Add question reporting and reference reviews

README.md

@@ -32,6 +32,94 @@ The Godot client reads this from `project.godot`:
 step3/questions_api_url
 ```
 
+## Question Image Copyright Review
+
+All questions containing images must receive a copyright and licensing review
+before publication or distribution. This applies both to newly submitted images
+and to every image already stored in the question bank.
+
+For each image-bearing question, document:
+
+- the original source and creator, when known;
+- the applicable license or written permission;
+- whether attribution is required and where it is displayed;
+- whether the image was modified or generated;
+- the reviewer and review date.
+
+Do not publish an image when its source or reuse rights cannot be established.
+Remove or replace images that fail review. Images added for development or
+manual testing are not exempt from this requirement.
+
+Outstanding action: audit every existing question with a non-empty `media`
+field before treating the current question bank as cleared for release.
+
+## Question Text Originality Review
+
+Every question must also receive an originality and copyright review before
+publication or distribution. Review the stem, lead-in, answer choices,
+explanations, follow-up questions, teaching points, and distinctive combinations
+of patient details for substantial overlap with copyrighted question banks,
+books, articles, screenshots, or other source material.
+
+Changing only names, ages, individual values, or a few words is not sufficient
+when the structure, sequence, and expression remain recognizably derived from a
+copyrighted source. Clinical facts and concepts may be used, but each question
+must express them independently with original organization and wording.
+
+For each reviewed question, document the reviewer, review date, any reference
+materials consulted, and whether revisions were required. Do not publish a
+question when substantial textual or structural overlap remains unresolved.
+
+Outstanding action: perform this review for every existing question in the
+question bank, not only newly submitted questions, before considering the bank
+cleared for release.
+
+## Question Verification References
+
+Every question must provide direct reference links to authoritative sources
+that allow reviewers to verify the clinical, scientific, statistical, or
+ethical information used in the stem, answer key, and explanation. References
+are required before publication, even when the tested fact is considered
+standard knowledge.
+
+Prefer current primary or authoritative sources, including professional society
+guidelines, government health agencies, original research, and official drug or
+product labeling. Use secondary sources only when a suitable primary or
+authoritative source is unavailable. Link to the specific guideline, article,
+or document rather than a search-results page or an organization's home page.
+
+For each question, document:
+
+- at least one direct reference URL;
+- the title and publishing organization for each reference;
+- which key claim or teaching point the reference supports;
+- the date the source was accessed and the reviewer who verified it.
+
+References must support the keyed answer and any management recommendations,
+diagnostic thresholds, formulas, or numerical claims. A citation does not grant
+permission to copy wording or media; the separate text-originality and image-
+copyright requirements still apply. If the question schema does not expose a
+reference field, retain this information in the associated authoring or review
+record until it can be stored with the question.
+
+## Duplicate Question Review
+
+Every question must be checked for duplicates before publication. This review
+must detect both exact duplicates and near-duplicates that test the same concept
+with substantially equivalent stems, decisive findings, lead-ins, answer sets,
+or teaching objectives despite different wording or external IDs.
+
+Repeated coverage of a learning objective is acceptable when the presentation,
+reasoning path, or learner task is meaningfully different. Reject exact copies
+and near-duplicates that merely change a patient age, reorder answers, or make
+minor value and wording changes. When substantial duplication remains, retain
+the stronger question, merge any useful unique teaching material, and remove or
+substantially differentiate the other version.
+
+Document the reviewer, review date, compared question IDs, and disposition of
+each potential duplicate. Outstanding action: run this review across the entire
+existing question bank before considering it cleared for release.
+
 ## Push Build
 
 `.github/workflows/questions-api.yml` builds and publishes the Questions API Docker image to GitHub Container Registry on pushes to `main`.