MDS Basic Science - 1 Week Study Timetable

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// ─── QUESTION DATA ────────────────────────────────────────────────

const sections = [

  {
    subject: "ANATOMY",
    leqs: [
      {
        q: "Describe the development of the mandible. Add a note on anomalies of mandibular development.",
        hint: "Meckel's cartilage, intramembranous ossification, secondary cartilages (condylar, coronoid, symphyseal), clinical significance"
      },
      {
        q: "Describe the trigeminal nerve with its branches and distribution. Discuss its clinical relevance in dentistry.",
        hint: "3 divisions (V1, V2, V3), ganglia, sensory/motor roots, local anesthesia blocks, trigeminal neuralgia"
      },
      {
        q: "Describe the development of the palate. What are the consequences of failure of fusion?",
        hint: "Primary palate (premaxilla), secondary palate, fusion timeline (8-12 weeks), cleft lip/palate types"
      },
      {
        q: "Write about the parotid gland - its anatomy, relations, and duct. What is Frey's syndrome?",
        hint: "Location, capsule, Stensen's duct, facial nerve relations, surgical relevance, auriculotemporal nerve"
      }
    ],
    seqs: [
      { q: "Briefly describe the temporomandibular joint.", hint: "Disc, capsule, ligaments, movements, muscles" },
      { q: "Write a short note on the lymphatic drainage of the tongue.", hint: "Tip, lateral margins, posterior, submental/submandibular/deep cervical nodes" },
      { q: "Describe the nerve supply of the tongue.", hint: "Anterior 2/3 (lingual, chorda tympani), posterior 1/3 (glossopharyngeal)" },
      { q: "Write a short note on the submandibular gland.", hint: "Wharton's duct, lingual nerve loop, relationships" },
      { q: "Describe the development of the face.", hint: "Frontonasal process, maxillary and mandibular prominences, fusion, timeline" },
      { q: "Write a short note on the pterygomandibular space.", hint: "Boundaries, contents, relevance to IANB" }
    ]
  },

  {
    subject: "PHYSIOLOGY",
    leqs: [
      {
        q: "Describe the composition and functions of saliva. Add a note on its role in the prevention of dental caries.",
        hint: "Serous & mucous glands, electrolytes (Na, K, Cl, HCO3), proteins (amylase, IgA, lactoferrin, mucins), buffering, remineralization"
      },
      {
        q: "Define cardiac output. Describe the factors that affect cardiac output and its clinical significance.",
        hint: "CO = HR × SV; preload, afterload, contractility; Starling's law; normal values; relevance to medically compromised child patients"
      },
      {
        q: "Describe the mechanism of blood coagulation. Discuss the role of platelets in hemostasis.",
        hint: "Intrinsic & extrinsic pathways, common pathway, fibrinogen to fibrin, platelet plug formation, coagulation factors"
      }
    ],
    seqs: [
      { q: "Write a short note on the control of salivary secretion.", hint: "Parasympathetic (chorda tympani, auriculotemporal), sympathetic, reflex arcs" },
      { q: "What is the Stephan curve? Explain its significance.", hint: "pH drop after sugar exposure, critical pH 5.5, remineralization window, fluoride effect" },
      { q: "Describe skeletal growth assessment methods.", hint: "Cervical vertebrae maturation (CVM), hand-wrist radiograph, dental age, chronological age" },
      { q: "Write a short note on platelet count and its significance in dental practice.", hint: "Normal 1.5-4 lakh/mm3, thrombocytopenia, pre-extraction screening" },
      { q: "Describe the regulation of body growth.", hint: "GH, IGF-1, thyroid hormones, sex hormones, nutritional factors" }
    ]
  },

  {
    subject: "BIOCHEMISTRY",
    leqs: [
      {
        q: "Describe the mechanism of action of fluoride in caries prevention. Discuss the recommended daily dosage and toxicity.",
        hint: "Fluorapatite formation, enzyme inhibition (enolase), effect on S. mutans, optimal level 0.7-1 ppm, acute vs chronic toxicity, fluorosis"
      },
      {
        q: "Classify vitamins. Describe the role of fat-soluble vitamins in oral health and their deficiency manifestations.",
        hint: "Vitamin A (epithelium, enamel hypoplasia), D (calcification, rickets), K (clotting), E (antioxidant)"
      },
      {
        q: "Describe the metabolism of carbohydrates and its relationship to dental caries.",
        hint: "Glycolysis, fermentable carbohydrates, acid production by bacteria, plaque pH, role of sucrose, ECC"
      }
    ],
    seqs: [
      { q: "Write a short note on Vitamin C and its oral manifestations of deficiency.", hint: "Scurvy, collagen synthesis, bleeding gums, BGDG, wound healing" },
      { q: "Describe the role of calcium and phosphorus in tooth development.", hint: "Hydroxyapatite, mineralization, dietary sources, Ca:P ratio" },
      { q: "Write a short note on Vitamin D deficiency and its dental effects.", hint: "Hypocalcification, enamel hypoplasia, rickets, delayed eruption" },
      { q: "What is dental plaque? Describe its biochemical composition.", hint: "Pellicle, early colonizers, matrix (polysaccharides, proteins), EPS (glucans, fructans)" },
      { q: "Write a short note on iron deficiency anemia and its oral manifestations.", hint: "Angular cheilitis, atrophic glossitis, pallor of mucosa, koilonychia" }
    ]
  },

  {
    subject: "MICROBIOLOGY",
    leqs: [
      {
        q: "Describe Streptococcus mutans - its properties, virulence factors, and role in the initiation and progression of dental caries.",
        hint: "Gram +ve cocci, acidogenic/aciduric, glucosyltransferase, glucan synthesis, biofilm, bacteriocins, mutacin"
      },
      {
        q: "Describe the normal oral microflora. How does it change in early childhood caries?",
        hint: "400+ species, Streptococci, Lactobacilli, Actinomyces, Prevotella, ECC microbial shift, S. mutans transmission"
      },
      {
        q: "Describe the structure and life cycle of Hepatitis B virus. How is cross-infection prevented in a pediatric dental clinic?",
        hint: "HBsAg, HBcAg, HBeAg, Dane particle, parenteral transmission, Universal precautions, sterilization, vaccination protocol"
      }
    ],
    seqs: [
      { q: "Write a short note on secretory IgA (sIgA) and its role in oral immunity.", hint: "J chain, secretory component, salivary IgA, agglutination of bacteria, first line defense" },
      { q: "Write a short note on Lactobacilli and dental caries.", hint: "Aciduric, progress lesion, Snyder test, Lactobacillus count" },
      { q: "Describe sterilization methods used in a dental clinic.", hint: "Autoclave, dry heat, chemical, EO gas, glutaraldehyde, classification of instruments" },
      { q: "Write a short note on Candida albicans in the oral cavity.", hint: "Oral candidiasis, predisposing factors, ANUG, denture stomatitis, neonatal candidiasis" },
      { q: "Describe the oral manifestations of HIV infection in children.", hint: "Oral candidiasis, linear gingival erythema, herpes, hairy leukoplakia, NHL, parotid enlargement" }
    ]
  },

  {
    subject: "PATHOLOGY",
    leqs: [
      {
        q: "Describe the process of acute inflammation. What are the local and systemic features? How does it differ from chronic inflammation?",
        hint: "Vascular changes, cellular events, chemical mediators (histamine, prostaglandins, complement), exudate, resolution vs chronicity"
      },
      {
        q: "Classify and describe the immune system. What is the role of cell-mediated immunity in oral infections?",
        hint: "Innate vs adaptive, T and B lymphocytes, MHC, cytokines, CD4/CD8, role in periodontal disease, herpetic infections"
      }
    ],
    seqs: [
      { q: "Write a short note on wound healing - primary vs secondary intention.", hint: "Phases (hemostasis, inflammatory, proliferative, remodeling), granulation tissue, scar" },
      { q: "Describe the role of eosinophils.", hint: "Antiparasitic, allergic reactions, major basic protein, Charcot-Leyden crystals" },
      { q: "Write a short note on spread of dental infection.", hint: "Periapical abscess, Ludwig's angina, spread to fascial spaces, cavernous sinus thrombosis" },
      { q: "Write a short note on tumor markers.", hint: "AFP, CEA, PSA, CA-125, SCCA for oral cancer, clinical use" }
    ]
  }

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    "1.  Attempt each question in timed conditions - allow 15 minutes per LEQ and 7 minutes per SEQ.",
    "2.  Use the hint line only if stuck. Try to answer without it first.",
    "3.  Structure every answer: Definition -> Classification -> Details -> Dental Relevance -> Diagram.",
    "4.  Prioritize questions marked HIGH YIELD - these appear most frequently in UHSR and other university papers.",
    "5.  For anatomy questions, always draw a labeled diagram - even a simple one adds marks.",
    "6.  Review your written answers against standard textbook headings after each session."
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// ── HIGH YIELD SUMMARY ──
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  ["Physiology",    "Saliva (composition + functions), Cardiac output, Stephan curve, Blood coagulation"],
  ["Biochemistry",  "Fluoride mechanism, Vitamin C & D deficiency, Carbohydrates and caries, Dental plaque"],
  ["Microbiology",  "Streptococcus mutans, Hepatitis B cross-infection, Secretory IgA, Oral microflora"],
  ["Pathology",     "Acute inflammation, Immunity (cell-mediated), Wound healing"]
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  HeadingLevel, AlignmentType, BorderStyle, WidthType, ShadingType,
  VerticalAlign, PageBreak
} = require('docx');
const fs = require('fs');

// ── PALETTE ──
const DARK_BLUE  = "1B3A6B";
const MED_BLUE   = "2E6DA4";
const LIGHT_BLUE = "D6E4F0";
const TEAL       = "1A7A6B";
const LIGHT_TEAL = "D0F0EA";
const GOLD       = "C8960C";
const LIGHT_GOLD = "FFF8E7";
const RED_DARK   = "8B1A1A";
const LIGHT_RED  = "FDEAEA";
const WHITE      = "FFFFFF";
const DARK_GRAY  = "2D2D2D";
const MID_GRAY   = "555555";
const LIGHT_GRAY = "F4F4F4";
const ORANGE     = "B85C00";
const LIGHT_ORG  = "FFF0E0";

// ── HELPERS ──
function spacer(pts = 160) {
  return new Paragraph({ spacing: { before: pts, after: 0 }, children: [] });
}

function pageBreak() {
  return new Paragraph({ children: [new TextRun({ break: 1 })] });
}

function sectionHeader(text, color = DARK_BLUE) {
  return new Paragraph({
    alignment: AlignmentType.LEFT,
    spacing: { before: 360, after: 160 },
    shading: { type: ShadingType.SOLID, color, fill: color },
    children: [new TextRun({ text: "   " + text + "   ", bold: true, size: 30, color: WHITE, font: "Calibri" })]
  });
}

function subHeader(text, color = MED_BLUE) {
  return new Paragraph({
    spacing: { before: 240, after: 100 },
    shading: { type: ShadingType.SOLID, color, fill: color },
    children: [new TextRun({ text: "  " + text, bold: true, size: 24, color: WHITE, font: "Calibri" })]
  });
}

function h3(text, color = DARK_BLUE) {
  return new Paragraph({
    spacing: { before: 200, after: 80 },
    children: [new TextRun({ text, bold: true, size: 24, color, font: "Calibri" })]
  });
}

function body(text, indent = 360) {
  return new Paragraph({
    spacing: { before: 60, after: 60 },
    indent: { left: indent },
    children: [new TextRun({ text, size: 20, color: DARK_GRAY, font: "Calibri" })]
  });
}

function bullet(text, indent = 360, color = DARK_GRAY) {
  return new Paragraph({
    spacing: { before: 50, after: 50 },
    indent: { left: indent + 200, hanging: 200 },
    children: [
      new TextRun({ text: "•  ", bold: true, size: 20, color: MED_BLUE, font: "Calibri" }),
      new TextRun({ text, size: 20, color, font: "Calibri" })
    ]
  });
}

function numbered(num, text, indent = 360) {
  return new Paragraph({
    spacing: { before: 60, after: 60 },
    indent: { left: indent + 200, hanging: 200 },
    children: [
      new TextRun({ text: `${num}.  `, bold: true, size: 20, color: MED_BLUE, font: "Calibri" }),
      new TextRun({ text, size: 20, color: DARK_GRAY, font: "Calibri" })
    ]
  });
}

function callout(label, text, bgColor, labelColor) {
  return new Table({
    width: { size: 100, type: WidthType.PERCENTAGE },
    margins: { top: 80, bottom: 80 },
    rows: [
      new TableRow({
        children: [
          new TableCell({
            width: { size: 14, type: WidthType.PERCENTAGE },
            shading: { type: ShadingType.SOLID, color: labelColor, fill: labelColor },
            verticalAlign: VerticalAlign.CENTER,
            margins: { top: 120, bottom: 120, left: 120, right: 120 },
            children: [new Paragraph({ alignment: AlignmentType.CENTER, children: [new TextRun({ text: label, bold: true, size: 20, color: WHITE, font: "Calibri" })] })]
          }),
          new TableCell({
            shading: { type: ShadingType.SOLID, color: bgColor, fill: bgColor },
            margins: { top: 80, bottom: 80, left: 160, right: 160 },
            children: [new Paragraph({ children: [new TextRun({ text, size: 20, color: DARK_GRAY, font: "Calibri" })] })]
          })
        ]
      })
    ]
  });
}

function twoCol(left, right, leftColor = LIGHT_BLUE, rightColor = LIGHT_GOLD, leftLabel = "", rightLabel = "") {
  return new Table({
    width: { size: 100, type: WidthType.PERCENTAGE },
    rows: [
      ...(leftLabel ? [new TableRow({
        children: [
          new TableCell({ shading: { type: ShadingType.SOLID, color: MED_BLUE, fill: MED_BLUE }, margins: { top: 80, bottom: 80, left: 120, right: 120 }, children: [new Paragraph({ alignment: AlignmentType.CENTER, children: [new TextRun({ text: leftLabel, bold: true, size: 20, color: WHITE, font: "Calibri" })] })] }),
          new TableCell({ shading: { type: ShadingType.SOLID, color: TEAL, fill: TEAL }, margins: { top: 80, bottom: 80, left: 120, right: 120 }, children: [new Paragraph({ alignment: AlignmentType.CENTER, children: [new TextRun({ text: rightLabel, bold: true, size: 20, color: WHITE, font: "Calibri" })] })] })
        ]
      })] : []),
      new TableRow({
        children: [
          new TableCell({
            shading: { type: ShadingType.SOLID, color: leftColor, fill: leftColor },
            margins: { top: 120, bottom: 120, left: 160, right: 160 },
            children: left.map(t => new Paragraph({ spacing: { before: 40, after: 40 }, children: [new TextRun({ text: t, size: 20, color: DARK_GRAY, font: "Calibri" })] }))
          }),
          new TableCell({
            shading: { type: ShadingType.SOLID, color: rightColor, fill: rightColor },
            margins: { top: 120, bottom: 120, left: 160, right: 160 },
            children: right.map(t => new Paragraph({ spacing: { before: 40, after: 40 }, children: [new TextRun({ text: t, size: 20, color: DARK_GRAY, font: "Calibri" })] }))
          })
        ]
      })
    ]
  });
}

function formulaBox(step, title, time, desc, items, color, lightColor) {
  const rows = [
    new TableRow({
      children: [
        new TableCell({
          columnSpan: 1,
          shading: { type: ShadingType.SOLID, color, fill: color },
          margins: { top: 100, bottom: 100, left: 160, right: 160 },
          children: [
            new Paragraph({ alignment: AlignmentType.CENTER, children: [new TextRun({ text: step, bold: true, size: 36, color: WHITE, font: "Calibri" })] }),
            new Paragraph({ alignment: AlignmentType.CENTER, children: [new TextRun({ text: time, size: 18, color: "E0E0E0", font: "Calibri" })] })
          ]
        }),
        new TableCell({
          shading: { type: ShadingType.SOLID, color: lightColor, fill: lightColor },
          margins: { top: 100, bottom: 100, left: 200, right: 160 },
          children: [
            new Paragraph({ spacing: { before: 0, after: 60 }, children: [new TextRun({ text: title, bold: true, size: 24, color: color, font: "Calibri" })] }),
            new Paragraph({ spacing: { before: 0, after: 80 }, children: [new TextRun({ text: desc, size: 19, color: MID_GRAY, italics: true, font: "Calibri" })] }),
            ...items.map(it => new Paragraph({ spacing: { before: 40, after: 20 }, indent: { left: 120, hanging: 120 }, children: [new TextRun({ text: "→  ", bold: true, size: 19, color: color, font: "Calibri" }), new TextRun({ text: it, size: 19, color: DARK_GRAY, font: "Calibri" })] }))
          ]
        })
      ]
    })
  ];
  return new Table({ width: { size: 100, type: WidthType.PERCENTAGE }, rows });
}

// ═══════════════════════════════════════════════════════════════════
// DOCUMENT CONTENT
// ═══════════════════════════════════════════════════════════════════

const children = [];

// ── COVER ──
children.push(
  new Paragraph({
    alignment: AlignmentType.CENTER,
    spacing: { before: 400, after: 0 },
    shading: { type: ShadingType.SOLID, color: DARK_BLUE, fill: DARK_BLUE },
    children: [new TextRun({ text: "  ANSWER WRITING  ", bold: true, size: 70, color: WHITE, font: "Calibri" })]
  }),
  new Paragraph({
    alignment: AlignmentType.CENTER,
    spacing: { before: 0, after: 0 },
    shading: { type: ShadingType.SOLID, color: DARK_BLUE, fill: DARK_BLUE },
    children: [new TextRun({ text: "STRATEGY GUIDE", bold: true, size: 52, color: GOLD, font: "Calibri" })]
  }),
  new Paragraph({
    alignment: AlignmentType.CENTER,
    spacing: { before: 80, after: 0 },
    shading: { type: ShadingType.SOLID, color: DARK_BLUE, fill: DARK_BLUE },
    children: [new TextRun({ text: "The Intro / Body / Conclusion Formula", size: 26, color: LIGHT_BLUE, font: "Calibri" })]
  }),
  new Paragraph({
    alignment: AlignmentType.CENTER,
    spacing: { before: 60, after: 0 },
    shading: { type: ShadingType.SOLID, color: DARK_BLUE, fill: DARK_BLUE },
    children: [new TextRun({ text: "MDS Basic Science  |  Pediatric & Preventive Dentistry  |  PT BD Sharma University", size: 20, color: "8AB8D8", font: "Calibri" })]
  }),
  new Paragraph({
    alignment: AlignmentType.CENTER,
    spacing: { before: 120, after: 200 },
    shading: { type: ShadingType.SOLID, color: DARK_BLUE, fill: DARK_BLUE },
    children: [new TextRun({ text: "Exam: July 21, 2026", size: 20, color: GOLD, font: "Calibri" })]
  }),
  pageBreak()
);

// ══════════════════════════════════
// SECTION 1: THE CORE PHILOSOPHY
// ══════════════════════════════════
children.push(
  sectionHeader("SECTION 1: THE CORE PHILOSOPHY"),
  spacer(120),
  h3("Why Answer Structure Matters More Than You Think"),
  body("Examiners in MDS university exams read dozens of answers per paper. A well-structured answer stands out immediately - not because it has more content, but because it is easy to read and mark. The examiner can see you know the topic within the first 3 lines."),
  spacer(80),
  body("The single most common mistake MDS students make is writing everything they know in continuous paragraphs with no headings. This hides your knowledge. Structure reveals it."),
  spacer(120),
  callout("RULE #1", "Start every answer with a definition or opening statement - never jump straight into content.", LIGHT_BLUE, MED_BLUE),
  spacer(80),
  callout("RULE #2", "Use subheadings for every major section. Examiners mark against headings, not paragraphs.", LIGHT_TEAL, TEAL),
  spacer(80),
  callout("RULE #3", "End every answer with 2-3 lines on dental/pediatric relevance. This is your 'so what' - it shows clinical thinking.", LIGHT_GOLD, GOLD),
  spacer(80),
  callout("RULE #4", "A labeled diagram anywhere in the answer adds marks even if it is simple.", LIGHT_ORG, ORANGE),
  pageBreak()
);

// ══════════════════════════════════
// SECTION 2: TIME MANAGEMENT
// ══════════════════════════════════
children.push(
  sectionHeader("SECTION 2: TIME MANAGEMENT"),
  spacer(120),
  h3("How to Divide Your Time (100-mark paper, 3 hours)"),
  spacer(60),
  new Table({
    width: { size: 100, type: WidthType.PERCENTAGE },
    rows: [
      new TableRow({
        tableHeader: true,
        children: [
          new TableCell({ shading: { type: ShadingType.SOLID, color: DARK_BLUE, fill: DARK_BLUE }, margins: { top: 80, bottom: 80, left: 120, right: 120 }, children: [new Paragraph({ children: [new TextRun({ text: "Activity", bold: true, color: WHITE, size: 20, font: "Calibri" })] })] }),
          new TableCell({ shading: { type: ShadingType.SOLID, color: DARK_BLUE, fill: DARK_BLUE }, margins: { top: 80, bottom: 80, left: 120, right: 120 }, children: [new Paragraph({ children: [new TextRun({ text: "Time Allotted", bold: true, color: WHITE, size: 20, font: "Calibri" })] })] }),
          new TableCell({ shading: { type: ShadingType.SOLID, color: DARK_BLUE, fill: DARK_BLUE }, margins: { top: 80, bottom: 80, left: 120, right: 120 }, children: [new Paragraph({ children: [new TextRun({ text: "What to Do", bold: true, color: WHITE, size: 20, font: "Calibri" })] })] })
        ]
      }),
      ...[
        ["Reading & planning", "5 min", "Read all questions, circle your best ones, jot key points for LEQs"],
        ["LEQ 1 (10 marks)", "15 min", "Full structured answer with diagram"],
        ["LEQ 2 (10 marks)", "15 min", "Full structured answer with diagram"],
        ["SEQ 1 (5 marks)", "7 min", "Tight structured answer, 1 diagram if possible"],
        ["SEQ 2 (5 marks)", "7 min", ""],
        ["SEQ 3 (5 marks)", "7 min", ""],
        ["SEQ 4 (5 marks)", "7 min", ""],
        ["SEQ 5 (5 marks)", "7 min", ""],
        ["SEQ 6 (5 marks)", "7 min", ""],
        ["SEQ 7 & 8 (5 marks each)", "14 min", ""],
        ["Revision & cleanup", "10 min", "Check headings, add missed points, underline key terms"]
      ].map(([act, time, note], i) => new TableRow({
        children: [
          new TableCell({ shading: { type: ShadingType.SOLID, color: i % 2 === 0 ? LIGHT_GRAY : WHITE, fill: i % 2 === 0 ? LIGHT_GRAY : WHITE }, margins: { top: 60, bottom: 60, left: 120, right: 120 }, children: [new Paragraph({ children: [new TextRun({ text: act, size: 20, font: "Calibri", bold: act.includes("LEQ") || act.includes("Revision") })] })] }),
          new TableCell({ shading: { type: ShadingType.SOLID, color: i % 2 === 0 ? LIGHT_GRAY : WHITE, fill: i % 2 === 0 ? LIGHT_GRAY : WHITE }, margins: { top: 60, bottom: 60, left: 120, right: 120 }, children: [new Paragraph({ children: [new TextRun({ text: time, size: 20, color: MED_BLUE, bold: true, font: "Calibri" })] })] }),
          new TableCell({ shading: { type: ShadingType.SOLID, color: i % 2 === 0 ? LIGHT_GRAY : WHITE, fill: i % 2 === 0 ? LIGHT_GRAY : WHITE }, margins: { top: 60, bottom: 60, left: 120, right: 120 }, children: [new Paragraph({ children: [new TextRun({ text: note, size: 18, color: MID_GRAY, italics: true, font: "Calibri" })] })] })
        ]
      }))
    ]
  }),
  spacer(80),
  callout("TIP", "If you run out of time on an SEQ, write headings only - you still get partial marks for structure.", LIGHT_TEAL, TEAL),
  pageBreak()
);

// ══════════════════════════════════
// SECTION 3: THE LEQ FORMULA
// ══════════════════════════════════
children.push(
  sectionHeader("SECTION 3: THE LEQ FORMULA (10-mark Long Essay)"),
  spacer(80),
  new Paragraph({
    spacing: { before: 100, after: 100 },
    children: [new TextRun({ text: "Use this exact structure for every LEQ. Adapt the subheadings to the topic.", size: 20, color: MID_GRAY, italics: true, font: "Calibri" })]
  }),
  spacer(60),

  formulaBox("STEP 1", "INTRODUCTION  (2-3 lines)", "~2 min", "Define the topic. One classification or historical fact if relevant.",
    ["Write 1 sentence definition of the topic", "Add a brief classification if applicable (e.g. 'Saliva is secreted by major and minor salivary glands...')", "Do NOT write more than 3 lines - keep it tight"],
    MED_BLUE, LIGHT_BLUE),

  spacer(100),

  formulaBox("STEP 2", "BODY  (12-15 lines)", "~10 min", "This is where you earn marks. Use numbered/bolded subheadings.",
    ["Subheading 1: Classification / Types (use a table or numbered list)", "Subheading 2: Structure / Composition / Anatomy (main content)", "Subheading 3: Mechanism / Functions / Physiology", "Subheading 4: Clinical features / Significance", "DIAGRAM: Draw and label here - place it within the body section"],
    TEAL, LIGHT_TEAL),

  spacer(100),

  formulaBox("STEP 3", "DENTAL / PEDIATRIC RELEVANCE  (3-4 lines)", "~2 min", "Show clinical application - this separates average from good answers.",
    ["How does this topic relate to pediatric dentistry specifically?", "Mention a condition, drug, or procedure where this is important", "Example: 'Understanding salivary IgA is key to understanding why ECC develops in early childhood when salivary immunity is not yet mature'"],
    GOLD, LIGHT_GOLD),

  spacer(100),

  formulaBox("STEP 4", "CONCLUSION  (1-2 lines)", "~1 min", "One sentence summary. Do not introduce new points.",
    ["Restate the importance of the topic in one sentence", "Example: 'Thus, saliva plays a multifactorial protective role and its reduced flow is a major risk factor for dental caries in children'"],
    ORANGE, LIGHT_ORG),

  pageBreak()
);

// ══════════════════════════════════
// SECTION 4: THE SEQ FORMULA
// ══════════════════════════════════
children.push(
  sectionHeader("SECTION 4: THE SEQ FORMULA (5-mark Short Essay)"),
  spacer(80),
  new Paragraph({
    spacing: { before: 100, after: 100 },
    children: [new TextRun({ text: "SEQs need to be tight, clear, and structured. Do not write as much as an LEQ - focus on precision.", size: 20, color: MID_GRAY, italics: true, font: "Calibri" })]
  }),
  spacer(60),

  formulaBox("STEP 1", "OPENING LINE  (1 line)", "~1 min", "One sentence - definition or key fact only.",
    ["No long intro needed - get to the point immediately", "Example for 'Stephan curve': 'The Stephan curve is a graph showing the drop in plaque pH following ingestion of fermentable carbohydrates'"],
    MED_BLUE, LIGHT_BLUE),

  spacer(100),

  formulaBox("STEP 2", "BODY  (6-8 lines)", "~5 min", "3-4 subheadings maximum. Be concise.",
    ["Use short bullet points under each subheading", "Include 1 key fact or number per point (e.g. 'critical pH is 5.5')", "Draw a small diagram if it helps - Stephan curve, nerve diagram, etc.", "Do not pad - quality over quantity"],
    TEAL, LIGHT_TEAL),

  spacer(100),

  formulaBox("STEP 3", "CLINICAL RELEVANCE + CLOSE  (2 lines)", "~1 min", "One point on dental significance. One sentence conclusion.",
    ["This shows you understand the clinical application of basic science", "Keep it to 1-2 lines maximum"],
    GOLD, LIGHT_GOLD),

  spacer(120),
  callout("REMINDER", "For SEQs: If you cover the topic clearly under 3-4 subheadings with a diagram, you will get full marks. Do not write paragraphs.", LIGHT_BLUE, MED_BLUE),
  pageBreak()
);

// ══════════════════════════════════
// SECTION 5: SUBJECT-SPECIFIC TEMPLATES
// ══════════════════════════════════
children.push(sectionHeader("SECTION 5: SUBJECT-SPECIFIC TEMPLATES"));

// ── ANATOMY template ──
children.push(
  subHeader("ANATOMY", MED_BLUE),
  spacer(80),
  h3("Template for: Nerve / Structure Questions  (e.g. Trigeminal Nerve)"),
  numbered(1, "Definition + type of nerve (sensory/motor/mixed)"),
  numbered(2, "Origin (nucleus in brainstem)"),
  numbered(3, "Course / path (numbered sub-points: V1, V2, V3)"),
  numbered(4, "Branches and distribution (table format works well here)"),
  numbered(5, "Applied anatomy / clinical significance (blocks, neuralgia, referred pain)"),
  numbered(6, "Diagram: draw the nerve branches on a simple face outline"),
  spacer(80),
  h3("Template for: Development Questions  (e.g. Mandible, Palate, Face)"),
  numbered(1, "Definition + embryological origin (e.g. neural crest cells)"),
  numbered(2, "Timeline (in weeks - be specific)"),
  numbered(3, "Process step by step"),
  numbered(4, "Secondary structures formed"),
  numbered(5, "Anomalies of development (cleft, hypoplasia, etc.)"),
  numbered(6, "Dental relevance (how does this affect tooth position, eruption, orthodontics?)"),
  numbered(7, "Diagram: embryonic stages"),
  spacer(120)
);

// ── PHYSIOLOGY template ──
children.push(
  subHeader("PHYSIOLOGY", TEAL),
  spacer(80),
  h3("Template for: Composition / Function Questions  (e.g. Saliva)"),
  numbered(1, "Definition + secretion rates (normal values)"),
  numbered(2, "Classification of glands + % contribution"),
  numbered(3, "Composition: table with inorganic (electrolytes) and organic (proteins) components"),
  numbered(4, "Functions: numbered list with one line each"),
  numbered(5, "Regulation: parasympathetic and sympathetic control"),
  numbered(6, "Clinical relevance: xerostomia, ECC, sjögren's, medications reducing flow"),
  spacer(80),
  h3("Template for: Mechanism / Process Questions  (e.g. Cardiac Output, Coagulation)"),
  numbered(1, "Definition + normal values"),
  numbered(2, "Components / factors (e.g. CO = HR × SV)"),
  numbered(3, "Regulation mechanisms (numbered)"),
  numbered(4, "Factors increasing / decreasing (two-column format)"),
  numbered(5, "Clinical / dental relevance (e.g. medically compromised child patients)"),
  numbered(6, "Diagram: flowchart of the pathway"),
  spacer(120)
);

// ── BIOCHEMISTRY template ──
children.push(
  subHeader("BIOCHEMISTRY", ORANGE),
  spacer(80),
  h3("Template for: Vitamins / Nutrients"),
  numbered(1, "Classification (fat-soluble vs water-soluble)"),
  numbered(2, "Source (dietary)"),
  numbered(3, "Metabolism / absorption"),
  numbered(4, "Functions (bulleted)"),
  numbered(5, "Deficiency: systemic + oral manifestations (table with two columns)"),
  numbered(6, "Daily requirement / toxicity if relevant"),
  spacer(80),
  h3("Template for: Fluoride / Caries Biochemistry"),
  numbered(1, "Definition / chemical form"),
  numbered(2, "Sources of exposure"),
  numbered(3, "Mechanism of action (3 points: fluorapatite, enzyme inhibition, antimicrobial)"),
  numbered(4, "Optimal level (0.7-1 ppm) and recommended dosage by age"),
  numbered(5, "Toxicity: acute (8 mg/kg lethal dose) vs chronic (fluorosis)"),
  numbered(6, "Dental relevance: systemic vs topical fluoride in children"),
  spacer(120)
);

// ── MICROBIOLOGY template ──
children.push(
  subHeader("MICROBIOLOGY", RED_DARK),
  spacer(80),
  h3("Template for: Microbial Organisms  (e.g. S. mutans, Candida)"),
  numbered(1, "Classification (Gram stain, morphology, aerobe/anaerobe)"),
  numbered(2, "Virulence factors (numbered)"),
  numbered(3, "Mechanism of pathogenicity"),
  numbered(4, "Diseases caused"),
  numbered(5, "Laboratory diagnosis"),
  numbered(6, "Treatment / prevention"),
  numbered(7, "Dental relevance"),
  spacer(80),
  h3("Template for: Cross-Infection / Immunity Questions  (e.g. Hepatitis B, IgA)"),
  numbered(1, "Definition / type of virus or immunoglobulin"),
  numbered(2, "Structure / components"),
  numbered(3, "Transmission / sites of action"),
  numbered(4, "Mechanism (infection pathway OR immune function)"),
  numbered(5, "Prevention / role in defense"),
  numbered(6, "Specific dental clinic implications"),
  spacer(120)
);

// ── PATHOLOGY template ──
children.push(
  subHeader("PATHOLOGY", DARK_BLUE),
  spacer(80),
  h3("Template for: Process Questions  (e.g. Inflammation, Healing)"),
  numbered(1, "Definition"),
  numbered(2, "Classification: acute vs chronic (two columns)"),
  numbered(3, "Acute inflammation - 5 cardinal signs + vascular and cellular events"),
  numbered(4, "Mediators (histamine, prostaglandins, complement, cytokines)"),
  numbered(5, "Outcomes (resolution, chronicity, abscess, fibrosis)"),
  numbered(6, "Dental relevance (periapical abscess, pulpitis, Ludwig's angina)"),
  numbered(7, "Diagram: vascular changes in acute inflammation"),
  pageBreak()
);

// ══════════════════════════════════
// SECTION 6: WORKED EXAMPLES
// ══════════════════════════════════
children.push(
  sectionHeader("SECTION 6: WORKED EXAMPLE ANSWERS"),
  spacer(80),
  new Paragraph({
    spacing: { before: 80, after: 80 },
    children: [new TextRun({ text: "These are model answer outlines - expand each point into 1-2 sentences in your actual answer.", size: 20, color: MID_GRAY, italics: true, font: "Calibri" })]
  }),

  // Example 1: Saliva
  subHeader("WORKED LEQ EXAMPLE: Composition and Functions of Saliva", TEAL),
  spacer(60),

  h3("Introduction", MED_BLUE),
  body("Saliva is a complex biological fluid secreted by the major salivary glands (parotid, submandibular, sublingual) and numerous minor salivary glands. It plays a central role in oral homeostasis and caries prevention."),

  h3("Classification of Salivary Glands", MED_BLUE),
  new Table({
    width: { size: 100, type: WidthType.PERCENTAGE },
    rows: [
      new TableRow({ tableHeader: true, children: [
        new TableCell({ shading: { type: ShadingType.SOLID, color: MED_BLUE, fill: MED_BLUE }, margins: { top: 60, bottom: 60, left: 120, right: 120 }, children: [new Paragraph({ children: [new TextRun({ text: "Gland", bold: true, color: WHITE, size: 20, font: "Calibri" })] })] }),
        new TableCell({ shading: { type: ShadingType.SOLID, color: MED_BLUE, fill: MED_BLUE }, margins: { top: 60, bottom: 60, left: 120, right: 120 }, children: [new Paragraph({ children: [new TextRun({ text: "Type of Secretion", bold: true, color: WHITE, size: 20, font: "Calibri" })] })] }),
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      ]}),
      ...[ ["Parotid", "Serous", "25%"], ["Submandibular", "Mixed (mainly serous)", "70%"], ["Sublingual", "Mucous", "5%"] ].map(([g, t, p], i) =>
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    ]
  }),

  h3("Composition of Saliva", MED_BLUE),
  body("Inorganic: Sodium, Potassium, Calcium, Phosphate, Bicarbonate, Chloride, Fluoride"),
  body("Organic proteins: Amylase (digestion), Mucin (lubrication), Lactoferrin (antimicrobial), Lysozyme (antimicrobial), Secretory IgA (immune), Proline-rich proteins (remineralization), Statherin (inhibits precipitation)"),

  h3("Functions of Saliva", MED_BLUE),
  bullet("Lubrication - mucins coat oral surfaces, aid in speech and swallowing"),
  bullet("Digestion - salivary amylase initiates starch breakdown"),
  bullet("Buffering - bicarbonate/phosphate buffer neutralizes plaque acid (critical pH 5.5)"),
  bullet("Antimicrobial - lysozyme, lactoferrin, sIgA, histatin - first line of defense"),
  bullet("Remineralization - calcium, phosphate, fluoride ions repair early enamel lesions"),
  bullet("Taste - dissolves food particles, carries them to taste buds"),
  bullet("Cleansing - mechanical washout of food debris and bacteria"),

  h3("Dental / Pediatric Relevance", TEAL),
  body("In children, salivary IgA levels are lower at birth and mature over the first years of life, making infants particularly susceptible to early childhood caries (ECC). Xerostomia from medications (antihistamines, antiepileptics used in children) removes these protective functions and dramatically increases caries risk. Fluoride in saliva participates in the remineralization cycle, making salivary fluoride an important consideration in topical fluoride therapy."),

  h3("Conclusion", ORANGE),
  body("Saliva is a multifactorial protective fluid. Its quantitative and qualitative reduction - whether due to systemic disease, medication, or irradiation - is a major etiological factor in rampant caries, especially in the pediatric population."),

  spacer(120),
  callout("NOTE", "In the actual exam, also draw a simple diagram of the salivary glands with duct openings labeled. This alone can earn you 1-2 extra marks.", LIGHT_GOLD, GOLD),
  pageBreak(),

  // Example 2: SEQ S. mutans
  subHeader("WORKED SEQ EXAMPLE: Streptococcus mutans and Dental Caries", RED_DARK),
  spacer(60),

  h3("Opening Line", MED_BLUE),
  body("Streptococcus mutans is a Gram-positive, facultatively anaerobic coccus and the primary aetiological agent of dental caries due to its unique acidogenic and aciduric properties."),

  h3("Classification", MED_BLUE),
  body("Kingdom: Bacteria | Phylum: Firmicutes | Class: Bacilli | Family: Streptococcaceae"),

  h3("Virulence Factors", MED_BLUE),
  bullet("Glucosyltransferase (GTF) - synthesizes glucans (sticky matrix) from sucrose - enables adherence to tooth"),
  bullet("Acidogenicity - produces lactic acid by fermentating sugars via glycolysis"),
  bullet("Aciduricity - survives at pH as low as 4.5 where other bacteria die"),
  bullet("Bacteriocins (mutacins) - suppresses competing bacteria, dominates caries plaque"),
  bullet("Antigen I/II (SpaP) - mediates adhesion to salivary pellicle"),

  h3("Role in Dental Caries", MED_BLUE),
  bullet("Initiates early caries lesion - demineralization begins when plaque pH drops below 5.5"),
  bullet("Transmission - primarily from mother to child (vertical transmission) during infancy"),
  bullet("ECC link - early colonization (window of infectivity 19-31 months) increases lifetime caries risk"),

  h3("Clinical Relevance + Conclusion", TEAL),
  body("Reducing S. mutans transmission from caregivers (avoiding shared utensils, treating mother's caries) is a key preventive strategy in pediatric dentistry. Mutans streptococci counts (Dentocult SM test) can predict caries risk in children."),

  pageBreak()
);

// ══════════════════════════════════
// SECTION 7: GOLDEN RULES CHEATSHEET
// ══════════════════════════════════
children.push(
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  twoCol(
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      "✓  Always start with a definition",
      "✓  Use subheadings for every section",
      "✓  Write normal values and numbers wherever possible",
      "✓  Draw at least 1 labeled diagram per LEQ",
      "✓  Include dental/pediatric relevance in every answer",
      "✓  Use tables for classifications and comparisons",
      "✓  Underline key terms (e.g. enzyme names, values)",
      "✓  Write legibly - rushed scrawl loses marks",
      "✓  If you forget content - write headings & 1-line points",
      "✓  End with a 1-sentence conclusion"
    ],
    [
      "✗  Do NOT write continuous paragraphs with no headings",
      "✗  Do NOT start with 'According to...' or filler sentences",
      "✗  Do NOT repeat the question back in your intro",
      "✗  Do NOT skip the dental relevance section",
      "✗  Do NOT use abbreviations without defining them first",
      "✗  Do NOT leave blank pages - attempt all questions",
      "✗  Do NOT write over the time limit for one question",
      "✗  Do NOT add new points in the conclusion",
      "✗  Do NOT ignore classification - examiners love tables",
      "✗  Do NOT draw unlabeled diagrams - they add no marks"
    ],
    LIGHT_TEAL, LIGHT_RED,
    "DO ✓", "DON'T ✗"
  ),

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      ...([
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        ["BODY", "4-5 subheadings + diagram (12-15 lines)", "3-4 subheadings + diagram optional (6-8 lines)"],
        ["DENTAL RELEVANCE", "3-4 lines - always include", "1-2 lines - always include"],
        ["CONCLUSION", "1-2 lines summary", "1 sentence"],
        ["TOTAL TIME", "15 minutes", "7 minutes"]
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    spacing: { before: 160, after: 60 },
    shading: { type: ShadingType.SOLID, color: DARK_BLUE, fill: DARK_BLUE },
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    shading: { type: ShadingType.SOLID, color: DARK_BLUE, fill: DARK_BLUE },
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const RED_DARK   = "8B1A1A";
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// ════════════════════════════════════════════
// QUESTION DATA — ALL 8 SUBJECTS
// ════════════════════════════════════════════
const sections = [
  {
    subject: "ANATOMY",
    color: MED_BLUE,
    leqs: [
      { q: "Describe the development of the mandible. Add a note on anomalies of mandibular development.", hint: "Meckel's cartilage, intramembranous ossification, secondary cartilages (condylar, coronoid, symphyseal), clinical significance" },
      { q: "Describe the trigeminal nerve with its branches and distribution. Discuss its clinical relevance in dentistry.", hint: "3 divisions (V1, V2, V3), ganglia, sensory/motor roots, local anesthesia blocks, trigeminal neuralgia" },
      { q: "Describe the development of the palate. What are the consequences of failure of fusion?", hint: "Primary palate (premaxilla), secondary palate, fusion at 8-12 weeks, cleft lip/palate types" },
      { q: "Write about the parotid gland - its anatomy, relations, and duct. What is Frey's syndrome?", hint: "Location, capsule, Stensen's duct, facial nerve relations, auriculotemporal nerve" }
    ],
    seqs: [
      { q: "Briefly describe the temporomandibular joint.", hint: "Disc, capsule, ligaments, movements, muscles of mastication" },
      { q: "Write a short note on the lymphatic drainage of the tongue.", hint: "Tip (submental), lateral (submandibular), posterior (deep cervical)" },
      { q: "Describe the nerve supply of the tongue.", hint: "Anterior 2/3: lingual + chorda tympani; posterior 1/3: glossopharyngeal" },
      { q: "Write a short note on the submandibular gland.", hint: "Wharton's duct, lingual nerve loop, floor of mouth" },
      { q: "Describe the development of the face.", hint: "Frontonasal process, maxillary & mandibular prominences, fusion timeline" },
      { q: "Write a short note on the pterygomandibular space.", hint: "Boundaries, contents, relevance to IANB" }
    ]
  },
  {
    subject: "PHYSIOLOGY",
    color: TEAL,
    leqs: [
      { q: "Describe the composition and functions of saliva. Add a note on its role in the prevention of dental caries.", hint: "Serous & mucous glands, electrolytes, proteins (amylase, IgA, lactoferrin, mucins), buffering, remineralization" },
      { q: "Define cardiac output. Describe the factors that affect cardiac output and its clinical significance.", hint: "CO = HR × SV; preload, afterload, contractility; Starling's law; relevance to medically compromised child patients" },
      { q: "Describe the mechanism of blood coagulation. Discuss the role of platelets in hemostasis.", hint: "Intrinsic & extrinsic pathways, common pathway, fibrinogen to fibrin, platelet plug" }
    ],
    seqs: [
      { q: "Write a short note on the control of salivary secretion.", hint: "Parasympathetic (chorda tympani, auriculotemporal), sympathetic, reflex arcs" },
      { q: "What is the Stephan curve? Explain its significance.", hint: "pH drop after sugar, critical pH 5.5, remineralization window, fluoride effect" },
      { q: "Describe skeletal growth assessment methods.", hint: "CVM, hand-wrist radiograph, dental age, chronological age" },
      { q: "Write a short note on platelet count and its significance in dental practice.", hint: "Normal 1.5-4 lakh/mm3, thrombocytopenia, pre-extraction screening" },
      { q: "Describe the regulation of body growth.", hint: "GH, IGF-1, thyroid hormones, sex hormones, nutrition" }
    ]
  },
  {
    subject: "BIOCHEMISTRY",
    color: ORANGE,
    leqs: [
      { q: "Describe the mechanism of action of fluoride in caries prevention. Discuss recommended dosage and toxicity.", hint: "Fluorapatite formation, enolase inhibition, effect on S. mutans, optimal level 0.7-1 ppm, acute vs chronic toxicity" },
      { q: "Classify vitamins. Describe the role of fat-soluble vitamins in oral health and deficiency manifestations.", hint: "Vitamin A (enamel hypoplasia), D (rickets, calcification), K (clotting), E (antioxidant)" },
      { q: "Describe the metabolism of carbohydrates and its relationship to dental caries.", hint: "Glycolysis, fermentable carbohydrates, acid production, plaque pH, role of sucrose, ECC" }
    ],
    seqs: [
      { q: "Write a short note on Vitamin C and its oral manifestations of deficiency.", hint: "Scurvy, collagen synthesis, bleeding gums, wound healing" },
      { q: "Describe the role of calcium and phosphorus in tooth development.", hint: "Hydroxyapatite, mineralization, Ca:P ratio, dietary sources" },
      { q: "Write a short note on Vitamin D deficiency and its dental effects.", hint: "Hypocalcification, enamel hypoplasia, rickets, delayed eruption" },
      { q: "What is dental plaque? Describe its biochemical composition.", hint: "Pellicle, early colonizers, matrix (polysaccharides, proteins), EPS" },
      { q: "Write a short note on iron deficiency anemia and its oral manifestations.", hint: "Angular cheilitis, atrophic glossitis, pallor of mucosa" }
    ]
  },
  {
    subject: "MICROBIOLOGY",
    color: RED_DARK,
    leqs: [
      { q: "Describe Streptococcus mutans - its properties, virulence factors, and role in initiation and progression of dental caries.", hint: "Gram +ve cocci, acidogenic/aciduric, glucosyltransferase, glucan synthesis, biofilm, mutacin" },
      { q: "Describe the normal oral microflora. How does it change in early childhood caries?", hint: "400+ species, Streptococci, Lactobacilli, Actinomyces, Prevotella, ECC microbial shift" },
      { q: "Describe the structure and life cycle of Hepatitis B virus. How is cross-infection prevented in a pediatric dental clinic?", hint: "HBsAg, HBcAg, HBeAg, Dane particle, universal precautions, sterilization, vaccination" }
    ],
    seqs: [
      { q: "Write a short note on secretory IgA (sIgA) and its role in oral immunity.", hint: "J chain, secretory component, salivary IgA, agglutination, first line defense" },
      { q: "Write a short note on Lactobacilli and dental caries.", hint: "Aciduric, progress lesion, Snyder test, Lactobacillus count" },
      { q: "Describe sterilization methods used in a dental clinic.", hint: "Autoclave, dry heat, chemical, EO gas, glutaraldehyde, Spaulding classification" },
      { q: "Write a short note on Candida albicans in the oral cavity.", hint: "Oral candidiasis, predisposing factors, denture stomatitis, neonatal candidiasis" },
      { q: "Describe the oral manifestations of HIV infection in children.", hint: "Candidiasis, LGE, herpes, hairy leukoplakia, parotid enlargement" }
    ]
  },
  {
    subject: "PATHOLOGY",
    color: DARK_BLUE,
    leqs: [
      { q: "Describe the process of acute inflammation. What are local and systemic features? How does it differ from chronic inflammation?", hint: "Vascular changes, cellular events, mediators (histamine, prostaglandins, complement), exudate, resolution vs chronicity" },
      { q: "Classify and describe the immune system. What is the role of cell-mediated immunity in oral infections?", hint: "Innate vs adaptive, T and B lymphocytes, MHC, cytokines, CD4/CD8, herpetic infections" }
    ],
    seqs: [
      { q: "Write a short note on wound healing - primary vs secondary intention.", hint: "Phases (hemostasis, inflammatory, proliferative, remodeling), granulation tissue, scar" },
      { q: "Describe the role of eosinophils.", hint: "Antiparasitic, allergic reactions, major basic protein" },
      { q: "Write a short note on spread of dental infection.", hint: "Periapical abscess, Ludwig's angina, fascial spaces, cavernous sinus thrombosis" },
      { q: "Write a short note on tumor markers.", hint: "AFP, CEA, PSA, CA-125, SCCA for oral cancer" }
    ]
  },
  {
    subject: "PHARMACOLOGY",
    color: GREEN,
    leqs: [
      { q: "Classify and describe local anesthetics used in pediatric dentistry. Discuss their mechanism of action, dosage, and complications.", hint: "Amide vs ester, lignocaine (max dose 4.4 mg/kg in children), articaine, bupivacaine, Na+ channel blockade, toxic dose, overdose management" },
      { q: "Describe the pharmacology of antibiotics used in pediatric dental infections. Discuss antibiotic prophylaxis in children with cardiac conditions.", hint: "Amoxicillin (first line), metronidazole (anaerobes), clindamycin (allergy), AHA prophylaxis protocol, doses in children" },
      { q: "Classify analgesics. Describe the use of analgesics in pediatric dental pain management.", hint: "Paracetamol (safest), ibuprofen (anti-inflammatory), aspirin (contraindicated <12 yrs - Reye syndrome), doses by weight, NSAIDs mechanism" }
    ],
    seqs: [
      { q: "Write a short note on conscious sedation in pediatric dentistry.", hint: "Midazolam (oral/IV), nitrous oxide, chloral hydrate, monitoring, indications, contraindications" },
      { q: "Write a short note on fluoride as a pharmacological agent.", hint: "Systemic vs topical, mechanism, dose schedule (Fluoride Dietary Supplement schedule), toxicity" },
      { q: "Describe the pharmacology of nitrous oxide in dentistry.", hint: "MAC, mechanism, scavenging, advantages (anxiolysis, analgesia), contraindications, recovery" },
      { q: "Write a short note on drug interactions relevant to pediatric dentistry.", hint: "Antibiotics + OCP, LA + beta blockers, NSAIDs + anticoagulants, paracetamol + hepatotoxic drugs" },
      { q: "Describe the management of anaphylaxis in a dental clinic.", hint: "Adrenaline 0.01 mg/kg IM, airway, oxygen, antihistamine, steroids, call emergency services" },
      { q: "Write a short note on topical fluoride agents used in pediatric dentistry.", hint: "NaF varnish (Duraphat), APF gel, silver diamine fluoride (SDF), concentrations, application protocol" }
    ]
  },
  {
    subject: "GENETICS",
    color: PURPLE,
    leqs: [
      { q: "Describe the structure of DNA. Explain transcription and translation with their relevance to oral diseases.", hint: "Double helix, Watson-Crick base pairs, mRNA, tRNA, codons/anticodons, protein synthesis, mutations in amelogenin causing AI" },
      { q: "Classify genetic disorders. Describe the genetic basis of cleft lip and palate.", hint: "Autosomal dominant/recessive, X-linked, multifactorial inheritance, chromosomal (trisomy 21), TBX22, IRF6 mutations, syndromic vs non-syndromic CLP" },
      { q: "Describe the chromosomal basis of Down syndrome. Discuss its oral and dental manifestations.", hint: "Trisomy 21, non-disjunction, translocation, mosaicism, macroglossia, delayed eruption, hypodontia, class III, high caries rate, periodontal disease" }
    ],
    seqs: [
      { q: "Write a short note on amelogenesis imperfecta - genetic basis and classification.", hint: "AMELX, ENAM, FAM20A mutations, hypoplastic/hypomaturation/hypocalcified types, inheritance patterns" },
      { q: "Write a short note on dentinogenesis imperfecta - genetics and clinical features.", hint: "DSPP mutation, AD inheritance, shields classification, amber/blue-grey teeth, pulp obliteration" },
      { q: "Describe the oral manifestations of Turner syndrome.", hint: "45,XO, enamel hypoplasia, delayed eruption, hypodontia, malocclusion" },
      { q: "Write a short note on Treacher Collins syndrome.", hint: "TCOF1 gene, AD, mandibular hypoplasia, coloboma, hearing loss, dental crowding" },
      { q: "Write a short note on ectodermal dysplasia.", hint: "EDA/EDAR genes, anhydrotic type, hypodontia/anodontia, hypotrichosis, hypohidrosis, early implant planning" },
      { q: "Describe the concept of genetic counseling in pediatric dentistry.", hint: "Risk assessment, pedigree analysis, recurrence risk, prenatal diagnosis, indications in dental genetics" }
    ]
  },
  {
    subject: "RESEARCH METHODOLOGY & BIOSTATISTICS",
    color: "7B3F00",
    leqs: [
      { q: "Define research. Classify research designs used in dentistry. Describe a randomized controlled trial (RCT) with its advantages and limitations.", hint: "Observational vs experimental, cohort/case-control/cross-sectional, RCT - randomization, blinding (single/double), control group, intention-to-treat, selection bias, CONSORT guidelines" },
      { q: "Describe the measures of central tendency and dispersion. How are they applied in dental research?", hint: "Mean, median, mode; range, variance, standard deviation, SE; normal distribution, skewed data; when to use which measure - e.g. median for DMFT data" },
      { q: "What is a null hypothesis? Describe types of errors in hypothesis testing. Explain p-value and confidence intervals.", hint: "H0, H1, Type I error (alpha, false positive), Type II error (beta, false positive), p < 0.05, 95% CI, statistical vs clinical significance" }
    ],
    seqs: [
      { q: "Write a short note on the DMFT / dmft index.", hint: "WHO criteria, permanent vs primary dentition, components (D, M, F), uses in epidemiology, limitations" },
      { q: "Describe sampling methods used in dental research.", hint: "Random (simple, stratified, cluster, systematic), non-random (convenience, purposive), sampling error, sample size calculation" },
      { q: "Write a short note on the chi-square test.", hint: "Non-parametric, tests association between categorical variables, contingency table, degrees of freedom, expected vs observed frequency" },
      { q: "Write a short note on sensitivity and specificity.", hint: "Sensitivity = TP/(TP+FN), Specificity = TN/(TN+FP), ROC curve, PPV, NPV, screening vs diagnostic tests" },
      { q: "Write a short note on ethical principles in dental research.", hint: "Declaration of Helsinki, Belmont Report (autonomy, beneficence, justice), informed consent, IRB/IEC approval, confidentiality" },
      { q: "Write a short note on bias in research and how to minimize it.", hint: "Selection bias, information bias, confounding, recall bias; randomization, blinding, matching, stratification as controls" }
    ]
  }
];

// ════════════════════════════════════════════
// MODEL QUESTION PAPER DATA
// ════════════════════════════════════════════
const modelPaper = {
  leqs: [
    { num: 1, q: "Describe the composition and functions of saliva. Add a note on its role in prevention of dental caries.", subject: "Physiology", marks: 10 },
    { num: 2, q: "Describe the mechanism of action of fluoride in caries prevention. Discuss recommended dosage and toxicity.", subject: "Biochemistry", marks: 10 }
  ],
  seqs: [
    { num: 1, q: "Development of the mandible.", subject: "Anatomy", marks: 5 },
    { num: 2, q: "Streptococcus mutans and dental caries.", subject: "Microbiology", marks: 5 },
    { num: 3, q: "Conscious sedation in pediatric dentistry.", subject: "Pharmacology", marks: 5 },
    { num: 4, q: "Write a short note on Down syndrome - oral and dental manifestations.", subject: "Genetics", marks: 5 },
    { num: 5, q: "Write a short note on the DMFT/dmft index.", subject: "Research Methodology", marks: 5 },
    { num: 6, q: "Acute inflammation - vascular changes and mediators.", subject: "Pathology", marks: 5 },
    { num: 7, q: "Stephan curve - draw and explain.", subject: "Physiology", marks: 5 },
    { num: 8, q: "Write a short note on amelogenesis imperfecta.", subject: "Genetics", marks: 5 }
  ]
};

// ════════════════════════════════════════════
// BUILD DOCUMENT
// ════════════════════════════════════════════
const children = [];

// ── COVER ──
children.push(
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);

// ── CONTENTS TABLE ──
children.push(
  sectionHeader("CONTENTS"),
  spacer(100),
  new Table({
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    rows: [
      headerRow(["#", "Subject", "LEQs", "SEQs"]),
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    ]
  }),
  pageBreak()
);

// ── QUESTION SECTIONS ──
for (const sec of sections) {
  children.push(sectionHeader(`SUBJECT: ${sec.subject}`, sec.color));

  // LEQs
  children.push(subjectBanner("Section A — Long Essay Questions (LEQ) | 10 Marks | 15 min each", sec.color));
  sec.leqs.forEach((item, idx) => {
    children.push(qNumber(idx+1, "LEQ", 10), qText(item.q), hintLine(item.hint), spacer(60), answerBox(), spacer(100));
  });

  // SEQs
  children.push(spacer(100), subjectBanner("Section B — Short Essay Questions (SEQ) | 5 Marks | 7 min each", sec.color));
  sec.seqs.forEach((item, idx) => {
    children.push(qNumber(idx+1, "SEQ", 5), qText(item.q), hintLine(item.hint), spacer(40), answerBox(), spacer(80));
  });

  children.push(pageBreak());
}

// ════════════════════════════════════════════
// MODEL QUESTION PAPER
// ════════════════════════════════════════════
children.push(
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  new Paragraph({ alignment: AlignmentType.CENTER, spacing: { before: 0, after: 0 }, shading: { type: ShadingType.SOLID, color: MED_BLUE, fill: MED_BLUE }, children: [new TextRun({ text: "   BASIC SCIENCES (Applied Basic Medical Sciences)   ", size: 20, color: LIGHT_BLUE, font: "Calibri" })] }),
  new Paragraph({ alignment: AlignmentType.CENTER, spacing: { before: 0, after: 0 }, shading: { type: ShadingType.SOLID, color: MED_BLUE, fill: MED_BLUE }, children: [new TextRun({ text: "   Branch: Pediatric and Preventive Dentistry   ", size: 20, color: LIGHT_BLUE, font: "Calibri" })] }),
  spacer(80),

  // Exam details table
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  spacer(80),

  // Instructions
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  spacer(120),

  // SECTION A
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  ...modelPaper.leqs.map(item => [
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      new TextRun({ text: `Q${item.num}.  `, bold: true, size: 26, color: DARK_BLUE, font: "Calibri" }),
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    answerBox(),
    spacer(80)
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  spacer(120),

  // SECTION B
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  new Paragraph({ spacing: { before: 60, after: 80 }, children: [new TextRun({ text: "Attempt any EIGHT questions. Each question carries 5 marks.", size: 20, color: MID_GRAY, italics: true, font: "Calibri" })] }),

  ...modelPaper.seqs.map(item => [
    new Paragraph({ spacing: { before: 160, after: 60 }, children: [
      new TextRun({ text: `Q${item.num}.  `, bold: true, size: 24, color: TEAL, font: "Calibri" }),
      new TextRun({ text: item.q, size: 22, color: DARK_GRAY, font: "Calibri" }),
      new TextRun({ text: `   [${item.marks} marks] `, size: 20, color: GOLD, font: "Calibri" }),
      new TextRun({ text: `(${item.subject})`, size: 18, color: MID_GRAY, italics: true, font: "Calibri" })
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    answerBox(),
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  spacer(200),
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);

// ── PACK ──
const doc = new Document({
  creator: "Orris AI",
  title: "MDS Basic Science Complete Question Bank v2 - Pedodontics",
  sections: [{ children }]
});

Packer.toBuffer(doc).then(buf => {
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  console.log("Done");
}).catch(e => { console.error(e); process.exit(1); });

const {
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} = require('docx');
const fs = require('fs');

// ── PALETTE ──
const DARK_BLUE  = "1B3A6B";
const MED_BLUE   = "2E6DA4";
const LIGHT_BLUE = "D6E4F0";
const TEAL       = "1A7A6B";
const LIGHT_TEAL = "D0F0EA";
const GOLD       = "C8960C";
const LIGHT_GOLD = "FFF8E7";
const PURPLE     = "5B2A8C";
const LIGHT_PURP = "EDE0FF";
const GREEN      = "1A6B3A";
const LIGHT_GRN  = "D0F0DF";
const ORANGE     = "B85C00";
const LIGHT_ORG  = "FFF0E0";
const WHITE      = "FFFFFF";
const DARK_GRAY  = "2D2D2D";
const MID_GRAY   = "555555";
const LIGHT_GRAY = "F4F4F4";
const RED_DARK   = "8B1A1A";
const LIGHT_RED  = "FDEAEA";
const BROWN      = "7B3F00";
const LIGHT_BRN  = "FFF3E0";

// ── HELPERS ──
function spacer(pts) { pts = pts||160; return new Paragraph({ spacing: { before: pts, after: 0 }, children: [] }); }
function pageBreak() { return new Paragraph({ children: [new TextRun({ break: 1 })] }); }
function sectionHeader(text, color) {
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}

// ════════════════════════════════════════
// QUESTION DATA — 8 SUBJECTS
// ════════════════════════════════════════
var sections = [
  { subject: "ANATOMY", color: MED_BLUE, leqs: [
    { q: "Describe the development of the mandible. Add a note on anomalies of mandibular development.", hint: "Meckel's cartilage, intramembranous ossification, secondary cartilages (condylar, coronoid, symphyseal), clinical significance" },
    { q: "Describe the trigeminal nerve with its branches and distribution. Discuss its clinical relevance in dentistry.", hint: "3 divisions (V1, V2, V3), ganglia, sensory/motor roots, LA blocks, trigeminal neuralgia" },
    { q: "Describe the development of the palate. What are the consequences of failure of fusion?", hint: "Primary palate (premaxilla), secondary palate, fusion at 8-12 weeks, cleft types" },
    { q: "Write about the parotid gland - anatomy, relations, and duct. What is Frey's syndrome?", hint: "Location, capsule, Stensen's duct, facial nerve, auriculotemporal nerve" }
  ], seqs: [
    { q: "Briefly describe the temporomandibular joint.", hint: "Disc, capsule, ligaments, movements, muscles of mastication" },
    { q: "Write a short note on lymphatic drainage of the tongue.", hint: "Tip (submental), lateral (submandibular), posterior (deep cervical)" },
    { q: "Describe the nerve supply of the tongue.", hint: "Anterior 2/3: lingual + chorda tympani; posterior 1/3: glossopharyngeal" },
    { q: "Write a short note on the submandibular gland.", hint: "Wharton's duct, lingual nerve loop, floor of mouth" },
    { q: "Describe the development of the face.", hint: "Frontonasal process, maxillary & mandibular prominences, fusion timeline" },
    { q: "Write a short note on the pterygomandibular space.", hint: "Boundaries, contents, relevance to IANB" }
  ]},
  { subject: "PHYSIOLOGY", color: TEAL, leqs: [
    { q: "Describe the composition and functions of saliva. Add a note on its role in prevention of dental caries.", hint: "Serous & mucous glands, electrolytes, proteins (amylase, IgA, lactoferrin, mucins), buffering, remineralization" },
    { q: "Define cardiac output. Describe factors affecting it and its clinical significance.", hint: "CO = HR x SV; preload, afterload, contractility; Starling's law; medically compromised patients" },
    { q: "Describe the mechanism of blood coagulation. Discuss the role of platelets in hemostasis.", hint: "Intrinsic & extrinsic pathways, common pathway, fibrinogen to fibrin, platelet plug" }
  ], seqs: [
    { q: "Write a short note on control of salivary secretion.", hint: "Parasympathetic (chorda tympani, auriculotemporal), sympathetic, reflex arcs" },
    { q: "What is the Stephan curve? Explain its significance.", hint: "pH drop after sugar, critical pH 5.5, remineralization window, fluoride effect" },
    { q: "Describe skeletal growth assessment methods.", hint: "CVM, hand-wrist radiograph, dental age, chronological age" },
    { q: "Write a short note on platelet count and its significance in dental practice.", hint: "Normal 1.5-4 lakh/mm3, thrombocytopenia, pre-extraction screening" },
    { q: "Describe the regulation of body growth.", hint: "GH, IGF-1, thyroid hormones, sex hormones, nutrition" }
  ]},
  { subject: "BIOCHEMISTRY", color: ORANGE, leqs: [
    { q: "Describe the mechanism of action of fluoride in caries prevention. Discuss recommended dosage and toxicity.", hint: "Fluorapatite formation, enolase inhibition, S. mutans, optimal level 0.7-1 ppm, acute vs chronic toxicity" },
    { q: "Classify vitamins. Describe fat-soluble vitamins in oral health and deficiency manifestations.", hint: "Vitamin A (enamel hypoplasia), D (rickets), K (clotting), E (antioxidant)" },
    { q: "Describe carbohydrate metabolism and its relationship to dental caries.", hint: "Glycolysis, fermentable carbohydrates, acid production, plaque pH, sucrose, ECC" }
  ], seqs: [
    { q: "Write a short note on Vitamin C and its oral manifestations of deficiency.", hint: "Scurvy, collagen synthesis, bleeding gums, wound healing" },
    { q: "Describe the role of calcium and phosphorus in tooth development.", hint: "Hydroxyapatite, mineralization, Ca:P ratio, dietary sources" },
    { q: "Write a short note on Vitamin D deficiency and dental effects.", hint: "Hypocalcification, enamel hypoplasia, rickets, delayed eruption" },
    { q: "What is dental plaque? Describe its biochemical composition.", hint: "Pellicle, early colonizers, matrix (polysaccharides, proteins), EPS (glucans, fructans)" },
    { q: "Write a short note on iron deficiency anemia and oral manifestations.", hint: "Angular cheilitis, atrophic glossitis, pallor of mucosa" }
  ]},
  { subject: "MICROBIOLOGY", color: RED_DARK, leqs: [
    { q: "Describe Streptococcus mutans - properties, virulence factors, and role in dental caries.", hint: "Gram +ve cocci, acidogenic/aciduric, glucosyltransferase, glucan synthesis, biofilm, mutacin" },
    { q: "Describe the normal oral microflora. How does it change in early childhood caries?", hint: "400+ species, Streptococci, Lactobacilli, Actinomyces, Prevotella, ECC microbial shift" },
    { q: "Describe the structure of Hepatitis B virus. How is cross-infection prevented in a pediatric dental clinic?", hint: "HBsAg, HBcAg, HBeAg, Dane particle, universal precautions, sterilization, vaccination" }
  ], seqs: [
    { q: "Write a short note on secretory IgA (sIgA) and its role in oral immunity.", hint: "J chain, secretory component, salivary IgA, agglutination, first line defense" },
    { q: "Write a short note on Lactobacilli and dental caries.", hint: "Aciduric, progress lesion, Snyder test, Lactobacillus count" },
    { q: "Describe sterilization methods used in a dental clinic.", hint: "Autoclave, dry heat, chemical, EO gas, glutaraldehyde, Spaulding classification" },
    { q: "Write a short note on Candida albicans in the oral cavity.", hint: "Oral candidiasis, predisposing factors, denture stomatitis, neonatal candidiasis" },
    { q: "Describe oral manifestations of HIV infection in children.", hint: "Candidiasis, LGE, herpes, hairy leukoplakia, parotid enlargement" }
  ]},
  { subject: "PATHOLOGY", color: DARK_BLUE, leqs: [
    { q: "Describe the process of acute inflammation. What are local and systemic features? How does it differ from chronic inflammation?", hint: "Vascular changes, cellular events, mediators (histamine, prostaglandins, complement), exudate, resolution vs chronicity" },
    { q: "Classify and describe the immune system. What is the role of cell-mediated immunity in oral infections?", hint: "Innate vs adaptive, T and B lymphocytes, MHC, cytokines, CD4/CD8, herpetic infections" }
  ], seqs: [
    { q: "Write a short note on wound healing - primary vs secondary intention.", hint: "Phases (hemostasis, inflammatory, proliferative, remodeling), granulation tissue, scar" },
    { q: "Describe the role of eosinophils.", hint: "Antiparasitic, allergic reactions, major basic protein" },
    { q: "Write a short note on spread of dental infection.", hint: "Periapical abscess, Ludwig's angina, fascial spaces, cavernous sinus thrombosis" },
    { q: "Write a short note on tumor markers.", hint: "AFP, CEA, PSA, CA-125, SCCA for oral cancer" }
  ]},
  { subject: "PHARMACOLOGY", color: GREEN, leqs: [
    { q: "Classify and describe local anesthetics used in pediatric dentistry. Discuss their mechanism of action, dosage, and complications.", hint: "Amide vs ester, lignocaine (max dose 4.4 mg/kg), articaine, bupivacaine, Na+ channel blockade, toxic dose, overdose management" },
    { q: "Describe the pharmacology of antibiotics used in pediatric dental infections. Discuss antibiotic prophylaxis in children with cardiac conditions.", hint: "Amoxicillin (first line), metronidazole (anaerobes), clindamycin (allergy), AHA prophylaxis protocol, weight-based doses" },
    { q: "Classify analgesics. Describe use of analgesics in pediatric dental pain management.", hint: "Paracetamol (safest), ibuprofen (anti-inflammatory), aspirin (contraindicated <12 yrs - Reye syndrome), weight-based doses, NSAIDs mechanism" }
  ], seqs: [
    { q: "Write a short note on conscious sedation in pediatric dentistry.", hint: "Midazolam (oral/IV), nitrous oxide, chloral hydrate, monitoring, indications, contraindications" },
    { q: "Write a short note on fluoride as a pharmacological agent.", hint: "Systemic vs topical, mechanism, dose schedule, toxicity" },
    { q: "Describe the pharmacology of nitrous oxide in dentistry.", hint: "MAC, mechanism, scavenging, anxiolysis, analgesia, contraindications, recovery" },
    { q: "Write a short note on drug interactions relevant to pediatric dentistry.", hint: "Antibiotics + OCP, LA + beta blockers, NSAIDs + anticoagulants, paracetamol + hepatotoxic drugs" },
    { q: "Describe the management of anaphylaxis in a dental clinic.", hint: "Adrenaline 0.01 mg/kg IM, airway, oxygen, antihistamine, steroids, emergency services" },
    { q: "Write a short note on topical fluoride agents used in pediatric dentistry.", hint: "NaF varnish (Duraphat), APF gel, silver diamine fluoride (SDF), concentrations, application protocol" }
  ]},
  { subject: "GENETICS", color: PURPLE, leqs: [
    { q: "Describe the structure of DNA. Explain transcription and translation with their relevance to oral diseases.", hint: "Double helix, Watson-Crick base pairs, mRNA, tRNA, codons/anticodons, protein synthesis, mutations in amelogenin causing AI" },
    { q: "Classify genetic disorders. Describe the genetic basis of cleft lip and palate.", hint: "Autosomal dominant/recessive, X-linked, multifactorial, chromosomal (trisomy 21), TBX22, IRF6 mutations, syndromic vs non-syndromic CLP" },
    { q: "Describe the chromosomal basis of Down syndrome. Discuss its oral and dental manifestations.", hint: "Trisomy 21, non-disjunction, translocation, mosaicism, macroglossia, delayed eruption, hypodontia, class III, high caries rate, periodontal disease" }
  ], seqs: [
    { q: "Write a short note on amelogenesis imperfecta - genetic basis and classification.", hint: "AMELX, ENAM, FAM20A mutations; hypoplastic/hypomaturation/hypocalcified types; inheritance patterns" },
    { q: "Write a short note on dentinogenesis imperfecta - genetics and clinical features.", hint: "DSPP mutation, AD inheritance, Shields classification, amber/blue-grey teeth, pulp obliteration" },
    { q: "Describe the oral manifestations of Turner syndrome.", hint: "45,XO; enamel hypoplasia, delayed eruption, hypodontia, malocclusion" },
    { q: "Write a short note on Treacher Collins syndrome.", hint: "TCOF1 gene, AD, mandibular hypoplasia, coloboma, hearing loss, dental crowding" },
    { q: "Write a short note on ectodermal dysplasia.", hint: "EDA/EDAR genes, anhydrotic type, hypodontia/anodontia, hypotrichosis, hypohidrosis, early implant planning" },
    { q: "Describe genetic counseling in pediatric dentistry.", hint: "Risk assessment, pedigree analysis, recurrence risk, prenatal diagnosis, indications" }
  ]},
  { subject: "RESEARCH METHODOLOGY & BIOSTATISTICS", color: BROWN, leqs: [
    { q: "Define research. Classify research designs used in dentistry. Describe a randomized controlled trial (RCT) with advantages and limitations.", hint: "Observational vs experimental, cohort/case-control/cross-sectional, RCT - randomization, blinding, control group, intention-to-treat, CONSORT guidelines" },
    { q: "Describe the measures of central tendency and dispersion. How are they applied in dental research?", hint: "Mean, median, mode; range, variance, SD, SE; normal distribution, skewed data; when to use each - e.g. median for DMFT data" },
    { q: "What is a null hypothesis? Describe types of errors in hypothesis testing. Explain p-value and confidence intervals.", hint: "H0, H1, Type I error (alpha - false positive), Type II error (beta), p < 0.05, 95% CI, statistical vs clinical significance" }
  ], seqs: [
    { q: "Write a short note on the DMFT / dmft index.", hint: "WHO criteria, permanent vs primary dentition, D-M-F components, uses in epidemiology, limitations" },
    { q: "Describe sampling methods used in dental research.", hint: "Random (simple, stratified, cluster, systematic), non-random (convenience, purposive), sampling error" },
    { q: "Write a short note on the chi-square test.", hint: "Non-parametric, categorical variables, contingency table, degrees of freedom, expected vs observed" },
    { q: "Write a short note on sensitivity and specificity.", hint: "Sensitivity = TP/(TP+FN), Specificity = TN/(TN+FP), ROC curve, PPV, NPV" },
    { q: "Write a short note on ethical principles in dental research.", hint: "Declaration of Helsinki, Belmont Report (autonomy, beneficence, justice), informed consent, IRB approval" },
    { q: "Write a short note on bias in research and how to minimize it.", hint: "Selection bias, information bias, confounding, recall bias; randomization, blinding, matching" }
  ]}
];

// ════════════════════════════════════════
// MODEL PAPER DATA
// ════════════════════════════════════════
var modelLEQs = [
  { num: 1, q: "Describe the composition and functions of saliva. Add a note on its role in prevention of dental caries.", subject: "Physiology", marks: 10 },
  { num: 2, q: "Describe the mechanism of action of fluoride in caries prevention. Discuss recommended dosage and toxicity.", subject: "Biochemistry", marks: 10 },
  { num: 3, q: "Classify and describe local anesthetics used in pediatric dentistry. Discuss mechanism of action, dosage, and complications.", subject: "Pharmacology", marks: 10 }
];
var modelSEQs = [
  { num: 1, q: "Development of the mandible.", subject: "Anatomy", marks: 5 },
  { num: 2, q: "Streptococcus mutans and dental caries.", subject: "Microbiology", marks: 5 },
  { num: 3, q: "Conscious sedation in pediatric dentistry.", subject: "Pharmacology", marks: 5 },
  { num: 4, q: "Down syndrome - oral and dental manifestations.", subject: "Genetics", marks: 5 },
  { num: 5, q: "The DMFT / dmft index.", subject: "Research Methodology", marks: 5 },
  { num: 6, q: "Acute inflammation - vascular changes and mediators.", subject: "Pathology", marks: 5 },
  { num: 7, q: "Stephan curve - draw and explain.", subject: "Physiology", marks: 5 },
  { num: 8, q: "Amelogenesis imperfecta - genetic basis and clinical features.", subject: "Genetics", marks: 5 }
];

// ════════════════════════════════════════
// BUILD DOCUMENT
// ════════════════════════════════════════
var children = [];

// COVER
children.push(
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  new Paragraph({ alignment: AlignmentType.CENTER, spacing: { before: 80, after: 0 }, shading: { type: ShadingType.SOLID, color: DARK_BLUE, fill: DARK_BLUE }, children: [new TextRun({ text: "Anatomy | Physiology | Biochemistry | Microbiology | Pathology | Pharmacology | Genetics | Research Methodology & Biostatistics", size: 18, color: "8AB8D8", font: "Calibri" })] }),
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);

// CONTENTS
children.push(sectionHeader("CONTENTS"), spacer(100));
var contRows = [headerRow(["#", "Subject", "LEQs", "SEQs"])];
sections.forEach(function(s, i) { contRows.push(dataRow([(i+1).toString(), s.subject, s.leqs.length.toString(), s.seqs.length.toString()], i%2===0 ? LIGHT_GRAY : WHITE)); });
contRows.push(dataRow(["", "MODEL QUESTION PAPER", "3 (attempt 2)", "8"], LIGHT_GOLD));
children.push(new Table({ width: { size: 100, type: WidthType.PERCENTAGE }, rows: contRows }), pageBreak());

// QUESTION SECTIONS
sections.forEach(function(sec) {
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  children.push(subjectBanner("Section A — Long Essay Questions (LEQ) | 10 Marks | 15 min each", sec.color));
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  children.push(spacer(100), subjectBanner("Section B — Short Essay Questions (SEQ) | 5 Marks | 7 min each", sec.color));
  sec.seqs.forEach(function(item, idx) {
    children.push(qNumber(idx+1, "SEQ", 5), qText(item.q), hintLine(item.hint), spacer(40), answerBox(), spacer(80));
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  children.push(pageBreak());
});

// MODEL QUESTION PAPER
children.push(
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  new Paragraph({ alignment: AlignmentType.CENTER, spacing: { before: 0, after: 0 }, shading: { type: ShadingType.SOLID, color: MED_BLUE, fill: MED_BLUE }, children: [new TextRun({ text: "   BASIC SCIENCES (Applied Basic Medical Sciences)   ", size: 20, color: LIGHT_BLUE, font: "Calibri" })] }),
  new Paragraph({ alignment: AlignmentType.CENTER, spacing: { before: 0, after: 0 }, shading: { type: ShadingType.SOLID, color: MED_BLUE, fill: MED_BLUE }, children: [new TextRun({ text: "   Branch: Pediatric and Preventive Dentistry   ", size: 20, color: LIGHT_BLUE, font: "Calibri" })] }),
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modelLEQs.forEach(function(item) {
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      new TextRun({ text: "Q"+item.num+".  ", bold: true, size: 26, color: DARK_BLUE, font: "Calibri" }),
      new TextRun({ text: item.q, size: 22, color: DARK_GRAY, font: "Calibri" }),
      new TextRun({ text: "   ["+item.marks+" marks] ", size: 20, color: GOLD, font: "Calibri" }),
      new TextRun({ text: "("+item.subject+")", size: 18, color: MID_GRAY, italics: true, font: "Calibri" })
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  new Paragraph({ spacing: { before: 60, after: 80 }, children: [new TextRun({ text: "Attempt ALL EIGHT questions. Each question carries 5 marks.  [8 x 5 = 40 marks]", size: 20, color: MID_GRAY, italics: true, font: "Calibri" })] })
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modelSEQs.forEach(function(item) {
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// PACK
var doc = new Document({
  creator: "Orris AI",
  title: "MDS Basic Science Complete Question Bank v2 - Pedodontics",
  sections: [{ children: children }]
});
Packer.toBuffer(doc).then(function(buf) {
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  console.log("Done");
}).catch(function(e) { console.error(e); process.exit(1); });

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    var shade = i%2===0?LIGHT_GRAY:WHITE;
    tableRows.push(new TableRow({children:[
      new TableCell({shading:{type:ShadingType.SOLID,color:shade,fill:shade},margins:{top:60,bottom:60,left:120,right:120},children:[new Paragraph({children:[new TextRun({text:r[0],bold:r[2]||false,size:20,color:DARK_GRAY,font:"Calibri"})]})]  }),
      new TableCell({shading:{type:ShadingType.SOLID,color:shade,fill:shade},margins:{top:60,bottom:60,left:120,right:120},children:[new Paragraph({children:[new TextRun({text:r[1],size:20,color:DARK_GRAY,font:"Calibri"})]})]  })
    ]}));
  });
  return new Table({width:{size:100,type:WidthType.PERCENTAGE},rows:tableRows});
}
function threeColTable(headers,rows) {
  var tableRows = [new TableRow({tableHeader:true,children:headers.map(function(h,i){
    var cols=[MED_BLUE,TEAL,ORANGE];
    return new TableCell({shading:{type:ShadingType.SOLID,color:cols[i],fill:cols[i]},margins:{top:70,bottom:70,left:120,right:120},children:[new Paragraph({children:[new TextRun({text:h,bold:true,color:WHITE,size:20,font:"Calibri"})]})]});
  })})];
  rows.forEach(function(r,i){
    var shade=i%2===0?LIGHT_GRAY:WHITE;
    tableRows.push(new TableRow({children:r.map(function(c){
      return new TableCell({shading:{type:ShadingType.SOLID,color:shade,fill:shade},margins:{top:60,bottom:60,left:120,right:120},children:[new Paragraph({children:[new TextRun({text:c,size:20,color:DARK_GRAY,font:"Calibri"})]})]});
    })}));
  });
  return new Table({width:{size:100,type:WidthType.PERCENTAGE},rows:tableRows});
}
function markScheme(items) {
  // items: array of {point, marks}
  var rows = [new TableRow({tableHeader:true,children:[
    new TableCell({shading:{type:ShadingType.SOLID,color:DARK_BLUE,fill:DARK_BLUE},width:{size:85,type:WidthType.PERCENTAGE},margins:{top:60,bottom:60,left:120,right:120},children:[new Paragraph({children:[new TextRun({text:"Marking Point",bold:true,color:WHITE,size:20,font:"Calibri"})]})]  }),
    new TableCell({shading:{type:ShadingType.SOLID,color:DARK_BLUE,fill:DARK_BLUE},width:{size:15,type:WidthType.PERCENTAGE},margins:{top:60,bottom:60,left:120,right:120},children:[new Paragraph({alignment:AlignmentType.CENTER,children:[new TextRun({text:"Marks",bold:true,color:WHITE,size:20,font:"Calibri"})]})]  })
  ]})];
  var total=0;
  items.forEach(function(item,i){
    var shade=i%2===0?LIGHT_GOLD:WHITE;
    rows.push(new TableRow({children:[
      new TableCell({shading:{type:ShadingType.SOLID,color:shade,fill:shade},margins:{top:60,bottom:60,left:120,right:120},children:[new Paragraph({children:[new TextRun({text:item.point,size:20,color:DARK_GRAY,font:"Calibri"})]})]  }),
      new TableCell({shading:{type:ShadingType.SOLID,color:shade,fill:shade},margins:{top:60,bottom:60,left:120,right:120},children:[new Paragraph({alignment:AlignmentType.CENTER,children:[new TextRun({text:item.marks.toString(),bold:true,size:20,color:GOLD,font:"Calibri"})]})]  })
    ]}));
    total+=item.marks;
  });
  rows.push(new TableRow({children:[
    new TableCell({shading:{type:ShadingType.SOLID,color:LIGHT_BLUE,fill:LIGHT_BLUE},margins:{top:60,bottom:60,left:120,right:120},children:[new Paragraph({children:[new TextRun({text:"TOTAL",bold:true,size:20,color:DARK_BLUE,font:"Calibri"})]})]  }),
    new TableCell({shading:{type:ShadingType.SOLID,color:LIGHT_BLUE,fill:LIGHT_BLUE},margins:{top:60,bottom:60,left:120,right:120},children:[new Paragraph({alignment:AlignmentType.CENTER,children:[new TextRun({text:total.toString(),bold:true,size:20,color:DARK_BLUE,font:"Calibri"})]})]  })
  ]}));
  return new Table({width:{size:100,type:WidthType.PERCENTAGE},rows:rows});
}

// ════════════════════════════════════════════════
// DOCUMENT
// ════════════════════════════════════════════════
var C = []; // children array

// ── COVER ──
C.push(
  new Paragraph({alignment:AlignmentType.CENTER,spacing:{before:400,after:0},shading:{type:ShadingType.SOLID,color:DARK_BLUE,fill:DARK_BLUE},children:[new TextRun({text:"MODEL ANSWER KEY",bold:true,size:64,color:WHITE,font:"Calibri"})]}),
  new Paragraph({alignment:AlignmentType.CENTER,spacing:{before:0,after:0},shading:{type:ShadingType.SOLID,color:DARK_BLUE,fill:DARK_BLUE},children:[new TextRun({text:"MDS BASIC SCIENCES — FIRST YEAR",bold:true,size:36,color:GOLD,font:"Calibri"})]}),
  new Paragraph({alignment:AlignmentType.CENTER,spacing:{before:60,after:0},shading:{type:ShadingType.SOLID,color:DARK_BLUE,fill:DARK_BLUE},children:[new TextRun({text:"Pediatric & Preventive Dentistry",size:26,color:LIGHT_BLUE,font:"Calibri"})]}),
  new Paragraph({alignment:AlignmentType.CENTER,spacing:{before:40,after:0},shading:{type:ShadingType.SOLID,color:DARK_BLUE,fill:DARK_BLUE},children:[new TextRun({text:"PT BD Sharma University of Health Sciences, Rohtak",size:22,color:"A0C4E8",font:"Calibri"})]}),
  new Paragraph({alignment:AlignmentType.CENTER,spacing:{before:80,after:0},shading:{type:ShadingType.SOLID,color:DARK_BLUE,fill:DARK_BLUE},children:[new TextRun({text:"Model Paper: 2 LEQs (10 marks each)  |  8 SEQs (5 marks each)  |  Total: 60 marks",size:20,color:"8AB8D8",font:"Calibri"})]}),
  new Paragraph({alignment:AlignmentType.CENTER,spacing:{before:60,after:200},shading:{type:ShadingType.SOLID,color:DARK_BLUE,fill:DARK_BLUE},children:[new TextRun({text:"Exam: July 21, 2026",size:20,color:GOLD,font:"Calibri"})]}),
  pb()
);

// ── HOW TO USE ──
C.push(
  banner("HOW TO USE THIS ANSWER KEY"),
  sp(80),
  noteBox("Each model answer follows the Intro > Body > Dental Relevance > Conclusion structure. A mark scheme table is included at the end of each answer so you can self-assess. Answers are written at exam-length depth — use them as your benchmark for timed practice.", LIGHT_BLUE, "GUIDE", MED_BLUE),
  sp(100),
  twoColTable(["For LEQs (10 marks)","For SEQs (5 marks)"],[
    ["Read the full model answer carefully","Read the opening line + body points"],
    ["Cover and attempt the question from memory (15 min)","Attempt the question timed (7 min)"],
    ["Compare your answer against the mark scheme","Check your key points against the mark scheme"],
    ["Identify missing headings, values, or dental relevance","Focus on: did you get the definition + 3 key facts + dental relevance?"]
  ]),
  pb()
);

// ════════════════════════════════
// LEQ 1: SALIVA
// ════════════════════════════════
C.push(...qBanner(1,"LEQ","Describe the composition and functions of saliva. Add a note on its role in prevention of dental caries.","Physiology",TEAL));
C.push(sp(80));

C.push(h2("INTRODUCTION",MED_BLUE));
C.push(para("Saliva is a complex biological oral fluid secreted by three pairs of major salivary glands (parotid, submandibular, sublingual) and numerous minor salivary glands scattered throughout the oral mucosa. It is secreted at a rate of approximately 0.5-1.5 litres per day. In the resting state the flow rate is ~0.3 mL/min; stimulated flow reaches 4-5 mL/min."));

C.push(h2("CLASSIFICATION OF SALIVARY GLANDS",MED_BLUE));
C.push(threeColTable(
  ["Gland","Secretion Type","% of Total Saliva"],
  [["Parotid","Serous (watery, enzyme-rich)","25%"],
   ["Submandibular","Mixed — predominantly serous","70%"],
   ["Sublingual","Mucous (viscous, mucin-rich)","5%"],
   ["Minor glands","Predominantly mucous","<5%"]]
));

C.push(h2("COMPOSITION OF SALIVA",MED_BLUE));
C.push(h3("A. Inorganic Components (electrolytes)",TEAL));
C.push(twoColTable(["Ion","Role"],[
  ["Sodium (Na+)","Osmotic balance"],
  ["Potassium (K+)","Higher concentration than plasma; maintains ionic balance"],
  ["Calcium (Ca2+)","Remineralization of enamel; inhibits bacterial growth"],
  ["Phosphate (PO43-)","Remineralization; acts as buffer"],
  ["Bicarbonate (HCO3-)","PRIMARY buffer — neutralizes plaque acid"],
  ["Chloride (Cl-)","Activates salivary amylase"],
  ["Fluoride (F-)","Fluorapatite formation; inhibits demineralization"]
]));
C.push(h3("B. Organic Components (proteins)",TEAL));
C.push(twoColTable(["Protein","Function"],[
  ["Salivary amylase (ptyalin)","Initiates starch digestion; also has antimicrobial properties"],
  ["Mucins (MUC5B, MUC7)","Lubrication of oral surfaces; protects mucosa from desiccation"],
  ["Secretory IgA (sIgA)","Agglutinates bacteria; prevents adhesion to enamel — immune defense"],
  ["Lactoferrin","Chelates iron; bacteriostatic against iron-dependent organisms"],
  ["Lysozyme","Cleaves peptidoglycan in bacterial cell walls"],
  ["Histatins","Antifungal; active against Candida albicans"],
  ["Proline-rich proteins","Bind tannins; regulate Ca/P precipitation; enamel protection"],
  ["Statherin","Inhibits spontaneous precipitation of Ca/P; maintains supersaturation"],
  ["Cystatins","Cysteine protease inhibitors; regulate epithelial turnover"],
  ["Peroxidase (salivary)","Generates hypothiocyanite — antimicrobial system"]
]));

C.push(h2("FUNCTIONS OF SALIVA",MED_BLUE));
C.push(numbered(1,"Lubrication: Mucins coat oral surfaces facilitating speech, mastication, and swallowing. Prevents mucosal trauma."));
C.push(numbered(2,"Digestion: Salivary amylase (alpha-amylase) hydrolyses starch to maltose and dextrins. Lingual lipase initiates fat digestion."));
C.push(numbered(3,"Buffering: Bicarbonate and phosphate buffer systems neutralize plaque acid produced by cariogenic bacteria. Maintains plaque pH above critical 5.5."));
C.push(numbered(4,"Antimicrobial action: sIgA, lysozyme, lactoferrin, histatins, and the salivary peroxidase system collectively inhibit bacterial colonization and fungal growth."));
C.push(numbered(5,"Remineralization: Calcium and phosphate ions in saliva are supersaturated relative to enamel, providing a continuous reservoir for remineralization of early carious lesions."));
C.push(numbered(6,"Cleansing: Salivary flow mechanically washes away food debris and loosely attached bacteria (clearance effect). Low flow = greater caries risk."));
C.push(numbered(7,"Taste facilitation: Dissolves tastant molecules; carries them to taste receptor cells on taste buds."));
C.push(numbered(8,"Wound healing: Growth factors (EGF — epidermal growth factor) in saliva accelerate oral wound healing."));
C.push(numbered(9,"Pellicle formation: Salivary proteins (proline-rich proteins, statherin, mucins) adsorb onto enamel to form the acquired salivary pellicle — a protective protein film."));
C.push(numbered(10,"Tissue repair and maintenance: Keeps oral mucosa moist; prevents xerostomia-associated trauma."));

C.push(h2("ROLE OF SALIVA IN PREVENTION OF DENTAL CARIES",MED_BLUE));
C.push(noteBox("This section is HIGH YIELD — examiners specifically ask for it. Include all 5 mechanisms.", LIGHT_TEAL, "EXAM TIP", TEAL));
C.push(sp(60));
C.push(boldBullet("Buffering","Salivary bicarbonate neutralizes lactic acid produced by cariogenic bacteria (S. mutans, Lactobacilli). Maintains plaque pH above critical level of 5.5 (below which enamel dissolves).",TEAL));
C.push(boldBullet("Remineralization","Calcium and phosphate ions in saliva replenish ions lost from enamel during acid attacks. Fluoride in saliva promotes fluorapatite formation which is more acid-resistant than hydroxyapatite.",TEAL));
C.push(boldBullet("Antimicrobial","sIgA prevents S. mutans from adhering to tooth surfaces. Lysozyme and lactoferrin reduce bacterial counts directly.",TEAL));
C.push(boldBullet("Clearance","Salivary flow washes fermentable carbohydrates from the oral cavity, reducing the substrate available for acid production. This is measured as the 'oral clearance time'.",TEAL));
C.push(boldBullet("Pellicle","The acquired salivary pellicle acts as a diffusion barrier, slowing the rate of enamel acid dissolution.",TEAL));

C.push(h2("DENTAL AND PEDIATRIC RELEVANCE",MED_BLUE));
C.push(para("In infants and young children, salivary IgA levels are immature, making them highly susceptible to early childhood caries (ECC). Xerostomia from medications commonly used in children (antihistamines, antiepileptics, antihypertensives) dramatically reduces all these protective functions and leads to rampant caries. Sjogren's syndrome in older patients and head and neck irradiation ablate salivary function with devastating caries consequences. Measuring salivary flow rate and buffering capacity is used clinically as a caries risk assessment tool."));

C.push(h2("CONCLUSION",MED_BLUE));
C.push(para("Saliva is a multifactorial protective fluid that defends the dentition through buffering, remineralization, antimicrobial action, clearance, and pellicle formation. Quantitative and qualitative reduction in saliva — particularly in young children — is one of the most important local risk factors for dental caries."));

C.push(sp(100));
C.push(h3("MARK SCHEME",GOLD));
C.push(markScheme([
  {point:"Introduction with definition, flow rate, glands",marks:1},
  {point:"Classification table of glands with % contribution",marks:1},
  {point:"Inorganic components correctly listed (minimum 4 ions with roles)",marks:1},
  {point:"Organic components — minimum 5 proteins with functions",marks:2},
  {point:"Functions of saliva — minimum 6 functions described",marks:2},
  {point:"Role in caries prevention — all 5 mechanisms (buffering, remineralization, antimicrobial, clearance, pellicle)",marks:2},
  {point:"Dental/pediatric relevance including ECC, xerostomia, clinical application",marks:1}
]));
C.push(pb());

// ════════════════════════════════
// LEQ 2: FLUORIDE
// ════════════════════════════════
C.push(...qBanner(2,"LEQ","Describe the mechanism of action of fluoride in caries prevention. Discuss recommended dosage and toxicity.","Biochemistry",ORANGE));
C.push(sp(80));

C.push(h2("INTRODUCTION",MED_BLUE));
C.push(para("Fluoride is a halide ion (F−) that at optimal concentrations is the most cost-effective and evidence-based agent available for caries prevention. It acts through multiple mechanisms at both pre-eruptive (systemic) and post-eruptive (topical) stages. The optimal water fluoride level recommended by WHO is 0.7–1.0 ppm (parts per million)."));

C.push(h2("MECHANISM OF ACTION",MED_BLUE));
C.push(h3("1. Fluorapatite Formation (Structural Effect)",TEAL));
C.push(para("Enamel hydroxyapatite: Ca10(PO4)6(OH)2",500));
C.push(para("Fluorapatite:         Ca10(PO4)6F2",500));
C.push(bullet("Fluoride replaces hydroxyl (OH−) groups in hydroxyapatite to form fluorapatite"));
C.push(bullet("Fluorapatite is significantly more resistant to acid dissolution (critical pH 4.5 vs 5.5 for hydroxyapatite)"));
C.push(bullet("Pre-eruptive fluoride incorporation during amelogenesis produces a harder, more acid-resistant enamel surface"));
C.push(bullet("Post-eruptive topical fluoride promotes remineralization of early (white spot) lesions by depositing fluorapatite in demineralized zones"));

C.push(h3("2. Inhibition of Bacterial Enzymes (Antimicrobial Effect)",TEAL));
C.push(bullet("Fluoride at low concentrations inhibits enolase — a key enzyme in glycolysis — reducing acid production by S. mutans and Lactobacilli"));
C.push(bullet("At higher concentrations fluoride inhibits H+-ATPase (proton pump) in bacterial membranes, further reducing acidogenesis and aciduricity"));
C.push(bullet("Inhibition of urease in plaque bacteria reduces ammonia production which would otherwise buffer acid"));

C.push(h3("3. Promotion of Remineralization",TEAL));
C.push(bullet("Fluoride in the oral fluid catalyzes the precipitation of calcium and phosphate onto demineralized enamel"));
C.push(bullet("Even at very low concentrations (0.04 ppm in plaque fluid) fluoride significantly enhances remineralization rate"));
C.push(bullet("This remineralization produces a fluoride-rich enamel surface more resistant to future acid attack"));

C.push(h3("4. Reduction of Enamel Solubility",TEAL));
C.push(bullet("Fluorapatite is 100 times less soluble in acid than hydroxyapatite at pH 5.5"));
C.push(bullet("This directly reduces the rate and depth of enamel demineralization during acid attacks"));

C.push(h2("RECOMMENDED DOSAGE",MED_BLUE));
C.push(h3("A. Systemic Fluoride (Water Fluoridation and Supplements)",TEAL));
C.push(twoColTable(["Age","Fluoride Supplement Dose (if water <0.3 ppm)"],[
  ["0-6 months","None"],
  ["6 months - 3 years","0.25 mg/day"],
  ["3 - 6 years","0.50 mg/day"],
  ["6 - 16 years","1.0 mg/day"],
  ["Optimal water level","0.7 - 1.0 ppm (WHO recommendation)"]
]));
C.push(h3("B. Topical Fluoride Agents and Concentrations",TEAL));
C.push(twoColTable(["Agent","Concentration / Protocol"],[
  ["Fluoride toothpaste (children <3 yrs)","1000 ppm — smear amount"],
  ["Fluoride toothpaste (3-6 yrs)","1000-1450 ppm — pea size"],
  ["Fluoride toothpaste (>6 yrs)","1450 ppm — standard"],
  ["NaF varnish (Duraphat)","22,600 ppm — apply 2-4x/year"],
  ["APF gel","12,300 ppm (1.23%) — 4 min tray application"],
  ["Silver Diamine Fluoride (SDF)","38% (44,800 ppm) — for arresting active caries"]
]));

C.push(h2("TOXICITY",MED_BLUE));
C.push(h3("A. Acute Toxicity",RED_DARK));
C.push(bullet("Certainly toxic dose (CTD): 5 mg/kg body weight (causes definite symptoms)"));
C.push(bullet("Lethal dose (LD50): 32-64 mg/kg body weight"));
C.push(bullet("Symptoms: nausea, vomiting, abdominal pain, hypocalcemia (tetany), hypotension, cardiac arrhythmia, death"));
C.push(bullet("Management: induce vomiting, give calcium gluconate or milk (binds fluoride), hospitalization, supportive care"));

C.push(h3("B. Chronic Toxicity — Dental Fluorosis",RED_DARK));
C.push(twoColTable(["Dean's Fluorosis Index Grade","Description"],[
  ["Normal (0)","Smooth, glossy, cream-white enamel"],
  ["Questionable (0.5)","Few white flecks"],
  ["Very mild (1)","White opaque areas <25% of surface"],
  ["Mild (2)","White opaque areas <50% of surface"],
  ["Moderate (3)","Brown staining; all surfaces affected"],
  ["Severe (4)","Pitting, erosion, brown staining, structural damage"]
]));
C.push(h3("C. Skeletal Fluorosis",RED_DARK));
C.push(bullet("Occurs with water fluoride >4 ppm for prolonged periods"));
C.push(bullet("Crippling skeletal fluorosis: >8-10 ppm; dense, brittle bones; ligament calcification"));

C.push(h2("DENTAL AND PEDIATRIC RELEVANCE",MED_BLUE));
C.push(para("Fluoride is the cornerstone of caries prevention in pediatric dentistry. The key clinical decision is matching the fluoride delivery route (systemic vs topical) to the child's age, caries risk, and local water fluoride level. Over-supplementation in areas with already-fluoridated water causes dental fluorosis. SDF (38%) is particularly valuable in managing early childhood caries (ECC) in uncooperative or pre-cooperative young children as a non-invasive, chair-side arrest agent."));

C.push(h2("CONCLUSION",MED_BLUE));
C.push(para("Fluoride acts through fluorapatite formation, enzyme inhibition, remineralization enhancement, and reduced enamel solubility. At optimal levels it dramatically reduces caries incidence. Exceeding safe doses causes fluorosis; clinical use must always balance efficacy with the risk of toxicity especially in young children."));

C.push(sp(100));
C.push(h3("MARK SCHEME",GOLD));
C.push(markScheme([
  {point:"Introduction with definition and optimal water fluoride level",marks:1},
  {point:"Mechanism 1: Fluorapatite formation — chemical formula, comparison with hydroxyapatite",marks:2},
  {point:"Mechanism 2: Enzyme inhibition (enolase, H+-ATPase) — antimicrobial effect",marks:2},
  {point:"Mechanism 3: Remineralization promotion",marks:1},
  {point:"Recommended dosage — supplements by age AND topical agents with concentrations",marks:2},
  {point:"Acute toxicity — CTD, LD, symptoms, management",marks:1},
  {point:"Chronic toxicity — dental fluorosis (Dean's index) and skeletal fluorosis",marks:1}
]));
C.push(pb());

// ════════════════════════════════
// SEQ 1: MANDIBLE DEVELOPMENT
// ════════════════════════════════
C.push(...qBanner(1,"SEQ","Development of the mandible.","Anatomy",MED_BLUE));
C.push(sp(80));

C.push(h2("INTRODUCTION",MED_BLUE));
C.push(para("The mandible is the first bone of the facial skeleton to ossify. It develops primarily by intramembranous ossification lateral to Meckel's cartilage, which acts as a temporary scaffold but does not directly form bone."));

C.push(h2("TIMELINE OF DEVELOPMENT",MED_BLUE));
C.push(twoColTable(["Week / Stage","Event"],[
  ["Week 6 IU","Meckel's cartilage (1st branchial arch cartilage) forms as a bar of hyaline cartilage"],
  ["Week 6-7","Intramembranous ossification begins lateral and inferior to Meckel's cartilage from a single ossification center near the mental foramen"],
  ["Week 7-8","Bone extends anteriorly and posteriorly; inferior alveolar nerve is enclosed"],
  ["8-12 weeks","Meckel's cartilage regresses; its perichondrium ossifies to form the spine of the sphenoid and sphenomandibular ligament"],
  ["Birth","Mandible has two halves joined by fibrous tissue at the symphysis menti"],
  ["1st year","Symphysis menti fuses completely (by end of year 1)"]
]));

C.push(h2("SECONDARY (ACCESSORY) CARTILAGES",MED_BLUE));
C.push(bullet("Condylar cartilage: Main growth center of the mandible; responsible for vertical and sagittal growth of the ramus. Replaced by endochondral ossification."));
C.push(bullet("Coronoid cartilage: Transient cartilage in the coronoid process; disappears before birth."));
C.push(bullet("Symphyseal cartilage: Small cartilages at symphysis menti; fuse and replaced by bone by end of year 1."));
C.push(bullet("Mental (incisor) cartilage: Forms the mental protuberance area; disappears early."));

C.push(h2("ANOMALIES OF MANDIBULAR DEVELOPMENT",MED_BLUE));
C.push(twoColTable(["Anomaly","Clinical Features"],[
  ["Condylar hyperplasia","Unilateral overdevelopment; facial asymmetry, crossbite"],
  ["Condylar hypoplasia","Underdeveloped condyle; micrognathia, retrognathia"],
  ["Pierre Robin sequence","Micrognathia + glossoptosis + cleft palate; airway obstruction in neonate"],
  ["Treacher Collins syndrome","TCOF1 mutation; bilateral mandibular hypoplasia, absent condyles"],
  ["Hemifacial microsomia","Unilateral mandibular hypoplasia; OMENS classification"],
  ["Agnathia","Complete absence of mandible — extremely rare, lethal"]
]));

C.push(h2("DENTAL RELEVANCE",MED_BLUE));
C.push(para("Understanding mandibular growth at the condyle is the basis of all functional appliance therapy in pediatric dentistry and orthodontics. The condyle is the primary site targeted by myofunctional appliances (e.g., Twin Block, Activator) in Class II skeletal correction during the growth phase. Mandibular development arrests at Meckel's cartilage level — injury to condyle in childhood (e.g., condylar fracture) can cause severe growth disturbance."));

C.push(sp(80));
C.push(h3("MARK SCHEME",GOLD));
C.push(markScheme([
  {point:"Intramembranous ossification; role of Meckel's cartilage; timing",marks:1},
  {point:"Timeline table — 4+ correct events with weeks",marks:1},
  {point:"Secondary cartilages — condylar, coronoid, symphyseal described",marks:1},
  {point:"Minimum 3 anomalies correctly described",marks:1},
  {point:"Dental/pediatric relevance — condylar growth, functional appliances",marks:1}
]));
C.push(pb());

// ════════════════════════════════
// SEQ 2: S. MUTANS
// ════════════════════════════════
C.push(...qBanner(2,"SEQ","Streptococcus mutans and dental caries.","Microbiology",RED_DARK));
C.push(sp(80));

C.push(h2("INTRODUCTION",MED_BLUE));
C.push(para("Streptococcus mutans is a Gram-positive, facultatively anaerobic, non-motile coccus arranged in chains, belonging to the viridans group of streptococci. It is the primary aetiological agent of dental caries due to its unique combination of acidogenicity, aciduricity, and ability to synthesize extracellular polysaccharides."));

C.push(h2("CLASSIFICATION",MED_BLUE));
C.push(bullet("Kingdom: Bacteria | Phylum: Firmicutes | Class: Bacilli | Order: Lactobacillales | Family: Streptococcaceae"));
C.push(bullet("Serotypes: c, e, f, k (serotype c most common in humans; >70% of human isolates)"));

C.push(h2("VIRULENCE FACTORS",MED_BLUE));
C.push(boldBullet("Glucosyltransferases (GTF-B, GTF-C, GTF-D)","Synthesize water-insoluble glucans (mutans) and water-soluble glucans from sucrose. Glucans form the structural scaffold of dental biofilm and mediate irreversible adhesion.",TEAL));
C.push(boldBullet("Antigen I/II (SpaP / PAc)","Cell surface protein that mediates initial adhesion to the salivary pellicle on tooth surfaces.",TEAL));
C.push(boldBullet("Glucan-binding proteins (GBP)","Enhance accumulation of S. mutans within glucan matrix; important for biofilm cohesion.",TEAL));
C.push(boldBullet("Acidogenicity","Ferments sucrose, glucose, fructose via glycolysis to produce lactic acid, lowering plaque pH below 5.5.",TEAL));
C.push(boldBullet("Aciduricity","Maintains metabolic activity and continues acid production at pH as low as 4.5, while other bacteria die.",TEAL));
C.push(boldBullet("Mutacins (bacteriocins)","Kill competing oral bacteria, allowing S. mutans to dominate the caries-active plaque microbiome.",TEAL));
C.push(boldBullet("Intracellular polysaccharides (IPS)","Store glycogen-like reserves; used for continued acid production between meals.",TEAL));

C.push(h2("ROLE IN DENTAL CARIES",MED_BLUE));
C.push(bullet("Colonization: S. mutans is transmitted from primary caregiver to infant during the 'window of infectivity' (19-31 months). Delayed colonization significantly reduces lifetime caries risk."));
C.push(bullet("Biofilm initiation: Adheres to pellicle via SpaP; produces glucans via GTF to anchor entire bacterial community."));
C.push(bullet("Acid production: Rapid drop in plaque pH below 5.5 (critical pH for enamel dissolution) following carbohydrate ingestion — demonstrated by the Stephan curve."));
C.push(bullet("Demineralization: Sustained low pH causes progressive dissolution of enamel hydroxyapatite — initiating the caries lesion."));
C.push(bullet("ECC link: High S. mutans counts in saliva of mother correlate directly with early childhood caries in the child."));

C.push(h2("DENTAL RELEVANCE",MED_BLUE));
C.push(para("Mutans streptococci count in saliva (Dentocult-SM test) is a validated caries risk assessment tool. Preventive strategies targeting S. mutans include: reducing dietary sucrose (its preferred substrate), xylitol (inhibits GTF and S. mutans metabolism), chlorhexidine varnish/gel, fluoride (inhibits enolase), and maternal oral health programs to delay colonization in infants."));

C.push(sp(80));
C.push(h3("MARK SCHEME",GOLD));
C.push(markScheme([
  {point:"Classification (Gram +ve, facultative anaerobe, viridans streptococcus)",marks:1},
  {point:"Virulence factors — minimum 4 with mechanism (GTF, acid, aciduricity, SpaP)",marks:2},
  {point:"Role in caries — colonization, biofilm, acid production, demineralization",marks:1},
  {point:"Pediatric relevance — window of infectivity, ECC, caries risk testing",marks:1}
]));
C.push(pb());

// ════════════════════════════════
// SEQ 3: CONSCIOUS SEDATION
// ════════════════════════════════
C.push(...qBanner(3,"SEQ","Conscious sedation in pediatric dentistry.","Pharmacology",GREEN));
C.push(sp(80));

C.push(h2("DEFINITION",MED_BLUE));
C.push(para("Conscious sedation is a minimally depressed level of consciousness in which the child retains the ability to maintain an independently patent airway and respond purposefully to verbal commands or light tactile stimulation, while anxiety and pain perception are reduced."));
C.push(noteBox("Distinguish from deep sedation/GA: in conscious sedation protective reflexes are maintained. Key safety principle: one level below the intended sedation level the child can always fall.", LIGHT_GOLD, "KEY", GOLD));

C.push(h2("INDICATIONS",MED_BLUE));
C.push(twoColTable(["Indication","Example"],[
  ["Uncooperative young child","Age <3 or pre-cooperative stage"],
  ["Severe dental anxiety/phobia","Failed behaviour management"],
  ["Physical/cognitive disability","Cerebral palsy, autism spectrum disorder"],
  ["Extensive treatment needed","Multiple restorations in one appointment"],
  ["Strong gag reflex","Prevents taking radiographs or impressions"]
]));

C.push(h2("AGENTS USED",MED_BLUE));
C.push(h3("1. Nitrous Oxide (N2O) — Most Common",TEAL));
C.push(bullet("Inhalation; onset 2-3 min; recovery rapid (5 min on 100% O2)"));
C.push(bullet("Dose: titrate from 20% N2O; maximum effective range 30-50%"));
C.push(bullet("Advantages: anxiolysis, mild analgesia, anti-emetic, operator controls depth"));
C.push(bullet("Contraindications: nasal obstruction, first trimester pregnancy, claustrophobia, certain respiratory conditions"));

C.push(h3("2. Midazolam (Oral)",TEAL));
C.push(bullet("Dose: 0.3-0.5 mg/kg orally; onset 15-20 min; duration 45-60 min"));
C.push(bullet("Benzodiazepine — GABAergic anxiolytic, amnesic"));
C.push(bullet("Reversal agent: Flumazenil (0.01 mg/kg IV)"));
C.push(bullet("Commonly combined with N2O for enhanced effect"));

C.push(h3("3. Chloral Hydrate (historical; now rarely used)",TEAL));
C.push(bullet("Dose: 50-75 mg/kg orally; maximum 1g"));
C.push(bullet("CNS depressant; used in very young/uncooperative children"));
C.push(bullet("Being phased out — narrow therapeutic index, no reversal agent"));

C.push(h2("MONITORING REQUIREMENTS",MED_BLUE));
C.push(bullet("Pulse oximetry (SpO2) — continuous throughout"));
C.push(bullet("Heart rate monitoring"));
C.push(bullet("Blood pressure — pre, during, post"));
C.push(bullet("Capnography (end-tidal CO2) — ideal for IV/deep sedation"));
C.push(bullet("Level of consciousness — response to verbal command"));
C.push(bullet("Recovery: child must achieve pre-sedation Aldrete score before discharge"));

C.push(h2("CONTRAINDICATIONS",MED_BLUE));
C.push(bullet("ASA III-IV patients without anaesthetist"), bullet("Airway abnormalities"), bullet("Active respiratory infection"), bullet("Child who cannot cooperate with monitoring"), bullet("Insufficient fasting (NPO status not met)"));

C.push(h2("DENTAL RELEVANCE",MED_BLUE));
C.push(para("Conscious sedation is a behaviour management technique used when conventional non-pharmacological behaviour management (tell-show-do, positive reinforcement) has failed. AAPD (American Academy of Pediatric Dentistry) guidelines recommend the minimum effective dose with continuous monitoring. N2O/O2 inhalation sedation is considered the safest first-line pharmacological behaviour management option in pediatric dentistry."));

C.push(sp(80));
C.push(h3("MARK SCHEME",GOLD));
C.push(markScheme([
  {point:"Correct definition with emphasis on maintained protective reflexes",marks:1},
  {point:"Agents — N2O (dose, onset, reversal, advantages, contraindications)",marks:1},
  {point:"Midazolam — route, dose, reversal agent",marks:1},
  {point:"Monitoring requirements — minimum 3 correct monitors",marks:1},
  {point:"Dental/pediatric context — AAPD guidelines, indications, comparison with GA",marks:1}
]));
C.push(pb());

// ════════════════════════════════
// SEQ 4: DOWN SYNDROME
// ════════════════════════════════
C.push(...qBanner(4,"SEQ","Down syndrome - oral and dental manifestations.","Genetics",PURPLE));
C.push(sp(80));

C.push(h2("INTRODUCTION",MED_BLUE));
C.push(para("Down syndrome (Trisomy 21) is the most common autosomal chromosomal disorder, occurring in approximately 1 in 700 live births. It results from an extra copy of chromosome 21. Three types: non-disjunction trisomy 21 (95%), Robertsonian translocation (4%), and mosaicism (1%)."));

C.push(h2("ORAL AND DENTAL MANIFESTATIONS",MED_BLUE));
C.push(h3("A. Hard Tissue (Teeth)",TEAL));
C.push(twoColTable(["Feature","Details"],[
  ["Hypodontia","Missing teeth — most commonly upper lateral incisors, second premolars"],
  ["Microdontia","Smaller than average tooth size; common in all teeth"],
  ["Taurodontism","Enlarged pulp chamber; apical displacement of pulp floor — classic finding"],
  ["Delayed eruption","Both primary and permanent teeth erupt later than normal"],
  ["Enamel hypoplasia","Developmental defects in enamel formation; increased caries susceptibility"],
  ["Fused teeth / gemination","Occasionally seen in primary dentition"],
  ["Abnormal crown morphology","Short, conical, or misshapen crowns"]
]));
C.push(h3("B. Periodontal",TEAL));
C.push(bullet("Severe early-onset periodontal disease — most significant oral finding"));
C.push(bullet("Generalised aggressive periodontitis even in young children (ages 5-10 years)"));
C.push(bullet("Due to impaired neutrophil function and defective chemotaxis, not simply poor hygiene"));
C.push(bullet("Often leads to premature tooth loss"));

C.push(h3("C. Soft Tissue / Oral Mucosa",TEAL));
C.push(bullet("Macroglossia: Relatively large tongue for oral cavity size — causes anterior open bite, mouth breathing"));
C.push(bullet("Fissured tongue: Deep grooves on dorsal surface — seen in ~50%; increases oral Candida colonization"));
C.push(bullet("Cheilitis: Dry, cracked lips — from mouth breathing"));
C.push(bullet("Geographic tongue (benign migratory glossitis): Patchy depapillation"));
C.push(bullet("High arched palate: Creates crowding and malocclusion"));

C.push(h3("D. Occlusion and Skeletal",TEAL));
C.push(bullet("Class III skeletal relationship: Due to maxillary hypoplasia + macroglossia"));
C.push(bullet("Anterior open bite"));
C.push(bullet("Crossbite (posterior and anterior)"));
C.push(bullet("Crowding due to reduced arch size + late eruption"));

C.push(h3("E. Caries",TEAL));
C.push(bullet("PARADOXICALLY: Caries rate is lower than in general population"));
C.push(bullet("Reasons: elevated salivary pH, higher salivary bicarbonate, different oral flora, delayed eruption reduces exposure time"));
C.push(bullet("However, when caries does occur, it progresses rapidly due to enamel hypoplasia"));

C.push(h2("MANAGEMENT CONSIDERATIONS",MED_BLUE));
C.push(bullet("Risk of atlantoaxial instability: Screen before dental treatment requiring neck extension (up to 15% have this)"));
C.push(bullet("Congenital heart disease in ~40-50%: Antibiotic prophylaxis required per AHA guidelines"));
C.push(bullet("Immune deficiency: Higher susceptibility to infections — aggressive preventive protocol"));

C.push(sp(80));
C.push(h3("MARK SCHEME",GOLD));
C.push(markScheme([
  {point:"Introduction: Trisomy 21, incidence, 3 types",marks:1},
  {point:"Dental hard tissue: taurodontism, hypodontia, delayed eruption, enamel hypoplasia",marks:1},
  {point:"Periodontal disease: aggressive/early-onset, neutrophil defect",marks:1},
  {point:"Soft tissue: macroglossia, fissured tongue, high palate, cheilitis",marks:1},
  {point:"Management considerations: cardiac prophylaxis, atlantoaxial instability, caries paradox",marks:1}
]));
C.push(pb());

// ════════════════════════════════
// SEQ 5: DMFT INDEX
// ════════════════════════════════
C.push(...qBanner(5,"SEQ","The DMFT / dmft index.","Research Methodology",ORANGE));
C.push(sp(80));

C.push(h2("DEFINITION",MED_BLUE));
C.push(para("The DMFT index (Klein, Palmer, Knutson — 1938) is a cumulative index used to measure the caries experience in the permanent dentition of a population or individual. 'dmft' (lowercase) is used for the primary (deciduous) dentition."));

C.push(h2("COMPONENTS",MED_BLUE));
C.push(threeColTable(
  ["Component","Permanent (DMFT)","Primary (dmft)"],
  [
    ["D / d","Decayed teeth — caries present (visible cavity by WHO criteria)","Decayed primary teeth"],
    ["M / m","Missing teeth — extracted due to caries","Extracted/indicated for extraction due to caries"],
    ["F / f","Filled teeth — restored due to caries","Filled primary teeth"],
    ["Range","0 to 28 (or 32 with wisdom teeth)","0 to 20 (primary dentition)"]
  ]
));

C.push(h2("WHO CRITERIA FOR CARIES RECORDING",MED_BLUE));
C.push(bullet("Uses a blunt probe (CPITN probe) — no force; visual + tactile examination"));
C.push(bullet("Examination under adequate light"));
C.push(bullet("Tooth surface must be dried and examined; radiographs not used in epidemiological surveys"));
C.push(bullet("Caries is recorded only when a definite cavity is present (no radiographic or white spot lesions in basic DMFT)"));

C.push(h2("INTERPRETATION",MED_BLUE));
C.push(twoColTable(["Mean DMFT (WHO classification)","Caries Severity"],[
  ["0.0 - 1.1","Very low"],
  ["1.2 - 2.6","Low"],
  ["2.7 - 4.4","Moderate"],
  ["4.5 - 6.5","High"],
  [">6.5","Very high"]
]));

C.push(h2("USES IN DENTAL RESEARCH",MED_BLUE));
C.push(bullet("Epidemiological surveys to assess population caries prevalence and severity"));
C.push(bullet("Monitoring trends in caries over time (secular trends)"));
C.push(bullet("Evaluating fluoridation programs and preventive interventions"));
C.push(bullet("International comparisons (WHO Global Oral Health Data Bank)"));

C.push(h2("LIMITATIONS",MED_BLUE));
C.push(bullet("Does not record early (non-cavitated) lesions or white spot lesions"));
C.push(bullet("Cumulative — cannot show reversal or remineralization"));
C.push(bullet("M component may overestimate caries if teeth extracted for other reasons"));
C.push(bullet("Observer variability — requires calibration to ensure reliability"));
C.push(bullet("No severity gradation — a small pit lesion = a large cavity, both scored as D=1"));

C.push(h2("DENTAL RELEVANCE",MED_BLUE));
C.push(para("In pediatric dentistry both DMFT (permanent) and dmft (primary) indices are used simultaneously for mixed dentition assessment. The 'def' index (decayed, extracted, filled) is an alternative for primary teeth. The SiC (Significant Caries) Index focuses on the one-third of the population with the highest DMFT scores — useful for identifying high-risk groups in children."));

C.push(sp(80));
C.push(h3("MARK SCHEME",GOLD));
C.push(markScheme([
  {point:"Correct definition with originator (Klein, Palmer) and year (1938)",marks:1},
  {point:"Components D/M/F and d/m/f correctly defined with primary vs permanent distinction",marks:1},
  {point:"WHO criteria for caries recording",marks:1},
  {point:"Interpretation table (very low to very high)",marks:1},
  {point:"Minimum 3 limitations",marks:1}
]));
C.push(pb());

// ════════════════════════════════
// SEQ 6: ACUTE INFLAMMATION
// ════════════════════════════════
C.push(...qBanner(6,"SEQ","Acute inflammation - vascular changes and mediators.","Pathology",DARK_BLUE));
C.push(sp(80));

C.push(h2("DEFINITION",MED_BLUE));
C.push(para("Acute inflammation is the immediate, early (hours to days) non-specific vascular and cellular response of living tissue to injury, infection, or irritation. Its purpose is to deliver leukocytes and plasma proteins to the site of injury to eliminate the causative agent and prepare for repair."));
C.push(para("Cardinal signs (Celsus + Virchow): Rubor (redness), Tumor (swelling), Calor (heat), Dolor (pain), Functio laesa (loss of function)."));

C.push(h2("VASCULAR CHANGES",MED_BLUE));
C.push(twoColTable(["Phase","Event","Mechanism"],[
  ["Transient vasoconstriction","Lasts seconds; arteriolar constriction","Neurogenic reflex"],
  ["Vasodilation","Arterioles and capillaries dilate — causes redness and heat","Histamine, prostaglandins (PGE2, PGI2), NO"],
  ["Increased vascular permeability","Protein-rich exudate leaks into tissue — causes swelling","Histamine + bradykinin — endothelial gap formation; leukotrienes (LTC4, LTD4) — sustained leakage"],
  ["Stasis","Blood flow slows as fluid leaves vessels; RBC aggregation","Increased viscosity from plasma loss"],
  ["Leukocyte margination","Neutrophils move to vessel periphery","Selectin-mediated rolling on endothelium"]
].map(function(r){return [r[0],r[1]+" | "+r[2]];})));

C.push(h2("CHEMICAL MEDIATORS",MED_BLUE));
C.push(twoColTable(["Mediator","Source","Key Actions"],[
  ["Histamine","Mast cells, basophils, platelets","Immediate vasodilation + increased permeability; first mediator released"],
  ["Bradykinin","Plasma (kinin system)","Vasodilation, increased permeability, pain (key mediator of inflammatory pain)"],
  ["Prostaglandins (PGE2, PGI2)","Arachidonic acid via COX pathway","Vasodilation, pain sensitization (hyperalgesia), fever — blocked by NSAIDs"],
  ["Leukotrienes (LTC4, LTD4, LTE4)","Arachidonic acid via LOX pathway","Sustained increased permeability, bronchoconstriction; blocked by montelukast"],
  ["Complement (C3a, C5a)","Plasma","C3a/C5a: anaphylatoxins (mast cell degranulation); C5a: chemotaxis of neutrophils"],
  ["TNF-alpha, IL-1","Macrophages","Fever, acute phase protein production (CRP), leukocytosis, endothelial activation"],
  ["Platelet Activating Factor (PAF)","Mast cells, platelets","Platelet aggregation, enhanced permeability"],
  ["Nitric Oxide (NO)","Endothelium, macrophages","Vasodilation; kills bacteria via oxidative mechanisms"]
]));

C.push(h2("CELLULAR EVENTS (EXUDATE FORMATION)",MED_BLUE));
C.push(numbered(1,"Margination: Neutrophils move to vessel wall periphery due to stasis"));
C.push(numbered(2,"Rolling: Neutrophils loosely adhere via selectins (P-selectin on endothelium, L-selectin on neutrophils)"));
C.push(numbered(3,"Adhesion: Firm adhesion via integrins (LFA-1 on neutrophil) + ICAM-1 on endothelium; induced by IL-1 and TNF"));
C.push(numbered(4,"Transmigration (diapedesis): Neutrophils squeeze between endothelial cells using PECAM-1 (CD31)"));
C.push(numbered(5,"Chemotaxis: Directional migration toward injury via C5a, IL-8, LTB4, bacterial peptides (fMLP)"));
C.push(numbered(6,"Phagocytosis: Engulfment of bacteria via opsonization (IgG, C3b) + intracellular killing (MPO, ROI, NO)"));

C.push(h2("DENTAL RELEVANCE",MED_BLUE));
C.push(para("Acute inflammation underlies periapical abscess, pulpitis, acute periodontal abscess, and post-extraction socket inflammation. Understanding prostaglandin-mediated pain allows rational use of NSAIDs (ibuprofen) in pediatric dental pain management. Bradykinin-mediated pain explains why inflamed pulp is difficult to anaesthetize (LA works better in alkaline pH; inflamed tissue is acidic)."));

C.push(sp(80));
C.push(h3("MARK SCHEME",GOLD));
C.push(markScheme([
  {point:"Definition with 5 cardinal signs",marks:1},
  {point:"Vascular changes — transient vasoconstriction, vasodilation, increased permeability, stasis (in order, with mechanism)",marks:1},
  {point:"Mediators — minimum 5 correctly matched to source and action",marks:2},
  {point:"Cellular events — margination, rolling, adhesion, diapedesis, chemotaxis (in order)",marks:1}
]));
C.push(pb());

// ════════════════════════════════
// SEQ 7: STEPHAN CURVE
// ════════════════════════════════
C.push(...qBanner(7,"SEQ","Stephan curve - draw and explain.","Physiology",TEAL));
C.push(sp(80));

C.push(h2("DEFINITION",MED_BLUE));
C.push(para("The Stephan curve (Robert M. Stephan, 1940) is a graphical representation of the change in plaque pH over time following exposure of oral bacteria to fermentable carbohydrates. It demonstrates the dynamic balance between demineralization and remineralization of enamel."));

C.push(h2("THE CURVE — DESCRIPTION",MED_BLUE));
C.push(twoColTable(["Phase","pH / Time","Event"],[
  ["Baseline","pH ~7.0 (resting pH)","Plaque at resting pH; slightly acidic due to normal bacterial metabolism"],
  ["Rapid drop","pH drops to <5.5 within 2-3 min","Cariogenic bacteria (S. mutans, Lactobacilli) ferment sugars to lactic acid via glycolysis"],
  ["Minimum pH","pH 4.5 - 5.0 at ~5-10 min","Maximum acid production; well below critical pH — active demineralization"],
  ["Recovery","pH gradually rises over 20-60 min","Salivary buffer (bicarbonate) neutralizes acid; oral clearance removes substrate"],
  ["Return to baseline","pH ~7.0 at 20-60 min","Remineralization can now occur; fluoride facilitates this process"]
]));

C.push(noteBox("DRAW THE CURVE: Y-axis = pH (range 4-8); X-axis = Time in minutes. Mark: 1) Resting pH (~7), 2) Rapid drop, 3) Critical pH line at 5.5, 4) Minimum pH, 5) Recovery curve. Shade the area below pH 5.5 to show the 'demineralization zone'.", LIGHT_TEAL, "DRAW", TEAL));

C.push(h2("CRITICAL pH",MED_BLUE));
C.push(bullet("Critical pH for enamel = 5.5 (below this, net demineralization of hydroxyapatite occurs)"));
C.push(bullet("Critical pH for dentine = 6.5 (dentine demineralizes at a higher pH than enamel — explains cervical and root caries)"));
C.push(bullet("The area under the curve below critical pH = total demineralization potential of a meal/snack"));

C.push(h2("FACTORS AFFECTING THE CURVE",MED_BLUE));
C.push(twoColTable(["Factor","Effect on Curve"],[
  ["Sucrose","Deepest, most rapid pH drop; worst substrate for Stephan curve"],
  ["Glucose/fructose","Deep drop but slightly slower than sucrose"],
  ["Xylitol","Minimal or no pH drop — not fermented by S. mutans"],
  ["Fluoride","Inhibits enolase; attenuates the depth of pH drop; accelerates recovery"],
  ["Saliva flow","High flow shortens recovery time (better buffering and clearance)"],
  ["Frequency of sugar intake","Repeated exposures prevent return to baseline — sustained below critical pH"],
  ["Plaque thickness","Thick plaque = deeper pH drop (poor buffering penetration)"]
]));

C.push(h2("SIGNIFICANCE IN CARIES PREVENTION",MED_BLUE));
C.push(bullet("Explains why frequency of sugar intake matters more than total amount"));
C.push(bullet("Basis for dietary counseling: 3-4 eating occasions per day allows return to baseline between meals"));
C.push(bullet("Explains mechanism of fluoride's caries preventive action (inhibits acid drop + accelerates remineralization)"));
C.push(bullet("Explains the protective role of cheese, xylitol, and high-buffer foods at end of meals"));

C.push(h2("DENTAL RELEVANCE",MED_BLUE));
C.push(para("The Stephan curve is the fundamental basis for all dietary advice in preventive pediatric dentistry. Advising parents to restrict the frequency (not just quantity) of sugary foods and drinks, particularly at night (no bottle at bedtime = no Stephan curve during sleep when salivary flow is minimal), is grounded in this concept. The prolonged below-critical pH during sleep explains the pathogenesis of early childhood caries (ECC)."));

C.push(sp(80));
C.push(h3("MARK SCHEME",GOLD));
C.push(markScheme([
  {point:"Correct definition with author and year",marks:1},
  {point:"Correct diagram with labeled axes, resting pH, critical pH line, minimum pH, recovery",marks:1},
  {point:"5-phase description of the curve with times",marks:1},
  {point:"Critical pH for enamel (5.5) and dentine (6.5) stated",marks:1},
  {point:"Clinical significance — frequency of intake, fluoride, dietary advice, ECC",marks:1}
]));
C.push(pb());

// ════════════════════════════════
// SEQ 8: AMELOGENESIS IMPERFECTA
// ════════════════════════════════
C.push(...qBanner(8,"SEQ","Amelogenesis imperfecta - genetic basis and clinical features.","Genetics",PURPLE));
C.push(sp(80));

C.push(h2("DEFINITION",MED_BLUE));
C.push(para("Amelogenesis imperfecta (AI) is a group of hereditary conditions affecting the quantity and/or quality of enamel in the absence of a systemic disorder. It affects both primary and permanent dentition and occurs in approximately 1 in 700 to 1 in 14,000 individuals depending on the population."));

C.push(h2("GENETIC BASIS",MED_BLUE));
C.push(twoColTable(["Gene Mutated","Protein / Role","Inheritance Pattern"],[
  ["AMELX (Xp22.3)","Amelogenin — scaffold protein (90% of organic enamel matrix)","X-linked dominant (most common); males more severely affected"],
  ["ENAM (4q21)","Enamelin — regulates mineral crystal growth","Autosomal dominant; most severe hypoplastic AI"],
  ["MMP20 (11q22)","Enamelysin — cleaves enamel matrix proteins during maturation","Autosomal recessive; hypomaturation type"],
  ["KLK4 (19q13)","Kallikrein-4 — degrades organic matrix during maturation","Autosomal recessive; hypomaturation type"],
  ["FAM20A (17q24)","Regulates enamel mineralization signaling","Autosomal recessive; hypocalcified type with gingival fibromatosis"],
  ["WDR72","Enamel maturation stage","Autosomal recessive; hypomaturation"]
]));

C.push(h2("CLASSIFICATION (Witkop, 1988 — Most Used)",MED_BLUE));
C.push(h3("Type I — Hypoplastic AI",TEAL));
C.push(bullet("Reduced quantity of enamel (matrix secretion stage defect)"));
C.push(bullet("Enamel is hard and of normal hardness; teeth look small, thin, pitted, or grooved"));
C.push(bullet("Enamel radiodensity is normal to slightly reduced"));
C.push(bullet("Subtypes: pitted, local, smooth, rough, aplastic"));

C.push(h3("Type II — Hypomaturation AI",TEAL));
C.push(bullet("Normal thickness but enamel is soft, opaque, mottled white/brown-yellow"));
C.push(bullet("Enamel chips and fractures easily from dentin — 'snow-capped' appearance on X-ray"));
C.push(bullet("Radiodensity of enamel approximates dentin (normally enamel is brighter)"));

C.push(h3("Type III — Hypocalcified AI",TEAL));
C.push(bullet("Normal enamel thickness at eruption but extremely soft and friable"));
C.push(bullet("Enamel rapidly lost — teeth appear yellow-brown; dentin exposed early"));
C.push(bullet("Worst prognosis; most severe sensitivity and wear"));
C.push(bullet("Radiolucent enamel on X-ray — less dense than dentin (opposite of normal)"));

C.push(h3("Type IV — Hypomaturation-Hypoplastic with Taurodontism",TEAL));
C.push(bullet("Combined features of Types I and II plus taurodont molars"));

C.push(h2("CLINICAL FEATURES",MED_BLUE));
C.push(bullet("All teeth (primary and permanent) affected"));
C.push(bullet("Severe hypersensitivity to thermal stimuli"));
C.push(bullet("Anterior open bite — common in hypocalcified type (eruption impairment)"));
C.push(bullet("Calculus accumulation — soft enamel retains plaque"));
C.push(bullet("Unaesthetic appearance — major psychosocial impact"));
C.push(bullet("Associated findings: gingival hyperplasia (FAM20A), taurodontism"));

C.push(h2("MANAGEMENT IN PEDIATRIC DENTISTRY",MED_BLUE));
C.push(bullet("Desensitization with fluoride varnish or casein phosphopeptide-amorphous calcium phosphate (CPP-ACP)"));
C.push(bullet("Primary dentition: composite restorations, stainless steel crowns (SSC) for molars"));
C.push(bullet("Permanent dentition: composite/porcelain veneers; full coverage crowns; implants after growth completion"));
C.push(bullet("Genetic counseling for affected families"));

C.push(sp(80));
C.push(h3("MARK SCHEME",GOLD));
C.push(markScheme([
  {point:"Correct definition with incidence",marks:1},
  {point:"Genetic basis — minimum 3 genes (AMELX, ENAM, MMP20) with inheritance pattern",marks:1},
  {point:"Witkop classification — all 3 main types (hypoplastic, hypomaturation, hypocalcified) with distinguishing feature",marks:2},
  {point:"Clinical features and management in pediatric context",marks:1}
]));

// CLOSING
C.push(pb());
C.push(
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