Burns’ Pediatric Primary Care (8th Ed.) — Complete Chapter-
by-Chapter Test Bank: Verified Answers & Detailed Rationales
(New Edition)
Question 1
Reference: Ch. 7, Section: Developmental Surveillance and
Screening
Question Stem:
A 4-year-old child presents for a well-child visit. The parent has
no specific developmental concerns. The pediatric primary care
provider is preparing to conduct developmental surveillance.
Which action is the most essential component of this process?
Options:
A. Administering the Ages and Stages Questionnaire (ASQ-3)
B. Observing the child's interactions and skills during the visit
C. Referring the child to a developmental specialist for a formal
evaluation
D. Asking the parent if the child can count to 20 and write their
name
,Correct Answer: B
Rationales:
• Correct: Developmental surveillance is a flexible,
continuous process whereby knowledgeable healthcare
professionals observe the child's development during
encounters and elicit and attend to parental concerns.
Direct observation is a cornerstone of this process.
• Incorrect A: Administering a standardized screening tool
like the ASQ-3 is a specific step called developmental
screening, which is a component of, but distinct from, the
ongoing process of surveillance.
• Incorrect C: A referral is indicated if surveillance or
screening identifies a potential problem; it is not the initial
step when no concerns are present.
• Incorrect D: While asking about specific skills is part of
history-taking, it is less comprehensive than holistic
observation and does not constitute the full scope of
surveillance.
Teaching Point: Developmental surveillance is a continuous
process centered on skilled observation and eliciting parental
concerns.
Question 2
Reference: Ch. 8, Section: Physical Examination
,Question Stem:
A 15-month-old is in the clinic for a routine health supervision
visit. The pediatric primary care provider notes the anterior
fontanel is still slightly open on palpation. Which action is the
most appropriate based on this finding?
Options:
A. Order a stat head CT scan to evaluate for increased
intracranial pressure.
B. Reassure the parent that this can be a normal finding and
monitor at the next visit.
C. Immediately refer the child to a pediatric neurosurgeon.
D. Prescribe vitamin D supplementation to accelerate fontanel
closure.
Correct Answer: B
Rationales:
• Correct: The anterior fontanel typically closes between 9
and 18 months. A patent fontanel at 15 months is at the
upper end of, but still within, the normal range and
requires only monitoring and anticipatory guidance.
• Incorrect A: This is an extreme and unnecessary response
for an isolated finding that is likely normal. Neuroimaging
is reserved for cases with other concerning signs (e.g.,
macrocephaly, developmental delay).
, • Incorrect C: Referral is not indicated without other
abnormal neurological findings or a fontanel that remains
open well beyond 18 months.
• Incorrect D: Vitamin D deficiency can cause delayed
fontanel closure, but supplementation is not indicated
without laboratory confirmation and other signs of rickets.
Teaching Point: Anterior fontanel closure is variable;
persistence until 18 months can be normal without other
concerning symptoms.
Question 3
Reference: Ch. 10, Section: Health Promotion
Question Stem:
During a 6-year-old's well-child visit, the pediatric primary care
provider plots the child's Body Mass Index (BMI) and finds it has
crossed from the 75th percentile to the 85th percentile since
the last visit. What is the most appropriate initial action?
Options:
A. Diagnose the child with obesity and initiate a structured,
calorie-restricted diet.
B. Provide education on healthy eating and physical activity,
focusing on specific, achievable goals.
C. Order thyroid-stimulating hormone (TSH) and free T4 labs to
rule out an endocrine cause.
by-Chapter Test Bank: Verified Answers & Detailed Rationales
(New Edition)
Question 1
Reference: Ch. 7, Section: Developmental Surveillance and
Screening
Question Stem:
A 4-year-old child presents for a well-child visit. The parent has
no specific developmental concerns. The pediatric primary care
provider is preparing to conduct developmental surveillance.
Which action is the most essential component of this process?
Options:
A. Administering the Ages and Stages Questionnaire (ASQ-3)
B. Observing the child's interactions and skills during the visit
C. Referring the child to a developmental specialist for a formal
evaluation
D. Asking the parent if the child can count to 20 and write their
name
,Correct Answer: B
Rationales:
• Correct: Developmental surveillance is a flexible,
continuous process whereby knowledgeable healthcare
professionals observe the child's development during
encounters and elicit and attend to parental concerns.
Direct observation is a cornerstone of this process.
• Incorrect A: Administering a standardized screening tool
like the ASQ-3 is a specific step called developmental
screening, which is a component of, but distinct from, the
ongoing process of surveillance.
• Incorrect C: A referral is indicated if surveillance or
screening identifies a potential problem; it is not the initial
step when no concerns are present.
• Incorrect D: While asking about specific skills is part of
history-taking, it is less comprehensive than holistic
observation and does not constitute the full scope of
surveillance.
Teaching Point: Developmental surveillance is a continuous
process centered on skilled observation and eliciting parental
concerns.
Question 2
Reference: Ch. 8, Section: Physical Examination
,Question Stem:
A 15-month-old is in the clinic for a routine health supervision
visit. The pediatric primary care provider notes the anterior
fontanel is still slightly open on palpation. Which action is the
most appropriate based on this finding?
Options:
A. Order a stat head CT scan to evaluate for increased
intracranial pressure.
B. Reassure the parent that this can be a normal finding and
monitor at the next visit.
C. Immediately refer the child to a pediatric neurosurgeon.
D. Prescribe vitamin D supplementation to accelerate fontanel
closure.
Correct Answer: B
Rationales:
• Correct: The anterior fontanel typically closes between 9
and 18 months. A patent fontanel at 15 months is at the
upper end of, but still within, the normal range and
requires only monitoring and anticipatory guidance.
• Incorrect A: This is an extreme and unnecessary response
for an isolated finding that is likely normal. Neuroimaging
is reserved for cases with other concerning signs (e.g.,
macrocephaly, developmental delay).
, • Incorrect C: Referral is not indicated without other
abnormal neurological findings or a fontanel that remains
open well beyond 18 months.
• Incorrect D: Vitamin D deficiency can cause delayed
fontanel closure, but supplementation is not indicated
without laboratory confirmation and other signs of rickets.
Teaching Point: Anterior fontanel closure is variable;
persistence until 18 months can be normal without other
concerning symptoms.
Question 3
Reference: Ch. 10, Section: Health Promotion
Question Stem:
During a 6-year-old's well-child visit, the pediatric primary care
provider plots the child's Body Mass Index (BMI) and finds it has
crossed from the 75th percentile to the 85th percentile since
the last visit. What is the most appropriate initial action?
Options:
A. Diagnose the child with obesity and initiate a structured,
calorie-restricted diet.
B. Provide education on healthy eating and physical activity,
focusing on specific, achievable goals.
C. Order thyroid-stimulating hormone (TSH) and free T4 labs to
rule out an endocrine cause.
