PI SPIDER WEB — FULL COVERAGE MAP

Feb 13, 2026 | Exam: Feb 14 | ~36 hours remaining
Done/Graded
Built/Needs Recall
Embedded
Gap HIGH
Gap MED
Gap LOW
Excluded
M-CVDMetabolic-CVD LIVERLiver RENALRenal INFECTInfection NEURONeuro-Nutrition
SLOT 1: NUTRITION / VITAMIN — 1-3 QsP=1.00
✅
Vitamin B12 (Cobalamin)8/10NEURO
MMA ↑ specific. Neuro without anemia 28%. Methyl trap → folate.
FolateSpinal cord/SACDNutritional neuroMetformin ↓B12
✅
Vitamin B6 (Pyridoxine) + INH7.5/10NEUROINFECT
PLP (Pyridoxal 5'-Phosphate) active form. Hydrazone complex. 10mg/day prophylaxis.
INH/TBSideroblastic anemiaNAT2 pharmacogenomics
📋
Vitamin B1 (Thiamine)NEURO
Blueprint. Thiamine BEFORE glucose. Wernicke's triad. Beriberi wet/dry. Pyruvate dehydrogenase cofactor.
Nutritional neuroRefeedingTPN
⬜
Vitamin B3 (Niacin) — EXCLUDED ×0.10
Sep25. Pellagra 3Ds. Safety net via B6-INH overlap.
⬜
Vitamin B9 (Folic Acid) — EXCLUDED ×0.25
Jan25. NTDs. Methyl trap in B12 answer.
✅
Vitamin C (Ascorbic Acid)
Fe³⁺→Fe²⁺ iron absorption. Collagen hydroxylation. Scurvy.
Iron absorption
✅
Vitamin D (Cholecalciferol)8.5/10RENAL
Parafollicular=Calcitonin. Chief=PTH. 1,25(OH)₂D₃ active. CKD→↓1α-hydroxylase.
Calcium metabolismNephronPTH axis
✅
Vitamin A (Retinol)7.5/10
MEASLES not mumps. Bitot's spots. Teratogenic. Rhodopsin.
Measles protocolXerophthalmia staging
✅
Vitamin K (Phylloquinone)8/10
Gamma-carboxyglutamate. Factors II,VII,IX,X. Bridging protects. Warfarin antagonism.
CoagulationWarfarin
⚠️
Vitamin E (Tocopherol)M-CVDNEURO
MINIMAL. Spinocerebellar. Lipid peroxidation. Antioxidant in olive oil/nuts.
SACDMediterraneanAtherosclerosis
✅
Iron / Heme7/10LIVER
Hepcidin-ferroportin axis. Hepcidin ↑ inflammation → iron trapping.
Vitamin CAnemia workupHemochromatosisHeme synthesis
✅
TPN (Total Parenteral Nutrition)8.5/10
Soybean oil lipid. Cycle 12-16hr. Trace: Zn,Cu,Mn,Cr,Se.
RefeedingNAFLDCritically ill
✅
Refeeding Syndrome8.5/10
BMI<16. PO₄ hallmark killer. Insulin surge→intracellular shift. Thiamine first.
ThiamineElectrolytesPEM
✅
Nutritional Neurological Disorders7/10NEURO
Victor-Adams. PLP=Pyridoxal 5'-Phosphate. Umbrella: B12/B1/B6/Cu/E.
B12/SACDB1/Wernicke'sSpinal cord
✅
Malabsorption Tests
D-xylose normal=pancreatic. D-xylose abnormal=mucosal. H₂ early=SIBO.
Investigation slotTropical sprue
🔗
Mediterranean DietM-CVD
FAILSAFE 3-4 lines. PREDIMED=30% CVD↓. Indian: mustard oil, fish, millets.
AtherosclerosisObesityOmega-3
✅
Obesity / BMI6/10M-CVD
ANCHOR. Waist 90M/80F. Thin-fat phenotype. Leptin RESISTANCE. Errors: BP=130/85, FIB-4=fibrosis.
Met syndromeDM pathophysAtherosclerosisOHALipid drugsNAFLDAnti-obesity drugs
🔗
Metabolic Syndrome / Syndrome XM-CVD
In obesity. IDF: waist mandatory+any 2. Indian waist 90M/80F. ATP III: any 3/5.
ObesityDMDyslipidemiaHTN/ACEi
🔗
Omega-3/6 Fatty AcidsM-CVD
In lipid section. PUFA. REDUCE-IT (icosapent ethyl). Coastal fish diet.
MediterraneanLipid lowering
❌
Iodine Deficiency Disorders
GAP-HIGH. Coastal paradox. Goiter, cretinism. Wolff-Chaikoff. Thyroid link.
Thyroid pathophysSeleniumMangalore
❌
ZincNEURO
GAP-MED. Excess Zn→Cu depletion→SACD mimic. Acrodermatitis enteropathica.
Cu deficiency/SACDTPN traceWilson's (inverse)
❌
PEM (Protein-Energy Malnutrition)
GAP-MED. Kwashiorkor vs Marasmus. Wellcome classification. Indian TB/HIV.
RefeedingAlbuminIndian public health
○
Selenium
GAP-LOW. Keshan (cardiomyopathy), Kashin-Beck. Thyroid deiodinase.
○
Chromium
GAP-LOW. Glucose tolerance factor. Potentiates insulin.
○
Enteral Nutrition
GAP-LOW. EN vs PN. "If gut works, use it."
○
ICMR RDA / Fluorosis
GAP-LOW. Programme territory. Fluorosis belt.
SLOT 2: ANATOMY / PHYSIOLOGY — 1-2 QsP=1.00
✅
Coronary CirculationM-CVD
Ungraded. LAD="widow maker." RCA→SA(60%),AV(80%). Right dominant 85%. Diastolic filling.
AtherosclerosisCardiac conductionACEi
📋
Cardiac Conduction System
Blueprint. SA→AV→His→Branches→Purkinje. SA blood supply RCA 60%.
CoronaryAntiarrhythmics
⬜
Cerebral Circulation — EXCLUDED ×0.10
Sep25. Lateral medullary covered.
✅
Spinal Cord TractsNEURO
Cross-section built. SACD=posterior columns+lateral corticospinal. B12/Cu/E localization.
B12/SACDNutritional neuroZinc→Cu→SACD
⬜
Nephron / Renal — EXCLUDED ×0.25RENAL
Jan25. Segment functions, GFR estimation.
○
GI Arterial Supply
GAP-LOW. Celiac, SMA, IMA. Watershed areas.
⚠️
Portal SystemLIVER
PARTIAL. Portacaval anastomoses from portal HTN context.
BilirubinHepatic encephalopathySchistosoma
⬜
Temperature Regulation — EXCLUDED ×0.10
Sep25.
SLOT 3: PHARMACOLOGY — 1 QP=1.00
✅
ACE Inhibitors (ACEi)StrongM-CVDRENAL
RAAS. Renoprotective. Cough (bradykinin). CI: bilateral RAS, pregnancy.
Met syndrome/HTNDiabetic nephropathyHyperkalemia
✅
Metformin7/10M-CVD
AMPK activation. Weight neutral. Lactic acidosis rare. ↓B12 long-term.
DM pathophysOHAObesityB12
📋
OHA Full ClassM-CVD
BUILT, needs recall. SGLT2i (empagliflozin, dapagliflozin)→CVD+renal. GLP-1RA (semaglutide, liraglutide)→weight+CVD. DPP-4i (sitagliptin)→neutral. SU→weight gain. TZD (pioglitazone)→NASH but weight gain.
DM pathophysObesityCVD trialsElectrolytes (DKA)
📋
Lipid Lowering AgentsM-CVD
BUILT, needs recall. Statins (HMG-CoA reductase). Ezetimibe (NPC1L1). PCSK9i (evolocumab, alirocumab). Inclisiran (siRNA). Bempedoic acid (ACL inhibitor). Fibrates (PPARα). Icosapent ethyl (EPA).
AtherosclerosisDyslipidemiaCVD trials
📋
Anti-Obesity DrugsM-CVD
BUILT, needs recall. Orlistat (lipase INHIBITOR). Semaglutide 2.4mg. Tirzepatide (GIP+GLP-1). Naltrexone-bupropion. SELECT trial.
ObesityGLP-1RA overlap
⬜
Antiarrhythmics — EXCLUDED ×0.10
Sep25.
⬜
Bedaquiline — EXCLUDED ×0.25
Jan25. ATP synthase inhibitor. MDR-TB.
❌
ARNi — Sacubitril/ValsartanM-CVD
GAP-MED. Asked 2023. Neprilysin inhibition→↑natriuretic peptides. PARADIGM-HF.
ACEiHeart failure
SLOT 4: PATHOPHYSIOLOGYP=0.80
⚠️
DM PathophysiologyM-CVD
ATTEMPTED. Ominous octet (DeFronzo). Insulin resistance→β-cell failure. NEEDS FINISHING.
ObesityOHAMet syndromeAtherosclerosisDKA
✅
Septic Shock8/10
Cytokine cascade. SIRS→Sepsis→Shock. TNF-α, IL-1, IL-6. Vasodilation, DIC.
✅
AtherosclerosisM-CVD
Ungraded. Endothelial dysfunction→foam cells→plaque→rupture→thrombosis.
CoronaryObesityLipid drugsMediterraneanDM
○
Heme Synthesis / PorphyriaLIVER
GAP-LOW. ALA synthase rate-limiting. Lead inhibits ALA dehydratase + ferrochelatase.
❌
Bilirubin MetabolismLIVER
GAP-MED. 2×2023. Conjugated/unconjugated. Gilbert's, Crigler-Najjar, Dubin-Johnson, Rotor. UGT1A1.
HemeIronHepatic encephPortal
❌
Hepatic EncephalopathyLIVER
GAP-MED. Ammonia. Astrocyte swelling. West Haven I-IV. Lactulose, rifaximin.
BilirubinPortalRespiratory alkalosis
❌
Thyroid Pathophysiology
GAP-MED. Could migrate from PIV. HPT axis. Hashimoto's vs Graves'. Links to iodine.
IodineSeleniumMangalore coastal
SLOT 5: PARASITOLOGY / LIFECYCLEP=0.75
📋
Strongyloides stercoralisINFECT
HTML built. Hyperinfection immunosuppressed. Autoinfection unique. Needs recall.
DIMAOEEosinophiliaKarnataka tropical
⬜
Echinococcus — EXCLUDED ×0.25
Jan25. Hydatid cyst.
⬜
Taenia solium — EXCLUDED ×0.10
Sep25. Cysticercosis.
○
Plasmodium falciparum
LOW. 2022 (×0.10). Cerebral malaria. Banana gametocytes.
❌
Leishmania donovaniINFECT
GAP-MED. Kala-azar. Sandfly. LD bodies. Pancytopenia+HSM. Amphotericin B. NVBDCP.
DIMAOEIndian programme
❌
Wuchereria bancroftiINFECT
GAP-MED. Lymphatic filariasis. Karnataka endemic. Culex. Nocturnal periodicity. DEC. MDA.
DIMAOEKarnatakaEosinophilia
○
SchistosomaLIVER
GAP-LOW. Portal HTN. Periportal fibrosis.
✅
DIMAOE Framework
Universal lifecycle template built. Applied to all parasites.
SLOT 6: ELECTROLYTEP=0.50
✅
Hypokalemia7/10RENAL
U-waves. GI loss, renal loss, RTA. ROMK.
Drug-inducedRTAMet alkalosis
✅
Hyperkalemia7/10RENAL
Peaked T→sine wave. ACEi, SGLT2i, spironolactone. Ca gluconate→insulin+glucose→dialysis.
ACEiDrug-inducedCKD
⚠️
Hyponatremia
MENTIONED, needs grading. SIADH, dilutional, depletional. Osmolality algorithm.
VaptansOsmotic demyelination
✅
Calcium Metabolism7/10RENAL
PTH-VitD-Calcitonin. Chvostek's, Trousseau's. Corrected Ca formula.
Vitamin DNephron
⚠️
Drug-Induced DyselectrolytemiaM-CVDRENAL
UNGRADED. SGLT2i→euglycemic DKA. Loop→hypoK,hypoMg. Thiazide→hypoNa. ACEi→hyperK.
OHAACEiAll electrolytes
○
Magnesium Disorders
GAP-LOW. Orphan. Refractory hypoK+hypoCa=think hypoMg. Torsades. PPI-induced.
SLOT 7: ACID-BASEP=0.50
✅
Metabolic Alkalosis8/10
Saline-responsive vs resistant. Urine Cl⁻ key test.
HypokalemiaDiuretics
⚠️
Metabolic Acidosis / HAGMAM-CVD
UNGRADED. MUDPILES. AG=Na-(Cl+HCO₃). DKA, lactic acidosis, uremia.
DKA/DMLactic (metformin, sepsis)Poisoning
❌
RTA (Renal Tubular Acidosis)RENAL
GAP-MED. Type1=distal,pH>5.5. Type2=proximal,HCO₃⁻. Type4=hypoaldo,hyperK.
NephronHypoK(1,2)HyperK(4)
○
Respiratory Acid-Base
GAP-LOW. COPD, PE, hepatic encephalopathy.
○
Mixed Disorders
GAP-LOW. Delta-delta. Salicylate=mixed.
SLOT 8: INVESTIGATIONP=0.60
📋
PFTs (Pulmonary Function Tests)
HTML drill built. FEV₁/FVC<0.7=obstructive. Normal/↑=restrictive. DLCO.
COPDILDAsthma
⬜
CBNAAT — EXCLUDED ×0.25
Jan25. GeneXpert. MTB+Rif resistance.
🔗
Metabolic Investigation PanelM-CVD
In obesity. HOMA-IR, hsCRP, FIB-4, non-HDL-C, ApoB, Lp(a), OGTT, ASCVD score, EOSS.
○
Bone Marrow Studies
GAP-LOW. 2022. Aspiration vs biopsy.
○
Lymph Node Biopsy
GAP-LOW. 2023. Excision vs FNAC.
○
Flow Cytometry
GAP-LOW. Pre-final PIV. CD markers.
SLOT 9: POISONINGP=0.40
✅
OP Poisoning6.5/10
AChE inhibition. DUMBELS. Atropine+Pralidoxime. Intermediate syndrome.
Agricultural Karnataka
⬜
Paracetamol — EXCLUDED ×0.10
Sep25. NAPQI. NAC. Rumack-Matthew.
○
Heavy Metals
GAP-LOW. Lead, arsenic. Chelation: DMSA, EDTA, BAL.
❌
Snake Venom
GAP-MED. Krait=neurotoxic. Viper=vasculotoxic/DIC. ASV. 20-min WBCT.
CoagulationMangalore coastal
○
Scorpion
GAP-LOW. Autonomic storm. Prazosin.
❌
Copper / Wilson'sLIVER
GAP-MED. ATP7B. KF rings. ↓Ceruloplasmin. Penicillamine, zinc, trientine.
ZincBilirubin/liverBasal ganglia
SLOT 10: GENETICS / PROGRAMME / OTHERP=0.20-0.30
⚠️
Gene Therapy
UNGRADED. AAV, lentivirus. Ex vivo/in vivo. CAR-T, Luxturna, Zolgensma.
○
Clinical Trials
GAP-LOW. Phase I-IV. Helsinki. ICMR.
○
Pharmacogenomics
GAP-LOW. NAT2, CYP2D6, CYP2C19, VKORC1.
B6+INHWarfarin
⬜
Biomedical Waste — EXCLUDED ×0.10
Sep25.
⬜
NACP — EXCLUDED ×0.10
Sep25.
○
Hypersensitivity Reactions
GAP-LOW. Gell-Coombs I-IV.

COVERAGE SUMMARY

15
DONE & GRADED
10
BUILT / RECALL NEEDED
6
EMBEDDED
1
GAP HIGH
12
GAP MED
16
GAP LOW
10
EXCLUDED

NETWORK CLUSTERS

M-CVD Metabolic-CVD — 13 nodes, 4 slots. Anchor: Obesity. Strongest. Newest.
LIVER Liver — 7 nodes, 3 slots. Anchor: Bilirubin (GAP). Iron done. Portal partial.
RENAL Renal — 7 nodes, 4 slots. Anchor: Nephron (excluded). Electrolytes mostly done. RTA gap.
INFECT Infection — 5 nodes, 2 slots. Anchor: Strongyloides (built). Leishmania, Wuchereria gaps.
NEURO Neuro-Nutrition — 7 nodes, 2 slots. Anchor: Spinal cord (done). Most complete cluster.

36-HOUR PRIORITIES

Recall-test built nodes: Obesity errors, OHA, Lipid lowering, Strongyloides, PFTs
Close HIGH gap: Iodine (Mangalore coastal, standalone risk)
Close MED gaps (yield): PEM, DM pathophys (finish), Bilirubin, RTA, Snake venom
Gold/sand filter + memory hooks: Queued for next session
PII/PIII/PIV data incoming: Will reshape drug placement understanding