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ABFM Adolescent Medicine study materials
ABFM Adolescent Medicine study resources

ABFM Adolescent Medicine practice questions

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Question 1Physical characteristics of adolescents and their health care problems and needs

At what age does the typical growth spurt in height begin in girls?

  1. About 15 to 16 years
  2. About 13 to 14 years
  3. About 9 to 10 years Correct answer.
  4. About 11 to 12 years

Explanation

Girls typically begin their pubertal height spurt around age 9 to 10, roughly 2 years earlier than boys, with peak height velocity near age 11.5 to 12. Boys' spurt begins around 11 to 12 years.

Question 2Physical characteristics of adolescents and their health care problems and needs

Tanner stage 3 breast development in a girl is best described as:

  1. Breast and areola enlarged with no contour separation Correct answer.
  2. Breast bud with small areolar mound
  3. Elevation of papilla only
  4. Mature contour with projection of the papilla only

Explanation

Tanner 3 describes enlargement of breast and areola with a single contour and no separation of their outlines. Stage 2 is the breast bud, and stage 4 shows the areola and papilla forming a secondary mound above the breast contour.

Question 3Physical characteristics of adolescents and their health care problems and needs

A 14-year-old boy has genitalia stage 4 and pubic hair stage 3. Which finding is most consistent with this pattern?

  1. Discordance suggesting possible androgen excess
  2. Normal progression of puberty Correct answer.
  3. Delayed puberty requiring evaluation
  4. Prepubertal status

Explanation

Pubic hair typically lags genital development by about one stage during male puberty, so genital stage 4 with pubic hair stage 3 is a normal sequence. Marked advancement of pubic hair relative to genitalia would raise concern for androgen excess.

Question 4Physical characteristics of adolescents and their health care problems and needs

Which is the most reliable first sign of puberty in boys?

  1. Appearance of pubic hair
  2. Axillary hair growth
  3. Testicular enlargement Correct answer.
  4. Voice change

Explanation

Increase in testicular volume, usually to at least 4 mL, is the first physical sign of male puberty and precedes other changes. Pubic hair, voice change, and axillary hair occur later in the sequence.

Question 5Physical characteristics of adolescents and their health care problems and needs

Menarche in U.S. girls typically occurs at approximately what age?

  1. 15 to 16 years
  2. 9 to 10 years
  3. 10 to 11 years
  4. 12 to 13 years Correct answer.

Explanation

Median menarche in U.S. girls is about 12 to 13 years, occurring roughly 2 to 2.5 years after breast budding. Menarche before age 9 warrants evaluation for precocious puberty.

Question 6Physical characteristics of adolescents and their health care problems and needs

A 13-year-old girl has no breast development and no pubic hair. Which statement about her evaluation is most accurate?

  1. This suggests isolated premature thelarche
  2. This indicates precocious puberty
  3. This warrants evaluation for delayed puberty Correct answer.
  4. This is within normal limits and requires no further assessment

Explanation

Absence of any breast development by age 13 in girls meets criteria for delayed puberty and warrants evaluation, including assessment of growth, gonadotropins, and karyotype. Lack of breast budding by 13 or menarche by 15 to 16 are common thresholds.

Question 7Physical characteristics of adolescents and their health care problems and needs

Which finding in a 7-year-old girl most strongly suggests central precocious puberty rather than premature thelarche?

  1. Normal bone age for chronologic age
  2. Isolated breast budding with prepubertal growth velocity
  3. Bilateral tender breast tissue without areolar enlargement
  4. Progressive breast development with accelerated linear growth Correct answer.

Explanation

Progressive pubertal development accompanied by growth acceleration and advanced bone age suggests activation of the hypothalamic-pituitary-gonadal axis (central precocious puberty). Isolated thelarche without progression or growth acceleration is usually benign.

Question 8Physical characteristics of adolescents and their health care problems and needs

Which gynecologic finding is a normal variant in early adolescence?

  1. Primary amenorrhea at age 16
  2. Irregular anovulatory cycles in the first 1 to 2 years after menarche Correct answer.
  3. Cycles shorter than 21 days persisting for 3 years
  4. Menstrual cycles longer than 90 days at any point

Explanation

Anovulatory cycles are common for the first 1 to 2 years after menarche because the hypothalamic-pituitary-ovarian axis is still maturing, producing irregular intervals. Persistently very long cycles, primary amenorrhea at 16, or persistently short cycles warrant evaluation.

Question 9Physical characteristics of adolescents and their health care problems and needs

A 15-year-old reports heavy menses soaking a pad every hour for several hours with dizziness. Which is the most appropriate initial step?

  1. Start combined oral contraceptives without further testing
  2. Assess hemodynamic status and hemoglobin, then evaluate for bleeding disorders Correct answer.
  3. Reassure that irregular bleeding is normal in adolescence
  4. Obtain pelvic imaging before any laboratory testing

Explanation

Heavy menstrual bleeding in adolescents can cause significant anemia and is associated with bleeding disorders such as von Willebrand disease. Initial assessment should include hemodynamic evaluation and a complete blood count, followed by targeted testing.

Question 10Physical characteristics of adolescents and their health care problems and needs

What is the recommended daily calcium intake for adolescents aged 9 to 18 years?

  1. 1300 mg Correct answer.
  2. 800 mg
  3. 2000 mg
  4. 500 mg

Explanation

The recommended dietary allowance for calcium in adolescents aged 9 to 18 is 1300 mg per day to support peak bone mass accrual. Intake below this is common and contributes to later osteoporosis risk.

Question 11Physical characteristics of adolescents and their health care problems and needs

Which statement about the sleep-wake pattern of adolescents is most accurate?

  1. Melatonin secretion timing advances earlier in adolescence
  2. Early school start times improve total sleep duration
  3. Total sleep need declines to about 6 hours per night
  4. Circadian phase delay is a normal developmental shift in adolescence Correct answer.

Explanation

A physiologic delay in circadian timing occurs during adolescence, shifting sleep onset later while total sleep need remains around 8 to 10 hours. Early school start times combined with this delay contribute to chronic sleep deprivation.

Question 12Physical characteristics of adolescents and their health care problems and needs

During the adolescent growth spurt, which sequence of body composition change is typical?

  1. Both sexes gain equal proportions of fat and lean mass
  2. Girls gain relatively more lean mass than fat
  3. Boys gain relatively more fat than lean mass
  4. Boys gain relatively more lean mass while girls gain relatively more fat mass Correct answer.

Explanation

Testosterone-driven changes in boys favor lean mass accretion, while estrogen-driven changes in girls favor fat deposition, particularly in hips and thighs. This sexual dimorphism in body composition emerges during puberty.

Question 13Physical characteristics of adolescents and their health care problems and needs

A 16-year-old presents for a pre-participation sports evaluation and reports no chronic conditions. Which screening element is most important to include?

  1. Routine echocardiography before clearance
  2. Routine resting electrocardiogram for all athletes
  3. Personal and family history of cardiac symptoms or sudden death Correct answer.
  4. Universal lipid panel screening

Explanation

The preparticipation evaluation relies on personal and family history plus physical exam to identify risk of sudden cardiac death; routine ECG or echocardiography is not recommended for all asymptomatic athletes. Lipid screening follows separate age-based guidelines.

Question 14Physical characteristics of adolescents and their health care problems and needs

Which is a normal finding on breast examination in an adolescent girl?

  1. Unilateral bloody nipple discharge
  2. A fixed, nontender mass
  3. Asymmetric breast budding during early development Correct answer.
  4. Peau d'orange appearance

Explanation

Transient asymmetry is common as breasts develop at slightly different rates. A fixed mass, bloody discharge, or skin changes such as peau d'orange are abnormal and require evaluation.

Question 15Physical characteristics of adolescents and their health care problems and needs

A 13-year-old boy has bilateral breast enlargement with a palpable, tender disc of tissue. Which is the most likely explanation?

  1. Breast carcinoma
  2. Pubertal gynecomastia Correct answer.
  3. Klinefelter syndrome
  4. Premature thelarche

Explanation

Pubertal gynecomastia is common in early-to-mid puberty due to transient estrogen-androgen imbalance and usually resolves within 1 to 2 years. It presents as a tender, palpable subareolar disc.

Question 16Physical characteristics of adolescents and their health care problems and needs

Which statement about the adolescent male genital examination is most accurate?

  1. Asymmetric testes always indicate malignancy
  2. Varicocele is typically found on the right side
  3. Testicular volume is best estimated with a Prader orchidometer Correct answer.
  4. Testicular volume is best assessed by penile length

Explanation

Testicular volume is estimated by comparison with a series of graduated ellipsoids (Prader orchidometer), with 4 mL marking pubertal onset. Varicoceles are far more common on the left, and mild asymmetry is often normal.

Question 17Physical characteristics of adolescents and their health care problems and needs

A 12-year-old girl has pubic hair and axillary hair but no breast development and no growth acceleration. Which is the most likely diagnosis?

  1. Central precocious puberty
  2. Premature thelarche
  3. Premature adrenarche Correct answer.
  4. Constitutional delay of growth

Explanation

Isolated early pubic and axillary hair without breast development or growth acceleration suggests premature adrenarche, driven by adrenal androgens. Central precocious puberty would typically include breast development and accelerated growth.

Question 18Physical characteristics of adolescents and their health care problems and needs

Which finding most strongly suggests that an adolescent's short stature is due to constitutional delay rather than growth hormone deficiency?

  1. Delayed bone age with predicted adult height consistent with genetic potential Correct answer.
  2. Growth velocity persistently below 3 cm per year
  3. Midparental height well above the patient's projected height
  4. Height far below genetic target with markedly delayed bone age and no pubertal signs

Explanation

Constitutional delay shows delayed bone age that matches the delayed height age, with a predicted adult height in line with genetic potential and eventual spontaneous puberty. Growth hormone deficiency more often shows persistently poor growth velocity and height below genetic target.

Question 19Physical characteristics of adolescents and their health care problems and needs

Which immunization is recommended for all adolescents at the 11- to 12-year visit?

  1. Hepatitis B vaccine series at this age
  2. Annual influenza vaccine only
  3. Pneumococcal polysaccharide vaccine
  4. Human papillomavirus vaccine series Correct answer.

Explanation

HPV vaccination is routinely recommended at 11 to 12 years, with catch-up through age 26. Hepatitis B is typically completed in infancy or early childhood, and pneumococcal polysaccharide vaccine is not routine for healthy adolescents.

Question 20Physical characteristics of adolescents and their health care problems and needs

Which screening is recommended at the 11- to 12-year preventive visit for a healthy adolescent?

  1. Depression screening Correct answer.
  2. Routine cervical cancer screening
  3. Routine screening for dyslipidemia in all adolescents
  4. Universal screening for type 2 diabetes with hemoglobin A1c

Explanation

Universal depression screening is recommended for adolescents aged 12 and older. Lipid screening follows age-based recommendations rather than universal testing at 11 to 12, and cervical cancer screening begins later.

Question 21Physical characteristics of adolescents and their health care problems and needs

Which statement about confidentiality in adolescent health care is most accurate?

  1. Confidentiality should be discussed with the adolescent and guardian at the start of the visit Correct answer.
  2. Confidentiality does not apply to any aspect of adolescent care
  3. Parents must always be informed of all visit details
  4. Adolescents should never be interviewed without a parent present

Explanation

Clinicians should explain confidentiality and its limits (e.g., safety concerns) to both the adolescent and guardian, and provide time for the adolescent to be interviewed alone. This supports disclosure of sensitive health information.

Question 22Physical characteristics of adolescents and their health care problems and needs

A 15-year-old's BMI is at the 96th percentile for age and sex. Which classification is correct?

  1. Severe obesity
  2. Obesity Correct answer.
  3. Overweight
  4. Normal weight

Explanation

For adolescents, BMI at or above the 95th percentile is classified as obesity, while 85th to less than 95th percentile is overweight. Severe obesity is generally defined as at least 120% of the 95th percentile.

Question 23Physical characteristics of adolescents and their health care problems and needs

Which physical finding is most consistent with a normal variant in an adolescent with mild gynecomastia?

  1. Nipple retraction with bloody discharge
  2. Hard, fixed, unilateral mass with skin dimpling
  3. Tender subareolar tissue that is mobile and bilateral Correct answer.
  4. Rapidly enlarging mass over weeks

Explanation

Pubertal gynecomastia typically presents as mobile, tender, often bilateral subareolar tissue that resolves over time. Hard fixed masses, skin changes, or rapid growth warrant evaluation for other pathology.

Question 24Physical characteristics of adolescents and their health care problems and needs

A 14-year-old with a BMI at the 99th percentile has acanthosis nigricans and a strong family history of type 2 diabetes. Which screening is most appropriate?

  1. Lipid panel only
  2. Routine oral glucose tolerance testing for all adolescents
  3. Fasting glucose or hemoglobin A1c Correct answer.
  4. No screening until age 18

Explanation

Adolescents with obesity plus risk factors such as acanthosis nigricans or family history should be screened for type 2 diabetes with fasting glucose or hemoglobin A1c. Universal screening of all adolescents is not recommended.

Question 25Physical characteristics of adolescents and their health care problems and needs

Which finding on a routine adolescent physical exam most warrants further evaluation?

  1. A fixed, widely split second heart sound Correct answer.
  2. Mild physiologic splitting of the second heart sound
  3. A grade 1 to 2 soft systolic murmur without symptoms
  4. Sinus arrhythmia that varies with respiration

Explanation

A fixed, widely split S2 suggests an atrial septal defect, because the split does not vary with respiration. Soft murmurs, physiologic splitting, and sinus arrhythmia are common benign findings in adolescents.

Question 26Physical characteristics of adolescents and their health care problems and needs

At what age does the typical pubertal growth spurt begin in girls?

  1. Around age 8 years
  2. Around age 13 to 14 years
  3. Around age 16 years
  4. Around age 10 to 11 years Correct answer.

Explanation

In girls the growth spurt usually starts at about 10 to 11 years, roughly coinciding with early breast budding, and peak height velocity follows within about a year. Boys typically spurt about two years later.

Question 27Physical characteristics of adolescents and their health care problems and needs

Which Tanner stage description corresponds to a girl whose breasts show a small mound with enlargement of the areolar diameter but no separation of contour?

  1. Stage 3
  2. Stage 1
  3. Stage 4
  4. Stage 2 Correct answer.

Explanation

Tanner stage 2 breast development is the breast bud stage: a small mound with increased areolar diameter and no contour separation. Stage 3 adds further enlargement and areolar enlargement without a secondary mound.

Question 28Physical characteristics of adolescents and their health care problems and needs

A healthy 14-year-old boy is noted to have a testicular volume of 10 mL bilaterally. Which statement about his pubertal status is most accurate?

  1. He is in early puberty with testicular enlargement underway Correct answer.
  2. He has testicular atrophy
  3. He has completed puberty
  4. He is prepubertal

Explanation

Testicular volume of 4 mL or greater marks the onset of male puberty, and 10 mL indicates progression into mid-puberty. Adult testicular volume is typically 15 to 25 mL, so 10 mL reflects ongoing, not completed, puberty.

Question 29Physical characteristics of adolescents and their health care problems and needs

Which statement best describes the typical order of pubertal events in boys?

  1. Pubic hair, then voice change, then testicular enlargement
  2. Testicular enlargement, then penile growth, then pubic hair Correct answer.
  3. Voice deepening, then testicular enlargement, then pubic hair
  4. Penile growth, then testicular enlargement, then axillary hair

Explanation

Male puberty characteristically begins with testicular enlargement, followed by penile growth and later pubic hair, with voice change occurring relatively late. This sequence helps distinguish normal progression from disorders such as androgen exposure without gonadotropin activation.

Question 30Physical characteristics of adolescents and their health care problems and needs

A 15-year-old girl has not yet had menarche. Which additional finding would most strongly suggest a need for evaluation rather than simple observation?

  1. Absence of any breast development Correct answer.
  2. A mother who had menarche at age 14 years
  3. A recent growth spurt with height at the 75th percentile
  4. Tanner stage 4 breasts and Tanner stage 4 pubic hair

Explanation

Lack of breast development by age 13 to 14 suggests delayed puberty or hypogonadism and warrants evaluation, whereas isolated absence of menarche with normal secondary sexual development is usually observed longer. Menarche typically follows breast development by about two to two and a half years.

Question 31Physical characteristics of adolescents and their health care problems and needs

Which finding on a routine examination of a 16-year-old boy is most consistent with normal physiology?

  1. A hydrocele that transilluminates brightly and appeared suddenly with pain
  2. A firm, painless 3-cm testicular mass
  3. Asymmetric testes with the right testis slightly larger and lower Correct answer.
  4. A varicocele that does not decompress when supine

Explanation

Slight asymmetry in testicular size and position is common and benign in adolescents. A firm mass, a varicocele that does not empty when supine, or a sudden painful hydrocele each raise concern for tumor, retroperitoneal pathology, or acute torsion respectively.

Question 32Physical characteristics of adolescents and their health care problems and needs

Which statement about the pubertal growth spurt in boys compared with girls is most accurate?

  1. Boys and girls have identical timing and magnitude
  2. Boys spurt later but gain less total height
  3. Boys spurt later and gain more peak height velocity Correct answer.
  4. Boys spurt earlier and gain less height

Explanation

Boys typically begin their spurt about two years later than girls but have a higher peak height velocity and a longer growth period, resulting in greater adult height. The later onset means boys may still be growing into late adolescence.

Question 33Physical characteristics of adolescents and their health care problems and needs

Which body composition change is expected during normal male puberty?

  1. Increase in both lean mass and body fat percentage equally
  2. Decrease in lean body mass and increase in body fat percentage
  3. No change in either lean mass or fat distribution
  4. Increase in lean body mass with a decline in body fat percentage Correct answer.

Explanation

Androgens drive an increase in lean body mass and a relative decline in body fat percentage in boys. Girls, in contrast, gain a higher proportion of body fat during puberty.

Question 34Physical characteristics of adolescents and their health care problems and needs

A 12-year-old girl has a BMI at the 90th percentile for age and sex. Which classification is correct?

  1. Overweight Correct answer.
  2. Obesity
  3. Normal weight
  4. Severe obesity

Explanation

For children and adolescents aged 2 to 18 years, a BMI at or above the 85th and below the 95th percentile is classified as overweight. Obesity begins at the 95th percentile and severe obesity at 120 percent of the 95th percentile.

Question 35Physical characteristics of adolescents and their health care problems and needs

Which laboratory screening is recommended for an adolescent with obesity and risk factors such as family history of diabetes or signs of insulin resistance?

  1. Complete blood count
  2. Serum amylase
  3. Fasting lipid panel only
  4. Fasting glucose or hemoglobin A1c Correct answer.

Explanation

Guidelines recommend screening adolescents with obesity and additional risk factors for type 2 diabetes using fasting glucose, an oral glucose tolerance test, or hemoglobin A1c. Lipids are also checked but do not address the diabetes risk.

Question 36Physical characteristics of adolescents and their health care problems and needs

Which statement about the timing of menarche relative to other pubertal events is most accurate?

  1. Menarche occurs simultaneously with breast budding
  2. Menarche occurs after peak height velocity, usually near the end of the growth spurt Correct answer.
  3. Menarche occurs before any pubic hair growth
  4. Menarche precedes the peak growth spurt by about two years

Explanation

Menarche typically follows peak height velocity by roughly one year and occurs late in the pubertal sequence, after most linear growth is complete. This is why girls who reach menarche early tend to be shorter as adults.

Question 37Physical characteristics of adolescents and their health care problems and needs

A 13-year-old boy has pubic hair growth but no testicular enlargement. Which explanation is most likely?

  1. Complete androgen insensitivity
  2. Normal progression of puberty
  3. Premature adrenarche or an androgen source independent of gonadarche Correct answer.
  4. Constitutional delay of growth and puberty

Explanation

Pubic hair developing without testicular enlargement suggests androgen effect without activation of the gonadal axis, such as premature adrenarche or an exogenous or adrenal androgen source. Normal puberty begins with testicular enlargement before pubic hair.

Question 38Physical characteristics of adolescents and their health care problems and needs

Which statement about the age at which puberty is considered precocious in boys is most accurate?

  1. Before age 12 years
  2. Before age 9 years Correct answer.
  3. Before age 10 years
  4. Before age 8 years

Explanation

Precocious puberty in boys is defined as onset before age 9, whereas in girls the threshold is before age 8. Boys with precocious puberty have a higher likelihood of an underlying central nervous system cause and warrant imaging.

Question 39Physical characteristics of adolescents and their health care problems and needs

A 16-year-old presents with primary amenorrhea, normal breast development, and cyclic pelvic pain. Which diagnosis should be considered first?

  1. Turner syndrome
  2. Polycystic ovary syndrome
  3. Imperforate hymen or other outflow tract obstruction Correct answer.
  4. Constitutional delay of puberty

Explanation

Normal breast development indicates estrogen production, and cyclic pain with amenorrhea suggests menstrual outflow obstruction such as an imperforate hymen or transverse vaginal septum. Turner syndrome and constitutional delay would typically present with absent or delayed breast development.

Question 40Physical characteristics of adolescents and their health care problems and needs

Which physical finding is most characteristic of normal spermarche in an adolescent boy?

  1. Blood in the urine
  2. Testicular volume below 4 mL
  3. Painful ejaculation
  4. Nocturnal emissions beginning in mid-puberty Correct answer.

Explanation

Spermarche, marked by the onset of nocturnal emissions, typically occurs in mid-puberty when testicular volume is around 10 to 12 mL. It is a normal milestone and does not require evaluation.

Question 41Physical characteristics of adolescents and their health care problems and needs

Which statement about acne in adolescents is most accurate?

  1. It is unrelated to pubertal androgen production
  2. It typically begins in early puberty and is driven by androgen-mediated sebum production Correct answer.
  3. It is caused primarily by poor hygiene
  4. It occurs only in adolescents with elevated testosterone levels

Explanation

Acne results from androgen-driven sebum production, follicular hyperkeratinization, and Cutibacterium acnes colonization, and commonly begins in early puberty. It occurs at normal androgen levels in most adolescents and is not caused by hygiene.

Question 42Physical characteristics of adolescents and their health care problems and needs

A 14-year-old girl reports that her acne has worsened and she has developed coarse facial hair and deepening of her voice over six months. Which evaluation is most appropriate?

  1. Evaluation for an androgen excess disorder with targeted laboratory testing Correct answer.
  2. Reassurance that these are normal pubertal changes
  3. A trial of a topical retinoid alone
  4. Screening for eating disorders

Explanation

Rapid virilization, including voice deepening and coarse facial hair, is not a normal pubertal change and suggests an androgen excess disorder such as an adrenal or ovarian tumor or nonclassic congenital adrenal hyperplasia. Targeted testing, including androgen levels, is indicated.

Question 43Physical characteristics of adolescents and their health care problems and needs

Which statement about thelarche in girls is most accurate?

  1. It is typically the first sign of puberty, appearing around age 9 to 11 Correct answer.
  2. It occurs simultaneously with the growth spurt in all girls
  3. It usually occurs after menarche
  4. It is absent in girls with normal puberty

Explanation

Breast budding is usually the first visible sign of puberty in girls, typically between ages 9 and 11, and precedes menarche by about two to two and a half years. The growth spurt generally begins around the same period.

Question 44Physical characteristics of adolescents and their health care problems and needs

Which finding on a routine adolescent physical examination most warrants further evaluation?

  1. A systolic murmur that varies with position and disappears when sitting
  2. A fixed, loud systolic murmur that radiates to the back Correct answer.
  3. Physiologic splitting of S2 that varies with respiration
  4. Mild thoracic kyphosis that corrects with standing

Explanation

A fixed, loud murmur radiating to the back raises concern for structural heart disease such as coarctation or a shunt lesion and warrants echocardiography. Positional murmurs and physiologic splitting are typical benign findings.

Question 45Physical characteristics of adolescents and their health care problems and needs

Which statement about scoliosis screening in adolescents is most accurate?

  1. It is recommended for all adolescents at every visit
  2. It is recommended only after age 18 years
  3. It is recommended for girls at ages 10 and 12 and boys at ages 13 and 14 Correct answer.
  4. It is not recommended at any age

Explanation

Adolescent idiopathic scoliosis screening with the forward bend test is recommended for girls at ages 10 and 12 and for boys at ages 13 and 14, when the condition is most likely to become apparent. Screening beyond these ages has lower yield.

Question 46Physical characteristics of adolescents and their health care problems and needs

A 15-year-old athlete has a body mass index at the 10th percentile and reports fatigue and cold intolerance. Which finding would most strongly suggest an eating disorder requiring urgent evaluation?

  1. Regular menstrual cycles
  2. Bradycardia with orthostatic dizziness Correct answer.
  3. A normal physical examination
  4. A stated desire to eat more frequently

Explanation

Bradycardia, orthostatic symptoms, fatigue, and cold intolerance in a low-weight adolescent suggest malnutrition and possible eating disorder with medical instability. These findings warrant prompt assessment of vital signs, electrolytes, and weight trends.

Question 47Physical characteristics of adolescents and their health care problems and needs

Which statement about blood pressure measurement in adolescents is most accurate?

  1. The diagnosis requires elevated readings on at least three separate occasions Correct answer.
  2. Adolescent hypertension is always secondary
  3. A single elevated reading establishes hypertension
  4. Blood pressure should be measured only if symptoms are present

Explanation

Hypertension in adolescents is diagnosed when elevated readings are confirmed on at least three separate occasions, ideally with the proper cuff size and the patient seated. Single elevated readings may reflect anxiety or improper technique.

Question 48Physical characteristics of adolescents and their health care problems and needs

Which statement about the male genital examination in an adolescent is most accurate?

  1. It is unnecessary after age 15 years
  2. It should be performed only by a urologist
  3. It should be omitted unless the patient reports symptoms
  4. It should include inspection and palpation of the testes and evaluation for varicocele Correct answer.

Explanation

The examination includes inspection of the penis and scrotum, palpation of the testes, and assessment for varicocele, hydrocele, and hernia. It is part of routine preventive care and can detect testicular cancer and other treatable conditions.

Question 49Physical characteristics of adolescents and their health care problems and needs

Which statement about the timing of pubertal onset in girls in the United States is most accurate?

  1. Thelarche typically begins between ages 8 and 13 years Correct answer.
  2. Thelarche typically begins between ages 13 and 15 years
  3. Thelarche typically begins before age 6 years
  4. Thelarche typically begins after menarche

Explanation

Breast budding in girls typically begins between ages 8 and 13, with the average around 9 to 10 years. Onset before age 8 suggests precocious puberty and warrants evaluation.

Question 50Physical characteristics of adolescents and their health care problems and needs

A 13-year-old girl has a BMI at the 97th percentile and acanthosis nigricans. Which additional finding most supports insulin resistance?

  1. Fasting insulin elevation with normal fasting glucose Correct answer.
  2. Elevated hemoglobin
  3. Normal fasting glucose with normal lipid panel
  4. Low blood pressure

Explanation

Acanthosis nigricans with an elevated fasting insulin level supports insulin resistance, which may precede overt glucose abnormalities. Fasting glucose may remain normal early in the course, so insulin measurement can be informative.