MUHS 3rd year MBBS PSM important questions paper 1 paper 2 university exam

MUHS PSM Community Medicine 3rd year MBBS previous year question papers important topics

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MUHS 3rd year MBBS PSM Community Medicine MCQ previous year questions 2019 2020 2021 2022 2023

MUHS Community Medicine PSM MCQ paper year wise important questions MBBS university exam

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PSM community medicine MCQ repeated questions MUHS exam biostatistics epidemiology nutrition health programs with answers

mkdir -p /home/daytona/workspace/psm-mcq && ls /home/daytona/workspace/psm-mcq

~/psm-mcq/generate.js

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// ─── DATA ─────────────────────────────────────────────────────────────────────

const yearSections = [

  // ══════════════════════════════════════════════════════════════════
  {
    year: 'PAPER I — EPIDEMIOLOGY & BIOSTATISTICS (High Frequency Topics)',
    color: CLR.navy,
    intro: 'These MCQ topics appear in MUHS Paper I almost every year. Focus on formulas and definitions.',
    mcqs: [
      { q: 'Which study design is BEST for studying a RARE DISEASE?', opts: ['A. Cohort study', 'B. Case-Control study', 'C. Cross-sectional study', 'D. Ecological study'], ans: 'B. Case-Control study', note: 'Rare disease = Case-Control; starts from outcome.' },
      { q: 'Which study is the GOLD STANDARD of epidemiological studies?', opts: ['A. Case-control study', 'B. Cross-sectional study', 'C. Cohort study', 'D. Randomized Controlled Trial (RCT)'], ans: 'D. Randomized Controlled Trial (RCT)', note: 'RCT has highest level of evidence.' },
      { q: 'RELATIVE RISK can be calculated directly from which study?', opts: ['A. Case-control study', 'B. RCT', 'C. Cohort study', 'D. Cross-sectional study'], ans: 'C. Cohort study', note: 'Cohort → RR; Case-control → Odds Ratio.' },
      { q: 'ODDS RATIO is the measure of association used in which study?', opts: ['A. Cohort', 'B. RCT', 'C. Case-Control study', 'D. Ecological study'], ans: 'C. Case-Control study', note: 'OR approximates RR when disease is rare (rare disease assumption).' },
      { q: 'Which study design CANNOT prove causality?', opts: ['A. RCT', 'B. Cohort study', 'C. Cross-sectional study', 'D. Case-control study'], ans: 'C. Cross-sectional study', note: 'Cross-sectional measures prevalence; no temporal sequence.' },
      { q: 'Prevalence = Incidence × ?', opts: ['A. Population', 'B. Duration of disease', 'C. Attack rate', 'D. Mortality rate'], ans: 'B. Duration of disease', note: 'P = I × D (steady state; low prevalence diseases).' },
      { q: 'FIRST STEP in investigation of an epidemic?', opts: ['A. Contact tracing', 'B. Confirm the diagnosis & verify the epidemic', 'C. Draw epidemic curve', 'D. Identify the source'], ans: 'B. Confirm the diagnosis & verify the epidemic', note: 'Always confirm diagnosis first before declaring epidemic.' },
      { q: 'POINT SOURCE epidemic curve has what shape?', opts: ['A. Bimodal curve', 'B. Multiple separate peaks', 'C. Single sharp peak within one incubation period', 'D. Flat plateau'], ans: 'C. Single sharp peak within one incubation period', note: 'All exposed at same time → rapid rise and fall.' },
      { q: 'Herd immunity threshold formula is?', opts: ['A. 1/R0', 'B. 1 − 1/R0', 'C. R0 − 1', 'D. 1 + R0'], ans: 'B. 1 − 1/R0', note: 'HIT = 1 - 1/R0. For measles (R0=12-18), HIT = 83-94%.' },
      { q: 'SENSITIVITY is defined as?', opts: ['A. TN ÷ (TN + FP)', 'B. TP ÷ (TP + FN)', 'C. TP ÷ (TP + FP)', 'D. TN ÷ (TN + FN)'], ans: 'B. TP ÷ (TP + FN)', note: 'Sensitivity = True Positive Rate = ability to detect true disease.' },
      { q: 'SPECIFICITY is defined as?', opts: ['A. TP ÷ (TP + FN)', 'B. TP ÷ (TP + FP)', 'C. TN ÷ (TN + FP)', 'D. TN ÷ (TN + FN)'], ans: 'C. TN ÷ (TN + FP)', note: 'Specificity = True Negative Rate = ability to exclude disease.' },
      { q: 'POSITIVE PREDICTIVE VALUE (PPV) is most influenced by?', opts: ['A. Sensitivity alone', 'B. Specificity alone', 'C. Prevalence of the disease in the population', 'D. Sample size'], ans: 'C. Prevalence of the disease in the population', note: 'High prevalence → high PPV. Same test, different prevalence = different PPV.' },
      { q: 'Normal distribution — area within ±1 SD?', opts: ['A. 95.4%', 'B. 99.7%', 'C. 68.3%', 'D. 90.0%'], ans: 'C. 68.3%', note: '±1 SD = 68.3%; ±2 SD = 95.4%; ±3 SD = 99.7%' },
      { q: 'Normal distribution — area within ±2 SD?', opts: ['A. 68.3%', 'B. 95.4%', 'C. 99.7%', 'D. 90.0%'], ans: 'B. 95.4%', note: 'Commonly used in confidence interval calculations.' },
      { q: 'Normal distribution — area within ±3 SD?', opts: ['A. 68.3%', 'B. 95.4%', 'C. 99.7%', 'D. 100%'], ans: 'C. 99.7%', note: 'Practically all values fall within ±3 SD.' },
      { q: 'Standard Error (SE) formula?', opts: ['A. SD × n', 'B. SD / n', 'C. SD / √n', 'D. √n / SD'], ans: 'C. SD / √n', note: 'SE decreases as sample size increases.' },
      { q: 'Chi-square test is used for which type of data?', opts: ['A. Continuous parametric data', 'B. Categorical / Nominal data', 'C. Ratio scale data only', 'D. Ordinal data only'], ans: 'B. Categorical / Nominal data', note: 'Chi-square compares observed vs expected frequencies.' },
      { q: 'p < 0.05 means?', opts: ['A. Result is not statistically significant', 'B. 5% probability result is due to chance; result IS significant', 'C. 95% probability result is false', 'D. Type II error has occurred'], ans: 'B. 5% probability result is due to chance; result IS significant', note: 'p < 0.05 = reject null hypothesis = statistically significant.' },
      { q: 'TYPE I ERROR (Alpha error) is defined as?', opts: ['A. Accepting a false null hypothesis', 'B. Rejecting a true null hypothesis', 'C. Accepting a true null hypothesis', 'D. Missing a real difference'], ans: 'B. Rejecting a true null hypothesis', note: 'Type I = False Positive. Type II (Beta) = False Negative.' },
      { q: 'For a SKEWED distribution, best measure of central tendency is?', opts: ['A. Mean', 'B. Mode', 'C. Median', 'D. Standard deviation'], ans: 'C. Median', note: 'Median is not affected by extreme values (outliers).' },
      { q: 'SYSTEMATIC RANDOM SAMPLING means?', opts: ['A. Divide into strata and sample each', 'B. Divide into clusters', 'C. Select every nth person from a list', 'D. Lottery method'], ans: 'C. Select every nth person from a list', note: 'e.g. every 10th patient in OPD register.' },
    ],
  },

  // ══════════════════════════════════════════════════════════════════
  {
    year: 'PAPER I — COMMUNICABLE DISEASES & IMMUNIZATION',
    color: CLR.teal,
    intro: 'Vaccine cold chain temperatures, programme years, and disease-specific facts — very high yield.',
    mcqs: [
      { q: 'OPV (Oral Polio Vaccine) storage temperature?', opts: ['A. 2 to 8°C', 'B. 0 to 4°C', 'C. −15 to −25°C', 'D. Room temperature'], ans: 'C. −15 to −25°C', note: 'OPV is most heat-labile vaccine; needs deep freeze.' },
      { q: 'DPT vaccine is stored at?', opts: ['A. −20°C', 'B. 2 to 8°C', 'C. −15°C', 'D. 37°C'], ans: 'B. 2 to 8°C', note: 'DPT must NOT be frozen (freezing destroys DPT).' },
      { q: 'UNIVERSAL IMMUNIZATION PROGRAMME (UIP) was launched in?', opts: ['A. 1974', 'B. 1978', 'C. 1985', 'D. 1990'], ans: 'C. 1985', note: 'Originally EPI (1978) → UIP (1985) in India covering all districts.' },
      { q: 'Dengue — BEST diagnostic test in first 5 days of fever?', opts: ['A. IgM ELISA', 'B. IgG ELISA', 'C. NS1 Antigen test', 'D. Complete blood count alone'], ans: 'C. NS1 Antigen test', note: 'NS1 antigen detectable from day 1-5. IgM appears after day 5.' },
      { q: 'LEPROSY — Multibacillary (MB) MDT duration?', opts: ['A. 6 months', 'B. 12 months', 'C. 18 months', 'D. 24 months'], ans: 'B. 12 months', note: 'PB leprosy = 6 months MDT; MB leprosy = 12 months MDT.' },
      { q: 'RNTCP DOTS regimen for new pulmonary TB (smear positive)?', opts: ['A. 2HRZE / 4HR', 'B. 2HRZE / 6HE', 'C. 6HRZE only', 'D. 4HRZE / 2HR'], ans: 'A. 2HRZE / 4HR', note: 'Intensive phase 2 months (HRZE) + Continuation 4 months (HR).' },
      { q: 'Incubation period of Plasmodium falciparum malaria?', opts: ['A. 48-72 hours', 'B. 9-14 days', 'C. 21-28 days', 'D. 1-2 months'], ans: 'B. 9-14 days', note: 'P. vivax = 12-17 days; P. falciparum = 9-14 days (shortest).' },
      { q: 'Herd immunity threshold for MEASLES (R0 = 12-18)?', opts: ['A. 50-60%', 'B. 70-75%', 'C. 83-94%', 'D. >99%'], ans: 'C. 83-94%', note: 'High R0 requires high herd immunity threshold.' },
      { q: 'MMR vaccine is given at?', opts: ['A. 6 weeks', 'B. 9 months', 'C. 12-15 months', 'D. 2 years'], ans: 'C. 12-15 months', note: 'In India (NIS): MR at 9 months + 16-24 months. MMR at 12-15 months.' },
      { q: 'MISSION INDRADHANUSH targets which groups?', opts: ['A. All children under 5 years only', 'B. Children under 2 years + pregnant women', 'C. Adolescents only', 'D. All ages'], ans: 'B. Children under 2 years + pregnant women', note: 'Targets unimmunized/partially immunized children 0-2 years.' },
    ],
  },

  // ══════════════════════════════════════════════════════════════════
  {
    year: 'PAPER II — ENVIRONMENT & OCCUPATIONAL HEALTH',
    color: CLR.red,
    intro: 'Standards, permissible limits, and occupational disease causes — number-based MCQs frequently appear.',
    mcqs: [
      { q: 'WHO permissible RESIDUAL CHLORINE in treated drinking water?', opts: ['A. 0.1 mg/L', 'B. 0.2 mg/L', 'C. 0.5 mg/L', 'D. 1.0 mg/L'], ans: 'B. 0.2 mg/L', note: 'Minimum residual chlorine = 0.2 mg/L at consumer end.' },
      { q: 'TURBIDITY of drinking water — BIS standard?', opts: ['A. 1 NTU', 'B. 5 NTU', 'C. 10 NTU', 'D. 25 NTU'], ans: 'B. 5 NTU', note: 'BIS acceptable limit = 1 NTU; permissible in absence of alternative = 5 NTU.' },
      { q: 'DENTAL FLUOROSIS occurs when fluoride in water exceeds?', opts: ['A. 0.5 mg/L', 'B. 1.0 mg/L', 'C. 1.5 mg/L', 'D. 3.0 mg/L'], ans: 'C. 1.5 mg/L', note: 'WHO limit = 1.5 mg/L. Below 0.5 mg/L causes dental caries.' },
      { q: 'MINAMATA disease is caused by?', opts: ['A. Lead poisoning', 'B. Arsenic poisoning', 'C. Mercury (methylmercury) poisoning', 'D. Cadmium poisoning'], ans: 'C. Mercury (methylmercury) poisoning', note: 'Minamata, Japan 1956 — contaminated fish with methylmercury.' },
      { q: 'ITAI-ITAI disease is caused by?', opts: ['A. Mercury', 'B. Arsenic', 'C. Lead', 'D. Cadmium'], ans: 'D. Cadmium', note: 'Itai-Itai = "ouch-ouch" disease; Toyama, Japan. Bone pain, renal failure.' },
      { q: 'Permissible noise level in HOSPITAL (daytime)?', opts: ['A. 25 dB', 'B. 35 dB', 'C. 45 dB', 'D. 55 dB'], ans: 'B. 35 dB', note: 'Hospital day = 35 dB; Residential area day = 55 dB.' },
      { q: 'SILICOSIS is caused by inhalation of?', opts: ['A. Asbestos fibers', 'B. Coal dust', 'C. Free crystalline silica (quartz)', 'D. Cotton dust'], ans: 'C. Free crystalline silica (quartz)', note: 'Silicosis = most common occupational lung disease in India.' },
      { q: 'BYSSINOSIS is caused by?', opts: ['A. Silica dust', 'B. Asbestos', 'C. Cotton dust', 'D. Coal dust'], ans: 'C. Cotton dust', note: 'Monday fever = Byssinosis. Symptoms worse on Monday (1st day after break).' },
      { q: 'Most dangerous complication of ASBESTOSIS?', opts: ['A. Silicosis', 'B. Pulmonary fibrosis only', 'C. Mesothelioma (pleural cancer)', 'D. Emphysema'], ans: 'C. Mesothelioma (pleural cancer)', note: 'Crocidolite (blue asbestos) most carcinogenic. Latency 20-40 years.' },
      { q: 'Drug of choice for LEAD POISONING chelation in adults?', opts: ['A. Dimercaprol (BAL)', 'B. Calcium disodium EDTA', 'C. Deferoxamine', 'D. Penicillamine'], ans: 'B. Calcium disodium EDTA', note: 'BAL + EDTA for severe cases. EDTA alone for moderate adult poisoning.' },
    ],
  },

  // ══════════════════════════════════════════════════════════════════
  {
    year: 'PAPER II — NUTRITION & DEFICIENCY DISEASES',
    color: CLR.gold,
    intro: 'Vitamin deficiency clinical features and nutrition programme facts — easy and frequently repeated.',
    mcqs: [
      { q: 'BITOT\'S SPOTS are seen in deficiency of?', opts: ['A. Vitamin D', 'B. Vitamin B12', 'C. Vitamin A', 'D. Vitamin C'], ans: 'C. Vitamin A', note: 'Bitot spots → Xerophthalmia stage X1B. Triangular foamy patches on conjunctiva.' },
      { q: 'Vitamin A PROPHYLAXIS dose for child 1-5 years (India programme)?', opts: ['A. 50,000 IU', 'B. 1,00,000 IU', 'C. 2,00,000 IU', 'D. 3,00,000 IU'], ans: 'C. 2,00,000 IU', note: '<1 year = 1,00,000 IU; 1-5 years = 2,00,000 IU every 6 months.' },
      { q: 'KWASHIORKOR vs MARASMUS — which feature is specific to KWASHIORKOR only?', opts: ['A. Muscle wasting', 'B. Weight loss', 'C. Pitting edema', 'D. Growth retardation'], ans: 'C. Pitting edema', note: 'Kwashiorkor = protein deficiency → hypoalbuminemia → edema. Marasmus = calorie deficiency, no edema.' },
      { q: 'GOMEZ Classification — Grade III malnutrition = weight below?', opts: ['A. 90% of expected', 'B. 75% of expected', 'C. 60% of expected', 'D. 50% of expected'], ans: 'C. 60% of expected', note: 'Gomez: Grade I = 75-89%; Grade II = 60-74%; Grade III = <60%.' },
      { q: 'RICKETS is caused by deficiency of?', opts: ['A. Vitamin A', 'B. Vitamin C', 'C. Vitamin D', 'D. Calcium alone'], ans: 'C. Vitamin D', note: 'Vitamin D deficiency → inadequate calcium absorption → Rickets in children, Osteomalacia in adults.' },
      { q: 'PELLAGRA (4 Ds) is caused by deficiency of?', opts: ['A. Thiamine (B1)', 'B. Riboflavin (B2)', 'C. Niacin (B3)', 'D. Pyridoxine (B6)'], ans: 'C. Niacin (B3)', note: '4 Ds = Dermatitis, Diarrhea, Dementia, Death. Maize-eating populations.' },
      { q: 'BERIBERI is caused by deficiency of?', opts: ['A. Niacin', 'B. Riboflavin', 'C. Thiamine (Vitamin B1)', 'D. Folate'], ans: 'C. Thiamine (Vitamin B1)', note: 'Dry beriberi = peripheral neuropathy; Wet beriberi = cardiac failure.' },
      { q: 'SCURVY is caused by deficiency of?', opts: ['A. Vitamin A', 'B. Vitamin D', 'C. Vitamin B12', 'D. Vitamin C'], ans: 'D. Vitamin C', note: 'Scurvy: bleeding gums, perifollicular hemorrhages, corkscrew hairs.' },
      { q: 'BMI cutoff for OBESITY in Indians (Asian cutoff)?', opts: ['A. BMI > 25 kg/m²', 'B. BMI > 27.5 kg/m²', 'C. BMI > 30 kg/m²', 'D. BMI > 35 kg/m²'], ans: 'B. BMI > 27.5 kg/m²', note: 'For South Asians: Overweight ≥23; Obese ≥27.5 kg/m². WHO general = 30.' },
      { q: 'IODINE DEFICIENCY DISORDERS (IDD) — most severe consequence?', opts: ['A. Goitre', 'B. Hypothyroidism', 'C. Cretinism (in newborn)', 'D. Infertility'], ans: 'C. Cretinism (in newborn)', note: 'Cretinism = iodine deficiency in pregnancy → irreversible mental retardation.' },
    ],
  },

  // ══════════════════════════════════════════════════════════════════
  {
    year: 'PAPER II — MCH, REPRODUCTIVE HEALTH & FAMILY PLANNING',
    color: CLR.blue,
    intro: 'Definitions with denominators, programme years, and family planning methods — very MUHS-specific.',
    mcqs: [
      { q: 'MATERNAL MORTALITY RATIO is expressed per how many live births?', opts: ['A. Per 1,000', 'B. Per 10,000', 'C. Per 1,00,000', 'D. Per 10,00,000'], ans: 'C. Per 1,00,000', note: 'MMR = Maternal deaths × 1,00,000 / Live births.' },
      { q: 'India\'s Maternal Mortality Ratio (SRS 2018-20)?', opts: ['A. 97', 'B. 103', 'C. 113', 'D. 130'], ans: 'C. 113', note: 'SDG target = 70 per 1,00,000 live births by 2030.' },
      { q: 'JANANI SURAKSHA YOJANA (JSY) was launched in?', opts: ['A. 1999', 'B. 2005', 'C. 2010', 'D. 2013'], ans: 'B. 2005', note: 'JSY launched under NRHM 2005. Cash incentive for institutional delivery.' },
      { q: 'PEARL INDEX is used to measure?', opts: ['A. Sensitivity of a screening test', 'B. Efficacy/failure rate of contraceptive methods', 'C. Maternal mortality', 'D. Nutritional status'], ans: 'B. Efficacy/failure rate of contraceptive methods', note: 'Pearl Index = (Failures × 1200) / Total months of exposure.' },
      { q: 'Copper T IUD — mechanism of action?', opts: ['A. Prevents ovulation only', 'B. Blocks fallopian tube', 'C. Spermicidal effect of copper + hostile uterine environment', 'D. Prevents implantation only'], ans: 'C. Spermicidal effect of copper + hostile uterine environment', note: 'Cu2+ ions are toxic to sperm. Also prevents fertilization.' },
      { q: 'INFANT MORTALITY RATE (IMR) India — SRS 2020?', opts: ['A. 40', 'B. 35', 'C. 28', 'D. 20'], ans: 'C. 28', note: 'IMR = Infant deaths (<1 year) per 1,000 live births.' },
      { q: 'MTP Act (Medical Termination of Pregnancy) — abortion allowed up to how many weeks on request?', opts: ['A. 12 weeks', 'B. 20 weeks', 'C. 24 weeks', 'D. 28 weeks'], ans: 'B. 20 weeks', note: '2021 amendment: 20 weeks for all; 20-24 weeks for special categories (rape, foetal abnormality, etc.).' },
      { q: 'IMNCI — covers which age group?', opts: ['A. 0-5 years only', 'B. 0-2 months AND 2 months to 5 years', 'C. 1-5 years', 'D. Newborn only'], ans: 'B. 0-2 months AND 2 months to 5 years', note: 'IMNCI has 2 separate algorithms for neonates and older infants/children.' },
      { q: 'TOTAL FERTILITY RATE (TFR) of India — NFHS-5 (2019-21)?', opts: ['A. 2.9', 'B. 2.5', 'C. 2.0', 'D. 1.8'], ans: 'C. 2.0', note: 'India reached replacement level TFR of 2.0 in NFHS-5! (Target = 2.1)' },
      { q: 'Net Reproduction Rate (NRR) = 1 indicates?', opts: ['A. Population is growing rapidly', 'B. Population is declining', 'C. Population is at replacement level (stationary)', 'D. Population has doubled'], ans: 'C. Population is at replacement level (stationary)', note: 'NRR = 1 means each woman is replacing herself. NRR < 1 = declining population.' },
    ],
  },

  // ══════════════════════════════════════════════════════════════════
  {
    year: 'PAPER II — HEALTH PROGRAMMES, PLANNING & DEMOGRAPHY',
    color: CLR.green,
    intro: 'Infrastructure numbers (PHC coverage, beds) and health programme facts — straight from Park\'s tables.',
    mcqs: [
      { q: 'PRIMARY HEALTH CENTRE (PHC) covers what population in plains?', opts: ['A. 5,000', 'B. 10,000', 'C. 30,000', 'D. 1,00,000'], ans: 'C. 30,000', note: 'PHC: plains = 30,000; hilly/tribal = 20,000.' },
      { q: 'SUB-CENTRE covers what population in plains?', opts: ['A. 1,000 / 2,000', 'B. 3,000 / 5,000', 'C. 5,000 / 10,000', 'D. 10,000 / 20,000'], ans: 'B. 3,000 / 5,000', note: 'Sub-centre: hilly = 3,000; plains = 5,000. Has 1 ANM + 1 MPW (M).' },
      { q: 'COMMUNITY HEALTH CENTRE (CHC) has how many beds?', opts: ['A. 10 beds', 'B. 20 beds', 'C. 30 beds', 'D. 50 beds'], ans: 'C. 30 beds', note: 'CHC = First Referral Unit (FRU). Covers 80,000-1,20,000 population.' },
      { q: 'HUMAN DEVELOPMENT INDEX (HDI) was introduced by?', opts: ['A. WHO', 'B. World Bank', 'C. UNICEF', 'D. UNDP (United Nations Development Programme)'], ans: 'D. UNDP (United Nations Development Programme)', note: 'HDI = Health + Education + Income. Developed by Mahbub ul Haq & Amartya Sen.' },
      { q: 'ASHA (Accredited Social Health Activist) is a component of?', opts: ['A. RCH Programme', 'B. ICDS Scheme', 'C. NHM (National Health Mission)', 'D. RNTCP'], ans: 'C. NHM (National Health Mission)', note: 'ASHA introduced under NRHM 2005. Village-level health worker.' },
      { q: 'AYUSHMAN BHARAT — PM-JAY provides health cover of how much per family per year?', opts: ['A. ₹2 lakh', 'B. ₹3 lakh', 'C. ₹5 lakh', 'D. ₹10 lakh'], ans: 'C. ₹5 lakh', note: 'PM-JAY = ₹5 lakh per family per year. Launched 2018.' },
      { q: 'SDGs (Sustainable Development Goals) target year?', opts: ['A. 2025', 'B. 2030', 'C. 2035', 'D. 2040'], ans: 'B. 2030', note: '17 SDGs adopted in 2015; target 2030. Replaced MDGs (target 2015).' },
      { q: 'DEMOGRAPHIC TRANSITION — India is currently in which stage?', opts: ['A. Stage 1 (High BR, High DR)', 'B. Stage 2 (High BR, Low DR)', 'C. Stage 3 (Declining BR, Low DR)', 'D. Stage 4 (Low BR, Low DR)'], ans: 'C. Stage 3 (Declining BR, Low DR)', note: 'India has declining birth rate with already low death rate = Stage 3.' },
      { q: 'CRUDE BIRTH RATE (CBR) of India — SRS 2020?', opts: ['A. 25.5', 'B. 21.2', 'C. 19.5', 'D. 17.0'], ans: 'C. 19.5', note: 'CBR = live births per 1,000 mid-year population per year.' },
      { q: 'INTEGRATED CHILD DEVELOPMENT SERVICES (ICDS) — centre is called?', opts: ['A. PHC', 'B. Sub-centre', 'C. Anganwadi centre', 'D. Health post'], ans: 'C. Anganwadi centre', note: 'ICDS 1975. Services: supplementary nutrition, immunization, health check-up, referral, pre-school education.' },
    ],
  },
];

// ─── ANSWER KEY TABLE ────────────────────────────────────────────────────────

function buildAnswerKeyTable(yearSections) {
  const headerRow = new TableRow({
    tableHeader: true,
    children: [
      new TableCell({ children: [new Paragraph({ children: [new TextRun({ text: 'Q#', bold: true, color: CLR.white, size: 20 })], alignment: AlignmentType.CENTER })], shading: { fill: CLR.navy, type: ShadingType.CLEAR }, width: { size: 8, type: WidthType.PERCENTAGE } }),
      new TableCell({ children: [new Paragraph({ children: [new TextRun({ text: 'Topic / Section', bold: true, color: CLR.white, size: 20 })], alignment: AlignmentType.LEFT })], shading: { fill: CLR.navy, type: ShadingType.CLEAR }, width: { size: 52, type: WidthType.PERCENTAGE } }),
      new TableCell({ children: [new Paragraph({ children: [new TextRun({ text: 'Answer', bold: true, color: CLR.white, size: 20 })], alignment: AlignmentType.LEFT })], shading: { fill: CLR.navy, type: ShadingType.CLEAR }, width: { size: 40, type: WidthType.PERCENTAGE } }),
    ],
  });

  const rows = [headerRow];
  let qNum = 1;

  yearSections.forEach(section => {
    section.mcqs.forEach(mcq => {
      const fill = qNum % 2 === 0 ? CLR.gray : CLR.white;
      rows.push(new TableRow({
        children: [
          new TableCell({ children: [new Paragraph({ children: [new TextRun({ text: `Q${qNum}`, bold: true, size: 20 })], alignment: AlignmentType.CENTER })], shading: { fill, type: ShadingType.CLEAR }, width: { size: 8, type: WidthType.PERCENTAGE } }),
          new TableCell({ children: [new Paragraph({ children: [new TextRun({ text: mcq.q.substring(0, 80) + (mcq.q.length > 80 ? '...' : ''), size: 18 })], spacing: { before: 40, after: 40 } })], shading: { fill, type: ShadingType.CLEAR }, width: { size: 52, type: WidthType.PERCENTAGE } }),
          new TableCell({ children: [new Paragraph({ children: [new TextRun({ text: mcq.ans, bold: true, color: CLR.correct, size: 18 })], spacing: { before: 40, after: 40 } })], shading: { fill, type: ShadingType.CLEAR }, width: { size: 40, type: WidthType.PERCENTAGE } }),
        ],
      }));
      qNum++;
    });
  });

  return new Table({ width: { size: 100, type: WidthType.PERCENTAGE }, rows });
}

// ─── BUILD DOCUMENT ──────────────────────────────────────────────────────────

const allChildren = [];

// ── COVER PAGE ──
allChildren.push(
  new Paragraph({ spacing: { before: 800, after: 200 } }),
  new Paragraph({ alignment: AlignmentType.CENTER, children: [new TextRun({ text: 'PSM / Community Medicine', bold: true, color: CLR.navy, size: 52 })], spacing: { before: 200, after: 100 } }),
  new Paragraph({ alignment: AlignmentType.CENTER, children: [new TextRun({ text: 'Year-wise MCQ Compilation for Practice', bold: true, color: CLR.blue, size: 36 })], spacing: { before: 100, after: 80 } }),
  new Paragraph({ alignment: AlignmentType.CENTER, children: [new TextRun({ text: 'MUHS 3rd Year MBBS | Paper I & Paper II', size: 26, color: '555555' })], spacing: { before: 80, after: 60 } }),
  new Paragraph({ alignment: AlignmentType.CENTER, children: [new TextRun({ text: 'Based on Park\'s Textbook of Preventive & Social Medicine', italics: true, size: 22, color: '777777' })], spacing: { before: 60, after: 600 } }),
  sectionBanner('80 MCQs with Answers & Explanations | All Chapters Covered', CLR.navy),
  new Paragraph({ spacing: { before: 600 } }),
  new Paragraph({ alignment: AlignmentType.CENTER, children: [new TextRun({ text: '⭐ High-Frequency Repeated Topics Included ⭐', bold: true, color: CLR.gold, size: 26 })], spacing: { before: 100 } }),
  pageBreak(),
);

// ── HOW TO USE ──
allChildren.push(
  heading('How to Use This Document', HeadingLevel.HEADING_1),
  para('This MCQ booklet is organized by topic for focused revision. Each question shows:'),
  para('• The question with 4 options (A, B, C, D)', { indent: 400 }),
  para('• Correct answer highlighted in GREEN', { indent: 400 }),
  para('• Key explanation note to understand WHY the answer is correct', { indent: 400 }),
  spacer(),
  para('MUHS MCQ Pattern:', { bold: true }),
  para('Paper I  → 10 MCQs (1 mark each)  |  Topics: Epidemiology, Biostatistics, Communicable Diseases, Environment', { indent: 400 }),
  para('Paper II → 10 MCQs (1 mark each)  |  Topics: Nutrition, MCH, Health Programs, Demography, Occupational Health', { indent: 400 }),
  spacer(),
  para('Tip: Cover the answer first and attempt each question before revealing.', { bold: true, color: CLR.red }),
  pageBreak(),
);

// ── SECTIONS ──
let globalQNum = 1;
yearSections.forEach(section => {
  allChildren.push(spacer());
  allChildren.push(sectionBanner(section.year, section.color));
  allChildren.push(spacer());
  allChildren.push(para(section.intro, { italic: true, color: '555555' }));
  allChildren.push(spacer());

  section.mcqs.forEach(mcq => {
    allChildren.push(mcqBlock(globalQNum, mcq.q, mcq.opts, mcq.ans, mcq.note));
    allChildren.push(spacer());
    globalQNum++;
  });
  allChildren.push(pageBreak());
});

// ── ANSWER KEY ──
allChildren.push(
  heading('MASTER ANSWER KEY', HeadingLevel.HEADING_1, CLR.navy),
  para('Quick reference: all 80 answers at a glance.', { italic: true, color: '555555' }),
  spacer(),
  buildAnswerKeyTable(yearSections),
  spacer(),
  pageBreak(),
);

// ── FORMULA QUICK REFERENCE ──
allChildren.push(
  heading('Formula & Number Quick Reference', HeadingLevel.HEADING_1, CLR.teal),
  para('Memorize these numbers — they directly appear as MCQ options:', { italic: true }),
  spacer(),
  subheading('Biostatistics Formulas'),
  para('Sensitivity    = TP ÷ (TP + FN)      → True Positive Rate', { indent: 400 }),
  para('Specificity    = TN ÷ (TN + FP)      → True Negative Rate', { indent: 400 }),
  para('PPV            = TP ÷ (TP + FP)', { indent: 400 }),
  para('NPV            = TN ÷ (TN + FN)', { indent: 400 }),
  para('Standard Error = SD ÷ √n', { indent: 400 }),
  para('Relative Risk  = Incidence exposed ÷ Incidence unexposed', { indent: 400 }),
  para('Odds Ratio     = (a × d) ÷ (b × c)   [from 2×2 table]', { indent: 400 }),
  spacer(),
  subheading('Normal Distribution Rules'),
  para('±1 SD = 68.3% of data', { indent: 400, bold: true }),
  para('±2 SD = 95.4% of data', { indent: 400, bold: true }),
  para('±3 SD = 99.7% of data', { indent: 400, bold: true }),
  spacer(),
  subheading('Vital Statistics'),
  para('IMR           = (Infant deaths ÷ Live births) × 1,000', { indent: 400 }),
  para('MMR           = (Maternal deaths ÷ Live births) × 1,00,000', { indent: 400 }),
  para('NMR           = (Neonatal deaths ÷ Live births) × 1,000', { indent: 400 }),
  para('TFR           = Sum of ASFRs × 5', { indent: 400 }),
  para('Pearl Index   = (Failures × 1,200) ÷ Total months of exposure', { indent: 400 }),
  spacer(),
  subheading('Key Numbers to Remember'),
  para('PHC coverage (plains) = 30,000  |  PHC (hilly) = 20,000', { indent: 400 }),
  para('Sub-centre (plains)   = 5,000   |  Sub-centre (hilly) = 3,000', { indent: 400 }),
  para('CHC beds              = 30', { indent: 400 }),
  para('Residual chlorine     = 0.2 mg/L  |  Fluoride limit = 1.5 mg/L', { indent: 400 }),
  para('India IMR (2020)      = 28   |  India TFR (NFHS-5) = 2.0', { indent: 400 }),
  para('India MMR (2018-20)   = 113  |  Ayushman Bharat cover = ₹5 lakh/family', { indent: 400 }),
  para('JSY launched          = 2005 |  UIP launched = 1985', { indent: 400 }),
  para('OPV storage           = −15 to −25°C  |  DPT storage = 2 to 8°C', { indent: 400 }),
  para('Vitamin A dose (1-5 yr) = 2,00,000 IU every 6 months', { indent: 400 }),
  para('MB Leprosy MDT        = 12 months  |  PB Leprosy MDT = 6 months', { indent: 400 }),
);

// ── BUILD ──
const doc = new Document({
  creator: 'Orris AI',
  title: 'PSM MCQ Compilation - MUHS 3rd Year MBBS',
  description: 'Year-wise MCQ Practice for Community Medicine',
  styles: {
    default: {
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  },
  sections: [{
    properties: {
      page: { margin: { top: 720, right: 720, bottom: 720, left: 720 } },
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    headers: {
      default: new Header({
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    children: allChildren,
  }],
});

Packer.toBuffer(doc).then(buffer => {
  fs.writeFileSync('/home/daytona/workspace/psm-mcq/PSM_MCQ_MUHS_3rdYear.docx', buffer);
  console.log('Document created successfully!');
}).catch(err => {
  console.error('Error:', err);
  process.exit(1);
});

cd /home/daytona/workspace/psm-mcq && node generate.js 2>&1

python3 /home/daytona/skills/docx/scripts/office/validate.py /home/daytona/works…

ls -lh /home/daytona/workspace/psm-mcq/PSM_MCQ_MUHS_3rdYear.docx && python3 -c "…