from reportlab.lib.pagesizes import A4
from reportlab.lib import colors
from reportlab.lib.styles import getSampleStyleSheet, ParagraphStyle
from reportlab.lib.enums import TA_CENTER
from reportlab.lib.units import cm
from reportlab.platypus import SimpleDocTemplate, Paragraph, Spacer, PageBreak, KeepTogether
from reportlab.pdfbase.ttfonts import TTFont
from reportlab.pdfbase import pdfmetrics
from reportlab.lib.colors import HexColor
from pypdf import PdfReader

OUT='/tmp/workspace/gynecology-mcq-pdf/output/Gynecology_60_MCQ_Exam_Style.pdf'

# Original questions based on high-yield concepts. Tags indicate question style, not verified past-paper provenance.
sections = [
('1. Menstrual Cycle and Reproductive Hormones', [
('In a 28-day cycle, the hormone surge that directly triggers ovulation is:', ['FSH','LH','Progesterone','Prolactin'], 'B', 'The mid-cycle LH surge causes follicular rupture, oocyte release, and luteinization.', 'INI-CET style'),
('The most reliable biochemical evidence of recent ovulation is:', ['High FSH on day 3','Raised mid-luteal serum progesterone','Low estradiol on day 14','Raised prolactin'], 'B', 'A raised serum progesterone about 7 days before the next expected menses supports ovulation.', 'NEET-PG style'),
('The endometrium is in its proliferative phase mainly under the influence of:', ['Progesterone','Estrogen','LH','Inhibin A'], 'B', 'Estrogen produced by developing follicles drives endometrial proliferation.', 'FMGE style'),
('The secretory transformation of endometrium follows ovulation because of:', ['FSH','LH alone','Progesterone from corpus luteum','Prolactin'], 'C', 'The corpus luteum produces progesterone, producing a secretory endometrium.', 'NEET-PG style'),
('Which phase of the ovarian cycle has the least variable duration?', ['Follicular phase','Luteal phase','Menstrual phase','Ovulatory phase'], 'B', 'The luteal phase is relatively fixed at about 14 days; cycle variation is mainly follicular.', 'INI-CET style'),
('Sustained high estradiol near mid-cycle produces:', ['Negative feedback only on LH','Positive feedback causing LH surge','Suppression of FSH and LH throughout','Corpus luteum regression'], 'B', 'Persistently high estradiol switches to positive feedback and precipitates the LH surge.', 'NEET-PG style'),
('The principal source of progesterone in the normal luteal phase is the:', ['Theca interna','Granulosa cells of dominant follicle','Corpus luteum','Adrenal cortex'], 'C', 'After ovulation, the ruptured follicle becomes the progesterone-secreting corpus luteum.', 'FMGE style'),
('Basal body temperature rises after ovulation primarily due to:', ['Estrogen','Progesterone','FSH','Inhibin B'], 'B', 'Progesterone has a thermogenic effect and raises basal body temperature after ovulation.', 'NEET-PG style'),
('The two-cell, two-gonadotropin concept states that LH acts predominantly on:', ['Granulosa cells to aromatize androgens','Theca cells to produce androgens','Endometrium to produce progesterone','Corpus luteum to produce FSH'], 'B', 'LH stimulates theca cells to synthesize androgens; FSH drives granulosa aromatization to estrogen.', 'INI-CET style'),
('Menstruation occurs after corpus luteum regression due principally to withdrawal of:', ['FSH and LH','Estrogen and progesterone','Prolactin and oxytocin','Inhibin A and B'], 'B', 'Falling estrogen and progesterone destabilize the functional endometrium, causing shedding.', 'FMGE style'),
]),
('2. Abnormal Uterine Bleeding (AUB)', [
('In PALM-COEIN classification, a submucosal leiomyoma is classified under:', ['P - Polyp','L - Leiomyoma','O - Ovulatory dysfunction','E - Endometrial'], 'B', 'Leiomyoma is a structural PALM cause; submucosal fibroids are particularly linked to heavy bleeding.', 'NEET-PG style'),
('Which is NOT included in the structural PALM group?', ['Polyp','Adenomyosis','Coagulopathy','Malignancy and hyperplasia'], 'C', 'Coagulopathy is a non-structural COEIN cause.', 'FMGE style'),
('A 44-year-old with heavy cyclic bleeding, obesity, and chronic anovulation should have which investigation to exclude endometrial pathology?', ['Serum CA-125','Endometrial sampling','Diagnostic laparoscopy','Hysterosalpingography'], 'B', 'Age and unopposed-estrogen risk factors make endometrial sampling appropriate.', 'INI-CET style'),
('The first test in evaluation of reproductive-age abnormal uterine bleeding is generally:', ['Pregnancy test','Endometrial biopsy','CT pelvis','Serum AMH'], 'A', 'Pregnancy and pregnancy-related bleeding must be excluded first.', 'NEET-PG style'),
('The most effective medical therapy for heavy menstrual bleeding in a woman desiring contraception is:', ['Oral iron alone','Levonorgestrel-releasing intrauterine system','Danazol for all patients','Hysterectomy'], 'B', 'LNG-IUS markedly reduces menstrual blood loss and provides contraception.', 'INI-CET style'),
('Tranexamic acid reduces menstrual blood loss mainly by:', ['Inhibiting cyclooxygenase','Inhibiting fibrinolysis','Suppressing GnRH','Inducing endometrial atrophy directly'], 'B', 'It blocks plasminogen activation and stabilizes fibrin clot.', 'FMGE style'),
('Acute heavy AUB with hemodynamic instability requires the initial priority of:', ['Immediate hysteroscopy','Resuscitation and assessment of hypovolemia','Endometrial ablation','Long-term LNG-IUS insertion'], 'B', 'Stabilization with assessment of shock and blood loss precedes etiologic treatment.', 'NEET-PG style'),
('Which condition is categorized as AUB-O?', ['Endometrial polyp','Ovulatory dysfunction in PCOS','Cesarean scar defect','Von Willebrand disease'], 'B', 'AUB-O denotes ovulatory dysfunction, commonly anovulation in PCOS.', 'INI-CET style'),
('Intermenstrual bleeding and a focal intracavitary lesion on ultrasound most strongly suggest:', ['Polyp','Coagulopathy','Ovulatory dysfunction','Iatrogenic AUB'], 'A', 'Endometrial polyps often cause intermenstrual or irregular bleeding.', 'FMGE style'),
('In adolescents with heavy menstrual bleeding since menarche, an important associated disorder to consider is:', ['Endometriosis','A bleeding disorder such as von Willebrand disease','Cervical cancer','Asherman syndrome'], 'B', 'Heavy bleeding from menarche can signal an inherited bleeding disorder.', 'NEET-PG style'),
]),
('3. Puberty and Precocious Puberty', [
('The first visible sign of normal puberty in most girls is:', ['Menarche','Breast budding (thelarche)','Pubic hair growth','Growth spurt completion'], 'B', 'Thelarche is usually the first visible pubertal event in girls.', 'NEET-PG style'),
('Precocious puberty in a girl is conventionally defined as onset of secondary sexual characteristics before:', ['6 years','7 years','8 years','10 years'], 'C', 'Development before age 8 years in girls requires evaluation for precocious puberty.', 'FMGE style'),
('Central precocious puberty is characterized by:', ['GnRH-independent sex steroid production','Activation of the hypothalamic-pituitary-gonadal axis','Suppressed gonadotropins after GnRH stimulation','No acceleration of bone age'], 'B', 'Central, or GnRH-dependent, precocity reflects early activation of the normal HPG axis.', 'INI-CET style'),
('A pubertal LH response after GnRH stimulation supports:', ['Peripheral precocious puberty','Central precocious puberty','Isolated premature thelarche only','Constitutional growth delay'], 'B', 'A pubertal LH response indicates HPG-axis activation, hence central precocity.', 'NEET-PG style'),
('The standard treatment for progressive central precocious puberty is:', ['Long-acting GnRH agonist','Combined oral contraceptive','Aromatase inhibitor in all cases','Thyroxine'], 'A', 'Continuous long-acting GnRH agonist suppresses pituitary gonadotropin release.', 'INI-CET style'),
('Peripheral precocious puberty is best described as:', ['GnRH-dependent','Always idiopathic','GnRH-independent sex steroid exposure or production','Associated with a pubertal LH response'], 'C', 'Peripheral precocity occurs from gonadal, adrenal, tumor-related, or exogenous sex steroids independent of GnRH.', 'FMGE style'),
('Isolated premature thelarche most commonly presents as:', ['Breast development without other progressive pubertal signs','Menses with rapid bone-age advancement','Virilization and clitoromegaly','Growth failure with absent breast development'], 'A', 'Premature thelarche is isolated breast development, usually benign and nonprogressive.', 'NEET-PG style'),
('The hormone most directly responsible for pubic and axillary hair in adrenarche is:', ['Estradiol','Adrenal androgens such as DHEAS','Progesterone','Inhibin B'], 'B', 'Adrenarche reflects increased adrenal androgen secretion, especially DHEAS.', 'INI-CET style'),
('In central precocious puberty, bone age is usually:', ['Delayed','Equal to chronologic age always','Advanced','Not useful'], 'C', 'Sex-steroid exposure accelerates skeletal maturation and may reduce final adult height if untreated.', 'FMGE style'),
('Vaginal bleeding, breast development, and suppressed gonadotropins in a young girl suggest:', ['Central precocious puberty','Peripheral precocious puberty','Constitutional delay','Turner syndrome'], 'B', 'Sexual development with suppressed gonadotropins points to GnRH-independent peripheral precocity.', 'NEET-PG style'),
]),
('4. Menopause and Hormone Therapy', [
('Natural menopause is diagnosed retrospectively after amenorrhea for:', ['3 months','6 months','12 months','24 months'], 'C', 'Menopause is defined retrospectively after 12 consecutive months of amenorrhea without another cause.', 'FMGE style'),
('The average age of natural menopause is approximately:', ['35 years','42 years','51 years','60 years'], 'C', 'Natural menopause occurs at a mean age of about 51 years.', 'NEET-PG style'),
('The characteristic gonadotropin pattern after menopause is:', ['Low FSH and low LH','High FSH and high LH','High progesterone','High inhibin B'], 'B', 'Loss of ovarian estrogen and inhibin feedback raises FSH and LH, with FSH typically more elevated.', 'INI-CET style'),
('For a woman with an intact uterus receiving systemic estrogen for menopausal symptoms, add a progestogen mainly to prevent:', ['Osteoporosis','Endometrial hyperplasia and cancer','Vasomotor symptoms','Vaginal candidiasis'], 'B', 'Unopposed systemic estrogen stimulates the endometrium; progestogen provides endometrial protection.', 'NEET-PG style'),
('A woman after total hysterectomy with troublesome vasomotor symptoms usually needs:', ['Estrogen plus progestogen solely for endometrial protection','Estrogen-only therapy if no contraindication','No hormonal option ever','Androgen-only therapy'], 'B', 'Without a uterus, routine progestogen is not needed for endometrial protection.', 'FMGE style'),
('The most effective treatment for moderate-to-severe vasomotor menopausal symptoms, when appropriate, is:', ['Systemic menopausal hormone therapy','Routine antibiotics','Long-term corticosteroids','Thyroxine'], 'A', 'Systemic estrogen-based therapy is most effective for vasomotor symptoms in eligible women.', 'INI-CET style'),
('Systemic menopausal hormone therapy is generally contraindicated in a patient with:', ['Bothersome hot flushes','Unexplained vaginal bleeding','Early natural menopause','Osteoarthritis'], 'B', 'Unexplained bleeding requires evaluation before systemic hormone therapy.', 'NEET-PG style'),
('For genitourinary syndrome of menopause confined to vaginal symptoms, a useful lower-systemic-exposure option is:', ['Local vaginal estrogen','High-dose systemic progestin','GnRH agonist','Danazol'], 'A', 'Low-dose vaginal estrogen is effective for local vulvovaginal and urinary symptoms.', 'FMGE style'),
('Which change contributes to postmenopausal bone loss?', ['Increased estrogen','Reduced osteoclast activity','Estrogen deficiency with increased bone resorption','High progesterone levels'], 'C', 'Estrogen deficiency increases bone resorption and accelerates bone loss.', 'INI-CET style'),
('Postmenopausal bleeding should be considered:', ['Normal in all women','A symptom that needs prompt evaluation','A reason to start estrogen immediately','Proof of benign atrophy only'], 'B', 'Postmenopausal bleeding warrants evaluation to exclude endometrial malignancy and other pathology.', 'NEET-PG style'),
]),
('5. Hirsutism and Hyperandrogenism', [
('Hirsutism refers to:', ['Generalized increase in vellus hair','Male-pattern terminal hair growth in women in androgen-sensitive sites','Hair loss limited to scalp','Hair growth due solely to medications'], 'B', 'Hirsutism is excessive terminal hair in a male-pattern distribution in women.', 'FMGE style'),
('The most common cause of hirsutism in reproductive-age women is:', ['Ovarian failure','Polycystic ovary syndrome','Cushing disease','Androgen-secreting tumor'], 'B', 'PCOS is the commonest cause of clinically significant hirsutism.', 'NEET-PG style'),
('A rapidly progressive hirsutism with virilization should raise concern for:', ['Physiologic puberty alone','Androgen-secreting ovarian or adrenal tumor','Idiopathic hirsutism only','Hypothyroidism'], 'B', 'Rapid onset or virilization warrants urgent assessment for an androgen-secreting tumor.', 'INI-CET style'),
('Which feature favors virilization rather than uncomplicated hirsutism?', ['Mild upper-lip hair','Deepening of voice','Regular ovulation','Normal libido'], 'B', 'Voice deepening, clitoromegaly, and increased muscle mass are virilizing features.', 'FMGE style'),
('The first-line pharmacologic therapy for patient-important hirsutism in a woman not seeking pregnancy is usually:', ['Combined oral contraceptive pill','Testosterone replacement','Warfarin','Oxytocin'], 'A', 'Combined oral contraceptives suppress ovarian androgen production and increase SHBG.', 'NEET-PG style'),
('Spironolactone used for hirsutism should be paired with reliable contraception because it:', ['Causes ovulation induction','Can affect development of a male fetus','Causes uterine rupture','Is a potent teratogen causing neural-tube defects specifically'], 'B', 'Antiandrogen exposure may feminize a male fetus; effective contraception is required.', 'INI-CET style'),
('An elevated DHEAS level points most strongly toward an androgen source from the:', ['Ovary','Adrenal gland','Pituitary only','Endometrium'], 'B', 'DHEAS is produced predominantly by the adrenal cortex.', 'FMGE style'),
('A screening test for nonclassic congenital adrenal hyperplasia in a woman with hirsutism is:', ['17-hydroxyprogesterone','Serum hCG only','CA-125','Serum calcitonin'], 'A', 'Early-morning 17-hydroxyprogesterone screening assesses for 21-hydroxylase deficiency.', 'NEET-PG style'),
('Idiopathic hirsutism typically has:', ['Markedly elevated androgens and irregular menses','Normal menses and no demonstrable androgen excess after exclusion of other causes','Rapid virilization','An adrenal tumor'], 'B', 'It is a diagnosis of exclusion and often reflects increased peripheral follicular sensitivity.', 'INI-CET style'),
('Clinical improvement with pharmacologic treatment of hirsutism is usually assessed after at least:', ['48 hours','1 week','6 months','1 day'], 'C', 'Hair-growth cycles are long, so response to hormonal therapy commonly needs about 6 months.', 'FMGE style'),
]),
('6. Integrated High-Yield Revision', [
('The dominant follicle is selected during the:', ['Early follicular phase','Late luteal phase only','Menstrual shedding phase only','Postmenopause'], 'A', 'Follicular recruitment and selection occur in the early-to-mid follicular phase.', 'INI-CET style'),
('Anovulatory AUB increases risk of endometrial hyperplasia primarily because of:', ['Excess progesterone','Chronic unopposed estrogen','Low insulin','High oxytocin'], 'B', 'Absent ovulation means inadequate progesterone opposition to estrogen-driven proliferation.', 'NEET-PG style'),
('A 7-year-old with isolated pubic hair but no breast development most likely has:', ['Central precocious puberty','Premature adrenarche','Complete androgen insensitivity','Menopause'], 'B', 'Isolated pubic hair typically reflects premature adrenarche, mediated by adrenal androgens.', 'FMGE style'),
('In a 28-day cycle, the endometrium is maximally secretory approximately on day:', ['5','14','21','28'], 'C', 'About one week after ovulation, progesterone produces maximal secretory transformation.', 'NEET-PG style'),
('A woman with AUB due to a polyp has a PALM-COEIN category of:', ['AUB-P','AUB-O','AUB-C','AUB-I'], 'A', 'P denotes polyp in the PALM structural group.', 'FMGE style'),
('The decline in ovarian follicle number at menopause leads most directly to lower:', ['FSH','Inhibin B','LH','GnRH pulse frequency'], 'B', 'Diminished follicles lower inhibin B, contributing to elevated FSH.', 'INI-CET style'),
('Which ovarian cell type converts androgens to estradiol under FSH stimulation?', ['Theca cells','Granulosa cells','Stromal fibroblasts','Oocytes'], 'B', 'Granulosa-cell aromatase, stimulated by FSH, converts theca-derived androgens to estradiol.', 'NEET-PG style'),
('A key distinction between hypertrichosis and hirsutism is that hypertrichosis:', ['Always indicates ovarian tumor','Is excess hair growth not limited to androgen-dependent areas','Is always associated with PCOS','Occurs only after menopause'], 'B', 'Hypertrichosis is generalized or non-androgen-dependent excessive hair growth.', 'FMGE style'),
('The source of estrogen that maintains the endometrium during early pregnancy before placental takeover is the:', ['Corpus luteum supported by hCG','Pituitary gland','Adrenal medulla','Endometrium'], 'A', 'hCG rescues the corpus luteum, which supplies progesterone and estrogen initially.', 'INI-CET style'),
('A major reason for adding progestogen to estrogen therapy in a woman with a uterus is that progestogen:', ['Raises FSH','Opposes estrogen-driven endometrial proliferation','Causes ovulation','Increases adrenal androgen output'], 'B', 'Progestogen counteracts endometrial proliferation and lowers hyperplasia risk.', 'NEET-PG style'),
])]

styles=getSampleStyleSheet()
styles.add(ParagraphStyle(name='TitleX', parent=styles['Title'], fontName='Helvetica-Bold', fontSize=20, leading=25, alignment=TA_CENTER, textColor=HexColor('#163A5F'), spaceAfter=12))
styles.add(ParagraphStyle(name='SubTitle', parent=styles['Normal'], fontSize=9.2, leading=12, alignment=TA_CENTER, textColor=HexColor('#455A64'), spaceAfter=16))
styles.add(ParagraphStyle(name='Sec', parent=styles['Heading2'], fontName='Helvetica-Bold', fontSize=13, leading=16, textColor=HexColor('#0B5C74'), spaceBefore=12, spaceAfter=8))
styles.add(ParagraphStyle(name='Q', parent=styles['Normal'], fontSize=9.3, leading=12.5, spaceAfter=2))
styles.add(ParagraphStyle(name='Opt', parent=styles['Normal'], fontSize=9.1, leading=11.7, leftIndent=12, spaceAfter=1))
styles.add(ParagraphStyle(name='Ans', parent=styles['Normal'], fontSize=9.2, leading=12.5, spaceAfter=7))
styles.add(ParagraphStyle(name='Foot', parent=styles['Normal'], fontSize=7.4, leading=9, textColor=HexColor('#546E7A')))

def p(text,style): return Paragraph(text.replace('&','&'),styles[style])
def footer(canvas,doc):
    canvas.saveState(); canvas.setStrokeColor(HexColor('#B0BEC5')); canvas.line(1.5*cm,1.25*cm,19.5*cm,1.25*cm)
    canvas.setFont('Helvetica',8); canvas.setFillColor(HexColor('#546E7A')); canvas.drawString(1.5*cm,.85*cm,'Gynecology 60-MCQ Practice Bank | Original exam-style questions')
    canvas.drawRightString(19.5*cm,.85*cm,f'Page {doc.page}'); canvas.restoreState()

doc=SimpleDocTemplate(OUT,pagesize=A4,rightMargin=1.5*cm,leftMargin=1.5*cm,topMargin=1.4*cm,bottomMargin=1.7*cm)
story=[p('Gynecology: 60 MCQ Practice Bank','TitleX'),p('Menstrual cycle | Hormones | AUB | Puberty & precocious puberty | Menopause & HRT | Hirsutism','SubTitle'),p('<b>Format:</b> Topic-wise single-best-answer MCQs. Tags indicate exam-style pattern only and are not claims of verified past-paper provenance. Answers and brief explanations are consolidated at the end.','Foot'),Spacer(1,10)]
allq=[]; n=1
for sec,qs in sections:
    story.append(p(sec,'Sec'))
    for q,opts,ans,exp,tag in qs:
        story.append(p(f'<b>{n}. [{tag}]</b> {q}','Q'))
        for i,o in enumerate(opts): story.append(p(f'{chr(65+i)}. {o}','Opt'))
        story.append(Spacer(1,4)); allq.append((n,ans,exp)); n+=1
story.append(PageBreak()); story.append(p('Answer Key with Brief Explanations','TitleX'))
story.append(p('Review your answers before reading the explanations.','SubTitle'))
for num,ans,exp in allq:
    story.append(p(f'<b>{num}. {ans}</b> - {exp}','Ans'))
story.append(Spacer(1,8))
story.append(p('<b>Sources used for content checking:</b> Berek & Novak\'s Gynecology (menstrual physiology, puberty and hyperandrogenism); Costanzo Physiology (LH surge and ovulation); Goldman-Cecil Medicine (menopause/HRT); ACOG clinical guidance on AUB. This is an educational practice resource, not clinical advice.','Foot'))
doc.build(story,onFirstPage=footer,onLaterPages=footer)
r=PdfReader(OUT)
assert len(r.pages)>0
text=''.join((pg.extract_text() or '') for pg in r.pages)
assert 'Answer Key' in text and '60. B' in text
print(f'Created {OUT} with {len(r.pages)} pages and {len(allq)} questions')