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
Early Childhood
Question Stem:
A 3-year-old child is brought to the clinic for a well-child visit.
The parent expresses concern that the child's speech is difficult
to understand compared to peers. The parent reports the child
has a vocabulary of about 50 words and primarily uses two-
word phrases. Which of the following is the most appropriate
initial action by the PNPP
Options:
A. Reassure the parent that this is within normal limits for a 3-
year-old.
B. Perform a formal audiology evaluation in the office.
C. Initiate a referral for a comprehensive speech and language
evaluation.
,D. Advise the parent to read to the child for 30 minutes daily
and re-evaluate in 6 months.
Correct Answer: C
Rationales:
• Correct: A 3-year-old should have a vocabulary of nearly
1,000 words and be speaking in 3- to 4-word sentences. A
50-word vocabulary and reliance on two-word phrases are
significant red flags for a language delay, warranting an
immediate referral for a comprehensive evaluation.
• Incorrect A: This is not within normal limits. The described
speech patterns are consistent with a significant expressive
language delay.
• Incorrect B: While hearing should be assessed, a formal
audiology evaluation is typically part of the workup, not
the initial in-office action for this specific presentation. The
primary concern is the clear language delay.
• Incorrect D: While reading is beneficial, a 6-month wait is
inappropriate given the significant deviation from expected
developmental milestones.
Teaching Point: A 3-year-old should use multi-word sentences.
Significant language delays require prompt referral for
evaluation.
Question 2
,Reference: Ch. 45, Section: Otitis Media
Question Stem:
A 22-month-old, otherwise healthy female presents with 48
hours of fussiness and fever to 38.8°C (101.8°F). Otoscopic
examination reveals a bulging, red, immobile tympanic
membrane with obscured landmarks. What is the most
appropriate management?
Options:
A. Prescribe amoxicillin 80-90 mg/kg/day in two divided doses
for 10 days.
B. Recommend ibuprofen for comfort and schedule a follow-up
in 48 hours for re-evaluation.
C. Prescribe amoxicillin-clavulanate 90 mg/kg/day of the
amoxicillin component for 10 days.
D. Instill otic analgesic drops and advise the parent to call if
symptoms persist beyond 72 hours.
Correct Answer: A
Rationales:
• Correct: This child meets diagnostic criteria for acute otitis
media (AOM): age < 2 years, fever, and a clearly abnormal
tympanic membrane. Antibiotic treatment with high-dose
amoxicillin is the first-line recommendation for children 6
months and older with severe symptoms (fever >39°C or
moderate-severe otalgia) or age <2 years with bilateral
AOM.
, • Incorrect B: Watchful waiting is not recommended for
children under 2 years of age with bilateral AOM or for any
child with severe symptoms (such as fever and otalgia).
• Incorrect C: Amoxicillin-clavulanate is reserved for cases of
treatment failure, recurrence within 30 days, or in children
who have received amoxicillin in the last 30 days.
• Incorrect D: Otic drops may help with pain but do not
address the bacterial infection, for which antibiotic therapy
is indicated in this case.
Teaching Point: High-dose amoxicillin is first-line for AOM in
young children or those with severe symptoms.
Question 3
Reference: Ch. 31, Section: Hypertension
Question Stem:
During a well-child visit for a 12-year-old obese male, his blood
pressure is measured at the 96th percentile for his age, gender,
and height. The reading is confirmed on two subsequent
occasions. Which of the following is the most appropriate next
step in management?
Options:
A. Initiate pharmacologic therapy with an ACE inhibitor.
B. Order a renal ultrasound and echocardiogram.
C. Recommend lifestyle modifications focusing on diet and
by-Chapter Test Bank: Verified Answers & Detailed Rationales
(New Edition)
Question 1
Reference: Ch. 23, Section: Developmental Management of
Early Childhood
Question Stem:
A 3-year-old child is brought to the clinic for a well-child visit.
The parent expresses concern that the child's speech is difficult
to understand compared to peers. The parent reports the child
has a vocabulary of about 50 words and primarily uses two-
word phrases. Which of the following is the most appropriate
initial action by the PNPP
Options:
A. Reassure the parent that this is within normal limits for a 3-
year-old.
B. Perform a formal audiology evaluation in the office.
C. Initiate a referral for a comprehensive speech and language
evaluation.
,D. Advise the parent to read to the child for 30 minutes daily
and re-evaluate in 6 months.
Correct Answer: C
Rationales:
• Correct: A 3-year-old should have a vocabulary of nearly
1,000 words and be speaking in 3- to 4-word sentences. A
50-word vocabulary and reliance on two-word phrases are
significant red flags for a language delay, warranting an
immediate referral for a comprehensive evaluation.
• Incorrect A: This is not within normal limits. The described
speech patterns are consistent with a significant expressive
language delay.
• Incorrect B: While hearing should be assessed, a formal
audiology evaluation is typically part of the workup, not
the initial in-office action for this specific presentation. The
primary concern is the clear language delay.
• Incorrect D: While reading is beneficial, a 6-month wait is
inappropriate given the significant deviation from expected
developmental milestones.
Teaching Point: A 3-year-old should use multi-word sentences.
Significant language delays require prompt referral for
evaluation.
Question 2
,Reference: Ch. 45, Section: Otitis Media
Question Stem:
A 22-month-old, otherwise healthy female presents with 48
hours of fussiness and fever to 38.8°C (101.8°F). Otoscopic
examination reveals a bulging, red, immobile tympanic
membrane with obscured landmarks. What is the most
appropriate management?
Options:
A. Prescribe amoxicillin 80-90 mg/kg/day in two divided doses
for 10 days.
B. Recommend ibuprofen for comfort and schedule a follow-up
in 48 hours for re-evaluation.
C. Prescribe amoxicillin-clavulanate 90 mg/kg/day of the
amoxicillin component for 10 days.
D. Instill otic analgesic drops and advise the parent to call if
symptoms persist beyond 72 hours.
Correct Answer: A
Rationales:
• Correct: This child meets diagnostic criteria for acute otitis
media (AOM): age < 2 years, fever, and a clearly abnormal
tympanic membrane. Antibiotic treatment with high-dose
amoxicillin is the first-line recommendation for children 6
months and older with severe symptoms (fever >39°C or
moderate-severe otalgia) or age <2 years with bilateral
AOM.
, • Incorrect B: Watchful waiting is not recommended for
children under 2 years of age with bilateral AOM or for any
child with severe symptoms (such as fever and otalgia).
• Incorrect C: Amoxicillin-clavulanate is reserved for cases of
treatment failure, recurrence within 30 days, or in children
who have received amoxicillin in the last 30 days.
• Incorrect D: Otic drops may help with pain but do not
address the bacterial infection, for which antibiotic therapy
is indicated in this case.
Teaching Point: High-dose amoxicillin is first-line for AOM in
young children or those with severe symptoms.
Question 3
Reference: Ch. 31, Section: Hypertension
Question Stem:
During a well-child visit for a 12-year-old obese male, his blood
pressure is measured at the 96th percentile for his age, gender,
and height. The reading is confirmed on two subsequent
occasions. Which of the following is the most appropriate next
step in management?
Options:
A. Initiate pharmacologic therapy with an ACE inhibitor.
B. Order a renal ultrasound and echocardiogram.
C. Recommend lifestyle modifications focusing on diet and
