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 reports the child can hop on one foot, draws a
person with three parts, and is mostly intelligible to strangers.
However, the child is not yet able to catch a ball reliably. Based
on typical developmental milestones, which finding requires the
most immediate further assessment?
Options:
A. Inability to catch a ball
B. Ability to hop on one foot
,C. Drawing a person with three parts
D. Speech being mostly intelligible to strangers
Correct Answer: A
Rationales:
• Correct (A): The inability to catch a ball by age 4 may
indicate a delay in gross motor skills and visual-motor
integration, warranting further assessment. Most 4-year-
olds can throw a ball overhand and begin to catch a
bounced ball.
• Incorrect (B): Hopping on one foot is a typical gross motor
milestone for a 4-year-old.
• Incorrect (C): Drawing a person with three parts is a typical
fine motor and cognitive milestone for this age.
• Incorrect (D): Speech that is 100% intelligible to strangers
is the expectation by age 4; "mostly intelligible" is a
common variation but is less concerning than a clear gross
motor delay.
Teaching Point: Prioritize assessing gross motor delays, as they
can signal neurological or musculoskeletal issues.
Question 2
Reference: Ch. 45, Section: Asthma
,Question Stem:
An 8-year-old with persistent asthma presents for a follow-up
visit. They are currently using a low-dose inhaled corticosteroid
(ICS) daily but are still experiencing nighttime symptoms twice a
week. According to the stepwise approach to asthma
management, what is the most appropriate next step?
Options:
A. Continue low-dose ICS and add a short-acting beta-agonist
(SABA) before bed.
B. Discontinue the ICS and switch to a leukotriene receptor
antagonist (LTRA).
C. Increase the dose of the inhaled corticosteroid to a medium-
dose regimen.
D. Refer the patient to a pulmonologist for biologic therapy.
Correct Answer: C
Rationales:
• Correct (C): For a child on step 2 therapy (low-dose ICS)
who is not well-controlled, the preferred step-up is to step
3, which includes a medium-dose ICS. This aligns with the
evidence-based stepwise approach to gain control.
• Incorrect (A): Adding a SABA for scheduled use is not
recommended for long-term control; it is for rescue
therapy only.
, • Incorrect (B): Discontinuing the controller medication
when control is inadequate is inappropriate and
dangerous.
• Incorrect (D): Referral for biologics is reserved for severe,
persistent asthma that is uncontrolled on high-dose ICS
and other controllers.
Teaching Point: For uncontrolled persistent asthma on low-dose
ICS, stepping up to medium-dose ICS is the preferred first-line
action.
Question 3
Reference: Ch. 24, Section: Otitis Media
Question Stem:
A 2-year-old, otherwise healthy child presents with a
temperature of 38.5°C (101.3°F) and signs of otalgia for 48
hours. Otoscopic examination reveals a bulging, red, immobile
tympanic membrane. What is the most appropriate initial
management?
Options:
A. Prescribe a 10-day course of high-dose amoxicillin.
B. Initiate a 5-day course of amoxicillin-clavulanate.
C. Recommend analgesic therapy and observe for 48-72 hours.
D. Prescribe a 10-day course of standard-dose amoxicillin.
Correct Answer: D
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 reports the child can hop on one foot, draws a
person with three parts, and is mostly intelligible to strangers.
However, the child is not yet able to catch a ball reliably. Based
on typical developmental milestones, which finding requires the
most immediate further assessment?
Options:
A. Inability to catch a ball
B. Ability to hop on one foot
,C. Drawing a person with three parts
D. Speech being mostly intelligible to strangers
Correct Answer: A
Rationales:
• Correct (A): The inability to catch a ball by age 4 may
indicate a delay in gross motor skills and visual-motor
integration, warranting further assessment. Most 4-year-
olds can throw a ball overhand and begin to catch a
bounced ball.
• Incorrect (B): Hopping on one foot is a typical gross motor
milestone for a 4-year-old.
• Incorrect (C): Drawing a person with three parts is a typical
fine motor and cognitive milestone for this age.
• Incorrect (D): Speech that is 100% intelligible to strangers
is the expectation by age 4; "mostly intelligible" is a
common variation but is less concerning than a clear gross
motor delay.
Teaching Point: Prioritize assessing gross motor delays, as they
can signal neurological or musculoskeletal issues.
Question 2
Reference: Ch. 45, Section: Asthma
,Question Stem:
An 8-year-old with persistent asthma presents for a follow-up
visit. They are currently using a low-dose inhaled corticosteroid
(ICS) daily but are still experiencing nighttime symptoms twice a
week. According to the stepwise approach to asthma
management, what is the most appropriate next step?
Options:
A. Continue low-dose ICS and add a short-acting beta-agonist
(SABA) before bed.
B. Discontinue the ICS and switch to a leukotriene receptor
antagonist (LTRA).
C. Increase the dose of the inhaled corticosteroid to a medium-
dose regimen.
D. Refer the patient to a pulmonologist for biologic therapy.
Correct Answer: C
Rationales:
• Correct (C): For a child on step 2 therapy (low-dose ICS)
who is not well-controlled, the preferred step-up is to step
3, which includes a medium-dose ICS. This aligns with the
evidence-based stepwise approach to gain control.
• Incorrect (A): Adding a SABA for scheduled use is not
recommended for long-term control; it is for rescue
therapy only.
, • Incorrect (B): Discontinuing the controller medication
when control is inadequate is inappropriate and
dangerous.
• Incorrect (D): Referral for biologics is reserved for severe,
persistent asthma that is uncontrolled on high-dose ICS
and other controllers.
Teaching Point: For uncontrolled persistent asthma on low-dose
ICS, stepping up to medium-dose ICS is the preferred first-line
action.
Question 3
Reference: Ch. 24, Section: Otitis Media
Question Stem:
A 2-year-old, otherwise healthy child presents with a
temperature of 38.5°C (101.3°F) and signs of otalgia for 48
hours. Otoscopic examination reveals a bulging, red, immobile
tympanic membrane. What is the most appropriate initial
management?
Options:
A. Prescribe a 10-day course of high-dose amoxicillin.
B. Initiate a 5-day course of amoxicillin-clavulanate.
C. Recommend analgesic therapy and observe for 48-72 hours.
D. Prescribe a 10-day course of standard-dose amoxicillin.
Correct Answer: D
