from reportlab.lib.pagesizes import A4
from reportlab.lib import colors
from reportlab.lib.styles import getSampleStyleSheet, ParagraphStyle
from reportlab.lib.units import cm, mm
from reportlab.platypus import (SimpleDocTemplate, Paragraph, Spacer, Table,
                                 TableStyle, HRFlowable, PageBreak, ListFlowable, ListItem)
from reportlab.lib.enums import TA_CENTER, TA_LEFT, TA_JUSTIFY
from reportlab.platypus import KeepTogether

OUTPUT = "/tmp/workspace/community-medicine/Community_Medicine_Quick_Reference.pdf"

doc = SimpleDocTemplate(
    OUTPUT,
    pagesize=A4,
    rightMargin=1.5*cm,
    leftMargin=1.5*cm,
    topMargin=1.8*cm,
    bottomMargin=1.8*cm,
    title="Community Medicine Quick Reference",
    author="Orris Study Companion"
)

# ── Colour Palette ──────────────────────────────────────────────────────────
TEAL       = colors.HexColor("#006d77")
TEAL_LIGHT = colors.HexColor("#83c5be")
CREAM      = colors.HexColor("#ffddd2")
ORANGE     = colors.HexColor("#e29578")
DARK       = colors.HexColor("#222222")
GREY_BG    = colors.HexColor("#f0f4f8")
WHITE      = colors.white
YELLOW_HL  = colors.HexColor("#fff3cd")
RED_LIGHT  = colors.HexColor("#fde8e8")
GREEN_LIGHT= colors.HexColor("#e8f5e9")

styles = getSampleStyleSheet()

# Custom styles
h_title = ParagraphStyle("h_title", parent=styles["Normal"],
    fontSize=22, textColor=WHITE, fontName="Helvetica-Bold",
    alignment=TA_CENTER, spaceAfter=4)

h_sub = ParagraphStyle("h_sub", parent=styles["Normal"],
    fontSize=11, textColor=TEAL_LIGHT, fontName="Helvetica",
    alignment=TA_CENTER, spaceAfter=2)

h1 = ParagraphStyle("h1", parent=styles["Normal"],
    fontSize=13, textColor=WHITE, fontName="Helvetica-Bold",
    alignment=TA_LEFT, spaceBefore=6, spaceAfter=4,
    leftIndent=6, borderPad=4)

h2 = ParagraphStyle("h2", parent=styles["Normal"],
    fontSize=11, textColor=TEAL, fontName="Helvetica-Bold",
    spaceBefore=6, spaceAfter=3)

body = ParagraphStyle("body", parent=styles["Normal"],
    fontSize=8.5, textColor=DARK, fontName="Helvetica",
    leading=12, spaceAfter=2)

bullet = ParagraphStyle("bullet", parent=styles["Normal"],
    fontSize=8.5, textColor=DARK, fontName="Helvetica",
    leading=12, leftIndent=10, bulletIndent=2, spaceAfter=1)

bold_kv = ParagraphStyle("bold_kv", parent=styles["Normal"],
    fontSize=8.5, textColor=DARK, fontName="Helvetica-Bold",
    leading=12, spaceAfter=1)

footer_style = ParagraphStyle("footer", parent=styles["Normal"],
    fontSize=7, textColor=colors.grey, alignment=TA_CENTER)

story = []

# ── Helper Functions ─────────────────────────────────────────────────────────

def section_header(text):
    """Teal banner section header."""
    tbl = Table([[Paragraph(text, h1)]], colWidths=[17.5*cm])
    tbl.setStyle(TableStyle([
        ("BACKGROUND", (0,0), (-1,-1), TEAL),
        ("ROUNDEDCORNERS", [4,4,4,4]),
        ("TOPPADDING",  (0,0),(-1,-1), 5),
        ("BOTTOMPADDING",(0,0),(-1,-1), 5),
        ("LEFTPADDING", (0,0),(-1,-1), 8),
    ]))
    story.append(tbl)
    story.append(Spacer(1, 4))

def subsection(text):
    story.append(Paragraph(text, h2))

def bp(text):
    story.append(Paragraph(f"• {text}", bullet))

def kv(key, val):
    story.append(Paragraph(f"<b>{key}:</b> {val}", body))

def note_box(text, bg=YELLOW_HL):
    tbl = Table([[Paragraph(f"⚡ {text}", body)]], colWidths=[17.5*cm])
    tbl.setStyle(TableStyle([
        ("BACKGROUND",(0,0),(-1,-1), bg),
        ("TOPPADDING",(0,0),(-1,-1), 5),
        ("BOTTOMPADDING",(0,0),(-1,-1), 5),
        ("LEFTPADDING",(0,0),(-1,-1), 8),
        ("GRID",(0,0),(-1,-1), 0.5, ORANGE),
    ]))
    story.append(tbl)
    story.append(Spacer(1,4))

def two_col_table(headers, rows, col_widths=None, bg=GREY_BG):
    if col_widths is None:
        col_widths = [5*cm, 12.5*cm]
    data = [headers] + rows
    tbl = Table(data, colWidths=col_widths, repeatRows=1)
    tbl.setStyle(TableStyle([
        ("BACKGROUND", (0,0), (-1,0), TEAL),
        ("TEXTCOLOR",  (0,0), (-1,0), WHITE),
        ("FONTNAME",   (0,0), (-1,0), "Helvetica-Bold"),
        ("FONTSIZE",   (0,0), (-1,-1), 8),
        ("BACKGROUND", (0,1), (-1,-1), bg),
        ("ROWBACKGROUNDS",(0,1),(-1,-1),[WHITE, GREY_BG]),
        ("GRID",       (0,0), (-1,-1), 0.4, TEAL_LIGHT),
        ("TOPPADDING", (0,0), (-1,-1), 4),
        ("BOTTOMPADDING",(0,0),(-1,-1), 4),
        ("LEFTPADDING", (0,0),(-1,-1), 5),
        ("VALIGN",     (0,0),(-1,-1), "TOP"),
        ("FONTNAME",   (0,1),(-1,-1), "Helvetica"),
    ]))
    story.append(tbl)
    story.append(Spacer(1,5))

def spacer(h=5):
    story.append(Spacer(1, h))

# ─────────────────────────────────────────────────────────────────────────────
# TITLE PAGE BANNER
# ─────────────────────────────────────────────────────────────────────────────
title_data = [[
    Paragraph("COMMUNITY MEDICINE", h_title),
    ],[
    Paragraph("Quick Reference Guide  |  Based on Park's Textbook of Preventive & Social Medicine", h_sub),
    ],[
    Paragraph("Exam Prep Edition  •  2026", h_sub),
]]
title_tbl = Table([[Paragraph("COMMUNITY MEDICINE", h_title)],
                   [Paragraph("Quick Reference Guide  |  Park's Textbook of Preventive & Social Medicine", h_sub)],
                   [Paragraph("Exam Prep Edition  •  July 2026", h_sub)]],
                  colWidths=[17.5*cm])
title_tbl.setStyle(TableStyle([
    ("BACKGROUND",(0,0),(-1,-1), TEAL),
    ("TOPPADDING",(0,0),(-1,-1),8),
    ("BOTTOMPADDING",(0,0),(-1,-1),8),
    ("LEFTPADDING",(0,0),(-1,-1),10),
]))
story.append(title_tbl)
story.append(Spacer(1,12))

# ─────────────────────────────────────────────────────────────────────────────
# 1. CONCEPTS OF HEALTH & DISEASE
# ─────────────────────────────────────────────────────────────────────────────
section_header("1. CONCEPTS OF HEALTH & DISEASE")

subsection("Definitions of Health")
two_col_table(
    [Paragraph("<b>Source</b>",body), Paragraph("<b>Definition</b>",body)],
    [
        ["WHO 1948", "A state of complete physical, mental and social well-being, not merely absence of disease or infirmity."],
        ["WHO 1984 (revised)", "Extent to which an individual/group is able to realise aspirations, satisfy needs, cope with environment."],
        ["Positive health", "Physical fitness + mental well-being + social adjustment + spiritual health + high morale."],
    ]
)

subsection("Spectrum of Disease / Natural History")
bp("Stage 1 – Susceptibility (pre-pathogenesis): risk factors present, no disease yet")
bp("Stage 2 – Pre-symptomatic: pathological changes, no symptoms (ideal for screening)")
bp("Stage 3 – Clinical disease: symptoms appear")
bp("Stage 4 – Disability / Death: outcome stage")
note_box("Levels of Prevention: Primary (health promotion + specific protection) | Secondary (early diagnosis + treatment) | Tertiary (rehabilitation)")

subsection("Iceberg Phenomenon")
bp("Tip (visible): clinical cases")
bp("Submerged (invisible): subclinical, latent, carrier states")
bp("Importance: true disease burden is always underestimated")

spacer()

# ─────────────────────────────────────────────────────────────────────────────
# 2. EPIDEMIOLOGY
# ─────────────────────────────────────────────────────────────────────────────
section_header("2. EPIDEMIOLOGY – METHODS & MEASURES")

subsection("Key Rates & Formulas")
two_col_table(
    [Paragraph("<b>Measure</b>",body), Paragraph("<b>Formula / Key Point</b>",body)],
    [
        ["Incidence Rate", "New cases / Population at risk × 1000 (per time period)"],
        ["Prevalence", "All existing cases / Total population × 100"],
        ["Prevalence vs Incidence", "Prevalence = Incidence × Duration of disease"],
        ["Attack Rate", "Cases during outbreak / Population exposed × 100"],
        ["Secondary Attack Rate (SAR)", "New cases among contacts / Susceptible contacts × 100"],
        ["CFR (Case Fatality Rate)", "Deaths from disease / Cases of disease × 100"],
        ["Proportional Mortality Rate", "Deaths from cause X / Total deaths × 100"],
        ["Infant Mortality Rate (IMR)", "Deaths <1 yr / Live births × 1000 (sensitive index of development)"],
        ["MMR", "Maternal deaths / Live births × 100,000"],
        ["NMR (Neonatal)", "Deaths <28 days / Live births × 1000"],
    ]
)

subsection("Study Designs (High-Yield)")
two_col_table(
    [Paragraph("<b>Study Type</b>",body), Paragraph("<b>Key Features</b>",body)],
    [
        ["Randomized Controlled Trial", "Gold standard for causation; experimental; prospective; minimises confounding"],
        ["Cohort Study", "Prospective; exposure → outcome; calculates RELATIVE RISK (RR); good for rare exposures"],
        ["Case-Control Study", "Retrospective; outcome → exposure; calculates ODDS RATIO (OR); good for rare diseases"],
        ["Cross-Sectional", "Prevalence study; one time point; calculates prevalence; quick & cheap"],
        ["Ecological Study", "Group level data; cannot infer individual causality (ecological fallacy)"],
        ["Systematic Review/Meta-analysis", "Highest level of evidence in hierarchy"],
    ]
)

subsection("Screening Criteria (Wilson & Jungner)")
bp("Disease should be an important health problem")
bp("Natural history well understood; recognisable latent stage")
bp("Acceptable, effective treatment available")
bp("Suitable test available: sensitive, specific, acceptable to population")
bp("Cost-effective and continuous process")

subsection("Sensitivity, Specificity & Predictive Values")
two_col_table(
    [Paragraph("<b>Term</b>",body), Paragraph("<b>Formula & Meaning</b>",body)],
    [
        ["Sensitivity (Se)", "TP / (TP+FN) × 100 — ability to detect TRUE positives (\"SnNout\" – sensitive test, negative result rules OUT)"],
        ["Specificity (Sp)", "TN / (TN+FP) × 100 — ability to identify TRUE negatives (\"SpPin\" – specific test, positive result rules IN)"],
        ["PPV", "TP / (TP+FP) × 100 — probability that positive test = true disease; rises with prevalence"],
        ["NPV", "TN / (TN+FN) × 100 — probability that negative test = truly disease-free"],
        ["Likelihood Ratio +ve", "Sensitivity / (1-Specificity)"],
    ]
)
note_box("High sensitivity → use for SCREENING. High specificity → use for CONFIRMATION/diagnosis.")

spacer()

# ─────────────────────────────────────────────────────────────────────────────
# 3. NUTRITION
# ─────────────────────────────────────────────────────────────────────────────
section_header("3. NUTRITION")

subsection("Protein-Energy Malnutrition (PEM)")
two_col_table(
    [Paragraph("<b>Condition</b>",body), Paragraph("<b>Features</b>",body)],
    [
        ["Kwashiorkor", "Protein deficiency dominant; oedema (hallmark); moon face; skin changes (flaky paint); growth retardation; fatty liver; age: 1–3 years"],
        ["Marasmus", "Calorie deficiency; severe wasting; no oedema; 'bag of bones' appearance; alert child; age: <1 year"],
        ["Marasmic Kwashiorkor", "Mixed features; worst prognosis"],
    ]
)

subsection("Vitamin Deficiency Diseases")
two_col_table(
    [Paragraph("<b>Vitamin</b>",body), Paragraph("<b>Deficiency Disease / Features</b>",body)],
    [
        ["Vitamin A", "Night blindness → Bitot's spots → Xerophthalmia → Keratomalacia (preventable blindness). Treat: 2 lakh IU vitamin A"],
        ["Vitamin D", "Rickets (children) – bow legs, Harrison's sulcus. Osteomalacia (adults). Sunlight is key source."],
        ["Vitamin C (Ascorbic acid)", "Scurvy – bleeding gums, perifollicular haemorrhage, corkscrew hair, Fraenkel's sign"],
        ["Vitamin B1 (Thiamine)", "Beriberi – Wet (cardiac, oedema), Dry (peripheral neuropathy), Wernicke's encephalopathy"],
        ["Vitamin B2 (Riboflavin)", "Cheilosis, angular stomatitis, glossitis, corneal vascularisation"],
        ["Niacin (B3)", "Pellagra – 3 Ds: Dermatitis, Diarrhoea, Dementia (+Death = 4th D)"],
        ["Vitamin B12 / Folate", "Megaloblastic anaemia; B12 deficiency → subacute combined degeneration of spinal cord"],
        ["Iodine", "Goitre, cretinism, hypothyroidism. Universal Salt Iodisation: 15 ppm at retail level"],
        ["Iron", "IDA – most common nutritional deficiency globally. Koilonychia, pallor, fatigue"],
    ]
)

note_box("National Vitamin A Prophylaxis: 5 doses in first 5 years – 1 lakh IU at 9 months, then 2 lakh IU every 6 months up to 5 years.")

subsection("Anthropometric Indices (Malnutrition Classification)")
two_col_table(
    [Paragraph("<b>Index</b>",body), Paragraph("<b>Indicates</b>",body)],
    [
        ["Weight for Age (W/A)", "Overall nutritional status; used in Gomez classification (Grade I/II/III PEM)"],
        ["Height for Age (H/A)", "Chronic malnutrition → Stunting"],
        ["Weight for Height (W/H)", "Acute malnutrition → Wasting"],
        ["MUAC <12.5 cm (child)", "Severe acute malnutrition (SAM)"],
    ]
)
spacer()

# ─────────────────────────────────────────────────────────────────────────────
# 4. IMMUNIZATION
# ─────────────────────────────────────────────────────────────────────────────
section_header("4. IMMUNIZATION & NATIONAL IMMUNIZATION SCHEDULE")

subsection("Universal Immunization Programme (UIP) – India")
two_col_table(
    [Paragraph("<b>Age</b>",body), Paragraph("<b>Vaccines</b>",body)],
    [
        ["Birth", "BCG, OPV-0 (birth dose), Hepatitis B (birth dose)"],
        ["6 weeks", "OPV-1, IPV-1, Penta-1 (DPT+HepB+Hib), Rota-1, PCV-1"],
        ["10 weeks", "OPV-2, Penta-2, Rota-2, PCV-2"],
        ["14 weeks", "OPV-3, IPV-2, Penta-3, Rota-3, PCV-3"],
        ["9 months", "MR-1, JE-1 (endemic areas), Vitamin A-1 (1 lakh IU)"],
        ["12 months", "PCV Booster"],
        ["16–24 months", "MR-2, DPT Booster-1, OPV Booster, JE-2 (endemic), Vitamin A (2nd dose)"],
        ["5–6 years", "DPT Booster-2"],
        ["10 years & 16 years", "Td (Tetanus + diphtheria adult formulation)"],
        ["Pregnant women", "TT-1 (early pregnancy), TT-2 (4 wks after TT-1), TT Booster (if prev vaccinated within 3 yrs)"],
    ]
)

note_box("BCG – given at birth; protects against TB meningitis & miliary TB (not pulmonary TB in adults). Scar appears 2–6 weeks after vaccination.")

subsection("Cold Chain")
bp("Temperature: +2°C to +8°C for most vaccines (walk-in coolers, ice-lined refrigerators, cold boxes)")
bp("OPV: stored at -15°C to -25°C (freezer)")
bp("Walk-in Freezer (WIF): District level | Walk-in Cooler (WIC): District level | ILR: PHC level | Cold box/vaccine carrier: field level")
bp("Vaccine Vial Monitor (VVM): colour change indicates heat exposure — DO NOT USE if inner square = outer circle colour")

subsection("Types of Immunity")
two_col_table(
    [Paragraph("<b>Type</b>",body), Paragraph("<b>Examples</b>",body)],
    [
        ["Active Natural", "Recovery from infection (e.g., measles, chickenpox)"],
        ["Active Artificial", "Vaccination (e.g., OPV, BCG, DPT)"],
        ["Passive Natural", "Maternal antibodies via placenta (IgG) / breast milk (IgA)"],
        ["Passive Artificial", "Immunoglobulin injections, anti-tetanus serum (ATS)"],
    ]
)
spacer()

# ─────────────────────────────────────────────────────────────────────────────
# 5. COMMUNICABLE DISEASES
# ─────────────────────────────────────────────────────────────────────────────
section_header("5. COMMUNICABLE DISEASES – HIGH YIELD")

subsection("Tuberculosis")
two_col_table(
    [Paragraph("<b>Aspect</b>",body), Paragraph("<b>Details</b>",body)],
    [
        ["Causative agent", "Mycobacterium tuberculosis (acid-fast bacillus)"],
        ["Diagnosis", "Sputum smear (Ziehl-Neelsen stain), CBNAAT/GeneXpert (gold standard for drug resistance), Mantoux test"],
        ["Mantoux test", "5 TU PPD; read at 48–72 hrs; induration ≥10 mm = positive (≥5 mm in HIV/immunocompromised)"],
        ["DOTS", "Directly Observed Treatment Short-course; cornerstone of RNTCP/NikshayNi-kshay program"],
        ["RNTCP → NI-KSHAY", "Category I (new): 2HRZE / 4HR; Category II (retreatment): 2HRZES / 1HRZE / 5HRE"],
        ["Contact tracing", "All household contacts screened; children <6 yrs = Isoniazid prophylaxis"],
    ]
)

subsection("Malaria")
two_col_table(
    [Paragraph("<b>Aspect</b>",body), Paragraph("<b>Details</b>",body)],
    [
        ["Species", "P. falciparum (malignant tertian, severe, chloroquine resistance) | P. vivax (benign tertian, relapse due to hypnozoites)"],
        ["Vector", "Female Anopheles mosquito; bites at night; breeds in clean, stagnant water"],
        ["Incubation period", "P. vivax: 12–14 days | P. falciparum: 9–14 days"],
        ["Diagnosis", "Thick blood smear (most sensitive for parasitaemia) | RDT (antigen-based)"],
        ["Complications P.f.", "Cerebral malaria, blackwater fever, algid malaria, ARDS, DIC"],
        ["Treatment", "P. vivax: Chloroquine + Primaquine (14 days). P. falciparum: ACT (Artesunate-based) + Primaquine single dose"],
        ["API", "Annual Parasite Incidence = Positive blood slides / Population × 1000"],
        ["ABER", "Annual Blood Examination Rate (target ≥10%)"],
    ]
)

subsection("Leprosy")
two_col_table(
    [Paragraph("<b>Aspect</b>",body), Paragraph("<b>Details</b>",body)],
    [
        ["Causative agent", "Mycobacterium leprae (cannot be cultured in vitro)"],
        ["Classification", "Paucibacillary (PB): 1–5 skin lesions, slit skin smear negative | Multibacillary (MB): >5 lesions, smear positive"],
        ["MDT regimen", "PB (6 months): Dapsone + Rifampicin monthly. MB (12 months): Dapsone + Clofazimine daily + Rifampicin monthly"],
        ["Reactions", "Type 1 (reversal): CMI-mediated | Type 2 (ENL): immune complex"],
        ["Disability grading", "Grade 0: no anaesthesia, no deformity | Grade 1: anaesthesia, no visible deformity | Grade 2: visible deformity"],
        ["Elimination target", "Prevalence <1 per 10,000 population (India achieved 2005)"],
    ]
)
spacer(3)
story.append(PageBreak())

# ─────────────────────────────────────────────────────────────────────────────
# 6. NATIONAL HEALTH PROGRAMMES
# ─────────────────────────────────────────────────────────────────────────────
section_header("6. NATIONAL HEALTH PROGRAMMES – KEY TARGETS")

two_col_table(
    [Paragraph("<b>Programme</b>",body), Paragraph("<b>Key Points</b>",body)],
    [
        ["RNTCP / Ni-kshay", "Detect ≥85% cases; DOTS treatment; cure rate ≥85%; Ni-kshay Poshan Yojana: ₹500/month to TB patient"],
        ["NMEP (Malaria)", "API <1 target for elimination by 2030; slide examination, DDT spraying, bed nets"],
        ["NLEP (Leprosy)", "MDT free of cost; elimination achieved 2005 (<1/10,000)"],
        ["NVBDCP", "National Vector Borne Disease Control Programme: Malaria, Dengue, Filaria, Kala-azar, JE, Chikungunya"],
        ["NPCB (Blindness)", "Reduce blindness to 0.3%; cataract surgery; school eye screening; Vit A prophylaxis"],
        ["NIDDCP (Iodine)", "Goitre control; iodised salt; target: USI"],
        ["NCD Mission (NPCDCS)", "Prevention of Cancer, Diabetes, CVD, Stroke; screening at 30+ yrs"],
        ["IDSP", "Integrated Disease Surveillance Programme: P (presumptive), L (lab-confirmed), S (syndromic) forms"],
        ["Ayushman Bharat – PMJAY", "₹5 lakh/family/yr; secondary & tertiary care; 107.4 crore beneficiaries"],
        ["NHM", "Rural + Urban Health Mission; strengthens PHC infrastructure; ASHA as key community link worker"],
        ["Janani Suraksha Yojana", "Cash incentive for institutional delivery; for BPL families"],
        ["PMMVY", "Pradhan Mantri Matru Vandana Yojana: ₹5000 for 1st live birth; conditional cash transfer"],
    ],
    col_widths=[5*cm, 12.5*cm]
)
spacer()

# ─────────────────────────────────────────────────────────────────────────────
# 7. FAMILY PLANNING & REPRODUCTIVE HEALTH
# ─────────────────────────────────────────────────────────────────────────────
section_header("7. FAMILY PLANNING & REPRODUCTIVE HEALTH")

subsection("Contraceptive Methods – Pearl Index (failures per 100 woman-years)")
two_col_table(
    [Paragraph("<b>Method</b>",body), Paragraph("<b>Pearl Index / Notes</b>",body)],
    [
        ["Combined OCP", "0.1–1; inhibits ovulation; taken Day 1–21; SE: nausea, DVT risk"],
        ["IUCD (Cu-T 380A)", "0.6–0.8; 10 years effective; MoA: spermicidal effect of copper ions; best: post-partum/post-abortion"],
        ["Condom", "2–15; also STI protection; female condom available"],
        ["DMPA (Depo-Provera)", "0.3; injection every 3 months; progestogen only"],
        ["Tubectomy (Minilap)", "<0.5; permanent; Pomeroy's technique most common; best: post-partum within 48 hrs or interval"],
        ["Vasectomy", "<0.15; permanent male sterilization; NSV (No-Scalpel Vasectomy) preferred in India"],
        ["Emergency Contraception", "Levonorgestrel 1.5 mg within 72 hrs (up to 120 hrs); Ulipristal up to 5 days; Cu-T within 5 days"],
        ["Lactational Amenorrhoea (LAM)", "<2; exclusive BF + amenorrhoea + <6 months postpartum (all 3 must be present)"],
    ]
)

subsection("Maternal & Child Health Targets (NHM)")
bp("MMR target: <100 per 100,000 live births by 2020 (current ~97 per NHM 2022)")
bp("IMR target: <25 per 1000 live births")
bp("NMR target: <10 per 1000 live births")
bp("TFR target: 2.1 (replacement level) — achieved nationally ~2.0 (NFHS-5)")
bp("Under-5 mortality target: <25 per 1000")
spacer()

# ─────────────────────────────────────────────────────────────────────────────
# 8. ENVIRONMENT & WATER
# ─────────────────────────────────────────────────────────────────────────────
section_header("8. ENVIRONMENT, WATER & SANITATION")

subsection("Water Quality Standards (BIS / WHO)")
two_col_table(
    [Paragraph("<b>Parameter</b>",body), Paragraph("<b>Standard</b>",body)],
    [
        ["Turbidity", "≤5 NTU (acceptable), ≤1 NTU (treated water)"],
        ["pH", "6.5 – 8.5"],
        ["Residual chlorine", "0.5 mg/L at source; 0.2 mg/L at tap (WHO)"],
        ["Fluoride", "0.5–1.5 mg/L (optimal 1 mg/L for dental health; >1.5 = dental fluorosis; >3 = skeletal fluorosis)"],
        ["Nitrate", "<45 mg/L (>45 = methaemoglobinaemia / blue baby syndrome)"],
        ["Coliforms", "0 per 100 mL in treated water (E. coli indicator of faecal contamination)"],
        ["Total Dissolved Solids", "<500 mg/L acceptable; <2000 permissible"],
    ]
)

subsection("Disinfection Methods")
bp("Chlorination: most widely used; Breakpoint chlorination; Residual chlorine 0.5 mg/L")
bp("Boiling: 100°C for 1 minute; kills all pathogens; most reliable for household")
bp("UV radiation: effective, no residual; used for bottled water")
bp("Bleaching powder (CaOCl2): contains 25–33% available chlorine; dose 2–3 mg/L")

subsection("Air Pollution Standards – WHO 2021 (PM2.5)")
bp("Annual mean: 5 μg/m³ | 24-hr mean: 15 μg/m³")
bp("PM10: Annual 15 μg/m³ | 24-hr: 45 μg/m³")
bp("COPD, lung cancer, IHD are major outcomes of long-term exposure")
spacer()

# ─────────────────────────────────────────────────────────────────────────────
# 9. BIOSTATISTICS – MUST KNOW
# ─────────────────────────────────────────────────────────────────────────────
section_header("9. BIOSTATISTICS ESSENTIALS")

two_col_table(
    [Paragraph("<b>Term</b>",body), Paragraph("<b>Meaning / Formula</b>",body)],
    [
        ["Mean", "Sum of all values / n; affected by outliers"],
        ["Median", "Middle value; not affected by outliers; used for skewed data"],
        ["Mode", "Most frequent value"],
        ["Normal distribution", "Mean = Median = Mode; bell-shaped curve; ±1 SD = 68.2%, ±2 SD = 95.4%, ±3 SD = 99.7%"],
        ["Standard Deviation (SD)", "Measure of spread around mean"],
        ["Standard Error (SE)", "SD / √n ; measures precision of sample mean"],
        ["95% CI", "Mean ± 1.96 SE; if CI does not include null = statistically significant"],
        ["p-value", "<0.05 = statistically significant (5% chance results due to chance)"],
        ["Relative Risk (RR)", "Incidence in exposed / Incidence in unexposed; used in cohort studies"],
        ["Odds Ratio (OR)", "Odds of exposure in cases / Odds of exposure in controls; case-control studies"],
        ["Attributable Risk (AR)", "Incidence exposed – Incidence unexposed; disease burden due to exposure"],
        ["NNT", "1 / Absolute Risk Reduction; number needed to treat"],
        ["Chi-square test", "Comparison of proportions / categorical data"],
        ["Student's t-test", "Comparison of means; 2 groups"],
        ["ANOVA", "Comparison of means; >2 groups"],
        ["Pearson's r", "Linear correlation; r=+1 perfect positive, r=-1 perfect negative, r=0 no correlation"],
    ]
)

note_box("Type I error (α): Rejecting a true null hypothesis (false positive). Type II error (β): Accepting a false null hypothesis (false negative). Power = 1 – β.")
spacer()

# ─────────────────────────────────────────────────────────────────────────────
# 10. HEALTH SYSTEM & ADMINISTRATION
# ─────────────────────────────────────────────────────────────────────────────
section_header("10. HEALTH SYSTEM & ADMINISTRATION")

subsection("Primary Health Care (Alma Ata Declaration, 1978)")
bp("Essential health care; first level of contact; universally accessible; affordable")
bp("8 components: Education, Nutrition, Safe water & sanitation, MCH & FP, Immunisation, Endemic disease control, Essential drugs, Treatment of common diseases")
bp("Principles: Equitable distribution, Community participation, Intersectoral coordination, Appropriate technology")

subsection("Rural Health Infrastructure (India)")
two_col_table(
    [Paragraph("<b>Level</b>",body), Paragraph("<b>Population Served / Details</b>",body)],
    [
        ["Sub-Centre (SC)", "5000 plains / 3000 hilly; ANM + Male Health Worker (MPW-M); first contact point"],
        ["Primary Health Centre (PHC)", "30,000 plains / 20,000 hilly; 1 MO + 14 paramedical staff; 6-bed facility; ESSENTIAL health services"],
        ["Community Health Centre (CHC)", "1,20,000 population; 30 beds; 4 specialists (surgeon, physician, OBG, paeds)"],
        ["District Hospital", "District HQ; 100–500 beds; all specialities"],
        ["Sub-Divisional Hospital", "Between CHC and District hospital"],
    ]
)

subsection("ASHA (Accredited Social Health Activist)")
bp("1 per 1000 rural population; link between community and health system")
bp("Minimum: 8th std pass, married/widow/divorced, 25–45 yrs (18 yrs in some states)")
bp("Incentive-based (not salaried); trained for 23 days + 4 rounds refresher")
bp("Key roles: JSY facilitation, immunisation tracking, DOTS, FP counselling, IMNCI")

subsection("Millennium Development Goals → Sustainable Development Goals")
bp("SDGs (2015–2030): 17 goals, 169 targets. SDG 3 = Ensure healthy lives & well-being for all at all ages")
bp("Key SDG 3 targets: End AIDS/TB/malaria; reduce NMR to ≤12; MMR to <70; UHC; road traffic injury reduction")
spacer()

# ─────────────────────────────────────────────────────────────────────────────
# MNEMONICS PAGE
# ─────────────────────────────────────────────────────────────────────────────
section_header("⚡ QUICK MNEMONICS & MEMORY HOOKS")

mnemonic_data = [
    ["Pellagra (4 Ds)", "Dermatitis, Diarrhoea, Dementia, Death (Niacin deficiency)"],
    ["Primary Health Care components (8)", "\"Every Nation Should Make Immunization Everyone's Duty True\" → Education, Nutrition, Safe water, MCH-FP, Immunization, Endemic disease, Essential drugs, Treatment"],
    ["Wilson-Jungner criteria (10)", "Important condition | Known natural history | Recognisable latent stage | Acceptable test | Acceptable treatment | Agreed policy | Facilities available | Recognisable early symptoms | Cost-effective | Continuous process"],
    ["Tetrad of malaria", "Fever, Chills, Rigors, Diaphoresis (sweating cycle)"],
    ["Leprosy disability grades", "0 = No problem, 1 = Anaesthesia, 2 = Deformity visible"],
    ["ASHA eligibility", "Married/Widow/Divorced, 25–45 yrs, 8th pass, local resident"],
    ["Kwashiorkor vs Marasmus", "Kwashiorkor = K for K (protein), has oedema | Marasmus = M for More calorie deficit, wasting"],
    ["CHC specialists (4)", "SOMP → Surgeon, Obstetrician, Medicine physician, Paediatrician"],
]

tbl = Table(
    [[Paragraph("<b>Concept</b>", body), Paragraph("<b>Mnemonic / Hook</b>", body)]] +
    [[Paragraph(r[0], body), Paragraph(r[1], body)] for r in mnemonic_data],
    colWidths=[5*cm, 12.5*cm], repeatRows=1
)
tbl.setStyle(TableStyle([
    ("BACKGROUND", (0,0), (-1,0), ORANGE),
    ("TEXTCOLOR",  (0,0), (-1,0), WHITE),
    ("FONTNAME",   (0,0), (-1,0), "Helvetica-Bold"),
    ("FONTSIZE",   (0,0), (-1,-1), 8),
    ("ROWBACKGROUNDS",(0,1),(-1,-1),[CREAM, WHITE]),
    ("GRID",       (0,0), (-1,-1), 0.4, ORANGE),
    ("TOPPADDING", (0,0), (-1,-1), 4),
    ("BOTTOMPADDING",(0,0),(-1,-1), 4),
    ("LEFTPADDING", (0,0),(-1,-1), 5),
    ("VALIGN",     (0,0),(-1,-1), "TOP"),
    ("FONTNAME",   (0,1),(-1,-1), "Helvetica"),
]))
story.append(tbl)
spacer(8)

# ─────────────────────────────────────────────────────────────────────────────
# FOOTER NOTE
# ─────────────────────────────────────────────────────────────────────────────
story.append(HRFlowable(width="100%", thickness=0.5, color=TEAL_LIGHT))
spacer(4)
story.append(Paragraph(
    "Prepared by Orris Study Companion  •  Based on Park's Textbook of Preventive & Social Medicine  •  July 2026  •  For exam revision use only",
    footer_style
))

# ─────────────────────────────────────────────────────────────────────────────
# BUILD
# ─────────────────────────────────────────────────────────────────────────────
doc.build(story)
print(f"PDF saved to: {OUTPUT}")

from reportlab.lib.pagesizes import A4
from reportlab.lib import colors
from reportlab.lib.styles import getSampleStyleSheet, ParagraphStyle
from reportlab.lib.units import cm
from reportlab.platypus import (SimpleDocTemplate, Paragraph, Spacer, Table,
                                 TableStyle, HRFlowable, PageBreak, KeepTogether)
from reportlab.lib.enums import TA_CENTER, TA_LEFT, TA_JUSTIFY

OUTPUT = "/tmp/workspace/community-medicine/RGUHS_Community_Medicine_5_Markers.pdf"

doc = SimpleDocTemplate(
    OUTPUT, pagesize=A4,
    rightMargin=1.8*cm, leftMargin=1.8*cm,
    topMargin=2*cm, bottomMargin=2*cm,
    title="RGUHS Community Medicine 5-Mark Questions with Answers",
    author="Orris Study Companion"
)

# ── Colours ──────────────────────────────────────────────────────────────────
TEAL       = colors.HexColor("#006d77")
TEAL_LIGHT = colors.HexColor("#83c5be")
CREAM      = colors.HexColor("#edf6f9")
ORANGE     = colors.HexColor("#e29578")
DARK       = colors.HexColor("#1a1a2e")
GREY_BG    = colors.HexColor("#f7f9fc")
WHITE      = colors.white
YELLOW     = colors.HexColor("#fff8e1")
GREEN_LT   = colors.HexColor("#e8f5e9")
BLUE_LT    = colors.HexColor("#e3f2fd")

styles = getSampleStyleSheet()

title_s  = ParagraphStyle("title_s",  fontSize=20, textColor=WHITE, fontName="Helvetica-Bold", alignment=TA_CENTER, spaceAfter=3)
sub_s    = ParagraphStyle("sub_s",    fontSize=10, textColor=TEAL_LIGHT, fontName="Helvetica", alignment=TA_CENTER, spaceAfter=2)
qnum_s   = ParagraphStyle("qnum_s",   fontSize=11, textColor=WHITE, fontName="Helvetica-Bold", alignment=TA_LEFT)
q_s      = ParagraphStyle("q_s",      fontSize=11, textColor=DARK, fontName="Helvetica-Bold", leading=15, spaceAfter=5, spaceBefore=0)
ans_head = ParagraphStyle("ans_head", fontSize=9,  textColor=TEAL, fontName="Helvetica-Bold", spaceAfter=2)
ans_body = ParagraphStyle("ans_body", fontSize=8.8,textColor=DARK, fontName="Helvetica", leading=13, spaceAfter=2)
bullet_s = ParagraphStyle("bullet_s", fontSize=8.8,textColor=DARK, fontName="Helvetica", leading=13, leftIndent=12, spaceAfter=1)
note_s   = ParagraphStyle("note_s",   fontSize=8,  textColor=colors.HexColor("#5d4037"), fontName="Helvetica-Oblique", leading=12)
footer_s = ParagraphStyle("footer_s", fontSize=7,  textColor=colors.grey, alignment=TA_CENTER)
cat_s    = ParagraphStyle("cat_s",    fontSize=13, textColor=WHITE, fontName="Helvetica-Bold", alignment=TA_CENTER, spaceAfter=2)
freq_s   = ParagraphStyle("freq_s",   fontSize=7.5,textColor=ORANGE, fontName="Helvetica-Bold")

story = []

# ── Helpers ───────────────────────────────────────────────────────────────────
def title_banner():
    rows = [
        [Paragraph("RGUHS COMMUNITY MEDICINE", title_s)],
        [Paragraph("5-Mark Short Essay Questions with Model Answers", sub_s)],
        [Paragraph("Based on Previous Year Papers (2008–2025)  |  Park's Textbook PSM  |  Exam Prep 2026", sub_s)],
    ]
    t = Table(rows, colWidths=[17*cm])
    t.setStyle(TableStyle([
        ("BACKGROUND",(0,0),(-1,-1),TEAL),
        ("TOPPADDING",(0,0),(-1,-1),7),("BOTTOMPADDING",(0,0),(-1,-1),7),
    ]))
    story.append(t); story.append(Spacer(1,10))

def category_banner(text):
    t = Table([[Paragraph(text, cat_s)]], colWidths=[17*cm])
    t.setStyle(TableStyle([
        ("BACKGROUND",(0,0),(-1,-1),ORANGE),
        ("TOPPADDING",(0,0),(-1,-1),6),("BOTTOMPADDING",(0,0),(-1,-1),6),
        ("LEFTPADDING",(0,0),(-1,-1),10),
    ]))
    story.append(t); story.append(Spacer(1,6))

def q_block(num, question, freq, answer_paragraphs, tip=None, bg=CREAM):
    """answer_paragraphs = list of (heading_or_None, list_of_bullet_strings)"""
    items = []

    # Question row
    q_header = Table([
        [Paragraph(f"Q{num}.", qnum_s),
         Paragraph(question, q_s),
         Paragraph(freq, freq_s)]
    ], colWidths=[1*cm, 13*cm, 3*cm])
    q_header.setStyle(TableStyle([
        ("BACKGROUND",(0,0),(-1,-1),TEAL),
        ("VALIGN",(0,0),(-1,-1),"MIDDLE"),
        ("TOPPADDING",(0,0),(-1,-1),6),("BOTTOMPADDING",(0,0),(-1,-1),6),
        ("LEFTPADDING",(0,0),(-1,-1),6),
    ]))
    items.append(q_header)

    # Answer body
    ans_rows = []
    for (heading, bullets) in answer_paragraphs:
        if heading:
            ans_rows.append([Paragraph(heading, ans_head)])
        for b in bullets:
            if b.startswith("**"):
                # bold line
                clean = b.replace("**","")
                ans_rows.append([Paragraph(f"<b>{clean}</b>", ans_body)])
            else:
                ans_rows.append([Paragraph(f"• {b}", bullet_s)])

    if tip:
        ans_rows.append([Spacer(1,4)])
        tip_t = Table([[Paragraph(f"✎ Exam Tip: {tip}", note_s)]], colWidths=[15.5*cm])
        tip_t.setStyle(TableStyle([
            ("BACKGROUND",(0,0),(-1,-1),YELLOW),
            ("LEFTPADDING",(0,0),(-1,-1),8),
            ("TOPPADDING",(0,0),(-1,-1),4),("BOTTOMPADDING",(0,0),(-1,-1),4),
            ("BOX",(0,0),(-1,-1),0.5,ORANGE),
        ]))
        ans_rows.append([tip_t])

    ans_tbl = Table(ans_rows, colWidths=[16*cm])
    ans_tbl.setStyle(TableStyle([
        ("BACKGROUND",(0,0),(-1,-1),bg),
        ("LEFTPADDING",(0,0),(-1,-1),10),
        ("RIGHTPADDING",(0,0),(-1,-1),8),
        ("TOPPADDING",(0,0),(-1,-1),3),
        ("BOTTOMPADDING",(0,0),(-1,-1),3),
        ("BOX",(0,0),(-1,-1),0.5,TEAL_LIGHT),
    ]))
    items.append(ans_tbl)
    items.append(Spacer(1,8))

    story.append(KeepTogether(items))

def sp(h=4): story.append(Spacer(1,h))

# ═════════════════════════════════════════════════════════════════════════════
# CONTENT STARTS
# ═════════════════════════════════════════════════════════════════════════════
title_banner()

# ── HOW TO USE BOX ───────────────────────────────────────────────────────────
usage = Table([[Paragraph(
    "<b>How to use this booklet:</b> Each question carries <b>5 marks</b>. "
    "Write answers in ~200–250 words. Use subheadings for clarity. "
    "Always include a definition + classification/types + key points + clinical relevance. "
    "Frequency tags show how often the topic appeared in RGUHS papers: "
    "<font color='#e29578'>★★★ Very Frequent</font> | ★★ Frequent | ★ Occasional",
    ans_body)]], colWidths=[17*cm])
usage.setStyle(TableStyle([
    ("BACKGROUND",(0,0),(-1,-1),BLUE_LT),
    ("BOX",(0,0),(-1,-1),0.8,TEAL),
    ("TOPPADDING",(0,0),(-1,-1),8),("BOTTOMPADDING",(0,0),(-1,-1),8),
    ("LEFTPADDING",(0,0),(-1,-1),10),
]))
story.append(usage); sp(10)

# ═════════════════════════════════════════════════════════════════════════════
# SECTION A: EPIDEMIOLOGY & BIOSTATISTICS
# ═════════════════════════════════════════════════════════════════════════════
category_banner("SECTION A: EPIDEMIOLOGY & BIOSTATISTICS")

q_block(1,
    "Describe the Epidemiological Triad and its importance in Public Health.",
    "★★★ Very Frequent",
    [
        ("Definition", [
            "The epidemiological triad (ecological triad) is the traditional model for studying infectious disease causation, consisting of three interacting components: Agent, Host, and Environment."
        ]),
        ("Components", [
            "AGENT: Biological (bacteria, virus, fungi), Chemical (toxins, pesticides), Physical (radiation, heat), Nutritional (deficiency/excess). Must be present in sufficient quantity.",
            "HOST: Susceptible individual; determinants include age, sex, genetic makeup, immunity, nutritional status, occupation, habits (smoking, alcohol).",
            "ENVIRONMENT: All external factors — physical (climate, geography), biological (vectors, reservoir), socioeconomic (poverty, overcrowding, sanitation).",
        ]),
        ("Mechanism of Disease", [
            "Disease occurs when the balance between agent, host, and environment is disrupted. The agent must reach the host through the environment.",
            "The triad sits on a 'see-saw' — when agent/environment factors overcome host defenses, disease results.",
        ]),
        ("Public Health Importance", [
            "Guides identification of risk factors and points for intervention",
            "Forms basis of disease prevention at multiple levels",
            "Helps in understanding disease clustering and epidemic investigation",
            "Modern extension: Web of Causation (MacMahon & Pugh) for multi-factorial diseases like CHD, cancer",
        ]),
    ],
    tip="Draw the triangle diagram of triad + label each component with examples. Mention Web of Causation as an extension."
)

q_block(2,
    "Define Sensitivity and Specificity. Calculate PPV and NPV with an example.",
    "★★★ Very Frequent",
    [
        ("2×2 Contingency Table", [
            "**Disease+  Disease-",
            "Test+     True Positive (TP)    False Positive (FP)",
            "Test-     False Negative (FN)   True Negative (TN)",
        ]),
        ("Formulas", [
            "Sensitivity = TP / (TP + FN) × 100 — ability to correctly identify disease-positive individuals",
            "Specificity = TN / (TN + FP) × 100 — ability to correctly identify disease-negative individuals",
            "Positive Predictive Value (PPV) = TP / (TP + FP) × 100",
            "Negative Predictive Value (NPV) = TN / (TN + FN) × 100",
        ]),
        ("Memory Aids", [
            "SnNout: High Sensitivity → Negative result RULES OUT disease (used for screening)",
            "SpPin: High Specificity → Positive result RULES IN disease (used for confirmation/diagnosis)",
        ]),
        ("Effect of Prevalence", [
            "PPV INCREASES as disease prevalence increases",
            "NPV DECREASES as disease prevalence increases",
            "Sensitivity and Specificity remain CONSTANT regardless of prevalence",
        ]),
        ("Example (Numerical)", [
            "In a population: TP=90, FP=10, FN=10, TN=190",
            "Sensitivity = 90/100 = 90%; Specificity = 190/200 = 95%",
            "PPV = 90/100 = 90%; NPV = 190/200 = 95%",
        ]),
    ],
    tip="Always draw the 2x2 table — it fetches marks easily. State the formulas clearly before calculating."
)

q_block(3,
    "Describe the differences between Cohort Study and Case-Control Study.",
    "★★★ Very Frequent",
    [
        ("Cohort Study", [
            "Direction: PROSPECTIVE — starts with exposure, follows forward to see if disease develops",
            "Measure of association: RELATIVE RISK (RR) = Incidence in exposed / Incidence in unexposed",
            "Best for: Rare exposures, multiple outcomes from one exposure",
            "Advantages: Temporal sequence established; incidence rates calculable; no recall bias",
            "Disadvantages: Expensive, time-consuming, loss to follow-up, not suitable for rare diseases",
            "Example: Framingham Heart Study (exposure = smoking → outcome = CHD)",
        ]),
        ("Case-Control Study", [
            "Direction: RETROSPECTIVE — starts with disease (cases) and compares exposure to controls",
            "Measure of association: ODDS RATIO (OR) = Odds of exposure in cases / Odds of exposure in controls",
            "Best for: Rare diseases, multiple exposures for one disease",
            "Advantages: Quick, cheap, suitable for rare diseases, no ethical issues",
            "Disadvantages: Recall bias, selection bias, cannot calculate incidence rates",
            "Example: Study linking smoking to lung cancer (Doll & Hill, 1950)",
        ]),
        ("Key Differences (Summary)", [
            "Starting point: Cohort = Exposure first | Case-Control = Disease first",
            "Time direction: Cohort = Forward | Case-Control = Backward",
            "Measure: Cohort = RR | Case-Control = OR",
            "Disease frequency: Cohort = Common diseases | Case-Control = Rare diseases",
        ]),
    ],
    tip="Draw a simple flow diagram showing the direction of each study. RGUHS frequently asks this — know the table by heart."
)

q_block(4,
    "What is Iceberg Phenomenon? Explain its significance with an example.",
    "★★ Frequent",
    [
        ("Definition", [
            "The 'Iceberg Phenomenon' in epidemiology, described by J.R. Paul (1938), states that for every diagnosed clinical case of disease, there exist a large number of undiagnosed subclinical, latent, or carrier cases in the community — like the submerged portion of an iceberg.",
        ]),
        ("The Iceberg Model", [
            "TIP (visible above water): Clinical cases — diagnosed and known to health services",
            "SUBMERGED PART (hidden): Subclinical infections, latent infections, carrier states, inapparent infections",
        ]),
        ("Examples", [
            "POLIO: For every 1 paralytic case → 100–1000 subclinical infections exist in community",
            "TUBERCULOSIS: Many sputum-negative cases remain undetected",
            "DIABETES MELLITUS: ~50% cases undiagnosed in India",
            "HYPERTENSION: Large undetected pool in community",
        ]),
        ("Public Health Significance", [
            "True burden of disease is always UNDERESTIMATED by clinical data alone",
            "Undiagnosed cases continue to spread infection (reservoir in community)",
            "Emphasises need for ACTIVE surveillance and SCREENING programmes",
            "Forms basis for WHO surveillance strategy and disease elimination targets",
            "Important for diseases with large subclinical pools: Polio, Typhoid, Hepatitis B",
        ]),
    ],
    tip="Draw the iceberg diagram with tip (clinical) and underwater parts labelled. Give POLIO as primary example."
)

q_block(5,
    "Explain Levels of Prevention with suitable examples.",
    "★★★ Very Frequent",
    [
        ("Definition", [
            "Leavell and Clark (1965) described three levels of prevention based on the natural history of disease, applied at different stages of disease progression.",
        ]),
        ("Primary Prevention (Pre-pathogenesis stage)", [
            "Aim: Prevent disease before it occurs by reducing risk factors",
            "a) Health Promotion: health education, good nutrition, adequate housing, exercise",
            "b) Specific Protection: immunization (BCG, OPV), use of helmets, fluoridation of water, condoms",
            "Examples: Vaccination against measles, iodised salt to prevent goitre",
        ]),
        ("Secondary Prevention (Early pathogenesis stage)", [
            "Aim: Detect disease early and treat before it progresses",
            "a) Early Diagnosis: screening tests, case-finding (Pap smear, mammography, blood sugar)",
            "b) Prompt Treatment: antibiotics for TB, antihypertensives for hypertension",
            "c) Disability Limitation: prevent complications",
            "Examples: Mantoux test for TB, antenatal screening for anaemia",
        ]),
        ("Tertiary Prevention (Late pathogenesis stage)", [
            "Aim: Reduce disability and restore function after disease has occurred",
            "a) Rehabilitation: physical, mental, social, vocational rehabilitation",
            "b) Examples: Prosthesis after amputation, physiotherapy after stroke, vocational training for disabled",
        ]),
        ("Primordial Prevention (Lalonde, 1974)", [
            "Prevents establishment of risk factors in society itself",
            "Example: Anti-tobacco laws, healthy diet policies, ban on alcohol advertising",
        ]),
    ],
    tip="RGUHS loves a diagram showing the 4 levels on a timeline of natural history. Include primordial prevention for extra marks."
)

story.append(PageBreak())

# ═════════════════════════════════════════════════════════════════════════════
# SECTION B: NUTRITION & MATERNAL-CHILD HEALTH
# ═════════════════════════════════════════════════════════════════════════════
category_banner("SECTION B: NUTRITION & MATERNAL-CHILD HEALTH")

q_block(6,
    "Describe the clinical features and management of Kwashiorkor.",
    "★★★ Very Frequent",
    [
        ("Definition", [
            "Kwashiorkor is a severe form of Protein-Energy Malnutrition (PEM) caused primarily by protein deficiency with relatively adequate caloric intake. The term means 'the disease the first child gets when the second child is born' (Cicely Williams, 1932).",
        ]),
        ("Epidemiology", [
            "Age: 1–3 years (post-weaning); common in developing countries; precipitated by infections (measles, gastroenteritis)"
        ]),
        ("Clinical Features", [
            "OEDEMA (hallmark feature): starts at feet, progresses upward; pitting oedema",
            "Growth retardation: weight deficit masked by oedema",
            "Skin changes: hyperpigmentation, 'flaky paint' dermatosis, desquamation",
            "Hair changes: reddish/brownish discolouration, flag sign (alternating pigmentation)",
            "Moon face (due to oedema)",
            "Hepatomegaly: fatty liver (due to deficient lipotropic factors)",
            "Apathy, irritability, anorexia, misery",
            "Pot belly, anaemia",
        ]),
        ("Investigations", [
            "Serum albumin: <2.8 g/dL (low — key biochemical marker)",
            "Serum total protein: decreased",
            "Haemoglobin: low; blood glucose: low",
        ]),
        ("Management", [
            "Phase 1 (Stabilisation, Day 1–7): treat infections, correct electrolyte imbalance, F-75 formula (75 kcal/100 mL)",
            "Phase 2 (Rehabilitation, Week 2–6): gradually increase to F-100 (100 kcal/100 mL), stimulation, micronutrients",
            "Vitamin A 200,000 IU on Day 1",
            "Folic acid, zinc, potassium supplementation",
            "Treat associated infections (malaria, TB, worms)",
            "Nutritional education for mother",
        ]),
    ],
    tip="Differentiate Kwashiorkor vs Marasmus in one line: Kwashiorkor = protein deficiency + OEDEMA; Marasmus = calorie deficiency + severe WASTING. RGUHS often asks comparison."
)

q_block(7,
    "Write a note on Vitamin A Deficiency and its prevention.",
    "★★★ Very Frequent",
    [
        ("Vitamin A – Overview", [
            "Fat-soluble vitamin; stored in liver; sources: liver, egg yolk, milk, fish, green leafy vegetables, yellow fruits (carotene)",
            "Functions: vision (retinol → rhodopsin), epithelial integrity, immunity, growth",
        ]),
        ("Clinical Spectrum (WHO XN → X3B)", [
            "XN — Night blindness (earliest symptom): difficulty seeing in dim light",
            "X1A — Conjunctival xerosis: dry, dull conjunctiva",
            "X1B — Bitot's spots: foamy triangular spots on temporal conjunctiva (pathognomonic)",
            "X2 — Corneal xerosis: dry, hazy cornea",
            "X3A — Corneal ulceration (<1/3 corneal surface)",
            "X3B — Keratomalacia: total corneal melt → BLINDNESS (irreversible)",
        ]),
        ("Prevention – National Vitamin A Prophylaxis Programme", [
            "Dose 1: 1,00,000 IU at 9 months (along with MR vaccine)",
            "Doses 2–9: 2,00,000 IU every 6 months from 18 months to 5 years (total 8 doses after first dose)",
            "Administered by ANM at Sub-Centre level",
            "Treatment: same doses for active deficiency + prophylaxis continued",
        ]),
        ("Additional Measures", [
            "Dietary diversification: promote green leafy vegetables, yellow fruits",
            "Food fortification: vitamin A in edible oil, vanaspati, sugar (in some countries)",
            "Vitamin A in therapeutic feeding: given with F-100 in SAM management",
            "Measles prevention: measles depletes Vit A stores rapidly",
        ]),
    ],
    tip="Remember the WHO grading XN to X3B in sequence. RGUHS often asks 'enumerate the stages of Vitamin A deficiency'."
)

q_block(8,
    "Describe the services provided by an Anganwadi Centre (AWC) under ICDS.",
    "★★★ Very Frequent",
    [
        ("ICDS – Background", [
            "Integrated Child Development Services (ICDS) launched in 1975; world's largest integrated early childhood programme; implemented through Anganwadi Centres (AWCs); one AWC per 1000 population.",
        ]),
        ("Target Beneficiaries", [
            "Children 0–6 years (focus on <3 yrs under ICDS 2.0)",
            "Pregnant and lactating women",
            "Adolescent girls (11–18 yrs) under SABLA scheme",
        ]),
        ("Six Services of ICDS (package of services)", [
            "1. Supplementary Nutrition: 500 kcal + 12–15 g protein/day for children 6 months–6 yrs; 600 kcal for pregnant/lactating mothers",
            "2. Immunization: facilitation by ANM at AWC (BCG, OPV, DPT, measles)",
            "3. Health Check-up: growth monitoring, physical examination, anaemia screening",
            "4. Referral Services: referral of malnourished/sick children to PHC/hospital",
            "5. Pre-school Non-formal Education (ECCE): early childhood education for 3–6 yr olds",
            "6. Nutrition and Health Education: for women 15–45 yrs on diet, hygiene, childcare",
        ]),
        ("Anganwadi Worker (AWW)", [
            "Local woman; 8th pass; 6-month training; serves 400–800 households",
            "Assisted by Anganwadi Helper (AWH) who assists with cooking and cleanliness",
        ]),
    ],
    tip="The 6 services are a very common 5-marker. Use the acronym 'S-I-H-R-P-N' to remember them."
)

q_block(9,
    "Write a note on Under Fives Clinic (Under-5 Clinic).",
    "★★ Frequent",
    [
        ("Definition", [
            "An Under-5 Clinic (U5C) is a special maternal and child health facility organised at the PHC/Sub-Centre level to provide comprehensive care to children below 5 years of age — the most vulnerable group in the community.",
        ]),
        ("Objectives", [
            "Reduce infant and child mortality",
            "Monitor growth and development (road to health card)",
            "Early detection and management of malnutrition and illness",
            "Ensure complete immunization",
        ]),
        ("Services Provided", [
            "Growth monitoring: weighing every month, plotting on growth chart (Road to Health Card)",
            "Immunization: as per national immunization schedule",
            "Nutritional assessment: MUAC, anthropometry, identification of SAM/MAM",
            "Health education to mothers: breastfeeding, weaning, hygiene, ORS use",
            "Treatment of common illnesses: ARI, diarrhoea (IMCI approach)",
            "Referral of severe cases to CHC/District hospital",
            "Vitamin A supplementation and deworming (Albendazole)",
        ]),
        ("Road to Health Card", [
            "Weight-for-age chart given to every child",
            "Green zone (normal), Yellow (moderate malnutrition), Red (severe malnutrition)",
            "Flat/falling curve prompts intervention",
        ]),
    ],
    tip="Draw the Road to Health (growth) card showing zones. RGUHS sometimes asks this as a 3-marker — know the coloured zones."
)

q_block(10,
    "Describe the methods of contraception and their Pearl Index.",
    "★★★ Very Frequent",
    [
        ("Pearl Index", [
            "Number of pregnancies per 100 woman-years of exposure to contraception. LOWER Pearl Index = MORE effective.",
        ]),
        ("Barrier Methods", [
            "Male condom: Pearl Index 2–15; also prevents STIs including HIV; only male-controlled reversible method",
            "Female condom: Pearl Index 5–21; female-controlled",
            "Diaphragm + spermicide: Pearl Index 6–12; must be inserted before intercourse",
        ]),
        ("Hormonal Methods", [
            "Combined OCP (Oestrogen + Progestogen): Pearl Index 0.1–1; taken Day 1–21; most effective oral method",
            "Progestogen-only pill (POP/'mini-pill'): Pearl Index 0.5–1; suitable for lactating women",
            "DMPA (Depo-Provera): Pearl Index 0.3; 3-monthly injection; progestogen only",
            "Implants (e.g., Implanon): Pearl Index <0.1; 3 years; subderm",
        ]),
        ("Intra-Uterine Devices (IUCD)", [
            "Cu-T 380A: Pearl Index 0.6–0.8; effective 10 years; MoA — spermicidal + endometrial effect of copper",
            "LNG-IUS (Mirena): Pearl Index 0.1; levonorgestrel releasing; also treats menorrhagia",
        ]),
        ("Permanent Methods", [
            "Tubectomy (female sterilisation): Pearl Index <0.5; Pomeroy/Madlener technique; best: post-partum within 48 hrs",
            "Vasectomy (NSV): Pearl Index <0.15; no-scalpel vasectomy preferred; simpler than tubectomy",
        ]),
        ("Emergency Contraception", [
            "Levonorgestrel 1.5 mg: within 72 hrs (up to 120 hrs); 85% effective",
            "Cu-T 380A: within 5 days of unprotected sex; most effective EC",
        ]),
    ],
    tip="Pearl Index table is very high-yield. Know at least 6 methods with their Pearl Index values and one key side-effect each."
)

story.append(PageBreak())

# ═════════════════════════════════════════════════════════════════════════════
# SECTION C: COMMUNICABLE DISEASES
# ═════════════════════════════════════════════════════════════════════════════
category_banner("SECTION C: COMMUNICABLE DISEASES")

q_block(11,
    "Describe the epidemiology and control of Malaria.",
    "★★★ Very Frequent",
    [
        ("Causative Agent & Vector", [
            "P. falciparum: malignant tertian malaria; most severe; chloroquine-resistant",
            "P. vivax: benign tertian malaria; relapses due to hypnozoites in liver",
            "Vector: Female Anopheles mosquito; bites dusk to dawn; breeds in clean stagnant water",
        ]),
        ("Epidemiology", [
            "Incubation: P. vivax 12–14 days; P. falciparum 9–14 days; P. malariae 18–40 days",
            "Transmission: bite of infected female Anopheles (inoculation of sporozoites)",
            "At-risk groups: children <5 yrs, pregnant women, migrants, forest workers",
            "Endemic areas in India: Odisha, Jharkhand, Chhattisgarh, NE states",
        ]),
        ("Clinical Features", [
            "Classic triad: Cold stage (chills) → Hot stage (fever 40–41°C) → Sweating stage",
            "P. falciparum complications: Cerebral malaria, blackwater fever, ARDS, severe anaemia, acute renal failure",
        ]),
        ("Diagnosis", [
            "Peripheral blood smear (thick smear most sensitive; thin smear for speciation)",
            "RDT (Rapid Diagnostic Test): antigen-based; HRP-2 for P.f.",
            "PCR: gold standard but not routine",
        ]),
        ("Treatment", [
            "P. vivax: Chloroquine 3 days + Primaquine 14 days (radical cure of hypnozoites)",
            "P. falciparum: ACT (Artesunate + SP) + Primaquine single dose",
            "Severe malaria: IV Artesunate",
        ]),
        ("Control Measures", [
            "Vector control: IRS (DDT/Malathion), insecticide-treated bed nets (ITBNs/LLINs)",
            "Larval control: anti-larval operations, bioenvironmental methods, Gambusia fish",
            "Chemoprophylaxis: chloroquine weekly for high-risk groups",
            "NVBDCP: National Vector Borne Disease Control Programme; target: elimination by 2030",
            "Indicators: API (Annual Parasite Incidence), ABER (Annual Blood Examination Rate ≥10%)",
        ]),
    ],
    tip="API = Positive blood slides per year / population × 1000. Draw the malaria transmission cycle. RGUHS frequently asks epidemiology OR control as separate 5-markers."
)

q_block(12,
    "Define Carrier. Describe types of carriers with examples.",
    "★★★ Very Frequent",
    [
        ("Definition", [
            "A carrier is a person who harbours a specific infectious agent in the absence of discernible clinical disease and serves as a potential source of infection. (WHO / Park's definition)",
        ]),
        ("Types of Carriers", [
            "**A. Based on Time Relationship to Illness:",
            "1. Incubatory Carrier: harbours agent during incubation period before disease onset. Ex: Measles, Chickenpox, Mumps, Polio",
            "2. Convalescent Carrier: person who has recovered clinically but continues to shed the organism. Ex: Typhoid (weeks to months), Cholera",
            "3. Healthy Carrier (Passive/Contact Carrier): carries agent without ever having clinical disease. Ex: Meningococcus (10–25% of population), Diphtheria",
            "4. Temporary Carrier: carries agent for a short period (days to weeks). Ex: Influenza",
            "5. Chronic Carrier: carries agent for months to years (>6 months). Ex: Typhoid (Mary Mallon — 'Typhoid Mary'), Hepatitis B, Salmonella",
            "**B. Based on Anatomical Site:",
            "Nasal/Throat carrier: Meningococcus, Diphtheria",
            "Intestinal carrier: Typhoid, Cholera, Polio",
            "Urinary carrier: Typhoid (prolonged in those with gallstones)",
        ]),
        ("Epidemiological Importance", [
            "Carriers act as RESERVOIR of infection — perpetuate disease in community",
            "Healthy carriers are the most dangerous (unaware, not isolated)",
            "Chronic carriers are important in typhoid and hepatitis B eradication",
            "Control: surveillance, isolation, treatment, health education",
        ]),
    ],
    tip="Always give specific examples for each type — examiners look for this. 'Typhoid Mary' is a great chronic carrier example."
)

q_block(13,
    "Describe the epidemiology and control of Tuberculosis in India.",
    "★★★ Very Frequent",
    [
        ("Agent & Transmission", [
            "Causative agent: Mycobacterium tuberculosis (AAFB — Acid and Alcohol Fast Bacillus)",
            "Transmission: airborne droplet nuclei (1–5 μm); sneezing, coughing, speaking",
            "Infectious source: open (sputum-positive) pulmonary TB case",
        ]),
        ("Epidemiology in India", [
            "India: highest TB burden globally — ~26% of world's TB cases",
            "Incidence: ~199 per 100,000 population (2022 GTB report)",
            "Risk factors: HIV co-infection, diabetes, malnutrition, overcrowding, silicosis, immunosuppression",
        ]),
        ("Diagnosis", [
            "Sputum smear microscopy (ZN stain): sensitivity ~60–70%",
            "CBNAAT/GeneXpert MTB-RIF: detects MTB + Rifampicin resistance; preferred for HIV+, children",
            "Mantoux (TST): 5 TU PPD intradermal; read 48–72 hrs; ≥10 mm positive (≥5 mm in HIV+)",
            "Chest X-ray: supportive; not diagnostic alone",
        ]),
        ("Treatment – Ni-kshay Programme (India)", [
            "New case (DS-TB): 2HRZE (2 months intensive) / 4HR (4 months continuation)",
            "Previously treated: 2HRZES / 1HRZE / 5HRE",
            "MDR-TB: Bedaquiline-based regimen (BPaL) for 6–24 months",
            "DOTS: Directly Observed Treatment Short-course — backbone of RNTCP/Ni-kshay",
        ]),
        ("Control", [
            "BCG vaccination at birth: protects against TB meningitis and miliary TB in children",
            "DOTS: ensures treatment completion; targets 85% cure rate",
            "Ni-kshay Poshan Yojana: ₹500/month nutritional support to TB patients",
            "Contact tracing: all household contacts screened; Isoniazid preventive therapy (IPT) for eligible contacts",
            "End TB Strategy target: 80% reduction in TB incidence by 2030 vs 2015 baseline",
        ]),
    ],
    tip="The DOTS regimen (drug names + months) is very high-yield. Write: H=Isoniazid, R=Rifampicin, Z=Pyrazinamide, E=Ethambutol, S=Streptomycin."
)

q_block(14,
    "Write about Post Exposure Prophylaxis (PEP) for Rabies.",
    "★★ Frequent",
    [
        ("Rabies – Overview", [
            "Rabies is a fatal viral encephalitis caused by Lyssavirus; transmitted by bite of rabid animals (dog 97% in India); incubation period: 10 days to 2 years (average 1–3 months).",
        ]),
        ("WHO Wound Category Classification", [
            "Category I: Touching/feeding animal, licks on intact skin — No PEP needed",
            "Category II: Nibbling of uncovered skin, minor scratches, abrasions, licks on broken skin — Wound care + vaccine",
            "Category III: Single/multiple transdermal bites/scratches; contamination of mucous membrane; bat contact — Wound care + vaccine + RIG",
        ]),
        ("Wound Management (Step 1)", [
            "Flush wound immediately with soap and water for at least 15 minutes",
            "Apply povidone-iodine / 70% alcohol",
            "DO NOT suture immediately (risk of seeding virus deeper)",
            "Give tetanus prophylaxis",
        ]),
        ("Post Exposure Prophylaxis (Step 2)", [
            "VACCINE: Purified Cell Culture Vaccine (PCCV) — Vero cell rabies vaccine",
            "Essen regimen (IM): 5 doses on Days 0, 3, 7, 14, 28 (at deltoid in adults, anterolateral thigh in children)",
            "Zagreb (2-1-1) regimen: 2 doses Day 0, 1 dose Day 7, 1 dose Day 21 — fewer clinic visits",
            "Previously vaccinated: 2 doses only (Day 0 + Day 3); NO RIG needed",
        ]),
        ("Rabies Immunoglobulin (RIG) – Category III only", [
            "Human RIG (HRIG): 20 IU/kg; equine RIG (ERIG): 40 IU/kg",
            "Infiltrate maximum dose into wound; remainder IM at distant site",
            "Must be given SIMULTANEOUSLY with first vaccine dose (not later)",
        ]),
    ],
    tip="Know the WHO Category I/II/III table — examiners love this. State: Category III = Wound + Vaccine + RIG. PEP has NO contraindications."
)

story.append(PageBreak())

# ═════════════════════════════════════════════════════════════════════════════
# SECTION D: ENVIRONMENT, HEALTH SYSTEM & NATIONAL PROGRAMMES
# ═════════════════════════════════════════════════════════════════════════════
category_banner("SECTION D: ENVIRONMENT, HEALTH SYSTEM & NATIONAL PROGRAMMES")

q_block(15,
    "Describe the functions of Primary Health Centre (PHC).",
    "★★★ Very Frequent",
    [
        ("Definition & Structure", [
            "A Primary Health Centre is the first contact point between the community and the medical officer. It serves a population of 30,000 (plains) or 20,000 (hilly/tribal/difficult areas).",
            "Staff: 1 Medical Officer, 1 Health Educator, 1 PHN, Block Extension Educator, Laboratory Technician, Pharmacist + 14 paramedical staff",
            "Infrastructure: 6-bed inpatient facility",
        ]),
        ("Functions (based on NHM guidelines)", [
            "Curative care: OPD for common illnesses (fever, diarrhoea, ARI, wounds)",
            "Preventive & Promotive care: health education, sanitation supervision",
            "Maternal & Child Health: ANC, delivery care, postnatal care, immunization",
            "Family Planning: all contraceptive services, counselling, referral",
            "Nutritional services: ICDS coordination, Vitamin A, iron-folic acid distribution",
            "Communicable disease control: DOTS for TB, malaria blood smear, leprosy MDT",
            "School health: periodic examination, deworming, vision/hearing screening",
            "Referral and coordination with Sub-Centres below and CHC above",
            "Vital statistics: registration of births and deaths; maintain health records",
        ]),
        ("Key Outreach Through PHC", [
            "24×7 delivery care under NHM (delivery point PHC)",
            "Janani Suraksha Yojana (JSY) cash transfers processed at PHC level",
            "ASHA coordination and performance-linked incentive disbursement",
        ]),
    ],
    tip="RGUHS also asks about CHC (30 beds, 4 specialists) and Sub-Centre (5000 pop, ANM). Know all three levels of the health pyramid."
)

q_block(16,
    "What is Solid Waste Management? Describe methods of disposal.",
    "★★ Frequent",
    [
        ("Definition", [
            "Solid waste (refuse/garbage) is all solid or semi-solid non-liquid waste material that has no further use to the producer. Municipal Solid Waste (MSW) includes household waste, institutional waste, street sweepings.",
        ]),
        ("Sources & Composition", [
            "Domestic: kitchen waste, ashes, packaging",
            "Commercial: shops, markets, offices",
            "Industrial: factory waste (may have hazardous components)",
            "Biomedical waste: categorised separately under BMW Rules 2016",
        ]),
        ("Collection and Storage", [
            "Primary collection: door-to-door by municipalities; segregation at source (dry/wet waste)",
            "Secondary collection: transfer to community bins/dumper placer containers",
        ]),
        ("Methods of Disposal", [
            "1. Sanitary Landfill: engineered disposal; waste compacted and covered with soil daily; prevents vectors, leachate managed; most practical for large cities",
            "2. Incineration: high-temperature burning (850–1100°C); reduces volume by 90%; ideal for biomedical/hazardous waste; air pollution is concern",
            "3. Composting: aerobic decomposition of organic waste; produces manure; Indore method (India) — 4–6 weeks in covered pits; eco-friendly",
            "4. Vermicomposting: earthworms decompose organic waste; produces nutrient-rich vermicompost; eco-friendly",
            "5. Recycling/Resource Recovery: paper, glass, metal, plastic reclaimed; reduces waste volume",
            "6. Pyrolysis: chemical decomposition at high temp without oxygen; produces fuel gas, oil",
        ]),
        ("Biomedical Waste – BMW Rules 2016", [
            "4 categories with colour-coded bags: Yellow (anatomical/infectious), Red (contaminated recyclable), White (sharps), Blue (glassware)",
            "Sharp containers: puncture-proof, leak-proof containers",
        ]),
    ],
    tip="Draw the colour-coded BMW waste bag table. Know the Indore composting method — frequently asked in RGUHS."
)

q_block(17,
    "Describe functions of the World Health Organization (WHO).",
    "★★ Frequent",
    [
        ("Overview", [
            "WHO is the United Nations' specialised agency for health, established on April 7, 1948 (World Health Day). HQ: Geneva, Switzerland. 194 member states. India is a founding member (SEARO region: New Delhi).",
        ]),
        ("Constitutional Functions (Article 2 of WHO Constitution)", [
            "Act as the directing and co-ordinating authority on international health work",
            "Establish and maintain effective collaboration with the UN, specialised agencies and NGOs",
            "Assist governments to strengthen health services on request",
            "Furnish appropriate technical assistance and emergency aid",
        ]),
        ("Key Functions", [
            "Normative/standard-setting: establish International Health Regulations (IHR 2005); set drug standards",
            "Surveillance: Global Disease Outbreak Alert and Response Network (GOARN); surveillance of emerging infections",
            "Research: coordinate and support health research globally",
            "Technical assistance: help countries develop national health plans, train health workers",
            "Publication: WHO Technical Report Series, Bulletin of WHO, World Health Statistics",
            "Disease eradication: led GLOBAL SMALLPOX ERADICATION (1980); leading polio eradication (GPEI)",
            "Classification: ICD (International Classification of Diseases); ICIDH for disabilities",
        ]),
        ("WHO in India", [
            "South-East Asia Regional Office (SEARO) in New Delhi",
            "Country Office in New Delhi; State offices in all states",
            "Key current priorities: COVID-19, TB elimination, malaria elimination, NCD control",
        ]),
    ],
    tip="State: WHO founded April 7 = World Health Day. SEARO = South East Asia Regional Office. Know at least 6 functions."
)

q_block(18,
    "Describe Disaster Preparedness and its components.",
    "★★ Frequent",
    [
        ("Definition", [
            "Disaster: A serious disruption of the functioning of a community causing widespread human, material or environmental losses that exceed the capacity of the affected community to cope using its own resources. (UNDP/WHO)",
        ]),
        ("Types of Disasters", [
            "Natural: earthquakes, floods, cyclones, droughts, epidemics, tsunamis",
            "Man-made: industrial accidents, chemical spills, nuclear leaks, wars, terrorist attacks, road accidents",
        ]),
        ("Disaster Management Cycle", [
            "1. Prevention: measures to prevent disaster (flood bunds, earthquake-resistant buildings)",
            "2. Mitigation: reduce impact of disaster (early warning systems, land use planning)",
            "3. Preparedness: plans, training, stockpiling of supplies BEFORE disaster",
            "4. Response: immediate actions during/after disaster (search & rescue, triage, relief)",
            "5. Recovery/Rehabilitation: restore normalcy; long-term rebuild",
        ]),
        ("Disaster Preparedness (Medical Component)", [
            "Health Emergency Operations Centre (HEOC) setup",
            "Pre-positioned medical supplies and drugs (essential drug list for disasters)",
            "Trained Rapid Response Teams (RRT) at district and state level",
            "Mock drills and table-top exercises",
            "TRIAGE system: START (Simple Triage and Rapid Treatment) — Red (immediate), Yellow (delayed), Green (minor), Black (dead/unsalvageable)",
            "Mass casualty management protocol",
            "Surveillance for outbreak prevention post-disaster: cholera, typhoid, leptospirosis, malaria",
        ]),
        ("NDMA & IDSP Role", [
            "National Disaster Management Authority (NDMA): coordination and policy",
            "IDSP: Integrated Disease Surveillance Programme activates during disasters for outbreak surveillance",
        ]),
    ],
    tip="Draw the Disaster Management Cycle (Prevention → Mitigation → Preparedness → Response → Recovery) as a cycle diagram."
)

q_block(19,
    "Write a note on Cancer Screening in India.",
    "★★ Frequent",
    [
        ("Introduction", [
            "Cancer is the 2nd leading cause of death globally. In India: ~14 lakh new cases/year. Major cancers: Oral (males), Cervical & Breast (females). NCD Mission (NPCDCS) includes cancer screening.",
        ]),
        ("Cervical Cancer Screening", [
            "Pap smear (Papanicolaou): cytological screening; recommended every 3 years for women 21–65 yrs",
            "VIA (Visual Inspection with Acetic Acid): simple, low-cost, no lab; white patches = positive; used in resource-limited settings under NPCDCS",
            "VILI (Visual Inspection with Lugol's Iodine): abnormal areas appear mustard/saffron yellow",
            "HPV DNA testing: most sensitive; detect oncogenic HPV types 16 and 18",
            "HPV Vaccine: Gardasil (4-valent), Cervarix (2-valent); given 9–14 yrs girls (best before sexual debut)",
        ]),
        ("Breast Cancer Screening", [
            "BSE (Breast Self-Examination): monthly; 7–10 days after menstruation",
            "CBE (Clinical Breast Examination): by trained health worker annually for women 30–65 yrs",
            "Mammography: gold standard; every 2 years for women 40–74 yrs (high-income settings)",
            "NPCDCS: CBE at health and wellness centres (HWCs) for all women 30+ yrs",
        ]),
        ("Oral Cancer Screening", [
            "Visual examination of oral cavity by trained health worker",
            "Toluidine blue staining: identifies premalignant lesions",
            "Focus on tobacco/gutkha/betel nut users",
        ]),
        ("NPCDCS Programme", [
            "Screening at 30+ years at HWC level: blood pressure, blood glucose, oral/breast/cervical cancer",
            "Opportunistic screening at all health facilities",
        ]),
    ],
    tip="Know VIA vs Pap smear differences. VIA is the practical tool used in India for cervical cancer screening. HPV vaccine schedule is high-yield."
)

q_block(20,
    "Describe the Integrated Child Development Services (ICDS) Scheme.",
    "★★★ Very Frequent",
    [
        ("Introduction", [
            "ICDS is the world's largest integrated early childhood care and development programme. Launched on October 2, 1975 by Government of India. It is the National Programme for Child Development and the sole programme catering to holistic development of children 0–6 years.",
        ]),
        ("Objectives (5 objectives)", [
            "1. Improve nutritional and health status of children 0–6 yrs",
            "2. Lay the foundation for proper psychological, physical and social development",
            "3. Reduce incidence of mortality, morbidity, malnutrition and school dropout",
            "4. Achieve effective coordination between policy and implementation among various departments",
            "5. Enhance the capability of mothers for normal child development through proper nutrition and health education",
        ]),
        ("Target Beneficiaries", [
            "Children 0–6 years (with special focus on 0–3 years under newer guidelines)",
            "Pregnant and lactating mothers",
            "Adolescent girls 11–18 years (under SABLA/Kishori Shakti Yojana)",
        ]),
        ("Six Services of ICDS", [
            "1. Supplementary Nutrition (SNP): 500 kcal + 12–15 g protein for children; 600 kcal for mothers",
            "2. Immunization: coordination with ANM",
            "3. Health Check-up: growth monitoring, Vitamin A, deworming",
            "4. Referral Services: sick/malnourished children to CHC/hospital",
            "5. Pre-school Non-formal Education (ECCE): play-based learning for 3–6 yrs",
            "6. Nutrition and Health Education for women (15–45 yrs)",
        ]),
        ("Anganwadi Centre (AWC)", [
            "Operational unit: 1 AWC per 400–800 children",
            "Staff: Anganwadi Worker (AWW) + Anganwadi Helper (AWH)",
            "AWW qualifications: local woman, 18+ years, 8th pass minimum; incentive-based",
        ]),
    ],
    tip="ICDS services mnemonic: 'SNP Health Education Referral ECCE Immunization' — or just remember SNPHER. October 2nd = ICDS launch date."
)

# ─────────────────────────────────────────────────────────────────────────────
# BONUS SECTION: ADDITIONAL SHORT NOTES (3 marks format — useful cross-ref)
# ─────────────────────────────────────────────────────────────────────────────
story.append(PageBreak())
category_banner("BONUS: HIGH-FREQUENCY TOPICS — QUICK NOTES")

bonus_data = [
    ("Epidemiological transition", "Shift from communicable to non-communicable diseases as development progresses. Omran (1971) described 3 stages: Age of Pestilence/Famine → Age of Receding Pandemics → Age of Degenerative/Man-made Diseases. India in stage of overlap."),
    ("Herd Immunity", "Resistance of a group to invasion by a disease due to immunity of a high proportion of members. Threshold varies by Ro: Measles 92–95%; Polio 80–85%; Smallpox 85%. Basis of elimination strategy."),
    ("Demographic Transition", "Change in population from high birth rate + high death rate (pre-industrial) to low birth rate + low death rate (developed). 5 stages. India currently in stage 3 (declining both rates but still high pop growth)."),
    ("Surveillance (Disease)", "Systematic collection, analysis and dissemination of health data for public health action. Types: Passive (routine), Active (case-finding), Sentinel, Syndromic. IDSP uses P-L-S forms."),
    ("Cluster Sampling", "Used when sampling frame is unavailable. Population divided into clusters; random clusters selected; all individuals in selected clusters included. Used in WHO EPI coverage surveys (30 × 7 method)."),
    ("Standardised Mortality Rate (SMR)", "Adjusts crude death rates for age (and sometimes sex) to allow valid comparison between populations. Methods: Direct (apply study age-specific rates to standard population) and Indirect (use standard rates to calculate expected deaths; SMR = Observed/Expected × 100)."),
    ("Sullivan's Index / DFLE", "Disability-Free Life Expectancy (DFLE) — also called Active Life Expectancy. Combines mortality data with disability data to estimate years lived free of disability. Quality-adjusted LE measure."),
    ("MCH Indicators", "IMR (<25 target), NMR (<10 target), MMR (<70 by 2030 SDG), U5MR (<25), TFR (2.1 replacement level), % institutional deliveries (NFHS-5: 88.6%)."),
    ("Reservoir of Infection", "The natural habitat of an infectious agent where it lives and multiplies. Human reservoir (typhoid, measles), Animal reservoir/Zoonosis (rabies, plague, brucellosis), Environmental reservoir (soil = tetanus, histoplasmosis)."),
    ("ANC visits (GoI)", "Minimum 4 ANC visits: 1st visit within 12 weeks, 2nd at 14–26 wks, 3rd at 28–34 wks, 4th at 36+ weeks. WHO now recommends ≥8 contacts."),
]

for i in range(0, len(bonus_data), 2):
    row_items = []
    for j in range(2):
        if i+j < len(bonus_data):
            topic, content = bonus_data[i+j]
            cell = [
                Paragraph(topic, ans_head),
                Paragraph(content, ans_body),
            ]
        else:
            cell = [Paragraph("", ans_body)]
        row_items.append(cell)

    tbl_row = Table([row_items], colWidths=[8.5*cm, 8.5*cm])
    tbl_row.setStyle(TableStyle([
        ("BACKGROUND",(0,0),(-1,-1), GREY_BG),
        ("GRID",(0,0),(-1,-1), 0.5, TEAL_LIGHT),
        ("VALIGN",(0,0),(-1,-1),"TOP"),
        ("TOPPADDING",(0,0),(-1,-1),5),
        ("BOTTOMPADDING",(0,0),(-1,-1),5),
        ("LEFTPADDING",(0,0),(-1,-1),6),
    ]))
    story.append(tbl_row)
    story.append(Spacer(1,4))

# ── Footer ────────────────────────────────────────────────────────────────────
story.append(Spacer(1,10))
story.append(HRFlowable(width="100%", thickness=0.5, color=TEAL_LIGHT))
story.append(Spacer(1,4))
story.append(Paragraph(
    "RGUHS Community Medicine — 5-Mark Q&A  |  Orris Study Companion  |  July 2026  |  "
    "Based on Park's Textbook PSM & RGUHS Previous Year Papers 2008–2025  |  For exam revision only",
    footer_s
))

doc.build(story)
print(f"PDF saved to: {OUTPUT}")

from reportlab.lib.pagesizes import A4
from reportlab.lib import colors
from reportlab.lib.styles import getSampleStyleSheet, ParagraphStyle
from reportlab.lib.units import cm
from reportlab.platypus import (SimpleDocTemplate, Paragraph, Spacer, Table,
                                 TableStyle, HRFlowable, PageBreak, KeepTogether)
from reportlab.lib.enums import TA_CENTER, TA_LEFT, TA_JUSTIFY

OUTPUT = "/tmp/workspace/community-medicine/RGUHS_CM_Applied_Aspects_5Markers.pdf"

doc = SimpleDocTemplate(
    OUTPUT, pagesize=A4,
    rightMargin=1.8*cm, leftMargin=1.8*cm,
    topMargin=2*cm, bottomMargin=2*cm,
    title="RGUHS Community Medicine Applied Aspects 5-Mark Q&A",
    author="Orris Study Companion"
)

# ── Colours ─────────────────────────────────────────────────────────────────
TEAL        = colors.HexColor("#005f73")
TEAL_LT     = colors.HexColor("#94d2bd")
ORANGE      = colors.HexColor("#ca6702")
ORANGE_LT   = colors.HexColor("#ee9b00")
CREAM       = colors.HexColor("#edf6f9")
DARK        = colors.HexColor("#1a1a2e")
GREY_BG     = colors.HexColor("#f7f9fc")
WHITE       = colors.white
YELLOW      = colors.HexColor("#fff8e1")
RED_LT      = colors.HexColor("#fce4ec")
GREEN_LT    = colors.HexColor("#e8f5e9")
BLUE_LT     = colors.HexColor("#e3f2fd")
PURPLE_LT   = colors.HexColor("#f3e5f5")

styles = getSampleStyleSheet()

title_s  = ParagraphStyle("ts",  fontSize=19, textColor=WHITE,  fontName="Helvetica-Bold", alignment=TA_CENTER, spaceAfter=3, leading=24)
sub_s    = ParagraphStyle("ss",  fontSize=9.5,textColor=TEAL_LT,fontName="Helvetica",      alignment=TA_CENTER, spaceAfter=2)
cat_s    = ParagraphStyle("cs",  fontSize=12, textColor=WHITE,  fontName="Helvetica-Bold", alignment=TA_CENTER)
qnum_s   = ParagraphStyle("qns", fontSize=10, textColor=WHITE,  fontName="Helvetica-Bold")
q_s      = ParagraphStyle("qs",  fontSize=10.5,textColor=DARK,  fontName="Helvetica-Bold", leading=14, spaceAfter=0)
case_s   = ParagraphStyle("cas", fontSize=9,  textColor=colors.HexColor("#1b4332"), fontName="Helvetica-Oblique", leading=13)
ans_head = ParagraphStyle("ah",  fontSize=9,  textColor=TEAL,   fontName="Helvetica-Bold", spaceAfter=1)
ans_body = ParagraphStyle("ab",  fontSize=8.8,textColor=DARK,   fontName="Helvetica",      leading=12.5, spaceAfter=1)
bullet_s = ParagraphStyle("bs",  fontSize=8.8,textColor=DARK,   fontName="Helvetica",      leading=12.5, leftIndent=10, spaceAfter=1)
note_s   = ParagraphStyle("ns",  fontSize=8,  textColor=colors.HexColor("#5d4037"), fontName="Helvetica-Oblique", leading=11)
footer_s = ParagraphStyle("fs",  fontSize=7,  textColor=colors.grey, alignment=TA_CENTER)
freq_s   = ParagraphStyle("frs", fontSize=7.5,textColor=ORANGE, fontName="Helvetica-Bold")
prac_s   = ParagraphStyle("ps",  fontSize=9,  textColor=colors.HexColor("#004d40"), fontName="Helvetica-Bold", spaceAfter=2)

story = []

# ── Helpers ──────────────────────────────────────────────────────────────────
def title_banner():
    rows = [
        [Paragraph("RGUHS COMMUNITY MEDICINE", title_s)],
        [Paragraph("Applied Aspects — 5-Mark Questions with Model Answers", sub_s)],
        [Paragraph("Integrated Modules: Anaemia · IHD · Diabetes · Tuberculosis · Hypertension · Thyroid", sub_s)],
        [Paragraph("As per RGUHS 2025 Blueprint  |  Park's Textbook PSM  |  Exam Prep 2026", sub_s)],
    ]
    t = Table(rows, colWidths=[17*cm])
    t.setStyle(TableStyle([
        ("BACKGROUND",(0,0),(-1,-1),TEAL),
        ("TOPPADDING",(0,0),(-1,-1),6),("BOTTOMPADDING",(0,0),(-1,-1),6),
    ]))
    story.append(t); story.append(Spacer(1,8))

def cat_banner(text, bg=ORANGE):
    t = Table([[Paragraph(text, cat_s)]], colWidths=[17*cm])
    t.setStyle(TableStyle([
        ("BACKGROUND",(0,0),(-1,-1),bg),
        ("TOPPADDING",(0,0),(-1,-1),6),("BOTTOMPADDING",(0,0),(-1,-1),6),
    ]))
    story.append(t); story.append(Spacer(1,6))

def info_box(text, bg=BLUE_LT, border=TEAL):
    t = Table([[Paragraph(text, ans_body)]], colWidths=[17*cm])
    t.setStyle(TableStyle([
        ("BACKGROUND",(0,0),(-1,-1),bg),
        ("BOX",(0,0),(-1,-1),0.8,border),
        ("TOPPADDING",(0,0),(-1,-1),7),("BOTTOMPADDING",(0,0),(-1,-1),7),
        ("LEFTPADDING",(0,0),(-1,-1),10),
    ]))
    story.append(t); story.append(Spacer(1,8))

def q_block(num, question, freq, case_vignette=None, answer_sections=None, tip=None, answer_bg=CREAM):
    items = []

    # Header row: Q number + question + freq tag
    q_tbl = Table([
        [Paragraph(f"Q{num}.", qnum_s),
         Paragraph(question, q_s),
         Paragraph(freq, freq_s)]
    ], colWidths=[0.9*cm, 13.2*cm, 2.9*cm])
    q_tbl.setStyle(TableStyle([
        ("BACKGROUND",(0,0),(-1,-1),TEAL),
        ("VALIGN",(0,0),(-1,-1),"MIDDLE"),
        ("TOPPADDING",(0,0),(-1,-1),6),("BOTTOMPADDING",(0,0),(-1,-1),6),
        ("LEFTPADDING",(0,0),(-1,-1),6),
    ]))
    items.append(q_tbl)

    # Case vignette (optional)
    if case_vignette:
        cv_tbl = Table([[Paragraph(f"📋 Case: {case_vignette}", case_s)]], colWidths=[17*cm])
        cv_tbl.setStyle(TableStyle([
            ("BACKGROUND",(0,0),(-1,-1),GREEN_LT),
            ("BOX",(0,0),(-1,-1),0.5,TEAL_LT),
            ("TOPPADDING",(0,0),(-1,-1),5),("BOTTOMPADDING",(0,0),(-1,-1),5),
            ("LEFTPADDING",(0,0),(-1,-1),8),
        ]))
        items.append(cv_tbl)

    # PRACTICE BOX (just the question — for self-practice)
    prac_tbl = Table([[Paragraph("✍ Practice Space (answer below is hidden — try it first!)", prac_s)]], colWidths=[17*cm])
    prac_tbl.setStyle(TableStyle([
        ("BACKGROUND",(0,0),(-1,-1),YELLOW),
        ("TOPPADDING",(0,0),(-1,-1),4),("BOTTOMPADDING",(0,0),(-1,-1),18),
        ("LEFTPADDING",(0,0),(-1,-1),8),
        ("BOX",(0,0),(-1,-1),0.5,ORANGE_LT),
    ]))
    items.append(prac_tbl)

    # MODEL ANSWER
    ans_rows = [[Paragraph("▶ MODEL ANSWER", ans_head)]]
    if answer_sections:
        for (heading, bullets) in answer_sections:
            if heading:
                ans_rows.append([Paragraph(heading, ans_head)])
            for b in bullets:
                if b.startswith("**"):
                    ans_rows.append([Paragraph(f"<b>{b[2:]}</b>", ans_body)])
                else:
                    ans_rows.append([Paragraph(f"• {b}", bullet_s)])

    if tip:
        ans_rows.append([Spacer(1,4)])
        tip_tbl = Table([[Paragraph(f"✎ Exam Tip: {tip}", note_s)]], colWidths=[15.5*cm])
        tip_tbl.setStyle(TableStyle([
            ("BACKGROUND",(0,0),(-1,-1),YELLOW),
            ("LEFTPADDING",(0,0),(-1,-1),8),
            ("TOPPADDING",(0,0),(-1,-1),4),("BOTTOMPADDING",(0,0),(-1,-1),4),
            ("BOX",(0,0),(-1,-1),0.5,ORANGE),
        ]))
        ans_rows.append([tip_tbl])

    ans_tbl = Table(ans_rows, colWidths=[16*cm])
    ans_tbl.setStyle(TableStyle([
        ("BACKGROUND",(0,0),(-1,-1),answer_bg),
        ("LEFTPADDING",(0,0),(-1,-1),10),("RIGHTPADDING",(0,0),(-1,-1),8),
        ("TOPPADDING",(0,0),(-1,-1),4),("BOTTOMPADDING",(0,0),(-1,-1),4),
        ("BOX",(0,0),(-1,-1),0.5,TEAL_LT),
    ]))
    items.append(ans_tbl)
    items.append(Spacer(1,10))
    story.append(KeepTogether(items))

def sp(h=5): story.append(Spacer(1,h))

# ═══════════════════════════════════════════════════════════════════════════
#  TITLE & INTRO
# ═══════════════════════════════════════════════════════════════════════════
title_banner()

info_box(
    "<b>About Applied Aspects Questions (RGUHS 2025 Blueprint):</b> "
    "Two 5-mark questions (Q8 and Q9 in the paper) are dedicated to 'Applied Aspects' with integrated module topics: "
    "<b>Anaemia, Ischaemic Heart Disease, Diabetes Mellitus, Tuberculosis, Hypertension, Thyroid disorders.</b> "
    "These are CASE SCENARIO-BASED — a brief clinical vignette is given, and you must answer from a Community Medicine perspective "
    "(epidemiology, risk factors, prevention, national programme, screening). "
    "Each answer: ~200 words. Format: Definition → Epidemiology → Risk Factors → Community Prevention → National Programme/Screening.",
    bg=BLUE_LT, border=TEAL
)

# ═══════════════════════════════════════════════════════════════════════════
#  MODULE 1: ANAEMIA
# ═══════════════════════════════════════════════════════════════════════════
cat_banner("MODULE 1 — ANAEMIA (Integrated Applied Aspects)", bg=colors.HexColor("#0077b6"))

q_block(1,
    "A 22-year-old pregnant woman presents with pallor and fatigue at 28 weeks gestation. Hb is 8 g/dL. Discuss the community medicine aspects of anaemia in pregnancy.",
    "★★★ Very Frequent",
    case_vignette="A 22-year-old G2P1 woman at 28 weeks gestation attends ANC clinic with pallor, fatigue and breathlessness. Hb = 8 g/dL, MCV low. She lives in a rural area and has had no ANC so far.",
    answer_sections=[
        ("Definition (WHO)", [
            "Anaemia in pregnancy: Hb < 11 g/dL (1st and 3rd trimester), < 10.5 g/dL (2nd trimester)",
            "Severe anaemia: Hb < 7 g/dL; Very severe: Hb < 4 g/dL",
        ]),
        ("Epidemiology in India", [
            "NFHS-5 (2019-21): 57% women (15-49 yrs) are anaemic; 52.2% pregnant women anaemic",
            "Most common nutritional deficiency disease globally and in India",
            "Commonest type: Iron Deficiency Anaemia (IDA) — microcytic hypochromic",
        ]),
        ("Risk Factors (Community Medicine Perspective)", [
            "Dietary: low iron intake, poor bioavailability (phytates in cereals block absorption), lack of Vitamin C",
            "Frequent pregnancies, short birth intervals (<2 years), adolescent pregnancy",
            "Infections: hookworm, malaria, tuberculosis — major causes of anaemia in rural India",
            "Socioeconomic: poverty, low education, lack of ANC access",
        ]),
        ("Consequences (if untreated)", [
            "Maternal: PPH (major risk), cardiac failure, increased susceptibility to infections",
            "Fetal: IUGR, preterm birth, low birth weight, perinatal death",
        ]),
        ("Community Prevention & National Programme", [
            "IFA (Iron-Folic Acid) Supplementation: 100 mg elemental iron + 500 mcg folic acid daily from 14 weeks onwards",
            "ANAEMIA MUKT BHARAT (AMB): Launched 2018 under POSHAN Abhiyaan; targets 6 groups: children, adolescents, pregnant women, lactating mothers",
            "Weekly Iron-Folic Acid Supplementation (WIFS): adolescent girls 10-19 yrs",
            "Pradhan Mantri Surakshit Matritva Abhiyan (PMSMA): fixed-day ANC on 9th of every month; Hb screening mandatory",
            "Dietary diversification: green leafy vegetables, jaggery, citrus fruits to enhance absorption",
            "Deworming: Albendazole 400 mg single dose at 2nd trimester",
        ]),
    ],
    tip="Remember NFHS-5 figures for anaemia (57% women). State Hb cut-offs for each degree of anaemia. Mention AMB programme + WIFS — these are RGUHS favourites.",
    answer_bg=CREAM
)

q_block(2,
    "Describe the epidemiology and community-based control of Iron Deficiency Anaemia (IDA) in children under 5 years.",
    "★★★ Very Frequent",
    answer_sections=[
        ("Epidemiology", [
            "NFHS-5: 67% children (6-59 months) are anaemic in India",
            "Peak prevalence: 6-24 months (when breast milk inadequate, weaning foods iron-poor)",
            "IDA accounts for ~50% of all anaemia cases in children",
        ]),
        ("Causes in Children", [
            "Inadequate dietary iron: exclusive breastfeeding beyond 6 months without complementary foods",
            "Low bioavailability: plant-based weaning foods (phytates reduce iron absorption)",
            "Hookworm/parasitic infections — blood loss from gut",
            "Frequent infections: malaria, diarrhoea, respiratory infections",
            "Prematurity/LBW: poor iron stores at birth",
        ]),
        ("Clinical Features", [
            "Pallor (conjunctival, palmar, nail bed), fatigue, anorexia",
            "Pica (eating soil/chalk), koilonychia (spoon-shaped nails)",
            "Cognitive impairment, poor school performance, behavioural problems",
            "Increased susceptibility to infections (impaired immunity)",
        ]),
        ("National Programme — Anaemia Mukt Bharat (AMB)", [
            "Children 6-59 months: Iron syrup (1 mg/kg/day) weekly; bi-annual deworming (Albendazole 200 mg)",
            "Children 5-9 years: IFA pink tablet (45 mg iron + 400 mcg folic acid) weekly",
            "Universal Salt Iodisation (concurrent micronutrient strategy)",
        ]),
        ("Community Interventions", [
            "Growth monitoring at AWC: identify underweight/anaemic children",
            "ICDS supplementary nutrition: iron-fortified foods",
            "Exclusive breastfeeding for 6 months; timely complementary feeding",
            "Vitamin C with meals to enhance iron absorption",
        ]),
    ],
    tip="NFHS-5: 67% children under 5 anaemic. AMB targets 6 beneficiary groups — memorise them. Deworming dose: Albendazole 200 mg (<2 yrs) or 400 mg (>2 yrs)."
)

story.append(PageBreak())

# ═══════════════════════════════════════════════════════════════════════════
#  MODULE 2: TUBERCULOSIS
# ═══════════════════════════════════════════════════════════════════════════
cat_banner("MODULE 2 — TUBERCULOSIS (Integrated Applied Aspects)", bg=colors.HexColor("#6a0572"))

q_block(3,
    "A 35-year-old male labourer presents with cough >2 weeks, evening rise of fever and weight loss. Discuss the applied community medicine aspects of TB including national programme.",
    "★★★ Very Frequent",
    case_vignette="A 35-year-old daily wage labourer presents with cough for 3 weeks, evening fever, night sweats and 5 kg weight loss. Sputum AFB smear: 2+ positive. He lives in a crowded slum with 8 family members.",
    answer_sections=[
        ("Definition & Agent", [
            "Tuberculosis: chronic granulomatous infectious disease caused by Mycobacterium tuberculosis (AAFB)",
            "Transmission: airborne droplet nuclei (1-5 μm); 1 open case infects 10-15 contacts/year",
        ]),
        ("Epidemiology — Community Medicine Perspective", [
            "India: highest TB burden globally — 26% of world's TB incidence (GTB Report 2022)",
            "~2.8 million new cases/year; ~4.93 lakh deaths/year (India, 2021)",
            "Social determinants: POVERTY, overcrowding, malnutrition, indoor air pollution are major community-level drivers",
            "Risk groups: HIV+ (30x higher risk), diabetics (3x), silicosis, immunosuppressed, contacts of open cases",
        ]),
        ("Contact Tracing (this case — 8 family members)", [
            "Screen all household contacts with symptom enquiry + Mantoux test/CBNAAT",
            "Children <5 yrs who are asymptomatic but Mantoux+ → Isoniazid Preventive Therapy (IPT) 6 months",
            "HIV-positive contacts: IPT regardless of Mantoux result",
            "Index case must be reported on Ni-kshay portal (mandatory under RTPCR rules)",
        ]),
        ("Ni-kshay (National TB Elimination Programme)", [
            "Treatment: 2HRZE (intensive 2 months) + 4HR (continuation 4 months) under DOTS",
            "DOTS: treatment taken under direct observation; community-based DOT provider assigned",
            "Ni-kshay Poshan Yojana: ₹500/month nutritional support to every TB patient",
            "Ni-kshay Mitra: volunteer/NGO sponsors diagnostic, nutritional and vocational support",
            "Target: TB-free India by 2025 (5 years ahead of SDG 2030 target)",
        ]),
        ("Community-Level Prevention", [
            "BCG vaccination at birth: prevents TB meningitis and miliary TB in children",
            "Improve living conditions: reduce overcrowding, improve ventilation",
            "Active case finding: sputum examination campaigns in high-risk communities",
            "IDSP surveillance: report clusters of respiratory illness",
        ]),
    ],
    tip="Know Ni-kshay Poshan Yojana (₹500/month). Contact tracing steps are very commonly asked as applied scenario. BCG protects children — NOT adults against pulmonary TB."
)

q_block(4,
    "As a Medical Officer at PHC, how will you manage a cluster of TB cases in a slum? Describe your community-level approach.",
    "★★ Frequent",
    answer_sections=[
        ("Step 1: Case Detection & Notification", [
            "Identify all presumptive TB cases: cough >2 weeks, haemoptysis, weight loss, fever",
            "Sputum CBNAAT/smear microscopy at PHC laboratory",
            "Notify all confirmed cases on Ni-kshay portal (mandatory for all TB cases — public and private)",
        ]),
        ("Step 2: Contact Tracing", [
            "Identify all household contacts; screen with symptom questionnaire + Mantoux test",
            "Children <5 yrs asymptomatic contacts → IPT (Isoniazid 5 mg/kg/day × 6 months)",
            "HIV-positive contacts → IPT regardless of Mantoux",
        ]),
        ("Step 3: DOTS Implementation", [
            "Assign community DOT provider (ASHA/AWW/family member) for each patient",
            "Daily supervised treatment; fixed-dose combinations (FDCs) available free at PHC",
            "Monthly sputum follow-up at 2, 5, 6 months to monitor treatment response",
        ]),
        ("Step 4: Nutritional & Social Support", [
            "Enrol in Ni-kshay Poshan Yojana (₹500/month); link with Ni-kshay Mitra if available",
            "Screen for comorbidities: HIV (offer ICTC), diabetes (FBS), malnutrition",
        ]),
        ("Step 5: Environmental & Community Measures", [
            "Improve ventilation in community spaces (schools, hostels, shelters)",
            "IEC activities: reduce stigma, encourage early care-seeking",
            "Screening camps in high-density areas (ACTIVE case finding)",
            "Ensure BCG vaccination for all unvaccinated children in the cluster",
        ]),
        ("Monitoring & Reporting", [
            "Maintain TB register at PHC; report outcomes at 6 months",
            "Cluster alerts through IDSP (district surveillance unit notified)",
        ]),
    ],
    tip="RGUHS loves the 'MO at PHC' scenario. Structure your answer as a step-wise action plan. Include Ni-kshay portal notification — it's mandatory and high-yield."
)

story.append(PageBreak())

# ═══════════════════════════════════════════════════════════════════════════
#  MODULE 3: HYPERTENSION
# ═══════════════════════════════════════════════════════════════════════════
cat_banner("MODULE 3 — HYPERTENSION (Integrated Applied Aspects)", bg=colors.HexColor("#c1121f"))

q_block(5,
    "Describe the epidemiology, risk factors and community-based prevention of Hypertension in India.",
    "★★★ Very Frequent",
    case_vignette="A 50-year-old male government employee is found to have BP 158/96 mmHg on routine screening at a Health and Wellness Centre. He is a smoker, eats high-salt food, and has a family history of stroke.",
    answer_sections=[
        ("Definition (JNC 8 / Indian guidelines)", [
            "Hypertension: Systolic BP ≥140 mmHg AND/OR Diastolic BP ≥90 mmHg on ≥2 separate readings",
            "Pre-hypertension: SBP 120-139 / DBP 80-89 (stage requiring lifestyle modification)",
            "Stage 1 HT: 140-159 / 90-99 | Stage 2 HT: ≥160 / ≥100",
        ]),
        ("Epidemiology — India", [
            "NFHS-5: 21% men and 24% women aged 15-49 yrs are hypertensive (India, 2019-21)",
            "Prevalence higher in urban than rural populations (urban: ~33%, rural: ~25%)",
            "Awareness, treatment and control are LOW: only ~38% hypertensives are aware, <30% controlled",
            "'Rule of halves': half unaware, half untreated, half uncontrolled",
        ]),
        ("Risk Factors (Modifiable & Non-modifiable)", [
            "**Modifiable: High salt intake (>5 g/day), obesity (BMI >25), physical inactivity, smoking, alcohol, stress, diabetes",
            "**Non-modifiable: Age (>45 yrs males, >55 yrs females), family history, sex (males > females pre-menopause)",
            "Social determinants: urbanisation, sedentary lifestyle, processed food consumption",
        ]),
        ("Consequences (if uncontrolled)", [
            "Cardiovascular: Ischaemic Heart Disease (IHD), heart failure",
            "Cerebrovascular: stroke (leading preventable cause of stroke in India)",
            "Renal: hypertensive nephropathy, chronic kidney disease",
            "Ocular: hypertensive retinopathy",
        ]),
        ("Community-based Prevention", [
            "**Primary Prevention: SHAKE package (WHO): Salt reduction, Harmful alcohol reduction, Activity increase, Quit tobacco, Eating healthy",
            "Salt reduction: restrict to <5 g/day; avoid processed/packaged foods",
            "DASH diet: high in fruits, vegetables, low-fat dairy; reduces BP by 8-14 mmHg",
            "Regular physical activity: 150 min/week moderate intensity",
        ]),
        ("National Programme — NPCDCS", [
            "National Programme for Prevention and Control of Cancer, Diabetes, CVD and Stroke (NPCDCS)",
            "Opportunistic screening at all health facilities: BP measured for ALL patients ≥30 yrs",
            "HWC (Health and Wellness Centre): population-based screening; 30+ years screened annually",
            "India Hypertension Control Initiative (IHCI): 2017 onwards; standardised protocol; long-term follow-up",
        ]),
    ],
    tip="Know the 'Rule of Halves' for hypertension. NPCDCS and India Hypertension Control Initiative (IHCI) are current programme names — use them. SHAKE = WHO salt reduction package."
)

q_block(6,
    "What are the risk factors for Hypertension? Describe the community-level strategies for its control.",
    "★★ Frequent",
    answer_sections=[
        ("Risk Factor Classification", [
            "**A. Non-modifiable Risk Factors:",
            "Age: risk doubles every 10 years after 35 yrs",
            "Family history (genetic predisposition)",
            "Sex: males at higher risk before menopause; females equal after menopause",
            "Ethnicity: higher prevalence in African-Americans (relevant globally)",
            "**B. Modifiable Risk Factors (Behavioural):",
            "High dietary sodium: every 100 mmol/day increase → 3-6 mmHg rise in SBP",
            "Obesity: BMI >30 → 2-6x higher risk; abdominal obesity (waist >90 cm males, >80 cm females in Indians)",
            "Physical inactivity: sedentary persons 20-50% higher risk",
            "Alcohol (>3 drinks/day): increases BP acutely and chronically",
            "Tobacco: direct vasopressor effect; nicotine raises sympathetic activity",
            "Psychological stress: chronic stress → cortisol → vasoconstriction",
        ]),
        ("Community-Level Control Strategies", [
            "**1. Health Promotion: mass media campaigns (Swasth Bharat), community walks, dietary counselling",
            "**2. Screening: BP measurement at all contact points; NPCDCS mandates BP check for all ≥30 yrs",
            "**3. Lifestyle Modification (non-pharmacological): DASH diet, salt restriction, weight reduction, exercise, quit smoking",
            "**4. Early Treatment: standard protocol (amlodipine-based) at PHC level; free drugs under NPCDCS/Jan Aushadhi",
            "**5. IHCI Protocol: fixed-dose protocol; monthly follow-up; Pradhan Mantri Jan Arogya Yojana for complications",
            "**6. Community engagement: ASHA/AWW for BP screening at household level; NCD clinics at CHC",
        ]),
    ],
    tip="Abdominal obesity cut-offs for Indians are LOWER (male: >90 cm, female: >80 cm) than international standards — often asked in MCQs."
)

story.append(PageBreak())

# ═══════════════════════════════════════════════════════════════════════════
#  MODULE 4: DIABETES MELLITUS
# ═══════════════════════════════════════════════════════════════════════════
cat_banner("MODULE 4 — DIABETES MELLITUS (Integrated Applied Aspects)", bg=colors.HexColor("#1a6b47"))

q_block(7,
    "Describe the epidemiology, community-based prevention and national programme for Diabetes Mellitus in India.",
    "★★★ Very Frequent",
    case_vignette="A 45-year-old overweight woman (BMI 29 kg/m²) with family history of DM is found to have fasting blood glucose 128 mg/dL on screening at HWC. She has no symptoms. What are the community medicine implications?",
    answer_sections=[
        ("Definition & Diagnostic Criteria (ADA / WHO)", [
            "Diabetes Mellitus: FPG ≥126 mg/dL | 2-hr OGTT ≥200 mg/dL | HbA1c ≥6.5% | Random plasma glucose ≥200 mg/dL with symptoms",
            "Pre-diabetes (IFG/IGT): FPG 100-125 mg/dL or 2-hr OGTT 140-199 mg/dL — target for prevention",
            "This case (FPG 128 mg/dL) = Diabetic; needs confirmation + management",
        ]),
        ("Epidemiology — India ('Diabetes Capital of the World')", [
            "India: 101 million diabetics (IDF 2021); ~136 million pre-diabetics",
            "ICMR-INDIAB study (2023): 11.4% national prevalence",
            "Rapid urbanisation, dietary change, physical inactivity → epidemic in young adults",
            "Urban prevalence (~14%) >> Rural (~8%)",
        ]),
        ("Risk Factors (Community Medicine Perspective)", [
            "**Non-modifiable: Age >40 yrs, family history (1st degree), Asian ethnicity, history of GDM",
            "**Modifiable: Overweight/obesity (BMI >23 for Asians), physical inactivity, high carbohydrate diet, smoking",
            "Social determinants: urbanisation, sedentary occupations, westernised diet, stress",
        ]),
        ("Community Prevention (3 Levels)", [
            "Primary: promote healthy diet (low glycaemic index), regular exercise (≥150 min/week), maintain BMI <23, avoid tobacco/alcohol",
            "Secondary: SCREENING — FPG annually for all adults ≥30 yrs with risk factors (NPCDCS mandate); HbA1c testing",
            "Tertiary: prevent complications (diabetic foot care, eye screening, renal function check, BP control)",
        ]),
        ("National Programme — NPCDCS", [
            "National Programme for Prevention and Control of Cancer, Diabetes, CVD and Stroke",
            "Opportunistic screening at HWC: ALL patients ≥30 yrs screened for BP, blood glucose, oral/breast/cervical cancer",
            "Free metformin and other essential medicines at PHC/CHC under NPCDCS",
            "India Diabetes Prevention Programme (IDPP): lifestyle intervention in pre-diabetics shown to reduce conversion by 28.5%",
        ]),
        ("Gestational Diabetes Mellitus (GDM) — Community Implication", [
            "GDM: DM diagnosed in 2nd-3rd trimester; prevalence ~10-14% in India",
            "Screened at 24-28 weeks by OGTT (75g); universal screening recommended in India",
            "Consequences if untreated: macrosomia, shoulder dystocia, neonatal hypoglycaemia",
            "Mother and child at long-term risk of T2DM — community follow-up important",
        ]),
    ],
    tip="India has 101 million diabetics (IDF 2021) — memorise this figure. NPCDCS is the national programme. Mention IDPP (Indian Diabetes Prevention Programme) for extra marks."
)

q_block(8,
    "What are the complications of Diabetes Mellitus? How can they be prevented at the community level?",
    "★★ Frequent",
    answer_sections=[
        ("Complications of DM", [
            "**Microvascular (due to small vessel damage):",
            "Diabetic retinopathy: leading cause of new blindness in working-age adults; ~18% diabetics in India",
            "Diabetic nephropathy: leading cause of ESRD (end-stage renal disease); microalbuminuria → proteinuria → renal failure",
            "Diabetic neuropathy: peripheral sensory neuropathy (glove-stocking), autonomic neuropathy (gastroparesis, postural hypotension)",
            "**Macrovascular (large vessel athersclerosis):",
            "Ischaemic Heart Disease (IHD): DM doubles cardiovascular risk",
            "Stroke: DM increases stroke risk 2-4 times",
            "Peripheral arterial disease → Diabetic foot → amputation",
            "**Others: increased susceptibility to infections (TB, fungal infections, UTI), poor wound healing",
        ]),
        ("Community-Level Prevention of Complications", [
            "Glycaemic control: HbA1c target <7% (reduces microvascular complications by 35-40%); free metformin at PHC",
            "BP control: target <130/80 mmHg in diabetics; ACE inhibitor/ARB preferred (nephroprotective)",
            "Annual screening: retinal examination (fundus photography), urine microalbumin, lipid profile, foot examination",
            "Diabetic foot care education: daily inspection, avoid barefoot walking, proper footwear",
            "NPCDCS free drug provision and follow-up clinics at CHC/district hospital",
            "Lifestyle modification: diet counselling, exercise programme, weight management",
            "Self-monitoring of blood glucose (SMBG): educate patient and family",
        ]),
    ],
    tip="Diabetic retinopathy screening by fundus photography is the community-level tool. Microalbuminuria testing is the early marker for nephropathy — mention both."
)

story.append(PageBreak())

# ═══════════════════════════════════════════════════════════════════════════
#  MODULE 5: ISCHAEMIC HEART DISEASE
# ═══════════════════════════════════════════════════════════════════════════
cat_banner("MODULE 5 — ISCHAEMIC HEART DISEASE (Integrated Applied Aspects)", bg=colors.HexColor("#8b0000"))

q_block(9,
    "Describe the epidemiology and risk factors of Ischaemic Heart Disease. What community measures can reduce its burden?",
    "★★★ Very Frequent",
    case_vignette="A 48-year-old male executive with a BMI of 31 kg/m², hypertension and a 20-pack-year smoking history presents to the OPD. His father died of a heart attack at 52. Discuss the community medicine aspects.",
    answer_sections=[
        ("Definition & Epidemiology", [
            "IHD/CHD: disease resulting from reduced blood supply to myocardium due to atherosclerotic coronary artery disease",
            "Leading cause of death in India and globally (WHO 2020): ~18 million CVD deaths globally/year",
            "India: ~3 lakh CVD deaths/year; IHD accounts for >50% of all CVD deaths",
            "Premature IHD (before age 55 in men): India has 2-3x higher prevalence vs Western populations",
            "Urban > Rural; but rural rates rapidly rising (nutrition and lifestyle transition)",
        ]),
        ("Risk Factors — Framingham Study Classification", [
            "**Major (Independent) Risk Factors:",
            "Hypertension: SBP ≥140 mmHg — doubles IHD risk",
            "Hypercholesterolaemia: LDL >160 mg/dL; for each 1% rise in LDL → 2% rise in IHD risk",
            "Diabetes Mellitus: 2-4x higher IHD risk; 'CHD risk equivalent'",
            "Tobacco smoking: 2-3x higher risk; risk returns to baseline 10-15 yrs after cessation",
            "Age and Sex: males >45 yrs; females >55 yrs (or post-menopausal)",
            "Family history: 1st degree relative with premature IHD",
            "**Modifiable Behavioural Risk Factors:",
            "Obesity (BMI >30/abdominal obesity), physical inactivity, unhealthy diet (high saturated fat, low fibre)",
            "Psychosocial stress, Type A personality, depression, social isolation",
            "Alcohol (heavy drinking — moderate may be protective: J-curve relationship)",
        ]),
        ("Community-level Prevention (Primordial + Primary)", [
            "**Primordial: anti-tobacco legislation (COTPA), food labelling laws, urban planning for walkability, school health curriculum",
            "**Primary: SHAKE (WHO Salt reduction, Harmful alcohol reduction, Activity, Quit tobacco, Eating healthy)",
            "WHO/India: reduce dietary salt to <5 g/day; trans-fat elimination from food supply",
            "Physical activity: 150 min/week moderate or 75 min vigorous; community walking groups",
            "Tobacco cessation: quitline (1800-11-2356), NRT free at PHC, mCessation app (India)",
            "Lipid lowering: statins free under NPCDCS for high-risk individuals",
        ]),
        ("National Programme & Screening", [
            "NPCDCS: screening at HWC for all ≥30 yrs — BP, blood glucose, lipid profile",
            "India Heart Watch Programme: community surveillance of CVD risk factors",
            "WHO HEARTS package implemented in India: standardised CVD risk management at PHC level",
            "Cardiovascular Risk Charts (WHO/ISH): estimate 10-year CVD risk; guide treatment decisions",
        ]),
    ],
    tip="'Premature IHD in Indians' is a common scenario. Risk factors from Framingham study are examinable. Mention WHO HEARTS package — it's implemented in India."
)

q_block(10,
    "Describe the web of causation of Ischaemic Heart Disease with community prevention strategies.",
    "★★★ Very Frequent",
    answer_sections=[
        ("Web of Causation (MacMahon & Pugh, 1960)", [
            "The 'Web of Causation' model recognises that diseases like IHD result from a COMPLEX INTERACTION of multiple factors at various levels — biological, behavioural, social and environmental — rather than a single cause.",
        ]),
        ("Web of Causation for IHD (Key Threads)", [
            "**Genetic/Constitutional thread: family history → hypercholesterolaemia → atherosclerosis",
            "**Dietary thread: high saturated fat + high salt → raised LDL + hypertension → atherosclerosis",
            "**Lifestyle thread: physical inactivity → obesity → hypertension + diabetes → IHD",
            "**Tobacco thread: smoking → endothelial damage + thrombogenesis + vasospasm → coronary artery disease",
            "**Psychosocial thread: stress → cortisol → hypertension + platelet aggregation → IHD",
            "**Final common pathway: atherosclerotic plaque → coronary artery stenosis → myocardial ischaemia → IHD",
        ]),
        ("Advantages of Web Model Over Epidemiological Triad", [
            "Captures MULTI-FACTORIAL nature of chronic non-communicable diseases",
            "Identifies MULTIPLE intervention points simultaneously",
            "Better suited for NCD prevention than the simple Agent-Host-Environment triad",
        ]),
        ("Community Prevention Strategies (Points of Intervention in the Web)", [
            "Dietary modification (upstream): reduce saturated fat, increase fibre, DASH diet",
            "Physical activity programmes: walking groups, school sports, workplace exercise",
            "Anti-tobacco initiatives: COTPA enforcement, Pictorial warnings on cigarette packs, NRT",
            "Stress reduction: mental health programmes at workplace, yoga, mindfulness",
            "Early detection: NPCDCS screening (BP, lipids, glucose) for all 30+ yrs at HWC",
            "Treatment of risk factors: free statins + antihypertensives + metformin at PHC under NPCDCS",
        ]),
    ],
    tip="Draw the web diagram showing multiple interconnected risk factors converging at 'myocardial ischaemia'. This earns full marks. Compare with epidemiological triad."
)

story.append(PageBreak())

# ═══════════════════════════════════════════════════════════════════════════
#  MODULE 6: THYROID DISORDERS
# ═══════════════════════════════════════════════════════════════════════════
cat_banner("MODULE 6 — THYROID DISORDERS / IODINE DEFICIENCY (Integrated Applied Aspects)", bg=colors.HexColor("#2d6a4f"))

q_block(11,
    "Describe the epidemiology, clinical spectrum and community-based prevention of Iodine Deficiency Disorders (IDD).",
    "★★★ Very Frequent",
    case_vignette="During a field visit to a hilly tribal area, a medical student notices that many villagers have visible neck swellings. Several children appear mentally slow, and a newborn is suspected to have cretinism. Discuss the community medicine approach.",
    answer_sections=[
        ("Iodine Deficiency Disorders (IDD) — Spectrum", [
            "Term coined by Basil Hetzel (1983) — encompasses ALL conditions due to inadequate iodine intake",
            "Iodine is an essential micronutrient required for thyroid hormone synthesis (T3, T4)",
        ]),
        ("Clinical Spectrum of IDD", [
            "**Fetus/Neonate: stillbirths, spontaneous abortions, congenital anomalies, cretinism (neurological OR myxoedematous)",
            "**Cretinism (Neurological): irreversible mental retardation, deaf-mutism, spastic diplegia, squint — occurs if deficiency in FIRST TRIMESTER",
            "**Cretinism (Myxoedematous): hypothyroidism, growth retardation, but less neurological damage",
            "**Children/Adults: goitre (Grade 0, 1a, 1b, 2 — WHO classification), hypothyroidism, impaired mental function",
            "**All ages: increased susceptibility to nuclear radiation (fallout iodine-131 uptake)",
        ]),
        ("Epidemiology in India", [
            "India is highly iodine-deficient: entire sub-Himalayan belt (Himalayas to Vindhyas) — 'Goitre Belt'",
            "350 million Indians at risk of IDD; 71 million have goitre",
            "Cause: iodine leached out of soil by glacial melt and floods; staple food crops are iodine-poor",
        ]),
        ("Community Prevention — Universal Salt Iodisation (USI)", [
            "USI: mandated under Prevention of Food Adulteration Act in India (now FSS Act 2006)",
            "Salt iodisation standard: 15 ppm at retail/household level (30 ppm at production level to allow for losses)",
            "National Iodine Deficiency Disorders Control Programme (NIDDCP): established 1962 (National Goitre Control Programme), renamed 1992",
            "Monitoring: urinary iodine excretion (UIE) — indicator of population iodine status; target UIE median >100 μg/L",
            "Goitre rate in school children <5% = adequate iodine control (elimination target)",
        ]),
        ("Neonatal Hypothyroidism Screening", [
            "TSH estimation on dried blood spot (Day 3-5 of life) for newborn screening",
            "TSH >20 μIU/mL = suspect; >40 μIU/mL = confirmed hypothyroidism → thyroxine replacement IMMEDIATELY",
            "Early treatment (within 2 weeks) prevents cretinism — critical window",
        ]),
    ],
    tip="Draw the spectrum of IDD on a timeline (fetus → newborn → child → adult). Remember USI standard: 15 ppm at consumer level. UIE is the population-level monitoring tool."
)

q_block(12,
    "Write about community-based control of Goitre. Add a note on neonatal hypothyroidism screening.",
    "★★ Frequent",
    answer_sections=[
        ("Goitre — Definition & Classification", [
            "Goitre: enlargement of thyroid gland; endemic goitre when >5% school-age children affected in an area",
            "WHO Classification: Grade 0 (no goitre) | Grade 1 (palpable, not visible) | Grade 2 (visible goitre)",
        ]),
        ("Causes of Goitre in India", [
            "Iodine deficiency: primary cause in India (endemic goitre in sub-Himalayan belt)",
            "Goitrogens: cassava, cabbage, soyabean, groundnuts — block iodine uptake by thyroid",
            "Autoimmune: Hashimoto's thyroiditis (non-endemic areas)",
        ]),
        ("Community Control of Endemic Goitre", [
            "Universal Salt Iodisation (USI): 15 ppm iodine in salt at consumer level (most effective, sustainable)",
            "Iodised oil: IM or oral — for remote areas, emergencies; 1 injection provides 1-2 years of iodine",
            "Dietary counselling: reduce goitrogenic foods; promote iodine-rich seafood (coastal) and dairy",
            "NIDDCP: surveillance of goitre prevalence in school children; urinary iodine monitoring",
            "Ban on non-iodised salt: India banned non-iodised salt for human consumption (2005); restored at state level — Rajasthan, UP allowed non-iodised salt in 2000 (reversed 2005)",
        ]),
        ("Neonatal Hypothyroidism Screening", [
            "Congenital hypothyroidism: 1 in 2500-4000 live births; most common preventable cause of mental retardation",
            "Screening: TSH from heel-prick dried blood spot on Day 3-5 of life",
            "TSH >40 mIU/L on whole blood = confirm with serum TSH + T4; start Levothyroxine immediately",
            "Treatment: Levothyroxine 10-15 mcg/kg/day; started within 2 weeks → normal neurodevelopment",
            "Programme: included in National NBS (Newborn Screening Programme) in select states under RBSK (Rashtriya Bal Swasthya Karyakram)",
        ]),
    ],
    tip="RBSK (Rashtriya Bal Swasthya Karyakram) includes neonatal screening for 4 Ds: Defects, Diseases, Deficiencies, Developmental delays. Know this — very RGUHS-relevant."
)

story.append(PageBreak())

# ═══════════════════════════════════════════════════════════════════════════
#  SECTION: QUICK PRACTICE QUESTION BANK
# ═══════════════════════════════════════════════════════════════════════════
cat_banner("QUICK PRACTICE QUESTION BANK — Applied Aspects (All 6 Modules)", bg=TEAL)

story.append(Spacer(1, 6))
story.append(Paragraph("The following is a consolidated list of 5-mark applied aspects questions for self-practice. Cover the answers below and attempt each question before checking the answer in the previous sections.", ans_body))
story.append(Spacer(1, 8))

pq_data = [
    ("ANAEMIA", [
        "1. A pregnant woman at 28 weeks has Hb 8 g/dL. Discuss community medicine aspects of anaemia in pregnancy.",
        "2. Describe the community-based control of Iron Deficiency Anaemia in children under 5 years.",
        "3. What is Anaemia Mukt Bharat (AMB)? Describe its targets and strategies.",
        "4. Discuss WIFS (Weekly Iron-Folic Acid Supplementation) programme in India.",
    ]),
    ("TUBERCULOSIS", [
        "5. A sputum-positive TB patient lives with 8 family members in a slum. How will you manage this from a community medicine perspective?",
        "6. Describe Ni-kshay programme for TB elimination in India.",
        "7. As MO at PHC, describe your approach to a cluster of TB cases in a village.",
        "8. What is DOTS? Describe its implementation and importance in TB control.",
    ]),
    ("HYPERTENSION", [
        "9. Describe the epidemiology and community prevention of Hypertension in India.",
        "10. What is NPCDCS? Describe its role in NCD prevention and control.",
        "11. A 50-year-old male on routine screening has BP 158/96 mmHg. Describe community medicine implications.",
        "12. Describe India Hypertension Control Initiative (IHCI) and its strategies.",
    ]),
    ("DIABETES MELLITUS", [
        "13. Describe the epidemiology and community prevention of Type 2 Diabetes Mellitus in India.",
        "14. A 45-year-old woman has FPG 128 mg/dL on screening. Discuss the community medicine approach.",
        "15. Describe Gestational Diabetes Mellitus from a community medicine perspective.",
        "16. What are the complications of DM? How can they be prevented at community level?",
    ]),
    ("ISCHAEMIC HEART DISEASE", [
        "17. Describe the Web of Causation of IHD and community prevention strategies.",
        "18. List risk factors of IHD. How will you implement primary prevention at PHC level?",
        "19. A 48-year-old male smoker with hypertension has a family history of MI. Discuss applied community medicine aspects.",
        "20. Describe the WHO HEARTS package and its implementation in India.",
    ]),
    ("THYROID / IDD", [
        "21. Describe Iodine Deficiency Disorders (IDD) — clinical spectrum, epidemiology and community prevention.",
        "22. Describe the community-based control of endemic goitre in India.",
        "23. What is Universal Salt Iodisation? Describe the iodine standards and monitoring.",
        "24. Write a note on neonatal hypothyroidism screening and its community importance.",
    ]),
]

for module_name, qs in pq_data:
    # Module header
    m_tbl = Table([[Paragraph(f"▸ {module_name}", ans_head)]], colWidths=[17*cm])
    m_tbl.setStyle(TableStyle([
        ("BACKGROUND",(0,0),(-1,-1),colors.HexColor("#e8f4f8")),
        ("BOX",(0,0),(-1,-1),0.5,TEAL),
        ("TOPPADDING",(0,0),(-1,-1),4),("BOTTOMPADDING",(0,0),(-1,-1),4),
        ("LEFTPADDING",(0,0),(-1,-1),8),
    ]))
    story.append(m_tbl)
    for q in qs:
        q_row = Table([[Paragraph(q, bullet_s)]], colWidths=[17*cm])
        q_row.setStyle(TableStyle([
            ("BACKGROUND",(0,0),(-1,-1),WHITE),
            ("LEFTPADDING",(0,0),(-1,-1),14),
            ("TOPPADDING",(0,0),(-1,-1),3),("BOTTOMPADDING",(0,0),(-1,-1),3),
            ("LINEBELOW",(0,0),(-1,-1),0.3,TEAL_LT),
        ]))
        story.append(q_row)
    story.append(Spacer(1, 5))

# ── Key Formulas / Quick Reference ───────────────────────────────────────────
story.append(Spacer(1, 6))
cat_banner("QUICK REFERENCE — Key Numbers to Remember", bg=colors.HexColor("#023e8a"))

key_data = [
    ["Anaemia (pregnancy)", "Hb < 11 g/dL; Severe < 7 g/dL; NFHS-5: 52.2% pregnant women anaemic"],
    ["Anaemia (children <5)", "NFHS-5: 67% children anaemic; IFA dose 1 mg/kg/day"],
    ["Diabetes", "FPG ≥126 mg/dL; India: 101 million diabetics (IDF 2021); ICMR-INDIAB: 11.4%"],
    ["Hypertension", "BP ≥140/90; NFHS-5: 21% men, 24% women; Rule of Halves"],
    ["TB", "India: 26% of global TB burden; 2 million cases/year; Ni-kshay ₹500/month"],
    ["IHD", "Leading global cause of death; premature IHD higher in Indians; 3 lakh CVD deaths/year in India"],
    ["IDD/Goitre", "Salt iodine: 15 ppm at consumer; 350 million at risk in India; Cretinism if deficiency in 1st trimester"],
    ["Neonatal Hypothyroidism", "1 in 2500-4000 births; TSH >40 mIU/L confirms; treatment within 2 weeks prevents retardation"],
    ["NPCDCS screening age", "All adults ≥30 years: BP, FBS, oral/breast/cervical cancer at HWC"],
    ["AMB target", "6 beneficiary groups: children 6-59 months, 5-9 yrs, 10-19 yrs, pregnant women, lactating mothers, women 15-49 (non-pregnant)"],
]

kt = Table(
    [[Paragraph("<b>Topic</b>", ans_head), Paragraph("<b>Key Number / Fact</b>", ans_head)]] +
    [[Paragraph(r[0], ans_body), Paragraph(r[1], ans_body)] for r in key_data],
    colWidths=[5*cm, 12*cm], repeatRows=1
)
kt.setStyle(TableStyle([
    ("BACKGROUND",(0,0),(-1,0), colors.HexColor("#023e8a")),
    ("TEXTCOLOR",(0,0),(-1,0), WHITE),
    ("FONTNAME",(0,0),(-1,0),"Helvetica-Bold"),
    ("ROWBACKGROUNDS",(0,1),(-1,-1),[WHITE, GREY_BG]),
    ("GRID",(0,0),(-1,-1),0.4,TEAL_LT),
    ("FONTSIZE",(0,0),(-1,-1),8),
    ("FONTNAME",(0,1),(-1,-1),"Helvetica"),
    ("TOPPADDING",(0,0),(-1,-1),4),("BOTTOMPADDING",(0,0),(-1,-1),4),
    ("LEFTPADDING",(0,0),(-1,-1),5),
    ("VALIGN",(0,0),(-1,-1),"TOP"),
]))
story.append(kt)

# ── Footer ─────────────────────────────────────────────────────────────────
story.append(Spacer(1,10))
story.append(HRFlowable(width="100%", thickness=0.5, color=TEAL_LT))
story.append(Spacer(1,4))
story.append(Paragraph(
    "RGUHS Community Medicine — Applied Aspects 5-Mark Q&A  |  Orris Study Companion  |  July 2026  |  "
    "Based on RGUHS 2025 Blueprint & Park's Textbook PSM  |  For exam revision only",
    footer_s
))

doc.build(story)
print(f"PDF saved: {OUTPUT}")