Pediatric Primary Care 2026/2027 | Burns’ Pediatric Primary
Care 8th Edition Study Guide, Practice Questions & Answers,
Pediatric Primary Care Exam Prep, Pediatric Nurse
Practitioner (PNP) & Family Nurse Practitioner (FNP) Review,
Child & Family Health Assessment, Growth & Development,
Health Promotion, Immunizations, Nutrition, Newborn &
Infant Care, Behavioral & Mental Health, Respiratory,
Cardiovascular, Gastrointestinal, Infectious, Endocrine,
Neurologic, Dermatologic, Genitourinary & Reproductive
Disorders, Pediatric Pharmacology & Detailed Rationales
Question 1: A 2-year-old child presents with a barking cough,
inspiratory stridor, and hoarseness that began at night. The
symptoms worsen when the child cries. What is the most likely
diagnosis?
A. Epiglottitis
B. Croup
C. Bronchiolitis
D. Foreign body aspiration
CORRECT ANSWER: B. Croup
Rationale: Croup (laryngotracheobronchitis) classically presents in children
aged 6 months to 3 years with a barking cough, inspiratory stridor, and
hoarseness. Symptoms are typically worse at night and aggravated by
agitation or crying. Epiglottitis presents with high fever, drooling, and tripod
positioning without a barking cough. Bronchiolitis presents with wheezing
and crackles in infants. Foreign body aspiration typically has sudden onset
without preceding viral symptoms.
Question 2: A 4-year-old child is brought to the clinic with a fever
of 104°F (40°C), drooling, and difficulty swallowing. The child is
sitting upright and leaning forward. What is the most appropriate
initial management?
A. Obtain a throat culture immediately
B. Inspect the throat with a tongue depressor
C. Keep the child calm and prepare for emergent airway management
D. Administer oral amoxicillin
CORRECT ANSWER: C. Keep the child calm and prepare for
emergent airway management
,Rationale: This presentation is highly suspicious for epiglottitis, a medical
emergency that can cause sudden airway obstruction. The child should be
kept calm and upright, and emergency airway management should be
arranged. Inspecting the throat or obtaining cultures may precipitate
complete airway obstruction and should be avoided until the airway is
secured.
Question 3: A 6-month-old infant presents with a 3-day history of
nasal congestion, low-grade fever, and a wet cough. On
examination, wheezing and fine crackles are heard bilaterally.
What is the most likely causative organism?
A. Streptococcus pneumoniae
B. Respiratory syncytial virus (RSV)
C. Haemophilus influenzae type B
D. Bordetella pertussis
CORRECT ANSWER: B. Respiratory syncytial virus (RSV)
Rationale: Bronchiolitis is most commonly caused by RSV and typically
affects infants under 12 months of age. It presents with upper respiratory
symptoms progressing to wheezing, crackles, and respiratory distress.
Streptococcus pneumoniae is a common cause of pneumonia but not
typically bronchiolitis. Haemophilus influenzae type B causes epiglottitis.
Bordetella pertussis causes paroxysmal coughing with a whoop.
Question 4: A 3-year-old child with a known peanut allergy is
brought to the clinic immediately after accidental ingestion. The
child has urticaria, wheezing, and hypotension. What is the first-
line medication?
A. Oral diphenhydramine
B. Intramuscular epinephrine
C. Intravenous corticosteroids
D. Nebulized albuterol
CORRECT ANSWER: B. Intramuscular epinephrine
Rationale: Intramuscular epinephrine is the first-line treatment for
anaphylaxis. It reverses airway edema, bronchospasm, and hypotension.
Antihistamines and corticosteroids are adjunctive treatments but do not
reverse life-threatening symptoms. Albuterol may help with bronchospasm
but does not address hypotension or systemic reactions.
,Question 5: A 5-year-old child presents with periorbital edema,
dark urine, and hypertension. Urinalysis shows hematuria and
proteinuria. What is the most likely diagnosis?
A. Nephrotic syndrome
B. Acute post-streptococcal glomerulonephritis
C. Urinary tract infection
D. IgA nephropathy
CORRECT ANSWER: B. Acute post-streptococcal
glomerulonephritis
Rationale: Acute post-streptococcal glomerulonephritis typically presents
1–2 weeks after a streptococcal infection with hematuria, proteinuria,
hypertension, and periorbital edema. Nephrotic syndrome presents with
massive proteinuria, hypoalbuminemia, and generalized edema without
hypertension. Urinary tract infection presents with dysuria and fever. IgA
nephropathy presents with recurrent gross hematuria during upper
respiratory infections.
Question 6: A 2-week-old infant presents with projectile vomiting
after feeding and a palpable olive-shaped mass in the right upper
quadrant. What is the most likely diagnosis?
A. Gastroesophageal reflux
B. Pyloric stenosis
C. Intussusception
D. Malrotation
CORRECT ANSWER: B. Pyloric stenosis
Rationale: Hypertrophic pyloric stenosis presents at 2–6 weeks of age with
projectile, non-bilious vomiting and a palpable olive-shaped mass in the
right upper quadrant. Gastroesophageal reflux is not projectile and lacks the
mass. Intussusception presents with intermittent colicky pain and currant
jelly stools. Malrotation can present with bilious vomiting and is a surgical
emergency.
Question 7: A 3-year-old child presents with a sudden onset of
severe abdominal pain, vomiting, and passage of currant jelly
stools. What is the most likely diagnosis?
, A. Pyloric stenosis
B. Intussusception
C. Appendicitis
D. Gastroenteritis
CORRECT ANSWER: B. Intussusception
Rationale: Intussusception classically presents in children aged 6 months to
3 years with intermittent colicky abdominal pain, vomiting, and currant jelly
stools (blood and mucus). Pyloric stenosis presents in younger infants with
projectile vomiting. Appendicitis presents with periumbilical pain migrating
to the right lower quadrant. Gastroenteritis presents with diarrhea and
diffuse abdominal pain.
Question 8: A 4-year-old child presents with fever, sore throat, and
a sandpaper-like rash. On examination, the tongue is strawberry-
colored and the pharynx is erythematous. What is the most likely
diagnosis?
A. Measles
B. Scarlet fever
C. Kawasaki disease
D. Rubella
CORRECT ANSWER: B. Scarlet fever
Rationale: Scarlet fever is caused by group A beta-hemolytic Streptococcus
and presents with fever, sore throat, a sandpaper-like rash, and a strawberry
tongue. Measles presents with Koplik spots and a maculopapular rash
spreading cephalocaudally. Kawasaki disease presents with prolonged fever,
conjunctivitis, oral changes, and extremity changes. Rubella presents with a
fine maculopapular rash and postauricular lymphadenopathy.
Question 9: A 6-year-old child presents with fever for 6 days,
bilateral conjunctivitis, cracked lips, strawberry tongue, and
swelling of the hands and feet. What is the most likely diagnosis?
A. Scarlet fever
B. Kawasaki disease
C. Measles
D. Rocky Mountain spotted fever
CORRECT ANSWER: B. Kawasaki disease
Care 8th Edition Study Guide, Practice Questions & Answers,
Pediatric Primary Care Exam Prep, Pediatric Nurse
Practitioner (PNP) & Family Nurse Practitioner (FNP) Review,
Child & Family Health Assessment, Growth & Development,
Health Promotion, Immunizations, Nutrition, Newborn &
Infant Care, Behavioral & Mental Health, Respiratory,
Cardiovascular, Gastrointestinal, Infectious, Endocrine,
Neurologic, Dermatologic, Genitourinary & Reproductive
Disorders, Pediatric Pharmacology & Detailed Rationales
Question 1: A 2-year-old child presents with a barking cough,
inspiratory stridor, and hoarseness that began at night. The
symptoms worsen when the child cries. What is the most likely
diagnosis?
A. Epiglottitis
B. Croup
C. Bronchiolitis
D. Foreign body aspiration
CORRECT ANSWER: B. Croup
Rationale: Croup (laryngotracheobronchitis) classically presents in children
aged 6 months to 3 years with a barking cough, inspiratory stridor, and
hoarseness. Symptoms are typically worse at night and aggravated by
agitation or crying. Epiglottitis presents with high fever, drooling, and tripod
positioning without a barking cough. Bronchiolitis presents with wheezing
and crackles in infants. Foreign body aspiration typically has sudden onset
without preceding viral symptoms.
Question 2: A 4-year-old child is brought to the clinic with a fever
of 104°F (40°C), drooling, and difficulty swallowing. The child is
sitting upright and leaning forward. What is the most appropriate
initial management?
A. Obtain a throat culture immediately
B. Inspect the throat with a tongue depressor
C. Keep the child calm and prepare for emergent airway management
D. Administer oral amoxicillin
CORRECT ANSWER: C. Keep the child calm and prepare for
emergent airway management
,Rationale: This presentation is highly suspicious for epiglottitis, a medical
emergency that can cause sudden airway obstruction. The child should be
kept calm and upright, and emergency airway management should be
arranged. Inspecting the throat or obtaining cultures may precipitate
complete airway obstruction and should be avoided until the airway is
secured.
Question 3: A 6-month-old infant presents with a 3-day history of
nasal congestion, low-grade fever, and a wet cough. On
examination, wheezing and fine crackles are heard bilaterally.
What is the most likely causative organism?
A. Streptococcus pneumoniae
B. Respiratory syncytial virus (RSV)
C. Haemophilus influenzae type B
D. Bordetella pertussis
CORRECT ANSWER: B. Respiratory syncytial virus (RSV)
Rationale: Bronchiolitis is most commonly caused by RSV and typically
affects infants under 12 months of age. It presents with upper respiratory
symptoms progressing to wheezing, crackles, and respiratory distress.
Streptococcus pneumoniae is a common cause of pneumonia but not
typically bronchiolitis. Haemophilus influenzae type B causes epiglottitis.
Bordetella pertussis causes paroxysmal coughing with a whoop.
Question 4: A 3-year-old child with a known peanut allergy is
brought to the clinic immediately after accidental ingestion. The
child has urticaria, wheezing, and hypotension. What is the first-
line medication?
A. Oral diphenhydramine
B. Intramuscular epinephrine
C. Intravenous corticosteroids
D. Nebulized albuterol
CORRECT ANSWER: B. Intramuscular epinephrine
Rationale: Intramuscular epinephrine is the first-line treatment for
anaphylaxis. It reverses airway edema, bronchospasm, and hypotension.
Antihistamines and corticosteroids are adjunctive treatments but do not
reverse life-threatening symptoms. Albuterol may help with bronchospasm
but does not address hypotension or systemic reactions.
,Question 5: A 5-year-old child presents with periorbital edema,
dark urine, and hypertension. Urinalysis shows hematuria and
proteinuria. What is the most likely diagnosis?
A. Nephrotic syndrome
B. Acute post-streptococcal glomerulonephritis
C. Urinary tract infection
D. IgA nephropathy
CORRECT ANSWER: B. Acute post-streptococcal
glomerulonephritis
Rationale: Acute post-streptococcal glomerulonephritis typically presents
1–2 weeks after a streptococcal infection with hematuria, proteinuria,
hypertension, and periorbital edema. Nephrotic syndrome presents with
massive proteinuria, hypoalbuminemia, and generalized edema without
hypertension. Urinary tract infection presents with dysuria and fever. IgA
nephropathy presents with recurrent gross hematuria during upper
respiratory infections.
Question 6: A 2-week-old infant presents with projectile vomiting
after feeding and a palpable olive-shaped mass in the right upper
quadrant. What is the most likely diagnosis?
A. Gastroesophageal reflux
B. Pyloric stenosis
C. Intussusception
D. Malrotation
CORRECT ANSWER: B. Pyloric stenosis
Rationale: Hypertrophic pyloric stenosis presents at 2–6 weeks of age with
projectile, non-bilious vomiting and a palpable olive-shaped mass in the
right upper quadrant. Gastroesophageal reflux is not projectile and lacks the
mass. Intussusception presents with intermittent colicky pain and currant
jelly stools. Malrotation can present with bilious vomiting and is a surgical
emergency.
Question 7: A 3-year-old child presents with a sudden onset of
severe abdominal pain, vomiting, and passage of currant jelly
stools. What is the most likely diagnosis?
, A. Pyloric stenosis
B. Intussusception
C. Appendicitis
D. Gastroenteritis
CORRECT ANSWER: B. Intussusception
Rationale: Intussusception classically presents in children aged 6 months to
3 years with intermittent colicky abdominal pain, vomiting, and currant jelly
stools (blood and mucus). Pyloric stenosis presents in younger infants with
projectile vomiting. Appendicitis presents with periumbilical pain migrating
to the right lower quadrant. Gastroenteritis presents with diarrhea and
diffuse abdominal pain.
Question 8: A 4-year-old child presents with fever, sore throat, and
a sandpaper-like rash. On examination, the tongue is strawberry-
colored and the pharynx is erythematous. What is the most likely
diagnosis?
A. Measles
B. Scarlet fever
C. Kawasaki disease
D. Rubella
CORRECT ANSWER: B. Scarlet fever
Rationale: Scarlet fever is caused by group A beta-hemolytic Streptococcus
and presents with fever, sore throat, a sandpaper-like rash, and a strawberry
tongue. Measles presents with Koplik spots and a maculopapular rash
spreading cephalocaudally. Kawasaki disease presents with prolonged fever,
conjunctivitis, oral changes, and extremity changes. Rubella presents with a
fine maculopapular rash and postauricular lymphadenopathy.
Question 9: A 6-year-old child presents with fever for 6 days,
bilateral conjunctivitis, cracked lips, strawberry tongue, and
swelling of the hands and feet. What is the most likely diagnosis?
A. Scarlet fever
B. Kawasaki disease
C. Measles
D. Rocky Mountain spotted fever
CORRECT ANSWER: B. Kawasaki disease
