RGUHS BDS 3rd Year - General Medicine

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

OUTPUT = "/tmp/workspace/rguhs-medicine-guide/RGUHS_BDS3_GeneralMedicine_StudyGuide.pdf"

doc = SimpleDocTemplate(
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    title="RGUHS BDS 3rd Year - General Medicine Study Guide",
    author="Orris Medical Study Guide"
)

# ── Colour palette ──────────────────────────────────────────────
NAVY   = colors.HexColor("#1a3a5c")
TEAL   = colors.HexColor("#0d7377")
AMBER  = colors.HexColor("#f0a500")
LTBLUE = colors.HexColor("#e8f4fd")
LTGRN  = colors.HexColor("#e8f8f5")
LTAMB  = colors.HexColor("#fff8e1")
LTREDD = colors.HexColor("#fff0f0")
WHITE  = colors.white
DKGREY = colors.HexColor("#333333")
MDGREY = colors.HexColor("#666666")
BGGREY = colors.HexColor("#f5f5f5")

styles = getSampleStyleSheet()

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cover_note = ParagraphStyle("cover_note", fontSize=11, fontName="Helvetica-Oblique",
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ch_heading = ParagraphStyle("ch_heading", fontSize=18, fontName="Helvetica-Bold",
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topic_num = ParagraphStyle("topic_num", fontSize=11, fontName="Helvetica-Bold",
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section_h = ParagraphStyle("section_h", fontSize=12, fontName="Helvetica-Bold",
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body = ParagraphStyle("body", fontSize=9.5, fontName="Helvetica",
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bullet_style = ParagraphStyle("bullet_style", fontSize=9.5, fontName="Helvetica",
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dental_style = ParagraphStyle("dental_style", fontSize=9.5, fontName="Helvetica",
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def dental_box(text):
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def bullet(text, level=0):
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def sub_bullet(text):
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    return tbl

# ══════════════════════════════════════════════════════════════════
# CONTENT DATA
# ══════════════════════════════════════════════════════════════════

TOPICS = [

# ── 1. DIABETES MELLITUS ─────────────────────────────────────────
{
"num": 1,
"title": "Diabetes Mellitus",
"freq": "★★★★★  Appears every year",
"marks": "10-mark Long Essay | Also asked as Short Essay on DKA, complications",
"definition": "Diabetes Mellitus is a group of metabolic disorders characterized by chronic hyperglycemia resulting from defects in insulin secretion, insulin action, or both, leading to disturbances of carbohydrate, fat, and protein metabolism.",
"classification": [
    ("Type 1 DM", "Autoimmune destruction of beta cells; absolute insulin deficiency; ketosis-prone; mainly children"),
    ("Type 2 DM", "Insulin resistance + relative insulin deficiency; adult onset; commonest type (90%)"),
    ("Gestational DM", "Glucose intolerance first recognised during pregnancy"),
    ("MODY", "Maturity Onset Diabetes of the Young; monogenic; rare"),
    ("Secondary DM", "Cushing's syndrome, acromegaly, pancreatitis, drugs (steroids, thiazides)"),
],
"pathophysiology": [
    "Type 1: T-cell mediated autoimmune destruction of islets of Langerhans → absolute insulin deficiency → hyperglycemia + lipolysis + ketogenesis",
    "Type 2: Peripheral insulin resistance (muscle, liver, fat) → compensatory hyperinsulinemia → progressive beta cell exhaustion → relative insulin deficiency",
    "Hyperglycemia → glycosylation of proteins → microvascular and macrovascular complications",
],
"clinical_features": [
    ("Classic 3 Ps", "Polyuria, Polydipsia, Polyphagia"),
    ("Type 1", "Weight loss, fatigue, DKA presentation (nausea, vomiting, abdominal pain, Kussmaul breathing, acetone breath)"),
    ("Type 2", "Often asymptomatic; discovered incidentally; recurrent infections, blurred vision, delayed wound healing"),
    ("Microvascular", "Retinopathy (leading cause of blindness), Nephropathy (proteinuria → CKD), Neuropathy (glove & stocking sensory loss)"),
    ("Macrovascular", "IHD (MI is silent in DM), stroke, peripheral vascular disease"),
],
"investigations": [
    "Fasting Plasma Glucose (FPG): ≥126 mg/dL (≥7.0 mmol/L)",
    "2-hr Post OGTT Glucose: ≥200 mg/dL (≥11.1 mmol/L)",
    "HbA1c: ≥6.5% (48 mmol/mol) — reflects 3-month glycemic control",
    "Random Plasma Glucose: ≥200 mg/dL + symptoms",
    "Urine: Glycosuria, ketonuria (Type 1); Microalbuminuria (early nephropathy)",
    "CBC: Infection screen; Lipid profile: Dyslipidemia common",
],
"management": [
    "Diet & Lifestyle: Low glycaemic diet, weight reduction, aerobic exercise",
    "Oral Hypoglycaemics: Metformin (1st line Type 2), Sulfonylureas (Glibenclamide), DPP-4 inhibitors, SGLT-2 inhibitors",
    "Insulin: All Type 1 DM; Type 2 when OHAs fail; types: rapid (Lispro), short (Regular), intermediate (NPH), long-acting (Glargine)",
    "Monitoring: SMBG, HbA1c every 3 months (target <7%)",
    "Complications management: ACE inhibitors for nephropathy, statins for CVD risk",
],
"dental": "Pre-op blood glucose check (ideal <200 mg/dL); morning appointments; avoid prolonged fasting; poor healing, increased infection risk, increased periodontal disease; candidiasis common; dry mouth (xerostomia); burning tongue syndrome; watch for hypoglycaemia in chair (give glucose immediately); antibiotic prophylaxis for major procedures; avoid nephrotoxic NSAIDs in nephropathy.",
"short_notes": ["DKA: DKA management", "Hyperosmolar Hyperglycaemic State (HHS)", "HbA1c", "Diabetic neuropathy", "Dawn phenomenon"],
},

# ── 2. INFECTIVE ENDOCARDITIS ────────────────────────────────────
{
"num": 2,
"title": "Infective Endocarditis",
"freq": "★★★★★  Core BDS topic",
"marks": "10-mark Long Essay | Short note: IE prophylaxis",
"definition": "Infective endocarditis (IE) is a microbial infection of the endocardium, most commonly affecting the heart valves, caused by bacteria (occasionally fungi), characterized by formation of vegetations (masses of fibrin, platelets, organisms, inflammatory cells).",
"classification": [
    ("Acute IE", "Highly virulent organisms (S. aureus); rapid valve destruction; high mortality if untreated"),
    ("Subacute IE (SBE)", "Less virulent (Strep viridans — most common); insidious onset; dental procedures implicated"),
    ("Native valve IE", "Affects previously normal or abnormal valves"),
    ("Prosthetic valve IE", "Early (<60 days, S. epidermidis) or Late (>60 days, Strep viridans)"),
    ("IVDU IE", "Right-sided; tricuspid valve; S. aureus commonest"),
],
"pathophysiology": [
    "Damaged endothelium / abnormal turbulent flow → sterile platelet-fibrin thrombus formation",
    "Transient bacteraemia (dental procedures, GI/GU instrumentation) → organisms adhere to thrombus",
    "Multiplication → vegetation formation → further valve damage, embolization",
    "Most common causative organism: Streptococcus viridans (alpha-haemolytic, normal oral flora)",
    "S. aureus increasingly common; HACEK group (Haemophilus, Actinobacillus, Cardiobacterium, Eikenella, Kingella)",
],
"clinical_features": [
    ("Constitutional", "Fever (most common, >90%), night sweats, malaise, weight loss, anaemia"),
    ("Cardiac", "New or changing murmur, heart failure, conduction defects"),
    ("Embolic", "Stroke, renal infarcts, splenic infarcts, pulmonary emboli (right-sided IE)"),
    ("Janeway lesions", "Non-tender erythematous macules on palms/soles — septic emboli"),
    ("Osler's nodes", "Tender, raised nodules on finger/toe pads — immune complex"),
    ("Roth spots", "Oval retinal haemorrhages with pale centre"),
    ("Splinter haemorrhages", "Linear haemorrhages under nails"),
    ("Splenomegaly", "Seen in subacute IE"),
    ("Clubbing", "In prolonged cases"),
],
"investigations": [
    "Blood cultures: 3 sets from different sites before antibiotics — GOLD STANDARD",
    "Echocardiogram: TTE first, TEE if TTE negative (higher sensitivity); visualizes vegetations",
    "Duke's Criteria: 2 major OR 1 major + 3 minor OR 5 minor criteria → definite IE",
    "CBC: Anaemia, leukocytosis, elevated ESR/CRP",
    "Urine: Microscopic haematuria, proteinuria",
    "CXR, ECG: Complications assessment",
],
"management": [
    "Medical: IV antibiotics for 4-6 weeks; empirical: Benzylpenicillin + Gentamicin (native valve); Vancomycin + Gentamicin if MRSA/prosthetic",
    "Guided by blood culture sensitivity; Strep viridans: Penicillin + Gentamicin 2 weeks",
    "Surgical: Valve replacement if: refractory heart failure, uncontrolled infection, large vegetations >10mm, recurrent emboli",
],
"dental": "MOST IMPORTANT for BDS: Dental procedures can cause transient bacteraemia → IE in susceptible patients. High-risk patients (prosthetic valves, previous IE, congenital heart disease, cardiac transplant with valvulopathy) require ANTIBIOTIC PROPHYLAXIS. Regimen: Amoxicillin 2g orally 30-60 min before procedure (or Clindamycin 600mg if penicillin-allergic). Maintain excellent oral hygiene. Minimize bacteraemia during procedures.",
"short_notes": ["Duke's criteria", "Osler's nodes vs Janeway lesions", "IE prophylaxis regimen", "Vegetation histology"],
},

# ── 3. VIRAL HEPATITIS B ─────────────────────────────────────────
{
"num": 3,
"title": "Viral Hepatitis B",
"freq": "★★★★★  Infection control relevance",
"marks": "10-mark Long Essay | Short notes: HBsAg, Hepatitis markers",
"definition": "Hepatitis B is a viral infection of the liver caused by the Hepatitis B Virus (HBV), a double-stranded DNA virus (Hepadnaviridae), transmitted parenterally, sexually, and vertically, capable of causing acute and chronic hepatitis, cirrhosis, and hepatocellular carcinoma.",
"classification": [
    ("Acute Hepatitis B", "Self-limiting in 90-95% adults; full recovery"),
    ("Chronic Hepatitis B", "Persistence >6 months; HBsAg positive >6 months; risk in neonates 90%"),
    ("Fulminant Hepatic Failure", "Massive necrosis; rare but fatal; 1% of acute cases"),
    ("Carrier State", "HBsAg positive, normal LFTs, no symptoms"),
],
"pathophysiology": [
    "HBV infects hepatocytes via HBsAg binding to receptors",
    "Viral replication → CD8+ T-cell mediated cytolysis of infected hepatocytes → liver damage",
    "Immune-mediated damage (not direct viral cytopathic effect in most)",
    "Chronic infection → persistent inflammation → fibrosis → cirrhosis → HCC",
],
"clinical_features": [
    ("Incubation", "60-180 days"),
    ("Prodromal", "Fatigue, anorexia, nausea, vomiting, right upper quadrant pain, low-grade fever, arthralgia"),
    ("Icteric phase", "Jaundice, dark urine (bilirubin), pale stools (clay-coloured), pruritus, tender hepatomegaly"),
    ("Extrahepatic", "Polyarteritis nodosa, membranous glomerulonephritis (immune complex), aplastic anaemia"),
    ("Chronic", "May be asymptomatic OR signs of chronic liver disease: spider naevi, palmar erythema, splenomegaly, ascites"),
],
"investigations": [
    "HBsAg: Surface antigen; FIRST to appear; marker of active infection; persists >6 months → chronic",
    "Anti-HBs: Protective antibody; appears after recovery or vaccination",
    "HBeAg: Core antigen (e antigen); high infectivity marker",
    "Anti-HBc IgM: Acute infection; IgG = past infection or chronic",
    "HBV DNA: Viral load; monitors treatment",
    "LFTs: Elevated ALT/AST (ALT > AST in hepatitis), bilirubin elevated",
    "Prothrombin time: Prolonged in severe disease (liver synthetic function)",
    "Liver biopsy: Grade inflammation, stage fibrosis",
],
"management": [
    "Acute: Supportive — rest, adequate nutrition, avoid alcohol and hepatotoxic drugs",
    "Chronic (indication for treatment): HBV DNA >2000 IU/mL + elevated ALT + liver inflammation on biopsy",
    "Antiviral drugs: Tenofovir disoproxil fumarate (TDF) or Entecavir (1st line); Pegylated Interferon-alpha (finite course)",
    "Monitoring: LFTs, HBV DNA, HBeAg/Anti-HBe seroconversion",
    "Vaccination: 3-dose recombinant vaccine (0, 1, 6 months); part of national immunisation; MANDATORY for healthcare workers",
],
"dental": "HBV is a MAJOR occupational hazard for dental professionals — highest risk bloodborne virus in dentistry. Universal precautions mandatory (gloves, mask, goggles, gown). Needle-stick protocol. All dental staff must be vaccinated. Check anti-HBs titre post-vaccination. Treat HBsAg-positive patients last in session with enhanced infection control. Check coagulation (PT/INR) before invasive procedures — liver disease may impair clotting.",
"short_notes": ["HBsAg interpretation", "Window period", "Hepatitis B vaccination schedule", "Comparison of Hepatitis A, B, C, E"],
},

# ── 4. HIV/AIDS ──────────────────────────────────────────────────
{
"num": 4,
"title": "HIV/AIDS",
"freq": "★★★★★  Oral manifestations critical for BDS",
"marks": "10-mark Long Essay | Short notes: Oral manifestations of AIDS, ART",
"definition": "Acquired Immunodeficiency Syndrome (AIDS) is the late stage of HIV infection caused by the Human Immunodeficiency Virus (HIV), a retrovirus (Lentivirus) that infects and destroys CD4+ T lymphocytes, leading to progressive immunodeficiency and susceptibility to opportunistic infections and malignancies.",
"classification": [
    ("CDC Stage 1 (Asymptomatic)", "CD4 >500 cells/μL; no AIDS-defining illness"),
    ("CDC Stage 2 (Symptomatic)", "CD4 200-499 cells/μL; minor OIs, constitutional symptoms"),
    ("CDC Stage 3 (AIDS)", "CD4 <200 cells/μL OR AIDS-defining illness"),
    ("WHO Clinical Stages", "Stage 1 (asymptomatic) to Stage 4 (AIDS-defining conditions)"),
],
"pathophysiology": [
    "HIV binds CD4 receptor (gp120) + co-receptor CCR5/CXCR4 → fusion (gp41) → entry into CD4+ T cells",
    "Reverse transcriptase converts viral RNA → DNA → integrates into host genome (provirus)",
    "Progressive CD4+ T cell depletion → loss of cell-mediated immunity",
    "When CD4 <200 → AIDS; <100 → severe OI risk (CMV, MAC); <50 → CMV retinitis, MAC",
    "Transmission: Sexual (most common), blood/blood products, IV drug use, vertical (mother to child)",
],
"clinical_features": [
    ("Acute retroviral syndrome", "2-4 weeks after infection; mononucleosis-like: fever, lymphadenopathy, pharyngitis, rash, myalgia; lasts 2-3 weeks"),
    ("Asymptomatic phase", "Variable duration (avg 8-10 years); persistent generalised lymphadenopathy (PGL)"),
    ("Symptomatic HIV", "Oral candidiasis, herpes zoster, TB, weight loss >10%, diarrhoea >1 month, PCP"),
    ("AIDS-defining illnesses", "PCP pneumonia, CMV retinitis, Toxoplasmosis (brain abscess), Cryptococcal meningitis, MAC, Kaposi sarcoma, NHL, wasting syndrome"),
],
"investigations": [
    "ELISA (screening): Detects anti-HIV antibodies; window period 2-12 weeks",
    "Western Blot (confirmatory): Detects antibodies to specific HIV proteins",
    "CD4+ T cell count: Immunological staging; guides prophylaxis and treatment",
    "HIV RNA (Viral Load): PCR; monitors treatment response; target: undetectable",
    "CBC: Lymphopenia, anaemia, thrombocytopenia",
    "Opportunistic infection workup: Sputum for TB, CXR, CT brain, LP",
],
"management": [
    "Antiretroviral Therapy (ART): Indicated for ALL HIV-positive patients regardless of CD4 count",
    "First-line ART (WHO 2021): 2 NRTIs + 1 INSTI (e.g., TDF + 3TC + DTG — Dolutegravir based)",
    "Goal: Viral load suppression to undetectable; CD4 count recovery",
    "OI prophylaxis: Cotrimoxazole prophylaxis (CD4 <200), Fluconazole (CD4 <100), INH prophylaxis for TB",
    "PMTCT: ART in pregnancy; avoid breastfeeding if safe alternatives available",
    "PEP: Post-exposure prophylaxis within 72 hours (TDF + 3TC + DTG for 28 days)",
],
"dental": "Oral manifestations are often the FIRST sign of HIV/AIDS. Know these well: (1) Oral Candidiasis (pseudomembranous — white plaques, erythematous) — most common; treat with fluconazole/nystatin. (2) Oral Hairy Leukoplakia — white corrugated lesions on lateral tongue; EBV-associated; cannot be wiped off. (3) Kaposi Sarcoma — purple/red lesions on palate. (4) Linear Gingival Erythema (LGE) and Necrotising Ulcerative Periodontitis (NUP). (5) Aphthous ulcers — major, recurrent. (6) Herpes simplex — severe, recurrent. (7) Xerostomia from medications. Infection control: Universal precautions mandatory. Do NOT refuse dental treatment to HIV patients.",
"short_notes": ["ELISA vs Western Blot", "Oral manifestations of AIDS", "Window period", "HAART drugs", "PEP protocol"],
},

# ── 5. IRON DEFICIENCY ANAEMIA ───────────────────────────────────
{
"num": 5,
"title": "Iron Deficiency Anaemia",
"freq": "★★★★★  Most common anaemia asked in BDS",
"marks": "10-mark Long Essay | Short essay: Blood picture in IDA",
"definition": "Iron deficiency anaemia (IDA) is the most common nutritional anaemia worldwide, characterized by decreased haemoglobin synthesis due to inadequate iron stores, resulting in a microcytic hypochromic anaemia.",
"classification": [
    ("Stage 1", "Depletion of iron stores (low ferritin); Hb and serum iron still normal"),
    ("Stage 2", "Iron-deficient erythropoiesis; low serum iron, high TIBC, low transferrin saturation; Hb still near normal"),
    ("Stage 3", "Iron deficiency anaemia; all parameters abnormal; symptoms appear"),
],
"pathophysiology": [
    "Causes: Chronic blood loss (peptic ulcer, menorrhagia — most common in females, hookworm), inadequate intake (vegetarians), malabsorption (coeliac disease, gastrectomy), increased demand (pregnancy, growth spurts)",
    "Iron depleted → reduced haemoglobin synthesis → RBCs small (microcytic) and pale (hypochromic)",
    "Reduced O2 carrying capacity → compensatory mechanisms: tachycardia, increased cardiac output",
],
"clinical_features": [
    ("Anaemia symptoms", "Fatigue, pallor (conjunctival, palmar, nail bed), dyspnoea on exertion, palpitations, dizziness"),
    ("Specific signs of IDA", "Koilonychia (spoon-shaped nails), Angular stomatitis / Angular cheilitis, Glossitis (smooth sore tongue), Pica (craving for non-food items — ice, clay, chalk)"),
    ("Plummer-Vinson Syndrome", "IDA + Dysphagia (postcricoid web) + Angular stomatitis; pre-malignant"),
    ("In children", "Irritability, poor concentration, poor school performance"),
],
"investigations": [
    "CBC: Hb ↓ (female <12, male <13 g/dL); MCV ↓ (<80 fL); MCH ↓; MCHC ↓",
    "Blood film: Microcytic hypochromic RBCs, pencil cells, target cells, anisocytosis, poikilocytosis",
    "Serum ferritin: ↓ (best early indicator of iron stores); <12 μg/L diagnostic",
    "Serum iron: ↓; TIBC (transferrin): ↑; Transferrin saturation ↓ (<15%)",
    "Reticulocyte count: Low (hypoproliferative)",
    "Bone marrow: Absent iron stores (Prussian blue stain) — gold standard but invasive",
    "Identify cause: Endoscopy (GI bleed), stool occult blood, menstrual history",
],
"management": [
    "Treat the underlying cause",
    "Oral iron: Ferrous sulphate 200mg TID (65mg elemental iron/tablet) for 3-6 months; take with vitamin C to enhance absorption; avoid with tea/milk/antacids",
    "Expected response: Reticulocytosis in 5-7 days; Hb rises 1-2 g/dL per week",
    "IV iron (Ferric carboxymaltose): If oral not tolerated, malabsorption, severe anaemia, non-compliance",
    "Blood transfusion: Only if Hb <7 g/dL with symptoms, or pre-op",
    "Continue oral iron 3 months after Hb normalises to replenish stores",
],
"dental": "Oral manifestations are classic and EXAMINABLE: Angular stomatitis (angular cheilitis) — soreness at corners of mouth; Glossitis — atrophic smooth red tongue (loss of filiform/fungiform papillae), burning sensation; Aphthous ulcers; Plummer-Vinson syndrome (postcricoid web with dysphagia — risk of oesophageal carcinoma). These oral signs may bring the patient to the dentist first. Treat the anaemia before elective dental surgery (Hb threshold: ≥10 g/dL). Reduced wound healing. Increased infection susceptibility.",
"short_notes": ["Blood picture in IDA", "Ferrous sulphate dose", "Plummer-Vinson syndrome", "IDA vs thalassaemia blood picture comparison"],
},

# ── 6. BRONCHIAL ASTHMA ──────────────────────────────────────────
{
"num": 6,
"title": "Bronchial Asthma",
"freq": "★★★★  Dental chair emergency",
"marks": "10-mark Long Essay | Short essay: Status Asthmaticus",
"definition": "Bronchial asthma is a chronic inflammatory disorder of the airways characterized by variable and reversible airflow obstruction, bronchial hyper-responsiveness, and airway inflammation (predominantly eosinophilic), manifesting as episodic wheezing, breathlessness, chest tightness, and cough.",
"classification": [
    ("Extrinsic (Atopic)", "IgE-mediated (Type I hypersensitivity); allergen-triggered; younger patients; positive family history"),
    ("Intrinsic (Non-atopic)", "Non-IgE mediated; triggered by infections, exercise, cold air; older patients; negative allergy tests"),
    ("Aspirin-sensitive asthma", "NSAIDs trigger attack; also nasal polyps; Samter's triad"),
    ("Exercise-induced", "Triggered by exercise; post-exertional bronchoconstriction"),
    ("Occupational asthma", "Due to workplace allergens (flour dust, isocyanates)"),
],
"pathophysiology": [
    "Sensitisation phase: Allergen exposure → Th2 cell activation → IL-4, IL-13 → IgE production → mast cell sensitisation",
    "Early phase (0-1 hr): Re-exposure → IgE cross-linking on mast cells → degranulation → histamine, leukotrienes, prostaglandins → bronchoconstriction, mucus secretion",
    "Late phase (4-8 hr): Eosinophil infiltration → eosinophil-derived toxins → mucosal damage, subepithelial fibrosis",
    "Airway remodelling in chronic asthma: Goblet cell hyperplasia, smooth muscle hypertrophy, thickened basement membrane",
],
"clinical_features": [
    ("Symptoms", "Episodic wheeze, breathlessness, chest tightness, cough (worse at night and early morning)"),
    ("Signs during attack", "Tachycardia, tachypnoea, use of accessory muscles, intercostal retractions, hyper-inflated chest, bilateral expiratory wheeze, prolonged expiration"),
    ("Peak expiratory flow (PEF)", "Reduced during attack; diurnal variation >20% diagnostic"),
    ("Status Asthmaticus", "Life-threatening: cannot speak in sentences, SpO2 <92%, PEF <33% predicted, silent chest (no air entry — ominous sign), cyanosis, bradycardia"),
],
"investigations": [
    "PFTs (Spirometry): Obstructive pattern — FEV1 ↓, FVC normal, FEV1/FVC ratio <0.7 (<70%); reversibility test: >12% improvement in FEV1 after bronchodilator",
    "Peak flow meter: Serial PEF monitoring; diurnal variation",
    "ABG: Hypoxaemia; initially hypocapnia (hyperventilation); rising PaCO2 = severe, impending respiratory failure",
    "CXR: Hyperinflation; exclude pneumothorax, infection",
    "Allergy tests: Skin prick tests, specific IgE (RAST)",
    "Bronchoprovocation (Methacholine challenge): Diagnose mild asthma",
],
"management": [
    "STEP therapy (GINA guidelines): Step 1 to 5",
    "Relievers (SABA): Salbutamol (Albuterol) inhaler — first-line for acute attack",
    "Controllers: Inhaled corticosteroids (ICS, e.g., Budesonide, Beclomethasone) — cornerstone of prevention",
    "Add-on: Long-acting beta-2 agonist (LABA, e.g., Salmeterol) + ICS combined inhalers",
    "Leukotriene receptor antagonists (Montelukast): Add-on; useful in aspirin-sensitive asthma",
    "Acute attack management: Sit upright, high-flow O2, nebulised Salbutamol 2.5-5mg, IV hydrocortisone, IV Magnesium sulphate (severe), intubation if needed",
    "Status Asthmaticus: Admit ICU; IV bronchodilators, IV steroids, O2, consider theophylline",
],
"dental": "Asthma attack CAN OCCUR in dental chair triggered by anxiety, stress, cold air, latex allergy, aspirin/NSAIDs, sulphite preservatives in local anaesthetics. Prevention: Avoid known triggers. Do not use aspirin or NSAIDs (use paracetamol instead). Avoid sulphite-containing anaesthetics in severe asthmatics. EMERGENCY: Stop procedure, sit patient upright, give patient's own salbutamol inhaler, call emergency services if no improvement. Oral side effects of ICS inhalers: oral candidiasis, dysphonia (rinse mouth after inhaler use).",
"short_notes": ["Status asthmaticus management", "FEV1/FVC ratio", "Salbutamol mechanism", "GINA classification", "Inhaler technique"],
},

# ── 7. EPILEPSY ──────────────────────────────────────────────────
{
"num": 7,
"title": "Epilepsy (Grand Mal Seizures)",
"freq": "★★★★  Dental chair emergency",
"marks": "10-mark Long Essay | Short essay: Status epilepticus",
"definition": "Epilepsy is a chronic neurological disorder characterized by recurrent (≥2) unprovoked seizures due to abnormal, excessive, or synchronous neuronal activity in the brain, separated by >24 hours.",
"classification": [
    ("Focal (Partial) Seizures", "Originate from one hemisphere; simple (no LOC), complex (impaired consciousness), secondary generalised"),
    ("Generalised Seizures", "Both hemispheres involved from onset; includes tonic-clonic (Grand mal), absence (Petit mal), myoclonic, tonic, atonic"),
    ("Grand Mal (GTCS)", "Tonic-clonic seizures; most common and clinically important"),
    ("Petit Mal (Absence)", "Brief staring spells (5-15 sec), no post-ictal confusion; childhood"),
    ("Status Epilepticus", "Seizure >30 min OR recurrent without regaining consciousness; EMERGENCY"),
],
"pathophysiology": [
    "Imbalance between excitatory (glutamate) and inhibitory (GABA) neurotransmitters",
    "Abnormal synchronised discharge from group of neurons (epileptic focus)",
    "Generalisation: Spread through cortex and subcortical structures",
    "Aetiology: Idiopathic (genetic), Symptomatic (tumour, trauma, infection, metabolic), Cryptogenic",
    "Common causes by age: Children (febrile seizures, congenital); Young adults (trauma, alcohol); Elderly (stroke, tumour, metabolic)",
],
"clinical_features": [
    ("Aura", "Warning symptoms before seizure (smell, visual, sensory): focal onset"),
    ("Tonic phase", "Sudden loss of consciousness, rigid extension, cry (air through larynx), 10-20 seconds"),
    ("Clonic phase", "Rhythmic jerking of all four limbs, tongue biting, urinary incontinence, 1-2 minutes"),
    ("Post-ictal phase", "Confusion, drowsiness, headache, Todd's paralysis (transient hemiplegia); 15 min to hours"),
    ("Aura absent in", "Generalised onset seizures — no warning"),
    ("Status Epilepticus", "Seizure >30 min; cyanosis, hypoxia, hyperthermia, rhabdomyolysis, lactic acidosis — HIGH MORTALITY"),
],
"investigations": [
    "EEG: CORNERSTONE — interictal spike-wave discharges; helps classify and localise",
    "MRI brain: Structural lesion (tumour, hippocampal sclerosis, cortical dysplasia); CT if MRI unavailable",
    "Blood tests: Blood glucose (hypoglycaemia!), electrolytes (Na, Ca, Mg), renal/liver function, FBC",
    "LP (lumbar puncture): If meningitis/encephalitis suspected",
    "ECG: Exclude cardiac arrhythmia mimicking seizure",
],
"management": [
    "Acute seizure: Protect airway (recovery position), DO NOT restrain, DO NOT put anything in mouth, time the seizure",
    "If >5 min: IV/rectal Diazepam 10mg OR buccal Midazolam 10mg; repeat once",
    "Status Epilepticus: IV Lorazepam → IV Phenytoin/Levetiracetam → General anaesthesia (Thiopentone, Propofol)",
    "Long-term AEDs: Sodium Valproate (broadest spectrum), Carbamazepine (focal seizures), Phenytoin (GTCS), Lamotrigine, Levetiracetam, Ethosuximide (absence only)",
    "Sodium Valproate: DOC for GTCS; AVOID in women of childbearing age (teratogenic — neural tube defects)",
    "Lifestyle: Avoid sleep deprivation, alcohol, flickering lights; no driving for 1 year",
],
"dental": "SEIZURE IN DENTAL CHAIR IS AN EMERGENCY. Risk factors: Anxiety, pain, hypoglycaemia, flashing dental light, missed medication, lack of sleep. Prevention: Take full medical history; morning appointments (less tired); ensure patient has taken AED that day; avoid triggering factors. MANAGEMENT: Clear field, lower chair flat, protect head (do NOT put anything in mouth), protect from falling, time the seizure, give oxygen, call ambulance if >5 min. Drug interactions: Phenytoin causes GINGIVAL HYPERPLASIA (overgrowth) — very important oral side effect. Carbamazepine causes Stevens-Johnson syndrome (SJS). Valproate increases bleeding time. Enzyme-inducing AEDs (Phenytoin, Carbamazepine) reduce efficacy of antibiotics (erythromycin, metronidazole).",
"short_notes": ["Gingival hyperplasia due to phenytoin", "Status epilepticus management", "AED classification", "EEG patterns"],
},

# ── 8. HEMOPHILIA ────────────────────────────────────────────────
{
"num": 8,
"title": "Haemophilia",
"freq": "★★★★  Bleeding management in dental practice",
"marks": "Long Essay | Short essay: Haemophilia A vs B, dental management",
"definition": "Haemophilia is an X-linked recessive inherited bleeding disorder caused by deficiency of clotting factors: Haemophilia A (Factor VIII deficiency) — commonest; Haemophilia B (Factor IX deficiency, Christmas disease); leading to impaired secondary haemostasis.",
"classification": [
    ("Mild", "Factor level 5-40%; bleeding only with major surgery/trauma"),
    ("Moderate", "Factor level 1-5%; bleeding with minor trauma, spontaneous bleeds occasionally"),
    ("Severe", "Factor level <1%; spontaneous joint and muscle bleeds (haemarthrosis)"),
    ("Haemophilia A", "Factor VIII deficiency; X-linked recessive; 1 in 5000 male births; commoner"),
    ("Haemophilia B", "Factor IX deficiency; X-linked recessive; 1 in 30000 male births"),
],
"pathophysiology": [
    "X-linked recessive: Males affected (XY); females are carriers (XX); daughters of affected males are obligate carriers",
    "Factor VIII/IX are part of intrinsic coagulation pathway (contact pathway)",
    "Deficiency → failure to form stable fibrin clot → prolonged bleeding after injury",
    "Platelet plug forms normally (primary haemostasis intact) → initial bleeding stops then restarts",
    "Haemarthrosis (bleeding into joints — knee most common) → synovitis → cartilage destruction → haemophilic arthropathy",
],
"clinical_features": [
    ("Haemarthrosis", "Joint swelling, warmth, pain, limited movement; knee > elbow > ankle"),
    ("Muscle haematoma", "Painful swelling; iliopsoas haematoma can compress femoral nerve"),
    ("Prolonged bleeding", "After minor cuts, dental extractions, surgery — bleeding does not stop initially"),
    ("Spontaneous bleeds", "Only in severe haemophilia"),
    ("Intracranial bleed", "Life-threatening; may follow trivial head trauma"),
    ("Normal findings", "No petechiae, no purpura, no superficial bruising (platelet function normal)"),
],
"investigations": [
    "APTT (aPTT): PROLONGED (intrinsic pathway affected)",
    "PT: NORMAL",
    "Bleeding time: NORMAL (primary haemostasis/platelets normal)",
    "Platelet count: NORMAL",
    "Factor VIII/IX assay: Specific diagnosis and severity classification",
    "Differentiating A vs B: Mix patient plasma with Haemophilia A patient plasma → APTT corrects = Haemophilia B",
],
"management": [
    "Factor replacement: Recombinant Factor VIII (Haemophilia A) or Factor IX (Haemophilia B) concentrate — mainstay",
    "Prophylactic factor replacement: Regular infusions to prevent bleeds in severe cases",
    "Desmopressin (DDAVP): For mild Haemophilia A — releases stored Factor VIII from endothelium; IV or intranasal",
    "Antifibrinolytics: Tranexamic acid — stabilise clot; VERY IMPORTANT for dental procedures",
    "Gene therapy: Emerging curative treatment (Factor IX gene therapy approved 2022 — Hemgenix)",
    "Haemarthrosis: PRICE (Protect, Rest, Ice, Compression, Elevation) + factor replacement",
    "Inhibitors: 30% Haemophilia A patients develop anti-FVIII antibodies → treat with bypassing agents (FEIBA, recombinant Factor VIIa)",
],
"dental": "HIGHEST DENTAL RELEVANCE: Dental extraction WITHOUT cover = uncontrolled haemorrhage. Pre-operative planning: (1) Check Factor level and inhibitor screen. (2) Co-ordinate with haematologist. (3) Give factor replacement to achieve ≥50% activity before procedure. (4) Use Tranexamic acid mouthwash (pre-op and 7-10 days post-op). (5) Local haemostatic measures: sutures, oxidised cellulose (Surgicel), Gelfoam, fibrin glue. (6) Avoid inferior alveolar nerve blocks if possible (floor of mouth haematoma risk) — use infiltration. (7) Avoid aspirin and NSAIDs. (8) Minimize trauma. Tranexamic acid 5% mouthwash (10 mL, 4x daily for 7-10 days) is key adjunct.",
"short_notes": ["Haemophilia A vs B — lab comparison", "DDAVP mechanism", "Tranexamic acid role in dentistry", "Haemarthrosis management"],
},

# ── 9. CIRRHOSIS OF LIVER ────────────────────────────────────────
{
"num": 9,
"title": "Cirrhosis of Liver",
"freq": "★★★★★  2023, 2025 papers",
"marks": "10-mark Long Essay | Short notes: Portal hypertension, ascites",
"definition": "Cirrhosis is the end-stage of chronic liver disease characterised by extensive hepatic fibrosis and replacement of normal liver parenchyma with regenerative nodules, resulting in loss of normal liver architecture and function.",
"classification": [
    ("Micronodular", "Nodules <3mm; alcoholic cirrhosis, haemochromatosis, biliary cirrhosis"),
    ("Macronodular", "Nodules >3mm; post-viral (HBV, HCV) cirrhosis"),
    ("Mixed", "Both types present"),
    ("By aetiology", "Alcoholic (most common in West), Viral (HBV/HCV — most common globally), Biliary, Wilson's disease, Haemochromatosis, Autoimmune, Cryptogenic"),
],
"pathophysiology": [
    "Chronic hepatocyte injury → hepatic stellate cell activation → excess collagen deposition (fibrosis)",
    "Fibrosis disrupts sinusoidal blood flow → portal hypertension (portal vein pressure >5 mmHg above IVC)",
    "Regenerative nodules form but lack normal architecture → impaired hepatic function",
    "Portal hypertension consequences: Varices (oesophageal, gastric), splenomegaly, ascites, hepatorenal syndrome",
    "Reduced hepatic synthetic function: ↓Albumin, ↓Clotting factors, ↓Bilirubin conjugation",
],
"clinical_features": [
    ("Compensated", "Often asymptomatic; fatigue, anorexia, mild hepatomegaly"),
    ("Decompensated", "Jaundice, ascites, variceal bleeding, hepatic encephalopathy, spontaneous bacterial peritonitis (SBP)"),
    ("Hands/nails", "Leukonychia (white nails), palmar erythema, Dupuytren's contracture, clubbing"),
    ("Skin/face", "Spider naevi (>5 = significant), jaundice, loss of body hair, gynaecomastia (in men), parotid enlargement (alcohol)"),
    ("Abdomen", "Hepatomegaly early → small liver late, splenomegaly, dilated veins (caput medusae), ascites (flank dullness, fluid thrill), fetor hepaticus"),
    ("Neurological", "Hepatic encephalopathy: flapping tremor (asterixis), confusion → coma"),
],
"investigations": [
    "LFTs: Elevated bilirubin, ↑ALT/AST, ↓albumin (<35 g/L), elevated ALP/GGT",
    "Coagulation: Prolonged PT/INR (reduced Factor II, VII, IX, X synthesis)",
    "FBC: Anaemia, thrombocytopenia (hypersplenism), leukopenia",
    "Serum albumin: ↓ (poor prognosis if <30 g/L)",
    "Child-Pugh Score: Bilirubin, albumin, PT, ascites, encephalopathy — grading A (compensated) to C (decompensated)",
    "MELD Score: For transplant listing (Model for End-stage Liver Disease)",
    "USS abdomen: Nodular liver, ascites, splenomegaly, portal vein diameter",
    "Liver biopsy: Definitive diagnosis — fibrosis staging (Ishak/METAVIR)",
    "Upper GI endoscopy: Oesophageal varices",
    "AFP (alpha-fetoprotein): Surveillance for hepatocellular carcinoma (HCC)",
],
"management": [
    "Treat underlying cause: Stop alcohol (abstinence), antivirals for HBV/HCV, chelation for Wilson's/haemochromatosis",
    "Portal hypertension: Non-selective beta-blockers (Propranolol, Carvedilol) reduce portal pressure; endoscopic variceal banding",
    "Ascites: Salt restriction (<90 mEq/day), diuretics (spironolactone 1st line + frusemide), paracentesis for refractory ascites",
    "Hepatic encephalopathy: Lactulose (acidifies colon, traps NH3), Rifaximin (antibiotic — reduces gut bacteria), low-protein diet is OUTDATED",
    "SBP: IV Cefotaxime; prophylaxis with Norfloxacin",
    "Variceal bleeding: IV terlipressin + endoscopic band ligation; TIPSS if refractory",
    "Liver transplantation: Definitive treatment for end-stage disease",
],
"dental": "Bleeding risk is MAJOR concern: ↓clotting factors (PT/INR prolonged), thrombocytopenia (↓platelets from hypersplenism). CHECK PT/INR and platelet count before any invasive procedure. Avoid all NSAIDs (worsens bleeding, nephrotoxic, precipitate renal failure). Avoid hepatotoxic drugs (paracetamol in therapeutic doses is safe but avoid overdose). Use lidocaine (lignocaine) carefully — impaired liver metabolism → increased toxicity risk → reduce dose. Oral manifestations: Jaundice, bleeding from gums, petechiae, parotid enlargement (alcohol cirrhosis), angular stomatitis. Fresh frozen plasma (FFP) may be needed to correct coagulopathy before surgery.",
"short_notes": ["Child-Pugh scoring", "Portal hypertension complications", "Hepatic encephalopathy management", "Spontaneous bacterial peritonitis"],
},

# ── 10. HYPERTENSION ─────────────────────────────────────────────
{
"num": 10,
"title": "Hypertension",
"freq": "★★★★  Common dental patient comorbidity",
"marks": "10-mark Long Essay | Short essay: Hypertensive crisis, antihypertensives",
"definition": "Hypertension is defined as persistently elevated arterial blood pressure ≥140/90 mmHg (JNC 7) or ≥130/80 mmHg (ACC/AHA 2017 guidelines) on ≥2 separate occasions, representing the most prevalent modifiable cardiovascular risk factor worldwide.",
"classification": [
    ("Normal", "SBP <120 AND DBP <80 mmHg"),
    ("Elevated / Pre-hypertension", "SBP 120-129 AND DBP <80 mmHg"),
    ("Stage 1", "SBP 130-139 OR DBP 80-89 mmHg"),
    ("Stage 2", "SBP ≥140 OR DBP ≥90 mmHg"),
    ("Hypertensive Crisis", "SBP >180 and/or DBP >120 mmHg"),
    ("Primary (Essential)", "~95%; no identifiable cause; multifactorial (genetic + lifestyle)"),
    ("Secondary", "~5%; Renal (renovascular, CKD), endocrine (Conn's, Cushing's, phaeochromocytoma), coarctation of aorta, drugs (OCP, NSAIDs)"),
],
"pathophysiology": [
    "BP = Cardiac Output × Total Peripheral Resistance",
    "Increased cardiac output (fluid overload, high sympathetic tone) OR increased TPR (vasoconstriction) → hypertension",
    "RAAS activation: Renin (kidney) → Angiotensin I → ACE → Angiotensin II → Vasoconstriction + Aldosterone → Na/water retention → ↑BP",
    "Risk factors: Age, male sex, family history, obesity (BMI >30), salt intake, alcohol, smoking, sedentary lifestyle, diabetes, dyslipidaemia",
    "Pathological changes: Hyaline arteriolosclerosis, microaneurysms, endothelial dysfunction, left ventricular hypertrophy (LVH)",
],
"clinical_features": [
    ("Usually", "ASYMPTOMATIC — 'silent killer'; discovered incidentally"),
    ("Symptoms when severe", "Headache (occipital, early morning), dizziness, blurred vision, palpitations"),
    ("Target organ damage", "Heart: LVH → angina, MI, heart failure; Brain: Stroke, hypertensive encephalopathy, retinopathy; Kidney: Proteinuria → CKD; Eyes: Grade I-IV Keith-Wagener retinopathy; Vessels: Peripheral arterial disease, aortic aneurysm"),
    ("Malignant/Accelerated HT", "DBP >120 mmHg + papilloedema + rapidly progressive renal failure"),
],
"investigations": [
    "Repeated BP measurements: 3 occasions, 2 readings each",
    "Ambulatory BP monitoring (ABPM): Gold standard; eliminates white coat hypertension",
    "Urinalysis: Proteinuria, haematuria (renal cause/damage)",
    "Renal function: Creatinine, eGFR",
    "Fasting glucose and lipids: Metabolic syndrome screening",
    "ECG: LVH (Sokolov-Lyon criteria), strain pattern",
    "Echo: LV mass, wall thickness, diastolic dysfunction",
    "CXR: Cardiac enlargement, pulmonary oedema in hypertensive failure",
    "Screen for secondary causes if: Young age, resistant hypertension, abrupt onset, hypokalaemia",
],
"management": [
    "Lifestyle modifications (all stages): Weight reduction, DASH diet (low sodium <2g/day, high potassium, fruits, vegetables), aerobic exercise (150 min/week), limit alcohol, stop smoking",
    "Drug therapy (Stage 2 or Stage 1 with high CV risk):",
    "First-line: ACE inhibitor (Ramipril, Enalapril) OR ARB (Losartan) — esp. with diabetes/CKD; Calcium channel blocker (Amlodipine); Thiazide diuretic (Hydrochlorothiazide, Chlorthalidone)",
    "Beta-blockers (Atenolol, Metoprolol): 4th line unless angina/AF/HF",
    "Combination therapy: ACE-I + CCB (preferred combination)",
    "Resistant HT (uncontrolled on 3 drugs): Add spironolactone; investigate secondary causes",
    "Hypertensive Crisis: Labetalol IV OR Sodium nitroprusside (parenteral); reduce BP by ≤25% in first hour, then gradually",
],
"dental": "VERY IMPORTANT for dental practice: Check BP at every appointment. Do NOT proceed with elective treatment if SBP >180 or DBP >110 mmHg (refer for medical management first). Anxiety/pain during dental treatment can raise BP acutely. Epinephrine (adrenaline) in local anaesthetic: Use cautiously (max 2 cartridges of 1:100,000 epi); avoid if on non-selective beta-blockers (risk of severe hypertension — epinephrine-beta blocker interaction → unopposed alpha effect → hypertensive crisis). Felodipine/Nifedipine (CCBs) and Amlodipine cause GINGIVAL HYPERPLASIA — important oral side effect. NSAIDs may raise BP and antagonise antihypertensives. ACE inhibitors can cause dry cough and angioedema (oral/pharyngeal swelling — EMERGENCY).",
"short_notes": ["RAAS pathway", "Keith-Wagener retinopathy grading", "CCB-induced gingival hyperplasia", "Hypertensive emergency vs urgency"],
},
]

# ══════════════════════════════════════════════════════════════════
# BUILD PDF
# ══════════════════════════════════════════════════════════════════

story = []

# ── COVER PAGE ─────────────────────────────────────────────────────
cover_data = [[
    Paragraph("RGUHS BDS 3rd Year", cover_title),
    Paragraph("General Medicine", ParagraphStyle("ct2", parent=cover_title, fontSize=30)),
    Spacer(1, 0.3*cm),
    Paragraph("Detailed Study Guide with Answer Outlines", cover_sub),
    Spacer(1, 0.2*cm),
    Paragraph("Top 10 Most Important Topics", cover_sub),
    Spacer(1, 0.6*cm),
    Paragraph("Includes: Long Essay Outlines  •  Short Notes  •  Investigations  •  Dental Significance", cover_note),
    Spacer(1, 0.3*cm),
    Paragraph("University Examinations  |  RGUHS Karnataka", cover_note),
]]

cover_tbl = Table(cover_data, colWidths=[17*cm])
cover_tbl.setStyle(TableStyle([
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    ("TOPPADDING", (0,0), (-1,-1), 40),
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    ("LEFTPADDING", (0,0), (-1,-1), 25),
    ("RIGHTPADDING", (0,0), (-1,-1), 25),
    ("ROUNDEDCORNERS", [6, 6, 6, 6]),
]))
story.append(Spacer(1, 1.5*cm))
story.append(cover_tbl)
story.append(Spacer(1, 1*cm))

# Pattern info box
story.append(info_box(
    "<b>EXAM PATTERN:</b>  Section I — 2 Long Essays (10 marks each, write 2/3)  |  "
    "Section II — 10 Short Essays (5 marks each, write 8)  |  "
    "Section III — 10 Short Answers (2 marks each, write 8)  |  Total: 60 Marks",
    bg=LTAMB, border=AMBER
))
story.append(Spacer(1, 0.4*cm))

# ── TABLE OF CONTENTS ──────────────────────────────────────────────
story.append(header_band("TABLE OF CONTENTS", bg=TEAL))
story.append(Spacer(1, 0.3*cm))

toc_rows = [
    ["1.", "Diabetes Mellitus", "★★★★★"],
    ["2.", "Infective Endocarditis", "★★★★★"],
    ["3.", "Viral Hepatitis B", "★★★★★"],
    ["4.", "HIV / AIDS", "★★★★★"],
    ["5.", "Iron Deficiency Anaemia", "★★★★★"],
    ["6.", "Bronchial Asthma", "★★★★"],
    ["7.", "Epilepsy (Grand Mal Seizures)", "★★★★"],
    ["8.", "Haemophilia", "★★★★"],
    ["9.", "Cirrhosis of Liver", "★★★★★"],
    ["10.", "Hypertension", "★★★★"],
]

toc_table_data = [
    [Paragraph("<b>No.</b>", ParagraphStyle("th", fontSize=10, fontName="Helvetica-Bold", textColor=WHITE)),
     Paragraph("<b>Topic</b>", ParagraphStyle("th", fontSize=10, fontName="Helvetica-Bold", textColor=WHITE)),
     Paragraph("<b>Frequency</b>", ParagraphStyle("th", fontSize=10, fontName="Helvetica-Bold", textColor=WHITE))]
]
for i, (num, topic, freq) in enumerate(toc_rows):
    bg = LTBLUE if i % 2 == 0 else WHITE
    toc_table_data.append([
        Paragraph(num, ParagraphStyle("tn", fontSize=10, fontName="Helvetica-Bold", textColor=NAVY)),
        Paragraph(topic, ParagraphStyle("tt", fontSize=10, fontName="Helvetica", textColor=DKGREY)),
        Paragraph(freq, ParagraphStyle("tf", fontSize=10, fontName="Helvetica", textColor=colors.HexColor("#c0392b"))),
    ])

toc_tbl = Table(toc_table_data, colWidths=[1.5*cm, 12*cm, 3.5*cm])
toc_tbl.setStyle(TableStyle([
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    ("VALIGN", (0,0), (-1,-1), "MIDDLE"),
]))
story.append(toc_tbl)
story.append(PageBreak())

# ── TOPIC PAGES ────────────────────────────────────────────────────
for t in TOPICS:
    # Topic header
    story.append(header_band(f"TOPIC {t['num']}:  {t['title'].upper()}", bg=NAVY))
    story.append(Spacer(1, 0.15*cm))

    # Frequency & marks tag
    freq_data = [[
        Paragraph(t['freq'], ParagraphStyle("fr", fontSize=9, fontName="Helvetica-Bold",
            textColor=colors.HexColor("#c0392b"))),
        Paragraph(t['marks'], ParagraphStyle("mk", fontSize=9, fontName="Helvetica-Oblique",
            textColor=MDGREY, alignment=TA_LEFT)),
    ]]
    freq_tbl = Table(freq_data, colWidths=[7*cm, 10*cm])
    freq_tbl.setStyle(TableStyle([
        ("BACKGROUND", (0,0), (-1,-1), LTAMB),
        ("GRID", (0,0), (-1,-1), 0.5, AMBER),
        ("TOPPADDING", (0,0), (-1,-1), 4),
        ("BOTTOMPADDING", (0,0), (-1,-1), 4),
        ("LEFTPADDING", (0,0), (-1,-1), 8),
    ]))
    story.append(freq_tbl)
    story.append(Spacer(1, 0.25*cm))

    # Definition
    story.append(Paragraph("DEFINITION", subsection_h))
    story.append(info_box(t['definition']))
    story.append(Spacer(1, 0.2*cm))

    # Classification
    story.append(Paragraph("CLASSIFICATION / TYPES", subsection_h))
    story.append(two_col_table(t['classification'], col1w=5*cm, col2w=12*cm))
    story.append(Spacer(1, 0.2*cm))

    # Pathophysiology
    story.append(Paragraph("PATHOPHYSIOLOGY / AETIOLOGY", subsection_h))
    for pt in t['pathophysiology']:
        story.append(bullet(pt))
    story.append(Spacer(1, 0.2*cm))

    # Clinical features
    story.append(Paragraph("CLINICAL FEATURES", subsection_h))
    story.append(two_col_table(t['clinical_features'], col1w=4.5*cm, col2w=12.5*cm))
    story.append(Spacer(1, 0.2*cm))

    # Investigations
    story.append(Paragraph("INVESTIGATIONS", subsection_h))
    for inv in t['investigations']:
        story.append(bullet(inv))
    story.append(Spacer(1, 0.2*cm))

    # Management
    story.append(Paragraph("MANAGEMENT", subsection_h))
    for m in t['management']:
        story.append(bullet(m))
    story.append(Spacer(1, 0.2*cm))

    # Dental significance box
    story.append(dental_box(t['dental']))
    story.append(Spacer(1, 0.2*cm))

    # Short notes
    story.append(Paragraph("ALSO PREPARE AS SHORT NOTES:", subsection_h))
    sn_text = "  |  ".join([f"• {s}" for s in t['short_notes']])
    story.append(info_box(sn_text, bg=LTGRN, border=colors.HexColor("#27ae60")))

    story.append(PageBreak())

# ── QUICK REFERENCE / EXAM TIPS ───────────────────────────────────
story.append(header_band("QUICK REFERENCE — EXAM TIPS & HIGH-YIELD TABLES", bg=TEAL))
story.append(Spacer(1, 0.3*cm))

story.append(Paragraph("COAGULATION TESTS — WHICH DISEASE AFFECTS WHAT", section_h))
coag_data = [
    ("Parameter", "Normal", "IDA", "Haemophilia A", "Haemophilia B", "Liver Disease", "ITP"),
    ("PT/INR", "11-14 sec", "Normal", "Normal", "Normal", "↑ Prolonged", "Normal"),
    ("APTT", "25-35 sec", "Normal", "↑ Prolonged", "↑ Prolonged", "↑ Prolonged", "Normal"),
    ("Bleeding Time", "2-7 min", "Normal", "Normal", "Normal", "Normal/↑", "↑ Prolonged"),
    ("Platelet count", "1.5-4 lakh", "Normal", "Normal", "Normal", "↓ Low", "↓ Low"),
    ("Factor assay", "—", "—", "↓ FVIII", "↓ FIX", "Multiple ↓", "—"),
]
coag_tbl_data = []
for i, row in enumerate(coag_data):
    style_fn = lambda txt, bold=False: Paragraph(
        f"<b>{txt}</b>" if bold else txt,
        ParagraphStyle("ct", fontSize=8, fontName="Helvetica-Bold" if bold else "Helvetica",
            textColor=WHITE if i == 0 else DKGREY, leading=11))
    coag_tbl_data.append([style_fn(c, bold=(i==0)) for c in row])

coag_tbl = Table(coag_tbl_data, colWidths=[2.5*cm, 1.8*cm, 1.8*cm, 2.2*cm, 2.2*cm, 2.5*cm, 1.7*cm])
coag_tbl.setStyle(TableStyle([
    ("BACKGROUND", (0,0), (-1,0), NAVY),
    ("ROWBACKGROUNDS", (0,1), (-1,-1), [LTBLUE, WHITE]),
    ("GRID", (0,0), (-1,-1), 0.5, colors.HexColor("#aaaaaa")),
    ("TOPPADDING", (0,0), (-1,-1), 4),
    ("BOTTOMPADDING", (0,0), (-1,-1), 4),
    ("LEFTPADDING", (0,0), (-1,-1), 4),
    ("FONTSIZE", (0,0), (-1,-1), 8),
    ("VALIGN", (0,0), (-1,-1), "MIDDLE"),
]))
story.append(coag_tbl)
story.append(Spacer(1, 0.4*cm))

story.append(Paragraph("DRUGS WITH ORAL SIDE EFFECTS — HIGH YIELD FOR BDS", section_h))
drug_data = [
    ("Drug / Drug Class", "Oral Side Effect", "Disease Treated"),
    ("Phenytoin", "GINGIVAL HYPERPLASIA", "Epilepsy"),
    ("Nifedipine / Amlodipine (CCB)", "GINGIVAL HYPERPLASIA", "Hypertension"),
    ("Cyclosporine", "GINGIVAL HYPERPLASIA", "Transplant immunosuppression"),
    ("ACE Inhibitors (Ramipril)", "Dry cough; ANGIOEDEMA (tongue/pharynx — emergency)", "Hypertension, Heart failure"),
    ("Inhaled Corticosteroids", "Oral candidiasis, dysphonia", "Asthma"),
    ("Bisphosphonates (IV)", "OSTEONECROSIS OF JAW (MRONJ)", "Osteoporosis, cancer"),
    ("Methotrexate", "Oral mucositis, ulcers", "RA, cancer"),
    ("Antiplatelet drugs (Aspirin)", "Prolonged bleeding after extraction", "IHD, stroke prevention"),
    ("Tetracyclines", "Dental staining (in children <8 years)", "Various infections"),
    ("Warfarin", "Prolonged bleeding; check INR <2.5 for dentistry", "AF, DVT, prosthetic valves"),
]
drug_tbl_data = []
for i, row in enumerate(drug_data):
    bold_flag = (i == 0)
    drug_tbl_data.append([
        Paragraph(f"<b>{row[0]}</b>" if bold_flag else row[0],
            ParagraphStyle("dt", fontSize=8.5, fontName="Helvetica-Bold" if bold_flag else "Helvetica",
                textColor=WHITE if bold_flag else DKGREY, leading=12)),
        Paragraph(f"<b>{row[1]}</b>" if bold_flag else f"<b><font color='#c0392b'>{row[1]}</font></b>" if i > 0 else row[1],
            ParagraphStyle("dt2", fontSize=8.5, fontName="Helvetica-Bold",
                textColor=WHITE if bold_flag else colors.HexColor("#c0392b"), leading=12)),
        Paragraph(f"<b>{row[2]}</b>" if bold_flag else row[2],
            ParagraphStyle("dt3", fontSize=8.5, fontName="Helvetica-Bold" if bold_flag else "Helvetica",
                textColor=WHITE if bold_flag else DKGREY, leading=12)),
    ])

drug_tbl = Table(drug_tbl_data, colWidths=[4.5*cm, 7*cm, 5.5*cm])
drug_tbl.setStyle(TableStyle([
    ("BACKGROUND", (0,0), (-1,0), NAVY),
    ("ROWBACKGROUNDS", (0,1), (-1,-1), [LTBLUE, WHITE]),
    ("GRID", (0,0), (-1,-1), 0.5, colors.HexColor("#aaaaaa")),
    ("TOPPADDING", (0,0), (-1,-1), 5),
    ("BOTTOMPADDING", (0,0), (-1,-1), 5),
    ("LEFTPADDING", (0,0), (-1,-1), 5),
    ("VALIGN", (0,0), (-1,-1), "TOP"),
]))
story.append(drug_tbl)
story.append(Spacer(1, 0.4*cm))

# Exam tips
story.append(Paragraph("GENERAL EXAM TIPS FOR RGUHS GENERAL MEDICINE", section_h))
tips = [
    "Always write a DEFINITION first in your answer — it fetches easy marks.",
    "CLASSIFICATION is always expected — use a table format if possible.",
    "Every long essay answer should end with DENTAL SIGNIFICANCE — worth 2 marks.",
    "Draw labelled diagrams wherever asked or wherever relevant (e.g., blood smear in IDA, ECG in MI, DKA flowchart).",
    "For investigations, list them in order: Blood tests → Urine → Imaging → Specialised.",
    "Management: Divide into Non-pharmacological → Pharmacological → Surgical.",
    "Learn normal lab values: Hb (M: 13-17, F: 12-15 g/dL), WBC (4000-11000/μL), Platelets (1.5-4 lakh/μL), PT (11-14 sec), APTT (25-35 sec), FBG (<126 mg/dL), HbA1c (<6.5%), INR (0.8-1.2).",
    "Repeat topics in 3-year cycles — check 2022 paper topics for 2025-26 probable questions.",
    "Short essay answers need introduction + 4-5 well-organised points + conclusion (approx 1 page).",
    "For 2-mark questions: Give ONE concise definition or ONE diagnostic criterion — no need for elaborate answers.",
]
for tip in tips:
    story.append(bullet(tip))

story.append(Spacer(1, 0.3*cm))
story.append(HRFlowable(width="100%", thickness=1, color=TEAL))
story.append(Spacer(1, 0.2*cm))
story.append(Paragraph(
    "This study guide is compiled for RGUHS BDS 3rd Year General Medicine examination preparation. "
    "Content is based on standard medical textbooks (Davidson's, Harrison's, CM Chuni & ST Shah for BDS). "
    "Always cross-reference with your college notes and latest RGUHS previous year papers.",
    ParagraphStyle("footer", fontSize=8, fontName="Helvetica-Oblique", textColor=MDGREY,
        alignment=TA_CENTER, leading=12)
))

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