100+ Free ABP Adolescent Practice Questions

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A 13-year-old girl presents with breast budding (Tanner B2) and sparse, slightly pigmented pubic hair (Tanner P2). Her growth velocity has accelerated. Which Tanner stage is most consistent with peak height velocity in girls?

Tanner stage 1

Tanner stage 2-3

Tanner stage 4-5

After menarche

to track

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2026 Statistics

Key Facts: ABP Adolescent Exam

100

ABP-AM single-best-answer items

ABP subspecialty CBT format

8 hrs

Total exam time

Single-day Pearson VUE CBT

20%

Reproductive Health weight

Largest blueprint domain (tied with Mental Health)

20%

Adolescent Mental Health weight

Tied largest blueprint domain

3 yr

Required Adolescent Medicine fellowship

ACGME-accredited; after ABP General Pediatrics

$2,200

Approximate exam fee

ABP subspecialty fee schedule

The ABP Adolescent Medicine subspecialty exam is an 8-hour CBT with ~100 single-best-answer items covering 8 domains: Normal Development (15%), Reproductive Health (20%), Mental Health (20%), Substance Use (10%), Chronic Illness Transition (10%), Confidentiality and Consent (10%), LGBTQ+/Gender-Affirming Care (10%), and Acute Care/Sports Medicine (5%). Eligibility requires ABP General Pediatrics certification plus 3 years of ACGME-accredited Adolescent Medicine fellowship. Fee is approximately $2,200. Maintenance uses ABP MOCA-Peds (quarterly questions) instead of a 10-year secure exam.

Sample ABP Adolescent Practice Questions

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

1A 13-year-old girl presents with breast budding (Tanner B2) and sparse, slightly pigmented pubic hair (Tanner P2). Her growth velocity has accelerated. Which Tanner stage is most consistent with peak height velocity in girls?

A.Tanner stage 1

B.Tanner stage 2-3

C.Tanner stage 4-5

D.After menarche

Explanation: Peak height velocity (PHV) in girls occurs at Tanner SMR 2-3, typically 6-12 months BEFORE menarche. In boys, PHV occurs later at SMR 3-4. By the time a girl reaches menarche (average ~12.5 years), most linear growth (95%) is complete and only 5-7 cm of additional height remains.

2A 14-year-old boy has not yet developed any signs of puberty. On exam, his testicular volume is 2 mL bilaterally and there is no pubic hair. The MOST appropriate next step is:

A.Reassurance — boys can begin puberty as late as age 16

B.Initiate testosterone replacement immediately

C.Evaluate for delayed puberty (workup including LH/FSH, testosterone, bone age, prolactin)

D.Order karyotype only

Explanation: Delayed puberty in boys is defined as no testicular enlargement (volume <4 mL or length <2.5 cm) by age 14. Workup includes morning LH/FSH and testosterone (to distinguish hypogonadotropic vs hypergonadotropic hypogonadism), bone age, prolactin, and consideration of karyotype (Klinefelter 47,XXY) or imaging. Constitutional delay is the most common cause but is a diagnosis of exclusion.

3A 7-year-old girl is brought in for early breast development. On exam, she has Tanner B2 breast development without pubic hair or growth acceleration. Which is the BEST next step?

A.Reassurance — this is within normal limits

B.Evaluate for precocious puberty including bone age, LH/FSH, estradiol, and pelvic ultrasound

C.Start GnRH agonist immediately

D.Order brain MRI without further workup

Explanation: Thelarche before age 8 in girls is considered precocious and warrants workup. Evaluation includes bone age (advanced suggests true central precocious puberty), basal and GnRH-stimulated LH/FSH (pubertal LH response indicates central CPP), estradiol, and pelvic US for ovarian/uterine size. Premature thelarche (isolated breast budding without other pubertal signs or bone age advancement) is a separate benign entity but requires monitoring. Brain MRI is indicated for confirmed central precocious puberty, especially in girls under 6 or in boys.

4A 15-year-old girl has not had her first menstrual period. She has Tanner B4 breast development and Tanner P4 pubic hair. Per AAP/ACOG guidance, evaluation for primary amenorrhea is indicated when:

A.There is no menarche by age 15 OR no thelarche by age 13

B.There is no menarche by age 18

C.Only when there is no breast development by age 14

D.Only after 3 years of secondary sexual development without menarche

Explanation: ACOG/AAP define primary amenorrhea evaluation criteria as: (1) absence of menarche by age 15 in the presence of normal secondary sexual characteristics, OR (2) absence of thelarche (breast development) by age 13, OR (3) absence of menarche within 3 years of thelarche. This girl meets criterion 1. Workup includes pregnancy test, TSH, prolactin, FSH/LH, estradiol, and pelvic ultrasound. Consider karyotype if FSH elevated.

5Per Erikson's psychosocial development theory, the central developmental task of adolescence (ages 12-18) is:

A.Trust vs Mistrust

B.Autonomy vs Shame and Doubt

C.Identity vs Role Confusion

D.Intimacy vs Isolation

Explanation: Erikson's stage 5 (adolescence, 12-18 years) is Identity vs Role Confusion. Adolescents work to integrate their childhood identifications with current capabilities, opportunities, and roles into a coherent sense of self. Successful resolution yields a stable identity (vocational, sexual, ideological); failure produces role confusion. Trust vs Mistrust is infancy, Autonomy vs Shame is toddlerhood, Intimacy vs Isolation is young adulthood (19-40).

6A 13-year-old can solve algebra problems, consider hypothetical scenarios, and reason about abstract moral dilemmas. According to Piaget, which cognitive developmental stage best describes this?

A.Sensorimotor

B.Preoperational

C.Concrete operational

D.Formal operational

Explanation: Piaget's Formal Operational stage begins around age 11-12 and is characterized by abstract reasoning, hypothetico-deductive logic, and the ability to systematically consider hypothetical scenarios. Not all adolescents fully achieve this stage, and risk-taking behavior in adolescence reflects ongoing prefrontal cortex development. Sensorimotor (0-2y), Preoperational (2-7y), Concrete Operational (7-11y, requires concrete examples to reason).

7Which of the following is the recommended structured psychosocial interview tool for adolescent visits?

A.SBAR

B.AMPLE

C.HEEADSSS

D.FAST

Explanation: HEEADSSS is the standard psychosocial interview for adolescents: Home, Education/Employment, Eating, Activities, Drugs, Sex/Sexuality, Suicide/Depression, Safety/Strengths. It begins with non-threatening domains and moves toward more sensitive topics, ideally conducted alone with the adolescent after a confidentiality discussion. SBAR is a clinical handoff tool, AMPLE is a trauma history mnemonic, FAST is a stroke screening tool.

8A 16-year-old male endorses feeling "different" from peers and asks about gender identity. The MOST appropriate initial approach is to:

A.Refer immediately to endocrinology for hormone therapy

B.Use open-ended, gender-affirming language; ask preferred name and pronouns; assess support and safety

C.Tell the adolescent these feelings are likely temporary

D.Insist on parental presence for any further discussion

Explanation: Gender-affirming care begins with using open-ended language, asking preferred name and pronouns, normalizing the conversation, assessing support systems and safety (LGBTQ+ youth have higher rates of bullying, depression, suicide risk), and providing confidential space. Per WPATH SOC 8 (2022) and AAP guidance, comprehensive psychosocial evaluation precedes any medical interventions, which are decided collaboratively with adolescent, family (when safe), and a multidisciplinary team.

9Compared to early adolescence (10-13), late adolescence (17-21) is characterized by:

A.Concrete thinking and intense focus on bodily changes

B.Beginning of abstract thought and identification with same-sex peer groups

C.More stable identity, future orientation, capacity for intimate relationships

D.Egocentrism and the 'imaginary audience' phenomenon

Explanation: Late adolescence (17-21) is marked by more consolidated identity, future orientation, more reliable abstract reasoning, capacity for intimate (not just identity-driven) relationships, and movement toward functional independence. Early adolescence (10-13) features concrete thinking and body preoccupation. Middle adolescence (14-16) has peak peer influence, risk-taking, and egocentrism (imaginary audience, personal fable).

10A 12-year-old girl asks why she is taller than most of the boys in her class. The BEST explanation is:

A.She likely has a growth disorder

B.Boys typically have peak height velocity 2 years later than girls (boys SMR 3-4, girls SMR 2-3)

C.Girls remain taller than boys throughout adolescence

D.This is unusual and warrants endocrinology referral

Explanation: The pubertal growth spurt occurs ~2 years earlier in girls than boys. Girls have peak height velocity (PHV) at SMR 2-3 (~age 11-12); boys at SMR 3-4 (~age 13-14). This is why early-pubertal girls are often taller than same-age boys. Eventually most males surpass females in height because their pre-pubertal growth period is longer and their PHV magnitude is higher (~10 cm/yr vs 9 cm/yr in girls).

About the ABP Adolescent Exam

The ABP Adolescent Medicine Subspecialty Certifying Examination is a co-sponsored ABIM/ABP/ABFM credential issued by the American Board of Pediatrics for pediatric diplomates who complete a 3-year ACGME-accredited Adolescent Medicine fellowship after ABP General Pediatrics certification. The CBT exam covers eight domains: Normal Adolescent Development (puberty/Tanner SMR, Erikson, Piaget) 15%, Reproductive Health (LARC, US MEC, CDC 2021 STI) 20%, Mental Health (mood, anxiety, eating disorders, suicide) 20%, Substance Use (CRAFFT, vaping, EVALI, opioid OUD) 10%, Chronic Illness Transition (Got Transition six elements) 10%, Confidentiality and Consent (Title X, mature minor) 10%, LGBTQ+ Health and Gender-Affirming Care (WPATH SOC 8) 10%, and Acute Care/Sports Medicine (PPE, concussion, RED-S, HCM) 5%. Maintenance of Certification is via ABP MOCA-Peds quarterly questions.

Questions

100 scored questions

Time Limit

8 hours (CBT)

Passing Score

Scaled by ABP

Exam Fee

~$2,200 (American Board of Pediatrics (ABP))

ABP Adolescent Exam Content Outline

15%

Normal Adolescent Development

Tanner SMR 1-5 (breast/genital/pubic hair), thelarche 8-13, menarche 10-15, peak height velocity (girls Tanner 2-3, boys Tanner 3-4), boys testicular enlargement at 9-14, Erikson Identity vs Role Confusion (12-18), Piaget Formal Operational (11+) abstract reasoning, Elkind imaginary audience and personal fable, HEEADSSS interview (Home, Education, Eating, Activities, Drugs, Sexuality, Suicide, Safety/Strengths).

20%

Reproductive Health

LARC first-line per AAP/ACOG (etonogestrel implant Nexplanon 3-yr, levonorgestrel IUDs Mirena 8-yr/Liletta/Kyleena/Skyla, copper IUD Paragard 10-yr), DMPA every 13 weeks (reversible BMD decrease), CDC US MEC 5 categories with absolute contraindications (migraine with aura, smoker ≥35yo + ≥15 cig/day, HTN ≥160/100, hx VTE/CVA/IHD), Plan B (levonorgestrel) OTC any age, Ella decreased efficacy at BMI ≥30, copper IUD up to 5 days post-coitus most effective EC, HPV Gardasil 9 ages 9-26 (2-dose if start 9-14, 3-dose if 15+), CDC 2021 STI: doxycycline 100mg BID x7d for chlamydia (preferred 2021+), ceftriaxone 500mg IM (1g if ≥150kg) for gonorrhea, metronidazole 500mg BID x7d for trichomoniasis in women, benzathine penicillin G 2.4M IM for syphilis, EPT for CT/GC.

20%

Adolescent Mental Health

PHQ-A modified for ages 12-17 (USPSTF B for depression screening 12-18), GAD-7, SCARED for anxiety, ASQ Ask Suicide-Screening Questions 4-item (universal screening from age 12 per AAP/Joint Commission), Columbia C-SSRS, eating disorders DSM-5-TR (anorexia restricting and binge-purge subtypes; bulimia; ARFID; binge eating disorder most prevalent), refeeding syndrome (hypophosphatemia, hypokalemia, hypomagnesemia, thiamine deficiency), SAHM 2015 hospitalization criteria, FDA black-box SSRI suicidality <25 (2004), fluoxetine and escitalopram FDA-approved adolescent MDD.

10%

Substance Use

CRAFFT 2.1 (Car, Relax, Alone, Forget, Family, Trouble — score ≥2 positive) ages 12-21, SBIRT framework (Screening, Brief Intervention, Referral to Treatment), motivational interviewing, vaping and EVALI 2019 outbreak (vitamin E acetate in THC vape oils), Cannabis Use Disorder DSM-5-TR (severe ≥6 of 11), opioid overdose naloxone 4mg intranasal, MAT for adolescents (buprenorphine FDA-approved ≥16 yr OUD, naltrexone off-label AUD), nicotine withdrawal and NRT.

10%

Chronic Illness Transition to Adult Care

Got Transition (gottransition.org) Six Core Elements: (1) transition policy, (2) tracking/monitoring registry, (3) readiness assessment (TRAQ tool), (4) transition planning, (5) transfer of care, (6) transfer completion confirmation. AAP/AAFP/ACP joint policy: begin at age 12-14. Disease-specific issues: T1DM puberty insulin resistance and adherence, sickle cell disease highest mortality in 18-30 transition window, CF reproductive considerations, IDD adapted transitions with guardianship/supported decision-making. Common preventable failures: insurance loss, inadequate handoff.

10%

Confidentiality and Consent

Mature Minor Doctrine (state-specific), state minor consent laws for STI/contraception/mental health/substance use (varies by state but STI consent in all 50 states), Title X confidential family planning regardless of parental consent, HIPAA permits but state law may require/prohibit parental access, EHR portal restriction of confidential adolescent visit notes (most EHRs configured per 21st Century Cures Act information-blocking rule exceptions), Pap NOT recommended <21 yrs regardless of activity (USPSTF), AAP Bright Futures private time alone with adolescent starting age 11, EOB confidentiality risks, emancipated minor full adult consent rights.

10%

LGBTQ+ Health and Gender-Affirming Care

WPATH Standards of Care 8 (2022) — gender-affirming care framework. GnRH agonists (leuprolide, histrelin, nafarelin) as reversible puberty blockers from Tanner 2+. Gender-affirming hormones (testosterone, estrogen) typically considered ≥16 with multidisciplinary team and informed consent (no minimum age in SOC 8). Higher rates of depression/anxiety/suicidality in TGD youth — family acceptance is profoundly protective (Family Acceptance Project). SOGI history-taking. Organ-based screening. State legal landscape — 24+ states banned gender-affirming care for minors as of 2024-2025; AAP/Endocrine Society/AMA oppose these laws. PrEP for adolescents ≥35 kg with quarterly monitoring.

Acute Care and Sports Medicine

Pre-Participation Physical Evaluation (AAP/AHA 14-element history and physical exam). Concussion per CDC HEADS UP — clinical diagnosis (no LOC required), no same-day return to play, return-to-learn before return-to-play, stepwise 5-stage progression. Female Athlete Triad / RED-S (low energy availability + menstrual dysfunction + low BMD). HCM is the most common cause of SCD in young US athletes; ECG screening NOT routinely recommended in US (different from Italian model). Sexual assault management (PEP, EC, mandatory reporting, SANE). Isotretinoin iPLEDGE REMS. Adolescent immunizations including MenACWY booster age 16 and MenB SCDM 16-18.

How to Pass the ABP Adolescent Exam

What You Need to Know

Passing score: Scaled by ABP
Exam length: 100 questions
Time limit: 8 hours (CBT)
Exam fee: ~$2,200

Keys to Passing

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

ABP Adolescent Study Tips from Top Performers

1Master Tanner Sexual Maturity Rating (SMR) cold — breast (B1-B5), genital (G1-G5 in boys), and pubic hair (P1-P5) — including the temporal sequence: thelarche begins age 8-13 in girls, testicular enlargement at 9-14 in boys, peak height velocity at SMR 2-3 in girls and SMR 3-4 in boys, and menarche typically 2.5 years after thelarche. Evaluate primary amenorrhea by age 15 (or by 13 if no thelarche).

2Memorize the CDC US Medical Eligibility Criteria for contraception. Know absolute contraindications (Category 4) to combined hormonal contraceptives: migraine WITH aura, smokers ≥35 with ≥15 cig/day, HTN ≥160/100, history of VTE/CVA/IHD, complicated valvular disease, current breast cancer, severe cirrhosis, and <6 weeks postpartum if breastfeeding. LARC methods are first-line for adolescents per AAP/ACOG (typical-use failure <1%).

3Know the CDC 2021 STI Treatment Guidelines updates: doxycycline 100 mg BID x 7 days is now PREFERRED for genital chlamydia (and REQUIRED for rectal CT); ceftriaxone increased to 500 mg IM single dose for uncomplicated gonorrhea (1 g if ≥150 kg) with no routine azithromycin add-on; metronidazole 500 mg BID x 7 days for trichomoniasis in women; PID outpatient regimen now includes metronidazole for anaerobic coverage.

4WPATH Standards of Care 8 (2022) is high-yield. GnRH agonists (puberty blockers) are reversible and may be offered after Tanner 2+ following multidisciplinary assessment. Gender-affirming hormones are partially reversible and typically considered in mid-adolescence. Family acceptance is profoundly protective per the Family Acceptance Project — 8x lower suicide attempt rates compared to family rejection. Know the changing state legal landscape (24+ states have restrictions as of 2024-2025).

5For mental health questions, fluoxetine (FDA-approved ≥8 yr) and escitalopram (≥12 yr) are the only FDA-approved SSRIs for adolescent MDD. The black-box warning for suicidality applies to all antidepressants in patients <25 — counsel patients/families and follow weekly for 4 weeks after initiation. Eating disorder hospitalization criteria (SAHM 2015): HR <50 daytime/<45 nighttime, BP <90/45, temperature <36°C, electrolyte derangement, severe malnutrition. Refeeding syndrome causes hypophosphatemia, hypokalemia, hypomagnesemia, and thiamine deficiency — monitor electrolytes daily for the first week.

Frequently Asked Questions

What is the ABP Adolescent Medicine Subspecialty Certification?

The ABP Adolescent Medicine Subspecialty Certification is a co-sponsored ABIM/ABP/ABFM credential issued by the American Board of Pediatrics for diplomates who complete an ACGME-accredited Adolescent Medicine fellowship. The certifying exam is a CBT covering eight content domains: normal adolescent development, reproductive health, mental health, substance use, chronic illness transition, confidentiality and consent, LGBTQ+ and gender-affirming care, and acute care/sports medicine. Maintenance of certification uses ABP MOCA-Peds quarterly questions.

Who is eligible for the ABP Adolescent Medicine exam?

Candidates must hold ABP General Pediatrics certification (or ABIM Internal Medicine or ABFM Family Medicine certification for the co-sponsored pathway) and have completed 3 years of ACGME-accredited Adolescent Medicine fellowship training. Candidates must hold a valid unrestricted medical license and have program director attestation.

What does the ABP Adolescent Medicine exam cover?

The exam blueprint emphasizes Reproductive Health (20%) and Adolescent Mental Health (20%), followed by Normal Adolescent Development (15%), Substance Use (10%), Chronic Illness Transition (10%), Confidentiality and Consent (10%), LGBTQ+ Health/Gender-Affirming Care (10%), and Acute Care/Sports Medicine (5%). High-yield topics include Tanner staging, LARC and US MEC categories, CDC 2021 STI Treatment Guidelines, HEEADSSS interview, eating disorders DSM-5-TR, CRAFFT, EVALI, Got Transition six core elements, Title X, WPATH SOC 8, concussion management, and the Female Athlete Triad/RED-S.

How long is the ABP Adolescent Medicine exam and what is the format?

The certifying exam is administered as a single-day CBT (approximately 8 hours) with single-best-answer multiple-choice items at Pearson VUE Professional Testing Centers. Each item has four or five answer options. ABP scaled scoring is criterion-referenced (not norm-referenced).

How much does the ABP Adolescent Medicine exam cost?

The certifying exam fee is approximately $2,200 (the ABP publishes updated subspecialty fees annually). Late registration adds an additional fee. MOC enrollment fees apply after initial certification.

How is the ABP Adolescent Medicine exam scored, and how does Maintenance of Certification work?

ABP uses a scaled, criterion-referenced score with a fixed pass threshold set by content-expert panels. Results are typically available 10-12 weeks after the exam. After initial certification, Maintenance of Certification (MOC) uses ABP MOCA-Peds — quarterly online questions delivered through the ABP portal — instead of a periodic 10-year secure recertification exam, plus Part 4 quality improvement activities and an annual fee.