole, Clozapine, Ticlopidine, Carbamazepine</td><td>Monitor WBC</td></tr> <tr><td>Hepatotoxicity</td><td>INH, Rifampicin, Pyrazinamide, Paracetamol, Statins</td><td>LFT monitoring for anti-TB</td></tr> <tr><td>Nephrotoxicity</td><td>Aminoglycosides, Cisplatin, NSAIDs, Amphotericin B, Vancomycin</td><td>ACNAV mnemonic</td></tr> <tr><td>Ototoxicity</td><td>Aminoglycosides (cochlear), Loop diuretics (Furosemide)</td><td>Synergistic when combined</td></tr> <tr><td>Peripheral neuropathy</td><td>INH, Metronidazole, Nitrofurantoin, Vincristine</td><td>Give B6 with INH</td></tr> <tr><td>Disulfiram-like reaction</td><td>Metronidazole, Chlorpropamide, Griseofulvin</td><td>Avoid alcohol</td></tr> <tr><td>Photosensitivity</td><td>Tetracyclines, Fluoroquinolones, Amiodarone, Chlorpromazine</td><td>TQAC</td></tr> <tr><td>QT prolongation</td><td>Amiodarone, Sotalol, Haloperidol, Erythromycin</td><td>Risk of Torsades de Pointes</td></tr> <tr><td>Gynecomastia</td><td>Spironolactone, Cimetidine, Digoxin, Ketoconazole, Estrogens</td><td>SCOKE</td></tr> <tr><td>SIADH</td><td>Carbamazepine, SSRIs, Cyclophosphamide, Vincristine</td><td>Hyponatremia</td></tr> <tr><td>Hyperuricemia/Gout</td><td>Thiazides, Pyrazinamide, Ethambutol, Cyclosporine</td><td>TPEC</td></tr> <tr><td>Rhabdomyolysis</td><td>Statins (esp. with fibrates), Alcohol, Cocaine</td><td>Check CK, myoglobinuria</td></tr></table> <div class="sub-header">8.4 ENZYME INDUCERS & INHIBITORS</div> <div class="imp">INDUCERS — "CRAP GPS" (REDUCE drug levels): Carbamazepine, Rifampicin, Alcohol (chronic), Phenytoin, Griseofulvin, Phenobarbitone, St. John's Wort</div> <div class="imp">INHIBITORS — "DEVICES" (INCREASE drug levels → toxicity): Diltiazem, Erythromycin/Clarithromycin, Verapamil, Isoniazid, Cimetidine, Erythromycin, Sodium valproate + Grapefruit, Ketoconazole, Fluconazole</div> <div class="sub-header">8.5 DRUG ANTIDOTES <span class="tag">★ PYQ</span></div> <table><tr><th>Poison/Drug</th><th>Antidote</th></tr> <tr><td>Paracetamol (acetaminophen)</td><td>N-acetylcysteine (NAC) — within 8-24 hrs</td></tr> <tr><td>Opioids</td><td>Naloxone IV/IM/intranasal</td></tr> <tr><td>Benzodiazepines</td><td>Flumazenil</td></tr> <tr><td>Warfarin</td><td>Vitamin K; FFP (urgent); 4-factor PCC</td></tr> <tr><td>Heparin</td><td>Protamine sulfate</td></tr> <tr><td>Digoxin</td><td>Digoxin-specific antibody fragments (Digibind)</td></tr> <tr><td>Organophosphates</td><td>Atropine (large doses) + Pralidoxime (2-PAM) if given early</td></tr> <tr><td>Carbon monoxide</td><td>100% O₂; Hyperbaric O₂ for severe</td></tr> <tr><td>Cyanide</td><td>Hydroxocobalamin (1st line); Sodium thiosulfate + Sodium nitrite</td></tr> <tr><td>Iron</td><td>Deferoxamine IV/IM</td></tr> <tr><td>Lead</td><td>DMSA oral (children); EDTA IV (severe)</td></tr> <tr><td>Methanol / Ethylene glycol</td><td>Fomepizole (ADH inhibitor); Ethanol; Folate (methanol)</td></tr> <tr><td>TCA overdose</td><td>IV Sodium bicarbonate (for arrhythmias)</td></tr> <tr><td>Beta-blocker overdose</td><td>Glucagon (1st line); Calcium gluconate; High-dose insulin</td></tr> <tr><td>CCB overdose</td><td>Calcium gluconate 10% IV; High-dose insulin + glucose</td></tr> <tr><td>Methemoglobinemia</td><td>Methylene blue 1-2 mg/kg IV</td></tr></table> <div class="sec-header">BONUS: MNEMONICS & QUICK REMINDERS</div> <div class="imp">Jones Criteria Major (CASPE): Carditis, Arthritis (migratory), Sydenham's chorea, subcutaneous (Pea-sized) nodules, Erythema marginatum</div> <div class="imp">HF drugs improving MORTALITY: ACEi + Beta-blocker + MRA + SGLT2i + Sacubitril-Valsartan (NOT diuretics)</div> <div class="imp">Ranson's on admission (GA LAW): Glucose>200, Age>55, LDH>350, AST>250, WBC>16,000</div> <div class="imp">CURB-65: Confusion, Urea>7, RR≥30, BP low (SBP<90), 65+ years</div> <div class="imp">CHA₂DS₂-VASc: CHF, HTN, Age≥75(×2), DM, Stroke(×2), Vascular disease, Age 65-74, Sex (female)</div> <div class="imp">Drugs causing SJS/TEN (CALPS): Carbamazepine, Allopurinol, Lamotrigine, Phenytoin, Sulphonamides</div> <div class="imp">Killip: I=No HF(6%), II=S3/crepitations(17%), III=Pulm oedema(38%), IV=Cardiogenic shock(81%)</div> <div class="imp">GOLD COPD FEV1: G1≥80%, G2=50-79%, G3=30-49%, G4<30%</div> <br><br> <div style="text-align:center;color:#757575;font-size:12px;border-top:1px solid #c5cae9;padding-top:10px;margin-top:20px;"> UPSC CMS 2026 | Medicine + Pharmacology Notes | Exam: August 2, 2026<br> <b style="color:#1a237e;">Study hard, stay consistent. 3 weeks is enough!</b> </div> </div> </body> </html> HTMLEOF echo "Medicine HTML done"
cat > /home/daytona/workspace/upsc-cms-notes/02_Surgery.html << 'HTMLEOF' <!DOCTYPE html> <html lang="en"> <head> <meta charset="UTF-8"> <meta name="viewport" content="width=device-width, initial-scale=1.0"> <title>UPSC CMS 2026 - Surgery</title> <style> body{font-family:'Segoe UI',Arial,sans-serif;margin:0;padding:0;background:#f5f5f5;color:#212121;font-size:14px;} .cover{background:linear-gradient(135deg,#1b5e20,#2e7d32);color:#fff;text-align:center;padding:60px 20px;} .cover h1{font-size:2.2em;margin:0 0 10px;} .cover h2{font-size:1.5em;margin:0 0 8px;color:#c8e6c9;} .cover p{font-size:1.1em;color:#a5d6a7;margin:4px 0;} .container{max-width:900px;margin:0 auto;padding:16px;} .sec-header{background:#1b5e20;color:#fff;padding:10px 16px;border-radius:6px;margin:24px 0 10px;font-size:1.2em;font-weight:bold;} .sub-header{background:#388e3c;color:#fff;padding:7px 14px;border-radius:4px;margin:16px 0 8px;font-size:1.05em;font-weight:bold;} .sub2{color:#1b5e20;font-size:1em;font-weight:bold;margin:12px 0 4px;border-left:4px solid #388e3c;padding-left:8px;} table{width:100%;border-collapse:collapse;margin:10px 0;font-size:13px;} th{background:#388e3c;color:#fff;padding:7px 8px;text-align:left;} td{padding:6px 8px;border:1px solid #c8e6c9;vertical-align:top;} tr:nth-child(even) td{background:#e8f5e9;} tr:nth-child(odd) td{background:#fff;} ul{margin:4px 0 8px 18px;padding:0;} li{margin:3px 0;line-height:1.5;} .imp{color:#b71c1c;font-weight:bold;background:#fff8f8;border-left:4px solid #b71c1c;padding:5px 10px;margin:6px 0;border-radius:0 4px 4px 0;} .note{color:#4a148c;font-style:italic;background:#f3e5f5;border-left:4px solid #7b1fa2;padding:5px 10px;margin:6px 0;} .tag{display:inline-block;background:#e8f5e9;color:#1b5e20;border-radius:3px;padding:1px 6px;font-size:11px;font-weight:bold;margin-left:4px;} @media print{body{background:#fff;font-size:12px;} th,.sec-header,.sub-header{-webkit-print-color-adjust:exact;print-color-adjust:exact;}} </style> </head> <body> <div class="cover"> <h1>UPSC CMS 2026</h1> <h2>HIGH-YIELD NOTES — PAPER 2</h2> <p style="font-size:1.3em;font-weight:bold;color:#fff;margin:12px 0;">Surgery (incl. ENT, Ophthalmology, Orthopaedics, Anaesthesia)</p> <p>Exam Date: <b>August 2, 2026</b></p> </div> <div class="container"> <div class="sec-header">SECTION 1: TRAUMA & EMERGENCY SURGERY</div> <div class="sub-header">1.1 ATLS PRIMARY SURVEY (ABCDE)</div> <table><tr><th>Step</th><th>Action</th></tr> <tr><td>A — Airway + C-spine</td><td>Chin-lift, jaw-thrust, oropharyngeal airway. Assume C-spine injury in any trauma. Intubate if GCS≤8.</td></tr> <tr><td>B — Breathing</td><td>Look for tension pneumothorax, open pneumothorax, massive hemothorax, flail chest. Give O2.</td></tr> <tr><td>C — Circulation</td><td>Control hemorrhage (direct pressure). 2 large-bore IVs. Fluid resuscitation. Check for cardiac tamponade.</td></tr> <tr><td>D — Disability (Neuro)</td><td>GCS, pupils (PEARL), blood glucose. Immobilize spine.</td></tr> <tr><td>E — Exposure/Environment</td><td>Fully expose patient. Prevent hypothermia (warm blankets, warmed fluids).</td></tr></table> <div class="sub-header">1.2 CHEST TRAUMA</div> <table><tr><th>Condition</th><th>Features</th><th>Immediate Management</th></tr> <tr><td>Tension Pneumothorax</td><td>Deviated trachea (AWAY from side), absent breath sounds, JVD, hypotension, tachycardia</td><td>NEEDLE DECOMPRESSION 2nd ICS MCL (don't wait for CXR) → chest tube 5th ICS AAL</td></tr> <tr><td>Open Pneumothorax</td><td>Sucking chest wound. Air enters with inspiration.</td><td>3-sided occlusive dressing → chest tube (separate site)</td></tr> <tr><td>Massive Hemothorax</td><td>Dull percussion, absent breath sounds, hypovolemia</td><td>Chest tube 5th ICS. If >1.5L initial or >200ml/hr → thoracotomy</td></tr> <tr><td>Cardiac Tamponade</td><td>Beck's triad: JVD + muffled heart sounds + hypotension. Kussmaul's sign (JVP rises on inspiration).</td><td>Pericardiocentesis. Definitive: pericardial window/thoracotomy</td></tr> <tr><td>Flail Chest</td><td>≥2 consecutive ribs fractured at ≥2 points. Paradoxical breathing.</td><td>Analgesia (epidural preferred), positive pressure ventilation if respiratory failure</td></tr></table> <div class="imp">Burns: Rule of Nines: Head 9%, Each arm 9%, Chest 9%, Abdomen 9%, Each thigh 9%, Each leg 9%, Perineum 1%. Parkland formula: 4ml × kg × % TBSA (Lactated Ringer's) — first HALF in 8 hours, second HALF in next 16 hours.</div> <div class="imp">Curling's ulcer: stress ulcer in burn patients (duodenum). Cushing's ulcer: stress ulcer in head injury patients (due to increased vagal tone).</div> <div class="sec-header">SECTION 2: GI SURGERY</div> <div class="sub-header">2.1 ACUTE ABDOMEN — SIGNS</div> <table><tr><th>Sign</th><th>Meaning</th></tr> <tr><td>Murphy's sign</td><td>Pain/arrest of inspiration on deep palpation of RUQ (cholecystitis)</td></tr> <tr><td>Rovsing's sign</td><td>Pain in RIF on palpation of LIF (appendicitis)</td></tr> <tr><td>Psoas sign</td><td>Pain on hip extension (retrocaecal appendicitis)</td></tr> <tr><td>Obturator sign</td><td>Pain on internal rotation of hip (pelvic appendicitis)</td></tr> <tr><td>Cullen's sign</td><td>Periumbilical bruising (severe acute pancreatitis, ruptured ectopic)</td></tr> <tr><td>Grey Turner's sign</td><td>Flank bruising (severe acute pancreatitis)</td></tr> <tr><td>Carnett's sign</td><td>Pain increases on tensing abdominal muscles (abdominal wall pain)</td></tr> <tr><td>Sister Mary Joseph nodule</td><td>Umbilical nodule — metastatic intra-abdominal cancer (gastric, ovarian)</td></tr></table> <div class="sub-header">2.2 APPENDICITIS — ALVARADO SCORE (MANTRELS) <span class="tag">★ PYQ</span></div> <table><tr><th>Feature</th><th>Points</th></tr> <tr><td>M — Migration of pain to RIF</td><td>1</td></tr> <tr><td>A — Anorexia</td><td>1</td></tr> <tr><td>N — Nausea/Vomiting</td><td>1</td></tr> <tr><td>T — Tenderness in RIF</td><td>2</td></tr> <tr><td>R — Rebound tenderness</td><td>1</td></tr> <tr><td>E — Elevated temperature (>37.3°C)</td><td>1</td></tr> <tr><td>L — Leukocytosis (>10,000)</td><td>2</td></tr> <tr><td>S — Shift of WBC to left (neutrophilia)</td><td>1</td></tr></table> <div class="imp">Score ≥7: likely appendicitis → surgery. Score 5-6: possible appendicitis → observe/CT. Score <5: appendicitis unlikely. Most common position: retrocaecal (65%). Treatment: laparoscopic appendicectomy.</div> <div class="sub-header">2.3 INTESTINAL OBSTRUCTION</div> <table><tr><th>Feature</th><th>Mechanical Obstruction</th><th>Paralytic Ileus</th></tr> <tr><td>Bowel sounds</td><td>High-pitched, tinkling, hyperactive (early)</td><td>Absent</td></tr> <tr><td>Pain</td><td>Colicky, intermittent</td><td>Mild, diffuse, constant</td></tr> <tr><td>Onset</td><td>Sudden</td><td>Gradual</td></tr> <tr><td>Cause</td><td>Adhesions (most common), hernia, volvulus, intussusception</td><td>Post-op, peritonitis, hypokalemia, drugs</td></tr> <tr><td>X-ray</td><td>Ladder pattern (multiple fluid levels)</td><td>Gaseous distension of all loops</td></tr></table> <div class="imp">Sigmoid volvulus: Coffee bean (bent inner tube) sign on plain X-ray. Treatment: flexible sigmoidoscopy/flatus tube decompression. Caecal volvulus: surgery. Intussusception in children: ileocaecal junction; currant jelly stools; treat with air enema (reduction) or surgery.</div> <div class="sub-header">2.4 HERNIA</div> <table><tr><th>Type</th><th>Key Features</th></tr> <tr><td>Indirect inguinal</td><td>Most common hernia. Goes through deep inguinal ring, inguinal canal, superficial ring. Lateral to inferior epigastric vessels. Congenital patent processus vaginalis.</td></tr> <tr><td>Direct inguinal</td><td>Through Hesselbach's triangle (medial to inferior epigastric vessels, above inguinal ligament). Acquired, elderly men.</td></tr> <tr><td>Femoral</td><td>Below and lateral to pubic tubercle. More common in women. HIGH risk of strangulation — always repair.</td></tr> <tr><td>Richter's hernia</td><td>Only part of bowel wall herniated (antimesenteric border). Can strangulate without obstruction.</td></tr> <tr><td>Maydl's hernia (W hernia)</td><td>Two loops of bowel in sac; middle loop inside abdomen → strangulates internally</td></tr> <tr><td>Littre's hernia</td><td>Contains Meckel's diverticulum in the sac</td></tr></table> <div class="sub-header">2.5 COLORECTAL CANCER</div> <table><tr><th>Dukes Stage</th><th>TNM Equivalent</th><th>Features</th><th>5-yr Survival</th></tr> <tr><td>A</td><td>T1-2 N0 M0</td><td>Confined to bowel wall</td><td>90%</td></tr> <tr><td>B</td><td>T3-4 N0 M0</td><td>Through bowel wall, no nodes</td><td>65%</td></tr> <tr><td>C</td><td>Any T, N1-2 M0</td><td>Regional lymph node metastasis</td><td>35%</td></tr> <tr><td>D</td><td>Any T, Any N, M1</td><td>Distant metastasis</td><td>5%</td></tr></table> <div class="imp">FAP (Familial Adenomatous Polyposis): APC gene mutation. >100 polyps. 100% malignant potential by age 40. Prophylactic colectomy. HNPCC/Lynch syndrome: MLH1, MSH2 mutations. Amsterdam criteria. Right-sided colon cancers. Colonoscopy screening.</div> <ul> <li>Virchow's node: left supraclavicular lymph node — metastasis from GI cancers</li> <li>Krukenberg tumor: bilateral ovarian metastasis from gastric/colorectal cancer (mucin-producing)</li> <li>Screening: colonoscopy at age 45 (average risk) or 10 years before youngest family member's age of diagnosis</li> </ul> <div class="sub-header">2.6 ANORECTAL CONDITIONS</div> <table><tr><th>Haemorrhoid Grade</th><th>Features</th><th>Treatment</th></tr> <tr><td>Grade I</td><td>Bleeding only, does not prolapse</td><td>Dietary fibre, lifestyle</td></tr> <tr><td>Grade II</td><td>Prolapse on straining, reduces spontaneously</td><td>Injection sclerotherapy, rubber band ligation</td></tr> <tr><td>Grade III</td><td>Prolapse requires manual reduction</td><td>Rubber band ligation, haemorrhoidectomy</td></tr> <tr><td>Grade IV</td><td>Irreducible prolapse</td><td>Haemorrhoidectomy</td></tr></table> <div class="imp">Anal fissure: Most common site — posterior midline. Spasm of internal sphincterotomy. DOC: GTN ointment/Diltiazem gel. Definitive: lateral internal sphincterotomy. If anterior midline fissure in female → suspect Crohn's/TB.</div> <div class="sec-header">SECTION 3: BREAST SURGERY</div> <div class="sub-header">3.1 BREAST CARCINOMA</div> <ul> <li>Risk factors: BRCA1/BRCA2 mutations, early menarche, late menopause, nulliparity, HRT, alcohol, obesity</li> <li>Triple assessment: Clinical examination + Imaging (USG/Mammography) + Biopsy (FNAC/core biopsy)</li> <li>Most common type: Invasive ductal carcinoma (IDC) — 75%</li> <li>Paget's disease of nipple: eczema-like rash of nipple-areola → always associated with underlying ductal carcinoma. Toker cells (CK7+) in epidermis.</li> </ul> <table><tr><th>Surgery</th><th>Criteria</th></tr> <tr><td>Breast Conserving Surgery (BCS/Lumpectomy)</td><td>Single tumor <4cm, no skin/chest wall involvement, no multifocal disease, patient preference, adequate margin achievable</td></tr> <tr><td>Modified Radical Mastectomy (MRM)</td><td>Large tumors, multifocal, prior RT, patient preference, positive margins after BCS</td></tr></table> <div class="imp">BCS must ALWAYS be followed by radiotherapy. Sentinel lymph node biopsy (SLNB) to assess axilla — avoids routine axillary clearance and its complications (lymphedema).</div> <div class="sec-header">SECTION 4: THYROID AND PARATHYROID</div> <div class="sub-header">4.1 THYROID CANCER</div> <table><tr><th>Type</th><th>% Cases</th><th>Key Features</th><th>Prognosis</th></tr> <tr><td>Papillary</td><td>70-80%</td><td>Psammoma bodies, Orphan Annie nuclei, BRAF mutation. Lymph node spread common.</td><td>Excellent (20-yr survival >95%)</td></tr> <tr><td>Follicular</td><td>10-15%</td><td>Capsular + vascular invasion. Hematogenous spread (bone, lung). FNA cannot diagnose (need histology).</td><td>Good</td></tr> <tr><td>Medullary</td><td>5-10%</td><td>Parafollicular C-cells → calcitonin. Associated with MEN2A and MEN2B. RET mutation.</td><td>Intermediate</td></tr> <tr><td>Anaplastic</td><td><5%</td><td>Elderly, rapidly growing mass, invades trachea/esophagus</td><td>Very poor (median survival 6 months)</td></tr></table> <div class="imp">MEN1 (Wermer): Pituitary + Parathyroid + Pancreatic islet cell tumors. MEN2A (Sipple): Medullary thyroid cancer + Pheochromocytoma + Parathyroid. MEN2B: Medullary thyroid + Pheo + Marfanoid habitus + Mucosal neuromas.</div> <ul> <li>Primary hyperparathyroidism: Stones (renal), Bones (osteitis fibrosa cystica), Groans (GI: constipation, peptic ulcer), Psychic moans (depression, psychosis)</li> <li>Management: Surgical parathyroidectomy</li> </ul> <div class="sec-header">SECTION 5: UROLOGY</div> <div class="sub-header">5.1 BENIGN PROSTATIC HYPERPLASIA (BPH)</div> <ul> <li>IPSS score: mild ≤7, moderate 8-19, severe ≥20. Quality of life score 0-6.</li> <li>Medical: Alpha-1 blockers (Tamsulosin — most used, uroselective) + 5-alpha reductase inhibitors (Finasteride — shrinks prostate, used for large prostates)</li> <li>Surgical: TURP (transurethral resection of prostate) — gold standard</li> <li>TURP syndrome: dilutional hyponatremia from irrigation fluid absorption (symptoms: nausea, confusion, visual disturbance)</li> </ul> <div class="sub-header">5.2 RENAL AND BLADDER TUMORS</div> <table><tr><th>Tumor</th><th>Features</th><th>Treatment</th></tr> <tr><td>Renal Cell Carcinoma (RCC)</td><td>Classic triad: hematuria + flank pain + flank mass (only 10% have all 3). Left-sided varicocele (RCC invades left renal vein → blocks testicular vein). Paraneoplastic: polycythemia (EPO), hypercalcemia, HTN.</td><td>Radical nephrectomy. Targeted therapy (Sunitinib, Sorafenib) for metastatic.</td></tr> <tr><td>Bladder cancer</td><td>Most common type: Transitional cell carcinoma (TCC/urothelial). Strongest risk factor: SMOKING. Painless hematuria. Schistosoma haematobium → squamous cell carcinoma.</td><td>TURBT (transurethral resection) for staging. Intravesical BCG for high-grade non-muscle invasive. Radical cystectomy for muscle-invasive.</td></tr></table> <div class="sub-header">5.3 UROLITHIASIS</div> <table><tr><th>Stone Type</th><th>Radiopacity</th><th>Cause</th><th>Notes</th></tr> <tr><td>Calcium oxalate</td><td>Radiopaque (most common)</td><td>Hyperoxaluria, hypercalciuria</td><td>Envelope-shaped crystals</td></tr> <tr><td>Uric acid</td><td>RADIOLUCENT</td><td>Gout, hyperuricemia</td><td>Alkalinize urine (sodium bicarbonate)</td></tr> <tr><td>Struvite (MgNH4PO4)</td><td>Radiopaque</td><td>Urease-producing bacteria (Proteus, Klebsiella)</td><td>Staghorn calculi, chronic UTI</td></tr> <tr><td>Cystine</td><td>Faintly opaque</td><td>Cystinuria (autosomal recessive)</td><td>Hexagonal crystals</td></tr></table> <div class="imp">Testicular tumors: Seminoma (homogeneous, very radiosensitive, AFP NOT raised, beta-hCG sometimes raised). NSGCT (AFP raised in most, beta-hCG raised). Retroperitoneal lymph node dissection ± chemo. Orchidectomy is first step always.</div> <div class="sec-header">SECTION 6: ENT</div> <div class="sub-header">6.1 EAR</div> <table><tr><th>Feature</th><th>Tubotympanic CSOM (Safe)</th><th>Atticoantral CSOM (Unsafe)</th></tr> <tr><td>Location</td><td>Anteroinferior (central) perforation</td><td>Attic/postero-superior marginal perforation</td></tr> <tr><td>Discharge</td><td>Profuse, mucoid, non-offensive</td><td>Scanty, purulent, FOUL-SMELLING</td></tr> <tr><td>Cholesteatoma</td><td>Absent</td><td>PRESENT</td></tr> <tr><td>Intracranial complication</td><td>Rare</td><td>COMMON (meningitis, brain abscess)</td></tr> <tr><td>Treatment</td><td>Aural toilet + antibiotics; myringoplasty</td><td>Surgery (mastoidectomy) — NO conservative treatment</td></tr></table> <div class="sub2">Tuning Fork Tests <span class="tag">★ PYQ</span></div> <table><tr><th>Test</th><th>Normal</th><th>Conductive Hearing Loss</th><th>SNHL</th></tr> <tr><td>Rinne test</td><td>AC > BC (Rinne positive)</td><td>BC > AC (Rinne NEGATIVE)</td><td>AC > BC (Rinne positive but reduced)</td></tr> <tr><td>Weber test</td><td>Heard in middle (no lateralization)</td><td>Lateralizes to AFFECTED ear</td><td>Lateralizes to BETTER ear</td></tr></table> <div class="imp">Cholesteatoma: keratinizing squamous epithelium in middle ear. Erodes ossicles, mastoid, tegmen. Risk of: facial nerve palsy, labyrinthine fistula, meningitis, brain abscess. Treatment: mastoidectomy (surgical).</div> <ul> <li>Epistaxis: Anterior (Kiesselbach's plexus = Little's area): direct pressure, chemical cautery. Posterior: nasal packing, Foley catheter, embolization.</li> <li>Tonsillectomy indications (Paradise criteria): 7 episodes/year x1 year, OR 5/year x2 years, OR 3/year x3 years</li> </ul> <div class="sub-header">6.2 VERTIGO</div> <table><tr><th>Condition</th><th>Features</th><th>Diagnosis/Treatment</th></tr> <tr><td>BPPV</td><td>Brief episodes of positional vertigo (<1 min). Most common cause of vertigo.</td><td>Dix-Hallpike test (positive = rotational nystagmus). Treatment: Epley maneuver (particle repositioning).</td></tr> <tr><td>Menière's disease</td><td>Triad: episodic vertigo + tinnitus + SNHL. Endolymphatic hydrops. Lasts 20min-24hrs.</td><td>Low-salt diet, diuretics (acetazolamide), betahistine. Severe: endolymphatic sac decompression.</td></tr> <tr><td>Labyrinthitis</td><td>Sudden vertigo + hearing loss + tinnitus. Often post-viral.</td><td>Vestibular suppressants (prochlorperazine, betahistine). Steroids if severe.</td></tr> <tr><td>Acoustic neuroma</td><td>Unilateral SNHL + tinnitus + vertigo. CPA angle tumor (Schwannoma of CN VIII).</td><td>MRI gadolinium. Treatment: surgery (microsurgery or radiosurgery).</td></tr></table> <div class="sub-header">6.3 LARYNGEAL CANCER</div> <table><tr><th>Type</th><th>Location</th><th>Presentation</th><th>Prognosis</th></tr> <tr><td>Glottic</td><td>True vocal cords</td><td>Early hoarseness (symptom comes early)</td><td>BEST (no lymphatics at cords level)</td></tr> <tr><td>Supraglottic</td><td>Above cords</td><td>Dysphagia, late hoarseness</td><td>Intermediate</td></tr> <tr><td>Subglottic</td><td>Below cords</td><td>Late presentation, airway obstruction</td><td>Worst</td></tr></table> <div class="sec-header">SECTION 7: OPHTHALMOLOGY</div> <div class="sub-header">7.1 GLAUCOMA <span class="tag">★ PYQ</span></div> <table><tr><th>Feature</th><th>Open Angle (POAG)</th><th>Angle Closure (PACG)</th></tr> <tr><td>Onset</td><td>Insidious, painless</td><td>Acute, painful red eye</td></tr> <tr><td>Symptoms</td><td>Gradual visual field loss (tunnel vision)</td><td>Halos around lights, severe headache, nausea, vomiting</td></tr> <tr><td>Pupil</td><td>Normal</td><td>Mid-dilated, fixed</td></tr> <tr><td>IOP</td><td>Elevated (>21 mmHg)</td><td>Very high (40-70 mmHg)</td></tr> <tr><td>Cup:disc ratio</td><td>>0.6 (normal <0.4)</td><td>Normal until late</td></tr> <tr><td>Treatment</td><td>Timolol (BB), Latanoprost (prostaglandin), Brimonidine; Trabeculectomy</td><td>EMERGENCY: IV Acetazolamide + Pilocarpine + Timolol. Laser iridotomy (definitive)</td></tr></table> <div class="imp">Pilocarpine mechanism: miosis (pupillary constriction) → opens trabecular meshwork → increases aqueous drainage. Contraindicated in POAG with peripheral anterior synechiae.</div> <div class="sub-header">7.2 DIABETIC RETINOPATHY <span class="tag">★ PYQ</span></div> <table><tr><th>Stage</th><th>Features</th><th>Treatment</th></tr> <tr><td>NPDR (Non-proliferative)</td><td>Microaneurysms (earliest), dot-blot hemorrhages, hard exudates, cotton wool spots, venous beading</td><td>Optimal glycemic control; treat CSME with anti-VEGF or laser</td></tr> <tr><td>PDR (Proliferative)</td><td>Neovascularization (new vessels on disc/elsewhere) → vitreous hemorrhage, tractional retinal detachment</td><td>Pan-retinal photocoagulation (PRP). Anti-VEGF (ranibizumab, bevacizumab).</td></tr></table> <div class="imp">Diabetic Macular Edema (DME) = most common cause of visual loss in diabetic retinopathy. CSME (Clinically Significant Macular Edema) → Anti-VEGF injections.</div> <div class="sub-header">7.3 OTHER EYE CONDITIONS</div> <table><tr><th>Condition</th><th>Key Features</th><th>Treatment</th></tr> <tr><td>Cataract</td><td>Gradual painless blurring. Nuclear (myopic shift), Cortical, Posterior subcapsular (worst visual symptoms; steroids, DM, radiation).</td><td>Phacoemulsification + IOL implant</td></tr> <tr><td>Retinal detachment (Rhegmatogenous)</td><td>Flashes of light + floaters + curtain defect in visual field. EMERGENCY.</td><td>Pneumatic retinopexy / scleral buckle / vitrectomy</td></tr> <tr><td>AMD (Wet)</td><td>Sudden central vision loss in elderly. CNVM (choroidal neovascularization). Metamorphopsia (distorted vision).</td><td>Anti-VEGF injections (Ranibizumab, Bevacizumab, Aflibercept)</td></tr> <tr><td>AMD (Dry)</td><td>Gradual central vision loss. Drusen deposits. Geographic atrophy.</td><td>AREDS vitamins (Vit C, E, Zinc, Copper, Lutein)</td></tr> <tr><td>Anterior Uveitis</td><td>Painful red eye, photophobia, ciliary flush, keratic precipitates (KPs), flare and cells in AC. HLA-B27 association.</td><td>Topical steroids + cycloplegics (atropine)</td></tr> <tr><td>Corneal ulcer (Herpetic)</td><td>Dendritic ulcer (branching pattern) with Rose Bengal staining. HSV-1.</td><td>Topical Aciclovir (Acyclovir) ointment. NO steroids (worsen HSV).</td></tr></table> <div class="sec-header">SECTION 8: ORTHOPAEDICS</div> <div class="sub-header">8.1 FRACTURE HEALING</div> <ul> <li>Stages: Haematoma formation → Fibrocartilaginous callus (soft callus, 2-3 weeks) → Bony callus (hard callus, 3-4 months) → Remodelling (years)</li> <li>Callus NOT seen in fractures treated by rigid internal fixation (direct bone healing)</li> </ul> <div class="sub-header">8.2 COMMON FRACTURES <span class="tag">★ PYQ</span></div> <table><tr><th>Fracture</th><th>Deformity</th><th>Mechanism</th><th>Key Point</th></tr> <tr><td>Colles' fracture</td><td>Dinner fork deformity (dorsal angulation)</td><td>FOOSH (fall on outstretched hand)</td><td>Distal radius, 2.5cm from wrist. Most common wrist fracture.</td></tr> <tr><td>Smith's fracture</td><td>Garden spade deformity (volar angulation)</td><td>Fall on dorsum of hand</td><td>Reverse Colles'. Volar Barton's variant.</td></tr> <tr><td>Scaphoid fracture</td><td>—</td><td>FOOSH</td><td>Anatomical snuffbox tenderness. Risk of AVN (proximal pole). Thumb spica cast. X-ray may be normal initially — treat as fracture if clinical suspicion.</td></tr> <tr><td>NOF fracture</td><td>Shortened, externally rotated leg</td><td>Elderly osteoporotic + fall</td><td>Garden I & II (undisplaced): DHS/cannulated screws. Garden III & IV (displaced): Hemiarthroplasty (elderly) or THR.</td></tr> <tr><td>Monteggia</td><td>—</td><td>Fall</td><td>Proximal ULNA fracture + Radial HEAD dislocation. "MontUlna" mnemonic.</td></tr> <tr><td>Galeazzi</td><td>—</td><td>Fall</td><td>Radial shaft fracture + Distal radio-ulnar joint dislocation. "GAleazzi = GA = distal RADial."</td></tr> <tr><td>Pott's fracture</td><td>—</td><td>Forced eversion</td><td>Bimalleolar ankle fracture</td></tr></table> <div class="imp">Compartment Syndrome — 6 P's: Pain (out of proportion, on passive stretch), Pressure, Pallor, Paresthesia, Paralysis, Pulselessness. Treatment: EMERGENCY FASCIOTOMY. Do not wait for all 6 P's.</div> <div class="sub-header">8.3 OSTEOMYELITIS</div> <table><tr><th>Type</th><th>Age</th><th>Organism</th><th>X-ray Features</th></tr> <tr><td>Acute haematogenous</td><td>Children (metaphysis)</td><td>Staph aureus (most common); Salmonella in sickle cell disease; Group B strep in neonates</td><td>Normal initially; periosteal elevation after 10 days</td></tr> <tr><td>Chronic</td><td>Any age</td><td>Staph aureus; mixed in adults</td><td>Involucrum (new bone), sequestrum (dead bone), cloaca (sinus)</td></tr> <tr><td>Brodie's abscess</td><td>Young adults</td><td>Staph aureus</td><td>Sclerotic rim around lucent area in metaphysis</td></tr></table> <div class="sub-header">8.4 BONE TUMORS <span class="tag">★ PYQ</span></div> <table><tr><th>Tumor</th><th>Age</th><th>Location</th><th>X-ray</th><th>Treatment</th></tr> <tr><td>Osteosarcoma</td><td>10-20 yrs</td><td>Metaphysis (distal femur > proximal tibia)</td><td>Codman's triangle + sunburst pattern</td><td>Neoadjuvant chemo (MAP) + limb salvage surgery</td></tr> <tr><td>Ewing's sarcoma</td><td>5-15 yrs</td><td>Diaphysis (flat bones too)</td><td>Onion-peel (lamellated periosteal reaction)</td><td>Chemo + RT ± surgery. t(11;22) translocation. Small round blue cells.</td></tr> <tr><td>Giant cell tumor (GCT)</td><td>20-40 yrs</td><td>Epiphysis (distal femur, proximal tibia)</td><td>Soap bubble appearance. Extends to subchondral bone.</td><td>Curettage + bone cement. Locally aggressive (rarely malignant).</td></tr> <tr><td>Chondrosarcoma</td><td>40-60 yrs</td><td>Pelvis, proximal femur</td><td>Endosteal scalloping, calcification (popcorn/ring-arc)</td><td>Wide surgical resection. Chemotherapy-RESISTANT.</td></tr></table> <div class="sub-header">8.5 SPINE</div> <ul> <li>PIVD (Prolapsed Intervertebral Disc): Most common levels — L4-L5 (L5 root: weak ankle dorsiflexion, decreased sensation lateral leg/dorsal foot) and L5-S1 (S1 root: weak plantarflexion, decreased Achilles reflex)</li> <li>Ankylosing Spondylitis: HLA-B27, bamboo spine, sacroiliitis (earliest change), uveitis, aortitis. Treat: NSAIDs + physiotherapy + anti-TNF biologics</li> <li>Spinal cord injury: ASIA classification (A-E). Anterior cord syndrome (preserved proprioception), Central cord syndrome (weak arms > legs), Brown-Séquard (ipsilateral motor + proprioception loss, contralateral pain/temp loss)</li> </ul> <div class="sec-header">SECTION 9: ANAESTHESIA HIGH YIELDS</div> <div class="sub-header">9.1 STAGES OF GENERAL ANAESTHESIA (Guedel)</div> <table><tr><th>Stage</th><th>Features</th></tr> <tr><td>Stage I — Analgesia</td><td>Conscious, sense of pain reduced, reflexes intact</td></tr> <tr><td>Stage II — Excitement (AVOID)</td><td>Unconscious but excitable, irregular breathing, risk of laryngospasm, vomiting. Do NOT operate.</td></tr> <tr><td>Stage III — Surgical anaesthesia</td><td>Planes 1-4: deepening loss of reflexes. Plane 2 (ideal for surgery): loss of eyelid reflex, regular breathing.</td></tr> <tr><td>Stage IV — Medullary depression (DANGER)</td><td>Apnea, cardiovascular collapse. Overdose.</td></tr></table> <div class="sub-header">9.2 INDUCTION AND VOLATILE AGENTS <span class="tag">★ PYQ</span></div> <table><tr><th>Drug</th><th>Type</th><th>Key Use</th><th>Side Effects</th></tr> <tr><td>Propofol</td><td>IV induction</td><td>Most commonly used induction agent; also for sedation/TIVA</td><td>Hypotension, pain on injection, apnea. Propofol infusion syndrome (rare, prolonged high-dose).</td></tr> <tr><td>Thiopentone (Thiopental)</td><td>IV induction (barbiturate)</td><td>Decreases ICP — good for head injury</td><td>Hypotension; NOT analgesic; porphyria contraindication</td></tr> <tr><td>Ketamine</td><td>IV dissociative</td><td>Hemorrhagic shock (maintains BP); pediatric ketamine; burn dressing</td><td>INCREASES ICP and BP — AVOID in head injury. Emergence reactions (hallucinations) — give benzodiazepine.</td></tr> <tr><td>Halothane</td><td>Volatile (inhaled)</td><td>Smooth induction (good for pediatric)</td><td>Hepatotoxicity (halothane hepatitis), TRIGGER for malignant hyperthermia</td></tr> <tr><td>Isoflurane</td><td>Volatile</td><td>Most widely used volatile agent</td><td>Coronary steal syndrome (theoretical)</td></tr> <tr><td>Sevoflurane</td><td>Volatile</td><td>Smooth induction, pediatric</td><td>Compound A (nephrotoxic in theory); fluoride release</td></tr> <tr><td>Desflurane</td><td>Volatile</td><td>Fastest recovery, day-surgery</td><td>Pungent — not for inhalation induction. Airway irritant.</td></tr></table> <div class="sub-header">9.3 MUSCLE RELAXANTS <span class="tag">★ PYQ</span></div> <table><tr><th>Drug</th><th>Type</th><th>Key Features</th></tr> <tr><td>Succinylcholine (Suxamethonium)</td><td>Depolarizing (only one)</td><td>FASTEST onset (60 sec), shortest duration (10-15 min). Used for RSI (rapid sequence intubation). Causes hyperkalemia (AVOID in burns, crush, denervation). Suxamethonium apnea in pseudocholinesterase deficiency (prolonged paralysis). Malignant hyperthermia trigger.</td></tr> <tr><td>Vecuronium, Rocuronium</td><td>Non-depolarizing (steroidal)</td><td>Intermediate duration. Reversed by Neostigmine (+ atropine to prevent bradycardia) or Sugammadex (for rocuronium specifically).</td></tr> <tr><td>Atracurium, Cisatracurium</td><td>Non-depolarizing (benzylisoquinolinium)</td><td>Hofmann elimination (liver/kidney independent). Safe in organ failure. Histamine release (atracurium).</td></tr> <tr><td>Mivacurium</td><td>Non-depolarizing (short-acting)</td><td>Metabolized by plasma cholinesterase (prolonged in pseudocholinesterase deficiency)</td></tr></table> <div class="imp">Malignant Hyperthermia: Triggered by volatile anaesthetics + succinylcholine. Hypermetabolic crisis: severe hyperthermia, muscle rigidity, rhabdomyolysis, metabolic acidosis. TREATMENT: DANTROLENE (only specific drug). Stop triggering agent, 100% O2, cooling, treat acidosis.</div> <div class="sub-header">9.4 LOCAL ANAESTHETICS</div> <ul> <li>Mechanism: block voltage-gated Na+ channels → prevent depolarization</li> <li>Esters: Cocaine, Procaine, Tetracaine (metabolized by plasma cholinesterase)</li> <li>Amides: Lidocaine, Bupivacaine, Ropivacaine (metabolized by liver)</li> <li>Adrenaline added to LA: prolongs duration, reduces systemic absorption, reduces bleeding</li> </ul> <div class="imp">Do NOT add adrenaline to LA for: ring blocks of digits (fingers, toes), penis, pinna, tip of nose — risk of ischemic necrosis due to vasoconstriction of end arteries. Max dose: Lidocaine plain 3-4 mg/kg, with adrenaline 7 mg/kg. Bupivacaine max 2 mg/kg (no adrenaline doesn't change much — more cardiotoxic).</div> <table><tr><th>LA Toxicity</th><th>Sequence</th></tr> <tr><td>CNS (first)</td><td>Perioral tingling, tinnitus, metallic taste, confusion, seizures</td></tr> <tr><td>CVS (later)</td><td>Hypotension, arrhythmias, cardiac arrest. Bupivacaine = most cardiotoxic.</td></tr></table> <div class="imp">Treatment of LA toxicity: IV Lipid emulsion (Intralipid 20%) — lipid sink mechanism. Supportive care, treat seizures with benzodiazepines.</div> <br><br> <div style="text-align:center;color:#757575;font-size:12px;border-top:1px solid #c8e6c9;padding-top:10px;margin-top:20px;"> UPSC CMS 2026 | Surgery + ENT + Ophthalmology + Orthopaedics + Anaesthesia Notes | Exam: August 2, 2026<br> <b style="color:#1b5e20;">Keep going — you're building your rank!</b> </div> </div> </body> </html> HTMLEOF echo "Surgery HTML done"
cat > /home/daytona/workspace/upsc-cms-notes/03_OBG.html << 'HTMLEOF' <!DOCTYPE html> <html lang="en"> <head> <meta charset="UTF-8"> <meta name="viewport" content="width=device-width, initial-scale=1.0"> <title>UPSC CMS 2026 - OBG</title> <style> body{font-family:'Segoe UI',Arial,sans-serif;margin:0;padding:0;background:#f5f5f5;color:#212121;font-size:14px;} .cover{background:linear-gradient(135deg,#880e4f,#ad1457);color:#fff;text-align:center;padding:60px 20px;} .cover h1{font-size:2.2em;margin:0 0 10px;} .cover h2{font-size:1.5em;margin:0 0 8px;color:#f8bbd0;} .cover p{font-size:1.1em;color:#f48fb1;margin:4px 0;} .container{max-width:900px;margin:0 auto;padding:16px;} .sec-header{background:#880e4f;color:#fff;padding:10px 16px;border-radius:6px;margin:24px 0 10px;font-size:1.2em;font-weight:bold;} .sub-header{background:#c2185b;color:#fff;padding:7px 14px;border-radius:4px;margin:16px 0 8px;font-size:1.05em;font-weight:bold;} .sub2{color:#880e4f;font-size:1em;font-weight:bold;margin:12px 0 4px;border-left:4px solid #c2185b;padding-left:8px;} table{width:100%;border-collapse:collapse;margin:10px 0;font-size:13px;} th{background:#c2185b;color:#fff;padding:7px 8px;text-align:left;} td{padding:6px 8px;border:1px solid #f8bbd0;vertical-align:top;} tr:nth-child(even) td{background:#fce4ec;} tr:nth-child(odd) td{background:#fff;} ul{margin:4px 0 8px 18px;padding:0;} li{margin:3px 0;line-height:1.5;} .imp{color:#b71c1c;font-weight:bold;background:#fff8f8;border-left:4px solid #b71c1c;padding:5px 10px;margin:6px 0;border-radius:0 4px 4px 0;} .tag{display:inline-block;background:#fce4ec;color:#880e4f;border-radius:3px;padding:1px 6px;font-size:11px;font-weight:bold;margin-left:4px;} @media print{body{background:#fff;font-size:12px;} th,.sec-header,.sub-header{-webkit-print-color-adjust:exact;print-color-adjust:exact;}} </style> </head> <body> <div class="cover"> <h1>UPSC CMS 2026</h1> <h2>HIGH-YIELD NOTES — PAPER 2</h2> <p style="font-size:1.3em;font-weight:bold;color:#fff;margin:12px 0;">Gynaecology & Obstetrics (OBG)</p> <p>Exam Date: <b>August 2, 2026</b></p> </div> <div class="container"> <div class="sec-header">PART A: OBSTETRICS</div> <div class="sub-header">1. ANTENATAL CARE (ANC)</div> <table><tr><th>Visit</th><th>Timing</th><th>Key Actions</th></tr> <tr><td>Booking visit (1st visit)</td><td><12 weeks</td><td>History, weight, height, BP, blood group & Rh, CBC, urine R/M, VDRL, HIV, Hep B, rubella, USG, folic acid</td></tr> <tr><td>2nd visit</td><td>14-26 weeks</td><td>Maternal serum AFP (NTD screening), anatomy scan USG at 18-20 weeks, OGTT if risk factors</td></tr> <tr><td>3rd visit</td><td>28 weeks</td><td>CBC (repeat), GDM screening (OGTT), anti-D if Rh-negative, Tdap vaccine</td></tr> <tr><td>4th visit</td><td>32-36 weeks</td><td>Presentation, GBS screening (35-37 weeks), fetal growth USG</td></tr> <tr><td>5th visit</td><td>38-40 weeks</td><td>Fetal wellbeing, plan for delivery</td></tr></table> <div class="imp">Tetanus Toxoid (TT): 2 doses in 1st pregnancy (4 weeks apart), 1 booster in subsequent pregnancies. IFA tablets (100mg elemental iron + 500mcg folic acid) from 12 weeks for minimum 100 days.</div> <div class="sub-header">2. HYPERTENSIVE DISORDERS OF PREGNANCY <span class="tag">★ PYQ</span></div> <table><tr><th>Condition</th><th>Definition</th><th>Key Features</th></tr> <tr><td>Gestational HTN</td><td>BP ≥140/90 after 20 weeks, NO proteinuria, normal labs</td><td>Resolves <12 weeks postpartum</td></tr> <tr><td>Pre-eclampsia</td><td>BP ≥140/90 after 20 weeks WITH proteinuria (≥300mg/24h) OR severe features</td><td>Headache, visual disturbance, epigastric pain, edema, proteinuria, thrombocytopenia, elevated creatinine</td></tr> <tr><td>Severe pre-eclampsia</td><td>BP ≥160/110 OR severe features (as above)</td><td>Requires hospitalization + antihypertensives + MgSO4</td></tr> <tr><td>Eclampsia</td><td>Convulsions in pre-eclampsia (not due to other cause)</td><td>Tonic-clonic seizures. MgSO4 is treatment of choice.</td></tr> <tr><td>HELLP syndrome</td><td>Hemolysis + Elevated Liver enzymes + Low Platelets</td><td>Variant of severe pre-eclampsia. Deliver baby.</td></tr> <tr><td>Chronic HTN</td><td>BP ≥140/90 before 20 weeks OR diagnosed before pregnancy</td><td>Treat with Methyldopa (1st line)</td></tr></table> <div class="sub2">MgSO4 Regimens for Eclampsia/Severe Pre-eclampsia</div> <table><tr><th>Regimen</th><th>Loading Dose</th><th>Maintenance</th><th>Antidote</th></tr> <tr><td>Pritchard (IM)</td><td>4g IV + 10g IM (5g each buttock)</td><td>5g IM 4-hourly</td><td>Calcium gluconate 10% IV (10 ml over 10 min)</td></tr> <tr><td>Zuspan (IV)</td><td>4g IV over 15-20 min</td><td>1-2g/hr IV infusion</td><td>Calcium gluconate</td></tr></table> <div class="imp">MgSO4 toxicity monitoring: BEFORE each dose check: Respiratory rate ≥16/min, Patellar reflex present (knee jerk), Urine output ≥25ml/hr. If toxicity: STOP MgSO4 + give Calcium gluconate IV.</div> <div class="imp">Antihypertensives for acute severe HTN in pregnancy: IV Labetalol (1st line) OR Oral Nifedipine OR IV Hydralazine. Target: reduce BP to <160/110 within 30-60 min.</div> <div class="sub-header">3. ANTEPARTUM HAEMORRHAGE (APH) <span class="tag">★ PYQ</span></div> <table><tr><th>Feature</th><th>Placenta Praevia</th><th>Abruptio Placentae</th></tr> <tr><td>Bleeding</td><td>PAINLESS, bright red, revealed</td><td>PAINFUL, dark red, concealed or revealed</td></tr> <tr><td>Uterus</td><td>Soft, non-tender</td><td>Tense, WOODY HARD, tender</td></tr> <tr><td>Fetal parts</td><td>Easily palpable</td><td>Difficult to palpate</td></tr> <tr><td>Fetal heart</td><td>Usually normal (unless bleeding massive)</td><td>Fetal distress (fetal hypoxia)</td></tr> <tr><td>Recurrence</td><td>Increases with each bleeding episode</td><td>High recurrence risk</td></tr> <tr><td>Shock</td><td>Proportional to visible bleeding</td><td>DISPROPORTIONATE to visible loss (concealed)</td></tr> <tr><td>Vaginal exam</td><td>NEVER per vaginally if PP suspected (placental trauma → severe hemorrhage)</td><td>Per vaginally safe</td></tr> <tr><td>Coagulopathy</td><td>Rare</td><td>Common (DIC)</td></tr></table> <div class="imp">Placenta Praevia grades: Type I (lateral), Type II (reaching os), Type III (over os), Type IV (centrally covers os). Type III & IV → C-section mandatory. "Double setup examination" only in theatre where C-section can be immediately done.</div> <div class="sub-header">4. LABOUR</div> <table><tr><th>Stage</th><th>Definition</th><th>Duration (Nullipara)</th><th>Duration (Multipara)</th></tr> <tr><td>1st stage (Latent phase)</td><td>Onset of labour to 3-4 cm dilation</td><td>Up to 20 hours</td><td>Up to 14 hours</td></tr> <tr><td>1st stage (Active phase)</td><td>4-10 cm dilation (rate ≥1 cm/hr)</td><td>Up to 12 hours</td><td>Up to 6 hours</td></tr> <tr><td>2nd stage</td><td>Full dilation to delivery of baby</td><td>Up to 2 hours (3h with epidural)</td><td>Up to 1 hour</td></tr> <tr><td>3rd stage</td><td>Delivery of baby to delivery of placenta</td><td colspan="2">Up to 30 minutes</td></tr> <tr><td>4th stage</td><td>First 2 hours postpartum</td><td colspan="2">Observation for PPH</td></tr></table> <div class="sub2">Bishop Score <span class="tag">★ PYQ</span></div> <table><tr><th>Parameter</th><th>0</th><th>1</th><th>2</th><th>3</th></tr> <tr><td>Dilation (cm)</td><td>Closed</td><td>1-2</td><td>3-4</td><td>≥5</td></tr> <tr><td>Effacement (%)</td><td>0-30</td><td>40-50</td><td>60-70</td><td>≥80</td></tr> <tr><td>Station</td><td>-3</td><td>-2</td><td>-1/0</td><td>+1/+2</td></tr> <tr><td>Consistency</td><td>Firm</td><td>Medium</td><td>Soft</td><td>—</td></tr> <tr><td>Position</td><td>Posterior</td><td>Mid</td><td>Anterior</td><td>—</td></tr></table> <div class="imp">Bishop score ≥8: favourable cervix → induction likely to succeed. Score <6: unfavourable → cervical ripening first (Prostaglandins: PGE2 gel, Misoprostol).</div> <div class="sub-header">5. POSTPARTUM HAEMORRHAGE (PPH)</div> <div class="sub2">4 T's of PPH Causes</div> <ul> <li><b>T</b>one (uterine atony) — 80% of PPH cases. Most common cause.</li> <li><b>T</b>issue (retained placenta, placenta accreta spectrum)</li> <li><b>T</b>rauma (lacerations, uterine rupture, haematomas)</li> <li><b>T</b>hrombin (coagulation disorders, DIC)</li> </ul> <div class="sub2">PPH Management Steps</div> <ul> <li>Call for help, IV access ×2, crossmatch blood</li> <li>Bimanual uterine compression, catheterize bladder</li> <li>Oxytocin 10 IU IV bolus → Ergometrine → Misoprostol (800mcg sublingual/rectal)</li> <li>Carboprost (PGF2α) 250mcg IM every 15 min (max 8 doses); C/I: asthma</li> <li>Tranexamic acid 1g IV within 3 hours of delivery</li> <li>Bakri balloon tamponade (intrauterine balloon)</li> <li>Surgical: B-Lynch suture, uterine artery ligation, internal iliac artery ligation</li> <li>Hysterectomy: last resort</li> </ul> <div class="imp">Primary PPH: >500ml blood loss within 24 hours of vaginal delivery (or >1000ml after C-section). Active management of 3rd stage (AMTSL): Oxytocin 10 IU IM within 1 min of baby delivery + controlled cord traction + uterine massage.</div> <div class="sub-header">6. BREECH PRESENTATION</div> <table><tr><th>Type</th><th>Features</th></tr> <tr><td>Frank breech (65%)</td><td>Thighs flexed, knees extended ("pike position")</td></tr> <tr><td>Complete breech (25%)</td><td>Thighs and knees both flexed ("sitting cross-legged")</td></tr> <tr><td>Footling/incomplete breech (10%)</td><td>One or both feet presenting. HIGHEST risk of cord prolapse.</td></tr></table> <div class="imp">External Cephalic Version (ECV): attempt at 36-37 weeks to convert breech to cephalic. Success rate ~50%. C/I: antepartum hemorrhage, previous C-section, multiple pregnancy, fetal compromise. Vaginal breech delivery criteria: experienced obstetrician, adequate pelvis, frank breech, estimated fetal weight 1.5-3.5 kg.</div> <div class="sub-header">7. CAESAREAN SECTION</div> <ul> <li>Lower Segment CS (LSCS): standard — less blood loss, better scar healing, lower rupture risk</li> <li>Classical CS (vertical uterine incision): for prematurity, transverse lie, placenta praevia (sometimes), emergency</li> </ul> <table><tr><th>Absolute Indications for LSCS</th><th>Relative Indications</th></tr> <tr><td>Complete placenta praevia (type III/IV)</td><td>Previous C-section (relative — VBAC possible)</td></tr> <tr><td>Cephalo-pelvic disproportion (CPD)</td><td>Breech (relative)</td></tr> <tr><td>Active genital herpes (at time of delivery)</td><td>Prolonged labour (failure to progress)</td></tr> <tr><td>Transverse lie</td><td>Pre-eclampsia / fetal distress</td></tr> <tr><td>Cord prolapse (acute, in 2nd stage)</td><td>Multiple gestation</td></tr></table> <div class="sec-header">PART B: GYNAECOLOGY</div> <div class="sub-header">8. PCOS — POLYCYSTIC OVARY SYNDROME <span class="tag">★ PYQ</span></div> <div class="sub2">Rotterdam Criteria (2 of 3 required)</div> <ul> <li>Oligo/anovulation (irregular cycles)</li> <li>Clinical or biochemical hyperandrogenism (hirsutism, acne, elevated androgens)</li> <li>Polycystic ovaries on USG (≥12 follicles 2-9mm OR ovarian volume >10ml)</li> </ul> <div class="imp">Rotterdam criteria: diagnosis requires 2 of 3 features AND exclusion of other causes (CAH, Cushing's, androgen-secreting tumors, hyperprolactinemia, thyroid disease).</div> <table><tr><th>Feature</th><th>Management</th></tr> <tr><td>Menstrual irregularity (no fertility desired)</td><td>Combined OCP (Ethinyl estradiol + Cyproterone acetate is preferred in PCOS) OR Progestogen withdrawal</td></tr> <tr><td>Infertility (anovulation)</td><td>Clomiphene citrate (1st line), then Letrozole (off-label but becoming 1st line), then Gonadotropins, then IVF</td></tr> <tr><td>Insulin resistance / Metabolic</td><td>Metformin (especially in overweight/obese) — improves insulin sensitivity, restores ovulation</td></tr> <tr><td>Hirsutism</td><td>OCP + anti-androgens (Spironolactone, Cyproterone acetate, Finasteride)</td></tr> <tr><td>Long-term risk</td><td>Endometrial hyperplasia/cancer (due to unopposed estrogen), DM type 2, cardiovascular disease</td></tr></table> <div class="sub-header">9. ENDOMETRIOSIS</div> <ul> <li>Endometrial tissue outside the uterus: most common site — ovaries (chocolate cyst = endometrioma), broad ligament, POD</li> <li>Classic triad: Dysmenorrhoea + Dyspareunia + Infertility</li> <li>CA-125 elevated (but non-specific). Definitive diagnosis: laparoscopy + biopsy</li> </ul> <table><tr><th>AFS Staging</th><th>Revised (rAFS) Score</th></tr> <tr><td>Stage I (Minimal)</td><td>1-5</td></tr> <tr><td>Stage II (Mild)</td><td>6-15</td></tr> <tr><td>Stage III (Moderate)</td><td>16-40</td></tr> <tr><td>Stage IV (Severe)</td><td>>40</td></tr></table> <ul> <li>Medical treatment: Combined OCP, Progestogens (Norethisterone), GnRH agonists (Leuprolide — induces medical menopause), Danazol (androgenic side effects)</li> <li>Surgical: Laparoscopic excision/fulguration. Definitive: total hysterectomy + BSO</li> </ul> <div class="sub-header">10. UTERINE FIBROIDS (LEIOMYOMAS)</div> <table><tr><th>Type (FIGO classification)</th><th>Features</th></tr> <tr><td>Submucosal (Type 0-2)</td><td>Most symptomatic — heavy menstrual bleeding, infertility, recurrent miscarriage</td></tr> <tr><td>Intramural (Type 3-4)</td><td>Menorrhagia, bulk symptoms (pelvic pressure, urinary frequency)</td></tr> <tr><td>Subserosal (Type 5-7)</td><td>Least symptomatic. Can become pedunculated. Urinary/bowel pressure.</td></tr></table> <div class="imp">Fibroid complications during pregnancy: red degeneration (most common — ischaemic infarction, pain, fever), abortion, malpresentation, postpartum haemorrhage. Fibroids are estrogen-dependent — regress after menopause.</div> <ul> <li>Medical: GnRH agonist (Leuprolide) — shrinks fibroid preoperatively; Tranexamic acid for bleeding; Progesterone IUS (Mirena) for menorrhagia</li> <li>Surgical: Myomectomy (preserve fertility), Hysterectomy (definitive), Uterine artery embolization (UAE)</li> </ul> <div class="sub-header">11. CERVICAL CANCER <span class="tag">★ PYQ</span></div> <ul> <li>Most common cause: HPV 16 (squamous cell, 70%) and HPV 18 (adenocarcinoma)</li> <li>Most common type: Squamous cell carcinoma (85%)</li> <li>Risk factors: early coitarche, multiple partners, STIs, immunosuppression, smoking, multiparity</li> <li>Screening: Pap smear (Cervical cytology) from age 21-25, or 3 years after sexual debut</li> </ul> <table><tr><th>CIN Grade</th><th>Features</th></tr> <tr><td>CIN I (LSIL)</td><td>Mild dysplasia, lower 1/3 epithelium</td></tr> <tr><td>CIN II (HSIL)</td><td>Moderate dysplasia, lower 2/3</td></tr> <tr><td>CIN III (HSIL/CIS)</td><td>Severe dysplasia/carcinoma in situ, full thickness</td></tr></table> <div class="imp">Colposcopy → biopsy. LLETZ (Large Loop Excision of Transformation Zone) = treatment for CIN II/III. Vaccine: HPV bivalent (Cervarix — HPV 16+18) or quadrivalent (Gardasil — HPV 6+11+16+18). India NIS includes HPV vaccine. FIGO staging: clinical (not surgical). Stage IB2+: chemoradiation.</div> <table><tr><th>FIGO Stage</th><th>Description</th><th>Treatment</th></tr> <tr><td>IA1</td><td>Microinvasion ≤3mm depth</td><td>LLETZ/cone biopsy if fertility desired; simple hysterectomy</td></tr> <tr><td>IA2-IB1</td><td>Confined to cervix, ≤4cm</td><td>Radical (Wertheim's) hysterectomy + PLND OR chemoradiation</td></tr> <tr><td>IIB+</td><td>Beyond cervix, parametrium involved</td><td>Concurrent chemoradiation (Cisplatin-based)</td></tr> <tr><td>IVB</td><td>Distant metastasis</td><td>Palliative chemo</td></tr></table> <div class="sub-header">12. OVARIAN CANCER</div> <ul> <li>Most common type: Serous cystadenocarcinoma (50%) — bilateral, psammoma bodies</li> <li>Most common ovarian tumor overall: Benign serous cystadenoma</li> <li>Tumor marker: CA-125 (not specific — elevated in many conditions; used for monitoring)</li> <li>BRCA1/BRCA2 mutations: hereditary ovarian cancer</li> <li>Symptoms: insidious — bloating, abdominal discomfort, urinary symptoms</li> <li>Spread: transperitoneal (omentum, peritoneum), then lymphatic, then hematogenous</li> <li>Treatment: Surgery (TAH+BSO + omentectomy + cytoreduction) + Platinum-based chemo (Carboplatin + Paclitaxel)</li> </ul> <div class="imp">Krukenberg tumor: bilateral metastatic ovarian tumors from GI primary (gastric most common). Contains signet ring cells (mucin-secreting). Always look for primary GI malignancy.</div> <div class="sub-header">13. GESTATIONAL TROPHOBLASTIC DISEASE (GTD)</div> <table><tr><th>Feature</th><th>Complete Mole</th><th>Partial Mole</th></tr> <tr><td>Karyotype</td><td>46XX (diploid, androgenetic)</td><td>69XXX or 69XXY (triploid)</td></tr> <tr><td>Fetal tissue</td><td>Absent</td><td>Present</td></tr> <tr><td>β-hCG</td><td>Very high</td><td>Moderately elevated</td></tr> <tr><td>USG appearance</td><td>"Snowstorm" pattern</td><td>Swiss cheese appearance</td></tr> <tr><td>Malignant transformation</td><td>15-20% → choriocarcinoma</td><td><5%</td></tr></table> <div class="imp">Treatment: Suction evacuation + send tissue for histology. Follow β-hCG weekly until 3 consecutive normal values. Avoid pregnancy for 6-12 months after mole. Contraception during follow-up (OCP safe). If β-hCG plateaus or rises → gestational trophoblastic neoplasia (GTN) → single-agent chemotherapy (Methotrexate for low-risk).</div> <div class="sub-header">14. HORMONAL CONTRACEPTION</div> <table><tr><th>Method</th><th>Failure Rate (typical)</th><th>Key Notes</th></tr> <tr><td>Combined OCP</td><td>7-9%</td><td>Estrogen + progestogen. C/I: migraine with aura, uncontrolled HTN, smoker >35, DVT/PE history, breastfeeding <6 months</td></tr> <tr><td>Progestogen-only pill (POP/mini-pill)</td><td>7-9%</td><td>Safe in breastfeeding, HTN. Must take at same time daily.</td></tr> <tr><td>Cu-IUD</td><td><1%</td><td>Non-hormonal. Most effective emergency contraception up to 5 days. C/I: Wilson's disease, heavy periods</td></tr> <tr><td>LNG-IUS (Mirena)</td><td><1%</td><td>Progestogen-releasing. Reduces menorrhagia. Good for endometriosis.</td></tr> <tr><td>Emergency contraception</td><td></td><td>Levonorgestrel 1.5mg (within 72h); Ulipristal (within 120h); Cu-IUD (most effective, within 5 days)</td></tr></table> <div class="imp">OCP effects: Estrogen → increases SHBG, TBG, clotting factors, HDL ↑, LDL ↓. Progesterone → decreases SHBG, LDL ↑, HDL ↓. Combined OCP does NOT increase overall breast cancer incidence significantly, but slightly increases risk in current users.</div> <br><br> <div style="text-align:center;color:#757575;font-size:12px;border-top:1px solid #f8bbd0;padding-top:10px;margin-top:20px;"> UPSC CMS 2026 | OBG Notes | Exam: August 2, 2026<br> <b style="color:#880e4f;">Every page you read brings you closer to success!</b> </div> </div> </body> </html> HTMLEOF echo "OBG HTML done"
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cat > /home/daytona/workspace/upsc-cms-notes/04_Paediatrics.html << 'HTMLEOF' <!DOCTYPE html> <html lang="en"> <head> <meta charset="UTF-8"> <meta name="viewport" content="width=device-width, initial-scale=1.0"> <title>UPSC CMS 2026 - Paediatrics</title> <style> body{font-family:'Segoe UI',Arial,sans-serif;margin:0;padding:0;background:#f5f5f5;color:#212121;font-size:14px;} .cover{background:linear-gradient(135deg,#e65100,#f57c00);color:#fff;text-align:center;padding:60px 20px;} .cover h1{font-size:2.2em;margin:0 0 10px;} .cover h2{font-size:1.5em;margin:0 0 8px;color:#ffe0b2;} .container{max-width:900px;margin:0 auto;padding:16px;} .sec-header{background:#e65100;color:#fff;padding:10px 16px;border-radius:6px;margin:24px 0 10px;font-size:1.2em;font-weight:bold;} .sub-header{background:#f57c00;color:#fff;padding:7px 14px;border-radius:4px;margin:16px 0 8px;font-size:1.05em;font-weight:bold;} .sub2{color:#e65100;font-size:1em;font-weight:bold;margin:12px 0 4px;border-left:4px solid #f57c00;padding-left:8px;} table{width:100%;border-collapse:collapse;margin:10px 0;font-size:13px;} th{background:#f57c00;color:#fff;padding:7px 8px;text-align:left;} td{padding:6px 8px;border:1px solid #ffe0b2;vertical-align:top;} tr:nth-child(even) td{background:#fff3e0;} tr:nth-child(odd) td{background:#fff;} ul{margin:4px 0 8px 18px;padding:0;} li{margin:3px 0;line-height:1.5;} .imp{color:#b71c1c;font-weight:bold;background:#fff8f8;border-left:4px solid #b71c1c;padding:5px 10px;margin:6px 0;border-radius:0 4px 4px 0;} .tag{display:inline-block;background:#fff3e0;color:#e65100;border-radius:3px;padding:1px 6px;font-size:11px;font-weight:bold;margin-left:4px;} @media print{body{background:#fff;font-size:12px;} th,.sec-header,.sub-header{-webkit-print-color-adjust:exact;print-color-adjust:exact;}} </style> </head> <body> <div class="cover"> <h1>UPSC CMS 2026</h1> <h2>HIGH-YIELD NOTES — PAPER 1</h2> <p style="font-size:1.3em;font-weight:bold;color:#fff;margin:12px 0;">Paediatrics</p> <p>Exam Date: <b>August 2, 2026</b></p> </div> <div class="container"> <div class="sec-header">SECTION 1: GROWTH & DEVELOPMENT</div> <div class="sub-header">1.1 DEVELOPMENTAL MILESTONES <span class="tag">★ PYQ</span></div> <table><tr><th>Age</th><th>Gross Motor</th><th>Fine Motor</th><th>Social/Language</th></tr> <tr><td>6 weeks</td><td>Lifts head briefly prone</td><td>Grasp reflex fading</td><td>Social smile ★</td></tr> <tr><td>3 months</td><td>Head steady, lifts chest prone</td><td>Holds rattle briefly</td><td>Coos, vocalizes</td></tr> <tr><td>6 months</td><td>Sits with support ★</td><td>Palmar grasp, transfers</td><td>Babbles, stranger anxiety begins</td></tr> <tr><td>9 months</td><td>Stands with support, crawls</td><td>Pincer grasp (thumb+finger) ★</td><td>Says "mama/dada" non-specifically; separation anxiety</td></tr> <tr><td>12 months</td><td>Walks with support → walks alone ★</td><td>Neat pincer grasp</td><td>1-2 meaningful words; understands "no"</td></tr> <tr><td>18 months</td><td>Runs (unsteady), walks up stairs</td><td>Scribbles, tower of 3-4 blocks</td><td>10-20 words, points to body parts</td></tr> <tr><td>2 years</td><td>Runs well, kicks ball</td><td>Tower of 6 blocks, circular scribble</td><td>2-word sentences ★, 50+ words</td></tr> <tr><td>3 years</td><td>Rides tricycle, goes up stairs alternating</td><td>Copies circle, tower of 9 blocks</td><td>3-word sentences, knows name/age/sex</td></tr> <tr><td>4 years</td><td>Hops on one foot ★, skips</td><td>Copies cross (+), draws person</td><td>Tells stories, plays cooperatively</td></tr> <tr><td>5 years</td><td>Skips, tandem walk</td><td>Copies square, ties laces</td><td>5-6 word sentences, counts to 10</td></tr></table> <div class="imp">Key milestones to memorize: Social smile 6 weeks, Sits without support 6 months, Pincer grasp 9 months, Walks 12 months, 2-word sentences 2 years, Hops on one foot 4 years.</div> <div class="sub-header">1.2 GROWTH PARAMETERS</div> <table><tr><th>Parameter</th><th>At Birth</th><th>1 year</th><th>2 years</th></tr> <tr><td>Weight</td><td>~3 kg</td><td>~3× birth weight = 9kg ★</td><td>4× birth weight = 12kg</td></tr> <tr><td>Height/Length</td><td>50 cm</td><td>75 cm (1.5× birth)</td><td>87 cm</td></tr> <tr><td>Head circumference</td><td>34 cm</td><td>47 cm</td><td>49 cm</td></tr> <tr><td>Chest circumference</td><td>32 cm (2cm < HC)</td><td>Equal to HC at 1 year ★</td><td>Chest > HC after 1 year</td></tr></table> <div class="imp">Birth weight doubles by 5 months, triples by 1 year, quadruples by 2 years. Normal weight gain: 25-30g/day in 1st 3 months, 400-500g/month in 1st year.</div> <div class="sec-header">SECTION 2: NATIONAL IMMUNIZATION SCHEDULE (NIS India 2026) <span class="tag">★ PYQ</span></div> <table><tr><th>Vaccine</th><th>Age</th><th>Dose/Route</th><th>Disease Prevented</th></tr> <tr><td>BCG</td><td>At birth</td><td>0.05ml intradermal (left arm)</td><td>TB (severe forms)</td></tr> <tr><td>OPV 0</td><td>At birth</td><td>2 drops oral</td><td>Polio</td></tr> <tr><td>Hepatitis B birth dose</td><td>Within 24 hours of birth</td><td>0.5ml IM</td><td>Hepatitis B</td></tr> <tr><td>OPV 1,2,3 + Pentavalent 1,2,3</td><td>6, 10, 14 weeks</td><td>OPV oral; Penta 0.5ml IM thigh</td><td>Polio, DPT, Hep B, Hib</td></tr> <tr><td>Rotavirus vaccine (RVV)</td><td>6, 10, 14 weeks</td><td>5 drops oral</td><td>Rotavirus diarrhea</td></tr> <tr><td>IPV 1,2</td><td>6 and 14 weeks</td><td>0.5ml IM</td><td>Polio (inactivated)</td></tr> <tr><td>PCV (Pneumococcal)</td><td>6, 14 weeks, 9 months</td><td>0.5ml IM</td><td>Pneumococcal disease</td></tr> <tr><td>MR vaccine (or MMR)</td><td>9-12 months</td><td>0.5ml SC</td><td>Measles, Rubella (Mumps)</td></tr> <tr><td>Typhoid conjugate vaccine (TCV)</td><td>9-12 months</td><td>0.5ml IM</td><td>Typhoid</td></tr> <tr><td>Vitamin A (1st dose)</td><td>9 months</td><td>1 lakh IU oral</td><td>Vitamin A deficiency</td></tr> <tr><td>DPT booster 1 + OPV booster</td><td>16-24 months</td><td>0.5ml IM</td><td>DPT booster</td></tr> <tr><td>MR 2nd dose</td><td>16-24 months</td><td>0.5ml SC</td><td>Measles, Rubella</td></tr> <tr><td>JE vaccine (endemic areas)</td><td>9-12 months + 16-24 months</td><td>0.5ml IM</td><td>Japanese Encephalitis</td></tr> <tr><td>DPT booster 2</td><td>5-6 years</td><td>0.5ml IM</td><td>DPT booster</td></tr> <tr><td>TT/Td</td><td>10 and 16 years</td><td>0.5ml IM</td><td>Tetanus, Diphtheria</td></tr></table> <div class="imp">Cold chain: Vaccines must be stored at 2-8°C (except OPV which can be stored at -20°C in deep freezer). Polio eradication: India certified polio-free in 2014. Last case: Howrah (West Bengal), January 13, 2011.</div> <div class="sec-header">SECTION 3: NEONATOLOGY</div> <div class="sub-header">3.1 NEONATAL JAUNDICE</div> <table><tr><th>Feature</th><th>Physiological Jaundice</th><th>Pathological Jaundice</th></tr> <tr><td>Onset</td><td>After 24 hours of age</td><td>WITHIN first 24 hours ★</td></tr> <tr><td>Duration</td><td>Disappears by day 14 (term), day 21 (preterm)</td><td>Persists beyond 14 days</td></tr> <tr><td>Rise of bilirubin</td><td><5 mg/dL/day</td><td>>5 mg/dL/day</td></tr> <tr><td>Total bilirubin</td><td><12 mg/dL (term), <14 mg/dL (preterm)</td><td>Any level requiring intervention</td></tr> <tr><td>Direct (conjugated)</td><td><2 mg/dL</td><td>Direct >2 mg/dL = always pathological</td></tr></table> <div class="imp">Pathological jaundice within 24h: most commonly hemolytic (Rh incompatibility, ABO incompatibility). Exchange transfusion: total bilirubin reaching exchange level on nomogram (or >20 mg/dL term, lower in preterm). Phototherapy: decomposes bilirubin in skin via photoisomerization. Eye patch during phototherapy.</div> <div class="sub-header">3.2 NEONATAL SEPSIS</div> <table><tr><th>Feature</th><th>Early Onset (EOS) <72h</th><th>Late Onset (LOS) >72h</th></tr> <tr><td>Organisms</td><td>Group B Streptococcus (GBS), E.coli, Listeria</td><td>Klebsiella, E.coli, Staph aureus, Coagulase-negative Staph</td></tr> <tr><td>Source</td><td>Vertical (maternal)</td><td>Nosocomial or community</td></tr> <tr><td>Presentation</td><td>Respiratory distress, temperature instability</td><td>Lethargy, poor feeding, temperature instability, jaundice</td></tr> <tr><td>Treatment</td><td>IV Ampicillin + Gentamicin</td><td>IV Cefotaxime ± Amikacin; Vancomycin if MRSA suspected</td></tr></table> <div class="imp">Sepsis screen: CRP, TLC, I:T ratio (>0.2 = abnormal), micro-ESR, band cells. Definitive diagnosis: blood culture. Antibiotic stewardship: review at 48-72 hours based on culture results.</div> <div class="sub-header">3.3 RESPIRATORY DISTRESS SYNDROME (RDS/HMD)</div> <ul> <li>Cause: surfactant deficiency in premature neonates (especially <28 weeks gestation)</li> <li>Surfactant composition: Dipalmitoyl phosphatidylcholine (DPPC) + phosphatidylglycerol + apoproteins</li> <li>CXR: bilateral diffuse ground-glass haziness + air bronchograms + white-out in severe</li> <li>Treatment: Surfactant replacement therapy (intratracheal) + CPAP/mechanical ventilation</li> <li>Prevention: Antenatal corticosteroids (Betamethasone 12mg IM × 2 doses 24h apart at 24-34 weeks) → accelerates surfactant production</li> </ul> <div class="sec-header">SECTION 4: MALNUTRITION</div> <div class="sub-header">4.1 PROTEIN-ENERGY MALNUTRITION (PEM)</div> <table><tr><th>Feature</th><th>Marasmus</th><th>Kwashiorkor</th></tr> <tr><td>Deficit</td><td>Calories + protein (severe caloric deficiency)</td><td>Protein deficiency (with adequate calories)</td></tr> <tr><td>Age</td><td><1 year (weaning age)</td><td>1-3 years (post-weaning)</td></tr> <tr><td>Appearance</td><td>Wasted ("old man" face), loose skin</td><td>Oedema (pitting), moon face, pot belly</td></tr> <tr><td>Oedema</td><td>ABSENT</td><td>PRESENT (hallmark) ★</td></tr> <tr><td>Hair changes</td><td>Thin, sparse</td><td>Flag sign (alternating bands) ★</td></tr> <tr><td>Skin</td><td>Dry, loose</td><td>Flaky paint dermatosis (crazy paving)</td></tr> <tr><td>Serum albumin</td><td>Normal or mildly low</td><td>VERY LOW ★</td></tr> <tr><td>Appetite</td><td>Usually good</td><td>Anorexia</td></tr> <tr><td>Liver</td><td>Normal</td><td>Fatty liver</td></tr></table> <div class="sub2">SAM (Severe Acute Malnutrition) Criteria</div> <ul> <li>MUAC <11.5 cm (6-59 months)</li> <li>Weight-for-height < -3 SD (Z-score)</li> <li>Bilateral pitting oedema (kwashiorkor)</li> </ul> <div class="imp">SAM Management (F-75 → F-100): F-75 (75 kcal/100ml) for initial stabilization phase (Days 1-7: treat hypoglycemia, hypothermia, dehydration, electrolytes). F-100 (100 kcal/100ml) for catch-up growth phase (Week 2 onwards). ReSoMal (Rehydration Solution for Malnutrition): low Na, high K and Mg. DO NOT use standard ORS in SAM.</div> <div class="sec-header">SECTION 5: COMMON PAEDIATRIC INFECTIONS</div> <div class="sub-header">5.1 CHILDHOOD EXANTHEMS <span class="tag">★ PYQ</span></div> <table><tr><th>Disease</th><th>Organism</th><th>Incubation</th><th>Rash Features</th><th>Key Sign</th></tr> <tr><td>Measles (Rubeola)</td><td>Paramyxovirus</td><td>10-14 days</td><td>Maculopapular, starts face, spreads downward (centrifugal). Lasts 5-7 days.</td><td>Koplik's spots (buccal mucosa, pathognomonic) ★</td></tr> <tr><td>Rubella (German measles)</td><td>Togavirus</td><td>14-21 days</td><td>Fine pink macules, face → trunk, fades quickly (3-day measles)</td><td>Forchheimer spots (soft palate); suboccipital lymphadenopathy</td></tr> <tr><td>Chickenpox (Varicella)</td><td>VZV</td><td>14-21 days</td><td>Centripetal (trunk → extremities), multiple stages simultaneously (macule, papule, vesicle, crust) ★</td><td>"Dew drops on rose petals" appearance</td></tr> <tr><td>Roseola infantum (6th disease)</td><td>HHV-6</td><td>5-15 days</td><td>Rash appears AFTER fever breaks (rose-pink macules, trunk) ★</td><td>High fever 3-5 days, then sudden defervescence + rash</td></tr> <tr><td>Scarlet fever</td><td>Group A Strep</td><td>2-4 days</td><td>Sandpaper rash, pastia's lines (accentuation in folds), facial flushing</td><td>Strawberry tongue ★</td></tr> <tr><td>Hand, foot & mouth disease</td><td>Coxsackievirus A16, Enterovirus 71</td><td>3-6 days</td><td>Vesicles on palms, soles, mouth</td><td>Painful oral ulcers</td></tr> <tr><td>Erythema infectiosum (5th disease)</td><td>Parvovirus B19</td><td>4-14 days</td><td>"Slapped cheek" appearance ★, lacy reticular rash on limbs</td><td>Aplastic crisis in sickle cell disease</td></tr></table> <div class="sub-header">5.2 DIARRHOEAL DISEASES MANAGEMENT</div> <div class="sub2">WHO ORS (Low Osmolarity) Composition</div> <table><tr><th>Component</th><th>mmol/L</th></tr> <tr><td>Sodium</td><td>75</td></tr> <tr><td>Chloride</td><td>65</td></tr> <tr><td>Glucose (anhydrous)</td><td>75</td></tr> <tr><td>Potassium</td><td>20</td></tr> <tr><td>Citrate</td><td>10</td></tr> <tr><td>Total osmolarity</td><td>245 mOsm/L ★</td></tr></table> <div class="imp">WHO PLAN A (No dehydration): ORS after each loose stool (10ml/kg) + zinc 20mg/day x 14 days + continue feeding. PLAN B (Some dehydration): ORS 75ml/kg over 4 hours. PLAN C (Severe dehydration): IV fluids (Ringer's lactate) 100ml/kg. Zinc reduces duration and severity of diarrhea.</div> <div class="sub-header">5.3 RESPIRATORY TRACT INFECTIONS</div> <table><tr><th>Condition</th><th>Age</th><th>Organism</th><th>Key Features</th><th>Treatment</th></tr> <tr><td>Acute otitis media</td><td><2 years</td><td>S. pneumoniae, H. influenzae, M. catarrhalis</td><td>Ear pain, fever, bulging TM</td><td>Amoxicillin (high-dose); analgesia</td></tr> <tr><td>Croup (Laryngotracheobronchitis)</td><td>6 months-3 years</td><td>Parainfluenza virus (most common)</td><td>Barking cough, stridor, steeple sign on X-ray ★</td><td>Dexamethasone oral/IM + nebulized Adrenaline (severe)</td></tr> <tr><td>Epiglottitis</td><td>2-6 years</td><td>H. influenzae type b (now rare due to Hib vaccine)</td><td>Rapid onset, toxic, drooling, tripod position, thumb sign on X-ray</td><td>EMERGENCY: IV antibiotics (Ceftriaxone), secure airway (intubation in OT)</td></tr> <tr><td>Bronchiolitis</td><td><2 years</td><td>RSV (most common)</td><td>Wheezing, hyperinflation, first episode (not asthma)</td><td>Supportive (O2, fluids). Salbutamol trial. Ribavirin only in severe immunocompromised.</td></tr></table> <div class="sec-header">SECTION 6: CHILDHOOD TB</div> <ul> <li>Primary complex (Ghon complex): Ghon focus (lung parenchymal lesion) + draining lymph node. Birbeck granule found in Langhans giant cells (classic histology).</li> <li>Mantoux (Tuberculin) test: 5TU (or 2TU RT23) injected intradermally. Read at 48-72h. Induration ≥10mm = positive in India.</li> <li>Positive Mantoux in HIV/malnourished/immunocompromised: ≥5mm = significant</li> <li>Treat childhood TB: same as adults — 2HRZE/4HR (with weight-based dosing)</li> </ul> <div class="imp">Ghon complex on CXR: primary focus + ipsilateral hilar lymphadenopathy. Most primary TB heals with calcification. TB can affect any organ in children (lymph nodes most common extrapulmonary site in India).</div> <div class="sec-header">SECTION 7: VITAMIN DEFICIENCIES <span class="tag">★ PYQ</span></div> <table><tr><th>Vitamin</th><th>Deficiency Disease</th><th>Key Features</th><th>Treatment</th></tr> <tr><td>Vitamin A</td><td>Xerophthalmia, Night blindness</td><td>Night blindness (earliest) → Bitot's spots → corneal xerosis → keratomalacia (corneal melting, irreversible)</td><td>Vit A 200,000 IU oral on day 1, 2, and 14</td></tr> <tr><td>Vitamin B1 (Thiamine)</td><td>Beriberi, Wernicke's</td><td>Dry beriberi: peripheral neuropathy. Wet beriberi: high-output cardiac failure. Wernicke's: confusion + ophthalmoplegia + ataxia (Classic triad)</td><td>IV/IM Thiamine (before glucose in alcoholics!)</td></tr> <tr><td>Vitamin B3 (Niacin)</td><td>Pellagra</td><td>4 Ds: Dermatitis (sun-exposed areas, Casal's necklace) + Diarrhoea + Dementia + Death</td><td>Nicotinamide (niacinamide)</td></tr> <tr><td>Vitamin B12 (Cobalamin)</td><td>Megaloblastic anaemia, Sub-acute combined degeneration (SACD)</td><td>Megaloblastic anaemia + subacute combined degeneration (posterior + lateral columns), glossitis. Schilling test for absorption.</td><td>IM Hydroxocobalamin or Cyanocobalamin</td></tr> <tr><td>Vitamin C (Ascorbic acid)</td><td>Scurvy</td><td>Perifollicular haemorrhages ★, corkscrew hairs, bleeding gums, poor wound healing, Fröhlich's "sabre tibia", Trümmerfeld zone on X-ray</td><td>Oral Vitamin C 200-500mg/day</td></tr> <tr><td>Vitamin D</td><td>Rickets (children), Osteomalacia (adults)</td><td>Rickets: bow legs, frontal bossing, rachitic rosary, Harrison's sulcus, craniotabes. X-ray: cupping, fraying, splaying of metaphysis ★</td><td>Vitamin D3 (Cholecalciferol) + Calcium supplements</td></tr> <tr><td>Vitamin K</td><td>Haemorrhagic disease of newborn (HDN)</td><td>Bleeding (GI, umbilical, ICH) in neonate 2-7 days</td><td>IM Vitamin K1 (Phytomenadione) at birth (prophylaxis)</td></tr> <tr><td>Folic acid</td><td>Megaloblastic anaemia, NTD</td><td>Neural tube defects if deficient in periconceptional period</td><td>Folic acid 400mcg/day periconceptionally (5mg in high risk)</td></tr></table> <div class="sec-header">SECTION 8: CONGENITAL HEART DISEASE IN CHILDREN</div> <table><tr><th>Feature</th><th>Acyanotic (L→R shunt)</th><th>Cyanotic (R→L shunt)</th></tr> <tr><td>Types</td><td>VSD (most common CHD overall), ASD, PDA, Coarctation, PS, AS</td><td>TOF (most common cyanotic CHD), TGA, Truncus arteriosus, TAPVC, Tricuspid atresia</td></tr> <tr><td>Oxygen saturation</td><td>Normal</td><td>Reduced SpO₂</td></tr> <tr><td>CXR heart size</td><td>Cardiomegaly</td><td>May be normal or abnormal (boot-shaped TOF, egg-on-side TGA)</td></tr></table> <div class="sub2">TOF — Tetralogy of Fallot <span class="tag">★ PYQ</span></div> <ul> <li>4 components: VSD + Pulmonary stenosis + Overriding aorta + Right ventricular hypertrophy</li> <li>Most common cyanotic CHD. Presents after 3-6 months (as PDA closes).</li> <li>Tet spells (hypercyanotic spells): sudden deep cyanosis, crying, squatting (increases systemic resistance → reduces R→L shunt). Treatment of tet spell: knee-chest position, O2, IV Morphine, propranolol, phenylephrine.</li> <li>Boot-shaped heart (coeur en sabot) on CXR</li> <li>Management: Blalock-Taussig shunt (palliative) → total surgical correction</li> </ul> <div class="imp">PDA (Patent Ductus Arteriosus): Indomethacin (NSAIDs) closes PDA. PGE1 (Prostaglandin E1/Alprostadil) MAINTAINS PDA — used in duct-dependent CHD (TGA, pulmonary atresia) as bridge to surgery.</div> <div class="sec-header">SECTION 9: FEBRILE SEIZURES</div> <table><tr><th>Feature</th><th>Simple Febrile Seizure</th><th>Complex Febrile Seizure</th></tr> <tr><td>Duration</td><td><15 minutes</td><td>>15 minutes</td></tr> <tr><td>Type</td><td>Generalized (tonic-clonic)</td><td>Focal or prolonged or Todd's palsy after</td></tr> <tr><td>Frequency</td><td>Single episode in 24 hours</td><td>Multiple in 24 hours</td></tr> <tr><td>Recurrence risk</td><td>30%</td><td>Higher</td></tr> <tr><td>Risk of epilepsy</td><td>Same as general population (~1-2%)</td><td>Increased (2-10%)</td></tr></table> <div class="imp">Acute treatment: Diazepam rectal 0.5mg/kg OR IV Lorazepam 0.1mg/kg. Intermittent prophylaxis: oral diazepam during febrile illness. Continuous prophylaxis: NOT recommended for simple febrile seizures. Parents education: most important management step.</div> <br><br> <div style="text-align:center;color:#757575;font-size:12px;border-top:1px solid #ffe0b2;padding-top:10px;margin-top:20px;"> UPSC CMS 2026 | Paediatrics Notes | Exam: August 2, 2026<br> <b style="color:#e65100;">You're doing great — keep the momentum going!</b> </div> </div> </body> </html> HTMLEOF echo "Paeds done"
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