100+ Free ABIM Adolescent Practice Questions

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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?

Reassure that this is normal pubertal progression and menarche typically occurs 2-3 years after thelarche

Order LH, FSH, and pelvic ultrasound for primary amenorrhea workup

Refer to pediatric endocrinology for delayed puberty

Begin a progestin challenge

to track

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2026 Statistics

Key Facts: ABIM Adolescent Exam

~100

Total MCQs (Initial Certification)

ABIM Adolescent Medicine Exam Information

8.5 hr

Total CBT Exam Day

ABIM Adolescent Medicine Exam Information

~$2,840

Initial Certification Fee

ABIM Fees 2026

3 yr

ACGME Adolescent Medicine Fellowship

ACGME Program Requirements

~30/qtr

LKA Questions per Quarter

ABIM LKA page

Tanner 1-5

Sexual Maturity Rating Stages

ABIM Adolescent Medicine Blueprint

The ABIM Adolescent Medicine subspecialty certification is the ABIM-issued board exam for internists who have completed at least 36 months of an ACGME-accredited Adolescent Medicine fellowship after attaining ABIM Internal Medicine certification. The exam is co-sponsored with the American Board of Pediatrics (ABP) and the American Board of Family Medicine (ABFM), and a single shared blueprint covers all three sponsoring boards. The 2026 ABIM application fee is approximately $2,840, and the 8.5-hour computer-based exam is delivered at Pearson VUE Professional Centers. Content domains include Normal Adolescent Development with Sexual Maturity Rating Tanner 1-5 (~15%), Reproductive Health (~20%) with USMEC-guided contraception emphasizing LARC first-line for adolescents and CDC 2021 STI screening, Mental Health (~20%) anchored by PHQ-9 modified for adolescents and the FDA SSRI Black Box warning for patients under 25, Substance Use & Behavioral Risks (~10%) using CRAFFT and SBIRT, Chronic Illness Transition (~10%) via Got Transition Six Core Elements, Confidentiality & Consent Law (~10%) including Mature Minor Doctrine and Title X, LGBTQ+ Adolescent Health & Gender-Affirming Care (~10%) per WPATH SOC 8 (2022), and adolescent Acute Care (~5%) covering pre-participation physicals, concussion return-to-learn/play, dysmenorrhea, and acne. Diplomates maintain certification on a continuous 10-year cycle through the Longitudinal Knowledge Assessment (LKA) — ~30 open-book questions per quarter over 5 years — or the traditional 10-year MOC exam.

Sample ABIM Adolescent Practice Questions

Try these sample questions to test your ABIM Adolescent 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 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?

A.Reassure that this is normal pubertal progression and menarche typically occurs 2-3 years after thelarche

B.Order LH, FSH, and pelvic ultrasound for primary amenorrhea workup

C.Refer to pediatric endocrinology for delayed puberty

D.Begin a progestin challenge

Explanation: Thelarche (breast bud development) is typically the first sign of female puberty, occurring at ages 8-13. Menarche follows approximately 2-3 years after thelarche, on average between ages 10 and 15. Primary amenorrhea workup is not warranted until age 15 with no menses, or age 13 with no thelarche.

2In adolescent female pubertal development, peak height velocity occurs at approximately which Sexual Maturity Rating (SMR) stage?

A.Tanner 2-3

B.Tanner 1

C.Tanner 4-5

D.After menarche

Explanation: In girls, peak height velocity occurs early in puberty around Tanner SMR 2-3, typically before menarche. After menarche, girls usually grow only an additional 5-7 cm. In boys, by contrast, peak height velocity occurs later, around Tanner SMR 3-4.

3A 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?

A.Initiate workup for delayed puberty

B.Reassure and reassess in 1 year

C.Begin testosterone therapy empirically

D.No further action — puberty in boys is variable until age 16

Explanation: Delayed puberty in boys is defined as no testicular enlargement (testicular volume <4 mL) by age 14. This patient meets criteria and warrants evaluation including LH, FSH, testosterone, prolactin, TSH, and bone age. The most common cause is constitutional delay of growth and puberty (CDGP), but pathologic causes (Klinefelter, hypogonadotropic hypogonadism, chronic illness) must be excluded.

4In male puberty, the first physical sign is most commonly which of the following?

A.Testicular enlargement (volume ≥4 mL)

B.Pubic hair development

C.Voice change

D.Peak height velocity

Explanation: Testicular enlargement to ≥4 mL volume (Tanner SMR 2 genital staging) is the first physical sign of male puberty, typically occurring between ages 9 and 14. Pubic hair, voice change, and peak height velocity all follow later in the pubertal sequence.

5A 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?

A.Initiate primary amenorrhea workup

B.Reassure and reassess in 1 year

C.Order karyotype only

D.No action needed; menarche may occur as late as age 17

Explanation: Primary amenorrhea is defined as no menses by age 15 in a patient with normal secondary sexual characteristics, or no menses by age 13 with absent secondary sex characteristics. Workup includes pelvic ultrasound, FSH/LH, prolactin, TSH, and karyotype if indicated to evaluate for outflow tract obstruction (imperforate hymen, Müllerian agenesis), Turner syndrome, hypogonadotropic hypogonadism, or PCOS.

6An 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)?

A.Stage 2

B.Stage 1

C.Stage 3

D.Stage 4

Explanation: Tanner pubic hair Stage 2 is characterized by sparse, slightly pigmented, straight hair at the base of the penis (or along the labia in females). Stage 1 is prepubertal (no hair). Stage 3 is darker, coarser, curly hair extending across the pubis. Stage 4 is adult-type hair limited to the pubic area, not yet on the medial thighs (Stage 5).

7According to Piaget's stages of cognitive development, the transition characteristic of mid-adolescence (around ages 12-15) is described as the move from:

A.Concrete operational to formal operational thinking

B.Sensorimotor to preoperational

C.Preoperational to concrete operational

D.Formal operational to postformal thinking

Explanation: Piaget's formal operational stage typically begins around ages 11-12, when adolescents acquire the ability to think abstractly, reason hypothetically, and consider multiple variables. This shift directly affects how clinicians counsel adolescents about risk, consequences, and chronic disease management.

8According to Erikson's psychosocial stages, the central developmental task of adolescence is:

A.Identity vs. role confusion

B.Industry vs. inferiority

C.Intimacy vs. isolation

D.Autonomy vs. shame

Explanation: Erikson described the adolescent stage as 'identity vs. role confusion,' typically ages 12-18. Successful resolution involves developing a coherent sense of self, values, and future direction. Industry vs. inferiority is school-age (6-12); intimacy vs. isolation is young adulthood; autonomy vs. shame is toddlerhood.

9A 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?

A.Pubertal signs before age 8

B.Pubertal signs before age 10

C.Pubertal signs before age 6

D.Menarche before age 12

Explanation: Precocious puberty is traditionally defined as the onset of secondary sexual characteristics before age 8 in girls and before age 9 in boys. Earlier age cutoffs (e.g., age 7 for non-Hispanic White girls and 6 for Black girls) have been proposed, but the classic exam cutoff remains 8 in girls and 9 in boys.

10A 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?

A.Stage 5

B.Stage 4

C.Stage 3

D.Stage 6 (postpartum)

Explanation: Tanner pubic hair Stage 5 is adult-quantity and adult-type pubic hair extending onto the medial thighs in the typical inverse-triangle distribution. Stage 4 is adult-type hair limited to the pubis without spread to the thighs. There is no Stage 6 in standard SMR.

About the ABIM Adolescent Exam

The ABIM Adolescent Medicine subspecialty certification is a co-sponsored exam (ABIM/ABP/ABFM) issued by ABIM for internists who completed at least 36 months of an ACGME-accredited Adolescent Medicine fellowship after ABIM Internal Medicine certification. The 8.5-hour computer-based test at Pearson VUE assesses knowledge across normal adolescent development, reproductive health, mental health, substance use, chronic illness transition, confidentiality and consent law, LGBTQ+ and gender-affirming care, and adolescent acute care. Diplomates maintain certification through the Longitudinal Knowledge Assessment (LKA — ~30 questions per quarter open-book) or the traditional 10-year MOC exam.

Questions

100 scored questions

Time Limit

8.5 hours (CBT)

Passing Score

Scaled by ABIM

Exam Fee

~$2,840 (American Board of Internal Medicine (ABIM))

ABIM Adolescent Exam Content Outline

~15%

Normal Adolescent Development

Tanner SMR 1-5 (breast, genital, pubic hair); puberty timing — girls thelarche 8-13, menarche 10-15, peak height velocity Tanner 2-3; boys testicular enlargement 9-14, peak height velocity Tanner 3-4; delayed puberty thresholds; cognitive (Piaget) and psychosocial (Erikson) development.

~20%

Reproductive Health

USMEC contraception criteria; LARC first-line (copper/levonorgestrel IUDs, etonogestrel implant); DMPA BMD effects; CHC VTE risk; Plan B OTC any age; Ella Rx; CDC 2021 STI screening (annual CT/GC for sexually active females ≤25, MSM extragenital + HIV/syphilis q3-12 mo); EPT; HPV 9-valent; Title X; HEEADSSS interview.

~20%

Mental Health

PHQ-9 modified for adolescents (≥10 moderate; USPSTF B 12-18); GAD-7; SCARED; Columbia C-SSRS; CRAFFT; eating disorders DSM-5-TR (AN, BN, ARFID, BED); ADHD Vanderbilt; SSRI FDA Black Box <25; FDA-approved fluoxetine + escitalopram for adolescent depression; fluvoxamine + sertraline for adolescent OCD; CBT first-line.

~10%

Substance Use & Behavioral Risks

CRAFFT; SBIRT; vaping/JUUL EVALI 2019; cannabis state variation and edibles overdose; intranasal naloxone for opioid OD; buprenorphine for OUD age ≥16; tobacco cessation; binge drinking and motor vehicle safety; gaming/social media addiction.

~10%

Chronic Illness & Transition

Got Transition Six Core Elements (pediatric to adult care typically ages 18-21); type 1 diabetes (pump, CGM, A1c); asthma GINA stepwise; IBD growth/puberty effects; congenital heart disease; cystic fibrosis adult transition; sickle cell disease; medication adherence.

~10%

Confidentiality & Consent Law

Mature Minor Doctrine (state-variable); state minor consent statutes for contraception, STI, mental health, substance use; HIPAA + state law on parental record access; EHR portal restrictions for confidential adolescent visits; Title X; mandatory reporting of abuse and statutory rape; emancipation.

~10%

LGBTQ+ Adolescent Health & Gender-Affirming Care

Minority stress model and elevated suicide risk; Trevor Project hotline; WPATH Standards of Care SOC 8 (2022); GnRH agonist puberty blockers from Tanner 2+; gender-affirming hormones typically age 16+ per WPATH; chest binding safety; PrEP for adolescent MSM and transgender youth; state legal landscape (multiple states banned 2023+).

~5%

Acute Care

Pre-Participation Physical Evaluation (PPE) for sports clearance; CDC HEADS UP concussion protocol (return-to-learn before return-to-play); Female Athlete Triad / RED-S; sudden cardiac death screening (HCM, long QT); dysmenorrhea (NSAIDs first-line, then hormonal); acne (topical retinoids + benzoyl peroxide; isotretinoin via iPLEDGE).

How to Pass the ABIM Adolescent Exam

What You Need to Know

Passing score: Scaled by ABIM
Exam length: 100 questions
Time limit: 8.5 hours (CBT)
Exam fee: ~$2,840

Keys to Passing

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

ABIM Adolescent Study Tips from Top Performers

1Anchor your review on the official ABIM Adolescent Medicine blueprint — Reproductive Health and Mental Health are each ~20% of the exam, so allocate roughly 40% of your study time to USMEC contraception, CDC 2021 STI guidelines, PHQ-9, and adolescent eating-disorder DSM-5-TR criteria

2Memorize Tanner Sexual Maturity Rating 1-5 cold (breast, genital, pubic hair stages) along with puberty timing thresholds — girls thelarche 8-13, menarche 10-15; boys testicular enlargement 9-14 — and the delayed-puberty cutoffs (no thelarche by 13, no menarche by 15, no testicular enlargement by 14)

3Drill the FDA SSRI Black Box for patients under 25, the FDA-approved adolescent psychiatric agents (fluoxetine and escitalopram for depression; fluvoxamine and sertraline for OCD), and the validated screens — PHQ-9, GAD-7, SCARED, Columbia C-SSRS, CRAFFT, and Vanderbilt for ADHD

4Learn the legal scaffolding behind every adolescent visit: Mature Minor Doctrine variation, state minor-consent statutes for contraception/STI/mental health/substance use, HIPAA + state law on EHR portal restrictions for confidential adolescent visits, Title X, and mandatory reporting for abuse and statutory rape

5Study WPATH Standards of Care 8 (2022) carefully — GnRH agonist puberty blockers from Tanner 2+, gender-affirming hormones typically age 16+, and the rapidly shifting state legal landscape for minors — and pair it with the Got Transition Six Core Elements framework for chronic illness handoffs at ages 18-21

Frequently Asked Questions

What is the ABIM Adolescent Medicine subspecialty exam?

The ABIM Adolescent Medicine exam is a co-sponsored subspecialty certification offered jointly by the American Board of Internal Medicine (ABIM), the American Board of Pediatrics (ABP), and the American Board of Family Medicine (ABFM). When a candidate is an ABIM-certified internist, the certificate is issued by ABIM. It is an 8.5-hour computer-based exam administered at Pearson VUE Professional Centers covering normal adolescent development, reproductive health, mental health, substance use, chronic illness transition, confidentiality and consent law, LGBTQ+ and gender-affirming care, and adolescent acute care.

What are the eligibility requirements for the ABIM Adolescent Medicine exam?

Candidates must (1) hold valid ABIM Internal Medicine certification, (2) complete 36 months in an ACGME-accredited Adolescent Medicine fellowship with satisfactory program director attestation of clinical competence, and (3) hold an active unrestricted U.S. medical license before the certificate is issued. The exam is co-sponsored, so pediatricians and family physicians may also sit but receive certificates from their primary board (ABP or ABFM).

How much does the ABIM Adolescent Medicine exam cost in 2026?

The 2026 ABIM Adolescent Medicine subspecialty initial certification application fee is approximately $2,840. A late fee applies if the application is submitted after the standard deadline. Candidates should also budget for adolescent medicine question banks, SAHM review courses or modules, and Pearson VUE travel. Total out-of-pocket preparation costs commonly reach $3,500 to $5,500 per attempt.

What content is on the ABIM Adolescent Medicine exam?

The shared adolescent medicine blueprint covers Normal Adolescent Development including Tanner SMR 1-5 (~15%), Reproductive Health with USMEC-guided contraception and CDC 2021 STI screening (~20%), Mental Health with PHQ-9 and the FDA SSRI Black Box (~20%), Substance Use & Behavioral Risks with CRAFFT/SBIRT (~10%), Chronic Illness Transition via Got Transition (~10%), Confidentiality & Consent Law including Mature Minor Doctrine and Title X (~10%), LGBTQ+ Adolescent Health & Gender-Affirming Care per WPATH SOC 8 (~10%), and adolescent Acute Care (~5%).

How is certification maintained after passing?

ABIM Adolescent Medicine certification is maintained on a continuous 10-year cycle. Diplomates choose between the Longitudinal Knowledge Assessment (LKA) — approximately 30 open-book questions per quarter over a 5-year cycle delivered through the ABIM portal — or the traditional 10-year MOC exam. Diplomates must also hold an active unrestricted medical license, earn 100 MOC points every 5 years, and pay annual diplomate fees.

Is the ABIM Adolescent Medicine exam different from the ABP version?

The exam content is the same across ABIM, ABP, and ABFM because adolescent medicine is co-sponsored — all candidates take a single shared blueprint exam. The difference is administrative: candidates apply through their primary board, pay that board's fee, and receive a certificate from that board. ABIM-certified internists pursuing adolescent medicine therefore complete an internal medicine subspecialty fellowship and apply through ABIM.