# -*- coding: utf-8 -*-
from docx import Document
from docx.shared import Pt, Inches, RGBColor
from docx.enum.text import WD_ALIGN_PARAGRAPH
from docx.enum.table import WD_TABLE_ALIGNMENT
from docx.oxml.ns import qn

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

RED = RGBColor(0xC0, 0x00, 0x00)
GREEN = RGBColor(0x1E, 0x7A, 0x1E)
GREY = RGBColor(0x59, 0x59, 0x59)

def add_title():
    t = doc.add_heading("NEET PG ENT (Otorhinolaryngology)", level=0)
    t.alignment = WD_ALIGN_PARAGRAPH.CENTER
    sub = doc.add_heading("Topic-Wise Previous Year Question Compilation (Last 10 Years)", level=2)
    sub.alignment = WD_ALIGN_PARAGRAPH.CENTER
    p = doc.add_paragraph()
    p.alignment = WD_ALIGN_PARAGRAPH.CENTER
    run = p.add_run("Covering high-yield ENT questions and repeat concepts from NEET PG (approx. 2016-2025)")
    run.italic = True
    run.font.color.rgb = GREY

def add_disclaimer():
    doc.add_heading("Important Note on Sources", level=2)
    p = doc.add_paragraph()
    p.add_run(
        "NBEMS (the exam conducting body) does not officially release NEET PG question papers or answer "
        "keys to the public. Every question in this compilation is reconstructed from candidate-recall "
        "data published by coaching platforms (PrepLadder, DigiNerve, eGurukul, Crazy Medicine and others) "
        "immediately after each exam, cross-checked against standard ENT textbooks (Dhingra, Mohan Bansal, "
        "PL Dhingra) for the correct answer and explanation. Exact wording of the original exam item can "
        "vary slightly between recall sources, but the tested concept and correct answer are accurate. "
        "Items marked [Concept-based / high-yield repeat] are frequently-tested topics reconstructed in "
        "standard exam style rather than tied to one specific recalled year, because the same concept has "
        "recurred across multiple NEET PG cycles in the last decade."
    ).font.size = Pt(9.5)
    doc.add_paragraph()

def add_toc_list(items):
    doc.add_heading("Topics Covered", level=2)
    for i, it in enumerate(items, 1):
        doc.add_paragraph(f"{i}. {it}", style="List Number")
    doc.add_page_break()

def add_topic_heading(title):
    doc.add_heading(title, level=1)

def add_subheading(title):
    h = doc.add_heading(title, level=3)
    for run in h.runs:
        run.font.color.rgb = RGBColor(0x1F, 0x4E, 0x79)

def add_question(qnum, stem, options, answer_idx, explanation, tag=None):
    p = doc.add_paragraph()
    run = p.add_run(f"Q{qnum}. {stem}")
    run.bold = True
    run.font.size = Pt(11)
    if tag:
        tagp = doc.add_paragraph()
        tagrun = tagp.add_run(tag)
        tagrun.italic = True
        tagrun.font.size = Pt(9)
        tagrun.font.color.rgb = GREY
    for i, opt in enumerate(options):
        letter = chr(97 + i)
        op = doc.add_paragraph(f"{letter}) {opt}", style="List Bullet")
        op.paragraph_format.left_indent = Inches(0.35)
        if i == answer_idx:
            for r in op.runs:
                r.font.color.rgb = GREEN
                r.bold = True
    ansp = doc.add_paragraph()
    ansrun = ansp.add_run(f"Answer: {options[answer_idx]}")
    ansrun.bold = True
    ansrun.font.color.rgb = GREEN
    expp = doc.add_paragraph()
    exprun = expp.add_run(f"Explanation: {explanation}")
    exprun.font.size = Pt(10)
    exprun.font.color.rgb = RGBColor(0x33, 0x33, 0x33)
    doc.add_paragraph()

# ---------------- CONTENT ----------------
add_title()
doc.add_page_break()
add_disclaimer()

topics = [
    "Otology (Ear) - Anatomy, CSOM, Otosclerosis, Vestibular Disorders",
    "Audiology - Tuning Fork Tests, Audiometry",
    "Rhinology (Nose & Paranasal Sinuses)",
    "Pharynx & Oral Cavity",
    "Larynx",
    "Head & Neck",
    "ENT Instruments & Emergencies",
]
add_toc_list(topics)

qn_counter = 0
def nq():
    global qn_counter
    qn_counter += 1
    return qn_counter

# ============ SECTION 1: OTOLOGY ============
add_topic_heading("1. Otology (Ear)")

add_subheading("1.1 Chronic Suppurative Otitis Media (CSOM) & Cholesteatoma")
add_question(nq(),
    "A 20-year-old patient presents with recurrent ear discharge. On otoscopic examination, the examiner "
    "notes the complete absence of the tympanic membrane. What is the best treatment option?",
    ["Myringoplasty", "Radical mastoidectomy", "Ossiculoplasty", "Tympanoplasty"],
    3,
    "Total TM absence with a dry, safe ear and intact/mobile ossicular chain is managed by tympanoplasty "
    "(graft repair of the TM, with or without ossicular reconstruction). Myringoplasty alone is for small "
    "perforations without ossicular involvement.",
    tag="[Recall - NEET PG 2025]")

add_question(nq(),
    "A patient with CSOM has attic erosion with squamous epithelium debris on HRCT temporal bone. Which "
    "type of CSOM is this?",
    ["Tubotympanic (safe) CSOM", "Atticoantral (unsafe) CSOM", "Otosclerosis", "Otomycosis"],
    1,
    "Attic/marginal perforation with cholesteatoma (keratinizing squamous epithelium) and bone erosion is "
    "characteristic of atticoantral (unsafe) CSOM, which carries risk of intracranial and extracranial "
    "complications and needs mastoidectomy.",
    tag="[Concept-based / high-yield repeat - asked in multiple recent cycles]")

add_question(nq(),
    "Which of the following is NOT a feature of tubercular otitis media?",
    ["Earache", "Multiple tympanic membrane perforations", "Pale, unhealthy granulation tissue", "Foul-smelling ear discharge"],
    0,
    "Tubercular otitis media is classically painless despite florid multiple perforations, pale granulations "
    "and copious foul discharge - earache is characteristically absent, which is the distinguishing clue from "
    "ordinary CSOM.",
    tag="[Recall - NEET PG, last 5 years]")

add_subheading("1.2 Otosclerosis, Facial Nerve & Miscellaneous Otology")
add_question(nq(),
    "A young adult female presents with progressive bilateral conductive hearing loss, tinnitus, and "
    "improvement of hearing in noisy environments (paracusis willisii). Otoscopy is normal with a Schwartze "
    "sign. What is the diagnosis?",
    ["Otosclerosis", "Presbycusis", "Meniere disease", "Otitis media with effusion"],
    0,
    "Otosclerosis classically presents in young adults (often female, worsened by pregnancy) with bilateral "
    "conductive hearing loss, paracusis willisii, a normal-looking TM, and a pink flush over the promontory "
    "(Schwartze sign) from otospongiotic bone. Treatment of choice is stapedectomy/stapedotomy.",
    tag="[Concept-based / high-yield repeat]")

add_question(nq(),
    "What is the surgery called that widens the cartilaginous part of the external auditory canal?",
    ["Meatoplasty", "Tympanoplasty", "Myringoplasty", "Otoplasty"],
    0,
    "Meatoplasty widens the bony/cartilaginous EAC meatus, typically performed as part of modified radical "
    "mastoidectomy to allow aeration and easy postoperative cleaning of the mastoid cavity.",
    tag="[Recall - NEET PG, last 8 years]")

add_question(nq(),
    "The saccule of the membranous labyrinth develops from which part of the otocyst?",
    ["Saccus anterior", "Saccus posterior", "Pars superior", "Pars inferior"],
    3,
    "The otocyst divides into a pars superior (gives rise to utricle, semicircular canals) and pars inferior "
    "(gives rise to the saccule and cochlear duct).",
    tag="[Recall - NEET PG, last 8 years]")

add_question(nq(),
    "A 45-year-old woman is diagnosed with right vestibular neuronitis. What is expected on the head impulse "
    "test?",
    ["Normal (no corrective saccade) bilaterally", "Corrective saccade when the head is turned toward the affected (right) side", "Corrective saccade only on the left", "Nystagmus abolished by fixation"],
    1,
    "In peripheral vestibular hypofunction (vestibular neuronitis), the head impulse test is positive/abnormal "
    "on the affected side - a rapid head thrust toward the weak labyrinth produces a catch-up (corrective) "
    "saccade, because the vestibulo-ocular reflex on that side is impaired.",
    tag="[Recall - NEET PG, last 5 years]")

add_question(nq(),
    "A patient presents with progressive unilateral sensorineural hearing loss and imbalance. Histopathology "
    "of the resected lesion shows Antoni A and Antoni B areas with Verocay bodies. What is the diagnosis?",
    ["Schwannoma (Vestibular schwannoma/acoustic neuroma)", "Ependymoma", "Meningioma", "Medulloblastoma"],
    0,
    "Antoni A (compact spindle cells with nuclear palisading forming Verocay bodies) and Antoni B (loose "
    "myxoid) areas are the classic histology of a schwannoma - in the cerebellopontine angle this is a "
    "vestibular schwannoma (acoustic neuroma), presenting with unilateral SNHL, tinnitus and imbalance.",
    tag="[Recall - NEET PG 2025]")

add_question(nq(),
    "A patient with atresia of the external auditory canal needs amplification. Which device is most "
    "appropriate since sound cannot travel through the external/middle ear?",
    ["Bone-anchored hearing aid (BAHA)", "Conventional air-conduction hearing aid", "Cochlear implant", "Middle ear implant"],
    0,
    "In congenital EAC atresia, a conventional air-conduction aid is ineffective because sound cannot reach "
    "the middle ear. A bone-anchored hearing aid bypasses the external/middle ear, transmitting sound via "
    "bone conduction directly to the cochlea.",
    tag="[Concept-based / high-yield repeat - PYQ discussion series]")

# ============ SECTION 2: AUDIOLOGY ============
add_topic_heading("2. Audiology (Tuning Fork Tests & Audiometry)")

add_question(nq(),
    "A 27-year-old male with recurrent ear infection has a central tympanic membrane perforation. Tuning "
    "fork test: Rinne negative on the left, positive on the right; Weber lateralises to the left. What is "
    "the type and side of hearing loss?",
    ["Left sensorineural hearing loss", "Right sensorineural hearing loss", "Left conductive hearing loss", "Right conductive hearing loss"],
    2,
    "Rinne negative (bone conduction better than air conduction) indicates a conductive loss in that ear; "
    "Weber lateralising to the same (worse, conductive) ear confirms it. Here that is the left ear - left "
    "conductive hearing loss, consistent with the central TM perforation.",
    tag="[Recall - NEET PG 2025]")

add_question(nq(),
    "A female patient with hearing loss is Rinne negative at 256 Hz and 512 Hz, but Rinne positive at "
    "1024 Hz. What air-bone gap does this correspond to?",
    ["30-45 dB", "15-30 dB", "45-60 dB", ">60 dB"],
    0,
    "The frequency at which Rinne test turns from negative to positive correlates with the size of the "
    "air-bone gap: negative at 256 & 512 Hz but positive at 1024 Hz corresponds to roughly a 30-45 dB "
    "conductive air-bone gap (rule of thumb used in absolute bone conduction/Rinne tuning fork grading).",
    tag="[Recall - NEET PG, last 5 years]")

add_question(nq(),
    "On pure tone audiometry, air conduction and bone conduction thresholds are both reduced by a similar "
    "amount with no air-bone gap. What type of hearing loss is this?",
    ["Conductive hearing loss", "Sensorineural hearing loss", "Mixed hearing loss", "Non-organic hearing loss"],
    1,
    "Equal reduction of air and bone conduction thresholds with a closed (absent) air-bone gap indicates "
    "sensorineural hearing loss (cochlear or retrocochlear pathology), as opposed to conductive loss where "
    "bone conduction remains normal while air conduction is reduced.",
    tag="[Concept-based / high-yield repeat]")

# ============ SECTION 3: RHINOLOGY ============
add_topic_heading("3. Rhinology (Nose & Paranasal Sinuses)")

add_question(nq(),
    "A patient presents with an injury shown on a lateral X-ray of the nose (nasal bone fracture). Which "
    "instrument/procedure is used to manage this?",
    ["Tilley's probe", "Luc's forceps", "Denis Browne probe", "Walsham's forceps"],
    3,
    "Walsham's forceps is specifically designed for closed reduction of a displaced fractured nasal bone; "
    "Asch's forceps is used for the septal cartilage. Tilley's and Luc's forceps are used in sinus/polyp "
    "surgery, not fracture reduction.",
    tag="[Recall - NEET PG 2025]")

add_question(nq(),
    "A 78-year-old diabetic, hypertensive male presents with nasal bleeding not controlled by anterior "
    "nasal packing. Which artery should be ligated/embolised to control the bleed?",
    ["Sphenopalatine artery", "Anterior ethmoidal artery", "Posterior ethmoidal artery", "Greater palatine artery"],
    0,
    "Posterior epistaxis refractory to packing (common in elderly hypertensive/diabetic patients) most often "
    "arises from the sphenopalatine artery (terminal branch of the maxillary artery); endoscopic "
    "sphenopalatine artery ligation or embolisation is first-line when packing fails.",
    tag="[Recall - NEET PG 2025]")

add_question(nq(),
    "A 16-year-old male presents with recurrent profuse epistaxis from the right nasal cavity. Endoscopy "
    "shows a globular vascular mass; CT shows bowing of the posterior wall of the maxillary sinus (Holman-"
    "Miller sign). What is the most probable diagnosis?",
    ["Juvenile Nasopharyngeal Angiofibroma (JNA)", "Antrochoanal polyp", "Rhinosporidiosis", "Rhinoscleroma"],
    0,
    "JNA is a benign but locally aggressive vascular tumour typically seen in adolescent males, presenting "
    "with recurrent severe epistaxis and a nasal/nasopharyngeal mass; anterior bowing of the posterior "
    "maxillary sinus wall (Holman-Miller/antral sign) on CT is classic. Treatment is preoperative "
    "embolisation followed by surgical excision.",
    tag="[Recall - NEET PG 2025]")

add_question(nq(),
    "A patient with acute frontal sinusitis develops a soft, doughy, boggy swelling over the forehead due "
    "to subperiosteal abscess from osteomyelitis of the frontal bone. What is this condition called?",
    ["Pott's puffy tumour", "Orbital cellulitis", "Preseptal cellulitis", "Mucocele"],
    0,
    "Pott's puffy tumour is a subperiosteal abscess with osteomyelitis of the frontal bone, a recognised "
    "complication of frontal sinusitis, presenting as a boggy forehead swelling; it requires imaging (CT/MRI) "
    "and combined ENT-neurosurgical management given the risk of intracranial spread.",
    tag="[Recall - NEET PG, last 8 years]")

add_question(nq(),
    "Pain sensation from the ethmoid sinus mucosa is carried predominantly by which nerve?",
    ["Nasociliary nerve", "Frontal nerve", "Lacrimal nerve", "Infraorbital nerve"],
    0,
    "The ethmoid sinuses are innervated by the anterior and posterior ethmoidal nerves, branches of the "
    "nasociliary nerve (itself a branch of the ophthalmic division of the trigeminal nerve), which carries "
    "pain sensation from this region.",
    tag="[Concept-based / high-yield repeat - AIIMS/NEET PG PYQ]")

add_question(nq(),
    "A young patient presents with a unilateral nasal mass. Imaging shows the mass filling the maxillary "
    "sinus and extending through the sinus ostium into the nasal cavity and choana ('dumbbell' shape). "
    "What is the most likely diagnosis?",
    ["Antrochoanal polyp", "Juvenile nasopharyngeal angiofibroma", "Inverted papilloma", "Rhinolith"],
    0,
    "An antrochoanal polyp (Killian's polyp) arises from the maxillary sinus mucosa and prolapses through "
    "the sinus ostium into the nasal cavity and posteriorly toward the choana, giving a dumbbell shape on "
    "imaging; it is unilateral, unlike allergic nasal polyps which are usually bilateral.",
    tag="[Concept-based / high-yield repeat]")

# ============ SECTION 4: PHARYNX & ORAL CAVITY ============
add_topic_heading("4. Pharynx & Oral Cavity")

add_question(nq(),
    "A 10-year-old child presents with throat pain, fever, and referred ear pain. He is diagnosed with acute "
    "tonsillitis. Which nerve is responsible for the referred ear pain?",
    ["Tympanic branch of the glossopharyngeal nerve (Jacobson's nerve)", "Greater auricular nerve", "Auriculotemporal nerve", "Auricular branch of the vagus nerve"],
    0,
    "The glossopharyngeal nerve supplies sensation to the tonsillar bed and, via its tympanic branch "
    "(Jacobson's nerve), also supplies the middle ear - shared innervation explains referred otalgia in "
    "tonsillitis/peritonsillar abscess and in tonsillar/tongue-base carcinoma.",
    tag="[Recall - NEET PG, last 8 years]")

add_question(nq(),
    "A patient presents with trismus, muffled 'hot potato' voice, uvular deviation, and a bulge above the "
    "tonsil. What is the most likely diagnosis?",
    ["Peritonsillar abscess (quinsy)", "Retropharyngeal abscess", "Ludwig's angina", "Parapharyngeal abscess"],
    0,
    "Quinsy (peritonsillar abscess) is the most common deep neck space infection, presenting with trismus, "
    "muffled voice, drooling, and displacement of the tonsil/uvula to the opposite side. Management is "
    "needle aspiration or incision and drainage plus antibiotics.",
    tag="[Concept-based / high-yield repeat]")

add_question(nq(),
    "A young child presents with snoring, mouth breathing, and adenoid facies. Lateral neck X-ray shows an "
    "enlarged soft-tissue shadow in the nasopharynx. What is the diagnosis and standard treatment if "
    "symptomatic?",
    ["Adenoid hypertrophy; adenoidectomy", "Retropharyngeal abscess; incision and drainage", "Nasopharyngeal angiofibroma; embolisation and excision", "Choanal atresia; surgical correction"],
    0,
    "Adenoid hypertrophy in children causes mouth breathing, snoring, nasal obstruction and the classic "
    "'adenoid facies'. Lateral neck X-ray demonstrates the adenoid soft-tissue shadow; symptomatic cases "
    "unresponsive to medical therapy are treated with adenoidectomy.",
    tag="[Concept-based / high-yield repeat]")

add_question(nq(),
    "Which virus is most strongly associated with nasopharyngeal carcinoma, and what is its most common "
    "histological type?",
    ["EBV; squamous cell carcinoma", "HPV; adenocarcinoma", "HSV; lymphoma", "CMV; sarcoma"],
    0,
    "Nasopharyngeal carcinoma shows a strong association with Epstein-Barr virus (elevated EBV antibody "
    "titres are used in diagnosis/monitoring); squamous cell carcinoma (including the undifferentiated/WHO "
    "type III variant) is the most common histology. Treatment is primarily radiotherapy +/- chemotherapy; "
    "neck disease is managed with radical neck dissection when needed.",
    tag="[Concept-based / high-yield repeat - PYQ discussion series]")

# ============ SECTION 5: LARYNX ============
add_topic_heading("5. Larynx")

add_question(nq(),
    "A singer has difficulty raising the pitch of her voice. Examination shows depressed and bowed vocal "
    "cords. Which muscle is most likely involved?",
    ["Cricothyroid", "Interarytenoid", "Posterior cricoarytenoid", "Lateral cricoarytenoid"],
    0,
    "The cricothyroid muscle tenses and elongates the vocal cords, raising pitch (it is supplied by the "
    "external branch of the superior laryngeal nerve). Weakness causes a bowed cord and inability to "
    "achieve higher pitch, as classically tested in singers/professional voice users.",
    tag="[Recall - NEET PG, last 5 years]")

add_question(nq(),
    "Following total thyroidectomy, a patient develops difficulty breathing and repeated failed attempts at "
    "extubation. What is the most probable cause?",
    ["Superior laryngeal nerve injury", "Unilateral recurrent laryngeal nerve injury", "Bilateral recurrent laryngeal nerve injury", "Neck haematoma"],
    2,
    "Bilateral recurrent laryngeal nerve injury causes both vocal cords to lie in the paramedian position, "
    "producing severe airway obstruction and stridor immediately post-extubation - a classic and dangerous "
    "complication of total thyroidectomy requiring re-intubation or emergency tracheostomy. Unilateral RLN "
    "injury typically causes hoarseness rather than airway obstruction.",
    tag="[Recall - NEET PG, last 5 years]")

add_question(nq(),
    "A 75-year-old male smoker presents with hoarseness and dysphagia. Laryngoscopy and biopsy confirm "
    "advanced squamous cell carcinoma involving both vocal cords, extending into the subglottis and "
    "invading the thyroid cartilage, not amenable to radiotherapy alone. What surgery is most appropriate?",
    ["Partial (vertical/horizontal) laryngectomy", "Total laryngectomy", "Emergency tracheostomy", "Submental tracheostomy"],
    1,
    "Bilateral vocal cord involvement with subglottic extension and thyroid cartilage invasion exceeds the "
    "limits of conservation (partial) laryngeal surgery, which requires at least one mobile, disease-free "
    "cord/arytenoid. Total laryngectomy is indicated for advanced disease not amenable to organ-preservation "
    "radiotherapy or partial surgery.",
    tag="[Recall - NEET PG 2025]")

add_question(nq(),
    "Injury to the external branch of the superior laryngeal nerve during thyroidectomy classically "
    "produces which voice change?",
    ["Inability to produce high-pitched sounds / vocal fatigue with a lower-pitched, weaker voice", "Complete aphonia", "Stridor requiring tracheostomy", "No voice change at all"],
    0,
    "The external branch of the superior laryngeal nerve supplies the cricothyroid muscle; injury causes "
    "loss of the ability to tense the cord and reach higher pitches, producing a monotonous, easily fatigued "
    "voice rather than the marked hoarseness or airway compromise seen with recurrent laryngeal nerve injury.",
    tag="[Concept-based / high-yield repeat]")

add_question(nq(),
    "Identify the structure marked on a laryngoscopic image lateral to the aryepiglottic fold, a common site "
    "for lodged foreign bodies and early hypopharyngeal cancer.",
    ["Thyroid cartilage", "Pyriform sinus", "Epiglottis", "Vallecula"],
    1,
    "The pyriform sinus (pyriform fossa) is a mucosal recess lateral to the aryepiglottic fold on either side "
    "of the larynx; it is a common site for foreign body impaction and the most common site of hypopharyngeal "
    "carcinoma.",
    tag="[Recall - NEET PG 2025]")

add_question(nq(),
    "A young adult presents with a hoarse, breathy voice and multiple wart-like lesions on both vocal "
    "cords, with a tendency to recur after excision. Which virus and lesion are most likely?",
    ["HPV 6/11; laryngeal papillomatosis", "HPV 16/18; laryngeal carcinoma", "EBV; lymphoma", "HSV; laryngeal ulcer"],
    0,
    "Recurrent respiratory (laryngeal) papillomatosis is caused by HPV types 6 and 11, presents with "
    "progressive hoarseness +/- airway obstruction in children (juvenile form) or adults, and is notorious "
    "for recurrence after excision, occasionally requiring multiple microlaryngoscopic debulking procedures.",
    tag="[Concept-based / high-yield repeat]")

# ============ SECTION 6: HEAD & NECK ============
add_topic_heading("6. Head & Neck")

add_question(nq(),
    "A patient with a dental infection develops rapidly progressive bilateral submandibular, sublingual and "
    "submental swelling with a 'woody' brawny induration, tongue elevation, and no discrete abscess "
    "collection. What is the diagnosis and the most urgent concern?",
    ["Ludwig's angina; airway obstruction", "Peritonsillar abscess; sepsis", "Parotitis; facial nerve palsy", "Branchial cyst infection; recurrent infection"],
    0,
    "Ludwig's angina is a rapidly spreading cellulitis of the submandibular, sublingual and submental spaces, "
    "usually of odontogenic origin, causing brawny bilateral swelling and tongue elevation. The chief danger "
    "is airway obstruction, so securing the airway (sometimes via tracheostomy) takes priority over "
    "antibiotics/drainage.",
    tag="[Concept-based / high-yield repeat]")

add_question(nq(),
    "A midline neck swelling in a child moves upward on tongue protrusion and with swallowing. What is the "
    "most likely diagnosis?",
    ["Thyroglossal duct cyst", "Branchial cleft cyst", "Dermoid cyst", "Cystic hygroma"],
    0,
    "A thyroglossal duct cyst, arising from remnants of the thyroglossal tract, is typically midline and "
    "moves upward with tongue protrusion (due to its attachment to the foramen cecum via the hyoid bone) "
    "as well as with swallowing. Branchial cysts are lateral, at the anterior border of sternocleidomastoid.",
    tag="[Concept-based / high-yield repeat]")

add_question(nq(),
    "The most common benign salivary gland tumour, typically arising in the parotid gland with a slow-"
    "growing, painless, mobile swelling, is:",
    ["Pleomorphic adenoma", "Warthin's tumour", "Mucoepidermoid carcinoma", "Adenoid cystic carcinoma"],
    0,
    "Pleomorphic adenoma (mixed parotid tumour) is the most common salivary gland neoplasm overall, most "
    "often in the parotid superficial lobe; it is treated by superficial parotidectomy with a cuff of "
    "normal tissue given its tendency to recur if enucleated, and small risk of malignant transformation.",
    tag="[Concept-based / high-yield repeat]")

# ============ SECTION 7: INSTRUMENTS & EMERGENCIES ============
add_topic_heading("7. ENT Instruments & Emergencies")

add_question(nq(),
    "Which instrument is specifically designed for closed reduction of a displaced nasal bone fracture?",
    ["Tilley's forceps", "Walsham's forceps", "Luc's forceps", "Bayonet forceps"],
    1,
    "Walsham's forceps has a specially angled blade design to grasp and disimpact the displaced nasal bones "
    "during closed reduction, distinguishing it from Asch's forceps (used on the septum) and Tilley's/Luc's "
    "forceps used in sinus and polyp surgery.",
    tag="[Recall - NEET PG, last 5 years]")

add_question(nq(),
    "A child presents with sudden-onset choking, coughing, and unilateral wheeze after playing with small "
    "objects. Chest X-ray shows unilateral hyperinflation. What is the most likely diagnosis and the "
    "definitive investigation/treatment?",
    ["Foreign body bronchus; rigid bronchoscopy and removal", "Bronchial asthma; bronchodilators", "Pneumonia; antibiotics", "Croup; nebulised adrenaline"],
    0,
    "Sudden choking with unilateral wheeze/hyperinflation in a child strongly suggests foreign body "
    "aspiration into a main bronchus (right more common due to a more vertical, wider bronchus). Rigid "
    "bronchoscopy is both diagnostic and therapeutic (foreign body removal) and should not be delayed.",
    tag="[Recall - NEET PG, PYQ discussion series]")

add_question(nq(),
    "In a case of acute epiglottitis in a child with stridor, drooling, and a 'tripod' posture, which of the "
    "following should be strictly avoided during examination?",
    ["Forceful tongue depressor examination of the throat/oropharynx", "Lateral neck X-ray", "Pulse oximetry monitoring", "Keeping the child calm in a parent's lap"],
    0,
    "In suspected acute epiglottitis, any distressing examination (tongue depressor, forceful throat exam, "
    "unnecessary lying flat) can precipitate complete airway obstruction. The child should be kept calm, "
    "with airway secured (often by anaesthesia/ENT team in a controlled setting) before any invasive "
    "examination.",
    tag="[Concept-based / high-yield repeat - ENT emergency]")

add_question(nq(),
    "A trauma patient requires an emergency airway but cricothyroidotomy is contraindicated due to "
    "laryngeal fracture. Which surgical airway procedure is preferred?",
    ["Emergency tracheostomy", "Nasotracheal intubation", "Needle cricothyroidotomy", "Submental intubation"],
    0,
    "When cricothyroidotomy is contraindicated (e.g. laryngeal/tracheal injury, young children), emergency "
    "tracheostomy below the level of injury is the airway of choice, despite being technically more time-"
    "consuming than cricothyroidotomy.",
    tag="[Concept-based / high-yield repeat]")

doc.add_page_break()
foot = doc.add_paragraph()
foot.alignment = WD_ALIGN_PARAGRAPH.CENTER
r = foot.add_run(
    "Compiled for revision purposes from publicly available NEET PG recall-question sources "
    "(PrepLadder, DigiNerve, eGurukul/Crazy Medicine PYQ discussion sessions) and standard ENT references. "
    "Not an official NBEMS publication."
)
r.italic = True
r.font.size = Pt(9)
r.font.color.rgb = GREY

doc.save("/tmp/workspace/ent-pyq-compilation/NEET_PG_ENT_PYQ_Topicwise_Compilation.docx")
print("Saved. Total questions:", qn_counter)

# -*- coding: utf-8 -*-
from docx import Document
from docx.shared import Pt, Inches, RGBColor
from docx.enum.text import WD_ALIGN_PARAGRAPH

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

RED = RGBColor(0xC0, 0x00, 0x00)
GREEN = RGBColor(0x1E, 0x7A, 0x1E)
GREY = RGBColor(0x59, 0x59, 0x59)
BLUE = RGBColor(0x1F, 0x4E, 0x79)

def add_title():
    t = doc.add_heading("NEET PG & INI-CET ENT (Otorhinolaryngology)", level=0)
    t.alignment = WD_ALIGN_PARAGRAPH.CENTER
    sub = doc.add_heading("Topic-Wise Previous Year Question Compilation (Last 10 Years)", level=2)
    sub.alignment = WD_ALIGN_PARAGRAPH.CENTER
    p = doc.add_paragraph()
    p.alignment = WD_ALIGN_PARAGRAPH.CENTER
    run = p.add_run("Covers NEET PG (approx. 2016-2025) and INI-CET / AIIMS-PGIMER combined entrance (2020-2025)")
    run.italic = True
    run.font.color.rgb = GREY

def add_disclaimer():
    doc.add_heading("Important Note on Sources", level=2)
    p = doc.add_paragraph()
    p.add_run(
        "Neither NBEMS (NEET PG) nor the INI-CET conducting body officially releases question papers or "
        "answer keys to the public. Every question here is reconstructed from candidate-recall data "
        "published by coaching platforms (PrepLadder, DigiNerve, Reflex Prep, eGurukul/Crazy Medicine PYQ "
        "discussion sessions and others) immediately after each exam, cross-checked against standard ENT "
        "textbooks (Dhingra, Mohan Bansal) for the correct answer and explanation. Exact wording of the "
        "original exam item can vary slightly between recall sources, but the tested concept and correct "
        "answer are accurate to the best available public record. Items marked [Concept-based / high-yield "
        "repeat] are frequently-tested topics reconstructed in standard exam style because the same concept "
        "has recurred across multiple exam cycles in the last decade, rather than being tied to one single "
        "recalled year/session."
    ).font.size = Pt(9.5)
    doc.add_paragraph()
    p2 = doc.add_paragraph()
    p2.add_run(
        "Scope note: A full 10-year archive of every single ENT item asked (roughly 8-10/exam x 2 NEET PG "
        "sessions/year x 10 years, plus 2 INI-CET sessions/year) would run into several hundred items. This "
        "document is a high-yield, non-redundant revision compilation covering every major repeat topic at "
        "least once, not a literal reproduction of every paper. Tell me if you want a specific year or topic "
        "expanded further with additional questions."
    ).font.size = Pt(9.5)

def add_toc_list(items):
    doc.add_heading("Topics Covered", level=2)
    for i, it in enumerate(items, 1):
        doc.add_paragraph(f"{i}. {it}", style="List Number")
    doc.add_page_break()

def add_topic_heading(title):
    doc.add_heading(title, level=1)

def add_subheading(title):
    h = doc.add_heading(title, level=3)
    for run in h.runs:
        run.font.color.rgb = BLUE

qn_counter = 0
def nq():
    global qn_counter
    qn_counter += 1
    return qn_counter

def add_question(stem, options, answer_idx, explanation, tag=None):
    qnum = nq()
    p = doc.add_paragraph()
    run = p.add_run(f"Q{qnum}. {stem}")
    run.bold = True
    run.font.size = Pt(11)
    if tag:
        tagp = doc.add_paragraph()
        tagrun = tagp.add_run(tag)
        tagrun.italic = True
        tagrun.font.size = Pt(9)
        tagrun.font.color.rgb = GREY
    for i, opt in enumerate(options):
        letter = chr(97 + i)
        op = doc.add_paragraph(f"{letter}) {opt}", style="List Bullet")
        op.paragraph_format.left_indent = Inches(0.35)
        if i == answer_idx:
            for r in op.runs:
                r.font.color.rgb = GREEN
                r.bold = True
    ansp = doc.add_paragraph()
    ansrun = ansp.add_run(f"Answer: {options[answer_idx]}")
    ansrun.bold = True
    ansrun.font.color.rgb = GREEN
    expp = doc.add_paragraph()
    exprun = expp.add_run(f"Explanation: {explanation}")
    exprun.font.size = Pt(10)
    exprun.font.color.rgb = RGBColor(0x33, 0x33, 0x33)
    doc.add_paragraph()

# ================= BUILD =================
add_title()
doc.add_page_break()
add_disclaimer()

topics = [
    "Otology (Ear) - Anatomy, CSOM, Otosclerosis, Vestibular Disorders",
    "Audiology - Tuning Fork Tests, Audiometry",
    "Rhinology (Nose & Paranasal Sinuses)",
    "Pharynx & Oral Cavity",
    "Larynx",
    "Head & Neck",
    "ENT Instruments & Emergencies",
    "INI-CET / AIIMS-PGIMER Specific Recall Questions (2020-2025)",
]
add_toc_list(topics)

# ============ SECTION 1: OTOLOGY ============
add_topic_heading("1. Otology (Ear)")

add_subheading("1.1 CSOM, Cholesteatoma & Complications")
add_question(
    "A 20-year-old patient presents with recurrent ear discharge. On otoscopic examination, the examiner "
    "notes the complete absence of the tympanic membrane. What is the best treatment option?",
    ["Myringoplasty", "Radical mastoidectomy", "Ossiculoplasty", "Tympanoplasty"],
    3,
    "Total TM absence with a dry, safe ear and intact/mobile ossicular chain is managed by tympanoplasty "
    "(graft repair of the TM, with or without ossicular reconstruction).",
    tag="[Recall - NEET PG 2025]")

add_question(
    "A patient with CSOM has attic erosion with squamous epithelium debris on HRCT temporal bone. Which "
    "type of CSOM is this?",
    ["Tubotympanic (safe) CSOM", "Atticoantral (unsafe) CSOM", "Otosclerosis", "Otomycosis"],
    1,
    "Attic/marginal perforation with cholesteatoma and bone erosion is characteristic of atticoantral "
    "(unsafe) CSOM, which carries risk of intracranial/extracranial complications and needs mastoidectomy.",
    tag="[Concept-based / high-yield repeat]")

add_question(
    "Which of the following is NOT a feature of tubercular otitis media?",
    ["Earache", "Multiple tympanic membrane perforations", "Pale, unhealthy granulation tissue", "Foul-smelling ear discharge"],
    0,
    "Tubercular OM is classically painless despite florid multiple perforations, pale granulations and "
    "copious foul discharge - absence of earache is the key distinguishing clue from ordinary CSOM.",
    tag="[Recall - NEET PG, last 5 years]")

add_question(
    "A patient develops a tender post-auricular swelling that pushes the pinna forward and outward, with "
    "sagging of the posterosuperior meatal wall, following untreated acute otitis media. What is the "
    "diagnosis?",
    ["Acute mastoiditis", "Furunculosis of the external canal", "Bezold's abscess", "Parotid abscess"],
    0,
    "Acute mastoiditis presents with post-auricular swelling pushing the pinna forward/down-and-out and "
    "sagging of the postero-superior meatal wall, following inadequately treated acute otitis media; it "
    "requires cortical mastoidectomy if it fails to resolve with IV antibiotics/myringotomy.",
    tag="[Concept-based / high-yield repeat]")

add_question(
    "Pus from mastoiditis tracks along the digastric muscle and presents as a swelling in the upper neck "
    "below the mastoid tip. What is this complication called?",
    ["Bezold's abscess", "Citelli's abscess", "Luc's abscess", "Zygomatic abscess"],
    0,
    "Bezold's abscess results from mastoid pus perforating the mastoid tip and tracking beneath the "
    "sternocleidomastoid/digastric muscle to present as an upper neck swelling; it is an extracranial "
    "complication of mastoiditis.",
    tag="[Concept-based / high-yield repeat]")

add_subheading("1.2 Otosclerosis, Facial Nerve, Tumours & Vestibular Disorders")
add_question(
    "A young adult female presents with progressive bilateral conductive hearing loss, tinnitus, and "
    "paracusis willisii (hearing better in noisy surroundings). Otoscopy is normal with a Schwartze sign. "
    "What is the diagnosis?",
    ["Otosclerosis", "Presbycusis", "Meniere disease", "Otitis media with effusion"],
    0,
    "Otosclerosis classically presents in young adults with bilateral conductive hearing loss, paracusis "
    "willisii, a normal-looking TM, and a pink flush over the promontory (Schwartze sign). Treatment of "
    "choice is stapedotomy/stapedectomy.",
    tag="[Concept-based / high-yield repeat]")

add_question(
    "What is the surgery called that widens the cartilaginous part of the external auditory canal?",
    ["Meatoplasty", "Tympanoplasty", "Myringoplasty", "Otoplasty"],
    0,
    "Meatoplasty widens the bony/cartilaginous EAC meatus, typically performed with modified radical "
    "mastoidectomy to allow aeration and easy postoperative cleaning of the mastoid cavity.",
    tag="[Recall - NEET PG, last 8 years]")

add_question(
    "The saccule of the membranous labyrinth develops from which part of the otocyst?",
    ["Saccus anterior", "Saccus posterior", "Pars superior", "Pars inferior"],
    3,
    "The otocyst divides into a pars superior (utricle, semicircular canals) and pars inferior (saccule and "
    "cochlear duct).",
    tag="[Recall - NEET PG, last 8 years]")

add_question(
    "A 45-year-old woman is diagnosed with right vestibular neuronitis. What is expected on the head "
    "impulse test?",
    ["Normal (no corrective saccade) bilaterally", "Corrective saccade when the head is turned toward the affected (right) side", "Corrective saccade only on the left", "Nystagmus abolished by fixation"],
    1,
    "In peripheral vestibular hypofunction, a rapid head thrust toward the weak labyrinth produces a "
    "catch-up (corrective) saccade because the vestibulo-ocular reflex on that side is impaired.",
    tag="[Recall - NEET PG, last 5 years]")

add_question(
    "A patient presents with progressive unilateral sensorineural hearing loss and imbalance. Histopathology "
    "shows Antoni A and Antoni B areas with Verocay bodies. What is the diagnosis?",
    ["Schwannoma (Vestibular schwannoma/acoustic neuroma)", "Ependymoma", "Meningioma", "Medulloblastoma"],
    0,
    "Antoni A (compact spindle cells with nuclear palisading forming Verocay bodies) and Antoni B (loose "
    "myxoid) areas are the classic histology of a schwannoma; in the cerebellopontine angle this is a "
    "vestibular schwannoma presenting with unilateral SNHL, tinnitus and imbalance.",
    tag="[Recall - NEET PG 2025]")

add_question(
    "A patient with atresia of the external auditory canal needs amplification. Which device is most "
    "appropriate since sound cannot travel through the external/middle ear?",
    ["Bone-anchored hearing aid (BAHA)", "Conventional air-conduction hearing aid", "Cochlear implant", "Middle ear implant"],
    0,
    "In congenital EAC atresia, a conventional air-conduction aid is ineffective. A BAHA bypasses the "
    "external/middle ear, transmitting sound via bone conduction directly to the cochlea.",
    tag="[Concept-based / high-yield repeat - PYQ discussion series]")

add_question(
    "A patient presents with sudden-onset facial weakness, ear pain, and grouped vesicles on the pinna and "
    "external auditory canal, along with sensorineural hearing loss and vertigo. What is the diagnosis?",
    ["Ramsay Hunt syndrome (herpes zoster oticus)", "Bell's palsy", "Otitis externa", "Malignant otitis externa"],
    0,
    "Ramsay Hunt syndrome is caused by reactivation of varicella zoster virus in the geniculate ganglion, "
    "producing facial nerve palsy plus vesicular eruption on the pinna/EAC, often with cochleovestibular "
    "involvement (SNHL, vertigo). Treatment is antivirals plus steroids, started early for best recovery.",
    tag="[Concept-based / high-yield repeat]")

add_question(
    "An elderly diabetic patient presents with severe ear pain, granulation tissue in the external canal "
    "at the bone-cartilage junction, and facial nerve palsy. Cultures grow Pseudomonas aeruginosa. What is "
    "the diagnosis?",
    ["Malignant (necrotising) otitis externa", "Furunculosis", "Otomycosis", "Acute mastoiditis"],
    0,
    "Malignant otitis externa is a skull-base osteomyelitis seen in elderly diabetics/immunocompromised "
    "patients, almost always caused by Pseudomonas aeruginosa, presenting with granulation tissue at the "
    "bony-cartilaginous junction and possible cranial nerve palsies (especially facial nerve). It requires "
    "prolonged anti-pseudomonal antibiotics.",
    tag="[Concept-based / high-yield repeat]")

# ============ SECTION 2: AUDIOLOGY ============
add_topic_heading("2. Audiology (Tuning Fork Tests & Audiometry)")

add_question(
    "A 27-year-old male with recurrent ear infection has a central tympanic membrane perforation. Tuning "
    "fork test: Rinne negative on the left, positive on the right; Weber lateralises to the left. What is "
    "the type and side of hearing loss?",
    ["Left sensorineural hearing loss", "Right sensorineural hearing loss", "Left conductive hearing loss", "Right conductive hearing loss"],
    2,
    "Rinne negative (bone conduction better than air conduction) indicates conductive loss in that ear; "
    "Weber lateralising to the same (worse, conductive) ear confirms it - here, left conductive hearing loss.",
    tag="[Recall - NEET PG 2025]")

add_question(
    "A female patient with hearing loss is Rinne negative at 256 Hz and 512 Hz, but Rinne positive at "
    "1024 Hz. What air-bone gap does this correspond to?",
    ["30-45 dB", "15-30 dB", "45-60 dB", ">60 dB"],
    0,
    "The frequency at which Rinne turns from negative to positive correlates with the size of the "
    "air-bone gap; negative at 256 & 512 Hz but positive at 1024 Hz corresponds to roughly a 30-45 dB "
    "conductive air-bone gap.",
    tag="[Recall - NEET PG, last 5 years]")

add_question(
    "On pure tone audiometry, air conduction and bone conduction thresholds are both reduced by a similar "
    "amount with no air-bone gap. What type of hearing loss is this?",
    ["Conductive hearing loss", "Sensorineural hearing loss", "Mixed hearing loss", "Non-organic hearing loss"],
    1,
    "Equal reduction of air and bone conduction thresholds with a closed air-bone gap indicates "
    "sensorineural hearing loss (cochlear or retrocochlear pathology).",
    tag="[Concept-based / high-yield repeat]")

add_question(
    "What is the correct sequence of the central auditory pathway from the cochlear nerve to the cortex?",
    ["8th nerve -> cochlear nuclei -> superior olivary nucleus -> lateral lemniscus -> inferior colliculus -> medial geniculate body -> auditory cortex",
     "8th nerve -> cochlear nuclei -> lateral lemniscus -> superior olivary nucleus -> inferior colliculus -> medial geniculate body -> auditory cortex",
     "8th nerve -> superior olivary nucleus -> lateral lemniscus -> inferior colliculus -> medial geniculate body -> auditory cortex -> cochlear nuclei",
     "8th nerve -> superior olivary nucleus -> inferior colliculus -> medial geniculate body -> auditory cortex -> cochlear nuclei -> lateral lemniscus"],
    0,
    "The classical ascending auditory pathway is: cochlear (8th) nerve -> cochlear nuclei (pons) -> "
    "superior olivary nucleus -> lateral lemniscus -> inferior colliculus (midbrain) -> medial geniculate "
    "body (thalamus) -> primary auditory cortex (Heschl's gyrus, temporal lobe).",
    tag="[Recall - INI-CET, last 5 years]")

add_question(
    "A sudden sensorineural hearing loss (idiopathic) is diagnosed within 72 hours of onset. What is the "
    "first-line treatment?",
    ["Oral/intratympanic corticosteroids", "Antivirals", "Antibiotics", "Vasodilators alone"],
    0,
    "Idiopathic sudden sensorineural hearing loss (ISSNHL) is treated as an emergency with high-dose oral "
    "corticosteroids (intratympanic steroids as salvage/alternative), started as early as possible - "
    "outcome is time-dependent, with best results when started within the first 1-2 weeks.",
    tag="[Concept-based / high-yield repeat]")

# ============ SECTION 3: RHINOLOGY ============
add_topic_heading("3. Rhinology (Nose & Paranasal Sinuses)")

add_question(
    "A patient presents with an injury shown on a lateral X-ray of the nose (nasal bone fracture). Which "
    "instrument is used for closed reduction?",
    ["Tilley's probe", "Luc's forceps", "Denis Browne probe", "Walsham's forceps"],
    3,
    "Walsham's forceps is specifically designed for closed reduction of a displaced fractured nasal bone; "
    "Asch's forceps is used for the septal cartilage instead.",
    tag="[Recall - NEET PG 2025]")

add_question(
    "A 78-year-old diabetic, hypertensive male presents with nasal bleeding not controlled by anterior "
    "nasal packing. Which artery should be ligated/embolised?",
    ["Sphenopalatine artery", "Anterior ethmoidal artery", "Posterior ethmoidal artery", "Greater palatine artery"],
    0,
    "Posterior epistaxis refractory to packing most often arises from the sphenopalatine artery (terminal "
    "branch of the maxillary artery); endoscopic ligation or embolisation is first-line when packing fails.",
    tag="[Recall - NEET PG 2025]")

add_question(
    "Which is the most common site of epistaxis in children?",
    ["Little's area", "Woodruff's plexus", "Sphenopalatine artery", "Anterior ethmoidal artery"],
    0,
    "In children, epistaxis most commonly originates from Little's area (Kiesselbach's plexus) on the "
    "antero-inferior nasal septum. Woodruff's plexus (posterior, venous) is more implicated in adult "
    "posterior epistaxis.",
    tag="[Recall - INI-CET, November 2022]")

add_question(
    "A 16-year-old male presents with recurrent profuse epistaxis from the right nasal cavity. Endoscopy "
    "shows a globular vascular mass; CT shows anterior bowing of the posterior wall of the maxillary sinus "
    "(Holman-Miller sign). What is the most probable diagnosis?",
    ["Juvenile Nasopharyngeal Angiofibroma (JNA)", "Antrochoanal polyp", "Rhinosporidiosis", "Rhinoscleroma"],
    0,
    "JNA is a benign but locally aggressive vascular tumour in adolescent males, presenting with recurrent "
    "severe epistaxis and a nasal/nasopharyngeal mass; anterior bowing of the posterior maxillary sinus wall "
    "on CT is classic. Treatment is preoperative embolisation followed by surgical excision.",
    tag="[Recall - NEET PG 2025]")

add_question(
    "Which of the following is NOT true of juvenile nasopharyngeal angiofibroma?",
    ["Recurrent epistaxis", "Unilateral nasal obstruction", "Occurs exclusively in adolescent boys", "Biopsy under anaesthesia is done to diagnose it"],
    3,
    "JNA is highly vascular; biopsy is avoided/contraindicated because it can cause severe, potentially "
    "life-threatening haemorrhage. Diagnosis is clinico-radiological (CT/MRI/angiography showing the Holman-"
    "Miller sign and tumour blush), not biopsy.",
    tag="[Recall - INI-CET May 2025]")

add_question(
    "A South Indian male farmer presents to the ENT clinic with a reddish, friable, bleeding mass "
    "protruding from the nose, described as having a 'strawberry-like' surface with tiny white/yellow "
    "spots. What is the likely diagnosis?",
    ["Rhinosporidiosis", "Rhinoscleroma", "Rhinophyma", "Nasal polyp"],
    0,
    "Rhinosporidiosis (caused by Rhinosporidium seeberi) is endemic in South India and Sri Lanka, typically "
    "affecting farmers/people in contact with stagnant water; it presents as a friable, vascular, "
    "strawberry-like polypoidal mass with visible sporangia (white dots) that bleeds easily on touch.",
    tag="[Recall - INI-CET May 2023]")

add_question(
    "A man presents with saddle nose deformity, cough, intermittent fever and haemoptysis. Septal "
    "perforation with pale granuloma is seen; chest X-ray shows multiple cavitary lesions; biopsy shows "
    "granuloma with multinucleated giant cells and caseous necrosis. What is the probable cause?",
    ["Wegener's granulomatosis", "Tuberculosis", "Syphilis", "Sarcoidosis"],
    1,
    "Nasal tuberculosis, usually secondary to pulmonary TB, commonly involves the anterior septum/inferior "
    "turbinate and can destroy the septum causing saddle nose deformity. Biopsy shows caseating granulomas "
    "with Langhans multinucleated giant cells - together with cavitary lung lesions this points to TB rather "
    "than Wegener's (which shows necrotising vasculitis without caseation).",
    tag="[Recall - INI-CET, last 5 years]")

add_question(
    "A 65-year-old presents with right-sided nasal obstruction and occasional blood-stained nasal "
    "discharge. CT and endoscopy show a unilateral polypoidal mass with a characteristic 'cerebriform' "
    "convoluted pattern on MRI. What is the underlying diagnosis?",
    ["Inverted papilloma", "Antrochoanal polyp", "Allergic nasal polyp", "Angiofibroma"],
    0,
    "Inverted papilloma is a benign but locally aggressive sinonasal tumour of older adults, typically "
    "unilateral, with a classic cerebriform/convoluted 'columnar' pattern on MRI; it has malignant "
    "transformation potential (to squamous cell carcinoma) and needs complete endoscopic excision with "
    "margin control.",
    tag="[Recall - INI-CET, last 5 years]")

add_question(
    "A 35-year-old female with nasal obstruction and post-nasal drip had FESS 5 years ago (uncinectomy and "
    "maxillary ostium dilation). Diagnostic nasal endoscopy now shows patent ostia with only mild mucosal "
    "edema of the maxillary sinus lining. What is the next best step?",
    ["Repeat surgery", "Macrolides for 4 months", "Steroid irrigation and antihistamines", "Biological therapy (anti-IgE/anti-IL5)"],
    2,
    "With a patent, well-fashioned ostium and only mild mucosal inflammation (no anatomical obstruction or "
    "recurrent polyps), medical optimisation with nasal steroid irrigation and antihistamines is preferred "
    "over repeat surgery, which is reserved for anatomical failure or recurrent polyposis.",
    tag="[Recall - INI-CET, last 5 years]")

add_question(
    "A patient presents with facial swelling and orbital edema 20 days after a minor wooden splinter "
    "injury. CT sinuses are normal but subcutaneous nodules are seen. Biopsy shows broad, aseptate hyphae "
    "positive on PAS and Grocott's methenamine silver stain. What is the likely diagnosis?",
    ["Phycomycosis (subcutaneous zygomycosis)", "Midline lethal granuloma", "Foreign body granuloma", "IgG4-related disease"],
    0,
    "Broad aseptate PAS/GMS-positive hyphae following minor trauma (classically with wood/vegetation) with "
    "subcutaneous nodules but normal sinus imaging points to subcutaneous phycomycosis (zygomycosis, e.g. "
    "Basidiobolus/Conidiobolus) rather than the acute rhino-orbito-cerebral mucormycosis of immunocompromised "
    "patients.",
    tag="[Recall - INI-CET, last 5 years]")

add_question(
    "Which of the following is a major (Bent and Kuhn) diagnostic criterion for allergic fungal "
    "rhinosinusitis?",
    ["Type I hypersensitivity (elevated fungus-specific IgE)", "Positive bacterial culture", "Elevated serum IgA", "Absence of nasal polyps"],
    0,
    "Bent and Kuhn's major criteria for allergic fungal rhinosinusitis include Type I (IgE-mediated) "
    "hypersensitivity, nasal polyposis, characteristic CT findings (heterogeneous, hyperattenuating "
    "'double density' sinus opacification), eosinophilic mucin without fungal tissue invasion, and a "
    "positive fungal stain/culture of that mucin - bacterial culture and serum IgA are not part of this "
    "criteria set.",
    tag="[Concept-based / high-yield repeat]")

# ============ SECTION 4: PHARYNX & ORAL CAVITY ============
add_topic_heading("4. Pharynx & Oral Cavity")

add_question(
    "A 10-year-old child presents with throat pain, fever, and referred ear pain. He is diagnosed with "
    "acute tonsillitis. Which nerve is responsible for the referred ear pain?",
    ["Tympanic branch of the glossopharyngeal nerve (Jacobson's nerve)", "Greater auricular nerve", "Auriculotemporal nerve", "Auricular branch of the vagus nerve"],
    0,
    "The glossopharyngeal nerve supplies the tonsillar bed and, via its tympanic branch, also supplies the "
    "middle ear - shared innervation explains referred otalgia in tonsillitis/peritonsillar abscess.",
    tag="[Recall - NEET PG, last 8 years]")

add_question(
    "A patient presents with trismus, muffled 'hot potato' voice, uvular deviation, and a bulge above the "
    "tonsil. What is the most likely diagnosis?",
    ["Peritonsillar abscess (quinsy)", "Retropharyngeal abscess", "Ludwig's angina", "Parapharyngeal abscess"],
    0,
    "Quinsy is the most common deep neck space infection, presenting with trismus, muffled voice, "
    "drooling, and displacement of the tonsil/uvula to the opposite side. Treated with aspiration/incision "
    "and drainage plus antibiotics.",
    tag="[Concept-based / high-yield repeat]")

add_question(
    "A young child presents with snoring, mouth breathing, and adenoid facies. Lateral neck X-ray shows an "
    "enlarged soft-tissue shadow in the nasopharynx. What is the standard treatment if symptomatic?",
    ["Adenoidectomy", "Incision and drainage", "Embolisation and excision", "Choanal atresia repair"],
    0,
    "Adenoid hypertrophy causes mouth breathing, snoring, nasal obstruction and adenoid facies; symptomatic "
    "cases unresponsive to medical therapy are treated with adenoidectomy.",
    tag="[Concept-based / high-yield repeat]")

add_question(
    "Which virus is most strongly associated with nasopharyngeal carcinoma, and what is its most common "
    "histological type?",
    ["EBV; squamous cell carcinoma", "HPV; adenocarcinoma", "HSV; lymphoma", "CMV; sarcoma"],
    0,
    "Nasopharyngeal carcinoma shows strong association with Epstein-Barr virus (elevated EBV antibody "
    "titres aid diagnosis/monitoring); squamous cell carcinoma is the most common histology. Radiotherapy "
    "+/- chemotherapy is primary treatment; neck disease is managed with radical neck dissection if needed.",
    tag="[Concept-based / high-yield repeat]")

add_question(
    "A middle-aged woman with iron deficiency anaemia presents with dysphagia to solids, glossitis, and "
    "koilonychia. Barium swallow shows a post-cricoid web. What is this syndrome called, and what is its "
    "clinical significance?",
    ["Plummer-Vinson syndrome; premalignant for post-cricoid/hypopharyngeal carcinoma", "Zenker's diverticulum; risk of aspiration", "Globus pharyngeus; purely psychogenic", "Eagle syndrome; styloid elongation"],
    0,
    "Plummer-Vinson (Paterson-Brown-Kelly) syndrome is iron-deficiency anaemia with dysphagia, glossitis, "
    "koilonychia and a post-cricoid oesophageal web; it is a recognised premalignant condition for "
    "post-cricoid and upper oesophageal carcinoma, so iron correction and surveillance are important.",
    tag="[Concept-based / high-yield repeat]")

# ============ SECTION 5: LARYNX ============
add_topic_heading("5. Larynx")

add_question(
    "A singer has difficulty raising the pitch of her voice. Examination shows depressed and bowed vocal "
    "cords. Which muscle is most likely involved?",
    ["Cricothyroid", "Interarytenoid", "Posterior cricoarytenoid", "Lateral cricoarytenoid"],
    0,
    "The cricothyroid muscle tenses and elongates the vocal cords, raising pitch (supplied by the external "
    "branch of the superior laryngeal nerve); weakness causes a bowed cord and inability to reach higher "
    "pitch.",
    tag="[Recall - NEET PG, last 5 years]")

add_question(
    "Following total thyroidectomy, a patient develops difficulty breathing and repeated failed attempts "
    "at extubation. What is the most probable cause?",
    ["Superior laryngeal nerve injury", "Unilateral recurrent laryngeal nerve injury", "Bilateral recurrent laryngeal nerve injury", "Neck haematoma"],
    2,
    "Bilateral recurrent laryngeal nerve injury causes both vocal cords to lie in the paramedian position, "
    "producing severe airway obstruction and stridor immediately post-extubation - a dangerous complication "
    "of total thyroidectomy requiring re-intubation or emergency tracheostomy.",
    tag="[Recall - NEET PG, last 5 years]")

add_question(
    "A 75-year-old male smoker presents with hoarseness and dysphagia. Biopsy confirms advanced squamous "
    "cell carcinoma involving both vocal cords, extending into the subglottis and invading the thyroid "
    "cartilage, not amenable to radiotherapy alone. What surgery is most appropriate?",
    ["Partial (vertical/horizontal) laryngectomy", "Total laryngectomy", "Emergency tracheostomy", "Submental tracheostomy"],
    1,
    "Bilateral vocal cord involvement with subglottic extension and cartilage invasion exceeds the limits "
    "of conservation (partial) laryngeal surgery. Total laryngectomy is indicated for advanced disease not "
    "amenable to organ-preservation therapy.",
    tag="[Recall - NEET PG 2025]")

add_question(
    "Entry of a foreign body into the laryngeal inlet is normally prevented by the cough/glottic closure "
    "reflex, which becomes sluggish after alcohol ingestion. Injury to which nerve is responsible for loss "
    "of this protective reflex?",
    ["Internal laryngeal nerve", "Glossopharyngeal nerve", "External laryngeal nerve", "Recurrent laryngeal nerve"],
    0,
    "The internal laryngeal nerve (branch of the superior laryngeal nerve) provides sensory innervation "
    "above the vocal cords, including the laryngeal inlet, mediating the protective cough/closure reflex "
    "against aspiration; alcohol blunts this reflex, and injury to this nerve (e.g. surgical) similarly "
    "predisposes to aspiration.",
    tag="[Recall - INI-CET May 2022]")

add_question(
    "Identify the structure marked on a laryngoscopic image lateral to the aryepiglottic fold, a common "
    "site for lodged foreign bodies and early hypopharyngeal cancer.",
    ["Thyroid cartilage", "Pyriform sinus", "Epiglottis", "Vallecula"],
    1,
    "The pyriform sinus is a mucosal recess lateral to the aryepiglottic fold; it is a common site for "
    "foreign body impaction and the most common site of hypopharyngeal carcinoma.",
    tag="[Recall - NEET PG 2025]")

add_question(
    "A young adult presents with a hoarse, breathy voice and multiple wart-like lesions on both vocal "
    "cords, recurring after excision. Which virus and lesion are most likely?",
    ["HPV 6/11; laryngeal papillomatosis", "HPV 16/18; laryngeal carcinoma", "EBV; lymphoma", "HSV; laryngeal ulcer"],
    0,
    "Recurrent respiratory (laryngeal) papillomatosis is caused by HPV 6/11, presents with progressive "
    "hoarseness in children (juvenile form) or adults, and is notorious for recurrence after excision.",
    tag="[Concept-based / high-yield repeat]")

add_question(
    "A newborn presents with inspiratory stridor that worsens on crying/supine position and improves in "
    "prone position, without cyanosis, and gradually resolves by 18-24 months. What is the most likely "
    "diagnosis?",
    ["Laryngomalacia", "Subglottic stenosis", "Vocal cord palsy", "Laryngeal web"],
    0,
    "Laryngomalacia is the most common cause of stridor in infants, due to a floppy, immature supraglottic "
    "structure; it is positional (worse supine/crying, better prone), self-limiting, and typically resolves "
    "by 18-24 months without treatment unless severe.",
    tag="[Concept-based / high-yield repeat]")

# ============ SECTION 6: HEAD & NECK ============
add_topic_heading("6. Head & Neck")

add_question(
    "A patient with a dental infection develops rapidly progressive bilateral submandibular, sublingual "
    "and submental swelling with brawny induration and tongue elevation, without a discrete abscess "
    "collection. What is the diagnosis and the most urgent concern?",
    ["Ludwig's angina; airway obstruction", "Peritonsillar abscess; sepsis", "Parotitis; facial nerve palsy", "Branchial cyst infection; recurrent infection"],
    0,
    "Ludwig's angina is a rapidly spreading cellulitis of the submandibular, sublingual and submental "
    "spaces, usually odontogenic, causing brawny bilateral swelling and tongue elevation. The chief danger "
    "is airway obstruction, so securing the airway takes priority.",
    tag="[Concept-based / high-yield repeat]")

add_question(
    "A midline neck swelling in a child moves upward on tongue protrusion and with swallowing. What is the "
    "most likely diagnosis?",
    ["Thyroglossal duct cyst", "Branchial cleft cyst", "Dermoid cyst", "Cystic hygroma"],
    0,
    "A thyroglossal duct cyst is typically midline and moves upward with tongue protrusion (due to its "
    "attachment via the hyoid bone to the foramen cecum) as well as with swallowing.",
    tag="[Concept-based / high-yield repeat]")

add_question(
    "The most common benign salivary gland tumour, typically arising in the parotid gland with a slow-"
    "growing, painless, mobile swelling, is:",
    ["Pleomorphic adenoma", "Warthin's tumour", "Mucoepidermoid carcinoma", "Adenoid cystic carcinoma"],
    0,
    "Pleomorphic adenoma (mixed parotid tumour) is the most common salivary gland neoplasm overall, treated "
    "by superficial parotidectomy with a cuff of normal tissue given its tendency to recur if enucleated.",
    tag="[Recall - INI-CET November 2020]")

add_question(
    "A painless, laterally mobile neck mass located at the carotid bifurcation shows a 'lyre sign' (splaying "
    "of internal and external carotid arteries) on angiography. What is the diagnosis?",
    ["Carotid body tumour (paraganglioma)", "Branchial cyst", "Metastatic lymph node", "Carotid artery aneurysm"],
    0,
    "A carotid body tumour (chemodectoma/paraganglioma) arises at the carotid bifurcation and classically "
    "splays the internal and external carotid arteries apart, producing the 'lyre sign' on angiography; it "
    "moves side-to-side but not vertically (Fontaine's sign).",
    tag="[Concept-based / high-yield repeat]")

add_question(
    "After superficial parotidectomy, a patient develops facial sweating and flushing over the cheek while "
    "eating. What is this condition called and what causes it?",
    ["Frey's syndrome; aberrant regeneration of parasympathetic fibres to sweat glands", "Bell's palsy; facial nerve injury", "Sialocele; salivary leak", "First bite syndrome; sympathetic denervation"],
    0,
    "Frey's syndrome (gustatory sweating) follows parotid surgery due to aberrant regrowth of severed "
    "parasympathetic secretomotor fibres (originally destined for salivary tissue) into cutaneous sweat "
    "glands, causing sweating/flushing with eating.",
    tag="[Concept-based / high-yield repeat]")

# ============ SECTION 7: INSTRUMENTS & EMERGENCIES ============
add_topic_heading("7. ENT Instruments & Emergencies")

add_question(
    "Which instrument is specifically designed for closed reduction of a displaced nasal bone fracture?",
    ["Tilley's forceps", "Walsham's forceps", "Luc's forceps", "Bayonet forceps"],
    1,
    "Walsham's forceps has specially angled blades to grasp and disimpact displaced nasal bones during "
    "closed reduction, distinct from Asch's forceps (used on the septum).",
    tag="[Recall - NEET PG, last 5 years]")

add_question(
    "Which mouth gag is classically used to maintain mouth opening and expose the tonsillar fossae during "
    "tonsillectomy?",
    ["Boyle-Davis mouth gag", "Doyen's mouth gag", "McIvor's gag", "Ferguson-Ackland gag"],
    0,
    "The Boyle-Davis mouth gag is the standard instrument used in tonsillectomy/adenoidectomy to keep the "
    "mouth open and depress the tongue, exposing the tonsillar fossae and nasopharynx.",
    tag="[Concept-based / high-yield repeat]")

add_question(
    "A child presents with sudden-onset choking, coughing, and unilateral wheeze after playing with small "
    "objects. Chest X-ray shows unilateral hyperinflation. What is the definitive investigation/treatment?",
    ["Rigid bronchoscopy and removal", "Bronchodilators", "Antibiotics", "Nebulised adrenaline"],
    0,
    "Sudden choking with unilateral wheeze/hyperinflation in a child strongly suggests foreign body "
    "aspiration into a main bronchus (right more common). Rigid bronchoscopy is both diagnostic and "
    "therapeutic and should not be delayed.",
    tag="[Concept-based / high-yield repeat - ENT emergency]")

add_question(
    "In a child with suspected acute epiglottitis presenting with stridor, drooling, and a 'tripod' "
    "posture, which of the following should be strictly avoided?",
    ["Forceful tongue depressor examination of the oropharynx", "Lateral neck X-ray", "Pulse oximetry monitoring", "Keeping the child calm in a parent's lap"],
    0,
    "In suspected acute epiglottitis, any distressing examination (tongue depressor, forceful throat exam, "
    "lying the child flat) can precipitate complete airway obstruction; the airway should be secured in a "
    "controlled setting before any invasive examination.",
    tag="[Concept-based / high-yield repeat - ENT emergency]")

add_question(
    "A trauma patient requires an emergency airway but cricothyroidotomy is contraindicated due to "
    "laryngeal fracture. Which surgical airway procedure is preferred?",
    ["Emergency tracheostomy", "Nasotracheal intubation", "Needle cricothyroidotomy", "Submental intubation"],
    0,
    "When cricothyroidotomy is contraindicated (e.g. laryngeal/tracheal injury, young children), emergency "
    "tracheostomy below the level of injury is the airway of choice.",
    tag="[Concept-based / high-yield repeat]")

# ============ SECTION 8: INI-CET SPECIFIC ============
add_topic_heading("8. INI-CET / AIIMS-PGIMER Specific Recall Questions (2020-2025)")
add_subheading("Note: INI-CET stems tend to be shorter and more mechanism/pathway-focused than NEET PG; several classic INI-CET items are woven into the topic sections above (tagged [Recall - INI-CET ...]). Additional distinct INI-CET recall items are below.")

add_question(
    "A patient presents with vertigo and horizontal nystagmus whose slow component is towards the left. "
    "What is the most likely diagnosis?",
    ["Posterior canal BPPV", "Superior canal BPPV", "Right hypoactive labyrinth", "Left hypoactive labyrinth"],
    3,
    "By convention, nystagmus is named for the fast (corrective) phase, so a slow phase to the left means "
    "the fast phase beats to the right - indicating irritative/normal drive from the right side and "
    "hypofunction of the left labyrinth (the eyes drift slowly toward the weaker/lesioned side before the "
    "fast corrective beat away from it).",
    tag="[Recall - INI-CET May 2022]")

add_question(
    "A patient presents with vertigo, tinnitus and head tilt six months after myringoplasty performed for "
    "safe-type CSOM. What is the most likely diagnosis?",
    ["Perilymphatic fistula", "Labyrinthitis", "Paget disease", "Vestibular schwannoma"],
    0,
    "Vertigo with tinnitus and head tilt appearing after middle ear/stapes-area surgical manipulation is "
    "classically attributed to a perilymphatic fistula (abnormal communication between the perilymph-filled "
    "inner ear and the middle ear, e.g. via a disturbed oval/round window), producing fluctuating "
    "vestibulocochlear symptoms.",
    tag="[Recall - INI-CET May 2021]")

add_question(
    "A patient with vertigo but no hearing loss undergoes a diagnostic positional manoeuvre, followed "
    "cautiously by a therapeutic one. What is the diagnostic manoeuvre?",
    ["Hampton's manoeuvre", "Dix-Hallpike manoeuvre", "Epley's manoeuvre", "Simon's manoeuvre"],
    1,
    "The Dix-Hallpike manoeuvre is the diagnostic test for BPPV, provoking characteristic positional "
    "nystagmus and vertigo; if positive, it is followed by the therapeutic Epley (canalith repositioning) "
    "manoeuvre.",
    tag="[Recall - INI-CET November 2020]")

add_question(
    "During ethmoidal sinus surgery, which nasal meatus is the key surgical landmark for the natural "
    "maxillary sinus ostium and drainage of the frontal and anterior ethmoid sinuses?",
    ["Inferior meatus", "Middle meatus", "Supreme meatus", "Superior meatus"],
    1,
    "The middle meatus contains the ostiomeatal complex, the common drainage pathway for the maxillary, "
    "frontal, and anterior ethmoid sinuses, and is the key target of functional endoscopic sinus surgery "
    "(FESS).",
    tag="[Recall - INI-CET, last 5 years]")

add_question(
    "A patient presents with headache, vomiting, gait ataxia and past pointing several weeks after an "
    "episode of untreated CSOM. Imaging reveals a ring-enhancing lesion in the posterior fossa. What is "
    "the most likely diagnosis?",
    ["Cerebellar abscess", "Extradural abscess", "Otitic hydrocephalus", "Lateral sinus thrombophlebitis"],
    0,
    "A cerebellar abscess is an intracranial complication of CSOM (via the labyrinth or posterior fossa "
    "dural plate), presenting with cerebellar signs - ataxia, past-pointing, nystagmus - along with raised "
    "intracranial pressure features (headache, vomiting) and a ring-enhancing lesion on imaging.",
    tag="[Concept-based / high-yield repeat - INI-CET pattern]")

doc.add_page_break()
foot = doc.add_paragraph()
foot.alignment = WD_ALIGN_PARAGRAPH.CENTER
r = foot.add_run(
    "Compiled for revision purposes from publicly available NEET PG and INI-CET recall-question sources "
    "(PrepLadder, DigiNerve, Reflex Prep, eGurukul/Crazy Medicine PYQ discussion sessions) and standard ENT "
    "references. Not an official NBEMS or INI-CET publication."
)
r.italic = True
r.font.size = Pt(9)
r.font.color.rgb = GREY

doc.save("/tmp/workspace/ent-pyq-compilation/NEET_PG_ENT_PYQ_Topicwise_Compilation.docx")
print("Saved. Total questions:", qn_counter)

# -*- coding: utf-8 -*-
from docx import Document
from docx.shared import Pt, Inches, RGBColor
from docx.enum.text import WD_ALIGN_PARAGRAPH

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

GREEN = RGBColor(0x1E, 0x7A, 0x1E)
GREY = RGBColor(0x59, 0x59, 0x59)
BLUE = RGBColor(0x1F, 0x4E, 0x79)
AMBER = RGBColor(0xB8, 0x86, 0x0B)

def add_title():
    t = doc.add_heading("NEET PG & INI-CET ENT (Otorhinolaryngology)", level=0)
    t.alignment = WD_ALIGN_PARAGRAPH.CENTER
    sub = doc.add_heading("Topic-Wise (NEET PG) + Year-Wise (INI-CET) PYQ Compilation", level=2)
    sub.alignment = WD_ALIGN_PARAGRAPH.CENTER
    p = doc.add_paragraph()
    p.alignment = WD_ALIGN_PARAGRAPH.CENTER
    run = p.add_run("NEET PG: approx. 2016-2025  |  INI-CET: every recoverable session, Nov 2020 - May 2026")
    run.italic = True
    run.font.color.rgb = GREY

def add_disclaimer():
    doc.add_heading("Important Note on Sources and Scope", level=2)
    p = doc.add_paragraph()
    p.add_run(
        "Neither NBEMS (NEET PG) nor the INI-CET conducting body officially releases question papers or "
        "answer keys. Every question here is reconstructed from candidate-recall data published by coaching "
        "platforms (PrepLadder, DigiNerve, Reflex Prep, eGurukul/Crazy Medicine, Marrow, Cerebellum Academy) "
        "immediately after each exam, cross-checked against standard ENT textbooks where possible. Exact "
        "wording can vary slightly between recall sources; the tested concept and correct answer are accurate "
        "to the best available public record."
    ).font.size = Pt(9.5)
    doc.add_paragraph()
    p2 = doc.add_paragraph()
    r2 = p2.add_run("INI-CET does not have 10 years of history: ")
    r2.bold = True
    r2.font.size = Pt(9.5)
    r2.font.color.rgb = AMBER
    p2.add_run(
        "INI-CET was launched only in 2020, replacing the earlier separate AIIMS PG and PGIMER entrance "
        "exams. It runs twice a year (May/July session and November session), so as of the current sitting "
        "(May 2026) there are at most about 12 exam sessions in total, not 10 years' worth. Section 8 below "
        "lists every INI-CET ENT recall item I could recover, organised session by session (Nov 2020 through "
        "May 2026). Some sessions (Nov 2021, Nov 2023, Nov 2024) have confirmed ENT recall discussions "
        "circulating as YouTube videos, but I could not find their text transcripts through public written "
        "sources - these gaps are marked explicitly rather than filled with guesses."
    ).font.size = Pt(9.5)
    doc.add_paragraph()
    p3 = doc.add_paragraph()
    p3.add_run(
        "Items marked [Concept-based / high-yield repeat] are frequently-tested topics reconstructed in "
        "standard exam style because the same concept has recurred across multiple exam cycles, rather than "
        "being tied to one single recalled session."
    ).font.size = Pt(9.5)

def add_toc_list(items):
    doc.add_heading("Topics Covered", level=2)
    for i, it in enumerate(items, 1):
        doc.add_paragraph(f"{i}. {it}", style="List Number")
    doc.add_page_break()

def add_topic_heading(title):
    doc.add_heading(title, level=1)

def add_subheading(title, color=BLUE):
    h = doc.add_heading(title, level=3)
    for run in h.runs:
        run.font.color.rgb = color

qn_counter = 0
def nq():
    global qn_counter
    qn_counter += 1
    return qn_counter

def add_question(stem, options, answer_idx, explanation, tag=None):
    qnum = nq()
    p = doc.add_paragraph()
    run = p.add_run(f"Q{qnum}. {stem}")
    run.bold = True
    run.font.size = Pt(11)
    if tag:
        tagp = doc.add_paragraph()
        tagrun = tagp.add_run(tag)
        tagrun.italic = True
        tagrun.font.size = Pt(9)
        tagrun.font.color.rgb = GREY
    for i, opt in enumerate(options):
        letter = chr(97 + i)
        op = doc.add_paragraph(f"{letter}) {opt}", style="List Bullet")
        op.paragraph_format.left_indent = Inches(0.35)
        if i == answer_idx:
            for r in op.runs:
                r.font.color.rgb = GREEN
                r.bold = True
    ansp = doc.add_paragraph()
    ansrun = ansp.add_run(f"Answer: {options[answer_idx]}")
    ansrun.bold = True
    ansrun.font.color.rgb = GREEN
    expp = doc.add_paragraph()
    exprun = expp.add_run(f"Explanation: {explanation}")
    exprun.font.size = Pt(10)
    exprun.font.color.rgb = RGBColor(0x33, 0x33, 0x33)
    doc.add_paragraph()

def add_gap_note(text):
    p = doc.add_paragraph()
    r = p.add_run(text)
    r.italic = True
    r.font.size = Pt(9.5)
    r.font.color.rgb = AMBER
    doc.add_paragraph()

# ================= BUILD =================
add_title()
doc.add_page_break()
add_disclaimer()

topics = [
    "Otology (Ear) - NEET PG topic-wise",
    "Audiology - NEET PG topic-wise",
    "Rhinology (Nose & Paranasal Sinuses) - NEET PG topic-wise",
    "Pharynx & Oral Cavity - NEET PG topic-wise",
    "Larynx - NEET PG topic-wise",
    "Head & Neck - NEET PG topic-wise",
    "ENT Instruments & Emergencies - NEET PG topic-wise",
    "INI-CET Year-Wise Compilation (Nov 2020 - May 2026)",
]
add_toc_list(topics)

# ============ SECTION 1: OTOLOGY ============
add_topic_heading("1. Otology (Ear)")
add_subheading("1.1 CSOM, Cholesteatoma & Complications")
add_question(
    "A 20-year-old patient presents with recurrent ear discharge. On otoscopic examination, the examiner "
    "notes the complete absence of the tympanic membrane. What is the best treatment option?",
    ["Myringoplasty", "Radical mastoidectomy", "Ossiculoplasty", "Tympanoplasty"],
    3,
    "Total TM absence with a dry, safe ear and intact/mobile ossicular chain is managed by tympanoplasty.",
    tag="[Recall - NEET PG 2025]")
add_question(
    "A patient with CSOM has attic erosion with squamous epithelium debris on HRCT temporal bone. Which "
    "type of CSOM is this?",
    ["Tubotympanic (safe) CSOM", "Atticoantral (unsafe) CSOM", "Otosclerosis", "Otomycosis"],
    1,
    "Attic/marginal perforation with cholesteatoma and bone erosion is characteristic of atticoantral "
    "(unsafe) CSOM, which needs mastoidectomy given risk of complications.",
    tag="[Concept-based / high-yield repeat]")
add_question(
    "Which of the following is NOT a feature of tubercular otitis media?",
    ["Earache", "Multiple tympanic membrane perforations", "Pale, unhealthy granulation tissue", "Foul-smelling ear discharge"],
    0,
    "Tubercular OM is classically painless despite florid multiple perforations and pale granulations - "
    "absence of earache is the key distinguishing clue from ordinary CSOM.",
    tag="[Recall - NEET PG, last 5 years]")
add_question(
    "A patient develops a tender post-auricular swelling that pushes the pinna forward and outward, with "
    "sagging of the postero-superior meatal wall, following untreated acute otitis media. Diagnosis?",
    ["Acute mastoiditis", "Furunculosis of the external canal", "Bezold's abscess", "Parotid abscess"],
    0,
    "Acute mastoiditis presents with post-auricular swelling and sagging postero-superior meatal wall; "
    "requires cortical mastoidectomy if unresponsive to IV antibiotics/myringotomy.",
    tag="[Concept-based / high-yield repeat]")
add_question(
    "Pus from mastoiditis tracks along the digastric muscle and presents as a swelling in the upper neck "
    "below the mastoid tip. What is this complication called?",
    ["Bezold's abscess", "Citelli's abscess", "Luc's abscess", "Zygomatic abscess"],
    0,
    "Bezold's abscess results from mastoid pus perforating the mastoid tip and tracking beneath "
    "sternocleidomastoid/digastric muscle - an extracranial complication of mastoiditis.",
    tag="[Concept-based / high-yield repeat]")

add_subheading("1.2 Otosclerosis, Facial Nerve, Tumours & Vestibular Disorders")
add_question(
    "A young adult female presents with progressive bilateral conductive hearing loss, tinnitus, and "
    "paracusis willisii. Otoscopy is normal with a Schwartze sign. Diagnosis?",
    ["Otosclerosis", "Presbycusis", "Meniere disease", "Otitis media with effusion"],
    0,
    "Otosclerosis presents in young adults with bilateral conductive hearing loss, paracusis willisii, a "
    "normal-looking TM, and a Schwartze sign; treated with stapedotomy/stapedectomy.",
    tag="[Concept-based / high-yield repeat]")
add_question(
    "What is the surgery called that widens the cartilaginous part of the external auditory canal?",
    ["Meatoplasty", "Tympanoplasty", "Myringoplasty", "Otoplasty"],
    0,
    "Meatoplasty widens the EAC meatus, usually performed with modified radical mastoidectomy.",
    tag="[Recall - NEET PG, last 8 years]")
add_question(
    "The saccule of the membranous labyrinth develops from which part of the otocyst?",
    ["Saccus anterior", "Saccus posterior", "Pars superior", "Pars inferior"],
    3,
    "The otocyst divides into pars superior (utricle, semicircular canals) and pars inferior (saccule and "
    "cochlear duct).",
    tag="[Recall - NEET PG, last 8 years]")
add_question(
    "A 45-year-old woman is diagnosed with right vestibular neuronitis. What is expected on the head "
    "impulse test?",
    ["Normal (no corrective saccade) bilaterally", "Corrective saccade when the head is turned toward the affected (right) side", "Corrective saccade only on the left", "Nystagmus abolished by fixation"],
    1,
    "A rapid head thrust toward the weak labyrinth produces a catch-up (corrective) saccade because the "
    "VOR on that side is impaired.",
    tag="[Recall - NEET PG, last 5 years]")
add_question(
    "A patient presents with progressive unilateral sensorineural hearing loss and imbalance. Histopathology "
    "shows Antoni A and Antoni B areas with Verocay bodies. Diagnosis?",
    ["Schwannoma (Vestibular schwannoma/acoustic neuroma)", "Ependymoma", "Meningioma", "Medulloblastoma"],
    0,
    "Antoni A/B areas with Verocay bodies are classic schwannoma histology; in the CP angle this is a "
    "vestibular schwannoma.",
    tag="[Recall - NEET PG 2025]")
add_question(
    "A patient with atresia of the external auditory canal needs amplification. Which device is most "
    "appropriate?",
    ["Bone-anchored hearing aid (BAHA)", "Conventional air-conduction hearing aid", "Cochlear implant", "Middle ear implant"],
    0,
    "A BAHA bypasses the external/middle ear, transmitting sound via bone conduction directly to the "
    "cochlea, since a conventional aid cannot work when the canal is atretic.",
    tag="[Concept-based / high-yield repeat]")
add_question(
    "A patient presents with sudden-onset facial weakness, ear pain, and grouped vesicles on the pinna and "
    "EAC, along with SNHL and vertigo. Diagnosis?",
    ["Ramsay Hunt syndrome (herpes zoster oticus)", "Bell's palsy", "Otitis externa", "Malignant otitis externa"],
    0,
    "Ramsay Hunt syndrome (VZV reactivation in the geniculate ganglion) causes facial palsy plus vesicular "
    "eruption on pinna/EAC, often with cochleovestibular involvement.",
    tag="[Concept-based / high-yield repeat]")
add_question(
    "An elderly diabetic presents with severe ear pain, granulation tissue at the bone-cartilage junction "
    "of the EAC, and facial nerve palsy. Cultures grow Pseudomonas aeruginosa. Diagnosis?",
    ["Malignant (necrotising) otitis externa", "Furunculosis", "Otomycosis", "Acute mastoiditis"],
    0,
    "Malignant otitis externa is a skull-base osteomyelitis in elderly diabetics, almost always caused by "
    "Pseudomonas, needing prolonged anti-pseudomonal therapy.",
    tag="[Concept-based / high-yield repeat]")

# ============ SECTION 2: AUDIOLOGY ============
add_topic_heading("2. Audiology (Tuning Fork Tests & Audiometry)")
add_question(
    "A 27-year-old male with recurrent ear infection has a central TM perforation. Rinne negative left, "
    "positive right; Weber lateralises left. Type and side of hearing loss?",
    ["Left sensorineural hearing loss", "Right sensorineural hearing loss", "Left conductive hearing loss", "Right conductive hearing loss"],
    2,
    "Rinne negative + Weber lateralising to the same ear confirms conductive loss in that (left) ear.",
    tag="[Recall - NEET PG 2025]")
add_question(
    "A female patient with hearing loss is Rinne negative at 256 Hz and 512 Hz, but Rinne positive at "
    "1024 Hz. What air-bone gap does this correspond to?",
    ["30-45 dB", "15-30 dB", "45-60 dB", ">60 dB"],
    0,
    "The frequency at which Rinne turns positive correlates with air-bone gap size; negative at 256/512 Hz "
    "but positive at 1024 Hz corresponds to roughly 30-45 dB.",
    tag="[Recall - NEET PG, last 5 years]")
add_question(
    "On PTA, air and bone conduction thresholds are both reduced by a similar amount with no air-bone gap. "
    "Type of hearing loss?",
    ["Conductive hearing loss", "Sensorineural hearing loss", "Mixed hearing loss", "Non-organic hearing loss"],
    1,
    "Equal reduction of AC and BC thresholds with a closed air-bone gap indicates sensorineural loss.",
    tag="[Concept-based / high-yield repeat]")
add_question(
    "What is the correct sequence of the central auditory pathway from the cochlear nerve to the cortex?",
    ["8th nerve -> cochlear nuclei -> superior olivary nucleus -> lateral lemniscus -> inferior colliculus -> medial geniculate body -> auditory cortex",
     "8th nerve -> cochlear nuclei -> lateral lemniscus -> superior olivary nucleus -> inferior colliculus -> medial geniculate body -> auditory cortex",
     "8th nerve -> superior olivary nucleus -> lateral lemniscus -> inferior colliculus -> medial geniculate body -> auditory cortex -> cochlear nuclei",
     "8th nerve -> superior olivary nucleus -> inferior colliculus -> medial geniculate body -> auditory cortex -> cochlear nuclei -> lateral lemniscus"],
    0,
    "Classical ascending auditory pathway: cochlear nerve -> cochlear nuclei (pons) -> superior olivary "
    "nucleus -> lateral lemniscus -> inferior colliculus (midbrain) -> medial geniculate body (thalamus) "
    "-> primary auditory cortex (Heschl's gyrus).",
    tag="[Recall - INI-CET, session unspecified, 2021-2025]")
add_question(
    "A sudden sensorineural hearing loss (idiopathic) is diagnosed within 72 hours of onset. First-line "
    "treatment?",
    ["Oral/intratympanic corticosteroids", "Antivirals", "Antibiotics", "Vasodilators alone"],
    0,
    "Idiopathic SSNHL is an emergency treated with high-dose corticosteroids (oral or intratympanic), "
    "started as early as possible for best outcome.",
    tag="[Concept-based / high-yield repeat]")

# ============ SECTION 3: RHINOLOGY ============
add_topic_heading("3. Rhinology (Nose & Paranasal Sinuses)")
add_question(
    "A patient presents with an injury shown on a lateral X-ray of the nose (nasal bone fracture). Which "
    "instrument is used for closed reduction?",
    ["Tilley's probe", "Luc's forceps", "Denis Browne probe", "Walsham's forceps"],
    3,
    "Walsham's forceps has specially angled blades for closed reduction of a displaced fractured nasal "
    "bone.",
    tag="[Recall - NEET PG 2025]")
add_question(
    "A 78-year-old diabetic, hypertensive male presents with nasal bleeding not controlled by anterior "
    "packing. Which artery should be ligated/embolised?",
    ["Sphenopalatine artery", "Anterior ethmoidal artery", "Posterior ethmoidal artery", "Greater palatine artery"],
    0,
    "Posterior epistaxis refractory to packing most often arises from the sphenopalatine artery; endoscopic "
    "ligation/embolisation is first-line.",
    tag="[Recall - NEET PG 2025]")
add_question(
    "Which is the most common site of epistaxis in children?",
    ["Little's area", "Woodruff's plexus", "Sphenopalatine artery", "Anterior ethmoidal artery"],
    0,
    "In children, epistaxis most commonly originates from Little's area (Kiesselbach's plexus).",
    tag="[Recall - INI-CET November 2022]")
add_question(
    "A 16-year-old male presents with recurrent profuse epistaxis from the right nasal cavity. Endoscopy "
    "shows a globular vascular mass; CT shows anterior bowing of the posterior maxillary sinus wall "
    "(Holman-Miller sign). Most probable diagnosis?",
    ["Juvenile Nasopharyngeal Angiofibroma (JNA)", "Antrochoanal polyp", "Rhinosporidiosis", "Rhinoscleroma"],
    0,
    "JNA is a benign but locally aggressive vascular tumour in adolescent males; treatment is preoperative "
    "embolisation followed by surgical excision.",
    tag="[Recall - NEET PG 2025]")
add_question(
    "A South Indian male farmer presents with a reddish, friable, bleeding, strawberry-like mass "
    "protruding from the nose, with visible tiny white/yellow spots. Likely diagnosis?",
    ["Rhinosporidiosis", "Rhinoscleroma", "Rhinophyma", "Nasal polyp"],
    0,
    "Rhinosporidiosis (Rhinosporidium seeberi) is endemic in South India/Sri Lanka, presenting as a "
    "friable strawberry-like polypoidal mass that bleeds easily on touch.",
    tag="[Recall - INI-CET May 2023]")
add_question(
    "A man presents with saddle nose deformity, cough, intermittent fever and haemoptysis. Septal "
    "perforation with pale granuloma is seen; CXR shows multiple cavitary lesions; biopsy shows granuloma "
    "with multinucleated giant cells and caseous necrosis. Probable cause?",
    ["Wegener's granulomatosis", "Tuberculosis", "Syphilis", "Sarcoidosis"],
    1,
    "Nasal TB commonly involves the anterior septum/inferior turbinate; caseating granulomas with Langhans "
    "giant cells plus cavitary lung disease point to TB rather than Wegener's (non-caseating vasculitis).",
    tag="[Recall - INI-CET November 2022]")
add_question(
    "A 65-year-old presents with right-sided nasal obstruction and blood-stained discharge. Imaging shows "
    "a unilateral polypoidal mass with a characteristic 'cerebriform' convoluted pattern on MRI. Diagnosis?",
    ["Inverted papilloma", "Antrochoanal polyp", "Allergic nasal polyp", "Angiofibroma"],
    0,
    "Inverted papilloma is a benign but locally aggressive sinonasal tumour with a classic cerebriform "
    "pattern on MRI and malignant transformation potential; needs complete endoscopic excision.",
    tag="[Recall - INI-CET, session unspecified]")
add_question(
    "A 35-year-old female with nasal obstruction/post-nasal drip had FESS 5 years ago (uncinectomy + "
    "maxillary ostium dilation). DNE now shows patent ostia with mild mucosal edema only. Next best step?",
    ["Repeat surgery", "Macrolides for 4 months", "Steroid irrigation and antihistamines", "Biological therapy (anti-IgE/anti-IL5)"],
    2,
    "With a patent ostium and only mild mucosal inflammation, medical optimisation is preferred over repeat "
    "surgery, which is reserved for anatomical failure or recurrent polyposis.",
    tag="[Recall - INI-CET, session unspecified]")
add_question(
    "A patient develops facial swelling and orbital edema 20 days after a minor wooden splinter injury. "
    "CT sinuses are normal but subcutaneous nodules are seen; biopsy shows broad aseptate hyphae positive "
    "on PAS and GMS stain. Likely diagnosis?",
    ["Phycomycosis (subcutaneous zygomycosis)", "Midline lethal granuloma", "Foreign body granuloma", "IgG4-related disease"],
    0,
    "Broad aseptate PAS/GMS-positive hyphae after minor wood trauma with subcutaneous nodules but normal "
    "sinus imaging points to subcutaneous phycomycosis rather than acute rhino-orbito-cerebral mucormycosis.",
    tag="[Recall - INI-CET, session unspecified]")
add_question(
    "Which of the following is a major (Bent and Kuhn) diagnostic criterion for allergic fungal "
    "rhinosinusitis?",
    ["Type I hypersensitivity (elevated fungus-specific IgE)", "Positive bacterial culture", "Elevated serum IgA", "Absence of nasal polyps"],
    0,
    "Bent and Kuhn's major criteria include Type I hypersensitivity, nasal polyposis, characteristic CT "
    "'double density' opacification, eosinophilic mucin without tissue invasion, and positive fungal "
    "stain/culture of that mucin.",
    tag="[Concept-based / high-yield repeat]")

# ============ SECTION 4: PHARYNX & ORAL CAVITY ============
add_topic_heading("4. Pharynx & Oral Cavity")
add_question(
    "A 10-year-old child presents with throat pain, fever, and referred ear pain, diagnosed with acute "
    "tonsillitis. Which nerve is responsible for the referred ear pain?",
    ["Tympanic branch of the glossopharyngeal nerve (Jacobson's nerve)", "Greater auricular nerve", "Auriculotemporal nerve", "Auricular branch of the vagus nerve"],
    0,
    "The glossopharyngeal nerve supplies the tonsillar bed and, via its tympanic branch, the middle ear - "
    "explaining referred otalgia in tonsillitis.",
    tag="[Recall - NEET PG, last 8 years]")
add_question(
    "A patient presents with trismus, muffled 'hot potato' voice, uvular deviation, and a bulge above the "
    "tonsil. Most likely diagnosis?",
    ["Peritonsillar abscess (quinsy)", "Retropharyngeal abscess", "Ludwig's angina", "Parapharyngeal abscess"],
    0,
    "Quinsy is the most common deep neck space infection; treated with aspiration/incision and drainage "
    "plus antibiotics.",
    tag="[Concept-based / high-yield repeat]")
add_question(
    "A young child presents with snoring, mouth breathing, and adenoid facies; lateral neck X-ray shows an "
    "enlarged nasopharyngeal soft-tissue shadow. Standard treatment if symptomatic?",
    ["Adenoidectomy", "Incision and drainage", "Embolisation and excision", "Choanal atresia repair"],
    0,
    "Adenoid hypertrophy causing persistent symptoms unresponsive to medical therapy is treated with "
    "adenoidectomy.",
    tag="[Concept-based / high-yield repeat]")
add_question(
    "Which virus is most strongly associated with nasopharyngeal carcinoma, and what is its most common "
    "histological type?",
    ["EBV; squamous cell carcinoma", "HPV; adenocarcinoma", "HSV; lymphoma", "CMV; sarcoma"],
    0,
    "Nasopharyngeal carcinoma is strongly associated with EBV; SCC (including the undifferentiated variant) "
    "is the most common histology.",
    tag="[Concept-based / high-yield repeat]")
add_question(
    "A middle-aged woman with iron deficiency anaemia presents with dysphagia to solids, glossitis, and "
    "koilonychia; barium swallow shows a post-cricoid web. Syndrome and its significance?",
    ["Plummer-Vinson syndrome; premalignant for post-cricoid/hypopharyngeal carcinoma", "Zenker's diverticulum; risk of aspiration", "Globus pharyngeus; purely psychogenic", "Eagle syndrome; styloid elongation"],
    0,
    "Plummer-Vinson syndrome (iron-deficiency anaemia + dysphagia + glossitis + koilonychia + post-cricoid "
    "web) is a recognised premalignant condition for post-cricoid/hypopharyngeal carcinoma.",
    tag="[Concept-based / high-yield repeat]")

# ============ SECTION 5: LARYNX ============
add_topic_heading("5. Larynx")
add_question(
    "A singer has difficulty raising the pitch of her voice; examination shows depressed, bowed vocal "
    "cords. Which muscle is most likely involved?",
    ["Cricothyroid", "Interarytenoid", "Posterior cricoarytenoid", "Lateral cricoarytenoid"],
    0,
    "The cricothyroid muscle tenses/elongates the cords to raise pitch (supplied by the external branch of "
    "the superior laryngeal nerve); weakness causes bowing and inability to reach high pitch.",
    tag="[Recall - NEET PG, last 5 years]")
add_question(
    "Following total thyroidectomy, a patient develops difficulty breathing and repeated failed attempts "
    "at extubation. Most probable cause?",
    ["Superior laryngeal nerve injury", "Unilateral recurrent laryngeal nerve injury", "Bilateral recurrent laryngeal nerve injury", "Neck haematoma"],
    2,
    "Bilateral RLN injury fixes both cords in the paramedian position, causing severe airway obstruction "
    "requiring re-intubation or emergency tracheostomy.",
    tag="[Recall - NEET PG, last 5 years]")
add_question(
    "A 75-year-old male smoker presents with hoarseness and dysphagia; biopsy confirms advanced SCC "
    "involving both vocal cords, subglottis, and thyroid cartilage, not amenable to radiotherapy alone. "
    "Most appropriate surgery?",
    ["Partial (vertical/horizontal) laryngectomy", "Total laryngectomy", "Emergency tracheostomy", "Submental tracheostomy"],
    1,
    "Bilateral cord involvement with subglottic extension and cartilage invasion exceeds the limits of "
    "conservation surgery; total laryngectomy is indicated.",
    tag="[Recall - NEET PG 2025]")
add_question(
    "Entry of a foreign body into the laryngeal inlet is normally prevented by the cough/glottic closure "
    "reflex, which becomes sluggish after alcohol ingestion. Injury to which nerve is responsible for loss "
    "of this protective reflex?",
    ["Internal laryngeal nerve", "Glossopharyngeal nerve", "External laryngeal nerve", "Recurrent laryngeal nerve"],
    0,
    "The internal laryngeal nerve provides sensory innervation above the vocal cords, mediating the "
    "protective cough/closure reflex against aspiration.",
    tag="[Recall - INI-CET May 2022]")
add_question(
    "Identify the structure marked on a laryngoscopic image lateral to the aryepiglottic fold, a common "
    "site for lodged foreign bodies and early hypopharyngeal cancer.",
    ["Thyroid cartilage", "Pyriform sinus", "Epiglottis", "Vallecula"],
    1,
    "The pyriform sinus is lateral to the aryepiglottic fold; a common site for foreign body impaction and "
    "the most common site of hypopharyngeal carcinoma.",
    tag="[Recall - NEET PG 2025]")
add_question(
    "A young adult presents with a hoarse, breathy voice and multiple wart-like lesions on both vocal "
    "cords, recurring after excision. Virus and lesion?",
    ["HPV 6/11; laryngeal papillomatosis", "HPV 16/18; laryngeal carcinoma", "EBV; lymphoma", "HSV; laryngeal ulcer"],
    0,
    "Recurrent respiratory (laryngeal) papillomatosis is caused by HPV 6/11 and is notorious for recurrence "
    "after excision.",
    tag="[Concept-based / high-yield repeat]")
add_question(
    "A newborn presents with inspiratory stridor that worsens on crying/supine position and improves "
    "prone, without cyanosis, gradually resolving by 18-24 months. Most likely diagnosis?",
    ["Laryngomalacia", "Subglottic stenosis", "Vocal cord palsy", "Laryngeal web"],
    0,
    "Laryngomalacia is the most common cause of infantile stridor, positional and self-limiting, resolving "
    "by 18-24 months in most cases.",
    tag="[Concept-based / high-yield repeat]")

# ============ SECTION 6: HEAD & NECK ============
add_topic_heading("6. Head & Neck")
add_question(
    "A patient with a dental infection develops rapidly progressive bilateral submandibular, sublingual "
    "and submental swelling with brawny induration and tongue elevation, without a discrete abscess "
    "collection. Diagnosis and most urgent concern?",
    ["Ludwig's angina; airway obstruction", "Peritonsillar abscess; sepsis", "Parotitis; facial nerve palsy", "Branchial cyst infection; recurrent infection"],
    0,
    "Ludwig's angina is a rapidly spreading odontogenic cellulitis; the chief danger is airway obstruction, "
    "so securing the airway takes priority.",
    tag="[Concept-based / high-yield repeat]")
add_question(
    "A midline neck swelling in a child moves upward on tongue protrusion and with swallowing. Most likely "
    "diagnosis?",
    ["Thyroglossal duct cyst", "Branchial cleft cyst", "Dermoid cyst", "Cystic hygroma"],
    0,
    "A thyroglossal duct cyst is midline and moves upward with tongue protrusion because of its attachment "
    "via the hyoid bone to the foramen cecum.",
    tag="[Concept-based / high-yield repeat]")
add_question(
    "The most common benign salivary gland tumour, typically arising in the parotid gland with a slow-"
    "growing, painless, mobile swelling, is:",
    ["Pleomorphic adenoma", "Warthin's tumour", "Mucoepidermoid carcinoma", "Adenoid cystic carcinoma"],
    0,
    "Pleomorphic adenoma is the most common salivary gland neoplasm overall, treated by superficial "
    "parotidectomy with a cuff of normal tissue.",
    tag="[Recall - INI-CET November 2020]")
add_question(
    "A painless, laterally mobile neck mass at the carotid bifurcation shows a 'lyre sign' (splaying of "
    "internal and external carotid arteries) on angiography. Diagnosis?",
    ["Carotid body tumour (paraganglioma)", "Branchial cyst", "Metastatic lymph node", "Carotid artery aneurysm"],
    0,
    "A carotid body tumour arises at the carotid bifurcation and classically splays the ICA/ECA apart, "
    "producing the 'lyre sign'.",
    tag="[Concept-based / high-yield repeat]")
add_question(
    "After superficial parotidectomy, a patient develops facial sweating and flushing over the cheek while "
    "eating. Condition and cause?",
    ["Frey's syndrome; aberrant regeneration of parasympathetic fibres to sweat glands", "Bell's palsy; facial nerve injury", "Sialocele; salivary leak", "First bite syndrome; sympathetic denervation"],
    0,
    "Frey's syndrome follows parotid surgery due to aberrant regrowth of severed parasympathetic "
    "secretomotor fibres into cutaneous sweat glands.",
    tag="[Concept-based / high-yield repeat]")

# ============ SECTION 7: INSTRUMENTS & EMERGENCIES ============
add_topic_heading("7. ENT Instruments & Emergencies")
add_question(
    "Which instrument is specifically designed for closed reduction of a displaced nasal bone fracture?",
    ["Tilley's forceps", "Walsham's forceps", "Luc's forceps", "Bayonet forceps"],
    1,
    "Walsham's forceps has specially angled blades to disimpact displaced nasal bones during closed "
    "reduction.",
    tag="[Recall - NEET PG, last 5 years]")
add_question(
    "Which mouth gag is classically used to maintain mouth opening and expose the tonsillar fossae during "
    "tonsillectomy?",
    ["Boyle-Davis mouth gag", "Doyen's mouth gag", "McIvor's gag", "Ferguson-Ackland gag"],
    0,
    "The Boyle-Davis mouth gag is the standard instrument used in tonsillectomy/adenoidectomy.",
    tag="[Concept-based / high-yield repeat]")
add_question(
    "A child presents with sudden-onset choking, coughing, and unilateral wheeze after playing with small "
    "objects; CXR shows unilateral hyperinflation. Definitive investigation/treatment?",
    ["Rigid bronchoscopy and removal", "Bronchodilators", "Antibiotics", "Nebulised adrenaline"],
    0,
    "Sudden choking with unilateral wheeze/hyperinflation suggests foreign body aspiration; rigid "
    "bronchoscopy is diagnostic and therapeutic.",
    tag="[Concept-based / high-yield repeat - ENT emergency]")
add_question(
    "In a child with suspected acute epiglottitis presenting with stridor, drooling, and a 'tripod' "
    "posture, which of the following should be strictly avoided?",
    ["Forceful tongue depressor examination of the oropharynx", "Lateral neck X-ray", "Pulse oximetry monitoring", "Keeping the child calm in a parent's lap"],
    0,
    "Any distressing examination in suspected epiglottitis can precipitate complete airway obstruction; "
    "the airway should be secured in a controlled setting first.",
    tag="[Concept-based / high-yield repeat - ENT emergency]")
add_question(
    "A trauma patient requires an emergency airway but cricothyroidotomy is contraindicated due to "
    "laryngeal fracture. Preferred surgical airway?",
    ["Emergency tracheostomy", "Nasotracheal intubation", "Needle cricothyroidotomy", "Submental intubation"],
    0,
    "When cricothyroidotomy is contraindicated (e.g. laryngeal/tracheal injury), emergency tracheostomy "
    "below the level of injury is preferred.",
    tag="[Concept-based / high-yield repeat]")

# ============ SECTION 8: INI-CET YEAR-WISE ============
add_topic_heading("8. INI-CET Year-Wise Compilation (Nov 2020 - May 2026)")
p = doc.add_paragraph()
p.add_run(
    "INI-CET began in 2020, so this section lists every ENT recall item recoverable for each session, "
    "in chronological order. Where a session's ENT recall could not be found in written form, this is noted "
    "explicitly rather than left silent."
).font.size = Pt(9.5)
doc.add_paragraph()

add_subheading("INI-CET - November 2020", color=BLUE)
add_question(
    "A patient with vertigo but no hearing loss undergoes a diagnostic positional manoeuvre, followed "
    "cautiously by a therapeutic one. What is the diagnostic manoeuvre?",
    ["Hampton's manoeuvre", "Dix-Hallpike manoeuvre", "Epley's manoeuvre", "Simon's manoeuvre"],
    1,
    "The Dix-Hallpike manoeuvre is the diagnostic test for BPPV; if positive, it is followed by the "
    "therapeutic Epley (canalith repositioning) manoeuvre.",
    tag="[Recall - INI-CET November 2020]")
add_question(
    "Which is the most common benign tumour of the parotid gland?",
    ["Pleomorphic adenoma", "Warthin tumour", "Oncocytoma", "Basal cell adenoma"],
    0,
    "Pleomorphic adenoma (mixed parotid tumour) is the most common benign salivary neoplasm.",
    tag="[Recall - INI-CET November 2020]")

add_subheading("INI-CET - May 2021", color=BLUE)
add_question(
    "A patient presents with vertigo, tinnitus, and head tilt six months after myringoplasty for safe-type "
    "CSOM. What is your diagnosis?",
    ["Perilymphatic fistula", "Labyrinthitis", "Paget disease", "Vestibular schwannoma"],
    0,
    "Vertigo, tinnitus and head tilt appearing after middle-ear surgical manipulation is classically "
    "attributed to a perilymphatic fistula (abnormal perilymph leak into the middle ear).",
    tag="[Recall - INI-CET May 2021]")
add_question(
    "Which among the following is NOT used in post-laryngectomy voice rehabilitation?",
    ["Tracheo-esophageal prosthesis (TEP)", "Esophageal speech", "Polite yawning", "Super supraglottic swallow"],
    3,
    "TEP, esophageal speech, and the 'polite yawning' technique are voice-restoration methods after "
    "laryngectomy. Super-supraglottic swallow is a swallowing-safety manoeuvre (airway protection), not a "
    "voice production/rehabilitation technique.",
    tag="[Recall - INI-CET May 2021]")

add_gap_note(
    "INI-CET November 2021: an ENT/airway-management recall session is known to have circulated (video "
    "discussions reference it), but I could not locate a written transcript with specific ENT question text "
    "within available public sources. Flagged as a gap rather than filled with an unverifiable guess."
)

add_subheading("INI-CET - May 2022", color=BLUE)
add_question(
    "A patient presents with vertigo and horizontal nystagmus whose slow component is towards the left. "
    "What is the most likely diagnosis?",
    ["Posterior canal BPPV", "Superior canal BPPV", "Right hypoactive labyrinth", "Left hypoactive labyrinth"],
    3,
    "Nystagmus is named for its fast phase; a slow phase to the left implies a fast phase to the right, "
    "indicating hypofunction of the left (lesioned) labyrinth.",
    tag="[Recall - INI-CET May 2022]")
add_question(
    "Foreign body entry into the laryngeal inlet is normally prevented by the cough reflex, which becomes "
    "sluggish with alcohol ingestion. Which nerve is likely injured when this reflex is lost?",
    ["Internal laryngeal nerve", "Glossopharyngeal nerve", "External laryngeal nerve", "Recurrent laryngeal nerve"],
    0,
    "The internal laryngeal nerve provides sensation above the vocal cords and mediates the protective "
    "glottic closure/cough reflex.",
    tag="[Recall - INI-CET May 2022]")

add_subheading("INI-CET - November 2022", color=BLUE)
add_question(
    "CT scan of a patient with laryngeal carcinoma is shown. What is the staging?",
    ["T1N0M0", "T4N1M0", "T2N1M0", "T3N0M0"],
    1,
    "Per the recalled imaging findings (extensive local tumour plus nodal involvement), the correct staging "
    "was T4N1M0.",
    tag="[Recall - INI-CET November 2022]")
add_question(
    "Which is the most common site of epistaxis in children?",
    ["Little's area", "Woodruff's plexus", "Sphenopalatine artery", "Anterior ethmoidal artery"],
    0,
    "Little's area (Kiesselbach's plexus) on the anteroinferior septum is the most common site of "
    "epistaxis in children.",
    tag="[Recall - INI-CET November 2022]")
add_question(
    "A man presents with saddle nose deformity, cough, fever and haemoptysis; septal perforation with pale "
    "granuloma, cavitary lung lesions, and biopsy showing caseating granulomas with giant cells. Probable "
    "cause?",
    ["Wegener's granulomatosis", "Tuberculosis", "Syphilis", "Sarcoidosis"],
    1,
    "Caseating granulomas with Langhans giant cells plus cavitary pulmonary disease point to nasal "
    "tuberculosis rather than Wegener's granulomatosis.",
    tag="[Recall - INI-CET November 2022]")

add_subheading("INI-CET - May 2023", color=BLUE)
add_question(
    "A South Indian male farmer presents with a reddish mass coming out of the nose (image/histopathology "
    "shown). What is the likely diagnosis?",
    ["Rhinosporidiosis", "Rhinoscleroma", "Rhinophyma", "Nasal polyp"],
    0,
    "The clinical picture (farmer, South Indian, friable reddish nasal mass) and histopathology are classic "
    "for rhinosporidiosis.",
    tag="[Recall - INI-CET May 2023]")

add_gap_note(
    "INI-CET November 2023: a dedicated ENT & Radiology recall session was conducted (confirmed via "
    "coaching-platform video/slide listings), but specific ENT question text was not recoverable from the "
    "written sources accessible to me. Flagged as a gap."
)

add_subheading("INI-CET - May 2024", color=BLUE)
add_question(
    "Which of the following is NOT typically seen in allergic rhinitis?",
    ["Otto Veraguth folds", "Allergic salute", "Allergic shiner", "Dennie-Morgan lines"],
    0,
    "Allergic salute, allergic shiner (infraorbital darkening) and Dennie-Morgan lines are recognised "
    "clinical signs of allergic rhinitis; Otto Veraguth folds are not a standard feature of this condition "
    "per the recalled answer key.",
    tag="[Recall - INI-CET May 2024]")
add_question(
    "A 13-year-old boy presents with right-sided nasal obstruction and recurrent epistaxis for six months. "
    "Most likely diagnosis?",
    ["Juvenile nasopharyngeal angiofibroma", "Allergic rhinitis", "Coagulation disorder", "Antrochoanal polyp"],
    3,
    "CAUTION - conflicting recall: the circulating answer key for this item marks 'Antrochoanal polyp' as "
    "correct, but the classic teaching is that an adolescent boy with unilateral nasal obstruction and "
    "recurrent epistaxis over months is the textbook presentation of Juvenile Nasopharyngeal Angiofibroma "
    "(JNA), not antrochoanal polyp (which usually causes obstruction without prominent recurrent bleeding). "
    "Treat this recalled answer with caution and verify locally before relying on it for exam prep.",
    tag="[Recall - INI-CET May 2024 - disputed answer, see explanation]")

add_gap_note(
    "INI-CET November 2024: a dedicated ENT recall session is confirmed to exist (coaching-platform video), "
    "but I could not retrieve its written question text from accessible public sources. Flagged as a gap."
)

add_subheading("INI-CET - 2025 session (exact month as published by source)", color=BLUE)
add_question(
    "Which of the following is NOT seen in juvenile nasopharyngeal angiofibroma?",
    ["Recurrent epistaxis", "Unilateral nasal obstruction", "Occurs exclusively in adolescent boys", "Biopsy under anaesthesia is done to diagnose it"],
    3,
    "JNA is highly vascular; biopsy is avoided because of severe haemorrhage risk. Diagnosis is "
    "clinico-radiological (CT/MRI/angiography), not biopsy.",
    tag="[Recall - INI-CET May 2025]")
add_question(
    "A middle-aged woman chokes while eating fish and develops coughing, hoarseness, and a foreign body "
    "sensation in the throat; the pyriform fossa is inflamed on examination. Which nerve supplies this "
    "region?",
    ["Internal laryngeal nerve", "External laryngeal nerve", "Glossopharyngeal nerve", "Recurrent laryngeal nerve"],
    0,
    "The internal laryngeal nerve (branch of the superior laryngeal nerve) supplies sensation to the "
    "pyriform fossa and supraglottic larynx.",
    tag="[Recall - INI-CET May 2025]")
add_question(
    "A 65-year-old male complains of difficulty hearing high-pitched sounds. Which region of the cochlea "
    "is primarily damaged?",
    ["Apex of the cochlea", "Base of the cochlea", "Stria vascularis", "Tectorial membrane"],
    1,
    "The base of the cochlea is tonotopically mapped to high frequencies; presbycusis and noise-induced "
    "loss typically damage basal hair cells first, causing high-frequency hearing loss.",
    tag="[Recall - INI-CET 2025]")
add_question(
    "A patient has carcinoma of the larynx involving the entire right true vocal cord, the anterior "
    "commissure, and one-third of the left true vocal cord, with extension into the paraglottic space and "
    "inner thyroid cartilage; the right vocal cord is completely immobile. Most likely tumour stage?",
    ["T1", "T4", "T3", "T2"],
    1,
    "Transglottic extension with paraglottic space/thyroid cartilage invasion and cord fixation meets "
    "criteria for T4 (advanced local disease) in laryngeal carcinoma staging.",
    tag="[Recall - INI-CET 2025]")
add_question(
    "Which of the following hearing tests is NOT performed in infants?",
    ["OAE (Otoacoustic Emissions)", "BERA (Brainstem Evoked Response Audiometry)", "Pure Tone Audiometry (PTA)", "Free-field audiometry"],
    2,
    "PTA requires voluntary behavioural responses and cannot be performed in infants; OAE and BERA are "
    "objective tests used for neonatal/infant hearing screening, and free-field/behavioural observation "
    "audiometry is used qualitatively in infants.",
    tag="[Recall - INI-CET 2025]")
add_question(
    "Arrange the following steps of Functional Endoscopic Sinus Surgery (FESS) in the correct order: "
    "(1) Uncinectomy, (2) Bullectomy, (3) Open the maxillary sinus, (4) Ethmoidectomy.",
    ["1-2-4-3 (ABDC)", "3-1-2-4 (CABD)", "1-3-2-4 (ACBD)", "3-2-1-4 (CBAD)"],
    2,
    "Per the recalled answer key, the sequence is Uncinectomy -> Open maxillary sinus -> Bullectomy -> "
    "Ethmoidectomy. (Note: standard FESS teaching usually sequences uncinectomy -> bullectomy -> anterior "
    "ethmoidectomy -> maxillary antrostomy -> posterior ethmoidectomy -> sphenoidotomy; verify the exact "
    "recalled order against current teaching before relying on it.)",
    tag="[Recall - INI-CET 2025 - verify exact sequence]")

add_subheading("INI-CET - May 2026 (most recent session)", color=BLUE)
add_question(
    "A patient develops acute-onset severe unilateral hearing loss with no identifiable cause; audiometry "
    "confirms sensorineural hearing loss. What is the first-line pharmacological treatment?",
    ["Antivirals", "Antibiotics", "Vasodilators", "Systemic (oral) or intratympanic corticosteroids"],
    3,
    "This describes idiopathic sudden sensorineural hearing loss; first-line pharmacological treatment is "
    "high-dose corticosteroids (oral, with intratympanic steroids as an alternative/salvage option).",
    tag="[Recall - INI-CET May 2026 - options reconstructed from standard teaching, source gave answer letter only]")
add_question(
    "Which of the following is NOT a component of the classical Melkersson-Rosenthal syndrome triad?",
    ["Recurrent orofacial edema", "Unilateral sensorineural hearing loss", "Relapsing facial nerve palsy", "Fissured tongue (lingua plicata)"],
    1,
    "The Melkersson-Rosenthal syndrome triad is recurrent orofacial edema/swelling, relapsing peripheral "
    "facial nerve palsy, and a fissured tongue (lingua plicata). Hearing loss is not part of this triad.",
    tag="[Recall - INI-CET May 2026 - distractor options reconstructed from standard teaching]")
add_question(
    "On a labelled diagram of the laryngeal intrinsic muscles, which single muscle is solely responsible "
    "for abduction (opening) of the vocal cords?",
    ["Posterior cricoarytenoid", "Lateral cricoarytenoid", "Transverse arytenoid", "Cricothyroid"],
    0,
    "The posterior cricoarytenoid is the only laryngeal muscle that abducts the vocal cords (widens the "
    "glottis); all other intrinsic laryngeal muscles are adductors or tensors.",
    tag="[Recall - INI-CET May 2026]")
add_question(
    "Which muscle attaches to the cartilaginous portion of the Eustachian tube and also blends with the "
    "soft palate?",
    ["Levator veli palatini", "Salpingopharyngeus", "Tensor veli palatini", "Palatopharyngeus"],
    2,
    "Tensor veli palatini arises partly from the cartilaginous Eustachian tube and the scaphoid fossa, "
    "blends into the palatal aponeurosis, and actively opens the Eustachian tube during swallowing/yawning.",
    tag="[Recall - INI-CET May 2026]")

doc.add_page_break()
foot = doc.add_paragraph()
foot.alignment = WD_ALIGN_PARAGRAPH.CENTER
r = foot.add_run(
    "Compiled for revision purposes from publicly available NEET PG and INI-CET recall-question sources "
    "(PrepLadder, DigiNerve, Reflex Prep, eGurukul/Crazy Medicine, Marrow, Cerebellum Academy) and standard "
    "ENT references. Not an official NBEMS or INI-CET publication. Items flagged 'disputed answer' or "
    "'verify' should be cross-checked before being treated as a definitive answer key."
)
r.italic = True
r.font.size = Pt(9)
r.font.color.rgb = GREY

doc.save("/tmp/workspace/ent-pyq-compilation/NEET_PG_ENT_PYQ_Topicwise_Compilation.docx")
print("Saved. Total questions:", qn_counter)

# -*- coding: utf-8 -*-
from docx import Document
from docx.shared import Pt, Inches, RGBColor
from docx.enum.text import WD_ALIGN_PARAGRAPH

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

GREEN = RGBColor(0x1E, 0x7A, 0x1E)
GREY = RGBColor(0x59, 0x59, 0x59)
BLUE = RGBColor(0x1F, 0x4E, 0x79)
AMBER = RGBColor(0xB8, 0x86, 0x0B)

def add_title():
    t = doc.add_heading("NEET PG & INI-CET Ophthalmology", level=0)
    t.alignment = WD_ALIGN_PARAGRAPH.CENTER
    sub = doc.add_heading("Topic-Wise (NEET PG) + Year-Wise (INI-CET) PYQ Compilation", level=2)
    sub.alignment = WD_ALIGN_PARAGRAPH.CENTER
    p = doc.add_paragraph()
    p.alignment = WD_ALIGN_PARAGRAPH.CENTER
    run = p.add_run("NEET PG: approx. 2016-2025  |  INI-CET: every recoverable session, May 2021 - May 2026")
    run.italic = True
    run.font.color.rgb = GREY

def add_disclaimer():
    doc.add_heading("Important Note on Sources and Scope", level=2)
    p = doc.add_paragraph()
    p.add_run(
        "Neither NBEMS (NEET PG) nor the INI-CET conducting body officially releases question papers or "
        "answer keys. Every question here is reconstructed from candidate-recall data published by coaching "
        "platforms (PrepLadder, DigiNerve, Reflex Prep, eGurukul, Marrow, Cerebellum Academy, DBMCI) "
        "immediately after each exam, cross-checked against standard ophthalmology textbooks where possible. "
        "Exact wording can vary slightly between recall sources; the tested concept and correct answer are "
        "accurate to the best available public record."
    ).font.size = Pt(9.5)
    doc.add_paragraph()
    p2 = doc.add_paragraph()
    r2 = p2.add_run("INI-CET does not have 10 years of history: ")
    r2.bold = True
    r2.font.size = Pt(9.5)
    r2.font.color.rgb = AMBER
    p2.add_run(
        "INI-CET launched only in 2020, replacing the earlier separate AIIMS PG and PGIMER entrance exams. "
        "It runs roughly twice a year. Section 10 below lists every INI-CET Ophthalmology recall item I could "
        "recover, organised session by session from May 2021 through May 2026. Sessions with no recoverable "
        "written Ophthalmology recall (e.g. November 2020, November 2021, November 2023, November 2024, "
        "November 2025) are noted explicitly as gaps rather than filled with guesses."
    ).font.size = Pt(9.5)
    doc.add_paragraph()
    p3 = doc.add_paragraph()
    p3.add_run(
        "Items marked [Concept-based / high-yield repeat] are frequently-tested topics reconstructed in "
        "standard exam style because the same concept recurs across multiple exam cycles, rather than being "
        "tied to one single recalled session."
    ).font.size = Pt(9.5)

def add_toc_list(items):
    doc.add_heading("Topics Covered", level=2)
    for i, it in enumerate(items, 1):
        doc.add_paragraph(f"{i}. {it}", style="List Number")
    doc.add_page_break()

def add_topic_heading(title):
    doc.add_heading(title, level=1)

def add_subheading(title, color=BLUE):
    h = doc.add_heading(title, level=3)
    for run in h.runs:
        run.font.color.rgb = color

qn_counter = 0
def nq():
    global qn_counter
    qn_counter += 1
    return qn_counter

def add_question(stem, options, answer_idx, explanation, tag=None):
    qnum = nq()
    p = doc.add_paragraph()
    run = p.add_run(f"Q{qnum}. {stem}")
    run.bold = True
    run.font.size = Pt(11)
    if tag:
        tagp = doc.add_paragraph()
        tagrun = tagp.add_run(tag)
        tagrun.italic = True
        tagrun.font.size = Pt(9)
        tagrun.font.color.rgb = GREY
    for i, opt in enumerate(options):
        letter = chr(97 + i)
        op = doc.add_paragraph(f"{letter}) {opt}", style="List Bullet")
        op.paragraph_format.left_indent = Inches(0.35)
        if i == answer_idx:
            for r in op.runs:
                r.font.color.rgb = GREEN
                r.bold = True
    ansp = doc.add_paragraph()
    ansrun = ansp.add_run(f"Answer: {options[answer_idx]}")
    ansrun.bold = True
    ansrun.font.color.rgb = GREEN
    expp = doc.add_paragraph()
    exprun = expp.add_run(f"Explanation: {explanation}")
    exprun.font.size = Pt(10)
    exprun.font.color.rgb = RGBColor(0x33, 0x33, 0x33)
    doc.add_paragraph()

def add_gap_note(text):
    p = doc.add_paragraph()
    r = p.add_run(text)
    r.italic = True
    r.font.size = Pt(9.5)
    r.font.color.rgb = AMBER
    doc.add_paragraph()

# ================= BUILD =================
add_title()
doc.add_page_break()
add_disclaimer()

topics = [
    "Optics & Refraction - NEET PG topic-wise",
    "Lens & Cataract - NEET PG topic-wise",
    "Glaucoma - NEET PG topic-wise",
    "Cornea & Sclera - NEET PG topic-wise",
    "Uvea (Uveitis) - NEET PG topic-wise",
    "Retina & Vitreous - NEET PG topic-wise",
    "Neuro-Ophthalmology - NEET PG topic-wise",
    "Squint, Orbit, Lids & Lacrimal System - NEET PG topic-wise",
    "Community Ophthalmology & Ocular Trauma/Emergencies - NEET PG topic-wise",
    "INI-CET Year-Wise Compilation (May 2021 - May 2026)",
]
add_toc_list(topics)

# ============ SECTION 1: OPTICS & REFRACTION ============
add_topic_heading("1. Optics & Refraction")
add_question(
    "A 25-year-old presents with difficulty seeing distant objects. Retinoscopy shows the far point of "
    "the eye lies in front of the retina. Which lens corrects this refractive error?",
    ["Concave (minus/diverging) lens", "Convex (plus/converging) lens", "Cylindrical lens only", "Prism"],
    0,
    "Myopia occurs when the image forms in front of the retina; a concave (diverging, minus power) lens "
    "moves the focal point back onto the retina.",
    tag="[Concept-based / high-yield repeat]")
add_question(
    "A child has clear vision when looking through a pinhole but blurred vision otherwise, with unequal "
    "corneal curvature in two meridians on keratometry. Diagnosis?",
    ["Astigmatism", "Myopia", "Hypermetropia", "Presbyopia"],
    0,
    "Astigmatism results from unequal corneal/lenticular curvature in different meridians, corrected with "
    "cylindrical lenses; a pinhole improves acuity by eliminating peripheral rays.",
    tag="[Concept-based / high-yield repeat]")
add_question(
    "A 45-year-old presents with difficulty reading fine print at near, with normal distance vision. "
    "Cause and correction?",
    ["Presbyopia due to reduced lens accommodation; convex lens for near work", "Myopia; concave lens", "Astigmatism; cylindrical lens", "Cataract; surgery mandatory"],
    0,
    "Presbyopia is the age-related physiological decline in accommodation (lens elasticity loss), corrected "
    "with reading (convex) glasses.",
    tag="[Concept-based / high-yield repeat]")
add_question(
    "Which instrument is used to objectively measure the refractive error of the eye by neutralising the "
    "movement of the reflex from the fundus?",
    ["Retinoscope", "Keratometer", "Applanation tonometer", "Perimeter"],
    0,
    "Retinoscopy (skiascopy) is an objective refraction technique using the movement of the retinal reflex "
    "to determine refractive error.",
    tag="[Concept-based / high-yield repeat]")
add_question(
    "The amplitude of accommodation in a healthy young child is approximately how many dioptres?",
    ["2 D", "5 D", "14 D", "25 D"],
    2,
    "A healthy child has a high amplitude of accommodation (around 14 D), which progressively declines with "
    "age until presbyopia develops by the mid-40s.",
    tag="[Recall - INI-CET May 2026]")

# ============ SECTION 2: LENS & CATARACT ============
add_topic_heading("2. Lens & Cataract")
add_question(
    "An elderly diabetic presents with painless, progressive diminution of vision. Slit-lamp shows a "
    "yellow-brown nuclear opacity. Which type of cataract is this?",
    ["Nuclear (brunescent) cataract", "Posterior subcapsular cataract", "Cortical cataract", "Christmas tree cataract"],
    0,
    "Nuclear sclerosis progresses through yellow to brown (brunescent) discolouration and is the most common "
    "senile cataract morphology causing gradual myopic shift before vision loss.",
    tag="[Concept-based / high-yield repeat]")
add_question(
    "According to the National Blindness and Visual Impairment Survey (2015-19), what is the most common "
    "cause of moderate-to-severe visual impairment in India?",
    ["Refractive error", "Untreated cataract", "Glaucoma", "Diabetic retinopathy"],
    1,
    "The 2015-19 national survey identified untreated cataract as the leading cause of moderate-severe "
    "visual impairment, followed by refractive error.",
    tag="[Recall - INI-CET May 2022]")
add_question(
    "A young myopic patient with astigmatism and a history of frequent spectacle changes and eye rubbing "
    "presents with sudden acute red, painful eye; slit-lamp shows corneal hydrops. Which procedure is used "
    "to manage acute corneal hydrops in this setting?",
    ["Intracameral C3F8 (perfluoropropane) gas injection", "Phacoemulsification", "Descemet's stripping endothelial keratoplasty (DSEK)", "Collagen cross-linking"],
    0,
    "This vignette describes keratoconus with acute hydrops (Descemet's membrane break); intracameral gas "
    "(C3F8/SF6) tamponade helps re-appose the detached Descemet's membrane and hasten resolution.",
    tag="[Recall - INI-CET 2025]")
add_question(
    "A patient develops sudden dimness of vision a few days after uncomplicated cataract surgery, with "
    "pain, redness, and hypopyon. Most feared diagnosis requiring emergency management?",
    ["Acute postoperative endophthalmitis", "Posterior capsular opacification", "Cystoid macular edema", "Toxic anterior segment syndrome"],
    0,
    "Acute endophthalmitis is a surgical emergency after cataract surgery, managed with vitreous "
    "tap/culture and intravitreal antibiotics +/- vitrectomy.",
    tag="[Concept-based / high-yield repeat]")
add_question(
    "A child with Marfan syndrome is noted to have supero-temporal subluxation of the lens. What is the "
    "typical direction of lens subluxation in homocystinuria for comparison?",
    ["Infero-nasal (downward)", "Supero-temporal (upward)", "No subluxation occurs", "Central, non-directional"],
    0,
    "Marfan syndrome classically causes upward (supero-temporal) lens subluxation/dislocation, whereas "
    "homocystinuria classically causes downward (infero-nasal) subluxation - a frequently tested contrast.",
    tag="[Concept-based / high-yield repeat]")

# ============ SECTION 3: GLAUCOMA ============
add_topic_heading("3. Glaucoma")
add_question(
    "A patient presents with sudden intense eye pain, headache, blurred vision, and coloured halos around "
    "lights. Examination shows a mid-dilated fixed pupil, hazy cornea, and markedly raised intraocular "
    "pressure. Most probable diagnosis?",
    ["Secondary angle closure due to anterior uveitis", "Acute endophthalmitis", "Orbital cellulitis", "Acute primary angle closure glaucoma"],
    3,
    "The classic triad of severe pain with haloes, mid-dilated fixed pupil, corneal oedema and markedly "
    "raised IOP is diagnostic of acute primary angle closure glaucoma - an ophthalmic emergency.",
    tag="[Recall - INI-CET 2025]")
add_question(
    "Which triad of findings is characteristically seen in the involved eye following an acute attack of "
    "angle-closure glaucoma (once the acute attack has settled)?",
    ["Vogt's triad", "Virchow's triad", "Hutchinson's triad", "Gaucher's triad"],
    0,
    "Vogt's triad after an acute congestive glaucoma attack comprises glaukomflecken (anterior subcapsular "
    "lens opacities), sector iris atrophy, and pigment dusting/degenerative changes over the trabecular "
    "meshwork and corneal endothelium.",
    tag="[Recall - INI-CET November 2022]")
add_question(
    "A patient has pigment deposition in a vertical spindle-shaped pattern on the corneal endothelium, "
    "with pigment dispersion in the anterior chamber and iris transillumination defects. Which type of "
    "glaucoma is this associated with?",
    ["Pigmentary glaucoma", "Malignant glaucoma", "Acute angle closure glaucoma", "Neovascular glaucoma"],
    0,
    "A Krukenberg spindle (vertical pigment deposition on the corneal endothelium) is characteristic of "
    "pigment dispersion syndrome, which can progress to pigmentary glaucoma.",
    tag="[Recall - INI-CET 2025]")
add_question(
    "A patient with uveitic glaucoma (anterior uveitis with IOP 38 mmHg, aqueous flare, and keratic "
    "precipitates) needs IOP-lowering therapy. Which class of anti-glaucoma drug should be avoided?",
    ["Prostaglandin analogues", "Beta-blockers", "Carbonic anhydrase inhibitors", "Osmotic agents (mannitol)"],
    0,
    "Prostaglandin analogues can worsen intraocular inflammation and cystoid macular oedema, so they are "
    "avoided in uveitic glaucoma; beta-blockers, CAIs, and osmotics are preferred instead.",
    tag="[Recall - INI-CET May 2021]")
add_question(
    "A neonate presents with excessive tearing (epiphora), photophobia, blepharospasm, and an enlarged "
    "hazy cornea (buphthalmos) bilaterally. Diagnosis and definitive management?",
    ["Primary congenital glaucoma; goniotomy/trabeculotomy", "Congenital nasolacrimal duct obstruction; probing", "Congenital cataract; lens aspiration", "Retinopathy of prematurity; laser"],
    0,
    "The triad of epiphora, photophobia, and blepharospasm with corneal enlargement (buphthalmos) in an "
    "infant is classic for primary congenital glaucoma, treated surgically (goniotomy or trabeculotomy).",
    tag="[Concept-based / high-yield repeat]")

# ============ SECTION 4: CORNEA & SCLERA ============
add_topic_heading("4. Cornea & Sclera")
add_question(
    "A contact lens user presents with severe ocular pain, photophobia, and blurred vision. Corneal "
    "examination shows a ring-shaped infiltrate. Which staining technique helps identify the likely "
    "causative organism?",
    ["Zinc stain", "Calcofluor white stain", "Gram stain", "GMS silver stain"],
    1,
    "A ring-shaped corneal infiltrate in a contact lens wearer is classic for Acanthamoeba keratitis; "
    "calcofluor white stain highlights the cysts under fluorescence microscopy.",
    tag="[Recall - INI-CET 2025]")
add_question(
    "A patient has a nodular, tender red eye where the vascularity blanches after instillation of topical "
    "phenylephrine. What is the likely diagnosis?",
    ["Nodular episcleritis", "Nodular scleritis", "Nodular phlyctenulosis", "Bacterial conjunctivitis"],
    0,
    "Phenylephrine blanches the superficial episcleral vessels (episcleritis) but does NOT blanch the "
    "deeper scleral vessels (scleritis) - a key bedside differentiating test.",
    tag="[Recall - INI-CET May 2023]")
add_question(
    "A patient with rheumatoid arthritis develops severe boring eye pain, a violaceous hue to the sclera, "
    "and thinning progressing to scleral show. Which is the most feared complication if untreated?",
    ["Scleromalacia perforans with globe perforation", "Cataract", "Ptosis", "Ectropion"],
    0,
    "Necrotising scleritis (often associated with rheumatoid arthritis and other vasculitides) can progress "
    "to scleromalacia perforans, risking perforation; needs systemic immunosuppression.",
    tag="[Concept-based / high-yield repeat]")
add_question(
    "Vernal keratoconjunctivitis in a child classically shows which limbal sign along with cobblestone "
    "papillae?",
    ["Horner-Trantas spots", "Bitot spots", "Koeppe nodules", "Busacca nodules"],
    0,
    "Horner-Trantas spots are white limbal dots of degenerated eosinophils seen in vernal "
    "keratoconjunctivitis, along with giant cobblestone papillae on the upper tarsal conjunctiva.",
    tag="[Concept-based / high-yield repeat]")
add_question(
    "A patient with dry eye disease undergoes Schirmer's test. What value (without anaesthesia, after 5 "
    "minutes) is considered abnormal/suggestive of aqueous tear deficiency?",
    ["Less than 10 mm of wetting", "Greater than 25 mm of wetting", "Exactly 20 mm of wetting", "Schirmer's test is not used for dry eye"],
    0,
    "Schirmer's test measures tear production; wetting less than 10 mm in 5 minutes (without anaesthesia) "
    "suggests reduced aqueous tear secretion.",
    tag="[Concept-based / high-yield repeat]")

# ============ SECTION 5: UVEA ============
add_topic_heading("5. Uvea (Uveitis)")
add_question(
    "A patient with anterior uveitis has mutton-fat keratic precipitates, iris nodules, and a positive "
    "chest X-ray for bilateral hilar lymphadenopathy. Most likely underlying systemic association?",
    ["Sarcoidosis", "Ankylosing spondylitis", "Tuberculosis alone", "Reiter's syndrome"],
    0,
    "Granulomatous anterior uveitis (mutton-fat KPs, Koeppe/Busacca iris nodules) with bilateral hilar "
    "lymphadenopathy strongly suggests sarcoidosis.",
    tag="[Concept-based / high-yield repeat]")
add_question(
    "A young man with HLA-B27 positivity and low back pain presents with acute, recurrent, unilateral, "
    "non-granulomatous anterior uveitis. Most likely associated systemic disease?",
    ["Ankylosing spondylitis", "Sarcoidosis", "Behcet disease", "Vogt-Koyanagi-Harada disease"],
    0,
    "HLA-B27-associated acute anterior uveitis is classically linked to seronegative spondyloarthropathies, "
    "most commonly ankylosing spondylitis.",
    tag="[Concept-based / high-yield repeat]")
add_question(
    "A patient presents with recurrent oral and genital ulcers, hypopyon uveitis, and skin pustules that "
    "flare at injection sites (pathergy). Diagnosis?",
    ["Behcet disease", "Reiter syndrome", "Sarcoidosis", "Vogt-Koyanagi-Harada disease"],
    0,
    "Behcet disease presents with recurrent oral/genital ulcers, uveitis (often with hypopyon), skin "
    "lesions, and a positive pathergy test.",
    tag="[Concept-based / high-yield repeat]")
add_question(
    "A patient with posterior uveitis shows a healed chorioretinal scar with a pigmented margin, and a "
    "new adjacent satellite lesion of active retinochoroiditis. Most likely organism?",
    ["Toxoplasma gondii", "Cytomegalovirus", "Toxocara canis", "Candida albicans"],
    0,
    "Recurrent toxoplasma retinochoroiditis classically produces new satellite lesions adjacent to an old "
    "healed pigmented scar (a 'satellite' pattern of reactivation).",
    tag="[Concept-based / high-yield repeat]")

# ============ SECTION 6: RETINA & VITREOUS ============
add_topic_heading("6. Retina & Vitreous")
add_question(
    "A diabetic patient's fundus examination shows neovascularisation at the disc, vitreous haemorrhage, "
    "and tractional changes. What stage of diabetic retinopathy is this?",
    ["Proliferative diabetic retinopathy (PDR)", "Mild non-proliferative diabetic retinopathy", "Moderate non-proliferative diabetic retinopathy", "Diabetic papillopathy alone"],
    0,
    "Neovascularisation (at the disc or elsewhere) defines proliferative diabetic retinopathy, requiring "
    "prompt pan-retinal photocoagulation and/or anti-VEGF therapy.",
    tag="[Concept-based / high-yield repeat]")
add_question(
    "An elderly hypertensive patient presents with sudden, painless, profound unilateral vision loss. "
    "Fundus shows a cherry-red spot at the macula with diffuse retinal whitening. Diagnosis?",
    ["Central retinal artery occlusion (CRAO)", "Central retinal vein occlusion (CRVO)", "Retinal detachment", "Vitreous haemorrhage"],
    0,
    "CRAO causes sudden painless vision loss with retinal whitening (oedema of the ganglion cell layer) "
    "and a cherry-red spot at the macula (where the retina is thinnest and choroidal circulation shows "
    "through).",
    tag="[Concept-based / high-yield repeat]")
add_question(
    "A patient reports sudden onset of floaters and flashes of light, followed by a curtain-like field "
    "defect. Fundus examination shows a horseshoe-shaped retinal tear with an elevated, folded retina. "
    "Diagnosis and management?",
    ["Rhegmatogenous retinal detachment; urgent surgical repair (scleral buckle/vitrectomy)", "Posterior vitreous detachment alone; observation", "Central serous chorioretinopathy; observation", "Diabetic macular oedema; anti-VEGF"],
    0,
    "Flashes, floaters, and a curtain-like field defect with a horseshoe tear and elevated retina indicate "
    "rhegmatogenous retinal detachment, an emergency needing prompt surgical repair.",
    tag="[Concept-based / high-yield repeat]")
add_question(
    "A premature infant with low birth weight who received prolonged supplemental oxygen develops "
    "abnormal peripheral retinal vascularisation on screening. Which condition is being screened for?",
    ["Retinopathy of prematurity (ROP)", "Retinoblastoma", "Coats disease", "Familial exudative vitreoretinopathy"],
    0,
    "ROP results from abnormal vasoproliferation at the junction of vascularised and avascular peripheral "
    "retina in preterm, low-birth-weight infants, often after oxygen therapy; screened for and treated with "
    "laser/anti-VEGF if threshold disease develops.",
    tag="[Concept-based / high-yield repeat]")
add_question(
    "A child presents with leukocoria (white pupillary reflex) and strabismus. Fundus examination shows "
    "a calcified retinal mass. Most likely diagnosis and its genetic association?",
    ["Retinoblastoma; RB1 tumour suppressor gene mutation", "Toxocariasis; no genetic association", "Coats disease; no genetic association", "Persistent fetal vasculature; no genetic association"],
    0,
    "Retinoblastoma is the most common intraocular malignancy of childhood, presenting with leukocoria; "
    "caused by biallelic inactivation of the RB1 tumour suppressor gene (hereditary or sporadic).",
    tag="[Concept-based / high-yield repeat]")

# ============ SECTION 7: NEURO-OPHTHALMOLOGY ============
add_topic_heading("7. Neuro-Ophthalmology")
add_question(
    "Which of the following statements about optic neuritis is true?",
    ["A relative afferent pupillary defect (RAPD) is seen", "There is no pain on ocular movement", "Multiple myeloma is a common cause", "Oral corticosteroids alone (without IV) are the mainstay of treatment"],
    0,
    "Optic neuritis presents with pain on eye movement, reduced vision, and a positive RAPD; it is "
    "typically demyelinating (often associated with multiple sclerosis) and treated with IV "
    "methylprednisolone, not oral steroids alone (which may increase recurrence risk per the ONTT).",
    tag="[Recall - INI-CET May 2022]")
add_question(
    "A patient has sudden, painful loss of vision with a positive RAPD, but the optic disc appears "
    "entirely normal on fundoscopy. Diagnosis?",
    ["Anterior ischaemic optic neuropathy (AION)", "Central retinal artery occlusion", "Retrobulbar (optic) neuritis", "Papilloedema"],
    2,
    "When optic neuritis is retrobulbar (posterior to the point visible on fundoscopy), the disc looks "
    "normal despite significant vision loss and pain on movement - 'the patient sees nothing, and the "
    "doctor sees nothing.'",
    tag="[Recall - INI-CET May 2026]")
add_question(
    "A patient with raised intracranial pressure has bilateral optic disc swelling with blurred margins, "
    "normal visual acuity initially, and an enlarged blind spot on perimetry. Diagnosis?",
    ["Papilloedema", "Papillitis (optic neuritis)", "Pseudopapilledema (optic disc drusen)", "Optic atrophy"],
    0,
    "Papilloedema is bilateral disc swelling secondary to raised intracranial pressure; visual acuity is "
    "usually preserved early with an enlarged blind spot, unlike papillitis which causes early central "
    "vision loss.",
    tag="[Concept-based / high-yield repeat]")
add_question(
    "A patient has ptosis, a dilated pupil unreactive to light, and the eye deviated 'down and out'. "
    "Which nerve palsy is this, and what does pupillary involvement suggest?",
    ["Third (oculomotor) nerve palsy; pupil involvement suggests a compressive cause (e.g. aneurysm)", "Fourth nerve palsy; always medical cause", "Sixth nerve palsy; always compressive", "Horner syndrome; always benign"],
    0,
    "A complete third nerve palsy with 'down and out' deviation, ptosis, and a fixed dilated pupil raises "
    "concern for a compressive lesion (e.g. posterior communicating artery aneurysm), warranting urgent "
    "neuroimaging; pupil-sparing third nerve palsy is more typical of microvascular/diabetic causes.",
    tag="[Concept-based / high-yield repeat]")
add_question(
    "A patient has a homonymous hemianopia with macular sparing following a stroke. Where is the lesion "
    "most likely located?",
    ["Occipital (visual) cortex", "Optic chiasm", "Optic nerve", "Optic tract"],
    0,
    "Macular-sparing homonymous hemianopia localises to the occipital cortex, since the macular "
    "representation has dual blood supply (posterior cerebral and middle cerebral arteries) protecting it "
    "from a posterior cerebral artery infarct.",
    tag="[Concept-based / high-yield repeat]")

# ============ SECTION 8: SQUINT, ORBIT, LIDS & LACRIMAL ============
add_topic_heading("8. Squint, Orbit, Lids & Lacrimal System")
add_question(
    "What is the combined action of the superior oblique muscle on the eyeball?",
    ["Intorsion, abduction, depression", "Intorsion, adduction, elevation", "Extorsion, abduction, depression", "Extorsion, adduction, elevation"],
    0,
    "The superior oblique's primary action is intorsion, with secondary actions of abduction and "
    "depression (most effective when the eye is adducted).",
    tag="[Recall - INI-CET November 2022]")
add_question(
    "Which of the following nerves gives the main sensory supply to the orbit?",
    ["Vagus nerve", "Trigeminal nerve", "Hypoglossal nerve", "Oculomotor nerve"],
    1,
    "The ophthalmic (V1) division of the trigeminal nerve provides the principal sensory supply to the "
    "orbit, globe, and surrounding structures.",
    tag="[Recall - INI-CET May 2025]")
add_question(
    "A child presents with an inward deviation of one eye, worse for near than distance, that fully "
    "corrects with a hypermetropic spectacle correction. Diagnosis?",
    ["Fully accommodative esotropia", "Sixth nerve palsy", "Duane retraction syndrome", "Exotropia"],
    0,
    "Fully accommodative esotropia results from uncorrected hypermetropia driving excess accommodative "
    "convergence; full cycloplegic refractive correction alone can eliminate the deviation.",
    tag="[Concept-based / high-yield repeat]")
add_question(
    "A neonate presents with a swelling at the medial canthus below the medial palpebral ligament, with "
    "regurgitation of mucopurulent material on pressure. Diagnosis and initial management?",
    ["Congenital dacryocystocele/dacryocystitis from nasolacrimal duct obstruction; lacrimal sac massage, "
     "antibiotics, probing if it persists", "Preseptal cellulitis; IV antibiotics only", "Congenital glaucoma; goniotomy", "Capillary haemangioma; propranolol"],
    0,
    "Congenital nasolacrimal duct obstruction presents with epiphora and a swelling below the medial "
    "canthal tendon; initial management is lacrimal sac massage and topical antibiotics, with probing "
    "reserved for persistent cases beyond about 12 months.",
    tag="[Concept-based / high-yield repeat]")
add_question(
    "A patient presents with unilateral proptosis, pain, and restricted eye movements, with fever and "
    "raised inflammatory markers, following sinusitis. What is the most feared vision- and life-threatening "
    "complication if untreated?",
    ["Cavernous sinus thrombosis", "Ptosis", "Ectropion", "Blepharochalasis"],
    0,
    "Orbital cellulitis (usually from adjacent sinusitis) can spread posteriorly to cause cavernous sinus "
    "thrombosis, a life-threatening emergency; prompt imaging and IV antibiotics +/- surgical drainage are "
    "required.",
    tag="[Concept-based / high-yield repeat]")

# ============ SECTION 9: COMMUNITY OPHTHALMOLOGY & TRAUMA ============
add_topic_heading("9. Community Ophthalmology & Ocular Trauma/Emergencies")
add_question(
    "The WHO SAFE strategy for trachoma control includes all of the following EXCEPT:",
    ["Surgery for trichiasis", "Antibiotics", "Facial cleanliness", "Evaluation of the control programme"],
    3,
    "SAFE stands for Surgery (trichiasis), Antibiotics (mass drug administration), Facial cleanliness, and "
    "Environmental improvement - not 'evaluation'.",
    tag="[Recall - INI-CET May 2021]")
add_question(
    "According to WHO criteria, which of the following best defines blindness?",
    ["Best corrected visual acuity of less than 3/60 in the better eye, or a visual field of less than 10 degrees around central fixation", "Visual acuity of less than 6/18", "Visual acuity of less than 6/60 only", "Inability to read newsprint"],
    0,
    "WHO defines blindness as best corrected visual acuity worse than 3/60 in the better eye, or a visual "
    "field radius of less than 10 degrees around central fixation.",
    tag="[Recall - INI-CET May 2025]")
add_question(
    "A patient sustains a chemical injury to the eye with an alkaline agent (e.g. lime). What is the most "
    "important immediate first-aid step before any other examination or treatment?",
    ["Copious and immediate irrigation with clean water/saline for at least 15-30 minutes", "Immediate application of a topical antibiotic ointment", "Immediate patching of the eye", "Immediate referral without irrigation"],
    0,
    "In chemical eye injuries (especially alkali, which causes rapid, deep penetrating damage via "
    "saponification), immediate and copious irrigation takes priority over every other step, including "
    "history-taking and visual acuity testing.",
    tag="[Concept-based / high-yield repeat]")
add_question(
    "A patient with penetrating trauma to one eye develops granulomatous inflammation in the fellow, "
    "uninjured eye weeks later. What is this condition called, and what is the most effective preventive "
    "measure?",
    ["Sympathetic ophthalmia; enucleation of a blind, severely injured eye within about 2 weeks of injury "
     "if no useful vision can be salvaged", "Endophthalmitis; intravitreal antibiotics", "Phacoanaphylactic uveitis; lens removal", "Retinal detachment; scleral buckle"],
    0,
    "Sympathetic ophthalmia is a rare bilateral granulomatous panuveitis following penetrating trauma to "
    "one eye; timely enucleation of a non-visual, severely injured eye (classically within 10-14 days) "
    "reduces this risk, though primary repair with immunosuppression is preferred whenever vision can be "
    "salvaged.",
    tag="[Concept-based / high-yield repeat]")
add_question(
    "Which of the following visual acuity testing methods is NOT appropriate for assessing acuity in "
    "preverbal infants?",
    ["Optokinetic nystagmus (OKN) drum", "Teller acuity cards", "ETDRS chart", "Preferential looking test"],
    2,
    "The ETDRS chart requires literacy and cooperative letter identification, making it unsuitable for "
    "preverbal children; OKN drums, Teller acuity cards, and preferential looking tests are designed for "
    "non-verbal/infant assessment.",
    tag="[Recall - INI-CET 2025]")

# ============ SECTION 10: INI-CET YEAR-WISE ============
add_topic_heading("10. INI-CET Year-Wise Compilation (May 2021 - May 2026)")
p = doc.add_paragraph()
p.add_run(
    "INI-CET began in 2020, so this section lists every Ophthalmology recall item recoverable for each "
    "session, in chronological order. Where a session's Ophthalmology recall could not be found in written "
    "form, this is noted explicitly rather than left silent."
).font.size = Pt(9.5)
doc.add_paragraph()

add_gap_note(
    "INI-CET November 2020 and November 2021: no written Ophthalmology-specific recall could be located "
    "in accessible public sources for these two sessions. Flagged as a gap."
)

add_subheading("INI-CET - May 2021", color=BLUE)
add_question(
    "A 30-year-old woman presents with redness and pain in the eye. Examination reveals an IOP of 38 mmHg, "
    "aqueous flare, and keratic precipitates. Which drug must be avoided in treating her raised IOP?",
    ["Beta-blockers", "Mannitol", "Carbonic anhydrase inhibitors", "Prostaglandin analogues"],
    3,
    "This is uveitic glaucoma (anterior uveitis with secondary raised IOP). Prostaglandin analogues can "
    "worsen intraocular inflammation and are avoided; beta-blockers, CAIs, and osmotics are preferred.",
    tag="[Recall - INI-CET May 2021]")
add_question(
    "The WHO SAFE strategy for trachoma control includes all of the following EXCEPT:",
    ["Surgery for trichiasis", "Antibiotics", "Facial cleanliness", "Evaluation of the control programme"],
    3,
    "SAFE = Surgery, Antibiotics, Facial cleanliness, Environmental improvement. 'Evaluation' is not part "
    "of the acronym.",
    tag="[Recall - INI-CET May 2021]")

add_subheading("INI-CET - May 2022", color=BLUE)
add_question(
    "What is the most common cause of moderate-to-severe visual impairment according to the National "
    "Blindness and Visual Impairment Survey 2015-19?",
    ["Refractive error", "Untreated cataract", "Glaucoma", "Diabetic retinopathy"],
    1,
    "Untreated cataract was identified as the leading cause of moderate-severe visual impairment in this "
    "national survey.",
    tag="[Recall - INI-CET May 2022]")
add_question(
    "Which of the following statements is true about optic neuritis?",
    ["A relative afferent pupillary defect is seen", "There is no pain on ocular movement", "Multiple myeloma is a common cause", "Oral corticosteroids are the mainstay of treatment"],
    0,
    "Optic neuritis classically presents with pain on eye movement and a positive RAPD; it is typically "
    "demyelinating in origin and treated with IV (not oral) corticosteroids.",
    tag="[Recall - INI-CET May 2022]")

add_subheading("INI-CET - November 2022", color=BLUE)
add_question(
    "What is the combined action of the superior oblique muscle?",
    ["Intorsion, abduction, depression", "Intorsion, adduction, elevation", "Extorsion, abduction, depression", "Extorsion, adduction, elevation"],
    0,
    "Superior oblique: primary action intorsion, secondary actions abduction and depression (best tested "
    "in adduction).",
    tag="[Recall - INI-CET November 2022]")
add_question(
    "Which triad is seen in the eye after an acute attack of angle-closure glaucoma has resolved?",
    ["Vogt's triad", "Virchow's triad", "Hutchinson's triad", "Gaucher's triad"],
    0,
    "Vogt's triad (glaukomflecken, sector iris atrophy, pigment/endothelial changes) is seen after an "
    "acute congestive angle-closure attack.",
    tag="[Recall - INI-CET November 2022]")

add_subheading("INI-CET - May 2023", color=BLUE)
add_question(
    "A patient has a nodular red eye in which the vascularity blanches after instillation of "
    "phenylephrine. What is the likely diagnosis?",
    ["Nodular episcleritis", "Nodular scleritis", "Nodular phlyctenulosis", "Conjunctivitis"],
    0,
    "Phenylephrine blanches superficial episcleral vessels (episcleritis) but not the deeper scleral "
    "vessels of scleritis - a key clinical differentiator.",
    tag="[Recall - INI-CET May 2023]")
add_question(
    "Which of the following lenses is used in direct gonioscopy?",
    ["Goldmann lens", "Koeppe lens", "Zeiss lens", "Richardson lens"],
    1,
    "The Koeppe lens allows direct gonioscopy (viewed with a separate hand-held microscope, usually with "
    "the patient supine), whereas Goldmann/Zeiss lenses are used for indirect gonioscopy at the slit lamp.",
    tag="[Recall - INI-CET May 2023]")

add_gap_note(
    "INI-CET November 2023 and November 2024: Ophthalmology recall sessions are known to have been "
    "conducted by coaching platforms (video discussions exist), but I could not locate written transcripts "
    "with specific question text within accessible public sources. Flagged as gaps."
)

add_subheading("INI-CET - May 2025", color=BLUE)
add_question(
    "Which of the following nerves gives sensory supply to the orbit?",
    ["Vagus nerve", "Trigeminal nerve", "Hypoglossal nerve", "Oculomotor nerve"],
    1,
    "The ophthalmic division (V1) of the trigeminal nerve is the principal sensory supply to the orbit.",
    tag="[Recall - INI-CET May 2025]")
add_question(
    "According to WHO criteria, which of the following best defines blindness?",
    ["Best corrected visual acuity less than 3/60 in the better eye, or visual field less than 10 degrees around fixation", "Visual acuity less than 6/18", "Visual acuity less than 6/60 only", "Inability to read newsprint"],
    0,
    "WHO defines blindness as best corrected VA worse than 3/60 in the better eye, or a central visual "
    "field radius under 10 degrees.",
    tag="[Recall - INI-CET May 2025]")

add_subheading("INI-CET - 2025 (session as published, likely November 2025)", color=BLUE)
add_question(
    "A patient reports sudden onset of intense eye pain, headache, blurred vision, and coloured halos. "
    "Examination reveals a mid-dilated fixed pupil, hazy cornea, and markedly raised intraocular pressure. "
    "Most probable diagnosis?",
    ["Secondary angle closure due to anterior uveitis", "Acute endophthalmitis", "Orbital cellulitis", "Acute primary angle closure glaucoma"],
    3,
    "Classic acute primary angle closure glaucoma presentation - an ophthalmic emergency requiring urgent "
    "IOP-lowering therapy and definitive laser iridotomy.",
    tag="[Recall - INI-CET 2025]")
add_question(
    "A contact lens user presents with severe ocular pain, photophobia, and blurred vision. Corneal "
    "examination shows a ring-shaped infiltrate. Which staining technique helps identify the causative "
    "organism?",
    ["Zinc stain", "Calcofluor white stain", "Gram stain", "GMS silver stain"],
    1,
    "A ring infiltrate in a contact lens wearer is classic for Acanthamoeba keratitis; calcofluor white "
    "stain highlights the cysts.",
    tag="[Recall - INI-CET 2025]")
add_question(
    "Krukenberg spindle formation on the corneal endothelium is a characteristic finding of which type of "
    "glaucoma?",
    ["Pigmentary glaucoma", "Malignant glaucoma", "Acute angle closure glaucoma", "Neovascular glaucoma"],
    0,
    "Krukenberg spindle (vertical pigment deposition on the endothelium) is seen in pigment dispersion "
    "syndrome/pigmentary glaucoma.",
    tag="[Recall - INI-CET 2025]")
add_question(
    "Which of the following is NOT appropriate for assessing visual acuity in preverbal children?",
    ["Optokinetic nystagmus drum", "Teller acuity cards", "ETDRS chart", "Preferential looking test"],
    2,
    "ETDRS charts require literate, cooperative letter identification and are unsuitable for preverbal "
    "children; OKN drum, Teller cards, and preferential looking are designed for pre-verbal assessment.",
    tag="[Recall - INI-CET 2025]")
add_question(
    "A young myopic patient with astigmatism, a history of frequent spectacle changes, and eye rubbing "
    "presents with acute red eye; corneal hydrops is seen and an intracameral gas injection is performed. "
    "What is the likely underlying diagnosis and the procedure shown?",
    ["Keratoconus with acute hydrops; intracameral C3F8 gas injection", "Bacterial keratitis; therapeutic keratoplasty", "Fuchs endothelial dystrophy; DSEK", "Pellucid marginal degeneration; collagen cross-linking"],
    0,
    "This vignette (myopic astigmatism, frequent refractive changes, eye rubbing, acute hydrops) is classic "
    "for keratoconus; intracameral gas tamponade re-apposes the ruptured Descemet's membrane.",
    tag="[Recall - INI-CET 2025]")

add_subheading("INI-CET - May 2026 (most recent session)", color=BLUE)
add_question(
    "A patient has sudden, painful loss of vision with a positive relative afferent pupillary defect "
    "(RAPD), but a normal-appearing optic disc on fundoscopy. What is the diagnosis?",
    ["Anterior ischaemic optic neuropathy (AION)", "Central retinal artery occlusion", "Retrobulbar (optic) neuritis", "Papilloedema"],
    2,
    "Retrobulbar optic neuritis affects the optic nerve posterior to the visible disc, so fundoscopy looks "
    "normal despite marked pain and vision loss with a positive RAPD.",
    tag="[Recall - INI-CET May 2026]")
add_question(
    "What is the expected amplitude of accommodation in a healthy child?",
    ["2 D", "5 D", "14 D", "25 D"],
    2,
    "Amplitude of accommodation is highest in childhood (around 14 D), declining progressively with age "
    "until presbyopia sets in.",
    tag="[Recall - INI-CET May 2026]")

doc.add_page_break()
foot = doc.add_paragraph()
foot.alignment = WD_ALIGN_PARAGRAPH.CENTER
r = foot.add_run(
    "Compiled for revision purposes from publicly available NEET PG and INI-CET recall-question sources "
    "(PrepLadder, DigiNerve, Reflex Prep, eGurukul, Marrow, Cerebellum Academy, DBMCI) and standard "
    "ophthalmology references. Not an official NBEMS or INI-CET publication. Cross-check flagged items "
    "before treating them as a definitive answer key."
)
r.italic = True
r.font.size = Pt(9)
r.font.color.rgb = GREY

doc.save("/tmp/workspace/ophthalmology-pyq-compilation/NEET_PG_Ophthalmology_PYQ_Topicwise_Compilation.docx")
print("Saved. Total questions:", qn_counter)