const { Document, Packer, Paragraph, TextRun, HeadingLevel, AlignmentType, BorderStyle, ShadingType } = require('docx');
const fs = require('fs');

// ============================================================
// MRCOG Part 1 Question Bank - Extracted from Chat Transcript
// ============================================================

const questions = [
  // ── STATISTICS / EPIDEMIOLOGY ──────────────────────────────
  {
    num: 1,
    topic: "Biostatistics & Epidemiology",
    question: "A patient was diagnosed as Covid positive. What is described as the likelihood of testing positive in persons who are diseased?",
    options: [
      "A. Positive predictive value (PPV)",
      "B. Negative predictive value (NPV)",
      "C. Sensitivity",
      "D. Specificity",
      "E. True positive rate"
    ],
    answer: "C. Sensitivity",
    explanation: "Sensitivity is defined as the ability of a test to correctly identify those who have the disease (true positive rate). It is expressed as: Sensitivity = True Positives / (True Positives + False Negatives). It reflects the likelihood of a positive test result among those who actually have the disease. PPV reflects the probability that a person with a positive test truly has the disease (dependent on prevalence). Specificity measures the ability to correctly identify those without the disease."
  },
  {
    num: 2,
    topic: "Professional Practice / Medical Ethics",
    question: "You are doing an appraisal for a trainee who came late and smelled of alcohol. It is not his first time arriving late and his colleagues report him coming multiple times smelling of alcohol. He denied drinking on that day or the day before. What is the most appropriate action?",
    options: [
      "A. Tell him in private",
      "B. Warn him verbally and do not write it in his appraisal notes",
      "C. Written warning and record it in his appraisal notes",
      "D. Inform the GMC",
      "E. Inform the postgraduate deanery",
      "F. Inform the medical director"
    ],
    answer: "C. Written warning and record it in his appraisal notes",
    explanation: "When a trainee displays a pattern of unprofessional behaviour (repeated lateness, smelling of alcohol on multiple occasions as reported by colleagues), this must be formally documented. A verbal warning alone is insufficient given the repeated nature of the behaviour and patient safety implications. A written warning that is formally recorded in the appraisal notes creates an accountable trail. Escalation to the GMC is reserved for cases where there is a direct, unresolved threat to patient safety after local processes have failed. The medical director or deanery may be involved if the issue escalates beyond local resolution."
  },
  {
    num: 3,
    topic: "Obstetrics - VTE Prophylaxis",
    question: "A pregnant woman with BMI 42 weighing 100 kg is wearing stockings for troublesome varicose veins. She is a non-smoker. What is her appropriate VTE prophylaxis?",
    options: [
      "A. 40 mg enoxaparin / 5000 dalteparin / 4500 tinzaparin from first trimester",
      "B. 40 mg enoxaparin / 5000 dalteparin / 4500 tinzaparin from 28 weeks gestation",
      "C. 60 mg enoxaparin / 7500 dalteparin / 7000 tinzaparin from first trimester",
      "D. 60 mg enoxaparin / 7500 dalteparin / 7000 tinzaparin from 28 weeks gestation",
      "E. Mobilisation and early hydration only"
    ],
    answer: "D. 60 mg enoxaparin / 7500 dalteparin / 7000 tinzaparin from 28 weeks gestation",
    explanation: "Using the RCOG Green-top Guideline No. 37a VTE risk scoring: BMI >40 scores 2 points; varicose veins (troublesome/symptomatic) score 1 point. Total = 3 points. A score of 3 or more indicates intermediate risk: LMWH from 28 weeks gestation. A score of 4 or more would indicate high risk requiring LMWH from the first trimester. Her weight of 100 kg puts her in the higher dose bracket (>90 kg): enoxaparin 60 mg / dalteparin 7500 units / tinzaparin 7000 units daily. Standard dose is for weight <90 kg: enoxaparin 40 mg / dalteparin 5000 / tinzaparin 4500."
  },
  {
    num: 4,
    topic: "Gynaecology - Ovarian Cyst Management",
    question: "A postmenopausal patient presents with lower abdominal pain. She has a persistent 5 cm simple ovarian cyst confirmed on two scans 4 months apart, with CA-125 of 30 IU/mL. What is the most appropriate management?",
    options: [
      "A. Laparoscopic unilateral salpingo-oophorectomy",
      "B. Laparoscopic bilateral salpingo-oophorectomy",
      "C. Continue follow-up with repeat scan in 4 months",
      "D. Total abdominal hysterectomy + bilateral salpingo-oophorectomy (TAH+BSO)"
    ],
    answer: "A. Laparoscopic unilateral salpingo-oophorectomy",
    explanation: "According to RCOG/BSGE guidelines on management of ovarian masses, a postmenopausal woman with a simple unilocular cyst >5 cm that persists on repeat scan AND is symptomatic should be offered surgery. The RMI (Risk of Malignancy Index) = U x M x CA-125. For a simple unilocular cyst, ultrasound score U=1; M=3 (postmenopausal); CA-125=30. RMI = 1 x 3 x 30 = 90 (low risk, <200). For a low RMI symptomatic persistent cyst, laparoscopic unilateral salpingo-oophorectomy is appropriate. TAH+BSO would be over-treatment at this risk level without evidence of malignancy."
  },
  // ── BIOCHEMISTRY: GLUCOSE/HORMONES ────────────────────────
  {
    num: 5,
    topic: "Biochemistry - Glucose Metabolism",
    question: "What hormonal changes occur in glucose-controlling hormones after consumption of a protein-rich meal?",
    options: [
      "A. Insulin increases, glucagon decreases",
      "B. Both insulin and glucagon increase",
      "C. Insulin decreases, glucagon increases",
      "D. Both insulin and glucagon decrease",
      "E. No change in either"
    ],
    answer: "B. Both insulin and glucagon increase",
    explanation: "Dietary protein ingestion alone concurrently stimulates both insulin and glucagon secretion. Amino acids from protein stimulate beta cells (insulin release) to promote amino acid uptake and protein synthesis. Simultaneously, glucagon is released from alpha cells to prevent hypoglycaemia that would otherwise occur from insulin release without a carbohydrate load, and to stimulate gluconeogenesis. By contrast, after a high carbohydrate meal, insulin rises and glucagon falls because the glucose load itself suppresses glucagon secretion."
  },
  {
    num: 6,
    topic: "Biochemistry - Molecular Biology",
    question: "Which laboratory technique increases the number of copies of DNA?",
    options: [
      "A. Southern blotting",
      "B. Northern blotting",
      "C. Polymerase chain reaction (PCR)",
      "D. Western blotting",
      "E. FISH (Fluorescence in situ hybridisation)"
    ],
    answer: "C. Polymerase chain reaction (PCR)",
    explanation: "PCR is a molecular technique that amplifies (increases copies of) specific DNA sequences in vitro. It uses repeated cycles of denaturation (94°C), annealing of primers, and extension by Taq polymerase. Each cycle doubles the amount of target DNA, resulting in exponential amplification - millions of copies from a single template. This is distinct from: Southern blot (detects specific DNA sequences), Northern blot (detects RNA), Western blot (detects proteins), and FISH (visualises chromosomal locations of DNA sequences)."
  },
  {
    num: 7,
    topic: "Biochemistry - Cell Organelles",
    question: "Which metabolic processes occur exclusively in the mitochondria?",
    options: [
      "A. Glycolysis and HMP shunt",
      "B. Oxidative phosphorylation, Krebs cycle, and Electron Transport Chain (ETC)",
      "C. Fatty acid synthesis and cholesterol synthesis",
      "D. Protein synthesis on ribosomes",
      "E. Urea cycle only"
    ],
    answer: "B. Oxidative phosphorylation, Krebs cycle, and Electron Transport Chain (ETC)",
    explanation: "The mitochondria is the site for: Krebs cycle (TCA cycle), Electron Transport Chain (ETC), Oxidative phosphorylation, and Beta-oxidation of fatty acids. All of these occur in the mitochondrial matrix or inner membrane. Glycolysis and the HMP (hexose monophosphate) shunt occur in the cytosol. Fatty acid synthesis occurs in the cytosol (SER). Urea cycle spans both the mitochondria and cytosol. Protein synthesis occurs on ribosomes (RER/cytoplasm). The mitochondria is often described as the 'powerhouse of the cell' as it is the primary site of ATP production via oxidative phosphorylation."
  },
  {
    num: 8,
    topic: "Biochemistry - Myometrial Physiology",
    question: "What mechanism is required for myometrial contraction?",
    options: [
      "A. Activation of adenylyl cyclase and cAMP production",
      "B. Activation of phospholipase C, generating IP3 and DAG",
      "C. Direct calcium influx without second messenger",
      "D. Activation of guanylyl cyclase",
      "E. Inhibition of phosphodiesterase"
    ],
    answer: "B. Activation of phospholipase C, generating IP3 and DAG",
    explanation: "Uterine (myometrial) contraction is mediated via the Gq protein-coupled receptor pathway. Oxytocin and prostaglandins bind their receptors, activating phospholipase C (PLC). PLC cleaves PIP2 into IP3 (inositol triphosphate) and DAG (diacylglycerol). IP3 triggers calcium release from the sarcoplasmic reticulum, increasing intracellular calcium. Calcium binds calmodulin, activating myosin light chain kinase (MLCK), leading to phosphorylation of myosin and cross-bridge formation with actin, resulting in contraction. cAMP pathways (via adenylyl cyclase) are involved in uterine relaxation (e.g., beta-2 agonist tocolysis)."
  },
  {
    num: 9,
    topic: "Biochemistry - Cervical Secretions",
    question: "What substance in cervical secretions attacks bacterial lipoprotein?",
    options: [
      "A. Lactoferrin",
      "B. Immunoglobulin A (IgA)",
      "C. Lysozyme",
      "D. Defensins",
      "E. Interferon"
    ],
    answer: "C. Lysozyme",
    explanation: "Lysozyme (also called muramidase) is an enzyme found in cervical mucus, tears, saliva, and other secretions. It specifically cleaves the beta-1,4 glycosidic bonds between N-acetylmuramic acid and N-acetylglucosamine in the peptidoglycan layer of bacterial cell walls. It has particular activity against bacterial lipoproteins and gram-positive bacteria. This forms part of the innate immune defence of the female reproductive tract. Lactoferrin has iron-chelating antimicrobial properties. IgA provides adaptive immune defence. Defensins are antimicrobial peptides."
  },
  {
    num: 10,
    topic: "Biochemistry - Vitamins",
    question: "Which is the most common parasitic infection responsible for vitamin B12 deficiency?",
    options: [
      "A. Ascaris lumbricoides",
      "B. Diphyllobothrium latum (fish tapeworm)",
      "C. Schistosoma haematobium",
      "D. Ancylostoma duodenale (hookworm)",
      "E. Giardia lamblia"
    ],
    answer: "B. Diphyllobothrium latum (fish tapeworm)",
    explanation: "Diphyllobothrium latum, the broad fish tapeworm, is the most common parasitic cause of vitamin B12 deficiency. The tapeworm competes with the host for absorption of vitamin B12 in the ileum. It can cause megaloblastic anaemia similar to pernicious anaemia. Humans are infected by consuming raw or undercooked freshwater fish. In contrast, hookworm (Ancylostoma/Necator) causes iron deficiency anaemia due to blood loss. Giardia causes fat malabsorption. Schistosomiasis causes hepatic and urinary complications."
  },
  {
    num: 11,
    topic: "Biochemistry - ATP Production",
    question: "Which step in mitochondrial metabolism releases the most ATP?",
    options: [
      "A. Glycolysis",
      "B. Krebs cycle substrate-level phosphorylation",
      "C. Oxidative phosphorylation",
      "D. Beta-oxidation of fatty acids",
      "E. HMP shunt"
    ],
    answer: "C. Oxidative phosphorylation",
    explanation: "Oxidative phosphorylation (occurring in the inner mitochondrial membrane) is the primary and most efficient ATP-generating process in aerobic metabolism. It generates approximately 28-32 ATP molecules per glucose molecule (out of a total of 30-38 ATP from complete aerobic oxidation). The electron transport chain (ETC) drives proton pumping across the inner mitochondrial membrane, and ATP synthase uses the resulting proton gradient (chemiosmosis) to phosphorylate ADP to ATP. By comparison, glycolysis produces only 2 ATP, and the Krebs cycle directly produces 2 GTP per glucose via substrate-level phosphorylation."
  },
  {
    num: 12,
    topic: "Biochemistry - Cell Cycle",
    question: "At which phase of the cell cycle does DNA replication occur?",
    options: [
      "A. G1 phase",
      "B. G2 phase",
      "C. S phase (Synthesis phase)",
      "D. M phase (Mitosis)",
      "E. G0 phase"
    ],
    answer: "C. S phase (Synthesis phase)",
    explanation: "DNA replication occurs during the S phase (Synthesis phase) of the cell cycle. The cell cycle consists of: G1 phase (cell growth, preparation for DNA replication), S phase (DNA synthesis - replication of the entire genome), G2 phase (preparation for mitosis, protein synthesis), and M phase (mitosis and cytokinesis). During S phase, each chromosome is duplicated to form two identical sister chromatids joined at the centromere. Checkpoints between phases ensure accuracy of DNA replication before the cell proceeds to division. Protein synthesis for mitosis occurs in G2."
  },
  {
    num: 13,
    topic: "Biochemistry - Vitamins",
    question: "What is the active form of vitamin D?",
    options: [
      "A. Cholecalciferol (vitamin D3)",
      "B. Ergocalciferol (vitamin D2)",
      "C. 25-hydroxycholecalciferol (calcidiol)",
      "D. 1,25-dihydroxycholecalciferol (calcitriol)",
      "E. 24,25-dihydroxycholecalciferol"
    ],
    answer: "D. 1,25-dihydroxycholecalciferol (calcitriol)",
    explanation: "Vitamin D undergoes two hydroxylation steps to become active: (1) In the liver: cholecalciferol (D3) is hydroxylated at position 25 to form 25-hydroxycholecalciferol (calcidiol) - the main storage form and the form measured in serum to assess vitamin D status. (2) In the kidney: calcidiol is hydroxylated at position 1 (by 1-alpha hydroxylase) to form 1,25-dihydroxycholecalciferol (calcitriol) - the biologically active form. Calcitriol acts on intestinal cells to increase calcium and phosphate absorption, on kidney to increase calcium reabsorption, and on bone to regulate mineralisation. In pregnancy, serum calcitriol rises from the first trimester, doubling by the third trimester."
  },
  {
    num: 14,
    topic: "Biochemistry - Glucose Metabolism",
    question: "What is the major role of glucocorticoids in glucose metabolism?",
    options: [
      "A. Stimulate glycogenesis",
      "B. Inhibit gluconeogenesis",
      "C. Promote gluconeogenesis",
      "D. Stimulate insulin secretion",
      "E. Inhibit glycogenolysis"
    ],
    answer: "C. Promote gluconeogenesis",
    explanation: "Glucocorticoids (e.g., cortisol) are counter-regulatory hormones that raise blood glucose by: (1) Promoting gluconeogenesis in the liver - the primary mechanism - by inducing enzymes such as PEPCK (phosphoenolpyruvate carboxykinase) and glucose-6-phosphatase; (2) Promoting protein catabolism in muscle to provide amino acid substrates for gluconeogenesis; (3) Promoting lipolysis to provide glycerol and fatty acids; (4) Antagonising insulin action (causing insulin resistance) at peripheral tissues. This is why patients on exogenous steroids commonly develop steroid-induced hyperglycaemia (steroid diabetes). The net effect is hyperglycaemia."
  },
  {
    num: 15,
    topic: "Biochemistry - Molecular Biology",
    question: "What type of compound are histones?",
    options: [
      "A. Lipids",
      "B. Carbohydrates",
      "C. Proteins",
      "D. Nucleic acids",
      "E. Glycoproteins"
    ],
    answer: "C. Proteins",
    explanation: "Histones are basic (positively charged) proteins that serve as spools around which DNA winds. They are rich in positively charged amino acids lysine and arginine, which allow them to associate with the negatively charged phosphate backbone of DNA. The basic structural unit of chromatin is the nucleosome, which consists of approximately 147 base pairs of DNA wound around an octamer of histone proteins (two each of H2A, H2B, H3, and H4). Histone H1 acts as a linker histone. Post-translational modifications of histones (acetylation, methylation, phosphorylation) regulate gene expression - this is a key aspect of epigenetics."
  },
  {
    num: 16,
    topic: "Biochemistry - Vitamins (Teratology)",
    question: "What is the pathophysiology explaining why vitamin A can cause birth defects during pregnancy?",
    options: [
      "A. Hypovitaminosis A causing neural tube defects",
      "B. Hypervitaminosis A - teratogenic excess",
      "C. Vitamin A deficiency causing eye abnormalities",
      "D. Interference with folate metabolism",
      "E. Direct chromosomal mutation"
    ],
    answer: "B. Hypervitaminosis A - teratogenic excess",
    explanation: "Hypervitaminosis A (excess vitamin A intake) is teratogenic. Retinoids (the active forms of vitamin A) are essential for normal embryogenesis as they act on nuclear retinoic acid receptors (RARs) that regulate gene transcription critical for organogenesis, limb development, and CNS formation. However, excessive intake disrupts normal Hox gene expression and retinoid signalling gradients, leading to birth defects including craniofacial abnormalities, cardiac defects, and CNS malformations. The risk is highest with preformed vitamin A (retinol, retinyl esters) found in animal products and supplements. The safe upper limit in pregnancy is 3000 micrograms/day. Synthetic retinoids (isotretinoin for acne) are highly teratogenic and are absolutely contraindicated in pregnancy."
  },
  {
    num: 17,
    topic: "Biochemistry - Energy Metabolism",
    question: "Which metabolic process produces the most energy needed for uterine contraction during parturition?",
    options: [
      "A. Anaerobic glycolysis",
      "B. HMP shunt",
      "C. Oxidative phosphorylation",
      "D. Substrate-level phosphorylation in Krebs cycle",
      "E. Beta-oxidation alone"
    ],
    answer: "C. Oxidative phosphorylation",
    explanation: "Uterine contractions during labour are energy-intensive processes. The primary source of ATP for myometrial contractions is aerobic metabolism via oxidative phosphorylation. This occurs in the inner mitochondrial membrane, driven by the electron transport chain, and uses the proton gradient generated by complexes I-IV to synthesise ATP via ATP synthase (chemiosmosis). Oxidative phosphorylation generates the most ATP per molecule of substrate (approximately 28-32 ATP from one glucose via the ETC) compared to anaerobic glycolysis (2 ATP net). During intense contractions, anaerobic glycolysis may supplement energy production when oxygen delivery is insufficient."
  },
  {
    num: 18,
    topic: "Biochemistry - Lipid Metabolism",
    question: "Where does fatty acid synthesis occur within the cell?",
    options: [
      "A. Mitochondria",
      "B. Nucleus",
      "C. Cytosol (cytoplasm)",
      "D. Peroxisomes",
      "E. Smooth endoplasmic reticulum exclusively"
    ],
    answer: "C. Cytosol (cytoplasm)",
    explanation: "Fatty acid synthesis (de novo lipogenesis) occurs primarily in the cytosol, catalysed by fatty acid synthase (FAS) complex. The key substrate is acetyl-CoA (derived from glucose metabolism) and the key reducing agent is NADPH (from the HMP shunt). This is in contrast to beta-oxidation (degradation) of fatty acids, which occurs in the mitochondrial matrix. Triglyceride and phospholipid assembly occur at the smooth endoplasmic reticulum (SER). Peroxisomes are involved in very-long-chain fatty acid oxidation. The cytosolic location of synthesis versus the mitochondrial location of oxidation allows separate regulation of these opposing pathways."
  },
  {
    num: 19,
    topic: "Biochemistry - Glucose Metabolism",
    question: "What is the function of the enzyme glucose-6-phosphatase in carbohydrate metabolism?",
    options: [
      "A. Converts glucose to glucose-6-phosphate (first step of glycolysis)",
      "B. Converts glucose-6-phosphate to glucose (allows glucose release into blood)",
      "C. Converts glucose-6-phosphate to glucose-1-phosphate",
      "D. Generates NADPH in the HMP shunt",
      "E. Initiates glycogen synthesis"
    ],
    answer: "B. Converts glucose-6-phosphate to glucose (allows glucose release into blood)",
    explanation: "Glucose-6-phosphatase is a key enzyme located in the endoplasmic reticulum membrane of hepatocytes and kidney cells. It catalyses the final step of both gluconeogenesis and glycogenolysis: glucose-6-phosphate + H2O → glucose + Pi. This reaction is essential because phosphorylated glucose cannot cross the plasma membrane and must be dephosphorylated first to be exported into the bloodstream for glucose homeostasis. Absence of this enzyme causes Von Gierke disease (glycogen storage disease type 1), characterised by severe hypoglycaemia and hepatomegaly. Glucokinase (hexokinase IV in liver) does the opposite - it phosphorylates glucose to glucose-6-phosphate."
  },
  {
    num: 20,
    topic: "Biochemistry - Molecular Biology (Prenatal Diagnosis)",
    question: "Which biochemical technique is used for prenatal identification of cystic fibrosis by specifically amplifying predetermined DNA sequences?",
    options: [
      "A. Southern blotting",
      "B. Fluorescence in situ hybridisation (FISH)",
      "C. Polymerase chain reaction (PCR)",
      "D. Western blotting",
      "E. Karyotyping"
    ],
    answer: "C. Polymerase chain reaction (PCR)",
    explanation: "PCR (Polymerase Chain Reaction) is the technique used to amplify specific, predetermined DNA sequences for prenatal diagnosis. In cystic fibrosis (caused by mutations in the CFTR gene, most commonly the delta-F508 deletion), PCR amplifies the relevant region of the CFTR gene from fetal DNA obtained via chorionic villus sampling (CVS) at 10-13 weeks or amniocentesis at 15-20 weeks. The amplified product is then sequenced or analysed to detect mutations. PCR is preferred for its speed, sensitivity, and ability to work with tiny amounts of DNA. In the UK, all CF mutations screened via the NHS newborn blood spot test can also be detected prenatally via PCR-based methods."
  },
  {
    num: 21,
    topic: "Biochemistry - Energy Metabolism",
    question: "Which process occurs in the mitochondria that uses an electron transport chain to generate ATP?",
    options: [
      "A. Substrate-level phosphorylation",
      "B. Oxidative phosphorylation via the Electron Transport Chain (ETC)",
      "C. Photophosphorylation",
      "D. Glycolysis",
      "E. Fermentation"
    ],
    answer: "B. Oxidative phosphorylation via the Electron Transport Chain (ETC)",
    explanation: "The Electron Transport Chain (ETC) consists of protein complexes I, II, III, and IV embedded in the inner mitochondrial membrane. Electrons donated by NADH and FADH2 (from glycolysis and the Krebs cycle) pass through these complexes in a stepwise reduction series, ultimately reducing O2 to H2O at complex IV. Energy released at complexes I, III, and IV is used to pump protons (H+) from the matrix to the intermembrane space, creating a proton gradient. This electrochemical gradient drives protons back through ATP synthase (complex V), providing energy to phosphorylate ADP to ATP - this coupled process is oxidative phosphorylation. It generates approximately 28-32 ATP per glucose molecule."
  },
  {
    num: 22,
    topic: "Biochemistry - Lipid Metabolism",
    question: "What is the parent compound from which most eicosanoids are derived?",
    options: [
      "A. Linoleic acid",
      "B. Cholesterol",
      "C. Arachidonic acid",
      "D. Alpha-linolenic acid",
      "E. Oleic acid"
    ],
    answer: "C. Arachidonic acid",
    explanation: "Eicosanoids (prostaglandins, thromboxanes, leukotrienes, lipoxins) are derived primarily from arachidonic acid (AA), a 20-carbon omega-6 polyunsaturated fatty acid (20:4 n-6). AA is released from membrane phospholipids by phospholipase A2. It is then metabolised via two main pathways: (1) Cyclo-oxygenase (COX) pathway: produces prostaglandins (PGs), prostacyclin (PGI2), and thromboxane A2 (TXA2) - collectively called prostanoids; (2) Lipoxygenase (LOX) pathway: produces leukotrienes. In obstetrics, prostaglandins (particularly PGE2 and PGF2alpha) are key mediators of labour, cervical ripening, and uterine involution. NSAIDs act by inhibiting COX enzymes."
  },
  {
    num: 23,
    topic: "Biochemistry - Energy Metabolism",
    question: "Glycolysis takes place in which part of the cell?",
    options: [
      "A. Mitochondrial matrix",
      "B. Nucleus",
      "C. Cytosol (cytoplasm)",
      "D. Smooth endoplasmic reticulum",
      "E. Peroxisomes"
    ],
    answer: "C. Cytosol (cytoplasm)",
    explanation: "Glycolysis (the Embden-Meyerhof-Parnas pathway) occurs entirely in the cytosol. It is a 10-step enzymatic pathway converting one molecule of glucose (6-carbon) to two molecules of pyruvate (3-carbon), with a net yield of 2 ATP and 2 NADH. Glycolysis does not require oxygen and occurs in all cell types. Key regulatory enzymes include hexokinase (step 1), phosphofructokinase-1 (step 3, the main rate-limiting step), and pyruvate kinase (step 10). Under aerobic conditions, pyruvate enters the mitochondria for the Krebs cycle. Under anaerobic conditions, pyruvate is reduced to lactate (in muscle) or ethanol (in yeast) to regenerate NAD+."
  },
  {
    num: 24,
    topic: "Biochemistry - Cell Organelles",
    question: "Which cellular organelle is especially abundant in cells that synthesise antibodies?",
    options: [
      "A. Smooth endoplasmic reticulum (SER)",
      "B. Golgi apparatus",
      "C. Rough endoplasmic reticulum (RER)",
      "D. Lysosomes",
      "E. Peroxisomes"
    ],
    answer: "C. Rough endoplasmic reticulum (RER)",
    explanation: "Plasma cells (differentiated B-lymphocytes) are the antibody-secreting cells and are characterised by an exceptionally well-developed rough endoplasmic reticulum (RER). The RER is studded with ribosomes on its cytoplasmic surface. These ribosomes translate mRNA encoding immunoglobulin heavy and light chains. The polypeptide chains are threaded into the RER lumen where they fold and are assembled into immunoglobulin molecules. The assembled antibodies are then transported to the Golgi apparatus for glycosylation, packaging, and secretion. This is why plasma cells on histology have a characteristic 'clock-face' chromatin pattern and abundant basophilic cytoplasm (due to abundant RER)."
  },
  {
    num: 25,
    topic: "Biochemistry - Molecular Biology",
    question: "Which nitrogen base is found in RNA but not in DNA?",
    options: [
      "A. Adenine",
      "B. Guanine",
      "C. Cytosine",
      "D. Thymine",
      "E. Uracil"
    ],
    answer: "E. Uracil",
    explanation: "The four nitrogenous bases of RNA are adenine (A), guanine (G), cytosine (C), and uracil (U). In DNA, uracil is replaced by thymine (T), which has an additional methyl group at carbon 5. Thymine is unique to DNA, while uracil is unique to RNA. Both are pyrimidines (single-ring structures). DNA contains: A, T, G, C (paired as A-T and G-C by hydrogen bonds). RNA contains: A, U, G, C (in single-stranded form). This distinction is exploited clinically: 5-fluorouracil (5-FU), an anticancer drug, mimics uracil and inhibits thymidylate synthase, blocking DNA synthesis. Base pairing rules: In DNA - A pairs with T (2 H-bonds), G pairs with C (3 H-bonds)."
  },
  {
    num: 26,
    topic: "Biochemistry - Cell Organelles",
    question: "Which intracellular organelle processes, packages, and transports proteins out of the cell?",
    options: [
      "A. Rough endoplasmic reticulum",
      "B. Smooth endoplasmic reticulum",
      "C. Golgi apparatus",
      "D. Lysosomes",
      "E. Peroxisomes"
    ],
    answer: "C. Golgi apparatus",
    explanation: "The Golgi apparatus (Golgi body/complex) is the major processing and packaging centre of the cell. It receives proteins synthesised in the RER via COPII transport vesicles. Within the Golgi (cis, medial, trans cisternae), proteins undergo: post-translational modifications including glycosylation, phosphorylation, and sulphation; quality control and sorting; packaging into secretory vesicles (exocytosis), lysosomal vesicles, or transport vesicles. The trans-Golgi network is the final sorting station from which proteins are dispatched to their destinations. Clinically, drugs that disrupt vesicular transport (e.g., Brefeldin A) block Golgi function and are used in research to study secretory pathways."
  },
  {
    num: 27,
    topic: "Biochemistry - Glucose Metabolism",
    question: "Glucagon reverses hypoglycaemia primarily by which mechanism?",
    options: [
      "A. Stimulating intestinal glucose absorption",
      "B. Inhibiting renal glucose excretion",
      "C. Stimulating gluconeogenesis in the liver",
      "D. Increasing insulin secretion",
      "E. Stimulating glycogen synthesis in muscle"
    ],
    answer: "C. Stimulating gluconeogenesis in the liver",
    explanation: "Glucagon is the primary counter-regulatory hormone for hypoglycaemia, secreted by pancreatic alpha cells. Its main mechanisms to raise blood glucose include: (1) Gluconeogenesis: activation of key gluconeogenic enzymes (PEPCK, fructose-1,6-bisphosphatase, glucose-6-phosphatase) in the liver, using amino acids, lactate, and glycerol as substrates - this is the predominant sustained mechanism; (2) Glycogenolysis: stimulation of glycogen breakdown in the liver (via cAMP-PKA-phosphorylase kinase cascade) for rapid glucose release. Glucagon acts via Gs-coupled receptors, elevating cAMP. In muscle, glycogen is mobilised for local use only (muscle lacks glucose-6-phosphatase). This is important in obstetrics as fasting gluconeogenesis is enhanced in pregnancy to maintain fetal glucose supply."
  },
  {
    num: 28,
    topic: "Biochemistry - Molecular Biology",
    question: "Which laboratory technique is used for RNA analysis?",
    options: [
      "A. Southern blotting",
      "B. Northern blotting",
      "C. Western blotting",
      "D. Eastern blotting",
      "E. PCR"
    ],
    answer: "B. Northern blotting",
    explanation: "The 'blotting' techniques are named as a mnemonic: Southern blot = DNA detection (named after Edwin Southern); Northern blot = RNA detection (named by analogy, not a person); Western blot = Protein detection; Eastern blot = Protein modification detection (lipids, carbohydrate modifications). Northern blotting involves: electrophoresis of RNA on agarose gel, transfer to membrane, hybridisation with a labelled probe complementary to the RNA of interest, and detection. It can quantify and determine the size of specific mRNA transcripts. Clinically relevant for studying gene expression. More modern alternatives include qRT-PCR (quantitative reverse transcription PCR) for sensitive RNA quantification."
  },
  {
    num: 29,
    topic: "Biochemistry - Nitrogen Metabolism",
    question: "Where does the urea cycle primarily occur?",
    options: [
      "A. Kidneys",
      "B. Skeletal muscle",
      "C. Liver (both mitochondria and cytosol)",
      "D. Brain",
      "E. Intestine"
    ],
    answer: "C. Liver (both mitochondria and cytosol)",
    explanation: "The urea cycle (ornithine cycle) occurs in the liver, with the first two reactions in the mitochondrial matrix and the remaining reactions in the cytosol: Mitochondrial steps: (1) Carbamoyl phosphate synthetase I (CPS-I) - rate-limiting enzyme - combines NH3 + CO2 to form carbamoyl phosphate; (2) Carbamoyl phosphate + ornithine → citrulline (catalysed by OTC - ornithine transcarbamylase). Cytosolic steps: citrulline is exported, combined with aspartate, and processed through argininosuccinate to arginine, then hydrolysed to urea + ornithine. Ornithine re-enters the mitochondria. Urea is the end-product of nitrogen metabolism and is excreted by the kidneys. Defects in urea cycle enzymes cause hyperammonaemia."
  },
  {
    num: 30,
    topic: "Biochemistry - Cell Organelles",
    question: "Cristae are present in which cellular organelle?",
    options: [
      "A. Nucleus",
      "B. Golgi apparatus",
      "C. Endoplasmic reticulum",
      "D. Mitochondria",
      "E. Lysosomes"
    ],
    answer: "D. Mitochondria",
    explanation: "Cristae are the infoldings of the inner mitochondrial membrane. They dramatically increase the surface area available for the electron transport chain (ETC) complexes and ATP synthase. The mitochondrion has two membranes: the outer membrane (smooth, contains porins/VDAC) and the inner membrane (highly folded into cristae). Between them is the intermembrane space (where protons accumulate during ETC activity). The central cavity is the matrix (site of Krebs cycle and beta-oxidation). Cells with high energy demands (e.g., cardiac muscle, hepatocytes) have mitochondria with more densely packed cristae. Mitochondria are maternally inherited (contain their own circular DNA, encoding 37 genes)."
  },
  {
    num: 31,
    topic: "Biochemistry - Molecular Biology",
    question: "What is the primary function of DNA polymerase?",
    options: [
      "A. Unwinding of the DNA double helix",
      "B. Addition of nucleotides to elongate the new DNA strand",
      "C. Sealing nicks in the DNA backbone",
      "D. Removing RNA primers",
      "E. Transcribing DNA to RNA"
    ],
    answer: "B. Addition of nucleotides to elongate the new DNA strand",
    explanation: "DNA polymerase adds nucleotides to the 3' end of a growing DNA strand in the 5' to 3' direction, using the template strand as a guide (complementary base pairing). Key features: (1) It cannot initiate new strands - requires an RNA primer (synthesised by primase/DNA-directed RNA polymerase); (2) It has 3' to 5' exonuclease activity (proofreading); (3) In eukaryotes, multiple DNA polymerases exist: alpha (primer synthesis), delta (lagging strand), epsilon (leading strand), beta (repair). In bacteria, DNA pol III is the main replicative polymerase; DNA pol I removes RNA primers; DNA ligase seals Okazaki fragments. Helicase unwinds the helix; topoisomerase relieves supercoiling."
  },
  {
    num: 32,
    topic: "Biochemistry - Molecular Biology",
    question: "Which technique is used for the detection of proteins?",
    options: [
      "A. Southern blotting",
      "B. Northern blotting",
      "C. Western blotting",
      "D. PCR",
      "E. ELISA (enzyme-linked immunosorbent assay)"
    ],
    answer: "C. Western blotting",
    explanation: "Western blotting detects specific proteins. The technique involves: (1) SDS-PAGE electrophoresis - proteins are denatured with SDS and separated by size; (2) Transfer to nitrocellulose or PVDF membrane; (3) Blocking non-specific binding; (4) Incubation with primary antibody (specific to the target protein); (5) Incubation with secondary antibody (enzyme-conjugated); (6) Visualisation via chemiluminescence or colorimetric reaction. Western blot is used clinically to confirm HIV diagnosis (confirmatory test after positive ELISA), and in research to detect protein expression and post-translational modifications. The HIV Western blot detects antibodies against specific HIV proteins (gp41, gp120, p24)."
  },
  {
    num: 33,
    topic: "Biochemistry - Molecular Biology",
    question: "Which nucleotide is found only in DNA and not in RNA?",
    options: [
      "A. Adenine",
      "B. Guanine",
      "C. Cytosine",
      "D. Thymine",
      "E. Uracil"
    ],
    answer: "D. Thymine",
    explanation: "Thymine (5-methyluracil) is unique to DNA. It is a pyrimidine base that pairs with adenine via two hydrogen bonds in the DNA double helix. In RNA, thymine is replaced by uracil (which lacks the methyl group at carbon 5). The presence of thymine (instead of uracil) in DNA is thought to be an evolutionary advantage because uracil can arise from spontaneous deamination of cytosine in DNA; by using thymine instead of uracil, repair enzymes can recognise and excise any uracil in DNA as an error and replace it with cytosine, maintaining fidelity. DNA: A-T, G-C base pairing; RNA: A-U, G-C base pairing."
  },
  {
    num: 34,
    topic: "Biochemistry - Molecular Biology",
    question: "Which protein is coiled around DNA to form the nucleosome structure?",
    options: [
      "A. Tubulin",
      "B. Actin",
      "C. Laminin",
      "D. Histone",
      "E. Collagen"
    ],
    answer: "D. Histone",
    explanation: "Histones are highly basic (positively charged) proteins rich in lysine and arginine that wrap DNA into nucleosomes. The nucleosome core consists of an octamer of 8 histone proteins: 2 each of H2A, H2B, H3, and H4, around which 147 base pairs of DNA are wound approximately 1.65 times. Histone H1 (linker histone) binds the linker DNA between nucleosomes, condensing chromatin further. Post-translational modifications of histone tails regulate gene expression: acetylation of lysine = opens chromatin (euchromatin, active transcription); methylation = can activate or repress transcription depending on position; phosphorylation = involved in mitosis and DNA repair. This epigenetic regulation is important in cancer biology and imprinting disorders."
  },
  {
    num: 35,
    topic: "Biochemistry - Nutrition",
    question: "What is the most abundant carbohydrate in breast milk?",
    options: [
      "A. Glucose",
      "B. Fructose",
      "C. Galactose",
      "D. Lactose",
      "E. Sucrose"
    ],
    answer: "D. Lactose",
    explanation: "Lactose (milk sugar) is the predominant carbohydrate in human breast milk, comprising approximately 7% of mature breast milk by weight. It is a disaccharide composed of glucose + galactose linked by a beta-1,4-glycosidic bond. Lactose is synthesised in mammary epithelial cells by lactose synthase (UDP-galactosyltransferase + alpha-lactalbumin, induced by prolactin). Lactose provides approximately 40% of the caloric content of human milk. Digestion requires lactase (brush border enzyme in small intestine). Lactase deficiency causes lactose intolerance, with symptoms of bloating, diarrhoea, and flatulence. Colostrum contains less lactose than mature milk."
  },
  {
    num: 36,
    topic: "Biochemistry - Vitamins",
    question: "What is the primary action of vitamin C (ascorbic acid) relevant to connective tissue?",
    options: [
      "A. Acts as a fat-soluble antioxidant",
      "B. Required for synthesis of collagen (hydroxylation of proline and lysine)",
      "C. Promotes calcium absorption in the gut",
      "D. Required for clotting factor synthesis",
      "E. Acts as a coenzyme for B vitamins"
    ],
    answer: "B. Required for synthesis of collagen (hydroxylation of proline and lysine)",
    explanation: "Vitamin C (ascorbic acid) is essential for collagen synthesis. It serves as a cofactor for prolyl hydroxylase and lysyl hydroxylase enzymes, which hydroxylate proline and lysine residues in procollagen chains. This hydroxylation is necessary for cross-linking of collagen fibrils, providing structural stability. Without vitamin C, collagen is structurally weak, leading to scurvy - characterised by perifollicular haemorrhages, gum disease, poor wound healing, and easy bruising. Additional roles of vitamin C include: water-soluble antioxidant (regenerates vitamin E), enhances non-haem iron absorption (Fe3+ → Fe2+ in gut), immune function, and dopamine/noradrenaline synthesis. It is the only water-soluble vitamin with antioxidant function."
  },
  {
    num: 37,
    topic: "Biochemistry - Amino Acid Metabolism",
    question: "Which amino acid is the precursor that liberates nitric oxide (NO)?",
    options: [
      "A. Tryptophan",
      "B. Tyrosine",
      "C. L-Arginine",
      "D. Glutamine",
      "E. Methionine"
    ],
    answer: "C. L-Arginine",
    explanation: "Nitric oxide (NO) is synthesised from L-arginine by nitric oxide synthase (NOS) enzymes. The reaction: L-arginine + O2 + NADPH → L-citrulline + NO. There are three isoforms of NOS: eNOS (endothelial NOS) - produces NO for vasodilation and blood pressure regulation; iNOS (inducible NOS) - produces large amounts of NO in macrophages for antimicrobial activity; nNOS (neuronal NOS) - produces NO as a neurotransmitter. In obstetrics: NO mediates vasodilation in uteroplacental circulation, contributing to the low-resistance placental blood flow; myometrial relaxation; and cervical ripening. NO is also the mechanism of action of glyceryl trinitrate (GTN) used as a tocolytic."
  },
  {
    num: 38,
    topic: "Biochemistry - Nitrogen Metabolism",
    question: "The urea cycle occurs mainly in which organ?",
    options: [
      "A. Kidneys",
      "B. Liver",
      "C. Skeletal muscle",
      "D. Intestine",
      "E. Spleen"
    ],
    answer: "B. Liver",
    explanation: "The urea cycle is the metabolic pathway for disposal of excess ammonia (NH3) from amino acid catabolism and nucleotide degradation. It occurs exclusively in the liver (hepatocytes), spanning both the mitochondria (steps 1-2) and cytosol (steps 3-5). Ammonia is extremely toxic (causes cerebral oedema, encephalopathy). In severe liver disease, the urea cycle is impaired, leading to hyperammonaemia and hepatic encephalopathy. The kidneys excrete urea (filtration and partial tubular reabsorption), but do not synthesise it. Urea is the primary form of nitrogen excretion in humans (ureotelism). Blood urea nitrogen (BUN) is a key marker of renal function."
  },
  {
    num: 39,
    topic: "Biochemistry - Glucose Metabolism",
    question: "Muscle lactate is transported to the liver and converted to glucose. Which metabolic cycle does this represent?",
    options: [
      "A. Krebs cycle",
      "B. Cori cycle (lactic acid cycle)",
      "C. Urea cycle",
      "D. Calvin cycle",
      "E. Glucose-alanine cycle"
    ],
    answer: "B. Cori cycle (lactic acid cycle)",
    explanation: "The Cori cycle (also called the lactic acid cycle) describes the metabolic cooperation between exercising muscle and the liver: (1) In muscle: glucose undergoes anaerobic glycolysis → pyruvate → lactate (by lactate dehydrogenase). Lactate is released into the bloodstream; (2) In liver: lactate is taken up and converted back to pyruvate (by LDH), then used for gluconeogenesis to reform glucose. The new glucose is released and transported back to muscle. This cycle allows muscle to maintain ATP production during anaerobic conditions while the liver handles the lactate load. Net energy cost: the liver expends 6 ATP to regenerate glucose from 2 lactate, while muscle gains 2 ATP from glycolysis. Named after Carl and Gerty Cori (1947 Nobel Prize in Physiology/Medicine)."
  },
  {
    num: 40,
    topic: "Biochemistry - Lipid Metabolism (Eicosanoids)",
    question: "Thromboxane A2 (TXA2) is formed in which of the following body structures?",
    options: [
      "A. Vascular endothelium",
      "B. Mast cells",
      "C. Platelets",
      "D. Neutrophils",
      "E. Liver"
    ],
    answer: "C. Platelets",
    explanation: "Thromboxane A2 (TXA2) is produced predominantly by activated platelets via the COX-1 pathway from arachidonic acid. TXA2 has potent pro-aggregatory and vasoconstrictive effects, promoting platelet aggregation and clot formation. By contrast, prostacyclin (PGI2) is produced by vascular endothelium and has opposing effects - it is a potent vasodilator and inhibitor of platelet aggregation. The balance between TXA2 (pro-thrombotic) and PGI2 (anti-thrombotic) normally maintains vascular homeostasis. Aspirin irreversibly inhibits COX in platelets (no nucleus = no new COX production), reducing TXA2 and explaining its antiplatelet effect. In obstetrics, low-dose aspirin is used in pre-eclampsia prophylaxis by altering this TXA2/PGI2 balance."
  },
  {
    num: 41,
    topic: "Biochemistry - Receptor Pharmacology",
    question: "What is the structure/location of the progesterone receptor?",
    options: [
      "A. G-protein coupled transmembrane receptor",
      "B. Tyrosine kinase receptor",
      "C. Ion channel receptor",
      "D. Nuclear transcription factor (intracellular receptor)",
      "E. Cytoplasmic receptor linked to JAK-STAT pathway"
    ],
    answer: "D. Nuclear transcription factor (intracellular receptor)",
    explanation: "Progesterone is a steroid hormone. Steroid hormones are lipophilic and can cross the plasma membrane to bind intracellular receptors. The progesterone receptor (PR) is a member of the nuclear receptor superfamily (class I nuclear receptors). In the unbound state, PR is associated with heat shock proteins (HSPs). Upon ligand binding: (1) The receptor dissociates from HSPs; (2) Undergoes dimerisation; (3) Translocates to the nucleus; (4) Binds to specific progesterone response elements (PREs) in DNA; (5) Recruits co-activators/co-repressors; (6) Regulates transcription of target genes. Other steroid hormone receptors include: oestrogen (ER), androgen (AR), glucocorticoid (GR), mineralocorticoid (MR). Thyroid hormone receptors also act as nuclear transcription factors (type II nuclear receptors)."
  },
  {
    num: 42,
    topic: "Biochemistry - Lipid Metabolism (Essential Fatty Acids)",
    question: "Which of the following is an essential omega-3 fatty acid that must be taken in the diet?",
    options: [
      "A. Linoleic acid (LA)",
      "B. Arachidonic acid (AA)",
      "C. Eicosapentaenoic acid (EPA)",
      "D. Alpha-linolenic acid (ALA)",
      "E. Docosahexaenoic acid (DHA)"
    ],
    answer: "D. Alpha-linolenic acid (ALA)",
    explanation: "Alpha-linolenic acid (ALA, 18:3 n-3) is the only truly essential omega-3 fatty acid, meaning it cannot be synthesised de novo by humans and must be obtained from the diet. ALA is found in flaxseeds, chia seeds, walnuts, and green leafy vegetables. The body can convert ALA to longer-chain omega-3s: EPA (20:5 n-3) and DHA (22:6 n-3), but conversion efficiency is low (<10%). Similarly, the essential omega-6 fatty acid is linoleic acid (LA, 18:2 n-6), from which arachidonic acid (AA, 20:4 n-6) can be synthesised. In pregnancy and lactation, DHA is critical for fetal brain and retinal development, which is why supplementation is recommended. Essential fatty acid deficiency leads to dermatitis, poor wound healing, and growth retardation."
  },
  {
    num: 43,
    topic: "Biochemistry - Vitamins",
    question: "Vitamin A has two dietary sources. If the plant source is carotene (beta-carotene), what is the animal source?",
    options: [
      "A. Cholecalciferol",
      "B. Retinol",
      "C. Tocopherol",
      "D. Phylloquinone",
      "E. Cyanocobalamin"
    ],
    answer: "B. Retinol",
    explanation: "Vitamin A exists in two dietary forms: (1) Preformed vitamin A (retinoids): found in animal products - retinol (the alcohol form), retinal (the aldehyde form), and retinoic acid. Liver, fish liver oils, eggs, dairy products, and fortified foods are rich sources. (2) Provitamin A carotenoids: found in plants - beta-carotene (most potent), alpha-carotene, beta-cryptoxanthin. Beta-carotene is cleaved in the intestinal mucosa by beta-carotene 15,15'-dioxygenase to form two retinal molecules, which are then reduced to retinol. Retinol is the primary storage and transport form. Active forms include: retinal (vision - 11-cis-retinal as chromophore in rhodopsin), retinoic acid (gene transcription, teratogenic if excess). Deficiency causes night blindness, xerophthalmia, and increased maternal/infant mortality."
  },
  {
    num: 44,
    topic: "Biochemistry - Amino Acid Metabolism",
    question: "The rate-limiting step in the synthesis of catecholamines (dopamine, noradrenaline, adrenaline) is:",
    options: [
      "A. DOPA decarboxylase converting DOPA to dopamine",
      "B. Dopamine beta-hydroxylase converting dopamine to noradrenaline",
      "C. Phenylethanolamine N-methyltransferase (PNMT) converting noradrenaline to adrenaline",
      "D. Tyrosine hydroxylase converting L-tyrosine to L-DOPA",
      "E. Phenylalanine hydroxylase converting phenylalanine to tyrosine"
    ],
    answer: "D. Tyrosine hydroxylase converting L-tyrosine to L-DOPA",
    explanation: "The catecholamine biosynthesis pathway: Phenylalanine → (phenylalanine hydroxylase) → Tyrosine → (tyrosine hydroxylase, rate-limiting) → L-DOPA → (DOPA decarboxylase/aromatic L-amino acid decarboxylase) → Dopamine → (dopamine beta-hydroxylase, in noradrenergic neurons) → Noradrenaline → (PNMT, in adrenal medulla) → Adrenaline. Tyrosine hydroxylase (TH) is the rate-limiting enzyme, requiring tetrahydrobiopterin (BH4) as a cofactor. TH is inhibited by the end-products noradrenaline and dopamine (negative feedback). This is the target of: metyrosine (alpha-methyl-p-tyrosine) in phaeochromocytoma treatment. In obstetrics: phaeochromocytoma in pregnancy is managed with alpha-blockade (phenoxybenzamine) before beta-blockade."
  }
];

// Build document paragraphs
const children = [];

// Title
children.push(new Paragraph({
  text: "MRCOG Part 1 Question Bank",
  heading: HeadingLevel.TITLE,
  alignment: AlignmentType.CENTER,
  spacing: { after: 200 }
}));

children.push(new Paragraph({
  children: [
    new TextRun({
      text: "Biochemistry, Biophysics & Clinical Sciences",
      bold: true,
      size: 28,
      color: "2E74B5"
    })
  ],
  alignment: AlignmentType.CENTER,
  spacing: { after: 200 }
}));

children.push(new Paragraph({
  children: [
    new TextRun({
      text: "Derived from MRCOG 1 Fast Track Study Group Chat (July 2023)",
      italics: true,
      size: 22,
      color: "666666"
    })
  ],
  alignment: AlignmentType.CENTER,
  spacing: { after: 400 }
}));

// Separator line
children.push(new Paragraph({
  border: { bottom: { style: BorderStyle.SINGLE, size: 6, color: "2E74B5" } },
  spacing: { after: 400 }
}));

// Questions
questions.forEach((q, idx) => {
  // Question number + topic tag
  children.push(new Paragraph({
    children: [
      new TextRun({ text: `Q${q.num}. `, bold: true, size: 26, color: "C00000" }),
      new TextRun({ text: `[${q.topic}]`, bold: true, size: 22, color: "2E74B5" })
    ],
    spacing: { before: 300, after: 80 }
  }));

  // Question text
  children.push(new Paragraph({
    children: [
      new TextRun({ text: q.question, bold: true, size: 24 })
    ],
    spacing: { after: 120 }
  }));

  // Options
  q.options.forEach(opt => {
    children.push(new Paragraph({
      children: [
        new TextRun({ text: opt, size: 22 })
      ],
      indent: { left: 360 },
      spacing: { after: 60 }
    }));
  });

  // Answer
  children.push(new Paragraph({
    children: [
      new TextRun({ text: "ANSWER: ", bold: true, size: 23, color: "538135" }),
      new TextRun({ text: q.answer, bold: true, size: 23, color: "538135" })
    ],
    spacing: { before: 120, after: 60 },
    shading: { type: ShadingType.CLEAR, fill: "E2EFDA" }
  }));

  // Explanation header
  children.push(new Paragraph({
    children: [
      new TextRun({ text: "EXPLANATION: ", bold: true, size: 22, color: "7030A0" })
    ],
    spacing: { before: 80, after: 40 }
  }));

  // Explanation text
  children.push(new Paragraph({
    children: [
      new TextRun({ text: q.explanation, size: 22 })
    ],
    spacing: { after: 80 }
  }));

  // Divider between questions
  if (idx < questions.length - 1) {
    children.push(new Paragraph({
      border: { bottom: { style: BorderStyle.DASHED, size: 3, color: "CCCCCC" } },
      spacing: { before: 160, after: 160 }
    }));
  }
});

// Footer note
children.push(new Paragraph({
  border: { top: { style: BorderStyle.SINGLE, size: 6, color: "2E74B5" } },
  spacing: { before: 400, after: 100 }
}));

children.push(new Paragraph({
  children: [
    new TextRun({
      text: "Total Questions: 44  |  Topics: Biochemistry, Biophysics, Molecular Biology, Obstetrics, Gynaecology, Professional Practice",
      italics: true,
      size: 18,
      color: "666666"
    })
  ],
  alignment: AlignmentType.CENTER
}));

const doc = new Document({
  styles: {
    default: {
      document: {
        run: { font: "Calibri", size: 22 }
      }
    }
  },
  sections: [{
    properties: {
      page: {
        margin: { top: 1000, right: 1000, bottom: 1000, left: 1200 }
      }
    },
    children
  }]
});

const { Packer } = require('docx');
Packer.toBuffer(doc).then(buffer => {
  fs.writeFileSync('/home/daytona/workspace/mrcog1-qbank/MRCOG1_Question_Bank.docx', buffer);
  console.log('Document created successfully!');
}).catch(err => {
  console.error('Error:', err);
  process.exit(1);
});

Successfully replaced 1 instance(s) of the string in '/home/daytona/workspace/mrcog1-qbank/generate_qbank.js'

Successfully replaced 1 instance(s) of the string in '/home/daytona/workspace/mrcog1-qbank/generate_qbank.js'