{"id":36876,"date":"2026-05-28T04:33:41","date_gmt":"2026-05-27T23:03:41","guid":{"rendered":"https:\/\/atsixty.com\/?p=36876"},"modified":"2026-05-28T04:34:11","modified_gmt":"2026-05-27T23:04:11","slug":"infectious-dermatoses","status":"publish","type":"post","link":"https:\/\/atsixty.com\/index.php\/28\/05\/2026\/infectious-dermatoses\/","title":{"rendered":"Infectious Dermatoses"},"content":{"rendered":"\n\n\n<link href=\"https:\/\/fonts.googleapis.com\/css2?family=Playfair+Display:ital,wght@0,400;0,600;0,700;1,400;1,600&#038;family=Source+Serif+4:ital,wght@0,300;0,400;0,600;1,400&#038;display=swap\" rel=\"stylesheet\">\n<style>\n\/* All styles namespaced to #infd01 -- no bleed into WordPress theme *\/\n#infd01 *,#infd01 *::before,#infd01 *::after{box-sizing:border-box;margin:0;padding:0}\n#infd01{\n  --ter:#8B3D20;--ter-light:#B85A38;--ter-pale:#FDF0EB;--ter-dark:#6B2D14;\n  --correct:#2D6B47;--correct-bg:#EAF6EF;--correct-border:#3A9960;\n  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.mr-stem{font-size:0.9rem}#infd01 .mr-opt-text{font-size:0.86rem}}\n<\/style>\n\n<div id=\"infd01\">\n\n  <div class=\"mr-header\">\n    <div class=\"mr-eyebrow\">Morning Rounds &middot; Daily Clinical Quiz<\/div>\n    <div class=\"mr-title\">\n      Infectious Dermatoses<br><em>Bacterial, Fungal, Viral &amp; Parasitic<\/em>\n    <\/div>\n    <div class=\"mr-subtitle\">Five high-yield clinical cases &middot; +4 \/ &minus;1 scoring &middot; NEET-PG and INI-CET<\/div>\n    <div class=\"mr-chips\">\n      <span class=\"mr-chip\">5 Cases<\/span>\n      <span class=\"mr-chip\">+4 \/ &minus;1 scoring<\/span>\n      <span class=\"mr-chip\">Options reshuffled<\/span>\n    <\/div>\n  <\/div>\n\n  <div class=\"mr-sentinel\" id=\"infd01-sentinel\"><\/div>\n\n  <div class=\"mr-progress\" id=\"infd01-progress\">\n    <div class=\"mr-prog-inner\">\n      <div class=\"mr-pips\" id=\"infd01-pips\"><\/div>\n    <\/div>\n  <\/div>\n\n  <div class=\"mr-body\">\n    <div id=\"infd01-cases\"><\/div>\n    <div class=\"mr-submit-wrap\">\n      <button class=\"mr-btn\" id=\"infd01-submit\">Submit for Debrief<\/button>\n    <\/div>\n    <div class=\"mr-score\" id=\"infd01-score\">\n      <div class=\"mr-score-in\">\n        <div class=\"mr-score-ey\">Round Complete<\/div>\n        <div class=\"mr-ring\" id=\"infd01-ring\">\n          <div class=\"mr-ring-in\">\n            <span class=\"mr-ring-pct\" id=\"infd01-pct\">0%<\/span>\n            <span class=\"mr-ring-sub\">net<\/span>\n          <\/div>\n        <\/div>\n        <div class=\"mr-score-title\">Your Debrief<\/div>\n        <div class=\"mr-score-net\" id=\"infd01-net\"><\/div>\n        <div class=\"mr-verdict\" id=\"infd01-verdict\"><\/div>\n        <div class=\"mr-bands\">\n          <span class=\"mr-band mr-band-c\" id=\"infd01-ct-c\"><\/span>\n          <span class=\"mr-band mr-band-w\" id=\"infd01-ct-w\"><\/span>\n          <span class=\"mr-band mr-band-s\" id=\"infd01-ct-s\"><\/span>\n        <\/div>\n        <button class=\"mr-retry\" id=\"infd01-retry\">&#8635; New Round<\/button>\n      <\/div>\n    <\/div>\n  <\/div>\n<\/div>\n\n<script>\n(function () {\n  'use strict';\n\n  var NS    = 'infd01';\n  var TOTAL = 5;\n  var MAX   = 20;\n  var LTRS  = ['A','B','C','D'];\n\n  \/* ================================================================\n     QUESTION BANK -- Infectious Dermatoses\n     NEET-PG level. Bacterial, Fungal, Viral, Parasitic.\n     ================================================================\n\n     Q1  SCABIES -- PATHOGNOMONIC LESION & TREATMENT (Easy-Medium)\n         Causative organism: Sarcoptes scabiei var hominis\n         Pathognomonic: burrow (linear grey track) in web spaces,\n           wrists, waistline, genitalia. Spares face in adults\n           (involved in infants).\n         Intense nocturnal pruritus (hypersensitivity to mite\n           antigens -- takes 4-6 weeks on first infestation).\n         Norwegian (crusted) scabies: immunocompromised patients;\n           millions of mites; not intensely pruritic; highly\n           contagious.\n         Treatment of choice: permethrin 5% cream (apply neck to\n           toe, leave 8-12 hours, repeat after 1 week).\n         Alternative: oral ivermectin (especially Norwegian scabies\n           and institutional outbreaks).\n         All contacts treated simultaneously.\n         Answer: Burrow -- linear track made by female mite in\n                 stratum corneum; permethrin 5% is treatment\n                 of choice\n\n     Q2  TINEA VERSICOLOR (Pityriasis Versicolor) (Easy)\n         Causative: Malassezia furfur (Pityrosporum orbiculare)\n         Lipophilic yeast, part of normal flora.\n         Hypopigmented (more visible in summer\/after tanning) OR\n           hyperpigmented macules on trunk, upper arms, neck.\n         KOH mount: spaghetti and meatballs appearance\n           (short hyphae + round spores = Malassezia).\n         Wood lamp: golden-yellow fluorescence.\n         Treatment: topical selenium sulphide, ketoconazole\n           shampoo, azoles. Oral fluconazole\/itraconazole for\n           extensive disease.\n         Pigment changes persist for months after treatment --\n           warn patients.\n         Answer: Malassezia furfur; KOH shows spaghetti and\n                 meatballs; golden-yellow on Wood lamp\n\n     Q3  IMPETIGO -- BULLOUS vs NON-BULLOUS (Medium)\n         Non-bullous (70%): Staph aureus or Strep pyogenes.\n           Golden-yellow crusted lesions. Most common in children.\n           Face, around nose and mouth.\n         Bullous (30%): Staph aureus phage group II ONLY.\n           Exfoliatin toxin (same as SSSS but localised -- produced\n           at the lesion site, not systemically).\n           Flaccid, easily ruptured bullae; collarette of scaling.\n           No systemic features.\n         Ecthyma: deeper ulcerating form; punched-out ulcers with\n           thick adherent crust; heals with scarring.\n         Treatment: topical mupirocin (first-line for localised);\n           oral flucloxacillin or amoxicillin-clavulanate for\n           extensive disease.\n         Post-streptococcal glomerulonephritis can follow\n           non-bullous impetigo (NOT rheumatic fever -- skin\n           strep does not cause RF).\n         Answer: Bullous impetigo caused by Staph aureus phage\n                 group II via localised exfoliatin production;\n                 non-bullous can cause post-streptococcal GN\n\n     Q4  HERPES ZOSTER -- DERMATOMAL DISTRIBUTION & COMPLICATIONS\n         (Medium)\n         VZV reactivation from dorsal root ganglia.\n         Prodrome: burning\/shooting pain BEFORE rash appears.\n         Grouped vesicles on erythematous base in a unilateral\n           dermatomal distribution -- never crosses midline.\n         Most common dermatome: thoracic (T3-T12).\n         Ramsay Hunt syndrome: VZV reactivation in geniculate\n           ganglion (CN VII) -- ear vesicles + ipsilateral\n           facial palsy + sensorineural hearing loss.\n         Hutchinson sign: vesicles on tip or side of nose\n           (nasociliary branch of V1) -- indicates risk of\n           ophthalmic zoster and eye involvement.\n         Post-herpetic neuralgia: most common complication,\n           especially in elderly.\n         Treatment: aciclovir\/valaciclovir within 72 hours of\n           rash onset. Reduces duration and risk of PHN.\n         Answer: Ramsay Hunt syndrome -- geniculate ganglion VZV;\n                 Hutchinson sign predicts ophthalmic involvement\n\n     Q5  TINEA CAPITIS -- MICROSPORUM vs TRICHOPHYTON (Medium)\n         Tinea capitis: dermatophyte infection of scalp.\n         Microsporum audouinii \/ M. canis:\n           Ectothrix infection (spores outside hair shaft).\n           Green fluorescence on Wood lamp.\n           Grey patch type -- scaling, broken hairs.\n         Trichophyton tonsurans (most common in India and USA now):\n           Endothrix (spores inside hair shaft).\n           NO Wood lamp fluorescence.\n           Black dot type -- hair breaks at scalp level leaving\n           black dots.\n         Kerion: inflammatory boggy mass; T. verrucosum (cattle);\n           can cause scarring alopecia if untreated.\n         Favus: T. schoenleinii; scutula (yellowish cup-shaped\n           crusts); mousy odour; permanent scarring alopecia.\n         Treatment: ORAL antifungals mandatory (topical does not\n           penetrate hair shaft) -- griseofulvin (traditional),\n           terbinafine (now preferred), itraconazole.\n         Answer: Trichophyton tonsurans -- endothrix, black dot\n                 type, no Wood lamp fluorescence; oral antifungal\n                 mandatory\n     ================================================================ *\/\n\n  var QS = [\n\n    \/* ---- Q1 : Scabies ---- *\/\n    {\n      id:      1,\n      tag:     'Infectious Dermatoses &mdash; Scabies',\n      stem:    'A <strong>24-year-old man<\/strong> presents with intense itching, worse at night, affecting his <strong>finger web spaces, wrists, and genitalia<\/strong> for three weeks. His wife has similar symptoms. Examination reveals excoriations and, in the web spaces, faint <strong>linear greyish tracks<\/strong> 5&ndash;10&nbsp;mm long. The pathognomonic lesion, its cause, and the treatment of choice are:',\n      correct: 'Burrow: a linear track excavated by the female Sarcoptes scabiei in the stratum corneum; permethrin 5% cream applied from neck to toe is the treatment of choice',\n      opts: [\n        'Burrow: a linear track excavated by the female Sarcoptes scabiei in the stratum corneum; permethrin 5% cream applied from neck to toe is the treatment of choice',\n        'Vesicle: a fluid-filled lesion from mite saliva toxin; oral antihistamines are the treatment of choice',\n        'Wheal: an urticarial response to mite antigens; topical corticosteroids are the treatment of choice',\n        'Papule: a solid raised lesion from mite egg deposition; benzyl benzoate 25% is the only effective treatment'\n      ],\n      exp:     'The <strong>burrow<\/strong> is the pathognomonic lesion of scabies &mdash; a short, tortuous, linear grey track representing the tunnel excavated by the <em>female Sarcoptes scabiei<\/em> as she lays eggs in the stratum corneum. Itching is intense and nocturnal, caused by hypersensitivity to mite antigens and faeces &mdash; it takes 4&ndash;6 weeks to develop on first infestation (hence the incubation period). <strong>Treatment of choice: permethrin 5% cream<\/strong>, applied from neck to toes (including under nails), left for 8&ndash;12 hours, repeated after one week. <strong>All household contacts must be treated simultaneously<\/strong> regardless of symptoms &mdash; a critical management point. <strong>Norwegian (crusted) scabies<\/strong> occurs in immunocompromised patients (HIV, organ transplant, elderly institutionalised): millions of mites, hyperkeratotic crusts, <em>minimal itching<\/em> (paradoxically), and highly contagious. Treatment: oral ivermectin + topical permethrin. <strong>Extra point:<\/strong> post-scabietic nodules &mdash; persistent reddish-brown nodules on genitalia and axillae after successful treatment &mdash; represent a hypersensitivity reaction to dead mite antigens, not treatment failure. They resolve spontaneously and do not require re-treatment.'\n    },\n\n    \/* ---- Q2 : Tinea Versicolor ---- *\/\n    {\n      id:      2,\n      tag:     'Infectious Dermatoses &mdash; Tinea Versicolor',\n      stem:    'A <strong>20-year-old college student<\/strong> presents with multiple <strong>hypopigmented, fine scaly macules<\/strong> on his chest and upper back, more noticeable after a beach holiday. He is otherwise healthy. KOH mount of skin scrapings shows <strong>short curved hyphae and clusters of round spores<\/strong>. Wood lamp examination reveals a <strong>golden-yellow fluorescence<\/strong>. The causative organism and the characteristic KOH finding are:',\n      correct: 'Malassezia furfur; spaghetti and meatballs appearance on KOH (short hyphae and spherical yeast cells)',\n      opts: [\n        'Malassezia furfur; spaghetti and meatballs appearance on KOH (short hyphae and spherical yeast cells)',\n        'Trichophyton rubrum; long branching hyphae with arthroconidia on KOH',\n        'Candida albicans; pseudohyphae with budding yeast cells in chains on KOH',\n        'Microsporum canis; ectothrix spores arranged around hair shaft on KOH'\n      ],\n      exp:     '<strong>Pityriasis (Tinea) versicolor<\/strong> is caused by <strong>Malassezia furfur<\/strong> (also known as <em>Pityrosporum orbiculare<\/em>), a lipophilic yeast that is part of normal skin flora. It converts to a pathogenic mycelial form when conditions favour overgrowth: heat, humidity, sebaceous skin, immunosuppression, and oral contraceptives. The KOH appearance of <strong>short curved hyphae + round yeast cells<\/strong> is classically described as <em>spaghetti and meatballs<\/em>. Wood lamp: <strong>golden-yellow fluorescence<\/strong>. The hypopigmentation occurs because <em>Malassezia<\/em> produces <strong>azelaic acid<\/strong>, which inhibits melanin synthesis in melanocytes. <strong>Important patient counselling point:<\/strong> the pigment change (hypo- or hyperpigmentation) persists for <em>months<\/em> after successful treatment because melanocytes need time to recover &mdash; patients must be told this to avoid confusion about treatment failure. <strong>Extra point:<\/strong> <em>Malassezia<\/em> is also implicated in <strong>seborrhoeic dermatitis<\/strong> (dandruff) and <strong>Malassezia folliculitis<\/strong> (itchy follicular papules and pustules on the upper trunk, mimicking acne). All three conditions respond to topical or oral antifungals targeting this organism.'\n    },\n\n    \/* ---- Q3 : Impetigo ---- *\/\n    {\n      id:      3,\n      tag:     'Infectious Dermatoses &mdash; Impetigo',\n      stem:    'A <strong>6-year-old girl<\/strong> develops multiple <strong>thin-roofed, flaccid bullae<\/strong> on her trunk and thighs that rupture easily, leaving behind a <em>collarette of scale<\/em>. There is no fever and she appears well. Her younger sibling has non-bullous crusted facial lesions. The causative organism of the bullous form, its mechanism, and an important complication of the non-bullous form are:',\n      correct: 'Staphylococcus aureus phage group II; localised exfoliatin toxin production cleaving desmoglein 1; post-streptococcal glomerulonephritis can follow non-bullous impetigo',\n      opts: [\n        'Staphylococcus aureus phage group II; localised exfoliatin toxin production cleaving desmoglein 1; post-streptococcal glomerulonephritis can follow non-bullous impetigo',\n        'Streptococcus pyogenes; streptolysin O production causing epidermal necrosis; rheumatic fever is the main complication of non-bullous impetigo',\n        'Staphylococcus aureus phage group II; systemic toxin dissemination causing full-thickness epidermal necrosis; toxic shock syndrome complicates all cases',\n        'Pseudomonas aeruginosa; exotoxin A production; ecthyma gangrenosum is the expected complication in immunocompetent children'\n      ],\n      exp:     '<strong>Bullous impetigo<\/strong> is caused exclusively by <strong>Staphylococcus aureus phage group II<\/strong>, which produces <strong>exfoliatin toxin locally<\/strong> at the infection site (unlike SSSS, where toxin is produced at a distant focus and disseminated haematogenously). The toxin cleaves <strong>desmoglein 1<\/strong> &mdash; same target as pemphigus foliaceus and SSSS &mdash; causing a subcorneal split and flaccid, easily ruptured bullae. No systemic features because the toxin remains localised. <strong>Non-bullous impetigo<\/strong> is caused by <em>S. aureus<\/em> or <em>Streptococcus pyogenes<\/em> (Group A Strep), producing the classic <em>honey-coloured crusted lesions<\/em>. <strong>Critical complication:<\/strong> post-streptococcal <strong>glomerulonephritis<\/strong> (PSGN) can follow skin infection with nephritogenic strains of GAS. <strong>Rheumatic fever does NOT follow skin strep infections<\/strong> &mdash; only throat infections trigger RF. This distinction is reliably tested. <strong>Extra point:<\/strong> <em>ecthyma<\/em> is the deeper ulcerating form of impetigo &mdash; a punched-out ulcer with a thick adherent crust that heals with scarring. Treatment: topical <strong>mupirocin<\/strong> for localised disease; oral antibiotics (flucloxacillin) for extensive or bullous disease.'\n    },\n\n    \/* ---- Q4 : Herpes Zoster ---- *\/\n    {\n      id:      4,\n      tag:     'Infectious Dermatoses &mdash; Herpes Zoster',\n      stem:    'A <strong>65-year-old diabetic man<\/strong> develops severe burning pain in his left ear for two days, followed by grouped vesicles in the external auditory canal and <strong>ipsilateral facial weakness<\/strong>. Audiometry shows sensorineural hearing loss on the left. Separately, a <strong>68-year-old woman<\/strong> with herpes zoster is noted to have vesicles on the <em>tip of her nose<\/em>. Which pair of statements correctly identifies the significance of each finding?',\n      correct: 'Ear vesicles + facial palsy + hearing loss = Ramsay Hunt syndrome (VZV in geniculate ganglion); vesicles on nasal tip = Hutchinson sign, indicating risk of ophthalmic zoster and corneal involvement',\n      opts: [\n        'Ear vesicles + facial palsy + hearing loss = Ramsay Hunt syndrome (VZV in geniculate ganglion); vesicles on nasal tip = Hutchinson sign, indicating risk of ophthalmic zoster and corneal involvement',\n        'Ear vesicles + facial palsy = Bell palsy triggered by HSV-1 reactivation; vesicles on nasal tip = incidental finding with no ophthalmological significance',\n        'Ear vesicles + facial palsy = Ramsay Hunt syndrome; vesicles on nasal tip indicate spread to the maxillary division of the trigeminal nerve with risk of palatal involvement',\n        'Ear vesicles + hearing loss = otitis externa from VZV; facial palsy indicates concurrent Bell palsy; nasal tip vesicles suggest HSV-2 infection'\n      ],\n      exp:     '<strong>Ramsay Hunt syndrome<\/strong> results from VZV reactivation in the <strong>geniculate ganglion<\/strong> of the facial nerve (CN VII). The triad: <em>vesicles in the external auditory canal and\/or pinna<\/em> + <em>ipsilateral lower motor neurone facial palsy<\/em> + <em>sensorineural hearing loss<\/em> (involvement of CN VIII at the internal auditory meatus). It carries a worse prognosis than Bell palsy &mdash; complete recovery occurs in only ~50% without treatment vs ~70% in Bell palsy. Treatment: aciclovir + prednisolone started early. <strong>Hutchinson sign<\/strong>: vesicles on the tip or side of the nose indicate involvement of the <strong>nasociliary branch of the ophthalmic division (V1)<\/strong> of the trigeminal nerve &mdash; the same branch that supplies the cornea. A positive Hutchinson sign warrants <em>urgent ophthalmological review<\/em> to exclude keratitis, uveitis, and corneal scarring. <strong>Extra point:<\/strong> <strong>post-herpetic neuralgia (PHN)<\/strong> is the most common and debilitating complication of herpes zoster, particularly in the elderly and diabetics. Early antiviral therapy (within 72 hours of rash onset) reduces its incidence. The <strong>recombinant zoster vaccine (Shingrix)<\/strong> &mdash; two doses &mdash; is now preferred over the live attenuated vaccine (Zostavax) for prevention in adults over 50.'\n    },\n\n    \/* ---- Q5 : Tinea Capitis ---- *\/\n    {\n      id:      5,\n      tag:     'Infectious Dermatoses &mdash; Tinea Capitis',\n      stem:    'A <strong>9-year-old boy<\/strong> presents with patchy scalp hair loss. Examination shows <strong>broken hairs at the scalp surface leaving black dots<\/strong>, with mild surrounding scale. <strong>Wood lamp examination is negative<\/strong>. His classmate has a similar presentation. The most likely organism, the type of hair shaft invasion, and the mandatory treatment route are:',\n      correct: 'Trichophyton tonsurans; endothrix invasion (spores inside hair shaft); oral antifungal mandatory as topical agents cannot penetrate the hair shaft',\n      opts: [\n        'Trichophyton tonsurans; endothrix invasion (spores inside hair shaft); oral antifungal mandatory as topical agents cannot penetrate the hair shaft',\n        'Microsporum canis; ectothrix invasion (spores outside hair shaft); topical clotrimazole cream is sufficient treatment',\n        'Trichophyton violaceum; favus with scutula formation; topical selenium sulphide shampoo is the treatment of choice',\n        'Microsporum audouinii; ectothrix invasion with green Wood lamp fluorescence; topical ketoconazole shampoo is curative'\n      ],\n      exp:     '<strong>Trichophyton tonsurans<\/strong> is the most common cause of tinea capitis in India and the USA. It causes <strong>endothrix<\/strong> infection &mdash; arthrospores fill the interior of the hair shaft, weakening it so that hair breaks at scalp level, leaving the characteristic <strong>black dot pattern<\/strong>. Wood lamp is <strong>negative<\/strong> (endothrix organisms do not fluoresce). <em>Microsporum<\/em> species cause <strong>ectothrix<\/strong> infection (spores on the outside of the shaft) and produce <strong>green fluorescence<\/strong> on Wood lamp. <strong>Treatment of tinea capitis is always oral<\/strong> &mdash; topical antifungals cannot penetrate the hair shaft. Options: <strong>griseofulvin<\/strong> (traditional, taken with fatty food for absorption), <strong>terbinafine<\/strong> (now preferred, shorter course, better for <em>Trichophyton<\/em>), itraconazole. <strong>Kerion<\/strong>: a boggy, inflammatory, pustular mass of the scalp caused by <em>T. verrucosum<\/em> (from cattle) &mdash; represents an exuberant host immune response. Treat with oral antifungal; add short course of steroids to reduce inflammation and prevent scarring alopecia. Do not incise &mdash; it is not an abscess. <strong>Extra point:<\/strong> <em>Favus<\/em> (caused by <em>T. schoenleinii<\/em>) produces characteristic <strong>scutula<\/strong> (yellowish cup-shaped crusts), a mousy odour, and <em>permanent scarring alopecia<\/em> if untreated &mdash; the only form of tinea capitis that causes irreversible hair loss.'\n    }\n\n  ];\n  \/* ================================================================\n     END OF CONTENT -- engine logic below, do not edit\n     ================================================================ *\/\n\n  var answers  = {};\n  var answered = 0;\n  var shuffled = {};\n  var done     = false;\n\n  function byId(id) { return document.getElementById(id); }\n  function gid(sfx) { return byId(NS + '-' + sfx); }\n\n  function shuffleArr(arr) {\n    var a = arr.slice(), i, j, t;\n    for (i = a.length - 1; i > 0; i--) {\n      j = Math.floor(Math.random() * (i + 1));\n      t = a[i]; a[i] = a[j]; a[j] = t;\n    }\n    return a;\n  }\n\n  function countVal(val) {\n    var k, n = 0;\n    for (k in answers) {\n      if (answers.hasOwnProperty(k) && answers[k] === val) n++;\n    }\n    return n;\n  }\n\n  function buildPips() {\n    var cont = gid('pips'), i, q, wl, wp, line, pip;\n    if (!cont) return;\n    cont.innerHTML = '';\n    for (i = 0; i < QS.length; i++) {\n      q = QS[i];\n      if (i > 0) {\n        wl = document.createElement('div'); wl.className = 'mr-pip-wrap';\n        line = document.createElement('div'); line.className = 'mr-pip-line';\n        line.id = NS + '-pl' + q.id;\n        wl.appendChild(line); cont.appendChild(wl);\n      }\n      wp = document.createElement('div'); wp.className = 'mr-pip-wrap';\n      pip = document.createElement('div'); pip.className = 'mr-pip';\n      pip.id = NS + '-pip' + q.id; pip.textContent = String(q.id);\n      wp.appendChild(pip); cont.appendChild(wp);\n    }\n  }\n\n  function build() {\n    var cont, i, q, opts, card, top, nd, meta, tg, st,\n        rule, od, ed, lb, tx, j, oe, ls, ts;\n    cont = gid('cases');\n    if (!cont) return;\n    cont.innerHTML = '';\n    answers = {}; answered = 0; shuffled = {}; done = false;\n    if (gid('score')) gid('score').style.display = 'none';\n    buildPips();\n    for (i = 0; i < QS.length; i++) {\n      q    = QS[i];\n      opts = shuffleArr(q.opts);\n      shuffled[q.id] = opts;\n      card = document.createElement('div'); card.className = 'mr-case';\n      top  = document.createElement('div'); top.className  = 'mr-case-top';\n      nd   = document.createElement('div'); nd.className   = 'mr-num';\n      nd.textContent = q.id < 10 ? 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No bug gets past you.'],\n      [4, 'Strong \\u2014 one organism to revisit before exam day.'],\n      [3, 'Solid base \\u2014 the India-specific points reward a second read.'],\n      [2, 'Halfway there \\u2014 the debrief panels have everything you need.'],\n      [0, 'Infectious dermatoses reward persistence. 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