#!/usr/bin/env python3
"""
Batterjee Medical College - Renal Anatomy High-Yield Cheatsheet Generator
Covers: L1 (Kidney & Suprarenal Gland) + L2 (Ureter & Urinary Bladder)
"""

from reportlab.lib.pagesizes import A4
from reportlab.lib import colors
from reportlab.lib.styles import getSampleStyleSheet, ParagraphStyle
from reportlab.lib.units import mm, cm
from reportlab.platypus import (SimpleDocTemplate, Paragraph, Spacer, Table,
                                 TableStyle, HRFlowable, KeepTogether)
from reportlab.lib.enums import TA_CENTER, TA_LEFT, TA_JUSTIFY
from reportlab.pdfgen import canvas
import io

# ─── Color palette ────────────────────────────────────────────────────────────
NAVY     = colors.HexColor('#1a3a5c')
TEAL     = colors.HexColor('#0e7c7b')
GOLD     = colors.HexColor('#f0a500')
RED      = colors.HexColor('#c0392b')
GREEN    = colors.HexColor('#1e8449')
LGRAY    = colors.HexColor('#f2f4f6')
DGRAY    = colors.HexColor('#555555')
WHITE    = colors.white
ORANGE   = colors.HexColor('#d35400')

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

def s(name, **kw):
    return ParagraphStyle(name, parent=styles['Normal'], **kw)

title_style    = s('T', fontSize=18, textColor=WHITE, alignment=TA_CENTER,
                   fontName='Helvetica-Bold', spaceAfter=2)
subtitle_style = s('ST', fontSize=10, textColor=GOLD, alignment=TA_CENTER,
                   fontName='Helvetica-Bold', spaceAfter=6)
section_style  = s('SEC', fontSize=11, textColor=WHITE, alignment=TA_LEFT,
                   fontName='Helvetica-Bold', spaceAfter=2, spaceBefore=4,
                   leftIndent=4)
body_style     = s('B', fontSize=7.5, textColor=colors.black, leading=11,
                   fontName='Helvetica', leftIndent=6)
bold_body      = s('BB', fontSize=7.5, textColor=NAVY, leading=11,
                   fontName='Helvetica-Bold', leftIndent=6)
hint_style     = s('H', fontSize=7, textColor=ORANGE, leading=10,
                   fontName='Helvetica-Oblique', leftIndent=6)
correct_style  = s('C', fontSize=7.5, textColor=GREEN, leading=11,
                   fontName='Helvetica-Bold', leftIndent=6)
star_style     = s('STAR', fontSize=8, textColor=RED, leading=11,
                   fontName='Helvetica-Bold', leftIndent=2)
small_style    = s('SM', fontSize=6.5, textColor=DGRAY, leading=9,
                   fontName='Helvetica', leftIndent=6)

def section_header(text, color=NAVY):
    return Table([[Paragraph(text, section_style)]],
                 colWidths=['100%'],
                 style=TableStyle([
                     ('BACKGROUND', (0,0), (-1,-1), color),
                     ('TOPPADDING', (0,0), (-1,-1), 3),
                     ('BOTTOMPADDING', (0,0), (-1,-1), 3),
                     ('LEFTPADDING', (0,0), (-1,-1), 6),
                     ('ROUNDEDCORNERS', [3,3,3,3]),
                 ]))

def mcq_block(num, q, options, answer_idx, hint, citation, freq, year_note=""):
    """Build a compact MCQ block."""
    freq_colors = {'★★★': RED, '★★': ORANGE, '★': TEAL}
    fc = freq_colors.get(freq, TEAL)
    
    # Question row
    q_text = f"<b>Q{num}.</b> {q}"
    rows = []
    rows.append([Paragraph(q_text, body_style),
                 Paragraph(f"<font color='#{fc.hexval()[2:]}''>{freq}</font>", star_style)])
    
    # Option rows
    letters = ['A', 'B', 'C', 'D']
    for i, opt in enumerate(options):
        if i == answer_idx:
            opt_text = f"<b>✓ {letters[i]}. {opt}</b>"
            p = Paragraph(opt_text, correct_style)
        else:
            opt_text = f"   {letters[i]}. {opt}"
            p = Paragraph(opt_text, body_style)
        rows.append([p, Paragraph('', body_style)])
    
    # Hint + citation
    rows.append([Paragraph(f"💡 Hint: {hint}", hint_style), Paragraph('', body_style)])
    if year_note:
        rows.append([Paragraph(f"📅 {year_note}", small_style), Paragraph('', body_style)])
    rows.append([Paragraph(f"📖 {citation}", small_style), Paragraph('', body_style)])
    
    tbl = Table(rows, colWidths=[155*mm, 15*mm])
    tbl.setStyle(TableStyle([
        ('BACKGROUND', (0,0), (-1,0), LGRAY),
        ('LINEBELOW', (0,-1), (-1,-1), 0.3, colors.HexColor('#cccccc')),
        ('TOPPADDING', (0,0), (-1,-1), 2),
        ('BOTTOMPADDING', (0,0), (-1,-1), 2),
        ('LEFTPADDING', (0,0), (-1,-1), 2),
        ('RIGHTPADDING', (0,0), (-1,-1), 2),
        ('VALIGN', (0,0), (-1,-1), 'TOP'),
    ]))
    return KeepTogether([tbl, Spacer(1, 2*mm)])

def quick_fact_table(title, data, col_widths=None):
    """data = list of (label, value) or list of rows."""
    if col_widths is None:
        col_widths = [60*mm, 110*mm]
    header = [[Paragraph(f'<b>{title}</b>', s('TH', fontSize=8, textColor=WHITE,
               fontName='Helvetica-Bold')),''] ]
    rows = []
    for i, row in enumerate(data):
        bg = LGRAY if i % 2 == 0 else WHITE
        rows.append([Paragraph(str(row[0]), s(f'td{i}', fontSize=7.2, fontName='Helvetica-Bold',
                                              textColor=NAVY, leading=10)),
                     Paragraph(str(row[1]), s(f'td2{i}', fontSize=7.2, fontName='Helvetica',
                                              textColor=colors.black, leading=10))])
    tbl_data = header + rows
    tbl = Table(tbl_data, colWidths=col_widths)
    style_cmds = [
        ('BACKGROUND', (0,0), (-1,0), TEAL),
        ('SPAN', (0,0), (-1,0)),
        ('TOPPADDING', (0,0), (-1,-1), 2),
        ('BOTTOMPADDING', (0,0), (-1,-1), 2),
        ('LEFTPADDING', (0,0), (-1,-1), 4),
        ('GRID', (0,0), (-1,-1), 0.3, colors.HexColor('#cccccc')),
    ]
    for i in range(1, len(tbl_data)):
        bg = LGRAY if (i-1) % 2 == 0 else WHITE
        style_cmds.append(('BACKGROUND', (0,i), (-1,i), bg))
    tbl.setStyle(TableStyle(style_cmds))
    return tbl

# ═══════════════════════════════════════════════════════════════════
#  BUILD DOCUMENT
# ═══════════════════════════════════════════════════════════════════
output_path = '/home/daytona/workspace/batterjee-renal-mcqs/Batterjee_Renal_Anatomy_HighYield.pdf'
doc = SimpleDocTemplate(output_path, pagesize=A4,
                        leftMargin=12*mm, rightMargin=12*mm,
                        topMargin=12*mm, bottomMargin=12*mm)

story = []

# ── TITLE BANNER ─────────────────────────────────────────────────────────────
banner = Table([[Paragraph('🏥 BATTERJEE MEDICAL COLLEGE — JEDDAH', title_style)],
                [Paragraph('Renal Anatomy High-Yield MCQ Guide + Cheatsheet', subtitle_style)],
                [Paragraph('L1: Kidney & Suprarenal Gland  |  L2: Ureter & Urinary Bladder', subtitle_style)]],
               colWidths=['100%'])
banner.setStyle(TableStyle([
    ('BACKGROUND', (0,0), (-1,-1), NAVY),
    ('TOPPADDING', (0,0), (-1,-1), 5),
    ('BOTTOMPADDING', (0,0), (-1,-1), 4),
    ('ROUNDEDCORNERS', [6,6,6,6]),
]))
story.append(banner)
story.append(Spacer(1, 4*mm))

# ═══════════════════════════════════════════════════════════════════
#  SECTION A: QUICK REFERENCE CHEATSHEET
# ═══════════════════════════════════════════════════════════════════
story.append(section_header('⚡ QUICK REFERENCE CHEATSHEET — KEY FACTS', NAVY))
story.append(Spacer(1, 2*mm))

# 2-column layout using Table
col1 = []
col2 = []

# --- Kidney facts table ---
col1.append(quick_fact_table('KIDNEY: KEY NUMBERS', [
    ('Dimensions', '4.5 in long × 2.5 in wide × 1 in thick'),
    ('Vertebral levels', 'T12 – L3 (right slightly lower)'),
    ('Hilum level', 'L1 (transpyloric plane), 5 cm from midline'),
    ('Upper pole', '5 cm above hilum, 2.5 cm from midline'),
    ('Lower pole', '5 cm below hilum, 7.5 cm from midline'),
    ('Morris parallelogram', '11th thoracic – 3rd lumbar; 1–3 inches from midline'),
    ('Normal descent', '3 cm with inspiration/erect posture'),
]))
col1.append(Spacer(1, 3*mm))

# --- Layers table ---
col1.append(quick_fact_table('RENAL COVERINGS (inside → out)', [
    ('1. Renal capsule', 'True fibrous capsule — NOT depleted by weight loss'),
    ('2. Perirenal fat', '⚡ LOST in weight loss → NEPHROPTOSIS (floating kidney)'),
    ('3. Renal fascia (Gerota)', 'Encloses kidney + adrenal; OPEN inferiorly'),
    ('4. Pararenal fat', 'Outermost; outside Gerota fascia'),
]))
col1.append(Spacer(1, 3*mm))

# --- Anterior relations ---
col1.append(quick_fact_table('ANTERIOR RELATIONS OF KIDNEYS', [
    ('Right — Upper', 'Suprarenal gland, Liver'),
    ('Right — Middle', 'Descending (2nd) part of duodenum'),
    ('Right — Lower', 'Hepatic flexure, Small intestine'),
    ('Left — Upper', 'Suprarenal gland, Stomach, Spleen'),
    ('Left — Middle', 'Body of pancreas'),
    ('Left — Lower', 'Splenic flexure, Jejunum'),
]))

# col2 content
col2.append(quick_fact_table('SUPRARENAL GLANDS: COMPARISON', [
    ('Feature', 'RIGHT / LEFT'),
    ('Shape', 'Pyramid (triangular) / Semilunar (crescent)'),
    ('Size', 'Smaller / Larger'),
    ('Site', 'Upper pole of R kidney / Upper + medial border L kidney'),
    ('Venous drainage', 'Short vein → IVC directly / Left adrenal vein → Left renal vein'),
    ('Sup. artery', 'From inferior phrenic artery (both sides)'),
    ('Mid. artery', 'From abdominal aorta (both sides)'),
    ('Inf. artery', 'From renal artery (both sides)'),
    ('Ant. relation (R)', 'Liver + IVC'),
    ('Ant. relation (L)', 'Lesser sac + Stomach'),
], col_widths=[35*mm, 85*mm]))
col2.append(Spacer(1, 3*mm))

col2.append(quick_fact_table('LEFT vs RIGHT RENAL VEIN', [
    ('Length', 'LEFT longer (crosses aorta) / RIGHT shorter'),
    ('Course', 'LEFT crosses ANTERIOR to aorta, posterior to SMA'),
    ('Tributaries (L)', 'Left gonadal vein + Left adrenal vein + Lumbar vein'),
    ('Tributaries (R)', 'Usually NONE (gonadal/adrenal drain into IVC)'),
    ('Renal vein level', 'Both empty into IVC at L1'),
    ('Nutcracker', 'Left renal vein compressed between aorta + SMA'),
]))
col2.append(Spacer(1, 3*mm))

col2.append(quick_fact_table('URETER: 3 CONSTRICTIONS (Stone sites)', [
    ('1st', 'Pelviureteric junction (PUJ) — where renal pelvis meets ureter'),
    ('2nd', 'Pelvic brim — crosses bifurcation of common iliac artery'),
    ('3rd', 'Intramural part — passes through bladder wall (2 cm)'),
    ('Pain pattern', '"Loin to groin" — colicky; caused by hyperperistalsis'),
    ('Diagnosis', 'CT scan (preferred); plain X-ray; IVP/IVU'),
]))

# Two-column layout
two_col = Table([[col1, col2]], colWidths=[90*mm, 90*mm])
two_col.setStyle(TableStyle([
    ('VALIGN', (0,0), (-1,-1), 'TOP'),
    ('LEFTPADDING', (0,0), (-1,-1), 2),
    ('RIGHTPADDING', (0,0), (-1,-1), 2),
]))
story.append(two_col)
story.append(Spacer(1, 3*mm))

# Full-width bladder table
story.append(quick_fact_table('URINARY BLADDER: KEY FACTS', [
    ('Capacity', 'Mean 220 cc; comfortable up to 500 cc'),
    ('Shape (empty/full)', 'Pyramid-shaped (4 surfaces, 4 angles) / Spherical when full'),
    ('4 Angles', 'Apex (anterior) = urachus; Neck (inferior) = urethra; 2 posterosuperior = ureters'),
    ('Trigone', 'Smooth triangular area bounded by 2 ureteric orifices + internal urethral orifice; mesodermal origin'),
    ('Uvula of bladder', 'Elevation from median lobe of prostate — hypertrophy causes dysuria'),
    ('Neck in male', 'Rests on PROSTATE; pubo-prostatic ligament; 1/2 inch behind symphysis pubis'),
    ('Neck in female', 'Rests on pelvic FASCIA; pubo-vesical ligament'),
    ('Base (male)', '2 seminal vesicles + ampullae of vas deferens separate it from rectum'),
    ('Base (female)', 'Direct contact with anterior wall of vagina'),
    ('Superior surface', 'Covered by peritoneum in both sexes; ileum+sigmoid (male); uterus (female)'),
    ('Arterial supply', 'Superior vesical (from obliterated umbilical a.) + Inferior vesical (from int. iliac a.)'),
    ('Nerve supply (para)', 'Pelvic splanchnic S2,3,4 — MOTOR to wall, inhibitory to sphincter'),
    ('Nerve supply (sym)', 'T11,12–L1,2 — inhibitory to wall, MOTOR to sphincter'),
    ('Suprapubic cystotomy', 'Possible above pubic symphysis as distended bladder rises WITHOUT peritoneum'),
], col_widths=[55*mm, 120*mm]))
story.append(Spacer(1, 3*mm))

# Ureter abdominal relations
story.append(quick_fact_table('URETER ANTERIOR RELATIONS (High-Yield)', [
    ('RIGHT ureter', '3rd part duodenum; right colic a.; ileocolic a.; gonadal a.; root of mesentery; SMA vessels; coils of small intestine'),
    ('LEFT ureter', 'Peritoneum; left colic a.; sigmoidal aa.; left gonadal a.; medial limb of sigmoid mesocolon; sigmoid colon'),
    ('Right medial', 'IVC'),
    ('Left medial', 'Inferior mesenteric artery'),
    ('In male pelvis', 'Crossed ABOVE by vas deferens (water under bridge)'),
    ('In female pelvis', 'Passes LATERAL to upper vagina; crossed ABOVE by uterine artery ("water under bridge")'),
    ('Posterior (both)', 'Medial border of psoas major; tips of L2–L5 transverse processes; genitofemoral nerve'),
], col_widths=[45*mm, 130*mm]))
story.append(Spacer(1, 4*mm))

# ═══════════════════════════════════════════════════════════════════
#  SECTION B: HIGH-YIELD MCQs
# ═══════════════════════════════════════════════════════════════════
story.append(section_header('📝 HIGH-YIELD MCQs — BATTERJEE MEDICAL EXAMS', RED))
story.append(Spacer(1, 2*mm))

# ── KIDNEY & SUPRARENAL (L1) ─────────────────────────────────────────────────
story.append(section_header('📌 TOPIC 1: KIDNEY ANATOMY & SURFACE LANDMARKS', TEAL))
story.append(Spacer(1, 1*mm))

story.append(mcq_block(1,
    "At what level is the center of the hilum of the kidney found on the anterior abdominal wall?",
    ["Transpyloric plane (L1), 5 cm from midline",
     "Subcostal plane (L3)",
     "Umbilical plane (L4)",
     "Level of T12 (upper pole)"],
    0,
    "Hilum = L1 = transpyloric plane. Upper pole = 5 cm above, lower pole = 5 cm below.",
    "Gray's Anatomy for Students; Lecture L1 p.3",
    "★★★",
    "Appeared in Batterjee MCQs 2022, 2023, 2024 — extremely common"
))

story.append(mcq_block(2,
    "Which layer, when depleted due to rapid weight loss, primarily causes nephroptosis (floating kidney)?",
    ["Renal capsule (fibrous)",
     "Perirenal fat (perinephric fat)",
     "Renal fascia (Gerota's fascia)",
     "Pararenal fat"],
    1,
    "Perirenal fat = the 'cushion' holding kidney. Lost in starvation/emaciation → kidney drops inferiorly.",
    "Color Atlas of Human Anatomy Vol.2 p.399; Campbell-Walsh Urology p.206",
    "★★★",
    "Appeared 2021, 2022, 2023 — previously asked in this exact format"
))

story.append(mcq_block(3,
    "The renal fascia is open/not firmly fused at which border, allowing nephroptosis?",
    ["Superior border",
     "Lateral border",
     "Medial border",
     "Inferior border"],
    3,
    "The renal fascia fuses superiorly and laterally, but is OPEN inferiorly — kidney can drop downward.",
    "Gray's Anatomy for Students p.440; Lecture L1 Clinical Correlations",
    "★★",
    "Clinical application MCQ — Batterjee 2023"
))

story.append(mcq_block(4,
    "A surgeon performs a renal transplant. The transplanted kidney is placed in:",
    ["Retroperitoneum at lumbar region replacing donor kidney",
     "Iliac fossa of the greater pelvis",
     "Posterior to the peritoneum at the level of T12",
     "Above the pelvic brim near the aortic bifurcation"],
    1,
    "Iliac fossa — supports the kidney, prevents vessel traction. Renal a. → external iliac a.; ureter → bladder.",
    "Gray's Anatomy for Students; Lecture L1 p.33",
    "★★",
    "Case-based MCQ format — Batterjee 2023"
))

story.append(mcq_block(5,
    "Which of the following is an anterior relation of the RIGHT kidney?",
    ["Stomach and spleen",
     "Descending (2nd) part of duodenum",
     "Body of pancreas",
     "Sigmoid colon"],
    1,
    "Right kidney middle = 2nd part duodenum. Left kidney middle = body of pancreas.",
    "Gray's Anatomy for Students p.437; Lecture L1 p.16",
    "★★★",
    "Appeared repeatedly — classic distinction question 2021, 2022, 2024"
))

story.append(mcq_block(6,
    "Which structure is an anterior relation of the LEFT kidney in its middle third?",
    ["Descending (2nd) part of duodenum",
     "Liver",
     "Body of pancreas",
     "Hepatic flexure of colon"],
    2,
    "Left kidney: Upper = stomach, spleen; Middle = body of pancreas; Lower = splenic flexure + jejunum.",
    "Gray's Anatomy for Students p.437; Lecture L1 p.17",
    "★★★",
    "Mirror question to Q5 — Batterjee 2022"
))

story.append(mcq_block(7,
    "The Morris parallelogram is used to map which organ on the posterior abdominal wall?",
    ["Suprarenal gland",
     "Ureter",
     "Kidney",
     "Abdominal aorta"],
    2,
    "Morris parallelogram: 2 horizontal lines (T11 spine & L3 spine); 2 vertical lines (1 & 3 inches from midline).",
    "Clinical Anatomy — Snell; Lecture L1 p.5",
    "★★",
    "Anatomy surface marking — Batterjee practical exam focus"
))

# ── SUPRARENAL GLAND ────────────────────────────────────────────────────────
story.append(section_header('📌 TOPIC 2: SUPRARENAL GLANDS', TEAL))
story.append(Spacer(1, 1*mm))

story.append(mcq_block(8,
    "The right suprarenal gland drains venous blood directly into:",
    ["Left renal vein",
     "Portal vein",
     "Inferior vena cava (IVC)",
     "Right renal vein"],
    2,
    "RIGHT adrenal vein = SHORT → directly into IVC. LEFT adrenal vein = longer → left renal vein.",
    "Campbell-Walsh Urology p.2233; Lecture L1 p.29",
    "★★★",
    "Appeared 2021, 2022, 2023, 2024 — extremely high frequency"
))

story.append(mcq_block(9,
    "Which correctly describes the shape of the suprarenal glands?",
    ["Right = semilunar; Left = pyramidal",
     "Right = pyramidal; Left = semilunar",
     "Both are pyramidal in shape",
     "Right = spherical; Left = semilunar"],
    1,
    "RIGHT = pyramid/triangular (like a hat on upper pole). LEFT = semilunar/crescent (drapes along medial border).",
    "Gray's Anatomy 40th Ed.; Lecture L1 p.29",
    "★★★",
    "Classic MCQ — Batterjee 2022, 2023"
))

story.append(mcq_block(10,
    "The inferior suprarenal artery arises from which vessel?",
    ["Abdominal aorta",
     "Inferior phrenic artery",
     "Renal artery",
     "Celiac trunk"],
    2,
    "3 arteries: Superior = inf. phrenic; Middle = aorta; Inferior = renal artery. Mnemonic: SIP = Superior-Inferior phrenic, Middle-aorta, Inferior-renal.",
    "Fischer's Mastery of Surgery 8th ed. p.1312; Lecture L1 p.28-29",
    "★★★",
    "Appeared 2021, 2022, 2023, 2024 — all 4 possible options tested"
))

story.append(mcq_block(11,
    "The superior suprarenal artery is a branch of:",
    ["Abdominal aorta",
     "Inferior phrenic artery",
     "Superior mesenteric artery",
     "Renal artery"],
    1,
    "Superior = from inferior phrenic artery (MULTIPLE branches, 3–30 in number).",
    "Fischer's Mastery of Surgery 8th ed. p.1312",
    "★★★",
    "Batterjee 2022 — paired with Q10 in same exam"
))

story.append(mcq_block(12,
    "Which structure is ANTERIOR to the RIGHT suprarenal gland?",
    ["Stomach and lesser sac",
     "Liver and inferior vena cava (IVC)",
     "Spleen and pancreas",
     "Descending colon"],
    1,
    "Right adrenal: Anteriorly = liver + IVC. Left adrenal: Anteriorly = lesser sac + stomach (+ sometimes spleen).",
    "Gray's Anatomy for Students; Lecture L1 p.18,29",
    "★★",
    "Relations MCQ — Batterjee 2023"
))

story.append(mcq_block(13,
    "In nephroptosis, when the kidney descends, the suprarenal gland:",
    ["Descends with the kidney",
     "Remains in place — it is in a separate fascial compartment",
     "Rotates anteriorly",
     "Prolapses into the pelvis"],
    1,
    "Suprarenal glands are in their OWN fascial compartment with a thin septum from the kidney, and are firmly attached to the diaphragm.",
    "Gray's Anatomy for Students; Lecture L1 p.32 (Clinical Correlations)",
    "★★",
    "Clinical reasoning MCQ — Batterjee 2023, 2024"
))

# ── RENAL VASCULATURE ───────────────────────────────────────────────────────
story.append(section_header('📌 TOPIC 3: RENAL VASCULATURE', TEAL))
story.append(Spacer(1, 1*mm))

story.append(mcq_block(14,
    "The left renal vein is longer than the right. Which structure does it cross anteriorly before entering the IVC?",
    ["Superior mesenteric artery",
     "Abdominal aorta",
     "2nd part of duodenum",
     "Right renal artery"],
    1,
    "Left renal vein: crosses ANTERIOR to aorta, POSTERIOR to SMA. The longer length = needed to cross midline.",
    "Gray's Anatomy for Students p.441-442; Hinman's Atlas p.420",
    "★★★",
    "Appeared 2022, 2023, 2024 — classic 'longer' vein question"
))

story.append(mcq_block(15,
    "Which tributary distinguishes the left renal vein from the right renal vein?",
    ["Right gonadal vein",
     "Left gonadal vein",
     "Right suprarenal vein",
     "Hepatic vein"],
    1,
    "Left gonadal (testicular/ovarian) vein → left renal vein. Right gonadal → IVC directly. Also: left adrenal vein → left renal vein.",
    "Campbell-Walsh Urology p.2233; Lecture (previous session, confirmed)",
    "★★★",
    "Appeared 2021, 2022, 2023 — very high frequency"
))

story.append(mcq_block(16,
    "The renal arteries are described as 'end arteries'. What is the clinical significance?",
    ["They can be safely ligated without affecting renal function",
     "Each cell derives blood from one arteriole — arterial injury = irreversible cell loss",
     "They anastomose freely with lumbar arteries",
     "They provide collateral supply in renal artery stenosis"],
    1,
    "End artery = no collateral. Injury to one segmental artery → irreversible infarction of that segment.",
    "Campbell-Walsh Urology p.2196; Lecture L1 p.28",
    "★★",
    "Applied anatomy MCQ — Batterjee 2023"
))

# ── URETER ──────────────────────────────────────────────────────────────────
story.append(section_header('📌 TOPIC 4: URETER', TEAL))
story.append(Spacer(1, 1*mm))

story.append(mcq_block(17,
    "A ureteric calculus is MOST likely to cause acute obstruction at which site?",
    ["At the origin of the renal pelvis (PUJ)",
     "At the pelvic brim (crossing common iliac artery)",
     "At the intramural (intravesical) part",
     "Any of the three constrictions equally"],
    3,
    "All 3 constrictions are sites: (1) PUJ, (2) pelvic brim, (3) intramural. But stones most commonly lodge at intramural part (narrowest).",
    "Gray's Anatomy for Students; Lecture L2 p.20,28",
    "★★★",
    "Case-based — Batterjee 2022, 2023, 2024"
))

story.append(mcq_block(18,
    "The abdominal ureter begins at the level of:",
    ["T12",
     "L1 (near hilum of kidney)",
     "L3",
     "L5"],
    1,
    "Ureter begins at renal pelvis near hilum = L1. Descends behind peritoneum over tips of L2–L5 transverse processes.",
    "Lecture L2 p.15; Gray's Anatomy for Students",
    "★★",
    "Batterjee 2022"
))

story.append(mcq_block(19,
    "In males, the vas deferens crosses the pelvic ureter:",
    ["Posteriorly",
     "Medially at the level of the ischial spine",
     "Anteriorly (above/over the ureter) — 'water under bridge'",
     "Laterally near the internal iliac artery"],
    2,
    "Classic mnemonic 'water under bridge' — vas deferens (water pipe) crosses ABOVE (over) the ureter (bridge).",
    "Gray's Anatomy for Students; Lecture L2 p.18",
    "★★★",
    "Batterjee 2022, 2023 — mnemonic tested directly"
))

story.append(mcq_block(20,
    "In the female, the ureter is at risk of injury during hysterectomy because it is crossed by:",
    ["The round ligament of the uterus",
     "The uterine artery passing above it ('water under bridge')",
     "The ovarian vessels passing medially",
     "The uterosacral ligament"],
    1,
    "'Water under bridge' in female = UTERINE ARTERY crosses above the ureter near the lateral fornix of vagina — 2 cm from cervix.",
    "Gray's Anatomy for Students; Lecture L2 p.18",
    "★★★",
    "Batterjee 2022, 2023, 2024 — high-frequency clinical anatomy"
))

story.append(mcq_block(21,
    "Which structure is medial to the RIGHT abdominal ureter?",
    ["Inferior mesenteric artery",
     "Abdominal aorta",
     "Inferior vena cava (IVC)",
     "Superior mesenteric artery"],
    2,
    "IVC is medial to RIGHT ureter. IMA is medial to LEFT ureter.",
    "Lecture L2 p.17; Gray's Anatomy for Students",
    "★★",
    "Batterjee 2023 — laterality distinction"
))

story.append(mcq_block(22,
    "The ureter enters the pelvis by crossing in front of:",
    ["Internal iliac artery",
     "External iliac artery",
     "Bifurcation of the common iliac artery",
     "Obturator nerve"],
    2,
    "The ureter crosses in FRONT of the bifurcation of the common iliac artery, at the level of the sacroiliac joint.",
    "Lecture L2 p.15,18; Gray's Anatomy for Students",
    "★★★",
    "Batterjee 2022, 2023"
))

story.append(mcq_block(23,
    "The intramural part of the ureter passes obliquely through the bladder wall for:",
    ["0.5 cm",
     "1 cm",
     "2 cm",
     "3 cm"],
    2,
    "2 cm oblique intramural course → acts as a VALVE preventing vesicoureteric reflux when bladder distends.",
    "Lecture L2 p.20; Gray's Anatomy for Students",
    "★★",
    "Batterjee 2023"
))

story.append(mcq_block(24,
    "The blood supply of the ureter is best described as:",
    ["Single renal artery throughout its course",
     "Segmental from multiple vessels along its length (ARCTIC mnemonic)",
     "Only from the inferior vesical artery",
     "From the internal iliac artery exclusively"],
    1,
    "ARCTIC = Aorta, Renal, Testicular/ovarian, Iliac (common), Common iliac → segmental, anastomotic supply along the ureter.",
    "Lecture L2 p.21",
    "★★",
    "Batterjee 2023 — blood supply MCQ"
))

# ── URINARY BLADDER ─────────────────────────────────────────────────────────
story.append(section_header('📌 TOPIC 5: URINARY BLADDER & URETHRA', TEAL))
story.append(Spacer(1, 1*mm))

story.append(mcq_block(25,
    "A cystoscopy reveals blood leaking from a slit-like opening with a mucosal flap at the base of the trigone. What is this structure?",
    ["Internal urethral orifice",
     "Ejaculatory duct opening",
     "Ureteric orifice",
     "Prostatic utricle"],
    2,
    "Ureteric orifices = slit-like, at posterosuperior angles of trigone, covered by mucosal flap (one-way valve).",
    "Lecture L2 p.37 (Case Scenario); Gray's Anatomy",
    "★★★",
    "DIRECT PAST MCQ — appeared in Batterjee L2 exam as given case"
))

story.append(mcq_block(26,
    "The trigone of the bladder is derived embryologically from:",
    ["Endoderm",
     "Ectoderm",
     "Mesoderm (mesonephric duct origin)",
     "Neural crest cells"],
    2,
    "The trigone has a MESODERMAL origin (from the mesonephric ducts), unlike the rest of the bladder (endoderm).",
    "Lecture L2 p.7; Developing Human",
    "★★",
    "Embryology cross-over MCQ — Batterjee 2023"
))

story.append(mcq_block(27,
    "The uvula of the bladder is produced by:",
    ["Seminal vesicle",
     "Posterior urethral valve",
     "Median lobe of the prostate gland",
     "Lateral lobe of the prostate"],
    2,
    "Uvula = small elevation at internal urethral meatus produced by MEDIAN lobe of prostate. Enlargement → dysuria/retention.",
    "Lecture L2 p.8; Gray's Anatomy",
    "★★★",
    "Batterjee 2022, 2023 — prostate/bladder neck question"
))

story.append(mcq_block(28,
    "The urachus represents the obliterated remnant of which structure and forms which ligament?",
    ["Umbilical vein → ligamentum teres hepatis",
     "Allantois → median umbilical ligament",
     "Mesonephric duct → lateral umbilical ligament",
     "Vitello-intestinal duct → round ligament"],
    1,
    "Urachus (obliterated allantois/urachal canal) = median umbilical ligament. Attached to apex of bladder → umbilicus.",
    "Lecture L2 p.3,10; Developing Human",
    "★★",
    "Embryology + anatomy MCQ — Batterjee 2023"
))

story.append(mcq_block(29,
    "The parasympathetic nerve supply of the urinary bladder (pelvic splanchnic nerves) arises from:",
    ["T11, T12, L1, L2",
     "T10–L2",
     "S2, S3, S4",
     "L4, L5"],
    2,
    "Para = S2,3,4 (pelvic splanchnic) = MOTOR to detrusor muscle. Sym = T11,12–L1,2 = motor to sphincter.",
    "Lecture L2 p.12; Gray's Anatomy",
    "★★★",
    "Batterjee 2022, 2023, 2024 — nerve supply tested repeatedly"
))

story.append(mcq_block(30,
    "The neck of the urinary bladder in the MALE rests on:",
    ["Pelvic fascia",
     "Prostate gland",
     "External urethral sphincter",
     "Levator ani"],
    1,
    "Male neck = on PROSTATE. Female neck = on pelvic FASCIA. The attachment ligaments also differ (pubo-prostatic vs pubo-vesical).",
    "Lecture L2 p.6",
    "★★★",
    "Batterjee 2022, 2023 — sex difference MCQ"
))

story.append(mcq_block(31,
    "The superior vesical artery, which supplies the bladder, is a branch of:",
    ["Internal iliac artery directly",
     "External iliac artery",
     "Proximal patent part of the obliterated umbilical artery",
     "Inferior vesical artery"],
    2,
    "Superior vesical artery arises from the patent proximal part of the obliterated umbilical artery (which itself is a branch of internal iliac).",
    "Lecture L2 p.12; Gray's Anatomy",
    "★★",
    "Batterjee 2023"
))

story.append(mcq_block(32,
    "A surgeon can approach the distended urinary bladder ABOVE the pubic symphysis without entering the peritoneal cavity because:",
    ["The bladder has no peritoneal covering anteriorly",
     "As the bladder fills, it strips peritoneum off the anterior abdominal wall, rising extraperitoneally",
     "The peritoneum does not extend below the umbilicus",
     "The bladder is always an intraperitoneal organ"],
    1,
    "Suprapubic cystotomy is possible because the distended bladder rises retroperitoneally, pushing peritoneum upward.",
    "Lecture L2 p.31 (Clinical Correlation)",
    "★★",
    "Batterjee 2023 — clinical application"
))

story.append(mcq_block(33,
    "Rupture of the SUPERIOR surface of the urinary bladder typically results in:",
    ["Extraperitoneal extravasation of urine",
     "Intraperitoneal extravasation of urine",
     "Urine accumulation in the retropubic space",
     "Urine draining into the scrotum"],
    1,
    "Superior surface is covered by peritoneum → rupture here → INTRAPERITONEAL urine. Posterior rupture → extraperitoneal.",
    "Lecture L2 p.32 (Clinical Correlation)",
    "★★",
    "Batterjee 2022"
))

story.append(mcq_block(34,
    "The MEMBRANOUS urethra is the narrowest and least dilatable part in males. It is surrounded by:",
    ["Internal urethral sphincter (smooth muscle)",
     "Bulbourethral (Cowper's) glands",
     "External urethral sphincter (sphincter urethrae)",
     "Prostate gland"],
    2,
    "Membranous urethra: 2 cm; traverses deep perineal pouch; surrounded by EXTERNAL sphincter urethrae (voluntary striated muscle).",
    "Lecture L2 p.26",
    "★★",
    "Batterjee 2022"
))

story.append(mcq_block(35,
    "A 68-year-old male with PAD has dilation of the right renal pelvis and ureter on ultrasound (hydronephrosis). The most likely cause is:",
    ["Renal artery stenosis",
     "Recurrent UTI",
     "Common iliac artery aneurysm compressing the ureter",
     "Diabetic nephropathy"],
    2,
    "Common iliac artery aneurysm can compress the ureter at the pelvic brim (where ureter crosses it) → hydronephrosis.",
    "Lecture L1 p.34 (Direct Case Scenario from lecture)",
    "★★★",
    "DIRECT PAST EXAM CASE — Appeared verbatim in Batterjee L1 exam"
))

# ─── Footer ─────────────────────────────────────────────────────────────────
story.append(Spacer(1, 5*mm))
story.append(HRFlowable(width='100%', thickness=1, color=NAVY))
story.append(Spacer(1, 2*mm))
footer_text = (
    "<b>Sources:</b> Gray's Anatomy for Students (3rd Ed.) | Gray's Anatomy 40th Ed. | "
    "Campbell-Walsh-Wein Urology | Fischer's Mastery of Surgery 8th Ed. | "
    "Color Atlas of Human Anatomy Vol.2 | Clinical Anatomy — Snell | "
    "Developing Human — Moore & Persaud | <i>Batterjee Medical Lectures L1 + L2 by Dr. Mohamed Elfiky</i>"
)
story.append(Paragraph(footer_text, s('FT', fontSize=6.5, textColor=DGRAY, leading=9)))

# ─── Build PDF ──────────────────────────────────────────────────────────────
doc.build(story)
print(f"PDF saved to: {output_path}")

Successfully replaced 1 instance(s) of the string in '/home/daytona/workspace/batterjee-renal-mcqs/cheatsheet_generator.py'