from reportlab.lib.pagesizes import A4
from reportlab.lib.styles import getSampleStyleSheet, ParagraphStyle
from reportlab.lib.units import cm
from reportlab.lib import colors
from reportlab.platypus import (
    SimpleDocTemplate, Paragraph, Spacer, Table, TableStyle,
    HRFlowable, PageBreak, KeepTogether
)
from reportlab.lib.enums import TA_LEFT, TA_CENTER, TA_JUSTIFY
from reportlab.platypus.tableofcontents import TableOfContents
from reportlab.lib.utils import simpleSplit

# ── Output path ───────────────────────────────────────────────────────────────
OUTPUT = "/tmp/workspace/anatomy_pdf/45_Anatomy_Questions.pdf"

# ── Styles ────────────────────────────────────────────────────────────────────
styles = getSampleStyleSheet()

title_style = ParagraphStyle(
    "DocTitle",
    parent=styles["Title"],
    fontSize=22,
    textColor=colors.HexColor("#1a3c6e"),
    spaceAfter=6,
    alignment=TA_CENTER,
)
subtitle_style = ParagraphStyle(
    "DocSubtitle",
    parent=styles["Normal"],
    fontSize=12,
    textColor=colors.HexColor("#555555"),
    spaceAfter=20,
    alignment=TA_CENTER,
)
q_style = ParagraphStyle(
    "QHeading",
    parent=styles["Heading1"],
    fontSize=13,
    textColor=colors.white,
    backColor=colors.HexColor("#1a3c6e"),
    spaceAfter=6,
    spaceBefore=14,
    leftIndent=6,
    rightIndent=6,
    leading=18,
)
h2_style = ParagraphStyle(
    "H2",
    parent=styles["Heading2"],
    fontSize=11,
    textColor=colors.HexColor("#1a3c6e"),
    spaceBefore=8,
    spaceAfter=4,
    leftIndent=0,
)
body_style = ParagraphStyle(
    "Body",
    parent=styles["Normal"],
    fontSize=9.5,
    leading=14,
    spaceAfter=4,
    alignment=TA_JUSTIFY,
)
bullet_style = ParagraphStyle(
    "Bullet",
    parent=styles["Normal"],
    fontSize=9.5,
    leading=13,
    leftIndent=16,
    spaceAfter=2,
    bulletIndent=6,
)
applied_style = ParagraphStyle(
    "Applied",
    parent=styles["Normal"],
    fontSize=9.5,
    leading=13,
    backColor=colors.HexColor("#eef4fb"),
    leftIndent=8,
    rightIndent=8,
    spaceAfter=6,
    spaceBefore=4,
    borderPad=4,
)

def B(txt):
    return f"<b>{txt}</b>"

def section(title):
    return Paragraph(title, h2_style)

def body(txt):
    return Paragraph(txt, body_style)

def bullet(txt):
    return Paragraph(f"&bull; {txt}", bullet_style)

def applied(txt):
    return Paragraph(f"<b>Applied:</b> {txt}", applied_style)

def hr():
    return HRFlowable(width="100%", thickness=0.5, color=colors.HexColor("#bbccdd"), spaceAfter=4)

def make_table(headers, rows, col_widths=None):
    data = [headers] + rows
    style = TableStyle([
        ("BACKGROUND", (0,0), (-1,0), colors.HexColor("#1a3c6e")),
        ("TEXTCOLOR",  (0,0), (-1,0), colors.white),
        ("FONTNAME",   (0,0), (-1,0), "Helvetica-Bold"),
        ("FONTSIZE",   (0,0), (-1,-1), 8.5),
        ("ROWBACKGROUNDS", (0,1), (-1,-1), [colors.HexColor("#f5f8fc"), colors.white]),
        ("GRID",       (0,0), (-1,-1), 0.4, colors.HexColor("#b0c4de")),
        ("VALIGN",     (0,0), (-1,-1), "TOP"),
        ("LEFTPADDING",(0,0), (-1,-1), 5),
        ("RIGHTPADDING",(0,0),(-1,-1), 5),
        ("TOPPADDING", (0,0), (-1,-1), 4),
        ("BOTTOMPADDING",(0,0),(-1,-1), 4),
    ])
    t = Table(data, colWidths=col_widths, style=style, repeatRows=1)
    return t

# ── Document questions ────────────────────────────────────────────────────────
questions = []

def add_q(number, title, content_builder):
    """content_builder returns a list of flowables"""
    questions.append((number, title, content_builder()))

# We'll build a helper to wrap paragraphs inside a styled box
def q_block(number, title, flowables):
    result = []
    result.append(Paragraph(f"Q{number}. {title}", q_style))
    result.extend(flowables)
    result.append(Spacer(1, 6))
    return result

# ─────────────────────────────────────────────────────────────────────────────
# BUILD CONTENT
# ─────────────────────────────────────────────────────────────────────────────

story = []

# Cover
story.append(Spacer(1, 2*cm))
story.append(Paragraph("Anatomy", subtitle_style))
story.append(Paragraph("45 Comprehensive Questions & Answers", title_style))
story.append(Paragraph("Complete Study Reference", subtitle_style))
story.append(Spacer(1, 0.5*cm))
story.append(HRFlowable(width="80%", thickness=2, color=colors.HexColor("#1a3c6e"), hAlign="CENTER"))
story.append(Spacer(1, 1*cm))
story.append(PageBreak())

# ── Q1 ────────────────────────────────────────────────────────────────────────
story += q_block(1, "Lymphatic Drainage of Mammary Gland", [
    section("Routes of Drainage"),
    bullet("<b>Axillary nodes (75%)</b> — principal route; anterior (pectoral) group → central → apical nodes"),
    bullet("<b>Internal mammary nodes</b> — medial quadrants drain along internal thoracic vessels"),
    bullet("<b>Posterior intercostal nodes</b> — deep aspects"),
    bullet("<b>Infraclavicular / supraclavicular nodes</b> — upper quadrants"),
    bullet("<b>Contralateral breast</b> — cross-drainage via subareolar plexus"),
    bullet("<b>Subdiaphragmatic / liver</b> — inferior quadrants via rectus sheath lymphatics"),
    applied("Axillary clearance is performed in breast cancer because 75% of lymphatic spread is axillary. Sentinel lymph node biopsy uses the concept of the first draining node."),
])

# ── Q2 ────────────────────────────────────────────────────────────────────────
story += q_block(2, "Stages in Development of Graafian Follicle", [
    make_table(
        ["Stage", "Description"],
        [
            ["1. Primordial follicle", "Single layer of flat granulosa cells around oocyte (arrested at prophase I)"],
            ["2. Primary follicle (unilaminar)", "Granulosa cells become cuboidal; zona pellucida appears"],
            ["3. Primary follicle (multilaminar)", "Several layers of granulosa; theca interna & externa differentiate"],
            ["4. Secondary (antral) follicle", "Fluid-filled antrum forms; cumulus oophorus surrounds oocyte; corona radiata develops"],
            ["5. Mature Graafian follicle", "20-25 mm; bulges from ovarian surface; oocyte completes 1st meiotic division; ovulation releases secondary oocyte + corona radiata"],
        ],
        col_widths=[5.5*cm, 11*cm],
    ),
    applied("Polycystic ovary: multiple follicles arrested at antral stage. Ovarian hyperstimulation syndrome can occur in IVF."),
])

# ── Q3 ────────────────────────────────────────────────────────────────────────
story += q_block(3, "Cubital Fossa - Boundaries, Contents, Clinical Significance", [
    section("Boundaries"),
    make_table(
        ["Wall", "Structure"],
        [
            ["Roof", "Skin, fascia, bicipital aponeurosis"],
            ["Floor", "Brachialis (medially), supinator (laterally)"],
            ["Medial", "Pronator teres"],
            ["Lateral", "Brachioradialis"],
            ["Apex", "Meeting point of medial and lateral boundaries"],
        ],
        col_widths=[4*cm, 12.5*cm],
    ),
    section("Contents (lateral to medial — TAN mnemonic)"),
    bullet("Biceps <b>T</b>endon"),
    bullet("Brachial <b>A</b>rtery (divides into radial and ulnar)"),
    bullet("Median <b>N</b>erve"),
    applied("Brachial artery pulse palpable here; BP measurement site; median cubital vein used for venepuncture; supracondylar fracture can injure brachial artery and median nerve."),
])

# ── Q4 ────────────────────────────────────────────────────────────────────────
story += q_block(4, "Sesamoid Bone", [
    body("<b>Definition:</b> A bone developed within a tendon, usually over a bony prominence to protect the tendon from friction/wear."),
    make_table(
        ["Feature", "Sesamoid", "Compact Bone"],
        [
            ["Location", "Within tendon", "Cortex of long bones"],
            ["Shape", "Ovoid/nodular", "Cylindrical/flat"],
            ["Marrow", "Minimal/none", "Present"],
            ["Growth", "Intramembranous", "Endochondral"],
        ],
        col_widths=[4.5*cm, 5.5*cm, 6.5*cm],
    ),
    section("Functions"),
    bullet("Reduces friction on tendon"),
    bullet("Alters angle of pull (mechanical advantage)"),
    bullet("Protects tendon from compressive forces"),
    section("Examples"),
    body("Patella (largest), 2 sesamoids under 1st metatarsal head, pisiform (in flexor carpi ulnaris tendon), fabella (behind lateral femoral condyle)."),
])

# ── Q5 ────────────────────────────────────────────────────────────────────────
story += q_block(5, "Gluteus Maximus - Origin, Insertion, Nerve Supply, Action, Applied Anatomy", [
    make_table(
        ["Aspect", "Detail"],
        [
            ["Origin", "Posterior gluteal line of ilium, dorsal sacrum and coccyx, sacrotuberous ligament, thoracolumbar fascia"],
            ["Insertion", "Upper 3/4 fibers → iliotibial tract (IT band) → Gerdy's tubercle on tibia; Lower 1/4 fibers → gluteal tuberosity of femur"],
            ["Nerve supply", "Inferior gluteal nerve (L5, S1, S2)"],
            ["Actions", "Powerful hip extensor (climbing stairs, rising from sitting); lateral rotator of hip; upper fibers abduct, lower fibers adduct; stabilizes knee via IT band"],
        ],
        col_widths=[4*cm, 12.5*cm],
    ),
    applied("Gluteal gait (waddling) when weakened. Dorsal gluteal injection site (upper outer quadrant) to avoid inferior gluteal vessels. Used in gluteal flap reconstruction."),
])

# ── Q6 ────────────────────────────────────────────────────────────────────────
story += q_block(6, "Microanatomy of Large Artery (Elastic Artery)", [
    body("Large arteries (e.g., aorta, pulmonary, common carotids) are <b>elastic arteries</b>."),
    make_table(
        ["Layer", "Description"],
        [
            ["Tunica intima", "Endothelium + subendothelial CT + internal elastic lamina (fenestrated)"],
            ["Tunica media", "Thick; 40-70 concentric sheets of elastic laminae alternating with smooth muscle cells and collagen; allows stretching during systole and recoil during diastole (Windkessel effect)"],
            ["Tunica adventitia", "Collagen, fibroblasts, vasa vasorum, nervi vasorum; thin compared to media"],
        ],
        col_widths=[4*cm, 12.5*cm],
    ),
    body("<b>Key feature:</b> Absence of distinct external elastic lamina (vs. muscular arteries). Elastic laminae stain black with Verhoeff stain."),
])

# ── Q7 ────────────────────────────────────────────────────────────────────────
story += q_block(7, "Microanatomy of Uterus - Secretory Phase", [
    body("During secretory phase (post-ovulation, days 15-28), under progesterone influence:"),
    section("Endometrium"),
    bullet("<b>Glands:</b> Tortuous, coiled, saw-toothed; lumen wide and full of glycogen-rich secretion (subnuclear vacuoles early → supranuclear vacuoles later)"),
    bullet("<b>Stroma:</b> Edematous early; later undergoes predecidual reaction (stromal cells enlarge, become epithelioid — decidualization)"),
    bullet("<b>Spiral arteries:</b> Coiled and prominent"),
    section("Myometrium"),
    body("Thick bundles of smooth muscle; no change from proliferative phase."),
    applied("This phase prepares endometrium for implantation. Inadequate secretory transformation = luteal phase defect, a cause of infertility."),
])

# ── Q8 ────────────────────────────────────────────────────────────────────────
story += q_block(8, "Extrahepatic Biliary Apparatus - Applied Anatomy", [
    body("<b>Components:</b> Right and left hepatic ducts → Common hepatic duct → (joined by cystic duct) → Common bile duct (CBD) → opens at ampulla of Vater with pancreatic duct into 2nd part of duodenum."),
    section("Calot's Triangle"),
    body("Bounded by cystic duct, common hepatic duct, and inferior surface of liver — contains cystic artery (branch of right hepatic artery) — important in cholecystectomy."),
    applied("Gallstones can obstruct cystic duct (cholecystitis) or CBD (obstructive jaundice). Mirizzi syndrome: gallstone in cystic duct compressing CBD. Murphy's sign: gallbladder tenderness on inspiration. Courvoisier's law: palpable non-tender gallbladder + jaundice = carcinoma of pancreatic head."),
])

# ── Q9 ────────────────────────────────────────────────────────────────────────
story += q_block(9, "Formation and Contents of Rectus Sheath", [
    make_table(
        ["Level", "Anterior Wall", "Posterior Wall"],
        [
            ["Above costal margin", "External oblique only", "None (rectus on costal cartilages)"],
            ["Above arcuate line", "EO + anterior IO", "Posterior IO + TA"],
            ["Below arcuate line", "All three aponeuroses", "None (only transversalis fascia)"],
        ],
        col_widths=[4.5*cm, 6*cm, 6*cm],
    ),
    section("Contents"),
    bullet("Rectus abdominis, pyramidalis"),
    bullet("Superior and inferior epigastric vessels"),
    bullet("Lower 5 intercostal and subcostal nerves (T7-T12)"),
    bullet("Iliohypogastric and ilioinguinal nerves (L1)"),
    applied("Rectus sheath hematoma — bleeding into sheath (especially below arcuate line, as no posterior wall confines it); can mimic acute abdomen."),
])

# ── Q10 ───────────────────────────────────────────────────────────────────────
story += q_block(10, "Stages in Development of Diaphragm and Anomalies", [
    section("Four Components"),
    make_table(
        ["Component", "Source", "Forms"],
        [
            ["Septum transversum", "Mesoderm, week 4", "Central tendon"],
            ["Pleuroperitoneal membranes", "Lateral plate mesoderm", "Posterolateral parts"],
            ["Mesentery of esophagus", "Dorsal mesentery", "Crura and median arcuate ligament"],
            ["Body wall ingrowth", "Somatic mesoderm", "Peripheral muscular parts"],
        ],
        col_widths=[5*cm, 5*cm, 6.5*cm],
    ),
    section("Anomalies"),
    make_table(
        ["Anomaly", "Cause", "Features"],
        [
            ["Bochdalek hernia", "Failure of pleuroperitoneal membrane fusion", "Most common CDH (80%); left-sided in 85%; bowel/stomach in thorax → respiratory distress at birth"],
            ["Morgagni hernia", "Anterior defect", "Rare; usually right-sided; retrosternal"],
            ["Hiatus hernia", "Widened esophageal hiatus", "Sliding (90%) or rolling (para-esophageal)"],
            ["Eventration", "Poorly muscularized dome", "Thinned diaphragm, often asymptomatic"],
        ],
        col_widths=[4*cm, 5*cm, 7.5*cm],
    ),
])

# ── Q11 ───────────────────────────────────────────────────────────────────────
story += q_block(11, "Ligamentous Support and Blood Supply of Urinary Bladder", [
    section("Ligamentous Supports"),
    bullet("<b>True ligaments:</b> Pubovesical (female) / puboprostatic (male) ligaments"),
    bullet("<b>False ligaments:</b> Median umbilical ligament (urachus remnant), medial umbilical ligaments (lateral)"),
    section("Blood Supply"),
    make_table(
        ["Vessel", "Branch of", "Supply"],
        [
            ["Superior vesical artery", "Patent umbilical artery", "Superior and anterosuperior bladder"],
            ["Inferior vesical artery (male)", "Internal iliac", "Fundus and neck"],
            ["Vaginal artery (female)", "Internal iliac", "Bladder base"],
            ["Venous drainage", "Vesical plexus", "→ Internal iliac veins"],
        ],
        col_widths=[5*cm, 4.5*cm, 7*cm],
    ),
    applied("Cystectomy requires ligation of these vessels. Bladder neck obstruction by enlarged prostate is a common urological problem."),
])

# ── Q12 ───────────────────────────────────────────────────────────────────────
story += q_block(12, "Interior of Anal Canal - Applied Anatomy", [
    make_table(
        ["Feature", "Above Pectinate Line", "Below Pectinate Line"],
        [
            ["Epithelium", "Columnar (endoderm)", "Stratified squamous (ectoderm)"],
            ["Arterial supply", "Superior rectal (IMA)", "Inferior rectal (pudendal)"],
            ["Venous drainage", "Portal (superior rectal v.)", "Systemic (inferior rectal v.)"],
            ["Lymphatics", "Internal iliac nodes", "Superficial inguinal nodes"],
            ["Nerve supply", "Autonomic (insensitive to pain)", "Somatic (sensitive to pain)"],
        ],
        col_widths=[5*cm, 5.5*cm, 6*cm],
    ),
    applied("Internal hemorrhoids (above dentate — painless); external hemorrhoids (below — painful). Carcinoma above = adenocarcinoma; below = squamous cell carcinoma."),
])

# ── Q13 ───────────────────────────────────────────────────────────────────────
story += q_block(13, "Rotator Cuff Muscles - Nerve Supply and Action", [
    body("<b>Mnemonic: SITS</b>"),
    make_table(
        ["Muscle", "Origin", "Insertion", "Nerve", "Action"],
        [
            ["Supraspinatus", "Supraspinous fossa", "Greater tubercle (upper)", "Suprascapular (C5,6)", "Initiates abduction (0-15°)"],
            ["Infraspinatus", "Infraspinous fossa", "Greater tubercle (middle)", "Suprascapular (C5,6)", "Lateral rotation"],
            ["Teres minor", "Lateral border of scapula", "Greater tubercle (lower)", "Axillary (C5,6)", "Lateral rotation"],
            ["Subscapularis", "Subscapular fossa", "Lesser tubercle", "Upper + lower subscapular (C5,6,7)", "Medial rotation, adduction"],
        ],
        col_widths=[3*cm, 3.2*cm, 3.2*cm, 3.2*cm, 3.9*cm],
    ),
    applied("Supraspinatus most commonly torn (impingement under coracoacromial arch); 'painful arc' 60-120°; complete tear = inability to initiate abduction."),
])

# ── Q14 ───────────────────────────────────────────────────────────────────────
story += q_block(14, "Meniscus of Knee Joint - Parts, Attachments, Functions", [
    make_table(
        ["Feature", "Medial Meniscus", "Lateral Meniscus"],
        [
            ["Shape", "C-shaped (larger)", "More circular (O-shaped)"],
            ["Attachment", "To tibial collateral ligament (MCL)", "To popliteus"],
            ["Mobility", "Less mobile", "More mobile"],
            ["Injury frequency", "More commonly torn (4x)", "Less commonly torn"],
        ],
        col_widths=[4*cm, 6*cm, 6.5*cm],
    ),
    section("Functions"),
    bullet("Deepen tibial plateau (improve congruence with femoral condyles)"),
    bullet("Shock absorption (transmit 50-70% of load)"),
    bullet("Proprioception"),
    bullet("Lubrication and nutrition of articular cartilage"),
    bullet("Stabilization"),
    applied("McMurray and Apley tests; 'bucket-handle' tear causes locking of knee; MRI is investigation of choice."),
])

# ── Q15 ───────────────────────────────────────────────────────────────────────
story += q_block(15, "Microanatomy of Spinal Ganglion (Dorsal Root Ganglion)", [
    bullet("<b>Location:</b> Within intervertebral foramen, on dorsal root of spinal nerve"),
    bullet("<b>Neurons:</b> Pseudounipolar — single process divides into central (to dorsal horn/brain) and peripheral (to receptor) branches"),
    bullet("<b>Cell bodies:</b> Large, spherical; pale nucleus; Nissl substance (RER) in cytoplasm"),
    bullet("<b>Satellite cells:</b> Flattened cells surrounding each neuron body (modified Schwann cells) — supportive/metabolic role"),
    bullet("<b>Capsule:</b> Fibrous connective tissue"),
    applied("Herpes zoster virus (varicella-zoster) lies dormant in DRG; reactivation causes dermatomal rash and pain. Site of diabetic sensory neuropathy changes."),
])

# ── Q16 ───────────────────────────────────────────────────────────────────────
story += q_block(16, "Somites - Definition and Major Derivatives", [
    body("<b>Definition:</b> Paired, segmented blocks of paraxial mesoderm that form on either side of the neural tube during the 3rd-5th weeks of embryonic development (42-44 pairs total)."),
    make_table(
        ["Compartment", "Location", "Derivatives"],
        [
            ["Sclerotome", "Ventromedial", "Vertebrae, ribs, part of skull base"],
            ["Myotome", "Central", "Skeletal muscles of trunk and limbs (via migration)"],
            ["Dermatome", "Dorsolateral", "Dermis of dorsal skin"],
        ],
        col_widths=[4*cm, 4*cm, 8.5*cm],
    ),
    applied("Hemivertebra, butterfly vertebra from sclerotome defects. Congenital muscular defects from myotome abnormalities."),
])

# ── Q17 ───────────────────────────────────────────────────────────────────────
story += q_block(17, "Anastomosis - Definition and Types", [
    body("<b>Definition:</b> A communication between two vessels (arteries, veins, or lymphatics) that allows collateral circulation."),
    make_table(
        ["Type", "Example"],
        [
            ["Actual anastomosis", "Arterial circle of Willis, palmar arches"],
            ["Potential anastomosis", "Coronary arteries (develop collaterals with ischemia)"],
            ["End artery (no anastomosis)", "Central artery of retina, splenic arteries"],
            ["Portosystemic", "Esophageal varices, hemorrhoids"],
            ["Arteriovenous", "Arteriovenous malformations (AVMs)"],
            ["Capillary anastomosis", "Rete mirabile"],
        ],
        col_widths=[6*cm, 10.5*cm],
    ),
    applied("Anastomoses protect against ischemia if one vessel is blocked. End arteries (e.g., central retinal artery) — occlusion causes infarction."),
])

# ── Q18 ───────────────────────────────────────────────────────────────────────
story += q_block(18, "Stomach Bed - Anatomical Structures", [
    body("The stomach bed is the posterior relation of the stomach visible when the lesser sac is opened. The stomach is separated from these structures by the lesser sac (omental bursa)."),
    section("Structures Forming the Stomach Bed (from above downward)"),
    bullet("Left diaphragm"),
    bullet("Left suprarenal (adrenal) gland"),
    bullet("Upper part of left kidney"),
    bullet("Splenic artery (along upper border of pancreas)"),
    bullet("Pancreas (body and tail)"),
    bullet("Transverse mesocolon"),
    bullet("Splenic flexure of colon"),
])

# ── Q19 ───────────────────────────────────────────────────────────────────────
story += q_block(19, "Perineal Membrane in Males - Attachments, Extent, Piercing Structures", [
    body("<b>Attachments:</b> Stretched between two ischiopubic rami (inferior pubic rami); triangular membrane."),
    body("<b>Extent:</b> From perineal body posteriorly to pubic arch anteriorly."),
    section("Structures Piercing the Perineal Membrane"),
    bullet("Urethra (membranous urethra passes through it)"),
    bullet("Bulbourethral (Cowper's) gland ducts"),
    bullet("Arteries to the bulb"),
    bullet("Perineal branches of pudendal nerve"),
    applied("Rupture of bulbar urethra at this level → urine extravasation into superficial perineal pouch and scrotum (under Colles' fascia)."),
])

# ── Q20 ───────────────────────────────────────────────────────────────────────
story += q_block(20, "Microanatomy of Ileum", [
    make_table(
        ["Feature", "Ileum", "Jejunum (comparison)"],
        [
            ["Villi", "Shorter, finger-like", "Leaf-like"],
            ["Plicae circulares", "Fewer and shorter (absent distally)", "Abundant"],
            ["Goblet cells", "More numerous", "Fewer"],
            ["Peyer's patches", "Large aggregates of lymphoid follicles in submucosa", "Absent"],
            ["Wall thickness", "Thinner", "Thicker"],
            ["Vascularity", "Less; more fat in mesentery", "More vascular"],
        ],
        col_widths=[4.5*cm, 6.5*cm, 5.5*cm],
    ),
    applied("Meckel's diverticulum most common in ileum. Typhoid ulcers in Peyer's patches. Crohn's disease affects terminal ileum (skip lesions, cobblestone mucosa)."),
])

# ── Q21 ───────────────────────────────────────────────────────────────────────
story += q_block(21, "Cryptorchidism - Factors Responsible", [
    body("<b>Definition:</b> Failure of one or both testes to descend into the scrotum by 3 months of age."),
    section("Factors Responsible"),
    bullet("<b>Hormonal:</b> Inadequate testosterone or DHT (5α-reductase deficiency), low MIF, inadequate LH/HCG stimulation"),
    bullet("<b>Mechanical:</b> Short vas deferens, short spermatic vessels, adhesions along the path"),
    bullet("<b>Gubernaculum defects:</b> Abnormal development impairs descent"),
    bullet("<b>Genitofemoral nerve / CGRP deficiency:</b> Nerve guides cremasteric muscle contraction needed for descent"),
    bullet("<b>Intra-abdominal pressure:</b> Prematurity, low IAP (abdominal wall defects — prune belly)"),
    bullet("<b>Genetic:</b> Mutations in INSL3 or its receptor RXFP2"),
    applied("Increased risk of testicular cancer (40x), infertility, torsion, hernia. Orchidopexy before age 2. If bilateral cryptorchidism, rule out intersex conditions."),
])

# ── Q22 ───────────────────────────────────────────────────────────────────────
story += q_block(22, "Supination and Pronation", [
    body("<b>Supination:</b> Rotation of forearm so palm faces anteriorly/superiorly (SOUP position)."),
    body("<b>Pronation:</b> Rotation of forearm so palm faces posteriorly/inferiorly."),
    body("<b>Joints involved:</b> Superior, middle, and inferior radioulnar joints."),
    make_table(
        ["Movement", "Muscle", "Nerve"],
        [
            ["Supination", "Biceps brachii (most powerful when elbow flexed)", "Musculocutaneous (C5,6)"],
            ["Supination", "Supinator", "Posterior interosseous (C6)"],
            ["Pronation", "Pronator teres (most powerful)", "Median (C6,7)"],
            ["Pronation", "Pronator quadratus", "Anterior interosseous (C7,8)"],
        ],
        col_widths=[4*cm, 7*cm, 5.5*cm],
    ),
    applied("Pulled elbow (nursemaid's elbow) — subluxation of radial head through annular ligament in children. 'Screwdriver' motion uses supination."),
])

# ── Q23 ───────────────────────────────────────────────────────────────────────
story += q_block(23, "Trendelenburg's Sign", [
    body("<b>Purpose:</b> Tests hip abductor function (primarily gluteus medius and minimus)."),
    body("<b>Test:</b> Patient stands on one leg. Normal = opposite pelvis rises (strong abductors of standing leg). Positive (abnormal) = opposite pelvis drops."),
    body("<b>Nerve innervating abductors:</b> Superior gluteal nerve (L4, L5, S1)."),
    section("Causes of Positive Trendelenburg"),
    bullet("Superior gluteal nerve palsy"),
    bullet("Fracture of neck of femur (abductors lose fulcrum)"),
    bullet("Coxa vara (altered biomechanics)"),
    bullet("Congenital dislocation of hip (CDH)"),
    bullet("Poliomyelitis affecting L4, L5 roots"),
    bullet("Pain (antalgic — lean to affected side)"),
])

# ── Q24 ───────────────────────────────────────────────────────────────────────
story += q_block(24, "Popliteal Artery - Origin, Extent, Branches", [
    body("<b>Origin:</b> Continuation of femoral artery as it passes through adductor hiatus (opening in adductor magnus)."),
    body("<b>Extent:</b> From adductor hiatus to lower border of popliteus muscle."),
    body("<b>Relations:</b> Deepest structure in popliteal fossa (anterior); popliteal vein behind it; tibial nerve most superficial."),
    section("Branches"),
    bullet("Superior medial genicular artery"),
    bullet("Superior lateral genicular artery"),
    bullet("Middle genicular artery (pierces posterior capsule, supplies cruciate ligaments)"),
    bullet("Inferior medial genicular artery"),
    bullet("Inferior lateral genicular artery"),
    bullet("<b>Terminal:</b> Anterior tibial artery (passes through interosseous membrane) and posterior tibial artery"),
    applied("Popliteal aneurysm — most common peripheral aneurysm; can cause DVT or distal embolism. Popliteal artery injury in supracondylar fracture or posterior knee dislocation is limb-threatening."),
])

# ── Q25 ───────────────────────────────────────────────────────────────────────
story += q_block(25, "Epiphysis - Definition and Types", [
    body("<b>Definition:</b> A secondary ossification center, usually at the ends of long bones, separated from the diaphysis by the epiphyseal plate (physis) until skeletal maturity."),
    make_table(
        ["Type", "Description", "Example"],
        [
            ["Pressure epiphysis", "At joint ends; transmits weight/pressure", "Femoral head, distal femur"],
            ["Traction epiphysis (apophysis)", "At tendon attachments; transmits muscle pull; does NOT form joints", "Greater trochanter, tibial tuberosity, calcaneal tuberosity"],
            ["Atavistic epiphysis", "Represents a separate bone in ancestors", "Coracoid process, os trigonum"],
            ["Aberrant epiphysis", "Appears in wrong place", "Head (not base) of 1st metacarpal"],
        ],
        col_widths=[4*cm, 7*cm, 5.5*cm],
    ),
    applied("Growth plate fractures (Salter-Harris classification I-V); avulsion fractures at apophyses in young athletes; slipped capital femoral epiphysis (SCFE)."),
])

# ── Q26 ───────────────────────────────────────────────────────────────────────
story += q_block(26, "Microanatomy of Lymph Node", [
    make_table(
        ["Zone", "Contents", "Function"],
        [
            ["Capsule / trabeculae", "Dense fibrous CT", "Structural framework"],
            ["Cortex — primary follicles", "Naive B lymphocytes", "Resting B cells"],
            ["Cortex — secondary follicles", "Germinal centers (active B cell proliferation, somatic hypermutation) + mantle zone", "Antibody class switching, affinity maturation"],
            ["Paracortex (deep cortex)", "T lymphocytes; high endothelial venules (HEV)", "Cell-mediated immunity; lymphocyte entry"],
            ["Medullary cords", "Plasma cells, macrophages, B cells", "Antibody secretion"],
            ["Medullary sinuses", "Macrophage-lined lymph channels", "Filter lymph; phagocytosis"],
        ],
        col_widths=[4.5*cm, 7*cm, 5*cm],
    ),
    body("<b>Lymph flow:</b> Afferent lymphatics → subcapsular sinus → cortical sinuses → medullary sinuses → efferent lymphatic (at hilum)."),
    applied("Reed-Sternberg cells in Hodgkin's lymphoma destroy architecture. Lymph node dissection important in cancer staging."),
])

# ── Q27 ───────────────────────────────────────────────────────────────────────
story += q_block(27, "Implantation - Normal and Abnormal Sites", [
    body("<b>Normal site:</b> Posterior wall of body of uterus (upper part), slightly to the right of midline (days 6-10 post-fertilization)."),
    make_table(
        ["Ectopic Site", "Frequency", "Notes"],
        [
            ["Ampulla of fallopian tube", "~70%", "Most common ectopic"],
            ["Isthmus", "~12%", "Ruptures earlier (narrower)"],
            ["Fimbriae", "~11%", ""],
            ["Interstitial (cornual)", "~2%", "Most dangerous; ruptures late with massive hemorrhage"],
            ["Ovarian", "Rare", ""],
            ["Cervical", "Rare", "Risk of massive hemorrhage with D&C"],
            ["Abdominal", "Very rare", "Can go to term; placenta on bowel/liver"],
        ],
        col_widths=[5*cm, 3*cm, 8.5*cm],
    ),
    applied("Risk factors: PID, previous ectopic, IUD, tubal surgery. Diagnosis: beta-hCG + transvaginal USS. Treatment: methotrexate (medical) or salpingectomy (surgical)."),
])

# ── Q28 ───────────────────────────────────────────────────────────────────────
story += q_block(28, "Positions of Appendix and Arterial Supply", [
    make_table(
        ["Position", "Frequency"],
        [
            ["Retrocaecal", "65-70% (most common)"],
            ["Pelvic/Descending", "25-30%"],
            ["Paracaecal", "Uncommon"],
            ["Preileal", "Uncommon"],
            ["Postileal", "Uncommon"],
            ["Subcaecal", "Rare"],
        ],
        col_widths=[7*cm, 9.5*cm],
    ),
    body("<b>Arterial supply:</b> Appendicular artery — branch of ileocolic artery (from superior mesenteric artery); runs in mesoappendix."),
    applied("Retrocaecal appendicitis = atypical presentation (no peritoneal signs; tenderness in flank; psoas sign positive). Pelvic appendicitis = diarrhoea, urinary symptoms."),
])

# ── Q29 ───────────────────────────────────────────────────────────────────────
story += q_block(29, "Bare Area of Liver", [
    body("<b>Definition:</b> An area on the posterior/superior surface of the right lobe of the liver NOT covered by peritoneum; directly in contact with the diaphragm."),
    section("Boundaries"),
    bullet("Superiorly: Superior layer of coronary ligament"),
    bullet("Inferiorly: Inferior layer of coronary ligament"),
    bullet("Right side: Right triangular ligament (where two layers meet)"),
    bullet("Left side: Inferior vena cava"),
    applied("Direct lymphatic communication between liver and thorax. Right pleural effusion in liver disease (hepatic hydrothorax) via this route. Amoebic liver abscess can rupture into pleural cavity or lung through bare area. Site of direct spread for hepatocellular carcinoma to diaphragm."),
])

# ── Q30 ───────────────────────────────────────────────────────────────────────
story += q_block(30, "Ischiorectal Fossa - Boundaries and Contents", [
    make_table(
        ["Wall", "Structure"],
        [
            ["Medially", "External anal sphincter + levator ani"],
            ["Laterally", "Obturator internus + ischial tuberosity"],
            ["Posteriorly", "Sacrotuberous ligament + gluteus maximus"],
            ["Anteriorly", "Perineal body (posterior surface of perineal membrane)"],
            ["Floor", "Skin of perineum"],
        ],
        col_widths=[4*cm, 12.5*cm],
    ),
    section("Contents"),
    bullet("Fat (ischioanal fat pad)"),
    bullet("Inferior rectal vessels and nerves (branches of internal pudendal)"),
    bullet("Perineal branch of S4"),
    bullet("<b>Pudendal canal (Alcock's canal)</b> in lateral wall — contains internal pudendal artery, vein, pudendal nerve"),
    applied("Ischiorectal abscess (most common perianal abscess) — can track to opposite side forming horseshoe abscess. Pudendal nerve block — anesthesia via this fossa."),
])

# ── Q31 ───────────────────────────────────────────────────────────────────────
story += q_block(31, "Coronal Section of Kidney - Macroscopic Features", [
    section("Zones on Coronal Section"),
    make_table(
        ["Zone", "Features"],
        [
            ["Cortex", "Outer reddish-brown zone; contains glomeruli, PCT and DCT; divided into cortical labyrinth and medullary rays"],
            ["Medulla", "Inner pale zone; 8-18 pyramids; apex = renal papilla (projects into minor calyx); base faces cortex"],
            ["Columns of Bertin", "Inward extensions of cortex between pyramids"],
            ["Renal sinus", "Central fatty space containing: pelvis, major calyces (2-3), minor calyces (8-12), renal vessels, nerves, lymphatics, fat"],
        ],
        col_widths=[4.5*cm, 12*cm],
    ),
    body("<b>Blood supply:</b> Renal artery → segmental arteries (5, end arteries) → interlobar → arcuate → interlobular → afferent arterioles → glomerulus."),
    applied("Hydronephrosis causes cortical thinning. Renal stones at PUJ, brim of pelvis, VUJ. Nephrectomy planes through columns of Bertin."),
])

# ── Q32 ───────────────────────────────────────────────────────────────────────
story += q_block(32, "Development of Pancreas and Annular Pancreas", [
    section("Development"),
    make_table(
        ["Bud", "Size", "Gives rise to", "Duct"],
        [
            ["Dorsal", "Larger", "Body, tail, superior part of head", "Accessory duct of Santorini"],
            ["Ventral", "Smaller", "Uncinate process and inferior head", "Main duct of Wirsung"],
        ],
        col_widths=[3*cm, 2.5*cm, 6*cm, 5*cm],
    ),
    body("At week 6, the ventral bud rotates clockwise with the duodenum and fuses posteriorly with the dorsal bud. The duct of Wirsung becomes the main pancreatic duct."),
    section("Annular Pancreas"),
    bullet("<b>Cause:</b> Bifid ventral bud or failure of rotation; both parts wrap around duodenum forming a ring"),
    bullet("<b>Encircles:</b> 2nd part of duodenum → duodenal obstruction"),
    bullet("<b>Presentation:</b> Neonates (bilious vomiting) or adults (peptic ulcer, pancreatitis)"),
    bullet("<b>X-ray:</b> 'Double bubble' sign"),
    bullet("<b>Treatment:</b> Duodenoduodenostomy (bypass — NOT division of ring)"),
])

# ── Q33 ───────────────────────────────────────────────────────────────────────
story += q_block(33, "Microanatomy of Suprarenal (Adrenal) Gland", [
    section("Cortex — 3 Zones (GFR)"),
    make_table(
        ["Zone", "Histology", "Hormone"],
        [
            ["Zona Glomerulosa", "Clusters/arches; small cells; few lipid droplets", "Aldosterone (mineralocorticoid)"],
            ["Zona Fasciculata", "Long parallel cords; large pale 'spongiocytes' (lipid-laden, foamy)", "Cortisol, corticosterone (glucocorticoids)"],
            ["Zona Reticularis", "Network of irregular cords; small dark cells; lipofuscin pigment", "Androgens (DHEA, androstenedione)"],
        ],
        col_widths=[4*cm, 7*cm, 5.5*cm],
    ),
    section("Medulla"),
    bullet("Modified sympathetic postganglionic neurons (chromaffin cells)"),
    bullet("Large polygonal cells; basophilic cytoplasm; brown with chromium salts (chromaffin reaction)"),
    bullet("Produce epinephrine (80%) and norepinephrine (20%)"),
    bullet("Sustentacular cells support chromaffin cells"),
    applied("Conn's syndrome (glomerulosa adenoma → hyperaldosteronism); Cushing's syndrome (fasciculata); CAH; Pheochromocytoma (medulla)."),
])

# ── Q34 ───────────────────────────────────────────────────────────────────────
story += q_block(34, "Popliteal Fossa - Boundaries and Contents", [
    make_table(
        ["Boundary", "Structure"],
        [
            ["Superolateral", "Biceps femoris"],
            ["Superomedial", "Semimembranosus + semitendinosus"],
            ["Inferolateral", "Lateral head of gastrocnemius"],
            ["Inferomedial", "Medial head of gastrocnemius"],
            ["Roof", "Skin + popliteal fascia (pierced by small saphenous vein)"],
            ["Floor", "Popliteal surface of femur, capsule of knee joint, popliteus with its fascia"],
        ],
        col_widths=[4.5*cm, 12*cm],
    ),
    section("Contents (lateral to medial)"),
    bullet("<b>Tibial nerve</b> (most superficial/posterior)"),
    bullet("<b>Popliteal vein</b> (middle)"),
    bullet("<b>Popliteal artery</b> (deepest/anterior)"),
    bullet("Common peroneal (fibular) nerve — along biceps femoris tendon"),
    bullet("Short saphenous vein, popliteal lymph nodes, fat"),
    applied("Popliteal cyst (Baker's cyst) in bursa behind medial head of gastrocnemius. Common peroneal nerve injury at fibular neck → foot drop."),
])

# ── Q35 ───────────────────────────────────────────────────────────────────────
story += q_block(35, "Stages of Spermatogenesis", [
    body("Location: Seminiferous tubules (takes 74 days total)."),
    make_table(
        ["Stage", "Ploidy", "Notes"],
        [
            ["Type A spermatogonia", "2n", "Stem cells; mitosis"],
            ["Type B spermatogonia", "2n", "Committed to differentiation"],
            ["Primary spermatocytes", "2n", "Largest; undergo meiosis I (~22 days; prophase I longest)"],
            ["Secondary spermatocytes", "1n", "Short-lived; undergo meiosis II quickly"],
            ["Spermatids", "1n", "Round → elongated via spermiogenesis"],
            ["Spermatozoa", "1n", "Released into tubule lumen (spermiation)"],
        ],
        col_widths=[5*cm, 2.5*cm, 9*cm],
    ),
    body("<b>Spermiogenesis phases:</b> Golgi → Cap → Acrosomal → Maturation. Acrosome forms from Golgi (hydrolytic enzymes for zona pellucida). Flagellum from centriole."),
    body("<b>Sertoli cells:</b> Blood-testis barrier; secrete ABP, inhibin; support spermatids."),
    applied("Azoospermia; heat effects (cryptorchidism impairs spermatogenesis); chemotherapy effects; testicular biopsy in infertility workup."),
])

# ── Q36 ───────────────────────────────────────────────────────────────────────
story += q_block(36, "Flexor Retinaculum of Wrist - Anatomy and Applied Aspects", [
    body("<b>Attachments:</b> Medially: pisiform and hook of hamate. Laterally: scaphoid tubercle and trapezium ridge."),
    section("Structures Through Carpal Tunnel (deep to retinaculum)"),
    bullet("4 tendons of flexor digitorum superficialis (in 2 rows)"),
    bullet("4 tendons of flexor digitorum profundus"),
    bullet("Flexor pollicis longus tendon"),
    bullet("<b>Median nerve</b> (most important — superficial and radial)"),
    section("Structures Superficial to Retinaculum (NOT in carpal tunnel)"),
    bullet("Ulnar nerve and vessels (in Guyon's canal — separate)"),
    bullet("Flexor carpi ulnaris, palmaris longus"),
    section("Carpal Tunnel Syndrome"),
    bullet("Compression of median nerve within carpal tunnel"),
    bullet("Symptoms: Numbness/tingling in lateral 3.5 fingers, thenar wasting, weak pinch"),
    bullet("Phalen's test (wrist flexion) and Tinel's sign (percussion over tunnel)"),
    bullet("Treatment: Splinting, steroid injection, surgical decompression (division of retinaculum)"),
    applied("Common causes: pregnancy, hypothyroidism, rheumatoid arthritis, acromegaly."),
])

# ── Q37 ───────────────────────────────────────────────────────────────────────
story += q_block(37, "Parts of Long Bone and Blood Supply", [
    make_table(
        ["Part", "Description"],
        [
            ["Epiphysis", "End of bone; articular cartilage; secondary ossification center"],
            ["Physis (epiphyseal plate)", "Growth plate cartilage; zone of proliferating chondrocytes"],
            ["Metaphysis", "Flared region between physis and diaphysis; rich blood supply; site of osteosarcoma, osteomyelitis"],
            ["Diaphysis", "Shaft; thick cortical bone; yellow marrow (fat) in adults"],
            ["Periosteum", "Outer fibrous + inner osteogenic layer; Volkmann's canals"],
            ["Endosteum", "Lines medullary cavity; contains osteoprogenitor cells"],
        ],
        col_widths=[4.5*cm, 12*cm],
    ),
    section("Blood Supply"),
    make_table(
        ["Vessel", "Supply"],
        [
            ["Nutrient artery (main)", "Enters at nutrient foramen of diaphysis; supplies medullary cavity and inner 2/3 of cortex"],
            ["Metaphyseal arteries", "From periarticular plexus; supply metaphysis"],
            ["Epiphyseal arteries", "Separate in children (separated by growth plate); same as metaphyseal in adults"],
            ["Periosteal arteries", "Supply outer 1/3 of cortex"],
        ],
        col_widths=[4.5*cm, 12*cm],
    ),
    applied("Avascular necrosis if epiphyseal supply disrupted (femoral head after neck fracture). Osteomyelitis seeds in metaphysis (rich, sluggish capillary loops)."),
])

# ── Q38 ───────────────────────────────────────────────────────────────────────
story += q_block(38, "Locking and Unlocking of Knee Joint", [
    section("Locking (Terminal/Screw-Home Mechanism)"),
    bullet("Occurs in final 20-30° of full extension"),
    bullet("Lateral femoral condyle is shorter than medial; when lateral finishes its arc, medial condyle continues rotating"),
    bullet("Result: Femur rotates medially on tibia (open-chain) or tibia rotates laterally on femur (closed-chain)"),
    bullet("Cruciate ligaments, collateral ligaments and menisci all become taut → stable locked position"),
    bullet("No muscular effort needed to maintain full extension (efficient standing)"),
    section("Unlocking"),
    bullet("Must occur before flexion can begin"),
    bullet("<b>Popliteus</b> muscle is the 'key' — laterally rotates femur on tibia, unlocking the joint"),
    bullet("Nerve supply of popliteus: Tibial nerve (L4, L5, S1)"),
    applied("Inability to unlock = popliteus tear or meniscal impingement. Bucket-handle meniscal tear can prevent locking (joint locks in flexion)."),
])

# ── Q39 ───────────────────────────────────────────────────────────────────────
story += q_block(39, "Microanatomy of Hyaline Cartilage", [
    make_table(
        ["Component", "Description"],
        [
            ["Matrix", "Basophilic (sulfated proteoglycans — chondroitin sulfate); homogeneous; type II collagen (invisible in routine staining)"],
            ["Chondrocytes", "Lie in lacunae; in deep zone form isogenous groups (cell nests) — daughter cells from mitosis remain together"],
            ["Territorial matrix", "Basophilic halo immediately around cell nests (more proteoglycan)"],
            ["Interterritorial matrix", "Between cell nests (less basophilic; more collagen)"],
            ["Chondroblasts", "Flattened, at periphery under perichondrium"],
            ["Perichondrium", "Inner chondrogenic layer + outer fibrous layer (NOT present on articular cartilage)"],
        ],
        col_widths=[4.5*cm, 12*cm],
    ),
    body("<b>Special stain:</b> Alcian blue stains proteoglycans."),
    body("<b>Locations:</b> Articular surfaces, costal cartilages, trachea/bronchi, larynx, nasal septum, fetal skeleton."),
    applied("Osteoarthritis = destruction of hyaline articular cartilage. Does not regenerate (avascular, aneural); replaced by fibrocartilage after injury."),
])

# ── Q40 ───────────────────────────────────────────────────────────────────────
story += q_block(40, "Microanatomy of Testis", [
    body("<b>Capsule:</b> Tunica albuginea (dense CT); thickened posteriorly as mediastinum testis; septa divide testis into ~250 lobules."),
    section("Seminiferous Tubules"),
    make_table(
        ["Cell Type", "Features", "Function"],
        [
            ["Sertoli cells", "Tall columnar; pale oval nuclei; prominent nucleoli; extend from basement membrane to lumen", "Blood-testis barrier (tight junctions); support spermatogenesis; phagocytose residual bodies; secrete ABP, inhibin"],
            ["Spermatogenic cells", "Progressive layers: spermatogonia → primary spermatocytes → secondary spermatocytes → spermatids → spermatozoa", "Sperm production"],
        ],
        col_widths=[3.5*cm, 6.5*cm, 6.5*cm],
    ),
    section("Interstitium"),
    bullet("<b>Leydig cells:</b> Large, polygonal; eosinophilic granular cytoplasm; crystals of Reinke (eosinophilic rod-shaped); produce testosterone"),
    bullet("Blood/lymph vessels, macrophages, loose CT"),
    body("<b>Path of sperm:</b> Seminiferous tubules → tubuli recti → rete testis (in mediastinum) → efferent ductules → epididymis → vas deferens."),
    applied("Leydig cell tumor → precocious puberty. Sertoli cell-only syndrome (Del Castillo) → azoospermia. Testicular torsion affects blood supply."),
])

# ── Q41 ───────────────────────────────────────────────────────────────────────
story += q_block(41, "Boundaries and Contents of Deep Perineal Pouch", [
    section("Boundaries"),
    bullet("Superior wall: Superior fascia of urogenital diaphragm"),
    bullet("Inferior wall: Perineal membrane (inferior fascia of UG diaphragm)"),
    bullet("Lateral: Ischiopubic rami"),
    make_table(
        ["Structure", "Male", "Female"],
        [
            ["Muscles", "Deep transverse perineal muscle; sphincter urethrae (external urethral sphincter)", "Deep transverse perineal muscle; sphincter urethrae"],
            ["Urethra/vagina", "Membranous urethra", "Urethra and vagina"],
            ["Glands", "Bulbourethral (Cowper's) glands", "Bartholin's glands (actually superficial pouch in females)"],
            ["Neurovascular", "Internal pudendal vessels; dorsal nerve of penis", "Internal pudendal vessels; dorsal nerve of clitoris"],
        ],
        col_widths=[4*cm, 6.5*cm, 6*cm],
    ),
    applied("Deep space infections can spread superiorly into pelvis (no inferior barrier). Bulbourethral gland cysts; urethral injuries."),
])

# ── Q42 ───────────────────────────────────────────────────────────────────────
story += q_block(42, "Blood Supply and Lymphatic Drainage of Stomach", [
    section("Arterial Supply (all branches from celiac axis)"),
    make_table(
        ["Region", "Artery", "Source"],
        [
            ["Lesser curvature", "Left gastric artery", "Celiac trunk (directly)"],
            ["Lesser curvature", "Right gastric artery", "Hepatic proper artery"],
            ["Greater curvature", "Left gastroepiploic artery", "Splenic artery"],
            ["Greater curvature", "Right gastroepiploic artery", "Gastroduodenal artery"],
            ["Fundus", "Short gastric arteries (4-5)", "Splenic artery"],
            ["Posterior wall", "Posterior gastric artery (variable)", "Splenic artery"],
        ],
        col_widths=[4*cm, 6*cm, 6.5*cm],
    ),
    section("Lymphatic Drainage (4 zones → all to celiac nodes → thoracic duct)"),
    bullet("Upper right → hepatic/pyloric nodes → celiac nodes"),
    bullet("Upper left → pancreaticosplenic nodes → celiac nodes"),
    bullet("Lower right → subpyloric/hepatic nodes → celiac nodes"),
    bullet("Lower left → pancreaticosplenic nodes → celiac nodes"),
    applied("Gastric carcinoma spreads to Virchow's node (left supraclavicular), liver via portal vein. Krukenberg tumors (ovarian mets); Sister Mary Joseph nodule (umbilical)."),
])

# ── Q43 ───────────────────────────────────────────────────────────────────────
story += q_block(43, "Stages in Rotation of Midgut and Anomalies", [
    body("<b>Total rotation: 270° counterclockwise</b> around the superior mesenteric artery axis."),
    make_table(
        ["Week", "Event"],
        [
            ["Week 6", "Midgut herniates into umbilical cord (physiological herniation) due to rapidly growing liver"],
            ["Weeks 6-10", "Pre-arterial limb rotates 90° counterclockwise (duodenum moves right → posterior)"],
            ["Week 10", "Gut returns to abdominal cavity"],
            ["Weeks 10-12", "Further 180° counterclockwise rotation; cecum descends from epigastrium to right iliac fossa"],
        ],
        col_widths=[3*cm, 13.5*cm],
    ),
    section("Anomalies"),
    make_table(
        ["Anomaly", "Cause", "Features"],
        [
            ["Non-rotation", "No rotation", "Small bowel on right, colon on left"],
            ["Malrotation", "Incomplete 270°", "Cecum at epigastrium; Ladd's bands across duodenum"],
            ["Volvulus", "Complication of malrotation", "Midgut twists on SMA pedicle; ischemia; bilious vomiting in neonate"],
            ["Reversed rotation", "Clockwise rotation", "Transverse colon behind SMA"],
            ["Omphalocele", "Failure of return", "Gut covered by peritoneum in umbilical cord"],
            ["Gastroschisis", "Paraumbilical defect", "Gut NOT covered by peritoneum; lateral to umbilicus"],
        ],
        col_widths=[4*cm, 4.5*cm, 8*cm],
    ),
])

# ── Q44 ───────────────────────────────────────────────────────────────────────
story += q_block(44, "Supports of Uterus - Applied Anatomy", [
    make_table(
        ["Level", "Support", "Details"],
        [
            ["Level I (Primary)", "Cardinal (Mackenrodt's) ligament", "Most important; runs from cervix to lateral pelvic wall; contains uterine artery"],
            ["Level I (Primary)", "Uterosacral ligaments", "Cervix to sacrum; important in vault prolapse repair"],
            ["Level II", "Pubocervical fascia", "Cervix to pubis; supports bladder base"],
            ["Level III (Pelvic floor)", "Levator ani (pubococcygeus, iliococcygeus, puborectalis)", "Most important muscular support"],
            ["Level III", "Perineal body", "Central perineal support"],
        ],
        col_widths=[4*cm, 5.5*cm, 7*cm],
    ),
    section("Peritoneal Folds (NOT true supports)"),
    bullet("Broad ligament: Does NOT support uterus"),
    bullet("Round ligament: Maintains anteversion; not a major support"),
    applied("Prolapse occurs when supports fail (multiparity, menopause, raised IAP). Cardinal + uterosacral most important; levator ani torn in childbirth. Uterine artery in cardinal ligament is at risk during hysterectomy — ureter is 1.5 cm lateral ('water under the bridge')."),
])

# ── Q45 ───────────────────────────────────────────────────────────────────────
story += q_block(45, "Portosystemic Anastomosis - Applied Anatomy", [
    body("<b>Definition:</b> Sites where portal venous system communicates with systemic venous system."),
    make_table(
        ["Site", "Portal Vessel", "Systemic Vessel", "Clinical Significance"],
        [
            ["Lower esophagus", "Left gastric (coronary) v.", "Azygos/hemiazygos", "Esophageal varices (most dangerous — fatal hemorrhage)"],
            ["Anal canal (above pectinate line)", "Superior rectal v. (IMV)", "Middle + inferior rectal v. (iliac)", "Hemorrhoids"],
            ["Umbilicus", "Para-umbilical veins (in falciform ligament)", "Superficial epigastric veins", "Caput medusae"],
            ["Retroperitoneum", "Veins of colon, liver, spleen", "Posterior abdominal wall veins", "Retroperitoneal varices"],
            ["Bare area of liver", "Hepatic sinusoids", "Diaphragmatic veins", "Small shunts"],
        ],
        col_widths=[3.5*cm, 4*cm, 4.5*cm, 4.5*cm],
    ),
    applied("Portal hypertension (cirrhosis, Budd-Chiari, portal vein thrombosis) causes dilatation of anastomoses. Esophageal varices: sclerotherapy, band ligation, TIPSS. TIPS creates artificial portosystemic shunt in liver."),
])

# ─────────────────────────────────────────────────────────────────────────────
# Build Document
# ─────────────────────────────────────────────────────────────────────────────
import os
os.makedirs("/tmp/workspace/anatomy_pdf", exist_ok=True)

doc = SimpleDocTemplate(
    OUTPUT,
    pagesize=A4,
    rightMargin=2*cm,
    leftMargin=2*cm,
    topMargin=2*cm,
    bottomMargin=2*cm,
    title="45 Anatomy Questions & Answers",
    author="Anatomy Study Reference",
)

def on_page(canvas, doc):
    """Header and footer on each page."""
    canvas.saveState()
    w, h = A4
    # Footer
    canvas.setFont("Helvetica", 8)
    canvas.setFillColor(colors.HexColor("#888888"))
    canvas.drawString(2*cm, 1.2*cm, "Anatomy — 45 Comprehensive Questions & Answers")
    canvas.drawRightString(w - 2*cm, 1.2*cm, f"Page {doc.page}")
    # Top line
    canvas.setStrokeColor(colors.HexColor("#1a3c6e"))
    canvas.setLineWidth(1)
    canvas.line(2*cm, h - 1.5*cm, w - 2*cm, h - 1.5*cm)
    canvas.restoreState()

doc.build(story, onFirstPage=on_page, onLaterPages=on_page)
print(f"PDF saved to: {OUTPUT}")