Burns Pediatric Primary Care, 8th Edition – Original
Practice Questions (200 MCQs)
Below are 200 original, high-quality multiple-choice questions aligned with the core topics from Burns
Pediatric Primary Care, 8th Edition. Each question is followed by the correct answer and a brief
explanation.
Questions 1–10: Foundations of Pediatric Primary Care
1. A 2-week-old infant presents with jaundice that started on day 4 of life, breastfeeds well, has yellow
sclera but otherwise normal exam. Total bilirubin is 12 mg/dL with direct fraction 0.5 mg/dL. What is the
most likely diagnosis?
- A) Pathologic jaundice
- B) Biliary atresia
- C) Physiologic jaundice
- D) Breastfeeding jaundice
Answer: D – Breastfeeding jaundice peaks at day 4–7, indirect hyperbilirubinemia, well-appearing infant.
Biliary atresia presents with direct hyperbilirubinemia.
2. Which developmental milestone would you expect a 12-month-old to have achieved?
- A) Walks independently
- B) Builds a tower of 6 cubes
- C) Uses a spoon without spilling
- D) Kicks a ball forward
Answer: A – Most 12-month-olds can take a few independent steps. B and C are 18-month skills; D is 24
months.
3. A 5-year-old presents with fever, sore throat, and tender anterior cervical lymphadenopathy. Rapid
strep test is positive. What is first-line treatment?
,- A) Amoxicillin for 10 days
- B) Penicillin VK for 10 days
- C) Azithromycin for 5 days
- D) Cephalexin for 7 days
Answer: B – Penicillin VK remains first-line for Group A strep pharyngitis. Amoxicillin is acceptable but
not preferred; macrolides are for penicillin allergy.
4. The mother of a 6-month-old asks about introducing peanuts. The infant has severe eczema. What do
current guidelines recommend?
- A) Avoid peanuts until age 3 years
- B) Introduce peanut butter mixed with water at home
- C) Perform peanut skin prick testing before introduction
- D) Give whole peanuts as a first food
Answer: C – High-risk infants (severe eczema, egg allergy) should have allergy evaluation and possible
supervised feeding. Whole peanuts are a choking hazard.
5. A 10-year-old’s BMI is at the 95th percentile for age/sex. Blood pressure is 118/76 (90th percentile).
Which comorbidity is most likely already present?
- A) Type 1 diabetes
- B) Nonalcoholic fatty liver disease
- C) Hypothyroidism
- D) Cushing syndrome
Answer: B – NAFLD is common in pediatric obesity. Hypertension is also common but BP here is normal.
Type 2 diabetes risk increases but less common than NAFLD.
6. A 4-year-old has a fever for 5 days, bilateral conjunctival injection without exudate, oral mucosal
changes, polymorphous rash, and cervical lymphadenopathy >1.5 cm. What is the most serious
complication to monitor?
,- A) Meningitis
- B) Coronary artery aneurysms
- C) Otitis media
- D) Encephalitis
Answer: B – These are diagnostic criteria for Kawasaki disease. Cardiac complications (coronary
aneurysms) are the primary concern.
7. Which immunization is routinely given at birth?
- A) Hepatitis B vaccine
- B) Rotavirus vaccine
- C) DTaP
- D) Haemophilus influenzae type b
Answer: A – Hepatitis B vaccine is the only routine birth dose. Rotavirus, DTaP, and Hib start at 2 months.
8. A 15-month-old has not yet said any words, does not point to objects, and avoids eye contact. Which
screening tool is most appropriate?
- A) M-CHAT (Modified Checklist for Autism in Toddlers)
- B) PEDS (Parents’ Evaluation of Developmental Status)
- C) ASQ (Ages and Stages Questionnaire)
- D) Vanderbilt rating scale
Answer: A – Red flags for autism (no words, no pointing, poor eye contact) warrant M-CHAT screening at
18 months but can be used at 15 months.
9. A 3-year-old has a blood lead level of 10 mcg/dL. What is the next best step?
- A) No action needed; level is normal
- B) Repeat venous lead level and initiate environmental investigation
- C) Start chelation therapy immediately
, - D) Give oral succimer at home
Answer: B – Current CDC reference level is 3.5 mcg/dL. Level 10 requires confirmation, environmental
assessment, and nutritional counseling. Chelation is for levels >45.
10. A 7-day-old newborn has a left eye with persistent tearing and mucoid discharge. No erythema of
lids. What is the most likely cause?
- A) Gonococcal ophthalmia
- B) Chlamydial conjunctivitis
- C) Nasolacrimal duct obstruction
- D) Herpes simplex keratitis
Answer: C – Nasolacrimal duct obstruction presents with tearing and discharge without redness, usually
resolves by 12 months. Chlamydia presents at 5–14 days but often with lid swelling.
Questions 11–20: Growth and Development
11. Which reflex disappears by 4–6 months of age?
- A) Patellar reflex
- B) Babinski reflex (plantar)
- C) Moro reflex
- D) Corneal reflex
Answer: C – Moro reflex disappears by 4–6 months. Babinski may persist up to 12 months. Patellar and
corneal are lifelong.
12. At what age should a child be able to draw a circle?
- A) 2 years
Practice Questions (200 MCQs)
Below are 200 original, high-quality multiple-choice questions aligned with the core topics from Burns
Pediatric Primary Care, 8th Edition. Each question is followed by the correct answer and a brief
explanation.
Questions 1–10: Foundations of Pediatric Primary Care
1. A 2-week-old infant presents with jaundice that started on day 4 of life, breastfeeds well, has yellow
sclera but otherwise normal exam. Total bilirubin is 12 mg/dL with direct fraction 0.5 mg/dL. What is the
most likely diagnosis?
- A) Pathologic jaundice
- B) Biliary atresia
- C) Physiologic jaundice
- D) Breastfeeding jaundice
Answer: D – Breastfeeding jaundice peaks at day 4–7, indirect hyperbilirubinemia, well-appearing infant.
Biliary atresia presents with direct hyperbilirubinemia.
2. Which developmental milestone would you expect a 12-month-old to have achieved?
- A) Walks independently
- B) Builds a tower of 6 cubes
- C) Uses a spoon without spilling
- D) Kicks a ball forward
Answer: A – Most 12-month-olds can take a few independent steps. B and C are 18-month skills; D is 24
months.
3. A 5-year-old presents with fever, sore throat, and tender anterior cervical lymphadenopathy. Rapid
strep test is positive. What is first-line treatment?
,- A) Amoxicillin for 10 days
- B) Penicillin VK for 10 days
- C) Azithromycin for 5 days
- D) Cephalexin for 7 days
Answer: B – Penicillin VK remains first-line for Group A strep pharyngitis. Amoxicillin is acceptable but
not preferred; macrolides are for penicillin allergy.
4. The mother of a 6-month-old asks about introducing peanuts. The infant has severe eczema. What do
current guidelines recommend?
- A) Avoid peanuts until age 3 years
- B) Introduce peanut butter mixed with water at home
- C) Perform peanut skin prick testing before introduction
- D) Give whole peanuts as a first food
Answer: C – High-risk infants (severe eczema, egg allergy) should have allergy evaluation and possible
supervised feeding. Whole peanuts are a choking hazard.
5. A 10-year-old’s BMI is at the 95th percentile for age/sex. Blood pressure is 118/76 (90th percentile).
Which comorbidity is most likely already present?
- A) Type 1 diabetes
- B) Nonalcoholic fatty liver disease
- C) Hypothyroidism
- D) Cushing syndrome
Answer: B – NAFLD is common in pediatric obesity. Hypertension is also common but BP here is normal.
Type 2 diabetes risk increases but less common than NAFLD.
6. A 4-year-old has a fever for 5 days, bilateral conjunctival injection without exudate, oral mucosal
changes, polymorphous rash, and cervical lymphadenopathy >1.5 cm. What is the most serious
complication to monitor?
,- A) Meningitis
- B) Coronary artery aneurysms
- C) Otitis media
- D) Encephalitis
Answer: B – These are diagnostic criteria for Kawasaki disease. Cardiac complications (coronary
aneurysms) are the primary concern.
7. Which immunization is routinely given at birth?
- A) Hepatitis B vaccine
- B) Rotavirus vaccine
- C) DTaP
- D) Haemophilus influenzae type b
Answer: A – Hepatitis B vaccine is the only routine birth dose. Rotavirus, DTaP, and Hib start at 2 months.
8. A 15-month-old has not yet said any words, does not point to objects, and avoids eye contact. Which
screening tool is most appropriate?
- A) M-CHAT (Modified Checklist for Autism in Toddlers)
- B) PEDS (Parents’ Evaluation of Developmental Status)
- C) ASQ (Ages and Stages Questionnaire)
- D) Vanderbilt rating scale
Answer: A – Red flags for autism (no words, no pointing, poor eye contact) warrant M-CHAT screening at
18 months but can be used at 15 months.
9. A 3-year-old has a blood lead level of 10 mcg/dL. What is the next best step?
- A) No action needed; level is normal
- B) Repeat venous lead level and initiate environmental investigation
- C) Start chelation therapy immediately
, - D) Give oral succimer at home
Answer: B – Current CDC reference level is 3.5 mcg/dL. Level 10 requires confirmation, environmental
assessment, and nutritional counseling. Chelation is for levels >45.
10. A 7-day-old newborn has a left eye with persistent tearing and mucoid discharge. No erythema of
lids. What is the most likely cause?
- A) Gonococcal ophthalmia
- B) Chlamydial conjunctivitis
- C) Nasolacrimal duct obstruction
- D) Herpes simplex keratitis
Answer: C – Nasolacrimal duct obstruction presents with tearing and discharge without redness, usually
resolves by 12 months. Chlamydia presents at 5–14 days but often with lid swelling.
Questions 11–20: Growth and Development
11. Which reflex disappears by 4–6 months of age?
- A) Patellar reflex
- B) Babinski reflex (plantar)
- C) Moro reflex
- D) Corneal reflex
Answer: C – Moro reflex disappears by 4–6 months. Babinski may persist up to 12 months. Patellar and
corneal are lifelong.
12. At what age should a child be able to draw a circle?
- A) 2 years
