100+ Free ABFM Adolescent Medicine Practice Questions

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Question 1

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A 12-year-old girl presents with breast budding and sparse pubic hair. Tanner staging reveals breast Tanner 2 and pubic hair Tanner 2. What is the approximate expected time to menarche?

0-6 months

1-2 years (peak height velocity precedes menarche by ~6 months)

4-5 years

Menarche should have already occurred

to track

2026 Statistics

Key Facts: ABFM Adolescent Medicine Exam

~200

Exam Questions

ABFM/ABIM/ABP 2026

~7 hours

Exam Duration (one-day)

ABFM/ABIM/ABP 2026

Even years

Exam Frequency (next 2026)

ABFM 2026

24+ months

ACGME Fellowship Required

ACGME/ABFM

3 boards

Joint ABFM/ABIM/ABP

ABMS 2026

~$1,800-$2,200

Application/Exam Fee

ABFM/ABIM/ABP 2026

The Adolescent Medicine CAQ certifies subspecialty expertise for ABFM/ABIM/ABP diplomates who have completed a minimum of 24 months of ACGME-accredited Adolescent Medicine fellowship training. It is offered as a one-day exam in even-numbered years (next in 2026), with approximately 200 multiple-choice items delivered over ~7 hours at Pearson VUE centers. High-yield content includes Tanner staging and precocious/delayed puberty workup, PCOS Rotterdam criteria, LARC-first contraception (etonogestrel implant, LNG-IUD, Cu-IUD) per ACOG/AAP 2023, ACOG/CDC STI screening (HIV opt-out 13-64, annual GC/CT <25, extragenital MSM), HPV 9-valent (default 11-12), HIV PrEP (≥35 kg), SAHM medical admission criteria for eating disorders, CRAFFT 2.1 screening, SSRI first-line for adolescent MDD, Columbia C-SSRS, WPATH SOC 8 gender-affirming care (GnRH agonist puberty blockers), AHA 14-element preparticipation screening, concussion graded return-to-play, isotretinoin/iPLEDGE, SCFE urgency, MenACWY 11-12 + booster 16, HEADSSS interview, and semaglutide 2022 approval for adolescents ≥12 years.

Sample ABFM Adolescent Medicine Practice Questions

Try these sample questions to test your ABFM Adolescent Medicine exam readiness. Each question includes a detailed explanation. Start the interactive quiz above for the full 100+ question experience with AI tutoring.

1A 12-year-old girl presents with breast budding and sparse pubic hair. Tanner staging reveals breast Tanner 2 and pubic hair Tanner 2. What is the approximate expected time to menarche?

A.0-6 months

B.1-2 years (peak height velocity precedes menarche by ~6 months)

C.4-5 years

D.Menarche should have already occurred

Explanation: Menarche typically occurs approximately 2-2.5 years after the onset of breast development (thelarche, Tanner 2) and follows peak height velocity by about 6 months. A girl with breast Tanner 2 is early in puberty, with menarche expected approximately 1-2 years later (most commonly during Tanner 3-4 stages). Average age of menarche in the U.S. is 12.5 years. Menarche before age 8 is precocious and after age 15 is primary amenorrhea.

2A 6-year-old girl presents with breast development and pubic hair. She has no other findings on exam. What is the next best step in workup?

A.Reassurance and observe

B.Bone age radiograph (left hand/wrist), LH/FSH, estradiol

C.Immediate MRI brain

D.Start GnRH agonist therapy

Explanation: Precocious puberty in girls is defined as secondary sexual characteristics before age 8 (or age 7 in Black girls per some guidelines). Initial workup includes bone age (advanced bone age suggests central precocious puberty), basal LH/FSH (elevated LH suggests central), and estradiol. GnRH stimulation test confirms central vs peripheral. MRI brain is obtained if central precocious puberty is confirmed, particularly in girls <6 or boys, to exclude CNS lesions. GnRH agonist (leuprolide) is treatment, not first step.

3A 14-year-old boy has no testicular enlargement. What defines delayed puberty in boys?

A.No testicular enlargement by age 12

B.No testicular enlargement (≥4 mL or ≥2.5 cm) by age 14

C.No testicular enlargement by age 16

D.No pubic hair by age 15

Explanation: Delayed puberty in boys is defined as the absence of testicular enlargement (testicular volume ≥4 mL or length ≥2.5 cm) by age 14. In girls, delayed puberty is defined as no breast development by age 13. Constitutional delay of growth and puberty is the most common cause in boys (often familial). Workup includes LH/FSH, testosterone, bone age, and evaluation for hypogonadotropic vs hypergonadotropic causes. Testosterone priming may be used therapeutically.

4A 14-year-old boy presents with bilateral tender breast tissue. Examination reveals firm, symmetric subareolar tissue approximately 2 cm bilaterally. He is Tanner 3 for genitalia and pubic hair. What is the most likely diagnosis?

A.Klinefelter syndrome

B.Pubertal (physiologic) gynecomastia

C.Testicular tumor

D.Prolactinoma

Explanation: Pubertal gynecomastia is common (up to 65% of adolescent boys) and typically presents during Tanner 3-4 with bilateral, tender, subareolar breast tissue. It results from a transient imbalance between estrogen and androgen activity and usually resolves within 6-24 months. Pathologic gynecomastia is suggested by: onset outside Tanner 3-4, unilateral/asymmetric, >4 cm, persistence >2 years, or associated findings (small testes suggest Klinefelter 47,XXY, testicular mass suggests tumor with hCG/estrogen). Drug causes include spironolactone, ketoconazole, cimetidine, cannabis, and anabolic steroids.

5A 15-year-old girl has never had menses. She has normal breast development (Tanner 5) and pubic hair (Tanner 5), and is sexually mature. What defines primary amenorrhea in her case?

A.No menarche by age 13 regardless of secondary sex characteristics

B.No menarche by age 15 with normal secondary sex characteristics, or by age 13 without

C.No menarche by age 18

D.Missing any 3 consecutive periods

Explanation: Primary amenorrhea is defined as absence of menarche by age 15 with normal secondary sexual characteristics, or by age 13 without secondary sexual characteristics. In a girl with normal pubertal development at age 15 who has never menstruated, workup should include pregnancy test, pelvic ultrasound (look for Müllerian anomalies such as Müllerian agenesis/MRKH or imperforate hymen), FSH, TSH, prolactin, and karyotype if indicated. Differential includes anatomic causes, androgen insensitivity, and outflow obstruction.

6A 17-year-old sexually active girl has not had her period in 4 months. She previously had regular cycles. What is the first test to order?

A.FSH and LH

B.Thyroid-stimulating hormone

C.Urine or serum hCG (pregnancy test)

D.Pelvic ultrasound

Explanation: Pregnancy is the most common cause of secondary amenorrhea and must always be excluded first with a urine or serum hCG, regardless of reported contraceptive use or sexual history. Other causes to work up after pregnancy is excluded: hypothalamic amenorrhea (stress, exercise, weight loss, eating disorder), PCOS, hyperprolactinemia, thyroid dysfunction, and premature ovarian insufficiency. The basic workup after negative pregnancy test is TSH, prolactin, FSH, and estradiol, with a progesterone challenge to assess estrogen status and outflow tract.

7A 16-year-old girl with irregular periods, acne, and hirsutism is diagnosed with PCOS. Which Rotterdam criterion combination supports the diagnosis?

A.Any one of: oligo/anovulation, hyperandrogenism, or polycystic ovaries

B.At least two of: oligo/anovulation, clinical/biochemical hyperandrogenism, polycystic ovaries on ultrasound, after exclusion of other causes

C.All three Rotterdam criteria must be met

D.Elevated testosterone alone

Explanation: The Rotterdam criteria (2003) for PCOS require at least 2 of 3: (1) oligo-ovulation or anovulation (irregular menses), (2) clinical or biochemical hyperandrogenism (hirsutism, acne, elevated free testosterone), (3) polycystic ovaries on ultrasound (≥12 follicles or ovarian volume >10 mL). Other causes must be excluded (thyroid disease, hyperprolactinemia, CAH, Cushing). Note: in adolescents within 8 years of menarche, ultrasound criteria are unreliable due to normal multi-follicular ovaries, so the International Consortium recommends only persistent oligomenorrhea + hyperandrogenism for adolescent diagnosis. First-line treatment is lifestyle plus combined OCPs and/or metformin.

8A 15-year-old girl presents with severe dysmenorrhea interfering with school attendance. What is the first-line therapy?

A.Combined oral contraceptives

B.NSAIDs (e.g., ibuprofen or naproxen) scheduled starting 1-2 days before menses

C.Laparoscopy to rule out endometriosis

D.GnRH agonist

Explanation: NSAIDs are first-line for primary dysmenorrhea, reducing prostaglandin production. They should be started 1-2 days before expected menses and continued through the first few days for maximum effect. If NSAIDs fail, combined hormonal contraception (continuous or cyclic) is the next step. Persistent dysmenorrhea despite NSAIDs and hormonal therapy (especially with other findings like dyspareunia, infertility, or persistent pain) should prompt evaluation for endometriosis, often with laparoscopy. Endometriosis is common in adolescents with chronic pelvic pain.

9A 14-year-old girl presents with heavy menstrual bleeding since menarche (soaking through pads every 1-2 hours, passing large clots). What is the most important workup consideration?

A.Endometrial biopsy

B.Evaluate for a bleeding disorder (von Willebrand disease testing)

C.CT scan of pelvis

D.Reassurance — heavy bleeding is always normal in adolescents

Explanation: Heavy menstrual bleeding from menarche in an adolescent raises concern for a bleeding disorder, most commonly von Willebrand disease (vWD), which affects approximately 1% of the population and up to 10-20% of adolescents presenting with heavy menstrual bleeding. Workup should include CBC, ferritin, PT/PTT, and vWD screening (vWF antigen, ristocetin cofactor activity, factor VIII). Platelet function testing and thyroid studies may also be indicated. ACOG recommends screening for bleeding disorders in adolescents with severe menorrhagia, especially those requiring hospitalization or transfusion.

10According to ACOG and AAP 2023 guidance, which contraceptive methods are first-line (Tier 1) for adolescents?

A.Combined oral contraceptive pills

B.Long-acting reversible contraception (LARC) — etonogestrel implant, LNG-IUD, Cu-IUD

C.Depot medroxyprogesterone (DMPA)

D.Condoms alone

Explanation: ACOG and the AAP both recommend LARC methods — the etonogestrel implant (99.95% efficacy), levonorgestrel IUDs (99.8%), and copper IUD (99.2%) — as first-line contraception for adolescents. LARC methods have typical-use failure rates equal to perfect-use rates because they require no user action after placement. Second-tier methods are DMPA (94% typical use) and combined hormonal contraception (patch, ring, pill, ~91% typical use). Condoms should always be recommended in addition to LARC for STI prevention (dual-method use).

About the ABFM Adolescent Medicine Exam

The Adolescent Medicine subspecialty certification (Certificate of Added Qualifications, or CAQ) is the ABMS-recognized board examination for family physicians, internists, and pediatricians who have completed an ACGME-accredited Adolescent Medicine fellowship. Delivered as a one-day computer-based exam, the CAQ covers the full breadth of adolescent health — puberty and growth, menstrual disorders, contraception (LARC-first per ACOG/AAP), STI/HIV screening and PrEP, eating disorders with SAHM admission criteria, substance use (SBIRT/CRAFFT), mental health (PHQ-9, C-SSRS, gender-affirming care per WPATH SOC 8), sports medicine, acne and common dermatology, musculoskeletal conditions, immunizations (MenACWY/MenB, HPV), confidentiality and minor consent, LGBTQ+ affirming care, and obesity management including adolescent GLP-1 approvals.

Questions

200 scored questions

Time Limit

Approximately 7 hours (one-day computer-based exam)

Passing Score

Criterion-referenced scaled passing score (not publicly disclosed)

Exam Fee

Approximately $1,800-$2,200 — confirm on theabfm.org, abim.org, or abp.org at time of registration (American Board of Family Medicine (ABFM) in conjunction with the American Boards of Internal Medicine (ABIM) and Pediatrics (ABP))

ABFM Adolescent Medicine Exam Content Outline

12%

Mental Health

PHQ-9 adolescent modified, Columbia C-SSRS suicide risk, SSRI first-line (fluoxetine/escitalopram), ADHD DSM-5 (5 symptoms if 17+), NSSI, gender dysphoria and WPATH SOC 8 (GnRH agonist puberty blockers reversible, partially reversible hormones)

10%

Puberty, Growth & Development

Tanner staging (SMR 1-5), precocious puberty workup (bone age, LH/FSH, GnRH stim), delayed puberty, growth velocity, pubertal vs pathologic gynecomastia (Klinefelter, tumor, drugs)

10%

Menstrual & Reproductive Health

Dysmenorrhea/endometriosis, primary amenorrhea (no menarche by 15 with 2° sex char or by 13 without), secondary amenorrhea workup, PCOS Rotterdam (2 of 3), heavy menstrual bleeding and vWD workup

10%

Contraception & Pregnancy

ACOG/AAP 2023 — LARC first-line (implant, LNG/Cu-IUD), combined OCP contraindications (smoker ≥35, migraine with aura), DMPA counseling, EC hierarchy (ulipristal > LNG > Cu-IUD), teen pregnancy counseling

10%

STI & HIV

HIV routine opt-out 13-64, annual GC/CT <25 females, extragenital pharyngeal/rectal MSM, syphilis staging and doxy-PEP, HPV 9-valent default 11-12, HIV PrEP in adolescents ≥35 kg (TDF/FTC or cabotegravir IM)

10%

Eating Disorders

DSM-5 AN/BN/ARFID/BED, medical complications (hypokalemia, QTc, refeeding — phosphate/Mg/K/thiamine), SAHM admission criteria (HR<50, orthostasis, <75% mBMI), family-based therapy, olanzapine/fluoxetine

Substance Use

SBIRT, CRAFFT 2.1 (2+ positive), EVALI (vitamin E acetate THC), cannabis use disorder, buprenorphine for adolescents (X-waiver removed 2023 MAT Act), naloxone, nicotine NRT/varenicline

Sports Medicine

AHA 14-element preparticipation, HCM, concussion SCAT6 graded 6-step RTP (24-48 hr rest then progressive), second-impact syndrome, female athlete triad/REDS (low EA, menstrual dysfunction, low BMD)

Immunizations & Preventive Care

MenACWY 11-12 + booster 16, MenB 16-23 shared CDM, HPV 9-valent 11-12, Tdap 11-12, annual flu, Bright Futures adolescent well visits

Dermatology (Acne)

Mild — topical retinoid + BPO; moderate — add doxycycline 3 mo + BPO; severe — isotretinoin with iPLEDGE (monthly pregnancy tests, 2 contraception methods), lipid/LFT monitoring

Musculoskeletal

Adolescent idiopathic scoliosis (Adams, Cobb, bracing 25-40°), SCFE (obese male 10-16, groin/knee pain — urgent ortho), Osgood-Schlatter, stress fractures, spondylolysis

Confidentiality & Consent

Minor consent by state (contraception, STI, mental health, substance use), Title X, HIPAA minor portals, mandatory reporting, HEADSSS interview

LGBTQ+ Adolescent Health

Higher depression/anxiety/suicide/substance use rates, affirming care (pronouns), HIV PrEP in MSM adolescents, WPATH SOC 8 gender-affirming care

How to Pass the ABFM Adolescent Medicine Exam

What You Need to Know

Passing score: Criterion-referenced scaled passing score (not publicly disclosed)
Exam length: 200 questions
Time limit: Approximately 7 hours (one-day computer-based exam)
Exam fee: Approximately $1,800-$2,200 — confirm on theabfm.org, abim.org, or abp.org at time of registration

Keys to Passing

Complete 500+ practice questions
Score 80%+ consistently before scheduling
Focus on highest-weighted sections
Use our AI tutor for tough concepts

ABFM Adolescent Medicine Study Tips from Top Performers

1Memorize adolescent contraception tiers cold: LARC first-line per ACOG/AAP 2023 (etonogestrel implant 99.95%, LNG-IUD 99.8%, Cu-IUD 99.2%), then DMPA (94%), then combined methods (OCP/patch/ring ~91%); absolute COC contraindications include smoker ≥35, migraine with aura, known VTE, active breast cancer, and <21 days postpartum

2Know STI screening guidelines precisely: universal opt-out HIV 13-64, annual GC/CT for sexually active females <25, extragenital pharyngeal/rectal testing for MSM or behavioral risks, syphilis in MSM/pregnant/at-risk, HPV 9-valent default at 11-12 (can start at 9), and HIV PrEP for adolescents ≥35 kg using tenofovir-emtricitabine PO or cabotegravir IM

3Master SAHM medical admission criteria for eating disorders: HR <50 bpm awake or <45 asleep, BP <90/45, orthostatic HR ↑20 or BP ↓20/10, temp <35.6°C, <75% median BMI, rapid weight loss, syncope, arrhythmia, electrolyte disturbance, or failure of outpatient treatment; watch for refeeding syndrome (hypophosphatemia, hypomagnesemia, hypokalemia, thiamine deficiency) in first week

4Memorize the CRAFFT 2.1 mnemonic for adolescent substance use: Car, Relax, Alone, Forget, Family/Friends, Trouble — 2+ positive warrants further assessment; pair with PHQ-9 for depression (adolescent-modified, cutoff ≥10 for moderate MDD) and Columbia C-SSRS for suicide risk; first-line SSRIs approved for adolescent MDD are fluoxetine (age 8+) and escitalopram (age 12+)

5Know acne stepwise therapy: mild — topical retinoid + BPO; moderate — add oral doxycycline (limit 3 months + BPO to prevent resistance); severe nodulocystic — isotretinoin with iPLEDGE (monthly pregnancy tests, two concurrent contraception methods, lipid/LFT monitoring, counsel about mood/IBD risk); SCFE is an urgent referral — obese adolescent male 10-16 with groin/knee pain and limp needs immediate non-weight-bearing status and ortho evaluation

Frequently Asked Questions

Who is eligible for the Adolescent Medicine CAQ?

Candidates must hold active primary certification from ABFM (Family Medicine), ABIM (Internal Medicine), or ABP (Pediatrics) and maintain it continuously. In addition, candidates must have completed a minimum of 24 months of full-time training in an ACGME-accredited Adolescent Medicine fellowship (most fellowships are 2-3 years). Candidates must hold a valid, full, and unrestricted U.S. or Canadian medical license.

How is the Adolescent Medicine CAQ exam structured?

The CAQ is a one-day computer-based exam delivered at Pearson VUE testing centers. It consists of approximately 200 multiple-choice items and runs about 7 hours including breaks. The blueprint spans adolescent growth and development, reproductive health, mental health, substance use, eating disorders, sports medicine, dermatology, musculoskeletal, immunizations, and psychosocial domains including confidentiality, LGBTQ+ care, and obesity management.

When is the 2026 Adolescent Medicine CAQ exam?

The Adolescent Medicine subspecialty CAQ is offered in even-numbered years. The 2026 exam window is typically in the fall. Exact dates, application windows, and deadlines are posted by the primary certifying boards (ABFM, ABIM, ABP) on their individual websites. Candidates should apply through the board that issued their primary certification.

What is the passing score for the Adolescent Medicine CAQ?

The CAQ uses a criterion-referenced scaled passing score set through standard-setting methodology. The passing score is not publicly disclosed as a percentage. Candidates receive a pass/fail notification and, if unsuccessful, a detailed performance report by content domain to guide remediation for a future attempt.

How much does the Adolescent Medicine CAQ cost?

The application/exam fee for the Adolescent Medicine CAQ is approximately $1,800-$2,200, in line with other ABMS subspecialty CAQs. The exact fee varies slightly by primary board (ABFM, ABIM, ABP). Candidates should confirm the current fee on their primary board portal when registering. Continuing certification requires annual CAQ maintenance fees in addition to the initial exam fee.

What high-yield topics dominate the Adolescent Medicine CAQ?

Highest-yield topics include Tanner staging and precocious/delayed puberty workup, PCOS Rotterdam criteria, LARC-first contraception counseling per ACOG/AAP 2023, STI screening guidelines (HIV opt-out 13+, annual GC/CT <25, extragenital MSM, HPV 9-valent, HIV PrEP in adolescents), eating disorder medical admission criteria per SAHM, PHQ-9/C-SSRS and SSRI use in adolescent MDD, gender-affirming care per WPATH SOC 8, CRAFFT substance screening, preparticipation 14-element screening, concussion return-to-play, isotretinoin/iPLEDGE, SCFE, HEADSSS interviewing, and adolescent obesity management including semaglutide (FDA-approved ≥12 years in 2022).

How long should I study for the Adolescent Medicine CAQ?

Most candidates study 150 to 250 hours over 4-6 months during or after fellowship. A typical study stack includes the AAP SAM (Adolescent Medicine) review, SAHM resources and annual meetings, Neinstein's Adolescent and Young Adult Health Care textbook, ACOG/AAP contraception guidance, WPATH SOC 8, and a board-level question bank. Clinical fellowship exposure is the single strongest predictor of first-attempt pass.

How do I maintain Adolescent Medicine CAQ certification?

Continuing certification is via longitudinal assessment through the primary board — ABFM Longitudinal Assessment for family physicians, ABIM Longitudinal Knowledge Assessment for internists, or MOCA-Peds for pediatricians. Diplomates must maintain primary board certification, meet CME requirements, and pay annual CAQ maintenance fees. The traditional high-stakes 10-year MOC exam has been replaced by longitudinal assessment at all three boards.