🧠 PSYCHIATRY - HIGH YIELD FMGE / NEET PG NOTES (5 Pages)

mkdir -p /home/daytona/workspace/psychiatry-cheatsheet && ls /home/daytona/works…

~/psychiatry-cheatsheet/generate_pdf.py

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

# ── Colour palette ──────────────────────────────────────────────────────────
C_NAVY   = HexColor("#0A2342")
C_TEAL   = HexColor("#0D7377")
C_GOLD   = HexColor("#F4A800")
C_RED    = HexColor("#C0392B")
C_GREEN  = HexColor("#1A7A4A")
C_PURPLE = HexColor("#6C3483")
C_BLUE   = HexColor("#1565C0")
C_ORANGE = HexColor("#E65100")
C_LTGRAY = HexColor("#F5F5F5")
C_MDGRAY = HexColor("#DDDDDD")
C_DKGRAY = HexColor("#444444")
C_PINK   = HexColor("#FCE4EC")
C_LYELLOW= HexColor("#FFFDE7")
C_LCYAN  = HexColor("#E0F7FA")
C_LGREEN = HexColor("#E8F5E9")
C_LPUR   = HexColor("#F3E5F5")

W, H = A4
M = 12*mm   # margin

# ── Styles ───────────────────────────────────────────────────────────────────
ss = getSampleStyleSheet()

def S(name, **kw):
    return ParagraphStyle(name, **kw)

TITLE = S("title", fontName="Helvetica-Bold", fontSize=18,
          textColor=white, alignment=TA_CENTER, spaceAfter=2)
PAGE_HEADER = S("ph", fontName="Helvetica-Bold", fontSize=11,
                textColor=white, alignment=TA_CENTER, spaceAfter=3)
H1 = S("h1", fontName="Helvetica-Bold", fontSize=9,
        textColor=white, spaceAfter=2, spaceBefore=4, leading=11)
H2 = S("h2", fontName="Helvetica-Bold", fontSize=8,
        textColor=C_NAVY, spaceAfter=1, spaceBefore=3, leading=10)
BODY = S("body", fontName="Helvetica", fontSize=7,
         textColor=C_DKGRAY, spaceAfter=1, leading=9)
BOLD = S("bold", fontName="Helvetica-Bold", fontSize=7,
         textColor=C_DKGRAY, spaceAfter=1, leading=9)
BULLET = S("bullet", fontName="Helvetica", fontSize=7,
           textColor=C_DKGRAY, spaceAfter=0.5, leading=9,
           leftIndent=8, bulletIndent=0)
RED_BOLD = S("rdb", fontName="Helvetica-Bold", fontSize=7,
             textColor=C_RED, spaceAfter=1, leading=9)
STAR = S("star", fontName="Helvetica-Bold", fontSize=7,
         textColor=C_ORANGE, spaceAfter=0.5, leading=9,
         leftIndent=8)

def hdr_block(text, color=C_NAVY):
    """A full-width coloured heading block."""
    t = Table([[Paragraph(text, H1)]], colWidths=[W - 2*M])
    t.setStyle(TableStyle([
        ("BACKGROUND", (0,0), (-1,-1), color),
        ("LEFTPADDING",  (0,0), (-1,-1), 5),
        ("RIGHTPADDING", (0,0), (-1,-1), 5),
        ("TOPPADDING",   (0,0), (-1,-1), 3),
        ("BOTTOMPADDING",(0,0), (-1,-1), 3),
        ("ROWBACKGROUNDS",(0,0),(-1,-1),[color]),
    ]))
    return t

def sub_hdr(text, color=C_TEAL):
    t = Table([[Paragraph(f"<b>{text}</b>", S("sh", fontName="Helvetica-Bold",
                fontSize=7.5, textColor=white, leading=10))]],
              colWidths=[W - 2*M])
    t.setStyle(TableStyle([
        ("BACKGROUND", (0,0),(-1,-1), color),
        ("LEFTPADDING",(0,0),(-1,-1), 4),
        ("TOPPADDING", (0,0),(-1,-1),2),
        ("BOTTOMPADDING",(0,0),(-1,-1),2),
    ]))
    return t

def two_col_table(rows, col_ratios=(0.38, 0.62), hdr_row=None, alt=True):
    cw = [(W-2*M)*r for r in col_ratios]
    data = []
    if hdr_row:
        data.append([Paragraph(f"<b>{h}</b>", S("th", fontName="Helvetica-Bold",
                    fontSize=7, textColor=white, leading=9)) for h in hdr_row])
    for r in rows:
        data.append([Paragraph(str(c), BODY) for c in r])
    ts = [
        ("FONTNAME",(0,0),(-1,-1),"Helvetica"),
        ("FONTSIZE",(0,0),(-1,-1),7),
        ("LEADING", (0,0),(-1,-1),9),
        ("GRID",(0,0),(-1,-1),0.3,C_MDGRAY),
        ("VALIGN",(0,0),(-1,-1),"TOP"),
        ("LEFTPADDING",(0,0),(-1,-1),3),
        ("RIGHTPADDING",(0,0),(-1,-1),3),
        ("TOPPADDING",(0,0),(-1,-1),2),
        ("BOTTOMPADDING",(0,0),(-1,-1),2),
    ]
    if hdr_row:
        ts += [("BACKGROUND",(0,0),(-1,0), C_NAVY),
               ("TEXTCOLOR",(0,0),(-1,0), white),
               ("FONTNAME",(0,0),(-1,0),"Helvetica-Bold")]
        if alt:
            for i in range(1, len(data)):
                bg = C_LTGRAY if i % 2 == 1 else white
                ts.append(("BACKGROUND",(0,i),(-1,i), bg))
    else:
        if alt:
            for i in range(len(data)):
                bg = C_LTGRAY if i % 2 == 0 else white
                ts.append(("BACKGROUND",(0,i),(-1,i), bg))
    t = Table(data, colWidths=cw)
    t.setStyle(TableStyle(ts))
    return t

def three_col_table(rows, col_ratios=(0.25,0.38,0.37), hdr_row=None):
    cw = [(W-2*M)*r for r in col_ratios]
    data = []
    if hdr_row:
        data.append([Paragraph(f"<b>{h}</b>", S("th3", fontName="Helvetica-Bold",
                    fontSize=7, textColor=white, leading=9)) for h in hdr_row])
    for r in rows:
        data.append([Paragraph(str(c), BODY) for c in r])
    ts = [
        ("FONTNAME",(0,0),(-1,-1),"Helvetica"),
        ("FONTSIZE",(0,0),(-1,-1),7),
        ("LEADING", (0,0),(-1,-1),9),
        ("GRID",(0,0),(-1,-1),0.3,C_MDGRAY),
        ("VALIGN",(0,0),(-1,-1),"TOP"),
        ("LEFTPADDING",(0,0),(-1,-1),3),
        ("RIGHTPADDING",(0,0),(-1,-1),3),
        ("TOPPADDING",(0,0),(-1,-1),2),
        ("BOTTOMPADDING",(0,0),(-1,-1),2),
    ]
    if hdr_row:
        ts += [("BACKGROUND",(0,0),(-1,0), C_NAVY),
               ("TEXTCOLOR",(0,0),(-1,0), white),
               ("FONTNAME",(0,0),(-1,0),"Helvetica-Bold")]
        for i in range(1, len(data)):
            bg = C_LTGRAY if i % 2 == 1 else white
            ts.append(("BACKGROUND",(0,i),(-1,i), bg))
    t = Table(data, colWidths=cw)
    t.setStyle(TableStyle(ts))
    return t

def pyq_box(q, a):
    """Yellow PYQ highlight box."""
    content = [
        [Paragraph(f"<b>⭐ PYQ:</b> {q}", S("pyqq", fontName="Helvetica-Bold",
                   fontSize=7, textColor=C_NAVY, leading=9)),
         Paragraph(f"<b>Ans:</b> {a}", S("pyqa", fontName="Helvetica-Bold",
                   fontSize=7, textColor=C_RED, leading=9))]
    ]
    t = Table(content, colWidths=[(W-2*M)*0.68, (W-2*M)*0.32])
    t.setStyle(TableStyle([
        ("BACKGROUND",(0,0),(-1,-1), C_LYELLOW),
        ("BOX",(0,0),(-1,-1),0.5, C_GOLD),
        ("LEFTPADDING",(0,0),(-1,-1),4),
        ("RIGHTPADDING",(0,0),(-1,-1),4),
        ("TOPPADDING",(0,0),(-1,-1),2),
        ("BOTTOMPADDING",(0,0),(-1,-1),2),
        ("VALIGN",(0,0),(-1,-1),"TOP"),
    ]))
    return t

def red_box(text):
    t = Table([[Paragraph(f"🚨 {text}", S("rb", fontName="Helvetica-Bold",
               fontSize=7, textColor=C_RED, leading=9))]],
              colWidths=[W-2*M])
    t.setStyle(TableStyle([
        ("BACKGROUND",(0,0),(-1,-1), HexColor("#FFEBEE")),
        ("BOX",(0,0),(-1,-1),0.8, C_RED),
        ("LEFTPADDING",(0,0),(-1,-1),5),
        ("TOPPADDING",(0,0),(-1,-1),2),
        ("BOTTOMPADDING",(0,0),(-1,-1),2),
    ]))
    return t

def sp(h=2):
    return Spacer(1, h*mm)

# ════════════════════════════════════════════════════════════════════════════
#  BUILD STORY
# ════════════════════════════════════════════════════════════════════════════
story = []

# ── COVER HEADER ────────────────────────────────────────────────────────────
cover = Table([[Paragraph("🧠  PSYCHIATRY — EXAM DAY CHEAT SHEET", TITLE)],
               [Paragraph("NEET PG · FMGE · INI-CET  |  All PYQ Concepts · 5 Pages · 2021–2025", PAGE_HEADER)]],
              colWidths=[W-2*M])
cover.setStyle(TableStyle([
    ("BACKGROUND",(0,0),(-1,-1), C_NAVY),
    ("TOPPADDING",(0,0),(-1,-1),5),
    ("BOTTOMPADDING",(0,0),(-1,-1),5),
    ("LEFTPADDING",(0,0),(-1,-1),8),
]))
story += [cover, sp(3)]

# ══════════════════════════════════════════════════════════
#  PAGE 1 — PSYCHOSIS, SCHIZOPHRENIA & ANTIPSYCHOTICS
# ══════════════════════════════════════════════════════════
story.append(hdr_block("PAGE 1 ▸ PSYCHOSIS · SCHIZOPHRENIA · ANTIPSYCHOTICS", C_NAVY))
story.append(sp(1))

# Duration criteria table
story.append(sub_hdr("▸ PSYCHOSIS SPECTRUM — DURATION CRITERIA (Most-tested!)", C_TEAL))
story.append(sp(1))
story.append(two_col_table([
    ["Brief Psychotic Disorder", "< 1 month (sudden onset, good prognosis)"],
    ["Schizophreniform Disorder", "1 – 6 months"],
    ["Schizophrenia", "> 6 months (1 month active + prodrome/residual)"],
    ["Schizoaffective Disorder", "Psychosis 2+ wks WITHOUT mood sx; mood + psychosis overlap"],
    ["Delusional Disorder", "≥1 month non-bizarre delusions; functioning INTACT"],
], hdr_row=["Disorder","Key Duration / Feature"]))
story.append(sp(1))

story.append(pyq_box("Minimum duration for diagnosis of Schizophrenia (DSM-5)?", "6 months (1 month active)"))
story.append(sp(1))
story.append(pyq_box("Schizophrenia duration in ICD-10?", "1 month"))
story.append(sp(1))

# Schneider First Rank
story.append(sub_hdr("▸ SCHNEIDER'S FIRST RANK SYMPTOMS (FRS) — Classic FMGE/NEET PYQ", C_PURPLE))
story.append(sp(1))
story.append(two_col_table([
    ["Thought alienation", "Thought insertion / withdrawal / broadcasting"],
    ["Passivity experiences", "Made feelings, impulses, actions (body controlled by outside force)"],
    ["Hallucinatory voices", "Voices arguing, voices commenting, thought echo (gedankenlautwerden)"],
    ["Delusional perception", "Normal perception + sudden delusional meaning (2-stage)"],
], hdr_row=["Category","Examples"]))
story.append(sp(1))
story.append(pyq_box("Thought broadcasting is classified as?", "Schneider's First Rank Symptom"))
story.append(sp(1))

# Positive vs Negative
story.append(sub_hdr("▸ POSITIVE vs NEGATIVE SYMPTOMS", C_GREEN))
story.append(sp(1))
story.append(two_col_table([
    ["<b>Positive (Type I)</b>", "Hallucinations, delusions, disorganized speech/behaviour, catatonia → Respond to TYPICALS"],
    ["<b>Negative (Type II)</b>", "5 A's: Affective flattening, Alogia, Avolition, Anhedonia, Asociality → Need ATYPICALS"],
], col_ratios=(0.28,0.72)))
story.append(sp(1))

# Good/bad prognosis
story.append(sub_hdr("▸ PROGNOSIS FACTORS IN SCHIZOPHRENIA", C_BLUE))
story.append(sp(1))
story.append(two_col_table([
    ["Good Prognosis", "Female, Older onset, Married, Acute onset, Obvious precipitant, Prominent +ve sx, Good premorbid, Affective sx, Short duration"],
    ["Poor Prognosis", "Male, Young onset, Single, Insidious onset, No precipitant, Prominent -ve sx, FH schizophrenia, Early onset"],
], col_ratios=(0.25,0.75)))
story.append(sp(1))

# Antipsychotics table
story.append(sub_hdr("▸ ANTIPSYCHOTICS — HIGH YIELD TABLE", C_ORANGE))
story.append(sp(1))
story.append(three_col_table([
    ["Haloperidol", "Typical (High potency)", "Most EPS, raised prolactin, IM for acute agitation"],
    ["Chlorpromazine", "Typical (Low potency)", "Sedation, anticholinergic, photosensitivity, corneal deposits"],
    ["Clozapine", "Atypical – GOLD STANDARD TRS", "Agranulocytosis (ANC monitoring!), NO EPS, NO prolactin rise, seizures, myocarditis, sialorrhoea"],
    ["Olanzapine", "Atypical", "Max metabolic syndrome, weight gain, sedation"],
    ["Risperidone", "Atypical", "Most prolactin rise of atypicals, dose-dep EPS"],
    ["Quetiapine", "Atypical", "Sedation, bipolar depression, least EPS, least prolactin"],
    ["Aripiprazole", "Atypical (partial D2 agonist)", "Weight neutral, akathisia, ASD irritability"],
    ["Amisulpride", "Atypical (D2/D3 selective)", "Prolactin rise, no sedation, negative sx"],
], hdr_row=["Drug","Class","Key Points"], col_ratios=(0.22,0.28,0.50)))
story.append(sp(1))

# EPS
story.append(sub_hdr("▸ EXTRAPYRAMIDAL SIDE EFFECTS (EPS) — Timing & Rx", C_RED))
story.append(sp(1))
story.append(three_col_table([
    ["Acute Dystonia", "Hours–Days", "Rx: Benztropine / Diphenhydramine IV"],
    ["Akathisia", "Days–Weeks", "Rx: Propranolol (FIRST), Benzodiazepines (NOT benztropine)"],
    ["Drug-induced Parkinsonism", "Weeks–Months", "Rx: Benztropine / Biperiden; reduce dose"],
    ["Tardive Dyskinesia (TD)", "Months–Years", "Rx: Valbenazine / Deutetrabenazine; STOP drug; irreversible if prolonged"],
    ["Neuroleptic Malignant Syndrome", "Any time", "Rx: STOP drug, Dantrolene + Bromocriptine; ICU; high fever, lead-pipe rigidity, elevated CK"],
], hdr_row=["EPS","Onset","Treatment"], col_ratios=(0.28,0.22,0.50)))
story.append(sp(1))

story.append(pyq_box("Drug of choice for acute dystonia?", "IV Benztropine / Diphenhydramine"))
story.append(sp(1))
story.append(pyq_box("Treatment-resistant schizophrenia (TRS) drug?", "Clozapine"))
story.append(sp(1))
story.append(pyq_box("Which antipsychotic causes agranulocytosis requiring ANC monitoring?", "Clozapine"))

story.append(PageBreak())

# ══════════════════════════════════════════════════════════
#  PAGE 2 — MOOD DISORDERS
# ══════════════════════════════════════════════════════════
story.append(hdr_block("PAGE 2 ▸ MOOD DISORDERS — DEPRESSION · MANIA · BIPOLAR", C_TEAL))
story.append(sp(2))

story.append(sub_hdr("▸ MDD — DSM-5 DIAGNOSTIC CRITERIA (SIGECAPS)", C_TEAL))
story.append(sp(1))
story.append(two_col_table([
    ["Duration", "≥2 weeks"],
    ["Required", "5 symptoms; ≥1 MUST be Depressed mood OR Anhedonia"],
    ["<b>S</b>leep", "Insomnia or hypersomnia"],
    ["<b>I</b>nterest", "Anhedonia (loss of pleasure)"],
    ["<b>G</b>uilt / Worthlessness", "Excessive or inappropriate guilt"],
    ["<b>E</b>nergy", "Fatigue / loss of energy"],
    ["<b>C</b>oncentration", "Difficulty thinking / deciding"],
    ["<b>A</b>ppetite / Weight", "↑ or ↓ weight / appetite"],
    ["<b>P</b>sychomotor", "Agitation or retardation"],
    ["<b>S</b>uicide", "Thoughts of death, suicidal ideation / attempt"],
], col_ratios=(0.30, 0.70)))
story.append(sp(1))

story.append(sub_hdr("▸ MDD SPECIFIERS — HIGH YIELD", C_BLUE))
story.append(sp(1))
story.append(three_col_table([
    ["Melancholic", "Severe anhedonia, early morning awakening, diurnal variation (worse AM), profound guilt, psychomotor Δ, weight loss", "Endogenous; DST non-suppression; TCAs/ECT effective"],
    ["Atypical", "Mood REACTIVITY, hypersomnia, hyperphagia, leaden paralysis, rejection sensitivity", "MAOIs drug of choice"],
    ["Psychotic", "Delusions/hallucinations; mood-congruent (90%) > mood-incongruent", "Antidepressant + Antipsychotic; OR ECT"],
    ["Seasonal (SAD)", "Winter depression, hypersomnia, hyperphagia, carbohydrate craving", "Light therapy 10,000 lux; SSRIs"],
    ["Peripartum", "Onset during pregnancy or within 4 weeks postpartum", "Baby blues (2 wks) → PPD (>2 wks) → Postpartum Psychosis (ECT if severe)"],
    ["Catatonic", "Waxy flexibility, mutism, negativism, posturing", "Benzodiazepines / ECT"],
], hdr_row=["Specifier","Features","Treatment / Notes"], col_ratios=(0.18,0.47,0.35)))
story.append(sp(1))

story.append(pyq_box("Depression with features of hypersomnia, hyperphagia, mood reactivity — DOC?", "MAOIs (atypical depression)"))
story.append(sp(1))
story.append(pyq_box("DST (Dexamethasone Suppression Test) non-suppression seen in?", "Melancholic depression"))
story.append(sp(1))

story.append(sub_hdr("▸ BIPOLAR DISORDER — KEY FACTS", C_PURPLE))
story.append(sp(1))
story.append(three_col_table([
    ["Bipolar I", "≥1 full Manic episode (depression NOT required)", "Lithium; Valproate; Atypical APs"],
    ["Bipolar II", "Hypomanic episodes + MDD; NO full mania", "Quetiapine; Lamotrigine"],
    ["Cyclothymia", "Hypomanic + depressive sx ≥2 years, never full criteria", "Lithium / Valproate"],
    ["Rapid Cycling", "≥4 episodes/year; more in females; assoc hypothyroidism", "Stop antidepressants; Valproate; Lamotrigine"],
    ["Mixed Features", "Manic + depressive sx simultaneously — HIGHEST suicide risk", "Valproate / Atypical APs"],
], hdr_row=["Type","Criteria","Treatment"], col_ratios=(0.20,0.47,0.33)))
story.append(sp(1))

# Manic episode
story.append(sub_hdr("▸ MANIC EPISODE — DIGFAST (DSM-5)", C_GOLD))
story.append(sp(1))
story.append(two_col_table([
    ["Duration", "≥7 days (or any duration if hospitalised)"],
    ["Mood", "Elevated / expansive / IRRITABLE (irritable → need 4 of DIGFAST; elevated → need 3)"],
    ["<b>D</b>istractibility", "Easily distracted by irrelevant stimuli"],
    ["<b>I</b>rresponsibility/Impulsivity", "Risky sexual behaviour, spending sprees, poor judgement"],
    ["<b>G</b>randiosity", "Inflated self-esteem, delusions of grandeur"],
    ["<b>F</b>light of Ideas", "Rapid switching thoughts; pressured speech"],
    ["<b>A</b>ctivity ↑", "Goal-directed activity increase or psychomotor agitation"],
    ["<b>S</b>leep ↓", "Decreased need for sleep WITHOUT fatigue"],
    ["<b>T</b>alkativeness", "More talkative, pressured speech"],
], col_ratios=(0.28, 0.72)))
story.append(sp(1))

story.append(pyq_box("Rapid cycling bipolar most common in which gender?", "Female"))
story.append(sp(1))
story.append(pyq_box("Which episode has highest suicide risk in bipolar?", "Mixed episode / Bipolar depression"))
story.append(sp(1))

# Lithium
story.append(sub_hdr("▸ LITHIUM — ALL HIGH-YIELD FACTS", C_RED))
story.append(sp(1))
story.append(two_col_table([
    ["Therapeutic range", "0.6 – 1.2 mEq/L (acute: 0.8–1.2; maintenance: 0.6–0.8)"],
    ["Toxicity levels", ">1.2 = mild (tremor, nausea); >1.5 = moderate (ataxia, confusion); >2.0 = severe (seizures, coma)"],
    ["Sample timing", "12 hours post-dose (trough level)"],
    ["Monitoring", "TFTs (hypothyroidism), Serum creatinine (nephrogenic DI), ECG (T-wave flattening/inversion)"],
    ["Teratogenicity", "Ebstein's anomaly (cardiac — tricuspid valve) — 1st trimester CI"],
    ["Drugs that ↑ Lithium levels (→ TOXICITY)", "NSAIDs, Thiazide diuretics, ACE inhibitors — REDUCE renal clearance"],
    ["Drugs that ↓ Lithium levels", "Theophylline, carbonic anhydrase inhibitors, caffeine"],
    ["Benefits", "Reduces suicide 6–7× in bipolar; only mood stabilizer with antisuicidal effect"],
    ["Side effects", "Fine tremor (β-blocker Rx), polyuria/polydipsia, weight gain, acne, leukocytosis (benign), hypothyroidism"],
], col_ratios=(0.35, 0.65)))
story.append(sp(1))
story.append(pyq_box("NSAIDs + Lithium → ?", "Increase Lithium levels → Toxicity (inhibit renal prostaglandin → ↓ renal clearance)"))

story.append(PageBreak())

# ══════════════════════════════════════════════════════════
#  PAGE 3 — ANXIETY, OCD, PTSD, SLEEP & SUICIDE
# ══════════════════════════════════════════════════════════
story.append(hdr_block("PAGE 3 ▸ ANXIETY · OCD · PTSD · SLEEP · SUICIDE", C_GREEN))
story.append(sp(2))

story.append(sub_hdr("▸ ANXIETY DISORDERS — QUICK REFERENCE", C_TEAL))
story.append(sp(1))
story.append(three_col_table([
    ["Panic Disorder", "Recurrent unexpected panic attacks + ≥1 month anticipatory anxiety; palpitations, SOB, chest pain, derealization", "SSRIs (1st line); AVOID benzodiazepines long-term; CBT"],
    ["Social Anxiety Disorder", "Fear of scrutiny in social situations; ≥6 months; performance only subtype", "SSRIs; β-blocker (propranolol) for performance; CBT"],
    ["Specific Phobia", "Intense fear of specific object/situation; most common anxiety Dx; immediate fear response", "Systematic desensitization / Exposure therapy (1st line)"],
    ["GAD", "Excessive uncontrollable worry ≥6 months about MULTIPLE topics + ≥3 WATCHERS sx", "SSRIs/SNRIs; Buspirone (non-BZD); Venlafaxine; CBT"],
    ["Agoraphobia", "Fear of ≥2: public transport, open spaces, crowds, queue, outside home alone; without panic", "SSRIs + CBT"],
    ["Selective Mutism", "Fails to speak in specific social situations despite speaking in others; childhood", "CBT; SSRIs adjunct"],
], hdr_row=["Disorder","Key Features","Treatment"], col_ratios=(0.22,0.44,0.34)))
story.append(sp(1))

story.append(pyq_box("Most common anxiety disorder overall?", "Specific Phobia"))
story.append(sp(1))
story.append(pyq_box("Most common anxiety disorder in children?", "Separation Anxiety Disorder"))
story.append(sp(1))

story.append(sub_hdr("▸ OCD & RELATED DISORDERS", C_PURPLE))
story.append(sp(1))
story.append(three_col_table([
    ["OCD", "Obsessions + Compulsions; >1 hr/day; ego-DYSTONIC; CSTC circuit (orbitofrontal-caudate loop)", "SSRIs (high dose); Clomipramine (most potent); CBT-ERP; augment with Risperidone/Aripiprazole"],
    ["Body Dysmorphic Disorder", "Preoccupation with imagined defect; muscle dysmorphia in males; often comorbid depression", "SSRIs (high dose); CBT"],
    ["Hoarding Disorder", "Inability to discard; distress; separated from OCD in DSM-5", "CBT; SSRIs"],
    ["Trichotillomania", "Compulsive hair pulling; hair loss patches; tension before, relief after", "HRT (Habit Reversal Training); N-acetylcysteine"],
    ["Excoriation", "Compulsive skin picking; similar mechanism to trichotillomania", "HRT; SSRIs"],
], hdr_row=["Disorder","Features","Treatment"], col_ratios=(0.22,0.44,0.34)))
story.append(sp(1))
story.append(pyq_box("OCD rating scale?", "Yale-Brown Obsessive Compulsive Scale (Y-BOCS)"))
story.append(sp(1))
story.append(pyq_box("Most potent drug for OCD?", "Clomipramine (TCA) — but SSRIs used first due to better tolerability"))
story.append(sp(1))

story.append(sub_hdr("▸ TRAUMA-RELATED DISORDERS — PTSD vs ASD", C_BLUE))
story.append(sp(1))
story.append(two_col_table([
    ["PTSD", "Sx >1 month after trauma; 4 clusters: Intrusion (flashbacks/nightmares), Avoidance, Negative cognitions/mood, Hyperarousal"],
    ["Acute Stress Disorder", "3 days – 1 month after trauma; dissociative sx prominent"],
    ["Adjustment Disorder", "Within 3 months of stressor; resolves within 6 months of stressor removal; NOT full PTSD"],
    ["PTSD Treatment", "Trauma-focused CBT (FIRST); EMDR; SSRIs (Sertraline/Paroxetine — FDA approved); Prazosin for nightmares"],
    ["Complex PTSD", "Prolonged repeated trauma; emotional dysregulation, identity disturbance, negative self-concept"],
], hdr_row=["Concept","Key Detail"], col_ratios=(0.30,0.70)))
story.append(sp(1))

story.append(sub_hdr("▸ SLEEP DISORDERS — PYQ TABLE", C_ORANGE))
story.append(sp(1))
story.append(three_col_table([
    ["Narcolepsy", "EDS + Cataplexy + Hypnagogic hallucinations + Sleep paralysis; HLA-DQ B1*0602; ↓ Orexin/Hypocretin", "Modafinil (EDS); Sodium Oxybate (cataplexy); Venlafaxine"],
    ["Obstructive Sleep Apnea", "Loud snoring, apnea, EDS; AHI >5/hr; Neck circumference >17\" M, >15\" F", "CPAP (gold standard); weight loss"],
    ["REM Sleep Behavior Disorder", "Acting out dreams; injury risk; assoc Parkinson's, Lewy body, MSA — REM without atonia", "Clonazepam (1st line); Melatonin"],
    ["Restless Leg Syndrome", "Urge to move legs at rest/night; dysesthesia; worse evening; ↓ serum ferritin", "Pramipexole / Ropinirole (dopamine agonist); Iron if ferritin low"],
    ["Sleepwalking / Night Terrors", "NREM Stage 3 (SWS); children >> adults; amnesia on waking; NO full awakening", "Reassurance; Clonazepam; safety measures"],
    ["Nightmares", "REM sleep; vivid recall; frequently during 2nd half of night; in PTSD", "Prazosin (PTSD nightmares)"],
], hdr_row=["Disorder","Key Features","Treatment"], col_ratios=(0.22,0.44,0.34)))
story.append(sp(1))

story.append(pyq_box("Narcolepsy HLA type?", "HLA-DQ B1*0602 (also HLA-DR2)"))
story.append(sp(1))
story.append(pyq_box("Night terrors occur in which stage of sleep?", "NREM Stage 3 (Slow Wave Sleep)"))
story.append(sp(1))

story.append(sub_hdr("▸ SUICIDE — HIGH-YIELD FACTS", C_RED))
story.append(sp(1))
story.append(two_col_table([
    ["Completion rate", "M > F (men complete more); F > M (women attempt more)"],
    ["Method lethality", "Firearms > Hanging > Drowning > Drug overdose"],
    ["Highest risk disorder", "Anorexia Nervosa (highest death rate); then Bipolar disorder > Schizophrenia > MDD"],
    ["Risk factors (SAD PERSONS scale)", "Sex (M), Age (elderly), Depression, Previous attempt, EtOH/drugs, Rational thinking loss, Social isolation, Organised plan, No spouse, Sickness"],
    ["Best predictor", "Previous suicide attempt (STRONGEST single predictor)"],
    ["Protective factors", "Family support, religious belief, children at home, reason for living"],
    ["Antisuicidal drugs", "Lithium (bipolar), Clozapine (schizophrenia) — only drugs proven to reduce suicide"],
], hdr_row=["Concept","Detail"], col_ratios=(0.30,0.70)))

story.append(PageBreak())

# ══════════════════════════════════════════════════════════
#  PAGE 4 — PHARMACOLOGY, ECT, SOMATOFORM & PERSONALITY
# ══════════════════════════════════════════════════════════
story.append(hdr_block("PAGE 4 ▸ PSYCHOPHARMACOLOGY · ECT · SOMATOFORM · PERSONALITY", C_PURPLE))
story.append(sp(2))

story.append(sub_hdr("▸ ANTIDEPRESSANTS — COMPLETE TABLE", C_TEAL))
story.append(sp(1))
story.append(three_col_table([
    ["SSRIs\n(Fluoxetine, Sertraline,\nEscitalopram, Paroxetine)", "Sexual dysfunction, GI upset, insomnia, serotonin syndrome; SAFEST in OD; Fluoxetine = longest half-life (active metabolite norfluoxetine)", "1st line: Depression, OCD, Panic, SAD, PTSD; Paroxetine/Sertraline FDA-approved for PTSD"],
    ["SNRIs\n(Venlafaxine, Duloxetine)", "Hypertension (NE effect), sweating, discontinuation syndrome; Duloxetine for neuropathic pain, fibromyalgia", "GAD, depression, neuropathic pain"],
    ["TCAs\n(Amitriptyline, Imipramine,\nClomipramine, Nortriptyline)", "3 A's: Anticholinergic (dry mouth, urinary retention, constipation, blurred vision), Antiadrenergic (orthostasis), Antihistamine (sedation); QTc prolongation; LETHAL in OD (cardiac)", "Imipramine: nocturnal enuresis; Clomipramine: most potent OCD; Amitriptyline: neuropathic pain, migraine prophylaxis"],
    ["MAOIs\n(Phenelzine, Tranylcypromine,\nMoclobemide — reversible)", "Tyramine-containing foods → Hypertensive crisis (cheese, wine, cured meats); Serotonin syndrome with meperidine/SSRIs; orthostasis", "Atypical depression (1st choice); treatment-resistant; social anxiety"],
    ["Mirtazapine", "Alpha-2 antagonist; 5HT2/3 antagonist; strong sedation (antihistamine); weight gain; NO sexual dysfunction; NO nausea", "Depression with insomnia + weight loss; elderly"],
    ["Bupropion", "DA + NE reuptake inhibitor; NO sexual dysfunction; NO weight gain; CONTRAINDICATED in eating disorders (seizures, lowers seizure threshold)", "Depression; smoking cessation; ADHD (off-label)"],
    ["Trazodone", "5HT2 antagonist + weak reuptake inhibitor; Priapism (warn male patients!); sedation; alpha-1 blockade → orthostasis", "Low dose for insomnia; depression"],
    ["Vortioxetine", "Multi-modal serotonin drug; improves cognition; GI side effects", "MDD especially with cognitive sx"],
], hdr_row=["Drug Class","Side Effects / Notes","Key Indications"], col_ratios=(0.24,0.44,0.32)))
story.append(sp(1))

story.append(pyq_box("Antidepressant with priapism as side effect?", "Trazodone"))
story.append(sp(1))
story.append(pyq_box("Antidepressant contraindicated in seizure disorder and eating disorders?", "Bupropion"))
story.append(sp(1))

story.append(sub_hdr("▸ SEROTONIN SYNDROME vs NMS — Classic Differentiator PYQ", C_RED))
story.append(sp(1))
story.append(three_col_table([
    ["Cause", "Serotonergic excess (SSRIs + MAOIs, tramadol, linezolid, triptans)", "Antipsychotics / any D2 blocker (haloperidol, metoclopramide)"],
    ["Onset", "RAPID (hours to 24h)", "GRADUAL (days to weeks)"],
    ["Muscle tone", "Hyperreflexia + CLONUS (key!)", "Lead-pipe RIGIDITY (no clonus)"],
    ["Pupils", "Mydriasis", "Normal / variable"],
    ["Temperature", "Hyperthermia", "Hyperthermia (often higher)"],
    ["CK", "Normal to mildly elevated", "MARKEDLY elevated"],
    ["GI Sx", "Diarrhea, nausea (prominent)", "Absent"],
    ["Treatment", "Cyproheptadine (5HT antagonist); Benzodiazepines; STOP drug; cooling", "STOP drug; Dantrolene (muscle); Bromocriptine (D2 agonist); ICU"],
], hdr_row=["Feature","Serotonin Syndrome","NMS"], col_ratios=(0.22,0.39,0.39)))
story.append(sp(1))

story.append(sub_hdr("▸ ECT (ELECTROCONVULSIVE THERAPY) — ALL HIGH-YIELD FACTS", C_BLUE))
story.append(sp(1))
story.append(two_col_table([
    ["Indications", "Severe depression with suicidality; Psychotic depression; Catatonia; NMS; Mania resistant to Rx; Schizophrenia (positive sx); Depression in PREGNANCY (safest Rx)"],
    ["Absolute CI", "NONE (no absolute contraindications)"],
    ["Relative CI", "Raised ICP, recent MI (<3 months), recent CVA, intracranial mass, aortic aneurysm, phaeochromocytoma"],
    ["Medications", "Atropine (antisecretory, prevent bradycardia); Thiopentone/Propofol (anaesthesia); Succinylcholine (suxamethonium — muscle relaxant to prevent fractures)"],
    ["Side effects", "Anterograde amnesia (most common — usually temporary); Headache; Confusion; Postictal delirium; Memory issues (retrograde amnesia less common)"],
    ["Bilateral vs Unilateral", "Bilateral: MORE effective, MORE cognitive SE; Unilateral: fewer cognitive SE, slightly less effective"],
    ["Number of sessions", "6–12 sessions; 3 times/week; response often after 6–8 sessions"],
    ["Maintenance ECT", "Monthly ECT to prevent relapse after successful acute ECT course"],
], col_ratios=(0.28,0.72)))
story.append(sp(1))
story.append(pyq_box("ECT is safest treatment for depression in?", "Pregnancy"))
story.append(sp(1))
story.append(pyq_box("Most common side effect of ECT?", "Anterograde amnesia (temporary)"))
story.append(sp(1))

story.append(sub_hdr("▸ SOMATOFORM DISORDERS — DSM-5 (PYQ FAVOURITE)", C_ORANGE))
story.append(sp(1))
story.append(three_col_table([
    ["Somatic Symptom Disorder (SSD)", "≥1 somatic sx + EXCESSIVE health-related thoughts/feelings/behaviours ≥6 months; REPLACES somatisation disorder DSM-IV", "CBT; treat comorbid depression/anxiety"],
    ["Illness Anxiety Disorder (IAD)", "High anxiety about HAVING illness; FEW/NO symptoms; ≥6 months; REPLACES hypochondriasis", "CBT; SSRIs"],
    ["Conversion Disorder (FND)", "Neurological sx (paralysis, seizures, blindness, gait) INCONSISTENT with neurology; La belle indifférence; glove-stocking anesthesia", "Physiotherapy; psychotherapy; suggestion"],
    ["Factitious Disorder (Munchausen)", "INTENTIONAL falsification of sx in SELF for SICK ROLE; no external gain", "Confrontation gently; psychiatric referral"],
    ["Factitious by Proxy\n(Munchausen by proxy)", "Falsifying sx in ANOTHER (usually child); perpetrator = usually MOTHER (caregiver); medical child abuse", "Child protection; confrontation"],
    ["Malingering", "INTENTIONAL, EXTERNAL GAIN (money, legal, avoiding jail, drugs); NOT a mental disorder", "No treatment indicated; legal implications"],
], hdr_row=["Disorder","Key Features","Management"], col_ratios=(0.24,0.44,0.32)))
story.append(sp(1))
story.append(pyq_box("La belle indifférence is seen in?", "Conversion Disorder (Functional Neurological Disorder)"))
story.append(sp(1))
story.append(pyq_box("Munchausen by proxy — perpetrator is usually?", "Mother (primary caregiver)"))

story.append(PageBreak())

# ══════════════════════════════════════════════════════════
#  PAGE 5 — CHILD PSY, PERSONALITY, SUBSTANCE & MEDICOLEGAL
# ══════════════════════════════════════════════════════════
story.append(hdr_block("PAGE 5 ▸ CHILD PSY · PERSONALITY · SUBSTANCE · MEDICOLEGAL · RATING SCALES", C_ORANGE))
story.append(sp(2))

story.append(sub_hdr("▸ PERSONALITY DISORDERS — CLUSTER TABLE", C_NAVY))
story.append(sp(1))
story.append(three_col_table([
    ["CLUSTER A\n(Odd / Eccentric)", "Paranoid\nSchizoid\nSchizotypal",
     "Paranoid: Distrust, reads hidden meaning, no delusions\nSchizoid: Detached, restricted affect, loner, NO psychosis, NO desire for relationships\nSchizotypal: Magical thinking, ideas of reference, eccentric, odd speech — genetically linked to schizophrenia"],
    ["CLUSTER B\n(Dramatic / Emotional)", "Antisocial (ASPD)\nBorderline (BPD)\nHistrionic\nNarcissistic",
     "ASPD: ≥18 yrs + conduct disorder before 15; callous, no remorse; most common in male prisoners\nBPD: Unstable relationships/mood/identity; splitting; self-harm; fear of abandonment; F>>M; Rx: DBT\nHistrionic: Theatrical, seductive, attention-seeking\nNarcissistic: Grandiosity, no empathy, entitlement"],
    ["CLUSTER C\n(Anxious / Fearful)", "Avoidant\nDependent\nOBSESSIVE-COMPULSIVE PD",
     "Avoidant: Social inhibition from FEAR of rejection (WANTS relationships — unlike Schizoid)\nDependent: Need to be cared for; submissive; clingy\nOCPD: Perfectionism, orderliness, control; EGO-SYNTONIC (unlike OCD which is EGO-DYSTONIC)"],
], hdr_row=["Cluster","Disorders","Key Differentiators"], col_ratios=(0.18,0.20,0.62)))
story.append(sp(1))
story.append(pyq_box("Treatment of Borderline Personality Disorder?", "DBT (Dialectical Behaviour Therapy) — Marsha Linehan"))
story.append(sp(1))
story.append(pyq_box("OCPD vs OCD — key difference?", "OCPD is ego-SYNTONIC (feels normal to patient); OCD is ego-DYSTONIC (distressing/unwanted)"))
story.append(sp(1))

story.append(sub_hdr("▸ CHILD PSYCHIATRY — PYQ TABLE", C_TEAL))
story.append(sp(1))
story.append(three_col_table([
    ["ADHD", "Before age 12; inattention and/or hyperactivity in ≥2 settings; Inattentive, Hyperactive-Impulsive, Combined types", "Methylphenidate (stimulant, 1st line); Atomoxetine (non-stimulant, SNRI — if tics); Clonidine; Guanfacine"],
    ["Autism Spectrum Disorder (ASD)", "Deficits in social communication + restricted/repetitive behaviours; males 4:1; assoc Fragile X, tuberous sclerosis; NO regression after 2 yrs (unlike Rett)", "No disease-modifying Rx; Risperidone/Aripiprazole (FDA) for irritability; ABA therapy"],
    ["Tourette's Disorder", "Motor + vocal tics >1 year; onset <18 yrs; OCD comorbidity 50%; ADHD comorbidity 50%", "Haloperidol / Pimozide; Clonidine / Guanfacine; CBIT (habit reversal)"],
    ["Conduct Disorder", "Repeated violations of rights of others/social norms before 18 yrs; precursor to ASPD; 4 categories: aggression, property, deceitfulness, rule violation", "CBT; multisystemic therapy; treat comorbid ADHD"],
    ["Enuresis", "Involuntary voiding ≥2×/week for ≥3 months after age 5; nocturnal most common", "Bell-and-pad conditioning (best long-term); Imipramine; Desmopressin (short-term)"],
    ["Separation Anxiety", "Most common anxiety Dx in children; excessive fear of separation from attachment figure", "CBT; SSRIs adjunct"],
    ["Selective Mutism", "Speaking normally in some situations; silent in others (school); anxiety-based", "CBT; SSRIs"],
    ["Intellectual Disability", "IQ <70 + adaptive functioning deficits; onset <18 yrs; Mild (IQ 50-70) most common; Down syndrome most common identifiable cause", "Behavioural interventions; speech/OT/PT"],
], hdr_row=["Disorder","Key Features","Treatment"], col_ratios=(0.20,0.45,0.35)))
story.append(sp(1))
story.append(pyq_box("First-line drug for ADHD?", "Methylphenidate (Ritalin)"))
story.append(sp(1))
story.append(pyq_box("ADHD non-stimulant drug choice when tics are present?", "Atomoxetine"))
story.append(sp(1))

story.append(sub_hdr("▸ SUBSTANCE USE — HIGH-YIELD FACTS", C_RED))
story.append(sp(1))
story.append(three_col_table([
    ["Alcohol Withdrawal Timeline", "6-24h: Tremor, anxiety, diaphoresis\n24-48h: Seizures (GTCS)\n48-72h: Delirium Tremens (DTs) — mortality 5-15% untreated; confusion, autonomic instability, hallucinations",
     "Benzodiazepines (lorazepam/diazepam) 1st line; Thiamine BEFORE glucose (prevent Wernicke's); Carbamazepine (alternative)"],
    ["Wernicke-Korsakoff", "Wernicke: Confusion + Ophthalmoplegia + Ataxia (triad); mammillary body damage; REVERSIBLE with thiamine\nKorsakoff: Anterograde amnesia + Confabulation + Personality change; IRREVERSIBLE",
     "IV Thiamine STAT before glucose"],
    ["Opioid Overdose / Withdrawal", "Overdose: Pinpoint pupils, respiratory depression, unconsciousness; Rx: Naloxone IV\nWithdrawal: Yawning, lacrimation, goosebumps, diarrhoea, myalgia; NOT life-threatening",
     "Methadone or Buprenorphine (maintenance); Clonidine (symptomatic); Naltrexone (relapse prevention)"],
    ["Alcohol Dependence Rx", "Disulfiram (Antabuse): blocks ALDH → acetaldehyde accumulates → aversion\nNaltrexone: reduces craving (μ opioid receptor antagonist)\nAcamprosate: reduces NMDA-mediated craving",
     "Abstinence-based support + CBT + medications"],
    ["Cocaine / Amphetamine", "Intoxication: euphoria, tachycardia, hypertension, dilated pupils\nWithdrawal: Crash — hypersomnia, hyperphagia, anhedonia, depression",
     "No FDA-approved Rx; CBT; Modafinil investigational"],
    ["Cannabis", "Most commonly used illicit drug worldwide; withdrawal: irritability, insomnia, anxiety (Cannabis Use Disorder)",
     "No specific pharmacotherapy; CBT"],
], hdr_row=["Topic","Key Facts","Management"], col_ratios=(0.22,0.44,0.34)))
story.append(sp(1))
story.append(pyq_box("Potentially fatal withdrawal syndromes?", "Alcohol and Benzodiazepines ONLY (NOT opioids)"))
story.append(sp(1))

story.append(sub_hdr("▸ RATING SCALES (Every Year PYQ!)", C_BLUE))
story.append(sp(1))
story.append(two_col_table([
    ["MMSE", "Cognitive screening; max 30; <24 = impairment; <10 = severe; tests orientation, registration, attention, recall, language"],
    ["MoCA (Montreal Cognitive Assessment)", "More sensitive for MCI than MMSE; max 30; <26 = impairment"],
    ["HAM-D (Hamilton Depression Rating Scale)", "Clinician-rated depression severity; >17 = moderate-severe"],
    ["HAM-A (Hamilton Anxiety Rating Scale)", "Clinician-rated anxiety severity"],
    ["YMRS (Young Mania Rating Scale)", "Clinician-rated mania severity"],
    ["PANSS (Positive & Negative Syndrome Scale)", "Schizophrenia — positive, negative, general psychopathology subscales"],
    ["BPRS (Brief Psychiatric Rating Scale)", "Overall psychopathology; widely used in schizophrenia trials"],
    ["Y-BOCS (Yale-Brown OC Scale)", "OCD severity; 0–40; >16 = moderate; gold standard"],
    ["GAF (Global Assessment of Functioning)", "0–100; overall psychiatric functioning; used in DSM-IV Axis V"],
    ["AUDIT", "Alcohol Use Disorders Identification Test; 10 items; ≥8 = hazardous use"],
    ["CAGE", "Alcohol screening 4 Qs: Cut down, Annoyed, Guilty, Eye-opener; ≥2 positive = significant"],
    ["EPDS (Edinburgh Postnatal Depression Scale)", "Postpartum depression screening; ≥13 = probable depression"],
    ["PHQ-9", "Patient Health Questionnaire; self-rated depression; widely used in primary care"],
    ["SAD PERSONS Scale", "Suicide risk assessment; 10 factors scored 0-2 each"],
], col_ratios=(0.30,0.70), hdr_row=["Scale","Details"]))
story.append(sp(1))

story.append(sub_hdr("▸ MEDICOLEGAL PSYCHIATRY — INDIA (FMGE SPECIAL)", C_NAVY))
story.append(sp(1))
story.append(two_col_table([
    ["IPC Section 84", "Act of person of unsound mind — no criminal responsibility if at time of act did not know nature OR did not know act was wrong (McNaughton's Rules equivalent in India)"],
    ["McNaughton's Rules", "Cognitive test: (1) Did not know nature of act, OR (2) Did not know act was wrong — at time of committing"],
    ["Mental Healthcare Act 2017", "Right to access mental healthcare; right to community living; Advance Directive; Nominated Representative; decriminalises suicide attempt (Section 115 → not be punished)"],
    ["Testamentary Capacity", "Ability to make a valid will; must understand: nature of will-making, extent of property, names of beneficiaries, nature of claims"],
    ["Informed Consent", "4 elements: Disclosure of information, Patient competence, Voluntariness, Comprehension"],
    ["Durham Rule", "Product rule: criminal not responsible if act was product of mental disease or defect"],
    ["Irresistible Impulse Rule", "Could not resist even if knew it was wrong"],
    ["Fitness to Stand Trial", "Understanding charges, nature of proceedings, ability to assist lawyer"],
], hdr_row=["Concept","Detail"], col_ratios=(0.30,0.70)))
story.append(sp(2))

# Footer summary
footer_data = [
    [Paragraph("<b>⭐ TOP 10 LAST-MINUTE FACTS</b>", S("ft", fontName="Helvetica-Bold", fontSize=7.5, textColor=C_NAVY, leading=10))]
]
facts = [
    "1. Schizophrenia: DSM-5 = 6 months; ICD-10 = 1 month | 2. Clozapine: TRS + Agranulocytosis (monitor ANC weekly ×6mo, then monthly)",
    "3. Lithium toxicity: >1.2 mEq/L | NSAIDs/Thiazides RAISE levels → toxicity | Ebstein anomaly in 1st trimester",
    "4. ECT: No absolute CI | Best for depression in pregnancy | Anterograde amnesia most common SE",
    "5. Serotonin syndrome: Clonus + rapid onset | NMS: Rigidity + gradual onset + HIGH CK | Rx different",
    "6. Atypical depression: Mood reactivity + hypersomnia + hyperphagia → MAOIs first choice",
    "7. Acute dystonia: Benztropine IV | Akathisia: Propranolol (NOT benztropine) | TD: Valbenazine",
    "8. PTSD: FDA-approved SSRIs = Sertraline + Paroxetine | EMDR | Prazosin for nightmares",
    "9. BPD treatment = DBT | OCD ego-dystonic; OCPD ego-syntonic | Clomipramine most potent anti-OCD",
    "10. Munchausen by proxy perpetrator = mother | Malingering = external gain (not a disorder) | Conversion = la belle indifférence",
]
for f in facts:
    footer_data.append([Paragraph(f, S("fi", fontName="Helvetica", fontSize=6.5, textColor=C_DKGRAY, leading=8.5))])

footer_t = Table(footer_data, colWidths=[W - 2*M])
footer_t.setStyle(TableStyle([
    ("BACKGROUND",(0,0),(-1,0), C_LYELLOW),
    ("BACKGROUND",(0,1),(-1,-1), HexColor("#FFFDF0")),
    ("BOX",(0,0),(-1,-1),1, C_GOLD),
    ("INNERGRID",(0,0),(-1,-1),0.2, C_MDGRAY),
    ("LEFTPADDING",(0,0),(-1,-1),5),
    ("RIGHTPADDING",(0,0),(-1,-1),5),
    ("TOPPADDING",(0,0),(-1,-1),2),
    ("BOTTOMPADDING",(0,0),(-1,-1),2),
]))
story.append(footer_t)

# ── Build PDF ─────────────────────────────────────────────────────────────
def on_page(canvas, doc):
    canvas.saveState()
    # footer bar
    canvas.setFillColor(C_NAVY)
    canvas.rect(0, 0, W, 10*mm, fill=1, stroke=0)
    canvas.setFillColor(white)
    canvas.setFont("Helvetica", 7)
    canvas.drawCentredString(W/2, 3.5*mm,
        "PSYCHIATRY EXAM DAY CHEAT SHEET  |  NEET PG · FMGE · INI-CET  |  Kaplan & Sadock's Synopsis of Psychiatry")
    canvas.drawRightString(W - M, 3.5*mm, f"Page {doc.page}")
    canvas.restoreState()

OUT = "/home/daytona/workspace/psychiatry-cheatsheet/Psychiatry_NEET_FMGE_CheatSheet.pdf"

doc = SimpleDocTemplate(
    OUT,
    pagesize=A4,
    leftMargin=M, rightMargin=M,
    topMargin=10*mm, bottomMargin=14*mm,
    title="Psychiatry NEET PG FMGE Cheat Sheet",
    author="Orris Medical AI",
)
doc.build(story, onFirstPage=on_page, onLaterPages=on_page)
print(f"PDF saved: {OUT}")

cd /home/daytona/workspace/psychiatry-cheatsheet && python generate_pdf.py 2>&1

ls -lh /home/daytona/workspace/psychiatry-cheatsheet/Psychiatry_NEET_FMGE_CheatS…

~/psychiatry-cheatsheet/generate_biochem_pdf.py

from reportlab.lib.pagesizes import A4
from reportlab.lib.styles import ParagraphStyle
from reportlab.lib.units import mm
from reportlab.lib.colors import HexColor, white, black
from reportlab.platypus import (SimpleDocTemplate, Paragraph, Spacer, Table,
                                TableStyle, PageBreak)
from reportlab.lib.enums import TA_CENTER, TA_LEFT

# ── Palette ──────────────────────────────────────────────────────────────
C_NAVY   = HexColor("#0A2342")
C_TEAL   = HexColor("#006D77")
C_GOLD   = HexColor("#F4A800")
C_RED    = HexColor("#C0392B")
C_GREEN  = HexColor("#1A7A4A")
C_PURPLE = HexColor("#6C3483")
C_BLUE   = HexColor("#1565C0")
C_ORANGE = HexColor("#E65100")
C_BROWN  = HexColor("#5D4037")
C_LTGRAY = HexColor("#F5F5F5")
C_MDGRAY = HexColor("#DDDDDD")
C_DKGRAY = HexColor("#333333")
C_LYELLOW= HexColor("#FFFDE7")
C_LGREEN = HexColor("#E8F5E9")
C_LCYAN  = HexColor("#E0F7FA")
C_LRED   = HexColor("#FFEBEE")

W, H = A4
M = 11*mm

# ── Styles ───────────────────────────────────────────────────────────────
def S(name, **kw):
    return ParagraphStyle(name, **kw)

TITLE  = S("T", fontName="Helvetica-Bold", fontSize=17, textColor=white, alignment=TA_CENTER, spaceAfter=1)
SUBT   = S("ST", fontName="Helvetica-Bold", fontSize=9.5, textColor=white, alignment=TA_CENTER, spaceAfter=2)
H1     = S("H1", fontName="Helvetica-Bold", fontSize=8.5, textColor=white, spaceAfter=2, spaceBefore=3, leading=11)
BODY   = S("BD", fontName="Helvetica", fontSize=6.8, textColor=C_DKGRAY, spaceAfter=0.8, leading=8.8)
BOLD   = S("BL", fontName="Helvetica-Bold", fontSize=6.8, textColor=C_DKGRAY, spaceAfter=0.8, leading=8.8)

def sp(h=1.5): return Spacer(1, h*mm)

def hdr(text, color=C_NAVY):
    t = Table([[Paragraph(text, H1)]], colWidths=[W-2*M])
    t.setStyle(TableStyle([
        ("BACKGROUND",(0,0),(-1,-1),color),
        ("LEFTPADDING",(0,0),(-1,-1),6),("RIGHTPADDING",(0,0),(-1,-1),6),
        ("TOPPADDING",(0,0),(-1,-1),4),("BOTTOMPADDING",(0,0),(-1,-1),4),
    ])); return t

def shdr(text, color=C_TEAL):
    ts = S("sh",fontName="Helvetica-Bold",fontSize=7.5,textColor=white,leading=10)
    t = Table([[Paragraph(text, ts)]], colWidths=[W-2*M])
    t.setStyle(TableStyle([
        ("BACKGROUND",(0,0),(-1,-1),color),
        ("LEFTPADDING",(0,0),(-1,-1),5),("TOPPADDING",(0,0),(-1,-1),2),
        ("BOTTOMPADDING",(0,0),(-1,-1),2),
    ])); return t

def tbl2(rows, cr=(0.35,0.65), hdr_row=None, alt=True):
    cw = [(W-2*M)*r for r in cr]
    data = []
    if hdr_row:
        data.append([Paragraph(f"<b>{h}</b>",
            S("th",fontName="Helvetica-Bold",fontSize=6.8,textColor=white,leading=9)) for h in hdr_row])
    for r in rows:
        data.append([Paragraph(str(c), BODY) for c in r])
    ts = [("GRID",(0,0),(-1,-1),0.3,C_MDGRAY),("VALIGN",(0,0),(-1,-1),"TOP"),
          ("LEFTPADDING",(0,0),(-1,-1),3),("RIGHTPADDING",(0,0),(-1,-1),3),
          ("TOPPADDING",(0,0),(-1,-1),2),("BOTTOMPADDING",(0,0),(-1,-1),2),
          ("FONTSIZE",(0,0),(-1,-1),6.8),("LEADING",(0,0),(-1,-1),8.8)]
    if hdr_row:
        ts += [("BACKGROUND",(0,0),(-1,0),C_NAVY),("TEXTCOLOR",(0,0),(-1,0),white),
               ("FONTNAME",(0,0),(-1,0),"Helvetica-Bold")]
        start=1
    else: start=0
    if alt:
        for i in range(start, len(data)):
            ts.append(("BACKGROUND",(0,i),(-1,i), C_LTGRAY if i%2==0 else white))
    t = Table(data, colWidths=cw)
    t.setStyle(TableStyle(ts)); return t

def tbl3(rows, cr=(0.25,0.38,0.37), hdr_row=None):
    cw = [(W-2*M)*r for r in cr]
    data = []
    if hdr_row:
        data.append([Paragraph(f"<b>{h}</b>",
            S("th3",fontName="Helvetica-Bold",fontSize=6.8,textColor=white,leading=9)) for h in hdr_row])
    for r in rows:
        data.append([Paragraph(str(c), BODY) for c in r])
    ts = [("GRID",(0,0),(-1,-1),0.3,C_MDGRAY),("VALIGN",(0,0),(-1,-1),"TOP"),
          ("LEFTPADDING",(0,0),(-1,-1),3),("RIGHTPADDING",(0,0),(-1,-1),3),
          ("TOPPADDING",(0,0),(-1,-1),2),("BOTTOMPADDING",(0,0),(-1,-1),2),
          ("FONTSIZE",(0,0),(-1,-1),6.8),("LEADING",(0,0),(-1,-1),8.8)]
    if hdr_row:
        ts += [("BACKGROUND",(0,0),(-1,0),C_NAVY),("TEXTCOLOR",(0,0),(-1,0),white),
               ("FONTNAME",(0,0),(-1,0),"Helvetica-Bold")]
        for i in range(1,len(data)):
            ts.append(("BACKGROUND",(0,i),(-1,i), C_LTGRAY if i%2==1 else white))
    t = Table(data, colWidths=cw)
    t.setStyle(TableStyle(ts)); return t

def pyq(q, a):
    c1 = Paragraph(f"<b>⭐ PYQ:</b> {q}",
                   S("pq",fontName="Helvetica-Bold",fontSize=6.8,textColor=C_NAVY,leading=9))
    c2 = Paragraph(f"<b>Ans:</b> {a}",
                   S("pa",fontName="Helvetica-Bold",fontSize=6.8,textColor=C_RED,leading=9))
    t = Table([[c1,c2]], colWidths=[(W-2*M)*0.65,(W-2*M)*0.35])
    t.setStyle(TableStyle([
        ("BACKGROUND",(0,0),(-1,-1),C_LYELLOW),
        ("BOX",(0,0),(-1,-1),0.6,C_GOLD),
        ("LEFTPADDING",(0,0),(-1,-1),4),("RIGHTPADDING",(0,0),(-1,-1),4),
        ("TOPPADDING",(0,0),(-1,-1),2),("BOTTOMPADDING",(0,0),(-1,-1),2),
        ("VALIGN",(0,0),(-1,-1),"TOP"),
    ])); return t

# ════════════════════════════════════════════════════════════════════════
story = []

# COVER
cover = Table([
    [Paragraph("⚗️  BIOCHEMISTRY — EXAM DAY CHEAT SHEET", TITLE)],
    [Paragraph("NEET PG · FMGE · INI-CET  |  All PYQ Concepts · 5 Pages · 2021–2025  |  Harper's & Lippincott's", SUBT)]
], colWidths=[W-2*M])
cover.setStyle(TableStyle([
    ("BACKGROUND",(0,0),(-1,-1),C_NAVY),
    ("TOPPADDING",(0,0),(-1,-1),5),("BOTTOMPADDING",(0,0),(-1,-1),5),
    ("LEFTPADDING",(0,0),(-1,-1),8),
]))
story += [cover, sp(3)]

# ══════════════════════════════════════════════════════════════════════
# PAGE 1 — CARBOHYDRATE METABOLISM
# ══════════════════════════════════════════════════════════════════════
story.append(hdr("PAGE 1 ▸ CARBOHYDRATE METABOLISM", C_NAVY))
story.append(sp(1.5))

story.append(shdr("▸ GLYCOLYSIS (Embden–Meyerhof Pathway) — 10 Steps Key Facts", C_TEAL))
story.append(sp(1))
story.append(tbl2([
    ["Location", "Cytoplasm (all cells, especially RBCs which have NO mitochondria)"],
    ["Net ATP yield", "2 ATP (anaerobic); 5–7 ATP (aerobic, via NADH → ETC)"],
    ["Key Irreversible Enzymes\n(Rate-limiting = PFK-1)", "1. Hexokinase/Glucokinase (Step 1)\n2. Phosphofructokinase-1 / PFK-1 (Step 3) — RATE LIMITING\n3. Pyruvate kinase (Step 10)"],
    ["PFK-1 Activators", "AMP, ADP, Fructose-2,6-bisphosphate (F-2,6-BP), Pi"],
    ["PFK-1 Inhibitors", "ATP, Citrate, H+ (acidosis)"],
    ["Glucokinase vs Hexokinase", "Glucokinase: liver/β-cells; HIGH Km (low affinity); NOT inhibited by G-6-P; induced by insulin\nHexokinase: most tissues; LOW Km (high affinity); inhibited by G-6-P"],
    ["Pyruvate kinase deficiency", "Most common RBC enzyme deficiency → Hemolytic anemia; ↑ 2,3-BPG"],
    ["Warburg Effect", "Cancer cells prefer anaerobic glycolysis even in presence of O₂ (aerobic glycolysis)"],
], hdr_row=["Concept","Detail"]))
story.append(sp(1))
story.append(pyq("Rate-limiting enzyme of glycolysis?", "Phosphofructokinase-1 (PFK-1)"))
story.append(sp(1))
story.append(pyq("Enzyme deficiency causing hemolytic anemia in RBCs?", "Pyruvate kinase deficiency"))
story.append(sp(1))

story.append(shdr("▸ TCA CYCLE (Krebs / Citric Acid Cycle) — Key Points", C_PURPLE))
story.append(sp(1))
story.append(tbl2([
    ["Location", "Mitochondrial matrix"],
    ["Entry substrate", "Acetyl CoA (2C) + Oxaloacetate (4C) → Citrate (6C)"],
    ["Per turn yield", "3 NADH + 1 FADH₂ + 1 GTP + 2 CO₂ (net per Acetyl CoA)"],
    ["Total ATP per glucose", "30–32 ATP (aerobic complete oxidation)"],
    ["Rate-limiting enzyme", "Isocitrate dehydrogenase (also: α-ketoglutarate DH, citrate synthase)"],
    ["Key irreversible steps", "Citrate synthase; Isocitrate DH; α-Ketoglutarate DH (all = 'Triple valve' — activated by ADP, Ca²⁺; inhibited by ATP, NADH)"],
    ["Anaplerotic reactions", "Pyruvate → OAA (by pyruvate carboxylase, needs biotin + ATP) — replenishes TCA"],
    ["α-Ketoglutarate DH cofactors", "TPP (B1), Lipoic acid, CoA (B5), FAD (B2), NAD+ (B3) — same as PDH complex"],
], hdr_row=["Concept","Detail"]))
story.append(sp(1))
story.append(pyq("Cofactors of Pyruvate Dehydrogenase complex?", "B1(TPP), B2(FAD/Lipoic acid), B3(NAD+), B5(CoA), Lipoic acid — 'Tender Loving Care For Nerves'"))
story.append(sp(1))

story.append(shdr("▸ GLUCONEOGENESIS — Bypass Enzymes (PYQ Every Year!)", C_GREEN))
story.append(sp(1))
story.append(tbl2([
    ["Location", "Liver (90%) + Kidney cortex (10%); NOT in muscle/brain"],
    ["Substrates", "Lactate (Cori cycle), Amino acids (esp. Alanine — glucose-alanine cycle), Glycerol, Propionate"],
    ["4 Bypass Enzymes\n(reverse glycolysis blocked steps)", "1. Pyruvate carboxylase: Pyruvate → OAA (biotin, ATP; activated by Acetyl CoA)\n2. PEPCK: OAA → PEP (GTP, CO₂ released)\n3. Fructose-1,6-bisphosphatase: F-1,6-BP → F-6-P (inhibited by AMP, F-2,6-BP)\n4. Glucose-6-phosphatase: G-6-P → Glucose (liver & kidney only; absent in muscle)"],
    ["Cori Cycle", "Lactate from muscle → Liver → Glucose → Back to muscle; net ATP cost to liver"],
    ["Key Regulators", "Glucagon/cortisol/glucagon ↑ GNG; Insulin ↓ GNG; F-2,6-BP inhibits F-1,6-BPase"],
    ["Von Gierke disease", "Glucose-6-phosphatase deficiency → fasting hypoglycemia, hepatomegaly, lactic acidosis, hyperuricemia"],
], hdr_row=["Concept","Detail"]))
story.append(sp(1))
story.append(pyq("Unique enzyme of gluconeogenesis absent in muscle?", "Glucose-6-phosphatase"))
story.append(sp(1))
story.append(pyq("Von Gierke disease — deficient enzyme?", "Glucose-6-phosphatase (Type Ia GSD)"))
story.append(sp(1))

story.append(shdr("▸ GLYCOGEN METABOLISM & GLYCOGEN STORAGE DISEASES", C_ORANGE))
story.append(sp(1))
story.append(tbl3([
    ["Type I — Von Gierke", "Glucose-6-phosphatase", "Liver, kidney; Fasting hypoglycemia, hepatomegaly, lactic acidosis, hyperuricemia, hyperlipidemia; ↑ G6P, ↑ lactate"],
    ["Type II — Pompe", "Lysosomal α-1,4-glucosidase (Acid maltase)", "ALL organs (generalized); Cardiomegaly, hypotonia, death by 2 yrs; ↑ glycogen in lysosomes"],
    ["Type III — Cori/Forbes", "Debranching enzyme (amylo-1,6-glucosidase)", "Liver + muscle; Milder than Von Gierke; abnormal glycogen (short outer branches)"],
    ["Type IV — Anderson", "Branching enzyme", "Liver cirrhosis; long unbranched glycogen chains"],
    ["Type V — McArdle", "Muscle phosphorylase", "Muscle only; Exercise intolerance, cramps, myoglobinuria; NO rise in lactate with exercise"],
    ["Type VI — Hers", "Liver phosphorylase", "Liver only; Mild hypoglycemia"],
    ["Type VII — Tarui", "Muscle PFK", "Muscle; Similar to McArdle; Also hemolytic anemia"],
], hdr_row=["Disease","Enzyme Deficient","Key Features"], cr=(0.22,0.28,0.50)))
story.append(sp(1))
story.append(pyq("GSD with cardiomegaly (pompe's) — enzyme deficient?", "Acid maltase (lysosomal α-1,4-glucosidase) — Type II"))
story.append(sp(1))
story.append(pyq("No rise in blood lactate after ischemic exercise test → ?", "McArdle disease (Type V GSD — muscle phosphorylase deficiency)"))

story.append(PageBreak())

# ══════════════════════════════════════════════════════════════════════
# PAGE 2 — LIPID METABOLISM + AMINO ACID METABOLISM
# ══════════════════════════════════════════════════════════════════════
story.append(hdr("PAGE 2 ▸ LIPID METABOLISM · AMINO ACID METABOLISM", C_TEAL))
story.append(sp(1.5))

story.append(shdr("▸ FATTY ACID SYNTHESIS vs β-OXIDATION", C_TEAL))
story.append(sp(1))
story.append(tbl3([
    ["Location", "Cytoplasm (synthesis)", "Mitochondrial matrix (β-oxidation)"],
    ["Rate-limiting enzyme", "Acetyl CoA Carboxylase (ACC)\n→ Acetyl CoA → Malonyl CoA\n(requires Biotin + ATP; activated by insulin/citrate; inhibited by glucagon/palmitoyl CoA)", "Carnitine palmitoyltransferase-1 (CPT-1)\n→ transfers FA into mitochondria\n(inhibited by Malonyl CoA — links synthesis & oxidation)"],
    ["Electron carrier", "NADPH (from HMP shunt)", "NADH + FADH₂ (→ ATP via ETC)"],
    ["Net yield — Palmitate (16C)", "7 ATP used; 8 Acetyl CoA produced", "7 cycles; 7 FADH₂ + 7 NADH + 8 Acetyl CoA → 106 ATP total"],
    ["Odd-chain FA oxidation", "Not applicable", "Yields Propionyl CoA → Succinyl CoA (requires B12 + biotin)"],
    ["Essential FA", "Linoleic acid (ω-6, 18:2) and α-Linolenic acid (ω-3, 18:3) — must come from diet"],
    ["Ketogenesis (excess β-ox)", "HMG CoA lyase in mitochondria → Acetoacetate, β-hydroxybutyrate, acetone\nOccurs in liver; used by brain/muscle in starvation", ""],
], hdr_row=["Feature","FA Synthesis","β-Oxidation"], cr=(0.22,0.39,0.39)))
story.append(sp(1))
story.append(pyq("Rate-limiting enzyme of fatty acid synthesis?", "Acetyl CoA Carboxylase (ACC)"))
story.append(sp(1))
story.append(pyq("Ketone body that cannot be measured in urine?", "β-Hydroxybutyrate (not a ketone chemically; urine dipstick misses it)"))
story.append(sp(1))

story.append(shdr("▸ CHOLESTEROL METABOLISM — High Yield", C_BLUE))
story.append(sp(1))
story.append(tbl2([
    ["Synthesis", "ALL nucleated cells; primarily liver; rate-limiting: HMG-CoA Reductase\nAcetyl CoA → HMG-CoA → Mevalonate → → Cholesterol (30C)"],
    ["HMG-CoA Reductase", "Inhibited by: Statins, Cholesterol (product), Glucagon; Activated by: Insulin"],
    ["Bile acids", "Primary: Cholic acid + Chenodeoxycholic acid (from cholesterol, liver)\nSecondary: Deoxycholic + Lithocholic (gut bacteria dehydroxylation)\nConjugated with Glycine/Taurine → bile salts"],
    ["Cholesterol transport", "Dietary → Chylomicrons → Liver; Liver → periphery via VLDL → IDL → LDL\nLDL taken up by LDL receptor (B-100 receptor); Reverse transport via HDL (apoA-1, LCAT)"],
    ["Familial Hypercholesterolemia", "LDL receptor mutation (autosomal dominant); very high LDL; xanthomas (tendon); premature CAD\nHetero: 1:500; Homo: 1:1,000,000; very high LDL"],
    ["Abetalipoproteinemia", "Inability to make apoB-containing lipoproteins → no chylomicron/VLDL; fat malabsorption, acanthocytes, spinocerebellar degeneration, vitamin ADEK deficiency"],
    ["Tangier disease", "↓ HDL; ABC-A1 transporter defect; orange tonsils; peripheral neuropathy"],
], hdr_row=["Concept","Detail"]))
story.append(sp(1))
story.append(pyq("Rate-limiting enzyme of cholesterol synthesis?", "HMG-CoA Reductase (target of statins)"))
story.append(sp(1))
story.append(pyq("Orange enlarged tonsils + low HDL = ?", "Tangier disease (ABC-A1 defect)"))
story.append(sp(1))

story.append(shdr("▸ AMINO ACID METABOLISM — KEY DISORDERS (PYQ Goldmine)", C_RED))
story.append(sp(1))
story.append(tbl3([
    ["Phenylketonuria (PKU)", "Phenylalanine hydroxylase deficiency (or BH4 cofactor)\nAutosomal recessive; Phenylalanine ↑ → phenylpyruvate in urine\nMusty/mousy odor; fair skin/hair/eyes; intellectual disability; seizures", "Low Phe diet; BH4 (sapropterin) for mild; newborn screening (Guthrie test)"],
    ["Alkaptonuria (Ochronosis)", "Homogentisate oxidase deficiency\nHomogentisic acid accumulates → urine turns black on standing\nOchronosis (dark pigment in connective tissue); Arthritis", "Vitamin C; low protein diet; no specific Rx"],
    ["Tyrosinemia Type I", "Fumarylacetoacetase deficiency\nCabbage odor urine; Hepatorenal involvement; ↑ succinylacetone → Fanconi syndrome; HIGH cancer risk", "NTBC (nitisinone) + diet restriction"],
    ["Homocystinuria", "Cystathionine β-synthase (CBS) deficiency (most common)\nHomocysteine ↑; Marfanoid habitus (tall, lens subluxation DOWN); Intellectual disability; Thrombosis\nB6 (pyridoxine) responsive in 50%", "B6 (if responsive); low Met + high cysteine diet; B12 + folate; betaine"],
    ["Maple Syrup Urine Disease (MSUD)", "Branched-chain α-keto acid DH deficiency (B1, B2, B3, B5, lipoic acid)\nLeucine, Isoleucine, Valine ↑; Sweet maple syrup odor urine; encephalopathy, cerebral edema", "Restrict BCAA; thiamine supplementation; dialysis acute"],
    ["Cystinuria", "Defect in renal tubular transport of COLA (Cystine, Ornithine, Lysine, Arginine)\nCystine kidney stones (hexagonal crystals); staghorn calculi\nNOT elevated serum cystine", "High fluid intake; alkalinize urine; D-penicillamine; tiopronin"],
    ["Hartnup Disease", "Defective neutral amino acid transport (tryptophan)\nPellagra-like (3Ds: Dermatitis, Diarrhea, Dementia); cerebellar ataxia; photosensitive rash", "High protein diet; Nicotinamide supplements"],
    ["Albinism", "Tyrosinase deficiency → No melanin synthesis\nOculocutaneous; photophobia; nystagmus; ↑ skin cancer risk", "Sun protection"],
    ["Urea Cycle Defects", "Ornithine transcarbamylase (OTC) deficiency — most common; X-linked\nAll others AR; Hyperammonemia → vomiting, encephalopathy, cerebral edema\nN-Acetylglutamate synthase (NAGS) — activates CPS-I (first enzyme)", "Low protein; Sodium benzoate/phenylbutyrate (scavenge nitrogen); Arginine supplement (except ARG deficiency); liver transplant"],
], hdr_row=["Disorder","Key Features","Treatment"], cr=(0.20,0.47,0.33)))
story.append(sp(1))
story.append(pyq("Lens subluxation DOWN + Marfanoid + Thrombosis + Intellectual disability?", "Homocystinuria (CBS deficiency) — Note: Marfan syndrome has lens sublux UP"))
story.append(sp(1))
story.append(pyq("Most common urea cycle defect?", "OTC (Ornithine Transcarbamylase) deficiency — X-linked"))
story.append(sp(1))
story.append(pyq("Maple syrup urine odor + BCAA elevated?", "MSUD — Branched-chain α-keto acid DH deficiency (requires B1/TPP)"))

story.append(PageBreak())

# ══════════════════════════════════════════════════════════════════════
# PAGE 3 — VITAMINS, MINERALS, ENZYMES & NUCLEOTIDE METABOLISM
# ══════════════════════════════════════════════════════════════════════
story.append(hdr("PAGE 3 ▸ VITAMINS · MINERALS · ENZYMES · NUCLEOTIDE METABOLISM", C_GREEN))
story.append(sp(1.5))

story.append(shdr("▸ FAT-SOLUBLE VITAMINS (A, D, E, K) — All High Yield", C_ORANGE))
story.append(sp(1))
story.append(tbl3([
    ["Vitamin A\n(Retinol)", "Night blindness (earliest sx); Xerophthalmia; Bitot's spots; keratomalacia\nToxicity: Pseudotumor cerebri (benign intracranial HTN), teratogenic (retinoic acid), hepatotoxicity\nActive form: 11-cis-retinal (vision); All-trans retinoic acid (differentiation)", "Liver (highest), yellow vegetables; Dose: 200,000 IU to children in endemic areas"],
    ["Vitamin D\n(Cholecalciferol D3)", "Rickets (children — bowing legs, craniotabes, rachitic rosary, Harrison's groove)\nOsteomalacia (adults — bone pain, Looser zones on X-ray)\nDeficiency: ↓Ca, ↓PO4, ↑PTH, ↑ALP\nSynthesis: Skin (7-dehydrocholesterol → D3) → Liver (25-OH, storage form) → Kidney (1,25-OH₂ = Calcitriol, active form)\nToxicity: Hypercalcemia, nephrocalcinosis, metastatic calcification", "Sunlight; D3 supplements; 1,25-(OH)₂D3 for renal failure"],
    ["Vitamin E\n(Tocopherol)", "Deficiency: Hemolytic anemia (premature infants), spinocerebellar ataxia, areflexia, retinitis pigmentosa\nMechanism: Lipid-soluble antioxidant; protects cell membranes from peroxidation\nABETALIPOPROTEINEMIA: can't absorb fat-sol vitamins → vit E deficiency", "Vegetable oils, nuts"],
    ["Vitamin K\n(Phylloquinone K1; Menaquinone K2)", "Deficiency: Prolonged PT (extrinsic pathway); bleeding; hemorrhagic disease of newborn\nMechanism: Cofactor for γ-carboxylation of Glu residues → Factors II,VII,IX,X (4 'K-factors') + Protein C,S,Z\nAntagonist: Warfarin (inhibits Vit K epoxide reductase)\nNOTE: PT prolonged first (Factor VII shortest half-life)", "Green leafy vegetables; Gut bacteria (K2); Newborns given IM vit K"],
], hdr_row=["Vitamin","Deficiency / Mechanism","Sources / Notes"], cr=(0.17,0.52,0.31)))
story.append(sp(1))
story.append(pyq("Active form of Vitamin D?", "1,25-dihydroxycholecalciferol (Calcitriol) — formed in kidney by 1α-hydroxylase"))
story.append(sp(1))
story.append(pyq("Vitamin K-dependent clotting factors?", "II, VII, IX, X + Protein C, S, Z"))
story.append(sp(1))

story.append(shdr("▸ WATER-SOLUBLE VITAMINS (B complex + C) — Complete PYQ Table", C_BLUE))
story.append(sp(1))
story.append(tbl3([
    ["B1 — Thiamine\n(TPP)", "Wet beriberi: High-output cardiac failure, dilated cardiomyopathy, peripheral edema\nDry beriberi: Peripheral neuropathy (glove-stocking)\nWernicke-Korsakoff: Ophthalmoplegia + Ataxia + Confusion; Mamillary body damage\nEnzymes: PDH, α-KGDH, Transketolase (HMP shunt), BCKDH (MSUD)\nTrasketolase activity in RBCs used to diagnose B1 deficiency", "Rice-based diet; alcoholism"],
    ["B2 — Riboflavin\n(FAD, FMN)", "Corneal neovascularization; Angular stomatitis (cheilosis); Magenta tongue; Seborrheic dermatitis; Photophobia\nCoenzyme: FAD/FMN for oxidation-reduction reactions", "Dairy, meat, eggs"],
    ["B3 — Niacin\n(NAD+, NADP+)", "Pellagra: 3 D's — Dermatitis (casal necklace), Diarrhea, Dementia (+Death = 4 D's)\nDermatitis is photosensitive (sun-exposed areas); Hartnup disease mimics pellagra\nToxicity: Flushing (prostaglandin-mediated; prevent with aspirin); Hepatotoxicity; Hyperglycemia; Hyperuricemia\nHighest nicotinic acid → used for ↑ HDL, ↓ triglycerides", "Meat, fish; synthesized from Tryptophan (60 mg Trp → 1 mg Niacin; needs B6)"],
    ["B5 — Pantothenic acid\n(CoA)", "Deficiency rare: 'Burning feet syndrome'; adrenal insufficiency\nCoenzyme A (CoA): Acetyl CoA, Malonyl CoA, Succinyl CoA", "Widespread in foods"],
    ["B6 — Pyridoxine\n(PLP)", "Peripheral neuropathy; Sideroblastic anemia (↓ δ-ALA synthase → ↓ heme)\nSeizures in infants (↓ GABA synthesis)\nIsoniazid (INH) → Vit B6 deficiency (give pyridoxine prophylactically)\nPLP-dependent enzymes: Aminotransferases (ALT/AST), Glycogen phosphorylase, δ-ALA synthase, Cystathionine β-synthase", "Meat, fish, potatoes"],
    ["B7 — Biotin", "Dermatitis, alopecia, glossitis, lactic acidosis\nRaw egg white (avidin) binds biotin → deficiency\nCarboxylase enzymes (all need biotin): Pyruvate carboxylase, ACC, Propionyl CoA carboxylase, β-Methylcrotonyl CoA carboxylase", "Egg yolk, liver, intestinal bacteria"],
    ["B9 — Folate\n(THF)", "Megaloblastic anemia (macrocytic, hypersegmented neutrophils); Glossitis; NO neurological sx\nNeural tube defects (spina bifida, anencephaly) — supplemented BEFORE conception\nMethotrexate, trimethoprim, pyrimethamine inhibit DHF reductase → functional folate deficiency\nFolate trap: B12 deficiency traps folate as 5-methyl-THF (cannot be used)", "Green leafy vegetables (foliage), liver, yeast; destroyed by cooking"],
    ["B12 — Cobalamin\n(Methylcobalamin, Adenosylcobalamin)", "Megaloblastic anemia + SUBACUTE COMBINED DEGENERATION of spinal cord (posterior and lateral columns)\nPeripheral neuropathy; Glossitis; Dementia\nNeeds Intrinsic Factor (IF, gastric parietal cells); absorbed in terminal ileum\nPernicious anemia: Anti-IF antibodies or anti-parietal cell antibodies\nMethylcobalamin: Homocysteine → Methionine (with MTHFR)\nAdenosylcobalamin: Methylmalonyl CoA → Succinyl CoA (↑ MMA in deficiency)", "Meat, dairy, eggs ONLY (no plant sources — vegans at risk)"],
    ["C — Ascorbic acid", "Scurvy: Perifollicular hemorrhage, corkscrew hairs, bleeding gums (scorbutic gums), poor wound healing, Sjögren-like, hemarthrosis\nMechanism: Hydroxylation of Pro and Lys in collagen synthesis (hydroxylase needs Vit C + Fe²+)\nAlso: Antioxidant; Enhances non-heme iron absorption (reduces Fe³+ → Fe²+); Regenerates Vit E\nToxicity: Oxalate kidney stones; GI upset; false-negative guaiac test", "Citrus fruits, berries, bell peppers; destroyed by cooking"],
], hdr_row=["Vitamin","Deficiency / Key Facts","Sources / Notes"], cr=(0.18,0.55,0.27)))
story.append(sp(1))
story.append(pyq("Vitamin causing flushing as side effect when used therapeutically?", "Niacin (B3) — prevented by aspirin pre-treatment"))
story.append(sp(1))
story.append(pyq("Megaloblastic anemia WITHOUT neurological symptoms?", "Folate deficiency (B12 deficiency has neuro sx — subacute combined degeneration)"))
story.append(sp(1))

story.append(shdr("▸ NUCLEOTIDE METABOLISM — Purines & Pyrimidines", C_PURPLE))
story.append(sp(1))
story.append(tbl2([
    ["Purines (A, G)", "De novo: made in liver; PRPP + Glutamine → IMP → AMP/GMP; Rate-limiting: PRPP Amidotransferase\nSalvage: HGPRT (Hypoxanthine-Guanine Phosphoribosyl Transferase) — saves purines\nDegradation: → Xanthine → Uric acid (by Xanthine oxidase)"],
    ["Pyrimidines (C, T, U)", "De novo: Carbamoyl phosphate + Aspartate → → UMP; Rate-limiting: Carbamoyl Phosphate Synthetase II (CPS II, cytoplasm)\nUnlike urea cycle: CPS I (mitochondria) uses NH₃; CPS II (cytoplasm) uses Glutamine"],
    ["Lesch-Nyhan Syndrome", "HGPRT deficiency (X-linked); Purines ↑ → Uric acid ↑; Gout + Intellectual disability + SELF-MUTILATION (biting fingers/lips); Choreoathetosis"],
    ["Gout", "↑ Uric acid (>6.8 mg/dL); Sodium urate crystals; Negatively birefringent needle-shaped crystals (YELLOW under parallel light)\nTarget: First MTP joint (podagra); tophi; nephropathy\nTreatment: Colchicine (acute); Allopurinol/Febuxostat (chronic — inhibit xanthine oxidase)"],
    ["Adenosine Deaminase (ADA) deficiency", "Deoxyadenosine accumulates → toxic to lymphocytes → SCID (Severe Combined Immunodeficiency); First disease treated with gene therapy"],
    ["Orotic Aciduria", "UMP Synthase deficiency (bifunctional enzyme); ↑ Orotic acid in urine; Megaloblastic anemia NOT corrected by B12/folate; ↓ BUN (unlike urea cycle defects)\nDistinguish from OTC deficiency: OTC → ↑ orotic acid + ↑ ammonia; Orotic aciduria → ↑ orotic acid + NORMAL ammonia"],
], hdr_row=["Topic","Key Facts"]))
story.append(sp(1))
story.append(pyq("Self-mutilation + Gout + Intellectual disability?", "Lesch-Nyhan Syndrome (HGPRT deficiency, X-linked)"))
story.append(sp(1))
story.append(pyq("Crystal color in gout under polarized light?", "Yellow under parallel light (negative birefringent); Blue under perpendicular light"))

story.append(PageBreak())

# ══════════════════════════════════════════════════════════════════════
# PAGE 4 — DNA, MOLECULAR BIOLOGY, ENZYMES & PORPHYRIN/HEME
# ══════════════════════════════════════════════════════════════════════
story.append(hdr("PAGE 4 ▸ MOLECULAR BIOLOGY · DNA/RNA · ENZYMES · HEME/PORPHYRIN", C_BLUE))
story.append(sp(1.5))

story.append(shdr("▸ DNA REPLICATION, TRANSCRIPTION & TRANSLATION — Key Facts", C_TEAL))
story.append(sp(1))
story.append(tbl3([
    ["DNA Replication", "Bidirectional from origin (oriC); semi-conservative\nDNA Pol III (prokaryote) / DNA Pol α,δ,ε (eukaryote) — 5'→3' synthesis only\nLeading strand: continuous; Lagging strand: Okazaki fragments (RNA primer removed by DNA Pol I)\nDNA ligase: seals nicks; Helicase: unwinds; Primase: makes RNA primer\nTopoisomerases: relieve torsional stress (I-cuts 1 strand; II-cuts both — target of fluoroquinolones in bacteria)", ""],
    ["Transcription", "DNA → pre-mRNA (nucleus); RNA Pol II makes mRNA; only template (antisense) strand read 3'→5'\n5' Cap (7-methylguanosine): protects from degradation; needed for ribosome binding\n3' Poly-A tail: stability, nuclear export, translation efficiency\nSplicing: Snurps (snRNPs) + spliceosome; Introns OUT, Exons IN\nAlternative splicing → protein diversity from single gene", ""],
    ["Translation", "mRNA read 5'→3'; ribosome moves 5'→3'; polypeptide grows N→C\nInitiation codon: AUG (Met/fMet); Stop codons: UAA, UAG, UGA ('U Are Away', 'U Are Gone', 'U Go Away')\nA site: aminoacyl-tRNA enters; P site: peptidyl-tRNA; E site: exit\nElongation: EF-1 (A site) → Peptidyl transferase (peptide bond) → EF-2 (translocation, needs GTP)", ""],
    ["Mutations", "Silent: same amino acid (wobble position, 3rd base)\nMissense: different amino acid (e.g., sickle cell — Glu→Val in β-globin, codon 6)\nNonsense: premature stop codon → truncated protein\nFrameshift: insertion/deletion (not multiple of 3) → all downstream changed", ""],
    ["Chromatin", "Nucleosome: 8 histones (2×H2A, 2×H2B, 2×H3, 2×H4) + 147 bp DNA wrapped around; H1 links nucleosomes\nEuchromatin (loose) = active transcription; Heterochromatin (tight) = silent\nHistone acetylation (HAT) → loosens → transcription ON; Methylation → variable", ""],
], hdr_row=["Process","Key Facts",""], cr=(0.20,0.55,0.25)))
story.append(sp(1))
story.append(pyq("Stop codons in mRNA translation?", "UAA, UAG, UGA"))
story.append(sp(1))
story.append(pyq("Mutation in sickle cell disease?", "Missense mutation — Glu (GAG) → Val (GTG) at codon 6 of β-globin"))
story.append(sp(1))

story.append(shdr("▸ ENZYME KINETICS — Michaelis-Menten", C_GREEN))
story.append(sp(1))
story.append(tbl2([
    ["Michaelis-Menten equation", "v = Vmax[S] / (Km + [S])"],
    ["Km", "Substrate concentration at half Vmax; LOW Km = HIGH affinity (less substrate needed)"],
    ["Vmax", "Maximum velocity when enzyme is saturated; proportional to enzyme concentration"],
    ["Competitive inhibition", "↑ Km (apparent); Vmax UNCHANGED; can overcome with ↑ substrate; Y-intercept same on Lineweaver-Burk; slope ↑"],
    ["Non-competitive inhibition", "Km UNCHANGED; ↓ Vmax (cannot overcome); binds allosteric site; Y-intercept ↑ on Lineweaver-Burk"],
    ["Uncompetitive inhibition", "↓ Km AND ↓ Vmax; only binds enzyme-substrate complex; both lines shifted parallel on Lineweaver-Burk"],
    ["Allosteric enzymes", "Sigmoidal (S-shaped) kinetics; NOT Michaelis-Menten; positive cooperativity; examples: Hb (O₂ binding), ATCase"],
    ["Feedback inhibition", "End product inhibits first committed step; conserves energy; e.g., Threonine deaminase inhibited by isoleucine"],
    ["Isoenzymes (Isozymes)", "Same reaction, different structure; tissue-specific; CK-MB (heart), CK-BB (brain), CK-MM (muscle); LDH-1 (heart > RBC), LDH-5 (liver > muscle)"],
], hdr_row=["Concept","Detail"]))
story.append(sp(1))
story.append(pyq("Competitive inhibitor effect on Km and Vmax?", "↑ Km (decreased affinity); Vmax UNCHANGED"))
story.append(sp(1))

story.append(shdr("▸ HEME SYNTHESIS & PORPHYRIAS", C_RED))
story.append(sp(1))
story.append(tbl2([
    ["Heme synthesis pathway", "Succinyl CoA + Glycine → δ-ALA (by δ-ALA synthase, rate-limiting; needs B6/PLP; induced by heme deficiency, drugs like phenobarbital)\n→ Porphobilinogen (PBG) → Uroporphyrinogen → Coproporphyrinogen → Protoporphyrin IX → Heme (+ Fe²+)"],
    ["δ-ALA Synthase (rate-limiting)", "Inhibited by heme (end product); Induced by drugs (phenobarbital, rifampicin), fasting, alcohol"],
    ["Lead Poisoning", "↓ δ-ALA dehydratase (FIRST enzyme affected, most sensitive) AND ↓ Ferrochelatase → ↑ δ-ALA + ↑ protoporphyrin IX\nBasophilic stippling of RBCs; Burton's line (blue gum line); Cognitive deficits, wrist/foot drop, microcytic anemia"],
    ["Acute Intermittent Porphyria (AIP)", "Porphobilinogen deaminase (uroporphyrinogen I synthase) deficiency; AD; MOST COMMON acute porphyria\n↑ δ-ALA + ↑ PBG in urine (urine turns dark red/port-wine on standing)\n5 P's: Painful abdomen, Psychiatric sx, Polyneuropathy, Precipitated by drugs/fasting/infection/hormones, Pee Port-wine color\nNO photosensitivity (cutaneous porphyrias have photosensitivity)"],
    ["Porphyria Cutanea Tarda (PCT)", "Uroporphyrinogen decarboxylase deficiency; MOST COMMON porphyria overall\nPhotosensitivity; Blistering skin on sun-exposed areas; Hypertrichosis; Liver disease; ↑ uroporphyrin in urine (tea-colored)\nAssociated: Hepatitis C, alcohol, estrogens, hemochromatosis"],
    ["Congenital Erythropoietic Porphyria\n(Gunther disease)", "Uroporphyrinogen III cosynthase deficiency; AR; severe photosensitivity from birth; port-wine urine; hemolytic anemia; red-brown teeth (erythrodontia) — fluoresce under UV (Wood's lamp)"],
], hdr_row=["Concept","Key Facts"]))
story.append(sp(1))
story.append(pyq("Most common porphyria overall?", "Porphyria Cutanea Tarda (PCT) — uroporphyrinogen decarboxylase deficiency"))
story.append(sp(1))
story.append(pyq("Most common ACUTE porphyria?", "Acute Intermittent Porphyria (AIP) — PBG deaminase deficiency; NO skin lesions"))
story.append(sp(1))
story.append(pyq("Lead poisoning — first enzyme inhibited?", "δ-ALA dehydratase (most sensitive to lead)"))

story.append(PageBreak())

# ══════════════════════════════════════════════════════════════════════
# PAGE 5 — HORMONES, CANCER BIOCHEM, PLASMA PROTEINS & INTEGRATION
# ══════════════════════════════════════════════════════════════════════
story.append(hdr("PAGE 5 ▸ HORMONES · HMP SHUNT · PLASMA PROTEINS · INTEGRATION PYQs", C_PURPLE))
story.append(sp(1.5))

story.append(shdr("▸ HMP SHUNT (Pentose Phosphate Pathway)", C_TEAL))
story.append(sp(1))
story.append(tbl2([
    ["Location", "Cytoplasm; active in liver, adrenal cortex, RBCs, lactating mammary gland, gonads"],
    ["Purpose", "1. NADPH production (antioxidant, lipid synthesis, steroid synthesis, CYP450)\n2. Ribose-5-phosphate (nucleotide synthesis)"],
    ["Rate-limiting enzyme", "Glucose-6-phosphate dehydrogenase (G6PD)"],
    ["G6PD Deficiency", "X-linked recessive; most common enzyme deficiency worldwide; affects NADPH → ↓ reduced glutathione → oxidative hemolysis\nTriggers: Primaquine, dapsone, sulfonamides, nitrofurantoin, moth balls (naphthalene), fava beans, infection\nHeinz bodies (denatured Hb); Bite cells on smear; Back pain + hemoglobinuria after trigger\nProtective against Plasmodium falciparum malaria"],
    ["NADPH functions", "Regenerates reduced glutathione; Fatty acid synthesis; Cholesterol/steroid synthesis; CYP450 monooxygenases; Phagocytic NADPH oxidase (respiratory burst); Nitric oxide synthesis"],
    ["Chronic Granulomatous Disease", "NADPH oxidase deficiency → no respiratory burst → recurrent catalase+ organisms (Staph aureus, Aspergillus, Klebsiella, Serratia, Nocardia); NBT test negative → diagnosis"],
], hdr_row=["Concept","Detail"]))
story.append(sp(1))
story.append(pyq("G6PD deficiency — drug triggering hemolysis?", "Primaquine, dapsone, sulfonamides — due to NADPH depletion (HMP shunt blocked)"))
story.append(sp(1))

story.append(shdr("▸ HORMONE BIOCHEMISTRY — Receptors & Second Messengers", C_PURPLE))
story.append(sp(1))
story.append(tbl3([
    ["cAMP (Gs)", "β1,β2 adrenergic; Glucagon; PTH; TSH; FSH/LH; ACTH; ADH (V2); Calcitonin; CRH; GHRH\nAdenylyl cyclase → cAMP → PKA; Gs: activated by Cholera toxin (locks Gs ON)", "Mnemonic: FLAT ChAMPS (FSH,LH,ACTH,TSH,CRH,ADH,MSH,PTH,Secretin)"],
    ["↓ cAMP (Gi)", "α2 adrenergic; M2 muscarinic; Dopamine D2; Somatostatin; Opioids\nGi inhibits adenylyl cyclase; Gi locked ON by Pertussis toxin", ""],
    ["IP3/DAG (Gq)", "α1 adrenergic; M1,M3 muscarinic; V1 (ADH); H1; Oxytocin; GnRH; Angiotensin II; Gastrin\nPLC → IP3 (↑ Ca²+) + DAG (→ PKC)", "Mnemonic: QHAVOC (Gq: H1, α1, V1, Oxytocin, mGluR, others)"],
    ["Receptor Tyrosine Kinase", "Insulin; IGF-1; GH (also STAT); EGF; FGF; PDGF; VEGF\nAutophosphorylation → Ras → MAP kinase → cell growth/differentiation", "Insulin receptor: α2β2 tetramer; β-subunit has intrinsic tyrosine kinase"],
    ["Intracellular receptors\n(nuclear)", "Cortisol; Aldosterone; Progesterone; Estrogen; Testosterone; T3/T4; Vitamin D; Retinoic acid\nMnemonic: CATPETS+D (Cortisol, Aldosterone, Testosterone, Progesterone, Estrogen, T3/T4, Vit D)\nBind intracellular receptors → transcription factors → gene expression changes (slow, hours)", ""],
    ["Guanylyl Cyclase\n(cGMP)", "ANP (atrial natriuretic peptide) — membrane; NO (nitric oxide) — soluble GC\ncGMP → PKG → smooth muscle relaxation, ↓ BP, natriuresis", "PDE-5 inhibitors (sildenafil) block cGMP breakdown"],
], hdr_row=["Pathway","Hormones / Details","Notes"], cr=(0.20,0.47,0.33)))
story.append(sp(1))
story.append(pyq("Cholera toxin mechanism?", "ADP-ribosylates Gs → locks Gs ON → ↑ cAMP → massive Cl⁻/water secretion"))
story.append(sp(1))
story.append(pyq("Insulin receptor type?", "Tyrosine kinase receptor (α2β2 tetramer)"))
story.append(sp(1))

story.append(shdr("▸ PLASMA PROTEINS & ELECTROPHORESIS", C_ORANGE))
story.append(sp(1))
story.append(tbl2([
    ["Albumin", "Most abundant plasma protein; main determinant of oncotic pressure; liver-synthesized; negative acute phase reactant; t½ 20 days; transports: bilirubin, FA, Ca²+, drugs, hormones"],
    ["α1-Antitrypsin (AAT)", "Inhibits neutrophil elastase; lungs and liver; deficiency → emphysema (panacinar) + hepatic cirrhosis; PiZZ genotype; PAS+ diastase-resistant inclusions in hepatocytes"],
    ["Ceruloplasmin", "Copper transport protein; ↓ in Wilson's disease; also ↓ in malnutrition; an acute phase protein; has ferroxidase activity"],
    ["Transferrin", "Fe³+ transport; ↑ in iron deficiency anemia; ↓ in iron overload/liver disease; TIBC ↑ in IDA"],
    ["Ferritin", "Iron storage; best marker of iron stores; ↑ in iron overload, acute phase; serum ferritin <12 ng/mL = IDA"],
    ["Haptoglobin", "Binds free Hb; ↓ in intravascular hemolysis (consumed binding free Hb); acute phase reactant"],
    ["C-Reactive Protein (CRP)", "Best acute phase reactant; made by liver; rises within 6 hours of inflammation; half-life 19 hrs; used to monitor treatment"],
    ["Fibrinogen", "Precursor to fibrin; highest molecular weight plasma protein after immunoglobulins; acute phase reactant; ↑ ESR"],
    ["γ-Globulins (IgG mainly)", "Monoclonal spike (M-protein) in multiple myeloma (γ region); polyclonal increase in chronic infections/autoimmune"],
    ["Electrophoresis bands (Anode→Cathode)", "Albumin → α1 → α2 → β → γ\nPattern in nephrotic syndrome: ↓ Albumin, ↑ α2 (↑ α2-macroglobulin), ↓ γ"],
], hdr_row=["Protein","Key Facts"]))
story.append(sp(1))
story.append(pyq("Best marker of iron stores?", "Serum Ferritin"))
story.append(sp(1))
story.append(pyq("Protein decreased in intravascular hemolysis?", "Haptoglobin (consumed binding free Hb)"))
story.append(sp(1))

story.append(shdr("▸ INTEGRATION: FASTING vs FED STATE METABOLISM", C_GREEN))
story.append(sp(1))
story.append(tbl3([
    ["Absorptive (Fed) State\n(Insulin dominates)", "Glucose → Glycolysis → ATP\nExcess glucose → Glycogen (liver + muscle)\nExcess glucose → FA synthesis → Triglycerides → VLDL\nAmino acids → Protein synthesis\nInsulin: ↑ GLUT4 (muscle/adipose), ↑ glycogen synthase, ↑ PFK, ↑ PDH, ↑ ACC, ↓ HSL",
     "Fuel priority: Glucose"],
    ["Postabsorptive/Fasting\n(Glucagon dominates)", "Liver glycogenolysis (0–4 hrs)\nGluconeogenesis (>4 hrs; from AA, lactate, glycerol)\nLipolysis: ↑ HSL → FA + glycerol; FA → β-oxidation → Acetyl CoA → Ketones (liver)\nBrain switches to ketones after 3–5 days\nMuscle uses FA and ketones to spare glucose",
     "Fuel priority: Fat/Ketones for most organs; Glucose mandatory for RBCs, renal medulla, eye lens/cornea (ALWAYS glycolytic)"],
    ["Prolonged Starvation", "Protein catabolism → gluconeogenesis (AA)\nKetone bodies rise markedly (brain uses ketones)\nMuscle atrophy; ↑ urea production\nRespiratory quotient (RQ) falls to ~0.7 (fat burning)\nRefeeding syndrome: hypophosphatemia, hypokalemia, hypomagnesemia when carbs reintroduced",
     "RQ: Carbs=1.0; Fat=0.7; Protein=0.8"],
], hdr_row=["State","Key Metabolic Events","Priority Fuel / Notes"], cr=(0.22,0.47,0.31)))
story.append(sp(1))
story.append(pyq("Cells that ALWAYS use glucose (obligate glycolytic)?", "RBCs (no mitochondria), Renal medulla, Eye lens/cornea, Testes (Sertoli cells)"))
story.append(sp(1))

# ── Last-minute 10 facts ────────────────────────────────────────────────
story.append(shdr("▸ TOP 10 LAST-MINUTE BIOCHEMISTRY FACTS", C_NAVY))
story.append(sp(1))
facts = [
    "1. Rate-limiting steps: Glycolysis=PFK-1 | TCA=Isocitrate DH | GNG=F-1,6-BPase | FA synth=ACC | Cholesterol=HMG-CoA reductase | HMP=G6PD | Urea cycle=CPS-I",
    "2. Vitamins needing biotin (carboxylases): Pyruvate carboxylase, ACC, Propionyl CoA carboxylase, β-Methylcrotonyl CoA carboxylase — raw egg white (avidin) inactivates biotin",
    "3. B12 deficiency: Megaloblastic anemia + Subacute combined degeneration (posterior+lateral spinal cord) | ↑ methylmalonic acid + ↑ homocysteine",
    "4. Folate deficiency: Megaloblastic anemia ONLY (no neuro sx) | ↑ homocysteine only (NOT methylmalonic acid) | NTDs if deficient in periconceptional period",
    "5. GSD Memory: Von Gierke=G6Pase, Pompe=Acid maltase (heart!), McArdle=Muscle phosphorylase, Cori=Debranching, Anderson=Branching, Hers=Liver phosphorylase",
    "6. Porphyria: AIP=most common ACUTE (PBG deaminase, NO skin sx) | PCT=most common OVERALL (uroD, skin blisters) | Lead inhibits δ-ALA DH first",
    "7. Amino acid disorders: PKU=Phe hydroxylase (mousy odor) | MSUD=BCKDH (maple syrup) | Homocystinuria=CBS (lens DOWN, thrombosis) | Alkaptonuria=homogentisate oxidase (urine black)",
    "8. Enzyme kinetics: Competitive=↑Km, same Vmax | Non-competitive=same Km, ↓Vmax | Uncompetitive=↓Km+↓Vmax",
    "9. Cholera toxin → locks Gs ON → ↑cAMP | Pertussis toxin → locks Gi ON → ↑cAMP | Both via ADP-ribosylation",
    "10. G6PD deficiency: X-linked; most common enzyme deficiency worldwide; Heinz bodies; bite cells; hemolysis with oxidant drugs (primaquine); protective against malaria",
]
rows = [[Paragraph(f, BODY)] for f in facts]
fact_t = Table(rows, colWidths=[W-2*M])
fact_t.setStyle(TableStyle([
    ("BOX",(0,0),(-1,-1),0.8,C_GOLD),
    ("INNERGRID",(0,0),(-1,-1),0.2,C_MDGRAY),
    ("LEFTPADDING",(0,0),(-1,-1),5),("RIGHTPADDING",(0,0),(-1,-1),5),
    ("TOPPADDING",(0,0),(-1,-1),2),("BOTTOMPADDING",(0,0),(-1,-1),2),
] + [("BACKGROUND",(0,i),(-1,i), C_LYELLOW if i%2==0 else HexColor("#FFFDF0")) for i in range(len(rows))]))
story.append(fact_t)

# ── Footer on every page ─────────────────────────────────────────────────
def on_page(canvas, doc):
    canvas.saveState()
    canvas.setFillColor(C_NAVY)
    canvas.rect(0, 0, W, 9.5*mm, fill=1, stroke=0)
    canvas.setFillColor(white)
    canvas.setFont("Helvetica", 6.8)
    canvas.drawCentredString(W/2, 3.5*mm,
        "BIOCHEMISTRY EXAM DAY CHEAT SHEET  |  NEET PG · FMGE · INI-CET  |  Harper's Illustrated Biochemistry & Lippincott's")
    canvas.drawRightString(W - M, 3.5*mm, f"Page {doc.page}")
    canvas.restoreState()

OUT = "/home/daytona/workspace/psychiatry-cheatsheet/Biochemistry_NEET_FMGE_CheatSheet.pdf"
doc = SimpleDocTemplate(OUT, pagesize=A4,
    leftMargin=M, rightMargin=M, topMargin=9*mm, bottomMargin=13*mm,
    title="Biochemistry NEET PG FMGE Cheat Sheet", author="Orris Medical AI")
doc.build(story, onFirstPage=on_page, onLaterPages=on_page)
print(f"PDF saved: {OUT}")

cd /home/daytona/workspace/psychiatry-cheatsheet && python generate_biochem_pdf.…

ls -lh /home/daytona/workspace/psychiatry-cheatsheet/Biochemistry_NEET_FMGE_Chea…

cd /home/daytona/workspace/psychiatry-cheatsheet && mkdir -p images && \ curl -s…

~/psychiatry-cheatsheet/generate_biochem_imagemcq.py

from reportlab.lib.pagesizes import A4
from reportlab.lib.styles import ParagraphStyle
from reportlab.lib.units import mm
from reportlab.lib.colors import HexColor, white, black
from reportlab.platypus import (SimpleDocTemplate, Paragraph, Spacer, Table,
                                TableStyle, PageBreak, Image, KeepTogether)
from reportlab.lib.enums import TA_CENTER, TA_LEFT
import os

# ── Palette ──────────────────────────────────────────────────────────────
C_NAVY   = HexColor("#0A2342")
C_TEAL   = HexColor("#006D77")
C_GOLD   = HexColor("#F4A800")
C_RED    = HexColor("#C0392B")
C_GREEN  = HexColor("#1A7A4A")
C_PURPLE = HexColor("#6C3483")
C_BLUE   = HexColor("#1565C0")
C_ORANGE = HexColor("#E65100")
C_BROWN  = HexColor("#5D4037")
C_LTGRAY = HexColor("#F5F5F5")
C_MDGRAY = HexColor("#DDDDDD")
C_DKGRAY = HexColor("#333333")
C_LYELLOW= HexColor("#FFFDE7")
C_LRED   = HexColor("#FFEBEE")
C_LPUR   = HexColor("#F3E5F5")
C_LCYAN  = HexColor("#E0F7FA")
C_LGREEN = HexColor("#E8F5E9")
C_IMG_BG = HexColor("#EEF4FF")

W, H = A4
M = 11*mm
IMG_DIR = "/home/daytona/workspace/psychiatry-cheatsheet/images"

def S(name, **kw): return ParagraphStyle(name, **kw)

TITLE = S("T",fontName="Helvetica-Bold",fontSize=17,textColor=white,alignment=TA_CENTER,spaceAfter=1)
SUBT  = S("ST",fontName="Helvetica-Bold",fontSize=9,textColor=white,alignment=TA_CENTER,spaceAfter=2)
H1    = S("H1",fontName="Helvetica-Bold",fontSize=8.5,textColor=white,spaceAfter=2,spaceBefore=3,leading=11)
BODY  = S("BD",fontName="Helvetica",fontSize=6.8,textColor=C_DKGRAY,spaceAfter=0.8,leading=8.8)
IMGQ  = S("IQ",fontName="Helvetica-Bold",fontSize=7.5,textColor=C_NAVY,leading=10,spaceAfter=1)
IMGQN = S("IQN",fontName="Helvetica",fontSize=7,textColor=C_DKGRAY,leading=9,spaceAfter=0.5)
IMGA  = S("IA",fontName="Helvetica-Bold",fontSize=7.5,textColor=C_RED,leading=10)
IMGKEY= S("IK",fontName="Helvetica",fontSize=6.8,textColor=C_DKGRAY,leading=9)

def sp(h=1.5): return Spacer(1,h*mm)

def hdr(text,color=C_NAVY):
    t=Table([[Paragraph(text,H1)]],colWidths=[W-2*M])
    t.setStyle(TableStyle([("BACKGROUND",(0,0),(-1,-1),color),
        ("LEFTPADDING",(0,0),(-1,-1),6),("RIGHTPADDING",(0,0),(-1,-1),6),
        ("TOPPADDING",(0,0),(-1,-1),4),("BOTTOMPADDING",(0,0),(-1,-1),4)]))
    return t

def shdr(text,color=C_TEAL):
    ts=S("sh",fontName="Helvetica-Bold",fontSize=7.5,textColor=white,leading=10)
    t=Table([[Paragraph(text,ts)]],colWidths=[W-2*M])
    t.setStyle(TableStyle([("BACKGROUND",(0,0),(-1,-1),color),
        ("LEFTPADDING",(0,0),(-1,-1),5),("TOPPADDING",(0,0),(-1,-1),2),
        ("BOTTOMPADDING",(0,0),(-1,-1),2)]))
    return t

def tbl2(rows,cr=(0.35,0.65),hdr_row=None,alt=True):
    cw=[(W-2*M)*r for r in cr]
    data=[]
    if hdr_row:
        data.append([Paragraph(f"<b>{h}</b>",
            S("th",fontName="Helvetica-Bold",fontSize=6.8,textColor=white,leading=9)) for h in hdr_row])
    for r in rows:
        data.append([Paragraph(str(c),BODY) for c in r])
    ts=[("GRID",(0,0),(-1,-1),0.3,C_MDGRAY),("VALIGN",(0,0),(-1,-1),"TOP"),
        ("LEFTPADDING",(0,0),(-1,-1),3),("RIGHTPADDING",(0,0),(-1,-1),3),
        ("TOPPADDING",(0,0),(-1,-1),2),("BOTTOMPADDING",(0,0),(-1,-1),2),
        ("FONTSIZE",(0,0),(-1,-1),6.8),("LEADING",(0,0),(-1,-1),8.8)]
    if hdr_row:
        ts+=[("BACKGROUND",(0,0),(-1,0),C_NAVY),("TEXTCOLOR",(0,0),(-1,0),white),
             ("FONTNAME",(0,0),(-1,0),"Helvetica-Bold")]
        start=1
    else: start=0
    if alt:
        for i in range(start,len(data)):
            ts.append(("BACKGROUND",(0,i),(-1,i),C_LTGRAY if i%2==0 else white))
    t=Table(data,colWidths=cw); t.setStyle(TableStyle(ts)); return t

def tbl3(rows,cr=(0.25,0.38,0.37),hdr_row=None):
    cw=[(W-2*M)*r for r in cr]
    data=[]
    if hdr_row:
        data.append([Paragraph(f"<b>{h}</b>",
            S("th3",fontName="Helvetica-Bold",fontSize=6.8,textColor=white,leading=9)) for h in hdr_row])
    for r in rows:
        data.append([Paragraph(str(c),BODY) for c in r])
    ts=[("GRID",(0,0),(-1,-1),0.3,C_MDGRAY),("VALIGN",(0,0),(-1,-1),"TOP"),
        ("LEFTPADDING",(0,0),(-1,-1),3),("RIGHTPADDING",(0,0),(-1,-1),3),
        ("TOPPADDING",(0,0),(-1,-1),2),("BOTTOMPADDING",(0,0),(-1,-1),2),
        ("FONTSIZE",(0,0),(-1,-1),6.8),("LEADING",(0,0),(-1,-1),8.8)]
    if hdr_row:
        ts+=[("BACKGROUND",(0,0),(-1,0),C_NAVY),("TEXTCOLOR",(0,0),(-1,0),white),
             ("FONTNAME",(0,0),(-1,0),"Helvetica-Bold")]
        for i in range(1,len(data)):
            ts.append(("BACKGROUND",(0,i),(-1,i),C_LTGRAY if i%2==1 else white))
    t=Table(data,colWidths=cw); t.setStyle(TableStyle(ts)); return t

def pyq(q,a):
    c1=Paragraph(f"<b>⭐ PYQ:</b> {q}",S("pq",fontName="Helvetica-Bold",fontSize=6.8,textColor=C_NAVY,leading=9))
    c2=Paragraph(f"<b>Ans:</b> {a}",S("pa",fontName="Helvetica-Bold",fontSize=6.8,textColor=C_RED,leading=9))
    t=Table([[c1,c2]],colWidths=[(W-2*M)*0.63,(W-2*M)*0.37])
    t.setStyle(TableStyle([("BACKGROUND",(0,0),(-1,-1),C_LYELLOW),
        ("BOX",(0,0),(-1,-1),0.6,C_GOLD),("LEFTPADDING",(0,0),(-1,-1),4),
        ("RIGHTPADDING",(0,0),(-1,-1),4),("TOPPADDING",(0,0),(-1,-1),2),
        ("BOTTOMPADDING",(0,0),(-1,-1),2),("VALIGN",(0,0),(-1,-1),"TOP")]))
    return t

def img_mcq_block(img_path, q_num, q_text, options, answer, key_points, img_w=55*mm, img_h=45*mm, bg=C_IMG_BG):
    """Create an image-based MCQ block with image on left, Q&A on right."""
    # Build option text
    opt_text = "<br/>".join([f"&nbsp;&nbsp;{o}" for o in options])
    right_content = [
        Paragraph(f"<b>Q{q_num}.</b> {q_text}", IMGQ),
        Paragraph(opt_text, IMGQN),
        sp(0.5),
        Paragraph(f"✅ Answer: {answer}", IMGA),
        sp(0.5),
        Paragraph(f"🔑 {key_points}", IMGKEY),
    ]
    # Build right cell as a nested table
    right_tbl = Table([[item] for item in right_content],
                      colWidths=[(W-2*M)*0.55])
    right_tbl.setStyle(TableStyle([
        ("BACKGROUND",(0,0),(-1,-1),bg),
        ("LEFTPADDING",(0,0),(-1,-1),5),("RIGHTPADDING",(0,0),(-1,-1),5),
        ("TOPPADDING",(0,0),(-1,-1),3),("BOTTOMPADDING",(0,0),(-1,-1),2),
    ]))
    # Image cell
    if os.path.exists(img_path):
        img = Image(img_path, width=img_w, height=img_h, kind='proportional')
    else:
        img = Paragraph(f"[Image: {os.path.basename(img_path)}]", BODY)
    img_cell = Table([[img]], colWidths=[(W-2*M)*0.42])
    img_cell.setStyle(TableStyle([
        ("BACKGROUND",(0,0),(-1,-1),HexColor("#F8F9FA")),
        ("BOX",(0,0),(-1,-1),0.5,C_MDGRAY),
        ("LEFTPADDING",(0,0),(-1,-1),3),("RIGHTPADDING",(0,0),(-1,-1),3),
        ("TOPPADDING",(0,0),(-1,-1),3),("BOTTOMPADDING",(0,0),(-1,-1),3),
        ("ALIGN",(0,0),(-1,-1),"CENTER"),("VALIGN",(0,0),(-1,-1),"MIDDLE"),
    ]))
    outer = Table([[img_cell, right_tbl]], colWidths=[(W-2*M)*0.42, (W-2*M)*0.58])
    outer.setStyle(TableStyle([
        ("BOX",(0,0),(-1,-1),1.0,C_BLUE),
        ("LEFTPADDING",(0,0),(-1,-1),0),("RIGHTPADDING",(0,0),(-1,-1),0),
        ("TOPPADDING",(0,0),(-1,-1),0),("BOTTOMPADDING",(0,0),(-1,-1),0),
        ("VALIGN",(0,0),(-1,-1),"TOP"),
    ]))
    return outer

def text_mcq_block(q_num, q_text, options, answer, key_points, bg=C_LPUR):
    """Text-based visual MCQ (diagrams described in text)."""
    opt_text = "<br/>".join([f"&nbsp;&nbsp;{o}" for o in options])
    data = [
        [Paragraph(f"<b>Q{q_num}. [IMAGE-BASED]</b> {q_text}",
                   S("tq",fontName="Helvetica-Bold",fontSize=7.2,textColor=C_NAVY,leading=10))],
        [Paragraph(opt_text, IMGQN)],
        [Paragraph(f"✅ Answer: {answer}", IMGA)],
        [Paragraph(f"🔑 {key_points}", IMGKEY)],
    ]
    t = Table(data, colWidths=[W-2*M])
    t.setStyle(TableStyle([
        ("BACKGROUND",(0,0),(-1,-1),bg),
        ("BOX",(0,0),(-1,-1),1.0,C_PURPLE),
        ("LEFTPADDING",(0,0),(-1,-1),6),("RIGHTPADDING",(0,0),(-1,-1),6),
        ("TOPPADDING",(0,0),(-1,-1),3),("BOTTOMPADDING",(0,0),(-1,-1),2),
    ]))
    return t

# ════════════════════════════════════════════════════════════════════════
story = []

# COVER
cover = Table([
    [Paragraph("⚗️  BIOCHEMISTRY — EXAM DAY CHEAT SHEET + IMAGE MCQs", TITLE)],
    [Paragraph("NEET PG · FMGE · INI-CET  |  All PYQ Concepts + Image-Based MCQs · 2021–2025  |  Harper's & Lippincott's", SUBT)]
], colWidths=[W-2*M])
cover.setStyle(TableStyle([
    ("BACKGROUND",(0,0),(-1,-1),C_NAVY),
    ("TOPPADDING",(0,0),(-1,-1),5),("BOTTOMPADDING",(0,0),(-1,-1),5),
    ("LEFTPADDING",(0,0),(-1,-1),8),
]))
story += [cover, sp(3)]

# ══════════════════════════════════════════════════════════════════════
# PAGE 1 — CARBOHYDRATE METABOLISM
# ══════════════════════════════════════════════════════════════════════
story.append(hdr("PAGE 1 ▸ CARBOHYDRATE METABOLISM", C_NAVY))
story.append(sp(1.5))

story.append(shdr("▸ GLYCOLYSIS — KEY FACTS (PFK-1 = Rate Limiting Step)", C_TEAL))
story.append(sp(1))
story.append(tbl2([
    ["Location", "Cytoplasm (all cells; RBCs — ONLY pathway, no mitochondria)"],
    ["Net ATP yield", "2 ATP net (anaerobic); substrate-level phosphorylation (Steps 7 & 10)"],
    ["3 Irreversible Enzymes", "1. Hexokinase/Glucokinase (Step 1)\n2. PFK-1 (Step 3) — RATE LIMITING\n3. Pyruvate Kinase (Step 10)"],
    ["PFK-1 Activators ↑ glycolysis", "AMP, ADP, F-2,6-BP (most potent), Pi, insulin"],
    ["PFK-1 Inhibitors ↓ glycolysis", "ATP, Citrate, H+ (acidosis), glucagon"],
    ["Glucokinase vs Hexokinase", "Glucokinase: liver/β-cells; HIGH Km; NOT inhibited by G-6-P; induced by insulin\nHexokinase: ubiquitous; LOW Km (high affinity); inhibited by G-6-P"],
    ["Pyruvate Kinase Deficiency", "Most common RBC glycolytic enzyme deficiency → hemolytic anemia\n↑ 2,3-BPG (shifts O₂ dissociation curve RIGHT → ↑ O₂ delivery)\nSplenomegaly; neonatal jaundice; Echinocytes on smear"],
    ["Warburg Effect", "Cancer cells prefer aerobic glycolysis (glucose → lactate even with O₂)\nReason: rapid ATP + biosynthetic precursors; basis of PET scan (↑ FDG uptake)"],
], hdr_row=["Concept","Detail"]))
story.append(sp(1))
story.append(pyq("Rate-limiting enzyme of glycolysis?", "Phosphofructokinase-1 (PFK-1)"))
story.append(sp(1))
story.append(pyq("Most common RBC enzyme deficiency → hemolytic anemia?", "Pyruvate Kinase deficiency (NOT G6PD which is HMP shunt enzyme)"))
story.append(sp(1))

story.append(shdr("▸ TCA CYCLE + GLUCONEOGENESIS + GLYCOGEN STORAGE DISEASES", C_GREEN))
story.append(sp(1))
story.append(tbl2([
    ["TCA Cycle Location + Rate-limiting", "Mitochondrial matrix | Rate-limiting = Isocitrate dehydrogenase\nYield per acetyl CoA: 3 NADH + 1 FADH₂ + 1 GTP + 2 CO₂\nTotal glucose → 30-32 ATP aerobic"],
    ["PDH Complex Cofactors", "B1 (TPP), Lipoic acid, B2 (FAD), B3 (NAD+), B5 (CoA)\nMnemonic: Tender Loving Care For Nerves"],
    ["Gluconeogenesis Bypass Enzymes\n(4 unique enzymes)", "1. Pyruvate carboxylase: Pyruvate → OAA (biotin, ATP; activated by Acetyl CoA)\n2. PEPCK: OAA → PEP (requires GTP)\n3. Fructose-1,6-bisphosphatase: F-1,6-BP → F-6-P (inhibited by AMP, F-2,6-BP)\n4. Glucose-6-phosphatase: G6P → Glucose (liver + kidney ONLY; absent muscle)"],
    ["Cori Cycle", "Lactate (muscle) → Liver → Glucose → back to muscle\nNet: consumes 6 ATP in liver; relieves lactate buildup"],
], hdr_row=["Topic","Key Facts"]))
story.append(sp(1))

story.append(shdr("▸ GLYCOGEN STORAGE DISEASES — COMPLETE TABLE", C_ORANGE))
story.append(sp(1))
story.append(tbl3([
    ["Type I — Von Gierke", "Glucose-6-phosphatase (liver + kidney)", "Fasting hypoglycemia, hepatomegaly, lactic acidosis, hyperuricemia, hyperlipidemia; Doll-like facies; NO ketosis"],
    ["Type II — Pompe", "Acid maltase (lysosomal α-1,4-glucosidase) ALL ORGANS", "CARDIOMEGALY (classic!), hypotonia, death < 2 yrs; Glycogen in lysosomes; 'Pompe = Pump fails (heart)'"],
    ["Type III — Cori/Forbes", "Debranching enzyme (liver + muscle)", "Milder Von Gierke; short outer chains; hepatomegaly + mild hypoglycemia"],
    ["Type IV — Anderson", "Branching enzyme (liver)", "Cirrhosis; abnormal long unbranched glycogen; liver failure"],
    ["Type V — McArdle", "Muscle phosphorylase (muscle ONLY)", "Exercise intolerance + cramps + myoglobinuria; NO rise in lactate after ischemic exercise test; ↑ ammonia instead"],
    ["Type VI — Hers", "Liver phosphorylase (liver)", "Mild; hepatomegaly; mild fasting hypoglycemia; benign course"],
    ["Type VII — Tarui", "Muscle PFK (muscle + RBCs)", "Like McArdle + hemolytic anemia; no rise in lactate after exercise"],
], hdr_row=["Disease","Enzyme Deficient","Key Features"], cr=(0.20,0.30,0.50)))
story.append(sp(1))
story.append(pyq("GSD with cardiomegaly?", "Pompe disease (Type II) — Acid maltase deficiency"))
story.append(sp(1))
story.append(pyq("Forearm ischemic exercise test shows NO rise in lactate?", "McArdle disease (Type V) — muscle phosphorylase deficiency; instead ↑ ammonia"))

story.append(PageBreak())

# ══════════════════════════════════════════════════════════════════════
# PAGE 2 — LIPID + AMINO ACID METABOLISM
# ══════════════════════════════════════════════════════════════════════
story.append(hdr("PAGE 2 ▸ LIPID METABOLISM · AMINO ACID DISORDERS", C_TEAL))
story.append(sp(1.5))

story.append(shdr("▸ FATTY ACID SYNTHESIS vs β-OXIDATION + CHOLESTEROL", C_TEAL))
story.append(sp(1))
story.append(tbl3([
    ["FA Synthesis", "Cytoplasm; Rate-limiting: Acetyl CoA Carboxylase (ACC)\nAcetyl CoA → Malonyl CoA (biotin + ATP)\nActivated by: Insulin, Citrate\nInhibited by: Glucagon, Palmitoyl CoA\nMalonyl CoA also inhibits CPT-1 (stops FA entry to mitochondria — no simultaneous synth + oxidation)",
     "NADPH source: HMP shunt\nActive in: Liver, adipose, lactating breast, adrenal cortex"],
    ["β-Oxidation", "Mitochondrial matrix; Rate-limiting entry: CPT-1 (Carnitine Palmitoyltransferase-1)\nInhibited by: Malonyl CoA\nEach 2C cycle: 1 FADH₂ + 1 NADH + 1 Acetyl CoA\nPalmitate (16C): 7 cycles → 106 ATP total\nOdd-chain FA: → Propionyl CoA → Succinyl CoA (needs B12 + biotin)",
     "Ketogenesis: Acetyl CoA excess → ketone bodies (liver mitochondria)\nHMG-CoA lyase → Acetoacetate\nBrain uses ketones after 3-5 days fasting"],
    ["Cholesterol Synthesis", "Rate-limiting: HMG-CoA Reductase\nHMG-CoA → Mevalonate (in ER, liver)\nInhibited by: Statins, Cholesterol (feedback), Glucagon\nActivated by: Insulin\nFamilial Hypercholesterolemia: LDL receptor mutation (AD)\nTangier disease: ABC-A1 transporter → ↓ HDL, orange tonsils",
     "Bile acids: Cholic + Chenodeoxycholic (primary)\nDeoxycholic + Lithocholic (secondary — gut bacteria)\nConjugated with Glycine/Taurine"],
], hdr_row=["Pathway","Key Biochemistry","Notes"], cr=(0.18,0.50,0.32)))
story.append(sp(1))
story.append(pyq("Rate-limiting enzyme of FA synthesis?", "Acetyl CoA Carboxylase (ACC) — needs Biotin + ATP"))
story.append(sp(1))
story.append(pyq("Malonyl CoA physiological role beyond FA synthesis?", "Inhibits CPT-1 → prevents FA entry into mitochondria → no simultaneous synthesis + oxidation"))
story.append(sp(1))

story.append(shdr("▸ AMINO ACID DISORDERS — COMPLETE NEET PG TABLE", C_RED))
story.append(sp(1))
story.append(tbl3([
    ["PKU\n(Phenylketonuria)", "Phenylalanine hydroxylase def (or BH4 cofactor def)\nAR; Phe ↑ → phenylpyruvate in urine\nMusty/mousy odor; fair skin/hair/blue eyes; intellectual disability; seizures; eczema\nDiagnosis: Guthrie test (newborn screening)", "Low Phe diet; BH4 (sapropterin) for mild/moderate; normal intelligence if treated early"],
    ["Alkaptonuria\n(Ochronosis)", "Homogentisate oxidase deficiency\nAR; homogentisic acid → urine turns BLACK on standing (exposure to air)\nOchronosis: dark pigment in cartilage/connective tissue; Arthritis\nDark staining of sclera, ear cartilage", "Vitamin C; low protein; no specific cure"],
    ["Tyrosinemia Type I", "Fumarylacetoacetase deficiency\nAR; ↑ succinylacetone (pathognomonic)\nHepatic failure, Fanconi syndrome (renal tubular), high HCC risk\nCabbage-like odor urine", "NTBC (nitisinone) + dietary restriction; liver transplant"],
    ["Homocystinuria\n(CBS deficiency)", "Cystathionine β-synthase def (most common type)\nAR; ↑ homocysteine + ↑ methionine\nMarfanoid habitus; lens sublux DOWNWARD (vs Marfan = UP); intellectual disability; THROMBOSIS (arterial+venous); osteoporosis\nB6 responsive in 50%", "B6 if responsive; low Met + cysteine supplementation; betaine; B12+folate"],
    ["MSUD\n(Maple Syrup Urine Disease)", "Branched-chain α-keto acid DH deficiency (BCKDH)\nRequires: B1 (TPP), lipoic acid, FAD, NAD+, CoA\nLeucine, Isoleucine, Valine ↑\nSweet maple syrup odor in urine/cerumen\nEncephalopathy; cerebral edema; neonatal death if untreated", "Restrict BCAA; IV glucose; thiamine (B1) supplement; dialysis acute crisis"],
    ["Cystinuria", "Defective renal tubule + intestinal transport of COAL: Cystine, Ornithine, Arginine, Lysine\nSerum levels NORMAL; excessive urinary loss\nCystine kidney stones (hexagonal crystals; staghorn)\nNot elevated blood cystine", "High fluid; alkalize urine (pH >7.5); D-penicillamine; tiopronin"],
    ["Hartnup Disease", "Defective neutral AA transport (esp. Tryptophan)\nPellagra-like: photosensitive rash, diarrhea, cerebellar ataxia\n↓ Tryptophan → ↓ niacin synthesis\nIntermittent; triggered by sun/poor diet", "High protein diet; nicotinamide supplementation"],
    ["Urea Cycle Defects", "OTC deficiency most common (X-linked)\nAll others AR; Hyperammonemia → N/V, encephalopathy, coma\nNote: ↑ orotic acid in OTC def (unlike other UCDs)\nNAGS deficiency: can't activate CPS-I → no urea cycle start", "Low protein; Na benzoate/phenylbutyrate; arginine supplement (except arginase def); liver transplant"],
], hdr_row=["Disorder","Key Features","Treatment"], cr=(0.18,0.50,0.32)))
story.append(sp(1))
story.append(pyq("Lens subluxation DOWNWARD + Marfanoid + Thrombosis?", "Homocystinuria (CBS def) — contrast with Marfan syndrome: lens sublux UPWARD"))
story.append(sp(1))
story.append(pyq("Urine turns black on standing — diagnosis?", "Alkaptonuria (homogentisate oxidase deficiency) — homogentisic acid oxidizes"))

story.append(PageBreak())

# ══════════════════════════════════════════════════════════════════════
# PAGE 3 — VITAMINS, NUCLEOTIDES, ENZYMES
# ══════════════════════════════════════════════════════════════════════
story.append(hdr("PAGE 3 ▸ VITAMINS · NUCLEOTIDES · ENZYME KINETICS", C_GREEN))
story.append(sp(1.5))

story.append(shdr("▸ WATER-SOLUBLE VITAMINS — Complete B-Complex + Vitamin C", C_BLUE))
story.append(sp(1))
story.append(tbl3([
    ["B1 — Thiamine (TPP)", "Wet beriberi: dilated cardiomyopathy, high-output cardiac failure\nDry beriberi: peripheral neuropathy (glove-stocking)\nWernicke's: Confusion + Ophthalmoplegia + Ataxia (mammillary body)\nKorsakoff: Anterograde amnesia + Confabulation (irreversible)\nEnzymes need B1: PDH, α-KGDH, Transketolase, BCKDH", "Test: Erythrocyte transketolase activity\nRice-polished diet; alcoholism\nGive B1 BEFORE glucose in suspected Wernicke's"],
    ["B2 — Riboflavin (FAD, FMN)", "Angular stomatitis (cheilosis), corneal neovascularization, magenta/glossy tongue, photophobia, seborrheic dermatitis\nCoenzyme in oxidation reactions", "Dairy, eggs, meat\nDeficiency common with B6 deficiency"],
    ["B3 — Niacin (NAD+, NADP+)", "Pellagra: 4 D's — Dermatitis (casal necklace/sun-exposed), Diarrhea, Dementia, Death\nHartnup disease mimics pellagra\nTherapeutic use: ↑ HDL (most effective), ↓ TG\nToxicity: FLUSHING (prostaglandin-mediated; ↓ by aspirin), hepatotoxicity, hyperglycemia, hyperuricemia", "60 mg Tryptophan → 1 mg Niacin\nNeeds B6 for conversion"],
    ["B5 — Pantothenic acid (CoA)", "Deficiency rare: 'Burning feet syndrome', adrenal insufficiency, fatigue\nCoenzyme A: essential for Acetyl CoA, Malonyl CoA, Succinyl CoA", "Widespread in foods (panto = everywhere)"],
    ["B6 — Pyridoxine (PLP)", "Peripheral neuropathy; Sideroblastic anemia (↓ δ-ALA synthase → ↓ heme)\nSeizures in neonates (↓ GABA synthesis)\nINH (isoniazid) → B6 deficiency\nPLP enzymes: ALT, AST, glycogen phosphorylase, δ-ALA synthase, CBS", "Give B6 prophylactically with INH therapy"],
    ["B7 — Biotin", "Dermatitis, alopecia, glossitis, lactic acidosis\nRaw egg white (AVIDIN) binds biotin → deficiency\nAll carboxylase enzymes need biotin:\nPyruvate carboxylase, ACC, Propionyl CoA carboxylase, β-methylcrotonyl CoA carboxylase", "Egg yolk, liver, gut bacteria synthesis"],
    ["B9 — Folate (THF)", "Megaloblastic anemia + glossitis; NO neurological symptoms\nNeural tube defects (anencephaly, spina bifida)\nMTX, TMP, pyrimethamine inhibit DHF reductase → functional deficiency\nFolate TRAP: B12 deficiency traps folate as 5-methyl-THF (cannot regenerate THF)", "Supplement 400 mcg/day BEFORE conception\nDestroyed by cooking"],
    ["B12 — Cobalamin\n(Methylcobalamin,\nAdenosylcobalamin)", "Megaloblastic anemia + SUBACUTE COMBINED DEGENERATION (posterior + lateral spinal cord)\nPeripheral neuropathy; dementia; glossitis\nNeeds Intrinsic Factor (gastric parietal cells) → absorbed terminal ileum\nPernicious anemia: Anti-IF or anti-parietal cell antibodies\nMethylcobalamin: Hcy → Methionine\nAdenosylcobalamin: Methylmalonyl CoA → Succinyl CoA\n↑ MMA + ↑ Hcy in B12 def (↑ MMA distinguishes from folate def)", "Only animal products; vegans at risk\nSchilling test for pernicious anemia"],
    ["C — Ascorbic acid", "Scurvy: Perifollicular hemorrhage, corkscrew hairs, bleeding gums, poor wound healing, hemarthrosis, 'Woody' painful extremities\nMechanism: Hydroxylation of proline + lysine residues in collagen (needs Fe²+)\nToxicity: Oxalate stones; false-negative guaiac test; hemolysis in G6PD", "Citrus fruits, bell peppers, guava\nEnhances non-heme iron absorption"],
], hdr_row=["Vitamin","Deficiency / Mechanism","Notes"], cr=(0.18,0.52,0.30)))
story.append(sp(1))
story.append(pyq("B12 deficiency unique finding vs Folate deficiency?", "↑ Methylmalonic acid (MMA) — only in B12 def; Folate def has ↑Hcy only"))
story.append(sp(1))
story.append(pyq("Biotin-dependent carboxylase enzymes (mnemonic)?", "PPAB: Pyruvate carboxylase, Propionyl CoA carboxylase, Acetyl CoA carboxylase, β-methylcrotonyl CoA carboxylase"))
story.append(sp(1))

story.append(shdr("▸ FAT-SOLUBLE VITAMINS (A, D, E, K)", C_ORANGE))
story.append(sp(1))
story.append(tbl2([
    ["Vitamin A (Retinol)", "Night blindness (earliest); Xerophthalmia; Bitot's spots; keratomalacia\nToxicity: Pseudotumor cerebri, teratogenic (retinoic acid), hepatotoxicity, alopecia\nActive forms: 11-cis-retinal (vision); All-trans retinoic acid (ATRA — treats APL)"],
    ["Vitamin D\n(Cholecalciferol D3)", "Rickets (children: bowing legs, rachitic rosary, craniotabes, Harrison's groove)\nOsteomalacia (adults: bone pain, Looser zones/pseudofractures on X-ray)\nDeficiency labs: ↓ Ca, ↓ PO₄, ↑ PTH, ↑ ALP\nSynthesis: Skin → D3 → Liver (25-OH-D3, storage form) → Kidney (1,25-(OH)₂D3 = Calcitriol, active)\nToxicity: Hypercalcemia, metastatic calcification, nephrocalcinosis"],
    ["Vitamin E (Tocopherol)", "Deficiency: Hemolytic anemia in premature infants; spinocerebellar ataxia; areflexia; retinitis pigmentosa\nLipid-soluble antioxidant; protects membrane PUFAs from peroxidation\nAbetalipoproteinemia: can't absorb fat-sol vitamins → Vit E deficiency → acanthocytes + neuro"],
    ["Vitamin K\n(K1 phylloquinone; K2 menaquinone)", "Deficiency: Prolonged PT (Factor VII has shortest half-life — first affected)\nHemorrhagic disease of newborn (no gut bacteria at birth → no K2)\nMechanism: γ-carboxylation of Glu → Factors II, VII, IX, X + Protein C, S, Z\nWarfarin inhibits Vit K epoxide reductase\nNewborns: IM Vit K prophylaxis at birth"],
], hdr_row=["Vitamin","Key Facts"]))
story.append(sp(1))
story.append(pyq("Active form of Vitamin D?", "1,25-dihydroxycholecalciferol (Calcitriol) — activated in kidney by 1α-hydroxylase"))
story.append(sp(1))
story.append(pyq("ATRA (all-trans retinoic acid) used to treat?", "Acute Promyelocytic Leukemia (APL) — derivative of Vitamin A"))
story.append(sp(1))

story.append(shdr("▸ NUCLEOTIDE METABOLISM — Purines, Pyrimidines & Disorders", C_PURPLE))
story.append(sp(1))
story.append(tbl2([
    ["Purines (A, G) — de novo", "PRPP + Glutamine → IMP → AMP/GMP\nRate-limiting: PRPP amidotransferase\nDegradation → Xanthine → Uric acid (by xanthine oxidase)\nSalvage: HGPRT recycles Hypoxanthine + Guanine → IMP/GMP"],
    ["Pyrimidines (C, T, U) — de novo", "CPS II (cytoplasm; uses glutamine) + Aspartate → → UMP\nRate-limiting: CPS II (contrast: CPS I in mitochondria uses NH₃ for urea cycle)"],
    ["Lesch-Nyhan Syndrome", "HGPRT deficiency; X-linked recessive\nPurines ↑ → Uric acid ↑; Gout; SELF-MUTILATION (biting lips/fingers); Intellectual disability; Choreoathetosis\nOrange sand in diapers (urate crystals)"],
    ["Gout", "↑ Uric acid (>6.8 mg/dL); Na urate crystals\nNEGATIVELY birefringent (needle-shaped; YELLOW parallel light, BLUE perpendicular)\nFirst MTP joint (podagra); tophi; renal stones\nAcute: Colchicine (inhibits microtubule polymerization → ↓ WBC migration)\nChronic: Allopurinol/Febuxostat (inhibit xanthine oxidase)"],
    ["Pseudogout", "Calcium pyrophosphate dihydrate (CPPD) crystals\nPOSITIVELY birefringent (rhomboid-shaped; BLUE parallel light, YELLOW perpendicular)\nKnee joint most common; chondrocalcinosis on X-ray"],
    ["ADA Deficiency", "Adenosine deaminase deficiency → deoxyadenosine → toxic to lymphocytes → SCID\nFirst disease treated by gene therapy; also treated with PEG-ADA (enzyme replacement)"],
    ["Orotic Aciduria", "UMP synthase deficiency; ↑ urinary orotic acid + megaloblastic anemia NOT corrected by B12/folate\nNormal ammonia (unlike OTC deficiency which has ↑ NH₃ + ↑ orotic acid)\nTreatment: Uridine supplementation"],
], hdr_row=["Topic","Key Facts"]))
story.append(sp(1))
story.append(pyq("Gout crystal birefringence under polarized light?", "NEGATIVELY birefringent needle crystals — YELLOW parallel, BLUE perpendicular (opposite for pseudogout)"))
story.append(sp(1))
story.append(pyq("Distinguish orotic aciduria from OTC deficiency?", "OTC: ↑ NH₃ + ↑ orotic acid; Orotic aciduria: NORMAL NH₃ + ↑ orotic acid"))

story.append(PageBreak())

# ══════════════════════════════════════════════════════════════════════
# PAGE 4 — MOLECULAR BIO, HEME/PORPHYRIN, HMP SHUNT
# ══════════════════════════════════════════════════════════════════════
story.append(hdr("PAGE 4 ▸ MOLECULAR BIOLOGY · HEME · HMP SHUNT · HORMONES", C_BLUE))
story.append(sp(1.5))

story.append(shdr("▸ DNA, TRANSCRIPTION & TRANSLATION ESSENTIALS", C_TEAL))
story.append(sp(1))
story.append(tbl2([
    ["DNA Replication", "Bidirectional; semi-conservative; Prokaryote: DNA Pol III (synthesizes); DNA Pol I (removes primers)\nEukaryote: Pol α (primer), Pol δ (lagging), Pol ε (leading)\nOkazaki fragments on lagging strand (5'→3' synthesis only); DNA ligase seals nicks\nTopoisomerases: Type I (cuts 1 strand); Type II (cuts both — target of fluoroquinolones/bacteria)"],
    ["Transcription", "DNA → pre-mRNA; RNA Pol II makes mRNA; template strand read 3'→5'\n5' Cap (7-methyl-guanosine): protects from degradation; ribosome binding\n3' Poly-A tail: stability, nuclear export\nSplicing: spliceosome removes introns; alternative splicing → protein diversity"],
    ["Translation", "mRNA 5'→3'; peptide grows N→C terminus\nStart: AUG (Met); Stop: UAA, UAG, UGA ('U Are Away, U Are Gone, U Go Away')\nA site (aminoacyl-tRNA entry) → P site (peptidyl-tRNA) → E site (exit)\nEF-1: delivers AA-tRNA to A site; EF-2: translocation (needs GTP)"],
    ["Mutations (High yield)", "Silent: same AA (wobble position, usually 3rd codon base)\nMissense: different AA → e.g., SCD Glu(GAG)→Val(GTG) codon 6 β-globin\nNonsense: premature STOP → truncated protein (e.g., Trp(UGG)→UGA)\nFrameshift: insertion/deletion NOT multiple of 3 → all downstream AA altered"],
    ["DNA Repair", "BER (Base Excision Repair): single base damaged; glycosylase removes base\nNER (Nucleotide Excision Repair): bulky lesions (UV pyrimidine dimers); XP (Xeroderma pigmentosum) = NER defect\nMMR (Mismatch Repair): mismatched bases; HNPCC/Lynch syndrome = MMR defect\nDSB Repair: NHEJ (fast, error-prone) or HR (accurate, uses homolog)"],
], hdr_row=["Process","Key Facts"]))
story.append(sp(1))
story.append(pyq("Mutation in Sickle Cell Disease?", "Missense: Glu(GAG)→Val(GTG) at codon 6 of β-globin chain"))
story.append(sp(1))
story.append(pyq("UV light causes what DNA damage? Repaired by?", "Pyrimidine dimers (C-C, T-T) → Nucleotide Excision Repair (NER); defect = Xeroderma pigmentosum"))
story.append(sp(1))

story.append(shdr("▸ HEME SYNTHESIS & PORPHYRIAS", C_RED))
story.append(sp(1))
story.append(tbl2([
    ["Rate-limiting step", "δ-ALA Synthase (succinyl CoA + glycine → δ-ALA)\nRequires: Pyridoxal phosphate (B6)\nInhibited by: Heme (end product feedback)\nInduced by: Drugs (phenobarbital, rifampicin, alcohol), fasting, sex hormones"],
    ["Lead Poisoning", "↓ δ-ALA dehydratase (MOST SENSITIVE enzyme, affected FIRST)\n↓ Ferrochelatase (last enzyme: inserts Fe²+ into protoporphyrin IX)\n↑ δ-ALA + ↑ Protoporphyrin IX (zinc protoporphyrin)\nBasophilic stippling (↓ 5'-nucleotidase), Burton's line (blue gum line), wrist/foot drop\nMicrocytic hypochromic anemia, cognitive impairment, encephalopathy in children"],
    ["AIP (Acute Intermittent Porphyria)", "PBG deaminase (uroporphyrinogen I synthase) deficiency\nAutosomal dominant; MOST COMMON acute porphyria\n5 P's: Painful abdomen, Psychiatric sx, Polyneuropathy, Precipitants (drugs/fasting/hormones), Port-wine urine (PBG + δ-ALA ↑)\nNO photosensitivity (no cutaneous involvement)\nWatson-Schwartz test: urine turns pink/red with Ehrlich's reagent"],
    ["PCT (Porphyria Cutanea Tarda)", "Uroporphyrinogen decarboxylase deficiency\nMOST COMMON porphyria overall; often acquired\nPhotosensitivity, blistering skin (sun-exposed), hypertrichosis, facial hyperpigmentation\n↑ Uroporphyrin in urine (tea-colored/cola-colored)\nAssoc: Hep C, alcohol, estrogens, hemochromatosis, HFE mutation"],
    ["Congenital Erythropoietic Porphyria\n(Günther disease)", "Uroporphyrinogen III cosynthase deficiency\nAR; MOST SEVERE; onset infancy\nRed-brown teeth (erythrodontia) — fluoresce pink under Wood's lamp (UV)\nHemolytic anemia; splenomegaly; severe photosensitivity; mutilating skin lesions"],
], hdr_row=["Concept","Key Facts"]))
story.append(sp(1))
story.append(pyq("Most common porphyria OVERALL?", "Porphyria Cutanea Tarda (PCT) — uroporphyrinogen decarboxylase deficiency"))
story.append(sp(1))
story.append(pyq("First enzyme inhibited by lead?", "δ-ALA dehydratase (most sensitive to lead inhibition)"))
story.append(sp(1))

story.append(shdr("▸ HMP SHUNT (Pentose Phosphate Pathway) + HORMONE RECEPTORS", C_PURPLE))
story.append(sp(1))
story.append(tbl2([
    ["HMP Shunt", "Location: Cytoplasm\nPurpose: NADPH + Ribose-5-phosphate\nRate-limiting: G6PD (Glucose-6-Phosphate Dehydrogenase)\nNADPH uses: Glutathione regeneration, FA synthesis, cholesterol synthesis, CYP450, phagocytic burst (NADPH oxidase), NO synthesis"],
    ["G6PD Deficiency", "X-linked recessive; most common enzyme deficiency worldwide; ↓ NADPH → ↓ GSH → oxidative hemolysis\nTriggers: Primaquine, dapsone, sulfonamides, nitrofurantoin, fava beans, infections, naphthalene\nHeinz bodies (denatured Hb); Bite cells (macrophages remove Heinz bodies)\nProtective vs P. falciparum malaria\nDiagnosis: G6PD enzyme assay (not during acute hemolysis — reticulocytes have normal G6PD)"],
    ["CGD (Chronic Granulomatous Disease)", "NADPH oxidase deficiency (gp91phox most common; X-linked)\nNo respiratory burst → can't kill catalase+ organisms\nOrganisms: Staph aureus, Aspergillus, Klebsiella, Serratia, Nocardia, E. coli\nNBT (Nitroblue Tetrazolium) test → stays YELLOW (negative); DHR flow cytometry\nRecurrent lymphadenitis, pneumonia, abscess, granulomas"],
    ["cAMP pathways (Gs → ↑ cAMP)", "β1/β2 adrenergic, Glucagon, PTH, TSH, FSH, LH, ACTH, ADH (V2), Calcitonin\nMnemonic: FLAT ChAMPS (FSH,LH,ACTH,TSH,CRH,ADH,MSH,PTH,Secretin)\nCholera toxin: ADP-ribosylates Gs → locks ON → massive ↑ cAMP → massive Cl⁻/H₂O secretion"],
    ["Gq pathway (IP3/DAG)", "α1, M1/M3, V1 (ADH), H1, Oxytocin, GnRH, Angiotensin II, Gastrin, TRH\nPLC-β → IP3 (↑ Ca²+) + DAG (→ PKC)\nPertussis toxin: locks Gi ON → ↑ cAMP in Bordetella pertussis"],
    ["Nuclear receptors\n(intracellular)", "Cortisol, Aldosterone, Testosterone, Progesterone, Estrogen, T3/T4, Vitamin D, Retinoic acid\nMnemonic: CATPETS-D\nBind intracellular receptor → translocate to nucleus → gene transcription (slow, hours)"],
    ["Tyrosine Kinase receptors", "Insulin (α2β2 tetramer; intrinsic TK on β-subunit), IGF-1, EGF, FGF, PDGF, VEGF\nRas → MAP kinase → cell growth\nInsulin resistance: post-receptor defect (↓ GLUT4 translocation)"],
], hdr_row=["Concept","Detail"]))
story.append(sp(1))
story.append(pyq("CGD diagnosis test?", "NBT test (Nitroblue Tetrazolium) — stays YELLOW (normal = turns BLUE/purple)"))
story.append(sp(1))
story.append(pyq("Cholera toxin mechanism at molecular level?", "ADP-ribosylates Gs alpha → locks Gs ON → constitutive ↑ adenylyl cyclase → ↑ cAMP"))

story.append(PageBreak())

# ══════════════════════════════════════════════════════════════════════
# PAGE 5 — IMAGE-BASED MCQs (Full Page)
# ══════════════════════════════════════════════════════════════════════
story.append(hdr("PAGE 5 ▸ IMAGE-BASED MCQs — NEET PG / FMGE 2021–2025 (All Possible Visual Questions)", C_RED))
story.append(sp(2))

story.append(shdr("▸ SECTION A: MCQs WITH TEXTBOOK IMAGES", C_NAVY))
story.append(sp(1.5))

# Q1 — Heinz bodies
story.append(img_mcq_block(
    img_path=f"{IMG_DIR}/heinz_bodies.png",
    q_num=1,
    q_text="A peripheral blood smear shows these inclusions in RBCs (visualized with crystal violet stain). What is this finding and which enzyme deficiency causes it?",
    options=["A. Howell-Jolly bodies — Splenectomy",
             "B. Heinz bodies — G6PD deficiency",
             "C. Pappenheimer bodies — Sideroblastic anemia",
             "D. Basophilic stippling — Lead poisoning"],
    answer="B. Heinz bodies — G6PD deficiency",
    key_points="Heinz bodies = denatured Hb inclusions. G6PD def → ↓NADPH → ↓GSH → oxidative Hb denaturation. Bite cells seen when spleen removes them. Triggered by primaquine, dapsone, fava beans.",
    img_w=55*mm, img_h=42*mm, bg=C_LCYAN
))
story.append(sp(2))

# Q2 — G6PD pathway diagram
story.append(img_mcq_block(
    img_path=f"{IMG_DIR}/g6pd_pathway.png",
    q_num=2,
    q_text="The diagram shows an erythrocyte metabolic pathway. The blocked enzyme (shown with double bar) leads to hemolysis. A patient develops hemolytic anemia after taking primaquine. What is the mechanism?",
    options=["A. Inhibition of pyruvate kinase → ATP depletion",
             "B. G6PD deficiency → ↓NADPH → ↓reduced glutathione → oxidative hemolysis",
             "C. PFK-1 inhibition → glycolysis block",
             "D. Hexokinase deficiency → ↓G6P → ↓HMP shunt"],
    answer="B. G6PD deficiency → ↓NADPH → ↓reduced glutathione → oxidative hemolysis",
    key_points="G6PD is rate-limiting enzyme of HMP/Pentose Phosphate Pathway. NADPH regenerates reduced glutathione (GSH). Without GSH, H₂O₂ oxidizes Hb → Heinz bodies → membrane rigidity → splenic destruction.",
    img_w=80*mm, img_h=40*mm, bg=C_LCYAN
))
story.append(sp(2))

# Q3 — Lineweaver-Burk plot
story.append(img_mcq_block(
    img_path=f"{IMG_DIR}/lineweaver_burk.png",
    q_num=3,
    q_text="A Lineweaver-Burk (double reciprocal) plot is shown. What do the x-intercept and y-intercept represent respectively?",
    options=["A. -1/Km and 1/Vmax (x and y intercepts)",
             "B. Km and Vmax directly",
             "C. 1/Km and -1/Vmax",
             "D. Vmax and Km/Vmax"],
    answer="A. x-intercept = -1/Km; y-intercept = 1/Vmax",
    key_points="Lineweaver-Burk plot: 1/v₀ vs 1/[S]. Slope = Km/Vmax. x-intercept = -1/Km. y-intercept = 1/Vmax. Competitive inhibitor: same y-intercept (Vmax unchanged), steeper slope (↑Km). Non-competitive: same x-intercept (Km unchanged), higher y-intercept (↓Vmax).",
    img_w=55*mm, img_h=42*mm, bg=HexColor("#E8F5E9")
))
story.append(sp(2))

# Q4 — Gout crystals
story.append(img_mcq_block(
    img_path=f"{IMG_DIR}/gout_crystals.png",
    q_num=4,
    q_text="Synovial fluid analysis under compensated polarized light microscopy shows these crystals (panel A = gout, panel B = pseudogout). What is the birefringence of gout (urate) crystals under PARALLEL polarized light?",
    options=["A. Positively birefringent rhomboid — BLUE under parallel light",
             "B. Negatively birefringent needle-shaped — YELLOW under parallel light",
             "C. Weakly positive rhomboid — YELLOW under parallel light",
             "D. Non-birefringent irregular — colorless"],
    answer="B. Negatively birefringent needle-shaped — YELLOW under parallel light",
    key_points="GOUT (MSU): Needle-shaped, NEGATIVELY birefringent (YELLOW parallel, BLUE perpendicular). PSEUDOGOUT (CPPD): Rhomboid, WEAKLY POSITIVELY birefringent (BLUE parallel, YELLOW perpendicular). Mnemonic: gout = 'Yellow when Parallel'.",
    img_w=75*mm, img_h=48*mm, bg=C_LYELLOW
))
story.append(sp(2))

# Q5 — SPEP
story.append(img_mcq_block(
    img_path=f"{IMG_DIR}/spep_myeloma.png",
    q_num=5,
    q_text="Serum protein electrophoresis (SPEP) shows a tall narrow 'church spire' peak in the gamma region. What does this represent and in which condition is it seen?",
    options=["A. Polyclonal gammopathy — chronic infection/autoimmune",
             "B. Monoclonal (M) protein spike — Multiple myeloma / MGUS",
             "C. Decreased albumin — nephrotic syndrome",
             "D. Alpha-2 macroglobulin increase — inflammation"],
    answer="B. Monoclonal (M) protein — Multiple myeloma / MGUS / Waldenström's",
    key_points="Monoclonal spike (M-protein): narrow, tall peak in γ (or β) region = single clone producing identical Ig. Multiple myeloma: IgG > IgA most common. Bence Jones protein (free light chains) in urine. Polyclonal: broad diffuse increase = multiple clones (infection, autoimmune, cirrhosis).",
    img_w=65*mm, img_h=45*mm, bg=HexColor("#FFF3E0")
))

story.append(PageBreak())

story.append(shdr("▸ SECTION B: VISUAL-CONCEPT IMAGE MCQs (Diagram/Pattern Recognition)", C_BLUE))
story.append(sp(1.5))

# Q6 — Urine colors
story.append(text_mcq_block(
    q_num=6,
    q_text="Urine colour chart. Match: (1) Black urine on standing (2) Port-wine/dark red urine, pink on Watson-Schwartz test (3) Orange sandy crystals in infant's diaper (4) Tea-coloured urine with skin blistering in sun-exposed areas",
    options=["A. (1)Alkaptonuria, (2)AIP, (3)Lesch-Nyhan, (4)PCT",
             "B. (1)PCT, (2)Alkaptonuria, (3)Lesch-Nyhan, (4)AIP",
             "C. (1)Alkaptonuria, (2)Lesch-Nyhan, (3)AIP, (4)PCT",
             "D. (1)Lesch-Nyhan, (2)AIP, (3)Alkaptonuria, (4)PCT"],
    answer="A. Alkaptonuria=black; AIP=port-wine; Lesch-Nyhan=orange sand; PCT=tea-colored",
    key_points="Alkaptonuria: homogentisic acid oxidizes → black. AIP: δ-ALA+PBG → port-wine. Lesch-Nyhan: urate crystals = orange grit. PCT: uroporphyrin = tea/cola colored urine + skin blisters in sun.",
    bg=C_LYELLOW
))
story.append(sp(1.5))

# Q7 — Electrophoresis patterns
story.append(text_mcq_block(
    q_num=7,
    q_text="Hemoglobin electrophoresis (cellulose acetate, alkaline pH) shows bands: HbS migrates LESS than HbA, HbA₂ is increased. What is the diagnosis? (HbA fastest, then F, then S/C, then A₂ slowest)",
    options=["A. Sickle cell trait (HbAS) — one HbS band + one HbA band",
             "B. Sickle cell disease (HbSS) — HbS band only + ↑ HbF, no HbA",
             "C. HbC disease — HbC band only",
             "D. β-Thalassemia major — ↑ HbF + ↑ HbA₂, absent HbA"],
    answer="B. Sickle cell disease — HbS band ONLY + ↑HbF, absent HbA; ↑HbA₂ suggests β-Thal component",
    key_points="Normal Hb: HbA (α₂β₂) 97%, HbA₂ (α₂δ₂) 2.5%, HbF (α₂γ₂) <1%. Sickle cell: Glu→Val β6 = HbS. β-Thal trait: ↑HbA₂ (>3.5%) is diagnostic. Sickle cell + β-Thal: HbS + ↑HbA₂ + ↑HbF, variable HbA.",
    bg=C_LCYAN
))
story.append(sp(1.5))

# Q8 — TCA cycle image concept
story.append(text_mcq_block(
    q_num=8,
    q_text="A diagram shows the TCA cycle. An arrow points to the step where OAA + Acetyl CoA → Citrate, and this enzyme is labeled as 'irreversible and regulated.' Which enzyme is this, and what is the RATE-LIMITING enzyme of the TCA cycle?",
    options=["A. Citrate synthase (shown) is rate-limiting",
             "B. Citrate synthase starts cycle; rate-limiting = Isocitrate dehydrogenase",
             "C. Malate dehydrogenase starts cycle; rate-limiting = α-KG dehydrogenase",
             "D. Aconitase starts cycle; rate-limiting = succinate dehydrogenase"],
    answer="B. Citrate synthase (Step 1, irreversible); Rate-limiting = Isocitrate dehydrogenase",
    key_points="TCA triple control point: Citrate synthase (Step 1), Isocitrate DH (rate-limiting, regulated by ADP/Ca²+ ↑, ATP/NADH ↓), α-KG DH (Step 4, same cofactors as PDH: B1/TPP, lipoic acid, FAD, NAD+, CoA).",
    bg=C_LGREEN
))
story.append(sp(1.5))

# Q9 — Lineweaver-Burk with inhibitor
story.append(text_mcq_block(
    q_num=9,
    q_text="Two Lineweaver-Burk lines are plotted. The inhibitor line crosses the y-axis at a HIGHER point (↑1/Vmax) but crosses the x-axis at the SAME point (-1/Km) as the control. What type of inhibition is this?",
    options=["A. Competitive inhibition — same Vmax, ↑Km",
             "B. Non-competitive inhibition — ↓Vmax, same Km",
             "C. Uncompetitive inhibition — ↓Vmax, ↓Km",
             "D. Irreversible inhibition — no Vmax"],
    answer="B. Non-competitive inhibition — ↓Vmax (↑y-intercept), same Km (same x-intercept)",
    key_points="Lineweaver-Burk inhibitor patterns: COMPETITIVE: same y-intercept (same Vmax), different x-intercept (↑Km). NON-COMPETITIVE: same x-intercept (same Km), different y-intercept (↓Vmax). UNCOMPETITIVE: parallel lines shifted (both ↓Km and ↓Vmax). Example: aspirin irreversibly inhibits COX (non-competitive type).",
    bg=C_LPUR
))
story.append(sp(1.5))

# Q10 — Oxygen dissociation curve
story.append(text_mcq_block(
    q_num=10,
    q_text="An oxygen-hemoglobin dissociation curve shows a RIGHT shift compared to normal. Which of the following conditions causes this RIGHT shift (↓ affinity for O₂ = MORE O₂ released to tissues)?",
    options=["A. Fetal Hb (HbF), Carboxyhemoglobin, Alkalosis",
             "B. Increased 2,3-BPG, Acidosis (↑H+), Hyperthermia, Pyruvate kinase deficiency",
             "C. Met-hemoglobin, Stored blood, CO poisoning",
             "D. Left shift — decreased pCO₂, hypothermia"],
    answer="B. ↑2,3-BPG, Acidosis (Bohr effect), ↑Temperature, ↑CO₂ → RIGHT shift (↓O₂ affinity, ↑O₂ delivery)",
    key_points="Right shift (HIGH-ALTITUDE adaptation, exercise, fever, anemia): 2,3-BPG ↑, H+ ↑ (Bohr), CO₂ ↑, Temp ↑. Left shift (↑ affinity, ↓ O₂ delivery): HbF, CO poisoning, Met-Hb, alkalosis, hypothermia, stored blood (depleted 2,3-BPG). Pyruvate kinase def → ↑2,3-BPG → right shift (partial compensation).",
    bg=C_LRED
))
story.append(sp(1.5))

# Q11 — Porphyria Wood's lamp
story.append(text_mcq_block(
    q_num=11,
    q_text="Under Wood's lamp (UV light), teeth of an infant show pink-red fluorescence. The infant has severe photosensitivity and hemolytic anemia from birth. What is the diagnosis?",
    options=["A. Porphyria Cutanea Tarda (PCT)",
             "B. Acute Intermittent Porphyria (AIP)",
             "C. Congenital Erythropoietic Porphyria (CEP/Günther disease)",
             "D. Erythropoietic Protoporphyria"],
    answer="C. Congenital Erythropoietic Porphyria (Günther disease) — erythrodontia + neonatal onset",
    key_points="CEP (Günther): uroporphyrinogen III cosynthase deficiency; AR; MOST SEVERE porphyria; onset infancy; erythrodontia (red-brown teeth fluorescing pink under Wood's lamp); hemolytic anemia; splenomegaly. PCT has skin blistering but no erythrodontia. AIP has no skin/dental findings.",
    bg=C_LYELLOW
))
story.append(sp(1.5))

# Q12 — Glycogen storage diseases
story.append(text_mcq_block(
    q_num=12,
    q_text="Echocardiography of a 6-month-old shows massive cardiomegaly. Muscle biopsy shows glycogen accumulation in lysosomes (electron microscopy). Enzyme assay confirms deficiency. What is the enzyme and diagnosis?",
    options=["A. Glucose-6-phosphatase — Von Gierke (Type I)",
             "B. Acid α-1,4-glucosidase (acid maltase) — Pompe disease (Type II)",
             "C. Muscle phosphorylase — McArdle disease (Type V)",
             "D. Debranching enzyme — Cori disease (Type III)"],
    answer="B. Acid maltase (lysosomal α-1,4-glucosidase) — Pompe disease (Type II GSD)",
    key_points="Pompe disease: LYSOSOMAL storage of glycogen (all organs, especially heart/muscle). Cardiomegaly is hallmark. Death by age 2 from cardiorespiratory failure. Treatment: Alglucosidase alfa (enzyme replacement). Mnemonic: 'Pompe = Pump failure'.",
    bg=C_LCYAN
))

# Final tip bar
story.append(sp(2))
tip_rows = [
    [Paragraph("<b>⚡ IMAGE MCQ EXAM TIPS</b>", S("et",fontName="Helvetica-Bold",fontSize=7.5,textColor=C_NAVY,leading=10))],
    [Paragraph("1. Heinz bodies (crystal violet) = G6PD def | Basophilic stippling = Lead poisoning | Howell-Jolly bodies = Splenectomy/asplenia | Pappenheimer bodies = Sideroblastic anemia", IMGKEY)],
    [Paragraph("2. Gout = YELLOW parallel (negative birefringent needles) | Pseudogout = BLUE parallel (positive birefringent rhomboids) — 'N for Negative, N for Needles, N for gout kNees→feet'", IMGKEY)],
    [Paragraph("3. SPEP patterns: Monoclonal spike = myeloma/MGUS | Polyclonal broad = infection/autoimmune | Absent γ = agammaglobulinemia | ↓albumin + ↑α2 = nephrotic syndrome", IMGKEY)],
    [Paragraph("4. Lineweaver-Burk: Competitive = SAME y-int, DIFFERENT x-int | Non-competitive = SAME x-int, DIFFERENT y-int | Uncompetitive = PARALLEL lines (both change proportionally)", IMGKEY)],
    [Paragraph("5. Wood's lamp: Pink-red teeth (CEP/Günther) | Coral-red fluorescence (Erythrasma = C. minutissimum) | Blue-green (Tinea capitis = Microsporum) | Vitiligo = bright white fluorescence", IMGKEY)],
    [Paragraph("6. O₂ dissociation curve: RIGHT = ↑delivery (exercise/fever) | LEFT = ↑affinity (HbF, CO, stored blood) | T50: normal = 26 mmHg (tension at 50% saturation)", IMGKEY)],
]
tip_t = Table(tip_rows, colWidths=[W-2*M])
tip_t.setStyle(TableStyle([
    ("BACKGROUND",(0,0),(-1,0),C_GOLD),
    ("BACKGROUND",(0,1),(-1,-1),C_LYELLOW),
    ("BOX",(0,0),(-1,-1),1,C_GOLD),
    ("INNERGRID",(0,0),(-1,-1),0.2,C_MDGRAY),
    ("LEFTPADDING",(0,0),(-1,-1),5),("RIGHTPADDING",(0,0),(-1,-1),5),
    ("TOPPADDING",(0,0),(-1,-1),2),("BOTTOMPADDING",(0,0),(-1,-1),2),
]))
story.append(tip_t)

# ── Footer ───────────────────────────────────────────────────────────────
def on_page(canvas, doc):
    canvas.saveState()
    canvas.setFillColor(C_NAVY)
    canvas.rect(0,0,W,9.5*mm,fill=1,stroke=0)
    canvas.setFillColor(white)
    canvas.setFont("Helvetica",6.8)
    canvas.drawCentredString(W/2,3.5*mm,
        "BIOCHEMISTRY EXAM DAY CHEAT SHEET + IMAGE MCQs  |  NEET PG · FMGE · INI-CET  |  Harper's & Lippincott's Illustrated Biochemistry")
    canvas.drawRightString(W-M,3.5*mm,f"Page {doc.page}")
    canvas.restoreState()

OUT = "/home/daytona/workspace/psychiatry-cheatsheet/Biochemistry_NEET_FMGE_ImageMCQ_CheatSheet.pdf"
doc = SimpleDocTemplate(OUT, pagesize=A4,
    leftMargin=M, rightMargin=M, topMargin=9*mm, bottomMargin=13*mm,
    title="Biochemistry NEET PG FMGE Cheat Sheet with Image MCQs", author="Orris Medical AI")
doc.build(story, onFirstPage=on_page, onLaterPages=on_page)
print(f"PDF saved: {OUT}")

cd /home/daytona/workspace/psychiatry-cheatsheet && python generate_biochem_imag…

ls -lh /home/daytona/workspace/psychiatry-cheatsheet/Biochemistry_NEET_FMGE_Imag…

ls /home/daytona/workspace/psychiatry-cheatsheet/images/ && ls -lh /home/daytona…