NEET PG surgery high yield topics past 10 years previous year questions pattern 2014-2024

https://image.prepladder.com/content/High-Yield%20Topics%20f…

mkdir -p /home/daytona/workspace/neet-pg-surgery && ls /home/daytona/workspace/n…

~/neet-pg-surgery/create_pptx.js

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pres.title = 'NEET PG Surgery - High Yield Notes (Past 10 Years)';
pres.author = 'Orris AI';

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// =============================================
// SLIDE CREATION BEGINS
// =============================================

// ── SLIDE 1: Title ─────────────────────────────────
titleSlide(
  "NEET PG Surgery\nHigh-Yield Notes",
  "Past 10 Years Pattern  •  Roadmaps Included  •  2015–2024 PYQ Analysis"
);

// ── SLIDE 2: About this deck ────────────────────────
{
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  const topics = [
    "★ 14 Major Surgery Modules with roadmaps based on PYQ pattern",
    "★ Each module = High-yield facts → Roadmap slide → Key recall bullets",
    "★ Color coding: GOLD = must-know, ORANGE = frequently asked, GREEN = scoring, RED = danger/warning",
    "★ Topics: General Surgery | GI | Trauma | Breast | Thyroid | Hernia | Hepatobiliary | Ano-rectal | Neurosurgery | Vascular | Plastic | Urology | Oncology | Pediatric Surgery",
    "★ Avg NEET PG: Surgery = 20–30 questions/paper → each correct answer = ~4 marks",
  ];
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}

// ── SLIDE 3: Weightage ──────────────────────────────
weightageSlide();

// ── SLIDE 4: Top Topics Frequency ───────────────────
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    { name: "GI Surgery (Appendix, PUD, Obstruction, Hernia)", pct: 28, color: C.accent },
    { name: "Trauma & Emergency Surgery (ATLS, Burns, Blunt Trauma)", pct: 18, color: C.accentRed },
    { name: "Breast Surgery (Cancer, Lump Evaluation)", pct: 14, color: C.orange },
    { name: "Thyroid & Parathyroid Surgery", pct: 10, color: C.teal },
    { name: "Hepatobiliary (Gallstones, Jaundice, Pancreatitis)", pct: 10, color: C.accentGreen },
    { name: "Anorectal & Colon (Hemorrhoids, Fissure, Carcinoma)", pct: 8, color: C.purple },
    { name: "Neurosurgery (EDH/SDH, Brain Tumors)", pct: 7, color: C.lightGray },
    { name: "Vascular, Urology, Oncology, Pediatric", pct: 5, color: C.subtleTxt },
  ];

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}

// ==============================================
//  MODULE 1 — GENERAL SURGERY PRINCIPLES
// ==============================================
sectionSlide("01", "General Surgery Principles", "🏥");

contentSlide("Wound Healing & Surgical Wounds", [
  { type: "header", text: "Phases of Wound Healing (NEET Favourite)" },
  "Inflammatory → Proliferative → Remodeling (Maturation)",
  { type: "sub", text: "Inflammation: Days 1–4 | Proliferation: Days 4–21 | Remodeling: Week 3 → 2 years" },
  { type: "key", text: "Tensile strength returns fastest in Proliferative phase; NEVER reaches 100% (max ~80%)" },
  { type: "header", text: "Wound Classification" },
  "Clean (Class I) → Clean-Contaminated (II) → Contaminated (III) → Dirty (IV)",
  { type: "sub", text: "Clean: SSI rate 1–2% | Dirty: SSI rate >27%" },
  { type: "header", text: "Keloid vs Hypertrophic Scar" },
  "Hypertrophic: stays within wound margins | Keloid: extends beyond margins",
  { type: "key", text: "MC site for keloid: Ear lobe, sternum, deltoid" },
  { type: "warn", text: "Keloid most common in darkly pigmented individuals (African, South Asian)" },
], { accentColor: C.teal });

roadmapSlide("Wound Healing Phases", [
  { title: "Hemostasis", body: ["0–few hours", "Platelet plug", "Fibrin clot", "Vasoconstriction"], color: C.accentRed },
  { title: "Inflammation", body: ["Day 1–4", "Neutrophils (first)", "Macrophages (predominant Day 3+)", "Growth factors release"], color: C.orange },
  { title: "Proliferation", body: ["Day 4–21", "Fibroblasts migrate", "Collagen III → I", "Angiogenesis, Re-epithelisation"], color: C.accent },
  { title: "Remodeling", body: ["Week 3 → 2 yrs", "Collagen I replaces III", "Max tensile strength ~80%", "Wound contraction"], color: C.teal },
], C.teal);

contentSlide("Sutures & Anastomoses (High Yield)", [
  { type: "header", text: "Absorbable Sutures" },
  "Catgut (plain) — absorbed in 10 days | Chromic catgut — 21 days",
  { type: "key", text: "Vicryl (polyglactin) — absorbed in 60–90 days — MOST used absorbable" },
  "PDS (polydioxanone) — absorbed in 180 days",
  { type: "header", text: "Non-Absorbable Sutures" },
  "Prolene (polypropylene) — vascular surgery, hernia mesh | Nylon — monofilament",
  { type: "key", text: "Strongest suture: Stainless steel wire" },
  { type: "header", text: "Anastomosis Types" },
  "End-to-end | End-to-side | Side-to-side",
  { type: "warn", text: "Mattress suture = everting (horizontal) or inverting (vertical) — NEET loves to ask which everts" },
], { accentColor: C.accent });

// ==============================================
//  MODULE 2 — SHOCK & FLUID MANAGEMENT
// ==============================================
sectionSlide("02", "Shock, Burns & Fluid Management", "💉");

contentSlide("Shock Classification (ATLS)", [
  { type: "header", text: "Hemorrhagic Shock — 4 Classes (ATLS)" },
  "Class I: <750 ml (<15%) | Class II: 750–1500 ml (15–30%)",
  "Class III: 1500–2000 ml (30–40%) | Class IV: >2000 ml (>40%)",
  { type: "key", text: "Class II: First class to show tachycardia | Class III: First class to show altered mental status" },
  { type: "key", text: "Class I & II: Crystalloid only | Class III: Crystalloid + blood | Class IV: Blood + surgery" },
  { type: "header", text: "Fluid Resuscitation" },
  "Hartmann's (Ringer's Lactate) = fluid of choice in acute haemorrhage",
  { type: "sub", text: "Normal saline in head injury (avoid hypotonic fluids)" },
  { type: "warn", text: "Crystalloid rule: Give 3 ml crystalloid per 1 ml blood lost (3:1 rule)" },
  { type: "header", text: "Other Shock Types" },
  "Septic: distributive — warm, vasodilated | Neurogenic: loss of sympathetic tone",
  "Cardiogenic: low CO, high PCWP | Obstructive: tension pneumothorax, cardiac tamponade",
], { accentColor: C.accentRed });

roadmapSlide("Burns Management (Rule of Nines + Resuscitation)", [
  { title: "Assess BSA", body: ["Rule of Nines (adults)", "Head 9%, Each arm 9%", "Each leg 18%", "Trunk ant 18%, post 18%", "Perineum 1%"], color: C.orange },
  { title: "Calculate Fluid", body: ["Parkland Formula:", "4 ml × wt(kg) × %BSA", "First 8 hrs: half total", "Next 16 hrs: other half", "Start from time of burn"], color: C.accentRed },
  { title: "Monitoring", body: ["Urine output goal:", "Adults: 0.5 ml/kg/hr", "Children: 1 ml/kg/hr", "Insert Foley catheter", "Monitor electrolytes"], color: C.teal },
  { title: "Wound Care", body: ["Superficial: Silver sulfadiazine", "Deep/Full: Escharotomy if circumferential", "Tangential excision + grafting", "Silver-containing dressings"], color: C.accent },
], C.orange);

contentSlide("Burns — Key Facts (PYQ Favourites)", [
  { type: "key", text: "Criteria for ICU/Burn Unit admission: >20% BSA burns, facial burns, inhalation injury, circumferential burns" },
  "First aid: Run cool water 20 min | Do NOT use ice (causes vasoconstriction → deeper burn)",
  { type: "header", text: "Burn Depth" },
  "Superficial (1°): Erythema only, no blisters | Partial (2°): Blisters present, painful",
  { type: "key", text: "Deep partial thickness: Pale/mottled, insensate — needs grafting" },
  "Full thickness (3°): Leathery, insensate, no bleeding — ALWAYS needs grafting",
  { type: "warn", text: "Most common cause of death in burns: Sepsis (not hypovolemia after resuscitation)" },
  { type: "header", text: "Inhalation Injury" },
  "Suspect if: facial burns, singed eyebrows, carbonaceous sputum, hoarseness",
  { type: "key", text: "Immediate management: 100% O2 via non-rebreather → early intubation if airway edema" },
], { accentColor: C.orange });

// ==============================================
//  MODULE 3 — GI SURGERY
// ==============================================
sectionSlide("03", "Gastrointestinal Surgery", "🫀");

contentSlide("Peptic Ulcer Disease & Perforation", [
  { type: "header", text: "Surgery Indications for PUD" },
  "Perforation | Hemorrhage unresponsive to endoscopy | Obstruction | Malignancy",
  { type: "key", text: "MC complication of PUD: Haemorrhage | MC cause of perforation: DU (anterior wall)" },
  { type: "header", text: "Perforated DU — Management Roadmap" },
  "Graham's patch (omental patch repair) = standard surgery for perforated DU",
  { type: "sub", text: "+ Helicobacter pylori eradication post-operatively" },
  { type: "header", text: "Acid Reduction Procedures (Historical but asked)" },
  "Truncal vagotomy + drainage | Highly selective vagotomy (no drainage needed)",
  { type: "key", text: "Dumping syndrome: Early = osmotic; Late = reactive hypoglycemia" },
  { type: "warn", text: "Dieulafoy lesion: Large submucosal artery, MC in gastric fundus — massive GI bleed" },
], { accentColor: C.teal });

contentSlide("Intestinal Obstruction", [
  { type: "header", text: "Small Bowel Obstruction (SBO)" },
  "MC cause adults: Adhesions (60%) | MC cause children: Intussusception",
  "X-ray: Central, ladder-pattern air-fluid levels | No gas in colon",
  { type: "key", text: "Stepladder pattern = SBO | Inverted-U/coffee bean = sigmoid volvulus" },
  { type: "header", text: "Large Bowel Obstruction (LBO)" },
  "MC cause: Carcinoma colon | X-ray: Peripheral, haustrated distension",
  { type: "warn", text: "Closed loop obstruction (sigmoid volvulus): Emergency — risk of strangulation/gangrene" },
  { type: "header", text: "Volvulus" },
  "Sigmoid volvulus: Coffee bean sign, omega sign | Caecal volvulus: Right-sided distension",
  { type: "key", text: "Sigmoid volvulus Rx: Rigid sigmoidoscopy + rectal flatus tube (decompression) first" },
  "Definitive: Hartmann's procedure or primary resection + anastomosis",
], { accentColor: C.accent });

roadmapSlide("Acute Appendicitis Management", [
  { title: "Clinical Dx", body: ["Periumbilical pain → RIF", "McBurney's point tenderness", "Rovsing's sign, Psoas sign", "MANTRELS score", "Temp >37.3°C"], color: C.accentRed },
  { title: "Investigations", body: ["WBC raised (neutrophilia)", "USS abdomen (first line)", "CT abdomen (gold standard)", "CRP elevated", "Exclude ectopic pregnancy (females)"], color: C.orange },
  { title: "Scoring", body: ["MANTRELS/Alvarado score", "1–4: Low risk (discharge)", "5–6: Equivocal (observe)", "7–10: High risk → OR", "Pediatric: PAS score"], color: C.accent },
  { title: "Surgery", body: ["Laparoscopic appendicectomy (gold std)", "Open: Lanz/Gridiron incision", "Perforated: IV antibiotics first", "Ochsner-Sherren for mass", "Interval appendicectomy at 6 wks"], color: C.teal },
], C.accentRed);

contentSlide("Hernia (Most Repeated Surgery Topic)", [
  { type: "header", text: "Inguinal Hernia" },
  "Indirect: Through deep ring, lateral to inferior epigastric vessels — MC in males",
  "Direct: Through Hesselbach's triangle, medial to inferior epigastric vessels",
  { type: "key", text: "Hasselbach's triangle: Inguinal ligament (inf) | Rectus abdominis (medial) | Inferior epigastric artery (lateral)" },
  { type: "header", text: "Femoral Hernia" },
  "MC in women | Passes through femoral canal | High risk of strangulation",
  { type: "key", text: "MC complication of femoral hernia: Strangulation (not obstruction)" },
  { type: "header", text: "Hernia Repair Procedures (PYQ)" },
  "Lichtenstein tension-free repair = gold standard (mesh repair)",
  "Bassini's repair (no mesh) | McVay's (Cooper's ligament) for femoral hernia",
  { type: "key", text: "TAPP (Trans-Abdominal Pre-Peritoneal) vs TEP (Totally Extra-Peritoneal) = laparoscopic repairs" },
  { type: "warn", text: "Richter's hernia: Only part of bowel wall herniated — can strangulate without obstruction" },
], { accentColor: C.accent });

// ==============================================
//  MODULE 4 — HEPATOBILIARY & PANCREAS
// ==============================================
sectionSlide("04", "Hepatobiliary & Pancreatitis", "🫁");

contentSlide("Gallstones & Jaundice", [
  { type: "header", text: "Gallstone Disease — Key Facts" },
  "MC type: Cholesterol stones (80%) | Pure pigment = haemolytic disease",
  { type: "key", text: "Charcot's triad = RUQ pain + fever + jaundice → Cholangitis" },
  "Reynold's pentad = Charcot's triad + shock + mental confusion → Suppurative cholangitis",
  { type: "header", text: "Acute Cholecystitis" },
  "Murphy's sign = inspiratory arrest on deep palpation RUQ",
  "USS = best initial investigation | HIDA scan = gold standard for acalculous",
  { type: "key", text: "Treatment: Laparoscopic cholecystectomy within 72 hrs of symptom onset (early lap cholecystectomy preferred)" },
  { type: "header", text: "Obstructive Jaundice Workup" },
  "Dark urine + pale stools + pruritus = obstructive pattern",
  "MRCP = non-invasive gold std | ERCP = therapeutic (stenting, stone removal)",
  { type: "warn", text: "Courvoisier's law: Palpable gallbladder + painless jaundice = malignancy (NOT gallstones)" },
], { accentColor: C.accentGreen });

contentSlide("Acute Pancreatitis", [
  { type: "header", text: "Causes — GET SMASHED" },
  "Gallstones | EtOH | Trauma | Steroids | Mumps | Autoimmune | Scorpion | Hypercalcaemia/lipidaemia | ERCP | Drugs",
  { type: "key", text: "MC cause of acute pancreatitis: Gallstones (40–50%) | 2nd: Alcohol" },
  { type: "header", text: "Severity Scoring — Ranson's Criteria (PYQ)" },
  "On admission: Age >55, WBC >16k, Glucose >11, LDH >350, AST >250",
  "At 48hrs: Hct fall >10%, BUN rise >5, Ca <2, PO2 <60, Base deficit >4, Fluid sequestration >6L",
  { type: "key", text: "Score ≥3 = Severe pancreatitis | Mortality rises sharply" },
  { type: "header", text: "CECT Abdomen (Balthazar Score)" },
  "Grade A-E with necrosis % → CTSI score: >6 = severe, high morbidity",
  { type: "warn", text: "Indications for surgery: Infected necrosis, abdominal compartment syndrome, failure to improve" },
], { accentColor: C.teal });

roadmapSlide("Obstructive Jaundice — Diagnostic Roadmap", [
  { title: "History & Exam", body: ["Age, risk factors", "Pain character", "Fever (Charcot's triad?)", "Weight loss (malignancy?)", "Courvoisier's law"], color: C.accent },
  { title: "LFTs + USS", body: ["Bilirubin: conjugated ↑", "ALP, GGT markedly ↑", "USS: Dilated ducts", "USS: GB stones vs GB distension", "Simple & non-invasive first"], color: C.teal },
  { title: "CT/MRCP", body: ["CT: Mass, lymph nodes", "MRCP: Bile duct anatomy", "Level of obstruction", "Pancreatic head mass?", "Hilar stricture (Klatskin)?"], color: C.orange },
  { title: "ERCP/PTC", body: ["ERCP: CBD stone → removal", "Stent for malignancy", "PTC if ERCP fails", "Biopsy if mass", "Decompression pre-op"], color: C.accentGreen },
], C.accentGreen);

// ==============================================
//  MODULE 5 — ANORECTAL SURGERY
// ==============================================
sectionSlide("05", "Anorectal Conditions", "🔴");

contentSlide("Haemorrhoids, Fissure & Fistula", [
  { type: "header", text: "Haemorrhoids (Piles)" },
  "Internal (above dentate line, visceral, painless) | External (below dentate, somatic, painful)",
  "Grading: I (bleed) | II (prolapse, reduce spontaneously) | III (manual reduction) | IV (irreducible)",
  { type: "key", text: "Grade I–II: Conservative + rubber band ligation | Grade III–IV: Haemorrhoidectomy (Milligan-Morgan)" },
  { type: "header", text: "Fissure-in-ano" },
  "MC site: Posterior midline (6 o'clock) | Anterior = rare, associated with Crohn's/pregnancy",
  { type: "key", text: "Sentinel pile (skin tag) at lower end = chronic fissure | Treatment: GTN cream, botox, or lateral sphincterotomy" },
  { type: "header", text: "Fistula-in-ano — Parks Classification" },
  "Intersphincteric (MC) | Trans-sphincteric | Suprasphincteric | Extrasphincteric",
  "Goodsall's Rule: Posterior fistula → curved track to posterior midline | Anterior → straight track",
  { type: "warn", text: "Horseshoe fistula: Circumferential with posterior midline opening — complex management" },
], { accentColor: C.accentRed });

contentSlide("Carcinoma Rectum & Colorectal Cancer", [
  { type: "header", text: "Colorectal Cancer Risk Factors" },
  "FAP (APC gene mutation) — 100% malignant risk by 40 yrs | HNPCC (Lynch syndrome) — MMR gene",
  { type: "key", text: "MC site for CRC: Rectosigmoid (50%) | MC histology: Adenocarcinoma" },
  { type: "header", text: "Dukes Staging (classic NEET question)" },
  "A: Limited to bowel wall | B: Through bowel wall, no LN | C: LN involved | D: Distant mets",
  { type: "key", text: "TNM has replaced Dukes but Dukes still commonly tested in NEET PG" },
  { type: "header", text: "Surgery" },
  "Upper rectum: Anterior resection | Lower rectum: Abdominoperineal resection (APR)",
  { type: "key", text: "TME (Total Mesorectal Excision) = standard for rectal cancer — reduces local recurrence" },
  { type: "warn", text: "Hartmann's procedure: End colostomy + rectal stump — used in emergency obstruction/perforation" },
], { accentColor: C.purple });

// ==============================================
//  MODULE 6 — BREAST SURGERY
// ==============================================
sectionSlide("06", "Breast Surgery", "🎗️");

contentSlide("Breast Lump Evaluation — Triple Assessment", [
  { type: "header", text: "Triple Assessment = Clinical + Imaging + Cytology/Biopsy" },
  "Clinical examination | Mammography/USS | FNAC or core needle biopsy",
  { type: "key", text: "USS preferred <35 yrs | Mammography preferred ≥35 yrs | Gold std: Core biopsy (not FNAC)" },
  { type: "header", text: "Breast Cancer Staging" },
  "Stage I: ≤2cm, no LN | Stage II: 2–5cm or axillary LN | Stage III: Advanced local | Stage IV: Metastatic",
  { type: "header", text: "Receptor Status" },
  "ER+/PR+: Benefit from hormonal therapy (tamoxifen, aromatase inhibitors)",
  "HER2+: Trastuzumab (Herceptin) | Triple negative: Chemotherapy only",
  { type: "key", text: "BRCA1 mutation → MC breast + ovarian | BRCA2 → MC male breast cancer" },
  { type: "warn", text: "Inflammatory breast cancer: Peau d'orange, NO discrete lump — highest T stage (T4d)" },
], { accentColor: C.orange });

roadmapSlide("Breast Cancer Management Roadmap", [
  { title: "Triple Assessment", body: ["Clinical exam", "Mammogram ≥35yrs", "USS <35yrs", "Core biopsy", "MRI if lobular/BRCA"], color: C.orange },
  { title: "Staging", body: ["CT chest/abdomen", "Bone scan if symptomatic", "ER/PR/HER2 status", "BRCA testing if <40yrs", "Multidisciplinary team"], color: C.accent },
  { title: "Surgery", body: ["WLE (lumpectomy) + RT", "Mastectomy ± reconstruction", "Sentinel LN biopsy", "ALND if SLN positive", "Oncoplastic techniques"], color: C.teal },
  { title: "Adjuvant Therapy", body: ["Chemo: Anthracycline-based", "Radiotherapy post WLE", "Hormone: Tamoxifen/AI", "HER2+: Trastuzumab 1yr", "Survival follow-up"], color: C.accentGreen },
], C.orange);

contentSlide("Benign Breast Conditions (PYQ)", [
  { type: "header", text: "Fibroadenoma" },
  "MC breast lump in <30 yr females | Mobile, firm, non-tender ('breast mouse')",
  "USS: Oval, well-circumscribed, homogeneous | Pathology: Proliferating ducts + stroma",
  { type: "key", text: "Giant fibroadenoma: >5cm — requires excision | Phyllodes tumour: Leaf-like projections, can be malignant" },
  { type: "header", text: "Fibrocystic Disease (ANDI)" },
  "Aberrations of Normal Development and Involution | Most common breast disease overall",
  { type: "sub", text: "Cyclical mastalgia, nodularity, cysts — worse premenstrually" },
  { type: "header", text: "Duct Ectasia vs Intraductal Papilloma" },
  "Duct ectasia: Green/brown nipple discharge, periareolar mass, older women",
  "Intraductal papilloma: Serous/bloody discharge, MC cause of nipple discharge in 30–50yrs",
  { type: "warn", text: "Bloody nipple discharge → always investigate (ductogram/ductoscopy) → exclude malignancy" },
], { accentColor: C.orange });

// ==============================================
//  MODULE 7 — THYROID & PARATHYROID
// ==============================================
sectionSlide("07", "Thyroid & Parathyroid Surgery", "🦋");

contentSlide("Thyroid Nodule & Thyroid Cancer", [
  { type: "header", text: "Solitary Thyroid Nodule — Approach" },
  "TSH first → if low → radionuclide scan → hot/cold nodule classification",
  { type: "key", text: "Cold nodule = 15% malignant risk | Hot nodule = almost always benign" },
  "FNAC = investigation of choice for thyroid nodule | USS for guided FNAC if needed",
  { type: "header", text: "Bethesda Classification (FNAC)" },
  "I: Non-diagnostic | II: Benign | III: AUS/FLUS | IV: FN | V: Suspicious | VI: Malignant",
  { type: "header", text: "Thyroid Cancer Types" },
  "Papillary (80%, best prognosis, Psammoma bodies, Orphan Annie eyes, nuclear grooves)",
  { type: "key", text: "Follicular thyroid CA: Spreads haematogenously (bone, lung) — unlike papillary (lymphatics)" },
  "Medullary: Calcitonin-producing, C-cells, MEN2A/2B | Anaplastic: Worst prognosis",
  { type: "warn", text: "RET proto-oncogene mutation = Medullary thyroid carcinoma + MEN2" },
], { accentColor: C.teal });

roadmapSlide("Thyroid Surgery Complications", [
  { title: "Recurrent Laryngeal N", body: ["Bilateral injury: Stridor, respiratory distress", "Unilateral: Hoarseness", "Identify before ligation", "Nerve monitoring (NIM)", "MC nerve injured in thyroid sx"], color: C.accentRed },
  { title: "Hypocalcaemia", body: ["Parathyroid devascularisation", "Onset: 24–48 hrs post-op", "Chvostek's & Trousseau's", "Perioral tingling, tetany", "Calcium gluconate IV (emergency)"], color: C.orange },
  { title: "Thyroid Storm", body: ["Uncontrolled hyperthyroid post-op", "High fever, tachycardia", "Rx: Propylthiouracil, Iodine, beta-blocker, steroids, cooling", "Lugol's iodine: blocks release"], color: C.accentGreen },
  { title: "Haemorrhage", body: ["Early: Haematoma → airway compromise", "Open wound at bedside!", "Suction drain in situ", "Return to theatre", "Keep stitch cutter at bedside"], color: C.purple },
], C.teal);

// ==============================================
//  MODULE 8 — TRAUMA
// ==============================================
sectionSlide("08", "Trauma & Emergency Surgery", "🚨");

contentSlide("ATLS Protocol — Primary Survey", [
  { type: "header", text: "ABCDE — Primary Survey (ATLS)" },
  { type: "key", text: "A — Airway (+ C-spine): Jaw thrust (not chin lift if C-spine injury), suction, OPA, NPA, intubation" },
  "B — Breathing: Look/Listen/Feel | Tension pneumothorax → immediate needle decompression (2nd ICS MCL)",
  "C — Circulation: 2 large bore IVs, crystalloid bolus 1L, blood if needed | FAST exam | Control haemorrhage",
  "D — Disability: GCS, pupils, AVPU | E — Exposure: Fully expose, prevent hypothermia",
  { type: "header", text: "Life-Threatening Thoracic Injuries (Treat in Primary Survey)" },
  "Tension pneumothorax | Open pneumothorax | Massive haemothorax | Flail chest | Cardiac tamponade | Aortic disruption",
  { type: "warn", text: "Cardiac tamponade: Beck's triad = hypotension + raised JVP + muffled heart sounds → Pericardiocentesis" },
  { type: "key", text: "GCS: Eyes (4) + Verbal (5) + Motor (6) = 15 max | <8 = Intubate" },
], { accentColor: C.accentRed });

contentSlide("Head Injury — EDH, SDH, SAH", [
  { type: "header", text: "Extradural Haematoma (EDH)" },
  "Arterial bleed (middle meningeal artery) | Lucid interval (classic) | Biconvex/lenticular on CT",
  { type: "key", text: "EDH: Burr hole / Craniotomy within 1–2 hrs of deterioration (life-saving)" },
  { type: "header", text: "Subdural Haematoma (SDH)" },
  "Venous bleed (bridging veins) | No lucid interval | Crescent-shaped on CT",
  "Acute SDH: High-density crescent | Chronic SDH: Low-density (isodense if subacute)",
  { type: "key", text: "Chronic SDH: Burr hole + irrigation | Acute SDH: Craniotomy" },
  { type: "header", text: "Diffuse Axonal Injury (DAI)" },
  "Rotational acceleration-deceleration | CT may be normal early | MRI better",
  { type: "warn", text: "Kernohan's notch: Contralateral hemiplegia due to tentorial notch compression of contralateral peduncle — FALSE localising sign" },
  { type: "warn", text: "Cushing's reflex = hypertension + bradycardia + irregular respiration = raised ICP (late sign)" },
], { accentColor: C.accentRed });

roadmapSlide("Blunt Abdominal Trauma", [
  { title: "Mechanism & History", body: ["RTA, fall, assault", "Seatbelt injury (Chance fracture)", "MC organ injured: Spleen", "2nd MC: Liver", "Hollow viscus: Duodenum"], color: C.accentRed },
  { title: "Primary Survey", body: ["ATLS ABCDE", "FAST ultrasound (focused)", "Free fluid in abdomen?", "Haemodynamically stable?", "Pelvis X-ray"], color: C.orange },
  { title: "Stable → CT", body: ["CT abdomen with contrast = gold std", "Organ injury grading", "Active extravasation?", "AAST grading system", "Hollow viscus injury?"], color: C.accent },
  { title: "Unstable → OR", body: ["Damage Control Surgery", "Control haemorrhage (pack)", "Temp closure (laparostomy)", "Resuscitate in ICU", "Relook at 24–48 hrs"], color: C.teal },
], C.accentRed);

// ==============================================
//  MODULE 9 — VASCULAR SURGERY
// ==============================================
sectionSlide("09", "Vascular Surgery", "🩸");

contentSlide("Arterial Disease & AAA", [
  { type: "header", text: "Peripheral Arterial Disease (PAD)" },
  "Fontaine classification: I (asymptomatic) → II (claudication) → III (rest pain) → IV (gangrene)",
  { type: "key", text: "ABI (ABPI): Normal >0.9 | Claudication 0.4–0.9 | Rest pain <0.4 | Incompressible >1.3 (calcified)" },
  { type: "header", text: "Acute Limb Ischaemia — 6 Ps" },
  "Pain | Pallor | Pulselessness | Paraesthesia | Paralysis | Perishing cold",
  { type: "key", text: "Paralysis & paraesthesia = limb-threatening → Emergency embolectomy (Fogarty catheter)" },
  { type: "header", text: "Abdominal Aortic Aneurysm (AAA)" },
  "Normal aorta <2cm | Aneurysm ≥3cm | Intervention threshold: ≥5.5cm",
  { type: "key", text: "Ruptured AAA: Classic triad = hypotension + pulsatile mass + back/flank pain → Emergency EVAR or open repair" },
  { type: "warn", text: "Berry aneurysm (intracranial) = MCC of subarachnoid haemorrhage → worst headache of life" },
], { accentColor: C.accentRed });

contentSlide("Varicose Veins & DVT", [
  { type: "header", text: "Varicose Veins" },
  "Dilated, tortuous superficial veins | MC in long saphenous vein territory",
  "Trendelenburg test: identifies SFJ incompetence | Tourniquet test",
  { type: "key", text: "Duplex USS = gold standard preoperative mapping | CEAP classification" },
  "Treatment: EVLA (endovenous laser ablation) | Foam sclerotherapy | Surgery (high tie + stripping)",
  { type: "header", text: "DVT & Pulmonary Embolism" },
  "Virchow's triad: Stasis + Endothelial injury + Hypercoagulability",
  { type: "key", text: "Wells score for DVT | D-dimer (sensitive, not specific) | Gold std: Duplex USS" },
  "PE: Wells/Geneva score → CTPA (gold std) | V/Q scan if CXR normal, renal impairment",
  { type: "warn", text: "Massive PE = Haemodynamic compromise → IV Alteplase (thrombolysis)" },
  { type: "key", text: "Homan's sign = unreliable (calf tenderness on dorsiflexion) — no longer recommended in ATLS" },
], { accentColor: C.teal });

// ==============================================
//  MODULE 10 — NEUROSURGERY
// ==============================================
sectionSlide("10", "Neurosurgery High Yield", "🧠");

contentSlide("Brain Tumors (PYQ)", [
  { type: "header", text: "Primary Brain Tumors — Adults" },
  "MC primary brain tumour (adults): Glioblastoma Multiforme (GBM) — GradeIV, worst prognosis",
  { type: "key", text: "GBM: Butterfly glioma (crosses corpus callosum), pseudo-palisading necrosis, GFAP positive" },
  "Meningioma: MC benign, WHO Grade I, extra-axial, dural tail sign on MRI",
  { type: "header", text: "Pediatric Brain Tumors" },
  "MC pediatric brain tumour: Medulloblastoma (posterior fossa, cerebellum)",
  { type: "key", text: "Medulloblastoma: Homer-Wright rosettes, PNET, spreads via CSF ('drop metastases')" },
  "Ependymoma: 4th ventricle | Craniopharyngioma: Suprasellar, calcified, bitemporal hemianopia",
  { type: "header", text: "Acoustic Neuroma (Vestibular Schwannoma)" },
  "NF2 (bilateral) | Unilateral sensorineural hearing loss, tinnitus, facial numbness",
  { type: "key", text: "CPA angle mass on MRI | Treatment: Surgery (translabyrinthine), Stereotactic radiosurgery" },
], { accentColor: C.purple });

contentSlide("Spinal Cord & Meningocele", [
  { type: "header", text: "Neural Tube Defects (Spina Bifida)" },
  "Spina bifida occulta: No protrusion, hairy patch, dermal sinus | Most common",
  "Meningocele: CSF + meninges protrude | Meningomyelocele: CSF + meninges + cord elements",
  { type: "key", text: "Meningomyelocele = most common symptomatic form | Associated with Arnold-Chiari malformation + hydrocephalus" },
  { type: "key", text: "Prevention: Folic acid 400mcg preconception | Timing of repair: <24–48 hrs to prevent meningitis" },
  { type: "header", text: "Spinal Cord Syndromes (NEET PYQ)" },
  "Central cord: Upper limb weakness > lower | Anterior cord: Loss of motor + pain/temp (spinothalamic), spared proprioception",
  { type: "key", text: "Brown-Sequard: Ipsilateral motor + proprioception loss; Contralateral pain + temp loss" },
  { type: "warn", text: "Cauda equina syndrome: Urinary/fecal incontinence + saddle anaesthesia = surgical emergency" },
], { accentColor: C.purple });

// ==============================================
//  MODULE 11 — UROLOGY
// ==============================================
sectionSlide("11", "Urology", "🔵");

contentSlide("BPH, Testicular Torsion & Urinary Calculi", [
  { type: "header", text: "Benign Prostatic Hyperplasia (BPH)" },
  "Zone: Transition zone | Histology: Stromal + epithelial hyperplasia",
  "IPSS score for severity | PSA may be mildly elevated",
  { type: "key", text: "Medical Rx: Alpha-blockers (tamsulosin) for rapid relief | 5-alpha reductase inhibitors (finasteride) for large prostate" },
  "Surgery: TURP (gold standard) | Complications: Retrograde ejaculation (MC), TURP syndrome",
  { type: "header", text: "Testicular Torsion" },
  "Peak age: 12–18 yrs | Sudden severe pain + high-riding testis + absent cremasteric reflex",
  { type: "key", text: "Management: Clinical diagnosis → IMMEDIATE surgical exploration (do NOT wait for USS)" },
  { type: "warn", text: "Salvage rate: >90% if detorsion <6 hrs | <10% if >24 hrs" },
  { type: "header", text: "Urinary Calculi" },
  "MC calculi: Calcium oxalate (80%) | Staghorn: Struvite (Mg-NH4-PO4) = infection stones",
  "Uric acid stones: Radiolucent (not seen on plain X-ray) | Visible on CT",
], { accentColor: C.teal });

// ==============================================
//  MODULE 12 — ONCOLOGY & SALIVARY/ORAL
// ==============================================
sectionSlide("12", "Oncology, Salivary & Oral Surgery", "🎯");

contentSlide("Salivary Gland Tumors", [
  { type: "header", text: "Salivary Gland Tumors — Key Facts" },
  "MC salivary gland tumor: Pleomorphic adenoma (mixed tumor, 80%) — MC in parotid",
  { type: "key", text: "Pleomorphic adenoma: Slow growing, painless, RECURS if inadequately excised (pseudopod extensions)" },
  "Warthin's tumor (cystadenoma lymphomatosum): MC bilateral | MC bilateral salivary tumor | Smokers",
  "Adenoid cystic carcinoma: MC malignant salivary tumor | Perineural invasion (spreads along nerves)",
  { type: "header", text: "Parotidectomy" },
  "Superficial parotidectomy: Facial nerve preserved | Total: All lobes",
  { type: "key", text: "Facial nerve landmark: Tragal pointer, posterior belly of digastric, stylomastoid foramen" },
  "Frey's syndrome: Auriculotemporal nerve injury → gustatory sweating (sweating while eating)",
  { type: "warn", text: "Adenoid cystic carcinoma: Skip lesions, perineural spread, late distant mets (lung) — worst prognosis" },
], { accentColor: C.accent });

contentSlide("Carcinoma Oral Cavity", [
  { type: "header", text: "Risk Factors" },
  "Tobacco (smoking + smokeless) | Alcohol | HPV-16 (oropharynx) | Betel nut (India)",
  "Premalignant lesions: Leukoplakia | Erythroplakia (higher malignant potential) | Oral submucous fibrosis",
  { type: "key", text: "Erythroplakia has HIGHEST malignant transformation rate (17–50%) vs leukoplakia (1–17%)" },
  { type: "header", text: "MC Site & Type" },
  "MC site in oral cavity: Lateral border of tongue | MC type: Squamous cell carcinoma (95%)",
  { type: "header", text: "Cervical LN Levels" },
  "Level I: Submental/Submandibular | II: Upper jugular | III: Mid-jugular | IV: Lower jugular | V: Posterior triangle | VI: Central",
  { type: "key", text: "RND (Radical Neck Dissection): Removes all levels + SCM + IJV + CN XI" },
  "MRND (Modified): Preserves one or more of: SCM, IJV, CN XI | SOHND: Levels I–III",
  { type: "warn", text: "Sentinel LN biopsy now standard for oral cavity SCC with cN0 neck (clinically node-negative)" },
], { accentColor: C.orange });

// ==============================================
//  MODULE 13 — PLASTIC & TRANSPLANT
// ==============================================
sectionSlide("13", "Plastic Surgery & Transplantation", "🧩");

contentSlide("Skin Grafting & Flaps", [
  { type: "header", text: "Skin Grafts" },
  "Split thickness (SSG/STSG): Epidermis + part dermis — takes better, more donor sites, contracts more",
  "Full thickness (FTSG): Epidermis + full dermis — better cosmesis, less contraction, limited donor sites",
  { type: "key", text: "Graft survival: Plasmatic imbibition (0–48h) → Inosculation (48h–5d) → Neovascularisation (>5d)" },
  { type: "header", text: "Flaps" },
  "Random flap: No named vessel | Axial flap: Named vessel (e.g. TRAM flap for breast reconstruction)",
  { type: "key", text: "Free flap = microsurgical anastomosis — gold standard for complex reconstruction" },
  { type: "header", text: "Marjolin's Ulcer" },
  "Malignant transformation in chronic scar/wound | Slow growing SCC | No LN spread initially",
  { type: "header", text: "Skin Malignancies" },
  "BCC (rodent ulcer): MC skin cancer, pearly edge, telangiectasia, sun-exposed | Rarely metastasises",
  { type: "warn", text: "Malignant Melanoma: ABCDE (Asymmetry, Border, Colour, Diameter, Evolution) | Breslow thickness = prognosis" },
], { accentColor: C.accent });

contentSlide("Transplantation Surgery", [
  { type: "header", text: "Graft Types" },
  "Autograft (self) | Isograft (identical twin) | Allograft (same species) | Xenograft (different species)",
  { type: "header", text: "Graft Rejection" },
  "Hyperacute: Minutes–hours | Preformed antibodies | Irreversible",
  { type: "key", text: "Acute rejection: Days–weeks | T-cell mediated | Reversible with steroids/anti-rejection meds" },
  "Chronic: Months–years | Antibody + cell-mediated | Slowly progressive graft dysfunction",
  { type: "header", text: "Liver Transplant" },
  "Indications: Cirrhosis (MELD ≥15), acute liver failure, HCC within Milan criteria",
  { type: "key", text: "Piggyback technique (IVC preservation) vs classical (IVC excision) — NEET PYQ" },
  { type: "header", text: "Maastricht Classification (Donation after Cardiac Death)" },
  "Category I: Dead on arrival | II: Unsuccessful resuscitation | III: Awaiting cardiac arrest | IV: Cardiac arrest after brain death",
  { type: "warn", text: "Living donor liver transplant: Right lobe most commonly donated (segments V–VIII)" },
], { accentColor: C.teal });

// ==============================================
//  MODULE 14 — LAPAROSCOPY & QUICK RECAP
// ==============================================
sectionSlide("14", "Laparoscopy, Bariatric & Exam Recap", "📋");

contentSlide("Laparoscopy & POEM", [
  { type: "header", text: "Pneumoperitoneum (Laparoscopy)" },
  "Veress needle at umbilicus | Gas of choice: CO2 (absorbed, not combustible)",
  "IAP maintained at 12–14 mmHg | Trendelenburg (head down) for pelvic, reverse Trendelenburg for upper GI",
  { type: "key", text: "Complications of laparoscopy: Gas embolism (rare, fatal), subcutaneous emphysema, visceral injury, vascular injury" },
  { type: "header", text: "Bariatric Surgery (Obesity)" },
  "Indications: BMI ≥40 OR BMI ≥35 + comorbidity (T2DM, HTN, OSA)",
  { type: "key", text: "Roux-en-Y Gastric Bypass (RYGB) = gold standard | Most effective for T2DM remission" },
  "Sleeve gastrectomy: Removes fundus, restrictive only | BPD/DS: Most malabsorptive",
  { type: "header", text: "POEM (Per-Oral Endoscopic Myotomy)" },
  "For achalasia cardia | Via endoscopy — incisionless | Complication: GERD post-procedure",
  { type: "warn", text: "Achalasia: Absent peristalsis + failure of LES relaxation | Barium swallow: Bird beak/rat tail sign" },
], { accentColor: C.teal });

// Final recap slide
{
  let s = pres.addSlide();
  s.background = { color: C.darkBg };
  s.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: 10, h: 0.14, fill: { color: C.accent } });

  s.addText("🏆  MUST-KNOW MNEMONICS & QUICK RECALL", {
    x: 0.3, y: 0.25, w: 9.4, h: 0.7, fontSize: 18, bold: true, color: C.accent, fontFace: "Calibri"
  });

  const mnemonics = [
    { t: "ATLS Primary Survey:", v: "A-B-C-D-E  (Airway → Breathing → Circulation → Disability → Exposure)" },
    { t: "GET SMASHED:", v: "Causes of Pancreatitis (Gallstones, EtOH, Trauma, Steroids, Mumps, AI, Scorpion, Hyperlipid, ERCP, Drugs)" },
    { t: "Charcot's Triad:", v: "RUQ pain + Fever + Jaundice = Cholangitis" },
    { t: "Reynold's Pentad:", v: "Charcot's + Shock + Mental confusion = Suppurative cholangitis" },
    { t: "Beck's Triad:", v: "Hypotension + raised JVP + muffled heart sounds = Cardiac tamponade" },
    { t: "Cushing's Reflex:", v: "HTN + Bradycardia + Irregular breathing = Raised ICP (late sign)" },
    { t: "Virchow's Triad:", v: "Stasis + Endothelial injury + Hypercoagulability = DVT" },
    { t: "Courvoisier's Law:", v: "Palpable painless GB + jaundice = Malignancy (NOT gallstones)" },
    { t: "Goodsall's Rule:", v: "Posterior external fistula → curved track | Anterior → straight track to anal canal" },
  ];

  const items = [];
  mnemonics.forEach(m => {
    items.push({ text: m.t + "  ", options: { bold: true, color: C.accent, fontSize: 12, breakLine: false } });
    items.push({ text: m.v, options: { bold: false, color: C.white, fontSize: 12, breakLine: true } });
  });
  s.addText(items, { x: 0.3, y: 1.05, w: 9.4, h: 4.35, fontFace: "Calibri", valign: "top", lineSpacingMultiple: 1.2 });
}

// Closing slide
{
  let s = pres.addSlide();
  s.background = { color: C.darkBg };
  s.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: 0.18, h: 5.625, fill: { color: C.accent } });
  s.addShape(pres.ShapeType.ellipse, { x: 7.5, y: 1.5, w: 3, h: 3, fill: { color: C.midBg }, line: { color: C.accent, width: 2 } });
  s.addText("BEST OF LUCK", { x: 7.5, y: 1.7, w: 3, h: 1.0, fontSize: 14, bold: true, color: C.accent, align: "center" });
  s.addText("NEET PG 2026", { x: 7.5, y: 2.8, w: 3, h: 0.8, fontSize: 18, bold: true, color: C.white, align: "center" });

  s.addText("NEET PG SURGERY", { x: 0.5, y: 1.5, w: 7, h: 0.8, fontSize: 28, bold: true, color: C.white, fontFace: "Calibri" });
  s.addText("High-Yield Notes", { x: 0.5, y: 2.35, w: 6, h: 0.6, fontSize: 20, color: C.accent, fontFace: "Calibri", italic: true });
  s.addShape(pres.ShapeType.rect, { x: 0.5, y: 3.05, w: 5.5, h: 0.05, fill: { color: C.accent } });
  s.addText("14 Modules  •  Roadmaps  •  PYQ Pattern 2015–2024", {
    x: 0.5, y: 3.2, w: 7, h: 0.5, fontSize: 13, color: C.lightGray, italic: true
  });
  s.addText("Remember: Consistency + Active Recall = NEET PG Success", {
    x: 0.5, y: 4.5, w: 8, h: 0.6, fontSize: 12, color: C.subtleTxt, italic: true
  });
}

// ── WRITE FILE ──────────────────────────────────────
pres.writeFile({ fileName: "/home/daytona/workspace/neet-pg-surgery/NEET_PG_Surgery_HighYield_Notes.pptx" })
  .then(() => console.log("SUCCESS: File created"))
  .catch(err => { console.error("ERROR:", err); process.exit(1); });

cd /home/daytona/workspace/neet-pg-surgery && node create_pptx.js

ls -lh /home/daytona/workspace/neet-pg-surgery/NEET_PG_Surgery_HighYield_Notes.p…

~/neet-pg-surgery/create_pdf.py

from reportlab.lib.pagesizes import A4
from reportlab.lib import colors
from reportlab.lib.units import mm, cm
from reportlab.lib.styles import getSampleStyleSheet, ParagraphStyle
from reportlab.lib.enums import TA_CENTER, TA_LEFT, TA_RIGHT
from reportlab.platypus import (
    SimpleDocTemplate, Table, TableStyle, Paragraph, Spacer,
    HRFlowable, KeepTogether, PageBreak
)
from reportlab.platypus.flowables import BalancedColumns
from reportlab.lib.colors import HexColor
import os

# ── PALETTE ──────────────────────────────────────────────────────────────────
DARK_BG    = HexColor("#0D1B2A")
MID_BG     = HexColor("#1B2A3B")
ACCENT     = HexColor("#E8AF2C")
ACCENT_RED = HexColor("#C0392B")
ACCENT_GRN = HexColor("#1E8449")
ACCENT_TEL = HexColor("#117A65")
ACCENT_PUR = HexColor("#6C3483")
ACCENT_ORG = HexColor("#D68910")
WHITE      = colors.white
LIGHT_GRAY = HexColor("#D5D8DC")
SUBTLE     = HexColor("#7F8C8D")
ROW_ALT    = HexColor("#EAF2FF")
ROW_ALT2   = HexColor("#FEF9E7")
HEADER_ROW = HexColor("#154360")
HEADER_TXT = WHITE

PAGE_W, PAGE_H = A4
MARGIN = 15 * mm

# ── DOCUMENT SETUP ───────────────────────────────────────────────────────────
OUTPUT = "/home/daytona/workspace/neet-pg-surgery/NEET_PG_Surgery_DiffDx_QuickRef.pdf"
doc = SimpleDocTemplate(
    OUTPUT,
    pagesize=A4,
    rightMargin=MARGIN, leftMargin=MARGIN,
    topMargin=18 * mm, bottomMargin=15 * mm,
    title="NEET PG Surgery – Differential Diagnosis Quick Reference",
    author="Orris AI"
)

# ── STYLES ────────────────────────────────────────────────────────────────────
styles = getSampleStyleSheet()

S = {
    "cover_title": ParagraphStyle("cover_title", fontSize=28, textColor=WHITE,
        fontName="Helvetica-Bold", alignment=TA_CENTER, leading=34),
    "cover_sub": ParagraphStyle("cover_sub", fontSize=13, textColor=ACCENT,
        fontName="Helvetica-Oblique", alignment=TA_CENTER, leading=18),
    "cover_meta": ParagraphStyle("cover_meta", fontSize=10, textColor=LIGHT_GRAY,
        fontName="Helvetica", alignment=TA_CENTER, leading=14),

    "section": ParagraphStyle("section", fontSize=13, textColor=WHITE,
        fontName="Helvetica-Bold", alignment=TA_LEFT, leading=16,
        spaceAfter=4, spaceBefore=8),
    "sub_section": ParagraphStyle("sub_section", fontSize=10.5, textColor=ACCENT,
        fontName="Helvetica-Bold", alignment=TA_LEFT, leading=13,
        spaceBefore=5, spaceAfter=3),

    "th": ParagraphStyle("th", fontSize=8.5, textColor=WHITE,
        fontName="Helvetica-Bold", alignment=TA_CENTER, leading=11),
    "th_left": ParagraphStyle("th_left", fontSize=8.5, textColor=WHITE,
        fontName="Helvetica-Bold", alignment=TA_LEFT, leading=11),
    "td": ParagraphStyle("td", fontSize=8, textColor=HexColor("#1A1A2E"),
        fontName="Helvetica", alignment=TA_LEFT, leading=11),
    "td_bold": ParagraphStyle("td_bold", fontSize=8, textColor=DARK_BG,
        fontName="Helvetica-Bold", alignment=TA_LEFT, leading=11),
    "td_red": ParagraphStyle("td_red", fontSize=8, textColor=ACCENT_RED,
        fontName="Helvetica-Bold", alignment=TA_LEFT, leading=11),
    "td_grn": ParagraphStyle("td_grn", fontSize=8, textColor=ACCENT_GRN,
        fontName="Helvetica-Bold", alignment=TA_LEFT, leading=11),
    "td_c": ParagraphStyle("td_c", fontSize=8, textColor=HexColor("#1A1A2E"),
        fontName="Helvetica", alignment=TA_CENTER, leading=11),
    "note": ParagraphStyle("note", fontSize=7.5, textColor=SUBTLE,
        fontName="Helvetica-Oblique", alignment=TA_LEFT, leading=10, spaceAfter=3),
    "footer_note": ParagraphStyle("footer_note", fontSize=8, textColor=ACCENT,
        fontName="Helvetica-Bold", alignment=TA_CENTER, leading=11),
}

# ── HELPERS ──────────────────────────────────────────────────────────────────
def section_banner(text, color=DARK_BG, text_color=WHITE, accent_color=ACCENT):
    """Returns a styled section header as a table."""
    tbl = Table([[Paragraph(text, ParagraphStyle("sb", fontSize=12, textColor=text_color,
        fontName="Helvetica-Bold", leading=15))]], colWidths=[PAGE_W - 2*MARGIN])
    tbl.setStyle(TableStyle([
        ("BACKGROUND", (0,0), (-1,-1), color),
        ("LEFTPADDING", (0,0), (-1,-1), 8),
        ("RIGHTPADDING", (0,0), (-1,-1), 8),
        ("TOPPADDING", (0,0), (-1,-1), 5),
        ("BOTTOMPADDING", (0,0), (-1,-1), 5),
        ("LINEBELOW", (0,0), (-1,-1), 2, accent_color),
    ]))
    return tbl

def make_table(headers, rows, col_widths, header_color=HEADER_ROW, alt_color=ROW_ALT):
    """Build a formatted diff-dx table."""
    header_row = [Paragraph(h, S["th"]) for h in headers]
    data = [header_row]
    for i, row in enumerate(rows):
        styled_row = []
        for j, cell in enumerate(row):
            if j == 0:
                styled_row.append(Paragraph(str(cell), S["td_bold"]))
            else:
                styled_row.append(Paragraph(str(cell), S["td"]))
        data.append(styled_row)

    tbl = Table(data, colWidths=col_widths, repeatRows=1)
    style = [
        ("BACKGROUND", (0,0), (-1,0), header_color),
        ("TEXTCOLOR", (0,0), (-1,0), WHITE),
        ("FONTNAME", (0,0), (-1,0), "Helvetica-Bold"),
        ("FONTSIZE", (0,0), (-1,0), 8.5),
        ("ALIGN", (0,0), (-1,0), "CENTER"),
        ("VALIGN", (0,0), (-1,-1), "TOP"),
        ("GRID", (0,0), (-1,-1), 0.4, HexColor("#BFBFBF")),
        ("LINEBELOW", (0,0), (-1,0), 1.2, ACCENT),
        ("ROWBACKGROUNDS", (0,1), (-1,-1), [WHITE, alt_color]),
        ("LEFTPADDING", (0,0), (-1,-1), 4),
        ("RIGHTPADDING", (0,0), (-1,-1), 4),
        ("TOPPADDING", (0,0), (-1,-1), 3),
        ("BOTTOMPADDING", (0,0), (-1,-1), 3),
        ("FONTNAME", (0,1), (0,-1), "Helvetica-Bold"),
    ]
    tbl.setStyle(TableStyle(style))
    return tbl

def note(text):
    return Paragraph(f"★ {text}", S["note"])

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

def hr(color=ACCENT):
    return HRFlowable(width="100%", thickness=1, color=color, spaceAfter=2)

# ── CONTENT ──────────────────────────────────────────────────────────────────
story = []
W = PAGE_W - 2*MARGIN  # usable width ~180mm

# ═══════════════════════════════════════════════════════════
# COVER PAGE
# ═══════════════════════════════════════════════════════════
cover_data = [[
    Paragraph("NEET PG SURGERY", S["cover_title"]),
    Paragraph("Differential Diagnosis Quick Reference", S["cover_sub"]),
    Paragraph("Past 10 Years PYQ Pattern  |  2015–2024  |  14 System Modules", S["cover_meta"]),
    Paragraph("⚡ High-Yield Tables  •  Key Distinguishing Features  •  Roadmaps", S["cover_meta"]),
]]
cover_tbl = Table([[c] for c in [
    Paragraph("NEET PG SURGERY", S["cover_title"]),
    Paragraph("Differential Diagnosis — Quick Reference", S["cover_sub"]),
    Spacer(1, 8*mm),
    Paragraph("Past 10 Years PYQ Pattern  |  2015–2024  |  14 System Modules", S["cover_meta"]),
    Paragraph("⚡ High-Yield Tables  •  Key Distinguishing Features  •  NEET PYQ Markers", S["cover_meta"]),
]], colWidths=[W])
cover_tbl.setStyle(TableStyle([
    ("BACKGROUND", (0,0), (-1,-1), DARK_BG),
    ("TOPPADDING", (0,0), (-1,-1), 6),
    ("BOTTOMPADDING", (0,0), (-1,-1), 6),
    ("LEFTPADDING", (0,0), (-1,-1), 10),
    ("RIGHTPADDING", (0,0), (-1,-1), 10),
    ("LINEBELOW", (0,3), (-1,3), 2, ACCENT),
]))
story.append(cover_tbl)
story.append(sp(6))

# Index
index_items = [
    ("01", "Abdominal Pain & GI Differentials"),
    ("02", "Jaundice — Differentials"),
    ("03", "Intestinal Obstruction"),
    ("04", "GI Bleeding (Upper & Lower)"),
    ("05", "Breast Lump Differentials"),
    ("06", "Thyroid — Nodule & Goitre"),
    ("07", "Neck Swelling Differentials"),
    ("08", "Hernia Types Comparison"),
    ("09", "Anorectal Conditions"),
    ("10", "Shock — Type Comparison"),
    ("11", "Burns — Depth & Management"),
    ("12", "Head Injury — EDH vs SDH vs SAH"),
    ("13", "Arterial vs Venous vs Neuropathic Ulcer"),
    ("14", "Salivary Gland & Oral Tumours"),
    ("15", "Scrotal Swelling Differentials"),
    ("16", "Acute vs Chronic Pancreatitis"),
    ("17", "Crohn's Disease vs Ulcerative Colitis"),
    ("18", "Wound Healing — Hypertrophic vs Keloid"),
    ("19", "Premalignant Lesions — Oral Cavity"),
    ("20", "Suture Types — Quick Reference"),
]
index_data = [[Paragraph(f"  {n}", S["td_bold"]), Paragraph(t, S["td"])] for n, t in index_items]
idx_tbl = Table(
    [[Paragraph("MODULE", S["th"]), Paragraph("TOPIC", S["th"])]] + index_data,
    colWidths=[18*mm, W - 18*mm]
)
idx_tbl.setStyle(TableStyle([
    ("BACKGROUND", (0,0), (-1,0), HEADER_ROW),
    ("TEXTCOLOR", (0,0), (-1,0), WHITE),
    ("FONTNAME", (0,0), (-1,0), "Helvetica-Bold"),
    ("GRID", (0,0), (-1,-1), 0.4, HexColor("#BFBFBF")),
    ("LINEBELOW", (0,0), (-1,0), 1.5, ACCENT),
    ("ROWBACKGROUNDS", (0,1), (-1,-1), [WHITE, ROW_ALT]),
    ("LEFTPADDING", (0,0), (-1,-1), 5),
    ("RIGHTPADDING", (0,0), (-1,-1), 5),
    ("TOPPADDING", (0,0), (-1,-1), 3),
    ("BOTTOMPADDING", (0,0), (-1,-1), 3),
    ("VALIGN", (0,0), (-1,-1), "MIDDLE"),
]))
story.append(section_banner("📋  TABLE OF CONTENTS"))
story.append(sp(2))
story.append(idx_tbl)
story.append(PageBreak())

# ═══════════════════════════════════════════════════════════
# 01  ABDOMINAL PAIN DIFFERENTIALS
# ═══════════════════════════════════════════════════════════
story.append(section_banner("01  ABDOMINAL PAIN — DIFFERENTIAL DIAGNOSIS", DARK_BG, WHITE, ACCENT))
story.append(sp(2))

ap_headers = ["Diagnosis", "Location", "Character", "Key Signs", "Investigations", "Management"]
ap_rows = [
    ["Acute Appendicitis", "Periumbilical → RIF", "Colicky → constant", "McBurney's, Rovsing's, Psoas sign; fever", "WBC↑, USS, CT abdomen (gold std)", "Laparoscopic appendicectomy"],
    ["Peptic Ulcer (perforated)", "Epigastric → generalised", "Sudden severe; board-like rigidity", "Absent bowel sounds, guarding", "Erect CXR (free air under diaphragm)", "Graham's patch repair"],
    ["Acute Cholecystitis", "RUQ radiating to right shoulder", "Constant, severe", "Murphy's sign positive, fever", "USS (gallstones, wall thickening)", "Lap cholecystectomy (<72 hrs)"],
    ["Acute Pancreatitis", "Epigastric radiating to back", "Band-like, severe", "Cullen's / Grey Turner's signs (haemorrhagic)", "Amylase/Lipase↑↑, CECT (Balthazar)", "NBM, IVF, analgesia; surgery if infected necrosis"],
    ["Intestinal Obstruction", "Central / generalised", "Colicky, waves", "Tinkling bowel sounds, distension", "AXR (air-fluid levels), CT", "NG tube, IVF; surgery if strangulation"],
    ["Mesenteric Ischaemia", "Periumbilical", "'Pain out of proportion to signs'", "Atrial fibrillation, rapid deterioration", "CT angiography (gold std)", "Anticoagulation + embolectomy/resection"],
    ["Ureteric Colic", "Loin to groin", "Colicky, severe, radiating to testis", "Restless patient (cf. peritonitis)", "Non-contrast CT KUB", "Analgesia (diclofenac), urological Rx"],
    ["Ectopic Pregnancy", "Iliac fossa (unilateral)", "Sharp, may have shoulder tip pain", "Amenorrhoea, vaginal bleed, cervical excitation", "β-hCG, transvaginal USS", "Surgery (salpingectomy/salpingostomy)"],
    ["Ovarian Cyst (torsion)", "Lower quadrant", "Sudden severe, nausea/vomiting", "Adnexal tenderness, no fever early", "USS (Doppler)", "Emergency laparoscopy"],
    ["Aortic Dissection/AAA rupture", "Epigastric/back", "Tearing, sudden onset", "Pulsatile mass, haemodynamic collapse", "CT aorta (stable) / bedside USS (unstable)", "Emergency EVAR or open repair"],
]
story.append(make_table(ap_headers, ap_rows,
    [28*mm, 22*mm, 22*mm, 32*mm, 30*mm, 42*mm]))
story.append(note("PYQ: McBurney's point = junction of lateral 1/3 and medial 2/3 of line from ASIS to umbilicus"))
story.append(note("PYQ: Cullen's sign = periumbilical bruising | Grey Turner's sign = flank bruising — both in haemorrhagic pancreatitis"))
story.append(sp(3))

# ═══════════════════════════════════════════════════════════
# 02  JAUNDICE DIFFERENTIALS
# ═══════════════════════════════════════════════════════════
story.append(section_banner("02  JAUNDICE — DIFFERENTIAL DIAGNOSIS", DARK_BG, WHITE, ACCENT))
story.append(sp(2))

jx_headers = ["Type", "Bilirubin", "Urine", "Stool", "ALP/GGT", "AST/ALT", "Key Feature"]
jx_rows = [
    ["Pre-hepatic (Haemolytic)", "Unconjugated↑", "Normal (urobilinogen↑, no bilirubin)", "Dark (urobilinogen↑)", "Normal", "Normal", "Anaemia, splenomegaly; Coombs test"],
    ["Hepatic (Hepatocellular)", "Both↑ (conjugated > unconjugated)", "Dark (bilirubin present)", "Pale (variable)", "Mild↑", "Markedly↑", "LFT derangement; hepatitis serology"],
    ["Post-hepatic (Obstructive)", "Conjugated↑", "Dark (bilirubin present)", "Pale/white (clay coloured)", "Markedly↑↑", "Mild↑", "Pruritus; Courvoisier's law"],
]
story.append(make_table(jx_headers, jx_rows,
    [30*mm, 28*mm, 28*mm, 20*mm, 20*mm, 20*mm, 34*mm]))

story.append(sp(2))
jx2_headers = ["Cause of Obstructive Jaundice", "Age", "Pain", "GB (Palpable?)", "Weight Loss", "Investigation of Choice"]
jx2_rows = [
    ["CBD calculus", "Any (MC: 40-60F)", "Biliary colic / Charcot's triad", "No (Courvoisier's -ve)", "No", "USS then ERCP"],
    ["Carcinoma head of pancreas", "Elderly male", "Dull back pain (late)", "YES — Courvoisier's +ve", "YES — significant", "CT abdomen / ERCP / biopsy"],
    ["Cholangiocarcinoma (Klatskin)", "60-70 yrs", "Mild/none", "No", "Yes", "MRCP (level of obstruction)"],
    ["Periampullary carcinoma", "60+ yrs", "Intermittent (silver stool)", "Yes", "Yes", "ERCP + biopsy"],
    ["Primary Sclerosing Cholangitis", "Young males, IBD assoc.", "RUQ discomfort, pruritus", "No", "No", "MRCP (beaded bile ducts)"],
    ["Mirizzi Syndrome", "Middle-aged F", "RUQ colicky", "No", "No", "USS + MRCP (stone in Hartmann's pouch)"],
]
story.append(sp(2))
story.append(section_banner("  Causes of Obstructive Jaundice Compared", MID_BG, WHITE, ACCENT_GRN))
story.append(sp(1))
story.append(make_table(jx2_headers, jx2_rows,
    [38*mm, 20*mm, 28*mm, 24*mm, 20*mm, 50*mm], header_color=HexColor("#1A5276"), alt_color=HexColor("#EAF7EE")))
story.append(note("PYQ: Courvoisier's law — palpable, non-tender GB + jaundice = malignancy (stones cause GB fibrosis → cannot distend)"))
story.append(sp(3))

# ═══════════════════════════════════════════════════════════
# 03  INTESTINAL OBSTRUCTION
# ═══════════════════════════════════════════════════════════
story.append(section_banner("03  INTESTINAL OBSTRUCTION — DIFFERENTIALS", DARK_BG, WHITE, ACCENT))
story.append(sp(2))

io_headers = ["Feature", "Small Bowel Obstruction", "Large Bowel Obstruction", "Sigmoid Volvulus", "Paralytic Ileus"]
io_rows = [
    ["MC Cause", "Adhesions (post-op)", "Carcinoma colon", "Redundant sigmoid (constipation)", "Post-operative, peritonitis"],
    ["Pain Character", "Colicky, central", "Colicky, lower abdominal", "Sudden severe, massive distension", "Absent pain, distension"],
    ["Vomiting", "Early, prominent", "Late, faeculent", "May be present", "Nausea, may vomit"],
    ["Distension", "Central (valvulae conniventes)", "Peripheral (haustrations)", "Massive, asymmetric", "Generalised, uniform"],
    ["Bowel Sounds", "High-pitched tinkling", "Absent or reduced", "Initially high-pitched then absent", "Absent"],
    ["AXR Finding", "Ladder-pattern air-fluid levels, central", "Peripheral haustrated loops, no gas in rectum", "Coffee bean / Omega sign", "Gaseous distension all loops including rectum"],
    ["Gas in Rectum", "No (diagnostic)", "No", "No", "YES"],
    ["Management", "NG decompression; surgery if strangulation", "Hartmann's / resection + stoma", "Rigid sigmoidoscopy + flatus tube; then elective surgery", "Treat cause; conservative (ambulation, prokinetics)"],
]
story.append(make_table(io_headers, io_rows,
    [28*mm, 38*mm, 38*mm, 36*mm, 40*mm]))
story.append(note("PYQ: Coffee bean sign (sigmoid volvulus) — convexity toward RUQ | Pseudoobstruction (Ogilvie's) = dilated colon without mechanical cause — Rx: Neostigmine"))
story.append(sp(3))

# ═══════════════════════════════════════════════════════════
# 04  GI BLEEDING
# ═══════════════════════════════════════════════════════════
story.append(section_banner("04  GASTROINTESTINAL BLEEDING — DIFFERENTIALS", DARK_BG, WHITE, ACCENT))
story.append(sp(2))

gib_headers = ["Cause", "Type", "Presentation", "Age/Risk", "Endoscopy Finding", "Management"]
ugib_rows = [
    ["Peptic Ulcer Disease", "UGIB (80%)", "Haematemesis / melaena", "NSAIDs, H. pylori, smoking", "Ulcer ± vessel (Forrest classification)", "Endoscopic Rx (injection + clip); PPI"],
    ["Oesophageal Varices", "UGIB", "Massive haematemesis, shock", "Cirrhosis / portal HTN", "Column of varices, cherry-red spots", "Terlipressin + Endoscopic band ligation; Sengstaken tube if failing"],
    ["Mallory-Weiss Tear", "UGIB", "Post-vomiting haematemesis", "Alcoholics, bulimia", "Linear tear at OGJ", "Usually self-limiting; endoscopic Rx if persists"],
    ["Dieulafoy Lesion", "UGIB", "Massive haematemesis, recurrent", "Any age", "Large submucosal vessel, no ulcer", "Endoscopic (difficult to identify); angioembolisation"],
    ["Gastric Antral Vascular Ectasia", "UGIB (chronic)", "Iron deficiency anaemia, melaena", "Elderly, cirrhosis", "Watermelon stomach", "Argon plasma coagulation"],
]
lgib_rows = [
    ["Haemorrhoids", "LGIB", "Bright red blood AFTER defaecation, painless", "Young-middle aged adults", "Proctoscopy: internal haemorrhoids", "Conservative; banding; haemorrhoidectomy (Gr III-IV)"],
    ["Anal Fissure", "LGIB", "Fresh blood + severe anal pain during/after defaecation", "Young adults, constipation", "Proctoscopy: posterior midline tear", "GTN cream / diltiazem / lateral sphincterotomy"],
    ["Colorectal Carcinoma", "LGIB (altered blood + mucus)", "Change in bowel habit, weight loss", ">50 yrs; FAP, HNPCC", "Colonoscopy: mass lesion, biopsy", "Surgical resection ± chemo/RT"],
    ["Diverticular Disease", "LGIB (often massive, painless)", "Sudden bright/dark red per rectum, older patient", ">60 yrs, low fibre diet", "Colonoscopy / CT colonography", "Usually self-limiting; selective angioembolisation if persistent"],
    ["Ischaemic Colitis", "LGIB", "Bloody diarrhoea, LIF pain, 'splenic flexure' — watershed area", "Elderly, atherosclerosis, post-aortic sx", "Colonoscopy: segmental erythema, thumb-printing on AXR", "Supportive; surgery if full-thickness necrosis"],
    ["Intussusception", "LGIB (paediatric)", "Redcurrant jelly stool, colicky pain, sausage-shaped mass", "6 months–2 years (MC paediatric cause)", "USS: target/donut sign", "Air-enema reduction; surgery if failed"],
]
story.append(Paragraph("▶ Upper GI Bleeding (Proximal to Ligament of Treitz)", S["sub_section"]))
story.append(make_table(gib_headers, ugib_rows, [30*mm, 14*mm, 30*mm, 28*mm, 30*mm, 48*mm], header_color=ACCENT_RED, alt_color=HexColor("#FDEDEC")))
story.append(sp(2))
story.append(Paragraph("▶ Lower GI Bleeding", S["sub_section"]))
story.append(make_table(gib_headers, lgib_rows, [30*mm, 14*mm, 30*mm, 28*mm, 30*mm, 48*mm], header_color=HexColor("#117A65"), alt_color=HexColor("#E8F8F5")))
story.append(note("PYQ: Rockall score = risk stratification in UGIB | Forrest Ia (spurting vessel) = highest re-bleed risk → endoscopic Rx mandatory"))
story.append(PageBreak())

# ═══════════════════════════════════════════════════════════
# 05  BREAST LUMP
# ═══════════════════════════════════════════════════════════
story.append(section_banner("05  BREAST LUMP — DIFFERENTIAL DIAGNOSIS", DARK_BG, WHITE, ACCENT))
story.append(sp(2))

bl_headers = ["Diagnosis", "Age", "Consistency", "Mobility", "Pain", "Associated Features", "Investigation"]
bl_rows = [
    ["Fibroadenoma", "<30 yrs", "Firm, smooth, rubbery", "Highly mobile ('breast mouse')", "Painless", "No skin changes, well-defined", "USS → core biopsy"],
    ["Fibrocystic Disease (ANDI)", "30–50 yrs", "Nodular, variable", "Variable", "Cyclical mastalgia (worse premenstrual)", "Bilateral, multiple lumps", "USS / mammogram"],
    ["Breast Cyst", "35–55 yrs", "Fluctuant, smooth", "Mobile", "Tender, sudden appearance", "May transilluminate", "USS (anechoic) → aspiration"],
    ["Breast Abscess", "Lactating (periareolar: non-lactating)", "Fluctuant, warm, tender", "Fixed (if abscess)", "Severe pain, fever", "Redness, nipple discharge (pus)", "USS + aspiration/I&D"],
    ["Carcinoma Breast", ">35 yrs (peak 50–70)", "Hard, irregular", "Fixed (to skin or chest wall)", "Usually painless", "Peau d'orange, nipple retraction, LN", "Triple assessment: Mammo + USS + core biopsy"],
    ["Phyllodes Tumour", "35–55 yrs", "Firm, bosselated", "Mobile initially", "Painless", "Rapid growth, overlying skin stretched", "Core biopsy (leaf-like pattern)"],
    ["Fat Necrosis", "Any (post-trauma/biopsy)", "Hard, irregular (mimics Ca)", "Fixed", "Tender initially then painless", "History of trauma, biopsy", "Mammogram (oil cyst/calcification), biopsy"],
    ["Intraductal Papilloma", "35–55 yrs", "Subareolar, small", "Mobile", "Serous/bloody nipple discharge", "Single duct discharge", "Ductoscopy / ductogram"],
    ["Galactocoele", "Lactating/post-lactation", "Soft, fluctuant", "Mobile", "Usually painless", "Retention of milk", "USS (complex cystic) → aspiration (milky)"],
]
story.append(make_table(bl_headers, bl_rows,
    [28*mm, 18*mm, 24*mm, 18*mm, 18*mm, 34*mm, 40*mm], alt_color=ROW_ALT2))
story.append(note("PYQ: Triple assessment = clinical + imaging + pathology. All 3 must agree (concordance) before benign diagnosis accepted"))
story.append(note("PYQ: BRCA1 = breast + ovarian Ca | BRCA2 = male breast Ca | ER+PR+ → tamoxifen | HER2+ → trastuzumab"))
story.append(sp(3))

# ═══════════════════════════════════════════════════════════
# 06  THYROID
# ═══════════════════════════════════════════════════════════
story.append(section_banner("06  THYROID — NODULE & CANCER DIFFERENTIALS", DARK_BG, WHITE, ACCENT))
story.append(sp(2))

th_headers = ["Cancer Type", "% of All Thyroid Ca", "Cell of Origin", "Spread", "Histology Marker", "Prognosis", "Special Feature"]
th_rows = [
    ["Papillary (PTC)", "80–85%", "Follicular cells", "Lymphatic → cervical LN", "Orphan Annie eye nuclei; Psammoma bodies; nuclear grooves", "Best (10yr survival >90%)", "Cold nodule; BRAF mutation; assoc. radiation"],
    ["Follicular (FTC)", "10–15%", "Follicular cells", "Haematogenous (bone, lung)", "Capsular & vascular invasion (no nuclear grooves)", "Good (10yr survival ~85%)", "FNAC CANNOT distinguish from follicular adenoma"],
    ["Medullary (MTC)", "5–10%", "Parafollicular C-cells", "Both lymphatic + haematogenous", "Amyloid stroma; calcitonin-positive", "Intermediate", "RET mutation; MEN2A/2B; calcitonin as tumour marker"],
    ["Anaplastic (ATC)", "<2%", "Follicular cells (dedifferentiated)", "Early local invasion + haematogenous", "Pleomorphic giant cells", "Worst (<6 months survival)", "Rapid onset in elderly; compressive Sx"],
    ["Lymphoma", "Rare", "Lymphocytes", "Lymphatic", "Large B-cell lymphoma", "Variable", "Assoc. Hashimoto's thyroiditis; rapid swelling"],
]
story.append(make_table(th_headers, th_rows,
    [24*mm, 18*mm, 18*mm, 28*mm, 36*mm, 24*mm, 32*mm]))
story.append(note("PYQ: FNAC (Bethesda) cannot diagnose follicular carcinoma — requires histology (capsular invasion). Follicular = Bethesda IV (indeterminate)"))
story.append(note("PYQ: Medullary TC = only thyroid cancer where calcitonin is the tumour marker. Screen MEN2 family with RET testing"))
story.append(sp(3))

# ═══════════════════════════════════════════════════════════
# 07  NECK SWELLING
# ═══════════════════════════════════════════════════════════
story.append(section_banner("07  NECK SWELLING — DIFFERENTIALS", DARK_BG, WHITE, ACCENT))
story.append(sp(2))

neck_headers = ["Swelling", "Location", "Age", "Moves with Swallowing", "Transillumination", "Key Features", "Investigation"]
neck_rows = [
    ["Thyroid Goitre", "Midline / anterior", "Any", "YES", "No", "Moves on swallowing AND tongue protrusion", "TFTs, USS, FNAC"],
    ["Thyroglossal Cyst", "Midline, below hyoid", "Children/young adults", "YES", "May transilluminate", "Moves on tongue protrusion (attached to hyoid)", "USS; excision (Sistrunk operation)"],
    ["Branchial Cyst", "Anterior triangle (upper 1/3 SCM)", "15–25 yrs", "No", "Transillumination +ve", "Smooth, fluctuant, cholesterol crystals on aspiration", "USS/CT; excision"],
    ["Cervical Lymphadenopathy", "Various levels", "Any", "No", "No", "Single or matted nodes; fever (infective vs malignant)", "USS + FNA/core biopsy"],
    ["Cystic Hygroma", "Posterior triangle", "Infants (<2 yrs)", "No", "Brilliantly transilluminant", "Soft, compressible; can extend to mediastinum", "USS/MRI; sclerotherapy or surgery"],
    ["Carotid Body Tumour", "At carotid bifurcation", "Adults", "No", "No", "Transmitted pulsation; side-to-side mobile (Fontaine's sign); NOT up-down mobile", "Duplex USS; CT angiography"],
    ["Dermoid Cyst", "Midline (sublingual/submental)", "Young", "No", "May transilluminate", "Doughy consistency; no attachment to hyoid", "USS; excision"],
    ["Pharyngeal Pouch (Zenker's)", "Posterior (left side)", "Elderly", "No", "No", "Regurgitation of undigested food; gurgling", "Barium swallow (gold std)"],
    ["Lymphoma", "Cervical chains", "Young (Hodgkin's) or elderly (NHL)", "No", "No", "Rubbery, firm, non-tender; B symptoms", "Excision biopsy; CT chest/abdomen"],
]
story.append(make_table(neck_headers, neck_rows,
    [28*mm, 22*mm, 16*mm, 20*mm, 18*mm, 38*mm, 38*mm]))
story.append(note("PYQ: Sistrunk's operation = thyroglossal cyst excision — includes body of hyoid to prevent recurrence"))
story.append(note("PYQ: Carotid body tumour (paraganglioma/chemodectoma) — Fontaine's sign = horizontal mobility present, vertical absent"))
story.append(PageBreak())

# ═══════════════════════════════════════════════════════════
# 08  HERNIA
# ═══════════════════════════════════════════════════════════
story.append(section_banner("08  HERNIA TYPES — COMPARISON TABLE", DARK_BG, WHITE, ACCENT))
story.append(sp(2))

h_headers = ["Hernia Type", "Location", "Relation to Inferior Epigastric", "At Risk / MC in", "Special Feature", "Surgery"]
h_rows = [
    ["Indirect Inguinal", "Inguinal canal — through deep ring → along canal", "LATERAL to inferior epigastric artery", "Males, young; MC hernia overall", "Passes through deep ring → superficial ring → scrotum", "Lichtenstein mesh repair"],
    ["Direct Inguinal", "Inguinal canal — through Hesselbach's triangle", "MEDIAL to inferior epigastric artery", "Elderly males, chronic cough/strain", "Bulge directly forward, rarely goes to scrotum", "Lichtenstein mesh repair"],
    ["Femoral", "Femoral canal (medial to femoral vein)", "Below and lateral to pubic tubercle", "MC in women (but inguinal still commoner overall)", "MC complication = strangulation | Richter's possible", "McVay repair / TAPP"],
    ["Umbilical", "Through umbilical defect", "—", "Children (para-umbilical in adults)", "Infantile = closes spontaneously by 2 yrs", "Mayo repair (vest-over-pants) in adults"],
    ["Para-umbilical", "Through linea alba near umbilicus", "—", "Obese middle-aged women", "Does NOT close spontaneously", "Surgical repair"],
    ["Epigastric", "Midline, linea alba, above umbilicus", "—", "Males 20–50 yrs", "Often small defect with pre-peritoneal fat; painful", "Simple repair"],
    ["Spigelian", "Lateral border of rectus at linea semilunaris", "—", "Middle-aged, often obese", "Interparietal (between muscle layers) → hard to detect", "CT/USS diagnosis; repair"],
    ["Obturator", "Obturator canal", "—", "Thin, elderly women ('Little old lady hernia')", "Howship-Romberg sign = medial thigh pain on hip extension | High strangulation risk", "Laparotomy/repair"],
    ["Gluteal / Sciatic", "Greater/lesser sciatic notch", "—", "Rare", "High strangulation risk; sciatica", "Surgical exploration"],
    ["Richter's Hernia", "Any hernia orifice", "—", "Femoral most common", "Only antimesenteric wall herniated — may strangulate WITHOUT obstruction", "High risk — emergency repair"],
    ["Maydl's Hernia", "Inguinal usually", "—", "Any", "W-loop of bowel — internal loop strangulates INSIDE abdomen while external appears viable", "Emergency repair"],
    ["Littre's Hernia", "Any", "—", "Any", "Contains Meckel's diverticulum as content", "Repair + Meckel's excision"],
]
story.append(make_table(h_headers, h_rows,
    [28*mm, 28*mm, 26*mm, 26*mm, 38*mm, 34*mm]))
story.append(note("PYQ: Hesselbach's triangle — boundaries: Inguinal ligament (inferior), Rectus sheath (medial), Inferior epigastric artery (lateral)"))
story.append(note("PYQ: MC hernia in females = inguinal (indirect) | BUT femoral hernia is relatively more common in females than males"))
story.append(sp(3))

# ═══════════════════════════════════════════════════════════
# 09  ANORECTAL
# ═══════════════════════════════════════════════════════════
story.append(section_banner("09  ANORECTAL CONDITIONS — QUICK REFERENCE", DARK_BG, WHITE, ACCENT))
story.append(sp(2))

ar_headers = ["Condition", "Site (Relation to Dentate Line)", "Pain", "Bleeding", "Examination", "Treatment"]
ar_rows = [
    ["Internal Haemorrhoids", "Above dentate line (visceral)", "Painless", "Bright red, AFTER defaecation, not mixed with stool", "Proctoscopy — above dentate", "Gr I-II: Conservative + RBL; Gr III-IV: Haemorrhoidectomy"],
    ["External Haemorrhoids", "Below dentate line (somatic)", "Painful (thrombosed = severe)", "Less common; bruise-coloured swelling", "Perianal inspection", "Conservative; thrombectomy if acute"],
    ["Anal Fissure (acute)", "Below dentate line, posterior midline (90%)", "Severe tearing pain during/after defaecation", "Small amount bright red blood", "Tear at 6 o'clock; sentinel pile", "Topical GTN / Diltiazem; Botox; Lateral internal sphincterotomy (LIS)"],
    ["Anorectal Abscess", "Perianal / Ischiorectal / Intersphincteric", "Throbbing, constant pain", "No/minimal", "Tender, fluctuant perianal mass; fever, WBC↑", "Incision and drainage (DO NOT aspirate)"],
    ["Fistula-in-ano", "Track between internal opening (dentate) and external opening (perianal skin)", "Chronic discharge, variable pain", "May have blood-stained discharge", "Goodsall's rule; probe gently", "Fistulotomy (intersphincteric); seton (trans-sphincteric); LIFT procedure"],
    ["Pilonidal Sinus", "Postanal/natal cleft (not anal margin)", "Intermittent pain, swelling", "Seropurulent discharge", "Pit(s) in natal cleft; hair visible", "Wide excision ± primary closure or Karydakis flap"],
    ["Rectal Prolapse", "Full-thickness rectal wall protrusion", "Discomfort, mucus discharge", "PR bleeding, mucus", "Concentric folds of mucosa (vs radial in haemorrhoids)", "Children: conservative | Adults: Delorme's / Altemeier's procedure / Rectopexy"],
    ["Carcinoma Rectum", "Above dentate line (upper/middle rectum)", "Late pain; tenesmus", "Altered blood + mucus mixed with stool", "Hard, irregular mass on DRE", "TME surgery ± neoadjuvant chemoRT"],
]
story.append(make_table(ar_headers, ar_rows,
    [28*mm, 28*mm, 18*mm, 24*mm, 30*mm, 52*mm]))
story.append(note("PYQ: Goodsall's rule — external openings POSTERIOR to transverse anal line → curved track to posterior midline; ANTERIOR → straight radial track"))
story.append(note("PYQ: Parks classification of fistula — Intersphincteric (MC, 70%) > Trans-sphincteric > Suprasphincteric > Extrasphincteric"))
story.append(PageBreak())

# ═══════════════════════════════════════════════════════════
# 10  SHOCK COMPARISON
# ═══════════════════════════════════════════════════════════
story.append(section_banner("10  SHOCK — TYPE COMPARISON", DARK_BG, WHITE, ACCENT))
story.append(sp(2))

shock_headers = ["Type", "CO", "SVR", "PCWP", "JVP", "Skin", "MC Cause", "Treatment"]
shock_rows = [
    ["Hypovolaemic", "↓↓", "↑↑", "↓", "↓", "Cold, clammy, pale", "Haemorrhage, burns, vomiting/diarrhoea", "IV fluids + blood; stop bleeding"],
    ["Distributive — Septic", "↑ (early) / ↓ (late)", "↓↓", "↓/normal", "↓/normal", "Warm, flushed (early); cold (late)", "Gram-neg bacteraemia", "IV antibiotics + fluids + vasopressors (noradrenaline)"],
    ["Distributive — Anaphylactic", "↑", "↓↓", "↓", "↓", "Warm, urticarial, flushed", "Drugs (penicillin), insect sting, food", "IM Adrenaline 0.5mg (first line) + antihistamine + steroid"],
    ["Distributive — Neurogenic", "↑", "↓↓", "↓", "↓", "Warm, dry, flushed (no sweating due to sympathectomy)", "Spinal cord injury (cervical/upper thoracic)", "IVF + vasopressors; avoid hypothermia/bradycardia"],
    ["Cardiogenic", "↓↓", "↑↑", "↑↑", "↑ (raised)", "Cold, clammy; pulmonary oedema", "MI, arrhythmia, acute valvular failure", "Inotropes (dobutamine), IABP, treat cause"],
    ["Obstructive — Tension PTX", "↓↓", "↑↑", "↓", "↑ (raised)", "Cold, clammy; trachea deviated away", "Positive pressure ventilation, trauma", "IMMEDIATE needle decompression (2nd ICS MCL)"],
    ["Obstructive — Cardiac Tamponade", "↓↓", "↑↑", "↑", "↑ (Beck's triad)", "Cold; muffled heart sounds; pulsus paradoxus", "Haemopericardium, pericarditis", "Pericardiocentesis (18G needle, subxiphoid)"],
]
story.append(make_table(shock_headers, shock_rows,
    [28*mm, 14*mm, 14*mm, 16*mm, 14*mm, 28*mm, 30*mm, 36*mm], alt_color=HexColor("#FDEDEC")))
story.append(note("PYQ: Haemorrhagic shock Class III = first class to show altered consciousness | Class II = first to show tachycardia (HR >100)"))
story.append(note("PYQ: Fluid of choice in haemorrhagic shock = Ringer's Lactate (Hartmann's) | Normal saline preferred in TBI (avoid hypotonic)"))
story.append(sp(3))

# ═══════════════════════════════════════════════════════════
# 11  BURNS
# ═══════════════════════════════════════════════════════════
story.append(section_banner("11  BURNS — DEPTH CLASSIFICATION & MANAGEMENT", DARK_BG, WHITE, ACCENT))
story.append(sp(2))

burn_headers = ["Degree", "Depth", "Appearance", "Sensation", "Blisters", "Healing", "Management"]
burn_rows = [
    ["Superficial (1st degree)", "Epidermis only", "Red, dry, no blisters", "Painful, hyperaesthetic", "No", "3–5 days", "Analgesia, topical emollients"],
    ["Superficial Partial Thickness (2nd - superficial)", "Epidermis + superficial dermis", "Red, moist, blisters", "Very painful", "YES", "10–14 days (minimal scarring)", "Silver sulfadiazine cream or modern dressings (Mepitel)"],
    ["Deep Partial Thickness (2nd - deep)", "Epidermis + deep dermis", "Pale, mottled, fixed staining", "Insensate / reduced sensation", "YES (may be deroofed)", "21–35 days (significant scarring)", "Tangential excision + split skin graft"],
    ["Full Thickness (3rd degree)", "All layers of skin", "Leathery, white/black/waxy, dry", "Insensate (nerve ends destroyed)", "No (leathery eschar)", "Does NOT heal without grafting", "Excision + split thickness skin graft (within 3–5 days)"],
    ["4th degree", "Down to bone/tendon/muscle", "Charred, black, dry", "Completely insensate", "No", "Does NOT heal", "Amputation / flap reconstruction"],
]
story.append(make_table(burn_headers, burn_rows,
    [28*mm, 22*mm, 28*mm, 20*mm, 16*mm, 22*mm, 44*mm], alt_color=HexColor("#FEF9E7")))
story.append(sp(2))
# Parkland formula box
pkland_data = [
    [Paragraph("PARKLAND FORMULA — Fluid Resuscitation in Burns", ParagraphStyle("pk", fontSize=10, textColor=WHITE, fontName="Helvetica-Bold", leading=13)),
     Paragraph("4 mL × Weight (kg) × % BSA burned", ParagraphStyle("pk2", fontSize=11, textColor=ACCENT, fontName="Helvetica-Bold", leading=14))],
    [Paragraph("Give first HALF in initial 8 hours (from time of burn, not admission)\nGive second HALF over next 16 hours\nFluid: Ringer's Lactate (crystalloid)\nMonitor: Urine output (Adults: 0.5 mL/kg/hr | Children: 1 mL/kg/hr)", ParagraphStyle("pk3", fontSize=9, textColor=WHITE, fontName="Helvetica", leading=12)),
     Paragraph("Rule of Nines (Adults):\nHead & Neck = 9%   Each Arm = 9%\nAnterior Trunk = 18%   Posterior Trunk = 18%\nEach Leg = 18%   Perineum = 1%\nPalmar Rule: Patient's palm = 1% BSA", ParagraphStyle("pk4", fontSize=9, textColor=LIGHT_GRAY, fontName="Helvetica", leading=12))],
]
pkland_tbl = Table(pkland_data, colWidths=[W//2, W//2])
pkland_tbl.setStyle(TableStyle([
    ("BACKGROUND", (0,0), (-1,0), DARK_BG),
    ("BACKGROUND", (0,1), (-1,1), MID_BG),
    ("GRID", (0,0), (-1,-1), 0.5, ACCENT),
    ("LEFTPADDING", (0,0), (-1,-1), 8),
    ("TOPPADDING", (0,0), (-1,-1), 6),
    ("BOTTOMPADDING", (0,0), (-1,-1), 6),
    ("VALIGN", (0,0), (-1,-1), "TOP"),
]))
story.append(pkland_tbl)
story.append(sp(3))

# ═══════════════════════════════════════════════════════════
# 12  HEAD INJURY
# ═══════════════════════════════════════════════════════════
story.append(section_banner("12  HEAD INJURY — EDH vs SDH vs SAH vs DAI", DARK_BG, WHITE, ACCENT))
story.append(sp(2))

hi_headers = ["Feature", "Extradural Haematoma (EDH)", "Acute Subdural Haematoma (ASDH)", "Chronic SDH", "Subarachnoid Haemorrhage (SAH)", "Diffuse Axonal Injury (DAI)"]
hi_rows = [
    ["Vessel", "Middle meningeal artery (arterial)", "Bridging veins (venous)", "Bridging veins", "Berry aneurysm (85%) / AVM", "Axons — no bleed"],
    ["Lucid Interval", "CLASSIC (30–50%)", "Absent", "Slowly progressive confusion", "Absent (sudden collapse)", "Absent — immediate coma"],
    ["Onset", "Rapid deterioration after brief lucid period", "Rapid deterioration", "Weeks after minor trauma", "Sudden-onset worst headache", "Immediate loss of consciousness"],
    ["CT Finding", "Biconvex (lenticular) hyperdense", "Crescent-shaped hyperdense (follows brain surface)", "Crescent-shaped HYPODENSE (or isodense subacute)", "Star-shaped hyperdense in cisterns/sulci", "CT may be normal; MRI shows white matter lesions"],
    ["Does not cross", "Suture lines", "Dural folds (falx/tentorium)", "Dural folds", "—", "—"],
    ["Management", "Emergency craniotomy (within 1–2 hrs)", "Emergency craniotomy (mortality high)", "Burr hole + irrigation (2 burr holes)", "Nimodipine + neurosurgery (clip or coil)", "Supportive; ICU; poor prognosis"],
    ["Key PYQ Fact", "Kernohan's notch = false localising; Duret haemorrhage = brainstem bleed from herniation", "GCS <9 at presentation = poor prognosis marker", "Elderly, alcoholics, anticoagulants — minor trauma", "Xanthochromia in CSF if CT negative; LP at 12 hrs", "Most common cause of persisting vegetative state post TBI"],
]
story.append(make_table(hi_headers, hi_rows,
    [28*mm, 30*mm, 30*mm, 26*mm, 28*mm, 38*mm]))
story.append(note("PYQ: Cushing's reflex (triad) = Hypertension + Bradycardia + Irregular breathing = raised ICP — LATE sign, indicates brainstem herniation"))
story.append(note("PYQ: GCS scoring: Eye (4) + Verbal (5) + Motor (6) = 15 max | GCS ≤8 = Intubate | Minimum GCS = 3"))
story.append(PageBreak())

# ═══════════════════════════════════════════════════════════
# 13  ULCER TYPES
# ═══════════════════════════════════════════════════════════
story.append(section_banner("13  LOWER LIMB ULCER — ARTERIAL vs VENOUS vs NEUROPATHIC", DARK_BG, WHITE, ACCENT))
story.append(sp(2))

ul_headers = ["Feature", "Arterial (Ischaemic) Ulcer", "Venous (Varicose) Ulcer", "Neuropathic (Diabetic) Ulcer"]
ul_rows = [
    ["Site", "Tips of toes, heel, pressure areas, malleoli", "Medial gaiter area (medial malleolus = MC site)", "Plantar surface, pressure points (metatarsal heads, heel)"],
    ["Pain", "Very painful (rest pain at night, relieved by hanging foot down)", "Mild/aching; relieved by elevation", "PAINLESS (loss of protective sensation)"],
    ["Margin", "Punched-out ('clean' edge)", "Sloping, irregular margin", "Punched-out with callus surrounding"],
    ["Base", "Pale, necrotic, no granulation tissue", "Granulating (red), sloughy", "Deep, may reach bone, granulating or necrotic"],
    ["Surrounding Skin", "Atrophic, shiny, hairless, cold, pale/cyanotic", "Lipodermatosclerosis (woody induration), haemosiderin (brown pigmentation), eczema", "Dry, cracked skin; warm (autonomic neuropathy); callus"],
    ["Pulses", "ABSENT or diminished", "Normal (venous ulcer)", "Normal or diminished (if arterial component)"],
    ["ABI", "<0.8 (usually <0.5)", ">0.8 (normal)", "Variable (calc. errors in DM)"],
    ["Varicosities", "Absent", "Present (CEAP ≥C5)", "Absent (unless combined)"],
    ["Investigation", "Duplex USS, CT/MR angiography", "Duplex USS (venous reflux), ABPI before compression", "Monofilament testing (Semmes-Weinstein), X-ray (osteomyelitis)"],
    ["Treatment", "Revascularisation (angioplasty/bypass); palliation if not feasible", "Compression bandaging (4-layer); wound care; treat reflux (EVLA/surgery)", "Offloading (Total Contact Cast); wound debridement; antibiotics if infected; revascularisation"],
]
story.append(make_table(ul_headers, ul_rows,
    [30*mm, 50*mm, 50*mm, 50*mm]))
story.append(note("PYQ: Marjolin's ulcer = malignant SCC arising in chronic wound/scar (eg. chronic venous ulcer, burn scar, sinuses) — slow growing, NO LN spread initially"))
story.append(sp(3))

# ═══════════════════════════════════════════════════════════
# 14  SALIVARY GLAND TUMOURS
# ═══════════════════════════════════════════════════════════
story.append(section_banner("14  SALIVARY GLAND & ORAL TUMOURS", DARK_BG, WHITE, ACCENT))
story.append(sp(2))

sg_headers = ["Tumour", "Gland (MC)", "Benign/Malignant", "Age", "Key Histology", "Key Clinical Feature", "Treatment"]
sg_rows = [
    ["Pleomorphic Adenoma", "Parotid (80%)", "Benign (but may malignise)", "40–60 yrs", "Epithelial + mesenchymal (myxoid) stroma; pseudopods", "MC salivary tumour; RECURS if incomplete excision (pseudopods)", "Superficial parotidectomy (with cuff of normal tissue)"],
    ["Warthin's Tumour (Cystadenoma lymphomatosum)", "Parotid (tail)", "Benign", "Elderly males", "Oncocytic epithelium + lymphoid stroma", "MC bilateral salivary tumour; smokers; bilateral 10%", "Excision; rarely needs surgery"],
    ["Adenoid Cystic Carcinoma", "Submandibular / minor salivary glands", "Malignant (MC malignant)", "40–60 yrs", "Swiss cheese / cribriform pattern; perineural invasion", "Perineural spread; facial pain/numbness; LATE distant mets (lung)", "Wide excision + RT; poor prognosis if high grade"],
    ["Mucoepidermoid Carcinoma", "Parotid (MC malignant in parotid)", "Malignant (low to high grade)", "Any age (MC in children)", "Mucous + epidermoid + intermediate cells", "MC malignant tumour of PAROTID; variable behaviour", "Surgery ± RT"],
    ["Acinic Cell Carcinoma", "Parotid", "Low-grade malignant", "Young adults", "Acinar cell differentiation (granular cytoplasm)", "Good prognosis; may recur", "Surgery"],
]
story.append(make_table(sg_headers, sg_rows,
    [28*mm, 22*mm, 18*mm, 14*mm, 34*mm, 36*mm, 28*mm]))
story.append(note("PYQ: Frey's syndrome (gustatory sweating) = auriculotemporal nerve injury after parotidectomy → sweating/flushing over cheek when eating"))
story.append(note("PYQ: Facial nerve landmark in parotidectomy: Tragal pointer / Posterior belly of digastric / Stylomastoid foramen / Tympanomastoid suture"))
story.append(sp(3))

# ═══════════════════════════════════════════════════════════
# 15  SCROTAL SWELLING
# ═══════════════════════════════════════════════════════════
story.append(section_banner("15  SCROTAL SWELLING — DIFFERENTIALS", DARK_BG, WHITE, ACCENT))
story.append(sp(2))

scr_headers = ["Diagnosis", "Age", "Pain", "Transillumination", "Testis Separate?", "Key Feature", "Management"]
scr_rows = [
    ["Epididymo-orchitis", "Any (STI: young; UTI: old)", "Acute pain, fever", "No", "Yes (tender mass)", "Prehn's sign +ve (pain relief on elevation); USS (hyperaemia)", "Antibiotics (doxycycline if STI; ciprofloxacin if UTI)"],
    ["Testicular Torsion", "12–18 yrs (peak)", "ACUTE severe pain, nausea/vomiting", "No", "Yes but high-riding", "Absent cremasteric reflex; transverse lie; Prehn's sign -ve", "EMERGENCY surgical exploration — golden period 6 hrs"],
    ["Hydrocoele", "Infants (congenital) / adults (primary/secondary)", "Painless", "YES (brilliantly transilluminant)", "Cannot get above swelling in congenital type", "Confirm testis separate and normal; check for secondary cause", "Jaboulay's / Lord's procedure; congenital: wait until 2 yrs"],
    ["Varicocoele", "15–25 yrs", "Dull aching, worse standing", "No", "Yes", "Bag of worms; disappears lying down; 90% LEFT side; MC cause of male infertility", "Embolisation or surgery (Palomo/Ivanissevich)"],
    ["Epididymal Cyst", "30–50 yrs", "Painless", "YES", "SEPARATE from testis (above and behind)", "Spermatocoele if contains spermatozoa; smooth, fluctuant", "Reassurance; excision if bothersome"],
    ["Testicular Tumour", "20–35 yrs", "Painless hard lump", "No", "Inseparable from testis (arising from it)", "Solid, hard; elevated AFP (NSGCT) / β-hCG (choriocarcinoma) / LDH", "RADICAL ORCHIDECTOMY (inguinal approach — never scrotal)"],
    ["Inguinoscrotal Hernia", "Any", "Discomfort/pain (obstructed = severe)", "No (unless hydrocele of hernial sac)", "Cannot get above it (can get above testicular pathology)", "Reducible bowel above testis", "Lichtenstein / TAPP repair"],
    ["Fournier's Gangrene", "Elderly, diabetics, immunosuppressed", "SEVERE pain → rapidly painless (nerve destruction)", "No", "Necrosis obliterates anatomy", "Necrotising fasciitis of perineum; crepitus; foul odour; rapidly spreading", "Emergency wide debridement + IV antibiotics; ICU"],
]
story.append(make_table(scr_headers, scr_rows,
    [26*mm, 14*mm, 14*mm, 20*mm, 20*mm, 44*mm, 42*mm]))
story.append(note("PYQ: Testicular torsion — cremasteric reflex is ABSENT (most reliable sign). Do NOT wait for USS — go directly to theatre"))
story.append(note("PYQ: Testicular tumour — ALWAYS via inguinal orchidectomy (never scrotal biopsy → avoids inguinal LN dissection being compromised)"))
story.append(PageBreak())

# ═══════════════════════════════════════════════════════════
# 16  PANCREATITIS
# ═══════════════════════════════════════════════════════════
story.append(section_banner("16  ACUTE vs CHRONIC PANCREATITIS", DARK_BG, WHITE, ACCENT))
story.append(sp(2))

pan_headers = ["Feature", "Acute Pancreatitis", "Chronic Pancreatitis"]
pan_rows = [
    ["Definition", "Acute inflammatory process of the pancreas with potential for systemic injury", "Progressive fibrotic destruction of pancreatic parenchyma"],
    ["MC Cause", "Gallstones (40–50%) then Alcohol (25–30%)", "Alcohol (70–80%) in developed world"],
    ["Pain", "Severe, epigastric, radiates to back, constant", "Persistent/recurrent, epigastric, radiates to back, weight loss"],
    ["Enzymes", "Amylase ↑↑ (>3× normal) | Lipase more specific and lasts longer", "Normal or mildly elevated (burnt-out)"],
    ["Imaging", "CECT: Pancreatic oedema / necrosis | Balthazar score", "X-ray / CT: Pancreatic calcification | MRCP: Ductal strictures ('chain of lakes' on ERCP)"],
    ["Scoring", "Ranson's criteria | APACHE II | CTSI (Balthazar)", "Cambridge classification"],
    ["Complications", "SIRS, ARDS, AKI, infected necrosis, pseudocyst, abscess, haemorrhage", "Steatorrhoea (exocrine failure), DM (endocrine failure), pseudocyst, bile duct stricture, malignancy"],
    ["Grey Turner / Cullen", "Present in haemorrhagic pancreatitis (retroperitoneal bleed)", "Absent"],
    ["Management", "NBM, IVF, analgesia, NG tube; ERCP if gallstone + cholangitis; surgery for infected necrosis", "Enzyme replacement (Creon), analgesia, insulin if DM, ERCP for duct stricture; surgery (Whipple/lateral pancreaticojejunostomy) for refractory pain"],
]
story.append(make_table(pan_headers, pan_rows, [28*mm, 76*mm, 76*mm], alt_color=ROW_ALT2))
story.append(note("PYQ: Ranson's criteria — on admission (5 factors) + at 48 hrs (6 factors) — score ≥3 = severe pancreatitis"))
story.append(note("PYQ: Pseudocyst = peripancreatic fluid collection >4 wks after pancreatitis — wall of reactive tissue (NOT epithelium); MC complication of chronic pancreatitis"))
story.append(sp(3))

# ═══════════════════════════════════════════════════════════
# 17  IBD
# ═══════════════════════════════════════════════════════════
story.append(section_banner("17  CROHN'S DISEASE vs ULCERATIVE COLITIS", DARK_BG, WHITE, ACCENT))
story.append(sp(2))

ibd_headers = ["Feature", "Crohn's Disease", "Ulcerative Colitis"]
ibd_rows = [
    ["Location", "Any part of GI tract — 'mouth to anus' (MC: terminal ileum + proximal colon)", "Colon only — ALWAYS starts in rectum and extends proximally (never skips)"],
    ["Distribution", "Skip lesions (areas of normal bowel between affected segments)", "Continuous (no skip lesions)"],
    ["Depth of Inflammation", "Transmural (all layers) → fistulas, strictures, abscesses", "Mucosal only (superficial)"],
    ["Rectal Involvement", "Often spared (30–50%)", "ALWAYS involved (panproctocolitis)"],
    ["Bloody Diarrhoea", "Less common; more abdominal mass + pain", "HALLMARK — bloody mucoid diarrhoea"],
    ["Endoscopy", "Cobblestone mucosa; deep ulcers; linear ulcers; aphthous ulcers", "Loss of haustrations; pseudopolyps; lead-pipe colon (late); friable mucosa"],
    ["Histology", "Non-caseating granulomas (60%); transmural inflammation; fissuring ulcers", "Crypt abscesses; distorted crypts; goblet cell depletion; NO granulomas"],
    ["Complications", "Strictures, fistulas (enterocutaneous, entero-enteric, perianal), abscess, malabsorption", "Toxic megacolon (MC cause death), perforation, haemorrhage, CRC (15–40× risk)"],
    ["Extra-intestinal", "Episcleritis, arthritis, erythema nodosum, PSC (less), uveitis, renal oxalate stones", "Primary Sclerosing Cholangitis (MC assoc.), pyoderma gangrenosum, arthritis"],
    ["Smoking", "Smoking WORSENS Crohn's", "Smoking is PROTECTIVE in UC"],
    ["Surgery", "Segmental resection (not curative — disease recurs); IBD surgery rates higher", "Proctocolectomy = CURATIVE (total colectomy)"],
    ["Cancer Risk", "Slightly increased (vs population)", "Significantly increased — pancolitis >10 yrs = highest risk"],
    ["p-ANCA / ASCA", "ASCA positive (anti-Saccharomyces cerevisiae)", "p-ANCA positive (perinuclear ANCA)"],
]
story.append(make_table(ibd_headers, ibd_rows, [32*mm, 74*mm, 74*mm], alt_color=ROW_ALT))
story.append(note("PYQ: Toxic megacolon — colon >6cm on AXR, systemic toxicity — emergency colectomy"))
story.append(note("PYQ: Pyoderma gangrenosum = more common in UC | PSC = more common in UC (but can occur in Crohn's)"))
story.append(sp(3))

# ═══════════════════════════════════════════════════════════
# 18  SCAR
# ═══════════════════════════════════════════════════════════
story.append(section_banner("18  HYPERTROPHIC SCAR vs KELOID", DARK_BG, WHITE, ACCENT))
story.append(sp(2))

scar_headers = ["Feature", "Hypertrophic Scar", "Keloid"]
scar_rows = [
    ["Definition", "Excessive scar confined within the original wound margins", "Scar that EXTENDS beyond the original wound margin ('tumour-like')"],
    ["Onset", "Within 4 weeks of injury", "Months to years after injury"],
    ["Regression", "May regress spontaneously over months", "Does NOT regress spontaneously"],
    ["Recurrence after excision", "Low", "High — excision alone = high recurrence"],
    ["Ethnicity", "Any", "MC in darkly pigmented individuals (African, South Asian)"],
    ["MC Sites", "Any wound site", "Ear lobe, sternum, deltoid, anterior chest, upper back"],
    ["Symptoms", "Pruritus, discomfort", "Pruritus, pain, cosmetic disfigurement"],
    ["Collagen", "Type III collagen — parallel arrangement", "Type III collagen — whorled/nodular arrangement"],
    ["Treatment", "Silicone gel sheeting, pressure garments, steroid injection", "Steroid injection (1st line), silicone, surgery + steroid, radiotherapy"],
    ["Association", "Burn wounds, surgical wounds", "Minor trauma (ear piercing), burns, acne"],
]
story.append(make_table(scar_headers, scar_rows, [32*mm, 74*mm, 74*mm], alt_color=ROW_ALT2))
story.append(sp(3))

# ═══════════════════════════════════════════════════════════
# 19  ORAL CAVITY PREMALIGNANT
# ═══════════════════════════════════════════════════════════
story.append(section_banner("19  ORAL PREMALIGNANT LESIONS — COMPARISON", DARK_BG, WHITE, ACCENT))
story.append(sp(2))

orl_headers = ["Lesion", "Appearance", "Malignant Potential", "Histology", "Management"]
orl_rows = [
    ["Leukoplakia", "White patch on oral mucosa; cannot be scraped off", "1–17% (higher in speckled variant)", "Hyperkeratosis; dysplasia varies (mild → severe CIS)", "Biopsy; excision if dysplasia; quit tobacco/alcohol"],
    ["Erythroplakia", "Bright red velvety patch", "HIGHEST — 17–50% already carcinoma at time of biopsy", "Severe dysplasia / carcinoma in situ", "URGENT biopsy + excision"],
    ["Speckled Erythroleukoplakia", "Mixed red-white", "Higher than pure leukoplakia (~30%)", "Variable dysplasia", "Biopsy multiple areas; excision"],
    ["Oral Submucous Fibrosis (OSMF)", "Fibrous bands; pale, stiff mucosa; restricted mouth opening (trismus)", "5–10% over 10 years", "Juxta-epithelial hyalinisation + fibrosis", "Cessation of betel nut; intralesional steroids; surgery for trismus"],
    ["Lichen Planus (erosive)", "White striae (Wickham's striae); erosive variant — red, painful", "1–3% (erosive only)", "Band-like lymphocytic infiltrate", "Corticosteroids; surveillance if erosive"],
    ["Actinic Keratosis (lip)", "Rough, scaly white patch on lower lip", "10–20% → SCC", "Atypical keratinocytes in lower epidermis", "Sunscreen; cryotherapy; excision"],
]
story.append(make_table(orl_headers, orl_rows, [30*mm, 38*mm, 24*mm, 34*mm, 54*mm]))
story.append(note("PYQ: Erythroplakia has the highest malignant potential of all oral premalignant lesions"))
story.append(note("PYQ: OSMF = submucosal fibrosis from areca nut (betel nut) chewing — leads to trismus (inability to open mouth)"))
story.append(sp(3))

# ═══════════════════════════════════════════════════════════
# 20  SUTURES
# ═══════════════════════════════════════════════════════════
story.append(section_banner("20  SUTURE TYPES — QUICK REFERENCE TABLE", DARK_BG, WHITE, ACCENT))
story.append(sp(2))

sut_headers = ["Suture", "Type", "Material", "Absorption Time", "Tensile Strength", "Uses", "Notes"]
sut_rows = [
    ["Catgut (plain)", "Absorbable, natural", "Sheep intestine collagen", "10–14 days", "Lost in 7–10 days", "Mucosal sutures, bowel (historical)", "Fastest absorbed; NOT used in presence of infection"],
    ["Chromic Catgut", "Absorbable, natural", "Catgut + chromium salts", "21–28 days", "Lost in 14 days", "Gynaecology, oral mucosa", "Delayed absorption vs plain catgut"],
    ["Vicryl (Polyglactin 910)", "Absorbable, synthetic, braided", "PGA + PLA copolymer", "60–90 days", "Maintains 50% at 3 wks", "MC used absorbable suture; deep tissues, bowel", "Braided → better handling; more infection risk than monofilament"],
    ["PDS (Polydioxanone)", "Absorbable, synthetic, monofilament", "Polydioxanone", "180–210 days", "Maintains 70% at 4 wks", "Abdominal wall closure, paediatric cardiac, tendon", "Longest lasting absorbable; ideal for slow-healing tissues"],
    ["Monocryl (Poliglecaprone)", "Absorbable, synthetic, monofilament", "Poliglecaprone 25", "91–119 days", "Lost rapidly (50% at 1 wk)", "Subcuticular skin closure", "Excellent cosmesis, low reactivity"],
    ["Nylon (Ethilon)", "Non-absorbable, synthetic, monofilament", "Polyamide", "Permanent", "High", "Skin, vascular surgery", "High memory (springs back); minimal tissue reactivity"],
    ["Prolene (Polypropylene)", "Non-absorbable, synthetic, monofilament", "Polypropylene", "Permanent", "High, stable", "Vascular anastomosis, hernia mesh, skin", "MC used in vascular surgery; blue coloured; minimal inflammatory reaction"],
    ["Silk", "Non-absorbable, natural, braided", "Silkworm protein", "Gradually weakens", "Good short-term", "Ligatures, oral surgery, ties", "Easy handling; MOST reactive; stimulates inflammation; NOT truly non-absorbable (loses strength over years)"],
    ["Steel Wire", "Non-absorbable, metallic", "Stainless steel", "Permanent", "HIGHEST tensile strength", "Sternal closure (cardiac surgery), orthopaedic", "Strongest suture material available"],
    ["Vicryl Rapide", "Absorbable, synthetic, braided", "PGA + PLA (faster absorbing)", "10–14 days", "Short lived", "Skin (paediatric), superficial wounds", "Alternative to prolene/nylon for skin — dissolves spontaneously"],
]
story.append(make_table(sut_headers, sut_rows,
    [24*mm, 18*mm, 24*mm, 20*mm, 18*mm, 32*mm, 44*mm]))
story.append(note("PYQ: Strongest suture = Steel wire | Fastest absorbed = Plain catgut | MC used absorbable = Vicryl | MC used in vascular = Prolene"))
story.append(note("PYQ: Mattress suture — Horizontal mattress = EVERTING (used for skin edges) | Vertical mattress = EVERTING (also for skin) | Figure-of-8 = for fascial closure"))

# ─── FINAL PAGE ──────────────────────────────────────────────────────────────
story.append(PageBreak())
final_banner_data = [
    [Paragraph("KEY MNEMONICS — SURGICAL QUICK RECALL", ParagraphStyle("fb", fontSize=13, textColor=WHITE, fontName="Helvetica-Bold", alignment=TA_CENTER, leading=16))],
]
fb_tbl = Table(final_banner_data, colWidths=[W])
fb_tbl.setStyle(TableStyle([
    ("BACKGROUND", (0,0), (-1,-1), DARK_BG),
    ("LINEBELOW", (0,0), (-1,-1), 2, ACCENT),
    ("TOPPADDING", (0,0), (-1,-1), 8),
    ("BOTTOMPADDING", (0,0), (-1,-1), 8),
]))
story.append(fb_tbl)
story.append(sp(2))

mnemonics = [
    ("GET SMASHED", "Gallstones | EtOH | Trauma | Steroids | Mumps | Autoimmune | Scorpion | Hyperlipidaemia/calcaemia | ERCP | Drugs → Causes of Pancreatitis"),
    ("ATLS ABCDE", "Airway (C-spine) | Breathing | Circulation | Disability (GCS/pupils) | Exposure — Primary Survey"),
    ("Beck's Triad", "Hypotension + Raised JVP + Muffled Heart Sounds → Cardiac Tamponade"),
    ("Charcot's Triad", "RUQ Pain + Fever + Jaundice → Cholangitis"),
    ("Reynold's Pentad", "Charcot's Triad + Shock + Mental confusion → Suppurative Cholangitis"),
    ("Courvoisier's Law", "Painless jaundice + Palpable GB (non-tender) = Malignancy (NOT gallstones — stones → fibrosed GB can't distend)"),
    ("Virchow's Triad", "Stasis + Endothelial Injury + Hypercoagulability → DVT"),
    ("Cushing's Reflex", "HTN + Bradycardia + Irregular Breathing → Raised ICP (LATE sign — impending herniation)"),
    ("Goodsall's Rule", "Posterior external fistula opening → curved track to posterior midline | Anterior → straight radial track to dentate"),
    ("MANTRELS Score", "Migration + Anorexia + Nausea + Tenderness + Rebound + Elevated temp + Leucocytosis + Shift to left → Appendicitis scoring"),
    ("Fontaine Classification (PAD)", "Stage I: Asymptomatic | II: Claudication | III: Rest pain | IV: Gangrene/tissue loss"),
    ("ABCDE Melanoma", "Asymmetry | Border irregularity | Colour variation | Diameter >6mm | Evolution → Malignant melanoma features"),
    ("Parks Classification (Fistula)", "Intersphincteric (MC) | Trans-sphincteric | Supra-sphincteric | Extra-sphincteric"),
    ("Rule of Nines (Burns)", "Head 9% | Each arm 9% | Anterior trunk 18% | Posterior trunk 18% | Each leg 18% | Perineum 1%"),
    ("6 Ps Acute Ischaemia", "Pain | Pallor | Pulselessness | Paraesthesia | Paralysis | Perishing cold → Limb ischaemia"),
]

mnem_data = [[Paragraph(m, ParagraphStyle("mk", fontSize=9, textColor=ACCENT, fontName="Helvetica-Bold", leading=11)),
              Paragraph(d, ParagraphStyle("md", fontSize=8.5, textColor=HexColor("#1A1A2E"), fontName="Helvetica", leading=11))]
             for m, d in mnemonics]
mnem_tbl = Table(
    [[Paragraph("MNEMONIC", S["th"]), Paragraph("MEANING", S["th"])]] + mnem_data,
    colWidths=[42*mm, W - 42*mm], repeatRows=1
)
mnem_tbl.setStyle(TableStyle([
    ("BACKGROUND", (0,0), (-1,0), DARK_BG),
    ("TEXTCOLOR", (0,0), (-1,0), WHITE),
    ("FONTNAME", (0,0), (-1,0), "Helvetica-Bold"),
    ("GRID", (0,0), (-1,-1), 0.4, HexColor("#BFBFBF")),
    ("LINEBELOW", (0,0), (-1,0), 1.5, ACCENT),
    ("ROWBACKGROUNDS", (0,1), (-1,-1), [WHITE, ROW_ALT2]),
    ("LEFTPADDING", (0,0), (-1,-1), 5),
    ("RIGHTPADDING", (0,0), (-1,-1), 5),
    ("TOPPADDING", (0,0), (-1,-1), 3),
    ("BOTTOMPADDING", (0,0), (-1,-1), 3),
    ("VALIGN", (0,0), (-1,-1), "TOP"),
    ("FONTNAME", (0,1), (0,-1), "Helvetica-Bold"),
]))
story.append(mnem_tbl)

# ─── BUILD PDF ────────────────────────────────────────────────────────────────
def add_page_number(canvas, doc):
    canvas.saveState()
    canvas.setFont("Helvetica", 8)
    canvas.setFillColor(SUBTLE)
    canvas.drawString(MARGIN, 8*mm, "NEET PG Surgery — Differential Diagnosis Quick Reference  |  Orris AI")
    canvas.drawRightString(PAGE_W - MARGIN, 8*mm, f"Page {doc.page}")
    canvas.setStrokeColor(ACCENT)
    canvas.setLineWidth(0.5)
    canvas.line(MARGIN, 11*mm, PAGE_W - MARGIN, 11*mm)
    canvas.restoreState()

doc.build(story, onFirstPage=add_page_number, onLaterPages=add_page_number)
print(f"SUCCESS: PDF created at {OUTPUT}")
print(f"Size: {os.path.getsize(OUTPUT)/1024:.1f} KB")

cd /home/daytona/workspace/neet-pg-surgery && python3 create_pdf.py