Golwalla Medicine auscultation respiratory qualitative quantitative sounds

mkdir -p /home/daytona/workspace/resp-exam-pptx

~/resp-exam-pptx/build.js

const pptxgen = require("pptxgenjs");
const pres = new pptxgen();
pres.layout = "LAYOUT_16x9";
pres.title = "Physical Examination Skills in Respiratory Assessment";
pres.author = "Medical Education";

// ─── COLOUR PALETTE ───────────────────────────────────────────────────────────
const C = {
  navy:    "0B2545",   // dominant dark (60%)
  teal:    "14517C",   // supporting mid
  sky:     "1B7AC4",   // accent blue
  mint:    "00B4A6",   // accent teal/green
  white:   "FFFFFF",
  offWht:  "F0F4F8",
  pale:    "D6EAF8",
  gold:    "F4C542",
  lightGr: "E8F5F3",
  text:    "1A1A2E",
  subtext: "4A6580",
};

// ─── HELPERS ──────────────────────────────────────────────────────────────────
function addBg(slide, color) {
  slide.addShape(pres.shapes.RECTANGLE, { x: 0, y: 0, w: 10, h: 5.625, fill: { color } });
}

function addAccentBar(slide, color = C.mint) {
  slide.addShape(pres.shapes.RECTANGLE, { x: 0, y: 5.25, w: 10, h: 0.375, fill: { color } });
}

function sectionTitle(slide, title, sub) {
  addBg(slide, C.navy);
  // Decorative circle left
  slide.addShape(pres.shapes.OVAL, { x: -0.8, y: -0.8, w: 3, h: 3, fill: { color: C.teal, transparency: 60 }, line: { type: "none" } });
  // Decorative circle right
  slide.addShape(pres.shapes.OVAL, { x: 8.5, y: 3.5, w: 2.5, h: 2.5, fill: { color: C.mint, transparency: 70 }, line: { type: "none" } });
  // Accent horizontal line
  slide.addShape(pres.shapes.RECTANGLE, { x: 0.6, y: 2.85, w: 1.2, h: 0.07, fill: { color: C.gold }, line: { type: "none" } });
  slide.addText(title, { x: 0.6, y: 1.7, w: 8.8, h: 0.9, fontSize: 36, bold: true, color: C.white, fontFace: "Calibri" });
  if (sub) slide.addText(sub, { x: 0.6, y: 2.95, w: 8.8, h: 0.5, fontSize: 17, color: C.pale, fontFace: "Calibri", italic: true });
}

function contentHeader(slide, title, color = C.navy) {
  slide.addShape(pres.shapes.RECTANGLE, { x: 0, y: 0, w: 10, h: 0.85, fill: { color } });
  slide.addShape(pres.shapes.RECTANGLE, { x: 0, y: 0.85, w: 10, h: 0.05, fill: { color: C.mint } });
  slide.addText(title, { x: 0.35, y: 0.1, w: 9.3, h: 0.65, fontSize: 22, bold: true, color: C.white, fontFace: "Calibri", valign: "middle", margin: 0 });
}

function bulletBox(slide, items, x, y, w, h, opts = {}) {
  const textArr = items.map((item, i) => ({
    text: item,
    options: { bullet: { type: "bullet", indent: 15 }, breakLine: i < items.length - 1, fontSize: opts.fontSize || 13.5, color: opts.color || C.text, fontFace: "Calibri" }
  }));
  slide.addText(textArr, { x, y, w, h, valign: "top", margin: [4, 6, 4, 6] });
}

function card(slide, x, y, w, h, fillColor, lineColor) {
  slide.addShape(pres.shapes.ROUNDED_RECTANGLE, {
    x, y, w, h,
    fill: { color: fillColor || C.offWht },
    line: { color: lineColor || C.sky, width: 1.5 },
    rectRadius: 0.1,
    shadow: { type: "outer", color: "000000", blur: 5, offset: 2, angle: 135, opacity: 0.1 }
  });
}

function footerLine(slide, label = "") {
  slide.addShape(pres.shapes.RECTANGLE, { x: 0, y: 5.38, w: 10, h: 0.245, fill: { color: C.navy } });
  if (label) {
    slide.addText(label, { x: 0.3, y: 5.38, w: 9.5, h: 0.245, fontSize: 9, color: C.pale, fontFace: "Calibri", valign: "middle", margin: 0 });
  }
}

// ══════════════════════════════════════════════════════════════════════════════
// SLIDE 1 – TITLE
// ══════════════════════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  addBg(s, C.navy);

  // Large background geometric shapes
  s.addShape(pres.shapes.OVAL, { x: 6.5, y: -1.5, w: 5.5, h: 5.5, fill: { color: C.teal, transparency: 65 }, line: { type: "none" } });
  s.addShape(pres.shapes.OVAL, { x: -1.2, y: 3.5, w: 4, h: 4, fill: { color: C.sky, transparency: 75 }, line: { type: "none" } });
  s.addShape(pres.shapes.RECTANGLE, { x: 0, y: 5.0, w: 10, h: 0.625, fill: { color: C.mint } });

  // Title text
  s.addText("Physical Examination Skills", {
    x: 0.6, y: 1.1, w: 8.8, h: 0.9,
    fontSize: 34, bold: true, color: C.white, fontFace: "Calibri", charSpacing: 1
  });
  s.addText("in Respiratory Assessment", {
    x: 0.6, y: 1.95, w: 8.8, h: 0.75,
    fontSize: 28, color: C.gold, fontFace: "Calibri", bold: false, charSpacing: 1
  });
  // Divider
  s.addShape(pres.shapes.RECTANGLE, { x: 0.6, y: 2.82, w: 3.5, h: 0.06, fill: { color: C.mint }, line: { type: "none" } });

  s.addText("A Comprehensive Guide for Medical Students", {
    x: 0.6, y: 3.0, w: 8.8, h: 0.45,
    fontSize: 14, color: C.pale, fontFace: "Calibri", italic: true
  });
  s.addText("Inspection • Palpation • Percussion • Auscultation", {
    x: 0.6, y: 3.55, w: 8.8, h: 0.4,
    fontSize: 12, color: C.mint, fontFace: "Calibri"
  });
  s.addText("Physical Examination Skills – Respiratory Assessment", {
    x: 0.3, y: 5.02, w: 9.5, h: 0.35, fontSize: 9, color: C.navy, fontFace: "Calibri", valign: "middle", margin: 0
  });
}

// ══════════════════════════════════════════════════════════════════════════════
// SLIDE 2 – OVERVIEW / TABLE OF CONTENTS
// ══════════════════════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  addBg(s, C.offWht);
  contentHeader(s, "Overview of Respiratory Physical Examination");
  footerLine(s, "Physical Examination Skills – Respiratory Assessment");

  const steps = [
    ["01", "General Inspection", "Breathing pattern, cyanosis, clubbing, shape of chest"],
    ["02", "Inspection of the Chest", "Static & dynamic deformities, respiratory movements"],
    ["03", "Palpation", "Tracheal position, chest expansion, tactile vocal fremitus"],
    ["04", "Percussion", "Resonant, dull, stony dull, hyper-resonant, tympanitic"],
    ["05", "Auscultation – Breath Sounds", "Vesicular, bronchial, bronchovesicular types"],
    ["06", "Auscultation – Added Sounds", "Crepitations, rhonchi, pleural rub, stridor"],
    ["07", "Vocal Resonance", "Bronchophony, whispering pectoriloquy, aegophony"],
    ["08", "Common Conditions at a Glance", "Consolidated findings for key diagnoses"],
  ];

  const rowH = 0.52;
  const startY = 1.0;
  steps.forEach(([num, title, desc], i) => {
    const y = startY + i * rowH;
    const bg = i % 2 === 0 ? C.white : C.pale;
    s.addShape(pres.shapes.RECTANGLE, { x: 0.35, y, w: 9.3, h: rowH - 0.04, fill: { color: bg }, line: { type: "none" } });
    // number badge
    s.addShape(pres.shapes.OVAL, { x: 0.38, y: y + 0.07, w: 0.38, h: 0.38, fill: { color: C.sky }, line: { type: "none" } });
    s.addText(num, { x: 0.38, y: y + 0.07, w: 0.38, h: 0.38, fontSize: 8.5, bold: true, color: C.white, align: "center", valign: "middle", fontFace: "Calibri", margin: 0 });
    s.addText(title, { x: 0.84, y: y + 0.04, w: 2.8, h: 0.22, fontSize: 12, bold: true, color: C.navy, fontFace: "Calibri", margin: 0 });
    s.addText(desc, { x: 0.84, y: y + 0.26, w: 8.5, h: 0.2, fontSize: 10, color: C.subtext, fontFace: "Calibri", margin: 0 });
  });
}

// ══════════════════════════════════════════════════════════════════════════════
// SLIDE 3 – GENERAL INSPECTION
// ══════════════════════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  addBg(s, C.offWht);
  contentHeader(s, "Step 1 — General Inspection");
  footerLine(s, "Physical Examination Skills – Respiratory Assessment");

  // Left column
  card(s, 0.35, 1.0, 4.3, 2.0, C.white, C.sky);
  s.addShape(pres.shapes.RECTANGLE, { x: 0.35, y: 1.0, w: 4.3, h: 0.38, fill: { color: C.sky }, line: { type: "none" } });
  s.addText("Breathing Pattern", { x: 0.45, y: 1.0, w: 4.1, h: 0.38, fontSize: 13, bold: true, color: C.white, fontFace: "Calibri", valign: "middle", margin: 0 });
  bulletBox(s, [
    "Rate: Normal 12–20/min",
    "Tachypnoea (>20) / Bradypnoea (<12)",
    "Cheyne-Stokes: crescendo-decrescendo cycles + apnoea",
    "Kussmaul: deep, rapid (metabolic acidosis)",
    "Biot's: irregular with apnoea (raised ICP)",
  ], 0.45, 1.42, 4.1, 1.5, { fontSize: 12 });

  // Right column
  card(s, 4.85, 1.0, 4.8, 2.0, C.white, C.mint);
  s.addShape(pres.shapes.RECTANGLE, { x: 4.85, y: 1.0, w: 4.8, h: 0.38, fill: { color: C.mint }, line: { type: "none" } });
  s.addText("Peripheral Signs", { x: 4.95, y: 1.0, w: 4.6, h: 0.38, fontSize: 13, bold: true, color: C.white, fontFace: "Calibri", valign: "middle", margin: 0 });
  bulletBox(s, [
    "Cyanosis — Central (tongue) vs Peripheral",
    "Clubbing — respiratory causes: fibrosis, Ca, empyema",
    "Flap (asterixis) — CO₂ retention (type 2 RF)",
    "Nicotine staining / tar deposits on fingers",
    "JVP — raised in cor pulmonale / SVC obstruction",
  ], 4.95, 1.42, 4.6, 1.5, { fontSize: 12 });

  // Bottom row
  card(s, 0.35, 3.15, 9.3, 1.85, C.white, C.teal);
  s.addShape(pres.shapes.RECTANGLE, { x: 0.35, y: 3.15, w: 9.3, h: 0.38, fill: { color: C.teal }, line: { type: "none" } });
  s.addText("Other General Inspection Points", { x: 0.45, y: 3.15, w: 9.1, h: 0.38, fontSize: 13, bold: true, color: C.white, fontFace: "Calibri", valign: "middle", margin: 0 });
  const row3 = [
    "Facial appearance (Horner's syndrome — ptosis, miosis, anhydrosis)",
    "Voice: hoarseness (recurrent laryngeal nerve palsy, malignancy)",
    "Sputum pot: character of sputum (mucoid, purulent, blood-stained, rusty)",
    "Inhalers / O₂ at bedside — clue to underlying condition",
  ];
  const rowTextArr3 = row3.map((t, i) => ({
    text: t,
    options: { bullet: { type: "bullet", indent: 15 }, breakLine: i < row3.length - 1, fontSize: 12, color: C.text, fontFace: "Calibri" }
  }));
  s.addText(rowTextArr3, { x: 0.5, y: 3.58, w: 9.1, h: 1.3, valign: "top", margin: [2, 6, 2, 6] });
}

// ══════════════════════════════════════════════════════════════════════════════
// SLIDE 4 – CHEST INSPECTION
// ══════════════════════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  addBg(s, C.offWht);
  contentHeader(s, "Step 2 — Inspection of the Chest");
  footerLine(s, "Physical Examination Skills – Respiratory Assessment");

  // Static deformities
  card(s, 0.35, 1.0, 4.3, 2.25, C.white, C.sky);
  s.addShape(pres.shapes.RECTANGLE, { x: 0.35, y: 1.0, w: 4.3, h: 0.38, fill: { color: C.sky }, line: { type: "none" } });
  s.addText("Static (Structural) Deformities", { x: 0.45, y: 1.0, w: 4.1, h: 0.38, fontSize: 13, bold: true, color: C.white, fontFace: "Calibri", valign: "middle", margin: 0 });
  bulletBox(s, [
    "Barrel chest — COPD/emphysema (↑ AP diameter, Hoover's sign)",
    "Pectus excavatum — funnel chest (depressed sternum)",
    "Pectus carinatum — pigeon chest (forward sternum)",
    "Harrison's sulcus — childhood asthma/rickets",
    "Kyphosis/Scoliosis — restrictive lung disease",
    "Gibbus deformity — TB of spine",
  ], 0.45, 1.42, 4.1, 1.75, { fontSize: 11.5 });

  // Dynamic movements
  card(s, 4.85, 1.0, 4.8, 2.25, C.white, C.mint);
  s.addShape(pres.shapes.RECTANGLE, { x: 4.85, y: 1.0, w: 4.8, h: 0.38, fill: { color: C.mint }, line: { type: "none" } });
  s.addText("Dynamic (Movement) Observations", { x: 4.95, y: 1.0, w: 4.6, h: 0.38, fontSize: 13, bold: true, color: C.white, fontFace: "Calibri", valign: "middle", margin: 0 });
  bulletBox(s, [
    "Symmetry of chest movement",
    "Unilateral lagging — pneumonia, effusion, collapse, fibrosis",
    "Use of accessory muscles (SCM, scalene, trapezius) — respiratory distress",
    "Intercostal recession — airway obstruction / children",
    "Subcostal recession — severe distress",
    "Paradoxical movement — flail chest (multiple rib fractures)",
  ], 4.95, 1.42, 4.6, 1.75, { fontSize: 11.5 });

  // Bottom note
  card(s, 0.35, 3.4, 9.3, 1.65, C.lightGr, C.teal);
  s.addText("KEY CLINICAL TIP", { x: 0.55, y: 3.5, w: 2.5, h: 0.32, fontSize: 11, bold: true, color: C.teal, fontFace: "Calibri", margin: 0 });
  s.addText(
    "Always inspect the chest from the end of the bed FIRST before moving closer. " +
    "Observe anterior chest, lateral aspects, and posterior chest systematically. " +
    "Note any skin changes — scars (previous surgery, drain sites), dilated veins (SVC obstruction), skin lesions (neurofibromatosis), " +
    "and chest wall asymmetry at rest and during breathing.",
    { x: 0.55, y: 3.85, w: 9.0, h: 1.1, fontSize: 12, color: C.text, fontFace: "Calibri" }
  );
}

// ══════════════════════════════════════════════════════════════════════════════
// SLIDE 5 – PALPATION
// ══════════════════════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  addBg(s, C.offWht);
  contentHeader(s, "Step 3 — Palpation");
  footerLine(s, "Physical Examination Skills – Respiratory Assessment");

  // 3 cards in a row
  const items3 = [
    {
      title: "Tracheal Position",
      color: C.sky,
      bullets: [
        "Index finger in suprasternal notch",
        "Central = normal",
        "Displaced TOWARDS lesion: collapse, fibrosis",
        "Displaced AWAY from lesion: tension pneumothorax, large effusion",
        "Check cricosternal distance (≥3 finger-widths normal)",
      ]
    },
    {
      title: "Chest Expansion",
      color: C.teal,
      bullets: [
        "Hands flat on posterior chest, thumbs raised horizontally",
        "Ask patient to take deep breath",
        "Thumbs move ≥5 cm bilaterally = normal",
        "Reduced bilaterally: COPD, fibrosis, bilateral consolidation",
        "Reduced unilaterally: effusion, collapse, pneumothorax, consolidation",
        "Repeat anteriorly (apices) and at base",
      ]
    },
    {
      title: "Vocal / Tactile Fremitus",
      color: C.mint,
      bullets: [
        "Ulnar edge of hand on chest wall",
        "Ask patient to say 'ninety-nine' / '99'",
        "Normal: vibration transmitted to hand",
        "Increased: consolidation (solid conducts better)",
        "Decreased: effusion, pneumothorax, thick chest wall, pleural thickening",
        "Absent: large effusion, complete pneumothorax",
      ]
    },
  ];

  items3.forEach(({ title, color, bullets }, i) => {
    const x = 0.28 + i * 3.2;
    card(s, x, 1.0, 3.1, 4.08, C.white, color);
    s.addShape(pres.shapes.RECTANGLE, { x, y: 1.0, w: 3.1, h: 0.38, fill: { color }, line: { type: "none" } });
    s.addText(title, { x: x + 0.1, y: 1.0, w: 2.9, h: 0.38, fontSize: 12.5, bold: true, color: C.white, fontFace: "Calibri", valign: "middle", margin: 0 });
    bulletBox(s, bullets, x + 0.15, 1.42, 2.85, 3.5, { fontSize: 11 });
  });
}

// ══════════════════════════════════════════════════════════════════════════════
// SLIDE 6 – PERCUSSION
// ══════════════════════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  addBg(s, C.offWht);
  contentHeader(s, "Step 4 — Percussion");
  footerLine(s, "Physical Examination Skills – Respiratory Assessment");

  // Technique box
  card(s, 0.35, 1.0, 3.5, 1.35, C.white, C.sky);
  s.addShape(pres.shapes.RECTANGLE, { x: 0.35, y: 1.0, w: 3.5, h: 0.34, fill: { color: C.sky }, line: { type: "none" } });
  s.addText("Technique", { x: 0.45, y: 1.0, w: 3.3, h: 0.34, fontSize: 13, bold: true, color: C.white, fontFace: "Calibri", valign: "middle", margin: 0 });
  bulletBox(s, [
    "Place middle finger (pleximeter) firmly on chest",
    "Strike middle phalanx with middle finger of other hand",
    "Strike with wrist movement — 2 quick strokes",
    "Compare side-to-side at each level",
  ], 0.45, 1.38, 3.3, 0.9, { fontSize: 11.5 });

  // Table of percussion notes
  const notes = [
    ["Note", "Quality", "Conditions", "Colour"],
    ["Resonant", "Hollow, drum-like", "Normal lung", C.sky],
    ["Dull", "Thud-like, short", "Consolidation, lung collapse, pleural thickening", C.teal],
    ["Stony Dull", "Extremely flat/dull", "Pleural effusion (most dull)", "2C5F7E"],
    ["Hyper-resonant", "Loud, booming, prolonged", "Pneumothorax, emphysema, large bulla", "1A8A6B"],
    ["Tympanitic", "Drum-like, very high pitched", "Large pneumothorax (with open communication), Traube's space", C.gold],
  ];

  const tblW = 9.3;
  const tblX = 0.35;
  const startY = 2.45;
  const rowH = 0.525;

  notes.forEach(([note, quality, condition, color], i) => {
    const y = startY + i * rowH;
    const bg = i === 0 ? C.navy : i % 2 === 0 ? C.pale : C.white;
    s.addShape(pres.shapes.RECTANGLE, { x: tblX, y, w: tblW, h: rowH, fill: { color: bg }, line: { type: "none" } });
    if (i > 0) {
      s.addShape(pres.shapes.RECTANGLE, { x: tblX + 0.08, y: y + 0.13, w: 0.2, h: 0.25, fill: { color }, line: { type: "none" } });
    }
    const colXs = [0.45, 2.15, 3.85];
    const colWs = [1.55, 1.6, 5.5];
    const colValues = i === 0 ? [note, quality, condition] : [note, quality, condition];
    colValues.forEach((val, j) => {
      s.addText(val, {
        x: tblX + colXs[j], y: y + 0.04,
        w: colWs[j], h: rowH - 0.08,
        fontSize: i === 0 ? 11.5 : 11,
        bold: i === 0,
        color: i === 0 ? C.white : C.text,
        fontFace: "Calibri",
        valign: "middle", margin: 0,
        wrap: true,
      });
    });
  });

  // Special percussion signs note
  s.addText("Special Signs: Traube's space (L lower chest) — normally resonant; dull = splenomegaly / large left effusion.  Bird-dull area = liver dullness starts at 5th ICS (R).", {
    x: 0.35, y: 5.1, w: 9.3, h: 0.3, fontSize: 9.5, color: C.subtext, fontFace: "Calibri", italic: true
  });
}

// ══════════════════════════════════════════════════════════════════════════════
// SLIDE 7 – AUSCULTATION INTRO + TECHNIQUE
// ══════════════════════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  addBg(s, C.offWht);
  contentHeader(s, "Step 5 — Auscultation: Technique & Normal Sounds");
  footerLine(s, "Physical Examination Skills – Respiratory Assessment");

  // Technique
  card(s, 0.35, 1.0, 4.55, 2.1, C.white, C.sky);
  s.addShape(pres.shapes.RECTANGLE, { x: 0.35, y: 1.0, w: 4.55, h: 0.38, fill: { color: C.sky }, line: { type: "none" } });
  s.addText("Technique", { x: 0.45, y: 1.0, w: 4.35, h: 0.38, fontSize: 13, bold: true, color: C.white, fontFace: "Calibri", valign: "middle", margin: 0 });
  bulletBox(s, [
    "Use diaphragm of stethoscope (directly on skin)",
    "Patient breathes deeply through open mouth",
    "Auscultate apex to base, comparing side-to-side",
    "Listen both anteriorly AND posteriorly",
    "Include axillary regions (RML, Lingula)",
    "Listen for at least one full breath at each site",
    "Note: quality, intensity, timing (insp/exp), any added sounds",
  ], 0.45, 1.42, 4.35, 1.6, { fontSize: 11.5 });

  // Normal sounds table
  const tableData = [
    ["Sound", "Site", "Character", "I:E Ratio"],
    ["Vesicular\n(Normal)", "Peripheral lung fields", "Soft, low-pitched rustling; insp > exp; no gap", "3:1"],
    ["Bronchovesicular", "1st/2nd ICS anteriorly;\nBetween scapulae", "Intermediate; medium pitch; insp ≈ exp; short gap", "1:1"],
    ["Bronchial\n(Tubular)", "Over trachea &\nmanubrium sterni", "Loud, high-pitched, hollow; exp > insp; gap between insp & exp", "1:2"],
    ["Tracheal", "Suprasternal notch\nover trachea", "Loud, harsh; heard both phases equally; broadest frequency range", "1:1"],
  ];

  const colXs = [4.98, 6.0, 7.3, 9.45];
  const colWs = [0.95, 1.25, 2.1, 0.6];
  const tblY = 1.0;
  const rowH = 0.68;

  tableData.forEach(([c0, c1, c2, c3], i) => {
    const y = tblY + i * rowH;
    const bg = i === 0 ? C.navy : i % 2 === 0 ? C.pale : C.white;
    s.addShape(pres.shapes.RECTANGLE, { x: 4.9, y, w: 4.8, h: rowH, fill: { color: bg }, line: { type: "none" } });
    [[c0, 4.98, 0.95], [c1, 5.97, 1.28], [c2, 7.28, 2.12], [c3, 9.44, 0.5]].forEach(([txt, x, w]) => {
      s.addText(txt, {
        x, y: y + 0.03, w, h: rowH - 0.06,
        fontSize: i === 0 ? 10.5 : 10, bold: i === 0,
        color: i === 0 ? C.white : C.text,
        fontFace: "Calibri", valign: "middle", wrap: true, margin: [2, 3, 2, 3]
      });
    });
  });

  // Differential note
  card(s, 0.35, 3.18, 9.3, 1.5, C.lightGr, C.teal);
  s.addText("Abnormal Bronchial Breathing (in Peripheral Sites)", {
    x: 0.5, y: 3.22, w: 9.0, h: 0.3, fontSize: 12, bold: true, color: C.teal, fontFace: "Calibri", margin: 0
  });
  const abnormalB = [
    "Tubular — consolidation (lobar pneumonia)",
    "Cavernous — lung abscess / large TB cavity (louder, lower, more hollow)",
    "Amphoric — large smooth-walled cavity / bronchopleural fistula (metallic, 'blowing over bottle')",
  ];
  bulletBox(s, abnormalB, 0.5, 3.56, 9.0, 1.05, { fontSize: 11.5, color: C.text });
}

// ══════════════════════════════════════════════════════════════════════════════
// SLIDE 8 – QUANTITATIVE CHANGES IN BREATH SOUNDS
// ══════════════════════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  addBg(s, C.offWht);
  contentHeader(s, "Auscultation — Quantitative Changes in Breath Sounds");
  footerLine(s, "Physical Examination Skills – Respiratory Assessment");

  const qCards = [
    {
      title: "Diminished / Reduced",
      color: C.teal,
      items: [
        "Pleural effusion — fluid absorbs sound",
        "Pneumothorax — air in pleural space",
        "Emphysema — air trapping, reduced airflow",
        "Obesity / thick chest wall",
        "Bronchial obstruction (tumour, mucus plug)",
        "Pleural thickening"
      ]
    },
    {
      title: "Absent",
      color: "B03A2E",
      items: [
        "Large pleural effusion",
        "Complete pneumothorax",
        "Complete bronchial obstruction",
        "Post-pneumonectomy"
      ]
    },
    {
      title: "Increased / Accentuated",
      color: "1A8A6B",
      items: [
        "Over compressed lung above effusion",
        "Compensatory areas adjacent to collapse",
        "Note: usually heard as bronchial breathing, not just 'louder vesicular'"
      ]
    }
  ];

  qCards.forEach(({ title, color, items }, i) => {
    const x = 0.28 + i * 3.2;
    card(s, x, 1.0, 3.1, 2.6, C.white, color);
    s.addShape(pres.shapes.RECTANGLE, { x, y: 1.0, w: 3.1, h: 0.38, fill: { color }, line: { type: "none" } });
    s.addText(title, { x: x + 0.1, y: 1.0, w: 2.9, h: 0.38, fontSize: 12.5, bold: true, color: C.white, fontFace: "Calibri", valign: "middle", margin: 0 });
    bulletBox(s, items, x + 0.12, 1.42, 2.85, 2.1, { fontSize: 11 });
  });

  // Reminder box
  card(s, 0.35, 3.75, 9.3, 1.52, C.white, C.gold);
  s.addShape(pres.shapes.RECTANGLE, { x: 0.35, y: 3.75, w: 9.3, h: 0.34, fill: { color: "B8860B" }, line: { type: "none" } });
  s.addText("Memory Aid — Causes of Reduced / Absent Breath Sounds", {
    x: 0.45, y: 3.75, w: 9.1, h: 0.34, fontSize: 12, bold: true, color: C.white, fontFace: "Calibri", valign: "middle", margin: 0
  });
  s.addText(
    "POET:  P — Pneumothorax / Pleural effusion / Pleural thickening\n" +
    "       O — Obesity / thick chest wall\n" +
    "       E — Emphysema (COPD)\n" +
    "       T — Tumour blocking bronchus (also Tracheobronchial obstruction)",
    { x: 0.5, y: 4.12, w: 9.0, h: 1.0, fontSize: 11.5, color: C.text, fontFace: "Calibri", valign: "top" }
  );
}

// ══════════════════════════════════════════════════════════════════════════════
// SLIDE 9 – ADDED SOUNDS: CREPITATIONS
// ══════════════════════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  addBg(s, C.offWht);
  contentHeader(s, "Auscultation — Added Sounds: Crepitations (Crackles / Rales)");
  footerLine(s, "Physical Examination Skills – Respiratory Assessment");

  s.addText("Non-continuous, interrupted, explosive sounds. Mechanism: sudden opening of collapsed small airways / alveoli OR movement of secretions.", {
    x: 0.35, y: 0.95, w: 9.3, h: 0.38, fontSize: 11.5, color: C.subtext, fontFace: "Calibri", italic: true
  });

  const creps = [
    {
      type: "Fine Crepitations",
      char: "Soft, high-pitched, short\n'Rubbing hair near ear' / Velcro-like",
      timing: "Late inspiratory",
      clears: "Do NOT clear with cough",
      causes: "Pulmonary fibrosis (IPF), early pulmonary oedema, atelectasis",
      color: C.sky
    },
    {
      type: "Medium Crepitations",
      char: "Medium pitch, medium duration",
      timing: "Mid-inspiratory",
      clears: "May partially clear with cough",
      causes: "Bronchiectasis, resolving pneumonia, pulmonary oedema",
      color: C.teal
    },
    {
      type: "Coarse Crepitations",
      char: "Loud, low-pitched, bubbling\n'Fluid in airway' quality",
      timing: "Early inspiratory or expiratory",
      clears: "Clear or change with coughing",
      causes: "Severe pulmonary oedema, bronchiectasis, bronchitis with secretions, lung abscess",
      color: "2C5F7E"
    }
  ];

  creps.forEach(({ type, char, timing, clears, causes, color }, i) => {
    const y = 1.42 + i * 1.27;
    s.addShape(pres.shapes.RECTANGLE, { x: 0.35, y, w: 9.3, h: 1.18, fill: { color: i % 2 === 0 ? C.pale : C.white }, line: { type: "none" } });
    s.addShape(pres.shapes.RECTANGLE, { x: 0.35, y, w: 0.18, h: 1.18, fill: { color }, line: { type: "none" } });
    s.addText(type, { x: 0.62, y: y + 0.06, w: 2.3, h: 0.3, fontSize: 12.5, bold: true, color, fontFace: "Calibri", margin: 0 });
    s.addText(char, { x: 0.62, y: y + 0.36, w: 2.3, h: 0.7, fontSize: 10.5, color: C.text, fontFace: "Calibri", wrap: true });
    s.addText("Timing: " + timing, { x: 3.1, y: y + 0.1, w: 2.1, h: 0.28, fontSize: 11, color: C.subtext, fontFace: "Calibri", margin: 0 });
    s.addText(clears, { x: 3.1, y: y + 0.42, w: 2.1, h: 0.56, fontSize: 11, color: "B03A2E", fontFace: "Calibri", bold: true, wrap: true });
    s.addText("Causes: " + causes, { x: 5.35, y: y + 0.1, w: 4.15, h: 1.0, fontSize: 11, color: C.text, fontFace: "Calibri", wrap: true });
  });

  // Tip
  s.addText("TIP: Fine late-inspiratory crackles that don't clear with coughing = alveolar/interstitial pathology.  Coarse early crackles that clear = secretions in large airways.", {
    x: 0.35, y: 5.08, w: 9.3, h: 0.28, fontSize: 9.5, color: C.teal, fontFace: "Calibri", italic: true
  });
}

// ══════════════════════════════════════════════════════════════════════════════
// SLIDE 10 – RHONCHI, STRIDOR, PLEURAL RUB
// ══════════════════════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  addBg(s, C.offWht);
  contentHeader(s, "Auscultation — Added Sounds: Rhonchi, Stridor & Pleural Rub");
  footerLine(s, "Physical Examination Skills – Respiratory Assessment");

  // Rhonchi
  card(s, 0.35, 1.0, 9.3, 1.65, C.white, C.sky);
  s.addShape(pres.shapes.RECTANGLE, { x: 0.35, y: 1.0, w: 9.3, h: 0.36, fill: { color: C.sky }, line: { type: "none" } });
  s.addText("Rhonchi (Wheezes) — Continuous Musical Sounds (>250 ms)", {
    x: 0.45, y: 1.0, w: 9.1, h: 0.36, fontSize: 13, bold: true, color: C.white, fontFace: "Calibri", valign: "middle", margin: 0
  });
  // Two sub-boxes
  s.addText([
    { text: "Sibilant Rhonchi (High-Pitched Wheeze)\n", options: { bold: true, fontSize: 12, color: C.sky, breakLine: false } },
    { text: "  •  High-pitched, hissing/squeaking, 'squeaky door'\n", options: { fontSize: 11, color: C.text, breakLine: false } },
    { text: "  •  Mainly expiratory; prolonged expiration\n", options: { fontSize: 11, color: C.text, breakLine: false } },
    { text: "  •  Polyphonic (multiple pitches) = diffuse airways disease (asthma)\n", options: { fontSize: 11, color: C.text, breakLine: false } },
    { text: "  •  Monophonic (single pitch) = localised obstruction (tumour, FB)", options: { fontSize: 11, color: C.text } },
  ], { x: 0.45, y: 1.4, w: 4.2, h: 1.2, valign: "top", wrap: true });

  s.addShape(pres.shapes.RECTANGLE, { x: 4.85, y: 1.04, w: 0.02, h: 1.55, fill: { color: C.pale }, line: { type: "none" } });
  s.addText([
    { text: "Sonorous Rhonchi (Low-Pitched Wheeze / Rhonchus)\n", options: { bold: true, fontSize: 12, color: C.teal, breakLine: false } },
    { text: "  •  Low-pitched, snoring/moaning quality\n", options: { fontSize: 11, color: C.text, breakLine: false } },
    { text: "  •  Inspiratory or expiratory\n", options: { fontSize: 11, color: C.text, breakLine: false } },
    { text: "  •  Caused by secretions in large airways\n", options: { fontSize: 11, color: C.text, breakLine: false } },
    { text: "  •  Causes: COPD, chronic bronchitis, mucus plugging", options: { fontSize: 11, color: C.text } },
  ], { x: 4.95, y: 1.4, w: 4.55, h: 1.2, valign: "top", wrap: true });

  // Stridor
  card(s, 0.35, 2.78, 4.55, 1.55, C.white, "B03A2E");
  s.addShape(pres.shapes.RECTANGLE, { x: 0.35, y: 2.78, w: 4.55, h: 0.36, fill: { color: "B03A2E" }, line: { type: "none" } });
  s.addText("Stridor — URGENT !", {
    x: 0.45, y: 2.78, w: 4.35, h: 0.36, fontSize: 13, bold: true, color: C.white, fontFace: "Calibri", valign: "middle", margin: 0
  });
  bulletBox(s, [
    "Loud, harsh, high-pitched, mainly INSPIRATORY",
    "Upper airway obstruction (extrathoracic)",
    "Best heard over trachea / neck",
    "Causes: epiglottitis, croup, foreign body, laryngeal oedema, tracheal tumour, anaphylaxis",
    "URGENT — assess airway immediately",
  ], 0.45, 3.18, 4.35, 1.1, { fontSize: 11 });

  // Pleural rub
  card(s, 5.05, 2.78, 4.6, 1.55, C.white, C.teal);
  s.addShape(pres.shapes.RECTANGLE, { x: 5.05, y: 2.78, w: 4.6, h: 0.36, fill: { color: C.teal }, line: { type: "none" } });
  s.addText("Pleural Friction Rub", {
    x: 5.15, y: 2.78, w: 4.4, h: 0.36, fontSize: 13, bold: true, color: C.white, fontFace: "Calibri", valign: "middle", margin: 0
  });
  bulletBox(s, [
    "Creaking, leathery, 'walking on snow' / rubbing leather",
    "Both inspiratory AND expiratory",
    "Disappears when breath is held (vs pericardial rub)",
    "Best heard: lower lateral chest",
    "Causes: pleurisy (infection, PE, malignancy, TB)",
  ], 5.15, 3.18, 4.4, 1.1, { fontSize: 11 });

  // Causes of wheeze mnemonic
  s.addText("Causes of Wheeze: ABCDE — Asthma, Bronchitis (COPD), Cardiac (LVF / cardiac asthma), D = Foreign body, E = Endobronchial tumour / extrinsic compression", {
    x: 0.35, y: 4.42, w: 9.3, h: 0.42, fontSize: 10.5, color: C.subtext, fontFace: "Calibri", italic: true
  });

  footerLine(s, "Physical Examination Skills – Respiratory Assessment");
}

// ══════════════════════════════════════════════════════════════════════════════
// SLIDE 11 – VOCAL RESONANCE
// ══════════════════════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  addBg(s, C.offWht);
  contentHeader(s, "Step 6 — Vocal Resonance (Voice Sounds)");
  footerLine(s, "Physical Examination Skills – Respiratory Assessment");

  s.addText("The patient phonates while you auscultate — changes in transmitted voice sounds give diagnostic clues.", {
    x: 0.35, y: 0.95, w: 9.3, h: 0.35, fontSize: 11.5, color: C.subtext, fontFace: "Calibri", italic: true
  });

  const vrData = [
    ["Sign", "Instruction to Patient", "Normal Finding", "Abnormal Finding", "Interpretation"],
    ["Vocal Resonance", "Say 'ninety-nine' repeatedly", "Muffled, indistinct words", "Clear/loud (increased) words", "Increased: consolidation\nDecreased: effusion, pneumothorax"],
    ["Bronchophony", "Say 'ninety-nine' loudly", "Words muffled, indistinct", "Loud, clear 'ninety-nine'", "Consolidation (solid lung transmits voice well)"],
    ["Whispering\nPectoriloquy", "Whisper 'one-two-three'", "Barely audible / inaudible", "Clearly heard whispered words", "Consolidation (MOST sensitive sign of consolidation)"],
    ["Aegophony\n(Egophony)", "Say 'E' (eee)", "Hear 'E' — same as said", "Hear 'A' (nasal, bleating quality)", "Compressed lung just above pleural effusion"],
  ];

  const tblX = 0.35;
  const tblY = 1.38;
  const rowH = 0.74;
  const colWs = [1.5, 2.0, 1.6, 1.85, 2.0];
  const colStarts = [0.38, 1.92, 3.96, 5.6, 7.5];

  vrData.forEach((row, i) => {
    const y = tblY + i * rowH;
    const bg = i === 0 ? C.navy : i % 2 === 0 ? C.pale : C.white;
    s.addShape(pres.shapes.RECTANGLE, { x: tblX, y, w: 9.3, h: rowH, fill: { color: bg }, line: { type: "none" } });
    row.forEach((cell, j) => {
      s.addText(cell, {
        x: colStarts[j], y: y + 0.04, w: colWs[j], h: rowH - 0.08,
        fontSize: i === 0 ? 10.5 : 10.5, bold: i === 0,
        color: i === 0 ? C.white : (j === 4 ? C.teal : C.text),
        fontFace: "Calibri", valign: "middle", wrap: true, margin: [2, 3, 2, 3]
      });
    });
  });
}

// ══════════════════════════════════════════════════════════════════════════════
// SLIDE 12 – COMMON CONDITIONS SUMMARY TABLE
// ══════════════════════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  addBg(s, C.offWht);
  contentHeader(s, "Clinical Correlations — Examination Findings at a Glance");
  footerLine(s, "Physical Examination Skills – Respiratory Assessment");

  const data = [
    ["Condition", "Trachea", "Expansion", "Percussion", "Breath Sounds", "Added Sounds", "Vocal Res."],
    ["Consolidation", "Central", "Reduced (ipsi)", "Dull", "Bronchial (tubular)", "Fine/med crepitations", "↑ Bronchophony, WP"],
    ["Pleural Effusion", "Central / away (large)", "Reduced (ipsi)", "Stony dull", "Absent/reduced; bronchial above", "Pleural rub (early)", "Absent; aegophony at top"],
    ["Pneumothorax", "Away (tension)", "Reduced (ipsi)", "Hyper-resonant", "Absent/reduced", "None", "Absent/reduced"],
    ["Emphysema\n(COPD)", "Central", "Reduced (bilat)", "Hyper-resonant", "Vesicular, reduced; prolong. exp.", "Rhonchi ± crepitations", "Reduced"],
    ["Asthma (acute)", "Central", "Reduced (bilat)", "Hyper-resonant", "Vesicular + prolong. exp.", "Polyphonic sibilant rhonchi", "Normal / reduced"],
    ["Fibrosis (IPF)", "Central", "Reduced (bilat)", "Dull", "Vesicular, reduced", "Bilateral fine late insp. creps (Velcro)", "Normal"],
    ["Collapse\n(Atelectasis)", "Towards (ipsi)", "Reduced (ipsi)", "Dull", "Reduced/absent (obstructive)", "None typically", "Reduced"],
    ["Lung Abscess", "Central", "Reduced (ipsi)", "Dull (or tympanitic over cavity)", "Cavernous / amphoric", "Coarse crepitations", "Increased over cavity"],
  ];

  const tblX = 0.25;
  const startY = 0.95;
  const rH = 0.515;
  const colXs =  [0.28, 1.48, 2.36, 3.22, 4.12, 5.62, 7.25];
  const colWs =  [1.15,  0.84, 0.82, 0.86, 1.46, 1.58, 2.45];

  data.forEach((row, i) => {
    const y = startY + i * rH;
    const bg = i === 0 ? C.navy : i % 2 === 0 ? C.pale : C.white;
    s.addShape(pres.shapes.RECTANGLE, { x: tblX, y, w: 9.5, h: rH, fill: { color: bg }, line: { type: "none" } });
    row.forEach((cell, j) => {
      s.addText(cell, {
        x: colXs[j], y: y + 0.02, w: colWs[j], h: rH - 0.04,
        fontSize: i === 0 ? 9.5 : 9,
        bold: i === 0 || j === 0,
        color: i === 0 ? C.white : (j === 0 ? C.navy : C.text),
        fontFace: "Calibri", valign: "middle", wrap: true, margin: [1, 2, 1, 2]
      });
    });
  });
}

// ══════════════════════════════════════════════════════════════════════════════
// SLIDE 13 – SPECIAL TESTS & SIGNS
// ══════════════════════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  addBg(s, C.offWht);
  contentHeader(s, "Special Tests & Eponymous Signs in Respiratory Examination");
  footerLine(s, "Physical Examination Skills – Respiratory Assessment");

  const signs = [
    { name: "Hoover's Sign", color: C.sky, desc: "On deep inspiration, the lower ribs move inwards instead of outwards. Seen in severe COPD (barrel chest, flat diaphragm)." },
    { name: "Pemberton's Sign", color: C.teal, desc: "Arms raised above head for 1 min → facial plethora, cyanosis, JVD = superior mediastinal obstruction (retrosternal goitre, lymphoma)." },
    { name: "Hamman's Sign", color: C.mint, desc: "Mediastinal crunch — crackling sound synchronous with heartbeat (not respiration). Seen in pneumomediastinum." },
    { name: "Bouchut's Sign", color: "8E44AD", desc: "Tubular breathing heard over a consolidated area in a child; helps diagnose early pneumonia when percussion is equivocal." },
    { name: "Skodaic Resonance", color: "B03A2E", desc: "Hyper-resonance heard above a pleural effusion — due to compensatory over-inflation of the lobe above the fluid." },
    { name: "Coin Test (Bell Sound)", color: "B8860B", desc: "One coin held on chest wall, another struck against it; auscultate anteriorly — metallic note = pneumothorax. Now obsolete (replaced by US)." },
  ];

  const cols = 2;
  const rows = 3;
  const cardW = 4.5;
  const cardH = 1.3;
  const startX = 0.35;
  const startY = 1.0;
  const gapX = 0.32;
  const gapY = 0.18;

  signs.forEach(({ name, color, desc }, i) => {
    const col = i % cols;
    const row = Math.floor(i / cols);
    const x = startX + col * (cardW + gapX);
    const y = startY + row * (cardH + gapY);
    card(s, x, y, cardW, cardH, C.white, color);
    s.addShape(pres.shapes.RECTANGLE, { x, y, w: 0.22, h: cardH, fill: { color }, line: { type: "none" } });
    s.addText(name, { x: x + 0.3, y: y + 0.1, w: cardW - 0.4, h: 0.3, fontSize: 12.5, bold: true, color, fontFace: "Calibri", margin: 0 });
    s.addText(desc, { x: x + 0.3, y: y + 0.42, w: cardW - 0.4, h: cardH - 0.48, fontSize: 10.5, color: C.text, fontFace: "Calibri", wrap: true });
  });
}

// ══════════════════════════════════════════════════════════════════════════════
// SLIDE 14 – SYSTEMATIC APPROACH / CHECKLIST
// ══════════════════════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  addBg(s, C.offWht);
  contentHeader(s, "Systematic Approach — Clinical Examination Checklist");
  footerLine(s, "Physical Examination Skills – Respiratory Assessment");

  // Two column checklist
  const left = [
    ["INTRODUCTION & POSITIONING", [
      "Wash hands, introduce self, consent",
      "Patient sitting at 45° or upright",
      "Adequate exposure (chest exposed)",
    ]],
    ["GENERAL INSPECTION (from end of bed)", [
      "Breathing pattern, accessory muscles, recession",
      "Cyanosis (central vs peripheral)",
      "Nutritional status, build",
      "Sputum pot, O₂, inhalers at bedside",
    ]],
    ["HANDS & ARMS", [
      "Clubbing, cyanosis, flap (asterixis)",
      "Nicotine staining, peripheral oedema",
      "Pulse rate & rhythm (bounding = CO₂ retention)",
    ]],
    ["FACE & NECK", [
      "Eyes: Horner's syndrome (Pancoast tumour)",
      "Mouth: central cyanosis, mucosa",
      "JVP elevation, tracheal position, LN",
    ]],
  ];

  const right = [
    ["CHEST INSPECTION", [
      "Shape (barrel, pigeon, funnel, scoliosis)",
      "Symmetry, scars, dilated veins",
      "Respiratory movements — symmetry, recession",
    ]],
    ["PALPATION", [
      "Tracheal position (central / deviated)",
      "Chest expansion (anterior & posterior)",
      "Tactile vocal fremitus (TVF) bilaterally",
    ]],
    ["PERCUSSION", [
      "Percuss all zones: apex, mid, base — bilateral",
      "Note: resonant / dull / stony dull / hyper-resonant",
    ]],
    ["AUSCULTATION", [
      "Breath sounds: type, intensity",
      "Added sounds: crepitations, rhonchi, rub, stridor",
      "Vocal resonance, bronchophony, WP, aegophony",
    ]],
  ];

  const renderSection = (sections, xBase) => {
    let y = 1.02;
    sections.forEach(([heading, items]) => {
      s.addShape(pres.shapes.RECTANGLE, { x: xBase, y, w: 4.35, h: 0.28, fill: { color: C.teal }, line: { type: "none" } });
      s.addText(heading, { x: xBase + 0.1, y, w: 4.15, h: 0.28, fontSize: 9.5, bold: true, color: C.white, fontFace: "Calibri", valign: "middle", margin: 0 });
      y += 0.28;
      items.forEach(item => {
        s.addText([{ text: "✓ " + item, options: { bullet: false, fontSize: 10.5, color: C.text, fontFace: "Calibri" } }], {
          x: xBase + 0.12, y, w: 4.2, h: 0.28, valign: "middle", margin: 0
        });
        y += 0.27;
      });
      y += 0.08;
    });
  };

  renderSection(left, 0.3);
  renderSection(right, 5.0);

  // Divider
  s.addShape(pres.shapes.RECTANGLE, { x: 4.88, y: 1.0, w: 0.025, h: 4.2, fill: { color: C.pale }, line: { type: "none" } });
}

// ══════════════════════════════════════════════════════════════════════════════
// SLIDE 15 – KEY TAKEAWAYS / CONCLUSION
// ══════════════════════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  addBg(s, C.navy);

  // Decorative elements
  s.addShape(pres.shapes.OVAL, { x: 7.5, y: -1.0, w: 4, h: 4, fill: { color: C.teal, transparency: 65 }, line: { type: "none" } });
  s.addShape(pres.shapes.OVAL, { x: -0.8, y: 3.5, w: 3.5, h: 3.5, fill: { color: C.mint, transparency: 72 }, line: { type: "none" } });
  s.addShape(pres.shapes.RECTANGLE, { x: 0, y: 5.25, w: 10, h: 0.375, fill: { color: C.mint } });

  s.addText("Key Takeaways", {
    x: 0.6, y: 0.3, w: 8.8, h: 0.55,
    fontSize: 28, bold: true, color: C.gold, fontFace: "Calibri"
  });
  s.addShape(pres.shapes.RECTANGLE, { x: 0.6, y: 0.9, w: 2.5, h: 0.05, fill: { color: C.mint }, line: { type: "none" } });

  const takeaways = [
    "Always follow the sequence: Inspection → Palpation → Percussion → Auscultation",
    "Quantitative changes = intensity of breath sounds (reduced, absent, increased)",
    "Qualitative changes = type of sound (vesicular → bronchial; character of added sounds)",
    "Crepitations that clear with cough = secretions; those that don't = alveolar/interstitial disease",
    "Tracheal deviation: towards lesion (collapse/fibrosis) or away (tension pneumothorax/large effusion)",
    "Stony dullness on percussion is virtually diagnostic of pleural effusion",
    "Whispering pectoriloquy is the most sensitive sign of consolidation",
    "Aegophony (E→A change) indicates compressed lung just above a pleural effusion",
    "Stridor = upper airway emergency — act immediately",
    "Correlate all findings together before reaching a diagnosis — no single sign is pathognomonic",
  ];

  takeaways.forEach((t, i) => {
    const y = 1.08 + i * 0.405;
    s.addShape(pres.shapes.OVAL, { x: 0.55, y: y + 0.07, w: 0.22, h: 0.22, fill: { color: C.mint }, line: { type: "none" } });
    s.addText((i + 1).toString(), { x: 0.55, y: y + 0.07, w: 0.22, h: 0.22, fontSize: 8, bold: true, color: C.navy, fontFace: "Calibri", align: "center", valign: "middle", margin: 0 });
    s.addText(t, { x: 0.85, y, w: 8.8, h: 0.38, fontSize: 12, color: C.pale, fontFace: "Calibri", valign: "middle" });
  });
}

// ─── WRITE FILE ───────────────────────────────────────────────────────────────
pres.writeFile({ fileName: "/home/daytona/workspace/resp-exam-pptx/Respiratory_Physical_Examination.pptx" })
  .then(() => console.log("Done: Respiratory_Physical_Examination.pptx"))
  .catch(e => { console.error(e); process.exit(1); });

cd /home/daytona/workspace/resp-exam-pptx && node build.js 2>&1

ls -lh /home/daytona/workspace/resp-exam-pptx/