Paeds Vivas · clinical-assessment-and-reasoning
Fatigue and lethargy in children and adolescents — viva
Branching structured oral on fatigue and lethargy in children and adolescents.
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Target exams
RACP DCEMRCPCH Clinical
Prompt
You are the paediatric registrar. A GP letter says 'tired all the time' for an 11-year-old. Separately, triage calls you about a floppy febrile infant.
Opening (must-hit)
"I separate emergency lethargy from fatigue with preserved interaction. Unstable or poorly interactive children get ABCDE first. Stable children get a mechanism-based differential and directed tests." [4] [6]
References7ShowHide
- [1]Clarke RT Clinical presentation of childhood leukaemia: a systematic review and meta-analysis. Archives of disease in childhood, 2016.PMID 27647842
- [2]Royston AP Severe myalgic encephalomyelitis/chronic fatigue syndrome in children and young people: a British Paediatric Surveillance Unit study. Archives of disease in childhood, 2023.PMID 36456114
- [3]Powers JM Prevention, Screening, Diagnosis, and Treatment of Iron Deficiency and Iron Deficiency Anemia in Infants, Children, and Adolescents: Clinical Report. Pediatrics, 2026.PMID 42324084
- [4]Mills E Association between caregiver concern for clinical deterioration and critical illness in children presenting to hospital: a prospective cohort study. The Lancet. Child & adolescent health, 2025.PMID 40451224
- [5]Marcus CL Diagnosis and management of childhood obstructive sleep apnea syndrome. Pediatrics, 2012.PMID 22926173
- [6]Weiss SL Surviving Sepsis Campaign International Guidelines for the Management of Sepsis and Septic Shock in Children 2026. Pediatric critical care medicine, 2026.PMID 41869844
- [7]Starmer AJ Changes in medical errors after implementation of a handoff program. The New England journal of medicine, 2014.PMID 25372088