Pediatrics Shelf Exam Tips: A Disney-themed Exam?
Intro
Well, today was my fourth shelf exam for my cores: pediatrics. I am so glad that it is over as I do not want to be a pediatrician. The key for the shelf exam, and for pediatrics overall, seems to be something easily learned from Disney’s Aladdin:
Only one may enter here. One whose worth lies far within. A diamond in the rough.
I am not claiming that the rotation is full of treacherous feats coupled with finding an awesome flying carpet, and neither is the exam. The world of outpatient pediatrics and my inpatient week in the NICU were both full of seeing overall healthy children. The ability to find the child with the leukemia or congenital adrenal hyperplasia among the hundreds or thousands of healthy children takes a keen eye and paying attention to signs that don’t always seem like sign. The prevalence of Lesch-Nyhan is approximately 1:380,000. I would be worried as a pediatrician that I would be the person who misses the diagnosis, and then feel bad for how this could impact the patient or the family. As a dad, I love my children very much and I would empathize too much with other parents that have sick children that I could almost envision developing a type of “I have healthy children” guilt or something.
When a patient's mom was freaking out as her child turned blue, I kept my cool when she handed me her baby to resuscitate. When his vitals normalized and the color returned to his face, the look of dread and fear within that mother’s face struck a chord within myself. I will likely blog about events that occurred during my Peds rotation in the future, but for now I will just say that I hugged my kids a little extra that night.
So, back to this post...
Pediatrics shelf exam contains 110 questions with an allotted 2 hours and 45 minutes. This is one exam where the long vignettes and the difficulty of the subject had me worried that I would run out of time toward the end of the test. I finished my exam with only two minutes to spare, which is very unlike my normal test taking strategy of “click-and-move” coupled with my freakishly-fast reading (or maybe I’m just an impulsive test taker normally and this time I lingered on each question).
Resources
What I don't really recommend (including these costume options):
For this exam, I followed my learning objectives provided by my school but there are some things I would not waste my time doing if I had another chance. I read a majority of Blueprints Pediatrics because my attending had a copy of it in his office so I would read some every day of the rotation. It was actually very basic compared to other books in this series, and lacked the detail that I generally appreciate from Blueprints books. It is a good book to reference questions you might have between patients, but definitely not essential to preparing for the exam.
MedU CLIPP Cases – these are great to just knock out in the first week of the rotation as they go through every general case you might encounter which was not high yield for the shelf in my opinion. The cases are good topics, but the cases are broad and cover what you might actually see in the real world. The exam covered some of the common stuff most would see in clinic, but this shelf was predominantly about the zebras. If you want to cut out a resource, this is a no brainer but I would suggest using these cases to preview pediatrics if you have time before you start the rotation (or during that first week).
What I DO recommend:
OnlineMedEd Videos: These were good and get the basics covered but do not do the best job with the rarer childhood diseases/disorders. I was able to watch the videos twice during my rotation, but alone they were not enough to be prepared for the exam.
uWorld Question Bank – this is a no brainer… do all the questions and do all the ones you get incorrect again. Read all of the explanations and gain a sense of what the question is trying to ask. There is a reason different answers show up, and it is usually because a slight change in the physical exam or lab findings will lead you to a different diagnosis… like do not be surprised if something you might think is acute rheumatic fever ends up being Kawasaki’s disease (hint: look for the conjunctivitis).
Kaplan qbank: so, this was an interesting trial for me. Kaplan offered a free month to students in hurricane or tropical storm affected areas. Since Georgia was affected, I figured I would give it a shot and try a new resource. I do and do not like the questions in the qbank. I like the questions because they tend to be a different way to learn than uWorld. Kaplan answers have a one sentence summary of the learning point. I did not like how the patient presentations were not like what you would typically expect for the different diseases, but it was a nice way to challenge my knowledge base…so take it for what it is I guess. It is not a must have in addition to uWorld, but I am glad to have gotten a month trial because I am now considering purchasing Kaplan for a month at the end of third year. My tentative Step 2 CK date is either April or May. My uWorld subscription ends the first week of May, so I may use Kaplan as an adjunct if I decide to take the exam in May.
Becker GuideMD: Ross University connects us with access to GuideMD for Step 1….and for Step 2! This is a resource that I think is easy for us to forget that we have access to but it was activated when we activated our uWorld access. There is software that can be downloaded to your computer. I signed up for the live online course early next year for Step 2 CK so that I could have the textbooks that accompany this resource sent to my house.
Unfortunately, I did not start using this resource until three days before my shelf exam. In retrospect, I would have started using it early in the rotation so I could spend more time with each concept to really master the pediatric concepts that will be tested on Step 2. This resource gives the best in-depth review of pediatrics through the different organ systems, and also helps tie in the adult diseases that can also present in childhood (for example, SLE presentation in children). Since I have internal medicine and surgery as my last two cores, I plan to continue using this resource as I feel like it will set me up for Step 2 CK the best… so if you haven’t given this resource a chance I highly recommend it because I think it helps to put everything that cannot be learned in clinic in one place and in a well-organized manner.
Topic List
Before I get started, I want to highlight for you that orthopedics means “straighten the child”… so consider that when you are debating what to study for the shelf because ortho definitely gets plenty of air time on the peds shelf.
This list is what I first entered the rotation with and wanted to make sure I was at least familiar with the topics. This information was found in our Ross recommended weekly assignments, EPEs, EPPs, and my own meandering experience. I like that our learning objectives also breaks down between age groups. I am usually good about reviewing what our department heads recommend for us as our learning objectives early in the rotation, but I think I need to work on remember reviewing these more frequently between the start of the rotation and the shelf exam. Anyway, here’s the list:
Well-child care: Anticipatory guidance and safety, developmental milestones, FTT, growth parameters, immunizations, infant nutrition, Tanner staging
Cardiology: Arrhythmia (SVT, long QT, WPW), Congenital heart disease, congestive heart disease, pericardial disease
Dermatology: Atopic dermatitis, diaper rash, impetigo, neonatal rashes (acne neonatorum, erythema toxicum, milia), psoriasis, scabies & lice, seborrheic dermatitis, viral exanthems
Endocrinology: Adrenal dysfunction (congenital adrenal hyperplasia), diabetes, thyroid dysfunction
Gastroenterology: Appendicitis, constipation, gastroesophageal reflux, Hirschsprung’s disease, intussusception, malrotation and volvulus, Meckel’s diverticulum, pyloric stenosis
Genetic disorders: trisomies 13, 18, 21 w/ common associations (CHARGE, VATER) and common syndromes (DiGeorge, Marfan’s, Noonan’s, Prader-Willi, Williams)
Sex chromosome disorders (Turners, Klinefelter’s, Fragile X)
Hematology and oncology: Anemia, sickle cell disease, thalassemia, childhood cancers (ALL, Wilms’ tumor, neuroblastoma)
Immunology: Autoimmune disorders (Henoch-Schönlein purpura, idiopathic thrombocytopenic purpura, juvenile idiopathic arthritis, Kawasaki disease)
Immunodeficiencies (T cell, B cell, combined, complement, phagocytic, HIV)
Infectious disease: acute otitis media, cellulitis, fever management, gastroenteritis, meningitis, orbital and periorbital cellulitis, osteomyelitis, pneumonia, STIs, sinusitis, streptococcal pharyngitis, UTI.
Neonatology: APGAR score, congenital infection, neonatal hyperbilirubinemia, prematurity, respiratory distress syndrome, Nec Entercolitis
Nephrology/urology: cryptorchidism, fluid and electrolyte management, hematuria and proteinuria, Hemolytic-uremic syndrome
Neurology: Cerebral palsy, febrile seizures, hydrocephalus, neural tube defects, seizure disorder, MENINGITIS – this one topic was one I underestimated and was definitely prominent on the exam. Reading CSF labs should also be a topic itself.
Orthopedics: developmental hyp dysplasia, limp, nursemaid’s elbow (sublaxation of the radial head), pediatric fractures, arthritis, JRA, septic joint, toxic synovitis, anything that can happen to a joint or bone, osteosarcoma, osteochondroma.
Psychiatry: ADHD, learning disorders, mental retardation
Pulmonology - Apnea, SIDS, Asthma, Bronchiolitis, bacterial tracheitis, croup, cystic fibrosis, Epiglottitis, Pertussis, Foreign body aspiration
Toxicology: Acetaminophen and salicylate toxicity, ingestions, lead poisoning
Trauma: child abuse, head injury
Wrap Up
Pediatrics is not a miniature adult medicine, but a patient population with a different physiology and clinical presentation. Clinic will be different depending on what month of the year you rotation because children are affected by different bugs depending on the season. My inpatient experience was neonatal ICU, so I did not see many different inpatient cases pertaining to older children. I also did not even begin to think about pediatric surgical cases so I recommend paying attention to post-op care of children.
Since I knew I was not interested in Pediatrics as a career over OBGYN, I did take the opportunity to ask pediatric attendings their opinions as how they think OBGYN docs can do a better job. One answer I found to be great feedback about was related to breast feeding education. This doctor was convinced that there was a direct correlation between breast feeding an infant and who the obgyn was providing prenatal care. Something to think about especially since breastfeeding benefits the mother and the child, and helping educate mothers could lead to a healthier population for the next generation.