Official Pediatrics Shelf Exam Thread

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MilkIsGood said:
A previously healthy 7 y.o brought to peds b/c 1 week history of low grade fever and fatigue and a 3 day history of rash and moderate pain and swelling of ankles. Rash first appeared on ankles but has spread over his legs during the past 24 hrs. Tep 38.2. Exam shows palpable petechiae and confluent purpuric areas over lower extremities. Ankles are swollen and mildly tender.
A. ankylosing spondylitis
B. Behcet syndrome
C. dermatomyositis
D. henoch schonlein purpura
E. Juvenile rheumatoid arthiritis
F. Kawasaki
G. Psoriatic arthiritis
H. Reactive arthritis
I. Sarcoidosis
J. Sjogren
K. SLE
L. scleroderma

palpable petechiae/purpura in lower extremities = HSP. Edema is due to kidney involvement.

2yo has 2week history of irritability, poor appetite, occasional cough, and reluctance to walk. Has had 2kg weight loss since her last exam 6mo ago. No history of reuccrent respiratory illness, constipation, vomiting, or diarrhea. Appears uncomfortable and quiet. 7th%ile for height and 25%ile for weight. Temp = 100.2, Pulse: 140, RR: 24, and BP: 145/100. Bluish discoloration under both eyelids. Cardiac and abdominal exam normal. Labs:
Hgb: 10.5
Leukocyte: 8300 (Neu: 40%, Lymph: 55%)
Plate: 240,000
Lateral x-ray of chest shows mass in posterior mediastnum. Diagnosis?
A. anthrax
B. Congenital heart disease
C. CF
D. Dermatomyositis
E. Neuroblastoma
F. Pulmonary Sequestration
G. Thymoma
H. TB

Reluctance to walk (possible bone lesion), weight loss, poor appetite, etc over the course of 2 weeks makes me worried about malignancy. When I read bluish discoloration under eyelids, I think of neuroblastoma (case files says it's due to orbital involvement of the neuroblastoma).

A previously healthy 3 year old boy brought to doc b/c fever, sore throat, malaise, poor appetite for 2 days. He says that his throat feels scratchy. There has been no vomiting, diarrhea, rhinorrhea. Active and alert. Temp of 38.7. Exam shows no abnormalities of tympanic membrane or pharynx. Leukocyte count is 9500.
A. acetaminophen
B. IV antibiotics
C. IVIG
D. IM ceftriaxone
E. Oral antibiotics
F. Oral corticosteroid
G. Xray chest

There's no obvious indication that the kid has a bacterial infection that warrants treatment (purulent discharge, ear infection, pharyngeal exudate, etc). WBC is normal. At this point, just control the fever with tylenol.

Previously healthy 1 month old boy brought to ER 2 hrs after onset of bilious vomiting. Less active than usual and feeding poorly. Last bowel 1 day ago. Born at 38 weeks. Appears ill. Tep of 38, pulse 180, resp 60, BP 70/40. Abdomen firm and distended. bowel sounds decreased. normal rectal tone. small amt of stool in rectal vault. occult blood positive.
A. hirschsprung
B. gastroenteritis
C. hypertrophic pyloric stenosis
D. intussusception
E. midgut vovulus

I used process of elimination. Too young for intussusception. Pyloric stenosis causes nonbilious vomiting. Gastroenteritis unlikely to cause bilious vomiting. Hirschsprung unlikely given BM 1 day ago.

7 month old brought ot ER 35 min after seizure onset. Jerking mvts began in left arm the to right arm and both legs. Cyanotic. Temp 39.7, pulse 160, resp 30, BP 90/60. upward deviation of eyes. generalized rigidity and hyperextension of neck, back, all extremities. Clonic jerking mvts. oxigen administered. next step?
A. acetaminophen
B. diazepam
C. Glucose
D. Naloxone
E. Thiamine

Stop the seizure

A 7 year old fainted while on field trip. Progressively lethargic over past winter, and complexion darkened. Her height and weight at 50th percentile. BP 80/40. Lab test?
A. plasma cortisol
B. serum glucose
C. serum gonadotropin
D. serum PTH
E. serum TSH

low BP and darkened complexion - think possible Addison disease
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For anybody who's taken the shelf recently...how similar did you think the nbme tests were to the real thing? The scaling thing on the test says the info is from 1992-93?
 
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I thought the real test felt a lot harder, but that's partly because my school still has the paper-based NBME and I didn't manage my time so well compared to the online versions w/ timers. I also stress out a lot during the real exams :-$

My real scaled score was 4 points lower than the NBME which I thought was pretty close.
 
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Sorry, I feel like this is a stupid question but where did you get the practice test from
 
Same place as the step 1 ones but they're called clinical science mastery exams
 
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Not that I know of. The tests from the nbme are 20 bucks a pop
 
au3s said:
A questions for clinical mastery nbme form 2 need help with

A previously healthy 3 weeks old newborn is brought to the doctor by his mom b/c his skin has become progressively yellow over the past 6 days. She says that her son’s stools have become lighter in color over the past 3 days. He was born at term after an uncomplicated pregnamcy and vaginal delivery. He has been fed formula since birth. Exam shows jaundice. His total serum bilirubin concentration is 14, with a direct portion of 6. Which is the most likely mechanism for this infant’s condition?


a. decreased conjugation of bilirubin

b. decreased excretion of bilirubin

c. hepatic enzume deficiency

d. increased enterohepatic circulation of bilirubin

e. increased production of bilirubin


SO please tell me what the diagnosis is and the answer to the question. thank you
Click to expand...

I would think C

seems like a direct hyperbilirubinemia and these are generally more severe ...anatomical defect, enzyme deficiency (crieggler najar, etc)
 
I'm pretty sure it was b....like biliary atresia or something. If it were an enzyme deficiency it would be unconj rather than a direct of 6
 
Agree with B. Light stool and direct hyperbili makes me think about obstruction (bile isn't getting out).
 
au3s said:
A questions for clinical mastery nbme form 2 need help with

A previously healthy 3 weeks old newborn is brought to the doctor by his mom b/c his skin has become progressively yellow over the past 6 days. She says that her son’s stools have become lighter in color over the past 3 days. He was born at term after an uncomplicated pregnamcy and vaginal delivery. He has been fed formula since birth. Exam shows jaundice. His total serum bilirubin concentration is 14, with a direct portion of 6. Which is the most likely mechanism for this infant’s condition?


a. decreased conjugation of bilirubin

b. decreased excretion of bilirubin

c. hepatic enzume deficiency

d. increased enterohepatic circulation of bilirubin

e. increased production of bilirubin


SO please tell me what the diagnosis is and the answer to the question. thank you
Click to expand...

acholic stool and high direct bilirubin is probably biliary atresia
 
Psai said:
acholic stool and high direct bilirubin is probably biliary atresia
Click to expand...
jdj16 said:
I'm pretty sure it was b....like biliary atresia or something. If it were an enzyme deficiency it would be unconj rather than a direct of 6
Click to expand...
jdj16 said:
I'm pretty sure it was b....like biliary atresia or something. If it were an enzyme deficiency it would be unconj rather than a direct of 6
Click to expand...

Whoops you guys are totally right...read that a little too fast and skipped to the answer choice ...good catch & good question!
 
Just took the test. Wish I started skimming brs peds from the beginning. I was skeptical because it's from 2004 but almost everything in there was right on the money. Uworld was good too but the explanations were very long. Read case files which helped me think about actual patients and make a differential but the questions they provided were kinda useless. Scored an 82 on the second peds nbme
 
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Psai said:
Just took the test. Wish I started skimming brs peds from the beginning. I was skeptical because it's from 2004 but almost everything in there was right on the money. Uworld was good too but the explanations were very long. Read case files which helped me think about actual patients and make a differential but the questions they provided were kinda useless. Scored an 82 on the second peds nbme
Click to expand...

Thanks for the feedback. I've basically finished uworld and have 2 weeks left...our faculty really pushes pre test as something we should do..do you think a run through of pre test or brs would be more helpful? I don't see myself making it through both...
 
Psai said:
Just took the test. Wish I started skimming brs peds from the beginning. I was skeptical because it's from 2004 but almost everything in there was right on the money. Uworld was good too but the explanations were very long. Read case files which helped me think about actual patients and make a differential but the questions they provided were kinda useless. Scored an 82 on the second peds nbme
Click to expand...

Thanks, hope it went well! Could you comment on if the questions were more management or just recognizing diseases from vignettes and facts?
 
Both. You'll have questions about what disease is this with labs provided or they will be like this kid has a painful swollen knee with a fever what test would you order. Don't know about pretest but I think brs is really good
 
I appreciate the advice..thanks again. Maybe I'll have to see if I can find a cheap copy.
 
I would personally recommend pretest if anything because I found BRS to be way too long for me - I got through < 10 pages before getting way too bored.

I studied with UWorld (read every explanation) and CaseFiles for the most part.
Did both NBME's and thought that was helpful.
Got through < 50 Qs on Pre-test but mainly because of a time constraint.
Did ~20 CLIPP Cases and did NOT think they were helpful.
This was enough to get me a 95 scaled score on the shelf.
 
From the Peds Pretest Book, I'm struggling with a certain notation from questions 228-234. Anyone understand what is meant by the "Excess pH" notation in Pediatrics pretest? The answer explanation seems to contradict what most sources online define as "Base Excess" which I assumed to be the same thing.

To create a context, the questions give us a set of values: Base pH, PCO2, PO2, and Excess pH. Based on the answer explanations, it seems that the higher the Excess pH, the more (metabolic) acidotic of a state the patient is in.

I posted about this in a specific question thread in the Clinical Rotations forum but in retrospect, I realize it may be better addressed in the official Peds Shelf thread. Sorry for the double post.
 
Anyone who has taken it know if vaccination schedules and milestones are worth the memorization/high yield?
 
I had no Q regarding specific vaccine schedules.
1 Q on whether a kid was meeting various milestones or not.
 
Raw: 97
Resources:
Brs x1
Case files x1
Pretestx1
Uworld peds qx1
Clipp casesx1

I recommend everything but pretest. Clipp is inefficient but high yield (required by school). Would not recommend clipp unless required. I could have made another pass of brs with the time. Brs is absolute gold standard. I highly recommend it . Case files is also good, but it is better for a quick review the last week or so. The test is difficult but not impossible. Don't waste time in vaccine schedules and know only the major developmental milestones.
 
Scaled Score 89
Percentile 95

Case Files (Great)
UWorld (Great)
Pretest (Good)
BRS (Questions only, can't read textbooks)
Blueprints (Mediocre at best, questions only as well)

A lot of IM problems in adolescent kids. Questions were fairly long and convoluted, definitely the toughest shelf I've written this year. Relatively high number of wtf questions.
 
Did pretty good on the shelf so wanted to report what I used since others have helped out so much:

1) BRS x1 (wish I went through this x2 or x3)
2) Pre-Test x1
3) CaseFiles x0.5 (wish I was able to finish this)

Did not do UWorld and judging by the questions I saw friends doing on the rotation, Pre-Test matched the ambiguity that I saw on the shelf

Best of luck everyone!
 
I took the shelf recently and received a scaled score of 89

Brs peds 1x
Pretest 1x
Uworld 2x
Mtb step 3 peds section
Nbme 1 98
Nbme 2 90

I thought the exam was more difficult than the nbme practice exams. It would have been nice to have had internal medicine prior to this exam as there were plenty of medicine questions that weren't addressed in any of the peds resources I used. Although I didn't do as well as I did on my practice exams, I am still happy with my score
 
A 12 yo girl has the onset of headaches and a change in mental status. She received the diagnosis of type 1 DM earlier today and was admitted to the hospital for treatment of DKA. Three IV boluses of 0.9% saline were administered during the past 2 hours, and her serum glucose concentration ahs decreased from 874 mg/dL to 400 mg/dL during this time. She responds to painful stimuli only. Her temperature is 97.9, pulse 56/min, respirations 12/min, and BP is 146/88. Fundoscopic examination shows absence of venous pulsations. Physical examination shows no abnormalities. Which of the following is the most likely cause of this patient’s altered mental status?
A) Cerebral edema <-- AMS + "absence of venous pulsations" on fundoscopy suggesting papilloedema. She was probably dehydrated due to DKA and her hypernatremia was corrected too quickly.
B) Hypoglycemia
C) Hypovolemia
D) Metabolic Acidosis (WRONG)
E) Persistent hyperglycemia
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A is the right answer, but the explanation is not correct. Correction of hypernatremia is not the correct mechanism.
First, many believe that any patient with DKA has some degree of cerebral edema, generally related hyperviscous blood due to dehydration caused by the osmotic diuresis (and poor PO intake/vomiting/gastro symptoms that are often a trigger for DKA) from the elevated blood sugar. This leads to areas of micro ischemia and injury with subsequent reperfusion injury. Further exacerbating the situation is the formation of osmotically active metabolites within neurons to maintain some semblance of a normal osmotic gradient between the brain and the blood (which is now hyper, hyper osmolar). When you treat with excessive amounts of fluid that is now relatively hypotonic (when your glucose is 874, Normal saline is NOT isotonic), you're changing that osmotic gradient and you have subsequent inflow of free water into neurons causing them to swell. Dropping the glucose more than about 100/hr is a dangerous rate of decline. The other components that should make you be thinking increased intracranial pressure are the bradycardia and hypertension which are two components of Cushing's Triad.
 
Hard to believe BRS Peds (2004 book) is still a great source.
 
Took the test last week and scored a 99.

-Uworld (x1)
-Pretest Peds (x2)
-Firecracker
-USMLE Rx (x1)
-Deja Review Peds (x3)
-CLIPP cases (worthless, but required by my school)
-NBME 1: 77 (2 weeks out)
-NBME 2: 98 (4 days out)

I used Deja Review Peds exclusively during the last week leading up to the exam. The exam itself was similar to the NBMEs. I could get the really hard questions down to 50/50 easily. I had one developmental milestone question and no specific vaccine questions. The rest felt like step 1 throwbacks.
 
NBME Question about rotavirus prevention: Would disposable diapers be the best way to prevent (since its fecal oral transmission?) Other answers were filtering well water, closing the daycare, removing pets. Vaccine was not an option. Anyone know what the answer was? And the Salmonella question was fully cooking the poultry, right? Thanks
 
Enzymes said:
NBME Question about rotavirus prevention: Would disposable diapers be the best way to prevent (since its fecal oral transmission?) Other answers were filtering well water, closing the daycare, removing pets. Vaccine was not an option. Anyone know what the answer was? And the Salmonella question was fully cooking the poultry, right? Thanks
Click to expand...

I think the answer was strict hand washing. And yea, the answer to the salmonella question was fully cook the poultry.
 
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Got around 80, used case files and uworld once. Both were good and I recommend them. Tried to skim brs which I thought was awesome but didn't have enough time. I should have studied more, especially during outpatient. I would have done pretest. I also think that some sort of textbook would be good for this rotation, that was a big weakness
 
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Couple of NBME questions:

1. 2yo girl with positive PPD test. What is the correct treatment?

I picked the four drugs (including streptomycin) but that was wrong. Any help on this one? Was it just a 3 drug treatment?

2. Rash following MMR vaccine is caused by what? Is it just live virus replication, but ultimately won't cause infection?

3. 22 month old with bowed legs. Drinks goat milk and lives in old peeling paint house? Cause of bowed legs: Degenerative, infectious, metabolic,neoplastic, toxic?
 
Enzymes said:
Couple of NBME questions:

1. 2yo girl with positive PPD test. What is the correct treatment?

I picked the four drugs (including streptomycin) but that was wrong. Any help on this one? Was it just a 3 drug treatment?
Positive PPD w/out x-ray findings or active symptoms = latent TB. Treat with INH for 6-9 months.

2. Rash following MMR vaccine is caused by what? Is it just live virus replication, but ultimately won't cause infection?
live virus can cause a mild case of rubella, answer was D, live virus replication

3. 22 month old with bowed legs. Drinks goat milk and lives in old peeling paint house? Cause of bowed legs: Degenerative, infectious, metabolic,neoplastic, toxic?
Click to expand...
It's rickets from drinking goat's milk, which is a poor source of vitamin D. Metabolic.
 
Have an 8 week rotation for peds - 2 nicu, 2 clinics, 4 wards. Was thinking of just doing BRS and UWx2 (+ selective rereading of BRS as time permits). Do I really need more of a question source? I read mixed things about pretest and case files in this thread
 
Scaled score: 88 (87 percentile)
Resources:
1. This ppt by Dr. Rahami is equivalent to Pestana for Surg i.e. high recommended (only 78 slides). X1 http://som.uthscsa.edu/StudentAffairs/documents/Pediatrics.pdf
2. FA x1 (didn't think this was that great- would probably replace with BRS or Blueprints)
3. Pre-test x1 (Excellent)
4. NBME 1: 90 (Excellent)
5. NBME 2: 82 (Excellent)
6. CLIPP exam: 83 (Relatively useful, would be nice if they had explanations available but at least they give you the correct answer unlike NBMEs)
7. CLIPP cases (BUT only because they are required, useless waste of time in my opinion)

As for the exam, it was definitely harder than both NBME exams as well as the CLIPP exam. Best advice would be to slow down and read the entire question since I missed some easy questions because I would jump on the first few words and then stop reading. Finished entire exam, but definitely didn't have enough time to review anything, not even the questions I had marked (~30).

Had IM and Surg before this, and scored similarly (87 on both, which corresponded to roughly 92 percentile each).
 
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Got my shelf score back: 95 scaled score. Did not get a raw score.
It was a typical shelf in that there were several wtf questions; I had an answer in mind after reading the question and then none of the answer choices really fit. The stuff you think should be heavily represented like well child care, really wasn't. There was maybe 1 development question, 1 vaccine question, 1 ethics question. Lots of congenital heart defects, URIs, meningitis. Then about 2 questions for each organ system.
I didn't read any texts to study. Just didn't like any of the options out there. I used questions.
Did all the Kaplan questions, most of U World, all of pretest, and both the practice NBMEs. Scored an 85 and 90 on the NBMEs.
 
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Has anyone used Shelf-Life Pediatrics to prepare for the shelf? It's a new book that just came out this year. I haven't heard much about it and there are only 5 reviews on amazon but all are excellent. Everyone at my school seems to use blueprints but no one is very satisfied with it so I am interested in seeing if anyone else has thoughts on this new book. Thanks!
 
I am tanking uworld with a week left

Not sure how apparently none of blueprints stuck in my head

this shelf is going to get me good
 
Missorleans said:
Previously healty 16 yo boy comes to doctor 6 hours after onset of fever and right foot pain. He ahs a 1 week Hx of progressive itching rash that started between 2nd and 3rd toes of both feet. Has an active lifestyle and plays baseball and football. Temp 101.1. Exam of right foor shows erythema and induration from the interdigital spaces to the medial malleoulus. Exam of left foot shows dry scaly skin between toes. A tender lymph node is palpated in right side of groin. Which organism is most likely?
A) E. coli
B) Mycobacterium tuberculosis
C) Pseudomonas aeruginosa <-- athelete's foot + fever (sign of systemic spread) (nope, wrong as well.)
D) Staph aureus
E) T. rubrum (WRONG)

It isn't Pseudomonas either. I picked that and it was marked wrong. Maybe it was a staph infection superimposed on athlete's foot.
Click to expand...

It's staph aureus from athlete's foot. He had tinea pedis which lead to a break in the skin which lead to staph invasion.
 
Resources:
BRS- questions, practice exam, and used as reference (highly recommended)
UWorld (highly recommended)
PreTest 300/500 - best pretest book I've used so far, wish I could've finished it (recommended)
NBME 1 and 2 (recommended, a few repeats showed up)

This was more than enough to perform well on the shelf.
 
Cytarabine said:
Have an 8 week rotation for peds - 2 nicu, 2 clinics, 4 wards. Was thinking of just doing BRS and UWx2 (+ selective rereading of BRS as time permits). Do I really need more of a question source? I read mixed things about pretest and case files in this thread
Click to expand...

Ended up doing UWx1, about half of BRS, and 5 of those cases no one recommends (also do not recommend). I just had motivation issues over the rotation. I felt very underprepared and didn't think I did well, and I'm usually a fairly accurate judge of my performance, but ended up doing well enough to honor the rotation. I think my original plan of UWx2 + BRS would be strong preparation and reasonable to get through over the course of an 8 week rotation
 
Did well enough for honors on this one.

Uworld and Case Files was enough for this IMO.
 
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Got an 83.

Just did UWorld (74% that section) and reading for the patients I saw.
Had BRS but only had time to read 4 chapters worth.
Did the 2 self assessments and got something like a 78% on one and 84% on the other.

Had Pretest as well, but didn't do any of it. Agree with others that if you can get through BRS that's probably sufficient to hit a 90% on the shelf and if you can get through at least half of pretest in addition to Uworld you'll definitely rock it.
 
2 weeks out. Finished uworld, most of pretest and almost done first pass of brs.
As I am doing pretest I find that some of the questions are so stupid/ poorly written. For my second pass should I just read the answer explanations?
 
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