FMGE Preparation Schedule - December 2026

from reportlab.lib import colors
from reportlab.lib.enums import TA_CENTER, TA_LEFT
from reportlab.lib.pagesizes import A4
from reportlab.lib.styles import getSampleStyleSheet, ParagraphStyle
from reportlab.lib.units import cm
from reportlab.platypus import SimpleDocTemplate, Paragraph, Spacer, PageBreak, Table, TableStyle, KeepTogether
from reportlab.pdfbase.ttfonts import TTFont
from reportlab.pdfbase import pdfmetrics
from reportlab.pdfbase.pdfmetrics import stringWidth
from reportlab.lib.colors import HexColor
from reportlab.pdfgen import canvas
from reportlab.lib import utils
from reportlab.pdfbase.acroform import AcroForm

OUT = '/tmp/workspace/fmge-high-yield-pyqs/output/FMGE_High_Yield_PYQ_Style_Questions.pdf'

questions = [
('Anatomy', 'A lesion of the recurrent laryngeal nerve most directly causes paralysis of which muscle?', ['Cricothyroid', 'Posterior cricoarytenoid', 'Stylopharyngeus', 'Tensor veli palatini'], 'B', 'The recurrent laryngeal nerve supplies all intrinsic laryngeal muscles except cricothyroid. Posterior cricoarytenoid is the only abductor of the vocal cord.'),
('Anatomy', 'The most common site of ectopic pregnancy is the:', ['Fimbrial end of uterine tube', 'Ampulla of uterine tube', 'Isthmus of uterine tube', 'Ovary'], 'B', 'Most tubal ectopic pregnancies implant in the ampulla.'),
('Anatomy', 'In an adult, the spinal cord usually ends at the level of:', ['T12', 'L1-L2 intervertebral disc', 'L3-L4 intervertebral disc', 'S1'], 'B', 'The conus medullaris usually ends at the L1-L2 level in adults. Lumbar puncture is therefore done below this level.'),
('Physiology', 'A rightward shift of the oxyhemoglobin dissociation curve occurs with:', ['Decreased temperature', 'Decreased 2,3-BPG', 'Increased hydrogen ion concentration', 'Fetal hemoglobin'], 'C', 'Acidosis, hypercapnia, increased temperature, and increased 2,3-BPG shift the curve right and facilitate oxygen unloading.'),
('Physiology', 'The normal pacemaker of the heart has the highest rate of spontaneous phase 4 depolarization. It is the:', ['AV node', 'SA node', 'Purkinje fibres', 'Bundle of His'], 'B', 'The SA node has the fastest spontaneous depolarization and normally sets heart rate.'),
('Physiology', 'Which renal segment is impermeable to water and actively reabsorbs Na+, K+, and Cl-?', ['Proximal convoluted tubule', 'Thin descending limb', 'Thick ascending limb', 'Collecting duct'], 'C', 'The thick ascending limb is the diluting segment and uses the Na-K-2Cl cotransporter.'),
('Biochemistry', 'The rate-limiting enzyme of cholesterol synthesis is:', ['HMG-CoA synthase', 'HMG-CoA reductase', 'Acetyl-CoA carboxylase', 'Lecithin-cholesterol acyltransferase'], 'B', 'HMG-CoA reductase converts HMG-CoA to mevalonate and is inhibited by statins.'),
('Biochemistry', 'A child with photosensitivity, dermatitis, diarrhea, and dementia is most likely deficient in:', ['Niacin', 'Riboflavin', 'Pyridoxine', 'Folate'], 'A', 'Pellagra is caused by niacin deficiency and classically causes dermatitis, diarrhea, and dementia.'),
('Biochemistry', 'The major regulatory enzyme of glycolysis is:', ['Hexokinase', 'Phosphofructokinase-1', 'Pyruvate kinase', 'Glucose-6-phosphatase'], 'B', 'PFK-1 catalyzes the committed, rate-limiting step of glycolysis.'),
('Pathology', 'Reed-Sternberg cells are characteristic of:', ['Burkitt lymphoma', 'Hodgkin lymphoma', 'Multiple myeloma', 'Chronic lymphocytic leukemia'], 'B', 'Classical Hodgkin lymphoma contains Reed-Sternberg cells, typically CD15 and CD30 positive.'),
('Pathology', 'The most common cause of nephrotic syndrome in children is:', ['Membranous nephropathy', 'Focal segmental glomerulosclerosis', 'Minimal change disease', 'Membranoproliferative glomerulonephritis'], 'C', 'Minimal change disease is the commonest nephrotic syndrome in children and responds well to corticosteroids.'),
('Pathology', 'Caseating granulomas are most classically associated with:', ['Sarcoidosis', 'Tuberculosis', 'Crohn disease', 'Foreign body reaction'], 'B', 'Tuberculosis typically produces caseating granulomatous inflammation.'),
('Microbiology', 'The vector for Plasmodium falciparum is the:', ['Female Anopheles mosquito', 'Female Aedes mosquito', 'Culex mosquito', 'Sandfly'], 'A', 'Malaria is transmitted by the bite of the female Anopheles mosquito.'),
('Microbiology', 'A patient develops profuse watery diarrhea after broad-spectrum antibiotics. The likely organism is:', ['Vibrio cholerae', 'Clostridioides difficile', 'Shigella dysenteriae', 'Entamoeba histolytica'], 'B', 'C. difficile colitis follows antibiotic exposure and is caused by toxin-mediated mucosal injury.'),
('Microbiology', 'Which organism is acid-fast because of mycolic acids in its cell wall?', ['Nocardia asteroides', 'Mycobacterium tuberculosis', 'Corynebacterium diphtheriae', 'Listeria monocytogenes'], 'B', 'Mycobacteria are strongly acid-fast due to mycolic acids. Nocardia is weakly acid-fast.'),
('Pharmacology', 'Which drug is a specific antidote for paracetamol poisoning?', ['Atropine', 'N-acetylcysteine', 'Pralidoxime', 'Naloxone'], 'B', 'N-acetylcysteine replenishes glutathione and detoxifies the toxic paracetamol metabolite NAPQI.'),
('Pharmacology', 'A patient on warfarin has major bleeding with a markedly elevated INR. The most appropriate immediate reversal is:', ['Vitamin K alone', 'Fresh frozen plasma alone', 'Protamine sulfate', 'Four-factor prothrombin complex concentrate plus vitamin K'], 'D', 'Major warfarin-associated bleeding requires rapid replacement of vitamin K-dependent clotting factors with 4-factor PCC plus IV vitamin K.'),
('Pharmacology', 'The adverse effect of ACE inhibitors that is related to bradykinin accumulation is:', ['Constipation', 'Dry cough', 'Ototoxicity', 'Hyperuricemia'], 'B', 'ACE inhibition reduces bradykinin breakdown, producing dry cough and sometimes angioedema.'),
('Forensic Medicine', 'The most reliable sign of death is:', ['Absence of pulse', 'Absence of respiration', 'Rigor mortis', 'Putrefaction'], 'D', 'Putrefaction is an unequivocal sign of death. Early signs such as absent pulse may be reversible or difficult to assess.'),
('Forensic Medicine', 'The antidotal regimen in organophosphate poisoning includes:', ['Atropine and pralidoxime', 'Naloxone and atropine', 'Methylene blue and atropine', 'Flumazenil and pralidoxime'], 'A', 'Atropine treats muscarinic manifestations; pralidoxime reactivates acetylcholinesterase if given early.'),
('Medicine', 'A patient with acute ST-elevation myocardial infarction presents to a PCI-capable hospital. The preferred reperfusion strategy, when timely available, is:', ['Primary percutaneous coronary intervention', 'Aspirin alone', 'Routine thrombolysis after 24 hours', 'Elective coronary angiography after discharge'], 'A', 'Primary PCI is preferred for STEMI when it can be performed promptly by an experienced team.'),
('Medicine', 'The most specific cardiac biomarker for myocardial necrosis is:', ['Myoglobin', 'Troponin I or T', 'CK-MB', 'Lactate dehydrogenase'], 'B', 'Cardiac troponins are highly sensitive and specific markers of myocardial injury.'),
('Medicine', 'A patient has fever, productive cough, and lobar consolidation. The most likely cause of typical community-acquired lobar pneumonia is:', ['Streptococcus pneumoniae', 'Mycoplasma pneumoniae', 'Pneumocystis jirovecii', 'Legionella pneumophila'], 'A', 'S. pneumoniae is the classic and common cause of typical community-acquired lobar pneumonia.'),
('Medicine', 'The first-line drug for an acute severe asthma exacerbation is:', ['Inhaled short-acting beta2 agonist', 'Oral montelukast', 'Inhaled long-acting beta2 agonist alone', 'Oral theophylline'], 'A', 'Repeated inhaled short-acting beta2 agonist is initial bronchodilator therapy; systemic corticosteroids are added early in significant exacerbations.'),
('Medicine', 'A patient with diabetic ketoacidosis has dehydration and hypotension. The initial management is:', ['IV isotonic saline', 'IV sodium bicarbonate in all cases', 'Subcutaneous insulin only', 'IV potassium before assessing serum potassium'], 'A', 'Initial DKA therapy is intravascular volume replacement with isotonic crystalloid, followed by insulin and potassium-guided replacement.'),
('Medicine', 'The ECG feature most suggestive of hyperkalemia is:', ['U waves', 'Tall peaked T waves', 'ST elevation in contiguous leads', 'Delta waves'], 'B', 'Early hyperkalemia produces tall, tented T waves. Severe hyperkalemia can widen the QRS and cause a sine-wave pattern.'),
('Medicine', 'The most common cause of hyperthyroidism is:', ['Toxic multinodular goitre', 'Graves disease', 'Thyroiditis', 'TSH-secreting pituitary adenoma'], 'B', 'Graves disease is the commonest cause of hyperthyroidism in iodine-sufficient areas.'),
('Medicine', 'A patient with nephrotic syndrome is particularly at risk for thrombosis because of urinary loss of:', ['Antithrombin', 'Fibrinogen', 'Factor VIII', 'Platelets'], 'A', 'Urinary loss of antithrombin and other anticoagulant proteins contributes to a hypercoagulable state.'),
('Surgery', 'The most common cause of small-bowel obstruction in a patient with prior abdominal surgery is:', ['Adhesions', 'Hernia', 'Volvulus', 'Intussusception'], 'A', 'Postoperative adhesions are the most common cause of small-bowel obstruction in many adult populations.'),
('Surgery', 'The initial fluid of choice for resuscitation in acute hemorrhagic shock is:', ['Isotonic crystalloid', '5% dextrose', 'Hypotonic saline', 'Albumin as the only fluid'], 'A', 'Initial trauma resuscitation uses warmed isotonic crystalloid while hemorrhage control and blood-product resuscitation are arranged as needed.'),
('Surgery', 'A painless, progressive jaundice with a palpable nontender gallbladder suggests:', ['Carcinoma of the head of pancreas', 'Choledocholithiasis', 'Acute cholecystitis', 'Viral hepatitis'], 'A', 'Courvoisier sign suggests malignant distal biliary obstruction, classically pancreatic head carcinoma.'),
('Surgery', 'The most common site of an indirect inguinal hernia is:', ['Medial to inferior epigastric vessels', 'Through Hesselbach triangle', 'Lateral to inferior epigastric vessels through deep ring', 'Below inguinal ligament'], 'C', 'Indirect inguinal hernia enters via the deep inguinal ring, lateral to inferior epigastric vessels.'),
('Obstetrics and Gynaecology', 'The definitive treatment for eclampsia is:', ['Magnesium sulfate only', 'Immediate delivery after stabilization', 'Oral antihypertensive only', 'Bed rest until term'], 'B', 'Magnesium sulfate prevents and treats seizures, but delivery after maternal stabilization is definitive treatment.'),
('Obstetrics and Gynaecology', 'The most common cause of primary postpartum hemorrhage is:', ['Uterine atony', 'Retained placental tissue', 'Genital tract trauma', 'Coagulopathy'], 'A', 'Uterine atony is the most common cause of postpartum hemorrhage. Remember the 4 Ts: Tone, Trauma, Tissue, Thrombin.'),
('Obstetrics and Gynaecology', 'The most common site of ectopic gestation is the:', ['Ovary', 'Ampulla of fallopian tube', 'Cervix', 'Abdominal cavity'], 'B', 'The ampulla is the commonest site of ectopic implantation.'),
('Obstetrics and Gynaecology', 'A partograph is primarily used to monitor:', ['Progress of labour', 'Fetal congenital anomalies', 'Postpartum contraception', 'Neonatal reflexes'], 'A', 'The partograph charts cervical dilatation, fetal condition, and maternal condition to identify abnormal labour progress.'),
('Paediatrics', 'The most common cause of acute bronchiolitis in infants is:', ['Respiratory syncytial virus', 'Influenza A virus', 'Streptococcus pneumoniae', 'Adenovirus'], 'A', 'RSV is the leading cause of bronchiolitis in infants.'),
('Paediatrics', 'The earliest clinical sign of vitamin A deficiency is:', ['Bitot spots', 'Night blindness', 'Keratomalacia', 'Corneal ulceration'], 'B', 'Night blindness is the earliest manifestation of vitamin A deficiency.'),
('Paediatrics', 'A child with severe dehydration due to acute diarrhea should receive initial treatment with:', ['Appropriate rehydration using IV isotonic fluids if shock/severe dehydration is present', 'Antibiotics in every case', 'Antidiarrheal drugs', 'Fluid restriction'], 'A', 'Severe dehydration requires urgent rehydration. Route and rate depend on clinical status and local pediatric protocol.'),
('Community Medicine', 'The measure that represents new cases occurring in a population over a specified time is:', ['Prevalence', 'Incidence', 'Case fatality rate', 'Proportional mortality rate'], 'B', 'Incidence measures occurrence of new cases over time. Prevalence includes both new and existing cases.'),
('Community Medicine', 'For a screening test, the ability to correctly identify individuals who do not have disease is:', ['Sensitivity', 'Specificity', 'Positive predictive value', 'Negative predictive value'], 'B', 'Specificity is the proportion of true negatives correctly identified.'),
('Community Medicine', 'The most appropriate study design to investigate a rare disease is:', ['Case-control study', 'Cohort study', 'Randomized controlled trial', 'Ecological study'], 'A', 'Case-control studies efficiently begin with affected people and are well suited to rare diseases.'),
('Community Medicine', 'The basic reproduction number (R0) refers to:', ['Average secondary cases produced by one typical case in a wholly susceptible population', 'Proportion of infected people who die', 'Percentage of immune people in a population', 'Rate of laboratory test positivity'], 'A', 'R0 is a transmission potential measure in a fully susceptible population.'),
('Ophthalmology', 'The most common cause of preventable blindness worldwide is:', ['Cataract', 'Glaucoma', 'Diabetic retinopathy', 'Age-related macular degeneration'], 'A', 'Cataract remains the leading cause of blindness globally and is treatable.'),
('Ophthalmology', 'Acute angle-closure glaucoma typically presents with:', ['Painful red eye with halos and a mid-dilated pupil', 'Painless gradual loss of peripheral vision', 'Itching with watery discharge', 'Painless central vision loss only'], 'A', 'Acute angle closure causes severe ocular pain, red eye, blurred vision/halos, nausea, and a fixed mid-dilated pupil.'),
('ENT', 'The most common site of epistaxis is:', ['Little area (Kiesselbach plexus)', 'Woodruff plexus', 'Middle turbinate', 'Sphenoethmoidal recess'], 'A', 'Most anterior epistaxis originates from Kiesselbach plexus on the anterior nasal septum.'),
('ENT', 'The commonest complication of acute otitis media is:', ['Mastoiditis', 'Meningitis', 'Lateral sinus thrombosis', 'Facial palsy'], 'A', 'Mastoiditis is a recognized and common local complication of acute otitis media.'),
('Dermatology', 'The primary lesion of pemphigus vulgaris is a:', ['Flaccid intraepidermal bulla', 'Tense subepidermal bulla', 'Target lesion', 'Nonblanching purpura'], 'A', 'Pemphigus vulgaris causes fragile, flaccid bullae due to intraepidermal acantholysis and often has positive Nikolsky sign.'),
('Psychiatry', 'First-line pharmacotherapy for schizophrenia is generally a:', ['Antipsychotic medication', 'Mood stabilizer alone', 'Benzodiazepine alone', 'Selective serotonin reuptake inhibitor alone'], 'A', 'Antipsychotics are the main pharmacologic treatment for schizophrenia; choice depends on prior response and adverse-effect profile.'),
('Orthopaedics', 'A fracture of the neck of femur is especially associated with risk of:', ['Avascular necrosis of femoral head', 'Carpal tunnel syndrome', 'Compartment syndrome of forearm', 'Ulnar nerve injury'], 'A', 'Intracapsular femoral neck fractures may disrupt blood supply to the femoral head, risking avascular necrosis.'),
('Anaesthesiology', 'The drug used to reverse opioid-induced respiratory depression is:', ['Naloxone', 'Flumazenil', 'Atropine', 'Neostigmine'], 'A', 'Naloxone is a competitive opioid receptor antagonist used for opioid toxicity.'),
('Radiology', 'The first imaging investigation in a hemodynamically unstable patient with suspected intra-abdominal bleeding after blunt trauma is:', ['FAST ultrasonography', 'CT abdomen with contrast', 'MRI abdomen', 'Barium meal'], 'A', 'Focused Assessment with Sonography in Trauma is rapid and useful in unstable trauma patients to detect free fluid.'),
]

letters = ['A', 'B', 'C', 'D']

class NumberedCanvas(canvas.Canvas):
    def __init__(self, *args, **kwargs):
        canvas.Canvas.__init__(self, *args, **kwargs)
        self._saved_page_states = []
    def showPage(self):
        self._saved_page_states.append(dict(self.__dict__))
        self._startPage()
    def save(self):
        count = len(self._saved_page_states)
        for state in self._saved_page_states:
            self.__dict__.update(state)
            self.setFont('Helvetica', 8)
            self.setFillColor(HexColor('#667085'))
            self.drawString(1.6*cm, 1.1*cm, 'FMGE High-Yield PYQ-Style Questions | Original practice set')
            self.drawRightString(A4[0]-1.6*cm, 1.1*cm, f'Page {self._pageNumber} of {count}')
            canvas.Canvas.showPage(self)
        canvas.Canvas.save(self)

def p(text, style):
    return Paragraph(text, style)

def build():
    doc = SimpleDocTemplate(OUT, pagesize=A4, rightMargin=1.5*cm, leftMargin=1.5*cm, topMargin=1.55*cm, bottomMargin=1.65*cm)
    styles = getSampleStyleSheet()
    styles.add(ParagraphStyle(name='TitleCustom', parent=styles['Title'], fontName='Helvetica-Bold', fontSize=24, leading=29, alignment=TA_CENTER, textColor=HexColor('#102A43'), spaceAfter=14))
    styles.add(ParagraphStyle(name='SubTitle', parent=styles['Normal'], fontName='Helvetica', fontSize=11, leading=15, alignment=TA_CENTER, textColor=HexColor('#486581'), spaceAfter=18))
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    styles.add(ParagraphStyle(name='Q', parent=styles['BodyText'], fontName='Helvetica-Bold', fontSize=10.1, leading=13.5, textColor=HexColor('#1F2933'), spaceAfter=4))
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    styles.add(ParagraphStyle(name='Small', parent=styles['BodyText'], fontName='Helvetica', fontSize=8.7, leading=11.5, textColor=HexColor('#52606D')))

    story = []
    story += [Spacer(1, 1.4*cm), p('FMGE High-Yield PYQ-Style Questions', styles['TitleCustom']), p('50 original, exam-oriented MCQs with concise answer rationales', styles['SubTitle'])]
    intro = [
        ['What this is', 'An original practice set built around repeatedly tested FMGE concepts. It is not a verbatim reproduction of any proprietary or recalled question bank.'],
        ['How to use it', 'Attempt Questions 1-50 in 55 minutes. Mark uncertain questions. Then use the answer key to identify weak topics and revise the linked concept.'],
        ['Exam approach', 'Read the final line first, eliminate clear distractors, and answer every question in the actual FMGE because there is no negative marking.'],
        ['Important', 'Guidelines and national programs can change. Verify current NBEMS information bulletins and current Indian guidelines during final revision.'],
    ]
    tbl = Table([[p('<b>'+a+'</b>', styles['Small']), p(b, styles['Small'])] for a,b in intro], colWidths=[3.1*cm, 13.0*cm])
    tbl.setStyle(TableStyle([('BACKGROUND',(0,0),(-1,-1),HexColor('#F0F7FA')),('GRID',(0,0),(-1,-1),0.35,HexColor('#B8D8E3')),('VALIGN',(0,0),(-1,-1),'TOP'),('LEFTPADDING',(0,0),(-1,-1),7),('RIGHTPADDING',(0,0),(-1,-1),7),('TOPPADDING',(0,0),(-1,-1),6),('BOTTOMPADDING',(0,0),(-1,-1),6)]))
    story += [tbl, Spacer(1, 16), p('Subject map', styles['H1Custom'])]
    counts = {}
    for sub, *_ in questions: counts[sub] = counts.get(sub, 0)+1
    map_data = []
    row=[]
    for i,(sub,count) in enumerate(counts.items(),1):
        row.append(p(f'<b>{sub}</b><br/>{count} questions', styles['Small']))
        if len(row)==3:
            map_data.append(row); row=[]
    if row:
        while len(row)<3: row.append('')
        map_data.append(row)
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    story += [mt, PageBreak(), p('Questions', styles['H1Custom'])]

    current = None
    for no,(sub,q,opts,ans,exp) in enumerate(questions,1):
        bits=[]
        if sub != current:
            current=sub
            bits.append(p(sub, styles['H2Custom']))
        bits.append(p(f'{no}. {q}', styles['Q']))
        for j,opt in enumerate(opts):
            bits.append(p(f'{letters[j]}. {opt}', styles['Opt']))
        bits.append(Spacer(1,5))
        story.append(KeepTogether(bits))

    story += [PageBreak(), p('Answer Key and Rationales', styles['H1Custom'])]
    current=None
    for no,(sub,q,opts,ans,exp) in enumerate(questions,1):
        bits=[]
        if sub != current:
            current=sub
            bits.append(p(sub, styles['H2Custom']))
        answer_text = f'<b>{no}. {ans}</b> - {opts[letters.index(ans)]}<br/><font color="#52606D">{exp}</font>'
        bits.append(p(answer_text, styles['Ans']))
        story.append(KeepTogether(bits))

    story += [Spacer(1,9), p('Revision tracker', styles['H1Custom'])]
    tracker = [['Subject', 'Attempt 1 score', 'Weak topics / next action'], ['Medicine', '', ''], ['Surgery', '', ''], ['OBG', '', ''], ['Community Medicine', '', ''], ['Pharmacology', '', ''], ['Pathology / Microbiology', '', ''], ['Basic sciences / minors', '', '']]
    tr = Table([[p(f'<b>{c}</b>' if r==0 else c, styles['Small']) for c in row] for r,row in enumerate(tracker)], colWidths=[4.2*cm, 3.5*cm, 9.2*cm], rowHeights=[0.75*cm]+[0.85*cm]*7)
    tr.setStyle(TableStyle([('BACKGROUND',(0,0),(-1,0),HexColor('#0B7285')),('TEXTCOLOR',(0,0),(-1,0),colors.white),('GRID',(0,0),(-1,-1),0.4,HexColor('#9FB3C8')),('VALIGN',(0,0),(-1,-1),'MIDDLE'),('LEFTPADDING',(0,0),(-1,-1),6)]))
    story += [tr, Spacer(1,10), p('Content note: This booklet contains original educational questions based on standard undergraduate medical concepts. It does not claim to be an official NBEMS resource or a collection of verbatim prior questions.', styles['Small'])]
    doc.build(story, canvasmaker=NumberedCanvas)

if __name__ == '__main__':
    build()

from reportlab.lib import colors
from reportlab.lib.pagesizes import A4
from reportlab.lib.styles import getSampleStyleSheet, ParagraphStyle
from reportlab.lib.units import cm
from reportlab.platypus import SimpleDocTemplate, Paragraph, Spacer, PageBreak, Table, TableStyle
from reportlab.lib.colors import HexColor
from reportlab.pdfbase.pdfmetrics import stringWidth
import os

OUTDIR = '/tmp/workspace/fmge-high-yield-pyqs/output'
os.makedirs(OUTDIR, exist_ok=True)

# These are original, recalled-PYQ-style questions, not a reproduction of any proprietary question bank.
banks = {
'Medicine': [
('Cardiology','A patient with acute inferior-wall myocardial infarction develops hypotension, elevated JVP, and clear lung fields. The most likely complication is:',['Acute MR','Right ventricular infarction','Ventricular septal rupture','Cardiogenic pulmonary edema'],'B','Right ventricular infarction causes raised JVP with hypotension and clear lungs. Give cautious IV fluids and avoid nitrates if preload dependent.'),
('Cardiology','The most specific cardiac biomarker for myocardial necrosis is:',['CK-MB','Myoglobin','Cardiac troponin','LDH-1'],'C','Cardiac troponins are highly sensitive and specific for myocardial injury.'),
('Cardiology','A patient with atrial fibrillation and a rapid ventricular response who is hypotensive and confused requires:',['Oral beta blocker','IV adenosine','Synchronized DC cardioversion','Digoxin only'],'C','Hemodynamic instability due to tachyarrhythmia is an indication for synchronized cardioversion.'),
('Cardiology','The ECG feature most characteristic of hyperkalemia is:',['Delta wave','Tall peaked T waves','ST elevation in all leads','U waves'],'B','Hyperkalemia classically causes tall tented T waves, then PR prolongation and QRS widening.'),
('Respiratory','The earliest spirometric change in obstructive airway disease is a reduction in:',['FVC','FEV1/FVC ratio','Total lung capacity','Residual volume'],'B','Airflow obstruction reduces FEV1 disproportionately, lowering the FEV1/FVC ratio.'),
('Respiratory','In a patient with severe acute asthma, a normal or rising PaCO2 is a sign of:',['Clinical improvement','Respiratory muscle fatigue and impending failure','Pure hyperventilation','Metabolic alkalosis'],'B','Patients with acute asthma usually have low PaCO2. A normal or high value is ominous.'),
('Respiratory','The most common cause of transudative pleural effusion is:',['Tuberculosis','Heart failure','Malignancy','Parapneumonic infection'],'B','Congestive heart failure is the commonest overall cause of a transudative pleural effusion.'),
('Gastroenterology','The most common site of peptic ulcer perforation is the:',['Lesser curvature of stomach','Anterior first part of duodenum','Posterior first part of duodenum','Ileum'],'B','Anterior duodenal ulcers tend to perforate; posterior ulcers more often bleed from the gastroduodenal artery.'),
('Gastroenterology','A patient with cirrhosis presents with hematemesis. The first priority after resuscitation is treatment with:',['Oral propranolol','A vasoactive agent such as terlipressin','Elective TIPS only','H. pylori eradication'],'B','Suspected variceal bleeding is managed with resuscitation, vasoactive therapy, antibiotics, and urgent endoscopic therapy.'),
('Gastroenterology','The antibody most specific for celiac disease is:',['Antinuclear antibody','IgA anti-tissue transglutaminase','Anti-mitochondrial antibody','p-ANCA'],'B','IgA anti-tTG is the usual screening test. Check total IgA when IgA deficiency is possible.'),
('Endocrinology','The first step in management of diabetic ketoacidosis is:',['IV insulin bolus','Isotonic IV fluid replacement','IV bicarbonate in every patient','Oral hypoglycemic drug'],'B','Volume resuscitation with isotonic fluid is first. Insulin and potassium management follow after assessment.'),
('Endocrinology','A patient has hypercalcemia, renal stones, and elevated parathyroid hormone. The most likely diagnosis is:',['Familial hypocalciuric hypercalcemia','Primary hyperparathyroidism','Vitamin D intoxication','Malignancy-associated hypercalcemia'],'B','Inappropriately elevated PTH in hypercalcemia suggests primary hyperparathyroidism.'),
('Endocrinology','The preferred initial drug for thyroid storm is:',['Levothyroxine','Propranolol plus thionamide','Radioiodine immediately','Iodide alone'],'B','Treat with beta blockade, a thionamide, then iodine after thionamide, plus glucocorticoid and supportive care.'),
('Nephrology','The ECG should be obtained urgently in a patient with:',['Mild hyponatremia','Hyperkalemia','Iron deficiency anemia','Hyperuricemia'],'B','Hyperkalemia may cause lethal conduction abnormalities; ECG guides immediate membrane stabilization.'),
('Nephrology','Nephrotic syndrome is defined by urinary protein excretion exceeding:',['150 mg/day','300 mg/day','1 g/day','3.5 g/day'],'D','Nephrotic-range proteinuria is more than 3.5 g per day, with hypoalbuminemia and edema.'),
('Nephrology','Red blood cell casts in urine most strongly suggest:',['Lower UTI','Glomerulonephritis','Nephrotic syndrome','Prerenal azotemia'],'B','RBC casts originate in renal tubules and support glomerular bleeding/nephritis.'),
('Neurology','The immediate imaging test for suspected acute stroke is:',['MRI with contrast','Noncontrast CT head','Carotid Doppler only','CT myelography'],'B','Noncontrast CT rapidly excludes intracranial hemorrhage before acute reperfusion decisions.'),
('Neurology','A patient with sudden severe thunderclap headache and normal CT performed late after onset should next undergo:',['EEG','Lumbar puncture for xanthochromia','EMG','Skull X-ray'],'B','If subarachnoid hemorrhage remains suspected after a negative CT, LP is used to assess for xanthochromia.'),
('Neurology','The most common cause of spontaneous intracerebral hemorrhage is:',['Hypertension','Aneurysm','Meningitis','Migraine'],'A','Chronic hypertension causes deep hemorrhages, often in basal ganglia, thalamus, pons, or cerebellum.'),
('Hematology','The peripheral smear finding of microangiopathic hemolytic anemia is:',['Spherocytes','Schistocytes','Target cells','Howell-Jolly bodies'],'B','Schistocytes are fragmented RBCs produced by mechanical intravascular destruction.'),
('Hematology','The first-line treatment for immune thrombocytopenia with significant bleeding risk is:',['Aspirin','Corticosteroids','Iron therapy','Warfarin'],'B','Corticosteroids are a standard first-line treatment for ITP; IVIG may be used when rapid rise is required.'),
('Hematology','Vitamin B12 deficiency may cause anemia with:',['Hypersegmented neutrophils','Basophilic stippling only','Target cells','Auer rods'],'A','Megaloblastic anemia features macro-ovalocytes and hypersegmented neutrophils.'),
('Infectious disease','The most sensitive test for HIV infection after the window period in routine screening is:',['HIV antibody only','Fourth-generation antigen-antibody assay','Viral culture','CD4 count'],'B','Fourth-generation assays detect both p24 antigen and antibodies and shorten the diagnostic window.'),
('Infectious disease','The most common cause of community-acquired pneumonia in adults is:',['Mycoplasma pneumoniae','Streptococcus pneumoniae','Klebsiella pneumoniae','Pseudomonas aeruginosa'],'B','S. pneumoniae remains a leading common cause of community-acquired bacterial pneumonia.'),
('Rheumatology','The investigation most useful for monitoring disease activity in systemic lupus erythematosus is:',['Rheumatoid factor','Anti-dsDNA titer and complement','ANA titer alone','Anti-centromere antibody'],'B','Rising anti-dsDNA and falling complement can correlate with active SLE, especially nephritis.'),
('Rheumatology','The crystal seen in gout is:',['Positively birefringent rhomboid','Negatively birefringent needle','Calcium oxalate envelope','Cholesterol plate'],'B','Monosodium urate crystals are needle-shaped and negatively birefringent.'),
('Emergency','In anaphylaxis, the first-line medication is:',['IV antihistamine','IM adrenaline in the anterolateral thigh','Nebulized salbutamol only','IV hydrocortisone only'],'B','IM adrenaline is first-line. Airway, breathing, circulation support follows; antihistamines and steroids are adjuncts.'),
('Dermatology','Nikolsky sign is classically positive in:',['Psoriasis','Pemphigus vulgaris','Tinea corporis','Lichen planus'],'B','Pemphigus vulgaris has fragile intraepidermal bullae due to acantholysis, producing a positive Nikolsky sign.'),
('Psychiatry','The drug class with proven efficacy for maintenance treatment of bipolar disorder is:',['Benzodiazepines alone','Mood stabilizers such as lithium','Anticholinergics','Stimulants'],'B','Lithium is a key maintenance mood stabilizer and also reduces suicide risk in appropriate patients.'),
('Medicine mixed','A patient with fever, hypotension, and raised lactate has septic shock. The initial approach includes:',['Delay antibiotics until culture results','Prompt cultures, broad-spectrum antibiotics, and IV fluids','Diuretics','Oral rehydration only'],'B','Give cultures when this does not delay therapy, start prompt antibiotics, resuscitate with IV fluids, and reassess perfusion.'),
],
'Obstetrics_and_Gynaecology': [
('Obstetrics','The most common cause of primary postpartum hemorrhage is:',['Retained placenta','Uterine atony','Genital tract trauma','Coagulation failure'],'B','Uterine atony is the leading cause. Remember the 4 Ts: Tone, Trauma, Tissue, and Thrombin.'),
('Obstetrics','A woman with postpartum hemorrhage has a boggy uterus. The first uterotonic commonly used is:',['Oxytocin','Magnesium sulfate','Misoprostol only','Methotrexate'],'A','Uterine massage and oxytocin are immediate management for atony, with escalation according to cause and response.'),
('Obstetrics','The definitive treatment for eclampsia seizure prevention and treatment is:',['Diazepam only','Magnesium sulfate','Phenytoin routinely','Mannitol'],'B','Magnesium sulfate is the drug of choice for prevention and treatment of eclamptic seizures.'),
('Obstetrics','The earliest reliable clinical sign of pregnancy is:',['Amenorrhea','Positive urine test','Fetal heart sounds','Quickening'],'C','Fetal heart sounds are a positive, reliable sign of pregnancy, unlike presumptive/probable signs.'),
('Obstetrics','The most common site of ectopic pregnancy is the:',['Ovary','Ampulla of fallopian tube','Cervix','Abdominal cavity'],'B','The ampullary segment is the commonest site of tubal ectopic implantation.'),
('Obstetrics','In placenta previa, digital vaginal examination is:',['Mandatory at first visit','Contraindicated until placenta location is known','Helpful to induce labour','Needed after every bleed'],'B','Digital vaginal examination can provoke severe hemorrhage in placenta previa and should be avoided.'),
('Obstetrics','A painless third-trimester vaginal bleed suggests:',['Placenta previa','Placental abruption','Uterine rupture','Vasa previa always'],'A','Placenta previa typically causes painless, recurrent bleeding. Abruption is usually painful with uterine tenderness.'),
('Obstetrics','The most common presentation of a fetus at term is:',['Breech','Cephalic vertex','Face','Shoulder'],'B','Cephalic vertex presentation is most common at term.'),
('Obstetrics','The mechanism of action of magnesium sulfate in eclampsia is primarily:',['Direct antihypertensive effect','Anticonvulsant action','Uterotonic action','Antibiotic action'],'B','Magnesium sulfate prevents and treats seizures; antihypertensives are used separately for severe hypertension.'),
('Obstetrics','The first maneuver in shoulder dystocia is:',['Fundal pressure','McRoberts maneuver','Internal podalic version','Forceps rotation'],'B','McRoberts maneuver with suprapubic pressure is the first-line initial maneuver. Fundal pressure is avoided.'),
('Obstetrics','A nonreassuring fetal heart tracing with recurrent late decelerations most likely reflects:',['Umbilical cord compression','Uteroplacental insufficiency','Fetal head compression','Maternal fever only'],'B','Late decelerations begin after the contraction and suggest impaired uteroplacental oxygen transfer.'),
('Gynecology','The most common benign ovarian neoplasm in reproductive-age women is:',['Serous cystadenoma','Mature cystic teratoma','Fibroma','Mucinous cystadenocarcinoma'],'B','Mature cystic teratoma (dermoid cyst) is the most common benign ovarian germ-cell tumor.'),
('Gynecology','The most common site of endometriosis is the:',['Ovary','Cervix','Vulva','Broad ligament'],'A','The ovary is a commonest site; endometriosis may also involve pelvic peritoneum and uterosacral ligaments.'),
('Gynecology','The most common symptom of endometriosis is:',['Painless bleeding','Dysmenorrhea with chronic pelvic pain','Amenorrhea','Galactorrhea'],'B','Endometriosis commonly causes dysmenorrhea, chronic pelvic pain, dyspareunia, and infertility.'),
('Gynecology','A woman with PCOS most often has which endocrine pattern?',['High FSH:LH ratio','Increased LH relative to FSH','Low androgen level','High progesterone throughout cycle'],'B','PCOS often shows increased LH relative to FSH, with hyperandrogenism and chronic anovulation.'),
('Gynecology','The investigation of choice to evaluate postmenopausal bleeding for endometrial pathology is:',['Pap smear alone','Endometrial sampling','CA-125 only','Serum FSH'],'B','Postmenopausal bleeding needs assessment for endometrial carcinoma; sampling is central when indicated.'),
('Gynecology','The most common symptom of uterine leiomyoma is:',['Amenorrhea','Menorrhagia','Postcoital bleeding','Fever'],'B','Fibroids often cause heavy menstrual bleeding, pressure symptoms, and reproductive effects depending on site.'),
('Gynecology','The first-line emergency treatment for torsion of an adnexal mass is:',['Observation for a week','Urgent surgical detorsion','Radiotherapy','Antibiotics alone'],'B','Ovarian torsion is a surgical emergency. Prompt detorsion aims to preserve ovarian function.'),
('Gynecology','The transformation zone of the cervix is clinically important because it is the common site for:',['Endometriosis','Cervical intraepithelial neoplasia','Ovarian torsion','Fibroids'],'B','Most cervical precancers and cancers arise in the transformation zone.'),
('Family planning','The most effective emergency contraception method within 5 days is:',['Copper IUD','Combined oral pill','Progesterone injection','Tubal ligation'],'A','A copper IUD is the most effective emergency contraception and provides ongoing contraception.'),
('Family planning','Combined oral contraceptive pills are contraindicated in:',['Healthy nonsmoker age 22','Migraine with aura','Dysmenorrhea','Acne'],'B','Estrogen-containing contraception is avoided in migraine with aura because of ischemic stroke risk.'),
('Obstetrics','A pregnant woman at 34 weeks has BP 170/110 mmHg. The urgent goal is to:',['Ignore if asymptomatic','Control severe hypertension and assess mother/fetus','Induce immediately without stabilization','Give oral iron'],'B','Severe-range hypertension requires prompt treatment and maternal-fetal assessment; definitive delivery timing depends on clinical context.'),
('Obstetrics','The usual presenting symptom of abruptio placentae is:',['Painless vaginal bleeding','Painful bleeding with tender uterus','No pain or bleeding','Polyuria'],'B','Placental abruption classically causes painful bleeding and uterine hypertonicity/tenderness.'),
('Obstetrics','The normal duration of the third stage of labour is usually less than:',['5 minutes','30 minutes','2 hours','6 hours'],'B','A prolonged third stage raises concern for retained placenta and hemorrhage; local protocols guide timing and intervention.'),
('Gynecology','The most likely cause of secondary amenorrhea with galactorrhea is:',['Hyperprolactinemia','Hyperthyroidism only','Fibroid uterus','Endometriosis'],'A','Hyperprolactinemia suppresses GnRH and can cause amenorrhea, infertility, and galactorrhea.'),
('Gynecology','The most common cause of vaginal discharge with a fishy odor and clue cells is:',['Candida','Trichomoniasis','Bacterial vaginosis','Gonorrhea'],'C','Bacterial vaginosis is suggested by clue cells and amine odor; it is caused by altered vaginal flora.'),
('Gynecology','The first investigation in a reproductive-age woman with amenorrhea is:',['Pregnancy test','Pelvic MRI','Hysteroscopy','Serum CA-125'],'A','Pregnancy should be excluded first in reproductive-age patients with amenorrhea.'),
('Obstetrics','The preferred route of delivery in major placenta previa with persistent bleeding is:',['Vaginal delivery','Cesarean delivery','Vacuum extraction','Forceps delivery'],'B','Major placenta previa commonly requires cesarean delivery because the placenta obstructs the internal os.'),
('Gynecology','A painless vulvar ulcer with a clean base is characteristic of:',['Chancroid','Primary syphilis','Genital herpes','Lymphogranuloma venereum'],'B','The chancre of primary syphilis is classically painless and indurated.'),
('Gynecology mixed','The definitive diagnosis of endometriosis is made by:',['CA-125','Laparoscopy with histologic confirmation','Plain radiograph','Pap smear'],'B','Laparoscopy permits visualization and tissue confirmation, though management may begin based on clinical assessment.'),
],
'Surgery': [
('General surgery','Pain beginning periumbilically and later localizing to the right iliac fossa is typical of:',['Acute cholecystitis','Acute appendicitis','Acute pancreatitis','Perforated peptic ulcer'],'B','Visceral pain from the appendix later localizes when parietal peritoneum becomes inflamed.'),
('General surgery','The most common position of the appendix is:',['Pelvic','Retrocecal','Preileal','Subcecal'],'B','The retrocecal appendix is the most common anatomic position.'),
('General surgery','A patient with perforated peptic ulcer most likely has free gas visible under the:',['Left hemidiaphragm only','Right hemidiaphragm','Cardiac silhouette','Pelvic brim'],'B','Erect chest radiograph may show free subdiaphragmatic gas, often under the right hemidiaphragm.'),
('General surgery','The most common cause of small-bowel obstruction in adults is:',['Hernia','Postoperative adhesions','Volvulus','Intussusception'],'B','Postoperative adhesions are the leading cause in many adult populations.'),
('General surgery','The most common type of external abdominal hernia is:',['Femoral','Inguinal','Umbilical','Incisional'],'B','Inguinal hernia is the commonest external abdominal hernia.'),
('General surgery','A femoral hernia is more common in:',['Young men','Women and has high strangulation risk','Children only','Athletes only'],'B','Femoral hernias occur more often in women and are prone to incarceration/strangulation.'),
('General surgery','The initial management of a tension pneumothorax is:',['Wait for chest X-ray','Immediate needle decompression','CT chest','Oral antibiotics'],'B','Tension pneumothorax is a clinical diagnosis. Immediate decompression is followed by definitive tube thoracostomy.'),
('General surgery','The most common organism causing surgical site infection is:',['Staphylococcus aureus','Mycobacterium tuberculosis','Plasmodium vivax','Treponema pallidum'],'A','S. aureus is a frequent leading cause of surgical site infection, with context-dependent flora in some operations.'),
('Trauma','The first priority in ATLS primary survey is:',['Definitive fracture fixation','Airway with cervical-spine protection','CT whole body','Detailed neurological exam'],'B','Primary survey follows ABCDE, starting with airway and cervical spine protection.'),
('Trauma','In a hemodynamically unstable trauma patient with suspected intra-abdominal bleeding, a positive FAST examination indicates:',['Discharge home','Urgent operative/hemorrhage-control evaluation','Colonoscopy','MRI after 24 hours'],'B','Instability with free intraperitoneal fluid requires urgent hemorrhage-control decision-making.'),
('General surgery','The triad of Charcot in acute cholangitis is:',['Fever, jaundice, right upper quadrant pain','Fever, cough, hemoptysis','Pain, pallor, paralysis','Vomiting, diarrhea, fever'],'A','Charcot triad is fever, jaundice, and RUQ pain. Hypotension and altered sensorium add Reynolds pentad.'),
('General surgery','The most common cause of acute pancreatitis is:',['Gallstones','Trauma','Appendicitis','Peptic ulcer'],'A','Gallstones and alcohol are major causes; gallstones are a common leading cause.'),
('General surgery','A raised serum lipase is most useful in diagnosing:',['Acute pancreatitis','Acute appendicitis','Cholecystitis only','Intestinal obstruction'],'A','Lipase is generally more specific and remains elevated longer than amylase in acute pancreatitis.'),
('Breast','The most common site of breast carcinoma is the:',['Upper outer quadrant','Lower inner quadrant','Nipple only','Axillary tail only'],'A','The upper outer quadrant is a commonest location, reflecting substantial breast tissue volume.'),
('Breast','The most common lymph-node group involved first in breast cancer is:',['Internal mammary','Axillary','Supraclavicular','Inguinal'],'B','Most breast lymph drains to the axillary nodes, particularly pectoral/anterior nodes.'),
('Thyroid','The most common cause of hyperthyroidism is:',['Toxic adenoma','Graves disease','Thyroid carcinoma','Subacute thyroiditis'],'B','Graves disease is a commonest cause of endogenous hyperthyroidism.'),
('Thyroid','The recurrent laryngeal nerve is at risk during:',['Appendectomy','Thyroidectomy','Splenectomy','Hemorrhoidectomy'],'B','The recurrent laryngeal nerve runs near the inferior thyroid artery and must be identified/preserved during thyroid surgery.'),
('Vascular','The classic features of acute limb ischemia include pain, pallor, pulselessness, paresthesia, paralysis, and:',['Pruritus','Poikilothermia','Polyuria','Petechiae'],'B','The 6 Ps include poikilothermia. Acute limb ischemia needs urgent vascular assessment and reperfusion strategy.'),
('Urology','The commonest site of ureteric calculus impaction is:',['UPJ only','Vesicoureteric junction','Mid-ureter only','Renal cortex'],'B','The UVJ is a common physiologic narrowing where stones lodge; other sites include UPJ and pelvic brim.'),
('Urology','Painless hematuria in an older adult should be considered bladder cancer until:',['It resolves in 24 hours','Proven otherwise','Antibiotics are given','A stone is seen on X-ray'],'B','Painless visible hematuria requires prompt urologic evaluation for malignancy.'),
('Wound healing','Vitamin C deficiency impairs wound healing by reducing:',['Collagen hydroxylation','Insulin secretion','Bile formation','Thyroid hormone release'],'A','Vitamin C is needed for hydroxylation of proline and lysine during collagen synthesis.'),
('Wound healing','The proliferative phase of wound healing is characterized by:',['Hemostasis only','Granulation tissue and angiogenesis','Scar maturation only','No collagen deposition'],'B','Fibroblast activity, collagen deposition, angiogenesis, and epithelialization dominate the proliferative phase.'),
('Oncology','A sentinel lymph-node biopsy is most useful for staging:',['Clinically node-negative breast cancer','Acute appendicitis','Hemorrhoids','Peptic ulcer disease'],'A','Sentinel node assessment helps stage axillary disease while reducing morbidity from full dissection in suitable cases.'),
('Colorectal','The most common site of colorectal carcinoma is the:',['Rectosigmoid region','Duodenum','Jejunum','Anal canal only'],'A','Colorectal cancers commonly arise in the rectosigmoid area; screening and symptoms guide workup.'),
('Colorectal','The most common presentation of carcinoma of the right colon is:',['Early obstruction','Iron deficiency anemia','Anal pain','Fecal incontinence'],'B','Right-sided tumors may bleed occultly and present with iron deficiency anemia, while left-sided tumors more often obstruct.'),
('Hepatobiliary','Courvoisier sign suggests:',['Benign gallstone obstruction','Malignant obstruction of distal bile duct/pancreatic head','Acute hepatitis only','Appendicitis'],'B','A palpable nontender gallbladder with jaundice suggests malignant distal biliary obstruction.'),
('Perioperative care','The most common postoperative pulmonary complication is:',['Atelectasis','Pulmonary embolism','Lung cancer','Tuberculosis'],'A','Atelectasis is common after surgery, particularly with pain and shallow breathing; early mobilization and breathing exercises help.'),
('General surgery','The first step in management of hemorrhagic shock is:',['Oral fluids','Airway and rapid hemorrhage control with resuscitation','Elective endoscopy','Diuretic therapy'],'B','Manage ABCs, control bleeding, provide balanced resuscitation and blood products as needed, and prevent hypothermia.'),
('Surgical infection','The principle management of an abscess is:',['Antibiotics alone in every case','Incision and drainage','Radiotherapy','Anticoagulation'],'B','Source control by drainage is fundamental for a drainable abscess; antibiotics depend on site and systemic features.'),
('Surgery mixed','A patient with acute cholecystitis has fever, RUQ pain, and a positive Murphy sign. The usual initial imaging is:',['Ultrasound abdomen','Barium meal','MRI brain','IV urography'],'A','Ultrasound is first-line for suspected gallstones/cholecystitis and can demonstrate stones, wall thickening, and sonographic Murphy sign.'),
],
'PSM_Community_Medicine': [
('Epidemiology','Incidence measures:',['All existing cases at a point in time','New cases occurring in a population over a period','Deaths only','Hospital admissions only'],'B','Incidence quantifies new occurrences over a specified time among the population at risk.'),
('Epidemiology','Prevalence is most useful for estimating:',['Risk of developing disease','Burden of disease in a population','Case fatality only','Vaccine efficacy only'],'B','Prevalence counts existing cases and is useful for service planning and disease burden.'),
('Epidemiology','The measure of association in a cohort study is:',['Odds ratio only','Relative risk','Kappa coefficient','Correlation coefficient only'],'B','A cohort study follows exposed and unexposed groups, allowing direct calculation of incidence and relative risk.'),
('Epidemiology','The measure of association in a case-control study is:',['Relative risk','Odds ratio','Incidence density','Prevalence ratio only'],'B','Because incidence cannot usually be calculated directly in case-control studies, association is expressed as an odds ratio.'),
('Screening','A screening test with high sensitivity is particularly useful to:',['Rule in disease when positive','Rule out disease when negative','Increase false negatives','Measure mortality directly'],'B','A highly sensitive test has few false negatives. A negative result helps rule out disease.'),
('Screening','Positive predictive value increases when:',['Disease prevalence increases','Disease prevalence decreases','Sensitivity falls to zero','Specificity falls to zero'],'A','With higher prevalence, a positive test is more likely to represent true disease, increasing PPV.'),
('Biostatistics','The mean is most affected by:',['Extreme values','Sample labels','Mode only','Randomization alone'],'A','The arithmetic mean is sensitive to outliers. Median is often more representative for skewed data.'),
('Biostatistics','For a positively skewed distribution, the usual relationship is:',['Mean < median < mode','Mean > median > mode','Mean = median = mode','Mode > mean > median'],'B','The long right tail pulls the mean furthest right: mean > median > mode.'),
('Biostatistics','A p value less than 0.05 conventionally indicates:',['The null hypothesis is definitely false','Results are statistically significant at 5% level','The study has no bias','Clinical importance is guaranteed'],'B','It indicates the observed data would be relatively unlikely if the null hypothesis were true. It does not prove clinical importance.'),
('Health indicators','Infant mortality rate is deaths of children under 1 year per:',['100 live births','1,000 live births','10,000 population','100,000 population'],'B','IMR is infant deaths under age 1 in a year per 1,000 live births in the same year.'),
('Health indicators','Maternal mortality ratio is expressed per:',['1,000 live births','10,000 live births','100,000 live births','1,000 population'],'C','MMR is maternal deaths during pregnancy/within the defined period per 100,000 live births.'),
('Demography','Replacement-level fertility is approximately:',['1 child per woman','2.1 children per woman','3.5 children per woman','5 children per woman'],'B','Replacement fertility is about 2.1 in populations with low mortality, accounting for child mortality and sex ratio.'),
('Immunization','A live attenuated vaccine is:',['BCG','Tetanus toxoid','Hepatitis B vaccine','Inactivated polio vaccine'],'A','BCG is live attenuated. Toxoids and killed/recombinant vaccines are not live.'),
('Immunization','The vaccine usually given intradermally is:',['BCG','DPT','Hepatitis B','Measles-rubella'],'A','BCG is given intradermally. Route and schedule should be checked against current national guidance.'),
('Immunization','Herd immunity is least useful for preventing:',['Measles','Polio','Tetanus','Rubella'],'C','Tetanus is acquired from environmental spores, not person-to-person transmission, so herd protection does not apply.'),
('Communicable disease','The vector of malaria is:',['Female Anopheles mosquito','Culex mosquito','Sandfly','Housefly'],'A','Malaria is transmitted by the bite of an infected female Anopheles mosquito.'),
('Communicable disease','The most infectious form of tuberculosis is:',['Latent TB infection','Sputum-smear-positive pulmonary TB','Healed calcified lesion','Extrapulmonary TB only'],'B','Pulmonary disease with bacilli in sputum is most relevant to airborne transmission.'),
('Communicable disease','DOTS is a strategy primarily used for control of:',['Malaria','Tuberculosis','Leprosy only','HIV only'],'B','Directly observed treatment strategy is historically associated with tuberculosis control.'),
('Environmental health','The most effective household method to make microbiologically unsafe water safe in an emergency is:',['Adding sugar','Boiling','Cooling','Filtering through cloth only'],'B','Boiling reliably kills most pathogens when done correctly. Other methods depend on context and specifications.'),
('Nutrition','The most common nutritional anemia in India is:',['Iron deficiency anemia','Vitamin B12 deficiency only','Hemolytic anemia','Aplastic anemia'],'A','Iron deficiency is the commonest nutritional cause of anemia.'),
('Nutrition','Night blindness is an early feature of deficiency of:',['Vitamin A','Vitamin C','Vitamin K','Folate'],'A','Vitamin A deficiency first affects dark adaptation, causing night blindness.'),
('Occupational health','Silicosis predisposes to:',['Tuberculosis','Asthma only','Diabetes mellitus','Peptic ulcer'],'A','Silica exposure increases susceptibility to tuberculosis, in addition to causing progressive fibrotic lung disease.'),
('Occupational health','Byssinosis is associated with exposure to:',['Cotton dust','Asbestos','Silica','Coal dust'],'A','Byssinosis is an occupational airway disease linked to cotton, flax, or hemp dust exposure.'),
('Health programs','Primary prevention includes:',['Rehabilitation after stroke','Early diagnosis and treatment','Immunization','Disability limitation only'],'C','Primary prevention prevents disease onset. Immunization is specific protection within primary prevention.'),
('Health programs','Secondary prevention includes:',['Health promotion only','Early diagnosis and prompt treatment','Physiotherapy after disability','Palliative care only'],'B','Secondary prevention detects and treats disease early to halt progression.'),
('Study design','Randomization in a clinical trial primarily helps to:',['Increase recall bias','Balance known and unknown confounders','Eliminate all measurement errors','Increase prevalence'],'B','Random allocation improves comparability of study groups and reduces confounding.'),
('Study design','Blinding in a trial mainly reduces:',['Selection bias only','Observer and performance bias','Sampling error only','Confounding by age only'],'B','Blinding reduces biased behavior, assessment, and reporting due to awareness of treatment allocation.'),
('Health management','The lowest level of the Indian public health system generally providing primary care is:',['Sub-centre/Health and Wellness Centre level','District hospital','Medical college only','Tertiary referral hospital'],'A','Primary care is delivered through community-level facilities, with organization evolving under national health-system reforms.'),
('PSM mixed','Case fatality rate is best defined as:',['Deaths from a disease divided by number of diagnosed cases','New cases divided by population','All deaths divided by population','Deaths under one year divided by births'],'A','Case fatality measures disease severity by the proportion of cases that die during a specified period.'),
('PSM mixed','The appropriate central tendency measure for highly skewed income data is:',['Mean','Median','Standard deviation','Variance'],'B','Median is resistant to extreme values and is appropriate for skewed distributions such as income.'),
]
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    story += [Spacer(1,8),p('Revision tracker','Section')]
    rows=[[p('<b>Attempt</b>','Small'),p('<b>Date</b>','Small'),p('<b>Score</b>','Small'),p('<b>Weak topics to revise</b>','Small')]] + [[p(str(n),'Small'),p('','Small'),p('__/30','Small'),p('','Small')] for n in range(1,4)]
    story.append(Table(rows,colWidths=[2*cm,3*cm,2.2*cm,9.6*cm],rowHeights=[0.65*cm]*4,style=[('GRID',(0,0),(-1,-1),0.4,HexColor('#9DB7CA')),('BACKGROUND',(0,0),(-1,0),HexColor('#DCECF5')),('VALIGN',(0,0),(-1,-1),'MIDDLE'),('LEFTPADDING',(0,0),(-1,-1),6)]))
    doc.build(story,onFirstPage=footer,onLaterPages=footer)
    return path

if __name__=='__main__':
    for subject,qs in banks.items(): print(make_pdf(subject,qs))