Burns’ Pediatric Primary Care (8th Ed.) — Complete Chapter-
by-Chapter Test Bank: Verified Answers & Detailed Rationales
(New Edition)
Question 1
Reference: Ch. 23, Section: Developmental Management of
Adolescents
Question Stem:
A 16-year-old female presents for a sports physical. She is
healthy, on no medications, and has normal vital signs. During
the confidential portion of the interview, she reports she is
sexually active with one male partner. What is the most
appropriate initial action by the primary care provider?
Options:
A. Perform a urine pregnancy test.
B. Prescribe a combined oral contraceptive pill.
C. Administer the HPV vaccine if she has not completed the
series.
D. Conduct a comprehensive sexual health assessment.
Correct Answer: D
Rationales:
• Correct (D): Before any intervention, a comprehensive
sexual health assessment is essential. This includes
, discussing sexual orientation, number of partners, condom
use, history of STIs, contraception needs and preferences,
and reproductive life plan to guide appropriate, patient-
centered care.
• Incorrect (A): A pregnancy test may be indicated, but it is
not the initial action. The assessment must guide which
tests are necessary.
• Incorrect (B): Prescribing should occur only after a
thorough assessment, including a medical history to
identify contraindications and a discussion of all
contraceptive options.
• Incorrect (C): While the HPV vaccine is a crucial part of
adolescent preventive care, it is not the most pressing
initial action in response to the disclosure of sexual
activity.
Teaching Point: A comprehensive sexual health assessment
must precede any intervention or prescribing.
Question 2
Reference: Ch. 44, Section: Otitis Media
Question Stem:
A previously healthy 2-year-old child presents with a 2-day
history of rhinorrhea and irritability. Otoscopic examination
reveals a bulging, red, immobile tympanic membrane. The
,child's temperature is 38.5°C (101.3°F). What is the most
appropriate management?
Options:
A. Prescribe amoxicillin 80-90 mg/kg/day for a 10-day course.
B. Recommend ibuprofen for discomfort and fever and initiate
watchful waiting for 48-72 hours.
C. Prescribe amoxicillin-clavulanate 90 mg/kg/day for a 10-day
course.
D. Refer immediately to an otolaryngologist for
tympanocentesis.
Correct Answer: A
Rationales:
• Correct (A): This presentation meets the criteria for acute
otitis media (AOM): moderate to severe bulging of the TM,
and is accompanied by fever. In a child over 2 years with
severe symptoms (fever >39°C or moderate-severe
otalgia), antibiotic treatment with high-dose amoxicillin is
the first-line recommendation.
• Incorrect (B): Watchful waiting may be an option for mild,
unilateral AOM in children 2 years and older without
severe symptoms. The presence of fever and a clearly
bulging TM makes antibiotic treatment appropriate.
• Incorrect (C): Amoxicillin-clavulanate is reserved for cases
of treatment failure, recurrence within 30 days, or in
, children with a history of recurrent AOM who have
received amoxicillin in the last 30 days.
• Incorrect (D): Tympanocentesis is not a first-line
intervention and is reserved for severe, refractory cases, or
in immunocompromised patients.
Teaching Point: High-dose amoxicillin is first-line for AOM with
severe symptoms or in young children.
Question 3
Reference: Ch. 31, Section: Pediatric Hypertension
Question Stem:
A 9-year-old boy is found to have a blood pressure reading at
the 97th percentile for his age, height, and sex on three
separate occasions. The physical exam is unremarkable, and
there is no family history of early hypertension. What is the
most appropriate next diagnostic step?
Options:
A. Initiate a low-dose ACE inhibitor and recheck BP in 2 weeks.
B. Order a renal ultrasound and echocardiogram.
C. Provide lifestyle counseling on diet and exercise and recheck
in 6 months.
D. Order a 24-hour ambulatory blood pressure monitoring.
Correct Answer: B
Rationales:
by-Chapter Test Bank: Verified Answers & Detailed Rationales
(New Edition)
Question 1
Reference: Ch. 23, Section: Developmental Management of
Adolescents
Question Stem:
A 16-year-old female presents for a sports physical. She is
healthy, on no medications, and has normal vital signs. During
the confidential portion of the interview, she reports she is
sexually active with one male partner. What is the most
appropriate initial action by the primary care provider?
Options:
A. Perform a urine pregnancy test.
B. Prescribe a combined oral contraceptive pill.
C. Administer the HPV vaccine if she has not completed the
series.
D. Conduct a comprehensive sexual health assessment.
Correct Answer: D
Rationales:
• Correct (D): Before any intervention, a comprehensive
sexual health assessment is essential. This includes
, discussing sexual orientation, number of partners, condom
use, history of STIs, contraception needs and preferences,
and reproductive life plan to guide appropriate, patient-
centered care.
• Incorrect (A): A pregnancy test may be indicated, but it is
not the initial action. The assessment must guide which
tests are necessary.
• Incorrect (B): Prescribing should occur only after a
thorough assessment, including a medical history to
identify contraindications and a discussion of all
contraceptive options.
• Incorrect (C): While the HPV vaccine is a crucial part of
adolescent preventive care, it is not the most pressing
initial action in response to the disclosure of sexual
activity.
Teaching Point: A comprehensive sexual health assessment
must precede any intervention or prescribing.
Question 2
Reference: Ch. 44, Section: Otitis Media
Question Stem:
A previously healthy 2-year-old child presents with a 2-day
history of rhinorrhea and irritability. Otoscopic examination
reveals a bulging, red, immobile tympanic membrane. The
,child's temperature is 38.5°C (101.3°F). What is the most
appropriate management?
Options:
A. Prescribe amoxicillin 80-90 mg/kg/day for a 10-day course.
B. Recommend ibuprofen for discomfort and fever and initiate
watchful waiting for 48-72 hours.
C. Prescribe amoxicillin-clavulanate 90 mg/kg/day for a 10-day
course.
D. Refer immediately to an otolaryngologist for
tympanocentesis.
Correct Answer: A
Rationales:
• Correct (A): This presentation meets the criteria for acute
otitis media (AOM): moderate to severe bulging of the TM,
and is accompanied by fever. In a child over 2 years with
severe symptoms (fever >39°C or moderate-severe
otalgia), antibiotic treatment with high-dose amoxicillin is
the first-line recommendation.
• Incorrect (B): Watchful waiting may be an option for mild,
unilateral AOM in children 2 years and older without
severe symptoms. The presence of fever and a clearly
bulging TM makes antibiotic treatment appropriate.
• Incorrect (C): Amoxicillin-clavulanate is reserved for cases
of treatment failure, recurrence within 30 days, or in
, children with a history of recurrent AOM who have
received amoxicillin in the last 30 days.
• Incorrect (D): Tympanocentesis is not a first-line
intervention and is reserved for severe, refractory cases, or
in immunocompromised patients.
Teaching Point: High-dose amoxicillin is first-line for AOM with
severe symptoms or in young children.
Question 3
Reference: Ch. 31, Section: Pediatric Hypertension
Question Stem:
A 9-year-old boy is found to have a blood pressure reading at
the 97th percentile for his age, height, and sex on three
separate occasions. The physical exam is unremarkable, and
there is no family history of early hypertension. What is the
most appropriate next diagnostic step?
Options:
A. Initiate a low-dose ACE inhibitor and recheck BP in 2 weeks.
B. Order a renal ultrasound and echocardiogram.
C. Provide lifestyle counseling on diet and exercise and recheck
in 6 months.
D. Order a 24-hour ambulatory blood pressure monitoring.
Correct Answer: B
Rationales:
