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const fs = require('fs');

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// ══════════════════════════════════════════════════════════════════════════════
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// ══════════════════════════════════════════════════════════════════════════════
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      // ═══ COVER ═══════════════════════════════════════════════════════════
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      // ═══ OVERVIEW TABLE ═══════════════════════════════════════════════════
      infoBox("Medical Surgical Nursing (Med-Surg) critically sick adults ki comprehensive nursing care ke baare mein hai. Yeh subject 2nd aur 3rd Year BSc Nursing mein padhaya jaata hai aur board exams mein highest weightage rakhta hai."),
      spacer(200),

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      spacer(300),

      // ══════════════════════════════════════════════════════════════════════
      //  PAPER I — 2nd YEAR
      // ══════════════════════════════════════════════════════════════════════
      new Paragraph({ children: [new PageBreak()] }),
      ...sectionHeader("MED-SURG NURSING I  —  2nd Year Syllabus", "📘"),

      // ── Unit 1 ──
      subSection("Unit 1: Introduction & Nursing Assessment"),
      bullet("Concept of Medical-Surgical Nursing aur scope"),
      bullet("Adult patient ki nursing assessment ka process"),
      bullet("Health history lena — subjective vs objective data"),
      bullet("Physical examination techniques: inspection, palpation, percussion, auscultation"),
      bullet("Functional health patterns — Gordon's 11 patterns"),
      bullet("Nursing Diagnosis formulation (NANDA framework)"),
      bullet("Nursing care plan banana"),
      spacer(100),

      // ── Unit 2 ──
      subSection("Unit 2: Pathophysiological Mechanisms of Disease"),
      infoBox("Yeh unit samjhata hai ke disease process kaise shuru hota hai — cell level se systemic level tak."),
      bullet("Cell injury ke causes: ischemia, toxins, infection, radiation"),
      bullet("Inflammation — acute vs chronic"),
      bullet("Repair aur regeneration of tissues"),
      bullet("Neoplasia — benign vs malignant tumor"),
      bullet("Shock ke types: hypovolemic, cardiogenic, distributive, obstructive"),
      bullet("Sepsis aur SIRS (Systemic Inflammatory Response Syndrome)"),
      spacer(100),

      // ── Unit 3 ──
      subSection("Unit 3: Altered Immune Response"),
      bullet("Immunity ke types: innate vs adaptive"),
      bullet("Hypersensitivity reactions — Type I, II, III, IV (Gell-Coombs classification)"),
      bullet("Anaphylaxis — symptoms, emergency management"),
      bullet("Autoimmune disorders ka overview"),
      bullet("HIV/AIDS — pathophysiology, stages, nursing care"),
      bullet("Organ transplant patients mein immunosuppression"),
      spacer(100),

      // ── Unit 4 ──
      subSection("Unit 4: Fluid & Electrolyte Balance and Imbalance"),
      bullet("Body fluid compartments: ICF, ECF"),
      bullet("Osmolarity, osmolality, tonicity"),
      bullet("Fluid imbalances: dehydration, overhydration, edema"),
      bullet("Electrolyte imbalances:"),
      bullet("Hypo/Hypernatremia (Na+)", true),
      bullet("Hypo/Hyperkalemia (K+)", true),
      bullet("Hypo/Hypercalcemia (Ca++)", true),
      bullet("Hypo/Hypermagnesemia (Mg++)", true),
      bullet("Acid-base balance: metabolic/respiratory acidosis & alkalosis"),
      bullet("IV fluid therapy — types of IV fluids, nursing responsibilities"),
      bullet("Blood transfusion — procedure, complications, nursing care"),
      spacer(100),

      // ── Unit 5 ──
      subSection("Unit 5: Operation Theatre Technique"),
      bullet("OT ka environment aur asepsis principles"),
      bullet("Sterilization aur disinfection methods"),
      bullet("Surgical team members aur unke roles"),
      bullet("Patient positioning in OT"),
      bullet("Surgical instruments ki pehchaan aur handling"),
      bullet("Pre-operative preparation — patient physical aur psychological"),
      bullet("Consent, bowel prep, skin prep"),
      spacer(100),

      // ── Unit 6 ──
      subSection("Unit 6: Management of Patients Undergoing Surgery"),
      bullet("Pre-operative assessment — history, examination, investigations"),
      bullet("Pre-op medications: sedatives, antiemetics, antibiotics"),
      bullet("Intra-operative nursing: scrub nurse vs circulating nurse"),
      bullet("Anesthesia types: general, regional, local"),
      bullet("Post-operative care in PACU (recovery room)"),
      bullet("Post-op complications:"),
      bullet("Wound infection, dehiscence, evisceration", true),
      bullet("Deep vein thrombosis (DVT)", true),
      bullet("Pulmonary embolism", true),
      bullet("Atelectasis, pneumonia", true),
      bullet("Urinary retention, constipation", true),
      bullet("Pain management post-surgery"),
      bullet("Wound dressing aur drain care"),
      spacer(100),

      // ── Unit 7 ──
      subSection("Unit 7: Respiratory System Disorders"),
      infoBox("Respiratory disorders — exam mein sabse zyada important unit!"),
      bullet("Upper Respiratory Infections: common cold, sinusitis, tonsillitis, laryngitis"),
      bullet("Pneumonia — types, causes, assessment, nursing management"),
      bullet("Tuberculosis (TB) — pathophysiology, DOTs therapy, infection control"),
      bullet("Chronic Obstructive Pulmonary Disease (COPD)"),
      bullet("  Emphysema aur Chronic Bronchitis ka difference", true),
      bullet("  Bronchodilators ka use, oxygen therapy precautions", true),
      bullet("Asthma — triggers, status asthmaticus, nebulization"),
      bullet("Pleural effusion, pneumothorax, hemothorax"),
      bullet("Lung cancer — types, staging, nursing care"),
      bullet("Chest physiotherapy techniques"),
      bullet("Mechanical ventilation — settings, weaning, nursing care"),
      bullet("Tracheostomy care"),
      spacer(100),

      // ── Unit 8 ──
      subSection("Unit 8: Gastrointestinal Disorders"),
      bullet("GI assessment — history, physical exam, diagnostic tests (endoscopy, colonoscopy)"),
      bullet("Oral disorders: stomatitis, oral cancer"),
      bullet("Esophageal disorders: GERD, achalasia, esophageal cancer"),
      bullet("Peptic Ulcer Disease (PUD) — H. pylori, treatment, complications"),
      bullet("Gastritis — acute vs chronic"),
      bullet("Inflammatory Bowel Disease: Crohn's vs Ulcerative Colitis"),
      bullet("Irritable Bowel Syndrome (IBS)"),
      bullet("Appendicitis — assessment, McBurney's point, appendectomy care"),
      bullet("Intestinal obstruction — paralytic ileus vs mechanical"),
      bullet("Colorectal cancer — screening, surgical care, colostomy care"),
      bullet("Liver disorders:"),
      bullet("Hepatitis A, B, C, D, E — prevention aur care", true),
      bullet("Liver cirrhosis — complications (ascites, varices, encephalopathy)", true),
      bullet("Liver failure", true),
      bullet("Cholecystitis aur cholelithiasis (gallstones), cholecystectomy"),
      bullet("Pancreatitis — acute vs chronic, nursing management"),
      bullet("Nasogastric tube insertion aur tube feeding"),
      spacer(100),

      // ── Unit 9 ──
      subSection("Unit 9: Metabolic & Endocrine Disorders"),
      bullet("Diabetes Mellitus — Type 1 vs Type 2"),
      bullet("  Insulin therapy — types, administration, sites", true),
      bullet("  Oral hypoglycemics", true),
      bullet("  Diabetic Ketoacidosis (DKA) management", true),
      bullet("  Hyperosmolar Hyperglycemic State (HHS)", true),
      bullet("  Chronic complications: neuropathy, retinopathy, nephropathy, foot care", true),
      bullet("Thyroid disorders:"),
      bullet("Hypothyroidism — myxedema", true),
      bullet("Hyperthyroidism — Graves' disease, thyroid storm", true),
      bullet("Thyroidectomy — post-op care, hypocalcemia watch", true),
      bullet("Parathyroid disorders: hypo/hyperparathyroidism"),
      bullet("Adrenal disorders:"),
      bullet("Addison's disease (adrenal insufficiency)", true),
      bullet("Cushing's syndrome (excess cortisol)", true),
      bullet("Pheochromocytoma", true),
      bullet("Pituitary disorders: SIADH, Diabetes Insipidus"),
      spacer(100),

      // ── Unit 10 ──
      subSection("Unit 10: Renal & Urinary Disorders"),
      bullet("Renal anatomy aur physiology review"),
      bullet("Urinary tract infections (UTI) — cystitis, pyelonephritis"),
      bullet("Urolithiasis (kidney stones) — types, management, lithotripsy"),
      bullet("Acute Kidney Injury (AKI) — pre-renal, intra-renal, post-renal"),
      bullet("Chronic Kidney Disease (CKD) — stages, complications"),
      bullet("Dialysis:"),
      bullet("Hemodialysis — AV fistula care, session care", true),
      bullet("Peritoneal dialysis — procedure, complications", true),
      bullet("Glomerulonephritis — nephrotic vs nephritic syndrome"),
      bullet("Renal transplant — pre/post-op care, rejection signs"),
      bullet("Bladder disorders: cystitis, bladder cancer"),
      bullet("Prostate disorders: BPH, prostate cancer"),
      bullet("Catheterization — indwelling catheter care"),
      spacer(100),

      // ── Unit 11 ──
      subSection("Unit 11: Neurological Disorders"),
      bullet("Neurological assessment — Glasgow Coma Scale (GCS), pupil check, reflexes"),
      bullet("Increased Intracranial Pressure (IICP) — signs, management, positioning"),
      bullet("Stroke (CVA) — ischemic vs hemorrhagic"),
      bullet("  FAST recognition, tPA thrombolysis, nursing care", true),
      bullet("Head injury — concussion, contusion, epidural/subdural hematoma"),
      bullet("Meningitis — bacterial vs viral, LP, nursing isolation"),
      bullet("Encephalitis"),
      bullet("Epilepsy aur Seizure Management — status epilepticus"),
      bullet("Parkinson's Disease — TRAP symptoms, dopaminergic drugs, safety"),
      bullet("Alzheimer's Disease — stages, nursing care"),
      bullet("Multiple Sclerosis — relapsing-remitting, nursing management"),
      bullet("Guillain-Barre Syndrome — ascending paralysis, respiratory watch"),
      bullet("Myasthenia Gravis — cholinergic vs myasthenic crisis"),
      bullet("Spinal cord injury — levels, ASIA classification, complications"),
      spacer(100),

      // ── Unit 12 ──
      subSection("Unit 12: Connective Tissue & Collagen Disorders"),
      bullet("Rheumatoid Arthritis — morning stiffness, drug therapy (DMARDs)"),
      bullet("Systemic Lupus Erythematosus (SLE) — butterfly rash, multisystem"),
      bullet("Osteoarthritis — weight-bearing joints, conservative management"),
      bullet("Gout — hyperuricemia, allopurinol, dietary advice"),
      bullet("Scleroderma, Polymyositis"),
      spacer(100),

      // ── Unit 13 ──
      subSection("Unit 13: Nursing Management of the Elderly"),
      bullet("Physiological changes of aging — all body systems"),
      bullet("Polypharmacy — risks, nursing responsibility"),
      bullet("Falls prevention — risk assessment, environment modification"),
      bullet("Dementia aur depression in elderly"),
      bullet("Elder abuse — types, assessment, reporting"),
      bullet("Palliative care principles"),

      spacer(300),

      // ══════════════════════════════════════════════════════════════════════
      //  PAPER II — 3rd YEAR
      // ══════════════════════════════════════════════════════════════════════
      new Paragraph({ children: [new PageBreak()] }),
      ...sectionHeader("MED-SURG NURSING II  —  3rd Year Syllabus", "📗"),

      // ── Unit 1 ──
      subSection("Unit 1: Oncology Nursing"),
      infoBox("Cancer nursing — pathophysiology se palliative care tak — ek complete unit hai."),
      bullet("Cancer ka pathophysiology — cell cycle, carcinogens, tumor markers"),
      bullet("Cancer staging — TNM classification"),
      bullet("Cancer treatment modalities:"),
      bullet("Surgery — curative, palliative, prophylactic", true),
      bullet("Chemotherapy — cell cycle specific/non-specific drugs, side effects", true),
      bullet("Radiation therapy — external beam, brachytherapy, safety precautions", true),
      bullet("Immunotherapy, targeted therapy, hormone therapy", true),
      bullet("Bone marrow / stem cell transplant", true),
      bullet("Oncological emergencies: tumor lysis syndrome, SVC syndrome, spinal cord compression"),
      bullet("Cancer pain management — WHO analgesic ladder"),
      bullet("Palliative care aur end-of-life nursing"),
      bullet("Psychosocial support — patient aur family"),
      spacer(100),

      // ── Unit 2 ──
      subSection("Unit 2: Breast Disorders"),
      bullet("Breast anatomy aur self-breast examination (SBE) teaching"),
      bullet("Fibroadenoma, fibrocystic disease"),
      bullet("Breast cancer — risk factors, types, staging"),
      bullet("Mastectomy types: lumpectomy, simple, modified radical mastectomy"),
      bullet("Post-mastectomy nursing care — lymphedema prevention, arm exercises"),
      bullet("Breast reconstruction — patient education"),
      spacer(100),

      // ── Unit 3 ──
      subSection("Unit 3: Integumentary System Disorders"),
      bullet("Skin assessment — lesions identification: macule, papule, vesicle, pustule"),
      bullet("Common skin infections: impetigo, cellulitis, tinea, herpes"),
      bullet("Dermatitis — contact, atopic, seborrheic"),
      bullet("Psoriasis — plaques, management, nursing care"),
      bullet("Burns:"),
      bullet("Classification: superficial, partial thickness, full thickness", true),
      bullet("Rule of Nines — TBSA calculation", true),
      bullet("Parkland formula — fluid resuscitation", true),
      bullet("Burn wound care, infection prevention, grafting", true),
      bullet("Rehabilitation of burn patients", true),
      bullet("Pressure ulcers (Bedsores) — staging, prevention, wound care"),
      bullet("Skin cancer — BCC, SCC, Melanoma"),
      spacer(100),

      // ── Unit 4 ──
      subSection("Unit 4: Ophthalmology & Ophthalmic Nursing"),
      bullet("Eye assessment — visual acuity, visual fields, fundoscopy"),
      bullet("Refractive errors: myopia, hyperopia, astigmatism"),
      bullet("Cataract — signs, surgical care, IOL, post-op nursing"),
      bullet("Glaucoma — open-angle vs closed-angle, IOP, medications"),
      bullet("Retinal detachment — 'curtain falling' symptom, surgical management"),
      bullet("Diabetic retinopathy, age-related macular degeneration"),
      bullet("Eye infections: conjunctivitis, corneal ulcer"),
      bullet("Eye drops instillation technique"),
      spacer(100),

      // ── Unit 5 ──
      subSection("Unit 5: Ear, Nose & Throat (ENT) Nursing"),
      bullet("Ear assessment — hearing tests (Weber, Rinne)"),
      bullet("Otitis media — acute vs chronic, myringotomy"),
      bullet("Hearing loss — conductive vs sensorineural"),
      bullet("Meniere's disease — vertigo, tinnitus, nursing care"),
      bullet("Nose disorders: epistaxis management (nasal packing), sinusitis, nasal polyp"),
      bullet("Throat disorders: tonsillitis, peritonsillar abscess, laryngeal cancer"),
      bullet("Tracheostomy — indications, care, suctioning technique"),
      spacer(100),

      // ── Unit 6 ──
      subSection("Unit 6: Cardiovascular, Circulatory & Hematological Disorders"),
      infoBox("Cardiovascular — exam ka sabse bada aur high-yield section!"),
      bullet("Cardiac assessment — history, ECG interpretation basics, cardiac enzymes"),
      bullet("Heart failure — left vs right sided, NYHA classification, management"),
      bullet("Coronary Artery Disease (CAD) — atherosclerosis, angina"),
      bullet("Myocardial Infarction (MI) — STEMI vs NSTEMI, thrombolytics, nursing care"),
      bullet("Cardiac arrhythmias — common ECG patterns, management"),
      bullet("Valvular heart disease — mitral/aortic stenosis & regurgitation"),
      bullet("Infective endocarditis — Duke's criteria, antibiotics"),
      bullet("Pericarditis, myocarditis"),
      bullet("Hypertension — JNC classification, anti-hypertensives, nursing care"),
      bullet("Vascular disorders:"),
      bullet("DVT — Homan's sign, anticoagulation", true),
      bullet("Varicose veins, Buerger's disease, Raynaud's phenomenon", true),
      bullet("Aneurysm — aortic, cerebral", true),
      bullet("Hematological disorders:"),
      bullet("Anemia types — iron deficiency, pernicious, aplastic, hemolytic", true),
      bullet("Leukemia — ALL, AML, CLL, CML — nursing care", true),
      bullet("Lymphoma — Hodgkin's vs Non-Hodgkin's", true),
      bullet("Multiple myeloma", true),
      bullet("Bleeding disorders: hemophilia, ITP, DIC", true),
      bullet("Blood transfusion reactions — identification aur management", true),
      spacer(100),

      // ── Unit 7 ──
      subSection("Unit 7: Communicable Diseases"),
      bullet("Chain of infection — reservoir, portal of entry/exit, host"),
      bullet("Standard precautions — hand hygiene, PPE"),
      bullet("Transmission-based precautions: airborne, droplet, contact"),
      bullet("Notifiable diseases in India"),
      bullet("Cholera, typhoid, malaria, dengue — pathophysiology, nursing management"),
      bullet("Tuberculosis (TB) — DOTS strategy, MDR-TB"),
      bullet("Viral hepatitis — A, B, C, D, E — prevention, vaccination"),
      bullet("Rabies — post-exposure prophylaxis"),
      bullet("Leptospirosis, brucellosis"),
      spacer(100),

      // ── Unit 8 ──
      subSection("Unit 8: Sexually Transmitted Diseases (STDs/STIs)"),
      bullet("Types: gonorrhea, syphilis, chlamydia, herpes, HPV, HIV"),
      bullet("Syphilis — primary, secondary, tertiary stages, VDRL test"),
      bullet("Gonorrhea — symptoms, complications (PID), treatment"),
      bullet("HIV/AIDS — transmission, window period, ART therapy, nursing care"),
      bullet("Stigma reduction aur patient counseling"),
      bullet("Prevention education — safe sex, condom use"),
      spacer(100),

      // ── Unit 9 ──
      subSection("Unit 9: Musculoskeletal Disorders"),
      bullet("Musculoskeletal assessment — ROM, muscle strength grading"),
      bullet("Fractures — types, healing stages, complications"),
      bullet("Immobilization — cast care, traction (skin vs skeletal)"),
      bullet("Fracture complications: fat embolism, compartment syndrome"),
      bullet("Osteoporosis — risk factors, prevention, bisphosphonates"),
      bullet("Osteomalacia vs Rickets"),
      bullet("Amputation — pre/post-op care, stump care, prosthesis, phantom limb pain"),
      bullet("Joint replacement (arthroplasty) — hip, knee — post-op nursing"),
      bullet("Osteomyelitis — acute vs chronic, antibiotic therapy"),
      bullet("Spinal disorders — herniated disc, scoliosis, spinal stenosis"),
      bullet("Orthopedic surgical procedures — ORIF, intramedullary nailing"),
      spacer(100),

      // ── Unit 10 ──
      subSection("Unit 10: Emergency & Disaster Nursing"),
      infoBox("Emergency nursing — practical knowledge aur fast decision-making dono zaruri hain!"),
      bullet("Emergency nursing — triage principles (START triage)"),
      bullet("Mass casualty incident (MCI) — disaster preparedness"),
      bullet("Basic Life Support (BLS) — CPR technique, AED use"),
      bullet("Advanced Cardiac Life Support (ACLS) overview"),
      bullet("Poisoning management — activated charcoal, antidotes"),
      bullet("Common poisonings:"),
      bullet("Organophosphate poisoning — atropine antidote", true),
      bullet("Paracetamol overdose — N-acetylcysteine", true),
      bullet("Snake bite — antivenom, nursing care", true),
      bullet("Drowning — near drowning management"),
      bullet("Heat stroke vs heat exhaustion"),
      bullet("Electric shock — safety, CPR"),
      bullet("Anaphylaxis — epinephrine 0.3 mg IM, protocol"),
      bullet("Trauma nursing — primary survey (ABCDE)"),
      bullet("Disaster nursing — roles, triage tags, field hospital"),

      spacer(400),

      // ══════════════════════════════════════════════════════════════════════
      //  IMPORTANT TABLES
      // ══════════════════════════════════════════════════════════════════════
      new Paragraph({ children: [new PageBreak()] }),
      ...sectionHeader("HIGH-YIELD QUICK REFERENCE TABLES", "⚡"),

      subSection("Key Antidotes — Emergency"),
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          twoColRow("Opioids (morphine)", "Naloxone (Narcan)", false),
          twoColRow("Benzodiazepines", "Flumazenil", true),
          twoColRow("Paracetamol", "N-Acetylcysteine", false),
          twoColRow("Heparin overdose", "Protamine Sulfate", true),
          twoColRow("Warfarin overdose", "Vitamin K / FFP", false),
          twoColRow("Digoxin toxicity", "Digoxin Immune Fab (Digibind)", true),
          twoColRow("Iron overdose", "Deferoxamine", false),
          twoColRow("Cyanide poisoning", "Hydroxocobalamin", true),
          twoColRow("CO poisoning", "100% Oxygen", false)
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      spacer(300),
      subSection("Electrolyte Imbalances — Quick Reference"),
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            new TableCell({ children: [new Paragraph({ children: [new TextRun({ text: "Thirst, dry mucous membrane, agitation", size: 19, font: "Calibri" })] })] }),
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      // ══════════════════════════════════════════════════════════════════════
      //  EXAM TIPS
      // ══════════════════════════════════════════════════════════════════════
      new Paragraph({ children: [new PageBreak()] }),
      ...sectionHeader("EXAM PREPARATION TIPS", "🎯"),

      subSection("High-Yield Topics — Har Exam Mein Aate Hain"),
      bullet("Fluid & Electrolytes — numbers yaad karo (Na: 135-145, K: 3.5-5.0, Ca: 8.5-10.5)"),
      bullet("Shock management — types aur nursing interventions"),
      bullet("Burns — Rule of Nines aur Parkland formula"),
      bullet("Diabetes — insulin types aur action time"),
      bullet("Post-operative complications — prevention aur early detection"),
      bullet("Antidotes — organophosphate, opioids, warfarin"),
      bullet("Glasgow Coma Scale — scoring (E4 V5 M6 = normal = 15)"),
      bullet("Triage — START method (RPM: Respiration, Pulse, Mental status)"),
      spacer(100),

      subSection("Study Strategy"),
      bullet("Pehle pathophysiology samjho — ratta lagane se better hai"),
      bullet("Har disease ke liye: Definition → Causes → Signs/Symptoms → Diagnosis → Treatment → Nursing Care"),
      bullet("Previous year papers zaroor solve karo"),
      bullet("Mnemonics banao — e.g., ARDS: 'A Respiratory Distress Syndrome' — Berlin criteria"),
      bullet("Clinical posting ke notes review karo — practical examples yaad rehte hain"),
      bullet("Group study mein case scenarios discuss karo"),
      spacer(100),

      infoBox("Best of luck for your Medical Surgical Nursing exam! Mehnat karo, concepts clear karo — success zaroor milegi. 🌟"),

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