Paeds Cases · mental-behavioural-and-psychosomatic
Chronic fatigue and post-viral fatigue syndromes OSCE — validation, energy management and school reintegration
Observed structured encounter testing a validating, function-first chronic-fatigue consultation: biopsychosocial assessment, recognising post-exertional malaise, excluding mimics once, explaining the energy envelope, an individualised management plan with CBT, declining rigid graded exercise, and a graded return-to-school.
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Target exams
RACP General PaediatricsRACP DCEMRCPCH ClinicalRCPSC Pediatrics
Prompt
Station A is a 14-year-old four months after glandular fever with fatigue, unrefreshing sleep and post-exertional malaise, attending school only half-days; the father wants her to push through. Station B is a 15-year-old with established CFS/ME who has new weight loss and night sweats, and whose family has been told the symptoms are part of her fatigue syndrome.
Station objectives
- Validate chronic fatigue as a real, multi-system illness and recognise post-exertional malaise as the hallmark. [1]
- Distinguish CFS/ME from depression and deconditioning, and confirm the focused exclusion of mimics. [1]
- Co-build a function-first plan — energy management within the energy envelope, CBT, individualised activity. [2]
- Decline rigid graded exercise clearly and empathically, and treat school reintegration as a clinical outcome. [4] [6]
References5ShowHide
- [1]Carruthers BM, van de Sande MI, De Meirleir KL, Klimas NG, Broderick G, Mitchell T, Staines D, Powles AC, Speight N, Vallings R, Bateman L Myalgic encephalomyelitis: International Consensus Criteria. Journal of internal medicine, 2011.PMID 21777306
- [2]Nijhof SL, Bleijenberg G, Uiterwaal CS, Kimpen JL, van de Putte EM Effectiveness of internet-based cognitive behavioural treatment for adolescents with chronic fatigue syndrome (FITNET): a randomised controlled trial. Lancet (London, England), 2012.PMID 22385683
- [4]Larun L, Brurberg KG, Odgaard-Jensen J, Price JR Exercise therapy for chronic fatigue syndrome. The Cochrane database of systematic reviews, 2019.PMID 31577366
- [5]Collin SM, Norris T, Nuevo R, Tilling K, Joinson C, Sterne JA, Crawley E Chronic Fatigue Syndrome at Age 16 Years. Pediatrics, 2016.PMID 26810786
- [6]Moore Y, Serafimova T, Anderson N, King H, Richards A, Brigden A, Sinai P, Higgins J, Ascough C, Clery P, Crawley EM Recovery from chronic fatigue syndrome: a systematic review-heterogeneity of definition limits study comparison. Archives of disease in childhood, 2021.PMID 33846138