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]

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.

References7Show ledger

[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

Opening (must-hit)

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.

References7Show ledger

[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

Fatigue and lethargy in children and adolescents — viva

Opening (must-hit)

Fatigue and lethargy in children and adolescents — viva

Opening (must-hit)