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

OUTPUT = "/home/daytona/workspace/retroperitoneal-cheatsheet/Retroperitoneal_Trauma_CheatSheet.pdf"

doc = SimpleDocTemplate(
    OUTPUT,
    pagesize=A4,
    leftMargin=10*mm, rightMargin=10*mm,
    topMargin=8*mm, bottomMargin=8*mm
)

W, H = A4

# ── colour palette ──────────────────────────────────────────────────────────
RED      = colors.HexColor("#C0392B")
ORANGE   = colors.HexColor("#E67E22")
BLUE     = colors.HexColor("#1A5276")
GREEN    = colors.HexColor("#1E8449")
LTBLUE   = colors.HexColor("#D6EAF8")
LTORANGE = colors.HexColor("#FDEBD0")
LTGREEN  = colors.HexColor("#D5F5E3")
LTRED    = colors.HexColor("#FADBD8")
LTYELLOW = colors.HexColor("#FEF9E7")
WHITE    = colors.white
DARK     = colors.HexColor("#1C2833")
GRAY     = colors.HexColor("#F2F3F4")
MIDGRAY  = colors.HexColor("#BDC3C7")

# ── styles ───────────────────────────────────────────────────────────────────
base = getSampleStyleSheet()

def S(name, parent="Normal", **kw):
    return ParagraphStyle(name, parent=base[parent], **kw)

title_s   = S("title_s",   fontSize=13, textColor=WHITE,   alignment=TA_CENTER,
               fontName="Helvetica-Bold", spaceAfter=0, leading=16)
hdr_s     = S("hdr_s",     fontSize=7.5, textColor=WHITE,  alignment=TA_CENTER,
               fontName="Helvetica-Bold", leading=10)
subhdr_s  = S("subhdr_s",  fontSize=7,  textColor=DARK,    alignment=TA_CENTER,
               fontName="Helvetica-Bold", leading=9)
body_s    = S("body_s",    fontSize=6.4, textColor=DARK,   alignment=TA_LEFT,
               fontName="Helvetica", leading=8.5)
bold_s    = S("bold_s",    fontSize=6.4, textColor=DARK,   alignment=TA_LEFT,
               fontName="Helvetica-Bold", leading=8.5)
red_s     = S("red_s",     fontSize=6.4, textColor=RED,    alignment=TA_LEFT,
               fontName="Helvetica-Bold", leading=8.5)
green_s   = S("green_s",   fontSize=6.4, textColor=GREEN,  alignment=TA_LEFT,
               fontName="Helvetica-Bold", leading=8.5)
center_s  = S("center_s",  fontSize=6.4, textColor=DARK,   alignment=TA_CENTER,
               fontName="Helvetica", leading=8.5)
cbold_s   = S("cbold_s",   fontSize=6.4, textColor=DARK,   alignment=TA_CENTER,
               fontName="Helvetica-Bold", leading=8.5)
cred_s    = S("cred_s",    fontSize=6.6, textColor=RED,    alignment=TA_CENTER,
               fontName="Helvetica-Bold", leading=9)
cgreen_s  = S("cgreen_s",  fontSize=6.6, textColor=GREEN,  alignment=TA_CENTER,
               fontName="Helvetica-Bold", leading=9)
corange_s = S("corange_s", fontSize=6.6, textColor=ORANGE, alignment=TA_CENTER,
               fontName="Helvetica-Bold", leading=9)
tiny_s    = S("tiny_s",    fontSize=5.8, textColor=DARK,   alignment=TA_LEFT,
               fontName="Helvetica", leading=7.5)
tinybold_s= S("tinybold_s",fontSize=5.8, textColor=DARK,   alignment=TA_LEFT,
               fontName="Helvetica-Bold", leading=7.5)

def P(txt, style=body_s): return Paragraph(txt, style)

# ── helper: section header row ───────────────────────────────────────────────
def sec_hdr(text, bg=BLUE, cols=1, col_widths=None):
    t = Table([[P(text, hdr_s)]], colWidths=col_widths or [175*mm])
    t.setStyle(TableStyle([
        ("BACKGROUND", (0,0),(-1,-1), bg),
        ("TOPPADDING",   (0,0),(-1,-1), 3),
        ("BOTTOMPADDING",(0,0),(-1,-1), 3),
        ("LEFTPADDING",  (0,0),(-1,-1), 4),
        ("RIGHTPADDING", (0,0),(-1,-1), 4),
    ]))
    return t

# ════════════════════════════════════════════════════════════════════════════
# BUILD CONTENT
# ════════════════════════════════════════════════════════════════════════════
story = []

# ── TITLE BAR ────────────────────────────────────────────────────────────────
title_tbl = Table(
    [[P("🔴  RETROPERITONEAL TRAUMA  —  Oral Exam Quick Reference  🔴", title_s)]],
    colWidths=[175*mm]
)
title_tbl.setStyle(TableStyle([
    ("BACKGROUND", (0,0),(-1,-1), RED),
    ("TOPPADDING",   (0,0),(-1,-1), 5),
    ("BOTTOMPADDING",(0,0),(-1,-1), 5),
    ("ROUNDEDCORNERS", [3]),
]))
story.append(title_tbl)
story.append(Spacer(1, 2*mm))

# ════════════════════════════════════════════════════════════════════════════
# ROW 1: Anatomy mnemonic + 2-min Framework  (side by side)
# ════════════════════════════════════════════════════════════════════════════
cw_left  = 85*mm
cw_right = 87*mm

# LEFT: Retroperitoneal structures
anat_rows = [
    [P("RETROPERITONEAL STRUCTURES — SAD PUCKER", hdr_s)],
    [P("<b>S</b>uprarenal glands (Adrenals)", body_s)],
    [P("<b>A</b>orta &amp; IVC", body_s)],
    [P("<b>D</b>uodenum (D2, D3, D4 only)", body_s)],
    [P("<b>P</b>ancreas (except tail tip)", body_s)],
    [P("<b>U</b>reters", body_s)],
    [P("<b>C</b>olon — ascending &amp; descending", body_s)],
    [P("<b>K</b>idneys", body_s)],
    [P("<b>E</b>sophagus (lower)", body_s)],
    [P("<b>R</b>ectum (lower 2/3)", body_s)],
]
anat_t = Table(anat_rows, colWidths=[cw_left])
anat_t.setStyle(TableStyle([
    ("BACKGROUND", (0,0),(0,0), BLUE),
    ("BACKGROUND", (0,1),(-1,-1), LTBLUE),
    ("TOPPADDING",   (0,0),(-1,-1), 2),
    ("BOTTOMPADDING",(0,0),(-1,-1), 2),
    ("LEFTPADDING",  (0,0),(-1,-1), 4),
    ("RIGHTPADDING", (0,0),(-1,-1), 4),
    ("BOX", (0,0),(-1,-1), 0.5, BLUE),
    ("INNERGRID", (0,0),(-1,-1), 0.3, MIDGRAY),
]))

# RIGHT: 2-min Think Framework
fw_rows = [
    [P("2-MINUTE ORAL FRAMEWORK  ⏱", hdr_s)],
    [P("1️⃣  MECHANISM → Blunt or Penetrating?", body_s)],
    [P("2️⃣  HEMODYNAMICS → Stable or Unstable?", body_s)],
    [P("3️⃣  ZONE → Which zone hematoma?", body_s)],
    [P("4️⃣  STRUCTURES AT RISK → What inside that zone?", body_s)],
    [P("5️⃣  DIAGNOSIS → CT (stable) / Direct OR (unstable)", body_s)],
    [P("6️⃣  EXPLORE? → Zone + Mechanism decide", body_s)],
    [P("7️⃣  EXPOSURE → Mattox / Cattell-Braasch / Kocher", body_s)],
    [P("8️⃣  DAMAGE CONTROL? → Lethal Triad present?", body_s)],
    [P("9️⃣  COMPLICATIONS → Fistula, abscess, ACS, sepsis", body_s)],
]
fw_t = Table(fw_rows, colWidths=[cw_right])
fw_t.setStyle(TableStyle([
    ("BACKGROUND", (0,0),(0,0), ORANGE),
    ("BACKGROUND", (0,1),(-1,-1), LTORANGE),
    ("TOPPADDING",   (0,0),(-1,-1), 2),
    ("BOTTOMPADDING",(0,0),(-1,-1), 2),
    ("LEFTPADDING",  (0,0),(-1,-1), 4),
    ("RIGHTPADDING", (0,0),(-1,-1), 4),
    ("BOX", (0,0),(-1,-1), 0.5, ORANGE),
    ("INNERGRID", (0,0),(-1,-1), 0.3, MIDGRAY),
]))

row1 = Table([[anat_t, fw_t]], colWidths=[cw_left+2*mm, cw_right+2*mm])
row1.setStyle(TableStyle([("VALIGN",(0,0),(-1,-1),"TOP"),
                           ("LEFTPADDING",(0,0),(-1,-1),0),
                           ("RIGHTPADDING",(0,0),(-1,-1),2*mm)]))
story.append(row1)
story.append(Spacer(1, 2*mm))

# ════════════════════════════════════════════════════════════════════════════
# ROW 2: ZONES TABLE (full width)
# ════════════════════════════════════════════════════════════════════════════
story.append(sec_hdr("ZONES OF RETROPERITONEUM  +  HEMATOMA MANAGEMENT", BLUE, col_widths=[175*mm]))

zone_data = [
    # header
    [P("ZONE", hdr_s), P("LOCATION", hdr_s), P("STRUCTURES", hdr_s),
     P("BLUNT", hdr_s), P("PENETRATING", hdr_s), P("EXPOSURE", hdr_s)],
    # zone 1
    [P("ZONE 1\n(Central)", cbold_s),
     P("Midline: aortic hiatus → iliac bifurcation", body_s),
     P("Aorta, IVC, Celiac, SMA, SMV,\nproximal renal vessels", body_s),
     P("✅ ALWAYS\nExplore", cred_s),
     P("✅ ALWAYS\nExplore", cred_s),
     P("Mattox (L)\nor Cattell-\nBraasch (R)", center_s)],
    # zone 2
    [P("ZONE 2\n(Lateral)", cbold_s),
     P("Bilateral lateral gutters", body_s),
     P("Kidneys, adrenals, renal A&V,\nproximal ureters", body_s),
     P("Only if expanding /\npulsatile / urine leak", corange_s),
     P("✅ ALWAYS\nExplore", cred_s),
     P("Medial renal\nvascular\ncontrol first", center_s)],
    # zone 3
    [P("ZONE 3\n(Pelvic)", cbold_s),
     P("Below iliac bifurcation → pelvis", body_s),
     P("Iliac arteries & veins,\npelvic venous plexus", body_s),
     P("❌ Do NOT\nOpen!", cgreen_s),
     P("✅ ALWAYS\nExplore", cred_s),
     P("Packing +\next. fixator;\nAngioembo.", center_s)],
]

cws = [18*mm, 32*mm, 42*mm, 26*mm, 26*mm, 28*mm]
zone_t = Table(zone_data, colWidths=cws, repeatRows=1)
zone_t.setStyle(TableStyle([
    ("BACKGROUND", (0,0),(-1,0), BLUE),
    ("BACKGROUND", (0,1),(-1,1), LTBLUE),
    ("BACKGROUND", (0,2),(-1,2), LTORANGE),
    ("BACKGROUND", (0,3),(-1,3), LTGREEN),
    ("BOX",       (0,0),(-1,-1), 0.8, BLUE),
    ("INNERGRID", (0,0),(-1,-1), 0.3, MIDGRAY),
    ("VALIGN",    (0,0),(-1,-1), "MIDDLE"),
    ("ALIGN",     (0,0),(-1,0),  "CENTER"),
    ("TOPPADDING",   (0,0),(-1,-1), 2),
    ("BOTTOMPADDING",(0,0),(-1,-1), 2),
    ("LEFTPADDING",  (0,0),(-1,-1), 3),
    ("RIGHTPADDING", (0,0),(-1,-1), 3),
]))
story.append(zone_t)
story.append(Spacer(1, 2*mm))

# ════════════════════════════════════════════════════════════════════════════
# ROW 3: Surgical Maneuvers + Damage Control  (side by side)
# ════════════════════════════════════════════════════════════════════════════
cw3a = 88*mm
cw3b = 84*mm

# LEFT: Maneuvers
man_rows = [
    [P("SURGICAL EXPOSURE MANEUVERS", hdr_s)],
    [P("<b>MATTOX (Left medial rotation)</b>", body_s)],
    [P("Mobilize: L colon + spleen + pancreas tail + stomach + L kidney → medially\n→ Exposes: Supramesocolic aorta, celiac, SMA, L renal hilum", tiny_s)],
    [P("<b>CATTELL-BRAASCH (Right medial rotation)</b>", body_s)],
    [P("Mobilize: R colon + cecum → superiorly &amp; to LEFT\n→ Exposes: Infrarenal IVC, R renal hilum, iliac vessels", tiny_s)],
    [P("<b>KOCHER Maneuver</b>", body_s)],
    [P("Duodenum D2 mobilized medially\n→ Exposes: Pancreatic head, IVC, right renal structures", tiny_s)],
    [P("⚠️  GOLDEN RULE: Proximal + Distal control FIRST, then explore!", red_s)],
]
man_t = Table(man_rows, colWidths=[cw3a])
man_t.setStyle(TableStyle([
    ("BACKGROUND", (0,0),(0,0), GREEN),
    ("BACKGROUND", (0,1),(-1,-1), LTGREEN),
    ("TOPPADDING",   (0,0),(-1,-1), 2),
    ("BOTTOMPADDING",(0,0),(-1,-1), 2),
    ("LEFTPADDING",  (0,0),(-1,-1), 4),
    ("RIGHTPADDING", (0,0),(-1,-1), 4),
    ("BOX",       (0,0),(-1,-1), 0.5, GREEN),
    ("INNERGRID", (0,0),(-1,-1), 0.3, MIDGRAY),
]))

# RIGHT: Damage Control
dc_rows = [
    [P("DAMAGE CONTROL SURGERY  💉", hdr_s)],
    [P("<b>Indications (Lethal Triad):</b>", bold_s)],
    [P("🌡️  Hypothermia  &lt; 32-34°C", body_s)],
    [P("🧪  Acidosis  pH &lt; 7.2", body_s)],
    [P("🩸  Coagulopathy  (INR elevated, ongoing bleed)", body_s)],
    [P("<b>3 Stages:</b>", bold_s)],
    [P("Stage 1: OR — control bleed + contamination (60-90 min max)", body_s)],
    [P("Stage 2: ICU — warm, correct coags, resuscitate", body_s)],
    [P("Stage 3: Planned reoperation at 24-48 hrs", body_s)],
]
dc_t = Table(dc_rows, colWidths=[cw3b])
dc_t.setStyle(TableStyle([
    ("BACKGROUND", (0,0),(0,0), RED),
    ("BACKGROUND", (0,1),(-1,-1), LTRED),
    ("TOPPADDING",   (0,0),(-1,-1), 2),
    ("BOTTOMPADDING",(0,0),(-1,-1), 2),
    ("LEFTPADDING",  (0,0),(-1,-1), 4),
    ("RIGHTPADDING", (0,0),(-1,-1), 4),
    ("BOX",       (0,0),(-1,-1), 0.5, RED),
    ("INNERGRID", (0,0),(-1,-1), 0.3, MIDGRAY),
]))

row3 = Table([[man_t, dc_t]], colWidths=[cw3a+2*mm, cw3b+2*mm])
row3.setStyle(TableStyle([("VALIGN",(0,0),(-1,-1),"TOP"),
                           ("LEFTPADDING",(0,0),(-1,-1),0),
                           ("RIGHTPADDING",(0,0),(-1,-1),2*mm)]))
story.append(row3)
story.append(Spacer(1, 2*mm))

# ════════════════════════════════════════════════════════════════════════════
# ROW 4: WHY Questions Table (full width)
# ════════════════════════════════════════════════════════════════════════════
story.append(sec_hdr('⚡  "WHY" QUICK ANSWERS  —  Most Likely Oral Questions', ORANGE, col_widths=[175*mm]))

why_data = [
    [P("WHY Question", hdr_s), P("Answer", hdr_s)],
    [P("WHY Zone 1 blunt — ALWAYS explore?", bold_s),
     P("Aorta/IVC/SMA present — life-threatening vascular injury risk — tamponade rupture = death", body_s)],
    [P("WHY Zone 2 blunt — observe?", bold_s),
     P("Perinephric hematoma = natural tamponade — opening loses it → massive bleed, high nephrectomy rate", body_s)],
    [P("WHY Zone 3 blunt — NEVER open?", bold_s),
     P("Pelvic fracture venous bleeding — natural tamponade critical — opening → uncontrolled exsanguination", body_s)],
    [P("WHY FAST misses retroperitoneal blood?", bold_s),
     P("FAST detects only INTRAPERITONEAL free fluid — retroperitoneum is a separate space entirely", body_s)],
    [P("WHY duodenal injury diagnosis is delayed?", bold_s),
     P("D2/D3/D4 are retroperitoneal — perforation leaks retro, NOT into peritoneum → peritoneal signs absent/late", body_s)],
    [P("WHY proximal control BEFORE exploring hematoma?", bold_s),
     P("Hematoma provides tamponade on injured vessel — opening without control → massive uncontrolled hemorrhage", body_s)],
    [P("WHY damage control instead of full repair?", bold_s),
     P("Lethal triad (hypothermia + acidosis + coagulopathy) — prolonged surgery worsens all three → death", body_s)],
    [P("WHY pancreas ductal injury (≥Grade III) needs surgery?", bold_s),
     P("Pancreatic enzymes are caustic — duct leak → peripancreatic digestion, fistula, abscess, pseudocyst", body_s)],
    [P("WHY Mattox = LEFT rotation?", bold_s),
     P("Supramesocolic aorta + celiac + SMA are left-sided — left rotation gives optimal exposure", body_s)],
    [P("WHY not repair renal artery if ischemia > 1 hour?", bold_s),
     P("Warm ischemia >1 hr → irreversible renal damage — repair futile, nephrectomy is better option", body_s)],
]

why_t = Table(why_data, colWidths=[68*mm, 105*mm])
why_style = [
    ("BACKGROUND", (0,0),(-1,0), ORANGE),
    ("BOX",       (0,0),(-1,-1), 0.8, ORANGE),
    ("INNERGRID", (0,0),(-1,-1), 0.3, MIDGRAY),
    ("VALIGN",    (0,0),(-1,-1), "MIDDLE"),
    ("TOPPADDING",   (0,0),(-1,-1), 2),
    ("BOTTOMPADDING",(0,0),(-1,-1), 2),
    ("LEFTPADDING",  (0,0),(-1,-1), 4),
    ("RIGHTPADDING", (0,0),(-1,-1), 4),
]
# Alternate row colors
for i in range(1, len(why_data)):
    bg = LTYELLOW if i % 2 == 1 else WHITE
    why_style.append(("BACKGROUND", (0,i),(-1,i), bg))

why_t.setStyle(TableStyle(why_style))
story.append(why_t)
story.append(Spacer(1, 2*mm))

# ════════════════════════════════════════════════════════════════════════════
# ROW 5: Organ-specific mini tables (Kidney + Duodenum + Pancreas)
# ════════════════════════════════════════════════════════════════════════════
cw5 = 57*mm

# KIDNEY
kidney_rows = [
    [P("KIDNEY TRAUMA (AAST Grade)", hdr_s)],
    [P("Gr 1-2: Contusion/minor lac → Conservative", body_s)],
    [P("Gr 3: Major lac, no collecting sys → Conservative", body_s)],
    [P("Gr 4: Lac + collecting sys / segmental vessel → Observe; stent if urine leak persists", body_s)],
    [P("Gr 5: Shattered / pedicle avulsion → Surgery + nephrectomy", red_s)],
    [P("Operate if: hemorrhage / pedicle avulsion / pulsatile hematoma / penetrating + unstable", tiny_s)],
]
kid_t = Table(kidney_rows, colWidths=[cw5])
kid_t.setStyle(TableStyle([
    ("BACKGROUND", (0,0),(0,0), BLUE),
    ("BACKGROUND", (0,1),(-1,-1), LTBLUE),
    ("TOPPADDING",   (0,0),(-1,-1), 2),
    ("BOTTOMPADDING",(0,0),(-1,-1), 2),
    ("LEFTPADDING",  (0,0),(-1,-1), 3),
    ("RIGHTPADDING", (0,0),(-1,-1), 3),
    ("BOX", (0,0),(-1,-1), 0.5, BLUE),
    ("INNERGRID", (0,0),(-1,-1), 0.3, MIDGRAY),
]))

# DUODENUM
duod_rows = [
    [P("DUODENUM TRAUMA", hdr_s)],
    [P("Hematoma (no perf): NGT + TPN, re-image at 5-7 days\nIf persist >14 days → operate to evacuate", body_s)],
    [P("Perforation: Emergency surgery\n→ Wide Kocher + primary repair (1 or 2 layer)", body_s)],
    [P("Large loss / near ampulla: Billroth II or Roux-en-Y", body_s)],
    [P("CT signs: Retroperitoneal FREE AIR (pathognomonic!)\n+ wall thickening + periduodenal fluid", red_s)],
    [P("Key: Peritoneal signs ABSENT (retro location) → always suspect!", tinybold_s)],
]
duo_t = Table(duod_rows, colWidths=[cw5])
duo_t.setStyle(TableStyle([
    ("BACKGROUND", (0,0),(0,0), ORANGE),
    ("BACKGROUND", (0,1),(-1,-1), LTORANGE),
    ("TOPPADDING",   (0,0),(-1,-1), 2),
    ("BOTTOMPADDING",(0,0),(-1,-1), 2),
    ("LEFTPADDING",  (0,0),(-1,-1), 3),
    ("RIGHTPADDING", (0,0),(-1,-1), 3),
    ("BOX", (0,0),(-1,-1), 0.5, ORANGE),
    ("INNERGRID", (0,0),(-1,-1), 0.3, MIDGRAY),
]))

# PANCREAS
panc_rows = [
    [P("PANCREAS TRAUMA (AAST Grade)", hdr_s)],
    [P("Gr I-II: No duct injury → Conservative + drain", body_s)],
    [P("Gr III: Duct injury, DISTAL → Distal pancreatectomy ± splenectomy", body_s)],
    [P("Gr IV: Duct injury, PROXIMAL (head) → Drainage; Whipple select cases", body_s)],
    [P("Gr V: Massive head disruption → Damage control + complex recon", red_s)],
    [P("Key: Serum amylase useful only if >3 hrs post-injury; CT sensitivity only 52-54%!", tinybold_s)],
]
pan_t = Table(panc_rows, colWidths=[cw5])
pan_t.setStyle(TableStyle([
    ("BACKGROUND", (0,0),(0,0), GREEN),
    ("BACKGROUND", (0,1),(-1,-1), LTGREEN),
    ("TOPPADDING",   (0,0),(-1,-1), 2),
    ("BOTTOMPADDING",(0,0),(-1,-1), 2),
    ("LEFTPADDING",  (0,0),(-1,-1), 3),
    ("RIGHTPADDING", (0,0),(-1,-1), 3),
    ("BOX", (0,0),(-1,-1), 0.5, GREEN),
    ("INNERGRID", (0,0),(-1,-1), 0.3, MIDGRAY),
]))

row5 = Table([[kid_t, duo_t, pan_t]], colWidths=[cw5+2*mm, cw5+2*mm, cw5+2*mm])
row5.setStyle(TableStyle([("VALIGN",(0,0),(-1,-1),"TOP"),
                           ("LEFTPADDING",(0,0),(-1,-1),0),
                           ("RIGHTPADDING",(0,0),(-1,-1),2*mm)]))
story.append(row5)
story.append(Spacer(1, 2*mm))

# ════════════════════════════════════════════════════════════════════════════
# FOOTER
# ════════════════════════════════════════════════════════════════════════════
footer_data = [[
    P("Hemodynamically <b>UNSTABLE</b> → Emergency Laparotomy  |  "
      "Hemodynamically <b>STABLE</b> → CT Abdomen (IV contrast)  |  "
      "FAST = Intraperitoneal only (misses retro!)  |  "
      "All Penetrating → Explore all zones  |  "
      "Blunt Zone 3 → NEVER open", center_s)
]]
footer_t = Table(footer_data, colWidths=[175*mm])
footer_t.setStyle(TableStyle([
    ("BACKGROUND", (0,0),(-1,-1), DARK),
    ("TOPPADDING",   (0,0),(-1,-1), 3),
    ("BOTTOMPADDING",(0,0),(-1,-1), 3),
    ("LEFTPADDING",  (0,0),(-1,-1), 5),
    ("RIGHTPADDING", (0,0),(-1,-1), 5),
]))
# override text color white for footer
footer_t2 = Table([[P(
    "<font color='white'>Hemodynamically <b>UNSTABLE</b> → Emergency Laparotomy  |  "
    "Hemodynamically <b>STABLE</b> → CT Abdomen (IV contrast)  |  "
    "FAST = Intraperitoneal only (misses retro!)  |  "
    "All Penetrating → Explore all zones  |  "
    "Blunt Zone 3 → NEVER open</font>", center_s)]], colWidths=[175*mm])
footer_t2.setStyle(TableStyle([
    ("BACKGROUND", (0,0),(-1,-1), DARK),
    ("TOPPADDING",   (0,0),(-1,-1), 3),
    ("BOTTOMPADDING",(0,0),(-1,-1), 3),
]))
story.append(footer_t2)

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

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

OUTPUT = "/home/daytona/workspace/retroperitoneal-cheatsheet/Retroperitoneal_Mock_Exam.pdf"

# ── colours ──────────────────────────────────────────────────────────────────
RED      = colors.HexColor("#C0392B")
ORANGE   = colors.HexColor("#E67E22")
BLUE     = colors.HexColor("#1A5276")
GREEN    = colors.HexColor("#1E8449")
PURPLE   = colors.HexColor("#6C3483")
TEAL     = colors.HexColor("#117A65")
LTBLUE   = colors.HexColor("#D6EAF8")
LTORANGE = colors.HexColor("#FDEBD0")
LTGREEN  = colors.HexColor("#D5F5E3")
LTRED    = colors.HexColor("#FADBD8")
LTPURPLE = colors.HexColor("#E8DAEF")
LTYELLOW = colors.HexColor("#FEF9E7")
LTTEAL   = colors.HexColor("#D1F2EB")
WHITE    = colors.white
DARK     = colors.HexColor("#1C2833")
MIDGRAY  = colors.HexColor("#BDC3C7")
LIGHTGRAY= colors.HexColor("#F2F3F4")

# ── styles ───────────────────────────────────────────────────────────────────
base = getSampleStyleSheet()
def S(name, **kw):
    return ParagraphStyle(name, parent=base["Normal"], **kw)

title_s   = S("ts",  fontSize=15, textColor=WHITE, alignment=TA_CENTER,
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sub_s     = S("ss",  fontSize=9,  textColor=WHITE, alignment=TA_CENTER,
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hdr_s     = S("hs",  fontSize=8,  textColor=WHITE, alignment=TA_CENTER,
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case_s    = S("cs",  fontSize=11, textColor=WHITE, alignment=TA_LEFT,
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scenario_s= S("sc",  fontSize=9.5,textColor=DARK, alignment=TA_JUSTIFY,
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q_s       = S("qs",  fontSize=10, textColor=BLUE, alignment=TA_LEFT,
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ans_hdr_s = S("ah",  fontSize=8.5,textColor=WHITE, alignment=TA_LEFT,
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ans_s     = S("as",  fontSize=8.5,textColor=DARK, alignment=TA_LEFT,
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ans_bold_s= S("ab",  fontSize=8.5,textColor=DARK, alignment=TA_LEFT,
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why_s     = S("ws",  fontSize=8.5,textColor=GREEN, alignment=TA_LEFT,
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red_s     = S("rs",  fontSize=8.5,textColor=RED, alignment=TA_LEFT,
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tip_s     = S("tip", fontSize=7.5,textColor=TEAL, alignment=TA_LEFT,
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bold_center_s = S("bc", fontSize=8, textColor=DARK, alignment=TA_CENTER,
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def P(txt, st=ans_s): return Paragraph(txt, st)
def HR(): return HRFlowable(width="100%", thickness=0.5, color=MIDGRAY, spaceAfter=3, spaceBefore=3)

# ════════════════════════════════════════════════════════════════════════════
# DATA: 3 EXAM SETS
# ════════════════════════════════════════════════════════════════════════════
# Each set: 2 cases × 4 questions
# Format: {set_title, set_color, cases: [{case_title, scenario, bg, questions: [{q, marks, time_s, answer, why_key}]}]}

EXAMS = [

# ━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━
# SET A
# ━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━
{
"title": "MOCK EXAM  —  SET A",
"color": BLUE,
"cases": [
  {
    "title": "CASE A-1  |  Blunt Abdominal Trauma",
    "bg": BLUE,
    "scenario": (
        "A 32-year-old male is brought to the ER after a high-speed motor vehicle collision. "
        "He was the unrestrained driver. On arrival: BP 70/40 mmHg, HR 148 bpm, RR 24/min, GCS 14. "
        "Abdomen is distended and tender diffusely. FAST exam shows free fluid in Morrison's pouch. "
        "Chest X-ray is clear. Pelvis X-ray shows no fracture."
    ),
    "questions": [
      {
        "q": "Q1. What is your immediate management priority for this patient?",
        "marks": 2.5,
        "time_s": 50,
        "answer": (
            "Immediate priority: ATLS primary survey — secure airway (intubate if needed), "
            "ensure adequate breathing, establish 2 large-bore IV access, aggressive fluid "
            "resuscitation with type-specific blood + crystalloids (1:1:1 — pRBC:FFP:platelets). "
            "Patient is hemodynamically UNSTABLE (BP 70/40, HR 148) with FAST-positive free fluid "
            "→ activate massive transfusion protocol → proceed to EMERGENCY LAPAROTOMY immediately. "
            "No time for CT scan in unstable patient."
        ),
        "why_key": "Unstable + FAST positive = straight to OR. CT wastes time → patient can die on table."
      },
      {
        "q": "Q2. At laparotomy, you find a large central (Zone 1) retroperitoneal hematoma that is not pulsatile but is expanding. What do you do and WHY?",
        "marks": 2.5,
        "time_s": 55,
        "answer": (
            "Zone 1 hematoma — ALWAYS explore, regardless of blunt or penetrating mechanism, "
            "regardless of whether it is pulsatile or not. "
            "Step 1: Achieve PROXIMAL control first — clamp the aorta at the diaphragmatic hiatus if needed. "
            "Step 2: Use LEFT MEDIAL VISCERAL ROTATION (Mattox maneuver) — mobilize left colon, spleen, "
            "stomach, pancreatic tail, left kidney medially → expose supramesocolic aorta, celiac, SMA. "
            "Step 3: Explore hematoma, identify bleeding vessel, repair or ligate."
        ),
        "why_key": "Zone 1 = Aorta/IVC/major vessels. Even non-pulsatile hematoma hides lethal vascular injury. Tamponade can rupture any moment → MUST explore."
      },
      {
        "q": "Q3. During exploration, the patient develops temperature 31°C, pH 7.15, and coagulopathy (INR 2.1). What strategy do you adopt?",
        "marks": 2.5,
        "time_s": 50,
        "answer": (
            "This is the LETHAL TRIAD — hypothermia (31°C) + acidosis (pH 7.15) + coagulopathy (INR 2.1). "
            "Switch to DAMAGE CONTROL SURGERY:\n"
            "Stage 1 (OR, 60-90 min MAX): Control hemorrhage with packing/clamps, control "
            "GI contamination with stapling — NO definitive repair.\n"
            "Stage 2 (ICU): Rewarm patient, correct coagulopathy (FFP/platelets/cryo), "
            "correct acidosis, resuscitate.\n"
            "Stage 3 (Planned reoperation 24-48 hrs): Definitive repair once physiologically stable."
        ),
        "why_key": "Continuing surgery in lethal triad worsens all 3 parameters → irreversible coagulopathy → death. Abbreviate to save life first."
      },
      {
        "q": "Q4. Post-op Day 3, patient develops abdominal distension, rising bladder pressure (28 mmHg), oliguria, and worsening oxygenation. What is the diagnosis and management?",
        "marks": 2.5,
        "time_s": 50,
        "answer": (
            "Diagnosis: ABDOMINAL COMPARTMENT SYNDROME (ACS) — defined as intra-abdominal "
            "pressure >20 mmHg with new organ dysfunction.\n"
            "Features here: Bladder pressure 28 mmHg + oliguria (renal) + poor oxygenation (pulmonary) "
            "+ distension (bowel).\n"
            "Management: EMERGENCY DECOMPRESSIVE LAPAROTOMY — open abdomen, do NOT close.\n"
            "Leave open with temporary abdominal closure (vacuum-assisted closure / Bogota bag).\n"
            "Definitive fascial closure after organ function normalizes (usually 3-5 days)."
        ),
        "why_key": "Raised intra-abdominal pressure compresses IVC (reduced preload), diaphragm (ventilation failure), renal vessels (oliguria). Decompression is the only treatment."
      },
    ]
  },
  {
    "title": "CASE A-2  |  Penetrating Abdominal Trauma — Stab Wound",
    "bg": TEAL,
    "scenario": (
        "A 22-year-old male presents with a stab wound to the right flank. "
        "BP 110/70, HR 104, RR 18. Abdomen mildly tender in right flank. "
        "No peritoneal signs. FAST exam shows no free fluid. "
        "CT abdomen with IV contrast shows a track entering the retroperitoneum, "
        "Grade 3 right renal laceration with a contained retroperitoneal hematoma "
        "and no active contrast extravasation. No pneumoperitoneum."
    ),
    "questions": [
      {
        "q": "Q1. FAST is negative and the patient is stable. Does a negative FAST rule out retroperitoneal injury? Explain.",
        "marks": 2.5,
        "time_s": 45,
        "answer": (
            "NO — negative FAST does NOT rule out retroperitoneal injury.\n"
            "FAST detects only INTRAPERITONEAL free fluid (Morrison's pouch, splenorenal recess, "
            "pelvis, pericardium). The retroperitoneum is a SEPARATE space — blood collecting "
            "there does NOT appear on FAST.\n"
            "In this case: retroperitoneal hematoma from renal laceration → FAST negative → "
            "but significant injury present.\n"
            "CT with IV contrast is the gold standard for retroperitoneal injury assessment "
            "in hemodynamically stable patients."
        ),
        "why_key": "FAST = intraperitoneal only. Retro is a separate compartment. Never use FAST alone to exclude retroperitoneal trauma."
      },
      {
        "q": "Q2. CT shows a right Zone 2 retroperitoneal hematoma from a Grade 3 renal laceration — no active bleeding. Penetrating mechanism. What is your management?",
        "marks": 2.5,
        "time_s": 55,
        "answer": (
            "Penetrating Zone 2 hematoma → ALWAYS explore (unlike blunt Zone 2 which can be observed).\n"
            "At laparotomy:\n"
            "Step 1: MEDIAL RENAL VASCULAR CONTROL first — isolate renal artery and vein medially "
            "BEFORE opening the perinephric hematoma. This prevents uncontrolled hemorrhage.\n"
            "Step 2: Open hematoma carefully, assess injury.\n"
            "Grade 3: Major laceration, no collecting system → attempt renorrhaphy (repair) to "
            "preserve the kidney. Use manual compression + hemostatic agents + suture.\n"
            "If expanding/pulsatile or uncontrolled: nephrectomy.\n"
            "Confirm contralateral kidney function before nephrectomy (one-shot IVP intraop)."
        ),
        "why_key": "All penetrating Zone 2 hematomas = explore. Medial vascular control first = prevents catastrophic bleed when hematoma is opened."
      },
      {
        "q": "Q3. Why do you achieve medial renal vascular control BEFORE opening the perinephric hematoma?",
        "marks": 2.5,
        "time_s": 40,
        "answer": (
            "The perinephric hematoma acts as a natural TAMPONADE on the injured renal parenchyma "
            "and vessels. If you open the hematoma without prior vascular control:\n"
            "→ Tamponade effect is lost instantly\n"
            "→ Massive, uncontrolled hemorrhage from renal hilum/parenchyma\n"
            "→ Surgeon forced into emergency nephrectomy\n"
            "By isolating the renal artery (and vein) medially FIRST:\n"
            "→ Can occlude vessels if uncontrolled bleeding occurs\n"
            "→ Allows safe renorrhaphy\n"
            "→ Significantly reduces nephrectomy rate"
        ),
        "why_key": "Control before opening = save the kidney. No control before opening = lose the kidney."
      },
      {
        "q": "Q4. Post-op Day 2: patient develops flank pain, fever 38.8°C, and urine output drops. CT shows urinoma (urine collection). What is the next step?",
        "marks": 2.5,
        "time_s": 45,
        "answer": (
            "Urinoma = urine extravasation from collecting system injury not recognized/repaired.\n"
            "Management — stepwise:\n"
            "1. Percutaneous drainage of urinoma (IR-guided) to decompress collection.\n"
            "2. Retrograde ureteral stenting (cystoscopy) to divert urine and allow collecting "
            "system to heal — PREFERRED first-line.\n"
            "3. If stenting fails or injury is large: nephrostomy tube placement (percutaneous).\n"
            "4. Operative repair only if above measures fail or injury is major.\n"
            "Monitor with follow-up CT urogram at 48-72 hrs."
        ),
        "why_key": "Urinoma = missed collecting system injury. Minimally invasive first — drain + stent. Avoid reoperation if possible."
      },
    ]
  },
]
},

# ━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━
# SET B
# ━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━
{
"title": "MOCK EXAM  —  SET B",
"color": GREEN,
"cases": [
  {
    "title": "CASE B-1  |  Blunt Trauma — Pelvic Fracture",
    "bg": GREEN,
    "scenario": (
        "A 45-year-old female is brought in after being struck by a bus. "
        "BP 85/50 mmHg, HR 138 bpm. Pelvis is unstable on compression. "
        "Pelvic X-ray: open-book pelvic fracture (symphysis pubis diastasis). "
        "FAST exam: no free intraperitoneal fluid. "
        "Despite 2L crystalloid resuscitation, BP remains 80/50."
    ),
    "questions": [
      {
        "q": "Q1. FAST is negative but the patient is hemodynamically unstable. Where is the bleeding coming from and why can FAST not detect it?",
        "marks": 2.5,
        "time_s": 50,
        "answer": (
            "Source of bleeding: Zone 3 retroperitoneum — pelvic fracture disrupts the pelvic "
            "venous plexus (and sometimes iliac arteries), causing massive RETROPERITONEAL hemorrhage.\n"
            "Why FAST is negative:\n"
            "Blood is collecting in the RETROPERITONEUM (Zone 3 pelvic space), NOT the peritoneal cavity. "
            "FAST only detects intraperitoneal fluid. Retroperitoneum is a separate compartment — blood "
            "there is invisible on FAST.\n"
            "Key teaching: Pelvic fracture + hemodynamic instability + negative FAST = Zone 3 "
            "retroperitoneal hemorrhage until proven otherwise."
        ),
        "why_key": "Open-book fracture tears pelvic venous plexus. Blood stays retroperitoneal. FAST = intraperitoneal only → missed entirely."
      },
      {
        "q": "Q2. How do you manage this Zone 3 retroperitoneal hematoma? Would you open it at laparotomy? WHY or WHY NOT?",
        "marks": 2.5,
        "time_s": 55,
        "answer": (
            "Zone 3, BLUNT mechanism → Do NOT open the hematoma at laparotomy.\n"
            "WHY NOT:\n"
            "• Pelvic fracture bleeding is predominantly VENOUS (pelvic venous plexus).\n"
            "• The retroperitoneal space acts as a natural tamponade — holds pressure on venous bleed.\n"
            "• Opening it releases the tamponade → uncontrolled exsanguination → death.\n\n"
            "Correct management:\n"
            "1. Apply pelvic binder / sheet immediately (temporary)\n"
            "2. External pelvic fixation (orthopaedics) — reduces pelvic volume, restores tamponade\n"
            "3. Preperitoneal pelvic packing (PPP) — pack anterior preperitoneal space\n"
            "4. If arterial bleeding suspected (no response to packing): Angiography + selective embolization\n"
            "5. REBOA (Resuscitative Endovascular Balloon Occlusion of Aorta) — in extremis"
        ),
        "why_key": "Venous bleeding + retroperitoneal tamponade = do NOT open. Opening = death. Restore tamponade by compressing pelvis mechanically."
      },
      {
        "q": "Q3. After pelvic packing and external fixation, BP stabilizes at 105/70. CT scan now shows no active arterial blush. What is the next step in management?",
        "marks": 2.5,
        "time_s": 45,
        "answer": (
            "Patient is now hemodynamically STABLE after packing + external fixation.\n"
            "No active arterial blush on CT → angioembolization not immediately needed.\n\n"
            "Next steps:\n"
            "1. Admit to ICU — continuous hemodynamic monitoring.\n"
            "2. Continue massive transfusion protocol (1:1:1 ratio) until coagulopathy corrected.\n"
            "3. Serial abdominal exams — watch for signs of re-bleeding.\n"
            "4. Packs removed at 24-48 hrs planned reoperation (damage control stage 3).\n"
            "5. Orthopaedics: plan definitive pelvic fixation once physiologically stable.\n"
            "6. If re-bleeding occurs → angiography + embolization."
        ),
        "why_key": "Stable after packing = ICU management. Remove packs at 24-48 hrs. Angioembo reserved for arterial blush or re-bleeding."
      },
      {
        "q": "Q4. During pelvic packing, you inadvertently enter the peritoneal cavity. What complications must you now watch for and why?",
        "marks": 2.5,
        "time_s": 45,
        "answer": (
            "By entering the peritoneum, you have disrupted the retroperitoneal barrier.\n\n"
            "Complications to watch for:\n"
            "1. LOSS OF TAMPONADE — peritoneum opened = retroperitoneal pressure equalizes "
            "with peritoneal cavity → pelvic hematoma decompresses → re-bleeding risk.\n"
            "2. FECAL CONTAMINATION — if bowel injury missed, now has free access to peritoneum.\n"
            "3. ABDOMINAL COMPARTMENT SYNDROME — blood + packs + bowel edema → raised IAP.\n"
            "4. INFECTION/SEPSIS — pelvic hematoma now communicates with peritoneal cavity.\n\n"
            "Management: Formal exploration, pack properly, close peritoneum if possible, "
            "monitor bladder pressure for ACS."
        ),
        "why_key": "Retroperitoneal tamponade works only if peritoneum is INTACT. Breach it = lose tamponade = re-bleed + contamination risk."
      },
    ]
  },
  {
    "title": "CASE B-2  |  Blunt Trauma — Seat Belt Injury",
    "bg": ORANGE,
    "scenario": (
        "A 28-year-old male, restrained driver, presents after head-on collision. "
        "Seat-belt sign across upper abdomen. BP 118/76, HR 92, RR 16. "
        "Mild epigastric tenderness. FAST negative. "
        "Serum amylase at 2 hrs post-injury: 140 U/L (normal). "
        "CT abdomen: hypodense line across the neck of pancreas with surrounding edema. No free fluid."
    ),
    "questions": [
      {
        "q": "Q1. What specific injury are you most concerned about and why is this mechanism (seat belt) classically associated with it?",
        "marks": 2.5,
        "time_s": 45,
        "answer": (
            "Most concerned about: PANCREATIC TRANSECTION at the neck — Grade III/IV pancreatic injury "
            "with probable main pancreatic duct disruption.\n\n"
            "Why seat belt mechanism:\n"
            "The pancreatic NECK overlies the vertebral column (L1-L2). In a seat belt injury, "
            "the anterior abdominal wall is forcibly compressed against the lap belt → "
            "pancreas is crushed between the seat belt/steering wheel AND the rigid vertebral column. "
            "The neck is the narrowest, most fixed part → maximum shear force here → transection.\n"
            "Classic: 'Handlebar injury' in children, 'Seat belt injury' in adults."
        ),
        "why_key": "Pancreatic neck = directly over vertebral column. Compression = crushing between two hard surfaces = transection. Retroperitoneal location = silent injury."
      },
      {
        "q": "Q2. Serum amylase at 2 hrs is NORMAL. Does this rule out pancreatic injury? What is the most useful investigation now?",
        "marks": 2.5,
        "time_s": 45,
        "answer": (
            "NO — normal early amylase does NOT rule out pancreatic injury.\n"
            "Amylase rises AFTER inflammation develops — serum amylase is only reliable if "
            "measured MORE THAN 3 HOURS after injury. Early levels (within 2-3 hrs) can be "
            "completely normal even with significant pancreatic injury.\n\n"
            "Sensitivity of amylase for pancreatic trauma: poor specificity.\n\n"
            "Best investigations now:\n"
            "1. CONTRAST-ENHANCED CT ABDOMEN (already done) — sensitivity 47-79% for parenchymal "
            "injury, 52-54% for ductal injury. CT shows pancreatic neck hypodensity here → high suspicion.\n"
            "2. MRCP (Magnetic Resonance Cholangiopancreatography) — best non-invasive test for "
            "DUCTAL integrity.\n"
            "3. ERCP — both diagnostic AND therapeutic (can stent duct)."
        ),
        "why_key": "Amylase < 3 hrs = unreliable. CT = first line but misses duct 50% of time. MRCP/ERCP = gold standard for ductal assessment."
      },
      {
        "q": "Q3. CT confirms Grade III pancreatic injury — transection at neck with likely main duct disruption. What is the operative management?",
        "marks": 2.5,
        "time_s": 55,
        "answer": (
            "Grade III = main pancreatic duct disruption, DISTAL to the superior mesenteric vein.\n\n"
            "Operative management:\n"
            "DISTAL PANCREATECTOMY ± splenectomy.\n\n"
            "Steps:\n"
            "1. Enter lesser sac via gastrocolic ligament division.\n"
            "2. Mobilize hepatic flexure.\n"
            "3. Kocher maneuver — mobilize pancreatic head.\n"
            "4. Assess injury — confirm duct involvement, location relative to SMV.\n"
            "5. Transect pancreas to LEFT of injury, oversew proximal stump.\n"
            "6. Distal pancreatectomy (remove body + tail).\n"
            "7. Splenectomy if splenic vessels involved (spleen-preserving possible in stable patients).\n"
            "8. Place closed-suction drain near pancreatic stump.\n\n"
            "WHY resect: Pancreatic enzymes are caustic — duct leak = peripancreatic digestion, "
            "fistula, pseudocyst, abscess."
        ),
        "why_key": "Grade III = duct disrupted, distal → distal pancreatectomy. Leaving duct leak = enzyme digestion of surrounding tissue = fistula/sepsis/death."
      },
      {
        "q": "Q4. Post-op Day 5: drain output increases to 200 mL/day, amylase in drain fluid: 3× serum amylase. What is this complication and how do you manage it?",
        "marks": 2.5,
        "time_s": 45,
        "answer": (
            "Diagnosis: PANCREATIC FISTULA (Post-operative pancreatic fistula — POPF).\n"
            "Defined as: drain amylase > 3× upper limit of normal serum amylase on/after post-op day 3.\n\n"
            "Grading (ISGPF):\n"
            "• Grade A (biochemical leak): No clinical impact → keep drain, observe\n"
            "• Grade B: Clinical impact, drain needed >3 wks or IR drainage → NPO + TPN + octreotide\n"
            "• Grade C: Organ failure / reoperation needed → aggressive management\n\n"
            "Management:\n"
            "1. Keep drain IN — do NOT remove (drain controls the fistula)\n"
            "2. NPO + Total Parenteral Nutrition (TPN)\n"
            "3. Octreotide (somatostatin analogue) — reduces pancreatic secretion\n"
            "4. ERCP + ductal stenting if partial duct disruption\n"
            "5. Most Grade A/B fistulas close spontaneously in 4-6 weeks"
        ),
        "why_key": "Drain amylase > 3× serum = POPF. Remove drain = uncontrolled fistula → abscess → sepsis. Keep drain in = controlled fistula → heals."
      },
    ]
  },
]
},

# ━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━
# SET C
# ━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━
{
"title": "MOCK EXAM  —  SET C",
"color": PURPLE,
"cases": [
  {
    "title": "CASE C-1  |  Gunshot Wound — Multiple Zones",
    "bg": PURPLE,
    "scenario": (
        "A 35-year-old male presents with a single gunshot wound to the abdomen (left of umbilicus). "
        "BP 90/60, HR 125. Abdomen rigid, peritoneal signs present. "
        "He is taken directly to the OR. At laparotomy: small bowel perforations (×2), "
        "and a large ZONE 1 pulsatile retroperitoneal hematoma is discovered."
    ),
    "questions": [
      {
        "q": "Q1. You find a Zone 1 pulsatile retroperitoneal hematoma during laparotomy. What is your approach and why is it ALWAYS mandatory to explore Zone 1?",
        "marks": 2.5,
        "time_s": 55,
        "answer": (
            "Zone 1, PENETRATING mechanism → MANDATORY exploration regardless of pulsatile or not.\n\n"
            "Approach:\n"
            "1. Achieve PROXIMAL AORTIC CONTROL first — compress aorta at diaphragmatic hiatus manually "
            "or clamp, before opening hematoma.\n"
            "2. LEFT MEDIAL VISCERAL ROTATION (Mattox maneuver) for supramesocolic Zone 1:\n"
            "   — Mobilize: L colon, spleen, stomach, pancreatic tail, L kidney → retract medially\n"
            "   — Exposes: entire abdominal aorta, celiac, SMA, L renal hilum.\n"
            "3. For infrarenal Zone 1 (right side): Cattell-Braasch maneuver.\n"
            "4. Identify injured vessel → repair primarily if possible, or damage control shunt.\n\n"
            "WHY always explore Zone 1:\n"
            "Zone 1 contains the aorta, IVC, celiac, SMA, SMV, proximal renal vessels — all "
            "potentially life-threatening if injured. Tamponade can fail at any moment. "
            "Missed vascular injury = death."
        ),
        "why_key": "Zone 1 = major vessels. Pulsatile or not = always explore. Proximal control first = controlled exploration."
      },
      {
        "q": "Q2. The Zone 1 hematoma is from an infrarenal aortic injury. You find a 1.5 cm lateral laceration. How do you repair it and what if primary repair causes >50% narrowing?",
        "marks": 2.5,
        "time_s": 50,
        "answer": (
            "Primary repair (lateral arteriorrhaphy):\n"
            "• Use 3-0 or 4-0 prolene suture, running or interrupted\n"
            "• Lateral repair of aortic laceration — close the hole without narrowing lumen\n\n"
            "If primary repair causes >30-50% narrowing of lumen:\n"
            "• PATCH ANGIOPLASTY — use a patch of autologous vein (saphenous) or prosthetic "
            "(Dacron/PTFE) to widen the repair.\n"
            "• In a contaminated field (bowel injury present here): prefer autologous vein patch "
            "or bovine pericardium — prosthetic graft has higher infection risk.\n\n"
            "If segment is destroyed: interposition graft (Dacron tube graft) — but HIGH infection "
            "risk with bowel contamination → damage control, extra-anatomic bypass later.\n\n"
            "Damage control option: temporary intraluminal shunt → definitive repair at Stage 3."
        ),
        "why_key": "Simple laceration = primary repair. Narrowing >30-50% = patch. Contaminated field = avoid prosthetic. Shunt = damage control."
      },
      {
        "q": "Q3. After aortic repair, you notice the right iliac artery has a Zone 3 penetrating injury with active bleeding. How does your management differ from a blunt Zone 3 hematoma?",
        "marks": 2.5,
        "time_s": 50,
        "answer": (
            "PENETRATING Zone 3 hematoma → ALWAYS explore and repair (unlike blunt Zone 3).\n\n"
            "Key difference from blunt Zone 3:\n"
            "• Blunt Zone 3 = venous fracture bleeding → do NOT open (loses tamponade)\n"
            "• Penetrating Zone 3 = arterial injury (iliac artery here) → MUST repair to prevent "
            "limb ischemia and ongoing hemorrhage\n\n"
            "Management of iliac artery injury:\n"
            "1. Proximal and distal control of iliac artery\n"
            "2. Primary repair if simple laceration (lateral arteriorrhaphy)\n"
            "3. Interposition graft if segment destroyed\n"
            "4. Damage control: temporary intraluminal shunt → definitive repair at Stage 3\n"
            "   (preferred if patient in lethal triad)\n"
            "5. Ligation is possible for external iliac in extremis (with planned bypass)\n"
            "NEVER ligate common iliac artery without bypass."
        ),
        "why_key": "Penetrating = arterial injury = must repair. Blunt = venous = do not open. Penetrating always = explore all zones."
      },
      {
        "q": "Q4. Post-op: Right lower limb is cold, pale, pulseless with paresthesia. What is this and what do you do next?",
        "marks": 2.5,
        "time_s": 45,
        "answer": (
            "Diagnosis: ACUTE LIMB ISCHEMIA — 6 P's: Pain, Pallor, Pulselessness, Paresthesia, "
            "Paralysis, Poikilothermia (cold).\n"
            "Here: Cold + pale + pulseless + paresthesia = critical ischemia → surgical emergency.\n\n"
            "Likely cause: Iliac artery repair thrombosis / stenosis / missed injury / "
            "temporary shunt occlusion.\n\n"
            "Immediate management:\n"
            "1. Anticoagulate immediately — IV heparin bolus (if no contraindication)\n"
            "2. Urgent duplex ultrasound / CT angiography to localize occlusion\n"
            "3. Return to OR IMMEDIATELY — explore iliac repair, Fogarty thrombectomy\n"
            "4. If repair stenosed: revise repair / patch\n"
            "5. Fasciotomy of compartments if ischemia >4-6 hrs (prevent compartment syndrome)\n"
            "Time is critical — >6 hours warm ischemia → irreversible muscle necrosis."
        ),
        "why_key": "6 P's = acute ischemia. Heparin + urgent return to OR + Fogarty. >6 hrs = irreversible damage. Fasciotomy if prolonged ischemia."
      },
    ]
  },
  {
    "title": "CASE C-2  |  Blunt Trauma — Duodenal Injury",
    "bg": TEAL,
    "scenario": (
        "A 40-year-old male, unrestrained driver, presents with epigastric pain after "
        "steering wheel impact. BP 122/80, HR 88, RR 14. Abdomen mildly tender epigastric region. "
        "No guarding or rigidity. FAST negative. "
        "CT abdomen: thickened duodenal wall (D2/D3), retroperitoneal air, periduodenal fluid. "
        "No free intraperitoneal air."
    ),
    "questions": [
      {
        "q": "Q1. CT shows retroperitoneal air near the duodenum but NO intraperitoneal free air. The patient has no peritoneal signs. Explain this clinical picture — why are peritoneal signs absent?",
        "marks": 2.5,
        "time_s": 45,
        "answer": (
            "This is the CLASSIC presentation of retroperitoneal duodenal perforation.\n\n"
            "Why peritoneal signs are absent:\n"
            "Duodenum D2, D3, D4 are RETROPERITONEAL — they lie behind the posterior parietal peritoneum. "
            "When a perforation occurs in these segments, duodenal contents (bile, fluid, air) leak "
            "into the RETROPERITONEAL space, NOT into the peritoneal cavity.\n\n"
            "Since the peritoneum is NOT contaminated:\n"
            "• No peritoneal irritation → no guarding, no rigidity\n"
            "• No intraperitoneal free air\n"
            "• FAST negative (no intraperitoneal fluid)\n\n"
            "Retroperitoneal air on CT (air tracking along retroperitoneal fat planes) = "
            "PATHOGNOMONIC of retroperitoneal perforation (duodenum most common).\n\n"
            "Teaching point: Absence of peritoneal signs does NOT exclude retroperitoneal visceral injury."
        ),
        "why_key": "D2/D3/D4 = retroperitoneal. Leak → retro space, not peritoneum. No peritoneal contact = no peritoneal signs. CT retro air = pathognomonic."
      },
      {
        "q": "Q2. CT confirms duodenal perforation (D2). Patient is hemodynamically stable. What is your operative management?",
        "marks": 2.5,
        "time_s": 55,
        "answer": (
            "Any evidence of perforation on imaging → EMERGENCY LAPAROTOMY.\n\n"
            "Operative steps:\n"
            "1. WIDE KOCHER MANEUVER — mobilize duodenum D2 (and D3) medially: incise lateral "
            "peritoneum along duodenum → reflect duodenum + pancreatic head medially → full exposure.\n"
            "2. Assess injury: size, location, proximity to ampulla of Vater, tissue viability.\n"
            "3. Debride devitalized tissue.\n"
            "4. Primary repair (most cases — up to 98% amenable):\n"
            "   • Single or double-layer closure with absorbable suture\n"
            "   • Transverse closure (to avoid narrowing) for longitudinal lacerations\n"
            "5. Reinforce with omentum patch over repair.\n"
            "6. Nasogastric/nasojejunal tube decompression.\n"
            "7. Drain placement — allows controlled fistula if leak occurs.\n\n"
            "If ampulla involved or large tissue loss:\n"
            "• Billroth II or Roux-en-Y reconstruction"
        ),
        "why_key": "Kocher = expose D2/D3. Primary repair in most cases. Omentum = reinforces suture line. Drain = controlled fistula protection."
      },
      {
        "q": "Q3. Intraoperatively, you find a large duodenal hematoma WITHOUT perforation. The patient is stable. How do you manage this?",
        "marks": 2.5,
        "time_s": 45,
        "answer": (
            "Duodenal intramural hematoma WITHOUT perforation → usually managed CONSERVATIVELY.\n\n"
            "Conservative management:\n"
            "1. Nasogastric tube (NGT) decompression — decompress stomach, rest duodenum\n"
            "2. NPO (nil per oral) — rest the bowel\n"
            "3. Total Parenteral Nutrition (TPN) — maintain nutrition\n"
            "4. Repeat contrast study (upper GI fluoroscopy or CT) at 5-7 days — check if "
            "obstruction resolving.\n\n"
            "If obstruction persists beyond 14 days:\n"
            "→ Operative exploration — evacuate hematoma, inspect duodenal wall for hidden "
            "perforation or stricture.\n\n"
            "Important: If hematoma found INCIDENTALLY at laparotomy → do NOT intentionally "
            "open it (risk of converting hematoma to perforation). Only open if full-thickness "
            "injury suspected.\n\n"
            "WHY conservative: Most hematomas reabsorb spontaneously. Surgery risks perforation."
        ),
        "why_key": "No perforation = conservative. NGT + TPN + repeat imaging. >14 days no resolution = operate. Never open hematoma unless suspecting full-thickness injury."
      },
      {
        "q": "Q4. Post-op Day 7 after duodenal repair: patient develops bile-stained drain output (500 mL/day). What is this complication and how do you manage it?",
        "marks": 2.5,
        "time_s": 45,
        "answer": (
            "Diagnosis: DUODENAL FISTULA (anastomotic leak / suture line failure).\n"
            "Bile-stained fluid >200 mL/day from drain = duodenal fistula.\n\n"
            "Management — stepwise:\n"
            "1. KEEP DRAIN IN — do NOT remove. This converts it to a CONTROLLED external fistula.\n"
            "2. NPO + Total Parenteral Nutrition (TPN) — complete bowel rest, maintain nutrition.\n"
            "3. Skin protection — duodenal juice is caustic (bile + enzymes) → protect skin with "
            "barrier cream, stomal appliance.\n"
            "4. Octreotide — reduces secretion, may help fistula close.\n"
            "5. CT scan — rule out undrained collection (if uncontrolled fistula = abscess risk).\n"
            "6. Most controlled fistulas close spontaneously in 4-8 weeks.\n\n"
            "If fistula does NOT close:\n"
            "• ERCP + biliary stenting (if bile duct involvement)\n"
            "• Reoperation (Roux-en-Y duodenojejunostomy) for persistent fistula."
        ),
        "why_key": "Controlled fistula = keep drain = heals. Uncontrolled = abscess = sepsis. NPO + TPN + protect skin. Remove drain = death spiral."
      },
    ]
  },
]
},

]  # end EXAMS

# ════════════════════════════════════════════════════════════════════════════
# BUILD PDF
# ════════════════════════════════════════════════════════════════════════════
doc = SimpleDocTemplate(
    OUTPUT, pagesize=A4,
    leftMargin=15*mm, rightMargin=15*mm,
    topMargin=12*mm, bottomMargin=12*mm
)

story = []
CW = 180*mm  # content width

# ── COVER PAGE ───────────────────────────────────────────────────────────────
cover = Table([[P("RETROPERITONEAL TRAUMA\nMOCK ORAL EXAMINATION", title_s)]], colWidths=[CW])
cover.setStyle(TableStyle([
    ("BACKGROUND",(0,0),(-1,-1), RED),
    ("TOPPADDING",(0,0),(-1,-1), 12),
    ("BOTTOMPADDING",(0,0),(-1,-1), 12),
    ("ROUNDEDCORNERS",[5]),
]))
story.append(cover)
story.append(Spacer(1, 4*mm))

info_data = [
    [P("<b>Format:</b>  2 Cases × 4 Questions per exam set", instr_s),
     P("<b>Time:</b>  7 minutes total", instr_s)],
    [P("<b>Marks:</b>  2.5 pts per question  →  20 pts total", instr_s),
     P("<b>Pass:</b>  12 / 20  (5 correct questions)", instr_s)],
    [P("<b>Sets included:</b>  SET A, SET B, SET C  (6 cases, 24 questions)", instr_s),
     P("<b>Tip:</b>  Talk with partner before answering!", instr_s)],
]
info_t = Table(info_data, colWidths=[90*mm, 90*mm])
info_t.setStyle(TableStyle([
    ("BACKGROUND",(0,0),(-1,-1), LTYELLOW),
    ("BOX",(0,0),(-1,-1), 1, ORANGE),
    ("INNERGRID",(0,0),(-1,-1), 0.3, MIDGRAY),
    ("TOPPADDING",(0,0),(-1,-1), 4),
    ("BOTTOMPADDING",(0,0),(-1,-1), 4),
    ("LEFTPADDING",(0,0),(-1,-1), 6),
    ("RIGHTPADDING",(0,0),(-1,-1), 6),
]))
story.append(info_t)
story.append(Spacer(1, 4*mm))

# time strategy box
strat_data = [[
    P("⏱  TIME STRATEGY", hdr_s),
    P("~50 sec / question", center_s),
    P("Partner: whisper answer (10 sec) → confirm → speak", center_s),
    P("Never skip — guess earns more than zero!", center_s),
]]
strat_t = Table(strat_data, colWidths=[32*mm, 32*mm, 72*mm, 44*mm])
strat_t.setStyle(TableStyle([
    ("BACKGROUND",(0,0),(0,0), ORANGE),
    ("BACKGROUND",(1,0),(-1,0), LTORANGE),
    ("BOX",(0,0),(-1,-1), 0.8, ORANGE),
    ("INNERGRID",(0,0),(-1,-1), 0.3, MIDGRAY),
    ("VALIGN",(0,0),(-1,-1),"MIDDLE"),
    ("TOPPADDING",(0,0),(-1,-1), 4),
    ("BOTTOMPADDING",(0,0),(-1,-1), 4),
    ("LEFTPADDING",(0,0),(-1,-1), 5),
]))
story.append(strat_t)
story.append(Spacer(1, 3*mm))

story.append(HR())
story.append(P("INSTRUCTIONS: Read each case carefully. Discuss with your partner. State your answer clearly. Remember — one answer, final. Time yourself with the timer shown for each question.", instr_s))
story.append(HR())

# ── EXAM SETS ────────────────────────────────────────────────────────────────
for ei, exam in enumerate(EXAMS):
    story.append(PageBreak())

    # SET TITLE BAR
    set_t = Table([[P(exam["title"], title_s)]], colWidths=[CW])
    set_t.setStyle(TableStyle([
        ("BACKGROUND",(0,0),(-1,-1), exam["color"]),
        ("TOPPADDING",(0,0),(-1,-1), 8),
        ("BOTTOMPADDING",(0,0),(-1,-1), 8),
    ]))
    story.append(set_t)
    story.append(Spacer(1, 3*mm))

    for ci, case in enumerate(exam["cases"]):
        # CASE HEADER
        case_t = Table([[P(case["title"], case_s)]], colWidths=[CW])
        case_t.setStyle(TableStyle([
            ("BACKGROUND",(0,0),(-1,-1), case["bg"]),
            ("TOPPADDING",(0,0),(-1,-1), 5),
            ("BOTTOMPADDING",(0,0),(-1,-1), 5),
            ("LEFTPADDING",(0,0),(-1,-1), 6),
        ]))
        story.append(case_t)
        story.append(Spacer(1, 1.5*mm))

        # SCENARIO BOX
        scen_t = Table([[P(case["scenario"], scenario_s)]], colWidths=[CW])
        scen_t.setStyle(TableStyle([
            ("BACKGROUND",(0,0),(-1,-1), LIGHTGRAY),
            ("BOX",(0,0),(-1,-1), 0.8, case["bg"]),
            ("TOPPADDING",(0,0),(-1,-1), 5),
            ("BOTTOMPADDING",(0,0),(-1,-1), 5),
            ("LEFTPADDING",(0,0),(-1,-1), 7),
            ("RIGHTPADDING",(0,0),(-1,-1), 7),
        ]))
        story.append(scen_t)
        story.append(Spacer(1, 2*mm))

        # QUESTIONS
        for qi, qdata in enumerate(case["questions"]):
            qnum = qi + 1
            marks_label = f"2.5 pts"
            timer_label = f"⏱ {qdata['time_s']} sec"

            # Question header row
            qhdr_data = [[
                P(f"Q{qnum}", qnum_s),
                P(qdata["q"], q_s),
                P(marks_label, pts_s),
                P(timer_label, timer_s),
            ]]
            qhdr_t = Table(qhdr_data, colWidths=[10*mm, 132*mm, 18*mm, 20*mm])
            qhdr_t.setStyle(TableStyle([
                ("BACKGROUND",(0,0),(0,0), case["bg"]),
                ("BACKGROUND",(1,0),(1,0), LTBLUE),
                ("BACKGROUND",(2,0),(2,0), GREEN),
                ("BACKGROUND",(3,0),(3,0), LTORANGE),
                ("BOX",(0,0),(-1,-1), 0.8, case["bg"]),
                ("INNERGRID",(0,0),(-1,-1), 0.3, MIDGRAY),
                ("VALIGN",(0,0),(-1,-1),"MIDDLE"),
                ("TOPPADDING",(0,0),(-1,-1), 4),
                ("BOTTOMPADDING",(0,0),(-1,-1), 4),
                ("LEFTPADDING",(0,0),(-1,-1), 4),
                ("RIGHTPADDING",(0,0),(-1,-1), 4),
                ("ALIGN",(2,0),(3,0),"CENTER"),
            ]))
            story.append(qhdr_t)

            # ANSWER BOX
            ans_lines = qdata["answer"].split("\n")
            ans_content = []
            for line in ans_lines:
                line = line.strip()
                if line:
                    if line.startswith("Step") or line.startswith("•") or line.startswith("1.") or line.startswith("2.") or line.startswith("3.") or line.startswith("4.") or line.startswith("5.") or line.startswith("Stage") or line.startswith("Grade"):
                        ans_content.append(P(f"  {line}", ans_s))
                    elif "WHY" in line and ":" in line:
                        ans_content.append(P(line, why_s))
                    elif line.endswith(":") or (len(line) < 60 and line.isupper()):
                        ans_content.append(P(line, ans_bold_s))
                    else:
                        ans_content.append(P(line, ans_s))

            why_note = P(f"KEY INSIGHT: {qdata['why_key']}", why_s)

            all_ans = ans_content + [Spacer(1,2), HR(), why_note]

            ans_t = Table([[all_ans]], colWidths=[CW])
            ans_t.setStyle(TableStyle([
                ("BACKGROUND",(0,0),(-1,-1), WHITE),
                ("BOX",(0,0),(-1,-1), 0.5, MIDGRAY),
                ("TOPPADDING",(0,0),(-1,-1), 4),
                ("BOTTOMPADDING",(0,0),(-1,-1), 4),
                ("LEFTPADDING",(0,0),(-1,-1), 7),
                ("RIGHTPADDING",(0,0),(-1,-1), 7),
                ("VALIGN",(0,0),(-1,-1),"TOP"),
            ]))
            story.append(ans_t)
            story.append(Spacer(1, 3*mm))

        if ci == 0:
            # divider between cases
            story.append(HR())
            story.append(Spacer(1, 2*mm))

    # Score table at end of each set
    score_t = Table([
        [P("CASE", hdr_s), P("Q1", hdr_s), P("Q2", hdr_s), P("Q3", hdr_s), P("Q4", hdr_s), P("SUBTOTAL", hdr_s)],
        [P(f"Case {exam['title'][-5:-3]}1", bold_center_s),
         P("__ / 2.5", center_s), P("__ / 2.5", center_s), P("__ / 2.5", center_s), P("__ / 2.5", center_s), P("__ / 10", bold_center_s)],
        [P(f"Case {exam['title'][-5:-3]}2", bold_center_s),
         P("__ / 2.5", center_s), P("__ / 2.5", center_s), P("__ / 2.5", center_s), P("__ / 2.5", center_s), P("__ / 10", bold_center_s)],
        [P("TOTAL", hdr_s), P("", center_s), P("", center_s), P("", center_s), P("", center_s), P("__ / 20", pts_s)],
    ], colWidths=[30*mm, 25*mm, 25*mm, 25*mm, 25*mm, 30*mm])
    score_t.setStyle(TableStyle([
        ("BACKGROUND",(0,0),(-1,0), exam["color"]),
        ("BACKGROUND",(0,3),(-1,3), exam["color"]),
        ("BACKGROUND",(0,1),(-1,2), LTYELLOW),
        ("BOX",(0,0),(-1,-1), 1, exam["color"]),
        ("INNERGRID",(0,0),(-1,-1), 0.4, MIDGRAY),
        ("TOPPADDING",(0,0),(-1,-1), 3),
        ("BOTTOMPADDING",(0,0),(-1,-1), 3),
        ("SPAN",(1,3),(4,3)),
        ("VALIGN",(0,0),(-1,-1),"MIDDLE"),
        ("ALIGN",(0,0),(-1,-1),"CENTER"),
    ]))
    story.append(Spacer(1, 4*mm))
    story.append(score_t)

doc.build(story)
print(f"Mock exam PDF created: {OUTPUT}")