scrotal anatomy layers diagram medical education labeled image

testicular torsion hydrocele varicocele medical diagram labeled pathophysiology

ls -la /home/daytona/workspace/ && mkdir -p /home/daytona/workspace/scrotal-swel…

~/scrotal-swelling-ppt/build.js

const pptxgen = require("pptxgenjs");
const { execSync } = require("child_process");

// ─── Color Palette ───────────────────────────────────────────────────────────
const BG_DARK    = "0D1B2A";   // deep navy – dominant
const BG_MID     = "1B3A5C";   // mid navy
const ACCENT     = "00B4D8";   // teal/cyan accent
const ACCENT2    = "90E0EF";   // light teal
const WHITE      = "FFFFFF";
const LIGHT_GRAY = "E0F4FF";
const GOLD       = "FFD166";
const SOFT_RED   = "EF476F";
const GREEN      = "06D6A0";

// ─── Image URLs ──────────────────────────────────────────────────────────────
const imgUrls = [
  "https://cdn.orris.care/cdss_images/2f85765029fe65b9f3e1feb04e3b15a501ecc8ef76538f352bdc84d1ccaeea81.png", // male reproductive anatomy
  "https://cdn.orris.care/cdss_images/bc9f8cd7a5e6b9d79370607e75e4a34ecb9855d31a810e59a431e189b3d168fb.png", // age distribution chart torsion
  "https://cdn.orris.care/cdss_images/bb769a43856c7c88ca76f3979157754df1e0faba30ec63f0c12c306a2099e5d8.png", // Doppler US torsion
  "https://cdn.orris.care/cdss_images/149b1f8484a9832b49d38235cd6a3caee4b50f887e987fee7ce402e8dcff3980.png", // hydrocele types
  "https://teachmeanatomy.info/wp-content/uploads/The-Scrotum-External-Muscle-and-Contents.jpg",               // scrotum layers
  "https://cdn.lecturio.com/assets/Varicocele-hydrocele-spermatocele-scaled.jpg",                             // varicocele hydrocele comparison
];

console.log("Fetching images...");
let images;
try {
  const out = execSync(
    `node /home/daytona/skills/shared/scripts/fetch_images.js ${imgUrls.map(u => `"${u}"`).join(" ")}`,
    { timeout: 60000 }
  ).toString();
  images = JSON.parse(out);
} catch(e) {
  console.error("Image fetch error:", e.message);
  images = imgUrls.map(u => ({ url: u, base64: null, error: "fetch failed" }));
}

// helper: use base64 if available, else skip
function imgData(idx) { return images[idx] && !images[idx].error ? images[idx].base64 : null; }

// ─── Helpers ─────────────────────────────────────────────────────────────────
function addSlide(pres, bgColor) {
  const s = pres.addSlide();
  s.background = { color: bgColor || BG_DARK };
  return s;
}

function sectionTitle(s, text, y) {
  s.addText(text, {
    x: 0.4, y: y || 0.15, w: 9.2, h: 0.55,
    fontSize: 26, bold: true, color: ACCENT, fontFace: "Calibri",
    borderBottom: true, borderColor: ACCENT2, borderPt: 1.5
  });
}

function bullet(items, color) {
  color = color || WHITE;
  return items.map((t, i) => ({
    text: t,
    options: { bullet: { code: "2022" }, color, fontSize: 15, fontFace: "Calibri",
               breakLine: i < items.length - 1, paraSpaceBefore: 6 }
  }));
}

function subbullet(items, color) {
  color = color || ACCENT2;
  return items.map((t, i) => ({
    text: "  " + t,
    options: { bullet: { code: "25E6" }, color, fontSize: 13, fontFace: "Calibri",
               breakLine: i < items.length - 1, paraSpaceBefore: 3 }
  }));
}

function addInfoBox(s, x, y, w, h, title, items, titleColor, bgCol) {
  s.addShape(pres.ShapeType.roundRect, { x, y, w, h, fill: { color: bgCol || BG_MID }, line: { color: ACCENT, pt: 1.2 }, rectRadius: 0.08 });
  s.addText(title, { x: x + 0.1, y: y + 0.05, w: w - 0.2, h: 0.35, fontSize: 14, bold: true, color: titleColor || GOLD, fontFace: "Calibri" });
  s.addText(bullet(items), { x: x + 0.1, y: y + 0.38, w: w - 0.2, h: h - 0.48, fontSize: 13, fontFace: "Calibri", valign: "top" });
}

// ─── Build Presentation ──────────────────────────────────────────────────────
const pres = new pptxgen();
pres.layout = "LAYOUT_16x9";
pres.title = "Physiology of Scrotal Swelling";
pres.author = "Medical Education";

// ═══════════════════════════════════════════════════════════
// SLIDE 1 – Title Slide
// ═══════════════════════════════════════════════════════════
{
  const s = addSlide(pres, BG_DARK);
  // left accent bar
  s.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: 0.18, h: 5.625, fill: { color: ACCENT } });
  // top decorative strip
  s.addShape(pres.ShapeType.rect, { x: 0.18, y: 0, w: 9.82, h: 0.08, fill: { color: ACCENT2 } });

  s.addText("PHYSIOLOGY OF", {
    x: 0.4, y: 0.8, w: 9.2, h: 0.7,
    fontSize: 30, bold: false, color: ACCENT2, fontFace: "Calibri", charSpacing: 8
  });
  s.addText("SCROTAL SWELLING", {
    x: 0.4, y: 1.4, w: 9.2, h: 1.1,
    fontSize: 52, bold: true, color: WHITE, fontFace: "Calibri"
  });
  s.addText("A Comprehensive Guide for Medical Students", {
    x: 0.4, y: 2.5, w: 9.2, h: 0.5,
    fontSize: 20, italic: true, color: ACCENT, fontFace: "Calibri"
  });

  // horizontal divider
  s.addShape(pres.ShapeType.line, { x: 0.4, y: 3.1, w: 9.2, h: 0, line: { color: ACCENT, pt: 1.5 } });

  s.addText([
    { text: "Topics Covered: ", options: { bold: true, color: GOLD, fontSize: 15 } },
    { text: "Anatomy · Physiology · Classification · Pathophysiology · Clinical Features · Diagnosis · Management", options: { color: LIGHT_GRAY, fontSize: 14 } }
  ], { x: 0.4, y: 3.25, w: 9.2, h: 0.5, fontFace: "Calibri" });

  s.addText("Sources: Bailey & Love's Surgery | Campbell-Walsh Urology | Rosen's Emergency Medicine | Goldman-Cecil Medicine", {
    x: 0.4, y: 4.9, w: 9.2, h: 0.4,
    fontSize: 11, italic: true, color: "5A7FA8", fontFace: "Calibri"
  });
}

// ═══════════════════════════════════════════════════════════
// SLIDE 2 – Anatomy of the Scrotum
// ═══════════════════════════════════════════════════════════
{
  const s = addSlide(pres, BG_DARK);
  sectionTitle(s, "Anatomy of the Scrotum", 0.15);

  // left column - text
  s.addText([
    { text: "Layers (Superficial → Deep)\n", options: { bold: true, color: GOLD, fontSize: 16, breakLine: true } },
    ...bullet([
      "Skin – rugose, pigmented, hair-bearing",
      "Dartos muscle – smooth muscle; wrinkles skin for thermoregulation",
      "External spermatic fascia – derived from external oblique aponeurosis",
      "Cremasteric muscle & fascia – striated muscle; elevates testis",
      "Internal spermatic fascia – derived from transversalis fascia",
      "Tunica vaginalis (parietal + visceral layers)",
      "Testis & epididymis"
    ]),
  ], { x: 0.3, y: 0.8, w: 5.0, h: 4.4, valign: "top", fontFace: "Calibri" });

  // right column - image (male reproductive anatomy)
  const d1 = imgData(0);
  if (d1) {
    s.addImage({ data: d1, x: 5.5, y: 0.75, w: 4.2, h: 3.8 });
    s.addText("Testes, Epididymis & Male Reproductive System\n(Rosen's Emergency Medicine)", {
      x: 5.5, y: 4.55, w: 4.2, h: 0.6, fontSize: 10, italic: true, color: ACCENT2, align: "center", fontFace: "Calibri"
    });
  }

  // bottom note
  s.addShape(pres.ShapeType.rect, { x: 0.3, y: 5.1, w: 5.0, h: 0.35, fill: { color: BG_MID }, line: { color: ACCENT, pt: 0.5 } });
  s.addText("Key: Scrotal layers correspond to abdominal wall layers (embryological derivation)", {
    x: 0.35, y: 5.12, w: 4.9, h: 0.3, fontSize: 11, color: ACCENT2, italic: true, fontFace: "Calibri"
  });
}

// ═══════════════════════════════════════════════════════════
// SLIDE 3 – Scrotum Layers Diagram
// ═══════════════════════════════════════════════════════════
{
  const s = addSlide(pres, BG_DARK);
  sectionTitle(s, "Scrotal Wall Layers & Temperature Regulation", 0.15);

  const d5 = imgData(4); // teachmeanatomy scrotum image
  if (d5) {
    s.addImage({ data: d5, x: 0.3, y: 0.85, w: 4.5, h: 3.8 });
    s.addText("Scrotum: External Muscle & Contents\n(TeachMeAnatomy)", {
      x: 0.3, y: 4.65, w: 4.5, h: 0.45, fontSize: 10, italic: true, color: ACCENT2, align: "center", fontFace: "Calibri"
    });
  }

  // right side content
  s.addText("Thermoregulation", { x: 5.1, y: 0.85, w: 4.6, h: 0.4, fontSize: 18, bold: true, color: GOLD, fontFace: "Calibri" });
  s.addText(bullet([
    "Testicular temperature must be 2–3°C BELOW core body temperature for spermatogenesis",
    "Dartos muscle – wrinkles skin → ↓ surface area → ↓ heat loss in cold",
    "Cremasteric muscle – elevates testis toward inguinal canal in cold",
    "Pampiniform plexus – countercurrent heat exchange: arterial blood cooled by venous blood",
    "Scrotal skin is thin and loosely attached to facilitate heat dissipation",
  ]), { x: 5.1, y: 1.3, w: 4.6, h: 2.6, valign: "top", fontFace: "Calibri" });

  s.addText("Blood Supply & Innervation", { x: 5.1, y: 3.9, w: 4.6, h: 0.35, fontSize: 16, bold: true, color: GOLD, fontFace: "Calibri" });
  s.addText(bullet([
    "Arterial: anterior scrotal (ext. pudendal) + posterior scrotal (int. pudendal)",
    "Innervation: ilioinguinal n., genitofemoral n., perineal branches of pudendal n.",
  ]), { x: 5.1, y: 4.28, w: 4.6, h: 1.1, valign: "top", fontFace: "Calibri" });
}

// ═══════════════════════════════════════════════════════════
// SLIDE 4 – Classification of Scrotal Swelling
// ═══════════════════════════════════════════════════════════
{
  const s = addSlide(pres, BG_DARK);
  sectionTitle(s, "Classification of Scrotal Swelling", 0.15);

  // Age-based classification boxes
  const ageGroups = [
    { age: "Infant",     items: ["Inguinal hernia", "Hydrocele"],                        x: 0.25, color: ACCENT },
    { age: "Child",      items: ["Inguinal hernia", "Testicular torsion", "Epididymitis"], x: 2.65, color: GREEN },
    { age: "Adolescent", items: ["Epididymitis", "Testicular torsion", "Trauma"],          x: 5.05, color: GOLD },
    { age: "Adult",      items: ["Epididymitis", "Inguinal hernia", "Trauma", "Tumor", "Torsion", "Fournier gangrene"], x: 7.45, color: SOFT_RED },
  ];

  ageGroups.forEach(g => {
    s.addShape(pres.ShapeType.roundRect, { x: g.x, y: 0.82, w: 2.25, h: 4.55, fill: { color: BG_MID }, line: { color: g.color, pt: 2 }, rectRadius: 0.1 });
    s.addShape(pres.ShapeType.rect, { x: g.x, y: 0.82, w: 2.25, h: 0.5, fill: { color: g.color } });
    s.addText(g.age, { x: g.x, y: 0.84, w: 2.25, h: 0.45, fontSize: 16, bold: true, color: BG_DARK, align: "center", fontFace: "Calibri" });
    s.addText(bullet(g.items, WHITE), { x: g.x + 0.1, y: 1.4, w: 2.05, h: 3.8, valign: "top", fontFace: "Calibri" });
  });

  s.addText("Based on: Rosen's Emergency Medicine (BOX 85.5)", {
    x: 0.25, y: 5.35, w: 9.5, h: 0.25, fontSize: 10, italic: true, color: "5A7FA8", fontFace: "Calibri"
  });
}

// ═══════════════════════════════════════════════════════════
// SLIDE 5 – Pathophysiology Overview
// ═══════════════════════════════════════════════════════════
{
  const s = addSlide(pres, BG_DARK);
  sectionTitle(s, "Pathophysiology – Mechanisms of Scrotal Swelling", 0.15);

  const mechanisms = [
    { title: "Fluid Accumulation", icon: "💧", items: ["Hydrocele: fluid between visceral/parietal tunica vaginalis layers", "Communicating: patent processus vaginalis → peritoneal fluid flows in", "Non-communicating: ↑ production or ↓ lymphatic absorption"], color: ACCENT },
    { title: "Vascular", icon: "🔴", items: ["Testicular torsion: twisting of spermatic cord → venous then arterial occlusion → ischemia", "Varicocele: incompetent valves in pampiniform plexus → venous stasis", "Hematocele: blood in tunica vaginalis (trauma)"], color: SOFT_RED },
    { title: "Inflammatory", icon: "🔥", items: ["Epididymitis/orchitis: infection → edema, hyperemia, exudate", "STI (Chlamydia, Gonorrhea) in <35 yrs; enteric bacteria in >35 yrs", "Reactive hydrocele may develop secondary to infection"], color: GOLD },
    { title: "Obstructive/Mass", icon: "⬛", items: ["Hernia: bowel/omentum descends through patent processus vaginalis", "Spermatocele: cystic dilatation of efferent ductules of rete testis", "Testicular tumor: germ cell tumors – painless hard mass"], color: GREEN },
  ];

  mechanisms.forEach((m, i) => {
    const col = i % 2 === 0 ? 0.3 : 5.2;
    const row = i < 2 ? 0.82 : 3.05;
    s.addShape(pres.ShapeType.roundRect, { x: col, y: row, w: 4.6, h: 2.1, fill: { color: BG_MID }, line: { color: m.color, pt: 1.5 }, rectRadius: 0.1 });
    s.addText(`${m.title}`, { x: col + 0.1, y: row + 0.07, w: 4.4, h: 0.38, fontSize: 15, bold: true, color: m.color, fontFace: "Calibri" });
    s.addText(bullet(m.items, WHITE), { x: col + 0.1, y: row + 0.45, w: 4.4, h: 1.55, valign: "top", fontFace: "Calibri" });
  });
}

// ═══════════════════════════════════════════════════════════
// SLIDE 6 – Hydrocele Deep Dive
// ═══════════════════════════════════════════════════════════
{
  const s = addSlide(pres, BG_DARK);
  sectionTitle(s, "Hydrocele – Pathophysiology & Types", 0.15);

  // left text
  s.addText([
    { text: "Definition\n", options: { bold: true, color: GOLD, fontSize: 16, breakLine: true } },
    { text: "Abnormal collection of fluid between the parietal and visceral layers of the tunica vaginalis\n\n", options: { color: WHITE, fontSize: 14, breakLine: true } },
    { text: "Epidemiology\n", options: { bold: true, color: GOLD, fontSize: 16, breakLine: true } },
    { text: "• >80% of newborns have patent processus vaginalis\n• Most close within 18 months of age\n• Affects ~1% of adult men\n\n", options: { color: WHITE, fontSize: 14, breakLine: true } },
    { text: "Types\n", options: { bold: true, color: GOLD, fontSize: 16, breakLine: true } },
    ...bullet([
      "Communicating (congenital): patent processus vaginalis; peritoneal fluid flows in; associated with indirect inguinal hernia",
      "Non-communicating (vaginal): closed processus; ↑ fluid production or ↓ lymphatic absorption",
      "Infantile hydrocele: mid-portion of processus remains patent",
      "Hydrocele of cord: isolated fluid pocket in spermatic cord",
      "Secondary: trauma, torsion, infection, neoplasm (>40 yrs)"
    ]),
  ], { x: 0.3, y: 0.8, w: 5.3, h: 4.6, valign: "top", fontFace: "Calibri" });

  // right image - hydrocele types diagram
  const d4 = imgData(3);
  if (d4) {
    s.addImage({ data: d4, x: 5.8, y: 0.9, w: 3.9, h: 3.5 });
    s.addText("Types of Hydrocele (Bailey & Love's Surgery, Fig. 86.8)", {
      x: 5.8, y: 4.42, w: 3.9, h: 0.5, fontSize: 10, italic: true, color: ACCENT2, align: "center", fontFace: "Calibri"
    });
  }

  s.addShape(pres.ShapeType.rect, { x: 0.3, y: 5.05, w: 5.3, h: 0.38, fill: { color: "1A3A1A" }, line: { color: GREEN, pt: 0.8 } });
  s.addText("Clinical Pearl: NEVER aspirate a hydrocele if malignancy is suspected – risk of malignant needle-track implantation", {
    x: 0.35, y: 5.07, w: 5.2, h: 0.34, fontSize: 11, color: GREEN, fontFace: "Calibri", bold: true
  });
}

// ═══════════════════════════════════════════════════════════
// SLIDE 7 – Testicular Torsion
// ═══════════════════════════════════════════════════════════
{
  const s = addSlide(pres, BG_DARK);
  sectionTitle(s, "Testicular Torsion – Physiology & Emergency Management", 0.15);

  // left content
  s.addText([
    { text: "Mechanism\n", options: { bold: true, color: SOFT_RED, fontSize: 16, breakLine: true } },
    { text: "Twisting of spermatic cord → venous obstruction (first) → arterial occlusion → ischemia/infarction\n\n", options: { color: WHITE, fontSize: 14, breakLine: true } },
    { text: "Bell-Clapper Deformity\n", options: { bold: true, color: GOLD, fontSize: 15, breakLine: true } },
    { text: "High insertion of tunica vaginalis around spermatic cord → testicle hangs freely like bell clapper → predisposes to torsion\n\n", options: { color: WHITE, fontSize: 13, breakLine: true } },
    { text: "Time-Viability Window ⚠️\n", options: { bold: true, color: SOFT_RED, fontSize: 15, breakLine: true } },
    ...bullet([
      "< 6 hrs: ~100% testicular viability",
      "6–12 hrs: ~70% viability",
      "12–24 hrs: <50% viability",
      "> 24 hrs: near 0% viability → orchiectomy"
    ], ACCENT2),
    { text: "\nTreatment: Surgical detorsion + bilateral orchiopexy\n", options: { color: GREEN, bold: true, fontSize: 14, breakLine: true } },
  ], { x: 0.3, y: 0.8, w: 5.3, h: 4.7, valign: "top", fontFace: "Calibri" });

  // right side - US image + age graph
  const d3 = imgData(2); // Doppler US
  const d2 = imgData(1); // age distribution
  if (d3) {
    s.addImage({ data: d3, x: 5.8, y: 0.85, w: 3.9, h: 2.2 });
    s.addText("Doppler US: absent flow in torsed testis (Rosen's Emergency Medicine, Fig. 85.10)", {
      x: 5.8, y: 3.07, w: 3.9, h: 0.45, fontSize: 10, italic: true, color: ACCENT2, align: "center", fontFace: "Calibri"
    });
  }
  if (d2) {
    s.addImage({ data: d2, x: 5.8, y: 3.6, w: 3.9, h: 1.75 });
    s.addText("Age distribution of acute scrotal conditions (Rosen's EM, Fig. 85.9)", {
      x: 5.8, y: 5.35, w: 3.9, h: 0.28, fontSize: 9, italic: true, color: ACCENT2, align: "center", fontFace: "Calibri"
    });
  }
}

// ═══════════════════════════════════════════════════════════
// SLIDE 8 – Varicocele & Epididymitis
// ═══════════════════════════════════════════════════════════
{
  const s = addSlide(pres, BG_DARK);
  sectionTitle(s, "Varicocele & Epididymitis", 0.15);

  // varicocele box left
  s.addShape(pres.ShapeType.roundRect, { x: 0.3, y: 0.82, w: 4.6, h: 4.7, fill: { color: BG_MID }, line: { color: SOFT_RED, pt: 1.5 }, rectRadius: 0.1 });
  s.addShape(pres.ShapeType.rect, { x: 0.3, y: 0.82, w: 4.6, h: 0.45, fill: { color: SOFT_RED } });
  s.addText("VARICOCELE", { x: 0.3, y: 0.84, w: 4.6, h: 0.4, fontSize: 17, bold: true, color: WHITE, align: "center", fontFace: "Calibri" });
  s.addText([
    { text: "Definition: ", options: { bold: true, color: GOLD, fontSize: 13, breakLine: false } },
    { text: "Abnormally dilated tortuous veins of the pampiniform plexus\n\n", options: { color: WHITE, fontSize: 13, breakLine: true } },
    { text: "Pathophysiology:\n", options: { bold: true, color: GOLD, fontSize: 13, breakLine: true } },
    ...bullet([
      "Incompetent valves in left internal spermatic vein (drains into left renal vein at right angle)",
      "Left >> Right (left spermatic vein drainage angle)",
      "↑ scrotal temperature → impaired spermatogenesis",
      "Venous stasis → hypoxia of seminiferous tubules",
      "Present in 15% of males; 40% of infertile males"
    ], WHITE),
    { text: "\nGrade (Dubin & Amelar):\n", options: { bold: true, color: GOLD, fontSize: 13, breakLine: true } },
    ...bullet(["Grade I: palpable only with Valsalva", "Grade II: palpable without Valsalva", "Grade III: visible through skin ('bag of worms')"], ACCENT2),
  ], { x: 0.45, y: 1.35, w: 4.3, h: 4.1, valign: "top", fontFace: "Calibri" });

  // epididymitis box right
  s.addShape(pres.ShapeType.roundRect, { x: 5.2, y: 0.82, w: 4.6, h: 4.7, fill: { color: BG_MID }, line: { color: GOLD, pt: 1.5 }, rectRadius: 0.1 });
  s.addShape(pres.ShapeType.rect, { x: 5.2, y: 0.82, w: 4.6, h: 0.45, fill: { color: GOLD } });
  s.addText("EPIDIDYMITIS", { x: 5.2, y: 0.84, w: 4.6, h: 0.4, fontSize: 17, bold: true, color: BG_DARK, align: "center", fontFace: "Calibri" });
  s.addText([
    { text: "Pathophysiology:\n", options: { bold: true, color: GOLD, fontSize: 13, breakLine: true } },
    ...bullet([
      "Retrograde spread of bacteria from urethra/bladder via vas deferens to epididymis",
      "Starts at cauda → ascends to caput → may extend to testis (orchitis)",
      "STI (<35 yrs): Chlamydia trachomatis, N. gonorrhoeae",
      "Enteric (>35 yrs): E. coli, Klebsiella",
      "Unilateral in 96% of cases"
    ], WHITE),
    { text: "\nKey Features:\n", options: { bold: true, color: GOLD, fontSize: 13, breakLine: true } },
    ...bullet([
      "Gradual onset pain (days to weeks) – unlike torsion",
      "Cremasteric reflex: INTACT",
      "Prehn's sign positive (elevation relieves pain)",
      "Pyuria on urinalysis",
      "US: hyperechoic enlarged epididymis + ↑ blood flow on Doppler"
    ], ACCENT2),
  ], { x: 5.35, y: 1.35, w: 4.3, h: 4.1, valign: "top", fontFace: "Calibri" });
}

// ═══════════════════════════════════════════════════════════
// SLIDE 9 – Varicocele/Hydrocele Image Slide
// ═══════════════════════════════════════════════════════════
{
  const s = addSlide(pres, BG_DARK);
  sectionTitle(s, "Scrotal Conditions – Visual Comparison", 0.15);

  const d6 = imgData(5); // Lecturio varicocele/hydrocele
  if (d6) {
    s.addImage({ data: d6, x: 1.2, y: 0.85, w: 7.6, h: 4.2 });
    s.addText("Varicocele, Hydrocele & Spermatocele – Comparative Anatomy (Lecturio Medical)", {
      x: 1.2, y: 5.07, w: 7.6, h: 0.4, fontSize: 11, italic: true, color: ACCENT2, align: "center", fontFace: "Calibri"
    });
  } else {
    s.addText([
      { text: "Varicocele vs Hydrocele vs Spermatocele\n\n", options: { bold: true, color: GOLD, fontSize: 20, breakLine: true } },
      ...bullet([
        "Varicocele: dilated pampiniform veins – 'bag of worms' – left side predominant",
        "Hydrocele: fluid in tunica vaginalis – transilluminates – smooth, non-tender",
        "Spermatocele: cyst of epididymis containing spermatozoa – above/behind testis"
      ]),
    ], { x: 1.5, y: 1.5, w: 7.0, h: 3.5, valign: "middle", fontFace: "Calibri" });
  }
}

// ═══════════════════════════════════════════════════════════
// SLIDE 10 – Clinical Examination Approach
// ═══════════════════════════════════════════════════════════
{
  const s = addSlide(pres, BG_DARK);
  sectionTitle(s, "Clinical Examination of a Scrotal Swelling", 0.15);

  // 4-step boxes
  const steps = [
    { n: "1", q: "Can you get ABOVE the swelling?", a: "NO → Inguinal hernia extending into scrotum\nYES → Scrotal origin", color: ACCENT },
    { n: "2", q: "Is the testis PALPABLE separately?", a: "NO → Swelling encloses testis (hydrocele, large hernia)\nYES → Swelling is separate (epididymal cyst, spermatocele)", color: GOLD },
    { n: "3", q: "Does it TRANSILLUMINATE?", a: "YES → Clear fluid content (hydrocele, spermatocele)\nNO → Solid/blood content (tumor, hematocele, hernia)", color: GREEN },
    { n: "4", q: "Is it TENDER?", a: "YES → Inflammatory/ischaemic (torsion, epididymitis, orchitis)\nNO → Likely benign/neoplastic (hydrocele, tumor, varicocele)", color: SOFT_RED },
  ];

  steps.forEach((st, i) => {
    const x = i % 2 === 0 ? 0.3 : 5.15;
    const y = i < 2 ? 0.85 : 3.25;
    s.addShape(pres.ShapeType.roundRect, { x, y, w: 4.55, h: 2.2, fill: { color: BG_MID }, line: { color: st.color, pt: 1.8 }, rectRadius: 0.1 });
    s.addShape(pres.ShapeType.ellipse, { x: x + 0.1, y: y + 0.1, w: 0.5, h: 0.5, fill: { color: st.color } });
    s.addText(st.n, { x: x + 0.1, y: y + 0.1, w: 0.5, h: 0.5, fontSize: 18, bold: true, color: BG_DARK, align: "center", valign: "middle", fontFace: "Calibri" });
    s.addText(st.q, { x: x + 0.7, y: y + 0.12, w: 3.75, h: 0.5, fontSize: 14, bold: true, color: st.color, fontFace: "Calibri" });
    s.addText(st.a, { x: x + 0.2, y: y + 0.68, w: 4.2, h: 1.4, fontSize: 12.5, color: WHITE, fontFace: "Calibri", valign: "top" });
  });

  s.addText("Bailey & Love's Surgery: 'Examination of a scrotal swelling should be undertaken in both upright and supine position'", {
    x: 0.3, y: 5.38, w: 9.4, h: 0.28, fontSize: 10, italic: true, color: "5A7FA8", fontFace: "Calibri"
  });
}

// ═══════════════════════════════════════════════════════════
// SLIDE 11 – Differential Diagnosis Table
// ═══════════════════════════════════════════════════════════
{
  const s = addSlide(pres, BG_DARK);
  sectionTitle(s, "Differential Diagnosis – Acute Scrotum Comparison", 0.15);

  const rows = [
    ["Parameter", "Testicular Torsion", "Epididymitis", "Torsion of Appendix Testis"],
    ["Age", "< 1 yr, puberty", "Adult (STI <35 / enteric >35)", "7–14 years"],
    ["Onset", "Sudden (hours)", "Gradual (days–weeks)", "1–2 days"],
    ["Pain location", "Entire testicle + lower abdomen", "Epididymis", "Upper pole of testis"],
    ["Cremasteric reflex", "ABSENT", "Intact", "Intact"],
    ["Testis position", "High-riding, transverse", "Normal", "Normal"],
    ["Pyuria", "Rare", "Present", "No"],
    ["Fever/Systemic", "Nausea, vomiting", "Possibly fever", "None"],
    ["Doppler US", "↓ / absent flow", "↑ flow (hyperemia)", "Normal flow"],
    ["Treatment", "Surgery (URGENT)", "Antibiotics", "Supportive (analgesia)"],
  ];

  const colW = [2.1, 2.5, 2.5, 2.5];
  const colX = [0.2, 2.35, 4.9, 7.45];
  const rowH = 0.42;

  rows.forEach((row, ri) => {
    row.forEach((cell, ci) => {
      const y = 0.82 + ri * rowH;
      const isHeader = ri === 0;
      const fillColor = isHeader ? ACCENT : (ri % 2 === 0 ? BG_MID : "122035");
      const textColor = isHeader ? BG_DARK : (ci === 0 ? GOLD : WHITE);
      s.addShape(pres.ShapeType.rect, { x: colX[ci], y, w: colW[ci], h: rowH, fill: { color: fillColor }, line: { color: "1A3A5C", pt: 0.5 } });
      s.addText(cell, { x: colX[ci] + 0.08, y: y + 0.02, w: colW[ci] - 0.16, h: rowH - 0.04, fontSize: isHeader ? 13 : 11.5, bold: isHeader || ci === 0, color: textColor, fontFace: "Calibri", valign: "middle" });
    });
  });

  s.addText("Source: Rosen's Emergency Medicine, Table 85.9", {
    x: 0.2, y: 5.15, w: 9.5, h: 0.25, fontSize: 10, italic: true, color: "5A7FA8", fontFace: "Calibri"
  });
}

// ═══════════════════════════════════════════════════════════
// SLIDE 12 – Fournier Gangrene & Scrotal Masses
// ═══════════════════════════════════════════════════════════
{
  const s = addSlide(pres, BG_DARK);
  sectionTitle(s, "Special Conditions: Fournier Gangrene & Testicular Tumors", 0.15);

  // Fournier
  s.addShape(pres.ShapeType.roundRect, { x: 0.3, y: 0.82, w: 4.5, h: 4.65, fill: { color: BG_MID }, line: { color: SOFT_RED, pt: 2 }, rectRadius: 0.1 });
  s.addShape(pres.ShapeType.rect, { x: 0.3, y: 0.82, w: 4.5, h: 0.48, fill: { color: SOFT_RED } });
  s.addText("⚠ FOURNIER GANGRENE", { x: 0.3, y: 0.84, w: 4.5, h: 0.43, fontSize: 15, bold: true, color: WHITE, align: "center", fontFace: "Calibri" });
  s.addText([
    { text: "Necrotizing fasciitis of the male genitalia and perineum\n\n", options: { bold: true, color: WHITE, fontSize: 14, breakLine: true } },
    ...bullet([
      "Also known as: idiopathic gangrene of scrotum, perineal phlegmon",
      "Polymicrobial infection (mixed aerobes + anaerobes) causing synergistic gangrene",
      "Risk factors: diabetes, obesity, immunosuppression, alcohol abuse",
      "Presents: severe pain, scrotal/genital swelling, skin discolouration, crepitus, foul-smelling discharge",
      "Mortality: up to 67% if untreated",
      "Treatment: EMERGENCY – aggressive surgical debridement + broad-spectrum antibiotics + ICU"
    ], WHITE),
  ], { x: 0.45, y: 1.38, w: 4.2, h: 4.0, valign: "top", fontFace: "Calibri" });

  // Testicular tumors
  s.addShape(pres.ShapeType.roundRect, { x: 5.2, y: 0.82, w: 4.5, h: 4.65, fill: { color: BG_MID }, line: { color: ACCENT, pt: 1.5 }, rectRadius: 0.1 });
  s.addShape(pres.ShapeType.rect, { x: 5.2, y: 0.82, w: 4.5, h: 0.48, fill: { color: ACCENT } });
  s.addText("TESTICULAR TUMORS", { x: 5.2, y: 0.84, w: 4.5, h: 0.43, fontSize: 15, bold: true, color: BG_DARK, align: "center", fontFace: "Calibri" });
  s.addText([
    { text: "Most common solid malignancy in males 15–35 years\n\n", options: { bold: true, color: WHITE, fontSize: 14, breakLine: true } },
    ...bullet([
      "Typically PAINLESS, firm scrotal mass – 'rock hard'",
      "May present with dull ache or sense of heaviness",
      "Risk factors: cryptorchidism (#1), family history, Klinefelter syndrome",
      "Types: Germ cell tumors (95%) – seminoma vs non-seminoma",
      "Tumor markers: AFP, β-hCG, LDH",
      "Secondary hydrocele may accompany tumor – DO NOT aspirate",
      "Differential: epididymitis (confused clinically), hydrocele"
    ], WHITE),
    { text: "\nTreatment: Radical inguinal orchiectomy (never trans-scrotal biopsy)", options: { bold: true, color: GREEN, fontSize: 12, breakLine: true } }
  ], { x: 5.35, y: 1.38, w: 4.2, h: 4.0, valign: "top", fontFace: "Calibri" });
}

// ═══════════════════════════════════════════════════════════
// SLIDE 13 – Investigations & Diagnostics
// ═══════════════════════════════════════════════════════════
{
  const s = addSlide(pres, BG_DARK);
  sectionTitle(s, "Investigations – A Systematic Approach", 0.15);

  const invs = [
    { title: "Bedside / Clinical", color: ACCENT, x: 0.3, y: 0.82, items: [
      "Transillumination test (hydrocele = bright glow)",
      "Cremasteric reflex (absent in torsion)",
      "Prehn's sign (pain relief on elevation = epididymitis)",
      "Blue dot sign (torsion of appendix testis)"
    ]},
    { title: "Urine Analysis & Culture", color: GREEN, x: 5.2, y: 0.82, items: [
      "Pyuria → suggests epididymitis / UTI",
      "First-void urine for Chlamydia NAAT",
      "Mid-stream urine for culture & sensitivity",
      "Absent in torsion (rare pyuria)"
    ]},
    { title: "Scrotal Ultrasound (Doppler)", color: GOLD, x: 0.3, y: 3.1, items: [
      "Investigation of choice for acute scrotum",
      "Sensitivity 96–100%, specificity 84–95% for torsion",
      "'Whirlpool sign' – twisting of spermatic cord",
      "Torsion: ↓ / absent flow; Epididymitis: ↑ flow",
      "Heterogeneous echotexture = late torsion / non-viable",
      "NOTE: Do NOT delay urology consult for USS if torsion suspected"
    ]},
    { title: "Blood Tests & Tumour Markers", color: SOFT_RED, x: 5.2, y: 3.1, items: [
      "FBC: ↑ WBC in infection/Fournier's",
      "CRP/ESR: inflammation markers",
      "AFP + β-hCG + LDH: testicular germ cell tumors",
      "STI screen: Chlamydia, Gonorrhoea serology"
    ]},
  ];

  invs.forEach(inv => {
    s.addShape(pres.ShapeType.roundRect, { x: inv.x, y: inv.y, w: 4.6, h: 2.15, fill: { color: BG_MID }, line: { color: inv.color, pt: 1.5 }, rectRadius: 0.08 });
    s.addText(inv.title, { x: inv.x + 0.1, y: inv.y + 0.07, w: 4.4, h: 0.38, fontSize: 14, bold: true, color: inv.color, fontFace: "Calibri" });
    s.addText(bullet(inv.items, WHITE), { x: inv.x + 0.1, y: inv.y + 0.48, w: 4.4, h: 1.58, valign: "top", fontFace: "Calibri" });
  });
}

// ═══════════════════════════════════════════════════════════
// SLIDE 14 – Management Summary
// ═══════════════════════════════════════════════════════════
{
  const s = addSlide(pres, BG_DARK);
  sectionTitle(s, "Management Summary", 0.15);

  const mgmt = [
    { cond: "Testicular Torsion", rx: "SURGICAL EMERGENCY\n• Manual detorsion (temporary only)\n• Urgent scrotal exploration\n• Bilateral orchiopexy\n• < 6 hrs for best viability", color: SOFT_RED, urgency: "EMERGENCY" },
    { cond: "Epididymitis", rx: "ANTIBIOTICS\n• STI: ceftriaxone 250mg IM + doxycycline 100mg BD × 10 days\n• Enteric: levofloxacin 500mg OD × 10 days\n• Scrotal elevation, NSAIDs, analgesia", color: GOLD, urgency: "URGENT" },
    { cond: "Hydrocele", rx: "CONSERVATIVE / SURGICAL\n• Congenital: watch & wait (resolves by 2 yrs)\n• Symptomatic/persistent: hydrocelectomy (Lord's / Jaboulay's)\n• Aspiration: only for poor surgical candidates", color: ACCENT, urgency: "ELECTIVE" },
    { cond: "Varicocele", rx: "CONSERVATIVE / SURGICAL\n• Grade I-II: analgesia, scrotal support\n• Grade III or infertility: surgical ligation or radiological embolisation\n• Yearly surveillance for testicular atrophy", color: GREEN, urgency: "ELECTIVE" },
    { cond: "Fournier Gangrene", rx: "SURGICAL EMERGENCY\n• Aggressive wide surgical debridement\n• Broad-spectrum IV antibiotics\n• ICU admission, +/- hyperbaric oxygen\n• Mortality up to 67% without prompt treatment", color: "FF6B35", urgency: "LIFE-THREATENING" },
    { cond: "Testicular Tumor", rx: "SURGERY + ONCOLOGY\n• Radical inguinal orchiectomy (NOT trans-scrotal biopsy)\n• Staging CT chest/abdomen/pelvis\n• Seminoma: radiotherapy/chemo\n• Non-seminoma: BEP chemotherapy", color: ACCENT2, urgency: "URGENT" },
  ];

  const colW = 3.05, rowH = 1.68;
  mgmt.forEach((m, i) => {
    const x = i % 3 === 0 ? 0.2 : i % 3 === 1 ? 3.43 : 6.65;
    const y = i < 3 ? 0.82 : 2.6;
    s.addShape(pres.ShapeType.roundRect, { x, y, w: colW, h: rowH, fill: { color: BG_MID }, line: { color: m.color, pt: 1.5 }, rectRadius: 0.08 });
    s.addShape(pres.ShapeType.rect, { x, y, w: colW, h: 0.38, fill: { color: m.color } });
    s.addText(m.cond, { x: x + 0.05, y: y + 0.02, w: colW - 0.1, h: 0.34, fontSize: 12, bold: true, color: BG_DARK, align: "center", fontFace: "Calibri" });
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  s.addText("🔑 Remember: In any acute scrotum with torsion suspected – SURGICAL EXPLORATION takes priority over investigations!", {
    x: 0.3, y: 4.37, w: 9.4, h: 0.24, fontSize: 12, bold: true, color: ACCENT2, fontFace: "Calibri"
  });
}

// ═══════════════════════════════════════════════════════════
// SLIDE 15 – Key Takeaways
// ═══════════════════════════════════════════════════════════
{
  const s = addSlide(pres, BG_DARK);
  s.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: 0.18, h: 5.625, fill: { color: ACCENT } });

  sectionTitle(s, "Key Takeaways & Exam Points", 0.15);

  const points = [
    { text: "Thermoregulation: Testes must be 2–3°C below core temperature – maintained by dartos muscle, cremaster, and pampiniform plexus countercurrent exchanger", color: ACCENT },
    { text: "Testicular torsion is a TIME-SENSITIVE EMERGENCY: 'time is testis' – aim for surgical exploration within 6 hours of symptom onset", color: SOFT_RED },
    { text: "Cremasteric reflex: ABSENT in torsion, INTACT in epididymitis and appendix testis torsion – most important clinical differentiator", color: GOLD },
    { text: "Transillumination: positive in hydrocele (clear fluid) and spermatocele; negative in tumor, hematocele, hernia", color: GREEN },
    { text: "Varicocele: left-sided predominance due to left internal spermatic vein drainage angle; Grade III = 'bag of worms' appearance", color: ACCENT2 },
    { text: "Hydrocele – NEVER aspirate if malignancy suspected (risk of needle-track seeding); testicular tumor – NEVER trans-scrotal biopsy", color: SOFT_RED },
    { text: "Fournier gangrene: polymicrobial necrotizing fasciitis – up to 67% mortality → immediate surgical debridement is life-saving", color: GOLD },
    { text: "Ultrasound Doppler is the investigation of choice for acute scrotum (sensitivity 96–100% for torsion), but must NOT delay urology consult", color: GREEN },
  ];

  points.forEach((p, i) => {
    const y = 0.82 + i * 0.57;
    s.addShape(pres.ShapeType.rect, { x: 0.3, y: y, w: 0.12, h: 0.42, fill: { color: p.color } });
    s.addText(p.text, { x: 0.52, y: y + 0.02, w: 9.2, h: 0.43, fontSize: 12.5, color: WHITE, fontFace: "Calibri", valign: "middle" });
  });
}

// ─── Write file ───────────────────────────────────────────────────────────────
pres.writeFile({ fileName: "/home/daytona/workspace/scrotal-swelling-ppt/Physiology_of_Scrotal_Swelling.pptx" })
  .then(() => console.log("✅ Presentation saved successfully!"))
  .catch(e => console.error("❌ Error:", e));

cd /home/daytona/workspace/scrotal-swelling-ppt && node build.js 2>&1

~/scrotal-swelling-ppt/build.js

Successfully replaced 1 instance(s) of the string in '/home/daytona/workspace/scrotal-swelling-ppt/build.js'

cd /home/daytona/workspace/scrotal-swelling-ppt && node build.js 2>&1

ls -lh /home/daytona/workspace/scrotal-swelling-ppt/