const {
  Document, Packer, Paragraph, TextRun, Table, TableRow, TableCell,
  HeadingLevel, AlignmentType, BorderStyle, WidthType, VerticalAlign,
  ShadingType, PageBreak, UnderlineType
} = require('docx');
const fs = require('fs');

// ─── STYLE HELPERS ───────────────────────────────────────────────────────────
const H1 = (text) => new Paragraph({
  text, heading: HeadingLevel.HEADING_1,
  spacing: { before: 360, after: 120 },
  pageBreakBefore: true
});
const H2 = (text) => new Paragraph({
  text, heading: HeadingLevel.HEADING_2,
  spacing: { before: 240, after: 80 }
});
const H3 = (text) => new Paragraph({
  text, heading: HeadingLevel.HEADING_3,
  spacing: { before: 160, after: 60 }
});
const P = (text) => new Paragraph({
  children: [new TextRun({ text, size: 22 })],
  spacing: { after: 60 }
});
const BOLD = (text) => new TextRun({ text, bold: true, size: 22 });
const NORMAL = (text) => new TextRun({ text, size: 22 });
const PB = (label, value) => new Paragraph({
  spacing: { after: 50 },
  children: [
    new TextRun({ text: label + ': ', bold: true, size: 22 }),
    new TextRun({ text: value, size: 22 })
  ]
});
const BULLET = (text, level = 0) => new Paragraph({
  children: [new TextRun({ text, size: 22 })],
  bullet: { level },
  spacing: { after: 40 }
});
const SUBBULLET = (text) => BULLET(text, 1);

// Table builder
function makeTable(headers, rows, colWidths) {
  const defaultShading = { type: ShadingType.CLEAR, color: 'auto', fill: 'FFFFFF' };
  const headerShading = { type: ShadingType.SOLID, color: 'auto', fill: '1F4E79' };

  const headerRow = new TableRow({
    children: headers.map((h, i) => new TableCell({
      width: { size: colWidths ? colWidths[i] : Math.floor(9000 / headers.length), type: WidthType.DXA },
      shading: headerShading,
      verticalAlign: VerticalAlign.CENTER,
      children: [new Paragraph({
        alignment: AlignmentType.CENTER,
        children: [new TextRun({ text: h, bold: true, color: 'FFFFFF', size: 20 })]
      })]
    }))
  });

  const dataRows = rows.map((row, ri) => new TableRow({
    children: row.map((cell, ci) => new TableCell({
      width: { size: colWidths ? colWidths[ci] : Math.floor(9000 / headers.length), type: WidthType.DXA },
      shading: { type: ShadingType.CLEAR, color: 'auto', fill: ri % 2 === 0 ? 'EBF3FB' : 'FFFFFF' },
      verticalAlign: VerticalAlign.CENTER,
      children: [new Paragraph({
        children: [new TextRun({ text: String(cell), size: 20 })]
      })]
    }))
  }));

  return new Table({
    width: { size: 9000, type: WidthType.DXA },
    rows: [headerRow, ...dataRows],
    margins: { top: 60, bottom: 60, left: 80, right: 80 }
  });
}

// ─── CONTENT ─────────────────────────────────────────────────────────────────
const children = [];

// TITLE PAGE
children.push(
  new Paragraph({
    children: [new TextRun({ text: 'PEDIATRICS', bold: true, size: 52, color: '1F4E79' })],
    alignment: AlignmentType.CENTER,
    spacing: { before: 1440, after: 240 }
  }),
  new Paragraph({
    children: [new TextRun({ text: 'High-Yield Study Notes', bold: true, size: 36, color: '2E75B6' })],
    alignment: AlignmentType.CENTER,
    spacing: { after: 240 }
  }),
  new Paragraph({
    children: [new TextRun({ text: 'Comprehensive Exam Preparation', size: 28, italics: true, color: '444444' })],
    alignment: AlignmentType.CENTER,
    spacing: { after: 1440 }
  })
);

// ══════════════════════════════════════════════════════════════════════════════
// SECTION 1: GROWTH & DEVELOPMENT
// ══════════════════════════════════════════════════════════════════════════════
children.push(H1('SECTION 1: GROWTH & DEVELOPMENT'));

// 1.1 Developmental Milestones
children.push(H2('1.1 Developmental Milestones'));
children.push(P('Developmental milestones are age-specific skills in 4 domains: Gross Motor, Fine Motor/Adaptive, Language, and Social/Personal.'));

children.push(makeTable(
  ['Age', 'Gross Motor', 'Fine Motor', 'Language', 'Social/Personal'],
  [
    ['2 months', 'Lifts head prone', 'Hands unfisted 50%', 'Coos', 'Social smile'],
    ['4 months', 'Head steady, rolls F→B', 'Reaches, grasps rattle', 'Laughs, squeals', 'Recognizes parents'],
    ['6 months', 'Sits with support, rolls B→F', 'Transfers objects', 'Babbles (ma, da)', 'Stranger anxiety starts'],
    ['9 months', 'Crawls, pulls to stand', 'Pincer grasp (crude)', 'Mama/dada nonspecific', 'Peek-a-boo, waves bye'],
    ['12 months', 'Walks with support', 'Neat pincer grasp', 'Mama/dada specific, 1-2 words', 'Imitates actions'],
    ['15 months', 'Walks alone', 'Stacks 2 blocks', '4-6 words', 'Feeds self with spoon'],
    ['18 months', 'Runs (stiff)', 'Stacks 3-4 blocks', '10-25 words', 'Temper tantrums'],
    ['2 years', 'Runs well, up stairs', 'Stacks 6 blocks, copies line', '50+ words, 2-word phrases', 'Parallel play'],
    ['3 years', 'Tricycle, jumps', 'Copies circle, uses scissors', '250 words, 3-word sentences', 'Group play, shares'],
    ['4 years', 'Hops on 1 foot', 'Copies cross (+)', 'Tells stories, counts 1-10', 'Cooperative play'],
    ['5 years', 'Skips', 'Copies triangle, ties shoelaces', 'Full sentences, prints name', 'Competitive games'],
    ['6 years', 'Rides bike', 'Copies diamond', 'Reads simple text', 'Rules understanding'],
  ],
  [900, 1700, 1700, 1700, 1700]
));

children.push(H3('Key Red Flags (Developmental Delay)'));
children.push(BULLET('No social smile by 3 months'));
children.push(BULLET('No babbling by 12 months'));
children.push(BULLET('No single words by 18 months'));
children.push(BULLET('No 2-word phrases by 24 months'));
children.push(BULLET('Loss of previously acquired skills at any age - always pathological'));
children.push(BULLET('Persistent asymmetric tonic neck reflex after 6 months'));

// 1.2 Anthropometry & Growth Charts
children.push(H2('1.2 Anthropometry, Growth Charts & X-ray Wrist'));
children.push(H3('Normal Growth Parameters'));
children.push(makeTable(
  ['Parameter', 'At Birth', '6 months', '1 year', '2 years', 'Formula'],
  [
    ['Weight', '3 kg', '6 kg', '9 kg (3×)', '12 kg', 'Age 3-12y: (Age×2)+8 kg'],
    ['Height', '50 cm', '65 cm', '75 cm', '87 cm', 'Age 2-12y: (Age×6)+77 cm'],
    ['Head Circumference', '33-35 cm', '43 cm', '47 cm', '49 cm', '~50 cm by 1 year'],
    ['Chest Circumference', '30-33 cm', '—', '= HC at 1yr', '> HC after 1yr', 'HC > CC until 1 year'],
  ],
  [1800, 1400, 1400, 1400, 2000]
));

children.push(H3('Weight Rules of Thumb'));
children.push(BULLET('Birth weight DOUBLES by 5-6 months'));
children.push(BULLET('Birth weight TRIPLES by 1 year'));
children.push(BULLET('Birth weight QUADRUPLES by 2 years'));
children.push(BULLET('Preterm: loses up to 10% in first week, regains by 10-14 days'));

children.push(H3('Growth Charts'));
children.push(BULLET('WHO charts (0-5 years): breastfed infants as standard'));
children.push(BULLET('CDC charts (2-20 years): descriptive of US children'));
children.push(BULLET('<3rd percentile OR crossing 2 major percentile lines = growth faltering'));
children.push(BULLET('Mid-parental height (MPH): Boys = (Father + Mother + 13)/2; Girls = (Father + Mother - 13)/2'));

children.push(H3('X-ray Wrist - Bone Age'));
children.push(BULLET('Greulich & Pyle atlas: compare left wrist AP X-ray to standards'));
children.push(BULLET('Bone age < chronological age: Growth hormone deficiency, hypothyroidism, malnutrition'));
children.push(BULLET('Bone age > chronological age: Precocious puberty, congenital adrenal hyperplasia'));
children.push(BULLET('Ossification centers in hand - "CRITOE" for elbow: Capitellum(1), Radial head(3), Internal(medial) epicondyle(5), Trochlea(7), Olecranon(9), External(lateral) epicondyle(11) - ages in years'));

children.push(H3('Dentition'));
children.push(makeTable(
  ['Teeth', 'Primary (months)', 'Permanent (years)'],
  [
    ['Central Incisors', '6-8 months (lower first)', '6-7 years'],
    ['Lateral Incisors', '9-13 months', '7-8 years'],
    ['Canines (cuspids)', '16-23 months', '9-12 years'],
    ['First Molars', '12-19 months', '6-7 years'],
    ['Second Molars', '24-33 months', '11-13 years'],
    ['Third Molars (wisdom)', '—', '17-21 years'],
  ],
  [2500, 2500, 2500]
));
children.push(BULLET('Total primary teeth: 20 (eruption complete by ~2.5 years)'));
children.push(BULLET('Total permanent teeth: 32 (wisdom teeth may be absent)'));
children.push(BULLET('First tooth appears ~6-7 months; mnemonic: number of teeth = age in months - 6 (up to 2 years)'));

// 1.3 Tanner Staging
children.push(H2('1.3 Tanner Staging & Puberty'));
children.push(H3('Female Puberty Sequence: THELARCHE → PUBARCHE → GROWTH SPURT → MENARCHE'));
children.push(P('Average age of onset: 8-13 years. Thelarche is the FIRST sign in girls.'));
children.push(makeTable(
  ['Stage', 'Breast (Female)', 'Pubic Hair', 'Male Genitalia'],
  [
    ['I', 'Prepubertal', 'None', 'Prepubertal (<3.5 cm testes)'],
    ['II', 'Breast budding (thelarche, ~8-13yr)', 'Sparse, straight, labia/base of penis', 'Testicular enlargement (>3.5 cm) - FIRST sign in males'],
    ['III', 'Breast/areola enlarge together', 'Darker, curlier, spreads over junction', 'Penile lengthening, scrotal darkening'],
    ['IV', 'Secondary mound of areola', 'Adult type, not spread to thighs', 'Penile breadth increases, adult testes'],
    ['V', 'Adult contour, areola recedes', 'Adult distribution, spread to thighs', 'Adult size'],
  ],
  [700, 2200, 2200, 2400]
));

children.push(H3('Male Puberty'));
children.push(BULLET('Onset: 9-14 years. First sign = TESTICULAR ENLARGEMENT (>3.5 cm / 4 mL volume)'));
children.push(BULLET('Sequence: Testicular enlargement → Pubic hair → Penile growth → Growth spurt → Spermarche → Axillary hair → Voice change'));
children.push(BULLET('Growth spurt: Girls peak ~12 years; Boys peak ~14 years (gain 8-14 cm/yr)'));
children.push(BULLET('Menarche occurs ~2.5 years after thelarche (Tanner stage II→IV)'));

children.push(H3('Precocious & Delayed Puberty'));
children.push(BULLET('Precocious puberty: Puberty before 8 years (girls) or 9 years (boys)'));
children.push(SUBBULLET('Central (GnRH-dependent): pulsatile LH/FSH - idiopathic (80% of girls), CNS tumors/lesions'));
children.push(SUBBULLET('Peripheral (GnRH-independent): McCune-Albright, CAH, adrenal/gonadal tumors, exogenous sex steroids'));
children.push(BULLET('Delayed puberty: No puberty by 13 years (girls) or 14 years (boys)'));
children.push(SUBBULLET('Most common cause: Constitutional delay (boys > girls)'));

// 1.4 Malnutrition
children.push(H2('1.4 Malnutrition'));
children.push(H3('Classification (WHO/Wellcome)'));
children.push(makeTable(
  ['Type', 'Weight for Age', 'Edema', 'Key Features'],
  [
    ['Kwashiorkor', '60-80% of expected', 'PRESENT', 'Protein deficiency. Edema, skin lesions (flaky paint), hair changes (flag sign), fatty liver, moon face, irritable'],
    ['Marasmus', '<60% of expected', 'ABSENT', 'Calorie deficiency. Severe wasting, monkey facies, baggy pants appearance, alert but apathetic'],
    ['Marasmic-Kwashiorkor', '<60% of expected', 'PRESENT', 'Mixed - worst prognosis'],
    ['Undernutrition (mild)', '80-90%', 'Absent', 'Grade I'],
    ['Undernutrition (moderate)', '70-80%', 'Absent', 'Grade II'],
    ['Severe undernutrition', '<70%', 'Absent', 'Grade III (Gomez classification)'],
  ],
  [1600, 1500, 1200, 4200]
));

children.push(H3('Anthropometric Indices'));
children.push(BULLET('Wasting (acute): Weight-for-Height <-2 SD → severe wasting <-3 SD'));
children.push(BULLET('Stunting (chronic): Height-for-Age <-2 SD → severe stunting <-3 SD'));
children.push(BULLET('Underweight: Weight-for-Age <-2 SD'));
children.push(BULLET('MUAC (mid-upper arm circumference): Red (<11.5 cm) = SAM; Yellow (11.5-12.5 cm) = MAM; Green (>12.5 cm) = normal (for 6-59 months)'));
children.push(BULLET('SAM (Severe Acute Malnutrition): MUAC <11.5 cm OR WHZ <-3 SD OR bilateral pitting edema'));

children.push(H3('Management of SAM (F-75, F-100 Protocol)'));
children.push(BULLET('Phase 1 (Stabilization, days 1-7): F-75 (75 kcal/100 mL), treat infections, electrolytes, no iron yet'));
children.push(BULLET('Phase 2 (Rehabilitation, weeks 2-6): F-100 (100 kcal/100 mL) or RUTF, iron supplementation'));
children.push(BULLET('10 Steps: Hypoglycemia, Hypothermia, Dehydration, Electrolytes, Infections, Micronutrients, Initiate feeding, Catch-up growth, Sensory stimulation, Follow-up'));
children.push(BULLET('Refeeding syndrome risk: hypophosphatemia - avoid rapid refeeding'));

// 1.5 Breastfeeding
children.push(H2('1.5 Breastfeeding'));
children.push(BULLET('WHO recommendation: Exclusive breastfeeding for 6 months; continue with complementary feeding up to 2 years'));
children.push(BULLET('Colostrum (days 1-3): High IgA, protein, low fat/lactose; YELLOW, thick; first immunization'));
children.push(BULLET('Foremilk: Watery, high lactose, quenches thirst'));
children.push(BULLET('Hindmilk: High fat content, satisfies hunger'));
children.push(H3('Benefits of Breastfeeding'));
children.push(BULLET('Infant: Protective against SIDS, otitis media, gastroenteritis, NEC, allergies, obesity, Type 1 DM'));
children.push(BULLET('Mother: Reduces risk of breast cancer, ovarian cancer, post-partum depression, promotes uterine involution'));
children.push(H3('Contraindications to Breastfeeding'));
children.push(BULLET('Absolute: HIV (in resource-rich settings), active TB (untreated), HTLV-1, galactosemia (infant), maternal chemotherapy/radioactive agents'));
children.push(BULLET('NOT contraindications: Hepatitis B (vaccinate infant), CMV, mastitis (continue feeding), mild maternal illness'));
children.push(BULLET('Complementary foods: Introduce at 6 months; semi-solid, soft foods; iron-rich foods important'));

// ══════════════════════════════════════════════════════════════════════════════
// SECTION 2: VACCINES & NEONATOLOGY
// ══════════════════════════════════════════════════════════════════════════════
children.push(H1('SECTION 2: VACCINES & NEONATOLOGY'));

// 2.1 Vaccines
children.push(H2('2.1 Vaccines - Types, Strains & NIS'));
children.push(H3('Types of Vaccines'));
children.push(makeTable(
  ['Type', 'Examples', 'Key Features'],
  [
    ['Live attenuated', 'BCG, OPV (Sabin), MMR, Varicella, Yellow fever, Rotavirus, Typhoid (oral)', 'Single dose often sufficient; cannot give to immunocompromised; require cold chain; best immunity'],
    ['Killed/Inactivated', 'IPV (Salk), Hepatitis A, Rabies, Influenza (inj.), Cholera (inj.)', 'Multiple doses needed; safe in immunocompromised; less immunogenic'],
    ['Toxoid', 'Diphtheria (D), Tetanus (T)', 'Treats exotoxin; stable; require boosters'],
    ['Subunit/Recombinant', 'Hepatitis B, HPV, Pertussis (acellular - aP), Pneumococcal (PCV), Meningococcal', 'Very safe; may need adjuvants; newer technology'],
    ['Polysaccharide', 'PPSV23 (pneumococcal), Typhoid (Vi), Meningococcal (MPSV4)', 'T-independent response; ineffective <2 years; no memory'],
    ['Conjugate', 'PCV13/15/20, Hib, MCV4 (meningococcal)', 'T-dependent response; effective <2 years; forms memory; preferred over polysaccharide'],
  ],
  [1600, 2400, 3500]
));

children.push(H3('India National Immunization Schedule (NIS) - Key Vaccines'));
children.push(makeTable(
  ['Age', 'Vaccine', 'Route/Site', 'Dose'],
  [
    ['Birth', 'BCG + OPV-0 + Hep B-1', 'BCG: ID (left arm) | OPV: Oral | Hep B: IM', 'BCG: 0.05 mL (<1m), 0.1 mL (>1m)'],
    ['6 weeks', 'OPV-1 + Penta-1 (DPT+HepB+Hib) + PCV-1 + Rota-1', 'IM/Oral', 'Standard doses'],
    ['10 weeks', 'OPV-2 + Penta-2 + PCV-2 + Rota-2', 'IM/Oral', 'Standard doses'],
    ['14 weeks', 'OPV-3 + Penta-3 + PCV-3 + Rota-3 + IPV-1', 'IM/Oral/ID', 'Standard doses'],
    ['9 months', 'MR vaccine (Measles-Rubella) + OPV Booster + Vitamin A (1st dose)', 'SC/Oral', 'MR: 0.5 mL SC'],
    ['12 months', 'PCV Booster', 'IM', '—'],
    ['16-24 months', 'DPT B1 + OPV B1 + MR-2 + Vitamin A (2nd dose)', 'IM/SC/Oral', '—'],
    ['5-6 years', 'DPT B2', 'IM', '—'],
    ['10 years', 'Td (Tetanus-diphtheria adult)', 'IM', '—'],
    ['16 years', 'Td booster', 'IM', '—'],
  ],
  [1200, 2200, 2200, 1900]
));

children.push(H3('Key Vaccine Facts - High Yield'));
children.push(BULLET('BCG: Protects against miliary TB and TB meningitis in children (not pulmonary TB); gives tuberculin sensitivity'));
children.push(BULLET('OPV strains: Sabin type 1, 2, 3 (VAPP risk ~1:750,000 first dose; switch to IPV now)'));
children.push(BULLET('Cold chain: -15 to -25°C (OPV, Varicella); 2-8°C (most vaccines); never freeze toxoids or killed vaccines'));
children.push(BULLET('Contraindication: Live vaccines in immunocompromised, pregnancy, within 3 months of immunoglobulin'));
children.push(BULLET('Rotavirus: Oral; 1st dose before 15 weeks; all 3 doses before 32 weeks'));
children.push(BULLET('Vitamin A supplementation: 9 months (1,00,000 IU), then every 6 months up to 5 years (2,00,000 IU)'));

// 2.2 IUGR & Neonatology
children.push(H2('2.2 IUGR & Neonatology'));
children.push(H3('IUGR - Intrauterine Growth Restriction'));
children.push(PB('Definition', 'Birth weight <10th percentile for gestational age'));
children.push(makeTable(
  ['Feature', 'Symmetric IUGR', 'Asymmetric IUGR'],
  [
    ['Timing', 'Early (1st trimester)', 'Late (3rd trimester)'],
    ['Cause', 'Chromosomal, TORCH, alcohol, radiation', 'Uteroplacental insufficiency, PIH, malnutrition'],
    ['Head circumference', 'Reduced (head sparing ABSENT)', 'Normal (head sparing PRESENT)'],
    ['HC/AC ratio', 'Normal (both reduced)', 'Increased (head>abdomen)'],
    ['Brain', 'Affected', 'Spared (brain sparing effect)'],
    ['Prognosis', 'Poorer', 'Better'],
    ['Ponderal Index', 'Normal', 'Reduced'],
  ],
  [2200, 2900, 2900]
));

children.push(H3('Classification by Birth Weight/Gestational Age'));
children.push(BULLET('LBW (Low Birth Weight): <2500 g'));
children.push(BULLET('VLBW (Very Low Birth Weight): <1500 g'));
children.push(BULLET('ELBW (Extremely Low Birth Weight): <1000 g'));
children.push(BULLET('Preterm: <37 weeks gestational age (premature)'));
children.push(BULLET('SGA (Small for Gestational Age): Weight <10th percentile'));
children.push(BULLET('LGA (Large for Gestational Age): Weight >90th percentile'));
children.push(BULLET('Post-term: ≥42 weeks'));

// 2.3 Fontanelles & Sutures
children.push(H2('2.3 Fontanelles & Sutures'));
children.push(makeTable(
  ['Fontanelle', 'Shape', 'Size at Birth', 'Closure Age'],
  [
    ['Anterior (bregma)', 'Diamond/rhomboid', '3×2 cm', '12-18 months (range 4-26 months)'],
    ['Posterior (lambda)', 'Triangular', '0.5-1 cm', '6-8 WEEKS (by 3 months)'],
    ['Sphenoidal (anterolateral)', 'Irregular', 'Small', '6 months'],
    ['Mastoid (posterolateral)', 'Irregular', 'Small', '6-18 months'],
  ],
  [2000, 1800, 2000, 3200]
));
children.push(H3('Clinical Significance'));
children.push(BULLET('Bulging AF: Raised ICP (meningitis, hydrocephalus, Vit A toxicity, hypothyroidism)'));
children.push(BULLET('Sunken AF: Dehydration'));
children.push(BULLET('Large/Late-closing AF: Hypothyroidism, Down syndrome, rickets, achondroplasia'));
children.push(BULLET('Early closure (craniosynostosis): Restricted brain growth, raised ICP'));
children.push(BULLET('Sutures: Coronal, sagittal, lambdoid, metopic; ridging = premature fusion'));

// 2.4 APGAR & Ballard Score
children.push(H2('2.4 APGAR & Ballard Score'));
children.push(H3('APGAR Score (assessed at 1 and 5 minutes)'));
children.push(makeTable(
  ['Sign', 'Score 0', 'Score 1', 'Score 2'],
  [
    ['A - Appearance (color)', 'Blue/pale all over', 'Blue extremities, pink body', 'Pink all over'],
    ['P - Pulse (heart rate)', 'Absent', '<100 bpm', '≥100 bpm'],
    ['G - Grimace (reflex)', 'No response', 'Grimace', 'Cough/sneeze/cry'],
    ['A - Activity (muscle tone)', 'Limp', 'Some flexion', 'Active motion'],
    ['R - Respiration', 'Absent', 'Weak, irregular', 'Strong cry'],
  ],
  [1800, 2200, 2200, 2200]
));
children.push(BULLET('Normal: 7-10 | Mild depression: 4-6 | Severe depression: 0-3'));
children.push(BULLET('1 min score: Indicates need for immediate resuscitation'));
children.push(BULLET('5 min score: Prognosis; if <7, repeat every 5 min up to 20 min'));
children.push(BULLET('APGAR does NOT guide resuscitation - resuscitation begins if not breathing regardless of score'));

children.push(H3('New Ballard Score - Gestational Age Assessment'));
children.push(BULLET('Used for preterm infants <34 weeks; most accurate if done within 12-20 hours of birth'));
children.push(BULLET('Two components: Neuromuscular maturity (6 criteria) + Physical maturity (6 criteria)'));
children.push(BULLET('Neuromuscular: Posture, Square window (wrist), Arm recoil, Popliteal angle, Scarf sign, Heel-to-ear'));
children.push(BULLET('Physical: Skin, Lanugo, Plantar surface, Breast, Eye/Ear, Genitals'));
children.push(BULLET('Score range: -10 to 50; GA = (score/2) + 20... (approximated from chart)'));
children.push(BULLET('Preterm skin features: Thin, transparent, gelatinous; Post-term: Leathery, cracked'));

// 2.5 Caput vs Cephalhematoma
children.push(H2('2.5 Caput Succedaneum vs Cephalhematoma'));
children.push(makeTable(
  ['Feature', 'Caput Succedaneum', 'Cephalhematoma'],
  [
    ['Definition', 'Edema/serum collection above periosteum', 'Blood between periosteum and skull bone (subperiosteal)'],
    ['Suture crossing', 'CROSSES sutures', 'DOES NOT cross sutures'],
    ['Onset', 'Present at birth', 'Appears hours to days after birth'],
    ['Swelling', 'Diffuse, poorly demarcated', 'Localized, firm, well-demarcated'],
    ['Consistency', 'Pitting edema/soft', 'Fluctuant, may calcify'],
    ['Resolution', 'Days', 'Weeks to months (6-8 weeks)'],
    ['Complications', 'Rare', 'Jaundice (RBC breakdown), anemia, skull fracture (25% cases)'],
    ['Bilateral', 'Can be', 'Usually unilateral'],
  ],
  [1500, 3500, 3500]
));
children.push(BULLET('Subgaleal hemorrhage: MOST dangerous - crosses sutures, large blood loss, hypovolemic shock'));

// 2.6 Neonatal Reflexes & Resuscitation
children.push(H2('2.6 Neonatal Reflexes & Resuscitation'));
children.push(H3('Primitive Reflexes'));
children.push(makeTable(
  ['Reflex', 'Elicitation', 'Appears', 'Disappears'],
  [
    ['Moro (startle)', 'Sudden head drop/loud noise; abduction then adduction of arms', 'Birth', '4-6 months'],
    ['Rooting', 'Stroke cheek → turns toward stimulus', 'Birth', '3-4 months (awake), 7-8 months (asleep)'],
    ['Sucking', 'Stimulus on lips/palate', 'Birth (28 wks)', '4 months voluntarily'],
    ['Grasp (palmar)', 'Pressure on palm → finger flexion', 'Birth', '4-6 months (palmar), 9-12 months (plantar)'],
    ['Tonic neck (ATNR)', 'Turn head → fencing posture (same side extends)', 'Birth-6 wks', '4-6 months'],
    ['Babinski', 'Stroke lateral sole → big toe extension', 'Birth', '12-18 months'],
    ['Stepping/Walking', 'Hold upright, feet touch surface → stepping', 'Birth', '2-3 months'],
    ['Landau', 'Prone suspension → head/legs extend', '3-4 months', '12-18 months'],
    ['Parachute', 'Tilt forward → arms extend for protection', '6-9 months', 'Persists'],
  ],
  [1500, 3000, 1500, 2000]
));
children.push(BULLET('ABSENT Moro = important sign of neurological dysfunction; ASYMMETRIC Moro = Erb palsy or clavicle fracture'));

children.push(H3('Neonatal Resuscitation (NRP Protocol)'));
children.push(BULLET('Initial steps (30 sec): Warm, Dry, Stimulate; assess Tone, Breathing, Heart Rate'));
children.push(BULLET('If HR <100 or apnea: Positive Pressure Ventilation (PPV) with 21% O2; rate 40-60 breaths/min'));
children.push(BULLET('If HR <60 despite 30 sec PPV: Chest compressions (3:1 ratio with PPV) + 100% O2'));
children.push(BULLET('If HR still <60: Epinephrine (0.01-0.03 mg/kg IV) or endotracheal epinephrine (0.05-0.1 mg/kg)'));
children.push(BULLET('Ventilation is the MOST important step in neonatal resuscitation'));
children.push(BULLET('Meconium-stained fluid: Suction ONLY if infant is not vigorous (limp, HR <100, poor resp)'));

// ══════════════════════════════════════════════════════════════════════════════
// SECTION 3: CHROMOSOMAL & GENETIC SYNDROMES
// ══════════════════════════════════════════════════════════════════════════════
children.push(H1('SECTION 3: CHROMOSOMAL & GENETIC SYNDROMES'));

children.push(makeTable(
  ['Syndrome', 'Karyotype', 'Maternal Age', 'Clinical Features', 'Key Associations'],
  [
    ['Down (Trisomy 21)', '47,XX/XY +21 (95% non-disjunction; 4% translocation 14;21; 1% mosaic)', 'Increases with age >35', 'Flat face, upslanting palpebral fissures, epicanthal folds, single palmar crease, brushfield spots, hypotonia, protruding tongue, short neck', 'ASD (most common CHD), AVSD (most specific), ALL, Alzheimers, Hirschsprung, hypothyroidism, atlantoaxial instability'],
    ['Patau (Trisomy 13)', '47,XX/XY +13', 'Increases with age', 'Holoprosencephaly, microphthalmos, cleft lip/palate, polydactyly, cutis aplasia, scalp defects', 'VSD, renal anomalies; Survival rarely >1 year'],
    ['Edwards (Trisomy 18)', '47,XX/XY +18', 'Increases with age', 'Rocker-bottom feet, overlapping fingers (index over 3rd), clenched fists, micrognathia, low-set ears, short sternum', 'VSD (most common), horseshoe kidney; Survival rarely >1 year; 80% female'],
    ['Cri-du-chat (5p-)', '46,XX/XY del(5p)', 'Not age-related', 'High-pitched cat cry (laryngeal hypoplasia), microcephaly, hypertelorism, mental retardation, low birth weight', 'CHD (VSD); cry most characteristic feature'],
    ['Turner (45,X)', '45,X0 (50%), mosaics', 'NOT maternal age-related', 'Short stature, webbed neck (pterygium colli), cubitus valgus, shield chest, widely spaced nipples, streak gonads, primary amenorrhea, coarctation of aorta', 'Coarctation (most common CHD), horseshoe kidney, bicuspid aortic valve; NORMAL intelligence'],
    ['Noonan', 'Normal (AD - PTPN11 mutation)', 'Not applicable', 'Phenotypically similar to Turner (webbed neck, short stature) but MALE predominantly; normal karyotype', 'Pulmonary stenosis (most common CHD), HCM; bleeding diathesis'],
    ['Rett', 'MECP2 mutation (X-linked, females)', 'Not applicable', 'Normal development until 6-18 months, then regression; hand-wringing stereotypies, loss of speech, seizures, autism features', 'Exclusively in females; breathing irregularities'],
    ['Fetal Alcohol Syndrome', 'Normal karyotype (teratogen)', 'Not applicable', 'IUGR, microcephaly, smooth philtrum, thin upper lip, short palpebral fissures, flat midface, intellectual disability', 'Most common preventable cause of intellectual disability; ASD/VSD; no safe dose of alcohol in pregnancy'],
  ],
  [1400, 1400, 900, 2400, 2400]
));

// ══════════════════════════════════════════════════════════════════════════════
// SECTION 4: SYSTEMIC PEDIATRICS - CVS
// ══════════════════════════════════════════════════════════════════════════════
children.push(H1('SECTION 4: SYSTEMIC PEDIATRICS - CARDIOVASCULAR'));

children.push(H2('4.1 Congenital Heart Diseases (CHD)'));
children.push(P('CHD occurs in ~1% of live births. Divided into acyanotic and cyanotic lesions.'));

children.push(H3('Acyanotic CHD (L→R Shunts): Pink at rest, may cyanose on exertion (Eisenmenger)'));
children.push(makeTable(
  ['Defect', 'Most Common?', 'Murmur', 'Key Features', 'Associations'],
  [
    ['VSD (Ventricular Septal Defect)', 'MOST COMMON CHD overall (30-35%)', 'Harsh pansystolic murmur, lower left sternal border, thrill present', 'Small VSDs often close spontaneously. Large VSD: CHF, failure to thrive, recurrent chest infections', 'Down syndrome, trisomy 18; 50% close spontaneously'],
    ['ASD (Atrial Septal Defect)', '2nd most common; Ostium secundum most common type', 'Ejection systolic murmur (pulmonary); wide FIXED split S2 (pathognomonic)', 'May present in adulthood; RV volume overload; paradoxical emboli', 'Lutembacher syndrome (ASD + MS); Down syndrome (AVSD)'],
    ['PDA (Patent Ductus Arteriosus)', 'Most common in premature infants', 'Continuous machinery murmur, infraclavicular, Gibson murmur', 'L→R shunt; pulse pressure widened; bounding pulses; heart failure in premature', 'Rubella infection; treat with Indomethacin (prostaglandin inhibitor) in premature'],
    ['AVSD (Atrioventricular Septal Defect)', 'Most common in Down syndrome', 'Combined ASD + VSD features', 'Complete AVSD = ASD + VSD + common AV valve', 'Down syndrome'],
    ['Pulmonary Stenosis', 'Isolated: common', 'Ejection click + systolic ejection murmur ULSB; louder on EXPIRATION (PS worsens on inspiration)', 'Right-sided obstruction; Noonan syndrome', 'Noonan syndrome, Rubella'],
    ['Aortic Stenosis', 'Less common isolated', 'Systolic ejection murmur RUSB; radiates to neck; ejection click', 'Left-sided obstruction; syncope, angina; bicuspid AoV most common cause', 'Williams syndrome (supravalvular AS)'],
    ['Coarctation of Aorta', 'Common in Turner syndrome', 'Systolic murmur, back (interscapular); rib notching on X-ray (>5 years)', 'BP higher in arms than legs; radio-femoral delay; Figure-3 sign on chest X-ray', 'Turner syndrome, bicuspid AoV, berry aneurysm (circle of Willis)'],
  ],
  [1500, 1200, 1600, 2200, 1500]
));

children.push(H3('Cyanotic CHD (R→L Shunts): Blue at rest, PaO2 does not normalize with 100% O2 (hyperoxia test)'));
children.push(makeTable(
  ['Defect', 'Key Features', 'X-Ray', 'Management'],
  [
    ['Tetralogy of Fallot (TOF)', 'MOST COMMON cyanotic CHD. 4 components: VSD + Pulmonary stenosis (RV outflow obstruction) + Overriding aorta + RVH. Cyanosis at birth or worsens over time. Tet spells (hypercyanotic) precipitated by crying/feeding - treat with knee-chest position, O2, morphine, propranolol, phenylephrine', 'Boot-shaped heart (coeur en sabot), oligemic lung fields', 'Palliative: BT shunt. Definitive: total correction'],
    ['Transposition of Great Arteries (TGA)', '2nd most common cyanotic CHD. Aorta from RV, PA from LV. Parallel circulations incompatible with life without mixing. Presents day 1-2 with severe cyanosis. Associated with DiGeorge', 'Egg-on-string appearance, narrow mediastinum', 'Emergency: PGE1 to maintain PDA; Rashkind balloon atrial septostomy; arterial switch (Jatene) within first 2 weeks'],
    ['Tricuspid Atresia', 'Absent tricuspid valve; requires ASD or VSD for survival. Cyanosis from birth. Left axis deviation on ECG (only cyanotic CHD with LAD)', 'Small heart, decreased vascularity', 'PGE1, shunts, Fontan procedure'],
    ['Total Anomalous Pulmonary Venous Connection (TAPVC)', 'Pulmonary veins drain into systemic circulation (SVC, coronary sinus, IVC, etc.). ASD mandatory for survival. TAPVC with obstruction = emergency (pulmonary edema + cyanosis)', 'Snowman appearance (type I supracardiac) OR normal/small heart with pulmonary congestion', 'Surgical correction'],
    ['Truncus Arteriosus', 'Single great vessel from both ventricles. Cyanosis + heart failure early.', 'Cardiomegaly, increased vascularity', 'Early surgical repair'],
    ['Ebstein Anomaly', 'Downward displacement of tricuspid valve into RV. Right-to-left shunt via ASD/PFO. Associated with maternal lithium use.', 'Box-shaped heart (massive RA)', 'Medical management; surgery if severe'],
  ],
  [1500, 3200, 1800, 2500]
));

children.push(H3('Key Memory Aids - CHD'));
children.push(BULLET('5 Ts of cyanotic CHD: TOF, TGA, Tricuspid atresia, TAPVC (Total anomalous PVC), Truncus arteriosus'));
children.push(BULLET('Eisenmenger syndrome: Pulmonary hypertension causes shunt reversal (L→R becomes R→L); IRREVERSIBLE'));
children.push(BULLET('Hyperoxia test: If PaO2 <150 mmHg with 100% O2 = structural cyanotic heart disease'));
children.push(BULLET('PGE1 (prostaglandin E1) = life-saving in duct-dependent lesions (TGA, pulmonary atresia, critical coarctation)'));

// ══════════════════════════════════════════════════════════════════════════════
// SECTION 5: INFECTIONS
// ══════════════════════════════════════════════════════════════════════════════
children.push(H1('SECTION 5: INFECTIOUS DISEASES'));

children.push(H2('5.1 TORCH Profile'));
children.push(P('TORCH = Toxoplasma, Other (syphilis, VZV, parvovirus, HIV, Zika), Rubella, CMV, Herpes simplex'));
children.push(makeTable(
  ['Infection', 'Transmission', 'Key Features in Neonate', 'Diagnosis', 'Treatment'],
  [
    ['Toxoplasmosis (Toxoplasma gondii)', 'Transplacental (especially 3rd trimester), undercooked meat, cat feces', 'Classic triad: Chorioretinitis + Hydrocephalus + Intracranial calcifications (diffuse/scattered). Also: jaundice, hepatosplenomegaly, rash', 'IgM antibodies; CT head (periventricular calcifications)', 'Pyrimethamine + Sulfadiazine + Leucovorin for 1 year'],
    ['Rubella', 'Transplacental (most damage in 1st trimester)', 'Classic triad: Cataracts + Sensorineural hearing loss + PDA/pulmonary stenosis. Blueberry muffin rash (dermal erythropoiesis), IUGR, thrombocytopenia, glaucoma', 'IgM; viral culture/PCR', 'No specific treatment; prevention by MMR vaccine'],
    ['CMV (Cytomegalovirus)', 'Transplacental, breast milk, blood. MOST COMMON congenital infection', 'Periventricular calcifications (pathognomonic), sensorineural hearing loss (most common sequela), microcephaly, hepatosplenomegaly, jaundice, petechiae/purpura, chorioretinitis', 'CMV PCR urine within 3 weeks of birth', 'Ganciclovir/Valganciclovir for symptomatic disease'],
    ['Herpes Simplex (HSV)', 'Peripartum (85%); primary maternal infection most dangerous', '3 patterns: SEM (skin, eyes, mouth), CNS disease, Disseminated. Vesicular lesions, encephalitis, multiorgan failure. Normal head CT initially', 'PCR of CSF/lesions; culture', 'IV Acyclovir (60 mg/kg/day x 14-21 days)'],
    ['Congenital Syphilis', 'Transplacental (any trimester)', 'Early (<2yr): Snuffles (rhinitis), maculopapular rash on palms/soles, hepatosplenomegaly, periostitis. Late (>2yr): Interstitial keratitis, Hutchinson teeth, saddle nose, saber shin, 8th nerve deafness', 'VDRL/RPR + TPHA/FTA-ABS; dark-field microscopy', 'Penicillin G (10 days IV)'],
  ],
  [1200, 1500, 2500, 1400, 1400]
));

children.push(H2('5.2 Viral Exanthems (Measles, Mumps, Rubella, Chickenpox)'));
children.push(makeTable(
  ['Disease', 'Agent', 'Incubation', 'Prodrome', 'Rash', 'Key Features & Complications'],
  [
    ['Measles (Rubeola)', 'Paramyxovirus (Morbillivirus)', '10-14 days', '3Cs: Cough + Coryza + Conjunctivitis + high fever (4 days)', 'Morbilliform: starts face/hairline D4, spreads centrifugally, spares palms/soles. KOPLIK SPOTS (pathognomonic) appear 24h before rash on buccal mucosa (white spots on red base)', 'Complications: Pneumonia (most common death), encephalitis, subacute sclerosing panencephalitis (SSPE - 7-10 yrs later), otitis media. Vitamin A treatment reduces mortality'],
    ['Mumps', 'Paramyxovirus', '14-21 days', 'Fever, malaise, headache', 'No rash', 'Parotitis (parotid swelling, trismus), orchitis (post-pubertal males - 25%, usually unilateral), oophoritis, pancreatitis, meningitis/encephalitis (most common neurological). Aseptic meningitis most common complication'],
    ['Rubella (German measles)', 'Togavirus (Rubivirus)', '14-21 days', 'Mild fever, malaise', 'Pink maculopapular rash: starts face, spreads down, clears in 3 days. FORCHHEIMER spots (petechiae on soft palate)', 'Postauricular & suboccipital lymphadenopathy (pathognomonic). Arthralgia common in adult women. Dangerous: Congenital rubella syndrome (1st trimester)'],
    ['Chickenpox (Varicella)', 'VZV (Varicella-Zoster Virus)', '14-21 days', '1-2 days fever, malaise', 'Pruritic: starts trunk, spreads to face/extremities. HALLMARK: Crops in different stages simultaneously (macule→papule→vesicle→crust). "Dew drop on rose petal" vesicles', 'Complications: Secondary bacterial infection (S. aureus, S. pyogenes), pneumonia (adults), encephalitis, Reye syndrome (with aspirin). Treatment: Acyclovir for high-risk. Reactivation = Herpes Zoster'],
    ['Roseola (Exanthem subitum)', 'HHV-6 (HHV-7)', '5-15 days', 'HIGH fever 3-5 days suddenly drops', 'Rose-pink macules appear as FEVER BREAKS; starts trunk, fades quickly (1-2 days)', 'Most common in 6 months - 3 years. Febrile seizures during high fever phase. Nagayama spots (erythematous papules on soft palate/uvula)'],
    ['Hand-Foot-Mouth Disease', 'Coxsackievirus A16 (also EV71)', '3-6 days', 'Fever, sore throat', 'Vesicles on palms, soles, mouth (herpangina). Oral ulcers painful', 'EV71: Associated with severe neurological complications. Highly contagious. Self-limited 7-10 days'],
    ['Scarlet Fever', 'Group A Strep (GAS)', '2-4 days', 'Fever, pharyngitis, vomiting', 'Sandpaper rash; starts neck/axilla; Pastia lines (flexure folds); circumoral pallor; strawberry tongue', 'Treat with penicillin. Risk of rheumatic fever if untreated'],
  ],
  [1300, 1100, 900, 1400, 1600, 2200]
));

children.push(H2('5.3 Hepatitis'));
children.push(makeTable(
  ['Feature', 'Hep A', 'Hep B', 'Hep C', 'Hep D', 'Hep E'],
  [
    ['Virus', 'HAV (RNA)', 'HBV (DNA)', 'HCV (RNA)', 'HDV (RNA - defective)', 'HEV (RNA)'],
    ['Transmission', 'Feco-oral', 'Parenteral, sexual, vertical', 'Parenteral (blood)', 'Parenteral (requires HBV)', 'Feco-oral'],
    ['Incubation', '15-50 days', '30-180 days', '15-160 days', 'Same as HBV', '15-60 days'],
    ['Chronicity', 'Never chronic', '5-10% adults, 90% neonates', '80% chronic', 'Superinfection: high chronicity', 'Never chronic (except in immunocompromised)'],
    ['Worst in pregnancy', 'No', 'No', 'No', 'No', 'YES (20-25% mortality)'],
    ['Vaccine available', 'Yes (inactivated)', 'Yes (recombinant)', 'No', 'HBV vaccine prevents HDV', 'Yes (China only)'],
    ['Key marker', 'IgM anti-HAV = acute; IgG anti-HAV = immunity', 'HBsAg = infection/carrier; Anti-HBs = immunity; HBeAg = high infectivity', 'Anti-HCV; HCV RNA for active infection', 'Anti-HDV; co-infection with HBV required', 'IgM anti-HEV'],
  ],
  [1100, 1100, 1100, 1100, 1100, 1100, 2400]
));

// ══════════════════════════════════════════════════════════════════════════════
// SECTION 6: RESPIRATORY
// ══════════════════════════════════════════════════════════════════════════════
children.push(H1('SECTION 6: RESPIRATORY DISEASES'));

children.push(H2('6.1 Pneumonia'));
children.push(makeTable(
  ['Age Group', 'Common Pathogens', 'Features', 'Treatment'],
  [
    ['Neonates (0-4 wks)', 'GBS, E. coli, Listeria, Chlamydia', 'GBS: early onset (<7 days) vs late onset (7-90 days)', 'Ampicillin + Gentamicin IV'],
    ['1-3 months', 'Chlamydia trachomatis, RSV, Pertussis', 'Chlamydia: afebrile pneumonia, staccato cough; Eosinophilia; Positive ELISA', 'Erythromycin/Azithromycin for Chlamydia'],
    ['3 months - 5 years', 'RSV (most common <2yr), S. pneumoniae, H. influenzae, S. aureus', 'RSV bronchiolitis vs pneumonia; Parapneumonic effusion = S. aureus', 'Amoxicillin (first-line); if severe = ampicillin/cephalosporin'],
    ['>5 years', 'S. pneumoniae, Mycoplasma pneumoniae, Chlamydia pneumoniae', 'Mycoplasma: atypical pneumonia, headache, cold agglutinins, skin rash (EM)', 'Amoxicillin; Macrolide if atypical'],
  ],
  [1500, 2000, 2700, 1800]
));
children.push(BULLET('WHO: Tachypnea thresholds: <2 months ≥60/min; 2-12 months ≥50/min; 1-5 years ≥40/min'));
children.push(BULLET('Severe pneumonia: Tachypnea + lower chest wall indrawing'));
children.push(BULLET('Very severe: Cyanosis, unable to feed, severe chest indrawing, stridor at rest'));
children.push(BULLET('Staphylococcal pneumonia: Pneumatoceles (thin-walled air cysts), pyopneumothorax, rapid progression'));

children.push(H2('6.2 Croup (Laryngotracheobronchitis)'));
children.push(PB('Agent', 'Parainfluenza virus type 1 (most common)'));
children.push(PB('Age', '6 months - 3 years (peak 2 years)'));
children.push(PB('Onset', 'Gradual (viral prodrome → barking cough → stridor)'));
children.push(PB('Classic features', 'BARKING (seal-like) cough, hoarseness, inspiratory stridor, low-grade fever'));
children.push(PB('X-ray neck', '"Steeple sign" (subglottic narrowing on AP view) - not required for diagnosis'));
children.push(PB('Westley Croup Score', 'Scores stridor, air entry, retractions, cyanosis, level of consciousness; mild <3, moderate 3-6, severe >6'));
children.push(BULLET('Treatment: Mild: Dexamethasone single dose (0.15-0.6 mg/kg PO); Moderate/Severe: Dexamethasone + Nebulized L-epinephrine; Heliox in severe cases'));
children.push(BULLET('Epiglottitis vs Croup: Epiglottitis - Haemophilus influenzae type b (Hib) - older child (2-7yr), abrupt onset, high fever, toxic, drooling, tripod position, "thumbprint sign" on X-ray - EMERGENCY: NO throat examination'));

children.push(H2('6.3 Bronchiolitis'));
children.push(PB('Agent', 'RSV (Respiratory Syncytial Virus) - most common (80%)'));
children.push(PB('Age', '<2 years (peak 2-6 months)'));
children.push(PB('Season', 'Winter/Fall epidemic'));
children.push(PB('Pathology', 'Small airway inflammation, mucus plugging, air trapping, hyperinflation'));
children.push(PB('Features', 'URI prodrome → wheeze + tachypnea + subcostal retractions; hyperinflated chest; fine crackles; may have apnea (premature infants)'));
children.push(PB('X-ray', 'Hyperinflation, peribronchial thickening, patchy atelectasis'));
children.push(BULLET('Treatment: Supportive - O2, adequate hydration, nasal suctioning; NO routine bronchodilators, steroids, antibiotics'));
children.push(BULLET('Prophylaxis: Palivizumab (anti-RSV monoclonal Ab) for high-risk infants (premature <29 wks, CLD, hemodynamically significant CHD)'));

children.push(H2('6.4 Cystic Fibrosis (CF)'));
children.push(PB('Gene', 'CFTR gene (chromosome 7q31) - autosomal recessive'));
children.push(PB('Mutation', 'ΔF508 (most common, 70%); >2000 mutations known'));
children.push(PB('Pathophysiology', 'Defective Cl- channel → thick viscous secretions in lungs, pancreas, liver, GI, reproductive tract'));
children.push(PB('Diagnosis', 'Sweat chloride test (GOLD STANDARD): >60 mEq/L diagnostic; newborn screening (IRT); CFTR mutation testing'));
children.push(makeTable(
  ['System', 'Manifestation'],
  [
    ['Respiratory', 'Recurrent infections (S. aureus early; P. aeruginosa later - hallmark), bronchiectasis, mucus plugging, hemoptysis, pneumothorax; Digital clubbing'],
    ['GI', 'Meconium ileus (10-20% at birth; pathognomonic of CF), distal intestinal obstruction, rectal prolapse'],
    ['Pancreatic', 'Exocrine insufficiency (85%): steatorrhea, fat-soluble vitamin deficiency (A,D,E,K); CF-related diabetes'],
    ['Liver', 'Focal biliary cirrhosis, portal hypertension'],
    ['Reproductive', 'Males: bilateral absence of vas deferens (CBAVD) - infertile; Females: reduced fertility (thick cervical mucus)'],
    ['Electrolytes', 'Heat prostration; elevated sweat Cl-; metabolic alkalosis (hyponatremia, hypochloremia)'],
  ],
  [2000, 6500]
));
children.push(BULLET('Treatment: Chest physiotherapy, DNase (dornase alfa), mucolytics, antibiotics for exacerbations, CFTR modulators (Ivacaftor, Tezacaftor, Elexacaftor)'));
children.push(BULLET('Most common cause of death: Respiratory failure from chronic infection'));

// ══════════════════════════════════════════════════════════════════════════════
// SECTION 7: CNS
// ══════════════════════════════════════════════════════════════════════════════
children.push(H1('SECTION 7: CENTRAL NERVOUS SYSTEM'));

children.push(H2('7.1 Neural Tube Defects (NTDs)'));
children.push(PB('Cause', 'Failure of neural tube closure (28 days after fertilization)'));
children.push(PB('Prevention', 'Folic acid 400 mcg/day periconceptionally (start 3 months before conception)'));
children.push(makeTable(
  ['Type', 'Description', 'Features', 'Prognosis'],
  [
    ['Anencephaly', 'Failure of rostral NT closure; absent cerebrum/calvarium', 'Incompatible with life; elevated AFP on amniocentesis', 'Lethal'],
    ['Spina Bifida Occulta', 'Posterior vertebral arch defect; no herniation; covered by skin', 'Tuft of hair, sacral dimple, lipoma over spine; usually asymptomatic', 'Good'],
    ['Meningocele', 'Meninges herniate through defect; spinal cord intact', 'Sac contains CSF only; no neural tissue', 'Good after repair'],
    ['Myelomeningocele', 'Meninges + spinal cord herniate; MOST COMMON symptomatic NTD', 'Paralysis, sensory loss, bladder/bowel dysfunction; hydrocephalus (70-80%, Arnold-Chiari II malformation)', 'Poor; significant disability'],
    ['Encephalocele', 'Brain tissue herniates through skull defect (occipital most common)', 'May include brain tissue', 'Variable'],
  ],
  [1500, 2000, 2500, 1500]
));
children.push(BULLET('AFP: Elevated in open NTDs (anencephaly, myelomeningocele); Low in Down syndrome'));
children.push(BULLET('Arnold-Chiari II: Downward displacement of cerebellar tonsils + brainstem through foramen magnum; associated with myelomeningocele'));

children.push(H2('7.2 Febrile Seizures'));
children.push(makeTable(
  ['Feature', 'Simple Febrile Seizure', 'Complex Febrile Seizure'],
  [
    ['Duration', '<15 minutes', '>15 minutes (or multiple episodes in 24h)'],
    ['Type', 'Generalized (tonic-clonic)', 'Focal OR generalized'],
    ['Recurrence', 'No recurrence in 24h', 'Recurs within 24 hours'],
    ['Post-ictal state', 'Brief', 'Prolonged'],
    ['Risk of epilepsy', '~1-2% (same as general population)', '~4-6%'],
    ['Treatment', 'No anticonvulsants; treat fever; reassurance', 'IV benzodiazepine if prolonged; investigate for meningitis'],
  ],
  [2000, 3100, 3100]
));
children.push(BULLET('Age: 6 months - 5 years; peak 18 months'));
children.push(BULLET('Temperature threshold: typically >38.5°C but any fever can trigger'));
children.push(BULLET('Recurrence risk: ~30% overall; highest if age <1 year at first seizure, family history, low fever temperature, short duration of fever before seizure'));
children.push(BULLET('LP indications in febrile seizure: Age <12 months, complex seizure, signs of meningism, post-ictal >1 hour, ill-looking child'));

children.push(H2('7.3 Epilepsy in Children'));
children.push(makeTable(
  ['Syndrome', 'Age', 'EEG', 'Features', 'Drug of Choice'],
  [
    ['West Syndrome (Infantile Spasms)', '3-12 months', 'Hypsarrhythmia (chaotic high-amplitude waves)', 'Salaam/flexion spasms in clusters; neurodevelopmental regression. Triad: spasms + hypsarrhythmia + regression', 'ACTH or Vigabatrin; Prednisolone'],
    ['Lennox-Gastaut Syndrome', '2-8 years', 'Slow spike-wave (<2.5 Hz) + polyspike', 'Multiple seizure types (atonic/drop attacks, tonic, absence), intellectual disability, refractory', 'Valproate; Rufinamide; Ketogenic diet'],
    ['Childhood Absence Epilepsy', '4-10 years (girls>boys)', '3 Hz spike-and-wave (pathognomonic)', 'Brief staring spells (5-30 sec), abrupt onset/offset, automatisms; normal development; precipitated by hyperventilation', 'Ethosuximide (drug of choice); Valproate'],
    ['Juvenile Myoclonic Epilepsy (JME)', 'Adolescence (12-18yr)', 'Polyspike-wave 3-6 Hz', 'Morning myoclonus, generalized tonic-clonic (awakening), absence; precipitated by sleep deprivation/alcohol; lifelong condition', 'Valproate (drug of choice); Levetiracetam'],
    ['Benign Rolandic Epilepsy (BECTS)', '3-13 years (boys>girls)', 'Centrotemporal spikes', 'Nocturnal hemifacial clonic seizures, drooling, speech arrest; self-limited (resolves by 16 years)', 'Often no treatment needed; Carbamazepine'],
    ['Dravet Syndrome', 'First year of life', 'Variable; early normal then progressive', 'Febrile then afebrile seizures; SCN1A mutation; severe intellectual disability', 'Valproate + Clobazam; avoid Na-channel blockers (carbamazepine, phenytoin)'],
  ],
  [1500, 1100, 1500, 2400, 1500]
));

children.push(H2('7.4 Cerebral Palsy (CP)'));
children.push(PB('Definition', 'Permanent, non-progressive disorder of movement/posture from damage to developing brain'));
children.push(makeTable(
  ['Type', 'Lesion', 'Features', 'Most Common?'],
  [
    ['Spastic (most common ~75%)', 'UMN - motor cortex or corticospinal tracts', 'Hypertonia, hyperreflexia, Babinski+, scissors gait, clonus. Diplegia (premature) most common, also hemiplegia, quadriplegia', 'YES - most common overall'],
    ['Dyskinetic (athetoid)', 'Basal ganglia/extrapyramidal', 'Involuntary writhing movements (athetosis), fluctuating tone; hearing loss; often due to kernicterus', 'Less common'],
    ['Ataxic', 'Cerebellum', 'Hypotonia, intention tremor, gait ataxia; least common', 'Least common'],
    ['Mixed', 'Multiple sites', 'Most common combination: spastic + dyskinetic', '—'],
  ],
  [1500, 1800, 3200, 1000]
));
children.push(BULLET('Most common cause: Hypoxic-ischemic encephalopathy (HIE); also prematurity, kernicterus, infections'));
children.push(BULLET('Non-progressive but deficits evolve with age; may have intellectual disability, seizures, vision/hearing problems'));

children.push(H2('7.5 Glasgow Coma Scale (GCS)'));
children.push(makeTable(
  ['Response', 'Score', 'Description'],
  [
    ['Eye Opening (E)', '4', 'Spontaneous'],
    ['', '3', 'To voice'],
    ['', '2', 'To pain'],
    ['', '1', 'None'],
    ['Verbal (V)', '5', 'Oriented'],
    ['', '4', 'Confused'],
    ['', '3', 'Inappropriate words'],
    ['', '2', 'Incomprehensible sounds'],
    ['', '1', 'None'],
    ['Motor (M)', '6', 'Obeys commands'],
    ['', '5', 'Localizes pain'],
    ['', '4', 'Withdraws'],
    ['', '3', 'Abnormal flexion (decorticate)'],
    ['', '2', 'Extension (decerebrate)'],
    ['', '1', 'None'],
  ],
  [2000, 1500, 5000]
));
children.push(BULLET('Maximum: 15 | Minimum: 3'));
children.push(BULLET('Severe TBI: GCS ≤8 (intubate) | Moderate: 9-12 | Mild: 13-15'));
children.push(BULLET('Pediatric GCS modified for verbal response in non-verbal children (<2yr): Coos/smiles(5), Cries consolable(4), Cries inappropriately(3), Moans(2), None(1)'));

// ══════════════════════════════════════════════════════════════════════════════
// SECTION 8: VASCULITIS
// ══════════════════════════════════════════════════════════════════════════════
children.push(H1('SECTION 8: VASCULITIS IN CHILDREN'));

children.push(makeTable(
  ['Disease', 'Vessels Affected', 'Age/Sex', 'Key Features', 'Diagnosis', 'Treatment'],
  [
    ['Kawasaki Disease', 'Medium vessels (coronary artery aneurysms - most feared complication)', '<5 years; boys > girls; Asian', 'FEVER >5 days + 4/5 criteria: (1) Bilateral non-purulent conjunctivitis (2) Strawberry tongue/lip cracking/oropharyngeal changes (3) Polymorphous rash (4) Extremity changes: erythema→desquamation of fingertips (5) Cervical lymphadenopathy (unilateral, >1.5 cm). Incomplete Kawasaki if fewer criteria', 'Clinical; Echo (coronary aneurysm); elevated CRP/ESR; leukocytosis; thrombocytosis (late)', 'IVIG 2g/kg single dose + High-dose Aspirin (anti-inflammatory phase), then low-dose Aspirin (antiplatelet). If resistant: Infliximab, Corticosteroids'],
    ['Henoch-Schönlein Purpura (HSP/IgA Vasculitis)', 'Small vessels (IgA immune complex deposition)', '3-15 years; boys > girls', 'Tetrad: (1) PALPABLE PURPURA on buttocks/lower limbs (pathognomonic - does not blanch) (2) Arthritis/arthralgia (3) Abdominal pain (colicky, GI bleeding, intussusception) (4) Renal involvement (IgA nephropathy, hematuria, proteinuria)', 'Clinical; skin biopsy shows IgA deposits; IgA elevated in 50%', 'Supportive; NSAIDs for joints; Steroids for severe GI/renal disease. Monitor BP and urine'],
    ['Takayasu Arteritis', 'Large vessels (aorta and branches)', 'Young women <40; Asian', 'Pulseless disease: absent pulses, BP difference between arms >10 mmHg, bruits, limb claudication, hypertension (renal artery stenosis), visual disturbances. Constitutional symptoms: fever, weight loss', 'Angiography (GOLD); CT/MR angiography; elevated ESR/CRP', 'Corticosteroids (prednisone); Methotrexate; Biologics (tocilizumab); Surgical bypass/angioplasty'],
    ['Buerger Disease (Thromboangiitis Obliterans)', 'Small/medium vessels', 'Young adult males, smokers', 'NOT a pediatric disease but asked. Occlusive inflammatory disease of peripheral vessels, Raynaud phenomenon, digital ulcers/gangrene, superficial thrombophlebitis. NEVER affects large vessels', 'Clinical; arteriography', 'STOP SMOKING (most important treatment). Prostacyclin; amputation if gangrene'],
  ],
  [1400, 1400, 1100, 2300, 1500, 1800]
));

// ══════════════════════════════════════════════════════════════════════════════
// SECTION 9: GI & RENAL
// ══════════════════════════════════════════════════════════════════════════════
children.push(H1('SECTION 9: GASTROINTESTINAL & RENAL'));

children.push(H2('9.1 Diarrhoea'));
children.push(makeTable(
  ['Feature', 'Acute Watery Diarrhoea', 'Dysentery', 'Persistent Diarrhoea'],
  [
    ['Duration', '<14 days', '<14 days', '>14 days'],
    ['Blood in stool', 'No', 'YES (defining feature)', 'May or may not'],
    ['Common causes', 'Rotavirus (most common in children <5), ETEC, Cholera, EPEC', 'Shigella (most common), Campylobacter, Amoeba, EIEC', 'Giardia, persistent rotavirus, post-infectious malabsorption'],
    ['Treatment', 'ORS, zinc (10-20 mg x 14 days), continue feeding, Vitamin A', 'Azithromycin or Ceftriaxone for Shigella', 'Metronidazole if Giardia/Amoeba; nutritional rehabilitation'],
  ],
  [1800, 1700, 2400, 3000]
));
children.push(BULLET('WHO ORS composition (2002 low-osmolarity): Na 75, Cl 65, K 20, Citrate 10, Glucose 75 mmol/L; osmolarity 245 mOsm/L'));
children.push(BULLET('Rehydration plan A (no dehydration): ORS at home, zinc, continue feeding'));
children.push(BULLET('Plan B (some dehydration): ORS 75 mL/kg over 4 hours in clinic'));
children.push(BULLET('Plan C (severe dehydration): IV Ringer lactate 100 mL/kg (infants: 5 mL/kg/hr first 1hr then 25 mL/kg/hr)'));
children.push(BULLET('Cholera: Rice-water stools, no fever, profuse watery. Vibrio cholerae O1/O139. Tx: Doxycycline (adults), Azithromycin (children)'));
children.push(BULLET('Rotavirus: Most common cause of severe dehydrating diarrhea in children <5; vaccine now in NIS'));

children.push(H2('9.2 Nephrotic vs Nephritic Syndrome'));
children.push(makeTable(
  ['Feature', 'Nephrotic Syndrome', 'Nephritic Syndrome'],
  [
    ['Mechanism', 'Glomerular PERMEABILITY (podocyte damage) → massive proteinuria', 'Glomerular INFLAMMATION → hematuria, reduced GFR'],
    ['Proteinuria', '>3.5 g/day (adult) or >40 mg/m²/hr (child)', 'Mild-moderate (<3.5 g/day)'],
    ['Hematuria', 'Absent or minimal', 'PRESENT (hallmark); RBC casts'],
    ['Edema', 'Severe (periorbital, ascites, pleural effusion)', 'Mild to moderate'],
    ['BP', 'Normal or low', 'HYPERTENSION (hallmark)'],
    ['GFR/Creatinine', 'Normal (initially)', 'Reduced (oliguria, azotemia)'],
    ['Serum albumin', 'LOW (<2.5 g/dL)', 'Normal or slightly low'],
    ['Cholesterol', 'HIGH (hyperlipidemia)', 'Normal or mild increase'],
    ['Lipiduria', 'Present (fatty casts, oval fat bodies)', 'Absent'],
    ['Most common in children', 'MINIMAL CHANGE DISEASE (MCD) - 80% of childhood NS', 'POST-STREPTOCOCCAL GN (PSGN) - 2-3 weeks after pharyngitis (Type XII Strep)'],
    ['Treatment', 'MCD: Prednisolone 2 mg/kg/day (60 mg/m²/day) for 4-6 weeks', 'PSGN: Supportive; treat hypertension; antibiotics if active infection'],
  ],
  [2000, 3800, 3700]
));

children.push(H3('Nephrotic Syndrome - Key Points'));
children.push(BULLET('Minimal Change Disease (MCD): Most common in boys 2-6 years; lipoid nephrosis; effacement of podocyte foot processes on EM; NORMAL light microscopy; responds to steroids'));
children.push(BULLET('Complications of NS: Infections (S. pneumoniae peritonitis, cellulitis due to low IgG), thrombosis (renal vein thrombosis due to loss of antithrombin III), hyperlipidemia'));
children.push(BULLET('Steroid-resistant NS: Defined as no remission after 8 weeks of steroids; consider FSGS, membranous nephropathy; biopsy needed'));

children.push(H3('Post-Streptococcal GN (PSGN) - Key Points'));
children.push(BULLET('Follows pharyngitis (1-3 weeks latency) or skin infection/impetigo (3-6 weeks latency)'));
children.push(BULLET('Throat culture/ASO titer positive; low C3, normal C4 (alternate pathway activation)'));
children.push(BULLET('Subepithelial hump-like deposits on EM ("humps" on GBM - IgG, C3)'));
children.push(BULLET('Prognosis: Excellent in children (95% recover fully); adults worse'));

// Final paragraph
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