ls /home/daytona/workspace/ 2>/dev/null && mkdir -p /home/daytona/workspace/viva…

~/viva-flashcards/generate.js

const pptxgen = require("pptxgenjs");

const pres = new pptxgen();
pres.layout = "LAYOUT_16x9";
pres.title = "Surgical Viva Flashcards";
pres.author = "Orris Medical";

// ─── COLOR PALETTE ───────────────────────────────────────────────
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  tealLight: "22A394",   // question card bg
  gold:      "F5A623",   // accent / question label
  answerBg:  "E8F5F3",   // light mint for answer panels
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  blue:      "1A5276",
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// ─── HELPERS ─────────────────────────────────────────────────────
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// ─── TABLE SLIDE ─────────────────────────────────────────────────
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// ══════════════════════════════════════════════════════════════════
// BUILD PRESENTATION
// ══════════════════════════════════════════════════════════════════

// TITLE SLIDE
titleSlide(
  "Surgical Viva Flashcards",
  "Instruments · Tubes · Drains · Sutures · Diathermy · Medications"
);

// ─── SECTION 1: SURGICAL INSTRUMENTS ─────────────────────────────
sectionSlide(1, "Surgical Instruments", [
  "Backhaus Towel Clamps",
  "Artery Forceps (Crile / Kelly / Mosquito)",
  "Tissue Forceps (Toothed & Non-toothed)",
  "Needle Holders (Mayo-Hegar)",
  "Suture Needles – Types & Selection",
]);

let card = 1;
const TOTAL = 60;

flashcard(
  "What is a Backhaus towel clamp used for, and can it be repositioned once applied?",
  [
    { type:"bullet", text:"Secures sterile drapes to the patient's skin/table edges" },
    { type:"bullet", text:"Sharp pointed tips pierce through drape and grip skin" },
    { type:"heading", text:"IMPORTANT:" },
    { type:"highlight", text:"Once applied to skin — CANNOT be repositioned" },
    { type:"normal", text:"Removal breaks the sterile field (tips contaminated by skin flora)" },
    { type:"heading", text:"Doyen clamp vs Backhaus:" },
    { type:"bullet", text:"Backhaus = sharp, piercing tips" },
    { type:"bullet", text:"Doyen = blunt, non-piercing" },
  ],
  "Surgical Instruments", card++, TOTAL
);

flashcard(
  "What is the difference between Crile, Kelly, and Mosquito artery forceps?",
  [
    { type:"bullet", text:"Mosquito: Smallest (5-6\"), superficial/fine vessels" },
    { type:"bullet", text:"Kelly: Medium; serrated DISTAL HALF of jaw only" },
    { type:"bullet", text:"Crile: Medium; FULLY serrated jaws — stronger grip" },
    { type:"bullet", text:"Rochester-Pean: Large, heavy — for major vessels" },
    { type:"heading", text:"Key Point:" },
    { type:"green", text:"Kelly = half-serrated  |  Crile = fully serrated" },
    { type:"normal", text:"All have ring handles, box joint, and ratchet lock" },
  ],
  "Surgical Instruments", card++, TOTAL
);

flashcard(
  "How do you correctly apply an artery forceps to a vessel?",
  [
    { type:"bullet", text:"Apply at RIGHT ANGLES to the vessel" },
    { type:"bullet", text:"Only the TIPS should grip (not full jaw length)" },
    { type:"bullet", text:"Apply 1st or 2nd ratchet click only (avoid crush injury)" },
    { type:"bullet", text:"Apply a 2nd forceps distal to the first" },
    { type:"bullet", text:"Divide vessel between the two clamps" },
    { type:"heading", text:"Ratchet Rule:" },
    { type:"highlight", text:"Never fully lock (3rd click) — excessive crush damages vessel wall" },
  ],
  "Surgical Instruments", card++, TOTAL
);

flashcard(
  "When do you use toothed vs non-toothed thumb forceps?",
  [
    { type:"heading", text:"TOOTHED (Rat-tooth / Adson):" },
    { type:"bullet", text:"Skin, fascia, tendon, dense connective tissue, bone" },
    { type:"heading", text:"NON-TOOTHED (Dressing / DeBakey):" },
    { type:"bullet", text:"Bowel, blood vessels, nerves, peritoneum, delicate mucosa" },
    { type:"heading", text:"Why NOT toothed on bowel/vessels?" },
    { type:"highlight", text:"Teeth lacerate/puncture delicate tissue → bleeding, perforation" },
    { type:"normal", text:"DeBakey forceps = fine longitudinal serrations, atraumatic for vascular work" },
  ],
  "Surgical Instruments", card++, TOTAL
);

flashcard(
  "How do you correctly load a suture needle onto a needle holder?",
  [
    { type:"bullet", text:"Grasp needle at junction of PROXIMAL 1/3 and MIDDLE 1/3" },
    { type:"bullet", text:"Needle must be PERPENDICULAR to the jaw" },
    { type:"bullet", text:"Apply only FIRST ratchet click (prevents needle damage)" },
    { type:"bullet", text:"Needle tip should point upward and slightly toward surgeon" },
    { type:"heading", text:"Needle Holder vs Artery Forceps:" },
    { type:"bullet", text:"Needle holder: shorter, wider jaw; cross-serrated; heavier shank" },
    { type:"bullet", text:"Artery forceps: longer jaw; longitudinal serrations; lighter" },
  ],
  "Surgical Instruments", card++, TOTAL
);

flashcard(
  "Classify suture needles by tip type, shape, and attachment method",
  [
    { type:"heading", text:"BY TIP:" },
    { type:"bullet", text:"Cutting (triangular) — skin, fascia; Reverse cutting — skin" },
    { type:"bullet", text:"Round/Tapered — bowel, peritoneum, muscle (atraumatic)" },
    { type:"heading", text:"BY SHAPE:" },
    { type:"bullet", text:"Straight, J-needle, 3/8 circle (most common), 1/2 circle (deep), 5/8 circle (pelvis)" },
    { type:"heading", text:"BY ATTACHMENT:" },
    { type:"bullet", text:"Atraumatic/Swaged: needle fused to suture (no eye) — less trauma" },
    { type:"bullet", text:"Traumatic: suture threaded through needle eye" },
  ],
  "Surgical Instruments", card++, TOTAL
);

// ─── SECTION 2: TUBES & CATHETERS ────────────────────────────────
sectionSlide(2, "Tubes & Catheters", [
  "Foley Catheter (2-way & 3-way)",
  "Ryle's Tube (Nasogastric Tube)",
  "Endotracheal Tube (ETT)",
  "Yankauer Suction Set",
  "Urethral Catheterization Technique",
]);

flashcard(
  "What are the indications for Foley catheterization and how is placement confirmed?",
  [
    { type:"heading", text:"INDICATIONS:" },
    { type:"bullet", text:"Acute urinary retention, monitoring urine output" },
    { type:"bullet", text:"Peri-operative, bladder decompression, neurogenic bladder" },
    { type:"bullet", text:"Continuous bladder irrigation (haematuria/clot retention)" },
    { type:"heading", text:"CONFIRM PLACEMENT BEFORE BALLOON INFLATION:" },
    { type:"green", text:"Drainage of clear urine = correct position" },
    { type:"highlight", text:"NEVER inflate balloon without seeing urine flow first!" },
    { type:"normal", text:"Balloon: 10 mL sterile WATER (not saline — crystallizes in valve)" },
  ],
  "Tubes & Catheters", card++, TOTAL
);

flashcard(
  "What is the difference between 2-way and 3-way Foley catheters? What is the French gauge?",
  [
    { type:"bullet", text:"2-way: Drainage channel + balloon inflation channel (standard)" },
    { type:"bullet", text:"3-way: Additional irrigation channel — used for haematuria, clot retention, post-TURP" },
    { type:"heading", text:"FRENCH GAUGE (Fr):" },
    { type:"normal", text:"1 Fr = 0.33 mm diameter  →  Larger number = Larger catheter" },
    { type:"bullet", text:"Adult male standard: 14-16 Fr" },
    { type:"bullet", text:"3-way (irrigation): 20-24 Fr" },
    { type:"bullet", text:"Pediatric: 6-10 Fr" },
  ],
  "Tubes & Catheters", card++, TOTAL
);

flashcard(
  "What are the complications of urethral catheterization?",
  [
    { type:"heading", text:"IMMEDIATE:" },
    { type:"bullet", text:"Failed insertion (stricture, BPH)" },
    { type:"highlight", text:"Balloon inflation in urethra → urethral rupture" },
    { type:"bullet", text:"False passage creation, trauma, bleeding" },
    { type:"heading", text:"SHORT-TERM:" },
    { type:"bullet", text:"CAUTI (most common complication)" },
    { type:"bullet", text:"Bladder spasm, paraphimosis (if foreskin unreduced)" },
    { type:"heading", text:"LONG-TERM:" },
    { type:"bullet", text:"Urethral stricture, bladder calculi, squamous metaplasia" },
  ],
  "Tubes & Catheters", card++, TOTAL
);

flashcard(
  "How do you confirm correct placement of a Ryle's (nasogastric) tube?",
  [
    { type:"heading", text:"GOLD STANDARD:" },
    { type:"green", text:"CXR — tube visible below diaphragm, tip in stomach" },
    { type:"heading", text:"BEDSIDE METHOD (UK NPSA recommended):" },
    { type:"green", text:"pH of aspirate ≤ 5.5 = gastric position" },
    { type:"heading", text:"UNRELIABLE — Do NOT rely on alone:" },
    { type:"highlight", text:"Whoosh/Air auscultation test — NOT reliable" },
    { type:"normal", text:"NEX measurement: Nose → Earlobe → Xiphisternum ≈ 55-65 cm" },
    { type:"normal", text:"Wide-bore (Ryle's): aspiration/decompression | Fine-bore: feeding" },
  ],
  "Tubes & Catheters", card++, TOTAL
);

flashcard(
  "What is the Murphy eye on an ETT? How do you confirm correct placement?",
  [
    { type:"heading", text:"MURPHY EYE:" },
    { type:"normal", text:"A lateral hole 1-2 cm from the beveled tip. If tip abuts carina/wall, gas exchange continues through Murphy eye — safety backup." },
    { type:"heading", text:"CONFIRM ETT PLACEMENT (ABCDE):" },
    { type:"bullet", text:"A: Auscultation — bilateral breath sounds" },
    { type:"bullet", text:"B: Bilateral chest rise" },
    { type:"green", text:"C: Capnography (ETCO2) — GOLD STANDARD" },
    { type:"bullet", text:"D: Direct visualization through cords at laryngoscopy" },
    { type:"bullet", text:"E: CXR — tip 2-3 cm above carina (T4-5)" },
  ],
  "Tubes & Catheters", card++, TOTAL
);

flashcard(
  "What is a Low Pressure High Volume ETT cuff? What is the correct cuff pressure?",
  [
    { type:"heading", text:"LPHV CUFF:" },
    { type:"normal", text:"Large volume cuff (15-20 mL) seals trachea at low pressure by conforming to irregular tracheal wall — prevents aspiration without causing ischemia" },
    { type:"heading", text:"CORRECT CUFF PRESSURE:" },
    { type:"green", text:"20-30 cmH2O (15-22 mmHg)" },
    { type:"highlight", text:"< 20 cmH2O → aspiration risk" },
    { type:"highlight", text:"> 30 cmH2O → tracheal mucosal ischemia → stenosis" },
    { type:"normal", text:"ETT depth: Male 23 cm | Female 21 cm | Rule: 3 × ID" },
  ],
  "Tubes & Catheters", card++, TOTAL
);

flashcard(
  "What is a Yankauer suction set? How does it differ from a flexible suction catheter?",
  [
    { type:"heading", text:"YANKAUER:" },
    { type:"bullet", text:"Rigid, angled oropharyngeal suction catheter" },
    { type:"bullet", text:"Wide-bore tip + side holes for high-flow suctioning" },
    { type:"bullet", text:"Used for: blood, vomit, secretions from oropharynx" },
    { type:"heading", text:"Yankauer vs Flexible Catheter:" },
    { type:"bullet", text:"Yankauer: Rigid, oropharynx only, high flow" },
    { type:"bullet", text:"Flexible: Soft, goes via ETT into trachea, lower flow" },
    { type:"heading", text:"Suction pressure (adults):" },
    { type:"green", text:"-100 to -150 mmHg (excessive = mucosal trauma)" },
  ],
  "Tubes & Catheters", card++, TOTAL
);

// ─── SECTION 3: DRAINAGE SYSTEMS ─────────────────────────────────
sectionSlide(3, "Drainage Systems", [
  "Water Sealed (Underwater Seal) Drainage",
  "Intercostal Drain — Site & Technique",
  "Swinging vs Bubbling in Chest Drain",
  "Romovac / Closed Wound Suction Drain",
  "Abdominal Drain — Indications & Monitoring",
]);

flashcard(
  "Explain the principle of underwater seal drainage. What are the indications for chest drain?",
  [
    { type:"heading", text:"PRINCIPLE:" },
    { type:"normal", text:"Water (2-3 cm depth) acts as a one-way flutter valve. Air/fluid exits pleural space (pleural pressure > water column) but atmospheric air cannot re-enter (would need to overcome water seal)." },
    { type:"heading", text:"INDICATIONS:" },
    { type:"bullet", text:"Pneumothorax (tension, large, symptomatic, bilateral)" },
    { type:"bullet", text:"Haemothorax, Empyema, Chylothorax" },
    { type:"bullet", text:"Pleural effusion (therapeutic), Post-thoracic surgery" },
  ],
  "Drainage Systems", card++, TOTAL
);

flashcard(
  "Where do you insert a chest drain and which structure must you avoid?",
  [
    { type:"heading", text:"SAFE TRIANGLE (recommended):" },
    { type:"green", text:"5th ICS, Mid-Axillary Line" },
    { type:"normal", text:"Borders: Lat. pectoralis major (ant.), Lat. latissimus dorsi (post.), Horizontal line from nipple (inf.), Apex of axilla (sup.)" },
    { type:"heading", text:"CRITICAL — Insert ABOVE upper border of rib:" },
    { type:"highlight", text:"Neurovascular bundle (VAN) runs in SUBCOSTAL groove" },
    { type:"normal", text:"V = Vein  |  A = Artery  |  N = Nerve (from above downward)" },
    { type:"bullet", text:"Pneumothorax tube directed to apex; Haemothorax: posterior/lateral" },
  ],
  "Drainage Systems", card++, TOTAL
);

flashcard(
  "What do 'swinging' and 'bubbling' mean in a chest drain? When should you NEVER clamp a drain?",
  [
    { type:"heading", text:"SWINGING (Tidaling):" },
    { type:"green", text:"Water rises on inspiration, falls on expiration = tube PATENT, in pleural space" },
    { type:"normal", text:"No swinging = tube blocked/kinked OR lung fully expanded" },
    { type:"heading", text:"BUBBLING:" },
    { type:"bullet", text:"Intermittent bubbling = air leaving pleural space (expected)" },
    { type:"highlight", text:"Continuous bubbling = ongoing air leak (bronchopleural fistula?)" },
    { type:"heading", text:"NEVER clamp when:" },
    { type:"highlight", text:"Active bubbling is present → risk of tension pneumothorax" },
  ],
  "Drainage Systems", card++, TOTAL
);

flashcard(
  "How does a Romovac drain work? What are the types of surgical drains?",
  [
    { type:"heading", text:"ROMOVAC:" },
    { type:"normal", text:"Bulb compressed flat then capped → creates ~70-100 mmHg negative pressure → draws fluid actively from wound as bulb re-expands" },
    { type:"heading", text:"DRAIN TYPES:" },
    { type:"bullet", text:"Passive open: Corrugated rubber (gravity + capillary)" },
    { type:"bullet", text:"Passive closed: Robinson drain (gravity → bag)" },
    { type:"bullet", text:"Active closed: Romovac, Redivac, Jackson-Pratt (suction)" },
    { type:"bullet", text:"Active open: Sump drain (suction + air vent)" },
    { type:"green", text:"Remove when: output < 30-50 mL/24 h" },
  ],
  "Drainage Systems", card++, TOTAL
);

// ─── SECTION 4: DIATHERMY ────────────────────────────────────────
sectionSlide(4, "Electrosurgical Diathermy", [
  "Principle of Surgical Diathermy",
  "Cut vs Coagulation Mode",
  "Monopolar vs Bipolar Diathermy",
  "Grounding Pad Placement",
  "Complications of Diathermy",
]);

flashcard(
  "What is the principle of surgical diathermy? Why doesn't it cause cardiac arrhythmia?",
  [
    { type:"heading", text:"PRINCIPLE:" },
    { type:"normal", text:"High-frequency AC current (300 kHz – 3 MHz) passed through tissue. Resistance of tissue converts electrical energy to HEAT." },
    { type:"bullet", text:"Cut: >100°C rapid heating → cell water vaporizes (explosive cut)" },
    { type:"bullet", text:"Coag: Slower heating → protein denaturation → hemostasis" },
    { type:"heading", text:"WHY NO CARDIAC FIBRILLATION?" },
    { type:"green", text:"Frequency > 100 kHz does not depolarize cardiac cells" },
    { type:"highlight", text:"Domestic AC (50 Hz) DOES cause ventricular fibrillation" },
  ],
  "Electrosurgical Diathermy", card++, TOTAL
);

flashcard(
  "What is the difference between CUT and COAGULATION modes in diathermy?",
  [
    { type:"heading", text:"CUT MODE:" },
    { type:"bullet", text:"Continuous undamped sine wave" },
    { type:"bullet", text:"Rapid, even tissue heating → explosive vaporization" },
    { type:"green", text:"Clean cut with minimal lateral thermal damage" },
    { type:"heading", text:"COAGULATION (FULGURATION) MODE:" },
    { type:"bullet", text:"Interrupted/damped waveform, high peak voltage" },
    { type:"bullet", text:"Slower heating → protein denaturation, charring" },
    { type:"highlight", text:"More lateral tissue damage (useful for hemostasis)" },
    { type:"heading", text:"BLEND MODE:" },
    { type:"bullet", text:"Mix of cut + coag — cutting with hemostasis" },
  ],
  "Electrosurgical Diathermy", card++, TOTAL
);

flashcard(
  "Monopolar vs Bipolar diathermy — differences, uses, and safety",
  [
    { type:"heading", text:"MONOPOLAR:" },
    { type:"bullet", text:"Current: Active tip → through patient body → return pad" },
    { type:"bullet", text:"Grounding pad required on thigh/back" },
    { type:"bullet", text:"Uses: Cutting, general coagulation, laparoscopy" },
    { type:"highlight", text:"Risk with pacemakers | Avoid near penis (circumferential burn)" },
    { type:"heading", text:"BIPOLAR:" },
    { type:"bullet", text:"Current only between two forceps tips — localized" },
    { type:"bullet", text:"No return pad needed" },
    { type:"green", text:"Safe near nerves, metal implants, pacemakers" },
    { type:"bullet", text:"Uses: Neurosurgery, fallopian tube ligation, fine tissue" },
  ],
  "Electrosurgical Diathermy", card++, TOTAL
);

flashcard(
  "What are the complications of diathermy?",
  [
    { type:"bullet", text:"Burns at return pad site (poor contact, skin fold, metal)" },
    { type:"bullet", text:"Alternate site burns (via ECG electrodes, IV lines)" },
    { type:"highlight", text:"Pacemaker/ICD malfunction — use bipolar or reprogram device" },
    { type:"highlight", text:"Fire/explosion — alcohol prep, bowel gas (methane, H2) in closed spaces" },
    { type:"bullet", text:"Insulation failure → electrocution" },
    { type:"bullet", text:"Capacitative coupling in laparoscopy → unintended bowel injury" },
    { type:"bullet", text:"Surgical smoke (diathermy plume): carcinogens, HPV DNA" },
    { type:"bullet", text:"Tracheal fire if diathermy used near ignited airway gases" },
  ],
  "Electrosurgical Diathermy", card++, TOTAL
);

// ─── SECTION 5: SUTURES ──────────────────────────────────────────
sectionSlide(5, "Sutures", [
  "Classification — Absorbable vs Non-absorbable",
  "Monofilament vs Braided / Natural vs Synthetic",
  "Tensile Strength & Absorption Timeline",
  "Suture Selection by Tissue Type",
  "Ideal Suture Properties",
]);

flashcard(
  "Classify sutures with examples of each type",
  [
    { type:"heading", text:"BY ABSORPTION:" },
    { type:"bullet", text:"Absorbable: Catgut (plain/chromic), Vicryl, PDS, Monocryl" },
    { type:"bullet", text:"Non-absorbable: Silk, Nylon, Prolene, Polyester (Mersilene)" },
    { type:"heading", text:"BY ORIGIN:" },
    { type:"bullet", text:"Natural: Catgut, Silk  |  Synthetic: Vicryl, PDS, Nylon, Prolene" },
    { type:"heading", text:"BY STRUCTURE:" },
    { type:"bullet", text:"Monofilament: Nylon, Prolene, PDS — less drag, less bacteria" },
    { type:"bullet", text:"Braided: Silk, Vicryl — easier handling, better knot security" },
    { type:"highlight", text:"Braided = higher capillarity → bacteria travel along suture" },
  ],
  "Sutures", card++, TOTAL
);

flashcard(
  "What is the absorption time and strength retention of key sutures?",
  [
    { type:"heading", text:"ABSORBABLE:" },
    { type:"bullet", text:"Plain Catgut: 7-10 days absorption, 50% strength lost by 7-10 days" },
    { type:"bullet", text:"Vicryl (PGA 910): 60-90 days absorption, 50% lost at 21 days" },
    { type:"green", text:"PDS: 180-210 days absorption, 50% strength retained at 42 days" },
    { type:"bullet", text:"Monocryl: 91-119 days, very fast early strength loss" },
    { type:"heading", text:"NON-ABSORBABLE:" },
    { type:"bullet", text:"Silk: Never absorbed (degrades slowly over years)" },
    { type:"bullet", text:"Nylon, Prolene: Never absorbed, retain strength permanently" },
    { type:"green", text:"PDS = best choice for fascia closure (long-lasting strength)" },
  ],
  "Sutures", card++, TOTAL
);

flashcard(
  "Which suture is used for which tissue?",
  [
    { type:"bullet", text:"Skin: Nylon 3-0/4-0, Prolene, or Monocryl (subcuticular)" },
    { type:"bullet", text:"Subcutaneous: Vicryl 2-0 or 3-0" },
    { type:"bullet", text:"Fascia: PDS (long-lasting) or Prolene" },
    { type:"bullet", text:"Bowel: Vicryl 2-0 or 3-0 (absorbable)" },
    { type:"green", text:"Vascular anastomosis: Prolene 4-0 to 7-0 (non-thrombogenic, monofilament)" },
    { type:"bullet", text:"Tendon: Ethibond (polyester) or PDS" },
    { type:"bullet", text:"Nerve repair: Nylon 8-0 to 10-0" },
    { type:"bullet", text:"Bile duct / Urological: Vicryl or PDS" },
  ],
  "Sutures", card++, TOTAL
);

flashcard(
  "Why is Prolene used for vascular anastomosis? What are properties of an ideal suture?",
  [
    { type:"heading", text:"PROLENE (Polypropylene) for vascular surgery:" },
    { type:"bullet", text:"Monofilament — minimal tissue reaction" },
    { type:"green", text:"Non-thrombogenic — does not promote clot formation" },
    { type:"bullet", text:"Retains tensile strength permanently" },
    { type:"bullet", text:"High elongation memory — accommodates vessel pulsations" },
    { type:"bullet", text:"Minimal capillarity — no bacterial wicking" },
    { type:"heading", text:"IDEAL SUTURE PROPERTIES:" },
    { type:"bullet", text:"Adequate tensile strength, predictable absorption" },
    { type:"bullet", text:"Minimal reaction, non-carcinogenic, non-allergenic" },
    { type:"bullet", text:"Easy to handle, secure knots, inexpensive" },
  ],
  "Sutures", card++, TOTAL
);

// ─── SECTION 6: IV & BLOOD TRANSFUSION ───────────────────────────
sectionSlide(6, "IV Sets & Blood Transfusion", [
  "Blood Transfusion Set — Filter & Duration",
  "Types of Transfusion Reactions",
  "Management of Transfusion Reaction",
  "IV Infusion Sets — Macro vs Microdrip",
  "IV Drip Rate Calculation",
]);

flashcard(
  "Why does a blood transfusion set have a filter? What is the maximum duration per unit?",
  [
    { type:"heading", text:"FILTER (170-200 micron mesh):" },
    { type:"normal", text:"Removes microaggregates (fibrin strands, platelet clumps, denatured proteins) that form in stored blood → prevents microemboli and transfusion-related lung injury (TRALI)" },
    { type:"heading", text:"MAXIMUM DURATION:" },
    { type:"green", text:"4 hours from removal from blood bank fridge" },
    { type:"highlight", text:"Beyond 4 h: bacterial proliferation risk → transfusion-transmitted bacteraemia" },
    { type:"heading", text:"Drip rate: 15 drops/mL (macrodrip)" },
  ],
  "IV & Blood Transfusion", card++, TOTAL
);

flashcard(
  "Classify blood transfusion reactions with mechanism and onset",
  [
    { type:"bullet", text:"Acute Hemolytic: ABO incompatibility (wrong blood) — MOST DANGEROUS, immediate" },
    { type:"bullet", text:"Febrile Non-Hemolytic: Cytokines in stored blood — MOST COMMON" },
    { type:"bullet", text:"Allergic/Anaphylaxis: Anti-IgA antibodies (IgA-deficient patients)" },
    { type:"bullet", text:"TRALI: Anti-HLA antibodies → lung injury, within 6 h" },
    { type:"bullet", text:"TACO: Circulatory overload (elderly, cardiac patients)" },
    { type:"bullet", text:"Delayed Hemolytic: 3-10 days (alloantibodies from prior sensitization)" },
    { type:"highlight", text:"Septic: Bacterial contamination — Yersinia, Pseudomonas" },
  ],
  "IV & Blood Transfusion", card++, TOTAL
);

flashcard(
  "What should you do if a transfusion reaction is suspected?",
  [
    { type:"heading", text:"IMMEDIATE STEPS:" },
    { type:"highlight", text:"1. STOP the transfusion immediately" },
    { type:"bullet", text:"2. Keep IV access — run normal saline" },
    { type:"bullet", text:"3. Check: patient ID vs blood bag label (rule out wrong blood)" },
    { type:"bullet", text:"4. Notify blood bank and senior" },
    { type:"heading", text:"SAMPLES TO SEND:" },
    { type:"bullet", text:"Blood bag + giving set, patient blood (EDTA + clot tube), urine" },
    { type:"heading", text:"TREATMENT:" },
    { type:"bullet", text:"Antihistamine (urticaria), Steroids, Adrenaline (anaphylaxis), Furosemide (TACO)" },
  ],
  "IV & Blood Transfusion", card++, TOTAL
);

flashcard(
  "How do you calculate IV drip rate? What is the difference between macrodrip and microdrip sets?",
  [
    { type:"heading", text:"FORMULA:" },
    { type:"green", text:"Drops/min = (Volume mL × Drop factor) ÷ Time (min)" },
    { type:"normal", text:"Example: 1000 mL NS over 8 hrs, 20 drops/mL set:" },
    { type:"normal", text:"= (1000 × 20) ÷ 480 = 41.7 ≈ 42 drops/min" },
    { type:"heading", text:"MACRODRIP vs MICRODRIP:" },
    { type:"bullet", text:"Macrodrip: 10, 15, or 20 drops/mL — adult fluid replacement" },
    { type:"bullet", text:"Microdrip: 60 drops/mL — pediatric/precise dosing" },
    { type:"normal", text:"Blood transfusion set: 15 drops/mL with 170-200 µm filter" },
  ],
  "IV & Blood Transfusion", card++, TOTAL
);

// ─── SECTION 7: NEEDLES & BLOOD COLLECTION ───────────────────────
sectionSlide(7, "Needles, Vacutainers & Blades", [
  "Needle Gauge Color Coding & Uses",
  "Vacutainer Tube Colors & Tests",
  "Order of Draw",
  "Surgical Blade Numbers & Uses",
  "Safe Blade Mounting & Removal",
]);

flashcard(
  "What do needle gauge colors mean and which gauge is used for what?",
  [
    { type:"bullet", text:"Orange 25G: SC injection (insulin, heparin)" },
    { type:"bullet", text:"Blue 23G: SC injection, intradermal tests" },
    { type:"bullet", text:"Green 21G: IM injection, blood drawing (standard)" },
    { type:"bullet", text:"Pink 18G: IV cannulation, thick drugs (IM), blood drawing" },
    { type:"bullet", text:"Grey 16G: Rapid IV fluid infusion" },
    { type:"heading", text:"GAUGE RULE (paradoxical):" },
    { type:"highlight", text:"LARGER gauge number = SMALLER diameter (BWG system)" },
    { type:"normal", text:"25G is finer than 18G; based on Birmingham Wire Gauge" },
  ],
  "Needles & Vacutainers", card++, TOTAL
);

flashcard(
  "What is the order of draw for vacutainer blood collection and why?",
  [
    { type:"heading", text:"ORDER OF DRAW:" },
    { type:"bullet", text:"1. Blood culture bottles (aerobic then anaerobic)" },
    { type:"green", text:"2. Blue (Sodium Citrate) — must be FIRST clear tube" },
    { type:"bullet", text:"3. Red/Gold (Serum — plain or SST)" },
    { type:"bullet", text:"4. Green (Lithium Heparin)" },
    { type:"bullet", text:"5. Purple/Lavender (EDTA)" },
    { type:"bullet", text:"6. Grey (Fluoride Oxalate)" },
    { type:"heading", text:"WHY THIS ORDER?" },
    { type:"highlight", text:"Prevents additive carryover between tubes that interferes with tests" },
  ],
  "Needles & Vacutainers", card++, TOTAL
);

flashcard(
  "Which surgical blade is used for which incision? How do you safely mount a blade?",
  [
    { type:"bullet", text:"No. 10: Large curved belly — general skin/subcutaneous incision" },
    { type:"bullet", text:"No. 11: Pointed straight — stab incisions, abscess drainage, arteriotomy" },
    { type:"bullet", text:"No. 15: Small curve — delicate face/hand surgery, lesion excision" },
    { type:"bullet", text:"No. 20/22: Large — major incisions, amputation" },
    { type:"bullet", text:"No. 12: Sickle — ENT/tonsillectomy, inaccessible areas" },
    { type:"heading", text:"SAFE MOUNTING/REMOVAL:" },
    { type:"green", text:"Always use a NEEDLE HOLDER — never fingers (sharps injury!)" },
    { type:"bullet", text:"Handle 3 = blades 10,11,12,15 | Handle 4 = blades 20-24" },
  ],
  "Needles & Vacutainers", card++, TOTAL
);

// ─── SECTION 8: MEDICATIONS ──────────────────────────────────────
sectionSlide(8, "Medications & Fluids", [
  "Paracetamol IV — Mechanism, Dose, Antidote",
  "Glycerin — Uses & Mechanism",
  "Neomycin Ointment — Class, Coverage, Why Topical Only",
  "Local Anaesthetics — Mechanism & Max Doses",
  "Ampoule vs Vial Differences",
]);

flashcard(
  "What is the mechanism of IV Paracetamol? What is the antidote for overdose?",
  [
    { type:"heading", text:"MECHANISM OF ACTION:" },
    { type:"bullet", text:"Central COX inhibition (COX-1/COX-2) — prostaglandin synthesis" },
    { type:"bullet", text:"Activates descending serotonergic pain inhibitory pathway" },
    { type:"bullet", text:"AM404 metabolite → endocannabinoid system activation" },
    { type:"highlight", text:"Minimal peripheral anti-inflammatory action (unlike NSAIDs)" },
    { type:"heading", text:"DOSE: 1g IV over 15 min every 6 hours (max 4g/day)" },
    { type:"heading", text:"ANTIDOTE FOR OVERDOSE:" },
    { type:"green", text:"N-Acetylcysteine (NAC) — replenishes glutathione, prevents NAPQI toxicity → centrilobular hepatic necrosis" },
  ],
  "Medications & Fluids", card++, TOTAL
);

flashcard(
  "What is the mechanism of local anaesthetics? What are the maximum doses for Lignocaine?",
  [
    { type:"heading", text:"MECHANISM:" },
    { type:"normal", text:"Block voltage-gated Na+ channels in neuronal membrane → prevent depolarization → block nerve impulse conduction. Effect is REVERSIBLE." },
    { type:"heading", text:"MAXIMUM DOSES — LIGNOCAINE (Lidocaine):" },
    { type:"green", text:"Plain: 3-4 mg/kg" },
    { type:"green", text:"With Adrenaline (1:200,000): 7 mg/kg" },
    { type:"heading", text:"BUPIVACAINE (longer acting 4-8 h):" },
    { type:"bullet", text:"Max dose: 2 mg/kg (with or without adrenaline)" },
    { type:"highlight", text:"Why adrenaline increases dose? Vasoconstriction reduces absorption, prolongs effect" },
  ],
  "Medications & Fluids", card++, TOTAL
);

flashcard(
  "Why is Neomycin only used topically? What class is it and what does it cover?",
  [
    { type:"heading", text:"CLASS: Aminoglycoside antibiotic" },
    { type:"normal", text:"Mechanism: Binds 30S ribosomal subunit → misreading of mRNA → aberrant non-functional proteins → bactericidal" },
    { type:"heading", text:"WHY TOPICAL ONLY?" },
    { type:"highlight", text:"Systemic aminoglycosides → nephrotoxicity (proximal tubule necrosis) + irreversible ototoxicity (cochlear & vestibular)" },
    { type:"heading", text:"COVERAGE:" },
    { type:"bullet", text:"Gram-negative: E. coli, Klebsiella, Proteus, Pseudomonas (variable)" },
    { type:"bullet", text:"Staphylococcus aureus (gram-positive exception)" },
    { type:"highlight", text:"NOT effective against Streptococci or anaerobes" },
  ],
  "Medications & Fluids", card++, TOTAL
);

flashcard(
  "What is the difference between an ampoule and a vial? What is glycerin used for?",
  [
    { type:"heading", text:"AMPOULE vs VIAL:" },
    { type:"bullet", text:"Ampoule: Sealed glass, broken at neck to open, single-use only" },
    { type:"bullet", text:"Vial: Rubber stopper + crimp cap, can be multi-dose (with preservative)" },
    { type:"bullet", text:"Vials can contain lyophilized (freeze-dried) powder or solution" },
    { type:"heading", text:"GLYCERIN USES:" },
    { type:"bullet", text:"Lubricant for catheters, endoscopes, speculums" },
    { type:"bullet", text:"Glycerin suppository/enema: osmotic laxative (draws water into rectum)" },
    { type:"bullet", text:"Skin moisturizer/humectant in topical preparations" },
    { type:"green", text:"IV Glycerol: cerebral oedema management (osmotherapy)" },
  ],
  "Medications & Fluids", card++, TOTAL
);

// ─── TABLE SLIDES ─────────────────────────────────────────────────
tableSlide(
  "Vacutainer Tube Color Reference",
  ["Color", "Additive", "Sample Type", "Tests"],
  [
    ["Red / Plain", "None / Clot activator", "Serum", "LFT, RFT, Cardiac enzymes, Serology"],
    ["Gold (SST)", "Gel + Clot activator", "Serum separator", "Biochemistry panel"],
    ["Purple (EDTA)", "EDTA (Ca chelator)", "Whole blood", "CBC, Blood group, HbA1c"],
    ["Light Blue", "Sodium Citrate 3.2%", "Plasma", "PT/INR, APTT, Fibrinogen, D-dimer"],
    ["Green", "Lithium Heparin", "Plasma", "ABG, Ammonia, Chromosomes"],
    ["Grey", "KOx + NaF (fluoride)", "Whole blood", "Blood glucose (fluoride inhibits glycolysis)"],
    ["Black", "Sodium Citrate 3.8%", "Whole blood", "ESR"],
  ],
  "Quick Reference"
);

tableSlide(
  "Suture Selection by Tissue",
  ["Tissue", "Preferred Suture", "Rationale"],
  [
    ["Skin", "Nylon 3-0/4-0, Prolene, Monocryl (subcuticular)", "Non-absorbable — skin heals with minimal support needed long-term"],
    ["Subcutaneous", "Vicryl 2-0, 3-0", "Absorbable — eliminates dead space, absorbed cleanly"],
    ["Fascia", "PDS (polydioxanone)", "Long tensile strength retention (42 days at 50%)"],
    ["Bowel", "Vicryl 2-0, 3-0", "Absorbable, minimal reaction, strength adequate for healing"],
    ["Vascular anastomosis", "Prolene 4-0 to 7-0", "Non-thrombogenic, monofilament, permanent strength"],
    ["Tendon", "Ethibond (polyester) / PDS", "High tensile strength, low stretch"],
    ["Nerve", "Nylon 8-0 to 10-0", "Monofilament, precise, minimal reaction"],
  ],
  "Quick Reference"
);

tableSlide(
  "Monopolar vs Bipolar Diathermy — At a Glance",
  ["Feature", "Monopolar", "Bipolar"],
  [
    ["Current path", "Active tip → through patient body → return pad", "Only between the two tips of bipolar forceps"],
    ["Return pad (grounding plate)", "REQUIRED on thigh/back", "NOT required"],
    ["Pacemaker safety", "RISK — avoid or reprogram pacemaker", "SAFE"],
    ["Near metallic implants", "Caution required", "Safe"],
    ["Use near penis/nerves", "AVOID (circumferential burn risk)", "PREFERRED"],
    ["Uses", "Cutting, general coagulation, laparoscopy", "Neurosurgery, fallopian tube, fine tissue"],
    ["Power requirement", "Higher output needed", "Lower (localised tissue)"],
  ],
  "Quick Reference"
);

tableSlide(
  "Surgical Instrument Quick Reference",
  ["Instrument", "Key Feature", "Primary Use"],
  [
    ["Backhaus Towel Clamp", "Sharp piercing tips; once applied cannot reposition", "Securing sterile drapes to patient"],
    ["Mosquito Forceps", "Smallest artery forceps (5-6 inch)", "Fine/superficial vessel hemostasis"],
    ["Kelly Forceps", "Half-serrated jaw (distal half only)", "Medium vessel hemostasis"],
    ["Crile Forceps", "Fully serrated jaw entire length", "Medium-large vessel hemostasis"],
    ["Rochester-Pean", "Large, heavy, fully serrated", "Major vessel hemostasis"],
    ["Adson Forceps", "Fine toothed (1x2 teeth), slim handle", "Delicate skin closure (face/hand)"],
    ["DeBakey Forceps", "Fine longitudinal serrations, non-toothed", "Atraumatic vessel/anastomosis handling"],
    ["Mayo-Hegar Needle Holder", "Short wide cross-serrated jaw, ring handle", "Driving suture needle"],
  ],
  "Quick Reference"
);

// ─── FINAL REVISION SUMMARY SLIDE ────────────────────────────────
const finalSlide = pres.addSlide();
finalSlide.addShape(pres.shapes.RECTANGLE, { x:0, y:0, w:10, h:5.625, fill:{ color: C.navy }, line:{ color: C.navy } });
finalSlide.addShape(pres.shapes.RECTANGLE, { x:0, y:0, w:10, h:0.12, fill:{ color: C.gold }, line:{ color: C.gold } });
finalSlide.addShape(pres.shapes.RECTANGLE, { x:0, y:5.2, w:10, h:0.425, fill:{ color: C.teal }, line:{ color: C.teal } });

finalSlide.addText("RAPID REVISION", {
  x:0.5, y:0.25, w:9, h:0.5,
  fontSize:14, bold:true, color:C.gold, fontFace:"Calibri",
  align:"center", charSpacing:6, margin:0
});
finalSlide.addText("Key Facts to Remember", {
  x:0.5, y:0.75, w:9, h:0.55,
  fontSize:26, bold:true, color:C.white, fontFace:"Calibri",
  align:"center", margin:0
});

const facts = [
  ["Backhaus clamp", "Once applied to skin — CANNOT be repositioned (sterile field broken)"],
  ["Kelly vs Crile", "Kelly = HALF serrated  |  Crile = FULLY serrated"],
  ["Foley balloon", "10 mL sterile WATER (never saline — crystallizes)"],
  ["NG tube confirm", "pH ≤5.5 = gastric | CXR = gold standard | Whoosh test = UNRELIABLE"],
  ["ETT cuff pressure", "20-30 cmH2O — <20 = aspiration risk, >30 = tracheal stenosis"],
  ["Chest drain site", "5th ICS mid-axillary (Safe Triangle) — insert ABOVE rib (VAN bundle below)"],
  ["Diathermy modes", "Cut = continuous wave | Coag = interrupted damped wave"],
  ["Vacutainer order", "Blood cultures → Blue → Red → Green → Purple → Grey"],
  ["PDS suture", "Best for fascia — 180-210 day absorption, 50% strength at 42 days"],
  ["Lignocaine dose", "Plain: 3-4 mg/kg | With adrenaline: 7 mg/kg"],
];

const col1Facts = facts.slice(0, 5);
const col2Facts = facts.slice(5);

col1Facts.forEach((f, i) => {
  const yPos = 1.42 + i * 0.77;
  finalSlide.addShape(pres.shapes.RECTANGLE, { x:0.25, y:yPos, w:4.55, h:0.65, fill:{ color:"122035" }, line:{ color:"1A7A6E", size:0.8 } });
  finalSlide.addText([
    { text: f[0] + ": ", options:{ bold:true, color:C.gold, fontSize:11, fontFace:"Calibri" } },
    { text: f[1], options:{ color:C.white, fontSize:11, fontFace:"Calibri" } },
  ], { x:0.35, y:yPos+0.05, w:4.3, h:0.55, valign:"middle", margin:0, wrap:true });
});

col2Facts.forEach((f, i) => {
  const yPos = 1.42 + i * 0.77;
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    { text: f[0] + ": ", options:{ bold:true, color:C.gold, fontSize:11, fontFace:"Calibri" } },
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  ], { x:5.3, y:yPos+0.05, w:4.3, h:0.55, valign:"middle", margin:0, wrap:true });
});

finalSlide.addText("Good Luck with Your Viva!", {
  x:0.5, y:5.2, w:9, h:0.425,
  fontSize:14, bold:true, color:C.white, fontFace:"Calibri",
  align:"center", valign:"middle", margin:0
});

// ─── WRITE FILE ───────────────────────────────────────────────────
pres.writeFile({ fileName: "/home/daytona/workspace/viva-flashcards/Surgical_Viva_Flashcards.pptx" })
  .then(() => console.log("SUCCESS: Surgical_Viva_Flashcards.pptx written"))
  .catch(e => console.error("ERROR:", e));

cd /home/daytona/workspace/viva-flashcards && node generate.js 2>&1

ls -lh /home/daytona/workspace/viva-flashcards/Surgical_Viva_Flashcards.pptx