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

OUTPUT = "/home/daytona/workspace/fmge-study-guide/FMGE_High_Yield_Study_Guide.pdf"

# ── colour palette ──────────────────────────────────────────────────────────
NAVY    = colors.HexColor("#1a3a5c")
TEAL    = colors.HexColor("#0e7490")
AMBER   = colors.HexColor("#b45309")
LIGHT   = colors.HexColor("#e0f2fe")
WHITE   = colors.white
GREY    = colors.HexColor("#f1f5f9")

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

TITLE_STYLE = ParagraphStyle("title_s", fontSize=26, textColor=WHITE,
                              alignment=TA_CENTER, fontName="Helvetica-Bold",
                              spaceAfter=6)
SUB_STYLE   = ParagraphStyle("sub_s",   fontSize=13, textColor=LIGHT,
                              alignment=TA_CENTER, fontName="Helvetica",
                              spaceAfter=4)
DATE_STYLE  = ParagraphStyle("date_s",  fontSize=10, textColor=LIGHT,
                              alignment=TA_CENTER, fontName="Helvetica-Oblique")

SEC_STYLE   = ParagraphStyle("sec_s",   fontSize=14, textColor=WHITE,
                              fontName="Helvetica-Bold", spaceAfter=2,
                              spaceBefore=4)
TOPIC_STYLE = ParagraphStyle("top_s",   fontSize=11, textColor=NAVY,
                              fontName="Helvetica-Bold", spaceAfter=2,
                              spaceBefore=6)
BULLET_STYLE= ParagraphStyle("bul_s",   fontSize=9.5, textColor=colors.HexColor("#1e293b"),
                              fontName="Helvetica", leftIndent=14,
                              spaceAfter=1, leading=13)
NOTE_STYLE  = ParagraphStyle("note_s",  fontSize=8.5, textColor=AMBER,
                              fontName="Helvetica-Bold", leftIndent=14,
                              spaceAfter=2, leading=12)

# ── data ─────────────────────────────────────────────────────────────────────
SUBJECTS = [
    {
        "name": "1. Anatomy",
        "topics": [
            ("Brachial Plexus", [
                "Roots C5-T1; trunks -> divisions -> cords -> branches",
                "Erb's palsy: C5-C6 (waiter's tip); Klumpke's: C8-T1 (claw hand)",
                "Axillary nerve: surgical neck # -> deltoid paralysis, loss sensation regimental badge area",
                "Radial nerve: spiral groove # -> wrist drop; long thoracic: winged scapula",
            ]),
            ("Triangles of Neck", [
                "Anterior triangle: carotid, muscular, submandibular, submental",
                "Posterior triangle: occipital, supraclavicular (subclavian)",
                "Carotid bifurcation at upper border of thyroid cartilage (C3-C4)",
                "Danger space of neck: between alar & prevertebral fascia -> mediastinum",
            ]),
            ("Heart & Great Vessels", [
                "SA node: right atrium, junction of SVC; supplied by RCA (60%) or LCx (40%)",
                "AV node: triangle of Koch; bundle of His -> LBB + RBB",
                "Coronary dominance: RCA dominant in 85%; LCA supplies most of LV",
                "Ventricular septal defect: most common CHD (membranous VSD commonest type)",
            ]),
            ("Peritoneum & Gut", [
                "Lesser sac (omental bursa) accessed via epiploic foramen of Winslow",
                "Meckel's diverticulum: 2 feet from ileocaecal valve, 2 inches long, 2% population",
                "Portal-systemic anastomoses: oesophageal, rectal, paraumbilical, retroperitoneal",
                "Femoral canal: contains fat & lymph node of Cloquet; medial to femoral vein",
            ]),
            ("Embryology High-Yield", [
                "Derivatives of pharyngeal arches: 1st -> mandible/muscles of mastication; 2nd -> stapedius/stylohyoid",
                "Branchial cyst: remnant of 2nd pharyngeal cleft (most common); anterior to SCM",
                "Neural tube defects: folic acid deficiency; spina bifida occulta vs cystica",
                "Thyroglossal cyst: moves with swallowing AND tongue protrusion (embryological attachment)",
            ]),
        ]
    },
    {
        "name": "2. Physiology",
        "topics": [
            ("Cardiac Physiology", [
                "Starling's law: stroke volume increases with end-diastolic volume (preload)",
                "Normal cardiac output: 5 L/min; CI = CO/BSA (normal 2.5-4.0 L/min/m2)",
                "Pressure-volume loop: isovolumetric contraction -> ejection -> isovolumetric relaxation -> filling",
                "Autonomic: sympathetic increases HR & contractility; vagus slows SA/AV node",
            ]),
            ("Respiratory Physiology", [
                "Dead space (Bohr equation): VD/VT = (PaCO2 - PECO2) / PaCO2",
                "FRC = ERV + RV; cannot be measured by spirometry (needs helium dilution/body plethysmography)",
                "Oxyhemoglobin curve shifts RIGHT: fever, acidosis, high 2,3-DPG, high pCO2",
                "Hypoxic pulmonary vasoconstriction (HPV): unique to lungs; Euler-Liljestrand reflex",
                "A-a gradient = PAO2 - PaO2; normal < 15 mmHg; increases in V/Q mismatch, diffusion defect, shunt",
            ]),
            ("Renal Physiology", [
                "GFR ~125 mL/min; RBF ~1200 mL/min; filtration fraction = GFR/RPF = 20%",
                "Tm for glucose: 375 mg/min; threshold ~180 mg/dL (glucosuria above this)",
                "Aldosterone: acts on principal cells (Na+ reabsorption, K+ secretion) in collecting duct",
                "ADH: V2 receptors -> aquaporin-2 insertion -> water reabsorption in collecting duct",
            ]),
            ("Nerve & Muscle", [
                "Resting membrane potential: -70 mV (neurons), -90 mV (muscle)",
                "Absolute refractory period: Na+ channels inactivated; no AP possible",
                "Neuromuscular junction: ACh -> nicotinic receptors -> end-plate potential",
                "Rigor mortis: ATP depletion -> permanent actin-myosin cross-bridge (onset 2-6 h, resolves 24-48 h)",
            ]),
        ]
    },
    {
        "name": "3. Biochemistry",
        "topics": [
            ("Enzyme & Metabolism", [
                "Km = substrate concentration at half Vmax; low Km = high affinity",
                "Competitive inhibition: increases Km, Vmax unchanged; non-competitive: Vmax decreases, Km unchanged",
                "Rate-limiting step: glycolysis = PFK-1; TCA = isocitrate DH; fatty acid synthesis = ACC",
                "Gluconeogenesis: liver + kidney cortex; substrates: lactate, alanine, glycerol, odd-chain FAs",
            ]),
            ("Vitamins", [
                "B1 (Thiamine): Wernicke's encephalopathy (ophthalmoplegia, ataxia, confusion), beriberi",
                "B3 (Niacin): pellagra (3Ds: dermatitis, diarrhoea, dementia); deficiency in Hartnup disease",
                "B12: subacute combined degeneration of cord; Schilling test; intrinsic factor from parietal cells",
                "Vit D: 7-dehydrocholesterol -> skin (UV) -> 25-OH (liver) -> 1,25-OH2 (kidney); rickets/osteomalacia",
                "Vit K: gamma-carboxylation of factors II, VII, IX, X, Protein C & S",
            ]),
            ("Genetic Disorders", [
                "PKU: phenylalanine hydroxylase deficiency; musty odour, fair skin, intellectual disability",
                "Alkaptonuria: homogentisate oxidase deficiency; dark urine, ochronosis, arthritis",
                "Maple syrup urine disease: BCAA dehydrogenase; sweet urine, neurodegeneration",
                "Gaucher's disease: glucocerebrosidase deficiency; Gaucher cells (crumpled tissue paper); most common LSD",
            ]),
        ]
    },
    {
        "name": "4. Pathology",
        "topics": [
            ("Cell Injury & Death", [
                "Coagulative necrosis: most tissues (heart, kidney); architecture preserved",
                "Liquefactive necrosis: brain infarct & bacterial abscesses",
                "Caseous necrosis: TB (cheese-like); combination coagulative + liquefactive",
                "Apoptosis: caspase activation; cell shrinkage, nuclear condensation; no inflammation",
                "Free radical injury: reperfusion injury, CCl4 toxicity; neutralised by SOD, catalase, glutathione peroxidase",
            ]),
            ("Inflammation", [
                "Acute: neutrophils; chemical mediators: histamine (mast cells), bradykinin, PGs, leukotrienes",
                "Chronic: macrophages + lymphocytes; IL-1, TNF-alpha, IL-6 -> systemic effects (fever, acute phase proteins)",
                "Granuloma: TB, sarcoidosis, Crohn's, fungal, foreign body; Langhans giant cells (TB) vs foreign body giant cells",
                "CRP: sensitive marker of inflammation; elevated in bacterial infection, MI, autoimmune disease",
            ]),
            ("Tumour Pathology", [
                "Benign: well-differentiated, encapsulated, no invasion/metastasis",
                "Malignant features: anaplasia, pleomorphism, high mitotic index, necrosis, invasion",
                "Oncogenes: ras (most common point mutation in human cancers), c-myc (Burkitt's), HER2/neu (breast)",
                "Tumour suppressors: p53 (guardian of genome), Rb (retinoblastoma), BRCA1/2",
                "Paraneoplastic syndromes: SIADH (small cell lung Ca), PTHrP (squamous cell lung Ca, renal Ca)",
            ]),
            ("Haematology Pathology", [
                "Iron deficiency anaemia: microcytic hypochromic; low serum iron, high TIBC, low ferritin",
                "B12/folate deficiency: macrocytic megaloblastic; hypersegmented neutrophils",
                "Sickle cell: HbS (Glu->Val at position 6 of beta chain); crisis precipitated by hypoxia, cold, dehydration",
                "CML: BCR-ABL (t9;22 Philadelphia chromosome); treated with imatinib",
                "Hodgkin's lymphoma: Reed-Sternberg cells (owl-eye nuclei); bimodal age distribution",
            ]),
        ]
    },
    {
        "name": "5. Pharmacology",
        "topics": [
            ("Autonomic Pharmacology", [
                "Atropine: muscarinic antagonist; increases HR, decreases secretions, mydriasis",
                "Neostigmine: anticholinesterase (reversible); used in myasthenia gravis, reversal of NMB",
                "Propranolol: non-selective beta-blocker; avoid in asthma, COPD, DM (masks hypoglycaemia)",
                "Adrenaline: alpha + beta agonist; DOC for anaphylaxis (IM into anterolateral thigh)",
            ]),
            ("Antimicrobials", [
                "Penicillins: inhibit cell wall synthesis (transpeptidase/PBP); bactericidal; beta-lactam ring",
                "Aminoglycosides: inhibit 30S ribosome; ototoxic + nephrotoxic; monitor trough levels",
                "Fluoroquinolones: inhibit DNA gyrase (topoisomerase II); avoid in children (cartilage toxicity)",
                "Metronidazole: anaerobes + protozoa; disulfiram-like reaction with alcohol",
                "Chloramphenicol: inhibits 50S (peptidyl transferase); grey baby syndrome; aplastic anaemia",
            ]),
            ("CNS Drugs", [
                "Phenytoin: Na+ channel blocker; zero-order kinetics; gingival hyperplasia, hirsutism, teratogen",
                "Lithium: mood stabiliser; narrow TI; nephrotoxic; monitor levels; avoid NSAIDs (increase levels)",
                "Haloperidol: D2 antagonist; extrapyramidal SE (acute dystonia, akathisia, tardive dyskinesia, parkinsonism)",
                "SSRIs: first-line for depression/OCD/panic; serotonin syndrome with MAOIs",
            ]),
            ("Cardiovascular Drugs", [
                "Digoxin: inhibits Na/K ATPase; narrow TI; toxicity: yellow vision, arrhythmias, nausea",
                "ACE inhibitors: dry cough (bradykinin); avoid in pregnancy (teratogen); hyperkalemia",
                "Heparin: activates antithrombin III; LMWH preferred; reversed by protamine sulphate",
                "Warfarin: inhibits Vit K reductase (factors II, VII, IX, X); reversed by Vit K/FFP",
            ]),
        ]
    },
    {
        "name": "6. Microbiology",
        "topics": [
            ("Bacteriology", [
                "Staphylococcus aureus: coagulase +ve; TSST-1 (toxic shock), exfoliatin (scalded skin), PVL (necrotising pneumonia)",
                "Streptococcus pyogenes (Group A): M protein; post-streptococcal: rheumatic fever, PSGN",
                "Mycobacterium tuberculosis: acid-fast bacillus; Ghon focus (primary TB); PPD/Mantoux test",
                "Clostridium difficile: pseudomembranous colitis; treat with vancomycin (oral) or fidaxomicin; metronidazole (mild)",
                "Gram negative: outer membrane (LPS/endotoxin); E.coli O157:H7 -> HUS; Salmonella typhi -> typhoid",
            ]),
            ("Virology", [
                "Hepatitis B: DNA virus (Hepadnavirus); HBsAg (surface), HBeAg (infectivity); anti-HBs (recovery/vaccination)",
                "HIV: RNA retrovirus; CCR5 co-receptor (R5 tropic); CD4+ T cells; window period: NAT < Ab tests",
                "Herpes simplex: HSV-1 (oral/encephalitis), HSV-2 (genital); latency in dorsal root ganglia",
                "Rabies: bullet-shaped rhabdovirus; Negri bodies (hippocampus); retrograde axonal transport",
                "Dengue: flavivirus; Aedes aegypti; NS1 antigen early; IgM ELISA day 4-5; dengue shock syndrome",
            ]),
            ("Parasitology", [
                "Plasmodium falciparum: most severe malaria; quotidian/irregular fever; cerebral malaria, blackwater fever",
                "Entamoeba histolytica: flask-shaped ulcers; amoebic liver abscess (chocolate sauce pus, anchovy paste)",
                "Wuchereria bancrofti: lymphatic filariasis; nocturnal periodicity; DEC is DOC",
                "Taenia solium: cysticercosis (humans = dead-end host); neurocysticercosis -> seizures",
                "Giardia lamblia: mountaineers' diarrhoea; steatorrhoea; trophozoites (falling-leaf motility); treat with metronidazole",
            ]),
        ]
    },
    {
        "name": "7. Medicine (Internal)",
        "topics": [
            ("Cardiology", [
                "STEMI: ST elevation > 1mm (limb), > 2mm (chest) in 2+ contiguous leads; treat within 90 min (PCI)",
                "Heart failure: BNP elevated; ESC criteria; HFrEF (EF <40%) vs HFpEF (EF ≥50%); ACEi + beta-blocker + MRA",
                "Hypertension: JNC 8 / ISH 2020: target <130/80 (general); first-line: ACEi/ARB, CCB, thiazide",
                "Atrial fibrillation: irregularly irregular pulse; AF score CHA2DS2-VASc for anticoagulation",
            ]),
            ("Respiratory Medicine", [
                "COPD: FEV1/FVC < 0.7; pink puffer (emphysema) vs blue bloater (chronic bronchitis)",
                "Bronchial asthma: reversible obstruction; peak flow monitoring; ICS mainstay of treatment",
                "Pulmonary embolism: Wells score; D-dimer; CTPA gold standard; anticoagulate (LMWH -> warfarin/DOAC)",
                "TB: 2HRZE / 4HR; directly observed therapy; MDR-TB = resistant to INH + rifampicin",
            ]),
            ("Gastroenterology", [
                "Peptic ulcer: H. pylori (80-90% duodenal, 70% gastric); triple therapy: PPI + amoxicillin + clarithromycin",
                "Cirrhosis: Child-Pugh / MELD score; complications: variceal bleed (terlipressin + banding), SBP, HE, HRS",
                "IBD: UC (mucosal, rectum -> proximal, pseudopolyps) vs Crohn's (transmural, skip lesions, fistulae)",
                "Pancreatitis: Ranson's criteria; amylase (rises fast, falls fast); lipase more specific; ERCP for gallstone pancreatitis",
            ]),
            ("Endocrinology", [
                "DM Type 2: HbA1c target < 7% (53 mmol/mol); metformin first-line; SGLT2i/GLP-1 have CV/renal benefits",
                "Hypothyroidism: TSH elevated, fT4 low; treat with levothyroxine; myxoedema coma -> IV T3/T4 + steroids",
                "Cushing's syndrome: high cortisol; overnight DST; 24h UFC; MRI pituitary (Cushing's disease) or CT adrenal",
                "Addison's disease: primary adrenal insufficiency; hyponatraemia + hyperkalaemia; short Synacthen test",
            ]),
        ]
    },
    {
        "name": "8. Surgery",
        "topics": [
            ("Acute Abdomen", [
                "Appendicitis: McBurney's point tenderness, Rovsing's sign; alvarado score; laproscopic appendicectomy",
                "Intestinal obstruction: SBO (adhesions #1 cause) vs LBO (colorectal cancer #1 in adults)",
                "Peritonitis: board-like rigidity; absent bowel sounds; erect CXR -> free air under diaphragm",
                "Gallstones: Courvoisier's law: palpable GB + jaundice = NOT gallstones (likely periampullary Ca)",
            ]),
            ("Hernias", [
                "Indirect inguinal: most common; congenital; lateral to inferior epigastric vessels",
                "Direct inguinal: medial to inferior epigastric; Hesselbach's triangle; weakness of transversalis fascia",
                "Femoral hernia: more common in women; below & lateral to pubic tubercle; HIGH risk of strangulation",
                "Richter's hernia: only part of bowel wall trapped (no obstruction); Maydl's hernia: W-loop",
            ]),
            ("Thyroid & Parathyroid", [
                "Papillary thyroid Ca: most common (80%); psammoma bodies; lymphatic spread; excellent prognosis",
                "Follicular thyroid Ca: haematogenous spread (bone, lung); radioiodine uptake positive",
                "Medullary thyroid Ca: calcitonin secreting; C-cells; MEN2A/2B association; RET mutation",
                "Hyperparathyroidism: stones, bones, groans, moans; elevated PTH + Ca; USS + sestamibi scan",
            ]),
            ("Orthopaedics", [
                "Colles' fracture: distal radius; dinner fork deformity; FOOSH; elderly females (osteoporosis)",
                "Compartment syndrome: 6 Ps (pain on passive stretch, pallor, pulselessness, paraesthesia, paralysis, pressure); fasciotomy",
                "Fracture neck of femur: Garden classification I-IV; intracapsular (I/II -> fixation; III/IV -> arthroplasty)",
                "Avascular necrosis: femoral head most common; risk: steroids, SCD, diving, alcohol, trauma",
            ]),
        ]
    },
    {
        "name": "9. Obstetrics & Gynaecology",
        "topics": [
            ("Obstetrics", [
                "Pre-eclampsia: hypertension (>140/90) + proteinuria after 20 weeks; treat with labetalol/nifedipine; MgSO4 for eclampsia",
                "Placenta praevia: low-lying placenta; painless antepartum haemorrhage; DO NOT do VE",
                "Placenta abruptio: painful APH; concealed or revealed; Couvelaire uterus; risk: HTN, trauma, cocaine",
                "Gestational diabetes: OGTT at 24-28 weeks; target FBS <95, 1h <140, 2h <120 mg/dL",
                "PPH: uterine atony = most common cause (80%); 4 Ts (tone, tissue, trauma, thrombin); oxytocin first-line",
            ]),
            ("Gynaecology", [
                "Ovarian cysts: dermoid (teratoma) = most common benign; CA-125 marker for epithelial ovarian Ca",
                "Ectopic pregnancy: ampullary part of fallopian tube (most common); serum hCG + TVS",
                "Cervical cancer: HPV 16/18 (squamous); Pap smear screening; colposcopy + biopsy for diagnosis",
                "PCOS: Rotterdam criteria (2/3): oligo-anovulation, hyperandrogenism, polycystic ovaries; metformin + OCP",
                "Endometriosis: chocolate cysts (endometriomas); CA-125 elevated; laparoscopy for diagnosis",
            ]),
        ]
    },
    {
        "name": "10. Paediatrics",
        "topics": [
            ("Neonatology", [
                "APGAR score: appearance, pulse, grimace, activity, respiration; scored at 1 & 5 min; 7-10 = normal",
                "Respiratory distress syndrome: surfactant deficiency; premature infants; ground-glass appearance on CXR",
                "Neonatal jaundice: physiological (day 2-3, resolves by day 10); pathological: day 1 jaundice = haemolytic",
                "Necrotising enterocolitis: premature, formula-fed; pneumatosis intestinalis on AXR; surgical emergency",
            ]),
            ("Common Paediatric Conditions", [
                "Febrile seizures: age 6 months - 5 years; simple (< 15 min, generalised) vs complex; reassure parents",
                "Intussusception: 3 months - 3 years; currant jelly stools; dance's sign; air enema reduction",
                "Kawasaki disease: fever > 5 days + 4/5 criteria (rash, conjunctivitis, lip changes, lymphadenopathy, extremity changes); IVIG + aspirin",
                "Congenital hypothyroidism: most common preventable cause of intellectual disability; heel prick TSH screening",
                "Croup (laryngotracheobronchitis): parainfluenza virus; steeple sign on X-ray; treat with nebulised adrenaline + dexamethasone",
            ]),
            ("Childhood Vaccinations (India - NIS)", [
                "BCG: at birth; left deltoid; Mantoux test positive after 6 weeks",
                "OPV: birth, 6, 10, 14 weeks, 9 & 18 months; also IPV at 6 & 14 weeks",
                "Pentavalent (DTP + Hep B + Hib): 6, 10, 14 weeks; booster DTP at 18 months & 5 years",
                "MMR: 9 months + 15-18 months; also Vitamin A at 9 months",
                "Typhoid conjugate vaccine (TCV): 9-12 months (new addition to NIS)",
            ]),
        ]
    },
    {
        "name": "11. Community Medicine (PSM)",
        "topics": [
            ("Epidemiology", [
                "Incidence: new cases in a period / population at risk; measures risk",
                "Prevalence = Incidence x Duration of disease; useful for planning health services",
                "Sensitivity: true positive rate (rules OUT disease when negative - SNOUT)",
                "Specificity: true negative rate (rules IN disease when positive - SPIN)",
                "NNT = 1 / Absolute Risk Reduction; NNH = 1 / Absolute Risk Increase",
            ]),
            ("Disease Control Programs", [
                "RNTCP/NTEP: DOTS; 2HRZE/4HR; bedaquiline for MDR-TB; notification mandatory",
                "NVBDCP: malaria, dengue, filariasis, kala-azar, JE, chikungunya",
                "NPCDCS: non-communicable diseases; screening for DM, HTN, oral/cervical/breast Ca",
                "Pulse Polio: OPV; last case of wild poliovirus in India: January 2011; India polio-free since March 2014",
                "ASHA: Accredited Social Health Activist; village level; incentive-based; link between community and health system",
            ]),
            ("Nutrition", [
                "PEM: kwashiorkor (protein deficiency: oedema, fatty liver, moon face) vs marasmus (total calorie: wasted look)",
                "SAM criteria: W/H < -3 SD, MUAC < 115 mm, bilateral pitting oedema, or W/A < 60%",
                "Iodine deficiency: endemic goitre, cretinism; iodised salt programme; Hetzel classification",
                "Vitamin A deficiency: Bitot's spots, xerophthalmia, night blindness; supplementation at 9 months, 16, 24 months",
            ]),
        ]
    },
    {
        "name": "12. Ophthalmology",
        "topics": [
            ("Glaucoma", [
                "POAG: open angle; insidious; elevated IOP; optic disc cupping; C:D ratio > 0.6 suspicious",
                "PACG: angle closure; acute: painful red eye, corneal oedema, fixed mid-dilated pupil; treat with pilocarpine + acetazolamide",
                "Normal IOP: 10-21 mmHg; measured by Goldmann applanation tonometry (gold standard)",
                "DOC for POAG: prostaglandin analogues (latanoprost); beta-blockers (timolol) also used",
            ]),
            ("Retinal Disorders", [
                "Diabetic retinopathy: background (microaneurysms, dot-blot haemorrhages, hard exudates) -> pre-proliferative -> proliferative",
                "CRVO: disc oedema, dilated tortuous veins, flame haemorrhages in all 4 quadrants; blood & thunder fundus",
                "CRAO: sudden painless loss of vision; pale retina, cherry red spot at fovea; emergency (massage, AC tap, O2)",
                "Retinal detachment: photopsia, floaters, shadow; rhegmatogenous most common; treat with laser/cryotherapy/surgery",
            ]),
            ("Common Eye Conditions", [
                "Pterygium: fibrovascular growth; nasal side; treat if approaching visual axis (surgery)",
                "Cataract: nuclear sclerosis (myopic shift); ECCE + IOL; most common cause of blindness in India (and world)",
                "Trachoma: C. trachomatis serovars A-C; SAFE strategy; leading infectious cause of blindness",
                "Horner's syndrome: ptosis, miosis, anhidrosis; interrupted sympathetic pathway",
            ]),
        ]
    },
    {
        "name": "13. ENT",
        "topics": [
            ("Ear", [
                "Otitis media with effusion (glue ear): conductive HL; type B tympanogram; grommet insertion",
                "Cholesteatoma: retraction pocket or perforation; keratin accumulation; erodes ossicles; complication: meningitis, facial palsy",
                "Otosclerosis: stapes fixation; Schwartz sign (flamingo pink blush); Carhart's notch at 2kHz; treat with stapedectomy",
                "BPPV: posterior semicircular canal; Dix-Hallpike test positive; Epley manoeuvre treatment",
            ]),
            ("Nose & Paranasal Sinuses", [
                "Deviated nasal septum: Killian's incision for SMR; functional septoplasty for FESS",
                "Epistaxis: anterior = Kiesselbach's plexus (Little's area); posterior = sphenopalatine artery (older, severe)",
                "Sinusitis: maxillary most common; CT is gold standard; treat with antibiotics + nasal decongestants",
                "Angiofibroma: adolescent males; nasal blockage + epistaxis; highly vascular; preop angioembolisation",
            ]),
            ("Throat & Larynx", [
                "Quinsy (peritonsillar abscess): medial displacement of tonsil; uvular deviation; treat with drainage + antibiotics",
                "Carcinoma larynx: glottic (best prognosis, early hoarseness); supraglottic (late presentation)",
                "Vocal cord polyp: unilateral; mucosal wave reduced; microlaryngoscopy; commonly in singers/smokers",
                "Recurrent laryngeal nerve: injury -> hoarseness; bilateral -> stridor; during thyroidectomy at risk",
            ]),
        ]
    },
    {
        "name": "14. Dermatology",
        "topics": [
            ("Infections", [
                "Tinea versicolor: Malassezia furfur; hypo/hyperpigmented patches; KOH: spaghetti & meatballs; treat with topical azoles",
                "Leprosy: M. leprae; AFB non-cultivable; Ridley-Jopling classification; MDT: PB (6 months) vs MB (12 months)",
                "Scabies: Sarcoptes scabiei; burrows in web spaces; treat with permethrin 5%; benzyl benzoate also used",
                "SSSS (Scalded Skin Syndrome): S. aureus exfoliatin toxin; cleavage in granular layer; Nikolsky sign +ve",
            ]),
            ("Inflammatory Conditions", [
                "Psoriasis: Koebner phenomenon; Auspitz sign (bleeding pinpoint when scale removed); plaque type most common",
                "Pemphigus vulgaris: intraepidermal (suprabasal) blister; anti-desmoglein 3 (& 1) antibodies; IIF fishnet pattern",
                "Bullous pemphigoid: subepidermal blister; anti-BP180/BP230; elderly; treat with steroids",
                "SLE skin: butterfly rash; photosensitive; discoid lesions; anti-dsDNA & anti-Sm specific",
                "Lichen planus: 6 Ps (pruritic, purple, polygonal, planar, papules, plaques); Wickham's striae",
            ]),
        ]
    },
    {
        "name": "15. Psychiatry",
        "topics": [
            ("Major Psychiatric Disorders", [
                "Schizophrenia: positive (hallucinations, delusions) + negative (flat affect, alogia, avolition) symptoms; onset 2nd-3rd decade",
                "MDD: DSM-5: 5+ symptoms for 2 weeks including depressed mood or anhedonia; first-line: SSRIs",
                "Bipolar disorder: mania (elevated mood, decreased sleep, grandiosity, flight of ideas) + depressive episodes",
                "OCD: ego-dystonic obsessions + compulsions; Y-BOCS scale; first-line: SSRIs + CBT; clomipramine second-line",
            ]),
            ("Psychopharmacology", [
                "Clozapine: most effective antipsychotic; agranulocytosis (monitor WBC weekly); metabolic syndrome",
                "ECT: severe depression, catatonia, suicidal ideation; modified with succinylcholine + anaesthesia",
                "Disulfiram: alcohol deterrent; inhibits aldehyde dehydrogenase; causes acetaldehyde accumulation -> flushing",
                "SSRI side effects: GI upset, sexual dysfunction, SIADH, serotonin syndrome with MAOIs",
            ]),
        ]
    },
    {
        "name": "16. Orthopaedics",
        "topics": [
            ("Bone Tumours", [
                "Osteosarcoma: most common primary bone malignancy; distal femur/proximal tibia; Codman's triangle, sunburst pattern",
                "Ewing's sarcoma: children; diaphysis; onion-peel periosteal reaction; t(11;22); chemotherapy + surgery",
                "Giant cell tumour: epiphysis; soap bubble appearance; eccentric lytic lesion; young adults",
                "Osteoid osteoma: < 2 cm; interlocking nidus; night pain relieved by aspirin; radiofrequency ablation",
            ]),
            ("Spine", [
                "PIVD: L4-L5 most common level; L5 nerve root compression (weakness of EHL, loss sensation dorsum foot)",
                "Spinal cord injury: Brown-Sequard syndrome (ipsilateral motor + proprioception loss, contralateral pain/temp loss)",
                "Pott's disease (spinal TB): anterior vertebral body; gibbus deformity; paraplegia; antitubercular therapy",
                "Cauda equina syndrome: saddle anaesthesia, bladder/bowel dysfunction; SURGICAL EMERGENCY",
            ]),
        ]
    },
    {
        "name": "17. Anaesthesia",
        "topics": [
            ("General Anaesthesia", [
                "Stages of anaesthesia (Guedel): I analgesia, II delirium/excitement, III surgical, IV medullary depression",
                "Thiopentone: ultra-short acting barbiturate; decreases ICP; avoid in porphyria; recovery by redistribution",
                "Propofol: TIVA; egg allergy? debated; PRIS (propofol infusion syndrome) with prolonged high-dose",
                "Succinylcholine: depolarising NMB; onset 60 sec; contraindicated in burns, crush injury, hyperkalaemia (phase 2 block at high doses)",
            ]),
            ("Regional Anaesthesia", [
                "Spinal anaesthesia: subarachnoid space; T10 for LSCS; hyperbaric bupivacaine; max level T4 safe",
                "Epidural: epidural space; useful for labour analgesia; loss of resistance technique",
                "Brachial plexus block: interscalene (shoulder), supraclavicular (arm), infraclavicular, axillary",
                "Complications of spinal: post-dural puncture headache (PDPH); treat with bed rest, caffeine, blood patch",
            ]),
        ]
    },
    {
        "name": "18. Forensic Medicine",
        "topics": [
            ("Thanatology (Death)", [
                "Post-mortem changes: livor mortis (1-2 h, fixed 6-12 h), rigor mortis (onset 2-6 h, full 12 h, resolves 24-48 h)",
                "Adipocere: saponification of body fat; moist soil; preservation of body",
                "Mummification: dry, hot conditions; preservation; loss of moisture",
                "Time since death estimation: rectal temp, lividity, rigor, stomach contents, putrefaction",
            ]),
            ("Medico-Legal", [
                "IPC 302: murder; IPC 304: culpable homicide not amounting to murder; IPC 304A: death by negligence",
                "MLC (Medico-Legal Case): mandatory in: assault, poisoning, rape, unnatural death, road traffic accident",
                "Dying declaration: statement by dying person; admissible even if death does not occur; no oath needed",
                "Age estimation radiologically: epiphyseal fusion; Gustafson's method (dental, histological)",
            ]),
            ("Toxicology", [
                "Organophosphate poisoning: SLUD (salivation, lacrimation, urination, defaecation); miosis; treat with atropine + pralidoxime (< 24 h)",
                "Cyanide poisoning: bright red blood; bitter almond smell; treat with sodium thiosulphate + hydroxycobalamin",
                "Carbon monoxide: cherry red colour; carboxyhaemoglobin; 100% O2; hyperbaric O2 in severe cases",
                "Arsenic poisoning: chronic: Mees' lines on nails, Aldrich-Mees lines, rain-drop pigmentation, Mees' nails",
            ]),
        ]
    },
    {
        "name": "19. Radiology",
        "topics": [
            ("Plain Radiographs", [
                "PA chest X-ray: right hilum lower than left; right hemidiaphragm higher (liver); cardiac shadow < 50% of thoracic width",
                "Causes of mediastinal widening: aortic aneurysm, lymphoma, thymoma, goitre, oesophageal Ca",
                "Pneumothorax: absent lung markings; tension PTX: mediastinal shift away from side of PTX",
                "Air bronchogram: bronchi visible against opacified alveoli; consolidation (pneumonia, pulmonary oedema)",
            ]),
            ("CT & MRI", [
                "CT head: hyperdense = acute blood; hypodense = oedema/infarct; isodense = subacute SDH",
                "CT pulmonary angiography (CTPA): gold standard for PE; saddle embolus; Hampton's hump (pleural-based opacity)",
                "MRI brain: T1 bright = fat, subacute blood; T2 bright = oedema, fluid, CSF; DWI bright = acute infarct",
                "Bone scan (Tc-99m): hot spots = metastases, infection, fracture; cold lesion = avascular necrosis, myeloma",
            ]),
            ("Interventional Radiology", [
                "ERCP: biliary stones, strictures, stenting; complication = pancreatitis (most common)",
                "FNAC vs core biopsy: FNAC = cytology; core = histology (preferred for lymphoma, soft tissue tumours)",
                "IVC filter: inserted for PE with contraindication to anticoagulation or recurrent PE on anticoagulation",
                "Angioplasty & stenting: balloon angioplasty + stent; restenosis less with drug-eluting stents",
            ]),
        ]
    },
]


def build_pdf():
    doc = SimpleDocTemplate(
        OUTPUT,
        pagesize=A4,
        leftMargin=1.8*cm, rightMargin=1.8*cm,
        topMargin=1.5*cm, bottomMargin=1.5*cm,
    )

    story = []

    # ── Cover page ────────────────────────────────────────────────────────────
    cover_data = [[
        Paragraph("FMGE High-Yield Study Guide", TITLE_STYLE),
    ]]
    cover_table = Table(cover_data, colWidths=[17*cm])
    cover_table.setStyle(TableStyle([
        ("BACKGROUND", (0,0), (-1,-1), NAVY),
        ("ROUNDEDCORNERS", [8]),
        ("TOPPADDING",    (0,0), (-1,-1), 28),
        ("BOTTOMPADDING", (0,0), (-1,-1), 6),
        ("LEFTPADDING",   (0,0), (-1,-1), 14),
        ("RIGHTPADDING",  (0,0), (-1,-1), 14),
    ]))
    story.append(cover_table)

    sub_data = [[
        Paragraph("All 19 FMGE Subjects • Bullet-Point Format • Key Facts for Exam Day", SUB_STYLE),
    ]]
    sub_table = Table(sub_data, colWidths=[17*cm])
    sub_table.setStyle(TableStyle([
        ("BACKGROUND", (0,0), (-1,-1), TEAL),
        ("TOPPADDING",    (0,0), (-1,-1), 8),
        ("BOTTOMPADDING", (0,0), (-1,-1), 8),
        ("LEFTPADDING",   (0,0), (-1,-1), 14),
        ("RIGHTPADDING",  (0,0), (-1,-1), 14),
    ]))
    story.append(sub_table)

    date_data = [[Paragraph("Prepared: June 2026  |  FMGE / NEXT Preparation", DATE_STYLE)]]
    date_table = Table(date_data, colWidths=[17*cm])
    date_table.setStyle(TableStyle([
        ("BACKGROUND", (0,0), (-1,-1), NAVY),
        ("TOPPADDING",    (0,0), (-1,-1), 5),
        ("BOTTOMPADDING", (0,0), (-1,-1), 10),
        ("LEFTPADDING",   (0,0), (-1,-1), 14),
        ("RIGHTPADDING",  (0,0), (-1,-1), 14),
    ]))
    story.append(date_table)
    story.append(Spacer(1, 0.5*cm))

    # quick tip box
    tip_text = (
        "<b>How to use this guide:</b>  Each subject lists its highest-yield topics with concise bullet points. "
        "Focus on bolded items first. Review one subject per session, then cycle back. "
        "FMGE = 300 MCQs in 3.5 hours. Passing mark = 150 (50%). "
        "Prioritise Medicine, Surgery, Obs/Gynae, Paediatrics, and Community Medicine."
    )
    tip_para = Paragraph(tip_text, ParagraphStyle("tip", fontSize=9, textColor=colors.HexColor("#1e293b"),
                                                   fontName="Helvetica", leading=13))
    tip_data = [[tip_para]]
    tip_table = Table(tip_data, colWidths=[17*cm])
    tip_table.setStyle(TableStyle([
        ("BACKGROUND", (0,0), (-1,-1), colors.HexColor("#fef3c7")),
        ("BOX",        (0,0), (-1,-1), 1, AMBER),
        ("TOPPADDING",    (0,0), (-1,-1), 8),
        ("BOTTOMPADDING", (0,0), (-1,-1), 8),
        ("LEFTPADDING",   (0,0), (-1,-1), 10),
        ("RIGHTPADDING",  (0,0), (-1,-1), 10),
    ]))
    story.append(tip_table)
    story.append(Spacer(1, 0.3*cm))
    story.append(PageBreak())

    # ── Subject sections ──────────────────────────────────────────────────────
    for subj in SUBJECTS:
        # Section header
        hdr_data = [[Paragraph(subj["name"], SEC_STYLE)]]
        hdr_table = Table(hdr_data, colWidths=[17*cm])
        hdr_table.setStyle(TableStyle([
            ("BACKGROUND", (0,0), (-1,-1), NAVY),
            ("TOPPADDING",    (0,0), (-1,-1), 7),
            ("BOTTOMPADDING", (0,0), (-1,-1), 7),
            ("LEFTPADDING",   (0,0), (-1,-1), 10),
            ("RIGHTPADDING",  (0,0), (-1,-1), 10),
        ]))

        block = [hdr_table, Spacer(1, 0.15*cm)]

        for i, (topic, bullets) in enumerate(subj["topics"]):
            bg = GREY if i % 2 == 0 else WHITE
            # Build topic + bullets as a single table row
            topic_para = Paragraph(topic, TOPIC_STYLE)
            bullet_paras = [Paragraph(f"• {b}", BULLET_STYLE) for b in bullets]
            cell_content = [topic_para] + bullet_paras

            row_data = [[cell_content]]
            row_table = Table(row_data, colWidths=[16.6*cm])
            row_table.setStyle(TableStyle([
                ("BACKGROUND", (0,0), (-1,-1), bg),
                ("TOPPADDING",    (0,0), (-1,-1), 4),
                ("BOTTOMPADDING", (0,0), (-1,-1), 6),
                ("LEFTPADDING",   (0,0), (-1,-1), 10),
                ("RIGHTPADDING",  (0,0), (-1,-1), 10),
                ("BOX",           (0,0), (-1,-1), 0.5, colors.HexColor("#cbd5e1")),
            ]))
            block.append(row_table)
            block.append(Spacer(1, 0.06*cm))

        block.append(Spacer(1, 0.3*cm))
        story.extend(block)
        story.append(PageBreak())

    # ── Final tips page ───────────────────────────────────────────────────────
    hdr_data = [[Paragraph("Last-Minute FMGE Tips", SEC_STYLE)]]
    hdr_table = Table(hdr_data, colWidths=[17*cm])
    hdr_table.setStyle(TableStyle([
        ("BACKGROUND", (0,0), (-1,-1), TEAL),
        ("TOPPADDING",    (0,0), (-1,-1), 7),
        ("BOTTOMPADDING", (0,0), (-1,-1), 7),
        ("LEFTPADDING",   (0,0), (-1,-1), 10),
        ("RIGHTPADDING",  (0,0), (-1,-1), 10),
    ]))
    story.append(hdr_table)
    story.append(Spacer(1, 0.2*cm))

    tips = [
        ("Exam Strategy", [
            "Attempt all questions - no negative marking in FMGE",
            "Flag difficult questions and return to them at the end",
            "Read each option carefully - avoid 'first glance' answers",
            "Keywords in stem: 'MOST common', 'BEST initial', 'NEXT step', 'GOLD STANDARD' - these change the answer",
        ]),
        ("Subject Weightage (approximate)", [
            "Medicine: ~50-55 questions | Surgery: ~50 questions",
            "Obs & Gynae: ~30 questions | Paediatrics: ~20-25 questions",
            "PSM / Community Medicine: ~25 questions",
            "Anatomy + Physiology + Biochemistry: ~35-40 questions combined",
            "Pharmacology + Pathology + Microbiology: ~35-40 questions combined",
            "Ophthal + ENT + Derma + Psychiatry + Forensic + Radio + Anaesthesia: ~30-35 questions",
        ]),
        ("High-Yield Last-Hour Facts", [
            "Most common CHD: VSD | Most common cyanotic CHD: TOF | Acyanotic with Rt->Lt: Eisenmenger's",
            "DOC anaphylaxis: adrenaline (IM) | DOC status epilepticus: IV lorazepam/diazepam",
            "Commonest cause of blindness in India: cataract | World: refractive error (uncorrected)",
            "Commonest cause of maternal mortality in India: haemorrhage",
            "RBC lifespan: 120 days | Platelets: 7-10 days | Neutrophil half-life in blood: 6-8 hours",
        ]),
    ]

    for topic, bullets in tips:
        topic_para = Paragraph(topic, TOPIC_STYLE)
        bullet_paras = [Paragraph(f"• {b}", BULLET_STYLE) for b in bullets]
        cell_content = [topic_para] + bullet_paras
        row_data = [[cell_content]]
        row_table = Table(row_data, colWidths=[16.6*cm])
        row_table.setStyle(TableStyle([
            ("BACKGROUND", (0,0), (-1,-1), LIGHT),
            ("TOPPADDING",    (0,0), (-1,-1), 4),
            ("BOTTOMPADDING", (0,0), (-1,-1), 6),
            ("LEFTPADDING",   (0,0), (-1,-1), 10),
            ("RIGHTPADDING",  (0,0), (-1,-1), 10),
            ("BOX",           (0,0), (-1,-1), 0.5, TEAL),
        ]))
        story.append(row_table)
        story.append(Spacer(1, 0.1*cm))

    story.append(Spacer(1, 0.4*cm))
    footer = Paragraph(
        "Good luck Ashok! You've got this. Stay calm, trust your preparation, and read every question carefully.",
        ParagraphStyle("footer", fontSize=10, textColor=NAVY, alignment=TA_CENTER,
                       fontName="Helvetica-Bold", leading=14)
    )
    story.append(footer)

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


build_pdf()