# Articles 106-113
PARTS = {
106: [
{"title": "Clinical paths", "content": """Imaging (transvaginal ultrasound or MRI) is considered if diagnosis is uncertain or to evaluate for complications such as tubo-ovarian abscess."""},
{"title": "Diagnosis", "content": """**Diagnostic workup:**
- A wet mount of vaginal secretions is performed to assess for white blood cells and to identify or exclude trichomonas or [[239|bacterial vaginosis]]
- Gonococcal and chlamydial cervical infection are tested for
- Serological testing for HIV and syphilis is performed"""},
{"title": "Management", "content": """**First-line antibiotic regimens** (one option below is selected, then additional agents are added):

**Option 1:**
- Ceftriaxone 250 mg IM once

**Option 2:**
- Cefoxitin 2 g IM plus probenecid 1 g orally, both in a single dose concurrently

**Option 3:**
- Other parenteral third-generation cephalosporin (ceftizoxime or cefotaxime)

**PLUS:**
- Doxycycline 100 mg orally twice daily for 14 days

**WITH or WITHOUT:**
- Metronidazole 500 mg orally twice daily for 14 days"""},
],

107: [
{"title": "Clinical paths", "content": """## Severe Asthma and Status Asthmaticus

In severe asthma or status asthmaticus, endotracheal intubation is risky as these patients do not tolerate apnea well. Invasive mechanical ventilation is challenging due to air trapping, dynamic hyperinflation (auto-PEEP), risk of cardiovascular collapse, and ventilator-associated pneumonia.

Non-invasive ventilation (NIV) may be beneficial, as it can unload respiratory muscles, offset intrinsic PEEP, recruit collapsed alveoli, stent small airways, decrease airflow resistance, minimize air-trapping, and improve delivery of aerosolized bronchodilators."""},
{"title": "Diagnosis", "content": """## Poor Response to Therapy

When children do not respond to standard therapy, consider:
- Inhalation technique problems
- Poor compliance with treatment plan
- Exacerbating factors (tobacco smoke, [[245|gastroesophageal reflux]], sinusitis)
- Alternative diagnoses ([[184|cystic fibrosis]], allergic bronchopulmonary aspergillosis, vocal cord dysfunction, hypersensitivity [[150|pneumonia]], sleep apnea)"""},
{"title": "Management", "content": """## Acute Exacerbation Management

Asthma treatment is divided into two major categories:

**Relievers (as-needed therapy):**
- Short-acting beta-agonists (e.g., albuterol, levalbuterol) for quick relief of acute symptoms

**Controllers (daily maintenance therapy):**
- Inhaled corticosteroids (e.g., budesonide, fluticasone)
- Leukotriene receptor antagonists (e.g., montelukast, zileuton)
- Long-acting beta-agonists (LABAs; e.g., formoterol, salmeterol) — always paired with an inhaled corticosteroid, as LABAs alone increase morbidity
- Single maintenance and reliever therapy (SMART) using combination inhalers with ICS and LABA (formoterol)

Treatment regimens vary by age and are based on symptom severity (intermittent, mild persistent, or other classifications)."""},
{"title": "Prognosis and outcome", "content": """Approximately 5% of children require prolonged courses of corticosteroids to maintain a symptom-free period."""},
],

108: [
{"title": "Clinical paths", "content": """**Clinical assessment:**

- Sexually active adolescents and young adults are screened
- In prepubertal girls, vaginal discharge, vaginal bleeding, vulvar pruritus, pain, or erythema are assessed for
- In adolescent girls, symptoms of cervical and urethral infection (pelvic/abdominal pain, spotting, irregular vaginal bleeding) are evaluated for
- In neonates born to infected mothers, conjunctivitis or signs of [[150|pneumonia]] are examined for"""},
{"title": "Diagnosis", "content": """**Diagnostic approach:**

- Nucleic acid amplification testing (NAAT) on urine or vaginal/endocervical swabs is obtained to confirm diagnosis
- Test of cure is not performed; positive results persist for up to 3 weeks after treatment
- Retesting is planned at 3 months even in asymptomatic patients due to high reinfection risk
- Coinfection with _Neisseria gonorrhoeae_ is tested for"""},
{"title": "Management", "content": """**Note:** The reference passages do not provide specific antibiotic dosing regimens or routes of administration for treatment."""},
],

109: [
{"title": "Clinical paths", "content": """**Initial Assessment**
- Tachypnea (respiratory rate 80–100 breaths/min) with shallow, rapid breathing is confirmed
- Chest retractions (typically minimal or absent) are assessed for
- Cyanosis is evaluated for
- Maternal history is obtained: mode of delivery, labor analgesia/anesthesia, gestational diabetes, [[107|asthma]], [[92|hypertension]]"""},
{"title": "Diagnosis", "content": """**Diagnostic Workup**
- A chest radiograph is obtained to identify characteristic findings: bilateral streaky opacities, hyperinflation, possible pleural fluid
- Other diagnoses are excluded: maternal [[355|chorioamnionitis]], maternal infection, meconium staining, premature rupture of membranes, [[226|sepsis]]
- Clinical judgment is essential as radiographs cannot reliably differentiate TTN from neonatal [[150|pneumonia]]"""},
{"title": "Management", "content": """**Supportive Care**
- Normal newborn care and feeding support are provided
- Oxygen is administered for mild cyanosis as needed
- Normal oral feeding is maintained when the infant is stable
- Respiratory status and clinical improvement are monitored
- Furosemide or inhaled racemic epinephrine is not used (no proven benefit)

**Follow-up**
- In healthy asymptomatic infants, follow-up radiographs are not necessary
- Prolonged tachypnea (>72 hours) or deteriorating clinical status is investigated with further evaluation"""},
{"title": "Prognosis and outcome", "content": """Symptom resolution is expected by 12–24 hours in most infants; 74% resolve by 48 hours. Respiratory symptoms typically disappear by 3 days. Radiographic resolution occurs within 24–48 hours."""},
],

110: [
{"title": "Clinical paths", "content": """1. Diagnosis and severity are confirmed
   - Hemodynamic status and degree of [[349|anemia]] are assessed
   - Severity is categorized as mild, moderate, or severe"""},
{"title": "Diagnosis", "content": """2. Life-threatening causes are excluded
   - Urine hCG (pregnancy test) in all patients
   - Complete blood count including platelets and reticulocyte count
   - Coagulation studies: prothrombin time, partial thromboplastin time, von Willebrand panel (especially if bleeding began at menarche or is severe)
   - Thyroid function tests (free T4, TSH)
   - Sexually transmitted infections are screened for in at-risk patients

3. Additional investigations are considered
   - Pelvic ultrasound if structural pathology is suspected
   - Follicle-stimulating hormone, luteinizing hormone, prolactin as clinically indicated"""},
{"title": "Management", "content": """**Treatment**

- Acute management typically consists of hormonal therapy tailored to severity and etiology
- High-dose estrogen therapy requires concurrent antiemetic medication
- A menstrual calendar (paper or smartphone app) is maintained to monitor response to therapy"""},
],

111: [
{"title": "Clinical paths", "content": """**Screening and Evaluation**

All children aged 4 to 18 years presenting with academic or behavioral concerns are screened for ADHD and common comorbid conditions including depression, anxiety, oppositional defiant disorder, and [[286|conduct disorder]]."""},
{"title": "Diagnosis", "content": """**Diagnostic Assessment**

Three diagnostic criteria are confirmed as met:

1. Persistent pattern of inattention and/or hyperactivity-impulsivity that is developmentally inappropriate
2. Symptoms present before at least 7 years of age
3. Symptoms occurring across multiple settings (not limited to home or school alone)

The degree to which symptoms interfere with the child's social, academic, and functional performance is assessed.

**Comorbidity Screening**

When ADHD is identified or suspected, evaluation for coexisting conditions is performed:
- Reading disability
- Oppositional defiant disorder
- [[286|Conduct disorder]]
- Anxiety disorder
- Depressive disorder"""},
{"title": "Management", "content": """The passages provided do not include specific medication dosing, routes, or detailed treatment protocols beyond the identification of ADHD and its comorbidities."""},
],

112: [
{"title": "Clinical paths", "content": """**For high-risk drugs** (such as epinephrine in neonatal emergencies), it is ensured that **only one concentration is available** in the clinical area. For neonatal resuscitation, only the **dilute epinephrine solution (0.1 mg/mL)** is stocked; the concentrated solution (1 mg/mL) should not be present, as accidental use causes a 10-fold overdose."""},
{"title": "Diagnosis", "content": """**Before prescribing or preparing any medication:**

**The child's weight is confirmed** and included in all verbal and written orders.

**The concentration is verified** by showing the medication box to another team member before preparation.

**The prepared dose is checked** against a weight-based reference chart or table.

**Intravenous line patency is verified** before any medication is injected, and endotracheal tube position is confirmed before drugs are administered via that route."""},
{"title": "Management", "content": """**Closed-loop communication is used**: the drug name, dose with units, route, and child's weight are stated; the recipient is asked to repeat back the intended dose.

**For oral liquid medications**, prescribing and administration use **milliliters only**. Teaspoons or tablespoons are not used. The child's carer is given a **syringe marked in metric units** rather than a household spoon.

**Ambiguous abbreviations are avoided** and prescriptions state both the drug name and its concentration (not volume alone)."""},
],

113: [
{"title": "Clinical paths", "content": """**History and Examination**
- Detailed surgical history (dental, abdominal, cardiac) is obtained
- Travel history and prophylaxis taken are documented
- Exposures are assessed: ill contacts, animals, insect/tick bites, water sources, soil/artifacts from distant areas
- Medications (including topical and household) and dietary history (raw/undercooked meat, unpasteurized milk) are reviewed
- Physical examination is performed while febrile if possible
- Rash appearance with fever, sweating pattern, growth parameters, skin findings, conjunctivitis, dental abnormalities, pharyngeal injection, gingival changes, arthritis, bone/muscle tenderness are examined for
- Pelvic examination is performed in sexually active females
- Rectal examination is performed and stool is checked for occult blood"""},
{"title": "Diagnosis", "content": """**First-Line Investigations**
- Complete blood count
- Chest X-ray
- Urinalysis
- Blood culture
- Malarial parasite testing
- C-reactive protein

**Interpretation of CBC**
- WBC <5,000/cu mm: [[232|viral infection]], dengue, or enteric fever is suspected
- WBC <15,000/cu mm: observation is continued; if fever persists >48 hours without localizing findings, comprehensive evaluation follows

**Respiratory Symptoms**
- If prolonged upper or lower respiratory symptoms present: chest X-ray and sinus imaging (CT or plain radiography) are obtained regardless of symptom severity

**[[152|Tuberculosis]] Evaluation**
- Tuberculin skin testing and interferon gamma release assay are performed
- Note: up to 50% of disseminated TB may show negative tuberculin skin test and negative interferon gamma release assay results
- Bone marrow biopsy is considered if skin testing and lab testing are negative or inconclusive"""},
{"title": "Management", "content": """**Further Investigation**
- If initial investigations negative or inconclusive: bone marrow biopsy is considered
- Abdominal ultrasound is performed as part of comprehensive evaluation when indicated"""},
],
}