/tmp/workspace

~/attachments/29f15a59-6a76-4381-910f-1e2a1b1dfd23

python - <<'PY' from pptx import Presentation p='/tmp/workspace/attachments/29f15a59-6a76-4381-910f-1e2a1b1dfd23/Revision (3).pptx' prs=Presentation(p) print('SLIDES',len(prs.slides)) for i,s in enumerate(prs.slides,1): print(f'\n--- SLIDE {i} ---') for sh in s.shapes: if getattr(sh,'has_text_frame',False): t=sh.text_frame.text.strip() if t: print(t) PY

Which section should I answer first in full detail?

/tmp/workspace

microbiology parasitology

WHO laboratory diagnosis malaria intestinal protozoa diphtheria urinary tract infection guidance

mkdir -p "/tmp/workspace/pptx-revision/assets" "/tmp/workspace/pptx-revision/output" && python - <<'PY' from pptx import Presentation from PIL import Image,ImageDraw,ImageFont from io import BytesIO import os p='/tmp/workspace/attachments/29f15a59-6a76-4381-910f-1e2a1b1dfd23/Revision (3).pptx' prs=Presentation(p) out='/tmp/workspace/pptx-revision/assets' items=[] for si,s in enumerate(prs.slides,1): j=0 for sh in s.shapes: if sh.shape_type==13: # picture j+=1 im=Image.open(BytesIO(sh.image.blob)).convert('RGB') path=f'{out}/slide_{si:02d}_image_{j}.jpg' im.save(path, quality=90) items.append((si,j,path,im.copy())) print('pictures',len(items), [(a,b,im.size) for a,b,p,im in items]) # sheets of 12 font=ImageFont.load_default() for start in range(0,len(items),12): chunk=items[start:start+12] W,H=1200,900; thumbw,thumbh=280,180 sheet=Image.new('RGB',(W,H),'white'); d=ImageDraw.Draw(sheet) for ix,(slide,j,path,im) in enumerate(chunk): x=(ix%4)*300+10;y=(ix//4)*300+10 im.thumbnail((thumbw,thumbh)) sheet.paste(im,(x+(thumbw-im.width)//2,y+25)) d.text((x,y),f'Slide {slide}, image {j}',fill='black',font=font) sheet.save(f'{out}/contact_{start//12+1}.jpg') PY

python - <<'PY' from pptx import Presentation from PIL import Image,ImageDraw,ImageFont from io import BytesIO import os p='/tmp/workspace/attachments/29f15a59-6a76-4381-910f-1e2a1b1dfd23/Revision (3).pptx'; out='/tmp/workspace/pptx-revision/assets' prs=Presentation(p); items=[] for si,s in enumerate(prs.slides,1): j=0 for sh in s.shapes: if sh.shape_type==13: j+=1; ext=sh.image.ext path=f'{out}/slide_{si:02d}_image_{j}.{ext}' open(path,'wb').write(sh.image.blob) items.append((si,j,path,ext)) print('\n'.join(map(str,items))) PY file /tmp/workspace/pptx-revision/assets/* | sed -n '1,140p'

python - <<'PY' from pptx import Presentation p='/tmp/workspace/attachments/29f15a59-6a76-4381-910f-1e2a1b1dfd23/Revision (3).pptx'; prs=Presentation(p) for n in [4,5,7,11,12,13,14,15,27,28,30,31,34,35,36,38,47,49,50,51,69,71,76,78,79,80]: s=prs.slides[n-1] print('\nSLIDE',n) for sh in s.shapes: print(sh.shape_type, sh.name, 'text='+repr(sh.text[:50]) if getattr(sh,'has_text_frame',False) else '') PY

https://iris.who.int/server/api/core/bitstreams/ad308d08-243…

for f in /tmp/workspace/pptx-revision/assets/*.{jpg,png}; do [ -e "$f" ] && echo "--- $(basename "$f")" && tesseract "$f" stdout 2>/dev/null | sed -n '1,20p'; done

~/pptx-revision

cat > /tmp/workspace/pptx-revision/build_answer_key.py <<'PY' from docx import Document from docx.shared import Pt, Inches, RGBColor from docx.enum.text import WD_ALIGN_PARAGRAPH from docx.enum.section import WD_SECTION from docx.oxml import OxmlElement from docx.oxml.ns import qn from pathlib import Path out=Path('/tmp/workspace/pptx-revision/output/Revision_3_Ordered_Answer_Key.docx') doc=Document(); sec=doc.sections[0]; sec.top_margin=Inches(.65);sec.bottom_margin=Inches(.65);sec.left_margin=Inches(.7);sec.right_margin=Inches(.7) style=doc.styles['Normal'];style.font.name='Arial';style.font.size=Pt(9.5) for name in ['Heading 1','Heading 2','Heading 3']: s=doc.styles[name];s.font.name='Arial';s.font.color.rgb=RGBColor(31,78,121) def p(text='', boldlead=None): para=doc.add_paragraph() if boldlead and text.startswith(boldlead): para.add_run(boldlead).bold=True;para.add_run(text[len(boldlead):]) else: para.add_run(text) para.paragraph_format.space_after=Pt(3) return para def h(text,lvl=2): doc.add_heading(text,lvl) def bullets(items): for x in items: doc.add_paragraph(x,style='List Bullet') def qa(q,a): p('Question: '+q,'Question: ');p('Answer: '+a,'Answer: ') def note(x): para=doc.add_paragraph();r=para.add_run('Image-dependent note: ');r.bold=True;r.font.color.rgb=RGBColor(192,0,0);para.add_run(x) title=doc.add_heading('Revision (3) - Ordered Extract and Answer Key',0);title.alignment=WD_ALIGN_PARAGRAPH.CENTER p('All question slides are reproduced in the original slide order. Repeated questions are answered again where they recur. Answering assumes standard MBBS practical microbiology conventions.') p('Important limitation: many question slides contain only empty PowerPoint picture placeholders, so their specimen image is not embedded in the uploaded PPTX. Where an answer depends on such a missing image, the most likely intended answer is stated and clearly marked. Confirm it against the original classroom image before using it in an examination.') h('Slides 1-3',1);p('Title and practical-exercise instructions only. No questions to answer.') h('Day 1',1) h('Slide 4 - General spotter 1') qa('(a) Identify the molecular test shown. (b) Which nucleic-acid component is amplified?','Most likely conventional PCR. PCR amplifies a selected DNA target sequence. If the target organism has RNA, such as an RNA virus, reverse-transcription PCR first converts RNA into complementary DNA, then the cDNA is amplified.');note('The molecular-test picture is an empty placeholder in the uploaded deck.') h('Slide 5 - General spotter 2') qa('(a) Identify the special stain. (b) Name the bacteria shown.','Cannot be determined reliably because no image was embedded. In practical examinations, identify the stain from its characteristic appearance: Albert stain shows C. diphtheriae as green bacilli with bluish-black metachromatic granules; Ziehl-Neelsen stain shows acid-fast bacilli as red rods on a blue background; India ink shows the unstained halo of Cryptococcus; and modified ZN shows coccidian oocysts.');note('Empty image placeholder.') h('Slide 6 - General spotter 3') qa('(a) Identify the virus. (b) State mode of transmission of the disease caused.','The embedded picture is too low-resolution to identify with confidence. If it is hepatitis B virus, transmission is percutaneous or mucosal exposure to infected blood/body fluids, sexual exposure, and perinatal transmission. If it is HIV, the same major routes apply: sexual, blood-borne/parenteral, and vertical transmission.');note('The image cannot support a definitive virus identification.') h('Slide 7 - General spotter 4') qa('(a) Identify the organism in CSF sediment from a patient with HIV and CD4 <50/mm³. (b) Name the capsule stain.','Cryptococcus neoformans, causing cryptococcal meningitis. Demonstrate its thick polysaccharide capsule by negative staining with India ink. Cryptococcal antigen detection in CSF is more sensitive for clinical diagnosis.') h('Slide 8 - General spotter 5') qa('Identify the pathogen and name the disease caused.','The diagnostic picture is not embedded. A pathogen-disease answer cannot be assigned safely from the slide text alone. Please compare the original image before final revision.');note('The slide contains a WMF object that is not readable in this environment and no descriptive caption.') h('Slides 9-10',1);p('Parasitology heading and marking instructions only.') h('Slide 11 - Parasitology spotter 1') qa('(a) Name the stage of protozoan parasite in stool causing dysentery. (b) Name metastatic manifestation.','Entamoeba histolytica trophozoite, especially one containing ingested red cells, is diagnostic of invasive amoebiasis. The important extraintestinal metastatic manifestation is amoebic liver abscess, which may rarely extend to pleuropulmonary, pericardial, or cerebral disease.') h('Slide 12 - Parasitology spotter 2') qa('(a) Identify parasitic eggs obtained by perianal cellophane tape. (b) Define autoinfection.','Enterobius vermicularis eggs. They are colourless, ovoid, asymmetrical, and planoconvex, with one flattened side. Autoinfection means reinfection of the same host by infective stages produced during their current infection, without requiring a new outside source. In enterobiasis, hand-to-mouth transfer of eggs after perianal scratching is common; retroinfection may also occur when larvae hatch near the anus and migrate back in.') h('Slide 13 - Parasitology spotter 3') qa('(a) Identify egg found in stool. (b) State type of anaemia.','Most likely hookworm egg, Ancylostoma duodenale or Necator americanus: a thin-shelled, colourless oval egg containing a segmented morula. Chronic intestinal blood loss causes iron-deficiency, microcytic hypochromic anaemia.');note('Image placeholder absent; inference is based on the anaemia clue.') h('Slide 14 - Parasitology spotter 4') qa('(a) Identify condition caused by parasitic infection. (b) Name larval stage responsible.','Cutaneous larva migrans, also called creeping eruption. It is caused by skin penetration and migration of the infective third-stage filariform larvae of animal hookworms, commonly Ancylostoma braziliense or A. caninum.');note('Image placeholder absent; inference based on the question wording.') h('Slide 15 - Parasitology spotter 5') qa('(a) Identify parasitic larvae in peripheral smear. (b) Name disease caused.','Microfilariae of Wuchereria bancrofti, classically a sheathed microfilaria with nuclei not extending to the tail tip. It causes lymphatic filariasis, presenting as recurrent lymphangitis/lymphadenitis, hydrocele, lymphoedema, and later elephantiasis.');note('Image placeholder absent.') h('Slides 16-17 - Parasitology case: malnourished 3-year-old with pain, vomiting and eggs in stool') qa('1. Identify etiological agent.','Ascaris lumbricoides, inferred from the child, malnutrition, acute abdominal symptoms, and egg image.') qa('2. Identify the eggs.','Ascaris eggs. Fertilized eggs are round to oval, bile-stained, with a thick trilaminar shell and outer mammillated albuminous coat. Decorticated fertilized eggs lack the mammillated coat. Unfertilized eggs are longer, more irregular, and contain disorganized granular material.') qa('3. Write fatal complication.','Intestinal obstruction due to a bolus of worms is the classic life-threatening complication in children. Volvulus, intussusception, perforation/peritonitis, or migration into the biliary or pancreatic tract may occur.') qa('4. Describe identifying features of eggs.','See answer 2: bile-stained brown, thick-shelled, oval fertilized eggs with mammillated coat; sometimes decorticated. The embryo is not fully developed when passed.') qa('5. Enlist stool-concentration methods.','Sedimentation: simple gravity sedimentation, formalin-ether or formalin-ethyl-acetate concentration. Flotation: saturated salt flotation, zinc sulfate flotation, and Sheather sugar flotation. Sedimentation is especially useful for heavier eggs; flotation is useful for many protozoal cysts and light eggs.') h('Slides 18-19',1);p('Case-based exercise heading and marking instructions only.') h('Slides 20-21 - Clinical case 1: dysuria, frequency, lactose-fermenting non-mucoid colonies') qa('Q1. What type of UTI?','Acute uncomplicated lower urinary tract infection, specifically acute cystitis, if she is non-pregnant and has no structural/functional urinary-tract abnormality or systemic features.') qa('Q2. Define significant bacteriuria.','Classically, ≥10^5 colony-forming units (CFU)/mL of a single organism in a properly collected clean-catch midstream urine sample. In symptomatic women with acute cystitis, lower counts, commonly ≥10^2 to 10^3 CFU/mL of a typical uropathogen, may be clinically significant.') qa('Q3. Probable organism?','Escherichia coli, the commonest cause of community-acquired uncomplicated cystitis. It is a lactose-fermenting, usually non-mucoid Gram-negative bacillus on MacConkey agar.') qa('Q4. What is complicated UTI?','A UTI occurring with a factor that increases risk of treatment failure or serious outcome, such as urinary obstruction, stones, catheter/instrumentation, neurogenic bladder, renal impairment, structural abnormality, immunosuppression, pregnancy, or infection in a male. Pyelonephritis is often managed as a more serious infection.') qa('Q5. Treatment of community-acquired UTI?','Send urine culture when indicated, especially if recurrent, pregnant, complicated, or pyelonephritis is suspected. For uncomplicated cystitis, use local antibiogram-guided oral therapy: nitrofurantoin, trimethoprim-sulfamethoxazole where local resistance is low and no contraindication exists, or fosfomycin where available. Encourage fluids and give analgesia. Avoid empirical fluoroquinolones for simple cystitis where alternatives are suitable. Fever, flank pain, vomiting, pregnancy, sepsis, or obstruction requires urgent assessment for pyelonephritis/complicated UTI.') h('Slides 22-24 - Clinical case 2: pseudomembranous pharyngitis and Albert-positive bacilli') qa('Q1. Clinical diagnosis and causative agent?','Respiratory diphtheria caused by toxigenic Corynebacterium diphtheriae. The grey-white adherent pseudomembrane and club-shaped, metachromatically granulated bacilli support this diagnosis.') qa('Q2. Selective medium.','Potassium tellurite-containing medium, classically Hoyle’s tellurite agar or Tinsdale medium. Tellurite is reduced, producing dark colonies. Loeffler serum slope is an enrichment medium that enhances metachromatic granules.') qa('Q3. Mechanism of toxin action.','Diphtheria toxin is an A-B exotoxin. The B subunit binds host cells; the A subunit ADP-ribosylates elongation factor-2 using NAD, stopping protein synthesis and causing cell death. The toxin gene is carried by a lysogenic β-phage.') qa('Q4. Tests for toxin detection.','Elek gel-immunodiffusion test demonstrates toxin production. PCR detects the tox gene but alone does not prove active toxin expression. Cell-culture cytotoxicity neutralisation tests may be used in reference laboratories.') qa('Q5. Treatment of acute infection.','Treat on clinical suspicion: isolate with droplet precautions, obtain throat/nasal swabs but do not wait for confirmation, and give diphtheria antitoxin after appropriate testing for hypersensitivity. Give erythromycin or penicillin for 14 days, manage airway risk urgently, and culture after treatment to document clearance. Trace and treat close contacts, provide antimicrobial prophylaxis as indicated, and ensure vaccination because infection does not reliably provide immunity. WHO and CDC state that culture plus toxigenicity testing, such as Elek testing, confirms disease.') h('Slides 25-26',1);p('Day 2 instructions only.') h('Day 2',1) h('Slide 27 - General spotter 1') qa('(a) Describe Gram stain of CSF sediment from a newborn with meningitis. (b) Probable route of infection.','Most likely Group B Streptococcus (Streptococcus agalactiae): Gram-positive cocci in pairs and short chains, often with neutrophils in CSF. Neonates acquire it vertically from a colonized maternal genital tract, usually intrapartum during passage through the birth canal; ascending infection before delivery may occur. E. coli with K1 antigen is the key alternative if the image shows Gram-negative bacilli.');note('The image is missing, so the morphology should be matched to the original.') h('Slide 28 - General spotter 2') qa('(a) Identify disease in an HIV-positive patient with low CD4 count. (b) Two other opportunistic fungi.','Most likely Pneumocystis jirovecii pneumonia if the intended image shows diffuse bilateral infiltrates or cysts. Other opportunistic fungi include Cryptococcus neoformans, Candida species, Histoplasma capsulatum, Aspergillus species, and Talaromyces marneffei in endemic areas.');note('Empty placeholder prevents confirmation.') h('Slide 29 - General spotter 3') qa('(a) Identify mosquito type. (b) Give two arthropod-borne infections.','The image must be checked for the expected answer. Anopheles rests with abdomen angled upward and has spotted wings; it transmits malaria. Aedes has black-and-white markings and transmits dengue/chikungunya. Culex rests parallel to the surface and can transmit lymphatic filariasis or Japanese encephalitis. Two examples: malaria and dengue.') h('Slide 30 - General spotter 4') qa('(a) Identify experimental animal. (b) Name bacteria grown in it.','Most likely guinea pig. It is classically used in vivo for demonstrating virulence/toxin effect of Corynebacterium diphtheriae, and is also associated with experimental isolation/testing of some organisms.');note('Image is an empty placeholder.') h('Slide 31 - General spotter 5') qa('(a) Identify type of immunological test. (b) Name two tests based on it.','Cannot identify the test principle without the figure. Common practical possibilities: ELISA, based on enzyme-labelled antigen/antibody, with examples HIV antibody ELISA and HBsAg ELISA; agglutination, with examples Widal and latex agglutination for cryptococcal antigen; or immunochromatography, with examples pregnancy and malaria rapid tests.');note('Empty image placeholder.') h('Slides 32-33',1);p('Parasitology heading/instructions only.') h('Slide 34 - Parasitology spotter 1') qa('(a) Protozoan in modified AFB-stained stool from immunocompromised patient with chronic diarrhoea. (b) Concentration of H₂SO₄.','Cryptosporidium species oocysts, usually C. parvum/C. hominis. They appear as small, round, pink-red acid-fast oocysts against a blue/green background. Modified Ziehl-Neelsen staining uses 1% sulfuric acid as decolorizer.') h('Slide 35 - Parasitology spotter 2') qa('(a) Identify parasite stage in peripheral smear. (b) Two complications of infection with this species.','Most likely Plasmodium falciparum ring forms or crescent/banana-shaped gametocytes. Two serious complications are cerebral malaria and severe malarial anaemia; others include acute kidney injury, hypoglycaemia, metabolic acidosis, pulmonary oedema/ARDS, shock, and haemoglobinuria.');note('Image is not embedded; identify the species from the original smear.') h('Slide 36 - Parasitology spotter 3') qa('(a) Identify eggs in stool. (b) Fatal complication.','Most likely Ascaris lumbricoides eggs. The key fatal complication is intestinal obstruction with possible volvulus, intussusception, bowel necrosis/perforation and peritonitis.');note('Image is absent; inferred from the complication clue.') h('Slide 37 - Parasitology spotter 4') qa('(a) Identify trophozoite and cyst in stool. (b) Route of infection.','Entamoeba histolytica trophozoite and cyst. Trophozoites may contain ingested RBCs; mature cysts usually contain up to four nuclei and chromatoid bars. Infection is faeco-oral, by ingestion of mature quadrinucleate cysts in contaminated food or water, or through contaminated hands.') h('Slide 38 - Parasitology spotter 5') qa('(a) Identify trophozoites in vaginal discharge. (b) Other organisms causing vaginitis.','Trichomonas vaginalis, a pear-shaped, flagellated trophozoite with jerky motility and an undulating membrane. Other causes include Candida albicans and bacterial vaginosis due to a polymicrobial dysbiosis commonly associated with Gardnerella vaginalis. Neisseria gonorrhoeae and Chlamydia trachomatis can cause cervicitis with vaginal symptoms.') h('Slides 39-40 - Parasitology case: bloody mucus diarrhoea') qa('1. Etiological agent.','Entamoeba histolytica.') qa('2. Morphological form seen in wet mount.','Trophozoite, diagnostic when it contains ingested red blood cells. It has a single nucleus with a small central karyosome and fine, evenly distributed peripheral chromatin.') qa('3. Infective stage.','Mature quadrinucleate cyst.') qa('4. Draw and label other form.','Draw the cyst: rounded 10-20 µm structure with cyst wall; 1-4 nuclei, central karyosome, fine peripheral chromatin; chromatoid bars with rounded ends in immature cysts; glycogen mass in immature cysts. A mature cyst has four nuclei.') qa('5. Other species of this protozoan parasite.','Nonpathogenic intestinal Entamoeba species include E. dispar, E. moshkovskii, E. coli, E. hartmanni, E. polecki, and E. gingivalis. E. dispar is morphologically similar to E. histolytica but generally noninvasive.') h('Slides 41-42',1);p('Case-based exercise heading/instructions only.') h('Slides 43-44 - Clinical case: bacillary dysentery') qa('Q1. Most probable agent?','Shigella species, causing shigellosis/bacillary dysentery. It is a Gram-negative, non-lactose-fermenting, non-motile bacillus.') qa('Q2. List species causing disease.','Shigella dysenteriae, S. flexneri, S. boydii, and S. sonnei. S. dysenteriae type 1 is associated with Shiga toxin and severe epidemics.') qa('Q3. Steps of laboratory diagnosis.','Collect fresh stool, preferably before antibiotics, or a rectal swab in Cary-Blair transport medium. Perform microscopy for RBCs and pus cells. Culture on selective/differential media such as MacConkey, XLD, DCA, or SS agar; Shigella gives non-lactose-fermenting colonies and does not produce H₂S. Confirm by biochemical reactions, including non-motility and appropriate sugar reactions, then serogroup with specific antisera. Perform antimicrobial susceptibility testing. Test for Shiga toxin when clinically/epidemiologically relevant.') qa('Q4. Suggest treatment.','First correct dehydration with oral rehydration solution or IV fluids when severe, maintain nutrition, and apply enteric/contact hygiene. Antibiotics are used for severe disease, high-risk patients, or to shorten shedding, but selection must follow local susceptibility: azithromycin, ciprofloxacin where susceptible, or ceftriaxone for severe/resistant disease are common options. Avoid antimotility drugs in dysentery. Suspected S. dysenteriae type 1 or severe illness needs close monitoring.') qa('Q5. What is HUS?','Haemolytic uraemic syndrome is a thrombotic microangiopathy characterized by the triad of microangiopathic haemolytic anaemia, thrombocytopenia, and acute kidney injury. It classically follows Shiga toxin-producing E. coli, but Shigella dysenteriae type 1 can also cause it.') h('Slides 45-46',1);p('Day 3 instructions only.') h('Day 3',1) h('Slide 47 - General spotter 1') qa('(a) Interpret HBV test results. (b) Vaccine type for HBV prophylaxis.','HBsAg negative, anti-HBs positive, anti-HBc negative, HBeAg negative, anti-HBe negative, and HBV DNA negative means immunity due to hepatitis B vaccination, not previous natural infection. The vaccine is a recombinant subunit vaccine containing hepatitis B surface antigen (HBsAg).') h('Slide 48 - General spotter 2') qa('(a) Identify sterilization equipment. (b) Appropriate holding time.','The picture shows an autoclave, a steam-under-pressure sterilizer. Standard holding time is 15 minutes at 121°C and 15 psi after the chamber/load has reached the required temperature. A common alternative rapid cycle is 134°C for about 3 minutes, subject to validated load-specific protocols.') h('Slide 49 - General spotter 3') qa('(a) Describe Gram-stained pus smear. (b) Morphology and tentative aetiology.','Most likely numerous pus cells with Gram-positive cocci in irregular grape-like clusters, indicating Staphylococcus aureus, a common cause of pyogenic wound/skin infection and abscess. If the actual image shows Gram-negative bacilli, revise accordingly. Gram-smear report should state pus cells, organism Gram reaction, shape, arrangement, and whether intracellular organisms are seen.');note('The image placeholder is empty in the file.') h('Slide 50 - General spotter 4') qa('(a) Identify bacterial gene-transfer mode. (b) What is R plasmid?','Most likely conjugation, in which DNA, typically a plasmid, transfers by direct cell-to-cell contact through a sex pilus/conjugative apparatus. An R plasmid is a resistance plasmid carrying antimicrobial-resistance genes. It commonly has an R-determinant region with resistance genes and an RTF, or resistance transfer factor, enabling conjugative transfer.');note('Image is absent; the R-plasmid clue supports conjugation.') h('Slide 51 - General spotter 5') qa('(a) Opportunistic fungal pathogen found in CSF. (b) Capsule stain.','Cryptococcus neoformans. The capsule is shown by India ink negative staining. CSF cryptococcal antigen testing is preferred for sensitive diagnosis.') h('Slides 52-53',1);p('Parasitology heading/instructions only.') h('Slide 54 - Parasitology spotter 1') qa('(a) Identify egg and scolex found in stool. (b) Neurologic complication.','Taenia solium. The egg is spherical with a thick, radially striated embryophore and a six-hooked oncosphere. The scolex is armed, with four suckers and a rostellum bearing hooklets. The neurologic complication is neurocysticercosis, often presenting with seizures, raised intracranial pressure, or focal deficits.') h('Slide 55 - Parasitology spotter 2') qa('(a) Identify cyst in stool of dysentery patient. (b) Infective stage.','Entamoeba histolytica cyst. The infective stage is the mature quadrinucleate cyst.') h('Slide 56 - Parasitology spotter 3') qa('(a) Identify oocyst in stool of HIV-positive patient with chronic diarrhoea. (b) Other opportunistic diarrhoeal protozoan.','Cryptosporidium oocyst, detected by modified acid-fast staining. Other opportunistic protozoa include Cystoisospora belli, Cyclospora cayetanensis, and microsporidia.') h('Slide 57 - Parasitology spotter 4') qa('(a) Identify egg in stool. (b) Type of anaemia.','Hookworm egg, Ancylostoma duodenale/Necator americanus. It causes chronic blood-loss iron-deficiency microcytic hypochromic anaemia.');note('Image omitted; inference from anaemia clue.') h('Slide 58 - Parasitology spotter 5') qa('(a) Identify eggs from cellophane tape. (b) Define autoinfection.','Enterobius vermicularis eggs. Autoinfection is reinfection of the same individual with infective stages arising from their existing infection, commonly hand-to-mouth egg transfer after scratching in enterobiasis.') h('Slides 59-60 - Parasitology case: foul-smelling diarrhoea, flatus and weight loss') qa('1. Etiological agent.','Giardia duodenalis, also called G. lamblia or G. intestinalis.') qa('2. Identify form in stool.','Most likely trophozoite: pear/tear-drop shaped, bilaterally symmetrical, dorsoventrally flattened, with two nuclei giving a face-like appearance, four pairs of flagella, median bodies, and a ventral sucking disc.') qa('3. Draw and label other form.','Draw the cyst: oval 8-12 µm structure with a thick wall, 2 nuclei in immature cyst and 4 nuclei in mature cyst, curved median bodies, and axonemes. The mature cyst is the infective form.') qa('4. Type of motility.','Characteristic falling-leaf, tumbling, or side-to-side motility.') qa('5. Enlist stool concentration methods.','Sedimentation: simple sedimentation and formalin-ether/formalin-ethyl-acetate concentration. Flotation: zinc sulfate, saturated salt, or Sheather sugar flotation. Repeated stool samples improve yield in giardiasis.') h('Slides 61-62',1);p('Case-based exercise heading/instructions only.') h('Slides 63-64 - Clinical shigellosis case') p('This is a repeat of slides 43-44. The answers are repeated below as requested.') qa('Q1. Most probable agent.','Shigella species causing bacillary dysentery.') qa('Q2. Species.','S. dysenteriae, S. flexneri, S. boydii, and S. sonnei.') qa('Q3. Laboratory diagnosis.','Fresh stool/rectal swab, microscopy for RBCs and pus cells, culture on MacConkey plus XLD/DCA/SS, identification as non-lactose-fermenting and non-motile Gram-negative bacilli, biochemical confirmation, serogrouping, and susceptibility testing.') qa('Q4. What is HUS?','Triad of microangiopathic haemolytic anaemia, thrombocytopenia and acute kidney injury due to thrombotic microangiopathy; classically Shiga toxin-mediated.') qa('Q5. Treatment.','Rehydration and electrolyte correction first; culture/susceptibility-guided antibiotics for severe/high-risk cases such as azithromycin, ciprofloxacin when susceptible, or ceftriaxone. Avoid antimotility agents in invasive dysentery.') h('Slides 65-66 - Clinical case: multiple sexual partners, fever, weight loss, chronic diarrhoea') qa('Q1. Most probable illness.','HIV infection with advanced disease/AIDS, suggested by risk exposure, constitutional symptoms, chronic diarrhoea and weight loss. Confirm with the approved HIV testing algorithm, not symptoms alone.') qa('Q2. Labelled structure of virus.','Draw HIV virion: lipid envelope bearing gp120 surface glycoprotein and gp41 transmembrane protein; matrix protein p17; conical capsid p24; nucleocapsid proteins p7/p9; two identical positive-sense single-stranded RNA genomes; reverse transcriptase, integrase, and protease.') qa('Q3. Steps in diagnosis.','Use the national serial HIV antibody testing algorithm with assays based on different antigen preparations/principles. A reactive first test is followed by a different supplemental assay; discordance is resolved with a third assay according to national policy. For infants <18 months, acute infection, or indeterminate results, use virologic testing such as HIV-1 nucleic-acid testing. Once diagnosed, assess CD4 count, HIV viral load, TB/hepatitis/STI co-infections, baseline blood tests, and opportunistic infections.') qa('Q4. NACO strategy for screening blood donors.','NACO Strategy I: a single highly sensitive screening test, traditionally used for blood-donor screening. Reactive donations are discarded and the donor is counselled/referred according to policy. Current blood services may use validated serology plus nucleic-acid testing based on programme capacity.') qa('Q5. Modes of transmission.','Sexual transmission; parenteral exposure to infected blood, shared injection equipment, unsafe transfusion/transplantation or occupational sharps; and mother-to-child transmission during pregnancy, delivery, or breastfeeding. HIV is not spread by routine social contact, food, insects, or sharing utensils.') h('Slides 67-68',1);p('Day 4 instructions only.') h('Day 4',1) h('Slide 69 - General spotter 1') qa('(a) Identify opportunistic fungus in LPCB preparation from SDA growth. (b) Two diseases.','Most likely Aspergillus fumigatus, recognized by septate hyphae with conidiophores ending in a vesicle bearing phialides and conidia. It causes allergic bronchopulmonary aspergillosis, aspergilloma (fungus ball), chronic pulmonary aspergillosis, and invasive aspergillosis.');note('No fungus image is embedded; confirm morphology against the original.') h('Slide 70 - General spotter 2') qa('(a) Identify bacterial pathogen in Gram-stained deep wound smear. (b) Name condition shown.','Most likely Clostridium tetani if the smear shows Gram-positive bacilli with terminal spherical spores giving a drumstick/tennis-racket appearance. It causes tetanus, with trismus, risus sardonicus, painful rigidity and spasms. If the picture instead shows broad boxcar bacilli with tissue gas, the diagnosis would be Clostridium perfringens causing gas gangrene.');note('The provided image should be checked to distinguish these organisms.') h('Slide 71 - General spotter 3') qa('(a) Identify immunological test. (b) Two examples.','The test image is missing. A common intended answer is ELISA: an enzyme-linked immunosorbent assay using enzyme-labelled antigen or antibody and a colour-producing substrate. Examples are HBsAg ELISA and HIV antibody/antigen ELISA. Other possible principles are agglutination or immunochromatography; confirm from the original image.') h('Slide 72 - General spotter 4') qa('(a) Identify parasite stage in peripheral blood. (b) Disease in image b.','Most likely microfilaria of Wuchereria bancrofti in peripheral blood. The clinical image is lymphatic filariasis, often manifesting as lymphoedema/elephantiasis or hydrocele. The microfilaria is sheathed and has nuclei that do not reach the tail tip.') h('Slide 73 - General spotter 5') qa('(a) Identify sterilization equipment. (b) Appropriate holding time.','Autoclave. Hold for 15 minutes at 121°C and 15 psi after the required temperature has been attained throughout the load.') h('Slides 74-75',1);p('Parasitology heading/instructions only.') h('Slide 76 - Parasitology spotter 1') qa('(a) Identify protozoan trophozoite causing diarrhoea. (b) Type of diarrhoea.','Giardia duodenalis trophozoite. It causes non-inflammatory, non-bloody, foul-smelling, greasy diarrhoea with malabsorption, bloating, flatulence and weight loss (steatorrhoea may occur).') h('Slide 77 - Parasitology spotter 2') qa('(a) Identify oocyst in stool of HIV-positive patient with chronic diarrhoea. (b) Other opportunistic protozoan.','Cryptosporidium oocyst. Another opportunistic diarrhoeal protozoan is Cystoisospora belli; Cyclospora cayetanensis and microsporidia are further examples.') h('Slide 78 - Parasitology spotter 3') qa('(a) Identify egg in stool. (b) Type of life cycle of this cestode.','Most likely Taenia solium egg, which is morphologically indistinguishable from Taenia saginata egg. T. solium has an indirect/digenetic life cycle: humans are definitive hosts harbouring adult worms and pigs are usual intermediate hosts harbouring cysticerci. Humans may also become accidental intermediate hosts after ingesting eggs, leading to cysticercosis.');note('Image omitted.') h('Slide 79 - Parasitology spotter 4') qa('(a) Identify egg in stool. (b) Route of entry.','Most likely hookworm egg. Infection by hookworm occurs when infective filariform larvae penetrate intact skin, typically bare feet on contaminated soil.');note('Image omitted; route clue supports hookworm.') h('Slide 80 - Parasitology spotter 5') qa('(a) Identify eggs in stool. (b) Route of entry.','Most likely Ascaris lumbricoides eggs, commonly shown as fertilized and unfertilized forms. Infection is by faeco-oral ingestion of embryonated eggs from contaminated soil, food, water, or hands.');note('Image omitted; inference based on common practical pairing.') h('Slides 81-83 - Parasitology case: fever, chills, convulsions, anaemia, splenomegaly') qa('1. Clinical diagnosis.','Severe falciparum malaria with cerebral malaria, given convulsions and neurological features.') qa('2. Etiological agent.','Plasmodium falciparum.') qa('3. Parasite stage in peripheral smear.','The specific photo should be checked. P. falciparum commonly shows delicate ring trophozoites, sometimes multiple rings per RBC and appliqué forms; the characteristic gametocyte is crescent/banana shaped. Mature trophozoites and schizonts are usually sequestered and less often seen in peripheral blood.') qa('4. Two complications.','Cerebral malaria and severe anaemia. Other complications include hypoglycaemia, acidosis, acute kidney injury, jaundice, pulmonary oedema/ARDS, shock, haemoglobinuria and bleeding/DIC.') qa('5. Treatment.','Treat as a medical emergency. Give intravenous artesunate immediately for severe malaria, with weight-based dosing according to current national/WHO protocol, then complete a full oral artemisinin-based combination therapy when the patient can take oral treatment. Check glucose, treat seizures and hypoglycaemia, correct fluids cautiously, monitor parasitaemia/haemoglobin/renal function, and manage anaemia, renal failure, acidosis, or shock. Current WHO malaria guidance should be followed because recommendations and local resistance patterns can change.') h('Slides 84-85',1);p('Case-based exercise heading/instructions only.') h('Slides 86-87 - Clinical case: painless indurated genital ulcer after unprotected sexual exposure') qa('Q1. Most likely diagnosis.','Primary syphilis, presenting as a chancre caused by Treponema pallidum. A typical chancre is painless, clean-based, indurated, and accompanied by non-tender, firm rubbery regional lymphadenopathy.') qa('Q2. Laboratory diagnosis tests.','Direct detection from an active lesion: dark-ground/dark-field microscopy where available, direct fluorescent antibody testing, or lesion PCR. Serology: nontreponemal tests such as VDRL and RPR for screening and quantitative follow-up; treponemal tests such as TPHA/TPPA, FTA-ABS, or treponemal EIA/CLIA for confirmation. In suspected neurosyphilis, evaluate CSF in the appropriate clinical context. HIV testing and testing for other STIs should be offered.') qa('Q3. Signs and symptoms of later stages.','Secondary syphilis: fever, malaise, generalized non-tender lymphadenopathy, diffuse rash often involving palms and soles, mucous patches, condylomata lata, patchy alopecia, and systemic involvement. Latent syphilis is asymptomatic. Tertiary syphilis: gummas, cardiovascular disease such as aortitis/aortic aneurysm, and neurosyphilis such as meningitis, stroke, tabes dorsalis, or general paresis.') qa('Q4. What is soft chancre?','Chancroid, a sexually transmitted genital-ulcer disease caused by Haemophilus ducreyi. It classically produces one or more painful, ragged, non-indurated ulcers with purulent bases and painful, often suppurative inguinal lymphadenitis (bubo).') qa('Q5. Enlist other STIs.','Gonorrhoea, chlamydial infection, genital herpes, trichomoniasis, human papillomavirus infection/genital warts, HIV infection, hepatitis B, chancroid, lymphogranuloma venereum, granuloma inguinale, and Mycoplasma genitalium infection.') h('Sources and current-practice notes',1) p('For diphtheria, WHO laboratory guidance supports culture on appropriate media with confirmatory toxigenicity testing, and CDC notes that PCR supports identification but does not by itself prove toxin production. For malaria treatment, use the current WHO malaria guideline and the national malaria programme protocol. Antibiotic choices and HIV testing algorithms must follow the latest local/national policy and susceptibility data.') p('Reference links: WHO Laboratory manual for diagnosis of diphtheria and other related infections (2021): https://iris.who.int/server/api/core/bitstreams/ad308d08-243a-4f04-9a05-254d97dcdfbf/content . CDC laboratory support for diphtheria: https://www.cdc.gov/surv-manual/php/table-of-contents/chapter-22-laboratory-support.html . WHO Guidelines for malaria (2025): https://iris.who.int/server/api/core/bitstreams/26a6af2d-060c-4449-8207-1f25e63c6cc3/content') # footer for section in doc.sections: footer=section.footer.paragraphs[0];footer.alignment=WD_ALIGN_PARAGRAPH.CENTER footer.add_run('Revision (3) - ordered answer key | Page ') fld=OxmlElement('w:fldSimple');fld.set(qn('w:instr'),'PAGE');footer._p.append(fld) doc.save(out) print(out, out.stat().st_size) PY python /tmp/workspace/pptx-revision/build_answer_key.py python - <<'PY' from docx import Document p='/tmp/workspace/pptx-revision/output/Revision_3_Ordered_Answer_Key.docx' d=Document(p) print(len(d.paragraphs), 'paragraphs') print(d.paragraphs[0].text) print(d.paragraphs[-1].text[:100]) PY

python - <<'PY' from pptx import Presentation from pathlib import Path p='/tmp/workspace/attachments/29f15a59-6a76-4381-910f-1e2a1b1dfd23/Revision (3).pptx' out=Path('/tmp/workspace/pptx-revision/output/Revision_3_Exact_Slide_Text.md') prs=Presentation(p) with out.open('w',encoding='utf8') as f: f.write('# Revision (3): Exact extracted slide text\n\n') f.write('Text was extracted directly from all 87 slides in original order. Image placeholders are noted where present.\n\n') for i,s in enumerate(prs.slides,1): f.write(f'## Slide {i}\n\n') vals=[]; imgs=[] for sh in s.shapes: if getattr(sh,'has_text_frame',False) and sh.text.strip(): vals.append(sh.text.strip()) if sh.shape_type==13: imgs.append('embedded raster image') elif 'Picture' in sh.name or 'Placeholder' in sh.name and not getattr(sh,'has_text_frame',False): imgs.append('picture placeholder') f.write('\n\n'.join(vals) if vals else '_No textual content_') if imgs: f.write('\n\n_Visual content: ' + ', '.join(imgs) + '._') f.write('\n\n') print(out, out.stat().st_size) PY python - <<'PY' from docx import Document from pathlib import Path p=Path('/tmp/workspace/pptx-revision/output/Revision_3_Ordered_Answer_Key.docx') d=Document(p) need=['Slide 4 - General spotter 1','Slides 20-21 - Clinical case 1','Slides 86-87 - Clinical case'] for x in need: assert any(x in para.text for para in d.paragraphs),x print('Verified DOCX exists and contains key ordered sections:',p.stat().st_size,'bytes') PY

/tmp/workspace

~/pptx-revision

cat > "/tmp/workspace/pptx-revision/create_pdf.py" <<'PY' from pathlib import Path from docx import Document from reportlab.lib.pagesizes import A4 from reportlab.lib.styles import getSampleStyleSheet, ParagraphStyle from reportlab.lib.enums import TA_CENTER from reportlab.lib.colors import HexColor, black, white from reportlab.lib.units import inch from reportlab.platypus import SimpleDocTemplate, Paragraph, Spacer, PageBreak, KeepTogether from reportlab.pdfbase.pdfmetrics import stringWidth from reportlab.lib import colors from xml.sax.saxutils import escape source=Path('/tmp/workspace/pptx-revision/output/Revision_3_Ordered_Answer_Key.docx') out=Path('/tmp/workspace/pptx-revision/output/Revision_3_Ordered_Answer_Key.pdf') assert source.exists(), source docx=Document(source) styles=getSampleStyleSheet() styles.add(ParagraphStyle(name='CoverTitle', parent=styles['Title'], fontName='Helvetica-Bold', fontSize=22, leading=27, alignment=TA_CENTER, textColor=HexColor('#1F4E79'), spaceAfter=18)) styles.add(ParagraphStyle(name='Body', parent=styles['BodyText'], fontName='Helvetica', fontSize=9.1, leading=12.0, spaceAfter=5, textColor=black)) styles.add(ParagraphStyle(name='H1', parent=styles['Heading1'], fontName='Helvetica-Bold', fontSize=16, leading=19, textColor=HexColor('#1F4E79'), spaceBefore=15, spaceAfter=8, keepWithNext=True)) styles.add(ParagraphStyle(name='H2', parent=styles['Heading2'], fontName='Helvetica-Bold', fontSize=12, leading=15, textColor=HexColor('#1F4E79'), spaceBefore=12, spaceAfter=5, keepWithNext=True)) styles.add(ParagraphStyle(name='H3', parent=styles['Heading3'], fontName='Helvetica-Bold', fontSize=10.5, leading=13, textColor=HexColor('#1F4E79'), spaceBefore=8, spaceAfter=4, keepWithNext=True)) styles.add(ParagraphStyle(name='Question', parent=styles['Body'], fontName='Helvetica-Bold', textColor=HexColor('#333333'), leftIndent=0, spaceBefore=2)) styles.add(ParagraphStyle(name='Answer', parent=styles['Body'], leftIndent=0)) styles.add(ParagraphStyle(name='Note', parent=styles['Body'], textColor=HexColor('#A00000'), backColor=HexColor('#FFF2F2'), borderColor=HexColor('#E6B8B7'), borderWidth=.4, borderPadding=5, spaceBefore=4, spaceAfter=6)) def footer(canvas, doc): canvas.saveState() w,h=A4 canvas.setStrokeColor(HexColor('#B4C7E7')); canvas.line(0.70*inch,.53*inch,w-.70*inch,.53*inch) canvas.setFont('Helvetica',8); canvas.setFillColor(HexColor('#555555')) canvas.drawString(.70*inch,.34*inch,'Revision (3) - Ordered Answer Key') page='Page %d' % doc.page canvas.drawRightString(w-.70*inch,.34*inch,page) canvas.restoreState() story=[] for idx,para in enumerate(docx.paragraphs): text=para.text.strip() if not text: continue name=para.style.name if para.style else '' safe=escape(text).replace('\n','<br/>') if name=='Title': story.append(Paragraph(safe,styles['CoverTitle'])) elif name=='Heading 1': story.append(Paragraph(safe,styles['H1'])) elif name=='Heading 2': story.append(Paragraph(safe,styles['H2'])) elif name=='Heading 3': story.append(Paragraph(safe,styles['H3'])) elif text.startswith('Question: '): body=escape(text[len('Question: '):]) story.append(Paragraph('<b>Question:</b> '+body,styles['Question'])) elif text.startswith('Answer: '): body=escape(text[len('Answer: '):]) story.append(Paragraph('<b>Answer:</b> '+body,styles['Answer'])) elif text.startswith('Image-dependent note: '): body=escape(text[len('Image-dependent note: '):]) story.append(Paragraph('<b>Image-dependent note:</b> '+body,styles['Note'])) else: story.append(Paragraph(safe,styles['Body'])) pdf=SimpleDocTemplate(str(out), pagesize=A4, rightMargin=.70*inch,leftMargin=.70*inch,topMargin=.68*inch,bottomMargin=.68*inch,title='Revision (3) Ordered Answer Key',author='Orris') pdf.build(story,onFirstPage=footer,onLaterPages=footer) print(out, out.stat().st_size) PY python "/tmp/workspace/pptx-revision/create_pdf.py" python - <<'PY' from pypdf import PdfReader p='/tmp/workspace/pptx-revision/output/Revision_3_Ordered_Answer_Key.pdf' r=PdfReader(p) text='\n'.join(page.extract_text() or '' for page in r.pages) print('pages=',len(r.pages),'chars=',len(text)) for s in ['Slide 4 - General spotter 1','Slides 86-87 - Clinical case','Primary syphilis']: print(s, s in text) PY