A technical term, not just a fever without obvious source! Essentially presence of confirmed fever for 8 days or more in a child in whom a careful thorough history and physical examination, and preliminary laboratory data fail to reveal a probable cause.
Long list of possible causes, long lists of possible tests – do thorough history and repeated examinations, then follow the clues!
In kids, infection is the commonest cause. But can be connective tissue disorder, or malignancy.
Beware factitious fever – admission sensible.
If possible, stop all drugs. Antipyretics may obscure the pattern of fever, and can occasionally be its cause (drug fever is one cause).
Unless the child is critically ill, try not to give antibiotics. If the diagnosis remains obscure, go back and take the history again, examine the child (fully) again, send the specimens again!
We quickly get used to doing case presentations, and talking with colleagues and patients, but we don’t really learn the skills of speaking with conviction, which Winston Churchill called the most precious gift of all the talents bestowed upon men.
Important for career development, advocacy and leadership.
At the age of 22yr Winston Churchill said the essential components of oratory were diction, rhythm, accumulation of argument, analogy and emotion.
It’s pretty obvious when a presentation is done badly – and so it is obvious what you need to do to give a good presentation.
Technical issues, esp poor sound
Overly busy slides, or slides that don’t seem to correspond with what is being discussed
Simply reading slides
Glaring bright slide backgrounds
Spelling mistakes or inconsistent formatting
Lack of a pointer
Not really understanding what a table/chart is actually showing
Rushing at the end, not leaving time for questions
The best presentations convey the importance of the topic, discuss real life issues, are funny (some of the time – otherwise risk of sounding callous). The speaker looks at (speaks to) you.
Consider the interviewer someone with their own agenda – know yours.
Abnormal renal excretion, leading to low potassium.
Presents in early childhood with failure to thrive. Could also be constipation, muscle cramps and weakness (potassium needed for membrane potential, so these are all neuromuscular) and non-specific dizziness and fatigue.
Characteristic hypokalemic, hypochloremic metabolic alkalosis. High plasma renin activity and high aldosterone concentration seen.
Gitelman syndrome is similar, less severe (distal tubule, rather than ascending limb of loop of Henle) – less failure to thrive, in fact often asymptomatic detected incidentally. Might present with nocturia/polyuria.
Urinary calcium excretion distinguishes the two syndromes. Bartter’s waste calcium (more severe, after all), Gitelman retain.
Treatment is with supplementation.
Decompensation can be precipitated by diarrhoea or vomiting. Acute treatment can include potassium-sparing diuretics (spironolactone), cyclo-oxygenase inhibitors and renin-angiotensin blockers.
Proteins responsible for a minority of allergic reactions to peanut, hazelnut, sesame among others – hydrophobic, so tend not to be well represented in skin prick and IgE test solutions. May explain false negatives.
Specific IgE tests have been developed, but otherwise you just have to challenge.
Dutch study however didn’t find that specific testing for oleosins helped much.
FMR1 gene is on X chromosome, obviously, and is a trinucleotide repeat disorder (along with Friedrich’s ataxia, myotonic dystrophy, Huntington disease etc), so inheritance is interesting.
Dads can carry gene, but only pass it on to their daughters (who will all get it).
Mums will carry gene on 1 chromosome, so sons and daughters can both get it, but 50:50 chance.
As with other trinucleotide repeat disorders, gene expands with each generation, so risk of disease increases from 1 generation to the next, and this is somewhat predictable: intermediate gene (so 45-54 copies) won’t expand to cause disease (200+ copies) in 1 generation, but premutation gene (55-199) copies probably will.
Moderately severe learning disability
Facial features – long face, midface hypoplasia, large lips and jaw, small ears
WHO 2019 definition – occupational experience characterized by:
Exhaustion (feelings of energy depletion)
Cynicism – increased mental distance from one’s job, or feelings of negativism related to one’s job
Reduced professional efficacy
The MBI-Human Services Survey (MBI-HSS) was published, followed by other versions, including one for teachers and one for medical personnel (MBI-MP). Gives scores for each of the 3 fields. No cut offs, just a continuum, although higher scores across all 3 would clearly fit with the WHO definition.
Attempts have been made to use the tool to then define or screen for burnout. But WHO never called it a disease or disorder, but “a legitimate occupational experience”.
Better to talk about the actual feelings – Overextended, Ineffective, Disengaged – cf Engaged – high scores across all 3 fields.
Organizations should not use the MBI in isolation. Other tools exist such as Areas of Worklife Survey (AWS), which looks at workplace culture in terms of workload, control, reward, community, fairness, values.