NEET PG 2025 2026 question distribution subject wise analysis previous year papers

NEET PG 2026 expected topics high yield subjects trend analysis

https://www.prepladder.com/neet-pg-study-material/preparatio…

mkdir -p /home/daytona/workspace/neet-pg-notes && ls /home/daytona/workspace/nee…

~/neet-pg-notes/generate_notes.py

#!/usr/bin/env python3
"""NEET PG 2026 High-Yield Notes PDF Generator - Big Four Subjects"""

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, KeepTogether
)
from reportlab.lib.enums import TA_LEFT, TA_CENTER, TA_JUSTIFY
from reportlab.platypus import ListFlowable, ListItem

OUTPUT_PATH = "/home/daytona/workspace/neet-pg-notes/NEET_PG_2026_BigFour_Notes.pdf"

# ── Color palette ──────────────────────────────────────────────────────────────
C_NAVY      = colors.HexColor("#1A3A5C")
C_TEAL      = colors.HexColor("#00827F")
C_ORANGE    = colors.HexColor("#E87722")
C_RED       = colors.HexColor("#C0392B")
C_GREEN     = colors.HexColor("#1E8449")
C_YELLOW_BG = colors.HexColor("#FFF9E6")
C_BLUE_BG   = colors.HexColor("#EBF5FB")
C_GREEN_BG  = colors.HexColor("#EAFAF1")
C_RED_BG    = colors.HexColor("#FDEDEC")
C_GREY_BG   = colors.HexColor("#F2F3F4")
C_WHITE     = colors.white
C_LIGHT_GREY= colors.HexColor("#BDC3C7")

# ── Styles ─────────────────────────────────────────────────────────────────────
styles = getSampleStyleSheet()

def make_style(name, parent="Normal", **kwargs):
    s = ParagraphStyle(name, parent=styles[parent], **kwargs)
    return s

COVER_TITLE   = make_style("CoverTitle",   fontSize=32, textColor=C_WHITE,    alignment=TA_CENTER, leading=40, fontName="Helvetica-Bold")
COVER_SUB     = make_style("CoverSub",     fontSize=16, textColor=C_WHITE,    alignment=TA_CENTER, leading=24, fontName="Helvetica")
COVER_INFO    = make_style("CoverInfo",    fontSize=12, textColor=C_YELLOW_BG,alignment=TA_CENTER, leading=18, fontName="Helvetica")

H_SUBJECT     = make_style("HSubject",     fontSize=22, textColor=C_WHITE,    fontName="Helvetica-Bold", leading=28, spaceAfter=6)
H_TOPIC       = make_style("HTopic",       fontSize=14, textColor=C_NAVY,     fontName="Helvetica-Bold", leading=20, spaceBefore=14, spaceAfter=4)
H_SUBTOPIC    = make_style("HSubtopic",    fontSize=11, textColor=C_TEAL,     fontName="Helvetica-Bold", leading=16, spaceBefore=8, spaceAfter=3)

BODY          = make_style("Body",         fontSize=9.5, textColor=colors.HexColor("#2C3E50"), leading=14, spaceAfter=3, fontName="Helvetica")
BODY_BOLD     = make_style("BodyBold",     fontSize=9.5, textColor=colors.HexColor("#2C3E50"), leading=14, spaceAfter=3, fontName="Helvetica-Bold")
BULLET        = make_style("Bullet",       fontSize=9.5, textColor=colors.HexColor("#2C3E50"), leading=14, leftIndent=14, firstLineIndent=-10, spaceAfter=2, fontName="Helvetica")
BULLET2       = make_style("Bullet2",      fontSize=9,   textColor=colors.HexColor("#2C3E50"), leading=13, leftIndent=28, firstLineIndent=-10, spaceAfter=1, fontName="Helvetica")
MNEMONIC      = make_style("Mnemonic",     fontSize=10,  textColor=C_NAVY,    fontName="Helvetica-Bold", leading=15, leftIndent=10, spaceAfter=2)
HIGHLIGHT     = make_style("Highlight",    fontSize=9.5, textColor=C_RED,     fontName="Helvetica-Bold", leading=14, spaceAfter=2)
TABLE_HEADER  = make_style("TblHdr",       fontSize=9,   textColor=C_WHITE,   fontName="Helvetica-Bold", alignment=TA_CENTER, leading=12)
TABLE_CELL    = make_style("TblCell",      fontSize=8.5, textColor=colors.HexColor("#2C3E50"), fontName="Helvetica", leading=12)
TABLE_CELL_B  = make_style("TblCellB",     fontSize=8.5, textColor=colors.HexColor("#2C3E50"), fontName="Helvetica-Bold", leading=12)
EXAM_TIP      = make_style("ExamTip",      fontSize=9,   textColor=C_GREEN,   fontName="Helvetica-BoldOblique", leading=13, leftIndent=8)

def b(text): return f"<b>{text}</b>"
def c(text, color="#C0392B"): return f'<font color="{color}">{text}</font>'
def bullet(text, style=BULLET): return Paragraph(f"• {text}", style)
def bullet2(text): return Paragraph(f"  ◦ {text}", BULLET2)
def h_topic(text): return Paragraph(text, H_TOPIC)
def h_sub(text): return Paragraph(text, H_SUBTOPIC)
def body(text): return Paragraph(text, BODY)
def space(h=4): return Spacer(1, h)
def hr(): return HRFlowable(width="100%", thickness=0.5, color=C_LIGHT_GREY, spaceAfter=6, spaceBefore=6)
def exam_tip(text): return Paragraph(f"★ EXAM TIP: {text}", EXAM_TIP)

def highlight_box(text, bg=C_YELLOW_BG, border=C_ORANGE):
    data = [[Paragraph(text, make_style("hb", fontSize=9.5, textColor=C_NAVY, fontName="Helvetica-Bold", leading=14))]]
    t = Table(data, colWidths=[17*cm])
    t.setStyle(TableStyle([
        ('BACKGROUND', (0,0), (-1,-1), bg),
        ('BOX', (0,0), (-1,-1), 1.5, border),
        ('TOPPADDING', (0,0), (-1,-1), 6),
        ('BOTTOMPADDING', (0,0), (-1,-1), 6),
        ('LEFTPADDING', (0,0), (-1,-1), 10),
        ('RIGHTPADDING', (0,0), (-1,-1), 10),
    ]))
    return t

def mnemonic_box(title, text, bg=C_BLUE_BG):
    data = [[Paragraph(f"<b>Mnemonic - {title}:</b> {text}", make_style("mn", fontSize=9.5, textColor=C_NAVY, fontName="Helvetica-BoldOblique", leading=14))]]
    t = Table(data, colWidths=[17*cm])
    t.setStyle(TableStyle([
        ('BACKGROUND', (0,0), (-1,-1), bg),
        ('BOX', (0,0), (-1,-1), 1, C_TEAL),
        ('TOPPADDING', (0,0), (-1,-1), 5),
        ('BOTTOMPADDING', (0,0), (-1,-1), 5),
        ('LEFTPADDING', (0,0), (-1,-1), 10),
        ('RIGHTPADDING', (0,0), (-1,-1), 8),
    ]))
    return t

def make_table(headers, rows, col_widths=None, header_color=C_NAVY):
    if col_widths is None:
        col_widths = [17*cm / len(headers)] * len(headers)
    header_row = [Paragraph(h, TABLE_HEADER) for h in headers]
    data = [header_row]
    for row in rows:
        data.append([Paragraph(str(cell), TABLE_CELL) for cell in row])
    t = Table(data, colWidths=col_widths)
    style = TableStyle([
        ('BACKGROUND', (0,0), (-1,0), header_color),
        ('TEXTCOLOR', (0,0), (-1,0), C_WHITE),
        ('ROWBACKGROUNDS', (0,1), (-1,-1), [C_WHITE, C_GREY_BG]),
        ('GRID', (0,0), (-1,-1), 0.4, C_LIGHT_GREY),
        ('TOPPADDING', (0,0), (-1,-1), 4),
        ('BOTTOMPADDING', (0,0), (-1,-1), 4),
        ('LEFTPADDING', (0,0), (-1,-1), 5),
        ('RIGHTPADDING', (0,0), (-1,-1), 5),
        ('VALIGN', (0,0), (-1,-1), 'TOP'),
    ])
    t.setStyle(style)
    return t

def subject_header(title, subtitle, color=C_NAVY):
    data = [[Paragraph(title, H_SUBJECT), Paragraph(subtitle, COVER_INFO)]]
    t = Table(data, colWidths=[12*cm, 5*cm])
    t.setStyle(TableStyle([
        ('BACKGROUND', (0,0), (-1,-1), color),
        ('TOPPADDING', (0,0), (-1,-1), 12),
        ('BOTTOMPADDING', (0,0), (-1,-1), 12),
        ('LEFTPADDING', (0,0), (0,0), 14),
        ('RIGHTPADDING', (-1,-1), (-1,-1), 14),
        ('VALIGN', (0,0), (-1,-1), 'MIDDLE'),
    ]))
    return t

# ══════════════════════════════════════════════════════════════════════════════
# CONTENT BUILDERS
# ══════════════════════════════════════════════════════════════════════════════

def build_cover():
    elems = []
    # Big colored cover block
    cover_data = [[
        Paragraph("NEET PG 2026", COVER_TITLE),
    ]]
    cover_data2 = [[Paragraph("HIGH-YIELD NOTES", COVER_SUB)]]
    cover_data3 = [[Paragraph("The Big Four Subjects", make_style("cs3", fontSize=20, textColor=colors.HexColor("#FFD700"), fontName="Helvetica-Bold", alignment=TA_CENTER))]]
    cover_data4 = [[Paragraph("Medicine  •  Surgery  •  Pharmacology  •  Pathology", COVER_INFO)]]
    cover_data5 = [[Paragraph("Based on PYQ Analysis | 2023–2025 Trends | 2026 Predictions", COVER_INFO)]]

    for d in [cover_data, cover_data2, cover_data3, cover_data4, cover_data5]:
        t = Table(d, colWidths=[17*cm])
        t.setStyle(TableStyle([
            ('BACKGROUND', (0,0), (-1,-1), C_NAVY),
            ('TOPPADDING', (0,0), (-1,-1), 6),
            ('BOTTOMPADDING', (0,0), (-1,-1), 6),
            ('LEFTPADDING', (0,0), (-1,-1), 10),
        ]))
        elems.append(t)

    elems.append(space(20))

    # Stats boxes
    stats = [
        ("~100 Questions", "from Big Four subjects\n(55% of paper)"),
        ("30%", "questions repeat from\nprevious years"),
        ("55%+", "clinical reasoning\nrequired in 2026"),
        ("15-20", "Drug of Choice (DOC)\nquestions per paper"),
    ]
    stat_data = [[Paragraph(s[0], make_style("sv", fontSize=16, textColor=C_ORANGE, fontName="Helvetica-Bold", alignment=TA_CENTER)),
                  Paragraph(s[1], make_style("sd", fontSize=8.5, textColor=C_NAVY, fontName="Helvetica", alignment=TA_CENTER, leading=12))]
                 for s in stats]
    for row in stat_data:
        t2 = Table([row], colWidths=[5*cm, 12*cm])
        t2.setStyle(TableStyle([
            ('BACKGROUND', (0,0), (-1,-1), C_GREY_BG),
            ('BOX', (0,0), (-1,-1), 1, C_TEAL),
            ('TOPPADDING', (0,0), (-1,-1), 6),
            ('BOTTOMPADDING', (0,0), (-1,-1), 6),
            ('VALIGN', (0,0), (-1,-1), 'MIDDLE'),
        ]))
        elems.append(t2)
        elems.append(space(4))

    elems.append(space(30))
    elems.append(Paragraph("How to Use These Notes", make_style("htu", fontSize=12, textColor=C_NAVY, fontName="Helvetica-Bold")))
    elems.append(space(4))
    for tip in [
        "Each topic begins with an Exam Tip showing what question pattern to expect.",
        "Red text = most commonly tested facts. Yellow boxes = guaranteed exam material.",
        "Mnemonics are in blue boxes — memorize these first.",
        "Tables are your quick-revision tool the night before the exam.",
        "★ markers = predicted guaranteed questions for NEET PG 2026.",
    ]:
        elems.append(bullet(tip))

    elems.append(PageBreak())
    return elems

# ── MEDICINE ──────────────────────────────────────────────────────────────────
def build_medicine():
    e = []
    e.append(subject_header("INTERNAL MEDICINE", "~35-40 Questions | Priority 1", C_NAVY))
    e.append(space(10))

    # ---- CARDIOLOGY ----
    e.append(h_topic("1. CARDIOLOGY (8-12 Questions)"))
    e.append(hr())

    e.append(h_sub("A. Acute Coronary Syndrome (ACS) - Most Tested ★★★"))
    e.append(exam_tip("'A patient presents with chest pain + ST elevation. What is the next step?' = Time-based decision: fibrinolysis vs PCI"))
    e.append(space(4))

    e.append(body(b("ACS Classification:")))
    e.append(bullet("STEMI: ST elevation in ≥2 contiguous leads OR new LBBB"))
    e.append(bullet("NSTEMI: Troponin elevated, NO ST elevation"))
    e.append(bullet("Unstable Angina: Troponin negative, chest pain at rest"))
    e.append(space(4))

    e.append(highlight_box("★ GOLDEN RULE: Door-to-balloon time <90 min (PCI) | Door-to-needle time <30 min (fibrinolysis)"))
    e.append(space(6))

    e.append(body(b("STEMI Management Decision:")))
    e.append(make_table(
        ["Scenario", "Choice", "Time Window"],
        [
            ["PCI-capable centre available", "Primary PCI (preferred)", "<12 hours of symptom onset"],
            ["PCI not available within 120 min", "Fibrinolysis (thrombolytics)", "<12 hours; give within 30 min"],
            ["Fibrinolysis failed (no reperfusion at 90 min)", "Rescue PCI", "Immediately"],
            ["After successful fibrinolysis", "Routine angiography (not immediate PCI)", "3-24 hours later"],
        ],
        col_widths=[5.5*cm, 5.5*cm, 6*cm]
    ))
    e.append(space(6))

    e.append(body(b("Fibrinolytic agents (remember doses):")))
    e.append(bullet(b("Streptokinase") + " – 1.5 million IU over 60 min (non-fibrin selective)"))
    e.append(bullet(b("Alteplase (tPA)") + " – fibrin selective, preferred in stroke"))
    e.append(bullet(b("Tenecteplase") + " – single IV bolus (most convenient)"))
    e.append(bullet(b("Contraindications to fibrinolysis:") + " Prior hemorrhagic stroke, active bleeding, BP >180/110, recent major surgery"))
    e.append(space(4))

    e.append(body(b("STEMI ECG Localization:")))
    e.append(make_table(
        ["Leads with Changes", "Wall Involved", "Artery"],
        [
            ["II, III, aVF", "Inferior wall", "RCA"],
            ["V1-V4", "Anterior wall", "LAD"],
            ["I, aVL, V5-V6", "Lateral wall", "LCX"],
            ["V1-V2 (tall R wave)", "Posterior wall", "RCA / LCX"],
            ["V3R, V4R", "Right ventricle", "RCA (proximal)"],
        ],
        col_widths=[4.5*cm, 6.5*cm, 6*cm]
    ))
    e.append(space(6))

    e.append(h_sub("B. Heart Failure (HF)"))
    e.append(exam_tip("Know NYHA classification + which drugs improve mortality vs just symptoms"))
    e.append(space(4))

    e.append(body(b("NYHA Classification:")))
    e.append(make_table(
        ["Class", "Symptoms", "6-min walk"],
        [
            ["I", "No symptoms with ordinary activity", ">425 m"],
            ["II", "Slight limitation, comfortable at rest", "300-425 m"],
            ["III", "Marked limitation, comfortable only at rest", "150-300 m"],
            ["IV", "Symptoms at rest, unable to do any activity", "<150 m"],
        ],
        col_widths=[2*cm, 10*cm, 5*cm]
    ))
    e.append(space(5))

    e.append(body(b("HFrEF (EF <40%) - Drugs that REDUCE MORTALITY:")))
    e.append(mnemonic_box("HF Mortality drugs", "ABC-D-A = ACEi/ARB, Beta-blocker, Combination (ARNI=Sacubitril+Valsartan), Diuretic (not mortality), Aldosterone antagonist (Spironolactone), SGLT2i (Dapagliflozin/Empagliflozin)"))
    e.append(space(4))
    e.append(make_table(
        ["Drug Class", "Example", "Benefit"],
        [
            ["ACE Inhibitor", "Ramipril, Enalapril", "Mortality ↓, remodeling ↓"],
            ["ARB", "Valsartan", "If ACEi not tolerated"],
            ["ARNI", "Sacubitril + Valsartan (Entresto)", "Superior to ACEi - 1st line now"],
            ["Beta-blocker", "Carvedilol, Metoprolol, Bisoprolol", "Mortality ↓, HR control"],
            ["Aldosterone antagonist", "Spironolactone, Eplerenone", "Mortality ↓ (EF<35% + symptomatic)"],
            ["SGLT2 inhibitor", "Dapagliflozin, Empagliflozin", "HF hospitalization ↓, mortality ↓"],
            ["Ivabradine", "Ivabradine", "HR>70 despite max beta-blocker"],
        ],
        col_widths=[4*cm, 6*cm, 7*cm]
    ))
    e.append(space(6))

    e.append(h_sub("C. Arrhythmias"))
    e.append(exam_tip("ECG strips of AF, VT, WPW are shown - identify + give drug of choice"))
    e.append(space(4))

    e.append(make_table(
        ["Arrhythmia", "ECG Finding", "Drug of Choice"],
        [
            ["Atrial Fibrillation (AF)", "Irregularly irregular, absent P waves", "Rate control: Metoprolol/Digoxin; Rhythm: Amiodarone"],
            ["Atrial Flutter", "Sawtooth F waves at 300/min, 2:1 or 4:1 block", "Cardioversion preferred; Diltiazem for rate"],
            ["SVT (AVNRT)", "Narrow complex tachycardia, no P waves", "Adenosine IV (DOC) → Verapamil if fails"],
            ["WPW Syndrome", "Short PR, delta wave, wide QRS", "Avoid adenosine/digoxin/verapamil! Use Procainamide"],
            ["VT (stable)", "Wide complex >120ms, AV dissociation", "Amiodarone IV; Lidocaine if ischemia"],
            ["VT (unstable/pulseless)", "Wide complex + no pulse", "Defibrillation immediately"],
            ["Torsades de Pointes", "Twisting QRS around isoelectric line", "IV Magnesium sulfate"],
            ["Complete Heart Block", "P and QRS dissociated", "Atropine (temporary), Pacemaker (definitive)"],
        ],
        col_widths=[4.5*cm, 6.5*cm, 6*cm]
    ))
    e.append(space(6))
    e.append(highlight_box("★ WPW trap: NEVER give Adenosine, Digoxin, or Verapamil in WPW with AF - can cause fatal VF! DOC = Procainamide or DC cardioversion", bg=C_RED_BG, border=C_RED))
    e.append(space(8))

    # ---- ENDOCRINOLOGY ----
    e.append(h_topic("2. ENDOCRINOLOGY (7-9 Questions)"))
    e.append(hr())

    e.append(h_sub("A. Diabetic Ketoacidosis (DKA) - THE #1 Most Tested Topic ★★★"))
    e.append(exam_tip("DKA questions test: diagnosis criteria, fluid choice, K+ management, insulin timing, anion gap closure"))
    e.append(space(4))

    e.append(body(b("Diagnostic Criteria (ALL three must be present):")))
    e.append(bullet(b("Blood glucose") + " >250 mg/dL (usually >300)"))
    e.append(bullet(b("Arterial pH") + " <7.3 OR serum bicarbonate <18 mEq/L"))
    e.append(bullet(b("Ketonemia/ketonuria") + " (urine ketones ≥2+ OR serum ketones positive)"))
    e.append(space(4))

    e.append(body(b("DKA Severity:")))
    e.append(make_table(
        ["Parameter", "Mild", "Moderate", "Severe"],
        [
            ["Blood glucose", ">250", ">250", ">250"],
            ["pH", "7.25-7.30", "7.00-7.24", "<7.00"],
            ["HCO3", "15-18", "10-15", "<10"],
            ["Anion gap", ">10", ">12", ">12"],
            ["Mental status", "Alert", "Alert/drowsy", "Stupor/coma"],
        ],
        col_widths=[4*cm, 4.3*cm, 4.3*cm, 4.4*cm]
    ))
    e.append(space(5))

    e.append(body(b("DKA Management - Step by Step:")))
    e.append(bullet(b("Step 1 - Fluids:") + " 0.9% Normal Saline 1L in first hour → 500mL/hr × 2h → 250mL/hr. Switch to D5 0.45% saline when glucose <250 mg/dL"))
    e.append(bullet(b("Step 2 - Potassium (THE TRAP):") + " Check K+ BEFORE giving insulin!"))
    e.append(bullet2("K+ <3.5: Replace K+ first, hold insulin until K+ >3.5"))
    e.append(bullet2("K+ 3.5-5.0: Give K+ 20-40 mEq/hr with insulin"))
    e.append(bullet2("K+ >5.0: Start insulin, hold K+ replacement"))
    e.append(bullet(b("Step 3 - Insulin:") + " Regular insulin IV infusion 0.1 units/kg/hr. Glucose should fall 50-75 mg/dL/hr. Bolus only if glucose not falling"))
    e.append(bullet(b("Step 4 - Bicarbonate:") + " Only if pH <6.9. NOT routinely given (worsens hypokalemia, cerebral edema)"))
    e.append(bullet(b("Step 5 - Resolution criteria:") + " Glucose <200 + pH >7.3 + HCO3 >15 + anion gap closed"))
    e.append(space(5))
    e.append(highlight_box("★ KEY: Anion Gap = Na - (Cl + HCO3). Normal = 8-12. In DKA typically >20. Resolution = AG closes, NOT just glucose normalization!", bg=C_YELLOW_BG, border=C_ORANGE))
    e.append(space(4))
    e.append(highlight_box("CEREBRAL EDEMA in DKA: MC in children. Presents with headache, altered consciousness after initial improvement. Tx: IV Mannitol", bg=C_RED_BG, border=C_RED))
    e.append(space(8))

    e.append(h_sub("B. Thyroid Disorders"))
    e.append(exam_tip("Thyroid function tests interpretation + drug of choice for each condition"))
    e.append(space(4))
    e.append(make_table(
        ["Condition", "TSH", "Free T4", "Free T3", "Key Features"],
        [
            ["Primary Hypothyroidism", "↑↑", "↓", "↓", "MC cause: Hashimoto's (TPO Ab+)"],
            ["Central Hypothyroidism", "↓/N", "↓", "↓", "TSH low despite low T4 - pituitary/hypothalamic"],
            ["Primary Hyperthyroidism", "↓↓", "↑", "↑", "Graves: TSH-R Ab+, pretibial myxedema"],
            ["Subclinical Hypothyroid", "↑", "N", "N", "Treat if TSH>10 or symptomatic"],
            ["T3 toxicosis", "↓", "N", "↑", "Normal T4 but high T3"],
            ["Sick Euthyroid", "N/↓", "N", "↓↓", "Ill patient - low T3, normal T4"],
        ],
        col_widths=[4*cm, 1.8*cm, 2*cm, 2*cm, 7.2*cm]
    ))
    e.append(space(5))
    e.append(body(b("Thyroid crisis (Storm): ")))
    e.append(bullet("Fever >38.5°C + tachycardia + altered consciousness in hyperthyroid patient"))
    e.append(bullet(b("Treatment order (ABCDE):") + " Propylthiouracil (PTU) → then iodine (>1h after PTU) → Beta-blocker (Propranolol) → Corticosteroids (Hydrocortisone) → treat precipitant"))
    e.append(mnemonic_box("Thyroid Storm Tx", "BIGS = Beta-blocker, Iodine (after PTU), Glucocorticoids, Solution (PTU/Methimazole)"))
    e.append(space(6))

    e.append(h_sub("C. PCOS (Rotterdam Criteria)"))
    e.append(body(b("Rotterdam Criteria - 2 out of 3:")))
    e.append(bullet("Oligo/anovulation (irregular cycles)"))
    e.append(bullet("Clinical or biochemical hyperandrogenism (acne, hirsutism, high testosterone)"))
    e.append(bullet("Polycystic ovaries on USG (≥12 follicles 2-9mm OR ovarian volume >10 mL)"))
    e.append(body(b("Treatment:")))
    e.append(bullet("1st line for menstrual irregularity: OCP (Combined oral contraceptive pill)"))
    e.append(bullet("1st line for infertility/ovulation induction: Clomiphene citrate"))
    e.append(bullet("Insulin resistance: Metformin"))
    e.append(bullet("Hirsutism: Spironolactone (anti-androgen)"))
    e.append(space(6))

    # ---- NEPHROLOGY ----
    e.append(h_topic("3. NEPHROLOGY (4-6 Questions)"))
    e.append(hr())

    e.append(h_sub("A. AKI - RIFLE / AKIN Criteria ★★"))
    e.append(exam_tip("RIFLE/AKIN are classic 'diagnostic criteria' questions - know them cold"))
    e.append(space(4))
    e.append(make_table(
        ["RIFLE Stage", "Creatinine (Scr)", "Urine Output", "AKIN Equivalent"],
        [
            ["Risk (R)", "×1.5 OR ↓GFR >25%", "<0.5 mL/kg/h × 6h", "Stage 1"],
            ["Injury (I)", "×2 OR ↓GFR >50%", "<0.5 mL/kg/h × 12h", "Stage 2"],
            ["Failure (F)", "×3 OR Scr >4 mg/dL", "<0.3 mL/kg/h × 24h OR anuria × 12h", "Stage 3"],
            ["Loss (L)", "Complete loss >4 weeks", "-", "-"],
            ["ESRD (E)", "Loss >3 months", "-", "-"],
        ],
        col_widths=[3.5*cm, 4.5*cm, 6*cm, 3*cm]
    ))
    e.append(space(5))

    e.append(body(b("Pre-renal vs Intrinsic AKI (key differentiators):")))
    e.append(make_table(
        ["Parameter", "Pre-renal", "Intrinsic (ATN)"],
        [
            ["BUN:Creatinine ratio", ">20:1", "<10:1"],
            ["Urine Na+", "<20 mEq/L", ">40 mEq/L"],
            ["FENa", "<1%", ">2%"],
            ["Urine osmolality", ">500 mOsm/kg", "<350 mOsm/kg"],
            ["Response to fluids", "Improves", "No improvement"],
        ],
        col_widths=[5*cm, 6*cm, 6*cm]
    ))
    e.append(space(5))

    e.append(body(b("Dialysis Indications (AEIOU):")))
    e.append(mnemonic_box("AEIOU", "Acidosis (pH<7.1), Electrolytes (K+>6.5 refractory), Intoxication (drugs), Overload (fluid), Uremia (pericarditis, encephalopathy, bleeding)"))
    e.append(space(6))

    # ---- RESPIRATORY ----
    e.append(h_topic("4. RESPIRATORY MEDICINE (4-6 Questions)"))
    e.append(hr())

    e.append(h_sub("A. COPD vs Asthma Differentiation ★"))
    e.append(make_table(
        ["Feature", "COPD", "Asthma"],
        [
            ["Age", "Usually >40 years", "Any age; often childhood"],
            ["Smoking", "Almost always", "Not required"],
            ["Reversibility (bronchodilator)", "Incomplete (<12%)", "Complete (≥12% + 200mL)"],
            ["Eosinophilia", "Not typically", "Common"],
            ["DLCO", "Reduced (emphysema)", "Normal"],
            ["FEV1/FVC", "<0.7 (fixed)", "<0.7 (reversible)"],
            ["CXR findings", "Hyperinflation, flat diaphragm", "Normal or hyperinflation"],
            ["Exacerbation triggers", "Infections, pollutants", "Allergens, exercise, cold"],
        ],
        col_widths=[4*cm, 6.5*cm, 6.5*cm]
    ))
    e.append(space(5))

    e.append(h_sub("B. Pneumonia Classification + DOC"))
    e.append(make_table(
        ["Type", "Common Organism", "DOC"],
        [
            ["Community-acquired (CAP) - mild", "Strep pneumoniae", "Amoxicillin"],
            ["CAP - moderate/severe", "Strep pneumoniae + atypicals", "Amox-Clav + Macrolide OR Respiratory FQ"],
            ["Hospital-acquired (HAP) >48h after admit", "Gram-negatives, MRSA", "Piperacillin-Tazobactam ± Vancomycin"],
            ["Aspiration pneumonia", "Anaerobes + GNR", "Amox-Clav OR Clindamycin + 3G Cephalosporin"],
            ["Atypical (walking pneumonia)", "Mycoplasma, Chlamydia, Legionella", "Macrolide (Azithromycin) OR Doxycycline"],
            ["PCP (Pneumocystis jirovecii)", "Immunocompromised/HIV (CD4 <200)", "TMP-SMX (Co-trimoxazole)"],
        ],
        col_widths=[5*cm, 6*cm, 6*cm]
    ))
    e.append(space(8))

    # ---- GASTROENTEROLOGY ----
    e.append(h_topic("5. GASTROENTEROLOGY (5-7 Questions)"))
    e.append(hr())

    e.append(h_sub("A. Chronic Liver Disease & Cirrhosis"))
    e.append(body(b("Child-Pugh Score (A/B/C):")))
    e.append(make_table(
        ["Parameter", "1 point", "2 points", "3 points"],
        [
            ["Bilirubin (mg/dL)", "<2", "2-3", ">3"],
            ["Albumin (g/dL)", ">3.5", "2.8-3.5", "<2.8"],
            ["PT prolongation (sec)", "<4", "4-6", ">6"],
            ["Ascites", "None", "Mild", "Moderate-severe"],
            ["Encephalopathy", "None", "Grade 1-2", "Grade 3-4"],
        ],
        col_widths=[5*cm, 4*cm, 4*cm, 4*cm]
    ))
    e.append(bullet("Score 5-6 = Class A (good), 7-9 = Class B, 10-15 = Class C (poor prognosis)"))
    e.append(space(5))

    e.append(body(b("Complications of Cirrhosis & Management:")))
    e.append(make_table(
        ["Complication", "First-line Treatment"],
        [
            ["Ascites (grade 2)", "Spironolactone ± Furosemide + low Na diet"],
            ["Spontaneous Bacterial Peritonitis (SBP)", "Cefotaxime IV; Prophylaxis: Norfloxacin/Ciprofloxacin"],
            ["Hepatic Encephalopathy", "Lactulose (1st line); Rifaximin (add-on); Low protein diet NOT routinely"],
            ["Hepatorenal Syndrome type 1", "Terlipressin + Albumin (DOC); Noradrenaline + Albumin (alt)"],
            ["Variceal bleeding (acute)", "Octreotide/Terlipressin + Endoscopic band ligation"],
            ["Primary prevention of varices", "Non-selective beta-blocker (Propranolol/Nadolol)"],
        ],
        col_widths=[6*cm, 11*cm]
    ))
    e.append(space(5))

    e.append(h_sub("B. IBD - Crohn's vs Ulcerative Colitis"))
    e.append(make_table(
        ["Feature", "Crohn's Disease", "Ulcerative Colitis"],
        [
            ["Location", "Anywhere (mouth to anus); skip lesions", "Colon only; continuous from rectum"],
            ["Rectal involvement", "Spared (50%)", "Always involved"],
            ["Wall involvement", "Transmural (all layers)", "Mucosa + submucosa only"],
            ["Histology", "Non-caseating granulomas", "Crypt abscesses, no granulomas"],
            ["Complications", "Fistulas, strictures, abscesses", "Toxic megacolon, colorectal cancer"],
            ["Smoking", "Worsens disease", "Protective (paradoxically)"],
            ["DOC (mild-moderate)", "Budesonide/Prednisolone + Metronidazole (perianal)", "5-ASA (Mesalazine)"],
            ["Severe/refractory", "Anti-TNF (Infliximab, Adalimumab)", "Anti-TNF or Vedolizumab"],
            ["Surgery", "Does NOT cure", "Total colectomy = curative"],
        ],
        col_widths=[4*cm, 6.5*cm, 6.5*cm]
    ))
    e.append(space(8))

    # ---- RHEUMATOLOGY ----
    e.append(h_topic("6. RHEUMATOLOGY (3-4 Questions)"))
    e.append(hr())

    e.append(h_sub("A. SLE - ACR/EULAR 2019 Criteria"))
    e.append(body(b("Entry criterion:") + " ANA positive (titer ≥1:80). Then score domains (≥10 points = SLE diagnosis):"))
    e.append(make_table(
        ["Domain", "Feature", "Score"],
        [
            ["Constitutional", "Fever >38.3°C", "2"],
            ["Hematological", "Hemolytic anemia", "4"],
            ["Hematological", "Leukopenia <4000 OR Lymphopenia <1000", "3"],
            ["Hematological", "Thrombocytopenia <100k", "4"],
            ["Neuropsychiatric", "Delirium", "2"],
            ["Mucocutaneous", "Acute lupus rash (malar)", "6"],
            ["Mucocutaneous", "Oral ulcers / Non-scarring alopecia", "2"],
            ["Serosal", "Pleuritis/pericarditis", "5"],
            ["Musculoskeletal", "Synovitis ≥2 joints", "6"],
            ["Renal", "Proteinuria >0.5 g/24h", "4"],
            ["Antiphospholipid Ab", "Anti-cardiolipin/beta2-GPI/Lupus anticoagulant", "2"],
            ["Complement", "Low C3 OR C4", "3"],
            ["SLE-specific Ab", "Anti-dsDNA OR Anti-Sm", "6"],
        ],
        col_widths=[4.5*cm, 8.5*cm, 4*cm]
    ))
    e.append(space(5))

    e.append(body(b("Key Antibodies in SLE:")))
    e.append(bullet(b("ANA:") + " Most sensitive (95%) - screening test"))
    e.append(bullet(b("Anti-dsDNA:") + " Most specific for SLE; correlates with disease activity (especially nephritis)"))
    e.append(bullet(b("Anti-Sm:") + " Most specific antibody (present in 25-30%)"))
    e.append(bullet(b("Anti-Ro/SSA:") + " Neonatal lupus, congenital heart block"))
    e.append(bullet(b("Anti-histone:") + " Drug-induced lupus (Hydralazine, Procainamide, Isoniazid)"))
    e.append(space(8))

    # ---- NEUROLOGY ----
    e.append(h_topic("7. NEUROLOGY (3-4 Questions)"))
    e.append(hr())

    e.append(h_sub("A. Stroke Localization"))
    e.append(make_table(
        ["Artery", "Deficits", "Key Feature"],
        [
            ["MCA (dominant)", "Contralateral hemiplegia (face+arm>leg), aphasia", "Most common stroke territory"],
            ["MCA (non-dominant)", "Contralateral hemiplegia + hemineglect", "Neglect = non-dominant"],
            ["ACA", "Contralateral leg > arm weakness, abulia", "Leg predominant"],
            ["PCA", "Contralateral homonymous hemianopia, memory", "Vision loss"],
            ["PICA (Lateral medullary = Wallenberg)", "Ipsilateral face + contralateral body sensory loss, Horner, dysphagia, nystagmus", "Crossed deficits"],
            ["Basilar artery", "Locked-in syndrome, quadriplegia, conscious", "Preserved consciousness"],
        ],
        col_widths=[4*cm, 8*cm, 5*cm]
    ))
    e.append(space(5))

    e.append(h_sub("B. Parkinson's Disease vs Tremors"))
    e.append(make_table(
        ["Feature", "Parkinson's", "Essential Tremor", "Cerebellar Tremor"],
        [
            ["Type", "Resting tremor (4-6 Hz)", "Action/postural tremor (8-12 Hz)", "Intention tremor"],
            ["Character", "Pill-rolling", "Bilateral hands/head", "Worsens on target"],
            ["Other signs", "Rigidity, bradykinesia, shuffling gait", "Improves with alcohol", "Dysdiadochokinesia, ataxia"],
            ["Treatment", "Levodopa+Carbidopa (DOC)", "Propranolol or Primidone", "Treat cause"],
        ],
        col_widths=[3*cm, 4.7*cm, 4.7*cm, 4.6*cm]
    ))
    e.append(PageBreak())

    # ── SURGERY ──────────────────────────────────────────────────────────────────
    e.append(subject_header("GENERAL SURGERY", "~30-35 Questions | Priority 2", C_TEAL))
    e.append(space(10))

    e.append(h_topic("1. TRAUMA / ATLS (5-6 Questions) ★★★ GUARANTEED"))
    e.append(hr())
    e.append(exam_tip("ATLS Primary Survey is tested EVERY year. Know ABCDE order + what to do at each step + prioritization"))
    e.append(space(4))

    e.append(body(b("ATLS Primary Survey - ABCDE:")))
    e.append(make_table(
        ["Step", "Action", "Key Points"],
        [
            ["A - Airway\n(+ C-spine)", "Establish patent airway; C-spine immobilization", "Chin-lift/jaw-thrust if no C-spine injury concern; Intubate if GCS≤8 or unable to protect airway"],
            ["B - Breathing", "Assess breathing + ventilation", "Life threats: Tension pneumothorax, Open pneumothorax, Flail chest, Massive hemothorax"],
            ["C - Circulation", "Control hemorrhage, IV access × 2, fluid resuscitation", "Shock class determines fluid; Massive bleed = O-neg blood immediately"],
            ["D - Disability", "Neurological status: GCS + pupils", "GCS, AVPU, pupil size/reactivity"],
            ["E - Exposure", "Expose fully + prevent hypothermia", "Remove all clothes; logroll for back; warm blankets"],
        ],
        col_widths=[2.5*cm, 5.5*cm, 9*cm]
    ))
    e.append(space(5))

    e.append(highlight_box("★ If airway obstruction AND massive hemorrhage - AIRWAY FIRST always (A before C)", bg=C_RED_BG, border=C_RED))
    e.append(space(5))

    e.append(body(b("Shock Classification in Trauma:")))
    e.append(make_table(
        ["Class", "Blood Loss", "HR", "BP", "RR", "GCS", "Treatment"],
        [
            ["I", "<750 mL (<15%)", "<100", "Normal", "14-20", "Normal", "Crystalloid"],
            ["II", "750-1500 mL (15-30%)", "100-120", "Normal", "20-30", "Anxious", "Crystalloid"],
            ["III", "1500-2000 mL (30-40%)", "120-140", "Decreased", "30-40", "Confused", "Crystalloid + Blood"],
            ["IV", ">2000 mL (>40%)", ">140", "Very low", ">35", "Lethargic", "Blood products immediately"],
        ],
        col_widths=[1.5*cm, 3.5*cm, 2*cm, 2.5*cm, 2*cm, 2.5*cm, 3*cm]
    ))
    e.append(space(5))

    e.append(body(b("FAST Scan (Focused Assessment with Sonography in Trauma) - ★ High Yield:")))
    e.append(bullet("4 windows: Perihepatic (Morrison's pouch), Perisplenic, Pericardial, Pelvic (retrovesical/rectouterine)"))
    e.append(bullet("Free fluid appears as BLACK (hypoechoic) on FAST"))
    e.append(bullet("Sensitivity for intraperitoneal fluid: ~80%; Specificity: ~99%"))
    e.append(bullet("Positive FAST + hemodynamically unstable = Emergency laparotomy (no time for CT)"))
    e.append(bullet("Positive FAST + hemodynamically stable = CT abdomen for detailed assessment"))
    e.append(space(5))

    e.append(body(b("Immediate Life-Threatening Chest Injuries (treat in primary survey):")))
    e.append(make_table(
        ["Injury", "Diagnosis", "Immediate Treatment"],
        [
            ["Tension Pneumothorax", "Absent breath sounds + tracheal deviation AWAY from lesion + JVD + hypotension", "Needle decompression 2nd ICS MCL → then chest tube 5th ICS AAL"],
            ["Open Pneumothorax", "Sucking chest wound", "3-sided dressing (flutter valve) → chest tube away from wound"],
            ["Massive Hemothorax", ">1500 mL blood in chest; absent sounds + dull percussion", "Chest tube (32-36F) at 5th ICS AAL; surgery if >1500 mL drained"],
            ["Flail Chest", "Paradoxical chest wall movement; >2 ribs fractured in >2 places", "Pain control + O2; IPPV if respiratory failure"],
            ["Cardiac Tamponade", "Beck's triad: JVD + muffled heart sounds + hypotension", "Pericardiocentesis (needle); Pericardiotomy (definitive)"],
            ["Airway Obstruction", "Stridor, gurgling, no air movement", "Clear airway, intubate; surgical airway if needed"],
        ],
        col_widths=[3.5*cm, 6*cm, 7.5*cm]
    ))
    e.append(space(8))

    e.append(h_topic("2. ACUTE ABDOMEN (4-5 Questions)"))
    e.append(hr())

    e.append(h_sub("A. Intestinal Obstruction"))
    e.append(body(b("Small Bowel vs Large Bowel Obstruction:")))
    e.append(make_table(
        ["Feature", "Small Bowel", "Large Bowel"],
        [
            ["Pain type", "Colicky, periumbilical", "Colicky, lower abdomen"],
            ["Vomiting", "Early, prominent, bilious", "Late, feculent"],
            ["Distension", "Mild-moderate, central", "Marked, peripheral"],
            ["X-ray", "Central ladder pattern, valvulae conniventes (complete across bowel)", "Peripheral haustrations (incomplete across)"],
            ["MC cause in adults", "Post-operative adhesions", "Colorectal carcinoma"],
            ["MC cause in children", "Intussusception (ileo-colic)", "Hirschsprung's disease"],
        ],
        col_widths=[3.5*cm, 6.5*cm, 7*cm]
    ))
    e.append(space(5))

    e.append(highlight_box("★ Closed loop obstruction = SURGICAL EMERGENCY. Signs: constant pain (not colicky) + rapidly deteriorating. Do NOT delay surgery!", bg=C_RED_BG, border=C_RED))
    e.append(space(5))

    e.append(h_sub("B. Appendicitis"))
    e.append(bullet(b("Classic presentation:") + " Periumbilical pain → migrates to RIF (McBurney's point = 1/3 of line from ASIS to umbilicus)"))
    e.append(bullet(b("Signs:") + " Rovsing's sign (pressure on LIF → pain in RIF), Psoas sign (hip extension pain), Obturator sign (internal rotation pain → pelvic appendix)"))
    e.append(bullet(b("Alvarado Score:") + " Migratory RIF pain (1), Anorexia (1), Nausea/vomiting (1), RIF tenderness (2), Rebound tenderness (1), Elevated temp (1), Leukocytosis (2), Shift to left (1). Score ≥7 = surgery"))
    e.append(bullet(b("Gold standard Dx:") + " CT abdomen (sensitivity 94-98%). USG in pregnant women/children"))
    e.append(bullet(b("Treatment:") + " Laparoscopic appendicectomy (laparoscopic preferred). Antibiotics only for uncomplicated appendicitis in selected patients"))
    e.append(space(5))

    e.append(h_sub("C. Acute Pancreatitis"))
    e.append(body(b("Causes: GET SMASHED")))
    e.append(mnemonic_box("GET SMASHED", "Gallstones (MC in India), Ethanol (2nd MC), Trauma, Steroids, Mumps/malignancy, Autoimmune, Scorpion sting, Hypertriglyceridemia/Hypercalcemia, ERCP/Emboli, Drugs (azathioprine, thiazides)"))
    e.append(space(4))
    e.append(body(b("Ranson's Criteria (severity scoring):")))
    e.append(bullet(b("On admission:") + " Age >55, WBC >16000, Glucose >200 mg/dL, LDH >350, AST >250"))
    e.append(bullet(b("At 48 hours:") + " HCT fall >10%, BUN rise >5, Ca <8 mg/dL, PaO2 <60 mmHg, Base deficit >4, Fluid sequestration >6L"))
    e.append(bullet(b("Score ≥3:") + " Severe pancreatitis; Score ≥5: Mortality >40%"))
    e.append(space(8))

    e.append(h_topic("3. BREAST & THYROID SURGERY (3-4 Questions)"))
    e.append(hr())

    e.append(h_sub("A. Triple Assessment of Breast Lump (★ Exam Favourite)"))
    e.append(mnemonic_box("Triple Assessment", "1. Clinical examination | 2. Imaging (USG <35yr / Mammogram >35yr) | 3. Tissue sampling (FNAC or Core needle biopsy)"))
    e.append(bullet("All 3 must be concordant. Any discordance = surgical excision biopsy"))
    e.append(space(5))

    e.append(h_sub("B. TNM Staging - Breast Cancer Key Points"))
    e.append(make_table(
        ["Stage", "T", "N", "M", "Key point"],
        [
            ["Stage I", "T1 (≤2cm)", "N0", "M0", "Early cancer, excellent prognosis"],
            ["Stage IIA", "T0-2", "N1 (1-3 nodes)", "M0", "Operable"],
            ["Stage IIB", "T2-3", "N0-1", "M0", "Operable"],
            ["Stage IIIA", "T3", "N2 (4-9 nodes)", "M0", "Locally advanced"],
            ["Stage IIIB", "T4 (skin/chest wall)", "Any N", "M0", "Inflammatory breast cancer = T4d"],
            ["Stage IV", "Any T", "Any N", "M1", "Distant mets - palliative"],
        ],
        col_widths=[2.5*cm, 3*cm, 4*cm, 2.5*cm, 5*cm]
    ))
    e.append(space(5))

    e.append(h_sub("C. Solitary Thyroid Nodule Algorithm"))
    e.append(bullet("Initial test: USG thyroid (ACR TIRADS scoring)"))
    e.append(bullet("TIRADS 1-2: No biopsy. TIRADS 3: Follow-up. TIRADS 4-5: FNAC"))
    e.append(bullet(b("FNAC results (Bethesda System):") + " I (non-diagnostic), II (benign), III (AUS/FLUS), IV (FN), V (suspicious malignant), VI (malignant)"))
    e.append(bullet("Bethesda VI (papillary carcinoma): Total thyroidectomy + central neck dissection"))
    e.append(bullet(b("Post-thyroidectomy complication:") + " Hoarseness = RLN injury; Tetany = Hypoparathyroidism"))
    e.append(space(8))

    e.append(h_topic("4. HERNIA (2-3 Questions)"))
    e.append(hr())
    e.append(make_table(
        ["Type", "Site", "Boundaries", "Key Fact"],
        [
            ["Inguinal - Indirect", "Lateral to inferior epigastric vessels", "Goes through internal ring", "MC inguinal hernia; MC hernia overall"],
            ["Inguinal - Direct", "Medial to inferior epigastric vessels", "Through Hesselbach's triangle", "Elderly men; through posterior wall"],
            ["Femoral", "Below inguinal ligament, medial to femoral vein", "Femoral canal", "MC in women; MC to strangulate"],
            ["Umbilical", "Umbilicus", "Umbilical ring", "MC in children; Patent urachus"],
            ["Spigelian", "Lateral edge of rectus, below arcuate line", "Spigelian aponeurosis", "Interparietal hernia"],
            ["Obturator", "Obturator foramen", "Obturator canal", "Howship-Romberg sign (medial thigh pain)"],
        ],
        col_widths=[3*cm, 4*cm, 4*cm, 6*cm]
    ))
    e.append(PageBreak())

    # ── PHARMACOLOGY ─────────────────────────────────────────────────────────────
    e.append(subject_header("PHARMACOLOGY", "~20-22 Questions | Priority 3", C_RED))
    e.append(space(10))

    e.append(h_topic("1. DRUGS OF CHOICE (DOC) - 15-20 Questions ★★★"))
    e.append(hr())
    e.append(exam_tip("DOC questions appear 15-20 times per paper. Know these as absolute facts."))
    e.append(space(4))

    e.append(h_sub("A. Cardiovascular DOCs"))
    e.append(make_table(
        ["Condition", "Drug of Choice", "Notes"],
        [
            ["Acute MI (fibrinolysis)", "Streptokinase / Tenecteplase", "Tenecteplase = single bolus"],
            ["AF - rate control", "Metoprolol / Diltiazem", "Not in HF: use Digoxin"],
            ["AF - rhythm control (DOC)", "Amiodarone", "Most effective antiarrhythmic"],
            ["SVT (acute)", "Adenosine IV", "Short-acting; monitor for bronchospasm"],
            ["WPW + AF", "Procainamide / DC Cardioversion", "AVOID Adenosine, Digoxin, Verapamil"],
            ["Torsades de Pointes", "IV Magnesium Sulfate", "Also stop offending drugs"],
            ["Hypertensive crisis", "IV Labetalol / IV Nicardipine", "Nitroprusside in aortic dissection"],
            ["HTN in pregnancy", "Methyldopa (1st line), Labetalol, Nifedipine", "AVOID ACEi/ARBs (teratogenic)"],
            ["HTN in diabetes", "ACE inhibitor (ramipril)", "Renal protective; add ARB if needed"],
            ["HTN in asthma/COPD", "CCB (Amlodipine)", "Avoid beta-blockers"],
            ["Heart failure (1st line)", "ACEi/ARNI + Beta-blocker + Spironolactone", "ARNI (sacubitril+valsartan) superior"],
            ["Digoxin toxicity", "Stop digoxin + Digoxin Fab antibodies", "For severe toxicity"],
        ],
        col_widths=[5*cm, 6.5*cm, 5.5*cm]
    ))
    e.append(space(6))

    e.append(h_sub("B. Infectious Disease DOCs"))
    e.append(make_table(
        ["Infection / Organism", "Drug of Choice", "Alternative"],
        [
            ["MRSA", "Vancomycin", "Linezolid, Daptomycin"],
            ["VRE (Vancomycin-resistant Enterococcus)", "Linezolid", "Daptomycin"],
            ["Pseudomonas aeruginosa", "Piperacillin-Tazobactam", "Ceftazidime, Imipenem"],
            ["C. difficile (mild-moderate)", "Metronidazole", "Vancomycin (oral)"],
            ["C. difficile (severe)", "Vancomycin (oral) / Fidaxomicin", "Fecal transplant (recurrent)"],
            ["Meningococcal meningitis", "Ceftriaxone / Benzylpenicillin", "Chloramphenicol (penicillin allergy)"],
            ["Pneumococcal meningitis", "Ceftriaxone + Dexamethasone", "Dexamethasone reduces neurological sequelae"],
            ["TB (standard regimen)", "2HRZE / 4HR (DOTS)", "H=INH, R=Rifampicin, Z=Pyrazinamide, E=Ethambutol"],
            ["Drug-resistant TB (MDR-TB)", "Bedaquiline + Pretomanid + Linezolid (BPaL)", "New NTEP regimen"],
            ["Typhoid fever", "Azithromycin (uncomplicated)", "Ceftriaxone (complicated); Ciprofloxacin (sensitive)"],
            ["Malaria - P.falciparum", "Artemisinin-based combo (ACT) = Artesunate + Lumefantrine", "Artesunate IV for severe"],
            ["Malaria - P.vivax", "Chloroquine + Primaquine", "Primaquine = kills hypnozoites (liver stage)"],
            ["Candida (invasive)", "Echinocandin (Caspofungin)", "Fluconazole (non-critical)"],
            ["Aspergillosis", "Voriconazole", "Liposomal Amphotericin B"],
            ["Leishmaniasis (Kala-azar)", "Liposomal Amphotericin B", "Miltefosine (oral)"],
        ],
        col_widths=[5*cm, 6.5*cm, 5.5*cm]
    ))
    e.append(space(6))

    e.append(h_sub("C. Other Important DOCs"))
    e.append(make_table(
        ["Condition", "DOC"],
        [
            ["H. pylori eradication (1st line)", "Triple therapy: PPI + Clarithromycin + Amoxicillin × 14 days"],
            ["GERD", "PPI (Omeprazole) - most effective acid suppression"],
            ["Peptic ulcer + NSAIDs", "PPI (Omeprazole); if H.pylori - eradicate"],
            ["Status epilepticus (1st line)", "IV Lorazepam (or Diazepam)"],
            ["Status epilepticus (2nd line)", "IV Phenytoin / Fosphenytoin / Valproate"],
            ["Absence seizures (DOC)", "Ethosuximide (pure absence); Valproate (absence + other types)"],
            ["Trigeminal neuralgia", "Carbamazepine"],
            ["Rheumatoid arthritis (DMARD)", "Methotrexate (1st line anchor drug)"],
            ["Gout - acute attack", "NSAIDs (Indomethacin) OR Colchicine"],
            ["Gout - chronic prevention", "Allopurinol (xanthine oxidase inhibitor)"],
            ["Anaphylaxis", "Adrenaline (Epinephrine) IM 0.5 mg (1:1000) - FIRST"],
            ["OCP failure (pregnancy)", "Levonorgestrel emergency contraception within 72h"],
            ["Paracetamol overdose", "N-acetylcysteine (NAC) - within 8h ideally"],
            ["Opioid overdose", "Naloxone IV"],
            ["Organophosphate poisoning", "Atropine (large doses) + Pralidoxime (within 24-48h)"],
            ["Benzodiazepine overdose", "Flumazenil"],
        ],
        col_widths=[8*cm, 9*cm]
    ))
    e.append(space(8))

    e.append(h_topic("2. AUTONOMIC PHARMACOLOGY (3-4 Questions)"))
    e.append(hr())
    e.append(exam_tip("Receptor subtype → effect → drug acting on it. Know which effect each drug produces and the clinical use."))
    e.append(space(4))
    e.append(make_table(
        ["Receptor", "Location", "Effect when activated", "Drug example"],
        [
            ["α1", "Vascular smooth muscle, eye", "Vasoconstriction, mydriasis", "Phenylephrine, Prazosin (blocker)"],
            ["α2 (presynaptic)", "Sympathetic terminals", "Decreases NA release (negative feedback)", "Clonidine (agonist), Yohimbine (blocker)"],
            ["β1", "Heart, kidney (JGA)", "↑HR, ↑contractility, ↑renin", "Dobutamine (agonist), Metoprolol (blocker)"],
            ["β2", "Bronchi, uterus, blood vessels", "Bronchodilation, uterine relaxation, vasodilation", "Salbutamol (agonist), Propranolol (blocker)"],
            ["β3", "Adipose tissue, bladder detrusor", "Lipolysis, bladder relaxation", "Mirabegron (OAB treatment)"],
            ["M1", "Gastric parietal cells, CNS", "↑Gastric acid, CNS effects", "Pirenzepine (blocker = peptic ulcer)"],
            ["M2", "Heart (SA node)", "↓HR, ↓conduction", "Atropine (blocker = bradycardia)"],
            ["M3", "Smooth muscle, glands", "Bronchoconstriction, ↑secretions, ↑GI motility", "Ipratropium (blocker = COPD)"],
            ["Nicotinic (NMJ)", "Skeletal muscle", "Muscle contraction", "Succinylcholine (agonist), Rocuronium (blocker)"],
        ],
        col_widths=[2.5*cm, 4.5*cm, 5*cm, 5*cm]
    ))
    e.append(space(8))

    e.append(h_topic("3. CYTOCHROME P450 (CYP) - Drug Interactions (3-4 Questions)"))
    e.append(hr())
    e.append(exam_tip("'Which drug increases/decreases levels of drug X?' = CYP inducers/inhibitors question"))
    e.append(space(4))

    e.append(body(b("CYP Inducers (increase metabolism → DECREASE drug levels):")))
    e.append(mnemonic_box("Inducers", "RIPES = Rifampicin, Isoniazid, Phenytoin, Ethanol (chronic), Smoking/St John's wort/Sulfonamides"))
    e.append(space(3))
    e.append(body(b("CYP Inhibitors (decrease metabolism → INCREASE drug levels → toxicity):")))
    e.append(mnemonic_box("Inhibitors", "SICKFACES.COM = Sodium valproate, Isoniazid, Cimetidine, Ketoconazole, Fluconazole, Amiodarone, Ciprofloxacin, Erythromycin/Sulfonamides, Chloramphenicol, Omeprazole, Metronidazole"))
    e.append(space(5))

    e.append(make_table(
        ["Clinical Scenario", "Mechanism", "Result"],
        [
            ["Rifampicin + OCP", "Rifampicin induces CYP3A4 → OCP metabolized faster", "OCP failure → pregnancy"],
            ["Rifampicin + Warfarin", "Rifampicin induces CYP2C9", "↓Warfarin effect → clot"],
            ["Erythromycin + Simvastatin", "Erythromycin inhibits CYP3A4", "↑Simvastatin → Rhabdomyolysis"],
            ["Amiodarone + Digoxin", "Amiodarone inhibits P-glycoprotein + CYP", "↑Digoxin toxicity"],
            ["Azole antifungals + Warfarin", "Inhibit CYP2C9", "↑Warfarin → bleeding"],
        ],
        col_widths=[5.5*cm, 6.5*cm, 5*cm]
    ))
    e.append(space(8))

    e.append(h_topic("4. NEWER DRUGS & ADVERSE EFFECTS (2-3 Questions)"))
    e.append(hr())

    e.append(h_sub("A. SGLT2 Inhibitors (Gliflozins) ★"))
    e.append(bullet(b("Drugs:") + " Dapagliflozin, Empagliflozin, Canagliflozin"))
    e.append(bullet(b("Mechanism:") + " Block SGLT2 in proximal tubule → glucose excreted in urine"))
    e.append(bullet(b("Benefits beyond glucose:") + " HF hospitalization ↓, CKD progression ↓, mortality ↓, weight loss, BP ↓"))
    e.append(bullet(b("Adverse effects:") + " Genital mycotic infections (MC), UTI, DKA (euglycemic - glucose may be normal!), Fournier's gangrene (rare but serious), Amputation risk (Canagliflozin)"))
    e.append(highlight_box("★ Euglycemic DKA: SGLT2i causes DKA with NORMAL blood sugar - diagnosis easily missed! Key: high ketones + metabolic acidosis + normal glucose", bg=C_YELLOW_BG, border=C_ORANGE))
    e.append(space(5))

    e.append(h_sub("B. GLP-1 Receptor Agonists"))
    e.append(bullet(b("Drugs:") + " Semaglutide (Ozempic), Liraglutide (Victoza/Saxenda), Exenatide"))
    e.append(bullet(b("Mechanism:") + " Mimic GLP-1 → ↑insulin (glucose-dependent), ↓glucagon, ↓gastric emptying, ↓appetite"))
    e.append(bullet(b("Benefits:") + " Weight loss (significant - semaglutide approved for obesity), CV protection, BP ↓"))
    e.append(bullet(b("Adverse effects:") + " Nausea/vomiting (MC), Pancreatitis, Thyroid C-cell tumors (contraindicated in MEN2/MTC), Gallstones"))
    e.append(space(5))

    e.append(h_sub("C. Monoclonal Antibodies - Key Examples"))
    e.append(make_table(
        ["Drug", "Target", "Use", "Key Adverse Effect"],
        [
            ["Infliximab / Adalimumab", "TNF-α", "RA, IBD, Psoriasis", "TB reactivation (screen before use!)"],
            ["Rituximab", "CD20 (B cells)", "NHL, RA, ANCA vasculitis", "Progressive multifocal leukoencephalopathy"],
            ["Trastuzumab (Herceptin)", "HER2/neu", "HER2+ Breast cancer", "Cardiotoxicity (cardiomyopathy)"],
            ["Bevacizumab", "VEGF", "Colorectal, lung cancers", "HTN, wound healing impaired, VTE"],
            ["Cetuximab / Panitumumab", "EGFR", "Colorectal cancer", "Acneiform rash"],
            ["Dupilumab", "IL-4/IL-13 receptor", "Atopic dermatitis, Asthma", "Conjunctivitis"],
            ["Omalizumab", "IgE", "Severe allergic asthma, CIU", "Anaphylaxis (rare)"],
        ],
        col_widths=[4*cm, 3*cm, 4*cm, 6*cm]
    ))
    e.append(PageBreak())

    # ── PATHOLOGY ─────────────────────────────────────────────────────────────────
    e.append(subject_header("PATHOLOGY", "~18-20 Questions | Priority 4", C_RED))
    e.append(space(10))

    e.append(h_topic("1. CELL INJURY (3-4 Questions)"))
    e.append(hr())
    e.append(exam_tip("'What is the EARLIEST/most sensitive sign of cell injury?' Questions test sequence of events"))
    e.append(space(4))

    e.append(h_sub("A. Sequence of Cell Injury Changes"))
    e.append(body(b("Reversible Injury (earliest to latest):")))
    e.append(make_table(
        ["Time", "Change", "Mechanism"],
        [
            ["Seconds", "↓ATP → Na/K pump fails → cell swelling (earliest change)", "ATP depletion"],
            ["Minutes", "ER swelling, ribosomes detach (↓protein synthesis), fatty change", "Continued ischemia"],
            ["Minutes", "↑Intracellular Ca2+ (most damaging)", "Membrane pump failure"],
            ["Still reversible", "Clumping of nuclear chromatin", "Acidosis from lactic acid"],
        ],
        col_widths=[3*cm, 8*cm, 6*cm]
    ))
    e.append(space(4))
    e.append(highlight_box("★ Earliest ultrastructural change: Cell swelling (hydropic change). Earliest light microscopic change: Fatty change (liver). Most important trigger of irreversible injury: Ca2+ influx", bg=C_YELLOW_BG, border=C_ORANGE))
    e.append(space(5))

    e.append(body(b("Irreversible Injury (point of no return):")))
    e.append(bullet("Severe mitochondrial dysfunction (cannot recover)"))
    e.append(bullet("Plasma membrane damage (loss of selective permeability)"))
    e.append(bullet("Lysosomal rupture (autolysis begins)"))
    e.append(space(5))

    e.append(h_sub("B. Types of Necrosis ★"))
    e.append(make_table(
        ["Type", "Appearance", "Where it occurs", "Cause/Example"],
        [
            ["Coagulative", "Ghost outlines preserved (cell shape maintained), nucleus gone", "Heart, kidney, adrenal (infarcts)", "Ischemia (most organs)"],
            ["Liquefactive", "Enzymatic digestion, liquid pus, ghost outlines LOST", "Brain infarct, Abscess", "Bacterial infections, CNS ischemia"],
            ["Caseous", "Cheese-like, amorphous, crumbly; no ghost outlines", "Lymph nodes, lung", "Tuberculosis (granuloma center)"],
            ["Fat necrosis", "Chalky white deposits (calcium soaps = saponification)", "Pancreas, breast, omentum", "Pancreatitis, trauma to breast"],
            ["Fibrinoid", "Pink homogeneous material in vessel walls", "Blood vessel walls", "Vasculitis, malignant HTN, SLE"],
            ["Gangrenous", "Dry = coagulative; Wet = liquefactive + coagulative", "Limbs", "Dry = vascular; Wet = infection added"],
        ],
        col_widths=[2.8*cm, 4.5*cm, 3.7*cm, 6*cm]
    ))
    e.append(space(5))

    e.append(h_sub("C. Apoptosis vs Necrosis"))
    e.append(make_table(
        ["Feature", "Apoptosis", "Necrosis"],
        [
            ["Initiator", "Programmed (caspase-mediated)", "Accidental (severe injury)"],
            ["Cell size", "Shrinks (condensation)", "Swells (hydropic change)"],
            ["Nucleus", "Karyorrhexis → pyknosis (fragmentation)", "Karyolysis (fades away)"],
            ["Membrane", "Intact, blebs form", "Ruptures"],
            ["Inflammation", "NONE (anti-inflammatory)", "YES (pro-inflammatory)"],
            ["DNA", "Ladder pattern (180 bp fragments)", "Smear pattern"],
            ["Pathological in", "Excessive: Parkinson's, cardiac atrophy", "All forms of acute injury"],
        ],
        col_widths=[3.5*cm, 6.5*cm, 7*cm]
    ))
    e.append(space(8))

    e.append(h_topic("2. ONCOLOGY / NEOPLASIA (5-6 Questions)"))
    e.append(hr())

    e.append(h_sub("A. Tumor Markers ★★ (5-7 questions per paper)"))
    e.append(exam_tip("Image + clinical features shown → identify tumor marker. Know the MOST SPECIFIC marker for each cancer"))
    e.append(make_table(
        ["Tumor Marker", "Cancer", "Notes"],
        [
            ["AFP (Alpha-fetoprotein)", "Hepatocellular carcinoma, Germ cell tumors (yolk sac)", "Also elevated in neural tube defects (AFP in amniotic fluid/maternal serum)"],
            ["CEA (Carcinoembryonic Ag)", "Colorectal cancer (CRC)", "Not diagnostic; used for monitoring recurrence. Also in gastric, pancreatic, lung"],
            ["PSA (Prostate-specific Ag)", "Prostate cancer", "PSA >10 = biopsy; Not organ-specific (elevated in BPH, prostatitis). Gleason grading"],
            ["CA-125", "Ovarian cancer (epithelial)", "Elevated in endometriosis too; used for monitoring"],
            ["CA 19-9", "Pancreatic cancer (most specific)", "Also cholangiocarcinoma"],
            ["CA 15-3", "Breast cancer", "Monitoring recurrence"],
            ["β-HCG", "Choriocarcinoma, Gestational trophoblastic disease, Testicular (non-seminoma)", "Diagnostic + monitoring"],
            ["LDH", "Seminoma, NHL, Ewing's sarcoma", "Non-specific but important prognostic marker"],
            ["Calcitonin", "Medullary thyroid carcinoma (MTC)", "MC familial form: MEN2A"],
            ["Chromogranin A", "Carcinoid tumor / Neuroendocrine tumors", "Also 5-HIAA in urine for carcinoid syndrome"],
            ["NSE (Neuron-specific enolase)", "Small cell lung cancer (SCLC), Neuroblastoma", "SCLC: paraneoplastic syndromes"],
        ],
        col_widths=[4.5*cm, 5*cm, 7.5*cm]
    ))
    e.append(space(6))

    e.append(h_sub("B. Immunohistochemistry (IHC) - Key Markers ★"))
    e.append(exam_tip("Image of stained biopsy → 'What marker is positive?' Questions are increasingly image-based"))
    e.append(make_table(
        ["IHC Marker", "Positive in", "Clinical Use"],
        [
            ["CD20", "B-cell lymphomas", "Target for Rituximab"],
            ["CD3", "T-cell lymphomas", "T-cell identification"],
            ["CD30", "Hodgkin lymphoma (RS cells), ALCL", "Binds Reed-Sternberg cells"],
            ["CD15", "Hodgkin lymphoma (classical)", "RS cells: CD15+, CD30+"],
            ["ER/PR (Estrogen/Progesterone receptor)", "Breast cancer", "Hormonal therapy (Tamoxifen/Aromatase inhibitors)"],
            ["HER2/neu (CerbB-2)", "Breast cancer (~20%)", "Trastuzumab therapy; worse prognosis"],
            ["PSA", "Prostate cancer", "Confirms prostatic origin of mets"],
            ["TTF-1 (Thyroid transcription factor)", "Lung adenocarcinoma, Thyroid cancer", "Differentiates primary lung from mets"],
            ["S-100", "Melanoma, Schwannoma, Langerhans cells", "Neural crest origin tumors"],
            ["Desmin", "Rhabdomyosarcoma (muscle tumor)", "Muscle marker"],
            ["CD45 (LCA)", "Lymphomas (all)", "Distinguishes lymphoma from carcinoma"],
            ["Cytokeratin (CK)", "Carcinomas (epithelial)", "Confirms epithelial origin"],
            ["Vimentin", "Sarcomas (mesenchymal)", "Soft tissue tumors"],
        ],
        col_widths=[5*cm, 5*cm, 7*cm]
    ))
    e.append(space(6))

    e.append(h_sub("C. Cytogenetics of Hematological Malignancies ★"))
    e.append(exam_tip("'Which translocation is associated with X disease?' - guaranteed question every year"))
    e.append(make_table(
        ["Translocation", "Disease", "Gene Fusion", "Mnemonic"],
        [
            ["t(9;22) = Philadelphia chromosome", "CML (>95%), ALL (poor prognosis)", "BCR-ABL → Imatinib (DOC)", "9+22 = 31 = Ph+"],
            ["t(15;17)", "Acute Promyelocytic Leukemia (M3 AML)", "PML-RARα → ATRA (treatment)", "15+17 = 32 = M3"],
            ["t(8;14)", "Burkitt lymphoma", "C-MYC dysregulation", "8+14 = 22 = Burkitt"],
            ["t(14;18)", "Follicular lymphoma (MC lymphoma)", "BCL-2 overexpression (anti-apoptosis)", "14+18 = 32 = Follicular"],
            ["t(11;14)", "Mantle cell lymphoma", "BCL-1/Cyclin D1", "11+14 = Mantle"],
            ["t(2;5)", "Anaplastic Large Cell Lymphoma (ALCL)", "NPM-ALK", ""],
            ["del(17p) = TP53", "CLL (poor prognosis), many solid tumors", "Loss of tumor suppressor", ""],
            ["del(5q)", "Myelodysplastic syndrome (MDS)", "Lenalidomide responsive", "5q- syndrome"],
        ],
        col_widths=[4*cm, 5*cm, 4*cm, 4*cm]
    ))
    e.append(space(8))

    e.append(h_topic("3. HEMATOLOGY (3-4 Questions)"))
    e.append(hr())

    e.append(h_sub("A. Anemia Classification and Diagnosis"))
    e.append(make_table(
        ["Type", "MCV", "Key Causes", "Peripheral smear"],
        [
            ["Microcytic hypochromic\n(MCV <80)", "Low", "IDA (MC worldwide), Thalassemia, Anemia of chronic disease (usually normocytic), Lead poisoning, Sideroblastic", "Pencil cells (IDA), Target cells (Thal), Basophilic stippling (lead)"],
            ["Normocytic normochromic\n(MCV 80-100)", "Normal", "Anemia of chronic disease (MC), Aplastic anemia, Hemolytic anemia, Early IDA", "Variable; spherocytes in hemolysis"],
            ["Macrocytic\n(MCV >100)", "High", "B12/Folate deficiency (megaloblastic), Alcohol, Hypothyroidism, Liver disease, Drugs (MTX, AZT)", "Hypersegmented neutrophils (megaloblastic)"],
        ],
        col_widths=[3.5*cm, 1.5*cm, 6.5*cm, 5.5*cm]
    ))
    e.append(space(5))

    e.append(body(b("Iron Deficiency Anemia (IDA) - Staging:")))
    e.append(bullet("Stage 1: ↓ Ferritin (first to fall) - storage iron depleted"))
    e.append(bullet("Stage 2: ↑ TIBC, ↓ Serum iron, ↓ Transferrin saturation"))
    e.append(bullet("Stage 3: ↓ Hemoglobin, MCV falls → microcytic hypochromic anemia"))
    e.append(highlight_box("★ Ferritin = BEST single test for IDA. TIBC is inversely proportional to iron stores. Low ferritin = IDA (even if MCV normal)", bg=C_YELLOW_BG, border=C_ORANGE))
    e.append(space(6))

    e.append(h_sub("B. Leukemias - Key Differentiating Features"))
    e.append(make_table(
        ["Type", "Age", "WBC", "Key Feature", "Marker", "DOC"],
        [
            ["ALL", "Children (2-5yr)", "Variable", "Common ALL Ag (CALLA/CD10+)", "t(12;21) good prognosis", "Vincristine+Prednisolone+Asparaginase"],
            ["AML (M3)", "Adults", "↓ or ↑", "DIC + Auer rods (promyelocytes)", "t(15;17) PML-RARα", "ATRA + Arsenic trioxide"],
            ["CML", "Adults 30-60yr", "↑↑↑ (>100k)", "Splenomegaly ++, Philadelphia chromosome", "t(9;22) BCR-ABL", "Imatinib (Gleevec)"],
            ["CLL", "Elderly >60yr", "↑ lymphocytes", "Smudge cells, CD5+CD19+", "del(17p) = worst prognosis", "Ibrutinib (BTK inhibitor)"],
            ["Hairy Cell Leukemia", "Middle-aged men", "↓ (pancytopenia)", "TRAP stain+, splenomegaly, hair-like projections", "CD11c, CD25, CD103+", "Cladribine (2-CDA)"],
        ],
        col_widths=[2.5*cm, 2.5*cm, 2.5*cm, 4.5*cm, 3*cm, 3*cm]
    ))
    e.append(space(8))

    e.append(h_topic("4. INFLAMMATION & GRANULOMA (2-3 Questions)"))
    e.append(hr())

    e.append(h_sub("A. Granulomatous Diseases - High Yield"))
    e.append(exam_tip("'What type of hypersensitivity is granuloma?' = Type IV (cell-mediated). 'What are granuloma components?' = Epithelioid macrophages + Langhans giant cells"))
    e.append(make_table(
        ["Disease", "Type of Granuloma", "Key Histology", "Stain"],
        [
            ["Tuberculosis", "Caseating (necrotizing)", "Central caseation + Langhans giant cells + lymphocytes", "Ziehl-Neelsen (acid-fast bacilli)"],
            ["Sarcoidosis", "Non-caseating (naked granuloma)", "Tight granulomas without necrosis; Schaumann/asteroid bodies", "No specific stain"],
            ["Leprosy - LL", "Non-caseating; foamy macrophages", "Lepra cells (vacuolated macrophages), many bacilli", "Wade-Fite stain"],
            ["Leprosy - TT", "Caseating epithelioid", "Well-formed granuloma, few/no bacilli", "Wade-Fite stain"],
            ["Crohn's disease", "Non-caseating", "Transmural inflammation + non-caseating granuloma", "H&E"],
            ["Cat-scratch disease", "Stellate microabscesses", "Warthin-Starry stain (Bartonella)", "Warthin-Starry"],
            ["Wegener's (GPA)", "Necrotizing + vasculitis", "c-ANCA (PR3) positive", "PAS"],
        ],
        col_widths=[3.5*cm, 3.5*cm, 5.5*cm, 4.5*cm]
    ))
    e.append(space(8))

    # ── QUICK REVISION PAGE ──────────────────────────────────────────────────────
    e.append(PageBreak())
    e.append(subject_header("QUICK REVISION", "Last-Minute High-Yield Facts", C_GREEN))
    e.append(space(10))

    e.append(h_topic("MUST-KNOW MNEMONICS"))
    e.append(hr())
    e.append(mnemonic_box("AEIOU (Dialysis indications)", "Acidosis, Electrolytes, Intoxication, Overload, Uremia"))
    e.append(mnemonic_box("ABCDE (ATLS Primary Survey)", "Airway, Breathing, Circulation, Disability, Exposure"))
    e.append(mnemonic_box("4Ts (PPH causes)", "Tone (uterine atony, MC), Tissue (retained), Trauma (lacerations), Thrombin (coagulopathy)"))
    e.append(mnemonic_box("GET SMASHED (Pancreatitis causes)", "Gallstones, Ethanol, Trauma, Steroids, Mumps, Autoimmune, Scorpion, Hypertriglyceridemia, ERCP, Drugs"))
    e.append(mnemonic_box("RIPES (CYP450 Inducers)", "Rifampicin, Isoniazid, Phenytoin, Ethanol (chronic), Smoking/St John's wort"))
    e.append(mnemonic_box("MUDPILES (High Anion Gap causes)", "Methanol, Uremia, DKA, Propylene glycol, Isoniazid/Iron, Lactic acidosis, Ethylene glycol, Salicylates"))
    e.append(mnemonic_box("ABCDE (HF Mortality drugs)", "ACEi/ARB/ARNI, Beta-blocker, Careful use of SGLT2i, Diuretics (symptom only), Eplerenone/Spironolactone"))
    e.append(space(6))

    e.append(h_topic("★ GUARANTEED QUESTIONS - NEET PG 2026"))
    e.append(hr())
    e.append(make_table(
        ["Topic", "What to Expect"],
        [
            ["DKA management", "K+ management steps, fluid choice, anion gap closure criteria"],
            ["ACS - fibrinolysis vs PCI", "Timing, door-to-balloon time, contraindications to fibrinolysis"],
            ["WPW syndrome", "Drugs to AVOID (Adenosine, Digoxin, Verapamil); DOC = Procainamide"],
            ["ATLS Primary Survey", "Order of ABCDE + what to do first when two threats present"],
            ["Tension pneumothorax", "Clinical diagnosis (don't wait for X-ray), immediate needle decompression"],
            ["Philadelphia chromosome", "t(9;22), BCR-ABL, CML, Imatinib"],
            ["SGLT2 inhibitor adverse effects", "Euglycemic DKA, genital infections, Fournier's gangrene"],
            ["Child-Pugh scoring", "5 parameters, scoring, classes A/B/C"],
            ["Drug of choice questions", "15-20 questions total - know all DOCs in this booklet"],
            ["Anti-TNF (Infliximab) + TB", "Screen for latent TB before starting anti-TNF therapy"],
        ],
        col_widths=[5*cm, 12*cm]
    ))
    e.append(space(6))

    e.append(highlight_box("REMEMBER: 30% of NEET PG questions are modified repeats from previous papers. Master PYQs alongside these notes!", bg=C_GREEN_BG, border=C_GREEN))

    return e

# ══════════════════════════════════════════════════════════════════════════════
# PAGE TEMPLATE
# ══════════════════════════════════════════════════════════════════════════════
def build_document():
    doc = SimpleDocTemplate(
        OUTPUT_PATH,
        pagesize=A4,
        rightMargin=2*cm,
        leftMargin=2*cm,
        topMargin=2.2*cm,
        bottomMargin=2.2*cm,
    )

    def on_page(canvas, doc):
        canvas.saveState()
        # Header line
        canvas.setStrokeColor(C_TEAL)
        canvas.setLineWidth(0.5)
        canvas.line(2*cm, A4[1]-1.5*cm, A4[0]-2*cm, A4[1]-1.5*cm)
        canvas.setFont("Helvetica", 7)
        canvas.setFillColor(C_TEAL)
        canvas.drawString(2*cm, A4[1]-1.2*cm, "NEET PG 2026 High-Yield Notes | The Big Four")
        canvas.drawRightString(A4[0]-2*cm, A4[1]-1.2*cm, "Medicine • Surgery • Pharmacology • Pathology")
        # Footer
        canvas.setStrokeColor(C_LIGHT_GREY)
        canvas.line(2*cm, 1.8*cm, A4[0]-2*cm, 1.8*cm)
        canvas.setFillColor(C_LIGHT_GREY)
        canvas.drawCentredString(A4[0]/2, 1.2*cm, f"Page {doc.page}")
        canvas.restoreState()

    story = []
    story += build_cover()
    story += build_medicine()
    story += build_surgery_extra()  # small additions
    story += build_pharmacology_extra()
    story += build_pathology_extra()

    doc.build(story, onFirstPage=on_page, onLaterPages=on_page)
    print(f"PDF created: {OUTPUT_PATH}")

def build_surgery_extra():
    return []  # already included in build_medicine() flow above

def build_pharmacology_extra():
    return []

def build_pathology_extra():
    return []

if __name__ == "__main__":
    build_document()

cd /home/daytona/workspace/neet-pg-notes && python generate_notes.py 2>&1

ls -lh /home/daytona/workspace/neet-pg-notes/NEET_PG_2026_BigFour_Notes.pdf

python3 -c " from pypdf import PdfReader r = PdfReader('/home/daytona/workspace/…

ls -lh /home/daytona/workspace/neet-pg-notes/ && file /home/daytona/workspace/ne…

~/neet-pg-notes/generate_html.py

#!/usr/bin/env python3
"""Generate NEET PG 2026 High-Yield Notes as a self-contained HTML file"""

OUTPUT = "/home/daytona/workspace/neet-pg-notes/NEET_PG_2026_BigFour_Notes.html"

html = """<!DOCTYPE html>
<html lang="en">
<head>
<meta charset="UTF-8">
<meta name="viewport" content="width=device-width, initial-scale=1.0">
<title>NEET PG 2026 - High-Yield Notes: Big Four Subjects</title>
<style>
  :root {
    --navy: #1A3A5C;
    --teal: #00827F;
    --orange: #E87722;
    --red: #C0392B;
    --green: #1E8449;
    --yellow-bg: #FFF9E6;
    --blue-bg: #EBF5FB;
    --green-bg: #EAFAF1;
    --red-bg: #FDEDEC;
    --grey-bg: #F2F3F4;
  }
  * { box-sizing: border-box; margin: 0; padding: 0; }
  body { font-family: 'Segoe UI', Arial, sans-serif; font-size: 13px; color: #2C3E50; background: #fff; }
  .container { max-width: 960px; margin: 0 auto; padding: 20px; }

  /* COVER */
  .cover { background: var(--navy); color: white; padding: 40px 30px; border-radius: 8px; margin-bottom: 30px; text-align: center; }
  .cover h1 { font-size: 36px; font-weight: 900; letter-spacing: 2px; }
  .cover h2 { font-size: 22px; font-weight: 400; margin-top: 8px; opacity: 0.9; }
  .cover .gold { color: #FFD700; font-size: 24px; font-weight: 700; margin: 12px 0; }
  .cover .subjects { font-size: 15px; opacity: 0.85; margin-top: 6px; }
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<div class="container">

<!-- COVER -->
<div class="cover">
  <h1>NEET PG 2026</h1>
  <h2>HIGH-YIELD NOTES</h2>
  <div class="gold">The Big Four Subjects</div>
  <div class="subjects">Medicine &nbsp;•&nbsp; Surgery &nbsp;•&nbsp; Pharmacology &nbsp;•&nbsp; Pathology</div>
  <div class="subjects" style="margin-top:8px;font-size:12px;opacity:0.7;">Based on PYQ Analysis | 2023–2025 Trends | 2026 Predictions</div>
  <div class="stat-row">
    <div class="stat-box"><div class="num">~100 Qs</div><div class="desc">from Big Four (55% of paper)</div></div>
    <div class="stat-box"><div class="num">30%</div><div class="desc">questions repeat from PYQs</div></div>
    <div class="stat-box"><div class="num">55%+</div><div class="desc">clinical reasoning required 2026</div></div>
    <div class="stat-box"><div class="num">15–20</div><div class="desc">Drug of Choice questions per paper</div></div>
  </div>
</div>

<!-- HOW TO USE -->
<div class="box-blue">
  <b>How to Use These Notes:</b> Red/bold = most tested facts. Yellow boxes = guaranteed exam material. Blue boxes = mnemonics. ★ = predicted must-know for 2026.
  <br><b>To save as PDF:</b> Open in Chrome → File → Print → Save as PDF (or Ctrl+P → Save as PDF)
</div>

<!-- ═══════════════════════════ MEDICINE ═══════════════════════════ -->
<div class="subject-header sh-medicine">
  <h2>INTERNAL MEDICINE</h2>
  <div class="meta">~35–40 Questions | Priority #1 | Cardiology · Endocrinology · Nephrology · Respiratory · GI · Rheumatology · Neurology</div>
</div>

<div class="topic">1. CARDIOLOGY (8–12 Questions)</div><hr class="section">

<div class="subtopic">A. Acute Coronary Syndrome (ACS) ★★★ Most Tested</div>
<p class="exam-tip">"Patient with chest pain + ST elevation → next step?" = Time-based PCI vs fibrinolysis decision</p>
<ul class="notes">
  <li><b>STEMI:</b> ST elevation ≥2 contiguous leads OR new LBBB</li>
  <li><b>NSTEMI:</b> Troponin elevated, NO ST elevation</li>
  <li><b>Unstable Angina:</b> Troponin negative, chest pain at rest</li>
</ul>
<div class="box-yellow">★ Door-to-balloon time &lt;90 min (PCI) | Door-to-needle time &lt;30 min (fibrinolysis)</div>
<div class="tbl-wrap"><table>
  <thead><tr><th>Scenario</th><th>Choice</th><th>Time Window</th></tr></thead>
  <tbody>
    <tr><td>PCI-capable centre available</td><td><b>Primary PCI (preferred)</b></td><td>&lt;12 hours of symptom onset</td></tr>
    <tr><td>PCI not available within 120 min</td><td><b>Fibrinolysis</b></td><td>&lt;12 hours; give within 30 min of diagnosis</td></tr>
    <tr><td>Fibrinolysis failed (no reperfusion at 90 min)</td><td><b>Rescue PCI</b></td><td>Immediately</td></tr>
    <tr><td>After successful fibrinolysis</td><td><b>Routine angiography</b></td><td>3–24 hours later (NOT immediate PCI)</td></tr>
  </tbody>
</table></div>
<div class="subtopic">STEMI ECG Localization</div>
<div class="tbl-wrap"><table>
  <thead><tr><th>Leads with Changes</th><th>Wall Involved</th><th>Artery</th></tr></thead>
  <tbody>
    <tr><td>II, III, aVF</td><td>Inferior wall</td><td>RCA</td></tr>
    <tr><td>V1–V4</td><td>Anterior wall</td><td>LAD</td></tr>
    <tr><td>I, aVL, V5–V6</td><td>Lateral wall</td><td>LCX</td></tr>
    <tr><td>V1–V2 (tall R wave)</td><td>Posterior wall</td><td>RCA / LCX</td></tr>
    <tr><td>V3R, V4R</td><td>Right ventricle</td><td>RCA (proximal)</td></tr>
  </tbody>
</table></div>

<div class="subtopic">B. Heart Failure (HF)</div>
<p class="exam-tip">Know NYHA classification + which drugs improve mortality vs just symptoms</p>
<div class="tbl-wrap"><table>
  <thead><tr><th>Class</th><th>Symptoms</th></tr></thead>
  <tbody>
    <tr><td>I</td><td>No symptoms with ordinary activity</td></tr>
    <tr><td>II</td><td>Slight limitation, comfortable at rest</td></tr>
    <tr><td>III</td><td>Marked limitation, comfortable only at rest</td></tr>
    <tr><td>IV</td><td>Symptoms at rest</td></tr>
  </tbody>
</table></div>
<div class="box-blue">Mnemonic – HF Mortality Drugs: <b>ABC-D-A</b> = ACEi/ARNI, Beta-blocker, Careful SGLT2i, Diuretic (symptom only), Aldosterone antagonist</div>
<div class="tbl-wrap"><table>
  <thead><tr><th>Drug Class</th><th>Example</th><th>Benefit</th></tr></thead>
  <tbody>
    <tr><td>ARNI (1st line now)</td><td><b>Sacubitril + Valsartan</b></td><td>Superior to ACEi; mortality ↓</td></tr>
    <tr><td>ACE Inhibitor</td><td>Ramipril, Enalapril</td><td>Mortality ↓, remodeling ↓</td></tr>
    <tr><td>Beta-blocker</td><td>Carvedilol, Metoprolol, Bisoprolol</td><td>Mortality ↓, HR control</td></tr>
    <tr><td>Aldosterone antagonist</td><td>Spironolactone, Eplerenone</td><td>Mortality ↓ (EF&lt;35%)</td></tr>
    <tr><td>SGLT2 inhibitor</td><td>Dapagliflozin, Empagliflozin</td><td>HF hospitalization ↓, mortality ↓</td></tr>
    <tr><td>Ivabradine</td><td>Ivabradine</td><td>HR&gt;70 on max beta-blocker</td></tr>
  </tbody>
</table></div>

<div class="subtopic">C. Arrhythmias</div>
<p class="exam-tip">ECG strips shown → identify + give DOC. WPW is a classic trap question.</p>
<div class="tbl-wrap"><table>
  <thead><tr><th>Arrhythmia</th><th>ECG Finding</th><th>Drug of Choice</th></tr></thead>
  <tbody>
    <tr><td>Atrial Fibrillation</td><td>Irregularly irregular, absent P waves</td><td>Rate: Metoprolol/Digoxin; Rhythm: Amiodarone</td></tr>
    <tr><td>Atrial Flutter</td><td>Sawtooth F waves at 300/min</td><td>Cardioversion preferred; Diltiazem for rate</td></tr>
    <tr><td>SVT (AVNRT)</td><td>Narrow complex, no P waves</td><td><b>Adenosine IV</b> → Verapamil if fails</td></tr>
    <tr><td><b>WPW Syndrome</b></td><td>Short PR, delta wave, wide QRS</td><td><b>Procainamide / DC Cardioversion</b></td></tr>
    <tr><td>VT (stable)</td><td>Wide complex &gt;120ms, AV dissociation</td><td>Amiodarone IV</td></tr>
    <tr><td>VT pulseless</td><td>Wide complex, no pulse</td><td><b>Defibrillation immediately</b></td></tr>
    <tr><td>Torsades de Pointes</td><td>Twisting QRS around isoelectric line</td><td><b>IV Magnesium sulfate</b></td></tr>
    <tr><td>Complete Heart Block</td><td>P and QRS dissociated</td><td>Atropine → Pacemaker (definitive)</td></tr>
  </tbody>
</table></div>
<div class="box-red">★ WPW TRAP: NEVER give Adenosine, Digoxin, or Verapamil in WPW with AF → can cause fatal VF! DOC = Procainamide or DC cardioversion</div>

<div class="topic">2. ENDOCRINOLOGY (7–9 Questions)</div><hr class="section">

<div class="subtopic">A. Diabetic Ketoacidosis (DKA) — THE #1 Most Tested Topic ★★★</div>
<p class="exam-tip">Tests: diagnosis criteria, fluid choice, K+ management, insulin timing, anion gap closure</p>
<ul class="notes">
  <li><b>Diagnostic Criteria (ALL 3):</b>
    <ul>
      <li>Blood glucose &gt;250 mg/dL</li>
      <li>Arterial pH &lt;7.3 OR HCO3 &lt;18 mEq/L</li>
      <li>Ketonemia/ketonuria positive</li>
    </ul>
  </li>
</ul>
<div class="tbl-wrap"><table>
  <thead><tr><th>Parameter</th><th>Mild</th><th>Moderate</th><th>Severe</th></tr></thead>
  <tbody>
    <tr><td>pH</td><td>7.25–7.30</td><td>7.00–7.24</td><td>&lt;7.00</td></tr>
    <tr><td>HCO3</td><td>15–18</td><td>10–15</td><td>&lt;10</td></tr>
    <tr><td>Anion Gap</td><td>&gt;10</td><td>&gt;12</td><td>&gt;12</td></tr>
    <tr><td>Mental status</td><td>Alert</td><td>Alert/drowsy</td><td>Stupor/coma</td></tr>
  </tbody>
</table></div>
<div class="subtopic">DKA Management — Step by Step</div>
<ul class="notes">
  <li><b>Step 1 – Fluids:</b> 0.9% NS 1L in 1st hour → 500mL/hr × 2h → 250mL/hr. Switch to D5 0.45%NS when glucose &lt;250 mg/dL</li>
  <li><b>Step 2 – Potassium (THE TRAP):</b> Check K+ BEFORE giving insulin!
    <ul>
      <li>K+ &lt;3.5: Replace K+ first, HOLD insulin until K+ &gt;3.5</li>
      <li>K+ 3.5–5.0: Give K+ 20–40 mEq/hr WITH insulin</li>
      <li>K+ &gt;5.0: Start insulin, hold K+ replacement</li>
    </ul>
  </li>
  <li><b>Step 3 – Insulin:</b> Regular insulin 0.1 units/kg/hr IV. Glucose should fall 50–75 mg/dL/hr</li>
  <li><b>Step 4 – Bicarbonate:</b> ONLY if pH &lt;6.9 (NOT routinely — worsens hypokalemia, cerebral edema)</li>
  <li><b>Resolution:</b> Glucose &lt;200 + pH &gt;7.3 + HCO3 &gt;15 + Anion gap CLOSED</li>
</ul>
<div class="box-yellow">★ Anion Gap = Na − (Cl + HCO3). Normal = 8–12. DKA typically &gt;20. Resolution = AG closes, NOT just glucose normalization!</div>
<div class="box-red">CEREBRAL EDEMA in DKA: MC in children. Headache + altered consciousness after initial improvement. Tx: IV Mannitol</div>

<div class="subtopic">B. Thyroid Disorders</div>
<div class="tbl-wrap"><table>
  <thead><tr><th>Condition</th><th>TSH</th><th>Free T4</th><th>Key Features</th></tr></thead>
  <tbody>
    <tr><td>Primary Hypothyroidism</td><td>↑↑</td><td>↓</td><td>MC cause: Hashimoto's (TPO Ab+)</td></tr>
    <tr><td>Central Hypothyroidism</td><td>↓/N</td><td>↓</td><td>Pituitary/hypothalamic cause</td></tr>
    <tr><td>Primary Hyperthyroidism</td><td>↓↓</td><td>↑</td><td>Graves: TSH-R Ab+, pretibial myxedema</td></tr>
    <tr><td>Subclinical Hypothyroid</td><td>↑</td><td>N</td><td>Treat if TSH &gt;10 or symptomatic</td></tr>
    <tr><td>Sick Euthyroid</td><td>N/↓</td><td>N</td><td>Low T3, normal T4 in ill patients</td></tr>
  </tbody>
</table></div>
<div class="box-blue">Mnemonic – Thyroid Storm Tx: <b>BIGS</b> = Beta-blocker, Iodine (after PTU &gt;1h), Glucocorticoids, Solution (PTU/Methimazole first)</div>

<div class="subtopic">C. PCOS — Rotterdam Criteria (2 of 3)</div>
<ul class="notes">
  <li>Oligo/anovulation (irregular cycles)</li>
  <li>Clinical or biochemical hyperandrogenism</li>
  <li>Polycystic ovaries on USG (≥12 follicles 2–9mm OR volume &gt;10 mL)</li>
  <li><b>Treatment:</b> Menstrual irregularity → OCP | Infertility → Clomiphene citrate | Insulin resistance → Metformin | Hirsutism → Spironolactone</li>
</ul>

<div class="topic">3. NEPHROLOGY (4–6 Questions)</div><hr class="section">

<div class="subtopic">A. RIFLE / AKIN Criteria for AKI ★★</div>
<div class="tbl-wrap"><table>
  <thead><tr><th>RIFLE Stage</th><th>Creatinine</th><th>Urine Output</th><th>AKIN</th></tr></thead>
  <tbody>
    <tr><td>Risk (R)</td><td>×1.5 or ↓GFR &gt;25%</td><td>&lt;0.5 mL/kg/h × 6h</td><td>Stage 1</td></tr>
    <tr><td>Injury (I)</td><td>×2 or ↓GFR &gt;50%</td><td>&lt;0.5 mL/kg/h × 12h</td><td>Stage 2</td></tr>
    <tr><td>Failure (F)</td><td>×3 or Scr &gt;4 mg/dL</td><td>&lt;0.3 mL/kg/h × 24h OR anuria × 12h</td><td>Stage 3</td></tr>
  </tbody>
</table></div>
<div class="tbl-wrap"><table>
  <thead><tr><th>Parameter</th><th>Pre-renal</th><th>Intrinsic (ATN)</th></tr></thead>
  <tbody>
    <tr><td>BUN:Creatinine</td><td>&gt;20:1</td><td>&lt;10:1</td></tr>
    <tr><td>Urine Na+</td><td>&lt;20 mEq/L</td><td>&gt;40 mEq/L</td></tr>
    <tr><td>FENa</td><td>&lt;1%</td><td>&gt;2%</td></tr>
    <tr><td>Urine Osmolality</td><td>&gt;500 mOsm/kg</td><td>&lt;350 mOsm/kg</td></tr>
  </tbody>
</table></div>
<div class="box-blue">Mnemonic – Dialysis Indications: <b>AEIOU</b> = Acidosis (pH&lt;7.1), Electrolytes (K+&gt;6.5 refractory), Intoxication, Overload (fluid), Uremia (pericarditis/encephalopathy/bleeding)</div>

<div class="topic">4. RESPIRATORY MEDICINE (4–6 Questions)</div><hr class="section">
<div class="subtopic">COPD vs Asthma</div>
<div class="tbl-wrap"><table>
  <thead><tr><th>Feature</th><th>COPD</th><th>Asthma</th></tr></thead>
  <tbody>
    <tr><td>Age</td><td>Usually &gt;40 years</td><td>Any age</td></tr>
    <tr><td>Smoking</td><td>Almost always</td><td>Not required</td></tr>
    <tr><td>Reversibility</td><td>Incomplete (&lt;12%)</td><td>Complete (≥12% + 200mL)</td></tr>
    <tr><td>FEV1/FVC</td><td>&lt;0.7 (fixed)</td><td>&lt;0.7 (reversible)</td></tr>
    <tr><td>DLCO</td><td>Reduced (emphysema)</td><td>Normal</td></tr>
    <tr><td>Eosinophilia</td><td>Not typically</td><td>Common</td></tr>
  </tbody>
</table></div>

<div class="subtopic">Pneumonia — Classification + DOC</div>
<div class="tbl-wrap"><table>
  <thead><tr><th>Type</th><th>Organism</th><th>DOC</th></tr></thead>
  <tbody>
    <tr><td>CAP – mild</td><td>Strep pneumoniae</td><td>Amoxicillin</td></tr>
    <tr><td>CAP – moderate/severe</td><td>Strep pneumoniae + atypicals</td><td>Amox-Clav + Macrolide OR Respiratory FQ</td></tr>
    <tr><td>HAP (&gt;48h after admission)</td><td>Gram-negatives, MRSA</td><td>Pip-Tazo ± Vancomycin</td></tr>
    <tr><td>Atypical (walking)</td><td>Mycoplasma, Chlamydia, Legionella</td><td>Azithromycin / Doxycycline</td></tr>
    <tr><td>PCP (HIV, CD4 &lt;200)</td><td>Pneumocystis jirovecii</td><td>TMP-SMX (Co-trimoxazole)</td></tr>
  </tbody>
</table></div>

<div class="topic">5. GASTROENTEROLOGY (5–7 Questions)</div><hr class="section">
<div class="subtopic">Child-Pugh Score</div>
<div class="tbl-wrap"><table>
  <thead><tr><th>Parameter</th><th>1 point</th><th>2 points</th><th>3 points</th></tr></thead>
  <tbody>
    <tr><td>Bilirubin (mg/dL)</td><td>&lt;2</td><td>2–3</td><td>&gt;3</td></tr>
    <tr><td>Albumin (g/dL)</td><td>&gt;3.5</td><td>2.8–3.5</td><td>&lt;2.8</td></tr>
    <tr><td>PT prolongation (sec)</td><td>&lt;4</td><td>4–6</td><td>&gt;6</td></tr>
    <tr><td>Ascites</td><td>None</td><td>Mild</td><td>Moderate-severe</td></tr>
    <tr><td>Encephalopathy</td><td>None</td><td>Grade 1–2</td><td>Grade 3–4</td></tr>
  </tbody>
</table></div>
<ul class="notes"><li>Score 5–6 = Class A (good) | 7–9 = Class B | 10–15 = Class C (poor prognosis)</li></ul>

<div class="subtopic">Cirrhosis Complications — Management</div>
<div class="tbl-wrap"><table>
  <thead><tr><th>Complication</th><th>Treatment</th></tr></thead>
  <tbody>
    <tr><td>Ascites (grade 2)</td><td>Spironolactone ± Furosemide + low Na diet</td></tr>
    <tr><td>SBP</td><td>Cefotaxime IV; Prophylaxis: Norfloxacin/Ciprofloxacin</td></tr>
    <tr><td>Hepatic Encephalopathy</td><td>Lactulose (1st line); Rifaximin (add-on)</td></tr>
    <tr><td>Hepatorenal Syndrome type 1</td><td>Terlipressin + Albumin (DOC)</td></tr>
    <tr><td>Variceal bleeding (acute)</td><td>Octreotide/Terlipressin + Endoscopic band ligation</td></tr>
    <tr><td>Primary prevention of varices</td><td>Non-selective beta-blocker (Propranolol/Nadolol)</td></tr>
  </tbody>
</table></div>

<div class="subtopic">Crohn's vs Ulcerative Colitis</div>
<div class="tbl-wrap"><table>
  <thead><tr><th>Feature</th><th>Crohn's</th><th>UC</th></tr></thead>
  <tbody>
    <tr><td>Location</td><td>Anywhere (skip lesions)</td><td>Colon only, continuous from rectum</td></tr>
    <tr><td>Rectal involvement</td><td>Spared (50%)</td><td>Always involved</td></tr>
    <tr><td>Wall involvement</td><td>Transmural</td><td>Mucosa + submucosa only</td></tr>
    <tr><td>Histology</td><td>Non-caseating granulomas</td><td>Crypt abscesses, no granulomas</td></tr>
    <tr><td>Complications</td><td>Fistulas, strictures, abscesses</td><td>Toxic megacolon, CRC</td></tr>
    <tr><td>Smoking</td><td>Worsens</td><td>Protective (paradoxically)</td></tr>
    <tr><td>DOC (mild)</td><td>Budesonide + Metronidazole</td><td>5-ASA (Mesalazine)</td></tr>
    <tr><td>Surgery</td><td>Does NOT cure</td><td>Total colectomy = curative</td></tr>
  </tbody>
</table></div>

<div class="topic">6. RHEUMATOLOGY (3–4 Questions)</div><hr class="section">
<div class="subtopic">SLE — ACR/EULAR 2019 Criteria</div>
<p>Entry criterion: ANA ≥1:80. Score ≥10 points = SLE diagnosis.</p>
<div class="tbl-wrap"><table>
  <thead><tr><th>Feature</th><th>Score</th></tr></thead>
  <tbody>
    <tr><td>Malar rash (acute cutaneous lupus)</td><td>6</td></tr>
    <tr><td>Synovitis ≥2 joints</td><td>6</td></tr>
    <tr><td>Anti-dsDNA OR Anti-Sm</td><td>6</td></tr>
    <tr><td>Pleuritis/pericarditis</td><td>5</td></tr>
    <tr><td>Hemolytic anemia</td><td>4</td></tr>
    <tr><td>Thrombocytopenia &lt;100k</td><td>4</td></tr>
    <tr><td>Proteinuria &gt;0.5g/24h</td><td>4</td></tr>
    <tr><td>Low C3 OR C4</td><td>3</td></tr>
    <tr><td>Leukopenia / Lymphopenia</td><td>3</td></tr>
  </tbody>
</table></div>
<ul class="notes">
  <li><b>ANA:</b> Most sensitive (95%) — screening test</li>
  <li><b>Anti-dsDNA:</b> Most specific; correlates with disease activity (nephritis)</li>
  <li><b>Anti-Sm:</b> Most specific antibody (25–30%)</li>
  <li><b>Anti-histone:</b> Drug-induced lupus (Hydralazine, Procainamide, Isoniazid)</li>
  <li><b>Anti-Ro/SSA:</b> Neonatal lupus, congenital heart block</li>
</ul>

<div class="topic">7. NEUROLOGY (3–4 Questions)</div><hr class="section">
<div class="subtopic">Stroke Localization</div>
<div class="tbl-wrap"><table>
  <thead><tr><th>Artery</th><th>Deficits</th><th>Key Feature</th></tr></thead>
  <tbody>
    <tr><td>MCA (dominant)</td><td>Contralateral hemiplegia (face+arm&gt;leg), aphasia</td><td>Most common stroke territory</td></tr>
    <tr><td>MCA (non-dominant)</td><td>Hemiplegia + hemineglect</td><td>Neglect = non-dominant side</td></tr>
    <tr><td>ACA</td><td>Contralateral leg &gt; arm weakness, abulia</td><td>Leg predominant</td></tr>
    <tr><td>PCA</td><td>Contralateral homonymous hemianopia</td><td>Vision loss</td></tr>
    <tr><td>PICA (Wallenberg)</td><td>Ipsilateral face + contralateral body sensory loss, Horner, dysphagia</td><td>Crossed deficits</td></tr>
    <tr><td>Basilar artery</td><td>Locked-in syndrome, quadriplegia, consciousness preserved</td><td>Preserved consciousness!</td></tr>
  </tbody>
</table></div>
<div class="subtopic">Parkinson's vs Tremors</div>
<div class="tbl-wrap"><table>
  <thead><tr><th>Feature</th><th>Parkinson's</th><th>Essential Tremor</th><th>Cerebellar</th></tr></thead>
  <tbody>
    <tr><td>Type</td><td>Resting (4–6 Hz)</td><td>Action/postural (8–12 Hz)</td><td>Intention tremor</td></tr>
    <tr><td>Other signs</td><td>Rigidity, bradykinesia, shuffling gait</td><td>Improves with alcohol</td><td>Dysdiadochokinesia, ataxia</td></tr>
    <tr><td>Treatment</td><td>Levodopa + Carbidopa (DOC)</td><td>Propranolol or Primidone</td><td>Treat cause</td></tr>
  </tbody>
</table></div>

<!-- ═══════════════════════════ SURGERY ═══════════════════════════ -->
<div class="subject-header sh-surgery">
  <h2>GENERAL SURGERY</h2>
  <div class="meta">~30–35 Questions | Priority #2 | ATLS · Acute Abdomen · Breast/Thyroid · Hernia · Orthopaedics</div>
</div>

<div class="topic">1. TRAUMA / ATLS (5–6 Questions) ★★★ GUARANTEED</div><hr class="section">
<p class="exam-tip">ATLS Primary Survey tested EVERY year. Know ABCDE order + what to do + how to prioritize when two threats present simultaneously</p>
<div class="tbl-wrap"><table>
  <thead><tr><th>Step</th><th>Action</th><th>Key Points</th></tr></thead>
  <tbody>
    <tr><td><b>A – Airway (+ C-spine)</b></td><td>Establish patent airway; immobilize C-spine</td><td>Intubate if GCS ≤8 or unable to protect airway; chin-lift/jaw-thrust</td></tr>
    <tr><td><b>B – Breathing</b></td><td>Assess breathing + ventilation</td><td>Life threats: Tension pneumo, Open pneumo, Flail chest, Massive hemothorax</td></tr>
    <tr><td><b>C – Circulation</b></td><td>Control hemorrhage, 2 large-bore IVs, fluids</td><td>Shock class → fluid amount; Massive bleed = O-neg blood immediately</td></tr>
    <tr><td><b>D – Disability</b></td><td>Neurological: GCS + pupils</td><td>AVPU scale; pupil size/reactivity</td></tr>
    <tr><td><b>E – Exposure</b></td><td>Expose fully + prevent hypothermia</td><td>Remove all clothes; logroll for back; warm blankets</td></tr>
  </tbody>
</table></div>
<div class="box-red">★ If BOTH airway obstruction AND massive hemorrhage present → AIRWAY FIRST always (A before C)</div>

<div class="subtopic">Shock Classification in Trauma</div>
<div class="tbl-wrap"><table>
  <thead><tr><th>Class</th><th>Blood Loss</th><th>HR</th><th>BP</th><th>GCS</th><th>Treatment</th></tr></thead>
  <tbody>
    <tr><td>I</td><td>&lt;750 mL (&lt;15%)</td><td>&lt;100</td><td>Normal</td><td>Normal</td><td>Crystalloid</td></tr>
    <tr><td>II</td><td>750–1500 mL (15–30%)</td><td>100–120</td><td>Normal</td><td>Anxious</td><td>Crystalloid</td></tr>
    <tr><td>III</td><td>1500–2000 mL (30–40%)</td><td>120–140</td><td>Decreased</td><td>Confused</td><td>Crystalloid + Blood</td></tr>
    <tr><td>IV</td><td>&gt;2000 mL (&gt;40%)</td><td>&gt;140</td><td>Very low</td><td>Lethargic</td><td>Blood products immediately</td></tr>
  </tbody>
</table></div>

<div class="subtopic">Immediate Life-Threatening Chest Injuries</div>
<div class="tbl-wrap"><table>
  <thead><tr><th>Injury</th><th>Diagnosis</th><th>Immediate Treatment</th></tr></thead>
  <tbody>
    <tr><td>Tension Pneumothorax</td><td>Absent breath sounds + tracheal deviation AWAY from lesion + JVD + hypotension</td><td>Needle decompression 2nd ICS MCL → then chest tube 5th ICS AAL</td></tr>
    <tr><td>Open Pneumothorax</td><td>Sucking chest wound</td><td>3-sided dressing (flutter valve) → chest tube away from wound</td></tr>
    <tr><td>Massive Hemothorax</td><td>&gt;1500 mL; absent sounds + dull percussion</td><td>Chest tube (32–36F); surgery if &gt;1500 mL drained initially</td></tr>
    <tr><td>Flail Chest</td><td>Paradoxical chest wall movement</td><td>Pain control + O2; IPPV if respiratory failure</td></tr>
    <tr><td>Cardiac Tamponade</td><td>Beck's triad: JVD + muffled sounds + hypotension</td><td>Pericardiocentesis (needle); Pericardiotomy (definitive)</td></tr>
  </tbody>
</table></div>

<div class="subtopic">FAST Scan ★</div>
<ul class="notes">
  <li>4 windows: Perihepatic (Morrison's pouch), Perisplenic, Pericardial, Pelvic</li>
  <li>Free fluid = BLACK (hypoechoic) on FAST</li>
  <li>Positive FAST + hemodynamically <b>unstable</b> = Emergency laparotomy</li>
  <li>Positive FAST + hemodynamically <b>stable</b> = CT abdomen</li>
</ul>

<div class="topic">2. ACUTE ABDOMEN (4–5 Questions)</div><hr class="section">
<div class="subtopic">Small Bowel vs Large Bowel Obstruction</div>
<div class="tbl-wrap"><table>
  <thead><tr><th>Feature</th><th>Small Bowel</th><th>Large Bowel</th></tr></thead>
  <tbody>
    <tr><td>Vomiting</td><td>Early, bilious</td><td>Late, feculent</td></tr>
    <tr><td>Distension</td><td>Central (periumbilical)</td><td>Peripheral</td></tr>
    <tr><td>X-ray</td><td>Valvulae conniventes (complete across bowel)</td><td>Haustrations (incomplete)</td></tr>
    <tr><td>MC cause (adults)</td><td>Post-op adhesions</td><td>Colorectal carcinoma</td></tr>
    <tr><td>MC cause (children)</td><td>Intussusception (ileo-colic)</td><td>Hirschsprung's</td></tr>
  </tbody>
</table></div>
<div class="box-red">★ Closed loop obstruction = SURGICAL EMERGENCY. Constant pain (not colicky) + rapid deterioration. Do NOT delay!</div>

<div class="subtopic">Appendicitis</div>
<ul class="notes">
  <li>Periumbilical pain → migrates to RIF (McBurney's point)</li>
  <li><b>Rovsing's sign:</b> LIF pressure → pain in RIF</li>
  <li><b>Psoas sign:</b> Hip extension pain → retrocaecal appendix</li>
  <li><b>Alvarado Score ≥7:</b> Surgery (RIF pain+migration+anorexia+N/V+tenderness+rebound+fever+leukocytosis+shift)</li>
  <li>Gold standard Dx: CT abdomen (94–98% sensitivity)</li>
</ul>

<div class="subtopic">Acute Pancreatitis</div>
<div class="box-blue">Mnemonic – Causes: <b>GET SMASHED</b> = Gallstones (MC India), Ethanol, Trauma, Steroids, Mumps, Autoimmune, Scorpion sting, Hypertriglyceridemia/Hypercalcemia, ERCP, Drugs</div>
<ul class="notes">
  <li><b>Ranson's Criteria On Admission:</b> Age&gt;55, WBC&gt;16k, Glucose&gt;200, LDH&gt;350, AST&gt;250</li>
  <li><b>Ranson's At 48h:</b> HCT fall&gt;10%, BUN rise&gt;5, Ca&lt;8, PaO2&lt;60, Base deficit&gt;4, Fluid sequestration&gt;6L</li>
  <li>Score ≥3 = severe; ≥5 = mortality &gt;40%</li>
</ul>

<div class="topic">3. BREAST & THYROID (3–4 Questions)</div><hr class="section">
<div class="box-blue">Mnemonic – Triple Assessment: 1. Clinical examination | 2. Imaging (USG&lt;35yr / Mammogram&gt;35yr) | 3. Tissue sampling (FNAC or Core biopsy). All 3 must be concordant!</div>
<div class="subtopic">Breast Cancer TNM Staging</div>
<div class="tbl-wrap"><table>
  <thead><tr><th>Stage</th><th>T</th><th>N</th><th>M</th><th>Key Point</th></tr></thead>
  <tbody>
    <tr><td>I</td><td>T1 (≤2cm)</td><td>N0</td><td>M0</td><td>Early, excellent prognosis</td></tr>
    <tr><td>IIA</td><td>T0–2</td><td>N1 (1–3 nodes)</td><td>M0</td><td>Operable</td></tr>
    <tr><td>IIIB</td><td>T4 (skin/chest wall)</td><td>Any</td><td>M0</td><td>Inflammatory breast cancer = T4d</td></tr>
    <tr><td>IV</td><td>Any</td><td>Any</td><td>M1</td><td>Distant mets — palliative</td></tr>
  </tbody>
</table></div>

<div class="topic">4. HERNIA TYPES (2–3 Questions)</div><hr class="section">
<div class="tbl-wrap"><table>
  <thead><tr><th>Type</th><th>Site</th><th>Key Fact</th></tr></thead>
  <tbody>
    <tr><td>Indirect Inguinal</td><td>Lateral to inferior epigastric vessels</td><td>MC inguinal hernia; MC hernia overall</td></tr>
    <tr><td>Direct Inguinal</td><td>Medial (Hesselbach's triangle)</td><td>Elderly men, through posterior wall</td></tr>
    <tr><td>Femoral</td><td>Medial to femoral vein, below inguinal ligament</td><td>MC in women; MC to strangulate</td></tr>
    <tr><td>Umbilical</td><td>Umbilical ring</td><td>MC in children</td></tr>
    <tr><td>Obturator</td><td>Obturator canal</td><td>Howship-Romberg sign (medial thigh pain)</td></tr>
  </tbody>
</table></div>

<!-- ═══════════════════════════ PHARMACOLOGY ═══════════════════════════ -->
<div class="subject-header sh-pharma">
  <h2>PHARMACOLOGY</h2>
  <div class="meta">~20–22 Questions | Priority #3 | Drug of Choice · Autonomic · CYP450 · Newer Drugs</div>
</div>

<div class="topic">1. DRUGS OF CHOICE (DOC) — 15–20 Questions ★★★</div><hr class="section">
<p class="exam-tip">DOC questions = 15–20 per paper as one-liners AND embedded in vignettes. Know all of these cold.</p>
<div class="subtopic">A. Cardiovascular DOCs</div>
<div class="tbl-wrap"><table class="red">
  <thead><tr><th>Condition</th><th>Drug of Choice</th><th>Notes</th></tr></thead>
  <tbody>
    <tr><td>ACS (fibrinolysis)</td><td>Tenecteplase / Streptokinase</td><td>Tenecteplase = single IV bolus</td></tr>
    <tr><td>AF – rate control</td><td>Metoprolol / Diltiazem</td><td>In HF: Digoxin</td></tr>
    <tr><td>AF – rhythm control</td><td><b>Amiodarone</b></td><td>Most effective antiarrhythmic</td></tr>
    <tr><td>SVT (acute)</td><td><b>Adenosine IV</b></td><td>Short-acting; monitor for bronchospasm</td></tr>
    <tr><td>WPW + AF</td><td><b>Procainamide / DC Cardioversion</b></td><td>AVOID Adenosine, Digoxin, Verapamil</td></tr>
    <tr><td>Torsades de Pointes</td><td><b>IV Magnesium Sulfate</b></td><td>Stop offending drugs too</td></tr>
    <tr><td>Hypertensive crisis</td><td>IV Labetalol / IV Nicardipine</td><td>Nitroprusside in aortic dissection</td></tr>
    <tr><td>HTN in pregnancy</td><td>Methyldopa (1st line), Labetalol, Nifedipine</td><td>AVOID ACEi/ARBs (teratogenic)</td></tr>
    <tr><td>HTN in diabetes</td><td>ACE inhibitor (Ramipril)</td><td>Renoprotective</td></tr>
    <tr><td>HTN in asthma/COPD</td><td>CCB (Amlodipine)</td><td>Avoid beta-blockers</td></tr>
    <tr><td>Heart failure (1st line)</td><td>ARNI (Sacubitril+Valsartan) + BB + Spironolactone</td><td>ARNI superior to ACEi</td></tr>
  </tbody>
</table></div>

<div class="subtopic">B. Infectious Disease DOCs</div>
<div class="tbl-wrap"><table class="red">
  <thead><tr><th>Infection / Organism</th><th>Drug of Choice</th><th>Alternative / Notes</th></tr></thead>
  <tbody>
    <tr><td>MRSA</td><td><b>Vancomycin</b></td><td>Linezolid, Daptomycin</td></tr>
    <tr><td>VRE</td><td><b>Linezolid</b></td><td>Daptomycin</td></tr>
    <tr><td>Pseudomonas</td><td>Piperacillin-Tazobactam</td><td>Ceftazidime, Imipenem</td></tr>
    <tr><td>C. difficile (mild)</td><td>Metronidazole</td><td>Vancomycin oral (severe)</td></tr>
    <tr><td>C. difficile (severe)</td><td><b>Oral Vancomycin / Fidaxomicin</b></td><td>Fecal transplant (recurrent)</td></tr>
    <tr><td>Meningococcal meningitis</td><td>Ceftriaxone / Benzylpenicillin</td><td>Chloramphenicol (penicillin allergy)</td></tr>
    <tr><td>Pneumococcal meningitis</td><td>Ceftriaxone + <b>Dexamethasone</b></td><td>Dex reduces neurological sequelae</td></tr>
    <tr><td>TB (standard)</td><td><b>2HRZE / 4HR (DOTS)</b></td><td>H=INH, R=Rifampicin, Z=Pyrazinamide, E=Ethambutol</td></tr>
    <tr><td>MDR-TB</td><td>Bedaquiline + Pretomanid + Linezolid (BPaL)</td><td>New NTEP regimen</td></tr>
    <tr><td>Typhoid (uncomplicated)</td><td>Azithromycin</td><td>Ceftriaxone (complicated)</td></tr>
    <tr><td>P. falciparum malaria</td><td>ACT: Artesunate + Lumefantrine</td><td>IV Artesunate for severe</td></tr>
    <tr><td>P. vivax malaria</td><td>Chloroquine + Primaquine</td><td>Primaquine = kills liver hypnozoites</td></tr>
    <tr><td>Invasive Candida</td><td>Echinocandin (Caspofungin)</td><td>Fluconazole (non-critical)</td></tr>
    <tr><td>Aspergillosis</td><td><b>Voriconazole</b></td><td>Liposomal Ampho B</td></tr>
    <tr><td>Kala-azar (Leishmaniasis)</td><td>Liposomal Amphotericin B</td><td>Miltefosine (oral)</td></tr>
  </tbody>
</table></div>

<div class="subtopic">C. General DOCs</div>
<div class="tbl-wrap"><table class="red">
  <thead><tr><th>Condition</th><th>DOC</th></tr></thead>
  <tbody>
    <tr><td>H. pylori eradication (1st line)</td><td>Triple therapy: PPI + Clarithromycin + Amoxicillin × 14 days</td></tr>
    <tr><td>GERD</td><td>PPI (Omeprazole)</td></tr>
    <tr><td>Status epilepticus (1st line)</td><td>IV Lorazepam (or Diazepam)</td></tr>
    <tr><td>Status epilepticus (2nd line)</td><td>IV Phenytoin / Fosphenytoin / Valproate</td></tr>
    <tr><td>Absence seizures</td><td>Ethosuximide (pure absence); Valproate (absence + other types)</td></tr>
    <tr><td>Trigeminal neuralgia</td><td>Carbamazepine</td></tr>
    <tr><td>RA (DMARD)</td><td>Methotrexate (anchor drug)</td></tr>
    <tr><td>Gout – acute</td><td>NSAIDs (Indomethacin) OR Colchicine</td></tr>
    <tr><td>Gout – chronic prevention</td><td>Allopurinol</td></tr>
    <tr><td>Anaphylaxis</td><td><b>Adrenaline IM 0.5 mg (1:1000)</b> — FIRST always</td></tr>
    <tr><td>Paracetamol overdose</td><td>N-acetylcysteine (NAC) — within 8h</td></tr>
    <tr><td>Opioid overdose</td><td>Naloxone IV</td></tr>
    <tr><td>Organophosphate poisoning</td><td>Atropine (large doses) + Pralidoxime (within 24–48h)</td></tr>
    <tr><td>Benzodiazepine overdose</td><td>Flumazenil</td></tr>
  </tbody>
</table></div>

<div class="topic">2. AUTONOMIC RECEPTORS (3–4 Questions)</div><hr class="section">
<div class="tbl-wrap"><table>
  <thead><tr><th>Receptor</th><th>Location</th><th>Effect</th><th>Drug example</th></tr></thead>
  <tbody>
    <tr><td>α1</td><td>Vascular SM, eye</td><td>Vasoconstriction, mydriasis</td><td>Phenylephrine (agonist), Prazosin (blocker)</td></tr>
    <tr><td>α2 (presynaptic)</td><td>Sympathetic terminals</td><td>↓ NA release (negative feedback)</td><td>Clonidine (agonist), Yohimbine (blocker)</td></tr>
    <tr><td>β1</td><td>Heart, kidney JGA</td><td>↑HR, ↑contractility, ↑renin</td><td>Dobutamine (agonist), Metoprolol (blocker)</td></tr>
    <tr><td>β2</td><td>Bronchi, uterus</td><td>Bronchodilation, uterine relaxation</td><td>Salbutamol (agonist), Propranolol (blocker)</td></tr>
    <tr><td>M2</td><td>Heart (SA node)</td><td>↓HR, ↓conduction</td><td>Atropine (blocker = bradycardia)</td></tr>
    <tr><td>M3</td><td>Smooth muscle, glands</td><td>Bronchoconstriction, ↑secretions</td><td>Ipratropium (blocker = COPD)</td></tr>
    <tr><td>NMJ (Nicotinic)</td><td>Skeletal muscle</td><td>Muscle contraction</td><td>Succinylcholine (depol. blocker), Rocuronium (non-depol)</td></tr>
  </tbody>
</table></div>

<div class="topic">3. CYP450 DRUG INTERACTIONS (3–4 Questions)</div><hr class="section">
<div class="box-blue">Mnemonic – Inducers (decrease drug levels): <b>RIPES</b> = Rifampicin, Isoniazid, Phenytoin, Ethanol (chronic), Smoking / St John's wort</div>
<div class="box-blue">Mnemonic – Inhibitors (increase drug levels → toxicity): <b>SICKFACES.COM</b> = Sodium valproate, Isoniazid, Cimetidine, Ketoconazole, Fluconazole, Amiodarone, Ciprofloxacin, Erythromycin, Sulfonamides, Chloramphenicol, Omeprazole, Metronidazole</div>
<div class="tbl-wrap"><table>
  <thead><tr><th>Clinical Scenario</th><th>Result</th></tr></thead>
  <tbody>
    <tr><td>Rifampicin + OCP</td><td>OCP failure → pregnancy (CYP3A4 induction)</td></tr>
    <tr><td>Rifampicin + Warfarin</td><td>↓Warfarin effect → clot</td></tr>
    <tr><td>Erythromycin + Simvastatin</td><td>↑Simvastatin → Rhabdomyolysis</td></tr>
    <tr><td>Amiodarone + Digoxin</td><td>↑Digoxin toxicity</td></tr>
    <tr><td>Azole antifungals + Warfarin</td><td>↑Warfarin → bleeding</td></tr>
  </tbody>
</table></div>

<div class="topic">4. NEWER DRUGS & ADVERSE EFFECTS (2–3 Questions)</div><hr class="section">
<div class="subtopic">SGLT2 Inhibitors (Gliflozins) ★</div>
<ul class="notes">
  <li><b>Drugs:</b> Dapagliflozin, Empagliflozin, Canagliflozin</li>
  <li><b>Mechanism:</b> Block SGLT2 in proximal tubule → glucose excreted in urine</li>
  <li><b>Benefits beyond glucose:</b> HF hospitalization ↓, CKD progression ↓, mortality ↓, weight loss</li>
  <li><b>Adverse effects:</b> Genital mycotic infections (MC), UTI, Euglycemic DKA, Fournier's gangrene (rare), Amputation risk (Canagliflozin)</li>
</ul>
<div class="box-yellow">★ EUGLYCEMIC DKA: SGLT2i causes DKA with NORMAL blood sugar — high ketones + metabolic acidosis + NORMAL glucose. Diagnosis easily missed!</div>

<div class="subtopic">GLP-1 Receptor Agonists</div>
<ul class="notes">
  <li><b>Drugs:</b> Semaglutide (Ozempic/Wegovy), Liraglutide (Victoza/Saxenda), Exenatide</li>
  <li><b>Mechanism:</b> Mimic GLP-1 → ↑insulin (glucose-dependent), ↓glucagon, ↓gastric emptying, ↓appetite</li>
  <li><b>Benefits:</b> Significant weight loss, CV protection, BP ↓</li>
  <li><b>Adverse effects:</b> Nausea/vomiting (MC), Pancreatitis, Thyroid C-cell tumors (<b>contraindicated in MEN2/MTC</b>), Gallstones</li>
</ul>

<div class="subtopic">Monoclonal Antibodies</div>
<div class="tbl-wrap"><table>
  <thead><tr><th>Drug</th><th>Target</th><th>Use</th><th>Key Adverse Effect</th></tr></thead>
  <tbody>
    <tr><td>Infliximab / Adalimumab</td><td>TNF-α</td><td>RA, IBD, Psoriasis</td><td><b>TB reactivation</b> (screen before use!)</td></tr>
    <tr><td>Rituximab</td><td>CD20</td><td>NHL, RA, ANCA vasculitis</td><td>PML (JC virus)</td></tr>
    <tr><td>Trastuzumab (Herceptin)</td><td>HER2/neu</td><td>HER2+ Breast cancer</td><td><b>Cardiotoxicity</b> (cardiomyopathy)</td></tr>
    <tr><td>Bevacizumab</td><td>VEGF</td><td>CRC, lung cancers</td><td>HTN, wound healing impaired</td></tr>
    <tr><td>Dupilumab</td><td>IL-4/IL-13R</td><td>Atopic dermatitis, Asthma</td><td>Conjunctivitis</td></tr>
    <tr><td>Omalizumab</td><td>IgE</td><td>Severe allergic asthma</td><td>Anaphylaxis (rare)</td></tr>
  </tbody>
</table></div>

<!-- ═══════════════════════════ PATHOLOGY ═══════════════════════════ -->
<div class="subject-header sh-pathology">
  <h2>PATHOLOGY</h2>
  <div class="meta">~18–20 Questions | Priority #4 | Cell Injury · Neoplasia · Tumor Markers · IHC · Cytogenetics · Hematology</div>
</div>

<div class="topic">1. CELL INJURY (3–4 Questions)</div><hr class="section">
<p class="exam-tip">"What is the EARLIEST sign of cell injury?" = Cell swelling (Na/K pump failure). Know sequence of events.</p>
<div class="tbl-wrap"><table>
  <thead><tr><th>Time</th><th>Change</th><th>Mechanism</th></tr></thead>
  <tbody>
    <tr><td>Seconds</td><td><b>Cell swelling</b> (earliest) — Na/K pump fails</td><td>ATP depletion</td></tr>
    <tr><td>Minutes</td><td>ER swelling, ribosomes detach (↓protein synthesis)</td><td>Continued ischemia</td></tr>
    <tr><td>Minutes</td><td>↑ Intracellular Ca2+ (<b>most damaging change</b>)</td><td>Membrane pump failure</td></tr>
    <tr><td>Reversible</td><td>Chromatin clumping (nuclear)</td><td>Acidosis from lactic acid</td></tr>
    <tr><td>Irreversible</td><td>Plasma membrane rupture + lysosomal release</td><td>Ca2+ influx, severe mitochondrial injury</td></tr>
  </tbody>
</table></div>
<div class="box-yellow">★ Earliest ultrastructural change = Cell swelling. Earliest light microscopic change = Fatty change (liver). Most important trigger of irreversible injury = Ca2+ influx</div>

<div class="subtopic">Types of Necrosis ★★</div>
<div class="tbl-wrap"><table>
  <thead><tr><th>Type</th><th>Appearance</th><th>Location</th><th>Cause</th></tr></thead>
  <tbody>
    <tr><td>Coagulative</td><td>Ghost outlines preserved, nucleus gone</td><td>Heart, kidney, adrenal (infarcts)</td><td>Ischemia (most organs)</td></tr>
    <tr><td>Liquefactive</td><td>Liquid pus, ghost outlines LOST</td><td>Brain infarct, Abscess</td><td>Bacterial infections, CNS ischemia</td></tr>
    <tr><td>Caseous</td><td>Cheese-like, crumbly, amorphous</td><td>Lymph nodes, lung</td><td><b>Tuberculosis</b></td></tr>
    <tr><td>Fat necrosis</td><td>Chalky white (Ca soaps = saponification)</td><td>Pancreas, breast</td><td>Pancreatitis, breast trauma</td></tr>
    <tr><td>Fibrinoid</td><td>Pink homogeneous in vessel walls</td><td>Blood vessel walls</td><td>Vasculitis, malignant HTN, SLE</td></tr>
  </tbody>
</table></div>

<div class="subtopic">Apoptosis vs Necrosis</div>
<div class="tbl-wrap"><table>
  <thead><tr><th>Feature</th><th>Apoptosis</th><th>Necrosis</th></tr></thead>
  <tbody>
    <tr><td>Initiator</td><td>Programmed (caspase-mediated)</td><td>Accidental (severe injury)</td></tr>
    <tr><td>Cell size</td><td>Shrinks (condensation)</td><td>Swells (hydropic)</td></tr>
    <tr><td>Nucleus</td><td>Karyorrhexis → pyknosis</td><td>Karyolysis (fades)</td></tr>
    <tr><td>Inflammation</td><td><b>NONE</b></td><td><b>YES</b></td></tr>
    <tr><td>DNA pattern</td><td>Ladder (180 bp fragments)</td><td>Smear pattern</td></tr>
  </tbody>
</table></div>

<div class="topic">2. TUMOR MARKERS ★★ (5–7 Questions per paper)</div><hr class="section">
<p class="exam-tip">Clinical features + image shown → identify tumor marker. Know the MOST SPECIFIC marker for each cancer.</p>
<div class="tbl-wrap"><table class="purple">
  <thead><tr><th>Marker</th><th>Cancer</th><th>Notes</th></tr></thead>
  <tbody>
    <tr><td><b>AFP</b></td><td>Hepatocellular carcinoma, Yolk sac tumor</td><td>Also elevated in neural tube defects (maternal serum)</td></tr>
    <tr><td><b>CEA</b></td><td>Colorectal cancer (CRC)</td><td>Not diagnostic; monitoring recurrence</td></tr>
    <tr><td><b>PSA</b></td><td>Prostate cancer</td><td>Not organ-specific; elevated in BPH, prostatitis too</td></tr>
    <tr><td><b>CA-125</b></td><td>Ovarian cancer (epithelial)</td><td>Also elevated in endometriosis</td></tr>
    <tr><td><b>CA 19-9</b></td><td>Pancreatic cancer (most specific)</td><td>Also cholangiocarcinoma</td></tr>
    <tr><td><b>CA 15-3</b></td><td>Breast cancer</td><td>Monitoring recurrence</td></tr>
    <tr><td><b>β-HCG</b></td><td>Choriocarcinoma, GTD, Testicular (non-seminoma)</td><td>Diagnostic + monitoring</td></tr>
    <tr><td><b>LDH</b></td><td>Seminoma, NHL, Ewing's sarcoma</td><td>Non-specific; prognostic</td></tr>
    <tr><td><b>Calcitonin</b></td><td>Medullary thyroid carcinoma (MTC)</td><td>MC familial: MEN2A</td></tr>
    <tr><td><b>Chromogranin A</b></td><td>Carcinoid / Neuroendocrine tumors</td><td>5-HIAA in urine for carcinoid syndrome</td></tr>
    <tr><td><b>NSE</b></td><td>SCLC, Neuroblastoma</td><td>SCLC: paraneoplastic syndromes</td></tr>
  </tbody>
</table></div>

<div class="topic">3. IMMUNOHISTOCHEMISTRY (IHC) ★ — Increasing Image-Based Questions</div><hr class="section">
<div class="tbl-wrap"><table class="purple">
  <thead><tr><th>IHC Marker</th><th>Positive in</th><th>Clinical Use</th></tr></thead>
  <tbody>
    <tr><td>CD20</td><td>B-cell lymphomas</td><td>Target for Rituximab</td></tr>
    <tr><td>CD30</td><td>Hodgkin lymphoma (RS cells), ALCL</td><td>Reed-Sternberg: CD15+, CD30+</td></tr>
    <tr><td>ER/PR</td><td>Breast cancer</td><td>Tamoxifen / Aromatase inhibitors</td></tr>
    <tr><td>HER2/neu (CerbB-2)</td><td>Breast cancer (~20%)</td><td>Trastuzumab; worse prognosis</td></tr>
    <tr><td>TTF-1</td><td>Lung adenocarcinoma, Thyroid cancer</td><td>Differentiates primary lung from mets</td></tr>
    <tr><td>S-100</td><td>Melanoma, Schwannoma, Langerhans cells</td><td>Neural crest origin</td></tr>
    <tr><td>CD45 (LCA)</td><td>All lymphomas</td><td>Distinguishes lymphoma from carcinoma</td></tr>
    <tr><td>Cytokeratin (CK)</td><td>Carcinomas (epithelial)</td><td>Confirms epithelial origin</td></tr>
    <tr><td>Vimentin</td><td>Sarcomas (mesenchymal)</td><td>Soft tissue tumors</td></tr>
    <tr><td>Desmin</td><td>Rhabdomyosarcoma</td><td>Muscle marker</td></tr>
  </tbody>
</table></div>

<div class="topic">4. CYTOGENETICS — Translocations ★★ (Guaranteed Every Year)</div><hr class="section">
<div class="tbl-wrap"><table class="purple">
  <thead><tr><th>Translocation</th><th>Disease</th><th>Gene Fusion</th><th>Treatment</th></tr></thead>
  <tbody>
    <tr><td><b>t(9;22) = Philadelphia Chr.</b></td><td>CML (&gt;95%), ALL (poor prognosis)</td><td>BCR-ABL (TK activity ↑)</td><td><b>Imatinib (DOC)</b></td></tr>
    <tr><td><b>t(15;17)</b></td><td>APL = M3 AML</td><td>PML-RARα</td><td><b>ATRA + Arsenic trioxide</b></td></tr>
    <tr><td><b>t(8;14)</b></td><td>Burkitt lymphoma</td><td>C-MYC dysregulation</td><td>Intensive chemotherapy</td></tr>
    <tr><td><b>t(14;18)</b></td><td>Follicular lymphoma (MC lymphoma)</td><td>BCL-2 overexpression (anti-apoptosis)</td><td>Rituximab + chemo</td></tr>
    <tr><td><b>t(11;14)</b></td><td>Mantle cell lymphoma</td><td>BCL-1/Cyclin D1</td><td>Ibrutinib</td></tr>
    <tr><td><b>del(17p) = TP53</b></td><td>CLL (worst prognosis), many solid tumors</td><td>Loss of p53 tumor suppressor</td><td></td></tr>
    <tr><td><b>del(5q)</b></td><td>MDS (5q- syndrome)</td><td></td><td>Lenalidomide</td></tr>
  </tbody>
</table></div>

<div class="topic">5. LEUKEMIAS — KEY DIFFERENTIATING FEATURES</div><hr class="section">
<div class="tbl-wrap"><table class="purple">
  <thead><tr><th>Type</th><th>Age</th><th>Key Feature</th><th>Marker</th><th>DOC</th></tr></thead>
  <tbody>
    <tr><td>ALL</td><td>Children 2–5yr</td><td>CALLA (CD10+), lymphadenopathy</td><td>t(12;21) good; t(9;22) poor prognosis</td><td>Vincristine+Prednisolone+Asparaginase</td></tr>
    <tr><td>AML (M3/APL)</td><td>Adults</td><td>DIC + Auer rods in promyelocytes</td><td>t(15;17) PML-RARα</td><td>ATRA + Arsenic trioxide</td></tr>
    <tr><td>CML</td><td>Adults 30–60yr</td><td>WBC &gt;100k, massive splenomegaly</td><td>t(9;22) BCR-ABL</td><td>Imatinib (Gleevec)</td></tr>
    <tr><td>CLL</td><td>Elderly &gt;60yr</td><td>Smudge cells, CD5+CD19+</td><td>del(17p) = worst</td><td>Ibrutinib (BTK inhibitor)</td></tr>
    <tr><td>Hairy Cell Leukemia</td><td>Middle-aged men</td><td>TRAP stain+, hairy projections, pancytopenia</td><td>CD11c+, CD25+, CD103+</td><td>Cladribine (2-CDA)</td></tr>
  </tbody>
</table></div>

<div class="topic">6. GRANULOMATOUS DISEASES</div><hr class="section">
<p class="exam-tip">Granuloma = Type IV hypersensitivity (cell-mediated). Components = Epithelioid macrophages + Langhans giant cells</p>
<div class="tbl-wrap"><table class="purple">
  <thead><tr><th>Disease</th><th>Type</th><th>Key Histology</th><th>Stain</th></tr></thead>
  <tbody>
    <tr><td>Tuberculosis</td><td>Caseating (necrotizing)</td><td>Central caseation + Langhans giant cells</td><td>Ziehl-Neelsen (AFB)</td></tr>
    <tr><td>Sarcoidosis</td><td>Non-caseating (naked granuloma)</td><td>Tight granulomas; Schaumann/asteroid bodies</td><td>None specific</td></tr>
    <tr><td>Leprosy – LL</td><td>Non-caseating; foamy macrophages</td><td>Lepra cells (vacuolated), many bacilli</td><td>Wade-Fite</td></tr>
    <tr><td>Crohn's disease</td><td>Non-caseating</td><td>Transmural inflammation + granuloma</td><td>H&amp;E</td></tr>
    <tr><td>Wegener's (GPA)</td><td>Necrotizing + vasculitis</td><td>c-ANCA (PR3) positive</td><td>PAS</td></tr>
  </tbody>
</table></div>

<!-- ═══════════════════════════ QUICK REVISION ═══════════════════════════ -->
<div class="subject-header sh-revision">
  <h2>QUICK REVISION</h2>
  <div class="meta">Last-Minute High-Yield Facts | Mnemonics | Guaranteed Questions for NEET PG 2026</div>
</div>

<div class="topic">MUST-KNOW MNEMONICS</div><hr class="section">
<div class="box-blue">AEIOU (Dialysis): Acidosis, Electrolytes (K+), Intoxication, Overload (fluid), Uremia</div>
<div class="box-blue">ABCDE (ATLS): Airway, Breathing, Circulation, Disability, Exposure</div>
<div class="box-blue">4Ts (PPH causes): Tone (uterine atony, MC), Tissue (retained), Trauma, Thrombin</div>
<div class="box-blue">GET SMASHED (Pancreatitis): Gallstones, Ethanol, Trauma, Steroids, Mumps, Autoimmune, Scorpion, Hypertriglyceridemia, ERCP, Drugs</div>
<div class="box-blue">RIPES (CYP Inducers): Rifampicin, Isoniazid, Phenytoin, Ethanol (chronic), Smoking</div>
<div class="box-blue">MUDPILES (High AG metabolic acidosis): Methanol, Uremia, DKA, Propylene glycol, Isoniazid/Iron, Lactic acidosis, Ethylene glycol, Salicylates</div>

<div class="topic">★ GUARANTEED QUESTIONS — NEET PG 2026</div><hr class="section">
<div class="tbl-wrap"><table class="green">
  <thead><tr><th>Topic</th><th>What to Expect in the Question</th></tr></thead>
  <tbody>
    <tr><td>DKA management</td><td>K+ management steps, fluid choice, anion gap closure criteria, euglycemic DKA (SGLT2i)</td></tr>
    <tr><td>ACS — fibrinolysis vs PCI</td><td>Timing, door-to-balloon, contraindications to fibrinolysis</td></tr>
    <tr><td>WPW syndrome</td><td>Drugs to AVOID (Adenosine, Digoxin, Verapamil); DOC = Procainamide</td></tr>
    <tr><td>ATLS Primary Survey</td><td>ABCDE order + what to do FIRST when two threats present simultaneously</td></tr>
    <tr><td>Tension pneumothorax</td><td>Clinical diagnosis (don't wait for X-ray); immediate needle decompression</td></tr>
    <tr><td>Philadelphia chromosome</td><td>t(9;22), BCR-ABL, CML diagnosis, Imatinib = DOC</td></tr>
    <tr><td>SGLT2 inhibitor adverse effects</td><td>Euglycemic DKA, genital infections, Fournier's gangrene</td></tr>
    <tr><td>Child-Pugh scoring</td><td>5 parameters, points, class A/B/C</td></tr>
    <tr><td>Drug of choice questions</td><td>15–20 questions total — every DOC in this booklet is fair game</td></tr>
    <tr><td>Anti-TNF + TB screening</td><td>Screen for latent TB before starting Infliximab/Adalimumab</td></tr>
    <tr><td>Tumor markers</td><td>Image/case → identify marker (AFP, CA 19-9, calcitonin especially)</td></tr>
    <tr><td>Biostatistics (PPV/NPV)</td><td>2x2 table calculation — sensitivity, specificity, PPV, NPV</td></tr>
  </tbody>
</table></div>

<div class="box-green">★ REMEMBER: 30% of NEET PG questions are modified repeats from previous years. Master PYQs alongside these notes for maximum impact!</div>
<br><br>
<div style="text-align:center;color:#aaa;font-size:11px;margin-top:20px;">NEET PG 2026 High-Yield Notes | Big Four Subjects | Generated for exam preparation purposes</div>

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