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pres.layout = "LAYOUT_16x9";
pres.title = "History Taking in General Surgery";
pres.author = "S Das - A Manual on Clinical Surgery";

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// ═══════════════════════════════════════════════════════════════
// SLIDE 1 — TITLE
// ═══════════════════════════════════════════════════════════════
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  s.addText("IN GENERAL SURGERY", { x: 0.5, y: 2.1, w: 5.0, h: 0.8, fontSize: 20, color: LIGHTGRAY, fontFace: "Arial", charSpacing: 2 });
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  s.addText("Based on S Das\nA Manual on Clinical Surgery\n13th Edition", {
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// ═══════════════════════════════════════════════════════════════
// SLIDE 2 — OVERVIEW: GENERAL SCHEME
// ═══════════════════════════════════════════════════════════════
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  const steps = [
    { num: "01", label: "History Taking",         sub: "Particulars, Complaints, Past History" },
    { num: "02", label: "Physical Examination",   sub: "General + Systemic" },
    { num: "03", label: "Special Investigations", sub: "Labs, Imaging, Biopsy" },
    { num: "04", label: "Clinical Diagnosis",     sub: "Provisional + Differential" },
    { num: "05", label: "Treatment",              sub: "Medical & Surgical" },
    { num: "06", label: "Progress & Follow-Up",   sub: "Post-op Monitoring" },
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}

// ═══════════════════════════════════════════════════════════════
// SLIDE 3 — SECTION DIVIDER: HISTORY TAKING
// ═══════════════════════════════════════════════════════════════
sectionDivider("HISTORY TAKING", "The art of patient-centred clinical interrogation");

// ═══════════════════════════════════════════════════════════════
// SLIDE 4 — PARTICULARS OF THE PATIENT
// ═══════════════════════════════════════════════════════════════
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  s.addText("01  PARTICULARS OF THE PATIENT", { x: 0.3, y: 0.1, w: 9.4, h: 0.8, fontSize: 18, bold: true, color: WHITE, fontFace: "Arial", valign: "middle" });
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  const items = [
    { label: "Name",      detail: "Builds rapport; address patient by name (e.g. 'Mr. Sirkar, how long...?') — psychological benefit pre- and post-op" },
    { label: "Age",       detail: "Congenital anomalies → birth; Wilms' tumour → infants; Sarcoma → teens; Carcinoma → >40 yrs; BPH/OA → elderly" },
    { label: "Sex",       detail: "Thyroid, movable kidney, cystitis → F; Ca stomach/lung/kidney → M; Haemophilia → M (carried by F)" },
    { label: "Religion",  detail: "Ca penis absent in Jews/Muslims (circumcision); Intussusception after Ramadan fast in Muslims" },
    { label: "Occupation",detail: "SCC bladder → aniline dye workers; Pneumoconiosis → miners; Varicose veins → prolonged standing" },
    { label: "Address",   detail: "Geographic/endemic diseases — filariasis, guinea worm; helps contact tracing" },
  ];

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}

// ═══════════════════════════════════════════════════════════════
// SLIDE 5 — CHIEF COMPLAINTS
// ═══════════════════════════════════════════════════════════════
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    { text: " — do NOT use medical jargon in the complaint list", options: { color: LIGHTGRAY } },
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    { text: " (e.g. 'Pain in abdomen × 2 months; vomiting × 1 week')", options: { color: LIGHTGRAY } },
    { text: "", options: { breakLine: true } },
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    ["S", "Site & Onset",    "Where exactly? Sudden / gradual?"],
    ["O", "Onset & Duration","When did it start? How long?"],
    ["C", "Character",       "Nature of pain/lump/discharge — dull, sharp, burning"],
    ["R", "Radiation",       "Does it spread? Which direction?"],
    ["A", "Aggravating",     "What makes it worse? Food, movement, posture?"],
    ["R", "Relieving",       "What provides relief? Drugs, rest, position?"],
    ["S", "Severity",        "Score 1–10; how does it affect daily life?"],
  ];
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// ═══════════════════════════════════════════════════════════════
// SLIDE 6 — PAIN (detailed analysis)
// ═══════════════════════════════════════════════════════════════
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  s.addText("PAIN — Detailed Analysis  (The Most Common Surgical Complaint)", {
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  const painItems = [
    { title: "Site",         body: "Ask patient to point with one finger. Superficial pain — localized; Visceral pain — diffuse, poorly localised" },
    { title: "Onset",        body: "Sudden → perforation, torsion, rupture. Gradual → inflammation, obstruction. Intermittent → colic (biliary, renal, intestinal)" },
    { title: "Character",    body: "Burning → peptic ulcer; Colicky → hollow viscus; Dull aching → solid organ; Throbbing → inflammatory/infective" },
    { title: "Radiation",    body: "Biliary → right shoulder tip; Renal → groin; Aortic aneurysm → back; Appendix → umbilicus then RIF" },
    { title: "Severity",     body: "Use pain scale 0–10; note effect on sleep, work, appetite" },
    { title: "Rel./Aggr.",   body: "Food relation (peptic ulcer); movement (peritonitis); micturition; bending (PUD vs cardiac)" },
    { title: "Assoc. Sx",    body: "N/V, fever, jaundice, change in bowel habits, hematuria, dysuria must all be actively sought" },
    { title: "Referred Pain", body: "Diaphragmatic irritation → shoulder tip (C3,4,5); Cardiac → left arm; Testicular → loin" },
  ];

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// ═══════════════════════════════════════════════════════════════
// SLIDE 7 — PAST HISTORY
// ═══════════════════════════════════════════════════════════════
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  s.addText("03  PAST HISTORY", {
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  });

  const pastItems = [
    { label: "Previous Illnesses",    text: "TB, diabetes, hypertension, jaundice, rheumatic fever, previous attacks of same complaint" },
    { label: "Previous Operations",   text: "Type, site, complications; adhesions post-laparotomy; previous anastomosis or stoma" },
    { label: "Previous Trauma",       text: "H/o fractures, head injuries, internal injuries; relevant to current presentation" },
    { label: "Drug History",          text: "Long-term steroids → immunosuppression + poor wound healing; anticoagulants → bleeding risk; NSAIDs → peptic ulcer" },
    { label: "Allergies",             text: "Drug (penicillin, sulpha), food, latex — critical before administering anaesthesia" },
    { label: "Menstrual & Obstetric", text: "LMP, parity, menopausal status — mandatory in all female patients; ectopic vs appendicitis" },
    { label: "Family History",        text: "FAP (familial adenomatous polyposis), BRCA1/2, MEN syndromes, carcinoma pattern in family" },
    { label: "Social History",        text: "Smoking (Buerger's, Ca lung), alcohol (cirrhosis, pancreatitis), travel history, sexual history" },
  ];

  pastItems.forEach((item, i) => {
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  });
}

// ═══════════════════════════════════════════════════════════════
// SLIDE 8 — SYSTEMIC INQUIRY
// ═══════════════════════════════════════════════════════════════
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  s.addText("04  SYSTEMIC INQUIRY (Review of Systems)", {
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  s.addText("Systematic questioning of each body system to uncover hidden pathology", {
    x: 0.4, y: 1.1, w: 9.2, h: 0.35, fontSize: 13, italic: true, color: MIDGRAY, fontFace: "Arial"
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  const systems = [
    { sys: "CVS",        qs: "Chest pain, palpitations, dyspnoea, ankle swelling, orthopnoea" },
    { sys: "Respiratory", qs: "Cough, haemoptysis, dyspnoea, wheeze, night sweats" },
    { sys: "GIT",        qs: "Dysphagia, nausea, vomiting, haematemesis, diarrhoea, malaena, PR bleed, altered bowel habit" },
    { sys: "GUT",        qs: "Dysuria, frequency, haematuria, urethral discharge, renal colic" },
    { sys: "CNS",        qs: "Headache, fits, LOC, weakness, paraesthesia, visual changes, hearing loss" },
    { sys: "Endo/Mets",  qs: "Weight loss, anorexia, night sweats, lumps elsewhere, bone pain — classic features of malignancy" },
    { sys: "Locomotor",  qs: "Joint pain/swelling, restricted movement, morning stiffness — rheumatoid, OA" },
    { sys: "Haematology",qs: "Easy bruising, prolonged bleeding, petechiae, lymph node enlargement" },
  ];

  systems.forEach((item, i) => {
    const col = i % 2;
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}

// ═══════════════════════════════════════════════════════════════
// SLIDE 9 — VOMITING (Important Surgical Symptom)
// ═══════════════════════════════════════════════════════════════
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  s.addText("VOMITING — History Analysis", {
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  });

  const vomItems = [
    { q: "Onset",           a: "Sudden → obstruction, raised ICP; Gradual → gastric outlet obstruction" },
    { q: "Relation to food",a: "Immediately after → gastric; 4–6 hrs after → duodenal/pyloric; Unrelated → raised ICP" },
    { q: "Nature of vomit", a: "Bile-stained → obstruction below ampulla of Vater; Faeculent → low intestinal obstruction; Undigested food → achalasia/pharyngeal pouch" },
    { q: "Blood in vomit",  a: "Haematemesis → peptic ulcer, oesophageal varices, Mallory-Weiss; 'coffee ground' → altered blood" },
    { q: "Amount",          a: "Large volume → pyloric stenosis or high small bowel obstruction" },
    { q: "Projectile",      a: "Projectile without nausea → pyloric stenosis (infants), raised ICP" },
    { q: "Associated Sx",   a: "Pain + vomiting → colic; Headache + vomiting → raised ICP; Vertigo + vomiting → Meniere's/labyrinthitis" },
  ];

  vomItems.forEach((item, i) => {
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  });
}

// ═══════════════════════════════════════════════════════════════
// SLIDE 10 — GENERAL CONDITION: HISTORY CLUES
// ═══════════════════════════════════════════════════════════════
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  s.addText("GENERAL CONDITION — Symptoms from History", {
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  });

  const gcItems = [
    { sym: "Anaemia",    detail: "Ask about pallor, weakness, fatigue, exertional dyspnoea, pica\n→ causes: GI bleed, malignancy, haemolysis, nutritional" },
    { sym: "Jaundice",   detail: "Yellow eyes/skin → obstructive (dark urine, pale stool, pruritus) vs haemolytic vs hepatocellular\nScratch marks = obstructive" },
    { sym: "Cyanosis",   detail: "Central (tongue + lips) = cardiopulmonary; Peripheral (nail beds) = vasospasm/reduced flow\nNot visible in severe anaemia (needs ≥5 g/dL reduced Hb)" },
    { sym: "Oedema",     detail: "Bilateral pitting → cardiac/hypoproteinaemia/renal; Unilateral → DVT, lymphoedema, filariasis\nAsk about puffiness of face (nephrotic)" },
    { sym: "Clubbing",   detail: "H/o chronic lung disease, cyanotic heart disease, IBD, cirrhosis, mesothelioma\nNote: not painful; ask how long nails have looked 'curved'" },
    { sym: "Lymph Nodes",detail: "Painless progressive lymphadenopathy → lymphoma, metastasis\nPainful tender nodes → reactive infection\nAsk about B-symptoms: fever, night sweats, weight loss" },
  ];

  gcItems.forEach((item, i) => {
    const col = i % 2;
    const row = Math.floor(i / 2);
    const x = col === 0 ? 0.25 : 5.2;
    const y = 1.1 + row * 1.45;
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  });
}

// ═══════════════════════════════════════════════════════════════
// SLIDE 11 — LUMP HISTORY (S Das criteria)
// ═══════════════════════════════════════════════════════════════
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  const lumpPoints = [
    ["1", "Duration",        "When first noticed? Sudden vs gradual onset"],
    ["2", "Onset",           "After trauma? Associated with pregnancy? Spontaneous?"],
    ["3", "Change in size",  "Growing, static, or reducing? Rate of growth → malignancy clue"],
    ["4", "Pain",            "Painful lumps: abscess, hernia strangulation; Painless: lipoma, Ca"],
    ["5", "Discharge",       "Pus (abscess), blood (carcinoma), mucus (fistula)"],
    ["6", "Associated Sx",   "Fever (infection), weight loss (Ca), dysphagia (neck lump → goitre)"],
    ["7", "Multiplicity",    "Single vs multiple — neurofibromatosis, lymphoma, sebaceous cysts"],
    ["8", "Previous lump",   "Recurrence after excision? Site of prior surgery (scar implant)?"],
    ["9", "Similar in family","Familial neurofibromatosis, FAP, MEN syndromes"],
    ["10","Bowel/bladder",   "Change in function associated → intra-abdominal neoplasm"],
  ];

  lumpPoints.forEach((row, i) => {
    const col = i % 2;
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  });
}

// ═══════════════════════════════════════════════════════════════
// SLIDE 12 — ULCER HISTORY
// ═══════════════════════════════════════════════════════════════
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  s.addText("HISTORY OF AN ULCER", {
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  const ulcerItems = [
    { pt: "Duration & Onset",    body: "How long? Sudden (traumatic) vs chronic (venous/neuropathic)" },
    { pt: "Site",                body: "Leg ulcers: medial malleolus (venous), lateral (arterial), sole (neuropathic/diabetic)" },
    { pt: "Pain",                body: "Painless: neuropathic (diabetes, leprosy, tabes dorsalis); Painful: arterial, traumatic" },
    { pt: "Discharge",           body: "Serous (venous), blood-stained (malignant ulcer = Marjolin's), offensive pus (infected)" },
    { pt: "Progress",            body: "Healing, static, spreading, or malignant change? (Marjolin's ulcer = Ca in chronic ulcer)" },
    { pt: "Systemic Causes",     body: "Diabetes, TB, syphilis (gummatous), vasculitis, IBD (pyoderma gangrenosum)" },
    { pt: "Bleeding",            body: "Profuse bleeding from ulcer → carcinomatous change must be suspected" },
    { pt: "Nutritional Status",  body: "Vitamin C deficiency → scurvy ulcers; protein malnutrition → poor healing" },
  ];

  ulcerItems.forEach((item, i) => {
    const col = i % 2;
    const row = Math.floor(i / 2);
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    s.addText(item.body, { x: x + 0.2, y: y + 0.4, w: 4.2, h: 0.48, fontSize: 10, color: MIDGRAY, fontFace: "Arial" });
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  });
}

// ═══════════════════════════════════════════════════════════════
// SLIDE 13 — SECTION DIVIDER: ABDOMINAL COMPLAINTS
// ═══════════════════════════════════════════════════════════════
sectionDivider("ABDOMINAL COMPLAINTS", "Key surgical history points for the abdomen");

// ═══════════════════════════════════════════════════════════════
// SLIDE 14 — BOWEL HABITS & RECTAL SYMPTOMS
// ═══════════════════════════════════════════════════════════════
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  s.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: 10, h: 1.0, fill: { color: WHITE } });
  s.addText("BOWEL HABITS & RECTAL SYMPTOMS", {
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  });

  const bowelItems = [
    { h: "Change in bowel habit", d: "Alternating constipation/diarrhoea → Ca colon until proved otherwise; progressive constipation → obstruction" },
    { h: "Constipation",          d: "Duration, onset, absolute vs relative; associated pain → obstruction; drugs (opioids, Ca blockers)" },
    { h: "Diarrhoea",             d: "Frequency, consistency, blood/mucus; night diarrhoea → organic cause; alternating → IBS vs Ca colon" },
    { h: "Rectal Bleeding",       d: "Bright red + tenesmus → haemorrhoids/fissure; mixed with stool → higher source; jet of blood → internal pile" },
    { h: "Malaena",               d: "Tarry black offensive stool = digested blood from upper GI. Must exclude right-sided colon bleeding" },
    { h: "Tenesmus",              d: "Sensation of incomplete evacuation → rectal carcinoma, proctitis, proctalgia fugax" },
    { h: "Mucus PR",              d: "Mucus alone → polyp, villous adenoma; mucus + blood → Ca rectum, ulcerative colitis, amoebic dysentery" },
    { h: "Flatus / Distension",   d: "Unable to pass flatus → complete obstruction; excessive wind → malabsorption, IBS" },
  ];

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    const col = i % 2;
    const row = Math.floor(i / 2);
    const x = col === 0 ? 0.3 : 5.2;
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  });
}

// ═══════════════════════════════════════════════════════════════
// SLIDE 15 — URINARY SYMPTOMS IN SURGICAL HISTORY
// ═══════════════════════════════════════════════════════════════
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  s.addText("URINARY SYMPTOMS IN SURGICAL HISTORY", {
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  const uriItems = [
    { sym: "Haematuria",    detail: "Painless → transitional cell Ca (bladder/kidney) until proved otherwise\nPainful → calculi, infection. Total haematuria = bladder; terminal = bladder neck/prostate; initial = urethra" },
    { sym: "Frequency",     detail: "Day + night → UTI, BPH; night only (nocturia) → BPH, DM, cardiac failure\nAsk number of times/day and/night" },
    { sym: "Dysuria",       detail: "Burning on micturition → UTI, urethritis; strangury (severe) → calculus in urethra/bladder" },
    { sym: "Poor stream",   detail: "Hesitancy, poor flow, post-void dribbling → BPH, urethral stricture, prostate Ca" },
    { sym: "Retention",     detail: "Inability to void → BPH, Ca prostate, spinal injury, drugs (anticholinergics, epidural)" },
    { sym: "Renal colic",   detail: "Severe loin-to-groin colicky pain ± haematuria → ureteric calculus. N/V + restlessness typical" },
  ];

  uriItems.forEach((item, i) => {
    const col = i % 2;
    const row = Math.floor(i / 2);
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  });
}

// ═══════════════════════════════════════════════════════════════
// SLIDE 16 — SECTION: SPECIAL SYMPTOMS
// ═══════════════════════════════════════════════════════════════
sectionDivider("SPECIAL SURGICAL SYMPTOMS", "Dysphagia, Jaundice, Itching & More");

// ═══════════════════════════════════════════════════════════════
// SLIDE 17 — DYSPHAGIA
// ═══════════════════════════════════════════════════════════════
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  s.addText("DYSPHAGIA — History Analysis", {
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  const dysItems = [
    { q: "Level",                a: "Patient can usually localise — cervical (pharyngeal pouch, web) vs retrosternal (oesophageal Ca, achalasia)" },
    { q: "Onset & Progression",  a: "Progressive dysphagia: solids first → liquids → Ca oesophagus (obstructive)\nBoth solids & liquids from start → achalasia, motility disorder" },
    { q: "Duration",             a: "Long history (years) → benign stricture, achalasia; Short (months) → carcinoma" },
    { q: "Associated pain",      a: "Odynophagia (pain on swallowing) → oesophagitis, spasm, carcinoma with ulceration" },
    { q: "Regurgitation",        a: "Undigested food (no bile, no acid) → pharyngeal pouch, achalasia\nPartially digested + acid → GORD stricture" },
    { q: "Weight loss",          a: "Marked weight loss with rapid progressive dysphagia → carcinoma of oesophagus" },
    { q: "Voice change",         a: "Hoarseness with dysphagia → recurrent laryngeal nerve involvement → mediastinal spread" },
  ];

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}

// ═══════════════════════════════════════════════════════════════
// SLIDE 18 — JAUNDICE (History)
// ═══════════════════════════════════════════════════════════════
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  s.addText("JAUNDICE — Surgical History", {
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      pts: ["Dark urine (bilirubinuria)", "Pale clay-coloured stool", "Pruritus (scratch marks)", "Progressive/painless → Ca head pancreas", "Painful + fever (Charcot triad) → cholangitis", "Right upper quadrant pain → gallstones"]
    },
    {
      type: "HEPATOCELLULAR", col: OFFWHITE, txtCol: BLACK,
      pts: ["H/o alcohol use, viral hepatitis", "Anorexia, nausea, malaise prodrome", "Mild jaundice, dark urine", "No pruritus usually", "Contact with jaundiced person", "Drug history (halothane, paracetamol)"]
    },
    {
      type: "HAEMOLYTIC", col: DARKGRAY, txtCol: WHITE,
      pts: ["Family h/o anaemia/jaundice", "Episodic (sickle cell, G6PD)", "Lemon-yellow tinge (mild)", "Dark urine absent", "Splenomegaly in family", "Gallstones (pigment) in young"]
    },
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}

// ═══════════════════════════════════════════════════════════════
// SLIDE 19 — PROVISIONAL DIAGNOSIS & DIFFERENTIAL
// ═══════════════════════════════════════════════════════════════
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  s.addText("FROM HISTORY TO PROVISIONAL DIAGNOSIS", {
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    { label: "Provisional\nDiagnosis",  x: 3.5, y: 1.65 },
    { label: "Differential\nDiagnosis", x: 6.7, y: 1.65 },
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  s.addText("Key Principles for Provisional Diagnosis from History:", {
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    "Age + sex + occupation + symptom pattern guide the most likely diagnosis",
    "Duration of symptoms guides acuity: acute vs chronic vs acute-on-chronic",
    "Always think: 'What is the most dangerous diagnosis I must not miss?'",
    "Malignancy must be actively excluded in any patient >40 with vague abdominal complaints",
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}

// ═══════════════════════════════════════════════════════════════
// SLIDE 20 — SUMMARY / TAKE-HOME POINTS
// ═══════════════════════════════════════════════════════════════
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  s.addText("TAKE-HOME POINTS", {
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  const takeHome = [
    { no: "1", msg: "Always start with patient particulars — age, sex, occupation, religion guide differential diagnoses immediately" },
    { no: "2", msg: "Chief complaints must be in the patient's own words, in chronological order, with duration for each" },
    { no: "3", msg: "Analyse each symptom (SOCRATES) before moving on — do not rush to diagnosis" },
    { no: "4", msg: "Past history, drug history, family history and social history are NOT optional — they change management" },
    { no: "5", msg: "Systemic inquiry uncovers hidden co-morbidities critical for anaesthetic and surgical risk" },
    { no: "6", msg: "In surgical practice: any painless progressive complaint in a patient >40 → suspect malignancy until excluded" },
    { no: "7", msg: "A complete, logical history is the single most important step — investigations only confirm what history suggests" },
  ];

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    s.addText(item.msg, { x: 0.85, y: y + 0.04, w: 8.9, h: 0.38, fontSize: 11.5, color: MIDGRAY, fontFace: "Arial" });
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}

// ═══════════════════════════════════════════════════════════════
// SLIDE 21 — CLOSING SLIDE
// ═══════════════════════════════════════════════════════════════
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  s.addText("IN GENERAL SURGERY", { x: 0.6, y: 2.1, w: 8.8, h: 0.7, fontSize: 22, color: LIGHTGRAY, fontFace: "Arial", align: "center", charSpacing: 3 });
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  s.addText('"Learn this scheme and make it a reflex"\n— S Das', {
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  });
}

// ─── WRITE FILE ─────────────────────────────────────────────────────────────
pres.writeFile({ fileName: "/home/daytona/workspace/history-taking-ppt/History_Taking_General_Surgery.pptx" })
  .then(() => console.log("SUCCESS: PPT created"))
  .catch(e => { console.error("ERROR:", e); process.exit(1); });

Successfully replaced 1 instance(s) of the string in '/home/daytona/workspace/history-taking-ppt/create_ppt.js'