ABFM Adolescent Medicine cheat sheet

Tanner staging: breast budding (B2) and testicular enlargement (≥4 mL) are typically the first signs of puberty, usually around age 8-13 in girls and 9-14 in boys.

Growth spurt peaks at roughly Tanner stage 3 in girls (about 2 years after thelarche) and Tanner stage 4 in boys; peak height velocity averages ~9 cm/yr in girls and ~10 cm/yr in boys.

Menarche occurs about 2-2.5 years after thelarche, typically Tanner breast stage 4, and generally follows peak height velocity.

Delayed puberty: no breast development by age 13 in girls or no testicular enlargement by age 14 in boys warrants evaluation (bone age, FSH/LH, karyotype in girls).

Precocious puberty: breast or pubic hair before age 8 in girls or testicular enlargement before age 9 in boys; GnRH stimulation distinguishes central from peripheral.

Recommended adolescent preventive visit frequency is annual (ages 11-21); screening includes BMI percentile, blood pressure, vision/hearing, and immunizations (HPV, Tdap, MenACWY).

Dyslipidemia screening is recommended once between ages 9-11 and again at 17-21; depression screening annually from age 12; HIV screening recommended from ages 15-65.

Iron deficiency risk rises with menarche and pregnancy; recommended dietary iron is higher in adolescent girls, and pregnancy creates additional iron and folate demands.

Acne, scoliosis (screening at ages 10-12 with forward bend test), and sports preparticipation evaluation are core physical health issues of adolescence.

Piaget: formal operational thought (abstract reasoning, hypothetical-deductive logic) typically emerges around age 11-12 and matures through adolescence.

Erikson's psychosocial stage is identity vs role identity confusion (roughly ages 12-18); successful resolution yields fidelity and a coherent self-concept.

Adolescent egocentrism includes the imaginary audience (belief of being constantly observed) and the personal fable (belief of invulnerability and uniqueness).

Depression screening: annual screening ages 12-18 (e.g., PHQ-9 modified for adolescents or PHQ-2); persistent depressed mood or anhedonia ≥2 weeks meets core criteria.

Suicide is a leading cause of death in adolescents; asking directly about suicidal ideation does not increase risk and is part of a complete risk assessment.

ADHD persisting into adolescence is associated with academic decline, risk-taking, and substance use; treatment continuity and school accommodations are key.

Eating disorders (anorexia nervosa, bulimia nervosa, binge-eating disorder) peak in adolescence; warning signs include weight change, body image distortion, and purging behaviors.

Substance use screening (e.g., CRAFFT) is recommended annually for adolescents; early initiation of alcohol or cannabis predicts later substance use disorder.

Confidentiality: adolescents should be given time alone with the clinician; most states allow confidential care for STI testing/treatment, contraception, and mental health, with limits for imminent danger.

Mandatory reporting: suspected child abuse or neglect must be reported to child protective services regardless of confidentiality promises.

Motor vehicle crashes are the leading cause of death in adolescents; graduated driver licensing and seat belt use reduce risk.

Firearm access in the home is a major risk factor for adolescent suicide and unintentional injury; counseling on safe storage is part of injury prevention.

School is a major social determinant: academic failure, bullying, and school disconnection correlate with mental health problems and risk behaviors.

Peer influence and family connectedness are strong predictors of adolescent risk behavior; high parental monitoring and connectedness are protective.

Sexual health: HPV vaccination recommended at ages 11-12 (can start at 9); STI screening for sexually active adolescents (chlamydia/gonorrhea in females annually, and as indicated in males).

Adolescent pregnancy carries increased risk of anemia, hypertensive disorders, preterm birth, and low birth weight; contraception counseling is a core preventive service.

Social media and digital media use is nearly universal; excessive use correlates with sleep disruption, body image concerns, and mood symptoms, and should be screened at preventive visits.