cd /home/daytona/workspace && python3 -c " import pdfplumber pdf_path = '/home/d…

cd /home/daytona/workspace && python3 -c " import pdfplumber, json pdf_path = '…

cd /home/daytona/workspace && python3 -c " import json with open('/home/daytona…

cat /home/daytona/workspace/cvs_fulltext.txt | wc -l

cd /home/daytona/workspace && python3 -c " import json with open('/home/daytona…

~/cvs_pyq_pdf.py

#!/usr/bin/env python3
"""
Generate CVS PYQ Study PDF from Ghai Pediatrics textbook content.
Black & white, printable, organized with tables and flowcharts.
"""

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

# ── Page setup ──────────────────────────────────────────────────────────────
PAGE_W, PAGE_H = A4
MARGIN = 1.5 * cm
DOC_WIDTH = PAGE_W - 2 * MARGIN

def build_styles():
    base = getSampleStyleSheet()
    styles = {}

    styles['title'] = ParagraphStyle(
        'DocTitle', fontName='Helvetica-Bold', fontSize=14,
        textColor=black, spaceAfter=4, spaceBefore=0,
        alignment=TA_CENTER, leading=18)

    styles['subtitle'] = ParagraphStyle(
        'SubTitle', fontName='Helvetica', fontSize=9,
        textColor=black, spaceAfter=10, alignment=TA_CENTER, leading=12)

    styles['q_heading'] = ParagraphStyle(
        'QHead', fontName='Helvetica-Bold', fontSize=11,
        textColor=black, spaceAfter=3, spaceBefore=10,
        leading=14, borderPad=3)

    styles['section'] = ParagraphStyle(
        'Section', fontName='Helvetica-Bold', fontSize=10,
        textColor=black, spaceAfter=2, spaceBefore=6, leading=13)

    styles['body'] = ParagraphStyle(
        'Body', fontName='Helvetica', fontSize=9,
        textColor=black, spaceAfter=2, spaceBefore=0,
        leading=12, alignment=TA_JUSTIFY)

    styles['bullet'] = ParagraphStyle(
        'Bullet', fontName='Helvetica', fontSize=9,
        textColor=black, spaceAfter=1, spaceBefore=0,
        leading=12, leftIndent=12, bulletIndent=0)

    styles['bullet2'] = ParagraphStyle(
        'Bullet2', fontName='Helvetica', fontSize=9,
        textColor=black, spaceAfter=1, spaceBefore=0,
        leading=11, leftIndent=24, bulletIndent=12)

    styles['note'] = ParagraphStyle(
        'Note', fontName='Helvetica-Oblique', fontSize=8,
        textColor=black, spaceAfter=2, leading=10)

    styles['table_header'] = ParagraphStyle(
        'THead', fontName='Helvetica-Bold', fontSize=8.5,
        textColor=black, leading=11, alignment=TA_CENTER)

    styles['table_cell'] = ParagraphStyle(
        'TCell', fontName='Helvetica', fontSize=8.5,
        textColor=black, leading=11)

    return styles

S = build_styles()

def hr():
    return HRFlowable(width='100%', thickness=0.5, color=black, spaceAfter=4, spaceBefore=4)

def q_header(num, title, years):
    """Returns a boxed question header block."""
    yr_str = '  |  '.join([f'({y})' for y in years])
    return [
        hr(),
        Paragraph(f"Q{num}. {title}", S['q_heading']),
        Paragraph(f"<i>Years: {yr_str}</i>", S['note']),
        Spacer(1, 3),
    ]

def section(title):
    return Paragraph(f"▶ {title}", S['section'])

def b(text):
    return Paragraph(f"• {text}", S['bullet'])

def bb(text):
    return Paragraph(f"  – {text}", S['bullet2'])

def body(text):
    return Paragraph(text, S['body'])

def bold_body(text):
    return Paragraph(f"<b>{text}</b>", S['body'])

def make_table(header_row, data_rows, col_widths=None):
    """Build a styled B&W table."""
    if col_widths is None:
        n = len(header_row)
        col_widths = [DOC_WIDTH / n] * n

    # Wrap all cells in Paragraph
    def wrap(text, is_header=False):
        if text is None:
            text = ''
        style = S['table_header'] if is_header else S['table_cell']
        return Paragraph(str(text), style)

    table_data = [[wrap(c, True) for c in header_row]]
    for row in data_rows:
        table_data.append([wrap(c) for c in row])

    t = Table(table_data, colWidths=col_widths, repeatRows=1)
    t.setStyle(TableStyle([
        ('BACKGROUND', (0, 0), (-1, 0), HexColor('#CCCCCC')),
        ('TEXTCOLOR', (0, 0), (-1, 0), black),
        ('GRID', (0, 0), (-1, -1), 0.4, black),
        ('VALIGN', (0, 0), (-1, -1), 'TOP'),
        ('ROWBACKGROUNDS', (0, 1), (-1, -1), [white, HexColor('#F5F5F5')]),
        ('LEFTPADDING', (0, 0), (-1, -1), 4),
        ('RIGHTPADDING', (0, 0), (-1, -1), 4),
        ('TOPPADDING', (0, 0), (-1, -1), 3),
        ('BOTTOMPADDING', (0, 0), (-1, -1), 3),
    ]))
    return t

def flow_box(title, items, width=None):
    """Simple flowchart-style box with title and items as a table."""
    if width is None:
        width = DOC_WIDTH
    rows = [[Paragraph(f"<b>{title}</b>", S['table_header'])]]
    for item in items:
        rows.append([Paragraph(f"• {item}", S['table_cell'])])
    t = Table(rows, colWidths=[width])
    t.setStyle(TableStyle([
        ('BACKGROUND', (0, 0), (-1, 0), HexColor('#DDDDDD')),
        ('GRID', (0, 0), (-1, -1), 0.4, black),
        ('VALIGN', (0, 0), (-1, -1), 'TOP'),
        ('LEFTPADDING', (0, 0), (-1, -1), 6),
        ('TOPPADDING', (0, 0), (-1, -1), 3),
        ('BOTTOMPADDING', (0, 0), (-1, -1), 3),
    ]))
    return t

def flowchart_horizontal(steps, width=None):
    """Horizontal flow: Step1 → Step2 → Step3 using a table."""
    if width is None:
        width = DOC_WIDTH
    n = len(steps)
    arrow_col = 0.4 * cm
    step_w = (width - (n - 1) * arrow_col) / n

    cells = []
    cw = []
    for i, step in enumerate(steps):
        cells.append(Paragraph(step, S['table_cell']))
        cw.append(step_w)
        if i < n - 1:
            cells.append(Paragraph("→", S['table_header']))
            cw.append(arrow_col)

    t = Table([cells], colWidths=cw)
    t.setStyle(TableStyle([
        ('BACKGROUND', (0, 0), (-1, -1), HexColor('#EEEEEE')),
        ('GRID', (0, 0), (-1, -1), 0.4, black),
        ('ALIGN', (0, 0), (-1, -1), 'CENTER'),
        ('VALIGN', (0, 0), (-1, -1), 'MIDDLE'),
        ('FONTNAME', (0, 0), (-1, -1), 'Helvetica'),
        ('FONTSIZE', (0, 0), (-1, -1), 8),
        ('TOPPADDING', (0, 0), (-1, -1), 4),
        ('BOTTOMPADDING', (0, 0), (-1, -1), 4),
    ]))
    return t

def two_col_table(left_header, left_items, right_header, right_items):
    """Two-column comparison table."""
    max_rows = max(len(left_items), len(right_items))
    rows = [[Paragraph(f"<b>{left_header}</b>", S['table_header']),
             Paragraph(f"<b>{right_header}</b>", S['table_header'])]]
    for i in range(max_rows):
        l = left_items[i] if i < len(left_items) else ''
        r = right_items[i] if i < len(right_items) else ''
        rows.append([Paragraph(f"• {l}", S['table_cell']),
                     Paragraph(f"• {r}", S['table_cell'])])
    t = Table(rows, colWidths=[DOC_WIDTH / 2, DOC_WIDTH / 2])
    t.setStyle(TableStyle([
        ('BACKGROUND', (0, 0), (-1, 0), HexColor('#CCCCCC')),
        ('GRID', (0, 0), (-1, -1), 0.4, black),
        ('VALIGN', (0, 0), (-1, -1), 'TOP'),
        ('LEFTPADDING', (0, 0), (-1, -1), 4),
        ('TOPPADDING', (0, 0), (-1, -1), 3),
        ('BOTTOMPADDING', (0, 0), (-1, -1), 3),
    ]))
    return t

# ═══════════════════════════════════════════════════════════════════════════
#  CONTENT BUILDER
# ═══════════════════════════════════════════════════════════════════════════
def build_content():
    story = []

    # ── Cover header ────────────────────────────────────────────────────────
    story += [
        Paragraph("PEDIATRIC CVS DISORDERS", S['title']),
        Paragraph("Previous Year Questions (MBBS Final Part II) — Ghai Essential Pediatrics, 10th Ed.", S['subtitle']),
        hr(),
        Spacer(1, 4),
    ]

    # ────────────────────────────────────────────────────────────────────────
    # Q1: Management of Congestive Heart Failure in Children (2009)
    # ────────────────────────────────────────────────────────────────────────
    story += q_header(1, "Management of Congestive Heart Failure (CHF) in Children", ["2009"])
    story += [
        section("Definition"),
        body("CHF = Inability of heart to maintain cardiac output for metabolic needs (systolic failure) "
             "AND/OR inability to receive blood at low pressure during diastole (diastolic failure)."),
        Spacer(1, 3),
        section("Goals of Treatment"),
    ]
    story += [
        make_table(
            ["Goal", "Mechanism"],
            [
                ["Improve cardiac contractility", "Digoxin, inotropes"],
                ["Reduce preload", "Diuretics (furosemide), fluid restriction"],
                ["Reduce afterload", "ACE inhibitors, vasodilators"],
                ["Treat arrhythmias", "Antiarrhythmic drugs"],
                ["Treat underlying cause", "Surgery, catheter intervention"],
            ],
            col_widths=[DOC_WIDTH * 0.45, DOC_WIDTH * 0.55]
        ),
        Spacer(1, 4),
        section("FLOWCHART: Treatment of CHF"),
        flowchart_horizontal(["Diagnose CHF\n(Clinical + Echo)", "Supportive Care\n(O2, posture, fluids)", "Diuretics\n(Furosemide)", "Digoxin\n(if systolic failure)", "ACE Inhibitor\n(Captopril/Enalapril)", "Treat Cause\n(Surgery/Cath)"]),
        Spacer(1, 4),
        section("Non-pharmacological"),
    ]
    story += [
        b("Semi-recumbent/propped up position; 30–45° head elevation"),
        b("Restrict fluids to 65–75% of normal maintenance"),
        b("Supplemental oxygen (maintain SpO2 > 94%)"),
        b("High caloric feeds (100–130 kcal/kg/day); nasogastric feeding if needed"),
        b("Treat precipitating factors: anemia, infection, arrhythmia, fever"),
        Spacer(1, 3),
        section("Pharmacological"),
        make_table(
            ["Drug", "Dose", "Mechanism / Notes"],
            [
                ["Furosemide", "1–2 mg/kg/dose IV/oral OD–BD", "Loop diuretic; first-line; reduces preload"],
                ["Spironolactone", "2–3 mg/kg/day oral in 2 doses", "K-sparing diuretic; aldosterone antagonist"],
                ["Digoxin", "Digitalizing: 20–30 µg/kg oral; Maintenance: 5–10 µg/kg/day BD", "Positive inotrope; also controls HR in AF"],
                ["Captopril", "0.1–0.5 mg/kg/dose 8-hourly oral", "ACE inhibitor; reduces afterload"],
                ["Carvedilol", "0.05–0.2 mg/kg/dose BD", "Beta-blocker; used in chronic dilated CMP"],
                ["Dobutamine", "5–15 µg/kg/min IV infusion", "Inotrope for acute decompensated CHF"],
                ["Milrinone", "0.25–0.75 µg/kg/min IV", "Phosphodiesterase inhibitor; inotrope + vasodilator"],
            ],
            col_widths=[DOC_WIDTH * 0.22, DOC_WIDTH * 0.33, DOC_WIDTH * 0.45]
        ),
    ]

    # ────────────────────────────────────────────────────────────────────────
    # Q2: Cyanotic Spell — Clinical Presentation, Pathogenesis and Management
    # ────────────────────────────────────────────────────────────────────────
    story += [PageBreak()]
    story += q_header(2, "Cyanotic Spell (Hypercyanotic / TET Spell) — Presentation, Pathogenesis & Management",
                      ["2019", "2017", "2015", "2010"])
    story += [
        section("Definition"),
        body("Episodic hypoxemia in a child with TOF (or other cyanotic CHD with infundibular PS) due to sudden "
             "decrease in pulmonary blood flow. Most common in 2–4 months age. Typically occurs in morning after feeding/crying/defecation."),
        Spacer(1, 3),
        section("FLOWCHART: Pathogenesis of Cyanotic Spell"),
    ]

    # Pathogenesis flowchart as vertical table
    patho_steps = [
        "Trigger: Crying / feeding / defecation / fever / anemia / dehydration",
        "↓ Systemic vascular resistance  OR  Infundibular spasm (RVOTO worsens)",
        "↑ Right-to-left shunt through VSD (more deoxygenated blood to aorta)",
        "↓ PaO2 → Hypoxemia → Hyperventilation → ↓ PaCO2 → Respiratory alkalosis",
        "Respiratory alkalosis → further ↑ RVOTO (worsens spasm) → Vicious cycle",
        "Severe: Loss of consciousness, seizures, stroke, death",
    ]
    path_rows = [[Paragraph(f"<b>Pathogenesis of Cyanotic Spell</b>", S['table_header'])]]
    for s in patho_steps:
        path_rows.append([Paragraph(s, S['table_cell'])])
    path_t = Table(path_rows, colWidths=[DOC_WIDTH])
    path_t.setStyle(TableStyle([
        ('BACKGROUND', (0, 0), (-1, 0), HexColor('#CCCCCC')),
        ('BACKGROUND', (0, 1), (-1, -1), white),
        ('GRID', (0, 0), (-1, -1), 0.4, black),
        ('VALIGN', (0, 0), (-1, -1), 'TOP'),
        ('LEFTPADDING', (0, 0), (-1, -1), 6),
        ('TOPPADDING', (0, 0), (-1, -1), 3),
        ('BOTTOMPADDING', (0, 0), (-1, -1), 3),
    ]))
    story += [path_t, Spacer(1, 4)]

    story += [
        section("Clinical Features"),
        b("Sudden onset of deep cyanosis and restlessness — child turns 'blue'"),
        b("Hyperpnea (rapid deep breathing) — most characteristic feature"),
        b("Murmur decreases or disappears (less blood flowing through RVOT)"),
        b("Pallor, cool extremities, sweating"),
        b("Limpness/unconsciousness in severe spell"),
        b("Squatting posture in older children (↑ SVR, ↓ R→L shunt)"),
        Spacer(1, 3),
        section("Management of Cyanotic Spell — STEP-BY-STEP"),
        make_table(
            ["Step", "Action", "Rationale"],
            [
                ["1", "Knee-chest position / squatting", "↑ SVR → ↓ R→L shunt"],
                ["2", "100% O2 by face mask", "Treat hypoxemia, pulmonary vasodilation"],
                ["3", "Morphine 0.1–0.2 mg/kg SC/IV", "Suppresses RVOT spasm, reduces hyperpnea"],
                ["4", "IV sodium bicarbonate 1 mEq/kg", "Correct metabolic acidosis (↓ respiratory drive)"],
                ["5", "IV Propranolol 0.1 mg/kg slowly (max 3 doses)", "↓ Heart rate, ↓ infundibular spasm"],
                ["6", "IV fluids (10–20 mL/kg NS) if dehydrated", "↑ Preload → ↑ pulmonary flow"],
                ["7", "Correct anemia (Hb < 12 g/dL → transfuse)", "Anemia is a precipitant"],
                ["8", "Vasopressor: Phenylephrine 5 µg/kg IV or Methoxamine", "↑ SVR → ↓ shunt"],
                ["9", "Persistent: Paralyze, intubate, ventilate", "Temporize; plan surgery"],
            ],
            col_widths=[DOC_WIDTH * 0.06, DOC_WIDTH * 0.50, DOC_WIDTH * 0.44]
        ),
        Spacer(1, 3),
        section("After the Spell"),
        b("Oral propranolol 0.5–1.5 mg/kg every 6–8 hr (long-term)"),
        b("Correct iron deficiency anemia (prophylactic iron if Hb < 12)"),
        b("Plan early surgical correction or palliative (BT shunt)"),
        b("Counsel parents on precipitating factors — avoid pain, dehydration, fever"),
    ]

    # ────────────────────────────────────────────────────────────────────────
    # Q3 + Q8: ARF — Criteria and Diagnosis + Management
    # ────────────────────────────────────────────────────────────────────────
    story += [PageBreak()]
    story += q_header(3, "Criteria for Diagnosis of Acute Rheumatic Fever (Jones Criteria)", ["2024", "2012"])
    story += [
        section("Jones Criteria (Modified, 2015 — AHA) for Diagnosis of ARF"),
        body("Required: Evidence of preceding GAS infection PLUS 2 major criteria OR 1 major + 2 minor criteria"),
        Spacer(1, 3),
        make_table(
            ["MAJOR CRITERIA", "MINOR CRITERIA"],
            [
                ["Carditis (clinical or subclinical/echo)", "Fever (≥38.5°C)"],
                ["Arthritis — migratory polyarthritis (large joints)", "Elevated ESR (≥60 mm/hr) or CRP (≥3 mg/dL)"],
                ["Chorea (Sydenham's chorea)", "Prolonged PR interval on ECG"],
                ["Erythema marginatum", "Arthralgia (only if arthritis not used as major)"],
                ["Subcutaneous nodules", ""],
            ],
            col_widths=[DOC_WIDTH * 0.5, DOC_WIDTH * 0.5]
        ),
        Spacer(1, 3),
        section("Evidence of Preceding GAS Infection (MANDATORY)"),
        b("Positive throat culture or rapid antigen test for GAS"),
        b("Elevated/rising ASO titer (>200 Todd units in school-age children)"),
        b("Elevated anti-DNase B titer"),
        Spacer(1, 3),
        section("Special Populations (2015 AHA modification)"),
        make_table(
            ["Population", "Major Criteria Modified"],
            [
                ["Low/moderate risk populations", "Monoarthritis counts; arthralgia may count if no other explanation"],
                ["High-risk populations (endemic areas like India)", "Monoarthritis/monoarthralgia can substitute for polyarthritis as major criterion"],
            ],
            col_widths=[DOC_WIDTH * 0.45, DOC_WIDTH * 0.55]
        ),
        Spacer(1, 3),
        section("Special Notes"),
        b("Chorea: Can diagnose ARF without fulfilling Jones criteria if isolated Sydenham's chorea"),
        b("Indolent carditis: Slowly progressive RHD also qualifies without other criteria"),
        b("Recurrence: Only 1 major OR 2 minor criteria needed if prior documented ARF"),
    ]

    # Q8: Diagnosis and management of ARF
    story += q_header(8, "Diagnosis and Management of Child with Acute Rheumatic Fever", ["2016", "2014"])
    story += [
        section("Diagnosis — (See Jones Criteria above, Q3)"),
        body("Diagnosis = Jones criteria satisfied + evidence of prior GAS infection. Additional investigations:"),
        make_table(
            ["Investigation", "Findings in ARF"],
            [
                ["ESR, CRP", "Elevated (acute phase reactants)"],
                ["ASO titre", "Elevated > 200 Todd units"],
                ["Throat swab culture", "May show GAS (often negative by time of presentation)"],
                ["ECG", "Prolonged PR interval; AF in mitral stenosis"],
                ["Echo-Doppler", "Mitral regurgitation (most common); Aortic regurgitation; Pericardial effusion"],
                ["CBC", "Leukocytosis, normocytic normochromic anemia"],
                ["Blood culture", "Usually negative (immune-mediated, not direct infection)"],
            ],
            col_widths=[DOC_WIDTH * 0.35, DOC_WIDTH * 0.65]
        ),
        Spacer(1, 3),
        section("Management"),
        make_table(
            ["Component", "Details"],
            [
                ["Bed rest", "Strict bed rest until ESR normal and clinical improvement (usually 2–6 weeks)"],
                ["Penicillin (eradicate GAS)", "Benzathine penicillin 1.2 MU IM single dose OR Oral penicillin V 250 mg BD × 10 days; Erythromycin if allergic"],
                ["Aspirin (arthritis/fever)", "75–100 mg/kg/day in 4 divided doses (max 4–6 g/day) × 6–8 weeks; dramatic response is diagnostic"],
                ["Prednisolone (carditis)", "2 mg/kg/day (max 60 mg/day) × 2–3 weeks then taper; given if moderate/severe carditis with CHF"],
                ["Penicillin prophylaxis", "Start after eradication course (see Q9 below)"],
            ],
            col_widths=[DOC_WIDTH * 0.30, DOC_WIDTH * 0.70]
        ),
    ]

    # ────────────────────────────────────────────────────────────────────────
    # Q4: Clinical features and management of VSD
    # ────────────────────────────────────────────────────────────────────────
    story += [PageBreak()]
    story += q_header(4, "Clinical Features and Management of Ventricular Septal Defect (VSD)", ["2012"])
    story += [
        section("Classification by Size"),
        make_table(
            ["Type", "Size", "Hemodynamics", "Symptoms"],
            [
                ["Small (Roger's disease)", "< 0.5 cm²/m²", "Restrictive, minimal L→R shunt", "Asymptomatic; loud harsh murmur"],
                ["Moderate", "0.5–1 cm²/m²", "Moderate L→R shunt, some PAH", "Mild dyspnea; moderate cardiomegaly"],
                ["Large", "> 1 cm²/m²", "Large L→R shunt; PAH", "CCF in 2–3 months; recurrent LRTI"],
            ],
            col_widths=[DOC_WIDTH * 0.18, DOC_WIDTH * 0.16, DOC_WIDTH * 0.33, DOC_WIDTH * 0.33]
        ),
        Spacer(1, 3),
        section("Clinical Features"),
    ]
    story += [
        b("Symptoms: Recurrent lower respiratory tract infections (LRTIs), difficulty feeding, failure to thrive, "
          "excessive sweating, dyspnea — present early (2–3 months) in large VSD"),
        b("Apex beat: Hyperdynamic, displaced laterally (volume overload)"),
        b("Murmur: Pansystolic murmur (PSM) best heard at lower left sternal border (LLSB), grade 3–5/6"),
        b("P2 loud if PAH develops"),
        b("Mitral diastolic flow murmur at apex — marker of large L→R shunt"),
        b("Signs of CCF: Hepatomegaly, tachycardia, tachypnea, basal crepitations"),
        Spacer(1, 3),
        section("Investigations"),
        make_table(
            ["Investigation", "Small VSD", "Large VSD"],
            [
                ["Chest X-ray", "Normal", "Cardiomegaly, ↑ pulmonary vascular markings, LA enlargement"],
                ["ECG", "Normal", "LVH; biventricular hypertrophy if PAH"],
                ["Echo-Doppler", "Site/size of defect; small shunt", "Large defect; PAH; high gradient across defect; dilated LV, LA"],
            ],
            col_widths=[DOC_WIDTH * 0.28, DOC_WIDTH * 0.26, DOC_WIDTH * 0.46]
        ),
        Spacer(1, 3),
        section("Management"),
        make_table(
            ["Type", "Management"],
            [
                ["Small VSD", "Observe; 50–80% close spontaneously by age 5 years; endocarditis prophylaxis"],
                ["Moderate VSD with symptoms", "Medical: Anti-CHF therapy (diuretics, digoxin, ACE inhibitor); high caloric feeds; reassess at 6 months"],
                ["Large VSD with CHF / PAH", "Surgical closure before 6 months to prevent irreversible PAH (Eisenmenger)"],
                ["Catheter-based", "Device closure (Amplatzer septal occluder) for muscular/perimembranous VSD"],
                ["Contraindication to surgery", "Eisenmenger syndrome (Qp:Qs < 1.5, PVR > 8 Wood units)"],
            ],
            col_widths=[DOC_WIDTH * 0.35, DOC_WIDTH * 0.65]
        ),
    ]

    # ────────────────────────────────────────────────────────────────────────
    # Q5: Definition and Etiology of Hypertension in Children
    # ────────────────────────────────────────────────────────────────────────
    story += [PageBreak()]
    story += q_header(5, "Definition and Etiology of Hypertension in Children", ["2013"])
    story += [
        section("Definition (NHBPEP / AAP 2017)"),
        make_table(
            ["Category", "BP Percentile"],
            [
                ["Normal BP", "< 90th percentile for age, sex, height"],
                ["Elevated BP", "≥ 90th to < 95th percentile"],
                ["Hypertension Stage 1", "≥ 95th percentile to < 95th + 12 mmHg (or ≥ 130/80 in ≥13 yr)"],
                ["Hypertension Stage 2", "≥ 95th percentile + 12 mmHg (or ≥ 140/90 in ≥13 yr)"],
                ["Hypertensive Urgency/Emergency", "Symptomatic HTN or organ damage with markedly elevated BP"],
            ],
            col_widths=[DOC_WIDTH * 0.5, DOC_WIDTH * 0.5]
        ),
        Spacer(1, 3),
        section("Etiology (Age-based)"),
        make_table(
            ["Age Group", "Common Causes"],
            [
                ["Neonates", "Renal artery thrombosis, renal artery stenosis, congenital renal malformations, coarctation of aorta, bronchopulmonary dysplasia"],
                ["Infants/1–6 yr", "Renal parenchymal disease (commonest overall), renal artery stenosis, coarctation, endocrine causes"],
                ["6–10 yr", "Renal parenchymal disease, renal artery stenosis, essential HTN (increasing)"],
                ["Adolescents", "Essential hypertension (most common at this age), obesity, renal disease, white-coat HTN"],
            ],
            col_widths=[DOC_WIDTH * 0.28, DOC_WIDTH * 0.72]
        ),
        Spacer(1, 3),
        section("Secondary Causes by System"),
    ]
    story += [
        b("Renal (most common secondary cause): Chronic GN, polycystic kidney, reflux nephropathy, renal artery stenosis, Wilms' tumor"),
        b("Cardiovascular: Coarctation of aorta (upper limb BP > lower limb BP; radio-femoral delay)"),
        b("Endocrine: Pheochromocytoma, Cushing's syndrome, hyperaldosteronism (Conn's), congenital adrenal hyperplasia, hyperthyroidism"),
        b("CNS: ↑ ICP, Guillain-Barré syndrome"),
        b("Drugs/toxins: Corticosteroids, OCP, cocaine, lead poisoning, licorice"),
        b("Miscellaneous: Obesity, sleep apnea"),
        Spacer(1, 3),
        section("Management (Brief)"),
        b("Non-pharmacological: Weight reduction, dietary salt restriction, physical activity, limit screen time"),
        b("Pharmacological: ACE inhibitors (1st line in renal disease), CCB, beta-blockers, diuretics"),
        b("Hypertensive emergency: IV labetalol or sodium nitroprusside or hydralazine; reduce BP by 25% in first 8 hr"),
    ]

    # ────────────────────────────────────────────────────────────────────────
    # Q6: Clinical features and complications of PDA / Prostaglandin in PDA
    # ────────────────────────────────────────────────────────────────────────
    story += [PageBreak()]
    story += q_header(6, "Clinical Features and Complications of PDA  |  Why Prostaglandin Inhibitor in Preterm PDA?",
                      ["2024"])
    story += [
        section("Patent Ductus Arteriosus — Overview"),
        body("PDA = Persistent communication between aorta (distal to left subclavian artery) and main pulmonary artery. "
             "Normal fetal structure; normally closes within 24–48 hr of birth (functional) and 2–3 weeks (anatomical). "
             "Persistent patency = PDA. More common in premature infants, rubella, high altitude."),
        Spacer(1, 3),
        section("Clinical Features"),
        make_table(
            ["Feature", "Details"],
            [
                ["Symptoms", "Asymptomatic if small; tachypnea, poor feeding, recurrent LRTI, CCF in large PDA"],
                ["Pulse", "Bounding/collapsing pulse (wide pulse pressure due to diastolic run-off into pulmonary artery)"],
                ["BP", "Wide pulse pressure"],
                ["Murmur", "Continuous ('machinery') murmur, best at 2nd left interspace/infraclavicular area; obliterates S2"],
                ["Thrill", "Present in large PDA at base"],
                ["Cardiomegaly", "LA and LV dilation"],
                ["Premature infant PDA", "Respiratory distress, failure to wean from ventilator, wide pulse pressure, bounding pulses"],
            ],
            col_widths=[DOC_WIDTH * 0.25, DOC_WIDTH * 0.75]
        ),
        Spacer(1, 3),
        section("Complications"),
    ]
    story += [
        b("Congestive cardiac failure (especially large PDA in preterm)"),
        b("Recurrent LRTIs — left lower lobe pneumonia"),
        b("Failure to thrive / poor weight gain"),
        b("Pulmonary arterial hypertension → Eisenmenger syndrome (if uncorrected)"),
        b("Infective endocarditis (endarteritis)"),
        b("Necrotizing enterocolitis (NEC) in premature infants"),
        b("Intraventricular hemorrhage (IVH) in premature infants"),
        Spacer(1, 3),
        section("Why Prostaglandin INHIBITOR in PDA of Preterm Infants?"),
        make_table(
            ["Mechanism", "Explanation"],
            [
                ["Ductus arteriosus maintained open by...", "PGE2 (prostaglandin E2) — keeps smooth muscle relaxed via cAMP"],
                ["At term birth...", "PO2 rises → ductus contracts; prostaglandins decrease → closure"],
                ["In preterms...", "High sensitivity to PGE2; low capacity to metabolize it → ductus stays open"],
                ["Indomethacin/Ibuprofen mechanism", "COX inhibitor → ↓ prostaglandin synthesis → ↓ PGE2 → ductus constricts and closes"],
                ["Clinical use", "Oral/IV Ibuprofen or Indomethacin in 3 doses over 3 days; effective in preterm PDA < 2 weeks age"],
                ["Contraindications", "Renal failure, thrombocytopenia, NEC, IVH grade III/IV, hyperbilirubinemia"],
            ],
            col_widths=[DOC_WIDTH * 0.38, DOC_WIDTH * 0.62]
        ),
        Spacer(1, 3),
        section("Management Summary"),
    ]
    story += [
        b("Preterm: Indomethacin 0.1–0.3 mg/kg IV q 12–24 hr x 3 doses (or Ibuprofen IV)"),
        b("Term infant/child: Surgical ligation OR catheter-based device closure (Amplatzer duct occluder)"),
        b("Watchful waiting for small PDA if asymptomatic in term infant (may close spontaneously)"),
    ]

    # ────────────────────────────────────────────────────────────────────────
    # Q7: Hypercyanotic spells in TOF
    # ────────────────────────────────────────────────────────────────────────
    story += [PageBreak()]
    story += q_header(7, "Hypercyanotic Spells in Tetralogy of Fallot (TOF)", ["2017", "2014"])
    story += [
        section("Tetralogy of Fallot — Components"),
        make_table(
            ["4 Components of TOF"],
            [
                ["1. Large VSD (malalignment type — subaortic)"],
                ["2. Right Ventricular Outflow Tract Obstruction (RVOTO) — infundibular stenosis (most common); may include valvar/supravalvar PS"],
                ["3. Overriding aorta (straddles VSD)"],
                ["4. Right ventricular hypertrophy (secondary to RVOTO)"],
            ],
            col_widths=[DOC_WIDTH]
        ),
        Spacer(1, 3),
        section("Hypercyanotic Spell (TET Spell)"),
        body("Most common in 2–4 months of age. Triggers: crying, feeding, defecation, waking from sleep, fever, anemia, dehydration. "
             "Due to acute ↑ RVOTO (infundibular spasm) → ↑ R→L shunt → acute hypoxemia."),
        Spacer(1, 3),
        section("Clinical Features of Spell"),
    ]
    story += [
        b("Sudden onset restlessness → deep cyanosis → hyperpnea"),
        b("Murmur softens/disappears (less flow through RVOT)"),
        b("Loss of consciousness, convulsions in severe spells"),
        b("Duration: minutes to hours"),
        b("Spontaneous recovery when child squats or falls asleep (knee-chest position)"),
        Spacer(1, 3),
        section("Acute Management (see also Q2)"),
        flowchart_horizontal([
            "Knee-chest\nposition",
            "O2\n100%",
            "Morphine\n0.1 mg/kg SC",
            "NaHCO3\n1 mEq/kg IV",
            "Propranolol\n0.1 mg/kg IV",
            "If no response:\nSurgery"
        ]),
        Spacer(1, 3),
        section("Long-term Management of TOF"),
        make_table(
            ["Option", "Age/Indication", "Details"],
            [
                ["Complete surgical correction (BT→total repair)", "3–12 months", "VSD patch closure + RVOTO relief (infundibulectomy ± transannular patch)"],
                ["BT shunt (palliative)", "If symptomatic neonates/infants unfit for correction", "Modified Blalock-Taussig shunt: subclavian artery → pulmonary artery (increases pulmonary blood flow)"],
                ["Propranolol maintenance", "Preoperative", "0.5–1.5 mg/kg every 6–8 hr; reduces infundibular spasm"],
                ["Iron therapy", "If Hb < 12 g/dL", "Prevents polycythemia complications; reduces spell frequency"],
            ],
            col_widths=[DOC_WIDTH * 0.30, DOC_WIDTH * 0.22, DOC_WIDTH * 0.48]
        ),
    ]

    # ────────────────────────────────────────────────────────────────────────
    # Q9: Rheumatic fever prophylaxis
    # ────────────────────────────────────────────────────────────────────────
    story += [PageBreak()]
    story += q_header(9, "Rheumatic Fever Prophylaxis", ["2019"])
    story += [
        section("Purpose"),
        body("ARF tends to recur with each streptococcal pharyngitis episode. Each recurrence worsens carditis "
             "and leads to cumulative valve damage. Continuous prophylaxis prevents GAS pharyngitis and thereby prevents ARF recurrences."),
        Spacer(1, 3),
        section("Primary Prevention (Prevent first attack of ARF)"),
        b("Treat GAS pharyngitis promptly with a complete 10-day course of penicillin"),
        b("Benzathine penicillin G 1.2 MU IM single dose (preferred — ensures compliance)"),
        b("Alternatively: Oral Penicillin V 250 mg BD × 10 days"),
        Spacer(1, 3),
        section("Secondary Prevention (Prevent recurrences)"),
        make_table(
            ["Drug", "Dose", "Route/Frequency"],
            [
                ["Benzathine penicillin G (PREFERRED)", "1.2 MU (> 27 kg); 0.6 MU (< 27 kg)", "IM every 3–4 weeks (3 weeks preferred in high-risk/India)"],
                ["Oral penicillin V (if IM not feasible)", "250 mg BD", "Oral twice daily"],
                ["Sulfadiazine (penicillin allergy)", "0.5 g/day (< 27 kg); 1 g/day (> 27 kg)", "Oral daily"],
                ["Erythromycin (sulfa + penicillin allergy)", "250 mg BD", "Oral twice daily"],
            ],
            col_widths=[DOC_WIDTH * 0.38, DOC_WIDTH * 0.28, DOC_WIDTH * 0.34]
        ),
        Spacer(1, 3),
        section("Duration of Secondary Prophylaxis"),
        make_table(
            ["Category", "Duration"],
            [
                ["ARF without carditis", "5 years after last episode OR until age 21 years (whichever is longer)"],
                ["ARF with mild carditis (no/minimal residual disease)", "10 years after last episode OR until age 21 years"],
                ["Persistent valvular disease (moderate-severe RHD)", "10 years after last episode OR until age 40 years (often lifelong)"],
                ["After valve surgery for RHD", "Lifelong prophylaxis"],
            ],
            col_widths=[DOC_WIDTH * 0.55, DOC_WIDTH * 0.45]
        ),
        Spacer(1, 3),
        section("High-Risk Factor (India)"),
        body("In developing countries like India with high-density living and poor access to healthcare, "
             "3-weekly rather than 4-weekly injections are recommended to maintain adequate penicillin levels."),
    ]

    # ────────────────────────────────────────────────────────────────────────
    # Q10: When to suspect CHD in a young infant
    # ────────────────────────────────────────────────────────────────────────
    story += [PageBreak()]
    story += q_header(10, "When Will You Suspect Congenital Heart Disease in a Young Infant?", ["2021"])
    story += [
        section("Clinical Clues to Suspect CHD in Infants"),
        make_table(
            ["Clinical Feature", "Significance / Interpretation"],
            [
                ["Cyanosis not responding to O2", "Fixed R→L shunt (cyanotic CHD — TGA, TOF, pulmonary atresia)"],
                ["Central cyanosis (lips, tongue, mucosa)", "SpO2 < 85% suggests cyanotic CHD"],
                ["Differential cyanosis (lower limbs cyanosed, upper limbs pink)", "PDA with Eisenmenger / coarctation with PPHN (R→L through PDA)"],
                ["Tachycardia + tachypnea + hepatomegaly without lung disease", "CHF from CHD (e.g. large VSD, AV canal)"],
                ["No murmur but cyanosed", "TGA (commonest cause of cyanosis without murmur in neonates)"],
                ["Loud single S2", "Pulmonary hypertension or single semilunar valve"],
                ["Collapsing/bounding pulse", "PDA, aortic regurgitation"],
                ["Absent femoral pulses / radio-femoral delay", "Coarctation of aorta"],
                ["Failure to thrive + recurrent LRTI from 2 months", "Large L→R shunt (VSD, AVSD, PDA)"],
                ["Murmur heard at routine examination", "Investigate: echo for structural defect"],
            ],
            col_widths=[DOC_WIDTH * 0.42, DOC_WIDTH * 0.58]
        ),
        Spacer(1, 3),
        section("Hyperoxia Test (Nitrogen Washout Test)"),
        body("100% O2 for 10 minutes: If PaO2 > 150 mmHg (or SpO2 > 95%) → Lung disease likely. "
             "If PaO2 < 100 mmHg → Cyanotic CHD likely (structural shunt that cannot be corrected by O2)."),
        Spacer(1, 3),
        section("Age-Based Presentation of CHD"),
        make_table(
            ["Age at Presentation", "Likely CHD"],
            [
                ["Birth–1 week", "TGA, HLHS, critical AS, critical PS (duct-dependent), obstructed TAPVC"],
                ["1–4 weeks", "Coarctation of aorta, truncus arteriosus, large VSD with coarctation"],
                ["1–2 months", "Large VSD, PDA, AVSD, TGA with VSD/PDA (when PVR falls)"],
                ["2–6 months", "Moderate–large VSD, PDA, AVSD (presenting with CHF as PVR drops)"],
                ["> 1 year", "ASD (often asymptomatic), mild PS, small VSD (incidental murmur)"],
            ],
            col_widths=[DOC_WIDTH * 0.35, DOC_WIDTH * 0.65]
        ),
    ]

    # ────────────────────────────────────────────────────────────────────────
    # Q11: Why L→R shunt becomes symptomatic at 6–8 weeks
    # ────────────────────────────────────────────────────────────────────────
    story += [PageBreak()]
    story += q_header(11,
                      "Why Does a Child with CHD with Left-to-Right Shunt Become Symptomatic at 6–8 Weeks of Life?",
                      ["2024"])
    story += [
        section("Physiological Basis"),
        body("At birth, pulmonary vascular resistance (PVR) is high (equal to systemic). "
             "The L→R shunt is therefore minimal even if a large VSD/PDA is present. "
             "Over the next 6–8 weeks, PVR gradually falls to adult levels → increasing L→R shunt → symptoms appear."),
        Spacer(1, 3),
        section("FLOWCHART: Why Symptoms Appear at 6–8 Weeks"),
    ]

    steps_6wk = [
        "Birth: PVR = SVR → Minimal L→R shunt → No symptoms",
        "Week 1–6: PVR progressively falls (muscular media of pulmonary arterioles regresses)",
        "6–8 Weeks: PVR reaches its nadir (~lowest point)",
        "↑ L→R shunt (VSD/PDA): Pulmonary overcirculation begins",
        "↑ Pulmonary blood return to LA → LA dilation → LV volume overload",
        "↑ Pulmonary venous pressure → Pulmonary edema → Tachypnea, breathlessness",
        "Symptoms of CHF: Tachycardia, hepatomegaly, poor feeding, failure to thrive",
    ]
    step_rows = [[Paragraph("<b>Timeline of L→R Shunt Symptoms (VSD / PDA / AVSD)</b>", S['table_header'])]]
    for s in steps_6wk:
        step_rows.append([Paragraph(s, S['table_cell'])])
    step_t = Table(step_rows, colWidths=[DOC_WIDTH])
    step_t.setStyle(TableStyle([
        ('BACKGROUND', (0, 0), (-1, 0), HexColor('#CCCCCC')),
        ('GRID', (0, 0), (-1, -1), 0.4, black),
        ('VALIGN', (0, 0), (-1, -1), 'TOP'),
        ('LEFTPADDING', (0, 0), (-1, -1), 6),
        ('TOPPADDING', (0, 0), (-1, -1), 3),
        ('BOTTOMPADDING', (0, 0), (-1, -1), 3),
    ]))
    story += [step_t, Spacer(1, 6)]

    story += [
        section("Key Concept Table"),
        make_table(
            ["Factor", "At Birth", "At 6–8 Weeks"],
            [
                ["PVR (Pulmonary Vascular Resistance)", "High (8–10 Wood units)", "Low (1–2 Wood units)"],
                ["L→R shunt magnitude", "Minimal", "Large"],
                ["PA pressure", "Near-systemic (high)", "Low/moderate"],
                ["Symptoms", "Absent / minimal", "CHF appears — tachypnea, poor feeding, hepatomegaly"],
            ],
            col_widths=[DOC_WIDTH * 0.38, DOC_WIDTH * 0.31, DOC_WIDTH * 0.31]
        ),
        Spacer(1, 3),
        section("Additional Contributing Factors at 6–8 Weeks"),
    ]
    story += [
        b("Fetal hemoglobin (HbF) replaced by HbA → relative anemia → ↑ cardiac workload"),
        b("Metabolic demands increase as infant grows → heart must work harder"),
        b("Relative anemia of infancy (physiological nadir of Hb at ~6–8 weeks) worsens symptoms"),
        b("If L→R shunt is not corrected, long-standing PAH → Eisenmenger syndrome (irreversible R→L shunt)"),
        Spacer(1, 6),
        hr(),
        Paragraph("<i>Source: Ghai Essential Pediatrics, 10th Ed. (Vinod K Paul & Arvind Bagga) | "
                  "Chapter 15: Disorders of Cardiovascular System</i>", S['note']),
    ]

    return story

# ═══════════════════════════════════════════════════════════════════════════
#  BUILD PDF
# ═══════════════════════════════════════════════════════════════════════════
import os
os.makedirs('/home/daytona/workspace/output', exist_ok=True)
output_path = '/home/daytona/workspace/output/CVS_PYQ_Ghai_Pediatrics.pdf'

doc = SimpleDocTemplate(
    output_path,
    pagesize=A4,
    leftMargin=MARGIN,
    rightMargin=MARGIN,
    topMargin=1.2 * cm,
    bottomMargin=1.2 * cm,
    title="CVS PYQ - Ghai Pediatrics",
    author="MBBS Final Year Study Aid",
)

story = build_content()
doc.build(story)
print(f"PDF created: {output_path}")

cd /home/daytona/workspace && python3 cvs_pyq_pdf.py 2>&1

~/cvs_pyq_pdf.py

Successfully replaced 1 instance(s) of the string in '/home/daytona/workspace/cvs_pyq_pdf.py'

cd /home/daytona/workspace && python3 cvs_pyq_pdf.py 2>&1

python3 -c " from pypdf import PdfReader r = PdfReader('/home/daytona/workspace/…

ls -la /home/daytona/workspace/output/ && python3 /home/daytona/workspace/cvs_py…

python3 -c " from pypdf import PdfReader r = PdfReader('/home/daytona/workspace/…

python3 -c " import subprocess # Convert page 1 to PNG using pdftoppm (poppler) …

python3 -c " from PIL import Image img = Image.open('/home/daytona/workspace/out…

cd /home/daytona/workspace/output && zip CVS_PYQ_Ghai_Pediatrics.zip CVS_PYQ_Gha…

python3 -c " import zipfile, shutil, os # Copy PDF to a temp location first the…

python3 -c " import zipfile, os, shutil src = '/home/daytona/workspace/output/C…

# Try copying PDF to a different directory structure cp /home/daytona/workspace/…

# Try zip from this location cd /home/daytona && zip CVS_PYQ_Ghai_Pediatrics.zip…

python3 -c " import subprocess, os # Convert all 11 pages to PNG images result …

python3 -c " import base64, os pages = sorted([f for f in os.listdir('/home/day…

python3 -c " import base64, os pages = sorted([f for f in os.listdir('/home/day…