SECTION 2: EMBRYOLOGY

from reportlab.lib.pagesizes import A4
from reportlab.lib.styles import getSampleStyleSheet, ParagraphStyle
from reportlab.lib.units import cm
from reportlab.platypus import SimpleDocTemplate, Paragraph, Spacer, HRFlowable
from reportlab.lib.enums import TA_LEFT, TA_CENTER
from reportlab.lib import colors

output_path = "/home/daytona/workspace/mcq-questions/MCQ_Q366_to_Q500.pdf"

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story = []

# Title
story.append(Paragraph("HISTOLOGY & EMBRYOLOGY MCQ BANK", title_style))
story.append(Paragraph("Questions 366 – 500 | Based on Langman, Keith Moore, Ross & Junqueira", subtitle_style))
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questions = [
    {
        "section": "ADIPOSE TISSUE (continued)",
        "subsection": None,
        "items": [
            {
                "num": 366,
                "q": "Regarding the innervation of adipose tissue:",
                "opts": [
                    "A: White adipose tissue receives sympathetic innervation. True or False",
                    "B: Brown adipose tissue is more richly innervated than white adipose tissue. True or False",
                    "C: Norepinephrine stimulates lipolysis in adipocytes. True or False",
                    "D: Parasympathetic innervation is the primary regulator of brown fat thermogenesis. True or False",
                ],
                "ans": "Answers: A-True, B-True, C-True, D-False",
            },
            {
                "num": 367,
                "q": "Which of the following statements about leptin are correct?",
                "opts": [
                    "A: Leptin is secreted by adipocytes. True or False",
                    "B: Leptin acts on the hypothalamus to suppress appetite. True or False",
                    "C: Leptin levels are low in obese individuals. True or False",
                    "D: Leptin promotes energy expenditure. True or False",
                ],
                "ans": "Answers: A-True, B-True, C-False (levels are HIGH in obese individuals; resistance develops), D-True",
            },
            {
                "num": 368,
                "q": "Regarding adiponectin:",
                "opts": [
                    "A: Adiponectin is secreted by adipocytes. True or False",
                    "B: Adiponectin levels are elevated in obesity. True or False",
                    "C: Adiponectin has anti-inflammatory properties. True or False",
                    "D: Adiponectin improves insulin sensitivity. True or False",
                ],
                "ans": "Answers: A-True, B-False (levels are decreased in obesity), C-True, D-True",
            },
            {
                "num": 369,
                "q": "Concerning the microscopic appearance of white adipose tissue:",
                "opts": [
                    "A: The nucleus of a white adipocyte is typically centrally located. True or False",
                    "B: White adipocytes appear as signet ring cells on routine H&E sections. True or False",
                    "C: The lipid droplet in white adipocytes is preserved in routine paraffin sections. True or False",
                    "D: White adipose tissue has abundant mitochondria visible on electron microscopy. True or False",
                ],
                "ans": "Answers: A-False (nucleus is peripherally displaced), B-True, C-False (lipid dissolves during processing), D-False (brown fat has abundant mitochondria)",
            },
            {
                "num": 370,
                "q": "Which of the following are features of beige (brite) adipocytes?",
                "opts": [
                    "A: Beige adipocytes arise within white adipose tissue depots. True or False",
                    "B: Beige adipocytes express UCP1 when stimulated. True or False",
                    "C: Cold exposure promotes browning of white adipose tissue. True or False",
                    "D: Beige adipocytes are identical to classical brown adipocytes in origin. True or False",
                ],
                "ans": "Answers: A-True, B-True, C-True, D-False (they differ in developmental origin)",
            },
            {
                "num": 371,
                "q": "Regarding the vascular supply of adipose tissue:",
                "opts": [
                    "A: Adipose tissue is poorly vascularized. True or False",
                    "B: Each adipocyte is in close contact with at least one capillary. True or False",
                    "C: The rich vascular supply facilitates rapid uptake and release of fatty acids. True or False",
                    "D: Adipose tissue contributes to angiogenesis through VEGF secretion. True or False",
                ],
                "ans": "Answers: A-False (it is richly vascularized), B-True, C-True, D-True",
            },
            {
                "num": 372,
                "q": "Which of the following correctly describes lipid metabolism in adipocytes?",
                "opts": [
                    "A: Lipoprotein lipase on capillary endothelium cleaves triglycerides from circulating lipoproteins. True or False",
                    "B: Insulin stimulates lipolysis. True or False",
                    "C: Hormone-sensitive lipase is activated by glucagon and catecholamines. True or False",
                    "D: Fatty acids released during lipolysis bind to albumin for transport in blood. True or False",
                ],
                "ans": "Answers: A-True, B-False (insulin promotes lipogenesis and inhibits lipolysis), C-True, D-True",
            },
            {
                "num": 373,
                "q": "Concerning visceral versus subcutaneous adipose tissue:",
                "opts": [
                    "A: Visceral adipose tissue is more metabolically active than subcutaneous fat. True or False",
                    "B: Visceral fat accumulation is more strongly associated with metabolic syndrome. True or False",
                    "C: Subcutaneous fat releases free fatty acids directly into the portal circulation. True or False",
                    "D: Visceral adipose tissue produces more inflammatory cytokines than subcutaneous fat. True or False",
                ],
                "ans": "Answers: A-True, B-True, C-False (visceral fat drains into portal circulation; subcutaneous into systemic), D-True",
            },
            {
                "num": 374,
                "q": "Which of the following statements about adipose tissue as an endocrine organ are true?",
                "opts": [
                    "A: Adipose tissue secretes resistin. True or False",
                    "B: Adipose tissue converts androgens to estrogens via aromatase. True or False",
                    "C: Adipose tissue secretes visfatin. True or False",
                    "D: Adipose tissue is the sole source of leptin in the body. True or False",
                ],
                "ans": "Answers: A-True, B-True, C-True, D-False (other tissues can produce small amounts)",
            },
            {
                "num": 375,
                "q": "Which of the following is NOT a characteristic of brown adipose tissue?",
                "opts": [
                    "A: Single large lipid droplet per cell",
                    "B: Multilocular lipid droplets",
                    "C: Abundant mitochondria",
                    "D: High expression of UCP1",
                ],
                "ans": "Answer: A",
            },
        ],
    },
    {
        "section": "EMBRYOLOGY",
        "subsection": "PART 1: GAMETOGENESIS",
        "items": [
            {
                "num": 376,
                "q": "Regarding spermatogenesis, which of the following are correct?",
                "opts": [
                    "A: Spermatogenesis begins at puberty. True or False",
                    "B: The entire process of spermatogenesis takes approximately 64-74 days in humans. True or False",
                    "C: Spermatogonia are located at the luminal surface of the seminiferous tubule. True or False",
                    "D: Sertoli cells provide physical and nutritional support to developing spermatids. True or False",
                ],
                "ans": "Answers: A-True, B-True, C-False (they are at the basal surface), D-True",
            },
            {
                "num": 377,
                "q": "Which of the following statements about spermiogenesis are correct?",
                "opts": [
                    "A: Spermiogenesis involves cell division. True or False",
                    "B: The acrosome is derived from the Golgi apparatus. True or False",
                    "C: Excess cytoplasm is shed as the residual body during spermiogenesis. True or False",
                    "D: The midpiece of the sperm contains mitochondria arranged in a helix. True or False",
                ],
                "ans": "Answers: A-False (spermiogenesis is differentiation without division), B-True, C-True, D-True",
            },
            {
                "num": 378,
                "q": "Concerning oogenesis:",
                "opts": [
                    "A: Oogonia undergo mitosis during fetal life. True or False",
                    "B: Primary oocytes are arrested in prophase of meiosis I at birth. True or False",
                    "C: The first meiotic division is completed at ovulation. True or False",
                    "D: The second meiotic division is completed only upon fertilization. True or False",
                ],
                "ans": "Answers: A-True, B-True, C-False (completed just before ovulation, producing a secondary oocyte), D-True",
            },
            {
                "num": 379,
                "q": "Which of the following are features of the blood-testis barrier?",
                "opts": [
                    "A: It is formed by tight junctions between adjacent Sertoli cells. True or False",
                    "B: It protects developing spermatocytes from autoimmune attack. True or False",
                    "C: It is established at puberty. True or False",
                    "D: Spermatogonia lie within the adluminal compartment behind the barrier. True or False",
                ],
                "ans": "Answers: A-True, B-True, C-True, D-False (spermatogonia are in the basal compartment, outside the barrier)",
            },
            {
                "num": 380,
                "q": "Regarding the hormonal control of spermatogenesis:",
                "opts": [
                    "A: FSH acts on Leydig cells to stimulate testosterone production. True or False",
                    "B: LH stimulates Leydig cells to produce testosterone. True or False",
                    "C: Testosterone is required for spermatogenesis. True or False",
                    "D: Inhibin B from Sertoli cells provides negative feedback on FSH. True or False",
                ],
                "ans": "Answers: A-False (FSH acts on Sertoli cells; LH acts on Leydig cells), B-True, C-True, D-True",
            },
            {
                "num": 381,
                "q": "Which of the following correctly describe the stages of meiosis in male gametogenesis?",
                "opts": [
                    "A: Primary spermatocytes undergo the first meiotic division to form secondary spermatocytes. True or False",
                    "B: Secondary spermatocytes are haploid. True or False",
                    "C: Spermatids result from the second meiotic division. True or False",
                    "D: Each primary spermatocyte ultimately produces four spermatids. True or False",
                ],
                "ans": "Answers: A-True, B-True (haploid for chromosomes), C-True, D-True",
            },
            {
                "num": 382,
                "q": "Concerning the structure of the mature spermatozoon:",
                "opts": [
                    "A: The head contains the nucleus and acrosome. True or False",
                    "B: The principal piece is the longest part of the sperm tail. True or False",
                    "C: The axoneme has a 9+2 arrangement of microtubules. True or False",
                    "D: The fibrous sheath surrounds the midpiece. True or False",
                ],
                "ans": "Answers: A-True, B-True, C-True, D-False (fibrous sheath surrounds the principal piece, not the midpiece)",
            },
            {
                "num": 383,
                "q": "Which of the following statements about folliculogenesis are correct?",
                "opts": [
                    "A: Primordial follicles consist of a primary oocyte surrounded by a single layer of squamous granulosa cells. True or False",
                    "B: The zona pellucida is first formed around the primary oocyte in the primordial follicle stage. True or False",
                    "C: The antrum forms in the secondary follicle stage. True or False",
                    "D: The Graafian follicle contains a secondary oocyte. True or False",
                ],
                "ans": "Answers: A-True, B-False (zona pellucida forms during the primary follicle stage), C-False (antrum forms in the tertiary/antral follicle stage), D-True",
            },
            {
                "num": 384,
                "q": "Regarding polar bodies:",
                "opts": [
                    "A: The first polar body is produced at completion of meiosis I. True or False",
                    "B: The first polar body may undergo a second meiotic division. True or False",
                    "C: Polar bodies receive equal amounts of cytoplasm compared to the oocyte. True or False",
                    "D: The second polar body is expelled upon fertilization. True or False",
                ],
                "ans": "Answers: A-True, B-True, C-False (polar bodies receive minimal cytoplasm), D-True",
            },
            {
                "num": 385,
                "q": "Which of the following are functions of Sertoli cells?",
                "opts": [
                    "A: Secretion of androgen-binding protein (ABP). True or False",
                    "B: Production of testosterone. True or False",
                    "C: Phagocytosis of residual bodies shed during spermiogenesis. True or False",
                    "D: Secretion of anti-Mullerian hormone (AMH). True or False",
                ],
                "ans": "Answers: A-True, B-False (Leydig cells produce testosterone), C-True, D-True",
            },
            {
                "num": 386,
                "q": "Concerning the ovarian cycle:",
                "opts": [
                    "A: The follicular phase is characterized by rising estrogen levels. True or False",
                    "B: The LH surge triggers ovulation. True or False",
                    "C: The corpus luteum secretes progesterone and estrogen. True or False",
                    "D: If fertilization does not occur, the corpus luteum persists for the entire menstrual cycle. True or False",
                ],
                "ans": "Answers: A-True, B-True, C-True, D-False (it degenerates into the corpus albicans after approximately 14 days)",
            },
            {
                "num": 387,
                "q": "Which of the following describe capacitation of spermatozoa?",
                "opts": [
                    "A: Capacitation occurs in the male reproductive tract. True or False",
                    "B: Capacitation involves removal of cholesterol from the sperm plasma membrane. True or False",
                    "C: Capacitation is required for the acrosome reaction. True or False",
                    "D: Capacitation results in hyperpolarization of the sperm membrane. True or False",
                ],
                "ans": "Answers: A-False (occurs in the female reproductive tract), B-True, C-True, D-False (it ultimately leads to hyperactivation)",
            },
            {
                "num": 388,
                "q": "Which of the following are correct regarding spermatogonial stem cells?",
                "opts": [
                    "A: Type A spermatogonia serve as stem cells. True or False",
                    "B: Type B spermatogonia differentiate into primary spermatocytes. True or False",
                    "C: Spermatogonial stem cells are located in the adluminal compartment. True or False",
                    "D: Spermatogonia divide by mitosis to maintain the stem cell pool. True or False",
                ],
                "ans": "Answers: A-True, B-True, C-False (they are in the basal compartment), D-True",
            },
            {
                "num": 389,
                "q": "Regarding the acrosome reaction:",
                "opts": [
                    "A: The acrosome reaction is triggered by contact with the zona pellucida. True or False",
                    "B: The acrosome reaction involves fusion of the outer acrosomal membrane with the plasma membrane. True or False",
                    "C: Acrosomal enzymes include hyaluronidase and acrosin. True or False",
                    "D: The acrosome reaction occurs before the sperm reaches the zona pellucida. True or False",
                ],
                "ans": "Answers: A-True, B-True, C-True, D-False (it is triggered by the zona pellucida)",
            },
            {
                "num": 390,
                "q": "Which of the following correctly describe oogenesis versus spermatogenesis?",
                "opts": [
                    "A: Oogenesis produces four functional gametes per primary oocyte. True or False",
                    "B: Spermatogenesis is a continuous process throughout adult life. True or False",
                    "C: Oogenesis is arrested at two different points during development. True or False",
                    "D: Spermatogenesis takes longer than oogenesis to complete. True or False",
                ],
                "ans": "Answers: A-False (produces one oocyte and up to three polar bodies), B-True, C-True (prophase I before birth; metaphase II until fertilization), D-True",
            },
        ],
    },
    {
        "section": None,
        "subsection": "PART 2: FERTILIZATION",
        "items": [
            {
                "num": 391,
                "q": "Which of the following statements about fertilization are correct?",
                "opts": [
                    "A: Fertilization normally occurs in the ampulla of the uterine tube. True or False",
                    "B: Fertilization restores the diploid chromosome number. True or False",
                    "C: The zona reaction prevents polyspermy. True or False",
                    "D: The sex of the embryo is determined at fertilization. True or False",
                ],
                "ans": "Answers: A-True, B-True, C-True, D-True",
            },
            {
                "num": 392,
                "q": "Regarding the cortical reaction:",
                "opts": [
                    "A: The cortical reaction is triggered by the rise in intracellular calcium following sperm penetration. True or False",
                    "B: Cortical granules fuse with the plasma membrane and release their contents into the perivitelline space. True or False",
                    "C: The cortical reaction modifies the zona pellucida to form the fertilization membrane. True or False",
                    "D: The cortical reaction is an example of a slow block to polyspermy. True or False",
                ],
                "ans": "Answers: A-True, B-True, C-True, D-True",
            },
            {
                "num": 393,
                "q": "Which of the following events occur during fertilization?",
                "opts": [
                    "A: Completion of the second meiotic division of the oocyte. True or False",
                    "B: Formation of male and female pronuclei. True or False",
                    "C: Immediate fusion of male and female pronuclei to form the zygote nucleus. True or False",
                    "D: Activation of the oocyte's metabolic machinery. True or False",
                ],
                "ans": "Answers: A-True, B-True, C-False (pronuclei do not fuse; their membranes break down at first cleavage), D-True",
            },
            {
                "num": 394,
                "q": "Regarding the fast block to polyspermy:",
                "opts": [
                    "A: It involves depolarization of the oocyte plasma membrane. True or False",
                    "B: It occurs within seconds of the first sperm binding. True or False",
                    "C: It is a permanent block to polyspermy. True or False",
                    "D: It is mediated by cortical granule exocytosis. True or False",
                ],
                "ans": "Answers: A-True, B-True, C-False (it is transient; the zona reaction is the permanent block), D-False (the zona reaction is mediated by cortical granule exocytosis)",
            },
            {
                "num": 395,
                "q": "Which of the following correctly describe sperm-egg interaction?",
                "opts": [
                    "A: ZP3 is the primary zona pellucida glycoprotein responsible for sperm binding. True or False",
                    "B: ZP2 functions as a secondary receptor after the acrosome reaction. True or False",
                    "C: The zona pellucida is composed of three glycoproteins: ZP1, ZP2, and ZP3. True or False",
                    "D: After fertilization, ZP3 is cleaved to prevent additional sperm binding. True or False",
                ],
                "ans": "Answers: A-True, B-True, C-True, D-True",
            },
            {
                "num": 396,
                "q": "Concerning the results of fertilization:",
                "opts": [
                    "A: A new genetically unique individual is created. True or False",
                    "B: The zygote is formed when cleavage begins. True or False",
                    "C: Determination of the sex of the new individual occurs. True or False",
                    "D: Metabolic activation of the egg occurs. True or False",
                ],
                "ans": "Answers: A-True, B-False (the zygote is the fertilized egg before cleavage begins), C-True, D-True",
            },
            {
                "num": 397,
                "q": "Which of the following are correct about sperm transport in the female reproductive tract?",
                "opts": [
                    "A: Sperm can reach the uterine tube within minutes of ejaculation. True or False",
                    "B: Uterine contractions assist in sperm transport. True or False",
                    "C: Only a small fraction of ejaculated sperm reach the site of fertilization. True or False",
                    "D: Sperm remain viable in the female reproductive tract for up to 7 days. True or False",
                ],
                "ans": "Answers: A-True, B-True, C-True, D-False (sperm remain viable for approximately 3-5 days)",
            },
            {
                "num": 398,
                "q": "Which of the following is the correct sequence of events in fertilization?",
                "opts": [
                    "A: Acrosome reaction → penetration of zona pellucida → fusion with oocyte membrane → cortical reaction",
                    "B: Cortical reaction → acrosome reaction → penetration of zona pellucida → fusion with oocyte membrane",
                    "C: Capacitation → acrosome reaction → penetration of zona pellucida → cortical reaction",
                    "D: Penetration of corona radiata → acrosome reaction → zona pellucida binding → cortical reaction",
                ],
                "ans": "Answer: A and C are both correct descriptions of sequential events",
            },
            {
                "num": 399,
                "q": "Regarding ectopic pregnancy:",
                "opts": [
                    "A: The most common site of ectopic implantation is the ampulla of the uterine tube. True or False",
                    "B: Ovarian ectopic pregnancy is more common than tubal ectopic pregnancy. True or False",
                    "C: Previous pelvic inflammatory disease is a risk factor for ectopic pregnancy. True or False",
                    "D: An ectopic pregnancy can produce hCG. True or False",
                ],
                "ans": "Answers: A-True, B-False (tubal ectopic is most common, >95%), C-True, D-True",
            },
            {
                "num": 400,
                "q": "Which of the following are correct about the zygote?",
                "opts": [
                    "A: The zygote is diploid. True or False",
                    "B: The zygote begins cleavage within 24-30 hours of fertilization. True or False",
                    "C: Cleavage divisions increase the size of the embryo. True or False",
                    "D: The cells produced by cleavage are called blastomeres. True or False",
                ],
                "ans": "Answers: A-True, B-True, C-False (blastomeres become progressively smaller), D-True",
            },
        ],
    },
    {
        "section": None,
        "subsection": "PART 3: WEEK 1 (CLEAVAGE, MORULA, BLASTOCYST)",
        "items": [
            {
                "num": 401,
                "q": "Which of the following correctly describe cleavage?",
                "opts": [
                    "A: Cleavage divisions are mitotic. True or False",
                    "B: During cleavage, the cells grow between divisions. True or False",
                    "C: By the 16-cell stage, the embryo is called a morula. True or False",
                    "D: Cleavage occurs as the zygote travels down the uterine tube. True or False",
                ],
                "ans": "Answers: A-True, B-False (cells do not grow; they get smaller), C-True, D-True",
            },
            {
                "num": 402,
                "q": "Regarding the morula:",
                "opts": [
                    "A: The morula consists of a distinct outer trophoblast and inner cell mass. True or False",
                    "B: Compaction of the morula is mediated by E-cadherin. True or False",
                    "C: The morula enters the uterine cavity approximately 3 days after fertilization. True or False",
                    "D: The morula is surrounded by the zona pellucida. True or False",
                ],
                "ans": "Answers: A-False (distinct ICM and trophoblast differentiation occurs in the blastocyst stage), B-True, C-True, D-True",
            },
            {
                "num": 403,
                "q": "Which of the following statements about the blastocyst are correct?",
                "opts": [
                    "A: The blastocyst has a fluid-filled cavity called the blastocoel. True or False",
                    "B: The inner cell mass (embryoblast) gives rise to the embryo proper. True or False",
                    "C: The trophoblast gives rise to the placenta. True or False",
                    "D: The blastocyst hatches from the zona pellucida before implantation. True or False",
                ],
                "ans": "Answers: A-True, B-True, C-True, D-True",
            },
            {
                "num": 404,
                "q": "Regarding implantation:",
                "opts": [
                    "A: Implantation normally occurs on approximately day 6-7 after fertilization. True or False",
                    "B: The most common site of implantation is the posterior wall of the uterine body. True or False",
                    "C: Implantation involves invasion of the endometrium by the trophoblast. True or False",
                    "D: The endometrium must be in the secretory phase for implantation to occur. True or False",
                ],
                "ans": "Answers: A-True, B-True, C-True, D-True",
            },
            {
                "num": 405,
                "q": "Which of the following describe the trophoblast at the time of implantation?",
                "opts": [
                    "A: The trophoblast differentiates into cytotrophoblast and syncytiotrophoblast. True or False",
                    "B: The syncytiotrophoblast invades the endometrial stroma. True or False",
                    "C: The cytotrophoblast is a mitotically active layer. True or False",
                    "D: The syncytiotrophoblast begins producing hCG at implantation. True or False",
                ],
                "ans": "Answers: A-True, B-True, C-True, D-True",
            },
            {
                "num": 406,
                "q": "Concerning hCG (human chorionic gonadotropin):",
                "opts": [
                    "A: hCG is produced by the syncytiotrophoblast. True or False",
                    "B: hCG maintains the corpus luteum in early pregnancy. True or False",
                    "C: hCG levels peak at approximately 8-10 weeks of gestation. True or False",
                    "D: hCG has LH-like activity. True or False",
                ],
                "ans": "Answers: A-True, B-True, C-True, D-True",
            },
            {
                "num": 407,
                "q": "Which of the following are features of Week 1 of embryonic development?",
                "opts": [
                    "A: Fertilization occurs. True or False",
                    "B: Implantation is completed. True or False",
                    "C: The blastocyst forms. True or False",
                    "D: Gastrulation begins. True or False",
                ],
                "ans": "Answers: A-True, B-False (implantation begins at end of week 1 but is completed in week 2), C-True, D-False (gastrulation occurs in week 3)",
            },
        ],
    },
    {
        "section": None,
        "subsection": "PART 4: WEEK 2 (BILAMINAR DISC)",
        "items": [
            {
                "num": 408,
                "q": "Which of the following events occur during the second week of development?",
                "opts": [
                    "A: Formation of the bilaminar embryonic disc. True or False",
                    "B: Appearance of the primitive streak. True or False",
                    "C: Formation of the amnion and yolk sac. True or False",
                    "D: Completion of implantation. True or False",
                ],
                "ans": "Answers: A-True, B-False (primitive streak appears in week 3), C-True, D-True",
            },
            {
                "num": 409,
                "q": "Regarding the inner cell mass (embryoblast) during week 2:",
                "opts": [
                    "A: It differentiates into epiblast and hypoblast. True or False",
                    "B: The epiblast forms the floor of the amniotic cavity. True or False",
                    "C: The hypoblast forms the roof of the primary yolk sac. True or False",
                    "D: The epiblast gives rise to all three germ layers. True or False",
                ],
                "ans": "Answers: A-True, B-True, C-True, D-True",
            },
            {
                "num": 410,
                "q": "Which of the following describe the extraembryonic membranes formed in week 2?",
                "opts": [
                    "A: The amnion is derived from epiblast cells. True or False",
                    "B: The primary yolk sac is lined by hypoblast (Heuser's membrane). True or False",
                    "C: The extraembryonic mesoderm fills the space between the trophoblast and amnion/yolk sac. True or False",
                    "D: The chorionic cavity (extraembryonic coelom) forms within the extraembryonic mesoderm. True or False",
                ],
                "ans": "Answers: A-True, B-True, C-True, D-True",
            },
            {
                "num": 411,
                "q": "Regarding the trophoblast in week 2:",
                "opts": [
                    "A: Lacunae form within the syncytiotrophoblast. True or False",
                    "B: Erosion of maternal blood vessels creates the uteroplacental circulation. True or False",
                    "C: Primary chorionic villi consist of a cytotrophoblast core covered by syncytiotrophoblast. True or False",
                    "D: The decidua basalis is the decidua between the embryo and the myometrium. True or False",
                ],
                "ans": "Answers: A-True, B-True, C-True, D-True",
            },
            {
                "num": 412,
                "q": "Which of the following is the 'week of twos' concept?",
                "opts": [
                    "A: Two germ layers (epiblast and hypoblast) form the bilaminar disc. True or False",
                    "B: Two cavities form (amniotic cavity and yolk sac). True or False",
                    "C: Two trophoblast layers differentiate (cytotrophoblast and syncytiotrophoblast). True or False",
                    "D: Two placental layers form (decidua basalis and decidua capsularis). True or False",
                ],
                "ans": "Answers: A-True, B-True, C-True, D-False (not part of the classic 'week of twos' teaching)",
            },
        ],
    },
    {
        "section": None,
        "subsection": "PART 5: WEEK 3 (GASTRULATION, NEURULATION)",
        "items": [
            {
                "num": 413,
                "q": "Which of the following correctly describe gastrulation?",
                "opts": [
                    "A: Gastrulation converts the bilaminar disc into a trilaminar disc. True or False",
                    "B: The primitive streak appears in the caudal region of the epiblast. True or False",
                    "C: Cells that migrate through the primitive streak form intraembryonic mesoderm and endoderm. True or False",
                    "D: The notochord develops from the primitive streak. True or False",
                ],
                "ans": "Answers: A-True, B-True, C-True, D-True (notochordal process from the primitive node)",
            },
            {
                "num": 414,
                "q": "Regarding the notochord:",
                "opts": [
                    "A: The notochord defines the longitudinal axis of the embryo. True or False",
                    "B: The notochord persists in the adult as the nucleus pulposus. True or False",
                    "C: The notochord induces the overlying ectoderm to form the neural plate. True or False",
                    "D: The notochord gives rise to the vertebral bodies. True or False",
                ],
                "ans": "Answers: A-True, B-True, C-True, D-False (vertebral bodies form from sclerotome of somites)",
            },
            {
                "num": 415,
                "q": "Which of the following are correct about neurulation?",
                "opts": [
                    "A: The neural plate is induced by the notochord. True or False",
                    "B: Neural folds fuse to form the neural tube. True or False",
                    "C: Fusion of neural folds begins in the middle of the embryo and proceeds bidirectionally. True or False",
                    "D: The rostral neuropore closes before the caudal neuropore. True or False",
                ],
                "ans": "Answers: A-True, B-True, C-True, D-True",
            },
            {
                "num": 416,
                "q": "Regarding neural crest cells:",
                "opts": [
                    "A: Neural crest cells originate at the lateral margins of the neural plate. True or False",
                    "B: Neural crest cells are pluripotent migratory cells. True or False",
                    "C: Neural crest cells give rise to dorsal root ganglia. True or False",
                    "D: Neural crest cells contribute to the bones of the skull. True or False",
                ],
                "ans": "Answers: A-True, B-True, C-True, D-True",
            },
            {
                "num": 417,
                "q": "Which of the following structures are derived from neural crest cells?",
                "opts": [
                    "A: Adrenal medulla. True or False",
                    "B: Melanocytes. True or False",
                    "C: Schwann cells. True or False",
                    "D: Adrenal cortex. True or False",
                ],
                "ans": "Answers: A-True, B-True, C-True, D-False (adrenal cortex is derived from mesoderm)",
            },
            {
                "num": 418,
                "q": "Concerning somite formation:",
                "opts": [
                    "A: Somites form from paraxial mesoderm. True or False",
                    "B: Somites differentiate into sclerotome, myotome, and dermatome. True or False",
                    "C: The sclerotome gives rise to vertebrae and ribs. True or False",
                    "D: The first somites appear in the occipital region. True or False",
                ],
                "ans": "Answers: A-True, B-True, C-True, D-True",
            },
            {
                "num": 419,
                "q": "Which of the following events characterize week 3 of development?",
                "opts": [
                    "A: Formation of the trilaminar germ disc. True or False",
                    "B: Establishment of the body axes. True or False",
                    "C: Development of the heart and blood vessels begins. True or False",
                    "D: Formation of the lens and optic cup. True or False",
                ],
                "ans": "Answers: A-True, B-True, C-True, D-False (lens and optic cup form later, in weeks 4-5)",
            },
            {
                "num": 420,
                "q": "Regarding the intraembryonic coelom:",
                "opts": [
                    "A: It forms within the lateral plate mesoderm. True or False",
                    "B: It gives rise to the pericardial, pleural, and peritoneal cavities. True or False",
                    "C: The somatic (parietal) layer of lateral plate mesoderm lines the intraembryonic coelom. True or False",
                    "D: The intraembryonic coelom is initially continuous with the extraembryonic coelom. True or False",
                ],
                "ans": "Answers: A-True, B-True, C-True, D-True",
            },
        ],
    },
    {
        "section": None,
        "subsection": "PART 6: WEEKS 4-8 (EMBRYONIC PERIOD - ORGANOGENESIS)",
        "items": [
            {
                "num": 421,
                "q": "Which of the following occur during week 4 of development?",
                "opts": [
                    "A: Folding of the embryonic disc in both cephalocaudal and lateral directions. True or False",
                    "B: Formation of the head fold and tail fold. True or False",
                    "C: The heart begins to beat. True or False",
                    "D: Upper limb buds appear. True or False",
                ],
                "ans": "Answers: A-True, B-True, C-True, D-True",
            },
            {
                "num": 422,
                "q": "Regarding the pharyngeal (branchial) arches:",
                "opts": [
                    "A: There are 5 pharyngeal arches in humans (1, 2, 3, 4, and 6). True or False",
                    "B: Each pharyngeal arch contains a nerve, artery, cartilage, and muscle component. True or False",
                    "C: The first pharyngeal arch gives rise to muscles of mastication. True or False",
                    "D: The second pharyngeal arch gives rise to muscles of facial expression. True or False",
                ],
                "ans": "Answers: A-True (arch 5 is rudimentary/absent), B-True, C-True, D-True",
            },
            {
                "num": 423,
                "q": "Which cranial nerve is associated with each pharyngeal arch?",
                "opts": [
                    "A: 1st arch - CN V (trigeminal). True or False",
                    "B: 2nd arch - CN VII (facial). True or False",
                    "C: 3rd arch - CN IX (glossopharyngeal). True or False",
                    "D: 4th and 6th arches - CN X (vagus). True or False",
                ],
                "ans": "Answers: A-True, B-True, C-True, D-True",
            },
            {
                "num": 424,
                "q": "Regarding derivatives of the pharyngeal pouches:",
                "opts": [
                    "A: The first pharyngeal pouch forms the tympanic cavity and Eustachian tube. True or False",
                    "B: The second pharyngeal pouch contributes to the palatine tonsil. True or False",
                    "C: The third pharyngeal pouch gives rise to the inferior parathyroid glands and thymus. True or False",
                    "D: The fourth pharyngeal pouch gives rise to the superior parathyroid glands and ultimobranchial body. True or False",
                ],
                "ans": "Answers: A-True, B-True, C-True, D-True",
            },
            {
                "num": 425,
                "q": "Which of the following are correct about limb development?",
                "opts": [
                    "A: Upper limb buds appear before lower limb buds. True or False",
                    "B: The apical ectodermal ridge (AER) controls proximodistal outgrowth of the limb. True or False",
                    "C: The zone of polarizing activity (ZPA) controls anteroposterior patterning. True or False",
                    "D: Sonic hedgehog (Shh) is the signaling molecule produced by the ZPA. True or False",
                ],
                "ans": "Answers: A-True, B-True, C-True, D-True",
            },
            {
                "num": 426,
                "q": "Regarding heart development:",
                "opts": [
                    "A: The heart is the first functional organ in the embryo. True or False",
                    "B: The cardiogenic region is located in the splanchnic mesoderm cranial to the prechordal plate. True or False",
                    "C: The heart begins to beat at approximately day 22-23. True or False",
                    "D: The heart tubes fuse to form a single heart tube. True or False",
                ],
                "ans": "Answers: A-True, B-True, C-True, D-True",
            },
            {
                "num": 427,
                "q": "Which of the following correctly describe the looping of the heart?",
                "opts": [
                    "A: The heart tube loops to the right (dextral looping) normally. True or False",
                    "B: Failure of normal looping can result in situs inversus. True or False",
                    "C: After looping, the bulbus cordis lies ventral and to the right. True or False",
                    "D: The atria come to lie cranial to the ventricles after looping. True or False",
                ],
                "ans": "Answers: A-True, B-True, C-True, D-False (atria lie dorsal and cranial; ventricles are more caudal and ventral)",
            },
            {
                "num": 428,
                "q": "Regarding gut development:",
                "opts": [
                    "A: The gut tube is derived from endoderm. True or False",
                    "B: The foregut gives rise to the esophagus, stomach, and upper duodenum. True or False",
                    "C: The midgut gives rise to the small intestine and proximal two-thirds of the colon. True or False",
                    "D: The hindgut gives rise to the distal one-third of the colon, rectum, and upper part of the anal canal. True or False",
                ],
                "ans": "Answers: A-True, B-True, C-True, D-True",
            },
            {
                "num": 429,
                "q": "Which of the following are correct about physiological umbilical herniation?",
                "opts": [
                    "A: The midgut herniates into the umbilical cord during week 6. True or False",
                    "B: The midgut undergoes 90-degree counterclockwise rotation during herniation. True or False",
                    "C: The midgut returns to the abdominal cavity by week 10-12. True or False",
                    "D: Failure of the midgut to return to the abdomen results in gastroschisis. True or False",
                ],
                "ans": "Answers: A-True, B-True, C-True, D-False (failure to return causes omphalocele, not gastroschisis)",
            },
            {
                "num": 430,
                "q": "Regarding the development of the respiratory system:",
                "opts": [
                    "A: The respiratory diverticulum arises from the floor of the foregut. True or False",
                    "B: The tracheoesophageal septum separates the trachea from the esophagus. True or False",
                    "C: Failure of the tracheoesophageal septum to form correctly results in tracheoesophageal fistula. True or False",
                    "D: Type II pneumocytes begin producing surfactant after 26 weeks of gestation. True or False",
                ],
                "ans": "Answers: A-True, B-True, C-True, D-True",
            },
        ],
    },
    {
        "section": None,
        "subsection": "PART 7: FETAL PERIOD (WEEK 9 TO BIRTH)",
        "items": [
            {
                "num": 431,
                "q": "Which of the following characterize the fetal period?",
                "opts": [
                    "A: The fetal period extends from week 9 to birth. True or False",
                    "B: Growth and maturation of organs that formed during the embryonic period occurs. True or False",
                    "C: Major organogenesis occurs during the fetal period. True or False",
                    "D: The fetus is most susceptible to teratogens during the embryonic period rather than the fetal period. True or False",
                ],
                "ans": "Answers: A-True, B-True, C-False (major organogenesis occurs during the embryonic period), D-True",
            },
            {
                "num": 432,
                "q": "Regarding fetal circulation:",
                "opts": [
                    "A: The foramen ovale allows blood to pass from the right atrium to the left atrium. True or False",
                    "B: The ductus arteriosus connects the pulmonary trunk to the aorta. True or False",
                    "C: Fetal blood has a higher affinity for oxygen than adult blood. True or False",
                    "D: The ductus venosus connects the umbilical vein to the inferior vena cava. True or False",
                ],
                "ans": "Answers: A-True, B-True, C-True, D-True",
            },
            {
                "num": 433,
                "q": "Which of the following are correct about changes at birth?",
                "opts": [
                    "A: The foramen ovale closes due to increased left atrial pressure. True or False",
                    "B: The ductus arteriosus closes due to increased oxygen tension and decreased prostaglandins. True or False",
                    "C: The umbilical arteries become the medial umbilical ligaments. True or False",
                    "D: The ductus venosus becomes the ligamentum teres hepatis. True or False",
                ],
                "ans": "Answers: A-True, B-True, C-True, D-False (ductus venosus becomes ligamentum venosum; umbilical vein becomes ligamentum teres hepatis)",
            },
            {
                "num": 434,
                "q": "Regarding the placenta:",
                "opts": [
                    "A: The placenta is derived from both fetal and maternal tissues. True or False",
                    "B: The chorion frondosum (villous chorion) contributes to the fetal part of the placenta. True or False",
                    "C: The decidua basalis forms the maternal part of the placenta. True or False",
                    "D: Maternal and fetal blood normally mix in the intervillous space. True or False",
                ],
                "ans": "Answers: A-True, B-True, C-True, D-False (maternal blood fills the intervillous space but does not mix with fetal blood)",
            },
            {
                "num": 435,
                "q": "Which of the following substances cross the placenta?",
                "opts": [
                    "A: IgG antibodies. True or False",
                    "B: Insulin. True or False",
                    "C: Heparin. True or False",
                    "D: Thyroxine. True or False",
                ],
                "ans": "Answers: A-True, B-False (insulin does not cross the placenta), C-False (heparin is too large), D-True (small amounts)",
            },
            {
                "num": 436,
                "q": "Regarding amniotic fluid:",
                "opts": [
                    "A: Amniotic fluid volume increases progressively throughout pregnancy. True or False",
                    "B: Fetal urine is the major source of amniotic fluid after 16 weeks. True or False",
                    "C: Fetal swallowing is the major route of amniotic fluid removal. True or False",
                    "D: Oligohydramnios is associated with renal agenesis. True or False",
                ],
                "ans": "Answers: A-True (until term), B-True, C-True, D-True",
            },
            {
                "num": 437,
                "q": "Which of the following are correct about the umbilical cord?",
                "opts": [
                    "A: The normal umbilical cord contains two arteries and one vein. True or False",
                    "B: The umbilical arteries carry oxygenated blood. True or False",
                    "C: Wharton's jelly is the connective tissue of the umbilical cord. True or False",
                    "D: A single umbilical artery is associated with congenital anomalies. True or False",
                ],
                "ans": "Answers: A-True, B-False (umbilical arteries carry deoxygenated blood from fetus to placenta), C-True, D-True",
            },
            {
                "num": 438,
                "q": "Which of the following describe the fetal kidney development?",
                "opts": [
                    "A: The three stages of kidney development are pronephros, mesonephros, and metanephros. True or False",
                    "B: The pronephros is the functional kidney in the human fetus. True or False",
                    "C: The metanephros is the permanent kidney. True or False",
                    "D: The ureteric bud induces the metanephric mesoderm to form nephrons. True or False",
                ],
                "ans": "Answers: A-True, B-False (pronephros is vestigial and non-functional in humans), C-True, D-True",
            },
            {
                "num": 439,
                "q": "Regarding viability of the fetus:",
                "opts": [
                    "A: A fetus is generally considered viable after 22-24 weeks of gestation. True or False",
                    "B: Surfactant production begins around 20 weeks but increases significantly after 28 weeks. True or False",
                    "C: Lecithin-to-sphingomyelin (L/S) ratio of 2:1 indicates lung maturity. True or False",
                    "D: Respiratory distress syndrome is more common in preterm infants due to surfactant deficiency. True or False",
                ],
                "ans": "Answers: A-True, B-True, C-True, D-True",
            },
            {
                "num": 440,
                "q": "Which of the following are landmarks of fetal development?",
                "opts": [
                    "A: At 8 weeks, all major organ systems have begun to form. True or False",
                    "B: At 12 weeks, external genitalia are distinguishable as male or female. True or False",
                    "C: At 16 weeks, fetal movements (quickening) are first felt by the mother. True or False",
                    "D: At 28 weeks, the eyes reopen. True or False",
                ],
                "ans": "Answers: A-True, B-True, C-True (range 16-20 weeks), D-True",
            },
        ],
    },
    {
        "section": None,
        "subsection": "PART 8: BIRTH DEFECTS (TERATOLOGY)",
        "items": [
            {
                "num": 441,
                "q": "Which of the following are principles of teratology as described by Wilson?",
                "opts": [
                    "A: Susceptibility to teratogenesis depends on the genotype of the embryo. True or False",
                    "B: Susceptibility to teratogens varies with the developmental stage at the time of exposure. True or False",
                    "C: Teratogens act by specific mechanisms on developing cells and tissues. True or False",
                    "D: The manifestations of abnormal development are death, malformation, growth restriction, and functional disorder. True or False",
                ],
                "ans": "Answers: A-True, B-True, C-True, D-True",
            },
            {
                "num": 442,
                "q": "Which of the following teratogens are correctly matched with their effects?",
                "opts": [
                    "A: Thalidomide - phocomelia (limb reduction defects). True or False",
                    "B: Warfarin - nasal hypoplasia and stippled epiphyses. True or False",
                    "C: Alcohol - fetal alcohol spectrum disorder. True or False",
                    "D: Isotretinoin - neural tube defects. True or False",
                ],
                "ans": "Answers: A-True, B-True, C-True, D-False (isotretinoin causes craniofacial abnormalities, heart defects, and CNS anomalies)",
            },
            {
                "num": 443,
                "q": "Regarding fetal alcohol syndrome (FAS):",
                "opts": [
                    "A: It is the most common preventable cause of intellectual disability. True or False",
                    "B: Features include microcephaly, smooth philtrum, and thin upper lip. True or False",
                    "C: There is a safe level of alcohol consumption in pregnancy. True or False",
                    "D: The CNS is affected because alcohol readily crosses the placenta. True or False",
                ],
                "ans": "Answers: A-True, B-True, C-False (no safe level has been established), D-True",
            },
            {
                "num": 444,
                "q": "Which of the following infections are TORCH agents known to cause congenital abnormalities?",
                "opts": [
                    "A: Toxoplasma gondii. True or False",
                    "B: Rubella virus. True or False",
                    "C: Cytomegalovirus (CMV). True or False",
                    "D: Hepatitis B virus. True or False",
                ],
                "ans": "Answers: A-True, B-True, C-True, D-False (Hepatitis B is not a TORCH agent)",
            },
            {
                "num": 445,
                "q": "Regarding congenital rubella syndrome:",
                "opts": [
                    "A: Maternal rubella in the first trimester carries the highest risk of fetal abnormalities. True or False",
                    "B: The classic triad includes cataracts, cardiac defects, and sensorineural deafness. True or False",
                    "C: Rubella virus crosses the placenta and infects fetal tissues. True or False",
                    "D: Vaccination in pregnancy is recommended to prevent congenital rubella. True or False",
                ],
                "ans": "Answers: A-True, B-True, C-True, D-False (live vaccines like rubella are contraindicated in pregnancy)",
            },
            {
                "num": 446,
                "q": "Which of the following are correctly described as multifactorial inheritance disorders?",
                "opts": [
                    "A: Neural tube defects. True or False",
                    "B: Cleft lip and palate. True or False",
                    "C: Down syndrome. True or False",
                    "D: Congenital hip dysplasia. True or False",
                ],
                "ans": "Answers: A-True, B-True, C-False (Down syndrome is chromosomal/trisomy 21), D-True",
            },
            {
                "num": 447,
                "q": "Regarding neural tube defects (NTDs):",
                "opts": [
                    "A: Anencephaly results from failure of the rostral neuropore to close. True or False",
                    "B: Spina bifida results from failure of the caudal neural tube to close. True or False",
                    "C: Folic acid supplementation before conception reduces the risk of NTDs. True or False",
                    "D: Alpha-fetoprotein (AFP) levels are elevated in maternal serum with open NTDs. True or False",
                ],
                "ans": "Answers: A-True, B-True, C-True, D-True",
            },
            {
                "num": 448,
                "q": "Which of the following are features of Down syndrome (Trisomy 21)?",
                "opts": [
                    "A: The most common chromosomal abnormality in live-born infants. True or False",
                    "B: Advanced maternal age is a risk factor. True or False",
                    "C: Atrioventricular septal defect (AVSD) is the most common cardiac defect. True or False",
                    "D: All cases result from meiotic nondisjunction. True or False",
                ],
                "ans": "Answers: A-True, B-True, C-True, D-False (approximately 4% result from Robertsonian translocation, and 1% are mosaic)",
            },
            {
                "num": 449,
                "q": "Regarding Edwards syndrome (Trisomy 18):",
                "opts": [
                    "A: It is the second most common autosomal trisomy in live-born infants. True or False",
                    "B: Characteristic features include overlapping fingers and rocker-bottom feet. True or False",
                    "C: Most affected fetuses are liveborn. True or False",
                    "D: Prognosis is poor, with most affected infants dying within the first year. True or False",
                ],
                "ans": "Answers: A-True, B-True, C-False (most are lost as spontaneous abortions), D-True",
            },
            {
                "num": 450,
                "q": "Which of the following correctly describe Patau syndrome (Trisomy 13)?",
                "opts": [
                    "A: It is associated with holoprosencephaly. True or False",
                    "B: Median cleft lip and palate are features. True or False",
                    "C: Polydactyly is a feature. True or False",
                    "D: Survival to adulthood is common. True or False",
                ],
                "ans": "Answers: A-True, B-True, C-True, D-False (most die within the first months of life)",
            },
            {
                "num": 451,
                "q": "Regarding Turner syndrome (45, X):",
                "opts": [
                    "A: It is the most common sex chromosome anomaly in females. True or False",
                    "B: Webbed neck (pterygium colli) is a feature. True or False",
                    "C: Coarctation of the aorta is the most common cardiac defect. True or False",
                    "D: Affected individuals are fertile. True or False",
                ],
                "ans": "Answers: A-True, B-True, C-True, D-False (streak gonads cause infertility)",
            },
            {
                "num": 452,
                "q": "Which of the following are correct about Klinefelter syndrome (47, XXY)?",
                "opts": [
                    "A: It is the most common sex chromosome abnormality in males. True or False",
                    "B: Affected males are typically tall with small testes. True or False",
                    "C: Gynecomastia is a feature. True or False",
                    "D: Affected males have normal fertility. True or False",
                ],
                "ans": "Answers: A-True, B-True, C-True, D-False (they are infertile due to azoospermia)",
            },
            {
                "num": 453,
                "q": "Regarding congenital heart defects:",
                "opts": [
                    "A: Ventricular septal defect (VSD) is the most common congenital heart defect. True or False",
                    "B: Transposition of the great arteries results in two parallel circulations. True or False",
                    "C: Tetralogy of Fallot includes VSD, overriding aorta, pulmonary stenosis, and right ventricular hypertrophy. True or False",
                    "D: Patent ductus arteriosus is more common in premature infants. True or False",
                ],
                "ans": "Answers: A-True, B-True, C-True, D-True",
            },
            {
                "num": 454,
                "q": "Which of the following teratogenic drugs are correctly matched with their mechanisms or effects?",
                "opts": [
                    "A: Valproic acid - neural tube defects by inhibiting folate metabolism. True or False",
                    "B: ACE inhibitors in second/third trimester - renal tubular dysplasia and oligohydramnios. True or False",
                    "C: Tetracyclines - discoloration of developing teeth and bone. True or False",
                    "D: Methotrexate - teratogenic effects by blocking folic acid. True or False",
                ],
                "ans": "Answers: A-True, B-True, C-True, D-True",
            },
            {
                "num": 455,
                "q": "Regarding congenital diaphragmatic hernia (CDH):",
                "opts": [
                    "A: It most commonly occurs on the left side. True or False",
                    "B: It results from failure of the pleuroperitoneal folds to fuse. True or False",
                    "C: Pulmonary hypoplasia is a major complication. True or False",
                    "D: The stomach and intestines herniate into the thorax on the right side. True or False",
                ],
                "ans": "Answers: A-True, B-True, C-True, D-False (herniation typically occurs on the LEFT side)",
            },
            {
                "num": 456,
                "q": "Which of the following are correctly associated with abnormal sex differentiation?",
                "opts": [
                    "A: Congenital adrenal hyperplasia (CAH) causes virilization of 46,XX females. True or False",
                    "B: Androgen insensitivity syndrome (AIS) results in a 46,XY individual with female external genitalia. True or False",
                    "C: In complete AIS, the gonads are testes. True or False",
                    "D: The SRY gene on the Y chromosome is required for testicular determination. True or False",
                ],
                "ans": "Answers: A-True, B-True, C-True, D-True",
            },
            {
                "num": 457,
                "q": "Regarding holoprosencephaly:",
                "opts": [
                    "A: It results from failure of the prosencephalon to divide into two cerebral hemispheres. True or False",
                    "B: It is associated with Trisomy 13. True or False",
                    "C: Cyclopia is the most severe form. True or False",
                    "D: It is always a lethal condition. True or False",
                ],
                "ans": "Answers: A-True, B-True, C-True, D-False (microforms exist with milder clinical presentations)",
            },
            {
                "num": 458,
                "q": "Which of the following statements about cleft lip and palate are correct?",
                "opts": [
                    "A: Cleft lip results from failure of fusion of the maxillary and medial nasal processes. True or False",
                    "B: Cleft palate can occur independently of cleft lip. True or False",
                    "C: Cleft lip with or without cleft palate is more common in males. True or False",
                    "D: Isolated cleft palate is more common in females. True or False",
                ],
                "ans": "Answers: A-True, B-True, C-True, D-True",
            },
            {
                "num": 459,
                "q": "Regarding gastroschisis versus omphalocele:",
                "opts": [
                    "A: Gastroschisis is a defect to the right of the umbilicus with no covering membrane. True or False",
                    "B: Omphalocele is covered by a membrane of amnion and peritoneum. True or False",
                    "C: Omphalocele is associated with chromosomal abnormalities more commonly than gastroschisis. True or False",
                    "D: Both conditions require surgical correction. True or False",
                ],
                "ans": "Answers: A-True, B-True, C-True, D-True",
            },
            {
                "num": 460,
                "q": "Which of the following are correct about oligohydramnios sequence (Potter sequence)?",
                "opts": [
                    "A: It results from severe reduction in amniotic fluid. True or False",
                    "B: It is classically associated with bilateral renal agenesis. True or False",
                    "C: Features include pulmonary hypoplasia, limb deformities, and characteristic facies. True or False",
                    "D: The underlying cause is always renal agenesis. True or False",
                ],
                "ans": "Answers: A-True, B-True, C-True, D-False (any cause of reduced fetal urine output can cause it)",
            },
            {
                "num": 461,
                "q": "Regarding DiGeorge syndrome (22q11.2 deletion):",
                "opts": [
                    "A: It results from abnormal development of pharyngeal pouches 3 and 4. True or False",
                    "B: Features include absence of thymus and parathyroid glands. True or False",
                    "C: T-cell immunodeficiency is a consequence. True or False",
                    "D: Conotruncal heart defects are common. True or False",
                ],
                "ans": "Answers: A-True, B-True, C-True, D-True",
            },
            {
                "num": 462,
                "q": "Which of the following are correct about chromosomal nondisjunction?",
                "opts": [
                    "A: Nondisjunction can occur during meiosis I or meiosis II. True or False",
                    "B: Nondisjunction during meiosis I affects both daughter cells. True or False",
                    "C: Maternal age affects the rate of nondisjunction in oogenesis. True or False",
                    "D: Mosaicism results from nondisjunction in a mitotic division after fertilization. True or False",
                ],
                "ans": "Answers: A-True, B-True, C-True, D-True",
            },
            {
                "num": 463,
                "q": "Regarding Meckel's diverticulum:",
                "opts": [
                    "A: It is a remnant of the vitello-intestinal (omphalomesenteric) duct. True or False",
                    "B: It is located on the antimesenteric border of the ileum. True or False",
                    "C: The 'rule of twos' states it is found in 2% of the population, 2 feet from the ileocecal valve, and is 2 inches long. True or False",
                    "D: It may contain ectopic gastric or pancreatic tissue. True or False",
                ],
                "ans": "Answers: A-True, B-True, C-True, D-True",
            },
            {
                "num": 464,
                "q": "Which of the following are correct about Hirschsprung disease?",
                "opts": [
                    "A: It results from failure of neural crest cells to migrate into the bowel wall. True or False",
                    "B: The affected segment of bowel lacks ganglion cells (aganglionosis). True or False",
                    "C: The rectosigmoid region is most commonly affected. True or False",
                    "D: The aganglionic segment is dilated (megacolon). True or False",
                ],
                "ans": "Answers: A-True, B-True, C-True, D-False (the aganglionic segment is NARROW; the proximal segment is dilated)",
            },
            {
                "num": 465,
                "q": "Regarding esophageal atresia with tracheoesophageal fistula:",
                "opts": [
                    "A: The most common type involves a blind upper esophageal pouch with a fistula between the lower esophagus and trachea. True or False",
                    "B: It presents with polyhydramnios prenatally. True or False",
                    "C: The H-type fistula has no associated esophageal atresia. True or False",
                    "D: It results from incomplete division of the foregut by the tracheoesophageal septum. True or False",
                ],
                "ans": "Answers: A-True, B-True, C-True, D-True",
            },
            {
                "num": 466,
                "q": "Which of the following are features of congenital hypothyroidism?",
                "opts": [
                    "A: It can result from thyroid dysgenesis or dyshormonogenesis. True or False",
                    "B: Newborn screening detects elevated TSH levels. True or False",
                    "C: Untreated congenital hypothyroidism causes cretinism. True or False",
                    "D: The thyroid gland descends from the base of the tongue during development. True or False",
                ],
                "ans": "Answers: A-True, B-True, C-True, D-True",
            },
            {
                "num": 467,
                "q": "Regarding cryptorchidism (undescended testes):",
                "opts": [
                    "A: The testes normally descend into the scrotum by birth or within the first few months. True or False",
                    "B: Cryptorchidism increases the risk of testicular cancer. True or False",
                    "C: It is associated with infertility. True or False",
                    "D: Orchiopexy is recommended before 2 years of age. True or False",
                ],
                "ans": "Answers: A-True, B-True, C-True, D-True",
            },
            {
                "num": 468,
                "q": "Which of the following drugs are known teratogens?",
                "opts": [
                    "A: Phenytoin. True or False",
                    "B: Lithium. True or False",
                    "C: Penicillin. True or False",
                    "D: Diethylstilbestrol (DES). True or False",
                ],
                "ans": "Answers: A-True (fetal hydantoin syndrome), B-True (Ebstein's anomaly), C-False (generally safe in pregnancy), D-True (vaginal clear cell adenocarcinoma in daughters)",
            },
            {
                "num": 469,
                "q": "Regarding the critical period for teratogen exposure:",
                "opts": [
                    "A: The pre-embryonic period (weeks 1-2) follows an 'all-or-nothing' rule. True or False",
                    "B: The embryonic period (weeks 3-8) is the most sensitive period for structural defects. True or False",
                    "C: The fetal period is insensitive to all teratogenic influences. True or False",
                    "D: The brain remains sensitive to teratogens throughout pregnancy. True or False",
                ],
                "ans": "Answers: A-True, B-True, C-False (functional defects and growth restriction can still occur), D-True",
            },
            {
                "num": 470,
                "q": "Which of the following are correct about polyhydramnios?",
                "opts": [
                    "A: It is defined as an excess of amniotic fluid above 2000 mL. True or False",
                    "B: Esophageal atresia is associated with polyhydramnios. True or False",
                    "C: Anencephaly is associated with polyhydramnios. True or False",
                    "D: Renal agenesis is associated with polyhydramnios. True or False",
                ],
                "ans": "Answers: A-True, B-True (fetus cannot swallow), C-True (impaired swallowing), D-False (renal agenesis causes oligohydramnios)",
            },
            {
                "num": 471,
                "q": "Regarding the development of the urogenital system:",
                "opts": [
                    "A: The indifferent gonad can develop into either a testis or ovary depending on genetic signals. True or False",
                    "B: In the absence of SRY, the indifferent gonad develops into an ovary. True or False",
                    "C: The Mullerian (paramesonephric) ducts form the uterus and uterine tubes in females. True or False",
                    "D: Testosterone from the fetal testis causes the Wolffian ducts to develop. True or False",
                ],
                "ans": "Answers: A-True, B-True, C-True, D-True",
            },
            {
                "num": 472,
                "q": "Which of the following are correct about the role of anti-Mullerian hormone (AMH)?",
                "opts": [
                    "A: AMH is produced by Sertoli cells of the fetal testis. True or False",
                    "B: AMH causes regression of the Mullerian ducts in males. True or False",
                    "C: AMH is required for development of the Wolffian ducts. True or False",
                    "D: Absence of AMH in females allows the Mullerian ducts to persist. True or False",
                ],
                "ans": "Answers: A-True, B-True, C-False (testosterone is required for Wolffian duct development, not AMH), D-True",
            },
            {
                "num": 473,
                "q": "Regarding congenital kidney malformations:",
                "opts": [
                    "A: Horseshoe kidney results from fusion of the lower poles of both kidneys during ascent. True or False",
                    "B: Horseshoe kidney is trapped below the inferior mesenteric artery during ascent. True or False",
                    "C: Polycystic kidney disease can be autosomal dominant or recessive. True or False",
                    "D: Duplex kidney (duplex collecting system) is always symptomatic. True or False",
                ],
                "ans": "Answers: A-True, B-True, C-True, D-False (many duplex kidneys are asymptomatic)",
            },
            {
                "num": 474,
                "q": "Which of the following are correct about the embryology of the face?",
                "opts": [
                    "A: The face develops primarily from the frontonasal process and the first pharyngeal arch. True or False",
                    "B: The nasal placodes invaginate to form the nasal pits. True or False",
                    "C: The upper lip is formed by fusion of the medial nasal processes and maxillary processes. True or False",
                    "D: The primary palate is formed from the frontonasal process. True or False",
                ],
                "ans": "Answers: A-True, B-True, C-True, D-True",
            },
            {
                "num": 475,
                "q": "Regarding the development of the eye:",
                "opts": [
                    "A: The optic vesicle develops as an outgrowth from the diencephalon. True or False",
                    "B: The lens is induced by the optic vesicle from the surface ectoderm. True or False",
                    "C: The retina is derived from neuroectoderm. True or False",
                    "D: Coloboma results from failure of the choroid fissure to close. True or False",
                ],
                "ans": "Answers: A-True, B-True, C-True, D-True",
            },
            {
                "num": 476,
                "q": "Which of the following are correct about the development of the ear?",
                "opts": [
                    "A: The membranous labyrinth develops from the otic vesicle (otocyst). True or False",
                    "B: The ossicles of the middle ear are derived from pharyngeal arch cartilages. True or False",
                    "C: The malleus and incus are derived from the first pharyngeal arch. True or False",
                    "D: The stapes is derived from the second pharyngeal arch. True or False",
                ],
                "ans": "Answers: A-True, B-True, C-True, D-True",
            },
            {
                "num": 477,
                "q": "Regarding the embryology of the pancreas:",
                "opts": [
                    "A: The pancreas develops from two buds - dorsal and ventral pancreatic buds. True or False",
                    "B: The ventral pancreatic bud rotates to fuse with the dorsal pancreatic bud. True or False",
                    "C: The main pancreatic duct (duct of Wirsung) is formed mainly from the ventral bud. True or False",
                    "D: Annular pancreas results from abnormal migration of the ventral pancreatic bud. True or False",
                ],
                "ans": "Answers: A-True, B-True, C-True, D-True",
            },
            {
                "num": 478,
                "q": "Which of the following are correct about the development of the liver?",
                "opts": [
                    "A: The liver develops from a hepatic diverticulum from the foregut endoderm. True or False",
                    "B: The liver is the main site of hematopoiesis in the second trimester. True or False",
                    "C: Kupffer cells are derived from mesoderm/monocyte lineage. True or False",
                    "D: The septum transversum contributes to the formation of the diaphragm. True or False",
                ],
                "ans": "Answers: A-True, B-True, C-True, D-True",
            },
            {
                "num": 479,
                "q": "Regarding the development of the spleen:",
                "opts": [
                    "A: The spleen is derived from mesoderm. True or False",
                    "B: The spleen develops from a condensation of mesenchyme in the dorsal mesogastrium. True or False",
                    "C: Accessory spleens (splenules) are common and clinically insignificant in most cases. True or False",
                    "D: The spleen is a retroperitoneal organ. True or False",
                ],
                "ans": "Answers: A-True, B-True, C-True, D-False (the spleen is an intraperitoneal organ)",
            },
            {
                "num": 480,
                "q": "Which of the following correctly describe the embryology of the adrenal gland?",
                "opts": [
                    "A: The adrenal cortex is derived from mesoderm. True or False",
                    "B: The adrenal medulla is derived from neural crest cells. True or False",
                    "C: The fetal adrenal cortex produces DHEA-S as a precursor for placental estrogen synthesis. True or False",
                    "D: The zona glomerulosa is the last zone of the adrenal cortex to develop. True or False",
                ],
                "ans": "Answers: A-True, B-True, C-True, D-False (the zona reticularis develops last)",
            },
            {
                "num": 481,
                "q": "Which of the following are correct about the embryology of the thyroid gland?",
                "opts": [
                    "A: The thyroid gland develops from an endodermal downgrowth from the tongue. True or False",
                    "B: The foramen cecum marks the origin of the thyroid. True or False",
                    "C: The thyroglossal duct normally obliterates. True or False",
                    "D: A thyroglossal cyst is the most common midline neck mass in children. True or False",
                ],
                "ans": "Answers: A-True, B-True, C-True, D-True",
            },
            {
                "num": 482,
                "q": "Regarding the embryology of the pituitary gland (hypophysis):",
                "opts": [
                    "A: The anterior pituitary (adenohypophysis) develops from Rathke's pouch (oral ectoderm). True or False",
                    "B: The posterior pituitary (neurohypophysis) develops from a downgrowth of the diencephalon. True or False",
                    "C: Craniopharyngioma arises from remnants of Rathke's pouch. True or False",
                    "D: The posterior pituitary produces ADH and oxytocin. True or False",
                ],
                "ans": "Answers: A-True, B-True, C-True, D-False (ADH and oxytocin are produced in the hypothalamus and transported to the posterior pituitary)",
            },
            {
                "num": 483,
                "q": "Which of the following are correct regarding the development of the cerebral cortex?",
                "opts": [
                    "A: Neurons of the cerebral cortex are produced in the ventricular zone by neurogenesis. True or False",
                    "B: Cortical neurons migrate outward in an 'inside-out' pattern. True or False",
                    "C: Radial glia provide a scaffold for neuronal migration. True or False",
                    "D: Lissencephaly results from a defect in neuronal migration. True or False",
                ],
                "ans": "Answers: A-True, B-True, C-True, D-True",
            },
            {
                "num": 484,
                "q": "Which of the following are correct about the embryology of skeletal muscle?",
                "opts": [
                    "A: Skeletal muscle is derived from myotomes of somites. True or False",
                    "B: Muscles of the limbs develop from somitic cells that migrate into the limb buds. True or False",
                    "C: Myoblasts are mononucleated precursor cells that fuse to form myotubes. True or False",
                    "D: Satellite cells maintain the ability to regenerate skeletal muscle in the adult. True or False",
                ],
                "ans": "Answers: A-True, B-True, C-True, D-True",
            },
            {
                "num": 485,
                "q": "Regarding the development of bone:",
                "opts": [
                    "A: Endochondral ossification involves a cartilage template that is replaced by bone. True or False",
                    "B: Intramembranous ossification occurs directly within a fibrous connective tissue membrane. True or False",
                    "C: The skull vault bones form by intramembranous ossification. True or False",
                    "D: Long bones form primarily by intramembranous ossification. True or False",
                ],
                "ans": "Answers: A-True, B-True, C-True, D-False (long bones form by endochondral ossification)",
            },
            {
                "num": 486,
                "q": "Which of the following are correct about the embryological basis of congenital hip dysplasia?",
                "opts": [
                    "A: It is more common in females. True or False",
                    "B: Breech presentation is a risk factor. True or False",
                    "C: It has multifactorial inheritance. True or False",
                    "D: The Ortolani and Barlow tests are used for clinical screening. True or False",
                ],
                "ans": "Answers: A-True, B-True, C-True, D-True",
            },
            {
                "num": 487,
                "q": "Regarding spina bifida:",
                "opts": [
                    "A: Spina bifida occulta involves only the vertebral arches without herniation of neural tissue. True or False",
                    "B: Meningocele involves herniation of meninges but not neural tissue. True or False",
                    "C: Myelomeningocele involves herniation of both meninges and neural tissue. True or False",
                    "D: Myelomeningocele is the least severe form of spina bifida. True or False",
                ],
                "ans": "Answers: A-True, B-True, C-True, D-False (myelomeningocele is the most severe form)",
            },
            {
                "num": 488,
                "q": "Which of the following are correct about Potter sequence?",
                "opts": [
                    "A: Bilateral renal agenesis is the classic underlying cause. True or False",
                    "B: Facial features include wide-set eyes, flattened nose, and low-set ears. True or False",
                    "C: Pulmonary hypoplasia is the major cause of death. True or False",
                    "D: It can result from prolonged premature rupture of membranes. True or False",
                ],
                "ans": "Answers: A-True, B-True, C-True, D-True",
            },
            {
                "num": 489,
                "q": "Which of the following are correct about the Wnt signaling pathway in embryology?",
                "opts": [
                    "A: Wnt signals from the dorsal ectoderm are important for dorsoventral patterning of the neural tube. True or False",
                    "B: Wnt/beta-catenin signaling is important for anterior-posterior axis determination. True or False",
                    "C: Wnt signaling promotes osteogenesis. True or False",
                    "D: Wnt signaling is involved in limb patterning. True or False",
                ],
                "ans": "Answers: A-True, B-True, C-True, D-True",
            },
            {
                "num": 490,
                "q": "Regarding the embryological development of the diaphragm:",
                "opts": [
                    "A: The diaphragm develops from four components: septum transversum, pleuroperitoneal membranes, body wall mesoderm, and dorsal mesentery of esophagus. True or False",
                    "B: The phrenic nerve is the motor nerve to the diaphragm and is derived from C3, C4, C5. True or False",
                    "C: The left pleuroperitoneal foramen closes later than the right, explaining why CDH is more common on the left. True or False",
                    "D: The septum transversum gives rise to the central tendon of the diaphragm. True or False",
                ],
                "ans": "Answers: A-True, B-True, C-True, D-True",
            },
        ],
    },
    {
        "section": "ADDITIONAL HISTOLOGY QUESTIONS",
        "subsection": None,
        "items": [
            {
                "num": 491,
                "q": "Which of the following are correct about intercalated discs of cardiac muscle?",
                "opts": [
                    "A: They contain both mechanical junctions (desmosomes and fascia adherens) and electrical junctions (gap junctions). True or False",
                    "B: Fascia adherens anchor actin filaments. True or False",
                    "C: Gap junctions allow direct electrical coupling between cardiomyocytes. True or False",
                    "D: Intercalated discs run perpendicular to the myofibrils. True or False",
                ],
                "ans": "Answers: A-True, B-True, C-True, D-True",
            },
            {
                "num": 492,
                "q": "Regarding the sarcoplasmic reticulum (SR) and T-tubules in skeletal muscle:",
                "opts": [
                    "A: T-tubules are invaginations of the sarcolemma. True or False",
                    "B: In skeletal muscle, T-tubules are located at the A-I band junction. True or False",
                    "C: The SR stores and releases calcium for muscle contraction. True or False",
                    "D: In cardiac muscle, T-tubules are located at the Z-disc level. True or False",
                ],
                "ans": "Answers: A-True, B-True, C-True, D-True",
            },
            {
                "num": 493,
                "q": "Which of the following describe the histology of hyaline cartilage?",
                "opts": [
                    "A: Hyaline cartilage contains type II collagen. True or False",
                    "B: The territorial matrix around chondrocytes stains intensely basophilic due to glycosaminoglycans. True or False",
                    "C: Hyaline cartilage is avascular. True or False",
                    "D: Hyaline cartilage has a perichondrium except at articular surfaces. True or False",
                ],
                "ans": "Answers: A-True, B-True, C-True, D-True",
            },
            {
                "num": 494,
                "q": "Regarding ground substance of connective tissue:",
                "opts": [
                    "A: Ground substance includes glycosaminoglycans (GAGs) and proteoglycans. True or False",
                    "B: Hyaluronic acid is a GAG that is not covalently linked to a core protein. True or False",
                    "C: Aggrecan is a major proteoglycan in cartilage. True or False",
                    "D: Ground substance is not visible on routine H&E staining. True or False",
                ],
                "ans": "Answers: A-True, B-True, C-True, D-True",
            },
            {
                "num": 495,
                "q": "Which of the following correctly describe type I collagen?",
                "opts": [
                    "A: It is the most abundant collagen in the body. True or False",
                    "B: It is found in bone, tendons, ligaments, and skin. True or False",
                    "C: It has a [Gly-Pro-Hyp]n repeating sequence. True or False",
                    "D: Defects in type I collagen cause Ehlers-Danlos syndrome type I. True or False",
                ],
                "ans": "Answers: A-True, B-True, C-True, D-False (osteogenesis imperfecta is caused by type I collagen defects; classical EDS is caused by COL5A1/COL5A2 mutations)",
            },
            {
                "num": 496,
                "q": "Regarding osteogenesis imperfecta:",
                "opts": [
                    "A: It is caused by defects in type I collagen. True or False",
                    "B: It presents with brittle bones and frequent fractures. True or False",
                    "C: Blue sclerae are a characteristic feature. True or False",
                    "D: It is always inherited in an autosomal dominant pattern. True or False",
                ],
                "ans": "Answers: A-True, B-True, C-True, D-False (most forms are autosomal dominant, but recessive forms exist)",
            },
            {
                "num": 497,
                "q": "Which of the following are correct about reticular fibers?",
                "opts": [
                    "A: Reticular fibers are composed of type III collagen. True or False",
                    "B: They are found in the framework of lymphoid organs, liver, and bone marrow. True or False",
                    "C: Reticular fibers stain black with silver impregnation (argyrophilic). True or False",
                    "D: Reticular fibers are visible on routine H&E staining. True or False",
                ],
                "ans": "Answers: A-True, B-True, C-True, D-False (they are not clearly visible on H&E; special stains like silver are needed)",
            },
            {
                "num": 498,
                "q": "Regarding the histology of the skin:",
                "opts": [
                    "A: The epidermis is a keratinized stratified squamous epithelium. True or False",
                    "B: The stratum basale contains melanocytes and Merkel cells. True or False",
                    "C: Langerhans cells are found in the stratum spinosum and function as antigen-presenting cells. True or False",
                    "D: The stratum lucidum is found only in thick skin. True or False",
                ],
                "ans": "Answers: A-True, B-True, C-True, D-True",
            },
            {
                "num": 499,
                "q": "Which of the following are correct about mast cells?",
                "opts": [
                    "A: Mast cells contain granules with histamine and heparin. True or False",
                    "B: Mast cells are derived from bone marrow precursors. True or False",
                    "C: Mast cells play a central role in type I hypersensitivity reactions. True or False",
                    "D: Mast cells and basophils are the same cell type. True or False",
                ],
                "ans": "Answers: A-True, B-True, C-True, D-False (they are distinct cell types although similar in function and content)",
            },
            {
                "num": 500,
                "q": "Regarding plasma cells:",
                "opts": [
                    "A: Plasma cells are terminally differentiated B lymphocytes. True or False",
                    "B: Plasma cells have a characteristic 'clockface' or 'cartwheel' chromatin pattern. True or False",
                    "C: Plasma cells produce antibodies. True or False",
                    "D: Plasma cells are abundant in germinal centers of lymph nodes. True or False",
                ],
                "ans": "Answers: A-True, B-True, C-True, D-False (germinal centers contain proliferating B cells; plasma cells are more abundant in the medullary cords)",
            },
        ],
    },
]

current_section = None
current_subsection = None

for group in questions:
    # Section header
    if group["section"] and group["section"] != current_section:
        current_section = group["section"]
        story.append(Spacer(1, 8))
        story.append(Paragraph(current_section, section_style))
        story.append(HRFlowable(width="100%", thickness=0.8, color=colors.HexColor("#1a1a2e"), spaceAfter=6))

    # Subsection header
    if group["subsection"] and group["subsection"] != current_subsection:
        current_subsection = group["subsection"]
        story.append(Paragraph(current_subsection, subsection_style))

    for item in group["items"]:
        # Question
        story.append(Paragraph(f"<b>Q{item['num']}. {item['q']}</b>", question_style))
        # Options - each on its own line
        for opt in item["opts"]:
            story.append(Paragraph(opt, option_style))
        # Answer
        story.append(Paragraph(f"&#x2713; {item['ans']}", answer_style))
        story.append(Spacer(1, 4))

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