Burns’ Pediatric Primary Care (8th Ed.) — Complete Chapter-
by-Chapter Test Bank: Verified Answers & Detailed Rationales
(New Edition)
Question 1
Reference: Ch. 10, Section: Developmental Management
Question Stem:
A 4-year-old child is brought to the clinic for a well-child visit.
The parent expresses concern that the child, while very
talkative, is often difficult to understand. Which of the following
speech patterns, if present, would be the most developmentally
atypical and warrant a referral for further evaluation?
Options:
A. Uses pronouns incorrectly (e.g., "Him go store").
B. Has a vocabulary of approximately 1,500 words.
C. Is 80% intelligible to an unfamiliar listener.
D. Produces sentences that are an average of 3 words in length.
Correct Answer: A
,Rationales:
• Correct: By age 4, a child should consistently use correct
pronouns (e.g., I, you, me, he, she). Persistent incorrect
usage is a red flag for a language disorder and warrants
further evaluation.
• Incorrect B: A vocabulary of 1,500 words is within the
expected range for a 4-year-old.
• Incorrect C: By age 4, a child's speech should be 100%
intelligible to an unfamiliar listener, making 80% a slight
concern, but pronoun errors are a more specific language
deficit.
• Incorrect D: A 4-year-old should be using 4- to 5-word
sentences, so 3-word sentences are slightly below average
but not the most significant red flag.
Teaching Point: Pronoun mastery is a key 4-year language
milestone; errors signal potential language disorders.
Question 2
Reference: Ch. 45, Section: Otitis Media
Question Stem:
A 15-month-old female presents with a 2-day history of
fussiness and fever to 38.8°C (101.8°F). Otoscopic examination
reveals a bulging, opaque, yellow tympanic membrane with
,impaired mobility. She has no known drug allergies. What is the
most appropriate initial management?
Options:
A. Prescribe amoxicillin 80-90 mg/kg/day in two divided doses
for 10 days.
B. Prescribe amoxicillin-clavulanate 90 mg/kg/day of the
amoxicillin component for 10 days.
C. Recommend ibuprofen and nasal saline sprays and schedule
a follow-up in 48-72 hours for re-evaluation.
D. Prescribe a single dose of ceftriaxone 50 mg/kg
intramuscularly.
Correct Answer: A
Rationales:
• Correct: This presentation is consistent with acute otitis
media (AOM). For children ≥ 6 months with severe
symptoms (fever ≥ 39°C or moderate-severe otalgia), or for
children < 2 years with bilateral AOM, antibiotic treatment
is recommended. High-dose amoxicillin is the first-line
therapy.
• Incorrect B: Amoxicillin-clavulanate is reserved for cases of
treatment failure, recurrence within 30 days, or in regions
with high rates of beta-lactamase producing H. influenzae.
• Incorrect C: Watchful waiting is an option only for non-
severe, unilateral AOM in children 6-23 months, or for non-
, severe AOM in children ≥ 2 years. This child's fever and age
make antibiotics indicated.
• Incorrect D: Ceftriaxone is a third-line agent, typically used
for children who cannot tolerate oral medications or have
failed initial therapy.
Teaching Point: High-dose amoxicillin remains first-line for AOM
in young children with severe symptoms or bilateral infection.
Question 3
Reference: Ch. 32, Section: Asthma
Question Stem:
During a well-child visit for an 8-year-old with persistent
asthma, the parent reports the child uses his albuterol sulfate
metered-dose inhaler 3-4 times per week for cough and before
soccer practice. His current regimen is fluticasone 110 mcg, two
puffs twice daily. What is the most appropriate next step in
management?
Options:
A. Increase the fluticasone dose to 220 mcg, two puffs twice
daily.
B. Switch to a combination inhaled corticosteroid/long-acting
beta-agonist (ICS/LABA).
C. Continue the current regimen and reinforce proper inhaler
technique.
D. Add a daily leukotriene receptor antagonist (LTRA).
by-Chapter Test Bank: Verified Answers & Detailed Rationales
(New Edition)
Question 1
Reference: Ch. 10, Section: Developmental Management
Question Stem:
A 4-year-old child is brought to the clinic for a well-child visit.
The parent expresses concern that the child, while very
talkative, is often difficult to understand. Which of the following
speech patterns, if present, would be the most developmentally
atypical and warrant a referral for further evaluation?
Options:
A. Uses pronouns incorrectly (e.g., "Him go store").
B. Has a vocabulary of approximately 1,500 words.
C. Is 80% intelligible to an unfamiliar listener.
D. Produces sentences that are an average of 3 words in length.
Correct Answer: A
,Rationales:
• Correct: By age 4, a child should consistently use correct
pronouns (e.g., I, you, me, he, she). Persistent incorrect
usage is a red flag for a language disorder and warrants
further evaluation.
• Incorrect B: A vocabulary of 1,500 words is within the
expected range for a 4-year-old.
• Incorrect C: By age 4, a child's speech should be 100%
intelligible to an unfamiliar listener, making 80% a slight
concern, but pronoun errors are a more specific language
deficit.
• Incorrect D: A 4-year-old should be using 4- to 5-word
sentences, so 3-word sentences are slightly below average
but not the most significant red flag.
Teaching Point: Pronoun mastery is a key 4-year language
milestone; errors signal potential language disorders.
Question 2
Reference: Ch. 45, Section: Otitis Media
Question Stem:
A 15-month-old female presents with a 2-day history of
fussiness and fever to 38.8°C (101.8°F). Otoscopic examination
reveals a bulging, opaque, yellow tympanic membrane with
,impaired mobility. She has no known drug allergies. What is the
most appropriate initial management?
Options:
A. Prescribe amoxicillin 80-90 mg/kg/day in two divided doses
for 10 days.
B. Prescribe amoxicillin-clavulanate 90 mg/kg/day of the
amoxicillin component for 10 days.
C. Recommend ibuprofen and nasal saline sprays and schedule
a follow-up in 48-72 hours for re-evaluation.
D. Prescribe a single dose of ceftriaxone 50 mg/kg
intramuscularly.
Correct Answer: A
Rationales:
• Correct: This presentation is consistent with acute otitis
media (AOM). For children ≥ 6 months with severe
symptoms (fever ≥ 39°C or moderate-severe otalgia), or for
children < 2 years with bilateral AOM, antibiotic treatment
is recommended. High-dose amoxicillin is the first-line
therapy.
• Incorrect B: Amoxicillin-clavulanate is reserved for cases of
treatment failure, recurrence within 30 days, or in regions
with high rates of beta-lactamase producing H. influenzae.
• Incorrect C: Watchful waiting is an option only for non-
severe, unilateral AOM in children 6-23 months, or for non-
, severe AOM in children ≥ 2 years. This child's fever and age
make antibiotics indicated.
• Incorrect D: Ceftriaxone is a third-line agent, typically used
for children who cannot tolerate oral medications or have
failed initial therapy.
Teaching Point: High-dose amoxicillin remains first-line for AOM
in young children with severe symptoms or bilateral infection.
Question 3
Reference: Ch. 32, Section: Asthma
Question Stem:
During a well-child visit for an 8-year-old with persistent
asthma, the parent reports the child uses his albuterol sulfate
metered-dose inhaler 3-4 times per week for cough and before
soccer practice. His current regimen is fluticasone 110 mcg, two
puffs twice daily. What is the most appropriate next step in
management?
Options:
A. Increase the fluticasone dose to 220 mcg, two puffs twice
daily.
B. Switch to a combination inhaled corticosteroid/long-acting
beta-agonist (ICS/LABA).
C. Continue the current regimen and reinforce proper inhaler
technique.
D. Add a daily leukotriene receptor antagonist (LTRA).
