When you review questions that have appeared on previous shelf exams, think of each as a type of question. From each stem, the question might be what is the diagnosis, how do you make the diagnosis (lab, etc), what is the next step in management or treatment, what are risk factors for the diagnosis, etc. Shelf exams like to test common things, but also uncommon things that shouldn’t be missed by any type of doctor, like cancers for example. So they stress recognizing risk factors for cancers or signs/symptoms of potentially serious conditions.

Here are some questions that students have recalled from recent exams. Don’t focus on the particular question, focus on the theme. This first set is from one student and one shelf. This can given you an idea of common areas of focus. Most shelf exams are similar in focus:

Here are some questions from another student:

Another student with our back and forth about questions she found difficult:

Other things that confuse students:

ACE/ARB

fetal renal tubular dysplasia and neonatal renal failure, oligohydramnios, intrauterine IUGR, lack of cranial ossification

EtOH

FAS (growth restriction before and after birth, mental retardation, midfacial hypoplasia, renal and cardiac defects). Consumption of >6 drinks a day associated with 40% risk of FAS

Carbamazepine

neural tube defects, fingernail hypoplasia, microcephaly, developmental delay, IUGR

Cocaine

bowel atresias; congenital malformations of the heart, limbs, face, and GU tract; microcephaly; IUGR; cerebral infarctions

DES (diethylstilbestrol)

clear cell adenocarcinoma of the vagina or cervix, vaginal adenosis, abnormalities of the cervix and uterus or testes, possible infertility

Lead

increased spontaneous abortion rate; stillbirths

Lithium

congenital heart disease (Ebstein's Anomaly)

Methotrexate

increased spontaneous abortion rate

Organic Mercury (from Whole Foods)

cerebral atrophy, microcephaly, mental retardation, spasticity, seizures, blindness

Phenytion

IUGR, mental retardation, microcephaly, dysmorphic craniofacial features, cardiac defects, fingernail hypoplasia

Radiation

microcephaly, mental retardation. Medical diagnostic radiation deliverying < 0.05 Gy to the fetus has no risk

Streptomycin and kanamycin

hearing loss; CN 8 dmg

tetracycline

permanent yellow-brown discoloration of deciduous teeth; hypoplasia of tooth enamel

thalidomide

bilateral limb deficiencies, anotia and microtia, cardiac and GI anomalies

Trimethadione and paramethadione

cleft lip or palate, cardiac defects, mricrocephaly, mental retardation

Valproic Acid

neural tube defects (spina bifida), minor craniofacial defects

Vitamin A and derivatives

increased spontaneous abortion rate, microtia, thymic agenesis, cardiovascular defects, craniofacial dysmorphism, micropththalmia, cleft lip or palate, mental retardation

Warfarin

nasal hypoplasia and stippled bone epiphyses, developmental delay, IUGR, ophthalmologic abnormalities