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

OUTPUT = "/tmp/workspace/ms-surgery-osce/MS_Surgery_OSCE_Study_Guide.pdf"

# ── Colour palette ──────────────────────────────────────────────────────────
DARK_BLUE   = colors.HexColor("#1B3A6B")
MED_BLUE    = colors.HexColor("#2E6DA4")
LIGHT_BLUE  = colors.HexColor("#D6E4F0")
ACCENT_RED  = colors.HexColor("#C0392B")
ACCENT_GREEN= colors.HexColor("#1A7F4B")
GOLD        = colors.HexColor("#D4AC0D")
LIGHT_GREY  = colors.HexColor("#F4F6F7")
MID_GREY    = colors.HexColor("#BDC3C7")
WHITE       = colors.white
BLACK       = colors.black

# ── Page numbering ───────────────────────────────────────────────────────────
class NumberedCanvas(canv_module.Canvas):
    def __init__(self, *args, **kwargs):
        super().__init__(*args, **kwargs)
        self._saved_page_states = []

    def showPage(self):
        self._saved_page_states.append(dict(self.__dict__))
        self._startPage()

    def save(self):
        num_pages = len(self._saved_page_states)
        for state in self._saved_page_states:
            self.__dict__.update(state)
            self.draw_page_number(num_pages)
            canv_module.Canvas.showPage(self)
        canv_module.Canvas.save(self)

    def draw_page_number(self, page_count):
        self.setFont("Helvetica", 8)
        self.setFillColor(MID_GREY)
        self.drawRightString(A4[0] - 1.5*cm, 1*cm,
                             f"Page {self._pageNumber} of {page_count}")
        self.drawString(1.5*cm, 1*cm,
                        "MS General Surgery - OSCE Study Guide 2026")

# ── Header/Footer on each page ───────────────────────────────────────────────
def header_footer(canvas, doc):
    canvas.saveState()
    # Top bar
    canvas.setFillColor(DARK_BLUE)
    canvas.rect(0, A4[1] - 1.2*cm, A4[0], 1.2*cm, fill=1, stroke=0)
    canvas.setFont("Helvetica-Bold", 10)
    canvas.setFillColor(WHITE)
    canvas.drawString(1.5*cm, A4[1] - 0.85*cm,
                      "MS General Surgery  |  OSCE Clinical Study Guide")
    canvas.restoreState()

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

title_style = ParagraphStyle("Title", parent=styles["Title"],
    fontSize=28, textColor=WHITE, alignment=TA_CENTER,
    fontName="Helvetica-Bold", spaceAfter=8)

subtitle_style = ParagraphStyle("Subtitle", parent=styles["Normal"],
    fontSize=14, textColor=LIGHT_BLUE, alignment=TA_CENTER,
    fontName="Helvetica", spaceAfter=6)

h1 = ParagraphStyle("H1", parent=styles["Heading1"],
    fontSize=16, textColor=WHITE, fontName="Helvetica-Bold",
    spaceBefore=14, spaceAfter=6, backColor=MED_BLUE,
    leftIndent=-10, rightIndent=-10, borderPadding=(6, 10, 6, 10))

h2 = ParagraphStyle("H2", parent=styles["Heading2"],
    fontSize=13, textColor=DARK_BLUE, fontName="Helvetica-Bold",
    spaceBefore=10, spaceAfter=4, borderPadding=(0,0,2,0),
    borderColor=DARK_BLUE, borderWidth=0)

h3 = ParagraphStyle("H3", parent=styles["Heading3"],
    fontSize=11, textColor=MED_BLUE, fontName="Helvetica-Bold",
    spaceBefore=8, spaceAfter=3)

body = ParagraphStyle("Body", parent=styles["Normal"],
    fontSize=9.5, textColor=BLACK, fontName="Helvetica",
    leading=14, spaceAfter=4, alignment=TA_JUSTIFY)

bullet = ParagraphStyle("Bullet", parent=styles["Normal"],
    fontSize=9.5, textColor=BLACK, fontName="Helvetica",
    leading=13, spaceAfter=3, leftIndent=14,
    bulletIndent=4)

small = ParagraphStyle("Small", parent=styles["Normal"],
    fontSize=8.5, textColor=colors.HexColor("#555555"),
    fontName="Helvetica-Italic", leading=12)

tip_style = ParagraphStyle("Tip", parent=styles["Normal"],
    fontSize=9, textColor=ACCENT_GREEN, fontName="Helvetica-Bold",
    leading=13, leftIndent=10)

warn_style = ParagraphStyle("Warn", parent=styles["Normal"],
    fontSize=9, textColor=ACCENT_RED, fontName="Helvetica-Bold",
    leading=13, leftIndent=10)

# ── Helper builders ──────────────────────────────────────────────────────────
def section_header(text):
    return [
        Spacer(1, 0.3*cm),
        Table([[Paragraph(text, ParagraphStyle("SH", parent=h1,
                fontSize=14, textColor=WHITE, fontName="Helvetica-Bold",
                alignment=TA_LEFT, spaceBefore=0, spaceAfter=0))]],
              colWidths=[17*cm],
              style=TableStyle([
                  ("BACKGROUND", (0,0), (-1,-1), MED_BLUE),
                  ("TOPPADDING",  (0,0), (-1,-1), 7),
                  ("BOTTOMPADDING",(0,0), (-1,-1), 7),
                  ("LEFTPADDING", (0,0), (-1,-1), 12),
                  ("ROWBACKGROUNDS", (0,0), (-1,-1), [MED_BLUE]),
              ])),
        Spacer(1, 0.2*cm),
    ]

def sub_header(text):
    return [
        Spacer(1, 0.15*cm),
        Paragraph(text, h2),
        HRFlowable(width="100%", thickness=1.5, color=MED_BLUE, spaceAfter=4),
    ]

def b(text):
    return Paragraph(f"<b>{text}</b>", body)

def bp(text):
    return Paragraph(f"&#8226;  {text}", bullet)

def tip(text):
    return Table([[Paragraph(f"&#9989;  EXAMINER TIP: {text}", tip_style)]],
                 colWidths=[17*cm],
                 style=TableStyle([
                     ("BACKGROUND",(0,0),(-1,-1), colors.HexColor("#E9F7EF")),
                     ("TOPPADDING",(0,0),(-1,-1),5),
                     ("BOTTOMPADDING",(0,0),(-1,-1),5),
                     ("LEFTPADDING",(0,0),(-1,-1),10),
                     ("BOX",(0,0),(-1,-1),1,ACCENT_GREEN),
                 ]))

def warn(text):
    return Table([[Paragraph(f"&#9888;  WATCH OUT: {text}", warn_style)]],
                 colWidths=[17*cm],
                 style=TableStyle([
                     ("BACKGROUND",(0,0),(-1,-1), colors.HexColor("#FDEDEC")),
                     ("TOPPADDING",(0,0),(-1,-1),5),
                     ("BOTTOMPADDING",(0,0),(-1,-1),5),
                     ("LEFTPADDING",(0,0),(-1,-1),10),
                     ("BOX",(0,0),(-1,-1),1,ACCENT_RED),
                 ]))

def make_table(headers, rows, col_widths=None):
    data = [[Paragraph(f"<b>{h}</b>",
             ParagraphStyle("TH", parent=body, fontSize=9,
                            textColor=WHITE, fontName="Helvetica-Bold"))
             for h in headers]]
    for row in rows:
        data.append([Paragraph(str(c),
                     ParagraphStyle("TD", parent=body, fontSize=9))
                     for c in row])
    if col_widths is None:
        col_widths = [17*cm / len(headers)] * len(headers)
    t = Table(data, colWidths=col_widths, repeatRows=1)
    t.setStyle(TableStyle([
        ("BACKGROUND",   (0,0), (-1,0),  DARK_BLUE),
        ("ROWBACKGROUNDS",(0,1),(-1,-1), [LIGHT_GREY, WHITE]),
        ("GRID",         (0,0), (-1,-1), 0.4, MID_GREY),
        ("TOPPADDING",   (0,0), (-1,-1), 5),
        ("BOTTOMPADDING",(0,0), (-1,-1), 5),
        ("LEFTPADDING",  (0,0), (-1,-1), 6),
        ("VALIGN",       (0,0), (-1,-1), "TOP"),
    ]))
    return t

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

# ── COVER PAGE ───────────────────────────────────────────────────────────────
cover_table = Table([[
    Paragraph("MS GENERAL SURGERY", title_style),
    ]],
    colWidths=[17*cm])
cover_table.setStyle(TableStyle([
    ("BACKGROUND",(0,0),(-1,-1), DARK_BLUE),
    ("TOPPADDING",(0,0),(-1,-1),30),
    ("BOTTOMPADDING",(0,0),(-1,-1),10),
    ("LEFTPADDING",(0,0),(-1,-1),20),
    ("RIGHTPADDING",(0,0),(-1,-1),20),
    ("BOX",(0,0),(-1,-1),2,GOLD),
]))
story.append(Spacer(1, 3.5*cm))
story.append(cover_table)
story.append(Spacer(1, 0.4*cm))

sub_box = Table([[
    Paragraph("OSCE CLINICAL EXAMINATION", subtitle_style),
    Paragraph("Comprehensive Study Guide for Final Year Postgraduates", subtitle_style),
    Paragraph("2026 Edition", ParagraphStyle("Ed", parent=subtitle_style,
              fontSize=11, textColor=GOLD)),
]],colWidths=[17*cm])
sub_box.setStyle(TableStyle([
    ("BACKGROUND",(0,0),(-1,-1),MED_BLUE),
    ("TOPPADDING",(0,0),(-1,-1),8),
    ("BOTTOMPADDING",(0,0),(-1,-1),10),
    ("LEFTPADDING",(0,0),(-1,-1),20),
]))
story.append(sub_box)
story.append(Spacer(1, 1.5*cm))

# Quick info box
info_data = [
    ["Examination", "MS General Surgery Practical Examination"],
    ["Guide Coverage", "10 Core OSCE Station Types"],
    ["Standard", "NBE / University PG Curriculum"],
    ["Year", "Final Year (3rd Year MS)"],
]
info_t = Table(info_data, colWidths=[5*cm, 12*cm])
info_t.setStyle(TableStyle([
    ("BACKGROUND",(0,0),(0,-1),LIGHT_BLUE),
    ("ROWBACKGROUNDS",(1,0),(1,-1),[WHITE, LIGHT_GREY]*5),
    ("GRID",(0,0),(-1,-1),0.5,MID_GREY),
    ("FONTNAME",(0,0),(0,-1),"Helvetica-Bold"),
    ("FONTSIZE",(0,0),(-1,-1),9.5),
    ("TOPPADDING",(0,0),(-1,-1),7),
    ("BOTTOMPADDING",(0,0),(-1,-1),7),
    ("LEFTPADDING",(0,0),(-1,-1),10),
]))
story.append(info_t)
story.append(PageBreak())

# ── HOW TO USE THIS GUIDE ────────────────────────────────────────────────────
story += section_header("How to Use This Guide")
story.append(Paragraph(
    "This study guide covers the <b>10 core OSCE station types</b> you will encounter in the "
    "MS General Surgery final examination. Each station section includes: the clinical scenario "
    "format, a structured response framework, key clinical content, examiner tips, and common "
    "pitfalls to avoid. Use this alongside your operative logbook and case-based revision.", body))
story.append(Spacer(1, 0.3*cm))

overview_data = [
    ["#", "Station Type", "Duration", "Marks"],
    ["1", "Long Case - History & Clinical Examination", "30 min", "30"],
    ["2", "Short Cases - Clinical Signs", "5-7 min each", "20"],
    ["3", "Operative Surgery Viva", "10-15 min", "20"],
    ["4", "Surgical Instruments & Specimens", "5 min", "10"],
    ["5", "Radiology / Imaging Interpretation", "5-7 min", "10"],
    ["6", "Procedural Skills / Suturing", "10 min", "15"],
    ["7", "Histopathology Specimens", "5 min", "10"],
    ["8", "Pre-operative Assessment Station", "5-7 min", "10"],
    ["9", "Communication & Consent Station", "7-10 min", "10"],
    ["10","Emergency Scenario / Critical Appraisal", "10 min", "15"],
]
story.append(make_table(overview_data[0], overview_data[1:],
             col_widths=[1*cm, 8.5*cm, 3.5*cm, 4*cm]))
story.append(PageBreak())

# ════════════════════════════════════════════════════════════════════════════
# STATION 1: LONG CASE
# ════════════════════════════════════════════════════════════════════════════
story += section_header("Station 1: Long Case - History & Clinical Examination")
story.append(Paragraph(
    "The long case is the cornerstone of the MS Surgery practical. You are given 30 minutes "
    "alone with the patient, followed by 15-20 minutes of examination by two examiners. "
    "It tests integrated clinical skills: history-taking, physical examination, differential "
    "diagnosis, investigation planning, and surgical management.", body))

story += sub_header("Structured Approach: SOAP Framework")
soap = [
    ["S - Subjective", "Chief complaint, history of presenting illness, past surgical/medical history, drug history, family history, social history"],
    ["O - Objective", "General examination, vital signs, systemic examination, local surgical examination (inspection, palpation, percussion, auscultation)"],
    ["A - Assessment", "Most likely diagnosis, differential diagnoses ranked by probability, complications present"],
    ["P - Plan", "Investigations needed, pre-op workup, surgical options, perioperative care, prognosis"],
]
story.append(make_table(["Component", "What to Cover"], soap, col_widths=[4*cm, 13*cm]))
story.append(Spacer(1, 0.3*cm))

story += sub_header("Common Long Case Conditions")
lc_conditions = [
    "Carcinoma of the colon / rectum - staging, management algorithm",
    "Carcinoma of the stomach - presentation, TNM staging, surgical options",
    "Carcinoma of the thyroid - types, workup (FNAC, TFTs, USG), surgery",
    "Carcinoma of the breast - triple assessment, staging, modified radical mastectomy",
    "Portal hypertension / cirrhosis with complications",
    "Obstructive jaundice - benign vs malignant causes, Whipple's procedure",
    "Chronic pancreatitis / pancreatic pseudocyst",
    "Large bowel obstruction / pseudo-obstruction",
    "Peripheral arterial disease / critical limb ischaemia",
    "Diabetic foot - Wagner grading, vascular vs neuropathic, management",
]
for c in lc_conditions:
    story.append(bp(c))
story.append(Spacer(1, 0.3*cm))
story.append(tip("Always present your case as if to a senior colleague: 'I reviewed a 55-year-old male with a 3-month history of altered bowel habits and weight loss. On examination...' Structure saves marks."))
story.append(Spacer(1,0.2*cm))
story.append(warn("Never skip the RECTAL EXAMINATION in colorectal cases. Examiners will specifically ask if you performed it."))
story.append(PageBreak())

# ════════════════════════════════════════════════════════════════════════════
# STATION 2: SHORT CASES
# ════════════════════════════════════════════════════════════════════════════
story += section_header("Station 2: Short Cases - Clinical Signs")
story.append(Paragraph(
    "Short cases test your ability to rapidly identify and describe surgical signs. "
    "You will be shown 4-6 patients/models and asked to examine a specific region and "
    "give a diagnosis with brief management. Time is limited - be systematic and fast.", body))

story += sub_header("High-Yield Short Case Topics by System")

sc_data = [
    ["System", "Key Short Case Topics"],
    ["Neck & Thyroid", "Goitre (solitary nodule vs MNG), thyroglossal cyst, branchial cyst, cervical lymphadenopathy, carotid body tumour"],
    ["Breast", "Fibroadenoma, breast abscess, carcinoma (skin tethering, peau d'orange), Paget's disease of nipple"],
    ["Hernia", "Inguinal (direct vs indirect), femoral, umbilical, incisional, Spigelian hernia"],
    ["Abdomen", "Hepatomegaly, splenomegaly, ascites, abdominal mass (kidney vs other), stomas"],
    ["Peripheral Vascular", "Varicose veins (Trendelenburg test, tourniquet test), arterial ulcer vs venous ulcer, DVT signs"],
    ["Skin & Soft Tissue", "Sebaceous cyst, lipoma, dermoid cyst, ganglion, pyogenic granuloma, malignant melanoma"],
    ["Anorectal", "Haemorrhoids, fissure-in-ano, fistula-in-ano, pilonidal sinus, rectal prolapse"],
    ["Scrotum", "Hydrocele, epididymo-orchitis, testicular tumour, varicocele, epididymal cyst"],
    ["Paediatric", "Inguinal hernia in child, undescended testis, hypospadias, Hirschsprung's disease"],
]
story.append(make_table(sc_data[0], sc_data[1:], col_widths=[4.5*cm, 12.5*cm]))
story.append(Spacer(1, 0.3*cm))

story += sub_header("Short Case Response Template")
for step in [
    "<b>Step 1 - General inspection:</b> 'On inspection, I see a swelling in the right groin region, approximately 4x3 cm, with no overlying skin changes...'",
    "<b>Step 2 - Specific findings:</b> Describe site, size, shape, surface, edge, consistency, reducibility, transillumination, pulsatility, bruit",
    "<b>Step 3 - Diagnosis:</b> 'My diagnosis is an indirect inguinal hernia based on...'",
    "<b>Step 4 - Differentials:</b> Offer 1-2 alternatives with reasoning",
    "<b>Step 5 - Management outline:</b> 'I would manage this with...' (conservative / surgical)",
]:
    story.append(bp(step))
story.append(Spacer(1,0.2*cm))
story.append(tip("For any neck swelling - always say you would assess MOVEMENT WITH SWALLOWING and ON TONGUE PROTRUSION before touching the patient."))
story.append(PageBreak())

# ════════════════════════════════════════════════════════════════════════════
# STATION 3: OPERATIVE VIVA
# ════════════════════════════════════════════════════════════════════════════
story += section_header("Station 3: Operative Surgery Viva")
story.append(Paragraph(
    "The operative viva assesses your theoretical and practical knowledge of standard surgical "
    "procedures. Questions follow a standard pattern: indications, anatomy, steps of operation, "
    "complications, and postoperative care. You must know your index procedures perfectly.", body))

story += sub_header("Index Procedures - Must Know in Full Detail")
ops_data = [
    ["Operation", "Key Points to Know"],
    ["Appendicectomy (open & lap)", "McBurney's incision, layers, stump handling, normal appendix - what to do"],
    ["Inguinal hernia repair (Lichtenstein)", "Anatomy of inguinal canal, mesh placement, ilioinguinal nerve, recurrence"],
    ["Cholecystectomy (laparoscopic)", "Critical view of safety, Calot's triangle, bile duct injury, port sites"],
    ["Whipple's (Pancreaticoduodenectomy)", "Indications, resection, 3 anastomoses, complications (POPF, DGE)"],
    ["Right hemicolectomy", "Landmarks, high ligation of ileocolic vessels, lymphadenectomy, anastomosis"],
    ["Anterior resection of rectum", "Total mesorectal excision (TME), autonomic nerve preservation, anastomosis"],
    ["Thyroidectomy (total/hemi)", "RLN identification, parathyroid preservation, Berry's ligament"],
    ["Modified Radical Mastectomy", "Patey vs Madden, axillary dissection levels, serratus anterior"],
    ["Splenectomy", "Short gastric vessels, tail of pancreas, overwhelming post-splenectomy infection (OPSI)"],
    ["Hartmann's procedure", "Indications (perforated sigmoid), reversal considerations"],
]
story.append(make_table(ops_data[0], ops_data[1:], col_widths=[6*cm, 11*cm]))
story.append(Spacer(1, 0.3*cm))

story += sub_header("Operative Viva Answer Framework - '5-Step Template'")
for s in [
    "<b>1. Indications:</b> 'This operation is indicated for...' (include elective and emergency)",
    "<b>2. Pre-operative preparation:</b> Consent, anaesthesia type, patient positioning, bowel prep if needed",
    "<b>3. Steps of the operation:</b> Incision - exposure - key anatomy - critical steps - closure",
    "<b>4. Complications:</b> Intraoperative / early postoperative / late (use this classification always)",
    "<b>5. Post-operative care:</b> Drains, diet, DVT prophylaxis, discharge criteria, follow-up",
]:
    story.append(bp(s))
story.append(Spacer(1,0.2*cm))
story.append(tip("When asked about complications, classify as: Immediate (0-24h), Early (1-30 days), Late (>30 days). Examiners love this structured answer."))
story.append(warn("Never say 'I would cut here' - always use anatomical landmarks. 'I would divide at the level of the inferior mesenteric artery origin' scores better."))
story.append(PageBreak())

# ════════════════════════════════════════════════════════════════════════════
# STATION 4: INSTRUMENTS & SPECIMENS
# ════════════════════════════════════════════════════════════════════════════
story += section_header("Station 4: Surgical Instruments & Specimens")
story.append(Paragraph(
    "You will be shown 5-10 instruments or surgical specimens and asked to identify, describe, "
    "and discuss their clinical use. Answer in a structured format: name, type, material, "
    "specific features, uses, and technique.", body))

story += sub_header("High-Yield Instruments by Category")
instr_data = [
    ["Category", "Key Instruments"],
    ["Retractors", "Langenbeck, Deaver, Morris, Self-retaining (Balfour, Weitlaner, Travers), Doyen"],
    ["Artery Forceps", "Kocher's, Dunhill, Spencer Wells, Roberts, Mosquito, Mixter right-angle"],
    ["Bowel Clamps", "Lane's, Doyen intestinal, Kocher crushing clamp"],
    ["Thyroid Surgery", "Lahey's thyroid forceps, Maingot artery forceps"],
    ["Anorectal", "Proctoscope, sigmoidoscope, Parks retractor, Lockhart-Mummery fistula probe"],
    ["Vascular", "Bulldog clamp, Satinsky clamp, vascular needle holders"],
    ["Laparoscopic", "Veress needle, trocar & cannula, clip applicator, harmonic scalpel"],
    ["Sutures", "Prolene, Vicryl, PDS, Monocryl, Nylon - know absorbable vs non-absorbable"],
    ["Miscellaneous", "Ryles tube, Foley catheter, chest drain, Sengstaken-Blakemore tube"],
]
story.append(make_table(instr_data[0], instr_data[1:], col_widths=[4.5*cm, 12.5*cm]))
story.append(Spacer(1, 0.3*cm))

story += sub_header("Specimen Identification Framework")
for s in [
    "<b>Organ:</b> Name the organ and part (e.g., 'This is a segment of large bowel, likely sigmoid colon')",
    "<b>Pathology:</b> Describe the lesion - ulcerating/proliferating/infiltrating, size, location in wall",
    "<b>Staging clue:</b> Note any lymph nodes in the mesentery, depth of invasion visible",
    "<b>Operation:</b> Name the operation this would come from",
    "<b>Important associations:</b> Mention relevant management (e.g., adjuvant chemotherapy for Dukes C)",
]:
    story.append(bp(s))
story.append(Spacer(1,0.2*cm))
story.append(tip("Pick up every instrument confidently and state: 'This is a [name], it is a [type] made of [material], with [specific feature], used for [purpose].'"))
story.append(PageBreak())

# ════════════════════════════════════════════════════════════════════════════
# STATION 5: RADIOLOGY
# ════════════════════════════════════════════════════════════════════════════
story += section_header("Station 5: Radiology & Imaging Interpretation")
story.append(Paragraph(
    "Imaging stations assess your ability to identify key radiological findings and correlate "
    "them with clinical management. Always use a systematic approach - never jump straight "
    "to the diagnosis without stating patient details and image quality.", body))

story += sub_header("Systematic Reporting Template")
for s in [
    "<b>1. Type of study:</b> 'This is a [PA chest X-ray / CT abdomen with contrast / USG abdomen]'",
    "<b>2. Patient demographics:</b> 'Taken of a [adult/child], [date if visible]'",
    "<b>3. Technical adequacy:</b> Rotation, exposure, inspiratory effort (for CXR)",
    "<b>4. Systematic review:</b> Go through all zones methodically",
    "<b>5. Diagnosis:</b> 'The main finding is... consistent with a diagnosis of...'",
    "<b>6. Surgical relevance:</b> 'This would require...' (immediate management / operation)",
]:
    story.append(bp(s))

story += sub_header("High-Yield Imaging Findings")
rad_data = [
    ["Modality", "Finding", "Diagnosis", "Surgical Action"],
    ["CXR", "Air under diaphragm", "Hollow viscus perforation", "Emergency laparotomy"],
    ["CXR", "Mediastinal widening", "Aortic dissection / oesophageal perforation", "CT aortogram / surgery"],
    ["CT Abdomen", "Double bubble sign (paeds)", "Duodenal atresia", "Duodeno-duodenostomy"],
    ["CT Abdomen", "Target sign in bowel wall", "Intussusception", "Barium reduction / surgery"],
    ["CT Abdomen", "Whirlpool sign", "Volvulus (sigmoid/caecal)", "Emergency laparotomy"],
    ["CT Abdomen", "Portal venous gas", "Mesenteric ischaemia", "Emergency laparotomy"],
    ["USG Abdomen", "Dilated CBD >8mm + stones", "Choledocholithiasis", "ERCP + LC"],
    ["USG Abdomen", "Non-compressible tubular structure in RIF", "Appendicitis", "Appendicectomy"],
    ["CECT Abdomen", "Pancreatic necrosis >30%", "Severe acute pancreatitis", "ITU, delayed necrosectomy"],
    ["Barium Enema", "Apple-core deformity", "Carcinoma colon", "Hemicolectomy"],
    ["IVU/CT Urogram", "Filling defect in pelvis", "Renal pelvis TCC", "Nephroureterectomy"],
    ["Angiogram", "Pooling of contrast in bowel", "GI haemorrhage", "Embolization / surgery"],
]
story.append(make_table(rad_data[0], rad_data[1:],
             col_widths=[3.5*cm, 4.5*cm, 4.5*cm, 4.5*cm]))
story.append(Spacer(1,0.2*cm))
story.append(tip("For CT scans, always mention: 'I note the scan is [with/without contrast], and I would ideally review all three phases (arterial, portal venous, delayed) for a complete assessment.'"))
story.append(PageBreak())

# ════════════════════════════════════════════════════════════════════════════
# STATION 6: PROCEDURAL SKILLS
# ════════════════════════════════════════════════════════════════════════════
story += section_header("Station 6: Procedural Skills & Suturing")
story.append(Paragraph(
    "Procedural stations test your technical skills on models or simulators. You will be "
    "assessed on your sterile technique, instrument handling, efficiency, and communication "
    "with the 'scrub nurse'. Common stations include wound closure, drain insertion, "
    "and catheterisation.", body))

story += sub_header("Suturing: Key Techniques")
suture_data = [
    ["Technique", "Type", "Use", "Key Feature"],
    ["Simple interrupted", "Non-continuous", "Skin closure, tension sutures", "Easy to remove; infection containment"],
    ["Mattress suture (vertical/horizontal)", "Non-continuous", "Wound under tension", "Reduces dead space"],
    ["Continuous over-and-over", "Continuous", "Subcuticular closure", "Cosmetic result"],
    ["Figure-of-eight", "Non-continuous", "Fascia closure, haemostasis", "Strong hold"],
    ["Purse-string suture", "Continuous", "Appendix stump, colostomy", "Invaginates tissue"],
    ["Connell suture", "Continuous inverting", "Bowel anastomosis inner layer", "Mucosal inversion"],
    ["Lembert suture", "Interrupted inverting", "Bowel seromuscular layer", "Serosal apposition"],
    ["Subcuticular suture", "Continuous intradermal", "Skin closure", "No stitch marks"],
]
story.append(make_table(suture_data[0], suture_data[1:],
             col_widths=[4*cm, 3.5*cm, 5*cm, 4.5*cm]))
story.append(Spacer(1, 0.3*cm))

story += sub_header("Knot-Tying Principles")
for s in [
    "Always use a <b>square knot</b> (reef knot) - never a granny knot",
    "Minimum <b>3 throws</b> for synthetic monofilament; 2 for braided sutures",
    "Keep suture taut during tying - avoid slack between throws",
    "Cut suture tails to <b>3-5 mm</b> for deep sutures; 2-3 mm subcuticular",
    "For laparoscopic knots: intracorporeal or extracorporeal (Roeder's knot)",
]:
    story.append(bp(s))
story.append(Spacer(1,0.2*cm))
story.append(tip("Before starting any procedure station: state 'I would confirm patient identity, obtain consent, ensure sterile field, and wear appropriate PPE.' This alone earns process marks."))
story.append(warn("Never cut the needle off the suture before finishing - keep the needle holder, suture, and needle organised on the trolley at all times."))
story.append(PageBreak())

# ════════════════════════════════════════════════════════════════════════════
# STATION 7: HISTOPATHOLOGY
# ════════════════════════════════════════════════════════════════════════════
story += section_header("Station 7: Histopathology Specimens")
story.append(Paragraph(
    "Histopathology stations test your ability to identify gross pathological specimens "
    "and discuss their microscopic features, staging, and management implications. "
    "You may be shown wet specimens, photographs, or actual histology slides.", body))

story += sub_header("High-Yield Histopathology Specimens")
histo_data = [
    ["Specimen", "Key Gross Features", "Histology", "Staging/Grade"],
    ["Colorectal carcinoma", "Ulcerating annular lesion, 'rolled everted edges'", "Adenocarcinoma (mucin-secreting)", "Dukes / TNM staging"],
    ["Carcinoma stomach", "Linitis plastica OR fungating growth at cardia/antrum", "Intestinal or diffuse type (Lauren)", "Siewert classification for GOJ"],
    ["Carcinoma thyroid", "Papillary: sand-like calcified nodule; Follicular: encapsulated", "Orphan Annie nuclei (papillary)", "MACIS score; TNM"],
    ["Carcinoma breast", "Irregular, spiculate, gritty on cut section", "IDC (ductal) vs ILC (lobular)", "Nottingham Grade I-III"],
    ["Cholecystitis/gallstones", "Thickened wall, pigment/cholesterol stones", "Chronic inflammatory infiltrate", "Rokitansky-Aschoff sinuses"],
    ["Appendix", "Faecalith, gangrenous tip, perforation", "Neutrophilic infiltrate of muscularis", "Note: carcinoid at tip (1%)"],
    ["Hydatid cyst (liver)", "Daughter cysts, germinal layer, pericyst", "Laminated membrane, scolices", "WHO classification"],
    ["HCC", "Cirrhotic background, greenish tumour", "Trabecular or acinar pattern, AFP", "Barcelona (BCLC) staging"],
]
story.append(make_table(histo_data[0], histo_data[1:],
             col_widths=[4*cm, 4.5*cm, 4.5*cm, 4*cm]))
story.append(Spacer(1,0.2*cm))
story.append(tip("Always mention: 'I would correlate with the patient's clinical presentation, tumour markers, and radiology before finalising the diagnosis and management plan.'"))
story.append(PageBreak())

# ════════════════════════════════════════════════════════════════════════════
# STATION 8: PRE-OPERATIVE ASSESSMENT
# ════════════════════════════════════════════════════════════════════════════
story += section_header("Station 8: Pre-operative Assessment")
story.append(Paragraph(
    "This station presents a patient scenario (or actor) requiring pre-operative evaluation. "
    "You must demonstrate systematic assessment of fitness for surgery, risk stratification, "
    "and optimisation planning.", body))

story += sub_header("Pre-operative Assessment Framework")
for s in [
    "<b>History:</b> Functional capacity (METs), co-morbidities (cardiac, respiratory, renal, DM), medications, allergies, previous anaesthesia",
    "<b>Examination:</b> Airway assessment (Mallampati), cardiorespiratory status, BMI, peripheral access",
    "<b>Investigations:</b> Stratify by ASA and procedure risk (low/intermediate/high)",
    "<b>Risk scoring:</b> ASA classification, POSSUM score, Lee's Revised Cardiac Risk Index, P-POSSUM",
    "<b>Optimisation:</b> HbA1c <8.5%, BP control, anaemia correction, prehabilitation",
    "<b>Consent discussion:</b> Operation, alternatives, specific risks, anaesthetic risks",
]:
    story.append(bp(s))
story.append(Spacer(1, 0.3*cm))

asa_data = [
    ["ASA Class", "Definition", "Example"],
    ["ASA I", "Normal healthy patient", "Young adult, no co-morbidities"],
    ["ASA II", "Mild systemic disease", "Controlled DM, mild HTN, smoker"],
    ["ASA III", "Severe systemic disease", "Poorly controlled DM, COPD, obesity BMI>40"],
    ["ASA IV", "Life-threatening disease", "Recent MI, severe CHF, liver failure"],
    ["ASA V", "Moribund - not expected to survive", "Ruptured AAA, massive stroke"],
    ["ASA VI", "Brain-dead for organ donation", "Donor surgery"],
    ["E suffix", "Emergency operation", "Any above class + E (e.g., ASA IIE)"],
]
story.append(make_table(asa_data[0], asa_data[1:], col_widths=[3*cm, 7*cm, 7*cm]))
story.append(Spacer(1,0.2*cm))
story.append(tip("Quote ACTUAL numbers: 'A patient with HbA1c of 11% would have an elevated risk of surgical site infection. Optimisation to <8.5% reduces SSI by approximately 50%.'"))
story.append(PageBreak())

# ════════════════════════════════════════════════════════════════════════════
# STATION 9: COMMUNICATION & CONSENT
# ════════════════════════════════════════════════════════════════════════════
story += section_header("Station 9: Communication & Consent")
story.append(Paragraph(
    "This station uses a standardised patient (actor) and tests your ability to communicate "
    "complex surgical information clearly, obtain valid informed consent, and handle "
    "difficult conversations. It is worth significant marks and is often underprepped.", body))

story += sub_header("SPIKES Protocol - Breaking Bad News")
spikes = [
    ["S", "Setting Up", "Private room, tissues, supportive person present, no bleeps"],
    ["P", "Perception", "'What do you already know about your condition?'"],
    ["I", "Invitation", "'Would you like me to share the results with you now?'"],
    ["K", "Knowledge", "Use plain language; avoid jargon; give in small chunks"],
    ["E", "Emotions", "Acknowledge, name, and validate: 'That must be very hard to hear'"],
    ["S", "Strategy & Summary", "Plan next steps; offer written info; arrange follow-up"],
]
story.append(make_table(["Letter", "Step", "Key Action"], spikes, col_widths=[1.5*cm, 4.5*cm, 11*cm]))
story.append(Spacer(1, 0.3*cm))

story += sub_header("Valid Informed Consent - Legal Requirements")
for s in [
    "<b>Voluntariness:</b> Patient must consent freely without coercion",
    "<b>Capacity:</b> Patient must understand, retain, weigh, and communicate the decision (Mental Capacity Act criteria)",
    "<b>Information:</b> Procedure, expected benefits, significant/common risks (>1%), alternatives including no treatment",
    "<b>Documentation:</b> Signed consent form PLUS verbal discussion recorded in notes",
    "<b>Who can consent:</b> The operating surgeon should ideally take consent; can be delegated to a trained trainee",
]:
    story.append(bp(s))
story.append(Spacer(1, 0.3*cm))

story += sub_header("Common Consent Scenarios in OSCE")
consent_data = [
    ["Scenario", "Key Risks to Mention"],
    ["Laparoscopic cholecystectomy", "Bile duct injury (0.3-0.5%), conversion to open, bleeding, visceral injury, port site hernia"],
    ["Total thyroidectomy", "RLN injury (1-2%), hypoparathyroidism (1-2%), bleeding/haematoma, hypothyroidism (permanent)"],
    ["Inguinal hernia repair", "Recurrence (1-2% mesh), chronic pain, ischaemic orchitis (0.3%), ilioinguinal nerve damage"],
    ["Anterior resection", "Anastomotic leak (5-10%), temporary stoma, bowel dysfunction, sexual dysfunction, permanent stoma"],
    ["Mastectomy", "Lymphoedema, seroma, numbness, body image issues, reconstruction options"],
]
story.append(make_table(consent_data[0], consent_data[1:], col_widths=[5*cm, 12*cm]))
story.append(Spacer(1,0.2*cm))
story.append(tip("In communication stations: maintain eye contact with the actor, not your notes. Use open-ended questions. Pause and give silence when the patient is emotional."))
story.append(warn("Never dismiss a patient's fears as trivial. Even if a risk is rare, if the patient considers it significant (e.g., hoarse voice in a singer) it MUST be discussed."))
story.append(PageBreak())

# ════════════════════════════════════════════════════════════════════════════
# STATION 10: EMERGENCY SCENARIOS
# ════════════════════════════════════════════════════════════════════════════
story += section_header("Station 10: Emergency Scenarios & Critical Appraisal")
story.append(Paragraph(
    "Emergency stations present an acute surgical scenario and test your ability to "
    "prioritise, resuscitate, investigate, and manage a critically unwell patient. "
    "Always start with ABCDE before jumping to diagnosis.", body))

story += sub_header("ABCDE Resuscitation Framework (Mandatory Starting Point)")
for s in [
    "<b>A - Airway:</b> Patent? Stridor? Jaw thrust / chin lift / intubation if needed",
    "<b>B - Breathing:</b> RR, SpO2, chest movement, added sounds - O2 15L via NRB mask",
    "<b>C - Circulation:</b> HR, BP, CRT, skin colour - 2 large bore IVs, fluid bolus, bloods",
    "<b>D - Disability:</b> GCS, AVPU, blood glucose, pupils",
    "<b>E - Exposure:</b> Full examination, temperature, look for source of sepsis / bleeding",
]:
    story.append(bp(s))
story.append(Spacer(1, 0.3*cm))

story += sub_header("High-Yield Emergency Scenarios")
em_data = [
    ["Scenario", "Immediate Action", "Key Investigation", "Definitive Treatment"],
    ["Ruptured AAA", "O negative blood, vascular surgery team", "FAST USS / CECT (if stable)", "Emergency EVAR or open repair"],
    ["Acute mesenteric ischaemia", "Anticoagulate, resuscitate", "CT angiogram", "Laparotomy, bowel resection"],
    ["Perforated peptic ulcer", "NGT, urinary catheter, IV PPI+ABx", "Erect CXR (air under diaphragm)", "Laparoscopic/open repair (Graham patch)"],
    ["Sigmoid volvulus", "Rigid sigmoidoscopy + flatus tube", "AXR (coffee bean sign)", "Elective sigmoid resection"],
    ["Obstructed + strangulated hernia", "Resuscitate, NBM, Foley", "Clinical diagnosis", "Emergency hernia repair +/- bowel resection"],
    ["Massive lower GI bleed", "Resuscitate, cross-match 6 units", "CT angiogram (active bleed)", "Interventional radiology / surgery"],
    ["Acute pancreatitis", "Fluids 250-500ml/hr, analgesia, NBM", "CT severity index (Balthazar)", "ITU if severe; ERCP if gallstone"],
    ["Postoperative haemorrhage", "Check drain, BP trend, Hb", "Bedside USS, return to OT", "Surgical re-exploration"],
]
story.append(make_table(em_data[0], em_data[1:],
             col_widths=[4*cm, 4.5*cm, 4*cm, 4.5*cm]))
story.append(Spacer(1,0.2*cm))
story.append(tip("Examiners want to hear: 'I would activate the Major Haemorrhage Protocol / call for senior help IMMEDIATELY' - showing you know your limitations is a POSITIVE attribute."))
story.append(PageBreak())

# ════════════════════════════════════════════════════════════════════════════
# QUICK REFERENCE: SURGICAL SCORES & CLASSIFICATIONS
# ════════════════════════════════════════════════════════════════════════════
story += section_header("Quick Reference: Surgical Scores & Classifications")

story += sub_header("Essential Scoring Systems")
score_data = [
    ["Score/Classification", "Used For", "Key Parameters"],
    ["Ranson's Criteria", "Acute pancreatitis severity", "5 at admission + 6 at 48h; >3 = severe"],
    ["BISAP Score", "Acute pancreatitis mortality", "BUN, Impaired sensorium, SIRS, Age>60, Pleural effusion"],
    ["TNM Staging", "All solid tumours", "T (tumour), N (nodes), M (metastasis)"],
    ["Dukes Classification", "Colorectal cancer", "A (mucosa), B (muscularis/pericolorectal), C (nodes), D (distant)"],
    ["Child-Pugh Score", "Liver cirrhosis surgical risk", "Bilirubin, Albumin, PT, Ascites, Encephalopathy"],
    ["MELD Score", "Liver disease mortality / transplant listing", "Creatinine, Bilirubin, INR"],
    ["Clavien-Dindo", "Surgical complication grading", "Grade I-V (V = death)"],
    ["Wagner Grade", "Diabetic foot ulcer depth", "Grade 0-5"],
    ["Rutherford Classification", "Peripheral arterial disease", "Category 0-6"],
    ["ASA Classification", "Anaesthetic risk", "Class I-VI"],
    ["P-POSSUM", "Operative mortality prediction", "Physiological + Operative severity score"],
    ["Glasgow Blatchford", "Upper GI bleed - need for intervention", "BUN, Hb, SBP, HR, melena, syncope"],
    ["Nottingham Grade", "Breast cancer histology", "Tubule formation + nuclear pleomorphism + mitosis (Grade 1-3)"],
]
story.append(make_table(score_data[0], score_data[1:],
             col_widths=[5.5*cm, 5.5*cm, 6*cm]))
story.append(PageBreak())

# ════════════════════════════════════════════════════════════════════════════
# EXAM DAY TIPS
# ════════════════════════════════════════════════════════════════════════════
story += section_header("Exam Day Strategy & Final Tips")

story += sub_header("The 5 Golden Rules")
golden = [
    "Always <b>THINK ALOUD</b> - examiners cannot mark what they cannot hear. Narrate your clinical reasoning.",
    "Never say <b>'I don't know'</b> without an attempt. Say: 'I would approach this systematically by...'",
    "<b>Admit uncertainty gracefully:</b> 'I would seek senior advice for this intraoperative finding' is safer than guessing.",
    "Be <b>patient-centred</b> in communication stations. Use the patient's name. Sit at eye level.",
    "Dress professionally, maintain <b>eye contact</b> with examiners, and project confidence - even when unsure.",
]
for g in golden:
    story.append(bp(g))
story.append(Spacer(1,0.3*cm))

story += sub_header("Last-Week Revision Checklist")
checklist_data = [
    ["Task", "Done?"],
    ["Revise all 10 index operations with steps + complications", "[ ]"],
    ["Practice knot-tying and suturing on a pad or model", "[ ]"],
    ["Review 20 plain X-rays (CXR + AXR) and 10 CT abdomen scans", "[ ]"],
    ["Identify 30 surgical instruments by sight", "[ ]"],
    ["Practice one full long case with a colleague (30 min + 15 min viva)", "[ ]"],
    ["Review consent discussion for top 5 operations", "[ ]"],
    ["Memorise Ranson's, Child-Pugh, TNM for colon, thyroid, breast", "[ ]"],
    ["Review your operative logbook - know your case numbers", "[ ]"],
    ["Practice ABCDE approach out loud for 3 emergency scenarios", "[ ]"],
    ["Read NICE/NBE guidelines summary for hernia, gallstones, colorectal cancer", "[ ]"],
]
story.append(make_table(checklist_data[0], checklist_data[1:], col_widths=[14*cm, 3*cm]))
story.append(Spacer(1, 0.3*cm))

# Final encouragement box
final_box = Table([[
    Paragraph(
        "Best of luck with your MS General Surgery examination. "
        "Systematic preparation, clinical exposure, and confident communication "
        "are the three pillars of success. You have trained for 3 years - trust your knowledge.",
        ParagraphStyle("Final", parent=body, fontSize=10,
                       textColor=DARK_BLUE, fontName="Helvetica-Bold",
                       alignment=TA_CENTER))
]], colWidths=[17*cm])
final_box.setStyle(TableStyle([
    ("BACKGROUND",(0,0),(-1,-1),LIGHT_BLUE),
    ("BOX",(0,0),(-1,-1),2,DARK_BLUE),
    ("TOPPADDING",(0,0),(-1,-1),15),
    ("BOTTOMPADDING",(0,0),(-1,-1),15),
    ("LEFTPADDING",(0,0),(-1,-1),20),
    ("RIGHTPADDING",(0,0),(-1,-1),20),
]))
story.append(Spacer(1, 0.5*cm))
story.append(final_box)

# ── Build PDF ────────────────────────────────────────────────────────────────
doc = SimpleDocTemplate(
    OUTPUT,
    pagesize=A4,
    leftMargin=2*cm, rightMargin=2*cm,
    topMargin=2*cm, bottomMargin=1.8*cm,
    title="MS General Surgery OSCE Study Guide",
    author="Orris AI",
    subject="OSCE Clinical Examination Study Guide",
)
doc.build(story, onFirstPage=header_footer, onLaterPages=header_footer,
          canvasmaker=NumberedCanvas)
print(f"PDF generated: {OUTPUT}")