# Articles 98-105
PARTS = {
98: [
{"title": "Clinical paths", "content": """**Assessment**

A detailed history of symptom onset, frequency, duration, and seasonal pattern is obtained. Potential allergen exposures (indoor and outdoor) are identified. Impact on sleep, school performance, and quality of life is assessed to determine severity classification."""},
{"title": "Diagnosis", "content": """Physical examination of the nasal mucosa is performed, noting turbinate swelling and color (red or pale pink-purple)."""},
{"title": "Management", "content": """**Pharmacological Treatment**

First-line agents:
- **Intranasal corticosteroids** — primary treatment option
- **Antihistamines** — available in oral and intranasal formulations
- **Leukotriene antagonists** — alternative or adjunctive therapy
- **Decongestants** — for symptomatic relief
- **Ipratropium nasal spray** — adjunctive therapy

**Non-pharmacological Measures**

- Nasal saline rinses wash away allergens
- Allergen avoidance and environmental control (removing or reducing exposure to identified triggers)
- For seasonal allergens, outdoor exposure is minimized during high pollen periods
- For perennial indoor allergens, dust mite control measures are implemented and animal dander sources are removed where possible

**Monitoring**

Response to treatment is assessed and therapy is adjusted based on symptom control and impact on quality of life. Treatment of nasal inflammation reduces associated asthma symptoms and emergency department visits in children with concurrent asthma."""},
],

99: [
{"title": "Clinical paths", "content": """A detailed history is obtained: duration of illness, frequency and character of vomiting/diarrhea, urine output, preillness weight, recent oral intake. Vital signs, general appearance, oral mucosa, respiratory pattern, eyes (sunken appearance, tears), skin turgor, and capillary refill are examined."""},
{"title": "Diagnosis", "content": """Fluid deficit is calculated: percentage dehydration × weight (kg) × 10 mL."""},
{"title": "Management", "content": """**Ongoing care:**
- Physical examination and vital signs are reassessed continually
- Urine output is monitored closely
- Ongoing losses are quantified and replaced
- Therapy is individualized based on dehydration type and severity

**Admission criteria:**
- [[161|Severe dehydration]] (>10% in infants; >6% in older children)
- Inability to keep up with ongoing losses
- Persistent hypoglycemia
- Appropriate outpatient care cannot be provided
- Etiology unclear and further workup required"""},
],

100: [
{"title": "Clinical paths", "content": """**Immediate actions:**
- Immediate cardiology consultation is obtained to direct further workup and management
- Hemodynamic monitoring is established to detect worsening cardiac function or shock
- Serial physical examinations are performed, particularly between fluid boluses, as findings may become more obvious after fluid administration"""},
{"title": "Diagnosis", "content": """**Diagnostic workup:**
- Electrocardiography (abnormal in >90% of cases)
- High-sensitivity troponin T (highly sensitive for acute myocarditis)
- Creatine phosphokinase level
- Echocardiography to assess ventricular function and identify pericardial effusion
- Chest radiography to evaluate for cardiomegaly"""},
{"title": "Management", "content": """**Supportive care:**
- Treatment remains largely supportive unless a treatable infectious pathogen is identified
- Patients with mild disease are observed for developing signs of [[285|congestive heart failure]]

**Management of congestive heart failure** (under pediatric cardiologist guidance):
- Diuretics
- Angiotensin-converting enzyme inhibitors
- Angiotensin II receptor antagonists
- Beta-blockers

**Management of arrhythmias:**
- Arrhythmias are treated with appropriate medications
- Temporary or permanent pacing is considered for persistent arrhythmias
- Implantable cardioverter-defibrillator is considered for appropriate indications"""},
],

101: [
{"title": "Clinical paths", "content": """**Motor Development Assessment**

Gross motor skills are examined by observing head control, ability to lift shoulders when prone, rolling, sitting balance, crawling, standing, and walking. Fine motor skills including visual tracking, reaching, grasping, and pincer grasp development are assessed. Findings are compared to age-appropriate milestones, noting that normal ranges exist around mean ages (e.g., walking: mean 12 months, normal range 9–17 months).

By 3 months of adjusted age, vocalization beyond crying, visual tracking, reaching attempts, arm support, and head lifting are assessed for. By 6 months of adjusted age, sitting with support, head control, and arm positioning are assessed for."""},
{"title": "Diagnosis", "content": """**Growth Monitoring**

Regular measurement and plotting of length/height and weight on appropriate growth charts is fundamental to clinical practice. For children from birth to 2 years, WHO standards are used. For children aged 2 to 19 years, CDC growth charts are used. For children with genetic conditions (Down syndrome, Turner syndrome, Noonan syndrome), condition-specific growth charts are used. Any deviation from expected centiles or the normal sequence of development requires further assessment."""},
{"title": "Management", "content": """**Early Intervention Referral**

Formal developmental surveillance should include referral to early intervention programs, particularly for extremely low birth weight infants. Routine screening tests alone are not sensitive enough to detect subtle neurodevelopmental abnormalities. The Individuals with Disabilities Education Act Part C guarantees early intervention services for eligible infants and young children."""},
],

102: [
{"title": "Clinical paths", "content": """**Recognition and initial assessment**

Prompt recognition of respiratory distress and early intervention prevent progression to respiratory failure and cardiorespiratory arrest. Clinical signs are identified: tachypnea, grunting, nasal flaring, subcostal and intercostal retractions, and cyanosis."""},
{"title": "Diagnosis", "content": """**Diagnostic confirmation**

A chest radiograph is obtained to confirm diagnosis. Poor lung expansion with homogenous ground-glass appearance and air bronchograms is looked for."""},
{"title": "Management", "content": """**Supportive care**

Supplemental oxygen is provided as needed to maintain adequate oxygenation and reduce cyanosis.

**Respiratory support**

Severe cases require positive pressure ventilation. It is initiated based on clinical severity and blood gas abnormalities (progressive hypoxemia and hypercarbia).

**Surfactant replacement therapy**

Exogenous surfactant is administered in severe cases. This is a key intervention that has significantly improved survival rates.

**Monitoring**

Oxygenation, ventilation status, and acid–base balance are continuously monitored. Response to therapy is assessed and support is adjusted accordingly."""},
],

103: [
{"title": "Clinical paths", "content": """**Initial evaluation:**

Pubertal status is determined using sexual maturity rating; this contextualizes growth velocity interpretation. A detailed history is taken including birth weight and gestational age, family history of short stature or delayed puberty, chronic illness, nutritional intake, and family dynamics.

**Distinguishing normal from pathological short stature:**

Children with normal growth velocity, normal pubertal timing, and normal bone age—particularly those with short parents or family history of delayed puberty—typically have familial short stature or constitutional growth delay and do not require extensive investigation.

Children with decreased growth velocity, abnormal pubertal timing, or delayed bone age require further evaluation for pathological causes."""},
{"title": "Diagnosis", "content": """Height is measured and plotted on age- and sex-appropriate growth charts; mid-parental target height is calculated using parental heights. Growth velocity is assessed by comparing current height to previous measurements; whether the child is following their own curve or crossing percentiles downward is determined.

A systematic physical examination is performed including:
- Head and eyes: hair quality, dysmorphism, midline defects, visual defects
- Face: tooth eruption, dysmorphic features
- Neck: webbing, goiter, low hairline
- Arm span measurement
- Hands and wrists: dermatoglyphics, abnormal fingers, [[325|rickets]]
- Chest: breast tissue, lung abnormalities
- Cardiovascular: blood pressure, heart abnormalities
- Abdomen: organomegaly, masses
- CNS: developmental assessment, features of brain tumor
- Genitalia: sexual maturity rating, hypogonadism, [[356|cryptorchidism]], micropenis
- Skin: birthmarks, pigmentation, fragility
- Body shape: muscle and fat distribution, asymmetry

**Further investigation when indicated:**

- **Bone age:** obtained if constitutional growth delay or pathological short stature is suspected
- **SHOX gene testing:** considered in idiopathic short stature; if negative, PAR1 deletion testing is pursued
- **Laboratory studies:** guided by clinical presentation and suspected etiology (thyroid function, growth hormone assessment, celiac serology, etc.)"""},
{"title": "Management", "content": """**Genetic evaluation:** Referral for genetic counseling and karyotype is made if dysmorphic features or syndromic appearance is present."""},
],

104: [
{"title": "Clinical paths", "content": """**Comprehensive Evaluation**

Assessment addresses multiple domains:
- **Medical evaluation**: Organic causes (malabsorption, maldigestion, increased metabolic demand, ineffective calorie use) are identified
- **Nutritional assessment**: Current intake is quantified and deficiencies are identified
- **Psychosocial evaluation**: Family circumstances, feeding practices, parental knowledge, and emotional factors are assessed
- **Developmental assessment**: Concurrent [[82|developmental delay]] is screened for"""},
{"title": "Diagnosis", "content": """**Growth Chart Plotting**

Accurate serial measurement and plotting are the foundation of assessment:
- Weight, length/height, and head circumference are plotted on WHO growth charts for children <2 years
- For premature infants, gestation-corrected age is used:
  - Weight: corrected until 24 months
  - Head circumference: corrected until 18 months
  - Length/height: corrected until 40 months
- Standing height is recorded as height, not recumbent length
- Crossing of percentile lines over 3–6 months or values below 3rd–5th percentile is identified"""},
{"title": "Management", "content": """**Multidisciplinary Management**

Effective intervention requires coordinated input from:
- Pediatrician or primary care provider
- Registered dietitian
- Social worker or family support specialist
- Developmental specialist as indicated

Management is sustained beyond acute phases and tailored to address the specific medical, nutritional, and psychosocial factors contributing to [[246|growth failure]] in each child and family."""},
],

105: [
{"title": "Clinical paths", "content": """**History and Examination**

A detailed history is obtained documenting:
- Timing and nature of symptoms (chronic versus acute onset)
- Temporal relationship to antigen exposure
- Seasonal patterns
- Associated cutaneous findings ([[195|atopic dermatitis]], urticaria)
- Respiratory symptoms (rhinorrhea, congestion, cough, wheezing, snoring)
- Ocular symptoms (tearing, pruritus, injection)
- Family history of allergic disease"""},
{"title": "Diagnosis", "content": """**Testing**

When drug allergy is suspected, penicillin skin testing is considered as a safe and effective evaluation tool in the pediatric population.

For suspected environmental or food allergens, allergen-specific IgE testing confirms sensitization.

**Primary [[122|Immunodeficiency]]**

When primary immunodeficiency is suspected, evaluation follows established practice parameters for diagnosis."""},
{"title": "Management", "content": """Allergen-specific IgE testing, when positive, guides management decisions. Established practice parameters also guide the management of primary immunodeficiency."""},
],
}