from docx import Document
from docx.shared import Pt, RGBColor
from docx.enum.text import WD_ALIGN_PARAGRAPH

doc = Document()
style = doc.styles["Normal"]
style.font.name = "Arial"
style.font.size = Pt(11)

title = doc.add_heading("Respiratory System Pathology - Revision Pack", level=0)
sub = doc.add_paragraph("2nd Year MBBS | Based on Robbins & Cotran Pathologic Basis of Disease / Robbins Basic Pathology")
sub.alignment = WD_ALIGN_PARAGRAPH.CENTER

doc.add_heading("PART A: FLASHCARDS", level=1)

flashcards = [
("Obstructive vs Restrictive", "What are the two functional categories of diffuse lung disease?",
 "Obstructive (limited airflow, reduced FEV1/FVC) and Restrictive (reduced lung expansion, reduced FVC, normal/increased FEV1/FVC)."),
("Obstructive Diseases", "Name the four major obstructive/COPD diseases.",
 "Emphysema, chronic bronchitis, asthma, bronchiectasis."),
("Emphysema - Definition", "Define emphysema.",
 "Permanent enlargement of air spaces distal to the terminal bronchiole due to destruction of alveolar walls, without significant fibrosis."),
("Emphysema - Centriacinar", "Which emphysema type is centered on the respiratory bronchiole, affects upper lobes, and is linked to smoking?",
 "Centriacinar (centrilobular) emphysema."),
("Emphysema - Panacinar", "Which emphysema type uniformly affects the acinus, predominates in lower lobes, and is due to alpha-1 antitrypsin deficiency?",
 "Panacinar (panlobular) emphysema."),
("Emphysema - Pathogenesis", "What is the protease-antiprotease hypothesis of emphysema?",
 "Neutrophil/macrophage elastase destroys alveolar elastin; normally inhibited by alpha-1 antitrypsin (A1AT). Smoking increases neutrophils/oxidants (inactivating A1AT); A1AT deficiency leaves elastase unopposed, causing panacinar emphysema."),
("Chronic Bronchitis - Definition", "Define chronic bronchitis clinically.",
 "Persistent productive cough for at least 3 months in at least 2 consecutive years, without other identifiable cause."),
("Chronic Bronchitis - Histology", "What is the histologic hallmark of chronic bronchitis?",
 "Hypertrophy of bronchial submucosal glands; increased Reid index (gland:wall thickness ratio > 0.4)."),
("Asthma - Definition", "What is asthma?",
 "Chronic inflammatory airway disorder causing recurrent wheeze, breathlessness, chest tightness and cough due to bronchial hyperresponsiveness and reversible airflow obstruction."),
("Asthma - Sputum Findings", "What are Curschmann spirals and Charcot-Leyden crystals?",
 "Curschmann spirals = mucus plugs with shed epithelium in a spiral shape; Charcot-Leyden crystals = crystals of eosinophil membrane protein (galectin-10). Both found in asthmatic sputum."),
("Asthma - Hypersensitivity", "What type of hypersensitivity reaction underlies atopic asthma?",
 "Type I (IgE-mediated), Th2-driven hypersensitivity."),
("Bronchiectasis - Definition", "Define bronchiectasis.",
 "Permanent dilation of bronchi/bronchioles due to destruction of muscle and elastic tissue, usually from chronic necrotizing infection."),
("Bronchiectasis - Causes", "What are classic causes of bronchiectasis?",
 "Bronchial obstruction (tumor, foreign body), congenital conditions (cystic fibrosis, primary ciliary dyskinesia/Kartagener syndrome), necrotizing pneumonia."),
("Cystic Fibrosis - Genetics", "What gene/mutation causes cystic fibrosis?",
 "CFTR gene on chromosome 7; most common mutation is F508del, causing a defective chloride channel and abnormally viscous secretions."),
("IPF - Histology", "What is the classic histologic pattern of idiopathic pulmonary fibrosis?",
 "Usual interstitial pneumonia (UIP): patchy interstitial fibrosis with fibroblastic foci, temporal and spatial heterogeneity, honeycombing."),
("NSIP vs UIP", "What distinguishes NSIP from UIP?",
 "NSIP shows uniform (temporally homogeneous) interstitial inflammation/fibrosis without fibroblastic foci or honeycombing; better prognosis than UIP."),
("Cryptogenic Organizing Pneumonia", "What characterizes cryptogenic organizing pneumonia (COP)?",
 "Polypoid plugs of loose organizing connective tissue (Masson bodies) within alveolar ducts/alveoli; responsive to steroids."),
("Sarcoidosis - Definition", "What disease shows non-caseating granulomas in lung, hilar nodes, skin, and eyes of unknown etiology?",
 "Sarcoidosis."),
("Sarcoidosis - Labs", "What lab findings are classically elevated in sarcoidosis?",
 "Serum ACE (angiotensin converting enzyme) and hypercalcemia (macrophage 1-alpha-hydroxylase activates vitamin D)."),
("Pneumoconioses", "Name the three classic pneumoconioses and their causative dust.",
 "Coal worker's pneumoconiosis (carbon dust), silicosis (silica), asbestosis (asbestos fibers)."),
("Asbestos Bodies", "What histologic finding is characteristic of asbestos exposure?",
 "Asbestos (ferruginous) bodies: golden-brown fusiform rods, iron-protein coated asbestos fibers."),
("Asbestos - Malignancy", "What malignancies are linked to asbestos exposure?",
 "Bronchogenic carcinoma (more common) and malignant mesothelioma (more specific)."),
("Hypersensitivity Pneumonitis", "What is hypersensitivity pneumonitis?",
 "Immunologically mediated interstitial lung disease from inhaled organic antigens (e.g., Farmer's lung, Bird fancier's lung); Type III/IV hypersensitivity."),
("DAD/ARDS Histology", "What is the histologic hallmark of diffuse alveolar damage (ARDS)?",
 "Hyaline membranes lining alveolar ducts/walls, composed of fibrin and necrotic cell debris."),
("ARDS - Pathogenesis", "What is the pathogenesis of ARDS?",
 "Injury to alveolar capillary endothelium and epithelium causes increased vascular permeability, alveolar edema, and hyaline membranes, leading to severe hypoxemia."),
("Neonatal RDS", "What is the underlying defect in neonatal respiratory distress syndrome?",
 "Surfactant deficiency from pulmonary immaturity, causing increased alveolar surface tension, atelectasis, and hyaline membranes."),
("PE - Source", "What is the most common source of pulmonary emboli?",
 "Deep vein thrombosis of the lower extremities (femoral, iliac, popliteal veins)."),
("PE - Infarction", "When does a pulmonary embolism cause infarction?",
 "Usually prevented by dual blood supply (bronchial + pulmonary) unless there is pre-existing compromised circulation (e.g., left heart failure); infarcts occur in ~10% of PEs."),
("Saddle Embolus", "What is a saddle embolus?",
 "A large embolus straddling the bifurcation of the main pulmonary artery; can cause sudden death."),
("Pulmonary HTN - Histology", "What is the pathologic hallmark of severe pulmonary arterial hypertension?",
 "Plexiform lesions (tufts of capillary channels within a dilated thin-walled vessel), plus medial hypertrophy and intimal fibrosis of pulmonary arteries."),
("GPA (Wegener)", "What is the classic triad of granulomatosis with polyangiitis (GPA)?",
 "Necrotizing granulomas of upper/lower respiratory tract, necrotizing vasculitis of small vessels, necrotizing glomerulonephritis. Associated with c-ANCA (PR3-ANCA)."),
("EGPA (Churg-Strauss)", "How does eosinophilic granulomatosis with polyangiitis differ from GPA?",
 "EGPA has asthma, peripheral eosinophilia, granulomatous necrotizing vasculitis with eosinophilic infiltration; associated with p-ANCA (MPO-ANCA)."),
("Goodpasture Syndrome", "What is Goodpasture syndrome?",
 "Autoimmune disease with antibodies against type IV collagen (alpha-3 NC1 domain) in alveolar and glomerular basement membranes, causing pulmonary hemorrhage and rapidly progressive glomerulonephritis; linear immunofluorescence pattern."),
("CAP - Organism", "What is the most common cause of community-acquired typical (bacterial) pneumonia?",
 "Streptococcus pneumoniae (pneumococcus)."),
("Lobar Pneumonia Stages", "List the four classic stages of lobar pneumonia.",
 "Congestion, red hepatization, gray hepatization, resolution."),
("Atypical Pneumonia", "What organism classically causes atypical pneumonia with interstitial pattern and non-productive cough?",
 "Mycoplasma pneumoniae (also viruses, Chlamydia, Coxiella)."),
("Hospital-Acquired Pneumonia", "What organisms commonly cause hospital-acquired (nosocomial) pneumonia?",
 "Gram-negative rods (Pseudomonas, E. coli, Klebsiella) and Staphylococcus aureus."),
("Aspiration Pneumonia", "What predisposes to aspiration pneumonia and where does it localize?",
 "Impaired consciousness, dysphagia; right lung (more vertical bronchus) most commonly affected; often mixed aerobic-anaerobic flora, abscess-forming."),
("Lung Abscess", "What is a lung abscess and its common causes?",
 "Localized suppurative necrosis of lung with cavitation; caused by aspiration, antecedent bacterial pneumonia, bronchial obstruction (tumor), septic emboli."),
("Primary TB", "What is the Ghon focus and Ghon complex in primary TB?",
 "Ghon focus = subpleural caseous granuloma (usually lower part of upper lobe/upper part of lower lobe); Ghon complex = Ghon focus + caseous hilar lymph node."),
("Ranke Complex", "What is a Ranke complex?",
 "A fibrocalcified (healed) Ghon complex."),
("Secondary TB", "Where does secondary (reactivation) TB classically localize, and why?",
 "Apex of the upper lobe(s); high oxygen tension there favors mycobacterial growth."),
("Miliary TB", "What is miliary TB?",
 "Hematogenous or lymphatic dissemination producing numerous tiny (~2mm) yellow-white granulomas resembling millet seeds."),
("TB Hypersensitivity", "What hypersensitivity reaction underlies TB granuloma formation?",
 "Type IV (delayed-type, cell-mediated), Th1-mediated with IFN-gamma activating macrophages."),
("Lung Cancer - Adenocarcinoma", "What is the most common histologic type of lung cancer overall, and in non-smokers/women?",
 "Adenocarcinoma."),
("Lung Cancer - Squamous", "Which lung cancer type is most linked to smoking, often centrally located, arising from bronchial epithelium?",
 "Squamous cell carcinoma."),
("Lung Cancer - Small Cell", "Which lung cancer subtype is a highly aggressive neuroendocrine tumor, centrally located, almost always in smokers?",
 "Small cell carcinoma (SCLC)."),
("SCLC Paraneoplastic", "What paraneoplastic syndromes are associated with small cell lung carcinoma?",
 "SIADH, ectopic ACTH (Cushing syndrome), Lambert-Eaton myasthenic syndrome (anti-voltage-gated calcium channel antibodies)."),
("Squamous Paraneoplastic", "What paraneoplastic hypercalcemia syndrome is associated with squamous cell carcinoma?",
 "PTHrP (parathyroid hormone-related peptide) secretion causing hypercalcemia."),
("Pancoast Tumor", "What is a Pancoast tumor and its associated findings?",
 "Apical lung cancer invading the sympathetic chain/brachial plexus, causing Horner syndrome (ptosis, miosis, anhidrosis) and shoulder/arm pain."),
("Pleural Effusion Types", "Differentiate transudate vs exudate pleural effusion.",
 "Transudate = low protein, from increased hydrostatic/decreased oncotic pressure (CHF, cirrhosis); Exudate = high protein/LDH, from increased vascular permeability (infection, malignancy, inflammation), meets Light's criteria."),
("Mesothelioma", "What is malignant mesothelioma strongly associated with?",
 "Asbestos exposure; arises from pleural mesothelial cells."),
]

for i, (topic, q, a) in enumerate(flashcards, 1):
    p = doc.add_paragraph()
    run = p.add_run(f"F{i}. [{topic}] Q: {q}")
    run.bold = True
    p2 = doc.add_paragraph(f"A: {a}")
    p2.paragraph_format.left_indent = Pt(18)

doc.add_page_break()
doc.add_heading("PART B: MCQs (with Answers & Explanations)", level=1)

mcqs = [
("A 55-year-old smoker has a markedly reduced FEV1/FVC ratio; CT shows enlarged air spaces predominantly in the upper lobes with destroyed alveolar septa. Which pattern of emphysema is this?",
 ["Panacinar","Centriacinar","Paraseptal","Distal acinar"], "B",
 "Centriacinar (centrilobular) emphysema is the classic smoking-related pattern, predominating in upper lobes."),
("A 30-year-old non-smoker has early-onset panacinar emphysema predominantly in the lower lobes plus liver cirrhosis. What is the underlying deficiency?",
 ["IgA","Alpha-1 antitrypsin","Surfactant protein B","CFTR"], "B",
 "Alpha-1 antitrypsin deficiency causes panacinar emphysema (lower lobe predominant) and can cause liver cirrhosis (misfolded protein accumulation in hepatocytes)."),
("Which enzyme, when unopposed, is the principal mediator of alveolar wall destruction in emphysema?",
 ["Elastase","Collagenase","Hyaluronidase","Trypsin"], "A",
 "Neutrophil/macrophage elastase destroys elastin; normally inhibited by alpha-1 antitrypsin."),
("The Reid index (submucosal gland thickness : bronchial wall thickness) is increased in which disease?",
 ["Emphysema","Chronic bronchitis","Bronchiectasis","Asthma"], "B",
 "Reid index > 0.4 is diagnostic of chronic bronchitis due to gland hypertrophy."),
("Which cell type and cytokine profile predominate in atopic (allergic) asthma?",
 ["Th1 cells, IFN-gamma","Th2 cells, IL-4/IL-5/IL-13","Th17 cells, IL-17","Cytotoxic T cells, perforin"], "B",
 "Atopic asthma is a Th2-driven, IgE-mediated (Type I hypersensitivity) process."),
("Charcot-Leyden crystals in asthmatic sputum are composed of:",
 ["Neutrophil granule protein","Eosinophil membrane protein (galectin-10)","Fibrin degradation products","Cholesterol esters"], "B",
 "These crystals form from eosinophil membrane protein (galectin-10)."),
("A patient with recurrent sinopulmonary infections, infertility, situs inversus, and bronchiectasis likely has:",
 ["Cystic fibrosis","Primary ciliary dyskinesia (Kartagener syndrome)","Alpha-1 antitrypsin deficiency","Common variable immunodeficiency"], "B",
 "Immotile cilia cause recurrent infections, infertility, and situs inversus (Kartagener triad)."),
("The most common CFTR mutation causing cystic fibrosis is:",
 ["G551D","F508del","W1282X","R117H"], "B",
 "Deletion of phenylalanine at position 508 (F508del) is the most common mutation."),
("Bronchiectasis is defined pathologically as:",
 ["Reversible bronchial narrowing","Permanent dilation of bronchi/bronchioles from wall destruction","Hypertrophy of submucosal glands","Enlargement of air spaces distal to terminal bronchiole"], "B",
 "Permanent dilation due to destruction of muscle/elastic tissue, usually from chronic necrotizing infection."),
("The histologic hallmark of usual interstitial pneumonia (UIP)/IPF is:",
 ["Uniform interstitial inflammation","Granulomas","Patchy fibrosis with fibroblastic foci and temporal heterogeneity","Hyaline membranes"], "C",
 "UIP shows temporally and spatially heterogeneous fibrosis with fibroblastic foci and honeycombing."),
("Masson bodies (polypoid plugs of organizing connective tissue in alveolar ducts) are characteristic of:",
 ["Usual interstitial pneumonia","Cryptogenic organizing pneumonia","Sarcoidosis","Hypersensitivity pneumonitis"], "B",
 "COP shows Masson bodies and typically responds well to corticosteroids."),
("A young woman presents with bilateral hilar lymphadenopathy, skin lesions, elevated serum ACE, and non-caseating granulomas on lung biopsy. Diagnosis?",
 ["Tuberculosis","Sarcoidosis","Hypersensitivity pneumonitis","Granulomatosis with polyangiitis"], "B",
 "Sarcoidosis is characterized by non-caseating granulomas and elevated ACE."),
("Ferruginous (asbestos) bodies are best described as:",
 ["Calcified granulomas","Golden-brown fusiform rods coated with iron-protein complex around asbestos fibers","Birefringent silica crystals","Cholesterol clefts"], "B",
 "Classic finding on lung biopsy in asbestos-exposed individuals."),
("Which pneumoconiosis carries the highest risk of malignant mesothelioma?",
 ["Coal worker's pneumoconiosis","Silicosis","Asbestosis","Berylliosis"], "C",
 "Asbestos exposure is strongly linked to mesothelioma."),
("Silicosis classically increases susceptibility to which infection?",
 ["Aspergillosis","Tuberculosis","Nocardiosis","Histoplasmosis"], "B",
 "Silica impairs macrophage function, increasing susceptibility to TB."),
("The pathologic hallmark seen in ARDS/diffuse alveolar damage is:",
 ["Granulomas","Hyaline membranes","Honeycombing","Ferruginous bodies"], "B",
 "Hyaline membranes (fibrin + necrotic debris) line the alveolar ducts in DAD."),
("Neonatal respiratory distress syndrome is primarily due to deficiency of:",
 ["Alpha-1 antitrypsin","Surfactant","CFTR protein","IgA"], "B",
 "Surfactant deficiency from pulmonary immaturity causes increased alveolar surface tension and atelectasis."),
("The most common source of pulmonary thromboemboli is:",
 ["Right atrial thrombus","Deep leg veins","Pelvic veins only","Hepatic veins"], "B",
 "Most emboli originate from deep vein thrombosis of the lower extremities."),
("A saddle embolus lodges at the:",
 ["Segmental pulmonary artery branches","Bifurcation of the main pulmonary artery","Pulmonary capillaries","Bronchial artery"], "B",
 "A saddle embolus straddles the main pulmonary artery bifurcation and can cause sudden death."),
("The characteristic vascular lesion of severe pulmonary arterial hypertension is:",
 ["Fibrinoid necrosis","Plexiform lesion","Onion-skin lesion","Aneurysmal dilation"], "B",
 "Plexiform lesions are tufts of capillary channels within a dilated, thin-walled vessel."),
("c-ANCA (anti-PR3) is most associated with:",
 ["Churg-Strauss syndrome","Granulomatosis with polyangiitis (Wegener)","Goodpasture syndrome","Polyarteritis nodosa"], "B",
 "GPA classically shows c-ANCA/PR3-ANCA positivity."),
("A patient with asthma, peripheral eosinophilia, and granulomatous necrotizing vasculitis with p-ANCA positivity has:",
 ["GPA","Eosinophilic granulomatosis with polyangiitis (Churg-Strauss)","Goodpasture syndrome","Sarcoidosis"], "B",
 "EGPA features asthma, eosinophilia, and p-ANCA (MPO-ANCA)."),
("Linear immunofluorescence along alveolar and glomerular basement membranes is characteristic of:",
 ["IgA nephropathy","Goodpasture syndrome","GPA","Lupus nephritis"], "B",
 "Anti-GBM antibodies target type IV collagen alpha-3 chain, producing a linear IF pattern."),
("The most common cause of community-acquired typical bacterial pneumonia is:",
 ["Klebsiella pneumoniae","Streptococcus pneumoniae","Mycoplasma pneumoniae","Pseudomonas aeruginosa"], "B",
 "Pneumococcus remains the leading cause of typical CAP."),
("Arrange the stages of lobar pneumonia in correct order:",
 ["Gray hepatization to red hepatization to congestion to resolution","Congestion to red hepatization to gray hepatization to resolution","Resolution to congestion to red hepatization to gray hepatization","Red hepatization to congestion to resolution to gray hepatization"], "B",
 "Classic sequence: congestion, red hepatization, gray hepatization, resolution."),
("\"Red hepatization\" of the lung refers to:",
 ["Alveoli filled with fibrin/neutrophils/RBCs giving liver-like red consistency","Fibrosis of alveolar septa","Granulomatous inflammation","Hyaline membrane formation"], "A",
 "This stage follows congestion, with exudation of RBCs, neutrophils, and fibrin into alveoli."),
("Atypical pneumonia with patchy interstitial inflammation and non-productive cough is classically caused by:",
 ["Streptococcus pneumoniae","Mycoplasma pneumoniae","Staphylococcus aureus","Klebsiella pneumoniae"], "B",
 "Mycoplasma is a classic cause of atypical (walking) pneumonia."),
("Which organisms most commonly cause hospital-acquired pneumonia?",
 ["Streptococcus pneumoniae and Haemophilus influenzae","Gram-negative rods (Pseudomonas, Klebsiella) and Staphylococcus aureus","Mycoplasma and Chlamydia","Anaerobes only"], "B",
 "Nosocomial pneumonia is usually caused by gram-negative rods and S. aureus."),
("Aspiration pneumonia most commonly affects which part of the lung due to bronchial anatomy?",
 ["Left upper lobe","Right lung, especially lower lobe","Lingula","Apex bilaterally"], "B",
 "The right main bronchus is more vertical, so aspirated material preferentially enters the right lung."),
("A lung abscess is best defined as:",
 ["Non-caseating granuloma","Localized suppurative necrosis with cavitation","Diffuse interstitial fibrosis","Hyaline membrane deposition"], "B",
 "Abscesses show localized suppurative necrosis and cavity formation."),
("In primary tuberculosis, a subpleural parenchymal lesion plus caseous hilar lymph node necrosis is called:",
 ["Ranke complex","Ghon complex","Miliary complex","Simon focus"], "B",
 "Ghon complex = Ghon focus + caseous hilar lymphadenitis."),
("A fibrocalcified, healed Ghon complex is termed:",
 ["Simon focus","Ranke complex","Assmann focus","Aschoff nodule"], "B",
 "The Ranke complex represents the healed, calcified Ghon complex."),
("Secondary (reactivation) tuberculosis classically localizes to the:",
 ["Lung bases","Apex of upper lobe","Hilar region","Pleura only"], "B",
 "High oxygen tension at the apex favors aerobic mycobacterial growth."),
("Miliary tuberculosis refers to:",
 ["A single large caseous cavity","Numerous small (~2mm) granulomas from hematogenous/lymphatic spread","Pleural thickening","Bronchiectasis secondary to TB"], "B",
 "Miliary TB resembles millet seeds scattered throughout the lung (or other organs)."),
("Granuloma formation in tuberculosis is mediated by which hypersensitivity reaction?",
 ["Type I","Type II","Type III","Type IV"], "D",
 "TB granulomas result from Type IV (delayed-type, cell-mediated) hypersensitivity."),
("The most common primary lung cancer overall, especially in women and non-smokers, is:",
 ["Squamous cell carcinoma","Adenocarcinoma","Small cell carcinoma","Large cell carcinoma"], "B",
 "Adenocarcinoma is now the most common subtype overall."),
("A central, cavitating lung mass with keratin pearls on histology in a heavy smoker suggests:",
 ["Adenocarcinoma","Squamous cell carcinoma","Carcinoid tumor","Small cell carcinoma"], "B",
 "Keratin pearls and intercellular bridges are classic for squamous cell carcinoma."),
("A centrally located, aggressive neuroendocrine lung tumor with 'salt and pepper' chromatin, almost exclusively in smokers:",
 ["Typical carcinoid","Small cell carcinoma","Adenocarcinoma","Squamous cell carcinoma"], "B",
 "SCLC is a high-grade neuroendocrine tumor strongly linked to smoking."),
("SIADH and Lambert-Eaton myasthenic syndrome are paraneoplastic manifestations most associated with:",
 ["Squamous cell carcinoma","Small cell carcinoma","Adenocarcinoma","Carcinoid tumor"], "B",
 "SCLC is classically associated with SIADH, ectopic ACTH, and Lambert-Eaton syndrome."),
("Hypercalcemia due to PTHrP secretion is a paraneoplastic feature of:",
 ["Small cell carcinoma","Squamous cell carcinoma","Adenocarcinoma","Mesothelioma"], "B",
 "Squamous cell carcinoma secretes PTHrP causing hypercalcemia of malignancy."),
("Horner syndrome (ptosis, miosis, anhidrosis) with shoulder pain in a lung cancer patient suggests:",
 ["Carcinoid syndrome","Pancoast tumor","SIADH","Superior vena cava syndrome"], "B",
 "A Pancoast (apical) tumor invades the sympathetic chain causing Horner syndrome."),
("Malignant mesothelioma is most strongly associated with exposure to:",
 ["Silica","Coal dust","Asbestos","Beryllium"], "C",
 "Asbestos exposure is the principal risk factor for malignant mesothelioma."),
("A pleural effusion with low protein and LDH, associated with congestive heart failure, is classified as:",
 ["Exudate","Transudate","Empyema","Hemothorax"], "B",
 "Transudates arise from increased hydrostatic or decreased oncotic pressure, as in CHF."),
("A spontaneous pneumothorax most commonly occurs in which population?",
 ["Elderly women","Tall, young, thin males (ruptured apical blebs)","Obese middle-aged women","Infants"], "B",
 "Primary spontaneous pneumothorax classically affects tall, thin young males from ruptured subpleural blebs."),
("Which of the following is the spirometric pattern of restrictive lung disease?",
 ["Decreased FEV1/FVC ratio","Normal or increased FEV1/FVC with decreased FVC and TLC","Increased TLC","Increased residual volume with normal FVC"], "B",
 "Restrictive disease reduces lung volumes (FVC, TLC) while FEV1/FVC is preserved or increased."),
("Which of the following is the spirometric pattern of obstructive lung disease?",
 ["Decreased FEV1/FVC ratio with normal or increased TLC","Decreased TLC","Decreased FVC with normal FEV1/FVC","Increased FEV1/FVC ratio"], "A",
 "Obstructive disease shows reduced FEV1/FVC due to airflow limitation; TLC is normal or increased (air trapping)."),
("Hypersensitivity pneumonitis (e.g., Farmer's lung) is caused by which type(s) of hypersensitivity reaction?",
 ["Type I only","Type II only","Type III and IV","Type IV only"], "C",
 "Hypersensitivity pneumonitis involves both immune complex (Type III) and cell-mediated (Type IV) mechanisms."),
("Which pneumoconiosis is caused by inhalation of carbon dust and can progress to progressive massive fibrosis?",
 ["Silicosis","Asbestosis","Coal worker's pneumoconiosis","Berylliosis"], "C",
 "Coal worker's pneumoconiosis can progress from simple to complicated form (progressive massive fibrosis)."),
("The most common cause of atelectasis in a postoperative patient is:",
 ["Pneumothorax","Resorption (obstruction) atelectasis from mucus plugging","Compression by pleural effusion","Contraction atelectasis from fibrosis"], "B",
 "Postoperative atelectasis is usually resorption atelectasis due to airway obstruction by mucus/secretions."),
("A patient with chronic cough, copious purulent sputum, clubbing, and CT showing dilated bronchi (signet-ring sign) most likely has:",
 ["Emphysema","Chronic bronchitis","Bronchiectasis","Asthma"], "C",
 "Dilated, thick-walled bronchi (signet-ring sign) with purulent sputum and clubbing are classic for bronchiectasis."),
]

for i, (q, opts, ans, exp) in enumerate(mcqs, 1):
    p = doc.add_paragraph()
    run = p.add_run(f"M{i}. {q}")
    run.bold = True
    labels = ["A","B","C","D"]
    for lbl, opt in zip(labels, opts):
        marker = " (Correct)" if lbl == ans else ""
        opt_p = doc.add_paragraph(f"   {lbl}) {opt}{marker}")
        opt_p.paragraph_format.left_indent = Pt(14)
    exp_p = doc.add_paragraph(f"Explanation: {exp}")
    exp_p.paragraph_format.left_indent = Pt(14)
    er = exp_p.runs[0]
    er.italic = True

out_path = "/tmp/workspace/resp_patho/Respiratory_Pathology_Revision.docx"
doc.save(out_path)
print("Saved:", out_path)
print("Flashcards:", len(flashcards), "MCQs:", len(mcqs))