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ABP Adolescent study materials
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ABP Adolescent practice questions

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Question 1Normal Adolescent Growth, Development, and Puberty

Which physical change is usually the first sign of puberty in girls?

  1. First menstrual period
  2. Breast budding Correct answer.
  3. Axillary hair growth
  4. Pubic hair growth

Explanation

Thelarche, or breast budding, is the typical first visible sign of puberty in girls and usually appears between ages 8 and 13. Pubic and axillary hair reflect adrenal androgen exposure and may appear before, during, or after breast development. Menarche is a late pubertal event that follows breast budding by roughly two years.

Question 2Normal Adolescent Growth, Development, and Puberty

Which finding marks the onset of gonadarche in boys?

  1. Progressive deepening of the voice from laryngeal growth
  2. Onset of nocturnal emissions
  3. Appearance of facial and body hair
  4. Testicular volume of at least 4 mL Correct answer.

Explanation

In boys, gonadarche is recognized clinically by testicular enlargement, conventionally a volume of 4 mL or a long axis of 2.5 cm. Voice change, facial hair, and nocturnal emissions are later androgen-mediated events that follow testicular growth by months to years.

Question 3Normal Adolescent Growth, Development, and Puberty

In a typical girl, how long after thelarche does menarche occur?

  1. 24 months Correct answer.
  2. 12 months
  3. 6 months
  4. 72 months

Explanation

Menarche usually follows thelarche by about 2 to 2.5 years, generally at Tanner breast stage 3 or 4. Growth velocity slows after menarche, and only a modest amount of additional height is gained.

Question 4Normal Adolescent Growth, Development, and Puberty

Which hormone increases during adrenarche?

  1. Testosterone from testicular Leydig cells
  2. Luteinizing hormone from the pituitary
  3. DHEAS from the zona reticularis Correct answer.
  4. Estradiol from ovarian granulosa cells

Explanation

Adrenarche is maturation of the adrenal zona reticularis, which begins secreting increasing amounts of DHEAS and other weak androgens around ages 6 to 8. These androgens drive pubic and axillary hair growth and are independent of gonadarche.

Question 5Normal Adolescent Growth, Development, and Puberty

Which statement about peak height velocity is correct?

  1. It occurs at approximately the same age in both sexes
  2. It typically precedes thelarche in girls by two years
  3. It occurs earlier in boys than in girls by two years
  4. It occurs about two years earlier in girls Correct answer.

Explanation

Girls reach peak height velocity near age 11.5 and boys near age 13.5, so the spurt begins about two years earlier in girls. Boys have a larger and longer spurt, which contributes to their greater average adult height.

Question 6Normal Adolescent Growth, Development, and Puberty

What is the average peak height velocity in boys?

  1. 15 cm/year
  2. 9-10 cm/year Correct answer.
  3. 4 cm/year
  4. 6 cm/year

Explanation

Boys average roughly 9 to 10 cm per year at peak height velocity, compared with about 8 to 9 cm per year in girls. The larger and longer male spurt accounts for much of the average 12 to 13 cm difference in adult height.

Question 7Normal Adolescent Growth, Development, and Puberty

In girls, precocious puberty is conventionally defined as onset before which age?

  1. 10 years
  2. 6 years
  3. 7 years
  4. 8 years Correct answer.

Explanation

The conventional threshold is breast development before age 8 in girls and testicular enlargement before age 9 in boys. Onset before these ages warrants evaluation, especially when progression is rapid or other features are atypical.

Question 8Normal Adolescent Growth, Development, and Puberty

Delayed puberty in boys is defined as absence of testicular enlargement by which age?

  1. 12 years
  2. 13 years
  3. 14 years Correct answer.
  4. 15 years

Explanation

Delayed puberty is defined as no testicular enlargement of at least 4 mL by age 14 in boys, or no breast development by age 13 in girls. Constitutional delay is the most common cause, but chronic illness and hypogonadism must also be considered.

Question 9Normal Adolescent Growth, Development, and Puberty

Which is the earliest endocrine event of gonadarche?

  1. A gradual rise in adrenal DHEAS secretion
  2. A steady fall in growth hormone secretion
  3. Nocturnal GnRH pulses increase in amplitude Correct answer.
  4. A pubertal surge in thyroid hormone release

Explanation

Reactivation of the hypothalamic GnRH pulse generator, initially most prominent during sleep, initiates gonadarche. Increasing GnRH pulses stimulate pituitary LH and FSH release, which then drive gonadal steroid production.

Question 10Normal Adolescent Growth, Development, and Puberty

How does leptin influence the onset of puberty?

  1. It directly triggers GnRH release at a fixed threshold
  2. It permits, rather than triggers, reproductive activation Correct answer.
  3. It has no relationship to the timing of puberty
  4. It suppresses gonadal steroidogenesis during puberty

Explanation

Leptin, secreted by adipocytes, signals that energy stores are adequate and acts permissively to allow activation of the reproductive axis. This helps explain why higher body fat and obesity are associated with earlier menarche.

Question 11Normal Adolescent Growth, Development, and Puberty

What is the midparental target height for a girl whose father is 180 cm and whose mother is 165 cm?

  1. 159.5 cm
  2. 172.5 cm
  3. 166 cm Correct answer.
  4. 179 cm

Explanation

For a girl, target height is the sum of the parents' heights minus 13 cm, divided by two, giving (180 + 165 - 13)/2 = 166 cm. The accepted target range extends about 8.5 cm on either side of this value.

Question 12Normal Adolescent Growth, Development, and Puberty

A 13-year-old boy with short stature has a bone age of 11 years. Which is the most likely explanation?

  1. Growth hormone excess
  2. Constitutional delay Correct answer.
  3. Precocious puberty
  4. Untreated hyperthyroidism

Explanation

Constitutional delay of growth and puberty typically produces a bone age that lags chronological age by one to three years, with eventual catch-up growth and a normal adult height. Advanced bone age instead points to precocious puberty, androgen excess, or hyperthyroidism.

Question 13Normal Adolescent Growth, Development, and Puberty

Which hormonal change drives the pubertal growth spurt?

  1. Suppression of the GH axis by estrogen
  2. Higher GH pulse amplitude with rising IGF-1 Correct answer.
  3. Rising cortisol with falling insulin sensitivity
  4. A fall in IGF-1 with rising GH secretion

Explanation

Sex steroids amplify growth hormone pulse amplitude and increase IGF-1 production, and this axis drives linear growth. Estrogen additionally matures the growth plate, which eventually leads to epiphyseal fusion.

Question 14Normal Adolescent Growth, Development, and Puberty

According to Erikson, the central psychosocial task of adolescence is:

  1. Identity versus role confusion Correct answer.
  2. Autonomy versus shame and doubt
  3. Intimacy versus isolation
  4. Industry versus inferiority

Explanation

Erikson placed identity formation in adolescence, with the task resolved through exploration of roles, values, and peer groups. Intimacy versus isolation belongs to young adulthood, and industry versus inferiority to middle childhood.

Question 15Normal Adolescent Growth, Development, and Puberty

A 14-year-old reasons hypothetically about abstract problems and tests deductions systematically. Which Piagetian stage does this describe?

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

Explanation

Formal operational thought emerges around age 11 and involves abstract, hypothetical-deductive reasoning. Concrete operational children reason logically but only about tangible, present situations.

Question 16Normal Adolescent Growth, Development, and Puberty

Why do many adolescents naturally stay up late and wake late?

  1. An increased sleep need of about 12 hours per night
  2. A delayed circadian phase preference Correct answer.
  3. A shortened circadian period causing early sleep onset
  4. Loss of melatonin production during puberty

Explanation

Puberty is accompanied by a shift toward later circadian timing and a slower buildup of homeostatic sleep pressure, so adolescents feel alert later at night. Early school start times then compound the resulting sleep restriction.

Question 17Normal Adolescent Growth, Development, and Puberty

Which body composition change is typical in girls during puberty?

  1. A fall in percentage body fat
  2. A rise in percentage body fat Correct answer.
  3. Loss of subcutaneous fat from the limbs
  4. Identical fat gain in both sexes

Explanation

Estrogen promotes gynoid fat deposition, so girls gain a higher percentage of body fat, particularly around the hips and thighs. Boys gain proportionally more lean mass under androgen influence, widening the sex difference in body composition.

Question 18Normal Adolescent Growth, Development, and Puberty

Which vital-sign trend is expected during normal adolescence?

  1. Systolic pressure rises and heart rate falls Correct answer.
  2. Both fall steadily through adolescence
  3. Systolic blood pressure falls steadily
  4. Resting heart rate rises while blood pressure is unchanged

Explanation

As stroke volume and left ventricular mass increase, systolic blood pressure rises gradually through adolescence and roughly tracks height. Resting heart rate declines from childhood values toward adult rates.

Question 19Normal Adolescent Growth, Development, and Puberty

In a 12-year-old girl with a 20-degree thoracic scoliotic curve, which factor best predicts curve progression?

  1. Presence of back pain
  2. Season of the year
  3. Remaining skeletal growth Correct answer.
  4. Family history of scoliosis

Explanation

Progression risk in adolescent idiopathic scoliosis depends mainly on how much growth remains, estimated from bone age, Risser staging, and menarchal status. Larger curves and thoracic curves also carry a higher risk of progression.

Question 20Normal Adolescent Growth, Development, and Puberty

How is the secular trend in pubertal timing best described?

  1. No change in pubertal timing over time
  2. Earlier menarche that has recently plateaued Correct answer.
  3. A delay in boys but not in girls
  4. Progressive delay in menarche of one year per decade

Explanation

Age at menarche fell by several months per decade in industrialized countries through the nineteenth and twentieth centuries, probably reflecting better nutrition and reduced disease burden. In many high-income settings the trend has now plateaued or slowed.

Question 21Normal Adolescent Growth, Development, and Puberty

Which statement about growth plate closure is correct?

  1. Fusion is unrelated to sex steroid exposure
  2. Estrogen drives growth plate closure Correct answer.
  3. Testosterone acts directly on the growth plate
  4. Fusion occurs before peak height velocity

Explanation

Estrogen, produced in boys largely by aromatization of testosterone, accelerates growth plate senescence and leads to epiphyseal fusion. This is illustrated by continued linear growth in men with aromatase deficiency or estrogen receptor mutations.

Question 22Normal Adolescent Growth, Development, and Puberty

A 7-year-old girl has pubic and axillary hair but no breast development. DHEAS is mildly elevated for age and bone age is 7.5 years. What is the most likely diagnosis?

  1. Central precocious puberty
  2. Congenital adrenal hyperplasia
  3. An ovarian androgen-secreting tumor
  4. Premature adrenarche Correct answer.

Explanation

Isolated pubic hair with a modest DHEAS elevation, absent breast development, and near-normal bone age is typical of premature adrenarche, a benign variant. Central precocious puberty would show breast development and advanced bone age, while virilizing tumors and classic congenital adrenal hyperplasia usually cause rapid virilization with marked bone age advancement.

Question 23Normal Adolescent Growth, Development, and Puberty

A boy's height tracked the 50th percentile at age 6 but has fallen to the 10th percentile at age 12, with a bone age equal to chronological age. Which interpretation is most concerning?

  1. Constitutional delay of growth
  2. A normal growth variant
  3. Pathologic growth failure Correct answer.
  4. Familial short stature with early puberty

Explanation

Downward crossing of two or more major height percentile lines after age 3 suggests an acquired or pathologic cause of growth failure and warrants evaluation. Familial short stature and constitutional delay usually show growth parallel to, though below, the expected percentile lines.

Question 24Normal Adolescent Growth, Development, and Puberty

Which sequence best describes adolescent brain maturation?

  1. White matter decreases while gray matter increases
  2. Gray matter volume increases linearly through adolescence
  3. Limbic circuits mature before prefrontal circuits Correct answer.
  4. Prefrontal cortex matures before the limbic system

Explanation

Subcortical limbic and striatal circuits mature earlier than prefrontal control circuitry, which continues to develop into the mid-20s. Over the same period, synaptic pruning reduces gray matter while myelination increases white matter.

Question 25Normal Adolescent Growth, Development, and Puberty

A 15-year-old girl who began menstruating two years ago reports fatigue, and her ferritin is 8 ng/mL. Which change in nutritional requirement best explains her finding?

  1. Higher vitamin K needs
  2. Higher vitamin B12 needs
  3. Higher iron needs Correct answer.
  4. Higher calcium needs

Explanation

Menstrual blood loss adds to the iron demands of rapid growth, so adolescent girls require about 15 mg of iron daily compared with 11 mg for boys. Low ferritin with fatigue suggests iron deficiency, which is common in this age group.

Question 26Normal Adolescent Growth, Development, and Puberty

Which physical change is typically the first visible sign of puberty in girls?

  1. Menarche
  2. Breast budding Correct answer.
  3. Peak height velocity
  4. Pubic hair growth

Explanation

Thelarche, or breast budding, is usually the first visible pubertal change in girls and typically appears between ages 8 and 13. Pubic hair often follows, while menarche occurs later, usually about 2 to 2.5 years after breast budding.

Question 27Normal Adolescent Growth, Development, and Puberty

In boys, which testicular volume on the Prader orchidometer is conventionally used to mark the onset of puberty?

  1. 4 mL Correct answer.
  2. 8 mL
  3. 1 mL
  4. 12 mL

Explanation

Testicular enlargement to 4 mL, corresponding to a length of about 2.5 cm, signals the start of gonadarche and Tanner stage G2. Volumes below 4 mL are generally considered prepubertal.

Question 28Normal Adolescent Growth, Development, and Puberty

What is the median age at menarche in the United States?

  1. 12.5 years Correct answer.
  2. 14.0 years
  3. 11.5 years
  4. 10.5 years

Explanation

The median age at menarche in the United States is approximately 12.5 years, and most girls experience menarche between 11 and 14 years. Menarche typically follows thelarche by about 2 to 2.5 years.

Question 29Normal Adolescent Growth, Development, and Puberty

What is a typical height velocity for a healthy prepubertal child?

  1. 2 cm per year
  2. 3 cm per year
  3. 4 cm per year
  4. 6 cm per year Correct answer.

Explanation

Healthy prepubertal children normally grow about 5 to 6 cm per year. A velocity persistently below 4 to 5 cm per year, or a falling height percentile, warrants evaluation.

Question 30Normal Adolescent Growth, Development, and Puberty

Which sequence best describes the typical order of pubertal events in girls?

  1. Menarche, thelarche, pubarche, PHV
  2. Pubarche, thelarche, menarche, PHV
  3. Thelarche, pubarche, PHV, menarche Correct answer.
  4. PHV, thelarche, menarche, pubarche

Explanation

In girls, breast budding usually initiates puberty, followed by pubic hair, the growth spurt, and finally menarche. The growth spurt typically peaks before menarche, and menarche is a late event.

Question 31Normal Adolescent Growth, Development, and Puberty

In girls, menarche usually occurs at what interval relative to peak height velocity?

  1. About 2 years before
  2. At the same time
  3. About 3 years after
  4. About 1 year after Correct answer.

Explanation

Peak height velocity typically occurs about 1 year before menarche in girls. Growth decelerates after menarche, so only a small amount of additional height is gained.

Question 32Normal Adolescent Growth, Development, and Puberty

Peak height velocity in girls most commonly occurs at which Tanner breast stage?

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

Explanation

The pubertal growth spurt in girls usually peaks at breast stage 3, roughly 1 year before menarche. Stage 1 is prepubertal, and stage 5 represents maturity with decelerating growth.

Question 33Normal Adolescent Growth, Development, and Puberty

Which body composition change is most characteristic of boys during puberty?

  1. Widening of the pelvic girdle
  2. Lean gain exceeds fat gain Correct answer.
  3. Rise in percentage body fat
  4. Fall in total lean body mass

Explanation

Boys typically gain a large amount of lean mass while their percentage of body fat declines slightly or remains stable. Girls tend to gain proportionally more fat, especially around the hips and thighs.

Question 34Normal Adolescent Growth, Development, and Puberty

A 14-year-old boy at Tanner stage 3 has bilateral breast enlargement. What is the most likely cause?

  1. Testicular tumor
  2. Prolactinoma
  3. Pubertal gynecomastia Correct answer.
  4. Klinefelter syndrome

Explanation

Physiologic gynecomastia is common in mid-puberty, peaking at Tanner stages 3 to 4, and usually resolves within 1 to 2 years. Persistent, rapidly progressive, or unilateral enlargement warrants further evaluation.

Question 35Normal Adolescent Growth, Development, and Puberty

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

  1. Immature HPO feedback Correct answer.
  2. Endometrial hyperplasia
  3. Persistent corpus luteum
  4. Premature ovarian failure

Explanation

Early cycles are often anovulatory because the hypothalamic-pituitary-ovarian feedback loop is still maturing, especially the estrogen-mediated LH surge. This irregularity usually resolves within 1 to 2 years.

Question 36Normal Adolescent Growth, Development, and Puberty

At what age does the normal adiposity rebound typically occur?

  1. 4 to 5 years
  2. 8 to 10 years
  3. 5 to 7 years Correct answer.
  4. 2 to 3 years

Explanation

Body mass index normally reaches a nadir around ages 5 to 7 and then rises, a pattern known as adiposity rebound. An earlier rebound is associated with a higher later BMI.

Question 37Normal Adolescent Growth, Development, and Puberty

Which radiograph is standard for estimating bone age in adolescents?

  1. Lateral cervical spine
  2. Left hand and wrist Correct answer.
  3. Right elbow
  4. Pelvis

Explanation

A left hand and wrist radiograph is compared with standard atlases, such as Greulich and Pyle, to estimate skeletal maturity. It helps assess growth potential and pubertal timing.

Question 38Normal Adolescent Growth, Development, and Puberty

Why may a child with central precocious puberty be tall during childhood but have a reduced adult height?

  1. Bone age remains delayed
  2. The pubertal spurt is smaller than usual
  3. Growth hormone secretion falls permanently
  4. Steroids accelerate growth and fusion Correct answer.

Explanation

Early sex steroid exposure increases growth velocity but also advances bone maturation and promotes earlier epiphyseal fusion. The result can be a tall child who becomes a shorter adult than predicted.

Question 39Normal Adolescent Growth, Development, and Puberty

After menarche, how much additional height do most girls gain?

  1. 8 to 10 cm
  2. 0 to 1 cm
  3. 12 to 15 cm
  4. 5 to 7 cm Correct answer.

Explanation

Most girls grow about 5 to 7 cm after menarche because the growth spurt peaks before menarche and then decelerates. This limited remaining growth is why adult height can be estimated from height at menarche.

Question 40Normal Adolescent Growth, Development, and Puberty

A 17-year-old has explored several career paths and now has a clear sense of her values and goals. In Marcia's framework, which identity status does this represent?

  1. Moratorium
  2. Diffusion
  3. Achievement Correct answer.
  4. Foreclosure

Explanation

Identity achievement follows a period of exploration that culminates in commitment. Foreclosure is commitment without exploration, diffusion is neither exploration nor commitment, and moratorium is exploration without commitment.

Question 41Adolescent Health Maintenance, Preventive Care, and Screening

At what age is the HPV vaccine series routinely recommended to begin for adolescents who have not received it earlier?

  1. 9 to 10 years
  2. 11 to 12 years Correct answer.
  3. 14 to 15 years
  4. 16 to 18 years

Explanation

Routine HPV vaccination begins at 11 to 12 years, although it may be started as early as 9. The series is two doses when begun before age 15 and three doses when begun at 15 or older. Catch-up vaccination is recommended through age 26.

Question 42Adolescent Health Maintenance, Preventive Care, and Screening

According to Bright Futures periodicity recommendations, how often should a healthy adolescent without chronic conditions have a preventive care visit?

  1. Once a year Correct answer.
  2. Every 2 years
  3. Every 6 months
  4. Only when symptoms arise

Explanation

Bright Futures recommends one comprehensive preventive visit each year for adolescents aged 11 through 21. More frequent visits are appropriate for chronic conditions or new concerns.

Question 43Adolescent Health Maintenance, Preventive Care, and Screening

A 12-year-old receives a first dose of quadrivalent meningococcal conjugate vaccine (MenACWY). When is the second dose routinely due?

  1. At 18 years
  2. At 15 years
  3. At 16 years Correct answer.
  4. At 13 to 14 years

Explanation

MenACWY is routinely given at 11 to 12 years with a booster at 16 years. Adolescents who receive their first dose at 16 or older do not need a booster.

Question 44Adolescent Health Maintenance, Preventive Care, and Screening

Which vaccine is routinely recommended at the 11- to 12-year preventive visit if not previously given?

  1. Rotavirus
  2. Hepatitis A
  3. Tdap Correct answer.
  4. Varicella

Explanation

Tdap is recommended at 11 to 12 years as a booster, followed by Td or Tdap every 10 years. Hepatitis A, varicella, and rotavirus are not routine adolescent boosters.

Question 45Adolescent Health Maintenance, Preventive Care, and Screening

A 15-year-old has a BMI at the 90th percentile for age and sex. What is the correct classification?

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

Explanation

BMI from the 85th through 94th percentile for age and sex is classified as overweight. Obesity begins at the 95th percentile.

Question 46Adolescent Health Maintenance, Preventive Care, and Screening

Which acronym organizes the adolescent psychosocial interview around home, education, activities, drugs, sexuality, and mood?

  1. CRAFFT
  2. GAD-7
  3. PHQ-A
  4. HEADSS Correct answer.

Explanation

HEADSS, or HEEADSSS, structures the psychosocial interview: home, education or employment, activities, drugs, sexuality, and mood. It helps identify risk and protective factors during confidential adolescent visits.

Question 47Adolescent Health Maintenance, Preventive Care, and Screening

How much sleep is recommended each night for most adolescents aged 13 to 18 years?

  1. 6 to 7 hours
  2. 7 to 8 hours
  3. 10 to 12 hours
  4. 8 to 10 hours Correct answer.

Explanation

The American Academy of Sleep Medicine recommends 8 to 10 hours of sleep per night for adolescents aged 13 to 18. Chronic short sleep is linked to mood, academic, and metabolic problems.

Question 48Adolescent Health Maintenance, Preventive Care, and Screening

Which statement best describes confidentiality in adolescent preventive care?

  1. Confidentiality is never appropriate before age 18
  2. A minor cannot consent to any health service
  3. Parents must remain in the room for the entire visit
  4. Offer private time and explain its limits Correct answer.

Explanation

Adolescents should have private time and be told what will remain confidential and what must be shared for safety. Many states allow minors to consent to certain services, including STI care and mental health care.

Question 49Adolescent Health Maintenance, Preventive Care, and Screening

Which screening tool is specifically designed to assess depression severity in adolescents and is commonly used after a positive PHQ-2?

  1. SCARED
  2. AUDIT-C
  3. PHQ-A Correct answer.
  4. CRAFFT

Explanation

The PHQ-A is the adolescent version of the Patient Health Questionnaire and is used to confirm and grade depression after a positive brief screen. CRAFFT screens substance use, AUDIT-C screens alcohol use, and SCARED screens anxiety.

Question 50Adolescent Health Maintenance, Preventive Care, and Screening

A 19-year-old sexually active woman has no symptoms. What does the USPSTF recommend for chlamydia and gonorrhea screening?

  1. Screening only after age 25
  2. No screening unless symptoms develop
  3. Screening every 3 years
  4. Annual screening Correct answer.

Explanation

Sexually active women 24 years or younger should be screened annually for chlamydia and gonorrhea. Older women with risk factors also warrant annual screening.