const { Document, Packer, Paragraph, TextRun, HeadingLevel, AlignmentType, UnderlineType } = require('docx');
const fs = require('fs');

const questions = [
  // === SECTION 1: BASICS & PRINCIPLES OF PHYSICAL REHABILITATION ===
  {
    q: "1. Physical rehabilitation is best defined as:",
    opts: ["A) Surgical correction of deformities", "B) A process that helps individuals regain or improve physical function lost due to injury or illness", "C) Pharmacological management of chronic pain", "D) Psychological counseling for disabled patients"],
    ans: "B"
  },
  {
    q: "2. Which of the following is NOT a goal of physical rehabilitation?",
    opts: ["A) Restore maximum functional capacity", "B) Prevent secondary complications", "C) Curative treatment of underlying disease", "D) Improve quality of life"],
    ans: "C"
  },
  {
    q: "3. The primary team member responsible for physical rehabilitation exercises and mobility training is the:",
    opts: ["A) Occupational therapist", "B) Speech therapist", "C) Physical therapist (physiotherapist)", "D) Recreational therapist"],
    ans: "C"
  },
  {
    q: "4. Occupational therapy in rehabilitation focuses on:",
    opts: ["A) Gait training and ambulation", "B) Activities of daily living (ADLs) and functional independence", "C) Respiratory muscle training", "D) Pain management with electrotherapy"],
    ans: "B"
  },
  {
    q: "5. Which of the following best describes the World Health Organization (WHO) International Classification of Functioning, Disability and Health (ICF)?",
    opts: ["A) A surgical classification of injuries", "B) A framework describing health and disability at individual and population levels", "C) A pharmacological dosing guide for rehabilitation drugs", "D) A rating scale for pain intensity"],
    ans: "B"
  },
  {
    q: "6. The FIM (Functional Independence Measure) is used to assess:",
    opts: ["A) Cardiovascular fitness", "B) Level of disability and functional status in rehabilitation", "C) Cognitive function only", "D) Pain severity"],
    ans: "B"
  },
  {
    q: "7. Which of the following is the correct sequence in the rehabilitation process?",
    opts: ["A) Treatment → Assessment → Goal setting → Discharge", "B) Assessment → Goal setting → Treatment → Discharge planning", "C) Goal setting → Assessment → Discharge → Treatment", "D) Discharge → Treatment → Goal setting → Assessment"],
    ans: "B"
  },
  {
    q: "8. In physical rehabilitation, the term 'impairment' refers to:",
    opts: ["A) Inability to perform a social role", "B) A problem in body function or structure", "C) Difficulty performing an activity", "D) Environmental barriers to participation"],
    ans: "B"
  },
  {
    q: "9. 'Disability' in the context of rehabilitation is defined as:",
    opts: ["A) Any structural or functional abnormality", "B) Restriction or lack of ability to perform an activity in the normal manner", "C) Social exclusion of persons with impairments", "D) Death or permanent loss of a body part"],
    ans: "B"
  },
  {
    q: "10. Which model of disability emphasizes social and environmental factors rather than the individual's condition?",
    opts: ["A) Medical model", "B) Biomedical model", "C) Social model", "D) Pathological model"],
    ans: "C"
  },

  // === SECTION 2: THERAPEUTIC MODALITIES ===
  {
    q: "11. Transcutaneous Electrical Nerve Stimulation (TENS) is primarily used for:",
    opts: ["A) Muscle strengthening", "B) Pain relief", "C) Wound healing", "D) Reduction of muscle spasticity"],
    ans: "B"
  },
  {
    q: "12. Ultrasound therapy in physiotherapy works by:",
    opts: ["A) Producing high-frequency sound waves that cause thermal and non-thermal effects in tissues", "B) Emitting ionizing radiation to kill bacteria", "C) Applying electrical current to contract muscles", "D) Using magnetic fields to reduce inflammation"],
    ans: "A"
  },
  {
    q: "13. Cryotherapy (cold therapy) is indicated in which of the following scenarios?",
    opts: ["A) Chronic arthritis requiring joint mobility", "B) Acute sprains and muscle strains within the first 48 hours", "C) Peripheral vascular disease", "D) Raynaud's phenomenon"],
    ans: "B"
  },
  {
    q: "14. Moist heat therapy is contraindicated in:",
    opts: ["A) Muscle spasm", "B) Chronic joint stiffness", "C) Acute inflammation", "D) Subacute tissue injury"],
    ans: "C"
  },
  {
    q: "15. The RICE protocol used in acute musculoskeletal injuries stands for:",
    opts: ["A) Rest, Ice, Compression, Elevation", "B) Rest, Immobilization, Cold, Exercise", "C) Rotation, Ice, Compression, Extension", "D) Rest, Inflammation control, Circulation, Exercise"],
    ans: "A"
  },
  {
    q: "16. Shortwave diathermy (SWD) produces its therapeutic effect by:",
    opts: ["A) Mechanical vibration of tissues", "B) Deep heating of tissues through electromagnetic energy", "C) Electrical stimulation of peripheral nerves", "D) Ultraviolet light absorption by skin"],
    ans: "B"
  },
  {
    q: "17. Which electrotherapy modality uses high-frequency alternating current to produce deep tissue heating?",
    opts: ["A) TENS", "B) Interferential therapy (IFT)", "C) Microwave diathermy", "D) Infrared radiation"],
    ans: "C"
  },
  {
    q: "18. Hydrotherapy (aquatic therapy) has which main advantage for rehabilitation patients?",
    opts: ["A) Eliminates need for physical therapist supervision", "B) Buoyancy reduces weight bearing, allowing earlier mobilization", "C) Cures underlying pathology", "D) Replaces all land-based exercises"],
    ans: "B"
  },
  {
    q: "19. Infrared radiation in physiotherapy primarily produces its effect by:",
    opts: ["A) Deep tissue heating beyond 3 cm depth", "B) Superficial heating of skin and subcutaneous tissue", "C) Stimulating muscle contractions", "D) Killing surface bacteria"],
    ans: "B"
  },
  {
    q: "20. The primary purpose of traction in physical rehabilitation is:",
    opts: ["A) Strengthening paraspinal muscles", "B) Reducing nerve root compression and relieving pain, especially in the spine", "C) Increasing joint range of motion through stretching", "D) Improving cardiovascular endurance"],
    ans: "B"
  },

  // === SECTION 3: EXERCISE THERAPY ===
  {
    q: "21. Isometric exercises involve:",
    opts: ["A) Joint movement with constant resistance", "B) Muscle contraction without change in muscle length or joint movement", "C) Variable resistance throughout the range of motion", "D) Eccentric muscle contractions only"],
    ans: "B"
  },
  {
    q: "22. Isotonic exercises are characterized by:",
    opts: ["A) Constant muscle tension with no joint movement", "B) Muscle contraction with joint movement and constant load", "C) Variable tension with no external resistance", "D) Electrical stimulation of muscles"],
    ans: "B"
  },
  {
    q: "23. Isokinetic exercise involves:",
    opts: ["A) Fixed speed of movement with variable resistance throughout the range", "B) Fixed load throughout the range of motion", "C) Maximal contraction without joint movement", "D) Passive movement by therapist"],
    ans: "A"
  },
  {
    q: "24. Progressive Resistive Exercise (PRE) was developed by:",
    opts: ["A) Kabat", "B) DeLorme and Watkins", "C) Brunnstrom", "D) Bobath"],
    ans: "B"
  },
  {
    q: "25. In the DeLorme method of progressive resistive exercise, the 10 RM refers to:",
    opts: ["A) Maximum weight that can be lifted 10 times", "B) Minimum weight for 10 repetitions", "C) 10% of body weight", "D) 10 sets of maximum resistance"],
    ans: "A"
  },
  {
    q: "26. Active-assisted exercises are indicated when the patient has muscle strength of:",
    opts: ["A) Grade 0 (no muscle contraction)", "B) Grade 1 (trace contraction only)", "C) Grade 2-3 (muscle contracts but cannot overcome gravity or resistance)", "D) Grade 5 (normal strength)"],
    ans: "C"
  },
  {
    q: "27. Proprioceptive Neuromuscular Facilitation (PNF) techniques are primarily used to:",
    opts: ["A) Reduce pain by gate control mechanism", "B) Facilitate neuromuscular function and improve range of motion and strength", "C) Provide cardiovascular conditioning", "D) Treat respiratory conditions"],
    ans: "B"
  },
  {
    q: "28. The 'hold-relax' technique in PNF works by:",
    opts: ["A) Isometric contraction of antagonist followed by passive stretch", "B) Active movement against maximum resistance", "C) Reciprocal inhibition of agonist", "D) Electrical facilitation of weak muscles"],
    ans: "A"
  },
  {
    q: "29. Stretching exercises to improve flexibility should be held for at least how many seconds to be effective?",
    opts: ["A) 5 seconds", "B) 10 seconds", "C) 15-30 seconds", "D) 60-90 seconds"],
    ans: "C"
  },
  {
    q: "30. Aerobic exercise is beneficial in cardiac rehabilitation primarily because it:",
    opts: ["A) Increases resting heart rate", "B) Increases myocardial oxygen demand at rest", "C) Improves cardiovascular efficiency and reduces cardiovascular risk factors", "D) Replaces the need for cardiac medications"],
    ans: "C"
  },

  // === SECTION 4: GAIT & AMBULATION ===
  {
    q: "31. Normal gait cycle consists of two phases. Which is correct?",
    opts: ["A) Swing phase (60%) and stance phase (40%)", "B) Stance phase (60%) and swing phase (40%)", "C) Stance phase (50%) and swing phase (50%)", "D) Acceleration phase (70%) and deceleration phase (30%)"],
    ans: "B"
  },
  {
    q: "32. Trendelenburg gait is caused by weakness of which muscle?",
    opts: ["A) Quadriceps", "B) Gluteus maximus", "C) Gluteus medius", "D) Hip flexors"],
    ans: "C"
  },
  {
    q: "33. Foot drop during gait is due to weakness of:",
    opts: ["A) Gastrocnemius and soleus", "B) Anterior tibialis and dorsiflexors", "C) Peroneus longus and brevis", "D) Intrinsic foot muscles"],
    ans: "B"
  },
  {
    q: "34. Steppage gait (high-stepping gait) is seen in:",
    opts: ["A) Spastic hemiplegia", "B) Foot drop (weakness of dorsiflexors)", "C) Cerebellar ataxia", "D) Parkinsonism"],
    ans: "B"
  },
  {
    q: "35. Festinating gait (small, accelerating steps) is characteristic of:",
    opts: ["A) Cerebellar disease", "B) Multiple sclerosis", "C) Parkinson's disease", "D) Huntington's disease"],
    ans: "C"
  },
  {
    q: "36. Hemiplegic (circumduction) gait involves:",
    opts: ["A) Waddling from side to side", "B) Swinging the affected leg outward in a semicircle due to spasticity", "C) Excessive knee flexion", "D) Bilateral foot drop"],
    ans: "B"
  },
  {
    q: "37. A Lofstrand (forearm) crutch provides better support than an axillary crutch because it:",
    opts: ["A) Allows full weight bearing through the axilla", "B) Provides forearm and wrist support, reducing axillary nerve injury risk", "C) Is used only for partial weight bearing", "D) Is preferred for bilateral lower limb paralysis"],
    ans: "B"
  },
  {
    q: "38. When a patient uses a cane for a right knee injury, the cane should be held in the:",
    opts: ["A) Right hand (ipsilateral side)", "B) Left hand (contralateral side)", "C) Either hand - no difference", "D) Both hands using a quad cane"],
    ans: "B"
  },
  {
    q: "39. The 'swing-through' crutch gait pattern is used for patients with:",
    opts: ["A) Single limb weakness", "B) Bilateral lower limb paralysis or amputation", "C) Balance disorders only", "D) Upper limb weakness"],
    ans: "B"
  },
  {
    q: "40. Cadence in gait analysis is defined as:",
    opts: ["A) Distance covered in one gait cycle", "B) Number of steps taken per unit time (steps/minute)", "C) Speed of walking in meters per second", "D) Length of each stride"],
    ans: "B"
  },

  // === SECTION 5: STROKE REHABILITATION ===
  {
    q: "41. The Brunnstrom stages of stroke recovery progress from:",
    opts: ["A) Normal function → Spasticity → Flaccidity", "B) Flaccidity → Spasticity → Synergy patterns → Isolated movements", "C) Isolated movements → Synergies → Spasticity → Normal", "D) Hyperreflexia → Flaccidity → Recovery"],
    ans: "B"
  },
  {
    q: "42. The Bobath (Neurodevelopmental Treatment) approach to stroke rehabilitation focuses on:",
    opts: ["A) Strengthening spastic muscles through resistance exercises", "B) Inhibiting abnormal tone and facilitating normal movement patterns", "C) Using compensatory strategies from the unaffected side", "D) Electrical stimulation of paralyzed muscles"],
    ans: "B"
  },
  {
    q: "43. Constraint-Induced Movement Therapy (CIMT) for stroke rehabilitation involves:",
    opts: ["A) Restraining the affected upper limb to rest it", "B) Restraining the unaffected limb to force use of the affected limb", "C) Complete bed rest for 2 weeks post-stroke", "D) Electrical stimulation of both limbs simultaneously"],
    ans: "B"
  },
  {
    q: "44. After stroke, the most common type of aphasia involving difficulty understanding spoken language is:",
    opts: ["A) Broca's aphasia", "B) Wernicke's aphasia", "C) Global aphasia", "D) Conduction aphasia"],
    ans: "B"
  },
  {
    q: "45. The Modified Rankin Scale (mRS) is used in stroke rehabilitation to measure:",
    opts: ["A) Cognitive function", "B) Level of disability and dependence in daily activities", "C) Pain intensity", "D) Swallowing function"],
    ans: "B"
  },
  {
    q: "46. Shoulder subluxation in stroke patients is best prevented by:",
    opts: ["A) Keeping the arm in a sling at all times", "B) Proper positioning, support, and early mobilization with handling techniques", "C) Immobilizing the shoulder for 6 weeks", "D) Injecting botulinum toxin into the rotator cuff"],
    ans: "B"
  },
  {
    q: "47. Dysphagia post-stroke is evaluated by which bedside test?",
    opts: ["A) Spirometry", "B) Water swallowing test / bedside swallowing assessment", "C) Barium meal X-ray", "D) Nerve conduction study"],
    ans: "B"
  },
  {
    q: "48. Early mobilization after stroke is recommended because it:",
    opts: ["A) Prevents hemorrhagic transformation", "B) Reduces complications such as DVT, pressure ulcers, and deconditioning", "C) Reverses neurological deficits immediately", "D) Eliminates the need for anticoagulation"],
    ans: "B"
  },
  {
    q: "49. Hemineglect (hemispatial neglect) after stroke is most commonly seen with damage to:",
    opts: ["A) Left frontal lobe", "B) Right parietal lobe", "C) Cerebellum", "D) Brainstem"],
    ans: "B"
  },
  {
    q: "50. Goal of upper limb rehabilitation post-stroke includes all EXCEPT:",
    opts: ["A) Reducing spasticity", "B) Improving dexterity", "C) Achieving complete anatomical cure of infarcted brain tissue", "D) Regaining functional use for ADLs"],
    ans: "C"
  },

  // === SECTION 6: SPINAL CORD INJURY REHABILITATION ===
  {
    q: "51. ASIA classification (American Spinal Injury Association) is used to classify:",
    opts: ["A) Severity of traumatic brain injury", "B) Completeness and neurological level of spinal cord injury", "C) Degree of spinal instability on imaging", "D) Type of surgical intervention needed"],
    ans: "B"
  },
  {
    q: "52. An ASIA grade A spinal cord injury indicates:",
    opts: ["A) Complete motor and sensory loss below the level of injury", "B) Incomplete injury - motor function preserved below level", "C) Normal sensory, impaired motor function", "D) Partial recovery with preserved sacral sparing"],
    ans: "A"
  },
  {
    q: "53. Autonomic dysreflexia is a life-threatening complication of spinal cord injury occurring at or above level:",
    opts: ["A) L1", "B) T10", "C) T6", "D) C8"],
    ans: "C"
  },
  {
    q: "54. First-line management of autonomic dysreflexia includes:",
    opts: ["A) Immediate administration of IV morphine", "B) Sitting patient upright and identifying/removing the triggering stimulus", "C) Lying patient flat and administering IV fluids", "D) Applying ice packs to the back"],
    ans: "B"
  },
  {
    q: "55. A patient with C6 complete spinal cord injury would be expected to have which functional ability?",
    opts: ["A) No arm function at all", "B) Wrist extension, allowing use of tenodesis grasp for ADLs", "C) Full hand and finger function", "D) Independent walking with knee-ankle-foot orthosis"],
    ans: "B"
  },
  {
    q: "56. Pressure ulcer prevention in spinal cord injury patients includes pressure relief by:",
    opts: ["A) Keeping patient in one position 24 hours a day for comfort", "B) Repositioning every 2 hours and using pressure-relieving surfaces", "C) Applying tight compression bandages", "D) Placing foam only under bony prominences at all times"],
    ans: "B"
  },
  {
    q: "57. Spasticity in spinal cord injury is best managed with all of the following EXCEPT:",
    opts: ["A) Baclofen (oral or intrathecal)", "B) Stretching exercises", "C) Botulinum toxin injections", "D) Increasing caffeine intake"],
    ans: "D"
  },
  {
    q: "58. Neurogenic bladder in spinal cord injury is initially managed by:",
    opts: ["A) Permanent indwelling urethral catheter", "B) Intermittent catheterization program (ICP)", "C) Diuretics to prevent bladder distension", "D) Surgical bladder augmentation"],
    ans: "B"
  },
  {
    q: "59. Orthostatic hypotension in spinal cord injury is best managed by:",
    opts: ["A) Rapid sitting up after long bed rest", "B) Gradual head-of-bed elevation, abdominal binder, and compression stockings", "C) High dose sodium restriction", "D) Beta-blocker medications"],
    ans: "B"
  },
  {
    q: "60. Heterotopic ossification (HO) in SCI rehabilitation refers to:",
    opts: ["A) Fractures of vertebrae due to falls", "B) Abnormal formation of bone in soft tissues around joints", "C) Osteoporosis of long bones", "D) Calcification of intervertebral discs"],
    ans: "B"
  },

  // === SECTION 7: ORTHOPAEDIC REHABILITATION ===
  {
    q: "61. Total knee replacement (TKR) rehabilitation typically begins:",
    opts: ["A) 6 weeks post-surgery", "B) Within 24-48 hours post-surgery", "C) Only after complete wound healing (3 months)", "D) When pain has completely resolved"],
    ans: "B"
  },
  {
    q: "62. After total hip replacement (posterior approach), which movements are initially restricted to prevent dislocation?",
    opts: ["A) Hip flexion beyond 90°, adduction beyond midline, and internal rotation", "B) Hip extension, external rotation, and abduction", "C) Knee flexion and extension", "D) Ankle plantarflexion and dorsiflexion"],
    ans: "A"
  },
  {
    q: "63. The 'unhappy triad' injury of the knee involves damage to:",
    opts: ["A) Medial meniscus, ACL, and MCL", "B) Lateral meniscus, PCL, and LCL", "C) ACL, PCL, and patellar tendon", "D) Medial meniscus, PCL, and LCL"],
    ans: "A"
  },
  {
    q: "64. Closed kinetic chain exercises for knee rehabilitation are preferred because they:",
    opts: ["A) Isolate the quadriceps without stressing the joint", "B) Produce more normal joint loading and reduce stress on anterior cruciate ligament", "C) Are performed in water only", "D) Use electrical stimulation to contract quadriceps"],
    ans: "B"
  },
  {
    q: "65. Supraspinatus tear rehabilitation focuses initially on:",
    opts: ["A) Immediate heavy resistance rotator cuff exercises", "B) Pain control, passive range of motion, and gentle active-assisted movement", "C) Full return to sport within 1 week", "D) Shoulder immobilization for 3 months"],
    ans: "B"
  },
  {
    q: "66. Colles' fracture rehabilitation should include which early intervention?",
    opts: ["A) Immediate full weight bearing through the wrist", "B) Finger and shoulder mobilization during cast immobilization to prevent stiffness", "C) Complete arm immobilization for 8 weeks", "D) Wrist fusion as primary management"],
    ans: "B"
  },
  {
    q: "67. Tennis elbow (lateral epicondylitis) is best managed in the subacute phase by:",
    opts: ["A) Steroid injection every 2 weeks indefinitely", "B) Eccentric strengthening exercises of the wrist extensors", "C) Complete rest and immobilization for 6 weeks", "D) Immediate surgical release"],
    ans: "B"
  },
  {
    q: "68. The primary goal of rehabilitation after ACL reconstruction in the first 2 weeks is:",
    opts: ["A) Return to sport activities", "B) Reduce swelling, regain full extension, and activate quadriceps", "C) Start running exercises", "D) Full weight bearing without crutches"],
    ans: "B"
  },
  {
    q: "69. Osteoarthritis rehabilitation includes all of the following EXCEPT:",
    opts: ["A) Aerobic exercise", "B) Quadriceps strengthening", "C) Joint replacement surgery as first-line", "D) Weight reduction in obese patients"],
    ans: "C"
  },
  {
    q: "70. Rheumatoid arthritis rehabilitation during disease flare should focus on:",
    opts: ["A) Aggressive strengthening exercises", "B) Rest, gentle range of motion, splinting of inflamed joints", "C) High-impact aerobic exercise", "D) Traction therapy for affected joints"],
    ans: "B"
  },

  // === SECTION 8: CARDIAC & PULMONARY REHABILITATION ===
  {
    q: "71. Cardiac rehabilitation after myocardial infarction consists of how many phases?",
    opts: ["A) 2 phases", "B) 3 phases", "C) 4 phases", "D) 5 phases"],
    ans: "B"
  },
  {
    q: "72. Phase I of cardiac rehabilitation (inpatient phase) involves:",
    opts: ["A) Vigorous aerobic training on a treadmill", "B) Low-intensity activity, patient education, and early mobilization in hospital", "C) High-intensity interval training", "D) Return to full occupational duties"],
    ans: "B"
  },
  {
    q: "73. Target heart rate during cardiac rehabilitation exercise is typically:",
    opts: ["A) Maximum heart rate (220 - age)", "B) 40-85% of maximum heart rate reserve (Karvonen formula)", "C) A fixed 60 beats per minute", "D) 95% of maximum heart rate"],
    ans: "B"
  },
  {
    q: "74. The Borg Rating of Perceived Exertion (RPE) scale most commonly used in cardiac rehabilitation is:",
    opts: ["A) 0-5 scale", "B) 0-20 scale (or modified 0-10 scale)", "C) 0-100 visual analog scale", "D) 1-3 scale (mild, moderate, severe)"],
    ans: "B"
  },
  {
    q: "75. Absolute contraindication to cardiac rehabilitation exercise includes:",
    opts: ["A) Controlled hypertension", "B) Unstable angina or acute decompensated heart failure", "C) Mild valve disease", "D) Post-CABG patient at 4 weeks"],
    ans: "B"
  },
  {
    q: "76. Pulmonary rehabilitation is most beneficial for patients with:",
    opts: ["A) Acute pneumonia", "B) Chronic obstructive pulmonary disease (COPD)", "C) Pulmonary embolism in the acute phase", "D) Asthma requiring emergency bronchodilator use"],
    ans: "B"
  },
  {
    q: "77. Pursed-lip breathing in COPD rehabilitation helps by:",
    opts: ["A) Increasing oxygen consumption", "B) Slowing expiration, increasing back pressure to prevent airway collapse", "C) Strengthening diaphragm", "D) Reducing functional residual capacity"],
    ans: "B"
  },
  {
    q: "78. The 6-Minute Walk Test (6MWT) in pulmonary rehabilitation measures:",
    opts: ["A) Lung function (FEV1)", "B) Submaximal exercise capacity and functional performance", "C) Arterial blood gases at rest", "D) Respiratory muscle strength"],
    ans: "B"
  },
  {
    q: "79. Inspiratory muscle training (IMT) in COPD is used to:",
    opts: ["A) Improve exhalation speed", "B) Strengthen the diaphragm and inspiratory muscles to reduce breathlessness", "C) Eliminate bronchospasm", "D) Cure the disease"],
    ans: "B"
  },
  {
    q: "80. Which breathing technique teaches patients to use the diaphragm more effectively?",
    opts: ["A) Pursed-lip breathing", "B) Diaphragmatic (abdominal) breathing", "C) Apneustic breathing", "D) Kussmaul breathing"],
    ans: "B"
  },

  // === SECTION 9: NEUROLOGICAL REHABILITATION ===
  {
    q: "81. Task-specific training in neurological rehabilitation is based on the principle of:",
    opts: ["A) Cross-education of muscles", "B) Neuroplasticity - the nervous system can reorganize in response to practice and experience", "C) Electrical stimulation replacing voluntary effort", "D) Passive movement inducing motor recovery"],
    ans: "B"
  },
  {
    q: "82. The Ashworth Scale is used to measure:",
    opts: ["A) Degree of muscle weakness", "B) Spasticity (resistance to passive stretch)", "C) Coordination and balance", "D) Pain intensity"],
    ans: "B"
  },
  {
    q: "83. In Parkinson's disease rehabilitation, the LSVT BIG program focuses on:",
    opts: ["A) Speech and voice therapy", "B) Large-amplitude movements to improve motor function", "C) Cognitive retraining", "D) Balance training only"],
    ans: "B"
  },
  {
    q: "84. Visual cues (e.g., lines on the floor) are used in Parkinson's disease rehabilitation to address:",
    opts: ["A) Visual field defects", "B) Freezing of gait and festination", "C) Tremor at rest", "D) Rigidity of trunk muscles"],
    ans: "B"
  },
  {
    q: "85. Falls prevention in elderly neurological patients should include all EXCEPT:",
    opts: ["A) Balance and coordination training", "B) Medication review (reducing sedatives/polypharmacy)", "C) Environmental modifications", "D) Enforcing complete bed rest to avoid falls"],
    ans: "D"
  },
  {
    q: "86. Functional electrical stimulation (FES) is used in neurological rehabilitation to:",
    opts: ["A) Heat deep tissues", "B) Stimulate paralyzed muscles to produce functional movements", "C) Reduce nerve conduction velocity", "D) Provide analgesia only"],
    ans: "B"
  },
  {
    q: "87. The Berg Balance Scale assesses:",
    opts: ["A) Cardiovascular fitness", "B) Static and dynamic balance through 14 functional tasks", "C) Muscle strength of lower limbs", "D) Gait speed and endurance"],
    ans: "B"
  },
  {
    q: "88. In multiple sclerosis rehabilitation, fatigue management strategies include:",
    opts: ["A) Avoiding all physical activity", "B) Energy conservation techniques, cool environment, and graded exercise", "C) High-dose steroid therapy permanently", "D) Sleep deprivation therapy"],
    ans: "B"
  },
  {
    q: "89. Which of the following is NOT a principle of neurological rehabilitation?",
    opts: ["A) Intensive, repetitive practice", "B) Task-oriented training", "C) Complete bed rest until full neurological recovery", "D) Use of feedback and motivation"],
    ans: "C"
  },
  {
    q: "90. Robot-assisted therapy in stroke rehabilitation is thought to improve outcomes because it:",
    opts: ["A) Replaces the need for human therapists permanently", "B) Allows high-intensity, repetitive, task-specific practice with sensory feedback", "C) Directly regenerates damaged neurons", "D) Works only for patients with complete recovery"],
    ans: "B"
  },

  // === SECTION 10: ORTHOTICS, PROSTHETICS & SPECIAL TOPICS ===
  {
    q: "91. An ankle-foot orthosis (AFO) is most commonly prescribed for:",
    opts: ["A) Knee instability", "B) Foot drop and ankle instability", "C) Hip abductor weakness", "D) Plantar fasciitis only"],
    ans: "B"
  },
  {
    q: "92. A knee-ankle-foot orthosis (KAFO) is indicated for patients with:",
    opts: ["A) Isolated ankle weakness", "B) Knee instability combined with foot drop or lower limb weakness", "C) Upper limb spasticity", "D) Low back pain"],
    ans: "B"
  },
  {
    q: "93. The preparatory (temporary) prosthesis in amputee rehabilitation is used for:",
    opts: ["A) Permanent cosmetic restoration", "B) Early ambulation training and residual limb conditioning before definitive prosthesis fitting", "C) High-performance sports activities", "D) Underwater aquatic therapy only"],
    ans: "B"
  },
  {
    q: "94. Phantom limb pain after amputation is best described as:",
    opts: ["A) Pain in the contralateral intact limb", "B) Painful sensation perceived in the removed limb", "C) Pain at the wound site due to infection", "D) Psychological hallucination with no neurological basis"],
    ans: "B"
  },
  {
    q: "95. Stump (residual limb) bandaging after below-knee amputation is performed using figure-8 technique primarily to:",
    opts: ["A) Immobilize the knee joint", "B) Shape the stump and reduce edema for prosthesis fitting", "C) Prevent infection", "D) Provide pain relief through compression"],
    ans: "B"
  },
  {
    q: "96. The most common complication of prolonged immobilization in rehabilitation is:",
    opts: ["A) Hypoglycemia", "B) Muscle atrophy, joint contractures, and deep vein thrombosis", "C) Hyperthyroidism", "D) Renal calculi only"],
    ans: "B"
  },
  {
    q: "97. Vocational rehabilitation aims to:",
    opts: ["A) Provide psychological counseling only", "B) Help disabled individuals return to work or gain new employment skills", "C) Replace occupational therapy", "D) Provide financial compensation for disability"],
    ans: "B"
  },
  {
    q: "98. In pediatric rehabilitation, cerebral palsy is classified using the Gross Motor Function Classification System (GMFCS) with levels:",
    opts: ["A) I to III (I = most severe)", "B) I to V (I = least impaired, V = most severely impaired)", "C) 0 to 4 (0 = normal)", "D) A to E (A = complete impairment)"],
    ans: "B"
  },
  {
    q: "99. Pain in rehabilitation is commonly assessed using which scale?",
    opts: ["A) Glasgow Coma Scale (GCS)", "B) Visual Analogue Scale (VAS) or Numeric Rating Scale (NRS)", "C) Modified Rankin Scale (mRS)", "D) ASIA Impairment Scale"],
    ans: "B"
  },
  {
    q: "100. Which approach is most evidence-based for low back pain rehabilitation?",
    opts: ["A) Strict bed rest for 6 weeks", "B) Active exercise, education, and graded return to activity", "C) Surgical fusion as first-line", "D) Continuous traction therapy for 3 months"],
    ans: "B"
  }
];

// Build document content
const children = [];

// Title
children.push(new Paragraph({
  text: "Physical Rehabilitation - 100 MCQ Questions",
  heading: HeadingLevel.TITLE,
  alignment: AlignmentType.CENTER,
  spacing: { after: 200 }
}));

// Subtitle
children.push(new Paragraph({
  children: [new TextRun({ text: "Undergraduate Level | Multiple Choice Questions", bold: true, size: 24 })],
  alignment: AlignmentType.CENTER,
  spacing: { after: 100 }
}));

children.push(new Paragraph({
  children: [new TextRun({ text: "Instructions: Choose the single best answer for each question.", italics: true, size: 22 })],
  alignment: AlignmentType.CENTER,
  spacing: { after: 400 }
}));

const sectionTitles = {
  1: "SECTION 1: Basics & Principles of Physical Rehabilitation (Q1-10)",
  11: "SECTION 2: Therapeutic Modalities (Q11-20)",
  21: "SECTION 3: Exercise Therapy (Q21-30)",
  31: "SECTION 4: Gait & Ambulation (Q31-40)",
  41: "SECTION 5: Stroke Rehabilitation (Q41-50)",
  51: "SECTION 6: Spinal Cord Injury Rehabilitation (Q51-60)",
  61: "SECTION 7: Orthopaedic Rehabilitation (Q61-70)",
  71: "SECTION 8: Cardiac & Pulmonary Rehabilitation (Q71-80)",
  81: "SECTION 9: Neurological Rehabilitation (Q81-90)",
  91: "SECTION 10: Orthotics, Prosthetics & Special Topics (Q91-100)"
};

questions.forEach((item, idx) => {
  const num = idx + 1;

  // Section heading
  if (sectionTitles[num]) {
    children.push(new Paragraph({
      children: [new TextRun({ text: sectionTitles[num], bold: true, size: 26, color: "1F5C99" })],
      spacing: { before: 400, after: 160 },
      border: { bottom: { color: "1F5C99", size: 6, space: 4, style: "single" } }
    }));
  }

  // Question
  children.push(new Paragraph({
    children: [new TextRun({ text: item.q, bold: true, size: 22 })],
    spacing: { before: 180, after: 60 }
  }));

  // Options
  item.opts.forEach(opt => {
    children.push(new Paragraph({
      children: [new TextRun({ text: opt, size: 22 })],
      indent: { left: 360 },
      spacing: { after: 40 }
    }));
  });

  // Answer
  children.push(new Paragraph({
    children: [new TextRun({ text: `Correct Answer: ${item.ans}`, bold: true, color: "2E7D32", size: 22 })],
    indent: { left: 360 },
    spacing: { after: 160 }
  }));
});

// Answer key at the end
children.push(new Paragraph({
  children: [new TextRun({ text: "ANSWER KEY SUMMARY", bold: true, size: 28, color: "1F5C99" })],
  heading: HeadingLevel.HEADING_1,
  spacing: { before: 600, after: 200 }
}));

let answerKeyText = "";
questions.forEach((item, idx) => {
  answerKeyText += `Q${idx + 1}: ${item.ans}   `;
  if ((idx + 1) % 10 === 0) answerKeyText += "\n";
});

children.push(new Paragraph({
  children: [new TextRun({ text: answerKeyText, size: 20, font: "Courier New" })],
  spacing: { after: 200 }
}));

const doc = new Document({
  creator: "Orris Medical Education",
  title: "Physical Rehabilitation MCQ - 100 Questions",
  description: "100 multiple choice questions on physical rehabilitation for undergraduate students",
  sections: [{
    properties: {},
    children: children
  }]
});

Packer.toBuffer(doc).then(buffer => {
  fs.writeFileSync('/home/daytona/workspace/physical-rehab-mcq/Physical_Rehabilitation_100_MCQ.docx', buffer);
  console.log('SUCCESS: File written.');
}).catch(err => {
  console.error('ERROR:', err);
});