Chronic fatigue and post-viral fatigue syndromes — branching viva

Branching viva on recognising post-exertional malaise, applying the paediatric three-month threshold, validating the illness, excluding mimics once, building a function-first energy-management plan with CBT, defending the graded-exercise controversy, and avoiding diagnostic overshadowing.

branching clinical structured oral4 min readVerification in progress

Prompt

You are the paediatric registrar in adolescent clinic. The examiner will move from a first presentation of chronic fatigue after glandular fever, to the diagnostic criteria and threshold, to a function-first plan, to the graded-exercise controversy, to a red-flag challenge and a school-absence disclosure.

Stem

The examiner will test whether you can run a validating, function-first chronic-fatigue pathway under pressure — refusing both dismissal and over-treatment, and recognising post-exertional malaise as the clinical core. [1] [2]

Paediatrics Fellowship Pro

You have read the opening of this viva. The complete unit — every section and its primary-source references — is part of the Paediatrics Fellowship fellowship atlas.

References6Show ledger

[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
[3]White PD, Goldsmith KA, Johnson AL, Potts L, Walwyn R, DeCesare JC, Baber HL, Burgess M, Clark LV, Cox DL, Bavinton J, Angus BJ, Murphy G, Murphy M, O'Dowd H, Wilks D, McCrone P, Chalder T, Sharpe M Comparison of adaptive pacing therapy, cognitive behaviour therapy, graded exercise therapy, and specialist medical care for chronic fatigue syndrome (PACE): a randomised trial. Lancet (London, England), 2011.PMID 21334061
[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
[8]Jason LA, Evans M, Brown A, Sunnquist M, Newton JL Chronic fatigue syndrome versus sudden onset myalgic encephalomyelitis. Journal of prevention & intervention in the community, 2015.PMID 25584529
[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