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Give me mcq regarding toxic shock syndrome

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I now have comprehensive content from multiple authoritative textbooks to build high-quality MCQs. Here are the MCQs:

Multiple Choice Questions: Toxic Shock Syndrome

Q1. Which toxin is responsible for 100% of menstruation-associated cases of staphylococcal toxic shock syndrome?
A) Staphylococcal enterotoxin A (SEA) B) Toxic shock syndrome toxin-1 (TSST-1) C) Exfoliative toxin A D) Staphylococcal enterotoxin B (SEB)
Answer: B) TSST-1 TSST-1 is responsible for 100% of tampon/menstruation-associated TSS cases. SEB, SEA, and SEC account for nonmenstrual TSS cases. (Goldman-Cecil Medicine)
Q2. TSST-1 exerts its pathogenic effect primarily by acting as a:
A) Endotoxin that activates complement B) Superantigen that binds MHC class II molecules and causes massive T-cell stimulation C) Proteolytic enzyme destroying basement membranes D) Pore-forming toxin targeting red blood cells
Answer: B) Superantigen binding MHC class II TSST-1 binds MHC class II molecules, causing non-specific T-cell stimulation and massive cytokine release (TNF-α, IL-1). It is the prototypical superantigen. (Jawetz Medical Microbiology)
Q3. Which of the following is NOT a diagnostic criterion for staphylococcal toxic shock syndrome?
A) Temperature ≥38.9°C B) Systolic BP <90 mmHg C) Positive blood culture for S. aureus D) Diffuse macular erythroderma
Answer: C) Positive blood culture for S. aureus Diagnosis is clinical. Blood cultures are actually expected to be NEGATIVE in staphylococcal TSS (positive in only ~5-15% of cases). A positive blood culture would point more toward streptococcal TSS (~50% positive). (Dermatology 5e; Goldman-Cecil Medicine)
Q4. How many organ systems must be involved to fulfil the diagnostic criteria for staphylococcal TSS?
A) One or more B) Two or more C) Three or more D) Four or more
Answer: C) Three or more Diagnosis requires fever, hypotension, rash, AND involvement of at least three organ systems (GI, muscular, CNS, renal, hepatic, or hematologic). (Rosen's Emergency Medicine)
Q5. The rash of toxic shock syndrome characteristically:
A) Begins as petechiae on the wrists and ankles B) Is a diffuse, blanching macular erythroderma followed by full-thickness desquamation of palms and soles C) Presents as vesicles that rupture and crust D) Appears first on the trunk and spares the extremities
Answer: B) Diffuse macular erythroderma with later desquamation of palms and soles The rash is a diffuse blanching macular erythroderma; it fades within 3 days and is followed by full-thickness desquamation, most commonly of the hands and feet, 1-2 weeks after onset. (Rosen's Emergency Medicine; Dermatology 5e)
Q6. Approximately what percentage of TSS cases are associated with menstruation?
A) 10% B) 30% C) 50% D) 80%
Answer: C) 50% Approximately 50% of TSS cases are menstruation-associated. The remaining cases occur in the postoperative setting, burns, postpartum infection, osteomyelitis, sinusitis, and other foci. (Rosen's Emergency Medicine)
Q7. For streptococcal toxic shock syndrome, what is the preferred antibiotic regimen?
A) Vancomycin alone B) Penicillin G plus clindamycin C) Oxacillin plus gentamicin D) Metronidazole plus cefazolin
Answer: B) Penicillin G plus clindamycin Streptococcal TSS is treated empirically with clindamycin (900 mg IV q8h) PLUS penicillin G (4 million units IV q4h). Clindamycin suppresses toxin synthesis. (Goldman-Cecil Medicine)
Q8. The gene for TSST-1 is found in approximately what proportion of S. aureus isolates?
A) 5% B) 20% C) 50% D) 75%
Answer: B) 20% The gene for TSST-1 is found in about 20% of S. aureus isolates, including MRSA strains. (Jawetz Medical Microbiology)
Q9. Which of the following cytokines is primarily responsible for the fever and erythema in TSS?
A) IL-6 and IL-10 B) TNF-α and IL-1 C) IL-4 and IL-13 D) IFN-γ and IL-2
Answer: B) TNF-α and IL-1 The clinical manifestations of TSS result from massive release of TNF-α and IL-1, causing fever, diffuse macular erythema, and multiorgan involvement. (Goldman-Cecil Medicine)
Q10. Which feature distinguishes streptococcal TSS from staphylococcal TSS diagnostically?
A) Presence of desquamation B) Isolation of Group A Streptococcus from a normally sterile site (definite case) C) Hypotension D) Involvement of three organ systems
Answer: B) Isolation of Group A Streptococcus from a sterile site Definite streptococcal TSS requires isolation of GAS from a normally sterile site (blood, CSF, tissue biopsy). Additionally, blood cultures are positive in ~50% of streptococcal TSS vs. only 5-15% in staphylococcal TSS. (Dermatology 5e; Goldman-Cecil Medicine)
Q11. For staphylococcal TSS due to methicillin-resistant S. aureus (MRSA), the treatment of choice is:
A) Oxacillin + clindamycin B) Vancomycin + clindamycin C) Penicillin G + rifampin D) Doxycycline monotherapy
Answer: B) Vancomycin + clindamycin MRSA-related staphylococcal TSS is treated with vancomycin (15-20 mg/kg q8-12h, max 2g/dose) PLUS clindamycin (900 mg IV q8h). Clindamycin is added to suppress toxin production. (Goldman-Cecil Medicine)
Q12. TSS following nasal packing is most likely caused by which organism?
A) Streptococcus pneumoniae B) Staphylococcus aureus C) Pseudomonas aeruginosa D) Haemophilus influenzae
Answer: B) Staphylococcus aureus TSS cases related to nasal packing are caused by S. aureus. Prolonged nasal packing causes bacterial overgrowth leading to toxin production and systemic illness. (K.J. Lee's Essential Otolaryngology)
Q13. The mucous membrane findings in TSS may include all of the following EXCEPT:
A) Strawberry tongue B) Non-exudative conjunctivitis C) Pharyngitis D) Koplik spots
Answer: D) Koplik spots Koplik spots are pathognomonic of measles. TSS mucous membrane findings include strawberry tongue, non-exudative conjunctivitis, pharyngitis, and vaginitis. (Rosen's Emergency Medicine)
Q14. The TSST-1 and enterotoxin genes are located on which genetic element?
A) Plasmid B) Transposon C) Chromosomal pathogenicity island D) Bacteriophage genome
Answer: C) Chromosomal pathogenicity island The exfoliative toxins, TSST-1, and enterotoxin genes are carried on a chromosomal pathogenicity island, which interacts with bacteriophages to produce the toxins. (Jawetz Medical Microbiology)
Q15. What is the approximate mortality of staphylococcal toxic shock syndrome?
A) <1% B) 5-15% C) 30-40% D) >50%
Answer: B) 5-15% Staphylococcal TSS has a mortality of approximately 5-15%. Streptococcal TSS tends to have higher mortality. (Goldman-Cecil Medicine)
Sources:
  • Goldman-Cecil Medicine, International Edition
  • Rosen's Emergency Medicine, 9e
  • Jawetz, Melnick & Adelberg's Medical Microbiology, 28e
  • Dermatology, 2-Volume Set, 5e
  • K.J. Lee's Essential Otolaryngology

Create a study guide PDF comparing staphylococcal vs streptococcal TSS00% in the question?

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mkdir -p /home/daytona/workspace/tss-study-guide

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~/tss-study-guide/generate_tss_pdf.py

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

OUTPUT_PATH = "/home/daytona/workspace/tss-study-guide/TSS_Study_Guide.pdf"

# ── Colours ────────────────────────────────────────────────────────────────────
DARK_BLUE   = colors.HexColor("#1A3A5C")
MED_BLUE    = colors.HexColor("#2E6DA4")
LIGHT_BLUE  = colors.HexColor("#D6E8F7")
STAPH_COL   = colors.HexColor("#1A5276")   # deep blue for staph column header
STREP_COL   = colors.HexColor("#1D6A33")   # deep green for strep column header
STAPH_LIGHT = colors.HexColor("#D6EAF8")
STREP_LIGHT = colors.HexColor("#D5F5E3")
ALT_GREY    = colors.HexColor("#F2F3F4")
GOLD        = colors.HexColor("#D4AC0D")
WHITE       = colors.white
RED_DARK    = colors.HexColor("#922B21")
ORANGE      = colors.HexColor("#CA6F1E")

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

def s(name, **kw):
    base = styles[name] if name in styles else styles["Normal"]
    return ParagraphStyle(name + "_custom_" + str(id(kw)), parent=base, **kw)

TITLE_STYLE = s("Title",
    fontSize=26, textColor=WHITE, alignment=TA_CENTER,
    fontName="Helvetica-Bold", spaceAfter=4, leading=30)

SUBTITLE_STYLE = s("Normal",
    fontSize=13, textColor=colors.HexColor("#AED6F1"),
    alignment=TA_CENTER, fontName="Helvetica", spaceAfter=2)

SECTION_STYLE = s("Normal",
    fontSize=14, textColor=WHITE, fontName="Helvetica-Bold",
    alignment=TA_LEFT, leading=18, spaceAfter=2, spaceBefore=10)

SUBSECTION_STYLE = s("Normal",
    fontSize=11, textColor=DARK_BLUE, fontName="Helvetica-Bold",
    spaceAfter=4, spaceBefore=8)

BODY_STYLE = s("Normal",
    fontSize=9.5, textColor=colors.HexColor("#2C2C2C"),
    fontName="Helvetica", leading=14, spaceAfter=3, alignment=TA_JUSTIFY)

BULLET_STYLE = s("Normal",
    fontSize=9.5, textColor=colors.HexColor("#2C2C2C"),
    fontName="Helvetica", leading=13, leftIndent=14, spaceAfter=2)

TABLE_HEADER_STYLE = s("Normal",
    fontSize=9.5, textColor=WHITE, fontName="Helvetica-Bold",
    alignment=TA_CENTER, leading=12)

TABLE_CELL_STYLE = s("Normal",
    fontSize=9, textColor=colors.HexColor("#1C1C1C"),
    fontName="Helvetica", leading=12, alignment=TA_LEFT)

TABLE_CELL_CENTER = s("Normal",
    fontSize=9, textColor=colors.HexColor("#1C1C1C"),
    fontName="Helvetica", leading=12, alignment=TA_CENTER)

CAPTION_STYLE = s("Normal",
    fontSize=8, textColor=colors.HexColor("#7F8C8D"),
    fontName="Helvetica-Oblique", alignment=TA_CENTER)

MNEMONIC_STYLE = s("Normal",
    fontSize=10, textColor=DARK_BLUE, fontName="Helvetica-Bold",
    leading=15, leftIndent=10, spaceAfter=2)

WARNING_STYLE = s("Normal",
    fontSize=9, textColor=RED_DARK, fontName="Helvetica-BoldOblique",
    leading=13, leftIndent=10, spaceAfter=2)

NOTE_STYLE = s("Normal",
    fontSize=8.5, textColor=colors.HexColor("#7D6608"),
    fontName="Helvetica-Oblique", leading=12, alignment=TA_CENTER)

# ── Helper: section banner ─────────────────────────────────────────────────────
def section_banner(title, bg=DARK_BLUE):
    data = [[Paragraph(title, SECTION_STYLE)]]
    t = Table(data, colWidths=[17.5 * cm])
    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), 10),
        ("ROUNDEDCORNERS", [4]),
    ]))
    return t

def bullet(text):
    return Paragraph(f"• {text}", BULLET_STYLE)

def body(text):
    return Paragraph(text, BODY_STYLE)

def spacer(h=0.3):
    return Spacer(1, h * cm)

def hr(color=MED_BLUE, thickness=1):
    return HRFlowable(width="100%", thickness=thickness,
                      color=color, spaceAfter=4, spaceBefore=4)

# ── Main comparison table ──────────────────────────────────────────────────────
def build_comparison_table():
    col_w = [4.5 * cm, 6.5 * cm, 6.5 * cm]

    def hdr(txt, bg):
        return Paragraph(txt, TABLE_HEADER_STYLE)

    def c(txt):
        return Paragraph(txt, TABLE_CELL_STYLE)

    def cc(txt):
        return Paragraph(txt, TABLE_CELL_CENTER)

    rows = [
        # Header row
        [Paragraph("Feature", TABLE_HEADER_STYLE),
         Paragraph("Staphylococcal TSS", TABLE_HEADER_STYLE),
         Paragraph("Streptococcal TSS", TABLE_HEADER_STYLE)],

        # Causative organism
        [c("Causative Organism"),
         c("Staphylococcus aureus (incl. MRSA)"),
         c("Group A Streptococcus (S. pyogenes); rarely Group G")],

        # Toxins
        [c("Key Toxin(s)"),
         c("TSST-1 (menstrual TSS 100%)\nSEA, SEB, SEC (non-menstrual)"),
         c("Pyrogenic exotoxins A, B, C (SPE-A/B/C)\nStreptococcal superantigen (SSA)\nMitogenic exotoxin Z")],

        # Mechanism
        [c("Mechanism"),
         c("Superantigen → binds MHC class II + T-cell Vβ receptor → massive cytokine release (TNF-α, IL-1)"),
         c("Superantigen + SPE-B (cysteine protease) → cytokine storm (TNF-α, TNF-β, IL-1, IL-2, IL-6)")],

        # Risk Factors
        [c("Risk Factors"),
         c("Tampon use (menstrual); nasal packing; surgical wounds; burns; postpartum; osteomyelitis; abscess"),
         c("Invasive soft tissue infections (necrotizing fasciitis, myositis); bacteremia; pneumonia; skin disruption")],

        # Typical Age
        [c("Typical Age"),
         c("Previously healthy adults 20–50 yrs"),
         c("Adults 20–50 yrs; also children (mean ~5 yrs)")],

        # Bacteremia
        [c("Bacteremia"),
         c("Uncommon: ~5–15% blood culture +ve"),
         c("Common: ~50% blood culture +ve")],

        # Rash
        [c("Rash Character"),
         c("Diffuse blanching macular erythroderma (sunburn-like); very common"),
         c("Generalized blanching macular erythema; less common than staph TSS; blistering more likely")],

        # Desquamation
        [c("Desquamation"),
         c("Full-thickness; palms & soles; 1–2 weeks after onset; very prominent"),
         c("Occurs in ~20% of patients; palms & soles; less prominent")],

        # Soft Tissue Infection
        [c("Soft Tissue Involvement"),
         c("Usually occult; skin/mucous membrane portal"),
         c("Necrotizing fasciitis or myositis in many cases; violaceous hue/bullae/necrosis = worse prognosis")],

        # Mucous membranes
        [c("Mucous Membrane Findings"),
         c("Strawberry tongue; non-exudative conjunctivitis; pharyngitis; vaginitis"),
         c("Less prominent mucous membrane involvement compared to staphylococcal TSS")],

        # Onset
        [c("Onset / Progression"),
         c("Acute; rapid onset of fever, rash, hypotension"),
         c("May be insidious initially (flu-like); shock develops 48–72 h after onset")],

        # Diagnostic criteria
        [c("Diagnostic Criteria"),
         c("Fever ≥38.9°C + hypotension (SBP <90) + rash + ≥3 organ systems; negative blood / CSF cultures"),
         c("GAS from sterile site + hypotension + ≥2 organ systems (definite); or GAS non-sterile site + same")],

        # Organ systems
        [c("Organ Systems Involved"),
         c("GI, muscular, CNS, renal, hepatic, hematologic (≥3 required)"),
         c("Renal impairment, coagulopathy, liver impairment, ARDS, soft tissue necrosis (≥2 required)")],

        # Lab findings
        [c("Key Lab Findings"),
         c("↑Creatinine, ↑LFTs, thrombocytopenia (<100,000/mm³), negative cultures usually"),
         c("↑Creatinine (early), ↑CPK (necrotizing fasciitis), leukocytosis with left shift, DIC, ARDS")],

        # Treatment - antibiotics
        [c("Antibiotic Rx\n(MSSA)"),
         c("Oxacillin or Nafcillin (2g IV q4h) OR Cefazolin (2g IV q8h) + Clindamycin (900mg IV q8h)"),
         c("Penicillin G (4M units IV q4h) + Clindamycin (900mg IV q8h); alt: ceftriaxone or vancomycin")],

        # Treatment - MRSA
        [c("Antibiotic Rx\n(MRSA / resistant)"),
         c("Vancomycin (15–20 mg/kg q8–12h, max 2g/dose) + Clindamycin (900mg IV q8h)"),
         c("N/A for MRSA; alternatives: ceftriaxone, cefazolin, vancomycin, daptomycin (6mg/kg IV q24h)")],

        # Why clindamycin?
        [c("Role of Clindamycin"),
         c("Suppresses toxin synthesis; added to β-lactam regardless of MSSA or MRSA"),
         c("Suppresses SPE toxin production; first-line partner to penicillin G; linezolid is alternative")],

        # Surgery
        [c("Surgical Intervention"),
         c("Source control (drainage, debridement of focus)"),
         c("Early, aggressive surgical debridement / fasciotomy / amputation — often life-saving")],

        # Other supportive
        [c("Other Therapy"),
         c("IV fluids, vasopressors, ventilatory support; IVIg (may neutralize toxins)"),
         c("IV fluids, vasopressors, ventilatory support; IVIg to neutralize toxins (evidence supports)")],

        # Mortality
        [c("Mortality"),
         c("~5–15%"),
         c("30–60% (up to 5× higher than staphylococcal TSS)")],

        # Recurrence
        [c("Recurrence Risk"),
         c("Higher — menstrual TSS can recur with continued tampon use"),
         c("Lower recurrence risk; single invasive episode common")],
    ]

    tbl = Table(rows, colWidths=col_w, repeatRows=1)

    style = TableStyle([
        # Header
        ("BACKGROUND",    (0, 0), (0, 0), DARK_BLUE),
        ("BACKGROUND",    (1, 0), (1, 0), STAPH_COL),
        ("BACKGROUND",    (2, 0), (2, 0), STREP_COL),
        ("TEXTCOLOR",     (0, 0), (-1, 0), WHITE),
        ("FONTNAME",      (0, 0), (-1, 0), "Helvetica-Bold"),
        ("FONTSIZE",      (0, 0), (-1, 0), 9.5),
        ("ALIGN",         (0, 0), (-1, 0), "CENTER"),

        # Feature column
        ("BACKGROUND",    (0, 1), (0, -1), colors.HexColor("#EBF5FB")),
        ("FONTNAME",      (0, 1), (0, -1), "Helvetica-Bold"),
        ("FONTSIZE",      (0, 1), (0, -1), 8.5),

        # Alternating row colours
        *[("BACKGROUND", (1, i), (1, i), STAPH_LIGHT if i % 2 == 0 else WHITE)
          for i in range(1, len(rows))],
        *[("BACKGROUND", (2, i), (2, i), STREP_LIGHT if i % 2 == 0 else WHITE)
          for i in range(1, len(rows))],

        # Grid
        ("GRID",          (0, 0), (-1, -1), 0.5, colors.HexColor("#BDC3C7")),
        ("VALIGN",        (0, 0), (-1, -1), "TOP"),
        ("TOPPADDING",    (0, 0), (-1, -1), 5),
        ("BOTTOMPADDING", (0, 0), (-1, -1), 5),
        ("LEFTPADDING",   (0, 0), (-1, -1), 5),
        ("RIGHTPADDING",  (0, 0), (-1, -1), 5),
        ("FONTSIZE",      (1, 1), (-1, -1), 8.5),
        ("ROWBACKGROUNDS",(0, 0), (-1, -1), [None]),
    ])
    tbl.setStyle(style)
    return tbl

# ── Diagnostic criteria box ────────────────────────────────────────────────────
def build_criteria_table():
    col_w = [8.5 * cm, 9 * cm]
    rows = [
        [Paragraph("STAPHYLOCOCCAL TSS CRITERIA", TABLE_HEADER_STYLE),
         Paragraph("STREPTOCOCCAL TSS CRITERIA", TABLE_HEADER_STYLE)],
        [
            Paragraph(
                "<b>ALL of the following:</b><br/>"
                "1. Fever: temperature ≥38.9°C (102°F)<br/>"
                "2. Rash: diffuse macular erythroderma<br/>"
                "3. Desquamation: 1–2 weeks after onset (palms &amp; soles)<br/>"
                "4. Hypotension: SBP &lt;90 mmHg (adults)<br/>"
                "5. Multisystem involvement (≥3 organ systems):<br/>"
                "   • GI  • Muscular  • CNS<br/>"
                "   • Renal  • Hepatic  • Hematologic<br/>"
                "6. Negative: Blood/CSF cultures, RMSF serology, leptospirosis, measles",
                TABLE_CELL_STYLE),
            Paragraph(
                "<b>DEFINITE case:</b> GAS from sterile site<br/>"
                "  (blood, CSF, tissue biopsy, surgical wound)<br/><br/>"
                "<b>PROBABLE case:</b> GAS from non-sterile site<br/>"
                "  (throat, sputum, vagina, superficial lesion)<br/><br/>"
                "<b>PLUS all of:</b><br/>"
                "• Hypotension: SBP &lt;90 mmHg (adults)<br/>"
                "• ≥2 of the following:<br/>"
                "   – Renal impairment<br/>"
                "   – Coagulopathy (plt &lt;100,000 or DIC)<br/>"
                "   – Liver impairment<br/>"
                "   – ARDS<br/>"
                "   – Erythematous rash ± desquamation<br/>"
                "   – Soft tissue necrosis",
                TABLE_CELL_STYLE),
        ]
    ]
    tbl = Table(rows, colWidths=col_w)
    tbl.setStyle(TableStyle([
        ("BACKGROUND",    (0, 0), (0, 0), STAPH_COL),
        ("BACKGROUND",    (1, 0), (1, 0), STREP_COL),
        ("TEXTCOLOR",     (0, 0), (-1, 0), WHITE),
        ("FONTNAME",      (0, 0), (-1, 0), "Helvetica-Bold"),
        ("ALIGN",         (0, 0), (-1, 0), "CENTER"),
        ("BACKGROUND",    (0, 1), (0, 1), STAPH_LIGHT),
        ("BACKGROUND",    (1, 1), (1, 1), STREP_LIGHT),
        ("GRID",          (0, 0), (-1, -1), 0.5, colors.HexColor("#BDC3C7")),
        ("VALIGN",        (0, 0), (-1, -1), "TOP"),
        ("TOPPADDING",    (0, 0), (-1, -1), 7),
        ("BOTTOMPADDING", (0, 0), (-1, -1), 7),
        ("LEFTPADDING",   (0, 0), (-1, -1), 7),
        ("RIGHTPADDING",  (0, 0), (-1, -1), 7),
        ("FONTSIZE",      (0, 1), (-1, -1), 8.5),
    ]))
    return tbl

# ── Treatment comparison table ─────────────────────────────────────────────────
def build_treatment_table():
    col_w = [3.5 * cm, 7 * cm, 7 * cm]
    rows = [
        [Paragraph("", TABLE_HEADER_STYLE),
         Paragraph("STAPHYLOCOCCAL TSS", TABLE_HEADER_STYLE),
         Paragraph("STREPTOCOCCAL TSS", TABLE_HEADER_STYLE)],

        [Paragraph("Supportive", TABLE_CELL_STYLE),
         Paragraph("IV fluids, vasopressors, ventilatory support", TABLE_CELL_STYLE),
         Paragraph("Aggressive IV fluids, vasopressors, ventilatory support", TABLE_CELL_STYLE)],

        [Paragraph("MSSA\n(1st line)", TABLE_CELL_STYLE),
         Paragraph("Oxacillin/Nafcillin 2g IV q4h\nOR Cefazolin 2g IV q8h\n+ Clindamycin 900mg IV q8h", TABLE_CELL_STYLE),
         Paragraph("Penicillin G 4 million units IV q4h\n+ Clindamycin 900mg IV q8h", TABLE_CELL_STYLE)],

        [Paragraph("MRSA", TABLE_CELL_STYLE),
         Paragraph("Vancomycin 15–20mg/kg IV q8–12h (max 2g/dose)\n+ Clindamycin 900mg IV q8h", TABLE_CELL_STYLE),
         Paragraph("Not applicable (GAS penicillin-sensitive)\nAlternatives: Ceftriaxone, Vancomycin, Daptomycin 6mg/kg IV q24h", TABLE_CELL_STYLE)],

        [Paragraph("Toxin suppression", TABLE_CELL_STYLE),
         Paragraph("Clindamycin (blocks ribosomal 50S → inhibits toxin synthesis)", TABLE_CELL_STYLE),
         Paragraph("Clindamycin; alternatively Linezolid\n(both block toxin production)", TABLE_CELL_STYLE)],

        [Paragraph("IVIg", TABLE_CELL_STYLE),
         Paragraph("May be considered to neutralize TSST-1", TABLE_CELL_STYLE),
         Paragraph("IVIg beneficial — neutralizes streptococcal superantigens; recommended in severe/refractory cases", TABLE_CELL_STYLE)],

        [Paragraph("Surgery", TABLE_CELL_STYLE),
         Paragraph("Source control: drain/debride focus of infection", TABLE_CELL_STYLE),
         Paragraph("Early aggressive surgical debridement / fasciotomy / amputation — often life-saving in necrotizing fasciitis", TABLE_CELL_STYLE)],

        [Paragraph("Source removal", TABLE_CELL_STYLE),
         Paragraph("Remove tampon / nasal packing / foreign body", TABLE_CELL_STYLE),
         Paragraph("Identify and treat portal of entry", TABLE_CELL_STYLE)],
    ]
    tbl = Table(rows, colWidths=col_w, repeatRows=1)
    tbl.setStyle(TableStyle([
        ("BACKGROUND",    (0, 0), (0, 0), DARK_BLUE),
        ("BACKGROUND",    (1, 0), (1, 0), STAPH_COL),
        ("BACKGROUND",    (2, 0), (2, 0), STREP_COL),
        ("TEXTCOLOR",     (0, 0), (-1, 0), WHITE),
        ("FONTNAME",      (0, 0), (-1, 0), "Helvetica-Bold"),
        ("ALIGN",         (0, 0), (-1, 0), "CENTER"),
        ("BACKGROUND",    (0, 1), (0, -1), colors.HexColor("#EBF5FB")),
        ("FONTNAME",      (0, 1), (0, -1), "Helvetica-Bold"),
        ("FONTSIZE",      (0, 1), (0, -1), 8),
        *[("BACKGROUND", (1, i), (1, i), STAPH_LIGHT if i % 2 == 1 else WHITE)
          for i in range(1, len(rows))],
        *[("BACKGROUND", (2, i), (2, i), STREP_LIGHT if i % 2 == 1 else WHITE)
          for i in range(1, len(rows))],
        ("GRID",          (0, 0), (-1, -1), 0.5, colors.HexColor("#BDC3C7")),
        ("VALIGN",        (0, 0), (-1, -1), "TOP"),
        ("TOPPADDING",    (0, 0), (-1, -1), 5),
        ("BOTTOMPADDING", (0, 0), (-1, -1), 5),
        ("LEFTPADDING",   (0, 0), (-1, -1), 5),
        ("RIGHTPADDING",  (0, 0), (-1, -1), 5),
        ("FONTSIZE",      (1, 1), (-1, -1), 8.5),
    ]))
    return tbl

# ── High-yield facts box ───────────────────────────────────────────────────────
def high_yield_box():
    staph_items = [
        "TSST-1 is responsible for <b>100%</b> of menstrual/tampon-associated TSS",
        "TSST-1 gene found in only ~<b>20%</b> of S. aureus isolates (incl. MRSA)",
        "Blood cultures positive in only <b>5–15%</b> of cases",
        "Desquamation of palms &amp; soles occurs <b>1–2 weeks</b> after onset",
        "Strawberry tongue + non-exudative conjunctivitis = classic mucous membrane findings",
        "Recurrence can occur with continued tampon use",
        "Mortality: <b>5–15%</b>",
        "Rash fades within <b>3 days</b>, desquamation follows",
    ]
    strep_items = [
        "Most cases associated with <b>necrotizing fasciitis</b> or myositis",
        "Blood cultures positive in ~<b>50%</b> of cases (much higher than staph TSS)",
        "Shock develops <b>48–72 hours</b> after symptom onset",
        "CPK elevation indicates necrotizing fasciitis / myonecrosis",
        "Rash and desquamation <b>less prominent</b> than in staphylococcal TSS",
        "NSAIDs can <b>mask early signs</b> — delay diagnosis and worsen outcome",
        "Mortality: <b>30–60%</b> (up to 5× that of staph TSS)",
        "Early surgery is often <b>life-saving</b>",
    ]

    col_w = [8.5 * cm, 9 * cm]
    rows = [
        [Paragraph("⭐ HIGH-YIELD: STAPHYLOCOCCAL TSS", TABLE_HEADER_STYLE),
         Paragraph("⭐ HIGH-YIELD: STREPTOCOCCAL TSS", TABLE_HEADER_STYLE)],
        [
            "\n".join([f"• {i}" for i in staph_items]),
            "\n".join([f"• {i}" for i in strep_items]),
        ]
    ]

    # Build cell content as Paragraphs
    body_rows = [rows[0]]
    cell_staph = [Paragraph(f"• {item}", ParagraphStyle("hy", parent=styles["Normal"],
        fontSize=8.5, fontName="Helvetica", leading=14, spaceAfter=2,
        textColor=colors.HexColor("#1A2F45"))) for item in staph_items]
    cell_strep = [Paragraph(f"• {item}", ParagraphStyle("hy2", parent=styles["Normal"],
        fontSize=8.5, fontName="Helvetica", leading=14, spaceAfter=2,
        textColor=colors.HexColor("#145A32"))) for item in strep_items]

    from reportlab.platypus import ListFlowable, ListItem
    body_rows.append([cell_staph, cell_strep])

    tbl = Table(body_rows, colWidths=col_w)
    tbl.setStyle(TableStyle([
        ("BACKGROUND",    (0, 0), (0, 0), STAPH_COL),
        ("BACKGROUND",    (1, 0), (1, 0), STREP_COL),
        ("TEXTCOLOR",     (0, 0), (-1, 0), WHITE),
        ("FONTNAME",      (0, 0), (-1, 0), "Helvetica-Bold"),
        ("ALIGN",         (0, 0), (-1, 0), "CENTER"),
        ("BACKGROUND",    (0, 1), (0, 1), STAPH_LIGHT),
        ("BACKGROUND",    (1, 1), (1, 1), STREP_LIGHT),
        ("GRID",          (0, 0), (-1, -1), 0.5, colors.HexColor("#BDC3C7")),
        ("VALIGN",        (0, 0), (-1, -1), "TOP"),
        ("TOPPADDING",    (0, 0), (-1, -1), 7),
        ("BOTTOMPADDING", (0, 0), (-1, -1), 7),
        ("LEFTPADDING",   (0, 0), (-1, -1), 7),
        ("RIGHTPADDING",  (0, 0), (-1, -1), 7),
    ]))
    return tbl

# ── Title page header ──────────────────────────────────────────────────────────
def title_block():
    data = [[
        Paragraph("TOXIC SHOCK SYNDROME", TITLE_STYLE),
        Paragraph("Staphylococcal vs Streptococcal — Comprehensive Study Guide", SUBTITLE_STYLE),
        Paragraph("Sources: Goldman-Cecil Medicine · Rosen's Emergency Medicine · Dermatology 5e · Jawetz Medical Microbiology · Tietz Laboratory Medicine", CAPTION_STYLE),
    ]]
    # stack vertically in one column
    inner = [[Paragraph("TOXIC SHOCK SYNDROME", TITLE_STYLE)],
             [Paragraph("Staphylococcal vs Streptococcal — Comprehensive Study Guide", SUBTITLE_STYLE)],
             [Spacer(1, 0.2 * cm)],
             [Paragraph("Sources: Goldman-Cecil Medicine · Rosen's Emergency Medicine · Dermatology 5e · Jawetz Medical Microbiology · Tietz Laboratory Medicine", CAPTION_STYLE)]]
    t = Table(inner, colWidths=[17.5 * cm])
    t.setStyle(TableStyle([
        ("BACKGROUND",    (0, 0), (-1, -1), DARK_BLUE),
        ("TOPPADDING",    (0, 0), (-1, -1), 10),
        ("BOTTOMPADDING", (0, 0), (-1, -1), 8),
        ("LEFTPADDING",   (0, 0), (-1, -1), 14),
        ("RIGHTPADDING",  (0, 0), (-1, -1), 14),
    ]))
    return t

# ── Mnemonic box ──────────────────────────────────────────────────────────────
def mnemonic_box():
    items = [
        ["F", "Fever (≥38.9°C / 102°F)"],
        ["R", "Rash — diffuse macular erythroderma"],
        ["A", "And Hypotension (SBP <90 mmHg)"],
        ["S", "Skin Desquamation (palms & soles, 1–2 weeks later)"],
        ["H", "Hypotension (multiorgan ≥3 systems in staph; ≥2 in strep)"],
    ]
    note = "Mnemonic: F-R-A-S-H for Staphylococcal TSS diagnostic features"
    rows = []
    for letter, meaning in items:
        rows.append([
            Paragraph(f"<b>{letter}</b>", ParagraphStyle("ml", parent=styles["Normal"],
                fontSize=14, textColor=GOLD, fontName="Helvetica-Bold", alignment=TA_CENTER)),
            Paragraph(meaning, ParagraphStyle("mm", parent=styles["Normal"],
                fontSize=9.5, textColor=DARK_BLUE, fontName="Helvetica", leading=13)),
        ])
    tbl = Table(rows, colWidths=[1.2 * cm, 16 * cm])
    tbl.setStyle(TableStyle([
        ("BACKGROUND",    (0, 0), (-1, -1), colors.HexColor("#FEF9E7")),
        ("GRID",          (0, 0), (-1, -1), 0.3, colors.HexColor("#F9E79F")),
        ("VALIGN",        (0, 0), (-1, -1), "MIDDLE"),
        ("TOPPADDING",    (0, 0), (-1, -1), 4),
        ("BOTTOMPADDING", (0, 0), (-1, -1), 4),
        ("LEFTPADDING",   (0, 0), (-1, -1), 6),
    ]))
    return [Paragraph(note, NOTE_STYLE), spacer(0.2), tbl]

# ── Quick differentiator box ───────────────────────────────────────────────────
def quick_diff_box():
    rows = [
        [Paragraph("KEY DIFFERENTIATORS", TABLE_HEADER_STYLE)],
        [Paragraph(
            "• <b>Blood culture positive</b>: ~50% in Strep TSS vs 5–15% in Staph TSS<br/>"
            "• <b>Necrotizing fasciitis</b>: characteristic of Strep TSS, not Staph TSS<br/>"
            "• <b>Mortality</b>: Strep TSS (30–60%) is 5× higher than Staph TSS (5–15%)<br/>"
            "• <b>Rash prominence</b>: more diffuse and reliable in Staph TSS; less common in Strep TSS<br/>"
            "• <b>Tampon/nasal packing</b>: classic risk factor for Staph TSS only<br/>"
            "• <b>TSST-1</b> = 100% of menstrual TSS (staph); <b>SPE A/B/C</b> = strep toxins<br/>"
            "• <b>Desquamation</b>: 100% in staph TSS; ~20% in strep TSS<br/>"
            "• <b>IVIg</b>: stronger evidence in strep TSS than staph TSS",
            ParagraphStyle("kd", parent=styles["Normal"], fontSize=9.5,
                           fontName="Helvetica", leading=15, textColor=DARK_BLUE)
        )]
    ]
    tbl = Table(rows, colWidths=[17.5 * cm])
    tbl.setStyle(TableStyle([
        ("BACKGROUND",    (0, 0), (-1, 0), MED_BLUE),
        ("BACKGROUND",    (0, 1), (-1, 1), colors.HexColor("#EBF5FB")),
        ("TEXTCOLOR",     (0, 0), (-1, 0), WHITE),
        ("FONTNAME",      (0, 0), (-1, 0), "Helvetica-Bold"),
        ("ALIGN",         (0, 0), (-1, 0), "CENTER"),
        ("GRID",          (0, 0), (-1, -1), 0.5, MED_BLUE),
        ("TOPPADDING",    (0, 0), (-1, -1), 7),
        ("BOTTOMPADDING", (0, 0), (-1, -1), 7),
        ("LEFTPADDING",   (0, 0), (-1, -1), 10),
        ("RIGHTPADDING",  (0, 0), (-1, -1), 10),
    ]))
    return tbl

# ── Pathogenesis table ─────────────────────────────────────────────────────────
def pathogenesis_table():
    col_w = [8.5 * cm, 9 * cm]
    rows = [
        [Paragraph("STAPHYLOCOCCAL TSS — Pathogenesis", TABLE_HEADER_STYLE),
         Paragraph("STREPTOCOCCAL TSS — Pathogenesis", TABLE_HEADER_STYLE)],
        [
            Paragraph(
                "<b>Organism:</b> S. aureus (coagulase +ve)<br/><br/>"
                "<b>Toxin:</b> TSST-1 (= enterotoxin F) — the prototypical superantigen<br/><br/>"
                "<b>Superantigen mechanism:</b> Binds MHC class II molecules on APCs without intracellular processing + binds Vβ region of TCR → massive non-specific T cell proliferation (5–30% of circulating T cells vs 0.01% for conventional antigen)<br/><br/>"
                "<b>Cytokine storm:</b> TNF-α, IL-1 — mediate fever, erythema, shock, organ dysfunction<br/><br/>"
                "<b>Gene location:</b> Chromosomal pathogenicity island (interacts with bacteriophages)",
                TABLE_CELL_STYLE),
            Paragraph(
                "<b>Organism:</b> Group A Streptococcus (S. pyogenes; M types 1 &amp; 3 virulent)<br/><br/>"
                "<b>Toxins:</b> SPE-A, B, C (pyrogenic exotoxins); streptococcal superantigen (SSA); mitogenic exotoxin Z; SPE-B (cysteine protease cleaves pre-IL-1β)<br/><br/>"
                "<b>Superantigen mechanism:</b> Same Vβ/MHC II binding → 5–30% T cell activation → cytokine storm<br/><br/>"
                "<b>Cytokine storm:</b> TNF-α, TNF-β, IL-1, IL-2, IL-6 — also upregulates TLR-2 &amp; TLR-4 → amplifies endotoxin effects<br/><br/>"
                "<b>Streptolysin O:</b> Acts synergistically with SPE-A",
                TABLE_CELL_STYLE),
        ]
    ]
    tbl = Table(rows, colWidths=col_w)
    tbl.setStyle(TableStyle([
        ("BACKGROUND",    (0, 0), (0, 0), STAPH_COL),
        ("BACKGROUND",    (1, 0), (1, 0), STREP_COL),
        ("TEXTCOLOR",     (0, 0), (-1, 0), WHITE),
        ("FONTNAME",      (0, 0), (-1, 0), "Helvetica-Bold"),
        ("ALIGN",         (0, 0), (-1, 0), "CENTER"),
        ("BACKGROUND",    (0, 1), (0, 1), STAPH_LIGHT),
        ("BACKGROUND",    (1, 1), (1, 1), STREP_LIGHT),
        ("GRID",          (0, 0), (-1, -1), 0.5, colors.HexColor("#BDC3C7")),
        ("VALIGN",        (0, 0), (-1, -1), "TOP"),
        ("TOPPADDING",    (0, 0), (-1, -1), 7),
        ("BOTTOMPADDING", (0, 0), (-1, -1), 7),
        ("LEFTPADDING",   (0, 0), (-1, -1), 7),
        ("RIGHTPADDING",  (0, 0), (-1, -1), 7),
        ("FONTSIZE",      (0, 1), (-1, 1), 8.5),
    ]))
    return tbl

# ── Footer ─────────────────────────────────────────────────────────────────────
def add_page_number(canvas, doc):
    canvas.saveState()
    canvas.setFont("Helvetica", 7.5)
    canvas.setFillColor(colors.HexColor("#7F8C8D"))
    canvas.drawString(2 * cm, 1.2 * cm, "TSS Comparison Study Guide  |  Orris Medical Education")
    canvas.drawRightString(19 * cm, 1.2 * cm, f"Page {doc.page}")
    canvas.restoreState()

# ── Build document ─────────────────────────────────────────────────────────────
def build():
    doc = SimpleDocTemplate(
        OUTPUT_PATH,
        pagesize=A4,
        topMargin=1.5 * cm,
        bottomMargin=2 * cm,
        leftMargin=2 * cm,
        rightMargin=2 * cm,
        title="Toxic Shock Syndrome — Staphylococcal vs Streptococcal Study Guide",
        author="Orris Medical Education",
    )

    story = []

    # ── TITLE ──────────────────────────────────────────────────────────────────
    story.append(title_block())
    story.append(spacer(0.5))

    # ── OVERVIEW ───────────────────────────────────────────────────────────────
    story.append(section_banner("1.  OVERVIEW"))
    story.append(spacer(0.3))
    story.append(body(
        "Toxic Shock Syndrome (TSS) is an acute, life-threatening febrile illness caused by the systemic effects "
        "of bacterial exotoxins acting as superantigens. Two distinct forms exist, caused by different organisms "
        "with overlapping but distinguishable presentations. Both types trigger a massive cytokine storm through "
        "non-specific T-cell stimulation, leading to fever, rash, hypotension, and multiorgan dysfunction."
    ))
    story.append(spacer(0.2))

    # ── PATHOGENESIS ───────────────────────────────────────────────────────────
    story.append(section_banner("2.  PATHOGENESIS"))
    story.append(spacer(0.3))
    story.append(pathogenesis_table())
    story.append(spacer(0.4))

    # ── MASTER COMPARISON TABLE ────────────────────────────────────────────────
    story.append(section_banner("3.  MASTER COMPARISON TABLE"))
    story.append(spacer(0.3))
    story.append(build_comparison_table())
    story.append(spacer(0.5))
    story.append(Paragraph("Table sources: Goldman-Cecil Medicine, Rosen's Emergency Medicine, Dermatology 5e, Jawetz Medical Microbiology, Tietz Laboratory Medicine", CAPTION_STYLE))
    story.append(spacer(0.5))

    # ── DIAGNOSTIC CRITERIA ────────────────────────────────────────────────────
    story.append(section_banner("4.  FORMAL DIAGNOSTIC CRITERIA"))
    story.append(spacer(0.3))
    story.append(build_criteria_table())
    story.append(spacer(0.4))

    # Mnemonic
    story.append(section_banner("5.  MNEMONIC (Staph TSS)", bg=colors.HexColor("#7D6608")))
    story.append(spacer(0.3))
    for item in mnemonic_box():
        story.append(item)
    story.append(spacer(0.4))

    # ── TREATMENT ──────────────────────────────────────────────────────────────
    story.append(section_banner("6.  TREATMENT"))
    story.append(spacer(0.3))
    story.append(build_treatment_table())
    story.append(spacer(0.3))
    story.append(Paragraph(
        "⚠  Clindamycin is added in BOTH types to suppress toxin synthesis (ribosomal 50S inhibitor). "
        "Do NOT use clindamycin as sole antibiotic — always combine with a cell-wall active agent.",
        ParagraphStyle("warn", parent=styles["Normal"], fontSize=9, fontName="Helvetica-BoldOblique",
                       textColor=RED_DARK, leading=13, leftIndent=8, spaceAfter=4)
    ))
    story.append(spacer(0.4))

    # ── HIGH YIELD ─────────────────────────────────────────────────────────────
    story.append(section_banner("7.  HIGH-YIELD EXAM FACTS", bg=colors.HexColor("#117A65")))
    story.append(spacer(0.3))
    story.append(high_yield_box())
    story.append(spacer(0.4))

    # ── KEY DIFFERENTIATORS ────────────────────────────────────────────────────
    story.append(section_banner("8.  KEY DIFFERENTIATORS AT A GLANCE"))
    story.append(spacer(0.3))
    story.append(quick_diff_box())
    story.append(spacer(0.5))

    # ── QUICK REFERENCE SUMMARY ────────────────────────────────────────────────
    story.append(section_banner("9.  QUICK REFERENCE SUMMARY", bg=colors.HexColor("#4A235A")))
    story.append(spacer(0.3))

    summary_rows = [
        [Paragraph("", TABLE_HEADER_STYLE),
         Paragraph("STAPH TSS", TABLE_HEADER_STYLE),
         Paragraph("STREP TSS", TABLE_HEADER_STYLE)],
        [Paragraph("Organism", TABLE_CELL_STYLE), Paragraph("S. aureus", TABLE_CELL_STYLE), Paragraph("S. pyogenes (GAS)", TABLE_CELL_STYLE)],
        [Paragraph("Key Toxin", TABLE_CELL_STYLE), Paragraph("TSST-1", TABLE_CELL_STYLE), Paragraph("SPE-A/B/C, SSA", TABLE_CELL_STYLE)],
        [Paragraph("Bacteremia", TABLE_CELL_STYLE), Paragraph("5–15%", TABLE_CELL_STYLE), Paragraph("~50%", TABLE_CELL_STYLE)],
        [Paragraph("Mortality", TABLE_CELL_STYLE), Paragraph("5–15%", TABLE_CELL_STYLE), Paragraph("30–60%", TABLE_CELL_STYLE)],
        [Paragraph("Classic Risk", TABLE_CELL_STYLE), Paragraph("Tampon / nasal packing", TABLE_CELL_STYLE), Paragraph("Necrotizing fasciitis", TABLE_CELL_STYLE)],
        [Paragraph("Rash", TABLE_CELL_STYLE), Paragraph("Very prominent macular erythroderma", TABLE_CELL_STYLE), Paragraph("Less common; blistering more likely", TABLE_CELL_STYLE)],
        [Paragraph("Desquamation", TABLE_CELL_STYLE), Paragraph("Prominent (palms & soles)", TABLE_CELL_STYLE), Paragraph("Only ~20%", TABLE_CELL_STYLE)],
        [Paragraph("Antibiotics", TABLE_CELL_STYLE), Paragraph("Oxacillin/Nafcillin + Clindamycin\n(MRSA: Vancomycin + Clinda)", TABLE_CELL_STYLE), Paragraph("Penicillin G + Clindamycin", TABLE_CELL_STYLE)],
        [Paragraph("Surgery", TABLE_CELL_STYLE), Paragraph("Source control", TABLE_CELL_STYLE), Paragraph("Early aggressive debridement", TABLE_CELL_STYLE)],
    ]
    sumtbl = Table(summary_rows, colWidths=[3.5 * cm, 7 * cm, 7 * cm], repeatRows=1)
    sumtbl.setStyle(TableStyle([
        ("BACKGROUND",    (0, 0), (0, 0), colors.HexColor("#4A235A")),
        ("BACKGROUND",    (1, 0), (1, 0), STAPH_COL),
        ("BACKGROUND",    (2, 0), (2, 0), STREP_COL),
        ("TEXTCOLOR",     (0, 0), (-1, 0), WHITE),
        ("FONTNAME",      (0, 0), (-1, 0), "Helvetica-Bold"),
        ("ALIGN",         (0, 0), (-1, 0), "CENTER"),
        ("BACKGROUND",    (0, 1), (0, -1), colors.HexColor("#EBF5FB")),
        ("FONTNAME",      (0, 1), (0, -1), "Helvetica-Bold"),
        ("FONTSIZE",      (0, 1), (0, -1), 8),
        *[("BACKGROUND", (1, i), (1, i), STAPH_LIGHT if i % 2 == 1 else WHITE) for i in range(1, 11)],
        *[("BACKGROUND", (2, i), (2, i), STREP_LIGHT if i % 2 == 1 else WHITE) for i in range(1, 11)],
        ("GRID",          (0, 0), (-1, -1), 0.5, colors.HexColor("#BDC3C7")),
        ("VALIGN",        (0, 0), (-1, -1), "TOP"),
        ("TOPPADDING",    (0, 0), (-1, -1), 5),
        ("BOTTOMPADDING", (0, 0), (-1, -1), 5),
        ("LEFTPADDING",   (0, 0), (-1, -1), 5),
        ("RIGHTPADDING",  (0, 0), (-1, -1), 5),
        ("FONTSIZE",      (1, 1), (-1, -1), 8.5),
    ]))
    story.append(sumtbl)
    story.append(spacer(0.5))

    # ── REFERENCES ─────────────────────────────────────────────────────────────
    story.append(hr())
    story.append(Paragraph(
        "<b>References:</b> Goldman-Cecil Medicine (International Ed.) · Rosen's Emergency Medicine 9e · "
        "Dermatology 2-Volume Set 5e (Elsevier) · Jawetz, Melnick &amp; Adelberg's Medical Microbiology 28e · "
        "Tietz Textbook of Laboratory Medicine 7e · Medical Microbiology 9e",
        CAPTION_STYLE
    ))

    doc.build(story, onFirstPage=add_page_number, onLaterPages=add_page_number)
    print(f"PDF saved to: {OUTPUT_PATH}")

if __name__ == "__main__":
    build()
Running Command

cd /home/daytona/workspace/tss-study-guide && python generate_tss_pdf.py 2>&1

Running Command

ls -lh /home/daytona/workspace/tss-study-guide/TSS_Study_Guide.pdf

Running Command

cd /home/daytona/workspace/tss-study-guide && python -c "from pypdf import PdfRe…

Running Command

cd /home/daytona/workspace/tss-study-guide && python -c " from pypdf import PdfR…

Your study guide PDF is ready:

TSS Study Guide

PDF Document · PDF

Here's what's inside the 5-page PDF (sourced from Goldman-Cecil Medicine, Rosen's Emergency Medicine, Dermatology 5e, Jawetz Medical Microbiology, and Tietz Laboratory Medicine):
Section 1 - Overview - Brief intro to the shared superantigen mechanism
Section 2 - Pathogenesis - Side-by-side comparison of TSST-1 vs SPE-A/B/C toxin mechanisms, MHC class II binding, cytokine storm differences
Section 3 - Master Comparison Table (22 rows) covering organism, toxins, risk factors, bacteremia rates, rash, desquamation, soft tissue involvement, lab findings, mucous membranes, onset, and more
Section 4 - Formal Diagnostic Criteria - Complete CDC/clinical criteria for both types side by side
Section 5 - Mnemonic - F-R-A-S-H for Staphylococcal TSS features
Section 6 - Treatment - Antibiotic dosing for MSSA, MRSA, streptococcal; role of clindamycin, IVIg, surgery
Section 7 - High-Yield Exam Facts - 8 bullet points per type (mortality, bacteremia %, TSST-1 %, desquamation timing, etc.)
Section 8 - Key Differentiators - The most commonly tested distinctions in a single box
Section 9 - Quick Reference Summary - Condensed 10-row cheat sheet for last-minute review
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