python3 << 'EOF' from docx import Document doc = Document('/tmp/workspace/attachments/b5ea3f91-916d-42c3-ba76-9377b21532a9/QuestionsAKTMU.docx') for i, p in enumerate(doc.paragraphs): if p.text.strip(): print(f"[{p.style.name}] {p.text}") EOF

python3 << 'EOF' import pdfplumber with pdfplumber.open('/tmp/workspace/attachments/b5ea3f91-916d-42c3-ba76-9377b21532a9/Quality mx.pdf') as pdf: for i, page in enumerate(pdf.pages): print(f"\n=== PAGE {i+1} ===") text = page.extract_text() if text: print(text) EOF

mkdir -p /tmp/workspace/quiz-ppt && python3 << 'PYEOF' import random from pptx import Presentation from pptx.util import Inches, Pt, Emu from pptx.dml.color import RGBColor from pptx.enum.text import PP_ALIGN # ─── ALL QUESTIONS (question_text, [options]) ─────────────────────────────── questions = [ # ── AKTMU block ────────────────────────────────────────────────────────── ("Which of the following best defines classic Fever of Unknown Origin (FUO) in adult patients?", ["A. Temperature >38.3°C on multiple occasions, lasting >2 weeks, with no diagnosis after 3 outpatient visits or 3 days of inpatient evaluation.", "B. Temperature >38.3°C on multiple occasions, lasting >3 weeks, with no diagnosis after 3 outpatient visits or 3 days of inpatient evaluation.", "C. Temperature >38.0°C on multiple occasions, lasting >3 weeks, with no diagnosis after 1 week of intensive investigation.", "D. Temperature >38.3°C on multiple occasions, lasting >4 weeks, with no diagnosis after 1 negative outpatient evaluation."]), ("In the workup of a 65-year-old patient with FUO, which of the following non-infectious inflammatory diseases is a classic etiology, especially when associated with jaw claudication, visual symptoms, and an elevated ESR?", ["A. Adult-onset Still's disease", "B. Polyarteritis nodosa", "C. Giant cell arteritis", "D. Systemic lupus erythematosus"]), ("A 40-year-old woman presents with intermittent fevers for 4 weeks without an obvious focus. After a comprehensive initial workup fails to reveal a source, what is the most appropriate next step in the diagnostic workup for FUO?", ["A. Empiric broad-spectrum antibiotics", "B. Empiric high-dose corticosteroids", "C. Contrast-enhanced CT of the abdomen and pelvis", "D. Diagnostic lumbar puncture"]), ("A 30-year-old male presents with a 4-week history of daily fevers, drenching night sweats, and a 5 kg weight loss. He drinks unpasteurized raw milk. Physical examination reveals hepatosplenomegaly. Which pathogen is the most likely cause of his FUO?", ["A. Brucella melitensis", "B. Borrelia burgdorferi", "C. Plasmodium falciparum", "D. Coxiella burnetii"]), ("A 25-year-old man presents with a 6-week history of fluctuating fevers, profound weight loss, and severe generalized pruritus. Fevers occur for a week, followed by an afebrile period before recurring (Pel-Ebstein fever). Lab results show elevated ESR and mild eosinophilia. What is the most likely diagnosis?", ["A. Multiple myeloma", "B. Acute myeloid leukemia", "C. Reactive arthritis", "D. Hodgkin lymphoma"]), ("Which of the following best describes the genetic inheritance and underlying biochemical defect in Fabry disease?", ["A. Autosomal recessive; deficiency of alpha-galactosidase A leading to Gb3 accumulation.", "B. X-linked recessive; deficiency of alpha-galactosidase A leading to Gb3 accumulation.", "C. X-linked recessive; deficiency of beta-glucosidase leading to glucocerebroside accumulation.", "D. Autosomal dominant; deficiency of sphingomyelinase leading to sphingomyelin accumulation."]), ("A 12-year-old boy presents with severe, burning pain in his hands and feet worsening during exercise and hot weather. Physical examination reveals clusters of small, dark red, non-blanching macules on his lower abdomen and groin. Which is the most likely early manifestation of his underlying condition?", ["A. Angiokeratomas and acroparesthesias", "B. Hepatosplenomegaly and bone crises", "C. Bilateral cataracts and muscular hypotonia", "D. Joint hypermobility and skin hyperextensibility"]), ("As Fabry disease progresses into adulthood, which major organs are most critically affected by progressive Gb3 accumulation, leading to early mortality?", ["A. Liver and lungs", "B. Spleen and bone marrow", "C. Kidneys, heart, and central nervous system", "D. Pancreas and skeletal muscles"]), ("A 35-year-old male is suspected of having Fabry disease. What is the most appropriate and definitive initial laboratory test to confirm the diagnosis in this male patient?", ["A. Measurement of plasma sphingomyelinase activity", "B. Urinary sediment microscopy for 'maltese cross' appearance", "C. Measurement of alpha-galactosidase A enzyme activity in leukocytes", "D. Skin biopsy of an angiokeratoma alone"]), ("Which of the following represents a disease-specific, targeted therapeutic option for patients diagnosed with Fabry disease?", ["A. High-dose oral corticosteroid therapy", "B. Enzyme replacement therapy (ERT) with recombinant alpha-galactosidase A", "C. Substrate reduction therapy with miglustat", "D. Weekly blood transfusions and splenectomy"]), ("What is the primary distinguishing feature between CRPS Type I and CRPS Type II?", ["A. CRPS Type I involves the lower extremities, while CRPS Type II affects only the upper extremities.", "B. CRPS Type I is caused by a central nervous system lesion, while CRPS Type II is peripheral.", "C. CRPS Type I occurs without a definable major nerve injury, while CRPS Type II develops after a known nerve injury.", "D. CRPS Type I is a purely dermatological condition, while CRPS Type II involves bone demineralization."]), ("According to the Budapest Criteria for CRPS, which of the following is NOT one of the official clinical categories?", ["A. Sensory (e.g., hyperalgesia or allodynia)", "B. Vasomotor (e.g., temperature asymmetry or skin color changes)", "C. Sudomotor/Edema (e.g., sweating changes or swelling)", "D. Hematological (e.g., localized leukocytosis or petechiae)"]), ("A 34-year-old woman presents 6 weeks after a minor wrist sprain with severe burning pain in her entire hand triggered by light touch from a tissue paper. The hand appears swollen, warm, and red with increased hair growth. What is the clinical term for pain triggered by a normally non-painful stimulus?", ["A. Allodynia", "B. Hyperalgesia", "C. Paresthesia", "D. Hyperpathia"]), ("When using triple-phase bone scintigraphy or plain X-rays to support a diagnosis of CRPS, which classic objective finding is often observed in the affected limb during later stages?", ["A. Diffuse osteosclerosis and bone thickening", "B. Patchy, periarticular demineralization (osteopenia)", "C. Osteolytic 'punched-out' lesions", "D. Subchondral bone cysts and joint space narrowing"]), ("A 45-year-old male is diagnosed with early-stage CRPS of the lower extremity following an ankle fracture. What is considered the most critical, foundational component of first-line management to prevent permanent disability?", ["A. Immediate surgical amputation of the limb", "B. High-dose long-term opioid therapy", "C. Physical therapy and occupational therapy focused on functional mobilization", "D. Complete, long-term immobilization of the limb in a plaster cast"]), ("Which of the following best describes the primary tissue of origin and the major hormones secreted by a classic pheochromocytoma?", ["A. Cortical cells of the adrenal gland; secreting aldosterone and cortisol.", "B. Chromaffin cells of the adrenal medulla; secreting catecholamines (epinephrine and norepinephrine).", "C. Parafollicular cells of the thyroid gland; secreting calcitonin.", "D. Juxtaglomerular cells of the kidney; secreting renin."]), ("A 38-year-old woman presents with episodes of severe, pounding headaches, generalized sweating, and a racing heart. Blood pressure spikes to 210/120 mmHg. Which classic triad of symptoms is most suggestive of pheochromocytoma?", ["A. Weight gain, moon facies, and abdominal striae", "B. Diarrhea, cutaneous flushing, and wheezing", "C. Headache, diaphoresis (sweating), and palpitations", "D. Hypokalemia, hypertension, and muscle weakness"]), ("A clinician suspects a pheochromocytoma in a patient with highly erratic blood pressure. Which initial biochemical test offers the highest sensitivity for confirming the diagnosis?", ["A. Random plasma epinephrine and norepinephrine levels", "B. 24-hour urinary 17-hydroxycorticosteroids", "C. Plasma free metanephrines or 24-hour urinary fractionated metanephrines", "D. Serum aldosterone-to-renin ratio"]), ("A patient is diagnosed with a pheochromocytoma alongside medullary thyroid cancer and primary hyperparathyroidism. Which genetic syndrome does this clinical picture represent?", ["A. Multiple Endocrine Neoplasia Type 1 (MEN 1)", "B. Multiple Endocrine Neoplasia Type 2A (MEN 2A)", "C. von Hippel-Lindau (VHL) disease", "D. Neurofibromatosis Type 1 (NF1)"]), ("A 45-year-old male with confirmed adrenal pheochromocytoma is scheduled for surgical resection. How must preoperative medical management be strictly sequenced to prevent a hypertensive crisis during surgery?", ["A. Start a beta-blocker first, followed by an alpha-blocker 2 days before surgery.", "B. Administer high-dose intravenous corticosteroids 1 week prior to surgery.", "C. Initiate alpha-adrenergic blockade first, followed by beta-adrenergic blockade later.", "D. Initiate immediate urgent surgical resection without any preoperative medication."]), ("Which of the following statements best defines a paraganglioma and distinguishes it from a classic pheochromocytoma?", ["A. A paraganglioma is a neuroendocrine tumor that arises exclusively from the adrenal cortex.", "B. A paraganglioma is an extra-adrenal chromaffin cell tumor arising from the sympathetic or parasympathetic ganglia.", "C. A paraganglioma is a benign vascular tumor found only in the subcutaneous tissues of the limbs.", "D. A paraganglioma is an epithelial tumor of the thyroid gland that secretes parathyroid hormone."]), ("Which of the following best characterizes head and neck paragangliomas (such as carotid body tumors)?", ["A. They are derived from sympathetic chains and almost always secrete massive amounts of epinephrine.", "B. They are derived from parasympathetic chains and are typically non-functional (rarely secrete catecholamines).", "C. They are highly malignant tumors that rapidly metastasize to the liver within weeks.", "D. They are caused exclusively by dietary intake of unpasteurized dairy products."]), ("Mutations in which of the following gene complexes are most classically responsible for familial paragangliomas?", ["A. Succinate dehydrogenase (SDHx) genes (e.g., SDHB, SDHD)", "B. BRCA1 and BRCA2 genes", "C. APC (Adenomatous Polyposis Coli) gene", "D. CFTR (Cystic Fibrosis Transmembrane Conductance Regulator) gene"]), ("A 42-year-old man presents with a painless, slow-growing swelling on the lateral aspect of his upper neck. The mass is mobile horizontally but fixed vertically (positive Fontaine's sign). Which diagnosis does this finding support?", ["A. Functional abdominal paraganglioma", "B. Carotid body tumor (Paraganglioma of the head and neck)", "C. Branchial cleft cyst", "D. Acute suppurative lymphadenitis"]), ("When evaluating a patient with suspected extra-adrenal paraganglioma, which functional nuclear medicine imaging modality is highly specific for targeting the norepinephrine transporter in these neuroendocrine tissues?", ["A. Technetium-99m bone scan", "B. Iodine-123 metaiodobenzylguanidine (I-123 MIBG) scintigraphy", "C. Gallium-67 scan", "D. Ventilation-perfusion (V/Q) lung scan"]), ("Which of the following best describes the genetic inheritance and underlying pathophysiology of Liddle syndrome?", ["A. Autosomal recessive; loss-of-function mutation in the epithelial sodium channel (ENaC).", "B. Autosomal dominant; gain-of-function mutation in the epithelial sodium channel (ENaC).", "C. X-linked recessive; deficiency of the 11-beta-hydroxysteroid dehydrogenase type 2 enzyme.", "D. Autosomal dominant; inactivating mutation in the thiazide-sensitive Na-Cl cotransporter (NCCT)."]), ("A 16-year-old boy is evaluated for severe hypertension. Lab testing reveals serum potassium of 2.8 mEq/L and metabolic alkalosis. Which combination of renin and aldosterone levels is classically expected?", ["A. High Renin, High Aldosterone", "B. Low Renin, High Aldosterone", "C. High Renin, Low Aldosterone", "D. Low Renin, Low Aldosterone"]), ("Liddle syndrome can be distinguished from primary aldosteronism by hormonal levels. Which of the following conditions shares the same hormonal profile (low renin, low aldosterone) as Liddle syndrome but is caused by an exogenous substance?", ["A. Conn's syndrome (adrenal adenoma)", "B. Chronic licorice ingestion", "C. Renal artery stenosis", "D. Spironolactone abuse"]), ("A 22-year-old female patient with Liddle syndrome requires medical management. Which medication is the most effective, mechanism-specific treatment for this condition?", ["A. Spironolactone", "B. Hydrochlorothiazide", "C. Amiloride", "D. Lisinopril"]), ("Why is genetic testing or a specific drug trial often required to distinguish Liddle syndrome from Syndrome of Apparent Mineralocorticoid Excess (SAME) or glucocorticoid-remediable aldosteronism (GRA)?", ["A. They all present with high renin and low aldosterone.", "B. They all cause severe hyperkalemia and metabolic acidosis.", "C. They all feature low renin, low aldosterone, hypertension, and hypokalemia, making them clinically indistinguishable on routine labs.", "D. Liddle syndrome is the only one that causes high blood pressure."]), ("Which of the following best describes the primary site of destruction and the most common etiology of Addison's disease in developed countries?", ["A. Destruction of the anterior pituitary gland due to ischemic necrosis.", "B. Autoimmune destruction of the adrenal cortex.", "C. Destruction of the adrenal medulla due to chronic tuberculosis infection.", "D. Neoplastic infiltration of the hypothalamus."]), ("A 28-year-old woman presents with progressive fatigue, weight loss, recurrent nausea, and severe orthostatic hypotension. Physical examination reveals striking hyperpigmentation of her skin, particularly in the palmar creases, oral mucosa, and old scars. What is the underlying mechanism responsible for this hyperpigmentation?", ["A. Excess secretion of epinephrine stimulating dermal melanocytes.", "B. Deposition of iron pigments in the skin due to chronic hemolysis.", "C. Elevated ACTH levels cross-reacting with and stimulating melanocortin-1 receptors.", "D. Severe vitamin B12 deficiency altering skin pigmentation."]), ("Which of the following sets of electrolyte and metabolic abnormalities is classically seen in a patient with untreated Addison's disease?", ["A. Hypernatremia, hypokalemia, and metabolic alkalosis.", "B. Hyponatremia, hyperkalemia, and non-anion gap metabolic acidosis.", "C. Hyponatremia, hypokalemia, and respiratory acidosis.", "D. Hypernatremia, hyperkalemia, and metabolic alkalosis."]), ("Which of the following diagnostic steps is considered the gold standard to confirm the diagnosis of Addison's disease?", ["A. A single random midnight salivary cortisol measurement.", "B. A 24-hour urinary free cortisol collection.", "C. Cosyntropin (synthetic ACTH) stimulation test.", "D. Oral glucose tolerance test."]), ("A 40-year-old male with known Addison's disease is brought to the ED with severe abdominal pain, confusion, and profound shock (BP 75/40 mmHg) following a severe viral infection. What is the most immediate and critical therapeutic intervention required?", ["A. High-dose oral fludrocortisone and fluid restriction.", "B. Intravenous administration of high-dose hydrocortisone and aggressive isotonic saline resuscitation.", "C. Urgent CT scan of the abdomen followed by broad-spectrum oral antibiotics.", "D. Intravenous insulin infusion to correct blood sugar anomalies."]), ("Which of the following sets of clinical and laboratory findings represents the classic diagnostic triad for nephrotic syndrome?", ["A. Hematuria, hypertension, and oliguria.", "B. Proteinuria (>3.5 g/24h), hypoalbuminemia (<3 g/dL), and generalized edema.", "C. Glycosuria, ketonuria, and polyuria.", "D. Azotemia, low serum complement (C3), and periorbital purpura."]), ("Patients with nephrotic syndrome are at significantly increased risk for thromboembolic events. What is the primary underlying mechanism for this hypercoagulable state?", ["A. Massive loss of clotting factors II, VII, and X in the urine.", "B. Urinary loss of endogenous anticoagulants, particularly antithrombin III (ATIII), along with increased hepatic production of procoagulants.", "C. Severe dehydration leading to absolute polycythemia.", "D. Excessive production of platelets by the kidneys."]), ("A 4-year-old boy presents with severe periorbital swelling and weight gain over the past week. Urinalysis reveals 4+ protein and no blood. He is started empirically on corticosteroid therapy, showing a dramatic improvement. What is the most likely underlying pathology?", ["A. Membranous nephropathy", "B. Minimal change disease (MCD)", "C. Focal segmental glomerulosclerosis (FSGS)", "D. Post-streptococcal glomerulonephritis (PSGN)"]), ("A 45-year-old African American male with a long history of poorly controlled HIV infection presents with nephrotic-range proteinuria and declining renal function. Which histopathological pattern is most highly associated with this patient's demographic and risk factors?", ["A. Minimal change disease", "B. Diffuse proliferative glomerulonephritis", "C. Focal segmental glomerulosclerosis (FSGS)", "D. IgA nephropathy"]), ("Why are patients with nephrotic syndrome particularly susceptible to severe bacterial infections, classically spontaneous bacterial peritonitis caused by encapsulated organisms?", ["A. Because they have a profound loss of neutrophils in the urine.", "B. Because of the urinary loss of immunoglobulins (especially IgG) and complement factors (like factor B).", "C. Because the edema fluid directly neutralizes circulating antibiotics.", "D. Because high cholesterol levels completely destroy T-lymphocytes."]), ("Alport syndrome is a hereditary disorder caused by mutations in genes encoding components of which structural protein, and what is its most common inheritance pattern?", ["A. Type I collagen; Autosomal dominant", "B. Type IV collagen; X-linked dominant", "C. Fibrillin-1; Autosomal dominant", "D. Dystrophin; X-linked recessive"]), ("A 14-year-old boy presents with recurrent episodes of gross hematuria following mild upper respiratory tract infections. Which classic extra-renal triad of symptoms is most characteristic of Alport syndrome?", ["A. Sensorineural hearing loss, anterior lenticonus, and progressive glomerulonephritis", "B. Conductive hearing loss, bilateral cataracts, and hepatic fibrosis", "C. Optic neuritis, cleft palate, and aortic root dilation", "D. Vertigo, nasal polyps, and hypertrophic cardiomyopathy"]), ("A renal biopsy is performed on a patient suspected of having Alport syndrome. Which classic ultrastructural pattern on electron microscopy confirms the diagnosis?", ["A. Diffuse subepithelial 'humps' of immune complexes", "B. Longitudinal splitting, lamellation, and alternating thinning and thickening of the glomerular basement membrane (GBM)", "C. Diffuse effacement of podocyte foot processes with a completely normal basement membrane", "D. Linear deposition of IgG along a smooth, regular basement membrane"]), ("Because the most common form of Alport syndrome is X-linked dominant, how does the clinical course typically differ between heterozygous females and hemizygous males?", ["A. Females never show any symptoms and are completely healthy carriers.", "B. Females generally experience a milder, slower disease course (often isolated hematuria), while males develop early-onset ESRD and hearing loss.", "C. Females develop severe kidney failure in early childhood, while males only show symptoms after age 60.", "D. Females only experience eye problems, while males only experience kidney problems."]), ("During the early stages of Alport syndrome, the renal biopsy can show isolated thinning of the GBM. Which benign familial condition must be differentiated from early Alport syndrome?", ["A. Membranoproliferative glomerulonephritis (MPGN)", "B. Thin basement membrane nephropathy (Benign Familial Hematuria)", "C. Focal segmental glomerulosclerosis (FSGS)", "D. IgA Nephropathy (Berger's disease)"]), ("A 35-year-old woman presents with a 4-week history of daily fevers, a painfully tender anterior neck mass radiating to her ears, suppressed TSH, elevated Free T4, and diffusely low radioactive iodine uptake. Which thyroid disorder is likely causing her FUO?", ["A. Hashimoto's thyroiditis", "B. Subacute granulomatous thyroiditis (De Quervain's)", "C. Graves' disease", "D. Papillary thyroid carcinoma"]), ("In a patient suspected of having a Thyroid Storm, which clinical scoring criteria is most widely used to evaluate the likelihood of this crisis?", ["A. Budapest Criteria", "B. Centor Criteria", "C. Burch-Wartofsky Point Scale (BWPS)", "D. Duke Criteria"]), ("A 28-year-old female is diagnosed with Graves' disease and started on antithyroid medication therapy. Three weeks later, she presents with a high fever (39.2°C) and severe sore throat, meeting criteria for neutropenic FUO. Which medication is most likely responsible, and what immediate lab test is required?", ["A. Propranolol; Serum potassium level", "B. Methimazole; Complete Blood Count (CBC) with differential", "C. Levothyroxine; Thyroid Stimulating Hormone (TSH) assay", "D. Radioactive Iodine (I-131); Serum calcium level"]), ("During the workup of a patient with FUO due to an occult intra-abdominal abscess, routine labs show low Total T3, normal-to-low T4, and a normal or slightly low TSH. What is the most likely interpretation of these findings?", ["A. Secondary hypothyroidism due to a pituitary adenoma", "B. Non-thyroidal illness syndrome (Euthyroid Sick Syndrome)", "C. Early-stage Graves' disease", "D. Factitious ingestion of exogenous thyroid hormones"]), ("A 50-year-old patient with a rapidly growing thyroid mass is being investigated for FUO. Biopsy confirms a highly aggressive thyroid malignancy associated with systemic symptoms and neoplastic fever. Which type of thyroid cancer is most notoriously linked to this aggressive presentation?", ["A. Papillary thyroid carcinoma", "B. Follicular thyroid carcinoma", "C. Anaplastic thyroid carcinoma", "D. Benign toxic adenoma"]), ("Which of the following best describes the classic anatomical distribution and transmural histopathological features of Crohn's disease?", ["A. Continuous inflammation limited strictly to the rectum and colon; superficial mucosal ulcerations.", "B. Skip lesions anywhere from the mouth to the anus, most commonly involving the terminal ileum; transmural inflammation with non-caseating granulomas.", "C. Diffuse ulcerations confined exclusively to the jejunum; absence of inflammatory cell infiltrate.", "D. Continuous transmural inflammation restricted only to the sigmoid colon; caseating granulomas with acid-fast bacilli."]), ("Due to the transmural nature of inflammation in Crohn's disease, patients are highly susceptible to specific structural complications. Which of the following is a classic complication of Crohn's disease but is rare in ulcerative colitis?", ["A. Toxic megacolon", "B. Superficial mucosal friability and continuous pseudopolyps", "C. Fistulas and perianal abscesses", "D. Ischemic colitis due to large vessel thrombosis"]), ("A 26-year-old male undergoes a colonoscopy for chronic diarrhea, weight loss, and right lower quadrant pain. Which of the following endoscopic findings is most characteristically diagnostic of Crohn's disease?", ["A. Continuous, uniform erythema with loss of vascular markings starting from the anal verge.", "B. 'Cobblestone' appearance of the mucosa with deep aphthous ulcers separated by normal tissue.", "C. Multiple concentric 'lead-pipe' rigid narrowings throughout the entire descending colon.", "D. Isolated, pedunculated adenomatous polyps in the cecum."]), ("A patient with a history of Crohn's disease presents with painful, red, raised nodules on her shins, along with worsening joint pain in her knees and ankles. Which extraintestinal manifestation of IBD is represented by these skin lesions?", ["A. Pyoderma gangrenosum", "B. Erythema nodosum", "C. Dermatitis herpetiformis", "D. Psoriasis vulgaris"]), ("A 34-year-old woman with a long history of Crohn's disease involving the terminal ileum is found to have macrocytic anemia (MCV >100 fL). Defective absorption of which specific nutrient complex is responsible for this anemia?", ["A. Iron bound to transferrin", "B. Folic acid in the proximal jejunum", "C. Vitamin B12 (cobalamin) bound to intrinsic factor", "D. Vitamin D and calcium complexes"]), ("Which of the following best describes the core bone marrow pathophysiology and cellularity characteristics of severe aplastic anemia?", ["A. Hypercellular bone marrow with clonal proliferation of blast cells.", "B. Hypocellular bone marrow with fatty replacement and absence of abnormal or malignant cells.", "C. Normocellular bone marrow with selective destruction of erythroid precursors only.", "D. Fibrotic bone marrow replacement due to excessive megakaryocyte activation."]), ("A 24-year-old man presents with progressive fatigue, multiple spontaneous bruises on his arms, and a recent high fever with a sore throat. A CBC reveals pancytopenia. Which of the following mechanisms directly accounts for the bleeding and bruising seen in this patient?", ["A. Autoimmune destruction of clotting factors VIII and IX.", "B. Severe thrombocytopenia due to impaired production of megakaryocytes.", "C. Qualitative defect in platelet aggregation caused by aspirin.", "D. Vitamin K deficiency causing prolonged prothrombin time."]), ("While most cases of aplastic anemia are idiopathic and immune-mediated, it can be triggered by specific exposures. Infection with which of the following viral agents is a well-known cause of severe, non-immune hepatitis-associated aplastic anemia?", ["A. Epstein-Barr Virus (EBV)", "B. Non-A, non-B, non-C, non-E hepatitis viruses (Seronegative Hepatitis)", "C. Human Immunodeficiency Virus (HIV)", "D. Influenza A virus"]), ("A 7-year-old girl has recurrent nosebleeds and progressive pallor. Physical examination reveals short stature, hyperpigmented skin patches (café-au-lait spots), and a missing thumb. Genetic testing reveals defective DNA cross-link repair mechanisms. What is the most likely diagnosis?", ["A. Fanconi Anemia", "B. Diamond-Blackfan Anemia", "C. Paroxysmal Nocturnal Hemoglobinuria", "D. Immune Thrombocytopenic Purpura (ITP)"]), ("In a 45-year-old patient with severe idiopathic aplastic anemia who does not have an HLA-matched sibling donor, which of the following medical regimens is considered the standard first-line immunosuppressive therapy?", ["A. High-dose empiric oral corticosteroids alone", "B. Combination of Anti-Thymocyte Globulin (ATG), Cyclosporine, and Eltrombopag", "C. Weekly plasma exchange and intravenous immunoglobulins (IVIG)", "D. Continuous low-dose multi-agent chemotherapy"]), # ── Quality Management block ───────────────────────────────────────────── ("Which of the following best describes the Donabedian model of healthcare quality?", ["A. A framework measuring cost, access, and patient satisfaction", "B. A system focused solely on clinical outcomes and mortality rates", "C. A triad of structure, process, and outcome as dimensions of quality", "D. A model comparing public vs. private healthcare quality"]), ("What primarily distinguishes quality assurance (QA) from quality improvement (QI)?", ["A. QA ensures compliance with minimum standards; QI continuously seeks to raise performance above those standards.", "B. QA is proactive; QI is reactive", "C. QA applies only to hospitals; QI applies to all facilities", "D. QA is driven by patients; QI is driven by physicians"]), ("In post-Soviet healthcare systems, quality assurance has historically relied most heavily on:", ["A. Patient satisfaction surveys and accreditation", "B. Normative control — adherence to clinical protocols and state standards", "C. Market competition among providers", "D. Independent peer review and clinical audits"]), ("'Equity' as a dimension of healthcare quality means:", ["A. Equal pay for healthcare workers", "B. Ensuring all patients receive identical treatments", "C. Distributing resources equally across all departments", "D. Care quality does not vary based on personal characteristics such as gender, ethnicity, or income"]), ("An internal quality audit differs from an external quality audit in that:", ["A. Internal audits are performed by the organization's own staff; external audits by independent parties", "B. Internal audits focus only on finance; external audits focus on clinical care", "C. External audits are voluntary; internal audits are mandatory", "D. Internal audits are always more rigorous"]), ("Healthcare accreditation differs from licensure in that accreditation:", ["A. Is mandatory for all healthcare facilities to operate", "B. Is a voluntary process evaluating whether an organization meets standards above the legal minimum", "C. Focuses only on financial compliance", "D. Is granted for a lifetime once achieved"]), ("Root Cause Analysis (RCA) in healthcare is primarily used to:", ["A. Assign individual blame for medical errors", "B. Calculate financial compensation for harmed patients", "C. Identify underlying systemic causes of an incident to prevent recurrence", "D. Rank hospitals by safety performance"]), ("A quality incident reporting system in healthcare is most effective when it promotes:", ["A. Punitive accountability to deter future errors", "B. A blame-free culture where staff can report near misses and errors without fear of punishment", "C. Confidential reporting accessible only to senior management", "D. Mandatory reporting of only serious adverse events"]), ("Why is the concept of 'efficiency' in the IOM's six dimensions of healthcare quality considered fundamentally distinct from 'effectiveness'?", ["A. Effectiveness measures whether care is delivered quickly; efficiency measures whether it is delivered by qualified staff.", "B. Effectiveness and efficiency are interchangeable terms in modern quality management frameworks.", "C. Efficiency is a financial concept only, while effectiveness is a purely clinical concept.", "D. Effectiveness refers to achieving the best possible clinical outcome based on evidence; efficiency refers to achieving outcomes without wasting resources — a highly effective intervention can be simultaneously highly inefficient."]), ("A nurse is preparing to administer medications during a busy shift. Which of the following actions is the MOST effective in preventing medication errors?", ["A. Administer medications quickly to reduce delays in patient care", "B. Rely on memory for commonly prescribed medications", "C. Follow the 'five rights' of medication administration", "D. Delegate medication administration to unlicensed staff"]), ("In Donabedian's quality framework, which triad correctly maps the evaluation dimensions of healthcare quality?", ["A. Input → Process → Outcome", "B. Personnel → Technology → Outcome", "C. Structure → Process → Outcome", "D. Planning → Delivery → Evaluation"]), ("Which of the following best characterizes the fundamental difference between quality assurance approaches in Western versus post-Soviet healthcare systems?", ["A. Western systems rely on state-mandated protocols; post-Soviet systems rely on market competition", "B. Western systems emphasize external accreditation and patient-centered standards; post-Soviet systems historically emphasized compliance with administrative norms and volume indicators", "C. Post-Soviet systems adopted ISO 9001 earlier than Western systems", "D. Western systems use no punitive mechanisms, while post-Soviet systems use only incentive-based approaches"]), ("A quality audit in healthcare is BEST distinguished from a routine clinical inspection by which characteristic?", ["A. Audits systematically compare actual performance against predetermined standards with a focus on improvement, not punishment", "B. Audits are conducted only by external government agencies", "C. Audits are limited to financial transactions and resource utilization", "D. Audits result in mandatory license suspension when deficiencies are found"]), ("Under most national healthcare quality laws, the concept of 'standard of care' serves primarily to:", ["A. Set a maximum performance ceiling that all providers must not exceed", "B. Define the minimum acceptable level of care that a reasonably competent provider would deliver in similar circumstances", "C. Establish billing codes for reimbursable procedures", "D. Mandate the specific number of staff per patient unit"]), ("A hospital reports a Caesarean section rate of 55% against a WHO benchmark of 10–15%. This is an example of which class of quality indicator?", ["A. Structural indicator — measuring resource availability", "B. Patient experience indicator — measuring subjective perception", "C. Sentinel event indicator — measuring rare catastrophic events", "D. Process indicator — measuring appropriateness of care delivery"]), ("Root Cause Analysis (RCA) in quality incident investigation is classified as which type of risk management activity?", ["A. Proactive risk identification — anticipating failures before they occur", "B. Reactive risk analysis — understanding causes after an adverse event to prevent recurrence", "C. Quantitative risk scoring — assigning numerical probability to future events", "D. External benchmarking — comparing incident rates across institutions"]), ("Which of the following is the PRIMARY systemic barrier to effective incident reporting in hospitals?", ["A. Overly complex electronic reporting forms that take more than 5 minutes to complete", "B. Lack of awareness among clinical staff that incident reporting systems exist", "C. Fear of blame, punitive consequences, and damage to professional reputation — rooted in a blame culture", "D. Inadequate financial incentives for staff who submit incident reports"]), ("A patient is prescribed metformin 500 mg orally twice daily. The ward nurse prepares metformin 500 mg but administers it intravenously due to a look-alike packaging confusion. Using the 'Five Rights' framework, which rights were violated?", ["A. Right drug and right dose only", "B. Right route and right patient only", "C. Right route — and potentially right drug if the IV formulation is a different compound — with secondary failure in right documentation", "D. Right route is the primary violation; right drug may also be violated if IV and oral metformin formulations differ in concentration or additives"]), ("A hospital implements barcode medication administration (BCMA) technology. According to evidence-based patient safety research, which error type is MOST effectively reduced by BCMA?", ["A. Prescribing errors — wrong drug selected by the physician at the point of order entry", "B. Wrong-patient and wrong-drug administration errors at the bedside — by verifying patient identity and drug match before administration", "C. Pharmacy dispensing errors — incorrect drug prepared in the pharmacy", "D. Transcription errors — incorrect copying of orders from paper to electronic systems"]), ("A 74-year-old male is admitted for elective knee replacement. He scores 55 on the Morse Fall Scale (moderate risk) and is currently on antihypertensives and a benzodiazepine. Which combination of interventions reflects the MOST evidence-based, individualized fall prevention strategy?", ["A. Bed alarm only, since the patient is independent at home and will likely manage safely", "B. Complete bed rest with bilateral side rails raised and hourly nursing checks", "C. Multifactorial intervention: medication review (especially benzodiazepine), non-slip footwear, call-bell within reach, patient education on fall risk, and supervised first ambulation post-op", "D. Transfer to a fall-prevention unit with 1:1 nursing supervision for the entire admission"]), ("The Plan-Do-Study-Act (PDSA) cycle is primarily used for:", ["A. Financial planning", "B. Staff recruitment", "C. Continuous quality improvement", "D. Medical diagnosis"]), ("Which patient is at the highest risk for a fall during hospitalization?", ["A. A 25-year-old admitted for appendicitis", "B. A 40-year-old with controlled hypertension", "C. An 82-year-old receiving sedative medication and requiring assistance with ambulation", "D. A 35-year-old receiving outpatient treatment"]), ("According to patient safety principles, the most effective strategy to reduce medication administration errors is:", ["A. Punishing staff involved in errors", "B. Encouraging voluntary reporting and system improvement", "C. Reducing incident reporting requirements", "D. Increasing patient admissions"]), ("The 'five rights' of medication administration include all of the following EXCEPT:", ["A. Right patient", "B. Right medication", "C. Right diagnosis", "D. Right dose"]), ("Which of the following is considered a patient safety outcome indicator?", ["A. Percentage of staff trained in fall prevention", "B. Compliance with medication administration policy", "C. Rate of hospital-acquired medication-related harm", "D. Number of safety meetings conducted"]), ("Which of the following is an outcome indicator of healthcare quality?", ["A. Percentage of nurses trained in medication safety", "B. Compliance rate with hand hygiene protocols", "C. Rate of patient falls with injury per 1,000 patient-days", "D. Number of safety meetings conducted each month"]), ("Which statement best describes a patient safety indicator (PSI)?", ["A. A measure used to assess hospital revenue generation", "B. A measure that identifies potential adverse events and complications resulting from healthcare delivery", "C. A measure of employee satisfaction only", "D. A measure used exclusively for staffing decisions"]), ("A hospital's ICU reports an increase in central line-associated bloodstream infections (CLABSIs) from 1.2 to 3.8 per 1,000 central line-days over six months. How should this measure be classified?", ["A. Structure indicator", "B. Process indicator", "C. Outcome indicator", "D. Financial indicator"]), ("A hospital achieved 98% compliance with hand hygiene protocols, yet the rate of healthcare-associated infections remained unchanged. What is the MOST appropriate interpretation?", ["A. Hand hygiene has no role in preventing infections", "B. High performance on a process indicator does not necessarily guarantee improvement in outcome indicators", "C. The infection data should be ignored because compliance is high", "D. The hospital should stop monitoring HAIs"]), ("A Key Performance Indicator (KPI) in healthcare should be:", ["A. Difficult to measure", "B. Specific, measurable, achievable, relevant, and time-bound (SMART)", "C. Based only on financial outcomes", "D. Used only during accreditation visits"]), ("The primary purpose of the WHO Surgical Safety Checklist is to:", ["A. Reduce hospital expenses", "B. Increase surgery duration", "C. Improve patient safety and reduce surgical complications", "D. Replace surgical protocols"]), ("Which of the following is an example of a 'near miss' medical error?", ["A. A patient dies from a wrong medication", "B. Wrong blood is prepared but detected before transfusion", "C. A patient develops a postoperative infection", "D. Surgery is performed on the wrong patient"]), ("Accreditation in healthcare mainly aims to:", ["A. Increase hospital profits only", "B. Punish healthcare workers", "C. Eliminate all risks completely", "D. Ensure compliance with quality and safety standards"]), ("Which indicator is considered an outcome indicator?", ["A. Hand hygiene compliance rate", "B. Nurse-to-patient ratio", "C. Patient mortality rate", "D. Availability of medical equipment"]), ("Which of the following is classified as an operational risk in healthcare?", ["A. Staff shortage in the emergency department", "B. Wrong-site surgery", "C. Medication allergy", "D. Hospital-acquired infection"]), ("Which situation best demonstrates a culture of patient safety?", ["A. Errors are discussed openly to improve systems", "B. Staff hide mistakes to avoid punishment", "C. Only physicians are responsible for safety", "D. Incident reports are ignored by management"]), ("A hospital reports 100% compliance with hand hygiene documentation, yet hospital-acquired infection rates continue to rise. Which of the following BEST explains this situation?", ["A. High compliance always guarantees patient safety", "B. Accreditation automatically prevents infections", "C. Documentation accuracy may not reflect actual clinical practice", "D. Infection rates are unrelated to hand hygiene"]), ("During risk assessment, a hospital identifies that ICU alarm fatigue is causing delayed responses to critical patient conditions. What is the MOST appropriate risk reduction strategy?", ["A. Increase alarm volume for all devices permanently", "B. Ignore noncritical alarms completely", "C. Implement alarm management protocols and staff training", "D. Reduce the number of ICU monitors used"]), ] # Shuffle all questions randomly random.seed(42) random.shuffle(questions) # ─── Build PPT ─────────────────────────────────────────────────────────────── prs = Presentation() prs.slide_width = Inches(13.33) prs.slide_height = Inches(7.5) DARK_BG = RGBColor(0x1A, 0x1A, 0x2E) # deep navy HEADER_BG = RGBColor(0x16, 0x21, 0x3E) # slightly lighter navy ACCENT = RGBColor(0x0F, 0x3F, 0x98) # cobalt blue for question box OPT_BG = RGBColor(0x0E, 0x2A, 0x5C) # darker blue for options TEXT_W = RGBColor(0xFF, 0xFF, 0xFF) TEXT_Y = RGBColor(0xFF, 0xD7, 0x00) # gold for Q number DIVIDER = RGBColor(0x0F, 0x3F, 0x98) blank_layout = prs.slide_layouts[6] # fully blank def add_rect(slide, x, y, w, h, fill_rgb, alpha=None): shape = slide.shapes.add_shape( 1, # MSO_SHAPE_TYPE.RECTANGLE Inches(x), Inches(y), Inches(w), Inches(h) ) shape.fill.solid() shape.fill.fore_color.rgb = fill_rgb shape.line.fill.background() return shape def add_textbox(slide, x, y, w, h, text, font_size, bold=False, color=TEXT_W, align=PP_ALIGN.LEFT, wrap=True): txb = slide.shapes.add_textbox(Inches(x), Inches(y), Inches(w), Inches(h)) txb.word_wrap = wrap tf = txb.text_frame tf.word_wrap = wrap p = tf.paragraphs[0] p.alignment = align run = p.add_run() run.text = text run.font.size = Pt(font_size) run.font.bold = bold run.font.color.rgb = color run.font.name = "Calibri" return txb # Title slide slide = prs.slides.add_slide(blank_layout) add_rect(slide, 0, 0, 13.33, 7.5, DARK_BG) add_rect(slide, 0, 3.0, 13.33, 0.06, DIVIDER) add_textbox(slide, 1, 1.5, 11.33, 1.2, "COMBINED QUIZ", 54, bold=True, color=TEXT_Y, align=PP_ALIGN.CENTER) add_textbox(slide, 1, 2.8, 11.33, 0.8, "AKTMU Clinical Sciences + Quality Management", 22, bold=False, color=TEXT_W, align=PP_ALIGN.CENTER) add_textbox(slide, 1, 4.0, 11.33, 0.6, f"Total Questions: {len(questions)} | Questions presented in random order", 16, color=RGBColor(0xAA, 0xCC, 0xFF), align=PP_ALIGN.CENTER) add_textbox(slide, 1, 5.2, 11.33, 0.5, "Select the single best answer for each question.", 14, color=RGBColor(0x88, 0xAA, 0xDD), align=PP_ALIGN.CENTER) for idx, (q_text, options) in enumerate(questions, 1): slide = prs.slides.add_slide(blank_layout) # Background add_rect(slide, 0, 0, 13.33, 7.5, DARK_BG) # Top bar add_rect(slide, 0, 0, 13.33, 0.70, HEADER_BG) # Question number badge add_rect(slide, 0.25, 0.10, 1.0, 0.50, ACCENT) add_textbox(slide, 0.25, 0.10, 1.0, 0.50, f"Q {idx}", 16, bold=True, color=TEXT_Y, align=PP_ALIGN.CENTER) # Progress text add_textbox(slide, 11.8, 0.12, 1.3, 0.40, f"{idx} / {len(questions)}", 13, color=RGBColor(0x88, 0xAA, 0xDD), align=PP_ALIGN.RIGHT) # Question box add_rect(slide, 0.25, 0.85, 12.83, 2.0, ACCENT) add_textbox(slide, 0.45, 0.92, 12.43, 1.86, q_text, 16, bold=False, color=TEXT_W) # Option colours (A/B/C/D alternating) opt_colors = [ RGBColor(0x0D, 0x34, 0x6B), RGBColor(0x0B, 0x2C, 0x5A), RGBColor(0x0D, 0x34, 0x6B), RGBColor(0x0B, 0x2C, 0x5A), ] y_start = 3.05 opt_h = 0.85 gap = 0.10 for i, opt in enumerate(options): y = y_start + i * (opt_h + gap) add_rect(slide, 0.25, y, 12.83, opt_h, opt_colors[i % 2]) # Option letter circle accent add_rect(slide, 0.35, y + 0.17, 0.45, 0.50, ACCENT) letter = opt[0] # "A", "B", "C", "D" add_textbox(slide, 0.35, y + 0.15, 0.45, 0.52, letter, 14, bold=True, color=TEXT_Y, align=PP_ALIGN.CENTER) # Option text (skip the "A. " prefix) opt_body = opt[3:] if len(opt) > 3 else opt add_textbox(slide, 0.90, y + 0.08, 12.0, opt_h - 0.16, opt_body, 13, color=TEXT_W) out = "/tmp/workspace/quiz-ppt/Combined_Quiz_Randomized.pptx" prs.save(out) print(f"Saved: {out}") print(f"Total slides: {len(prs.slides)} (1 title + {len(questions)} questions)") PYEOF