PNCB PMHS Pediatric Primary Care Mental Health Specialist

At what well-child visit ages does the AAP recommend universal autism-specific screening using the M-CHAT-R/F?

• A9 and 18 months
• B18 and 24 months
• C24 and 30 months
• D12 and 18 months

A parent of a 4-month-old asks how to foster secure attachment. Which response BEST reflects evidence-based anticipatory guidance?

• ALet the infant cry it out so they learn independence early.
• BRespond consistently and warmly to the infant's cues.
• CHold the baby only at scheduled feeding times to prevent spoiling.
• DLimit eye contact so the infant becomes self-soothing.

Which screening tool is BEST suited for universal psychosocial screening of school-age children in pediatric primary care?

• AVanderbilt ADHD Diagnostic Rating Scale
• BPediatric Symptom Checklist (PSC-17 or PSC-35)
• CColumbia Suicide Severity Rating Scale (C-SSRS)
• DM-CHAT-R/F

The PHQ-9 Modified for Adolescents (PHQ-A) is recommended by USPSTF and AAP for universal depression screening starting at what age?

• AAge 8
• BAge 10
• CAge 12
• DAge 16

Which best describes the role of temperament in anticipatory guidance?

• ATemperament should be modified by parents to fit family preferences.
• BTemperament is a stable individual difference that shapes goodness-of-fit between child a…
• CTemperament refers to a child's intelligence quotient.
• DTemperament is identical across siblings raised in the same home.

A parent reports that their 7-year-old has frequent meltdowns over transitions. Which evidence-based parenting strategy should the PMHS first recommend?

• ASpanking when the meltdown begins
• BPredictable routines with advance warnings before transitions
• CWithholding meals as a consequence
• DLengthy lectures during the meltdown

An adolescent with no known mental health concerns presents for an annual visit. Which screening battery is MOST consistent with Bright Futures recommendations?

• APHQ-A and CRAFFT
• BM-CHAT-R/F and ASQ-SE
• CVanderbilt and SCARED
• DC-SSRS only, with no other screening

Which is the BEST example of psychoeducation about social determinants of health?

• ATelling a family that mental illness is purely genetic
• BDiscussing how housing instability and food insecurity influence a child's behavioral hea…
• CRecommending that all families purchase organic food
• DAvoiding any discussion of finances or housing in primary care

Which AAP recommendation BEST supports healthy media use for a 3-year-old?

• AUnlimited screen time as long as content is educational
• BNo screens at all until age 6
• CLimit non-educational screen use to about 1 hour per day of high-quality programming, co-…
• DAllow background TV during all meals

A teen reports being bullied at school and online. Which initial response is MOST therapeutic?

• ATell the teen to ignore the bullies and they will stop.
• BValidate the teen's experience, screen for safety/depression/suicidality, and collaborate…
• CRecommend the teen retaliate online.
• DReassure the teen that bullying does not have lasting effects.

The Ages & Stages Questionnaire (ASQ-3) is BEST described as a:

• ADiagnostic instrument for autism
• BParent-completed developmental screening tool used at well-child visits
• CProvider-administered cognitive test
• DSuicide risk assessment for adolescents

Which is the MOST appropriate guidance for sleep hygiene in a 10-year-old with difficulty falling asleep?

• AAllow phone use in bed to help relax
• BKeep bedtime variable to match the child's energy level
• CMaintain a consistent bedtime routine and remove screens from the bedroom
• DGive caffeine in the afternoon to reduce evening alertness

What is the PRIMARY purpose of developmental surveillance at every well-child visit?

• ATo replace formal developmental screening
• BTo longitudinally observe development and identify concerns that warrant a formal screen
• CTo diagnose specific developmental disorders
• DTo bill for additional services

Which CRAFFT screening result indicates the need for further substance use assessment in an adolescent?

• AScore of 0
• BScore of 1 or below
• CScore of 2 or higher
• DAny 'no' response

Which is the BEST example of fostering resilience in a child exposed to adversity?

• ATelling the child to 'just be tough'
• BPromoting at least one stable, supportive caregiver relationship and predictable routines
• CAvoiding all discussion of the adverse event
• DEncouraging avoidance of school

Which item BEST demonstrates the use of the HEEADSSS interview in adolescent care?

• AMeasuring head circumference
• BAsking systematically about Home, Education, Eating, Activities, Drugs, Sexuality, Suicid…
• CPerforming a head and neck physical exam
• DScreening only for eating disorders

Which statement about the ACE (Adverse Childhood Experiences) Questionnaire is MOST accurate?

• AA high ACE score is diagnostic of PTSD.
• BHigher ACE scores are associated with greater risk of behavioral, mental, and physical he…
• CACE scores predict exact future medical diagnoses.
• DACE scores should never be discussed with families.

Which is the MOST appropriate way to introduce universal mental health screening to a family?

• AScreen only families who appear distressed.
• BExplain that screening is a routine part of care for all children to support overall heal…
• CApologize for needing to screen.
• DTell the family screening is required by law and offer no rationale.

A 16-year-old girl reports recent dieting and exercise. Which question BEST screens for an eating disorder?

• A'Have you ever tried to lose weight?'
• BUse of validated SCOFF questions about self-induced vomiting, control over eating, weight…
• C'You look healthy—any concerns?'
• D'Just eat more—do you?'

When using the SCARED to evaluate anxiety in a 10-year-old, which statement is MOST accurate?

• AOnly the child version should be used.
• BBoth child self-report and parent-report SCARED versions should be administered and compa…
• CParents should never complete the SCARED.
• DSCARED replaces the need for clinical interview.

The Vanderbilt Assessment Scale is BEST described as a:

• AUniversal psychosocial screen for all ages
• BRisk-related ADHD diagnostic and monitoring rating scale completed by parents and teachers
• CSuicide risk assessment
• DAutism screen

Which is a key principle of trauma-informed primary care?

• AAvoid asking about trauma to prevent re-traumatization.
• BRealize widespread impact of trauma, recognize signs, respond appropriately, and resist r…
• CRequire detailed trauma narratives at every visit.
• DTreat all behavior problems as pure misbehavior.

What is the BEST anticipatory guidance for a parent worried about an LGBTQ+ adolescent?

• AEncourage the parent to discourage identity exploration.
• BAffirm the youth's identity, screen for depression and suicidality, and connect with supp…
• CRefer to conversion therapy.
• DRecommend complete confidentiality from the parent without rationale.

An 8-year-old child has a sibling recently diagnosed with leukemia. Which intervention BEST supports the child's mental health?

• AAvoid discussing the illness with the child.
• BProvide age-appropriate explanation, validate feelings, maintain routines, and monitor fo…
• CTell the child to be strong for the family.
• DSend the child to live with relatives indefinitely.

Which is the MOST appropriate use of the Pediatric Symptom Checklist - Youth Self-Report (PSC-Y)?

• AUniversal screening for adolescents able to self-report (typically age 11+)
• BDiagnosing autism spectrum disorder
• CReplacing the PHQ-A in adolescents
• DUsed only when parents refuse to complete a screen

When obtaining a developmental and behavioral history, which interview technique BEST elicits the caregiver's primary concern?

• AClosed yes/no questions only
• BOpen-ended questions such as 'Tell me what brings you in today and what worries you most.'
• CReading from a checklist without engagement
• DSpeaking primarily to the child and ignoring the caregiver

Why is a multigenerational family history particularly important in pediatric mental health evaluation?

• AIt is required for billing.
• BMany psychiatric and developmental disorders have heritable components, and family histor…
• CIt replaces the need for screening tools.
• DIt only matters for autism.

A 9-year-old presents with new-onset behavioral changes after a family move. Which environmental factor MOST warrants exploration?

• AFavorite food preferences
• BRecent stressors, school transition, social supports, and exposure to violence or instabi…
• CType of family pet
• DColor of the child's bedroom

Which laboratory work-up is MOST appropriate as part of an initial evaluation for a 15-year-old with new-onset depressive symptoms and fatigue?

• ANo labs are ever indicated.
• BTSH, CBC, and consider other targeted labs (vitamin D, B12) based on history.
• CComplete genetic panel for all known psychiatric variants.
• DLumbar puncture in all cases.

A child diagnosed with ADHD has had Vanderbilt scales completed by parents only. What is the MOST appropriate next step before initiating stimulant medication?

• ABegin medication immediately.
• BObtain teacher Vanderbilt and review impairment across at least two settings.
• COrder an EEG.
• DRefer to neurosurgery.

Which physical exam observation is MOST relevant during evaluation of a child with possible autism spectrum disorder?

• ACardiac auscultation only
• BObservation of social reciprocity, eye contact, joint attention, repetitive behaviors, an…
• CReflex testing only
• DSkin turgor only

Which factor is MOST important to assess regarding cultural and linguistic context in pediatric mental health evaluation?

• AFamily's preferred language and cultural beliefs about behavior, emotion, and help-seekin…
• BThe child's favorite holiday only.
• CWhether the family speaks English at home.
• DFamily's national origin documented in chart only.

What is the MOST appropriate use of school records in evaluating a child with possible learning disorder?

• AAvoid reviewing them to remain unbiased.
• BObtain report cards, prior testing, and any IEP/504 documentation as collateral data.
• CUse them to override parental concerns.
• DRely solely on the child's verbal report.

Which question BEST screens for trauma exposure in a school-age child during a primary-care visit?

• A'Have anything scary or upsetting happened to you or your family that you can tell me abo…
• B'You haven't been abused, right?'
• C'Are you traumatized?'
• DAvoid any direct trauma questions.

When evaluating an adolescent for a possible eating disorder, which physical finding is MOST concerning?

• AMild fatigue only
• BBradycardia, orthostatic hypotension, hypothermia, or significant weight loss
• COccasional acne
• DNormal vital signs

Which observation during a parent-child interaction is MOST suggestive of a problematic attachment pattern in a 2-year-old?

• AChild intermittently checks back with parent during play.
• BChild shows minimal distress at separation, indifference at reunion, and avoids the paren…
• CChild seeks parent for comfort when hurt.
• DChild engages in joint play with parent.

A 4-year-old has not yet combined two-word phrases. Which is the MOST appropriate next step?

• AReassure parents and re-evaluate at age 6.
• BRefer for audiologic evaluation and speech-language assessment.
• CBegin stimulant medication.
• DRecommend more screen time for language exposure.

Why is observing the child in multiple states (e.g., during play, with caregiver, alone) important during evaluation?

• ATo prolong the visit for billing.
• BBecause behavior, attention, and social engagement vary by context and inform diagnosis a…
• CBecause parents prefer longer visits.
• DTo compare the child to others in the waiting room.

When evaluating a child with possible developmental delay, what is the MOST appropriate first-line laboratory or imaging study?

• AMRI of the brain in all cases
• BTargeted work-up based on history and exam (e.g., chromosomal microarray, fragile X, lead…
• CToxicology screen routinely
• DPET scan

Which is the BEST way to incorporate the caregiver's perception of the concern into evaluation?

• AOverride parent concerns with screening data.
• BDocument parent concerns explicitly and integrate them with screening, observation, and h…
• CDocument parent concerns only if confirmed by screening.
• DIgnore parent concerns when child appears 'fine.'

Which is the MOST important reason to assess for somatic symptoms in a child with anxiety?

• AAnxiety in children frequently presents with stomachaches, headaches, and other somatic c…
• BSomatic symptoms always indicate medical illness only.
• CSomatic symptoms are unrelated to mental health.
• DSomatic symptoms cannot be assessed in children.

Which assessment tool is MOST appropriate to evaluate functional impairment from ADHD across home and school?

• APHQ-9 only
• BVanderbilt parent and teacher rating scales
• CM-CHAT-R/F
• DSCOFF

Which is a key consideration when interpreting screening tools across diverse populations?

• ACultural and linguistic validity, including normative samples for the population.
• BCutoff scores are universal and require no adaptation.
• CScreening tools never need translation.
• DAll screening tools work identically across all groups.

When evaluating a child for possible OCD, which of the following BEST distinguishes obsessions from typical worries?

• AObsessions are unwanted, intrusive, and cause significant distress; the child often perfo…
• BObsessions are normal childhood interests.
• CObsessions only occur after age 18.
• DObsessions are voluntary thoughts the child enjoys.

Which is the MOST appropriate first step when a parent reports new-onset enuresis in an 8-year-old who was previously toilet-trained?

• ABegin desmopressin immediately.
• BEvaluate for medical causes (UTI, constipation, diabetes), psychosocial stressors, and sl…
• CPunish the child for the accidents.
• DLimit all daytime fluids dramatically.

Which is the BEST description of how to integrate teacher input in evaluating a child for ADHD?

• AUse only parent reports to avoid teacher bias.
• BUse validated teacher rating scales and direct communication (with consent) to capture cr…
• CAvoid contacting schools.
• DSend evaluations to the teacher without parental consent.

Which is MOST appropriate to assess in a comprehensive substance use evaluation for an adolescent?

• AType, frequency, route, age of first use, context, consequences, and readiness to change.
• BSubstance type only.
• CWhether parents approve of substance use.
• DUrine drug screen alone.