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    new Paragraph({
      children: [new TextRun({ text: 'MUHS Final BAMS Exam', bold: true, size: 52, color: '1F3864' })],
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    new Paragraph({
      children: [new TextRun({ text: 'Shalakya Tantra', bold: true, size: 64, color: '2E74B5' })],
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      children: [new TextRun({ text: 'Eye (Netra Roga) & ENT (Shira-Karna-Nasa-Mukha Roga)', size: 28, color: '595959', italics: true })],
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    new Paragraph({
      children: [new TextRun({ text: 'Including Ayurvedic Nidana, Samprapti, Lakshana, Chikitsa', size: 24, color: '7F7F7F', italics: true })],
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// ─── CONTENT ─────────────────────────────────────────────────────────────────

const children = [
  ...titlePage(),

  // INDEX
  h1('INDEX'),
  para('PART A: EYE (NETRA ROGA)'),
  bullet('Glaucoma (Adhimantha / Kacha)'),
  bullet('Cataract (Linganasha / Kacha)'),
  bullet('Conjunctivitis (Abhishyanda)'),
  bullet('Trachoma (Trachoma / Granular Conjunctivitis)'),
  bullet('Corneal Ulcer (Savrana Shukla)'),
  bullet('Stye / Chalazion (Anjananamika / Shuklarma)'),
  bullet('Retinal Detachment'),
  bullet('Uveitis (Krimigranthi / Uveal Tract Disease)'),
  bullet('Dacryocystitis (Ashru Nadi Shotha)'),
  para('PART B: ENT (KARNA-NASA-MUKHA-KANTHA ROGA)'),
  bullet('Otitis Media (Karna Shoola / Pootikarna)'),
  bullet('Meniere\'s Disease'),
  bullet('Epistaxis (Nasagata Rakta Pitta)'),
  bullet('Sinusitis (Peenasa / Dushta Pratishyaya)'),
  bullet('Tonsillitis (Tundikeri)'),
  bullet('Laryngitis / Hoarseness (Svarabheda)'),
  bullet('Foreign Body in Ear/Nose/Throat'),
  pageBreak(),

  // ═══════════════════════════════════════
  // PART A: EYE DISEASES
  // ═══════════════════════════════════════
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  // ─── 1. GLAUCOMA ─────────────────────────────────────────────────────────
  h1('1. GLAUCOMA'),
  h2('Ayurvedic Correlation'),
  boldPara('Sanskrit Names', 'Adhimantha (acute/inflammatory type), Kacha (chronic type). Some texts correlate it with a subtype of Abhishyanda progressing to Adhimantha.'),
  boldPara('Dosha', 'Tridoshaja predominance; Vata-Pitta in acute; Kapha-Vata in chronic/angle-closure type.'),

  h2('Definition (Modern)'),
  para('Glaucoma is a group of optic neuropathies characterized by progressive retinal nerve fibre layer (RNFL) thinning, glaucomatous optic nerve damage, characteristic visual field loss, and an open or narrow/closed anterior chamber angle, with intraocular pressure (IOP) as the key modifiable risk factor.'),

  h2('Classification'),
  bullet('Primary Open-Angle Glaucoma (POAG)', ''),
  bullet('Primary Angle-Closure Glaucoma (PACG)', ''),
  bullet('Normal-Tension Glaucoma (NTG)', ''),
  bullet('Secondary Glaucoma', ''),
  bullet('Congenital / Developmental Glaucoma (Buphthalmos)', ''),

  h2('Pathophysiology'),
  para('Aqueous humor is produced by the ciliary body, flows through the pupil into the anterior chamber, and drains via the trabecular meshwork into Schlemm\'s canal. In glaucoma, outflow obstruction (trabecular in POAG; pupillary block in PACG) raises IOP, compressing the optic nerve at the lamina cribrosa, causing progressive axonal damage.'),

  h2('Risk Factors (POAG)'),
  bullet('IOP > 21 mmHg (asymmetry >4 mmHg significant)'),
  bullet('Age > 40 years'),
  bullet('Black race (4x higher prevalence, earlier onset)'),
  bullet('Family history (siblings 4x risk, offspring 2x)'),
  bullet('Myopia'),
  bullet('Thin central corneal thickness (CCT < 555 µm)'),
  bullet('Systemic calcium-channel blockers, anti-VEGF therapy'),

  h2('Clinical Features'),
  h3('POAG (Open Angle) - Silent Thief of Sight'),
  bullet('Asymptomatic until late; peripheral vision lost first'),
  bullet('Normal-appearing anterior chamber angle (gonioscopy)'),
  bullet('Increased C/D ratio (>0.65 suspicious; >0.7 in only 2% normal)'),
  bullet('ISNT rule violation: inferior > superior > nasal > temporal rim'),
  bullet('Visual field defects: arcuate scotoma, nasal step, paracentral scotoma, tunnel vision'),
  bullet('IOP > 21 mmHg (normal 10-21 mmHg by Goldmann applanation)'),

  h3('PACG (Angle Closure) - Acute Attack'),
  bullet('Sudden severe eye pain, headache, nausea/vomiting'),
  bullet('Blurred vision, halos around lights'),
  bullet('Ciliary injection (perilimbal), corneal oedema (steamy cornea)'),
  bullet('Fixed mid-dilated pupil (~6 mm, oval)'),
  bullet('Shallow anterior chamber, narrow angle on gonioscopy'),
  bullet('IOP dramatically elevated (>40 mmHg common)'),

  h2('Investigations'),
  bullet('Tonometry: Goldmann Applanation Tonometry (GAT) - Gold standard; Schiotz for field use'),
  bullet('Gonioscopy: to classify open vs. closed angle'),
  bullet('Visual Field Testing: Humphrey automated perimetry (24-2 pattern for POAG)'),
  bullet('Optic Disc imaging: OCT (Optical Coherence Tomography) - RNFL thickness'),
  bullet('Pachymetry: central corneal thickness (thin CCT = higher risk)'),
  bullet('Fundus examination: C/D ratio, RNFL defects'),

  h2('Treatment'),
  h3('Medical (First Line for POAG)'),
  new Paragraph({
    children: [
      new TextRun({ text: 'Prostaglandin analogues', bold: true, size: 22 }),
      new TextRun({ text: ' (e.g., Latanoprost 0.005%): First-line; increase uveoscleral outflow; once daily night', size: 22 }),
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      new TextRun({ text: ' (e.g., Timolol 0.5%): Reduce aqueous production; twice daily; CI: asthma, heart block', size: 22 }),
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      new TextRun({ text: 'Carbonic anhydrase inhibitors', bold: true, size: 22 }),
      new TextRun({ text: ' (e.g., Dorzolamide drops; Acetazolamide oral 250 mg QID): Reduce aqueous production; CI: sulfonamide allergy', size: 22 }),
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  h3('Acute PACG Emergency Treatment'),
  bullet('Immediate: IV Acetazolamide 500 mg + Mannitol 20% IV (hyperosmotic)'),
  bullet('Pilocarpine 2% to break attack + constrict pupil'),
  bullet('Analgesics, antiemetics'),
  bullet('Definitive: Laser Peripheral Iridotomy (LPI) - procedure of choice'),

  h3('Surgical'),
  bullet('Trabeculectomy (filtration surgery): Creates new drainage pathway (bleb)'),
  bullet('Glaucoma Drainage Devices (tubes/shunts): Molteno, Ahmed, Baerveldt'),
  bullet('Laser Trabeculoplasty (ALT/SLT): For POAG as adjunct'),
  bullet('Combined trabeculotomy-trabeculectomy: For congenital/developmental glaucoma'),
  bullet('Diode laser cycloblation: When other modalities fail'),

  h2('Ayurvedic Management (Adhimantha/Kacha)'),
  bullet('Snehana (oleation): Triphala ghrita, Mahatriphala ghrita - eye drops and oral'),
  bullet('Virechana (purgation) to reduce Pitta'),
  bullet('Tarpana (eye bath) with Triphala ghrita'),
  bullet('Nasya: Anu taila nasya'),
  bullet('Siravedha (bloodletting): For acute Vata-Pitta type (modern: not practiced)'),
  bullet('Anjana (collyrium): Saindhava, Rasanjana'),
  bullet('Lepa: Triphala, Musta paste on closed eyes to reduce congestion'),
  bullet('Avoid: Suppression of natural urges, excess straining, bright light exposure'),

  h2('Prognosis'),
  para('POAG: Slowly progressive; can be controlled but not cured. NTG: worse prognosis. Congenital: depends on early intervention. Acute PACG: emergency - irreversible vision loss if delayed >24-48 hrs.'),

  divider(),
  pageBreak(),

  // ─── 2. CATARACT ─────────────────────────────────────────────────────────
  h1('2. CATARACT (Linganasha / Kacha)'),
  h2('Ayurvedic Correlation'),
  boldPara('Sanskrit Name', 'Linganasha (blindness from cataract) or Kacha (opacity). Sushruta describes 76 eye diseases (Netra Rogas), cataract being among the most important.'),
  boldPara('Dosha', 'Vata pradhan (Vataj Linganasha = curable stage), Tridoshaja (Saindhavaja = incurable).'),

  h2('Definition'),
  para('Cataract is any opacity of the crystalline lens or its capsule that impairs vision. It is the leading cause of reversible blindness worldwide.'),

  h2('Classification'),
  h3('By Age'),
  bullet('Congenital cataract: Present at birth; TORCH infections, galactosemia, Down syndrome'),
  bullet('Juvenile: < 40 years'),
  bullet('Senile/Age-related: > 50 years (most common type)'),

  h3('By Morphology (Senile)'),
  bullet('Nuclear sclerotic: Yellowing/browning of nucleus; myopic shift ("second sight of aged"); best seen on oblique slit lamp'),
  bullet('Cortical: Cuneiform/spoke-like wedge opacities; glare; starts inferonasal quadrant'),
  bullet('Posterior subcapsular (PSC): Most visually disabling; glare; near vision worse; at nodal point; caused by steroids, radiation, diabetes'),
  bullet('Anterior subcapsular: Fibrous metaplasia of lens epithelium'),

  h3('By Maturity'),
  bullet('Immature: Lens partially opaque; iris shadow present; vision impaired'),
  bullet('Mature: Completely opaque white lens; no iris shadow; vision = finger counting to hand movements'),
  bullet('Hypermature: Liquefied cortex; shrunken or Morgagnian (nucleus sinks to bottom)'),
  bullet('Intumescent: Swollen lens due to water uptake; can precipitate PACG'),

  h2('Causes'),
  bullet('Age-related: Most common (senile cataract)'),
  bullet('Metabolic: Diabetes (snowflake/true diabetic cataract; earlier onset), galactosemia, Wilson\'s disease'),
  bullet('Drugs: Long-term steroids (PSC type), chlorpromazine, amiodarone, busulfan'),
  bullet('Trauma: Rosette-shaped cataract; perforating injuries'),
  bullet('Radiation: X-rays, UV-B, infrared ("glass-blower\'s cataract")'),
  bullet('Secondary: Uveitis, glaucoma, retinitis pigmentosa, high myopia'),
  bullet('Congenital: Rubella (most common cause - nuclear type), galactosemia, Down, Marfan\'s'),

  h2('Clinical Features'),
  bullet('Painless, progressive blurring of vision'),
  bullet('Glare and photophobia (especially PSC and cortical)'),
  bullet('Monocular diplopia / polyopia'),
  bullet('Change in colour perception (yellowing)'),
  bullet('Second sight in nuclear cataract (temporary myopic improvement)'),
  bullet('On examination: Diminished red reflex, lens opacity on slit lamp, absent fundal glow in mature'),

  h2('Investigations'),
  bullet('Slit lamp examination: Type and extent of opacity'),
  bullet('Visual acuity (Snellen chart)'),
  bullet('IOP measurement (rule out associated glaucoma)'),
  bullet('B-scan ultrasound: When fundus not visible (mature/traumatic)'),
  bullet('IOL power calculation: A-scan biometry + keratometry (for surgical planning)'),

  h2('Treatment (Modern - Surgical)'),
  bullet('Phacoemulsification (PHACO): Gold standard; small incision (~2.5-3.0 mm); ultrasound emulsification; foldable IOL implanted; self-sealing wound; rapid recovery'),
  bullet('MSICS (Manual Small Incision Cataract Surgery): Most common in India for volume surgery; sutureless tunnel incision; PMMA IOL'),
  bullet('ECCE (Extracapsular Cataract Extraction): Large incision; rigid PMMA IOL; sutures required; for hypermature, subluxated lens'),
  bullet('ICCE (Intracapsular Cataract Extraction): Entire lens + capsule removed; now largely obsolete; for dislocated lens'),
  bullet('IOL types: Monofocal, multifocal, toric (astigmatism), accommodating'),

  h2('Ayurvedic Management'),
  bullet('Early cataract: Saptamrita lauha, Triphala ghrita (Rasayana therapy)'),
  bullet('Tarpana: Triphala + ghrita filling the eye socket - nourishes lens'),
  bullet('Putapaka: Eye wash with medicated decoctions'),
  bullet('Nasya: Anu taila or Shadbindu taila for sensory organ nourishment'),
  bullet('Rasayana: Amalaki, Shatavari, Ashwagandha for lens health'),
  bullet('Avoid: Excessive sunlight, strain, Pitta-aggravating diet'),
  boldPara('Surgical (Shastra Karma)', 'Sushruta described "Couching" (Viddha vidhi) - pushing the lens posteriorly. Historical procedure, not practiced today.'),

  divider(),
  pageBreak(),

  // ─── 3. CONJUNCTIVITIS ───────────────────────────────────────────────────
  h1('3. CONJUNCTIVITIS (Abhishyanda)'),
  h2('Ayurvedic Correlation'),
  boldPara('Sanskrit Name', 'Abhishyanda ("flowing together") - described by dosha: Vataja, Pittaja, Kaphaja, Sannipata Abhishyanda. Corresponds to simple/acute conjunctivitis.'),

  h2('Definition'),
  para('Conjunctivitis is inflammation of the conjunctiva (bulbar and palpebral) characterized by hyperemia, discharge, and discomfort. It is the most common external eye disease globally.'),

  h2('Classification & Features'),
  h3('Bacterial Conjunctivitis'),
  bullet('Causative agents: Staphylococcus aureus (adults), Streptococcus pneumoniae, H. influenzae (children), Neisseria gonorrhoeae (neonates/STI), N. meningitidis'),
  bullet('Features: Mucopurulent/purulent discharge; lid crusting on waking; conjunctival hyperemia; papillary reaction; burning/grittiness'),
  bullet('Gonococcal: Hyperacute - profuse purulent discharge, risk of corneal perforation within 24 hrs; treat with systemic ceftriaxone + topical'),
  bullet('Neonatal (Ophthalmia neonatorum): N. gonorrhoeae (1-3 days), Chlamydia (5-14 days), S. aureus (4-5 days)'),

  h3('Viral Conjunctivitis'),
  bullet('Most common cause of infective conjunctivitis'),
  bullet('Adenovirus (EKC/PCF): Epidemic Keratoconjunctivitis (type 8,19) - follicular reaction, preauricular lymph node, subepithelial corneal infiltrates (SPK); highly contagious'),
  bullet('Herpes simplex: Vesicular lid lesions, dendritic ulcer if cornea involved'),
  bullet('Enterovirus 70, Coxsackie A24: Acute hemorrhagic conjunctivitis (AHC) - sudden onset, subconjunctival hemorrhage, follicles'),

  h3('Allergic Conjunctivitis'),
  bullet('Seasonal allergic (SAC): Bilateral itching, watery discharge, papillae; associated with atopy; type I hypersensitivity; treat with antihistamines + mast cell stabilizers'),
  bullet('Vernal keratoconjunctivitis (VKC): Bilateral; young males; cobblestone papillae on upper tarsal plate; limbal form: Horner-Trantas dots; shield ulcer (complications); treat: topical steroids, cyclosporine'),
  bullet('Atopic keratoconjunctivitis (AKC): Older adults; bilateral; inferior fornix papillae; corneal vascularization; fibrosis'),
  bullet('Giant papillary conjunctivitis (GPC): Contact lens users; large papillae; mucus discharge; itching'),

  h3('Chlamydial Conjunctivitis'),
  bullet('Adult inclusion conjunctivitis: Chlamydia trachomatis serovars D-K; sexually active adults; chronic follicular conjunctivitis; superior corneal pannus mild; treat: oral azithromycin 1g single dose or doxycycline 100 mg BD x 3 weeks'),

  h2('Clinical Signs'),
  bullet('Hyperemia: Conjunctival redness (not ciliary injection)'),
  bullet('Discharge: Watery (viral/allergic), mucopurulent (bacterial), stringy mucoid (allergic VKC)'),
  bullet('Follicles: Lymphoid aggregates - viral, chlamydial, toxic; in fornices; no vasculature in center'),
  bullet('Papillae: Vascular core; bacterial, allergic; cobblestone in VKC'),
  bullet('Chemosis: Conjunctival oedema - allergic/gonococcal'),

  h2('Treatment Summary'),
  bullet('Bacterial: Topical chloramphenicol / ciprofloxacin / tobramycin drops/ointment'),
  bullet('Viral (adeno): Self-limiting; cold compresses; lubricants; steroids for subepithelial infiltrates'),
  bullet('HSV: Topical acyclovir 3% ointment; oral acyclovir for recurrent disease'),
  bullet('Allergic: Antihistamine drops (olopatadine), mast cell stabilizers (sodium cromoglicate), steroids only for severe VKC/AKC under supervision'),
  bullet('Gonococcal: IV/IM Ceftriaxone 1g + topical irrigation + saline lavage'),

  h2('Ayurvedic Management (Abhishyanda)'),
  bullet('Vataja Abhishyanda: Triphala kwatha seka (eye wash); Saindhava + Rasanjana anjana; Ghrita tarpana'),
  bullet('Pittaja: Cooling herbs - Chandana, Amalaki, Yashtimadhu; Triphala ghrita; avoid hot/spicy food'),
  bullet('Kaphaja: Drying herbs - Haridra, Saindhava, Trikatu; warm decoction seka; ruksha anjana'),
  bullet('Sannipata: Tridosha treatment + Rakta shodhana'),
  bullet('General: Bidalaka (paste application on lids), Aschyotana (eye drops), Seka (washing)'),

  divider(),
  pageBreak(),

  // ─── 4. TRACHOMA ─────────────────────────────────────────────────────────
  h1('4. TRACHOMA'),
  h2('Ayurvedic Correlation'),
  boldPara('Sanskrit Name', 'Arjuna roga or a form of Kaphaja/Sannipata Abhishyanda progressing to Pakshmakopa (inturned lashes) and Shukra (corneal opacity).'),

  h2('Definition'),
  para('Trachoma is a chronic keratoconjunctivitis caused by Chlamydia trachomatis (serovars A, B, Ba, C). It is the world\'s leading cause of preventable irreversible infectious blindness.'),

  h2('Epidemiology'),
  bullet('Endemic in sub-Saharan Africa, South Asia, parts of India (rural)'),
  bullet('Related to poverty, overcrowding, poor hygiene, limited water supply'),
  bullet('Young children are the main reservoir; flies are important vectors'),
  bullet('Repeat infections elicit Type IV hypersensitivity -> scarring'),

  h2('WHO SAFE Strategy'),
  bullet('S - Surgery (for trichiasis)'),
  bullet('A - Antibiotics (azithromycin mass distribution)'),
  bullet('F - Facial cleanliness'),
  bullet('E - Environmental improvement (water, sanitation)'),

  h2('WHO Grading (TF, TI, TS, TT, CO)'),
  bullet('TF (Trachomatous Inflammation - Follicular): >=5 follicles (>0.5 mm) in upper tarsal plate - active stage in children'),
  bullet('TI (Trachomatous Inflammation - Intense): Intense inflammatory thickening obscuring >50% of deep tarsal vessels'),
  bullet('TS (Trachomatous Scarring): Tarsal scarring (Arlt\'s line - white fibrous bands across tarsal plate)'),
  bullet('TT (Trachomatous Trichiasis): At least one lash touching the eyeball (inturned); entropion'),
  bullet('CO (Corneal Opacity): Easily visible corneal opacity over pupil -> blindness'),

  h2('Pathology Stages'),
  h3('Active (Inflammatory)'),
  bullet('Mixed follicular/papillary conjunctivitis'),
  bullet('Mucopurulent discharge'),
  bullet('Limbal follicles (Herber\'t pits - pathognomonic: depressions at superior limbus after follicle resolution)'),
  bullet('Superior corneal pannus (vascularization)'),

  h3('Cicatricial (Chronic-Scarring)'),
  bullet('Tarsal scarring: Arlt\'s lines (white horizontal bands on upper tarsal plate)'),
  bullet('Entropion (inturning of lid margin)'),
  bullet('Trichiasis (inturned lashes abrading cornea)'),
  bullet('Dry eye due to goblet cell destruction and lacrimal duct scarring'),
  bullet('Corneal scarring -> irreversible blindness'),

  h2('Treatment'),
  bullet('Single-dose Azithromycin 1g (>25 kg) / 20 mg/kg pediatric - first line; WHO SAFE strategy antibiotic'),
  bullet('Tetracycline 1% eye ointment BD x 6 weeks - alternative'),
  bullet('Surgery for trichiasis: Bilamellar tarsal rotation procedure'),
  bullet('Corneal transplant for CO stage with good visual potential'),

  divider(),
  pageBreak(),

  // ─── 5. CORNEAL ULCER ────────────────────────────────────────────────────
  h1('5. CORNEAL ULCER (Savrana Shukla / Keratitis)'),
  h2('Ayurvedic Correlation'),
  boldPara('Sanskrit Name', 'Savrana Shukla (white opacity with ulcer), Krishnagata roga (disease of black of eye = cornea), Shukra (scar/corneal opacity post-healing).'),

  h2('Definition'),
  para('Corneal ulcer is a loss of epithelium with underlying stromal involvement of the cornea, typically infective in etiology. It is an ophthalmic emergency.'),

  h2('Etiology'),
  h3('Bacterial (Most common)'),
  bullet('Pseudomonas aeruginosa: Most common in contact lens wearers; rapid progression; "ground glass" stromal infiltrate'),
  bullet('Staphylococcus aureus: Marginal keratitis/abscess'),
  bullet('Streptococcus pneumoniae (Pneumococcal): Classic hypopyon ulcer; serpiginous (creeping) corneal ulcer'),
  bullet('Moraxella: Alcoholics, elderly; indolent inferior ulcer'),

  h3('Fungal'),
  bullet('Aspergillus, Fusarium: Common in agricultural workers after vegetable/plant trauma'),
  bullet('Features: Dry, crumbly, grey infiltrate with feathery margins; satellite lesions; endothelial plaque; hypopyon; slow progression'),
  bullet('Treatment: Natamycin 5% drops (first line for filamentous); Voriconazole (Candida/refractory)'),

  h3('Viral'),
  bullet('HSV (Herpes Simplex): Dendritic ulcer (branching fluorescein-staining); geographic ulcer (advanced); decreased corneal sensation; treat with topical acyclovir'),
  bullet('HZO (Herpes Zoster Ophthalmicus): V1 dermatomal rash; Hutchinson\'s sign (tip of nose rash) = high risk of eye involvement; treat with oral acyclovir/valacyclovir'),

  h3('Acanthamoeba'),
  bullet('Contact lens wearers; swimming pool exposure; severe pain out of proportion; ring infiltrate; perineural infiltrates (pathognomonic)'),
  bullet('Treat: Polyhexamethylene biguanide (PHMB) + propamidine isethionate (Brolene)'),

  h2('Clinical Features'),
  bullet('Pain, redness, photophobia, watering, discharge, decreased vision'),
  bullet('Corneal infiltrate (grey/white opacity) with overlying epithelial defect'),
  bullet('Ciliary injection (perilimbal redness)'),
  bullet('Hypopyon: Pus in anterior chamber (bacterial/fungal)'),
  bullet('Fluorescein staining: Epithelial defect stains green'),
  bullet('Fluorescein + Rose Bengal staining: Dendrite in HSV'),

  h2('Investigations'),
  bullet('Corneal scraping + Gram stain + KOH + culture (blood agar, Sabouraud) - before starting treatment'),
  bullet('PCR for viral/Acanthamoeba'),
  bullet('Confocal microscopy: Acanthamoeba cysts/trophozoites (non-invasive)'),

  h2('Treatment'),
  bullet('Bacterial: Fluoroquinolone drops (Moxifloxacin 0.5% / Ciprofloxacin 0.3%) every 1-2 hours initially'),
  bullet('Fungal: Natamycin 5% hourly; Voriconazole for refractory/Candida'),
  bullet('Viral HSV: Topical acyclovir 3% ointment 5x/day; Ganciclovir gel'),
  bullet('Cycloplegic: Atropine 1% (prevents synechiae, relieves ciliary spasm)'),
  bullet('Never use steroids in active ulcer'),
  bullet('Surgical: Therapeutic keratoplasty if medical treatment fails'),

  h2('Ayurvedic Management'),
  bullet('Triphala kwatha seka (wash) - antimicrobial, anti-inflammatory'),
  bullet('Saindhava lavanam anjana (saline collyrium)'),
  bullet('Rasanjana anjana for Kaphaja type'),
  bullet('Haridra (turmeric) + Amalaki paste bidalaka'),
  bullet('Ghrita tarpana: For nourishment and healing in cicatricial stage'),
  bullet('Avoid: Astringent and harsh anjanas in acute stage'),

  divider(),
  pageBreak(),

  // ─── 6. STYE & CHALAZION ─────────────────────────────────────────────────
  h1('6. STYE (Hordeolum) & CHALAZION'),
  h2('Ayurvedic Correlation'),
  boldPara('Stye', 'Anjananamika or Vibanadha (Sushruta) - Vataja/Pittaja type; tender swelling of lid margin.'),
  boldPara('Chalazion', 'Lagophthalmos or Upanaha (chronic) - Kaphaja/Pittaja; painless meibomian gland granuloma.'),

  h2('Stye (Hordeolum Externum)'),
  bullet('Infection of Zeis or Moll glands (lash follicle); Staphylococcus aureus most common'),
  bullet('Painful tender red swelling at lid margin'),
  bullet('Pointing abscess; usually self-draining'),
  bullet('Treatment: Hot fomentation (3-4x/day), topical antibiotics; I&D if pointing'),

  h2('Internal Hordeolum'),
  bullet('Infection of Meibomian gland; points toward conjunctival surface; more painful'),
  bullet('May need incision on conjunctival side'),

  h2('Chalazion'),
  bullet('Chronic granulomatous inflammation of Meibomian gland (lipogranuloma); non-infective'),
  bullet('Painless, hard, round nodule in lid; away from lid margin'),
  bullet('May cause ptosis, astigmatism if large'),
  bullet('Treatment: Most resolve spontaneously; warm compresses; intralesional triamcinolone injection; I&C (incision & curettage) - definitive'),

  divider(),
  pageBreak(),

  // ─── 7. RETINAL DETACHMENT ───────────────────────────────────────────────
  h1('7. RETINAL DETACHMENT'),
  h2('Definition'),
  para('Separation of the neurosensory retina from the retinal pigment epithelium (RPE). It is an ophthalmic emergency.'),

  h2('Types'),
  h3('1. Rhegmatogenous RD (Most common)'),
  bullet('Due to retinal break (rhegma = rent); fluid from vitreous enters subretinal space'),
  bullet('Risk factors: Myopia (most common), aphakia, trauma, lattice degeneration, family history'),
  bullet('Symptoms: Flashes of light (photopsia), floaters, "curtain/shadow" across vision, painless progressive field loss'),
  bullet('Signs: Corrugated, billowing grey retina; tobacco dust (Shafer\'s sign) in vitreous; relative afferent pupillary defect (RAPD) in total RD'),

  h3('2. Tractional RD'),
  bullet('Vitreoretinal traction from fibrovascular membranes pulls retina'),
  bullet('Causes: Proliferative diabetic retinopathy (most common), sickle cell, ROP, penetrating trauma'),
  bullet('Concave, immobile, does not extend to ora serrata'),

  h3('3. Exudative (Secondary) RD'),
  bullet('No break or traction; fluid accumulation from choroidal disease'),
  bullet('Causes: Vogt-Koyanagi-Harada, posterior scleritis, choroidal tumors, hypertensive retinopathy'),
  bullet('Shifting fluid (changes position with posture) is characteristic'),

  h2('Investigations'),
  bullet('Dilated fundus examination: Indirect ophthalmoscopy + scleral indentation'),
  bullet('B-scan ultrasound: When media hazy (vitreous hemorrhage, dense cataract)'),
  bullet('OCT: For assessment of macula involvement'),

  h2('Treatment'),
  bullet('Rhegmatogenous: Surgical emergency - Scleral buckling, Pneumatic retinopexy, Pars plana vitrectomy (PPV)'),
  bullet('Retinal breaks without RD: Laser photocoagulation (demarcation) or cryotherapy'),
  bullet('Tractional: PPV + membrane peeling; treat underlying cause'),
  bullet('Exudative: Treat underlying cause; no surgery usually'),
  boldPara('Macular status', 'Macula-on RD: Surgical emergency; Macula-off: Worse prognosis; VAs usually 6/60 or worse post-op.'),

  divider(),
  pageBreak(),

  // ─── 8. UVEITIS ──────────────────────────────────────────────────────────
  h1('8. UVEITIS'),
  h2('Ayurvedic Correlation'),
  boldPara('Sanskrit Name', 'Krimigranthi (infectious); Kshata Shukra / Savrana Shukla for corneal involvement; classified under Sarvagata Netra Roga (generalized eye disease).'),

  h2('Definition'),
  para('Uveitis is inflammation of the uveal tract (iris, ciliary body, choroid). Classified anatomically as anterior (iritis/iridocyclitis), intermediate (pars planitis), posterior (choroiditis/retinitis), or panuveitis.'),

  h2('Etiology'),
  bullet('Anterior uveitis: HLA-B27 associated conditions (ankylosing spondylitis, Reiter\'s, psoriatic arthritis, IBD), trauma, HSV/HZV, sarcoidosis'),
  bullet('Posterior uveitis: Toxoplasma (most common), Toxocara, CMV, syphilis, TB, sarcoid'),
  bullet('Panuveitis: Vogt-Koyanagi-Harada, Behcet\'s disease, sarcoidosis, sympathetic ophthalmia'),

  h2('Clinical Features'),
  h3('Anterior Uveitis (Iritis/Iridocyclitis)'),
  bullet('Pain, photophobia, blurred vision, watering'),
  bullet('Ciliary injection (perilimbal flush)'),
  bullet('Keratic precipitates (KP): Fine (non-granulomatous - viral, HLA-B27); Large mutton-fat KP (granulomatous - TB, sarcoid, Fuchs)'),
  bullet('Flare and cells in anterior chamber (Tyndall effect)'),
  bullet('Posterior synechiae (adhesion of iris to lens)'),
  bullet('Hypopyon (sterile - Behcet\'s)'),

  h2('Treatment'),
  bullet('Topical steroids (Prednisolone 1% hourly initially) - mainstay of anterior uveitis'),
  bullet('Cycloplegic (Atropine 1%): Prevents synechiae; relieves ciliary spasm'),
  bullet('Oral steroids: Severe/posterior/panuveitis'),
  bullet('Immunosuppressants: Methotrexate, azathioprine, mycophenolate, cyclosporine for chronic/recurrent'),
  bullet('Anti-TNF (Adalimumab): For HLA-B27 associated refractory uveitis'),
  bullet('Treat underlying systemic cause'),

  divider(),
  pageBreak(),

  // ─── 9. DACRYOCYSTITIS ───────────────────────────────────────────────────
  h1('9. DACRYOCYSTITIS (Ashru Nadi Shotha)'),
  h2('Ayurvedic Correlation'),
  boldPara('Sanskrit Name', 'Ashrunali (lacrimal passage disease). Ashrunali Vidradhi (abscess) corresponds to acute dacryocystitis. Causes: Tridosha with Kapha-Rakta predominance.'),

  h2('Definition'),
  para('Dacryocystitis is infection/inflammation of the lacrimal sac, usually resulting from obstruction of the nasolacrimal duct (NLD).'),

  h2('Classification'),
  bullet('Acute dacryocystitis: Painful, tender, inflamed swelling below medial canthus; Staphylococcus aureus, Streptococcus; abscess formation'),
  bullet('Chronic dacryocystitis: Persistent watering (epiphora); mucopurulent regurgitation on pressure over lacrimal sac; no pain'),

  h2('Clinical Features'),
  bullet('Epiphora (watering from eye) - cardinal symptom'),
  bullet('Mucoid/mucopurulent discharge on pressure over lacrimal sac (regurgitation test)'),
  bullet('Acute: Tender red swelling inferior to medial canthus (lacrimal sac area)'),
  bullet('Mucocele: Cystic non-inflammatory distension of lacrimal sac'),
  bullet('Complications: Corneal abscess, fistula formation'),

  h2('Investigations'),
  bullet('Syringing and probing of NLD: Identifies level of obstruction'),
  bullet('Dacryocystography (DCG): X-ray with contrast to show obstruction site'),
  bullet('Dacryoscintigraphy: Nuclear medicine test for functional nasolacrimal obstruction'),

  h2('Treatment'),
  bullet('Acute: IV/oral antibiotics (Flucloxacillin/Amoxicillin-Clavulanate); hot fomentation; I&D if fluctuant abscess'),
  bullet('Chronic: DCR (Dacryocystorhinostomy) - Gold standard surgical procedure; creates new passage between lacrimal sac and nasal cavity'),
  bullet('Endoscopic DCR (EnDCR): Preferred (no external scar)'),
  bullet('Probing & syringing: For congenital NLD obstruction in infants (Hasner\'s valve)'),

  divider(),
  pageBreak(),

  // ═══════════════════════════════════════
  // PART B: ENT DISEASES
  // ═══════════════════════════════════════
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  // ─── 10. OTITIS MEDIA ────────────────────────────────────────────────────
  h1('10. OTITIS MEDIA (Pootikarna / Karnasula)'),
  h2('Ayurvedic Correlation'),
  boldPara('Sanskrit Name', 'Pootikarna (foul-smelling ear) = chronic suppurative otitis media; Karnasula (earache) = acute; Badhirya (deafness) = complication. Kapha-Vata predominant.'),

  h2('Anatomy Basics'),
  para('Middle ear (tympanic cavity) communicates with nasopharynx via Eustachian tube (ET). ET dysfunction -> negative pressure -> fluid accumulation -> infection.'),

  h2('Classification'),
  h3('1. Acute Otitis Media (AOM)'),
  bullet('Rapid onset ear infection; most common in children 6-24 months'),
  bullet('Organisms: Streptococcus pneumoniae (most common), Haemophilus influenzae, Moraxella catarrhalis'),
  bullet('Preceding URTI -> ET dysfunction -> bacterial ascent'),
  bullet('Symptoms: Ear pain (otalgia), fever, decreased hearing, irritability in children; ear pulling'),
  bullet('Signs: Bulging, erythematous tympanic membrane (TM); TM mobility decreased on pneumatic otoscopy'),
  bullet('Treatment: Amoxicillin 40-90 mg/kg/day x 5-10 days; Watchful waiting (48-72 hrs) for mild-moderate cases ≥2 years; analgesia'),

  h3('2. Otitis Media with Effusion (OME / Glue Ear)'),
  bullet('Non-suppurative; effusion behind TM without signs of acute infection'),
  bullet('Amber/blue TM; decreased mobility; air-fluid levels'),
  bullet('Commonest cause of hearing loss in children; most resolve spontaneously in 3 months'),
  bullet('Treatment: Watchful waiting (3 months); Grommets (ventilation tubes) if bilateral hearing loss persists'),

  h3('3. Chronic Suppurative Otitis Media (CSOM)'),
  bullet('Persistent discharge from ear (otorrhoea) through TM perforation for >2-3 months'),
  h3('a) Tubotympanic (Safe / Mucosal CSOM)'),
  bullet2('Central TM perforation (not involving pars flaccida/annulus)'),
  bullet2('Mucopurulent, odorless discharge; conductive hearing loss'),
  bullet2('No cholesteatoma; SAFE type'),
  bullet2('Treatment: Aural toilet + topical antibiotics (ciprofloxacin drops); Myringoplasty when dry'),

  h3('b) Atticoantral (Unsafe / Squamous CSOM + Cholesteatoma)'),
  bullet2('Attic/marginal/posterosuperior TM perforation or retraction pocket'),
  bullet2('UNSAFE due to cholesteatoma formation'),
  bullet2('Keratin-filled cyst; destroys bone by collagenase; FOUL-smelling discharge'),
  bullet2('Complications: Mastoiditis, meningitis, brain abscess, facial nerve palsy, labyrinthitis, lateral sinus thrombosis'),
  bullet2('Treatment: Surgical - Mastoidectomy (Canal wall down/modified radical/radical; Atticotomy for limited disease)'),

  h2('Complications of CSOM (Important for Exam)'),
  h3('Intratemporal'),
  bullet('Mastoiditis (most common complication)'),
  bullet('Labyrinthitis (vertigo, SNHL)'),
  bullet('Facial nerve palsy'),
  bullet('Petrositis (Gradenigo\'s syndrome: Otorrhoea + diplopia + trigeminal pain)'),

  h3('Intracranial'),
  bullet('Meningitis (most common intracranial complication)'),
  bullet('Brain abscess (temporal lobe / cerebellar)'),
  bullet('Extradural abscess'),
  bullet('Lateral/sigmoid sinus thrombophlebitis'),
  bullet('Otitic hydrocephalus'),

  h2('Ayurvedic Management'),
  bullet('Karnapoorana (ear drops): Bilva taila, Nirgundi taila, Anu taila'),
  bullet('Nasya: For ET dysfunction and underlying nasal pathology'),
  bullet('Virechana for Pitta-Kapha excess'),
  bullet('Gandusha (gargling) with decoctions for associated pharyngitis'),
  bullet('Avoid: Water entry into ear, avoid cold and suppression of natural urges'),

  divider(),
  pageBreak(),

  // ─── 11. MENIERE'S DISEASE ───────────────────────────────────────────────
  h1('11. MENIERE\'S DISEASE'),
  h2('Ayurvedic Correlation'),
  boldPara('Sanskrit Name', 'Brahmana Rog (vertigo/spinning) with Karnanada (tinnitus) and Badhirya (deafness) - Vata-Kapha predominant.'),

  h2('Definition'),
  para('Meniere\'s disease is an inner ear disorder caused by endolymphatic hydrops (increased endolymph volume in membranous labyrinth), characterized by the classic triad.'),

  h2('Classic Triad'),
  bullet('1. Episodic vertigo: Sudden rotatory, 20 min-12 hours; nausea/vomiting; incapacitating'),
  bullet('2. Sensorineural hearing loss (SNHL): Initially fluctuating, low-frequency; later permanent'),
  bullet('3. Tinnitus: Low-pitched roaring, unilateral; worse before/during attack'),
  para('Plus: Aural fullness/pressure (common 4th symptom)'),

  h2('Pathophysiology'),
  para('Endolymphatic hydrops -> rupture of Reissner\'s membrane -> mixing of perilymph (high Na) and endolymph (high K) -> K intoxication of hair cells -> attack.'),

  h2('Investigations'),
  bullet('Pure tone audiogram (PTA): Low-frequency SNHL initially; later flat'),
  bullet('Electrocochleography (ECoG): Increased summating potential / action potential (SP/AP ratio >0.3-0.4)'),
  bullet('Glycerol dehydration test: Transient improvement in hearing after glycerol (300 mL oral) - confirms hydrops'),
  bullet('MRI brain with gadolinium (FLAIR/inversion recovery): Shows endolymphatic hydrops after IV gadolinium'),
  bullet('VHIT, cVEMP, oVEMP: Vestibular function tests'),

  h2('Treatment'),
  h3('Medical (Acute Attack)'),
  bullet('Prochlorperazine (Stemetil) or Cinnarizine: Vestibular sedative'),
  bullet('Diazepam: For acute severe vertigo'),
  bullet('Antiemetics: Ondansetron, metoclopramide'),

  h3('Prophylaxis'),
  bullet('Low sodium diet (<1500 mg/day) + Betahistine 16-24 mg TDS (increases cochlear blood flow)'),
  bullet('Diuretics: Hydrochlorothiazide + triamterene (reduces endolymph production)'),
  bullet('Avoid caffeine, alcohol, smoking, stress'),

  h3('Surgical / Interventional'),
  bullet('Intratympanic gentamicin (chemical labyrinthectomy): Destroys vestibular hair cells; risk of hearing loss'),
  bullet('Endolymphatic sac decompression/shunt: Conservative surgery'),
  bullet('Vestibular nerve section: Retrolabyrinthine; controls vertigo, preserves hearing'),
  bullet('Labyrinthectomy: Total ablation; for no useful hearing'),

  divider(),
  pageBreak(),

  // ─── 12. EPISTAXIS ───────────────────────────────────────────────────────
  h1('12. EPISTAXIS (Nasagata Rakta Pitta / Nasashonitam)'),
  h2('Ayurvedic Correlation'),
  boldPara('Sanskrit Name', 'Nasagata Raktapitta (blood from nose due to Pitta vitiation) or Nasashonitam. Causes: Pitta-Rakta dushti, Vatapitta, trauma. Chikitsa: Raktapitta management.'),

  h2('Definition'),
  para('Epistaxis is bleeding from the nose, arising from nasal mucosa, nasal cavity, or nasopharynx.'),

  h2('Site of Bleeding'),
  bullet('Little\'s area (Kiesselbach\'s plexus): Anterior part of nasal septum; anastomosis of 4 arteries (anterior ethmoidal, sphenopalatine, greater palatine, superior labial); site of 90% of anterior epistaxis'),
  bullet('Posterior epistaxis: From sphenopalatine artery (branch of maxillary artery); occurs in elderly, hypertensives; more severe; harder to control'),
  bullet('Woodruff\'s plexus: Posterior nasal wall; site of posterior epistaxis'),

  h2('Causes'),
  h3('Local'),
  bullet('Trauma (nose picking, facial fractures - most common), dry mucosa, rhinitis, deviated septum, nasal polyps, angiofibroma, carcinoma'),

  h3('Systemic'),
  bullet('Hypertension (most common systemic), coagulopathy (hemophilia, thrombocytopenia, liver disease), anticoagulants (warfarin, aspirin), hereditary hemorrhagic telangiectasia (Osler-Weber-Rendu), leukemia, Wegener\'s, vitamin C/K deficiency'),

  h2('Management'),
  h3('First Aid (Little\'s area - Anterior Epistaxis)'),
  bullet('Sit upright, lean forward (prevent swallowing blood)'),
  bullet('Pinch soft part of nose (Trotter\'s method) for 10-15 minutes continuously'),
  bullet('Cold compress over nose bridge'),
  bullet('Identify and treat cause'),

  h3('Active Bleeding'),
  bullet('Cauterization: Silver nitrate / TCA / electrocautery of Little\'s area under LA'),
  bullet('Anterior nasal packing: Bismuth iodoform paraffin paste (BIPP) ribbon gauze; Merocel sponge; keep 48-72 hrs with antibiotics'),
  bullet('Posterior packing: Brighton\'s balloon / Foley catheter (14 Fr inflated with 7-10 mL saline); for posterior bleeding uncontrolled by anterior pack'),
  bullet('Surgical: Endoscopic sphenopalatine artery ligation (ESPAL); anterior ethmoid artery ligation; septoplasty for recurrent'),
  bullet('Angiographic embolization: For massive/recurrent uncontrolled epistaxis'),

  h2('Ayurvedic Management'),
  bullet('Nasya: Cooling - Chandana taila, Anu taila (Sita nasya) to reduce Pitta'),
  bullet('Sheeta seka (cold nasal wash with Chandana/Ushira decoction)'),
  bullet('Tampon: Yashtimadhu paste/Chandana paste nasal packing'),
  bullet('Oral: Shatavari, Amalaki, Chandana, Durva svarasa (Cynodon dactylon juice)'),
  bullet('Shiro lepa: Chandana + Ushira paste on head to reduce Pitta'),
  bullet('Avoid hot foods, alcohol, overexertion, hot weather'),

  divider(),
  pageBreak(),

  // ─── 13. SINUSITIS ───────────────────────────────────────────────────────
  h1('13. SINUSITIS (Peenasa / Dushta Pratishyaya)'),
  h2('Ayurvedic Correlation'),
  boldPara('Sanskrit Name', 'Pratishyaya = common cold/rhinitis (acute). Dushta Pratishyaya or Pinas (Peenasa) = chronic sinusitis/rhinosinusitis. Kshavathu (sneezing) is associated. Dosha: Kapha-Vata.'),

  h2('Definition'),
  para('Sinusitis (rhinosinusitis) is inflammation of the paranasal sinuses and nasal mucosa. Classified as acute (<4 weeks), subacute (4-12 weeks), chronic (>12 weeks with or without acute exacerbations).'),

  h2('Microbiology'),
  bullet('Acute (viral): Rhinovirus, adenovirus, influenza (most common)'),
  bullet('Acute (bacterial): S. pneumoniae (most common), H. influenzae, M. catarrhalis; suspect if >7-10 days without improvement'),
  bullet('Chronic: Polymicrobial; S. aureus, anaerobes, Gram-negatives; fungal (Aspergillus in immunocompromised)'),

  h2('Predisposing Factors'),
  bullet('URTI (most common), nasal polyps, deviated nasal septum, dental infection (maxillary sinusitis), immunodeficiency, cystic fibrosis, allergic rhinitis, Kartagener\'s syndrome'),

  h2('Clinical Features'),
  bullet('Facial pain/pressure (worsened by bending forward), unilateral > bilateral'),
  bullet('Nasal congestion and blockage'),
  bullet('Purulent nasal discharge (anterior or posterior/PND)'),
  bullet('Hyposmia/anosmia, headache'),
  bullet('Fever (acute bacterial)'),
  bullet('Maxillary sinusitis: Cheek pain/pressure, upper molar toothache'),
  bullet('Frontal: Forehead pain, worse in morning'),
  bullet('Ethmoid: Inter-orbital pain, epiphora'),
  bullet('Sphenoid: Vertex headache, retro-orbital pain (most dangerous)'),

  h2('Investigations'),
  bullet('Clinical diagnosis usually sufficient for acute'),
  bullet('CT PNS (Paranasal sinuses): Gold standard; mucosal thickening, air-fluid levels, bony changes; NOT plain X-ray (less sensitive)'),
  bullet('Nasal endoscopy: Visualize middle meatus, polyps, discharge'),
  bullet('MRI: For fungal sinusitis, tumor, intracranial extension'),
  bullet('Allergy testing: For recurrent/chronic with allergic component'),

  h2('Treatment'),
  h3('Acute Viral'),
  bullet('Saline nasal irrigation (first line), analgesics, decongestants'),
  bullet('Intranasal corticosteroids (Mometasone, Fluticasone)'),
  bullet('No antibiotics for viral or mild-moderate uncomplicated <7-10 days'),

  h3('Acute Bacterial'),
  bullet('Amoxicillin-Clavulanate 875/125 mg BD x 5-7 days (first line)'),
  bullet('Doxycycline or Levofloxacin for penicillin allergy'),
  bullet('Decongestants (Xylometazoline 0.1% nasal spray, max 3-5 days) + saline rinse'),

  h3('Chronic Sinusitis'),
  bullet('Prolonged antibiotics (3-6 weeks) + intranasal steroids'),
  bullet('Surgery: FESS (Functional Endoscopic Sinus Surgery) - Gold standard for chronic/recurrent; restores normal sinus drainage'),
  bullet('Caldwell-Luc operation: For maxillary sinusitis (largely replaced by FESS)'),

  h2('Complications'),
  bullet('Orbital: Preseptal/periorbital cellulitis -> orbital cellulitis -> subperiosteal abscess -> orbital abscess'),
  bullet('Intracranial: Meningitis, brain abscess, cavernous sinus thrombosis, subdural empyema'),
  bullet('Frontal: Pott\'s puffy tumor (frontal bone osteomyelitis)'),

  h2('Ayurvedic Management'),
  bullet('Nasya: Anu taila nasya (primary treatment for all nasal diseases); Panchakola taila; Shadbindu taila'),
  bullet('Dhumapana (medicated steam inhalation): Haridra, Nimba, Tulasi steam'),
  bullet('Gandusha (oil pulling): For associated oral-pharyngeal symptoms'),
  bullet('Snehana-Swedana: Local oleation and fomentation to face/head'),
  bullet('Virechana: To eliminate Kapha/Pitta from head region'),
  bullet('Diet: Avoid cold/sour/heavy foods; ginger, turmeric, black pepper beneficial'),

  divider(),
  pageBreak(),

  // ─── 14. TONSILLITIS ─────────────────────────────────────────────────────
  h1('14. TONSILLITIS (Tundikeri)'),
  h2('Ayurvedic Correlation'),
  boldPara('Sanskrit Name', 'Tundikeri (tonsillitis) - described as Kapha-Pitta roga; Galagganda (goiter/throat swelling) includes tonsil enlargement. Galashotha = throat inflammation.'),

  h2('Definition'),
  para('Tonsillitis is inflammation of the palatine tonsils, predominantly caused by infectious agents.'),

  h2('Microbiology'),
  bullet('Viral (most common): Adenovirus, EBV (infectious mononucleosis), rhinovirus, enterovirus, HSV'),
  bullet('Bacterial: Group A beta-hemolytic Streptococcus pyogenes (GABHS/GAS) - most important (15-30% of cases); Staphylococcus, Anaerobes (chronic)'),

  h2('Centor Criteria (GABHS scoring)'),
  bullet('+1 each: Tonsillar exudates, Tender anterior cervical lymphadenopathy, Fever history >38°C, Absence of cough'),
  bullet('Score 0-1: No culture/antibiotics; Score 2-3: Culture-guided; Score 4: Empirical antibiotics'),

  h2('Clinical Features'),
  h3('Acute Tonsillitis'),
  bullet('Sore throat, odynophagia (painful swallowing), dysphagia'),
  bullet('Fever, malaise, headache'),
  bullet('Trismus (peritonsillar abscess complication)'),
  bullet('Examination: Red, enlarged tonsils; exudate/follicles (follicular tonsillitis); white membrane (diphtheria/EBV)'),
  bullet('Cervical lymphadenopathy (jugulodigastric nodes most commonly)'),

  h3('Peritonsillar Abscess (Quinsy)'),
  bullet('Complication of acute tonsillitis; pus between tonsillar capsule and superior pharyngeal constrictor'),
  bullet('Trismus, muffled "hot potato" voice, unilateral swelling with uvular deviation toward opposite side, drooling'),
  bullet('Treatment: I&D (incision & drainage) or needle aspiration under LA; antibiotics; consider interval tonsillectomy'),

  h2('Indications for Tonsillectomy (Paradise Criteria)'),
  bullet('≥7 episodes/year in past 1 year, OR'),
  bullet('≥5 episodes/year for 2 consecutive years, OR'),
  bullet('≥3 episodes/year for 3 consecutive years'),
  bullet('Other: OSA with adenotonsillar hypertrophy, peritonsillar abscess (recurrent), suspected malignancy, cor pulmonale'),

  h2('Treatment'),
  bullet('Viral: Symptomatic - analgesics (paracetamol/ibuprofen), gargles, fluids; AVOID aspirin in children (Reye\'s syndrome)'),
  bullet('GABHS: Penicillin V 500 mg QID x 10 days (first line); Amoxicillin x 10 days; Azithromycin if penicillin allergy; AVOID Ampicillin/Amoxicillin in EBV (causes morbilliform rash)'),
  bullet('Tonsillectomy: For recurrent/chronic tonsillitis per Paradise criteria'),

  h2('Rheumatic Fever Prevention'),
  para('Untreated GABHS tonsillitis -> Acute Rheumatic Fever (ARF) -> Rheumatic Heart Disease. Hence, complete 10-day penicillin course is essential.'),

  h2('Ayurvedic Management'),
  bullet('Gandusha (gargling): Trikatu decoction, Triphala decoction, Irimedadi taila'),
  bullet('Kavala (oil pulling): Tila taila with saindhava lavana'),
  bullet('Pratisarana (application): Yashti-madhu churna + honey applied to tonsils; Saindhava + Marich paste'),
  bullet('Nasya: For associated nasal symptoms'),
  bullet('Internal: Sudarshana churna, Talisadi churna, Sitopaladi churna for Kaphaja type'),
  bullet('Langhana (fasting/light diet), ginger tea, warm water gargles'),
  bullet('Raktamokshana: Jalaukavacharan (leech therapy) in Rakta-Pitta type (modern: not practiced)'),

  divider(),
  pageBreak(),

  // ─── 15. SVARABHEDA (Laryngitis) ─────────────────────────────────────────
  h1('15. HOARSENESS OF VOICE / LARYNGITIS (Svarabheda)'),
  h2('Ayurvedic Correlation'),
  boldPara('Sanskrit Name', 'Svarabheda (splitting/loss of voice) - classified as Vataja, Pittaja, Kaphaja, Sannipata, Kshataja (trauma), Medaja (obesity). Corresponds to laryngitis, vocal cord palsy, dysphonia.'),

  h2('Common Causes'),
  bullet('Acute laryngitis: URTI, voice overuse (most common); usually viral'),
  bullet('Chronic laryngitis: Smoking, alcohol, GERD (reflux laryngitis), voice abuse'),
  bullet('Vocal cord nodules ("Singer\'s nodules"): Bilateral, at junction of anterior 1/3 and posterior 2/3; voice abuse'),
  bullet('Vocal cord polyps: Unilateral; hemorrhagic; Reinke\'s oedema (bilateral, diffuse - smoking)'),
  bullet('Carcinoma of larynx: Hoarseness >3 weeks without cause = investigate'),
  bullet('Vocal cord palsy: RLN (Recurrent Laryngeal Nerve) palsy; left > right (longer course); causes: thyroid surgery, thoracic surgery, aortic aneurysm, lung ca, mediastinal mass'),

  h2('Investigation (Red Flags for >3 Weeks Hoarseness)'),
  bullet('Indirect laryngoscopy / Video laryngoscopy: First investigation; visualizes vocal cords'),
  bullet('Direct microlaryngoscopy (DML): Under GA; for biopsy, surgery of vocal cord lesions'),
  bullet('CT neck/chest: RLN palsy workup (thyroid, mediastinum, aorta)'),
  bullet('GERD workup: 24-hr pH monitoring if reflux suspected'),

  h2('Treatment'),
  bullet('Acute laryngitis: Voice rest; steam inhalation; adequate hydration; antibiotics only if bacterial; steroids for performers (short course)'),
  bullet('GERD laryngitis: PPI + head elevation + dietary changes'),
  bullet('Vocal nodules: Voice therapy (first line); surgery (microlaryngoscopy + stripping) if refractory'),
  bullet('Carcinoma larynx: Depends on stage - early glottic: radiotherapy (excellent results, preserves voice); advanced: Total laryngectomy + RT + chemo'),
  bullet('RLN palsy: Treat cause; medialization laryngoplasty for permanent unilateral palsy'),

  h2('Ayurvedic Management'),
  bullet('Gandusha/Kavala: Yashti-madhu + Ghrita + honey; Talisadi churna'),
  bullet('Dhumapana: Medicated smoking with Agaru, Haridra for Kaphaja Svarabheda'),
  bullet('Nasya: For associated nasal causes'),
  bullet('Voice rest + warm liquid diet'),
  bullet('Sitopaladi churna + honey for acute viral laryngitis'),

  divider(),
  pageBreak(),

  // ─── 16. FOREIGN BODY ────────────────────────────────────────────────────
  h1('16. FOREIGN BODY IN EAR/NOSE/THROAT'),
  h2('Foreign Body in Ear (Karnasharkara)'),
  bullet('Most common in children; insects, beads, seeds, vegetable matter'),
  bullet('Symptoms: Hearing loss, earache, tinnitus; insects: buzzing/pain'),
  bullet('Management: Syringing (for hard inorganic objects); forceps/hook/suction under direct vision; NEVER push deeper; Insects: Kill first with olive oil/spirit drops, then remove; General anaesthesia for uncooperative children or deep/impacted FBs'),

  h2('Foreign Body in Nose (Nasa Shalyam)'),
  bullet('Common in children; beads, small toys, vegetable matter'),
  bullet('Unilateral foul-smelling purulent nasal discharge = FB until proven otherwise'),
  bullet('Rhinolith: Calcified FB'),
  bullet('Management: Positive pressure technique (parent blows into mouth while occluding normal nostril); Jobson-Horne probe/crocodile forceps under direct vision; GA for difficult cases'),

  h2('Foreign Body in Throat/Oesophagus'),
  bullet('Fish bones: Most common; impacted in tonsillar fossa, base of tongue, pyriform fossa, post-cricoid region, cricopharyngeus level'),
  bullet('Coins: Children; usually at level of cricopharyngeus (C6) or aortic arch or gastro-oesophageal junction'),
  bullet('Symptoms: Dysphagia, odynophagia, drooling, regurgitation; inability to swallow'),
  bullet('Investigation: Plain X-ray neck/chest (radiopaque); Barium swallow (radiolucent/fish bones)'),
  bullet('Management: Rigid oesophagoscopy under GA for removal; Flexible endoscopy for FB in stomach/oesophagus'),
  bullet('Laryngeal/tracheal FB: Emergency; stridor, cough, choking; NEVER perform blind finger sweep; Heimlich maneuver; rigid bronchoscopy under GA'),

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  // ─── QUICK REFERENCE TABLE ───────────────────────────────────────────────
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        ['Glaucoma', 'Adhimantha / Kacha', 'Vata-Pitta / Tridosha', 'Tarpana, Triphala ghrita, LPI (modern)'],
        ['Cataract', 'Linganasha / Kacha', 'Vata (Vataj - curable)', 'Tarpana, Mahatriphala ghrita, Phaco (modern)'],
        ['Conjunctivitis', 'Abhishyanda', 'Tridosha (4 types)', 'Seka, Aschyotana, Bidalaka, Anjana'],
        ['Trachoma', 'Arjuna Roga / Kaphaja Abhishyanda progressed', 'Kapha-Pitta', 'Seka, Azithromycin (modern), Surgery trichiasis'],
        ['Corneal Ulcer', 'Savrana Shukla / Krishnagata Roga', 'Pitta-Tridosha', 'Triphala seka, Rasanjana anjana'],
        ['Stye', 'Anjananamika / Vibanadha', 'Vata-Pitta', 'Hot fomentation, I&D, Anjana'],
        ['Chalazion', 'Upanaha (Kaphaja)', 'Kapha', 'I&C (modern), Ushna sweda'],
        ['Retinal Detachment', 'Drishti Kshaya (advanced)', 'Vata', 'Rasayana, Tarpana; Surgery (modern)'],
        ['Dacryocystitis', 'Ashrunali Vidradhi / Shotha', 'Kapha-Rakta', 'Seka, DCR (modern)'],
        ['Otitis Media', 'Pootikarna / Karnasula', 'Kapha-Vata', 'Karnapoorana (Bilva taila), Nasya'],
        ['Meniere\'s Disease', 'Brahmana Roga + Karnanada + Badhirya', 'Vata-Kapha', 'Betahistine (modern), Snehana, Basti'],
        ['Epistaxis', 'Nasagata Raktapitta', 'Pitta-Rakta', 'Sita nasya (Chandana taila), Sheeta seka'],
        ['Sinusitis', 'Peenasa / Dushta Pratishyaya', 'Kapha-Vata', 'Nasya (Anu taila), Dhumapana, FESS (modern)'],
        ['Tonsillitis', 'Tundikeri / Galashotha', 'Kapha-Pitta', 'Gandusha, Kavala, Pratisarana, Tonsillectomy'],
        ['Hoarseness', 'Svarabheda', 'Vataja / 6 types', 'Gandusha, Dhumapana, Voice rest'],
        ['Foreign Body Ear', 'Karnasharkara', 'Vata', 'Karnapoorana then removal'],
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  // ─── IMPORTANT SHORT NOTES (Commonly Asked in MUHS) ─────────────────────
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  h2('1. Shadbindu Taila (Nasya formulation)'),
  bullet('Contains: Bala, Ashwagandha, Shatavari, Yashtimadhu, Jivanti, Shatapushpa in sesame oil base'),
  bullet('Used as Pratimarsha nasya (daily) and Marsha nasya (therapeutic dose 6 drops each nostril)'),
  bullet('Indications: Sinusitis (Peenasa), migraine (Ardhavabhedaka), facial palsy, eye diseases, premature greying, hair fall, memory enhancement'),

  h2('2. Anu Taila (Nasya)'),
  bullet('Most commonly used Nasya taila; contains 26+ herbs in sesame/sesame+milk base'),
  bullet('Indications: All Urdhvajatrugata rogas (diseases above clavicle); first choice for Nasya in practice'),

  h2('3. Triphala (Haritaki, Amalaki, Vibhitaki)'),
  bullet('Rasayana herb combination; richest source of Vitamin C (Amalaki)'),
  bullet('Eye applications: Triphala kwatha seka (antiseptic, anti-inflammatory wash); Triphala ghrita (tarpana, internal); Triphala churna (anjana - dry collyrium)'),
  bullet('Properties: Tridosha shamaka, Deepana, Pachana, Rasayana'),

  h2('4. Saptamrita Lauha'),
  bullet('Classical preparation: Lauha (iron), Triphala, Yashtimadhu, Ghrita'),
  bullet('Main indication: Early cataract, retinal disorders, anemia with eye symptoms'),
  bullet('Dose: 500 mg-1g BD with honey/ghrita'),

  h2('5. Mahatriphala Ghrita'),
  bullet('Enhanced Triphala ghrita with additional herbs including Haritaki, Vibhitaki, Amalaki, plus Dhataki, Priyangu, and various other herbs'),
  bullet('Indications: Vataja and Pittaja eye diseases, early cataract (Kacha/Linganasha), glaucoma, vitreous disorders'),
  bullet('Administration: 1-2 tsp oral BD; also used for Tarpana (eye bath)'),

  h2('6. Aschyotana (Eye Drops) vs Anjana (Collyrium) vs Seka (Wash) vs Tarpana'),
  bullet('Aschyotana: Medicated liquid dropped into eye; equivalent to modern eye drops'),
  bullet('Anjana: Collyrium applied as streak inside lower lid; dry (churna) or wet (rasa); most potent for local effect'),
  bullet('Seka: Stream/wash of medicated liquid poured over closed eye; anti-inflammatory, cleansing'),
  bullet('Tarpana: Eye bath in ghee-based medium in a dough ring dam for specified time (5-10 min); nourishes and strengthens the eye; done in sterile conditions'),

  h2('7. Mystic 76 Eye Diseases (Sushruta)'),
  bullet('Sushruta\'s Shalakya Tantra describes 76 eye diseases (Netra Rogas)'),
  bullet('Distribution: 16 (Vartmagata - lid), 11 (Sandhigata - canthal), 4 (Shuklagata - sclera/conjunctiva), 11 (Krishnagata - cornea/uvea), 10 (Drishtigata - lens/vitreous/retina), 2 (Sarvagata - whole eye), 1 (Bahya - external)'),

  h2('8. Glaucoma Drugs - Mnemonic: "BAP CoM" (B=Beta-blocker, A=Alpha agonist, P=Prostaglandin, Co=CAI, M=Miotics)'),
  bullet('Prostaglandin analogues (Latanoprost/Bimatoprost/Travoprost): First-line POAG; once daily night; IOP reduction 25-35%'),
  bullet('Beta-blockers (Timolol/Betaxolol): Reduce aqueous production; CI: asthma, heart block, COPD'),
  bullet('Alpha-2 agonists (Brimonidine): Dual mechanism; avoid in children (can cause apnea/CNS depression)'),
  bullet('CAIs - Carbonic Anhydrase Inhibitors (Dorzolamide drops/Acetazolamide oral): CI sulfonamide allergy; oral CAI causes paresthesia, hypokalemia, metabolic acidosis'),
  bullet('Miotics (Pilocarpine): Used mainly in PACG + as provocative test; causes miosis, browache, myopia'),

  h2('9. Aural Vertigo vs Central Vertigo - Key Differences'),
  bullet('Peripheral/Aural: Rotatory, direction-fixed nystagmus, hearing loss/tinnitus, no neurological signs, Hallpike positive (BPPV), fatigable'),
  bullet('Central: Direction-changing nystagmus, no hearing loss, neurological signs, gait ataxia, non-fatigable, Hallpike negative'),

  h2('10. Audiological Tests Summary'),
  bullet('Weber test: Tuning fork on vertex; lateralizes to DEAF ear in CHL; lateralizes to NORMAL ear in SNHL'),
  bullet('Rinne test: Tuning fork on mastoid then air; AC > BC = Rinne positive (normal/SNHL); BC > AC = Rinne negative (CHL)'),
  bullet('Pure Tone Audiogram (PTA): Gold standard hearing test; Air-bone gap >10 dB = conductive hearing loss'),
  bullet('Impedance audiometry (Tympanometry): Eardrum compliance; Type A normal; Type B flat = OME/perforation; Type C = negative pressure/ET dysfunction'),

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