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ABIM Adolescent study materials
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ABIM Adolescent practice questions

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Question 1Normal Adolescent Growth, Development, and Psychosocial Milestones

An 11-year-old girl is evaluated for pubertal development. Which finding is the earliest reliable sign of central puberty?

  1. Breast budding (thelarche) Correct answer.
  2. Pubic hair growth
  3. Menarche
  4. Axillary hair growth

Explanation

Thelarche is usually the first physical sign of central puberty in girls, typically appearing between ages 8 and 13. Pubic hair may reflect adrenarche and can precede or follow breast development. Menarche is a late pubertal event that occurs after peak height velocity.

Question 2Normal Adolescent Growth, Development, and Psychosocial Milestones

In boys, the first physical sign of gonadarche is best assessed by which finding?

  1. Pubic hair development
  2. Voice deepening
  3. Testicular volume ≥4 mL Correct answer.
  4. Peak height velocity

Explanation

Enlargement of the testes to at least 4 mL is the first physical sign of central puberty in boys. Pubic hair can be due to adrenal androgen production. Voice change and the growth spurt occur later in puberty.

Question 3Normal Adolescent Growth, Development, and Psychosocial Milestones

According to Erikson, the central psychosocial task of adolescence is which of the following?

  1. Trust versus mistrust
  2. Industry versus inferiority
  3. Identity versus confusion Correct answer.
  4. Intimacy versus isolation

Explanation

Erikson described adolescence as the stage of identity versus role confusion, when the young person integrates self-concepts and social roles. Industry versus inferiority belongs to school-age development. Intimacy versus isolation is the task of young adulthood.

Question 4Normal Adolescent Growth, Development, and Psychosocial Milestones

A 15-year-old argues that moral rules can be changed if they harm people. This reasoning is most consistent with which Piagetian stage?

  1. Formal operational Correct answer.
  2. Concrete operational
  3. Preoperational
  4. Sensorimotor

Explanation

Formal operational thought typically emerges around age 11 or 12 and enables abstract, hypothetical, and flexible moral reasoning. Concrete operational children reason mainly about tangible situations. Preoperational thought is characterized by symbolic and egocentric thinking.

Question 5Normal Adolescent Growth, Development, and Psychosocial Milestones

A 16-year-old reports difficulty falling asleep before midnight and sleeping until 10 AM on weekends. This pattern most likely represents which of the following?

  1. Sleep terrors
  2. Obstructive sleep apnea
  3. Narcolepsy
  4. Physiologic sleep phase delay Correct answer.

Explanation

Adolescents commonly show a circadian phase delay with later sleep onset and later wake times. This is physiologic but can lead to insufficient sleep on school days. Narcolepsy involves irresistible sleep attacks, and obstructive sleep apnea involves snoring or breathing pauses.

Question 6Normal Adolescent Growth, Development, and Psychosocial Milestones

In a healthy adolescent girl, menarche typically occurs how long after thelarche?

  1. 2 to 2.5 years Correct answer.
  2. 1 year
  3. 5 years
  4. 6 months

Explanation

Menarche usually follows thelarche by about 2 to 2.5 years, generally during Tanner breast stage 3 or 4. It occurs after peak height velocity. An interval of 5 years would be unusually long.

Question 7Normal Adolescent Growth, Development, and Psychosocial Milestones

In girls, peak height velocity during puberty usually occurs at which time?

  1. After Tanner stage 5
  2. After menarche
  3. Before menarche Correct answer.
  4. At thelarche

Explanation

Girls' peak height velocity typically occurs about 6 to 12 months before menarche. Growth decelerates after menarche and is largely complete within 2 years. This makes menarche a late marker of pubertal growth.

Question 8Normal Adolescent Growth, Development, and Psychosocial Milestones

A 14.5-year-old boy has no testicular enlargement or pubic hair. Which definition best characterizes delayed puberty?

  1. No growth spurt by 13 years
  2. Absence of testicular enlargement by 14 years Correct answer.
  3. Testicular volume <10 mL at 14 years
  4. No pubic hair by 12 years

Explanation

Delayed puberty in boys is conventionally defined as absence of testicular enlargement to at least 4 mL by age 14. This threshold is about 2 standard deviations beyond the mean. Pubic hair alone is less reliable because adrenarche varies.

Question 9Normal Adolescent Growth, Development, and Psychosocial Milestones

Which age thresholds define precocious puberty?

  1. Girls <8 years; boys <9 years Correct answer.
  2. Girls <9 years; boys <10 years
  3. Girls <7 years; boys <8 years
  4. Girls <10 years; boys <11 years

Explanation

Precocious puberty is defined as secondary sexual development before age 8 in girls or before age 9 in boys. Pubic hair alone may represent premature adrenarche rather than central puberty. Menarche and voice change are later events and are not used for this definition.

Question 10Normal Adolescent Growth, Development, and Psychosocial Milestones

A 13-year-old girl's father is 180 cm and mother is 165 cm. What is her mid-parental height target?

  1. 169 cm
  2. 166 cm Correct answer.
  3. 172.5 cm
  4. 179.5 cm

Explanation

For girls, mid-parental height is calculated as (father's height + mother's height − 13 cm) ÷ 2. Using these values: (180 + 165 − 13) ÷ 2 = 166 cm. This value estimates a genetic target, not a guaranteed adult height.

Question 11Normal Adolescent Growth, Development, and Psychosocial Milestones

Which description corresponds to Tanner pubic hair stage 4?

  1. Sparse, long, slightly pigmented hair
  2. Moderately dark, curly hair over the pubis
  3. Prepubertal, no pubic hair
  4. Coarse curly hair beyond the pubic triangle Correct answer.

Explanation

Stage 4 pubic hair is coarse and curly and extends beyond the mons pubis but not to the thighs. Stage 2 hair is sparse and slightly pigmented. Stage 3 hair is darker and begins to curl, while stage 5 extends to the thighs.

Question 12Normal Adolescent Growth, Development, and Psychosocial Milestones

A 14-year-old boy notices bilateral breast enlargement. He is Tanner genital stage 4. What is the most likely diagnosis?

  1. Pubertal gynecomastia Correct answer.
  2. Klinefelter syndrome
  3. Prolactinoma
  4. Breast cancer

Explanation

Pubertal gynecomastia is common and peaks in Tanner stages 3 to 4. It results from a temporary estrogen-androgen imbalance and usually resolves within 1 to 2 years. Klinefelter syndrome should be considered if small testes, tall stature, or persistence are present.

Question 13Normal Adolescent Growth, Development, and Psychosocial Milestones

Which statement best explains the irregular menstrual cycles often seen in the first 1 to 2 years after menarche?

  1. Immature HPO feedback causes anovulation Correct answer.
  2. Endometrial hyperplasia is universal
  3. Progesterone levels are persistently high
  4. Ovarian failure causes low estrogen

Explanation

Early cycles are often anovulatory because the hypothalamic-pituitary-ovarian axis is still maturing. This immaturity can cause irregular bleeding. Ovarian failure would cause hypoestrogenism and often delayed puberty rather than typical postmenarchal irregularity.

Question 14Normal Adolescent Growth, Development, and Psychosocial Milestones

Parent-adolescent conflict over autonomy typically follows which pattern?

  1. It is absent in healthy families
  2. It is higher in girls at all ages
  3. It peaks in early adolescence Correct answer.
  4. It peaks in late adolescence

Explanation

Mild conflict over autonomy typically increases in early adolescence and then declines. Severe or persistent conflict is not normative. Consistent gender differences across all ages are not well established.

Question 15Normal Adolescent Growth, Development, and Psychosocial Milestones

Increased risk-taking in adolescence is best explained by which of the following?

  1. Earlier maturation of reward than control circuits Correct answer.
  2. Absence of synaptic pruning
  3. Lower sensitivity to peer influence
  4. Complete maturation of the prefrontal cortex

Explanation

The limbic reward system matures earlier than prefrontal control regions, contributing to sensation-seeking. Peer presence can amplify reward sensitivity. This mismatch is normative and does not indicate pathology.

Question 16Normal Adolescent Growth, Development, and Psychosocial Milestones

A 14-year-old boy with short stature has a bone age of 11 years and delayed pubic hair. His height velocity is normal. Which is most likely?

  1. Growth hormone deficiency
  2. Constitutional delay of puberty Correct answer.
  3. Precocious puberty
  4. Primary hypothyroidism

Explanation

Constitutional delay of growth and puberty shows delayed bone age, normal growth velocity, and often a family history of late puberty. Growth hormone deficiency often has decreased height velocity. Precocious puberty would advance bone age rather than delay it.

Question 17Normal Adolescent Growth, Development, and Psychosocial Milestones

In boys, peak height velocity most typically occurs at which Tanner genital stage?

  1. Stage 1
  2. Stage 4 Correct answer.
  3. Stage 5
  4. Stage 2

Explanation

Boys' peak height velocity usually occurs at genital stage 4, roughly 2 years after the start of testicular enlargement. This is later than the timing of the growth spurt relative to breast development in girls. Growth velocity then slows as boys approach stage 5.

Question 18Normal Adolescent Growth, Development, and Psychosocial Milestones

The secular trend in menarche refers to which of the following?

  1. Earlier menarche over recent generations Correct answer.
  2. Later menarche in urban populations
  3. Earlier menarche in malnourished girls
  4. A fixed age across populations

Explanation

The secular trend describes a decline in the average age of menarche over the past century, linked to improved nutrition and health. It has plateaued in many high-income countries. Malnutrition tends to delay menarche rather than advance it.

Question 19Normal Adolescent Growth, Development, and Psychosocial Milestones

Which statement about sexual identity development in adolescence is most accurate?

  1. Same-sex attraction always indicates gender dysphoria
  2. Most sexual minority youth disclose to parents before age 12
  3. Sexual orientation is usually fixed in early childhood and cannot evolve
  4. Questioning and disclosure are normal with variable timing Correct answer.

Explanation

Sexual identity development, including questioning and disclosure, is a normative process with wide variation in timing. Sexual orientation is distinct from gender identity. Disclosure may be delayed for safety or social reasons.

Question 20Normal Adolescent Growth, Development, and Psychosocial Milestones

A 13-year-old is convinced that everyone is watching her new haircut and that no one can understand her feelings. This is best described as which of the following?

  1. Imaginary audience Correct answer.
  2. Separation anxiety
  3. Oppositional defiance
  4. Concrete operational thinking

Explanation

Elkind described the imaginary audience as the belief that others are intensely focused on oneself. The personal fable is the related belief that one's experiences are unique and not understood by others. These features of adolescent egocentrism are normative and usually diminish with age.

Question 21Adolescent Health Maintenance, Screening, and Immunization

A 12-year-old girl with no immunocompromising conditions receives her first dose of the 9-valent human papillomavirus (HPV) vaccine. When should the second dose be given?

  1. One month after the first dose
  2. Six to twelve months after the first dose Correct answer.
  3. Two months after the first dose
  4. Twenty-four months after the first dose

Explanation

Adolescents who start the HPV series before age 15 need two doses, with the second dose given 6 to 12 months after the first and no earlier than 5 months. The 0-, 1- to 2-, and 6-month three-dose schedule is reserved for immunocompromised patients and for those who begin vaccination at age 15 or older.

Question 22Adolescent Health Maintenance, Screening, and Immunization

A 16-year-old has documentation of a MenACWY vaccine at age 11 and no other doses. What is the recommended next step?

  1. Give a MenACWY booster at age 18
  2. No further meningococcal vaccination is needed
  3. Restart the primary series with two doses
  4. Give a MenACWY booster now Correct answer.

Explanation

MenACWY is given at 11 or 12 years with a booster at 16 years, because protection wanes and 16 to 18 years is the period of highest meningococcal risk. A first dose at 16 years or older does not require a booster.

Question 23Adolescent Health Maintenance, Screening, and Immunization

A 14-year-old has completed the DTaP series but has never received Tdap. What should be given at this visit?

  1. Td only
  2. Defer until age 18
  3. Restart the DTaP primary series
  4. Tdap now Correct answer.

Explanation

Tdap is recommended at 11 or 12 years for all adolescents, and catch-up vaccination should occur at the next visit for anyone who has not received it. Tdap replaces one Td booster and does not require restarting the primary series.

Question 24Adolescent Health Maintenance, Screening, and Immunization

Which vaccine is recommended annually for all adolescents without contraindications?

  1. Meningococcal conjugate vaccine
  2. Hepatitis A vaccine
  3. Influenza vaccine Correct answer.
  4. Pneumococcal conjugate vaccine

Explanation

Annual influenza vaccination is recommended for everyone 6 months and older, including all adolescents, unless contraindicated. The other vaccines listed are given on risk-based or age-based schedules rather than annually.

Question 25Adolescent Health Maintenance, Screening, and Immunization

A 19-year-old sexually active woman has no symptoms. Which test is recommended annually for her age group?

  1. Herpes culture
  2. Chlamydia NAAT Correct answer.
  3. Syphilis serology
  4. Trichomonas NAAT

Explanation

Annual chlamydia screening is recommended for sexually active women 24 years and younger, regardless of symptoms, because most infections are asymptomatic. Syphilis, trichomonas, and herpes testing are risk-based rather than routine at this age.

Question 26Adolescent Health Maintenance, Screening, and Immunization

The USPSTF recommends routine screening for major depressive disorder in which age range?

  1. Only when symptoms are reported
  2. 12 through 18 years Correct answer.
  3. 19 through 24 years
  4. 6 through 11 years

Explanation

The USPSTF recommends screening for major depressive disorder in adolescents 12 through 18 years, with systems in place for accurate diagnosis and treatment. Screening younger children or adults falls outside this recommendation.

Question 27Adolescent Health Maintenance, Screening, and Immunization

A 22-year-old woman has never received HPV vaccine. What is recommended?

  1. Vaccinate through age 26 Correct answer.
  2. Vaccinate only if HPV DNA testing is positive
  3. Vaccinate only through age 18
  4. Vaccinate routinely through age 45

Explanation

HPV vaccination is recommended through age 26 for all people who are not adequately vaccinated, using a three-dose schedule when the series begins at 15 years or older. Routine vaccination is not recommended after age 26; shared clinical decision-making applies from 27 through 45 years.

Question 28Adolescent Health Maintenance, Screening, and Immunization

A healthy 17-year-old college freshman has completed MenACWY. What is the recommendation for serogroup B meningococcal vaccine?

  1. Routine administration at 11 to 12 years
  2. Contraindicated after age 18
  3. Shared clinical decision-making for ages 16 through 23 Correct answer.
  4. Indicated only for asplenia

Explanation

MenB vaccine is not part of the routine adolescent schedule; it is recommended for persons 16 through 23 years on the basis of shared clinical decision-making, and for those at increased risk at any age. MenACWY remains the routine meningococcal vaccine at 11 to 12 years with a booster at 16.

Question 29Adolescent Health Maintenance, Screening, and Immunization

A 16-year-old had a normal lipid panel at age 10. What does universal screening recommend now?

  1. No further screening until adulthood
  2. Repeat the panel now
  3. Annual fasting lipid panels
  4. Repeat once between ages 17 and 21 Correct answer.

Explanation

Universal lipid screening is recommended once between 9 and 11 years and again between 17 and 21 years. A normal panel at age 10 does not eliminate the need for the second screen in late adolescence.

Question 30Adolescent Health Maintenance, Screening, and Immunization

USPSTF recommends screening for anxiety in which age range?

  1. 3 through 7 years
  2. 8 through 18 years Correct answer.
  3. 19 through 25 years
  4. 12 through 18 years

Explanation

The USPSTF recommends screening for anxiety in children and adolescents 8 through 18 years. Screening younger children is not recommended because of insufficient evidence, and adults have separate recommendations.

Question 31Adolescent Health Maintenance, Screening, and Immunization

Which validated instrument screens adolescents for substance use?

  1. PHQ-A
  2. SCARED
  3. Vanderbilt scale
  4. CRAFFT Correct answer.

Explanation

The CRAFFT is a brief validated screener designed for adolescents and covers alcohol and drug use. The PHQ-A, SCARED, and Vanderbilt instruments screen for depression, anxiety, and ADHD, respectively.

Question 32Adolescent Health Maintenance, Screening, and Immunization

A 17-year-old is sexually active. What is the USPSTF recommendation for HIV screening?

  1. Test only if symptoms suggest acute infection
  2. Screen annually regardless of risk
  3. Screen at least once between ages 15 and 65 Correct answer.
  4. Test only before age 18

Explanation

The USPSTF recommends that all adolescents and adults aged 15 to 65 years be screened for HIV at least once, with more frequent screening for those at increased risk. Testing only when symptoms appear misses the long asymptomatic phase of infection.

Question 33Adolescent Health Maintenance, Screening, and Immunization

How often should blood pressure be measured at health maintenance visits for a healthy adolescent?

  1. At least once each year Correct answer.
  2. Only if there is a family history of hypertension
  3. Only at the 18-year visit
  4. Once between ages 11 and 14

Explanation

Blood pressure should be measured at least annually at health maintenance visits beginning at age 3 and compared with age-, sex-, and height-specific percentiles. Selective measurement based on family history or a single age would miss many cases of hypertension.

Question 34Adolescent Health Maintenance, Screening, and Immunization

A 15-year-old passed newborn hearing screening and has no risk factors. What screening is recommended?

  1. Testing only if symptoms are reported
  2. Annual audiometry
  3. No further hearing screening
  4. At least once during ages 11 through 21 Correct answer.

Explanation

Hearing screening is recommended at least once during each of the adolescent age periods: 11 through 14, 15 through 17, and 18 through 21 years. A normal newborn screen does not eliminate the need for later screening.

Question 35Adolescent Health Maintenance, Screening, and Immunization

When should average-risk cervical cancer screening begin?

  1. At age 21 Correct answer.
  2. At age 18
  3. At first sexual intercourse
  4. At age 25

Explanation

Cervical cancer screening begins at age 21 in average-risk women regardless of the age at first sexual activity. Screening before 21 is not recommended because cervical cancer is rare and HPV infection is usually transient in adolescents.

Question 36Adolescent Health Maintenance, Screening, and Immunization

A 20-year-old woman reports multiple sexual partners. Which screening is recommended annually?

  1. HPV DNA testing
  2. HSV-2 serology
  3. Bacterial vaginosis testing
  4. Gonorrhea screening Correct answer.

Explanation

Sexually active women 24 years or younger, and older women at increased risk, should be screened annually for gonorrhea. Serology for HSV, testing for bacterial vaginosis, and HPV DNA testing are not routine annual screening tests in this scenario.

Question 37Adolescent Health Maintenance, Screening, and Immunization

A 15-year-old with HIV has not received HPV vaccine. Which schedule is recommended?

  1. Three doses at 0, 1 to 2, and 6 months Correct answer.
  2. Four doses at 0, 2, 6, and 12 months
  3. Two doses 6 to 12 months apart
  4. One dose

Explanation

Patients with immunocompromising conditions, including HIV, need the three-dose HPV schedule at 0, 1 to 2, and 6 months regardless of the age at initiation. The two-dose schedule is only for healthy patients who start before age 15.

Question 38Adolescent Health Maintenance, Screening, and Immunization

An 18-year-old has a terminal complement deficiency. Which meningococcal vaccines are indicated?

  1. Both MenACWY and MenB Correct answer.
  2. Neither vaccine
  3. MenACWY only
  4. MenB only

Explanation

Persons with terminal complement deficiency or asplenia are at high risk for invasive meningococcal disease and should receive both MenACWY and MenB vaccines. Neither vaccine alone covers all pathogenic serogroups.

Question 39Adolescent Health Maintenance, Screening, and Immunization

A 19-year-old man who has sex with men reports receptive anal intercourse and a negative urine NAAT. What additional screening is recommended?

  1. Urethral culture for gonorrhea
  2. No further testing
  3. HSV-2 serology
  4. Rectal NAAT for chlamydia and gonorrhea Correct answer.

Explanation

Sexually active men who have sex with men should be screened annually for chlamydia and gonorrhea at all exposed sites, including the rectum and pharynx, because urine NAAT alone can miss extragenital infections. Rectal NAAT is the appropriate additional test in this scenario.

Question 40Adolescent Health Maintenance, Screening, and Immunization

A 13-year-old has no history of varicella and has never been vaccinated. How should varicella vaccine be given?

  1. One dose
  2. Two doses 6 to 12 months apart
  3. Two doses 4 to 8 weeks apart Correct answer.
  4. Three doses at 0, 2, and 6 months

Explanation

Adolescents 13 years and older without evidence of varicella immunity should receive two doses of varicella vaccine 4 to 8 weeks apart. A single dose is recommended only for children younger than 13.

Question 41Adolescent Mental Health and Behavioral Disorders

Which medication is the most appropriate first-line pharmacologic treatment for a 15-year-old with major depressive disorder?

  1. Venlafaxine
  2. Amitriptyline
  3. Fluoxetine Correct answer.
  4. Paroxetine

Explanation

Fluoxetine has the strongest evidence base in adolescents and is FDA-approved for major depressive disorder in patients aged 8 to 18 years; escitalopram is the other approved option. Treatment should pair medication with cognitive behavioral therapy or interpersonal psychotherapy. Agents with less favorable youth safety data or higher overdose toxicity are reserved for later lines.

Question 42Adolescent Mental Health and Behavioral Disorders

The US Preventive Services Task Force recommends that all adolescents aged 12 to 18 years receive routine screening for which condition?

  1. Type 2 diabetes
  2. Latent tuberculosis infection
  3. Iron-deficiency anemia
  4. Major depressive disorder Correct answer.

Explanation

The USPSTF recommends screening all adolescents aged 12 to 18 years for major depressive disorder, with systems in place for accurate diagnosis, treatment, and follow-up. The American Academy of Pediatrics similarly endorses depression screening at annual well visits. Screening is not routinely recommended at this age for the other conditions listed.

Question 43Adolescent Mental Health and Behavioral Disorders

For a diagnosis of bipolar I disorder, a manic episode must last at least how long unless hospitalization is required?

  1. 4 weeks
  2. 4 days
  3. 24 hours
  4. 7 days Correct answer.

Explanation

A manic episode requires elevated, expansive, or irritable mood with increased energy lasting at least 1 week, or any duration if hospitalization is necessary. A duration of at least 4 days defines hypomania rather than mania. The distinction matters because only mania establishes bipolar I disorder.

Question 44Adolescent Mental Health and Behavioral Disorders

Which class of medication is first-line pharmacotherapy for attention-deficit/hyperactivity disorder in adolescents?

  1. Stimulants Correct answer.
  2. Alpha-2 agonists
  3. Atomoxetine
  4. Selective serotonin reuptake inhibitors

Explanation

Stimulants (methylphenidate and amphetamine formulations) have the largest effect sizes and are recommended first-line for ADHD across the lifespan. Atomoxetine and alpha-2 agonists are second-line or adjunctive options, often chosen when stimulant misuse risk or comorbid conditions influence the plan. Monitoring includes growth, blood pressure, and misuse or diversion.

Question 45Adolescent Mental Health and Behavioral Disorders

Which medication should be avoided in a 16-year-old with bulimia nervosa because it lowers the seizure threshold?

  1. Bupropion Correct answer.
  2. Fluoxetine
  3. Sertraline
  4. Topiramate

Explanation

Bupropion is contraindicated in bulimia nervosa because purging-related electrolyte disturbances combined with bupropion's proconvulsant effect substantially raise seizure risk. When an antidepressant is indicated in bulimia nervosa, a selective serotonin reuptake inhibitor such as fluoxetine is preferred. Purging behaviors should be clarified before prescribing any agent.

Question 46Adolescent Mental Health and Behavioral Disorders

Which validated screening instrument is designed specifically for substance use in adolescents?

  1. CAGE questionnaire
  2. AUDIT-C
  3. CRAFFT Correct answer.
  4. Mini-Mental State Examination

Explanation

CRAFFT is a six-item screen developed and validated for adolescents, covering Car, Relax, Alone, Forget, Family or Friends, and Trouble. It performs well in pediatric primary care and is recommended by the American Academy of Pediatrics. The CAGE and AUDIT-C were developed primarily in adult populations.

Question 47Adolescent Mental Health and Behavioral Disorders

Which electrolyte disturbance is most characteristic of refeeding syndrome in a patient treated for anorexia nervosa?

  1. Hypercalcemia
  2. Hyperkalemia
  3. Hypernatremia
  4. Hypophosphatemia Correct answer.

Explanation

Refeeding syndrome is driven by a surge of insulin that drives phosphate, potassium, and magnesium intracellularly, producing hypophosphatemia as the hallmark abnormality. It can cause arrhythmias, heart failure, seizures, and rhabdomyolysis. Refeeding must start low and advance slowly with electrolyte monitoring and thiamine supplementation.

Question 48Adolescent Mental Health and Behavioral Disorders

A 16-year-old started risperidone 5 days ago and now has a temperature of 40°C, diffuse muscle rigidity, confusion, and a creatine kinase of 4,000 U/L. What is the most appropriate immediate step?

  1. Start an SSRI for agitation
  2. Add benztropine for rigidity
  3. Increase the risperidone dose
  4. Stop the antipsychotic Correct answer.

Explanation

Fever, lead-pipe rigidity, autonomic instability, altered mental status, and markedly elevated creatine kinase after antipsychotic initiation indicate neuroleptic malignant syndrome. The essential first step is immediate discontinuation of the offending agent with aggressive supportive care, cooling, and hydration. Dantrolene or bromocriptine may be added in severe or refractory cases.

Question 49Adolescent Mental Health and Behavioral Disorders

Which psychotherapy is first-line for obsessive-compulsive disorder in adolescents?

  1. Exposure and response prevention Correct answer.
  2. Psychodynamic psychotherapy
  3. Dialectical behavior therapy
  4. Motivational interviewing

Explanation

Exposure and response prevention, a form of cognitive behavioral therapy, is the best-supported first-line treatment for pediatric OCD, alone for mild disease and combined with an SSRI for moderate to severe disease. It targets the fear hierarchy while blocking compulsive rituals. The other modalities lack evidence for OCD.

Question 50Adolescent Mental Health and Behavioral Disorders

Which treatment is first-line for posttraumatic stress disorder in adolescents?

  1. Benzodiazepines
  2. Trauma-focused cognitive behavioral therapy Correct answer.
  3. Atypical antipsychotics
  4. Beta blockers

Explanation

Trauma-focused cognitive behavioral therapy is the best-evidenced first-line treatment for pediatric PTSD and addresses trauma narratives, gradual exposure, and caregiver involvement. SSRIs are considered when psychotherapy is unavailable or insufficient. Medications that blunt arousal are not recommended as initial therapy.