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

OUTPUT = "/tmp/workspace/vitals-pilcode/Vitals_PILCODE_MacLeod.pdf"

# ── Colours ──────────────────────────────────────────────────────────────────
NAVY      = colors.HexColor("#1a3a5c")
TEAL      = colors.HexColor("#0f7273")
LIGHT_BG  = colors.HexColor("#eaf4f4")
ORANGE    = colors.HexColor("#d95f02")
GOLD      = colors.HexColor("#e6a817")
PALE_GOLD = colors.HexColor("#fff8e7")
PALE_BLUE = colors.HexColor("#e8f0fe")
WHITE     = colors.white
GREY_LIGHT= colors.HexColor("#f4f4f4")
GREY_MID  = colors.HexColor("#c0c0c0")
RED_SOFT  = colors.HexColor("#c0392b")
GREEN_SOFT= colors.HexColor("#1e8449")
TEXT_DARK = colors.HexColor("#1a1a1a")

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

def make_style(name, parent="Normal", **kw):
    s = ParagraphStyle(name, parent=styles[parent], **kw)
    return s

cover_title = make_style("CoverTitle", fontSize=28, textColor=WHITE,
                          fontName="Helvetica-Bold", alignment=TA_CENTER,
                          leading=36, spaceAfter=6)
cover_sub   = make_style("CoverSub", fontSize=16, textColor=GOLD,
                          fontName="Helvetica-Bold", alignment=TA_CENTER,
                          leading=22, spaceAfter=4)
cover_info  = make_style("CoverInfo", fontSize=11, textColor=LIGHT_BG,
                          fontName="Helvetica", alignment=TA_CENTER,
                          leading=16)

ch_title    = make_style("ChTitle", fontSize=18, textColor=WHITE,
                          fontName="Helvetica-Bold", alignment=TA_CENTER,
                          leading=24)
sec_head    = make_style("SecHead", fontSize=13, textColor=NAVY,
                          fontName="Helvetica-Bold", spaceBefore=10,
                          spaceAfter=4, leading=18)
sub_head    = make_style("SubHead", fontSize=11, textColor=TEAL,
                          fontName="Helvetica-Bold", spaceBefore=6,
                          spaceAfter=3, leading=15)
body        = make_style("Body", fontSize=9.5, textColor=TEXT_DARK,
                          fontName="Helvetica", leading=14, spaceAfter=3,
                          alignment=TA_JUSTIFY)
bullet_style= make_style("Bullet", fontSize=9.5, textColor=TEXT_DARK,
                          fontName="Helvetica", leading=13, leftIndent=14,
                          spaceAfter=2)
table_head  = make_style("TH", fontSize=9, textColor=WHITE,
                          fontName="Helvetica-Bold", alignment=TA_CENTER,
                          leading=12)
table_cell  = make_style("TC", fontSize=8.5, textColor=TEXT_DARK,
                          fontName="Helvetica", leading=12, alignment=TA_LEFT)
table_cell_c= make_style("TCC", fontSize=8.5, textColor=TEXT_DARK,
                          fontName="Helvetica-Bold", leading=12, alignment=TA_CENTER)
small_note  = make_style("Note", fontSize=8, textColor=colors.HexColor("#555555"),
                          fontName="Helvetica-Oblique", leading=11, spaceAfter=2)
alert_style = make_style("Alert", fontSize=9, textColor=RED_SOFT,
                          fontName="Helvetica-Bold", leading=13, leftIndent=10)
green_style = make_style("Green", fontSize=9, textColor=GREEN_SOFT,
                          fontName="Helvetica-Bold", leading=13, leftIndent=10)

# ── Helpers ───────────────────────────────────────────────────────────────────
def chapter_banner(title, color=NAVY):
    data = [[Paragraph(title, ch_title)]]
    t = Table(data, colWidths=[17*cm])
    t.setStyle(TableStyle([
        ("BACKGROUND", (0,0), (-1,-1), color),
        ("ROUNDEDCORNERS", [6]),
        ("TOPPADDING",  (0,0), (-1,-1), 10),
        ("BOTTOMPADDING",(0,0),(-1,-1), 10),
        ("LEFTPADDING", (0,0), (-1,-1), 12),
    ]))
    return t

def section_banner(title, color=TEAL):
    data = [[Paragraph(title, make_style("SB", fontSize=11, textColor=WHITE,
                                          fontName="Helvetica-Bold",
                                          alignment=TA_LEFT, leading=15))]]
    t = Table(data, colWidths=[17*cm])
    t.setStyle(TableStyle([
        ("BACKGROUND", (0,0), (-1,-1), color),
        ("TOPPADDING",  (0,0), (-1,-1), 6),
        ("BOTTOMPADDING",(0,0),(-1,-1), 6),
        ("LEFTPADDING", (0,0), (-1,-1), 10),
    ]))
    return t

def pilcode_table(rows, header_color=NAVY):
    """rows = list of (letter, label, content)"""
    header = [
        Paragraph("Letter", table_head),
        Paragraph("Stands For", table_head),
        Paragraph("Clinical Application", table_head),
    ]
    data = [header]
    for letter, label, content in rows:
        data.append([
            Paragraph(f"<b>{letter}</b>", table_cell_c),
            Paragraph(f"<b>{label}</b>", table_cell),
            Paragraph(content, table_cell),
        ])
    t = Table(data, colWidths=[1.2*cm, 3.5*cm, 12.3*cm], repeatRows=1)
    row_styles = [
        ("BACKGROUND",   (0,0), (-1,0), header_color),
        ("TEXTCOLOR",    (0,0), (-1,0), WHITE),
        ("FONTNAME",     (0,0), (-1,0), "Helvetica-Bold"),
        ("FONTSIZE",     (0,0), (-1,-1), 8.5),
        ("ROWBACKGROUNDS",(0,1),(-1,-1), [WHITE, GREY_LIGHT]),
        ("GRID",         (0,0), (-1,-1), 0.4, GREY_MID),
        ("VALIGN",       (0,0), (-1,-1), "TOP"),
        ("TOPPADDING",   (0,0), (-1,-1), 5),
        ("BOTTOMPADDING",(0,0), (-1,-1), 5),
        ("LEFTPADDING",  (0,0), (-1,-1), 5),
    ]
    # Colour the letter column alternating
    for i in range(1, len(data)):
        bg = PALE_BLUE if i % 2 == 1 else LIGHT_BG
        row_styles.append(("BACKGROUND", (0,i), (0,i), bg))
    t.setStyle(TableStyle(row_styles))
    return t

def simple_table(headers, rows, col_widths, hdr_color=NAVY):
    header_row = [Paragraph(h, table_head) for h in headers]
    data = [header_row]
    for row in rows:
        data.append([Paragraph(str(c), table_cell) for c in row])
    t = Table(data, colWidths=col_widths, repeatRows=1)
    t.setStyle(TableStyle([
        ("BACKGROUND",    (0,0), (-1,0), hdr_color),
        ("TEXTCOLOR",     (0,0), (-1,0), WHITE),
        ("FONTNAME",      (0,0), (-1,0), "Helvetica-Bold"),
        ("FONTSIZE",      (0,0), (-1,-1), 8.5),
        ("ROWBACKGROUNDS",(0,1),(-1,-1), [WHITE, GREY_LIGHT]),
        ("GRID",          (0,0), (-1,-1), 0.4, GREY_MID),
        ("VALIGN",        (0,0), (-1,-1), "TOP"),
        ("TOPPADDING",    (0,0), (-1,-1), 5),
        ("BOTTOMPADDING", (0,0),(-1,-1), 5),
        ("LEFTPADDING",   (0,0), (-1,-1), 5),
    ]))
    return t

def highlight_box(text, bg=PALE_GOLD, border=GOLD):
    data = [[Paragraph(text, make_style("HB", fontSize=9, textColor=TEXT_DARK,
                                         fontName="Helvetica", leading=13,
                                         alignment=TA_LEFT))]]
    t = Table(data, colWidths=[17*cm])
    t.setStyle(TableStyle([
        ("BACKGROUND",   (0,0), (-1,-1), bg),
        ("BOX",          (0,0), (-1,-1), 1.2, border),
        ("TOPPADDING",   (0,0), (-1,-1), 8),
        ("BOTTOMPADDING",(0,0), (-1,-1), 8),
        ("LEFTPADDING",  (0,0), (-1,-1), 10),
    ]))
    return t

def alert_box(text, bg=colors.HexColor("#fdf3f3"), border=RED_SOFT):
    return highlight_box(text, bg=bg, border=border)

def green_box(text):
    return highlight_box(text, bg=colors.HexColor("#eafaf1"), border=GREEN_SOFT)

def sp(n=1):
    return Spacer(1, n*4*mm)

# ── Page numbering ─────────────────────────────────────────────────────────────
def add_page_number(canvas, doc):
    canvas.saveState()
    canvas.setFont("Helvetica", 8)
    canvas.setFillColor(colors.HexColor("#888888"))
    canvas.drawCentredString(A4[0]/2, 1.5*cm,
        f"Vitals & PILCODE — MacLeod's Clinical Examination  |  Page {doc.page}")
    canvas.setStrokeColor(GREY_MID)
    canvas.setLineWidth(0.5)
    canvas.line(2*cm, 2*cm, A4[0]-2*cm, 2*cm)
    canvas.restoreState()

# ── Build PDF ─────────────────────────────────────────────────────────────────
doc = SimpleDocTemplate(
    OUTPUT,
    pagesize=A4,
    leftMargin=2*cm, rightMargin=2*cm,
    topMargin=2.2*cm, bottomMargin=2.5*cm,
    title="Vitals & PILCODE – MacLeod's Clinical Examination",
    author="Orris AI Medical Notes",
)

story = []

# ════════════════════════════════════════════════════════════════════
# COVER PAGE
# ════════════════════════════════════════════════════════════════════
cover_bg_data = [[Paragraph(
    "VITALS &amp; PILCODE<br/>IN HISTORY TAKING",
    cover_title
)]]
cover_t = Table(cover_bg_data, colWidths=[17*cm])
cover_t.setStyle(TableStyle([
    ("BACKGROUND",    (0,0), (-1,-1), NAVY),
    ("ROUNDEDCORNERS",[8]),
    ("TOPPADDING",    (0,0), (-1,-1), 28),
    ("BOTTOMPADDING", (0,0), (-1,-1), 28),
]))
story.append(cover_t)
story.append(sp(2))

sub_t = Table([[Paragraph("Based on MacLeod's Clinical Examination (15th Edition)", cover_sub)]],
              colWidths=[17*cm])
sub_t.setStyle(TableStyle([
    ("BACKGROUND",   (0,0),(-1,-1), TEAL),
    ("TOPPADDING",   (0,0),(-1,-1), 10),
    ("BOTTOMPADDING",(0,0),(-1,-1), 10),
]))
story.append(sub_t)
story.append(sp(3))

info_lines = [
    "Dover · Innes · Fairhurst — Elsevier Health Sciences, 2023",
    "Vital Signs  •  Cardinal Symptoms  •  PILCODE Framework  •  Normal Values",
    "Clinical Significance of Increases &amp; Decreases",
]
for line in info_lines:
    story.append(Paragraph(line, make_style("CI2", fontSize=10,
                                             textColor=NAVY, fontName="Helvetica",
                                             alignment=TA_CENTER, leading=16)))
    story.append(sp(0.5))

story.append(sp(4))
story.append(HRFlowable(width="100%", thickness=1, color=GOLD))
story.append(sp(1))
story.append(Paragraph(
    "This document covers: (1) Normal ranges for all vital signs, "
    "(2) Clinical causes of increases and decreases, "
    "(3) PILCODE framework applied to each vital sign and cardinal symptom by system.",
    make_style("Desc", fontSize=9.5, textColor=colors.HexColor("#444444"),
               fontName="Helvetica-Oblique", alignment=TA_CENTER, leading=14)))
story.append(PageBreak())

# ════════════════════════════════════════════════════════════════════
# PART 1 — PILCODE MNEMONIC
# ════════════════════════════════════════════════════════════════════
story.append(chapter_banner("PART 1 — THE PILCODE MNEMONIC", NAVY))
story.append(sp(2))

story.append(Paragraph("What is PILCODE?", sec_head))
story.append(Paragraph(
    "PILCODE is a structured mnemonic used during history taking to systematically "
    "analyse any symptom or clinical finding. It ensures no important dimension of "
    "a complaint is missed and guides the clinician toward the correct differential diagnosis.",
    body))
story.append(sp(1))

pilcode_intro = [
    ("P", "Place / Site", "Where is the problem located? Which organ, region or body system is affected?"),
    ("I", "Intensity / Severity", "How severe is it? Use a 0-10 pain scale or assess functional impact (e.g. exercise tolerance, NYHA class)."),
    ("L", "Length / Duration", "How long has the symptom been present? Is it continuous or episodic? Getting better or worse?"),
    ("C", "Character / Quality", "What does it feel like? (crushing, burning, sharp, colicky, throbbing, dull ache, etc.)"),
    ("O", "Onset", "When and how did it start? Was onset sudden (seconds), rapid (minutes) or gradual (days/weeks)?"),
    ("D", "Duration + Associated features", "Time course of each episode AND associated symptoms: fever, nausea, diaphoresis, discharge, weight loss, etc."),
    ("E", "Exacerbating &amp; Relieving factors", "What makes it worse (exercise, eating, breathing, position)? What makes it better (rest, GTN, posture, medications)?"),
]
story.append(pilcode_table(pilcode_intro, NAVY))
story.append(sp(2))

story.append(highlight_box(
    "<b>Key Point (MacLeod's):</b> The history remains the cornerstone of clinical diagnosis. "
    "Up to 80% of diagnoses can be reached from the history alone before any examination or "
    "investigation. PILCODE ensures systematic, complete symptom analysis.",
    bg=PALE_GOLD, border=GOLD
))
story.append(PageBreak())

# ════════════════════════════════════════════════════════════════════
# PART 2 — VITAL SIGNS OVERVIEW
# ════════════════════════════════════════════════════════════════════
story.append(chapter_banner("PART 2 — VITAL SIGNS: NORMAL VALUES & IMPORTANCE", TEAL))
story.append(sp(2))

story.append(Paragraph("Normal Ranges — Adult", sec_head))
normal_rows = [
    ["Temperature (oral)", "36.5 – 37.5°C", "Rectal +0.5°C; Axillary −0.5°C; Tympanic ≈ oral"],
    ["Pulse Rate", "60 – 100 bpm", "Athletes may be 40–50 bpm (normal for them)"],
    ["Respiratory Rate", "12 – 20 breaths/min", "Most sensitive early warning sign of deterioration"],
    ["Blood Pressure", "<120/80 mmHg (optimal)\n≤140/90 mmHg (accepted)", "Measure both arms; pulse pressure = systolic − diastolic (normal 40–60 mmHg)"],
    ["SpO₂ (Oxygen sat.)", "≥95%", "<94% requires investigation; <90% = hypoxaemia"],
]
story.append(simple_table(
    ["Vital Sign", "Normal Range", "Key Notes"],
    normal_rows,
    [4.5*cm, 5*cm, 7.5*cm],
    hdr_color=TEAL
))
story.append(sp(2))

story.append(Paragraph("Why Vital Signs Matter in History Taking", sec_head))
story.append(Paragraph(
    "MacLeod's emphasises recording vital signs BEFORE proceeding to systematic history "
    "and examination because they:", body))

why_bullets = [
    "Identify immediately life-threatening conditions (e.g. sepsis: fever + tachycardia + hypotension)",
    "Provide clinical context that guides the differential diagnosis",
    "Allow pattern recognition — combinations of abnormal vitals are diagnostic clues",
    "Establish a baseline for monitoring response to treatment",
    "Feed into Early Warning Scores (NEWS2) to escalate care appropriately",
]
for b in why_bullets:
    story.append(Paragraph(f"• {b}", bullet_style))
story.append(sp(1))

story.append(highlight_box(
    "<b>Classic Vital Sign Patterns:</b><br/>"
    "• Fever + tachycardia + hypotension = Sepsis (Septic Shock)<br/>"
    "• Bradycardia + hypertension + irregular breathing = Cushing's Triad (raised ICP)<br/>"
    "• Fever + relative bradycardia = Typhoid / Legionella / Drug fever (Faget's Sign)<br/>"
    "• Hypotension + tachycardia + narrow pulse pressure = Cardiogenic shock / Tamponade<br/>"
    "• Bradypnoea + pinpoint pupils = Opioid overdose",
    bg=PALE_BLUE, border=NAVY
))
story.append(PageBreak())

# ════════════════════════════════════════════════════════════════════
# PART 3 — TEMPERATURE
# ════════════════════════════════════════════════════════════════════
story.append(chapter_banner("PART 3 — TEMPERATURE (Normal: 36.5–37.5°C)", ORANGE))
story.append(sp(2))

# Increase/Decrease quick table
story.append(Paragraph("Increases and Decreases at a Glance", sec_head))
temp_id = [
    ["↑ Pyrexia", ">37.5°C", "Infection, inflammation, malignancy, drugs, PE, DVT, thyroid storm"],
    ["↑↑ Hyperpyrexia", ">41°C", "Severe infection, heat stroke, malignant hyperthermia, NMS — LIFE-THREATENING"],
    ["↓ Hypothermia", "<35°C", "Environmental exposure, hypothyroidism, hypoglycaemia, alcohol, septic shock (late)"],
]
story.append(simple_table(
    ["Direction", "Threshold", "Key Causes"],
    temp_id, [2.5*cm, 3*cm, 11.5*cm], hdr_color=ORANGE
))
story.append(sp(1.5))

story.append(Paragraph("PILCODE Applied to Temperature", sec_head))
temp_pilcode = [
    ("P", "Place / Site",
     "Measured orally (standard), rectally (most accurate, +0.5°C), axillary (least accurate, −0.5°C), "
     "tympanically (quick screening). Site matters — always document method."),
    ("I", "Intensity / Severity",
     "Low-grade: 37.5–38°C | Fever: >38°C | High fever: >39°C | Hyperpyrexia: >41°C | "
     "Hypothermia: <35°C (mild 32–35°C, moderate 28–32°C, severe <28°C)"),
    ("L", "Length / Duration",
     "Acute fever <7 days (infection) | Prolonged fever >2–3 weeks = Fever of Unknown Origin (FUO) — "
     "investigate for occult infection, autoimmune, malignancy | Relapsing fever: malaria, Borrelia"),
    ("C", "Character / Pattern",
     "Continuous (stays elevated, e.g. lobar pneumonia, typhoid) | "
     "Remittent (fluctuates but never normal: TB, infective endocarditis) | "
     "Intermittent (returns to normal: malaria — tertian/quartan) | "
     "Hectic/Septic (swings >1°C with rigors/sweats: abscess, pyaemia)"),
    ("O", "Onset",
     "Sudden with rigors: pneumococcal pneumonia, malaria, bacteraemia | "
     "Gradual onset: typhoid, TB, SBE | "
     "Relation to travel, animal contact, bites?"),
    ("D", "Duration + Associated",
     "Associated rigors/chills? Night sweats (TB, lymphoma, HIV)? Rash (viral, meningococcal)? "
     "Weight loss? Recent travel? Animal or tick exposure? New medications?"),
    ("E", "Exacerbating / Relieving",
     "Responds to antipyretics (most infections)? Diurnal pattern (TB: afternoon/evening peak)? "
     "Fever + no tachycardia = typhoid/drug fever/Legionella (Faget's sign) — key exam point!"),
]
story.append(pilcode_table(temp_pilcode, ORANGE))
story.append(sp(1.5))

story.append(alert_box(
    "⚠ ALERT: Hyperpyrexia (>41°C) is a medical emergency. Consider: severe infection, heat stroke, "
    "malignant hyperthermia (post-anaesthesia), neuroleptic malignant syndrome (antipsychotics)."))
story.append(sp(1))
story.append(green_box(
    "✓ Remember — Rule of thumb: Pulse rises ~10 bpm per 1°C rise in temperature. "
    "If pulse does NOT rise with fever = relative bradycardia = typhoid, Legionella, drug fever."))
story.append(PageBreak())

# ════════════════════════════════════════════════════════════════════
# PART 4 — PULSE RATE
# ════════════════════════════════════════════════════════════════════
story.append(chapter_banner("PART 4 — PULSE RATE (Normal: 60–100 bpm)", NAVY))
story.append(sp(2))

story.append(Paragraph(
    "MacLeod's teaches assessment of the pulse using FIVE features: "
    "Rate · Rhythm · Volume (Amplitude) · Character (Waveform) · Radio-femoral delay",
    body))
story.append(sp(1))

pulse_id = [
    ["↑ Tachycardia", ">100 bpm", "Fever, hypovolaemia, anaemia, HF, thyrotoxicosis, PE, sepsis, pain, anxiety, drugs (cocaine, atropine)"],
    ["↓ Bradycardia", "<60 bpm", "Athletes (normal), hypothyroidism, hypothermia, raised ICP, heart block, beta-blockers, digoxin toxicity, jaundice"],
]
story.append(simple_table(
    ["Direction", "Definition", "Key Causes"],
    pulse_id, [2.5*cm, 2.5*cm, 12*cm], hdr_color=NAVY
))
story.append(sp(1.5))

story.append(Paragraph("PILCODE Applied to Pulse Rate", sec_head))
pulse_pilcode = [
    ("P", "Place / Site",
     "Radial (routine) | Carotid (volume & character best here) | Brachial (contour) | "
     "Femoral (radio-femoral delay — coarctation of aorta) | Dorsalis pedis / Posterior tibial (PVD assessment)"),
    ("I", "Intensity / Rate",
     "Bradycardia: <60 | Normal: 60–100 | Tachycardia: >100 | Extreme: >150 bpm. "
     "Count for a full 60 seconds if irregular. Use 15-sec × 4 only if regular."),
    ("L", "Length / Duration",
     "Persistent tachycardia (sepsis, thyrotoxicosis, HF) vs. Paroxysmal/episodic (SVT — sudden onset/offset) "
     "vs. Effort-related (inappropriate sinus tachycardia, PE)"),
    ("C", "Character / Quality",
     "Regular vs. Irregularly irregular (AF) vs. Regularly irregular (ectopics) | "
     "Bounding (sepsis, AR, thyrotoxicosis, fever) | "
     "Thready/weak (cardiogenic shock, severe AS, hypovolaemia) | "
     "Collapsing/water-hammer (aortic regurgitation — de Musset's sign) | "
     "Pulsus bisferiens (HOCM, combined AS+AR) | Pulsus alternans (severe LV failure)"),
    ("O", "Onset",
     "Sudden palpitations: SVT, AF, VT, panic attack | "
     "Gradual tachycardia: anaemia, thyrotoxicosis, progressive HF | "
     "Palpitations with syncope = cardiac arrhythmia until proven otherwise"),
    ("D", "Duration + Associated",
     "Chest pain? Dyspnoea? Syncope or near-syncope? Diaphoresis? "
     "Drug history: digoxin, beta-blockers, antiarrhythmics, cocaine, sympathomimetics? "
     "Pacemaker in situ?"),
    ("E", "Exacerbating / Relieving",
     "Worse on exercise (demand ischaemia)? Palpitations start/stop abruptly (SVT: vagal manoeuvres help)? "
     "Triggered by caffeine, alcohol, stress? Pulsus paradoxus (>10 mmHg BP drop on inspiration) = "
     "cardiac tamponade, severe asthma"),
]
story.append(pilcode_table(pulse_pilcode, NAVY))
story.append(sp(1.5))

story.append(Paragraph("Special Pulse Patterns — Key Exam Points", sec_head))
pulse_special = [
    ["Collapsing (water-hammer)", "Aortic regurgitation, high-output states (thyrotoxicosis, anaemia, AV fistula, Paget's)"],
    ["Pulsus paradoxus (>10 mmHg ↓ on inspiration)", "Cardiac tamponade, severe asthma, tension pneumothorax, constrictive pericarditis"],
    ["Radio-femoral delay", "Coarctation of the aorta"],
    ["Irregularly irregular", "Atrial fibrillation (completely irregular, no two beats the same)"],
    ["Pulsus alternans", "Severe left ventricular failure (alternating strong/weak beats)"],
    ["Bisferiens pulse", "HOCM or combined aortic stenosis + regurgitation"],
    ["Jerky pulse", "HOCM (hypertrophic obstructive cardiomyopathy)"],
    ["Slow rising / plateau", "Aortic stenosis (severe)"],
]
story.append(simple_table(
    ["Pulse Pattern", "Condition"],
    pulse_special, [6*cm, 11*cm], hdr_color=colors.HexColor("#34495e")
))
story.append(PageBreak())

# ════════════════════════════════════════════════════════════════════
# PART 5 — RESPIRATORY RATE
# ════════════════════════════════════════════════════════════════════
story.append(chapter_banner("PART 5 — RESPIRATORY RATE (Normal: 12–20/min)", TEAL))
story.append(sp(2))

story.append(highlight_box(
    "<b>MacLeod's Key Teaching:</b> Respiratory Rate is the MOST SENSITIVE early warning sign of "
    "serious illness. It is often the FIRST vital sign to become abnormal in deteriorating patients. "
    "Count for a full 60 seconds. Do NOT tell the patient you are counting respirations — they will "
    "alter their breathing consciously.",
    bg=PALE_BLUE, border=TEAL
))
story.append(sp(1.5))

rr_id = [
    ["↑ Tachypnoea", ">20/min", "Pneumonia, PE, asthma, COPD, pulmonary oedema, metabolic acidosis, sepsis, pain, anxiety, anaemia"],
    ["↑↑ Severe", ">25/min", "CURB-65 pneumonia criterion; NEWS2 high score"],
    ["↑↑↑ Critical", ">30/min", "Respiratory failure imminent; ICU involvement"],
    ["↓ Bradypnoea", "<12/min", "Opioid/sedative overdose (classic), CNS depression, hypothyroidism, severe metabolic alkalosis"],
]
story.append(simple_table(
    ["Direction", "Threshold", "Key Causes"],
    rr_id, [2.5*cm, 3*cm, 11.5*cm], hdr_color=TEAL
))
story.append(sp(1.5))

story.append(Paragraph("PILCODE Applied to Respiratory Rate / Breathing", sec_head))
rr_pilcode = [
    ("P", "Place / Site",
     "Observed at the chest wall (upper chest) and abdomen. Both should rise and fall together. "
     "Paradoxical abdominal movement (chest rises, abdomen falls) = respiratory muscle fatigue."),
    ("I", "Intensity / Severity",
     "Mild: 20–24/min | Moderate: 25–29/min | Severe: ≥30/min | Critical: use of accessory muscles, "
     "cyanosis, inability to speak in full sentences. NYHA class for dyspnoea severity."),
    ("L", "Length / Duration",
     "Acute dyspnoea <1h: PE, pneumothorax, acute LVF, anaphylaxis | "
     "Subacute hours-days: pneumonia, asthma exacerbation | "
     "Chronic weeks-months: COPD, ILD, heart failure, anaemia"),
    ("C", "Character / Breathing Pattern",
     "Cheyne-Stokes: crescendo-decrescendo with apnoea (raised ICP, heart failure, uraemia, altitude) | "
     "Kussmaul: deep, regular, rapid, sighing — metabolic acidosis (DKA, renal failure) | "
     "Biot's: irregular with unpredictable apnoea — medullary damage | "
     "Apnoeustic: prolonged inspiration + pause — pontine lesion | "
     "Stridor (inspiratory): upper airway obstruction — EMERGENCY"),
    ("O", "Onset",
     "Sudden onset: PE, pneumothorax, anaphylaxis, acute LVF, foreign body | "
     "Gradual: COPD exacerbation, heart failure, anaemia, ILD | "
     "Nocturnal: asthma, LVF (PND — woken from sleep, must sit upright)"),
    ("D", "Duration + Associated",
     "Cough (productive/dry)? Haemoptysis? Wheeze? Chest pain (pleuritic = worse on breathing)? "
     "Fever + purulent sputum (pneumonia)? Ankle oedema + orthopnoea (HF)? Weight loss + night sweats (TB/malignancy)?"),
    ("E", "Exacerbating / Relieving",
     "Orthopnoea (worse lying flat) = LVF, asthma | "
     "Worse with allergens/cold/exercise = asthma | "
     "Better sitting forward = pericardial effusion | "
     "Worse on breathing = pleuritic (pneumonia, PE, pleurisy) | "
     "Better with bronchodilators = asthma/COPD | "
     "Better with diuretics = pulmonary oedema"),
]
story.append(pilcode_table(rr_pilcode, TEAL))
story.append(sp(1))
story.append(alert_box(
    "⚠ STRIDOR = Inspiratory noise = upper airway obstruction. This is a MEDICAL EMERGENCY. "
    "Causes: croup (barking cough, child), epiglottitis (drooling, toxic child), "
    "anaphylaxis, foreign body, angioedema. Do NOT examine throat with tongue depressor in suspected epiglottitis."))
story.append(PageBreak())

# ════════════════════════════════════════════════════════════════════
# PART 6 — BLOOD PRESSURE
# ════════════════════════════════════════════════════════════════════
story.append(chapter_banner("PART 6 — BLOOD PRESSURE (Normal: <120/80 mmHg)", colors.HexColor("#6c3483")))
story.append(sp(2))

bp_class = [
    ["Normal", "<120", "<80", "Ideal — lowest CV risk"],
    ["Elevated", "120–129", "<80", "Lifestyle modification advised"],
    ["Stage 1 HT", "130–139", "80–89", "Consider treatment + lifestyle"],
    ["Stage 2 HT", "≥140", "≥90", "Medication usually required"],
    ["Hypertensive Urgency", ">180", ">120", "No end-organ damage — oral treatment"],
    ["Hypertensive Emergency", ">180", ">120", "WITH end-organ damage — IV treatment, ICU"],
    ["Hypotension", "<90", "—", "Shock, dehydration, drugs, cardiac failure"],
]
story.append(simple_table(
    ["Classification", "Systolic (mmHg)", "Diastolic (mmHg)", "Action"],
    bp_class, [3.5*cm, 3.5*cm, 3.5*cm, 6.5*cm],
    hdr_color=colors.HexColor("#6c3483")
))
story.append(sp(1.5))

story.append(Paragraph("PILCODE Applied to Blood Pressure", sec_head))
bp_pilcode = [
    ("P", "Place / Site",
     "Both arms (>15 mmHg difference = subclavian stenosis, aortic dissection) | "
     "Lying AND standing (postural drop >20 mmHg systolic = orthostatic hypotension) | "
     "Ankle-Brachial Index: ABI <0.9 = peripheral arterial disease | "
     "Legs vs arms: normally legs slightly higher — reversal = coarctation of aorta"),
    ("I", "Intensity / Severity",
     "Grade hypertension (see classification table above) | "
     "Pulse pressure = Systolic − Diastolic (normal 40–60 mmHg) | "
     "Wide PP (>60): AR, thyrotoxicosis, anaemia, fever, AV fistula | "
     "Narrow PP (<25): tamponade, severe AS, cardiogenic shock, hypovolaemia"),
    ("L", "Length / Duration",
     "Chronic essential HT (years, usually asymptomatic) | Acute hypertensive crisis | "
     "Duration of known hypertension and current treatment compliance"),
    ("C", "Character",
     "Systolic predominance (elderly, isolated systolic HT — aortic stiffness) | "
     "Diastolic predominance (younger patients, essential HT) | "
     "Labile BP (anxiety, phaeochromocytoma — episodic HT with headache, sweating, palpitations) | "
     "White coat hypertension (high in clinic only — confirm with 24h ambulatory BP monitoring)"),
    ("O", "Onset",
     "Sudden severe 'thunderclap' headache + HT = hypertensive encephalopathy, SAH | "
     "Young patient + severe HT = secondary cause (renal, endocrine) | "
     "Gradual/insidious: essential hypertension (most common)"),
    ("D", "Duration + Associated",
     "Headache (occipital, worse in morning)? Visual disturbance/blurring (hypertensive retinopathy)? "
     "Chest/back pain (dissection)? Haematuria (renal)? Drug history: OCP, NSAIDs, steroids, "
     "sympathomimetics? Family history of HT/renal disease/stroke?"),
    ("E", "Exacerbating / Relieving",
     "White coat effect (higher in clinic)? Postural drop on standing (autonomic neuropathy, "
     "dehydration, antihypertensives, diuretics, antidepressants, Parkinson's)? "
     "Worse with stress? Better after urination (overflow/volume)?"),
]
story.append(pilcode_table(bp_pilcode, colors.HexColor("#6c3483")))
story.append(sp(1.5))

story.append(Paragraph("Secondary Causes of Hypertension (Always Consider in Young/Resistant)", sec_head))
htn_secondary = [
    ["Renal", "Chronic kidney disease, renal artery stenosis (renovascular HT — bruit over renal artery)"],
    ["Endocrine", "Conn's syndrome (hyperaldosteronism — hypokalaemia + HT) | Cushing's (moon face, striae, central obesity) | Phaeochromocytoma (episodic HT, palpitations, sweating) | Acromegaly | Hypothyroidism/Hyperthyroidism"],
    ["Vascular", "Coarctation of aorta (radio-femoral delay, BP arms >> legs, systolic murmur)"],
    ["Drugs", "OCP, NSAIDs, corticosteroids, sympathomimetics, ciclosporin, erythropoietin"],
    ["Pregnancy", "Pre-eclampsia (HT + proteinuria + oedema after 20 weeks)"],
]
story.append(simple_table(
    ["Category", "Examples"],
    htn_secondary, [3.5*cm, 13.5*cm],
    hdr_color=colors.HexColor("#6c3483")
))
story.append(PageBreak())

# ════════════════════════════════════════════════════════════════════
# PART 7 — CARDINAL SYMPTOMS (MacLeod's Box 2.10)
# ════════════════════════════════════════════════════════════════════
story.append(chapter_banner("PART 7 — CARDINAL SYMPTOMS (MacLeod's Box 2.10)", colors.HexColor("#1a5276")))
story.append(sp(2))

story.append(Paragraph(
    "Cardinal symptoms are the key presenting complaints asked for each body system during "
    "the Systematic Enquiry (SE) in history taking. MacLeod's Box 2.10 lists these by system. "
    "PILCODE is then applied to any positive finding.",
    body))
story.append(sp(1.5))

story.append(Paragraph("MacLeod's Systematic Enquiry — Cardinal Symptoms by System", sec_head))
cardinals_table_data = [
    ["General", "Wellbeing, appetite, weight change, energy, fatigue, sleep, mood, fever, night sweats"],
    ["Cardiovascular", "Chest pain on exertion (angina), dyspnoea (orthopnoea, PND), palpitations, syncope/presyncope, ankle oedema, claudication"],
    ["Respiratory", "Dyspnoea (exercise tolerance), cough, wheeze, haemoptysis, sputum (colour/amount), pleuritic chest pain, stridor"],
    ["Gastrointestinal", "Abdominal pain, nausea/vomiting, dysphagia (solids vs liquids), change in bowel habit, rectal bleeding, melaena, jaundice, weight loss"],
    ["Urological/Renal", "Dysuria, frequency, urgency, haematuria, loin pain, incontinence, nocturia, hesitancy, poor stream"],
    ["Neurological", "Headache, seizures, weakness (upper/lower limb), numbness/paraesthesia, visual disturbance, speech problems, syncope/blackout, gait disturbance"],
    ["Musculoskeletal", "Joint pain, swelling, stiffness (morning duration), back pain, muscle weakness, reduced range of motion"],
    ["Endocrine", "Heat/cold intolerance, polydipsia, polyuria, weight change, tremor, skin/hair changes, sexual dysfunction"],
    ["Skin", "Rash (distribution, character), itch (pruritus), changes in moles, hair loss, nail changes"],
    ["Psychiatric", "Mood, anxiety, sleep disturbance, appetite, suicidal ideation, hallucinations, memory change"],
]
story.append(simple_table(
    ["System", "Cardinal Symptoms to Ask"],
    cardinals_table_data, [4*cm, 13*cm],
    hdr_color=colors.HexColor("#1a5276")
))
story.append(PageBreak())

# ── CARDIOVASCULAR CARDINALS ──
story.append(section_banner("7A — CARDIOVASCULAR SYSTEM: CHEST PAIN", NAVY))
story.append(sp(1.5))

chest_pilcode = [
    ("P", "Place / Site",
     "Central/retrosternal (ischaemia, oesophageal, aortic dissection) | "
     "Left lateral (pleuritic, pericarditic) | "
     "Tearing through to back (aortic dissection) | "
     "Epigastric (MI — inferior, oesophageal, peptic ulcer)"),
    ("I", "Intensity",
     "0–10 pain scale | Crushing, elephant-on-chest (ischaemia) | "
     "Functional impact: does it stop the patient mid-activity?"),
    ("L", "Length",
     "<20 min: stable angina (exertional) | >20 min: ACS (unstable angina/NSTEMI/STEMI) | "
     "Seconds: musculoskeletal, oesophageal spasm | Hours-days: pericarditis, pleurisy, MSK"),
    ("C", "Character",
     "Crushing/pressure/heaviness/tightness (ischaemia) | "
     "Sharp/stabbing, worse on breathing (pleuritic: PE, pneumonia, pneumothorax) | "
     "Sharp, better sitting forward (pericarditis) | "
     "Tearing/ripping (aortic dissection — immediate life threat) | "
     "Burning (GORD, oesophagitis)"),
    ("O", "Onset",
     "On exertion (stable angina: fixed atheromatous stenosis) | "
     "At rest (unstable angina, NSTEMI: plaque rupture) | "
     "Sudden maximal 'thunderclap' (aortic dissection, pneumothorax) | "
     "After eating (oesophageal, mesenteric ischaemia) | "
     "Positional: worse lying (pericarditis better sitting forward)"),
    ("D", "Duration + Associated",
     "Radiation to jaw/left arm/shoulder (MI) | "
     "Diaphoresis + nausea + vomiting (classic MI presentation — women/elderly may lack chest pain) | "
     "Dyspnoea, pallor, syncope | "
     "Unequal arm BP (dissection) | "
     "Fever + pericardial friction rub (pericarditis)"),
    ("E", "Exacerbating / Relieving",
     "Relieved by GTN within 2–5 min (angina) | "
     "Not relieved by GTN (STEMI, oesophageal spasm, dissection) | "
     "Relieved by sitting forward (pericarditis) | "
     "Worse on inspiration (pleuritic) | "
     "Worse with palpation (musculoskeletal — Tietze syndrome, costochondritis)"),
]
story.append(pilcode_table(chest_pilcode, NAVY))
story.append(sp(1))

story.append(Paragraph("Differential Diagnosis of Chest Pain at a Glance", sub_head))
chest_dd = [
    ["Stable angina", "Exertional, <20 min, relieved GTN, retrosternal"],
    ["STEMI/NSTEMI", ">20 min, rest pain, radiation to jaw/arm, diaphoresis, unresponsive to GTN"],
    ["Aortic dissection", "Tearing, sudden, radiating to back, unequal arm BP — EMERGENCY"],
    ["Pulmonary embolism", "Pleuritic chest pain + dyspnoea + haemoptysis + risk factors (DVT, immobility, OCP)"],
    ["Pneumothorax", "Sudden pleuritic pain + dyspnoea + reduced breath sounds — Tension = EMERGENCY"],
    ["Pericarditis", "Sharp, better sitting forward/leaning, pericardial rub, ECG: saddle-shaped ST elevation"],
    ["GORD/Oesophageal", "Burning, retrosternal, worse after eating/lying, relieved by antacids"],
    ["Musculoskeletal", "Reproduced by palpation, positional, no radiation"],
]
story.append(simple_table(
    ["Diagnosis", "Distinguishing Features"],
    chest_dd, [4*cm, 13*cm],
    hdr_color=colors.HexColor("#34495e")
))
story.append(PageBreak())

# ── DYSPNOEA ──
story.append(section_banner("7B — CARDIOVASCULAR / RESPIRATORY: DYSPNOEA", TEAL))
story.append(sp(1.5))

dysp_pilcode = [
    ("P", "Place / Site", "Cardiac vs. respiratory origin | Use NYHA functional classification for cardiac dyspnoea"),
    ("I", "Intensity",
     "NYHA I: no limitation | NYHA II: limitation on moderate exertion | "
     "NYHA III: limitation on minimal exertion | NYHA IV: symptoms at rest | "
     "Document exact exercise tolerance: 'How far can you walk on a good day?'"),
    ("L", "Length",
     "Acute (<1h): PE, acute LVF, pneumothorax, anaphylaxis | "
     "Subacute (hours-days): pneumonia, asthma exacerbation | "
     "Chronic (weeks-months): COPD, ILD, heart failure, anaemia"),
    ("C", "Character",
     "Orthopnoea (cannot lie flat — number of pillows needed): LVF, asthma | "
     "Paroxysmal nocturnal dyspnoea (PND): woken from sleep by breathlessness, must sit upright — LVF | "
     "Wheeze (expiratory): asthma, COPD | "
     "Stridor (inspiratory): upper airway obstruction — EMERGENCY"),
    ("O", "Onset",
     "Sudden: PE, pneumothorax, anaphylaxis, acute LVF | "
     "Gradual: COPD, heart failure, ILD, anaemia | "
     "Nocturnal: asthma (3–4 AM), LVF (PND)"),
    ("D", "Duration + Associated",
     "Cough? Sputum (colour, amount, blood)? Ankle oedema (HF)? Weight gain/loss? "
     "Chest pain? Palpitations? Fever (infection)? Smoking history (pack-years)?"),
    ("E", "Exacerbating / Relieving",
     "Worse lying flat (orthopnoea = LVF) | "
     "Triggered by allergens/cold/exercise/NSAIDs/aspirin (asthma) | "
     "Better with bronchodilators (asthma/COPD) | "
     "Better with diuretics (pulmonary oedema) | "
     "Better sitting upright or in tripod position (COPD, asthma)"),
]
story.append(pilcode_table(dysp_pilcode, TEAL))
story.append(PageBreak())

# ── COUGH ──
story.append(section_banner("7C — RESPIRATORY: COUGH", TEAL))
story.append(sp(1.5))
cough_pilcode = [
    ("P", "Place / Site",
     "Upper airway (dry, tickling: URTI, post-nasal drip, ACE inhibitor) | "
     "Lower airway (deep, productive: pneumonia, bronchiectasis, COPD) | "
     "Wheeze suggests airway obstruction"),
    ("I", "Intensity",
     "Severity: interfering with sleep? Daily activities? Haemoptysis always serious — quantify (streaks, frank blood)."),
    ("L", "Length",
     "Acute <3 weeks (URTI, pneumonia) | "
     "Subacute 3–8 weeks (post-infectious, pertussis) | "
     "Chronic >8 weeks: TB, lung cancer, GORD, asthma, bronchiectasis, ILD, ACE inhibitor, heart failure"),
    ("C", "Character",
     "Dry/non-productive (ACE inhibitor — 20% of users, ILD, early asthma) | "
     "Productive (COPD, pneumonia, bronchiectasis) | "
     "Barking/seal-like (croup) | "
     "Whooping inspiratory whoop (pertussis) | "
     "Bovine cough (recurrent laryngeal nerve palsy — lung cancer, aortic aneurysm)"),
    ("O", "Onset",
     "Following URTI? New medication (ACE inhibitor — commonest cause of drug-induced cough)? "
     "Occupational exposure (occupational asthma)? Prolonged fever + weight loss (TB)?"),
    ("D", "Duration + Associated",
     "Sputum colour: clear (viral/allergy) | Yellow/green (bacterial infection) | "
     "Rusty/red (pneumococcal pneumonia) | "
     "Haemoptysis: TB, lung cancer, bronchiectasis, PE | "
     "Fever? Night sweats? Weight loss (TB, malignancy)?"),
    ("E", "Exacerbating / Relieving",
     "Worse at night (asthma, GORD, post-nasal drip) | "
     "Worse with cold air, exercise, allergens (asthma) | "
     "Worse lying down (GORD, post-nasal drip) | "
     "Positional: worse on certain side (localised bronchiectasis) | "
     "Relieved by stopping ACE inhibitor (ACE-inhibitor cough)?"),
]
story.append(pilcode_table(cough_pilcode, TEAL))
story.append(PageBreak())

# ── ABDOMINAL PAIN ──
story.append(section_banner("7D — GASTROINTESTINAL: ABDOMINAL PAIN", colors.HexColor("#117a65")))
story.append(sp(1.5))
abd_pilcode = [
    ("P", "Place / Site",
     "RUQ: liver, gallbladder (Murphy's sign: cholecystitis) | "
     "Epigastric: peptic ulcer, pancreatitis, gastritis, aortic aneurysm, MI (inferior) | "
     "RIF: appendicitis (McBurney's point), ovarian cyst/torsion, ileocaecal TB | "
     "LIF: diverticulitis, sigmoid volvulus, ovarian | "
     "Loin-to-groin: renal colic (ureter) | "
     "Diffuse/generalised: peritonitis, mesenteric ischaemia, IBD, IBS"),
    ("I", "Intensity",
     "Worst pain imaginable: renal colic, biliary colic (patient writhes = colicky) | "
     "Lying still in pain: peritonitis | "
     "0–10 scale | Functional impact"),
    ("L", "Length",
     "Acute surgical emergency <24h: perforation, ischaemia, ruptured AAA, ectopic | "
     "Acute <72h: appendicitis, cholecystitis, pancreatitis | "
     "Chronic/recurrent: IBS, IBD, peptic ulcer disease"),
    ("C", "Character",
     "Colicky (comes in waves, patient writhes): bowel obstruction, renal/biliary colic | "
     "Constant dull ache (inflammatory): cholecystitis, appendicitis, pancreatitis | "
     "Burning epigastric (peptic ulcer, GORD) | "
     "Sudden tearing (ruptured AAA or dissection — EMERGENCY)"),
    ("O", "Onset",
     "Sudden onset: perforation (peptic/appendix), mesenteric ischaemia, ruptured ectopic, ruptured AAA | "
     "Gradual crescendo: appendicitis, cholecystitis | "
     "After eating (postprandial): mesenteric ischaemia (intestinal angina), peptic ulcer, gastric ulcer"),
    ("D", "Duration + Associated",
     "Nausea/vomiting — before pain (surgical: vomiting follows pain onset)? "
     "After pain (medical) | "
     "Change in bowel habit? Rectal bleeding (melaena = upper GI; fresh blood = lower GI)? "
     "Jaundice (gallstones, hepatitis, malignancy)? Urinary symptoms (UTI, renal colic)? "
     "Last menstrual period (ectopic pregnancy)?"),
    ("E", "Exacerbating / Relieving",
     "Relieved by eating: duodenal ulcer (pain 2–3h after food, relieved by eating/antacids) | "
     "Worse after eating: gastric ulcer (pain within 30–60 min), mesenteric ischaemia | "
     "Relieved by defecation: IBS, diverticular disease | "
     "Worse on breathing: peritonitis (any movement worsens pain — patient lies still)"),
]
story.append(pilcode_table(abd_pilcode, colors.HexColor("#117a65")))
story.append(PageBreak())

# ── HEADACHE ──
story.append(section_banner("7E — NEUROLOGICAL: HEADACHE", colors.HexColor("#6c3483")))
story.append(sp(1.5))
head_pilcode = [
    ("P", "Place / Site",
     "Unilateral: migraine, cluster headache, temporal arteritis | "
     "Bilateral (band-like): tension headache | "
     "Occipital + neck stiffness: SAH, meningitis, raised ICP, cervicogenic | "
     "Frontal/sinus: sinusitis, tension"),
    ("I", "Intensity",
     "Thunderclap (10/10, maximal at onset, 'worst headache of my life') = SAH until proven otherwise | "
     "Cluster: excruciatingly severe, 'suicide headache' | "
     "Gradual build-up: tension, migraine"),
    ("L", "Length",
     "Cluster: 15 min – 3 hours (1–8 attacks/day, clusters over weeks then remits) | "
     "Migraine: 4–72 hours | "
     "Tension: 30 min – 7 days | "
     "SAH: sudden, persistent | "
     "Progressive worsening over days-weeks: raised ICP (tumour, SDH)"),
    ("C", "Character",
     "Throbbing/pulsating (migraine) | "
     "Non-pulsating pressure/tightness (tension) | "
     "Severe stabbing/drilling, periorbital (cluster) | "
     "Sudden explosive (SAH) | "
     "Dull constant aching that worsens over time (raised ICP, SDH)"),
    ("O", "Onset",
     "Thunderclap (0–1 second) = SAH — do CT head then LP if CT negative | "
     "On exertion/coughing/sneezing (raised ICP, benign exertional headache) | "
     "Morning headache (raised ICP — worse when waking) | "
     "Triggered by food (tyramine: cheese, wine), alcohol, stress, hormones (migraine)"),
    ("D", "Duration + Associated",
     "Nausea + vomiting + photophobia + phonophobia (migraine) | "
     "Visual aura (scotoma, fortification spectra, unilateral visual loss) — migraine with aura | "
     "Neck stiffness + fever + rash (meningococcal meningitis — EMERGENCY) | "
     "Unilateral red, watery eye, rhinorrhoea (cluster) | "
     "Neurological deficit (stroke, SOL) | "
     "Temporal artery tenderness + jaw claudication (GCA — elderly, ↑ESR, risk of blindness)"),
    ("E", "Exacerbating / Relieving",
     "Worse on bending/straining/coughing (raised ICP) | "
     "Worse lying down, better upright (raised ICP) | "
     "Better in dark/quiet room with sleep (migraine) | "
     "Relieved by simple analgesia (tension) | "
     "Triptans effective (migraine) | "
     "O₂ 100% + sumatriptan (cluster headache)"),
]
story.append(pilcode_table(head_pilcode, colors.HexColor("#6c3483")))
story.append(sp(1))
story.append(alert_box(
    "⚠ RED FLAGS in Headache (MacLeod's — require urgent investigation):\n"
    "• Thunderclap headache (SAH until proven otherwise — CT head urgently)\n"
    "• Headache + fever + neck stiffness ± rash (meningitis/encephalitis)\n"
    "• Headache + papilloedema (raised ICP — space-occupying lesion)\n"
    "• Progressive worsening headache over days/weeks (SOL, SDH)\n"
    "• New headache in patient >50 years (GCA, malignancy)\n"
    "• Headache with neurological deficit or change in consciousness"))
story.append(PageBreak())

# ── JOINT PAIN ──
story.append(section_banner("7F — MUSCULOSKELETAL: JOINT PAIN", colors.HexColor("#935116")))
story.append(sp(1.5))
joint_pilcode = [
    ("P", "Place / Site",
     "Monoarthritis (1 joint): gout, septic arthritis, trauma, reactive arthritis | "
     "Oligoarthritis (2–4): psoriatic arthropathy, ankylosing spondylitis, reactive arthritis | "
     "Polyarthritis (>4 joints): RA, SLE, viral arthritis (parvovirus, rubella) | "
     "Axial (spine/sacroiliac): ankylosing spondylitis (young male, morning stiffness, back) | "
     "DIP joints: OA (Heberden's nodes), psoriatic"),
    ("I", "Intensity",
     "0–10 scale | Functional limitation: stairs, dressing, grip strength, handwriting | "
     "Can they open jars? Button shirts? Walk unaided?"),
    ("L", "Length",
     "Acute overnight joint (gout, septic arthritis, trauma) | "
     "Subacute/migratory (rheumatic fever, gonorrhoal arthritis, viral) | "
     "Chronic (OA — years; RA — progressive with flares)"),
    ("C", "Character",
     "Warm, red, swollen, tender (inflammatory/infective) | "
     "Hard, bony, non-tender swelling (OA — Heberden's/Bouchard's nodes) | "
     "Morning stiffness >1 hour (inflammatory: RA, AS, psoriatic) — improves with activity | "
     "Morning stiffness <30 min (mechanical: OA) — worse with activity"),
    ("O", "Onset",
     "Sudden overnight peak pain (gout — often first MTP joint — 'podagra') | "
     "Gradual: RA, OA | "
     "Following infection (reactive arthritis: 2–4 weeks post-urethritis/gastroenteritis — Reiter's triad) | "
     "After trauma"),
    ("D", "Duration + Associated",
     "Morning stiffness duration (key discriminator: inflammatory vs. mechanical) | "
     "Systemic features (fever, weight loss, fatigue = inflammatory/infective) | "
     "Skin: psoriatic plaques (psoriatic arthropathy) | "
     "Eyes: uveitis/iritis (AS, reactive arthritis, sarcoid) | "
     "Urethral discharge (reactive arthritis, gonococcal) | "
     "Butterfly rash (SLE) | Raynaud's phenomenon (SLE, scleroderma)"),
    ("E", "Exacerbating / Relieving",
     "Worse after rest, improves with movement (inflammatory: RA, AS) | "
     "Worse with activity, better with rest (mechanical: OA) | "
     "Gout: precipitated by alcohol, purine-rich food, diuretics, dehydration | "
     "Better with NSAIDs (gout, RA) | "
     "Better with colchicine (gout specifically)"),
]
story.append(pilcode_table(joint_pilcode, colors.HexColor("#935116")))
story.append(PageBreak())

# ════════════════════════════════════════════════════════════════════
# PART 8 — QUICK REFERENCE SUMMARY
# ════════════════════════════════════════════════════════════════════
story.append(chapter_banner("PART 8 — QUICK REFERENCE SUMMARY", colors.HexColor("#1a3a5c")))
story.append(sp(2))

story.append(Paragraph("Vital Signs Normal Values — Adults", sec_head))
summary_vitals = [
    ["Temperature", "36.5 – 37.5°C", ">38°C = Fever | >41°C = Hyperpyrexia | <35°C = Hypothermia"],
    ["Pulse Rate", "60 – 100 bpm", ">100 = Tachycardia | <60 = Bradycardia"],
    ["Respiratory Rate", "12 – 20/min", ">20 = Tachypnoea | <12 = Bradypnoea | >30 = Critical"],
    ["Blood Pressure", "<120/80 mmHg", "≥140/90 = Hypertension | <90 systolic = Hypotension"],
    ["SpO₂", "≥95%", "<94% investigate | <90% = Hypoxaemia"],
    ["Pulse Pressure", "40–60 mmHg", "Wide >60 (AR, thyrotoxicosis) | Narrow <25 (tamponade, AS)"],
]
story.append(simple_table(
    ["Vital Sign", "Normal Range", "Abnormal Thresholds"],
    summary_vitals, [3.5*cm, 4*cm, 9.5*cm],
    hdr_color=NAVY
))
story.append(sp(2))

story.append(Paragraph("Vital Sign Combinations — Diagnostic Patterns", sec_head))
patterns = [
    ["Fever + Tachycardia + Hypotension + Tachypnoea", "Sepsis / Septic Shock — EMERGENCY"],
    ["Bradycardia + Hypertension + Irregular breathing", "Cushing's Triad — Raised ICP (brain herniation)"],
    ["Fever + Relative Bradycardia (no tachycardia)", "Typhoid / Legionella / Drug Fever (Faget's sign)"],
    ["Hypotension + Tachycardia + Narrow Pulse Pressure", "Cardiogenic Shock / Cardiac Tamponade"],
    ["Hypotension + Tachycardia + Wide Pulse Pressure", "Septic Shock / Anaphylaxis (vasodilatory)"],
    ["Bradypnoea + Bradycardia + Low GCS", "Opioid Overdose / CNS Depression"],
    ["Tachycardia + Wide Pulse Pressure + Bounding Pulse", "Thyrotoxicosis / Aortic Regurgitation / Anaemia"],
    ["Hypertension + Bradycardia (in trauma)", "Cushing's Response — Impending Brainstem Herniation"],
]
story.append(simple_table(
    ["Pattern of Vital Signs", "Consider"],
    patterns, [8*cm, 9*cm],
    hdr_color=RED_SOFT
))
story.append(sp(2))

story.append(Paragraph("PILCODE Summary Card", sec_head))
pilcode_summary = [
    ["P", "Place / Site", "Where is the symptom or measurement taken/located?"],
    ["I", "Intensity / Severity", "How bad is it? 0–10 scale, functional impact, threshold values"],
    ["L", "Length / Duration", "How long present? Acute / subacute / chronic? Continuous vs. episodic?"],
    ["C", "Character / Quality", "What does it feel like? Describe the nature/type of symptom"],
    ["O", "Onset", "When/how did it start? Sudden / gradual? Any trigger?"],
    ["D", "Duration + Associated", "Time course of episodes + all associated symptoms, discharge"],
    ["E", "Exacerbating / Relieving", "What makes it worse or better? Position, food, drugs, activity?"],
]
story.append(pilcode_table(pilcode_summary, NAVY))
story.append(sp(2))

story.append(HRFlowable(width="100%", thickness=1, color=GOLD))
story.append(sp(1))
story.append(Paragraph(
    "Reference: MacLeod's Clinical Examination, 15th Edition — Dover, Innes, Fairhurst — Elsevier Health Sciences, 2023  |  "
    "Goldman-Cecil Medicine — Cardinal Symptoms of Cardiovascular Disease (Table 39-1)  |  "
    "Roberts &amp; Hedges' Clinical Procedures in Emergency Medicine — Vital Signs",
    small_note))

# ════════════════════════════════════════════════════════════════════
# BUILD
# ════════════════════════════════════════════════════════════════════
doc.build(story, onFirstPage=add_page_number, onLaterPages=add_page_number)
print(f"PDF generated: {OUTPUT}")