Official Pediatrics Shelf Exam Thread

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Felt like those chapters were pretty low yield. Your time would def be spent getting through the meat of that book.
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What up, ya'll.

I finished reading through Blueprints and figured I'd share my reading notes. I won't say they're completely comprehensive as if you want completely comprehensive you should just read the text, but they're fairly detailed while still being "concise" (by concise I mean 128 pages in Word). You can get it here: https://drive.google.com/file/d/0B2W2KIoJyztwQXJEM0ZUSXBqaGM/edit?usp=sharing

There are multiple references to seeing charts and tables below which intentionally don't refer to anything. They were pictures of the text that I was too lazy to transcribe that I removed for copyright reasons.

Good luck, and happy studying.
 
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BRS + UWorld was clutch for the shelf. Didn't use any other resources to study from. The 2 practice NBMEs online were easier than the real deal and they under-predicted my final score -- not sure how accurate they've been for others.
 
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Hi guys, just took NBME practice test 1 and was wondering if anyone got these questions correct on the practice nbme. An explanation to your reasoning would be really appreciated as well, thanks in advance!

1. 13yo girls brought in for 6 weeks of constant abdominal pressure, breast tenderness, and weight gain. Never had menstrual period. Vitals are normal. Breast and pubic hair Tanner 3. Abdominal exam shows a nontender mass below umbilicus. Next step in diagnosis?
a. urinalysis
b. measure serum alpha-fetorotein
c. measure serum beta-hCG
d. x-ray of abdomen
e. CT scan of pelvice (WRONG)
No idea what the diagnosis is....

2. 17yo girl brought to ED after found lying on the street. Outside temp is 40F. En route to hospital, paramedics administered O2 and ECG showed J-wave. She is lethargic and poorly responsive to verbal commands. Temp is 32 (89.6F). Puls = 60, RR = 12, BP = 90/60. There is an odor of ethanol on her breath. Which of the following is most likely explanation for the patient's cardiac findings?
a. cocaine toxicity, b. ethanol toxicity, c. hyperkalemia, d. hypocalcemia, e. hypothermia, f. increased intracranial pressure, g. MI
Again, no idea what the "cardiac finding" is.... Ethanol toxicity was the wrong answer

3. 1week old newborn has 1 day history of difficulty breathing and discoloration of extremities. Appears ill, temp = 97.5, pulse = 160, resp = 52, BP = 60/36 in upper extremities and unobtainable in lower extremities. Skin, mucous membranes, and nail beds are dusky, and there is mottled discoloration of the extremeties. Moderate intercostal retractiosn and grunting. Lungs clear. Holosystolic murmuc along left sternal border. Liver edge palpable 4cm below costal margin.
pH = 7.15, CO2 = 28, O2 = 98
Intubation, mechanical ventilation, and iv fluid initiated, but no improvement one hour later. x-ray shows cardiomegaly and pulmonary congestion. Explanation of this condition?
a. cosure of ductur arteriosus
b. deacreased pulm vascular resistance
c. increased pulm vascular resistance
d. intracardiac right to left shunt (Wrong)
e. opening of ductus arteriosus
Again, not sure what the diagnosis/pathology is here. Thought it was a VSD or something and the shunt turned into right to left (although its too early since its a newborn). any explanation of whats going on??

4. 3yo comes in for rapid breathing and cant catch his breath. pulse = 100, RR = 30, BP=120/80. lungs clear. slight hyperresonance on right chest. decreased breatah sounds on right. x-ray shows slight overexpansion of right lung compared with left. no infiltrates or effusions. Best management?
a. hyperbaric Oxygen
b. CT of chest
c. bronchoscopy
d. Thoracotomy (Wrong)
e. Tube thoracostomy
Pretty sure this was tension pneumothorax and couldnt find thoracocentesis. Didn't really know the difference between thoracotomy and tube thoracostomy (kinda embarrassing). I'm guessing its tube thoracostomy but wanted to check... lol

5. 16yo boy comes for routine health exam. Both maternal and paternal family history includes premature coronary artery disease, HTN, and hyperlipidemia. BMI is 35. Cardiac exam no abnormalities. Fasting serum lipids studies show:
Choldesterol (total): 214; HDL: 32, LDL: 144
Triglycerides: 187
Best step in management?
a. reduced calorie diet
b. weight training program
c. Beta-blocking agent therapy
d. cholesterol binding resin therapy
e. stating (wrong)
Somehow thought it said dad and paternal grandfather so I was thinking familial hyperchol... I'm guessing its either A or B
 
Just making sure when you guys say BRS Peds, are you actually talking about the 2004 BRS Peds, or are you using it as short for blueprints, thanks.
 
soccerboy2288 said:
Hi guys, just took NBME practice test 1 and was wondering if anyone got these questions correct on the practice nbme. An explanation to your reasoning would be really appreciated as well, thanks in advance!

1. 13yo girls brought in for 6 weeks of constant abdominal pressure, breast tenderness, and weight gain. Never had menstrual period. Vitals are normal. Breast and pubic hair Tanner 3. Abdominal exam shows a nontender mass below umbilicus. Next step in diagnosis?
a. urinalysis
b. measure serum alpha-fetorotein
c. measure serum beta-hCG
d. x-ray of abdomen
e. CT scan of pelvice (WRONG)
No idea what the diagnosis is....

Anyone with amenorrhea always get a beta-hcg to r/o pregnancy, even if they have never had a menstrual period. She could be pregnant, or she could have outflow tract obstruction (or something else).

2. 17yo girl brought to ED after found lying on the street. Outside temp is 40F. En route to hospital, paramedics administered O2 and ECG showed J-wave. She is lethargic and poorly responsive to verbal commands. Temp is 32 (89.6F). Puls = 60, RR = 12, BP = 90/60. There is an odor of ethanol on her breath. Which of the following is most likely explanation for the patient's cardiac findings?
a. cocaine toxicity, b. ethanol toxicity, c. hyperkalemia, d. hypocalcemia, e. hypothermia, f. increased intracranial pressure, g. MI
Again, no idea what the "cardiac finding" is.... Ethanol toxicity was the wrong answer

Cardiac finding is the J-wave on ECG--associated with hypothermia

3. 1week old newborn has 1 day history of difficulty breathing and discoloration of extremities. Appears ill, temp = 97.5, pulse = 160, resp = 52, BP = 60/36 in upper extremities and unobtainable in lower extremities. Skin, mucous membranes, and nail beds are dusky, and there is mottled discoloration of the extremeties. Moderate intercostal retractiosn and grunting. Lungs clear. Holosystolic murmuc along left sternal border. Liver edge palpable 4cm below costal margin.
pH = 7.15, CO2 = 28, O2 = 98
Intubation, mechanical ventilation, and iv fluid initiated, but no improvement one hour later. x-ray shows cardiomegaly and pulmonary congestion. Explanation of this condition?
a. closure of ductus arteriosus
b. deacreased pulm vascular resistance
c. increased pulm vascular resistance
d. intracardiac right to left shunt (Wrong)
e. opening of ductus arteriosus
Again, not sure what the diagnosis/pathology is here. Thought it was a VSD or something and the shunt turned into right to left (although its too early since its a newborn). any explanation of whats going on??

Probably has tetralogy. Closure of the PDA with severe pulmonary stenosis leads to his sudden onset of cyanosis.

4. 3yo comes in for rapid breathing and cant catch his breath. pulse = 100, RR = 30, BP=120/80. lungs clear. slight hyperresonance on right chest. decreased breatah sounds on right. x-ray shows slight overexpansion of right lung compared with left. no infiltrates or effusions. Best management?
a. hyperbaric Oxygen
b. CT of chest
c. bronchoscopy
d. Thoracotomy (Wrong)
e. Tube thoracostomy
Pretty sure this was tension pneumothorax and couldnt find thoracocentesis. Didn't really know the difference between thoracotomy and tube thoracostomy (kinda embarrassing). I'm guessing its tube thoracostomy but wanted to check... lol

Thoracotomy is a large incision typically in the lateral chest wall used for CT surgery. Tube thoracostomy (AKA chest tube) is indicated here.

5. 16yo boy comes for routine health exam. Both maternal and paternal family history includes premature coronary artery disease, HTN, and hyperlipidemia. BMI is 35. Cardiac exam no abnormalities. Fasting serum lipids studies show:
Choldesterol (total): 214; HDL: 32, LDL: 144
Triglycerides: 187
Best step in management?
a. reduced calorie diet
b. weight training program
c. Beta-blocking agent therapy
d. cholesterol binding resin therapy
e. stating (wrong)
Somehow thought it said dad and paternal grandfather so I was thinking familial hyperchol... I'm guessing its either A or B

He's fat. He needs to lose weight.
Click to expand...

I bolded the answers that I believe to be correct.
 
Stellar Clouds said:
I bolded the answers that I believe to be correct.
Click to expand...

Thanks alot, I appreciate your help.

For the congenital heard defect question, I was wondering if this could also be isolated ToF without an associated PDA. ToF can present any time right (mostly early childhood)? Or would that not present so acutely?? If this was an isolated ToF with a decompensation, then the answer would be increased pulmonary vascular resistance... I think?
 
jayhawkjbc said:
I'm not sure if anyone will see this, but number 4 is actually bronchoscopy- it's a foreign body aspiration.
Click to expand...

Thanks jayhawkjbc! wow I don't know why I didn't think of that.... but it makes sense now that you mentioned it lol Is there a way to differentiate foreign body aspiration vs tension pneumothorax or was that based on the age group? Some wheezing in the stem would've been helpful... Anyways thank for the input. Any input regarding for the questions I posted below??
 
So my shelf is coming up and I took the NBME form 2. Was wondering if anyone could help me with these questions as well. Hopefully those who take it in the future will find these helpfull as well.. Thanks in advance!!

1. 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. anthroax, B. Congenital heart disease, C. CF, D. Dermatomyositis (WRONG), E. Neuroblastoma, F. Pulmonary Sequestration, G. Thymoma, H. TB
Based on the x-ray and high BP my next guess would be Neuroblastoma (arising from the sympathetic chain)... But I dont know what to make of the physical exam findings (bluish under eyelids, reluctance to walk, etc).... Any idea whats going on??

2. Healthy 16yo from Africa has painless lesion on vulva for 4 days. Sexually active with one male and no contraception used. 10-mm, sharply demarcated, elevated, round lesion on right labium majus. Base of the lesion is smooth and nonpurulent. Organism??
A. Chlamydia, B. Gardnerella Vaginitis, C Haemophilus ducrey, D. HSV, E. HPV (WRONG), F. Neisseria Gonorrhea, G. Teponema pallidum, H. Trichomonas vaginalis.
Thought genital warts would present like this. My next guess would be syphillus since I just read that it can present as elevated papule, but I thought it would be ulcerated classically. And why would this NOT be HPV? wouldnt genital warts present like this??

3. 3400g male newborn has decreased muscle tone. Born at GA: 38wks, apgar 6 and 9. Temp: 98.2, Pulse: 150, RR: 60. Pulse oximetry on room shows 92%. Exam shows epicanthal folds, white stellate spots on iris, single palmar crease, truncal hypotonia, and wide spaces between 1st and 2nd toes. Best next step in management?
A. measure creatine kinase and MRI of brain
B. Chest x-ray and blood cultures
C. ECG and chromosomal analysis
D. Give PGE1 and oxygen supplementation (WRONG)
E. Give surfactant and I.V. ampicillin and gentamicin
Thought the best thing to do is give oxygen (and I guess PGE1) because of the low O2 and because he may have a congenital heart defect (due to Down syndrome). I guess his APGAR is good, hes not cyanotic, and pulse is >100 so you don't need to intervene. So I'm guessing ECG and chromosomal analysis is the right answer?

4. 4wk old girl brought in because 2weeks of irritability and passing stools streaked with mucus and blood. No vomiting. 2 weeks ago, switched from cow's milk-based formula to soy milk-based formula. She is at 35%ile for length, weight, and head circum. Weight remains unchanged from 2wks ago. Most appropriate next step is to begin what?
A. Electrolyte rehydration solution for 24hrs (WRONG)
B. Formula with evaporated milk, water, and corn syrup
C. Formula with hydrolyzed casein
D. Oral Amoxicillin
E. Oral Ranitidine
Really don't know whats going on here... I'm guessing its B or C but don't really know what either of those answers mean.

Thanks in advance guys.
 
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soccerboy2288 said:
So my shelf is coming up and I took the NBME form 2. Was wondering if anyone could help me with these questions as well. Hopefully those who take it in the future will find these helpfull as well.. Thanks in advance!!

1. 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. anthroax, B. Congenital heart disease, C. CF, D. Dermatomyositis (WRONG), E. Neuroblastoma, F. Pulmonary Sequestration, G. Thymoma, H. TB
Based on the x-ray and high BP my next guess would be Neuroblastoma (arising from the sympathetic chain)... But I dont know what to make of the physical exam findings (bluish under eyelids, reluctance to walk, etc).... Any idea whats going on??

2. Healthy 16yo from Africa has painless lesion on vulva for 4 days. Sexually active with one male and no contraception used. 10-mm, sharply demarcated, elevated, round lesion on right labium majus. Base of the lesion is smooth and nonpurulent. Organism??
A. Chlamydia, B. Gardnerella Vaginitis, C Haemophilus ducrey, D. HSV, E. HPV (WRONG), F. Neisseria Gonorrhea, G. Teponema pallidum, H. Trichomonas vaginalis.
Thought genital warts would present like this. My next guess would be syphillus since I just read that it can present as elevated papule, but I thought it would be ulcerated classically. And why would this NOT be HPV? wouldnt genital warts present like this??

G. Treponema - painless chancre of syphilis

3. 3400g male newborn has decreased muscle tone. Born at GA: 38wks, apgar 6 and 9. Temp: 98.2, Pulse: 150, RR: 60. Pulse oximetry on room shows 92%. Exam shows epicanthal folds, white stellate spots on iris, single palmar crease, truncal hypotonia, and wide spaces between 1st and 2nd toes. Best next step in management?
A. measure creatine kinase and MRI of brain
B. Chest x-ray and blood cultures
C. ECG and chromosomal analysis
D. Give PGE1 and oxygen supplementation (WRONG)
E. Give surfactant and I.V. ampicillin and gentamicin
Thought the best thing to do is give oxygen (and I guess PGE1) because of the low O2 and because he may have a congenital heart defect (due to Down syndrome). I guess his APGAR is good, hes not cyanotic, and pulse is >100 so you don't need to intervene. So I'm guessing ECG and chromosomal analysis is the right answer?
yes C is the right answer

4. 4wk old girl brought in because 2weeks of irritability and passing stools streaked with mucus and blood. No vomiting. 2 weeks ago, switched from cow's milk-based formula to soy milk-based formula. She is at 35%ile for length, weight, and head circum. Weight remains unchanged from 2wks ago. Most appropriate next step is to begin what?
A. Electrolyte rehydration solution for 24hrs (WRONG)
B. Formula with evaporated milk, water, and corn syrup
C. Formula with hydrolyzed casein
D. Oral Amoxicillin
E. Oral Ranitidine
Really don't know whats going on here... I'm guessing its B or C but don't really know what either of those answers mean.

C is the right answer

Thanks in advance guys.
Click to expand...


I answered the last 3 questions.I wasnt sure of the first one. hope it helps
 
Chiomsy said:
I answered the last 3 questions.I wasnt sure of the first one. hope it helps
Click to expand...

Thanks a lot chiomsy, really appreciate your help. Was this based on you getting them correct on the nbme test?
Also what does hydrolyzed casein even mean? is the patient allergic to soy milk?? Would appreciate any reasoning to this answer...
 
Yes, pt is allergic to soy, so you give a formula with more broken down components, aka hydrolized milk proteins (casein). If pt further cannot tolerate that, give you ultimate, which is amino acid based feed.
 
Yes, pt is allergic to soy, so you give a formula with more broken down components, aka hydrolized milk proteins (casein). If pt further cannot tolerate that, give you ultimate, which is amino acid based feed.
 
NickNaylor said:
What up, ya'll.

I finished reading through Blueprints and figured I'd share my reading notes. I won't say they're completely comprehensive as if you want completely comprehensive you should just read the text, but they're fairly detailed while still being "concise" (by concise I mean 128 pages in Word). You can get it here: https://drive.google.com/file/d/0B2W2KIoJyztwQXJEM0ZUSXBqaGM/edit?usp=sharing

There are multiple references to seeing charts and tables below which intentionally don't refer to anything. They were pictures of the text that I was too lazy to transcribe that I removed for copyright reasons.

Good luck, and happy studying.
Click to expand...


Thank you for putting this together. :)
 
If I were to use:

BRS Pediatrics
UWorld Peds 2x (UWorld Medicine & OB/GYN are already done)
CLIPP Cases
and UpToDate throughout the rotation

would I be set for the shelf?
 
Hello, So I just got my shelf score. Didnt score in the 90's like most people here but il still share my experience. This was my first shelf and my brain was still on vacation mode so I started studying late and wasnt able to get through the books I purchased.

BRS - I read so many positive comments about the book but unfortunately I was only able to get through the first 3 chapters
U world- did all peds questions 1x.
Case files - I did the first 7 cases
Kaplan lecture videos - I watched about 70 %. They were helpful in the evenings after a long day in the hospital and my brain was too fried to read or do questions.

Nbme 1: 80
Nbme 2: 82
Shelf score : 86

U world and NBME exams were the most helpful resources for me. I got very similar questions to the NBME practice exams
 
I just took my Peds Shelf and was honestly blown away by it. Going into it, I did have one disadvantage being that my rotation was 100% outpatient. However, I actually felt like I prepared for this Shelf better and more efficiently than any other exam. I was shocked about how long all my questions were, with a ton of irrelevant lab results. Also, all the main topics for Pediatrics I thought would be on the exam, wasn't. I finished with only 14 minutes to spare to review my marked answers, which is also a first for me.

For my prep: I studied Case Files, First Aid for the Wards (Peds), First Aid for Step 2 CK (Peds section), Kaplan Peds Videos & Notes, all UWorld Peds questions (including repeating all the ones I got wrong, once I finished going through it once), an NBME Peds Shelf Assessment, some Pretest questions (which I hated), and miscellaneous other resources.

It honestly shocks me that with the prep I did, the test felt so foreign to me, though I suppose I will have to wait and see how I did *crosses fingers*
 
Hi guys,

This may sound like a noob question but are the Kaplan videos that were mentioned in this thread the same as the Kaplan step 2 pediatrics videos?
 
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Entropic said:
Hi guys,

This may sound like a noob question but are the Kaplan videos that were mentioned in this thread the same as the Kaplan step 2 pediatrics videos?
Click to expand...
Yes
 
I just took this yesterday. I was confident going into this shelf but it was much tougher than expected. I normally hate it when people say that they thought an exam was challenging bc they could only cut the answers down to 2 choices (bc I usually think that person just didn't study enough) .... buuut that's exactly what happened to me for about half of this test.

I used UW x 1, Pretest x 1, Kaplan vids x 1, BRS x 1, ~20 CLIPP cases, First Aid PEDs as reference.
 
Shakeys said:
I just took my Peds Shelf and was honestly blown away by it. Going into it, I did have one disadvantage being that my rotation was 100% outpatient. However, I actually felt like I prepared for this Shelf better and more efficiently than any other exam. I was shocked about how long all my questions were, with a ton of irrelevant lab results. Also, all the main topics for Pediatrics I thought would be on the exam, wasn't. I finished with only 14 minutes to spare to review my marked answers, which is also a first for me.

For my prep: I studied Case Files, First Aid for the Wards (Peds), First Aid for Step 2 CK (Peds section), Kaplan Peds Videos & Notes, all UWorld Peds questions (including repeating all the ones I got wrong, once I finished going through it once), an NBME Peds Shelf Assessment, some Pretest questions (which I hated), and miscellaneous other resources.

It honestly shocks me that with the prep I did, the test felt so foreign to me, though I suppose I will have to wait and see how I did *crosses fingers*
Click to expand...
So, I suppose I should mention that I did fine, got an A and got essentially the same grade as I did in Family Medicine, so as bad as I thought the exam was, it was apparently on-par and manageable.
 
g8orlife said:
I just took this yesterday. I was confident going into this shelf but it was much tougher than expected. I normally hate it when people say that they thought an exam was challenging bc they could only cut the answers down to 2 choices (bc I usually think that person just didn't study enough) .... buuut that's exactly what happened to me for about half of this test.

I used UW x 1, Pretest x 1, Kaplan vids x 1, BRS x 1, ~20 CLIPP cases, First Aid PEDs as reference.
Click to expand...

Just got my score: 83 raw. No percentile given. Pretty bummed b/c this is now my lowest NBME score since last year.

I agree with prior posters' comments about the exam, and this was my hardest shelf so far (already had IM and Neuro).
 
soccerboy2288 said:
Thanks jayhawkjbc! wow I don't know why I didn't think of that.... but it makes sense now that you mentioned it lol Is there a way to differentiate foreign body aspiration vs tension pneumothorax or was that based on the age group? Some wheezing in the stem would've been helpful... Anyways thank for the input. Any input regarding for the questions I posted below??
Click to expand...
The question read: "x-ray shows OVEREXPANSION of right lung." In a pneumothorax the lung shrinks in size, not overexpands. In a foreign body aspiration there is air trapping and hence overexpansion of lung due to the presence of a foreign body.
 
Finished a few weeks ago, thought I would share my experience. I read the forum, and decided on BRS Peds for this exam. I am the kind of person that likes to beast one resource as opposed to kind of knowing a bunch. I was a little skeptical since its from 2004, but the only true "error" I found was that it still teaches ABCs instead of CAB in the Emergency chapter. Yes it looks long, but it's a smaller book and in outline form. Easy to read. It was great. All I did to prepare for this exam was BRS Peds x2 and UWorld Qs x1. I expected this exam to be crazy hard, but it wasn't as bad as I thought it would be. If you known BRS Peds front to back and do UWorld, you should be good.

NBME 1: 85
Actual Shelf: 90 scaled score
 
I believe 3 is hemolytic disease of the newborn because mom is O+ and you are supposed to infer in the case of increasing jaundice that the baby is not.
I think 4 may be cholelithiasis due to hemolysis, but that's just a guess. I also got that question wrong.
 
Just took the shelf exam after 8 weeks of peds. 4 weeks inpatient and 4 weeks outpatient. This was my second-to-last rotation of third year (wahooooo!).

I read most of BRS Peds and annotated all of the peds uworld questions into MTB2/3. I also completed 20 CLIPP cases (school requirement).

There was a surprising amount of adult medicine on this shelf (17/18 yo M/F presents with…). Also a large amount of derm and electrolyte/acid-base questions. Overall I think it was reasonable. Passing is 60 and honoring is 80 at my school. Good luck!

NBME 1 - 80
Actual shelf score - 74

I suppose it could have gone better, but I prepared well and did not procrastinate so there is no use beating myself up about it!
 
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Anyone think you can get >90 with just 1) Uworld 2) Kaplan Videos 3) MTB- Peds Section ?
 
Peds was my 5th rotation (of 6 total).

For this rotation, I:

1) Read Case Files X1 and did all the questions
2) Worked through about half of pretest
3) Read a couple chapters of BRS and then realized its way too long for an 8 week rotation and switched to Case Files
4) Did all the Uworld questions for Peds

Shelf: 94th percentile

For reference I did the NBME practice test 2 a couple weeks prior and got a raw score of 88 (whatever that means) -- I think I missed 7 on it of the 50

Shelf really wasn't that bad. I think people overdo it with BRS... I'd rather really learn something shorter like Case Files than try to force my way through a dense book like BRS Peds... just my opinion though...
 
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95th percentile on the shelf exam

UW Peds 1.5x
Pretest Peds
Kaplan Qbook for peds
BRS Peds 1x

Pretty fair exam. My form had lots of surgery and rheum.
 
Does anyone even touch Nelson?

@normtheniner do you think your advice would apply to someone who had peds as their first rotation?

Sent from my SM-N9005 using Tapatalk
 
It sounds like BRS is the way to go, but I'm concerned about having enough time to get through it and blueprints (required for my rotation). About how many hours does it take to go through both of these?
 
Brain Bucket said:
Does anyone even touch Nelson?

@normtheniner do you think your advice would apply to someone who had peds as their first rotation?

Sent from my SM-N9005 using Tapatalk
Click to expand...


I think so. I had medicine first and my biggest mistake was using too many resources. My strategy for shelves changed to finding things that are manageable to get through while working hard on rotations at the same time. Once I did this my shelf scores went above 90th percentile.

I'd much rather get through a shorter book and have time to go back and review vs trying to finish something like BRS Peds before my times up and not being sure if I retained everything. With that said, I am a slow reader... so trying to get through BRS was hopeless for me.
 
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normtheniner said:
I think so. I had medicine first and my biggest mistake was using too many resources. My strategy for shelves changed to finding things that are manageable to get through while working hard on rotations at the same time. Once I did this my shelf scores went above 90th percentile.

I'd much rather get through a shorter book and have time to go back and review vs trying to finish something like BRS Peds before my times up and not being sure if I retained everything. With that said, I am a slow reader... so trying to get through BRS was hopeless for me.
Click to expand...
Thanks dude.
 
BRS x2, UWorld x1, 100 Q's from Pretest, first 10 cases in Casefiles

Shelf: 98

In my opinion, BRS + UWorld should be the foundation of studying for the shelf. I only went to Pretest to do questions in my weak areas. Knowing random genetic trivia will get you a few questions but the bulk was bread and butter Peds
 
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i think peds might be a good rotation to start with.
 
I'm reading through brs pediatrics and there's just so much information. Some of it overlaps from step 1 but there's a lot of new material. How did you guys deal with it? I was going to try to read the book first and then do questions. Should I try doing questions at the same time? I have pretest and case files but haven't bought uworld yet
 
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birthdaycake said:
Hi guys,

If anyone knows the answer to any of these, please share (and with an explanation if possible):

1. 15 month old girl has a 1 day history of rash and fever for the last 3 days. She got the MMR 10 days ago. No acute distress, temp is 101.2 F. She has an erythematous maculopapular rash over the face, trunk, and extremities. Which of the following is the most likely explanation for these findings?

A) arthus reaction from preexisting antibody to rubella virus (wrong)
B) delayed type hypersensitivity reaction to rubella antigen
C) immune complex disease from vaccine preservatives
D) replication of a live vaccine virus strain
E) viral dissemination in an immunocompromised host

2. A previously healthy 3 year old girl brought to physician because of a 2-month history of a right-sided limp. The limp is most obvious when she awakens and gradually becomes less noticeable as she plays. She has no recent history of fever, rash, or other illness and has not been exposed to pets or ticks. Today she appears well but walks with a limp. Temp is 98.2 F. No rash, normal pupils, normal red reflex, normal pharynx, normal cardiac exam. Right knee is swollen and warm but not erythematous or tender. The patient holds the right lower extremity in a slightly flexed position and will not fully extend it when she stands or walks. Laboratory studies show:
ESR 64 mm/h

Serum ANA+
Rheumatoid Factor -
ASO titer -
Lyme Ab -

In addition to the administration of naproxen, what's the best next step?
A) slit lamp exam
B) Bartonella henselae titer
C) Upper GI series
D) Arthroscopy
E) Surgical Aspiration of the right knee (wrong)

3. An 18 hour old female newborn is being evaluated bc of jaundice. She was born at term following an uncomplicated pregnancy and spontaneous vaginal delivery to a 31 year old woman, G2P1. She weighed 3799 g/8 lb 6 oz at birth. Mother's blood group is O+. Newborn has urinated twice but has had no bowel movements. Urine is dark yellow. She has had difficulty latching onto the breast correctly. She is alert. Exam shows jaundice of the face and chest. Abdomen is soft. Liver edge palpated 1 cm below the right costal margin, and the spleen tip is palpated 1 cm below the left costal margin. Serum total bilirubin is 11.1 with direct component of 0.1. What's the most likely diagnosis?

A) Breast milk jaundice
B) Galacatosemia
C) Hemolytic disease of the newborn
D) Physiologic jaundice of the newborn (wrong)
E) Sickle cell disease

4. An 8 year old girl brought to physician because of pallor and easy fatigability for the past 2 months. Symptoms began after URI. She was adopted, and her family history is unknown. She appears pale, spleen tip palpated 2 cm below left costal margin. Her HCT is 28%, retic count is 4% with 3+ spherocytes. Splenectomy is most likely to prevent which of the following complications?

A) cholelithiasis
B) esophageal varices
C) overwhelming sepsis
D) painful crises
E) pancreatitis

5. A 10 year old girl is brought to the the emergency department following a generalized tonic clonic seizure. She has a 1 month history of behavior disturbances and a 2 week history of fever, weakness, and painful swelling of the left knee. Her hemoglobin concentration is 9, leukocyte count is 3800, platelet count is 65K. Coomb's test is positive. UA shows protein and microscopic blood. What's the most likely diagnosis?

A) Hodgkin disease
B) Henoch Schonlein Purpura
C) Mononucleosis
D) Systemic lupus erythematosus
E) Viral encephalitis (wrong)
Click to expand...

Does anyone have answers and explanations to these questions?
 
1. D) replication of a live vaccine virus strain -- to me the fever and rash sounded like a mild case of rubella, which can happen with live attenuated vaccines

2. A) slit lamp exam -- I didn't think it was septic arthritis given that she feels better with usage. ANA+ made me think of autoimmune causes of joint pain, which made me think about associated eye findings. Case Files says that uveitis is an important thing to catch in JIA and recommends doing a slit lamp exam on everyone suspected to have JIA.

3. C) Hemolytic disease of the newborn -- it is not physiologic before 24-36hr of life.

4. A) cholelithiasis -- patients with spherocytosis/hemolysis have high risk of gallstones from bilirubin

5. I got this wrong too :( I had guessed Hodgkin disease, so that's not it. I'm guessing SLE at this point because rheumatology.org says Lupus can present in kids with fever, joint pain/swelling, seizure/CNS issues, kidney issues w/ abnormal UA, and problems with blood (anemia, thrombocytopenia, leukopenia). Of course!
 
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Guys, I have a few questions from the nbme clinical mastery series that I got wrong, please help me with them.


1. 1week old newborn has 1 day history of difficulty breathing and discoloration of extremities. Appears ill, temp = 97.5, pulse = 160, resp = 52, BP = 60/36 in upper extremities and unobtainable in lower extremities. Skin, mucous membranes, and nail beds are dusky, and there is mottled discoloration of the extremeties. Moderate intercostal retractiosn and grunting. Lungs clear. Holosystolic murmuc along left sternal border. Liver edge palpable 4cm below costal margin.
pH = 7.15, CO2 = 28, O2 = 98
Intubation, mechanical ventilation, and iv fluid initiated, but no improvement one hour later. x-ray shows cardiomegaly and pulmonary congestion. Explanation of this condition?
a. cosure of ductur arteriosus
b. deacreased pulm vascular resistance
c. increased pulm vascular resistance
d. intracardiac right to left shunt (Wrong)
e. opening of ductus arteriosus

It says the infant has holosystolic murmur at the left sternal border, so I'm assuming it's VSD, the CXR shows large heart and pulmomary congestion. Also the pt has cyanosis. So does the infant have pure VSD and now cyanotic due to eisenmenger syndrome or Tetralogy of Fallot? Even if it's due to eisenmenger syndrome, then both choice C (increase pulmonary resistance) & choice D (intracardial right to left shunting) are correct. If its Tetralogy of Fallot, then I don't know which answer corresponds to it. And TOF should also have increased pulm vascular resistance (choice C)



2. A 5lb 5 oz newborn is delivered at 37 weeks gestation to a 32 year old women, gravida 1 para 1, following an uncomplicated delivery. The mom has history of IV drug use and received no prenatal care. She did not take any med during pregnancy. Rapid HIV testing of the mother after delivery is positive. Exam of newborn shows no abnormalities. Which of the following is the best next step to manage the newborn?
A) A 6-week course of oral AZT beginning at the 2 week exam
B) A 6-week course of oral AZT only if CD4 count decreases to less than 200/mm
C) A 6-week course of oral AZT within 12 hours after delivery
D) A 6-week course of triple antiretroviral therapy beginning at the 2 week exam
E) A 6-week course of triple antiretroviral therapy if the CD4 T count decrease to less than 200/mm
F) A 6-week course of triple antiretroviral therapy within 24 hours after delivery


For this question it seems like its baby of HIV positive mom who had not taken any antiretral virals during pregnancy. So is the any F) triple drugs for baby within 24 hours? I remember that if the mom is on AZT during pregnancy, then its 6 week of only AZT within 12 hours (C). but since the mom did not take AZT, so the infant has to be on triple therapy right?

P.S. someone plz tell me if (all moms r HIV positive):
1) the mom is on AZT throughout pregnancy + C-section then what u
do with baby? Tx or test first like PCR and stuff
2) the mom is on AZT throughout pregnancy, but vaginal delivery
3) mom did not take meds during pregnancy, but C-section
4) mom didn't take meds and vaginal delivery (I think thats the same
as the question stem)

Sry for asking so many questions
 
So does the sickle cell pt have pneumonia? MC due to strep pneumo? Is that why nafcillin is wrong b/c it only covers staph not strep? Also in the stem it says that the pt skipped a dose of penicillin does that matter or not? thanks
 
This is my first shelf on Friday. Took NBME practice test 2 and got estimated score of 74. How do I improve this score for the next few days? Ive done UWorld, BRS, Casefiles, and Pretest.
 
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