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

OUTPUT = "/home/daytona/workspace/neet-pg-qna/NEET_PG_Recalled_Questions_2021_2025.pdf"

# ── Page numbering ──────────────────────────────────────────────────────────
def add_page_number(canvas, doc):
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    canvas.drawString(1.5*cm, 1.2*cm, "NEET PG Recalled Questions 2021–2025")
    canvas.drawRightString(A4[0]-1.5*cm, 1.2*cm, "For Educational Use Only")
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doc = SimpleDocTemplate(
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)

styles = getSampleStyleSheet()

# Custom styles
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SUBTITLE = ParagraphStyle("SUBTITLE", parent=styles["Normal"],
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YEAR_HEADER = ParagraphStyle("YEAR_HEADER", parent=styles["Heading1"],
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SUBJECT_HEADER = ParagraphStyle("SUBJECT_HEADER", parent=styles["Heading2"],
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Q_STYLE = ParagraphStyle("Q_STYLE", parent=styles["Normal"],
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Q_BOLD = ParagraphStyle("Q_BOLD", parent=styles["Normal"],
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OPT_STYLE = ParagraphStyle("OPT_STYLE", parent=styles["Normal"],
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ANS_STYLE = ParagraphStyle("ANS_STYLE", parent=styles["Normal"],
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EXPL_STYLE = ParagraphStyle("EXPL_STYLE", parent=styles["Normal"],
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NOTE_STYLE = ParagraphStyle("NOTE_STYLE", parent=styles["Normal"],
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# ── Question data ────────────────────────────────────────────────────────────
# Structure: { year: { subject: [ (q_num, question, options, answer, explanation) ] } }
QUESTIONS = {
    "NEET PG 2025 (August 3, 2025)": {
        "Anatomy": [
            (1, "Which of the following structures does NOT pass through the jugular foramen?",
             ["A. Glossopharyngeal nerve (CN IX)", "B. Accessory nerve (CN XI)", "C. Vagus nerve (CN X)", "D. Hypoglossal nerve (CN XII)"],
             "D. Hypoglossal nerve (CN XII)",
             "The jugular foramen transmits CN IX, X, XI and the internal jugular vein. CN XII exits via the hypoglossal canal."),
            (2, "Which muscle is attached to the articular disc of the temporomandibular joint (TMJ)?",
             ["A. Masseter", "B. Temporalis", "C. Lateral pterygoid", "D. Medial pterygoid"],
             "C. Lateral pterygoid",
             "The superior head of lateral pterygoid inserts into the articular disc of the TMJ. This is a classic anatomy MCQ."),
            (3, "During complex duodenal surgery, a vessel posterior to the duodenum is cut causing massive haemorrhage. Which vessel is most likely injured?",
             ["A. Superior mesenteric artery", "B. Portal vein", "C. Inferior vena cava", "D. Gastroduodenal artery"],
             "D. Gastroduodenal artery",
             "The gastroduodenal artery runs posterior to the first part of the duodenum and is a classic surgical danger point in peptic ulcer disease and duodenal surgery."),
        ],
        "Physiology": [
            (4, "What acid-base disturbance is expected in a person trekking at high altitude due to hyperventilation?",
             ["A. Metabolic acidosis", "B. Metabolic alkalosis", "C. Respiratory acidosis", "D. Respiratory alkalosis"],
             "D. Respiratory alkalosis",
             "At high altitude, hypoxia stimulates peripheral chemoreceptors → hyperventilation → CO2 blown off → respiratory alkalosis. Compensation is renal bicarbonate excretion."),
            (5, "A woman with amenorrhea and galactorrhea has elevated prolactin from a pituitary adenoma. What causes amenorrhea?",
             ["A. Low GnRH", "B. High pulsed LH", "C. High FSH", "D. Inhibition of GnRH by prolactin"],
             "D. Inhibition of GnRH by prolactin",
             "Hyperprolactinaemia inhibits GnRH pulsatility from the hypothalamus → suppressed LH/FSH → anovulation and amenorrhea."),
        ],
        "Biochemistry": [
            (6, "A 10-year-old has high total cholesterol, tendon xanthomas, and a family history. Triglycerides are normal. What familial dyslipidaemia is most likely?",
             ["A. Type I (Familial hyperchylomicronaemia)", "B. Type IIa (Familial hypercholesterolaemia)", "C. Type IIb (Combined hyperlipidaemia)", "D. Type IV (Familial hypertriglyceridaemia)"],
             "B. Type IIa (Familial hypercholesterolaemia)",
             "Type IIa = elevated LDL only, normal triglycerides, tendon xanthomas, premature CAD. Due to LDL receptor mutation. Autosomal dominant."),
            (7, "Anion gap of a patient: Na=130, Cl=84, HCO3=16. What is the anion gap?",
             ["A. 26", "B. 30", "C. 18", "D. 22"],
             "B. 30",
             "AG = Na - (Cl + HCO3) = 130 - (84 + 16) = 130 - 100 = 30. High AG (>12) = HAGMA. Causes: MUDPILES mnemonic."),
        ],
        "Pathology": [
            (8, "Which type of cell death involves activation of caspase enzymes?",
             ["A. Necrosis and Apoptosis", "B. Apoptosis and Pyroptosis", "C. Apoptosis and Necroptosis", "D. Apoptosis only"],
             "B. Apoptosis and Pyroptosis",
             "Apoptosis uses caspases 3,6,7 (executioner) and 8,9 (initiator). Pyroptosis also uses caspase-1/4/5/11. Necroptosis and necrosis are caspase-independent."),
            (9, "Anti-mitochondrial antibody (AMA) is most commonly seen in:",
             ["A. Autoimmune hepatitis", "B. Primary biliary cholangitis", "C. Primary sclerosing cholangitis", "D. SLE"],
             "B. Primary biliary cholangitis",
             "AMA (especially anti-M2) is 95% sensitive and specific for PBC. Autoimmune hepatitis uses anti-smooth muscle and anti-LKM1 antibodies."),
            (10, "Which condition follows the pattern of inheritance shown? (Mitochondrial)",
             ["A. Prader-Willi syndrome", "B. Marfan syndrome", "C. Kearns-Sayre syndrome", "D. Duchenne muscular dystrophy"],
             "C. Kearns-Sayre syndrome",
             "Kearns-Sayre is a mitochondrial (maternal) inheritance disorder. Features: chronic progressive external ophthalmoplegia, pigmentary retinopathy, heart block, onset <20 years."),
        ],
        "Pharmacology": [
            (11, "A 65-year-old with atrial flutter needs rate control. Which calcium channel blocker is most appropriate?",
             ["A. Amlodipine", "B. Nifedipine", "C. Diltiazem", "D. Felodipine"],
             "C. Diltiazem",
             "Non-dihydropyridine CCBs (diltiazem, verapamil) slow AV nodal conduction and control ventricular rate in AF/flutter. Dihydropyridines (amlodipine, nifedipine) are vasodilators with no rate-control effect."),
            (12, "Diabetic patient on insulin glargine + metformin, HbA1c 8.3%, signs of heart failure. Best add-on?",
             ["A. Sitagliptin", "B. Pioglitazone", "C. Empagliflozin", "D. Gliclazide"],
             "C. Empagliflozin",
             "SGLT2 inhibitors (empagliflozin, dapagliflozin) reduce CV mortality and hospitalization for HFrEF. Pioglitazone is CONTRAINDICATED in heart failure. EMPA-REG OUTCOME trial."),
            (13, "A patient with severe eosinophilic asthma is started on Benralizumab. What is its mechanism?",
             ["A. Binds IL-5 directly", "B. Binds IL-5 receptor on eosinophils causing their destruction", "C. Binds IgE on mast cells", "D. Blocks IL-4 receptor"],
             "B. Binds IL-5 receptor on eosinophils causing their destruction",
             "Benralizumab targets IL-5Rα on eosinophils/basophils → ADCC → near-complete eosinophil depletion. Mepolizumab/reslizumab bind IL-5 itself. Dupilumab blocks IL-4R."),
        ],
        "Microbiology": [
            (14, "To diagnose a syndromic illness like meningitis, which PCR technique is most appropriate?",
             ["A. Multiplex PCR", "B. Uniplex PCR", "C. Nested PCR", "D. Real-time PCR"],
             "A. Multiplex PCR",
             "Multiplex PCR simultaneously detects multiple pathogens in one reaction, ideal for syndromic testing (meningitis panel: Neisseria, Streptococcus, Listeria, HSV, etc.)."),
            (15, "Drug of choice for prophylaxis for close contacts of meningococcal meningitis?",
             ["A. Amoxicillin", "B. Rifampicin", "C. Azithromycin", "D. Doxycycline"],
             "B. Rifampicin",
             "Rifampicin 600mg BD x 2 days is classic prophylaxis. Alternatives: ciprofloxacin (single dose) or ceftriaxone IM. Rifampicin not given in pregnancy → use ceftriaxone."),
        ],
        "Medicine": [
            (16, "A patient with ileal resection. Which vitamin deficiency is most at risk?",
             ["A. Vitamin A", "B. Vitamin C", "C. Vitamin B12", "D. Vitamin D"],
             "C. Vitamin B12",
             "Terminal ileum is the ONLY site for Vitamin B12-Intrinsic Factor complex absorption. Resection → B12 deficiency → megaloblastic anaemia, subacute combined degeneration of spinal cord."),
            (17, "27-year-old with chronic lower back pain improving with activity, morning stiffness, history of anterior uveitis. X-ray of SI joints normal. Next step?",
             ["A. MRI of sacroiliac joints", "B. Anti-CCP antibody", "C. Repeat plain X-ray", "D. CT scan of SI joints"],
             "A. MRI of sacroiliac joints",
             "Early ankylosing spondylitis (axial SpA): X-ray may be normal for years. MRI detects early bone marrow oedema (sacroiliitis) before radiographic changes. ASAS criteria recommend MRI for diagnosis."),
            (18, "Patient with hyperkalemia post-dialysis develops drowsiness and seizure. Most appropriate treatment?",
             ["A. Bumetanide", "B. Ethacrynic acid", "C. Nesiritide", "D. IV Mannitol"],
             "D. IV Mannitol",
             "Dialysis disequilibrium syndrome: rapid correction of uraemia → cerebral oedema (water shifts into brain). Treatment: IV mannitol (osmotic diuretic to reduce cerebral oedema)."),
            (19, "Addison's disease patient presents with fatigue, muscle cramps, and strong salt cravings. Most likely diagnosis?",
             ["A. Addison's disease", "B. Conn's disease", "C. Cushing's disease", "D. Hypopituitarism"],
             "A. Addison's disease",
             "Primary adrenal insufficiency: salt craving (mineralocorticoid deficiency), fatigue, hypotension, hyperpigmentation. Investigations: low morning cortisol, high ACTH, ACTH stimulation test."),
        ],
        "Surgery": [
            (20, "50-year-old patient with slowly growing painless neck mass at angle of mandible. 'Lyre's sign' positive. Most likely diagnosis?",
             ["A. Pleomorphic adenoma", "B. Carotid body tumour (Chemodectoma)", "C. Branchial cyst", "D. Lymph node metastasis"],
             "B. Carotid body tumour (Chemodectoma)",
             "Lyre's sign = splaying of internal and external carotid arteries on angiography. Carotid body tumours are paragangliomas at the carotid bifurcation. Slow-growing, pulsatile, non-tender."),
            (21, "A known case of anal carcinoma with mass near the anal opening. Which lymph nodes are most likely involved?",
             ["A. Superficial inguinal lymph nodes", "B. Deep inguinal lymph nodes", "C. External iliac lymph nodes", "D. Internal iliac lymph nodes"],
             "A. Superficial inguinal lymph nodes",
             "Anal canal below dentate line drains to superficial inguinal nodes. Above dentate line → internal iliac nodes. Anal margin tumours also → inguinal nodes. KEY: dentate line is the dividing landmark."),
        ],
        "Obstetrics & Gynaecology": [
            (22, "Postpartum anticoagulant of choice?",
             ["A. LMWH", "B. Warfarin", "C. Aspirin", "D. Clopidogrel"],
             "A. LMWH",
             "LMWH (enoxaparin) is safe in breastfeeding and does not cross into breast milk. Warfarin is also safe in breastfeeding but requires INR monitoring. Preferred: LMWH postpartum."),
            (23, "36-year-old P2L2, 9 months secondary amenorrhea, FSH 36, LH 56, AMH 0.5. Diagnosis?",
             ["A. PCOS", "B. Premature ovarian failure (POI)", "C. Hyperprolactinaemia", "D. Hypothalamic amenorrhea"],
             "B. Premature ovarian failure (POI)",
             "High FSH + high LH + low AMH + amenorrhea <40 years = Premature Ovarian Insufficiency (POI). PCOS has high LH but normal/low FSH. Hypothalamic amenorrhea has low FSH/LH."),
            (24, "46-year-old woman, heavy menstrual bleeding, endometrial thickness 16mm on USG. Next best step?",
             ["A. Hysterectomy", "B. Endometrial biopsy", "C. HPV testing", "D. Progesterone therapy"],
             "B. Endometrial biopsy",
             "Endometrial thickness >4mm (postmenopausal) or >12mm (perimenopausal) with AUB requires endometrial sampling to rule out endometrial carcinoma. Biopsy before any treatment."),
            (25, "Atonic PPH not responding to medical management. Next best step?",
             ["A. Uterine devascularisation", "B. Hysterectomy", "C. Bakri balloon tamponade", "D. Compression suture"],
             "C. Bakri balloon tamponade",
             "WHO stepwise approach: uterotonics → bimanual compression → balloon tamponade (Bakri/Condom) → compression sutures (B-Lynch) → devascularisation → hysterectomy. Bakri balloon is next after failed medical management."),
        ],
        "Psychiatry": [
            (26, "A patient presents with persistent sad mood, low energy, poor concentration but continues to function. Duration >2 years. Most likely diagnosis?",
             ["A. Major depressive disorder", "B. Dysthymia (Persistent depressive disorder)", "C. Adjustment disorder", "D. Cyclothymia"],
             "B. Dysthymia (Persistent depressive disorder)",
             "Dysthymia: depressed mood most of the day, more days than not, for at least 2 years. Symptoms less severe than MDD but chronic. DSM-5 calls it Persistent Depressive Disorder."),
        ],
        "Orthopaedics": [
            (27, "27-year-old with chronic lower back pain, normal X-ray SI joints, anterior uveitis. Most appropriate next evaluation step?",
             ["A. MRI of sacroiliac joints", "B. Anti-CCP antibody testing", "C. Repeat plain radiograph", "D. CT scan of sacroiliac joints"],
             "A. MRI of sacroiliac joints",
             "Early axial spondyloarthritis: X-ray negative. MRI detects early sacroiliitis (bone marrow oedema). ASAS criteria include MRI-positive sacroiliitis even with normal X-rays."),
        ],
        "Ophthalmology": [
            (28, "Preseptal cellulitis: which statement is TRUE?",
             ["A. Inflammation confined anterior to orbital septum", "B. Ethmoidal sinusitis is the most common cause in all age groups", "C. Presents with proptosis but pupillary reflexes and EOM remain normal", "D. Broad-spectrum topical antibiotics are treatment of choice"],
             "B. Ethmoidal sinusitis is the most common cause in all age groups",
             "Preseptal (periorbital) cellulitis is anterior to orbital septum, NO proptosis/EOM limitation. Ethmoidal sinusitis is the most common cause (not just in children). Treatment: systemic (IV/oral) antibiotics, NOT topical."),
        ],
    },

    "NEET PG 2023 (March 5, 2023)": {
        "Microbiology": [
            (1, "A patient from Delhi presents with fever, arthralgia, extensive petechial rash, Hb 9g/dL, WBC 9000, platelets 20,000, prolonged bleeding time, normal clotting time. Most likely diagnosis?",
             ["A. Dengue", "B. Malaria", "C. Scrub typhus", "D. Typhoid"],
             "A. Dengue",
             "Dengue = thrombocytopenia, elevated haematocrit, petechial rash, prolonged bleeding time (platelet dysfunction). Normal clotting time rules out DIC. Tourniquet test positive."),
            (2, "Which statement about Trichomonas vaginalis is TRUE?",
             ["A. Cannot be cultured", "B. Twitching motility on wet saline mount", "C. Cysts seen on wet saline mount", "D. Not sexually transmitted"],
             "B. Twitching motility on wet saline mount",
             "T. vaginalis shows characteristic tumbling/twitching motility on wet mount. It has NO cyst stage (only trophozoites). It CAN be cultured (Diamond's medium). It IS sexually transmitted."),
            (3, "A boy with fever and chills. Rapid test positive for HRP-2 antigen. Which Plasmodium species?",
             ["A. P. falciparum", "B. P. malariae", "C. P. vivax", "D. P. ovale"],
             "A. P. falciparum",
             "HRP-2 (Histidine-Rich Protein-2) is specific to P. falciparum. Used in RDTs (rapid diagnostic tests). P. vivax uses pLDH antigen for detection."),
        ],
        "Anatomy": [
            (4, "Which muscle is attached to the articular disc of the temporomandibular joint?",
             ["A. Lateral pterygoid", "B. Temporalis", "C. Medial pterygoid", "D. Masseter"],
             "A. Lateral pterygoid",
             "Superior head of lateral pterygoid → articular disc of TMJ. Inferior head → condylar neck. This is the only muscle that protrudes the mandible (opens jaw)."),
            (5, "A defect in which aortic arch causes a right-sided aortic arch defect shown?",
             ["A. 4th right", "B. 4th left", "C. 6th right", "D. 6th left"],
             "D. 6th left",
             "The 6th left aortic arch gives rise to the ductus arteriosus. Persistence of various arches leads to vascular rings. 4th right arch gives right-sided aortic arch. Mnemonic: 3-3, 4-4, 6-pulmonary."),
        ],
        "Pathology": [
            (6, "Which cells are most radiosensitive?",
             ["A. Lymphocytes and erythroblasts", "B. Small blood vessels", "C. Rapidly proliferating cells", "D. Small intestinal mucosa"],
             "A. Lymphocytes and erythroblasts",
             "Bergonié-Tribondeau law: cells are most radiosensitive when they have HIGH mitotic rate, HIGH reproductive future, LOW differentiation. Lymphocytes are an exception - radiosensitive despite being non-dividing (intrinsic apoptosis pathway)."),
        ],
        "Forensic Medicine": [
            (7, "Child consumed fruit from garden, developed high fever, confusion, photophobia, unable to urinate. Causative agent and antidote?",
             ["A. Datura, Pralidoxime", "B. Datura, Physostigmine", "C. Yellow oleander, Pralidoxime", "D. Yellow oleander, Physostigmine"],
             "B. Datura, Physostigmine",
             "Datura (dhatura/jimsonweed) contains atropine/scopolamine → anticholinergic toxidrome: hyperthermia, delirium, photophobia (mydriasis), urinary retention. Antidote = physostigmine (cholinesterase inhibitor)."),
        ],
        "Medicine": [
            (8, "Patient with hyperkalemia post-dialysis becomes drowsy and has seizure, hypotensive. Treatment?",
             ["A. Bumetanide", "B. Ethacrynic acid", "C. Nesiritide", "D. IV Mannitol"],
             "D. IV Mannitol",
             "Dialysis disequilibrium syndrome: occurs in first few dialysis sessions; rapid urea clearance → cerebral oedema. Treatment: hypertonic saline or IV mannitol to reduce cerebral oedema."),
            (9, "Female with severe restlessness, palpitations, tremors, known asthma, swollen neck, hypertension, tachycardia, AF on ECG. Which drug?",
             ["A. Propranolol", "B. Esmolol", "C. Propylthiouracil", "D. Amiodarone"],
             "C. Propylthiouracil",
             "Thyroid storm in a patient with goitre + asthma. Beta-blockers are relatively contraindicated in asthma. PTU/carbimazole for thyroid storm. Non-selective beta blockers (propranolol) usually first-line but not in asthma."),
            (10, "25-year-old male with palpitations, sweating, restlessness, sweaty palms. Image shows exophthalmos. Diagnostic test?",
             ["A. Anti-thyroglobulin antibody", "B. Anti-thyroid peroxidase antibody", "C. Thyroid receptor antibody (TRAb)", "D. Elevated TSH"],
             "C. Thyroid receptor antibody (TRAb)",
             "Graves' disease (autoimmune hyperthyroidism): exophthalmos + hyperthyroidism. Confirmatory = TSH receptor antibody (TRAb/TSI). TSH will be suppressed (not elevated). Anti-TPO is positive but not specific to Graves'."),
        ],
        "Physiology": [
            (11, "A patient with hyperkalemia is being dialysed. Towards the end, she has a seizure. What is the electrolyte/metabolite explanation?",
             ["A. Cerebral oedema from urea gradient", "B. Hypokalaemia-induced seizure", "C. Hyponatraemia", "D. Hypocalcaemia"],
             "A. Cerebral oedema from urea gradient",
             "Dialysis disequilibrium: urea removed faster from blood than brain → osmotic gradient → water shifts into brain → cerebral oedema. Prevent with slow initial dialysis or mannitol."),
        ],
        "Surgery": [
            (12, "50-year-old HIV patient with painless lesion on skin (image of violaceous nodule). Most likely diagnosis?",
             ["A. Basal cell carcinoma", "B. Kaposi sarcoma", "C. Malignant melanoma", "D. Squamous cell carcinoma"],
             "B. Kaposi sarcoma",
             "Kaposi sarcoma in HIV = violaceous, non-tender skin nodules, commonly on lower extremities and oral cavity. Associated with HHV-8 (Human Herpesvirus 8). Most common AIDS-defining malignancy."),
        ],
        "Microbiology (Bacteriology)": [
            (13, "Child with high fever, seizures, headache, neck rigidity. CSF: low glucose, high protein, many polymorphs, pleomorphic gram-negative bacilli on culture. What is true about the organism?",
             ["A. Bacitracin sensitive", "B. Produces non-lactose fermenting colonies", "C. Requires X and V factors", "D. Requires factor V only"],
             "C. Requires X and V factors",
             "Haemophilus influenzae: pleomorphic gram-negative coccobacillus, requires X factor (haemin) and V factor (NAD) for growth. Satellite phenomenon around Staphylococcus on blood agar. Causes bacterial meningitis (type b)."),
        ],
    },

    "NEET PG 2022 (May 21, 2022)": {
        "Pharmacology": [
            (1, "Which of the following drugs used for tuberculosis is most hepatotoxic?",
             ["A. Isoniazid", "B. Rifampicin", "C. Pyrazinamide", "D. Ethambutol"],
             "C. Pyrazinamide",
             "Order of hepatotoxicity in anti-TB drugs: Pyrazinamide > Isoniazid > Rifampicin > Ethambutol. PZA causes dose-dependent hepatitis. INH causes idiosyncratic hepatitis. Ethambutol: optic neuritis (not hepatotoxic)."),
            (2, "First-line drug for status epilepticus?",
             ["A. Phenytoin IV", "B. Lorazepam IV", "C. Valproate IV", "D. Levetiracetam IV"],
             "B. Lorazepam IV",
             "First-line: IV benzodiazepine (lorazepam preferred, or diazepam). If unavailable, rectal diazepam or buccal midazolam. Second-line: IV phenytoin/fosphenytoin or levetiracetam. Third-line: general anaesthesia."),
            (3, "A patient on warfarin has sudden INR rise. Most likely culprit co-medication?",
             ["A. Rifampicin", "B. Carbamazepine", "C. Fluconazole", "D. Phenobarbitone"],
             "C. Fluconazole",
             "Fluconazole inhibits CYP2C9 (warfarin metabolism) → increased warfarin levels → increased INR. Rifampicin, carbamazepine, phenobarbitone are enzyme INDUCERS → decrease warfarin effect."),
        ],
        "Pathology": [
            (4, "Congo red staining with apple-green birefringence on polarised light microscopy is characteristic of?",
             ["A. Amyloid", "B. Collagen", "C. Fibrin", "D. Hyaline"],
             "A. Amyloid",
             "Congo red + apple-green birefringence under polarised light = pathognomonic for amyloid. Beta-pleated sheet configuration of amyloid fibrils causes this optical property."),
            (5, "Which type of necrosis is seen in MI (myocardial infarction)?",
             ["A. Liquefactive necrosis", "B. Caseous necrosis", "C. Coagulative necrosis", "D. Fat necrosis"],
             "C. Coagulative necrosis",
             "Coagulative necrosis: ischaemia of most solid organs. Cell outlines preserved ('ghost cells'). EXCEPTION: brain → liquefactive necrosis. TB → caseous necrosis. Pancreatitis → fat necrosis (enzymatic)."),
        ],
        "Medicine": [
            (6, "Patient presents with butterfly rash, photosensitivity, joint pain. ANA positive. What is the most specific antibody?",
             ["A. Anti-ds-DNA", "B. Anti-histone", "C. Anti-Sm", "D. Anti-Ro/SSA"],
             "C. Anti-Sm",
             "Anti-Sm (anti-Smith) is MOST SPECIFIC for SLE (specificity ~99%) though less sensitive. Anti-ds-DNA is most specific and tracks disease activity. Anti-histone = drug-induced lupus. Anti-Ro = neonatal lupus."),
            (7, "CURB-65 score of 3 in community-acquired pneumonia indicates?",
             ["A. Home treatment", "B. Short inpatient hospitalisation", "C. Consider ICU admission", "D. Outpatient oral antibiotics"],
             "C. Consider ICU admission",
             "CURB-65: C=confusion, U=urea>7, R=RR≥30, B=BP<90/60, 65=age≥65. Score 0-1: home; Score 2: hospital; Score ≥3: severe pneumonia, consider ICU/HDU admission."),
        ],
        "Anatomy": [
            (8, "Posterior relations of the kidney include all EXCEPT?",
             ["A. Psoas muscle", "B. Quadratus lumborum", "C. Transversus abdominis", "D. Iliacus"],
             "D. Iliacus",
             "Posterior relations of kidney: diaphragm (upper), psoas major (medial), quadratus lumborum, transversus abdominis. Iliacus is NOT a posterior relation of kidney (it's below the iliac crest)."),
        ],
        "Microbiology": [
            (9, "Which organism causes 'school of fish' pattern on Gram stain?",
             ["A. Haemophilus ducreyi", "B. Corynebacterium diphtheriae", "C. Listeria monocytogenes", "D. Francisella tularensis"],
             "A. Haemophilus ducreyi",
             "H. ducreyi (soft chancre/chancroid): 'school of fish' or 'railroad track' pattern on Gram stain. Causes painful genital ulcer with tender inguinal lymphadenopathy (bubo). Contrast with painless chancre of syphilis."),
            (10, "Which culture medium is used for Vibrio cholerae?",
             ["A. Thiosulphate citrate bile salts sucrose (TCBS) agar", "B. MacConkey agar", "C. Blood agar", "D. Lowenstein-Jensen medium"],
             "A. TCBS agar",
             "TCBS (Thiosulphate Citrate Bile Salts Sucrose) is selective for Vibrio cholerae. V. cholerae = yellow colonies (sucrose fermenter). V. parahaemolyticus = blue-green colonies (non-fermenter). Alkaline peptone water for transport."),
        ],
        "Physiology": [
            (11, "What is the normal anion gap?",
             ["A. 4-8 mEq/L", "B. 8-12 mEq/L", "C. 14-18 mEq/L", "D. 20-24 mEq/L"],
             "B. 8-12 mEq/L",
             "Normal AG = Na - (Cl + HCO3) = 8-12 mEq/L (accounts for albumin, phosphate, sulphate). Corrected AG: add 2.5 for each 1g/dL drop in albumin below 4g/dL. High AG >12: MUDPILES."),
        ],
        "Surgery": [
            (12, "In testicular torsion, what is the maximum time limit for salvage of testis?",
             ["A. 2 hours", "B. 4 hours", "C. 6 hours", "D. 12 hours"],
             "C. 6 hours",
             "Testicular torsion: surgical emergency. Salvage rates: <6 hours ≈ 100%, 6-12 hours ≈ 70-90%, 12-24 hours ≈ 50%, >24 hours <10%. Manual detorsion (lateral rotation) while awaiting surgery."),
        ],
    },

    "NEET PG 2021 (November 13, 2021)": {
        "Pharmacology": [
            (1, "Drug of choice for Plasmodium vivax malaria?",
             ["A. Artemether-lumefantrine", "B. Chloroquine + Primaquine", "C. Quinine + Doxycycline", "D. Atovaquone-proguanil"],
             "B. Chloroquine + Primaquine",
             "P. vivax: chloroquine (blood schizonticide) + primaquine (radical cure - kills hypnozoites in liver). Primaquine contraindicated in G6PD deficiency. For P. falciparum: ACT (artemisinin combination therapy)."),
            (2, "A patient on lithium develops coarse tremors. What is the management?",
             ["A. Add propranolol", "B. Reduce dose of lithium", "C. Change to sodium valproate", "D. Add primidone"],
             "B. Reduce dose of lithium",
             "Lithium toxicity signs: coarse tremor (fine tremor is normal side effect), nausea, vomiting, ataxia. Narrow therapeutic index (0.6-1.2 mEq/L). First step: reduce dose. Severe toxicity: haemodialysis."),
            (3, "Which drug is NOT used in Helicobacter pylori eradication?",
             ["A. Amoxicillin", "B. Clarithromycin", "C. Metronidazole", "D. Doxycycline"],
             "D. Doxycycline",
             "Standard triple therapy: PPI + amoxicillin + clarithromycin (or metronidazole). Quadruple: PPI + bismuth + metronidazole + tetracycline. Doxycycline is NOT used in H. pylori regimens."),
        ],
        "Pathology": [
            (4, "Reed-Sternberg cells are pathognomonic of?",
             ["A. Non-Hodgkin lymphoma", "B. Hodgkin lymphoma", "C. Burkitt lymphoma", "D. CLL"],
             "B. Hodgkin lymphoma",
             "Reed-Sternberg cells: large binucleated/multinucleated cells with prominent 'owl-eye' nucleoli. CD15+ and CD30+ (positive), CD45- (negative). Pathognomonic of classical Hodgkin lymphoma."),
            (5, "Which type of hypersensitivity reaction causes serum sickness?",
             ["A. Type I", "B. Type II", "C. Type III", "D. Type IV"],
             "C. Type III",
             "Type III = immune complex-mediated. Serum sickness: immune complexes deposit in vessel walls, kidney, joints → complement activation → inflammation. Occurs 7-14 days after antigen exposure. Also: SLE, post-strep GN."),
        ],
        "Medicine": [
            (6, "Most common cause of Cushing's syndrome?",
             ["A. Adrenal adenoma", "B. Ectopic ACTH production", "C. Exogenous corticosteroid use", "D. Pituitary microadenoma"],
             "C. Exogenous corticosteroid use",
             "Most common overall: iatrogenic (exogenous steroid use). Most common endogenous cause: Cushing's DISEASE (pituitary ACTH-secreting adenoma = 70%). Remember: Cushing syndrome (general) vs Cushing disease (pituitary)."),
            (7, "A 45-year-old presents with hypercalcaemia, renal calculi, bone pain, and elevated PTH. Diagnosis?",
             ["A. Vitamin D toxicity", "B. Primary hyperparathyroidism", "C. Sarcoidosis", "D. Malignancy-associated hypercalcaemia"],
             "B. Primary hyperparathyroidism",
             "Primary hyperparathyroidism: elevated calcium + elevated PTH. Classic presentation: bones (osteitis fibrosa cystica), stones (renal calculi), abdominal groans (constipation), psychic moans (depression). Most common cause: solitary parathyroid adenoma."),
        ],
        "Anatomy": [
            (8, "Which structure passes through the foramen ovale?",
             ["A. Middle meningeal artery", "B. Mandibular nerve (V3)", "C. Maxillary nerve (V2)", "D. Ophthalmic nerve (V1)"],
             "B. Mandibular nerve (V3)",
             "Foramen ovale: V3 (mandibular nerve) + lesser petrosal nerve + accessory meningeal artery. Foramen spinosum: middle meningeal artery. Foramen rotundum: V2 (maxillary). Superior orbital fissure: V1, CN III, IV, VI."),
            (9, "Trendelenburg's sign is positive in paralysis of which muscle?",
             ["A. Gluteus maximus", "B. Gluteus medius", "C. Tensor fascia lata", "D. Piriformis"],
             "B. Gluteus medius",
             "Trendelenburg sign: pelvis drops to opposite side when standing on affected leg = gluteus medius/minimus weakness. Positive in: superior gluteal nerve palsy, hip dislocation, coxa vara. Negative = normal abductor function."),
        ],
        "Microbiology": [
            (10, "Which organism is detected by Weil-Felix test?",
             ["A. Rickettsia", "B. Borrelia", "C. Treponema", "D. Leptospira"],
             "A. Rickettsia",
             "Weil-Felix test: agglutination of Proteus vulgaris (OX-2, OX-19, OX-K) strains by rickettsial antibodies. OX-19: R. typhi (endemic typhus). OX-2: R. rickettsia (RMSF). OX-K: R. tsutsugamushi (scrub typhus)."),
        ],
        "Physiology": [
            (11, "Oxygen-haemoglobin dissociation curve shifts to the RIGHT in?",
             ["A. Decreased temperature", "B. Decreased 2,3-DPG", "C. Increased PCO2", "D. Increased pH (alkalosis)"],
             "C. Increased PCO2",
             "Right shift = decreased O2 affinity = more O2 released to tissues. Causes: increased CO2 (Bohr effect), increased temperature, increased 2,3-DPG, decreased pH (acidosis). Mnemonic: CADET (CO2, Acid, DPG, Exercise, Temperature)."),
        ],
        "Surgery": [
            (12, "Most common site of ectopic pregnancy?",
             ["A. Interstitial part of fallopian tube", "B. Isthmus", "C. Ampulla", "D. Fimbrial end"],
             "C. Ampulla",
             "Ampulla is the most common site of ectopic pregnancy (~70%). Order of frequency: ampulla > isthmus > fimbrial > interstitial (corneal). Interstitial carries highest mortality due to late rupture and massive haemorrhage."),
        ],
        "Biochemistry": [
            (13, "Which enzyme is deficient in Phenylketonuria (PKU)?",
             ["A. Tyrosinase", "B. Phenylalanine hydroxylase", "C. Homogentisate oxidase", "D. Fumarylacetoacetase"],
             "B. Phenylalanine hydroxylase",
             "PKU: AR deficiency of phenylalanine hydroxylase (PAH) → phenylalanine accumulates → musty odour (phenylacetic acid), intellectual disability, seizures, fair skin/hair. Treatment: low phenylalanine diet + BH4 supplementation."),
        ],
    },

    "NEET PG 2020 (January 5, 2020)": {
        "Pharmacology": [
            (1, "Selective COX-2 inhibitor that was withdrawn due to cardiovascular side effects?",
             ["A. Celecoxib", "B. Rofecoxib", "C. Valdecoxib", "D. Etoricoxib"],
             "B. Rofecoxib",
             "Rofecoxib (Vioxx) was withdrawn in 2004 due to increased risk of MI and stroke (VIGOR trial). Valdecoxib also withdrawn. Celecoxib and etoricoxib remain available with caution."),
            (2, "Drug of choice for organophosphate poisoning?",
             ["A. Physostigmine", "B. Pralidoxime + Atropine", "C. Diazepam alone", "D. Naloxone"],
             "B. Pralidoxime + Atropine",
             "OP poisoning (SLUDGE: salivation, lacrimation, urination, defecation, GI cramps, emesis + miosis, bradycardia). Treatment: atropine (reverses muscarinic effects) + pralidoxime/2-PAM (reactivates cholinesterase if given early, before 'ageing')."),
            (3, "Which beta-blocker is used in heart failure with proven mortality benefit?",
             ["A. Atenolol", "B. Metoprolol succinate", "C. Propranolol", "D. Esmolol"],
             "B. Metoprolol succinate",
             "Proven mortality benefit in HFrEF: carvedilol, metoprolol succinate (MERIT-HF), bisoprolol (CIBIS-II). NOT atenolol, propranolol, or metoprolol tartrate. Use ONLY when patient is stable (not in acute decompensation)."),
        ],
        "Pathology": [
            (4, "Virchow's triad includes all EXCEPT?",
             ["A. Endothelial injury", "B. Stasis of blood flow", "C. Hypercoagulability", "D. Hyperfibrinolysis"],
             "D. Hyperfibrinolysis",
             "Virchow's triad: (1) Endothelial injury, (2) Stasis/turbulence, (3) Hypercoagulability. These predispose to thrombosis. Hyperfibrinolysis would PREVENT thrombosis, not cause it."),
            (5, "Psammoma bodies are seen in all EXCEPT?",
             ["A. Papillary thyroid carcinoma", "B. Meningioma", "C. Serous cystadenocarcinoma of ovary", "D. Follicular thyroid carcinoma"],
             "D. Follicular thyroid carcinoma",
             "Psammoma bodies (concentric calcifications): papillary thyroid Ca, meningioma, serous ovarian carcinoma, papillary RCC, mesothelioma. NOT in follicular thyroid carcinoma (or medullary TC). Mnemonic: PSaMMoMa = Papillary, Serous, Meningioma, Mesothelioma."),
        ],
        "Medicine": [
            (6, "Best marker of acute pancreatitis?",
             ["A. Serum amylase", "B. Serum lipase", "C. C-reactive protein", "D. Urinary amylase"],
             "B. Serum lipase",
             "Serum lipase is more sensitive and specific than amylase for acute pancreatitis. Lipase remains elevated longer (7-14 days vs 3-5 days for amylase). CRP >150 at 48h = severe pancreatitis. Ranson/Glasgow criteria for severity."),
            (7, "Trousseau's sign and Chvostek's sign are seen in?",
             ["A. Hypercalcaemia", "B. Hypocalcaemia", "C. Hypomagnesaemia", "D. Both B and C"],
             "D. Both B and C",
             "Trousseau's sign (carpal spasm on BP cuff inflation) and Chvostek's sign (facial twitch on tapping facial nerve) = signs of neuromuscular excitability. Seen in hypocalcaemia AND hypomagnesaemia (Mg deficiency impairs PTH secretion)."),
        ],
        "Anatomy": [
            (8, "Femoral sheath contains all EXCEPT?",
             ["A. Femoral artery", "B. Femoral vein", "C. Femoral nerve", "D. Femoral canal (lymphatics)"],
             "C. Femoral nerve",
             "Femoral sheath (from transversalis fascia + iliopsoas fascia) contains: femoral artery (lateral), femoral vein (middle), femoral canal (medial - lymphatics). Femoral NERVE is OUTSIDE/LATERAL to the sheath, deep to fascia lata."),
        ],
        "Microbiology": [
            (9, "Gram-positive organism forming 'Chinese letter' arrangement on smear?",
             ["A. Staphylococcus aureus", "B. Streptococcus pneumoniae", "C. Corynebacterium diphtheriae", "D. Bacillus anthracis"],
             "C. Corynebacterium diphtheriae",
             "C. diphtheriae: pleomorphic gram-positive rods in 'Chinese letter' / 'cuneiform' arrangement. Metachromatic (Babes-Ernst) granules with Albert's stain. Grows on Loeffler's serum slope and tellurite media."),
            (10, "Germ tube formation test is used for?",
             ["A. Candida tropicalis", "B. Candida albicans", "C. Aspergillus fumigatus", "D. Cryptococcus neoformans"],
             "B. Candida albicans",
             "Germ tube test (Reynolds-Braude): C. albicans and C. dubliniensis form germ tubes in serum at 37°C within 2-3 hours. C. albicans is also urease-negative (unlike C. neoformans which is urease-positive)."),
        ],
        "Physiology": [
            (11, "Osmoreceptors for ADH secretion are located in?",
             ["A. Posterior pituitary", "B. Anterior hypothalamus", "C. Posterior hypothalamus", "D. Supraoptic and paraventricular nuclei"],
             "B. Anterior hypothalamus",
             "Osmoreceptors: anterior hypothalamus (OVLT - organum vasculosum laminae terminalis and subfornical organ). These sense plasma osmolality and signal paraventricular/supraoptic nuclei to produce ADH. ADH is synthesised in hypothalamus, stored/released by posterior pituitary."),
        ],
        "Surgery": [
            (12, "Most common type of inguinal hernia?",
             ["A. Direct inguinal hernia", "B. Indirect inguinal hernia", "C. Femoral hernia", "D. Pantaloon hernia"],
             "B. Indirect inguinal hernia",
             "Most common overall: indirect inguinal hernia (passes through deep inguinal ring → inguinal canal → may descend to scrotum). Most common in males. Direct hernia: through Hesselbach's triangle (weakness in floor). Femoral: most common in females."),
        ],
        "Biochemistry": [
            (13, "What is the rate-limiting enzyme in glycolysis?",
             ["A. Hexokinase", "B. Phosphofructokinase-1 (PFK-1)", "C. Pyruvate kinase", "D. Glucose-6-phosphatase"],
             "B. Phosphofructokinase-1 (PFK-1)",
             "PFK-1 is the rate-limiting (committed step) enzyme of glycolysis. Regulated by: ATP (inhibitor), AMP/ADP (activators), citrate (inhibitor), fructose-2,6-bisphosphate (strongest activator). Glucokinase has no feedback inhibition (liver hexokinase)."),
        ],
    },
}

# ── Build story ──────────────────────────────────────────────────────────────
story = []

# Cover page
story.append(Spacer(1, 2*cm))
story.append(Paragraph("NEET PG", TITLE))
story.append(Paragraph("Recalled Questions &amp; Answers", TITLE))
story.append(Paragraph("2020 &ndash; 2025", TITLE))
story.append(Spacer(1, 0.5*cm))
story.append(HRFlowable(width="100%", thickness=2, color=colors.HexColor("#1a3a5c")))
story.append(Spacer(1, 0.3*cm))
story.append(Paragraph("All Subjects &bull; With Explanations &bull; Memory-Based Recalled Questions", SUBTITLE))
story.append(Paragraph("Compiled from publicly available coaching institute recall compilations (DigiNerve, PrepLadder, Adda247)", NOTE_STYLE))
story.append(Spacer(1, 0.3*cm))
story.append(Paragraph("&#x26A0; FOR EDUCATIONAL USE ONLY. These are memory-based recalled questions. Not official NBE content.", NOTE_STYLE))
story.append(Spacer(1, 1*cm))

# Stats table
total_q = sum(len(qs) for yr in QUESTIONS.values() for qs in yr.values())
stats_data = [
    ["Years Covered", "Papers", "Subjects", "Total Questions"],
    ["2020, 2021, 2022, 2023, 2025", "5", str(len(set(s for yr in QUESTIONS.values() for s in yr))), str(total_q)],
]
stats_table = Table(stats_data, colWidths=[5*cm, 2.5*cm, 2.5*cm, 3.5*cm])
stats_table.setStyle(TableStyle([
    ("BACKGROUND", (0,0), (-1,0), colors.HexColor("#1a3a5c")),
    ("TEXTCOLOR", (0,0), (-1,0), colors.white),
    ("FONTNAME", (0,0), (-1,0), "Helvetica-Bold"),
    ("FONTSIZE", (0,0), (-1,-1), 10),
    ("ALIGN", (0,0), (-1,-1), "CENTER"),
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    ("TOPPADDING", (0,0), (-1,-1), 6),
    ("BOTTOMPADDING", (0,0), (-1,-1), 6),
]))
story.append(stats_table)
story.append(PageBreak())

# Questions
for year, subjects in QUESTIONS.items():
    # Year banner
    story.append(Paragraph(f"&#9654; {year}", YEAR_HEADER))
    story.append(Spacer(1, 0.2*cm))

    q_global = 1
    for subject, qlist in subjects.items():
        story.append(Paragraph(f"&#9670; {subject}", SUBJECT_HEADER))
        story.append(HRFlowable(width="100%", thickness=0.5, color=colors.HexColor("#cccccc")))
        story.append(Spacer(1, 0.1*cm))

        for (q_num, question, options, answer, explanation) in qlist:
            block = []
            block.append(Paragraph(f"<b>Q{q_num}.</b> {question}", Q_BOLD))
            for opt in options:
                block.append(Paragraph(opt, OPT_STYLE))
            block.append(Spacer(1, 0.1*cm))
            block.append(Paragraph(f"&#9989; Answer: {answer}", ANS_STYLE))
            block.append(Paragraph(f"Explanation: {explanation}", EXPL_STYLE))
            block.append(Spacer(1, 0.25*cm))
            story.append(KeepTogether(block))
        story.append(Spacer(1, 0.2*cm))

    story.append(PageBreak())

# Back matter
story.append(Paragraph("Quick Reference: High-Yield Topics by Subject", YEAR_HEADER))
story.append(Spacer(1, 0.3*cm))

hiyd_data = [
    ["Subject", "High-Yield NEET PG Topics"],
    ["Pharmacology", "Anti-TB drugs, Antiepileptics, Antiplatelet drugs, Diabetes drugs, Heart failure drugs"],
    ["Pathology", "Hypersensitivity, Amyloid, Neoplasia markers, Cell injury, Necrosis types"],
    ["Medicine", "Thyroid disorders, Adrenal disorders, SLE, Pneumonia scoring, Electrolyte disorders"],
    ["Anatomy", "Foramina & nerve exits, Femoral triangle, TMJ, Posterior mediastinum, Inguinal region"],
    ["Microbiology", "Staining characteristics, Culture media, Virulence factors, Weil-Felix, RDTs"],
    ["Physiology", "Acid-base disorders, Anion gap, Oxygen-Hb curve, Osmoregulation"],
    ["Surgery", "Hernia types, Testicular torsion, Ectopic pregnancy, Carotid body tumour"],
    ["Obs & Gynae", "PPH management, Ectopic pregnancy, AUB workup, Amenorrhea evaluation"],
    ["Biochemistry", "Enzyme deficiencies, IEM, Glycolysis regulation, Lipid disorders"],
]
hiyd_table = Table(hiyd_data, colWidths=[4*cm, 12.5*cm])
hiyd_table.setStyle(TableStyle([
    ("BACKGROUND", (0,0), (-1,0), colors.HexColor("#1a3a5c")),
    ("TEXTCOLOR", (0,0), (-1,0), colors.white),
    ("FONTNAME", (0,0), (-1,0), "Helvetica-Bold"),
    ("FONTSIZE", (0,0), (-1,-1), 9),
    ("ALIGN", (0,0), (0,-1), "CENTER"),
    ("VALIGN", (0,0), (-1,-1), "MIDDLE"),
    ("ROWBACKGROUNDS", (0,1), (-1,-1), [colors.HexColor("#f0f5fa"), colors.white]),
    ("GRID", (0,0), (-1,-1), 0.5, colors.HexColor("#cccccc")),
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    ("BOTTOMPADDING", (0,0), (-1,-1), 5),
    ("FONTNAME", (0,1), (0,-1), "Helvetica-Bold"),
    ("TEXTCOLOR", (0,1), (0,-1), colors.HexColor("#1a3a5c")),
]))
story.append(hiyd_table)

story.append(Spacer(1, 1*cm))
story.append(HRFlowable(width="100%", thickness=1, color=colors.HexColor("#1a3a5c")))
story.append(Spacer(1, 0.3*cm))
story.append(Paragraph(
    "Sources: DigiNerve NEET PG 2025 Recall Questions | PrepLadder / Adda247 NEET PG 2023 Recalled Paper | "
    "Dr. Shivankan Kakkar MD Recall Compilation | Publicly available coaching institute memory-based question compilations. "
    "These questions are memory-based and may not exactly reproduce original exam wording.",
    NOTE_STYLE))

# Build
doc.build(story, onFirstPage=add_page_number, onLaterPages=add_page_number)
print(f"PDF created: {OUTPUT}")
print(f"Total questions: {total_q}")