NEET PG previous year questions lens ophthalmology 2019 2020 2021 2022 2023 2024

NEET PG ophthalmology lens cataract previous year MCQ topics high yield 2024 2025

ls /home/daytona/workspace/ 2>/dev/null && echo "---" && node --version

mkdir -p /home/daytona/workspace/lens-flashcards && ls /home/daytona/workspace/l…

~/lens-flashcards/build.js

const pptxgen = require("pptxgenjs");

const pres = new pptxgen();
pres.layout = "LAYOUT_16x9";
pres.title = "Lens MCQ Flashcards - NEET PG 2026";
pres.author = "Orris Medical Mentor";

// ─── COLOR PALETTE ─────────────────────────────────────
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// ─── MCQ DATA ───────────────────────────────────────────
// Each card: { id, tag, question, options:[A,B,C,D], answer:"A"|"B"|"C"|"D", explanation, memory }
const cards = [
  {
    id: 1,
    tag: "Embryology",
    question: "The crystalline lens develops from which embryological layer?",
    options: [
      "A. Neural ectoderm",
      "B. Surface ectoderm",
      "C. Mesoderm",
      "D. Neural crest cells"
    ],
    answer: "B",
    explanation: "The lens develops from the SURFACE ECTODERM via the lens placode → lens pit → lens vesicle sequence. Neural ectoderm forms the retina and optic nerve. Neural crest cells form the stroma of the cornea and uveal tissues. This is a classic embryology MCQ that repeats every 2-3 years.",
    memory: "\"Surface → See → Lens\" — the lens is for SEEING and comes from SURFACE ectoderm"
  },
  {
    id: 2,
    tag: "Embryology",
    question: "The adult lens receives its nutrition from which source?",
    options: [
      "A. Hyaloid artery",
      "B. Central retinal artery",
      "C. Aqueous humor (diffusion)",
      "D. Ciliary arteries"
    ],
    answer: "C",
    explanation: "The adult lens is AVASCULAR and anuclleate (mature fibers). During development, it receives blood from the hyaloid artery via the tunica vasculosa lentis. After the hyaloid artery degenerates in the fetal period, the lens depends entirely on DIFFUSION from aqueous humor (anterior) and vitreous humor (posterior). This makes it metabolically unique — predominantly anaerobic glycolysis.",
    memory: "No vessels, no nerves — lens lives on 'aqueous room service' (diffusion)"
  },
  {
    id: 3,
    tag: "Anatomy",
    question: "Which part of the lens capsule is the THINNEST?",
    options: [
      "A. Anterior pole",
      "B. Anterior equator",
      "C. Posterior pole",
      "D. Equatorial zone"
    ],
    answer: "C",
    explanation: "The POSTERIOR POLE of the lens capsule is the thinnest (~2–4 μm). The anterior capsule near the equator is the thickest (~14 μm). This is clinically crucial: during cataract surgery, the posterior capsule is most vulnerable to rupture. Phacoemulsification is designed to PRESERVE the posterior capsule for IOL support. PCO (after-cataract) occurs when residual cells populate this retained capsule.",
    memory: "POSTERIOR = thinnest. Surgeons fear posterior capsule rupture most!"
  },
  {
    id: 4,
    tag: "Anatomy / Histology",
    question: "The lens epithelium (subcapsular epithelium) is present on which surface of the lens?",
    options: [
      "A. Anterior surface only",
      "B. Posterior surface only",
      "C. Both anterior and posterior surfaces",
      "D. Only at the equator"
    ],
    answer: "A",
    explanation: "Lens epithelium exists ONLY on the ANTERIOR surface — a single layer of cuboidal cells beneath the anterior capsule. There is NO epithelium on the posterior surface. The germinative zone (equatorial region of this anterior epithelium) is where cells divide continuously to form new lens fibers. This is why anterior subcapsular cataract involves fibrous metaplasia of these epithelial cells.",
    memory: "One-sided: epithelium on ANTERIOR only. Posterior = naked capsule."
  },
  {
    id: 5,
    tag: "Physiology",
    question: "A 45-year-old teacher notices difficulty reading the blackboard while wearing reading glasses. She requires a change in spectacle prescription every year. This condition is most likely due to?",
    options: [
      "A. Increasing myopia",
      "B. Ciliary muscle spasm",
      "C. Progressive loss of lens elasticity",
      "D. Zonular laxity"
    ],
    answer: "C",
    explanation: "This is PRESBYOPIA. The primary mechanism is progressive loss of LENS ELASTICITY as the lens nucleus hardens (nuclear sclerosis) — the lens can no longer increase its curvature for near vision. Ciliary muscle weakness may contribute but is secondary. Zonular laxity would cause lens dislocation, not presbyopia. Onset is typically 40–45 years; treatment is convex (+) reading glasses.",
    memory: "Presbyopia = 'Old eye' in Greek. Hard lens = can't squeeze for near = needs PLUS lens"
  },
  {
    id: 6,
    tag: "Physiology",
    question: "A diabetic patient presents with sudden onset of blurred distance vision after a period of very high blood sugar. His glasses that usually help for distance now make vision worse. What is the mechanism?",
    options: [
      "A. Diabetic retinopathy",
      "B. Hyperglycemia → sorbitol → myopic shift",
      "C. Macular edema",
      "D. Cataract formation"
    ],
    answer: "B",
    explanation: "Hyperglycemia → excess glucose enters the lens → converted by ALDOSE REDUCTASE to SORBITOL → sorbitol accumulates (impermeable to cell membrane) → OSMOTIC OVERHYDRATION of lens fibers → increased refractive index of nucleus → MYOPIC SHIFT. This causes sudden blurred distance vision. Distance glasses now over-correct. With hypoglycemia, the opposite occurs (hypermetropic shift). This classic 'fluctuating refraction' in diabetics is tested frequently.",
    memory: "HIGH sugar → sorbitol → swollen lens → MYOPIA. LOW sugar → shrunk lens → HYPERMETROPIA"
  },
  {
    id: 7,
    tag: "Age-related Cataract",
    question: "Which type of age-related cataract causes the WORST visual symptoms in bright light and during near work, despite relatively preserved distance visual acuity?",
    options: [
      "A. Nuclear sclerotic cataract",
      "B. Cortical cataract",
      "C. Posterior subcapsular cataract (PSC)",
      "D. Anterior subcapsular cataract"
    ],
    answer: "C",
    explanation: "POSTERIOR SUBCAPSULAR CATARACT (PSC) is located at the nodal point of the eye. It causes: (1) Severe GLARE in bright light / oncoming headlights, (2) Worsened vision in MIOSIS (near work, bright sunlight — pupil constricts exposing the central opacity), (3) Disproportionately poor vision despite relatively preserved distant acuity. PSC is associated with steroids, radiation, diabetes, and retinitis pigmentosa. The vacuolated bladder (Wedl) cells on retroillumination are pathognomonic.",
    memory: "PSC = worst in BRIGHT LIGHT and NEAR WORK = 'pupil shrinks, exposing the opacity'"
  },
  {
    id: 8,
    tag: "Age-related Cataract",
    question: "An elderly patient with nuclear sclerotic cataract says he can now read his newspaper without glasses for the first time in years. This phenomenon is called?",
    options: [
      "A. Accommodation recovery",
      "B. Second sight of the aged",
      "C. Pseudoaccommodation",
      "D. Miotic pupil effect"
    ],
    answer: "B",
    explanation: "'SECOND SIGHT OF THE AGED' — Nuclear sclerosis increases the refractive index of the lens nucleus, causing a MYOPIC SHIFT. Patients who were previously hypermetropic (needing reading glasses) find they can suddenly read without glasses. However, distance vision worsens. This is temporary — as the cataract progresses, all vision declines. This is a classic NEET PG trap: it sounds like vision is improving, but the lens is becoming more cataractous.",
    memory: "Nuclear sclerosis → MYOPIA → hypermetrope reads again → 'Second Sight' — but it's still a cataract!"
  },
  {
    id: 9,
    tag: "Cataract Maturity",
    question: "In which stage of cataract maturity does the IRIS SHADOW test become NEGATIVE (absent shadow)?",
    options: [
      "A. Immature cataract",
      "B. Mature cataract",
      "C. Only Morgagnian cataract",
      "D. Hypermature cataract"
    ],
    answer: "B",
    explanation: "The iris shadow test: a light is shone obliquely on the eye. In IMMATURE cataract (partially opaque), light passing through the clear anterior portion casts a SHADOW of the iris on the opaque posterior portion — POSITIVE shadow. In MATURE cataract (completely opaque), no light can pass through — NO SHADOW (NEGATIVE). In Morgagnian and hypermature cataracts, shadow is also absent. The iris shadow test differentiates mature from immature clinically without instruments.",
    memory: "IMMATURE = shadow PRESENT (clear part allows light). MATURE = shadow ABSENT (full opacity)"
  },
  {
    id: 10,
    tag: "Cataract Maturity",
    question: "A hypermature cataract in which the cortex has liquefied and the nucleus has sunk to the bottom is called?",
    options: [
      "A. Intumescent cataract",
      "B. Morgagnian cataract",
      "C. Brunescent cataract",
      "D. Mature cataract"
    ],
    answer: "B",
    explanation: "MORGAGNIAN CATARACT is a hypermature cataract where the cortex has completely liquefied (milky white fluid), and the brown-black sclerotic nucleus sinks INFERIORLY under gravity. It appears as a dark nucleus floating at the bottom of a white lens. This is one of the most visually striking and high-yield cataract images in NEET PG. Intumescent = swollen (early mature/immature). Brunescent = brown-colored nucleus (advanced nuclear sclerosis).",
    memory: "MORGAGNIAN = Morgan's cataract (the nucleus 'drowns' in liquefied cortex and sinks)"
  },
  {
    id: 11,
    tag: "Systemic Associations",
    question: "A 25-year-old presents with bilateral posterior subcapsular cataract and is found to have haematuria and bilateral sensorineural hearing loss. Slit lamp shows a forward protrusion of the anterior lens surface. Diagnosis?",
    options: [
      "A. Marfan syndrome",
      "B. Alport syndrome",
      "C. Homocystinuria",
      "D. Lowe syndrome"
    ],
    answer: "B",
    explanation: "ALPORT SYNDROME triad: (1) HAEMATURIA (glomerulonephritis — Type IV collagen defect in GBM), (2) SENSORINEURAL DEAFNESS, (3) ANTERIOR LENTICONUS (forward conical protrusion of anterior lens surface → progressive myopia → cataract). X-linked dominant (COL4A5 mutation). Marfan: lens dislocation upward. Homocystinuria: lens dislocation downward + thromboembolism. Lowe: X-linked, amino aciduria + intellectual disability + cataract.",
    memory: "ALPORT: 'A-E-I' — Anterior lenticonus, Ears (deafness), hematUrIa (blood in urine)"
  },
  {
    id: 12,
    tag: "Systemic Associations",
    question: "Sunflower cataract is MOST CHARACTERISTICALLY seen in which condition?",
    options: [
      "A. Diabetes mellitus",
      "B. Wilson's disease",
      "C. Myotonic dystrophy",
      "D. Atopic dermatitis"
    ],
    answer: "B",
    explanation: "SUNFLOWER CATARACT — a disc-shaped, greenish-brown anterior subcapsular opacity with petal-like extensions — is pathognomonic of WILSON'S DISEASE (hepatolenticular degeneration). Copper deposition in the lens creates this pattern. It is also seen in CHALCOSIS (copper IOFB — intraocular foreign body). Wilson's also shows Kayser-Fleischer rings (copper in Descemet's membrane of cornea). The cataract is visible on slit lamp but does not significantly impair vision usually.",
    memory: "Wilson's = 'Wilson SUNFLOWER' + KF rings. Copper deposits make 'flower patterns'"
  },
  {
    id: 13,
    tag: "Systemic Associations",
    question: "Classic 'snowflake' cortical cataract in a 22-year-old is most closely associated with?",
    options: [
      "A. Steroid therapy",
      "B. Diabetes mellitus",
      "C. Myotonic dystrophy",
      "D. Hypoparathyroidism"
    ],
    answer: "B",
    explanation: "CLASSIC DIABETIC CATARACT (snowflake/stellate cortical opacities) occurs in YOUNG diabetics and may mature within a few DAYS — this is the classic/textbook diabetic cataract. It is actually RARE. The COMMON diabetic cataract is nuclear sclerosis in the elderly. Mechanism: glucose → aldose reductase → sorbitol → osmotic cortical vacuoles → frank snowflake opacities. This is a 'classic' question that tests whether you know the difference between the CLASSIC (rare, young) and COMMON (nuclear, elderly) forms.",
    memory: "SNOWFLAKE cataract → Young DIABETIC → Classic form (RARE but heavily tested!)"
  },
  {
    id: 14,
    tag: "Systemic Associations",
    question: "A patient on long-term systemic steroids for nephrotic syndrome develops cataract. Which type is MOST LIKELY?",
    options: [
      "A. Nuclear sclerotic",
      "B. Anterior subcapsular",
      "C. Posterior subcapsular (PSC)",
      "D. Cortical wedge-shaped"
    ],
    answer: "C",
    explanation: "STEROID-INDUCED CATARACT is ALWAYS POSTERIOR SUBCAPSULAR (PSC) — regardless of route (oral, topical eye drops, inhaled). Mechanism: steroids may affect lens epithelial cell metabolism and cause posterior migration of lens epithelial cells → PSC. The PSC due to steroids is characteristically visually debilitating (at the nodal point), causing severe glare and near vision problems. Duration and dose of steroid use correlate with risk. This is one of the most frequently repeated drug-cataract associations.",
    memory: "STEROID → PSC (Posterior SubCapsular). S-S: Steroid → Subcapsular Posterior"
  },
  {
    id: 15,
    tag: "Drug-induced Cataract",
    question: "Long-term chlorpromazine use leads to which type of cataract?",
    options: [
      "A. Posterior subcapsular",
      "B. Anterior star-shaped (stellate) opacity",
      "C. Nuclear brunescent",
      "D. Cortical spoke-like"
    ],
    answer: "B",
    explanation: "CHLORPROMAZINE (a phenothiazine antipsychotic) causes a characteristic ANTERIOR STAR-SHAPED (stellate) opacity in the anterior lens capsule and anterior cortex. Phenothiazines deposit pigment granules in exposed tissues (lens, cornea, skin). This is opposite to steroids (PSC). Memory hook: 'Chlor = CLEAR FRONT gets stars.' Other phenothiazines (thioridazine) affect the RETINA. Long-term miotics like echothiophate can also cause anterior subcapsular cataract.",
    memory: "ChlorPROMazine = FRONT (anterior) STAR. Steroid = BACK (posterior) subcapsular."
  },
  {
    id: 16,
    tag: "Traumatic Cataract",
    question: "A 30-year-old cricketer is hit by a ball on the eye. Slit lamp shows a ring-shaped brownish-red deposit on the anterior lens capsule. What is this called?",
    options: [
      "A. Rosette cataract",
      "B. Vossius ring",
      "C. Sunflower cataract",
      "D. True exfoliation"
    ],
    answer: "B",
    explanation: "VOSSIUS RING — a ring-shaped opacity on the anterior lens capsule at the pupillary margin, resulting from blunt ocular trauma. The iris pigment and uveal tissue are imprinted onto the anterior lens surface at the moment of impact (the iris is crushed against the lens). It is brownish-red due to pigment. It does not significantly affect vision. Rosette cataract = flower/stellate shaped opacity at the posterior sutures (also from blunt trauma). Both are classic traumatic cataract patterns.",
    memory: "VOSSIUS RING = 'iris stamp' on lens after blunt hit. Ring-shaped = iris outline."
  },
  {
    id: 17,
    tag: "Traumatic Cataract",
    question: "A glassblower develops a condition where a thin membrane peels off the ANTERIOR LENS CAPSULE. This is known as?",
    options: [
      "A. Pseudoexfoliation",
      "B. True exfoliation (capsular delamination)",
      "C. Phacomorphic change",
      "D. Anterior subcapsular cataract"
    ],
    answer: "B",
    explanation: "TRUE EXFOLIATION (capsular delamination) — intense INFRARED RADIATION (as in glassblowers, iron foundry workers) causes a thin lamellar sheet to peel off the anterior lens capsule. This is distinct from PSEUDOEXFOLIATION, which is a systemic fibrillopathy where abnormal extracellular material (NOT the capsule itself) is deposited on the lens surface. Glaucoma is UNCOMMON with true exfoliation. True exfoliation can also occur with severe uveitis or trauma.",
    memory: "TRUE exfoliation = CAPSULE PEELS (glassblower, heat). PSEUDO exfoliation = dandruff deposits ON capsule."
  },
  {
    id: 18,
    tag: "Pseudoexfoliation",
    question: "An elderly patient has 'white dandruff-like material' on the anterior lens capsule in a target pattern on slit lamp. Gonioscopy shows Sampaolesi line. What is the MOST LIKELY glaucoma type associated?",
    options: [
      "A. Primary angle closure glaucoma",
      "B. Pigmentary glaucoma",
      "C. Pseudoexfoliative (exfoliative) glaucoma",
      "D. Neovascular glaucoma"
    ],
    answer: "C",
    explanation: "PSEUDOEXFOLIATION SYNDROME is the COMMONEST identifiable cause of open-angle glaucoma worldwide. Features: (1) White flaky material in target pattern on anterior lens capsule (central disc + clear zone + peripheral ring), (2) Sampaolesi line on gonioscopy (pigment anterior to Schwalbe line), (3) Poor pupil dilation, (4) Zonular weakness → difficult cataract surgery. The associated glaucoma (pseudoexfoliative/exfoliative glaucoma) is an open-angle type with very HIGH, fluctuating IOP — often hardest to control medically.",
    memory: "PEX = 'Dandruff on lens + Sampaolesi line + Open angle glaucoma' — the triad!"
  },
  {
    id: 19,
    tag: "Lens Dislocation",
    question: "A 16-year-old tall boy with arachnodactyly, pectus excavatum, and aortic root dilatation is found to have bilateral lens dislocation. In which direction has the lens most likely dislocated?",
    options: [
      "A. Inferonasal",
      "B. Inferotemporal",
      "C. Superotemporal (up and out)",
      "D. Directly downward"
    ],
    answer: "C",
    explanation: "MARFAN SYNDROME — autosomal dominant, FBN1 gene, fibrillin-1 defect → weak zonular fibers → bilateral lens dislocation SUPEROTEMPORAL (upward and outward) in ~60–70% of cases. Associated features: tall stature, arachnodactyly, pectus deformity, aortic root dilatation (risk of aortic dissection), mitral valve prolapse. The lens dislocation direction is the most repeated Marfan MCQ. Remember: Marfan = UPWARD. Homocystinuria = DOWNWARD.",
    memory: "MAR-FAN = Fans above = Lens goes UP (superotemporal). FAN the sky upward!"
  },
  {
    id: 20,
    tag: "Lens Dislocation",
    question: "A 20-year-old with lens dislocation undergoes elective surgery. Post-op he develops massive pulmonary embolism. Which diagnosis should have been screened for pre-operatively?",
    options: [
      "A. Marfan syndrome",
      "B. Weill-Marchesani syndrome",
      "C. Homocystinuria",
      "D. Aniridia"
    ],
    answer: "C",
    explanation: "HOMOCYSTINURIA (CBS gene defect, autosomal recessive) — the lens dislocates INFERONASAL (down and inward). The CRITICAL distinguishing feature is a HIGH RISK OF THROMBOEMBOLIC EVENTS (DVT, pulmonary embolism, stroke) due to abnormal homocysteine causing endothelial damage and platelet aggregation. General anesthesia and surgery should be done with anticoagulation prophylaxis. Also: intellectual disability, marfanoid habitus, fair hair/skin (unlike Marfan). Diet: methionine-restricted + pyridoxine (B6) supplementation.",
    memory: "HOMOCYSTINURIA = DOWNWARD lens + THROMBOSIS risk. 'Goes DOWN, blood CLOTS UP'"
  },
  {
    id: 21,
    tag: "Congenital Cataract",
    question: "A 6-week-old infant has a unilateral dense white cataract (leukocoria). The most important principle guiding the timing of surgery is?",
    options: [
      "A. Prevent glaucoma",
      "B. Prevent amblyopia",
      "C. Wait until child can tolerate GA safely",
      "D. Correct associated systemic disease first"
    ],
    answer: "B",
    explanation: "PREVENTION OF AMBLYOPIA is the critical driving force for urgent surgery in congenital cataract. Dense unilateral cataract deprives the visual cortex of patterned visual input during the critical period of visual development (first weeks to months of life) → STIMULUS DEPRIVATION AMBLYOPIA. This amblyopia is permanent if the cataract is not removed early. Surgery should be done within 6–8 weeks. After surgery, the child needs optical correction (contact lens preferred) AND aggressive patching of the fellow eye to force use of the amblyopic eye.",
    memory: "Congenital cataract URGENCY = 'Race against AMBLYOPIA clock' — operate before cortex is wired wrong"
  },
  {
    id: 22,
    tag: "Congenital Cataract",
    question: "Which congenital cataract is REVERSIBLE with dietary modification?",
    options: [
      "A. Rubella cataract",
      "B. Galactosemia (galactose-1-P uridyltransferase deficiency)",
      "C. Lowe syndrome",
      "D. Down syndrome cataract"
    ],
    answer: "B",
    explanation: "GALACTOSEMIA cataract (Type I — galactose-1-phosphate uridyltransferase deficiency) — excess galactose is converted by aldose reductase to GALACTITOL, which accumulates in the lens → oil-droplet cataract. If detected early and treated with a GALACTOSE-FREE DIET, the cataract can REGRESS. This makes it unique among congenital cataracts. Galactokinase deficiency (Type II, milder) also causes oil-droplet cataract (cataracts only, no systemic effects). Rubella, Lowe, and Down syndrome cataracts are NOT reversible.",
    memory: "GALACTOSEMIA = 'Galactose-free diet = cataract dissolves' — the ONLY reversible congenital cataract!"
  },
  {
    id: 23,
    tag: "Lens-Related Glaucoma",
    question: "A patient with a mature cataract presents with sudden painful red eye, nausea, corneal edema, and IOP of 54 mmHg. Gonioscopy shows CLOSED angle. What is the diagnosis?",
    options: [
      "A. Phacolytic glaucoma",
      "B. Phacomorphic glaucoma",
      "C. Acute primary angle closure glaucoma",
      "D. Neovascular glaucoma"
    ],
    answer: "B",
    explanation: "PHACOMORPHIC GLAUCOMA — the intumescent (swollen) or large mature cataract pushes the iris-lens diaphragm forward → PUPIL BLOCK → acute angle CLOSURE glaucoma. Key: CLOSED ANGLE on gonioscopy. Clinical features identical to acute angle closure: severe pain, redness, corneal oedema, nausea, fixed mid-dilated pupil, IOP >40. Treatment: URGENT cataract extraction (definitive) + medical management to lower IOP before surgery. This is an ophthalmic emergency. Do NOT confuse with phacolytic (OPEN angle).",
    memory: "PhacoMORPHIC = lens MORPHOLOGY (big/swollen) → CLOSES the angle. Emergency!"
  },
  {
    id: 24,
    tag: "Lens-Related Glaucoma",
    question: "A hypermature cataract patient presents with gradual painless loss of vision, IOP 42 mmHg, white fluff in anterior chamber, and macrophages on gonioscopy blocking the trabecular meshwork. Angle is OPEN. Diagnosis?",
    options: [
      "A. Phacomorphic glaucoma",
      "B. Phacolytic glaucoma",
      "C. Phacoanaphylactic uveitis",
      "D. Ghost cell glaucoma"
    ],
    answer: "B",
    explanation: "PHACOLYTIC GLAUCOMA — hypermature/mature cataract leaks lens proteins through the intact capsule. These high-molecular-weight proteins → macrophages engulf them → macrophage-protein complexes BLOCK the TRABECULAR MESHWORK → OPEN angle glaucoma (very high IOP). Signs: white fluff/milky flakes in AC, macrophages on gonioscopy, no cells/flare of uveitis (unlike phacoanaphylactic). Painless progressive IOP rise. Treatment: URGENT cataract extraction. Phacoanaphylactic uveitis = granulomatous UVEITIS after lens rupture (mutton-fat KPs).",
    memory: "PhacoLYTIC = lens LEAKS (lysis) → proteins → macrophages → OPEN angle. Painless, gradual."
  },
  {
    id: 25,
    tag: "Cataract Surgery",
    question: "What is the MOST COMMON late complication of phacoemulsification with IOL implantation?",
    options: [
      "A. IOL dislocation",
      "B. Cystoid macular edema",
      "C. Posterior capsular opacification (PCO)",
      "D. Endophthalmitis"
    ],
    answer: "C",
    explanation: "POSTERIOR CAPSULAR OPACIFICATION (PCO) — also called 'after-cataract' or 'secondary cataract' — is the MOST COMMON late complication of cataract surgery. Residual lens epithelial cells (from the germinative zone) migrate posteriorly and populate the retained posterior capsule → form Elschnig pearls (bladder/Wedl cells) → PCO. Presents: months to years post-op with painless gradual visual loss (identical to original cataract). Treatment: Nd:YAG LASER posterior capsulotomy (quick, outpatient, definitive). Endophthalmitis is most feared early complication (not late).",
    memory: "PCO = 'cataract comes back ghost' on the retained capsule. Treat with YAG LASER."
  },
  {
    id: 26,
    tag: "Cataract Surgery",
    question: "After uncomplicated cataract surgery, a patient is left aphakic (no IOL placed). What is the POWER of the corrective spectacle lens needed, and what is its most significant complication?",
    options: [
      "A. +3D; myopia induced",
      "B. +10D; ring scotoma",
      "C. +10D; barrel distortion only",
      "D. −10D; ring scotoma"
    ],
    answer: "B",
    explanation: "APHAKIC SPECTACLES require approximately +10 DIOPTERS (convex) to compensate for the missing lens. Complications: (1) RING SCOTOMA — an annular blind area at ~20–30° from fixation, caused by the prismatic edge effect of the thick convex lens; (2) JACK-IN-BOX PHENOMENON — objects suddenly appear and disappear at the edges; (3) Image magnification of +25–33% — causes diplopia if only one eye is aphakic (aniseikonia); (4) Barrel distortion. The ring scotoma is the most clinically significant and frequently tested complication.",
    memory: "+10D for aphakia. RING SCOTOMA is the trap complication! Objects 'disappear' at periphery."
  },
  {
    id: 27,
    tag: "Microspherophakia",
    question: "A 15-year-old short-statured child with short stubby fingers presents with myopia and bilateral small spherical lenses. On mydriasis the equator of the lens is visible. The lens occasionally slips anteriorly causing angle closure. Diagnosis?",
    options: [
      "A. Marfan syndrome",
      "B. Weill-Marchesani syndrome",
      "C. Homocystinuria",
      "D. Alport syndrome"
    ],
    answer: "B",
    explanation: "WEILL-MARCHESANI SYNDROME — autosomal recessive or dominant. The INVERSE of Marfan: SHORT stature, BRACHYDACTYLY (short stubby fingers), MICROSPHEROPHAKIA (small spherical lens) causing HIGH MYOPIA, and lens dislocation (usually inferiorly). The small spherical lens can dislocate anteriorly through the pupil → PUPIL BLOCK → angle closure glaucoma. Treatment of acute attack: PRONE POSITIONING (lets lens fall back), mydriatics (dilate to prevent pupil block), then lens extraction. Miotic drops are CONTRAINDICATED (worsen pupil block).",
    memory: "Weill-Marchesani = ANTI-Marfan: SHORT + stubby + spherical lens. Miosis = DANGER here!"
  },
  {
    id: 28,
    tag: "Lens Proteins",
    question: "Fabry disease (alpha-galactosidase A deficiency) produces which SPECIFIC lens finding?",
    options: [
      "A. Sunflower cataract",
      "B. Oil-droplet cataract",
      "C. Posterior spoke-like (propeller/whorl) opacity",
      "D. Anterior shield cataract"
    ],
    answer: "C",
    explanation: "FABRY DISEASE (X-linked recessive, alpha-galactosidase A deficiency) → glycolipid (ceramide trihexoside) deposition in tissues. Ocular findings: (1) CORNEA VERTICILLATA — whorl-like corneal opacity (most common), (2) POSTERIOR LENS SPOKE-LIKE/PROPELLER OPACITY (specific to Fabry). The lens opacity has a distinctive radiating spoke or propeller configuration in the posterior subcapsular region. Males (hemizygous) show full features. Also: painful crises, angiokeratomas, renal failure, cardiac disease. Treatment: enzyme replacement therapy.",
    memory: "FABRY = 'Verticillata (cornea whorl) + Propeller (lens)' — a spinning theme!"
  },
  {
    id: 29,
    tag: "Congenital Anomalies",
    question: "Persistent hyperplastic primary vitreous (PHPV) / Persistent Fetal Vasculature (PFV) typically presents as?",
    options: [
      "A. Bilateral cataracts in a premature infant",
      "B. Unilateral leukocoria with microphthalmia in a full-term infant",
      "C. Bilateral lens dislocation",
      "D. Bilateral lens coloboma"
    ],
    answer: "B",
    explanation: "PERSISTENT FETAL VASCULATURE (PFV) / PHPV — failure of regression of the primary vitreous (hyaloid vascular system). Presents as: (1) UNILATERAL leukocoria (white pupillary reflex — must be differentiated from retinoblastoma!), (2) MICROPHTHALMIA (small eye), (3) Full-term infant (not premature — unlike retinopathy of prematurity). On examination: white fibrovascular membrane behind the lens, often with an elongated ciliary process. Retinoblastoma is bilateral in 40%, no microphthalmia, hard white mass on CT. PHPV/PFV: unilateral, small eye, fibrovascular stalk.",
    memory: "PFV = Unilateral leukocoria + SMALL EYE (microphthalmia) = failed hyaloid regression"
  },
  {
    id: 30,
    tag: "Lens Coloboma / Embryology",
    question: "Coloboma of the lens (notch in the lens) is located in which quadrant?",
    options: [
      "A. Superotemporal",
      "B. Inferonasal",
      "C. Superonasal",
      "D. Inferotemporal"
    ],
    answer: "B",
    explanation: "LENS COLOBOMA is located in the INFERONASAL quadrant because it results from incomplete closure of the EMBRYONIC FETAL FISSURE (optic fissure), which is located inferonasal. The same mechanism causes colobomas of the iris, choroid, optic disc, and retina — all inferonasal. The lens coloboma appears as a flat notch or indentation at the equator of the lens, inferonasally. Clinically: the zonular fibers are absent in that area. Associated with various systemic syndromes. This is an anatomy-embryology crossover MCQ.",
    memory: "ALL colobomas = INFERONASAL = fetal fissure fails to close. Lens, iris, choroid, disc — all inferonasal!"
  }
];

// ─── HELPER FUNCTIONS ───────────────────────────────────

function addCoverSlide(pres) {
  const slide = pres.addSlide();

  // Background
  slide.addShape(pres.ShapeType.rect, {
    x: 0, y: 0, w: 10, h: 5.625,
    fill: { color: C.darkBg }
  });

  // Decorative top bar
  slide.addShape(pres.ShapeType.rect, {
    x: 0, y: 0, w: 10, h: 0.08,
    fill: { color: C.accent }
  });

  // Decorative bottom bar
  slide.addShape(pres.ShapeType.rect, {
    x: 0, y: 5.545, w: 10, h: 0.08,
    fill: { color: C.accent }
  });

  // Left accent strip
  slide.addShape(pres.ShapeType.rect, {
    x: 0.35, y: 1.1, w: 0.08, h: 3.4,
    fill: { color: C.accent }
  });

  // Eye/lens icon circle (decorative)
  slide.addShape(pres.ShapeType.ellipse, {
    x: 7.5, y: 0.9, w: 2.1, h: 2.1,
    fill: { color: C.optionBg },
    line: { color: C.accent, width: 2 }
  });
  slide.addShape(pres.ShapeType.ellipse, {
    x: 8.1, y: 1.5, w: 0.9, h: 0.9,
    fill: { color: C.accent }
  });

  slide.addText("LENS", {
    x: 0.6, y: 1.1, w: 6.5, h: 0.8,
    fontSize: 52, bold: true, color: C.accent,
    fontFace: "Calibri", margin: 0
  });
  slide.addText("MCQ FLASHCARD DECK", {
    x: 0.6, y: 1.85, w: 6.5, h: 0.65,
    fontSize: 22, bold: true, color: C.white,
    fontFace: "Calibri", charSpacing: 4, margin: 0
  });

  slide.addShape(pres.ShapeType.rect, {
    x: 0.6, y: 2.7, w: 4.5, h: 0.06,
    fill: { color: C.lightGrey }
  });

  slide.addText("NEET PG 2026   |   30 PYQ-Based Questions   |   Ophthalmology", {
    x: 0.6, y: 2.85, w: 8.5, h: 0.45,
    fontSize: 13, color: C.lightGrey,
    fontFace: "Calibri", margin: 0
  });

  slide.addText([
    { text: "Topics Covered: ", options: { bold: true, color: C.softGold } },
    { text: "Embryology  •  Anatomy  •  Physiology  •  Age-related Cataract  •  Systemic Associations", options: { color: C.lightGrey } }
  ], {
    x: 0.6, y: 3.4, w: 9, h: 0.5,
    fontSize: 11.5, fontFace: "Calibri", margin: 0
  });

  slide.addText([
    { text: "Traumatic Cataract  •  Drug-induced  •  Pseudoexfoliation  •  Lens Dislocation  •  Surgery", options: { color: C.lightGrey } }
  ], {
    x: 0.6, y: 3.82, w: 9, h: 0.45,
    fontSize: 11.5, fontFace: "Calibri", margin: 0
  });

  slide.addText([
    { text: "Lens-Induced Glaucoma  •  Congenital Anomalies  •  Flashcard Format (Q → Answer)", options: { color: C.lightGrey } }
  ], {
    x: 0.6, y: 4.2, w: 9, h: 0.45,
    fontSize: 11.5, fontFace: "Calibri", margin: 0
  });

  slide.addText("Orris Medical Mentor  |  NEET PG 2026", {
    x: 0.6, y: 5.1, w: 8, h: 0.3,
    fontSize: 9.5, color: "6A7F95",
    fontFace: "Calibri", margin: 0
  });
}

function addQuestionSlide(pres, card) {
  const slide = pres.addSlide();

  // Full background
  slide.addShape(pres.ShapeType.rect, {
    x: 0, y: 0, w: 10, h: 5.625,
    fill: { color: C.darkBg }
  });

  // Top bar
  slide.addShape(pres.ShapeType.rect, {
    x: 0, y: 0, w: 10, h: 0.06,
    fill: { color: C.accent }
  });

  // Tag pill
  slide.addShape(pres.ShapeType.roundRect, {
    x: 0.4, y: 0.18, w: 2.0, h: 0.38,
    fill: { color: C.tagBg },
    line: { color: C.accent, width: 1 },
    rectRadius: 0.1
  });
  slide.addText(card.tag.toUpperCase(), {
    x: 0.4, y: 0.18, w: 2.0, h: 0.38,
    fontSize: 8.5, bold: true, color: C.accent,
    align: "center", valign: "middle",
    fontFace: "Calibri", margin: 0
  });

  // Q number
  slide.addText(`Q${card.id}`, {
    x: 8.8, y: 0.13, w: 0.9, h: 0.46,
    fontSize: 14, bold: true, color: "4A6580",
    align: "right", fontFace: "Calibri", margin: 0
  });

  // Question
  const questionLines = card.question.length > 110 ? 1.05 : 0.85;
  slide.addText(card.question, {
    x: 0.35, y: 0.72, w: 9.3, h: questionLines,
    fontSize: 14.5, bold: true, color: C.white,
    fontFace: "Calibri", wrap: true, margin: 0
  });

  // Options
  const optY = [1.85, 2.58, 3.31, 4.04];
  const optColors = [C.optionBg, C.optionBg, C.optionBg, C.optionBg];

  card.options.forEach((opt, i) => {
    // Option box
    slide.addShape(pres.ShapeType.roundRect, {
      x: 0.35, y: optY[i], w: 9.3, h: 0.58,
      fill: { color: optColors[i] },
      line: { color: "2A3F55", width: 0.75 },
      rectRadius: 0.07
    });
    slide.addText(opt, {
      x: 0.55, y: optY[i], w: 9.0, h: 0.58,
      fontSize: 12.5, color: C.lightGrey,
      fontFace: "Calibri", valign: "middle", margin: 0, wrap: true
    });
  });

  // Flip prompt at bottom
  slide.addShape(pres.ShapeType.rect, {
    x: 0, y: 5.35, w: 10, h: 0.275,
    fill: { color: "091523" }
  });
  slide.addText("▶  Next slide for Answer & Explanation", {
    x: 0, y: 5.35, w: 10, h: 0.275,
    fontSize: 9, color: "4A6580",
    align: "center", valign: "middle",
    fontFace: "Calibri", margin: 0
  });
}

function addAnswerSlide(pres, card) {
  const slide = pres.addSlide();

  // Full background
  slide.addShape(pres.ShapeType.rect, {
    x: 0, y: 0, w: 10, h: 5.625,
    fill: { color: C.answerBg }
  });

  // Top bar
  slide.addShape(pres.ShapeType.rect, {
    x: 0, y: 0, w: 10, h: 0.06,
    fill: { color: C.correct }
  });

  // Left stripe
  slide.addShape(pres.ShapeType.rect, {
    x: 0, y: 0.06, w: 0.2, h: 5.565,
    fill: { color: C.correct }
  });

  // Answer header
  slide.addText("ANSWER", {
    x: 0.4, y: 0.1, w: 2.5, h: 0.42,
    fontSize: 9, bold: true, color: C.correct,
    charSpacing: 5, fontFace: "Calibri", margin: 0
  });
  slide.addText(`Q${card.id}   |   ${card.tag}`, {
    x: 5.0, y: 0.1, w: 4.8, h: 0.42,
    fontSize: 9, color: "5A8070",
    align: "right", fontFace: "Calibri", margin: 0
  });

  // Correct option label
  slide.addShape(pres.ShapeType.roundRect, {
    x: 0.4, y: 0.65, w: 9.2, h: 0.62,
    fill: { color: "1E4D35" },
    line: { color: C.correct, width: 1.5 },
    rectRadius: 0.08
  });

  // find full option text for correct answer
  const correctLetter = card.answer; // "A", "B", "C", "D"
  const correctIdx = ["A","B","C","D"].indexOf(correctLetter);
  const correctText = card.options[correctIdx];

  slide.addText([
    { text: "✓  ", options: { bold: true, color: C.correct, fontSize: 15 } },
    { text: correctText, options: { bold: true, color: C.softGold, fontSize: 13.5 } }
  ], {
    x: 0.55, y: 0.65, w: 9.0, h: 0.62,
    fontFace: "Calibri", valign: "middle", margin: 0, wrap: true
  });

  // Explanation header
  slide.addText("EXPLANATION", {
    x: 0.4, y: 1.42, w: 3, h: 0.3,
    fontSize: 8.5, bold: true, color: "5A9E80",
    charSpacing: 3, fontFace: "Calibri", margin: 0
  });
  slide.addShape(pres.ShapeType.rect, {
    x: 0.4, y: 1.7, w: 9.2, h: 0.02,
    fill: { color: "2A5040" }
  });

  // Explanation text
  slide.addText(card.explanation, {
    x: 0.4, y: 1.78, w: 9.2, h: 2.6,
    fontSize: 11, color: C.lightGrey,
    fontFace: "Calibri", wrap: true, valign: "top", margin: 0
  });

  // Memory hook section
  slide.addShape(pres.ShapeType.roundRect, {
    x: 0.4, y: 4.52, w: 9.2, h: 0.82,
    fill: { color: "162832" },
    line: { color: C.softGold, width: 1 },
    rectRadius: 0.07
  });
  slide.addText([
    { text: "💡 Memory Hook:  ", options: { bold: true, color: C.softGold, fontSize: 10.5 } },
    { text: card.memory, options: { color: C.lightGrey, fontSize: 10.5, italic: true } }
  ], {
    x: 0.55, y: 4.52, w: 9.0, h: 0.82,
    fontFace: "Calibri", valign: "middle", wrap: true, margin: 0
  });
}

// ─── BUILD DECK ─────────────────────────────────────────

addCoverSlide(pres);

cards.forEach(card => {
  addQuestionSlide(pres, card);
  addAnswerSlide(pres, card);
});

// End slide
const end = pres.addSlide();
end.addShape(pres.ShapeType.rect, {
  x: 0, y: 0, w: 10, h: 5.625,
  fill: { color: C.darkBg }
});
end.addShape(pres.ShapeType.rect, {
  x: 0, y: 0, w: 10, h: 0.08,
  fill: { color: C.accent }
});
end.addShape(pres.ShapeType.rect, {
  x: 0, y: 5.545, w: 10, h: 0.08,
  fill: { color: C.accent }
});
end.addText("30", {
  x: 2.5, y: 1.0, w: 5, h: 1.2,
  fontSize: 90, bold: true, color: C.accent,
  align: "center", fontFace: "Calibri", margin: 0
});
end.addText("MCQs COMPLETE", {
  x: 1, y: 2.2, w: 8, h: 0.7,
  fontSize: 26, bold: true, color: C.white,
  align: "center", charSpacing: 6, fontFace: "Calibri", margin: 0
});
end.addShape(pres.ShapeType.rect, {
  x: 2.5, y: 3.05, w: 5, h: 0.04,
  fill: { color: "3A5570" }
});
end.addText("Revise again in 24h  •  Attempt weak topics again  •  Best of luck for NEET PG 2026!", {
  x: 0.5, y: 3.18, w: 9, h: 0.55,
  fontSize: 11, color: C.lightGrey,
  align: "center", fontFace: "Calibri", margin: 0
});
end.addText("Orris Medical Mentor  |  Lens Flashcard Deck  |  Ophthalmology", {
  x: 1, y: 5.05, w: 8, h: 0.35,
  fontSize: 9, color: "4A6580",
  align: "center", fontFace: "Calibri", margin: 0
});

pres.writeFile({ fileName: "/home/daytona/workspace/lens-flashcards/Lens_MCQ_Flashcards_NEET_PG_2026.pptx" })
  .then(() => console.log("SUCCESS: Flashcard deck created!"))
  .catch(err => { console.error("ERROR:", err); process.exit(1); });

cd /home/daytona/workspace/lens-flashcards && node build.js 2>&1

ls -lh /home/daytona/workspace/lens-flashcards/