I am currently on my pediatrics rotation, which is a wonderful and fantastic world for a number of reasons:
- Everyone is nice, although this means by definition I cannot be a pediatrician;
- The patients get better;
- You get thrown up on all the time.
Okay so the last one isn’t a positive. On my first two weeks – my outpatient rotation – I was vomited on by no less than eight children. One day I was actually nailed from 3 feet away with projectile vomitus from a 3-year-old whom I am convinced simply did not like me.
Now I’m on inpatient, and on the infectious disease team. Which is awesome. Kids get the WEIRDEST things wrong with them and it is extremely cool. Then you treat them and they mostly get better, which is a huge difference from adults who get very sick.
But I’m not here to talk about that. I’m here to talk about studying for the pediatrics shelf, which is generally considered one of the harder ones of the year – even though the rotation itself is one of the easiest, at least in terms of people hating you or yelling at you or making you work eighteen-hour days.
Anyway. The best way to study for any shelf is to do practice questions, and the National Board of Medical Examiners (NBME), praised be to Them, are more than happy to contribute to the education and development of the world’s future compassionate doctors by providing practice questions similar to the real thing, free of charge.
HAHAHAHA of course not the questions cost like $400 and the deed to your car.
Anyway. So when your med student comes home, fifty-eight Chipotle burritos poorer, to his bowl of ramen noodles to hunker down for some questions, he gets to choose what subject, how many, and how like the real thing his question sets will be.
There are about 350 pediatrics questions, which actually isn’t that many considering a) it’s an eight-week block and b) the Medicine section easily cracks 1,000. I’ve been parsing them out slowly, by which I mean “not doing anything while watching March Madness games.”
A typical shelf question looks like this:
“A 26-year-old male medical student complains of chest pain and shortness of breath while being asked absurdly specific questions about X-linked agammaglobulinemia by his attending physician during rounds. He denies chest pain at rest. What is the appropriate next step in management for this patient?”
The answer choices will require you to already know the diagnosis (Nate is having a panic attack) and skip straight to “what do you do about it.” In theory, this is a good way to assess knowledge. In practice…
On the pediatrics shelf, there is a strong overemphasis on genetic syndromes. One in particular stands out above all the rest – Turner Syndrome.
For those who want to know, Turner Syndrome is a genetic condition where a female is born with only one X chromosome. Patients are short, have a webbed neck, a “shield chest,” hand and foot swelling, and messed up ovaries. Complications include, apparently, everything. Especially coarctation of the aorta, which I understand to be a Very Bad Thing.
Except they have normal intelligence. I know this, because I’ve gotten this wrong twice, and also because I obviously do not have Turner Syndrome* because I have abnormally low intelligence.
*I think. That said, if I were on an NBME question and Turner Syndrome was an answer choice, the smart money is still on Turner Syndrome.
I did a set of ten questions yesterday. Seven of them were on Turner Syndrome. When I clicked, “submit,” I had gotten six out of seven wrong. The reason was not a knowledge deficit – it was that I sat in total disbelief that yet another question was about Turner Syndrome. How is that even possible!?
“A 9-year-old girl presents with a webbed neck…” It’s Turners.
“A newborn female has swelling of her hands and feet…” Yep, still Turners.
“A 13-year-old girl comes to your office complaining of not having her period yet…” STILL TURNERS.
“A 28-year-old male* is shot in the head…” – IT’S EFFING TURNERS!!
*Men can’t get Turner’s. I know. Thanks for thinking to correct me.
It’s almost comical. I have gotten to the point where when a question pops up I immediately scan the answer choices for a Turner Syndrome-related answer. If any question has one of the following phrases or characteristics, I just pick the TS answer choice – it’s ALWAYS AN ANSWER CHOICE – and move on:
- Turner’s Syndrome (duh)
- 45;XO (the way to write “lacks a second X chromosome”)
- Webbed neck
- Ovarian dysgenesis
- Has two thumbs
- Lacks two thumbs
- Is female
- Is a question
The last question in the series was a classic Turner’s presentation. It went something like this:
“A 15-year-old girl with a webbed neck, shield chest, and primary amenorrhea comes to your office complaining of chest pain.” Blah blah blah, the answer is Turner’s syndrome. Obviously. Slam dunk.
WRONG. It was a sickle cell crisis, because the NBME hates me.
I hate everything.