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

# ── Output path ──────────────────────────────────────────────────────────────
OUTPUT = "/tmp/workspace/DMD_vs_SMA_Quick_Reference.pdf"

# ── Colour palette ────────────────────────────────────────────────────────────
C_DMD      = colors.HexColor("#1A3C6E")   # deep navy  – DMD column
C_SMA      = colors.HexColor("#7B1F1F")   # deep red   – SMA column
C_HEAD_BG  = colors.HexColor("#0D1B2A")   # almost black – main title bar
C_SEC_BG   = colors.HexColor("#E8EDF4")   # light steel – section sub-header
C_ROW_ALT  = colors.HexColor("#F5F7FA")   # very light blue – alternate rows
C_WHITE    = colors.white
C_YELLOW   = colors.HexColor("#FFF4CC")   # mnemonic boxes
C_GREEN    = colors.HexColor("#D6F0D6")   # memory hooks
C_RED_LIGHT= colors.HexColor("#FDECEA")   # MCQ box
C_BORDER   = colors.HexColor("#BBCDE5")

# ── Page setup ────────────────────────────────────────────────────────────────
doc = SimpleDocTemplate(
    OUTPUT,
    pagesize=A4,
    leftMargin=10*mm, rightMargin=10*mm,
    topMargin=10*mm,  bottomMargin=10*mm,
)
W = A4[0] - 20*mm   # usable width

# ── Paragraph styles ─────────────────────────────────────────────────────────
def PS(name, size, bold=False, color=colors.black, align=TA_LEFT, leading=None):
    return ParagraphStyle(
        name, fontSize=size,
        fontName="Helvetica-Bold" if bold else "Helvetica",
        textColor=color, alignment=align,
        leading=leading or size*1.25,
        spaceAfter=0, spaceBefore=0,
    )

title_s   = PS("title",  13, bold=True,  color=C_WHITE,  align=TA_CENTER, leading=16)
sec_s     = PS("sec",     8, bold=True,  color=C_DMD,    align=TA_LEFT)
cell_bold = PS("cb",      7, bold=True,  color=colors.black)
cell_norm = PS("cn",      7,             color=colors.black)
cell_dmd  = PS("cdmd",    7, bold=True,  color=C_DMD)
cell_sma  = PS("csma",    7, bold=True,  color=C_SMA)
hook_s    = PS("hook",    7, bold=False, color=colors.HexColor("#1A472A"))
mcq_q     = PS("mcqq",   7,             color=colors.black)
mcq_a     = PS("mcqa",   7, bold=True,  color=C_DMD)
footer_s  = PS("foot",   6,             color=colors.grey, align=TA_CENTER)

# ── Helpers ───────────────────────────────────────────────────────────────────
def B(txt):   return Paragraph(txt, cell_bold)
def N(txt):   return Paragraph(txt, cell_norm)
def D(txt):   return Paragraph(txt, cell_dmd)
def S(txt):   return Paragraph(txt, cell_sma)
def H(txt):   return Paragraph(txt, hook_s)

def section_header(text):
    tbl = Table([[Paragraph(text, sec_s)]], colWidths=[W])
    tbl.setStyle(TableStyle([
        ("BACKGROUND", (0,0), (-1,-1), C_SEC_BG),
        ("TOPPADDING",    (0,0), (-1,-1), 3),
        ("BOTTOMPADDING", (0,0), (-1,-1), 3),
        ("LEFTPADDING",   (0,0), (-1,-1), 6),
        ("BOX", (0,0), (-1,-1), 0.5, C_BORDER),
    ]))
    return tbl

def make_table(headers, rows, col_widths, alt=True):
    """Build a styled comparison table."""
    data = [headers] + rows
    tbl  = Table(data, colWidths=col_widths, repeatRows=1)
    style = [
        # Header row
        ("BACKGROUND",    (0,0), (-1,0),  C_DMD),
        ("TEXTCOLOR",     (0,0), (-1,0),  C_WHITE),
        ("FONTNAME",      (0,0), (-1,0),  "Helvetica-Bold"),
        ("FONTSIZE",      (0,0), (-1,0),  7.5),
        ("ALIGN",         (0,0), (-1,0),  "CENTER"),
        ("TOPPADDING",    (0,0), (-1,0),  3),
        ("BOTTOMPADDING", (0,0), (-1,0),  3),
        # Body rows
        ("FONTSIZE",      (0,1), (-1,-1), 7),
        ("TOPPADDING",    (0,1), (-1,-1), 2),
        ("BOTTOMPADDING", (0,1), (-1,-1), 2),
        ("LEFTPADDING",   (0,0), (-1,-1), 4),
        ("RIGHTPADDING",  (0,0), (-1,-1), 4),
        ("VALIGN",        (0,0), (-1,-1), "MIDDLE"),
        ("GRID",          (0,0), (-1,-1), 0.4, C_BORDER),
    ]
    if alt:
        for i in range(1, len(data)):
            if i % 2 == 0:
                style.append(("BACKGROUND", (0,i), (-1,i), C_ROW_ALT))
    tbl.setStyle(TableStyle(style))
    return tbl

def hook_box(text, bg=C_GREEN):
    tbl = Table([[H(text)]], colWidths=[W])
    tbl.setStyle(TableStyle([
        ("BACKGROUND",    (0,0), (-1,-1), bg),
        ("TOPPADDING",    (0,0), (-1,-1), 3),
        ("BOTTOMPADDING", (0,0), (-1,-1), 3),
        ("LEFTPADDING",   (0,0), (-1,-1), 6),
        ("BOX",           (0,0), (-1,-1), 0.5, colors.HexColor("#7CB87C")),
    ]))
    return tbl

def sp(h=2): return Spacer(1, h*mm)

# ── Column widths ─────────────────────────────────────────────────────────────
CW3 = [W*0.32, W*0.34, W*0.34]   # Feature | DMD | SMA
CW2 = [W*0.32, W*0.68]           # two-col (abbrev etc.)
CW4 = [W*0.18, W*0.20, W*0.25, W*0.15, W*0.22]  # SMA types

# =============================================================================
story = []

# ── MAIN TITLE ────────────────────────────────────────────────────────────────
title_tbl = Table(
    [[Paragraph("DMD  vs  SMA  —  Quick Reference Card", title_s),
      Paragraph("Final MBBS Yr 5  |  Paediatrics", PS("sub",8,color=C_WHITE,align=TA_CENTER))]],
    colWidths=[W*0.65, W*0.35]
)
title_tbl.setStyle(TableStyle([
    ("BACKGROUND", (0,0), (-1,-1), C_HEAD_BG),
    ("TOPPADDING",    (0,0), (-1,-1), 5),
    ("BOTTOMPADDING", (0,0), (-1,-1), 5),
    ("LEFTPADDING",   (0,0), (-1,-1), 8),
    ("VALIGN",        (0,0), (-1,-1), "MIDDLE"),
]))
story += [title_tbl, sp(2)]

# ── ABBREVIATIONS (compact inline) ───────────────────────────────────────────
story.append(section_header("ABBREVIATIONS"))
abbr_data = [
    [B("DMD"),  N("Duchenne Muscular Dystrophy"),   B("SMA"),  N("Spinal Muscular Atrophy")],
    [B("CK"),   N("Creatine Kinase"),               B("DCM"),  N("Dilated Cardiomyopathy")],
    [B("IHC"),  N("Immunohistochemistry"),          B("NIV"),  N("Non-Invasive Ventilation")],
    [B("EMG"),  N("Electromyography"),              B("NCV"),  N("Nerve Conduction Velocity")],
    [B("MLPA"), N("Multiplex Ligation Probe Ampl."),B("LMN"),  N("Lower Motor Neuron")],
    [B("XLR"),  N("X-Linked Recessive"),            B("AR"),   N("Autosomal Recessive")],
    [B("MUP"),  N("Motor Unit Potential"),          B("NBS"),  N("Newborn Screening")],
    [B("ACE-I"),N("ACE Inhibitor (cardiac drug)"),  B("CVS"),  N("Chorionic Villus Sampling")],
]
abbr_tbl = Table(abbr_data, colWidths=[W*0.1, W*0.4, W*0.1, W*0.4])
abbr_tbl.setStyle(TableStyle([
    ("FONTSIZE",      (0,0), (-1,-1), 7),
    ("TOPPADDING",    (0,0), (-1,-1), 1.5),
    ("BOTTOMPADDING", (0,0), (-1,-1), 1.5),
    ("LEFTPADDING",   (0,0), (-1,-1), 4),
    ("GRID",          (0,0), (-1,-1), 0.3, C_BORDER),
    *[("BACKGROUND", (0,i), (-1,i), C_ROW_ALT) for i in range(0,8,2)],
]))
story += [abbr_tbl, sp(2)]

# ── CHUNK 1: IDENTITY ─────────────────────────────────────────────────────────
story.append(section_header("1. IDENTITY — Who Gets It?"))
rows = [
    [B("Disease type"),   D("Myopathy (muscle)"),               S("Motor neuron disease")],
    [B("Gene / Chr"),     D("DMD gene — Xp21.2"),               S("SMN1 gene — Chr 5q13")],
    [B("Protein lost"),   D("Dystrophin (structural)"),         S("SMN protein (mRNA splicing)")],
    [B("Inheritance"),    D("X-Linked Recessive (XLR)"),        S("Autosomal Recessive (AR)")],
    [B("Sex affected"),   D("Males ONLY"),                      S("Both sexes")],
    [B("Incidence"),      D("1 in 3,500 males"),                S("1 in 6,000–10,000")],
    [B("Spontaneous mut"),D("30% cases"),                       S("Rare")],
]
story.append(make_table([B("Feature"), D("DMD"), S("SMA")], rows, CW3))
story.append(hook_box("Hook: DMD = X = eXclusively males  |  SMA = chromosome 5 = both sexes"))
story.append(sp(2))

# ── CHUNK 2: LESION SITE ──────────────────────────────────────────────────────
story.append(section_header("2. SITE OF LESION"))
rows = [
    [B("Primary site"),   D("Muscle fibre (sarcolemma)"),       S("Spinal anterior horn cells")],
    [B("Neuron involved"),D("NO"),                              S("YES — LMN only")],
    [B("UMN signs"),      D("Absent"),                         S("Absent")],
    [B("Sensation"),      D("Normal"),                         S("Normal — PURE motor")],
    [B("Bulbar"),         D("Spared"),                         S("Type I — tongue/swallowing")],
]
story.append(make_table([B("Feature"), D("DMD"), S("SMA")], rows, CW3))
story.append(hook_box("Hook: DMD = Muscle dies  |  SMA = Motor neuron dies → muscle wastes secondarily"))
story.append(sp(2))

# ── CHUNK 3: ONSET & PROGRESSION ─────────────────────────────────────────────
story.append(section_header("3. ONSET & PROGRESSION"))
rows = [
    [B("Onset age"),      D("2–5 yrs (mean dx 41 mo)"),        S("Birth → adulthood")],
    [B("First clue"),     D("Toe walking, falls"),              S("Floppy baby / hypotonia")],
    [B("Early milestones"),D("Initially NORMAL"),              S("Delayed from birth (Type I)")],
    [B("Wheelchair"),     D("10–15 yrs ← KEY exam fact"),      S("Type I: never walks")],
    [B("Cause of death"), D("DCM + respiratory failure"),      S("Resp failure (Type I <1 yr)")],
]
story.append(make_table([B("Feature"), D("DMD"), S("SMA")], rows, CW3))
story.append(sp(2))

# ── CHUNK 4A: MOTOR — WEAKNESS ────────────────────────────────────────────────
story.append(section_header("4A. MOTOR SIGNS — Weakness Pattern"))
rows = [
    [B("Pattern"),        D("Proximal > Distal"),              S("Proximal > Distal")],
    [B("Limb onset"),     D("Lower limbs first"),              S("Lower limbs worse")],
    [B("Axial muscles"),  D("Weak (lordosis early)"),          S("Weak (poor head control)")],
    [B("Progression"),    D("Steady downhill"),                S("Progressive / brief plateau")],
]
story.append(make_table([B("Feature"), D("DMD"), S("SMA")], rows, CW3))
story.append(sp(1))

# ── CHUNK 4B: MOTOR — TONE & REFLEXES ────────────────────────────────────────
story.append(section_header("4B. MOTOR SIGNS — Tone & Reflexes"))
rows = [
    [B("Muscle tone"),    D("Hypotonia (develops later)"),     S("Profound hypotonia — EARLY")],
    [B("DTRs"),           D("Reduced late"),                   S("ABSENT EARLY — hallmark")],
    [B("Ankle reflex"),   D("Lost late"),                      S("Lost earliest")],
]
story.append(make_table([B("Feature"), D("DMD"), S("SMA")], rows, CW3))
story.append(hook_box("Hook: Absent reflexes EARLY = SMA (anterior horn gone = no reflex arc)"))
story.append(sp(1))

# ── CHUNK 4C: MOTOR — INVOLUNTARY ─────────────────────────────────────────────
story.append(section_header("4C. MOTOR SIGNS — Involuntary Movements"))
rows = [
    [B("Fasciculations"), D("ABSENT"),                         S("PRESENT — LMN sign")],
    [B("Tongue fascicula"),D("Absent"),                        S("Classic Type I — KEY SIGN")],
    [B("Fibrillations EMG"),D("Absent"),                       S("Present on EMG")],
]
story.append(make_table([B("Feature"), D("DMD"), S("SMA")], rows, CW3))
story.append(hook_box("Hook: Twitching tongue + floppy baby = SMA Type I until proven otherwise"))
story.append(sp(1))

# ── CHUNK 4D: MOTOR — CLASSIC SIGNS ──────────────────────────────────────────
story.append(section_header("4D. MOTOR SIGNS — Classic Clinical Signs"))
rows = [
    [B("Gower's sign"),   D("CLASSIC — hands climb up thighs"),S("ABSENT")],
    [B("Calf pseudohypert"),D("CLASSIC — firm, rubbery calves"),S("ABSENT")],
    [B("Lumbar lordosis"), D("Early sign"),                    S("Less prominent")],
    [B("Waddling gait"),  D("Present"),                       S("Absent (can't walk Type I-II)")],
]
story.append(make_table([B("Feature"), D("DMD"), S("SMA")], rows, CW3))
story.append(hook_box("Hook: Big calves that are WEAK = pseudohypertrophy = DMD (fat + fibrosis, not muscle)"))
story.append(sp(1))

# ── CHUNK 4E: MOTOR — FACE & BULBAR ──────────────────────────────────────────
story.append(section_header("4E. MOTOR SIGNS — Face & Bulbar"))
rows = [
    [B("Facial muscles"), D("Spared"),                         S("Involved — Type I")],
    [B("Tongue"),         D("Normal"),                         S("Fasciculating + wasted")],
    [B("Swallowing"),     D("Normal"),                         S("Dysphagia — aspiration risk")],
    [B("Head control"),   D("Normal initially"),               S("LOST EARLY — Type I")],
]
story.append(make_table([B("Feature"), D("DMD"), S("SMA")], rows, CW3))
story.append(sp(2))

# ── CHUNK 5: NON-MOTOR ────────────────────────────────────────────────────────
story.append(section_header("5. NON-MOTOR FEATURES"))
rows = [
    [B("Intelligence"),   D("LOW IQ — non-progressive"),       S("NORMAL — brain unaffected")],
    [B("Sensation"),      D("Normal"),                         S("Normal")],
    [B("Cardiac — DCM"),  D("UNIVERSAL — all patients"),       S("Absent")],
    [B("Arrhythmia"),     D("Conduction defects"),             S("Absent")],
    [B("Respiratory"),    D("Late — affects ALL"),             S("Early in Type I (<1 yr)")],
    [B("Scoliosis"),      D("Post-wheelchair"),                S("Severe Types II–III")],
    [B("Contractures"),   D("Achilles, hips, knees"),          S("Hip dislocation Type II")],
]
story.append(make_table([B("Feature"), D("DMD"), S("SMA")], rows, CW3))
story.append(hook_box("Hook: SMA = ONLY motor neurons. Heart, brain, sensation — all NORMAL"))
story.append(sp(2))

# ── CHUNK 6: INVESTIGATIONS ───────────────────────────────────────────────────
story.append(section_header("6. INVESTIGATIONS"))
rows = [
    [B("CK level"),       D(">10–50× normal (10,000–50,000)"), S("Normal / mildly raised")],
    [B("CK at birth"),    D("Already elevated!"),              S("Normal")],
    [B("LDH/AST/ALT"),    D("Mildly raised (from muscle)"),    S("Normal")],
    [B("EMG pattern"),    D("MYOPATHIC — small, polyphasic"),  S("NEUROGENIC — large MUPs")],
    [B("Fibrillations"),  D("Absent"),                         S("Present on EMG")],
    [B("NCV"),            D("Normal"),                         S("Normal")],
    [B("Biopsy pattern"), D("Random necrosis + fat replacement"),S("GROUPED fibre atrophy")],
    [B("Fibre necrosis"), D("Present"),                        S("Absent")],
    [B("Type II fibres"), D("Variable"),                       S("Hypertrophied (compensatory)")],
    [B("Dystrophin IHC"), D("ABSENT — diagnostic"),            S("Present / Normal")],
    [B("Genetic test"),   D("MLPA — DMD gene deletion"),       S("MLPA — SMN1 copy number=0")],
]
story.append(make_table([B("Test"), D("DMD"), S("SMA")], rows, CW3))
story.append(hook_box("Hook: CK sky-high = DMD  |  Normal CK + floppy baby + absent reflexes = SMA  |  Grouped atrophy on biopsy = SMA"))
story.append(sp(2))

# ── CHUNK 7: TREATMENT ────────────────────────────────────────────────────────
story.append(section_header("7. TREATMENT"))
rows = [
    [B("Steroids"),       D("Deflazacort / Prednisolone"),     S("NOT used")],
    [B("Nusinersen"),     D("No"),                             S("YES — intrathecal injection")],
    [B("Risdiplam"),      D("No"),                             S("YES — oral daily")],
    [B("Onasemnogene"),   D("No"),                             S("YES — IV one-time gene therapy")],
    [B("Eteplirsen"),     D("YES — exon 51 skipping"),         S("No")],
    [B("Cardiac"),        D("ACE-I + Beta-blockers + Diuretics"),S("Not needed")],
    [B("Respiratory"),    D("NIV (late)"),                     S("NIV Types I–II (early)")],
    [B("Spinal surgery"), D("Fusion for scoliosis"),           S("Fusion Types II–III")],
]
story.append(make_table([B("Drug / Rx"), D("DMD"), S("SMA")], rows, CW3))
story.append(hook_box("SMA drugs = NRO: Nusinersen · Risdiplam · Onasemnogene  |  DMD = Deflazacort + Exon-skipping"))
story.append(sp(2))

# ── CHUNK 8: SMA TYPES ────────────────────────────────────────────────────────
story.append(section_header("8. SMA TYPES — One Glance"))
sma_hdr = [B("Type"), B("Alias"), B("Onset"), B("Best Milestone"), B("Survival")]
sma_rows = [
    [B("0"),  N("Prenatal"),           N("In womb"),      N("None — resp failure at birth"), N("Weeks")],
    [B("I"),  D("Werdnig-Hoffmann"),   N("<6 months"),    N("Cannot sit"),                   N("<1 year")],
    [B("II"), N("Intermediate"),       N("7–18 months"),  N("Sits — cannot walk"),            N("3rd decade")],
    [B("III"),N("Kugelberg-Welander"), N(">18 months"),   N("Walks (may lose later)"),        N("Normal")],
    [B("IV"), N("Adult SMA"),          N("20s–30s"),       N("Ambulatory"),                   N("Normal")],
]
sma_tbl = Table([sma_hdr]+sma_rows, colWidths=CW4)
sma_tbl.setStyle(TableStyle([
    ("BACKGROUND",    (0,0), (-1,0),  C_SMA),
    ("TEXTCOLOR",     (0,0), (-1,0),  C_WHITE),
    ("FONTNAME",      (0,0), (-1,0),  "Helvetica-Bold"),
    ("FONTSIZE",      (0,0), (-1,-1), 7),
    ("ALIGN",         (0,0), (-1,0),  "CENTER"),
    ("TOPPADDING",    (0,0), (-1,-1), 2),
    ("BOTTOMPADDING", (0,0), (-1,-1), 2),
    ("LEFTPADDING",   (0,0), (-1,-1), 4),
    ("GRID",          (0,0), (-1,-1), 0.4, C_BORDER),
    ("BACKGROUND",    (0,2), (-1,2),  C_ROW_ALT),
    ("BACKGROUND",    (0,4), (-1,4),  C_ROW_ALT),
    # Highlight Type I row
    ("BACKGROUND",    (0,1), (-1,1),  colors.HexColor("#FDECEA")),
]))
story += [sma_tbl]
story.append(hook_box("Rule: Type I = never sits  |  Type II = sits only  |  Type III = walks  |  IV = adult onset"))
story.append(sp(2))

# ── CHUNK 9: DMD STAGES ───────────────────────────────────────────────────────
story.append(section_header("9. DMD DISEASE STAGES"))
dmd_rows = [
    [B("Silent"),       N("0–2 yrs"),        N("CK already sky-high — NO symptoms yet")],
    [B("Early"),        N("2–5 yrs"),        N("Toe walking · Falls · Gower's sign · Calf hypertrophy")],
    [B("Progressive"),  N("5–10 yrs"),       N("Proximal weakness · Lordosis · Scoliosis starts")],
    [B("Wheelchair"),   D("10–15 yrs"),      D("Loss of ambulation  ← MOST EXAM-TESTED FACT")],
    [B("Terminal"),     N("Teens–20s"),      N("DCM + Respiratory failure = Cause of death")],
]
dmd_tbl = Table([[B("Stage"), B("Age"), B("Key Event")]]+dmd_rows,
                colWidths=[W*0.15, W*0.13, W*0.72])
dmd_tbl.setStyle(TableStyle([
    ("BACKGROUND",    (0,0), (-1,0),  C_DMD),
    ("TEXTCOLOR",     (0,0), (-1,0),  C_WHITE),
    ("FONTNAME",      (0,0), (-1,0),  "Helvetica-Bold"),
    ("FONTSIZE",      (0,0), (-1,-1), 7),
    ("TOPPADDING",    (0,0), (-1,-1), 2),
    ("BOTTOMPADDING", (0,0), (-1,-1), 2),
    ("LEFTPADDING",   (0,0), (-1,-1), 4),
    ("GRID",          (0,0), (-1,-1), 0.4, C_BORDER),
    ("BACKGROUND",    (0,2), (-1,2),  C_ROW_ALT),
    ("BACKGROUND",    (0,4), (-1,4),  C_ROW_ALT),
    # Highlight wheelchair row
    ("BACKGROUND",    (0,4), (-1,4),  colors.HexColor("#FFF4CC")),
]))
story += [dmd_tbl, sp(2)]

# ── CHUNK 10: MNEMONICS ────────────────────────────────────────────────────────
story.append(section_header("10. MEMORY MNEMONICS"))
mnem_data = [
    [Paragraph("<b>DMD = \"3C + X + G\"</b>", PS("mn",8,bold=True,color=C_DMD)),
     Paragraph("<b>SMA = \"FANGS\"</b>", PS("mn2",8,bold=True,color=C_SMA))],
    [
        Table([
            [B("C"), N("Calf pseudohypertrophy — big but WEAK")],
            [B("C"), N("Cardiomyopathy — DCM universal")],
            [B("C"), N("CK — sky high (>10× normal)")],
            [B("X"), N("X-linked — males only")],
            [B("G"), N("Gower's sign — uses hands to stand")],
        ], colWidths=[W*0.03, W*0.44]),
        Table([
            [B("F"), N("Fasciculations — tongue esp. Type I")],
            [B("A"), N("Anterior horn cell — LMN death")],
            [B("N"), N("Normal IQ + Normal sensation")],
            [B("G"), N("Grouped atrophy on biopsy")],
            [B("S"), N("SMN1 deleted — Chr 5q13")],
        ], colWidths=[W*0.03, W*0.44]),
    ]
]
mnem_tbl = Table(mnem_data, colWidths=[W*0.5, W*0.5])
mnem_tbl.setStyle(TableStyle([
    ("BACKGROUND",    (0,0), (0,0), colors.HexColor("#D6E4F0")),
    ("BACKGROUND",    (1,0), (1,0), colors.HexColor("#FDECEA")),
    ("BACKGROUND",    (0,1), (0,1), colors.HexColor("#EBF5FB")),
    ("BACKGROUND",    (1,1), (1,1), colors.HexColor("#FEF9F9")),
    ("TOPPADDING",    (0,0), (-1,-1), 3),
    ("BOTTOMPADDING", (0,0), (-1,-1), 3),
    ("LEFTPADDING",   (0,0), (-1,-1), 5),
    ("BOX",           (0,0), (-1,-1), 0.5, C_BORDER),
    ("INNERGRID",     (0,0), (-1,-1), 0.3, C_BORDER),
    ("VALIGN",        (0,0), (-1,-1), "TOP"),
    ("ALIGN",         (0,0), (-1,0), "CENTER"),
]))
story += [mnem_tbl, sp(2)]

# ── CHUNK 11: MCQ RAPID FIRE ──────────────────────────────────────────────────
story.append(section_header("11. MCQ / MEQ RAPID FIRE — Must Know"))
mcq_items = [
    ("Firm calves + proximal weakness + 4yr boy",                    "DMD"),
    ("Child uses hands to climb up his own legs to stand",           "DMD — Gower's sign"),
    ("CK = 20,000 U/L in a toddler",                                "DMD"),
    ("Dilated cardiomyopathy + muscle weakness in a child",          "DMD"),
    ("Low IQ + proximal weakness in boy",                            "DMD"),
    ("Dystrophin absent on IHC / muscle biopsy",                     "DMD"),
    ("Deflazacort prescribed for muscle disease",                    "DMD"),
    ("Floppy infant + tongue fasciculations + absent reflexes",      "SMA Type I"),
    ("Cannot sit at 9 months + normal CK + absent DTRs",            "SMA Type I"),
    ("Both sexes + AR + sits but NEVER walks",                       "SMA Type II"),
    ("Teenager walks but has proximal leg weakness",                 "SMA Type III"),
    ("Grouped atrophy of type I fibres on biopsy",                   "SMA"),
    ("Neurogenic EMG + normal CK + floppy baby",                     "SMA"),
    ("AR inheritance + pure motor + normal IQ + normal sensation",   "SMA"),
    ("Nusinersen / Risdiplam prescribed",                            "SMA"),
    ("Myopathic EMG + massively raised CK",                         "DMD"),
    ("Reduced fetal movements + hypotonia at birth + resp failure",  "SMA Type 0"),
    ("Normal CK + no sensation loss + absent reflexes + infant",     "SMA"),
]
mcq_data = [[B("If question says..."), B("Answer")]]
for q, a in mcq_items:
    col = C_DMD if "DMD" in a else C_SMA
    mcq_data.append([
        Paragraph(q, mcq_q),
        Paragraph(a, PS("ans", 7, bold=True, color=col))
    ])
mcq_tbl = Table(mcq_data, colWidths=[W*0.68, W*0.32])
mcq_tbl.setStyle(TableStyle([
    ("BACKGROUND",    (0,0), (-1,0),  colors.HexColor("#2C3E50")),
    ("TEXTCOLOR",     (0,0), (-1,0),  C_WHITE),
    ("FONTNAME",      (0,0), (-1,0),  "Helvetica-Bold"),
    ("FONTSIZE",      (0,0), (-1,-1), 7),
    ("TOPPADDING",    (0,0), (-1,-1), 2),
    ("BOTTOMPADDING", (0,0), (-1,-1), 2),
    ("LEFTPADDING",   (0,0), (-1,-1), 4),
    ("GRID",          (0,0), (-1,-1), 0.3, C_BORDER),
    *[("BACKGROUND", (0,i), (-1,i), C_ROW_ALT) for i in range(1,len(mcq_data),2)],
]))
story += [mcq_tbl, sp(2)]

# ── FOOTER ─────────────────────────────────────────────────────────────────────
story.append(HRFlowable(width=W, thickness=0.5, color=C_BORDER))
story.append(sp(1))
story.append(Paragraph(
    "Sources: Tietz Textbook of Laboratory Medicine 7e  |  Bradley & Daroff's Neurology in Clinical Practice  |  "
    "Campbell's Operative Orthopaedics 15e 2026  —  For educational use: Final MBBS Yr 5",
    footer_s
))

# ── BUILD ─────────────────────────────────────────────────────────────────────
doc.build(story)
print("PDF built:", OUTPUT)

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

OUTPUT = "/tmp/workspace/DMD_vs_SMA_QuickRef_v2.pdf"

# ── Colours ───────────────────────────────────────────────────────────────────
C_DMD      = colors.HexColor("#1A3C6E")
C_SMA      = colors.HexColor("#7B1F1F")
C_HEAD_BG  = colors.HexColor("#0D1B2A")
C_SEC_BG   = colors.HexColor("#E8EDF4")
C_ROW_ALT  = colors.HexColor("#F5F7FA")
C_WHITE    = colors.white
C_GREEN    = colors.HexColor("#D6F0D6")
C_YELLOW   = colors.HexColor("#FFF9E6")
C_BORDER   = colors.HexColor("#BBCDE5")
C_INV_HDR  = colors.HexColor("#1B4F72")   # investigations header
C_TX_HDR   = colors.HexColor("#4A235A")   # treatment header
C_ORANGE   = colors.HexColor("#F5CBA7")   # highlight important rows

# ── Page ──────────────────────────────────────────────────────────────────────
doc = SimpleDocTemplate(
    OUTPUT, pagesize=A4,
    leftMargin=10*mm, rightMargin=10*mm,
    topMargin=10*mm,  bottomMargin=10*mm,
)
W = A4[0] - 20*mm

# ── Styles ────────────────────────────────────────────────────────────────────
def PS(name, size, bold=False, color=colors.black, align=TA_LEFT, leading=None):
    return ParagraphStyle(
        name, fontSize=size,
        fontName="Helvetica-Bold" if bold else "Helvetica",
        textColor=color, alignment=align,
        leading=leading or size*1.3,
        spaceAfter=0, spaceBefore=0,
    )

title_s   = PS("title", 13, bold=True, color=C_WHITE,  align=TA_CENTER)
sub_s     = PS("sub",    8, bold=False, color=C_WHITE,  align=TA_CENTER)
sec_s     = PS("sec",    8, bold=True,  color=C_DMD)
cb        = lambda t: Paragraph(t, PS("cb", 7, bold=True))
cn        = lambda t: Paragraph(t, PS("cn", 7))
cd        = lambda t: Paragraph(t, PS("cd", 7, bold=True, color=C_DMD))
cs        = lambda t: Paragraph(t, PS("cs", 7, bold=True, color=C_SMA))
hook_s    = PS("hook", 7, color=colors.HexColor("#1A472A"))
foot_s    = PS("foot", 6, color=colors.grey, align=TA_CENTER)

def sp(h=2): return Spacer(1, h*mm)

def sec_hdr(text, color=C_SEC_BG, text_color=C_DMD):
    tbl = Table([[Paragraph(text, PS("sh", 8, bold=True, color=text_color))]], colWidths=[W])
    tbl.setStyle(TableStyle([
        ("BACKGROUND",    (0,0), (-1,-1), color),
        ("TOPPADDING",    (0,0), (-1,-1), 3),
        ("BOTTOMPADDING", (0,0), (-1,-1), 3),
        ("LEFTPADDING",   (0,0), (-1,-1), 6),
        ("BOX",           (0,0), (-1,-1), 0.5, C_BORDER),
    ]))
    return tbl

def inv_hdr(text):
    """Dark blue header for investigation sub-sections"""
    tbl = Table([[Paragraph(text, PS("ih", 7.5, bold=True, color=C_WHITE))]], colWidths=[W])
    tbl.setStyle(TableStyle([
        ("BACKGROUND",    (0,0), (-1,-1), C_INV_HDR),
        ("TOPPADDING",    (0,0), (-1,-1), 2.5),
        ("BOTTOMPADDING", (0,0), (-1,-1), 2.5),
        ("LEFTPADDING",   (0,0), (-1,-1), 8),
    ]))
    return tbl

def tx_hdr(text):
    """Purple header for treatment sub-sections"""
    tbl = Table([[Paragraph(text, PS("th", 7.5, bold=True, color=C_WHITE))]], colWidths=[W])
    tbl.setStyle(TableStyle([
        ("BACKGROUND",    (0,0), (-1,-1), C_TX_HDR),
        ("TOPPADDING",    (0,0), (-1,-1), 2.5),
        ("BOTTOMPADDING", (0,0), (-1,-1), 2.5),
        ("LEFTPADDING",   (0,0), (-1,-1), 8),
    ]))
    return tbl

def make_table(headers, rows, col_widths, hdr_color=C_DMD, highlights=None):
    data = [headers] + rows
    tbl  = Table(data, colWidths=col_widths, repeatRows=1)
    style = [
        ("BACKGROUND",    (0,0), (-1,0),  hdr_color),
        ("TEXTCOLOR",     (0,0), (-1,0),  C_WHITE),
        ("FONTNAME",      (0,0), (-1,0),  "Helvetica-Bold"),
        ("FONTSIZE",      (0,0), (-1,0),  7.5),
        ("ALIGN",         (0,0), (-1,0),  "CENTER"),
        ("TOPPADDING",    (0,0), (-1,0),  3),
        ("BOTTOMPADDING", (0,0), (-1,0),  3),
        ("FONTSIZE",      (0,1), (-1,-1), 7),
        ("TOPPADDING",    (0,1), (-1,-1), 2),
        ("BOTTOMPADDING", (0,1), (-1,-1), 2),
        ("LEFTPADDING",   (0,0), (-1,-1), 4),
        ("RIGHTPADDING",  (0,0), (-1,-1), 4),
        ("VALIGN",        (0,0), (-1,-1), "MIDDLE"),
        ("GRID",          (0,0), (-1,-1), 0.4, C_BORDER),
    ]
    for i in range(1, len(data)):
        if i % 2 == 0:
            style.append(("BACKGROUND", (0,i), (-1,i), C_ROW_ALT))
    if highlights:
        for row_idx, bg in highlights:
            style.append(("BACKGROUND", (0, row_idx), (-1, row_idx), bg))
    tbl.setStyle(TableStyle(style))
    return tbl

def hook_box(text, bg=C_GREEN):
    tbl = Table([[Paragraph(text, hook_s)]], colWidths=[W])
    tbl.setStyle(TableStyle([
        ("BACKGROUND",    (0,0), (-1,-1), bg),
        ("TOPPADDING",    (0,0), (-1,-1), 3),
        ("BOTTOMPADDING", (0,0), (-1,-1), 3),
        ("LEFTPADDING",   (0,0), (-1,-1), 6),
        ("BOX",           (0,0), (-1,-1), 0.5, colors.HexColor("#7CB87C")),
    ]))
    return tbl

# ── Column presets ────────────────────────────────────────────────────────────
CW3  = [W*0.30, W*0.35, W*0.35]
CW3b = [W*0.32, W*0.34, W*0.34]

# =============================================================================
story = []

# ── TITLE ─────────────────────────────────────────────────────────────────────
title_tbl = Table(
    [[Paragraph("DMD  vs  SMA — Quick Reference Card", title_s),
      Paragraph("Final MBBS Yr 5  |  Paediatrics", sub_s)]],
    colWidths=[W*0.65, W*0.35]
)
title_tbl.setStyle(TableStyle([
    ("BACKGROUND", (0,0), (-1,-1), C_HEAD_BG),
    ("TOPPADDING",    (0,0), (-1,-1), 6),
    ("BOTTOMPADDING", (0,0), (-1,-1), 6),
    ("LEFTPADDING",   (0,0), (-1,-1), 8),
    ("VALIGN",        (0,0), (-1,-1), "MIDDLE"),
]))
story += [title_tbl, sp(2)]

# ── ABBREVIATIONS ─────────────────────────────────────────────────────────────
story.append(sec_hdr("ABBREVIATIONS — Know These First"))
abbr = [
    [cb("DMD"), cn("Duchenne Muscular Dystrophy"),    cb("SMA"),  cn("Spinal Muscular Atrophy")],
    [cb("CK"),  cn("Creatine Kinase (muscle enzyme)"),cb("DCM"),  cn("Dilated Cardiomyopathy")],
    [cb("IHC"), cn("Immunohistochemistry"),           cb("NIV"),  cn("Non-Invasive Ventilation")],
    [cb("EMG"), cn("Electromyography"),               cb("NCV"),  cn("Nerve Conduction Velocity")],
    [cb("MUP"), cn("Motor Unit Potential"),           cb("DTR"),  cn("Deep Tendon Reflex")],
    [cb("LMN"), cn("Lower Motor Neuron"),             cb("UMN"),  cn("Upper Motor Neuron")],
    [cb("XLR"), cn("X-Linked Recessive"),             cb("AR"),   cn("Autosomal Recessive")],
    [cb("MLPA"),cn("Multiplex Ligation Probe Amplification (gene test)"), cb("CVS"), cn("Chorionic Villus Sampling")],
    [cb("ACE-I"),cn("ACE Inhibitor"),                 cb("NBS"),  cn("Newborn Screening")],
]
at = Table(abbr, colWidths=[W*0.09, W*0.41, W*0.09, W*0.41])
at.setStyle(TableStyle([
    ("FONTSIZE",      (0,0),(-1,-1), 7),
    ("TOPPADDING",    (0,0),(-1,-1), 1.5),
    ("BOTTOMPADDING", (0,0),(-1,-1), 1.5),
    ("LEFTPADDING",   (0,0),(-1,-1), 4),
    ("GRID",          (0,0),(-1,-1), 0.3, C_BORDER),
    *[("BACKGROUND",  (0,i),(-1,i), C_ROW_ALT) for i in range(0,9,2)],
]))
story += [at, sp(2)]

# ── 1. IDENTITY ───────────────────────────────────────────────────────────────
story.append(sec_hdr("1.  IDENTITY — Who Gets It?"))
rows = [
    [cb("Disease type"),   cd("Myopathy — muscle disease"),         cs("Motor Neuron Disease")],
    [cb("Gene"),           cd("DMD gene"),                          cs("SMN1 gene")],
    [cb("Chromosome"),     cd("Xp21.2"),                            cs("5q13")],
    [cb("Protein lost"),   cd("Dystrophin (structural protein)"),   cs("SMN protein (mRNA splicing)")],
    [cb("Inheritance"),    cd("X-Linked Recessive (XLR)"),          cs("Autosomal Recessive (AR)")],
    [cb("Sex affected"),   cd("Males ONLY"),                        cs("Both sexes equally")],
    [cb("Incidence"),      cd("1 in 3,500 males"),                  cs("1 in 6,000–10,000")],
    [cb("Spontaneous mut"),cd("30% — no family history"),           cs("Rare")],
]
story.append(make_table([cb("Feature"), cd("DMD"), cs("SMA")], rows, CW3))
story.append(hook_box("Hook: DMD = X = eXclusively males  |  SMA = Chr 5 = both 5eXes"))
story.append(sp(2))

# ── 2. SITE OF LESION ─────────────────────────────────────────────────────────
story.append(sec_hdr("2.  SITE OF LESION"))
rows = [
    [cb("Primary site"),    cd("Muscle fibre — sarcolemma"),       cs("Spinal anterior horn cells")],
    [cb("Neuron involved?"),cd("NO"),                              cs("YES — LMN only")],
    [cb("UMN signs?"),      cd("Absent"),                         cs("Absent")],
    [cb("Sensory loss?"),   cd("NO — normal sensation"),          cs("NO — PURE motor disease")],
    [cb("Bulbar involved?"),cd("NO — face spared"),               cs("YES — Type I (tongue, swallow)")],
]
story.append(make_table([cb("Feature"), cd("DMD"), cs("SMA")], rows, CW3))
story.append(hook_box("Hook: DMD = Muscle dies  |  SMA = Motor neuron dies → muscle wastes secondary"))
story.append(sp(2))

# ── 3. ONSET & PROGRESSION ────────────────────────────────────────────────────
story.append(sec_hdr("3.  ONSET & PROGRESSION"))
rows = [
    [cb("Onset age"),       cd("2–5 yrs (mean diagnosis 41 mo)"),   cs("Birth → adulthood (type-dependent)")],
    [cb("First clue"),      cd("Toe walking, frequent falls"),       cs("Floppy baby / hypotonia")],
    [cb("Early milestones"),cd("Initially NORMAL"),                 cs("Delayed from birth (Type I)")],
    [cb("Wheelchair age"),  cd("10–15 yrs  ← KEY EXAM FACT"),       cs("Type I: never walks; Type III: may lose walking")],
    [cb("Cause of death"),  cd("DCM + Respiratory failure"),        cs("Respiratory failure (Type I <1 yr)")],
]
story.append(make_table([cb("Feature"), cd("DMD"), cs("SMA")], rows, CW3,
             highlights=[(4, C_ORANGE)]))
story.append(sp(2))

# ── 4. MOTOR SIGNS (5 sub-chunks) ─────────────────────────────────────────────
story.append(sec_hdr("4.  MOTOR SIGNS"))
story.append(sp(1))

# 4A Weakness
story.append(inv_hdr("  4A.  Weakness Pattern"))
rows = [
    [cb("Pattern"),         cd("Proximal > Distal"),              cs("Proximal > Distal")],
    [cb("Limb onset"),      cd("Lower limbs FIRST, then upper"),  cs("Lower limbs worse than upper")],
    [cb("Axial muscles"),   cd("Weak — lumbar lordosis early"),   cs("Weak — poor head control early")],
    [cb("Progression"),     cd("Steady downhill"),                cs("Progressive / brief plateau possible")],
]
story.append(make_table([cb("Feature"), cd("DMD"), cs("SMA")], rows, CW3))
story.append(sp(1))

# 4B Tone & Reflexes
story.append(inv_hdr("  4B.  Tone & Deep Tendon Reflexes (DTRs)"))
rows = [
    [cb("Muscle tone"),     cd("Hypotonia — develops LATER"),     cs("Profound hypotonia — FROM BIRTH (Type I)")],
    [cb("DTRs overall"),    cd("Reduced — LATE in disease"),      cs("ABSENT — EARLY hallmark sign")],
    [cb("Ankle reflex"),    cd("Lost late"),                      cs("LOST EARLIEST")],
    [cb("Knee reflex"),     cd("Lost later"),                     cs("Also absent")],
]
story.append(make_table([cb("Feature"), cd("DMD"), cs("SMA")], rows, CW3))
story.append(hook_box("Hook: Absent reflexes EARLY = SMA. Anterior horn cell gone = no reflex arc."))
story.append(sp(1))

# 4C Involuntary
story.append(inv_hdr("  4C.  Involuntary Movements"))
rows = [
    [cb("Fasciculations"),     cd("ABSENT"),                     cs("PRESENT — LMN sign")],
    [cb("Tongue fascicul."),   cd("Absent"),                     cs("CLASSIC in Type I  ← KEY exam sign")],
    [cb("Fibrillations (EMG)"),cd("Absent"),                     cs("Present on EMG")],
    [cb("Muscle cramps"),      cd("Occasionally"),               cs("Less common")],
]
story.append(make_table([cb("Feature"), cd("DMD"), cs("SMA")], rows, CW3))
story.append(hook_box("Hook: Twitching tongue + floppy baby = SMA Type I until proven otherwise"))
story.append(sp(1))

# 4D Classic signs
story.append(inv_hdr("  4D.  Classic Clinical Signs"))
rows = [
    [cb("Gower's sign"),          cd("CLASSIC — hands climb thighs to stand"), cs("ABSENT")],
    [cb("Calf pseudohypertrophy"),cd("CLASSIC — firm, rubbery (fat+fibrosis)"), cs("ABSENT")],
    [cb("Lumbar lordosis"),       cd("Early prominent sign"),                  cs("Less prominent")],
    [cb("Waddling gait"),         cd("Present"),                              cs("Types I-II cannot walk")],
    [cb("Trendelenburg gait"),    cd("Present"),                              cs("Absent")],
]
story.append(make_table([cb("Feature"), cd("DMD"), cs("SMA")], rows, CW3))
story.append(hook_box("Hook: Big calves that are WEAK = pseudohypertrophy = DMD  (fat+fibrosis replacing muscle)"))
story.append(sp(1))

# 4E Face & Bulbar
story.append(inv_hdr("  4E.  Face & Bulbar Signs"))
rows = [
    [cb("Facial muscles"),  cd("SPARED"),                        cs("Involved — Type I only")],
    [cb("Tongue"),          cd("Normal"),                        cs("Fasciculating + wasted (Type I)")],
    [cb("Swallowing"),      cd("Normal"),                        cs("Dysphagia — aspiration risk (Type I)")],
    [cb("Feeding"),         cd("Normal"),                        cs("Difficulty feeding — Type I")],
    [cb("Head control"),    cd("Normal initially"),              cs("LOST EARLY — Type I")],
]
story.append(make_table([cb("Feature"), cd("DMD"), cs("SMA")], rows, CW3))
story.append(sp(2))

# ── 5. NON-MOTOR FEATURES ────────────────────────────────────────────────────
story.append(sec_hdr("5.  NON-MOTOR FEATURES"))
story.append(sp(1))

story.append(inv_hdr("  5A.  Cognition & Intelligence"))
rows = [
    [cb("Intelligence / IQ"),cd("LOW — non-progressive cognitive impairment"), cs("NORMAL — brain unaffected")],
    [cb("Why low IQ?"),      cd("Dystrophin isoforms expressed in brain"),     cs("Not applicable")],
    [cb("Behaviour"),        cd("ADHD, autism-like features possible"),         cs("Normal behaviour")],
]
story.append(make_table([cb("Feature"), cd("DMD"), cs("SMA")], rows, CW3))
story.append(sp(1))

story.append(inv_hdr("  5B.  Cardiac"))
rows = [
    [cb("Cardiac involvement"),cd("UNIVERSAL — affects ALL patients"),           cs("ABSENT (generally)")],
    [cb("Type"),               cd("Dilated Cardiomyopathy (DCM)"),               cs("None")],
    [cb("Mechanism"),          cd("Cardiac fibrosis — dystrophin absent in heart"),cs("Not applicable")],
    [cb("Arrhythmia"),         cd("Conduction defects"),                         cs("Absent")],
    [cb("Heart failure"),      cd("LV dilation → Congestive Heart Failure"),      cs("Absent")],
]
story.append(make_table([cb("Feature"), cd("DMD"), cs("SMA")], rows, CW3))
story.append(hook_box("Hook: Heart also has dystrophin → no dystrophin = heart destroyed too in DMD"))
story.append(sp(1))

story.append(inv_hdr("  5C.  Respiratory"))
rows = [
    [cb("Respiratory failure"),cd("Late — affects ALL patients eventually"),    cs("EARLY in Type I (<1 yr)")],
    [cb("Mechanism"),          cd("Resp. muscle weakness + scoliosis"),         cs("Intercostal + diaphragm weakness")],
    [cb("Type I SMA"),         cd("—"),                                         cs("Resp. failure = cause of death <1 yr")],
]
story.append(make_table([cb("Feature"), cd("DMD"), cs("SMA")], rows, CW3))
story.append(sp(1))

story.append(inv_hdr("  5D.  Orthopaedic / Skeletal"))
rows = [
    [cb("Scoliosis"),         cd("Yes — worsens post-wheelchair"),             cs("Yes — severe in Types II–III")],
    [cb("Contractures"),      cd("Achilles tendon, hip flexors, knees"),       cs("Hip dislocation — Type II")],
    [cb("Lumbar lordosis"),   cd("Prominent early"),                           cs("Less common")],
    [cb("Fractures"),         cd("Steroid-related + immobility"),              cs("Muscle weakness-related")],
]
story.append(make_table([cb("Feature"), cd("DMD"), cs("SMA")], rows, CW3))
story.append(sp(2))

# ═══════════════════════════════════════════════════════════════════
# ── 6. INVESTIGATIONS — FULLY EXPANDED, SEQ-READY ─────────────────
# ═══════════════════════════════════════════════════════════════════
story.append(sec_hdr("6.  INVESTIGATIONS  (SEQ / MEQ Ready)", color=colors.HexColor("#D0E4F7"), text_color=C_INV_HDR))
story.append(sp(1))

# 6A Blood
story.append(inv_hdr("  6A.  Blood Tests"))
rows = [
    [cb("CK — Creatine Kinase"),
     cd("MASSIVELY elevated\n>10–50× normal\nTypical: 10,000–50,000 U/L\nAlready HIGH at birth (before symptoms!)"),
     cs("Normal OR mildly elevated\nUsually <500 U/L\nNormal at birth")],
    [cb("LDH\n(Lactate Dehydrogenase)"),
     cd("Mildly elevated\n(from dying muscle cells)"),
     cs("Normal")],
    [cb("AST / ALT\n(liver enzymes)"),
     cd("Mildly elevated\nCAUSE = muscle, NOT liver!\nAlways check CK if raised in a child"),
     cs("Normal")],
]
bt = Table([[cb("Test"), cd("DMD — What to Write"), cs("SMA — What to Write")]] + rows,
           colWidths=[W*0.28, W*0.36, W*0.36], repeatRows=1)
bt.setStyle(TableStyle([
    ("BACKGROUND",    (0,0),(-1,0), C_INV_HDR),
    ("TEXTCOLOR",     (0,0),(-1,0), C_WHITE),
    ("FONTNAME",      (0,0),(-1,0), "Helvetica-Bold"),
    ("FONTSIZE",      (0,0),(-1,-1),7),
    ("TOPPADDING",    (0,0),(-1,-1),3),
    ("BOTTOMPADDING", (0,0),(-1,-1),3),
    ("LEFTPADDING",   (0,0),(-1,-1),4),
    ("VALIGN",        (0,0),(-1,-1),"TOP"),
    ("GRID",          (0,0),(-1,-1),0.4, C_BORDER),
    ("BACKGROUND",    (0,2),(-1,2), C_ROW_ALT),
]))
story += [bt, sp(1)]

# 6B EMG
story.append(inv_hdr("  6B.  EMG — Electromyography"))
rows = [
    [cb("Overall pattern"),  cd("MYOPATHIC"),                       cs("NEUROGENIC")],
    [cb("MUP size"),         cd("Small, short, low amplitude"),     cs("Large, long duration MUPs")],
    [cb("Polyphasic MUPs"),  cd("YES — characteristic"),           cs("Less prominent")],
    [cb("Fibrillations"),    cd("ABSENT"),                          cs("PRESENT — denervation sign")],
    [cb("Fasciculations"),   cd("ABSENT"),                          cs("PRESENT")],
    [cb("Recruitment"),      cd("Early recruitment (many small units)"),cs("Reduced recruitment (fewer large units)")],
]
story.append(make_table([cb("EMG Finding"), cd("DMD"), cs("SMA")], rows, CW3, hdr_color=C_INV_HDR))
story.append(hook_box("Hook: Myopathic = small units (fewer fibres work)  |  Neurogenic = large units (surviving neurons compensate)"))
story.append(sp(1))

# 6C NCV
story.append(inv_hdr("  6C.  Nerve Conduction Velocity (NCV)"))
rows = [
    [cb("Motor NCV"),      cd("NORMAL"),                cs("NORMAL")],
    [cb("Sensory NCV"),    cd("NORMAL"),                cs("NORMAL")],
    [cb("Interpretation"), cd("Nerves intact — muscle is the problem"), cs("Nerves intact — neuron BODY is dying (not the nerve)")],
]
story.append(make_table([cb("NCV Finding"), cd("DMD"), cs("SMA")], rows, CW3, hdr_color=C_INV_HDR))
story.append(sp(1))

# 6D Muscle Biopsy — Pattern
story.append(inv_hdr("  6D.  Muscle Biopsy — Gross Histological Pattern"))
rows = [
    [cb("Overall pattern"),  cd("Random scattered necrosis"),         cs("GROUPED fibre atrophy")],
    [cb("Fat infiltration"), cd("YES — late feature"),               cs("NO")],
    [cb("Fibrosis"),         cd("Endomysial fibrosis — YES"),        cs("NO")],
    [cb("Inflammation"),     cd("Mild inflammatory infiltrate"),      cs("NO")],
]
story.append(make_table([cb("Finding"), cd("DMD"), cs("SMA")], rows, CW3, hdr_color=C_INV_HDR))
story.append(sp(1))

# 6E Muscle Biopsy — Fibres
story.append(inv_hdr("  6E.  Muscle Biopsy — Individual Fibre Changes"))
rows = [
    [cb("Fibre necrosis"),       cd("PRESENT — hallmark"),           cs("ABSENT")],
    [cb("Fibre regeneration"),   cd("PRESENT — basophilic fibres"),  cs("ABSENT")],
    [cb("Fibre size variation"), cd("YES — marked"),                 cs("Less prominent")],
    [cb("Type I fibres"),        cd("Variable atrophy"),             cs("GROUPED ATROPHY — hallmark")],
    [cb("Type II fibres"),       cd("Variable"),                     cs("HYPERTROPHIED — compensatory")],
    [cb("Fibre type grouping"),  cd("ABSENT"),                       cs("PRESENT — reinnervation pattern")],
]
story.append(make_table([cb("Fibre Finding"), cd("DMD"), cs("SMA")], rows, CW3, hdr_color=C_INV_HDR))
story.append(sp(1))

# 6F Biopsy — Special Stains
story.append(inv_hdr("  6F.  Muscle Biopsy — Special Stains (IHC)"))
rows = [
    [cb("Dystrophin IHC"),       cd("ABSENT — DIAGNOSTIC"),          cs("PRESENT / Normal")],
    [cb("H&E stain"),            cd("Necrosis + regeneration"),       cs("Grouped atrophy")],
    [cb("Modified Gomori"),      cd("Fibrosis prominent"),            cs("Less prominent")],
    [cb("ATPase stain"),         cd("Fibre size variation"),          cs("Grouped atrophy of Type I")],
]
story.append(make_table([cb("Stain / Test"), cd("DMD"), cs("SMA")], rows, CW3, hdr_color=C_INV_HDR))
story.append(hook_box("Biopsy Exam Rule: Grouped atrophy = SMA (neuron died → muscle regrouped)  |  Dystrophin absent = DMD"))
story.append(sp(1))

# 6G Genetic
story.append(inv_hdr("  6G.  Genetic Testing"))
rows = [
    [cb("Gold standard test"),  cd("MLPA / PCR\n(DMD gene deletion / duplication)"),  cs("MLPA for SMN1\n(copy number = 0 confirms SMA)")],
    [cb("Confirm diagnosis"),   cd("Dystrophin absent on IHC\n+ gene test"),          cs("SMN1 deletion confirmed")],
    [cb("Prenatal test"),       cd("CVS or amniocentesis"),                           cs("CVS or amniocentesis")],
    [cb("Carrier testing"),     cd("Female relatives (XLR)"),                         cs("Both parents (AR)")],
    [cb("Newborn screening"),   cd("CK on dried blood spot"),                         cs("SMN1 copy number")],
]
story.append(make_table([cb("Genetic Test"), cd("DMD"), cs("SMA")], rows, CW3, hdr_color=C_INV_HDR))
story.append(sp(2))

# ═══════════════════════════════════════════════════════════════════
# ── 7. TREATMENT — FULLY EXPANDED, SEQ-READY ──────────────────────
# ═══════════════════════════════════════════════════════════════════
story.append(sec_hdr("7.  TREATMENT  (SEQ / MEQ Ready)", color=colors.HexColor("#EDE0F5"), text_color=C_TX_HDR))
story.append(sp(1))

# 7A Steroids
story.append(tx_hdr("  7A.  Corticosteroids"))
rows = [
    [cb("Used?"),          cd("YES — FIRST LINE in DMD"),              cs("NO — not used in SMA")],
    [cb("Drug of choice"), cd("Deflazacort (preferred)\nor Prednisolone"), cs("—")],
    [cb("Purpose"),        cd("Slows muscle weakness\nDelays wheelchair by ~2 yrs"), cs("—")],
    [cb("Start age"),      cd("~4–5 years of age"),                    cs("—")],
    [cb("Side effects"),   cd("Weight gain, Cushingoid features\nOsteoporosis, Growth delay"), cs("—")],
]
st = Table([[cb("Point"), cd("DMD"), cs("SMA")]] + rows,
           colWidths=CW3, repeatRows=1)
st.setStyle(TableStyle([
    ("BACKGROUND",    (0,0),(-1,0), C_TX_HDR),
    ("TEXTCOLOR",     (0,0),(-1,0), C_WHITE),
    ("FONTNAME",      (0,0),(-1,0), "Helvetica-Bold"),
    ("FONTSIZE",      (0,0),(-1,-1),7),
    ("TOPPADDING",    (0,0),(-1,-1),3),
    ("BOTTOMPADDING", (0,0),(-1,-1),3),
    ("LEFTPADDING",   (0,0),(-1,-1),4),
    ("VALIGN",        (0,0),(-1,-1),"TOP"),
    ("GRID",          (0,0),(-1,-1),0.4, C_BORDER),
    *[("BACKGROUND",  (0,i),(-1,i), C_ROW_ALT) for i in range(1,6,2)],
]))
story += [st, sp(1)]

# 7B Disease-modifying
story.append(tx_hdr("  7B.  Disease-Modifying Therapies"))
dm_hdr = [cb("Drug"), cb("For DMD?"), cb("For SMA?"), cb("Route"), cb("Mechanism")]
dm_rows = [
    [cd("Deflazacort / Prednisolone"),
     cd("YES — 1st line"),
     cs("NO"),
     cn("Oral"),
     cn("Corticosteroid — slows degeneration")],
    [cs("Nusinersen"),
     cd("NO"),
     cs("YES"),
     cn("Intrathecal\n(into spinal fluid)"),
     cn("Antisense oligonucleotide\nIncreases full-length SMN protein from SMN2")],
    [cs("Risdiplam"),
     cd("NO"),
     cs("YES"),
     cn("Oral daily\n(syrup)"),
     cn("SMN2 splicing modifier\nIncreases functional SMN protein")],
    [cs("Onasemnogene\nabeparvovec"),
     cd("NO"),
     cs("YES"),
     cn("IV — ONE TIME\ngene therapy"),
     cn("Delivers functional SMN1 gene\nvia AAV9 vector")],
    [cd("Eteplirsen"),
     cd("YES\n(exon 51 del.)"),
     cs("NO"),
     cn("IV infusion"),
     cn("Exon 51 skipping\nRestores partial dystrophin")],
    [cd("Ataluren"),
     cd("YES\n(nonsense mut.)"),
     cs("NO"),
     cn("Oral"),
     cn("Read-through of premature\nstop codon")],
]
dm_cw = [W*0.22, W*0.12, W*0.10, W*0.16, W*0.40]
dm_t = Table([dm_hdr]+dm_rows, colWidths=dm_cw, repeatRows=1)
dm_t.setStyle(TableStyle([
    ("BACKGROUND",    (0,0),(-1,0), C_TX_HDR),
    ("TEXTCOLOR",     (0,0),(-1,0), C_WHITE),
    ("FONTNAME",      (0,0),(-1,0), "Helvetica-Bold"),
    ("FONTSIZE",      (0,0),(-1,-1),7),
    ("TOPPADDING",    (0,0),(-1,-1),2.5),
    ("BOTTOMPADDING", (0,0),(-1,-1),2.5),
    ("LEFTPADDING",   (0,0),(-1,-1),4),
    ("VALIGN",        (0,0),(-1,-1),"TOP"),
    ("GRID",          (0,0),(-1,-1),0.4, C_BORDER),
    *[("BACKGROUND",  (0,i),(-1,i), C_ROW_ALT) for i in range(1,7,2)],
    # SMA drugs highlight
    ("BACKGROUND",    (0,2),(-1,2), colors.HexColor("#FDECEA")),
    ("BACKGROUND",    (0,3),(-1,3), colors.HexColor("#FDECEA")),
    ("BACKGROUND",    (0,4),(-1,4), colors.HexColor("#FDECEA")),
]))
story += [dm_t]
story.append(hook_box("SMA drugs = NRO: Nusinersen · Risdiplam · Onasemnogene  |  DMD = Deflazacort (steroid) + Eteplirsen/Ataluren (gene-level)"))
story.append(sp(1))

# 7C Cardiac treatment
story.append(tx_hdr("  7C.  Cardiac Treatment"))
rows = [
    [cb("Indication"),        cd("DCM present in ALL DMD patients"),  cs("NOT needed (no cardiac disease)")],
    [cb("ACE Inhibitor"),     cd("YES — start early (enalapril)"),    cs("—")],
    [cb("Beta-blocker"),      cd("YES — carvedilol / metoprolol"),    cs("—")],
    [cb("Diuretics"),         cd("YES — for heart failure / oedema"), cs("—")],
    [cb("When to start"),     cd("From ~10 yrs or when DCM detected"),cs("—")],
]
ct = Table([[cb("Drug / Point"), cd("DMD"), cs("SMA")]] + rows, colWidths=CW3, repeatRows=1)
ct.setStyle(TableStyle([
    ("BACKGROUND",    (0,0),(-1,0), C_TX_HDR),
    ("TEXTCOLOR",     (0,0),(-1,0), C_WHITE),
    ("FONTNAME",      (0,0),(-1,0), "Helvetica-Bold"),
    ("FONTSIZE",      (0,0),(-1,-1),7),
    ("TOPPADDING",    (0,0),(-1,-1),3),
    ("BOTTOMPADDING", (0,0),(-1,-1),3),
    ("LEFTPADDING",   (0,0),(-1,-1),4),
    ("VALIGN",        (0,0),(-1,-1),"TOP"),
    ("GRID",          (0,0),(-1,-1),0.4, C_BORDER),
    *[("BACKGROUND",  (0,i),(-1,i), C_ROW_ALT) for i in range(1,6,2)],
]))
story += [ct, sp(1)]

# 7D Respiratory treatment
story.append(tx_hdr("  7D.  Respiratory Treatment"))
rows = [
    [cb("Non-invasive ventilation (NIV)"),cd("YES — when FVC drops\n(BiPAP / CPAP)"),       cs("YES — Types I–II\nearly and essential")],
    [cb("Tracheostomy"),                  cd("Considered very late"),                        cs("Type I — sometimes needed")],
    [cb("Cough assist device"),           cd("YES — for secretion clearance"),               cs("YES — Type I")],
    [cb("Chest physiotherapy"),           cd("YES"),                                         cs("YES")],
]
rt = Table([[cb("Respiratory Rx"), cd("DMD"), cs("SMA")]] + rows, colWidths=CW3, repeatRows=1)
rt.setStyle(TableStyle([
    ("BACKGROUND",    (0,0),(-1,0), C_TX_HDR),
    ("TEXTCOLOR",     (0,0),(-1,0), C_WHITE),
    ("FONTNAME",      (0,0),(-1,0), "Helvetica-Bold"),
    ("FONTSIZE",      (0,0),(-1,-1),7),
    ("TOPPADDING",    (0,0),(-1,-1),3),
    ("BOTTOMPADDING", (0,0),(-1,-1),3),
    ("LEFTPADDING",   (0,0),(-1,-1),4),
    ("VALIGN",        (0,0),(-1,-1),"TOP"),
    ("GRID",          (0,0),(-1,-1),0.4, C_BORDER),
    *[("BACKGROUND",  (0,i),(-1,i), C_ROW_ALT) for i in range(1,5,2)],
]))
story += [rt, sp(1)]

# 7E Orthopaedic
story.append(tx_hdr("  7E.  Orthopaedic / Supportive Treatment"))
rows = [
    [cb("Spinal fusion"),         cd("YES — for progressive scoliosis"),  cs("YES — Types II–III")],
    [cb("Achilles tendon release"),cd("YES — for contractures"),          cs("Less common")],
    [cb("Physiotherapy"),         cd("Maintain ambulation as long as possible"), cs("Prevent contractures, positioning")],
    [cb("Nutritional support"),   cd("For steroid side effects\n(weight/growth monitoring)"), cs("Gastrostomy tube — Type I\n(feeding difficulty)")],
    [cb("Genetic counselling"),   cd("Female carriers — prenatal testing"), cs("Both parents — prenatal / NBS")],
]
ot = Table([[cb("Support"), cd("DMD"), cs("SMA")]] + rows, colWidths=CW3, repeatRows=1)
ot.setStyle(TableStyle([
    ("BACKGROUND",    (0,0),(-1,0), C_TX_HDR),
    ("TEXTCOLOR",     (0,0),(-1,0), C_WHITE),
    ("FONTNAME",      (0,0),(-1,0), "Helvetica-Bold"),
    ("FONTSIZE",      (0,0),(-1,-1),7),
    ("TOPPADDING",    (0,0),(-1,-1),3),
    ("BOTTOMPADDING", (0,0),(-1,-1),3),
    ("LEFTPADDING",   (0,0),(-1,-1),4),
    ("VALIGN",        (0,0),(-1,-1),"TOP"),
    ("GRID",          (0,0),(-1,-1),0.4, C_BORDER),
    *[("BACKGROUND",  (0,i),(-1,i), C_ROW_ALT) for i in range(1,6,2)],
]))
story += [ot, sp(2)]

# ── 8. SMA TYPES ─────────────────────────────────────────────────────────────
story.append(sec_hdr("8.  SMA TYPES — One Glance"))
sma_hdr = [cb("Type"), cb("Alias / Name"), cb("Onset Age"), cb("Best Milestone EVER"), cb("Survival")]
sma_rows = [
    [cb("0"),  cn("Prenatal / Severe"),        cn("In womb"),        cn("NONE — resp. failure at birth"), cn("Weeks")],
    [cb("I"),  cd("Werdnig-Hoffmann"),          cn("<6 months"),      cn("Cannot sit"),                   cn("<1 year")],
    [cb("II"), cn("Intermediate SMA"),          cn("7–18 months"),    cn("Sits — cannot walk"),            cn("3rd decade")],
    [cb("III"),cn("Kugelberg-Welander"),        cn(">18 months"),     cn("Walks (may lose later)"),        cn("Normal")],
    [cb("IV"), cn("Adult SMA"),                 cn("20s–30s"),        cn("Ambulatory"),                    cn("Normal")],
]
sma_cw = [W*0.07, W*0.24, W*0.15, W*0.30, W*0.24]
sma_t = Table([sma_hdr]+sma_rows, colWidths=sma_cw)
sma_t.setStyle(TableStyle([
    ("BACKGROUND",    (0,0),(-1,0), C_SMA),
    ("TEXTCOLOR",     (0,0),(-1,0), C_WHITE),
    ("FONTNAME",      (0,0),(-1,0), "Helvetica-Bold"),
    ("FONTSIZE",      (0,0),(-1,-1),7),
    ("TOPPADDING",    (0,0),(-1,-1),2.5),
    ("BOTTOMPADDING", (0,0),(-1,-1),2.5),
    ("LEFTPADDING",   (0,0),(-1,-1),4),
    ("GRID",          (0,0),(-1,-1),0.4, C_BORDER),
    ("BACKGROUND",    (0,2),(-1,2), C_ROW_ALT),
    ("BACKGROUND",    (0,4),(-1,4), C_ROW_ALT),
    ("BACKGROUND",    (0,1),(-1,1), colors.HexColor("#FDECEA")),  # Type I highlight
]))
story += [sma_t]
story.append(hook_box("Rule: Type I = never sits  |  Type II = sits only  |  Type III = walks  |  Type IV = adult onset"))
story.append(sp(2))

# ── 9. DMD STAGES ────────────────────────────────────────────────────────────
story.append(sec_hdr("9.  DMD DISEASE STAGES"))
dmd_rows = [
    [cb("Silent"),       cn("0–2 yrs"),      cn("CK already sky-high — child looks COMPLETELY NORMAL")],
    [cb("Early"),        cn("2–5 yrs"),      cn("Toe walking · Frequent falls · Gower's sign · Calf hypertrophy appears")],
    [cb("Progressive"),  cn("5–10 yrs"),     cn("Proximal weakness · Lumbar lordosis · Scoliosis begins · CK still very high")],
    [cb("Wheelchair"),   cd("10–15 yrs"),    cd("LOSS OF AMBULATION  ← MOST TESTED EXAM FACT")],
    [cb("Terminal"),     cn("Late teens–20s"),cn("DCM + Respiratory failure = Primary cause of death")],
]
dmd_t = Table([[cb("Stage"), cb("Age"), cb("Key Event / Landmark")]]+dmd_rows,
              colWidths=[W*0.14, W*0.13, W*0.73])
dmd_t.setStyle(TableStyle([
    ("BACKGROUND",    (0,0),(-1,0), C_DMD),
    ("TEXTCOLOR",     (0,0),(-1,0), C_WHITE),
    ("FONTNAME",      (0,0),(-1,0), "Helvetica-Bold"),
    ("FONTSIZE",      (0,0),(-1,-1),7),
    ("TOPPADDING",    (0,0),(-1,-1),2.5),
    ("BOTTOMPADDING", (0,0),(-1,-1),2.5),
    ("LEFTPADDING",   (0,0),(-1,-1),4),
    ("GRID",          (0,0),(-1,-1),0.4, C_BORDER),
    ("BACKGROUND",    (0,2),(-1,2), C_ROW_ALT),
    ("BACKGROUND",    (0,4),(-1,4), C_YELLOW),  # wheelchair
]))
story += [dmd_t, sp(2)]

# ── 10. MNEMONICS ─────────────────────────────────────────────────────────────
story.append(sec_hdr("10.  MEMORY MNEMONICS"))
m1 = Table([
    [Paragraph("DMD = \"3C + X + G\"", PS("m1h",8,bold=True,color=C_DMD))],
    [Table([
        [cb("C"), cn("Calf pseudohypertrophy — big but WEAK")],
        [cb("C"), cn("Cardiomyopathy (DCM) — universal")],
        [cb("C"), cn("CK — sky high >10× normal")],
        [cb("X"), cn("X-linked — males ONLY")],
        [cb("G"), cn("Gower's sign — hands climb thighs")],
    ], colWidths=[W*0.04, W*0.43])],
], colWidths=[W*0.47])
m1.setStyle(TableStyle([
    ("BACKGROUND",(0,0),(-1,0),colors.HexColor("#D6E4F0")),
    ("BACKGROUND",(0,1),(-1,1),colors.HexColor("#EBF5FB")),
    ("TOPPADDING",(0,0),(-1,-1),3),("BOTTOMPADDING",(0,0),(-1,-1),3),
    ("LEFTPADDING",(0,0),(-1,-1),5),
    ("BOX",(0,0),(-1,-1),0.5,C_BORDER),
]))

m2 = Table([
    [Paragraph("SMA = \"FANGS\"", PS("m2h",8,bold=True,color=C_SMA))],
    [Table([
        [cb("F"), cn("Fasciculations — tongue esp. Type I")],
        [cb("A"), cn("Anterior horn cell death — LMN")],
        [cb("N"), cn("Normal IQ + Normal sensation")],
        [cb("G"), cn("Grouped atrophy on biopsy")],
        [cb("S"), cn("SMN1 deleted — Chr 5q13")],
    ], colWidths=[W*0.04, W*0.43])],
], colWidths=[W*0.47])
m2.setStyle(TableStyle([
    ("BACKGROUND",(0,0),(-1,0),colors.HexColor("#FDECEA")),
    ("BACKGROUND",(0,1),(-1,1),colors.HexColor("#FEF9F9")),
    ("TOPPADDING",(0,0),(-1,-1),3),("BOTTOMPADDING",(0,0),(-1,-1),3),
    ("LEFTPADDING",(0,0),(-1,-1),5),
    ("BOX",(0,0),(-1,-1),0.5,C_BORDER),
]))

mnem_outer = Table([[m1, Spacer(W*0.06,1), m2]], colWidths=[W*0.47, W*0.06, W*0.47])
mnem_outer.setStyle(TableStyle([("VALIGN",(0,0),(-1,-1),"TOP")]))
story += [mnem_outer, sp(2)]

# ── 11. MCQ RAPID FIRE ────────────────────────────────────────────────────────
story.append(sec_hdr("11.  MCQ / SEQ / MEQ RAPID FIRE"))
mcq_items = [
    ("Firm calves + proximal weakness + 4yr boy",                      "DMD",        C_DMD),
    ("Child uses hands to climb up legs to stand",                     "DMD — Gower's sign", C_DMD),
    ("CK = 20,000 U/L in a toddler",                                  "DMD",        C_DMD),
    ("Dilated cardiomyopathy + muscle weakness in a child",            "DMD",        C_DMD),
    ("Low IQ + proximal weakness in a boy",                            "DMD",        C_DMD),
    ("Dystrophin absent on IHC",                                       "DMD",        C_DMD),
    ("Deflazacort prescribed for a child with muscle disease",         "DMD",        C_DMD),
    ("Myopathic EMG + massively raised CK",                           "DMD",        C_DMD),
    ("Floppy infant + tongue fasciculations + absent reflexes",        "SMA Type I", C_SMA),
    ("Cannot sit at 9 months + normal CK + absent DTRs",              "SMA Type I", C_SMA),
    ("Both sexes affected + AR + sits but NEVER walks",               "SMA Type II",C_SMA),
    ("Teenager walks but has proximal leg weakness, normal CK",        "SMA Type III",C_SMA),
    ("Grouped atrophy of type I fibres on biopsy",                    "SMA",        C_SMA),
    ("Neurogenic EMG + normal CK + floppy baby",                      "SMA",        C_SMA),
    ("Pure motor + normal IQ + normal sensation + AR inheritance",    "SMA",        C_SMA),
    ("Nusinersen / Risdiplam prescribed",                             "SMA",        C_SMA),
    ("Reduced fetal movements + hypotonia at birth + resp failure",   "SMA Type 0", C_SMA),
    ("Normal CK + no sensation loss + absent reflexes + infant",      "SMA",        C_SMA),
]
mcq_data = [[cb("If question / stem says..."), cb("Answer")]]
for q, a, c in mcq_items:
    mcq_data.append([
        Paragraph(q, PS("mq",7)),
        Paragraph(a, PS("ma",7,bold=True,color=c))
    ])
mcq_t = Table(mcq_data, colWidths=[W*0.70, W*0.30], repeatRows=1)
mcq_t.setStyle(TableStyle([
    ("BACKGROUND",    (0,0),(-1,0), colors.HexColor("#2C3E50")),
    ("TEXTCOLOR",     (0,0),(-1,0), C_WHITE),
    ("FONTNAME",      (0,0),(-1,0), "Helvetica-Bold"),
    ("FONTSIZE",      (0,0),(-1,-1),7),
    ("TOPPADDING",    (0,0),(-1,-1),2),
    ("BOTTOMPADDING", (0,0),(-1,-1),2),
    ("LEFTPADDING",   (0,0),(-1,-1),4),
    ("VALIGN",        (0,0),(-1,-1),"MIDDLE"),
    ("GRID",          (0,0),(-1,-1),0.3, C_BORDER),
    *[("BACKGROUND",  (0,i),(-1,i), C_ROW_ALT) for i in range(1,len(mcq_data),2)],
]))
story += [mcq_t, sp(2)]

# ── FOOTER ─────────────────────────────────────────────────────────────────────
story.append(HRFlowable(width=W, thickness=0.5, color=C_BORDER))
story.append(sp(1))
story.append(Paragraph(
    "Sources: Tietz Textbook of Laboratory Medicine 7e  |  "
    "Bradley & Daroff's Neurology in Clinical Practice  |  "
    "Campbell's Operative Orthopaedics 15e 2026   —   For educational use · Final MBBS Yr 5",
    foot_s
))

doc.build(story)
print("PDF built:", OUTPUT)