Prompt

Clinic: a 3-year-old with clockwork 5-weekly attacks of high fever, sore throat, mouth ulcers and tender cervical nodes, completely well between episodes; the examiner may probe Mediterranean ancestry, periorbital oedema, vaccination triggers and the role of tonsillectomy mid-station.

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Examiner: How do you classify childhood fever that is prolonged, recurrent or periodic? [1]

Candidate: Three patterns. A single continuous illness beyond 7 to 14 days is prolonged fever, or fever of unknown origin. Several discrete episodes with the child well between is recurrent fever. Periodic fever is the subset where attacks recur at clockwork, stereotyped intervals. The pattern — not the height of the fever — drives the diagnosis, so I pattern it first before I order tests. [1]

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]Long SS. Distinguishing among prolonged, recurrent, and periodic fever syndromes: approach of a pediatric infectious diseases subspecialist. Pediatr Clin North Am, 2005.PMID 15925664
[2]Marshall GS, Edwards KM, Butler J, Lawton AR. Syndrome of periodic fever, pharyngitis, and aphthous stomatitis. J Pediatr, 1987.PMID 3794885
[3]Thomas KT, Feder HM Jr, Lawton AR, Edwards KM. Periodic fever syndrome in children. J Pediatr, 1999.PMID 10393598
[4]Hofer M, Pillet P, Cochard MM, Berg S, et al. International periodic fever, aphthous stomatitis, pharyngitis, cervical adenitis syndrome cohort: description of distinct phenotypes in 301 patients. Rheumatology (Oxford), 2014.PMID 24505122
[5]Gattorno M, Hofer M, Federici S, et al. Classification criteria for autoinflammatory recurrent fevers. Ann Rheum Dis, 2019.PMID 31018962
[6]Livneh A, Langevitz P, Zemer D, Zaks N, et al. Criteria for the diagnosis of familial Mediterranean fever. Arthritis Rheum, 1997.PMID 9336425
[7]Steichen O, van der Hilst J, Simon A, Cuisset L. A clinical criterion to exclude the hyperimmunoglobulin D syndrome (mild mevalonate kinase deficiency) in patients with recurrent fever. J Rheumatol, 2009.PMID 19531764

Opening

Examiner: How do you classify childhood fever that is prolonged, recurrent or periodic? [1]

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]Long SS. Distinguishing among prolonged, recurrent, and periodic fever syndromes: approach of a pediatric infectious diseases subspecialist. Pediatr Clin North Am, 2005.PMID 15925664
[2]Marshall GS, Edwards KM, Butler J, Lawton AR. Syndrome of periodic fever, pharyngitis, and aphthous stomatitis. J Pediatr, 1987.PMID 3794885
[3]Thomas KT, Feder HM Jr, Lawton AR, Edwards KM. Periodic fever syndrome in children. J Pediatr, 1999.PMID 10393598
[4]Hofer M, Pillet P, Cochard MM, Berg S, et al. International periodic fever, aphthous stomatitis, pharyngitis, cervical adenitis syndrome cohort: description of distinct phenotypes in 301 patients. Rheumatology (Oxford), 2014.PMID 24505122
[5]Gattorno M, Hofer M, Federici S, et al. Classification criteria for autoinflammatory recurrent fevers. Ann Rheum Dis, 2019.PMID 31018962
[6]Livneh A, Langevitz P, Zemer D, Zaks N, et al. Criteria for the diagnosis of familial Mediterranean fever. Arthritis Rheum, 1997.PMID 9336425
[7]Steichen O, van der Hilst J, Simon A, Cuisset L. A clinical criterion to exclude the hyperimmunoglobulin D syndrome (mild mevalonate kinase deficiency) in patients with recurrent fever. J Rheumatol, 2009.PMID 19531764

Prolonged, recurrent and periodic fever — branching viva

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Prolonged, recurrent and periodic fever — branching viva

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