const {
  Document, Packer, Paragraph, TextRun, Table, TableRow, TableCell,
  HeadingLevel, AlignmentType, BorderStyle, WidthType, ShadingType,
  VerticalAlign, PageNumber, Header, Footer, PageBreak,
  TableOfContents, LevelFormat
} = require('docx');
const fs = require('fs');

// ─── Color palette ───────────────────────────────────────────────────────────
const C = {
  red:    "C0392B",  // cardiovascular
  blue:   "1A5276",  // hematology
  green:  "1E8449",  // rheumatology
  dark:   "212121",
  white:  "FFFFFF",
  lightRed:  "FADBD8",
  lightBlue: "D6EAF8",
  lightGreen:"D5F5E3",
  lightGrey: "F2F3F4",
  midGrey:   "D5D8DC",
  yellow:    "FFF9C4",
  orange:    "F39C12",
};

// ─── Helpers ──────────────────────────────────────────────────────────────────
function coloredHeading(text, color, level = HeadingLevel.HEADING_1) {
  return new Paragraph({
    heading: level,
    spacing: { before: 240, after: 80 },
    children: [
      new TextRun({ text, bold: true, color, size: level === HeadingLevel.HEADING_1 ? 32 : 26 })
    ]
  });
}

function sectionBanner(text, bgColor) {
  return new Table({
    width: { size: 100, type: WidthType.PERCENTAGE },
    rows: [
      new TableRow({
        children: [
          new TableCell({
            shading: { fill: bgColor, type: ShadingType.CLEAR },
            margins: { top: 100, bottom: 100, left: 200, right: 200 },
            children: [new Paragraph({
              alignment: AlignmentType.CENTER,
              children: [new TextRun({ text, bold: true, color: C.white, size: 32 })]
            })]
          })
        ]
      })
    ]
  });
}

function subHeading(text, color) {
  return new Paragraph({
    heading: HeadingLevel.HEADING_2,
    spacing: { before: 180, after: 60 },
    children: [new TextRun({ text, bold: true, color, size: 24 })]
  });
}

function subSubHeading(text) {
  return new Paragraph({
    heading: HeadingLevel.HEADING_3,
    spacing: { before: 120, after: 40 },
    children: [new TextRun({ text, bold: true, color: C.dark, size: 22 })]
  });
}

function para(text, opts = {}) {
  return new Paragraph({
    spacing: { before: 40, after: 40 },
    children: [new TextRun({ text, size: 20, color: C.dark, ...opts })]
  });
}

function bullet(text, level = 0) {
  return new Paragraph({
    bullet: { level },
    spacing: { before: 30, after: 30 },
    children: [new TextRun({ text, size: 20 })]
  });
}

function boldBullet(label, value, color = C.dark) {
  return new Paragraph({
    bullet: { level: 0 },
    spacing: { before: 30, after: 30 },
    children: [
      new TextRun({ text: label + ": ", bold: true, size: 20, color }),
      new TextRun({ text: value, size: 20 })
    ]
  });
}

function mnemonicBox(title, items) {
  const rows = [
    new TableRow({
      children: [
        new TableCell({
          columnSpan: 2,
          shading: { fill: C.yellow, type: ShadingType.CLEAR },
          margins: { top: 80, bottom: 80, left: 160, right: 160 },
          children: [new Paragraph({ children: [new TextRun({ text: "🧠 MNEMONIC: " + title, bold: true, size: 22, color: C.orange })] })]
        })
      ]
    }),
    ...items.map(item => new TableRow({
      children: [
        new TableCell({
          width: { size: 12, type: WidthType.PERCENTAGE },
          shading: { fill: C.yellow, type: ShadingType.CLEAR },
          margins: { top: 60, bottom: 60, left: 160, right: 80 },
          children: [new Paragraph({ children: [new TextRun({ text: item.letter, bold: true, size: 22, color: C.orange })] })]
        }),
        new TableCell({
          shading: { fill: "FEFEFE", type: ShadingType.CLEAR },
          margins: { top: 60, bottom: 60, left: 160, right: 160 },
          children: [new Paragraph({ children: [new TextRun({ text: item.meaning, size: 20 })] })]
        })
      ]
    }))
  ];
  return new Table({ width: { size: 100, type: WidthType.PERCENTAGE }, rows });
}

function makeTable(headers, rows, headerBg = C.dark, altBg = C.lightGrey) {
  const headerRow = new TableRow({
    tableHeader: true,
    children: headers.map(h => new TableCell({
      shading: { fill: headerBg, type: ShadingType.CLEAR },
      margins: { top: 80, bottom: 80, left: 120, right: 120 },
      verticalAlign: VerticalAlign.CENTER,
      children: [new Paragraph({
        alignment: AlignmentType.CENTER,
        children: [new TextRun({ text: h, bold: true, color: C.white, size: 18 })]
      })]
    }))
  });
  const dataRows = rows.map((row, ri) => new TableRow({
    children: row.map(cell => new TableCell({
      shading: { fill: ri % 2 === 0 ? C.white : altBg, type: ShadingType.CLEAR },
      margins: { top: 60, bottom: 60, left: 120, right: 120 },
      children: [new Paragraph({ children: [new TextRun({ text: cell, size: 18 })] })]
    }))
  }));
  return new Table({ width: { size: 100, type: WidthType.PERCENTAGE }, rows: [headerRow, ...dataRows] });
}

function examBox(questions) {
  const rows = [
    new TableRow({
      children: [
        new TableCell({
          shading: { fill: C.orange, type: ShadingType.CLEAR },
          margins: { top: 80, bottom: 80, left: 160, right: 160 },
          children: [new Paragraph({ children: [new TextRun({ text: "⭐ LIKELY EXAM QUESTIONS", bold: true, size: 22, color: C.white })] })]
        })
      ]
    }),
    ...questions.map((q, i) => new TableRow({
      children: [
        new TableCell({
          shading: { fill: i % 2 === 0 ? "FEF9E7" : "FDEBD0", type: ShadingType.CLEAR },
          margins: { top: 60, bottom: 60, left: 160, right: 160 },
          children: [new Paragraph({ children: [new TextRun({ text: (i+1) + ". " + q, size: 19 })] })]
        })
      ]
    }))
  ];
  return new Table({ width: { size: 100, type: WidthType.PERCENTAGE }, rows });
}

function spacer() {
  return new Paragraph({ spacing: { before: 120, after: 120 }, children: [new TextRun({ text: "" })] });
}

function pageBreak() {
  return new Paragraph({ children: [new PageBreak()] });
}

// ─── BUILD DOCUMENT ─────────────────────────────────────────────────────────
const children = [];

// ── TITLE PAGE ──
children.push(
  new Paragraph({ spacing: { before: 600, after: 200 }, alignment: AlignmentType.CENTER,
    children: [new TextRun({ text: "IInd SESSIONAL EXAM", bold: true, size: 52, color: C.red })] }),
  new Paragraph({ spacing: { before: 100, after: 100 }, alignment: AlignmentType.CENTER,
    children: [new TextRun({ text: "Final Year MBBS — Medicine", bold: true, size: 36, color: C.dark })] }),
  new Paragraph({ spacing: { before: 100, after: 400 }, alignment: AlignmentType.CENTER,
    children: [new TextRun({ text: "Quick Revision Notes  |  July 2026", size: 24, color: "888888", italics: true })] }),
  new Table({
    width: { size: 90, type: WidthType.PERCENTAGE },
    rows: [
      new TableRow({ children: [
        new TableCell({ shading: { fill: C.red, type: ShadingType.CLEAR }, margins: { top: 120, bottom: 120, left: 200, right: 200 },
          children: [new Paragraph({ alignment: AlignmentType.CENTER, children: [new TextRun({ text: "1. Cardiovascular", bold: true, color: C.white, size: 26 })] })] }),
        new TableCell({ shading: { fill: C.blue, type: ShadingType.CLEAR }, margins: { top: 120, bottom: 120, left: 200, right: 200 },
          children: [new Paragraph({ alignment: AlignmentType.CENTER, children: [new TextRun({ text: "2. Hematology", bold: true, color: C.white, size: 26 })] })] }),
        new TableCell({ shading: { fill: C.green, type: ShadingType.CLEAR }, margins: { top: 120, bottom: 120, left: 200, right: 200 },
          children: [new Paragraph({ alignment: AlignmentType.CENTER, children: [new TextRun({ text: "3. CTD Rheumatology", bold: true, color: C.white, size: 26 })] })] }),
      ]})
    ]
  }),
  pageBreak()
);

// ════════════════════════════════════════════════════════════════
// SECTION 1 – CARDIOVASCULAR
// ════════════════════════════════════════════════════════════════
children.push(
  sectionBanner("❤  SECTION 1: CARDIOVASCULAR", C.red),
  spacer(),

  // Heart Failure
  subHeading("A. HEART FAILURE", C.red),
  subSubHeading("Types by Ejection Fraction"),
  makeTable(
    ["Type", "EF", "Mechanism"],
    [
      ["HFrEF (Systolic)", "< 40%", "Reduced contractility"],
      ["HFmrEF (Mid-range)", "40–49%", "Mixed features"],
      ["HFpEF (Diastolic)", "≥ 50%", "Impaired relaxation / filling"],
    ], C.red
  ),
  spacer(),

  subSubHeading("NYHA Functional Classification"),
  makeTable(
    ["Class", "Description"],
    [
      ["I", "No symptoms with ordinary activity"],
      ["II", "Slight limitation — comfortable at rest"],
      ["III", "Marked limitation — comfortable only at rest"],
      ["IV", "Symptoms at rest — unable to carry any activity"],
    ], C.red, C.lightRed
  ),
  spacer(),

  subSubHeading("ACC/AHA Staging"),
  makeTable(
    ["Stage", "Description"],
    [
      ["A", "Risk factors only, no structural disease"],
      ["B", "Structural disease, no symptoms"],
      ["C", "Structural disease + current or prior symptoms"],
      ["D", "Refractory HF requiring advanced/transplant therapy"],
    ], C.red, C.lightRed
  ),
  spacer(),

  subSubHeading("Clinical Features"),
  bullet("LEFT HF: Dyspnea, orthopnea, PND, basal crepitations, S3 gallop, displaced apex"),
  bullet("RIGHT HF: Raised JVP, pitting edema, hepatomegaly, ascites"),
  bullet("Best biomarker: BNP / NT-proBNP (elevated)"),
  bullet("Best investigation to assess EF: Echocardiography"),
  spacer(),

  subSubHeading("Treatment of HFrEF"),
  mnemonicBox("BANANA — HFrEF Drugs", [
    { letter: "B", meaning: "Beta blockers (carvedilol, bisoprolol, metoprolol)" },
    { letter: "A", meaning: "ACE inhibitors / ARBs (enalapril, ramipril, losartan)" },
    { letter: "N", meaning: "Nitrates — symptomatic relief" },
    { letter: "A", meaning: "Aldosterone antagonists (spironolactone, eplerenone)" },
    { letter: "N", meaning: "Neprilysin inhibitor + ARB = Sacubitril/Valsartan (ARNI)" },
    { letter: "A", meaning: "SGLT2 inhibitors (dapagliflozin, empagliflozin) — newer addition" },
  ]),
  spacer(),
  bullet("Diuretics (furosemide) for fluid overload symptom relief"),
  bullet("ICD/CRT indicated when EF < 35%"),
  spacer(),

  // IHD
  subHeading("B. ISCHEMIC HEART DISEASE", C.red),
  makeTable(
    ["Type", "Feature"],
    [
      ["Stable Angina", "Exertional, relieved by rest/nitrates, fixed threshold"],
      ["Unstable Angina", "Rest angina, new onset, or crescendo — MEDICAL EMERGENCY"],
      ["Prinzmetal/Variant", "Coronary vasospasm, ST elevation, occurs at rest/night"],
    ], C.red
  ),
  spacer(),

  subSubHeading("STEMI vs NSTEMI"),
  bullet("STEMI: ST elevation ≥ 1 mm (limb leads) / ≥ 2 mm (precordial) + troponin rise"),
  bullet("NSTEMI: Troponin rise + ischemic symptoms, NO ST elevation"),
  spacer(),

  subSubHeading("Cardiac Biomarker Timeline"),
  makeTable(
    ["Marker", "Rise", "Peak", "Normalise"],
    [
      ["Troponin I/T", "3–6 h", "12–24 h", "10–14 days"],
      ["CK-MB", "4–8 h", "18–24 h", "48–72 h"],
      ["Myoglobin", "1–3 h (earliest)", "6–8 h", "24 h"],
    ], C.red, C.lightRed
  ),
  spacer(),

  subSubHeading("ECG Changes in MI (Sequence)"),
  bullet("Hyperacute T waves (within minutes)"),
  bullet("ST elevation (hours)"),
  bullet("Q waves (hours to days) — permanent marker"),
  bullet("T wave inversion (days to weeks)"),
  spacer(),

  subSubHeading("Acute STEMI Treatment"),
  mnemonicBox("MONA-B — Acute MI Management", [
    { letter: "M", meaning: "Morphine — pain relief" },
    { letter: "O", meaning: "Oxygen — only if SpO2 < 90%" },
    { letter: "N", meaning: "Nitrates — sublingual GTN" },
    { letter: "A", meaning: "Aspirin 300 mg stat + Clopidogrel / Ticagrelor" },
    { letter: "B", meaning: "Beta blocker (IV if haemodynamically stable)" },
  ]),
  spacer(),
  bullet("Reperfusion: Primary PCI (gold standard, within 90 min of door) > Thrombolysis"),
  bullet("Thrombolysis (streptokinase, tPA) — if PCI unavailable, within 12 h of onset"),
  spacer(),

  // Hypertension
  subHeading("C. HYPERTENSION", C.red),
  makeTable(
    ["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"],
    ], C.red, C.lightRed
  ),
  spacer(),
  boldBullet("Urgency", "Crisis WITHOUT end organ damage — oral drugs, reduce over 24–48 h"),
  boldBullet("Emergency", "Crisis WITH end organ damage (brain, heart, kidney, eyes) — IV drugs, reduce by 25% in 1st hour"),
  spacer(),
  subSubHeading("Secondary Hypertension Causes"),
  bullet("Renal: Renovascular (renal artery stenosis), CKD"),
  bullet("Endocrine: Conn's syndrome (primary hyperaldosteronism), Cushing's, phaeochromocytoma"),
  bullet("Structural: Coarctation of aorta"),
  spacer(),

  // Valvular
  subHeading("D. VALVULAR HEART DISEASE", C.red),
  makeTable(
    ["Lesion", "Classic Sign", "Murmur"],
    [
      ["Mitral Stenosis", "Loud S1, Opening snap, malar flush", "Mid-diastolic rumble at apex"],
      ["Mitral Regurgitation", "Soft/absent S1, displaced apex", "Pansystolic at apex — radiates to axilla"],
      ["Aortic Stenosis", "Slow-rising pulse, narrow pulse pressure", "Ejection systolic (aortic area) — radiates to neck"],
      ["Aortic Regurgitation", "Wide pulse pressure, Corrigan's pulse, de Musset's sign", "Early diastolic at left sternal border"],
    ], C.red
  ),
  spacer(),
  bullet("Most common cause of Mitral Stenosis in India: Rheumatic fever"),
  bullet("Mitral stenosis: left atrial thrombus risk — anticoagulate if AF develops"),
  spacer(),
  pageBreak(),

  // ════════════════════════════════════════════════════════════════
  // SECTION 2 – HEMATOLOGY
  // ════════════════════════════════════════════════════════════════
  sectionBanner("🩸  SECTION 2: HEMATOLOGY", C.blue),
  spacer(),

  subHeading("A. ANEMIA", C.blue),
  subSubHeading("Classification by MCV"),
  makeTable(
    ["Type", "MCV", "Causes"],
    [
      ["Microcytic", "< 80 fL", "Iron deficiency, Thalassemia, Sideroblastic, ACD"],
      ["Normocytic", "80–100 fL", "Aplastic anemia, Acute blood loss, Hemolytic, CKD"],
      ["Macrocytic", "> 100 fL", "B12/Folate deficiency (megaloblastic), Liver disease, Hypothyroid"],
    ], C.blue, C.lightBlue
  ),
  spacer(),

  subSubHeading("Iron Studies Comparison (Microcytic Anemias)"),
  makeTable(
    ["Lab Test", "Iron Deficiency", "Thalassemia Trait", "Anemia of Chronic Disease"],
    [
      ["Serum Ferritin", "↓↓ (most sensitive)", "Normal / ↑", "↑"],
      ["Serum Iron", "↓", "Normal", "↓"],
      ["TIBC", "↑", "Normal", "↓"],
      ["Transferrin Sat", "↓", "Normal", "↓"],
    ], C.blue, C.lightBlue
  ),
  spacer(),

  subSubHeading("Iron Deficiency Anemia — Key Points"),
  bullet("Most common anemia worldwide"),
  bullet("Clinical: Koilonychia (spoon nails), angular stomatitis, atrophic glossitis, pagophagia (pica for ice)"),
  bullet("Plummer-Vinson syndrome: IDA + dysphagia + postcricoid esophageal web"),
  bullet("Treatment: Ferrous sulfate 200 mg TID x 3–6 months (continue 3 months after Hb normalises)"),
  spacer(),

  subSubHeading("Megaloblastic Anemia (B12 vs Folate)"),
  makeTable(
    ["Feature", "B12 Deficiency", "Folate Deficiency"],
    [
      ["Neurological (SACDSC)", "YES — dorsal + lateral column damage", "NO"],
      ["Peripheral smear", "Hypersegmented neutrophils (pathognomonic)", "Same"],
      ["Causes", "Pernicious anemia, gastrectomy, terminal ileum disease", "Poor diet, pregnancy, methotrexate, alcohol"],
      ["Treatment", "IM cyanocobalamin / hydroxocobalamin", "Oral folic acid 5 mg/day"],
    ], C.blue, C.lightBlue
  ),
  spacer(),
  bullet("Pernicious anemia: anti-intrinsic factor antibodies + anti-parietal cell antibodies (autoimmune)"),
  spacer(),

  subHeading("B. HEMOLYTIC ANEMIAS", C.blue),
  makeTable(
    ["Feature", "Intravascular", "Extravascular"],
    [
      ["Hemoglobinuria", "YES (urine turns dark)", "No"],
      ["Hemoglobinemia", "YES", "No"],
      ["Jaundice", "Mild", "Prominent"],
      ["Splenomegaly", "Absent / mild", "Present"],
      ["Examples", "G6PD, PNH, transfusion reaction", "Hereditary spherocytosis, Sickle cell"],
    ], C.blue
  ),
  spacer(),

  subSubHeading("Sickle Cell Disease"),
  bullet("Mutation: Glutamic acid → Valine at position 6 of beta-globin chain"),
  bullet("Crisis types: Vaso-occlusive (pain), Splenic sequestration, Aplastic crisis (parvovirus B19)"),
  bullet("Features: Autosplenectomy → susceptibility to encapsulated organisms (Pneumococcus, Hib, Meningococcus)"),
  bullet("Diagnosis: Hb electrophoresis showing HbS"),
  bullet("Treatment: Hydroxyurea (↑ HbF, ↓ HbS sickling); IV fluids + analgesia for crisis"),
  spacer(),

  subSubHeading("G6PD Deficiency"),
  bullet("X-linked recessive — affects males primarily"),
  bullet("Triggers: Primaquine, dapsone, fava beans, infections (oxidative stress)"),
  bullet("Blood film: Heinz bodies, bite cells"),
  bullet("Hemolysis is self-limiting once offending agent removed"),
  spacer(),

  subHeading("C. LEUKEMIAS", C.blue),
  makeTable(
    ["Feature", "ALL", "AML", "CLL", "CML"],
    [
      ["Age", "Children (peak 3–5 y)", "Adults (any age)", "Elderly (>60 y)", "Middle age (30–50 y)"],
      ["Cell Type", "Lymphoblast (B/T)", "Myeloblast", "Mature B lymphocyte", "Granulocyte"],
      ["Key Marker", "CD10 (CALLA), TdT", "MPO+, Auer rods", "CD5, CD23, smudge cells", "Philadelphia chr. (BCR-ABL)"],
      ["Translocation", "t(12;21) common", "t(15;17) in APL-M3", "—", "t(9;22)"],
      ["Treatment", "VCR + Pred + L-Asp", "7+3 (Cytarabine+Dauno)", "Chlorambucil/FCR", "Imatinib (TKI)"],
    ], C.blue
  ),
  spacer(),
  bullet("Auer rods — pathognomonic of AML (especially M3/APL)"),
  bullet("Smudge cells — pathognomonic of CLL"),
  bullet("Philadelphia chromosome t(9;22) — CML (also found in some ALL)"),
  bullet("Blast crisis = transformation of CML to acute leukemia"),
  spacer(),

  subHeading("D. LYMPHOMAS", C.blue),
  makeTable(
    ["Feature", "Hodgkin Lymphoma", "Non-Hodgkin Lymphoma"],
    [
      ["Age", "Bimodal: 20s and >50s", "Any age (more common elderly)"],
      ["Spread", "Contiguous, predictable", "Non-contiguous"],
      ["Pathognomonic cell", "Reed-Sternberg cell (owl-eye nucleoli)", "None specific"],
      ["B symptoms", "Common", "Less common"],
      ["Treatment", "ABVD + Radiotherapy", "R-CHOP (Rituximab-CHOP)"],
      ["Prognosis", "Generally better", "Variable by subtype"],
    ], C.blue, C.lightBlue
  ),
  spacer(),
  subSubHeading("Ann Arbor Staging (I–IV)"),
  makeTable(
    ["Stage", "Involvement"],
    [
      ["I", "Single lymph node region or single extranodal site"],
      ["II", "≥ 2 regions on the SAME side of diaphragm"],
      ["III", "Lymph node regions on BOTH sides of diaphragm"],
      ["IV", "Disseminated extranodal involvement (liver, bone marrow)"],
    ], C.blue, C.lightBlue
  ),
  spacer(),
  bullet("B symptoms: Fever >38°C + Night sweats + Weight loss >10% in 6 months"),
  spacer(),

  subHeading("E. COAGULATION DISORDERS", C.blue),
  makeTable(
    ["Condition", "PT", "APTT", "Platelets", "Key Feature"],
    [
      ["Hemophilia A (Factor VIII)", "Normal", "↑", "Normal", "X-linked recessive, males"],
      ["Hemophilia B (Factor IX)", "Normal", "↑", "Normal", "X-linked recessive, males"],
      ["von Willebrand Disease", "Normal", "↑ (usually)", "Normal/↓", "vWF antigen ↓, most common inherited bleeding disorder"],
      ["ITP", "Normal", "Normal", "↓↓", "Anti-platelet antibodies, spleen enlargement minimal"],
      ["DIC", "↑", "↑", "↓", "D-dimer ↑, fibrinogen ↓, schistocytes on smear"],
      ["Warfarin toxicity", "↑ (mainly)", "↑", "Normal", "Vit K antagonist — reverse with Vit K / FFP"],
    ], C.blue
  ),
  spacer(),
  bullet("ITP Treatment: Corticosteroids (first line) → IVIG → Rituximab → Splenectomy"),
  bullet("Hemophilia A Treatment: Factor VIII concentrate; DDAVP for mild cases"),
  spacer(),
  pageBreak(),

  // ════════════════════════════════════════════════════════════════
  // SECTION 3 – CTD RHEUMATOLOGY
  // ════════════════════════════════════════════════════════════════
  sectionBanner("🦴  SECTION 3: CONNECTIVE TISSUE & RHEUMATOLOGY", C.green),
  spacer(),

  subHeading("A. RHEUMATOID ARTHRITIS (RA)", C.green),
  subSubHeading("ACR/EULAR 2010 Criteria (score ≥ 6/10 = definite RA)"),
  makeTable(
    ["Domain", "Score"],
    [
      ["Joint involvement: 1 large joint", "0"],
      ["2–10 large joints", "1"],
      ["1–3 small joints", "2"],
      ["4–10 small joints", "3"],
      ["Serology: RF+/Anti-CCP+ low positive", "2"],
      ["Serology: RF+/Anti-CCP+ high positive (>3x ULN)", "3"],
      ["Acute phase: Abnormal CRP or ESR", "1"],
      ["Duration ≥ 6 weeks", "1"],
    ], C.green, C.lightGreen
  ),
  spacer(),
  bullet("Anti-CCP antibody: MORE SPECIFIC than RF for RA"),
  bullet("Morning stiffness > 1 hour — hallmark feature"),
  bullet("Distribution: Symmetrical polyarthritis of MCP, PIP joints — spares DIP"),
  spacer(),

  subSubHeading("Deformities in RA"),
  makeTable(
    ["Deformity", "Description"],
    [
      ["Ulnar deviation", "MCP joints deviated toward ulnar side"],
      ["Swan neck", "PIP hyperextension + DIP flexion"],
      ["Boutonnière", "PIP flexion + DIP hyperextension"],
      ["Z-deformity (thumb)", "MCP flexion + IP hyperextension"],
    ], C.green, C.lightGreen
  ),
  spacer(),
  bullet("Extra-articular: Rheumatoid nodules, pleural effusion, pericarditis, episcleritis"),
  bullet("Felty's syndrome: RA + splenomegaly + neutropenia"),
  spacer(),

  subSubHeading("RA Treatment"),
  bullet("NSAIDs: Short-term symptom relief only"),
  bullet("Glucocorticoids: Short-term bridging during DMARD initiation"),
  bullet("First-line csDMARD: Methotrexate (+ folic acid to prevent side effects)"),
  bullet("Other csDMARDs: Hydroxychloroquine, Sulfasalazine, Leflunomide"),
  bullet("Biological DMARDs (if inadequate response): Anti-TNF (etanercept, adalimumab, infliximab), Anti-IL6 (tocilizumab), Anti-CD20 (rituximab)"),
  bullet("MTX side effects: Hepatotoxicity, bone marrow suppression, pneumonitis — always co-prescribe folic acid"),
  spacer(),

  subHeading("B. SYSTEMIC LUPUS ERYTHEMATOSUS (SLE)", C.green),
  subSubHeading("ACR Criteria — need ≥ 4 of 11"),
  mnemonicBox("MD SOAP BRAIN — SLE Criteria", [
    { letter: "M", meaning: "Malar (butterfly) rash — spares nasolabial folds" },
    { letter: "D", meaning: "Discoid rash — scarring, follicular plugging" },
    { letter: "S", meaning: "Serositis — pleuritis or pericarditis" },
    { letter: "O", meaning: "Oral ulcers (painless)" },
    { letter: "A", meaning: "Arthritis — non-erosive, ≥ 2 peripheral joints" },
    { letter: "P", meaning: "Photosensitivity" },
    { letter: "B", meaning: "Blood — hemolytic anemia, leukopenia (<4000), lymphopenia, thrombocytopenia (<100k)" },
    { letter: "R", meaning: "Renal — proteinuria >0.5 g/day or cellular casts" },
    { letter: "A", meaning: "ANA — positive (sensitive screening test)" },
    { letter: "I", meaning: "Immunologic — anti-dsDNA, anti-Sm, antiphospholipid" },
    { letter: "N", meaning: "Neurologic — seizures or psychosis" },
  ]),
  spacer(),

  subSubHeading("Antibody Profile in SLE"),
  makeTable(
    ["Antibody", "Specificity/Significance"],
    [
      ["ANA", "Most sensitive (95%) — screening test; NOT specific"],
      ["Anti-dsDNA", "Specific for SLE; correlates with disease activity and lupus nephritis"],
      ["Anti-Sm", "MOST specific (30–40% sensitivity) — diagnostic of SLE"],
      ["Anti-Ro (SS-A)", "Neonatal lupus, subacute cutaneous lupus, Sjogren's overlap"],
      ["Anti-La (SS-B)", "Associated with Sjogren's overlap"],
      ["Anti-phospholipid", "Thrombosis, recurrent miscarriages (antiphospholipid syndrome)"],
    ], C.green, C.lightGreen
  ),
  spacer(),

  subSubHeading("Lupus Nephritis — ISN/RPS Classes"),
  makeTable(
    ["Class", "Pathology", "Notes"],
    [
      ["I", "Minimal mesangial", "Good prognosis"],
      ["II", "Mesangial proliferative", "Good prognosis"],
      ["III", "Focal proliferative (<50% glomeruli)", "Requires immunosuppression"],
      ["IV", "Diffuse proliferative (≥50% glomeruli)", "Worst prognosis; most aggressive treatment"],
      ["V", "Membranous", "Nephrotic syndrome predominant"],
      ["VI", "Advanced sclerosing", "Poor prognosis"],
    ], C.green, C.lightGreen
  ),
  spacer(),
  bullet("Class IV treatment: Mycophenolate mofetil + steroids (or cyclophosphamide + steroids)"),
  bullet("Hydroxychloroquine: given to ALL SLE patients (reduces flares, protects against organ damage)"),
  spacer(),

  subHeading("C. SYSTEMIC SCLEROSIS (SCLERODERMA)", C.green),
  makeTable(
    ["Feature", "Limited (lcSSc)", "Diffuse (dcSSc)"],
    [
      ["Skin involvement", "Distal to elbows/knees + face", "Proximal limbs + trunk"],
      ["CREST syndrome", "YES", "No"],
      ["Antibody", "Anti-centromere (ACA)", "Anti-Scl-70 (topoisomerase I)"],
      ["Internal organs early", "Less common", "More common (lung, heart, kidney)"],
      ["PAH", "Late complication (common)", "Less common"],
      ["Prognosis", "Better", "Worse"],
    ], C.green, C.lightGreen
  ),
  spacer(),
  mnemonicBox("CREST Syndrome", [
    { letter: "C", meaning: "Calcinosis — calcium deposits under skin" },
    { letter: "R", meaning: "Raynaud's phenomenon — WHITE → BLUE → RED" },
    { letter: "E", meaning: "Esophageal dysmotility — GERD, dysphagia" },
    { letter: "S", meaning: "Sclerodactyly — tight, thickened fingers" },
    { letter: "T", meaning: "Telangiectasia — dilated blood vessels on skin/mucosa" },
  ]),
  spacer(),

  subHeading("D. INFLAMMATORY MYOPATHIES", C.green),
  makeTable(
    ["Feature", "Polymyositis", "Dermatomyositis"],
    [
      ["Rash", "Absent", "Heliotrope rash (eyelids) + Gottron's papules (knuckles)"],
      ["Weakness", "Proximal (symmetric)", "Proximal (symmetric)"],
      ["CPK", "Markedly elevated", "Markedly elevated"],
      ["Malignancy risk", "Low", "Higher — screen for occult cancer"],
      ["Antibody", "Anti-Jo-1 (antisynthetase)", "Anti-Mi-2"],
      ["Treatment", "Corticosteroids ± methotrexate", "Corticosteroids ± methotrexate"],
    ], C.green, C.lightGreen
  ),
  spacer(),

  subHeading("E. GOUT & PSEUDOGOUT", C.green),
  makeTable(
    ["Feature", "Gout", "Pseudogout (CPPD)"],
    [
      ["Crystal", "Monosodium urate (MSU)", "Calcium pyrophosphate dihydrate"],
      ["Birefringence", "NEGATIVE (needle-shaped)", "POSITIVE (rhomboid-shaped)"],
      ["Joints", "1st MTP (podagra), ankle, knee", "Knee, wrist (larger joints)"],
      ["X-ray", "Punched-out lesions, overhanging edges, tophi", "Chondrocalcinosis (cartilage calcification)"],
      ["Associations", "Obesity, alcohol, diuretics, CKD, myeloproliferative", "Hemochromatosis, hyperparathyroidism, hypothyroid"],
    ], C.green, C.lightGreen
  ),
  spacer(),
  subSubHeading("Gout Treatment"),
  makeTable(
    ["Phase", "Drug of Choice", "Notes"],
    [
      ["Acute attack", "Colchicine (1st line)", "NSAIDs (naproxen) or steroids if colchicine CI"],
      ["Prophylaxis", "Allopurinol (xanthine oxidase inhibitor)", "START only after acute attack resolves"],
      ["Allopurinol alternative", "Febuxostat", "Used if allopurinol intolerant"],
      ["Target uric acid", "< 6 mg/dL (< 5 in tophi)", "SGLT2 inhibitors also lower uric acid"],
    ], C.green, C.lightGreen
  ),
  spacer(),

  subHeading("F. VASCULITIS — BY VESSEL SIZE", C.green),
  makeTable(
    ["Vessel Size", "Disease", "Key Features"],
    [
      ["Large", "Giant Cell Arteritis (GCA)", "Age >50, temporal headache, jaw claudication, blindness risk — IMMEDIATE steroids"],
      ["Large", "Takayasu's Arteritis", "Young Asian females, 'pulseless disease', BP difference between arms"],
      ["Medium", "Polyarteritis Nodosa (PAN)", "ANCA-negative, no glomerulonephritis, aneurysms on angiography"],
      ["Medium", "Kawasaki Disease", "Children <5 y, fever >5 days, strawberry tongue, coronary artery aneurysms"],
      ["Small (ANCA+)", "GPA (Wegener's)", "c-ANCA (anti-PR3), saddle-nose, upper respiratory + lungs + kidneys"],
      ["Small (ANCA+)", "Microscopic Polyangiitis", "p-ANCA (anti-MPO), rapidly progressive GN, pulmonary hemorrhage"],
      ["Small (ANCA+)", "Eosinophilic GPA (Churg-Strauss)", "p-ANCA, asthma + eosinophilia + granulomas"],
      ["Small (Immune complex)", "IgA Vasculitis (HSP)", "Children, palpable purpura buttocks/legs, arthritis, GN, GI involvement"],
    ], C.green
  ),
  spacer(),
  pageBreak(),

  // ════════════════════════════════════════════════════════════════
  // EXAM PREP
  // ════════════════════════════════════════════════════════════════
  sectionBanner("⭐  EXAM PREPARATION GUIDE", C.orange),
  spacer(),

  subHeading("LONG QUESTIONS (10 marks)", C.orange),
  examBox([
    "Describe the clinical features, investigations and management of chronic heart failure",
    "Classify anemia. Describe pathophysiology, clinical features and treatment of iron deficiency anemia",
    "Discuss SLE — diagnostic criteria, clinical manifestations, antibody profile and treatment",
    "Describe etiopathogenesis, clinical features and management of Rheumatoid Arthritis",
    "Write about acute myocardial infarction — classification, ECG changes, complications and treatment",
    "Discuss Hodgkin's lymphoma — pathology, staging, clinical features and treatment",
    "Describe the laboratory profile of coagulation disorders (Hemophilia, DIC, ITP)",
  ]),
  spacer(),

  subHeading("SHORT NOTES (5 marks)", C.orange),
  examBox([
    "NYHA classification of heart failure",
    "Reed-Sternberg cell — description and significance",
    "Philadelphia chromosome and CML — BCR-ABL and imatinib",
    "ACR criteria for SLE (any 4 of 11)",
    "CREST syndrome — components and antibody",
    "Gout — pathophysiology, joints involved, crystal type and treatment",
    "DIC — coagulation profile and management principles",
    "Sickle cell crisis — types (vaso-occlusive, sequestration, aplastic)",
    "Pernicious anemia — pathogenesis, features and treatment",
    "Hypertensive emergency vs urgency",
    "G6PD deficiency — inheritance, triggers, blood film findings",
    "Ann Arbor staging of lymphoma",
    "Raynaud's phenomenon — types and management",
    "Takayasu's arteritis vs Giant Cell Arteritis",
    "Anti-CCP antibody in RA — significance vs RF",
  ]),
  spacer(),

  subHeading("ONE-LINERS — MUST MEMORISE", C.orange),
  makeTable(
    ["Topic", "Answer"],
    [
      ["Most sensitive test for IDA", "Serum ferritin"],
      ["Most specific antibody in SLE", "Anti-Sm"],
      ["Pathognomonic cell in AML", "Auer rods"],
      ["Pathognomonic cell in CLL", "Smudge cells"],
      ["Pathognomonic cell in HL", "Reed-Sternberg (owl-eye nucleoli)"],
      ["Crystal in gout", "Negatively birefringent, needle-shaped (MSU)"],
      ["Crystal in pseudogout", "Positively birefringent, rhomboid (CPPD)"],
      ["First-line DMARD in RA", "Methotrexate (+ folic acid)"],
      ["TKI for CML", "Imatinib (BCR-ABL inhibitor)"],
      ["Immediate treatment to prevent blindness in GCA", "High-dose prednisolone (60 mg/day)"],
      ["Mutation in sickle cell disease", "Glu → Val at position 6 of beta-globin"],
      ["Best biomarker in heart failure", "BNP / NT-proBNP"],
      ["STEMI reperfusion gold standard", "Primary PCI within 90 minutes"],
      ["Antibody in diffuse scleroderma", "Anti-Scl-70 (topoisomerase I)"],
      ["Antibody in limited scleroderma/CREST", "Anti-centromere antibody (ACA)"],
      ["Rash pathognomonic for dermatomyositis", "Heliotrope rash + Gottron's papules"],
      ["Most common cause of megaloblastic anemia in India", "Folate deficiency"],
      ["SACDSC occurs in which deficiency only", "Vitamin B12 (NOT folate)"],
      ["Hypersegmented neutrophils are seen in", "Megaloblastic anemia"],
      ["Philadelphia chromosome translocation", "t(9;22) — BCR-ABL fusion gene"],
    ], C.orange, "FEF9E7"
  ),
  spacer(),

  subHeading("MASTER MNEMONICS QUICK REFERENCE", C.dark),
  makeTable(
    ["Topic", "Mnemonic", "Expansion"],
    [
      ["Heart failure drugs", "BANANA", "Beta blocker, ACE/ARB, Nitrates, Aldosterone antag, ARNI (sacubitril/val), SGLT2i"],
      ["Acute MI management", "MONA-B", "Morphine, Oxygen, Nitrates, Aspirin, Beta blocker"],
      ["SLE criteria (11)", "MD SOAP BRAIN", "Malar, Discoid, Serositis, Oral, Arthritis, Photo, Blood, Renal, ANA, Immunologic, Neurologic"],
      ["Scleroderma limited", "CREST", "Calcinosis, Raynaud's, Esophageal, Sclerodactyly, Telangiectasia"],
      ["B symptoms lymphoma", "FaN", "Fever >38°C, Night sweats, involuntary weight loss >10% in 6 months"],
      ["Raynaud's color sequence", "WBR", "White (ischemia) → Blue (cyanosis) → Red (reperfusion)"],
      ["Gout crystal memory", "Negative Needles / Positive Pseudogout", "Gout = negative birefringent needles; CPPD = positive rhomboids"],
      ["Prolonged QT causes", "HALT", "Hypocalcemia/K/Mg, Amiodarone/antipsychotics, LQTS congenital, Tricyclics"],
    ], C.dark
  ),
  spacer(),

  new Paragraph({
    spacing: { before: 200, after: 200 },
    alignment: AlignmentType.CENTER,
    children: [
      new TextRun({ text: "━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━", color: C.midGrey, size: 18 })
    ]
  }),
  new Paragraph({
    spacing: { before: 60, after: 60 },
    alignment: AlignmentType.CENTER,
    children: [
      new TextRun({ text: "Sources: Harrison's Principles 22E (2025) • Goldman-Cecil Medicine • Katzung Pharmacology 16E • Washington Manual of Medical Therapeutics", italics: true, size: 16, color: "888888" })
    ]
  }),
  new Paragraph({
    spacing: { before: 60, after: 200 },
    alignment: AlignmentType.CENTER,
    children: [
      new TextRun({ text: "All the best for your 2nd Sessional!  Study smart.", bold: true, size: 22, color: C.green })
    ]
  }),
);

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