#!/usr/bin/env python3
"""NEET PG Surgery Rapid Revision PDF Generator"""

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

OUTPUT = "/home/daytona/workspace/surgery-neet-pg/NEET_PG_Surgery_Revision.pdf"

# ── Colour palette ──────────────────────────────────────────────────────────
C_NAVY   = colors.HexColor("#1a2e5a")
C_TEAL   = colors.HexColor("#0d7377")
C_ORANGE = colors.HexColor("#e07b3a")
C_RED    = colors.HexColor("#c0392b")
C_GREEN  = colors.HexColor("#1e8449")
C_YELLOW = colors.HexColor("#f4d03f")
C_LIGHT  = colors.HexColor("#eaf4fb")
C_LGREEN = colors.HexColor("#eafaf1")
C_LRED   = colors.HexColor("#fdf2f2")
C_LYELLOW= colors.HexColor("#fefde7")
C_LGREY  = colors.HexColor("#f8f9fa")
C_WHITE  = colors.white

# ── Styles ───────────────────────────────────────────────────────────────────
base = getSampleStyleSheet()

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

COVER_TITLE = S("CoverTitle", fontSize=32, textColor=C_WHITE,
                alignment=TA_CENTER, spaceAfter=6, fontName="Helvetica-Bold")
COVER_SUB   = S("CoverSub",   fontSize=16, textColor=C_YELLOW,
                alignment=TA_CENTER, spaceAfter=4, fontName="Helvetica-Bold")
COVER_INFO  = S("CoverInfo",  fontSize=11, textColor=C_WHITE,
                alignment=TA_CENTER, spaceAfter=3)

CH_TITLE = S("ChTitle", fontSize=20, textColor=C_WHITE,
             fontName="Helvetica-Bold", alignment=TA_LEFT,
             spaceAfter=4, spaceBefore=2)
CH_SUB   = S("ChSub",   fontSize=13, textColor=C_TEAL,
             fontName="Helvetica-Bold", spaceBefore=10, spaceAfter=3)
CH_SUB2  = S("ChSub2",  fontSize=11, textColor=C_NAVY,
             fontName="Helvetica-Bold", spaceBefore=6, spaceAfter=2)

BODY     = S("Body",    fontSize=9.5, leading=14, spaceAfter=3, alignment=TA_JUSTIFY)
BULLET   = S("Bullet",  fontSize=9.5, leading=14, leftIndent=14, spaceAfter=2,
             bulletIndent=4)
PYQ_S    = S("PYQ",     fontSize=9,   textColor=C_NAVY, leading=13,
             leftIndent=8, fontName="Helvetica-Oblique")
IMP_S    = S("ImpBox",  fontSize=9,   textColor=C_RED,  leading=13,
             fontName="Helvetica-Bold", leftIndent=8)
TIP_S    = S("Tip",     fontSize=9,   textColor=C_GREEN, leading=13,
             leftIndent=8, fontName="Helvetica-Bold")
BOLD_S   = S("BoldS",   fontSize=9.5, fontName="Helvetica-Bold", leading=14)
TOC_S    = S("TOC",     fontSize=11,  leading=18, leftIndent=10)

def header_table(text, bg=C_NAVY, fg=C_WHITE, fontsize=16):
    """Full-width coloured header band."""
    st = ParagraphStyle("ht", fontSize=fontsize, textColor=fg,
                        fontName="Helvetica-Bold", alignment=TA_LEFT, leading=fontsize+4)
    t = Table([[Paragraph(text, st)]], colWidths=[170*mm])
    t.setStyle(TableStyle([
        ("BACKGROUND", (0,0), (-1,-1), bg),
        ("TOPPADDING",    (0,0), (-1,-1), 6),
        ("BOTTOMPADDING", (0,0), (-1,-1), 6),
        ("LEFTPADDING",   (0,0), (-1,-1), 10),
        ("RIGHTPADDING",  (0,0), (-1,-1), 6),
    ]))
    return t

def box_table(rows_data, bg=C_LIGHT, border_color=C_TEAL, col_widths=None):
    """Simple info box."""
    if col_widths is None:
        col_widths = [170*mm]
    t = Table(rows_data, colWidths=col_widths)
    t.setStyle(TableStyle([
        ("BACKGROUND",    (0,0), (-1,-1), bg),
        ("BOX",           (0,0), (-1,-1), 1.5, border_color),
        ("TOPPADDING",    (0,0), (-1,-1), 5),
        ("BOTTOMPADDING", (0,0), (-1,-1), 5),
        ("LEFTPADDING",   (0,0), (-1,-1), 8),
        ("RIGHTPADDING",  (0,0), (-1,-1), 8),
        ("VALIGN",        (0,0), (-1,-1), "TOP"),
    ]))
    return t

def pyq_box(questions):
    """Orange-bordered PYQ box."""
    rows = []
    rows.append([Paragraph("★ PYQ / FREQUENTLY ASKED", S("ph", fontSize=9,
                  fontName="Helvetica-Bold", textColor=C_ORANGE))])
    for q in questions:
        rows.append([Paragraph("• " + q, PYQ_S)])
    t = Table(rows, colWidths=[170*mm])
    t.setStyle(TableStyle([
        ("BACKGROUND",    (0,0), (-1,-1), C_LYELLOW),
        ("BOX",           (0,0), (-1,-1), 2,   C_ORANGE),
        ("LINEBELOW",     (0,0), (0,0),   0.5, C_ORANGE),
        ("TOPPADDING",    (0,0), (-1,-1), 4),
        ("BOTTOMPADDING", (0,0), (-1,-1), 4),
        ("LEFTPADDING",   (0,0), (-1,-1), 8),
        ("RIGHTPADDING",  (0,0), (-1,-1), 8),
    ]))
    return t

def imp_box(points):
    """Red high-importance box."""
    rows = [[Paragraph("🔴 HIGH YIELD / REMEMBER", S("rh", fontSize=9,
              fontName="Helvetica-Bold", textColor=C_RED))]]
    for p in points:
        rows.append([Paragraph("► " + p, IMP_S)])
    t = Table(rows, colWidths=[170*mm])
    t.setStyle(TableStyle([
        ("BACKGROUND",    (0,0), (-1,-1), C_LRED),
        ("BOX",           (0,0), (-1,-1), 2,   C_RED),
        ("LINEBELOW",     (0,0), (0,0),   0.5, C_RED),
        ("TOPPADDING",    (0,0), (-1,-1), 4),
        ("BOTTOMPADDING", (0,0), (-1,-1), 4),
        ("LEFTPADDING",   (0,0), (-1,-1), 8),
        ("RIGHTPADDING",  (0,0), (-1,-1), 8),
    ]))
    return t

def tip_box(points):
    """Green mnemonic/tip box."""
    rows = [[Paragraph("💡 MNEMONIC / TIP", S("gh", fontSize=9,
              fontName="Helvetica-Bold", textColor=C_GREEN))]]
    for p in points:
        rows.append([Paragraph("✓ " + p, TIP_S)])
    t = Table(rows, colWidths=[170*mm])
    t.setStyle(TableStyle([
        ("BACKGROUND",    (0,0), (-1,-1), C_LGREEN),
        ("BOX",           (0,0), (-1,-1), 2,   C_GREEN),
        ("LINEBELOW",     (0,0), (0,0),   0.5, C_GREEN),
        ("TOPPADDING",    (0,0), (-1,-1), 4),
        ("BOTTOMPADDING", (0,0), (-1,-1), 4),
        ("LEFTPADDING",   (0,0), (-1,-1), 8),
        ("RIGHTPADDING",  (0,0), (-1,-1), 8),
    ]))
    return t

def two_col_table(left_data, right_data, header_left="", header_right=""):
    """Two-column comparison table."""
    col_w = [83*mm, 83*mm]
    rows = []
    if header_left or header_right:
        hs = S("th", fontSize=9, fontName="Helvetica-Bold",
               textColor=C_WHITE, alignment=TA_CENTER)
        rows.append([Paragraph(header_left, hs), Paragraph(header_right, hs)])
    max_len = max(len(left_data), len(right_data))
    for i in range(max_len):
        l = Paragraph("• " + left_data[i],  BULLET) if i < len(left_data)  else Paragraph("", BODY)
        r = Paragraph("• " + right_data[i], BULLET) if i < len(right_data) else Paragraph("", BODY)
        rows.append([l, r])
    style = [
        ("BACKGROUND",    (0,0), (-1,-1), C_LGREY),
        ("BOX",           (0,0), (-1,-1), 1, C_TEAL),
        ("INNERGRID",     (0,0), (-1,-1), 0.5, colors.HexColor("#b0bec5")),
        ("TOPPADDING",    (0,0), (-1,-1), 4),
        ("BOTTOMPADDING", (0,0), (-1,-1), 4),
        ("LEFTPADDING",   (0,0), (-1,-1), 6),
        ("RIGHTPADDING",  (0,0), (-1,-1), 6),
        ("VALIGN",        (0,0), (-1,-1), "TOP"),
    ]
    if header_left or header_right:
        style += [("BACKGROUND", (0,0), (1,0), C_NAVY),
                  ("FONTNAME",   (0,0), (1,0), "Helvetica-Bold")]
    t = Table(rows, colWidths=col_w)
    t.setStyle(TableStyle(style))
    return t

def data_table(header_row, data_rows, col_widths=None):
    """Generic data table with header."""
    if col_widths is None:
        n = len(header_row)
        col_widths = [170*mm/n]*n
    hs = S("dth", fontSize=9, fontName="Helvetica-Bold", textColor=C_WHITE, alignment=TA_CENTER)
    rows = [[Paragraph(h, hs) for h in header_row]]
    bs = S("dtr", fontSize=9, leading=13)
    for row in data_rows:
        rows.append([Paragraph(str(c), bs) for c in row])
    style = [
        ("BACKGROUND",    (0,0), (-1,0),  C_NAVY),
        ("BACKGROUND",    (0,1), (-1,-1), C_LGREY),
        ("ROWBACKGROUNDS",(0,1), (-1,-1), [C_WHITE, C_LGREY]),
        ("BOX",           (0,0), (-1,-1), 1,   C_NAVY),
        ("INNERGRID",     (0,0), (-1,-1), 0.5, colors.HexColor("#b0bec5")),
        ("TOPPADDING",    (0,0), (-1,-1), 4),
        ("BOTTOMPADDING", (0,0), (-1,-1), 4),
        ("LEFTPADDING",   (0,0), (-1,-1), 6),
        ("RIGHTPADDING",  (0,0), (-1,-1), 6),
        ("VALIGN",        (0,0), (-1,-1), "TOP"),
    ]
    t = Table(rows, colWidths=col_widths)
    t.setStyle(TableStyle(style))
    return t

sp  = lambda h=6: Spacer(1, h)
hr  = lambda: HRFlowable(width="100%", thickness=0.5, color=C_TEAL, spaceAfter=4, spaceBefore=4)

# ════════════════════════════════════════════════════════════════════════════
# CONTENT BUILDER
# ════════════════════════════════════════════════════════════════════════════
def build_story():
    story = []

    # ── COVER PAGE ────────────────────────────────────────────────────────
    cover_bg = Table(
        [[Paragraph("NEET PG", COVER_TITLE)],
         [Paragraph("SURGERY", S("cs2", fontSize=44, textColor=C_YELLOW,
                                  fontName="Helvetica-Bold", alignment=TA_CENTER))],
         [Paragraph("RAPID REVISION NOTES", COVER_SUB)],
         [sp(8)],
         [Paragraph("2-Day Complete Surgery Revision", COVER_INFO)],
         [Paragraph("High-Yield • PYQs • Mnemonics • Clinical Algorithms", COVER_INFO)],
         [sp(4)],
         [Paragraph("Topics: General Surgery • Trauma • GI • Hepatobiliary • Breast • Thyroid •", COVER_INFO)],
         [Paragraph("Hernia • Urology • Burns • Vascular • Paediatric Surgery • Oncology", COVER_INFO)],
         [sp(20)],
         [Paragraph("Prepared for NEET PG / INI-CET / FMGE  |  July 2026", COVER_INFO)],
        ],
        colWidths=[190*mm]
    )
    cover_bg.setStyle(TableStyle([
        ("BACKGROUND",    (0,0), (-1,-1), C_NAVY),
        ("TOPPADDING",    (0,0), (-1,-1), 12),
        ("BOTTOMPADDING", (0,0), (-1,-1), 12),
        ("LEFTPADDING",   (0,0), (-1,-1), 20),
        ("RIGHTPADDING",  (0,0), (-1,-1), 20),
    ]))
    story.append(cover_bg)
    story.append(PageBreak())

    # ── TABLE OF CONTENTS ─────────────────────────────────────────────────
    story.append(header_table("  TABLE OF CONTENTS", C_TEAL))
    story.append(sp(6))
    toc_items = [
        ("1", "General Surgery Principles", "Wound Healing • Shock • Fluids • Sterilisation • Sutures"),
        ("2", "Trauma & Emergency Surgery", "ATLS • Burns • Head Injury • Abdominal Trauma"),
        ("3", "Gastrointestinal Surgery", "Appendicitis • Peptic Ulcer • Intestinal Obstruction • GI Cancers"),
        ("4", "Hepatobiliary & Pancreas", "Gallstones • Pancreatitis • Liver Abscess • Jaundice"),
        ("5", "Breast Surgery",            "Breast Lumps • Carcinoma • Staging • Operations"),
        ("6", "Thyroid & Parathyroid",      "Goitre • Carcinoma • Hyperthyroidism • Parathyroid"),
        ("7", "Hernia",                     "Inguinal • Femoral • Special Hernias • Complications"),
        ("8", "Urology",                    "Renal Stones • BPH • Bladder CA • Testicular Torsion"),
        ("9", "Vascular Surgery",           "AAA • DVT • Varicose Veins • Peripheral Vascular Disease"),
        ("10","Paediatric Surgery",         "Pyloric Stenosis • Intussusception • Hirschsprung • CDH"),
        ("11","Surgical Oncology",          "Staging • TNM • Tumour Markers • Biopsy Types"),
        ("12","Surgical Instruments & Procedures", "Key Instruments • Drains • Anastomosis • Laparoscopy"),
    ]
    for num, title, subtopics in toc_items:
        row = [[Paragraph(f"<b>{num}.</b>  <b>{title}</b>", TOC_S),
                Paragraph(f"<i>{subtopics}</i>", S("ts", fontSize=9, textColor=colors.grey, leading=14))]]
        t = Table(row, colWidths=[65*mm, 105*mm])
        t.setStyle(TableStyle([
            ("TOPPADDING",    (0,0), (-1,-1), 3),
            ("BOTTOMPADDING", (0,0), (-1,-1), 3),
            ("LEFTPADDING",   (0,0), (-1,-1), 4),
            ("LINEBELOW",     (0,0), (-1,-1), 0.3, colors.HexColor("#cfd8dc")),
        ]))
        story.append(t)
    story.append(PageBreak())

    # ════════════════════════════════════════════════════════════════════════
    # CHAPTER 1 - GENERAL SURGERY PRINCIPLES
    # ════════════════════════════════════════════════════════════════════════
    story.append(header_table("  CHAPTER 1 - GENERAL SURGERY PRINCIPLES"))
    story.append(sp(8))

    story.append(Paragraph("1.1  WOUND HEALING", CH_SUB))
    story.append(data_table(
        ["Type", "Definition", "Examples", "Healing Time"],
        [
            ["Primary (1st) Intention", "Clean wound closed within 6-8 hrs; edges approximated", "Surgical incisions, sutured lacerations", "7-10 days"],
            ["Secondary (2nd) Intention", "Wound left open; heals by granulation, contraction, epithelialisation", "Infected wounds, ulcers, abscesses", "Weeks-months"],
            ["Tertiary (3rd) Intention\n(Delayed 1st)", "Wound initially left open; closed later after infection controlled", "Contaminated wounds", "Variable"],
        ],
        col_widths=[38*mm, 48*mm, 52*mm, 30*mm]
    ))
    story.append(sp(6))
    story.append(Paragraph("Phases of Wound Healing", CH_SUB2))
    story.append(data_table(
        ["Phase", "Timing", "Key Events", "Cells Involved"],
        [
            ["Haemostasis", "Immediate (0-hrs)", "Vasoconstriction, platelet plug, clot formation, fibrin mesh", "Platelets"],
            ["Inflammation", "Day 1-4", "Vasodilation, WBC migration, phagocytosis, debridement", "Neutrophils (1st 48h), then Macrophages"],
            ["Proliferation", "Day 4 - 3 weeks", "Fibroblast migration, collagen synthesis (Type III first), angiogenesis, granulation tissue", "Fibroblasts, Endothelial cells"],
            ["Remodelling/Maturation", "3 wks - 2 yrs", "Type III collagen replaced by Type I, wound contracts, scar matures. Max tensile strength 80% at 3 months", "Myofibroblasts"],
        ],
        col_widths=[36*mm, 28*mm, 72*mm, 34*mm]
    ))
    story.append(sp(4))
    story.append(imp_box([
        "Collagen TYPE III produced first in granulation tissue -> replaced by Type I in remodelling",
        "Max wound tensile strength = 80% of normal (never 100%) - reached at ~3 months",
        "MACROPHAGES are the most important cells for wound healing overall",
        "Neutrophils dominate in first 48 hours; Macrophages take over after 48-72 hours",
        "Vitamin C deficiency -> poor collagen synthesis -> wound dehiscence (scurvy)",
        "Zinc deficiency -> impaired wound healing; Zinc is cofactor for DNA polymerase",
    ]))
    story.append(sp(4))
    story.append(pyq_box([
        "Q: Which type of collagen is first synthesised during wound healing? Ans: Type III (later replaced by Type I)",
        "Q: Maximum tensile strength of a healed wound is? Ans: 80% of original tissue strength",
        "Q: Most important cell in wound healing? Ans: Macrophage",
        "Q: Which vitamin is essential for collagen cross-linking in wound healing? Ans: Vitamin C (ascorbic acid)",
        "Q: Wound contraction is mediated by? Ans: Myofibroblasts",
    ]))
    story.append(sp(6))

    story.append(Paragraph("1.2  SHOCK", CH_SUB))
    story.append(data_table(
        ["Class", "Blood Loss", "% Blood Vol", "HR", "BP", "RR", "Urine Output", "Mental Status"],
        [
            ["Class I",   "<750 mL",    "<15%",  "<100", "Normal",   "14-20", ">30 mL/hr",  "Normal/anxious"],
            ["Class II",  "750-1500",   "15-30%", "100-120","Normal","20-30", "20-30 mL/hr","Anxious"],
            ["Class III", "1500-2000",  "30-40%", "120-140","Decreased","30-40","5-15 mL/hr","Confused"],
            ["Class IV",  ">2000 mL",   ">40%",   ">140",  "Very low","  >35", "<5 mL/hr",  "Lethargic/comatose"],
        ],
        col_widths=[18*mm,22*mm,18*mm,18*mm,22*mm,16*mm,22*mm,32*mm]
    ))
    story.append(sp(4))
    story.append(tip_box([
        "MNEMONIC for Shock Types: H-D-N-S = Hypovolaemic, Distributive (Septic/Anaphylactic/Neurogenic), Neurogenic, Spinal",
        "Obstructive shock: Tension pneumothorax, cardiac tamponade, massive PE",
        "Neurogenic shock: Bradycardia + Hypotension (unlike other shock types with tachycardia)",
        "First line for hypovolaemic shock: IV crystalloid (Ringer's Lactate) - 2 large bore cannulae",
    ]))
    story.append(sp(4))
    story.append(pyq_box([
        "Q: Neurogenic shock is characterised by? Ans: Bradycardia + hypotension (warm peripheries)",
        "Q: Best initial fluid for haemorrhagic shock? Ans: Ringer's Lactate (Hartmann's solution)",
        "Q: Urine output of <0.5 mL/kg/hr indicates? Ans: Inadequate tissue perfusion / shock",
        "Q: Beck's triad in cardiac tamponade? Ans: Hypotension, JVD (raised JVP), muffled heart sounds",
    ]))
    story.append(PageBreak())

    story.append(Paragraph("1.3  SURGICAL SITE INFECTION (SSI) & WOUND CLASSIFICATION", CH_SUB))
    story.append(data_table(
        ["Wound Class", "Definition", "Infection Risk"],
        [
            ["Class I - Clean",           "Elective, no GI/GU/Respiratory tract entered, no inflammation", "1-5%"],
            ["Class II - Clean-Contaminated", "GI/GU/Respiratory entered under controlled conditions", "5-15%"],
            ["Class III - Contaminated",  "Open fresh traumatic wound, gross spillage from GI tract", "15-30%"],
            ["Class IV - Dirty/Infected", "Old traumatic wound, perforated viscus, clinical infection present", ">30%"],
        ],
        col_widths=[52*mm, 88*mm, 28*mm]
    ))
    story.append(sp(4))
    story.append(pyq_box([
        "Q: Appendicectomy for non-perforated appendicitis = which wound class? Ans: Class II (Clean-Contaminated)",
        "Q: Elective cholecystectomy wound class? Ans: Class II",
        "Q: Prophylactic antibiotic for clean surgery? Ans: Not required routinely (Class I)",
        "Q: Most common organism in SSI? Ans: Staphylococcus aureus",
    ]))

    story.append(Paragraph("1.4  SUTURES & SURGICAL MATERIALS", CH_SUB))
    story.append(data_table(
        ["Suture", "Type", "Uses", "Absorption"],
        [
            ["Catgut (Plain)",    "Absorbable, natural",    "Mucosa, ligation",              "10-14 days"],
            ["Chromic Catgut",    "Absorbable, natural",    "GI, GU tracts",                 "21-28 days"],
            ["Vicryl (Polyglactin)", "Absorbable, synthetic","Fascial closure, subcutaneous","56-70 days"],
            ["PDS (Polydioxanone)","Absorbable, synthetic", "Abdominal wall, tendon repair", "180+ days"],
            ["Prolene (Polypropylene)","Non-absorbable, synthetic","Vascular anastomosis, hernia","Permanent"],
            ["Nylon (Ethilon)",   "Non-absorbable, synthetic","Skin closure, tendons",       "Permanent"],
            ["Silk",              "Non-absorbable, natural","Ligation, skin",                "Permanent (but degrades)"],
        ],
        col_widths=[42*mm, 40*mm, 55*mm, 31*mm]
    ))
    story.append(sp(4))
    story.append(imp_box([
        "Strongest suture per diameter: Prolene > Nylon > Silk",
        "Best suture for vascular anastomosis: Prolene (monofilament, non-thrombogenic)",
        "Absorbable suture NOT to use in infected field: Catgut (rapid degradation)",
        "DELAYED ABSORBABLE sutures (PDS, Maxon) preferred for abdominal wall closure",
    ]))
    story.append(PageBreak())

    # ════════════════════════════════════════════════════════════════════════
    # CHAPTER 2 - TRAUMA & BURNS
    # ════════════════════════════════════════════════════════════════════════
    story.append(header_table("  CHAPTER 2 - TRAUMA & EMERGENCY SURGERY"))
    story.append(sp(8))

    story.append(Paragraph("2.1  BURNS", CH_SUB))
    story.append(Paragraph("Rule of Nines (Wallace's Rule) - Adult", CH_SUB2))
    story.append(data_table(
        ["Body Region", "% TBSA", "Notes"],
        [
            ["Head + Neck",    "9%",   "Head 7% + Neck 2%"],
            ["Each Upper Limb","9% each (18% total)", "Arm 4% + Forearm 3% + Hand 2%"],
            ["Anterior Trunk", "18%",  "Chest 9% + Abdomen 9%"],
            ["Posterior Trunk","18%",  "Upper back 9% + Lower back 9%"],
            ["Each Lower Limb","18% each (36% total)","Thigh 9% + Leg 6% + Foot 3%"],
            ["Perineum/Genitalia","1%",""],
            ["TOTAL",          "100%", ""],
        ],
        col_widths=[55*mm, 60*mm, 55*mm]
    ))
    story.append(sp(4))
    story.append(tip_box([
        "Lund & Browder Chart: MORE ACCURATE than Rule of Nines, especially in CHILDREN",
        "Palmar method: Patient's palm (fingers included) = 1% TBSA - useful for patchy burns",
        "CHILDREN: Head proportionally larger (18% at birth) -> Berkow formula / Lund-Browder",
    ]))
    story.append(sp(4))
    story.append(Paragraph("Burns Depth Classification", CH_SUB2))
    story.append(data_table(
        ["Degree", "Depth", "Appearance", "Sensation", "Healing", "Treatment"],
        [
            ["1st Degree\n(Superficial)", "Epidermis only", "Red, dry, no blisters", "Painful", "3-5 days", "Conservative"],
            ["2nd Degree Superficial\n(Partial thickness)", "Epidermis + Superficial dermis", "Blisters, moist, pink", "Very painful", "14-21 days", "Dressings"],
            ["2nd Degree Deep\n(Deep partial thickness)", "Epidermis + Deep dermis", "Pale/mottled, less moist", "Reduced pain", "21-35 days, may need graft", "Grafting"],
            ["3rd Degree\n(Full thickness)", "All skin layers", "White/charred/leathery", "Painless", "No self-healing", "Excision + Grafting"],
            ["4th Degree", "Skin + subcutaneous tissue, muscle, bone", "Charred, eschar", "Painless", "Amputation/major reconstruction", "Surgical"],
        ],
        col_widths=[30*mm, 32*mm, 32*mm, 24*mm, 28*mm, 24*mm]
    ))
    story.append(sp(4))
    story.append(Paragraph("Fluid Resuscitation in Burns", CH_SUB2))
    story.append(box_table([
        [Paragraph("<b>Parkland Formula (Most used in India/NEET PG):</b>", BOLD_S)],
        [Paragraph("Total fluid in 24 hrs = 4 mL x Weight (kg) x % TBSA burn (2nd + 3rd degree only)", BODY)],
        [Paragraph("• Give HALF in first 8 hours (from time of burn, not from hospital arrival)", BODY)],
        [Paragraph("• Give REMAINING HALF over next 16 hours", BODY)],
        [Paragraph("• Fluid: Ringer's Lactate (Hartmann's solution)", BODY)],
        [Paragraph("<b>Muir & Barclay Formula:</b> (UK/older)", BOLD_S)],
        [Paragraph("= Weight (kg) x % TBSA / 2 = per period (6 periods: 4h, 4h, 4h, 6h, 6h, 12h)", BODY)],
        [Paragraph("• Fluid: Colloid (Human Albumin Solution / FFP)", BODY)],
    ]))
    story.append(sp(4))
    story.append(imp_box([
        "Parkland formula - fluid: Ringer's Lactate; Muir-Barclay formula - fluid: Colloid",
        "Children: Add maintenance fluid (dextrose saline) to Parkland formula",
        "Target urine output: Adult = 0.5-1 mL/kg/hr; Children = 1 mL/kg/hr",
        "Burns >15% TBSA in adults / >10% in children = MAJOR BURN requiring IV resuscitation",
        "Smoke inhalation injury = strong indication for early intubation",
        "Circumferential full-thickness burns -> ESCHAROTOMY to prevent compartment syndrome",
    ]))
    story.append(sp(4))
    story.append(pyq_box([
        "Q: Parkland formula for burn resuscitation? Ans: 4 mL x kg x % TBSA; half in first 8 hrs, RL solution",
        "Q: Rule of nines - TBSA of lower limb in adult? Ans: 18% each (9% thigh + 9% leg/foot)",
        "Q: Most accurate method for calculating burns in children? Ans: Lund and Browder Chart",
        "Q: Which type of burn is PAINLESS? Ans: Full thickness (3rd degree) - nerve endings destroyed",
        "Q: Earliest sign of adequate fluid resuscitation in burns? Ans: Adequate urine output (0.5 mL/kg/hr)",
        "Q: Escharotomy is done for? Ans: Circumferential full-thickness burns - to prevent compartment syndrome",
    ]))
    story.append(PageBreak())

    story.append(Paragraph("2.2  ATLS PRIMARY SURVEY (ABCDE)", CH_SUB))
    story.append(data_table(
        ["Step", "Stands For", "Action", "Key Points"],
        [
            ["A", "Airway + C-spine", "Clear airway, chin lift/jaw thrust, C-spine immobilisation", "Assume C-spine injury in all blunt trauma until proven otherwise"],
            ["B", "Breathing + Ventilation", "Look-listen-feel, O2, treat pneumothorax", "Life threats: Tension PTX, Open PTX, Haemothorax, Flail chest"],
            ["C", "Circulation + Haemorrhage", "2 large bore IVs, fluid resuscitation, control external bleeding", "FAST exam, pelvic binder if pelvic fracture"],
            ["D", "Disability (Neuro)", "GCS, pupils, glucose, AVPU scale", "GCS <8 -> intubate; unilateral dilated pupil = herniation"],
            ["E", "Exposure + Environment", "Undress patient, prevent hypothermia", "Log roll, check back and perineum"],
        ],
        col_widths=[12*mm, 38*mm, 62*mm, 58*mm]
    ))
    story.append(sp(4))
    story.append(Paragraph("2.3  TENSION PNEUMOTHORAX vs CARDIAC TAMPONADE", CH_SUB))
    story.append(two_col_table(
        ["Tracheal deviation AWAY from affected side",
         "Absent breath sounds on affected side",
         "Hypotension + tachycardia",
         "JVP raised",
         "Treatment: Immediate needle decompression (2nd ICS MCL), then chest drain"],
        ["Tracheal deviation - midline (no deviation)",
         "Heart sounds muffled",
         "Hypotension + tachycardia",
         "JVP raised (Beck's triad)",
         "Treatment: Pericardiocentesis (emergent), pericardial window"],
        "Tension Pneumothorax", "Cardiac Tamponade"
    ))
    story.append(sp(4))
    story.append(pyq_box([
        "Q: Triad of cardiac tamponade (Beck's triad)? Ans: Hypotension, raised JVP, muffled heart sounds",
        "Q: Kussmaul's sign is seen in? Ans: Cardiac tamponade (JVP rises on inspiration)",
        "Q: Treatment of tension pneumothorax? Ans: Immediate needle decompression - 2nd ICS midclavicular line",
        "Q: Most common cause of haemothorax in trauma? Ans: Intercostal vessel injury",
        "Q: Flail chest definition? Ans: 3+ consecutive ribs fractured at 2+ sites each - paradoxical movement",
    ]))
    story.append(PageBreak())

    # ════════════════════════════════════════════════════════════════════════
    # CHAPTER 3 - GI SURGERY
    # ════════════════════════════════════════════════════════════════════════
    story.append(header_table("  CHAPTER 3 - GASTROINTESTINAL SURGERY"))
    story.append(sp(8))

    story.append(Paragraph("3.1  ACUTE APPENDICITIS", CH_SUB))
    story.append(box_table([
        [Paragraph("<b>Classic Presentation:</b> Central colicky pain -> shifting to RIF (McBurney's point) + fever + nausea/vomiting", BODY)],
        [Paragraph("<b>McBurney's Point:</b> Junction of lateral 1/3 and medial 2/3 of line joining ASIS to umbilicus", BODY)],
        [Paragraph("<b>Rovsing's Sign:</b> Pressure on LIF causes pain in RIF (peritoneal irritation)", BODY)],
        [Paragraph("<b>Psoas Sign:</b> Pain on extending right hip (retrocaecal appendix)", BODY)],
        [Paragraph("<b>Obturator Sign:</b> Pain on internal rotation of flexed right hip (pelvic appendix)", BODY)],
    ], bg=C_LIGHT))
    story.append(sp(4))
    story.append(Paragraph("Alvarado Score (MANTRELS)", CH_SUB2))
    story.append(data_table(
        ["Criterion", "Score"],
        [
            ["Migration of pain to RIF", "1"],
            ["Anorexia", "1"],
            ["Nausea/Vomiting", "1"],
            ["Tenderness in RIF", "2"],
            ["Rebound tenderness", "1"],
            ["Elevated temperature (>37.3°C)", "1"],
            ["Leukocytosis (WBC >10,000)", "2"],
            ["Shift to left (neutrophilia)", "1"],
            ["TOTAL", "10"],
        ],
        col_widths=[130*mm, 38*mm]
    ))
    story.append(sp(4))
    story.append(tip_box([
        "MANTRELS mnemonic: Migration, Anorexia, Nausea, Tenderness RIF, Rebound, Elevated Temp, Leukocytosis, Shift left",
        "Score 7-10 = High probability -> Surgery; Score 5-6 = Observe; Score <5 = Low probability",
        "Score of 2 each for: RIF Tenderness + Leukocytosis (highest weighted criteria)",
    ]))
    story.append(sp(4))
    story.append(imp_box([
        "Best investigation for appendicitis: CT scan (most accurate 94-98% sensitivity)",
        "Preferred in children/pregnancy: Ultrasound first (no radiation), then MRI",
        "Position of appendix most common: Retrocaecal (65%)",
        "Pelvic appendix -> Dysuria, frequency (mimics UTI)",
        "Perforation risk increases dramatically after 24-36 hours",
        "Laparoscopic appendicectomy = gold standard (less infection, faster recovery)",
    ]))
    story.append(sp(4))
    story.append(pyq_box([
        "Q: Most common position of appendix? Ans: Retrocaecal (65%)",
        "Q: Best investigation for appendicitis? Ans: CT scan (most accurate); USG first in children/pregnant",
        "Q: Alvarado score of 7-10 indicates? Ans: High probability appendicitis - proceed to surgery",
        "Q: Rovsing's sign is? Ans: Pressure on LIF causes pain in RIF",
        "Q: Appendicectomy incision? Ans: Grid-iron incision (Lanz incision for cosmesis)",
    ]))
    story.append(sp(6))

    story.append(Paragraph("3.2  INTESTINAL OBSTRUCTION", CH_SUB))
    story.append(two_col_table(
        ["Most common cause adult small bowel: Adhesions (post-op)",
         "Most common cause large bowel: Carcinoma",
         "Features: Colicky pain, vomiting, distension, constipation",
         "High obstruction: Vomiting early, distension mild",
         "Low obstruction: Vomiting late/feculent, distension marked",
         "X-ray: Dilated loops, air-fluid levels, step-ladder pattern",
         "Small bowel: Valvulae conniventes (cross whole width)",
         "Large bowel: Haustra (partial width)",
         "Treatment: NBM, NGT, IV fluids, then surgery if needed"],
        ["Strangulation signs: Continuous pain (not colicky), fever, peritonism",
         "Closed loop obstruction: Most dangerous - rapid vascular compromise",
         "Volvulus: Sigmoid (most common) or Caecal",
         "Sigmoid volvulus X-ray: Coffee bean/bent inner tube sign",
         "Caecal volvulus X-ray: Kidney bean sign",
         "Intussusception: Children 6mo-2yr, currant jelly stools",
         "Richter's hernia: Knuckle of bowel - no complete obstruction",
         "Gallstone ileus: Air in biliary tree (pneumobilia)",
         "Ogilvie's syndrome: Pseudo-obstruction of colon (no mechanical cause)"],
        "Mechanical Obstruction Features", "Important Subtypes"
    ))
    story.append(sp(4))
    story.append(pyq_box([
        "Q: Most common cause of small bowel obstruction in adults? Ans: Adhesions (post-operative)",
        "Q: Most common cause of large bowel obstruction? Ans: Carcinoma of colon",
        "Q: Currant jelly stools in a child suggests? Ans: Intussusception",
        "Q: Coffee bean sign on X-ray? Ans: Sigmoid volvulus",
        "Q: Gallstone ileus - pathognomonic finding on X-ray? Ans: Air in biliary tree (pneumobilia / Rigler's triad)",
        "Q: Intussusception treatment in children? Ans: Air/hydrostatic enema reduction (first line); Surgery if failed/peritonitis",
    ]))
    story.append(PageBreak())

    story.append(Paragraph("3.3  PEPTIC ULCER DISEASE", CH_SUB))
    story.append(two_col_table(
        ["DU: Pain relieved by food (Hunger pain)",
         "DU: Hypersecretory state",
         "DU: More common (4x than GU)",
         "DU: Posterior DU -> bleeds from Gastroduodenal artery",
         "DU: Anterior DU -> perforates (peritonitis)",
         "DU: H. pylori in 95-100%",
         "DU: Rarely malignant"],
        ["GU: Pain WORSENED by food (Fear of food)",
         "GU: Normal/hypo secretory state",
         "GU: Less common, but ALWAYS exclude malignancy",
         "GU: Posterior GU -> bleeds from Left Gastric artery",
         "GU: Lesser curve most common site",
         "GU: H. pylori in 70-80%",
         "GU: 5% risk of malignancy - always biopsy"],
        "Duodenal Ulcer (DU)", "Gastric Ulcer (GU)"
    ))
    story.append(sp(4))
    story.append(pyq_box([
        "Q: Artery eroded in bleeding posterior DU? Ans: Gastroduodenal artery",
        "Q: Artery eroded in bleeding lesser curve GU? Ans: Left gastric artery",
        "Q: Most common complication of peptic ulcer? Ans: Bleeding (haemorrhage)",
        "Q: Most common site of perforation in PUD? Ans: Anterior wall of first part of duodenum",
        "Q: H. pylori eradication regimen (Triple therapy)? Ans: PPI + Amoxicillin + Clarithromycin x 7-14 days",
    ]))
    story.append(PageBreak())

    # ════════════════════════════════════════════════════════════════════════
    # CHAPTER 4 - HEPATOBILIARY
    # ════════════════════════════════════════════════════════════════════════
    story.append(header_table("  CHAPTER 4 - HEPATOBILIARY & PANCREATIC SURGERY"))
    story.append(sp(8))

    story.append(Paragraph("4.1  GALLSTONES (CHOLELITHIASIS)", CH_SUB))
    story.append(data_table(
        ["Type", "Composition", "Association", "X-ray Visible?"],
        [
            ["Cholesterol stones", "Cholesterol >50%", "Obesity, OCP, Pregnancy, Female, 40yr (5 F's)", "No (80% radiolucent)"],
            ["Pigment - Black stones", "Calcium bilirubinate", "Haemolytic anaemia, Cirrhosis", "Yes (radio-opaque)"],
            ["Pigment - Brown stones", "Calcium bilirubinate + fatty acids", "Bacterial/parasitic infection, bile stasis", "Partially"],
            ["Mixed stones", "Cholesterol + Pigment", "Most common type (80%)", "Variable"],
        ],
        col_widths=[40*mm, 42*mm, 56*mm, 32*mm]
    ))
    story.append(sp(4))
    story.append(tip_box([
        "5 F's of cholesterol gallstones: Fat, Female, Fertile, Forty, Fair (Caucasian)",
        "Charcot's triad of cholangitis: Fever + Jaundice + RUQ Pain",
        "Reynold's pentad: Charcot's triad + Hypotension + Confusion (severe cholangitis/sepsis)",
        "Courvoisier's Law: Palpable GB + painless jaundice = NOT gallstones (= periampullary malignancy)",
        "Murphy's sign: Cessation of inspiration on deep palpation of RUQ (acute cholecystitis)",
    ]))
    story.append(sp(4))
    story.append(pyq_box([
        "Q: Charcot's triad of cholangitis? Ans: Fever, Jaundice, RUQ Pain",
        "Q: Courvoisier's law? Ans: Palpable GB + painless jaundice usually NOT due to stones (implies malignancy)",
        "Q: Best investigation for gallstones? Ans: Ultrasound (USG) - gold standard",
        "Q: Treatment of choice for symptomatic gallstones? Ans: Laparoscopic cholecystectomy",
        "Q: ERCP is done for? Ans: Common bile duct stones (CBD stones), before/after cholecystectomy",
        "Q: Mirizzi syndrome? Ans: External compression of CHD by stone in cystic duct/Hartmann's pouch -> jaundice",
    ]))
    story.append(sp(6))

    story.append(Paragraph("4.2  ACUTE PANCREATITIS", CH_SUB))
    story.append(box_table([
        [Paragraph("<b>Common causes (GET SMASHED):</b> Gallstones (40%), Ethanol (35%), Trauma, Steroids, Mumps/Autoimmune, Scorpion/Spider venom, Hyperlipidaemia/Hypercalcaemia, ERCP/Emboli, Drugs (azathioprine, thiazides)", BODY)],
    ], bg=C_LYELLOW, border_color=C_ORANGE))
    story.append(sp(4))
    story.append(Paragraph("Ranson's Criteria (prognostic scoring)", CH_SUB2))
    story.append(data_table(
        ["At Admission", "At 48 Hours"],
        [
            ["Age >55 years", "Haematocrit fall >10%"],
            ["WBC >16,000/mm3", "BUN rise >5 mg/dL"],
            ["Blood glucose >200 mg/dL", "Serum Ca <8 mg/dL"],
            ["LDH >350 IU/L", "PaO2 <60 mmHg"],
            ["AST >250 IU/L", "Base deficit >4 mEq/L"],
            ["", "Fluid sequestration >6 L"],
        ],
        col_widths=[85*mm, 85*mm]
    ))
    story.append(sp(4))
    story.append(imp_box([
        "Ranson score: <3 = mild; 3-5 = moderate; >5 = severe (>6 = near 100% mortality)",
        "Best imaging for pancreatitis complications: CT scan (CECT abdomen)",
        "CT Severity Index (Balthazar score): Grade A-E based on CT findings",
        "Cullen's sign: Periumbilical bruising (haemorrhagic pancreatitis - retroperitoneal bleed)",
        "Grey-Turner's sign: Flank bruising (same significance)",
        "Amylase vs Lipase: Lipase is MORE SPECIFIC for acute pancreatitis",
        "Pancreatic necrosis + infection -> Infected necrotising pancreatitis -> Surgery / Drainage",
    ]))
    story.append(sp(4))
    story.append(pyq_box([
        "Q: Most common cause of acute pancreatitis in India? Ans: Gallstones",
        "Q: Most specific enzyme for pancreatitis? Ans: Lipase (more specific than amylase)",
        "Q: Cullen's sign is seen in? Ans: Haemorrhagic pancreatitis (periumbilical bruising)",
        "Q: Ranson score >5 suggests? Ans: Severe pancreatitis with high mortality",
        "Q: Most common complication of acute pancreatitis? Ans: Pancreatic pseudocyst",
        "Q: Pseudocyst management if >6cm and persistent >6wks? Ans: Internal drainage (cystogastrostomy)",
    ]))
    story.append(PageBreak())

    # ════════════════════════════════════════════════════════════════════════
    # CHAPTER 5 - BREAST SURGERY
    # ════════════════════════════════════════════════════════════════════════
    story.append(header_table("  CHAPTER 5 - BREAST SURGERY"))
    story.append(sp(8))

    story.append(Paragraph("5.1  BREAST LUMPS - DIFFERENTIAL DIAGNOSIS", CH_SUB))
    story.append(data_table(
        ["Condition", "Age", "Features", "Consistency"],
        [
            ["Fibroadenoma", "15-30 yrs", "'Breast mouse' - mobile, smooth, well-defined, non-tender, no skin changes", "Firm, rubbery"],
            ["Fibrocystic disease\n(ANDI)", "30-50 yrs", "Cyclical pain/tenderness, multiple lumps, worse pre-menstrual, bilateral", "Nodular"],
            ["Breast Cyst",   "35-55 yrs", "Smooth, well-defined, tense, transilluminates, aspirated", "Cystic/firm"],
            ["Carcinoma",     ">40 yrs",   "Hard, irregular, poorly defined, skin tethering, nipple retraction, LN involved", "Hard, stony"],
            ["Abscess/Mastitis", "Lactating women", "Red, hot, tender, fluctuant, fever, WBC raised", "Fluctuant"],
            ["Fat Necrosis",  "Any age (trauma)", "History of trauma, hard lump, skin retraction - mimics CA", "Hard"],
        ],
        col_widths=[38*mm, 26*mm, 72*mm, 32*mm]
    ))
    story.append(sp(4))
    story.append(Paragraph("5.2  BREAST CARCINOMA", CH_SUB))
    story.append(imp_box([
        "Most common breast cancer histological type: Invasive Ductal Carcinoma (IDC) - 75-80%",
        "Most common site: Upper outer quadrant (50%)",
        "Inflammatory breast cancer: Peau d'orange skin (dermal lymphatic invasion), worst prognosis",
        "BRCA1 mutation: Breast + Ovarian cancer risk; BRCA2: Breast + Pancreatic/Prostate cancer",
        "Triple assessment for breast lump: Clinical examination + Imaging (USG/Mammography) + FNAC/Biopsy",
        "Sentinel lymph node biopsy: First node to drain tumour - if negative, avoids axillary dissection",
    ]))
    story.append(sp(4))
    story.append(Paragraph("Breast Cancer Staging (TNM Summary)", CH_SUB2))
    story.append(data_table(
        ["Stage", "TNM", "Features", "5-yr Survival"],
        [
            ["Stage I",   "T1, N0, M0", "Tumour <2cm, no node involvement, no mets", "~95%"],
            ["Stage IIA", "T0-2, N1, M0 or T2N0", "Mobile ipsilateral axillary nodes or T2 no nodes", "~85%"],
            ["Stage IIB", "T2N1 or T3N0", "T2 + mobile nodes, or T3 no nodes", "~70%"],
            ["Stage IIIA", "T0-3, N2, M0 or T3N1", "Fixed axillary nodes", "~55%"],
            ["Stage IIIB", "T4, any N, M0", "Chest wall/skin involvement (incl inflammatory)", "~40%"],
            ["Stage IV",  "Any T, Any N, M1", "Distant metastases", "~25%"],
        ],
        col_widths=[20*mm, 38*mm, 72*mm, 28*mm]
    ))
    story.append(sp(4))
    story.append(pyq_box([
        "Q: Most common type of breast cancer? Ans: Invasive Ductal Carcinoma (IDC)",
        "Q: Most common site of breast cancer? Ans: Upper outer quadrant",
        "Q: Paget's disease of nipple is associated with? Ans: Underlying intraductal carcinoma",
        "Q: Triple assessment of breast lump? Ans: Clinical exam + Imaging + Pathology (FNAC/Biopsy)",
        "Q: Sentinel lymph node drainage site for breast? Ans: Axillary nodes (level I first)",
        "Q: Tamoxifen is used in? Ans: ER/PR positive breast cancer (pre and post-menopausal); SERM",
    ]))
    story.append(PageBreak())

    # ════════════════════════════════════════════════════════════════════════
    # CHAPTER 6 - THYROID & PARATHYROID
    # ════════════════════════════════════════════════════════════════════════
    story.append(header_table("  CHAPTER 6 - THYROID & PARATHYROID SURGERY"))
    story.append(sp(8))

    story.append(Paragraph("6.1  THYROID CANCER - TYPES & FEATURES", CH_SUB))
    story.append(data_table(
        ["Type", "Incidence", "Age/Sex", "Spread", "Prognosis", "Special Features"],
        [
            ["Papillary", "70-80% (most common)", "Young females", "Lymphatic (LN)", "Excellent (>95% 10yr)", "Psammoma bodies, Orphan Annie eye nuclei, Intranuclear inclusions"],
            ["Follicular", "15-20%", "Middle age", "Haematogenous (lung, bone)", "Good", "Vascular invasion diagnostic; not diagnose by FNAC (capsule needed)"],
            ["Medullary", "5%", "Familial (MEN 2A/2B)", "Both LN + haematogenous", "Moderate", "Calcitonin as tumour marker; amyloid deposits; RET proto-oncogene"],
            ["Anaplastic", "<5% (rarest)", "Elderly", "Local invasion + widespread", "Very poor (<6 months)", "Most aggressive; radio-resistant; airway compromise"],
        ],
        col_widths=[26*mm, 28*mm, 26*mm, 30*mm, 26*mm, 32*mm]
    ))
    story.append(sp(4))
    story.append(imp_box([
        "Most common thyroid cancer: Papillary (70-80%)",
        "Best prognosis: Papillary > Follicular > Medullary > Anaplastic (worst)",
        "Psammoma bodies seen in: Papillary thyroid CA, Meningioma, Serous papillary ovarian CA",
        "MEN 2A: Medullary thyroid CA + Phaeochromocytoma + Primary hyperparathyroidism",
        "MEN 2B: Medullary thyroid CA + Phaeochromocytoma + Mucosal neuromas + Marfanoid habitus",
        "Calcitonin = tumour marker for Medullary thyroid carcinoma",
        "Recurrent laryngeal nerve (RLN) injury during thyroid surgery -> hoarseness",
        "Bilateral RLN injury -> stridor, respiratory distress - EMERGENCY tracheotomy needed",
    ]))
    story.append(sp(4))
    story.append(pyq_box([
        "Q: Most common thyroid cancer? Ans: Papillary carcinoma",
        "Q: Psammoma bodies are seen in which thyroid cancer? Ans: Papillary carcinoma",
        "Q: Tumour marker for medullary thyroid cancer? Ans: Calcitonin",
        "Q: Follicular carcinoma is diagnosed by? Ans: Histopathology (capsular/vascular invasion) - NOT by FNAC",
        "Q: Most aggressive thyroid cancer? Ans: Anaplastic (undifferentiated) carcinoma",
        "Q: MEN 2A components? Ans: Medullary thyroid CA + Phaeochromocytoma + Hyperparathyroidism",
    ]))
    story.append(PageBreak())

    # ════════════════════════════════════════════════════════════════════════
    # CHAPTER 7 - HERNIA
    # ════════════════════════════════════════════════════════════════════════
    story.append(header_table("  CHAPTER 7 - HERNIA"))
    story.append(sp(8))

    story.append(Paragraph("7.1  INGUINAL HERNIA - INDIRECT vs DIRECT", CH_SUB))
    story.append(two_col_table(
        ["Through deep inguinal ring -> inguinal canal -> superficial ring",
         "Younger age group (congenital persistent processus vaginalis)",
         "More common overall (3:1 ratio over direct)",
         "Lateral to inferior epigastric vessels",
         "Covered by all three layers of spermatic cord",
         "Can descend into scrotum",
         "Higher risk of strangulation",
         "Hesselbach's triangle: Lateral border"],
        ["Through Hesselbach's triangle (posterior wall weakness)",
         "Older age (acquired - weakness of transversalis fascia)",
         "Less common than indirect",
         "Medial to inferior epigastric vessels",
         "Not covered by internal spermatic fascia",
         "Rarely descends into scrotum",
         "Lower risk of strangulation",
         "Hesselbach's triangle: Medial border"],
        "INDIRECT Inguinal Hernia", "DIRECT Inguinal Hernia"
    ))
    story.append(sp(4))
    story.append(box_table([
        [Paragraph("<b>Hesselbach's Triangle boundaries:</b> Medial = Lateral border of rectus abdominis | Lateral = Inferior epigastric vessels | Inferior = Inguinal ligament", BODY)],
        [Paragraph("<b>Inguinal canal boundaries:</b> Anterior wall = External oblique aponeurosis | Posterior wall = Transversalis fascia (+ conjoined tendon medially) | Roof = Transversus + internal oblique | Floor = Inguinal ligament", BODY)],
    ]))
    story.append(sp(4))

    story.append(Paragraph("7.2  FEMORAL HERNIA", CH_SUB))
    story.append(box_table([
        [Paragraph("<b>Site:</b> Through femoral ring, femoral canal - BELOW and LATERAL to pubic tubercle", BODY)],
        [Paragraph("<b>Demographics:</b> More common in women (due to wider pelvis) but inguinal hernia is STILL more common in women overall", BODY)],
        [Paragraph("<b>Neck of femoral ring boundaries:</b> Medially = Lacunar ligament | Laterally = Femoral vein | Anteriorly = Inguinal ligament | Posteriorly = Pectineal ligament (Cooper's ligament)", BODY)],
        [Paragraph("<b>High strangulation risk</b> due to narrow, unyielding neck (lacunar ligament medially)", BODY)],
    ]))
    story.append(sp(4))

    story.append(Paragraph("7.3  SPECIAL HERNIAS (HIGH YIELD!)", CH_SUB))
    story.append(data_table(
        ["Type", "Definition", "Clinical Significance"],
        [
            ["Richter's Hernia", "Only antimesenteric wall of bowel in sac (knuckle) - NO complete obstruction", "Can strangulate WITHOUT obstruction - DANGEROUS, easily missed"],
            ["Littre's Hernia", "Meckel's diverticulum in hernial sac", "Diverticulum strangulates"],
            ["Maydl's Hernia\n(W hernia)", "Two loops of bowel in sac forming W shape - middle loop inside abdomen strangulates", "Dangerous - intraabdominal loop strangulates unnoticed"],
            ["Spigelian Hernia", "Through spigelian fascia (lateral border of rectus, at linea semilunaris)", "Interparietal hernia - difficult to detect clinically"],
            ["Obturator Hernia", "Through obturator foramen - elderly thin women", "Howship-Romberg sign: medial thigh pain radiating on hip movement"],
            ["Sliding Hernia\n(en Glissade)", "Wall of viscus forms part of the sac", "Sigmoid colon (left) or caecum (right) most common"],
            ["Pantaloon Hernia", "Combined direct + indirect hernia straddling inferior epigastric vessels", "Both medial and lateral components"],
        ],
        col_widths=[38*mm, 72*mm, 58*mm]
    ))
    story.append(sp(4))
    story.append(pyq_box([
        "Q: Which hernia can strangulate without obstruction? Ans: Richter's hernia",
        "Q: Littre's hernia contains? Ans: Meckel's diverticulum",
        "Q: Howship-Romberg sign is seen in? Ans: Obturator hernia",
        "Q: Femoral hernia passes below which landmark? Ans: Below and lateral to pubic tubercle",
        "Q: Inguinal hernia passes above which landmark? Ans: Above and medial to pubic tubercle",
        "Q: Most common type of hernia in females? Ans: Inguinal hernia (indirect) - inguinal > femoral in females too",
    ]))
    story.append(PageBreak())

    # ════════════════════════════════════════════════════════════════════════
    # CHAPTER 8 - UROLOGY
    # ════════════════════════════════════════════════════════════════════════
    story.append(header_table("  CHAPTER 8 - UROLOGY"))
    story.append(sp(8))

    story.append(Paragraph("8.1  URINARY STONES (UROLITHIASIS)", CH_SUB))
    story.append(data_table(
        ["Stone Type", "% of Stones", "Radio-opacity", "Associations", "Urine pH"],
        [
            ["Calcium Oxalate\n(most common)", "70-80%", "Radio-opaque", "Hypercalciuria, hyperoxaluria, Crohn's disease", "Acidic"],
            ["Uric Acid", "5-10%", "Radiolucent (pure)", "Gout, dehydration, high purine diet, myeloproliferative", "Acidic (<5.5)"],
            ["Struvite (triple phosphate)", "10-15%", "Radio-opaque (staghorn)", "Urease-producing organisms (Proteus, Klebsiella)", "Alkaline (>7)"],
            ["Cystine", "1-3%", "Faintly opaque", "Cystinuria (AR) - defective tubular reabsorption", "Acidic"],
            ["Calcium Phosphate", "5-10%", "Radio-opaque", "Hyperparathyroidism, RTA type I", "Alkaline"],
        ],
        col_widths=[32*mm, 20*mm, 28*mm, 58*mm, 26*mm]
    ))
    story.append(sp(4))
    story.append(tip_box([
        "Most radio-opaque: Calcium oxalate > Calcium phosphate > Struvite > Cystine > Uric acid (radiolucent)",
        "Staghorn calculi = Struvite stones (fill renal pelvis + calyces)",
        "Treatment of uric acid stones: Urinary alkalinisation (potassium citrate) + hydration",
        "First-line investigation: KUB X-ray + USG; CT-KUB (non-contrast) = gold standard",
        "ESWL (Extracorporeal Shock Wave Lithotripsy): Best for stones <2cm in renal pelvis",
        "PCNL (Percutaneous Nephrolithotomy): Stones >2cm or staghorn calculi",
    ]))
    story.append(sp(4))
    story.append(pyq_box([
        "Q: Most common renal stone? Ans: Calcium oxalate (70-80%)",
        "Q: Only radiolucent stone on plain X-ray? Ans: Uric acid stone",
        "Q: Staghorn calculus is composed of? Ans: Struvite (magnesium ammonium phosphate - triple phosphate)",
        "Q: Organism causing struvite stones? Ans: Proteus mirabilis (urease-producing)",
        "Q: ESWL is suitable for stones of what size? Ans: <2 cm in renal pelvis",
        "Q: Investigation of choice for ureteric colic? Ans: Non-contrast CT-KUB (NCCT abdomen)",
    ]))
    story.append(sp(6))

    story.append(Paragraph("8.2  BPH (BENIGN PROSTATIC HYPERPLASIA)", CH_SUB))
    story.append(box_table([
        [Paragraph("<b>Zone affected:</b> Transitional zone (central) | Prostate CA affects Peripheral zone", BODY)],
        [Paragraph("<b>Features - LUTS:</b> Frequency, urgency, nocturia, poor stream, hesitancy, terminal dribbling, incomplete emptying", BODY)],
        [Paragraph("<b>PSA:</b> Raised (but not diagnostic of CA alone - also raised in BPH, prostatitis, UTI)", BODY)],
        [Paragraph("<b>Rectal exam:</b> Enlarged, smooth, firm, non-tender, median groove preserved (vs CA: hard, irregular, nodular)", BODY)],
        [Paragraph("<b>Treatment:</b> Alpha-blockers (tamsulosin, alfuzosin) first line for symptoms | 5-alpha reductase inhibitors (finasteride) for large glands | TURP (gold standard surgical treatment)", BODY)],
    ]))
    story.append(sp(4))
    story.append(pyq_box([
        "Q: Zone of prostate affected in BPH? Ans: Transitional (central) zone",
        "Q: Zone affected in prostate carcinoma? Ans: Peripheral zone",
        "Q: Gold standard surgical treatment of BPH? Ans: TURP (TransUrethral Resection of Prostate)",
        "Q: TUR syndrome is caused by? Ans: Absorption of hypotonic irrigation fluid -> dilutional hyponatraemia",
        "Q: First line medical treatment of BPH? Ans: Alpha-1 blockers (tamsulosin, alfuzosin)",
    ]))
    story.append(PageBreak())

    # ════════════════════════════════════════════════════════════════════════
    # CHAPTER 9 - VASCULAR SURGERY
    # ════════════════════════════════════════════════════════════════════════
    story.append(header_table("  CHAPTER 9 - VASCULAR SURGERY"))
    story.append(sp(8))

    story.append(Paragraph("9.1  ABDOMINAL AORTIC ANEURYSM (AAA)", CH_SUB))
    story.append(box_table([
        [Paragraph("<b>Definition:</b> Dilatation of aorta >3 cm (normal <2.5cm) | TRUE aneurysm involves all 3 layers", BODY)],
        [Paragraph("<b>Risk factors:</b> Atherosclerosis, Smoking (strongest RF), Male, Age >65, Hypertension, Family history", BODY)],
        [Paragraph("<b>Most common site:</b> Infrarenal aorta (90%)", BODY)],
        [Paragraph("<b>Indications for surgery:</b> >5.5 cm | Rapidly expanding (>1 cm/year) | Symptomatic | Ruptured", BODY)],
        [Paragraph("<b>Ruptured AAA triad:</b> Sudden severe back/flank pain + Hypotension + Pulsatile abdominal mass", BODY)],
        [Paragraph("<b>Treatment:</b> EVAR (Endovascular Aneurysm Repair) preferred if anatomy suitable; Open repair alternatively", BODY)],
    ]))
    story.append(sp(4))
    story.append(pyq_box([
        "Q: Most common site of AAA? Ans: Infrarenal aorta",
        "Q: When is elective AAA repair indicated? Ans: Diameter >5.5 cm or expanding >1 cm/year",
        "Q: Classical triad of ruptured AAA? Ans: Sudden back pain + Hypotension + Pulsatile abdominal mass",
        "Q: Most common cause of AAA? Ans: Atherosclerosis",
    ]))
    story.append(sp(6))

    story.append(Paragraph("9.2  DEEP VEIN THROMBOSIS (DVT) & PULMONARY EMBOLISM", CH_SUB))
    story.append(data_table(
        ["Feature", "DVT", "Pulmonary Embolism"],
        [
            ["Presentation", "Unilateral leg swelling, pain, warmth, Homan's sign (unreliable)", "Dyspnoea, pleuritic chest pain, haemoptysis, tachycardia"],
            ["Investigation", "Doppler USG (first line); D-dimer screening", "CTPA (gold standard); V/Q scan; ECG: S1Q3T3"],
            ["Treatment", "LMWH/Heparin -> Warfarin/DOAC for 3-6 months; compression stockings", "Anticoagulation; Thrombolysis if haemodynamically unstable; IVC filter"],
            ["Prophylaxis", "LMWH, early mobilisation, compression stockings, hydration", "Same as DVT prophylaxis"],
        ],
        col_widths=[28*mm, 70*mm, 70*mm]
    ))
    story.append(sp(4))
    story.append(pyq_box([
        "Q: ECG finding in massive PE? Ans: S1Q3T3 pattern (S wave in lead I, Q wave and T inversion in lead III)",
        "Q: Gold standard investigation for PE? Ans: CT Pulmonary Angiography (CTPA)",
        "Q: Virchow's triad for DVT? Ans: Stasis + Endothelial injury + Hypercoagulability",
        "Q: Most common source of pulmonary embolism? Ans: DVT of lower limb (femoral/iliac veins)",
    ]))
    story.append(PageBreak())

    # ════════════════════════════════════════════════════════════════════════
    # CHAPTER 10 - PAEDIATRIC SURGERY
    # ════════════════════════════════════════════════════════════════════════
    story.append(header_table("  CHAPTER 10 - PAEDIATRIC SURGERY"))
    story.append(sp(8))

    story.append(data_table(
        ["Condition", "Age", "Presentation", "Investigation", "Treatment"],
        [
            ["Pyloric Stenosis", "2-6 weeks (M>F 4:1)", "Projectile non-bilious vomiting, 'olive' mass, hungry baby", "USG (pyloric muscle thickness >4mm, length >16mm); Metabolic alkalosis", "Ramstedt's pyloromyotomy (after correction of electrolytes)"],
            ["Intussusception", "6 months-2 years", "Colicky pain, vomiting, currant jelly stools, sausage mass in RUQ", "USG: Target sign / Doughnut sign", "Air/hydrostatic enema (first line); Surgery if failed or peritonitis"],
            ["Hirschsprung's Disease", "Neonates/infants", "Delayed meconium passage (>48hrs), abdominal distension, ribbon stools", "Rectal biopsy (gold standard): absence of ganglion cells; Anorectal manometry", "Surgical pull-through procedure (Swenson/Duhamel/Soave)"],
            ["Congenital Diaphragmatic Hernia (CDH)", "Neonate", "Respiratory distress, scaphoid abdomen, bowel sounds in chest", "CXR: bowel in chest", "Stabilise first, then surgical repair; Left side more common (Bochdalek)"],
            ["Tracheo-Oesophageal Fistula (TOF)", "Neonate", "Coughing/choking on feeding, respiratory distress, copious secretions", "NGT coiling on CXR; H-type detected by contrast study", "Surgical repair; most common type C (blind upper pouch + fistula lower)"],
            ["Meckel's Diverticulum", "Any age (usually 2 yrs)", "Rule of 2s: 2% pop, 2 inches long, 2 feet from ileocaecal valve, 2x more in males", "Tc-99m pertechnetate scan (ectopic gastric mucosa)", "Surgical excision if symptomatic"],
        ],
        col_widths=[36*mm, 24*mm, 44*mm, 36*mm, 38*mm]
    ))
    story.append(sp(4))
    story.append(imp_box([
        "Pyloric stenosis: Metabolic alkalosis with hypochloraemia and hypokalaemia - correct BEFORE surgery",
        "Hirschsprung's disease: Absent ganglion cells in Meissner's and Auerbach's plexuses (gold standard = rectal biopsy)",
        "Meckel's Rule of 2s: 2% population, 2 inches, 2 feet from ileocaecal valve, presents before age 2",
        "Most common site for ectopic tissue in Meckel's: Gastric mucosa (causes bleeding)",
        "Most common type of TOF: Type C (85%) - proximal oesophageal atresia + distal tracheo-oesophageal fistula",
    ]))
    story.append(sp(4))
    story.append(pyq_box([
        "Q: Meckel's diverticulum - rule of 2s? Ans: 2% population, 2 inches, 2 feet from IC valve, M:F = 2:1",
        "Q: Diagnosis of Hirschsprung's disease? Ans: Rectal biopsy showing absent ganglion cells",
        "Q: Currant jelly stools are characteristic of? Ans: Intussusception",
        "Q: Investigation for pyloric stenosis? Ans: USG (muscle thickness >4mm); Metabolic alkalosis on bloods",
        "Q: Technetium scan is used for? Ans: Meckel's diverticulum (ectopic gastric mucosa)",
    ]))
    story.append(PageBreak())

    # ════════════════════════════════════════════════════════════════════════
    # CHAPTER 11 - ONCOLOGY
    # ════════════════════════════════════════════════════════════════════════
    story.append(header_table("  CHAPTER 11 - SURGICAL ONCOLOGY"))
    story.append(sp(8))

    story.append(Paragraph("11.1  TUMOUR MARKERS", CH_SUB))
    story.append(data_table(
        ["Tumour Marker", "Associated Tumour", "Notes"],
        [
            ["CEA (Carcinoembryonic Antigen)", "Colorectal CA (primary monitoring)", "Also: gastric, pancreatic, breast, lung CA; smokers"],
            ["AFP (Alpha-fetoprotein)", "Hepatocellular CA, Germ cell tumours (non-seminoma)", "Also elevated in pregnancy, liver disease"],
            ["PSA (Prostate Specific Antigen)", "Prostate carcinoma", "Also raised in BPH, prostatitis; organ-specific not cancer-specific"],
            ["CA 19-9", "Pancreatic CA (primary), biliary CA", "Best tumour marker for pancreatic CA monitoring"],
            ["CA 125", "Ovarian CA (epithelial)", "Also in endometriosis, fibroids, pelvic inflammation"],
            ["CA 15-3", "Breast carcinoma", "Used for monitoring, not screening"],
            ["Calcitonin", "Medullary thyroid carcinoma", "Also used to screen family members (MEN 2)"],
            ["Beta-hCG", "Choriocarcinoma, Gestational trophoblastic disease, Testicular CA (non-seminoma)", ""],
            ["LDH", "Seminoma, Lymphoma, Ewing's sarcoma", "Non-specific marker"],
            ["S-100", "Melanoma, Schwannoma, Astrocytoma", "Neural crest cell tumours"],
        ],
        col_widths=[48*mm, 72*mm, 48*mm]
    ))
    story.append(sp(4))
    story.append(pyq_box([
        "Q: Tumour marker for pancreatic carcinoma? Ans: CA 19-9",
        "Q: Tumour marker for hepatocellular carcinoma? Ans: AFP (alpha-fetoprotein)",
        "Q: Best marker for monitoring colorectal cancer? Ans: CEA",
        "Q: Tumour marker for medullary thyroid cancer? Ans: Calcitonin",
        "Q: Which tumour marker is raised in seminoma? Ans: LDH (AFP and beta-hCG typically negative in pure seminoma)",
    ]))
    story.append(PageBreak())

    # ════════════════════════════════════════════════════════════════════════
    # CHAPTER 12 - INSTRUMENTS & PROCEDURES
    # ════════════════════════════════════════════════════════════════════════
    story.append(header_table("  CHAPTER 12 - SURGICAL INSTRUMENTS & PROCEDURES"))
    story.append(sp(8))

    story.append(Paragraph("12.1  KEY SURGICAL DRAINS", CH_SUB))
    story.append(data_table(
        ["Drain", "Type", "Uses"],
        [
            ["Corrugated rubber drain", "Passive, open", "Superficial wounds, subcutaneous drains"],
            ["Robinson drain (straight tube)", "Active closed (suction)", "Post-op abdominal, orthopaedic surgery"],
            ["Jackson-Pratt (JP)", "Active closed (bulb suction)", "After mastectomy, neck dissection, TRAM flap"],
            ["Blake drain", "Active closed", "Thoracic, cardiac surgery"],
            ["Chest drain (intercostal)", "Water-seal or Heimlich valve", "Haemothorax, pneumothorax, pleural effusion"],
            ["Sump drain (double lumen)", "Active irrigation + drainage", "Subphrenic abscess, bile leaks"],
            ["T-tube drain", "Passive", "CBD after choledochotomy for stones"],
        ],
        col_widths=[48*mm, 45*mm, 75*mm]
    ))
    story.append(sp(4))
    story.append(pyq_box([
        "Q: T-tube drain is used after? Ans: Choledochotomy (CBD exploration for stones) - maintains bile drainage",
        "Q: Drain used after mastectomy? Ans: Jackson-Pratt drain (closed suction)",
        "Q: Chest drain goes through which space? Ans: 5th ICS, midaxillary line (safe triangle)",
    ]))
    story.append(sp(6))

    story.append(Paragraph("12.2  STERILISATION METHODS", CH_SUB))
    story.append(data_table(
        ["Method", "Temperature", "Best For", "Cannot Use For"],
        [
            ["Autoclave (Steam sterilisation)", "121°C/15 psi x 15 min or 134°C x 3 min", "Metal instruments, drapes, gowns, glass, rubber", "Heat-sensitive equipment"],
            ["Dry Heat (hot air oven)", "160°C x 1hr or 180°C x 30min", "Glassware, oils, powders, sharp instruments (no steam blunting)", "Rubber, plastics, paper"],
            ["Ethylene Oxide (EO)", "50-60°C", "Endoscopes, plastics, rubber, electronics - heat sensitive", "Prolonged aeration needed (toxic residue)"],
            ["Glutaraldehyde (2%)", "Room temp", "Endoscopes (high-level disinfection)", "Not true sterilisation"],
            ["Gamma Radiation", "Room temp", "Disposables, sutures, packaged sterile items", "Industrial use; not bedside"],
            ["Plasma/Hydrogen peroxide", "50°C", "Delicate instruments, fibre optics", "Cellulose, linens"],
        ],
        col_widths=[42*mm, 36*mm, 52*mm, 38*mm]
    ))
    story.append(sp(4))
    story.append(imp_box([
        "Autoclave = moist heat = most reliable, most common method for surgical instruments",
        "Prions (CJD) are resistant to standard autoclaving - require 134°C x 18 min extended cycle or incineration",
        "Ethylene oxide: Toxic, carcinogenic, long aeration time (8-12 hrs) needed",
        "Best method for sharp instruments (to prevent blunting): Dry heat or Ethylene oxide",
    ]))
    story.append(sp(4))
    story.append(pyq_box([
            "Q: Most reliable method of sterilisation? Ans: Autoclave (moist heat under pressure)",
            "Q: Sterilisation of laparoscopes/endoscopes? Ans: Glutaraldehyde (2%) for high-level disinfection; EO for sterilisation",
            "Q: Which organisms are most resistant to sterilisation? Ans: Prions > Bacterial spores > Mycobacteria > Fungi > Viruses > Vegetative bacteria",
    ]))
    story.append(PageBreak())

    # ════════════════════════════════════════════════════════════════════════
    # QUICK REFERENCE - LAST MINUTE REVISION
    # ════════════════════════════════════════════════════════════════════════
    story.append(header_table("  QUICK REFERENCE - LAST MINUTE HIGH-YIELD FACTS", C_RED))
    story.append(sp(8))

    story.append(Paragraph("MUST-KNOW MNEMONICS", CH_SUB))
    story.append(data_table(
        ["Mnemonic", "Stands For", "Topic"],
        [
            ["MANTRELS", "Migration, Anorexia, Nausea, Tenderness RIF, Rebound, Elevated Temp, Leukocytosis, Shift left", "Alvarado Score for Appendicitis"],
            ["GET SMASHED", "Gallstones, Ethanol, Trauma, Steroids, Mumps, Autoimmune, Scorpion, Hyperlipidaemia, ERCP, Drugs", "Causes of Acute Pancreatitis"],
            ["5 F's", "Fat, Female, Fertile, Forty, Fair", "Risk factors for Cholesterol Gallstones"],
            ["AMPLE", "Allergies, Medications, Past history, Last meal, Events leading to injury", "ATLS History Taking"],
            ["Rule of 2s", "2% pop, 2 inches, 2 feet from IC valve, 2 yr age, 2:1 M:F", "Meckel's Diverticulum"],
            ["ABCDE", "Airway, Breathing, Circulation, Disability, Exposure", "Primary Survey in Trauma (ATLS)"],
            ["Virchow's Triad", "Stasis + Endothelial injury + Hypercoagulability", "DVT Formation"],
            ["Beck's Triad", "Hypotension + Muffled heart sounds + Raised JVP", "Cardiac Tamponade"],
            ["Charcot's Triad", "Fever + Jaundice + RUQ Pain", "Acute Cholangitis"],
            ["Reynolds Pentad", "Charcot's Triad + Hypotension + Confusion", "Severe/Suppurative Cholangitis"],
        ],
        col_widths=[32*mm, 90*mm, 46*mm]
    ))
    story.append(sp(6))

    story.append(Paragraph("TOP 30 MOST REPEATED SURGERY PYQs IN NEET PG", CH_SUB))
    pyq_final = [
        "1.  Most common position of appendix: RETROCAECAL (65%)",
        "2.  Most common cause of intestinal obstruction in adults: ADHESIONS (post-op) for SB; CARCINOMA for LB",
        "3.  Rule of nines: Lower limb = 18%, Upper limb = 9%, Head = 9%, Trunk (ant+post) = 36%",
        "4.  Parkland formula: 4 x kg x %TBSA in RL; half in first 8 hours",
        "5.  Most common thyroid cancer: Papillary (psammoma bodies, lymphatic spread, best prognosis)",
        "6.  Charcot's triad: Fever + Jaundice + RUQ pain = Cholangitis",
        "7.  Courvoisier's law: Palpable GB + painless jaundice = malignancy (NOT stones)",
        "8.  Beck's triad (cardiac tamponade): Hypotension + muffled sounds + raised JVP",
        "9.  Most common type of hernia (overall): INDIRECT inguinal hernia",
        "10. Richter's hernia: Strangulates WITHOUT complete obstruction (knuckle of bowel wall)",
        "11. Best prognosis thyroid cancer: Papillary; Worst: Anaplastic",
        "12. Tumour marker: Pancreatic CA = CA 19-9; Hepatoma = AFP; Medullary thyroid = Calcitonin",
        "13. Meckel's diverticulum rule of 2s - Tc-99m pertechnetate scan for diagnosis",
        "14. Hirschsprung's disease: Absent ganglion cells on rectal biopsy (gold standard)",
        "15. Intussusception: Currant jelly stools + sausage mass + USG target sign",
        "16. Most common type of wound healing: PRIMARY intention (clean surgical wound)",
        "17. Collagen type first in wound healing: Type III -> replaced by Type I",
        "18. Maximum tensile strength of healed wound: 80% (at 3 months)",
        "19. Most important cell in wound healing: MACROPHAGE",
        "20. Most common cause of SSI: Staphylococcus aureus",
        "21. TURP syndrome: Dilutional hyponatraemia from hypotonic irrigation fluid absorption",
        "22. Most common renal stone: Calcium oxalate (70-80%); Only radiolucent: Uric acid",
        "23. Struvite (staghorn) stone organism: Proteus mirabilis (urease-producing)",
        "24. Ranson score >5 = severe pancreatitis; Cullen's sign = periumbilical bruising",
        "25. Lithotripsy (ESWL) best for: Stones <2 cm in renal pelvis",
        "26. Sentinel lymph node biopsy: First line axillary staging for early breast cancer",
        "27. MEN 2A: Medullary thyroid CA + Pheochromocytoma + Hyperparathyroidism",
        "28. Best investigation for gallstones: Ultrasound (USG) - gold standard",
        "29. S1Q3T3 on ECG = Pulmonary Embolism; CTPA = gold standard investigation",
        "30. Tension pneumothorax: Immediate needle decompression at 2nd ICS midclavicular line",
    ]
    for q in pyq_final:
        story.append(Paragraph(q, BULLET))
    story.append(sp(4))

    # ── FINAL PAGE ──────────────────────────────────────────────────────────
    story.append(PageBreak())
    footer_table = Table(
        [[Paragraph("ALL THE BEST FOR NEET PG!", S("ft", fontSize=22,
           textColor=C_WHITE, fontName="Helvetica-Bold", alignment=TA_CENTER))],
         [Paragraph("You've got this! Revise smart, not hard.", S("fs", fontSize=13,
           textColor=C_YELLOW, alignment=TA_CENTER))],
         [sp(10)],
         [Paragraph("Sources: Bailey & Love 28e | Schwartz's Surgery 11e | Current Surgical Therapy 14e | Sabiston Surgery | Tintinalli Emergency Medicine | Maingot's Abdominal Operations", S("fsrc", fontSize=8, textColor=C_WHITE, alignment=TA_CENTER))],
        ],
        colWidths=[190*mm]
    )
    footer_table.setStyle(TableStyle([
        ("BACKGROUND", (0,0), (-1,-1), C_NAVY),
        ("TOPPADDING",    (0,0), (-1,-1), 14),
        ("BOTTOMPADDING", (0,0), (-1,-1), 14),
        ("LEFTPADDING",   (0,0), (-1,-1), 20),
    ]))
    story.append(footer_table)

    return story


# ── Page Template (header + footer) ─────────────────────────────────────────
from reportlab.platypus import Frame, PageTemplate
from reportlab.platypus.doctemplate import BaseDocTemplate

class SurgeryDoc(BaseDocTemplate):
    def __init__(self, filename, **kwargs):
        super().__init__(filename, **kwargs)
        frame = Frame(self.leftMargin, self.bottomMargin,
                      self.width, self.height, id='main')
        template = PageTemplate(id='main', frames=[frame],
                                onPage=self._add_page_decor)
        self.addPageTemplates([template])

    def _add_page_decor(self, canvas, doc):
        canvas.saveState()
        # Top thin stripe
        canvas.setFillColor(C_TEAL)
        canvas.rect(0, A4[1]-8, A4[0], 8, fill=1, stroke=0)
        # Bottom thin stripe
        canvas.setFillColor(C_NAVY)
        canvas.rect(0, 0, A4[0], 20, fill=1, stroke=0)
        # Footer text
        canvas.setFillColor(C_WHITE)
        canvas.setFont("Helvetica", 7)
        canvas.drawString(15*mm, 7, "NEET PG Surgery Rapid Revision Notes  |  2-Day Complete Revision")
        canvas.drawRightString(A4[0]-15*mm, 7, f"Page {doc.page}")
        canvas.restoreState()


def main():
    doc = SurgeryDoc(
        OUTPUT,
        pagesize=A4,
        leftMargin=18*mm, rightMargin=18*mm,
        topMargin=16*mm, bottomMargin=22*mm,
        title="NEET PG Surgery Rapid Revision Notes",
        author="Orris AI",
    )
    story = build_story()
    doc.build(story)
    print(f"PDF generated: {OUTPUT}")

if __name__ == "__main__":
    main()

<!DOCTYPE html>
<html lang="en">
<head>
<meta charset="UTF-8">
<meta name="viewport" content="width=device-width, initial-scale=1.0">
<title>Surgery 700+ Bootcamp Atlas - Page 1</title>
<style>
  @import url('https://fonts.googleapis.com/css2?family=Montserrat:wght@400;500;600;700;800;900&display=swap');

  * { margin: 0; padding: 0; box-sizing: border-box; }

  body {
    font-family: 'Montserrat', Arial, sans-serif;
    background: white;
    width: 794px;
    min-height: 1123px;
    font-size: 7.5px;
    color: #1a1a2e;
  }

  /* ── HEADER ── */
  .header {
    background: #0B1B3D;
    padding: 7px 12px 5px 12px;
    display: flex;
    align-items: center;
    justify-content: space-between;
  }
  .page-num {
    background: #0B1B3D;
    border: 2px solid #fff;
    color: white;
    font-weight: 900;
    font-size: 11px;
    padding: 4px 8px;
    text-align: center;
    line-height: 1.1;
    min-width: 40px;
  }
  .page-num span { font-size: 7px; font-weight: 600; display: block; }
  .header-center { text-align: center; flex: 1; }
  .main-title {
    color: white;
    font-size: 22px;
    font-weight: 900;
    letter-spacing: 0.5px;
    text-transform: uppercase;
    line-height: 1.1;
  }
  .main-title span { color: #FFD700; }
  .sub-title {
    color: #b0c4de;
    font-size: 9px;
    font-weight: 700;
    letter-spacing: 2px;
    text-transform: uppercase;
    margin: 2px 0;
  }
  .badges {
    display: flex;
    justify-content: center;
    gap: 14px;
    margin-top: 3px;
  }
  .badge {
    color: #FFD700;
    font-size: 7px;
    font-weight: 700;
    letter-spacing: 0.5px;
  }
  .badge::before { content: "★ "; }
  .vision-box {
    background: #1a3a6b;
    border: 1.5px solid #FFD700;
    border-radius: 6px;
    padding: 5px 8px;
    text-align: center;
    min-width: 80px;
  }
  .vision-box .vtitle {
    color: #FFD700;
    font-weight: 900;
    font-size: 9px;
    letter-spacing: 1px;
  }
  .vision-box .vtext {
    color: white;
    font-size: 6.5px;
    line-height: 1.5;
    font-weight: 600;
  }

  /* ── MAIN BODY ── */
  .body { padding: 6px 8px; background: white; }

  /* ── TOP SECTION: TWO COLUMNS + MIND MAP ── */
  .top-section {
    display: grid;
    grid-template-columns: 178px 1fr 178px;
    gap: 6px;
    margin-bottom: 6px;
  }

  .domain-box {
    border-radius: 8px;
    overflow: hidden;
    border: 1.5px solid;
  }
  .domain-box.left { border-color: #9b1d6e; }
  .domain-box.right { border-color: #007878; }

  .domain-header {
    padding: 4px 6px;
    color: white;
    font-weight: 800;
    font-size: 7.5px;
    text-transform: uppercase;
    text-align: center;
    letter-spacing: 0.5px;
  }
  .domain-box.left .domain-header { background: #9b1d6e; }
  .domain-box.right .domain-header { background: #007878; }

  .domain-list { padding: 5px 6px; }
  .domain-item {
    display: flex;
    align-items: flex-start;
    gap: 5px;
    margin-bottom: 5px;
  }
  .domain-icon {
    width: 18px;
    height: 18px;
    border-radius: 50%;
    display: flex;
    align-items: center;
    justify-content: center;
    flex-shrink: 0;
    font-size: 9px;
  }
  .domain-box.left .domain-icon { background: #f4d0e8; }
  .domain-box.right .domain-icon { background: #d0f0ef; }
  .domain-item-text { flex: 1; }
  .domain-item-title {
    font-weight: 800;
    font-size: 7px;
    color: #1a1a2e;
    line-height: 1.2;
  }
  .domain-item-sub {
    font-size: 6px;
    color: #555;
    line-height: 1.3;
    margin-top: 1px;
  }

  /* ── MIND MAP ── */
  .mindmap-container {
    display: flex;
    align-items: center;
    justify-content: center;
    position: relative;
  }
  .mindmap-svg { width: 100%; height: 290px; }

  /* ── MIDDLE THREE COLUMNS ── */
  .middle-section {
    display: grid;
    grid-template-columns: 1fr 1fr 1fr;
    gap: 6px;
    margin-bottom: 6px;
  }

  .card {
    border-radius: 8px;
    overflow: hidden;
    border: 1.5px solid;
  }
  .card-header {
    padding: 4px 8px;
    color: white;
    font-weight: 800;
    font-size: 7.5px;
    text-transform: uppercase;
    text-align: center;
    letter-spacing: 0.5px;
  }
  .card-body { padding: 5px 6px; }

  /* Gold Standards */
  .card.gold { border-color: #007878; }
  .card.gold .card-header { background: #007878; }
  .gold-row {
    display: flex;
    align-items: flex-start;
    gap: 4px;
    margin-bottom: 3.5px;
    font-size: 6.5px;
    line-height: 1.3;
  }
  .gold-check {
    width: 14px; height: 14px;
    background: #007878;
    border-radius: 50%;
    color: white;
    font-size: 8px;
    font-weight: 900;
    display: flex; align-items: center; justify-content: center;
    flex-shrink: 0;
    margin-top: 1px;
  }
  .gold-condition { font-weight: 700; color: #0B1B3D; flex: 1; }
  .gold-answer { color: #007878; font-weight: 700; flex: 1; text-align: right; }

  /* Key Principles */
  .card.principles { border-color: #e07b3a; }
  .card.principles .card-header { background: #e07b3a; }
  .principle-row {
    display: flex;
    align-items: center;
    gap: 5px;
    margin-bottom: 2.5px;
    font-size: 6.5px;
  }
  .principle-letter {
    width: 14px; height: 14px;
    border-radius: 3px;
    color: white;
    font-weight: 900;
    font-size: 8px;
    display: flex; align-items: center; justify-content: center;
    flex-shrink: 0;
  }

  /* High Yield */
  .card.highyield { border-color: #6a0dad; }
  .card.highyield .card-header { background: #6a0dad; }
  .hy-row {
    display: flex;
    align-items: flex-start;
    gap: 4px;
    margin-bottom: 3px;
    font-size: 6.5px;
    line-height: 1.35;
  }
  .hy-star { color: #6a0dad; font-size: 9px; flex-shrink: 0; margin-top: 0px; }
  .hy-text { color: #1a1a2e; }
  .hy-text b { color: #6a0dad; }
  .hy-warn { color: #c0392b; font-size: 9px; margin-left: 3px; }

  /* ── LOWER SECTION ── */
  .lower-section {
    display: grid;
    grid-template-columns: 175px 1fr 155px;
    gap: 6px;
    margin-bottom: 6px;
  }

  .def-box {
    background: #eaf4fb;
    border: 1.5px solid #2980b9;
    border-radius: 8px;
    padding: 5px 7px;
  }
  .def-title {
    background: #2980b9;
    color: white;
    font-weight: 800;
    font-size: 7px;
    text-transform: uppercase;
    padding: 3px 6px;
    border-radius: 4px;
    margin: -5px -7px 5px -7px;
    text-align: center;
    letter-spacing: 0.5px;
  }
  .def-item {
    font-size: 6.5px;
    margin-bottom: 2.5px;
    line-height: 1.35;
    color: #1a1a2e;
  }
  .def-item b { color: #2980b9; }

  .abbr-box {
    background: #f8f9fa;
    border: 1.5px solid #6c757d;
    border-radius: 8px;
    padding: 5px 7px;
  }
  .abbr-title {
    background: #495057;
    color: white;
    font-weight: 800;
    font-size: 7px;
    text-transform: uppercase;
    padding: 3px 6px;
    border-radius: 4px;
    margin: -5px -7px 5px -7px;
    text-align: center;
    letter-spacing: 0.5px;
  }
  .abbr-grid {
    display: grid;
    grid-template-columns: 1fr 1fr 1fr;
    gap: 2px;
  }
  .abbr-item {
    font-size: 6px;
    line-height: 1.4;
    color: #1a1a2e;
  }
  .abbr-item b { color: #c0392b; }

  .exam-box {
    background: #fdf2f8;
    border: 1.5px solid #9b1d6e;
    border-radius: 8px;
    padding: 5px 7px;
  }
  .exam-title {
    background: #9b1d6e;
    color: white;
    font-weight: 800;
    font-size: 7px;
    text-transform: uppercase;
    padding: 3px 6px;
    border-radius: 4px;
    margin: -5px -7px 5px -7px;
    text-align: center;
    letter-spacing: 0.5px;
  }
  .exam-step {
    display: flex;
    align-items: flex-start;
    gap: 4px;
    margin-bottom: 3px;
    font-size: 6.5px;
    line-height: 1.3;
  }
  .step-num {
    background: #9b1d6e;
    color: white;
    border-radius: 50%;
    width: 13px; height: 13px;
    font-size: 7px;
    font-weight: 800;
    display: flex; align-items: center; justify-content: center;
    flex-shrink: 0;
  }

  /* ── FOOTER CALLOUTS ── */
  .footer-cards {
    display: grid;
    grid-template-columns: 1fr 1fr 1fr 1fr;
    gap: 5px;
    margin-bottom: 5px;
  }
  .footer-card {
    border-radius: 7px;
    padding: 5px 7px;
    border: 1.5px solid;
  }
  .footer-card-title {
    font-weight: 800;
    font-size: 7.5px;
    margin-bottom: 3px;
    display: flex;
    align-items: center;
    gap: 4px;
    text-transform: uppercase;
  }
  .footer-card-icon { font-size: 10px; }
  .footer-card-text { font-size: 6px; line-height: 1.45; }

  .fc-pyq { background: #fffce6; border-color: #f1c40f; }
  .fc-pyq .footer-card-title { color: #9b7c00; }
  .fc-ini { background: #eaf4fb; border-color: #2980b9; }
  .fc-ini .footer-card-title { color: #1a5276; }
  .fc-trap { background: #fdf2f2; border-color: #c0392b; }
  .fc-trap .footer-card-title { color: #c0392b; }
  .fc-mantra { background: #f4eafd; border-color: #8e44ad; }
  .fc-mantra .footer-card-title { color: #6c3483; }

  .mantra-flow {
    font-size: 7.5px;
    font-weight: 800;
    color: #6c3483;
    text-align: center;
    margin-top: 3px;
  }

  /* ── BOTTOM BAR ── */
  .bottom-bar {
    background: #0B1B3D;
    color: #FFD700;
    text-align: center;
    padding: 5px;
    font-size: 7.5px;
    font-weight: 800;
    letter-spacing: 0.5px;
    text-transform: uppercase;
    border-radius: 0 0 4px 4px;
  }

  /* ── PYQ BOX within sections ── */
  .pyq-inline {
    background: #fffce6;
    border-left: 3px solid #f39c12;
    border-radius: 4px;
    padding: 3px 5px;
    margin-top: 3px;
    font-size: 6px;
    line-height: 1.4;
  }
  .pyq-inline-title {
    color: #c27c00;
    font-weight: 800;
    font-size: 6.5px;
    margin-bottom: 2px;
  }
</style>
</head>
<body>

<!-- HEADER -->
<div class="header">
  <div class="page-num"><span>PAGE</span>1</div>
  <div class="header-center">
    <div class="main-title">SURGERY <span>700+</span> BOOTCAMP ATLAS</div>
    <div class="sub-title">Master Map of General Surgery &amp; Surgical Specialties</div>
    <div class="badges">
      <span class="badge">High Yield</span>
      <span class="badge">Exam Focused</span>
      <span class="badge">Concept Based</span>
      <span class="badge">PYQ Driven</span>
    </div>
  </div>
  <div class="vision-box">
    <div class="vtitle">🎯 VISION</div>
    <div class="vtext">Understand<br>Organize<br>Remember<br>Score 700+</div>
  </div>
</div>

<!-- MAIN BODY -->
<div class="body">

  <!-- TOP SECTION -->
  <div class="top-section">

    <!-- LEFT: General Surgery Domains -->
    <div class="domain-box left">
      <div class="domain-header">General Surgery – Core Domains</div>
      <div class="domain-list">
        <div class="domain-item">
          <div class="domain-icon">🔪</div>
          <div class="domain-item-text">
            <div class="domain-item-title">Wound Healing &amp; Infection</div>
            <div class="domain-item-sub">Phases, Collagen types, SSI, Dehiscence</div>
          </div>
        </div>
        <div class="domain-item">
          <div class="domain-icon">💉</div>
          <div class="domain-item-text">
            <div class="domain-item-title">Shock &amp; Resuscitation</div>
            <div class="domain-item-sub">Hypovolaemic, Septic, Neurogenic, Obstructive</div>
          </div>
        </div>
        <div class="domain-item">
          <div class="domain-icon">🔥</div>
          <div class="domain-item-text">
            <div class="domain-item-title">Burns &amp; Trauma</div>
            <div class="domain-item-sub">Rule of Nines, Parkland, ATLS, ABCDE</div>
          </div>
        </div>
        <div class="domain-item">
          <div class="domain-icon">🏥</div>
          <div class="domain-item-text">
            <div class="domain-item-title">Acute Abdomen</div>
            <div class="domain-item-sub">Appendicitis, Peritonitis, Obstruction, Perforation</div>
          </div>
        </div>
        <div class="domain-item">
          <div class="domain-icon">♻️</div>
          <div class="domain-item-text">
            <div class="domain-item-title">Sterilisation &amp; Asepsis</div>
            <div class="domain-item-sub">Autoclave, EO, Glutaraldehyde, Drains, Sutures</div>
          </div>
        </div>
        <div class="domain-item">
          <div class="domain-icon">🩸</div>
          <div class="domain-item-text">
            <div class="domain-item-title">Preoperative Assessment</div>
            <div class="domain-item-sub">ASA Grade, Risk factors, Blood transfusion, DVT prophylaxis</div>
          </div>
        </div>
        <div class="domain-item">
          <div class="domain-icon">⚕️</div>
          <div class="domain-item-text">
            <div class="domain-item-title">Postoperative Complications</div>
            <div class="domain-item-sub">Fever, DVT/PE, Ileus, Anastomotic leak, Pulmonary</div>
          </div>
        </div>
      </div>
    </div>

    <!-- CENTER: Mind Map SVG -->
    <div class="mindmap-container">
      <svg class="mindmap-svg" viewBox="0 0 438 290" xmlns="http://www.w3.org/2000/svg">
        <!-- Background -->
        <rect width="438" height="290" fill="white"/>

        <!-- Petal paths (8 petals around center) -->
        <!-- Top: Emergency Surgery -->
        <ellipse cx="219" cy="60" rx="54" ry="28" fill="#c0392b" opacity="0.85" transform="rotate(0,219,145)"/>
        <!-- Top-right: GI Surgery -->
        <ellipse cx="219" cy="60" rx="54" ry="28" fill="#e67e22" opacity="0.85" transform="rotate(45,219,145)"/>
        <!-- Right: Hepatobiliary -->
        <ellipse cx="219" cy="60" rx="54" ry="28" fill="#f39c12" opacity="0.85" transform="rotate(90,219,145)"/>
        <!-- Bottom-right: Urology -->
        <ellipse cx="219" cy="60" rx="54" ry="28" fill="#27ae60" opacity="0.85" transform="rotate(135,219,145)"/>
        <!-- Bottom: Vascular -->
        <ellipse cx="219" cy="60" rx="54" ry="28" fill="#16a085" opacity="0.85" transform="rotate(180,219,145)"/>
        <!-- Bottom-left: Hernia -->
        <ellipse cx="219" cy="60" rx="54" ry="28" fill="#2980b9" opacity="0.85" transform="rotate(225,219,145)"/>
        <!-- Left: Breast+Thyroid -->
        <ellipse cx="219" cy="60" rx="54" ry="28" fill="#8e44ad" opacity="0.85" transform="rotate(270,219,145)"/>
        <!-- Top-left: Paeds+Onco -->
        <ellipse cx="219" cy="60" rx="54" ry="28" fill="#9b1d6e" opacity="0.85" transform="rotate(315,219,145)"/>

        <!-- Center circle (white mask) -->
        <circle cx="219" cy="145" r="60" fill="white"/>
        <!-- Center circle dark -->
        <circle cx="219" cy="145" r="58" fill="#0B1B3D" stroke="#FFD700" stroke-width="2.5"/>
        <!-- Center inner ring -->
        <circle cx="219" cy="145" r="53" fill="none" stroke="#FFD700" stroke-width="1" opacity="0.4"/>

        <!-- Center text -->
        <text x="219" y="130" text-anchor="middle" fill="white" font-family="Montserrat,Arial" font-size="9" font-weight="900">SURGERY</text>
        <text x="219" y="143" text-anchor="middle" fill="#FFD700" font-family="Montserrat,Arial" font-size="11" font-weight="900">MASTER MAP</text>
        <text x="219" y="155" text-anchor="middle" fill="#b0c4de" font-family="Montserrat,Arial" font-size="6" font-weight="600">Think Systematically</text>
        <text x="219" y="164" text-anchor="middle" fill="#b0c4de" font-family="Montserrat,Arial" font-size="6" font-weight="600">Score Consistently</text>
        <text x="219" y="176" text-anchor="middle" font-size="14">🧠</text>

        <!-- Petal labels -->
        <!-- TOP: Emergency Surgery -->
        <text x="219" y="19" text-anchor="middle" fill="white" font-family="Montserrat,Arial" font-size="7" font-weight="800">EMERGENCY</text>
        <text x="219" y="28" text-anchor="middle" fill="white" font-family="Montserrat,Arial" font-size="6.5">Shock, Trauma</text>
        <text x="219" y="37" text-anchor="middle" fill="white" font-family="Montserrat,Arial" font-size="6.5">Burns, ATLS</text>

        <!-- TOP-RIGHT: GI Surgery -->
        <text x="314" y="57" text-anchor="middle" fill="white" font-family="Montserrat,Arial" font-size="7" font-weight="800">GI SURGERY</text>
        <text x="320" y="66" text-anchor="middle" fill="white" font-family="Montserrat,Arial" font-size="6">Appendix, Bowel</text>
        <text x="320" y="74" text-anchor="middle" fill="white" font-family="Montserrat,Arial" font-size="6">PUD, Obstruction</text>

        <!-- RIGHT: Hepatobiliary -->
        <text x="366" y="138" text-anchor="middle" fill="white" font-family="Montserrat,Arial" font-size="7" font-weight="800">HEPATO-</text>
        <text x="366" y="147" text-anchor="middle" fill="white" font-family="Montserrat,Arial" font-size="7" font-weight="800">BILIARY</text>
        <text x="366" y="157" text-anchor="middle" fill="white" font-family="Montserrat,Arial" font-size="6">Gallstones</text>
        <text x="366" y="165" text-anchor="middle" fill="white" font-family="Montserrat,Arial" font-size="6">Pancreatitis</text>

        <!-- BOTTOM-RIGHT: Urology -->
        <text x="314" y="222" text-anchor="middle" fill="white" font-family="Montserrat,Arial" font-size="7" font-weight="800">UROLOGY</text>
        <text x="314" y="232" text-anchor="middle" fill="white" font-family="Montserrat,Arial" font-size="6">Stones, BPH</text>
        <text x="314" y="240" text-anchor="middle" fill="white" font-family="Montserrat,Arial" font-size="6">Bladder CA</text>

        <!-- BOTTOM: Vascular -->
        <text x="219" y="256" text-anchor="middle" fill="white" font-family="Montserrat,Arial" font-size="7" font-weight="800">VASCULAR</text>
        <text x="219" y="265" text-anchor="middle" fill="white" font-family="Montserrat,Arial" font-size="6">AAA, DVT, PE</text>
        <text x="219" y="273" text-anchor="middle" fill="white" font-family="Montserrat,Arial" font-size="6">Varicose Veins</text>

        <!-- BOTTOM-LEFT: Hernia -->
        <text x="124" y="222" text-anchor="middle" fill="white" font-family="Montserrat,Arial" font-size="7" font-weight="800">HERNIA</text>
        <text x="124" y="232" text-anchor="middle" fill="white" font-family="Montserrat,Arial" font-size="6">Inguinal, Femoral</text>
        <text x="124" y="240" text-anchor="middle" fill="white" font-family="Montserrat,Arial" font-size="6">Special Hernias</text>

        <!-- LEFT: Breast+Thyroid -->
        <text x="72" y="138" text-anchor="middle" fill="white" font-family="Montserrat,Arial" font-size="7" font-weight="800">BREAST &amp;</text>
        <text x="72" y="147" text-anchor="middle" fill="white" font-family="Montserrat,Arial" font-size="7" font-weight="800">THYROID</text>
        <text x="72" y="157" text-anchor="middle" fill="white" font-family="Montserrat,Arial" font-size="6">Carcinoma</text>
        <text x="72" y="165" text-anchor="middle" fill="white" font-family="Montserrat,Arial" font-size="6">Goitre, MEN</text>

        <!-- TOP-LEFT: Paeds+Onco -->
        <text x="124" y="57" text-anchor="middle" fill="white" font-family="Montserrat,Arial" font-size="7" font-weight="800">PAEDS &amp;</text>
        <text x="124" y="66" text-anchor="middle" fill="white" font-family="Montserrat,Arial" font-size="7" font-weight="800">ONCOLOGY</text>
        <text x="118" y="76" text-anchor="middle" fill="white" font-family="Montserrat,Arial" font-size="6">Tumour Markers</text>
      </svg>
    </div>

    <!-- RIGHT: Surgical Specialty Domains -->
    <div class="domain-box right">
      <div class="domain-header">Surgical Specialties – Core Domains</div>
      <div class="domain-list">
        <div class="domain-item">
          <div class="domain-icon">🔬</div>
          <div class="domain-item-text">
            <div class="domain-item-title">Breast Surgery</div>
            <div class="domain-item-sub">Carcinoma, Staging, Mastectomy, SLNB</div>
          </div>
        </div>
        <div class="domain-item">
          <div class="domain-icon">🦋</div>
          <div class="domain-item-text">
            <div class="domain-item-title">Thyroid &amp; Parathyroid</div>
            <div class="domain-item-sub">Cancer types, MEN syndromes, Calcitonin</div>
          </div>
        </div>
        <div class="domain-item">
          <div class="domain-icon">🫘</div>
          <div class="domain-item-text">
            <div class="domain-item-title">Hepatobiliary Surgery</div>
            <div class="domain-item-sub">Gallstones, CBD, Pancreatitis, Liver abscess</div>
          </div>
        </div>
        <div class="domain-item">
          <div class="domain-icon">🫁</div>
          <div class="domain-item-text">
            <div class="domain-item-title">Urology</div>
            <div class="domain-item-sub">Renal stones, BPH, Bladder/Prostate CA</div>
          </div>
        </div>
        <div class="domain-item">
          <div class="domain-icon">🩻</div>
          <div class="domain-item-text">
            <div class="domain-item-title">Vascular Surgery</div>
            <div class="domain-item-sub">AAA, DVT/PE, Varicose veins, PVD</div>
          </div>
        </div>
        <div class="domain-item">
          <div class="domain-icon">👶</div>
          <div class="domain-item-text">
            <div class="domain-item-title">Paediatric Surgery</div>
            <div class="domain-item-sub">Pyloric stenosis, Intussusception, Hirschsprung</div>
          </div>
        </div>
        <div class="domain-item">
          <div class="domain-icon">🎗️</div>
          <div class="domain-item-text">
            <div class="domain-item-title">Surgical Oncology</div>
            <div class="domain-item-sub">TNM staging, Tumour markers, Biopsy types</div>
          </div>
        </div>
      </div>
    </div>
  </div>

  <!-- MIDDLE 3 COLUMNS -->
  <div class="middle-section">

    <!-- Gold Standards -->
    <div class="card gold">
      <div class="card-header">🏆 Gold Standards in Surgery</div>
      <div class="card-body">
        <div class="gold-row"><div class="gold-check">✓</div><span class="gold-condition">Acute Appendicitis</span><span class="gold-answer">CT Scan (94–98% sensitivity)</span></div>
        <div class="gold-row"><div class="gold-check">✓</div><span class="gold-condition">Gallstones (Cholelithiasis)</span><span class="gold-answer">Ultrasound (USG)</span></div>
        <div class="gold-row"><div class="gold-check">✓</div><span class="gold-condition">Ureteric Colic / Stone</span><span class="gold-answer">Non-contrast CT-KUB</span></div>
        <div class="gold-row"><div class="gold-check">✓</div><span class="gold-condition">Breast Lump</span><span class="gold-answer">Triple Assessment (Clinic+Imaging+Biopsy)</span></div>
        <div class="gold-row"><div class="gold-check">✓</div><span class="gold-condition">Pancreatitis Complications</span><span class="gold-answer">CECT Abdomen (Balthazar)</span></div>
        <div class="gold-row"><div class="gold-check">✓</div><span class="gold-condition">DVT</span><span class="gold-answer">Doppler Ultrasound</span></div>
        <div class="gold-row"><div class="gold-check">✓</div><span class="gold-condition">Pulmonary Embolism</span><span class="gold-answer">CT Pulmonary Angiography (CTPA)</span></div>
        <div class="gold-row"><div class="gold-check">✓</div><span class="gold-condition">Hirschsprung's Disease</span><span class="gold-answer">Rectal Biopsy (absent ganglion cells)</span></div>
        <div class="gold-row"><div class="gold-check">✓</div><span class="gold-condition">Pyloric Stenosis</span><span class="gold-answer">Ultrasound (muscle thickness >4mm)</span></div>
        <div class="gold-row"><div class="gold-check">✓</div><span class="gold-condition">Meckel's Diverticulum</span><span class="gold-answer">Tc-99m Pertechnetate Scan</span></div>
        <div class="gold-row"><div class="gold-check">✓</div><span class="gold-condition">AAA (Screening)</span><span class="gold-answer">Ultrasound; CT Angiography for repair planning</span></div>
        <div class="gold-row"><div class="gold-check">✓</div><span class="gold-condition">Follicular Thyroid CA</span><span class="gold-answer">Histopathology (capsular invasion)</span></div>
      </div>
    </div>

    <!-- Key Principles -->
    <div class="card principles">
      <div class="card-header">⚡ Key Principles – S·U·R·G·E·O·N</div>
      <div class="card-body">
        <div style="font-size:6px; color:#888; margin-bottom:4px; font-style:italic;">Remember the SURGEON framework for every case</div>

        <div class="principle-row"><div class="principle-letter" style="background:#c0392b">S</div><span><b>Stabilise first</b> – ABC before definitive surgery</span></div>
        <div class="principle-row"><div class="principle-letter" style="background:#e67e22">U</div><span><b>Understand anatomy</b> – landmarks, boundaries, relations</span></div>
        <div class="principle-row"><div class="principle-letter" style="background:#f39c12">R</div><span><b>Resuscitate appropriately</b> – RL for hypovolaemia, correct electrolytes</span></div>
        <div class="principle-row"><div class="principle-letter" style="background:#27ae60">G</div><span><b>Gold standard investigations</b> – order the right test first</span></div>
        <div class="principle-row"><div class="principle-letter" style="background:#16a085">E</div><span><b>Exclude malignancy</b> – always biopsy suspicious lesions</span></div>
        <div class="principle-row"><div class="principle-letter" style="background:#2980b9">O</div><span><b>Operate with a plan</b> – consent, anaesthesia, prophylaxis</span></div>
        <div class="principle-row"><div class="principle-letter" style="background:#8e44ad">N</div><span><b>Next best step</b> – NEET PG always asks "what next?"</span></div>

        <div style="height:5px"></div>
        <div style="font-size:7px; font-weight:800; color:#e07b3a; margin-bottom:3px; border-top:1px solid #f5cba7; padding-top:4px;">CLINICAL APPROACH TO ACUTE ABDOMEN</div>
        <div class="principle-row"><div class="principle-letter" style="background:#c0392b">1</div><span>Rule out <b>perforation</b> – erect CXR (gas under diaphragm)</span></div>
        <div class="principle-row"><div class="principle-letter" style="background:#e67e22">2</div><span>Rule out <b>obstruction</b> – AXR (dilated loops, air-fluid levels)</span></div>
        <div class="principle-row"><div class="principle-letter" style="background:#27ae60">3</div><span>Suspect <b>appendicitis</b> – RIF pain + Alvarado score</span></div>
        <div class="principle-row"><div class="principle-letter" style="background:#2980b9">4</div><span>Check <b>hernia orifices</b> – always examine groin in obstruction</span></div>
        <div class="principle-row"><div class="principle-letter" style="background:#8e44ad">5</div><span><b>Digital PR exam</b> – mandatory in acute abdomen</span></div>
      </div>
    </div>

    <!-- High Yield Fact File -->
    <div class="card highyield">
      <div class="card-header">★ High Yield Fact File</div>
      <div class="card-body">
        <div class="hy-row"><span class="hy-star">★</span><span class="hy-text">Most common cause SB obstruction: <b>Adhesions</b> (post-op)</span></div>
        <div class="hy-row"><span class="hy-star">★</span><span class="hy-text">Most common LB obstruction: <b>Carcinoma colon</b></span></div>
        <div class="hy-row"><span class="hy-star">★</span><span class="hy-text">Most common position of appendix: <b>Retrocaecal (65%)</b></span></div>
        <div class="hy-row"><span class="hy-star">★</span><span class="hy-text">Most common thyroid cancer: <b>Papillary carcinoma</b></span></div>
        <div class="hy-row"><span class="hy-star">★</span><span class="hy-text">Most common breast cancer: <b>Invasive Ductal Carcinoma</b></span></div>
        <div class="hy-row"><span class="hy-star">★</span><span class="hy-text">Most common renal stone: <b>Calcium oxalate (70-80%)</b></span></div>
        <div class="hy-row"><span class="hy-star">★</span><span class="hy-text">Only radiolucent stone: <b>Uric acid</b><span class="hy-warn">!</span></span></div>
        <div class="hy-row"><span class="hy-star">★</span><span class="hy-text">Most common cause of pancreatitis in India: <b>Gallstones</b></span></div>
        <div class="hy-row"><span class="hy-star">★</span><span class="hy-text">Staghorn calculus: <b>Struvite (Proteus mirabilis)</b></span></div>
        <div class="hy-row"><span class="hy-star">★</span><span class="hy-text">Most common hernia overall: <b>Indirect Inguinal</b></span></div>
        <div class="hy-row"><span class="hy-star">★</span><span class="hy-text">Hernia that strangulates WITHOUT obstruction: <b>Richter's</b><span class="hy-warn">!</span></span></div>
        <div class="hy-row"><span class="hy-star">★</span><span class="hy-text">Best prognosis thyroid CA: <b>Papillary</b>; Worst: <b>Anaplastic</b></span></div>
        <div class="hy-row"><span class="hy-star">★</span><span class="hy-text">Wound tensile strength max: <b>80%</b> at 3 months<span class="hy-warn">!</span></span></div>
        <div class="hy-row"><span class="hy-star">★</span><span class="hy-text">Most important cell in wound healing: <b>Macrophage</b></span></div>
        <div class="hy-row"><span class="hy-star">★</span><span class="hy-text">Collagen first synthesized: <b>Type III</b> → replaced by <b>Type I</b></span></div>
        <div class="hy-row"><span class="hy-star">★</span><span class="hy-text">Rule of nines – lower limb: <b>18%</b>; Upper limb: <b>9%</b></span></div>
        <div class="hy-row"><span class="hy-star">★</span><span class="hy-text">Parkland formula fluid: <b>Ringer's Lactate</b> (Muir-Barclay: Colloid)</span></div>
        <div class="hy-row"><span class="hy-star">★</span><span class="hy-text">MEN 2A: Medullary thyroid CA + <b>Phaeochromocytoma</b> + HPT</span></div>
      </div>
    </div>

  </div>

  <!-- LOWER SECTION -->
  <div class="lower-section">

    <!-- Important Definitions -->
    <div class="def-box">
      <div class="def-title">Important Definitions</div>
      <div class="def-item">• <b>Class I Shock:</b> Blood loss &lt;15% (&lt;750mL), HR &lt;100, BP normal</div>
      <div class="def-item">• <b>Class III Shock:</b> 30–40% loss, BP drops, confused patient</div>
      <div class="def-item">• <b>Clean wound (Class I):</b> Elective, no hollow organ entered, &lt;5% infection</div>
      <div class="def-item">• <b>Alvarado score 7–10:</b> High probability appendicitis → surgery</div>
      <div class="def-item">• <b>Major burn adult:</b> &gt;15% TBSA; Child: &gt;10% TBSA</div>
      <div class="def-item">• <b>AAA repair indicated:</b> Diameter &gt;5.5 cm or expanding &gt;1 cm/yr</div>
      <div class="def-item">• <b>Viable bowel (ischaemia):</b> Pink colour, peristalsis, arterial pulsation</div>
      <div class="def-item">• <b>Meckel's Rule of 2s:</b> 2%, 2 inches, 2 feet, 2 types, 2:1 M:F</div>
      <div class="def-item">• <b>Hernia strangulation:</b> Bowel ischaemia – needs URGENT surgery</div>
    </div>

    <!-- Abbreviations -->
    <div class="abbr-box">
      <div class="abbr-title">Abbreviations – Must Know</div>
      <div class="abbr-grid">
        <div>
          <div class="abbr-item"><b>ATLS</b> – Advanced Trauma Life Support</div>
          <div class="abbr-item"><b>FAST</b> – Focused Assessment Sonography in Trauma</div>
          <div class="abbr-item"><b>SSI</b> – Surgical Site Infection</div>
          <div class="abbr-item"><b>DVT</b> – Deep Vein Thrombosis</div>
          <div class="abbr-item"><b>PE</b> – Pulmonary Embolism</div>
          <div class="abbr-item"><b>CTPA</b> – CT Pulmonary Angiography</div>
          <div class="abbr-item"><b>LMWH</b> – Low Molecular Weight Heparin</div>
          <div class="abbr-item"><b>AAA</b> – Abdominal Aortic Aneurysm</div>
          <div class="abbr-item"><b>EVAR</b> – Endovascular Aneurysm Repair</div>
        </div>
        <div>
          <div class="abbr-item"><b>ERCP</b> – Endoscopic Retrograde Cholangiopancreatography</div>
          <div class="abbr-item"><b>PCNL</b> – Percutaneous Nephrolithotomy</div>
          <div class="abbr-item"><b>ESWL</b> – Extracorporeal Shock Wave Lithotripsy</div>
          <div class="abbr-item"><b>TURP</b> – TransUrethral Resection of Prostate</div>
          <div class="abbr-item"><b>BPH</b> – Benign Prostatic Hyperplasia</div>
          <div class="abbr-item"><b>FNAC</b> – Fine Needle Aspiration Cytology</div>
          <div class="abbr-item"><b>SLNB</b> – Sentinel Lymph Node Biopsy</div>
          <div class="abbr-item"><b>IDC</b> – Invasive Ductal Carcinoma</div>
          <div class="abbr-item"><b>TNM</b> – Tumour Node Metastasis staging</div>
        </div>
        <div>
          <div class="abbr-item"><b>PUD</b> – Peptic Ulcer Disease</div>
          <div class="abbr-item"><b>SBO</b> – Small Bowel Obstruction</div>
          <div class="abbr-item"><b>CBD</b> – Common Bile Duct</div>
          <div class="abbr-item"><b>RLN</b> – Recurrent Laryngeal Nerve</div>
          <div class="abbr-item"><b>RIF</b> – Right Iliac Fossa</div>
          <div class="abbr-item"><b>PR</b> – Per Rectum (digital rectal exam)</div>
          <div class="abbr-item"><b>NGT</b> – Nasogastric Tube</div>
          <div class="abbr-item"><b>ICS</b> – Intercostal Space</div>
          <div class="abbr-item"><b>TBSA</b> – Total Body Surface Area</div>
        </div>
      </div>
    </div>

    <!-- Exam Approach -->
    <div class="exam-box">
      <div class="exam-title">📋 Exam Approach</div>
      <div class="exam-step"><div class="step-num">1</div><span>Read the stem carefully – spot the key finding</span></div>
      <div class="exam-step"><div class="step-num">2</div><span>Identify the diagnosis or complication first</span></div>
      <div class="exam-step"><div class="step-num">3</div><span>Think pathophysiology – why does it happen?</span></div>
      <div class="exam-step"><div class="step-num">4</div><span>Apply NEXT BEST STEP logic (not ideal, but practical)</span></div>
      <div class="exam-step"><div class="step-num">5</div><span>Eliminate wrong options (2 usually clearly wrong)</span></div>
      <div class="exam-step"><div class="step-num">6</div><span>Choose the best answer – not the perfect one</span></div>
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  <!-- FOOTER CALLOUT CARDS -->
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    <div class="footer-card fc-pyq">
      <div class="footer-card-title"><span class="footer-card-icon">💡</span>PYQ Pearl</div>
      <div class="footer-card-text">
        &gt;60% surgery questions are case-based. Concept clarity + clinical reasoning = the key.<br><br>
        Focus: <b>Shock class + Burns formula + Hernia types + Appendicitis score + Stone types</b> – these repeat every year!
      </div>
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    <div class="footer-card fc-ini">
      <div class="footer-card-title"><span class="footer-card-icon">⭐</span>INI-CET Pearl</div>
      <div class="footer-card-text">
        INI-CET focuses on <b>algorithms</b>, next-best-step, first-line investigation, and complications.<br><br>
        Master: Alvarado score, Parkland formula, Ranson criteria, TNM staging, ATLS sequence.
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    <div class="footer-card fc-trap">
      <div class="footer-card-title"><span class="footer-card-icon">⚠️</span>Exam Trap</div>
      <div class="footer-card-text">
        • Don't confuse <b>Richter's</b> (no obstruction) with regular strangulation<br>
        • Uric acid stone = <b>radiolucent</b> – NOT seen on plain X-ray<br>
        • <b>Neurogenic shock</b> = Bradycardia (not tachycardia like all others!)<br>
        • Follicular CA: NOT diagnosed by FNAC – needs histopathology
      </div>
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    <div class="footer-card fc-mantra">
      <div class="footer-card-title"><span class="footer-card-icon">🧠</span>Quick Revision Mantra</div>
      <div class="footer-card-text">Revise topics systematically, then test yourself with PYQs, then apply in clinical MCQs.</div>
      <div class="mantra-flow">Revise → Recall → Apply → <span style="color:#c0392b">REPEAT!</span></div>
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    ★ CONSISTENT STUDY + SMART REVISION + PYQ PRACTICE = 700+ IS POSSIBLE ★
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<!-- ═══════════════════════════════════════════════════════════════
     PAGE 2: WOUNDS, SHOCK, BURNS & TRAUMA
════════════════════════════════════════════════════════════════ -->
<div class="page">
  <div class="pg-header">
    <div class="pg-num"><span>PAGE</span>2</div>
    <div style="flex:1;text-align:center">
      <div class="pg-title">Wounds · Shock · Burns · Trauma</div>
      <div class="pg-subtitle">⭐ General Surgery Principles | ATLS | Fluid Management</div>
    </div>
    <div class="pg-badge"><div class="bt">🔥 HIGH YIELD</div><div class="bs">Repeated Every Year<br>★★★★★</div></div>
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  <div class="body">

    <div class="two-col">
      <!-- WOUND HEALING -->
      <div>
        <div class="sec-header" style="background:#1e8449">🔬 Wound Healing – Phases</div>
        <div class="sec-body" style="border-color:#1e8449">
          <table>
            <tr><th class="green">Phase</th><th class="green">Timing</th><th class="green">Key Events</th><th class="green">Cells</th></tr>
            <tr><td><b>Haemostasis</b></td><td>Immediate</td><td>Vasoconstriction, platelet plug, fibrin clot</td><td>Platelets</td></tr>
            <tr><td><b>Inflammation</b></td><td>Day 1–4</td><td>Vasodilation, phagocytosis, debridement</td><td>Neutrophils (1–2d) → Macrophages</td></tr>
            <tr><td><b>Proliferation</b></td><td>Day 4–3wk</td><td>Fibroblasts, Type III collagen, angiogenesis, granulation tissue</td><td>Fibroblasts, Endothelial</td></tr>
            <tr><td><b>Remodelling</b></td><td>3wk–2yr</td><td>Type III → Type I collagen, wound contracts, scar matures</td><td>Myofibroblasts</td></tr>
          </table>
          <div class="red-box">
            <div class="red-box-title">🔴 Key Facts (PYQ)</div>
            <div class="li"><b>First collagen synthesised:</b> Type III → replaced by Type I</div>
            <div class="li"><b>Max tensile strength:</b> 80% of normal at 3 months (never 100%)</div>
            <div class="li"><b>Most important cell:</b> MACROPHAGE (orchestrates all phases)</div>
            <div class="li"><b>Wound contraction:</b> Myofibroblasts</div>
            <div class="li"><b>Vitamin C:</b> Essential for collagen cross-linking (hydroxylation of proline)</div>
            <div class="li"><b>Zinc deficiency:</b> Impaired wound healing (cofactor for DNA polymerase)</div>
          </div>
        </div>
      </div>

      <!-- SHOCK -->
      <div>
        <div class="sec-header" style="background:#c0392b">💉 Haemorrhagic Shock – ATLS Classification</div>
        <div class="sec-body" style="border-color:#c0392b">
          <table>
            <tr><th class="red">Class</th><th class="red">Blood Loss</th><th class="red">HR</th><th class="red">BP</th><th class="red">Urine</th><th class="red">Mental</th></tr>
            <tr><td><b>I</b></td><td>&lt;750mL (&lt;15%)</td><td>&lt;100</td><td>Normal</td><td>&gt;30mL/hr</td><td>Normal</td></tr>
            <tr><td><b>II</b></td><td>750–1500 (15–30%)</td><td>100–120</td><td>Normal</td><td>20–30</td><td>Anxious</td></tr>
            <tr class="highlight"><td><b>III</b></td><td>1500–2000 (30–40%)</td><td>120–140</td><td>↓</td><td>5–15</td><td>Confused</td></tr>
            <tr class="highlight"><td><b>IV</b></td><td>&gt;2000mL (&gt;40%)</td><td>&gt;140</td><td>Very low</td><td>&lt;5mL</td><td>Lethargic</td></tr>
          </table>
          <div class="green-box">
            <div class="green-box-title">💡 Shock Types – Must Know</div>
            <div class="li"><b>Neurogenic shock:</b> Bradycardia + hypotension (warm peripheries) – UNIQUE! <span class="hy-badge">TRAP</span></div>
            <div class="li"><b>Obstructive:</b> Tension PTX, Tamponade, Massive PE</div>
            <div class="li"><b>Beck's triad (tamponade):</b> Hypotension + Muffled sounds + Raised JVP</div>
            <div class="li"><b>First line fluid:</b> Ringer's Lactate (Hartmann's) via 2 large-bore IV</div>
            <div class="li"><b>Urine target:</b> 0.5 mL/kg/hr adult; 1 mL/kg/hr child</div>
          </div>
        </div>
      </div>
    </div>

    <!-- BURNS - Full width -->
    <div class="sec-header" style="background:#e07b3a">🔥 Burns – Classification, Rule of Nines & Fluid Resuscitation</div>
    <div class="sec-body" style="border-color:#e07b3a">
      <div class="three-col">
        <div>
          <table>
            <tr><th class="orange">Rule of Nines (Adult)</th><th class="orange">% TBSA</th></tr>
            <tr><td><b>Head + Neck</b></td><td>9% (Head 7%, Neck 2%)</td></tr>
            <tr><td><b>Each Upper Limb</b></td><td>9% each (18% total)</td></tr>
            <tr><td><b>Anterior Trunk</b></td><td>18% (Chest 9% + Abd 9%)</td></tr>
            <tr><td><b>Posterior Trunk</b></td><td>18%</td></tr>
            <tr><td><b>Each Lower Limb</b></td><td>18% each (36% total)</td></tr>
            <tr><td><b>Perineum</b></td><td>1%</td></tr>
          </table>
          <div class="blue-box" style="margin-top:4px">
            <div class="blue-box-title">💡 Children</div>
            <div class="li">Use <b>Lund &amp; Browder Chart</b> – more accurate</div>
            <div class="li">Head proportionally larger (18% at birth)</div>
            <div class="li">Palm method: 1% TBSA for patchy burns</div>
          </div>
        </div>
        <div>
          <table>
            <tr><th class="orange">Depth</th><th class="orange">Features</th><th class="orange">Sensation</th></tr>
            <tr><td><b>1st Degree</b> (Superficial)</td><td>Red, dry, NO blisters</td><td>Painful</td></tr>
            <tr><td><b>2nd Superficial</b> (Partial)</td><td>Blisters, moist, pink</td><td>Very painful</td></tr>
            <tr><td><b>2nd Deep</b> (Deep partial)</td><td>Pale, mottled</td><td>Reduced</td></tr>
            <tr class="highlight"><td><b>3rd Degree</b> (Full thickness)</td><td>White/charred/leathery</td><td><b>PAINLESS</b></td></tr>
            <tr><td><b>4th Degree</b></td><td>Charred, muscle/bone</td><td>Painless</td></tr>
          </table>
        </div>
        <div>
          <div class="yellow-box">
            <div class="yellow-box-title">★ Parkland Formula (India/NEET)</div>
            <div style="font-size:7.5px; font-weight:800; color:#c0392b; margin-bottom:4px;">4 mL × Weight(kg) × %TBSA (2nd+3rd only)</div>
            <div class="li">½ in <b>first 8 hours</b> (from time of burn)</div>
            <div class="li">½ over next 16 hours</div>
            <div class="li">Fluid: <b>Ringer's Lactate</b></div>
          </div>
          <div class="yellow-box">
            <div class="yellow-box-title">Muir &amp; Barclay (UK)</div>
            <div style="font-size:6.5px;"><b>Weight × %TBSA ÷ 2</b> per period<br>6 periods: 4h, 4h, 4h, 6h, 6h, 12h<br>Fluid: <b>Colloid</b> (Human Albumin)</div>
          </div>
          <div class="red-box" style="margin-top:3px">
            <div class="red-box-title">⚠ Critical Points</div>
            <div class="li">Circumferential burn → <b>Escharotomy</b></div>
            <div class="li">Smoke inhalation → <b>Early intubation</b></div>
            <div class="li">Major burn adult: &gt;15% TBSA</div>
          </div>
        </div>
      </div>

      <div class="pyq-box">
        <div class="pyq-title">★ PYQ / Frequently Asked</div>
        <div class="pyq-item">Parkland formula fluid? Ans: Ringer's Lactate; half in first 8 hours from time of burn</div>
        <div class="pyq-item">Most accurate burns chart in children? Ans: Lund &amp; Browder Chart</div>
        <div class="pyq-item">Full thickness burn – sensation? Ans: PAINLESS (nerve endings destroyed)</div>
        <div class="pyq-item">Muir-Barclay uses which fluid? Ans: Colloid; Parkland uses crystalloid (RL)</div>
        <div class="pyq-item">Target urine output in burns? Ans: 0.5 mL/kg/hr (adult), 1 mL/kg/hr (child)</div>
      </div>
    </div>

    <!-- ATLS & TRAUMA -->
    <div class="two-col">
      <div>
        <div class="sec-header" style="background:#0B1B3D">🚨 ATLS Primary Survey – ABCDE</div>
        <div class="sec-body" style="border-color:#0B1B3D">
          <table>
            <tr><th>Step</th><th>Meaning</th><th>Key Action</th><th>Life Threats</th></tr>
            <tr><td><b>A</b></td><td>Airway + C-spine</td><td>Clear airway, immobilise C-spine</td><td>Foreign body, C-spine injury</td></tr>
            <tr><td><b>B</b></td><td>Breathing</td><td>Look-listen-feel, O2</td><td>Tension PTX, Open PTX, Haemothorax, Flail chest</td></tr>
            <tr><td><b>C</b></td><td>Circulation</td><td>2 large IVs, RL, FAST exam</td><td>Haemorrhage, tamponade</td></tr>
            <tr><td><b>D</b></td><td>Disability (Neuro)</td><td>GCS, pupils, glucose</td><td>GCS&lt;8 → intubate; unilateral dilated pupil = herniation</td></tr>
            <tr><td><b>E</b></td><td>Exposure</td><td>Undress, log roll, warm</td><td>Hidden injuries back/perineum</td></tr>
          </table>
        </div>
      </div>
      <div>
        <div class="triad-grid">
          <div class="triad-card" style="background:#fdf2f2; border-color:#c0392b">
            <div class="triad-title" style="color:#c0392b">Beck's Triad</div>
            <div style="font-size:7px; color:#c0392b; font-weight:800; margin-bottom:3px;">Cardiac Tamponade</div>
            <div class="triad-body">1. Hypotension<br>2. Muffled heart sounds<br>3. Raised JVP<br><br><b>Tx: Pericardiocentesis</b></div>
          </div>
          <div class="triad-card" style="background:#eaf4fb; border-color:#2980b9">
            <div class="triad-title" style="color:#2980b9">Charcot's Triad</div>
            <div style="font-size:7px; color:#2980b9; font-weight:800; margin-bottom:3px;">Acute Cholangitis</div>
            <div class="triad-body">1. Fever + rigors<br>2. Jaundice<br>3. RUQ pain<br><br><b>+2 = Reynolds Pentad</b></div>
          </div>
          <div class="triad-card" style="background:#eafaf1; border-color:#1e8449">
            <div class="triad-title" style="color:#1e8449">Rigler's Triad</div>
            <div style="font-size:7px; color:#1e8449; font-weight:800; margin-bottom:3px;">Gallstone Ileus</div>
            <div class="triad-body">1. Small bowel obstruction<br>2. Air in biliary tree<br>3. Ectopic gallstone<br><br><b>X-ray: Pneumobilia</b></div>
          </div>
        </div>
        <div class="red-box">
          <div class="red-box-title">⚠ Tension PTX vs Tamponade</div>
          <div style="font-size:6.5px; display:grid; grid-template-columns:1fr 1fr; gap:4px;">
            <div><b>Tension PTX:</b> Trachea DEVIATED away, absent breath sounds, hyperresonance → Needle decompression 2nd ICS MCL</div>
            <div><b>Tamponade:</b> Trachea MIDLINE, muffled sounds, Beck's triad → Pericardiocentesis</div>
          </div>
        </div>
      </div>
    </div>

  </div>
  <div class="pg-footer">★ WOUNDS • SHOCK • BURNS • TRAUMA – Know These Cold! ★</div>
</div>


<!-- ═══════════════════════════════════════════════════════════════
     PAGE 3: GI SURGERY + HEPATOBILIARY
════════════════════════════════════════════════════════════════ -->
<div class="page">
  <div class="pg-header">
    <div class="pg-num"><span>PAGE</span>3</div>
    <div style="flex:1;text-align:center">
      <div class="pg-title">Gastrointestinal Surgery</div>
      <div class="pg-subtitle">⭐ Appendicitis · Obstruction · PUD · Hepatobiliary · Pancreatitis</div>
    </div>
    <div class="pg-badge"><div class="bt">🏆 TOP PRIORITY</div><div class="bs">Most Repeated<br>GI Topics ★★★★★</div></div>
  </div>
  <div class="body">

    <div class="two-col">
      <!-- APPENDICITIS -->
      <div>
        <div class="sec-header" style="background:#c0392b">🎯 Acute Appendicitis</div>
        <div class="sec-body" style="border-color:#c0392b">
          <div class="mnemonic">
            <div class="mnemonic-title">MANTRELS = Alvarado Score (Max 10)</div>
            <div class="mnemonic-row"><div class="mnem-letter">M</div><span><b>M</b>igration of pain to RIF <span style="color:#c0392b; font-weight:800">(1pt)</span></span></div>
            <div class="mnemonic-row"><div class="mnem-letter">A</div><span><b>A</b>norexia <span style="color:#c0392b; font-weight:800">(1pt)</span></span></div>
            <div class="mnemonic-row"><div class="mnem-letter">N</div><span><b>N</b>ausea/Vomiting <span style="color:#c0392b; font-weight:800">(1pt)</span></span></div>
            <div class="mnemonic-row"><div class="mnem-letter">T</div><span><b>T</b>enderness RIF <span style="color:#c0392b; font-weight:800">(2pts) ★</span></span></div>
            <div class="mnemonic-row"><div class="mnem-letter">R</div><span><b>R</b>ebound tenderness <span style="color:#c0392b; font-weight:800">(1pt)</span></span></div>
            <div class="mnemonic-row"><div class="mnem-letter">E</div><span><b>E</b>levated temperature &gt;37.3°C <span style="color:#c0392b; font-weight:800">(1pt)</span></span></div>
            <div class="mnemonic-row"><div class="mnem-letter">L</div><span><b>L</b>eukocytosis &gt;10,000 <span style="color:#c0392b; font-weight:800">(2pts) ★</span></span></div>
            <div class="mnemonic-row"><div class="mnem-letter">S</div><span><b>S</b>hift to left (neutrophilia) <span style="color:#c0392b; font-weight:800">(1pt)</span></span></div>
          </div>
          <div style="font-size:6.5px; background:#fff3cd; border-radius:4px; padding:3px 6px; margin-bottom:4px;">
            <b>Score interpretation:</b> 7–10 = High probability → Surgery | 5–6 = Observe | &lt;5 = Low probability
          </div>
          <div class="li"><b>McBurney's Point:</b> Junction lateral ⅓ + medial ⅔ of ASIS-to-umbilicus line</div>
          <div class="li"><b>Rovsing's sign:</b> LIF pressure → RIF pain</div>
          <div class="li"><b>Psoas sign:</b> Pain on hip extension (retrocaecal appendix)</div>
          <div class="li"><b>Obturator sign:</b> Pain on internal hip rotation (pelvic appendix)</div>
          <div class="li"><b>Most common position:</b> Retrocaecal (65%) <span class="hy-badge">PYQ</span></div>
          <div class="li"><b>Best investigation:</b> CT scan (94–98%); USG for children/pregnant</div>
          <div class="pyq-box" style="margin-top:4px">
            <div class="pyq-title">★ PYQ</div>
            <div class="pyq-item">Most common position of appendix? Ans: Retrocaecal (65%)</div>
            <div class="pyq-item">Best investigation for appendicitis? Ans: CT (most accurate); USG in children</div>
            <div class="pyq-item">Alvarado score of 7–10? Ans: High probability → proceed to surgery</div>
          </div>
        </div>
      </div>

      <!-- INTESTINAL OBSTRUCTION -->
      <div>
        <div class="sec-header" style="background:#e07b3a">🔄 Intestinal Obstruction</div>
        <div class="sec-body" style="border-color:#e07b3a">
          <table>
            <tr><th class="orange">Feature</th><th class="orange">Small Bowel</th><th class="orange">Large Bowel</th></tr>
            <tr><td><b>Most common cause</b></td><td>Adhesions (post-op) ★</td><td>Carcinoma colon ★</td></tr>
            <tr><td><b>Vomiting</b></td><td>Early, projectile</td><td>Late, feculent</td></tr>
            <tr><td><b>Distension</b></td><td>Central, mild</td><td>Peripheral, marked</td></tr>
            <tr><td><b>X-ray pattern</b></td><td>Valvulae conniventes (full-width)</td><td>Haustra (partial-width)</td></tr>
            <tr><td><b>Air-fluid levels</b></td><td>Step-ladder pattern</td><td>Inverted U pattern</td></tr>
          </table>
          <div class="red-box">
            <div class="red-box-title">⭐ Special Types (All PYQ)</div>
            <div style="display:grid; grid-template-columns:1fr 1fr; gap:3px; font-size:6.5px;">
              <div><b>Richter's hernia:</b> No complete obstruction but can strangulate <span class="hy-badge">TRAP</span></div>
              <div><b>Sigmoid volvulus:</b> Coffee bean / Bent inner tube sign on X-ray</div>
              <div><b>Gallstone ileus:</b> Air in biliary tree (pneumobilia) = Rigler's triad</div>
              <div><b>Intussusception:</b> Currant jelly stools, sausage mass, target sign USG</div>
              <div><b>Caecal volvulus:</b> Kidney bean sign on X-ray</div>
              <div><b>Ogilvie's syndrome:</b> Pseudo-obstruction colon (no mechanical cause)</div>
            </div>
          </div>
          <div class="pyq-box">
            <div class="pyq-title">★ PYQ</div>
            <div class="pyq-item">Coffee bean sign on X-ray? Ans: Sigmoid volvulus</div>
            <div class="pyq-item">Currant jelly stools in a child? Ans: Intussusception</div>
            <div class="pyq-item">Air in biliary tree? Ans: Gallstone ileus (pneumobilia)</div>
          </div>
        </div>
      </div>
    </div>

    <div class="two-col">
      <!-- HEPATOBILIARY -->
      <div>
        <div class="sec-header" style="background:#007878">🫘 Hepatobiliary Surgery</div>
        <div class="sec-body" style="border-color:#007878">
          <table>
            <tr><th class="teal">Stone Type</th><th class="teal">Composition</th><th class="teal">Association</th><th class="teal">X-ray</th></tr>
            <tr><td><b>Cholesterol</b></td><td>Cholesterol &gt;50%</td><td>5 F's (Fat, Female, Fertile, Forty, Fair)</td><td>Radiolucent (80%)</td></tr>
            <tr><td><b>Black Pigment</b></td><td>Ca bilirubinate</td><td>Haemolytic anaemia, Cirrhosis</td><td>Radio-opaque</td></tr>
            <tr><td><b>Brown Pigment</b></td><td>Ca bilirubinate + FA</td><td>Bacterial infection, biliary stasis</td><td>Partial</td></tr>
          </table>
          <div class="green-box">
            <div class="green-box-title">💡 Key Clinical Signs</div>
            <div class="li"><b>Murphy's sign:</b> Cessation of inspiration on RUQ deep palpation (cholecystitis)</div>
            <div class="li"><b>Charcot's triad:</b> Fever + Jaundice + RUQ pain = Cholangitis</div>
            <div class="li"><b>Reynolds pentad:</b> Charcot's + Hypotension + Confusion = Severe cholangitis</div>
            <div class="li"><b>Courvoisier's law:</b> Palpable GB + painless jaundice = NOT stones = Malignancy <span class="hy-badge">★</span></div>
            <div class="li"><b>Mirizzi syndrome:</b> Stone in cystic duct → external compression of CBD → jaundice</div>
          </div>
          <div class="pyq-box">
            <div class="pyq-title">★ PYQ</div>
            <div class="pyq-item">Courvoisier's law significance? Ans: Palpable GB + painless jaundice = periampullary malignancy (NOT stones)</div>
            <div class="pyq-item">Best investigation for gallstones? Ans: Ultrasound</div>
            <div class="pyq-item">CBD stones treatment? Ans: ERCP + sphincterotomy</div>
          </div>
        </div>
      </div>

      <!-- PANCREATITIS -->
      <div>
        <div class="sec-header" style="background:#6a0dad">🔴 Acute Pancreatitis</div>
        <div class="sec-body" style="border-color:#6a0dad">
          <div class="mnemonic">
            <div class="mnemonic-title">GET SMASHED – Causes of Pancreatitis</div>
            <div style="display:grid; grid-template-columns:1fr 1fr; gap:2px; font-size:6.5px;">
              <div><b>G</b>allstones (40% – most common India)</div>
              <div><b>E</b>thanol/Alcohol (35%)</div>
              <div><b>T</b>rauma</div>
              <div><b>S</b>teroids</div>
              <div><b>M</b>umps / Autoimmune</div>
              <div><b>A</b>utoimmune / Scorpion sting</div>
              <div><b>S</b>corpion / Hyperlipidaemia</div>
              <div><b>H</b>ypercalcaemia / ERCP</div>
              <div><b>E</b>mboli / Drugs (azathioprine)</div>
              <div><b>D</b>rugs (thiazides, valproate)</div>
            </div>
          </div>
          <table style="margin-top:4px">
            <tr><th class="purple">Ranson's Criteria</th><th class="purple">At Admission</th><th class="purple">At 48 hrs</th></tr>
            <tr><td>Parameters</td><td>Age&gt;55, WBC&gt;16k, Glucose&gt;200, LDH&gt;350, AST&gt;250</td><td>HCT drop&gt;10%, BUN↑5, Ca&lt;8, PaO₂&lt;60, Base deficit&gt;4, Fluids&gt;6L</td></tr>
            <tr class="highlight"><td><b>Score</b></td><td colspan="2">&lt;3 = Mild | 3–5 = Moderate | &gt;5 = Severe (high mortality)</td></tr>
          </table>
          <div class="li" style="margin-top:4px"><b>Cullen's sign:</b> Periumbilical bruising (haemorrhagic pancreatitis)</div>
          <div class="li"><b>Grey-Turner's sign:</b> Flank bruising</div>
          <div class="li"><b>Lipase vs Amylase:</b> Lipase MORE SPECIFIC for pancreatitis <span class="hy-badge">PYQ</span></div>
          <div class="li"><b>Pseudocyst &gt;6cm &gt;6wks:</b> Cystogastrostomy (internal drainage)</div>
        </div>
      </div>
    </div>

  </div>
  <div class="pg-footer">★ GI SURGERY – Appendicitis • Obstruction • Gallstones • Pancreatitis ★</div>
</div>


<!-- ═══════════════════════════════════════════════════════════════
     PAGE 4: BREAST, THYROID & HERNIA
════════════════════════════════════════════════════════════════ -->
<div class="page">
  <div class="pg-header">
    <div class="pg-num"><span>PAGE</span>4</div>
    <div style="flex:1;text-align:center">
      <div class="pg-title">Breast · Thyroid · Hernia</div>
      <div class="pg-subtitle">⭐ Surgical Oncology + Endocrine Surgery + Abdominal Wall Hernias</div>
    </div>
    <div class="pg-badge"><div class="bt">⭐ HIGH YIELD</div><div class="bs">Top PYQ Topics<br>★★★★★</div></div>
  </div>
  <div class="body">

    <div class="two-col">
      <!-- BREAST -->
      <div>
        <div class="sec-header" style="background:#9b1d6e">🎗️ Breast Surgery</div>
        <div class="sec-body" style="border-color:#9b1d6e">
          <table>
            <tr><th style="background:#9b1d6e;color:white">Condition</th><th style="background:#9b1d6e;color:white">Age</th><th style="background:#9b1d6e;color:white">Features</th><th style="background:#9b1d6e;color:white">Consistency</th></tr>
            <tr><td><b>Fibroadenoma</b></td><td>15–30 yrs</td><td>'Breast mouse' – mobile, smooth, non-tender</td><td>Firm, rubbery</td></tr>
            <tr><td><b>Fibrocystic</b></td><td>30–50 yrs</td><td>Cyclical pain, bilateral, pre-menstrual</td><td>Nodular</td></tr>
            <tr><td><b>Breast Cyst</b></td><td>35–55 yrs</td><td>Smooth, tense, transilluminates</td><td>Cystic</td></tr>
            <tr class="highlight"><td><b>Carcinoma</b></td><td>&gt;40 yrs</td><td>Hard, irregular, skin tethering, nipple retraction, LN</td><td>Stony hard</td></tr>
            <tr><td><b>Fat Necrosis</b></td><td>Any (trauma)</td><td>Skin retraction – mimics CA</td><td>Hard</td></tr>
          </table>
          <div class="red-box">
            <div class="red-box-title">🔴 Breast Carcinoma – Key Facts</div>
            <div class="li"><b>Most common histology:</b> Invasive Ductal Carcinoma (75–80%) <span class="hy-badge">PYQ</span></div>
            <div class="li"><b>Most common site:</b> Upper outer quadrant (50%)</div>
            <div class="li"><b>Inflammatory breast CA:</b> Peau d'orange (dermal lymphatic invasion) – worst prognosis</div>
            <div class="li"><b>Paget's disease of nipple:</b> Associated with underlying intraductal carcinoma</div>
            <div class="li"><b>Triple assessment:</b> Clinical + Imaging (USG/mammography) + FNAC/biopsy</div>
            <div class="li"><b>BRCA1:</b> Breast + Ovarian; <b>BRCA2:</b> Breast + Pancreatic/Prostate</div>
            <div class="li"><b>Tamoxifen:</b> ER/PR+ breast cancer; SERM (pre + post-menopausal)</div>
          </div>
          <div class="pyq-box">
            <div class="pyq-title">★ PYQ</div>
            <div class="pyq-item">Most common type of breast cancer? Ans: Invasive Ductal Carcinoma</div>
            <div class="pyq-item">Peau d'orange in breast? Ans: Inflammatory breast carcinoma – dermal lymphatic invasion</div>
            <div class="pyq-item">Sentinel lymph node for breast drains to? Ans: Axillary nodes (Level I first)</div>
            <div class="pyq-item">Paget's disease of nipple associated with? Ans: Underlying intraductal carcinoma</div>
          </div>
        </div>
      </div>

      <!-- THYROID -->
      <div>
        <div class="sec-header" style="background:#007878">🦋 Thyroid Cancer</div>
        <div class="sec-body" style="border-color:#007878">
          <table>
            <tr><th class="teal">Type</th><th class="teal">Freq</th><th class="teal">Spread</th><th class="teal">Prognosis</th><th class="teal">Special</th></tr>
            <tr class="highlight"><td><b>Papillary</b></td><td>70–80%</td><td>Lymphatic (LN)</td><td>Excellent (&gt;95%)</td><td>Psammoma bodies, Orphan Annie nuclei</td></tr>
            <tr><td><b>Follicular</b></td><td>15–20%</td><td>Haematogenous (lung, bone)</td><td>Good</td><td>Vascular invasion; NOT by FNAC ★</td></tr>
            <tr><td><b>Medullary</b></td><td>5%</td><td>Both</td><td>Moderate</td><td>Calcitonin marker; MEN 2A/2B; RET gene</td></tr>
            <tr class="highlight"><td><b>Anaplastic</b></td><td>&lt;5%</td><td>Local + widespread</td><td>Very poor</td><td>Most aggressive; radio-resistant; elderly</td></tr>
          </table>
          <div style="display:grid; grid-template-columns:1fr 1fr; gap:4px; margin-top:4px;">
            <div class="blue-box">
              <div class="blue-box-title">MEN 2A</div>
              <div class="li">Medullary thyroid CA</div>
              <div class="li">Phaeochromocytoma</div>
              <div class="li">Primary Hyperparathyroidism</div>
            </div>
            <div class="purple-box">
              <div class="purple-box-title">MEN 2B</div>
              <div class="li">Medullary thyroid CA</div>
              <div class="li">Phaeochromocytoma</div>
              <div class="li">Mucosal neuromas</div>
              <div class="li">Marfanoid habitus</div>
            </div>
          </div>
          <div class="red-box" style="margin-top:4px">
            <div class="red-box-title">⚠ RLN Injury During Thyroidectomy</div>
            <div class="li"><b>Unilateral RLN:</b> Hoarseness (temporary or permanent)</div>
            <div class="li"><b>Bilateral RLN:</b> Stridor + respiratory distress → Emergency tracheotomy</div>
            <div class="li"><b>Hypocalcaemia:</b> Parathyroid gland inadvertent removal → Chvostek/Trousseau signs</div>
          </div>
          <div class="pyq-box">
            <div class="pyq-title">★ PYQ</div>
            <div class="pyq-item">Psammoma bodies in thyroid? Ans: Papillary carcinoma</div>
            <div class="pyq-item">Follicular CA diagnosed by? Ans: Histopathology (capsular/vascular invasion) – NOT FNAC</div>
            <div class="pyq-item">Tumour marker for medullary CA? Ans: Calcitonin</div>
          </div>
        </div>
      </div>
    </div>

    <!-- HERNIA -->
    <div class="sec-header" style="background:#2980b9">🔵 Hernia – Inguinal, Femoral &amp; Special Types</div>
    <div class="sec-body" style="border-color:#2980b9">
      <div class="three-col">
        <div>
          <table>
            <tr><th class="teal" style="background:#2980b9">Feature</th><th class="teal" style="background:#2980b9">Indirect</th><th class="teal" style="background:#2980b9">Direct</th></tr>
            <tr><td><b>Route</b></td><td>Deep ring → canal → superficial ring</td><td>Hesselbach's triangle</td></tr>
            <tr><td><b>Cause</b></td><td>Congenital (patent processus vaginalis)</td><td>Acquired (weak transversalis)</td></tr>
            <tr><td><b>Age</b></td><td>Young</td><td>Older</td></tr>
            <tr><td><b>Inf. epigastric</b></td><td>Lateral to it</td><td>Medial to it</td></tr>
            <tr class="highlight"><td><b>Strangulation</b></td><td>Higher risk</td><td>Lower risk</td></tr>
            <tr><td><b>Scrotum</b></td><td>Can descend</td><td>Rarely</td></tr>
          </table>
          <div class="blue-box" style="margin-top:4px">
            <div class="blue-box-title">Hesselbach's Triangle</div>
            <div class="li"><b>Medial:</b> Lateral border of Rectus abdominis</div>
            <div class="li"><b>Lateral:</b> Inferior epigastric vessels</div>
            <div class="li"><b>Inferior:</b> Inguinal ligament</div>
          </div>
        </div>
        <div>
          <div class="blue-box">
            <div class="blue-box-title">Femoral Hernia</div>
            <div class="li">Below + lateral to pubic tubercle</div>
            <div class="li">More common in women (wider pelvis)</div>
            <div class="li">BUT: Inguinal still more common in women!</div>
            <div class="li"><b>High strangulation risk</b> (narrow, rigid neck)</div>
            <div class="li">Lacunar lig. medially – can't be relieved!</div>
          </div>
          <table style="margin-top:4px">
            <tr><th class="teal" style="background:#2980b9">Special Hernia</th><th class="teal" style="background:#2980b9">Definition</th></tr>
            <tr class="highlight"><td><b>Richter's</b></td><td>Knuckle of bowel wall – strangulates WITHOUT obstruction <span class="hy-badge">★</span></td></tr>
            <tr><td><b>Littre's</b></td><td>Meckel's diverticulum in sac</td></tr>
            <tr class="highlight"><td><b>Maydl's (W hernia)</b></td><td>Middle loop of W strangulates inside abdomen <span class="hy-badge">★</span></td></tr>
            <tr><td><b>Spigelian</b></td><td>Linea semilunaris – interparietal, difficult to detect</td></tr>
            <tr><td><b>Obturator</b></td><td>Elderly thin woman; Howship-Romberg sign</td></tr>
            <tr><td><b>Sliding</b></td><td>Viscus wall forms part of hernia sac</td></tr>
          </table>
        </div>
        <div>
          <div class="yellow-box">
            <div class="yellow-box-title">★ Inguinal Canal (Boundaries)</div>
            <div class="li"><b>Anterior wall:</b> External oblique aponeurosis</div>
            <div class="li"><b>Posterior wall:</b> Transversalis fascia (+ conjoined tendon medially)</div>
            <div class="li"><b>Roof:</b> Transversus + Internal oblique</div>
            <div class="li"><b>Floor:</b> Inguinal ligament</div>
          </div>
          <div class="pyq-box" style="margin-top:4px">
            <div class="pyq-title">★ PYQ</div>
            <div class="pyq-item">Hernia that strangulates WITHOUT obstruction? Ans: Richter's hernia</div>
            <div class="pyq-item">Howship-Romberg sign? Ans: Obturator hernia (medial thigh pain)</div>
            <div class="pyq-item">Femoral hernia passes below which structure? Ans: Inguinal ligament (below + lateral to pubic tubercle)</div>
            <div class="pyq-item">Littre's hernia contains? Ans: Meckel's diverticulum</div>
            <div class="pyq-item">Most common hernia in females? Ans: Indirect inguinal (inguinal &gt; femoral even in women)</div>
          </div>
        </div>
      </div>
    </div>

  </div>
  <div class="pg-footer">★ BREAST • THYROID • HERNIA – Master the Details ★</div>
</div>


<!-- ═══════════════════════════════════════════════════════════════
     PAGE 5: UROLOGY + VASCULAR + PAEDIATRIC SURGERY
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<div class="page">
  <div class="pg-header">
    <div class="pg-num"><span>PAGE</span>5</div>
    <div style="flex:1;text-align:center">
      <div class="pg-title">Urology · Vascular · Paediatric Surgery</div>
      <div class="pg-subtitle">⭐ Stones · BPH · AAA · DVT/PE · Pyloric Stenosis · Intussusception · Hirschsprung</div>
    </div>
    <div class="pg-badge"><div class="bt">🎯 PYQ HEAVY</div><div class="bs">Many PYQs Here<br>★★★★☆</div></div>
  </div>
  <div class="body">

    <!-- UROLOGY -->
    <div class="sec-header" style="background:#1e8449">🫘 Urology – Urinary Stones (Urolithiasis)</div>
    <div class="sec-body" style="border-color:#1e8449">
      <table>
        <tr><th class="green">Stone Type</th><th class="green">% Stones</th><th class="green">Radio-opacity</th><th class="green">Associations</th><th class="green">Urine pH</th><th class="green">Treatment Tips</th></tr>
        <tr class="highlight"><td><b>Calcium Oxalate</b> (most common)</td><td>70–80%</td><td>Radio-opaque</td><td>Hypercalciuria, Crohn's disease, hyperoxaluria</td><td>Acidic</td><td>Hydration, low oxalate diet</td></tr>
        <tr class="highlight"><td><b>Uric Acid</b></td><td>5–10%</td><td><b>RADIOLUCENT</b> ★</td><td>Gout, dehydration, myeloproliferative</td><td>Acidic (&lt;5.5)</td><td>Alkalinise urine (K-citrate)</td></tr>
        <tr><td><b>Struvite (Staghorn)</b></td><td>10–15%</td><td>Radio-opaque</td><td><b>Proteus mirabilis</b> (urease organism) ★</td><td>Alkaline (&gt;7)</td><td>PCNL + antibiotics</td></tr>
        <tr><td><b>Cystine</b></td><td>1–3%</td><td>Faintly opaque</td><td>Cystinuria (AR) – defective tubular reabsorption</td><td>Acidic</td><td>Alkalinise, penicillamine</td></tr>
        <tr><td><b>Calcium Phosphate</b></td><td>5–10%</td><td>Radio-opaque</td><td>Hyperparathyroidism, RTA type I</td><td>Alkaline</td><td>Treat underlying cause</td></tr>
      </table>
      <div class="three-col" style="margin-top:0">
        <div class="green-box">
          <div class="green-box-title">Radio-opacity Order</div>
          <div style="font-size:7px; font-weight:800; color:#1e8449; text-align:center; padding:3px">
            Ca Oxalate &gt; Ca Phosphate &gt; Struvite &gt; Cystine &gt; <span style="color:#c0392b">Uric Acid (LUCENT)</span>
          </div>
        </div>
        <div class="blue-box">
          <div class="blue-box-title">Treatment by Size</div>
          <div class="li">&lt;5mm: Conservative (pass spontaneously)</div>
          <div class="li">5–10mm: ESWL or ureteroscopy</div>
          <div class="li">&gt;2cm renal: PCNL</div>
          <div class="li">Staghorn: PCNL</div>
        </div>
        <div class="pyq-box">
          <div class="pyq-title">★ PYQ</div>
          <div class="pyq-item">Only radiolucent stone? Ans: Uric acid stone</div>
          <div class="pyq-item">Staghorn calculus = ? Ans: Struvite stone (Proteus mirabilis)</div>
          <div class="pyq-item">Investigation for ureteric colic? Ans: Non-contrast CT-KUB (NCCT)</div>
        </div>
      </div>
    </div>

    <div class="two-col">
      <!-- BPH -->
      <div>
        <div class="sec-header" style="background:#2980b9">🔵 BPH vs Prostate Carcinoma</div>
        <div class="sec-body" style="border-color:#2980b9">
          <table>
            <tr><th style="background:#2980b9;color:white">Feature</th><th style="background:#2980b9;color:white">BPH</th><th style="background:#2980b9;color:white">Prostate CA</th></tr>
            <tr class="highlight"><td><b>Zone</b></td><td><b>Transitional (Central)</b> ★</td><td><b>Peripheral zone</b> ★</td></tr>
            <tr><td>DRE</td><td>Smooth, firm, enlarged, groove preserved</td><td>Hard, nodular, irregular, no groove</td></tr>
            <tr><td>PSA</td><td>Raised (mod)</td><td>Markedly raised</td></tr>
            <tr><td>1st-line medical Rx</td><td>Alpha-blockers (tamsulosin)</td><td>Androgen deprivation</td></tr>
            <tr class="highlight"><td>Surgical gold standard</td><td><b>TURP</b></td><td>Radical prostatectomy</td></tr>
          </table>
          <div class="red-box">
            <div class="red-box-title">⚠ TUR Syndrome</div>
            <div class="li">Absorption of hypotonic irrigation fluid during TURP</div>
            <div class="li">→ Dilutional <b>hyponatraemia</b> → confusion, seizures</div>
            <div class="li">Treatment: Hypertonic saline + diuresis</div>
          </div>
        </div>
      </div>

      <!-- VASCULAR -->
      <div>
        <div class="sec-header" style="background:#c0392b">🩸 Vascular Surgery</div>
        <div class="sec-body" style="border-color:#c0392b">
          <div class="red-box">
            <div class="red-box-title">AAA – Abdominal Aortic Aneurysm</div>
            <div class="li"><b>Definition:</b> Aorta &gt;3cm (normal &lt;2.5cm)</div>
            <div class="li"><b>Most common site:</b> Infrarenal aorta (90%) <span class="hy-badge">PYQ</span></div>
            <div class="li"><b>Strongest RF:</b> Smoking; also atherosclerosis, male, &gt;65yrs</div>
            <div class="li"><b>Repair if:</b> &gt;5.5cm, expanding &gt;1cm/yr, symptomatic, ruptured <span class="hy-badge">★</span></div>
            <div class="li"><b>Ruptured triad:</b> Back pain + Hypotension + Pulsatile mass</div>
            <div class="li"><b>Treatment:</b> EVAR (preferred) or Open repair</div>
          </div>
          <table style="margin-top:3px">
            <tr><th class="red">DVT</th><th class="red">Pulmonary Embolism</th></tr>
            <tr><td>Unilateral leg swelling, Homan's sign (unreliable)</td><td>Dyspnoea, pleuritic pain, haemoptysis, tachycardia</td></tr>
            <tr><td>Investigation: Doppler USG (1st line)</td><td>Investigation: <b>CTPA</b> (gold standard) ★</td></tr>
            <tr class="highlight"><td>Virchow's triad: Stasis + Endothelial injury + Hypercoagulability</td><td>ECG: <b>S1Q3T3 pattern</b> ★</td></tr>
            <tr><td colspan="2">Treatment: LMWH → Warfarin/DOAC for 3–6 months; thrombolysis if haemodynamically unstable</td></tr>
          </table>
        </div>
      </div>
    </div>

    <!-- PAEDIATRIC SURGERY -->
    <div class="sec-header" style="background:#e07b3a">👶 Paediatric Surgery – High Yield Conditions</div>
    <div class="sec-body" style="border-color:#e07b3a">
      <table>
        <tr><th class="orange">Condition</th><th class="orange">Age</th><th class="orange">Presentation</th><th class="orange">Investigation</th><th class="orange">Treatment</th></tr>
        <tr class="highlight"><td><b>Pyloric Stenosis</b></td><td>2–6 weeks (M&gt;F 4:1)</td><td>Projectile NON-BILIOUS vomiting, 'olive' mass, hungry baby</td><td>USG (muscle &gt;4mm); Metabolic alkalosis + hypochloraemia</td><td>Ramstedt's pyloromyotomy (correct electrolytes FIRST)</td></tr>
        <tr class="highlight"><td><b>Intussusception</b></td><td>6mo–2yrs</td><td>Colicky pain, currant jelly stools, sausage mass RUQ</td><td>USG: Target sign / Doughnut sign</td><td>Air/hydrostatic enema (1st); Surgery if failed/peritonitis</td></tr>
        <tr><td><b>Hirschsprung's</b></td><td>Neonates</td><td>Delayed meconium (&gt;48hrs), distension, ribbon stools</td><td>Rectal biopsy: absent ganglion cells (GOLD STANDARD) ★</td><td>Surgical pull-through (Swenson/Duhamel/Soave)</td></tr>
        <tr><td><b>CDH</b></td><td>Neonate</td><td>Respiratory distress, scaphoid abdomen, bowel in chest</td><td>CXR: bowel in chest</td><td>Stabilise → surgical repair; Left-sided (Bochdalek) more common</td></tr>
        <tr class="highlight"><td><b>Meckel's Diverticulum</b></td><td>Rule of 2s</td><td>2% pop, 2 inches, 2 feet from IC valve, M:F 2:1</td><td>Tc-99m pertechnetate scan (ectopic gastric mucosa) ★</td><td>Surgical excision if symptomatic</td></tr>
      </table>
      <div class="pyq-box">
        <div class="pyq-title">★ PYQ</div>
        <div class="pyq-item">Meckel's Rule of 2s? Ans: 2% pop, 2 inches, 2 feet from ileocaecal valve, 2:1 M:F, ectopic gastric mucosa</div>
        <div class="pyq-item">Hirschsprung's gold standard investigation? Ans: Rectal biopsy (absent ganglion cells in Meissner's + Auerbach's plexus)</div>
        <div class="pyq-item">Currant jelly stools = ? Ans: Intussusception</div>
        <div class="pyq-item">Pyloric stenosis metabolic disturbance? Ans: Metabolic alkalosis + hypochloraemia + hypokalaemia (correct before surgery!)</div>
        <div class="pyq-item">ECG in massive PE? Ans: S1Q3T3 pattern; Gold standard investigation = CTPA</div>
      </div>
    </div>

  </div>
  <div class="pg-footer">★ UROLOGY • VASCULAR • PAEDIATRIC SURGERY ★</div>
</div>


<!-- ═══════════════════════════════════════════════════════════════
     PAGE 6: QUICK REFERENCE + TOP 40 PYQs
════════════════════════════════════════════════════════════════ -->
<div class="page">
  <div class="pg-header">
    <div class="pg-num"><span>PAGE</span>6</div>
    <div style="flex:1;text-align:center">
      <div class="pg-title">Quick Reference + Top 40 PYQs</div>
      <div class="pg-subtitle">⭐ Tumour Markers · Mnemonics · Instruments · Must-Know Facts</div>
    </div>
    <div class="pg-badge"><div class="bt">🎯 LAST-MINUTE</div><div class="bs">Final Revision<br>★★★★★</div></div>
  </div>
  <div class="body">

    <div class="two-col">
      <!-- TUMOUR MARKERS -->
      <div>
        <div class="sec-header" style="background:#6a0dad">🔬 Tumour Markers</div>
        <div class="sec-body" style="border-color:#6a0dad">
          <table>
            <tr><th class="purple">Marker</th><th class="purple">Primary Tumour</th><th class="purple">Notes</th></tr>
            <tr class="highlight"><td><b>CA 19-9</b></td><td>Pancreatic CA ★</td><td>Also biliary CA; best for monitoring</td></tr>
            <tr class="highlight"><td><b>AFP</b></td><td>Hepatocellular CA ★; Germ cell (non-seminoma)</td><td>Elevated in pregnancy, cirrhosis</td></tr>
            <tr><td><b>CEA</b></td><td>Colorectal CA (monitoring)</td><td>Also gastric, breast, lung; smokers</td></tr>
            <tr><td><b>PSA</b></td><td>Prostate CA</td><td>Also BPH, prostatitis; organ-specific</td></tr>
            <tr><td><b>CA 125</b></td><td>Ovarian CA (epithelial)</td><td>Also endometriosis, fibroids</td></tr>
            <tr><td><b>CA 15-3</b></td><td>Breast CA</td><td>Monitoring only (not screening)</td></tr>
            <tr class="highlight"><td><b>Calcitonin</b></td><td>Medullary Thyroid CA ★</td><td>Screen family members (MEN 2)</td></tr>
            <tr><td><b>Beta-hCG</b></td><td>Choriocarcinoma; Testicular CA</td><td>Gestational trophoblastic disease</td></tr>
            <tr><td><b>LDH</b></td><td>Seminoma, Lymphoma, Ewing's</td><td>Non-specific</td></tr>
            <tr><td><b>S-100</b></td><td>Melanoma, Schwannoma</td><td>Neural crest cell tumours</td></tr>
          </table>
        </div>
      </div>

      <!-- MNEMONICS -->
      <div>
        <div class="sec-header" style="background:#1a5276">💡 Key Mnemonics</div>
        <div class="sec-body" style="border-color:#1a5276">
          <table>
            <tr><th style="background:#1a5276;color:white">Mnemonic</th><th style="background:#1a5276;color:white">Stands For</th><th style="background:#1a5276;color:white">Topic</th></tr>
            <tr><td><b>MANTRELS</b></td><td>Migration, Anorexia, Nausea, Tenderness RIF, Rebound, Elevated Temp, Leukocytosis, Shift left</td><td>Alvarado Score (Appendicitis)</td></tr>
            <tr><td><b>GET SMASHED</b></td><td>Gallstones, Ethanol, Trauma, Steroids, Mumps, Autoimmune, Scorpion, Hyperlipidaemia, ERCP, Drugs</td><td>Pancreatitis causes</td></tr>
            <tr><td><b>5 F's</b></td><td>Fat, Female, Fertile, Forty, Fair</td><td>Cholesterol gallstones</td></tr>
            <tr><td><b>Rule of 2s</b></td><td>2%, 2 inches, 2 feet, &lt;2yrs, 2:1 M:F</td><td>Meckel's diverticulum</td></tr>
            <tr><td><b>ABCDE</b></td><td>Airway, Breathing, Circulation, Disability, Exposure</td><td>ATLS Primary Survey</td></tr>
            <tr><td><b>Virchow's Triad</b></td><td>Stasis + Endothelial injury + Hypercoagulability</td><td>DVT formation</td></tr>
            <tr><td><b>Beck's Triad</b></td><td>Hypotension + Muffled sounds + Raised JVP</td><td>Cardiac Tamponade</td></tr>
            <tr><td><b>Charcot's Triad</b></td><td>Fever + Jaundice + RUQ pain</td><td>Acute Cholangitis</td></tr>
            <tr><td><b>Reynolds Pentad</b></td><td>Charcot's + Hypotension + Confusion</td><td>Severe Cholangitis</td></tr>
            <tr><td><b>Rigler's Triad</b></td><td>SBO + Pneumobilia + Ectopic stone</td><td>Gallstone Ileus</td></tr>
          </table>
        </div>
      </div>
    </div>

    <!-- TOP 40 PYQs -->
    <div class="sec-header" style="background:#c0392b">🏆 TOP 40 MOST REPEATED SURGERY PYQs (NEET PG / INI-CET)</div>
    <div class="sec-body" style="border-color:#c0392b">
      <div style="display:grid; grid-template-columns:1fr 1fr; gap:6px; font-size:6.5px;">
        <div>
          <div style="background:#fff3cd; border-left:3px solid #f39c12; padding:3px 5px; border-radius:3px; margin-bottom:2px;"><b>1.</b> Most common position of appendix: <b>Retrocaecal (65%)</b></div>
          <div style="padding:2px 5px; margin-bottom:2px;"><b>2.</b> Most common SBO cause (adults): <b>Adhesions</b></div>
          <div style="background:#fff3cd; border-left:3px solid #f39c12; padding:3px 5px; border-radius:3px; margin-bottom:2px;"><b>3.</b> Most common LBO cause: <b>Carcinoma colon</b></div>
          <div style="padding:2px 5px; margin-bottom:2px;"><b>4.</b> Parkland formula: <b>4 × kg × %TBSA in RL; half in first 8 hrs</b></div>
          <div style="background:#fff3cd; border-left:3px solid #f39c12; padding:3px 5px; border-radius:3px; margin-bottom:2px;"><b>5.</b> Rule of nines – lower limb: <b>18%; upper limb: 9%</b></div>
          <div style="padding:2px 5px; margin-bottom:2px;"><b>6.</b> Full thickness burn sensation: <b>Painless</b></div>
          <div style="background:#fff3cd; border-left:3px solid #f39c12; padding:3px 5px; border-radius:3px; margin-bottom:2px;"><b>7.</b> Most common thyroid cancer: <b>Papillary (psammoma bodies, lymphatic)</b></div>
          <div style="padding:2px 5px; margin-bottom:2px;"><b>8.</b> Best prognosis thyroid CA: <b>Papillary</b>; Worst: <b>Anaplastic</b></div>
          <div style="background:#fff3cd; border-left:3px solid #f39c12; padding:3px 5px; border-radius:3px; margin-bottom:2px;"><b>9.</b> Follicular CA diagnosed by: <b>Histopathology (not FNAC)</b></div>
          <div style="padding:2px 5px; margin-bottom:2px;"><b>10.</b> Charcot's triad: <b>Fever + Jaundice + RUQ pain = Cholangitis</b></div>
          <div style="background:#fff3cd; border-left:3px solid #f39c12; padding:3px 5px; border-radius:3px; margin-bottom:2px;"><b>11.</b> Courvoisier's law: <b>Palpable GB + painless jaundice = Malignancy</b></div>
          <div style="padding:2px 5px; margin-bottom:2px;"><b>12.</b> Tumour marker pancreatic CA: <b>CA 19-9</b></div>
          <div style="background:#fff3cd; border-left:3px solid #f39c12; padding:3px 5px; border-radius:3px; margin-bottom:2px;"><b>13.</b> Tumour marker hepatocellular CA: <b>AFP</b></div>
          <div style="padding:2px 5px; margin-bottom:2px;"><b>14.</b> Most specific enzyme pancreatitis: <b>Lipase &gt; Amylase</b></div>
          <div style="background:#fff3cd; border-left:3px solid #f39c12; padding:3px 5px; border-radius:3px; margin-bottom:2px;"><b>15.</b> Cullen's sign: <b>Periumbilical bruising = Haemorrhagic pancreatitis</b></div>
          <div style="padding:2px 5px; margin-bottom:2px;"><b>16.</b> Richter's hernia: <b>Strangulates WITHOUT obstruction</b></div>
          <div style="background:#fff3cd; border-left:3px solid #f39c12; padding:3px 5px; border-radius:3px; margin-bottom:2px;"><b>17.</b> Howship-Romberg sign: <b>Obturator hernia</b></div>
          <div style="padding:2px 5px; margin-bottom:2px;"><b>18.</b> Littre's hernia contains: <b>Meckel's diverticulum</b></div>
          <div style="background:#fff3cd; border-left:3px solid #f39c12; padding:3px 5px; border-radius:3px; margin-bottom:2px;"><b>19.</b> Most common hernia in females: <b>Indirect inguinal (not femoral!)</b></div>
          <div style="padding:2px 5px; margin-bottom:2px;"><b>20.</b> Inguinal hernia – above/below pubic tubercle: <b>Above + medial</b></div>
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          <div style="background:#fdf2f2; border-left:3px solid #c0392b; padding:3px 5px; border-radius:3px; margin-bottom:2px;"><b>21.</b> Femoral hernia: <b>Below + lateral to pubic tubercle</b></div>
          <div style="padding:2px 5px; margin-bottom:2px;"><b>22.</b> Most common breast cancer: <b>Invasive Ductal Carcinoma (75–80%)</b></div>
          <div style="background:#fdf2f2; border-left:3px solid #c0392b; padding:3px 5px; border-radius:3px; margin-bottom:2px;"><b>23.</b> Most common renal stone: <b>Calcium oxalate (70–80%)</b></div>
          <div style="padding:2px 5px; margin-bottom:2px;"><b>24.</b> Only radiolucent stone: <b>Uric acid stone</b></div>
          <div style="background:#fdf2f2; border-left:3px solid #c0392b; padding:3px 5px; border-radius:3px; margin-bottom:2px;"><b>25.</b> Staghorn calculus: <b>Struvite (Proteus mirabilis)</b></div>
          <div style="padding:2px 5px; margin-bottom:2px;"><b>26.</b> Zone of prostate in BPH: <b>Transitional zone</b></div>
          <div style="background:#fdf2f2; border-left:3px solid #c0392b; padding:3px 5px; border-radius:3px; margin-bottom:2px;"><b>27.</b> Zone of prostate CA: <b>Peripheral zone</b></div>
          <div style="padding:2px 5px; margin-bottom:2px;"><b>28.</b> Gold standard BPH surgery: <b>TURP</b></div>
          <div style="background:#fdf2f2; border-left:3px solid #c0392b; padding:3px 5px; border-radius:3px; margin-bottom:2px;"><b>29.</b> TUR syndrome: <b>Dilutional hyponatraemia</b></div>
          <div style="padding:2px 5px; margin-bottom:2px;"><b>30.</b> Most common site AAA: <b>Infrarenal aorta (90%)</b></div>
          <div style="background:#fdf2f2; border-left:3px solid #c0392b; padding:3px 5px; border-radius:3px; margin-bottom:2px;"><b>31.</b> AAA repair indication: <b>&gt;5.5 cm or expanding &gt;1 cm/year</b></div>
          <div style="padding:2px 5px; margin-bottom:2px;"><b>32.</b> ECG in PE: <b>S1Q3T3 pattern</b>; Gold standard: <b>CTPA</b></div>
          <div style="background:#fdf2f2; border-left:3px solid #c0392b; padding:3px 5px; border-radius:3px; margin-bottom:2px;"><b>33.</b> Intussusception: <b>Currant jelly stools + Target sign USG</b></div>
          <div style="padding:2px 5px; margin-bottom:2px;"><b>34.</b> Hirschsprung's diagnosis: <b>Rectal biopsy (absent ganglion cells)</b></div>
          <div style="background:#fdf2f2; border-left:3px solid #c0392b; padding:3px 5px; border-radius:3px; margin-bottom:2px;"><b>35.</b> Meckel's scan: <b>Tc-99m pertechnetate (ectopic gastric mucosa)</b></div>
          <div style="padding:2px 5px; margin-bottom:2px;"><b>36.</b> First collagen in wound healing: <b>Type III → replaced by Type I</b></div>
          <div style="background:#fdf2f2; border-left:3px solid #c0392b; padding:3px 5px; border-radius:3px; margin-bottom:2px;"><b>37.</b> Max wound tensile strength: <b>80% at 3 months</b></div>
          <div style="padding:2px 5px; margin-bottom:2px;"><b>38.</b> Most important wound healing cell: <b>Macrophage</b></div>
          <div style="background:#fdf2f2; border-left:3px solid #c0392b; padding:3px 5px; border-radius:3px; margin-bottom:2px;"><b>39.</b> Neurogenic shock: <b>Bradycardia + Hypotension (NOT tachycardia!)</b></div>
          <div style="padding:2px 5px; margin-bottom:2px;"><b>40.</b> Tension pneumothorax treatment: <b>Needle decompression – 2nd ICS MCL</b></div>
        </div>
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