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

OUTPUT = "/home/daytona/workspace/ncd-questions/NCD_Epidemiology_University_Questions.pdf"

doc = SimpleDocTemplate(
    OUTPUT,
    pagesize=A4,
    leftMargin=2*cm, rightMargin=2*cm,
    topMargin=2*cm, bottomMargin=2*cm,
    title="Epidemiology of NCDs - University Questions",
    author="Park's Textbook Reference"
)

styles = getSampleStyleSheet()

# Custom styles
title_style = ParagraphStyle(
    'CustomTitle', parent=styles['Title'],
    fontSize=18, textColor=colors.HexColor('#1a237e'),
    spaceAfter=6, spaceBefore=0, alignment=TA_CENTER
)
subtitle_style = ParagraphStyle(
    'Subtitle', parent=styles['Normal'],
    fontSize=11, textColor=colors.HexColor('#455a64'),
    spaceAfter=16, alignment=TA_CENTER, italic=True
)
section_style = ParagraphStyle(
    'Section', parent=styles['Heading1'],
    fontSize=13, textColor=colors.white,
    backColor=colors.HexColor('#1a237e'),
    spaceBefore=14, spaceAfter=4,
    leftIndent=-0.3*cm, rightIndent=-0.3*cm,
    borderPadding=(6, 8, 6, 8)
)
q_heading_style = ParagraphStyle(
    'QHeading', parent=styles['Heading2'],
    fontSize=11, textColor=colors.HexColor('#0d47a1'),
    spaceBefore=10, spaceAfter=3
)
body_style = ParagraphStyle(
    'Body', parent=styles['Normal'],
    fontSize=9.5, leading=14, spaceAfter=3,
    alignment=TA_JUSTIFY
)
bullet_style = ParagraphStyle(
    'Bullet', parent=styles['Normal'],
    fontSize=9.5, leading=13, leftIndent=16, spaceAfter=2,
    bulletIndent=4
)
sub_bullet_style = ParagraphStyle(
    'SubBullet', parent=styles['Normal'],
    fontSize=9, leading=13, leftIndent=30, spaceAfter=1,
    bulletIndent=18, textColor=colors.HexColor('#333333')
)
note_style = ParagraphStyle(
    'Note', parent=styles['Normal'],
    fontSize=9, leading=13, textColor=colors.HexColor('#e65100'),
    backColor=colors.HexColor('#fff3e0'),
    borderPadding=(5,6,5,6), spaceAfter=6, spaceBefore=4,
    leftIndent=4, rightIndent=4
)
label_style = ParagraphStyle(
    'Label', parent=styles['Normal'],
    fontSize=8.5, textColor=colors.white,
    backColor=colors.HexColor('#c62828'),
    alignment=TA_CENTER
)

story = []

# ── TITLE ──────────────────────────────────────────────────────────────────
story.append(Spacer(1, 0.3*cm))
story.append(Paragraph("Important University Questions", title_style))
story.append(Paragraph("Epidemiology of Non-Communicable Diseases", title_style))
story.append(Paragraph("Based on Park's Textbook of Preventive and Social Medicine", subtitle_style))
story.append(HRFlowable(width="100%", thickness=2, color=colors.HexColor('#1a237e'), spaceAfter=8))

# ── SECTION 1 : LONG QUESTIONS ─────────────────────────────────────────────
story.append(Paragraph("LONG QUESTIONS  (10–15 Marks)", section_style))
story.append(Spacer(1, 0.2*cm))

lqs = [
    {
        "num": "Q1.",
        "title": "Discuss the epidemiology, risk factors, and prevention of Coronary Heart Disease (CHD).",
        "points": [
            "Definition: 'Impairment of heart function due to inadequate blood flow caused by obstructive changes in the coronary circulation' (WHO calls it the modern epidemic)",
            "Presentations: Angina pectoris, Myocardial infarction, Arrhythmias, Cardiac failure, Sudden death",
            "Measuring burden: PMR, Loss of life expectancy, Incidence rate, Age-specific death rates, Prevalence rate",
            "Non-modifiable risk factors: Age, Male sex, Family history, Type A personality",
            "Modifiable risk factors: Hypertension, Hypercholesterolaemia, Smoking, Diabetes, Obesity, Sedentary lifestyle, Stress, Diet (saturated fat)",
            "Mention Framingham Heart Study (identified major CHD risk factors - prospective cohort)",
            "Primary, secondary, tertiary prevention"
        ]
    },
    {
        "num": "Q2.",
        "title": "Describe the epidemiology of Diabetes Mellitus with its classification, complications, and control measures.",
        "points": [
            "Definition: Group of metabolic disorders characterised by hyperglycaemia due to defects in insulin secretion, action or both",
            "WHO 2019 Classification: Type 1, Type 2, Hybrid forms (Slowly evolving immune-mediated / LADA; Ketosis-prone Type 2), Monogenic, Diseases of exocrine pancreas, Endocrine disorders, Drug-induced, Unclassified",
            "Complications: Retinopathy, Nephropathy, Neuropathy, CVD, Peripheral arterial disease, Cerebrovascular disease, Cataracts, Increased TB risk",
            "Screening: Urine sugar, fasting/post-prandial blood glucose, HbA1c",
            "NPCDCS - National Programme for Prevention and Control of Cancer, Diabetes, CVD and Stroke",
            "Primary prevention: Lifestyle modification, weight control, diet"
        ]
    },
    {
        "num": "Q3.",
        "title": "Describe the epidemiology, risk factors, and control of Hypertension.",
        "points": [
            "Definition and JNC/WHO classification of blood pressure levels",
            "Risk factors: Age, obesity, excess salt intake, alcohol, physical inactivity, stress, family history",
            "Complications: Stroke (most common), CHD, Renal failure, Heart failure, Retinopathy",
            "Prevention: Sodium reduction (<5g/day), DASH diet, weight reduction, exercise, alcohol moderation",
            "Screening: Mass screening vs selective screening of high-risk groups",
            "Treatment: Lifestyle + pharmacotherapy (diuretics, beta-blockers, ACEi, CCBs, ARBs)"
        ]
    },
    {
        "num": "Q4.",
        "title": "Write in detail about the Epidemiology of Cancer with specific reference to India.",
        "points": [
            "Global burden: Leading causes of cancer death - lung, stomach, liver (males); breast, cervix, colorectum (females)",
            "India - ICMR National Cancer Registry data; Common cancers: oral cavity, cervix, breast, lung, oesophagus",
            "Risk factors: Tobacco (most important), alcohol, diet, infections (HPV → cervix, HBV → liver), occupational carcinogens, radiation",
            "Cancer patterns: Westernization trend - decline in infection-related cancers, rise in breast/prostate/colorectal",
            "Cancer control: Primary (avoid risk factors), Secondary (screening - Pap smear, mammography, oral exam), Tertiary (treatment/palliation)",
            "National Cancer Control Programme (NCCP) objectives"
        ]
    },
    {
        "num": "Q5.",
        "title": "Write in detail about Obesity - measurement, determinants, health hazards, and control.",
        "points": [
            "Definition: BMI ≥30 kg/m² (WHO); Asian cut-off ≥27.5 kg/m²",
            "Assessment methods: BMI (wt/ht²), Waist circumference, Waist-hip ratio, Skinfold thickness (Harpenden callipers)",
            "WHO BMI classification: Underweight <18.5, Normal 18.5–24.9, Overweight 25–29.9, Obese ≥30",
            "Determinants: Excess calorie intake, physical inactivity, genetic factors, endocrine (hypothyroidism, Cushing's), drugs",
            "Health hazards: T2DM, Hypertension, CHD, Dyslipidaemia, Osteoarthritis, Sleep apnoea, Cancers (breast, colon, endometrium), Psychological",
            "Control: Diet modification, physical activity, behaviour therapy, pharmacotherapy, bariatric surgery"
        ]
    }
]

for q in lqs:
    items = [
        Paragraph(f'<b>{q["num"]}</b> {q["title"]}', q_heading_style),
    ]
    items.append(Paragraph("<b>Key points to cover:</b>", body_style))
    for pt in q["points"]:
        items.append(Paragraph(f"\u2022 {pt}", bullet_style))
    items.append(Spacer(1, 0.2*cm))
    story.append(KeepTogether(items))

# ── SECTION 2 : SHORT QUESTIONS ────────────────────────────────────────────
story.append(Spacer(1, 0.3*cm))
story.append(Paragraph("SHORT QUESTIONS  (5 Marks)", section_style))
story.append(Spacer(1, 0.2*cm))

sqs = [
    ("Q6.", "Risk factors of Coronary Heart Disease (CHD)", [
        "Non-modifiable: Age (>45 men, >55 women), Male sex, Family history, Type A personality",
        "Modifiable: Hypertension, Hypercholesterolaemia (LDL↑, HDL↓), Smoking, Diabetes mellitus, Obesity (BMI ≥30), Sedentary lifestyle, Diet rich in saturated fat",
        "Framingham study established smoking, hypertension, dyslipidaemia as the 'big three' risk factors"
    ]),
    ("Q7.", "Secondary Prevention of Rheumatic Fever", [
        "Benzathine benzyl penicillin IM every 3 weeks (21 days)",
        "Dose: Adults 1.2 million units; Children 600,000 units",
        "Duration: No carditis → 5 years or until 18 yrs; Mild carditis → 10 years or until 25 yrs; Severe/post-surgery → Life-long",
        "Alternative (penicillin allergy): Erythromycin / Sulfadiazine"
    ]),
    ("Q8.", "Stroke - Epidemiology and Control", [
        "Types: Ischaemic (80%) vs Haemorrhagic (20%)",
        "Most important risk factor: Hypertension",
        "Other risk factors: Diabetes, Smoking, Atrial fibrillation, Hyperlipidaemia, Obesity, Sedentary lifestyle",
        "Stroke control programme in India under NPCDCS",
        "Prevention: Control of hypertension, antiplatelet drugs, anticoagulation in AF"
    ]),
    ("Q9.", "BMI and Classification of Obesity", [
        "Formula: Weight (kg) ÷ Height² (m²)",
        "WHO: Underweight <18.5 | Normal 18.5–24.9 | Overweight 25–29.9 | Obese ≥30 | Morbidly obese ≥40",
        "Asian/Indian cut-offs: Overweight ≥23 | Obese ≥25",
        "Waist circumference risk threshold: Men >102 cm (WHO) / >90 cm (Asian); Women >88 cm / >80 cm (Asian)"
    ]),
    ("Q10.", "NPCDCS - National Programme for Prevention and Control of Cancer, Diabetes, CVD and Stroke", [
        "Launched under 11th Five Year Plan; now continued under NHM",
        "Two sub-components: (A) Cancer; (B) Diabetes + CVD + Stroke",
        "Infrastructure: District NCD Clinic, CHC NCD Clinic, CHO-led primary care NCD screening",
        "Objectives: Health promotion, early diagnosis, treatment at primary level, referral system",
        "Population-based screening for hypertension, diabetes, 3 common cancers (oral, breast, cervix)"
    ]),
    ("Q11.", "Metabolic Syndrome", [
        "Also called Syndrome X / Insulin resistance syndrome",
        "IDF criteria: Central obesity (waist ≥90 cm men / ≥80 cm women for Asians) PLUS any 2 of:",
        "  – Raised triglycerides ≥150 mg/dL  |  Low HDL <40 (men) / <50 (women) mg/dL",
        "  – Hypertension ≥130/85 mmHg  |  Raised fasting glucose ≥100 mg/dL",
        "Significance: 5× increased risk of T2DM; 2× increased CVD risk",
        "Treatment: Lifestyle modification (cornerstone), treat individual components"
    ]),
    ("Q12.", "Epidemiology of Rheumatic Heart Disease (RHD) in India", [
        "Caused by Group A beta-haemolytic streptococcal pharyngitis → Acute Rheumatic Fever → RHD",
        "India prevalence: 5–7 per 1000 in 5–15 year age group; ~1 million RHD cases",
        "20–30% of all CVD hospital admissions in India are due to RHD",
        "High-risk groups: School-age children (5–15 yrs), slum dwellers, closed communities",
        "RF occurs in 1–3% of streptococcal infections; higher in poor socio-economic conditions",
        "Prevention: Primary (treat strep throat) + Secondary (benzathine penicillin prophylaxis)"
    ]),
]

for q in sqs:
    items = [Paragraph(f'<b>{q[0]}</b> {q[1]}', q_heading_style)]
    for pt in q[2]:
        indent = sub_bullet_style if pt.startswith("  –") else bullet_style
        items.append(Paragraph(f"\u2022 {pt.strip()}", indent))
    items.append(Spacer(1, 0.15*cm))
    story.append(KeepTogether(items))

# ── SECTION 3 : VERY SHORT / ONE-LINERS ───────────────────────────────────
story.append(Spacer(1, 0.3*cm))
story.append(Paragraph("VERY SHORT / ONE-LINER QUESTIONS  (2–3 Marks)", section_style))
story.append(Spacer(1, 0.3*cm))

table_data = [
    [Paragraph("<b>Question</b>", label_style), Paragraph("<b>Key Answer</b>", label_style)],
    ["Modern epidemic according to WHO", "Coronary Heart Disease (CHD)"],
    ["Most important modifiable risk factor for stroke", "Hypertension"],
    ["Drug for secondary prevention of Rheumatic Fever", "Benzathine benzyl penicillin IM (3-weekly)"],
    ["BMI formula", "Weight (kg) / Height² (m²)"],
    ["Global visually impaired (2010)", "285 million (39 million blind)"],
    ["Vision 2020 launched on", "18th February 1999 by WHO"],
    ["Four-tier structure under Vision 2020 (India)", "Centres of Excellence (20), Training (200), Service (2000), Vision Centres (20,000)"],
    ["Most common cancer in Indian females", "Cervix uteri / Breast"],
    ["Most common cancer in Indian males", "Oral cavity / Lung"],
    ["NPCDCS stands for", "National Programme for Prevention and Control of Cancer, Diabetes, CVD and Stroke"],
    ["Iceberg phenomenon applicable to", "Diabetes, Hypertension (many undiagnosed cases)"],
    ["Framingham study design", "Prospective cohort study - identified major CHD risk factors"],
    ["Type A personality associated with", "Increased CHD risk"],
    ["WHO criterion: Obesity BMI", "≥ 30 kg/m²"],
    ["RF incidence in streptococcal infection", "1–3% of streptococcal pharyngitis cases"],
    ["Target for Global Eye Health Action Plan 2014-2019", "25% reduction in avoidable visual impairment by 2019 from 2010 baseline"],
]

col_widths = [9*cm, 8.5*cm]
tbl = Table(table_data, colWidths=col_widths, repeatRows=1)
tbl.setStyle(TableStyle([
    ('BACKGROUND', (0,0), (-1,0), colors.HexColor('#c62828')),
    ('TEXTCOLOR', (0,0), (-1,0), colors.white),
    ('FONTNAME', (0,0), (-1,0), 'Helvetica-Bold'),
    ('FONTSIZE', (0,0), (-1,0), 9),
    ('FONTSIZE', (0,1), (-1,-1), 9),
    ('ROWBACKGROUNDS', (0,1), (-1,-1), [colors.white, colors.HexColor('#fce4ec')]),
    ('GRID', (0,0), (-1,-1), 0.5, colors.HexColor('#bdbdbd')),
    ('VALIGN', (0,0), (-1,-1), 'MIDDLE'),
    ('TOPPADDING', (0,0), (-1,-1), 5),
    ('BOTTOMPADDING', (0,0), (-1,-1), 5),
    ('LEFTPADDING', (0,0), (-1,-1), 6),
    ('RIGHTPADDING', (0,0), (-1,-1), 6),
    ('WORDWRAP', (0,0), (-1,-1), True),
]))
story.append(tbl)

# ── SECTION 4 : SPECIAL TOPICS ─────────────────────────────────────────────
story.append(Spacer(1, 0.4*cm))
story.append(Paragraph("SPECIAL / FREQUENTLY ASKED TOPICS", section_style))
story.append(Spacer(1, 0.2*cm))

specials = [
    ("Q13.", "Levels of Prevention for NCDs (with examples)", [
        "Primordial: Prevent risk factors from emerging — healthy public policy, tobacco control legislation",
        "Primary: Health promotion + specific protection — diet counselling, exercise promotion, HBV/HPV vaccination",
        "Secondary: Early diagnosis and prompt treatment — screening for DM, HTN, breast/cervical cancer",
        "Tertiary: Disability limitation + Rehabilitation — cardiac rehab, diabetic foot care, stroke rehabilitation"
    ]),
    ("Q14.", "Tobacco and Non-Communicable Diseases", [
        "Tobacco linked to: Lung cancer (RR ~10×), oral cancer, CHD, COPD, stroke, peripheral vascular disease, bladder cancer",
        "COTPA 2003 (Cigarettes and Other Tobacco Products Act) - India's legislative framework",
        "WHO MPOWER package: Monitor, Protect, Offer cessation, Warn, Enforce bans, Raise taxes",
        "Smokeless tobacco (betel quid, khaini) strongly linked to oral cavity cancer in India"
    ]),
    ("Q15.", "Diet and NCDs", [
        "Saturated fat / trans fat → ↑LDL → CHD",
        "Excess dietary sodium → Hypertension",
        "Vitamin A deficiency → Xerophthalmia → Blindness (commonest preventable cause of childhood blindness)",
        "Dietary fibre deficiency → Colorectal cancer",
        "Excess calories / refined sugars → Obesity → Diabetes, HTN, CVD",
        "Alcohol → Liver cirrhosis, oral/oesophageal/hepatic cancer, hypertension, cardiomyopathy"
    ]),
    ("Q16.", "Vision 2020: The Right to Sight", [
        "Global initiative to eliminate avoidable blindness; launched by WHO on 18th February 1999",
        "Key concept: Sight as a fundamental HUMAN RIGHT",
        "Target diseases: Cataract, Xerophthalmia, Childhood blindness, Refractive errors, Trachoma, Corneal blindness",
        "India additionally includes: Glaucoma, Diabetic retinopathy",
        "Four-tier structure: Centres of Excellence (20), Training Centres (200), Service Centres (2000), Vision Centres (20,000)",
        "Global Eye Health Action Plan 2014–19: 25% reduction in avoidable VI from 2010 baseline"
    ]),
]

for q in specials:
    items = [Paragraph(f'<b>{q[0]}</b> {q[1]}', q_heading_style)]
    for pt in q[2]:
        items.append(Paragraph(f"\u2022 {pt}", bullet_style))
    items.append(Spacer(1, 0.15*cm))
    story.append(KeepTogether(items))

# ── EXAM TIP BOX ─────────────────────────────────────────────────────────
story.append(Spacer(1, 0.3*cm))
story.append(HRFlowable(width="100%", thickness=1, color=colors.HexColor('#e65100'), spaceAfter=6))
story.append(Paragraph(
    "<b>Exam Tip:</b> University exams frequently combine two NCDs (e.g., 'Diabetes and Hypertension as "
    "risk factors for CHD'), or pair a disease with its national programme. Always structure answers as: "
    "Definition → Epidemiology/Burden → Risk Factors → Prevention → National Programme.",
    note_style
))
story.append(HRFlowable(width="100%", thickness=1, color=colors.HexColor('#e65100'), spaceBefore=4))

# ── FOOTER NOTE ──────────────────────────────────────────────────────────
story.append(Spacer(1, 0.3*cm))
story.append(Paragraph(
    "Source: Park's Textbook of Preventive and Social Medicine | Community Medicine Reference",
    ParagraphStyle('Footer', parent=styles['Normal'], fontSize=8,
                   textColor=colors.HexColor('#9e9e9e'), alignment=TA_CENTER)
))

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

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

OUTPUT = "/home/daytona/workspace/ncd-questions/CD_Epidemiology_University_Questions.pdf"

doc = SimpleDocTemplate(
    OUTPUT, pagesize=A4,
    leftMargin=2*cm, rightMargin=2*cm,
    topMargin=2*cm, bottomMargin=2*cm,
    title="Epidemiology of Communicable Diseases - University Questions",
    author="Park's Textbook Reference"
)

styles = getSampleStyleSheet()

title_style = ParagraphStyle('T', parent=styles['Title'], fontSize=18,
    textColor=colors.HexColor('#1b5e20'), spaceAfter=4, alignment=TA_CENTER)
subtitle_style = ParagraphStyle('ST', parent=styles['Normal'], fontSize=11,
    textColor=colors.HexColor('#455a64'), spaceAfter=14, alignment=TA_CENTER, italic=True)
section_style = ParagraphStyle('Sec', parent=styles['Heading1'], fontSize=13,
    textColor=colors.white, backColor=colors.HexColor('#1b5e20'),
    spaceBefore=14, spaceAfter=4, leftIndent=-0.3*cm, rightIndent=-0.3*cm,
    borderPadding=(6,8,6,8))
q_style = ParagraphStyle('Q', parent=styles['Heading2'], fontSize=11,
    textColor=colors.HexColor('#2e7d32'), spaceBefore=10, spaceAfter=3)
body_style = ParagraphStyle('B', parent=styles['Normal'], fontSize=9.5,
    leading=14, spaceAfter=3, alignment=TA_JUSTIFY)
bullet_style = ParagraphStyle('Blt', parent=styles['Normal'], fontSize=9.5,
    leading=13, leftIndent=16, spaceAfter=2, bulletIndent=4)
sub_bullet_style = ParagraphStyle('SBlt', parent=styles['Normal'], fontSize=9,
    leading=13, leftIndent=30, spaceAfter=1, bulletIndent=18,
    textColor=colors.HexColor('#333333'))
note_style = ParagraphStyle('Note', parent=styles['Normal'], fontSize=9,
    leading=13, textColor=colors.HexColor('#e65100'),
    backColor=colors.HexColor('#fff3e0'), borderPadding=(5,6,5,6),
    spaceAfter=6, spaceBefore=4, leftIndent=4, rightIndent=4)
footer_style = ParagraphStyle('Ft', parent=styles['Normal'], fontSize=8,
    textColor=colors.HexColor('#9e9e9e'), alignment=TA_CENTER)

story = []

# TITLE
story.append(Spacer(1, 0.3*cm))
story.append(Paragraph("Important University Questions", title_style))
story.append(Paragraph("Epidemiology of Communicable Diseases", title_style))
story.append(Paragraph("Based on Park's Textbook of Preventive and Social Medicine", subtitle_style))
story.append(HRFlowable(width="100%", thickness=2, color=colors.HexColor('#1b5e20'), spaceAfter=8))

# ── SECTION 1: LONG QUESTIONS ──────────────────────────────────────────────
story.append(Paragraph("LONG QUESTIONS  (10–15 Marks)", section_style))
story.append(Spacer(1, 0.2*cm))

long_qs = [
    {
        "num": "Q1.",
        "title": "Discuss the epidemiology, modes of transmission, and control of Tuberculosis.",
        "points": [
            "Definition: Specific infectious disease caused by Mycobacterium tuberculosis; primarily affects lungs",
            "Global burden: ~10 million cases in 2019; 1.2 million deaths (HIV-negative); 8.2% co-infected with HIV; 1/3rd of world population asymptomatically infected",
            "MDR/RR-TB: 3.3% of new cases; 18% of previously treated cases had MDR/RR-TB",
            "India: Highest TB burden globally (~26% of world's cases); Nikshay portal for notification",
            "Agent: M. tuberculosis (acid-fast bacillus); one smear-positive case can infect 10–15 persons per year",
            "Transmission: Droplet nuclei (airborne); 5% of infected develop primary disease; 5% develop reactivation later",
            "Risk factors: Malnutrition, overcrowding, HIV/AIDS, diabetes, silicosis, immunosuppression",
            "Diagnosis: Sputum smear microscopy, culture, CBNAAT/GeneXpert, Tuberculin skin test (TST/Mantoux), IGRA",
            "Treatment: DOTS (Directly Observed Treatment Short-course): 2HRZE + 4HR (first-line regimen)",
            "National TB Elimination Programme (NTEP) - target: Eliminate TB by 2025 (5 years ahead of SDG target)",
            "Prevention: BCG vaccination at birth, early case detection, contact tracing, chemoprophylaxis with isoniazid"
        ]
    },
    {
        "num": "Q2.",
        "title": "Describe the epidemiology, vector, life cycle, and control of Malaria.",
        "points": [
            "Definition: Protozoal disease caused by Plasmodium species (P. falciparum, P. vivax, P. malariae, P. ovale, P. knowlesi)",
            "Vector: Female Anopheles mosquito; breeds in clear, slow-moving water",
            "Life cycle: Sporogony in mosquito; schizogony in human (liver: exoerythrocytic; RBCs: erythrocytic)",
            "Global burden: 229 million cases in 2019; India largest reduction in SEA - 20 million (2000) to 5.6 million (2019)",
            "Typical attack: Cold stage → Hot stage → Sweating stage; P. vivax/ovale = 48 hrs (tertian); P. malariae = 72 hrs (quartan)",
            "Severe/complicated malaria: Caused by P. falciparum; cerebral malaria, blackwater fever, algid malaria",
            "Diagnosis: Blood smear (gold standard), RDT, QBC, PCR",
            "Treatment: Uncomplicated P. falciparum → ACT (Artemisinin Combination Therapy); P. vivax → Chloroquine + Primaquine",
            "Chemoprophylaxis: Chloroquine or Mefloquine for travellers",
            "Vector control: ITNs (Insecticide Treated Nets), IRS (Indoor Residual Spraying), larvivorous fish (Gambusia)",
            "National Vector Borne Disease Control Programme (NVBDCP); National Framework for Malaria Elimination (NFME) 2016–2030"
        ]
    },
    {
        "num": "Q3.",
        "title": "Discuss the epidemiology, clinical features, and control of Cholera.",
        "points": [
            "Causative agent: Vibrio cholerae O1 (Classical / El Tor biotype) and O139 (first identified in Bangladesh, 1992)",
            "O139 confined to South-East Asia; El Tor now dominates globally; new El Tor variants with higher CFR emerging",
            "Incubation period: Few hours to 5 days (usually 1–3 days)",
            "Clinical: Sudden profuse painless watery ('rice-water') diarrhoea, vomiting, rapid dehydration, muscle cramps, suppression of urine; CFR up to 30–40% if untreated",
            "Global burden: 923,037 cases in 2019 (55 countries); true burden estimated 1.3–4 million cases/year",
            "Transmission: Faecal-oral via contaminated water/food; closely linked to inadequate water & sanitation",
            "Cholera is a key indicator of lack of social development (WHO)",
            "Vibrio Carrier state: Important in spread; convalescent carriers",
            "Treatment: ORS (cornerstone), IV Ringer's lactate for severe dehydration; antibiotics (doxycycline, azithromycin) shorten illness",
            "Control: Safe water supply, sanitation, food hygiene, cholera vaccine (Shanchol/OCV), case notification",
            "OCV (Oral Cholera Vaccine): 2-dose schedule; used in outbreak settings and high-risk areas"
        ]
    },
    {
        "num": "Q4.",
        "title": "Write in detail about the epidemiology, classification, and control of Leprosy.",
        "points": [
            "Causative agent: Mycobacterium leprae (Hansen's bacillus); does not grow in vitro",
            "Primarily affects peripheral nerves, skin, eyes, mucous membranes",
            "Ridley-Jopling classification: TT (Tuberculoid), BT, BB, BL, LL (Lepromatous) - spectrum based on host immunity",
            "WHO classification (for treatment): Paucibacillary (PB) - up to 5 lesions; Multibacillary (MB) - 6 or more lesions",
            "Cardinal features: Hypopigmented/erythematous skin patch with loss of sensation, thickened peripheral nerves, AFB in skin smear",
            "Source of infection: Untreated lepromatous patient; transmission via nasal droplets and skin contact",
            "Incubation period: 2–5 years average (range 6 months to 40 years)",
            "Global burden: Prevalence fell from 21.1/10,000 (1985) to 22.4/million (2018); >16 million cured in 20 years",
            "MDT (Multi-Drug Therapy) - WHO regimen: PB = Rifampicin (monthly) + Dapsone (daily) × 6 months; MB = Rifampicin + Dapsone + Clofazimine × 12 months",
            "National Leprosy Eradication Programme (NLEP); elimination target: <1 case per 10,000 population",
            "Disability prevention and rehabilitation: Grade 0/1/2 disability grading; self-care instructions"
        ]
    },
    {
        "num": "Q5.",
        "title": "Describe the epidemiology and control of Typhoid Fever.",
        "points": [
            "Causative agent: Salmonella typhi (enteric fever also includes S. paratyphi A, B, C)",
            "Incubation period: 10–14 days (range 3–60 days)",
            "Clinical: Continuous (Widal's ladder pattern) fever 3–4 weeks, relative bradycardia, rose spots, splenomegaly, constipation then diarrhoea",
            "Global burden: 11–20 million cases/year; 128,000–161,000 deaths/year; predominantly children in Asia",
            "MDR typhoid: Resistant to chloramphenicol, ampicillin and cotrimoxazole; XDR (extensively drug-resistant) strains emerging",
            "Transmission: Faecal-oral via contaminated water and food; carrier state important (Typhoid Mary concept)",
            "Carrier types: Convalescent, temporary, chronic (gallbladder/urinary) carriers",
            "Diagnosis: Blood culture (gold standard - Week 1), Widal test (Week 2 onwards), bone marrow culture (most sensitive)",
            "Treatment: Fluoroquinolones (ciprofloxacin) first line; cefixime/ceftriaxone for MDR; azithromycin",
            "Vaccines: Vi polysaccharide vaccine (single dose, ≥2 years, 70% efficacy); Typhoid Conjugate Vaccine (TCV) - longer immunity",
            "Prevention: Safe water, food hygiene, sanitation, hand washing; notification to health authorities"
        ]
    },
    {
        "num": "Q6.",
        "title": "Discuss Herd Immunity - definition, elements, threshold, and significance in disease control.",
        "points": [
            "Definition: Type of immunity where vaccination of a portion of population protects unprotected individuals by interrupting chain of infection",
            "Mechanism: When large numbers are immune, susceptible persons are unlikely to contact infectious agent",
            "Classical example: Measles epidemic in Faroe Islands (1854) - 'virgin' population, high attack + CFR; epidemic declined with build-up of natural herd immunity",
            "Elements contributing to herd immunity: (a) Clinical and subclinical infections in herd; (b) Immunization of herd; (c) Herd structure",
            "Herd structure: Influenced by new births, deaths, population mobility; also includes animal hosts and insect vectors",
            "Herd immunity threshold: Proportion of immune individuals above which disease can no longer persist; varies with R0 (basic reproduction number), vaccine efficacy, contact pattern",
            "100% herd immunity not necessary - smallpox eradicated, polio near-eliminated without it",
            "Exception: Tetanus - herd immunity does NOT protect the individual (toxin-mediated, not person-to-person)",
            "Determined by: Serological surveys (serological epidemiology)",
            "Applications: Eradication of smallpox, elimination of polio, control of measles, diphtheria",
            "High herd immunity maintained by ongoing immunization programmes"
        ]
    },
    {
        "num": "Q7.",
        "title": "Write in detail about Dengue Fever - epidemiology, clinical spectrum (dengue syndrome), and management.",
        "points": [
            "Causative agent: Dengue virus (Flavivirus) - 4 serotypes (DEN 1, 2, 3, 4); all 4 can cause dengue and DHF",
            "Vector: Aedes aegypti (primary); Aedes albopictus (secondary); peridomestic, day-biting mosquito",
            "Breeding site: Clean, stagnant water in artificial containers (flower pots, tyres, coolers, overhead tanks)",
            "Clinical spectrum: (1) Undifferentiated fever; (2) Classic Dengue Fever (DF); (3) Dengue Haemorrhagic Fever (DHF); (4) Dengue Shock Syndrome (DSS)",
            "Classic DF: Sudden fever, severe headache, retro-orbital pain, myalgia, arthralgia ('breakbone fever'), rash",
            "DHF: High fever + haemorrhagic manifestations + thrombocytopenia (<1,00,000) + plasma leakage (haemoconcentration, pleural effusion, ascites)",
            "WHO DHF Grades: Grade I (fever + tourniquet test positive); Grade II (+spontaneous bleeding); Grade III (circulatory failure); Grade IV (profound shock)",
            "Dengue Shock Syndrome: Grade III and IV DHF with hypotension/narrow pulse pressure",
            "Pathophysiology: Secondary infection with different serotype → antibody-dependent enhancement → severe disease",
            "Management: No specific antiviral; supportive (fluids, paracetamol - NOT NSAIDs/aspirin); Grade III/IV → ICU",
            "Prevention: Source reduction (eliminate breeding sites), larvicides (Temephos), biological control, personal protection (repellents, nets)",
            "NVBDCP: National Vector Borne Disease Control Programme manages dengue control in India"
        ]
    }
]

for q in long_qs:
    items = [Paragraph(f'<b>{q["num"]}</b> {q["title"]}', q_style)]
    items.append(Paragraph("<b>Key points to cover:</b>", body_style))
    for pt in q["points"]:
        items.append(Paragraph(f"\u2022 {pt}", bullet_style))
    items.append(Spacer(1, 0.2*cm))
    story.append(KeepTogether(items))

# ── SECTION 2: SHORT QUESTIONS ─────────────────────────────────────────────
story.append(Spacer(1, 0.3*cm))
story.append(Paragraph("SHORT QUESTIONS  (5 Marks)", section_style))
story.append(Spacer(1, 0.2*cm))

short_qs = [
    ("Q8.", "DOTS (Directly Observed Treatment Short-course) for Tuberculosis", [
        "WHO recommended strategy for TB control; cornerstone of NTEP (National TB Elimination Programme)",
        "5 components of DOTS: Political commitment; Microscopy services; Drug supply; Surveillance & evaluation; Direct observation of treatment",
        "DOTS regimen (Category I): Intensive phase: 2 months HRZE (Isoniazid, Rifampicin, Pyrazinamide, Ethambutol); Continuation phase: 4 months HR",
        "Daily fixed-dose combinations (FDC) now preferred over thrice-weekly regimen",
        "DOTS-Plus: For MDR-TB; second-line drugs under PMDT (Programmatic Management of Drug-resistant TB)",
        "India's target: Eliminate TB by 2025 (5 yrs ahead of global SDG 2030 target)"
    ]),
    ("Q9.", "Chain of Infection / Epidemiological Triad", [
        "Three components: Agent (pathogen) + Host (susceptible person) + Environment",
        "Chain: Infectious agent → Reservoir → Portal of exit → Mode of transmission → Portal of entry → Susceptible host",
        "Breaking the chain: Eliminate reservoir; Block portal of exit; Interrupt transmission; Block portal of entry; Increase host resistance",
        "Modes of transmission: Direct (contact, droplet, transplacental) and Indirect (vehicle-borne, vector-borne, air-borne, fomite)",
        "Applied to all communicable diseases; essential framework for outbreak investigation"
    ]),
    ("Q10.", "Outbreak Investigation - Steps", [
        "1. Confirm existence of outbreak (verify diagnosis; compare with baseline)",
        "2. Case definition and case finding (attack rate calculation)",
        "3. Descriptive epidemiology - Person, Place, Time (epidemic curve)",
        "4. Formulate hypothesis about source/vehicle/mode",
        "5. Test hypothesis (analytic study - case-control or cohort)",
        "6. Control measures (simultaneously, do not wait for full investigation)",
        "7. Report writing and follow-up surveillance",
        "Epidemic curve shape: Point source (sharp rise/fall); Propagated (multiple peaks); Mixed"
    ]),
    ("Q11.", "BCG Vaccine and its Role in TB Control", [
        "BCG (Bacille Calmette-Guérin): Live attenuated strain of M. bovis",
        "Given at birth (or as early as possible after birth) - 0.1 mL intradermal, left deltoid",
        "Efficacy: 80% against severe forms (miliary TB, TB meningitis) in children; variable for pulmonary TB",
        "Does NOT prevent infection but prevents dissemination and severe disease",
        "Mantoux test (TST): Read at 48–72 hours; induration ≥10 mm = positive (≥5 mm if immunocompromised/HIV)",
        "BCG does not affect Mantoux positivity interpretation if given in infancy"
    ]),
    ("Q12.", "Pulse Polio Immunization (PPI) Programme in India", [
        "India declared Polio-free by WHO on 27th March 2014",
        "PPI: Supplementary immunization activity - 2 drops OPV to all children <5 years on National Immunization Days (NIDs)",
        "Strategy: NID (National Immunization Days) + SNID (Sub-National Immunization Days) + mopping-up",
        "AFP (Acute Flaccid Paralysis) surveillance: Sensitive indicator for monitoring polio eradication",
        "OPV (Oral Polio Vaccine - Sabin): Live attenuated; 3 serotypes; mucosal immunity; herd immunity via faeco-oral spread",
        "IPV (Inactivated Polio Vaccine - Salk): Now introduced in routine immunization in India alongside OPV"
    ]),
    ("Q13.", "Classification and Treatment of Leprosy (MDT Regimen)", [
        "WHO Classification: Paucibacillary (PB) - ≤5 skin lesions; Multibacillary (MB) - ≥6 skin lesions",
        "PB-MDT: Rifampicin 600 mg monthly (supervised) + Dapsone 100 mg daily × 6 months",
        "MB-MDT: Rifampicin 600 mg + Clofazimine 300 mg monthly (supervised) + Dapsone 100 mg + Clofazimine 50 mg daily × 12 months",
        "Children: Doses adjusted based on weight",
        "Leprosy reactions: Type 1 (reversal reaction) - treat with steroids; Type 2 (ENL/Erythema Nodosum Leprosum) - treat with thalidomide/clofazimine",
        "NLEP: National Leprosy Eradication Programme; elimination target <1/10,000 population - achieved nationally"
    ]),
    ("Q14.", "Carrier in Communicable Diseases", [
        "Definition: Person who harbours the infectious agent without apparent illness but can transmit it to others",
        "Types: Incubatory carrier (window period), Convalescent carrier (recovery phase), Chronic carrier (>3 months; e.g., Typhoid Mary), Healthy/contact carrier",
        "Examples: Typhoid (gallbladder carrier), Cholera (convalescent), Diphtheria (nasal carrier), Hepatitis B (HBsAg positive), HIV (asymptomatic)",
        "Importance: Major source of infection; difficult to detect; maintain endemicity",
        "Detection: Stool cultures (typhoid), Throat swabs (diphtheria), Blood tests (HBsAg, HIV ELISA)",
        "Control: Treatment, surveillance, restriction from high-risk occupations (food handlers, healthcare workers)"
    ]),
    ("Q15.", "National Immunization Schedule (UIP - Universal Immunization Programme)", [
        "At birth: BCG, OPV-0, Hepatitis B (birth dose)",
        "6, 10, 14 weeks: OPV 1/2/3, Pentavalent (DPT+Hep B+Hib) 1/2/3, Rotavirus vaccine, IPV, PCV (in select states)",
        "9 months: MR (Measles-Rubella) vaccine 1st dose, Vitamin A 1st dose, JE (in endemic districts)",
        "16–24 months: DPT booster 1, OPV booster, MR 2nd dose, Vitamin A 2nd dose",
        "5–6 years: DPT booster 2; 10 & 16 years: TT vaccine",
        "UIP provides free vaccines for 12 vaccine-preventable diseases under the National Health Mission"
    ]),
]

for q in short_qs:
    items = [Paragraph(f'<b>{q[0]}</b> {q[1]}', q_style)]
    for pt in q[2]:
        items.append(Paragraph(f"\u2022 {pt}", bullet_style))
    items.append(Spacer(1, 0.15*cm))
    story.append(KeepTogether(items))

# ── SECTION 3: ONE-LINERS TABLE ────────────────────────────────────────────
story.append(Spacer(1, 0.3*cm))
story.append(Paragraph("VERY SHORT / ONE-LINER QUESTIONS  (2–3 Marks)", section_style))
story.append(Spacer(1, 0.3*cm))

header_label = ParagraphStyle('HL', parent=styles['Normal'], fontSize=9,
    textColor=colors.white, backColor=colors.HexColor('#1b5e20'),
    fontName='Helvetica-Bold', alignment=TA_CENTER)

table_data = [
    [Paragraph("<b>Question</b>", header_label), Paragraph("<b>Key Answer</b>", header_label)],
    ["Causative agent of TB", "Mycobacterium tuberculosis (acid-fast bacillus)"],
    ["One smear-positive TB patient infects", "10–15 persons per year"],
    ["DOTS stands for", "Directly Observed Treatment Short-course"],
    ["TB elimination target in India", "2025 (5 years ahead of SDG 2030)"],
    ["Vector of malaria", "Female Anopheles mosquito"],
    ["Most dangerous species of Plasmodium", "P. falciparum (cerebral malaria, blackwater fever)"],
    ["P. vivax periodicity of fever", "Every 48 hours (tertian malaria)"],
    ["Vector of dengue", "Aedes aegypti (day-biting)"],
    ["Dengue 'breakbone fever' refers to", "Severe myalgia and arthralgia in classic dengue fever"],
    ["DHF Grades I–IV defined by", "WHO DHF grading scale"],
    ["Cholera rice-water stool caused by", "Vibrio cholerae O1 El Tor / O139 enterotoxin"],
    ["Cholera O139 first identified in", "Bangladesh, 1992"],
    ["Typhoid blood culture best in", "Week 1 of illness"],
    ["Typhoid 'Widal ladder' fever pattern", "Stepladder rise in temperature over first week"],
    ["MDR typhoid resistant to", "Chloramphenicol + Ampicillin + Cotrimoxazole (all 3 first-line drugs)"],
    ["Leprosy causative agent", "Mycobacterium leprae (Hansen's bacillus)"],
    ["MB leprosy MDT duration", "12 months"],
    ["PB leprosy MDT duration", "6 months"],
    ["NLEP elimination target", "<1 case per 10,000 population (nationally achieved)"],
    ["India declared polio-free on", "27th March 2014 by WHO"],
    ["AFP surveillance used for", "Polio eradication monitoring"],
    ["Herd immunity does NOT protect individual in", "Tetanus (toxin-mediated, not spread person-to-person)"],
    ["Herd immunity threshold determined by", "R0 (basic reproduction number), vaccine efficacy, contact pattern"],
    ["Serological epidemiology determines", "Herd immunity levels in population"],
    ["BCG vaccine prevents", "Severe TB (miliary, meningitis) in children; NOT infection"],
    ["BCG given at", "Birth (or as early as possible); 0.1 mL intradermal, left deltoid"],
    ["Carrier who spread typhoid globally", "'Typhoid Mary' - chronic gallbladder carrier"],
    ["Gambusia fish used in", "Biological control of malaria (larvivorous fish)"],
    ["NVBDCP covers", "Malaria, Dengue, Filaria, Kala-azar, JE, Chikungunya"],
]

col_widths = [9*cm, 8.5*cm]
tbl = Table(table_data, colWidths=col_widths, repeatRows=1)
tbl.setStyle(TableStyle([
    ('BACKGROUND', (0,0), (-1,0), colors.HexColor('#1b5e20')),
    ('TEXTCOLOR', (0,0), (-1,0), colors.white),
    ('FONTNAME', (0,0), (-1,0), 'Helvetica-Bold'),
    ('FONTSIZE', (0,0), (-1,0), 9),
    ('FONTSIZE', (0,1), (-1,-1), 9),
    ('ROWBACKGROUNDS', (0,1), (-1,-1), [colors.white, colors.HexColor('#e8f5e9')]),
    ('GRID', (0,0), (-1,-1), 0.5, colors.HexColor('#bdbdbd')),
    ('VALIGN', (0,0), (-1,-1), 'MIDDLE'),
    ('TOPPADDING', (0,0), (-1,-1), 4),
    ('BOTTOMPADDING', (0,0), (-1,-1), 4),
    ('LEFTPADDING', (0,0), (-1,-1), 6),
    ('RIGHTPADDING', (0,0), (-1,-1), 6),
]))
story.append(tbl)

# ── SECTION 4: SPECIAL TOPICS ──────────────────────────────────────────────
story.append(Spacer(1, 0.4*cm))
story.append(Paragraph("SPECIAL / FREQUENTLY ASKED TOPICS", section_style))
story.append(Spacer(1, 0.2*cm))

specials = [
    ("Q16.", "Epidemic Curve - Types and Interpretation", [
        "Epidemic curve: Histogram of cases plotted by date/time of onset",
        "Point source epidemic: All exposed at same time/place; sharp rise and fall within one incubation period (e.g., food poisoning)",
        "Propagated/progressive epidemic: Person-to-person spread; multiple peaks, each separated by approximately one incubation period (e.g., measles)",
        "Mixed epidemic: Starts as point source, then propagated (e.g., cholera from contaminated water + person-to-person spread)",
        "Continuous source epidemic: Exposure ongoing over extended period; plateau pattern",
        "Incubation period can be estimated from epidemic curve (time from exposure to peak in point source outbreak)"
    ]),
    ("Q17.", "Surveillance in Communicable Diseases", [
        "Definition (WHO): Continuous scrutiny of factors that determine occurrence and distribution of disease",
        "Types: Passive (routine reporting), Active (field teams seek cases), Sentinel (selected sites), Syndromic (symptom-based)",
        "AFP surveillance: ≥1 case of AFP per 100,000 <15 years population per year = adequate sensitivity for polio surveillance",
        "Integrated Disease Surveillance Programme (IDSP) in India: State + district surveillance units; P (presumptive) + C (clinically confirmed) + L (lab-confirmed) data",
        "Notifiable diseases in India: Cholera, plague, yellow fever, dengue, malaria, polio, etc.",
        "Surveillance → Detection of outbreaks → Response → Evaluation of control measures"
    ]),
    ("Q18.", "Zoonoses - Definition, Classification, and Examples", [
        "Definition (WHO): Diseases and infections naturally transmitted between vertebrate animals and man",
        "Types: Anthropozoonoses (animal → man, e.g., Rabies, Brucellosis, Leptospirosis); Zooanthroponoses (man → animal, e.g., TB); Amphixenoses (both directions, e.g., Salmonellosis, Streptococcal infections)",
        "Important zoonoses: Rabies (dog bite), Plague (rat flea), Brucellosis (cattle/goat), Leptospirosis (rat urine/water), Anthrax (cattle), Q fever, Toxoplasma, Cysticercosis",
        "Control: Animal vaccination (rabies), vector control, pasteurisation of milk, PPE for at-risk workers, proper carcass disposal",
        "Post-exposure prophylaxis (PEP) for rabies: Wound washing + Anti-Rabies Vaccine (ARV) + Rabies Immunoglobulin (RIG) for category III exposure"
    ]),
    ("Q19.", "HIV/AIDS - Epidemiology, Transmission, and Prevention", [
        "Causative agent: HIV-1 (global) and HIV-2 (West Africa); Retrovirus targeting CD4+ T lymphocytes",
        "Transmission: Sexual (most common globally); Blood/blood products; Vertical (mother to child - MTCT); Not by casual contact",
        "Window period: 6–12 weeks (time to seroconversion); person is infectious during this period",
        "CD4 count determines stage: <200 cells/mm³ = AIDS-defining; <350 cells/mm³ = initiate ART",
        "NACP (National AIDS Control Programme) - India: NACP-V; 90-90-90 target (UNAIDS)",
        "Prevention: ABC (Abstinence, Be faithful, Condom use); Harm reduction (needle exchange); PMTCT (Prevention of Mother-to-Child Transmission); ART for all HIV-positive individuals; PrEP",
        "ICTC (Integrated Counselling and Testing Centres) for voluntary testing; NACO oversees programme in India"
    ]),
    ("Q20.", "Water-borne Diseases - Prevention and Water Purification", [
        "Major water-borne diseases: Cholera, Typhoid, Dysentery (amoebic/bacillary), Hepatitis A & E, Polio, Giardiasis, Leptospirosis",
        "Sanitary requirements for drinking water: WHO guidelines - <1 coliform/100 mL; turbidity <5 NTU; pH 6.5–8.5",
        "Water purification methods: Sedimentation → Coagulation (alum) → Filtration (slow/rapid sand) → Disinfection (chlorination)",
        "Residual chlorine: 0.5 mg/L after 30 min contact = adequate disinfection",
        "Emergency purification: Boiling (most effective); Chlorine tablets; Bleaching powder (1 mg/L residual chlorine)",
        "Sanitation: Open defecation free (ODF) status under Swachh Bharat Mission; Oral-faecal route interruption"
    ]),
]

for q in specials:
    items = [Paragraph(f'<b>{q[0]}</b> {q[1]}', q_style)]
    for pt in q[2]:
        items.append(Paragraph(f"\u2022 {pt}", bullet_style))
    items.append(Spacer(1, 0.15*cm))
    story.append(KeepTogether(items))

# ── EXAM TIP ───────────────────────────────────────────────────────────────
story.append(Spacer(1, 0.3*cm))
story.append(HRFlowable(width="100%", thickness=1, color=colors.HexColor('#e65100'), spaceAfter=6))
story.append(Paragraph(
    "<b>Exam Tip:</b> For communicable disease questions, always structure your answer as: "
    "Definition → Agent → Source/Reservoir → Transmission → Incubation period → Clinical features → "
    "Diagnosis → Treatment → Prevention and Control → National Programme. "
    "Questions on Herd Immunity, Carrier state, Chain of infection, and Outbreak investigation are "
    "common theory questions. Always link disease with its national programme (NTEP for TB, NVBDCP for Malaria/Dengue, NLEP for Leprosy, NACP for HIV).",
    note_style
))
story.append(HRFlowable(width="100%", thickness=1, color=colors.HexColor('#e65100'), spaceBefore=4))

# FOOTER
story.append(Spacer(1, 0.3*cm))
story.append(Paragraph(
    "Source: Park's Textbook of Preventive and Social Medicine | Community Medicine Reference",
    footer_style
))

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

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

OUTPUT = "/home/daytona/workspace/ncd-questions/Environment_Health_University_Questions.pdf"

doc = SimpleDocTemplate(
    OUTPUT, pagesize=A4,
    leftMargin=2*cm, rightMargin=2*cm,
    topMargin=2*cm, bottomMargin=2*cm,
    title="Environment and Health - University Questions",
    author="Park's Textbook Reference"
)

styles = getSampleStyleSheet()
BLUE = colors.HexColor('#01579b')
BLUE_LIGHT = colors.HexColor('#e1f5fe')
ORANGE = colors.HexColor('#e65100')

title_style = ParagraphStyle('T', parent=styles['Title'], fontSize=18,
    textColor=BLUE, spaceAfter=4, alignment=TA_CENTER)
subtitle_style = ParagraphStyle('ST', parent=styles['Normal'], fontSize=11,
    textColor=colors.HexColor('#455a64'), spaceAfter=14, alignment=TA_CENTER, italic=True)
section_style = ParagraphStyle('Sec', parent=styles['Heading1'], fontSize=13,
    textColor=colors.white, backColor=BLUE,
    spaceBefore=14, spaceAfter=4, leftIndent=-0.3*cm, rightIndent=-0.3*cm,
    borderPadding=(6,8,6,8))
q_style = ParagraphStyle('Q', parent=styles['Heading2'], fontSize=11,
    textColor=BLUE, spaceBefore=10, spaceAfter=3)
body_style = ParagraphStyle('B', parent=styles['Normal'], fontSize=9.5,
    leading=14, spaceAfter=3, alignment=TA_JUSTIFY)
bullet_style = ParagraphStyle('Blt', parent=styles['Normal'], fontSize=9.5,
    leading=13, leftIndent=16, spaceAfter=2)
sub_style = ParagraphStyle('SBlt', parent=styles['Normal'], fontSize=9,
    leading=13, leftIndent=30, spaceAfter=1, textColor=colors.HexColor('#333333'))
note_style = ParagraphStyle('Note', parent=styles['Normal'], fontSize=9,
    leading=13, textColor=ORANGE,
    backColor=colors.HexColor('#fff3e0'), borderPadding=(5,6,5,6),
    spaceAfter=6, spaceBefore=4, leftIndent=4, rightIndent=4)
footer_style = ParagraphStyle('Ft', parent=styles['Normal'], fontSize=8,
    textColor=colors.HexColor('#9e9e9e'), alignment=TA_CENTER)
tbl_hdr = ParagraphStyle('TH', parent=styles['Normal'], fontSize=9,
    textColor=colors.white, fontName='Helvetica-Bold', alignment=TA_CENTER)

story = []

# ── TITLE ──────────────────────────────────────────────────────────────────
story.append(Spacer(1, 0.3*cm))
story.append(Paragraph("Important University Questions", title_style))
story.append(Paragraph("Environment and Health", title_style))
story.append(Paragraph("Based on Park's Textbook of Preventive and Social Medicine", subtitle_style))
story.append(HRFlowable(width="100%", thickness=2, color=BLUE, spaceAfter=8))

# ── LONG QUESTIONS ─────────────────────────────────────────────────────────
story.append(Paragraph("LONG QUESTIONS  (10–15 Marks)", section_style))
story.append(Spacer(1, 0.2*cm))

long_qs = [
    {
        "num": "Q1.",
        "title": "Describe the sources of water, water pollution, water-related diseases, and principles of water purification on a large scale.",
        "points": [
            "Sources of water: Rain water (purest natural water), Surface water (rivers, lakes, reservoirs - turbid, prone to pollution), Ground water (wells, springs, tube-wells - may need only disinfection)",
            "Water quality standards: WHO - <1 coliform per 100 mL; turbidity <5 NTU; pH 6.5–8.5; residual chlorine 0.5 mg/L after 30 min",
            "Water pollution sources: (a) Sewage - organic matter + pathogens; (b) Industrial wastes - metal salts, synthetic chemicals; (c) Agricultural pollutants - fertilizers, pesticides; (d) Physical - thermal pollution, radioactive substances",
            "Indicators of water pollution: Total suspended solids, BOD (Biochemical Oxygen Demand), chlorides, nitrogen, phosphorus, dissolved oxygen (absent = polluted)",
            "Water-related disease classification: (A) Biological: Water-borne (viral - Hep A/E, polio; bacterial - typhoid, cholera, dysentery; protozoal - amoebiasis, giardiasis; helminthic); Water-washed (scabies, trachoma); Water-based (guinea worm, schistosomiasis); Water-related insect vectors (malaria, dengue, filariasis)",
            "(B) Chemical: Fluorosis (excess fluoride), Methaemoglobinaemia (excess nitrates in infants), Arsenicosis, Endemic goitre (iodine-deficient water)",
            "Purification on large scale: Storage (90% suspended impurities settle in 24 hrs; optimum 10–14 days; bacterial count drops 90% in 5–7 days) → Coagulation/Sedimentation (alum - aluminium sulphate added; flocculation) → Filtration → Disinfection",
            "Slow sand filter (biological/Schmutzdecke filter): Rate 0.1–0.4 m/hr; removes 98–99% bacteria; 'zoogleal layer' (Schmutzdecke) key; first used 1804 in Scotland",
            "Rapid sand filter: Rate 5–15 m/hr; requires pre-coagulation; cleaned by backwashing; used in large urban supplies",
            "Disinfection (Chlorination): Chlorine demand = amount consumed by impurities; Residual chlorine 0.5 mg/L after 30 min; Break-point chlorination concept; Horrock's test to determine amount of bleaching powder needed",
            "Small-scale purification: Boiling (most effective), Bleaching powder, Chlorine tablets (Halazone), Iodine, Katadyn filter, Solar disinfection (SODIS)"
        ]
    },
    {
        "num": "Q2.",
        "title": "Discuss air pollution - sources, types of pollutants, effects on health, and control measures.",
        "points": [
            "Definition: Presence of substances in ambient atmosphere at concentrations that interfere with human health, safety or comfort or injure vegetation, animals and environment",
            "Types: Primary pollutants (emitted directly - SO2, NO2, CO, particulates, lead); Secondary pollutants (formed in atmosphere by reactions - ozone, photochemical smog)",
            "Physical form: Gaseous pollutants (pass through filters; if water-soluble, deposit in URT); Particulate pollutants (solid/liquid suspended particles, 1–100 μm)",
            "Major outdoor sources: Motor vehicles (CO, hydrocarbons, lead, NO2), Power plants/industries (SO2, particulates), Biomass burning",
            "Major pollutants and health effects:",
            "  – SO2: Exacerbation of asthma, COPD, respiratory irritation",
            "  – NO2: Bronchial hyperactivity, impaired lung defences, bronchiolitis obliterans",
            "  – CO: Binds haemoglobin (carboxyhaemoglobin) → tissue hypoxia",
            "  – Lead: Neurotoxicity in children - impaired IQ, poor school performance, behaviour",
            "  – Ozone: Cough, bronchoconstriction, substernal discomfort",
            "  – Hydrocarbons (PAH): Lung cancer",
            "Indoor air pollution: 4.3 million premature deaths/year from household air pollution; biomass burning causes 12% pneumonia, 34% stroke, 26% IHD, 22% COPD, 6% lung cancer deaths",
            "London smog disaster (1952): Air pollution episode resulting in ~4,000–12,000 deaths - reference event",
            "Bhopal gas tragedy (1984): MIC (Methyl Isocyanate) leak from Union Carbide plant; worst industrial disaster",
            "Control: Legislation (Air Prevention and Control of Pollution Act 1981, India); Clean fuels; Catalytic converters; Emission standards; CAAQM (Central Ambient Air Quality Monitoring); PPCB",
            "National Clean Air Programme (NCAP): Target 20–30% reduction in PM2.5 and PM10 by 2024 (base year 2017)"
        ]
    },
    {
        "num": "Q3.",
        "title": "Describe the health aspects of Housing - criteria for healthful housing, housing standards, and effects of poor housing on health.",
        "points": [
            "WHO definition (1961): 'Residential environment = physical structure + environs + all necessary services, facilities and equipment for physical, mental health and social well-being'",
            "Social goals of housing: Shelter (basic need), Family life, Access to community facilities, Family participation in community, Economic stability",
            "WHO Criteria for Healthful Housing (6 criteria): (1) Physical protection and shelter; (2) Adequate cooking, eating, washing, excretory facilities; (3) Designed to prevent spread of communicable diseases; (4) Protection from noise and pollution; (5) Free from unsafe physical arrangements and toxic materials; (6) Promotes mental health, social relationships, ecological principles",
            "Housing standards - Minimum requirements: Air space per person (minimum 400–500 cubic feet/person); Floor area (minimum 50–100 sq ft/person); Natural lighting and ventilation (window area ≥1/10th of floor area); Thermal comfort; Overcrowding standards",
            "Overcrowding: >1.5 persons/room (WHO definition); >2 persons/room (Indian standard); linked to spread of TB, respiratory infections, mental illness, domestic violence",
            "Effects of poor housing on health: Communicable diseases (TB, URTI, skin diseases via overcrowding); Non-communicable diseases (mental illness, stress, domestic accidents); Physical injuries (falls, burns in poorly designed kitchens); Vector breeding (mosquitoes, rodents, cockroaches)",
            "Indicators of housing: Percentage of dwellings below standard, Person per room ratio, Percentage without piped water, Percentage without flush toilet, Percentage overcrowded",
            "Rural housing: Kutcha (temporary) vs Pucca (permanent) housing; Rajiv Awaas Yojana; PM Awas Yojana (PMAY)",
            "Housing and mental health: Crowding, lack of privacy and insecurity → anxiety, depression, aggressive behaviour"
        ]
    },
    {
        "num": "Q4.",
        "title": "Discuss the methods of Excreta Disposal - sanitary latrine types, requirements, and sewage treatment.",
        "points": [
            "Importance: Safe excreta disposal prevents faecal-oral disease transmission (cholera, typhoid, dysentery, hookworm, ascariasis)",
            "Sanitation coverage in India: Open Defecation Free (ODF) status under Swachh Bharat Mission (SBM)",
            "Criteria for a satisfactory latrine: No contamination of soil/water; No contact by flies/insects; No odour/unsightliness; Simple, cheap, durable; Safe for children",
            "Pit latrine (conservancy type): Simple, low cost; not suitable for water-logged/rocky soils; odour problem",
            "Ventilated Improved Pit (VIP) latrine: Screened vent pipe removes odour and flies; suitable for rural areas",
            "Septic tank: Anaerobic digestion of sewage; sedimentation + decomposition; effluent to soak pit; suitable for individual houses",
            "Aqua privy: Tank beneath latrine; submerged inlet prevents odour; suitable for high water table areas",
            "Pour flush latrine (Sulabh Shauchalay): Water-seal prevents odour and fly access; most popular in India",
            "Bore-hole latrine: Deep narrow bore; suitable for stable soil; simple but cannot be cleaned",
            "Sewage treatment (urban): Preliminary (screening, grit removal) → Primary (sedimentation - removes 60% suspended solids, 30% BOD) → Secondary/Biological (activated sludge, trickling filters - removes 90%+ BOD) → Tertiary (nutrient removal, disinfection)",
            "BOD (Biochemical Oxygen Demand): Standard measure of organic pollution; BOD at 20°C for 5 days (BOD5); clean water BOD <2 mg/L; raw sewage BOD 200–400 mg/L",
            "Sludge disposal: Composting, drying beds, lagooning, incineration, land fill"
        ]
    },
    {
        "num": "Q5.",
        "title": "Write in detail about Solid Waste Management - types, health hazards, and methods of disposal.",
        "points": [
            "Definition: All solid and semi-solid wastes from domestic, commercial, agricultural and industrial sources",
            "Sources: Domestic/Municipal (food waste, ash, paper, plastics), Commercial, Industrial (hazardous waste), Biomedical/Hospital waste, Agricultural, E-waste",
            "Composition of municipal solid waste (India): 40–60% organic matter, 10–15% recyclables (paper, plastic, metal, glass), ash/inert material",
            "Health hazards: Vector breeding (rats, cockroaches, flies → disease transmission); Contamination of soil and water; Air pollution (burning); Methane generation (greenhouse gas); Biomedical waste → HIV, HBV, HCV transmission risk to health workers",
            "Principles: 3Rs - Reduce, Reuse, Recycle (also 5Rs: Refuse, Reduce, Reuse, Recycle, Recover)",
            "Collection and transport: Door-to-door collection; segregation at source (dry/wet/hazardous)",
            "Methods of disposal: Sanitary landfill (controlled burial - best for non-recyclables; leachate control required); Composting (aerobic decomposition → manure; Indore method, Bangalore method, vermicomposting); Incineration (high-temperature burning; for biomedical waste; reduces volume 90%; air pollution concern); Biomethanation (anaerobic decomposition → biogas/methane)",
            "Biomedical Waste (BMW) Rules 2016: 4-colour coding: Yellow (incinerate), Red (autoclave/shred), Blue (glass/metallic), White (sharps); No mixing of categories",
            "Swachh Bharat Mission (SBM-Urban): Door-to-door collection, scientific landfill, waste to energy",
            "E-waste: Heavy metals (lead, mercury, cadmium, chromium) → soil/water pollution; formal recycling required"
        ]
    },
    {
        "num": "Q6.",
        "title": "Discuss Noise Pollution - sources, health effects, measurement, and control.",
        "points": [
            "Definition: Any unwanted or disturbing sound that adversely affects health and well-being",
            "Unit: Decibel (dB); Decibel A-weighted (dBA) for human hearing; logarithmic scale",
            "WHO recommended levels: Outdoor residential <55 dBA (day), <45 dBA (night); Hospitals <35 dBA; Industrial <75 dBA; Sleep disturbance threshold 45 dBA",
            "Sources: Transport (traffic, aircraft, railways), Industrial (machinery, compressors), Construction, Domestic (TV, music), Occupational",
            "Health effects of noise: Auditory: NIHL (Noise Induced Hearing Loss) - most important occupational disease; NIPTS (Noise Induced Permanent Threshold Shift) after long exposure; TTS (Temporary Threshold Shift) after brief exposure",
            "Non-auditory effects: Cardiovascular (hypertension, increased HR), Psychological (anxiety, stress, sleep disturbance, reduced cognitive performance), Neuroendocrine (↑adrenaline, ↑cortisol), GI disturbances",
            "Measurement: Sound level meter; Audiometry (pure tone audiometry - gold standard for NIHL assessment); Audiogram shows characteristic notch at 4000 Hz in NIHL",
            "Safe exposure limit (OSHA/India): 90 dBA for 8 hours/day; reduces with increasing dB (85 dBA → 16 hrs; 100 dBA → 2 hrs)",
            "Noise Pollution (Regulation & Control) Rules 2000, India: Day zone limits (residential 55, commercial 65, industrial 75, silence zone 50 dBA)",
            "Control: Engineering controls (noise barriers, sound insulation, vibration damping); Administrative controls (job rotation, reduce exposure time); PPE (earplugs, earmuffs); Urban planning (buffer zones, green belts)",
            "Occupational noise exposure: Construction workers, airport ground staff, factory workers, miners most at risk"
        ]
    }
]

for q in long_qs:
    items = [Paragraph(f'<b>{q["num"]}</b> {q["title"]}', q_style)]
    items.append(Paragraph("<b>Key points to cover:</b>", body_style))
    for pt in q["points"]:
        if pt.startswith("  –"):
            items.append(Paragraph(f"\u2013 {pt.strip()[2:]}", sub_style))
        else:
            items.append(Paragraph(f"\u2022 {pt}", bullet_style))
    items.append(Spacer(1, 0.2*cm))
    story.append(KeepTogether(items))

# ── SHORT QUESTIONS ─────────────────────────────────────────────────────────
story.append(Spacer(1, 0.3*cm))
story.append(Paragraph("SHORT QUESTIONS  (5 Marks)", section_style))
story.append(Spacer(1, 0.2*cm))

short_qs = [
    ("Q7.", "Chlorination of Water - Methods, Break-point Chlorination, Horrock's Test", [
        "Chlorination: Addition of chlorine or chlorine compounds to water for disinfection; most widely used method",
        "Mechanism: Hypochlorous acid (HOCl) formed in water is the active agent; acts as powerful oxidising agent",
        "Chlorine demand: Amount of chlorine consumed by organic matter, bacteria, and chemical reactions in water",
        "Residual chlorine = Total chlorine applied - Chlorine demand; Required: 0.5 mg/L after 30 min contact time",
        "Break-point chlorination: Point beyond which additional chlorine persists as free residual; ensures complete disinfection and destruction of chloramines",
        "Methods: Plain chlorination (direct), Double chlorination (at source + service reservoir), Superchlorination + dechlorination",
        "Horrock's test: Simple field test to determine amount of bleaching powder required; uses 6 cups with increasing amounts of bleaching powder",
        "Chloramine method: Chlorine + ammonia → chloramines; more stable, less taste/odour, slower but persistent action",
        "Disinfection by-products (DBPs): Trihalomethanes (THMs) formed when chlorine reacts with organic matter; potential carcinogens - a limitation of chlorination"
    ]),
    ("Q8.", "Slow Sand Filter vs Rapid Sand Filter - Comparison", [
        "Slow Sand Filter: Rate 0.1–0.4 m/hr; removes 98–99% bacteria; Schmutzdecke (zoogleal layer) is key biological layer; no coagulation needed; cleaned by scraping top layer; first used 1804 Scotland; suitable for small supplies",
        "Rapid Sand Filter (Mechanical): Rate 5–15 m/hr (40× faster); requires prior coagulation with alum; cleaned by backwashing; removes suspended matter but less effective for bacteria without pre-treatment; used in large urban supplies",
        "Comparison table: Slow (biological action, no coagulant, lower rate, scraping to clean, produces purer water) vs Rapid (physical filtration, needs coagulant, higher rate, backwash to clean, needs post-chlorination)",
        "Both followed by disinfection (chlorination) for complete safety",
        "Slow sand filter is preferred where land is cheap and supply not too large"
    ]),
    ("Q9.", "Fluoride in Water - Fluorosis and Defluoridation", [
        "Optimal fluoride level: 0.5–0.8 mg/L (WHO); protects teeth from caries (dental benefits)",
        "Excess fluoride (>1.5 mg/L): Dental fluorosis (mottled enamel - white/brown spots); Skeletal fluorosis (joint pain, genu valgum, kyphosis, osteosclerosis) at levels >3–4 mg/L",
        "Deficiency (<0.5 mg/L): Increased dental caries",
        "Endemic fluorosis: High in Rajasthan, AP, Telangana, Gujarat, Punjab (India) - fluoride-rich rocks/soil",
        "Defluoridation methods: Nalgonda technique (alum + lime + coagulation - developed in India, NEERI); Activated alumina adsorption; Bone char; Reverse osmosis",
        "Fluoridation of public water supplies (where levels low): Adds sodium fluoride to raise to optimal level"
    ]),
    ("Q10.", "Biomedical Waste Management - BMW Rules 2016", [
        "Legal basis: Biomedical Waste (Management and Handling) Rules 1998, revised as BMW Rules 2016",
        "4-colour coding system: YELLOW bag (incinerable waste - body parts, anatomical, expired medicines, chemical/cytotoxic waste); RED bag (contaminated recyclable waste - IV tubes, catheters - autoclave/shred); BLUE bag (glassware, metallic implants - shred/mutilate/autoclave); WHITE/TRANSLUCENT puncture-proof container (sharps - needles, syringes - encapsulation/plasma pyrolysis)",
        "Generator responsibility: Segregation at source, not to mix categories, proper labelling, record keeping",
        "Treatment methods: Incineration (yellow); Autoclaving/hydroclave (red, blue); Chemical treatment (liquid waste); Microwaving; Plasma pyrolysis (sharps)",
        "Needle-stick injury prevention: Safety-engineered sharps, never recap needles, proper disposal in puncture-proof containers",
        "Common Biomedical Waste Treatment Facilities (CBMWTFs): Centralized treatment for small generators"
    ]),
    ("Q11.", "Occupational Health Hazards - Dust, Chemicals, and Physical Agents", [
        "Pneumoconioses (dust diseases): Silicosis (crystalline silica → foundry, mining, stone-cutting workers; progressive fibrosis, ↑TB risk); Asbestosis (asbestos → shipbuilding, insulation workers; mesothelioma, lung cancer); Coal worker's pneumoconiosis (coal dust); Byssinosis (cotton dust → textile workers; 'Monday fever', chronic bronchitis)",
        "Chemical hazards: Lead poisoning (foundry, painters, battery workers); Mercury poisoning (chloralkali industry); Benzene (leukaemia); Carbon monoxide (COHb formation); Organophosphate pesticides",
        "Biological hazards: Brucellosis, anthrax, leptospirosis, TB (healthcare workers)",
        "Physical hazards: Noise (NIHL); Vibration (Raynaud's phenomenon - white finger disease); Heat stress (heat exhaustion, heat stroke); Radiation (ionizing → malignancy; non-ionizing → cataract)",
        "Ergonomic hazards: Musculoskeletal disorders, repetitive strain injuries",
        "Prevention: Elimination/substitution, engineering controls, administrative controls, PPE (hierarchy of controls)"
    ]),
    ("Q12.", "Radiation Hazards - Types, Effects, and Protection", [
        "Ionizing radiation: X-rays, gamma rays, alpha/beta particles, neutrons; sufficient energy to ionize atoms",
        "Sources: Natural background (cosmic rays, radon, terrestrial), Medical (X-rays, CT scans, nuclear medicine - largest man-made source), Nuclear power plants, Industrial",
        "Units: Roentgen (exposure); Rad/Gray (absorbed dose; 1 Gy = 100 rad); Rem/Sievert (effective dose; accounts for tissue sensitivity; 1 Sv = 100 rem)",
        "Health effects: Deterministic (dose-dependent, threshold; radiation sickness, cataracts, skin burns); Stochastic (no threshold, probabilistic; cancer, genetic effects)",
        "ALARA principle: As Low As Reasonably Achievable",
        "Protection principles: Time (minimize exposure time); Distance (inverse square law - double distance = 1/4 dose); Shielding (lead aprons, lead glass, concrete walls)",
        "Non-ionizing radiation: UV (sunburn, cataract, skin cancer), Infrared (heat burns, cataract), Microwave/RF, Laser",
        "Atomic Energy Regulatory Board (AERB): Regulatory body for radiation safety in India"
    ]),
    ("Q13.", "Climate Change and Health", [
        "Climate change: Global warming due to greenhouse gases (CO2, methane, N2O, water vapor, CFCs) → global temperature rise",
        "Greenhouse effect: Natural (essential for life) vs Enhanced (man-made - burning fossil fuels, deforestation, agriculture)",
        "Health effects: Direct (heat waves → heat-related illness, death); Extreme weather events (floods, cyclones → injuries, deaths, displacement)",
        "Indirect effects: Changed disease vector distribution (malaria, dengue moving to new areas); Food insecurity (crop failures); Water scarcity; Air quality deterioration; Mental health impacts",
        "Ozone depletion: CFCs destroy stratospheric ozone → ↑UV-B → skin cancer, cataract, immune suppression; Montreal Protocol (1987) addresses CFCs",
        "India's commitments: National Action Plan on Climate Change (NAPCC) - 8 missions including National Solar Mission, Green India Mission",
        "SDG 13: Climate Action; Paris Agreement (2015) - limit warming to 1.5°C above pre-industrial levels"
    ]),
]

for q in short_qs:
    items = [Paragraph(f'<b>{q[0]}</b> {q[1]}', q_style)]
    for pt in q[2]:
        items.append(Paragraph(f"\u2022 {pt}", bullet_style))
    items.append(Spacer(1, 0.15*cm))
    story.append(KeepTogether(items))

# ── ONE-LINERS TABLE ────────────────────────────────────────────────────────
story.append(Spacer(1, 0.3*cm))
story.append(Paragraph("VERY SHORT / ONE-LINER QUESTIONS  (2–3 Marks)", section_style))
story.append(Spacer(1, 0.3*cm))

table_data = [
    [Paragraph("<b>Question</b>", tbl_hdr), Paragraph("<b>Key Answer</b>", tbl_hdr)],
    ["Purest form of natural water", "Rain water"],
    ["Indicator organisms for water pollution", "Coliform bacteria (E. coli)"],
    ["WHO standard for drinking water coliforms", "<1 coliform per 100 mL"],
    ["Optimal period of storage for river water", "10–14 days"],
    ["Slow sand filter first used in", "1804, Scotland"],
    ["Rate of slow sand filter", "0.1–0.4 m/hr"],
    ["Rate of rapid sand filter", "5–15 m/hr"],
    ["Schmutzdecke / zoogleal layer", "Biological layer on slow sand filter responsible for purification"],
    ["Residual chlorine required in water", "0.5 mg/L after 30 minutes contact time"],
    ["Horrock's test used for", "Determining amount of bleaching powder needed for chlorination"],
    ["Break-point chlorination", "Point beyond which additional chlorine persists as free residual"],
    ["Optimal fluoride in water", "0.5–0.8 mg/L (WHO)"],
    ["Defluoridation method developed in India", "Nalgonda technique (by NEERI)"],
    ["Skeletal fluorosis occurs at fluoride levels of", ">3–4 mg/L in water"],
    ["BOD of clean water", "<2 mg/L; raw sewage 200–400 mg/L"],
    ["London smog disaster year", "1952 (~4,000–12,000 deaths)"],
    ["Bhopal gas tragedy - chemical involved", "MIC (Methyl Isocyanate), 1984"],
    ["Unit of sound measurement", "Decibel (dB) / dBA"],
    ["Characteristic audiogram finding in NIHL", "Notch at 4000 Hz"],
    ["Safe noise exposure limit (occupational)", "90 dBA for 8 hours/day"],
    ["Noise Pollution Rules (India)", "Noise Pollution (Regulation & Control) Rules 2000"],
    ["Overcrowding definition (WHO)", ">1.5 persons per room"],
    ["WHO criteria for healthful housing", "6 criteria (shelter, sanitation, disease prevention, noise/pollution protection, safety, mental health)"],
    ["PMAY stands for", "Pradhan Mantri Awas Yojana"],
    ["BMW Yellow bag - what waste", "Incinerable waste (body parts, expired drugs, cytotoxic waste)"],
    ["BMW White container - what waste", "Sharps (needles, syringes) - puncture-proof container"],
    ["Silicosis caused by", "Crystalline silica dust (mining, foundry, stone-cutting workers)"],
    ["Asbestosis complication", "Mesothelioma (pleural cancer), lung cancer"],
    ["Byssinosis caused by", "Cotton dust (textile workers); 'Monday fever'"],
    ["ALARA principle in radiation", "As Low As Reasonably Achievable"],
    ["Ionizing radiation unit of effective dose", "Sievert (Sv); 1 Sv = 100 rem"],
    ["Greenhouse gas most important", "Carbon dioxide (CO2) - fossil fuel combustion"],
    ["Montreal Protocol (1987) addresses", "CFCs causing ozone layer depletion"],
    ["NCAP target in India", "20–30% reduction in PM2.5 and PM10 by 2024 from 2017 baseline"],
]

col_widths = [9*cm, 8.5*cm]
tbl = Table(table_data, colWidths=col_widths, repeatRows=1)
tbl.setStyle(TableStyle([
    ('BACKGROUND', (0,0), (-1,0), BLUE),
    ('TEXTCOLOR', (0,0), (-1,0), colors.white),
    ('FONTSIZE', (0,0), (-1,0), 9),
    ('FONTSIZE', (0,1), (-1,-1), 9),
    ('ROWBACKGROUNDS', (0,1), (-1,-1), [colors.white, BLUE_LIGHT]),
    ('GRID', (0,0), (-1,-1), 0.5, colors.HexColor('#bdbdbd')),
    ('VALIGN', (0,0), (-1,-1), 'MIDDLE'),
    ('TOPPADDING', (0,0), (-1,-1), 4),
    ('BOTTOMPADDING', (0,0), (-1,-1), 4),
    ('LEFTPADDING', (0,0), (-1,-1), 6),
    ('RIGHTPADDING', (0,0), (-1,-1), 6),
]))
story.append(tbl)

# ── SPECIAL TOPICS ──────────────────────────────────────────────────────────
story.append(Spacer(1, 0.4*cm))
story.append(Paragraph("SPECIAL / FREQUENTLY ASKED TOPICS", section_style))
story.append(Spacer(1, 0.2*cm))

specials = [
    ("Q14.", "Environmental Sanitation - Definition, Scope and Importance", [
        "Definition (WHO): Control of all those factors in man's physical environment which exercise or may exercise a deleterious effect on his physical development, health and survival",
        "Scope: Safe water supply, Excreta disposal, Refuse/solid waste disposal, Control of insects and rodents, Food sanitation, Housing, Air pollution control, Radiation hazards, Occupational health",
        "Importance: Faeco-oral disease prevention, Vector control, Food safety, Sustainable development",
        "Environmental sanitation indicators: % households with safe water, % with sanitary latrine, % with solid waste collection, Under-5 diarrhoea incidence rate",
        "Swachh Bharat Mission (SBM): India's flagship sanitation programme; ODF (Open Defecation Free) villages; household toilets; community sanitation complexes",
        "Nirmal Bharat Abhiyan (NBA) → evolved into SBM in 2014"
    ]),
    ("Q15.", "Water Quality Standards - Physical, Chemical and Bacteriological", [
        "Physical standards: Colour (colorless/pale yellow, <5 Hazen units); Turbidity (<5 NTU); Odour (odourless); Taste (tasteless); Temperature (10–15°C preferred)",
        "Chemical standards: pH 6.5–8.5; TDS <500 mg/L (max 1000 mg/L); Hardness <300 mg/L as CaCO3; Fluoride 0.5–1.0 mg/L; Nitrates <45 mg/L; Iron <0.3 mg/L; Arsenic <0.01 mg/L; Lead <0.01 mg/L; Chlorides <250 mg/L",
        "Bacteriological standards: No E. coli or thermotolerant coliform in 100 mL; Total coliforms <1/100 mL; No Clostridium perfringens",
        "Hard water: Caused by calcium and magnesium salts; temporary (carbonate) and permanent (sulphate/chloride); softened by boiling (temporary), lime-soda process, base exchange (zeolite) or distillation",
        "Hard water does NOT cause disease but creates scale in pipes/boilers and increases soap consumption",
        "Soft water: More corrosive to lead pipes → risk of lead poisoning"
    ]),
    ("Q16.", "Food Hygiene and Food Adulteration", [
        "Food safety goals: Prevent contamination, prevent multiplication of organisms, destroy organisms",
        "HACCP (Hazard Analysis and Critical Control Points): International food safety standard for identifying and controlling hazards",
        "Food adulteration: Addition of inferior, harmful or foreign substance to food or removal of valuable constituent; governed by PFA Act (Prevention of Food Adulteration Act 1954), now FSSAI (Food Safety and Standards Authority of India Act 2006)",
        "Common adulterants: Metanil yellow in turmeric/dal; Kesari dal (lathyrus sativus) in besan → lathyrism; Argemone oil in mustard oil → epidemic dropsy; Oxytocin in fruits/vegetables; Formaldehyde in milk",
        "Food poisoning types: Bacterial (Staph. aureus, Salmonella, C. perfringens, C. botulinum, Bacillus cereus); Fungal (Aflatoxin - Aspergillus in groundnuts → hepatocellular carcinoma); Chemical (pesticides, heavy metals)",
        "FSSAI: Regulatory body for food safety in India; issues licenses to food businesses; sets standards"
        ]
    ),
]

for q in specials:
    items = [Paragraph(f'<b>{q[0]}</b> {q[1]}', q_style)]
    for pt in q[2]:
        items.append(Paragraph(f"\u2022 {pt}", bullet_style))
    items.append(Spacer(1, 0.15*cm))
    story.append(KeepTogether(items))

# ── EXAM TIP ────────────────────────────────────────────────────────────────
story.append(Spacer(1, 0.3*cm))
story.append(HRFlowable(width="100%", thickness=1, color=ORANGE, spaceAfter=6))
story.append(Paragraph(
    "<b>Exam Tip:</b> Environment and Health is one of the highest-scoring topics in community medicine. "
    "Water purification (slow vs rapid sand filter, chlorination, Horrock's test) and Air Pollution "
    "(pollutants, indoor air pollution, London smog) are almost always asked. "
    "For housing questions, remember the 6 WHO criteria for healthful housing. "
    "BMW colour coding (Yellow/Red/Blue/White) and Noise Pollution limits (90 dBA occupational) "
    "are high-yield one-liners. Always link environmental topics to relevant Indian legislation "
    "(Air Act 1981, Water Act 1974, BMW Rules 2016, FSSAI 2006, Noise Rules 2000).",
    note_style
))
story.append(HRFlowable(width="100%", thickness=1, color=ORANGE, spaceBefore=4))

# ── FOOTER ──────────────────────────────────────────────────────────────────
story.append(Spacer(1, 0.3*cm))
story.append(Paragraph(
    "Source: Park's Textbook of Preventive and Social Medicine | Community Medicine Reference",
    footer_style
))

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

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

OUTPUT = "/home/daytona/workspace/ncd-questions/Occupational_Health_University_Questions.pdf"

doc = SimpleDocTemplate(
    OUTPUT, pagesize=A4,
    leftMargin=2*cm, rightMargin=2*cm,
    topMargin=2*cm, bottomMargin=2*cm,
    title="Occupational Health - University Questions",
    author="Park's Textbook Reference"
)

styles = getSampleStyleSheet()
PURPLE      = colors.HexColor('#4a148c')
PURPLE_LITE = colors.HexColor('#f3e5f5')
ORANGE      = colors.HexColor('#e65100')

def ps(name, **kw):
    base = kw.pop('parent', styles['Normal'])
    return ParagraphStyle(name, parent=base, **kw)

title_s  = ps('T',  parent=styles['Title'], fontSize=18, textColor=PURPLE, spaceAfter=4, alignment=TA_CENTER)
sub_s    = ps('ST', fontSize=11, textColor=colors.HexColor('#455a64'), spaceAfter=14, alignment=TA_CENTER, italic=True)
sec_s    = ps('Sc', parent=styles['Heading1'], fontSize=13, textColor=colors.white, backColor=PURPLE,
               spaceBefore=14, spaceAfter=4, leftIndent=-0.3*cm, rightIndent=-0.3*cm, borderPadding=(6,8,6,8))
q_s      = ps('Q',  parent=styles['Heading2'], fontSize=11, textColor=PURPLE, spaceBefore=10, spaceAfter=3)
body_s   = ps('B',  fontSize=9.5, leading=14, spaceAfter=3, alignment=TA_JUSTIFY)
blt_s    = ps('Bl', fontSize=9.5, leading=13, leftIndent=16, spaceAfter=2)
sub_blt  = ps('SB', fontSize=9,   leading=13, leftIndent=30, spaceAfter=1, textColor=colors.HexColor('#333333'))
note_s   = ps('N',  fontSize=9,   leading=13, textColor=ORANGE, backColor=colors.HexColor('#fff3e0'),
               borderPadding=(5,6,5,6), spaceAfter=6, spaceBefore=4, leftIndent=4, rightIndent=4)
foot_s   = ps('F',  fontSize=8,   textColor=colors.HexColor('#9e9e9e'), alignment=TA_CENTER)
th_s     = ps('TH', fontSize=9,   textColor=colors.white, fontName='Helvetica-Bold', alignment=TA_CENTER)

story = []

# ── TITLE ──────────────────────────────────────────────────────────────────
story.append(Spacer(1, 0.3*cm))
story.append(Paragraph("Important University Questions", title_s))
story.append(Paragraph("Occupational Health", title_s))
story.append(Paragraph("Based on Park's Textbook of Preventive and Social Medicine", sub_s))
story.append(HRFlowable(width="100%", thickness=2, color=PURPLE, spaceAfter=8))

# ── LONG QUESTIONS ─────────────────────────────────────────────────────────
story.append(Paragraph("LONG QUESTIONS  (10–15 Marks)", sec_s))
story.append(Spacer(1, 0.2*cm))

lqs = [
    {
        "num": "Q1.",
        "title": "Define occupational disease. Describe the classification of occupational hazards with examples.",
        "pts": [
            "Definition: Disease caused or provoked by work or working conditions; unique in that it is preventable if hazard is controlled",
            "Difference from work-related disease: Work-related = work is one of several contributing factors; Occupational disease = work is the primary/sole cause",
            "A. Physical hazards:",
            "  – Noise: NIHL (Noise-Induced Hearing Loss); 4000 Hz notch on audiogram",
            "  – Heat: Heat exhaustion, heat stroke, heat cramps, heat syncope",
            "  – Cold: Frostbite, chilblains, trench foot, hypothermia",
            "  – Vibration: Hand-arm vibration syndrome (HAVS) / Raynaud's phenomenon (white finger disease) - chain-saw operators, pneumatic drill workers",
            "  – Radiation (ionizing): Leukaemia, thyroid cancer, aplastic anaemia, cataracts",
            "  – Non-ionizing (UV/IR): Cataract (glass blowers, furnace workers), photokeratitis, skin burns",
            "  – Barotrauma: Decompression sickness ('caisson disease' / 'bends') in divers, tunnel workers",
            "B. Chemical hazards:",
            "  – Dusts (pneumoconiosis): Silicosis, asbestosis, anthracosis, byssinosis, bagassosis",
            "  – Metals: Lead (plumbism), mercury, arsenic, cadmium, manganese",
            "  – Solvents: Benzene (leukaemia), carbon tetrachloride (hepatotoxic), toluene, xylene",
            "  – Gases/fumes: Carbon monoxide, hydrogen sulphide, phosgene",
            "  – Pesticides: Organophosphates (cholinesterase inhibition), organochlorines",
            "C. Biological hazards:",
            "  – Anthrax (wool sorters, leather workers), Brucellosis (veterinarians, abattoir workers), Leptospirosis (sewer workers, farmers), TB (healthcare workers), Hepatitis B/C (healthcare workers)",
            "D. Ergonomic hazards:",
            "  – Musculoskeletal disorders (MSDs): Repetitive strain injury (RSI), low back pain, carpal tunnel syndrome, tendinitis",
            "  – Associated with awkward postures, repetitive movements, forceful exertions, prolonged standing",
            "E. Psychosocial hazards:",
            "  – Occupational stress, burnout, shift work effects, workplace violence, job insecurity"
        ]
    },
    {
        "num": "Q2.",
        "title": "Describe Pneumoconiosis - definition, types, pathology, clinical features and prevention.",
        "pts": [
            "Definition: Dust accumulation in lungs and resulting tissue reaction; caused by dust particles 0.5–3 micron in size (most dangerous - reach alveoli)",
            "Factors determining hazard: Chemical composition, fineness/size, concentration, duration of exposure, host susceptibility",
            "Types of pneumoconiosis: Silicosis (SiO2), Asbestosis (asbestos), Anthracosis/Coal workers' pneumoconiosis (coal dust), Byssinosis (cotton dust), Bagassosis (bagasse/sugarcane dust), Farmer's lung (mouldy hay - Thermophilic actinomycetes), Siderosis (iron oxide - benign)",
            "SILICOSIS: Causative agent = free crystalline silica (SiO2); at-risk industries = mining (coal, gold, mica), stone-cutting, sandblasting, pottery, ceramics, foundry, iron/steel; First reported in India: Kolar Gold Mines, Mysore, 1947",
            "Silicosis pathology: Phagocytes ingest particles → block lymph channels → dense nodular fibrosis (nodules 3–4 mm); Upper lobe predominance",
            "Silicosis clinical features: Insidious onset; irritant cough, exertional dyspnoea, chest pain; X-ray = 'snowstorm' appearance; Progressive even after removal from dust; Association with TB = silico-tuberculosis",
            "ASBESTOSIS: Fibrous silicates (chrysolite - serpentine 90%; amphibole types - crocidolite/blue, amosite/brown); Industries: asbestos cement, fire-proof textiles, brake lining, shipbuilding; Fibrosis = peribronchal, diffuse, BASAL (contrast to silicosis = nodular, UPPER lobe)",
            "Asbestosis features: Dyspnoea, clubbing, cyanosis, cardiac distress; X-ray = 'ground-glass' appearance in lower 2/3 lung fields; Sputum shows 'asbestos bodies'; Complications: Bronchial carcinoma (amplified by smoking), MESOTHELIOMA (pleural/peritoneal - strongly linked to crocidolite), GI cancer",
            "BYSSINOSIS: Cotton dust inhalation; Textile workers (Mumbai, Ahmedabad, Delhi surveys - 7–8% incidence); Symptoms = chronic cough, progressive dyspnoea → chronic bronchitis, emphysema; 'Monday fever' = symptoms worst on first day of work week",
            "BAGASSOSIS: Sugarcane/bagasse dust; due to Thermoactinomyces sacchari; First reported in India by Ganguli and Pal (1955) near Kolkata; Acute diffuse bronchiolitis → fibrosis, emphysema, bronchiectasis",
            "Prevention principles: Dust suppression (wet methods, enclosed apparatus, exhaust ventilation), Substitution, Pre-employment and periodic medical examinations, Respiratory PPE (masks/respirators), TLV (Threshold Limit Values) for dusts, X-ray surveillance, Biological monitoring"
        ]
    },
    {
        "num": "Q3.",
        "title": "Describe Lead Poisoning (Plumbism) - sources, absorption, clinical features, diagnosis and prevention.",
        "pts": [
            "Lead: Most widely used toxic metal in industry; all lead compounds toxic; lead arsenate, lead oxide, lead carbonate most dangerous; lead sulphide least toxic",
            "Industrial uses: Storage batteries, glass manufacture, shipbuilding, printing, potteries, rubber industry (>200 industries)",
            "Non-occupational sources: Leaded gasoline (automobile exhaust), drinking water from lead pipes, chewing lead paint (children - pica)",
            "Routes of absorption: (1) Inhalation (most common in industry - fumes and dust); (2) Ingestion (contaminated hands/food); (3) Skin absorption (only organic compounds - tetraethyl lead, NOT inorganic)",
            "Body stores: Average adult stores 150–400 mg; Blood level normally ~25 μg/100 mL; Clinical symptoms appear when >70 μg/100 mL",
            "Distribution: 90% ingested lead excreted in faeces; absorbed lead → 95% enters erythrocytes → liver, kidneys → bones (metabolically inactive store); Mechanism = inhibits SH-group enzymes in porphyrin synthesis",
            "Clinical features - INORGANIC LEAD (plumbism): Gastrointestinal (lead colic - acute severe abdominal pain, constipation, 'lead line' on gums = Burton's blue line); Neuromuscular (wrist drop = extensor muscle paralysis - most characteristic; peripheral motor neuropathy); CNS (lead encephalopathy - headache, convulsions, coma - mainly children); Haematological (anaemia - hypochromic, basophilic stippling of RBCs)",
            "Clinical features - ORGANIC LEAD (tetraethyl lead): Predominantly CNS effects - insomnia, nightmares, hyperexcitability, psychosis, mania",
            "Laboratory diagnosis: Blood lead level (>40 μg/dL in adults = action level; >10 μg/dL in children = elevated); Urinary ALA (delta-aminolaevulinic acid) - increased; Basophilic stippling on blood film; FEP (free erythrocyte protoporphyrin)",
            "Treatment: Chelation therapy - BAL (British Anti-Lewisite/Dimercaprol), EDTA (Ca-EDTA), DMSA (Dimercaptosuccinic acid - oral, especially for children)",
            "Prevention: Engineering controls (exhaust ventilation, enclosed processes), Biological monitoring (blood lead surveillance), Pre-employment/periodic medical exams, PPE (respirators, gloves), Prohibition of eating/smoking in workplace, Personal hygiene, Phasing out leaded petrol"
        ]
    },
    {
        "num": "Q4.",
        "title": "Describe Occupational Cancer - types, causative agents, at-risk industries and control.",
        "pts": [
            "Definition: Cancer causally related to occupational exposure to a carcinogen; accounts for 5–10% of all cancers (ILO estimate)",
            "Key characteristics: (1) Appear after prolonged exposure; (2) Latency period 10–25 years; (3) May develop even after cessation of exposure; (4) Earlier average age than general cancer; (5) Tumour localisation remarkably constant in each occupation",
            "Historical landmark: Percival Pott (1775) - first to describe cancer of scrotum in chimney sweeps (from coal tar/polycyclic aromatic hydrocarbons)",
            "Sites commonly affected: Skin, Lungs, Urinary bladder, Blood-forming organs (leukaemia)",
            "SKIN CANCER (75% of occupational cancers): Coal tar, X-rays, certain oils and dyes; at-risk = gas workers, coke oven workers, tar distillers, oil refiners, dye-stuff makers, road makers, mineral oil/pitch/tar industries",
            "LUNG CANCER: Asbestos industry, gas industry, nickel/chromium work, arsenic roasting plants, uranium mining; Proved carcinogens = nickel, chromates, asbestos, coal tar (3,4-benzpyrene), radioactive substances + cigarette smoking",
            "BLADDER CANCER: First noted in aniline dye industry (1895); aromatic amines (beta-naphthylamine, benzidine, para-amino-diphenyl, auramine, magenta); Industries = dye-stuffs, dyeing, rubber, gas, electric cable",
            "LEUKAEMIA: Benzene (most important), ionising radiation (X-rays), radioactive substances; may appear long after exposure ceased",
            "MESOTHELIOMA: Crocidolite (blue asbestos) - strongest association; pleural and peritoneal mesothelioma",
            "Other occupational cancers: Nasal/sinus cancer (hardwood dust, nickel), Scrotal cancer (mineral oils), Liver angiosarcoma (vinyl chloride monomer), Skin cancer (UV in outdoor workers)",
            "Control: (1) Eliminate/substitute carcinogens; (2) Engineering controls; (3) Medical surveillance (early detection, regular screening); (4) Biological monitoring; (5) Worker education; (6) Statutory notification; (7) Personal hygiene (most important for skin cancers)"
        ]
    },
    {
        "num": "Q5.",
        "title": "Discuss the Factories Act 1948 and ESI Act 1948 in the context of occupational health services in India.",
        "pts": [
            "Background: India's industrialization → need to protect worker health; Indian Constitution Directive Principles (Art. 39, 42) mandate just, humane working conditions",
            "Important early reports: Adarkar Report (1945) on health insurance; Bedford Report (1946) on health of industrial workers",
            "FACTORIES ACT 1948:",
            "  – Applies to: Premises using power with ≥10 workers; or without power with ≥20 workers",
            "  – Health provisions: Cleanliness, disposal of waste/effluents, ventilation and temperature, dust/fume control, lighting, drinking water, latrines/urinals, spittoons",
            "  – Safety provisions: Fencing of machinery, prohibition of employment of young persons on dangerous machines, protection of eyes",
            "  – Welfare provisions: Washing facilities, first-aid boxes (1 per 150 workers), canteen (>250 workers), crèches (>30 women workers), rest rooms/lunch rooms",
            "  – Working hours: Max 48 hrs/week; Max 9 hrs/day; overtime limit; rest interval of ≥30 min after 5 hrs work",
            "  – Hazardous processes: Special provisions for health surveillance, medical examinations",
            "EMPLOYEES STATE INSURANCE (ESI) ACT 1948:",
            "  – Applies to: Non-seasonal factories with ≥10 employees (with power); extended to certain other establishments",
            "  – Benefits: Sickness benefit (91 days/year - 70% wages); Maternity benefit (26 weeks); Disablement benefit (90% wages for employment injury); Dependants benefit (death from employment injury); Medical benefit (full medical care for employee + family); Funeral expenses",
            "  – Contribution: Employer 3.25% + Employee 0.75% of wages",
            "  – Administered by: ESIC (Employees State Insurance Corporation)",
            "WORKMEN'S COMPENSATION ACT 1923 (now Employees' Compensation Act 2010): Compensation for employment injury/occupational disease; lists scheduled occupational diseases",
            "Other relevant legislation: Mines Act 1952; Dock Workers Act; Building & Other Construction Workers Act 1996; Occupational Safety, Health and Working Conditions Code 2020 (consolidates 13 labour laws)"
        ]
    },
    {
        "num": "Q6.",
        "title": "Describe the health effects of Heat Stress, its measurement indices and prevention.",
        "pts": [
            "Occupational heat exposure: Foundry workers, steel mill workers, miners, bakery workers, laundry workers, glass blowers",
            "Physiological responses: Increased heart rate, sweating (evaporative cooling), vasodilation, increased respiratory rate",
            "Heat disorders (from mild to severe):",
            "  – Heat cramps: Painful muscle spasms (legs, abdomen); due to salt depletion with sweating; treat with oral salt + water",
            "  – Heat syncope (fainting): Vasodilation + orthostatic pooling; recovery on lying down",
            "  – Heat exhaustion: Weakness, dizziness, headache, nausea, pale/cool/clammy skin; core temp <40°C; due to water/salt depletion; treat with cool environment + IV fluids",
            "  – Heat stroke: MEDICAL EMERGENCY; core temp >40°C; HOT, dry skin; absent sweating; confusion, delirium, coma; organ failure; treat with rapid cooling (ice packs, cold water immersion)",
            "  – Miliaria (Prickly heat): Blocked sweat ducts → papulo-vesicular rash; reduces sweating capacity",
            "Heat stress indices: (1) WBGT (Wet Bulb Globe Temperature) - most widely used; combines natural wet bulb, dry bulb and globe temperature; (2) Effective temperature (ET) - combines dry bulb temp + humidity + air velocity; (3) Heat stress index (HSI); (4) Oxford index (WD) = 0.85 wet bulb + 0.15 dry bulb; (5) Kata thermometer - measures cooling power of air",
            "WBGT formula: Outdoors = 0.7 NWB + 0.2 GT + 0.1 DB; Indoors = 0.7 NWB + 0.3 GT",
            "ACGIH TLV-WBGT: Recommended action levels by workload category (light/moderate/heavy/very heavy) and work-rest ratio",
            "Prevention: Engineering controls (insulation of hot surfaces, air conditioning, local exhaust ventilation, cool rest areas); Administrative controls (acclimatization - 10-14 days; work-rest schedules; shift scheduling to avoid hottest periods); PPE (cooling vests, reflective clothing); Medical: pre-employment exam, exclude those with CVD/renal disease; Hydration (water + electrolytes)"
        ]
    }
]

for q in lqs:
    items = [Paragraph(f'<b>{q["num"]}</b> {q["title"]}', q_s)]
    items.append(Paragraph("<b>Key points to cover:</b>", body_s))
    for pt in q["pts"]:
        if pt.startswith("  –"):
            items.append(Paragraph(f"\u2013 {pt.strip()[2:]}", sub_blt))
        else:
            items.append(Paragraph(f"\u2022 {pt}", blt_s))
    items.append(Spacer(1, 0.2*cm))
    story.append(KeepTogether(items))

# ── SHORT QUESTIONS ─────────────────────────────────────────────────────────
story.append(Spacer(1, 0.3*cm))
story.append(Paragraph("SHORT QUESTIONS  (5 Marks)", sec_s))
story.append(Spacer(1, 0.2*cm))

sqs = [
    ("Q7.", "Silicosis vs Asbestosis - Comparative Study", [
        "SILICOSIS: Agent = free silica (SiO2); Industries = mining, stone-cutting, sandblasting, pottery, foundry; Fibrosis = nodular, UPPER lobes; X-ray = snowstorm appearance; Complication = silico-tuberculosis (↑ TB risk); Progression continues even after removal",
        "ASBESTOSIS: Agent = asbestos fibres (chrysolite, crocidolite, amosite); Industries = asbestos cement, shipbuilding, brake lining, insulation; Fibrosis = diffuse peribronchal, BASAL; X-ray = ground-glass appearance in lower 2/3; Complication = mesothelioma (crocidolite), bronchogenic carcinoma",
        "Common features: Both irreversible fibrosis; no cure; preventive measures similar",
        "Sputum: Silicosis (may show TB bacilli); Asbestosis (shows asbestos bodies = fibres coated with fibrin)",
        "Latency: Silicosis 6 months–6 years; Asbestosis 5–10+ years",
        "Prevention: Dust suppression, substitution, PPE, periodic X-ray surveillance, TLV enforcement"
    ]),
    ("Q8.", "Threshold Limit Values (TLV) in Occupational Health", [
        "Definition: Airborne concentration of a substance to which nearly all workers may be repeatedly exposed, day after day, without adverse health effects",
        "Established by: ACGIH (American Conference of Governmental Industrial Hygienists); adopted by most countries",
        "Types: TLV-TWA (Time-Weighted Average - 8 hrs/day, 40 hrs/week); TLV-STEL (Short-Term Exposure Limit - 15 min max); TLV-C (Ceiling - must never be exceeded at any time)",
        "Biological Exposure Indices (BEI): Biological monitoring equivalents (e.g., blood lead level, urinary ALA for lead workers)",
        "Importance: Legal basis for workplace air quality standards; guides engineering controls; used in medical surveillance",
        "India: Occupational exposure limits set under Factories Act and referenced in Bureau of Indian Standards"
    ]),
    ("Q9.", "Ergonomics in Occupational Health", [
        "Definition: Scientific study of the relationship between workers and their work environment; aims to fit the job to the worker (not worker to the job)",
        "Ergonomic hazards: Repetitive movements, awkward postures, heavy lifting, forceful exertions, whole-body/hand-arm vibration, poor workstation design",
        "Common ergonomic disorders: Carpal tunnel syndrome (repetitive wrist flexion/extension - computer users); Low back pain (heavy lifting, prolonged sitting); Tendinitis; Tennis elbow; Neck/shoulder pain",
        "Work-related MSDs (WRMSDs): Most common occupational health problem globally; cause of significant absenteeism",
        "Prevention: Workstation redesign (adjustable chairs, monitor height), Job rotation, Mechanical aids (trolleys, lifts), Training in correct posture/lifting technique, Rest breaks",
        "NIOSH lifting equation: Tool to calculate Recommended Weight Limit (RWL) for manual lifting tasks"
    ]),
    ("Q10.", "Occupational Health Services - Components and ILO/WHO Definition", [
        "ILO/WHO Joint Committee definition (1950, revised 1995): 'Occupational health should aim at promotion and maintenance of the highest degree of physical, mental and social well-being of workers in all occupations'",
        "Three objectives (revised 1995): (1) Maintenance and promotion of workers' health and working capacity; (2) Improvement of working environment and work to become conducive to safety and health; (3) Development of work organizations and working cultures in a direction that supports health",
        "Components of Occupational Health Service (OHS): Pre-employment medical examination; Periodic medical examination; Biological monitoring; Health surveillance; First aid; Treatment services; Health promotion; Rehabilitation; Records and statistics",
        "Pre-employment examination: Assess fitness for specific job; detect pre-existing conditions; baseline for future comparison",
        "Periodic examination: Detect early occupational disease; monitor biological exposure indices; assess fitness to continue",
        "India: No comprehensive national OHS; covered piecemeal by Factories Act, ESI Act, Mines Act; Central Labour Institute (Mumbai, 1960); Regional Labour Institutes (Kanpur, Kolkata, Chennai)"
    ]),
    ("Q11.", "Mercury Poisoning in Occupational Settings", [
        "Industries at risk: Chlor-alkali plants (mercury cells), thermometer/instrument manufacturing, dental (mercury amalgam), felt hat manufacturing (hatters), gold extraction (mercury amalgamation)",
        "Routes: Inhalation of mercury vapour (most common); skin absorption (organic mercury); ingestion",
        "Types: Inorganic mercury (metallic + salts); Organic mercury (methyl mercury - most toxic, bioaccumulates)",
        "Minamata disease: Methyl mercury poisoning from industrial effluent into Minamata Bay, Japan (1950s); fish accumulation → severe neurological damage, congenital defects in children",
        "Clinical features - Inorganic mercury: Erethism (mercurialism) - shyness, memory loss, irritability, tremor, insomnia; gingivitis, salivation, colitis; kidney damage",
        "Clinical features - Organic/methyl mercury: Ataxia, constriction of visual fields, dysarthria, deafness, sensory disturbances, CNS damage (permanent)",
        "Treatment: Remove from exposure; chelation (DMSA, BAL for inorganic mercury); no effective treatment for organic mercury damage",
        "Prevention: Eliminate/substitute mercury; engineering controls; biological monitoring (blood/urinary mercury); PPE"
    ]),
    ("Q12.", "Organophosphate Pesticide Poisoning - Mechanism and Management", [
        "Mechanism: Irreversible inhibition of acetylcholinesterase → accumulation of acetylcholine at nerve endings → overstimulation of muscarinic and nicotinic receptors",
        "Workers at risk: Agricultural workers (spraying), pesticide manufacturers, greenhouse workers",
        "Clinical features - SLUDGE mnemonic (Muscarinic): Salivation, Lacrimation, Urination, Defaecation, GI distress, Emesis; also: miosis (small pupils), bradycardia, bronchospasm, bronchorrhoea",
        "Nicotinic effects: Muscle fasciculations, weakness, paralysis (including respiratory muscles); tachycardia",
        "CNS effects: Anxiety, restlessness, convulsions, coma",
        "Diagnosis: Plasma cholinesterase and RBC cholinesterase levels (decreased); biological monitoring of workers",
        "Treatment: (1) Decontamination (remove clothing, wash skin); (2) Atropine (muscarinic antagonist - antidote; repeat until atropinization); (3) Pralidoxime (2-PAM) - reactivates cholinesterase if given early (before 'ageing')",
        "Prevention: PPE (gloves, protective clothing, face shields), Safe handling training, biological monitoring of cholinesterase, rotation of workers, restricted access to high-risk areas"
    ]),
]

for q in sqs:
    items = [Paragraph(f'<b>{q[0]}</b> {q[1]}', q_s)]
    for pt in q[2]:
        items.append(Paragraph(f"\u2022 {pt}", blt_s))
    items.append(Spacer(1, 0.15*cm))
    story.append(KeepTogether(items))

# ── ONE-LINERS TABLE ────────────────────────────────────────────────────────
story.append(Spacer(1, 0.3*cm))
story.append(Paragraph("VERY SHORT / ONE-LINER QUESTIONS  (2–3 Marks)", sec_s))
story.append(Spacer(1, 0.3*cm))

rows = [
    [Paragraph("<b>Question</b>", th_s), Paragraph("<b>Key Answer</b>", th_s)],
    ["Pneumoconiosis-causing dust particle size", "0.5–3 micron (most dangerous; reach alveoli)"],
    ["Silicosis - causative agent", "Free crystalline silica / silicon dioxide (SiO2)"],
    ["Silicosis first reported in India", "Kolar Gold Mines, Mysore, 1947"],
    ["Silicosis X-ray appearance", "'Snowstorm' appearance"],
    ["Silicosis complication", "Silico-tuberculosis (increased TB susceptibility)"],
    ["Asbestosis X-ray appearance", "'Ground-glass' appearance in lower 2/3 lung fields"],
    ["Asbestosis sputum finding", "Asbestos bodies (fibres coated with fibrin)"],
    ["Mesothelioma associated with which asbestos type", "Crocidolite (blue asbestos)"],
    ["Asbestosis fibrosis location", "Peribronchal, diffuse, BASAL (lower lobe)"],
    ["Silicosis fibrosis location", "Nodular, UPPER lobe"],
    ["Byssinosis caused by", "Cotton fibre dust (textile workers)"],
    ["Byssinosis 'Monday fever'", "Symptoms worst on first day of work week"],
    ["Bagassosis causative organism", "Thermoactinomyces sacchari (in sugarcane/bagasse dust)"],
    ["Bagassosis first reported in India by", "Ganguli and Pal (1955), near Kolkata"],
    ["Percival Pott's contribution", "First to describe scrotal cancer in chimney sweeps (1775)"],
    ["75% of occupational cancers involve", "Skin cancer"],
    ["Bladder cancer occupational agent", "Aromatic amines (beta-naphthylamine, benzidine)"],
    ["Occupational leukaemia caused by", "Benzene, ionizing radiation"],
    ["Lead poisoning clinical triad", "Lead colic + Wrist drop + Anaemia with basophilic stippling"],
    ["Burton's blue line", "Lead line on gums in chronic lead poisoning"],
    ["Blood lead level causing symptoms", ">70 μg/100 mL"],
    ["Chelating agent for lead poisoning", "EDTA (Ca-EDTA), BAL (Dimercaprol), DMSA (oral, for children)"],
    ["Minamata disease caused by", "Methyl mercury (organic mercury) - Minamata Bay, Japan"],
    ["Organophosphate antidote", "Atropine + Pralidoxime (2-PAM)"],
    ["SLUDGE mnemonic in OP poisoning", "Salivation, Lacrimation, Urination, Defaecation, GI distress, Emesis"],
    ["Caisson disease / Bends", "Decompression sickness (nitrogen bubble formation) in divers"],
    ["WBGT stands for", "Wet Bulb Globe Temperature (most widely used heat stress index)"],
    ["Heat stroke key feature", "Core temp >40°C + HOT DRY skin + no sweating (emergency)"],
    ["Factories Act applies to", "Premises with ≥10 workers (power) or ≥20 workers (no power)"],
    ["Crèche compulsory under Factories Act when", ">30 women workers employed"],
    ["Canteen compulsory under Factories Act when", ">250 workers"],
    ["First-aid box ratio under Factories Act", "1 per 150 workers"],
    ["ESI employer contribution", "3.25% of wages"],
    ["ESI employee contribution", "0.75% of wages"],
    ["Central Labour Institute established", "Mumbai, 1960"],
    ["TLV-TWA definition", "Airborne concentration for 8 hrs/day, 40 hrs/week without adverse effects"],
    ["Carpal tunnel syndrome - occupational cause", "Repetitive wrist flexion/extension (ergonomic hazard)"],
    ["Raynaud's / White finger disease", "Hand-arm vibration syndrome (HAVS) - pneumatic drill, chain-saw workers"],
]

col_w = [9*cm, 8.5*cm]
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tbl.setStyle(TableStyle([
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story.append(tbl)

# ── SPECIAL TOPICS ──────────────────────────────────────────────────────────
story.append(Spacer(1, 0.4*cm))
story.append(Paragraph("SPECIAL / FREQUENTLY ASKED TOPICS", sec_s))
story.append(Spacer(1, 0.2*cm))

specials = [
    ("Q13.", "Hierarchy of Controls in Occupational Health (NIOSH Model)", [
        "Most effective to least effective (memorize as EEAAP):",
        "1. Elimination: Completely remove the hazard from the workplace (most effective; e.g., stop using asbestos)",
        "2. Substitution: Replace hazardous substance with safer one (e.g., replace benzene solvent with toluene)",
        "3. Engineering controls: Isolate workers from hazard without relying on behaviour (e.g., exhaust ventilation, enclosed processes, noise barriers, machine guarding)",
        "4. Administrative controls: Change work practices/procedures (e.g., job rotation, limiting exposure time, acclimatization for heat, shift scheduling)",
        "5. PPE (Personal Protective Equipment): Last resort; protects individual worker (e.g., respirators, earplugs, gloves, protective clothing) - least effective as it relies on consistent correct use",
        "Combined approach: Best practice uses multiple levels simultaneously; PPE never replaces engineering/administrative controls"
    ]),
    ("Q14.", "Pre-employment and Periodic Medical Examination", [
        "Pre-employment examination: Conducted before starting work; assess fitness for specific job; detect pre-existing conditions; establish baseline records; place worker in suitable job (placement test)",
        "Purposes: Exclude those at special risk (e.g., lead worker with anaemia; asbestos worker with prior lung disease); legal requirement for hazardous processes under Factories Act",
        "Components: Full history; physical examination; investigations (blood count, urine, X-ray chest, audiometry, spirometry, blood lead, cholinesterase as appropriate to hazard)",
        "Periodic (Routine) Medical Examination: At regular intervals during employment; detect early/subclinical occupational disease; monitor biological exposure indices; assess ongoing fitness",
        "Frequency: Depends on hazard level (e.g., lead workers every 6 months; general workers annually)",
        "Return to work examination: After prolonged absence (illness, injury); ensure fitness before resuming hazardous work",
        "Medical records: Confidential; maintained by occupational health physician; used for epidemiological studies of occupational disease"
    ]),
    ("Q15.", "Occupational Diseases - Notification, Compensation and Scheduled Diseases", [
        "Notification: Occupational diseases notifiable under Factories Act and state rules; helps surveillance and data collection",
        "Employees' Compensation Act 2010 (earlier Workmen's Compensation Act 1923): Compensation for employment injury or occupational disease",
        "Schedule III diseases: List of occupational diseases for which compensation is payable (e.g., lead poisoning, mercury poisoning, silicosis, asbestosis, byssinosis, anthrax, compressed air illness/bends, etc.)",
        "Compensation: Dependent on degree of disability (temporary/permanent; partial/total); death benefits to dependants",
        "ESIC: Also covers employment injuries with disablement benefit (90% wages for temporary total disablement)",
        "Key principle: Burden of proof reversed - employer must show disease NOT occupational for scheduled diseases",
        "ILO List of Occupational Diseases (2010): International reference; regularly updated"
    ]),
]

for q in specials:
    items = [Paragraph(f'<b>{q[0]}</b> {q[1]}', q_s)]
    for pt in q[2]:
        if pt[0].isdigit():
            items.append(Paragraph(pt, sub_blt))
        else:
            items.append(Paragraph(f"\u2022 {pt}", blt_s))
    items.append(Spacer(1, 0.15*cm))
    story.append(KeepTogether(items))

# ── EXAM TIP ───────────────────────────────────────────────────────────────
story.append(Spacer(1, 0.3*cm))
story.append(HRFlowable(width="100%", thickness=1, color=ORANGE, spaceAfter=6))
story.append(Paragraph(
    "<b>Exam Tip:</b> Pneumoconiosis (especially Silicosis vs Asbestosis comparison) is almost always "
    "asked. Remember: Silicosis = NODULAR, UPPER lobe, snowstorm X-ray, TB risk; Asbestosis = DIFFUSE, "
    "BASAL, ground-glass X-ray, mesothelioma risk. Lead poisoning features (wrist drop, Burton's line, "
    "basophilic stippling) are high-yield. Factories Act 1948 provisions (crèche >30 women, canteen >250 "
    "workers, first-aid 1 per 150 workers) are common short-answer points. Always link occupational "
    "disease with its specific industry, carcinogen, and preventive legislation.",
    note_s
))
story.append(HRFlowable(width="100%", thickness=1, color=ORANGE, spaceBefore=4))

story.append(Spacer(1, 0.3*cm))
story.append(Paragraph(
    "Source: Park's Textbook of Preventive and Social Medicine | Community Medicine Reference",
    foot_s
))

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