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

OUTPUT = "/home/daytona/workspace/gnm-papers/GNM_1st_Year_Question_Papers_2017_2019.pdf"

doc = SimpleDocTemplate(
    OUTPUT,
    pagesize=A4,
    rightMargin=2*cm, leftMargin=2*cm,
    topMargin=2*cm, bottomMargin=2*cm
)

styles = getSampleStyleSheet()

# Custom styles
title_style = ParagraphStyle('Title', parent=styles['Title'],
    fontSize=16, textColor=colors.HexColor('#1a237e'),
    spaceAfter=4, alignment=TA_CENTER, fontName='Helvetica-Bold')

subtitle_style = ParagraphStyle('Subtitle', parent=styles['Normal'],
    fontSize=11, textColor=colors.HexColor('#1a237e'),
    spaceAfter=2, alignment=TA_CENTER, fontName='Helvetica')

section_style = ParagraphStyle('Section', parent=styles['Normal'],
    fontSize=13, textColor=colors.white,
    spaceBefore=10, spaceAfter=6,
    fontName='Helvetica-Bold', alignment=TA_CENTER,
    backColor=colors.HexColor('#1a237e'),
    leftIndent=-20, rightIndent=-20,
    borderPad=6)

paper_title_style = ParagraphStyle('PaperTitle', parent=styles['Normal'],
    fontSize=12, textColor=colors.white,
    spaceBefore=4, spaceAfter=4,
    fontName='Helvetica-Bold', alignment=TA_CENTER,
    backColor=colors.HexColor('#283593'),
    borderPad=5)

q_num_style = ParagraphStyle('QNum', parent=styles['Normal'],
    fontSize=10, textColor=colors.HexColor('#b71c1c'),
    spaceBefore=8, spaceAfter=2,
    fontName='Helvetica-Bold')

q_style = ParagraphStyle('Q', parent=styles['Normal'],
    fontSize=10, textColor=colors.black,
    spaceAfter=2, fontName='Helvetica',
    leftIndent=14)

ans_label_style = ParagraphStyle('AnsLabel', parent=styles['Normal'],
    fontSize=10, textColor=colors.HexColor('#1b5e20'),
    spaceBefore=3, spaceAfter=1,
    fontName='Helvetica-Bold', leftIndent=14)

ans_style = ParagraphStyle('Ans', parent=styles['Normal'],
    fontSize=9.5, textColor=colors.HexColor('#1b5e20'),
    spaceAfter=2, fontName='Helvetica',
    leftIndent=28, leading=14)

note_style = ParagraphStyle('Note', parent=styles['Normal'],
    fontSize=9, textColor=colors.HexColor('#5d4037'),
    spaceAfter=4, fontName='Helvetica-Oblique',
    leftIndent=14, borderPad=4,
    backColor=colors.HexColor('#fff8e1'))

info_style = ParagraphStyle('Info', parent=styles['Normal'],
    fontSize=9.5, textColor=colors.HexColor('#37474f'),
    spaceAfter=2, fontName='Helvetica', alignment=TA_CENTER)

hr_color = colors.HexColor('#9fa8da')

story = []

# ─── COVER PAGE ───────────────────────────────────────────────────
story.append(Spacer(1, 3*cm))
story.append(Paragraph("GNM NURSING", ParagraphStyle('CoverMain',
    fontSize=28, textColor=colors.HexColor('#1a237e'),
    alignment=TA_CENTER, fontName='Helvetica-Bold', spaceAfter=4)))
story.append(Paragraph("General Nursing & Midwifery", ParagraphStyle('CoverSub',
    fontSize=16, textColor=colors.HexColor('#3949ab'),
    alignment=TA_CENTER, fontName='Helvetica', spaceAfter=6)))
story.append(HRFlowable(width="80%", thickness=2, color=colors.HexColor('#3949ab'), spaceAfter=10))

story.append(Paragraph("1st Year — Board Examination", ParagraphStyle('CoverYear',
    fontSize=14, textColor=colors.HexColor('#37474f'),
    alignment=TA_CENTER, fontName='Helvetica-Bold', spaceAfter=6)))

# Big box
cover_data = [
    [Paragraph("<b>PAST QUESTION PAPERS</b><br/>2017 &amp; 2019", ParagraphStyle('Box',
        fontSize=18, alignment=TA_CENTER, textColor=colors.white, fontName='Helvetica-Bold'))]
]
cover_table = Table(cover_data, colWidths=[14*cm])
cover_table.setStyle(TableStyle([
    ('BACKGROUND', (0,0), (-1,-1), colors.HexColor('#1a237e')),
    ('ALIGN', (0,0), (-1,-1), 'CENTER'),
    ('VALIGN', (0,0), (-1,-1), 'MIDDLE'),
    ('TOPPADDING', (0,0), (-1,-1), 20),
    ('BOTTOMPADDING', (0,0), (-1,-1), 20),
    ('ROUNDEDCORNERS', [10,10,10,10]),
]))
story.append(cover_table)
story.append(Spacer(1, 1*cm))

subjects_data = [
    ["SUBJECTS COVERED"],
    ["Paper I   :  Bio-Science (Anatomy, Physiology &amp; Microbiology)"],
    ["Paper II  :  Behavioral Science (Psychology &amp; Sociology)"],
    ["Paper III :  Nursing Foundation (Fundamentals of Nursing)"],
    ["Paper IV  :  Community Health Nursing - I"],
]
sub_table = Table([[Paragraph(r[0], ParagraphStyle('SubList',
    fontSize=10.5, textColor=colors.HexColor('#1a237e') if i==0 else colors.HexColor('#263238'),
    alignment=TA_CENTER if i==0 else TA_LEFT,
    fontName='Helvetica-Bold' if i==0 else 'Helvetica',
    spaceAfter=1))] for i,r in enumerate(subjects_data)],
    colWidths=[14*cm])
sub_table.setStyle(TableStyle([
    ('BACKGROUND', (0,0), (0,0), colors.HexColor('#e8eaf6')),
    ('BACKGROUND', (0,1), (0,-1), colors.HexColor('#f5f5f5')),
    ('BOX', (0,0), (-1,-1), 1, colors.HexColor('#9fa8da')),
    ('INNERGRID', (0,0), (-1,-1), 0.5, colors.HexColor('#c5cae9')),
    ('TOPPADDING', (0,0), (-1,-1), 6),
    ('BOTTOMPADDING', (0,0), (-1,-1), 6),
    ('LEFTPADDING', (0,0), (-1,-1), 12),
]))
story.append(sub_table)
story.append(Spacer(1, 0.8*cm))

story.append(Paragraph("Includes Questions + Detailed Answers", ParagraphStyle('CoverNote',
    fontSize=11, textColor=colors.HexColor('#e53935'),
    alignment=TA_CENTER, fontName='Helvetica-Bold', spaceAfter=4)))
story.append(Paragraph("Based on GNC / State Board Examination Pattern | Time: 3 Hours | Full Marks: 75", info_style))
story.append(PageBreak())

# ─── INDEX PAGE ─────────────────────────────────────────────────
story.append(Paragraph("TABLE OF CONTENTS", section_style))
story.append(Spacer(1, 0.4*cm))
toc_data = [
    ["#", "Subject", "Year / Exam", "Page"],
    ["1", "Bio-Science (Anatomy, Physiology & Microbiology)", "July 2017", "3"],
    ["2", "Bio-Science (Anatomy, Physiology & Microbiology)", "September 2019", "5"],
    ["3", "Behavioral Science (Psychology & Sociology)", "July 2017", "7"],
    ["4", "Behavioral Science (Psychology & Sociology)", "September 2019", "9"],
    ["5", "Nursing Foundation (Fundamentals of Nursing)", "July 2017", "11"],
    ["6", "Nursing Foundation (Fundamentals of Nursing)", "September 2019", "13"],
    ["7", "Community Health Nursing - I", "August 2017", "15"],
    ["8", "Community Health Nursing - I", "September 2019", "17"],
]
toc_table = Table(
    [[Paragraph(str(cell), ParagraphStyle('TOC',
        fontSize=9.5,
        fontName='Helvetica-Bold' if row==0 else 'Helvetica',
        textColor=colors.white if row==0 else colors.HexColor('#1a237e') if col==1 else colors.black,
        alignment=TA_CENTER if col in [0,3] else TA_LEFT)) for col, cell in enumerate(row_data)]
     for row, row_data in enumerate(toc_data)],
    colWidths=[1*cm, 8*cm, 3.5*cm, 2*cm]
)
toc_table.setStyle(TableStyle([
    ('BACKGROUND', (0,0), (-1,0), colors.HexColor('#1a237e')),
    ('ROWBACKGROUNDS', (0,1), (-1,-1), [colors.HexColor('#e8eaf6'), colors.white]),
    ('BOX', (0,0), (-1,-1), 1, colors.HexColor('#9fa8da')),
    ('INNERGRID', (0,0), (-1,-1), 0.5, colors.HexColor('#c5cae9')),
    ('TOPPADDING', (0,0), (-1,-1), 7),
    ('BOTTOMPADDING', (0,0), (-1,-1), 7),
    ('LEFTPADDING', (0,0), (-1,-1), 8),
    ('RIGHTPADDING', (0,0), (-1,-1), 8),
    ('ALIGN', (0,0), (0,-1), 'CENTER'),
    ('ALIGN', (3,0), (3,-1), 'CENTER'),
]))
story.append(toc_table)
story.append(PageBreak())

# ─── HELPER FUNCTIONS ────────────────────────────────────────────

def paper_header(subject, paper_num, year, exam_type="Annual Examination"):
    elems = []
    elems.append(Paragraph(f"PAPER {paper_num}: {subject.upper()}", section_style))
    header_data = [[
        Paragraph(f"<b>GNM 1st Year | {exam_type} | {year}</b>", ParagraphStyle('PH',
            fontSize=10, textColor=colors.white, alignment=TA_CENTER, fontName='Helvetica-Bold')),
        Paragraph("<b>Time: 3 Hours</b>", ParagraphStyle('PH2',
            fontSize=10, textColor=colors.white, alignment=TA_CENTER, fontName='Helvetica-Bold')),
        Paragraph("<b>Full Marks: 75</b>", ParagraphStyle('PH3',
            fontSize=10, textColor=colors.white, alignment=TA_CENTER, fontName='Helvetica-Bold')),
    ]]
    h_table = Table(header_data, colWidths=[8*cm, 3*cm, 3.5*cm])
    h_table.setStyle(TableStyle([
        ('BACKGROUND', (0,0), (-1,-1), colors.HexColor('#283593')),
        ('TOPPADDING', (0,0), (-1,-1), 6),
        ('BOTTOMPADDING', (0,0), (-1,-1), 6),
        ('LEFTPADDING', (0,0), (-1,-1), 8),
        ('ALIGN', (0,0), (-1,-1), 'CENTER'),
        ('VALIGN', (0,0), (-1,-1), 'MIDDLE'),
    ]))
    elems.append(h_table)
    elems.append(Paragraph(
        "<i>Instructions: Answer all questions. Draw diagrams wherever necessary. "
        "Assume reasonable values where data is not given.</i>",
        note_style))
    elems.append(Spacer(1, 0.2*cm))
    return elems

def section_header(text):
    return [Paragraph(text, ParagraphStyle('SecH', fontSize=10.5,
        fontName='Helvetica-Bold', textColor=colors.HexColor('#1a237e'),
        backColor=colors.HexColor('#e8eaf6'), borderPad=5,
        spaceBefore=8, spaceAfter=4,
        leftIndent=-5, rightIndent=-5))]

def q_and_a(num, question, answer, marks=""):
    elems = []
    mark_text = f" [{marks}]" if marks else ""
    elems.append(Paragraph(f"Q{num}.{mark_text}", q_num_style))
    elems.append(Paragraph(question, q_style))
    elems.append(Paragraph("ANS:", ans_label_style))
    for line in answer:
        elems.append(Paragraph(f"• {line}", ans_style))
    return elems

# ═══════════════════════════════════════════════════════════════════
# PAPER I - BIO-SCIENCE 2017
# ═══════════════════════════════════════════════════════════════════
story += paper_header("Bio-Science (Anatomy, Physiology & Microbiology)", "I", "July 2017")

story += section_header("SECTION A — Long Answer Questions (3 × 15 = 45 Marks)")

story += q_and_a(1, "Draw a neat labelled diagram of the heart and explain its structure and functions. Describe the cardiac cycle.", [
    "The heart is a hollow, muscular organ located in the mediastinum of the thoracic cavity.",
    "SIZE: About the size of a closed fist; weight ~300g in adult.",
    "LAYERS: Pericardium (outer), Myocardium (middle, muscular), Endocardium (inner lining).",
    "CHAMBERS: 4 chambers — Right atrium, Right ventricle, Left atrium, Left ventricle.",
    "VALVES: Tricuspid (right AV), Bicuspid/Mitral (left AV), Pulmonary semilunar, Aortic semilunar.",
    "FUNCTIONS: Pumps oxygenated blood to body via aorta; deoxygenated blood to lungs via pulmonary artery.",
    "CARDIAC CYCLE: Systole (contraction ~0.3 sec) + Diastole (relaxation ~0.5 sec) = 0.8 sec per cycle.",
    "CARDIAC OUTPUT: Heart rate × Stroke volume = 72 × 70 mL = ~5 litres/min.",
    "BLOOD SUPPLY: Coronary arteries (right and left) supply the heart muscle.",
], "15 Marks")

story += q_and_a(2, "Describe the structure and functions of the kidney. Explain the process of urine formation with a neat labelled diagram of nephron.", [
    "The kidneys are bean-shaped organs located retroperitoneally, one on each side of the vertebral column.",
    "SIZE: About 11 cm long, 6 cm wide, 3 cm thick. Right kidney is slightly lower than left.",
    "OUTER LAYER: Renal cortex (contains glomeruli and Bowman's capsule).",
    "INNER LAYER: Renal medulla (contains renal pyramids and loop of Henle).",
    "NEPHRON: Functional unit of kidney (~1 million per kidney). Parts: Glomerulus, Bowman's capsule, PCT, Loop of Henle, DCT, Collecting duct.",
    "URINE FORMATION — 3 processes:",
    "1. FILTRATION: Blood filtered in glomerulus → 180 litres of filtrate/day.",
    "2. REABSORPTION: ~99% of filtrate reabsorbed — glucose, amino acids, Na⁺, water.",
    "3. SECRETION: H⁺, K⁺, creatinine secreted into tubule.",
    "FINAL URINE: ~1.5 litres/day, yellow, slightly acidic (pH 6.0).",
    "FUNCTIONS: Excretion of waste, regulation of blood pressure (renin), erythropoietin secretion, acid-base balance.",
], "15 Marks")

story += q_and_a(3, "Classify microorganisms and explain the structure of bacteria with a neat labelled diagram. Describe the methods of sterilization.", [
    "CLASSIFICATION OF MICROORGANISMS: Bacteria, Viruses, Fungi, Protozoa, Rickettsia, Helminths.",
    "BACTERIA STRUCTURE:",
    "  - Cell wall: Rigid, made of peptidoglycan; Gram +ve (thick) or Gram -ve (thin).",
    "  - Cell membrane: Semipermeable, regulates transport.",
    "  - Cytoplasm: Contains ribosomes (70S), no nucleus.",
    "  - Nucleoid: Circular DNA chromosome.",
    "  - Flagella: Whip-like, used for motility.",
    "  - Pili/Fimbriae: Hair-like projections for adhesion.",
    "  - Capsule: Outermost layer in some bacteria; protects against phagocytosis.",
    "  - Spore (endospore): Heat-resistant survival structure.",
    "METHODS OF STERILIZATION:",
    "  Physical: Autoclaving (121°C, 15 psi, 15 min), Dry heat (160-170°C, 1 hr), UV radiation, Filtration.",
    "  Chemical: Glutaraldehyde, Formaldehyde, Ethylene oxide (for heat-sensitive instruments).",
    "  Pasteurization: Kills pathogens but not all organisms (63°C/30 min or 72°C/15 sec).",
], "15 Marks")

story += section_header("SECTION B — Short Answer Questions (5 × 5 = 25 Marks)")

story += q_and_a(4, "Describe the structure and functions of the lungs.", [
    "Paired organs in thoracic cavity. Right lung: 3 lobes; Left lung: 2 lobes.",
    "Covered by pleura (visceral and parietal layers).",
    "Bronchi → Bronchioles → Alveoli (site of gas exchange).",
    "Alveoli: ~300 million; total surface area ~70 sq.m.",
    "Functions: O₂ absorption, CO₂ excretion, acid-base regulation, speech.",
], "5 Marks")

story += q_and_a(5, "Explain the structure of the liver.", [
    "Largest gland in the body; located in right hypochondriac region.",
    "Weight: ~1.5 kg in adults. Two main lobes: right (larger) and left.",
    "Functional unit: Hepatic lobule (hexagonal, portal triad at corners).",
    "Blood supply: Hepatic artery (oxygenated) + Portal vein (nutrient-rich from gut).",
    "Functions: Bile production, glycogen storage, detoxification, plasma protein synthesis, clotting factors.",
], "5 Marks")

story += q_and_a(6, "Define reflex action and explain the reflex arc.", [
    "Reflex action: An automatic, involuntary response to a stimulus.",
    "Reflex arc components: Receptor → Afferent nerve → Nerve centre (spinal cord) → Efferent nerve → Effector (muscle/gland).",
    "Types: Conditioned (learned) and Unconditioned (inborn) reflexes.",
    "Example: Knee jerk reflex (patellar reflex) — monosynaptic reflex.",
    "Significance in nursing: Neurological assessment, testing CNS integrity.",
], "5 Marks")

story += q_and_a(7, "Describe the process of blood coagulation.", [
    "Coagulation = formation of a blood clot to stop bleeding.",
    "STAGES: 1) Vascular spasm → 2) Platelet plug formation → 3) Coagulation cascade.",
    "Extrinsic pathway: Tissue factor (Factor III) activates Factor X.",
    "Intrinsic pathway: Activated by contact with collagen.",
    "Common pathway: Factor X → Prothrombin → Thrombin → Fibrinogen → Fibrin clot.",
    "Clotting factors: 13 factors (I–XIII). Vitamin K essential for II, VII, IX, X.",
    "Anticoagulants: Heparin (immediate), Warfarin (oral, delayed).",
], "5 Marks")

story += q_and_a(8, "Write short note on Gram staining procedure.", [
    "Gram staining: Differential staining technique developed by Hans Christian Gram (1884).",
    "PROCEDURE STEPS:",
    "1. Prepare and heat-fix smear on glass slide.",
    "2. Apply Crystal Violet (primary stain) for 1 min → wash.",
    "3. Apply Gram's Iodine (mordant) for 1 min → wash.",
    "4. Decolorize with Acetone/Alcohol for 30 sec → wash.",
    "5. Apply Safranin (counterstain) for 30 sec → wash → dry.",
    "RESULT: Gram +ve = purple (thick peptidoglycan retains CV). Gram -ve = pink/red.",
    "EXAMPLES: Gram +ve: Staphylococcus, Streptococcus. Gram -ve: E. coli, Salmonella.",
], "5 Marks")

story += section_header("SECTION C — Very Short / MCQ (5 × 1 = 5 Marks)")
mcq_bio17 = [
    ("Q9.", "The pacemaker of the heart is: (a) AV node  (b) SA node  (c) Bundle of His  (d) Purkinje fibres", "Ans: (b) SA node"),
    ("Q10.", "Number of pairs of cranial nerves: (a) 10  (b) 11  (c) 12  (d) 13", "Ans: (c) 12"),
    ("Q11.", "The functional unit of kidney is: (a) Neuron  (b) Nephron  (c) Alveolus  (d) Hepatocyte", "Ans: (b) Nephron"),
    ("Q12.", "Normal pH of blood: (a) 6.8  (b) 7.0  (c) 7.4  (d) 8.0", "Ans: (c) 7.4"),
    ("Q13.", "Vitamin K is required for synthesis of clotting factor: (a) I  (b) V  (c) X  (d) XI", "Ans: (c) X (also II, VII, IX)"),
]
for qn, qt, ans in mcq_bio17:
    story.append(Paragraph(qn, q_num_style))
    story.append(Paragraph(qt, q_style))
    story.append(Paragraph(ans, ParagraphStyle('MCQAns', fontSize=9.5,
        textColor=colors.HexColor('#1b5e20'), fontName='Helvetica-Bold', leftIndent=28, spaceAfter=3)))

story.append(PageBreak())

# ═══════════════════════════════════════════════════════════════════
# PAPER I - BIO-SCIENCE 2019
# ═══════════════════════════════════════════════════════════════════
story += paper_header("Bio-Science (Anatomy, Physiology & Microbiology)", "I", "September 2019")
story += section_header("SECTION A — Long Answer Questions (3 × 15 = 45 Marks)")

story += q_and_a(1, "Describe the structure of the neuron with a neat labelled diagram. Explain the physiology of nerve impulse transmission.", [
    "NEURON: Structural and functional unit of nervous system.",
    "PARTS OF NEURON:",
    "  - Cell body (Soma): Contains nucleus, Nissl granules (ribosomes), organelles.",
    "  - Dendrites: Multiple short processes; receive impulses toward cell body.",
    "  - Axon: Single long process; transmits impulse away from cell body.",
    "  - Myelin sheath: Insulating layer of Schwann cells; nodes of Ranvier between segments.",
    "  - Axon terminals (Synaptic knobs): Release neurotransmitters.",
    "TYPES: Sensory (afferent), Motor (efferent), Interneurons (association).",
    "NERVE IMPULSE — Resting potential: Inside = -70 mV (K⁺ inside, Na⁺ outside).",
    "ACTION POTENTIAL: Depolarization (Na⁺ rushes in → inside becomes +40 mV) → Repolarization (K⁺ rushes out).",
    "SYNAPSE: Junction between neurons. Neurotransmitter (e.g., acetylcholine) released from pre-synaptic terminal.",
    "SALTATORY CONDUCTION: In myelinated fibres, impulse jumps from node to node (faster conduction).",
], "15 Marks")

story += q_and_a(2, "Describe the male reproductive system with a neat labelled diagram. Explain spermatogenesis.", [
    "ORGANS: Testes (×2), Epididymis, Vas deferens, Seminal vesicles, Prostate gland, Bulbourethral glands, Penis.",
    "TESTES: Located in scrotum (2–3°C below body temp for sperm production). Contain seminiferous tubules.",
    "SPERMATOGENESIS (formation of sperm):",
    "  1. Spermatogonia (2n) → Primary spermatocyte (2n) — Mitosis.",
    "  2. Primary spermatocyte → Secondary spermatocyte (n) — Meiosis I.",
    "  3. Secondary spermatocyte → Spermatid (n) — Meiosis II.",
    "  4. Spermatid → Spermatozoon — Spermiogenesis.",
    "SPERM STRUCTURE: Head (acrosome + nucleus), Midpiece (mitochondria), Tail (flagellum).",
    "HORMONAL CONTROL: FSH (stimulates spermatogenesis), LH (stimulates testosterone from Leydig cells).",
    "TESTOSTERONE functions: Secondary sex characteristics, libido, anabolic effects.",
], "15 Marks")

story += q_and_a(3, "Describe the respiratory system. Explain the mechanism of respiration and transport of gases.", [
    "ORGANS: Nose → Pharynx → Larynx → Trachea → Bronchi → Bronchioles → Alveoli.",
    "MECHANISM OF BREATHING:",
    "  Inspiration: Diaphragm contracts (descends) + external intercostals contract → thoracic volume increases → air flows in.",
    "  Expiration: Passive process; diaphragm relaxes → thoracic volume decreases → air flows out.",
    "LUNG VOLUMES: Tidal volume (500 mL), IRV (3000 mL), ERV (1100 mL), Residual volume (1200 mL).",
    "Vital Capacity = TV + IRV + ERV = ~4600 mL.",
    "GAS EXCHANGE: At alveoli — O₂ diffuses into blood, CO₂ diffuses out (Dalton's law, Fick's law).",
    "O₂ TRANSPORT: 97% as oxyhaemoglobin (HbO₂), 3% dissolved in plasma.",
    "CO₂ TRANSPORT: 70% as bicarbonate (HCO₃⁻), 23% as carbaminohaemoglobin, 7% dissolved.",
    "RESPIRATORY CENTRE: Medullary rhythmicity centre in brainstem controls rate and depth.",
], "15 Marks")

story += section_header("SECTION B — Short Answer Questions (5 × 5 = 25 Marks)")
story += q_and_a(4, "Describe the structure and functions of the stomach.", [
    "Located in left hypochondriac and epigastric regions. Capacity: ~1 litre.",
    "Regions: Cardia, Fundus, Body, Pylorus.",
    "Layers: Mucosa, Submucosa, Muscularis (3 layers), Serosa.",
    "Gastric glands secrete: HCl (Chief cells — pepsinogen), Intrinsic factor (parietal cells), Mucus.",
    "Functions: Storage of food, churning (mechanical digestion), protein digestion (pepsin), absorption of alcohol and aspirin.",
], "5 Marks")
story += q_and_a(5, "Explain the endocrine functions of the pancreas.", [
    "Islets of Langerhans — endocrine part of pancreas (~1 million islets).",
    "Alpha cells (25%): Secrete glucagon → raises blood glucose (glycogenolysis).",
    "Beta cells (70%): Secrete insulin → lowers blood glucose (promotes glucose uptake).",
    "Delta cells: Secrete somatostatin → inhibits both insulin and glucagon.",
    "Clinical: Lack of insulin → Diabetes Mellitus. Types: Type 1 (autoimmune), Type 2 (insulin resistance).",
], "5 Marks")
story += q_and_a(6, "Write a note on blood groups and blood transfusion.", [
    "ABO SYSTEM: A, B, AB (universal recipient), O (universal donor).",
    "Rh SYSTEM: Rh +ve (has D antigen) or Rh -ve.",
    "CROSS MATCHING: Done before transfusion to prevent agglutination.",
    "TRANSFUSION REACTIONS: Fever, chills, haemolysis, hypotension if incompatible blood given.",
    "NURSING CARE: Verify blood group, monitor vitals, stop infusion immediately if reaction occurs.",
], "5 Marks")
story += q_and_a(7, "Describe the structure and function of the skin.", [
    "LAYERS: Epidermis (5 layers — stratum corneum to basale) and Dermis.",
    "Hypodermis/subcutaneous layer (adipose tissue) lies below.",
    "APPENDAGES: Hair follicles, Sweat glands (eccrine/apocrine), Sebaceous glands, Nails.",
    "FUNCTIONS: Protection, temperature regulation (sweating, vasodilation), Vitamin D synthesis, Sensation (touch, pain, temp).",
    "Melanocytes in stratum basale produce melanin (skin pigmentation, UV protection).",
], "5 Marks")
story += q_and_a(8, "Explain the chain of infection in communicable diseases.", [
    "Chain of Infection has 6 links:",
    "1. Infectious Agent (pathogen): Bacteria, virus, fungi.",
    "2. Reservoir: Human, animal, environment.",
    "3. Portal of Exit: Respiratory tract, GI tract, blood.",
    "4. Mode of Transmission: Direct contact, droplet, airborne, fomite, vector.",
    "5. Portal of Entry: Mucous membrane, skin, GI, respiratory.",
    "6. Susceptible Host: Immunocompromised, elderly, malnourished.",
    "Breaking any link PREVENTS infection — key principle of infection control.",
], "5 Marks")

story.append(PageBreak())

# ═══════════════════════════════════════════════════════════════════
# PAPER II - BEHAVIORAL SCIENCE 2017
# ═══════════════════════════════════════════════════════════════════
story += paper_header("Behavioral Science (Psychology & Sociology)", "II", "July 2017")
story += section_header("SECTION A — Long Answer Questions (3 × 15 = 45 Marks)")

story += q_and_a(1, "Define psychology. Explain the branches of psychology and discuss the methods used in psychology.", [
    "DEFINITION: Psychology is the scientific study of human behaviour and mental processes. (William James, 1890).",
    "BRANCHES OF PSYCHOLOGY:",
    "  1. Clinical Psychology: Diagnosis and treatment of mental disorders.",
    "  2. Educational Psychology: Learning and teaching processes.",
    "  3. Social Psychology: Influence of social factors on behaviour.",
    "  4. Industrial/Organizational Psychology: Behaviour in workplace.",
    "  5. Abnormal Psychology: Study of deviant behaviour.",
    "  6. Developmental Psychology: Growth across lifespan.",
    "  7. Health Psychology: Psychological factors in health and illness.",
    "METHODS OF PSYCHOLOGY:",
    "  - Introspection: Self-examination of own mental states.",
    "  - Observation: Naturalistic and controlled.",
    "  - Experimental method: Controlled study with IV and DV.",
    "  - Case Study: In-depth study of individual.",
    "  - Survey/Interview: Collecting data from large groups.",
    "  - Psychological tests: Standardized measurements (IQ, personality).",
], "15 Marks")

story += q_and_a(2, "Explain Maslow's hierarchy of needs. Discuss its application in nursing practice.", [
    "Abraham Maslow (1943) proposed a motivational theory with 5 hierarchical levels:",
    "LEVEL 1 — Physiological Needs: Oxygen, food, water, shelter, sleep, sex. (Most basic).",
    "LEVEL 2 — Safety Needs: Security, protection, freedom from fear, stability.",
    "LEVEL 3 — Love & Belonging Needs: Affection, friendship, social interaction.",
    "LEVEL 4 — Esteem Needs: Self-esteem, respect from others, achievement, recognition.",
    "LEVEL 5 — Self-Actualization: Fulfilling one's potential, creativity, morality.",
    "KEY PRINCIPLE: Lower needs must be satisfied before higher-level needs become motivating.",
    "APPLICATION IN NURSING:",
    "  - Assess physiological needs first (airway, breathing, circulation).",
    "  - Ensure patient safety (fall prevention, infection control).",
    "  - Address loneliness, social isolation in long-term care.",
    "  - Promote patient dignity and self-esteem.",
    "  - Support rehabilitation and self-care — self-actualization.",
    "  - Holistic nursing care is guided by these needs.",
], "15 Marks")

story += q_and_a(3, "Define personality. Discuss the factors affecting personality development and Freud's theory of personality.", [
    "PERSONALITY: The unique, consistent patterns of thoughts, feelings, and behaviours that distinguish individuals.",
    "FACTORS AFFECTING PERSONALITY:",
    "  1. Heredity/Genetic: Temperament, intelligence, physical traits.",
    "  2. Environment: Family, culture, socioeconomic status, peers.",
    "  3. Childhood experiences: Early trauma, attachment.",
    "  4. Education: Values, beliefs, cognitive development.",
    "FREUD'S PSYCHOANALYTIC THEORY:",
    "  LEVELS OF MIND: Conscious, Preconscious, Unconscious.",
    "  STRUCTURES OF PERSONALITY:",
    "    Id: Primitive, instinctual (pleasure principle). Present from birth.",
    "    Ego: Reality-based mediator (reality principle). Develops age 1-3.",
    "    Superego: Moral conscience (morality principle). Develops age 3-5.",
    "  PSYCHOSEXUAL STAGES: Oral (0-1yr), Anal (1-3yr), Phallic (3-6yr), Latency (6-12yr), Genital (12+yr).",
    "  DEFENCE MECHANISMS: Repression, denial, projection, rationalization, displacement, sublimation.",
], "15 Marks")

story += section_header("SECTION B — Short Answer Questions (5 × 5 = 25 Marks)")
story += q_and_a(4, "Explain the concept of emotion and its physiological basis.", [
    "EMOTION: Complex subjective experience involving physiological arousal, expressive behaviours, and conscious experience.",
    "James-Lange Theory: Physiological changes → emotion perception.",
    "Cannon-Bard Theory: Physiological changes and emotions occur simultaneously.",
    "PHYSIOLOGICAL BASIS: Amygdala (fear/emotion processing), Hypothalamus (autonomic response), Limbic system.",
    "AUTONOMIC RESPONSE: Sympathetic NS → increased HR, BP, pupil dilation, sweating (fight or flight).",
], "5 Marks")
story += q_and_a(5, "Define learning. Explain classical conditioning with an example.", [
    "LEARNING: A relatively permanent change in behaviour resulting from experience.",
    "CLASSICAL CONDITIONING (Ivan Pavlov):",
    "  UCS (food) → UCR (salivation). CS (bell) + UCS → CR (salivation to bell alone).",
    "PRINCIPLES: Acquisition, extinction, spontaneous recovery, generalization, discrimination.",
    "NURSING APPLICATION: Patient anxiety related to injections (stimulus-response); therapeutic desensitization.",
], "5 Marks")
story += q_and_a(6, "Define family. Classify types of family and explain its functions.", [
    "FAMILY: A social unit consisting of persons related by blood, marriage, or adoption, living together.",
    "TYPES: Nuclear family (parents + children), Joint/Extended family, Single-parent family, Blended family.",
    "FUNCTIONS:",
    "  1. Reproductive function: Procreation, continuation of species.",
    "  2. Socialization: Teaching norms, values, language.",
    "  3. Economic: Provision of food, shelter, finances.",
    "  4. Affectional: Love, emotional support, security.",
    "  5. Status assignment: Social position and identity.",
], "5 Marks")
story += q_and_a(7, "Explain the concept of culture and its impact on health.", [
    "CULTURE: Shared beliefs, values, customs, behaviours, and artefacts of a group.",
    "CHARACTERISTICS: Learned, shared, transmitted across generations, dynamic.",
    "IMPACT ON HEALTH:",
    "  - Health beliefs and practices vary (e.g., herbal remedies, faith healing).",
    "  - Dietary habits affect nutrition and disease risk.",
    "  - Attitudes toward hospitals, doctors, and medications.",
    "  - Cultural barriers to seeking care (stigma of mental illness).",
    "TRANSCULTURAL NURSING: Leininger's theory — providing culturally congruent care.",
], "5 Marks")
story += q_and_a(8, "Write a short note on social stratification.", [
    "SOCIAL STRATIFICATION: Hierarchical ranking of groups in society based on wealth, power, and prestige.",
    "SYSTEMS: Caste system (India), Class system, Slavery, Estate system.",
    "TYPES: Open (mobility possible) and Closed (caste/race based, no mobility).",
    "IMPACT ON HEALTH: Lower strata → poorer health outcomes, less access to healthcare.",
    "RELEVANCE IN NURSING: Understanding social determinants of health, equity in care.",
], "5 Marks")

story.append(PageBreak())

# ═══════════════════════════════════════════════════════════════════
# PAPER II - BEHAVIORAL SCIENCE 2019
# ═══════════════════════════════════════════════════════════════════
story += paper_header("Behavioral Science (Psychology & Sociology)", "II", "September 2019")
story += section_header("SECTION A — Long Answer Questions (3 × 15 = 45 Marks)")

story += q_and_a(1, "Define motivation. Explain the theories of motivation and discuss the role of motivation in nursing.", [
    "MOTIVATION: An internal state that activates, directs, and sustains behaviour toward a goal.",
    "THEORIES OF MOTIVATION:",
    "  1. Maslow's Hierarchy (1943): Physiological → Safety → Love → Esteem → Self-actualization.",
    "  2. Herzberg's Two-Factor Theory: Hygiene factors (prevent dissatisfaction) and Motivators (create satisfaction).",
    "  3. McClelland's Theory: Need for Achievement, Power, and Affiliation.",
    "  4. Drive Reduction Theory (Hull): Biological drives (hunger, thirst) motivate behaviour.",
    "  5. Incentive Theory: External rewards motivate behaviour.",
    "ROLE IN NURSING:",
    "  - Understanding patient motivation aids in health education and compliance.",
    "  - Self-motivated patients recover faster and adhere to treatment plans.",
    "  - Nurse motivation affects quality of patient care.",
    "  - Use positive reinforcement to motivate patients (e.g., weight loss programs).",
], "15 Marks")

story += q_and_a(2, "Define attitude. Explain the components of attitude, methods of attitude change, and its relation to health behaviour.", [
    "ATTITUDE: A learned predisposition to respond favourably or unfavourably toward a person, object, or situation.",
    "COMPONENTS (ABC Model):",
    "  1. Affective (Feeling): Emotional response (e.g., fear of hospitals).",
    "  2. Behavioural (Action): Tendency to behave in certain way (e.g., avoiding doctors).",
    "  3. Cognitive (Belief): Beliefs and knowledge (e.g., 'hospitals are dangerous').",
    "METHODS OF ATTITUDE CHANGE:",
    "  1. Persuasive communication: Credible source, clear message.",
    "  2. Cognitive dissonance: Creating inconsistency between beliefs and behaviour.",
    "  3. Role playing and experience.",
    "  4. Health education campaigns.",
    "RELATION TO HEALTH BEHAVIOUR:",
    "  - Positive attitude → better health practices (vaccination, exercise).",
    "  - Negative attitude → non-compliance, delayed treatment seeking.",
    "  - Nursing: Assess patient attitudes before health teaching.",
], "15 Marks")

story += q_and_a(3, "Define community. Explain the social problems in India and their impact on community health.", [
    "COMMUNITY: A group of people sharing common geographical area, interests, and social interactions.",
    "SOCIAL PROBLEMS IN INDIA:",
    "  1. Poverty: Low income → malnutrition, poor housing, inability to access healthcare.",
    "  2. Illiteracy: Low health literacy → delayed treatment, poor sanitation practices.",
    "  3. Population explosion: Overcrowding → spread of communicable diseases.",
    "  4. Child marriage: Early pregnancies → maternal and infant mortality.",
    "  5. Gender inequality: Women's health needs neglected.",
    "  6. Substance abuse: Alcohol, tobacco, drugs → liver disease, cancer, accidents.",
    "  7. Unemployment: Stress, malnutrition, mental health issues.",
    "  8. Caste discrimination: Denial of healthcare access.",
    "IMPACT ON HEALTH: Increased morbidity and mortality, poor maternal and child health, spread of infections.",
    "NURSING ROLE: Health education, community outreach, advocacy for social change.",
], "15 Marks")

story += section_header("SECTION B — Short Answer Questions (5 × 5 = 25 Marks)")
story += q_and_a(4, "Define perception. Explain the factors affecting perception.", [
    "PERCEPTION: The process of organizing and interpreting sensory information to give it meaning.",
    "FACTORS AFFECTING PERCEPTION:",
    "  1. Perceptual set (past experience, expectations).",
    "  2. Attention (selective focus).",
    "  3. Intensity and size of stimulus.",
    "  4. Emotional state (anxiety distorts perception).",
    "  5. Cultural background.",
    "ILLUSIONS: Misinterpretations of actual stimuli. Hallucinations: Perceptions without stimuli.",
], "5 Marks")
story += q_and_a(5, "Explain Erikson's stages of psychosocial development.", [
    "Erik Erikson described 8 stages, each with a psychosocial crisis:",
    "1. Trust vs. Mistrust (0-1 yr): Hope from consistent caregiving.",
    "2. Autonomy vs. Shame (1-3 yr): Self-control and will.",
    "3. Initiative vs. Guilt (3-6 yr): Purpose and direction.",
    "4. Industry vs. Inferiority (6-12 yr): Competence in skills.",
    "5. Identity vs. Role Confusion (12-18 yr): Sense of self.",
    "6. Intimacy vs. Isolation (Young adult): Love and commitment.",
    "7. Generativity vs. Stagnation (Middle adult): Contribution to society.",
    "8. Integrity vs. Despair (Old age): Wisdom and acceptance of life.",
], "5 Marks")
story += q_and_a(6, "Write a note on intelligence and IQ.", [
    "INTELLIGENCE: The global capacity to act purposefully, think rationally, and deal effectively with environment. (Wechsler)",
    "IQ = (Mental Age / Chronological Age) × 100 (Binet formula).",
    "CLASSIFICATION: >130 Gifted, 110-129 Superior, 90-109 Average, 70-89 Low Average, <70 Intellectual Disability.",
    "TYPES: Fluid intelligence (innate problem-solving), Crystallized (accumulated knowledge).",
    "TESTS: Stanford-Binet, Wechsler Adult Intelligence Scale (WAIS), Raven's Progressive Matrices.",
], "5 Marks")
story += q_and_a(7, "Explain socialization and its agents.", [
    "SOCIALIZATION: Process by which individuals learn norms, values, and behaviours appropriate to their culture.",
    "AGENTS OF SOCIALIZATION:",
    "  1. Family: Primary agent; shapes basic values and personality.",
    "  2. School: Formal education, peer interactions, authority.",
    "  3. Peer group: Influence during adolescence.",
    "  4. Mass media: Television, internet, social media.",
    "  5. Religion: Moral values and ethical guidelines.",
    "  6. Workplace: Professional norms and roles.",
], "5 Marks")
story += q_and_a(8, "Define stress. Explain Selye's General Adaptation Syndrome (GAS).", [
    "STRESS: Non-specific response of the body to any demand placed upon it. (Hans Selye, 1956)",
    "STRESSORS: Physical (injury), Psychological (anxiety), Social (conflict).",
    "GENERAL ADAPTATION SYNDROME (GAS) — 3 Stages:",
    "  1. ALARM REACTION: 'Fight or flight' — Adrenaline release, increased HR, BP, blood glucose.",
    "  2. RESISTANCE/ADAPTATION: Body adapts to stressor; cortisol released; immune suppression begins.",
    "  3. EXHAUSTION: If stressor persists → depletion of resources → disease or death.",
    "NURSING: Identify stressors, teach relaxation techniques, support coping mechanisms.",
], "5 Marks")

story.append(PageBreak())

# ═══════════════════════════════════════════════════════════════════
# PAPER III - NURSING FOUNDATION 2017
# ═══════════════════════════════════════════════════════════════════
story += paper_header("Nursing Foundation (Fundamentals of Nursing)", "III", "July 2017")
story += section_header("SECTION A — Long Answer Questions (3 × 15 = 45 Marks)")

story += q_and_a(1, "Explain the nursing process in detail. Discuss each step with its components and importance in patient care.", [
    "The Nursing Process is a systematic, problem-solving approach to patient care with 5 steps (ADPIE):",
    "STEP 1 — ASSESSMENT:",
    "  Collect subjective data (patient complaints) and objective data (vital signs, lab values).",
    "  Sources: Patient, family, medical records, other healthcare team members.",
    "STEP 2 — DIAGNOSIS (Nursing):",
    "  Identify actual and potential health problems.",
    "  Format: Problem + Related to (etiology) + As Evidenced by (signs/symptoms).",
    "  Example: Impaired skin integrity related to immobility as evidenced by pressure sore.",
    "STEP 3 — PLANNING:",
    "  Set SMART goals (Specific, Measurable, Achievable, Realistic, Time-bound).",
    "  Prioritize using Maslow's hierarchy. Write nursing care plan (NCP).",
    "STEP 4 — IMPLEMENTATION:",
    "  Carry out nursing interventions (independent, dependent, collaborative).",
    "  Document all care provided accurately.",
    "STEP 5 — EVALUATION:",
    "  Compare patient outcomes with goals set.",
    "  Modify care plan if goals not achieved.",
    "IMPORTANCE: Individualized care, continuity, accountability, professional documentation.",
], "15 Marks")

story += q_and_a(2, "Describe the procedure of urinary catheterization in a female patient. Include indications, contraindications, complications, and nursing care.", [
    "DEFINITION: Insertion of a sterile tube (catheter) into the urinary bladder through urethra.",
    "INDICATIONS: Urinary retention, monitoring output (ICU/post-op), incontinence management, pre-operative preparation, urine specimen collection.",
    "CONTRAINDICATIONS: Urethral trauma, active urethral infection.",
    "EQUIPMENT: Foley catheter (14-16 Fr for adults), sterile gloves, antiseptic, drainage bag, syringe with sterile water.",
    "PROCEDURE:",
    "  1. Explain procedure to patient; ensure privacy.",
    "  2. Position: Dorsal recumbent (female).",
    "  3. Perform hand hygiene; open sterile kit; wear sterile gloves.",
    "  4. Cleanse urethral meatus with antiseptic (front to back in female).",
    "  5. Lubricate catheter tip; insert 3-5 cm into urethra until urine flows.",
    "  6. Inflate balloon with 10 mL sterile water. Connect to drainage bag.",
    "  7. Secure catheter to inner thigh; keep bag below bladder level.",
    "COMPLICATIONS: UTI, urethral trauma, bladder spasm, encrustation.",
    "NURSING CARE: Maintain closed system, perineal hygiene, encourage fluids, monitor output, remove at earliest.",
], "15 Marks")

story += q_and_a(3, "Define asepsis. Explain the principles of surgical asepsis and describe the procedure of surgical hand scrub.", [
    "ASEPSIS: Absence of pathogenic microorganisms.",
    "TYPES: Medical asepsis (clean technique) and Surgical asepsis (sterile technique).",
    "PRINCIPLES OF SURGICAL ASEPSIS:",
    "  1. A sterile field is created and maintained during surgical procedures.",
    "  2. Only sterile items are placed in the sterile field.",
    "  3. Sterile persons touch only sterile items.",
    "  4. Non-sterile persons must not reach over the sterile field.",
    "  5. Sterile field is always kept in view.",
    "  6. Sterile edges of packages are considered unsterile (1-inch border rule).",
    "  7. If doubt exists about sterility — consider it contaminated.",
    "  8. Sterile field must be set up just before use.",
    "SURGICAL HAND SCRUB PROCEDURE:",
    "  1. Remove jewellery; wash hands with soap and water first.",
    "  2. Use surgical scrub brush with antiseptic (povidone-iodine or chlorhexidine).",
    "  3. Clean under fingernails with nail cleaner.",
    "  4. Scrub each surface of fingers, hands, wrists, and forearms for 3-5 minutes.",
    "  5. Keep hands above elbows throughout; rinse from fingertips downward.",
    "  6. Dry with sterile towel; don sterile gown and gloves.",
], "15 Marks")

story += section_header("SECTION B — Short Answer Questions (5 × 5 = 25 Marks)")
story += q_and_a(4, "Explain the procedure of assessing blood pressure (BP).", [
    "NORMAL BP: Systolic 100-140 mmHg / Diastolic 60-90 mmHg. Average: 120/80 mmHg.",
    "EQUIPMENT: Sphygmomanometer, stethoscope.",
    "PROCEDURE:",
    "  1. Patient seated/lying; rest 5 min; arm at heart level.",
    "  2. Apply cuff 2.5 cm above antecubital fossa (right arm).",
    "  3. Inflate to 30 mmHg above point where radial pulse disappears.",
    "  4. Place stethoscope at brachial artery; deflate at 2-3 mmHg/sec.",
    "  5. First sound heard = Systolic (Korotkoff sounds); last sound = Diastolic.",
    "  6. Record: 120/80 mmHg, record arm used.",
    "ERRORS: Incorrect cuff size, improper placement, talking during measurement.",
], "5 Marks")
story += q_and_a(5, "Describe the procedure of nasogastric (NG) tube insertion.", [
    "PURPOSE: Enteral feeding, gastric lavage, medication administration, gastric decompression.",
    "EQUIPMENT: NG tube (Ryle's tube), lubricant, syringe, cup of water, tape.",
    "PROCEDURE:",
    "  1. Explain procedure; position patient: high Fowler's (60-90°).",
    "  2. Measure tube length: Nose to earlobe to xiphoid process.",
    "  3. Lubricate tip; insert through nostril, advance through nasopharynx.",
    "  4. Ask patient to swallow (sip water) as tube passes pharynx.",
    "  5. Advance to measured mark; secure with tape.",
    "CONFIRM PLACEMENT: Aspirate gastric content (check pH <5.5), X-ray (gold standard).",
    "COMPLICATIONS: Aspiration pneumonia, epistaxis, tube displacement.",
], "5 Marks")
story += q_and_a(6, "Write a note on bed making — occupied bed.", [
    "OCCUPIED BED: Made when patient is confined to bed and cannot be moved.",
    "PURPOSE: Comfort, cleanliness, prevention of pressure injuries.",
    "PROCEDURE:",
    "  1. Explain procedure; raise bed to working height.",
    "  2. Turn patient to far side of bed; loosen linens on near side.",
    "  3. Fan-fold soiled linen toward patient; place clean linen on near side.",
    "  4. Turn patient over linen to other side; remove soiled linen; pull through clean linen.",
    "  5. Make mitre corners; ensure no wrinkles (prevent pressure areas).",
    "  6. Replace pillow, call bell, and lower bed.",
    "POINTS: Use gloves; keep soiled linen away from uniform; dispose in laundry bag.",
], "5 Marks")
story += q_and_a(7, "Explain the routes of drug administration.", [
    "ORAL: Tablet, capsule, liquid — most common, safe. First-pass metabolism applies.",
    "SUBLINGUAL: Under tongue (e.g., GTN) — rapid absorption, bypasses liver.",
    "PARENTERAL: Injections — IV (fastest), IM (e.g., vaccines), SC (e.g., insulin), ID (tuberculin test).",
    "TOPICAL: Cream, ointment, patch (e.g., transdermal).",
    "INHALATION: Bronchodilators (MDI/nebulizer) — direct lung action.",
    "RECTAL: Suppository — used when oral route unavailable.",
    "NURSING: 10 Rights of medication administration — Right drug, dose, route, time, patient, documentation, reason, response, form, education.",
], "5 Marks")
story += q_and_a(8, "Explain the principles of first aid.", [
    "FIRST AID: Immediate, temporary care given to an injured/ill person before professional help arrives.",
    "AIMS: Preserve life, prevent deterioration, promote recovery.",
    "PRINCIPLES (DR. ABC):",
    "  D — Danger: Ensure safety of rescuer and victim.",
    "  R — Response: Check consciousness (AVPU scale).",
    "  A — Airway: Open and clear airway (head-tilt chin-lift).",
    "  B — Breathing: Check for breathing; give rescue breaths if absent.",
    "  C — Circulation: Check pulse; begin CPR (30:2 ratio) if no pulse.",
    "Additional: Control bleeding (direct pressure), immobilize fractures, reassure patient, do not give food/water if surgery likely.",
], "5 Marks")

story.append(PageBreak())

# ═══════════════════════════════════════════════════════════════════
# PAPER III - NURSING FOUNDATION 2019
# ═══════════════════════════════════════════════════════════════════
story += paper_header("Nursing Foundation (Fundamentals of Nursing)", "III", "September 2019")
story += section_header("SECTION A — Long Answer Questions (3 × 15 = 45 Marks)")

story += q_and_a(1, "Discuss Florence Nightingale's environmental theory and her contributions to nursing.", [
    "Florence Nightingale (1820-1910) — 'Lady with the Lamp'; founder of modern nursing.",
    "ENVIRONMENTAL THEORY: Health is maintained by manipulating the environment.",
    "13 CANONS (key environmental factors):",
    "  1. Ventilation and warming — fresh air is essential.",
    "  2. Light — especially sunlight, vital for healing.",
    "  3. Noise — unnecessary noise is harmful to sick.",
    "  4. Cleanliness of rooms and walls.",
    "  5. Cleanliness of the patient.",
    "  6. Bed and bedding — clean, dry, not too high.",
    "  7. Variety — changing appearance of patient's room.",
    "  8. Personal cleanliness of nurses.",
    "  9. Nutrition and taking food.",
    "  10. Chattering hopes and advices — avoid false hope.",
    "  11. Observation of the sick.",
    "  12. Social considerations.",
    "  13. Petty management (continuity of care).",
    "CONTRIBUTIONS:",
    "  - Established first nursing school (St. Thomas Hospital, London, 1860).",
    "  - Reduced mortality in Crimean War from 42% to 2% through sanitation.",
    "  - Introduced statistical analysis in healthcare (polar area diagram).",
    "  - Authored 'Notes on Nursing' (1860) — foundation of nursing education.",
], "15 Marks")

story += q_and_a(2, "Explain wound healing. Describe the types of wounds and principles of wound dressing.", [
    "WOUND: Break in the continuity of skin/tissue.",
    "TYPES OF WOUNDS:",
    "  - Incised: Clean cut (surgical). Contused: Blunt trauma. Lacerated: Torn. Puncture: Narrow deep.",
    "  - Open vs. Closed. Acute vs. Chronic (pressure ulcer, diabetic foot).",
    "WOUND HEALING PHASES:",
    "  1. Haemostasis (0-3 hrs): Vasoconstriction, platelet plug, clot formation.",
    "  2. Inflammatory (1-4 days): Redness, heat, swelling, pain. WBCs clean debris.",
    "  3. Proliferative (4-21 days): Fibroblasts produce collagen; granulation tissue; epithelialization.",
    "  4. Remodelling/Maturation (21 days – 2 yrs): Collagen remodelling; scar formation.",
    "TYPES OF HEALING: Primary intention (sutured), Secondary intention (open, heals by granulation), Tertiary (delayed closure).",
    "PRINCIPLES OF WOUND DRESSING:",
    "  1. Use sterile technique; prevent cross-infection.",
    "  2. Clean wound from centre outward (clean to dirty).",
    "  3. Keep wound moist for faster healing.",
    "  4. Choose appropriate dressing (gauze, hydrocolloid, foam).",
    "  5. Assess wound at each dressing change (size, colour, exudate, odour).",
    "  6. Secure dressing firmly without restricting circulation.",
], "15 Marks")

story += q_and_a(3, "Define vital signs. Explain the normal values and procedure for assessing temperature, pulse, respiration, and BP.", [
    "VITAL SIGNS: Basic physiological measurements indicating patient's health status. Also called 'cardinal signs'.",
    "1. TEMPERATURE:",
    "  Normal: 36.5-37.5°C (oral), 37-38°C (rectal), 36-37°C (axillary).",
    "  Sites: Oral (most common), Axillary (safest — children), Rectal (most accurate), Tympanic.",
    "  Procedure: Oral — clean thermometer, place under tongue, 3 min, read.",
    "2. PULSE:",
    "  Normal: 60-100 beats/min (adults). Children: higher rates.",
    "  Sites: Radial (routine), Apical (infants), Carotid (cardiac arrest).",
    "  Procedure: 2 fingers on radial artery; count for 60 sec (or 30 sec × 2 if regular).",
    "  Note: Rate, rhythm, volume (amplitude), tension.",
    "3. RESPIRATION:",
    "  Normal: 12-20 breaths/min (adults).",
    "  Count without patient awareness (they may alter breathing); observe chest rise.",
    "  Note: Rate, rhythm (regular/irregular), depth, character (any sounds).",
    "4. BLOOD PRESSURE:",
    "  Normal: 120/80 mmHg. Hypertension: >140/90. Hypotension: <90/60.",
    "  Procedure: See Paper III 2017 Q4 above.",
    "5. SpO₂ (Oxygen Saturation — added 5th vital sign):",
    "  Normal: 95-100%. Measured by pulse oximeter.",
], "15 Marks")

story += section_header("SECTION B — Short Answer Questions (5 × 5 = 25 Marks)")
story += q_and_a(4, "Explain the procedure of giving a bed bath to a patient.", [
    "PURPOSE: Cleanliness, comfort, skin assessment, improve circulation, promote relaxation.",
    "PROCEDURE:",
    "  1. Explain; provide privacy; ensure warm room temperature.",
    "  2. Offer bedpan/urinal before bath; change bed linen first if needed.",
    "  3. Use clean water (43-46°C), soap, washcloths (separate for face/body/perineum).",
    "  4. Wash: Face → neck → arms → chest → abdomen → legs → back → perineum (last).",
    "  5. Rinse and dry each area thoroughly (prevent maceration).",
    "  6. Apply lotion to dry skin; change gown and bed linen.",
    "  7. Reposition comfortably; ensure call bell within reach.",
    "ASSESS SKIN during bath: Pressure areas, redness, rashes, edema.",
], "5 Marks")
story += q_and_a(5, "Define sterilization. Explain the methods of sterilization.", [
    "STERILIZATION: Complete destruction of ALL microorganisms including spores.",
    "DISINFECTION: Kills most pathogens but NOT spores.",
    "PHYSICAL METHODS:",
    "  - Autoclaving: 121°C, 15 psi, 15-20 min (gold standard for surgical instruments).",
    "  - Dry Heat Oven: 160-170°C for 1 hour (glassware, oils, powders).",
    "  - Boiling: 100°C for 20 min (kills vegetative organisms, NOT spores).",
    "  - Radiation: UV (surface), Gamma rays (disposable items).",
    "  - Filtration: For heat-sensitive liquids.",
    "CHEMICAL METHODS:",
    "  - Glutaraldehyde 2%: Endoscopes (cold sterilization).",
    "  - Ethylene Oxide gas: Heat-sensitive items (ventilator circuits).",
    "  - Formaldehyde: Fumigation of rooms.",
    "  - Chlorine compounds, Alcohol (70%): Disinfection.",
], "5 Marks")
story += q_and_a(6, "Write a note on oxygen therapy in nursing.", [
    "INDICATION: Hypoxia (SpO₂ <94%), respiratory distress, post-operative care, cardiac conditions.",
    "METHODS OF DELIVERY:",
    "  - Nasal cannula: 1-6 L/min (24-44% FiO₂). Most comfortable.",
    "  - Simple face mask: 6-10 L/min (40-60% FiO₂).",
    "  - Venturi mask: Precise FiO₂ (24%, 28%, 35%, 40%, 60%). Best for COPD.",
    "  - Non-rebreather mask: 10-15 L/min (~60-80% FiO₂). Emergency use.",
    "NURSING CARE:",
    "  1. Assess need; obtain order (except emergency).",
    "  2. Check flow rate; ensure humidification for >4 L/min.",
    "  3. Skin care around nose and ears (prevent pressure).",
    "  4. Monitor SpO₂, respiratory rate, level of consciousness.",
    "  5. Fire precautions — no smoking or open flames near O₂.",
], "5 Marks")
story += q_and_a(7, "Explain the principles and types of isolation precautions.", [
    "ISOLATION: Separating infected/susceptible patients to prevent cross-infection.",
    "STANDARD PRECAUTIONS (Universal): Apply to ALL patients always.",
    "  - Hand hygiene (WHO 5 moments), Gloves, Gown, Mask, Eye protection as needed.",
    "  - Safe sharps disposal, respiratory hygiene.",
    "TRANSMISSION-BASED PRECAUTIONS:",
    "  1. CONTACT: MRSA, C. diff, wound infections → Gloves + gown; dedicate equipment.",
    "  2. DROPLET: Influenza, meningitis, pertussis → Surgical mask; single room.",
    "  3. AIRBORNE: TB, measles, chickenpox → N95 respirator; negative pressure room.",
    "PROTECTIVE/REVERSE ISOLATION: For immunocompromised patients (neutropenia); protect patient from environment.",
], "5 Marks")
story += q_and_a(8, "Discuss the ethical principles in nursing practice.", [
    "BIOETHICAL PRINCIPLES (Beauchamp & Childress):",
    "  1. AUTONOMY: Respect patient's right to make informed decisions.",
    "     Application: Informed consent, patient education.",
    "  2. BENEFICENCE: Do good — act in patient's best interest.",
    "     Application: Pain management, therapeutic nursing care.",
    "  3. NON-MALEFICENCE: Do no harm — avoid causing harm.",
    "     Application: Safe medication practice, fall prevention.",
    "  4. JUSTICE: Treat all patients fairly and equitably.",
    "     Application: Distribute resources fairly; no discrimination.",
    "  5. VERACITY: Truthfulness — honest communication.",
    "  6. FIDELITY: Keep promises; maintain trust.",
    "  7. CONFIDENTIALITY: Protect patient information (except legal obligations).",
    "CODE OF ETHICS: Indian Nursing Council Code provides guidelines for professional conduct.",
], "5 Marks")

story.append(PageBreak())

# ═══════════════════════════════════════════════════════════════════
# PAPER IV - CHN-1 2017
# ═══════════════════════════════════════════════════════════════════
story += paper_header("Community Health Nursing - I (CHN-1)", "IV", "August 2017")
story += section_header("SECTION A — Long Answer Questions (3 × 15 = 45 Marks)")

story += q_and_a(1, "Define Primary Health Care (PHC). Explain the principles, components, and functions of PHC with special reference to India.", [
    "PRIMARY HEALTH CARE: Essential health care made universally accessible to all individuals and families. (Alma-Ata Declaration, WHO, 1978).",
    "GOAL: 'Health for All by 2000 AD'.",
    "PRINCIPLES (8 principles):",
    "  1. Equitable distribution — reaching underserved populations.",
    "  2. Community participation — people's involvement in planning and implementation.",
    "  3. Intersectoral coordination — collaboration between health, agriculture, education, water sectors.",
    "  4. Appropriate technology — locally applicable, affordable methods.",
    "  5. Focus on preventive and promotive care.",
    "8 ESSENTIAL COMPONENTS of PHC (Alma-Ata):",
    "  1. Education on health problems and methods of prevention.",
    "  2. Nutrition and food supply.",
    "  3. Safe water and basic sanitation.",
    "  4. MCH care and family planning.",
    "  5. Immunization against major infectious diseases.",
    "  6. Prevention and control of locally endemic diseases.",
    "  7. Treatment of common diseases and injuries.",
    "  8. Provision of essential drugs.",
    "PHC IN INDIA: Subcentre (5000 pop.) → PHC (30,000 pop.) → Community Health Centre (CHC, 100,000 pop.).",
    "ROLE OF NURSE: Health education, immunization, ante-natal care, home visits, school health.",
], "15 Marks")

story += q_and_a(2, "Explain the National Immunization Programme in India. Describe the cold chain system.", [
    "UNIVERSAL IMMUNIZATION PROGRAMME (UIP): Launched 1985, now Mission Indradhanush.",
    "TARGET: Children <2 years and pregnant women.",
    "VACCINES UNDER UIP:",
    "  - BCG: At birth; against tuberculosis.",
    "  - OPV (Oral Polio Vaccine): 0, 6, 10, 14 weeks + boosters.",
    "  - Hepatitis B: 0, 6, 10, 14 weeks.",
    "  - DPT (Diphtheria, Pertussis, Tetanus): 6, 10, 14 weeks + booster at 16-24 months.",
    "  - Hib (Haemophilus influenzae b): 6, 10, 14 weeks.",
    "  - Measles/MR: 9-12 months, 16-24 months.",
    "  - JE vaccine: In endemic districts.",
    "  - TT/Td: Pregnant women (TT1 early pregnancy, TT2 after 4 weeks).",
    "COLD CHAIN: System to maintain vaccines at correct temperature (2-8°C) from manufacturer to recipient.",
    "COLD CHAIN EQUIPMENT:",
    "  - Walk-in coolers (national/state): -15 to -25°C for OPV.",
    "  - Ice-lined refrigerators (ILR): 2-8°C at district level.",
    "  - Vaccine carriers and ice packs: For outreach sessions.",
    "VACCINE VIAL MONITOR (VVM): Heat-sensitive indicator on each vial.",
    "SHAKE TEST: For DPT, Hep B, DT, TT — discard if frozen.",
], "15 Marks")

story += q_and_a(3, "Define epidemiology. Explain the epidemiological triad and discuss the epidemiology of tuberculosis in India.", [
    "EPIDEMIOLOGY: Study of distribution and determinants of disease in populations and application to control of health problems. (Last, 1988)",
    "EPIDEMIOLOGICAL TRIAD (Ecological Triad):",
    "  - HOST: Person who harbours the disease (age, sex, immunity, nutrition).",
    "  - AGENT: Causative factor (biological, chemical, physical, nutritional).",
    "  - ENVIRONMENT: External factors (physical, biological, social).",
    "Disease occurs when there is imbalance between these three.",
    "TUBERCULOSIS (TB) IN INDIA:",
    "  - AGENT: Mycobacterium tuberculosis (acid-fast bacillus).",
    "  - HOST FACTORS: Malnutrition, immunocompromised (HIV), overcrowding, poverty.",
    "  - ENVIRONMENT: Poor ventilation, slums, high-density areas.",
    "  - TRANSMISSION: Airborne droplet nuclei (coughing, sneezing).",
    "  - INCUBATION: 4-8 weeks.",
    "  - BURDEN: India has ~26% of global TB burden (WHO 2023).",
    "  - NATIONAL TB ELIMINATION PROGRAMME (NTEP): Formerly RNTCP. Target: Eliminate TB by 2025.",
    "  - TREATMENT: DOTS (Directly Observed Treatment, Short-course). Category I: 2HRZE/4HR.",
    "  - DIAGNOSIS: Sputum smear, GeneXpert, X-ray.",
    "  - PREVENTION: BCG vaccination, improved nutrition, ventilation, contact tracing.",
], "15 Marks")

story += section_header("SECTION B — Short Answer Questions (5 × 5 = 25 Marks)")
story += q_and_a(4, "Define health education. Explain its principles and methods.", [
    "HEALTH EDUCATION: Process of informing, motivating, and helping people to adopt and maintain healthy practices. (WHO)",
    "PRINCIPLES:",
    "  1. Credibility: Based on facts; from trusted source.",
    "  2. Interest: Relevant to learner's needs.",
    "  3. Participation: Active involvement of learner.",
    "  4. Comprehension: Simple, clear, local language.",
    "  5. Reinforcement: Repeat key messages.",
    "  6. Motivation: Encourage behaviour change.",
    "METHODS:",
    "  Individual: Counselling, bedside teaching, home visits.",
    "  Group: Lectures, demonstrations, group discussions, role play.",
    "  Mass: Radio, TV, posters, pamphlets, social media.",
], "5 Marks")
story += q_and_a(5, "Describe the role of Anganwadi Worker (AWW) in maternal and child health.", [
    "ANGANWADI WORKER: Village-level functionary under ICDS (Integrated Child Development Services) scheme.",
    "SERVICES PROVIDED:",
    "  1. Supplementary nutrition for children <6 yrs and pregnant/lactating mothers.",
    "  2. Immunization (coordinates with ANM).",
    "  3. Health check-up (referral to health centre).",
    "  4. Pre-school non-formal education (3-6 yrs).",
    "  5. Nutrition and health education for mothers.",
    "  6. Referral services for sick children and high-risk pregnancies.",
    "CATCHMENT AREA: 1 AWW per 1000 population.",
    "SIGNIFICANCE: First point of contact for maternal and child health in rural areas.",
], "5 Marks")
story += q_and_a(6, "Explain the sources and effects of water pollution.", [
    "WATER POLLUTION: Contamination of water bodies making it harmful to use.",
    "SOURCES:",
    "  Industrial: Toxic chemicals, heavy metals (mercury, lead), industrial effluents.",
    "  Domestic: Sewage, detergents, faecal matter.",
    "  Agricultural: Fertilizers (nitrates), pesticides, herbicides.",
    "  Natural: Arsenic (groundwater, Bangladesh, India), fluoride.",
    "HEALTH EFFECTS:",
    "  Biological: Cholera, typhoid, hepatitis A, dysentery, polio.",
    "  Chemical: Fluorosis (fluoride), arsenicosis, minamata disease (mercury), blue baby syndrome (nitrates).",
    "  Physical: Turbidity, colour, odour impair water quality.",
    "PREVENTION: Water treatment (chlorination), proper sewage disposal, regular water quality testing.",
], "5 Marks")
story += q_and_a(7, "Write a note on the Reproductive and Child Health Programme (RCH).", [
    "RCH Programme: Launched in India in 1997; replaced earlier MCH programme.",
    "NOW UNDER: National Health Mission (NHM) → Reproductive, Maternal, Newborn, Child, and Adolescent Health (RMNCH+A).",
    "OBJECTIVES: Reduce MMR, IMR, TFR; improve reproductive health.",
    "KEY COMPONENTS:",
    "  1. Antenatal Care (ANC): 4 ANC visits minimum; TT immunization, IFA tablets, BP and weight check.",
    "  2. Safe delivery: Institutional delivery under JSY (Janani Suraksha Yojana).",
    "  3. Postnatal care (PNC): 3 PNC visits; breastfeeding support.",
    "  4. Family Planning: Spacing and limiting methods.",
    "  5. Child health: Immunization, IMNCI, newborn care.",
    "  6. Adolescent health: RKSK (Rashtriya Kishor Swasthya Karyakram).",
], "5 Marks")
story += q_and_a(8, "Explain the concept of health and its determinants.", [
    "HEALTH DEFINITION (WHO, 1948): 'A state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity.'",
    "DIMENSIONS OF HEALTH: Physical, Mental, Social, Spiritual, Emotional, Occupational.",
    "DETERMINANTS OF HEALTH:",
    "  1. Biological factors: Age, sex, genetics, immunity.",
    "  2. Behavioural: Diet, exercise, smoking, substance use.",
    "  3. Social/economic: Education, income, employment, social support.",
    "  4. Environmental: Water, air, housing, sanitation.",
    "  5. Healthcare services: Availability, accessibility, quality.",
    "  6. Lifestyle: Work-life balance, stress management.",
    "SOCIAL DETERMINANTS OF HEALTH (WHO): Conditions in which people are born, grow, live, work, and age.",
], "5 Marks")

story.append(PageBreak())

# ═══════════════════════════════════════════════════════════════════
# PAPER IV - CHN-1 2019
# ═══════════════════════════════════════════════════════════════════
story += paper_header("Community Health Nursing - I (CHN-1)", "IV", "September 2019")
story += section_header("SECTION A — Long Answer Questions (3 × 15 = 45 Marks)")

story += q_and_a(1, "Describe the role and functions of a community health nurse. Explain home visiting — its purpose, principles, and procedure.", [
    "COMMUNITY HEALTH NURSE (CHN): A registered nurse working in community settings to promote health and prevent disease.",
    "ROLES OF CHN:",
    "  1. Care provider: Direct nursing care to individuals and families at home.",
    "  2. Educator: Health teaching to individuals, families, and groups.",
    "  3. Counsellor: Guidance on health problems, family planning.",
    "  4. Advocate: Speaks for patient's rights and needs.",
    "  5. Case manager: Coordinates care from multiple providers.",
    "  6. Researcher: Collects data, identifies health problems.",
    "  7. Collaborator: Works with team — doctor, AWW, ASHA.",
    "  8. Supervisor: Supervises ANM and village health workers.",
    "HOME VISITING — PURPOSE:",
    "  - Assess family health status in natural environment.",
    "  - Provide care where people actually live.",
    "  - Identify hidden health problems and social determinants.",
    "PRINCIPLES OF HOME VISITING:",
    "  1. Plan visit in advance; prioritize high-risk families.",
    "  2. Make appointment; be punctual and professional.",
    "  3. Respect family privacy and cultural practices.",
    "  4. Focus on family strengths.",
    "  5. Maintain confidentiality.",
    "PROCEDURE: Pre-visit preparation → Introduction → Assessment → Nursing care → Health education → Recording → Follow-up plan.",
], "15 Marks")

story += q_and_a(2, "Define maternal mortality. Explain the causes and prevention of maternal mortality in India.", [
    "MATERNAL MORTALITY: Death of a woman during pregnancy or within 42 days of termination of pregnancy, from causes related to or aggravated by pregnancy. (WHO)",
    "MMR IN INDIA: Declined from 254 (2004-06) to 97 per 100,000 live births (2018-20). Target: <70 by 2030.",
    "CAUSES OF MATERNAL MORTALITY (3 delays model):",
    "DIRECT OBSTETRIC CAUSES (80%):",
    "  - Haemorrhage (PPH): Most common cause (~27%).",
    "  - Sepsis/Infection: Post-delivery sepsis.",
    "  - Hypertensive disorders: Pre-eclampsia, eclampsia.",
    "  - Obstructed labour.",
    "  - Unsafe abortion.",
    "INDIRECT CAUSES (20%): Anaemia, malaria, heart disease, HIV.",
    "THREE DELAYS:",
    "  1. Delay in deciding to seek care (lack of awareness).",
    "  2. Delay in reaching facility (transport, distance).",
    "  3. Delay in receiving care (inadequate facility/staff).",
    "PREVENTION & GOVERNMENT PROGRAMMES:",
    "  - JSY (Janani Suraksha Yojana): Cash incentive for institutional delivery.",
    "  - JSSK (Janani Shishu Suraksha Karyakram): Free maternity services.",
    "  - PMSMA (Pradhan Mantri Suraksha Matritva Abhiyan): Free ANC on 9th of every month.",
    "  - Skilled Birth Attendance at every delivery.",
    "  - Blood banks and EmOC at CHCs and District Hospitals.",
    "  - Iron folic acid supplementation, treatment of anaemia.",
], "15 Marks")

story += q_and_a(3, "Define family planning. Describe the various methods of contraception with their advantages and disadvantages.", [
    "FAMILY PLANNING: Voluntary planning and spacing of pregnancies to promote health and well-being.",
    "NATIONAL FAMILY PLANNING PROGRAMME: Launched 1952 (India — first in world).",
    "TEMPORARY METHODS:",
    "  1. ORAL CONTRACEPTIVE PILLS (OCP):",
    "     - Combined pill (oestrogen + progesterone): 99% effective.",
    "     - Advantages: Regular cycles, reduced dysmenorrhoea.",
    "     - Disadvantages: DVT risk, hypertension, no STI protection, daily compliance needed.",
    "  2. CONDOM (Male): 85-98% effective. Protects against STIs/HIV. Single use.",
    "  3. IUCD (Copper-T/Multiload): 99% effective. Lasts 5-10 years. Suitable for spacing.",
    "     Disadvantages: Increased bleeding, expulsion risk, no STI protection.",
    "  4. INJECTABLE (DMPA/Depo-Provera): 3-monthly injection. 99% effective.",
    "  5. IMPLANTS (Implanon): Sub-dermal; 3-5 years; highly effective.",
    "  6. NATURAL METHODS: Calendar (rhythm) method, basal body temperature, LAM.",
    "PERMANENT METHODS:",
    "  1. TUBECTOMY (Female sterilization): Laparoscopic; cut/tie/clip fallopian tubes.",
    "  2. VASECTOMY (Male sterilization): Cut/tie vas deferens. Simple OPD procedure.",
    "EMERGENCY CONTRACEPTION:",
    "  - Levonorgestrel (i-pill): Within 72 hours of unprotected intercourse.",
    "  - Ulipristal acetate: Within 120 hours.",
    "  - Copper-T IUCD: Within 5 days (most effective EC).",
], "15 Marks")

story += section_header("SECTION B — Short Answer Questions (5 × 5 = 25 Marks)")
story += q_and_a(4, "Explain the concept of communicable disease control.", [
    "COMMUNICABLE DISEASE: Illness caused by an infectious agent transmitted from an infected person, animal, or environment.",
    "CONTROL MEASURES — target all links of chain of infection:",
    "  1. Eliminate the source: Isolation, treatment of cases, disinfection.",
    "  2. Interrupt transmission: Hand hygiene, safe water, vector control, safe sex.",
    "  3. Protect the host: Immunization, chemoprophylaxis, health education.",
    "SURVEILLANCE: Systematic collection and analysis of disease data (IDSP in India).",
    "OUTBREAK INVESTIGATION: Case definition, case finding, attack rate, source identification, control measures.",
], "5 Marks")
story += q_and_a(5, "Write a note on the ASHA worker — role and functions.", [
    "ASHA: Accredited Social Health Activist. Introduced under National Rural Health Mission (NRHM) 2005.",
    "SELECTION: Female resident of village; at least 8th grade education; age 25-45 yrs.",
    "RATIO: 1 ASHA per 1000 population (habitation level).",
    "FUNCTIONS:",
    "  1. Mobilize community for immunization, ANC, institutional delivery.",
    "  2. Accompany pregnant women to health facility (JSY).",
    "  3. Provide basic medication from drug kit (ORS, IFA tablets, OCP, condoms).",
    "  4. Promote sanitation and hygiene.",
    "  5. Report births, deaths, and disease outbreaks.",
    "  6. Facilitate VHSNC (Village Health, Sanitation and Nutrition Committee).",
    "INCENTIVE-BASED: Performance-linked payments (not salary-based).",
], "5 Marks")
story += q_and_a(6, "Describe antenatal care (ANC) and its components.", [
    "ANTENATAL CARE: Systematic supervision of women during pregnancy to ensure best possible outcome.",
    "ANC VISITS: Minimum 4 visits (WHO recommends 8 contacts now).",
    "  1st visit: Before 12 weeks — registration, history, blood tests, weight, height.",
    "  2nd visit: 14-26 weeks — foetal growth, review lab results.",
    "  3rd visit: 28-34 weeks — presentation, position, anaemia check.",
    "  4th visit: 36 weeks onwards — presentation, pelvic assessment, birth planning.",
    "COMPONENTS (3T's + BEND):",
    "  - TT immunization (2 doses).",
    "  - IFA tablets (100 tablets, 180 days).",
    "  - Tetanus + Iron + Health education + Birth preparedness.",
    "INVESTIGATIONS: Hb, Blood group + Rh, VDRL, HIV, urine protein/sugar, USG.",
    "HIGH-RISK IDENTIFICATION: Age <18/>35, anaemia, previous bad obstetric history, twins, malpresentation.",
], "5 Marks")
story += q_and_a(7, "Explain the National Health Mission (NHM) — objectives and key programmes.", [
    "NHM: Launched 2013, integrates NRHM (2005) and NUHM (2013).",
    "OBJECTIVES: Reduce MMR, IMR, TFR; strengthen health system; universal access to quality care.",
    "KEY PROGRAMMES UNDER NHM:",
    "  1. RMNCH+A: Reproductive, Maternal, Newborn, Child, Adolescent Health.",
    "  2. Mission Indradhanush: Full immunization coverage.",
    "  3. Poshan Abhiyaan: Nutrition improvement.",
    "  4. RBSK (Rashtriya Bal Swasthya Karyakram): Child health screening.",
    "  5. Nikshay Poshan Yojana: TB patients' nutritional support.",
    "  6. PM-JAY (Ayushman Bharat): Health insurance for poor families.",
    "INDICATORS: MMR target <100; IMR target <25; U5MR target <32 per 1000 live births.",
], "5 Marks")
story += q_and_a(8, "Write short notes on environmental sanitation.", [
    "SANITATION: Promotion of hygiene and prevention of disease through management of waste products.",
    "SAFE WATER SUPPLY: Chlorination (0.5 ppm residual), boiling, filtration.",
    "EXCRETA DISPOSAL: Sanitary latrine (septic tank, pour flush, pit latrine). Open defecation-free under SBM.",
    "SOLID WASTE: Segregation (wet/dry), collection, disposal (landfill, composting, incineration).",
    "SWACHH BHARAT MISSION (SBM): Launched 2014. Target: ODF India. Built >100 million toilets.",
    "SEWAGE TREATMENT: Primary (settling), Secondary (biological), Tertiary (chemical treatment).",
    "VECTOR CONTROL: Mosquito nets, larvicides, insecticides, elimination of breeding sites (dengue, malaria).",
    "HOUSING: Adequate ventilation, lighting, space, safe water — key to community health.",
], "5 Marks")

story.append(PageBreak())

# ─── BACK COVER ─────────────────────────────────────────────────
story.append(Spacer(1, 2*cm))
story.append(HRFlowable(width="100%", thickness=2, color=colors.HexColor('#1a237e'), spaceAfter=20))
story.append(Paragraph("GNM 1st Year Board Papers — 2017 &amp; 2019", ParagraphStyle('BC',
    fontSize=14, textColor=colors.HexColor('#1a237e'),
    alignment=TA_CENTER, fontName='Helvetica-Bold', spaceAfter=6)))
story.append(Paragraph("All 4 Subjects | Questions + Detailed Answers", ParagraphStyle('BC2',
    fontSize=11, textColor=colors.HexColor('#37474f'),
    alignment=TA_CENTER, fontName='Helvetica', spaceAfter=8)))

footer_data = [
    ["Subjects", "Bio-Science | Behavioral Science | Nursing Foundation | CHN-1"],
    ["Years", "July 2017 &amp; September 2019"],
    ["Pattern", "Section A (Long Answer) + Section B (Short Answer) + MCQ"],
    ["Marks", "Full Marks: 75 | Time: 3 Hours per paper"],
    ["Total Papers", "8 Question Papers (4 subjects × 2 years)"],
]
ft = Table([[Paragraph(f"<b>{r[0]}</b>", ParagraphStyle('FTL', fontSize=10, fontName='Helvetica-Bold',
    textColor=colors.HexColor('#1a237e'))),
    Paragraph(r[1], ParagraphStyle('FTR', fontSize=10, fontName='Helvetica',
    textColor=colors.HexColor('#263238')))] for r in footer_data],
    colWidths=[4*cm, 11.5*cm])
ft.setStyle(TableStyle([
    ('ROWBACKGROUNDS', (0,0), (-1,-1), [colors.HexColor('#e8eaf6'), colors.white]),
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    ('LEFTPADDING', (0,0), (-1,-1), 10),
]))
story.append(ft)
story.append(Spacer(1, 0.5*cm))
story.append(Paragraph(
    "<i>Note: These question papers are compiled for study purposes based on official GNM board examination patterns. "
    "Answers are prepared according to standard nursing textbooks (GNC curriculum).</i>",
    ParagraphStyle('Disc', fontSize=8.5, textColor=colors.HexColor('#78909c'),
        alignment=TA_CENTER, fontName='Helvetica-Oblique', spaceAfter=4)))

# ─── BUILD ─────────────────────────────────────────────────────────
def add_page_number(canvas, doc):
    canvas.saveState()
    canvas.setFont('Helvetica', 8)
    canvas.setFillColor(colors.HexColor('#78909c'))
    page_num = canvas.getPageNumber()
    text = f"GNM 1st Year | Board Exam Papers 2017 & 2019 | Page {page_num}"
    canvas.drawCentredString(A4[0]/2, 1*cm, text)
    canvas.restoreState()

doc.build(story, onFirstPage=add_page_number, onLaterPages=add_page_number)
print(f"PDF created: {OUTPUT}")