From 36f34b161e853c6dddcc18e02eb6414adfa051cf Mon Sep 17 00:00:00 2001 From: Gerrit Cloete Date: Thu, 2 Jan 2025 09:50:36 +0200 Subject: [PATCH] Add: initialize project with package.json, .gitignore, and deployment workflow; implement scripts for indexing and converting questions --- .github/workflows/deploy.yml | 53 + .gitignore | 1 + package-lock.json | 1172 +++++++++++++++++ package.json | 18 + public/index.html | 94 ++ public/questionIndex.json | 74 ++ .../cardiology/arrhythmias/afib.html | 68 + .../cardiology/emergencies/tamponade.html | 78 ++ .../critical-care/mods/fulminant-case.html | 145 ++ .../sepsis/vasopressor-choice.html | 110 ++ .../endocrinology/adrenal/crisis.html | 120 ++ .../endocrinology/thyroid/thyroid-storm.html | 115 ++ .../hematology/ttp/acute-management.html | 137 ++ .../acid-base/complex-disorders.html | 120 ++ .../acid-base/metabolic-alkalosis.html | 104 ++ scripts/convertMarkdown.js | 69 + scripts/indexQuestions.js | 45 + 17 files changed, 2523 insertions(+) create mode 100644 .github/workflows/deploy.yml create mode 100644 .gitignore create mode 100644 package-lock.json create mode 100644 package.json create mode 100644 public/index.html create mode 100644 public/questionIndex.json create mode 100644 public/questions/cardiology/arrhythmias/afib.html create mode 100644 public/questions/cardiology/emergencies/tamponade.html create mode 100644 public/questions/critical-care/mods/fulminant-case.html create mode 100644 public/questions/critical-care/sepsis/vasopressor-choice.html create mode 100644 public/questions/endocrinology/adrenal/crisis.html create mode 100644 public/questions/endocrinology/thyroid/thyroid-storm.html create mode 100644 public/questions/hematology/ttp/acute-management.html create mode 100644 public/questions/nephrology/acid-base/complex-disorders.html create mode 100644 public/questions/nephrology/acid-base/metabolic-alkalosis.html create mode 100644 scripts/convertMarkdown.js create mode 100644 scripts/indexQuestions.js diff --git a/.github/workflows/deploy.yml b/.github/workflows/deploy.yml new file mode 100644 index 0000000..1c4d3f6 --- /dev/null +++ b/.github/workflows/deploy.yml @@ -0,0 +1,53 @@ +name: Deploy to GitHub Pages + +on: + push: + branches: ["master"] + workflow_dispatch: + +permissions: + contents: read + pages: write + id-token: write + +concurrency: + group: "pages" + cancel-in-progress: false + +jobs: + build: + runs-on: ubuntu-latest + steps: + - name: Checkout + uses: actions/checkout@v4 + - name: Setup Pages + uses: actions/configure-pages@v4 + - name: Setup Node.js + uses: actions/setup-node@v4 + with: + node-version: '18' + cache: 'npm' + - name: Install dependencies + run: npm ci + - name: Build + run: npm run build + - name: Upload artifact + uses: actions/upload-pages-artifact@v2 + with: + path: ./public + + deploy: + needs: build + runs-on: ubuntu-latest + permissions: + pages: write + id-token: write + environment: + name: production + url: ${{ github.server_url }}/${{ github.repository }} + steps: + - name: Deploy to GitHub Pages + id: deployment + uses: actions/deploy-pages@v3 + env: + GITHUB_TOKEN: ${{ github.token }} \ No newline at end of file diff --git a/.gitignore b/.gitignore new file mode 100644 index 0000000..40b878d --- /dev/null +++ b/.gitignore @@ -0,0 +1 @@ +node_modules/ \ No newline at end of file diff --git a/package-lock.json b/package-lock.json new file mode 100644 index 0000000..077d185 --- /dev/null +++ b/package-lock.json @@ -0,0 +1,1172 @@ +{ + "name": "internal-med-questions", + "version": "1.0.0", + "lockfileVersion": 3, + "requires": true, + "packages": { + "": { + "name": "internal-med-questions", + "version": "1.0.0", + "dependencies": { + "gray-matter": "^4.0.3", + "http-server": "^14.1.1", + "marked": "^15.0.4", + "rimraf": "^6.0.1" + } + }, + "node_modules/@isaacs/cliui": { + "version": "8.0.2", + "resolved": "https://registry.npmjs.org/@isaacs/cliui/-/cliui-8.0.2.tgz", + "integrity": 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"dependencies": { + "gray-matter": "^4.0.3", + "http-server": "^14.1.1", + "marked": "^4.0.12", + "rimraf": "^3.0.2" + } +} diff --git a/public/index.html b/public/index.html new file mode 100644 index 0000000..178ead2 --- /dev/null +++ b/public/index.html @@ -0,0 +1,94 @@ + + + + + + Internal Medicine Questions + + + +
+
+ + + + + +
+
+
+ + + + diff --git a/public/questionIndex.json b/public/questionIndex.json new file mode 100644 index 0000000..2fb0634 --- /dev/null +++ b/public/questionIndex.json @@ -0,0 +1,74 @@ +[ + { + "filepath": "questions/cardiology/arrhythmias/afib.html", + "specialty": "cardiology", + "topic": "arrhythmias", + "difficulty": "medium", + "id": "CARD001", + "title": "---\r" + }, + { + "filepath": "questions/cardiology/emergencies/tamponade.html", + "specialty": "cardiology", + "topic": "emergencies", + "difficulty": "hard", + "id": "CARD002", + "title": "---\r" + }, + { + "filepath": "questions/critical-care/mods/fulminant-case.html", + "specialty": "critical-care", + "topic": "MODS", + "difficulty": "ultra-hard", + "id": "CRIT002", + "title": "---\r" + }, + { + "filepath": "questions/critical-care/sepsis/vasopressor-choice.html", + "specialty": "critical-care", + "topic": "sepsis", + "difficulty": "hard", + "id": "CRIT001", + "title": "---\r" + }, + { + "filepath": "questions/endocrinology/adrenal/crisis.html", + "specialty": "endocrinology", + "topic": "adrenal", + "difficulty": "hard", + "id": "ENDO002", + "title": "---\r" + }, + { + "filepath": "questions/endocrinology/thyroid/thyroid-storm.html", + "specialty": "endocrinology", + "topic": "thyroid", + "difficulty": "hard", + "id": "ENDO001", + "title": "---\r" + }, + { + "filepath": "questions/hematology/ttp/acute-management.html", + "specialty": "hematology", + "topic": "TTP", + "difficulty": "ultra-hard", + "id": "HEME001", + "title": "---\r" + }, + { + "filepath": "questions/nephrology/acid-base/complex-disorders.html", + "specialty": "nephrology", + "topic": "acid-base", + "difficulty": "hard", + "id": "NEPH001", + "title": "---\r" + }, + { + "filepath": "questions/nephrology/acid-base/metabolic-alkalosis.html", + "specialty": "nephrology", + "topic": "acid-base", + "difficulty": "hard", + "id": "NEPH002", + "title": "---\r" + } +] \ No newline at end of file diff --git a/public/questions/cardiology/arrhythmias/afib.html b/public/questions/cardiology/arrhythmias/afib.html new file mode 100644 index 0000000..ce67c79 --- /dev/null +++ b/public/questions/cardiology/arrhythmias/afib.html @@ -0,0 +1,68 @@ + + + + + + + arrhythmias + + + +

Atrial Fibrillation Management

+

Question

+

A 72-year-old woman with newly diagnosed atrial fibrillation has a CHA₂DS₂-VASc score of 4. She has normal renal function and no history of bleeding. Which is the most appropriate anticoagulation strategy?

+

Options

+ + + + + + + + + + + + + + + + + + + + + + + +
OptionDescription
A)No anticoagulation needed
B)Aspirin 81mg daily
C)Warfarin with target INR 2-3
D)Direct oral anticoagulant (DOAC)
+
+View Answer + +

Correct Answer

+

D

+

Explanation

+ +

References

+
+ + + + \ No newline at end of file diff --git a/public/questions/cardiology/emergencies/tamponade.html b/public/questions/cardiology/emergencies/tamponade.html new file mode 100644 index 0000000..719333d --- /dev/null +++ b/public/questions/cardiology/emergencies/tamponade.html @@ -0,0 +1,78 @@ + + + + + + + emergencies + + + +

Cardiac Tamponade Management

+

Question

+

A 45-year-old man with metastatic lung cancer presents with acute dyspnea, hypotension (BP 82/60), and tachycardia (HR 125). Bedside echo shows a large pericardial effusion with right ventricular diastolic collapse. Despite 2L of IV fluids, his condition worsens with:

+ +

Which combination of immediate management steps is most appropriate?

+

Options

+

A) Immediate pericardiocentesis + supplemental O2 + call cardiology +B) Start dobutamine + IV fluids + prepare for OR +C) Pericardial window in OR + mechanical ventilation +D) Supplemental O2 + empiric antibiotics + CT chest +E) Start norepinephrine + mechanical ventilation + cardiology consult

+
+View Answer + +

Correct Answer

+

A

+

Explanation

+

This is a case of life-threatening cardiac tamponade requiring immediate intervention:

+
    +

  1. Key diagnostic findings:

    +
      +
    • Beck's triad: hypotension, JVD, muffled heart sounds
      • +
    • Pulsus paradoxus >10 mmHg (here 25 mmHg)
      • +
    • Echo showing RV diastolic collapse
      • +
    • Known malignancy (common cause)
      • +
    +
    2. +

  2. Critical management principles:

    +
      +
    • Emergent pericardiocentesis is indicated due to:
        +
      • Hemodynamic compromise
        • +
      • Altered mental status
        • +
      • Failed fluid challenge
        • +
      +
      • +
    • Delay for OR or imaging could be fatal
      • +
    • Inotropes/pressors won't address underlying problem
      • +
    • Mechanical ventilation could worsen cardiac output
      • +
    +
    3. +

  3. Common pitfalls:

    +
      +
    • Waiting for CT imaging
      • +
    • Prioritizing mechanical ventilation
      • +
    • Over-reliance on medical management
      • +
    +
    4. +
+

References

+
+ + + + \ No newline at end of file diff --git a/public/questions/critical-care/mods/fulminant-case.html b/public/questions/critical-care/mods/fulminant-case.html new file mode 100644 index 0000000..b35a3e6 --- /dev/null +++ b/public/questions/critical-care/mods/fulminant-case.html @@ -0,0 +1,145 @@ + + + + + + + MODS + + + +

Complex Multi-Organ Dysfunction Management

+

Question

+

A 38-year-old previously healthy woman presents with toxic shock syndrome. Current status:

+

Respiratory:

+ +

Cardiovascular:

+ +

Renal/Metabolic:

+ +

Hematologic:

+ +

Hepatic:

+ +

Which combination of immediate interventions will most likely improve survival?

+

Options

+ + + + + + + + + + + + + + + + + + + + + + + + + + + +
OptionDescription
A)Prone positioning + vasopressin + CRRT + plasma exchange + stress-dose steroids
B)VV-ECMO + inotropes + hemodialysis + FFP/platelets + NAC infusion
C)Recruitment maneuver + epinephrine + CVVH + activated protein C + IVIG
D)High-frequency oscillation + dobutamine + peritoneal dialysis + antithrombin III
E)Airway pressure release + terlipressin + diuretics + factor VIIa + albumin
+
+View Answer + +

Correct Answer

+

A

+

Explanation

+

This ultra-complex case requires careful consideration of multiple organ systems:

+
    +

  1. Respiratory Management:

    +
      +
    • Severe ARDS (P/F < 100) requires prone positioning
      • +
    • High plateau pressure contraindicates recruitment
      • +
    • ECMO criteria met but higher mortality with shock
      • +
    +
    2. +

  2. Circulatory Support:

    +
      +
    • Vasopressin indicated for norepinephrine >0.5 µg/kg/min
      • +
    • Inotropes may worsen shock-induced cardiomyopathy
      • +
    • Low ScvO2 reflects poor oxygen delivery
      • +
    +
    3. +

  3. Renal/Metabolic:

    +
      +
    • CRRT preferred due to:
        +
      • Hemodynamic instability
        • +
      • Hyperkalemia
        • +
      • Severe acidosis
        • +
      • Volume management needs
        • +
      +
      • +
    +
    4. +

  4. Hematologic/Inflammatory:

    +
      +
    • DIC requires supportive care
      • +
    • Plasma exchange beneficial in toxic shock
      • +
    • Factor VIIa contraindicated in DIC
      • +
    • Activated protein C withdrawn from market
      • +
    +
    5. +

  5. Evidence-Based Rationale:

    +
      +
    • Prone positioning: 16% absolute mortality reduction in severe ARDS
      • +
    • Vasopressin: Reduces norepinephrine requirements
      • +
    • CRRT: Better hemodynamic tolerance than intermittent
      • +
    • Plasma exchange: Removes inflammatory mediators
      • +
    • Steroids: Indicated in refractory shock
      • +
    +
    6. +
+

References

+
+ + + + \ No newline at end of file diff --git a/public/questions/critical-care/sepsis/vasopressor-choice.html b/public/questions/critical-care/sepsis/vasopressor-choice.html new file mode 100644 index 0000000..7491773 --- /dev/null +++ b/public/questions/critical-care/sepsis/vasopressor-choice.html @@ -0,0 +1,110 @@ + + + + + + + sepsis + + + +

Vasopressor Selection in Septic Shock

+

Question

+

A 68-year-old man with pneumonia presents with septic shock. After receiving 30 mL/kg IV crystalloids:

+

Vitals/Labs:

+ +

Which combination of interventions is most appropriate at this time?

+

Options

+ + + + + + + + + + + + + + + + + + + + + + + + + + + +
OptionDescription
A)Start norepinephrine + continue fluid resuscitation
B)Start vasopressin as first-line + inotrope
C)Start epinephrine alone + hold fluids
D)Start phenylephrine + stress-dose steroids
E)Start dopamine + diuretics
+
+View Answer + +

Correct Answer

+

A

+

Explanation

+

This is a classic warm septic shock case requiring specific interventions:

+
    +

  1. Hemodynamic Analysis:

    +
      +
    • Hyperdynamic state (high CI)
      • +
    • Vasodilatory shock (low SVR)
      • +
    • Tissue hypoperfusion (high lactate, low ScvO2)
      • +
    • Adequate preload (CVP 12)
      • +
    +
    2. +

  2. Management Rationale:

    +
      +
    • Norepinephrine is first-line because:
        +
      • Increases SVR with minimal chronotropy
        • +
      • Maintains splanchnic perfusion
        • +
      • Better survival vs dopamine
        • +
      +
      • +
    • Continued fluids needed for:
        +
      • Ongoing losses
        • +
      • Persistent hypoperfusion
        • +
      +
      • +
    +
    3. +

  3. Why other options are wrong:

    +
      +
    • Vasopressin: Second-line agent
      • +
    • Epinephrine: May worsen tachycardia/lactate
      • +
    • Phenylephrine: Poor splanchnic flow
      • +
    • Dopamine: Higher arrhythmia risk
      • +
    +
    4. +
+

References

+
+ + + + \ No newline at end of file diff --git a/public/questions/endocrinology/adrenal/crisis.html b/public/questions/endocrinology/adrenal/crisis.html new file mode 100644 index 0000000..5e9d79a --- /dev/null +++ b/public/questions/endocrinology/adrenal/crisis.html @@ -0,0 +1,120 @@ + + + + + + + adrenal + + + +

Adrenal Crisis Management

+

Question

+

A 45-year-old woman with known Addison's disease presents to ED with:

+ +

Labs show:

+ +

She hasn't taken her usual hydrocortisone for 2 days due to vomiting. What is the most appropriate immediate management?

+

Options

+ + + + + + + + + + + + + + + + + + + + + + + + + + + +
OptionDescription
A)IV hydrocortisone 100mg + NS bolus + D5W + broad-spectrum antibiotics
B)IM hydrocortisone 50mg + oral rehydration + antiemetics
C)IV dexamethasone 4mg + albumin + vasopressors
D)Oral prednisone 60mg + potassium-sparing diuretics
E)IV methylprednisolone 125mg + NS maintenance + insulin
+
+View Answer + +

Correct Answer

+

A

+

Explanation

+

This is an acute adrenal crisis requiring immediate intervention:

+
    +

  1. Key diagnostic features:

    +
      +
    • Known Addison's disease
      • +
    • Precipitating illness (likely gastroenteritis)
      • +
    • Classic presentation:
        +
      • Hypotension
        • +
      • Hyponatremia
        • +
      • Hyperkalemia
        • +
      • Hypoglycemia
        • +
      • Fever
        • +
      +
      • +
    +
    2. +

  2. Management priorities:

    +
      +
    • Immediate glucocorticoid replacement
        +
      • Hydrocortisone preferred (mineralocorticoid activity)
        • +
      • High dose needed (100mg IV)
        • +
      +
      • +
    • Aggressive fluid resuscitation
        +
      • Normal saline corrects volume/sodium
        • +
      +
      • +
    • Glucose replacement
      • +
    • Empiric antibiotics (rule out sepsis)
      • +
    +
    3. +

  3. Why other options are wrong:

    +
      +
    • IM route insufficient in shock
      • +
    • Dexamethasone lacks mineralocorticoid effect
      • +
    • Oral therapy inappropriate (vomiting)
      • +
    • Methylprednisolone not first-line
      • +
    +
    4. +
+

References

+
+ + + + \ No newline at end of file diff --git a/public/questions/endocrinology/thyroid/thyroid-storm.html b/public/questions/endocrinology/thyroid/thyroid-storm.html new file mode 100644 index 0000000..5543a08 --- /dev/null +++ b/public/questions/endocrinology/thyroid/thyroid-storm.html @@ -0,0 +1,115 @@ + + + + + + + thyroid + + + +

Thyroid Storm Management

+

Question

+

A 32-year-old woman with known Graves' disease presents to the ED with:

+ +

Labs:

+ +

Which combination of immediate treatments is most appropriate?

+

Options

+ + + + + + + + + + + + + + + + + + + + + + + + + + + +
OptionDescription
A)PTU + propranolol + hydrocortisone + cooling measures
B)Methimazole + metoprolol + radioactive iodine
C)Lugol's solution + aspirin + propranolol
D)PTU + diltiazem + prednisone
E)Total thyroidectomy + beta blockade
+
+View Answer + +

Correct Answer

+

A

+

Explanation

+

This is a case of thyroid storm requiring prompt intervention:

+
    +

  1. Diagnostic Criteria (Burch-Wartofsky Score >45):

    +
      +
    • High fever: 39.8°C (15 points)
      • +
    • Severe tachycardia >140 (25 points)
      • +
    • Agitation/delirium (20 points)
      • +
    • GI-hepatic dysfunction absent (0 points)
      • +
    • Total score ~60 points
      • +
    +
    2. +

  2. Management principles:

    +
      +
    • Block hormone synthesis (PTU preferred over methimazole)
        +
      • PTU also blocks T4→T3 conversion
        • +
      +
      • +
    • Block sympathetic effects (propranolol)
        +
      • Non-selective β-blockade needed
        • +
      +
      • +
    • Block hormone release (iodine solution after PTU)
      • +
    • Support adrenals (hydrocortisone)
      • +
    • Treat precipitant
      • +
    • Supportive care/cooling
      • +
    +
    3. +

  3. Why other options are wrong:

    +
      +
    • RAI contraindicated in thyroid storm
      • +
    • Calcium channel blockers less effective
      • +
    • Surgery too risky in acute phase
      • +
    • Aspirin may increase free T4
      • +
    +
    4. +
+

References

+
+ + + + \ No newline at end of file diff --git a/public/questions/hematology/ttp/acute-management.html b/public/questions/hematology/ttp/acute-management.html new file mode 100644 index 0000000..85c7348 --- /dev/null +++ b/public/questions/hematology/ttp/acute-management.html @@ -0,0 +1,137 @@ + + + + + + + TTP + + + +

Complex TTP Management with Neurological Deterioration

+

Question

+

A 35-year-old woman presents with:

+ +

After starting plasma exchange, she develops:

+ +

Which management strategy offers the best survival benefit?

+

Options

+ + + + + + + + + + + + + + + + + + + + + + + + + + + +
OptionDescription
A)Double-volume plasmapheresis + rituximab + steroids + ECMO + continue anticoagulation
B)Single-volume plasmapheresis + caplacizumab + hold anticoagulation
C)Switch to hemodialysis + IVIG + platelet transfusion
D)Fresh frozen plasma infusion + cyclophosphamide + IVC filter
E)Therapeutic plasma exchange + splenectomy + antiepileptics
+
+View Answer + +

Correct Answer

+

A

+

Explanation

+

This is a catastrophic TTP case with multiple life-threatening complications:

+
    +

  1. Disease Severity Assessment:

    +
      +
    • Severe thrombocytopenia with end-organ damage
      • +
    • Neurological deterioration
      • +
    • Cardiac involvement
      • +
    • Respiratory failure
      • +
    • DIC complication
      • +
    • Thrombotic complications
      • +
    +
    2. +

  2. Management Rationale:

    +
      +
    • Double-volume plasmapheresis:
        +
      • More rapid ADAMTS13 replacement
        • +
      • Better clearance of autoantibodies
        • +
      • Indicated in neurological deterioration
        • +
      +
      • +
    • Rituximab:
        +
      • Early administration improves outcomes
        • +
      • Reduces relapse risk
        • +
      • Addresses autoimmune component
        • +
      +
      • +
    • ECMO support:
        +
      • Manages cardiogenic shock
        • +
      • Provides respiratory support
        • +
      • Allows time for treatment response
        • +
      +
      • +
    +
    3. +

  3. Critical Considerations:

    +
      +
    • Anticoagulation must continue despite bleeding risk:
        +
      • Catastrophic microthrombi formation
        • +
      • Central line maintenance
        • +
      • DVT presence
        • +
      +
      • +
    • Platelet transfusion contraindicated unless life-threatening bleeding
      • +
    • IVC filter contraindicated (increases thrombosis risk)
      • +
    • Splenectomy outdated, high mortality risk
      • +
    +
    4. +

  4. Expected Outcomes:

    +
      +
    • Mortality >90% without aggressive intervention
      • +
    • ~70% survival with optimal management
      • +
    • Neurological recovery possible with prompt treatment
      • +
    +
    5. +
+

References

+
+ + + + \ No newline at end of file diff --git a/public/questions/nephrology/acid-base/complex-disorders.html b/public/questions/nephrology/acid-base/complex-disorders.html new file mode 100644 index 0000000..dfea72d --- /dev/null +++ b/public/questions/nephrology/acid-base/complex-disorders.html @@ -0,0 +1,120 @@ + + + + + + + acid-base + + + +

Complex Acid-Base Disorder Analysis

+

Question

+

A 62-year-old diabetic presents with severe diarrhea, DKA, and acute kidney injury. Labs show:

+ +

Which combination of acid-base disorders best explains these findings?

+

Options

+ + + + + + + + + + + + + + + + + + + + + + + + + + + +
OptionDescription
A)Metabolic acidosis (high AG) + Respiratory acidosis
B)Metabolic acidosis (high AG) + Metabolic acidosis (normal AG)
C)Metabolic acidosis (high AG) + Respiratory alkalosis
D)Triple disorder: Metabolic acidosis (high AG) + Metabolic acidosis (normal AG) + Respiratory alkalosis
E)Metabolic acidosis (high AG) + Metabolic alkalosis
+
+View Answer + +

Correct Answer

+

D

+

Explanation

+

This is a complex triple disorder:

+
    +

  1. Primary disorders identification:

    +
      +
    • High anion gap metabolic acidosis (DKA)
        +
      • Elevated AG = 20
        • +
      • Ketoacidosis from DKA
        • +
      +
      • +
    • Normal anion gap metabolic acidosis
        +
      • GI bicarbonate loss from diarrhea
        • +
      • Delta ratio 0.8 suggests mixed metabolic acidosis
        • +
      +
      • +
    • Respiratory alkalosis
        +
      • Expected pCO2 = (1.5 × HCO3) + 8 ± 2
        • +
      • Expected = 21.5 mmHg
        • +
      • Actual = 24 mmHg
        • +
      • Relative respiratory alkalosis present
        • +
      +
      • +
    +
    2. +

  2. Supporting evidence:

    +
      +
    • Delta gap = 2.0 confirms additional non-AG acidosis
      • +
    • Multiple appropriate clinical triggers:
        +
      • DKA causing high AG acidosis
        • +
      • Diarrhea causing normal AG acidosis
        • +
      • Respiratory compensation plus sepsis/DKA driving respiratory alkalosis
        • +
      +
      • +
    +
    3. +

  3. Clinical pearls:

    +
      +
    • Multiple disorders often coexist in critically ill patients
      • +
    • Delta ratio helps identify mixed metabolic disorders
      • +
    • Clinical context crucial for interpretation
      • +
    +
    4. +
+

References

+
+ + + + \ No newline at end of file diff --git a/public/questions/nephrology/acid-base/metabolic-alkalosis.html b/public/questions/nephrology/acid-base/metabolic-alkalosis.html new file mode 100644 index 0000000..952f2cc --- /dev/null +++ b/public/questions/nephrology/acid-base/metabolic-alkalosis.html @@ -0,0 +1,104 @@ + + + + + + + acid-base + + + +

Metabolic Alkalosis Evaluation

+

Question

+

A 54-year-old woman with history of CHF presents with 2 weeks of nausea and weakness. She's been taking high doses of furosemide. Labs show:

+ +

Which statement best explains her acid-base disorder and appropriate management?

+

Options

+ + + + + + + + + + + + + + + + + + + + + + + + + + + +
OptionDescription
A)Contraction alkalosis; treat with isotonic saline and potassium replacement
B)Diuretic-induced alkalosis; treat with KCl and continue diuretics
C)Primary metabolic alkalosis; treat with acetazolamide
D)Respiratory acidosis with metabolic compensation; no treatment needed
E)Mixed alkalosis; treat with fluid restriction and hydrogen chloride
+
+View Answer + +

Correct Answer

+

A

+

Explanation

+

This case represents chloride-responsive (saline-responsive) metabolic alkalosis:

+
    +

  1. Key diagnostic findings:

    +
      +
    • Elevated pH and HCO3 confirm metabolic alkalosis
      • +
    • Low urine Cl (<20 mEq/L) suggests chloride-responsive state
      • +
    • Hypokalemia and hypovolemia from diuretic use
      • +
    • Appropriate respiratory compensation (expected pCO2 = 0.7 × HCO3 + 20 ± 5)
      • +
    +
    2. +

  2. Pathophysiology:

    +
      +
    • Volume contraction from furosemide leads to:
        +
      • Increased bicarbonate reabsorption
        • +
      • Enhanced K+ and H+ exchange
        • +
      • Chloride depletion maintaining alkalosis
        • +
      +
      • +
    +
    3. +

  3. Management principles:

    +
      +
    • Volume repletion with NaCl restores chloride
      • +
    • K+ replacement essential for recovery
      • +
    • Underlying CHF needs careful monitoring
      • +
    • Diuretic adjustment may be needed
      • +
    +
    4. +
+

References

+
+ + + + \ No newline at end of file diff --git a/scripts/convertMarkdown.js b/scripts/convertMarkdown.js new file mode 100644 index 0000000..c0f3f41 --- /dev/null +++ b/scripts/convertMarkdown.js @@ -0,0 +1,69 @@ +const fs = require('fs'); +const path = require('path'); +const marked = require('marked'); +const matter = require('gray-matter'); + +function convertMarkdownFiles(questionsDir, outputDir) { + console.log(`Converting markdown files from ${questionsDir} to ${outputDir}`); + + const walkSync = (dir) => { + const files = fs.readdirSync(dir); + files.forEach(file => { + const filepath = path.join(dir, file); + const stat = fs.statSync(filepath); + + // Calculate relative path maintaining directory structure + const relativeToQuestions = path.relative(questionsDir, dir); + const currentOutputDir = path.join(outputDir, relativeToQuestions); + + if (stat.isDirectory()) { + console.log(`Creating directory: ${currentOutputDir}`); + fs.mkdirSync(currentOutputDir, { recursive: true }); + walkSync(filepath); + } else if (path.extname(file) === '.md') { + // Create output directory if it doesn't exist + if (!fs.existsSync(currentOutputDir)) { + console.log(`Creating directory: ${currentOutputDir}`); + fs.mkdirSync(currentOutputDir, { recursive: true }); + } + + const content = fs.readFileSync(filepath, 'utf8'); + const { data, content: markdownContent } = matter(content); + + const html = ` + + + + + + ${data.topic || 'Medical Question'} + + + + ${marked.parse(markdownContent)} + +`; + + const outputPath = path.join(currentOutputDir, file.replace('.md', '.html')); + console.log(`Writing file: ${outputPath}`); + fs.writeFileSync(outputPath, html); + } + }); + }; + + // Ensure base output directory exists + if (!fs.existsSync(outputDir)) { + console.log(`Creating base output directory: ${outputDir}`); + fs.mkdirSync(outputDir, { recursive: true }); + } + + walkSync(questionsDir); +} + +module.exports = convertMarkdownFiles; diff --git a/scripts/indexQuestions.js b/scripts/indexQuestions.js new file mode 100644 index 0000000..dde9848 --- /dev/null +++ b/scripts/indexQuestions.js @@ -0,0 +1,45 @@ +const fs = require('fs'); +const path = require('path'); +const matter = require('gray-matter'); + +function indexQuestions(questionsDir) { + const questions = []; + const walkSync = (dir) => { + const files = fs.readdirSync(dir); + files.forEach(file => { + const filepath = path.join(dir, file); + if (fs.statSync(filepath).isDirectory()) { + walkSync(filepath); + } else if (path.extname(file) === '.md') { + const content = fs.readFileSync(filepath, 'utf8'); + const { data } = matter(content); + if (data.specialty) { + // Extract just the path after 'questions' directory + const relativePath = filepath + .split(/[\/\\]questions[\/\\]/)[1] // Split on questions directory + .replace(/\\/g, '/') // Convert backslashes to forward slashes + .replace('.md', '.html'); + + questions.push({ + filepath: `questions/${relativePath}`, // Add questions prefix + specialty: data.specialty, + topic: data.topic, + difficulty: data.difficulty, + id: data.id, + title: content.split('\n')[0].replace('# ', '') + }); + } + } + }); + }; + + walkSync(questionsDir); + return questions.sort((a, b) => a.specialty.localeCompare(b.specialty)); +} + +const questionsDir = path.join(__dirname, '../questions'); +const index = indexQuestions(questionsDir); +fs.writeFileSync( + path.join(__dirname, '../public/questionIndex.json'), + JSON.stringify(index, null, 2) +);