# -*- coding: utf-8 -*-
from reportlab.lib.pagesizes import A4
from reportlab.lib.units import cm
from reportlab.lib.styles import getSampleStyleSheet, ParagraphStyle
from reportlab.lib.enums import TA_CENTER
from reportlab.platypus import SimpleDocTemplate, Paragraph, Spacer, PageBreak
from reportlab.lib import colors

doc = SimpleDocTemplate(
    "/tmp/workspace/reasoning-anat/output/Reasoning_Anatomy_Answers.pdf",
    pagesize=A4,
    topMargin=1.5*cm, bottomMargin=1.5*cm, leftMargin=1.8*cm, rightMargin=1.8*cm,
    title="Reasoning Anatomy - Answers"
)

styles = getSampleStyleSheet()

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section_style = ParagraphStyle('SectionStyle', parent=styles['Heading1'], fontSize=16, spaceBefore=18, spaceAfter=10, textColor=colors.HexColor("#0b3d91"), borderPadding=0)
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story = []
story.append(Paragraph("Reasoning Anatomy - Answers", title_style))
story.append(Paragraph("Reference: Vishram Singh, Gray's Anatomy, BD Chaurasia (Textbooks of Anatomy)", subtitle_style))

def add_section(title, qa_list):
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    for num, q, a in qa_list:
        text = f"<b>{num}. {q}</b><br/>{a}"
        story.append(Paragraph(text, qnum_style))

# ---------------- LOWER LIMB ----------------
lower_limb = [
(1, "Anatomical basis of Trendelenburg's sign and gait",
 "Gluteus medius and minimus normally hold the pelvis level when standing on one leg. If these muscles are weak or paralysed (superior gluteal nerve injury, hip dislocation, coxa vara), the pelvis on the opposite (non-standing) side drops when the patient stands on the affected leg &ndash; a positive Trendelenburg sign. Bilateral weakness produces a waddling Trendelenburg gait."),
(2, "Anatomical basis of Trendelenburg's test",
 "The test checks the same mechanism: normally the opposite side of pelvis rises when standing on one leg (gluteus medius/minimus of the standing leg contract). If it falls instead, the test is positive, indicating gluteal abductor weakness or hip instability."),
(3, "Anatomical basis of foot drop",
 "Injury to the common peroneal (fibular) nerve or its deep branch paralyses the anterior compartment muscles (tibialis anterior, extensor digitorum/hallucis longus) that dorsiflex the foot. Unopposed plantarflexors let the foot drop at the ankle."),
(4, "Femoral hernia is more common in females",
 "Women have a wider pelvis, hence a wider and more oval femoral ring/canal, with relatively less fat filling it. Pregnancy also weakens pelvic connective tissue, making herniation through the femoral canal easier."),
(5, "Anatomical basis of Varicose veins",
 "Due to incompetent valves in the great/small saphenous veins and their perforators. Once a valve fails, gravity causes retrograde blood flow and pooling, worsened by prolonged standing, obesity, or pregnancy raising intra-abdominal pressure on the iliac veins."),
(6, "Medial meniscus tear more common than lateral meniscus tear",
 "The medial meniscus is larger, more C-shaped, and firmly fixed to the tibial (medial) collateral ligament and joint capsule, so it cannot move out of the way during twisting injuries &ndash; making it more prone to tearing than the more mobile lateral meniscus."),
(7, "Soleus muscle is referred to as \"Peripheral Heart\"",
 "The soleus contains a rich network of valved venous sinuses. Its rhythmic contraction during walking squeezes venous blood upward toward the heart, acting as a secondary pump for venous return from the leg."),
(8, "High stepping gait",
 "A compensatory mechanism for foot drop &ndash; the patient lifts the leg unusually high (extra hip and knee flexion) so the dropped foot/toes clear the ground while walking."),
(9, "Anatomical basis of flat foot",
 "Results from weakness of the muscles and ligaments supporting the medial longitudinal arch &ndash; mainly tibialis posterior, spring (calcaneonavicular) ligament, and plantar aponeurosis &ndash; causing the arch to collapse."),
(10, "Intramuscular injection given in upper outer quadrant of gluteal region",
 "This quadrant overlies gluteus medius and is safely away from the sciatic nerve and superior gluteal vessels, which run in the lower/inner parts of the region."),
(11, "Piriformis muscle referred to as key muscle of gluteal region",
 "It divides the greater sciatic foramen into a space above it (superior gluteal vessels/nerve) and below it (sciatic nerve, inferior gluteal vessels, pudendal nerve, posterior cutaneous nerve of thigh, nerve to obturator internus). Knowing piriformis lets you locate every major structure in the region."),
(12, "Avascular necrosis of head of femur following fracture neck of femur",
 "The femoral head's blood supply mainly comes from retinacular vessels (branches of the medial circumflex femoral artery) running along the femoral neck under the capsule. A neck fracture tears these vessels, and the artery in the ligamentum teres is usually inadequate to sustain the head &ndash; leading to avascular necrosis."),
(13, "Disease of knee joint - pain referred to hip joint and vice versa",
 "Both joints share nerve supply from the femoral and obturator nerves (Hilton's Law &ndash; the nerve supplying a joint also supplies the muscles moving it and skin over it). This shared innervation causes pain from one joint to be felt at the other."),
(14, "Anatomical basis of Housemaid's and Clergyman's knee",
 "Both are bursitis from kneeling. Housemaid's knee = prepatellar bursitis (kneeling upright, as when scrubbing floors). Clergyman's knee = infrapatellar bursitis (kneeling with trunk bent forward, as in prayer). Different kneeling postures stress different bursae."),
(15, "Anatomical basis of Psoas abscess",
 "Tuberculous infection of the thoracolumbar vertebrae (Pott's disease) forms pus that tracks down within the fascial sheath of psoas major (which arises from T12-L5 vertebrae), presenting as a swelling below the inguinal ligament or in the thigh."),
(16, "Anatomical basis of Sciatica",
 "Compression or irritation of the sciatic nerve roots (L4-S3), commonly from a prolapsed lumbar disc or piriformis syndrome, causing pain radiating along the nerve's course &ndash; buttock, back of thigh, and leg."),
(17, "Anatomical basis of Venesection in Great saphenous vein",
 "Performed just anterior to the medial malleolus because the vein is constant in position there (anchored by fascia) and superficial, making it accessible even when peripheral veins have collapsed in shock."),
(18, "Popliteus muscle helps in unlocking of knee joint",
 "At full extension the knee \"locks\" via the screw-home mechanism (medial rotation of femur on tibia). Popliteus laterally rotates the femur on the tibia (unlocking it), which must happen before flexion can begin."),
(19, "Femoral nerve is not a content of femoral sheath",
 "The femoral sheath (formed by fascia transversalis and fascia iliaca) only encloses the femoral artery, vein, and femoral canal. The femoral nerve lies outside and lateral to the sheath because it descends in the groove between psoas and iliacus, covered by iliac fascia but not drawn into the sheath."),
(20, "Anatomical basis of sleeping foot",
 "Caused by pressure on the common peroneal nerve where it winds superficially around the neck of the fibula &ndash; easily compressed against bone during prolonged cross-legged sitting or squatting, causing tingling/numbness."),
(21, "Dislocation of hip joint is less common than shoulder dislocation",
 "The hip is a deep ball-and-socket joint &ndash; the acetabulum is deep (further deepened by the labrum), reinforced by strong ligaments (iliofemoral, pubofemoral, ischiofemoral) and thick surrounding muscles. The shoulder's glenoid cavity is shallow by comparison, sacrificing stability for mobility."),
(22, "Which nerve is called nervus hesitans and why?",
 "The deep peroneal (fibular) nerve. It is called \"hesitant\" because of its winding course in the leg &ndash; it crosses the anterior tibial vessels first from lateral to anterior, then anterior to medial, giving it a zig-zag, hesitant path down to the ankle."),
]

# ---------------- THORAX ----------------
thorax = [
(1, "Anatomical basis of Thoracic inlet syndrome",
 "Compression of the brachial plexus and subclavian vessels as they pass through the narrow space bounded by the clavicle, first rib, and scalene muscles &ndash; often aggravated by a cervical rib &ndash; causing arm pain, paraesthesia, or vascular symptoms."),
(2, "Anatomical basis of hiccups",
 "Sudden, involuntary spasm of the diaphragm against a closed glottis, triggered by irritation of the phrenic nerve (C3-C5) or vagus nerve anywhere along their course &ndash; gastric distension, mediastinal disease, or diaphragmatic irritation are common causes."),
(3, "Anatomical basis of congenital diaphragmatic hernia",
 "Failure of the pleuroperitoneal membrane to fuse properly with the septum transversum and body wall during development, most often on the left (foramen of Bochdalek), allowing abdominal organs to herniate into the thorax."),
(4, "Anatomical basis of symptoms of cervical rib",
 "An extra rib from C7 compresses the lower trunk of the brachial plexus (C8, T1) and the subclavian artery, producing pain/numbness along the medial forearm and hand plus diminished pulse or ischemic symptoms in the limb."),
(5, "Lung abscess more commonly affects right lung",
 "The right main bronchus is wider, shorter, and more vertical &ndash; almost a direct continuation of the trachea &ndash; so aspirated material (pus, infected secretions) preferentially enters the right bronchial tree, usually settling in the lower lobe."),
(6, "Foreign body more commonly lodges in lower lobe of right lung",
 "Same reasoning &ndash; the wide, short, more vertical right main bronchus directs inhaled foreign bodies preferentially into the right lower lobe."),
(7, "Thoracocentesis - needle inserted in midaxillary line through lower part of 6th intercostal space",
 "Needle is inserted just above the upper border of the rib below, to avoid the neurovascular bundle that runs in the costal groove along the lower border of the rib above. This level and line avoid the diaphragm and major vessels/nerves while accessing the pleural cavity."),
(8, "Metaplasia is more common at lower end of esophagus",
 "Chronic acid reflux (GERD) at the gastroesophageal junction causes the normal squamous epithelium to transform into columnar epithelium (Barrett's esophagus) as an adaptive but pre-malignant response to repeated acid injury."),
(9, "Aspiration pneumonia more common in lower lobe of right lung",
 "Same anatomical reasoning &ndash; the wide, short, vertical right main bronchus (in line with the trachea) directs aspirated material, especially in supine patients, preferentially into the right lower lobe."),
(10, "Wall of left ventricle is 3 times thicker than the right ventricle",
 "The left ventricle pumps against the high resistance of the systemic circulation (~120 mmHg), while the right ventricle pumps into the low-resistance pulmonary circuit (~25 mmHg) &ndash; hence it needs far more muscle mass."),
(11, "Which artery is called the Widow's artery and its anatomical basis",
 "The left anterior descending (LAD) coronary artery. It supplies most of the anterior left ventricular wall and interventricular septum, so sudden blockage causes a large, often fatal infarct &ndash; earning it the name \"widow-maker.\""),
(12, "Anatomical basis of Pancoast tumor (syndrome)",
 "A lung apex (superior sulcus) tumor invades nearby structures because of their close proximity at the thoracic inlet &ndash; the sympathetic chain/stellate ganglion (causing Horner's syndrome: ptosis, miosis, anhidrosis), the brachial plexus lower trunk (arm pain/weakness), and subclavian vessels."),
(13, "Embryological basis of pain nature of parietal and visceral pleura",
 "Parietal pleura develops from somatic mesoderm and is supplied by somatic nerves (intercostal, phrenic), making it pain-sensitive. Visceral pleura develops from splanchnic mesoderm with only autonomic supply, so it is insensitive to pain, only to stretch."),
(14, "In mitral stenosis, patient presents with dysphagia",
 "Mitral stenosis causes the left atrium to enlarge; since the esophagus runs directly behind the left atrium in the mediastinum, an enlarged atrium compresses it, causing difficulty swallowing."),
]

# ---------------- ABDOMEN ----------------
abdomen = [
(1, "Deep fascia is absent in anterior abdominal wall",
 "So the wall can expand freely &ndash; for pregnancy, obesity, after meals, or ascites &ndash; which a restrictive deep fascia layer would prevent."),
(2, "Indirect inguinal hernia more common in male children",
 "It occurs through a persistent processus vaginalis, the peritoneal outpouching that guides testicular descent &ndash; a structure present only in males, since the testis (not the ovary) has to travel through the inguinal canal into the scrotum."),
(3, "Direct hernia more common in old age",
 "Caused by age-related weakening/atrophy of the transversalis fascia and conjoint tendon forming the posterior wall of the inguinal canal (Hesselbach's triangle), unlike indirect hernia which uses a pre-formed congenital sac."),
(4, "Anatomical basis for Caput medusae, Hemorrhoids and Hematemesis",
 "All result from portal hypertension dilating portosystemic anastomoses &ndash; paraumbilical veins with superficial epigastric veins (caput medusae), superior rectal with middle/inferior rectal veins (hemorrhoids), and esophageal veins via the left gastric vein (hematemesis from varices)."),
(5, "Anatomical basis for Varicocele",
 "The left testicular vein drains at a right angle into the left renal vein (higher resistance), while the right vein drains obliquely and directly into the IVC. The longer course and right-angle drainage on the left predispose to venous stasis and dilation of the pampiniform plexus."),
(6, "Anatomical basis for Omphalocele",
 "Failure of the midgut, which normally herniates physiologically at 6 weeks, to return to the abdominal cavity by 10 weeks, combined with failure of the body wall folds to close &ndash; leaving bowel covered only by peritoneum/amnion outside the abdomen."),
(7, "Anatomical basis for Congenital umbilical hernia",
 "Unlike omphalocele, here the gut has returned normally, but the umbilical ring fails to close completely, so a hernia (covered by skin) protrudes at the umbilicus."),
(8, "Anatomical basis for Meckel's diverticulum",
 "A remnant of the vitellointestinal (omphalomesenteric) duct that normally disappears by the 6th week but persists here &ndash; found on the antimesenteric border of the ileum, roughly 2 feet from the ileocecal junction (\"rule of 2s\")."),
(9, "Anatomical basis for urinary fistula",
 "Often due to persistence of the embryonic urachus (giving an umbilical-urinary fistula) or abnormal tracts from disease/trauma following the path of least resistance between the bladder and skin."),
(10, "Anatomical basis for Kehr's sign",
 "Pain referred to the tip of the left shoulder from a ruptured/injured spleen. Blood irritating the diaphragm stimulates the phrenic nerve (C3-C5), and pain is referred to the shoulder region supplied by the same cervical segments (supraclavicular nerves, C3-C4)."),
(11, "Anatomical basis for Fecal fistula",
 "An abnormal tract between the bowel and skin, usually from disease (Crohn's, diverticulitis) or trauma breaking through tissue layers along the path of least resistance."),
(12, "Hepatic vein is not a component of Portal triad",
 "The portal triad (portal vein, hepatic artery, bile duct) consists of structures that enter the liver together at the porta hepatis via the lesser omentum. Hepatic veins carry blood out of the liver directly into the IVC at the bare area, bypassing the porta hepatis entirely."),
(13, "Extravasation of urine in bulbar (penile) urethra injury does not enter into thigh",
 "Colles' fascia (superficial perineal fascia) fuses firmly with the deep fascia (fascia lata) just below the inguinal ligament, sealing off the thigh from the spreading urine."),
(14, "Extravasation of urine in bulbar (penile) urethra injury enters into anterior abdominal wall, scrotum and penis",
 "If Buck's fascia is torn, urine spreads deep to Colles' fascia, which is continuous with Scarpa's fascia of the abdomen and dartos fascia of the scrotum/penis &ndash; so urine tracks into these regions along that fascial plane."),
(15, "Anatomical basis for Horse shoe kidney",
 "During ascent of the developing kidneys, if their lower poles fuse (usually in front of the aorta), the fused isthmus gets caught below the inferior mesenteric artery, arresting further ascent &ndash; the kidney ends up lower and fused."),
(16, "Anatomical basis for Pelvic kidney",
 "Simple failure of the kidney to ascend from its embryonic pelvic position up to the normal lumbar level."),
(17, "Anatomical basis for Ectopic vesicae",
 "Failure of mesoderm to migrate between the ectoderm and the cloacal membrane in the infraumbilical region, so the cloacal membrane ruptures prematurely, exposing the posterior bladder wall through a defect in the anterior abdominal wall (bladder exstrophy)."),
(18, "Anatomical basis for Imperforate anus",
 "Results from failure of the urorectal septum to properly separate the cloaca, or failure of the anal membrane to rupture/canalize."),
(19, "Anatomical basis for Cryptorchidism",
 "Incomplete descent of the testis anywhere along its normal path (abdomen or inguinal canal) instead of reaching the scrotum."),
(20, "Anatomical basis for Ectopic testis",
 "The testis deviates entirely from its normal path of descent (misdirected gubernaculum) and lodges somewhere abnormal &ndash; e.g. superficial inguinal pouch, perineum, root of penis, or opposite scrotum."),
(21, "Left testis is lower than the right testis - Reason why?",
 "The right testis descends slightly later than the left during development, and the left testicular vein has a longer course &ndash; both contribute to the left testis hanging lower in most men."),
(22, "Umbilicus acts as a water shed line of anterior abdominal wall",
 "Above the umbilicus, venous and lymphatic drainage goes toward the axilla; below it, drainage goes toward the femoral vein/inguinal nodes. The umbilicus is the dividing line between these two drainage territories."),
(23, "Pectinate line acts as a water shed line of anal canal",
 "It separates the upper anal canal (endoderm-derived, columnar epithelium, superior rectal vessels, drains to internal iliac nodes, autonomic/pain-insensitive nerve supply) from the lower anal canal (ectoderm-derived, squamous epithelium, inferior rectal vessels, drains to superficial inguinal nodes, somatic/pain-sensitive pudendal nerve supply)."),
(24, "Gastric ulcer is common along lesser curvature of stomach",
 "This region has relatively poor, end-artery type blood supply (from left and right gastric arteries with fewer collaterals) and lies directly in the path of the food stream (magenstrasse), making the mucosa more vulnerable to acid injury and ischemia."),
(25, "During splenomegaly, it cannot enlarge vertically downwards",
 "The spleen's upper pole is anchored by the lienorenal and gastrosplenic ligaments, and the phrenicocolic ligament forms a shelf below its lower pole, so it cannot enlarge straight downward."),
(26, "Spleen enlarges towards right iliac fossa",
 "As the spleen enlarges it grows along the long axis of the 10th rib &ndash; forward, downward, and medially &ndash; toward the right iliac fossa, sometimes crossing the midline."),
(27, "Splenic artery has tortuous course",
 "The distance it must travel from its origin at the celiac trunk to the spleen is short relative to its actual length, and it needs slack to accommodate movement/distension of the stomach and pancreas along its course &ndash; hence the wavy, tortuous path."),
(28, "Anatomical basis for Troisier's sign",
 "Enlargement of the left supraclavicular lymph node (Virchow's node), usually from metastatic abdominal cancer (classically stomach) spreading via lymphatics into the thoracic duct, which drains into the venous system at the junction of the left subclavian and internal jugular veins &ndash; right where this node sits."),
(29, "Anatomical basis for Divarication of recti",
 "Separation of the two rectus abdominis muscles due to stretching/weakening of the linea alba (the fibrous midline raphe), commonly from repeated abdominal distension in pregnancy, obesity, or ascites."),
(30, "Explain the reason for occurrence of Jaundice in annular pancreas and pancreatic tumors",
 "The common bile duct runs through or behind the head of the pancreas before opening into the duodenum. An annular pancreas (a ring of pancreatic tissue from abnormal rotation of the ventral bud) or a tumor of the pancreatic head compresses this duct, causing obstructive jaundice."),
(31, "Anatomical basis for prolapse uterus",
 "Weakness of the pelvic floor (levator ani, perineal body) and uterine ligamentous supports (cardinal/transverse cervical, pubocervical, uterosacral ligaments), typically from multiple childbirths or aging, allows the uterus to descend through the vagina."),
(32, "1st part of duodenum is common site for duodenal ulcer",
 "This segment receives the most concentrated, unbuffered acidic chyme straight from the stomach, before pancreatic and biliary secretions (entering at the 2nd part) can neutralize it &ndash; making it the classic site for peptic ulceration."),
(33, "Left 1/3rd of transverse colon is supplied by inferior mesenteric artery branches",
 "Embryologically, this segment develops from the hindgut (supplied by the inferior mesenteric artery), while the proximal two-thirds develops from the midgut (supplied by the superior mesenteric artery) &ndash; the junction, near the splenic flexure, is Griffith's watershed point."),
(34, "Reason for doing liver biopsy at 9th or 10th intercostal space",
 "At this level in the midaxillary line, the needle passes below the lung's lower reflection (avoiding pneumothorax) but still overlies solid liver tissue, avoiding injury to lung, pleura, or bowel."),
(35, "Prostatic cancer spreads to vertebrae",
 "Via the valveless vertebral venous plexus (Batson's plexus), which communicates directly with the prostatic venous plexus, letting malignant cells travel straight to the vertebrae without passing through the lungs first."),
(36, "Anatomical basis for lumbar puncture",
 "The spinal cord ends at the L1-L2 level (conus medullaris) in adults. Below this, the subarachnoid space contains only the cauda equina (freely floating nerve roots), which are pushed aside by the needle rather than injured &ndash; hence LP is done at L3-L4 or L4-L5."),
(37, "Greater omentum is called policeman of abdomen",
 "It is mobile and can migrate to wrap around and wall off any site of infection or inflammation (like a perforated appendix or ulcer), containing the spread of infection within the peritoneal cavity."),
(38, "Fluid, Pus and blood collection in Pouch of Douglas",
 "It is the most dependent (lowest) part of the peritoneal cavity in an upright or supine female, so gravity directs free intraperitoneal fluid there."),
(39, "Digital rectal examination is done in left lateral position",
 "This position allows comfortable relaxation of the patient, easy access for a (typically right-handed) examiner, and good exposure of the anal canal and rectal wall/prostate."),
(40, "External hemorrhoids are more painful than Internal hemorrhoids",
 "External hemorrhoids lie below the pectinate line, covered by skin/anal epithelium with somatic (pain-sensitive) innervation. Internal hemorrhoids lie above the line, covered by mucosa with only autonomic (pain-insensitive) innervation."),
(41, "Anatomical basis for suprapubic cystostomy",
 "A distended bladder rises above the pubic symphysis, pushing the peritoneal reflection upward and leaving a bare area of bladder wall in direct contact with the abdominal wall &ndash; allowing safe extraperitoneal access above the pubis."),
(42, "Urinary tract infection is more common in females",
 "The female urethra is much shorter (~4 cm vs ~20 cm in males) and lies close to the vaginal and anal openings, giving bacteria an easier, shorter route to ascend into the bladder."),
(43, "Benign prostatic hypertrophy causes urinary tract obstruction in elderly males",
 "The prostatic urethra runs directly through the prostate; enlargement of the median and lateral lobes compresses and distorts this urethral segment, obstructing urine outflow."),
(44, "Site for pudendal nerve block",
 "Given at the ischial spine, because the pudendal nerve passes very close to it while travelling from the greater to the lesser sciatic foramen (entering Alcock's canal) &ndash; a reliable, palpable landmark, especially useful during childbirth."),
(45, "In splenectomy, tail of pancreas has to be preserved",
 "The pancreatic tail lies close to (often touching) the splenic hilum within the lienorenal ligament, so splenic vessels must be ligated carefully to avoid injuring it."),
(46, "Anatomical basis of development of 2nd part of duodenum",
 "The upper half of the first part and the second part of the duodenum develop from the foregut, while the rest develops from the midgut. The junction of fore- and midgut lies exactly where the bile and pancreatic ducts open (major duodenal papilla, 2nd part)."),
(47, "Urinary tract infection and pelvic infection leads to peritonitis in females",
 "The uterine tubes open directly into the peritoneal cavity via their abdominal ostia, giving ascending infections from the vagina, uterus, or tubes a direct pathway into the peritoneal cavity &ndash; a route that doesn't exist in males."),
(48, "Mediolateral episiotomy is preferred during vaginal delivery",
 "It avoids the anal canal and external anal sphincter, greatly reducing the risk of the incision extending into the rectum (a risk with median episiotomy), even though it cuts through more muscle and bleeds more."),
]

add_section("LOWER LIMB", lower_limb)
story.append(PageBreak())
add_section("ABDOMEN", abdomen)
story.append(PageBreak())
add_section("THORAX", thorax)

doc.build(story)
print("PDF created successfully")