const { Document, Packer, Paragraph, TextRun, Table, TableRow, TableCell,
        AlignmentType, HeadingLevel, BorderStyle, WidthType, ShadingType,
        VerticalAlign, PageNumber, Header, Footer } = require('docx');
const fs = require('fs');

// ─── EXAM DOCUMENT ────────────────────────────────────────────────────────────

const examDoc = new Document({
  styles: {
    default: {
      document: {
        run: { font: "Times New Roman", size: 24 }
      }
    }
  },
  sections: [{
    properties: {},
    headers: {
      default: new Header({
        children: [
          new Paragraph({
            alignment: AlignmentType.CENTER,
            children: [
              new TextRun({ text: "Anatomy of the Female Pelvic Organs — Examination", bold: true, size: 22, font: "Times New Roman" })
            ]
          })
        ]
      })
    },
    footers: {
      default: new Footer({
        children: [
          new Paragraph({
            alignment: AlignmentType.CENTER,
            children: [
              new TextRun({ text: "Page ", size: 20, font: "Times New Roman" }),
              new TextRun({ children: [PageNumber.CURRENT], size: 20, font: "Times New Roman" }),
              new TextRun({ text: " of ", size: 20, font: "Times New Roman" }),
              new TextRun({ children: [PageNumber.TOTAL_PAGES], size: 20, font: "Times New Roman" }),
            ]
          })
        ]
      })
    },
    children: [
      // Title
      new Paragraph({
        alignment: AlignmentType.CENTER,
        spacing: { after: 100 },
        children: [
          new TextRun({ text: "EXAMINATION", bold: true, size: 36, font: "Times New Roman", underline: {} })
        ]
      }),
      new Paragraph({
        alignment: AlignmentType.CENTER,
        spacing: { after: 60 },
        children: [
          new TextRun({ text: "Anatomy of the Female Pelvic Organs", bold: true, size: 28, font: "Times New Roman" })
        ]
      }),
      new Paragraph({
        alignment: AlignmentType.CENTER,
        spacing: { after: 60 },
        children: [
          new TextRun({ text: "Chapter 1 — Textbook of Gynecology", italics: true, size: 22, font: "Times New Roman" })
        ]
      }),
      new Paragraph({
        spacing: { after: 60 },
        children: [
          new TextRun({ text: "Name: ________________________    Date: ____________    Score: _____ / 100", size: 22, font: "Times New Roman" })
        ]
      }),
      new Paragraph({
        spacing: { after: 200 },
        children: [
          new TextRun({ text: "Instructions: ", bold: true, size: 22, font: "Times New Roman" }),
          new TextRun({ text: "Answer ALL questions. Read each question carefully. Time allowed: 60 minutes.", size: 22, font: "Times New Roman" })
        ]
      }),

      // ─── SECTION A ─────────────────────────────────────────────────────────
      new Paragraph({
        spacing: { before: 200, after: 100 },
        children: [
          new TextRun({ text: "SECTION A: Multiple Choice Questions (MCQ)", bold: true, size: 26, font: "Times New Roman", underline: {} })
        ]
      }),
      new Paragraph({
        spacing: { after: 160 },
        children: [
          new TextRun({ text: "(40 marks — 2 marks each. Choose the single best answer.)", italics: true, size: 22, font: "Times New Roman" })
        ]
      }),

      // Q1
      new Paragraph({ spacing: { after: 80 }, children: [new TextRun({ text: "1.  The uterus is described as a hollow pyriform organ. Its normal weight is:", bold: false, size: 22, font: "Times New Roman" })] }),
      new Paragraph({ spacing: { after: 60 }, indent: { left: 480 }, children: [new TextRun({ text: "A.  20–30 g", size: 22, font: "Times New Roman" })] }),
      new Paragraph({ spacing: { after: 60 }, indent: { left: 480 }, children: [new TextRun({ text: "B.  50–80 g", size: 22, font: "Times New Roman" })] }),
      new Paragraph({ spacing: { after: 60 }, indent: { left: 480 }, children: [new TextRun({ text: "C.  100–120 g", size: 22, font: "Times New Roman" })] }),
      new Paragraph({ spacing: { after: 160 }, indent: { left: 480 }, children: [new TextRun({ text: "D.  150–200 g", size: 22, font: "Times New Roman" })] }),

      // Q2
      new Paragraph({ spacing: { after: 80 }, children: [new TextRun({ text: "2.  The normal position of the uterus is:", size: 22, font: "Times New Roman" })] }),
      new Paragraph({ spacing: { after: 60 }, indent: { left: 480 }, children: [new TextRun({ text: "A.  Retroversion and anteflexion", size: 22, font: "Times New Roman" })] }),
      new Paragraph({ spacing: { after: 60 }, indent: { left: 480 }, children: [new TextRun({ text: "B.  Anteversion and anteflexion", size: 22, font: "Times New Roman" })] }),
      new Paragraph({ spacing: { after: 60 }, indent: { left: 480 }, children: [new TextRun({ text: "C.  Anteversion and retroflexion", size: 22, font: "Times New Roman" })] }),
      new Paragraph({ spacing: { after: 160 }, indent: { left: 480 }, children: [new TextRun({ text: "D.  Retroversion and retroflexion", size: 22, font: "Times New Roman" })] }),

      // Q3
      new Paragraph({ spacing: { after: 80 }, children: [new TextRun({ text: "3.  Which of the following is the lowermost part of the uterus?", size: 22, font: "Times New Roman" })] }),
      new Paragraph({ spacing: { after: 60 }, indent: { left: 480 }, children: [new TextRun({ text: "A.  Fundus", size: 22, font: "Times New Roman" })] }),
      new Paragraph({ spacing: { after: 60 }, indent: { left: 480 }, children: [new TextRun({ text: "B.  Corpus", size: 22, font: "Times New Roman" })] }),
      new Paragraph({ spacing: { after: 60 }, indent: { left: 480 }, children: [new TextRun({ text: "C.  Isthmus", size: 22, font: "Times New Roman" })] }),
      new Paragraph({ spacing: { after: 160 }, indent: { left: 480 }, children: [new TextRun({ text: "D.  Cervix", size: 22, font: "Times New Roman" })] }),

      // Q4
      new Paragraph({ spacing: { after: 80 }, children: [new TextRun({ text: "4.  The isthmus of the uterus measures approximately:", size: 22, font: "Times New Roman" })] }),
      new Paragraph({ spacing: { after: 60 }, indent: { left: 480 }, children: [new TextRun({ text: "A.  0.5 cm", size: 22, font: "Times New Roman" })] }),
      new Paragraph({ spacing: { after: 60 }, indent: { left: 480 }, children: [new TextRun({ text: "B.  1.0 cm", size: 22, font: "Times New Roman" })] }),
      new Paragraph({ spacing: { after: 60 }, indent: { left: 480 }, children: [new TextRun({ text: "C.  1.5 cm", size: 22, font: "Times New Roman" })] }),
      new Paragraph({ spacing: { after: 160 }, indent: { left: 480 }, children: [new TextRun({ text: "D.  2.0 cm", size: 22, font: "Times New Roman" })] }),

      // Q5
      new Paragraph({ spacing: { after: 80 }, children: [new TextRun({ text: "5.  The uterine artery crosses the ureter at which level?", size: 22, font: "Times New Roman" })] }),
      new Paragraph({ spacing: { after: 60 }, indent: { left: 480 }, children: [new TextRun({ text: "A.  At the level of the anatomical internal os", size: 22, font: "Times New Roman" })] }),
      new Paragraph({ spacing: { after: 60 }, indent: { left: 480 }, children: [new TextRun({ text: "B.  About 1.5 cm above the level of the internal os", size: 22, font: "Times New Roman" })] }),
      new Paragraph({ spacing: { after: 60 }, indent: { left: 480 }, children: [new TextRun({ text: "C.  About 1.5 cm below the level of the internal os", size: 22, font: "Times New Roman" })] }),
      new Paragraph({ spacing: { after: 160 }, indent: { left: 480 }, children: [new TextRun({ text: "D.  At the level of the external os", size: 22, font: "Times New Roman" })] }),

      // Q6
      new Paragraph({ spacing: { after: 80 }, children: [new TextRun({ text: "6.  The cavity of the uterine body on coronal section is:", size: 22, font: "Times New Roman" })] }),
      new Paragraph({ spacing: { after: 60 }, indent: { left: 480 }, children: [new TextRun({ text: "A.  Circular", size: 22, font: "Times New Roman" })] }),
      new Paragraph({ spacing: { after: 60 }, indent: { left: 480 }, children: [new TextRun({ text: "B.  Oval", size: 22, font: "Times New Roman" })] }),
      new Paragraph({ spacing: { after: 60 }, indent: { left: 480 }, children: [new TextRun({ text: "C.  Triangular", size: 22, font: "Times New Roman" })] }),
      new Paragraph({ spacing: { after: 160 }, indent: { left: 480 }, children: [new TextRun({ text: "D.  Rectangular", size: 22, font: "Times New Roman" })] }),

      // Q7
      new Paragraph({ spacing: { after: 80 }, children: [new TextRun({ text: "7.  The total length of the uterine cavity (including the cervical canal) is normally:", size: 22, font: "Times New Roman" })] }),
      new Paragraph({ spacing: { after: 60 }, indent: { left: 480 }, children: [new TextRun({ text: "A.  4–5 cm", size: 22, font: "Times New Roman" })] }),
      new Paragraph({ spacing: { after: 60 }, indent: { left: 480 }, children: [new TextRun({ text: "B.  6–7 cm", size: 22, font: "Times New Roman" })] }),
      new Paragraph({ spacing: { after: 60 }, indent: { left: 480 }, children: [new TextRun({ text: "C.  8–9 cm", size: 22, font: "Times New Roman" })] }),
      new Paragraph({ spacing: { after: 160 }, indent: { left: 480 }, children: [new TextRun({ text: "D.  10–11 cm", size: 22, font: "Times New Roman" })] }),

      // Q8
      new Paragraph({ spacing: { after: 80 }, children: [new TextRun({ text: "8.  The serous coat (perimetrium) of the uterus is:", size: 22, font: "Times New Roman" })] }),
      new Paragraph({ spacing: { after: 60 }, indent: { left: 480 }, children: [new TextRun({ text: "A.  The innermost layer", size: 22, font: "Times New Roman" })] }),
      new Paragraph({ spacing: { after: 60 }, indent: { left: 480 }, children: [new TextRun({ text: "B.  The outermost layer and invests the entire organ except on the lateral borders", size: 22, font: "Times New Roman" })] }),
      new Paragraph({ spacing: { after: 60 }, indent: { left: 480 }, children: [new TextRun({ text: "C.  The middle muscular layer", size: 22, font: "Times New Roman" })] }),
      new Paragraph({ spacing: { after: 160 }, indent: { left: 480 }, children: [new TextRun({ text: "D.  The mucous lining of the cavity", size: 22, font: "Times New Roman" })] }),

      // Q9
      new Paragraph({ spacing: { after: 80 }, children: [new TextRun({ text: "9.  The arterial supply of the uterus comes primarily from:", size: 22, font: "Times New Roman" })] }),
      new Paragraph({ spacing: { after: 60 }, indent: { left: 480 }, children: [new TextRun({ text: "A.  The ovarian artery only", size: 22, font: "Times New Roman" })] }),
      new Paragraph({ spacing: { after: 60 }, indent: { left: 480 }, children: [new TextRun({ text: "B.  The external iliac artery", size: 22, font: "Times New Roman" })] }),
      new Paragraph({ spacing: { after: 60 }, indent: { left: 480 }, children: [new TextRun({ text: "C.  The uterine artery (one on each side), arising from the internal iliac or anterior division", size: 22, font: "Times New Roman" })] }),
      new Paragraph({ spacing: { after: 160 }, indent: { left: 480 }, children: [new TextRun({ text: "D.  The superior vesical artery", size: 22, font: "Times New Roman" })] }),

      // Q10
      new Paragraph({ spacing: { after: 80 }, children: [new TextRun({ text: "10.  The sympathetic nerve supply of the uterus arises from spinal segments:", size: 22, font: "Times New Roman" })] }),
      new Paragraph({ spacing: { after: 60 }, indent: { left: 480 }, children: [new TextRun({ text: "A.  T5 and T6", size: 22, font: "Times New Roman" })] }),
      new Paragraph({ spacing: { after: 60 }, indent: { left: 480 }, children: [new TextRun({ text: "B.  T10 to L1", size: 22, font: "Times New Roman" })] }),
      new Paragraph({ spacing: { after: 60 }, indent: { left: 480 }, children: [new TextRun({ text: "C.  L2 to L4", size: 22, font: "Times New Roman" })] }),
      new Paragraph({ spacing: { after: 160 }, indent: { left: 480 }, children: [new TextRun({ text: "D.  S2 to S4 only", size: 22, font: "Times New Roman" })] }),

      // Q11
      new Paragraph({ spacing: { after: 80 }, children: [new TextRun({ text: "11.  The endocervical canal is lined mainly by:", size: 22, font: "Times New Roman" })] }),
      new Paragraph({ spacing: { after: 60 }, indent: { left: 480 }, children: [new TextRun({ text: "A.  Stratified squamous epithelium", size: 22, font: "Times New Roman" })] }),
      new Paragraph({ spacing: { after: 60 }, indent: { left: 480 }, children: [new TextRun({ text: "B.  Transitional (urothelial) epithelium", size: 22, font: "Times New Roman" })] }),
      new Paragraph({ spacing: { after: 60 }, indent: { left: 480 }, children: [new TextRun({ text: "C.  Single layer of tall columnar epithelium with basal nuclei", size: 22, font: "Times New Roman" })] }),
      new Paragraph({ spacing: { after: 160 }, indent: { left: 480 }, children: [new TextRun({ text: "D.  Cuboidal epithelium", size: 22, font: "Times New Roman" })] }),

      // Q12
      new Paragraph({ spacing: { after: 80 }, children: [new TextRun({ text: "12.  The transitional zone (transformation zone) of the cervix is clinically important because:", size: 22, font: "Times New Roman" })] }),
      new Paragraph({ spacing: { after: 60 }, indent: { left: 480 }, children: [new TextRun({ text: "A.  It is resistant to infections", size: 22, font: "Times New Roman" })] }),
      new Paragraph({ spacing: { after: 60 }, indent: { left: 480 }, children: [new TextRun({ text: "B.  It is static and never changes", size: 22, font: "Times New Roman" })] }),
      new Paragraph({ spacing: { after: 60 }, indent: { left: 480 }, children: [new TextRun({ text: "C.  It is the site of highest risk for severe dysplasia, carcinoma in situ, or invasive carcinoma", size: 22, font: "Times New Roman" })] }),
      new Paragraph({ spacing: { after: 160 }, indent: { left: 480 }, children: [new TextRun({ text: "D.  It secretes mucus that forms the mucus plug", size: 22, font: "Times New Roman" })] }),

      // Q13
      new Paragraph({ spacing: { after: 80 }, children: [new TextRun({ text: "13.  At puberty, the body-to-cervix ratio of the uterus becomes:", size: 22, font: "Times New Roman" })] }),
      new Paragraph({ spacing: { after: 60 }, indent: { left: 480 }, children: [new TextRun({ text: "A.  1:2", size: 22, font: "Times New Roman" })] }),
      new Paragraph({ spacing: { after: 60 }, indent: { left: 480 }, children: [new TextRun({ text: "B.  1:1", size: 22, font: "Times New Roman" })] }),
      new Paragraph({ spacing: { after: 60 }, indent: { left: 480 }, children: [new TextRun({ text: "C.  2:1", size: 22, font: "Times New Roman" })] }),
      new Paragraph({ spacing: { after: 160 }, indent: { left: 480 }, children: [new TextRun({ text: "D.  3:1", size: 22, font: "Times New Roman" })] }),

      // Q14
      new Paragraph({ spacing: { after: 80 }, children: [new TextRun({ text: "14.  The fallopian tubes measure approximately:", size: 22, font: "Times New Roman" })] }),
      new Paragraph({ spacing: { after: 60 }, indent: { left: 480 }, children: [new TextRun({ text: "A.  5 cm", size: 22, font: "Times New Roman" })] }),
      new Paragraph({ spacing: { after: 60 }, indent: { left: 480 }, children: [new TextRun({ text: "B.  10 cm", size: 22, font: "Times New Roman" })] }),
      new Paragraph({ spacing: { after: 60 }, indent: { left: 480 }, children: [new TextRun({ text: "C.  15 cm", size: 22, font: "Times New Roman" })] }),
      new Paragraph({ spacing: { after: 160 }, indent: { left: 480 }, children: [new TextRun({ text: "D.  20 cm", size: 22, font: "Times New Roman" })] }),

      // Q15
      new Paragraph({ spacing: { after: 80 }, children: [new TextRun({ text: "15.  The abdominal ostium (fimbrial end) of the fallopian tube has a diameter of:", size: 22, font: "Times New Roman" })] }),
      new Paragraph({ spacing: { after: 60 }, indent: { left: 480 }, children: [new TextRun({ text: "A.  1 mm", size: 22, font: "Times New Roman" })] }),
      new Paragraph({ spacing: { after: 60 }, indent: { left: 480 }, children: [new TextRun({ text: "B.  2 mm", size: 22, font: "Times New Roman" })] }),
      new Paragraph({ spacing: { after: 60 }, indent: { left: 480 }, children: [new TextRun({ text: "C.  5 mm", size: 22, font: "Times New Roman" })] }),
      new Paragraph({ spacing: { after: 160 }, indent: { left: 480 }, children: [new TextRun({ text: "D.  10 mm", size: 22, font: "Times New Roman" })] }),

      // Q16
      new Paragraph({ spacing: { after: 80 }, children: [new TextRun({ text: "16.  In which layer of the fallopian tube are the folds most complex?", size: 22, font: "Times New Roman" })] }),
      new Paragraph({ spacing: { after: 60 }, indent: { left: 480 }, children: [new TextRun({ text: "A.  Isthmus", size: 22, font: "Times New Roman" })] }),
      new Paragraph({ spacing: { after: 60 }, indent: { left: 480 }, children: [new TextRun({ text: "B.  Interstitial part", size: 22, font: "Times New Roman" })] }),
      new Paragraph({ spacing: { after: 60 }, indent: { left: 480 }, children: [new TextRun({ text: "C.  Ampulla", size: 22, font: "Times New Roman" })] }),
      new Paragraph({ spacing: { after: 160 }, indent: { left: 480 }, children: [new TextRun({ text: "D.  Infundibulum", size: 22, font: "Times New Roman" })] }),

      // Q17
      new Paragraph({ spacing: { after: 80 }, children: [new TextRun({ text: "17.  The ovary in a nulliparous woman lies in the:", size: 22, font: "Times New Roman" })] }),
      new Paragraph({ spacing: { after: 60 }, indent: { left: 480 }, children: [new TextRun({ text: "A.  Presacral space", size: 22, font: "Times New Roman" })] }),
      new Paragraph({ spacing: { after: 60 }, indent: { left: 480 }, children: [new TextRun({ text: "B.  Ovarian fossa on the lateral pelvic wall", size: 22, font: "Times New Roman" })] }),
      new Paragraph({ spacing: { after: 60 }, indent: { left: 480 }, children: [new TextRun({ text: "C.  Broad ligament only", size: 22, font: "Times New Roman" })] }),
      new Paragraph({ spacing: { after: 160 }, indent: { left: 480 }, children: [new TextRun({ text: "D.  Pararectal space", size: 22, font: "Times New Roman" })] }),

      // Q18
      new Paragraph({ spacing: { after: 80 }, children: [new TextRun({ text: "18.  Arterial supply to the ovary comes from:", size: 22, font: "Times New Roman" })] }),
      new Paragraph({ spacing: { after: 60 }, indent: { left: 480 }, children: [new TextRun({ text: "A.  The internal iliac artery", size: 22, font: "Times New Roman" })] }),
      new Paragraph({ spacing: { after: 60 }, indent: { left: 480 }, children: [new TextRun({ text: "B.  The ovarian artery, a branch of the abdominal aorta", size: 22, font: "Times New Roman" })] }),
      new Paragraph({ spacing: { after: 60 }, indent: { left: 480 }, children: [new TextRun({ text: "C.  The external iliac artery", size: 22, font: "Times New Roman" })] }),
      new Paragraph({ spacing: { after: 160 }, indent: { left: 480 }, children: [new TextRun({ text: "D.  The superior mesenteric artery", size: 22, font: "Times New Roman" })] }),

      // Q19
      new Paragraph({ spacing: { after: 80 }, children: [new TextRun({ text: "19.  The functional units of the ovary's cortex are:", size: 22, font: "Times New Roman" })] }),
      new Paragraph({ spacing: { after: 60 }, indent: { left: 480 }, children: [new TextRun({ text: "A.  Hilus cells", size: 22, font: "Times New Roman" })] }),
      new Paragraph({ spacing: { after: 60 }, indent: { left: 480 }, children: [new TextRun({ text: "B.  Follicular structures (primordial, maturing, Graafian follicles, and corpus luteum)", size: 22, font: "Times New Roman" })] }),
      new Paragraph({ spacing: { after: 60 }, indent: { left: 480 }, children: [new TextRun({ text: "C.  Tunica albuginea cells only", size: 22, font: "Times New Roman" })] }),
      new Paragraph({ spacing: { after: 160 }, indent: { left: 480 }, children: [new TextRun({ text: "D.  Stromal cells of the medulla", size: 22, font: "Times New Roman" })] }),

      // Q20
      new Paragraph({ spacing: { after: 80 }, children: [new TextRun({ text: "20.  The female urethra measures approximately:", size: 22, font: "Times New Roman" })] }),
      new Paragraph({ spacing: { after: 60 }, indent: { left: 480 }, children: [new TextRun({ text: "A.  2 cm, diameter 3 mm", size: 22, font: "Times New Roman" })] }),
      new Paragraph({ spacing: { after: 60 }, indent: { left: 480 }, children: [new TextRun({ text: "B.  4 cm, diameter 6 mm", size: 22, font: "Times New Roman" })] }),
      new Paragraph({ spacing: { after: 60 }, indent: { left: 480 }, children: [new TextRun({ text: "C.  6 cm, diameter 8 mm", size: 22, font: "Times New Roman" })] }),
      new Paragraph({ spacing: { after: 160 }, indent: { left: 480 }, children: [new TextRun({ text: "D.  8 cm, diameter 10 mm", size: 22, font: "Times New Roman" })] }),

      // ─── SECTION B ─────────────────────────────────────────────────────────
      new Paragraph({
        spacing: { before: 300, after: 100 },
        children: [
          new TextRun({ text: "SECTION B: Short Answer Questions (SAQ)", bold: true, size: 26, font: "Times New Roman", underline: {} })
        ]
      }),
      new Paragraph({
        spacing: { after: 160 },
        children: [
          new TextRun({ text: "(30 marks — 5 marks each. Answer in 4–6 sentences or bullet points.)", italics: true, size: 22, font: "Times New Roman" })
        ]
      }),

      new Paragraph({ spacing: { after: 60 }, children: [new TextRun({ text: "1.  Describe the measurements and parts of the uterus. Include the dimensions of the body, isthmus, and cervix.", size: 22, font: "Times New Roman" })] }),
      new Paragraph({ spacing: { after: 60 }, indent: { left: 480 }, children: [new TextRun({ text: "Answer: _______________________________________________________________", size: 22, font: "Times New Roman" })] }),
      new Paragraph({ spacing: { after: 60 }, indent: { left: 480 }, children: [new TextRun({ text: "________________________________________________________________________", size: 22, font: "Times New Roman" })] }),
      new Paragraph({ spacing: { after: 160 }, indent: { left: 480 }, children: [new TextRun({ text: "________________________________________________________________________", size: 22, font: "Times New Roman" })] }),

      new Paragraph({ spacing: { after: 60 }, children: [new TextRun({ text: "2.  Name and briefly describe the THREE layers of the uterine wall (body).", size: 22, font: "Times New Roman" })] }),
      new Paragraph({ spacing: { after: 60 }, indent: { left: 480 }, children: [new TextRun({ text: "Answer: _______________________________________________________________", size: 22, font: "Times New Roman" })] }),
      new Paragraph({ spacing: { after: 60 }, indent: { left: 480 }, children: [new TextRun({ text: "________________________________________________________________________", size: 22, font: "Times New Roman" })] }),
      new Paragraph({ spacing: { after: 160 }, indent: { left: 480 }, children: [new TextRun({ text: "________________________________________________________________________", size: 22, font: "Times New Roman" })] }),

      new Paragraph({ spacing: { after: 60 }, children: [new TextRun({ text: "3.  Describe the blood supply of the uterus, including the key anatomical landmark where the uterine artery crosses the ureter.", size: 22, font: "Times New Roman" })] }),
      new Paragraph({ spacing: { after: 60 }, indent: { left: 480 }, children: [new TextRun({ text: "Answer: _______________________________________________________________", size: 22, font: "Times New Roman" })] }),
      new Paragraph({ spacing: { after: 60 }, indent: { left: 480 }, children: [new TextRun({ text: "________________________________________________________________________", size: 22, font: "Times New Roman" })] }),
      new Paragraph({ spacing: { after: 160 }, indent: { left: 480 }, children: [new TextRun({ text: "________________________________________________________________________", size: 22, font: "Times New Roman" })] }),

      new Paragraph({ spacing: { after: 60 }, children: [new TextRun({ text: "4.  List the FOUR parts of the fallopian tube and state the diameter at each end.", size: 22, font: "Times New Roman" })] }),
      new Paragraph({ spacing: { after: 60 }, indent: { left: 480 }, children: [new TextRun({ text: "Answer: _______________________________________________________________", size: 22, font: "Times New Roman" })] }),
      new Paragraph({ spacing: { after: 60 }, indent: { left: 480 }, children: [new TextRun({ text: "________________________________________________________________________", size: 22, font: "Times New Roman" })] }),
      new Paragraph({ spacing: { after: 160 }, indent: { left: 480 }, children: [new TextRun({ text: "________________________________________________________________________", size: 22, font: "Times New Roman" })] }),

      new Paragraph({ spacing: { after: 60 }, children: [new TextRun({ text: "5.  Describe the changes in the uterus with age from birth to menopause, focusing on the body-to-cervix ratio.", size: 22, font: "Times New Roman" })] }),
      new Paragraph({ spacing: { after: 60 }, indent: { left: 480 }, children: [new TextRun({ text: "Answer: _______________________________________________________________", size: 22, font: "Times New Roman" })] }),
      new Paragraph({ spacing: { after: 60 }, indent: { left: 480 }, children: [new TextRun({ text: "________________________________________________________________________", size: 22, font: "Times New Roman" })] }),
      new Paragraph({ spacing: { after: 160 }, indent: { left: 480 }, children: [new TextRun({ text: "________________________________________________________________________", size: 22, font: "Times New Roman" })] }),

      new Paragraph({ spacing: { after: 60 }, children: [new TextRun({ text: "6.  Describe the structural components and two main functions of the ovary.", size: 22, font: "Times New Roman" })] }),
      new Paragraph({ spacing: { after: 60 }, indent: { left: 480 }, children: [new TextRun({ text: "Answer: _______________________________________________________________", size: 22, font: "Times New Roman" })] }),
      new Paragraph({ spacing: { after: 60 }, indent: { left: 480 }, children: [new TextRun({ text: "________________________________________________________________________", size: 22, font: "Times New Roman" })] }),
      new Paragraph({ spacing: { after: 160 }, indent: { left: 480 }, children: [new TextRun({ text: "________________________________________________________________________", size: 22, font: "Times New Roman" })] }),

      // ─── SECTION C ─────────────────────────────────────────────────────────
      new Paragraph({
        spacing: { before: 300, after: 100 },
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      new Paragraph({ spacing: { after: 60 }, indent: { left: 480 }, children: [new TextRun({ text: "________________________________________________________________________", size: 22, font: "Times New Roman" })] }),
      new Paragraph({ spacing: { after: 160 }, indent: { left: 480 }, children: [new TextRun({ text: "________________________________________________________________________", size: 22, font: "Times New Roman" })] }),

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      // ─── ANSWER KEY ────────────────────────────────────────────────────────
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// ─── NOTES ON SUPPORT OF THE UTERUS ──────────────────────────────────────────

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            children: [
              new TextRun({ text: "Textbook of Gynecology — Chapter 1: Anatomy of the Female Pelvic Organs", bold: true, size: 20, font: "Times New Roman", italics: true })
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    children: [
      // Title
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          new TextRun({ text: "SUPPORT OF THE UTERUS", bold: true, size: 36, font: "Times New Roman", underline: {} })
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          new TextRun({ text: "Source: Textbook of Gynecology, Chapter 1", italics: true, size: 22, font: "Times New Roman" })
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      // ─── 1. OVERVIEW ───────────────────────────────────────────────────────
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          new TextRun({ text: "1.  NORMAL POSITION OF THE UTERUS", bold: true, size: 26, font: "Times New Roman", underline: {} })
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        children: [
          new TextRun({ text: "The normal position of the uterus is ", size: 22, font: "Times New Roman" }),
          new TextRun({ text: "anteversion and anteflexion.", bold: true, size: 22, font: "Times New Roman" }),
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          new TextRun({ text: "  •  ", bold: true, size: 22, font: "Times New Roman" }),
          new TextRun({ text: "Anteversion", bold: true, size: 22, font: "Times New Roman" }),
          new TextRun({ text: ": The long axis of the cervix is directed to the long axis of the vagina at an angle of approximately 90 degrees.", size: 22, font: "Times New Roman" }),
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          new TextRun({ text: "Anteflexion", bold: true, size: 22, font: "Times New Roman" }),
          new TextRun({ text: ": The long axis of the body is related to the long axis of the cervix at approximately 120 degrees.", size: 22, font: "Times New Roman" }),
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        children: [
          new TextRun({ text: "  •  In erect posture: ", size: 22, font: "Times New Roman" }),
          new TextRun({ text: "the internal os lies on the upper border of the symphysis pubis", italics: true, size: 22, font: "Times New Roman" }),
          new TextRun({ text: " and the external os lies at the level of the ischial spines.", size: 22, font: "Times New Roman" }),
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        children: [
          new TextRun({ text: "  •  In 15–20% of women, the uterus remains in a retroverted position (this is a normal variant).", size: 22, font: "Times New Roman" }),
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        children: [
          new TextRun({ text: "  •  The cervix is directed to the left (levorotation), keeping it in close relation with the left ureter.", size: 22, font: "Times New Roman" }),
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      // ─── 2. FACTORS OF SUPPORT ─────────────────────────────────────────────
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        children: [
          new TextRun({ text: "Support of the uterus is provided by two broad categories:", size: 22, font: "Times New Roman" })
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          new TextRun({ text: "  A.  ", bold: true, size: 22, font: "Times New Roman" }),
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          new TextRun({ text: "  B.  ", bold: true, size: 22, font: "Times New Roman" }),
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          new TextRun({ text: "Key point: ", bold: true, italics: true, size: 22, font: "Times New Roman" }),
          new TextRun({ text: "The uterus is MAINLY supported by the pelvic floor muscles and perineal body, NOT primarily by the ligaments.", bold: false, italics: true, size: 22, font: "Times New Roman" }),
        ]
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      // ─── 2A PRIMARY ────────────────────────────────────────────────────────
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          new TextRun({ text: "A.  Pelvic Floor (Primary Support)", bold: true, size: 24, font: "Times New Roman" })
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          new TextRun({ text: "  •  ", size: 22, font: "Times New Roman" }),
          new TextRun({ text: "Levator ani muscles", bold: true, size: 22, font: "Times New Roman" }),
          new TextRun({ text: ": Form the muscular pelvic diaphragm and provide the main structural platform on which the pelvic organs rest.", size: 22, font: "Times New Roman" }),
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          new TextRun({ text: "  •  ", size: 22, font: "Times New Roman" }),
          new TextRun({ text: "Perineal body", bold: true, size: 22, font: "Times New Roman" }),
          new TextRun({ text: ": A fibromuscular node at the center of the perineum that anchors multiple muscles. Its integrity is essential for pelvic support.", size: 22, font: "Times New Roman" }),
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        children: [
          new TextRun({ text: "  •  ", size: 22, font: "Times New Roman" }),
          new TextRun({ text: "Endopelvic fascia and parametrium", bold: true, size: 22, font: "Times New Roman" }),
          new TextRun({ text: ": Dense connective tissue condensations around the cervix and vagina that distribute load to the pelvic walls.", size: 22, font: "Times New Roman" }),
        ]
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      // ─── 2B LIGAMENTS ──────────────────────────────────────────────────────
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          new TextRun({ text: "B.  Ligamentous Support (Passive Supports)", bold: true, size: 24, font: "Times New Roman" })
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        children: [
          new TextRun({ text: "The following ligaments anchor the uterus, but their role is secondary to pelvic floor muscle tone:", size: 22, font: "Times New Roman" })
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      }),

      // Round ligament
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          new TextRun({ text: "i.  Round Ligament of the Uterus", bold: true, size: 24, font: "Times New Roman", underline: {} })
        ]
      }),
      new Paragraph({ spacing: { after: 60 }, children: [new TextRun({ text: "  •  Arises near the uterine horns, lateral to the fallopian tube.", size: 22, font: "Times New Roman" })] }),
      new Paragraph({ spacing: { after: 60 }, children: [new TextRun({ text: "  •  Contains smooth muscle cells.", size: 22, font: "Times New Roman" })] }),
      new Paragraph({ spacing: { after: 60 }, children: [new TextRun({ text: "  •  Passes through the inguinal canal and ends in the subcutaneous fat of the labia majora.", size: 22, font: "Times New Roman" })] }),
      new Paragraph({ spacing: { after: 60 }, children: [new TextRun({ text: "  •  Courses inferolaterally toward the internal inguinal ring.", size: 22, font: "Times New Roman" })] }),
      new Paragraph({ spacing: { after: 60 }, children: [new TextRun({ text: "  •  Derived from the gonadal fold; a continuation of the suspensory ligament of the ovary.", size: 22, font: "Times New Roman" })] }),
      new Paragraph({ spacing: { after: 80 }, children: [new TextRun({ text: "  •  Function: Helps maintain anteversion of the uterus (a minor role; it does NOT provide major structural support).", italics: true, size: 22, font: "Times New Roman" })] }),

      // Broad ligament
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        spacing: { before: 120, after: 60 },
        children: [
          new TextRun({ text: "ii.  Broad Ligament of the Uterus", bold: true, size: 24, font: "Times New Roman", underline: {} })
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      new Paragraph({ spacing: { after: 60 }, children: [new TextRun({ text: "  •  A double peritoneal fold between the lateral margin of the uterus and the lateral pelvic wall.", size: 22, font: "Times New Roman" })] }),
      new Paragraph({ spacing: { after: 60 }, children: [new TextRun({ text: "  •  Contains the fallopian tube (in its upper free border), the round ligament, ovarian ligament, uterine and ovarian vessels, ureter, lymphatics, and nerves.", size: 22, font: "Times New Roman" })] }),
      new Paragraph({ spacing: { after: 60 }, children: [new TextRun({ text: "  •  Divisions: Mesosalpinx (upper), mesovarium (posterior), mesometrium (largest, lateral).", size: 22, font: "Times New Roman" })] }),
      new Paragraph({ spacing: { after: 60 }, children: [new TextRun({ text: "  •  The double folds of peritoneum are attached laterally between which the uterine artery ascends up.", size: 22, font: "Times New Roman" })] }),
      new Paragraph({
        spacing: { after: 80 },
        children: [
          new TextRun({ text: "  •  Function: ", size: 22, font: "Times New Roman" }),
          new TextRun({ text: "Does NOT provide significant support to the uterus", bold: true, italics: true, size: 22, font: "Times New Roman" }),
          new TextRun({ text: " — it is mainly a peritoneal drape/mesentery carrying neurovascular structures.", size: 22, font: "Times New Roman" }),
        ]
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      // Cardinal (Mackenrodt's) ligament
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        spacing: { before: 120, after: 60 },
        children: [
          new TextRun({ text: "iii.  Cardinal Ligament (Mackenrodt's / Transverse Cervical Ligament)", bold: true, size: 24, font: "Times New Roman", underline: {} })
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      new Paragraph({ spacing: { after: 60 }, children: [new TextRun({ text: "  •  A condensation of connective tissue at the base of the broad ligament.", size: 22, font: "Times New Roman" })] }),
      new Paragraph({ spacing: { after: 60 }, children: [new TextRun({ text: "  •  Extends from the cervix and upper vagina laterally to the pelvic wall (pelvic diaphragm).", size: 22, font: "Times New Roman" })] }),
      new Paragraph({ spacing: { after: 60 }, children: [new TextRun({ text: "  •  The uterine arteries travel within the cardinal ligament before ascending the lateral aspect of the uterus.", size: 22, font: "Times New Roman" })] }),
      new Paragraph({ spacing: { after: 60 }, children: [new TextRun({ text: "  •  Provides support to the cervix and upper vagina.", size: 22, font: "Times New Roman" })] }),
      new Paragraph({ spacing: { after: 60 }, children: [new TextRun({ text: "  •  Contributes to support of the bladder base.", size: 22, font: "Times New Roman" })] }),
      new Paragraph({ spacing: { after: 60 }, children: [new TextRun({ text: "  •  Attachment of Mackenrodt's ligament extends from the internal os down to the supravaginal cervix and lateral vaginal wall.", size: 22, font: "Times New Roman" })] }),
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        children: [
          new TextRun({ text: "  •  Clinical relevance: ", bold: true, size: 22, font: "Times New Roman" }),
          new TextRun({ text: "Damage during childbirth or surgery leads to uterine prolapse and bladder base descent. The ureter lies medial to this ligament — risk of ureteric injury during hysterectomy.", size: 22, font: "Times New Roman" }),
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      // Uterosacral ligament
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          new TextRun({ text: "iv.  Uterosacral Ligament (Rectouterine Ligament / Sacrouterine Ligament)", bold: true, size: 24, font: "Times New Roman", underline: {} })
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      }),
      new Paragraph({ spacing: { after: 60 }, children: [new TextRun({ text: "  •  A peritoneal fold (rectouterine fold) containing dense subperitoneal connective tissue and autonomic nerve fibers of the inferior hypogastric nerve plexus.", size: 22, font: "Times New Roman" })] }),
      new Paragraph({ spacing: { after: 60 }, children: [new TextRun({ text: "  •  Arises from the cervix and upper vagina, passes posterolaterally, and attaches to the posterolateral pelvic wall (sacrum and coccygeus muscle area).", size: 22, font: "Times New Roman" })] }),
      new Paragraph({ spacing: { after: 60 }, children: [new TextRun({ text: "  •  The tissue alongside the cervix ascends to the posterolateral pelvic wall.", size: 22, font: "Times New Roman" })] }),
      new Paragraph({ spacing: { after: 60 }, children: [new TextRun({ text: "  •  Provides support to the cervix and upper vagina; interdigitates with fibers from the cardinal ligament near the cervix.", size: 22, font: "Times New Roman" })] }),
      new Paragraph({ spacing: { after: 60 }, children: [new TextRun({ text: "  •  Bounds the rectouterine pouch (pouch of Douglas) on each side.", size: 22, font: "Times New Roman" })] }),
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        spacing: { after: 80 },
        children: [
          new TextRun({ text: "  •  Clinical relevance: ", bold: true, size: 22, font: "Times New Roman" }),
          new TextRun({ text: "Uterine prolapse is generally the result of poor cardinal or uterosacral ligament support, allowing downward protrusion of the cervix and uterus toward the introitus. Endometriosis nodules commonly implant on these ligaments.", size: 22, font: "Times New Roman" }),
        ]
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      // Pubocervical ligament
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          new TextRun({ text: "v.  Pubocervical Ligament (Anterior Parametrium)", bold: true, size: 24, font: "Times New Roman", underline: {} })
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      new Paragraph({ spacing: { after: 60 }, children: [new TextRun({ text: "  •  Connects the cervix to the pubic bones anteriorly.", size: 22, font: "Times New Roman" })] }),
      new Paragraph({ spacing: { after: 80 }, children: [new TextRun({ text: "  •  Together with the cardinal and uterosacral ligaments, they stabilize the uterus in the pelvic cavity.", size: 22, font: "Times New Roman" })] }),

      // ─── 3. DELANCEY LEVELS ────────────────────────────────────────────────
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        children: [
          new TextRun({ text: "3.  LEVELS OF PELVIC SUPPORT (DeLancey Classification)", bold: true, size: 26, font: "Times New Roman", underline: {} })
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      new Paragraph({ spacing: { after: 80 }, children: [new TextRun({ text: "Pelvic organ support has been described as three functional levels:", size: 22, font: "Times New Roman" })] }),
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        spacing: { after: 60 },
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          new TextRun({ text: "  Level I — Apical support: ", bold: true, size: 22, font: "Times New Roman" }),
          new TextRun({ text: "Uterosacral/cardinal ligament complex — maintains vaginal length and axis. Vertical fiber orientation suspends the uterus and upper vagina.", size: 22, font: "Times New Roman" }),
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        spacing: { after: 60 },
        children: [
          new TextRun({ text: "  Level II — Mid-vaginal support: ", bold: true, size: 22, font: "Times New Roman" }),
          new TextRun({ text: "Lateral attachments of the mid-vagina to the arcus tendineus fasciae pelvis (white line) and levator ani. Prevents cystocele and rectocele.", size: 22, font: "Times New Roman" }),
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      }),
      new Paragraph({
        spacing: { after: 60 },
        children: [
          new TextRun({ text: "  Level III — Distal support: ", bold: true, size: 22, font: "Times New Roman" }),
          new TextRun({ text: "Perineal membrane, perineal body, and external anal sphincter complex at the pelvic outlet.", size: 22, font: "Times New Roman" }),
        ]
      }),

      // ─── 4. RELATIONS RELEVANT TO SUPPORT ──────────────────────────────────
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          new TextRun({ text: "4.  ANATOMICAL RELATIONS RELEVANT TO UTERINE SUPPORT", bold: true, size: 26, font: "Times New Roman", underline: {} })
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      new Paragraph({ spacing: { after: 80 }, children: [new TextRun({ text: "  •  Anteriorly: The uterus is separated from the bladder by the vesicouterine pouch. Below the internal os it is separated from the bladder base by loose areolar tissue.", size: 22, font: "Times New Roman" })] }),
      new Paragraph({ spacing: { after: 80 }, children: [new TextRun({ text: "  •  Posteriorly: Covered by peritoneum forming the anterior wall of the pouch of Douglas (rectouterine pouch), which contains coils of intestine.", size: 22, font: "Times New Roman" })] }),
      new Paragraph({ spacing: { after: 80 }, children: [new TextRun({ text: "  •  Laterally: The broad ligaments attach the uterus to the lateral pelvic wall. The uterine artery ascends in the base of the broad ligament.", size: 22, font: "Times New Roman" })] }),
      new Paragraph({
        spacing: { after: 80 },
        children: [
          new TextRun({ text: "  •  Critical surgical landmark: ", bold: true, size: 22, font: "Times New Roman" }),
          new TextRun({ text: "The uterine artery crosses the ureter anteriorly about 1.5 cm above the level of the internal os as it ascends along the lateral border of the uterus. This crossing occurs just before the ureter enters the ureteric tunnel through the cardinal ligament — a key danger point in hysterectomy (\"water under the bridge\").", size: 22, font: "Times New Roman" }),
        ]
      }),

      // ─── 5. CLINICAL NOTE ──────────────────────────────────────────────────
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          new TextRun({ text: "5.  CLINICAL SIGNIFICANCE OF UTERINE SUPPORT", bold: true, size: 26, font: "Times New Roman", underline: {} })
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        children: [
          new TextRun({ text: "  •  Uterine prolapse", bold: true, size: 22, font: "Times New Roman" }),
          new TextRun({ text: ": Results from failure of the cardinal and/or uterosacral ligament support, causing downward descent of the cervix and uterus. Risk factors include childbirth trauma, multiparity, obesity, and postmenopausal atrophy.", size: 22, font: "Times New Roman" }),
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      }),
      new Paragraph({
        spacing: { after: 80 },
        children: [
          new TextRun({ text: "  •  Vault prolapse (post-hysterectomy)", bold: true, size: 22, font: "Times New Roman" }),
          new TextRun({ text: ": After hysterectomy, the vaginal apex can shift downward if apical (Level I) support is not restored.", size: 22, font: "Times New Roman" }),
        ]
      }),
      new Paragraph({
        spacing: { after: 80 },
        children: [
          new TextRun({ text: "  •  Ureteric injury risk", bold: true, size: 22, font: "Times New Roman" }),
          new TextRun({ text: ": When clamping the cardinal ligament (transverse cervical ligament) during hysterectomy, the ureter can be injured as it passes medially just below this ligament. Always identify the ureter first.", size: 22, font: "Times New Roman" }),
        ]
      }),
      new Paragraph({
        spacing: { after: 80 },
        children: [
          new TextRun({ text: "  •  Retroverted uterus", bold: true, size: 22, font: "Times New Roman" }),
          new TextRun({ text: ": Present in 15–20% of women. Usually of no clinical consequence unless the uterus becomes fixed in retroversion (e.g., by endometriosis or pelvic inflammatory disease adhesions).", size: 22, font: "Times New Roman" }),
        ]
      }),

      // ─── SUMMARY TABLE ─────────────────────────────────────────────────────
      new Paragraph({
        spacing: { before: 200, after: 100 },
        children: [
          new TextRun({ text: "6.  SUMMARY TABLE: LIGAMENTS OF THE UTERUS", bold: true, size: 26, font: "Times New Roman", underline: {} })
        ]
      }),
      new Paragraph({ spacing: { after: 80 }, children: [new TextRun({ text: "Ligament | Attachment | Main Role | Clinical Note", bold: true, size: 22, font: "Times New Roman" })] }),
      new Paragraph({ spacing: { after: 60 }, children: [new TextRun({ text: "Round ligament | Uterine horn → inguinal canal → labia majora | Maintains anteversion | Painful in pregnancy; Hunterian ligament equivalent", size: 22, font: "Times New Roman" })] }),
      new Paragraph({ spacing: { after: 60 }, children: [new TextRun({ text: "Broad ligament | Lateral uterus → lateral pelvic wall | Peritoneal drape; carries vessels/nerves | NOT a true support ligament", size: 22, font: "Times New Roman" })] }),
      new Paragraph({ spacing: { after: 60 }, children: [new TextRun({ text: "Cardinal (Mackenrodt's) | Cervix + upper vagina → lateral pelvic wall | Primary ligamentous support of cervix | Ureter runs below; risk of injury in hysterectomy", size: 22, font: "Times New Roman" })] }),
      new Paragraph({ spacing: { after: 60 }, children: [new TextRun({ text: "Uterosacral | Cervix + upper vagina → sacrum/posterolateral pelvic wall | Apical support; maintains uterine axis | Endometriosis site; used in prolapse repair (sacrospinous fixation)", size: 22, font: "Times New Roman" })] }),
      new Paragraph({ spacing: { after: 160 }, children: [new TextRun({ text: "Pubocervical | Cervix → pubic bone (anterior) | Anterior stabilization | Damaged in anterior compartment prolapse", size: 22, font: "Times New Roman" })] }),

      new Paragraph({
        spacing: { before: 200, after: 100 },
        children: [
          new TextRun({ text: "Important Memory Aid:", bold: true, italics: true, size: 22, font: "Times New Roman" }),
          new TextRun({ text: " \"The FLOOR holds the uterus; the LIGAMENTS only anchor it.\" — Primary support is muscular (levator ani + perineal body). Ligamentous support is passive and secondary.", italics: true, size: 22, font: "Times New Roman" }),
        ]
      }),
    ]
  }]
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