ls -la /tmp/workspace/ 2>/dev/null || mkdir -p /tmp/workspace && echo "created"

mkdir -p /tmp/workspace/anatomy-study && cat << 'PYEOF' > /tmp/workspace/anatomy-study/generate_pdf.py from reportlab.lib.pagesizes import A4 from reportlab.lib.styles import getSampleStyleSheet, ParagraphStyle from reportlab.lib.units import cm, mm from reportlab.lib.colors import HexColor, black, white from reportlab.platypus import (SimpleDocTemplate, Paragraph, Spacer, Table, TableStyle, PageBreak, HRFlowable, KeepTogether) from reportlab.lib.enums import TA_LEFT, TA_CENTER, TA_JUSTIFY from reportlab.lib import colors OUTPUT = "/tmp/workspace/anatomy-study/Anatomy_Essay_Answers_Phase1_MBBS.pdf" # Color scheme DARK_BLUE = HexColor("#1a3a5c") MID_BLUE = HexColor("#2e6da4") LIGHT_BLUE = HexColor("#d6e8f7") ACCENT_GOLD = HexColor("#e8a020") PALE_GOLD = HexColor("#fdf3dc") LIGHT_GRAY = HexColor("#f4f6f9") MED_GRAY = HexColor("#d0d6de") DARK_GRAY = HexColor("#3a3a3a") GREEN = HexColor("#1d7a3a") LIGHT_GREEN = HexColor("#e6f4ec") RED = HexColor("#c0392b") PALE_RED = HexColor("#fdecea") doc = SimpleDocTemplate( OUTPUT, pagesize=A4, rightMargin=1.8*cm, leftMargin=1.8*cm, topMargin=2.2*cm, bottomMargin=2.2*cm, title="Anatomy Essay Answers - Phase I MBBS 2025-26", author="Orris Study Notes" ) W = A4[0] - 3.6*cm # usable width styles = getSampleStyleSheet() # Custom styles def S(name, **kwargs): return ParagraphStyle(name, **kwargs) cover_title = S("CoverTitle", fontSize=28, textColor=white, alignment=TA_CENTER, fontName="Helvetica-Bold", leading=34, spaceAfter=8) cover_sub = S("CoverSub", fontSize=14, textColor=LIGHT_BLUE, alignment=TA_CENTER, fontName="Helvetica", leading=18, spaceAfter=6) cover_small = S("CoverSmall", fontSize=11, textColor=MED_GRAY, alignment=TA_CENTER, fontName="Helvetica", spaceAfter=4) q_header = S("QHeader", fontSize=16, textColor=white, fontName="Helvetica-Bold", leading=20, spaceBefore=4, spaceAfter=4) section_ttl = S("SecTitle", fontSize=13, textColor=MID_BLUE, fontName="Helvetica-Bold", leading=16, spaceBefore=10, spaceAfter=4, borderPadding=(0,0,2,0)) sub_ttl = S("SubTitle", fontSize=11, textColor=DARK_BLUE, fontName="Helvetica-Bold", leading=14, spaceBefore=6, spaceAfter=3) body = S("Body", fontSize=10, textColor=DARK_GRAY, fontName="Helvetica", leading=15, spaceBefore=2, spaceAfter=2, alignment=TA_JUSTIFY) bullet_s = S("BulletS", fontSize=10, textColor=DARK_GRAY, fontName="Helvetica", leading=14, spaceBefore=1, spaceAfter=1, leftIndent=14, bulletIndent=4) key_pt = S("KeyPt", fontSize=10, textColor=GREEN, fontName="Helvetica-Bold", leading=14, spaceBefore=2, spaceAfter=2) applied_s = S("Applied", fontSize=10, textColor=RED, fontName="Helvetica", leading=14, spaceBefore=1, spaceAfter=1, leftIndent=14, bulletIndent=4) toc_item = S("TOCItem", fontSize=11, textColor=DARK_BLUE, fontName="Helvetica", leading=18, leftIndent=10) toc_hd = S("TOCHd", fontSize=13, textColor=DARK_BLUE, fontName="Helvetica-Bold", leading=18, spaceAfter=4) footer_s = S("Footer", fontSize=8, textColor=MED_GRAY, alignment=TA_CENTER, fontName="Helvetica") def q_banner(num, title, marks=""): label = f"Q{num} {title}" if marks: label += f" [{marks}]" data = [[Paragraph(label, q_header)]] t = Table(data, colWidths=[W]) t.setStyle(TableStyle([ ("BACKGROUND", (0,0), (-1,-1), DARK_BLUE), ("TOPPADDING", (0,0), (-1,-1), 10), ("BOTTOMPADDING", (0,0), (-1,-1), 10), ("LEFTPADDING", (0,0), (-1,-1), 14), ("RIGHTPADDING", (0,0), (-1,-1), 14), ("ROUNDEDCORNERS",(0,0), (-1,-1), [6,6,6,6]), ])) return t def section_box(title): data = [[Paragraph(f"► {title}", section_ttl)]] t = Table(data, colWidths=[W]) t.setStyle(TableStyle([ ("BACKGROUND", (0,0), (-1,-1), LIGHT_BLUE), ("TOPPADDING", (0,0), (-1,-1), 5), ("BOTTOMPADDING", (0,0), (-1,-1), 5), ("LEFTPADDING", (0,0), (-1,-1), 10), ("LINEBELOW", (0,0), (-1,-1), 1.5, MID_BLUE), ])) return t def applied_box(items): """Red-tinted box for applied anatomy points.""" rows = [] for i, item in enumerate(items, 1): rows.append([Paragraph(f"<b>{i}.</b> {item}", applied_s)]) data = rows t = Table(data, colWidths=[W-8]) t.setStyle(TableStyle([ ("BACKGROUND", (0,0), (-1,-1), PALE_RED), ("TOPPADDING", (0,0), (-1,-1), 4), ("BOTTOMPADDING", (0,0), (-1,-1), 4), ("LEFTPADDING", (0,0), (-1,-1), 10), ("LINEAFTER", (0,0), (0,-1), 3, RED), ])) return t def make_table(headers, rows, col_widths=None): data = [headers] + rows if col_widths is None: col_widths = [W / len(headers)] * len(headers) hdr_style = S("THdr", fontSize=9, textColor=white, fontName="Helvetica-Bold", leading=12, alignment=TA_CENTER) cell_style = S("TCell", fontSize=9, textColor=DARK_GRAY, fontName="Helvetica", leading=12) fmt_data = [] for ri, row in enumerate(data): fmt_row = [] for ci, cell in enumerate(row): if ri == 0: fmt_row.append(Paragraph(str(cell), hdr_style)) else: fmt_row.append(Paragraph(str(cell), cell_style)) fmt_data.append(fmt_row) t = Table(fmt_data, colWidths=col_widths, repeatRows=1) t.setStyle(TableStyle([ ("BACKGROUND", (0,0), (-1,0), MID_BLUE), ("BACKGROUND", (0,1), (-1,-1), white), ("ROWBACKGROUNDS",(0,1), (-1,-1), [white, LIGHT_GRAY]), ("GRID", (0,0), (-1,-1), 0.5, MED_GRAY), ("TOPPADDING", (0,0), (-1,-1), 5), ("BOTTOMPADDING", (0,0), (-1,-1), 5), ("LEFTPADDING", (0,0), (-1,-1), 6), ("RIGHTPADDING", (0,0), (-1,-1), 6), ("ALIGN", (0,0), (-1,0), "CENTER"), ("VALIGN", (0,0), (-1,-1), "MIDDLE"), ])) return t def hr(): return HRFlowable(width=W, thickness=0.5, color=MED_GRAY, spaceAfter=4, spaceBefore=4) def sp(h=6): return Spacer(1, h) def bp(): return PageBreak() def B(txt): return Paragraph(f"• {txt}", bullet_s) def P(txt): return Paragraph(txt, body) def KP(txt): return Paragraph(txt, key_pt) # ───────────────────────────────────────── # PAGE CALLBACKS # ───────────────────────────────────────── def on_page(canvas, doc): canvas.saveState() # Header bar canvas.setFillColor(DARK_BLUE) canvas.rect(0, A4[1]-1.4*cm, A4[0], 1.4*cm, fill=1, stroke=0) canvas.setFont("Helvetica-Bold", 9) canvas.setFillColor(white) canvas.drawString(1.8*cm, A4[1]-0.9*cm, "Shri Sathya Sai Medical College | Dept. of Anatomy | Phase I MBBS 2025-26") # Footer canvas.setFillColor(MED_GRAY) canvas.rect(0, 0, A4[0], 1.3*cm, fill=1, stroke=0) canvas.setFont("Helvetica", 8) canvas.setFillColor(DARK_BLUE) canvas.drawCentredString(A4[0]/2, 0.5*cm, f"Page {doc.page} | Anatomy Essay Answers – Study Notes") canvas.restoreState() def cover_page(canvas, doc): canvas.saveState() # Full-page gradient background canvas.setFillColor(DARK_BLUE) canvas.rect(0, 0, A4[0], A4[1], fill=1, stroke=0) # Accent stripe canvas.setFillColor(ACCENT_GOLD) canvas.rect(0, A4[1]*0.38, A4[0], 4, fill=1, stroke=0) canvas.setFillColor(ACCENT_GOLD) canvas.rect(0, A4[1]*0.38-8, A4[0], 1.5, fill=1, stroke=0) canvas.restoreState() # ───────────────────────────────────────── # BUILD STORY # ───────────────────────────────────────── story = [] # ── COVER ────────────────────────────────────────────────────────────────── story.append(Spacer(1, 3.5*cm)) story.append(Paragraph("ANATOMY", cover_title)) story.append(Paragraph("Essay Answers — Complete Study Notes", cover_sub)) story.append(Spacer(1, 0.4*cm)) story.append(Paragraph("Paper I | Phase I MBBS | 2025–26", cover_small)) story.append(Paragraph("Shri Sathya Sai Medical College &amp; Research Institute", cover_small)) story.append(Paragraph("Department of Anatomy", cover_small)) story.append(Spacer(1, 4*cm)) # 8-question summary box on cover cov_data = [ ["Q1", "Shoulder Joint Dislocation"], ["Q2", "Varicose Veins / Great Saphenous Vein"], ["Q3", "Brachial Plexus / Erb's Palsy"], ["Q4", "Radial Nerve / Wrist Drop"], ["Q5", "Pancreas"], ["Q6", "Portal Vein &amp; Portosystemic Anastomosis"], ["Q7", "Uterus"], ["Q8", "Kidney"], ] cov_hdr = S("CovHdr", fontSize=10, textColor=white, fontName="Helvetica-Bold", alignment=TA_CENTER, leading=14) cov_q = S("CovQ", fontSize=10, textColor=ACCENT_GOLD, fontName="Helvetica-Bold", alignment=TA_CENTER, leading=14) cov_t = S("CovT", fontSize=10, textColor=white, fontName="Helvetica", leading=14) fmt_cov = [[Paragraph(r[0], cov_q), Paragraph(r[1], cov_t)] for r in cov_data] ct = Table(fmt_cov, colWidths=[1.5*cm, W-1.5*cm]) ct.setStyle(TableStyle([ ("BACKGROUND", (0,0), (-1,-1), HexColor("#1e4a70")), ("ROWBACKGROUNDS",(0,0), (-1,-1), [HexColor("#1e4a70"), HexColor("#163c5c")]), ("TOPPADDING", (0,0), (-1,-1), 7), ("BOTTOMPADDING", (0,0), (-1,-1), 7), ("LEFTPADDING", (0,0), (-1,-1), 12), ("GRID", (0,0), (-1,-1), 0.3, HexColor("#2a5a80")), ])) story.append(ct) story.append(Spacer(1, 1*cm)) story.append(Paragraph("Compiled using Gray's Anatomy for Students &amp; standard MBBS references", cover_small)) story.append(bp()) # ── Q1 ───────────────────────────────────────────────────────────────────── story.append(q_banner(1, "Shoulder Joint Dislocation")) story.append(sp()) story.append(section_box("Clinical Scenario")) story.append(P("30-year-old male, fall from vehicle landing on right shoulder. Painful swollen shoulder, totally restricted movements, loss of rounded contour, X-ray: complete de-arrangement of articulation bones.")) story.append(sp(4)) story.append(section_box("a) Identify the Cause")) story.append(KP("Diagnosis: ANTERIOR DISLOCATION of the Glenohumeral Joint (~95% of all shoulder dislocations)")) story.append(P("<b>Mechanism:</b> Landing on the abducted, externally rotated arm levers the humeral head anteroinferiorly through the weakest part of the capsule (no muscular reinforcement inferiorly).")) story.append(P("<b>Types:</b> Subcoracoid (most common) → Subglenoid → Subclavicular")) story.append(P("<b>X-ray finding:</b> Humeral head displaced medially and inferiorly; 'squared-off' shoulder deformity.")) story.append(sp(4)) story.append(section_box("b) Ligaments and Muscles Supporting the Joint")) story.append(Paragraph("<b>Ligaments:</b>", sub_ttl)) lig_rows = [ ["Glenohumeral (superior, middle, inferior)", "Anterior capsule", "Inferior GHL is most important - resists anterior dislocation"], ["Coracohumeral", "Coracoid process → Greater tubercle", "Limits extension and external rotation"], ["Transverse humeral", "Between greater and lesser tubercles", "Retains long head of biceps in groove"], ["Coracoacromial", "Coracoid → Acromion (not part of joint)", "Prevents superior displacement; forms arch"], ] story.append(make_table(["Ligament","Location","Function"], lig_rows, [5.5*cm, 5.5*cm, 6.5*cm])) story.append(sp(5)) story.append(Paragraph("<b>Rotator Cuff Muscles (SITS) — Primary Dynamic Stabilizers:</b>", sub_ttl)) rc_rows = [ ["Supraspinatus", "Suprascapular (C5)", "Initiates abduction (0–15°); depresses humeral head"], ["Infraspinatus", "Suprascapular (C5,C6)", "Lateral/external rotation"], ["Teres minor", "Axillary (C5,C6)", "Lateral rotation"], ["Subscapularis", "Upper + Lower subscapular (C5,C6)", "Medial/internal rotation; prevents anterior dislocation"], ] story.append(make_table(["Muscle (SITS)","Nerve","Action"], rc_rows, [4.5*cm, 5.5*cm, 7.5*cm])) story.append(sp(4)) story.append(section_box("c) Movements With Muscles Involved")) mov_rows = [ ["Flexion", "0–180°", "Anterior deltoid, pec major (clavicular), coracobrachialis, biceps", "Axillary, pectoral, musculocutaneous"], ["Extension", "0–60°", "Posterior deltoid, latissimus dorsi, teres major", "Axillary, thoracodorsal, subscapular"], ["Abduction", "0–180°", "Supraspinatus (0–15°), Deltoid (15–90°), Trapezius + Serratus anterior (90–180°)", "Suprascapular, axillary, accessory, long thoracic"], ["Adduction", "0–45°", "Pectoralis major, latissimus dorsi, teres major", "Pectoral, thoracodorsal"], ["Medial rotation", "0–70°", "Subscapularis, teres major, ant. deltoid, pec major, latissimus", "Subscapular, thoracodorsal, axillary"], ["Lateral rotation", "0–90°", "Infraspinatus, teres minor, post. deltoid", "Suprascapular, axillary"], ] story.append(make_table(["Movement","Range","Muscles","Nerves"], mov_rows, [3*cm, 1.5*cm, 7.5*cm, 5.5*cm])) story.append(sp(4)) story.append(section_box("d) Applied Aspects")) story.append(applied_box([ "<b>Axillary nerve injury:</b> Winds around surgical neck of humerus; stretched in dislocation → loss of deltoid power (abduction) + 'regimental badge' sensory loss (lateral arm)", "<b>Bankart lesion:</b> Avulsion of anteroinferior glenoid labrum → predisposes to recurrent dislocation", "<b>Hill-Sachs lesion:</b> Compression fracture of posterosuperior humeral head impacting on glenoid rim", "<b>Recurrent dislocation:</b> Due to capsular laxity or bony defects; treated with Bankart repair (arthroscopic)", "<b>Rotator cuff tear:</b> Especially supraspinatus; common in elderly with dislocation", "<b>'Squared-off' shoulder:</b> Loss of normal rounded deltoid contour due to humeral head displacement", ])) story.append(bp()) # ── Q2 ───────────────────────────────────────────────────────────────────── story.append(q_banner(2, "Varicose Veins / Great Saphenous Vein")) story.append(sp()) story.append(section_box("Clinical Scenario")) story.append(P("50-year-old waiter (10+ years), tortuous prominent veins over medial aspect of left leg, dull aching pain and heaviness especially on prolonged standing. Diagnosis: Varicose veins.")) story.append(sp(4)) story.append(section_box("a) Clinical Condition and Vein Involved")) story.append(KP("Clinical Condition: VARICOSE VEINS (Superficial Venous Incompetence / Chronic Venous Insufficiency)")) story.append(P("Vein involved: <b>Great (Long) Saphenous Vein</b> — most commonly affected. Prolonged standing → venous hypertension → valve incompetence → tortuous dilated superficial veins on medial aspect of leg.")) story.append(sp(4)) story.append(section_box("b) Great Saphenous Vein — Formation, Course, Relations, Tributaries, Termination")) story.append(Paragraph("<b>Formation:</b>", sub_ttl)) story.append(P("Arises from the <b>medial end of the dorsal venous arch of the foot</b>, anterior to the medial malleolus.")) story.append(Paragraph("<b>Course:</b>", sub_ttl)) gsv_course = [ ["Origin", "Medial end of dorsal venous arch — anterior to medial malleolus"], ["Leg", "Ascends along medial aspect of leg with the saphenous nerve (L3,L4)"], ["Knee", "Passes posterior to the medial femoral condyle"], ["Thigh", "Ascends along anteromedial surface of thigh"], ["Termination", "Passes through the saphenous opening (fossa ovalis) in cribriform fascia, 3.5 cm inferolateral to pubic tubercle → joins FEMORAL VEIN in the femoral triangle"], ] story.append(make_table(["Segment","Description"], gsv_course, [3.5*cm, 14*cm])) story.append(sp(5)) story.append(Paragraph("<b>5 Tributaries at Saphenofemoral Junction:</b>", sub_ttl)) for t in ["Superficial epigastric vein", "Superficial circumflex iliac vein", "Superficial external pudendal vein", "Deep external pudendal vein", "Posterolateral (accessory saphenous) vein"]: story.append(B(t)) story.append(sp(4)) story.append(section_box("c) Perforating Veins — Location and Functional Role")) perf_rows = [ ["Dodd's perforator", "Lower third of medial thigh (Hunter's canal region)"], ["Boyd's perforator", "Medial calf, just below the knee (~tibial tuberosity level)"], ["Cockett's I, II, III", "Posteromedial leg: 7, 12, 18 cm above medial malleolus ('gaiter area')"], ["Paratibial perforators", "Medial leg along tibial border"], ] story.append(make_table(["Perforator","Location"], perf_rows, [5*cm, 12.5*cm])) story.append(sp(4)) story.append(Paragraph("<b>Functional Role:</b>", sub_ttl)) story.append(P("Valves in perforators normally direct flow <b>superficial → deep</b> (aided by calf muscle pump). When valves become incompetent: deep → superficial reflux during muscle contraction → venous hypertension in superficial veins → varicosities, edema, skin changes (lipodermatosclerosis), and ulceration.")) story.append(applied_box([ "<b>Venous ulceration:</b> Classically above medial malleolus ('gaiter area') — corresponds to Cockett's incompetent perforators", "<b>CEAP classification:</b> C0–C6 staging of chronic venous disease", "<b>Trendelenburg test:</b> Controls saphenofemoral junction to test for valve competence", "<b>Treatment:</b> Compression stockings, endovenous ablation (EVLA), foam sclerotherapy, high ligation + stripping", ])) story.append(bp()) # ── Q3 ───────────────────────────────────────────────────────────────────── story.append(q_banner(3, "Brachial Plexus / Erb's Palsy")) story.append(sp()) story.append(section_box("Clinical Scenario")) story.append(P("6-hour-old newborn, flaccid right arm hanging limply, adducted and medially rotated, forearm extended and pronated. History of shoulder dystocia during prolonged labour with fundal pressure.")) story.append(sp(4)) story.append(section_box("a) Probable Clinical Condition")) story.append(KP("Diagnosis: ERB'S PALSY (Erb-Duchenne Palsy) — Upper Brachial Plexus Birth Injury")) story.append(P("Classic <b>'waiter's tip' / 'porter's tip' posture</b>: arm adducted + medially rotated, elbow extended, forearm pronated. Caused by excessive lateral traction on the neck during shoulder dystocia, stretching C5 and C6 roots.")) story.append(sp(4)) story.append(section_box("b) Root Values Involved")) story.append(KP("C5 AND C6 — Upper trunk of brachial plexus (Erb's point)")) story.append(Paragraph("<b>Paralyzed muscles and resulting deformity:</b>", sub_ttl)) erb_rows = [ ["Deltoid", "Axillary (C5,C6)", "Abduction lost → arm hangs adducted"], ["Biceps brachii, Brachialis, Coracobrachialis", "Musculocutaneous (C5,C6)", "Elbow flexion and supination lost → elbow extended + forearm pronated"], ["Supraspinatus, Infraspinatus", "Suprascapular (C5,C6)", "Abduction initiation + lateral rotation lost → arm medially rotated"], ["Teres minor", "Axillary (C5,C6)", "Lateral rotation lost"], ["Brachioradialis", "Radial (C5,C6)", "Weak elbow flexion in midpronation"], ] story.append(make_table(["Muscle","Nerve","Effect"], erb_rows, [5*cm, 5*cm, 7.5*cm])) story.append(P("<b>Intact:</b> Wrist and finger flexors/extensors (C7,C8,T1) — hence hand function preserved (differentiates from Klumpke's palsy).")) story.append(sp(4)) story.append(section_box("c) Brachial Plexus — Formation, Relations, Branches, Applied")) story.append(Paragraph("<b>Formation:</b> Anterior rami of C5, C6, C7, C8, T1 (± C4 pre-fixed; ± T2 post-fixed)", sub_ttl)) story.append(Paragraph("<b>Parts: Roots → Trunks → Divisions → Cords → Branches</b>", sub_ttl)) bp_rows = [ ["ROOTS", "C5+C6 / C7 / C8+T1", "Between anterior and middle scalene muscles, above subclavian artery", "Dorsal scapular (C5), Long thoracic (C5,6,7), Nerve to subclavius (C5,6), Suprascapular (C5,6)"], ["TRUNKS", "Upper (C5+6) / Middle (C7) / Lower (C8+T1)", "Posterior triangle of neck", "From upper trunk only"], ["DIVISIONS", "Anterior + posterior from each trunk (6 total)", "Behind clavicle / 1st rib lateral border", "None directly"], ["LATERAL CORD", "Ant. div. of upper + middle trunk (C5-C7)", "Lateral to axillary artery", "Lateral pectoral n., Musculocutaneous n., Lateral root of median n."], ["MEDIAL CORD", "Ant. div. of lower trunk (C8,T1)", "Medial to axillary artery", "Medial pectoral n., Medial cutaneous n. arm+forearm, Ulnar n., Medial root of median n."], ["POSTERIOR CORD", "Post. div. of ALL trunks (C5-T1)", "Posterior to axillary artery", "Upper + lower subscapular n., Thoracodorsal n., Axillary n., Radial n."], ] story.append(make_table(["Part","Composition","Relation","Branches"], bp_rows, [3*cm, 4*cm, 4*cm, 6.5*cm])) story.append(sp(5)) story.append(Paragraph("<b>Terminal Branches:</b>", sub_ttl)) term_rows = [ ["Musculocutaneous", "Lateral cord (C5,6,7)", "Biceps, brachialis, coracobrachialis; lateral cutaneous nerve of forearm (sensory)"], ["Median", "Medial + lateral cords (C5–T1)", "Forearm flexors (except FCU + medial FDP), thenar muscles, lateral 2 lumbricals; skin of lateral 3½ digits (palm)"], ["Ulnar", "Medial cord (C8,T1)", "FCU, medial FDP, all intrinsic hand muscles except thenar + lat 2 lumbricals; skin medial 1½ digits"], ["Radial", "Posterior cord (C5–T1)", "All extensors of arm, forearm, wrist, fingers; dorsum of hand lateral 3½ digits"], ["Axillary", "Posterior cord (C5,6)", "Deltoid, teres minor; skin over lateral arm"], ] story.append(make_table(["Nerve","Origin","Innervation"], term_rows, [3.5*cm, 4*cm, 10*cm])) story.append(sp(4)) story.append(applied_box([ "<b>Erb's palsy (C5,C6):</b> 'Waiter's tip' posture; most common birth injury; traction on neck during shoulder dystocia", "<b>Klumpke's palsy (C8,T1):</b> 'Claw hand'; traction on abducted arm; ± Horner's syndrome (T1 sympathetics)", "<b>Thoracic outlet syndrome:</b> Compression of lower trunk + subclavian vessels between rib I and clavicle or by cervical rib", "<b>Pancoast tumor:</b> Apex lung tumor invading lower trunk (C8,T1) + stellate ganglion → Horner's syndrome + intrinsic hand wasting", "<b>Winged scapula:</b> Long thoracic nerve (C5,6,7) palsy → serratus anterior paralysis", "<b>Erb's point:</b> Junction of C5 and C6 nerve roots, ~2–3 cm above the clavicle in the posterior triangle", ])) story.append(bp()) # ── Q4 ───────────────────────────────────────────────────────────────────── story.append(q_banner(4, "Radial Nerve / Wrist Drop")) story.append(sp()) story.append(section_box("Clinical Scenario")) story.append(P("5-year-old boy, bicycle accident. Loss of sensation on lateral aspect of dorsum of hand + wrist drop. X-ray: fracture of shaft of humerus.")) story.append(sp(4)) story.append(section_box("a) Structure Involved with Root Value")) story.append(KP("Structure: RADIAL NERVE — Root value: C5, C6, C7, C8, T1 (Posterior cord of brachial plexus)")) story.append(P("Injury site: <b>Radial groove (spiral groove)</b> of the humerus — the radial nerve is tightly bound here with the profunda brachii artery between the medial and lateral heads of triceps. Midshaft humeral fracture stretches or transects the nerve at this level.")) story.append(sp(4)) story.append(section_box("b) Course of the Radial Nerve")) rad_course = [ ["Axilla", "Largest branch of posterior cord; passes posterior to axillary artery; between long head of triceps and humerus"], ["Triangular interval", "Exits axilla through triangular interval (teres major above, long head of triceps medial, lateral head lateral) with profunda brachii artery"], ["Posterior arm (radial groove)", "Passes diagonally medial → lateral on posterior surface of humerus in the radial (spiral) groove; gives off muscular + cutaneous branches"], ["Lateral intermuscular septum", "Pierces septum ~10 cm above lateral epicondyle; enters anterior compartment between brachioradialis and brachialis"], ["Anterior to lateral epicondyle", "Enters forearm deep to brachioradialis; divides into 2 terminal branches at the level of the lateral epicondyle"], ["Superficial branch (sensory)", "Runs under brachioradialis; emerges at lower 1/3 of forearm → dorsum of hand, lateral 3½ digits (up to PIP joints)"], ["Deep branch / PIN", "Posterior interosseous nerve (purely motor); pierces supinator through Arcade of Frohse; supplies all posterior compartment forearm muscles"], ] story.append(make_table(["Segment","Description"], rad_course, [4.5*cm, 13*cm])) story.append(sp(4)) story.append(section_box("c) Distribution")) story.append(Paragraph("<b>Motor (complete list):</b>", sub_ttl)) story.append(P("<u>In arm:</u> Triceps brachii (all 3 heads), Anconeus, Brachioradialis, Extensor carpi radialis longus, lateral part of Brachialis")) story.append(P("<u>In forearm via Posterior Interosseous Nerve:</u> Supinator, Extensor carpi radialis brevis, Extensor digitorum communis, Extensor digiti minimi, Extensor carpi ulnaris, Abductor pollicis longus, Extensor pollicis longus, Extensor pollicis brevis, Extensor indicis")) story.append(Paragraph("<b>Sensory:</b>", sub_ttl)) story.append(P("Posterior cutaneous nerve of arm → posterior skin of arm; Inferior lateral cutaneous nerve of arm → lateral arm below deltoid; Posterior cutaneous nerve of forearm → strip of posterior forearm; Superficial branch → dorsolateral hand + dorsal surface of lateral 3½ digits (proximal to PIP joints). <b>Autonomous zone = first web space (dorsum)</b>")) story.append(sp(4)) story.append(section_box("d) Applied Aspects")) story.append(applied_box([ "<b>Wrist drop:</b> Hallmark of radial nerve injury in spiral groove. All wrist and finger extensors denervated. Triceps spared (branches arise proximal to groove). Test: patient cannot extend wrist against gravity.", "<b>Midshaft humerus fracture:</b> Most common cause of radial nerve injury. Always test radial nerve with any humeral shaft fracture.", "<b>'Saturday night palsy'/'Honeymoon palsy':</b> Compression against spiral groove (sleeping with arm over chair back/partner's head) → wrist drop + sensory loss dorsum of hand.", "<b>Posterior interosseous nerve (PIN) palsy:</b> Injury in proximal forearm (below ECRL origin). Wrist extension preserved (ECRL intact); only finger drop. No sensory loss.", "<b>Sensory loss:</b> Autonomous zone = dorsum of 1st web space; lateral 3½ fingers up to PIP joints.", "<b>Wartenberg's syndrome:</b> Compression of superficial radial nerve at wrist → pure sensory loss over dorsum of hand.", ])) story.append(bp()) # ── Q5 ───────────────────────────────────────────────────────────────────── story.append(q_banner(5, "Pancreas")) story.append(sp()) story.append(section_box("a) Parts")) story.append(P("The pancreas is a <b>secondarily retroperitoneal</b> mixed exocrine + endocrine gland, lying obliquely at the level of <b>L1–L2</b> across the posterior abdominal wall.")) pan_parts = [ ["Head", "Lies within the C-curve of the duodenum; the <b>uncinate process</b> is a projection passing posterior to the superior mesenteric vessels; the bile duct runs in a groove posteriorly or within the head"], ["Neck", "Short (2 cm); overlies the superior mesenteric vessels; portal vein formed posterior to the neck by union of SMV + splenic vein"], ["Body", "Crosses the vertebral column; related to the stomach anteriorly (via lesser sac); splenic vein runs posterior to it"], ["Tail", "Reaches the hilum of the spleen; lies within the splenorenal ligament (intraperitoneally covered — the only mobile part)"], ] story.append(make_table(["Part","Features"], pan_parts, [2*cm, 15.5*cm])) story.append(sp(4)) story.append(section_box("b) Visceral and Peritoneal Relations")) story.append(Paragraph("<b>Anterior relations:</b>", sub_ttl)) story.append(P("Stomach (separated by lesser sac / omental bursa), transverse colon and mesocolon (attached to anterior surface of body), coils of small bowel")) story.append(Paragraph("<b>Posterior relations:</b>", sub_ttl)) post_pan = [ ["Head", "Inferior vena cava, portal/superior mesenteric vein, bile duct, right renal vessels, right ureter"], ["Neck", "Portal vein formation (SMV + splenic vein junction), superior mesenteric vessels"], ["Body", "Aorta, origin of superior mesenteric artery, left suprarenal gland, left kidney and renal vessels, splenic vein"], ["Tail", "Left kidney, hilum of spleen"], ] story.append(make_table(["Part","Posterior Relations"], post_pan, [2*cm, 15.5*cm])) story.append(P("<b>Peritoneal status:</b> Secondarily retroperitoneal (covered by peritoneum anteriorly only), except the tail which is intraperitoneal within the splenorenal ligament.")) story.append(sp(4)) story.append(section_box("c) Blood Supply")) story.append(Paragraph("<b>Arterial supply:</b>", sub_ttl)) pan_art = [ ["Head", "Superior pancreaticoduodenal artery (from gastroduodenal a., branch of common hepatic a.) and Inferior pancreaticoduodenal artery (from SMA) — form anterior and posterior arcades"], ["Body and tail", "Branches of splenic artery: Dorsal pancreatic a., Great pancreatic a. (arteria pancreatica magna), Caudal pancreatic a."], ] story.append(make_table(["Part","Arterial Supply"], pan_art, [2.5*cm, 15*cm])) story.append(P("<b>Venous drainage:</b> Pancreaticoduodenal veins → portal vein; body and tail veins → splenic vein and superior mesenteric vein → portal system.")) story.append(sp(4)) story.append(section_box("d) Lymphatic Drainage")) story.append(P("Lymphatics follow blood vessels and drain to:")) for l in ["Pancreaticoduodenal lymph nodes (in the groove between head and duodenum)", "Coeliac lymph nodes", "Superior mesenteric lymph nodes", "Pre-aortic (coeliac) nodes → Cisterna chyli → Thoracic duct"]: story.append(B(l)) story.append(sp(4)) story.append(section_box("e) Applied Anatomy")) story.append(applied_box([ "<b>Acute pancreatitis:</b> Gallstones (obstructing hepatopancreatic ampulla) or alcohol; autodigestion; pseudocyst in lesser sac is a complication. Serum amylase + lipase elevated.", "<b>Carcinoma of pancreas:</b> Head (60–70%) → painless obstructive jaundice + Courvoisier's sign (palpable, non-tender gallbladder). Poor prognosis (CA 19-9 marker). Head → Whipple's procedure.", "<b>Portal vein compression:</b> Neck tumor compresses portal vein → portal hypertension, ascites, splenomegaly.", "<b>Whipple's operation (pancreaticoduodenectomy):</b> Removes head of pancreas, entire duodenum, distal bile duct, gallbladder, and sometimes distal stomach.", "<b>Annular pancreas:</b> Congenital ring of pancreatic tissue around 2nd part of duodenum → duodenal obstruction in neonates; 'double bubble' on X-ray.", "<b>Insulinoma:</b> Most common islet cell tumor; causes hypoglycemia (Whipple's triad: fasting hypoglycemia, symptoms relieved by glucose, blood glucose <2.5 mmol/L).", ])) story.append(bp()) # ── Q6 ───────────────────────────────────────────────────────────────────── story.append(q_banner(6, "Portal Vein & Portosystemic Anastomosis [1+2+2+4+1 marks]")) story.append(sp()) story.append(section_box("Formation")) story.append(KP("Portal vein = SMV (Superior Mesenteric Vein) + Splenic Vein, posterior to the NECK OF PANCREAS at level of L2")) story.append(P("Length: ~8 cm. The inferior mesenteric vein (IMV) usually drains into the splenic vein (or SMV junction). The union occurs behind the neck of the pancreas in the transpyloric plane.")) story.append(sp(4)) story.append(section_box("Parts & Course")) pv_course = [ ["Formation", "Posterior to neck of pancreas (L2)"], ["Ascent", "Passes posterior to superior part of duodenum (1st part)"], ["Lesser omentum", "Enters free edge of lesser omentum (hepatoduodenal ligament); relations: bile duct (right), hepatic artery (left), portal vein (posterior) — remembered as BAP from right to left"], ["Omental foramen", "Anterior to the epiploic foramen (foramen of Winslow) — Pringle's maneuver compresses it here"], ["Porta hepatis", "Divides into right and left branches entering liver parenchyma"], ] story.append(make_table(["Segment","Description"], pv_course, [3.5*cm, 14*cm])) story.append(sp(4)) story.append(section_box("Relations in Hepatoduodenal Ligament")) story.append(P("From <b>right to left</b>: <b>B</b>ile duct – <b>A</b>rtery (hepatic proper) – <b>P</b>ortal vein ('BAP'). Portal vein is the most posterior.")) story.append(sp(4)) story.append(section_box("Tributaries")) story.append(Paragraph("<b>Direct tributaries to portal vein:</b>", sub_ttl)) trib_rows = [ ["Right + Left gastric veins", "Lesser curvature of stomach and lower esophagus"], ["Cystic veins", "From the gallbladder"], ["Para-umbilical veins", "Along ligamentum teres of liver; connect to anterior abdominal wall veins → important in portal hypertension (caput medusae)"], ["(SMV + Splenic vein)", "Roots of formation — NOT tributaries per se"], ] story.append(make_table(["Tributary","From"], trib_rows, [5*cm, 12.5*cm])) story.append(sp(4)) story.append(Paragraph("<b>Tributaries of Splenic Vein:</b> Short gastric veins, Left gastro-omental vein, Pancreatic veins, Inferior mesenteric vein (usually)", body)) story.append(sp(2)) story.append(Paragraph("<b>Tributaries of SMV:</b> Jejunal and ileal veins, Right gastro-omental vein, Pancreaticoduodenal veins, Middle colic vein", body)) story.append(sp(4)) story.append(section_box("Portosystemic Anastomoses")) story.append(P("Sites where portal and systemic venous systems communicate. In <b>portal hypertension</b> (normal pressure 5–10 mmHg; hypertension >12 mmHg), blood is diverted through these channels which become dilated and can bleed.")) story.append(sp(3)) ps_rows = [ ["Lower esophagus ★ MOST DANGEROUS", "Left gastric (coronary) vein (portal)", "Esophageal veins → azygos/hemiazygos (systemic)", "ESOPHAGEAL VARICES — risk of fatal hematemesis"], ["Umbilicus", "Para-umbilical veins (portal)", "Superficial epigastric veins (systemic)", "CAPUT MEDUSAE — radiating periumbilical veins"], ["Anal canal / lower rectum", "Superior rectal vein (portal, from IMV)", "Middle + inferior rectal veins (systemic, from internal iliac)", "ANORECTAL VARICES / Hemorrhoids"], ["Retroperitoneum", "Colic, mesenteric, pancreatic veins (portal)", "Lumbar, phrenic, renal veins (systemic)", "Retzius veins — retroperitoneal varices"], ["Bare area of liver", "Portal branches in liver", "Phrenic + hepatic veins (IVC system)", "Collateral formation in cirrhosis"], ] story.append(make_table(["Site","Portal Tributary","Systemic Tributary","Clinical Effect"], ps_rows, [4.5*cm, 4.5*cm, 4.5*cm, 4*cm])) story.append(sp(4)) story.append(applied_box([ "<b>Bleeding esophageal varices:</b> Most feared complication of portal hypertension (mortality 20–40% per episode). Treatment: IV terlipressin + endoscopic variceal band ligation (EVL); prophylaxis: non-selective beta-blockers (propranolol)", "<b>TIPS (Transjugular Intrahepatic Portosystemic Shunt):</b> Radiological creation of intrahepatic shunt between portal and hepatic veins to decompress portal system", "<b>Pringle's maneuver:</b> Manual compression of hepatoduodenal ligament (compresses portal vein + hepatic artery) to control liver hemorrhage during surgery", "<b>Caput medusae:</b> Dilated para-umbilical veins seen in cirrhosis; blood flows away from the umbilicus (versus superior vena cava obstruction where it flows upward)", ])) story.append(bp()) # ── Q7 ───────────────────────────────────────────────────────────────────── story.append(q_banner(7, "Uterus [2+2+3+1+2 marks]")) story.append(sp()) story.append(section_box("a) Normal Position [2 marks]")) story.append(KP("Normal Position: ANTEVERTED + ANTEFLEXED")) ut_pos = [ ["Anteverted", "The long axis of the uterus (cervix) is tilted forward relative to the long axis of the vagina. Angle: ~90° between vaginal axis and cervical axis. The uterus leans forward over the bladder."], ["Anteflexed", "The body of the uterus is bent forward on the cervix at the internal os. Angle: ~120–125° between long axis of cervix and body."], ["Retroversion", "Uterus tilts posteriorly (8–10% of women; usually asymptomatic). In early pregnancy, a retroverted uterus can become 'incarcerated' in the sacral hollow before 14 weeks → urinary retention."], ] story.append(make_table(["Position","Description"], ut_pos, [3*cm, 14.5*cm])) story.append(sp(4)) story.append(section_box("b) Parts & Relations [2 marks]")) story.append(Paragraph("<b>Parts of the Uterus:</b>", sub_ttl)) ut_parts = [ ["Fundus", "Dome-shaped part above the openings of uterine tubes"], ["Body (Corpus)", "Main bulky part; cavity = slit-like sagittally, triangular frontally; site of implantation"], ["Isthmus", "Constriction between body and cervix (~1 cm); forms the LOWER UTERINE SEGMENT in pregnancy (LSCS incision site)"], ["Cervix", "Cylindrical; divided by vaginal fornix into supravaginal (above) and portio vaginalis (below); central canal connects uterine cavity to vagina"], ] story.append(make_table(["Part","Description"], ut_parts, [3*cm, 14.5*cm])) story.append(sp(4)) story.append(Paragraph("<b>Relations:</b>", sub_ttl)) ut_rel = [ ["Anterior", "Uterovesical pouch (peritoneum) → upper surface of bladder"], ["Posterior", "Rectouterine pouch (Pouch of Douglas / cul-de-sac) → rectum; most dependent part of peritoneal cavity — collects fluid/pus/blood"], ["Lateral", "Broad ligament; uterine artery and ureter (ureter passes under uterine artery 1.5 cm lateral to cervix — 'water under the bridge')"], ["Below", "Vagina"], ["Above", "Peritoneal cavity; loops of small intestine when uterus is enlarged"], ] story.append(make_table(["Direction","Relation"], ut_rel, [3*cm, 14.5*cm])) story.append(sp(4)) story.append(section_box("c) Supports [3 marks]")) story.append(Paragraph("<b>Primary (Ligamentous) Supports:</b>", sub_ttl)) ut_supp = [ ["Transverse cervical (Cardinal / Mackenrodt's) ligament ★", "Cervix + vaginal vault → lateral pelvic wall; contains uterine artery; MOST IMPORTANT — resists downward descent; damage → uterine prolapse"], ["Uterosacral ligaments", "Cervix posteriorly → sacrum; maintain anteversion; often damaged in prolapse"], ["Pubocervical ligaments", "Cervix anteriorly → posterior pubic bones; support vesicouterine angle"], ] story.append(make_table(["Ligament","Details"], ut_supp, [5.5*cm, 12*cm])) story.append(sp(4)) story.append(Paragraph("<b>Secondary (Peritoneal Fold) Supports:</b>", sub_ttl)) ut_supp2 = [ ["Broad ligament", "Double fold of peritoneum from uterus → lateral pelvic wall; contains uterine tubes, ovaries, round ligament, uterine vessels, ureter. Does NOT prevent prolapse."], ["Round ligament", "Uterine fundus → deep inguinal ring → labium majus; maintains anteversion (weak); may cause pain during pregnancy"], ["Ovarian ligament", "Medial pole of ovary → uterus"], ] story.append(make_table(["Ligament","Details"], ut_supp2, [3.5*cm, 14*cm])) story.append(sp(3)) story.append(KP("Most important functional support: LEVATOR ANI (Pelvic diaphragm) — weakness leads to uterine prolapse")) story.append(sp(4)) story.append(section_box("d) Blood Supply [1 mark]")) story.append(P("<b>Arterial:</b> <b>Uterine artery</b> — arises from the anterior division of the <b>internal iliac (hypogastric) artery</b>. It crosses superior to the ureter ('water under the bridge') 1.5 cm lateral to the cervix at the level of the internal os. Ascends tortuously along the lateral border of the uterus. Anastomoses with the ovarian artery near the uterine tube.")) story.append(P("<b>Venous:</b> Uterine veins → uterine venous plexus → internal iliac vein → common iliac vein → IVC")) story.append(Paragraph("<b>Lymphatics:</b>", sub_ttl)) ut_lymph = [ ["Fundus + upper body", "Para-aortic (lumbar) nodes (following ovarian vessels)"], ["Lower body + cervix", "External iliac and internal iliac nodes"], ["Cervix (also)", "Obturator nodes"], ["Via round ligament", "Superficial inguinal nodes (minor pathway)"], ] story.append(make_table(["Region","Lymph Nodes"], ut_lymph, [5*cm, 12.5*cm])) story.append(sp(4)) story.append(section_box("e) Applied Aspects [2 marks]")) story.append(applied_box([ "<b>Uterine prolapse:</b> 1° (cervix within vagina), 2° (cervix at introitus), 3°/Procidentia (uterus outside). Weakness of levator ani + cardinal and uterosacral ligaments (multiparity, aging, obesity).", "<b>Ureter injury in hysterectomy:</b> Ureter passes 1.5 cm lateral to cervix just below uterine artery. Can be inadvertently ligated or cut — 'ureter sacrificed while clamping the artery.'", "<b>Cesarean section (LSCS):</b> Transverse incision at the lower uterine segment (isthmus); avascular, heals well, minimal risk of bladder injury, away from peritoneal cavity.", "<b>Incarcerated retroverted uterus:</b> Trapped in sacral hollow before 14 weeks → acute urinary retention; treated by manual reduction under anesthesia.", "<b>Cervical carcinoma spread:</b> Spreads laterally along cardinal ligament → obstructs ureter → hydronephrosis and renal failure.", "<b>Pouch of Douglas:</b> Most dependent peritoneal space; site of pelvic abscess/endometriosis/Krukenberg tumor; accessed by culdocentesis (posterior fornix puncture).", ])) story.append(bp()) # ── Q8 ───────────────────────────────────────────────────────────────────── story.append(q_banner(8, "Kidney")) story.append(sp()) story.append(section_box("a) Location With Extent")) story.append(KP("The kidneys are paired retroperitoneal organs. Left kidney is slightly HIGHER than right (right pushed down by liver).")) kid_loc = [ ["Right kidney", "Upper pole: T12 vertebra", "Lower pole: L3 vertebra"], ["Left kidney", "Upper pole: T11 vertebra", "Lower pole: L2–L3 vertebra"], ] story.append(make_table(["","Upper Pole","Lower Pole"], kid_loc, [4*cm, 6.5*cm, 7*cm])) story.append(P("Dimensions: ~<b>10 × 5 × 2.5 cm</b>, Weight: ~<b>150 g</b>. Hilum is at the level of <b>L2</b> (transpyloric plane). Both kidneys descend 2–3 cm on deep inspiration (clinical: percuss in full expiration; biopsy under fluoroscopy).")) story.append(sp(4)) story.append(section_box("b) Coverings (from inside outward)")) cov_rows = [ ["1. True (Fibrous) Capsule", "Thin, tough fibrous layer directly investing renal parenchyma. Easily stripped in health; adherent in pyelonephritis/perinephric abscess."], ["2. Perinephric (Perirenal) Fat", "Thick cushion of adipose tissue within Gerota's fascia; protects kidney. Reduced in cachexia → ptosis (nephroptosis)."], ["3. Renal Fascia (Gerota's fascia)", "Condensation of extraperitoneal connective tissue. Anterior = Toldt's fascia; Posterior = Zuckerkandl's fascia. Encloses kidney + suprarenal gland. Fused superiorly and laterally; OPEN INFERIORLY (allows tracking of perinephric abscess into pelvis)."], ["4. Paranephric (Pararenal) Fat", "External to Gerota's fascia; thick posterolaterally."], ["5. Peritoneum", "Covers anterior surface only (kidneys are retroperitoneal)."], ] story.append(make_table(["Layer","Description"], cov_rows, [4.5*cm, 13*cm])) story.append(sp(4)) story.append(section_box("c) Relations")) story.append(Paragraph("<b>Hilum contents (anterior → posterior): V-A-P (Vein–Artery–Pelvis)</b>", sub_ttl)) story.append(P("<b>Right kidney — Anterior:</b> Right suprarenal gland (upper pole), right lobe of liver, 2nd part of duodenum (medially), hepatic flexure of colon (lower pole), coils of small intestine")) story.append(P("<b>Right kidney — Posterior:</b> Diaphragm, 12th rib, iliohypogastric nerve, ilioinguinal nerve, subcostal nerve/vessels, quadratus lumborum, psoas major")) story.append(sp(2)) story.append(P("<b>Left kidney — Anterior:</b> Left suprarenal gland (upper pole), stomach/body of spleen (upper lateral), tail of pancreas + splenic vessels (at hilum), splenic flexure of colon (lower pole), coils of jejunum")) story.append(P("<b>Left kidney — Posterior:</b> Diaphragm, 11th and 12th ribs, iliohypogastric nerve, ilioinguinal nerve, subcostal nerve/vessels, quadratus lumborum, psoas major")) story.append(sp(4)) story.append(section_box("d) Blood Supply")) story.append(Paragraph("<b>Arterial Supply:</b>", sub_ttl)) story.append(P("<b>Renal arteries</b> — direct lateral branches of the <b>abdominal aorta at L2</b> (just below origin of superior mesenteric artery).")) kid_art = [ ["Right renal artery", "Longer; passes posterior to IVC, right renal vein, head of pancreas, and 2nd part of duodenum"], ["Left renal artery", "Shorter; passes posterior to left renal vein, body of pancreas, and splenic vein"], ["Segmental arteries", "Each renal artery divides into anterior and posterior divisions supplying 5 segments: Apical, Upper, Middle, Lower, Posterior. These are END-ARTERIES (no anastomoses — infarction of individual segments possible)"], ["Accessory renal arteries", "Present in 25–30%; arise from aorta; enter at poles (lower pole most common). Must be identified in renal transplant surgery."], ] story.append(make_table(["Vessel","Details"], kid_art, [4.5*cm, 13*cm])) story.append(sp(4)) story.append(Paragraph("<b>Venous Drainage:</b>", sub_ttl)) story.append(P("<b>Renal veins → Inferior Vena Cava (IVC)</b>")) story.append(P("<b>Left renal vein</b> is longer (crosses aorta anteriorly); receives left gonadal vein, left suprarenal vein, and left inferior phrenic vein. <b>Right renal vein</b> is short (no major tributaries).")) story.append(P("<b>Lymphatics:</b> To lateral aortic (para-aortic / lumbar) lymph nodes at L2.")) story.append(sp(4)) story.append(section_box("e) Applied Aspects")) story.append(applied_box([ "<b>Renal calculi (nephrolithiasis):</b> Stones form in pelvis/calyx. 3 sites of ureteric narrowing: (1) PUJ, (2) crossing of iliac vessels, (3) vesicoureteric junction (VUJ — narrowest). Colicky flank pain radiating to groin/scrotum/labia. Treatment: ESWL, ureteroscopy (URS), PCNL.", "<b>Horseshoe kidney:</b> Most common fusion anomaly; lower poles fused across midline by isthmus of renal tissue; held inferiorly by inferior mesenteric artery (cannot ascend normally). Predisposes to stone, infection, and PUJ obstruction.", "<b>Perinephric abscess:</b> Infection in perinephric fat. Tracks inferiorly (Gerota's fascia open below) into pelvis. Presents with fever, loin mass, and rigidity.", "<b>Renal transplant:</b> Donor kidney placed heterotopically in the right iliac fossa; renal artery anastomosed to external iliac artery, renal vein to external iliac vein, ureter to bladder.", "<b>PCNL (Percutaneous Nephrolithotomy):</b> Posterior calyx accessed percutaneously through 12th rib bed + posterior Gerota's fascia. Used for large/staghorn calculi.", "<b>Nutcracker phenomenon:</b> Left renal vein compressed between aorta and SMA → left-sided hematuria ± varicocele (left).", "<b>Retroperitoneal hematoma (renal trauma):</b> Blood contained by Gerota's fascia; flank ecchymosis = Grey Turner's sign.", ])) story.append(sp(8)) # ── QUICK REFERENCE PAGE ─────────────────────────────────────────────────── story.append(bp()) qr_title = S("QRTitle", fontSize=20, textColor=DARK_BLUE, fontName="Helvetica-Bold", alignment=TA_CENTER, leading=24, spaceAfter=10) story.append(Paragraph("QUICK REFERENCE SUMMARY", qr_title)) story.append(hr()) story.append(sp(6)) summary_rows = [ ["Q1", "Anterior shoulder dislocation", "Axillary nerve injury + Bankart + Hill-Sachs lesions; SITS rotator cuff"], ["Q2", "Varicose veins — Great Saphenous Vein", "Dorsal arch → medial malleolus → fossa ovalis → femoral vein; 3 key perforators"], ["Q3", "Erb's palsy (C5,C6)", "Waiter's tip; brachial plexus: C5–T1; Roots→Trunks→Divisions→Cords→Branches"], ["Q4", "Radial nerve (C5–T1) injury", "Wrist drop; spiral groove of humerus; PIN (posterior interosseous nerve)"], ["Q5", "Pancreas", "Retroperitoneal; portal vein formed posterior to neck; Whipple's operation"], ["Q6", "Portal vein (SMV + Splenic)", "BAP in lesser omentum; 4 portosystemic anastomoses; esophageal varices (★)"], ["Q7", "Uterus (anteverted + anteflexed)", "Mackenrodt's ligament (most important); ureter 1.5 cm lateral to cervix"], ["Q8", "Kidney (T12–L3)", "5 coverings; VAP at hilum; 5 segmental arteries (end-arteries); Gerota's fascia"], ] story.append(make_table(["Q","Topic","Key Points to Remember"], summary_rows, [1*cm, 5*cm, 11.5*cm])) story.append(sp(10)) story.append(hr()) story.append(Paragraph("Compiled for Phase I MBBS Anatomy Paper I — Shri Sathya Sai Medical College &amp; Research Institute, 2025–26", footer_s)) story.append(Paragraph("Source: Gray's Anatomy for Students | Snell's Clinical Anatomy | Standard MBBS Anatomy Textbooks", footer_s)) # ── BUILD ────────────────────────────────────────────────────────────────── doc.build(story, onFirstPage=cover_page, onLaterPages=on_page) print(f"PDF created: {OUTPUT}") PYEOF echo "Script written"

cd /tmp/workspace/anatomy-study && python generate_pdf.py 2>&1

ls -lh /tmp/workspace/anatomy-study/Anatomy_Essay_Answers_Phase1_MBBS.pdf