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,
    PageBreak, HRFlowable
)
from reportlab.lib.enums import TA_CENTER, TA_LEFT, TA_JUSTIFY
from reportlab.platypus import KeepTogether

OUTPUT = "/tmp/workspace/dmst-questions/DMST_Important_Questions.pdf"

doc = SimpleDocTemplate(
    OUTPUT,
    pagesize=A4,
    rightMargin=2*cm,
    leftMargin=2*cm,
    topMargin=2*cm,
    bottomMargin=2*cm,
)

styles = getSampleStyleSheet()

# Custom styles
title_style = ParagraphStyle(
    'CustomTitle',
    parent=styles['Title'],
    fontSize=20,
    textColor=colors.HexColor('#1a3a5c'),
    spaceAfter=6,
    alignment=TA_CENTER,
    fontName='Helvetica-Bold',
)
subtitle_style = ParagraphStyle(
    'Subtitle',
    parent=styles['Normal'],
    fontSize=11,
    textColor=colors.HexColor('#444444'),
    spaceAfter=4,
    alignment=TA_CENTER,
    fontName='Helvetica',
)
section_style = ParagraphStyle(
    'Section',
    parent=styles['Heading1'],
    fontSize=13,
    textColor=colors.white,
    spaceBefore=14,
    spaceAfter=6,
    fontName='Helvetica-Bold',
    backColor=colors.HexColor('#1a3a5c'),
    leftIndent=-6,
    rightIndent=-6,
    borderPad=5,
)
subsection_style = ParagraphStyle(
    'Subsection',
    parent=styles['Heading2'],
    fontSize=11,
    textColor=colors.HexColor('#1a3a5c'),
    spaceBefore=10,
    spaceAfter=4,
    fontName='Helvetica-Bold',
    borderPad=2,
)
q_style = ParagraphStyle(
    'Question',
    parent=styles['Normal'],
    fontSize=9.5,
    textColor=colors.HexColor('#222222'),
    spaceBefore=5,
    spaceAfter=2,
    fontName='Helvetica-Bold',
    leftIndent=6,
)
option_style = ParagraphStyle(
    'Option',
    parent=styles['Normal'],
    fontSize=9,
    textColor=colors.HexColor('#333333'),
    spaceBefore=1,
    spaceAfter=1,
    leftIndent=20,
    fontName='Helvetica',
)
answer_style = ParagraphStyle(
    'Answer',
    parent=styles['Normal'],
    fontSize=9,
    textColor=colors.HexColor('#006400'),
    spaceBefore=2,
    spaceAfter=4,
    leftIndent=20,
    fontName='Helvetica-Bold',
)
short_q_style = ParagraphStyle(
    'ShortQ',
    parent=styles['Normal'],
    fontSize=9.5,
    textColor=colors.HexColor('#222222'),
    spaceBefore=5,
    spaceAfter=2,
    fontName='Helvetica-Bold',
    leftIndent=6,
)
short_a_style = ParagraphStyle(
    'ShortA',
    parent=styles['Normal'],
    fontSize=9,
    textColor=colors.HexColor('#1a1a6e'),
    spaceBefore=1,
    spaceAfter=5,
    leftIndent=20,
    fontName='Helvetica',
)
note_style = ParagraphStyle(
    'Note',
    parent=styles['Normal'],
    fontSize=8.5,
    textColor=colors.HexColor('#7a0000'),
    spaceBefore=2,
    spaceAfter=2,
    leftIndent=20,
    fontName='Helvetica-Oblique',
)
body_style = ParagraphStyle(
    'Body',
    parent=styles['Normal'],
    fontSize=9.5,
    textColor=colors.HexColor('#222222'),
    spaceBefore=3,
    spaceAfter=3,
    fontName='Helvetica',
    alignment=TA_JUSTIFY,
)

story = []

# ── COVER PAGE ──────────────────────────────────────────────────────────────
story.append(Spacer(1, 2*cm))
story.append(Paragraph("DIPLOMA IN MEDICAL STERILISATION TECHNOLOGY", title_style))
story.append(Paragraph("(DMST)", title_style))
story.append(Spacer(1, 0.4*cm))
story.append(HRFlowable(width="100%", thickness=2, color=colors.HexColor('#1a3a5c')))
story.append(Spacer(1, 0.3*cm))
story.append(Paragraph("MOST IMPORTANT & REPEATED QUESTIONS", subtitle_style))
story.append(Paragraph("All Subjects | MCQs + Short Answer + Long Answer", subtitle_style))
story.append(Spacer(1, 0.3*cm))
story.append(HRFlowable(width="100%", thickness=1, color=colors.HexColor('#1a3a5c')))
story.append(Spacer(1, 0.5*cm))

cover_data = [
    ["Subjects Covered", "7 Core Subjects"],
    ["Question Types", "MCQ + Short Answer + Long Answer"],
    ["Total Questions", "200+"],
    ["Prepared For", "DMST Public Examination"],
    ["Date", "July 2026"],
]
cover_table = Table(cover_data, colWidths=[7*cm, 9*cm])
cover_table.setStyle(TableStyle([
    ('BACKGROUND', (0,0), (0,-1), colors.HexColor('#e8f0f7')),
    ('BACKGROUND', (1,0), (1,-1), colors.white),
    ('TEXTCOLOR', (0,0), (-1,-1), colors.HexColor('#1a3a5c')),
    ('FONTNAME', (0,0), (0,-1), 'Helvetica-Bold'),
    ('FONTNAME', (1,0), (1,-1), 'Helvetica'),
    ('FONTSIZE', (0,0), (-1,-1), 10),
    ('GRID', (0,0), (-1,-1), 0.5, colors.HexColor('#cccccc')),
    ('ROWBACKGROUND', (0,0), (-1,-1), [colors.HexColor('#e8f0f7'), colors.white]),
    ('PADDING', (0,0), (-1,-1), 8),
    ('VALIGN', (0,0), (-1,-1), 'MIDDLE'),
]))
story.append(cover_table)
story.append(Spacer(1, 1*cm))

subjects_list = [
    "1. Microbiology & Infection Control",
    "2. Sterilisation Methods & Techniques",
    "3. CSSD (Central Sterile Supply Department)",
    "4. Anatomy & Physiology",
    "5. Medical Instruments & Equipment",
    "6. Biomedical Waste Management",
    "7. Hospital Infection Control & OT Practice",
]
for s in subjects_list:
    story.append(Paragraph(s, body_style))

story.append(PageBreak())

# ═══════════════════════════════════════════════════════════════════════════════
# SUBJECT 1: MICROBIOLOGY & INFECTION CONTROL
# ═══════════════════════════════════════════════════════════════════════════════
story.append(Paragraph("SUBJECT 1: MICROBIOLOGY & INFECTION CONTROL", section_style))
story.append(Spacer(1, 0.2*cm))

story.append(Paragraph("Part A – MCQ Questions (with Answers)", subsection_style))

mcq1 = [
    ("Q1. Which of the following is the SMALLEST microorganism?",
     ["A) Bacteria", "B) Fungi", "C) Virus", "D) Protozoa"], "C) Virus"),
    ("Q2. The process of destroying ALL forms of microbial life including spores is called:",
     ["A) Disinfection", "B) Sterilisation", "C) Antisepsis", "D) Fumigation"], "B) Sterilisation"),
    ("Q3. Which bacterium forms the MOST resistant spores?",
     ["A) E. coli", "B) Staphylococcus aureus", "C) Clostridium tetani", "D) Pseudomonas"], "C) Clostridium tetani"),
    ("Q4. Gram-positive bacteria stain:",
     ["A) Pink/Red", "B) Blue/Violet", "C) Yellow", "D) Green"], "B) Blue/Violet"),
    ("Q5. Which organism is responsible for hospital-acquired MRSA infections?",
     ["A) Streptococcus pyogenes", "B) Methicillin-resistant Staphylococcus aureus", "C) Klebsiella pneumoniae", "D) E. coli"], "B) Methicillin-resistant Staphylococcus aureus"),
    ("Q6. HAI (Hospital-Acquired Infection) is also called:",
     ["A) Endogenous infection", "B) Nosocomial infection", "C) Exogenous infection", "D) Iatrogenic infection"], "B) Nosocomial infection"),
    ("Q7. Which of the following is a biological indicator used in autoclave monitoring?",
     ["A) Bowie-Dick tape", "B) Geobacillus stearothermophilus spores", "C) Thermocouple", "D) Chemical indicator strip"], "B) Geobacillus stearothermophilus spores"),
    ("Q8. Contact transmission of infection occurs through:",
     ["A) Air droplets", "B) Direct or indirect contact", "C) Vectors", "D) Contaminated water"], "B) Direct or indirect contact"),
    ("Q9. Standard precautions apply to:",
     ["A) Only HIV patients", "B) Only TB patients", "C) ALL patients regardless of diagnosis", "D) Only surgical patients"], "C) ALL patients regardless of diagnosis"),
    ("Q10. Which virus is MOST commonly transmitted via needle-stick injury?",
     ["A) HIV", "B) Hepatitis B virus (HBV)", "C) Hepatitis A", "D) Influenza"], "B) Hepatitis B virus (HBV)"),
]

for q_text, opts, ans in mcq1:
    story.append(Paragraph(q_text, q_style))
    for opt in opts:
        story.append(Paragraph(opt, option_style))
    story.append(Paragraph(f"Answer: {ans}", answer_style))

story.append(Spacer(1, 0.3*cm))
story.append(Paragraph("Part B – Short Answer Questions", subsection_style))

saq1 = [
    ("Q1. Define sterilisation and disinfection. Give two differences.",
     "Sterilisation: Complete destruction of all microorganisms including spores (e.g., autoclave). Disinfection: Destruction of most pathogenic microorganisms but NOT spores (e.g., glutaraldehyde). Key differences: (i) Sterilisation kills spores; disinfection does not. (ii) Sterilisation is used for surgical instruments; disinfection is used for environmental surfaces."),
    ("Q2. What is a nosocomial infection? Name 4 common causative organisms.",
     "A nosocomial (hospital-acquired) infection is an infection that was not present on admission and develops after 48 hours of hospitalisation. Common organisms: (i) Staphylococcus aureus (MRSA), (ii) Pseudomonas aeruginosa, (iii) Klebsiella pneumoniae, (iv) E. coli."),
    ("Q3. Explain the chain of infection.",
     "The chain of infection has 6 links: (1) Infectious agent (pathogen), (2) Reservoir (host/environment), (3) Portal of exit (sneezing, wounds), (4) Mode of transmission (contact, droplet, airborne), (5) Portal of entry (mouth, wounds), (6) Susceptible host. Breaking any link prevents infection spread."),
    ("Q4. What are standard precautions? List 5 components.",
     "Standard precautions are infection control practices applied to ALL patients: (1) Hand hygiene, (2) Use of PPE (gloves, mask, gown), (3) Safe needle disposal, (4) Respiratory hygiene/cough etiquette, (5) Safe injection practices, (6) Proper handling of soiled linen/equipment."),
    ("Q5. Write a short note on Hepatitis B in healthcare settings.",
     "Hepatitis B is a blood-borne viral infection highly prevalent in healthcare workers. Transmission: needle-stick injury, contact with infected blood/body fluids. Prevention: HBV vaccination (3 doses - 0, 1, 6 months), use of gloves, safe needle disposal, post-exposure prophylaxis with HBIG."),
]

for qn, an in saq1:
    story.append(Paragraph(qn, short_q_style))
    story.append(Paragraph(an, short_a_style))

story.append(Spacer(1, 0.3*cm))
story.append(Paragraph("Part C – Long Answer Questions", subsection_style))
laq1 = [
    ("Q1. Describe the modes of transmission of hospital infections and the preventive measures for each.",
     ["Contact transmission (direct/indirect): Prevention - hand hygiene, gloves, barrier nursing.",
      "Droplet transmission (>5 micron particles): Prevention - surgical mask, distance >1 metre.",
      "Airborne transmission (<5 micron droplet nuclei, e.g., TB): Prevention - N95 mask, negative pressure room, HEPA filters.",
      "Vehicle-borne (contaminated food/water/blood): Prevention - safe food handling, sterile IV fluids.",
      "Vector-borne (insects): Prevention - pest control, insect repellents.",
      "General measures: Hand washing with soap & water (5 moments), PPE use, isolation of infectious patients, environmental cleaning."]),
    ("Q2. Explain the role of the sterilisation technician in preventing hospital-acquired infections.",
     ["Ensure proper decontamination, cleaning, packaging, and sterilisation of all reusable medical devices.",
      "Monitor sterilisation processes using physical, chemical, and biological indicators.",
      "Maintain CSSD records and documentation.",
      "Perform regular equipment maintenance and quality checks.",
      "Train staff on proper handling of sterile items.",
      "Comply with infection control policies and standard precautions.",
      "Report any breach in sterility and take corrective action."]),
]
for qn, bullets in laq1:
    story.append(Paragraph(qn, short_q_style))
    for b in bullets:
        story.append(Paragraph(f"• {b}", short_a_style))
    story.append(Spacer(1, 0.2*cm))

story.append(PageBreak())

# ═══════════════════════════════════════════════════════════════════════════════
# SUBJECT 2: STERILISATION METHODS & TECHNIQUES
# ═══════════════════════════════════════════════════════════════════════════════
story.append(Paragraph("SUBJECT 2: STERILISATION METHODS & TECHNIQUES", section_style))
story.append(Spacer(1, 0.2*cm))

story.append(Paragraph("Part A – MCQ Questions", subsection_style))
mcq2 = [
    ("Q1. Standard autoclave temperature and pressure for sterilisation is:",
     ["A) 100°C at 1 atm", "B) 121°C at 15 psi for 15 minutes", "C) 160°C at 10 psi", "D) 134°C at 5 psi"], "B) 121°C at 15 psi for 15 minutes"),
    ("Q2. Which sterilisation method is used for HEAT-SENSITIVE instruments (e.g., endoscopes)?",
     ["A) Dry heat oven", "B) Autoclave", "C) Ethylene oxide (ETO) gas", "D) Boiling"], "C) Ethylene oxide (ETO) gas"),
    ("Q3. Hot air oven sterilises at:",
     ["A) 100°C for 30 min", "B) 121°C for 15 min", "C) 160°C for 60 min (or 170°C for 30 min)", "D) 200°C for 15 min"], "C) 160°C for 60 min (or 170°C for 30 min)"),
    ("Q4. Bowie-Dick test is used to check:",
     ["A) Biological indicator performance", "B) Air removal from pre-vacuum autoclave", "C) Chemical indicator colour change", "D) ETO concentration"], "B) Air removal from pre-vacuum autoclave"),
    ("Q5. Which chemical is used for COLD STERILISATION of instruments?",
     ["A) Povidone iodine", "B) 2% Glutaraldehyde (Cidex)", "C) 70% Alcohol", "D) Hypochlorite"], "B) 2% Glutaraldehyde (Cidex)"),
    ("Q6. The recommended soaking time for 2% glutaraldehyde to achieve sterilisation is:",
     ["A) 10 minutes", "B) 30 minutes", "C) 10 hours", "D) 1 hour"], "C) 10 hours"),
    ("Q7. Flash sterilisation (immediate use sterilisation) is performed at:",
     ["A) 121°C for 3 min (unwrapped)", "B) 134°C for 3 min (unwrapped)", "C) 160°C for 1 min", "D) 100°C for 10 min"], "B) 134°C for 3 min (unwrapped)"),
    ("Q8. Dry heat sterilisation is suitable for:",
     ["A) Rubber goods", "B) Glassware and sharp instruments", "C) Textiles", "D) Endoscopes"], "B) Glassware and sharp instruments"),
    ("Q9. The aeration time after ETO sterilisation is required to remove:",
     ["A) Moisture", "B) Toxic ETO residues", "C) Heat", "D) Spores"], "B) Toxic ETO residues"),
    ("Q10. Which type of steam steriliser has the FASTEST cycle?",
     ["A) Gravity displacement autoclave", "B) Pre-vacuum (porous load) autoclave", "C) Flash steriliser", "D) Benchtop steriliser"], "B) Pre-vacuum (porous load) autoclave"),
    ("Q11. The D-value in sterilisation refers to:",
     ["A) Depth of sterilisation", "B) Time required to reduce microbial population by 90% (1 log)", "C) Dose of ETO", "D) Diameter of spores"], "B) Time required to reduce microbial population by 90% (1 log)"),
    ("Q12. Low-temperature plasma sterilisation uses:",
     ["A) Formaldehyde", "B) ETO", "C) Hydrogen peroxide plasma (STERRAD)", "D) Peracetic acid"], "C) Hydrogen peroxide plasma (STERRAD)"),
    ("Q13. Which indicator turns from BLUE to BROWN when autoclaved correctly?",
     ["A) Bowie-Dick tape", "B) Browne's tube (chemical indicator)", "C) Biological indicator", "D) Thermocouple"], "B) Browne's tube (chemical indicator)"),
    ("Q14. Pasteurisation is a form of:",
     ["A) Sterilisation", "B) Disinfection", "C) Fumigation", "D) Decontamination"], "B) Disinfection"),
    ("Q15. Radiation sterilisation (gamma rays) is used for:",
     ["A) Reusable surgical instruments", "B) Single-use disposable medical devices", "C) Liquids", "D) Food preparation"], "B) Single-use disposable medical devices"),
]

for q_text, opts, ans in mcq2:
    story.append(Paragraph(q_text, q_style))
    for opt in opts:
        story.append(Paragraph(opt, option_style))
    story.append(Paragraph(f"Answer: {ans}", answer_style))

story.append(Spacer(1, 0.3*cm))
story.append(Paragraph("Part B – Short Answer Questions", subsection_style))
saq2 = [
    ("Q1. Compare moist heat vs. dry heat sterilisation.",
     "Moist heat (autoclave): 121°C/15 psi/15 min; kills by protein denaturation via steam; used for rubber, textiles, surgical packs. Dry heat (oven): 160°C/60 min; kills by oxidation; used for glassware, oils, powders, sharp metal instruments. Moist heat is more efficient as water conducts heat better."),
    ("Q2. Write the advantages and disadvantages of ETO sterilisation.",
     "Advantages: (i) Effective for heat-sensitive items (endoscopes, plastics), (ii) Deep penetration. Disadvantages: (i) Long cycle time (2-6 hrs + aeration), (ii) Toxic to humans (carcinogen), (iii) Expensive, (iv) Requires special aeration chamber. Aeration time: 8-12 hrs at room temperature or 1-4 hrs in heated aerator."),
    ("Q3. What is the Spaulding classification? Give examples.",
     "Spaulding (1968) classifies medical devices by infection risk: (1) Critical items (enter sterile tissue/bloodstream): surgical instruments - require STERILISATION. (2) Semi-critical items (contact mucous membranes): endoscopes - require HIGH-LEVEL DISINFECTION. (3) Non-critical items (contact intact skin): blood pressure cuffs - require LOW-LEVEL DISINFECTION."),
    ("Q4. Name 5 methods of sterilisation used in hospitals.",
     "(1) Steam under pressure - autoclave, (2) Dry heat - hot air oven, (3) Ethylene oxide gas, (4) Hydrogen peroxide plasma (STERRAD), (5) Gamma radiation, (6) Peracetic acid (for endoscopes), (7) Low-temperature steam formaldehyde (LTSF)."),
    ("Q5. What is a chemical indicator? Give examples.",
     "A chemical indicator changes colour when exposed to specific sterilisation conditions (temperature, time, steam). Examples: (1) Autoclave tape (Class 1 - process indicator), (2) Multi-parameter indicators (Class 5/6), (3) Browne's tube, (4) Bowie-Dick test sheet. They do NOT confirm sterility but indicate conditions were met."),
]
for qn, an in saq2:
    story.append(Paragraph(qn, short_q_style))
    story.append(Paragraph(an, short_a_style))

story.append(Spacer(1, 0.3*cm))
story.append(Paragraph("Part C – Long Answer Questions", subsection_style))
laq2 = [
    ("Q1. Describe the working principle, procedure, and monitoring of steam autoclave sterilisation.",
     ["Principle: Moist heat (saturated steam under pressure) denatures microbial proteins and kills all microorganisms including spores.",
      "Types: (i) Gravity displacement - steam enters from top, air exhausted from bottom. (ii) Pre-vacuum/porous load - vacuum removes air before steam entry; faster and more efficient.",
      "Standard cycle: 121°C, 15 psi, 15 min (gravity) OR 134°C, 30 psi, 3-4 min (porous load).",
      "Procedure: Load items, close door, set cycle, run, allow drying, unload and inspect.",
      "Monitoring: Physical (temperature/pressure gauges, printouts), Chemical (autoclave tape, Bowie-Dick test), Biological (Geobacillus stearothermophilus spore vials - weekly or each load).",
      "Validation: Routine monitoring + periodic revalidation + maintenance records."]),
    ("Q2. Explain the decontamination process in CSSD from collection to dispatch.",
     ["Step 1 - Collection: Collect used instruments from wards/OT in closed, leak-proof containers.",
      "Step 2 - Sorting: Sort instruments by type, material, and sterilisation method required.",
      "Step 3 - Decontamination/Cleaning: Manual cleaning or ultrasonic cleaner + washer-disinfector. Remove all organic debris.",
      "Step 4 - Inspection: Check for cleanliness, function, damage using magnifying glass and light.",
      "Step 5 - Assembly & Packaging: Assemble sets, pack in appropriate wrapping (crepe paper, non-woven fabric, pouches). Add chemical indicator.",
      "Step 6 - Sterilisation: Load according to type; run validated cycle.",
      "Step 7 - Storage: Store in clean, dry, closed shelving. Date-label packs.",
      "Step 8 - Distribution: Dispatch to wards in closed trolleys. FIFO (First In First Out) system."]),
]
for qn, bullets in laq2:
    story.append(Paragraph(qn, short_q_style))
    for b in bullets:
        story.append(Paragraph(f"• {b}", short_a_style))
    story.append(Spacer(1, 0.2*cm))

story.append(PageBreak())

# ═══════════════════════════════════════════════════════════════════════════════
# SUBJECT 3: CSSD
# ═══════════════════════════════════════════════════════════════════════════════
story.append(Paragraph("SUBJECT 3: CSSD - CENTRAL STERILE SUPPLY DEPARTMENT", section_style))
story.append(Spacer(1, 0.2*cm))
story.append(Paragraph("Part A – MCQ Questions", subsection_style))

mcq3 = [
    ("Q1. CSSD stands for:",
     ["A) Central Surgical Supply Division", "B) Central Sterile Supply Department", "C) Core Sterile Services Department", "D) Central Surgical Sterilisation Division"], "B) Central Sterile Supply Department"),
    ("Q2. The CSSD is divided into zones. The clean zone is used for:",
     ["A) Receiving and decontamination of dirty instruments", "B) Packaging and assembly of sterile items", "C) Dispatch of sterile items", "D) Storage of hazardous chemicals"], "B) Packaging and assembly of sterile items"),
    ("Q3. The recommended air pressure in the CSSD clean/sterile zone should be:",
     ["A) Negative pressure", "B) Positive pressure", "C) Equal to dirty zone", "D) Zero pressure"], "B) Positive pressure"),
    ("Q4. What does FIFO stand for in CSSD stock management?",
     ["A) First In, First Out", "B) Fast Items, Fresh Out", "C) Final Inspection, Final Output", "D) Fixed Item Follow-up Order"], "A) First In, First Out"),
    ("Q5. Shelf life of a sterile pack is determined by:",
     ["A) Only the expiry date", "B) Event-related (condition of pack) rather than time alone", "C) The sterilisation cycle only", "D) Temperature of storage only"], "B) Event-related (condition of pack) rather than time alone"),
    ("Q6. Which type of packaging is NOT recommended for steam sterilisation?",
     ["A) Non-woven polypropylene wrap", "B) Crepe paper", "C) Polyethylene (PE) plastic bags", "D) Peel pouches (paper-plastic)"], "C) Polyethylene (PE) plastic bags"),
    ("Q7. A washer-disinfector achieves what level of decontamination?",
     ["A) Sterilisation", "B) High-level disinfection", "C) Low-level disinfection", "D) Cleaning only"], "B) High-level disinfection"),
    ("Q8. The recommended temperature for washer-disinfector thermal disinfection is:",
     ["A) 60°C", "B) 80-93°C for 1-10 minutes (A0 concept)", "C) 100°C", "D) 50°C for 30 min"], "B) 80-93°C for 1-10 minutes (A0 concept)"),
    ("Q9. Double wrapping of sterile packs is done to:",
     ["A) Save on packaging material", "B) Provide an extra protective layer and maintain sterility during transport", "C) Speed up the sterilisation cycle", "D) Improve autoclave efficiency"], "B) Provide an extra protective layer and maintain sterility during transport"),
    ("Q10. The traceability system in CSSD ensures:",
     ["A) Faster delivery", "B) Each sterile item can be tracked from sterilisation to patient use", "C) Reduced cost", "D) Better packaging"], "B) Each sterile item can be tracked from sterilisation to patient use"),
]
for q_text, opts, ans in mcq3:
    story.append(Paragraph(q_text, q_style))
    for opt in opts:
        story.append(Paragraph(opt, option_style))
    story.append(Paragraph(f"Answer: {ans}", answer_style))

story.append(Spacer(1, 0.3*cm))
story.append(Paragraph("Part B – Short Answer Questions", subsection_style))
saq3 = [
    ("Q1. Name the zones of CSSD and their functions.",
     "(1) Dirty/Decontamination zone: Receiving and cleaning soiled instruments. (2) Inspection/Assembly zone: Checking, assembling, and packaging clean instruments. (3) Sterile/Clean zone: Loading autoclave and storing sterile packs. (4) Dispatch zone: Distribution of sterile items to wards. Air pressure: dirty zone < clean zone < sterile zone (prevents cross-contamination)."),
    ("Q2. What is an ultrasonic cleaner? How does it work?",
     "An ultrasonic cleaner uses high-frequency sound waves (ultrasound, 20-50 kHz) transmitted through a cleaning solution. This creates cavitation (microscopic bubbles) that implode and dislodge debris from instrument surfaces, including lumens and joints. Advantages: Excellent cleaning of complex instruments, removes blood/tissue from hard-to-reach areas. It is a cleaning device ONLY - not a steriliser."),
    ("Q3. What information should be labelled on a sterile pack?",
     "Every sterile pack must have: (1) Contents description, (2) Lot/batch number, (3) Sterilisation date, (4) Expiry date, (5) Steriliser number and cycle number, (6) Technician ID (for traceability), (7) Chemical indicator. This enables recall if a sterilisation failure is identified."),
    ("Q4. List the quality assurance tests performed in CSSD.",
     "(1) Physical monitoring - temperature, pressure, time printouts. (2) Chemical indicators (Class 1-6). (3) Biological indicators (weekly/per load). (4) Bowie-Dick test (daily for pre-vacuum autoclaves). (5) Washer-disinfector validation (ATP bioluminescence, soil test). (6) Pack integrity inspection. (7) Load configuration studies."),
]
for qn, an in saq3:
    story.append(Paragraph(qn, short_q_style))
    story.append(Paragraph(an, short_a_style))

story.append(Paragraph("Part C – Long Answer Question", subsection_style))
story.append(Paragraph("Q1. Describe the complete workflow of CSSD with the functions of each zone and the staff responsibilities.", short_q_style))
bullets_cssd = [
    "Decontamination Zone: Receive soiled items, sort, pre-rinse, manual clean or washer-disinfector, then rinse.",
    "Inspection Zone: Inspect for cleanliness (light box), test function, assemble instrument sets, place chemical indicators, package.",
    "Sterilisation Zone: Load autoclaves/ETO chambers as per guidelines, run validated cycles, unload and inspect packs.",
    "Storage and Dispatch: Store sterile packs on clean shelves, FIFO rotation, deliver to wards in sealed trolleys.",
    "Staff duties: CSSD technician - operates equipment, monitors indicators, maintains records, reports failures.",
    "Supervisor: Quality assurance, staff training, policy compliance.",
    "Documentation: Sterilisation records, equipment maintenance logs, biological indicator results - all retained for audit.",
]
for b in bullets_cssd:
    story.append(Paragraph(f"• {b}", short_a_style))

story.append(PageBreak())

# ═══════════════════════════════════════════════════════════════════════════════
# SUBJECT 4: ANATOMY & PHYSIOLOGY
# ═══════════════════════════════════════════════════════════════════════════════
story.append(Paragraph("SUBJECT 4: ANATOMY & PHYSIOLOGY (Relevant to Sterilisation Practice)", section_style))
story.append(Spacer(1, 0.2*cm))
story.append(Paragraph("Part A – MCQ Questions", subsection_style))
mcq4 = [
    ("Q1. The largest organ of the body is:",
     ["A) Liver", "B) Lung", "C) Skin", "D) Kidney"], "C) Skin"),
    ("Q2. Normal body temperature is:",
     ["A) 35°C", "B) 36.5–37.5°C", "C) 38°C", "D) 39°C"], "B) 36.5–37.5°C"),
    ("Q3. The function of the liver includes:",
     ["A) Gas exchange", "B) Hormone production", "C) Detoxification and bile production", "D) Filtration of blood"], "C) Detoxification and bile production"),
    ("Q4. The peritoneum is:",
     ["A) Membrane lining the lungs", "B) Membrane lining the abdominal cavity", "C) Outer covering of the heart", "D) Lining of joints"], "B) Membrane lining the abdominal cavity"),
    ("Q5. The pH of normal blood is:",
     ["A) 6.8", "B) 7.0", "C) 7.35–7.45", "D) 8.0"], "C) 7.35–7.45"),
    ("Q6. Which cells produce antibodies?",
     ["A) Red blood cells", "B) Neutrophils", "C) B lymphocytes (plasma cells)", "D) Platelets"], "C) B lymphocytes (plasma cells)"),
    ("Q7. The respiratory rate in a healthy adult is:",
     ["A) 5-8/min", "B) 12-20/min", "C) 25-30/min", "D) 35-40/min"], "B) 12-20/min"),
    ("Q8. Which part of the body does aseptic technique MOST aim to protect during surgery?",
     ["A) Intact skin", "B) Sterile body cavity / surgical wound", "C) Mucous membranes", "D) Hair"], "B) Sterile body cavity / surgical wound"),
    ("Q9. The blood vessel that carries oxygenated blood FROM the lungs to the heart is:",
     ["A) Pulmonary artery", "B) Pulmonary vein", "C) Aorta", "D) Vena cava"], "B) Pulmonary vein"),
    ("Q10. The first line of defense against infection in the body is:",
     ["A) Antibodies", "B) White blood cells", "C) Intact skin and mucous membranes", "D) Lymph nodes"], "C) Intact skin and mucous membranes"),
]
for q_text, opts, ans in mcq4:
    story.append(Paragraph(q_text, q_style))
    for opt in opts:
        story.append(Paragraph(opt, option_style))
    story.append(Paragraph(f"Answer: {ans}", answer_style))

story.append(Spacer(1, 0.3*cm))
story.append(Paragraph("Part B – Short Answer Questions", subsection_style))
saq4 = [
    ("Q1. Name the types of muscle tissue and their locations.",
     "(1) Skeletal muscle - voluntary, limbs and trunk. (2) Cardiac muscle - involuntary, heart wall. (3) Smooth muscle - involuntary, walls of blood vessels, GIT, uterus."),
    ("Q2. What is the lymphatic system's role in immunity?",
     "The lymphatic system transports lymph (fluid + white cells) from tissues back to blood. Lymph nodes filter lymph and trap pathogens. Lymphocytes (T and B cells) produce immune responses. Spleen filters blood and removes old red cells. The thymus is where T cells mature."),
    ("Q3. Describe the inflammatory response to infection.",
     "Inflammation is the body's local response to infection/injury: (1) Vasodilation - increased blood flow (redness, heat). (2) Increased vascular permeability - fluid leaks into tissue (swelling). (3) Neutrophil migration - phagocytosis of bacteria. (4) Cardinal signs: Redness, heat, swelling, pain, loss of function. Purpose: destroy pathogen and initiate healing."),
]
for qn, an in saq4:
    story.append(Paragraph(qn, short_q_style))
    story.append(Paragraph(an, short_a_style))

story.append(PageBreak())

# ═══════════════════════════════════════════════════════════════════════════════
# SUBJECT 5: MEDICAL INSTRUMENTS & EQUIPMENT
# ═══════════════════════════════════════════════════════════════════════════════
story.append(Paragraph("SUBJECT 5: MEDICAL INSTRUMENTS & EQUIPMENT", section_style))
story.append(Spacer(1, 0.2*cm))
story.append(Paragraph("Part A – MCQ Questions", subsection_style))
mcq5 = [
    ("Q1. Which instrument is used to hold and pass needles during suturing?",
     ["A) Artery forceps", "B) Needle holder (Mayo-Hegar)", "C) Tissue forceps", "D) Towel clip"], "B) Needle holder (Mayo-Hegar)"),
    ("Q2. Haemostatic forceps are used to:",
     ["A) Cut tissue", "B) Clamp blood vessels to control bleeding", "C) Retract tissues", "D) Suture wounds"], "B) Clamp blood vessels to control bleeding"),
    ("Q3. A retractor is used in surgery to:",
     ["A) Cut tissue", "B) Hold tissues aside to improve surgical access", "C) Ligate vessels", "D) Suture skin"], "B) Hold tissues aside to improve surgical access"),
    ("Q4. Cannulas and trocars are used in:",
     ["A) Open surgery only", "B) Laparoscopic surgery to insert instruments through body wall", "C) Cardiac surgery only", "D) Dental surgery"], "B) Laparoscopic surgery to insert instruments through body wall"),
    ("Q5. Which material requires ETO or low-temperature sterilisation and CANNOT withstand autoclaving?",
     ["A) Stainless steel", "B) Glass", "C) Polyvinyl chloride (PVC) tubing / delicate optics", "D) Linen"], "C) Polyvinyl chloride (PVC) tubing / delicate optics"),
    ("Q6. A curette is used to:",
     ["A) Aspirate fluids", "B) Scrape tissue from body cavities", "C) Incise tissue", "D) Apply sutures"], "B) Scrape tissue from body cavities"),
    ("Q7. Which instrument is used to examine the interior of hollow organs (e.g., colon)?",
     ["A) Retractor", "B) Endoscope", "C) Speculum", "D) Trocar"], "B) Endoscope"),
    ("Q8. What is the recommended reprocessing method for flexible endoscopes?",
     ["A) Autoclave at 134°C", "B) High-level disinfection with glutaraldehyde or AER", "C) Dry heat oven", "D) Hot water 80°C"], "B) High-level disinfection with glutaraldehyde or AER"),
    ("Q9. Stainless steel surgical instruments are identified by the grade:",
     ["A) 304 and 316 series", "B) 200 series", "C) 100 series", "D) 500 series"], "A) 304 and 316 series"),
    ("Q10. Rust on surgical instruments is prevented by:",
     ["A) Soaking in saline", "B) Lubrication with instrument milk and proper drying after sterilisation", "C) Storing in water", "D) Using bleach solution"], "B) Lubrication with instrument milk and proper drying after sterilisation"),
]
for q_text, opts, ans in mcq5:
    story.append(Paragraph(q_text, q_style))
    for opt in opts:
        story.append(Paragraph(opt, option_style))
    story.append(Paragraph(f"Answer: {ans}", answer_style))

story.append(Spacer(1, 0.3*cm))
story.append(Paragraph("Part B – Short Answer Questions", subsection_style))
saq5 = [
    ("Q1. Name 10 common surgical instruments and their uses.",
     "(1) Scalpel - incise tissue. (2) Scissors (Mayo/Metzenbaum) - cut tissue. (3) Needle holder - hold suture needle. (4) Haemostatic forceps (artery forceps) - clamp vessels. (5) Tissue forceps (toothed/non-toothed) - hold tissue. (6) Retractor (Langenbeck/Deaver) - retract tissue. (7) Trocar & cannula - laparoscopic access. (8) Bone curette - scrape bone. (9) Towel clip - hold drapes. (10) Suction tip (Yankauer) - aspirate blood/fluid."),
    ("Q2. How should endoscopes be reprocessed? List all steps.",
     "(1) Pre-cleaning at bedside - wipe scope, flush channels with water. (2) Leak test before immersion. (3) Manual cleaning - enzymatic detergent, brushing all channels. (4) Rinse thoroughly. (5) High-level disinfection: 2% glutaraldehyde (20 min) or Automated Endoscope Reprocessor (AER). (6) Final rinse with sterile/filtered water. (7) Dry with 70% alcohol then air dry. (8) Store hanging vertically in ventilated cabinet."),
    ("Q3. What is instrument milk/lubricant and when is it used?",
     "Instrument milk (lubricant) is a water-soluble silicone-based solution used to lubricate hinges and box-locks of surgical instruments after cleaning and before sterilisation. It prevents rust, stiffness, and corrosion. It is compatible with steam sterilisation (unlike oil-based lubricants which are not). Applied by dipping instruments or spraying after the wash cycle."),
]
for qn, an in saq5:
    story.append(Paragraph(qn, short_q_style))
    story.append(Paragraph(an, short_a_style))

story.append(PageBreak())

# ═══════════════════════════════════════════════════════════════════════════════
# SUBJECT 6: BIOMEDICAL WASTE MANAGEMENT
# ═══════════════════════════════════════════════════════════════════════════════
story.append(Paragraph("SUBJECT 6: BIOMEDICAL WASTE MANAGEMENT", section_style))
story.append(Spacer(1, 0.2*cm))
story.append(Paragraph("Part A – MCQ Questions", subsection_style))
mcq6 = [
    ("Q1. As per Biomedical Waste Rules 2016 (India), a YELLOW bag is used for:",
     ["A) Recyclable plastics", "B) Human anatomical waste, soiled dressings, and expired medicines", "C) Sharps only", "D) Cytotoxic waste"], "B) Human anatomical waste, soiled dressings, and expired medicines"),
    ("Q2. A RED bag is used for:",
     ["A) Anatomical waste", "B) Recyclable contaminated plastics (IV sets, syringes without needles)", "C) Cytotoxic drugs", "D) General waste"], "B) Recyclable contaminated plastics (IV sets, syringes without needles)"),
    ("Q3. Used needles and sharps should be disposed of in a:",
     ["A) Yellow bag", "B) Red bag", "C) Puncture-proof sharps container", "D) Blue bag"], "C) Puncture-proof sharps container"),
    ("Q4. Which colour container is used for broken glassware?",
     ["A) Red", "B) Yellow", "C) Blue/White translucent", "D) Black"], "C) Blue/White translucent"),
    ("Q5. The preferred method of treatment for infectious biomedical waste is:",
     ["A) Landfill", "B) Autoclaving / chemical disinfection before landfill", "C) Open burning", "D) Recycling as-is"], "B) Autoclaving / chemical disinfection before landfill"),
    ("Q6. Needle-stick injury protocol requires FIRST:",
     ["A) Reporting to supervisor", "B) Immediately wash with soap and water, allow bleeding, do NOT squeeze", "C) Apply tourniquet", "D) Take antibiotics immediately"], "B) Immediately wash with soap and water, allow bleeding, do NOT squeeze"),
    ("Q7. Post-exposure prophylaxis (PEP) for HIV should be started within:",
     ["A) 72 hours", "B) 7 days", "C) 24 hours (ideally as soon as possible)", "D) 2 weeks"], "C) 24 hours (ideally as soon as possible)"),
    ("Q8. Cytotoxic (chemotherapy) waste is disposed in:",
     ["A) Yellow bag", "B) Red bag", "C) Black bag with cytotoxic label", "D) Blue bag"], "C) Black bag with cytotoxic label"),
    ("Q9. BMW (Biomedical Waste) segregation is the responsibility of:",
     ["A) Housekeeping staff only", "B) All healthcare workers who generate the waste", "C) Laboratory staff only", "D) Hospital administration"], "B) All healthcare workers who generate the waste"),
    ("Q10. The colour of the bag used for general non-hazardous waste is:",
     ["A) Yellow", "B) Red", "C) Black", "D) Blue"], "C) Black"),
]
for q_text, opts, ans in mcq6:
    story.append(Paragraph(q_text, q_style))
    for opt in opts:
        story.append(Paragraph(opt, option_style))
    story.append(Paragraph(f"Answer: {ans}", answer_style))

story.append(Spacer(1, 0.3*cm))
story.append(Paragraph("Part B – Short Answer Questions", subsection_style))
saq6 = [
    ("Q1. Classify biomedical waste with colour coding (BMW Rules 2016).",
     "YELLOW: Anatomical waste, body parts, expired medicines, soiled items. RED: Recyclable contaminated plastics, IV bottles, tubing. BLUE/WHITE: Broken/discarded glassware, sharps (glass). SHARPS CONTAINER (translucent): Used needles, syringes with needles, broken/contaminated metals. BLACK: General non-hazardous municipal waste. Cytotoxic: Separate labelled black container."),
    ("Q2. What steps should be taken after a needle-stick injury?",
     "(1) Immediately remove gloves, wash area with soap and running water for 2-3 minutes. (2) Do NOT squeeze or suck the wound. (3) Apply antiseptic. (4) Report to supervisor and occupational health immediately. (5) Blood test (baseline HIV, HBV, HCV) for source patient and worker. (6) Initiate PEP for HIV within 72 hrs if source is HIV positive. (7) HBV immunoglobulin if not vaccinated. (8) Document incident. (9) Follow-up serology at 6 weeks, 3 months, 6 months."),
    ("Q3. What is an autoclave used for in biomedical waste management?",
     "Autoclaves are used to pre-treat infectious biomedical waste (microbiological waste, sharps, used dressings) before final disposal in landfill. Steam sterilisation kills pathogens, reducing infection risk during transport and landfill. After autoclaving, waste is rendered non-infectious and can be sent to municipal solid waste disposal. This is mandatory for Category 1 and Category 2 BMW in India."),
]
for qn, an in saq6:
    story.append(Paragraph(qn, short_q_style))
    story.append(Paragraph(an, short_a_style))

story.append(PageBreak())

# ═══════════════════════════════════════════════════════════════════════════════
# SUBJECT 7: HOSPITAL INFECTION CONTROL & OT PRACTICE
# ═══════════════════════════════════════════════════════════════════════════════
story.append(Paragraph("SUBJECT 7: HOSPITAL INFECTION CONTROL & OT PRACTICE", section_style))
story.append(Spacer(1, 0.2*cm))
story.append(Paragraph("Part A – MCQ Questions", subsection_style))
mcq7 = [
    ("Q1. The OT temperature should be maintained at:",
     ["A) 15-17°C", "B) 18-22°C (ideally 20-24°C)", "C) 25-30°C", "D) 10-15°C"], "B) 18-22°C (ideally 20-24°C)"),
    ("Q2. OT fumigation is done using:",
     ["A) Chlorhexidine", "B) Formaldehyde (formalin) vapour", "C) Povidone iodine spray", "D) Bleach solution"], "B) Formaldehyde (formalin) vapour"),
    ("Q3. Surgical hand scrub is performed for a minimum of:",
     ["A) 30 seconds", "B) 1 minute", "C) 3-5 minutes", "D) 10 minutes"], "C) 3-5 minutes"),
    ("Q4. The WHO recommends hand hygiene at how many moments?",
     ["A) 2", "B) 3", "C) 5", "D) 7"], "C) 5"),
    ("Q5. A sterile field is considered contaminated if:",
     ["A) A sterile item is added to it", "B) It is left unattended briefly", "C) A non-sterile person reaches over it / item falls below waist level", "D) The surgeon touches it"], "C) A non-sterile person reaches over it / item falls below waist level"),
    ("Q6. Air changes per hour (ACH) recommended in an operating theatre is:",
     ["A) 5-10 ACH", "B) 15-25 ACH (positive pressure HEPA filtered)", "C) 30-40 ACH", "D) 1-5 ACH"], "B) 15-25 ACH (positive pressure HEPA filtered)"),
    ("Q7. PPE should be worn in which order?",
     ["A) Gloves, gown, mask, eye protection", "B) Gown, mask, eye protection, gloves", "C) Mask, gown, gloves, eye protection", "D) Any order is acceptable"], "B) Gown, mask, eye protection, gloves"),
    ("Q8. Surgical site infection (SSI) prevention includes:",
     ["A) Shaving the operative site 24 hours before surgery", "B) Clipping hair immediately before surgery / skin antisepsis with chlorhexidine", "C) Not administering prophylactic antibiotics", "D) Increasing OT traffic"], "B) Clipping hair immediately before surgery / skin antisepsis with chlorhexidine"),
    ("Q9. Prophylactic antibiotics for surgery are given:",
     ["A) 1 day before surgery", "B) Within 60 minutes before skin incision", "C) After wound closure", "D) At the time of discharge"], "B) Within 60 minutes before skin incision"),
    ("Q10. Which disinfectant is used for skin preparation before surgery?",
     ["A) Lysol", "B) 0.5-2% chlorhexidine gluconate in 70% alcohol (or povidone-iodine)", "C) Formalin", "D) Bleach"], "B) 0.5-2% chlorhexidine gluconate in 70% alcohol (or povidone-iodine)"),
]
for q_text, opts, ans in mcq7:
    story.append(Paragraph(q_text, q_style))
    for opt in opts:
        story.append(Paragraph(opt, option_style))
    story.append(Paragraph(f"Answer: {ans}", answer_style))

story.append(Spacer(1, 0.3*cm))
story.append(Paragraph("Part B – Short Answer Questions", subsection_style))
saq7 = [
    ("Q1. What are the WHO 5 Moments of Hand Hygiene?",
     "(1) Before touching a patient. (2) Before a clean/aseptic procedure. (3) After body fluid exposure risk. (4) After touching a patient. (5) After touching patient surroundings. Correct technique: use alcohol-based hand rub for 20-30 seconds, or soap and water for 40-60 seconds using the 6-step technique."),
    ("Q2. What is aseptic technique? How is it maintained in the OT?",
     "Aseptic technique: set of practices to prevent contamination of sterile fields and surgical wounds. Maintained by: (i) Surgical hand scrub before gowning/gloving. (ii) Wearing sterile gown and gloves. (iii) Maintaining sterile field boundaries. (iv) Using sterile instruments and drapes. (v) Minimising OT traffic. (vi) Keeping sterile items above waist level. (vii) Not reaching across sterile field."),
    ("Q3. Name and explain types of surgical wound classification.",
     "(1) Class I - Clean: No infection, no hollow viscus opened. SSI risk: 1-5%. (2) Class II - Clean-contaminated: Controlled opening of hollow viscus (GIT, respiratory, GU tract). Risk: 5-10%. (3) Class III - Contaminated: Open/fresh traumatic wounds, major break in aseptic technique. Risk: 10-15%. (4) Class IV - Dirty/infected: Perforated viscus, old traumatic wounds, frank pus. Risk: >15%."),
    ("Q4. What is HEPA filtration in OT ventilation?",
     "HEPA (High Efficiency Particulate Air) filters remove 99.97% of particles >=0.3 microns. Used in OT laminar airflow systems to provide ultra-clean air and reduce airborne contamination. Essential in orthopaedic and cardiac surgery. Combined with positive pressure (to prevent outside air entering) and 15-25 air changes/hour."),
    ("Q5. List the daily cleaning protocol for an operating theatre.",
     "Before first case: damp-mop floors with disinfectant, wipe all surfaces. Between cases: remove used instruments/drapes, wipe OT table and equipment with disinfectant, mop floor. After last case: full terminal cleaning - all surfaces, walls, lights, equipment. Weekly: deep clean, OT fumigation with formalin. Regular microbiological air sampling for quality monitoring."),
]
for qn, an in saq7:
    story.append(Paragraph(qn, short_q_style))
    story.append(Paragraph(an, short_a_style))

story.append(Spacer(1, 0.3*cm))
story.append(Paragraph("Part C – Long Answer Questions", subsection_style))
laq7 = [
    ("Q1. Describe the prevention and control of Surgical Site Infections (SSI).",
     ["Pre-operative measures: Patient bathing with antiseptic soap, nasal decolonisation for S. aureus carriers, blood glucose control, stop smoking 30 days before, prophylactic antibiotics within 60 min of incision.",
      "Intra-operative measures: Strict aseptic technique, skin prep with chlorhexidine-alcohol, maintain normothermia, adequate tissue perfusion, gentle tissue handling, minimal OT traffic.",
      "Post-operative measures: Sterile wound dressing for 24-48 hrs, hand hygiene before wound care, early removal of drains.",
      "Environment: HEPA-filtered positive pressure OT, 15-25 ACH, regular terminal cleaning.",
      "Sterilisation: All instruments must be properly sterilised - monitored with biological/chemical indicators.",
      "Surveillance: SSI rates monitored and fed back to surgical teams for quality improvement."]),
    ("Q2. Explain the role of the CSSD technician in the Operation Theatre.",
     ["Instrument supply: Prepare and dispatch sterilised instrument sets to OT before each surgical list.",
      "Emergency sterilisation: Flash sterilise dropped/contaminated instruments urgently if required.",
      "OT stock management: Maintain adequate stock of sterile consumables (gloves, drapes, sutures).",
      "Decontamination after surgery: Collect used instruments from OT safely, return to CSSD in covered containers.",
      "Communication: Liaise with OT nurses on instrument requirements, report damaged instruments.",
      "Documentation: Record all loads sterilised for each OT case (traceability).",
      "Quality: Ensure only in-date, intact sterile packs reach OT. Reject any compromised packs."]),
]
for qn, bullets in laq7:
    story.append(Paragraph(qn, short_q_style))
    for b in bullets:
        story.append(Paragraph(f"• {b}", short_a_style))
    story.append(Spacer(1, 0.2*cm))

story.append(PageBreak())

# ═══════════════════════════════════════════════════════════════════════════════
# QUICK REVISION TABLE
# ═══════════════════════════════════════════════════════════════════════════════
story.append(Paragraph("QUICK REVISION: KEY FACTS TABLE", section_style))
story.append(Spacer(1, 0.3*cm))

rev_data = [
    ["Topic", "Key Fact / Answer"],
    ["Autoclave temp (standard)", "121°C, 15 psi, 15 minutes"],
    ["Autoclave temp (porous load)", "134°C, 30 psi, 3-4 minutes"],
    ["Hot air oven", "160°C / 60 min OR 170°C / 30 min"],
    ["ETO sterilisation", "For heat-sensitive items; toxic - needs 8-12hr aeration"],
    ["STERRAD (H2O2 plasma)", "Low-temp, no toxic residue, fast cycle"],
    ["Glutaraldehyde (HLD)", "20 min; sterilisation 10 hours"],
    ["Bowie-Dick test", "Daily, tests air removal in pre-vacuum autoclaves"],
    ["Biological indicator (autoclave)", "Geobacillus stearothermophilus"],
    ["Biological indicator (ETO)", "Bacillus atrophaeus"],
    ["Spaulding: Critical items", "Surgical instruments → STERILISATION"],
    ["Spaulding: Semi-critical", "Endoscopes → HIGH-LEVEL DISINFECTION"],
    ["Spaulding: Non-critical", "BP cuffs → LOW-LEVEL DISINFECTION"],
    ["BMW Yellow bag", "Anatomical waste, soiled items, expired medicines"],
    ["BMW Red bag", "Recyclable contaminated plastics"],
    ["BMW Sharps container", "Needles, syringes with needles"],
    ["Needle-stick first action", "Wash with soap and water, let bleed, report"],
    ["HIV PEP start time", "Within 72 hrs (ideally ASAP)"],
    ["WHO Hand hygiene moments", "5 moments"],
    ["OT temperature", "18-24°C"],
    ["OT air changes/hr", "15-25 ACH (HEPA filtered, positive pressure)"],
    ["Surgical scrub time", "3-5 minutes"],
    ["Nosocomial infection onset", "After 48 hrs of hospitalisation"],
    ["FIFO", "First In, First Out - stock management in CSSD"],
    ["CSSD dirty zone pressure", "Negative (vs positive in sterile zone)"],
    ["Flash sterilisation", "134°C, 3 min unwrapped - emergency use only"],
]
rev_table = Table(rev_data, colWidths=[8*cm, 8*cm])
rev_table.setStyle(TableStyle([
    ('BACKGROUND', (0,0), (-1,0), colors.HexColor('#1a3a5c')),
    ('TEXTCOLOR', (0,0), (-1,0), colors.white),
    ('FONTNAME', (0,0), (-1,0), 'Helvetica-Bold'),
    ('FONTNAME', (0,1), (0,-1), 'Helvetica-Bold'),
    ('FONTNAME', (1,1), (1,-1), 'Helvetica'),
    ('FONTSIZE', (0,0), (-1,-1), 8.5),
    ('GRID', (0,0), (-1,-1), 0.5, colors.HexColor('#cccccc')),
    ('ROWBACKGROUNDS', (0,1), (-1,-1), [colors.HexColor('#f0f5fa'), colors.white]),
    ('PADDING', (0,0), (-1,-1), 5),
    ('VALIGN', (0,0), (-1,-1), 'TOP'),
]))
story.append(rev_table)

story.append(PageBreak())

# ═══════════════════════════════════════════════════════════════════════════════
# ADDITIONAL IMPORTANT REPEATED QUESTIONS
# ═══════════════════════════════════════════════════════════════════════════════
story.append(Paragraph("MOST REPEATED EXAM QUESTIONS - ALL SUBJECTS", section_style))
story.append(Spacer(1, 0.3*cm))
story.append(Paragraph("The following questions appear repeatedly in DMST examinations:", body_style))
story.append(Spacer(1, 0.2*cm))

repeated = [
    "1. What is sterilisation? Describe the various methods of sterilisation with their advantages and disadvantages.",
    "2. Explain the working of an autoclave. What are the parameters monitored during the autoclave cycle?",
    "3. What is CSSD? Describe its zones and workflow.",
    "4. Classify biomedical waste with colour coding as per Biomedical Waste Rules 2016.",
    "5. What is the Spaulding classification? Give examples for each level.",
    "6. What is ETO sterilisation? Describe its advantages, disadvantages, and safety precautions.",
    "7. Define: Sterilisation, Disinfection, Antiseptic, Asepsis. Give one example of each.",
    "8. What is a nosocomial infection? List the common organisms and preventive measures.",
    "9. Describe the WHO 5 moments of hand hygiene and the correct technique.",
    "10. What are biological indicators? How and when are they used in CSSD?",
    "11. Describe the decontamination process for flexible endoscopes step by step.",
    "12. What is the management of needle-stick injury? Describe all steps.",
    "13. Describe the layout and design requirements of an Operation Theatre.",
    "14. What is the Bowie-Dick test? Why is it performed and how often?",
    "15. Describe the role and responsibilities of a CSSD technician.",
    "16. What is surgical site infection (SSI)? Classify surgical wounds and list prevention strategies.",
    "17. Explain high-level disinfection using glutaraldehyde - concentration, contact time, and indications.",
    "18. What is hydrogen peroxide plasma sterilisation (STERRAD)? When is it preferred?",
    "19. Describe the correct procedure for packaging instruments for sterilisation.",
    "20. What is post-exposure prophylaxis (PEP)? When and how is it given?",
]

for q in repeated:
    story.append(Paragraph(q, body_style))

story.append(Spacer(1, 0.5*cm))
story.append(HRFlowable(width="100%", thickness=1, color=colors.HexColor('#1a3a5c')))
story.append(Spacer(1, 0.2*cm))
story.append(Paragraph("END OF QUESTION BANK", ParagraphStyle('End', parent=styles['Normal'], fontSize=10, textColor=colors.HexColor('#1a3a5c'), alignment=TA_CENTER, fontName='Helvetica-Bold')))
story.append(Paragraph("Best of luck with your DMST Examination!", ParagraphStyle('Wish', parent=styles['Normal'], fontSize=9, textColor=colors.HexColor('#444444'), alignment=TA_CENTER, fontName='Helvetica-Oblique')))

doc.build(story)
print(f"PDF generated: {OUTPUT}")