ABIM Adolescent Medicine

A 12-year-old girl presents for her well-child visit. Her mother is concerned because the patient has not yet started menstruating but has had breast development for the past year. On exam she has Tanner stage 3 breasts and Tanner stage 2 pubic hair. What is the most appropriate response?

• AReassure that this is normal pubertal progression and menarche typically occurs 2-3 years…
• BOrder LH, FSH, and pelvic ultrasound for primary amenorrhea workup
• CRefer to pediatric endocrinology for delayed puberty
• DBegin a progestin challenge

In adolescent female pubertal development, peak height velocity occurs at approximately which Sexual Maturity Rating (SMR) stage?

• ATanner 2-3
• BTanner 1
• CTanner 4-5
• DAfter menarche

A 14-year-old boy has not yet shown any signs of puberty. Exam shows testicular volume of 2 mL bilaterally and Tanner 1 pubic hair. What is the appropriate next step?

• AInitiate workup for delayed puberty
• BReassure and reassess in 1 year
• CBegin testosterone therapy empirically
• DNo further action — puberty in boys is variable until age 16

In male puberty, the first physical sign is most commonly which of the following?

• ATesticular enlargement (volume ≥4 mL)
• BPubic hair development
• CVoice change
• DPeak height velocity

A 15-year-old girl has not yet had menarche. She has Tanner 4 breasts and Tanner 4 pubic hair. What is the most appropriate next step?

• AInitiate primary amenorrhea workup
• BReassure and reassess in 1 year
• COrder karyotype only
• DNo action needed; menarche may occur as late as age 17

An 11-year-old boy is being staged for puberty. He has 5 mL testicular volume bilaterally and a few sparse, slightly pigmented pubic hairs at the base of the penis. How would you stage his pubic hair (Tanner pubic hair stage)?

• AStage 2
• BStage 1
• CStage 3
• DStage 4

According to Piaget's stages of cognitive development, the transition characteristic of mid-adolescence (around ages 12-15) is described as the move from:

• AConcrete operational to formal operational thinking
• BSensorimotor to preoperational
• CPreoperational to concrete operational
• DFormal operational to postformal thinking

According to Erikson's psychosocial stages, the central developmental task of adolescence is:

• AIdentity vs. role confusion
• BIndustry vs. inferiority
• CIntimacy vs. isolation
• DAutonomy vs. shame

A 10-year-old girl presents with thelarche, pubic hair, and a recent growth spurt. Bone age is advanced by 2 years. Workup confirms central precocious puberty. What is the threshold age below which precocious puberty is generally diagnosed in girls?

• APubertal signs before age 8
• BPubertal signs before age 10
• CPubertal signs before age 6
• DMenarche before age 12

A 13-year-old has Tanner 5 breast development, fully adult pubic hair distribution including the medial thighs, and regular menses. How would you stage her pubic hair?

• AStage 5
• BStage 4
• CStage 3
• DStage 6 (postpartum)

A 9-year-old boy has unilateral testicular enlargement to 6 mL with no other signs of puberty. The contralateral testis is 2 mL. What is the most appropriate next step?

• AScrotal ultrasound to evaluate for testicular tumor
• BReassure and follow up in 6 months
• CBegin GnRH agonist therapy
• DOrder LH/FSH and reassess in 1 year

A 14-year-old female with anorexia nervosa has primary amenorrhea, BMI of 15, and no thelarche. Bone age is delayed. The most likely mechanism for her delayed puberty is:

• AFunctional hypothalamic suppression of GnRH from low energy availability
• BPrimary ovarian failure
• CHypothyroidism
• DHyperprolactinemia

In healthy adolescents, gynecomastia (palpable subareolar breast tissue) most commonly occurs in:

• ABoys at Tanner 3-4, resolving spontaneously within 1-2 years
• BGirls at Tanner 1, requiring biopsy
• CBoys at Tanner 5, indicating Klinefelter syndrome
• DGirls at Tanner 5, indicating prolactinoma

A 16-year-old wrestler has lost 12 pounds in 4 weeks to make weight class. He reports fatigue and decreased libido. Labs show low testosterone and low LH/FSH. The most likely diagnosis is:

• AFunctional hypogonadotropic hypogonadism from low energy availability
• BKlinefelter syndrome
• CPrimary testicular failure
• DCushing syndrome

Brain development during adolescence is characterized by:

• ASynaptic pruning and prefrontal cortex maturation continuing into the mid-20s
• BComplete maturation of all brain regions by age 16
• CPredominant growth in the cerebellum and brainstem
• DAccelerated white matter loss

A 16-year-old sexually active female asks about long-acting reversible contraception. Per CDC USMEC and AAP/ACOG, which is the recommended first-line approach for adolescents?

• ALARC (IUD or etonogestrel implant) is first-line for adolescents
• BCombined oral contraceptive pill is first-line
• CDepot medroxyprogesterone acetate is first-line
• DBarrier methods alone are first-line

A 17-year-old reports unprotected intercourse 48 hours ago. Which emergency contraceptive is most effective at this interval and is available without a prescription for any age?

• ALevonorgestrel 1.5 mg (Plan B) — OTC any age
• BUlipristal acetate (Ella) — Rx only
• CCopper IUD — requires same-day insertion
• DMifepristone

A 16-year-old female smoker who smokes 20 cigarettes per day asks about combined oral contraceptive pills. Per CDC USMEC, what is the appropriate recommendation?

• ACHC is acceptable in smokers under age 35; counsel on smoking cessation
• BCHC is contraindicated in any smoker regardless of age
• CSwitch to progestin-only methods only
• DOffer DMPA exclusively

A 15-year-old female on DMPA for 2 years asks about long-term safety. Which of the following is the most accurate counseling regarding DMPA and bone mineral density?

• ADMPA causes a reversible decrease in BMD that returns to baseline after discontinuation
• BDMPA causes permanent osteoporosis
• CDMPA improves BMD
• DDMPA has no effect on bone density

A 16-year-old sexually active female with no contraception requests an IUD. Per ACOG, what is the most appropriate same-day approach?

• ASame-day IUD insertion is appropriate; pregnancy can be reasonably excluded by history
• BWait for next menses before insertion
• CRequire 2 normal pregnancy tests over 4 weeks before insertion
• DDefer until age 18

Per CDC 2021 STI Treatment Guidelines, sexually active females ≤25 years old should be screened for which STIs at least annually?

• AChlamydia and gonorrhea
• BHIV and syphilis only
• CTrichomoniasis only
• DHepatitis C only

A 17-year-old sexually active male who has sex with men (MSM) presents for routine care. Per CDC 2021 STI Treatment Guidelines, what is the appropriate STI screening interval?

• AHIV, syphilis, and extragenital (rectal/pharyngeal) gonorrhea/chlamydia every 3-12 months…
• BAnnual urethral chlamydia and gonorrhea testing only
• CNo STI screening unless symptomatic
• DGenital herpes serology annually

A 16-year-old female is treated for chlamydia. Her partner cannot or will not present for evaluation. What is the most appropriate next step in most U.S. states?

• AProvide expedited partner therapy (EPT) — written prescription or medication for the part…
• BRefuse to treat the partner and document
• CTreat only after the partner presents in person
• DNotify the partner via state health department before any therapy

Per the CDC ACIP 2024 schedule, the routine recommended starting age for the 9-valent HPV vaccine is:

• AAge 9 (with routine recommendation at 11-12 and catch-up to age 26)
• BAge 13
• CAge 18
• DAge 26

The HEEADSSS psychosocial interview is used in adolescent health visits. Which of the following best lists the components in order?

• AHome, Education/Employment, Eating, Activities, Drugs, Sex, Suicide/Depression, Safety
• BHome, Energy, Allergies, Diet, Smoking, Sleep, Stress, Social
• CHygiene, Education, Activities, Diet, Drugs, Sex, Sleep, Symptoms
• DHealth, Environment, Education, Activities, Diet, Sex, Suicide, Safety

A 16-year-old female on combined oral contraceptives presents with unilateral leg swelling and pleuritic chest pain. CT angiography confirms pulmonary embolism. Which is the most likely contributing factor?

• AEstrogen-containing CHC increases VTE risk approximately 3-4 fold
• BDMPA causes more VTE than CHC
• CProgestin-only pills are higher risk than CHC
• DLevonorgestrel IUD increases systemic VTE risk

A 15-year-old presents 18 hours after unprotected intercourse. She weighs 95 kg (BMI 38). Which emergency contraceptive is most likely to be effective in this patient?

• ACopper IUD insertion (within 5 days)
• BLevonorgestrel 1.5 mg (Plan B)
• CPlan B doubled to 3 mg
• DCombined oral contraceptive Yuzpe regimen

A 16-year-old with a positive urine pregnancy test asks about her options. The most appropriate counseling approach is to:

• AProvide non-directive options counseling — parenting, adoption, and (where legal) abortio…
• BDirect the patient toward parenting only
• CDirect the patient toward adoption only
• DRefuse to discuss abortion under any circumstance

Per the 2021 USPSTF recommendation on chlamydia screening in young women, the recommended approach for sexually active women aged ≤24 is:

• AAnnual screening with Grade B recommendation
• BScreening only if symptomatic
• COne-time lifetime screening
• DScreening only after age 25

A 17-year-old female with regular menses develops sudden severe lower abdominal pain. Pelvic ultrasound shows a large adnexal mass with absent Doppler flow. The most likely diagnosis and required management:

• AOvarian torsion — emergent surgical detorsion
• BPelvic inflammatory disease — IV antibiotics
• CEctopic pregnancy — methotrexate
• DOvarian cyst rupture — observation

What is the recommended STI partner therapy regimen for chlamydia?

• ADoxycycline 100 mg PO BID × 7 days (preferred per CDC 2021)
• BSingle-dose azithromycin 1 g for both partners
• CSingle-dose ceftriaxone IM
• DNo therapy needed

Per CDC 2021, the recommended treatment for uncomplicated urogenital gonorrhea in adolescents is:

• ACeftriaxone 500 mg IM single dose (1 g if weight ≥150 kg); add doxycycline if chlamydia n…
• BCefixime 400 mg PO single dose
• CAzithromycin 2 g PO single dose
• DCiprofloxacin 500 mg PO single dose

A 17-year-old female asks about Title X family planning services. Which of the following is true about Title X?

• ATitle X-funded clinics provide confidential family planning services to adolescents on a…
• BTitle X requires parental consent for any service to a minor
• CTitle X services are restricted to patients with private insurance
• DTitle X covers only abortion services

Hormonal contraception in transgender adolescent males (assigned female at birth) on testosterone is best counseled as:

• APregnancy is still possible — appropriate contraception is recommended for those with rep…
• BTestosterone is contraceptive, so no other contraception is needed
• CCombined estrogen pills are first-line in this population
• DPregnancy is impossible while on testosterone

A 16-year-old female is starting combined oral contraceptive pills. Which of the following requires routine pre-prescription evaluation per CDC USMEC?

• ABlood pressure measurement
• BPelvic exam
• CPap smear
• DMammography

A 14-year-old female has primary dysmenorrhea. NSAIDs are inadequate. The most appropriate next step per ACOG is:

• ACombined hormonal contraception (suppression of ovulation reduces dysmenorrhea)
• BOpioid analgesics
• CHysterectomy referral
• DAntidepressants

Per the modified PHQ-9 (PHQ-A) for adolescents, which score range indicates moderate depression warranting active treatment consideration?

• A10-14
• B0-4
• C5-9
• D20-27

USPSTF Grade B recommends routine depression screening in adolescents in which age range?

• A12-18 years
• B8-12 years
• C18-24 years
• D6-10 years

FDA-approved first-line pharmacologic agents for adolescent major depressive disorder include:

• AFluoxetine and escitalopram
• BParoxetine and venlafaxine
• CBupropion and mirtazapine
• DTricyclic antidepressants

The FDA Black Box warning regarding SSRIs and suicidality in young patients applies to which age group?

• APatients under age 25
• BPatients over age 65
• CAll age groups
• DPatients age 12-18 only

Which SSRIs are FDA-approved for pediatric obsessive-compulsive disorder?

• AFluvoxamine, sertraline, and fluoxetine
• BEscitalopram and citalopram
• CParoxetine only
• DBupropion and mirtazapine

The Columbia C-SSRS is used to:

• AAssess suicidal ideation severity and behavior
• BScreen for substance use
• CScreen for ADHD
• DScreen for autism spectrum disorder

A 15-year-old has restricted intake, BMI 15.5, denies the seriousness of low weight, and has not had menses for 6 months. Per DSM-5-TR, the most likely diagnosis is:

• AAnorexia nervosa, restricting type
• BBulimia nervosa
• CAvoidant/restrictive food intake disorder (ARFID)
• DBinge eating disorder

An adolescent with anorexia nervosa is admitted with weight 75% of expected, bradycardia 38 bpm, hypotension, and hypothermia. Which complication of feeding is the most concerning early in refeeding?

• ARefeeding syndrome with hypophosphatemia, hypokalemia, and hypomagnesemia
• BHyperkalemia
• CHypernatremic dehydration
• DHyperphosphatemia

A 14-year-old has recurrent binge eating with self-induced vomiting at least weekly for 3 months and overvaluation of weight/shape. BMI is 22. The most likely diagnosis is:

• ABulimia nervosa
• BAnorexia nervosa
• CARFID
• DBinge eating disorder

The Vanderbilt ADHD Diagnostic Rating Scale is unique among ADHD screens because it:

• AIncludes both parent and teacher rating forms required for diagnosis
• BIs administered to the child only
• CIs a single-form pediatrician questionnaire
• DReplaces the need for DSM criteria

A 12-year-old with ADHD requires medication. Per AAP 2019 ADHD guidelines, first-line pharmacotherapy in school-age children and adolescents is:

• AFDA-approved stimulant (methylphenidate or amphetamine class)
• BAtomoxetine
• CGuanfacine extended release
• DBupropion