🗓️ YOUR 3-MONTH PT EXAM STUDY PLAN

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

OUTPUT = "/home/daytona/workspace/pt-study-plan/PT_3Month_Study_Plan.pdf"

doc = SimpleDocTemplate(
    OUTPUT,
    pagesize=A4,
    rightMargin=1.8*cm,
    leftMargin=1.8*cm,
    topMargin=2*cm,
    bottomMargin=2*cm
)

styles = getSampleStyleSheet()

# ---- Custom styles ----
title_style = ParagraphStyle(
    "Title", parent=styles["Title"],
    fontSize=22, textColor=colors.HexColor("#1a237e"),
    spaceAfter=6, alignment=TA_CENTER, fontName="Helvetica-Bold"
)
subtitle_style = ParagraphStyle(
    "Subtitle", parent=styles["Normal"],
    fontSize=11, textColor=colors.HexColor("#455a64"),
    spaceAfter=4, alignment=TA_CENTER
)
h1_style = ParagraphStyle(
    "H1", parent=styles["Heading1"],
    fontSize=14, textColor=colors.white,
    backColor=colors.HexColor("#1a237e"),
    spaceBefore=14, spaceAfter=6,
    leftIndent=-4, rightIndent=-4,
    borderPad=5, fontName="Helvetica-Bold"
)
h2_style = ParagraphStyle(
    "H2", parent=styles["Heading2"],
    fontSize=12, textColor=colors.HexColor("#1a237e"),
    spaceBefore=10, spaceAfter=4,
    fontName="Helvetica-Bold",
    borderPad=2
)
h3_style = ParagraphStyle(
    "H3", parent=styles["Heading3"],
    fontSize=10.5, textColor=colors.HexColor("#b71c1c"),
    spaceBefore=7, spaceAfter=2,
    fontName="Helvetica-Bold"
)
body_style = ParagraphStyle(
    "Body", parent=styles["Normal"],
    fontSize=9.5, leading=14,
    spaceAfter=3, textColor=colors.HexColor("#212121")
)
bullet_style = ParagraphStyle(
    "Bullet", parent=styles["Normal"],
    fontSize=9.5, leading=13,
    leftIndent=14, spaceAfter=2,
    textColor=colors.HexColor("#212121")
)
note_style = ParagraphStyle(
    "Note", parent=styles["Normal"],
    fontSize=9, leading=12,
    backColor=colors.HexColor("#fff9c4"),
    borderPad=6, spaceAfter=6,
    textColor=colors.HexColor("#4e342e")
)
red_note_style = ParagraphStyle(
    "RedNote", parent=styles["Normal"],
    fontSize=9, leading=12,
    backColor=colors.HexColor("#ffebee"),
    borderPad=6, spaceAfter=6,
    textColor=colors.HexColor("#b71c1c")
)

def h1(text): return Paragraph(f"  {text}", h1_style)
def h2(text): return Paragraph(text, h2_style)
def h3(text): return Paragraph(text, h3_style)
def body(text): return Paragraph(text, body_style)
def bullet(text): return Paragraph(f"• {text}", bullet_style)
def note(text): return Paragraph(f"<b>NOTE:</b> {text}", note_style)
def red_note(text): return Paragraph(f"<b>⚠</b> {text}", red_note_style)
def sp(n=6): return Spacer(1, n)
def hr(): return HRFlowable(width="100%", thickness=0.5, color=colors.HexColor("#cfd8dc"), spaceAfter=4)

def make_table(data, col_widths=None, header_color="#1565c0"):
    t = Table(data, colWidths=col_widths, repeatRows=1)
    style = [
        ("BACKGROUND", (0,0), (-1,0), colors.HexColor(header_color)),
        ("TEXTCOLOR", (0,0), (-1,0), colors.white),
        ("FONTNAME", (0,0), (-1,0), "Helvetica-Bold"),
        ("FONTSIZE", (0,0), (-1,0), 9),
        ("ALIGN", (0,0), (-1,0), "CENTER"),
        ("FONTNAME", (0,1), (-1,-1), "Helvetica"),
        ("FONTSIZE", (0,1), (-1,-1), 8.5),
        ("ROWBACKGROUNDS", (0,1), (-1,-1), [colors.white, colors.HexColor("#f5f5f5")]),
        ("GRID", (0,0), (-1,-1), 0.4, colors.HexColor("#bdbdbd")),
        ("VALIGN", (0,0), (-1,-1), "MIDDLE"),
        ("TOPPADDING", (0,0), (-1,-1), 4),
        ("BOTTOMPADDING", (0,0), (-1,-1), 4),
        ("LEFTPADDING", (0,0), (-1,-1), 6),
        ("RIGHTPADDING", (0,0), (-1,-1), 6),
    ]
    t.setStyle(TableStyle(style))
    return t

# ===================== BUILD CONTENT =====================
story = []

# ---- COVER ----
story.append(sp(40))
story.append(Paragraph("3-MONTH PT EXAM", title_style))
story.append(Paragraph("STUDY PLAN", title_style))
story.append(sp(10))
story.append(Paragraph("3rd Year Bachelor of Physiotherapy", subtitle_style))
story.append(Paragraph("Start: July 15, 2026  |  Exam: Mid-October 2026", subtitle_style))
story.append(Paragraph("2–3 Hours/Day  |  6 Days/Week", subtitle_style))
story.append(sp(20))
story.append(hr())
story.append(sp(8))
story.append(Paragraph("Subjects Covered:", subtitle_style))
subjects_cover = [
    ["#", "Subject", "Assessment", "Priority"],
    ["1", "General Medicine", "Written", "HIGH (Weak)"],
    ["2", "General Surgery", "Written", "HIGH (Weak)"],
    ["3", "Orthopedics & Traumatology", "Written", "MEDIUM"],
    ["4", "Musculoskeletal & Sports PT", "Written + Oral + Practical", "HIGH"],
    ["5", "Cardiorespiratory & General PT", "Written + Oral + Practical", "HIGH (Weak)"],
]
story.append(sp(6))
story.append(make_table(subjects_cover, col_widths=[1*cm, 6.5*cm, 5.5*cm, 3.5*cm]))
story.append(sp(30))
story.append(body("Generated by Orris AI Study Assistant"))
story.append(PageBreak())

# ---- SECTION 1: HOW TO USE THIS PLAN ----
story.append(h1("HOW TO USE THIS PLAN"))
story.append(sp(6))
story.append(note("Read this page first before you start studying!"))
story.append(sp(4))
story.append(h2("Daily Study Method (2-3 hours)"))
steps = [
    ("<b>Hour 1 (60 min):</b> Read 1 topic from today's plan. Focus on: Etiology → Clinical Features → Management. Understand, don't memorize."),
    ("<b>Hour 2 (45 min):</b> Make SHORT handwritten bullet-point notes. Use flowcharts for complex topics like DM, IHD, COPD."),
    ("<b>Hour 3 (30-45 min):</b> Quiz yourself — close notes, write key points from memory. Re-read only what you forgot."),
    ("<b>Before sleep (15 min):</b> Skim yesterday's notes. This is your single best retention tool."),
]
for s in steps:
    story.append(bullet(s))
    story.append(sp(3))

story.append(sp(6))
story.append(h2("Key Strategy"))
strategy = [
    "Topics OVERLAP between subjects — Ortho feeds into MSK PT; Medicine feeds into Cardiorespiratory PT. Learn once, use twice.",
    "MSK PT and Cardiorespiratory PT have PRACTICALS + ORALS — don't just read, practice techniques on friends.",
    "Use college notes/slides FIRST before heavy textbooks — they are already exam-filtered.",
    "Skip 'reading everything perfectly' — read once, note once, revise twice.",
    "Start with HIGH-YIELD topics in each subject, not from page 1.",
]
for s in strategy:
    story.append(bullet(s))
story.append(PageBreak())

# ---- SECTION 2: MONTH 1 ----
story.append(h1("MONTH 1: JULY 15 – AUGUST 14"))
story.append(Paragraph("General Medicine + General Surgery", subtitle_style))
story.append(sp(8))

story.append(h2("Week 1–2: General Medicine (High-Yield First)"))
story.append(body("Start with Cardiovascular + Respiratory — these are your weakest AND have the most syllabus hours (17 hrs combined)."))
story.append(sp(4))

w1_data = [
    ["Day", "Topic", "Syllabus Hours"],
    ["Day 1–2", "Cardiovascular Disease — ECG, Hypertension, IHD, Pericarditis, Myocarditis, Heart failure", "8 hrs"],
    ["Day 3–4", "Respiratory Disease — COPD, Asthma, TB, Pneumonia, Respiratory failure, Pleural diseases", "9 hrs"],
    ["Day 5–6", "Digestive System — GI diseases, Liver (Hepatitis, Cirrhosis, Wilson's), GI bleeding, Peptic ulcer", "7 hrs"],
    ["Day 7", "REVISION — Write 1-page notes for each system covered this week", "—"],
]
story.append(make_table(w1_data, col_widths=[2*cm, 11.5*cm, 3*cm]))
story.append(sp(8))

story.append(h2("Week 3: General Medicine (Remaining Topics)"))
w3_data = [
    ["Day", "Topic"],
    ["Day 8–9", "Endocrine — Diabetes Mellitus (detailed: etiology, clinical features, complications, management), Thyroid"],
    ["Day 10", "Blood Disorders — Anemia (types, management), Hemophilia, clinical features of blood disorders"],
    ["Day 11", "Infections — HIV/AIDS, Food Poisoning, Gastroenteritis, Vaccinations, STDs"],
    ["Day 12", "Nutrition & Obesity — Protein-energy malnutrition, deficiency diseases, Obesity management; Poisoning"],
    ["Day 13", "Skin Diseases (Leprosy, Psoriasis, Dermatitis) + Pediatrics (CP, Spina Bifida, Developmental delay)"],
    ["Day 14", "Psychiatry (Classifications, causes, treatment) + FULL Medicine Revision"],
]
story.append(make_table(w3_data, col_widths=[2*cm, 14.5*cm]))
story.append(sp(8))

story.append(h2("Week 4: General Surgery (High-Yield First)"))
w4_data = [
    ["Day", "Topic", "Hours"],
    ["Day 15–16", "Surgical Basics — Wound healing (phases, factors), Fluid/Electrolytes, Anaesthesia types, Incisions, Hemostasis, Surgical infections, Post-op complications", "6 hrs"],
    ["Day 17–18", "Thoracic Trauma — Pneumothorax, Hemothorax, Cardiac Tamponade, Aortic disruption + Chest Wall/Lung disorders (Pleural Effusion, Empyema, Lung abscess, Carcinoma of breast)", "9 hrs"],
    ["Day 19–20", "Heart Disorders — Congenital (ASD, VSD, TOF, PDA) + Acquired (Mitral/Aortic stenosis, IHD) + Thoracic surgeries (Pneumonectomy, Lobectomy, CABG, Open/Closed heart surgery)", "12 hrs"],
    ["Day 21", "Burns (classification, Rule of 9s, management, skin grafts) + Arteries & Veins (DVT, Varicose veins, PE, Atherosclerosis)", "9 hrs"],
]
story.append(make_table(w4_data, col_widths=[2*cm, 10.5*cm, 4*cm]))
story.append(sp(6))
story.append(red_note("Surgery exam tip: Know wound healing phases, burns classification (Rule of 9s), and DVT/PE management — these appear almost every year."))
story.append(PageBreak())

# ---- SECTION 3: MONTH 2 ----
story.append(h1("MONTH 2: AUGUST 15 – SEPTEMBER 14"))
story.append(Paragraph("Orthopedics & Traumatology + MSK & Sports Physiotherapy", subtitle_style))
story.append(sp(8))

story.append(h2("Week 5–6: Orthopedics & Traumatology"))
story.append(body("These topics directly feed into MSK PT — learn them well here and you won't need to re-study for MSK."))
story.append(sp(4))
ortho_data = [
    ["Day", "Topic", "Hours"],
    ["Day 22–23", "Intro to Ortho + Fracture basics (types, healing, complications, management principles) + Upper limb fractures (Clavicle, Humerus, Radius/Ulna, Scaphoid, Phalanges)", "9 hrs"],
    ["Day 24–25", "Lower limb fractures — Pelvis, Neck of femur (classification!), Femur shaft, Tibia/Fibula, Ankle (Pott's, Trimalleolar), Calcaneum, Talus, Metatarsals", "5 hrs"],
    ["Day 26", "Spinal Fractures — Cervical (Hangman's, Odontoid), Thoracolumbar, Rib, Sternum + Traumatic Spinal Cord Injuries (Paraplegia, Quadriplegia)", "6 hrs"],
    ["Day 27", "Dislocations — Anterior/Posterior shoulder (Kocher's, Hippocrates), Hip (Anterior/Posterior/Central), Elbow, Patella", "—"],
    ["Day 28", "Soft Tissue Injuries — Sprains/Strains, Meniscal injuries, Cruciate ligaments, Collateral ligaments, Ankle ligaments, Tendon ruptures (Achilles, Rotator cuff)", "3 hrs"],
    ["Day 29", "Deformities — Congenital (CTEV, CDH, Scoliosis, Torticollis, Flat foot, Limb deficiencies) + Acquired (Kyphosis, Lordosis, Scoliosis, Genu valgum/varum)", "6 hrs"],
    ["Day 30", "Disease of Bones & Joints — OA, RA, Osteomyelitis (acute/chronic), Septic arthritis, Bone tumors (Osteosarcoma, Ewing's), Metabolic bone disease (Osteoporosis, Rickets)", "4 hrs"],
]
story.append(make_table(ortho_data, col_widths=[2*cm, 10.5*cm, 4*cm]))
story.append(sp(8))

story.append(h2("Week 7: Orthopedics (Remaining) + Start MSK PT"))
w7_data = [
    ["Day", "Topic"],
    ["Day 31", "Cervical & Lumbar Pathology — PID, Spondylosis, Spondylolisthesis, Spinal Canal Stenosis, Lumbago/Lumbosacral strain"],
    ["Day 32", "Inflammatory/Degenerative — OA, RA, Ankylosing Spondylitis, Gout, SLE, Scleroderma, Dermatomyositis, MCTD"],
    ["Day 33", "Syndromes — TOS, Piriformis, Cervicobrachial, Scalenus + Regional Conditions (Frozen shoulder, Tennis elbow, Plantar fasciitis, Patellar tendinitis, Morton's Neuroma)"],
    ["Day 34", "Neuromuscular Disorders — CP, Poliomyelitis, Leprosy, Spinal Dysraphism + Orthopedic surgeries overview (Arthroplasty, Arthrodesis, Osteotomy, External fixators)"],
    ["Day 35", "REVISION — Quick revision of all Ortho topics + Start reading MSK PT assessment chapter"],
]
story.append(make_table(w7_data, col_widths=[2*cm, 14.5*cm]))
story.append(sp(8))

story.append(h2("Week 8: MSK & Sports PT (Core Theory — Practical Exam Focus)"))
story.append(red_note("MSK PT has Written + Oral + Practical exams. SOAP format and clinical assessment are the most tested in practicals/viva."))
story.append(sp(4))
w8_data = [
    ["Day", "Topic", "Exam Type"],
    ["Day 36–37", "PT Assessment — Full SOAP format: Subjective (history), Objective (observation, palpation, ROM, MMT, Special tests, Neurological exam), Assessment, Plan. Practice writing a full SOAP note.", "Practical + Oral"],
    ["Day 38–39", "PT Management in Fractures — Complications (Compartment syndrome, Fat embolism, AVN, Myositis ossificans), Goals of PT, Guidelines during immobilization and post-immobilization", "Written + Oral"],
    ["Day 40–41", "Specific Fractures PT — Upper limb (shoulder, elbow, wrist, hand fractures + dislocations), Lower limb (hip, knee, ankle fractures), Spine", "Written + Practical"],
    ["Day 42", "Degenerative & Inflammatory PT — OA (knee, hip, hand), RA, Ankylosing Spondylitis, Gout, Perthes disease, Periarthritic shoulder", "Written + Oral"],
]
story.append(make_table(w8_data, col_widths=[2*cm, 9*cm, 5.5*cm]))
story.append(PageBreak())

# ---- SECTION 4: MONTH 3 ----
story.append(h1("MONTH 3: SEPTEMBER 15 – OCTOBER 14"))
story.append(Paragraph("Cardiorespiratory & General PT + Full Revision + Practical Prep", subtitle_style))
story.append(sp(8))

story.append(h2("Week 9–10: Cardiorespiratory & General PT (Most Time Here — Your Weakest)"))
w9_data = [
    ["Day", "Topic", "Hours"],
    ["Day 43–44", "Bedside Assessment (Adult & Pediatric) + Investigations — PFT interpretation (FEV1, FVC, FEV1/FVC), ABG analysis, ECG basics, Chest X-ray, Exercise tolerance testing", "6 hrs"],
    ["Day 45–46", "PT to increase lung volume — Positioning, Breathing exercises (diaphragmatic, pursed lip), Incentive Spirometry, CPAP, IPPB, Neurophysiological facilitation", "3 hrs"],
    ["Day 47", "PT to clear secretions — Postural drainage (positions per lobe!), Percussion, Vibration, ACBT, Flutter, PEP, Autogenic drainage, Huff and cough, Suctioning", "3 hrs"],
    ["Day 48", "PT to decrease work of breathing — IPPB, CPAP, BiPAP, Breathing re-education + Drug therapy (bronchodilators, mucolytics, steroids, inhalers)", "4 hrs"],
    ["Day 49", "Obstructive lung PT (COPD, Asthma, Bronchiectasis) + Restrictive lung PT (ILD, pulmonary fibrosis) + Management of breathlessness", "6 hrs"],
    ["Day 50–51", "Respiratory failure — O2 therapy types, Mechanical ventilation (modes, indications, weaning) + ICU PT — ARDS, Shock, Head injury, Tetanus, Multi-organ failure, Near drowning", "4 hrs"],
    ["Day 52", "Pulmonary Rehabilitation — Program components, patient selection, exercise training, education, psychosocial support, outcomes", "4 hrs"],
    ["Day 53", "Cardiac Rehabilitation (Phases I-IV, MET levels, activity progression) + PT following cardiac surgeries (post-CABG, post-valve surgery) + PT following PVD", "7 hrs"],
]
story.append(make_table(w9_data, col_widths=[2*cm, 10.5*cm, 3.5*cm]))
story.append(sp(8))

story.append(h2("Week 11: General PT Topics"))
w11_data = [
    ["Day", "Topic"],
    ["Day 54", "Neonatal & Pediatric Chest PT — Neonatal unit, chest PT for children, modifications, emergencies + Drug therapy for respiratory conditions"],
    ["Day 55", "PT in Obstetrics — Antenatal care, exercise, postnatal care, pelvic floor re-education, electrotherapy in obstetrics"],
    ["Day 56", "Wound management — Care of ulcers/wounds, surgical scars, UVR therapy, electrotherapeutics for wound healing, keloids, hypertrophic scars"],
    ["Day 57", "PT following Lung surgeries (post-pneumonectomy, lobectomy, thoracotomy) + PT following Abdominal surgeries"],
    ["Day 58", "Burns PT — Mobilization, positioning, splinting, exercise + Dermatology PT (Vitiligo, Leprosy, skin conditions)"],
    ["Day 59", "PT in Medical conditions — Hypertension, Diabetes, Renal failure, Obesity (exercise prescriptions, precautions)"],
    ["Day 60", "Health Fitness & Promotion + Applied Yoga in cardiorespiratory conditions + Oncology PT"],
]
story.append(make_table(w11_data, col_widths=[2*cm, 14.5*cm]))
story.append(PageBreak())

# ---- REVISION SPRINT ----
story.append(h1("WEEK 12–13: REVISION SPRINT"))
story.append(Paragraph("Day 61–90 | Full Subject Revisions + Practical Preparation", subtitle_style))
story.append(sp(8))

story.append(h2("Theory Revision Schedule"))
rev_data = [
    ["Day", "Focus", "Method"],
    ["Day 61–62", "General Medicine", "Cheat sheets: 1 page per system. Focus on Cardio, Respiratory, Diabetes"],
    ["Day 63–64", "General Surgery", "Wound healing flowchart, Burns Rule of 9s, Surgical procedures & complications"],
    ["Day 65–66", "Orthopedics & Traumatology", "All fractures + Deformities + Diseases. Draw Ortho X-ray findings from memory"],
    ["Day 67–68", "MSK & Sports PT", "SOAP practice, PT protocols for fractures/OA/RA/Spinal conditions, Sports injuries"],
    ["Day 69–70", "Cardiorespiratory PT", "All PT techniques, ICU PT, Pulmonary rehab, Cardiac rehab phases"],
    ["Day 71–75", "PRACTICAL PREP", "Practice: SOAP writing, ROM measurement, MMT grading, Special tests, Postural drainage positioning"],
    ["Day 76–80", "Previous Year Papers", "Attempt past exam questions under timed conditions. Identify weak areas"],
    ["Day 81–85", "Mock Answers + Viva", "Write out long answers. Practice viva with a classmate/in front of mirror"],
    ["Day 86–90", "Light Revision Only", "Cheat sheets only. Sleep well. No new topics!"],
]
story.append(make_table(rev_data, col_widths=[2*cm, 5.5*cm, 9*cm]))
story.append(PageBreak())

# ---- HIGH YIELD TOPICS ----
story.append(h1("HIGH-YIELD TOPICS (Most Likely Exam Questions)"))
story.append(sp(6))

story.append(h2("General Medicine — Must Know"))
med_hy = [
    "Diabetes Mellitus — etiology, clinical features, ALL complications (DKA, HHS, Neuropathy, Nephropathy, Retinopathy), management",
    "Hypertension — JNC classification, causes, investigations, management (lifestyle + drugs)",
    "IHD / Myocardial Infarction — pathogenesis, ECG changes, management, complications",
    "COPD vs Asthma — key differences, clinical features, spirometry pattern, management",
    "Tuberculosis — types, diagnosis (Mantoux, Sputum, HRCT), DOTS treatment regimen",
    "Anemia — iron deficiency vs B12/folate vs hemolytic — clinical features, investigations, management",
    "Rheumatic Fever → Valve disease (Mitral stenosis most common)",
    "Viral Hepatitis — types A/B/C/D/E, transmission, complications (Cirrhosis, HCC)",
]
for t in med_hy:
    story.append(bullet(t))

story.append(sp(6))
story.append(h2("General Surgery — Must Know"))
surg_hy = [
    "Wound Healing — 3 phases (Inflammatory, Proliferative, Remodeling), factors affecting healing",
    "Burns — Wallace Rule of 9s, depth classification (superficial/partial/full thickness), Fluid resuscitation formula, skin grafts",
    "DVT / Pulmonary Embolism — Virchow's triad, clinical features, Homan's sign, management (anticoagulation)",
    "Thoracic Trauma — Tension pneumothorax (emergency!), Hemothorax, Cardiac Tamponade (Beck's triad)",
    "Breast Carcinoma — TNM staging, types, management",
    "Cholecystectomy — indications, laparoscopic vs open, complications",
    "Hernia — types (inguinal, femoral, umbilical), reducible vs irreducible vs strangulated",
    "Appendicectomy — McBurney's point, clinical features of appendicitis",
]
for t in surg_hy:
    story.append(bullet(t))

story.append(sp(6))
story.append(h2("Orthopedics & Traumatology — Must Know"))
ortho_hy = [
    "Fracture Neck of Femur — Garden classification, management (conservative vs surgical, hemiarthroplasty vs THA), complications (AVN)",
    "Colles' Fracture — mechanism (FOOSH), clinical features (dinner fork deformity), management",
    "Supracondylar fracture of humerus — most common in children, Volkmann's ischemic contracture complication",
    "Anterior dislocation of shoulder — mechanism, clinical features, Kocher's/Hippocrates reduction, Bankart lesion",
    "CTEV (Club foot) — components (CAVE), management (Ponseti method)",
    "CDH — clinical features, Barlow/Ortolani tests, management",
    "OA — clinical features, radiological features (joint space narrowing, osteophytes, subchondral sclerosis), management",
    "RA — clinical features, extra-articular features, DMARDs management",
    "PID — L4-L5, L5-S1 most common, dermatomal signs, management (conservative vs surgical)",
    "Scoliosis — Cobb's angle, types, Harrington rod/Luque's instrumentation",
]
for t in ortho_hy:
    story.append(bullet(t))

story.append(sp(6))
story.append(h2("MSK & Sports PT — Must Know for Practical/Viva"))
msk_hy = [
    "SOAP Assessment format — know all components by heart, practice writing in 15 minutes",
    "PT for OA knee — exercises (quad strengthening, ROM), electrotherapy (TENS, ultrasound), hydrotherapy, home program",
    "PT after TKR/THR — Day-wise protocol (Day 0, 1, 2... Week 1, 2...), precautions (dislocation precautions for THR)",
    "PT for spinal conditions — PID (Williams vs McKenzie exercises), Cervical/Lumbar spondylosis",
    "ACL injury rehabilitation — pre-op PT, post-op protocol (weeks 0-6-12), criteria for RTS (return to sport)",
    "Meniscal injury — conservative vs post-meniscectomy PT",
    "PT for fractures — immobilization phase goals, post-immobilization phase (prevent stiffness, restore strength)",
    "Manual therapy — Maitland grades of mobilization (I-IV), McKenzie approach for spine",
    "Orthotics & Prosthetics — types of AFO, KAFO, upper/lower limb prostheses, stump care, gait training",
    "Sports PT — stages of soft tissue healing (acute/subacute/chronic), PRICE principle, return to sport criteria",
]
for t in msk_hy:
    story.append(bullet(t))

story.append(sp(6))
story.append(h2("Cardiorespiratory PT — Must Know"))
cardio_hy = [
    "Postural Drainage positions — know which position drains EACH lobe/segment (draw it out!)",
    "ACBT (Active Cycle of Breathing Technique) — 3 components (breathing control, thoracic expansion, forced expiration), indications",
    "PFT interpretation — FEV1, FVC, FEV1/FVC ratio (Obstructive: <0.7, Restrictive: >0.7 but reduced FVC)",
    "ABG interpretation — pH, PaO2, PaCO2, HCO3 — identify respiratory vs metabolic acidosis/alkalosis",
    "ICU PT — indications, contraindications, positioning, mobilization protocol, precautions in ICU",
    "Pulmonary Rehabilitation — components, benefits, exercise training prescription, education",
    "Cardiac Rehabilitation Phases — Phase I (in-hospital), Phase II (outpatient 6-12 wks), Phase III (community), Phase IV (maintenance) + MET levels",
    "PT after CABG/Thoracotomy — deep breathing, coughing techniques, early mobilization, scar management",
    "Mechanical Ventilation — modes (SIMV, CMV, CPAP), weaning criteria, PT role in ventilated patients",
    "PT in Obstetrics — antenatal exercises, pelvic floor exercises, breathing in labour, postnatal care",
]
for t in cardio_hy:
    story.append(bullet(t))
story.append(PageBreak())

# ---- RECOMMENDED BOOKS ----
story.append(h1("RECOMMENDED BOOKS"))
story.append(sp(6))

books_data = [
    ["Subject", "Book", "Author", "Priority"],
    ["MSK & Cardiorespiratory PT", "Tidy's Physiotherapy", "Tidy's", "MUST BUY"],
    ["Cardiorespiratory PT", "Cash's Textbook of Chest, Heart, Vascular Disorders for Physiotherapists", "Cash", "MUST BUY"],
    ["Medicine & Surgery (PT view)", "Cash's Textbook of General Medicine & Surgical Conditions for Physiotherapists", "Cash", "MUST BUY"],
    ["Cardiorespiratory PT", "Physiotherapy in Respiratory Care", "Alexandra Hough", "MUST BUY"],
    ["MSK PT", "Orthopedic Physiotherapy", "Jayant Joshi", "MUST BUY"],
    ["Orthopedics", "Outline of Fractures + Outline of Orthopedics", "John Crawford Adams", "Recommended"],
    ["General Medicine", "Davidson's Principles and Practice of Medicine", "Davidson", "Reference"],
    ["General Surgery", "Bailey and Love's Short Practice of Surgery", "Bailey & Love", "Reference"],
]
story.append(make_table(books_data, col_widths=[4*cm, 7*cm, 3.5*cm, 2*cm]))
story.append(PageBreak())

# ---- PRACTICAL EXAM TIPS ----
story.append(h1("PRACTICAL EXAM TIPS"))
story.append(sp(6))

story.append(h2("MSK PT Practical — What Examiners Test"))
msk_prac = [
    "SOAP note writing — given a case, write a complete SOAP note in 15 minutes. Practice daily from Month 2.",
    "Special tests — Know: Lachman's (ACL), McMurray's (Meniscus), Empty can/Drop arm (Supraspinatus), Spurling's (Cervical nerve root), SLR (Lumbar disc), FABER/FADIR (Hip), Thomas test (Hip flexor tightness)",
    "MMT grading — 0 to 5 grading. Practice on yourself and classmates.",
    "ROM measurement — know normal values for all major joints. Practice goniometry.",
    "Gait analysis — identify antalgic gait, Trendelenburg gait, steppage gait, scissor gait",
    "PT treatment planning — given 'OA knee patient', state goals (short + long term), treatment plan, home program",
]
for t in msk_prac:
    story.append(bullet(t))

story.append(sp(8))
story.append(h2("Cardiorespiratory PT Practical — What Examiners Test"))
cardio_prac = [
    "Postural drainage — demonstrate correct position for each lobe. Draw on paper if unsure.",
    "ACBT — demonstrate full cycle on a patient/model",
    "Breathing exercises — diaphragmatic, pursed lip, segmental, lateral costal",
    "Percussion and vibration technique — correct hand position, when to use each",
    "Bedside assessment — auscultation (normal vs adventitious sounds), chest expansion measurement, observation (cyanosis, clubbing, barrel chest)",
    "Incentive spirometry — explain and demonstrate to 'patient'",
    "Cardiac rehab — know Phase I exercises: ankle pumps, deep breathing, sitting to standing, supervised walking",
]
for t in cardio_prac:
    story.append(bullet(t))

story.append(sp(10))
story.append(note("VIVA TIP: Always start your viva answer with 'Physiotherapy assessment of this patient would include...' — examiners love a systematic approach."))
story.append(sp(6))
story.append(red_note("Don't skip practical prep. Many students pass written but fail practical — it's where easy marks are if you prepare, but easy marks to lose if you don't."))
story.append(PageBreak())

# ---- WEEKLY SUMMARY TABLE ----
story.append(h1("3-MONTH OVERVIEW AT A GLANCE"))
story.append(sp(6))

overview_data = [
    ["Month", "Weeks", "Subject Focus", "Goal"],
    ["Month 1\nJul 15 – Aug 14", "Week 1–2", "General Medicine\n(Cardio, Respiratory, Digestive, Endo, Blood, Infections, Pediatrics)", "Complete all theory\n1-page notes per topic"],
    ["", "Week 3–4", "General Surgery\n(Wound healing, Thoracic trauma, Heart disorders, Burns, Vascular, Women's health)", "Complete theory\nFocus on surgical procedures"],
    ["Month 2\nAug 15 – Sep 14", "Week 5–7", "Orthopedics & Traumatology\n(Fractures, Dislocations, Deformities, Bone diseases, Spine)", "Complete Ortho theory\nMake fracture summary"],
    ["", "Week 7–8", "MSK & Sports PT\n(SOAP assessment, Fracture PT, Inflammatory conditions PT, Spinal PT)", "Begin SOAP practice\nLink Ortho to PT management"],
    ["Month 3\nSep 15 – Oct 14", "Week 9–11", "Cardiorespiratory & General PT\n(Bedside assessment, PT techniques, ICU, Pulm rehab, Cardiac rehab, General PT)", "Complete all theory\nPractice all PT techniques"],
    ["", "Week 12–13", "FULL REVISION + PRACTICAL PREP\n(All subjects, Previous papers, Mock viva, Practical skills)", "Pass the exam!"],
]
story.append(make_table(overview_data, col_widths=[3*cm, 2*cm, 7.5*cm, 4*cm]))

story.append(sp(12))
story.append(hr())
story.append(sp(6))
story.append(Paragraph("You've got this. Start today, be consistent, and 3 months is more than enough.", 
    ParagraphStyle("Motivate", parent=styles["Normal"], fontSize=11, alignment=TA_CENTER, 
    textColor=colors.HexColor("#1a237e"), fontName="Helvetica-Bold")))
story.append(sp(4))
story.append(Paragraph("Generated by Orris AI Study Assistant | July 2026", subtitle_style))

# ---- BUILD PDF ----
doc.build(story)
print("PDF created successfully:", OUTPUT)

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

OUTPUT = "/home/daytona/workspace/pt-study-plan/General_Medicine_Notes.pdf"

doc = SimpleDocTemplate(
    OUTPUT, pagesize=A4,
    rightMargin=1.8*cm, leftMargin=1.8*cm,
    topMargin=2*cm, bottomMargin=2*cm
)

styles = getSampleStyleSheet()

# ---- Styles ----
title_s = ParagraphStyle("TitleS", fontSize=24, textColor=colors.HexColor("#0d47a1"),
    alignment=TA_CENTER, fontName="Helvetica-Bold", spaceAfter=6)
subtitle_s = ParagraphStyle("SubS", fontSize=11, textColor=colors.HexColor("#455a64"),
    alignment=TA_CENTER, spaceAfter=4)
h1_s = ParagraphStyle("H1S", fontSize=13, textColor=colors.white,
    backColor=colors.HexColor("#0d47a1"), spaceBefore=12, spaceAfter=5,
    fontName="Helvetica-Bold", leftIndent=-4, rightIndent=-4, borderPad=5)
h2_s = ParagraphStyle("H2S", fontSize=11, textColor=colors.HexColor("#0d47a1"),
    spaceBefore=8, spaceAfter=3, fontName="Helvetica-Bold")
h3_s = ParagraphStyle("H3S", fontSize=10, textColor=colors.HexColor("#b71c1c"),
    spaceBefore=5, spaceAfter=2, fontName="Helvetica-Bold")
body_s = ParagraphStyle("BodyS", fontSize=9.5, leading=14, spaceAfter=2,
    textColor=colors.HexColor("#212121"))
bullet_s = ParagraphStyle("BulletS", fontSize=9.5, leading=13,
    leftIndent=14, spaceAfter=2, textColor=colors.HexColor("#212121"))
sub_bullet_s = ParagraphStyle("SubBulletS", fontSize=9, leading=12,
    leftIndent=28, spaceAfter=1, textColor=colors.HexColor("#424242"))
imp_s = ParagraphStyle("ImpS", fontSize=9, leading=12,
    backColor=colors.HexColor("#fff9c4"), borderPad=5, spaceAfter=5,
    textColor=colors.HexColor("#4e342e"))
red_s = ParagraphStyle("RedS", fontSize=9, leading=12,
    backColor=colors.HexColor("#ffebee"), borderPad=5, spaceAfter=5,
    textColor=colors.HexColor("#b71c1c"))
green_s = ParagraphStyle("GreenS", fontSize=9, leading=12,
    backColor=colors.HexColor("#e8f5e9"), borderPad=5, spaceAfter=5,
    textColor=colors.HexColor("#1b5e20"))

def h1(t): return Paragraph(f"  {t}", h1_s)
def h2(t): return Paragraph(t, h2_s)
def h3(t): return Paragraph(t, h3_s)
def body(t): return Paragraph(t, body_s)
def bl(t): return Paragraph(f"• {t}", bullet_s)
def sbl(t): return Paragraph(f"  – {t}", sub_bullet_s)
def imp(t): return Paragraph(f"<b>★ KEY:</b> {t}", imp_s)
def red(t): return Paragraph(f"<b>⚠ EXAM TIP:</b> {t}", red_s)
def green(t): return Paragraph(f"<b>✔ REMEMBER:</b> {t}", green_s)
def sp(n=5): return Spacer(1, n)
def hr(): return HRFlowable(width="100%", thickness=0.5, color=colors.HexColor("#bbdefb"), spaceAfter=3)

def tbl(data, widths=None, hcol="#1565c0"):
    t = Table(data, colWidths=widths, repeatRows=1)
    t.setStyle(TableStyle([
        ("BACKGROUND", (0,0), (-1,0), colors.HexColor(hcol)),
        ("TEXTCOLOR", (0,0), (-1,0), colors.white),
        ("FONTNAME", (0,0), (-1,0), "Helvetica-Bold"),
        ("FONTSIZE", (0,0), (-1,0), 8.5),
        ("ALIGN", (0,0), (-1,-1), "LEFT"),
        ("FONTNAME", (0,1), (-1,-1), "Helvetica"),
        ("FONTSIZE", (0,1), (-1,-1), 8.5),
        ("ROWBACKGROUNDS", (0,1), (-1,-1), [colors.white, colors.HexColor("#e3f2fd")]),
        ("GRID", (0,0), (-1,-1), 0.4, colors.HexColor("#90caf9")),
        ("VALIGN", (0,0), (-1,-1), "TOP"),
        ("TOPPADDING", (0,0), (-1,-1), 4),
        ("BOTTOMPADDING", (0,0), (-1,-1), 4),
        ("LEFTPADDING", (0,0), (-1,-1), 5),
        ("RIGHTPADDING", (0,0), (-1,-1), 5),
    ]))
    return t

story = []

# ======== COVER ========
story += [sp(40),
    Paragraph("GENERAL MEDICINE", title_s),
    Paragraph("Complete Study Notes", title_s),
    sp(10),
    Paragraph("3rd Year BPT | University Written Exam", subtitle_s),
    Paragraph("Based on Official Syllabus", subtitle_s),
    sp(20),
    HRFlowable(width="100%", thickness=1, color=colors.HexColor("#0d47a1"), spaceAfter=8),
    sp(6)]

toc_data = [
    ["#", "Topic", "Syllabus Hours"],
    ["1", "Infection", "3 hrs"],
    ["2", "Poisoning", "2 hrs"],
    ["3", "Food & Nutrition", "4 hrs"],
    ["4", "Endocrine Diseases", "4 hrs"],
    ["5", "Diseases of the Blood", "4 hrs"],
    ["6", "Diseases of the Digestive System", "7 hrs"],
    ["7", "Cardiovascular Disease", "8 hrs"],
    ["8", "Respiratory Disease", "9 hrs"],
    ["9", "Diseases of the Skin", "6 hrs"],
    ["10", "Pediatrics", "8 hrs"],
    ["11", "Psychiatric Disorders", "5 hrs"],
]
story.append(tbl(toc_data, widths=[1*cm, 12*cm, 3.5*cm]))
story += [sp(30), Paragraph("Orris AI Study Assistant | July 2026", subtitle_s), PageBreak()]

# ======== TOPIC 1: INFECTION ========
story.append(h1("TOPIC 1: INFECTION  [3 Hours]"))
story += [sp(4)]

story.append(h2("1.1 Effects of Infection on the Body"))
story += [bl("Localised infection — confined to entry site (abscess, cellulitis)"),
    bl("Generalised (systemic) infection — spreads via blood (bacteremia, septicemia, toxemia)"),
    bl("Inflammatory response — redness, heat, swelling, pain, loss of function"),
    bl("Systemic effects — fever (pyrexia), tachycardia, leukocytosis, raised ESR/CRP"),
    sp()]

story.append(h2("1.2 Pathology — Source & Spread of Infection"))
story += [
    tbl([["Source", "Examples"],
         ["Exogenous", "Bacteria from environment, other people, contaminated instruments"],
         ["Endogenous", "Normal flora of skin, gut, respiratory tract becoming pathogenic"],
         ["Nosocomial", "Hospital-acquired infections (HAI) — E. coli, MRSA, Pseudomonas"],
    ], widths=[5*cm, 11.5*cm]),
    sp(4),
    h3("Routes of Spread:"),
    bl("Direct contact — touch, droplets"),
    bl("Indirect — contaminated water, food, fomites"),
    bl("Vector-borne — mosquito (malaria, dengue), tick (Lyme disease)"),
    bl("Airborne — TB, measles, influenza"),
    bl("Blood-borne — HIV, Hepatitis B/C"),
    sp()]

story.append(h2("1.3 Vaccinations"))
story += [
    tbl([["Vaccine", "Disease Prevented", "Schedule"],
         ["BCG", "Tuberculosis", "At birth"],
         ["OPV / IPV", "Poliomyelitis", "6, 10, 14 weeks + boosters"],
         ["DPT", "Diphtheria, Pertussis, Tetanus", "6, 10, 14 weeks"],
         ["MMR", "Measles, Mumps, Rubella", "9 months + 15-18 months"],
         ["Hepatitis B", "Hep B infection", "0, 1, 6 months"],
         ["Typhoid", "Typhoid fever", "2 years onwards, every 3 years"],
         ["Influenza", "Flu", "Annual"],
    ], widths=[4*cm, 6*cm, 6.5*cm]),
    sp(4),
    imp("Types of immunity: Active (vaccines, natural infection), Passive (maternal antibodies, immunoglobulins)")]

story.append(h2("1.4 Rashes & Common Infections"))
story += [
    tbl([["Infection", "Rash/Feature", "Causative Agent"],
         ["Measles", "Koplik spots → maculopapular rash (head to toe)", "Paramyxovirus"],
         ["Chickenpox", "Itchy vesicular rash — different stages at same time", "VZV"],
         ["Rubella", "Fine pink rash, posterior cervical lymphadenopathy", "Rubella virus"],
         ["Typhoid", "Rose spots on trunk", "Salmonella typhi"],
         ["Meningococcemia", "Petechial/purpuric non-blanching rash", "N. meningitidis"],
    ], widths=[3.5*cm, 7*cm, 6*cm]),
    sp(4)]

story.append(h2("1.5 Food Poisoning & Gastroenteritis"))
story += [bl("<b>Food Poisoning:</b> Illness from eating contaminated food"),
    bl("Most common organisms: Salmonella, Staphylococcus aureus, Clostridium perfringens, E. coli"),
    bl("Features: Nausea, vomiting, diarrhea, abdominal cramps, within 1-72 hrs of eating"),
    bl("Management: Oral rehydration therapy (ORT), rest, antibiotics only if severe/systemic"),
    sp(3),
    bl("<b>Gastroenteritis:</b> Inflammation of stomach + intestines"),
    bl("Causes: Rotavirus (most common in children), Norovirus (adults), Bacteria, Parasites"),
    bl("Features: Diarrhea, vomiting, fever, dehydration"),
    bl("Management: ORT (Oral Rehydration Salts — ORS), zinc supplementation in children, treat cause"),
    imp("ORS formula: 1L water + 6 tsp sugar + 0.5 tsp salt")]

story.append(h2("1.6 Sexually Transmitted Diseases (STDs)"))
story += [
    tbl([["Disease", "Organism", "Features", "Treatment"],
         ["Gonorrhea", "N. gonorrhoeae", "Urethral discharge, dysuria, pelvic pain (women)", "Ceftriaxone"],
         ["Syphilis", "T. pallidum", "Primary: painless chancre; Secondary: rash; Tertiary: gumma", "Penicillin G"],
         ["Chlamydia", "C. trachomatis", "Often asymptomatic; urethritis, cervicitis, PID", "Azithromycin"],
         ["Herpes Genitalis", "HSV-2", "Painful vesicles/ulcers on genitals, recurrent", "Acyclovir"],
         ["Trichomoniasis", "T. vaginalis", "Frothy yellow-green vaginal discharge, itching", "Metronidazole"],
    ], widths=[3*cm, 3*cm, 5.5*cm, 5*cm]),
    sp(4)]

story.append(h2("1.7 HIV Infection & AIDS"))
story += [
    h3("Definition:"),
    bl("HIV (Human Immunodeficiency Virus) — attacks CD4+ T lymphocytes"),
    bl("AIDS (Acquired Immunodeficiency Syndrome) — CD4 count <200 cells/μL OR AIDS-defining illness"),
    sp(3),
    h3("Transmission:"),
    bl("Sexual contact (most common)"),
    bl("Blood transfusion / needle sharing (IV drug users)"),
    bl("Mother to child (vertical transmission) — during pregnancy, childbirth, breastfeeding"),
    sp(3),
    h3("Stages of HIV:"),
    tbl([["Stage", "CD4 Count", "Features"],
         ["Acute HIV (2-4 wks)", ">500", "Flu-like illness, fever, lymphadenopathy, rash — lasts 2-4 weeks"],
         ["Asymptomatic (latent)", "200-500", "No symptoms. Can last years. Still infectious!"],
         ["Symptomatic HIV", "200-500", "Weight loss, oral candidiasis, TB, recurrent infections"],
         ["AIDS", "<200", "Opportunistic infections: PCP, CMV retinitis, Cryptococcal meningitis, Kaposi's sarcoma"],
    ], widths=[3*cm, 3*cm, 10.5*cm]),
    sp(4),
    h3("Diagnosis:"),
    bl("ELISA (screening test) → confirmed by Western Blot"),
    bl("CD4 count — monitors immune status"),
    bl("Viral load — monitors disease progression and treatment response"),
    sp(3),
    h3("Treatment — ART (Antiretroviral Therapy):"),
    bl("HAART (Highly Active ART) — combination of 3 or more drugs from different classes"),
    bl("Goal: Reduce viral load to undetectable, maintain CD4 >500"),
    bl("Common regimen: 2 NRTIs + 1 NNRTI or 1 PI"),
    bl("Not curative, but controls disease — patient must take lifelong"),
    red("HIV exam tip: Know the CD4 thresholds (200 for AIDS), transmission routes, diagnosis (ELISA + Western Blot), and ART. Very common question!"),
    PageBreak()]

# ======== TOPIC 2: POISONING ========
story.append(h1("TOPIC 2: POISONING  [2 Hours]"))
story += [sp(4)]

story.append(h2("2.1 General Management of Poisoning"))
story += [
    h3("Initial Steps (ABCDE):"),
    bl("A — Airway: maintain airway, intubate if unconscious"),
    bl("B — Breathing: O2, ventilation if needed"),
    bl("C — Circulation: IV access, fluids, treat shock"),
    bl("D — Disability: GCS, pupils, glucose"),
    bl("E — Exposure: remove contaminated clothing, identify poison"),
    sp(3),
    h3("Decontamination:"),
    bl("Skin exposure: Remove clothes, wash with water 15-20 min"),
    bl("Eye exposure: Irrigate with normal saline"),
    bl("<b>Gastric lavage:</b> Only within 1 hour of ingestion if poison is NOT corrosive/hydrocarbon"),
    bl("<b>Activated charcoal:</b> 50g in adults — adsorbs most poisons (NOT effective for iron, lithium, cyanide, alcohols)"),
    bl("Cathartics: Sorbitol — speeds gut transit"),
    imp("Never induce vomiting in corrosive/petroleum poisoning — causes more damage!")]

story.append(h2("2.2 Common Poisons & Their Management"))
story += [
    tbl([["Poison", "Features", "Specific Treatment / Antidote"],
         ["Organophosphate\n(pesticides)", "DUMBBELS: Diarrhea, Urination, Miosis, Bradycardia, Bronchospasm, Emesis, Lacrimation, Salivation", "Atropine (large doses) + Pralidoxime (2-PAM)"],
         ["Paracetamol\n(Acetaminophen)", "Initially nausea/vomiting. Liver failure at 24-72 hrs (jaundice, coagulopathy)", "N-Acetylcysteine (NAC) — within 8-10 hrs is most effective"],
         ["Opioids (morphine,\nheroin, codeine)", "Triad: Miosis (pinpoint pupils), Respiratory depression, Coma", "Naloxone (Narcan) — IV/IM/intranasal"],
         ["Benzodiazepines", "Sedation, CNS depression, respiratory depression", "Flumazenil"],
         ["Iron", "GI hemorrhage, shock, liver failure", "Desferrioxamine (chelation)"],
         ["Cyanide", "Bitter almond smell, rapid collapse, metabolic acidosis", "Hydroxocobalamin + Sodium thiosulfate"],
         ["CO (Carbon\nMonoxide)", "Headache, nausea, cherry-red skin (late sign), confusion, coma", "100% O2 via non-rebreathing mask; hyperbaric O2"],
         ["Corrosives\n(acid/alkali)", "Severe burns of mouth, throat, esophagus; drooling", "Dilute with water (milk); NO gastric lavage; supportive"],
    ], widths=[3*cm, 6*cm, 7.5*cm]),
    sp(4),
    red("Most tested antidote: Atropine for organophosphate, Naloxone for opioids, NAC for paracetamol")]

story.append(h2("2.3 Drugs of Misuse"))
story += [
    tbl([["Drug", "Type", "Effects", "Withdrawal Features"],
         ["Alcohol", "Depressant", "Euphoria, disinhibition, ataxia, coma", "Tremors, seizures, delirium tremens (DTs)"],
         ["Heroin/Opioids", "Depressant", "Euphoria, analgesia, miosis, respiratory depression", "Yawning, lacrimation, goosebumps, diarrhea, cramps"],
         ["Cannabis", "Stimulant/Hallucinogen", "Euphoria, red eyes, increased appetite, paranoia", "Mild: irritability, insomnia, anxiety"],
         ["Cocaine/Crack", "Stimulant", "Euphoria, tachycardia, hypertension, arrhythmias", "Crash: depression, fatigue, cravings"],
         ["Amphetamines", "Stimulant", "Increased energy, decreased appetite, paranoia", "Fatigue, depression, hypersomnia"],
    ], widths=[2.5*cm, 2.5*cm, 6*cm, 5.5*cm]),
    PageBreak()]

# ======== TOPIC 3: FOOD AND NUTRITION ========
story.append(h1("TOPIC 3: FOOD & NUTRITION  [4 Hours]"))
story += [sp(4)]

story.append(h2("3.1 Nutritional & Energy Requirements"))
story += [
    tbl([["Nutrient", "Function", "RDA (Adult)"],
         ["Carbohydrates", "Primary energy source (4 kcal/g)", "55-60% of total calories"],
         ["Proteins", "Tissue building, enzymes, antibodies (4 kcal/g)", "0.8-1.0 g/kg/day"],
         ["Fats", "Energy, fat-soluble vitamins, cell membranes (9 kcal/g)", "25-30% of total calories"],
         ["Water", "Solvent, temperature regulation, transport", "2-3 L/day"],
    ], widths=[3.5*cm, 7*cm, 6*cm]),
    sp(4),
    imp("Total energy needs: Basal Metabolic Rate (BMR) + Physical Activity + Thermogenesis. Average adult needs ~2000-2500 kcal/day.")]

story.append(h2("3.2 Deficiency Diseases"))
story += [
    tbl([["Deficiency", "Disease", "Clinical Features", "Treatment"],
         ["Vitamin A", "Night blindness, Xerophthalmia", "Poor night vision, Bitot spots, corneal ulceration, keratomalacia", "Vitamin A supplements"],
         ["Vitamin B1 (Thiamine)", "Beriberi", "Wet Beriberi: cardiac failure + edema; Dry Beriberi: peripheral neuropathy; Wernicke's encephalopathy", "Thiamine IV/oral"],
         ["Vitamin B3 (Niacin)", "Pellagra", "4 Ds: Dermatitis, Diarrhea, Dementia, Death", "Niacin supplements"],
         ["Vitamin B12/Folate", "Megaloblastic Anemia", "Fatigue, pallor, macrocytic anemia; B12 also causes subacute combined degeneration of spinal cord", "B12/Folate supplements"],
         ["Vitamin C", "Scurvy", "Bleeding gums, perifollicular hemorrhage, poor wound healing, corkscrew hairs", "Vitamin C (ascorbic acid)"],
         ["Vitamin D", "Rickets (children)\nOsteomalacia (adults)", "Rickets: bow legs, knock knees, costochondral rosary, Harrison's sulcus. Osteomalacia: bone pain, proximal myopathy", "Vitamin D + Calcium"],
         ["Iron", "Iron deficiency anemia", "Fatigue, pallor, koilonychia (spoon nails), angular stomatitis, glossitis, pica", "Ferrous sulphate oral"],
         ["Iodine", "Goitre, Cretinism", "Goitre (thyroid enlargement); Cretinism in children: intellectual disability, short stature, deaf-mutism", "Iodized salt, KI supplements"],
    ], widths=[3*cm, 3*cm, 5.5*cm, 5*cm]),
    sp(4)]

story.append(h2("3.3 Protein-Energy Malnutrition (PEM)"))
story += [
    tbl([["Feature", "Kwashiorkor", "Marasmus"],
         ["Cause", "Protein deficiency (adequate calories)", "Severe calorie + protein deficiency"],
         ["Age", "Older infants / toddlers (1-3 yrs)", "Infants (<1 yr)"],
         ["Weight", "Normal or slightly low", "Severe wasting (<60% expected weight)"],
         ["Edema", "Present (pitting edema)", "Absent"],
         ["Appearance", "Moon face, pot belly, flaky paint skin, depigmented hair (flag sign)", "Skin and bones — wizened old man appearance"],
         ["Serum Albumin", "Very low", "Low to normal"],
         ["Treatment", "High protein diet + micronutrients + treat infections", "Gradual caloric rehabilitation; F-75 then F-100 formulas (WHO)"],
    ], widths=[3*cm, 7.5*cm, 6*cm]),
    sp(4),
    red("Kwashiorkor vs Marasmus is a very common exam differentiation question. Learn the table above by heart.")]

story.append(h2("3.4 Obesity"))
story += [
    h3("Definition & Classification (BMI):"),
    tbl([["BMI (kg/m²)", "Classification"],
         ["<18.5", "Underweight"],
         ["18.5–24.9", "Normal weight"],
         ["25–29.9", "Overweight"],
         ["30–34.9", "Class I Obesity"],
         ["35–39.9", "Class II Obesity (Severe)"],
         ["≥40", "Class III Obesity (Morbid)"],
    ], widths=[5*cm, 11.5*cm]),
    sp(4),
    h3("Causes:"), bl("Genetic predisposition"), bl("Excessive caloric intake > expenditure"), bl("Sedentary lifestyle"), bl("Endocrine causes — hypothyroidism, Cushing's syndrome, PCOS"), bl("Medications — steroids, antipsychotics, insulin"),
    sp(3),
    h3("Complications:"),
    bl("Cardiovascular — Hypertension, IHD, stroke, heart failure"),
    bl("Metabolic — Type 2 Diabetes, dyslipidemia, metabolic syndrome"),
    bl("Respiratory — Sleep apnea, obesity hypoventilation syndrome"),
    bl("Musculoskeletal — OA knee, low back pain, gout"),
    bl("Psychological — Depression, low self-esteem"),
    bl("Malignancy — Breast, colon, endometrial, prostate cancers"),
    sp(3),
    h3("Management:"),
    bl("<b>Diet:</b> Caloric restriction (500 kcal/day deficit = ~0.5 kg/week weight loss)"),
    bl("<b>Exercise:</b> 150-300 min/week moderate activity; resistance training"),
    bl("<b>Medications:</b> Orlistat (lipase inhibitor), GLP-1 agonists (semaglutide, liraglutide)"),
    bl("<b>Bariatric surgery:</b> BMI >40 OR >35 with comorbidities — sleeve gastrectomy, RYGB"),
    PageBreak()]

# ======== TOPIC 4: ENDOCRINE ========
story.append(h1("TOPIC 4: ENDOCRINE DISEASES  [4 Hours]"))
story += [sp(4)]

story.append(h2("4.1 Diabetes Mellitus (DM)"))
story += [
    tbl([["Feature", "Type 1 DM", "Type 2 DM"],
         ["Pathogenesis", "Autoimmune destruction of beta cells → absolute insulin deficiency", "Insulin resistance + relative insulin deficiency"],
         ["Age of onset", "Young (<30 yrs)", "Middle-aged/elderly (>40 yrs), but rising in youth"],
         ["Body habitus", "Lean/normal weight", "Usually overweight/obese"],
         ["Onset", "Acute (days-weeks)", "Insidious (months-years)"],
         ["Ketoacidosis", "Common", "Rare"],
         ["Treatment", "Insulin mandatory", "Lifestyle first → Oral drugs → Insulin"],
    ], widths=[3.5*cm, 6.5*cm, 6.5*cm]),
    sp(4),
    h3("Clinical Features (3 Ps + more):"),
    bl("Polyuria — excessive urination (osmotic diuresis)"),
    bl("Polydipsia — excessive thirst"),
    bl("Polyphagia — increased hunger (Type 1)"),
    bl("Weight loss (Type 1), weight gain (Type 2)"),
    bl("Fatigue, blurred vision, recurrent infections (skin, UTI, candida)"),
    bl("Slow healing wounds"),
    sp(3),
    h3("Diagnosis (WHO Criteria):"),
    tbl([["Test", "Normal", "Pre-diabetes", "Diabetes"],
         ["Fasting Plasma Glucose", "<5.6 mmol/L (<100 mg/dL)", "5.6-6.9 mmol/L (100-125)", "≥7.0 mmol/L (≥126 mg/dL)"],
         ["2-hr Post-glucose (OGTT)", "<7.8 mmol/L (<140)", "7.8-11.0 mmol/L (140-199)", "≥11.1 mmol/L (≥200 mg/dL)"],
         ["Random Glucose + symptoms", "—", "—", "≥11.1 mmol/L (≥200 mg/dL)"],
         ["HbA1c", "<5.7%", "5.7-6.4%", "≥6.5%"],
    ], widths=[4*cm, 4*cm, 4*cm, 4.5*cm]),
    sp(4),
    imp("HbA1c reflects average blood glucose over past 2-3 months. Target in treated DM: <7%."),
    sp(3),
    h3("Complications of Diabetes:"),
    h3("Acute Complications:"),
    tbl([["Complication", "Features", "Treatment"],
         ["DKA (Type 1)", "BG >250, Ketones+, pH<7.3, fruity breath, Kussmaul breathing, vomiting", "IV fluids, insulin infusion, K+ replacement, treat cause"],
         ["HHS (Type 2)", "BG >600, no ketosis, severe dehydration, altered consciousness", "IV fluids (slowly), insulin (small doses), treat cause"],
         ["Hypoglycemia", "BG <3.9 mmol/L; sweating, tremor, palpitations, confusion, seizures", "15g fast-acting carbs (glucose tabs, juice) if conscious; IV dextrose/glucagon if unconscious"],
    ], widths=[3*cm, 7*cm, 6.5*cm]),
    sp(4),
    h3("Chronic Complications:"),
    tbl([["Type", "Complication", "Details"],
         ["Microvascular", "Diabetic Retinopathy", "Most common cause of blindness in working-age adults; background → proliferative"],
         ["Microvascular", "Diabetic Nephropathy", "Microalbuminuria → proteinuria → CKD → ESRD; treated with ACE inhibitors"],
         ["Microvascular", "Diabetic Neuropathy", "Glove & stocking sensory loss, autonomic neuropathy (postural hypotension, gastroparesis)"],
         ["Macrovascular", "IHD / MI", "2-4x increased risk; often silent MI in diabetics"],
         ["Macrovascular", "Peripheral Vascular Disease", "Claudication → rest pain → gangrene → amputation"],
         ["Macrovascular", "Stroke", "2-3x increased risk"],
         ["Other", "Diabetic Foot", "Combination of neuropathy + PVD → ulcers + infection + gangrene"],
    ], widths=[2.5*cm, 4*cm, 10*cm]),
    sp(4),
    h3("Management of Type 2 DM:"),
    bl("Step 1: Lifestyle — diet (low GI, reduce calories, low fat), exercise (150 min/week), weight loss"),
    bl("Step 2: Metformin (first-line drug) — reduces hepatic glucose production, weight neutral, cheap"),
    bl("Step 3: Add second agent — Sulfonylurea (glipizide), SGLT2 inhibitor (empagliflozin), GLP-1 agonist"),
    bl("Step 4: Insulin when oral drugs fail"),
    red("DM is the MOST tested endocrine topic. Know: 3 Ps, diagnostic criteria, DKA vs HHS, all complications, management steps.")]

story.append(h2("4.2 Other Endocrine Diseases"))
story += [
    tbl([["Disease", "Cause", "Key Features", "Treatment"],
         ["Hypothyroidism", "Autoimmune (Hashimoto's); iodine deficiency; post-thyroidectomy", "Weight gain, fatigue, cold intolerance, constipation, bradycardia, dry skin, myxedema, raised TSH, low T3/T4", "Levothyroxine (T4 replacement)"],
         ["Hyperthyroidism (Graves')", "Autoimmune (TSH-receptor antibodies)", "Weight loss, heat intolerance, tachycardia, tremor, exophthalmos, goitre, low TSH, high T3/T4", "Propylthiouracil, Carbimazole, Beta-blockers, Radioiodine, Surgery"],
         ["Cushing's Syndrome", "Excess cortisol (ACTH-secreting tumor, adrenal tumor, steroid drugs)", "Moon face, buffalo hump, central obesity, striae, hypertension, hyperglycemia, osteoporosis, proximal weakness", "Treat cause; Metyrapone/Ketoconazole to lower cortisol; Surgery"],
         ["Addison's Disease", "Autoimmune adrenal insufficiency — cortisol + aldosterone deficiency", "Fatigue, hypotension, hyperpigmentation (buccal, scars, skin creases), hyponatremia, hyperkalemia, hypoglycemia", "Hydrocortisone + Fludrocortisone lifelong"],
         ["Acromegaly", "GH-secreting pituitary adenoma (adult)", "Large hands/feet/jaw, coarse facial features, sweating, headache, visual field defects, DM, OSA", "Surgery (transsphenoidal), Octreotide, Radiotherapy"],
    ], widths=[2.5*cm, 3.5*cm, 6*cm, 4.5*cm]),
    PageBreak()]

# ======== TOPIC 5: BLOOD ========
story.append(h1("TOPIC 5: DISEASES OF THE BLOOD  [4 Hours]"))
story += [sp(4)]

story.append(h2("5.1 Anemia — Overview"))
story += [
    body("Definition: Hemoglobin below normal — Men <13 g/dL, Women <12 g/dL"),
    sp(3),
    h3("Classification by MCV:"),
    tbl([["Type", "MCV", "Causes"],
         ["Microcytic (small RBCs)", "Low (<80 fL)", "Iron deficiency, Thalassemia, Anemia of chronic disease (sometimes), Sideroblastic"],
         ["Normocytic (normal RBCs)", "Normal (80-100 fL)", "Acute blood loss, Hemolytic anemia, Anemia of chronic disease, Aplastic anemia, CKD"],
         ["Macrocytic (large RBCs)", "High (>100 fL)", "B12 deficiency, Folate deficiency, Liver disease, Hypothyroidism, Drugs (methotrexate)"],
    ], widths=[3.5*cm, 3*cm, 10*cm]),
    sp(4),
    h3("General Features of Anemia:"),
    bl("Fatigue, weakness, dyspnea on exertion"),
    bl("Pallor (conjunctiva, palm, tongue, nail bed)"),
    bl("Tachycardia, palpitations"),
    bl("Headache, dizziness, fainting"),
    bl("Severe: heart failure, angina"),
    sp(4)]

story.append(h2("5.2 Iron Deficiency Anemia (IDA)"))
story += [
    h3("Causes:"), bl("Inadequate intake (poor diet)"), bl("Malabsorption (celiac disease, post-gastrectomy)"), bl("Increased need (pregnancy, growth)"), bl("Blood loss — GI bleeding (most common cause in adults: peptic ulcer, colorectal cancer), menorrhagia"),
    sp(3),
    h3("Specific Features:"), bl("Koilonychia (spoon-shaped nails)"), bl("Angular stomatitis (cracks at corners of mouth)"), bl("Glossitis (smooth, sore tongue)"), bl("Pica (craving non-food items — ice, chalk, dirt)"), bl("Plummer-Vinson syndrome — IDA + dysphagia (post-cricoid web)"),
    sp(3),
    h3("Investigations:"), bl("CBC: Low Hb, Low MCV, Low MCH, High RDW"), bl("Serum ferritin: LOW (most sensitive indicator of iron stores)"), bl("Serum iron: LOW, TIBC: HIGH"),
    sp(3),
    h3("Treatment:"), bl("Ferrous sulphate 200mg TDS for 3-6 months"), bl("Continue for 3 months after Hb normalizes to replenish stores"), bl("IV iron if oral not tolerated or malabsorption"), bl("Treat underlying cause!"),
    imp("Reticulocyte count rises in 5-7 days after iron treatment — first sign of response.")]

story.append(h2("5.3 B12 & Folate Deficiency — Megaloblastic Anemia"))
story += [
    tbl([["Feature", "B12 Deficiency", "Folate Deficiency"],
         ["Cause", "Pernicious anemia (anti-intrinsic factor Ab), gastrectomy, strict vegan diet, malabsorption", "Poor dietary intake (alcohol, poor diet), malabsorption, pregnancy need, drugs (methotrexate, phenytoin)"],
         ["Neurological features", "YES — Subacute Combined Degeneration of spinal cord (SACD): posterior + lateral column — proprioception loss, spasticity", "NO neurological features"],
         ["Blood film", "Hypersegmented neutrophils + macro-ovalocytes", "Same"],
         ["Treatment", "Hydroxocobalamin IM injections", "Folic acid oral tablets"],
    ], widths=[3*cm, 6.5*cm, 7*cm]),
    sp(4),
    red("Key difference: Only B12 deficiency causes neurological damage (SACD). Folate deficiency does NOT.")]

story.append(h2("5.4 Hemophilia"))
story += [
    h3("Definition:"), body("Hereditary bleeding disorder due to clotting factor deficiency"),
    tbl([["Type", "Deficient Factor", "Inheritance"],
         ["Hemophilia A (most common)", "Factor VIII", "X-linked recessive (males affected, females carriers)"],
         ["Hemophilia B (Christmas disease)", "Factor IX", "X-linked recessive"],
    ], widths=[5.5*cm, 4.5*cm, 6.5*cm]),
    sp(4),
    h3("Clinical Features:"),
    bl("Spontaneous bleeding into joints (hemarthrosis) — knees, ankles, elbows → chronic joint damage"),
    bl("Deep muscle hematomas"), bl("Prolonged bleeding after injury/surgery/dental procedures"),
    bl("Severity: Mild (5-40% factor), Moderate (1-5%), Severe (<1% factor)"),
    sp(3),
    h3("Investigations:"), bl("Prolonged APTT (activated partial thromboplastin time)"), bl("Normal PT, Normal bleeding time, Normal platelet count"), bl("Reduced Factor VIII or IX levels"),
    sp(3),
    h3("Management:"), bl("Factor replacement therapy — recombinant Factor VIII (Hemophilia A) or IX (Hemophilia B)"), bl("DDAVP (desmopressin) — mild Hemophilia A only"), bl("Avoid NSAIDs and IM injections"), bl("Physiotherapy for hemarthrosis — post-acute: gentle ROM exercises, hydrotherapy"),
    imp("PT role: Hydrotherapy, gentle ROM, muscle strengthening, orthoses for joint protection. AVOID joint manipulation during acute bleeds."),
    PageBreak()]

# ======== TOPIC 6: DIGESTIVE ========
story.append(h1("TOPIC 6: DISEASES OF THE DIGESTIVE SYSTEM  [7 Hours]"))
story += [sp(4)]

story.append(h2("6.1 Key GI Conditions"))
story += [
    tbl([["Condition", "Key Features", "Management"],
         ["Reflux Oesophagitis (GERD)", "Heartburn worse lying down/after meals, regurgitation, water brash, odynophagia. Complications: Barrett's esophagus, stricture, adenocarcinoma", "Lifestyle changes, PPI (omeprazole), H2 blockers, antacids, surgery (fundoplication) if severe"],
         ["Achalasia Cardia", "Failure of LES relaxation. Progressive dysphagia (solids AND liquids equally), regurgitation, weight loss, chest pain. Barium swallow: bird-beak appearance", "Balloon dilatation, Heller's myotomy, Botox injection"],
         ["Peptic Ulcer Disease", "Epigastric pain: Duodenal — relieved by food, worse at night; Gastric — worse with food. H. pylori + NSAIDs are main causes. Complications: perforation (board-like rigidity), hemorrhage, obstruction", "H. pylori eradication: Triple therapy (PPI + Amoxicillin + Clarithromycin) × 7-14 days; PPIs; avoid NSAIDs"],
         ["GI Bleeding", "Upper GI: Hematemesis (vomiting blood), melena (tarry black stool); Causes: PUD, varices, Mallory-Weiss tear. Lower GI: Hematochezia (fresh blood PR); Causes: Hemorrhoids, diverticulosis, colorectal CA", "Resuscitate, IV PPI, Endoscopy (diagnose + treat), surgery if needed"],
         ["Ulcerative Colitis", "Bloody diarrhea, urgency, tenesmus. Starts in rectum, extends proximally. Continuous involvement. Complications: toxic megacolon, colorectal cancer", "5-ASA (mesalazine), Steroids, Immunosuppressants, Surgery (colectomy = curative)"],
         ["Crohn's Disease", "Any part of GI tract (mouth to anus). Skip lesions. Transmural inflammation. Features: diarrhea, abdominal pain, weight loss, fistulas, strictures", "5-ASA, Steroids, Azathioprine, Biologics (infliximab), Surgery (not curative)"],
    ], widths=[3.5*cm, 7*cm, 6*cm]),
    sp(4),
    red("UC vs Crohn's is a classic exam question. UC: rectum, continuous, bloody diarrhea, curative surgery. Crohn's: any part, skip lesions, fistulas, not curative.")]

story.append(h2("6.2 Liver Diseases"))
story += [
    h3("Viral Hepatitis — Quick Comparison:"),
    tbl([["Type", "Transmission", "Chronic?", "Vaccine?", "Notes"],
         ["Hep A", "Fecal-oral", "No", "Yes", "Acute self-limiting; endemic in poor sanitation areas"],
         ["Hep B", "Blood, sexual, vertical", "Yes (5-10%)", "Yes", "Most common cause of cirrhosis + HCC worldwide"],
         ["Hep C", "Blood (IV drug use, transfusion)", "Yes (80%)", "No", "Treatable with DAAs (Direct-Acting Antivirals)"],
         ["Hep D", "Blood (only with Hep B)", "Yes (with B)", "Hep B vaccine", "Superinfection — worsens Hep B"],
         ["Hep E", "Fecal-oral", "No (usually)", "Limited", "Dangerous in pregnancy (high mortality)"],
    ], widths=[1.5*cm, 3.5*cm, 2*cm, 2*cm, 7.5*cm]),
    sp(4),
    h3("Cirrhosis:"),
    bl("End-stage liver disease — normal liver tissue replaced by fibrosis"),
    bl("Causes: Alcohol (most common in Western world), Hep B/C, NAFLD, autoimmune"),
    bl("Features:"),
    sbl("Liver failure signs: Jaundice, coagulopathy, encephalopathy, hypoalbuminemia"),
    sbl("Portal hypertension: Splenomegaly, ascites, esophageal varices, caput medusae"),
    sbl("Other: Spider nevi, palmar erythema, leukonychia, gynecomastia, loss of body hair"),
    bl("Complications: Ascites, SBP (spontaneous bacterial peritonitis), Hepatic encephalopathy, Hepatorenal syndrome, Hepatocellular carcinoma (HCC)"),
    bl("Treatment: Treat cause, diuretics for ascites, propranolol for varices, liver transplant for ESLD"),
    sp(3),
    h3("Other Liver Conditions:"),
    tbl([["Condition", "Key Features"],
         ["Wilson's Disease", "Autosomal recessive; copper accumulation in liver/brain/eyes. Features: liver disease, neuropsychiatric symptoms, Kayser-Fleischer rings (cornea). Treatment: Penicillamine"],
         ["Alpha-1 Antitrypsin Deficiency", "Genetic disorder; AAT accumulates in liver (cirrhosis) + unprotected lung (emphysema). No smoking!"],
         ["Gallstones (Cholelithiasis)", "Most common: cholesterol stones. Risk factors: 5 Fs — Female, Fat, Forty, Fertile, Fair. Features: biliary colic, cholecystitis, jaundice (if CBD stone). Treatment: Cholecystectomy (laparoscopic)"],
         ["Cholecystitis", "Acute: RUQ pain, fever, Murphy's sign positive, Nausea. Treatment: Antibiotics + Cholecystectomy"],
         ["Carcinoma of Pancreas", "CA head of pancreas: Painless progressive jaundice, weight loss, Courvoisier's sign (palpable GB). Late presentation = poor prognosis. Treatment: Whipple's surgery if resectable"],
    ], widths=[3.5*cm, 13*cm]),
    PageBreak()]

# ======== TOPIC 7: CARDIOVASCULAR ========
story.append(h1("TOPIC 7: CARDIOVASCULAR DISEASE  [8 Hours]"))
story += [sp(4)]

story.append(h2("7.1 Examination of CVS + Investigations"))
story += [
    h3("Key Investigations:"),
    tbl([["Investigation", "What it shows"],
         ["ECG", "Heart rate, rhythm, conduction defects, ischemia (ST changes), infarct (Q waves), LVH"],
         ["Exercise Stress Test", "Assesses exercise-induced ischemia (ST depression), exercise capacity (METs)"],
         ["Echocardiogram", "Cardiac structure, ejection fraction, valve function, wall motion abnormalities"],
         ["Chest X-Ray", "Cardiomegaly (CTR >50%), pulmonary congestion, pleural effusion"],
         ["Cardiac Enzymes", "Troponin I/T (most sensitive & specific for MI), CK-MB, LDH"],
         ["Coronary Angiography", "Gold standard for coronary artery disease — shows stenosis/blockage"],
    ], widths=[4.5*cm, 12*cm]),
    sp(4)]

story.append(h2("7.2 Hypertension"))
story += [
    h3("Classification (JNC 8 / ESC 2018):"),
    tbl([["Category", "Systolic (mmHg)", "Diastolic (mmHg)"],
         ["Normal", "<120", "<80"],
         ["Elevated", "120-129", "<80"],
         ["Stage 1 HTN", "130-139", "80-89"],
         ["Stage 2 HTN", "≥140", "≥90"],
         ["Hypertensive Crisis", ">180", ">120"],
    ], widths=[5*cm, 5.5*cm, 6*cm]),
    sp(4),
    h3("Causes:"), bl("<b>Primary (Essential):</b> No identifiable cause — 95% of all hypertension"), bl("<b>Secondary:</b> Renal disease (most common secondary cause), Renal artery stenosis, Primary aldosteronism (Conn's), Phaeochromocytoma, Coarctation of aorta, Cushing's, Oral contraceptive pill"),
    sp(3),
    h3("Complications (Target Organ Damage):"), bl("Heart: LVH, IHD, Heart failure"), bl("Brain: Stroke (ischemic/hemorrhagic), hypertensive encephalopathy"), bl("Kidney: Hypertensive nephropathy → CKD"), bl("Eyes: Hypertensive retinopathy (A/V nicking, flame hemorrhages, papilledema in severe)"), bl("Arteries: Aortic dissection, peripheral arterial disease"),
    sp(3),
    h3("Management:"),
    bl("Lifestyle: Salt restriction (<6g/day), weight loss, exercise, stop smoking, limit alcohol, DASH diet"),
    bl("First-line drugs:"),
    sbl("ACE inhibitor (e.g., ramipril) — especially with DM/CKD/heart failure"),
    sbl("ARB (e.g., losartan) — if ACE inhibitor cough"),
    sbl("CCB (e.g., amlodipine) — elderly, Afro-Caribbean"),
    sbl("Thiazide diuretic (e.g., bendroflumethiazide)"),
    sbl("Beta-blocker (e.g., atenolol) — if IHD or heart failure"),
    imp("ABCD rule: A = ACE/ARB, B = Beta-blocker, C = CCB, D = Diuretic")]

story.append(h2("7.3 Ischemic Heart Disease (IHD) / Coronary Artery Disease"))
story += [
    h3("Spectrum of IHD:"),
    tbl([["Condition", "Definition", "Key Features", "ECG Changes"],
         ["Stable Angina", "Predictable chest pain on exertion, relieved by rest/GTN within 5 min", "Crushing central chest pain radiating to left arm/jaw; S/S: GTN, Beta-blockers, CCBs, Aspirin", "ST depression during attack; normal at rest"],
         ["Unstable Angina (NSTEMI)", "Chest pain at rest OR new onset severe angina; no enzyme rise (UA) or small rise (NSTEMI)", "Unpredictable, prolonged, not fully relieved by GTN; MEDICAL EMERGENCY", "ST depression or T-wave inversion; Troponin raised in NSTEMI"],
         ["STEMI (Full thickness MI)", "Complete coronary artery occlusion; transmural infarction", "Severe crushing chest pain >20 min, sweating, nausea, breathlessness, fear of death", "ST elevation; Q waves develop later; Troponin markedly elevated"],
    ], widths=[3*cm, 4*cm, 4.5*cm, 5*cm]),
    sp(4),
    h3("STEMI Management (TIME IS MUSCLE):"),
    bl("Aspirin 300mg + Clopidogrel (P2Y12 inhibitor) IMMEDIATELY"),
    bl("Morphine for pain + Antiemetic"), bl("O2 only if SpO2 <94%"),
    bl("<b>Primary PCI (Percutaneous Coronary Intervention):</b> Best treatment — open blocked artery with balloon + stent, within 90 min of presentation"),
    bl("If PCI not available within 120 min: Thrombolysis (streptokinase, tPA)"),
    bl("Post-MI: Aspirin + Statin + Beta-blocker + ACE inhibitor + Cardiac Rehab"),
    red("ECG in STEMI: Hyperacute T waves → ST elevation → Q waves → T-wave inversion. Know the evolution!")]

story.append(h2("7.4 Heart Failure"))
story += [
    tbl([["Feature", "Left Heart Failure", "Right Heart Failure"],
         ["Cause", "IHD, HTN, Mitral/Aortic valve disease, Cardiomyopathy", "Left heart failure (most common), COPD (Cor Pulmonale), Pulmonary HTN"],
         ["Mechanism", "LV fails → backs up into pulmonary veins → pulmonary edema", "RV fails → backs up into systemic veins → peripheral congestion"],
         ["Symptoms", "Dyspnea, orthopnea (can't lie flat), PND, pink frothy sputum", "Peripheral edema, ascites, hepatomegaly, raised JVP"],
         ["Signs", "Bibasal crepitations, S3 gallop, displaced apex beat", "Pitting ankle/leg edema, raised JVP, hepatomegaly"],
         ["Treatment", "Diuretics (furosemide), ACE inhibitor, Beta-blocker, Spironolactone, Digoxin", "Treat cause + Diuretics"],
    ], widths=[2.5*cm, 6*cm, 8*cm]),
    sp(4),
    imp("NYHA Functional Classification: Class I — no symptoms at normal activity; II — mild limitation; III — marked limitation; IV — symptoms at rest")]

story.append(h2("7.5 Valvular Heart Disease"))
story += [
    tbl([["Valve Disease", "Cause", "Murmur", "Symptoms"],
         ["Mitral Stenosis", "Rheumatic fever (most common cause)", "Mid-diastolic rumble at apex; opening snap", "Dyspnea, AF, hemoptysis, pulmonary HTN"],
         ["Mitral Regurgitation", "Rheumatic fever, MVP, IHD, IE", "Pansystolic murmur at apex, radiates to axilla", "Dyspnea, fatigue, LV dilatation"],
         ["Aortic Stenosis", "Calcific degeneration (elderly), bicuspid aortic valve (young)", "Ejection systolic murmur, radiates to carotids", "SAD: Syncope, Angina, Dyspnea (bad prognosis signs)"],
         ["Aortic Regurgitation", "Rheumatic, IE, aortic root dilatation (Marfan's)", "Early diastolic murmur at left sternal edge", "Wide pulse pressure, water hammer pulse, Quincke's sign"],
    ], widths=[3*cm, 3.5*cm, 5*cm, 5*cm]),
    sp(4),
    red("Rheumatic Fever causes: JONES criteria — Joints (migratory arthritis), cOreia, Nodules (subcutaneous), Erythema marginatum, Carditis (pancarditis — pericarditis, myocarditis, endocarditis). Treatment: Penicillin + Anti-inflammatory."),
    PageBreak()]

# ======== TOPIC 8: RESPIRATORY ========
story.append(h1("TOPIC 8: RESPIRATORY DISEASE  [9 Hours]"))
story += [sp(4)]

story.append(h2("8.1 Investigations"))
story += [
    h3("Pulmonary Function Tests (PFT):"),
    tbl([["Parameter", "Normal", "Obstructive", "Restrictive"],
         ["FEV1", "≥80% predicted", "Reduced", "Reduced"],
         ["FVC", "≥80% predicted", "Normal or reduced", "Reduced"],
         ["FEV1/FVC ratio", ">0.70 (70%)", "<0.70 (diagnostic of obstruction)", ">0.70 (normal or increased)"],
         ["TLC", "Normal", "Increased (air trapping)", "Reduced"],
         ["Examples", "—", "COPD, Asthma, Bronchiectasis", "Pulmonary fibrosis, Sarcoidosis, Obesity"],
    ], widths=[3*cm, 3*cm, 5*cm, 5.5*cm]),
    sp(4),
    h3("ABG Normal Values:"),
    tbl([["Parameter", "Normal Range", "Significance"],
         ["pH", "7.35–7.45", "<7.35 = Acidosis; >7.45 = Alkalosis"],
         ["PaO2", "80–100 mmHg", "<60 mmHg = respiratory failure"],
         ["PaCO2", "35–45 mmHg", ">45 = CO2 retention (hypoventilation); <35 = hyperventilation"],
         ["HCO3", "22–26 mEq/L", "Reflects metabolic component"],
         ["SaO2", ">95%", "<90% = serious hypoxemia"],
    ], widths=[2.5*cm, 3.5*cm, 10.5*cm]),
    sp(4),
    imp("Type 1 Respiratory Failure: Low PaO2, normal/low PaCO2 (failure of oxygenation — e.g., pneumonia, pulmonary edema). Type 2: Low PaO2 + HIGH PaCO2 (failure of ventilation — e.g., COPD, neuromuscular disease).")]

story.append(h2("8.2 COPD vs Asthma"))
story += [
    tbl([["Feature", "COPD", "Asthma"],
         ["Definition", "Chronic, progressive, largely irreversible airflow limitation", "Chronic reversible airway inflammation"],
         ["Age", ">40 years", "Often starts in childhood/young adults"],
         ["Cause", "Smoking (main), pollution, AAT deficiency", "Allergy, genetics, environmental triggers"],
         ["Reversibility", "Largely irreversible", "Reversible (with bronchodilators)"],
         ["Sputum", "Chronic productive cough", "May be dry or minimal sputum"],
         ["Spirometry", "FEV1/FVC <0.70 post-bronchodilator", "FEV1/FVC <0.70 pre-bronchodilator; reverses with salbutamol"],
         ["GOLD Stages (COPD)", "Based on FEV1: I>80%, II 50-79%, III 30-49%, IV<30%", "BTS steps 1-5 based on symptom control"],
    ], widths=[3.5*cm, 7*cm, 6*cm]),
    sp(4),
    h3("COPD Management (GOLD Guidelines):"),
    bl("Smoking cessation — MOST important intervention, slows decline"),
    bl("Bronchodilators: SABA (salbutamol) PRN → LAMA (tiotropium) → LABA + LAMA → add ICS if frequent exacerbations"),
    bl("Pulmonary Rehabilitation — improves exercise tolerance, QoL"),
    bl("LTOT (Long-Term Oxygen Therapy) — if PaO2 <7.3 kPa at rest; minimum 15 hrs/day"),
    bl("Vaccinations: annual influenza + pneumococcal"),
    bl("Acute exacerbation: Controlled O2, nebulized bronchodilators, systemic steroids, antibiotics"),
    sp(4),
    h3("Asthma Management (BTS Stepwise):"),
    bl("Step 1: SABA (salbutamol) PRN only"),
    bl("Step 2: + Low-dose ICS (beclomethasone)"),
    bl("Step 3: + LABA (salmeterol) — MUST be with ICS"),
    bl("Step 4: Increase ICS dose or add LTRA (montelukast)"),
    bl("Step 5: Specialist referral, oral steroids, biologics (omalizumab for allergic asthma)"),
    bl("Acute severe asthma: O2, nebulized salbutamol + ipratropium, IV/oral steroids, Magnesium sulfate IV, ICU if life-threatening"),
    red("PEFR (Peak Expiratory Flow Rate): Best of 3 measurements. In asthma: diurnal variation >20% is diagnostic. <50% predicted = severe attack.")]

story.append(h2("8.3 Key Respiratory Conditions"))
story += [
    tbl([["Condition", "Key Features", "Management"],
         ["Tuberculosis (TB)", "Primary: asymptomatic or mild. Post-primary: Cough >3 weeks, hemoptysis, night sweats, weight loss, fever, apical shadowing on CXR. Dx: Sputum AFB, GeneXpert, Mantoux test, HRCT", "DOTS: 2 months RHEZ + 4 months RH (RIF, INH, ETH, PZA). Adherence is critical."],
         ["Pneumonia", "Productive cough, fever, pleuritic chest pain, dyspnea. CXR: consolidation. CAP (community-acquired) vs HAP. CURB-65 score for severity", "Antibiotics (amoxicillin for mild CAP; co-amoxiclav + macrolide for moderate/severe). O2, fluids, physio"],
         ["Bronchiectasis", "Abnormal permanent dilation of bronchi. Causes: TB, CF, recurrent infections. Features: Copious purulent sputum, haemoptysis, coarse crepitations, 'tram-track' sign on CT", "Physiotherapy (postural drainage, ACBT), antibiotics for exacerbations, surgery in localized disease"],
         ["Pleural Effusion", "Fluid in pleural space. Transudate: heart failure, cirrhosis, nephrotic syndrome. Exudate: infection (empyema), malignancy, PE. Dx: Stony dullness, CXR (blunting of costophrenic angle)", "Treat cause; Thoracocentesis (diagnostic + therapeutic); Chest drain for empyema"],
         ["Cystic Fibrosis", "Autosomal recessive CFTR gene mutation. Features: Recurrent chest infections, bronchiectasis, pancreatic insufficiency, meconium ileus in newborns, infertility in males, salty sweat. Dx: Sweat chloride test >60 mmol/L", "Physiotherapy (daily CPT essential!), DNase (dornase alfa), antibiotics, pancreatic enzymes, lung transplant"],
         ["Pulmonary Embolism", "Blood clot in pulmonary artery. Risk: DVT, immobility, surgery, OCP, malignancy. Features: Sudden dyspnea, pleuritic chest pain, hemoptysis, tachycardia. CTPA: gold standard. ECG: S1Q3T3 pattern", "Anticoagulation (LMWH → warfarin/NOAC); Thrombolysis if massive PE with hemodynamic compromise"],
    ], widths=[3.5*cm, 7*cm, 6*cm]),
    sp(4),
    imp("TB treatment: Remember RHEZ for 2 months, then RH for 4 months. R=Rifampicin, H=Isoniazid, E=Ethambutol, Z=Pyrazinamide. Side effects: Rifampicin turns urine/secretions orange; INH causes peripheral neuropathy (give pyridoxine)."),
    PageBreak()]

# ======== TOPIC 9: SKIN ========
story.append(h1("TOPIC 9: DISEASES OF THE SKIN  [6 Hours]"))
story += [sp(4)]

story += [
    tbl([["Condition", "Cause/Type", "Clinical Features", "Management"],
         ["Leprosy", "Mycobacterium leprae (acid-fast bacillus). Spread by droplets from nasal secretions.", "Hypopigmented/erythematous patches with loss of sensation; thickened nerves; Tuberculoid (limited, paucibacillary) vs Lepromatous (widespread, multibacillary). Nerve involvement → claw hand, foot drop, lagophthalmos", "Multi-Drug Therapy (MDT): Paucibacillary — Rifampicin + Dapsone × 6 months. Multibacillary — add Clofazimine × 12 months. Physiotherapy for nerve damage/disability prevention."],
         ["Psoriasis", "Autoimmune T-cell mediated skin disease. Genetic predisposition + triggers (stress, infection, drugs)", "Well-defined salmon-pink plaques with silvery scales. Extensor surfaces (elbows, knees), scalp, lower back. Nail changes (pitting, onycholysis). Auspitz sign (pinpoint bleeding on scale removal). Psoriatic arthritis in some", "Topical: Emollients, steroids, Vitamin D analogues (calcipotriol), coal tar. Systemic: Methotrexate, Ciclosporin. Biologics (anti-TNF) for severe. Phototherapy: PUVA, narrow-band UVB."],
         ["Dermatitis (Eczema)", "Atopic: genetic, associated with asthma/hay fever/food allergy. Contact: allergic (Type IV) or irritant", "Atopic: Itchy, dry, scaly, weeping patches in flexures (antecubital, popliteal fossa). Contact: at site of contact. Dry skin is the hallmark", "Emollients (moisturizers) — backbone of treatment. Topical steroids for flares. Antihistamines for itch. Avoid triggers. Topical tacrolimus."],
         ["Vitiligo", "Autoimmune destruction of melanocytes. Associated with other autoimmune diseases (thyroid, DM)", "Well-defined white depigmented patches on skin; acral and perioral areas common; Wood's lamp — bright white fluorescence", "Topical steroids, Tacrolimus; PUVA, Narrow-band UVB (phototherapy); Surgical (skin grafting); Camouflage makeup"],
         ["Fungal Infections", "Dermatophytes (tinea) infect skin/hair/nails. Candida infects moist areas", "Tinea corporis: ring-shaped lesion with active border. Tinea pedis (athlete's foot): maceration between toes. Onychomycosis: thickened, discolored nails. Candida: white plaques, genital thrush", "Topical antifungals (clotrimazole, miconazole); Systemic: Fluconazole, Terbinafine, Griseofulvin for nail/hair"],
    ], widths=[3*cm, 3.5*cm, 6*cm, 4*cm]),
    red("Leprosy is high-yield for physiotherapy students due to the PT role in prevention of disability, splinting, wound care, and rehabilitation."),
    PageBreak()]

# ======== TOPIC 10: PEDIATRICS ========
story.append(h1("TOPIC 10: PEDIATRICS  [8 Hours]"))
story += [sp(4)]

story.append(h2("10.1 Low Birth Weight (LBW) & Neonatal Problems"))
story += [
    tbl([["Term", "Definition"],
         ["LBW", "Birth weight <2500g"],
         ["VLBW", "<1500g"],
         ["Preterm", "Birth <37 weeks gestation"],
         ["SGA (Small for Gestational Age)", "Birth weight <10th percentile for gestational age"],
    ], widths=[5.5*cm, 11*cm]),
    sp(4),
    h3("Problems of LBW/Preterm Infants:"),
    bl("Respiratory Distress Syndrome (RDS/HMD) — Surfactant deficiency → collapse of alveoli → grunting, nasal flaring, intercostal recession. Treatment: Surfactant replacement, CPAP, ventilation"),
    bl("Hypothermia — poor thermoregulation; warm in incubator/kangaroo care"),
    bl("Hypoglycemia — poor glycogen stores; early feeds"),
    bl("Jaundice (Hyperbilirubinemia) — immature liver; phototherapy, exchange transfusion if severe"),
    bl("Infections — immature immune system; sepsis risk"),
    bl("IVH (Intraventricular Hemorrhage) — fragile blood vessels in preterm brain"),
    sp(4)]

story.append(h2("10.2 Cerebral Palsy (CP)"))
story += [
    body("Definition: Non-progressive disorder of movement and posture due to damage to the developing brain (before, during, or after birth, up to age 2)."),
    sp(3),
    h3("Types of CP:"),
    tbl([["Type", "Lesion Site", "Features", "Incidence"],
         ["Spastic (most common)", "Pyramidal/Cortical", "Increased tone, hyperreflexia, scissors gait, clonus", "75-80%"],
         ["Dyskinetic/Athetoid", "Basal ganglia", "Involuntary writhing movements (athetosis), dysarthria", "10-15%"],
         ["Ataxic", "Cerebellum", "Poor balance, incoordination, wide-based gait", "5%"],
         ["Mixed", "Multiple areas", "Combination of above", "10%"],
    ], widths=[3.5*cm, 3.5*cm, 6*cm, 3.5*cm]),
    sp(4),
    h3("Common Problems in CP:"),
    bl("Motor: Abnormal tone, primitive reflexes not integrated, poor balance, reduced ROM, contractures"),
    bl("Communication: Dysarthria, aphasia"), bl("Cognitive: Intellectual disability (50%)"), bl("Epilepsy (30%)"), bl("Vision/hearing deficits"), bl("Feeding difficulties"),
    sp(3),
    h3("Management (MDT approach):"),
    bl("Physiotherapy: Key role — NDT (Bobath), stretching, strengthening, gait training, splinting, positioning"),
    bl("Spasticity management: Baclofen (oral/intrathecal), Botulinum toxin injections, surgical (SDR)"),
    bl("Orthotics: AFOs, KAFO for gait support"),
    bl("Occupational therapy, Speech therapy, Special education"),
    imp("CP PT key techniques: NDT/Bobath, Vojta, conductive education, CIMT, hippotherapy. Know carrying techniques and home program.")]

story.append(h2("10.3 Other Pediatric Conditions"))
story += [
    tbl([["Condition", "Key Features & Management"],
         ["Spina Bifida", "Neural tube defect. Types: Spina bifida occulta (minor, no neurological deficit), Meningocele (meninges herniate), Myelomeningocele (most severe — spinal cord + meninges herniate; paralysis, bowel/bladder dysfunction, hydrocephalus). Prevention: Folic acid. Treatment: Surgical closure, shunt for hydrocephalus, PT for mobility/disability."],
         ["Epilepsy", "Recurrent unprovoked seizures. Types: Focal (partial), Generalized (absence, tonic-clonic, myoclonic). Dx: EEG. Management: Valproate (generalized), Carbamazepine (focal), Lamotrigine. Status epilepticus: Diazepam IV → Phenytoin IV → General anesthesia."],
         ["Developmental Delay", "Failure to achieve motor/language/social milestones at expected age. Red flags: Not sitting by 9 months, not walking by 18 months, no words by 18 months. Causes: CP, hypothyroidism, genetic disorders (Down's), hearing loss. Assessment: Denver Developmental Screen."],
         ["Autism Spectrum Disorder (ASD)", "Neurodevelopmental disorder. Features: Social communication deficits, repetitive behaviors/restricted interests, sensory sensitivities. Diagnosis clinical. No cure — ABA therapy, speech therapy, PT, OT, special education."],
         ["Down's Syndrome", "Trisomy 21. Features: upslanting eyes, epicanthic folds, single palmar crease, hypotonia, intellectual disability, ASD/VSD, increased Alzheimer's risk. Dx: Karyotype. Management: MDT, cardiac surgery if needed, PT for hypotonia/developmental milestones."],
    ], widths=[3.5*cm, 13*cm]),
    PageBreak()]

# ======== TOPIC 11: PSYCHIATRY ========
story.append(h1("TOPIC 11: PSYCHIATRIC DISORDERS  [5 Hours]"))
story += [sp(4)]

story.append(h2("11.1 Classification of Psychiatric Disorders"))
story += [
    tbl([["Category", "Examples"],
         ["Mood Disorders", "Depression, Bipolar disorder"],
         ["Anxiety Disorders", "GAD, Panic disorder, Social anxiety, Specific phobias, PTSD, OCD"],
         ["Psychotic Disorders", "Schizophrenia, Schizoaffective disorder"],
         ["Personality Disorders", "Borderline, Antisocial, Narcissistic"],
         ["Neurodevelopmental", "Autism, ADHD, Intellectual disability"],
         ["Substance Use Disorders", "Alcohol use disorder, opioid dependence"],
         ["Eating Disorders", "Anorexia nervosa, Bulimia nervosa"],
         ["Somatic Disorders", "Conversion disorder, Somatic symptom disorder, Hypochondria"],
    ], widths=[5*cm, 11.5*cm]),
    sp(4)]

story.append(h2("11.2 Key Psychiatric Conditions"))
story += [
    tbl([["Condition", "Causes", "Clinical Features", "Treatment"],
         ["Depression", "Biopsychosocial: genetics, serotonin/norepinephrine imbalance, life events, chronic illness", "Core: Low mood, anhedonia (loss of pleasure), fatigue. Others: Sleep disturbance (early morning waking), poor concentration, worthlessness, guilt, weight change, suicidal ideation. Diagnosis: ≥2 weeks, ≥5 symptoms", "Mild: CBT, exercise, psychosocial support. Moderate-Severe: SSRIs (fluoxetine, sertraline) first-line + CBT. Severe + suicidal: Hospital admission, ECT"],
         ["Bipolar Disorder", "Genetic + environmental triggers", "Episodes of mania (elevated/irritable mood, grandiosity, decreased sleep, impulsivity, flight of ideas) AND depression. Type I: full mania; Type II: hypomania + depression", "Mood stabilizers: Lithium (gold standard, narrow TI — monitor levels, renal, thyroid), Valproate, Lamotrigine. Acute mania: Haloperidol, Risperidone"],
         ["Schizophrenia", "Dopamine excess (mesolimbic pathway), genetic factors", "Positive symptoms: hallucinations (auditory most common), delusions, disorganized thought/speech. Negative symptoms: flat affect, alogia, avolition, social withdrawal, anhedonia. Duration ≥6 months", "Antipsychotics: Typical (Haloperidol, Chlorpromazine) vs Atypical (Risperidone, Olanzapine, Clozapine for treatment-resistant). CBT, psychosocial rehabilitation"],
         ["Generalized Anxiety Disorder (GAD)", "Chronic worry, stress, temperament, serotonin/GABA imbalance", "Excessive, uncontrollable worry about multiple things, ≥6 months. Associated: restlessness, fatigue, concentration problems, muscle tension, sleep disturbance", "CBT (most effective long-term), SSRIs/SNRIs, Buspirone, Benzodiazepines (short-term only)"],
         ["PTSD", "Traumatic event (war, assault, disaster, abuse)", "Flashbacks, nightmares, hyperarousal, emotional numbing, avoidance of reminders. Onset within 1 month; lasts >1 month", "Trauma-focused CBT, EMDR (Eye Movement Desensitization), SSRIs (sertraline, paroxetine)"],
    ], widths=[3*cm, 3*cm, 6.5*cm, 4*cm]),
    sp(6),
    imp("For physiotherapy: Psychiatric patients may have physical comorbidities. PT should adopt a non-judgmental, empathetic approach. Motivational interviewing is useful. Exercise therapy has strong evidence for depression and anxiety."),
    red("Most tested: Depression (features, diagnosis criteria, treatment), Schizophrenia (positive vs negative symptoms), and Bipolar disorder (lithium monitoring)."),
    sp(10),
    HRFlowable(width="100%", thickness=1, color=colors.HexColor("#0d47a1"), spaceAfter=6),
    Paragraph("END OF GENERAL MEDICINE NOTES", ParagraphStyle("End", fontSize=12, alignment=TA_CENTER, textColor=colors.HexColor("#0d47a1"), fontName="Helvetica-Bold", spaceBefore=6)),
    Paragraph("Orris AI Study Assistant | For 3rd Year BPT Exam Preparation | July 2026", subtitle_s)]

doc.build(story)
print("SUCCESS:", OUTPUT)

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

OUTPUT = "/home/daytona/workspace/pt-study-plan/General_Surgery_Notes.pdf"

doc = SimpleDocTemplate(
    OUTPUT, pagesize=A4,
    rightMargin=1.8*cm, leftMargin=1.8*cm,
    topMargin=2*cm, bottomMargin=2*cm
)
styles = getSampleStyleSheet()

title_s  = ParagraphStyle("TS",  fontSize=24, textColor=colors.HexColor("#1b5e20"), alignment=TA_CENTER, fontName="Helvetica-Bold", spaceAfter=6)
sub_s    = ParagraphStyle("SS",  fontSize=11, textColor=colors.HexColor("#455a64"), alignment=TA_CENTER, spaceAfter=4)
h1_s     = ParagraphStyle("H1",  fontSize=13, textColor=colors.white, backColor=colors.HexColor("#1b5e20"), spaceBefore=12, spaceAfter=5, fontName="Helvetica-Bold", leftIndent=-4, rightIndent=-4, borderPad=5)
h2_s     = ParagraphStyle("H2",  fontSize=11, textColor=colors.HexColor("#1b5e20"), spaceBefore=8, spaceAfter=3, fontName="Helvetica-Bold")
h3_s     = ParagraphStyle("H3",  fontSize=10, textColor=colors.HexColor("#b71c1c"), spaceBefore=5, spaceAfter=2, fontName="Helvetica-Bold")
body_s   = ParagraphStyle("BD",  fontSize=9.5, leading=14, spaceAfter=2)
bullet_s = ParagraphStyle("BL",  fontSize=9.5, leading=13, leftIndent=14, spaceAfter=2)
sub_b_s  = ParagraphStyle("SBL", fontSize=9,   leading=12, leftIndent=28, spaceAfter=1, textColor=colors.HexColor("#424242"))
imp_s    = ParagraphStyle("IMP", fontSize=9,   leading=12, backColor=colors.HexColor("#f1f8e9"), borderPad=5, spaceAfter=5, textColor=colors.HexColor("#1b5e20"))
red_s    = ParagraphStyle("RED", fontSize=9,   leading=12, backColor=colors.HexColor("#ffebee"), borderPad=5, spaceAfter=5, textColor=colors.HexColor("#b71c1c"))
warn_s   = ParagraphStyle("WRN", fontSize=9,   leading=12, backColor=colors.HexColor("#fff9c4"), borderPad=5, spaceAfter=5, textColor=colors.HexColor("#4e342e"))

def h1(t):  return Paragraph(f"  {t}", h1_s)
def h2(t):  return Paragraph(t, h2_s)
def h3(t):  return Paragraph(t, h3_s)
def body(t):return Paragraph(t, body_s)
def bl(t):  return Paragraph(f"• {t}", bullet_s)
def sbl(t): return Paragraph(f"  – {t}", sub_b_s)
def imp(t): return Paragraph(f"<b>★ KEY:</b> {t}", imp_s)
def red(t): return Paragraph(f"<b>⚠ EXAM TIP:</b> {t}", red_s)
def warn(t):return Paragraph(f"<b>★ NOTE:</b> {t}", warn_s)
def sp(n=5):return Spacer(1, n)
def hr():   return HRFlowable(width="100%", thickness=0.5, color=colors.HexColor("#a5d6a7"), spaceAfter=3)

def tbl(data, widths=None, hcol="#2e7d32"):
    t = Table(data, colWidths=widths, repeatRows=1)
    t.setStyle(TableStyle([
        ("BACKGROUND",    (0,0), (-1,0),  colors.HexColor(hcol)),
        ("TEXTCOLOR",     (0,0), (-1,0),  colors.white),
        ("FONTNAME",      (0,0), (-1,0),  "Helvetica-Bold"),
        ("FONTSIZE",      (0,0), (-1,0),  8.5),
        ("ALIGN",         (0,0), (-1,-1), "LEFT"),
        ("FONTNAME",      (0,1), (-1,-1), "Helvetica"),
        ("FONTSIZE",      (0,1), (-1,-1), 8.5),
        ("ROWBACKGROUNDS",(0,1), (-1,-1), [colors.white, colors.HexColor("#f1f8e9")]),
        ("GRID",          (0,0), (-1,-1), 0.4, colors.HexColor("#81c784")),
        ("VALIGN",        (0,0), (-1,-1), "TOP"),
        ("TOPPADDING",    (0,0), (-1,-1), 4),
        ("BOTTOMPADDING", (0,0), (-1,-1), 4),
        ("LEFTPADDING",   (0,0), (-1,-1), 5),
        ("RIGHTPADDING",  (0,0), (-1,-1), 5),
    ]))
    return t

story = []

# ── COVER ──
story += [sp(40),
    Paragraph("GENERAL SURGERY", title_s),
    Paragraph("Complete Study Notes", title_s), sp(10),
    Paragraph("3rd Year BPT  |  University Written Exam", sub_s),
    Paragraph("Based on Official Syllabus  |  60 Hours Theory", sub_s), sp(20),
    HRFlowable(width="100%", thickness=1, color=colors.HexColor("#1b5e20"), spaceAfter=8), sp(6)]

toc = [["#","Topic","Hours"],
       ["1","Surgical Basics – Fluids, Wound Healing, Haemostasis, Infections","6"],
       ["2","Anaesthesia, Incisions, Surgical Procedures & Drains","3"],
       ["3","Thoracic Trauma","4"],
       ["4","Surgical Oncology","3"],
       ["5","Chest Wall, Lung & Mediastinum Disorders","5"],
       ["6","Disorders of the Heart","6"],
       ["7","Thoracic Surgeries (Lung & Cardiac)","6"],
       ["8","Diseases of Arteries & Veins","5"],
       ["9","Common Abdominal Operations","4"],
       ["10","Burns","4"],
       ["11","Women's Health & Obstetric Surgery","8"],
       ["12","ENT","3"],
       ["13","Ophthalmology","3"],]
story.append(tbl(toc, widths=[1*cm, 13*cm, 2.5*cm]))
story += [sp(30), Paragraph("Orris AI Study Assistant | July 2026", sub_s), PageBreak()]

# ══════════════════════════════════════════════════════
# TOPIC 1 – SURGICAL BASICS
# ══════════════════════════════════════════════════════
story.append(h1("TOPIC 1: SURGICAL BASICS  [6 Hours]"))
story += [sp(4)]

story.append(h2("1.1 Fluid, Electrolyte & Acid-Base Disturbances"))
story += [
    tbl([["Electrolyte Disorder","Causes","Features","Treatment"],
         ["Hyponatremia\n(Na <135 mEq/L)","SIADH, heart failure, cirrhosis, over-hydration","Confusion, seizures, coma (if acute)","Fluid restriction; hypertonic saline if severe/symptomatic"],
         ["Hypernatremia\n(Na >145 mEq/L)","Dehydration, diabetes insipidus","Thirst, lethargy, confusion, seizures","Free water replacement (oral or IV D5W) — SLOWLY"],
         ["Hypokalemia\n(K <3.5 mEq/L)","Diuretics, vomiting, diarrhea, alkalosis","Muscle weakness, cramps, arrhythmias, U-waves on ECG","Oral/IV KCl — NEVER IV bolus"],
         ["Hyperkalemia\n(K >5.5 mEq/L)","Renal failure, ACE inhibitors, Addison's","Peaked T waves, bradycardia, VF, muscle weakness","IV Calcium gluconate (stabilise heart), insulin+glucose, kayexalate, dialysis"],
         ["Metabolic Acidosis","Diabetic ketoacidosis, lactic acidosis, renal failure, diarrhea","pH<7.35, low HCO3, Kussmaul breathing","Treat cause; NaHCO3 if pH<7.1"],
         ["Metabolic Alkalosis","Vomiting, NG suction, diuretics, antacids","pH>7.45, high HCO3, hypoventilation","IV NaCl + KCl; treat cause"],
        ], widths=[3*cm, 4*cm, 4.5*cm, 5*cm]),
    sp(4),
    h3("Surgical IV Fluids:"),
    tbl([["Fluid","Contents","When Used"],
         ["Normal Saline (0.9% NaCl)","Na 154, Cl 154","Volume replacement, hyponatremia (cautious), with blood transfusion"],
         ["Hartmann's / Ringer's Lactate","Na, K, Ca, Cl, Lactate","Closest to plasma — fluid resuscitation, burns, GI losses"],
         ["5% Dextrose","Glucose 50g/L (becomes free water)","Maintenance, hypernatremia, post-op maintenance"],
         ["Colloids (Gelofusine, Albumin)","Large molecules stay intravascular","Hypoalbuminemia, massive hemorrhage"],
        ], widths=[3.5*cm, 5.5*cm, 7.5*cm]),
    sp(4)]

story.append(h2("1.2 Wound Healing"))
story += [
    h3("Phases of Wound Healing (★ MOST TESTED TOPIC in Surgery):"),
    tbl([["Phase","Timing","Key Events","Cells Involved"],
         ["Haemostasis","Immediate (0-minutes)","Vasoconstriction, platelet aggregation, clot formation (fibrin)","Platelets, clotting factors"],
         ["Inflammatory","0–5 days","Vasodilation, increased permeability, phagocytosis of debris and bacteria, pain/redness/swelling/heat","Neutrophils (first), then Macrophages (clean-up crew)"],
         ["Proliferative\n(Granulation)","3 days – 3 weeks","Fibroblasts lay down collagen, angiogenesis (new blood vessels), wound contraction (myofibroblasts), epithelialization","Fibroblasts, Endothelial cells, Myofibroblasts"],
         ["Remodelling\n(Maturation)","3 weeks – 2 years","Collagen type III replaced by type I (stronger), scar matures, tensile strength increases (max ~80% of original)","Fibroblasts"],
        ], widths=[3*cm, 3*cm, 7*cm, 3.5*cm]),
    sp(4),
    imp("Maximum tensile strength of healed wound is only 80% of original skin — never 100%. Collagen is made by FIBROBLASTS. Macrophages orchestrate healing — most important cell overall."),
    sp(4),
    h3("Types of Wound Healing:"),
    bl("<b>Primary intention:</b> Clean surgical wound, edges closely apposed — minimal scarring, heals fastest"),
    bl("<b>Secondary intention:</b> Wound left open (infected/contaminated wounds) — fills from base up with granulation tissue — more scarring"),
    bl("<b>Tertiary intention (delayed primary closure):</b> Wound cleaned first, then closed after 4-5 days"),
    sp(4),
    h3("Factors Affecting Wound Healing:"),
    tbl([["Local Factors (at wound)","Systemic Factors (patient)"],
         ["Infection — most common cause of delayed healing","Diabetes mellitus — impaired neutrophil function, microangiopathy"],
         ["Poor blood supply / ischaemia","Malnutrition — Vitamin C (collagen synthesis), Zinc, Protein"],
         ["Haematoma / seroma — provides bacterial culture medium","Steroids — suppress inflammation and fibroblast proliferation"],
         ["Foreign body / necrotic tissue","Jaundice — impairs healing"],
         ["Radiation damage","Anaemia — reduced O2 delivery"],
         ["Wound tension / excessive movement","Age — elderly heal more slowly"],
        ], widths=[8*cm, 8.5*cm]),
    sp(4),
    h3("Types of Scars:"),
    tbl([["Scar Type","Features","Treatment"],
         ["Normal scar","Pale, flat, soft — within wound margins","None needed"],
         ["Hypertrophic scar","Raised, red, within wound margins — improves with time","Compression garments, silicone gel, steroid injection"],
         ["Keloid scar","Raised, extends BEYOND wound margins, does not regress — more common in dark-skinned individuals","Steroid injection, surgery (+ post-op steroids/radiation to prevent recurrence)"],
         ["Contracture","Scar shrinks across a joint → restricts movement — common after burns","Physiotherapy (stretching), splinting, surgical release (Z-plasty)"],
        ], widths=[3.5*cm, 7.5*cm, 5.5*cm]),
    red("Know the 4 phases of healing in order with timing + key cells. Draw a timeline if it helps. Examiner favourite!"),
    sp(4)]

story.append(h2("1.3 Haemostasis"))
story += [
    h3("Coagulation Cascade (simplified):"),
    bl("<b>Intrinsic pathway:</b> Triggered by damaged vessel wall (contact activation). Tests by APTT."),
    bl("<b>Extrinsic pathway:</b> Triggered by tissue factor (Factor III) released from damaged tissue. Tested by PT/INR."),
    bl("<b>Common pathway:</b> Both pathways converge at Factor X → Thrombin → Fibrin clot"),
    sp(3),
    tbl([["Test","Normal","What it Measures","Prolonged in"],
         ["PT/INR","10-14 sec / INR 1.0","Extrinsic + Common pathway (Factors VII, X, V, II, I)","Warfarin use, Vitamin K deficiency, Liver disease, DIC"],
         ["APTT","25-35 seconds","Intrinsic + Common pathway (Factors XII, XI, IX, VIII, X, V, II, I)","Heparin use, Haemophilia A/B, DIC"],
         ["Bleeding Time","2-7 minutes","Platelet function and number","Thrombocytopenia, VWD, Aspirin use"],
         ["Platelet Count","150,000-400,000/μL","Platelet number","ITP, DIC, hypersplenism"],
        ], widths=[2.5*cm, 3*cm, 5.5*cm, 5.5*cm]),
    sp(4),
    h3("Blood Transfusion:"),
    bl("Indications: Hb <7 g/dL (symptomatic anaemia, major surgery, active haemorrhage)"),
    tbl([["Component","Content","Indication"],
         ["Packed Red Blood Cells (PRBC)","RBCs, minimal plasma","Anaemia, haemorrhage"],
         ["Fresh Frozen Plasma (FFP)","All clotting factors","Coagulopathy, massive transfusion, warfarin reversal"],
         ["Platelets","Platelets","Platelets <50,000 with bleeding; <10,000 prophylactically"],
         ["Cryoprecipitate","Factor VIII, vWF, fibrinogen","Haemophilia A, DIC, fibrinogen deficiency"],
        ], widths=[4*cm, 5*cm, 7.5*cm]),
    sp(4),
    h3("Transfusion Reactions:"),
    tbl([["Reaction","Features","Management"],
         ["Acute Haemolytic (ABO incompatibility)","Fever, rigors, flank pain, haemoglobinuria, shock","STOP transfusion immediately; IV fluids; urgent crossmatch recheck"],
         ["Febrile Non-Haemolytic","Fever, chills — most common reaction","Stop/slow transfusion; paracetamol; restart slowly if stable"],
         ["Allergic/Anaphylactic","Urticaria, bronchospasm, hypotension","Stop; Adrenaline, antihistamine, steroids"],
         ["TRALI (Transfusion-Related Acute Lung Injury)","Acute respiratory distress within 6 hrs of transfusion","Supportive: O2, ventilation; most common cause of transfusion death"],
         ["Transfusion Overload (TACO)","Pulmonary oedema, hypertension","Slow transfusion; diuretics"],
        ], widths=[3.5*cm, 5.5*cm, 7.5*cm]),
    sp(4)]

story.append(h2("1.4 Surgical Nutrition"))
story += [
    bl("Surgical patients are often catabolic (increased protein breakdown) — adequate nutrition is essential"),
    bl("Enteral nutrition (via NGT, PEG tube) preferred over parenteral — maintains gut integrity, cheaper, fewer complications"),
    bl("Parenteral nutrition (TPN): IV nutrition when gut is non-functional (ileus, bowel obstruction, short bowel syndrome)"),
    bl("Pre-op: ERAS (Enhanced Recovery After Surgery) protocols — allow clear fluids up to 2 hrs before surgery"),
    bl("Post-op: Early enteral feeding preferred — reduces infection, improves wound healing"),
    sp(4)]

story.append(h2("1.5 Surgical Infections"))
story += [
    tbl([["Infection","Organism","Features","Treatment"],
         ["Cellulitis","Strep pyogenes, S. aureus","Red, warm, swollen skin — no pus, no defined margin","Oral/IV antibiotics (flucloxacillin, amoxicillin-clavulanate)"],
         ["Abscess","S. aureus (most common)","Localised collection of pus — fluctuant, tender swelling","Incision & Drainage (I&D) — antibiotics alone NOT enough"],
         ["Necrotising Fasciitis","Polymicrobial (Group A Strep + anaerobes)","Severe pain out of proportion to appearance, crepitus, rapid spread, systemic sepsis — SURGICAL EMERGENCY","Urgent wide surgical debridement + broad-spectrum IV antibiotics + ICU"],
         ["Gas Gangrene","Clostridium perfringens","Wound with gas in tissues (crepitus), foul smell, rapidly spreading necrosis, septic shock","Emergency amputation + high-dose Penicillin G + Hyperbaric O2"],
         ["Tetanus","Clostridium tetani (exotoxin)","Trismus (lockjaw), risus sardonicus, opisthotonos (arched back), laryngospasm — triggered by wound infection","Tetanus immunoglobulin + Metronidazole + Diazepam for spasms + ICU"],
        ], widths=[2.5*cm, 3*cm, 5.5*cm, 5.5*cm]),
    sp(4)]

story.append(h2("1.6 Post-Operative Complications"))
story += [
    tbl([["Timing","Complication","Features","Action"],
         ["Immediate (0-24 hrs)","Primary haemorrhage","Bleeding from wound/drain, tachycardia, hypotension","IV fluids, blood transfusion, return to theatre"],
         ["Immediate","Reactionary haemorrhage","Bleeding within 4-6 hrs as BP rises and clots dislodge","As above"],
         ["Early (24hrs–1wk)","Secondary haemorrhage","Bleeding at 7-14 days due to infection eroding vessel","Antibiotics + control bleeding"],
         ["Early","Wound infection","Pyrexia Day 3-5, red, swollen wound, pus","Antibiotics; open wound if fluctuant"],
         ["Early","Atelectasis / Pneumonia","Pyrexia Day 1-2; shallow breathing, collapse","Physiotherapy! Deep breathing, ambulation, incentive spirometry"],
         ["Early","DVT","Calf pain, swelling — Homan's sign (unreliable)","Anticoagulation (LMWH/NOAC); TEDS stockings, early mobilisation for prevention"],
         ["Early","Urinary retention","Inability to pass urine post-op — especially after pelvic/spinal surgery","Catheterisation"],
         ["Late (>1wk)","Wound dehiscence","Superficial/burst abdomen — risk factors: obesity, poor nutrition, infection, steroids","Resurgery or conservative with wound management"],
         ["Late","Incisional hernia","Protrusion through abdominal wound — usually months-years later","Surgical repair"],
        ], widths=[2.5*cm, 3*cm, 5.5*cm, 5.5*cm]),
    imp("PT role post-surgery: Deep breathing exercises and early mobilisation from Day 1 are the MOST important PT interventions to prevent atelectasis, pneumonia, DVT, and deconditioning."),
    PageBreak()]

# ══════════════════════════════════════════════════════
# TOPIC 2 – ANAESTHESIA, INCISIONS, PROCEDURES
# ══════════════════════════════════════════════════════
story.append(h1("TOPIC 2: ANAESTHESIA, INCISIONS & PROCEDURES  [3 Hours]"))
story += [sp(4)]

story.append(h2("2.1 Types of Anaesthesia"))
story += [
    tbl([["Type","Description","Examples/Uses"],
         ["General Anaesthesia (GA)","Complete unconsciousness — induction (IV/inhalational) + maintenance + muscle relaxation","Major abdominal, thoracic, neuro surgeries"],
         ["Regional Anaesthesia","Block of specific nerve region — patient awake or sedated","Spinal/epidural (lower body), Brachial plexus block (upper limb), Femoral nerve block"],
         ["Local Anaesthesia","Infiltration of local agent — small area numbed","Minor procedures: wound repair, skin biopsy"],
         ["Sedation / Monitored Care","Patient drowsy but rousable — IV midazolam/propofol","Endoscopy, minor procedures"],
        ], widths=[3.5*cm, 6*cm, 7*cm]),
    sp(4),
    h3("Spinal vs Epidural:"),
    tbl([["Feature","Spinal Anaesthesia","Epidural Anaesthesia"],
         ["Drug injection site","Subarachnoid space (into CSF)","Epidural space (outside dura)"],
         ["Onset","Fast (2-5 min)","Slower (10-20 min)"],
         ["Duration","Shorter (1.5-3 hrs)","Longer (continuous catheter)"],
         ["Uses","Lower limb surgery, C-section, lower abdominal surgery","Labour pain, post-op analgesia, thoracic surgery"],
         ["Complication","Spinal headache (dural puncture)","Epidural haematoma, infection, incomplete block"],
        ], widths=[3.5*cm, 6*cm, 7*cm]),
    sp(4),
    h3("Effects of Anaesthesia on the Patient (PT relevance):"),
    bl("Respiratory: Decreased tidal volume, atelectasis, impaired cough reflex — need deep breathing exercises post-op"),
    bl("Cardiovascular: Hypotension (vasodilation), arrhythmias"),
    bl("GI: Nausea, vomiting, ileus (bowel stops working)"),
    bl("Neurological: Shivering, confusion (especially elderly), delayed awakening"),
    bl("Musculoskeletal: Prolonged immobility → DVT, pressure sores, joint stiffness"),
    sp(4)]

story.append(h2("2.2 Types of Incisions"))
story += [
    tbl([["Incision","Location","Used For"],
         ["Midline (Median)","Vertical midline of abdomen","Most abdominal/pelvic surgeries — fastest, best access"],
         ["Paramedian","2.5 cm lateral to midline, vertical","Bowel surgery"],
         ["Kocher's (Subcostal)","Below right costal margin","Cholecystectomy, hepatic surgery"],
         ["Pfannenstiel (Bikini)","Transverse, just above pubis","C-section, gynaecological surgery"],
         ["McBurney's/Gridiron","Right iliac fossa (McBurney's point)","Appendicectomy"],
         ["Lanz","Transverse in RIF","Appendicectomy (better cosmesis)"],
         ["Thoracotomy (Posterolateral)","Posterior chest wall, between ribs","Lung, oesophageal surgery"],
         ["Sternotomy (Median)","Vertical split of sternum","Cardiac surgery (CABG, valve surgery)"],
        ], widths=[4*cm, 5*cm, 7.5*cm]),
    sp(4)]

story.append(h2("2.3 Surgical Instruments"))
story += [
    tbl([["Instrument","Purpose"],
         ["Scalpel (knife)","Make incisions — handle + disposable blade"],
         ["Clips (haemostatic)","Control bleeding vessels — artery forceps, Halsted mosquito"],
         ["Ligatures (ties)","Tie off blood vessels — absorbable (Vicryl, catgut) vs non-absorbable (silk, nylon, Prolene)"],
         ["Sutures","Close wounds — absorbable (PDS, Vicryl) vs non-absorbable (nylon, Prolene); continuous vs interrupted"],
         ["Retractors","Hold wound edges open — Langenbeck, Deaver, self-retaining (Balfour)"],
         ["Endoscope","Visualise body cavities — rigid or flexible; used for diagnosis and therapeutic procedures"],
         ["Biopsy forceps / punch","Obtain tissue specimens for histology"],
        ], widths=[4.5*cm, 12*cm]),
    sp(4),
    h3("Drainage Systems:"),
    bl("<b>Corrugated drain:</b> Passive drainage of wound cavity — used for abscess cavities"),
    bl("<b>Closed suction drain (Redivac/Jackson-Pratt):</b> Negative pressure removes blood/serous fluid post-op"),
    bl("<b>Chest drain (intercostal tube):</b> Drains air (pneumothorax) or fluid (haemothorax, pleural effusion)"),
    bl("<b>T-tube drain:</b> Placed in common bile duct after CBD exploration — drains bile"),
    bl("<b>Nasogastric tube (NGT):</b> Drainage of stomach contents, feeding, drug administration"),
    PageBreak()]

# ══════════════════════════════════════════════════════
# TOPIC 3 – THORACIC TRAUMA
# ══════════════════════════════════════════════════════
story.append(h1("TOPIC 3: THORACIC TRAUMA  [4 Hours]"))
story += [sp(4)]

story.append(h2("Immediately Life-Threatening Thoracic Injuries — 'ATOM FC'"))
story += [
    tbl([["Injury","Mechanism","Clinical Features","Emergency Management"],
         ["Airway Obstruction","Foreign body, trauma, haematoma","Stridor, cyanosis, use of accessory muscles, inability to speak","Chin-lift/jaw-thrust, suction, intubation, surgical airway (cricothyrotomy)"],
         ["Tension Pneumothorax","Air enters pleural space and CANNOT escape — builds up, compresses mediastinum","Tracheal deviation AWAY from affected side, absent breath sounds, hypotension, raised JVP, tachycardia — SURGICAL EMERGENCY","Immediate needle decompression (2nd intercostal space, midclavicular line) → then chest drain"],
         ["Open Pneumothorax (Sucking Chest Wound)","Chest wall defect >2/3 tracheal diameter — air preferentially enters through wound","Sucking/hissing sound on breathing, respiratory distress","3-sided occlusive dressing → chest drain"],
         ["Massive Haemothorax",">1500 mL blood in pleural cavity — major vessel injury","Dullness + absent breath sounds on affected side, haemorrhagic shock, tracheal deviation TOWARD affected side","IV access + fluids + blood, chest drain (large bore), thoracotomy if >200 mL/hr ongoing"],
         ["Flail Chest","≥3 consecutive ribs fractured in ≥2 places — segment moves paradoxically (IN on inspiration, OUT on expiration)","Paradoxical chest movement, severe pain, respiratory failure, underlying pulmonary contusion","O2, pain control (epidural), PPV/IPPB if severe, ICU; PT: breathing exercises, positioning"],
         ["Cardiac Tamponade","Blood in pericardial sac — compresses heart","BECK'S TRIAD: Hypotension + Raised JVP + Muffled heart sounds; pulsus paradoxus","Pericardiocentesis (needle aspiration) or pericardial window"],
        ], widths=[2.5*cm, 3*cm, 5.5*cm, 5.5*cm]),
    sp(4),
    h3("Other Thoracic Injuries:"),
    tbl([["Injury","Features","Management"],
         ["Tracheobronchial disruption","Persistent large air leak from chest drain, surgical emphysema, pneumomediastinum","Intubation (below level of tear), thoracotomy for repair"],
         ["Aortic disruption","High-speed deceleration injury. Most at aortic isthmus. Widened mediastinum on CXR","CT angiography, urgent surgery/endovascular repair — very high mortality"],
         ["Diaphragmatic disruption","Left side more common. Bowel herniates into thorax","NGT in chest on CXR, surgical repair"],
         ["Oesophageal disruption","Penetrating trauma or Boerhaave syndrome (forceful vomiting)","Surgical emergency — repair within 12-24 hrs"],
         ["Pulmonary Contusion","Bruising of lung parenchyma","Hypoxia, haemoptysis, management: O2, analgesia, physiotherapy, careful fluids"],
        ], widths=[3.5*cm, 6*cm, 7*cm]),
    red("TENSION PNEUMOTHORAX and CARDIAC TAMPONADE are the two most tested thoracic emergencies. Know Beck's Triad and the immediate treatment for each!"),
    PageBreak()]

# ══════════════════════════════════════════════════════
# TOPIC 4 – SURGICAL ONCOLOGY
# ══════════════════════════════════════════════════════
story.append(h1("TOPIC 4: SURGICAL ONCOLOGY  [3 Hours]"))
story += [sp(4)]

story.append(h2("4.1 Cancer — Overview"))
story += [
    h3("Types of Tumours:"),
    tbl([["Feature","Benign","Malignant"],
         ["Growth","Slow, expansile","Rapid, invasive"],
         ["Capsule","Yes (encapsulated)","No capsule"],
         ["Metastasis","Does NOT metastasise","DOES metastasise (local, lymphatic, haematogenous)"],
         ["Recurrence after removal","Rare","Common"],
         ["Effect on host","Local pressure effects","Systemic: weight loss, cachexia, anaemia, paraneoplastic syndromes"],
        ], widths=[3*cm, 6*cm, 7.5*cm]),
    sp(4),
    h3("Spread of Cancer:"),
    bl("<b>Local invasion:</b> Directly into surrounding tissues"),
    bl("<b>Lymphatic spread:</b> Most common route for carcinomas (e.g., breast → axillary nodes)"),
    bl("<b>Haematogenous spread:</b> Via blood — sarcomas, and late-stage carcinomas → liver, lungs, brain, bone"),
    bl("<b>Transcoelomic spread:</b> Via body cavities (peritoneum, pleura) — e.g., ovarian cancer → peritoneal implants"),
    bl("<b>Perineural spread:</b> Along nerve sheaths — prostate, pancreas"),
    sp(4),
    h3("Staging — TNM System:"),
    tbl([["Letter","Meaning","Values"],
         ["T","Primary Tumour size/extent","T0 = no primary tumour; T1-T4 = increasing size/invasion; Tis = carcinoma in situ"],
         ["N","Regional lymph Node involvement","N0 = no nodes; N1-N3 = increasing node involvement"],
         ["M","Distant Metastasis","M0 = no metastasis; M1 = distant metastasis present"],
        ], widths=[2*cm, 5.5*cm, 9*cm]),
    sp(4)]

story.append(h2("4.2 Surgical Procedures in Cancer Management"))
story += [
    tbl([["Procedure","Purpose"],
         ["Wide Local Excision","Remove tumour with adequate margin of normal tissue (curative intent)"],
         ["Radical Resection","Remove tumour + regional lymph nodes (e.g., Radical mastectomy, Whipple's for pancreatic CA)"],
         ["Palliative Surgery","Relieve symptoms but not curative — e.g., bypass for bowel obstruction, debulking"],
         ["Sentinel Lymph Node Biopsy","First draining lymph node sampled — if negative, no further node dissection needed (breast, melanoma)"],
         ["Reconstructive Surgery","After tumour removal — e.g., breast reconstruction after mastectomy"],
         ["Cytoreductive Surgery","Remove as much tumour as possible before chemo/radiation — e.g., ovarian cancer"],
        ], widths=[4.5*cm, 12*cm]),
    sp(4),
    imp("Cancer treatment is multimodal: Surgery + Chemotherapy + Radiotherapy + Targeted therapy + Immunotherapy. PT role: Pre-op conditioning, post-op rehabilitation, lymphoedema management, fatigue management, palliative care."),
    PageBreak()]

# ══════════════════════════════════════════════════════
# TOPIC 5 – CHEST WALL, LUNG & MEDIASTINUM
# ══════════════════════════════════════════════════════
story.append(h1("TOPIC 5: CHEST WALL, LUNG & MEDIASTINUM  [5 Hours]"))
story += [sp(4)]

story += [
    tbl([["Condition","Key Features","Management"],
         ["Spontaneous Pneumothorax","Air enters pleural space from ruptured bleb. Primary (young, tall, thin males) vs Secondary (COPD, TB). Features: sudden pleuritic pain, dyspnoea, reduced breath sounds + hyperresonance on affected side","Small (<2cm): O2 + observation. Larger: Needle aspiration or chest drain. Pleurodesis for recurrence"],
         ["Pleural Effusion","Fluid in pleural space. Transudate (heart failure, cirrhosis, nephrotic syndrome) vs Exudate (infection, malignancy, PE). Features: Dullness on percussion, reduced breath sounds, trachea deviation toward (large effusion)","Treat cause; Thoracocentesis for diagnosis + relief; Chest drain for empyema/large effusion"],
         ["Empyema Thoracis","Pus in pleural space — complication of pneumonia, TB, lung abscess, post-surgery. Features: Fever, pleuritic pain, CXR shows opaque hemithorax","IV antibiotics + chest drain (large bore); fibrinolytics (streptokinase) via drain; surgery (VATS decortication) if not resolving"],
         ["Lung Abscess","Pus-filled cavity in lung — aspiration (commonest cause), necrotising pneumonia, septic emboli. Features: Fever, productive foul-smelling sputum, haemoptysis, CXR: air-fluid level inside cavity","IV antibiotics (amoxicillin-clavulanate + metronidazole) × 4-6 weeks; Physiotherapy (postural drainage, ACBT); Surgical drainage if no response"],
         ["Bronchogenic Carcinoma (Lung Cancer)","#1 cause of cancer death worldwide. Types: Non-small cell (NSCLC — adenocarcinoma, squamous, large cell) 85%; Small cell (SCLC) 15%. Features: Cough, haemoptysis, weight loss, chest pain, clubbing, recurrent pneumonia. Pancoast tumour (apex): Horner's syndrome + brachial plexus pain","NSCLC: Surgery (lobectomy/pneumonectomy) if resectable + chemo/radiotherapy. SCLC: Chemo + radiotherapy (rarely surgical). Palliative PT for breathlessness, mobility"],
         ["Carcinoma of Breast","Most common cancer in women. Risk factors: Family history, BRCA1/2 mutation, early menarche, late menopause, nulliparity, HRT, obesity. Features: Painless hard lump, skin dimpling (peau d'orange), nipple retraction/discharge, axillary lymphadenopathy","Triple assessment: Clinical examination + Imaging (mammogram/USS) + Biopsy. Surgery: WLE (lumpectomy) or Mastectomy + Sentinel node biopsy/axillary clearance. Adjuvant: Radiotherapy, Chemotherapy, Hormone therapy (tamoxifen, aromatase inhibitors), Trastuzumab (HER2+). PT: Post-mastectomy shoulder rehab, lymphoedema management"],
         ["Mesothelioma","Malignant tumour of pleura. Almost always due to ASBESTOS exposure. Latent period 20-40 years. Features: Chest pain, dyspnoea, pleural effusion, weight loss. CT: pleural thickening + effusion","Diagnosis: CT + pleural biopsy/VATS. Median survival 9-12 months. Palliative: Chemo (pemetrexed+cisplatin), pleurodesis for effusion, PT for breathlessness management"],
        ], widths=[3.5*cm, 7*cm, 6*cm]),
    PageBreak()]

# ══════════════════════════════════════════════════════
# TOPIC 6 – HEART DISORDERS (SURGICAL)
# ══════════════════════════════════════════════════════
story.append(h1("TOPIC 6: DISORDERS OF THE HEART  [6 Hours]"))
story += [sp(4)]

story.append(h2("6.1 Congenital Heart Disease (CHD)"))
story += [
    h3("Acyanotic vs Cyanotic CHD:"),
    tbl([["Type","Definition","Conditions"],
         ["Acyanotic","Left-to-right shunt — oxygenated blood recirculates through lungs. No cyanosis initially but can progress to Eisenmenger's syndrome (reversal of shunt → cyanosis) with pulmonary HTN","VSD (most common CHD), ASD, PDA, Coarctation of aorta, Pulmonary stenosis, Aortic stenosis"],
         ["Cyanotic","Right-to-left shunt — deoxygenated blood enters systemic circulation. Cyanosis from birth.","Tetralogy of Fallot (TOF — most common cyanotic CHD), Transposition of Great Arteries (TGA), Tricuspid atresia, Total Anomalous Pulmonary Venous Return (TAPVR)"],
        ], widths=[2*cm, 6.5*cm, 8*cm]),
    sp(4),
    tbl([["Condition","Defect","Key Features","Management"],
         ["VSD\n(Ventricular Septal Defect)","Hole in interventricular septum","Pansystolic murmur at LSE; Small VSDs close spontaneously; Large: pulmonary HTN, heart failure","Small: observe. Large: surgical patch closure or catheter device closure"],
         ["ASD\n(Atrial Septal Defect)","Hole in interatrial septum","Fixed split S2; ejection systolic murmur; RV overload, AF, pulmonary HTN (late)","Device closure (catheter) or surgical repair"],
         ["PDA\n(Patent Ductus Arteriosus)","Failure of ductus arteriosus to close after birth","Continuous 'machinery' murmur under left clavicle; bounding pulse","Indomethacin (preterm infants); surgical ligation or catheter coil"],
         ["TOF\n(Tetralogy of Fallot)","4 components: VSD + Overriding aorta + Pulmonary stenosis + RV hypertrophy","Cyanosis, clubbing, squatting position (increases SVR), Tet spells (hypercyanotic spells), Boot-shaped heart on CXR","Surgical repair (complete correction). Palliation: BT shunt (subclavian-PA). Tet spell: O2 + propranolol + morphine + knee-chest position"],
         ["Coarctation of Aorta","Narrowing of aorta near ductus arteriosus","Hypertension in arms, weak/absent femoral pulses, BP difference arms vs legs >20mmHg, rib notching on CXR","Balloon dilatation + stenting or surgical resection"],
        ], widths=[2.5*cm, 3.5*cm, 5.5*cm, 5*cm]),
    red("TOF = Tetralogy of Fallot — most common CYANOTIC CHD. TOF components: VSD, Overriding Aorta, Pulmonary Stenosis, RVH. Squatting increases SVR → reduces R-to-L shunt → relieves cyanosis."),
    sp(4)]

story.append(h2("6.2 Acquired Heart Disease"))
story += [
    tbl([["Condition","Causes","Key Features","Surgical Management"],
         ["Mitral Stenosis","Rheumatic fever (most common in developing world)","Dyspnoea, AF, haemoptysis, malar flush, mid-diastolic rumble, opening snap; CXR: left atrial enlargement","Balloon valvuloplasty (if suitable), Mitral valve replacement (MVR) — mechanical or bioprosthetic"],
         ["Mitral Regurgitation","Rheumatic, MVP, IHD, IE","Pansystolic murmur at apex → axilla; LV dilatation; Dyspnoea, fatigue","Mitral valve repair (preferred) or MVR"],
         ["Aortic Stenosis","Calcific degeneration (commonest in elderly), Bicuspid aortic valve (commonest in <60)","SAD triad (Syncope, Angina, Dyspnoea), ejection systolic murmur → carotids, narrow pulse pressure, slow-rising pulse","Aortic Valve Replacement (AVR) — open surgery or TAVI (Transcatheter Aortic Valve Implantation) for high-risk patients"],
         ["Aortic Regurgitation","Rheumatic, IE, Marfan's, aortic root dilatation","Early diastolic murmur at LSE; wide pulse pressure; water-hammer pulse; Austin Flint murmur; LV dilatation/failure","AVR when symptomatic or LV dysfunction developing"],
         ["Ischaemic Heart Disease — Surgical","Atherosclerosis of coronary arteries","Angina, MI — when PCI fails or anatomy unsuitable","CABG (Coronary Artery Bypass Graft)"],
        ], widths=[2.5*cm, 3*cm, 5.5*cm, 5.5*cm]),
    PageBreak()]

# ══════════════════════════════════════════════════════
# TOPIC 7 – THORACIC SURGERIES
# ══════════════════════════════════════════════════════
story.append(h1("TOPIC 7: THORACIC SURGERIES  [6 Hours]"))
story += [sp(4)]

story.append(h2("7.1 Lung Surgeries"))
story += [
    h3("Types of Thoracotomy Incisions:"),
    tbl([["Incision","Approach","Used For"],
         ["Posterolateral thoracotomy","Most common. Patient lateral, incision curves from anterior to posterior around chest","Lung resections, oesophageal surgery"],
         ["Anterolateral thoracotomy","Patient supine, curved incision anterior chest wall","Cardiac, emergency access"],
         ["Median sternotomy","Vertical split of sternum","Cardiac surgery — CABG, valve surgery"],
         ["VATS (Video-Assisted Thoracoscopic Surgery)","Minimally invasive — ports through chest wall","Lung biopsy, wedge resection, pleurodesis, early lung cancer"],
        ], widths=[4*cm, 5.5*cm, 7*cm]),
    sp(4),
    h3("Lung Resection Procedures:"),
    tbl([["Procedure","What is Removed","Indications","Physiological Changes"],
         ["Wedge Resection","Small peripheral segment","Peripheral lung tumour, lung biopsy","Minimal loss of function"],
         ["Segmentectomy","Bronchopulmonary segment","Small tumours in specific segment","Moderate loss"],
         ["Lobectomy","One lobe (right: 3 lobes; left: 2 lobes)","Lung cancer — standard surgery; Bronchiectasis","Remaining lung compensates partially"],
         ["Pneumonectomy","Entire lung","Large/central tumour, TB destroyed lung","Significant loss — remaining lung + heart compensates; Post-pneumonectomy space fills with fluid"],
        ], widths=[3.5*cm, 3.5*cm, 4.5*cm, 5*cm]),
    sp(4),
    h3("Complications of Lung Surgery:"),
    bl("Respiratory: Atelectasis (most common), pneumonia, bronchopleural fistula (air leak), respiratory failure"),
    bl("Haemorrhage: From pulmonary vessels"),
    bl("Empyema: Post-op infection in pleural space"),
    bl("Cardiac arrhythmias: AF very common after lung surgery (right pneumonectomy)"),
    bl("Post-pneumonectomy syndrome: Mediastinal shift causing breathlessness"),
    imp("PT ROLE after thoracotomy/lung surgery: Pre-op: breathing exercises, education. Post-op Day 0-1: Deep breathing, incentive spirometry, huffing+coughing. Day 2-3: Mobilisation, shoulder ROM. Ongoing: Pulmonary rehabilitation."),
    sp(4)]

story.append(h2("7.2 Cardiac Surgeries"))
story += [
    h3("Cardiopulmonary Bypass (CPB) Machine:"),
    bl("Takes over heart and lung function during surgery"),
    bl("Blood drained from right atrium → oxygenated + CO2 removed → pumped back to aorta"),
    bl("Heart stopped with cardioplegia (cold potassium solution)"),
    bl("Complications: Stroke, neurological dysfunction, coagulopathy, systemic inflammatory response"),
    sp(4),
    tbl([["Surgery","Description","PT Role Post-op"],
         ["CABG (Coronary Artery Bypass Grafting)","Bypass blocked coronary arteries using graft vessels (LIMA — left internal mammary artery, preferred; Saphenous vein; Radial artery). On-pump (CPB) or Off-pump (beating heart)","Early breathing exercises, sternal precautions (no lifting >5 lbs × 6-8 weeks), early ambulation, cardiac rehabilitation"],
         ["Open Heart Surgery (Valve Replacement/Repair)","Heart opened via sternotomy under CPB — valves replaced with mechanical (lifelong warfarin) or bioprosthetic (no warfarin, but less durable)","Sternal precautions, breathing exercises, early mobilisation, wound care"],
         ["Closed Heart Surgery","Without opening heart chambers — e.g., BT shunt, coarctation repair, PDA ligation","Post-thoracotomy PT"],
         ["Transplant Surgery (Heart, Lung, Kidney)","End-stage organ failure. Immune suppression required lifelong. Heart transplant: donor heart implanted (recipient's own removed); Lung transplant: one or both lungs. Complications: rejection, infection","PT: Early mobilisation, pulmonary rehab, exercise training. Denervated heart after transplant — no vagal response, relies on circulating catecholamines for HR increase"],
        ], widths=[3.5*cm, 7.5*cm, 5.5*cm]),
    PageBreak()]

# ══════════════════════════════════════════════════════
# TOPIC 8 – ARTERIES & VEINS
# ══════════════════════════════════════════════════════
story.append(h1("TOPIC 8: DISEASES OF ARTERIES & VEINS  [5 Hours]"))
story += [sp(4)]

story += [
    tbl([["Condition","Pathology","Clinical Features","Management"],
         ["Atherosclerosis","Lipid-laden plaques in intima of arteries → narrowing → ischaemia","Asymptomatic initially → symptoms depend on vessel affected: angina (coronary), TIA/stroke (carotid), claudication (peripheral)","Risk factor modification: smoking cessation, statins, antihypertensives, antiplatelet (aspirin/clopidogrel). Revascularisation if needed"],
         ["Peripheral Arterial Disease (PAD)","Atherosclerosis of lower limb arteries","Intermittent claudication (pain on walking, relieved by rest) → Rest pain → Ulceration → Gangrene (critical limb ischaemia). ABPI <0.9 diagnostic","Conservative: exercise programme, smoking cessation, medications. Angioplasty ± stenting. Bypass surgery. Amputation if gangrene"],
         ["Aneurysm (AAA)","Abnormal dilatation of artery ≥50% of normal diameter. AAA (abdominal aortic aneurysm) >3cm — normal aorta is 2cm. Risk: smoking, HTN, male >65yrs","Often asymptomatic — found on ultrasound screening. If large (>5.5cm) or rupturing: severe back/abdominal pain, collapse, pulsatile abdominal mass","<5.5cm: surveillance USS every 6-12 months. ≥5.5cm: Elective EVAR (endovascular repair) or open surgery. Ruptured AAA: Emergency surgery — very high mortality"],
         ["Buerger's Disease (TAO)","Inflammatory occlusion of small/medium arteries. EXCLUSIVELY in heavy smokers","Young men who smoke. Claudication, rest pain, Raynaud's, gangrene of digits. Positive Allen's test","Stop smoking IMMEDIATELY (only effective treatment). Sympathectomy for pain"],
         ["Raynaud's Disease/Phenomenon","Vasospasm of digital arteries triggered by cold/stress","Triphasic colour change: WHITE (ischaemia) → BLUE (deoxygenation) → RED (reperfusion). Primary (Raynaud's disease) vs Secondary (connective tissue disease, scleroderma)","Primary: Keep warm, avoid cold. Nifedipine (CCB) for severe. Secondary: Treat underlying cause"],
         ["Deep Vein Thrombosis (DVT)","Thrombus in deep veins, usually lower limb (DVT) — Virchow's Triad: Stasis + Endothelial damage + Hypercoagulability","Calf pain, swelling, warmth, erythema. Wells score for pre-test probability. D-dimer (sensitive, not specific). Confirmed by compression USS. Complication: Pulmonary Embolism (PE)","LMWH (enoxaparin) bridge to warfarin or NOAC (rivaroxaban, apixaban) × 3-6 months. TED stockings. EARLY MOBILISATION prevents DVT — key PT message"],
         ["Pulmonary Embolism (PE)","DVT embolises to pulmonary arteries","Sudden dyspnoea, pleuritic chest pain, haemoptysis, tachycardia. CXR: normal or Hampton's hump/Westermark sign. CTPA = gold standard. ECG: S1Q3T3, sinus tachycardia","Anticoagulation (as DVT). Massive PE with haemodynamic compromise: Thrombolysis (alteplase) or surgical embolectomy"],
         ["Varicose Veins","Tortuous dilated superficial leg veins due to valvular incompetence","Visible bulging veins, aching, heaviness, swelling. Complications: Varicose eczema, lipodermatosclerosis, venous ulcers","Conservative: compression stockings, elevation, exercise. Interventional: Endovenous laser/radiofrequency ablation, foam sclerotherapy, surgical (ligation + stripping)"],
         ["Thrombophlebitis","Inflammation + thrombus in superficial vein","Red, tender, firm, cord-like vein; low fever","NSAIDs, warm compress, low-dose LMWH. Usually self-limiting"],
        ], widths=[2.5*cm, 4*cm, 5.5*cm, 4.5*cm]),
    red("Virchow's Triad: (1) Venous stasis, (2) Endothelial damage, (3) Hypercoagulability — the three factors causing DVT. PT prevents DVT with early mobilisation, ankle exercises, and TED stockings."),
    PageBreak()]

# ══════════════════════════════════════════════════════
# TOPIC 9 – COMMON ABDOMINAL OPERATIONS
# ══════════════════════════════════════════════════════
story.append(h1("TOPIC 9: COMMON ABDOMINAL OPERATIONS  [4 Hours]"))
story += [sp(4)]

story += [
    tbl([["Operation","Indication","What Is Done","Physiological Changes & PT Role"],
         ["Cholecystectomy","Gallstones, cholecystitis, biliary colic","Removal of gallbladder. Laparoscopic (preferred) or open (Kocher's incision)","Laparoscopic: CO2 shoulder tip pain post-op (diaphragmatic irritation), early discharge. PT: Deep breathing, early ambulation. Open: Risk of pulmonary complications — intensive chest physio"],
         ["Appendicectomy","Acute appendicitis","Removal of appendix. Laparoscopic or open (McBurney's/Lanz incision)","Uncomplicated: quick recovery. Perforated: longer hospital stay, drain. PT: Early ambulation"],
         ["Colostomy","Bowel obstruction, colorectal cancer, diverticular disease, trauma","Part of colon brought to surface of abdomen as stoma. Temporary (loop colostomy) or permanent (end colostomy after AP resection for rectal cancer)","Patient education about stoma care. PT: Core strengthening (avoid Valsalva), activity modification"],
         ["Ileostomy","After colectomy for UC/Crohn's, right hemicolectomy","Terminal ileum brought to skin surface — liquid stool","High output → dehydration risk. Patient education on stoma care, diet, fluid intake"],
         ["Gastrectomy","Gastric cancer, peptic ulcer disease","Partial (Billroth I/II) or Total gastrectomy. Total requires B12 supplementation (no intrinsic factor)","Post-gastrectomy syndrome (dumping): Early — 15-30 min post-meal: nausea, sweating, diarrhoea. Late — 2-3 hrs: hypoglycaemia. Management: Small frequent meals, lie down after eating"],
         ["Hernias Repair","Symptomatic hernia — groin pain, lump","Mesh repair (Lichtenstein — tension-free). Laparoscopic (TEP/TAPP). Strangulated hernia = EMERGENCY","PT post-repair: No heavy lifting × 6 weeks. Core strengthening when healed"],
         ["Mastectomy","Breast cancer","Simple/total mastectomy (breast only) or Radical/Modified radical mastectomy (breast + axillary nodes)","PT: Shoulder mobilisation from Day 1 (prevent frozen shoulder), arm exercises, lymphoedema prevention/management, scar massage"],
         ["Nephrectomy","Renal cell carcinoma, non-functioning kidney, donor transplant","Removal of one kidney — open or laparoscopic","Remaining kidney compensates. PT: Early ambulation, breathing exercises"],
         ["Prostatectomy","Prostate cancer (radical), BPH (TURP — transurethral)","Radical: removes entire prostate. TURP: resection of prostate via urethra","Complications: Urinary incontinence, erectile dysfunction. PT: Pelvic floor exercises ESSENTIAL pre- and post-op"],
        ], widths=[2.5*cm, 3*cm, 5.5*cm, 5.5*cm]),
    imp("PT after any abdominal surgery: (1) Deep breathing + incentive spirometry Day 0-1, (2) Gentle ambulation Day 1-2, (3) Avoid Valsalva manoeuvre for 6+ weeks (no straining), (4) Core muscle exercises from 6-8 weeks."),
    PageBreak()]

# ══════════════════════════════════════════════════════
# TOPIC 10 – BURNS
# ══════════════════════════════════════════════════════
story.append(h1("TOPIC 10: BURNS  [4 Hours]"))
story += [sp(4)]

story.append(h2("10.1 Classification of Burns"))
story += [
    tbl([["Depth","Also Called","Features","Healing"],
         ["Superficial (1st degree)","Epidermal","Redness (erythema), pain, no blisters. Example: Sunburn","Heals in 3-7 days without scarring"],
         ["Superficial Partial Thickness (2nd degree)","Superficial dermal","Blisters, very painful (nerve endings intact), moist, pink/red wound base","Heals in 14-21 days, minimal scarring"],
         ["Deep Partial Thickness (2nd degree)","Deep dermal","Pale/mottled, reduced sensation, blisters, moist","Heals in 21-35 days, significant scarring; may need grafting"],
         ["Full Thickness (3rd degree)","Full dermal","Dry, leathery, white/black, painless (nerve endings destroyed), no blisters","Does NOT heal spontaneously; requires skin grafting"],
         ["Sub-dermal (4th degree)","Sub-dermal","Burns through skin into muscle, bone, tendon","Requires excision; may need amputation"],
        ], widths=[3.5*cm, 3*cm, 5*cm, 5*cm]),
    sp(4)]

story.append(h2("10.2 Estimation of Burn Area"))
story += [
    h3("Wallace Rule of Nines (★ MUST KNOW):"),
    tbl([["Body Part","Adult (%)","Child adjustment"],
         ["Head & Neck","9%","Head = 18% in infant (larger)"],
         ["Each Upper Limb","9% (x2 = 18%)","—"],
         ["Anterior Trunk","18%","—"],
         ["Posterior Trunk","18%","—"],
         ["Each Lower Limb","18% (x2 = 36%)","Legs relatively smaller in children"],
         ["Perineum","1%","—"],
         ["TOTAL","100%","—"],
        ], widths=[5*cm, 4.5*cm, 7*cm]),
    sp(4),
    h3("Palmar Method:"),
    bl("Patient's palm (including fingers) = ~1% of TBSA — useful for patchy burns"),
    sp(4)]

story.append(h2("10.3 Pathological Changes & Systemic Effects"))
story += [
    bl("<b>Zone of Coagulation:</b> Central core of burn — irreversible cell death"),
    bl("<b>Zone of Stasis:</b> Surrounds coagulation — potentially salvageable with good treatment"),
    bl("<b>Zone of Hyperaemia:</b> Outermost zone — inflammation, heals spontaneously"),
    sp(3),
    h3("Systemic Effects (Burns >15-20% TBSA in adults / >10% in children):"),
    bl("Fluid shifts: Massive plasma loss from capillary leakage → hypovolaemic shock (burn shock)"),
    bl("Inhalation injury: Most common cause of death in burns patients — CO poisoning, airway oedema, chemical injury"),
    bl("Hypermetabolism: Massive caloric demand (up to 3x normal) — early enteral nutrition critical"),
    bl("Infection/Sepsis: Most common cause of death after initial resuscitation — wound infection, pneumonia"),
    bl("Anaemia: Blood loss + haemolysis + suppressed erythropoiesis"),
    sp(4)]

story.append(h2("10.4 Management of Burns"))
story += [
    h3("Initial Management (A-E approach):"),
    bl("A: Airway — assess for inhalation injury (singed nasal hairs, hoarseness, stridor, carbonaceous sputum); early intubation if airway at risk"),
    bl("B: Breathing — 100% O2 via non-rebreathing mask for CO poisoning"),
    bl("C: Circulation — IV access (2 large-bore); fluid resuscitation"),
    bl("D: Disability — analgesia (IV morphine), assess consciousness"),
    bl("E: Exposure — estimate TBSA, remove clothing/jewellery, warm patient"),
    sp(3),
    h3("Fluid Resuscitation:"),
    bl("<b>Parkland Formula (Baxter formula):</b>"),
    bl("Total fluid in first 24 hours = 4 mL × Weight (kg) × TBSA (%) of burns"),
    bl("Give HALF in first 8 hours (from time of burn, not from admission); remaining HALF over next 16 hours"),
    bl("Fluid of choice: Hartmann's/Ringer's Lactate"),
    bl("Monitor: Urine output target = 0.5–1 mL/kg/hr in adults; 1 mL/kg/hr in children"),
    imp("Parkland Formula: 4 × Weight (kg) × %TBSA = Total mL Hartmann's in 24 hrs. Half in 8 hrs, half in 16 hrs."),
    sp(4),
    h3("Wound Management:"),
    tbl([["Depth","Wound Management"],
         ["Superficial/Superficial Partial Thickness","Cleanse, non-adherent dressings (e.g., Mepitel), change every 2-3 days, analgesia"],
         ["Deep Partial Thickness","Early tangential excision + skin grafting within 48-72 hrs improves outcomes"],
         ["Full Thickness","Escharotomy if circumferential (releases compartment pressure) → Excision + Skin Grafting mandatory"],
        ], widths=[5*cm, 11.5*cm]),
    sp(4),
    h3("Skin Grafting:"),
    tbl([["Type","Source","Details"],
         ["Split-skin graft (SSG)","Autograft from donor site (thigh)","Epidermis + part of dermis. Most commonly used. Donor site heals by re-epithelialization"],
         ["Full thickness graft (FTSG)","Autograft (face, hands, groin)","Epidermis + full dermis. Better cosmesis, less contracture. Donor site needs direct closure"],
         ["Allograft","Cadaver skin","Temporary cover — biological dressing until autograft available"],
         ["Xenograft","Animal skin (pig most common)","Temporary cover"],
         ["Flaps","Tissue with own blood supply (local/pedicled/free flap)","For complex wounds over joints, exposed bone/tendon"],
        ], widths=[3.5*cm, 3.5*cm, 9.5*cm]),
    sp(4),
    h3("Complications of Burns:"),
    tbl([["Early","Late"],
         ["Hypovolaemic shock, Inhalation injury, CO poisoning","Hypertrophic scarring, Keloid formation"],
         ["Acute kidney injury (myoglobinuria in electrical burns)","Contractures — across joints → limit function"],
         ["Curling's ulcer (stress ulcer of duodenum)","Marjolin's ulcer (SCC arising in old burn scar)"],
         ["Infection → Sepsis (most common late cause of death)","Psychological trauma, PTSD"],
        ], widths=[8*cm, 8.5*cm], hcol="#455a64"),
    sp(4),
    imp("PT role in Burns: Acute phase: Positioning (anti-contracture), passive/active ROM, breathing exercises. Sub-acute: Active ROM, strengthening, pressure garments for scar management (worn 23 hrs/day for 12-18 months), silicone gel sheets. Rehabilitation: Functional retraining, gait training, ADL retraining, prosthesis if amputation."),
    red("Burns exam essentials: Rule of Nines (know numbers by heart), 4 depths of burns, Parkland formula, 3 zones of burns, causes of death (early: shock + inhalation; late: sepsis)."),
    PageBreak()]

# ══════════════════════════════════════════════════════
# TOPIC 11 – WOMEN'S HEALTH
# ══════════════════════════════════════════════════════
story.append(h1("TOPIC 11: WOMEN'S HEALTH & OBSTETRIC SURGERY  [8 Hours]"))
story += [sp(4)]

story.append(h2("11.1 Menstrual Disorders"))
story += [
    tbl([["Term","Definition","Common Causes"],
         ["Menorrhagia","Heavy periods (>80 mL or periods lasting >7 days)","Fibroids, endometriosis, endometrial polyp, IUCD, coagulation disorders, hypothyroidism"],
         ["Dysmenorrhoea","Painful periods","Primary (no pathology — prostaglandins), Secondary (endometriosis, PID, fibroids)"],
         ["Amenorrhoea","Absence of menstruation","Primary (never started): Turner's, imperforate hymen. Secondary (stopped): pregnancy, hypothalamic amenorrhoea, PCOS, premature menopause"],
         ["PCOS","Polycystic Ovary Syndrome","Oligomenorrhoea, hirsutism, acne, obesity, infertility. USS: polycystic ovaries. Management: Lifestyle + weight loss, OCP, Metformin, Clomifene (for fertility)"],
        ], widths=[3*cm, 3.5*cm, 10*cm]),
    sp(4)]

story.append(h2("11.2 Menopause"))
story += [
    bl("Average age: 51 years. Defined as 12 months of amenorrhoea after final period"),
    bl("Causes of early menopause: Premature ovarian failure, surgery (bilateral oophorectomy), chemotherapy, radiotherapy"),
    h3("Features:"),
    bl("Vasomotor: Hot flushes, night sweats"), bl("Urogenital: Vaginal dryness, dyspareunia, urinary frequency/incontinence"),
    bl("Psychological: Mood changes, poor concentration, insomnia"), bl("Long-term: Osteoporosis (↑fracture risk), cardiovascular risk"),
    h3("Management:"),
    bl("HRT (Hormone Replacement Therapy): Oestrogen + Progesterone — most effective for hot flushes. Risks: VTE, breast cancer, stroke (slightly increased)"),
    bl("Non-hormonal: SSRIs, Clonidine for hot flushes"), bl("Calcium + Vitamin D + Exercise for osteoporosis prevention"),
    sp(4)]

story.append(h2("11.3 Pregnancy — Maternal Physiology & Complications"))
story += [
    h3("Normal Physiological Changes in Pregnancy:"),
    tbl([["System","Change"],
         ["CVS","Cardiac output ↑40%, Heart rate ↑15-20 bpm, Blood pressure ↓ (especially 2nd trimester), Blood volume ↑40-50%, Physiological anaemia (dilutional)"],
         ["Respiratory","Tidal volume ↑40%, Minute ventilation ↑, Respiratory rate same/slightly ↑, FRC ↓ (uterus pushes up diaphragm), Progesterone causes mild hyperventilation → compensated respiratory alkalosis"],
         ["Musculoskeletal","Centre of gravity shifts forward, lumbar lordosis ↑, ligament laxity (relaxin hormone), sacroiliac joint changes, common: low back pain, SPD (symphysis pubis dysfunction)"],
         ["GI","Nausea/vomiting (1st trimester), constipation (progesterone slows gut), GERD, delayed gastric emptying"],
         ["Renal","GFR ↑50%, glycosuria possible (normal), UTI risk increases"],
        ], widths=[3*cm, 13.5*cm]),
    sp(4),
    h3("Prenatal Complications:"),
    tbl([["Complication","Features","Management"],
         ["Pre-eclampsia","HTN >140/90 + proteinuria after 20 weeks gestation. Symptoms: headache, visual disturbance, RUQ pain, oedema","Antihypertensives (labetalol, nifedipine), MgSO4 for seizure prevention, delivery if severe"],
         ["Eclampsia","Pre-eclampsia + seizures — OBSTETRIC EMERGENCY","IV MgSO4, stabilise, urgent delivery"],
         ["Gestational Diabetes","Glucose intolerance developing in pregnancy. Risk of macrosomia, shoulder dystocia, stillbirth","Diet modification → Insulin if not controlled. Resolves after delivery (but 50% risk T2DM later)"],
         ["Placenta Praevia","Placenta covering internal os. Feature: Painless bright red antepartum haemorrhage","Bed rest, avoid digital examination, C-section delivery"],
         ["Placental Abruption","Premature separation of normally situated placenta. Feature: Painful dark red haemorrhage, tender rigid uterus","Emergency — resuscitate, monitor fetus, delivery"],
        ], widths=[3*cm, 5.5*cm, 8*cm]),
    sp(4)]

story.append(h2("11.4 Childbirth & Post-Natal"))
story += [
    h3("Stages of Labour:"),
    bl("<b>Stage 1:</b> Onset of labour to full cervical dilatation (10 cm). Latent phase (0-4cm) + Active phase (4-10cm)"),
    bl("<b>Stage 2:</b> Full dilatation to delivery of baby — pushing phase"),
    bl("<b>Stage 3:</b> Delivery of placenta — up to 30 minutes after baby"),
    sp(3),
    h3("Pain Relief in Labour:"),
    bl("Entonox (50% N2O + 50% O2) — inhaled"), bl("Pethidine IM — opioid, causes neonatal respiratory depression"),
    bl("Epidural — most effective pain relief"), bl("TENS (Transcutaneous Electrical Nerve Stimulation) — non-invasive, mild benefit"),
    sp(3),
    h3("Post-Natal Care:"),
    bl("Breast feeding: Encourages uterine involution, reduces breast cancer risk, ideal nutrition for infant"),
    bl("Post-natal depression: 10-15% of mothers, 2 weeks to 12 months post-delivery. Features: persistent low mood, difficulty bonding with baby. Treatment: CBT, SSRIs"),
    bl("Pelvic floor dysfunction: Urinary incontinence, prolapse — PT role: pelvic floor exercises (Kegel's)"),
    sp(4)]

story.append(h2("11.5 Gynaecological Surgical Procedures"))
story += [
    tbl([["Procedure","Indication","Details"],
         ["Hysterosalpingography (HSG)","Infertility investigation","X-ray with contrast injected through cervix — outlines uterine cavity and fallopian tubes"],
         ["Dilatation & Curettage (D&C)","Diagnosis of endometrial pathology, incomplete miscarriage","Cervical dilatation + endometrial scraping under GA"],
         ["Laparoscopy","Diagnosis of endometriosis, ectopic pregnancy, PID, infertility","Minimally invasive — camera through umbilical port"],
         ["Colposcopy","Abnormal cervical smear (CIN)","Magnified examination of cervix; biopsy if needed"],
         ["Hysterectomy","Fibroids, endometrial cancer, cervical cancer, menorrhagia not responding to conservative treatment","Total (uterus + cervix) or Subtotal (uterus only). Abdominal, vaginal, or laparoscopic approach"],
        ], widths=[3.5*cm, 4*cm, 9*cm]),
    PageBreak()]

# ══════════════════════════════════════════════════════
# TOPIC 12 – ENT
# ══════════════════════════════════════════════════════
story.append(h1("TOPIC 12: ENT  [3 Hours]"))
story += [sp(4)]

story += [
    tbl([["Condition","Key Features","Management"],
         ["Otitis Media\n(Acute/Chronic)","Acute: Ear pain (otalgia), fever, reduced hearing, bulging red tympanic membrane — most common in children. Chronic: Persistent discharge (otorrhoea), conductive hearing loss, perforated TM","Acute: Analgesics + Amoxicillin (if bacterial). Chronic: Myringoplasty (repair TM), Tympanoplasty"],
         ["Otosclerosis","Abnormal bone growth fixing stapes → progressive conductive hearing loss. Features: Paracusis (hears better in noisy environment)","Stapedectomy (replace fixed stapes with prosthesis), hearing aid"],
         ["Facial Palsy (Bell's Palsy)","LMN VII nerve palsy — unilateral weakness of ALL facial muscles (forehead involved — distinguishes from UMN). Features: Cannot close eye (lagophthalmos), droop, loss of nasolabial fold, loss of taste (ant 2/3 tongue)","Prednisolone (within 72 hrs), eye drops (prevent corneal damage), PT: facial exercises, electrical stimulation"],
         ["Deafness","Conductive (external/middle ear pathology — wax, OM, otosclerosis) vs Sensorineural (inner ear/nerve — noise, ageing, ototoxic drugs)","Rinne + Weber tests to differentiate. Hearing aids, cochlear implants for severe SNHL"],
         ["Functional Achonia\n(Aphonia)","Loss of voice — no organic cause. Conversion disorder / vocal cord misuse","Voice therapy, counselling, treat psychosocial factors"],
        ], widths=[3.5*cm, 7*cm, 6*cm]),
    imp("Facial palsy PT: Facial mirror exercises, electrical stimulation (NMES), eye protection (artificial tears, eye patch at night), prevention of contracture."),
    PageBreak()]

# ══════════════════════════════════════════════════════
# TOPIC 13 – OPHTHALMOLOGY
# ══════════════════════════════════════════════════════
story.append(h1("TOPIC 13: OPHTHALMOLOGY  [3 Hours]"))
story += [sp(4)]

story += [
    tbl([["Condition","Cause","Key Features","Management"],
         ["Refractive Errors","Myopia (short-sighted — eyeball too long), Hypermetropia (long-sighted — too short), Astigmatism (irregular cornea), Presbyopia (ageing — loss of accommodation)","Blurred vision at distance or near depending on type","Spectacles, contact lenses, LASER surgery (LASIK, PRK)"],
         ["Conjunctivitis","Bacterial (S. aureus, H. influenzae), Viral (adenovirus — most common), Allergic","Red eye, discharge (purulent = bacterial; watery = viral; mucoid = allergic), gritty sensation, normal vision","Bacterial: Antibiotic eye drops. Viral: Self-limiting, lubricants. Allergic: Antihistamine drops, avoid allergen"],
         ["Glaucoma","Primary Open Angle: Raised IOP (>21 mmHg) → gradual optic nerve damage → irreversible peripheral vision loss → tunnel vision (SILENT — no pain). Primary Angle Closure: Sudden raised IOP — PAINFUL","POAG: asymptomatic until advanced. PACG: Severe eye pain, headache, nausea, halos around lights, redness, fixed dilated pupil — EMERGENCY","POAG: Eye drops (beta-blockers, prostaglandin analogues), laser (SLT), surgery (trabeculectomy). PACG Emergency: IV acetazolamide, pilocarpine drops, laser iridotomy"],
         ["Cataract","Lens opacification — Senile (age, most common), Congenital, Diabetic, Steroid-induced, Post-traumatic","Gradual painless blurring of vision, glare, difficulty with bright lights, faded colours","Phacoemulsification (ultrasound + aspiration) + IOL (intraocular lens) implant"],
         ["Iritis (Anterior Uveitis)","Autoimmune (AS, IBD, Sarcoid), HLA-B27 associated","Red eye, photophobia, blurred vision, irregular pupil, hypopyon (pus in anterior chamber)","Topical steroids + mydriatics (atropine) to prevent posterior synechiae"],
         ["Retinal Detachment","Predisposed by myopia, trauma, surgery. Retina separates from RPE","Flashes, floaters (vitreous detachment), 'curtain coming down' visual field loss — PAINLESS EMERGENCY","Laser photocoagulation (small tears), scleral buckling or vitrectomy (large detachment). Surgery must be within hours"],
         ["Extra-Ocular Muscle Defects","CN III (ptosis, diplopia, eye down-and-out, dilated pupil — uncal herniation), CN IV (vertical diplopia, head tilt), CN VI (convergent squint, horizontal diplopia — most common CN palsy)","Diplopia, squint, abnormal head posture","Treat cause; prism glasses; surgery for persistent strabismus"],
        ], widths=[2.5*cm, 3.5*cm, 5.5*cm, 5*cm]),
    sp(10),
    HRFlowable(width="100%", thickness=1, color=colors.HexColor("#1b5e20"), spaceAfter=6),
    Paragraph("END OF GENERAL SURGERY NOTES", ParagraphStyle("End", fontSize=12, alignment=TA_CENTER, textColor=colors.HexColor("#1b5e20"), fontName="Helvetica-Bold", spaceBefore=6)),
    Paragraph("Orris AI Study Assistant  |  For 3rd Year BPT Exam Preparation  |  July 2026", sub_s)]

doc.build(story)
print("SUCCESS:", OUTPUT)

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

OUTPUT = "/home/daytona/workspace/pt-study-plan/Simple_General_Medicine_Notes.pdf"

doc = SimpleDocTemplate(OUTPUT, pagesize=A4,
    rightMargin=2*cm, leftMargin=2*cm, topMargin=2*cm, bottomMargin=2*cm)

# ── styles ──────────────────────────────────────────────────────────────────
cover_title = ParagraphStyle("CT", fontSize=26, textColor=colors.HexColor("#0d47a1"),
    alignment=TA_CENTER, fontName="Helvetica-Bold", spaceAfter=8)
cover_sub   = ParagraphStyle("CS", fontSize=12, textColor=colors.HexColor("#546e7a"),
    alignment=TA_CENTER, spaceAfter=5)

chapter_title = ParagraphStyle("ChT", fontSize=15, textColor=colors.white,
    backColor=colors.HexColor("#0d47a1"), fontName="Helvetica-Bold",
    spaceBefore=14, spaceAfter=8, leftIndent=-6, rightIndent=-6, borderPad=7)

section = ParagraphStyle("SEC", fontSize=12, textColor=colors.HexColor("#0d47a1"),
    fontName="Helvetica-Bold", spaceBefore=10, spaceAfter=4)

subsec = ParagraphStyle("SUB", fontSize=10.5, textColor=colors.HexColor("#b71c1c"),
    fontName="Helvetica-Bold", spaceBefore=6, spaceAfter=3)

# MAIN body - easy conversational text
easy = ParagraphStyle("EZ", fontSize=10.5, leading=17, spaceAfter=6,
    textColor=colors.HexColor("#1a1a1a"), alignment=TA_JUSTIFY)

# Highlighted box - yellow "remember this!"
remember = ParagraphStyle("REM", fontSize=10, leading=15,
    backColor=colors.HexColor("#fffde7"), borderPad=8, spaceAfter=8,
    textColor=colors.HexColor("#4e342e"), leftIndent=8, rightIndent=8)

# Blue analogy box
analogy = ParagraphStyle("ANA", fontSize=10, leading=15,
    backColor=colors.HexColor("#e3f2fd"), borderPad=8, spaceAfter=8,
    textColor=colors.HexColor("#0d47a1"), leftIndent=8, rightIndent=8)

# Green exam tip
examtip = ParagraphStyle("EXT", fontSize=10, leading=15,
    backColor=colors.HexColor("#e8f5e9"), borderPad=8, spaceAfter=8,
    textColor=colors.HexColor("#1b5e20"), leftIndent=8, rightIndent=8)

# Red warning
warn = ParagraphStyle("WRN", fontSize=10, leading=15,
    backColor=colors.HexColor("#ffebee"), borderPad=8, spaceAfter=8,
    textColor=colors.HexColor("#b71c1c"), leftIndent=8, rightIndent=8)

bullet = ParagraphStyle("BUL", fontSize=10.5, leading=16, leftIndent=16,
    spaceAfter=3, textColor=colors.HexColor("#1a1a1a"))

def CH(t):  return Paragraph(f"  {t}", chapter_title)
def SEC(t): return Paragraph(t, section)
def SUB(t): return Paragraph(t, subsec)
def E(t):   return Paragraph(t, easy)
def REM(t): return Paragraph(f"<b>🔑 Remember:</b> {t}", remember)
def ANA(t): return Paragraph(f"<b>💡 Think of it this way:</b> {t}", analogy)
def TIP(t): return Paragraph(f"<b>📝 Exam Tip:</b> {t}", examtip)
def WRN(t): return Paragraph(f"<b>⚠ Important:</b> {t}", warn)
def BL(t):  return Paragraph(f"• {t}", bullet)
def sp(n=6):return Spacer(1, n)
def hr():   return HRFlowable(width="100%", thickness=0.5,
                color=colors.HexColor("#bbdefb"), spaceAfter=4)

story = []

# ── COVER ───────────────────────────────────────────────────────────────────
story += [sp(50),
    Paragraph("GENERAL MEDICINE", cover_title),
    Paragraph("Easy-to-Understand Study Notes", cover_title), sp(12),
    Paragraph("Written like a friend explaining — not a textbook!", cover_sub),
    Paragraph("3rd Year BPT  |  University Exam Preparation", cover_sub), sp(8),
    HRFlowable(width="100%", thickness=2, color=colors.HexColor("#0d47a1"), spaceAfter=10),
    E("These notes cover all 11 topics from your General Medicine syllabus. Every topic is explained in plain English with simple examples so you actually understand what is happening in the body — not just memorise words."),
    sp(6),
    E("<b>Topics covered:</b>"),
    BL("Topic 1 — Infection (HIV, STDs, vaccinations)"),
    BL("Topic 2 — Poisoning"),
    BL("Topic 3 — Food and Nutrition (Malnutrition, Obesity)"),
    BL("Topic 4 — Endocrine (Diabetes — very detailed)"),
    BL("Topic 5 — Blood Disorders (Anaemia, Haemophilia)"),
    BL("Topic 6 — Digestive System (GI, Liver)"),
    BL("Topic 7 — Cardiovascular (Heart attacks, Hypertension)"),
    BL("Topic 8 — Respiratory (COPD, Asthma, TB)"),
    BL("Topic 9 — Skin Diseases"),
    BL("Topic 10 — Paediatrics (Child health)"),
    BL("Topic 11 — Psychiatry"),
    sp(30),
    Paragraph("Orris AI Study Assistant  |  July 2026", cover_sub),
    PageBreak()]

# ════════════════════════════════════════════════════════════════
# TOPIC 1 — INFECTION
# ════════════════════════════════════════════════════════════════
story += [CH("TOPIC 1 — INFECTION"), sp(6)]

story += [SEC("What is an infection?"), sp(4),
E("Okay so imagine your body is a house. Normally the doors are locked — your skin, your immune system, your mucus membranes are all guards. An infection happens when a germ (bacteria, virus, fungus, or parasite) breaks into the house and starts causing trouble."),
sp(4),
E("When germs enter, your body fights back by sending soldiers — white blood cells. This fight causes inflammation — which is why you get redness, swelling, heat, and pain at the infected spot. If the germs spread to your blood, the whole body feels the battle — you get fever, chills, tiredness, and increased heart rate."),
sp(4),
ANA("Think of a bacterial infection like a burglar who breaks in, makes a mess, and leaves. A virus is more like a hacker — it gets inside your own cells and uses them to make copies of itself. Your body has to destroy its own cells to stop the virus."),
sp(6)]

story += [SEC("How does infection spread?"), sp(4),
E("Infections spread in several ways. Direct contact means touching an infected person or their fluids — like shaking hands with someone who has the flu and then touching your mouth. Airborne spread means tiny droplets float in the air — TB and measles spread this way. Fecal-oral spread means the germ gets from someone's poo into another person's mouth — through contaminated food or dirty water (like cholera, hepatitis A). Blood-borne spread means the germ is in the blood — HIV and Hepatitis B/C spread this way through needles, blood transfusions, or unprotected sex."),
sp(6)]

story += [SEC("Vaccinations — giving your body a shortcut"), sp(4),
E("Normally your body learns to fight a germ only after it gets infected — and by then you might be very sick. A vaccine tricks your body into learning the fight WITHOUT actually getting the disease. It shows your immune system a harmless version of the germ (or just a piece of it), your body makes antibodies, and if the real germ ever comes — your body is already ready."),
sp(4),
E("Important vaccines you should know: BCG — given at birth, protects against TB. DPT — protects against Diphtheria, Pertussis (whooping cough), and Tetanus. OPV/IPV — protects against Polio. MMR — Measles, Mumps, Rubella. Hepatitis B vaccine — given at 0, 1, and 6 months."),
REM("Active immunity = your body makes antibodies (from vaccine or natural infection). Passive immunity = you receive ready-made antibodies (like a newborn getting antibodies from mother's milk)."),
sp(6)]

story += [SEC("Food Poisoning and Gastroenteritis"), sp(4),
E("Food poisoning happens when you eat food that has bacteria or their toxins in it. Staphylococcus aureus is a common cause — it releases a toxin in food that causes vomiting within 1-6 hours of eating. Salmonella is another common cause — comes from undercooked chicken or eggs. You get diarrhoea, vomiting, and stomach cramps."),
sp(4),
E("Gastroenteritis is inflammation of the stomach and intestines — the main features are diarrhoea and vomiting. Rotavirus is the most common cause in children. The real danger is dehydration — especially in babies and elderly people."),
sp(4),
E("Treatment is mostly supportive — Oral Rehydration Salts (ORS). ORS is just water + sugar + salt in the right proportions. It helps the body absorb fluid even when the gut is inflamed. Antibiotics are only needed in severe cases."),
ANA("ORS works because there's a special pump in the gut wall — glucose and sodium get absorbed together, and water follows. That's why plain water alone is NOT as effective as ORS."),
sp(6)]

story += [SEC("HIV and AIDS — explained simply"), sp(4),
E("HIV stands for Human Immunodeficiency Virus. It attacks a specific type of white blood cell called CD4+ T cells — these are like the generals of your immune army. As HIV slowly kills more and more of these generals, your immune system gets weaker and weaker."),
sp(4),
E("AIDS is the final stage — when your CD4 count drops below 200 (normal is 500-1500). At this point, your immune system is so weak that even germs that would never harm a healthy person can kill you. These are called opportunistic infections — like a type of pneumonia called PCP, a fungal meningitis, and a cancer called Kaposi's sarcoma."),
sp(4),
E("How does HIV spread? Through unprotected sex (most common), sharing needles, blood transfusions with infected blood, or from mother to baby during pregnancy, delivery, or breastfeeding. It does NOT spread through hugging, sharing food, mosquito bites, or toilet seats."),
sp(4),
E("Stages of HIV: First, about 2-4 weeks after infection, the person gets a flu-like illness — fever, rash, swollen lymph nodes. Then it goes quiet for years — the person looks healthy but is still infectious. Eventually symptoms come back — weight loss, mouth infections, TB. Then AIDS, when the CD4 is below 200."),
sp(4),
E("Diagnosis: First do an ELISA test (blood test that looks for HIV antibodies). If positive, confirm with a Western Blot test. The CD4 count tells how sick the immune system is. Viral load tells how much virus is in the blood."),
sp(4),
E("Treatment: ART — Antiretroviral Therapy. A combination of drugs that stop the virus from multiplying. It is NOT a cure, but it keeps the virus suppressed so the person can live a normal life. They must take it every day for life."),
TIP("For exams: HIV CD4 thresholds — above 500 = healthy, 200-500 = symptomatic HIV, below 200 = AIDS. Know ELISA + Western Blot for diagnosis. Know ART = treatment (not cure)."),
sp(6)]

story += [SEC("STDs — Sexually Transmitted Diseases"), sp(4),
E("These are infections spread through sexual contact. Key ones to know:"),
sp(4),
E("<b>Gonorrhoea:</b> Caused by bacteria Neisseria gonorrhoeae. In men — burning when urinating and thick yellow-green discharge from the penis. In women — often no symptoms but can cause pelvic pain and infertility. Treatment: Ceftriaxone injection."),
sp(4),
E("<b>Syphilis:</b> Caused by Treponema pallidum. Has 3 stages. Primary — a painless ulcer (called a chancre) appears where infection entered. Secondary — a body-wide rash, including on palms and soles. Tertiary — years later, affects heart and brain. Treatment: Penicillin G."),
sp(4),
E("<b>Chlamydia:</b> Most common STD. Often NO symptoms, so people don't know they have it. Can cause pelvic inflammatory disease and infertility in women. Treatment: Azithromycin (single dose)."),
TIP("Remember Syphilis stages: Painless chancre (Primary) → Rash on palms and soles (Secondary) → Heart/brain damage (Tertiary). Rash on PALMS is a classic exam clue — very few rashes go to palms."),
PageBreak()]

# ════════════════════════════════════════════════════════════════
# TOPIC 2 — POISONING
# ════════════════════════════════════════════════════════════════
story += [CH("TOPIC 2 — POISONING"), sp(6)]

story += [SEC("General approach to any poisoning"), sp(4),
E("When someone comes in after taking a poison, the first thing you do is NOT worry about which poison — you stabilise the patient first using the ABCDE approach. A = is the airway open? B = are they breathing? C = is the heart pumping and BP okay? D = is the brain working (check Glasgow Coma Scale and blood sugar)? E = expose them to find clues (rash, burns around mouth, needle marks)."),
sp(4),
E("After stabilising, you try to remove the poison. If it was on skin or eyes, wash it off with lots of water. If they swallowed it recently (within 1 hour) and it's not a corrosive or oil-based substance, you can do gastric lavage — put a tube into the stomach through the mouth and wash it out. Activated charcoal (a black powder mixed with water) can be given by mouth — it absorbs many poisons in the gut before they get absorbed into blood. But it does NOT work for metals like iron or lithium."),
WRN("NEVER make someone vomit if they swallowed a corrosive (acid or alkali like toilet cleaner) or a petroleum product (like petrol or kerosene). Vomiting will burn their throat again on the way up — making it much worse!"),
sp(6)]

story += [SEC("Specific Poisons — Know the Antidote!"), sp(4),
E("<b>Organophosphate Poisoning (pesticides like insecticides):</b> Very common in India — agricultural workers and suicide attempts. These poisons block an enzyme called acetylcholinesterase, which means the nerve-muscle chemical acetylcholine builds up everywhere. The result is what we call DUMBBELS — Diarrhoea, Urination (involuntary), Miosis (tiny pupils), Bradycardia (slow heart), Bronchospasm (breathing difficulty), Emesis (vomiting), Lacrimation (tears), Salivation (drooling). The patient is literally leaking from everywhere and their heart is slowing down. Antidote: ATROPINE in large doses (blocks the acetylcholine effects) PLUS Pralidoxime (actually reactivates the blocked enzyme if given early)."),
sp(4),
E("<b>Paracetamol (Crocin/Dolo) Overdose:</b> This is deceptive — the patient feels fine for the first 24 hours. But paracetamol in overdose produces a toxic byproduct in the liver that destroys liver cells. By day 2-3, the patient develops liver failure — jaundice, bleeding, confusion, coma. Antidote: N-Acetylcysteine (NAC) — must be given within 8-10 hours for best effect. It provides the raw material the liver needs to neutralise the toxic byproduct."),
sp(4),
E("<b>Opioid Overdose (morphine, heroin, codeine):</b> Classic triad — tiny pinpoint pupils + very slow breathing + unconscious/coma. Think of it as the brain's 'off switch' being hit too hard. Antidote: Naloxone — it kicks the opioid off its receptors almost instantly and the patient wakes up. But naloxone wears off faster than heroin, so you may need to give repeat doses."),
sp(4),
E("<b>Carbon Monoxide (CO) Poisoning:</b> Colourless, odourless gas from fires, car exhausts, generators in closed rooms. CO binds to haemoglobin much more tightly than oxygen — so the blood carries CO instead of O2 and the person slowly suffocates. Skin colour may look cherry red (though this is a late sign). Headache, confusion, then coma. Treatment: 100% oxygen through a non-rebreathing mask forces the CO off the haemoglobin."),
REM("Antidotes summary: Organophosphate → Atropine + Pralidoxime | Paracetamol → N-Acetylcysteine | Opioids → Naloxone | Benzodiazepines → Flumazenil | Iron → Desferrioxamine | CO → 100% Oxygen"),
TIP("In any poisoning exam question, they describe the clinical picture and ask for the antidote. Learn the classic features of each poison and its antidote pair."),
PageBreak()]

# ════════════════════════════════════════════════════════════════
# TOPIC 3 — FOOD AND NUTRITION
# ════════════════════════════════════════════════════════════════
story += [CH("TOPIC 3 — FOOD AND NUTRITION"), sp(6)]

story += [SEC("Why do we need food?"), sp(4),
E("Food gives our body three things: Energy (to run all processes), Building blocks (proteins to make cells, hormones, antibodies), and Regulatory nutrients (vitamins and minerals that control thousands of body functions). When any of these are missing, specific diseases develop."),
sp(6)]

story += [SEC("Vitamin Deficiency Diseases"), sp(4),
E("<b>Vitamin A deficiency:</b> Vitamin A keeps your eyes and skin healthy. Without it, the first problem is night blindness — you cannot see in dim light. If it gets worse, the surface of the eye dries up (Xerophthalmia), white foamy spots called Bitot's spots appear on the whites of eyes, and eventually the cornea melts away (Keratomalacia) causing permanent blindness. This is the leading cause of preventable blindness in children worldwide."),
sp(4),
E("<b>Vitamin B1 (Thiamine) deficiency — Beriberi:</b> Thiamine is essential for nerves and heart muscles. Without it you get two forms: Dry Beriberi — your peripheral nerves die, starting from the feet (peripheral neuropathy — numbness, weakness). Wet Beriberi — your heart muscle weakens, leading to heart failure and swelling of the body. There's also Wernicke's Encephalopathy — confusion, eye movement problems, and stumbling gait from thiamine deficiency in alcoholics."),
sp(4),
E("<b>Vitamin B3 (Niacin) deficiency — Pellagra:</b> Remember the 4 Ds — Dermatitis (a sunburn-like rash on sun-exposed skin), Diarrhoea, Dementia, and if untreated — Death. Common in people who eat mostly maize (corn)."),
sp(4),
E("<b>Vitamin C deficiency — Scurvy:</b> Vitamin C is essential for making collagen — the glue that holds your body together. Without it, collagen breaks down. You get bleeding gums, tiny bleeding spots around hair follicles, wounds that won't heal, and your teeth loosen. Classic history: old sailors on long voyages with no fresh fruit."),
sp(4),
E("<b>Vitamin D deficiency:</b> Vitamin D controls calcium absorption. Without it, bones become soft. In children this causes Rickets — bow legs, knock knees, and a rosary of beads you can feel on the ribs where they join cartilage (costochondral rosary). In adults it causes Osteomalacia — bone pain and muscle weakness (proximal myopathy — difficulty climbing stairs or rising from a chair)."),
sp(4),
E("<b>Iron deficiency:</b> Iron makes haemoglobin. Without enough iron, haemoglobin falls — you get anaemia. The specific signs of iron deficiency are: Koilonychia (spoon-shaped nails — the nail curves upward instead of downward), angular stomatitis (painful cracks at corners of mouth), glossitis (smooth red tongue), and Pica (eating weird things like ice, chalk, clay)."),
ANA("Think of iron as the ingredient that makes haemoglobin red. Without iron, haemoglobin production falls, red blood cells become small and pale — that's microcytic hypochromic anaemia."),
sp(6)]

story += [SEC("Kwashiorkor vs Marasmus — very commonly tested!"), sp(4),
E("Both are types of severe malnutrition in children, but they have different causes and appearances."),
sp(4),
E("<b>Marasmus</b> is pure starvation — not enough of ANY food. The child's body eats itself for energy — burns all the fat, then the muscles. The child looks like a tiny old person — all skin and bones, no fat anywhere, but no swelling. Weight is severely low (less than 60% of expected). Most common in infants under 1 year."),
sp(4),
E("<b>Kwashiorkor</b> happens when the child gets some calories (usually from starchy food like rice or cassava) but almost NO protein. Without protein, the liver can't make albumin (the protein that keeps fluid inside blood vessels). Fluid leaks out into tissues causing oedema — swollen belly, swollen face (moon face), swollen legs. The child may look chubby but it's all fluid, not fat. Skin gets flaky (flaky paint dermatitis) and hair loses its colour (flag sign — alternating light and dark bands). Seen more in 1-3 year olds."),
REM("Key difference: Marasmus = NO oedema, severely underweight, skin and bones. Kwashiorkor = HAS oedema, moon face, flaky skin. Both have low albumin but Kwashiorkor's is much lower."),
TIP("Exam favourite: Draw a table comparing Kwashiorkor vs Marasmus. Know: oedema (yes/no), age, cause, appearance, albumin level."),
sp(6)]

story += [SEC("Obesity"), sp(4),
E("Obesity means having too much body fat. We measure it using BMI (Body Mass Index) = Weight in kg divided by Height in metres squared. Normal BMI is 18.5-24.9. Overweight is 25-29.9. Obese is 30 and above. Morbidly obese is 40 and above."),
sp(4),
E("Why is obesity dangerous? Carrying too much weight damages almost every organ. The heart has to work harder — high blood pressure, heart disease. Insulin doesn't work properly in fat tissue — Type 2 Diabetes. The joints get overloaded — knee and hip arthritis. Fat around the neck causes sleep apnoea — you stop breathing while sleeping. And obesity increases the risk of several cancers."),
sp(4),
E("Treatment: The most important intervention is lifestyle change — eating less calories and exercising more. Even a 5-10% weight loss significantly reduces health risks. Medications like Orlistat (blocks fat absorption in the gut) or newer GLP-1 drugs (like Ozempic) help. For morbidly obese patients with complications, bariatric surgery (sleeve gastrectomy or gastric bypass) gives dramatic results."),
PageBreak()]

# ════════════════════════════════════════════════════════════════
# TOPIC 4 — ENDOCRINE
# ════════════════════════════════════════════════════════════════
story += [CH("TOPIC 4 — ENDOCRINE DISEASES"), sp(6)]

story += [SEC("Diabetes Mellitus — The Most Important Topic in Medicine!"), sp(4),
E("Diabetes is about blood sugar. Normally, when you eat, blood sugar rises, and the pancreas releases insulin. Insulin is like a KEY that opens the door of cells so glucose can enter and be used for energy. In diabetes, either the key doesn't exist (Type 1) or the lock is broken (Type 2)."),
sp(4),
ANA("Imagine glucose is people trying to enter a building (your cells). Insulin is the key card. Type 1: The key card machine is broken — no key cards are being made. Everyone (glucose) is stuck outside (in the blood). Type 2: The key card machine works but the doors (cell receptors) are jammed — they need many key cards to open."),
sp(4),
E("<b>Type 1 Diabetes:</b> The body's own immune system attacks and destroys the beta cells of the pancreas (the cells that make insulin). Without any insulin, glucose piles up in the blood. The body thinks it's starving (because glucose can't enter cells), so it starts breaking down fat — producing ketones. This can lead to Diabetic Ketoacidosis (DKA) — a life-threatening emergency. Type 1 is mostly in young people, they are usually thin, and they MUST have insulin injections to survive."),
sp(4),
E("<b>Type 2 Diabetes:</b> The pancreas still makes insulin, but the body's cells have stopped responding to it properly — this is called Insulin Resistance. It's common in overweight, older adults, and strongly linked to lifestyle. It develops slowly over years — the person may not know they have it for a long time."),
sp(4),
E("<b>Symptoms of Diabetes (The 3 Ps):</b> Polyuria — you pee a LOT because the kidneys try to flush out excess glucose in the urine, and water follows the glucose. Polydipsia — you are extremely thirsty because you're losing so much water. Polyphagia — you feel hungry all the time because even though blood glucose is high, it can't get into cells, so cells feel starved. Plus: weight loss, tiredness, blurred vision, slow-healing wounds, and frequent infections (bacteria love high glucose)."),
sp(4),
E("<b>Diagnosing Diabetes:</b> Fasting blood glucose of 126 mg/dL (7.0 mmol/L) or above — on two occasions. OR random blood glucose of 200 mg/dL with symptoms. OR HbA1c of 6.5% or above. HbA1c is like a 3-month average of your blood sugar — glucose sticks to haemoglobin, and the more glucose there is over time, the more sticks."),
REM("HbA1c = the 3-month average blood sugar report card. Target for a diabetic on treatment is below 7%. It's the best long-term monitoring test."),
sp(6),
SEC("Complications of Diabetes — Understanding WHY they happen"),
sp(4),
E("High blood glucose is toxic — it damages blood vessels and nerves over time. This causes two categories of complications:"),
sp(4),
E("<b>Microvascular (small blood vessel damage):</b> RETINOPATHY — damage to the tiny blood vessels in the retina of the eye. New, fragile blood vessels grow (like weeds) and can bleed, causing vision loss. Diabetes is the most common cause of blindness in working-age adults. Get annual eye check. NEPHROPATHY — damage to the filtering units of the kidney (glomeruli). First sign is protein leaking into urine (microalbuminuria). Progresses to kidney failure. ACE inhibitors help protect the kidneys. NEUROPATHY — nerves die from lack of blood supply. Starts as numbness and tingling in feet (glove and stocking pattern). Autonomic neuropathy causes dizziness on standing, constipation, inability to empty bladder, erectile dysfunction."),
sp(4),
E("<b>Macrovascular (large blood vessel damage):</b> The big arteries get blocked with atherosclerosis faster in diabetics. This causes Heart attacks (IHD), Strokes, and Peripheral arterial disease (poor blood supply to legs). The combination of neuropathy (can't feel the feet) + poor blood supply to feet = DIABETIC FOOT — ulcers develop, get infected, don't heal, and can lead to amputation."),
sp(4),
E("<b>Acute Emergencies:</b> DKA (mostly Type 1) — body breaks down fat, makes ketones, blood becomes acid. Patient has fruity breath, deep rapid breathing (Kussmaul), vomiting, confusion. Treated with IV fluids + insulin drip + potassium. HHS (Hyperosmolar Hyperglycaemic State — mostly Type 2) — blood glucose goes extremely high (above 600) without ketones. Severe dehydration, confusion. HYPOGLYCAEMIA — blood sugar drops too low (below 3.9). Causes sweating, shaking, hunger, palpitations. If severe — seizures and coma. Treatment: 15g of fast sugar immediately (glucose tablets, fruit juice) — 'Fifteen-fifteen rule'."),
sp(4),
E("<b>Treatment of Type 2 DM:</b> Start with lifestyle — diet changes and exercise, aim for weight loss. Then add Metformin (the standard first drug — cheap, safe, doesn't cause weight gain). Then add more drugs as needed. Eventually insulin if tablets aren't enough."),
TIP("DM exam questions: Know the 3 Ps, HbA1c target (<7%), DKA vs HHS difference, all complications and the vessels/nerves they affect, management steps. Diabetes comes in almost EVERY medicine exam."),
sp(6)]

story += [SEC("Thyroid Problems"), sp(4),
E("<b>Hypothyroidism (too little thyroid hormone):</b> The thyroid is like the body's throttle — it controls how fast everything runs. When it's underactive, everything slows down — your heart rate slows, digestion slows (constipation), metabolism slows (you gain weight), you feel cold all the time, your skin and hair become dry, and you feel deeply fatigued. In severe cases, a thick gel-like substance accumulates under the skin — this is called myxoedema. The TSH (from pituitary) goes HIGH because the brain is shouting 'make more thyroid hormone!' but the thyroid can't respond. Treatment: Thyroxine (T4) tablets daily — the TSH comes back to normal when replacement is adequate."),
sp(4),
E("<b>Hyperthyroidism (too much thyroid hormone):</b> Now the throttle is stuck on maximum. Heart races (palpitations), you lose weight despite eating a lot, you feel hot and sweaty all the time, your hands tremble, you feel anxious and can't sleep, and bowels move too fast (diarrhoea). In Graves' Disease (autoimmune cause, most common), the eyes may bulge outwards — called exophthalmos. TSH is LOW because the pituitary sees enough thyroid hormone and stops asking. Treatment: Anti-thyroid drugs (Carbimazole), Beta-blockers to slow the heart, radioactive iodine to destroy overactive thyroid tissue, or surgery."),
ANA("Thyroid = your body's engine throttle. Hypo = engine running too slow, everything sluggish. Hyper = engine revving too fast, everything racing."),
PageBreak()]

# ════════════════════════════════════════════════════════════════
# TOPIC 5 — BLOOD DISEASES
# ════════════════════════════════════════════════════════════════
story += [CH("TOPIC 5 — DISEASES OF THE BLOOD"), sp(6)]

story += [SEC("Anaemia — When Your Blood Can't Carry Enough Oxygen"), sp(4),
E("Haemoglobin is the protein in red blood cells that carries oxygen. Anaemia means haemoglobin is below normal — below 13 g/dL in men and 12 g/dL in women. When this happens, your body gets less oxygen, and you feel: tired and weak (most common), breathless on walking or climbing stairs, your heart beats faster trying to compensate, and you look pale — check the inside of the lower eyelid, the palms, and the tongue — these will look white instead of pink."),
sp(6)]

story += [SEC("Iron Deficiency Anaemia — Most Common Anaemia Worldwide"), sp(4),
E("Iron is the most important ingredient to make haemoglobin. You can run out of iron because you're not eating enough (poor diet, vegetarians without supplementation), you're losing blood (in women — heavy periods; in men — bleeding from the gut such as a stomach ulcer or bowel cancer), or you're not absorbing it properly (celiac disease, after stomach surgery)."),
sp(4),
E("What's special about iron deficiency, beyond just anaemia? The nails become spoon-shaped and concave — this is called Koilonychia. Cracks appear at the corners of the mouth — Angular Stomatitis. The tongue becomes smooth and sore — Glossitis. And some patients develop Pica — they crave weird non-food things like ice, chalk, dirt, or clay. The red blood cells become small (microcytic) and pale (hypochromic) because there's not enough iron to fill them."),
sp(4),
E("Treatment: Iron tablets — Ferrous Sulphate, taken 3 times a day for 3-6 months. Continue for 3 months AFTER the haemoglobin becomes normal to refill the iron stores. The first sign the treatment is working is a rise in reticulocytes (young red blood cells) within 5-7 days."),
REM("In iron deficiency: Ferritin is LOW (ferritin stores iron — it's the first to fall), TIBC is HIGH (when iron is low, the body makes more carrier protein to grab any iron it can find)."),
sp(6)]

story += [SEC("Haemophilia — When Blood Won't Clot"), sp(4),
E("Normally when you cut yourself, a complex chain reaction happens involving proteins called clotting factors, ending in a fibrin clot that plugs the wound. In Haemophilia, one of these factors is missing."),
sp(4),
E("Haemophilia A is missing Factor 8 (eight). Haemophilia B is missing Factor 9 (nine). Both are X-linked — meaning the gene is on the X chromosome. Since men have only one X chromosome, if it's faulty, they get haemophilia. Women have two X chromosomes, so if one is faulty, the other compensates — they are carriers but don't usually have the disease."),
sp(4),
E("What happens? Even small injuries cause prolonged bleeding. Spontaneous bleeding into joints — especially knees, ankles, elbows — is very common. The joint fills with blood, becomes swollen, hot, and extremely painful. Repeated bleeds damage the joint permanently (haemophilic arthropathy). Bleeding into muscles causes deep haematomas."),
sp(4),
E("Treatment: Give the missing clotting factor — recombinant Factor VIII (for Haemophilia A) or Factor IX (for Haemophilia B). For mild Haemophilia A, DDAVP can temporarily raise Factor VIII levels."),
E("<b>PT role:</b> During acute joint bleeds — RICE (Rest, Ice, Compression, Elevation). NO manipulation or vigorous exercises during bleeding. Once bleeding has stopped — gentle range of motion exercises, pool therapy (hydrotherapy is excellent as water supports body weight), and gradual strengthening to protect the joints."),
TIP("APTT is prolonged in Haemophilia (measures intrinsic pathway). PT/INR is normal. Platelet count is normal. Bleeding time is normal. Only APTT is abnormal."),
PageBreak()]

# ════════════════════════════════════════════════════════════════
# TOPIC 6 — DIGESTIVE SYSTEM
# ════════════════════════════════════════════════════════════════
story += [CH("TOPIC 6 — DIGESTIVE SYSTEM"), sp(6)]

story += [SEC("GERD — Acid coming up the wrong way"), sp(4),
E("Gastro-Oesophageal Reflux Disease. The stomach has a valve at the top called the Lower Oesophageal Sphincter (LES) that normally keeps stomach acid from going up into the food pipe (oesophagus). In GERD, this valve is weak or relaxes too often — acid comes up and burns the oesophagus."),
sp(4),
E("Symptoms: Heartburn — a burning feeling in the centre of the chest, especially after meals and when lying down. Water brash — sudden flooding of the mouth with saliva. Regurgitation — food/acid coming back up. If this goes on for years, the normal lining of the oesophagus gets replaced by an abnormal lining (Barrett's oesophagus) — which can become cancer."),
sp(4),
E("Treatment: Lifestyle first — don't lie down after meals, raise the head of the bed, avoid fatty food, coffee, alcohol, cigarettes. Medications: Antacids for quick relief. PPIs (like Omeprazole) — the best treatment — reduce acid production dramatically."),
sp(6)]

story += [SEC("Peptic Ulcer Disease"), sp(4),
E("A peptic ulcer is a hole or sore in the lining of the stomach or the first part of the small intestine (duodenum). The lining normally protects itself from the acid inside, but two things damage this protection: H. pylori bacteria (tiny bacteria that burrow into the stomach lining and weaken its defences) and NSAIDs (painkillers like ibuprofen and diclofenac that reduce the protective mucus layer)."),
sp(4),
E("Duodenal ulcer pain: Epigastric (upper middle abdomen) pain that comes on when the stomach is EMPTY — 2-3 hours after meals and at night. It's relieved by eating. Gastric ulcer pain: Pain comes on SOON after eating (stomach acid hitting the ulcer) and eating makes it worse."),
sp(4),
E("Complications: If the ulcer bleeds — vomiting blood (haematemesis) or black tarry stools (melaena). If it perforates — acid spills into the abdomen, causing sudden severe 'board-like' rigidity of the abdomen — surgical emergency!"),
sp(4),
E("Treatment: Test for H. pylori (breath test, stool antigen). If positive — Triple therapy: PPI + Amoxicillin + Clarithromycin for 7-14 days. Stop NSAIDs. Take PPIs."),
sp(6)]

story += [SEC("UC vs Crohn's Disease — Know the Difference!"), sp(4),
E("Both are inflammatory bowel diseases — the immune system attacks the bowel for unknown reasons. But they are different diseases."),
sp(4),
E("<b>Ulcerative Colitis (UC):</b> Only affects the large bowel (colon). Always starts in the rectum and spreads continuously upward. Only the inner lining of the bowel is inflamed. Main symptom: BLOODY diarrhoea with mucus, urgency, needing to run to the toilet. Complications include toxic megacolon (colon dilates dangerously) and increased risk of colon cancer. Surgery (removing the entire colon) is CURATIVE."),
sp(4),
E("<b>Crohn's Disease:</b> Can affect ANY part of the gut from mouth to anus. Has 'skip lesions' — healthy areas of bowel between inflamed patches. The inflammation goes through the ENTIRE wall of the bowel (transmural). This means it can cause fistulas (abnormal tunnels between loops of bowel or to skin) and strictures (narrowing). Symptoms: Abdominal pain, diarrhoea (may not be bloody), weight loss, fatigue. Surgery removes the diseased segment but is NOT curative — Crohn's comes back elsewhere."),
ANA("UC: a continuous house fire starting from the back door (rectum), going forward. Crohn's: random fires anywhere from basement to attic, fires go through the walls (full thickness)."),
TIP("Classic exam question: What is bloody diarrhoea in IBD? UC. What has skip lesions and fistulas? Crohn's. Which one is cured by surgery? UC."),
sp(6)]

story += [SEC("Liver — Hepatitis and Cirrhosis"), sp(4),
E("Hepatitis simply means inflammation of the liver. It can be caused by viruses (A, B, C, D, E), alcohol, drugs, or the immune system attacking itself."),
sp(4),
E("<b>Hepatitis A and E:</b> Spread through contaminated food and water (fecal-oral route). Cause acute hepatitis — fever, jaundice, dark urine, pale stools, nausea. Hepatitis A almost always gets better on its own. Hepatitis E is especially dangerous in pregnant women — can cause acute liver failure. No specific treatment — the body clears it. Vaccine available for Hep A."),
sp(4),
E("<b>Hepatitis B:</b> Spread through blood, sex, and mother to baby. Most people clear it (90% of adults). But 10% develop chronic Hepatitis B — the virus stays in the liver for life, slowly causing damage, potentially leading to cirrhosis and liver cancer (Hepatocellular Carcinoma). Vaccine is available and is given to all newborns."),
sp(4),
E("<b>Hepatitis C:</b> Mainly spread through blood (sharing needles, tattoo needles, blood transfusions before screening was introduced). The sneaky one — 80% of infected people develop chronic infection, often with no symptoms for 20-30 years, until they develop cirrhosis. No vaccine, but it can now be CURED with modern Direct-Acting Antiviral drugs (DAAs) in 8-12 weeks."),
sp(4),
E("<b>Cirrhosis:</b> This is the end-result of ANY chronic liver disease — years of damage lead to the normal liver tissue being replaced by scar tissue (fibrosis). A scarred liver cannot function properly. Signs of a failing liver: Jaundice (yellow skin/eyes — liver can't process bilirubin), Ascites (fluid accumulates in the belly — looks like a swollen pregnant belly), Bleeding easily (liver makes clotting factors, so without a functioning liver you can't clot properly), Confusion and coma (Hepatic Encephalopathy — the liver normally detoxifies ammonia from gut bacteria, a failing liver can't, so ammonia builds up and affects the brain). Signs of portal hypertension (high blood pressure in the portal vein): Oesophageal varices (swollen veins in the food pipe that can burst and cause massive bleeding), Caput medusae (visible veins radiating from the belly button — like Medusa's hair)."),
WRN("Oesophageal variceal bleed is a life-threatening emergency — patients vomit large amounts of bright red blood. Mortality is very high. Treatment: IV terlipressin, urgent endoscopy (band ligation)."),
PageBreak()]

# ════════════════════════════════════════════════════════════════
# TOPIC 7 — CARDIOVASCULAR
# ════════════════════════════════════════════════════════════════
story += [CH("TOPIC 7 — CARDIOVASCULAR DISEASE"), sp(6)]

story += [SEC("Hypertension — The Silent Killer"), sp(4),
E("Blood pressure is the force of blood pushing against artery walls. Normal is below 120/80 mmHg. Hypertension is defined as persistently above 140/90 mmHg. It's called the silent killer because it usually has NO symptoms — people walk around with dangerously high blood pressure for years without knowing. The damage is happening silently to the heart, brain, kidneys, and eyes."),
sp(4),
E("95% of hypertension has no identifiable single cause — this is called Essential (Primary) hypertension. Genes + lifestyle (salt, obesity, stress, alcohol, inactivity) all play a role. Only 5% has an identifiable cause (Secondary hypertension) like kidney disease, an adrenal gland tumour, or narrowing of the main artery to the kidney."),
sp(4),
E("What damage does it do? The constant high pressure is like blowing too hard into a balloon — eventually something bursts or gets blocked. In the brain: stroke (blood vessel bursts or blocks). In the heart: left ventricle has to pump against high pressure, so it gets thick and enlarged (LVH), eventually failing. Coronary arteries get damaged leading to heart attacks. In the kidneys: high pressure in the tiny kidney filters (glomeruli) damages them — eventually kidney failure. In the eyes: vessels in the retina get damaged — hypertensive retinopathy, sometimes seen as bleeding or whitish patches on the retina."),
sp(4),
E("Treatment: First try lifestyle — reduce salt (huge impact!), lose weight, exercise regularly, stop smoking, reduce alcohol. If blood pressure stays high after 3 months of lifestyle changes, add medication. Common drugs: ACE inhibitors (like Ramipril) — especially good if you also have diabetes or heart failure. CCBs (Calcium Channel Blockers like Amlodipine) — good for elderly. Thiazide diuretics (like Bendroflumethiazide) — make you pee out excess fluid. Beta-blockers if you also have a fast heart or IHD."),
TIP("Exam: Hypertension complications = ABCDE: A = Aortic dissection, B = Brain (stroke), C = Coronary artery disease, D = (kidney) Damage, E = Eyes (retinopathy)."),
sp(6)]

story += [SEC("Heart Attack (IHD/MI) — When Heart Gets No Blood"), sp(4),
E("Your heart muscle is always working — it never rests. To do this, it needs a constant supply of oxygen from the coronary arteries. Ischemic Heart Disease (IHD) is when these coronary arteries get blocked or narrowed, starving part of the heart muscle of oxygen."),
sp(4),
E("How does blockage happen? Over years, fat (cholesterol) deposits build up inside the walls of the coronary arteries, forming plaques (atherosclerosis). The plaque makes the artery narrower, like a clogged pipe. When enough blood can't get through during exercise — the heart hurts: this is Angina — a tight, crushing, or heavy pain in the centre of the chest, often radiating to the left arm or jaw, coming on with exertion and going away with rest or GTN spray."),
sp(4),
E("A heart attack (MI) happens when a plaque suddenly ruptures and a blood clot forms on top — completely blocking the artery. Now part of the heart muscle is completely cut off from blood supply and starts dying. The pain is severe, crushing, doesn't go away with rest, the person sweats profusely, feels sick, and has a feeling of doom. This is a STEMI (ST Elevation Myocardial Infarction) if the full wall of the heart is involved."),
sp(4),
E("Treatment: TIME IS MUSCLE — the longer the artery stays blocked, the more heart muscle dies forever. Immediately give Aspirin 300mg (prevents more clotting) + Clopidogrel. Morphine for pain. Oxygen only if blood oxygen is low. Then URGENTLY open the blocked artery — Primary PCI (angioplasty) where a wire with a balloon is threaded up to the blocked coronary artery, the balloon inflates to push open the blockage, and a metal stent is left to keep it open. This must happen within 90 minutes of the patient arriving at hospital — 'door to balloon time'."),
ANA("Think of primary PCI like a plumber using a drain snake to unblock a pipe and then putting in a mesh sleeve to keep it open. The sooner you do it, the less damage is done."),
sp(6)]

story += [SEC("Heart Failure — When the Pump is Failing"), sp(4),
E("Heart failure means the heart cannot pump enough blood to meet the body's needs. The most common cause is damage from previous heart attacks — parts of the heart muscle become scar tissue and can't pump."),
sp(4),
E("Left heart failure: The left ventricle fails to pump blood forward. Blood backs up into the lungs, making them waterlogged (pulmonary oedema). The person cannot breathe lying flat (Orthopnoea) — they need multiple pillows. They wake up gasping at night (Paroxysmal Nocturnal Dyspnoea — PND). You can hear crackling sounds in the lung bases (crepitations) like walking on bubble wrap."),
sp(4),
E("Right heart failure: Usually caused by left heart failure. Blood backs up into the body. Ankles and legs swell with fluid (pitting oedema). The liver gets engorged and painful. The neck veins are visibly swollen (raised JVP)."),
sp(4),
E("Treatment: Diuretics (Furosemide) to flush out excess fluid — the patient passes huge amounts of urine. ACE inhibitors to reduce the load on the heart. Beta-blockers to allow the weakened heart muscle to recover. Spironolactone for additional benefit."),
PageBreak()]

# ════════════════════════════════════════════════════════════════
# TOPIC 8 — RESPIRATORY
# ════════════════════════════════════════════════════════════════
story += [CH("TOPIC 8 — RESPIRATORY DISEASE"), sp(6)]

story += [SEC("Understanding Lung Function Tests"), sp(4),
E("A spirometer is a machine you breathe into that measures how well your lungs work. The key measurements: FEV1 — how much air you can blow out in 1 second. FVC — the total amount you can blow out completely. The ratio FEV1/FVC tells us what type of lung problem you have."),
sp(4),
E("If the ratio is BELOW 0.70 (70%) — the airways are narrowed (Obstructive pattern). Air gets trapped in. Examples: COPD, Asthma. If the ratio is NORMAL or ABOVE 0.70 but both FEV1 and FVC are reduced — the lungs are stiff and small (Restrictive pattern). Examples: Pulmonary fibrosis, severe kyphosis."),
ANA("Obstructive = a narrow straw (airways are narrowed, hard to blow air out fast). Restrictive = a small stiff balloon (lungs can't expand, total volume is small)."),
sp(6)]

story += [SEC("COPD — Chronic Obstructive Pulmonary Disease"), sp(4),
E("COPD is the most common serious lung disease, almost always caused by long-term cigarette smoking. Smoke damages the airways and lung tissue over 20-30 years. There are two types within COPD: Chronic Bronchitis — the airways are inflamed and produce huge amounts of mucus — cough with phlegm every day for at least 3 months a year, for 2 or more years. Emphysema — the tiny air sacs (alveoli) at the end of the airways get destroyed. Their walls break down and they merge into large, floppy sacs that can't transfer oxygen efficiently. The chest overinflates and becomes barrel-shaped."),
sp(4),
E("COPD gets worse over time and cannot be reversed — the damaged lung tissue doesn't regenerate. The most important treatment is stopping smoking immediately — it slows the decline dramatically. Then bronchodilators (inhalers) to widen the airways. Pulmonary rehabilitation — a structured exercise and education programme — is extremely effective at improving quality of life and exercise tolerance (very relevant to you as a PT!). For very severe cases with low blood oxygen, Long-Term Oxygen Therapy (LTOT) at home is prescribed."),
TIP("COPD is graded by severity using GOLD criteria based on FEV1: Grade 1 = mild (FEV1 ≥80%), Grade 2 = moderate (50-79%), Grade 3 = severe (30-49%), Grade 4 = very severe (<30%)."),
sp(6)]

story += [SEC("Asthma — The Reversible Airways Disease"), sp(4),
E("Asthma is inflammation and hypersensitivity of the airways. The airways are chronically inflamed and when exposed to a trigger — cold air, dust, pollen, exercise, smoke, stress — they go into spasm (bronchoconstriction), the lining swells, and thick mucus is produced. This makes breathing out very difficult. The classic features are wheeze (a whistling sound when breathing), cough (often worse at night), chest tightness, and shortness of breath. These come and go — between attacks, the patient may be completely fine."),
sp(4),
E("The key difference from COPD: Asthma is REVERSIBLE — a reliever inhaler (Salbutamol) opens the airways within minutes. COPD is largely irreversible. Asthma mostly starts in youth, is often allergic in nature, and the lungs are structurally normal between attacks."),
sp(4),
E("A severe asthma attack is a medical emergency — the patient cannot speak in full sentences, breathing rate is very fast, oxygen level drops. Treatment: High-flow oxygen, back-to-back nebulised salbutamol, IV/oral steroids, and if not responding — IV magnesium sulphate and ICU."),
sp(6)]

story += [SEC("Tuberculosis (TB) — Very Important in India"), sp(4),
E("TB is caused by Mycobacterium tuberculosis — a special slow-growing bacterium that loves oxygen-rich environments, especially the lungs. It spreads through tiny respiratory droplets when an infected person coughs, sneezes, or speaks. In India, TB is endemic — one of the highest TB burdens in the world."),
sp(4),
E("When TB bacteria first enter the lungs, the immune system usually contains them in a small nodule called a Ghon focus. Most people never develop symptoms (Latent TB) — the bacteria are dormant. But if immunity weakens (from HIV, malnutrition, steroids, old age), the bacteria reactivate and cause active TB."),
sp(4),
E("Active Pulmonary TB features: Cough lasting more than 3 weeks (especially with blood — haemoptysis), fever (typically low-grade in evenings), night sweats (soaking the bedsheet), and weight loss. On X-ray: shadowing at the top (apex) of the lungs."),
sp(4),
E("Diagnosis: Sputum test — look for bacteria under microscope (AFB — Acid-Fast Bacilli using Ziehl-Neelsen stain). GeneXpert (Cartridge-Based Nucleic Acid Amplification Test) is now widely used — quick, detects TB and drug resistance. Mantoux test — inject a tiny amount of TB protein under the skin — a positive reaction (induration >10mm) suggests TB exposure."),
sp(4),
E("Treatment: DOTS — Directly Observed Treatment Short course. 2 months of RHEZ (Rifampicin + Isoniazid + Ethambutol + Pyrazinamide) — the intensive phase. Then 4 months of RH (Rifampicin + Isoniazid) — the continuation phase. Total 6 months. Must be completed fully — stopping early leads to drug-resistant TB (MDR-TB) which is very difficult and expensive to treat."),
REM("Rifampicin turns urine, sweat, and tears orange — warn patients, it's normal! Isoniazid can cause peripheral neuropathy — give Pyridoxine (Vitamin B6) to prevent this."),
PageBreak()]

# ════════════════════════════════════════════════════════════════
# TOPIC 9 — SKIN
# ════════════════════════════════════════════════════════════════
story += [CH("TOPIC 9 — DISEASES OF THE SKIN"), sp(6)]

story += [SEC("Leprosy — Important for Physiotherapists!"), sp(4),
E("Leprosy is caused by Mycobacterium leprae — a relative of the TB bacterium. It spreads through prolonged close contact with infected nasal secretions (not casual touch). It grows very slowly and has a very long incubation period — symptoms may not appear for 2-10 years after infection."),
sp(4),
E("The bacterium attacks skin and peripheral nerves. On skin: you get patches that are pale (hypopigmented) or reddish, and crucially — LOSS OF SENSATION in these patches. This is the key distinguishing feature. If you find a skin patch without sensation — think leprosy. Peripheral nerve thickening is another hallmark — you can feel enlarged, cord-like nerves (ulnar nerve at elbow, common peroneal nerve at knee, great auricular nerve at neck)."),
sp(4),
E("Two main types: Tuberculoid Leprosy — strong immune response — few, well-defined patches, fewer bacteria, less contagious. Lepromatous Leprosy — weak immune response — widespread, symmetrical patches, numerous bacteria, thickened skin especially on face (leonine facies), loss of eyebrows (madarosis)."),
sp(4),
E("Complications (deformities) occur because of nerve damage: Claw hand — ulnar nerve damage weakens the intrinsic hand muscles. Foot drop — common peroneal nerve damage. Lagophthalmos — inability to close the eye (facial nerve damage) — leading to corneal damage and blindness if untreated. Loss of sensation means patients don't feel pain from injuries, burns, or pressure — so wounds develop and worsen without the patient knowing."),
sp(4),
E("Treatment: Multi-Drug Therapy (MDT) — combination of Rifampicin, Dapsone, and Clofazimine. Duration: 6 months for Paucibacillary (few bacteria), 12 months for Multibacillary (many bacteria). Available free from government health centres in India."),
E("<b>PT role in Leprosy:</b> This is highly relevant for you! Prevention of deformity — proper footwear, protective gloves, daily wound inspection, patient education. Splinting — to prevent contractures. Exercises — to maintain ROM and strengthen affected muscles. Tendon transfer surgery may be needed to restore function — PT before and after surgery is essential. Sensory re-education."),
TIP("Leprosy is the MOST physiotherapy-relevant skin disease. PT prevents disability, manages deformity, and rehabilitates after surgery."),
sp(6)]

story += [SEC("Psoriasis"), sp(4),
E("Psoriasis is an autoimmune skin disease where the skin cells multiply about 10 times faster than normal. Normally skin cells take about a month to mature and fall off. In psoriasis they do this in 3-4 days — the old cells pile up on the surface as thick, silvery-white scales on a red base (plaques). It looks alarming but it is NOT infectious."),
sp(4),
E("It typically appears on extensor surfaces (elbows, knees), scalp, and lower back. The Auspitz sign is when you scrape off the scales and pinpoint bleeding appears — this is characteristic of psoriasis. Nails can develop pitting (tiny holes like a thimble), thickening, and separation from the nail bed. About 30% of patients develop Psoriatic Arthritis — a type of joint inflammation similar to Rheumatoid Arthritis."),
sp(4),
E("Treatment: Mild cases — moisturisers (emollients), topical steroid creams, Vitamin D creams (calcipotriol). Moderate — phototherapy (UVB light). Severe — systemic drugs like Methotrexate (suppresses the immune overactivity), Ciclosporin, or newer Biologics (anti-TNF injections like Adalimumab — very effective but expensive)."),
PageBreak()]

# ════════════════════════════════════════════════════════════════
# TOPIC 10 — PAEDIATRICS
# ════════════════════════════════════════════════════════════════
story += [CH("TOPIC 10 — PAEDIATRICS"), sp(6)]

story += [SEC("Cerebral Palsy (CP) — Your Most Important Paediatrics Topic as a PT"), sp(4),
E("Cerebral Palsy is the umbrella term for a group of movement disorders caused by damage to the developing brain. The word 'cerebral' means brain, and 'palsy' means weakness or movement problem. Crucially — the brain damage does NOT get worse over time (non-progressive). But the consequences on the body — like muscle tightness and contractures — can worsen if not managed."),
sp(4),
E("Causes: Before birth — infections during pregnancy (rubella, CMV), lack of oxygen to the fetus, brain malformations. During birth — prolonged or complicated labour cutting off oxygen to the baby's brain (Birth Asphyxia — the most common cause in developing countries). After birth (up to age 2) — meningitis, brain injury, severe jaundice causing brain damage (kernicterus)."),
sp(4),
E("Types of CP: Spastic CP (75-80% of cases) — damage to the motor cortex or pyramidal tracts. Muscles are stiff (spastic), hyperreflexia, clonus (rhythmic jerking), and movement is stiff and effortful. Commonest pattern: Spastic Diplegia (both legs involved — 'scissors gait', legs cross when walking) or Spastic Hemiplegia (one side of the body). Dyskinetic/Athetoid CP (10-15%) — damage to the basal ganglia. Involuntary, writhing, twisting movements (athetosis) that disappear during sleep. Speech may be severely affected (dysarthria). Ataxic CP (5%) — damage to the cerebellum. Poor balance and coordination, wide-based unsteady gait, intention tremor (hand shakes as it reaches for something)."),
sp(4),
E("Associated problems: Epilepsy (30% of CP children). Intellectual disability (50% — but many children with CP have normal intelligence!). Visual problems (squint, cortical visual impairment). Hearing loss. Feeding difficulties (dysphagia — difficulty swallowing due to poor oral motor control). Communication difficulties."),
sp(4),
E("Management — this is team work (MDT): Physiotherapy is the backbone of CP management. NDT/Bobath approach — uses handling and positioning techniques to inhibit abnormal reflexes and facilitate normal movement. Stretching — prevents contractures in tight muscles. Strengthening — improves functional movement. Gait training. Adaptive equipment — walking frames, wheelchairs. Postural management 24 hours — correct positioning day, night, and in school to prevent deformity. Spasticity management: Baclofen (oral or pump implant directly to spinal cord), Botulinum toxin injections into spastic muscles (temporarily relaxes them for 3-4 months, allowing effective physiotherapy and splinting). Surgery — Selective Dorsal Rhizotomy (cuts overactive nerve roots to reduce spasticity permanently) — followed by intensive PT."),
REM("As a physiotherapist, CP is one of your most important conditions. Know the types, know the PT approaches (NDT/Bobath, carrying techniques, positioning), and know that EARLY intervention gives better outcomes."),
sp(6)]

story += [SEC("Spina Bifida — When the Spinal Tube Doesn't Close"), sp(4),
E("In the first few weeks of pregnancy, the baby's spinal cord develops from a flat sheet of tissue that rolls up into a tube and closes. In Spina Bifida, this tube fails to close completely — leaving the spinal cord exposed or malformed."),
sp(4),
E("Three types: Spina Bifida Occulta — minor defect, spinal cord is fine, no neurological problems. There may be a dimple or tuft of hair over the lower back. Meningocele — the membranes covering the spinal cord (meninges) bulge out through the gap as a fluid-filled sac, but the spinal cord is NOT in the sac — usually no neurological deficit. Myelomeningocele — the most severe type — both the meninges AND the spinal cord herniate out. The spinal cord is damaged at that level — paralysis and loss of sensation below the defect, bladder and bowel dysfunction, high risk of meningitis if the sac ruptures."),
sp(4),
E("Most myelomeningoceles also cause Hydrocephalus — blockage of CSF flow causes the fluid to build up and the head to enlarge. A shunt (tube) is surgically placed to drain the excess CSF. Prevention: Folic acid 5mg daily before and during the first 12 weeks of pregnancy dramatically reduces the risk of neural tube defects."),
sp(6)]

story += [SEC("Epilepsy"), sp(4),
E("A seizure happens when a sudden uncontrolled electrical discharge occurs in the brain — like an electrical storm. Epilepsy is when this happens repeatedly without a clear cause."),
sp(4),
E("Types: Focal (Partial) seizures — the electrical storm starts in one area of the brain. The person may remain conscious (simple focal) or have impaired consciousness (complex focal). Generalised seizures — the whole brain is involved. Tonic-Clonic (Grand Mal) — the classic 'fit' — body goes rigid, then jerks rhythmically, person falls and may bite tongue, lose bladder control, then is deeply confused afterwards (postictal state). Absence (Petit Mal) — momentary blank stare, eye flutter, lasts only 3-10 seconds — common in children, often mistaken for daydreaming."),
sp(4),
E("Treatment: Valproate — broad spectrum, good for generalised epilepsy. Carbamazepine — good for focal seizures. Status Epilepticus — a seizure lasting more than 5 minutes or repeated seizures without recovery — EMERGENCY. First line: Diazepam (rectal or IV). If persists: IV Phenytoin or Levetiracetam. If still not controlled: General anaesthesia in ICU."),
TIP("Status epilepticus = seizure >5 minutes = emergency. First line is always benzodiazepine (diazepam, lorazepam, midazolam). Know this for exams."),
PageBreak()]

# ════════════════════════════════════════════════════════════════
# TOPIC 11 — PSYCHIATRY
# ════════════════════════════════════════════════════════════════
story += [CH("TOPIC 11 — PSYCHIATRIC DISORDERS"), sp(6)]

story += [SEC("Depression — More Than Just 'Feeling Sad'"), sp(4),
E("Depression is a clinical illness — it is not a choice or a weakness. The brain's chemistry changes — levels of neurotransmitters like serotonin and norepinephrine are low. It affects how you think, feel, and function. To diagnose depression, the person must have LOW MOOD AND/OR ANHEDONIA (inability to feel pleasure in things they used to enjoy) — for at least 2 weeks — plus at least 5 symptoms from: sleep disturbance (typically waking early at 3-4am and cannot get back to sleep), reduced energy, poor concentration, reduced appetite and weight loss, feelings of worthlessness and guilt, slowed thinking and movement, and in severe cases — thoughts of death or suicide."),
sp(4),
E("Treatment: Mild — exercise (strong evidence!), CBT (Cognitive Behavioural Therapy — helps change negative thought patterns), social support. Moderate-Severe — add antidepressants. SSRIs (like Fluoxetine — Prozac, or Sertraline) are first-line — they increase serotonin. Take 4-6 weeks to work. Continue for at least 6 months after recovery. Severe with suicidal risk — hospital admission. If all treatments fail — ECT (Electroconvulsive Therapy) is highly effective."),
ANA("Depression is to mental health what pneumonia is to the lungs — a real illness that needs real treatment, not just 'try harder' or 'think positive'."),
sp(6)]

story += [SEC("Schizophrenia — When Reality Breaks Down"), sp(4),
E("Schizophrenia is a severe mental illness where the person loses touch with reality. The brain's dopamine system is overactive in certain areas, causing distorted perceptions and thinking."),
sp(4),
E("Symptoms are divided into Positive (added abnormal experiences) and Negative (loss of normal functions). Positive symptoms: Hallucinations — perceiving things that aren't there. Most commonly auditory — hearing voices commenting on their actions or telling them to do things. Visual hallucinations can occur. Delusions — fixed false beliefs that cannot be changed with logic. E.g., believing the CIA is following them, or that neighbours are poisoning their food. Disorganised thinking — jumping from topic to topic with no logical connection. Negative symptoms: Flat affect — no emotional expression, face is expressionless. Alogia — very little speech. Avolition — complete loss of motivation — cannot start or finish tasks. Social withdrawal — isolates from everyone."),
sp(4),
E("Treatment: Antipsychotic medications reduce dopamine activity. Typical antipsychotics (older — Haloperidol, Chlorpromazine) — work well for positive symptoms but cause movement side effects (like Parkinsonism). Atypical antipsychotics (newer — Risperidone, Olanzapine, Quetiapine) — better side effect profile, also help negative symptoms. Clozapine is reserved for treatment-resistant cases — most effective but requires regular blood monitoring (risk of agranulocytosis — white blood cell crash). Psychosocial rehabilitation is also essential — life skills training, social skills, supported employment."),
TIP("Positive symptoms = 'added' — hallucinations, delusions. Negative symptoms = 'taken away' — no expression, no motivation, no speech. Antipsychotics work better on positive than negative symptoms."),
sp(6)]

story += [SEC("Bipolar Disorder — The Highs and Lows"), sp(4),
E("Bipolar disorder is characterised by extreme swings in mood — from episodes of mania (abnormally elevated, expansive, or irritable mood) to episodes of depression. It is NOT just 'mood swings' — each episode lasts days to weeks and is severe enough to disrupt life."),
sp(4),
E("During a MANIC episode: The person feels absolutely invincible — needs very little sleep (maybe 2-3 hours) but has boundless energy. They talk very fast, jumping from idea to idea (flight of ideas). They have grandiose beliefs — believing they are especially gifted, famous, or powerful. They make impulsive decisions — spending huge amounts of money, starting many projects, hypersexuality. They can be irritable and aggressive if challenged. Severe mania can include psychosis (hallucinations, delusions)."),
sp(4),
E("Treatment: Mood stabilisers — Lithium is the gold standard for long-term prevention of both manic and depressive episodes. It is a simple salt but has a NARROW THERAPEUTIC INDEX — meaning the difference between therapeutic and toxic levels is small. Must regularly monitor lithium blood levels, kidney function, and thyroid function. Valproate is an alternative. Acute mania is treated with antipsychotics (Haloperidol, Olanzapine)."),
REM("Lithium monitoring: Check lithium levels (aim 0.6-1.0 mmol/L), renal function (lithium is excreted by kidneys), and thyroid function (lithium can cause hypothyroidism) every 6 months once stable."),
sp(10),
hr(),
sp(6),
Paragraph("END OF GENERAL MEDICINE — SIMPLE NOTES", ParagraphStyle("End", fontSize=13,
    alignment=TA_CENTER, textColor=colors.HexColor("#0d47a1"),
    fontName="Helvetica-Bold", spaceBefore=6, spaceAfter=4)),
E("You've covered all 11 topics. Read these notes once through first without stopping to memorise. Then go back topic by topic and write short notes from memory. That is how understanding gets locked in."),
sp(4),
Paragraph("Orris AI Study Assistant  |  July 2026", cover_sub)]

doc.build(story)
print("SUCCESS:", OUTPUT)