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  #1  
Old 03-08-2016
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Default clinical mastery pediatrics form 3

a 4-day-old newborn is brought to the physician b/c of a 2-day history of progressive jaundice. He was born at 36 weeks' gestation to a 27-year-old woman, gravid2, para 2, following an uncomplicated pregnancy and delivery and weighed 2608 g(5lb 12oz). The newborn's blood group is O, Rh-positive, and the mother's blood group is B, Rh-positive. He has been breast-fed since birth and receives 1 to 2 ounces of a supplemental soy milk-based formula every day. His mother says that he has had about seven wet diapers daily, and his stools are yellow and seedy. At discharge 2 days ago, his weight as 2495 g; he now weights 2608 g. His temp is 36.9C, pulse 138/min, respirations 32/min, BP 65/40. Exam shows scleral icterus and jaundice from the face to the lower abdomen. The liver edge is palpated 2 cm below the right costal margin. Laboratory studies at 36 hours of age and now show:

at 36hrs of age Now
hct 54% 52%
serum
Bilirubin, total (mg/dL) 8.2 12.5
Direct (mg/dL) 0.1 0.3

Which of the following is the most likely explanation for these findings?

a) ABO isoimmunization
b) biliary obstruction
c) dehydration
d) Erythrocyte enzyme defect
e) physiologic jaundice
F) polycythemia

*picked F it was wrong

A healthy 16-year-old girl comes to the physician for an examination prior to participation in school sports. She had chickenpox at age 3, but has no history of serious illness. Her immunizations were up-to-date when she began kindergarten; the only immunization she has received since then is a diphtheria-tetanus toxoid at the age of 10 years for a laceration on her leg. She has been sexually active for the past year w/ two male partners who have used condoms consistently. She is 163cm and weights 54kg; BMI 21. Vital signs are w/in normal limits. Examination shows no abnormalities. Administration of which of the following vaccines is most appropriate at this time?

a) hepatitis B, diphtheria-tetanus-toxoid, HPV
B) HPV, meningococcal, TdaP
c) MMR, TdaP, hepatitis B
d) PCV, PCV-7, IPV, hepatitis B
e) PCV 7, IPV, MMR
f) Td, meningococcal, MMR

*picked A it was wrong

a 1 month old infant has had a 12x8 cm, red, raised, well-defined lesion that is lobulated and compressible overlying the buttocks since birth. Examination also shows multiple petechiae and bruises. Which of the following is the most likely explanation for these findings.

a) DIC
b) high-output congestive heart failure
c) impaired tissue growth due to altered vascular supply
d) increased tissue growth due to increased vascular supply
e) thrombocytopenia from platelet sequestration

*picked D was wrong

an 18-month girl is brought to the emergency department 1 hour after the onset of vomiting and drooling. She had been left alone in the bathroom of her home for a few minutes before the onset of the symptoms. The family keeps nasal decongestants, acetaminophen, ibuprofen, diphenhydramine, and drain cleaner, and insecticide spray in the bathroom. During the past 5 days, she has had an upper respiratory traction infection treated w/ a nasal decongestant containing pseudoephedrine and acetaminophen. She is agitated and drooling. Her temperature is 37C, pulse is 120/min, respirations are 26/min, and BP IS 80/60. Examination shows two small superficial ulcers on the lips and tongue. the remainder of the examination shows no abnormalities. the most likely cause of these findings is ingestion of which of the following?

a) acetaminophen
b) diphenhydramine
c) drain cleaner
d) ibuprofen
e) organophosphate
f) pseudoephedrine

* picked E was wrong

a 5 year old girl with a 1 year history of chronic non productive cought is brought for a followup exam. the cough occurs during day and night and is not exacerbated by exercise. She has no had chills, diarrhea, or weight loss. Inhaled B-adrenergic agnosts, two courses of oral antibiotics, and a d 10-day course of oral prednisone have not relieved her symptoms. She is at the 50th percentile for height and weight. She appers well. Her temp is 37.5C, pulse 96/min, respirations 18/min, blood pressure is 82/60. examination shows no abnormalities. CXR: no abnormalities except for a linear consolidation in the right middle lobe. Which of the following is the most likely diagnosis?

a)a1-antitrypsin deficiency
b) asthma
c) bronchiectasis
d) congenital emphysema
e) cystic fibrosis
* picked A was wrong

a 2-month-old boy is brought to the physician by his parents for a well-child examination. He was born at 39 weeks' gestation following an uncomplicated pregnancy, labor, and delivery. He is at the 50th percentile for length and weight and 75% for head circumference. His rectal temp 37.2C, pulse 130min, RR 45/min. pulse ox 97% R thumb, 98% L thumb and right great toe. The apical impulse is prominent, and there is a thrill in the 2nd left intercostal space. There is a continuous "machinery-like" murmur increasing in intensity during systole and waning during diastole; it is loudest in the 2nd Left ICS and radiates down the left sternal border. peripheral pulses are 4+ in all extremities. the remainder of the exam shows no abnormalities. which of the following is the most likely explanation for these findings?

a) extracardiac left-to-right shunt
b) extracardiac right-to-left shunt
c) intracardiac atrial left-to-right shunt
d) intracardiac atrial right-to-left shunt
e) intracardiac ventricular left-to-right shunt
f) intracardiac ventricular right-to-left shunt

*pick B, it was wrong

a 2-month old boy is brought for a well child examination. he is feeding well. growth and development are appropriate for age. immunizations are uptodate. his vital signs are w/in normal limits. the lungs are clear to asucultation. a grade 3/6 holosystolic murmur is heard at the LLSB w/ radiation throughout the precordium. a systolic thrill is palpated at the lower left sternal border. abdominal examination shows no abnormalities. femoral pulses are equal. an ECG shows no abnormalities. an x-ray of the chest shows an enlarged L atrium. which of the following is the most likely diagnosis

a) aortic stenosis
b) atrial septal defect
c) pulmonic valve stenosis
d) TOF
e) VSD

* picked B it was wrong
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  #2  
Old 03-18-2016
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Quote:
Originally Posted by chiefcomplaint View Post
a 4-day-old newborn is brought to the physician b/c of a 2-day history of progressive jaundice. He was born at 36 weeks' gestation to a 27-year-old woman, gravid2, para 2, following an uncomplicated pregnancy and delivery and weighed 2608 g(5lb 12oz). The newborn's blood group is O, Rh-positive, and the mother's blood group is B, Rh-positive. He has been breast-fed since birth and receives 1 to 2 ounces of a supplemental soy milk-based formula every day. His mother says that he has had about seven wet diapers daily, and his stools are yellow and seedy. At discharge 2 days ago, his weight as 2495 g; he now weights 2608 g. His temp is 36.9C, pulse 138/min, respirations 32/min, BP 65/40. Exam shows scleral icterus and jaundice from the face to the lower abdomen. The liver edge is palpated 2 cm below the right costal margin. Laboratory studies at 36 hours of age and now show:

at 36hrs of age Now
hct 54% 52%
serum
Bilirubin, total (mg/dL) 8.2 12.5
Direct (mg/dL) 0.1 0.3

Which of the following is the most likely explanation for these findings?

a) ABO isoimmunization
b) biliary obstruction
c) dehydration
d) Erythrocyte enzyme defect
e) physiologic jaundice
F) polycythemia

Correct answer is EE

A healthy 16-year-old girl comes to the physician for an examination prior to participation in school sports. She had chickenpox at age 3, but has no history of serious illness. Her immunizations were up-to-date when she began kindergarten; the only immunization she has received since then is a diphtheria-tetanus toxoid at the age of 10 years for a laceration on her leg. She has been sexually active for the past year w/ two male partners who have used condoms consistently. She is 163cm and weights 54kg; BMI 21. Vital signs are w/in normal limits. Examination shows no abnormalities. Administration of which of the following vaccines is most appropriate at this time?

a) hepatitis B, diphtheria-tetanus-toxoid, HPV
B) HPV, meningococcal, TdaP
c) MMR, TdaP, hepatitis B
d) PCV, PCV-7, IPV, hepatitis B
e) PCV 7, IPV, MMR
f) Td, meningococcal, MMR

Correct answer is BB

a 1 month old infant has had a 12x8 cm, red, raised, well-defined lesion that is lobulated and compressible overlying the buttocks since birth. Examination also shows multiple petechiae and bruises. Which of the following is the most likely explanation for these findings.

a) DIC
b) high-output congestive heart failure
c) impaired tissue growth due to altered vascular supply
d) increased tissue growth due to increased vascular supply
e) thrombocytopenia from platelet sequestration

Correct answer is EE

an 18-month girl is brought to the emergency department 1 hour after the onset of vomiting and drooling. She had been left alone in the bathroom of her home for a few minutes before the onset of the symptoms. The family keeps nasal decongestants, acetaminophen, ibuprofen, diphenhydramine, and drain cleaner, and insecticide spray in the bathroom. During the past 5 days, she has had an upper respiratory traction infection treated w/ a nasal decongestant containing pseudoephedrine and acetaminophen. She is agitated and drooling. Her temperature is 37C, pulse is 120/min, respirations are 26/min, and BP IS 80/60. Examination shows two small superficial ulcers on the lips and tongue. the remainder of the examination shows no abnormalities. the most likely cause of these findings is ingestion of which of the following?

a) acetaminophen
b) diphenhydramine
c) drain cleaner
d) ibuprofen
e) organophosphate
f) pseudoephedrine

Correct answer is CC

a 2-month old boy is brought for a well child examination. he is feeding well. growth and development are appropriate for age. immunizations are uptodate. his vital signs are w/in normal limits. the lungs are clear to asucultation. a grade 3/6 holosystolic murmur is heard at the LLSB w/ radiation throughout the precordium. a systolic thrill is palpated at the lower left sternal border. abdominal examination shows no abnormalities. femoral pulses are equal. an ECG shows no abnormalities. an x-ray of the chest shows an enlarged L atrium. which of the following is the most likely diagnosis

a) aortic stenosis
b) atrial septal defect
c) pulmonic valve stenosis
d) TOF
e) VSD
Correct answer is EE
Answers are below each question in red font.
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  #3  
Old 03-21-2016
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Default Thanks!

I have my shelf in a few days.... did you complete peds form4 as well?

Quote:
Originally Posted by chiefcomplaint View Post
a 4-day-old newborn is brought to the physician b/c of a 2-day history of progressive jaundice. He was born at 36 weeks' gestation to a 27-year-old woman, gravid2, para 2, following an uncomplicated pregnancy and delivery and weighed 2608 g(5lb 12oz). The newborn's blood group is O, Rh-positive, and the mother's blood group is B, Rh-positive. He has been breast-fed since birth and receives 1 to 2 ounces of a supplemental soy milk-based formula every day. His mother says that he has had about seven wet diapers daily, and his stools are yellow and seedy. At discharge 2 days ago, his weight as 2495 g; he now weights 2608 g. His temp is 36.9C, pulse 138/min, respirations 32/min, BP 65/40. Exam shows scleral icterus and jaundice from the face to the lower abdomen. The liver edge is palpated 2 cm below the right costal margin. Laboratory studies at 36 hours of age and now show:

at 36hrs of age Now
hct 54% 52%
serum
Bilirubin, total (mg/dL) 8.2 12.5
Direct (mg/dL) 0.1 0.3

Which of the following is the most likely explanation for these findings?

a) ABO isoimmunization
b) biliary obstruction
c) dehydration
d) Erythrocyte enzyme defect
e) physiologic jaundice
F) polycythemia

*picked F it was wrong

A healthy 16-year-old girl comes to the physician for an examination prior to participation in school sports. She had chickenpox at age 3, but has no history of serious illness. Her immunizations were up-to-date when she began kindergarten; the only immunization she has received since then is a diphtheria-tetanus toxoid at the age of 10 years for a laceration on her leg. She has been sexually active for the past year w/ two male partners who have used condoms consistently. She is 163cm and weights 54kg; BMI 21. Vital signs are w/in normal limits. Examination shows no abnormalities. Administration of which of the following vaccines is most appropriate at this time?

a) hepatitis B, diphtheria-tetanus-toxoid, HPV
B) HPV, meningococcal, TdaP
c) MMR, TdaP, hepatitis B
d) PCV, PCV-7, IPV, hepatitis B
e) PCV 7, IPV, MMR
f) Td, meningococcal, MMR

*picked A it was wrong

a 1 month old infant has had a 12x8 cm, red, raised, well-defined lesion that is lobulated and compressible overlying the buttocks since birth. Examination also shows multiple petechiae and bruises. Which of the following is the most likely explanation for these findings.

a) DIC
b) high-output congestive heart failure
c) impaired tissue growth due to altered vascular supply
d) increased tissue growth due to increased vascular supply
e) thrombocytopenia from platelet sequestration

*picked D was wrong

an 18-month girl is brought to the emergency department 1 hour after the onset of vomiting and drooling. She had been left alone in the bathroom of her home for a few minutes before the onset of the symptoms. The family keeps nasal decongestants, acetaminophen, ibuprofen, diphenhydramine, and drain cleaner, and insecticide spray in the bathroom. During the past 5 days, she has had an upper respiratory traction infection treated w/ a nasal decongestant containing pseudoephedrine and acetaminophen. She is agitated and drooling. Her temperature is 37C, pulse is 120/min, respirations are 26/min, and BP IS 80/60. Examination shows two small superficial ulcers on the lips and tongue. the remainder of the examination shows no abnormalities. the most likely cause of these findings is ingestion of which of the following?

a) acetaminophen
b) diphenhydramine
c) drain cleaner
d) ibuprofen
e) organophosphate
f) pseudoephedrine

* picked E was wrong

a 5 year old girl with a 1 year history of chronic non productive cought is brought for a followup exam. the cough occurs during day and night and is not exacerbated by exercise. She has no had chills, diarrhea, or weight loss. Inhaled B-adrenergic agnosts, two courses of oral antibiotics, and a d 10-day course of oral prednisone have not relieved her symptoms. She is at the 50th percentile for height and weight. She appers well. Her temp is 37.5C, pulse 96/min, respirations 18/min, blood pressure is 82/60. examination shows no abnormalities. CXR: no abnormalities except for a linear consolidation in the right middle lobe. Which of the following is the most likely diagnosis?

a)a1-antitrypsin deficiency
b) asthma
c) bronchiectasis
d) congenital emphysema
e) cystic fibrosis
* picked A was wrong

a 2-month-old boy is brought to the physician by his parents for a well-child examination. He was born at 39 weeks' gestation following an uncomplicated pregnancy, labor, and delivery. He is at the 50th percentile for length and weight and 75% for head circumference. His rectal temp 37.2C, pulse 130min, RR 45/min. pulse ox 97% R thumb, 98% L thumb and right great toe. The apical impulse is prominent, and there is a thrill in the 2nd left intercostal space. There is a continuous "machinery-like" murmur increasing in intensity during systole and waning during diastole; it is loudest in the 2nd Left ICS and radiates down the left sternal border. peripheral pulses are 4+ in all extremities. the remainder of the exam shows no abnormalities. which of the following is the most likely explanation for these findings?

a) extracardiac left-to-right shunt
b) extracardiac right-to-left shunt
c) intracardiac atrial left-to-right shunt
d) intracardiac atrial right-to-left shunt
e) intracardiac ventricular left-to-right shunt
f) intracardiac ventricular right-to-left shunt

*pick B, it was wrong

a 2-month old boy is brought for a well child examination. he is feeding well. growth and development are appropriate for age. immunizations are uptodate. his vital signs are w/in normal limits. the lungs are clear to asucultation. a grade 3/6 holosystolic murmur is heard at the LLSB w/ radiation throughout the precordium. a systolic thrill is palpated at the lower left sternal border. abdominal examination shows no abnormalities. femoral pulses are equal. an ECG shows no abnormalities. an x-ray of the chest shows an enlarged L atrium. which of the following is the most likely diagnosis

a) aortic stenosis
b) atrial septal defect
c) pulmonic valve stenosis
d) TOF
e) VSD

* picked B it was wrong
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  #4  
Old 03-21-2016
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Quote:
Originally Posted by DrNewB View Post
Answers are below each question in red font.
Can you provide insight on the "New" peds shelf exam? I was told there's an extra 10questions???
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  #5  
Old 03-23-2016
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Quote:
Originally Posted by mommy_busybee View Post
Can you provide insight on the "New" peds shelf exam? I was told there's an extra 10questions???
I have not solved the old one so unfortunately I don't know what's new in this form. It is pretty good though.
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  #6  
Old 05-05-2016
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Please can someone tell me which is a good score to get on this mastery series questions?
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  #7  
Old 05-05-2016
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Can someone tell me how to interpretate clinical mastery series score. I am getting scores of 20. which is 71 in subject examination score. This is suppose to be average. Can someone give me a good explanation of this?
Thanks.
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  #8  
Old 05-07-2016
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Quote:
Originally Posted by JosepRiv View Post
Can someone tell me how to interpretate clinical mastery series score. I am getting scores of 20. which is 71 in subject examination score. This is suppose to be average. Can someone give me a good explanation of this?
Thanks.
Its not possible to interpret clinical mastery series independently. You can have a rough idea of where you would stand in the exam for that subject. I would just look at all the mistakes well, get an idea of which topics are being heavily tested and move on to nbme or uswa for score prediction. Good luck
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  #9  
Old 06-05-2016
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Can somebody help me with these questions?

1. A 9mo old boy has pneumonia for the fourth time. He was born at 28wks with a grade 4 intraventricular hemorrhage and generalized neurologic devastation. Barium swallow shows a grade 4 GERD. Which of the following operative procedures is most likely to decreased the frequency of recurrent pneumonia?

a) Esophagostomy
b) Fundoplication
c) Gastrostomy
d) pyloromyotomy
e) vagotomy and pyloroplasty (Incorrect)


2. An 8yo girl is brought to the physician because of a diffuse rash for 24hr. She has had cough, congestion, eye discharge, and fever for 4 days. The rash initially began on her face and chest but has spread to involve her abdomen, back, and lower extremities. Her temprature is 38.9 (102.1F), pulse is 100/min, RR 16/min, and BP is 115/70. Examination shows diffuse red, macular and papular rash involving the face, trunk, and extremities; there are no leasions on the palms or soles. Which of the following is the most likely diagnosis?

a) Ehrlichiosis
b) HSP
c) Id reaction
d) Kawasaki disease
e) Pityriasis rosea
f) RMSF
g) Rubeola
h) scabies
i) Scarlet fever
j) Staph Scaled skin syndrome


3. A 5yo girl w/ a 1 yr hx of chronic nonproductive cough is brought for a follow-up examination. The cough occurs during the day and night and is not exacerbated by exercise. She has not had chills, diarrhea, or weight loss. Inhaled beta adrenergic agonists, two courses of oral abx, and 10 day course of orapred have not relieved her symptoms. She is at the 50th percentile for height and weight. She appears well. Her temp is 37.5C, pulse 96/min, RR 18/min, and BP 82/60. Examination shows no abnormalities. An x-ray of the chest shows no abnormalities except for linear consolidation in the right middle lobe. Which of the following is the most likely diagnosis?

a) alpha-1 antitrypsin deficiency
b) asthma
c) bronchiectasis
d) congenital emphysema
e) CF
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  #10  
Old 06-05-2016
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surgery GERD (possibly 2/2 hiatal hernia given the hx of prematurit) = fundoplication wrapping the fundus around lower esophagus to tighten LES

Cough, coryza, conjunctivitis, fever followed by diffuse macupapular rash starting at head and spreading down = measles or rubeola. Rubella has kinda similar rash with post auricular and occipital lymphadenopathy and palatal spots (forgot the name for this bit it starts with F..forschiemer?). Koplik spots on buccal mucosa in measles

Chronic non productive cough + failure to thrive + linear consolidation of lobe = congenital emphysema (I got this wrong)

Last edited by saxo; 06-07-2016 at 02:12 AM.
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  #11  
Old 06-05-2016
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Read the last one on SDN, so not really sure
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  #12  
Old 06-05-2016
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Quote:
Originally Posted by saxo View Post
surgery GERD (possibly 2/2 hiatal hernia given the hx of prematurit) = fundoplication wrapping the fundus around lower esophagus to tighten LES

Cough, coryza, conjunctivitis, fever followed by diffuse macupapular rash starting at head and spreading down = measles or rubeola. Rubella has kinda similar rash with post auricular and occipital lymphadenopathy and palatal spots (forgot the name for this bit it starts with H..herscheimer?). Koplik spots on buccal mucosa in measles

Chronic non productive cough + failure to thrive + linear consolidation of lobe = congenital emphysema (I got this wrong)
Thanks for the response! For the last one, I picked congenital emphysema and it's not the right answer.
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  #13  
Old 06-05-2016
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Quote:
Originally Posted by smile8888 View Post
Thanks for the response! For the last one, I picked congenital emphysema and it's not the right answer.
From google it looks like right middle lung syndrome
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