from pptx import Presentation
from pptx.util import Inches, Pt, Emu
from pptx.dml.color import RGBColor
from pptx.enum.text import PP_ALIGN, MSO_ANCHOR
from pptx.util import Inches, Pt
import copy
from lxml import etree

prs = Presentation()
prs.slide_width = Inches(13.333)
prs.slide_height = Inches(7.5)

# ─── Color Palette ────────────────────────────────────────────────
NAVY       = RGBColor(0x0A, 0x2A, 0x5E)   # dark navy blue
CRIMSON    = RGBColor(0xC0, 0x20, 0x2F)   # medical red
GOLD       = RGBColor(0xF0, 0xA5, 0x00)   # accent gold
WHITE      = RGBColor(0xFF, 0xFF, 0xFF)
LIGHT_BLUE = RGBColor(0xE8, 0xF1, 0xFB)
DARK_GRAY  = RGBColor(0x2C, 0x2C, 0x2C)
MID_GRAY   = RGBColor(0x55, 0x55, 0x55)
TEAL       = RGBColor(0x00, 0x7B, 0x83)
GREEN      = RGBColor(0x1A, 0x7A, 0x1A)
ORANGE     = RGBColor(0xE0, 0x60, 0x00)
LIGHT_NAVY = RGBColor(0x1A, 0x3F, 0x8A)

blank_layout = prs.slide_layouts[6]

# ─── Helper Functions ─────────────────────────────────────────────
def add_rect(slide, x, y, w, h, fill_color, border_color=None):
    shape = slide.shapes.add_shape(1, Inches(x), Inches(y), Inches(w), Inches(h))
    shape.fill.solid()
    shape.fill.fore_color.rgb = fill_color
    if border_color:
        shape.line.color.rgb = border_color
        shape.line.width = Pt(1)
    else:
        shape.line.fill.background()
    return shape

def add_textbox(slide, text, x, y, w, h, font_name="Calibri", size=14, bold=False,
                color=DARK_GRAY, align=PP_ALIGN.LEFT, italic=False, wrap=True):
    tb = slide.shapes.add_textbox(Inches(x), Inches(y), Inches(w), Inches(h))
    tf = tb.text_frame
    tf.word_wrap = wrap
    tf.margin_left = Inches(0.05)
    tf.margin_right = Inches(0.05)
    tf.margin_top = Inches(0.02)
    tf.margin_bottom = Inches(0.02)
    p = tf.paragraphs[0]
    p.alignment = align
    run = p.add_run()
    run.text = text
    run.font.name = font_name
    run.font.size = Pt(size)
    run.font.bold = bold
    run.font.italic = italic
    run.font.color.rgb = color
    return tf

def add_para(tf, text, size=13, bold=False, color=DARK_GRAY, align=PP_ALIGN.LEFT,
             italic=False, space_before=6, indent=0):
    p = tf.add_paragraph()
    p.alignment = align
    p.space_before = Pt(space_before)
    if indent:
        p.level = indent
    run = p.add_run()
    run.text = text
    run.font.name = "Calibri"
    run.font.size = Pt(size)
    run.font.bold = bold
    run.font.italic = italic
    run.font.color.rgb = color
    return p

def add_bullet_para(tf, text, size=12.5, color=DARK_GRAY, bold_prefix=None, rest_text=None):
    """Add a bullet point; optionally bold_prefix + rest_text for bold+normal in one line."""
    p = tf.add_paragraph()
    p.alignment = PP_ALIGN.LEFT
    p.space_before = Pt(4)
    # bullet symbol
    run_bullet = p.add_run()
    run_bullet.text = "  \u2022  "
    run_bullet.font.size = Pt(size)
    run_bullet.font.color.rgb = CRIMSON
    run_bullet.font.bold = True
    run_bullet.font.name = "Calibri"
    if bold_prefix:
        rb = p.add_run()
        rb.text = bold_prefix
        rb.font.size = Pt(size)
        rb.font.bold = True
        rb.font.color.rgb = NAVY
        rb.font.name = "Calibri"
        rn = p.add_run()
        rn.text = rest_text if rest_text else ""
        rn.font.size = Pt(size)
        rn.font.color.rgb = color
        rn.font.name = "Calibri"
    else:
        run = p.add_run()
        run.text = text
        run.font.size = Pt(size)
        run.font.color.rgb = color
        run.font.bold = False
        run.font.name = "Calibri"


# ══════════════════════════════════════════════════════════════════
# SLIDE 1 — TITLE / AIM & OBJECTIVES
# ══════════════════════════════════════════════════════════════════
slide1 = prs.slides.add_slide(blank_layout)

# Full navy background
add_rect(slide1, 0, 0, 13.333, 7.5, NAVY)

# Red accent bar left
add_rect(slide1, 0, 0, 0.4, 7.5, CRIMSON)

# Gold divider line
add_rect(slide1, 0.4, 3.05, 12.933, 0.06, GOLD)

# Top label
tf_label = add_textbox(slide1, "MICROTEACHING PRESENTATION", 0.6, 0.2, 12, 0.45,
                       size=11, bold=True, color=GOLD, align=PP_ALIGN.LEFT)

# Heart-beat icon simulation (text)
add_textbox(slide1, "♥", 11.5, 0.15, 1.5, 0.6, size=22, color=CRIMSON, align=PP_ALIGN.RIGHT)

# Main Title
tf_title = add_textbox(slide1, "Dynamic Auscultation", 0.6, 0.75, 12.5, 1.05,
                       font_name="Calibri", size=46, bold=True, color=WHITE, align=PP_ALIGN.LEFT)

# Subtitle
tf_sub = add_textbox(slide1, "The Physiological Stress Test | HOCM vs. Aortic Stenosis",
                     0.6, 1.85, 12.5, 0.6,
                     font_name="Calibri", size=20, bold=False, color=GOLD, align=PP_ALIGN.LEFT)

# Tagline
add_textbox(slide1, "Differentiating life-threatening murmurs at the bedside — without an Echo",
            0.6, 2.5, 12.5, 0.5,
            font_name="Calibri", size=14, bold=False, color=RGBColor(0xB0,0xC8,0xFF), align=PP_ALIGN.LEFT,
            italic=True)

# ── AIM box (left panel) ──────────────────────────────────────────
add_rect(slide1, 0.55, 3.25, 5.8, 3.8, RGBColor(0x0D, 0x35, 0x70))

tf_aim = add_textbox(slide1, "AIM", 0.75, 3.3, 5.4, 0.4,
                     size=15, bold=True, color=GOLD, align=PP_ALIGN.LEFT)
add_para(tf_aim, "To teach PG trainees how bedside dynamic maneuvers change the intensity "
         "of cardiac murmurs, enabling accurate clinical differentiation of Hypertrophic "
         "Obstructive Cardiomyopathy (HOCM) from Aortic Stenosis (AS) — without echocardiography.",
         size=12.5, color=WHITE)

# ── OBJECTIVES box (right panel) ──────────────────────────────────
add_rect(slide1, 6.6, 3.25, 6.4, 3.8, RGBColor(0x0D, 0x35, 0x70))

tf_obj = add_textbox(slide1, "LEARNING OBJECTIVES", 6.8, 3.3, 6.0, 0.4,
                     size=15, bold=True, color=GOLD, align=PP_ALIGN.LEFT)
for obj in [
    "Explain the physiological basis of preload-dependent murmur changes",
    "Correctly perform & interpret the Valsalva maneuver and squatting/leg-raise",
    "Construct a 2×2 matrix contrasting HOCM vs. AS responses",
    "Identify Wide Fixed Splitting vs. Paradoxical Splitting of S₂",
    "Apply carotid-precordial synchronization to time murmurs in tachycardia",
    "Answer OSCE/viva-style questions on dynamic auscultation with confidence",
]:
    add_bullet_para(tf_obj, obj, size=12, color=WHITE)

# Bottom footer
add_rect(slide1, 0, 7.1, 13.333, 0.4, RGBColor(0x06, 0x19, 0x40))
add_textbox(slide1, "7-Minute High-Impact Microteaching  |  Cardiovascular Examination  |  PG Medicine",
            0.4, 7.12, 12.5, 0.3, size=10.5, color=RGBColor(0xA0,0xB8,0xE0), align=PP_ALIGN.CENTER)


# ══════════════════════════════════════════════════════════════════
# SLIDE 2 — CLINICAL CASE (PG HOOK)
# ══════════════════════════════════════════════════════════════════
slide2 = prs.slides.add_slide(blank_layout)

# Background
add_rect(slide2, 0, 0, 13.333, 7.5, RGBColor(0xF4, 0xF7, 0xFF))

# Header bar
add_rect(slide2, 0, 0, 13.333, 1.0, NAVY)
add_rect(slide2, 0, 0, 0.5, 1.0, CRIMSON)
add_textbox(slide2, "SLIDE 2  |  CLINICAL CASE", 0.65, 0.05, 6, 0.35,
            size=11, bold=True, color=GOLD)
add_textbox(slide2, "Minute 0–1: The PG Hook (Problem-Based)", 0.65, 0.45, 10, 0.45,
            size=16, bold=True, color=WHITE)
add_textbox(slide2, "⏱", 12.0, 0.1, 1.0, 0.8, size=28, color=GOLD, align=PP_ALIGN.RIGHT)

# Case scenario header
add_rect(slide2, 0.5, 1.15, 12.333, 0.48, CRIMSON)
add_textbox(slide2, "🚨  RAPID-FIRE CASE SCENARIO — YOU ARE IN THE ICCU", 0.65, 1.2, 12, 0.38,
            size=14, bold=True, color=WHITE)

# Case text box
add_rect(slide2, 0.5, 1.7, 12.333, 1.9, RGBColor(0xFF, 0xF0, 0xF0))
tf_case = add_textbox(slide2,
    '"You are in the ICCU. A 22-year-old male athlete collapsed and syncoped on the field.',
    0.7, 1.78, 11.9, 0.4, size=14.5, bold=False, color=DARK_GRAY, italic=True)
add_para(tf_case,
    'On examination: Heart rate 98 bpm, BP 110/70 mmHg. You auscultate a harsh, grade 3/6 '
    'crescendo-decrescendo systolic murmur, heard best at the left sternal border.',
    size=14.5, italic=True, color=DARK_GRAY)
add_para(tf_case,
    'ECG shows LVH with repolarization changes. Echo is NOT immediately available.',
    size=14.5, italic=True, color=DARK_GRAY)
add_para(tf_case, '', size=6)
add_para(tf_case,
    'Is this benign aortic sclerosis — or a life-threatening HOCM? Today, we will '
    'differentiate them in 2 minutes without an Echo."',
    size=15, bold=True, italic=True, color=CRIMSON)

# ── Two question boxes ────────────────────────────────────────────
add_rect(slide2, 0.5, 3.72, 5.9, 1.4, NAVY)
tf_q1 = add_textbox(slide2, "❓ THE CLINICAL DILEMMA", 0.7, 3.78, 5.5, 0.35,
                    size=13, bold=True, color=GOLD)
add_para(tf_q1, "Both HOCM and Aortic Stenosis produce a SYSTOLIC murmur.", size=12.5, color=WHITE)
add_para(tf_q1, "Both can cause syncope, dyspnea & angina.", size=12.5, color=WHITE)
add_para(tf_q1, "They SOUND similar on basic auscultation.", size=12.5, color=WHITE)

add_rect(slide2, 6.7, 3.72, 6.13, 1.4, TEAL)
tf_q2 = add_textbox(slide2, "💡 THE KEY DIFFERENTIATOR", 6.9, 3.78, 5.8, 0.35,
                    size=13, bold=True, color=GOLD)
add_para(tf_q2, "Dynamic maneuvers change PRELOAD.", size=12.5, color=WHITE)
add_para(tf_q2, "Preload change → Opposite murmur responses in HOCM vs. AS.", size=12.5, color=WHITE)
add_para(tf_q2, "Valsalva specificity for HOCM: >90% (AHA guidelines).", size=12.5, color=WHITE)

# ── Why it matters ────────────────────────────────────────────────
add_rect(slide2, 0.5, 5.28, 12.333, 1.05, RGBColor(0xFF, 0xF7, 0xE0))
tf_why = add_textbox(slide2, "WHY THIS MATTERS", 0.7, 5.32, 5, 0.35,
                     size=13, bold=True, color=CRIMSON)
add_para(tf_why, "HOCM is the #1 cause of sudden cardiac death in young athletes. "
         "Misdiagnosis as innocent murmur or AS can be fatal. "
         "β-blockers (used in HOCM) worsen symptoms in severe AS. "
         "Correct bedside diagnosis guides IMMEDIATE management decisions.", size=12.5, color=DARK_GRAY)

# Footer
add_rect(slide2, 0, 6.45, 13.333, 0.05, GOLD)
add_rect(slide2, 0, 7.1, 13.333, 0.4, NAVY)
add_textbox(slide2, "Dynamic Auscultation  |  Microteaching  |  Slide 2 of 8",
            0.4, 7.13, 12.5, 0.3, size=10.5, color=RGBColor(0xA0,0xB8,0xE0), align=PP_ALIGN.CENTER)


# ══════════════════════════════════════════════════════════════════
# SLIDE 3 — PROCEDURE: PHYSIOLOGY & MANEUVERS (Part 1)
# ══════════════════════════════════════════════════════════════════
slide3 = prs.slides.add_slide(blank_layout)
add_rect(slide3, 0, 0, 13.333, 7.5, RGBColor(0xF4, 0xF7, 0xFF))
add_rect(slide3, 0, 0, 13.333, 1.0, NAVY)
add_rect(slide3, 0, 0, 0.5, 1.0, CRIMSON)
add_textbox(slide3, "SLIDE 3  |  PROCEDURE & PHYSIOLOGY", 0.65, 0.05, 8, 0.35,
            size=11, bold=True, color=GOLD)
add_textbox(slide3, "Minute 1–3: The Concept Matrix — How Preload Flips the Murmur",
            0.65, 0.45, 12, 0.45, size=16, bold=True, color=WHITE)

# ── Physiology panel left ─────────────────────────────────────────
add_rect(slide3, 0.5, 1.1, 4.0, 5.95, NAVY)
tf_phys = add_textbox(slide3, "PHYSIOLOGICAL BASIS", 0.65, 1.15, 3.7, 0.4,
                      size=13, bold=True, color=GOLD)
add_para(tf_phys, "HOCM: Dynamic LVOT Obstruction", size=12.5, bold=True, color=WHITE)
add_para(tf_phys,
    "SAM (Systolic Anterior Motion) of mitral leaflet + asymmetric septal hypertrophy "
    "cause dynamic obstruction of LVOT.", size=11.5, color=RGBColor(0xC8,0xDC,0xFF))
add_para(tf_phys, "", size=4)
add_para(tf_phys, "⬇ Preload → LV cavity shrinks → LVOT narrower → Obstruction WORSENS → Murmur LOUDER",
    size=12, bold=True, color=GOLD)
add_para(tf_phys, "", size=4)
add_para(tf_phys, "⬆ Preload → LV cavity enlarges → LVOT wider → Obstruction LESSENS → Murmur SOFTER",
    size=12, bold=True, color=RGBColor(0x90, 0xFF, 0x90))
add_para(tf_phys, "", size=6)
add_para(tf_phys, "AORTIC STENOSIS: Fixed Valve Obstruction", size=12.5, bold=True, color=WHITE)
add_para(tf_phys,
    "Calcified / congenitally bicuspid aortic valve. Obstruction is at the valve level — "
    "FIXED regardless of LV size.", size=11.5, color=RGBColor(0xC8,0xDC,0xFF))
add_para(tf_phys, "", size=4)
add_para(tf_phys,
    "⬆ Preload → more blood flows across the stenosed valve → Murmur LOUDER",
    size=12, bold=True, color=RGBColor(0x90, 0xFF, 0x90))
add_para(tf_phys, "", size=4)
add_para(tf_phys,
    "⬇ Preload → less flow across valve → Murmur SOFTER",
    size=12, bold=True, color=GOLD)

# ── 2×2 Matrix center/right ───────────────────────────────────────
add_rect(slide3, 4.8, 1.1, 8.1, 0.45, CRIMSON)
add_textbox(slide3, "THE 2×2 DIAGNOSTIC MATRIX", 4.95, 1.15, 7.9, 0.35,
            size=14, bold=True, color=WHITE, align=PP_ALIGN.CENTER)

# Matrix headers
add_rect(slide3, 4.8, 1.6, 3.9, 0.42, LIGHT_NAVY)
add_textbox(slide3, "MANEUVER / EFFECT", 4.85, 1.62, 3.8, 0.38,
            size=12, bold=True, color=WHITE, align=PP_ALIGN.CENTER)
add_rect(slide3, 8.75, 1.6, 2.0, 0.42, TEAL)
add_textbox(slide3, "HOCM", 8.78, 1.62, 1.95, 0.38,
            size=13, bold=True, color=WHITE, align=PP_ALIGN.CENTER)
add_rect(slide3, 10.8, 1.6, 2.1, 0.42, TEAL)
add_textbox(slide3, "Aortic Stenosis", 10.83, 1.62, 2.0, 0.38,
            size=12, bold=True, color=WHITE, align=PP_ALIGN.CENTER)

rows = [
    ("Valsalva (strain phase)\n⬇ Preload", "⬆ LOUDER", "⬇ SOFTER", RGBColor(0xFF,0xF0,0xF0), RGBColor(0xFF,0xE0,0xE0), RGBColor(0xE0,0xFF,0xE0)),
    ("Squatting / Passive Leg Raise\n⬆ Preload", "⬇ SOFTER", "⬆ LOUDER", RGBColor(0xF0,0xFF,0xF0), RGBColor(0xE0,0xFF,0xE0), RGBColor(0xFF,0xE0,0xE0)),
    ("Standing from Squat\n⬇ Preload", "⬆ LOUDER", "⬇ SOFTER", RGBColor(0xFF,0xF5,0xE8), RGBColor(0xFF,0xE8,0xD0), RGBColor(0xE0,0xF5,0xE0)),
    ("Handgrip (⬆ Afterload)", "⬇ Slightly softer", "⬇ Slightly softer", RGBColor(0xF0,0xF4,0xFF), RGBColor(0xE0,0xEC,0xFF), RGBColor(0xE0,0xEC,0xFF)),
    ("Amyl Nitrite (⬇ Afterload)", "⬆ LOUDER", "⬇ SOFTER", RGBColor(0xFF,0xF0,0xFF), RGBColor(0xFF,0xE0,0xFF), RGBColor(0xE0,0xFF,0xFF)),
]
for i, (maneuver, hocm, as_, bg_m, bg_h, bg_a) in enumerate(rows):
    y = 2.08 + i*0.78
    add_rect(slide3, 4.8, y, 3.9, 0.72, bg_m, RGBColor(0xCC,0xCC,0xCC))
    add_textbox(slide3, maneuver, 4.85, y+0.04, 3.78, 0.64, size=11, color=DARK_GRAY)
    add_rect(slide3, 8.75, y, 2.0, 0.72, bg_h, RGBColor(0xCC,0xCC,0xCC))
    h_color = CRIMSON if "LOUDER" in hocm else GREEN
    add_textbox(slide3, hocm, 8.78, y+0.04, 1.92, 0.64, size=12, bold=True,
                color=h_color, align=PP_ALIGN.CENTER)
    add_rect(slide3, 10.8, y, 2.1, 0.72, bg_a, RGBColor(0xCC,0xCC,0xCC))
    a_color = GREEN if "LOUDER" in as_ else CRIMSON
    add_textbox(slide3, as_, 10.83, y+0.04, 2.0, 0.64, size=12, bold=True,
                color=a_color, align=PP_ALIGN.CENTER)

# Memory tip
add_rect(slide3, 4.8, 6.18, 8.1, 0.85, RGBColor(0xFF, 0xF7, 0xD0))
tf_mem = add_textbox(slide3, "🧠  MEMORY TIP: ", 4.95, 6.22, 2.5, 0.35,
                     size=13, bold=True, color=CRIMSON)
add_para(tf_mem, '"HOCM HATES squatting" (preload increase collapses the gradient) | '
         '"AS APPRECIATES squatting" (more flow = louder murmur)', size=12.5, italic=True, color=DARK_GRAY)

add_rect(slide3, 0, 7.1, 13.333, 0.4, NAVY)
add_textbox(slide3, "Dynamic Auscultation  |  Microteaching  |  Slide 3 of 8",
            0.4, 7.13, 12.5, 0.3, size=10.5, color=RGBColor(0xA0,0xB8,0xE0), align=PP_ALIGN.CENTER)


# ══════════════════════════════════════════════════════════════════
# SLIDE 4 — PROCEDURE: PERFORMING THE MANEUVERS (Step-by-Step)
# ══════════════════════════════════════════════════════════════════
slide4 = prs.slides.add_slide(blank_layout)
add_rect(slide4, 0, 0, 13.333, 7.5, RGBColor(0xF2, 0xF5, 0xFF))
add_rect(slide4, 0, 0, 13.333, 1.0, NAVY)
add_rect(slide4, 0, 0, 0.5, 1.0, CRIMSON)
add_textbox(slide4, "SLIDE 4  |  PROCEDURE — STEP BY STEP", 0.65, 0.05, 8, 0.35,
            size=11, bold=True, color=GOLD)
add_textbox(slide4, "How to Perform Dynamic Maneuvers at the Bedside",
            0.65, 0.45, 12, 0.45, size=16, bold=True, color=WHITE)

# ── Valsalva Panel ────────────────────────────────────────────────
add_rect(slide4, 0.5, 1.1, 5.9, 5.6, NAVY)
add_rect(slide4, 0.5, 1.1, 5.9, 0.45, CRIMSON)
add_textbox(slide4, "VALSALVA MANEUVER", 0.65, 1.14, 5.6, 0.37,
            size=14, bold=True, color=WHITE)

tf_v = add_textbox(slide4, "Definition:", 0.7, 1.62, 5.5, 0.3,
                   size=12.5, bold=True, color=GOLD)
add_para(tf_v, "Forced expiration against a closed glottis — straining phase.", size=12, color=WHITE)
add_para(tf_v, "", size=4)
add_para(tf_v, "TECHNIQUE (4 Phases):", size=12.5, bold=True, color=GOLD)
for step in [
    ("Phase 1", "Initial deep inspiration"),
    ("Phase 2 (key)", "Strain for 10–15 sec against closed glottis — ⬇ venous return → ⬇ preload"),
    ("Phase 3", "Release of strain — sudden ⬆ venous return"),
    ("Phase 4", "Overshoot bradycardia via baroreceptor reflex"),
]:
    add_para(tf_v, f"  {step[0]}: {step[1]}", size=11.5, color=RGBColor(0xC0,0xD8,0xFF))
add_para(tf_v, "", size=4)
add_para(tf_v, "AUSCULTATION TIMING:", size=12.5, bold=True, color=GOLD)
add_para(tf_v, "  Listen DURING Phase 2 (strain) for the murmur change.", size=12, color=WHITE)
add_para(tf_v, "", size=4)
add_para(tf_v, "INTERPRETATION:", size=12.5, bold=True, color=GOLD)
add_para(tf_v, "  ⬆ Louder during strain → HOCM (specificity >90%)", size=12, bold=True, color=GOLD)
add_para(tf_v, "  ⬇ Softer during strain → Aortic Stenosis", size=12, bold=True, color=RGBColor(0x90,0xFF,0x90))
add_para(tf_v, "", size=4)
add_para(tf_v, "CONTRAINDICATIONS:", size=12.5, bold=True, color=GOLD)
add_para(tf_v, "  Glaucoma, severe HTN (>180/110), retinopathy, recent MI.", size=11.5, color=RGBColor(0xFF,0xC0,0xC0))

# ── Squatting / Leg Raise Panel ───────────────────────────────────
add_rect(slide4, 6.65, 1.1, 6.2, 5.6, RGBColor(0x0D, 0x35, 0x70))
add_rect(slide4, 6.65, 1.1, 6.2, 0.45, TEAL)
add_textbox(slide4, "SQUATTING / PASSIVE LEG RAISE", 6.8, 1.14, 5.9, 0.37,
            size=14, bold=True, color=WHITE)

tf_s = add_textbox(slide4, "SQUATTING:", 6.8, 1.62, 5.8, 0.3,
                   size=12.5, bold=True, color=GOLD)
add_para(tf_s, "Ask patient to squat from standing position for 10–15 seconds.", size=12, color=WHITE)
add_para(tf_s, "Mechanism: ⬆ venous return → ⬆ preload + ⬆ afterload.", size=12, color=RGBColor(0xC0,0xD8,0xFF))
add_para(tf_s, "", size=4)
add_para(tf_s, "PASSIVE LEG RAISE (PLR):", size=12.5, bold=True, color=GOLD)
add_para(tf_s, "Patient supine; raise both legs to 45° for 30–60 seconds.", size=12, color=WHITE)
add_para(tf_s, "Auto-transfuses ~300–500 mL from lower limbs → ⬆ preload.", size=12, color=RGBColor(0xC0,0xD8,0xFF))
add_para(tf_s, "", size=4)
add_para(tf_s, "INTERPRETATION:", size=12.5, bold=True, color=GOLD)
add_para(tf_s, "  Murmur SOFTER → HOCM (LV cavity expands, gradient collapses)", size=12, bold=True, color=RGBColor(0x90,0xFF,0x90))
add_para(tf_s, "  Murmur LOUDER → Aortic Stenosis (more flow across fixed stenosis)", size=12, bold=True, color=GOLD)
add_para(tf_s, "", size=4)
add_para(tf_s, "CLINICAL PEARL:", size=12.5, bold=True, color=GOLD)
add_para(tf_s, "  PLR is safer for acutely ill patients & can be reversed instantly.", size=11.5, color=RGBColor(0xC0,0xD8,0xFF))
add_para(tf_s, "  Combine Valsalva + PLR to confirm diagnosis at the bedside.", size=11.5, color=RGBColor(0xC0,0xD8,0xFF))
add_para(tf_s, "", size=4)
add_para(tf_s, "CAROTID-PRECORDIAL SYNC:", size=12.5, bold=True, color=GOLD)
add_para(tf_s, "  Palpate carotid pulse simultaneously while auscultating precordium.", size=11.5, color=WHITE)
add_para(tf_s, "  Helps TIME murmur precisely (early vs. mid vs. late systolic) even at high HR.", size=11.5, color=WHITE)

# Stethoscope tip box
add_rect(slide4, 0.5, 6.78, 12.333, 0.28, GOLD)
add_textbox(slide4, "🩺  STETHOSCOPE TIPS: Use DIAPHRAGM for high-pitched murmurs (AS).  "
            "Use BELL (light pressure) for low-pitched sounds & S3/S4.",
            0.65, 6.79, 12.0, 0.26, size=11.5, bold=True, color=DARK_GRAY, align=PP_ALIGN.CENTER)

add_rect(slide4, 0, 7.1, 13.333, 0.4, NAVY)
add_textbox(slide4, "Dynamic Auscultation  |  Microteaching  |  Slide 4 of 8",
            0.4, 7.13, 12.5, 0.3, size=10.5, color=RGBColor(0xA0,0xB8,0xE0), align=PP_ALIGN.CENTER)


# ══════════════════════════════════════════════════════════════════
# SLIDE 5 — S₂ SPLITTING & CAROTID-PRECORDIAL SYNCHRONIZATION
# ══════════════════════════════════════════════════════════════════
slide5 = prs.slides.add_slide(blank_layout)
add_rect(slide5, 0, 0, 13.333, 7.5, RGBColor(0xF4, 0xF7, 0xFF))
add_rect(slide5, 0, 0, 13.333, 1.0, NAVY)
add_rect(slide5, 0, 0, 0.5, 1.0, CRIMSON)
add_textbox(slide5, "SLIDE 5  |  CLINICAL IMPORTANCE — ADVANCED AUSCULTATION", 0.65, 0.05, 9, 0.35,
            size=11, bold=True, color=GOLD)
add_textbox(slide5, "The Art of Splitting (S₂) + Carotid-Precordial Synchronization",
            0.65, 0.45, 12, 0.45, size=16, bold=True, color=WHITE)

# ── S2 Splitting left ─────────────────────────────────────────────
add_rect(slide5, 0.5, 1.1, 6.2, 5.55, NAVY)
add_rect(slide5, 0.5, 1.1, 6.2, 0.42, TEAL)
add_textbox(slide5, "THE ART OF S₂ SPLITTING", 0.65, 1.13, 6.0, 0.36,
            size=14, bold=True, color=WHITE)

tf_s2 = add_textbox(slide5, "Normal Physiological Splitting:", 0.68, 1.6, 5.9, 0.32,
                    size=12.5, bold=True, color=GOLD)
add_para(tf_s2, "A₂ (aortic closure) → P₂ (pulmonic closure). During inspiration: increased "
         "venous return delays P₂ → widens splitting.", size=11.5, color=WHITE)
add_para(tf_s2, "", size=5)
add_para(tf_s2, "WIDE FIXED SPLITTING:", size=12.5, bold=True, color=GOLD)
add_para(tf_s2, "  • Cause: Atrial Septal Defect (ASD)", size=12, color=RGBColor(0xC0,0xD8,0xFF))
add_para(tf_s2, "  • Splitting wide AND fixed — doesn't change with breathing", size=12, color=WHITE)
add_para(tf_s2, "  • Why: Constant left-to-right shunt equalizes pressures regardless of respiration", size=11.5, color=RGBColor(0xA0,0xC0,0xFF))
add_para(tf_s2, "", size=5)
add_para(tf_s2, "PARADOXICAL (REVERSED) SPLITTING:", size=12.5, bold=True, color=GOLD)
add_para(tf_s2, "  • Causes: LBBB, Severe Aortic Stenosis, HCM, RV pacing", size=12, color=RGBColor(0xC0,0xD8,0xFF))
add_para(tf_s2, "  • P₂ comes BEFORE A₂ (LV delayed, P₂ now leads)", size=12, color=WHITE)
add_para(tf_s2, "  • Splitting heard on EXPIRATION; narrows or disappears on inspiration", size=11.5, color=RGBColor(0xA0,0xC0,0xFF))
add_para(tf_s2, "", size=5)
add_para(tf_s2, "NARROW / ABSENT SPLITTING:", size=12.5, bold=True, color=GOLD)
add_para(tf_s2, "  • Pulmonary HTN (loud P₂, early closure), Severe AS (soft A₂)", size=12, color=WHITE)
add_para(tf_s2, "", size=5)
add_para(tf_s2, "TEACHING INNOVATION:", size=12.5, bold=True, color=GOLD)
add_para(tf_s2, "  Use voice/metronome to mimic acoustic timing. Have trainees close eyes "
         "to identify blind audio patterns — multisensory audio-visual approach.", size=11.5, color=RGBColor(0xC0,0xD8,0xFF))

# ── Carotid-Precordial right ──────────────────────────────────────
add_rect(slide5, 6.95, 1.1, 5.9, 5.55, RGBColor(0x0D, 0x35, 0x70))
add_rect(slide5, 6.95, 1.1, 5.9, 0.42, CRIMSON)
add_textbox(slide5, "CAROTID-PRECORDIAL SYNCHRONIZATION", 7.1, 1.13, 5.65, 0.36,
            size=13, bold=True, color=WHITE)

tf_cp = add_textbox(slide5, "The Clinical Problem:", 7.1, 1.6, 5.6, 0.32,
                    size=12.5, bold=True, color=GOLD)
add_para(tf_cp, "At HR >100 bpm, it is extremely difficult to time systolic vs. diastolic "
         "events by ear alone.", size=11.5, color=WHITE)
add_para(tf_cp, "", size=5)
add_para(tf_cp, "THE TECHNIQUE:", size=12.5, bold=True, color=GOLD)
add_para(tf_cp, "  1. Place stethoscope on precordium at the auscultation area of interest",
         size=12, color=RGBColor(0xC0,0xD8,0xFF))
add_para(tf_cp, "  2. Simultaneously palpate the RIGHT carotid artery with 2 fingers",
         size=12, color=RGBColor(0xC0,0xD8,0xFF))
add_para(tf_cp, "  3. Carotid upstroke = START of systole (after S₁)", size=12, color=WHITE)
add_para(tf_cp, "  4. Any murmur heard SIMULTANEOUSLY with carotid = systolic", size=12, color=WHITE)
add_para(tf_cp, "  5. Murmur heard in the PAUSE between pulses = diastolic", size=12, color=White if False else WHITE)
add_para(tf_cp, "", size=5)
add_para(tf_cp, "CLINICAL UTILITY:", size=12.5, bold=True, color=GOLD)
for pt in [
    "Isolates early-systolic (innocent/HOCM) from mid-systolic (AS) murmurs",
    "Identifies diastolic murmur of AR (immediately after carotid pulse)",
    "Essential in AF where heart rate varies beat-to-beat",
    "Helps confirm S₃ gallop (just after carotid — S1-S2-S3 sequence)",
]:
    add_bullet_para(tf_cp, pt, size=11.5, color=WHITE)
add_para(tf_cp, "", size=5)
add_para(tf_cp, "TEACHING INNOVATION:", size=12.5, bold=True, color=GOLD)
add_para(tf_cp, "Pair trainees — one taps chaotic rhythm on desk, partner locates "
         "own carotid pulse to practice synchronization under pressure.", size=11.5, color=RGBColor(0xC0,0xD8,0xFF))

add_rect(slide5, 0, 7.1, 13.333, 0.4, NAVY)
add_textbox(slide5, "Dynamic Auscultation  |  Microteaching  |  Slide 5 of 8",
            0.4, 7.13, 12.5, 0.3, size=10.5, color=RGBColor(0xA0,0xB8,0xE0), align=PP_ALIGN.CENTER)


# ══════════════════════════════════════════════════════════════════
# SLIDE 6 — CLINICAL IMPORTANCE & SPECIAL SCENARIOS
# ══════════════════════════════════════════════════════════════════
slide6 = prs.slides.add_slide(blank_layout)
add_rect(slide6, 0, 0, 13.333, 7.5, RGBColor(0xF4, 0xF7, 0xFF))
add_rect(slide6, 0, 0, 13.333, 1.0, NAVY)
add_rect(slide6, 0, 0, 0.5, 1.0, CRIMSON)
add_textbox(slide6, "SLIDE 6  |  CLINICAL IMPORTANCE", 0.65, 0.05, 8, 0.35,
            size=11, bold=True, color=GOLD)
add_textbox(slide6, "Why Dynamic Auscultation Is a Non-Negotiable Bedside Skill",
            0.65, 0.45, 12, 0.45, size=16, bold=True, color=WHITE)

# ── 6 clinical importance boxes (3x2 grid) ───────────────────────
importance_data = [
    ("🏥 Avoids Misdiagnosis",
     "HOCM misdiagnosed as benign murmur is the leading cause of preventable sudden "
     "cardiac death in athletes under 35. Dynamic auscultation prevents this."),
    ("💊 Guides Drug Choice",
     "β-blockers & disopyramide are first-line for HOCM. Vasodilators (used in AS) "
     "are DANGEROUS in HOCM — worsen obstruction. Correct diagnosis is life-saving."),
    ("🏆 OSCE High-Yield",
     "Dynamic auscultation is consistently tested in MD/DNB/MRCP finals. "
     "Examiners specifically probe: 'What happens to the murmur on squatting?'"),
    ("📊 Diagnostic Accuracy",
     "Valsalva specificity for HOCM: >90% (AHA). PLR sensitivity for volume "
     "responsiveness: ~85%. These rival many echocardiographic parameters."),
    ("🚑 Emergency Decision-Making",
     "In resource-limited settings (field, PHC, duty ward at night), bedside maneuvers "
     "provide IMMEDIATE hemodynamic information without waiting for Echo."),
    ("🔬 Pathophysiology Integration",
     "Maneuver responses integrate Starling's law, Frank-Starling mechanism, baroreceptor "
     "reflexes, and ventricular geometry — bridging basic science to clinical medicine."),
]

for idx, (title, body) in enumerate(importance_data):
    row, col = divmod(idx, 3)
    x = 0.5 + col * 4.28
    y = 1.18 + row * 2.2
    add_rect(slide6, x, y, 4.1, 2.05, NAVY if row == 0 else RGBColor(0x0D, 0x35, 0x70))
    add_rect(slide6, x, y, 4.1, 0.4, TEAL if row == 0 else CRIMSON)
    add_textbox(slide6, title, x+0.1, y+0.04, 3.9, 0.32, size=12.5, bold=True, color=WHITE)
    add_textbox(slide6, body, x+0.12, y+0.48, 3.86, 1.45, size=11, color=RGBColor(0xC8,0xDC,0xFF), wrap=True)

# Bottom tip
add_rect(slide6, 0.5, 5.62, 12.333, 0.65, RGBColor(0xFF, 0xF7, 0xD0))
tf_tip = add_textbox(slide6, "💡  ADVANCED TIP FOR EVALUATION: ", 0.65, 5.66, 4.5, 0.35,
                     size=13, bold=True, color=CRIMSON)
add_para(tf_tip,
    'Avoid putting textbook definitions of S₁ and S₂ on your slides — evaluators will mark you down for '
    'treating PGs like undergraduates. Instead, cite diagnostic utility stats: '
    '"The specificity of the Valsalva maneuver for HOCM is over 90%." Reference current AHA/ESC cardiology guidelines.',
    size=12.5, color=DARK_GRAY)

add_rect(slide6, 0, 7.1, 13.333, 0.4, NAVY)
add_textbox(slide6, "Dynamic Auscultation  |  Microteaching  |  Slide 6 of 8",
            0.4, 7.13, 12.5, 0.3, size=10.5, color=RGBColor(0xA0,0xB8,0xE0), align=PP_ALIGN.CENTER)


# ══════════════════════════════════════════════════════════════════
# SLIDE 7 — PEER SIMULATION & OSCE CHALLENGE
# ══════════════════════════════════════════════════════════════════
slide7 = prs.slides.add_slide(blank_layout)
add_rect(slide7, 0, 0, 13.333, 7.5, RGBColor(0xF2, 0xF5, 0xFF))
add_rect(slide7, 0, 0, 13.333, 1.0, NAVY)
add_rect(slide7, 0, 0, 0.5, 1.0, CRIMSON)
add_textbox(slide7, "SLIDE 7  |  PEER SIMULATION & OSCE ASSESSMENT", 0.65, 0.05, 9, 0.35,
            size=11, bold=True, color=GOLD)
add_textbox(slide7, "Minutes 3–6: Simulated Practice + OSCE Assessment Challenge",
            0.65, 0.45, 12, 0.45, size=16, bold=True, color=WHITE)

# Peer Simulation section
add_rect(slide7, 0.5, 1.12, 12.333, 0.42, TEAL)
add_textbox(slide7, "⚕  MINUTE 3–5: PEER-TO-PEER SIMULATION", 0.65, 1.15, 12, 0.35,
            size=13, bold=True, color=WHITE)

tf_sim = add_textbox(slide7, "Step 1: Perform Valsalva on yourself — notice the blood pressure sensation.", 0.65, 1.65, 12.5, 0.35, size=13, color=DARK_GRAY)
add_para(tf_sim, "Step 2: Instructor plays two audio clips (HOCM murmur vs. AS murmur pre/post Valsalva) over Bluetooth speaker.", size=13, color=DARK_GRAY)
add_para(tf_sim, "Step 3: Trainees identify which clip represents HOCM vs. AS based on volume change.", size=13, color=DARK_GRAY)
add_para(tf_sim, "Step 4: Pair up — one person taps chaotic heart rhythm on desk; partner locates carotid pulse to practice synchronization.", size=13, color=DARK_GRAY)

# OSCE Challenge section
add_rect(slide7, 0.5, 2.72, 12.333, 0.42, CRIMSON)
add_textbox(slide7, "🏆  MINUTE 5–6: THE OSCE ASSESSMENT CHALLENGE", 0.65, 2.75, 12, 0.35,
            size=13, bold=True, color=WHITE)

tf_osce = add_textbox(slide7, "Show 60-second video clip of a clinician performing flawed auscultation technique.", 0.65, 3.25, 12.5, 0.35, size=13, color=DARK_GRAY)
add_para(tf_osce, "Ask trainees to critically evaluate:", size=13, bold=True, color=DARK_GRAY)
add_para(tf_osce, "  ❶  Patient POSITIONING — is the patient in left lateral decubitus? Standing? Squatting?", size=12.5, color=DARK_GRAY)
add_para(tf_osce, "  ❷  STETHOSCOPE CHOICE — bell (low-pitched) vs. diaphragm (high-pitched)?", size=12.5, color=DARK_GRAY)
add_para(tf_osce, "  ❸  PATIENT INSTRUCTIONS — was the maneuver explained clearly and performed correctly?", size=12.5, color=DARK_GRAY)
add_para(tf_osce, "  ❹  DOCUMENTATION — did the clinician note the maneuver response in the case records?", size=12.5, color=DARK_GRAY)

# Quick summary table
add_rect(slide7, 0.5, 4.55, 12.333, 0.38, NAVY)
tf_sum_h = add_textbox(slide7, "QUICK REVISION: COMPLETE COMPARISON TABLE", 0.65, 4.57, 12, 0.32,
                       size=13, bold=True, color=WHITE, align=PP_ALIGN.CENTER)

cols = ["Feature", "HOCM", "Aortic Stenosis"]
col_x = [0.5, 4.8, 9.1]
col_w = [4.3, 4.3, 4.2]
col_colors = [NAVY, RGBColor(0x0D,0x35,0x70), RGBColor(0x0D,0x35,0x70)]

for ci, (cx, cw, hdr) in enumerate(zip(col_x, col_w, cols)):
    add_rect(slide7, cx, 4.97, cw, 0.35, TEAL if ci == 0 else (CRIMSON if ci == 1 else GREEN))
    add_textbox(slide7, hdr, cx+0.08, 4.99, cw-0.1, 0.3, size=12, bold=True, color=WHITE)

table_rows = [
    ("Murmur type", "Crescendo-decrescendo systolic LSB", "Crescendo-decrescendo systolic RSB/RUSB"),
    ("Radiation", "Does not radiate to neck", "Radiates to carotids"),
    ("Valsalva (⬇ preload)", "⬆ LOUDER", "⬇ SOFTER"),
    ("Squatting (⬆ preload)", "⬇ SOFTER", "⬆ LOUDER"),
    ("Pulse character", "Bifid/spike-and-dome", "Pulsus parvus et tardus"),
]
for ri, row_data in enumerate(table_rows):
    row_y = 5.36 + ri * 0.3
    row_bg = RGBColor(0xE8,0xF1,0xFF) if ri % 2 == 0 else WHITE
    for ci, (cx, cw, cell) in enumerate(zip(col_x, col_w, row_data)):
        add_rect(slide7, cx, row_y, cw, 0.28, row_bg, RGBColor(0xBB,0xCC,0xDD))
        c_color = DARK_GRAY
        if ci == 1 and "LOUDER" in cell: c_color = CRIMSON
        if ci == 1 and "SOFTER" in cell: c_color = GREEN
        if ci == 2 and "LOUDER" in cell: c_color = GREEN
        if ci == 2 and "SOFTER" in cell: c_color = CRIMSON
        add_textbox(slide7, cell, cx+0.08, row_y+0.02, cw-0.12, 0.24, size=11, color=c_color, bold=("LOUDER" in cell or "SOFTER" in cell))

add_rect(slide7, 0, 7.1, 13.333, 0.4, NAVY)
add_textbox(slide7, "Dynamic Auscultation  |  Microteaching  |  Slide 7 of 8",
            0.4, 7.13, 12.5, 0.3, size=10.5, color=RGBColor(0xA0,0xB8,0xE0), align=PP_ALIGN.CENTER)


# ══════════════════════════════════════════════════════════════════
# SLIDE 8 — QUERY / VIVA QUESTIONS (Microteaching Format)
# ══════════════════════════════════════════════════════════════════
slide8 = prs.slides.add_slide(blank_layout)
add_rect(slide8, 0, 0, 13.333, 7.5, NAVY)
add_rect(slide8, 0, 0, 0.5, 7.5, CRIMSON)

add_textbox(slide8, "SLIDE 8  |  QUERY — MICROTEACHING ASSESSMENT", 0.65, 0.1, 10, 0.38,
            size=11, bold=True, color=GOLD)
add_rect(slide8, 0.5, 0.6, 12.333, 0.06, GOLD)

add_textbox(slide8, "Minute 6–7: Wrap-Up & Viva Questions", 0.65, 0.72, 12, 0.45,
            size=18, bold=True, color=WHITE)

# High-yield Viva question 1
add_rect(slide8, 0.65, 1.3, 12.0, 0.45, CRIMSON)
add_textbox(slide8, "❓ VIVA QUESTION 1  (From your case)", 0.8, 1.33, 11.5, 0.38,
            size=13, bold=True, color=WHITE)
add_rect(slide8, 0.65, 1.78, 12.0, 0.6, RGBColor(0x12, 0x30, 0x60))
add_textbox(slide8,
    '"Your patient squats and the murmur instantly softens. What is your provisional diagnosis?"',
    0.8, 1.82, 11.6, 0.52, size=14.5, bold=True, color=GOLD, italic=True)
add_rect(slide8, 0.65, 2.42, 12.0, 0.38, RGBColor(0x08, 0x22, 0x50))
add_textbox(slide8,
    "Expected Answer: HOCM — squatting ⬆ preload → LV cavity enlarges → dynamic LVOT gradient collapses → murmur softens",
    0.8, 2.44, 11.6, 0.33, size=12, color=RGBColor(0x90, 0xFF, 0x90))

# Viva question 2
add_rect(slide8, 0.65, 2.9, 12.0, 0.42, TEAL)
add_textbox(slide8, "❓ VIVA QUESTION 2", 0.8, 2.93, 11.5, 0.35, size=13, bold=True, color=WHITE)
add_rect(slide8, 0.65, 3.35, 12.0, 0.55, RGBColor(0x12, 0x30, 0x60))
add_textbox(slide8,
    '"A patient has a harsh systolic murmur that INCREASES during the strain phase of Valsalva. '
    'What is the single most likely diagnosis? And what is the sensitivity of this finding?"',
    0.8, 3.38, 11.6, 0.48, size=14, bold=True, color=GOLD, italic=True)
add_rect(slide8, 0.65, 3.93, 12.0, 0.38, RGBColor(0x08, 0x22, 0x50))
add_textbox(slide8,
    "Expected Answer: HOCM. Specificity of Valsalva for HOCM: >90%. Murmur louder = ⬇ preload → dynamic obstruction worsens.",
    0.8, 3.95, 11.6, 0.33, size=12, color=RGBColor(0x90, 0xFF, 0x90))

# Viva question 3
add_rect(slide8, 0.65, 4.42, 12.0, 0.42, CRIMSON)
add_textbox(slide8, "❓ VIVA QUESTION 3", 0.8, 4.45, 11.5, 0.35, size=13, bold=True, color=WHITE)
add_rect(slide8, 0.65, 4.87, 12.0, 0.55, RGBColor(0x12, 0x30, 0x60))
add_textbox(slide8,
    '"What type of S₂ splitting would you expect in a patient with an ASD? '
    'And how does it differ from paradoxical splitting seen in LBBB?"',
    0.8, 4.90, 11.6, 0.48, size=14, bold=True, color=GOLD, italic=True)
add_rect(slide8, 0.65, 5.45, 12.0, 0.5, RGBColor(0x08, 0x22, 0x50))
add_textbox(slide8,
    "Expected Answer: ASD → WIDE FIXED splitting (constant L-R shunt). LBBB → PARADOXICAL splitting "
    "(P₂ before A₂; heard on expiration, narrows on inspiration).",
    0.8, 5.48, 11.6, 0.43, size=12, color=RGBColor(0x90, 0xFF, 0x90))

# Take-home message
add_rect(slide8, 0.65, 6.05, 12.0, 0.78, RGBColor(0xF0, 0xA5, 0x00))
add_textbox(slide8,
    "🏆  TAKE-HOME MESSAGE: Two maneuvers — Valsalva + Squatting — give you 90% diagnostic accuracy "
    "for HOCM vs. AS at the BEDSIDE. Master them before any Echo is ordered.",
    0.8, 6.1, 11.7, 0.68, size=13.5, bold=True, color=DARK_GRAY, align=PP_ALIGN.CENTER)

add_rect(slide8, 0, 7.1, 13.333, 0.4, RGBColor(0x06, 0x19, 0x40))
add_textbox(slide8, "Dynamic Auscultation  |  Microteaching  |  Slide 8 of 8  |  Thank You",
            0.4, 7.13, 12.5, 0.3, size=10.5, color=RGBColor(0xA0,0xB8,0xE0), align=PP_ALIGN.CENTER)


# ──────────────────────────────────────────────────────────────────
# SAVE
# ──────────────────────────────────────────────────────────────────
output_path = "/tmp/workspace/dynamic-auscultation-ppt/Dynamic_Auscultation_Microteaching.pptx"
prs.save(output_path)
print(f"Saved: {output_path}")
print(f"Total slides: {len(prs.slides)}")