Hi! How can I help you today?

Am working as mbbs intern

That's great! Internship is one of the most intense and rewarding phases of medical training - you get real hands-on experience across all major departments.

How can I help you? Feel free to ask about:

Clinical cases - symptoms, differentials, workup
Drugs & dosages - pharmacology, interactions
Procedures - how-tos, indications, contraindications
Theory - pathophysiology, anatomy, guidelines
Exam prep - if you have any upcoming assessments

What's on your mind?

Yes i want all

Perfect! I'm here for all of it. Just ask me anything as it comes up during your internship rotation.

Here's how to get the most out of me:

Clinical scenarios

"Patient with chest pain, BP 90/60, diaphoresis - what do I do?"

Drug queries

"Dose of metformin in a newly diagnosed T2DM patient"

Quick theory

"Explain the mechanism of ACE inhibitors"

Procedures

"Steps for IV cannulation / pleural tap / lumbar puncture"

Differentials

"DDx for a young patient with painless jaundice"

Investigations

"What labs to order for suspected sepsis?"

Just type your question naturally - as if you're asking a senior resident. I'll give you a clear, practical answer backed by medical textbooks and current evidence.

What's your first question? 🩺

If patuentvcame with sore throat

Reading File

Finding Sources

Reading File

Here's a practical, structured approach to a patient presenting with sore throat:

🩺 Patient with Sore Throat - Clinical Approach

1. FIRST - Think About the Causes

Infectious (most common):

Cause	Frequency	Clue
Rhinovirus / Coronavirus	~25%	Common cold symptoms, runny nose, cough
Adenovirus	5%	Fever, conjunctivitis, pharyngitis
Group A beta-hemolytic Strep (GABHS)	5-15% adults, 20-30% children	Exudate, no cough, fever
EBV (Mono)	1-6% young adults	Posterior cervical LN, splenomegaly
Influenza A/B	2%	Myalgia, fever, headache
HSV	4%	Ulcers/vesicles
HIV (acute)	Rare	High-risk history

Non-infectious (don't miss):

GERD, postnasal drip, allergies, smoking
Acute thyroiditis
Neoplasm (if chronic/recurrent)

2. USE THE CENTOR SCORE (for adults)

Score 1 point for each:

✅ History of fever
✅ No cough
✅ Tender anterior cervical lymphadenopathy
✅ Tonsillar exudate or swelling

Score	GAS Probability	Action
0	2%	No test, no antibiotic
1	3%	No test, no antibiotic
2	8%	Do rapid strep test
3	19%	Do rapid strep test
4	41%	Treat empirically OR rapid test

In children - always confirm with test even if criteria met, as Centor is less specific in kids.

3. INVESTIGATIONS

Rapid Strep Antigen Test - sensitivity ~80%, specificity ~95%, result in minutes
Throat culture - sensitivity 85-90%, takes 24-48 hrs (not routine in adults)
If mono suspected: CBC (atypical lymphocytes >10%), Monospot test
If STI risk: throat swab for Gonorrhea
If immunocompromised: HIV test

4. TREATMENT

For ALL pharyngitis (viral or bacterial):

Paracetamol / NSAIDs for pain
Saline gargles, soft diet, warm fluids with honey

For confirmed/likely GABHS (strep throat):

First line: Penicillin V - 10 day course (no resistance ever documented!)
Alternative: Amoxicillin (especially in kids - palatable syrup)
Penicillin mild allergy: Cephalexin or Cefadroxil
Severe penicillin allergy: Erythromycin, Clarithromycin, or Clindamycin

⚠️ Must complete 7-10 days even if symptoms resolve earlier - shorter courses are less effective for strep!

Steroids (dexamethasone) - NOT recommended routinely. Short-term pain benefit only; associated with sepsis, GI bleed, VTE risk.

5. RED FLAGS - Tell patient to return if:

Shaking chills/rigors
Neck swelling (beyond lymph nodes)
Difficulty swallowing or drooling (think peritonsillar abscess)
Symptoms not improving after 5 days
Muffled "hot potato" voice - peritonsillar abscess

6. COMPLICATIONS TO PREVENT

Suppurative	Nonsuppurative
Peritonsillar abscess	Acute Rheumatic Fever
Retropharyngeal abscess	Post-streptococcal glomerulonephritis
Otitis media	Scarlet fever
Sinusitis

This is why we treat confirmed strep - to prevent rheumatic fever (especially important in India where prevalence is higher).

Sources: - Harrison's Principles of Internal Medicine 22E, p. 301 | Symptom to Diagnosis: An Evidence-Based Guide, 4th Ed, p. 535

Create a quick reference guide on pharyngitis for my internship

Asking for Preferences

Reading File

Running Command

ls /home/daytona/workspace/ 2>/dev/null || echo "workspace empty or missing"

Running Command

mkdir -p /home/daytona/workspace/pharyngitis-guide

Writing File

~/pharyngitis-guide/create_guide.py

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

# ── Color palette ──────────────────────────────────────────────────
DARK_BLUE   = colors.HexColor("#1a3a5c")
MED_BLUE    = colors.HexColor("#2563a8")
LIGHT_BLUE  = colors.HexColor("#dbeafe")
ORANGE      = colors.HexColor("#ea580c")
ORANGE_LIGHT= colors.HexColor("#fff7ed")
GREEN       = colors.HexColor("#166534")
GREEN_LIGHT = colors.HexColor("#dcfce7")
RED         = colors.HexColor("#991b1b")
RED_LIGHT   = colors.HexColor("#fee2e2")
YELLOW      = colors.HexColor("#854d0e")
YELLOW_LIGHT= colors.HexColor("#fef9c3")
GREY_BG     = colors.HexColor("#f1f5f9")
GREY_LINE   = colors.HexColor("#cbd5e1")
WHITE       = colors.white
BLACK       = colors.HexColor("#1e293b")

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

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

title_style = make_style('DocTitle', fontSize=22, textColor=WHITE,
                         fontName='Helvetica-Bold', alignment=TA_CENTER,
                         spaceAfter=4)
subtitle_style = make_style('DocSub', fontSize=11, textColor=colors.HexColor("#bfdbfe"),
                            fontName='Helvetica', alignment=TA_CENTER, spaceAfter=2)
badge_style  = make_style('Badge', fontSize=9, textColor=WHITE,
                           fontName='Helvetica-Bold', alignment=TA_CENTER)

section_head = make_style('SecHead', fontSize=12, textColor=WHITE,
                          fontName='Helvetica-Bold', alignment=TA_LEFT,
                          spaceBefore=2, spaceAfter=2)

body = make_style('Body', fontSize=9, textColor=BLACK,
                  fontName='Helvetica', leading=14, spaceAfter=2)
body_bold = make_style('BodyBold', fontSize=9, textColor=BLACK,
                       fontName='Helvetica-Bold', leading=14)
small = make_style('Small', fontSize=8, textColor=colors.HexColor("#475569"),
                   fontName='Helvetica', leading=11)
small_bold = make_style('SmallBold', fontSize=8, textColor=BLACK,
                        fontName='Helvetica-Bold', leading=11)
footnote = make_style('Footnote', fontSize=7.5, textColor=colors.HexColor("#64748b"),
                      fontName='Helvetica-Oblique', alignment=TA_CENTER, leading=11)

red_alert = make_style('RedAlert', fontSize=9, textColor=RED,
                       fontName='Helvetica-Bold', leading=14)

# ── Helper: coloured section header row ───────────────────────────
def section_table(text, bg=MED_BLUE, emoji=""):
    label = f"{emoji}  {text}" if emoji else text
    t = Table([[Paragraph(label, section_head)]], colWidths=[17.6*cm])
    t.setStyle(TableStyle([
        ('BACKGROUND', (0,0), (-1,-1), bg),
        ('ROUNDEDCORNERS', [4,4,4,4]),
        ('TOPPADDING', (0,0), (-1,-1), 6),
        ('BOTTOMPADDING', (0,0), (-1,-1), 6),
        ('LEFTPADDING', (0,0), (-1,-1), 10),
    ]))
    return t

def coloured_box(content_rows, bg=LIGHT_BLUE, col_widths=None):
    """Wrap a list of [cell, cell] rows in a coloured box table."""
    if col_widths is None:
        col_widths = [17.6*cm]
    t = Table(content_rows, colWidths=col_widths)
    t.setStyle(TableStyle([
        ('BACKGROUND', (0,0), (-1,-1), bg),
        ('TOPPADDING', (0,0), (-1,-1), 4),
        ('BOTTOMPADDING', (0,0), (-1,-1), 4),
        ('LEFTPADDING', (0,0), (-1,-1), 8),
        ('RIGHTPADDING', (0,0), (-1,-1), 8),
        ('GRID', (0,0), (-1,-1), 0.3, GREY_LINE),
    ]))
    return t

# ── Document setup ─────────────────────────────────────────────────
output_path = "/home/daytona/workspace/pharyngitis-guide/Pharyngitis_Quick_Reference.pdf"
doc = SimpleDocTemplate(
    output_path,
    pagesize=A4,
    leftMargin=1.2*cm, rightMargin=1.2*cm,
    topMargin=1.0*cm, bottomMargin=1.2*cm,
    title="Pharyngitis Quick Reference Guide",
    author="Orris Medical"
)

story = []

# ══════════════════════════════════════════════════════════════════
# HEADER BANNER
# ══════════════════════════════════════════════════════════════════
header_data = [[
    Paragraph("PHARYNGITIS", title_style),
],[
    Paragraph("Quick Reference Guide for MBBS Interns  |  ENT / General OPD", subtitle_style),
],[
    Paragraph("Sources: Harrison's Principles 22E · Symptom to Diagnosis 4E · Scott-Brown's ORL · Textbook of Family Medicine 9E", footnote),
]]
header_table = Table(header_data, colWidths=[17.6*cm])
header_table.setStyle(TableStyle([
    ('BACKGROUND', (0,0), (-1,-1), DARK_BLUE),
    ('TOPPADDING', (0,0), (-1,-1), 8),
    ('BOTTOMPADDING', (0,0), (-1,-1), 8),
    ('LEFTPADDING', (0,0), (-1,-1), 12),
    ('ROUNDEDCORNERS', [6,6,6,6]),
]))
story.append(header_table)
story.append(Spacer(1, 0.3*cm))

# ══════════════════════════════════════════════════════════════════
# SECTION 1 — DEFINITION + EPIDEMIOLOGY
# ══════════════════════════════════════════════════════════════════
story.append(section_table("1.  DEFINITION & EPIDEMIOLOGY", bg=MED_BLUE))
story.append(Spacer(1, 0.15*cm))

epi_data = [
    [Paragraph("<b>Pharyngitis</b>", small_bold),
     Paragraph("Inflammation of the pharynx and/or tonsils. One of the most common OPD presentations.", small)],
    [Paragraph("<b>Viral (most common)</b>", small_bold),
     Paragraph("Rhinovirus & coronavirus account for ~25% of all sore throats", small)],
    [Paragraph("<b>GABHS (bacterial)</b>", small_bold),
     Paragraph("5–15% in adults | 20–30% in children — most common bacterial cause", small)],
    [Paragraph("<b>Peak season</b>", small_bold),
     Paragraph("Winter and early spring", small)],
    [Paragraph("<b>High-risk groups</b>", small_bold),
     Paragraph("Children 5–15 yrs, healthcare workers, teachers, parents of young children", small)],
]
t = Table(epi_data, colWidths=[4*cm, 13.6*cm])
t.setStyle(TableStyle([
    ('BACKGROUND', (0,0), (0,-1), LIGHT_BLUE),
    ('BACKGROUND', (1,0), (1,-1), WHITE),
    ('ROWBACKGROUNDS', (1,0), (1,-1), [WHITE, GREY_BG]),
    ('TOPPADDING', (0,0), (-1,-1), 5),
    ('BOTTOMPADDING', (0,0), (-1,-1), 5),
    ('LEFTPADDING', (0,0), (-1,-1), 7),
    ('GRID', (0,0), (-1,-1), 0.3, GREY_LINE),
    ('VALIGN', (0,0), (-1,-1), 'MIDDLE'),
]))
story.append(t)
story.append(Spacer(1, 0.25*cm))

# ══════════════════════════════════════════════════════════════════
# SECTION 2 — DIFFERENTIAL DIAGNOSIS TABLE
# ══════════════════════════════════════════════════════════════════
story.append(section_table("2.  DIFFERENTIAL DIAGNOSIS", bg=MED_BLUE))
story.append(Spacer(1, 0.15*cm))

ddx_header = [
    Paragraph("<b>Pathogen</b>", small_bold),
    Paragraph("<b>Type</b>", small_bold),
    Paragraph("<b>Freq.</b>", small_bold),
    Paragraph("<b>Key Clinical Features</b>", small_bold),
]
ddx_rows = [
    [Paragraph("Rhinovirus / Coronavirus", small), Paragraph("Viral", small), Paragraph("~25%", small), Paragraph("Common cold, runny nose, mild throat pain, NO fever", small)],
    [Paragraph("Adenovirus", small), Paragraph("Viral", small), Paragraph("5%", small), Paragraph("Pharyngo-conjunctival fever: sore throat + conjunctivitis + fever", small)],
    [Paragraph("Influenza A/B", small), Paragraph("Viral", small), Paragraph("2%", small), Paragraph("High fever, myalgia, headache, non-exudative pharyngitis", small)],
    [Paragraph("HSV 1/2", small), Paragraph("Viral", small), Paragraph("4%", small), Paragraph("Vesicles/ulcers on pharynx or lips, stomatitis", small)],
    [Paragraph("EBV (Mono)", small), Paragraph("Viral", small), Paragraph("1–6%", small), Paragraph("Exudate + posterior cervical LAP + splenomegaly; young adults", small)],
    [Paragraph("HIV (acute)", small), Paragraph("Viral", small), Paragraph("Rare", small), Paragraph("Mono-like illness; high-risk history; fever, rash, LAP", small)],
    [Paragraph("GABHS (Strep A)", small), Paragraph("Bacterial", small), Paragraph("5–30%", small), Paragraph("Exudate, fever, NO cough, tender ant. cervical LN — USE CENTOR", small)],
    [Paragraph("Fusobacterium", small), Paragraph("Bacterial", small), Paragraph("Uncommon", small), Paragraph("Unilateral severe sore throat; risk of Lemierre syndrome", small)],
    [Paragraph("N. gonorrhoeae", small), Paragraph("Bacterial", small), Paragraph("~1%", small), Paragraph("STI history, often asymptomatic or exudative pharyngitis", small)],
    [Paragraph("C. diphtheriae", small), Paragraph("Bacterial", small), Paragraph("Rare", small), Paragraph("Grey pseudomembrane, bull neck, unvaccinated patient", small)],
]
ddx_table_data = [ddx_header] + ddx_rows
ddx_col_w = [4.0*cm, 2.0*cm, 1.8*cm, 9.8*cm]
ddx_t = Table(ddx_table_data, colWidths=ddx_col_w)
ddx_t.setStyle(TableStyle([
    ('BACKGROUND', (0,0), (-1,0), DARK_BLUE),
    ('TEXTCOLOR', (0,0), (-1,0), WHITE),
    ('ROWBACKGROUNDS', (0,1), (-1,-1), [WHITE, GREY_BG]),
    ('TOPPADDING', (0,0), (-1,-1), 4),
    ('BOTTOMPADDING', (0,0), (-1,-1), 4),
    ('LEFTPADDING', (0,0), (-1,-1), 6),
    ('GRID', (0,0), (-1,-1), 0.3, GREY_LINE),
    ('VALIGN', (0,0), (-1,-1), 'MIDDLE'),
    # Highlight GABHS row (index 7)
    ('BACKGROUND', (0,7), (-1,7), colors.HexColor("#fef3c7")),
]))
story.append(ddx_t)

story.append(Spacer(1, 0.1*cm))
story.append(Paragraph("★  Non-infectious causes: GERD, postnasal drip, allergies, smoking, acute thyroiditis, neoplasm (consider if chronic/recurrent)", small))
story.append(Spacer(1, 0.25*cm))

# ══════════════════════════════════════════════════════════════════
# SECTION 3 — CENTOR SCORE (2 columns)
# ══════════════════════════════════════════════════════════════════
story.append(section_table("3.  CENTOR SCORE  (Identifies likely GABHS in Adults)", bg=colors.HexColor("#d97706")))
story.append(Spacer(1, 0.15*cm))

# Left: criteria  | Right: score table
centor_criteria = Table([
    [Paragraph("<b>Score 1 point for each criterion:</b>", small_bold)],
    [Paragraph("1.  History of <b>fever</b>", small)],
    [Paragraph("2.  <b>Absence of cough</b>", small)],
    [Paragraph("3.  Tender <b>anterior cervical lymphadenopathy</b>", small)],
    [Paragraph("4.  <b>Tonsillar exudate</b> or swelling", small)],
    [Paragraph("  ", small)],
    [Paragraph("<i>In children: always confirm with rapid test\nregardless of score (Centor less specific).</i>", small)],
], colWidths=[8.4*cm])
centor_criteria.setStyle(TableStyle([
    ('BACKGROUND', (0,0), (-1,-1), YELLOW_LIGHT),
    ('TOPPADDING', (0,0), (-1,-1), 4),
    ('BOTTOMPADDING', (0,0), (-1,-1), 3),
    ('LEFTPADDING', (0,0), (-1,-1), 8),
    ('GRID', (0,0), (-1,-1), 0, WHITE),
]))

score_data = [
    [Paragraph("<b>Score</b>", small_bold), Paragraph("<b>GAS Prob.</b>", small_bold), Paragraph("<b>Action</b>", small_bold)],
    [Paragraph("0", small), Paragraph("2%", small), Paragraph("No test, no antibiotic", small)],
    [Paragraph("1", small), Paragraph("3%", small), Paragraph("No test, no antibiotic", small)],
    [Paragraph("2", small), Paragraph("8%", small), Paragraph("Rapid strep test", small)],
    [Paragraph("3", small), Paragraph("19%", small), Paragraph("Rapid strep test", small)],
    [Paragraph("4", small), Paragraph("41%", small), Paragraph("<b>Treat empirically OR rapid test</b>", small)],
]
score_t = Table(score_data, colWidths=[1.6*cm, 2.4*cm, 5.0*cm])
score_t.setStyle(TableStyle([
    ('BACKGROUND', (0,0), (-1,0), colors.HexColor("#92400e")),
    ('TEXTCOLOR', (0,0), (-1,0), WHITE),
    ('ROWBACKGROUNDS', (0,1), (-1,-1), [WHITE, GREY_BG]),
    ('BACKGROUND', (0,5), (-1,5), colors.HexColor("#fde68a")),
    ('TOPPADDING', (0,0), (-1,-1), 4),
    ('BOTTOMPADDING', (0,0), (-1,-1), 4),
    ('LEFTPADDING', (0,0), (-1,-1), 6),
    ('GRID', (0,0), (-1,-1), 0.3, GREY_LINE),
    ('ALIGN', (0,0), (1,-1), 'CENTER'),
    ('VALIGN', (0,0), (-1,-1), 'MIDDLE'),
]))

centor_combined = Table([[centor_criteria, score_t]], colWidths=[8.6*cm, 9.0*cm])
centor_combined.setStyle(TableStyle([
    ('VALIGN', (0,0), (-1,-1), 'TOP'),
    ('TOPPADDING', (0,0), (-1,-1), 0),
    ('LEFTPADDING', (0,0), (-1,-1), 0),
    ('RIGHTPADDING', (0,0), (-1,-1), 0),
]))
story.append(centor_combined)
story.append(Spacer(1, 0.25*cm))

# ══════════════════════════════════════════════════════════════════
# SECTION 4 — INVESTIGATIONS
# ══════════════════════════════════════════════════════════════════
story.append(section_table("4.  INVESTIGATIONS", bg=colors.HexColor("#0f766e")))
story.append(Spacer(1, 0.15*cm))

inv_data = [
    [Paragraph("<b>Test</b>", small_bold), Paragraph("<b>Details</b>", small_bold), Paragraph("<b>When to order</b>", small_bold)],
    [Paragraph("Rapid Strep Antigen", small),
     Paragraph("Sensitivity ~80%, Specificity ~95%. Results in minutes.", small),
     Paragraph("Centor score 2–4", small)],
    [Paragraph("Throat Culture", small),
     Paragraph("Sensitivity 85–90%. Takes 24–48 hrs. Not routine in adults.", small),
     Paragraph("Children, treatment failure", small)],
    [Paragraph("CBC + Peripheral Smear", small),
     Paragraph("Atypical lymphocytes >10% → EBV mono", small),
     Paragraph("Suspect mono (young adult + posterior LAP)", small)],
    [Paragraph("Monospot Test", small),
     Paragraph("Rapid heterophile antibody test for EBV", small),
     Paragraph("Suspect mono", small)],
    [Paragraph("Throat swab for culture", small),
     Paragraph("GC culture on Thayer-Martin medium", small),
     Paragraph("STI risk / gonorrheal pharyngitis", small)],
    [Paragraph("HIV test", small),
     Paragraph("4th gen Ag/Ab combo test", small),
     Paragraph("High risk history, mono-like illness", small)],
]
inv_t = Table(inv_data, colWidths=[4.0*cm, 8.0*cm, 5.6*cm])
inv_t.setStyle(TableStyle([
    ('BACKGROUND', (0,0), (-1,0), colors.HexColor("#134e4a")),
    ('TEXTCOLOR', (0,0), (-1,0), WHITE),
    ('ROWBACKGROUNDS', (0,1), (-1,-1), [WHITE, GREEN_LIGHT]),
    ('TOPPADDING', (0,0), (-1,-1), 4),
    ('BOTTOMPADDING', (0,0), (-1,-1), 4),
    ('LEFTPADDING', (0,0), (-1,-1), 6),
    ('GRID', (0,0), (-1,-1), 0.3, GREY_LINE),
    ('VALIGN', (0,0), (-1,-1), 'MIDDLE'),
]))
story.append(inv_t)
story.append(Spacer(1, 0.25*cm))

# ══════════════════════════════════════════════════════════════════
# SECTION 5 — TREATMENT (2 cols: symptomatic | antibiotics)
# ══════════════════════════════════════════════════════════════════
story.append(section_table("5.  TREATMENT", bg=colors.HexColor("#7c3aed")))
story.append(Spacer(1, 0.15*cm))

sym_box = Table([
    [Paragraph("<b>Symptomatic (ALL pharyngitis)</b>", small_bold)],
    [Paragraph("• Paracetamol 500 mg–1 g PO q6h PRN", small)],
    [Paragraph("• NSAIDs (Ibuprofen 400 mg TDS with food)", small)],
    [Paragraph("• Warm saline gargles 3–4× daily", small)],
    [Paragraph("• Soft diet, warm fluids, honey in tea", small)],
    [Paragraph("• Humidification", small)],
    [Paragraph("<i>Note: Glucocorticoids NOT recommended routinely.\nMay reduce pain at 24 h but risk of sepsis, GI bleed,\nVTE within 30 days.</i>", small)],
], colWidths=[8.4*cm])
sym_box.setStyle(TableStyle([
    ('BACKGROUND', (0,0), (-1,-1), colors.HexColor("#f5f3ff")),
    ('TOPPADDING', (0,0), (-1,-1), 4),
    ('BOTTOMPADDING', (0,0), (-1,-1), 3),
    ('LEFTPADDING', (0,0), (-1,-1), 8),
]))

abx_box = Table([
    [Paragraph("<b>Antibiotics — ONLY for confirmed/likely GABHS</b>", small_bold)],
    [Paragraph("<b>1st line:</b>  Penicillin V 500 mg PO BD–TDS × 10 days", small)],
    [Paragraph("<b>Children:</b>  Amoxicillin 50 mg/kg/day (palatable syrup)", small)],
    [Paragraph("<b>Mild PCN allergy:</b>  Cephalexin or Cefadroxil × 10 days", small)],
    [Paragraph("<b>Severe PCN allergy:</b>  Erythromycin / Clarithromycin / Clindamycin", small)],
    [Paragraph(" ", small)],
    [Paragraph("⚠  Complete full 7–10 day course even if symptoms\nresolve earlier. Shorter courses are less effective.", red_alert)],
], colWidths=[9.0*cm])
abx_box.setStyle(TableStyle([
    ('BACKGROUND', (0,0), (-1,-1), colors.HexColor("#fdf4ff")),
    ('TOPPADDING', (0,0), (-1,-1), 4),
    ('BOTTOMPADDING', (0,0), (-1,-1), 3),
    ('LEFTPADDING', (0,0), (-1,-1), 8),
]))

tx_combined = Table([[sym_box, abx_box]], colWidths=[8.6*cm, 9.0*cm])
tx_combined.setStyle(TableStyle([
    ('VALIGN', (0,0), (-1,-1), 'TOP'),
    ('TOPPADDING', (0,0), (-1,-1), 0),
    ('LEFTPADDING', (0,0), (-1,-1), 0),
    ('RIGHTPADDING', (0,0), (-1,-1), 0),
    ('GRID', (0,0), (-1,-1), 0.3, GREY_LINE),
]))
story.append(tx_combined)
story.append(Spacer(1, 0.25*cm))

# ══════════════════════════════════════════════════════════════════
# SECTION 6 — RED FLAGS + COMPLICATIONS (2 cols)
# ══════════════════════════════════════════════════════════════════
story.append(section_table("6.  RED FLAGS & COMPLICATIONS", bg=colors.HexColor("#be123c")))
story.append(Spacer(1, 0.15*cm))

red_flags_box = Table([
    [Paragraph("<b>🚨 Red Flags — Refer/Act Immediately</b>", small_bold)],
    [Paragraph("• Stridor or respiratory distress", small)],
    [Paragraph("• Drooling / inability to swallow (Epiglottitis / PTA)", small)],
    [Paragraph("• 'Hot potato' muffled voice → Peritonsillar Abscess", small)],
    [Paragraph("• Neck swelling beyond lymphadenopathy", small)],
    [Paragraph("• Shaking chills / rigors (bacteraemia)", small)],
    [Paragraph("• Symptoms not improving after 5 days", small)],
    [Paragraph("• Unilateral tonsillar enlargement (malignancy?)", small)],
    [Paragraph("• Trismus (difficulty opening mouth)", small)],
], colWidths=[8.4*cm])
red_flags_box.setStyle(TableStyle([
    ('BACKGROUND', (0,0), (-1,-1), RED_LIGHT),
    ('TOPPADDING', (0,0), (-1,-1), 4),
    ('BOTTOMPADDING', (0,0), (-1,-1), 3),
    ('LEFTPADDING', (0,0), (-1,-1), 8),
]))

comp_box = Table([
    [Paragraph("<b>Complications of Strep Pharyngitis</b>", small_bold)],
    [Paragraph("<b>Suppurative:</b>", small_bold)],
    [Paragraph("• Peritonsillar abscess (Quinsy)", small)],
    [Paragraph("• Retropharyngeal abscess", small)],
    [Paragraph("• Otitis media", small)],
    [Paragraph("• Sinusitis", small)],
    [Paragraph("<b>Non-suppurative:</b>", small_bold)],
    [Paragraph("• Acute Rheumatic Fever (ARF) → treat to PREVENT", small)],
    [Paragraph("• Post-streptococcal GN", small)],
    [Paragraph("• Scarlet fever", small)],
], colWidths=[9.0*cm])
comp_box.setStyle(TableStyle([
    ('BACKGROUND', (0,0), (-1,-1), colors.HexColor("#fff1f2")),
    ('TOPPADDING', (0,0), (-1,-1), 4),
    ('BOTTOMPADDING', (0,0), (-1,-1), 3),
    ('LEFTPADDING', (0,0), (-1,-1), 8),
]))

rf_combined = Table([[red_flags_box, comp_box]], colWidths=[8.6*cm, 9.0*cm])
rf_combined.setStyle(TableStyle([
    ('VALIGN', (0,0), (-1,-1), 'TOP'),
    ('TOPPADDING', (0,0), (-1,-1), 0),
    ('LEFTPADDING', (0,0), (-1,-1), 0),
    ('RIGHTPADDING', (0,0), (-1,-1), 0),
    ('GRID', (0,0), (-1,-1), 0.3, GREY_LINE),
]))
story.append(rf_combined)
story.append(Spacer(1, 0.25*cm))

# ══════════════════════════════════════════════════════════════════
# SECTION 7 — SPECIAL SCENARIOS
# ══════════════════════════════════════════════════════════════════
story.append(section_table("7.  SPECIAL SCENARIOS", bg=colors.HexColor("#0369a1")))
story.append(Spacer(1, 0.15*cm))

sp_data = [
    [Paragraph("<b>Scenario</b>", small_bold), Paragraph("<b>Key Clues</b>", small_bold), Paragraph("<b>Action</b>", small_bold)],
    [Paragraph("Infectious Mono (EBV)", small),
     Paragraph("Young adult, posterior cervical LAP, splenomegaly, petechiae on palate, atypical lymphocytes", small),
     Paragraph("Monospot + CBC. No amoxicillin (causes rash). No contact sports (spleen rupture risk).", small)],
    [Paragraph("Peritonsillar Abscess", small),
     Paragraph("Unilateral bulge, uvula deviation, muffled 'hot potato' voice, trismus", small),
     Paragraph("ENT referral for I&D. IV antibiotics. Admit.", small)],
    [Paragraph("Diphtheria", small),
     Paragraph("Grey pseudomembrane, bull neck, unvaccinated / incomplete vaccines, sweet-smelling breath", small),
     Paragraph("Antitoxin + Penicillin/Erythromycin. Isolate. Notify.", small)],
    [Paragraph("Gonococcal", small),
     Paragraph("STI history, mild or no symptoms, exudative pharyngitis", small),
     Paragraph("Throat swab GC culture. Ceftriaxone 500 mg IM single dose.", small)],
    [Paragraph("History of ARF", small),
     Paragraph("Any pharyngitis in a patient with prior ARF", small),
     Paragraph("Lower threshold to treat empirically for GABHS. Long-term penicillin prophylaxis.", small)],
]
sp_t = Table(sp_data, colWidths=[3.8*cm, 7.0*cm, 6.8*cm])
sp_t.setStyle(TableStyle([
    ('BACKGROUND', (0,0), (-1,0), colors.HexColor("#075985")),
    ('TEXTCOLOR', (0,0), (-1,0), WHITE),
    ('ROWBACKGROUNDS', (0,1), (-1,-1), [WHITE, LIGHT_BLUE]),
    ('TOPPADDING', (0,0), (-1,-1), 4),
    ('BOTTOMPADDING', (0,0), (-1,-1), 4),
    ('LEFTPADDING', (0,0), (-1,-1), 6),
    ('GRID', (0,0), (-1,-1), 0.3, GREY_LINE),
    ('VALIGN', (0,0), (-1,-1), 'MIDDLE'),
]))
story.append(sp_t)
story.append(Spacer(1, 0.25*cm))

# ══════════════════════════════════════════════════════════════════
# FOOTER
# ══════════════════════════════════════════════════════════════════
story.append(HRFlowable(width="100%", thickness=0.5, color=GREY_LINE))
story.append(Spacer(1, 0.1*cm))
story.append(Paragraph(
    "References: Harrison's Principles of Internal Medicine 22E (2025) · Symptom to Diagnosis 4E · "
    "Scott-Brown's ORL Head & Neck Surgery · Textbook of Family Medicine 9E  |  "
    "Compiled by Orris AI · July 2026  |  For educational use only — always apply clinical judgment.",
    footnote
))

# ── Build ──────────────────────────────────────────────────────────
doc.build(story)
print(f"PDF created: {output_path}")

Running Command

cd /home/daytona/workspace/pharyngitis-guide && python create_guide.py 2>&1

Running Command

ls -lh /home/daytona/workspace/pharyngitis-guide/

Your Pharyngitis Quick Reference Guide is ready! Here's what's included in the single-page PDF:

Pharyngitis Quick Reference

PDF Document · PDF

The guide covers 7 sections on one A4 page:

Definition & Epidemiology - frequency, high-risk groups, seasonality
Differential Diagnosis Table - 10 pathogens with frequency and key clinical clues
Centor Score - criteria + score-to-action table (highlighted for score 4)
Investigations - when to order rapid strep test, mono workup, GC culture, HIV
Treatment - symptomatic for all + antibiotic choice chart (Penicillin V first line, alternatives for allergy)
Red Flags & Complications - when to refer, suppurative vs non-suppurative complications
Special Scenarios - EBV mono, peritonsillar abscess, diphtheria, gonococcal, prior ARF patient

Print it out and keep it in your white coat pocket! Ask me for any other topic guides.

Create a guide for another common OPD complaint (fever, cough, abdomen pain, jaundice)

Asking for Preferences

Finding Sources

Reading File

Finding Sources

Reading File

Writing File

~/pharyngitis-guide/abdominal_pain_guide.py

from reportlab.lib.pagesizes import A4
from reportlab.lib import colors
from reportlab.lib.units import cm
from reportlab.lib.styles import getSampleStyleSheet, ParagraphStyle
from reportlab.platypus import (SimpleDocTemplate, Paragraph, Spacer, Table,
                                TableStyle, HRFlowable)
from reportlab.lib.enums import TA_CENTER, TA_LEFT

# ── Color palette ──────────────────────────────────────────────────
DARK_TEAL   = colors.HexColor("#0f4c5c")
MED_TEAL    = colors.HexColor("#0e7490")
LIGHT_TEAL  = colors.HexColor("#cffafe")
ORANGE      = colors.HexColor("#c2410c")
ORANGE_LIGHT= colors.HexColor("#fff7ed")
GREEN       = colors.HexColor("#166534")
GREEN_LIGHT = colors.HexColor("#dcfce7")
RED         = colors.HexColor("#991b1b")
RED_LIGHT   = colors.HexColor("#fee2e2")
PURPLE      = colors.HexColor("#6d28d9")
PURPLE_LIGHT= colors.HexColor("#ede9fe")
YELLOW      = colors.HexColor("#92400e")
YELLOW_LIGHT= colors.HexColor("#fef3c7")
GREY_BG     = colors.HexColor("#f1f5f9")
GREY_LINE   = colors.HexColor("#cbd5e1")
WHITE       = colors.white
BLACK       = colors.HexColor("#1e293b")
DARK_BLUE   = colors.HexColor("#1e3a5f")
MED_BLUE    = colors.HexColor("#2563a8")
LIGHT_BLUE  = colors.HexColor("#dbeafe")

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

def ms(name, parent='Normal', **kw):
    return ParagraphStyle(name, parent=styles[parent], **kw)

title_s   = ms('T', fontSize=22, textColor=WHITE, fontName='Helvetica-Bold', alignment=TA_CENTER, spaceAfter=3)
subtitle_s= ms('S', fontSize=10, textColor=colors.HexColor("#a5f3fc"), fontName='Helvetica', alignment=TA_CENTER)
sec_s     = ms('H', fontSize=11, textColor=WHITE, fontName='Helvetica-Bold', alignment=TA_LEFT, spaceBefore=1, spaceAfter=1)
body      = ms('B', fontSize=8.5, textColor=BLACK, fontName='Helvetica', leading=13)
body_b    = ms('BB', fontSize=8.5, textColor=BLACK, fontName='Helvetica-Bold', leading=13)
small     = ms('Sm', fontSize=8, textColor=BLACK, fontName='Helvetica', leading=12)
small_b   = ms('SmB', fontSize=8, textColor=BLACK, fontName='Helvetica-Bold', leading=12)
red_s     = ms('R', fontSize=8, textColor=RED, fontName='Helvetica-Bold', leading=12)
foot_s    = ms('F', fontSize=7, textColor=colors.HexColor("#64748b"), fontName='Helvetica-Oblique', alignment=TA_CENTER, leading=10)

def sec_hdr(text, bg=MED_TEAL):
    t = Table([[Paragraph(text, sec_s)]], colWidths=[17.6*cm])
    t.setStyle(TableStyle([
        ('BACKGROUND', (0,0), (-1,-1), bg),
        ('TOPPADDING', (0,0), (-1,-1), 5),
        ('BOTTOMPADDING', (0,0), (-1,-1), 5),
        ('LEFTPADDING', (0,0), (-1,-1), 9),
    ]))
    return t

# ── Document ───────────────────────────────────────────────────────
out = "/home/daytona/workspace/pharyngitis-guide/AbdominalPain_Quick_Reference.pdf"
doc = SimpleDocTemplate(out, pagesize=A4,
    leftMargin=1.2*cm, rightMargin=1.2*cm,
    topMargin=1.0*cm, bottomMargin=1.2*cm,
    title="Abdominal Pain Quick Reference Guide")

story = []

# ── HEADER ─────────────────────────────────────────────────────────
hdr = Table([
    [Paragraph("ABDOMINAL PAIN", title_s)],
    [Paragraph("Quick Reference Guide for MBBS Interns  |  General OPD / Emergency", subtitle_s)],
    [Paragraph("Sources: Yamada's Gastroenterology 7E · Harrison's 22E · Rosen's Emergency Medicine · Bailey & Love 28E · Textbook of Family Medicine 9E", foot_s)],
], colWidths=[17.6*cm])
hdr.setStyle(TableStyle([
    ('BACKGROUND', (0,0), (-1,-1), DARK_TEAL),
    ('TOPPADDING', (0,0), (-1,-1), 7),
    ('BOTTOMPADDING', (0,0), (-1,-1), 7),
    ('LEFTPADDING', (0,0), (-1,-1), 10),
]))
story.append(hdr)
story.append(Spacer(1, 0.25*cm))

# ══════════════════════════════════════════════════════════════════
# 1. HISTORY — SOCRATES
# ══════════════════════════════════════════════════════════════════
story.append(sec_hdr("1.  HISTORY — USE SOCRATES + KEY QUESTIONS", bg=DARK_TEAL))
story.append(Spacer(1, 0.12*cm))

soc_data = [
    [Paragraph("<b>S</b>ite", small_b), Paragraph("Where exactly? Point with one finger. Quadrant / diffuse?", small),
     Paragraph("<b>A</b>ssociated Sx", small_b), Paragraph("N/V, fever, jaundice, change in bowel/urinary habits, menstrual hx", small)],
    [Paragraph("<b>O</b>nset", small_b), Paragraph("Sudden (perforation/torsion/AAA) vs gradual (IBD/PUD/cancer)", small),
     Paragraph("<b>R</b>elieving", small_b), Paragraph("Food (PUD improves/worsens), posture, defecation (IBS), antacids", small)],
    [Paragraph("<b>C</b>haracter", small_b), Paragraph("Colicky = hollow viscus; Burning = PUD; Tearing = AAA; Dull/aching = solid organ", small),
     Paragraph("<b>T</b>iming", small_b), Paragraph("Constant vs intermittent; post-meal (mesenteric ischaemia); nocturnal waking (PUD)", small)],
    [Paragraph("<b>R</b>adiation", small_b), Paragraph("Shoulder tip (diaphragm/liver/spleen); Back (pancreatitis/AAA); Groin (ureteric colic)", small),
     Paragraph("<b>S</b>everity", small_b), Paragraph("Score 0–10. Severity ≠ seriousness (peritonitis may be deceptively mild in elderly)", small)],
    [Paragraph("<b>E</b>xacerbating", small_b), Paragraph("Movement (peritonitis); eating (mesenteric ischaemia/PUD); inspiration (cholecystitis)", small),
     Paragraph("<b>Key extras</b>", small_b), Paragraph("Last menstrual period (women); recent travel; medications (NSAIDs, steroids, antibiotics)", small)],
]
soc_t = Table(soc_data, colWidths=[2.4*cm, 6.4*cm, 2.6*cm, 6.2*cm])
soc_t.setStyle(TableStyle([
    ('ROWBACKGROUNDS', (0,0), (-1,-1), [WHITE, GREY_BG]),
    ('BACKGROUND', (0,0), (0,-1), LIGHT_TEAL),
    ('BACKGROUND', (2,0), (2,-1), LIGHT_TEAL),
    ('TOPPADDING', (0,0), (-1,-1), 4),
    ('BOTTOMPADDING', (0,0), (-1,-1), 4),
    ('LEFTPADDING', (0,0), (-1,-1), 5),
    ('GRID', (0,0), (-1,-1), 0.3, GREY_LINE),
    ('VALIGN', (0,0), (-1,-1), 'MIDDLE'),
]))
story.append(soc_t)
story.append(Spacer(1, 0.2*cm))

# ══════════════════════════════════════════════════════════════════
# 2. DDx BY QUADRANT
# ══════════════════════════════════════════════════════════════════
story.append(sec_hdr("2.  DIFFERENTIAL DIAGNOSIS BY QUADRANT / REGION", bg=MED_TEAL))
story.append(Spacer(1, 0.12*cm))

ddx_header = [
    Paragraph("<b>Region</b>", small_b),
    Paragraph("<b>Common Causes</b>", small_b),
    Paragraph("<b>Don't Miss</b>", small_b),
]

ddx_rows = [
    [Paragraph("RUQ", small_b),
     Paragraph("Acute cholecystitis, cholelithiasis, hepatitis (A/B/E), PUD, GERD, right lower lobe pneumonia, liver abscess, Fitz-Hugh-Curtis syndrome", small),
     Paragraph("Inferior wall MI, ruptured liver abscess, cholangitis (Charcot's triad)", small)],

    [Paragraph("LUQ", small_b),
     Paragraph("Gastritis, PUD (gastric ulcer), splenic pathology (splenomegaly, infarct), pancreatitis tail, left lower lobe pneumonia", small),
     Paragraph("Splenic rupture (trauma/mono), aortic dissection", small)],

    [Paragraph("Epigastric", small_b),
     Paragraph("PUD, GERD, gastritis, pancreatitis, early appendicitis, MI (inferior wall)", small),
     Paragraph("Leaking AAA, perforated peptic ulcer, acute MI — ECG mandatory!", small)],

    [Paragraph("RLQ", small_b),
     Paragraph("Acute appendicitis, Meckel's diverticulitis, Crohn's disease (terminal ileum), mesenteric lymphadenitis, ectopic pregnancy (female), ovarian cyst/torsion (female), renal/ureteral calculi", small),
     Paragraph("Ectopic pregnancy (must exclude in all females of reproductive age), appendicitis in retrocecal position", small)],

    [Paragraph("LLQ", small_b),
     Paragraph("Diverticulitis (sigmoid), constipation, IBS, IBD (ulcerative colitis), renal/ureteral calculi, ectopic pregnancy, ovarian cyst/torsion", small),
     Paragraph("Sigmoid volvulus, perforated diverticulitis", small)],

    [Paragraph("Central / Periumbilical", small_b),
     Paragraph("Early appendicitis (migrates to RLQ), small bowel obstruction, mesenteric ischaemia, aortic aneurysm, IBD", small),
     Paragraph("Mesenteric ischaemia (pain out of proportion to findings), AAA", small)],

    [Paragraph("Hypogastric / Suprapubic", small_b),
     Paragraph("UTI/cystitis, PID, ectopic pregnancy, ovarian pathology, constipation, urinary retention, IBS", small),
     Paragraph("Ectopic pregnancy, ovarian torsion, urinary retention in elderly males", small)],

    [Paragraph("Diffuse / Generalised", small_b),
     Paragraph("Peritonitis (any cause), gastroenteritis, IBD, bowel obstruction, DKA, constipation, IBS", small),
     Paragraph("Perforated viscus, mesenteric ischaemia, ruptured AAA, DKA", small)],
]

ddx_data = [ddx_header] + ddx_rows
ddx_t = Table(ddx_data, colWidths=[2.8*cm, 8.4*cm, 6.4*cm])
ddx_t.setStyle(TableStyle([
    ('BACKGROUND', (0,0), (-1,0), DARK_TEAL),
    ('TEXTCOLOR', (0,0), (-1,0), WHITE),
    ('ROWBACKGROUNDS', (0,1), (-1,-1), [WHITE, GREY_BG]),
    ('BACKGROUND', (2,1), (2,-1), RED_LIGHT),
    ('TOPPADDING', (0,0), (-1,-1), 4),
    ('BOTTOMPADDING', (0,0), (-1,-1), 4),
    ('LEFTPADDING', (0,0), (-1,-1), 5),
    ('GRID', (0,0), (-1,-1), 0.3, GREY_LINE),
    ('VALIGN', (0,0), (-1,-1), 'MIDDLE'),
]))
story.append(ddx_t)
story.append(Spacer(1, 0.2*cm))

# ══════════════════════════════════════════════════════════════════
# 3. CLINICAL SIGNS TABLE
# ══════════════════════════════════════════════════════════════════
story.append(sec_hdr("3.  KEY CLINICAL SIGNS & WHAT THEY MEAN", bg=colors.HexColor("#1d4ed8")))
story.append(Spacer(1, 0.12*cm))

signs_data = [
    [Paragraph("<b>Sign</b>", small_b), Paragraph("<b>How to Elicit</b>", small_b), Paragraph("<b>Positive if...</b>", small_b), Paragraph("<b>Suggests</b>", small_b)],
    [Paragraph("Murphy's Sign", small), Paragraph("Deep palpation RUQ + ask patient to inspire deeply", small), Paragraph("Pain arrests inspiration", small), Paragraph("Acute cholecystitis (Sens 65%, Spec 87%)", small)],
    [Paragraph("Rovsing's Sign", small), Paragraph("Press/release LLQ", small), Paragraph("Pain felt in RLQ", small), Paragraph("Appendicitis (indirect rebound)", small)],
    [Paragraph("Psoas Sign", small), Paragraph("Patient lifts right thigh vs resistance (supine)", small), Paragraph("RLQ pain increases", small), Paragraph("Retrocecal appendicitis, psoas abscess", small)],
    [Paragraph("Obturator Sign", small), Paragraph("Flex R hip+knee 90°, rotate internally/externally", small), Paragraph("Pain reproduced", small), Paragraph("Appendicitis, PID, pelvic abscess", small)],
    [Paragraph("Guarding / Rigidity", small), Paragraph("Gentle palpation; assess muscle tone during respiration", small), Paragraph("Board-like abdomen", small), Paragraph("Peritonitis (involuntary > voluntary)", small)],
    [Paragraph("CVAT", small), Paragraph("Firm fist percussion over costovertebral angle", small), Paragraph("Tenderness elicited", small), Paragraph("Pyelonephritis, renal calculus", small)],
    [Paragraph("Cullen's / Grey Turner's", small), Paragraph("Periumbilical (Cullen) or flank (Grey Turner) discolouration", small), Paragraph("Bruising visible", small), Paragraph("Retroperitoneal bleed, severe pancreatitis", small)],
]
signs_t = Table(signs_data, colWidths=[3.2*cm, 5.0*cm, 4.0*cm, 5.4*cm])
signs_t.setStyle(TableStyle([
    ('BACKGROUND', (0,0), (-1,0), colors.HexColor("#1e3a8a")),
    ('TEXTCOLOR', (0,0), (-1,0), WHITE),
    ('ROWBACKGROUNDS', (0,1), (-1,-1), [WHITE, LIGHT_BLUE]),
    ('TOPPADDING', (0,0), (-1,-1), 4),
    ('BOTTOMPADDING', (0,0), (-1,-1), 4),
    ('LEFTPADDING', (0,0), (-1,-1), 5),
    ('GRID', (0,0), (-1,-1), 0.3, GREY_LINE),
    ('VALIGN', (0,0), (-1,-1), 'MIDDLE'),
]))
story.append(signs_t)
story.append(Spacer(1, 0.2*cm))

# ══════════════════════════════════════════════════════════════════
# 4. INVESTIGATIONS + 5. RED FLAGS side by side
# ══════════════════════════════════════════════════════════════════
story.append(sec_hdr("4.  INVESTIGATIONS                                                                5.  RED FLAGS", bg=colors.HexColor("#6d28d9")))
story.append(Spacer(1, 0.12*cm))

inv_box = Table([
    [Paragraph("<b>Basic workup (most patients)</b>", small_b)],
    [Paragraph("• CBC — WBC↑ (infection/inflammation), Hb↓ (bleed/perforation)", small)],
    [Paragraph("• CRP / ESR — infection, IBD, abscess", small)],
    [Paragraph("• LFTs — hepatitis, biliary, pancreatitis (AST/ALT)", small)],
    [Paragraph("• Serum amylase/lipase — pancreatitis (lipase more specific)", small)],
    [Paragraph("• RFTs + electrolytes — renal colic, obstruction", small)],
    [Paragraph("• Urine routine / microscopy — UTI, renal calculi, DKA", small)],
    [Paragraph("• Urine β-hCG — all females of reproductive age (MANDATORY)", small_b)],
    [Paragraph(" ", small)],
    [Paragraph("<b>Targeted investigations</b>", small_b)],
    [Paragraph("• USG abdomen — biliary, liver, kidney, gynaecological, AAA", small)],
    [Paragraph("• CECT abdomen/pelvis — appendicitis, pancreatitis, malignancy", small)],
    [Paragraph("• ECG — mandatory in all epigastric pain (rule out MI)", small_b)],
    [Paragraph("• Stool exam — dysentery, parasite, occult blood", small)],
    [Paragraph("• Blood culture — if febrile (suspect sepsis/peritonitis)", small)],
], colWidths=[8.4*cm])
inv_box.setStyle(TableStyle([
    ('BACKGROUND', (0,0), (-1,-1), PURPLE_LIGHT),
    ('TOPPADDING', (0,0), (-1,-1), 3),
    ('BOTTOMPADDING', (0,0), (-1,-1), 3),
    ('LEFTPADDING', (0,0), (-1,-1), 7),
]))

rf_box = Table([
    [Paragraph("<b>🚨 Red Flags — Urgent / Surgical Referral</b>", red_s)],
    [Paragraph("• Sudden onset severe pain (perforation, AAA, torsion)", small)],
    [Paragraph("• Hemodynamic instability — BP↓, HR↑, sweating", small)],
    [Paragraph("• Peritonism — guarding, rigidity, rebound tenderness", small)],
    [Paragraph("• Positive pregnancy test + pain (ectopic pregnancy)", small)],
    [Paragraph("• Abdominal distension + absolute constipation (obstruction)", small)],
    [Paragraph("• Pulsatile abdominal mass (AAA)", small)],
    [Paragraph("• Fever >38.5°C + RLQ pain + Rovsing/Psoas/Obturator +ve (appendicitis)", small)],
    [Paragraph("• Jaundice + fever + RUQ pain = Charcot's triad → Cholangitis", small)],
    [Paragraph("• Pain out of proportion to physical findings → mesenteric ischaemia", small)],
    [Paragraph("• Blood PR (fresh or melena) → GI bleed", small)],
    [Paragraph("• Age >60 with new-onset abdominal pain — always take seriously", small)],
    [Paragraph(" ", small)],
    [Paragraph("<b>Populations requiring extra caution:</b>", small_b)],
    [Paragraph("Elderly | Pregnant | Immunocompromised | Post-bariatric surgery | Known vascular disease", small)],
], colWidths=[9.0*cm])
rf_box.setStyle(TableStyle([
    ('BACKGROUND', (0,0), (-1,-1), RED_LIGHT),
    ('TOPPADDING', (0,0), (-1,-1), 3),
    ('BOTTOMPADDING', (0,0), (-1,-1), 3),
    ('LEFTPADDING', (0,0), (-1,-1), 7),
]))

inv_rf = Table([[inv_box, rf_box]], colWidths=[8.6*cm, 9.0*cm])
inv_rf.setStyle(TableStyle([
    ('VALIGN', (0,0), (-1,-1), 'TOP'),
    ('LEFTPADDING', (0,0), (-1,-1), 0),
    ('RIGHTPADDING', (0,0), (-1,-1), 0),
    ('TOPPADDING', (0,0), (-1,-1), 0),
    ('GRID', (0,0), (-1,-1), 0.3, GREY_LINE),
]))
story.append(inv_rf)
story.append(Spacer(1, 0.2*cm))

# ══════════════════════════════════════════════════════════════════
# 6. COMMON CONDITIONS AT A GLANCE
# ══════════════════════════════════════════════════════════════════
story.append(sec_hdr("6.  COMMON CONDITIONS — QUICK RECOGNITION & INITIAL MANAGEMENT", bg=colors.HexColor("#065f46")))
story.append(Spacer(1, 0.12*cm))

cond_data = [
    [Paragraph("<b>Condition</b>", small_b), Paragraph("<b>Classic Presentation</b>", small_b), Paragraph("<b>Key Test</b>", small_b), Paragraph("<b>Initial Management</b>", small_b)],

    [Paragraph("Acute Appendicitis", small),
     Paragraph("Periumbilical pain → RLQ, N/V, low-grade fever, RLQ tenderness, Rovsing +ve", small),
     Paragraph("USG / CECT abdomen; WBC↑", small),
     Paragraph("NBM, IV fluids, analgesia, surgical referral", small)],

    [Paragraph("Acute Cholecystitis", small),
     Paragraph("RUQ colicky pain post-fatty meal, N/V, Murphy's sign +ve, fever", small),
     Paragraph("USG abdomen (gallstones + wall thickening)", small),
     Paragraph("NBM, analgesia, IV fluids, antibiotics, surgical consult", small)],

    [Paragraph("Acute Pancreatitis", small),
     Paragraph("Severe epigastric pain radiating to back, N/V, relieved by leaning forward; H/O alcohol or gallstones", small),
     Paragraph("Serum lipase >3× ULN; CECT for severity (Balthazar score)", small),
     Paragraph("NBM, aggressive IV fluids, analgesia, monitor vitals. No food until pain-free.", small)],

    [Paragraph("Peptic Ulcer / Perforation", small),
     Paragraph("Epigastric burning; H/O NSAIDs/H.pylori; Perforation: sudden board-like rigidity", small),
     Paragraph("Erect CXR (free air under diaphragm); OGD", small),
     Paragraph("Perforation: emergency surgery. PUD: PPI, H.pylori eradication (Triple therapy)", small)],

    [Paragraph("Intestinal Obstruction", small),
     Paragraph("Colicky central pain, distension, absolute constipation, bilious vomiting, visible peristalsis", small),
     Paragraph("Plain X-ray abdomen erect + supine (air-fluid levels, dilated loops)", small),
     Paragraph("NGT suction, IV fluids, NBM, Foley catheter, surgical referral", small)],

    [Paragraph("Renal / Ureteric Colic", small),
     Paragraph("Severe loin-to-groin colicky pain, hematuria, restlessness (can't sit still), N/V", small),
     Paragraph("Urine microscopy; NCCT KUB (best); USG", small),
     Paragraph("Diclofenac 75 mg IM or IV, adequate hydration, sieve urine, urology referral if stone >5 mm", small)],

    [Paragraph("Ectopic Pregnancy", small),
     Paragraph("Amenorrhoea + LLQ/RLQ pain + vaginal bleeding; haemodynamic instability possible", small),
     Paragraph("Urine/serum β-hCG; Transvaginal USG", small),
     Paragraph("EMERGENCY — IV access, fluid resuscitation, O2, urgent gynae referral / OT", small)],

    [Paragraph("PID / Salpingitis", small),
     Paragraph("Young female; bilateral lower abdominal pain, cervical motion tenderness, vaginal discharge, fever", small),
     Paragraph("Pelvic exam, HVS, HCG (rule out ectopic)", small),
     Paragraph("Doxycycline + Metronidazole ± Ceftriaxone; outpatient if mild", small)],

    [Paragraph("Acute Gastroenteritis", small),
     Paragraph("N/V + diarrhoea ± cramping, often diffuse tenderness, fever, recent food hx", small),
     Paragraph("Stool exam, culture; CBC if severe", small),
     Paragraph("Oral/IV rehydration; antibiotics only if bacterial (Ciprofloxacin for severe shigella/salmonella)", small)],
]

cond_t = Table(cond_data, colWidths=[3.0*cm, 5.5*cm, 3.8*cm, 5.3*cm])
cond_t.setStyle(TableStyle([
    ('BACKGROUND', (0,0), (-1,0), colors.HexColor("#014737")),
    ('TEXTCOLOR', (0,0), (-1,0), WHITE),
    ('ROWBACKGROUNDS', (0,1), (-1,-1), [WHITE, GREEN_LIGHT]),
    ('TOPPADDING', (0,0), (-1,-1), 4),
    ('BOTTOMPADDING', (0,0), (-1,-1), 4),
    ('LEFTPADDING', (0,0), (-1,-1), 5),
    ('GRID', (0,0), (-1,-1), 0.3, GREY_LINE),
    ('VALIGN', (0,0), (-1,-1), 'MIDDLE'),
    # Highlight ectopic row (index 7) as high danger
    ('BACKGROUND', (0,7), (-1,7), colors.HexColor("#fde68a")),
]))
story.append(cond_t)
story.append(Spacer(1, 0.2*cm))

# ══════════════════════════════════════════════════════════════════
# 7. ANALGESIA NOTE + BOTTOM TIPS
# ══════════════════════════════════════════════════════════════════
story.append(sec_hdr("7.  ANALGESIA & PRACTICAL TIPS", bg=colors.HexColor("#b45309")))
story.append(Spacer(1, 0.12*cm))

tips_data = [
    [Paragraph("<b>On analgesia:</b> Studies confirm that giving analgesics does NOT mask diagnosis or increase diagnostic errors. Do not withhold pain relief while evaluating. Use IV morphine 0.1 mg/kg titrated or IV paracetamol.", small),
     Paragraph("<b>On referral:</b> Immediate surgical referral if: peritonism, haemodynamic instability, suspected perforation, obstruction, ectopic pregnancy, or any patient where diagnosis is unclear after initial assessment.", small)],
    [Paragraph("<b>Nonspecific Abdominal Pain (NSAP):</b> ~40% of acute abdominal pain admissions. Diagnosis of exclusion. Active observation with serial examinations is acceptable. Early laparoscopy improves diagnosis rate but not clinical outcomes.", small),
     Paragraph("<b>Elderly caution:</b> Reduced peritoneal reaction — examination findings underestimate severity. Higher threshold for admission. Common causes missed: mesenteric ischaemia, aortic aneurysm, acute MI (atypical presentation).", small)],
]
tips_t = Table(tips_data, colWidths=[8.6*cm, 9.0*cm])
tips_t.setStyle(TableStyle([
    ('ROWBACKGROUNDS', (0,0), (-1,-1), [YELLOW_LIGHT, colors.HexColor("#fff7ed")]),
    ('TOPPADDING', (0,0), (-1,-1), 5),
    ('BOTTOMPADDING', (0,0), (-1,-1), 5),
    ('LEFTPADDING', (0,0), (-1,-1), 7),
    ('GRID', (0,0), (-1,-1), 0.3, GREY_LINE),
    ('VALIGN', (0,0), (-1,-1), 'TOP'),
]))
story.append(tips_t)
story.append(Spacer(1, 0.15*cm))

# ── FOOTER ─────────────────────────────────────────────────────────
story.append(HRFlowable(width="100%", thickness=0.5, color=GREY_LINE))
story.append(Spacer(1, 0.08*cm))
story.append(Paragraph(
    "References: Yamada's Textbook of Gastroenterology 7E · Harrison's Principles of Internal Medicine 22E (2025) · "
    "Rosen's Emergency Medicine · Bailey & Love's Short Practice of Surgery 28E · Textbook of Family Medicine 9E  |  "
    "Compiled by Orris AI · July 2026  |  For educational use only — always apply clinical judgment.",
    foot_s
))

doc.build(story)
print(f"PDF created: {out}")

Running Command

cd /home/daytona/workspace/pharyngitis-guide && python abdominal_pain_guide.py 2>&1

Running Command

ls -lh /home/daytona/workspace/pharyngitis-guide/

Your Abdominal Pain Quick Reference Guide is ready!

AbdominalPain Quick Reference

PDF Document · PDF

What's inside — 7 sections on one A4 page:

History (SOCRATES) - Full structured history framework with abdominal-specific extras (LMP, NSAIDs, travel)
DDx by Quadrant - All 8 regions (RUQ, LUQ, RLQ, LLQ, Epigastric, Central, Hypogastric, Diffuse) with common causes + "Don't Miss" column
Clinical Signs Table - Murphy's, Rovsing, Psoas, Obturator, Guarding, CVAT, Cullen's/Grey Turner's - how to elicit + what each means
Investigations - Tiered: basic workup → targeted (with reminders like β-hCG mandatory in all women, ECG for epigastric pain)
Red Flags - 11 urgent findings + high-risk populations
Common Conditions at a Glance - 9 conditions (appendicitis, cholecystitis, pancreatitis, PUD, obstruction, renal colic, ectopic pregnancy, PID, gastroenteritis) with classic presentation, key test, and initial management
Analgesia & Practical Tips - Key reminder that analgesics don't mask diagnosis + NSAP approach + elderly caution

Want guides for the other complaints too - Fever, Cough, or Jaundice?

Cough

Finding Sources

Reading File

Finding Sources

Reading File

Finding Sources

Writing File

~/pharyngitis-guide/cough_guide.py

from reportlab.lib.pagesizes import A4
from reportlab.lib import colors
from reportlab.lib.units import cm
from reportlab.lib.styles import getSampleStyleSheet, ParagraphStyle
from reportlab.platypus import (SimpleDocTemplate, Paragraph, Spacer, Table,
                                TableStyle, HRFlowable)
from reportlab.lib.enums import TA_CENTER, TA_LEFT

# ── Palette ──────────────────────────────────────────────────────
DARK_GREEN   = colors.HexColor("#14532d")
MED_GREEN    = colors.HexColor("#16a34a")
LIGHT_GREEN  = colors.HexColor("#dcfce7")
TEAL_DARK    = colors.HexColor("#0f4c5c")
TEAL         = colors.HexColor("#0e7490")
TEAL_LIGHT   = colors.HexColor("#cffafe")
BLUE_DARK    = colors.HexColor("#1e3a8a")
BLUE         = colors.HexColor("#2563eb")
BLUE_LIGHT   = colors.HexColor("#dbeafe")
ORANGE_DARK  = colors.HexColor("#9a3412")
ORANGE       = colors.HexColor("#c2410c")
ORANGE_LIGHT = colors.HexColor("#fff7ed")
RED          = colors.HexColor("#991b1b")
RED_LIGHT    = colors.HexColor("#fee2e2")
PURPLE_DARK  = colors.HexColor("#4c1d95")
PURPLE       = colors.HexColor("#7c3aed")
PURPLE_LIGHT = colors.HexColor("#ede9fe")
YELLOW_DARK  = colors.HexColor("#78350f")
YELLOW_LIGHT = colors.HexColor("#fef3c7")
GREY_BG      = colors.HexColor("#f1f5f9")
GREY_LINE    = colors.HexColor("#cbd5e1")
WHITE        = colors.white
BLACK        = colors.HexColor("#1e293b")

styles = getSampleStyleSheet()

def ms(name, **kw):
    return ParagraphStyle(name, parent=styles['Normal'], **kw)

title_s   = ms('T', fontSize=22, textColor=WHITE, fontName='Helvetica-Bold', alignment=TA_CENTER, spaceAfter=3)
sub_s     = ms('S', fontSize=10, textColor=colors.HexColor("#bbf7d0"), fontName='Helvetica', alignment=TA_CENTER)
sec_s     = ms('H', fontSize=11, textColor=WHITE, fontName='Helvetica-Bold', alignment=TA_LEFT, spaceBefore=1, spaceAfter=1)
small     = ms('Sm', fontSize=8, textColor=BLACK, fontName='Helvetica', leading=12)
small_b   = ms('SmB', fontSize=8, textColor=BLACK, fontName='Helvetica-Bold', leading=12)
red_s     = ms('R', fontSize=8, textColor=RED, fontName='Helvetica-Bold', leading=12)
orange_s  = ms('O', fontSize=8, textColor=ORANGE, fontName='Helvetica-Bold', leading=12)
foot_s    = ms('F', fontSize=7, textColor=colors.HexColor("#64748b"), fontName='Helvetica-Oblique', alignment=TA_CENTER, leading=10)

def shdr(text, bg=TEAL_DARK):
    t = Table([[Paragraph(text, sec_s)]], colWidths=[17.6*cm])
    t.setStyle(TableStyle([
        ('BACKGROUND', (0,0), (-1,-1), bg),
        ('TOPPADDING', (0,0), (-1,-1), 5),
        ('BOTTOMPADDING', (0,0), (-1,-1), 5),
        ('LEFTPADDING', (0,0), (-1,-1), 9),
    ]))
    return t

out = "/home/daytona/workspace/pharyngitis-guide/Cough_Quick_Reference.pdf"
doc = SimpleDocTemplate(out, pagesize=A4,
    leftMargin=1.2*cm, rightMargin=1.2*cm,
    topMargin=1.0*cm, bottomMargin=1.2*cm,
    title="Cough Quick Reference Guide")

story = []

# ── HEADER ────────────────────────────────────────────────────────
hdr = Table([
    [Paragraph("COUGH", title_s)],
    [Paragraph("Quick Reference Guide for MBBS Interns  |  General OPD / Respiratory Clinic", sub_s)],
    [Paragraph("Sources: Murray & Nadel's Respiratory Medicine 7E · Textbook of Family Medicine 9E · Harrison's 22E · Rosen's Emergency Medicine", foot_s)],
], colWidths=[17.6*cm])
hdr.setStyle(TableStyle([
    ('BACKGROUND', (0,0), (-1,-1), DARK_GREEN),
    ('TOPPADDING', (0,0), (-1,-1), 7),
    ('BOTTOMPADDING', (0,0), (-1,-1), 7),
    ('LEFTPADDING', (0,0), (-1,-1), 10),
]))
story.append(hdr)
story.append(Spacer(1, 0.22*cm))

# ══════════════════════════════════════════════════════════════════
# 1. CLASSIFICATION BY DURATION
# ══════════════════════════════════════════════════════════════════
story.append(shdr("1.  CLASSIFY FIRST — DURATION OF COUGH", bg=DARK_GREEN))
story.append(Spacer(1, 0.12*cm))

dur_data = [
    [Paragraph("<b>Type</b>", small_b), Paragraph("<b>Duration</b>", small_b), Paragraph("<b>Most Common Causes</b>", small_b), Paragraph("<b>Key Action</b>", small_b)],
    [Paragraph("ACUTE", small_b),
     Paragraph("<3 weeks", small),
     Paragraph("Viral URTI (most common), acute bronchitis, sinusitis, pneumonia, exacerbation of asthma/COPD, foreign body (children)", small),
     Paragraph("Treat conservatively. No antibiotics unless bacterial infection confirmed. CXR if fever, hemoptysis, or SOB.", small)],
    [Paragraph("SUBACUTE", small_b),
     Paragraph("3–8 weeks", small),
     Paragraph("Post-infectious cough (most common), pertussis (Bordetella), UACS/postnasal drip, asthma exacerbation", small),
     Paragraph("Consider pertussis especially if whooping + post-tussive vomiting. Macrolide if pertussis confirmed.", small)],
    [Paragraph("CHRONIC", small_b),
     Paragraph(">8 weeks", small),
     Paragraph("Non-smoker: Postnasal drip, Asthma, GERD, ACE inhibitor (PAGA mnemonic). Smoker: Add chronic bronchitis, lung cancer, bronchiectasis, TB", small),
     Paragraph("CXR mandatory. Spirometry. Trial of empiric therapy. ACE inhibitor? Switch to ARB.", small)],
]
dur_t = Table(dur_data, colWidths=[2.2*cm, 2.0*cm, 7.4*cm, 6.0*cm])
dur_t.setStyle(TableStyle([
    ('BACKGROUND', (0,0), (-1,0), DARK_GREEN),
    ('TEXTCOLOR', (0,0), (-1,0), WHITE),
    ('ROWBACKGROUNDS', (0,1), (-1,-1), [WHITE, LIGHT_GREEN]),
    ('TOPPADDING', (0,0), (-1,-1), 5),
    ('BOTTOMPADDING', (0,0), (-1,-1), 5),
    ('LEFTPADDING', (0,0), (-1,-1), 5),
    ('GRID', (0,0), (-1,-1), 0.3, GREY_LINE),
    ('VALIGN', (0,0), (-1,-1), 'MIDDLE'),
    ('BACKGROUND', (0,3), (1,3), colors.HexColor("#fde68a")),
]))
story.append(dur_t)
story.append(Spacer(1, 0.2*cm))

# ══════════════════════════════════════════════════════════════════
# 2. HISTORY — KEY QUESTIONS
# ══════════════════════════════════════════════════════════════════
story.append(shdr("2.  HISTORY — KEY QUESTIONS TO ASK", bg=TEAL_DARK))
story.append(Spacer(1, 0.12*cm))

hx_data = [
    [Paragraph("<b>Question</b>", small_b), Paragraph("<b>What it suggests</b>", small_b),
     Paragraph("<b>Question</b>", small_b), Paragraph("<b>What it suggests</b>", small_b)],
    [Paragraph("Productive or dry?", small),
     Paragraph("<b>Dry:</b> Asthma, GERD, ACE inhibitor, IPF, viral  |  <b>Productive:</b> Infection, bronchiectasis, TB, lung abscess", small),
     Paragraph("Nocturnal cough?", small),
     Paragraph("Asthma (classic!), GERD, postnasal drip, heart failure", small)],
    [Paragraph("Sputum colour?", small),
     Paragraph("<b>Clear/white:</b> Viral, asthma  |  <b>Yellow/green:</b> Bacterial  |  <b>Rusty:</b> Pneumococcal pneumonia  |  <b>Pink frothy:</b> Pulmonary oedema", small),
     Paragraph("Post-tussive vomiting?", small),
     Paragraph("Pertussis (whooping cough) — especially with paroxysmal nature", small)],
    [Paragraph("Haemoptysis?", small),
     Paragraph("TB, bronchiectasis, lung carcinoma, pulmonary embolism, mitral stenosis — NEVER ignore!", small),
     Paragraph("Wheezing / SOB?", small),
     Paragraph("Asthma, COPD, bronchitis, cardiac failure (cardiac asthma)", small)],
    [Paragraph("Heartburn / regurgitation?", small),
     Paragraph("GERD-related cough — often no GI symptoms despite GERD being the cause", small),
     Paragraph("Smoking history?", small),
     Paragraph("Chronic bronchitis, lung cancer, COPD. Pack-year history essential.", small)],
    [Paragraph("ACE inhibitor use?", small),
     Paragraph("Dry persistent cough — up to 15% of patients on ACEi. Switch to ARB.", small),
     Paragraph("TB contacts / travel?", small),
     Paragraph("TB — ask about weight loss, night sweats, fever. Mandatory in India.", small)],
    [Paragraph("Occupation / exposure?", small),
     Paragraph("Coal/grain dust → pneumoconiosis; birds → hypersensitivity pneumonitis; asbestos → mesothelioma", small),
     Paragraph("Child with sudden onset?", small),
     Paragraph("Foreign body aspiration until proven otherwise", small)],
]
hx_t = Table(hx_data, colWidths=[3.0*cm, 5.8*cm, 3.0*cm, 5.8*cm])
hx_t.setStyle(TableStyle([
    ('BACKGROUND', (0,0), (-1,0), TEAL_DARK),
    ('TEXTCOLOR', (0,0), (-1,0), WHITE),
    ('ROWBACKGROUNDS', (0,1), (-1,-1), [WHITE, TEAL_LIGHT]),
    ('TOPPADDING', (0,0), (-1,-1), 4),
    ('BOTTOMPADDING', (0,0), (-1,-1), 4),
    ('LEFTPADDING', (0,0), (-1,-1), 5),
    ('GRID', (0,0), (-1,-1), 0.3, GREY_LINE),
    ('VALIGN', (0,0), (-1,-1), 'MIDDLE'),
]))
story.append(hx_t)
story.append(Spacer(1, 0.2*cm))

# ══════════════════════════════════════════════════════════════════
# 3. COMMON CAUSES WITH RECOGNITION + MANAGEMENT
# ══════════════════════════════════════════════════════════════════
story.append(shdr("3.  COMMON CAUSES — RECOGNITION & MANAGEMENT", bg=BLUE_DARK))
story.append(Spacer(1, 0.12*cm))

cond_data = [
    [Paragraph("<b>Condition</b>", small_b), Paragraph("<b>Classic Clues</b>", small_b), Paragraph("<b>Test</b>", small_b), Paragraph("<b>Management</b>", small_b)],
    [Paragraph("Viral URTI / Acute Bronchitis", small),
     Paragraph("Acute cough, runny nose, sore throat, no fever >38°C, self-limiting <3 weeks", small),
     Paragraph("Clinical diagnosis. No investigations needed routinely.", small),
     Paragraph("Supportive: fluids, honey, steam inhalation. No antibiotics. Paracetamol for fever.", small)],
    [Paragraph("Pneumonia", small),
     Paragraph("Fever, productive cough, tachypnoea, pleuritic chest pain, dullness on percussion, bronchial breath sounds", small),
     Paragraph("CXR (consolidation); CBC (WBC↑); sputum culture; SpO2", small),
     Paragraph("CAP: Amoxicillin 500 mg TDS × 5–7 days (outpatient). Severe/atypical: Add Azithromycin/Doxycycline. Admit if CURB-65 ≥2.", small)],
    [Paragraph("Asthma / Cough-variant Asthma", small),
     Paragraph("Nocturnal dry cough ± wheeze, breathlessness, reversible with bronchodilator; episodic; triggered by cold, exercise, allergens", small),
     Paragraph("Spirometry (FEV1/FVC <0.7, reversible); Peak flow variability >20%; CXR (hyperinflation)", small),
     Paragraph("Inhaled SABA (Salbutamol) for acute. Add ICS (Beclomethasone) for persistent. Trial of oral prednisolone if diagnosis unclear.", small)],
    [Paragraph("Postnasal Drip (UACS)", small),
     Paragraph("Sensation of drip at back of throat, throat clearing, cobblestoning of pharynx, often no nasal symptoms", small),
     Paragraph("Clinical. CT sinuses if recurrent sinusitis.", small),
     Paragraph("Nasal topical steroid (Fluticasone spray) + antihistamine. Ipratropium nasal spray for excessive secretions. Antibiotics if bacterial sinusitis.", small)],
    [Paragraph("GERD", small),
     Paragraph("Chronic dry cough worsened by lying down, post-meal; heartburn may be absent! Responds to PPI trial.", small),
     Paragraph("Clinical + PPI trial. OGD if refractory.", small),
     Paragraph("PPI (Omeprazole 20–40 mg OD) × 8 weeks. Elevate head of bed, avoid triggers (spicy food, coffee, alcohol, late meals).", small)],
    [Paragraph("ACE Inhibitor Cough", small),
     Paragraph("Persistent dry tickly cough starting weeks–months after ACEi initiation; no other symptoms", small),
     Paragraph("Clinical. Drug history.", small),
     Paragraph("Stop ACE inhibitor. Switch to ARB (Losartan). Cough resolves in 1–4 weeks.", small)],
    [Paragraph("Tuberculosis (TB)", small),
     Paragraph("Chronic productive cough >3 weeks, haemoptysis, evening fever, night sweats, weight loss, TB contact", small),
     Paragraph("Sputum AFB × 3 (or CBNAAT/Xpert MTB), CXR (upper lobe involvement, cavitation)", small),
     Paragraph("Refer to DOTS centre. RHEZ (Rifampicin, INH, Ethambutol, Pyrazinamide) × 2 months then RH × 4 months.", small)],
    [Paragraph("COPD (exacerbation)", small),
     Paragraph("Smoker, chronic productive cough + increased sputum volume/purulence, worsening dyspnoea", small),
     Paragraph("Spirometry (FEV1/FVC <0.7, not fully reversible); CXR; ABG if severe", small),
     Paragraph("SABD (Salbutamol + Ipratropium), systemic steroids (Prednisolone 30–40 mg × 5 days), antibiotics if purulent sputum (Amoxicillin/Doxycycline).", small)],
    [Paragraph("Bronchiectasis", small),
     Paragraph("Chronic copious mucopurulent/foul-smelling sputum, daily cough, recurrent chest infections, finger clubbing possible", small),
     Paragraph("HRCT chest (gold standard: dilated thick-walled bronchi)", small),
     Paragraph("Postural drainage/chest physiotherapy. Antibiotics for exacerbations. Inhaled LABA + ICS. Treat underlying cause.", small)],
    [Paragraph("Lung Cancer", small),
     Paragraph("Smoker >40 yrs, new or changed cough, haemoptysis, weight loss, hoarseness (recurrent laryngeal nerve), clubbing", small),
     Paragraph("CXR → CT chest (mass lesion). Bronchoscopy + biopsy.", small),
     Paragraph("Urgent oncology/pulmonology referral. Staging required before treatment.", small)],
]
cond_t = Table(cond_data, colWidths=[3.0*cm, 5.0*cm, 3.8*cm, 5.8*cm])
cond_t.setStyle(TableStyle([
    ('BACKGROUND', (0,0), (-1,0), BLUE_DARK),
    ('TEXTCOLOR', (0,0), (-1,0), WHITE),
    ('ROWBACKGROUNDS', (0,1), (-1,-1), [WHITE, BLUE_LIGHT]),
    ('TOPPADDING', (0,0), (-1,-1), 4),
    ('BOTTOMPADDING', (0,0), (-1,-1), 4),
    ('LEFTPADDING', (0,0), (-1,-1), 5),
    ('GRID', (0,0), (-1,-1), 0.3, GREY_LINE),
    ('VALIGN', (0,0), (-1,-1), 'MIDDLE'),
    # Highlight TB row (index 7) - important in India
    ('BACKGROUND', (0,7), (-1,7), colors.HexColor("#fde68a")),
    # Highlight lung cancer row (index 10)
    ('BACKGROUND', (0,10), (-1,10), RED_LIGHT),
]))
story.append(cond_t)
story.append(Spacer(1, 0.2*cm))

# ══════════════════════════════════════════════════════════════════
# 4. INVESTIGATIONS  +  5. RED FLAGS  (side by side)
# ══════════════════════════════════════════════════════════════════
story.append(shdr("4.  INVESTIGATIONS                                                               5.  RED FLAGS", bg=PURPLE_DARK))
story.append(Spacer(1, 0.12*cm))

inv_box = Table([
    [Paragraph("<b>All patients with cough >3 weeks:</b>", small_b)],
    [Paragraph("• CXR PA view — MOST valuable single test", small_b)],
    [Paragraph("• CBC — eosinophilia (asthma), WBC↑ (infection), anaemia (malignancy)", small)],
    [Paragraph("• SpO2 — assess respiratory compromise", small)],
    [Paragraph(" ", small)],
    [Paragraph("<b>Targeted by suspected cause:</b>", small_b)],
    [Paragraph("• Sputum AFB × 3 / CBNAAT — if TB suspected (>3 wks cough in India)", small)],
    [Paragraph("• Spirometry — if asthma/COPD suspected (reversibility test)", small)],
    [Paragraph("• HRCT chest — bronchiectasis (dilated bronchi), ILD, malignancy", small)],
    [Paragraph("• CT sinuses — recurrent sinusitis/UACS", small)],
    [Paragraph("• OGD / 24h pH study — refractory GERD-related cough", small)],
    [Paragraph("• Sputum cytology — if malignancy suspected", small)],
    [Paragraph("• Bronchoscopy — haemoptysis, suspected malignancy, FB aspiration", small)],
    [Paragraph("• Mantoux/IGRA (Quantiferon) — TB latent/active workup", small)],
    [Paragraph(" ", small)],
    [Paragraph("<b>Empiric trials (if CXR normal, non-smoker):</b>", small_b)],
    [Paragraph("Stop ACEi → Wait 4 weeks | PPI trial × 8 wks | Nasal steroid × 4 wks | ICS trial × 6 wks", small)],
], colWidths=[8.4*cm])
inv_box.setStyle(TableStyle([
    ('BACKGROUND', (0,0), (-1,-1), PURPLE_LIGHT),
    ('TOPPADDING', (0,0), (-1,-1), 3),
    ('BOTTOMPADDING', (0,0), (-1,-1), 3),
    ('LEFTPADDING', (0,0), (-1,-1), 7),
]))

rf_box = Table([
    [Paragraph("<b>🚨 Red Flags — Urgent Evaluation / Refer</b>", red_s)],
    [Paragraph("• Haemoptysis — never ignore (TB, cancer, PE)", small)],
    [Paragraph("• Weight loss + night sweats + chronic cough → TB / malignancy", small)],
    [Paragraph("• Stridor — upper airway obstruction (epiglottitis, foreign body, tumour)", small)],
    [Paragraph("• SpO2 <94% on air — respiratory failure", small)],
    [Paragraph("• Respiratory rate >30/min — severe pneumonia / sepsis", small)],
    [Paragraph("• Pleuritic chest pain + SOB — PE, pneumonia, pneumothorax", small)],
    [Paragraph("• Hoarse voice + cough → recurrent laryngeal nerve palsy (lung cancer)", small)],
    [Paragraph("• Clubbing + chronic cough → bronchiectasis, IPF, malignancy", small)],
    [Paragraph("• Cough + superior vena cava syndrome (face/arm oedema, JVP↑)", small)],
    [Paragraph("• Sudden onset severe dyspnoea + cough — pneumothorax, massive PE", small)],
    [Paragraph("• Child: sudden onset cough after playing with small objects → FB aspiration", small)],
    [Paragraph(" ", small)],
    [Paragraph("<b>CURB-65 (Admit if score ≥2):</b>", small_b)],
    [Paragraph("C=Confusion | U=Urea >7 mmol/L | R=RR ≥30 | B=BP<90/60 | 65=Age≥65", small)],
    [Paragraph("Score 0–1: Home | Score 2: Hospital | Score 3–5: ICU consider", small)],
], colWidths=[9.0*cm])
rf_box.setStyle(TableStyle([
    ('BACKGROUND', (0,0), (-1,-1), RED_LIGHT),
    ('TOPPADDING', (0,0), (-1,-1), 3),
    ('BOTTOMPADDING', (0,0), (-1,-1), 3),
    ('LEFTPADDING', (0,0), (-1,-1), 7),
]))

combined = Table([[inv_box, rf_box]], colWidths=[8.6*cm, 9.0*cm])
combined.setStyle(TableStyle([
    ('VALIGN', (0,0), (-1,-1), 'TOP'),
    ('LEFTPADDING', (0,0), (-1,-1), 0),
    ('RIGHTPADDING', (0,0), (-1,-1), 0),
    ('TOPPADDING', (0,0), (-1,-1), 0),
    ('GRID', (0,0), (-1,-1), 0.3, GREY_LINE),
]))
story.append(combined)
story.append(Spacer(1, 0.2*cm))

# ══════════════════════════════════════════════════════════════════
# 6. CHRONIC COUGH MNEMONIC + SPECIAL NOTES
# ══════════════════════════════════════════════════════════════════
story.append(shdr("6.  CHRONIC COUGH MNEMONIC  +  SPECIAL CLINICAL NOTES", bg=colors.HexColor("#b45309")))
story.append(Spacer(1, 0.12*cm))

memo_box = Table([
    [Paragraph("<b>PAGA — Top 4 Causes of Chronic Cough (Non-smoker)</b>", small_b)],
    [Paragraph("<b>P</b> — Postnasal drip / Upper Airway Cough Syndrome (UACS)  →  most common", small)],
    [Paragraph("<b>A</b> — Asthma (including cough-variant asthma)  →  nocturnal, reversible", small)],
    [Paragraph("<b>G</b> — GERD  →  dry cough, no GI symptoms in 40%; PPI trial diagnostic", small)],
    [Paragraph("<b>A</b> — ACE inhibitor  →  dry tickly cough, 10–15% of users; stops when drug stopped", small)],
    [Paragraph(" ", small)],
    [Paragraph("<b>In Smokers, add:</b>  Chronic bronchitis | Lung carcinoma | Bronchiectasis | TB", small_b)],
], colWidths=[8.4*cm])
memo_box.setStyle(TableStyle([
    ('BACKGROUND', (0,0), (-1,-1), YELLOW_LIGHT),
    ('TOPPADDING', (0,0), (-1,-1), 4),
    ('BOTTOMPADDING', (0,0), (-1,-1), 4),
    ('LEFTPADDING', (0,0), (-1,-1), 8),
]))

notes_box = Table([
    [Paragraph("<b>Practical Tips for OPD</b>", small_b)],
    [Paragraph("• <b>Cough-variant asthma:</b> Cough is the ONLY symptom in up to 57% of asthmatics. No wheeze needed for diagnosis.", small)],
    [Paragraph("• <b>GERD cough:</b> May be completely silent — no heartburn or regurgitation. Diagnose by PPI trial response.", small)],
    [Paragraph("• <b>Pertussis in adults:</b> Whooping sound or post-tussive vomiting + paroxysmal cough + 3–8 week duration = suspect pertussis. Treat with Azithromycin 500 mg OD × 3 days.", small)],
    [Paragraph("• <b>TB in India:</b> Any cough >2–3 weeks needs sputum AFB / CBNAAT. Do not delay testing. Free DOTS treatment available.", small)],
    [Paragraph("• <b>IPF:</b> Chronic dry cough + progressive dyspnoea + Velcro crackles at bases = suspect IPF. HRCT is diagnostic. Refer pulmonology.", small)],
    [Paragraph("• <b>Foreign body (children):</b> Sudden onset choking + cough after playing = FB until proven otherwise. Urgent bronchoscopy.", small)],
], colWidths=[9.0*cm])
notes_box.setStyle(TableStyle([
    ('BACKGROUND', (0,0), (-1,-1), LIGHT_GREEN),
    ('TOPPADDING', (0,0), (-1,-1), 4),
    ('BOTTOMPADDING', (0,0), (-1,-1), 4),
    ('LEFTPADDING', (0,0), (-1,-1), 8),
]))

tips = Table([[memo_box, notes_box]], colWidths=[8.6*cm, 9.0*cm])
tips.setStyle(TableStyle([
    ('VALIGN', (0,0), (-1,-1), 'TOP'),
    ('LEFTPADDING', (0,0), (-1,-1), 0),
    ('RIGHTPADDING', (0,0), (-1,-1), 0),
    ('TOPPADDING', (0,0), (-1,-1), 0),
    ('GRID', (0,0), (-1,-1), 0.3, GREY_LINE),
]))
story.append(tips)
story.append(Spacer(1, 0.15*cm))

# ── FOOTER ────────────────────────────────────────────────────────
story.append(HRFlowable(width="100%", thickness=0.5, color=GREY_LINE))
story.append(Spacer(1, 0.08*cm))
story.append(Paragraph(
    "References: Murray & Nadel's Textbook of Respiratory Medicine 7E · Textbook of Family Medicine 9E · "
    "Harrison's Principles of Internal Medicine 22E (2025) · Rosen's Emergency Medicine  |  "
    "Compiled by Orris AI · July 2026  |  For educational use only — always apply clinical judgment.",
    foot_s
))

doc.build(story)
print(f"PDF created: {out}")

Running Command

cd /home/daytona/workspace/pharyngitis-guide && python cough_guide.py 2>&1

Running Command

ls -lh /home/daytona/workspace/pharyngitis-guide/

Your Cough Quick Reference Guide is ready!

Cough Quick Reference

PDF Document · PDF

What's inside — 6 sections on one A4 page:

Classify First by Duration - Acute (<3 wks) / Subacute (3–8 wks) / Chronic (>8 wks) with causes and key action for each
History - Key Questions - Productive vs dry, sputum colour, haemoptysis, nocturnal cough, GERD symptoms, ACE inhibitor use, TB contact, smoking, occupation, foreign body in children
Common Causes Table - 10 conditions (viral URTI, pneumonia, asthma, postnasal drip, GERD, ACEi cough, TB, COPD, bronchiectasis, lung cancer) with clues, test, and management
- TB row highlighted - particularly relevant for India
- Lung cancer row - highlighted as red flag
Investigations - Tiered: basic (CXR, CBC, SpO2) → targeted → empiric trial sequence
Red Flags - 11 warning signs including haemoptysis, stridor, hoarseness, clubbing + CURB-65 score for pneumonia admission decision
PAGA Mnemonic + Practical Tips - Postnasal drip/Asthma/GERD/ACEi, plus 6 key OPD pearls (cough-variant asthma, silent GERD, pertussis in adults, TB in India, IPF, foreign body)

You now have all 3 guides. Want the Fever or Jaundice guide next?

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