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PMHS practice questions

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Question 1Pediatric Primary Care Mental Health Specialist

A 7-year-old is brought to the pediatric primary care clinic with a 4-week history of irritability, sleep disturbance, and declining school performance. Which screening tool is specifically designed for caregiver-completed assessment of common pediatric psychosocial problems in this age range?

  1. CRAFFT screening tool
  2. Generalized Anxiety Disorder-7 (GAD-7)
  3. Pediatric Symptom Checklist (PSC) Correct answer.
  4. Patient Health Questionnaire-9 (PHQ-9)

Explanation

The Pediatric Symptom Checklist is a caregiver-completed broadband screen validated for children ages 4-16 that identifies psychosocial dysfunction including internalizing and externalizing problems. The PHQ-9 and GAD-7 are adult self-report measures, and CRAFFT screens adolescents for substance use.

Question 2Pediatric Primary Care Mental Health Specialist

According to the American Academy of Pediatrics recommendations, at what age should routine screening for autism spectrum disorder using a validated tool such as the M-CHAT-R occur?

  1. Only at 6 months
  2. At 18 and 24 months Correct answer.
  3. At 10 and 12 years
  4. Only at 4 years

Explanation

The AAP recommends developmental surveillance at every well-child visit plus autism-specific screening with a validated instrument at 18 and 24 months, because early identification enables earlier intervention. Screening only at later ages or in infancy misses this window.

Question 3Pediatric Primary Care Mental Health Specialist

A 14-year-old presents with depressed mood, anhedonia, and fatigue for 5 weeks. Which finding would most strongly suggest the need for urgent safety assessment rather than routine outpatient follow-up?

  1. Difficulty falling asleep two nights per week
  2. Mild decline in one class grade
  3. Passive thoughts that life is not worth living with a specific plan and access to means Correct answer.
  4. Occasional irritability during homework

Explanation

Suicidal ideation with a specific plan and access to lethal means constitutes a psychiatric emergency requiring immediate safety assessment and intervention. Irritability, intermittent sleep difficulty, and a single grade decline are common and do not by themselves indicate imminent risk.

Question 4Pediatric Primary Care Mental Health Specialist

Which class of medication is considered first-line pharmacotherapy for attention-deficit/hyperactivity disorder in a school-age child when medication is indicated?

  1. Stimulants such as methylphenidate Correct answer.
  2. Atypical antipsychotics
  3. Selective serotonin reuptake inhibitors
  4. Benzodiazepines

Explanation

Stimulant medications, including methylphenidate and amphetamine formulations, have the strongest evidence base and are first-line for ADHD in school-age children. SSRIs, antipsychotics, and benzodiazepines are not first-line ADHD treatments.

Question 5Pediatric Primary Care Mental Health Specialist

A 9-year-old repeatedly refuses to speak in school but talks freely at home. Symptoms have persisted for 2 months and impair classroom participation. Which diagnosis best fits?

  1. Expressive language disorder
  2. Selective mutism Correct answer.
  3. Social anxiety disorder
  4. Oppositional defiant disorder

Explanation

Selective mutism is characterized by consistent failure to speak in specific social situations where speaking is expected, despite speaking in other settings, lasting at least one month and impairing functioning. Social anxiety may co-occur but the situational speech failure is the defining feature here.

Question 6Pediatric Primary Care Mental Health Specialist

Which statement best describes the recommended approach to mental health screening in pediatric primary care?

  1. Rely solely on clinician intuition without standardized tools
  2. Use validated screening tools at defined intervals with clinical follow-up of positive results Correct answer.
  3. Screen only when parents explicitly request it
  4. Screen only after academic failure is documented

Explanation

Best practice uses validated, age-appropriate screening instruments at scheduled intervals, with positive screens followed by clinical assessment and appropriate referral. Relying on intuition, parent request alone, or academic failure delays identification of treatable conditions.

Question 7Pediatric Primary Care Mental Health Specialist

A 6-year-old is described by parents as having frequent tantrums, arguing with adults, and deliberately annoying others for the past 7 months. Which diagnosis should be considered first?

  1. Autism spectrum disorder
  2. Separation anxiety disorder
  3. Oppositional defiant disorder Correct answer.
  4. Major depressive disorder

Explanation

Oppositional defiant disorder involves a persistent pattern of angry/irritable mood, argumentative/defiant behavior, or vindictiveness lasting at least six months. The described behaviors align most closely with ODD rather than mood, anxiety, or autism spectrum presentations.

Question 8Pediatric Primary Care Mental Health Specialist

Which factor most increases the risk of adolescent depression and should prompt closer monitoring in primary care?

  1. Seasonal pollen allergy
  2. Preference for solitary reading
  3. Family history of depression in a first-degree relative Correct answer.
  4. Left-handedness

Explanation

A family history of depression in first-degree relatives is a well-established risk factor for adolescent depression and warrants heightened surveillance. Allergy, handedness, and reading preference are not established risk factors.

Question 9Pediatric Primary Care Mental Health Specialist

A 12-year-old with ADHD on a stimulant reports reduced appetite and a 2-kg weight loss over 6 weeks. Which management approach is most appropriate?

  1. Add a second stimulant to offset appetite effects
  2. Adjust timing of doses around meals and monitor growth, coordinating with the prescriber Correct answer.
  3. Immediately discontinue the medication without contacting the prescriber
  4. Reassure the family that weight loss requires no follow-up

Explanation

Appetite suppression is a common stimulant side effect; strategies include dosing after meals, encouraging calorie-dense foods, and monitoring growth, with prescriber coordination for significant weight loss. Abrupt discontinuation or adding another stimulant without prescriber involvement is inappropriate.

Question 10Pediatric Primary Care Mental Health Specialist

A 15-year-old presents with 3 weeks of low mood, hypersomnia, and weight gain occurring every winter for 3 consecutive years. Which pattern best describes this presentation?

  1. Seasonal pattern specifier for major depressive disorder Correct answer.
  2. Bipolar I disorder
  3. Persistent depressive disorder
  4. Premenstrual dysphoric disorder

Explanation

A seasonal pattern specifier applies when mood episodes recur at the same time of year, typically winter, with full remission at other times, across at least two years. Persistent depressive disorder is chronic and not seasonally bound, and the presentation lacks manic or premenstrual features.

Question 11Pediatric Primary Care Mental Health Specialist

A 10-year-old with a new diagnosis of type 1 diabetes develops refusal to check blood glucose and fear of hypoglycemia after an episode of severe hypoglycemia. Which approach best reflects integrated behavioral care in primary care?

  1. Discontinuation of glucose monitoring to reduce distress
  2. Reassurance that anxiety will resolve without intervention
  3. Referral only to an endocrinologist without behavioral involvement
  4. Collaborative care coordinating the diabetes team with a behavioral health clinician to address health anxiety Correct answer.

Explanation

Integrated collaborative care combining medical and behavioral health expertise addresses illness-related anxiety and adherence in chronic pediatric conditions. Ignoring the behavioral component, reassurance alone, or stopping monitoring would worsen outcomes.

Question 12Pediatric Primary Care Mental Health Specialist

A 13-year-old is brought in for irritability and declining grades. On interview the teen reports feeling watched and hearing whispers when alone. Which next step is most appropriate?

  1. Urgent psychiatric evaluation for possible psychosis Correct answer.
  2. Reassurance and no further action
  3. Routine follow-up in 3 months
  4. Referral for vision and hearing testing only

Explanation

Ideas of reference and auditory hallucinations in an adolescent suggest possible psychotic symptoms and warrant urgent psychiatric evaluation. Routine follow-up, reassurance alone, or sensory testing alone would delay necessary assessment.

Question 13Pediatric Primary Care Mental Health Specialist

Which behavioral intervention has the strongest evidence as first-line treatment for mild to moderate pediatric anxiety disorders?

  1. Psychodynamic play therapy alone
  2. Dietary elimination of sugar
  3. Cognitive behavioral therapy Correct answer.
  4. Antihistamine pharmacotherapy

Explanation

Cognitive behavioral therapy has the strongest evidence base and is recommended first-line for mild to moderate pediatric anxiety. Play therapy alone, antihistamines, and sugar elimination lack comparable evidence.

Question 14Pediatric Primary Care Mental Health Specialist

A 5-year-old has nighttime fears, occasional nightmares, and brief episodes of crying after waking. These episodes occur most nights but the child is fully consolable and oriented. Which interpretation is most accurate?

  1. Developmentally typical nighttime fears rather than a disorder Correct answer.
  2. Psychotic disorder
  3. Separation anxiety disorder
  4. Night terror disorder requiring medication

Explanation

Nighttime fears and occasional nightmares are common and developmentally typical in young children when the child is consolable and oriented. Night terrors involve inconsolability and confusion, and the presentation lacks psychotic or separation-specific features.

Question 15Pediatric Primary Care Mental Health Specialist

A 16-year-old discloses passive suicidal ideation without plan or intent. Which action best reflects appropriate pediatric primary care management?

  1. Immediately hospitalize all adolescents with any ideation
  2. Refer to outpatient therapy without any safety assessment
  3. Dismiss the disclosure because no plan is present
  4. Conduct a structured risk assessment, develop a safety plan, and arrange close follow-up Correct answer.

Explanation

Passive ideation without plan or intent still requires structured risk assessment, safety planning, means restriction counseling, and close follow-up. Dismissal is unsafe, routine hospitalization is not indicated for all passive ideation, and therapy referral without assessment omits essential safety steps.

Question 16Pediatric Primary Care Mental Health Specialist

A 4-year-old is noted to have limited eye contact, delayed language, and repetitive hand flapping. Which initial step is most appropriate in primary care?

  1. Reassure parents that the child will outgrow the behaviors
  2. Delay evaluation until kindergarten entry
  3. Start an SSRI empirically
  4. Refer for comprehensive developmental and autism evaluation while initiating early intervention referral Correct answer.

Explanation

Red flags for autism warrant prompt referral for comprehensive evaluation and early intervention services, which improve outcomes. Reassurance, empirical SSRI use, or delaying evaluation until school entry would delay needed support.

Question 17Pediatric Primary Care Mental Health Specialist

A 17-year-old presents with 2 weeks of elevated mood, decreased need for sleep, racing thoughts, and impulsive spending. Which diagnosis should be considered?

  1. Major depressive disorder
  2. Attention-deficit/hyperactivity disorder
  3. Bipolar I disorder Correct answer.
  4. Generalized anxiety disorder

Explanation

Elevated mood with decreased need for sleep, racing thoughts, and impulsive spending suggests a manic episode consistent with bipolar I disorder. Depression, anxiety, and ADHD do not account for the full manic symptom cluster.

Question 18Pediatric Primary Care Mental Health Specialist

Which statement about confidentiality when treating an adolescent for mental health concerns is most accurate?

  1. Clinicians should explain limits of confidentiality, including risk of harm, at the outset Correct answer.
  2. Confidentiality never applies to mental health care
  3. Everything disclosed must be shared with parents without exception
  4. Adolescents have no confidentiality protections

Explanation

Clinicians should establish clear expectations about confidentiality and its limits, including safety concerns, at the start of care. Absolute parental disclosure, no protections, and no confidentiality in mental health care are inaccurate.

Question 19Pediatric Primary Care Mental Health Specialist

A 15-year-old reports binge drinking on weekends. Which screening tool is designed specifically to identify adolescent substance use risk?

  1. Vanderbilt ADHD scale
  2. CRAFFT Correct answer.
  3. PHQ-9
  4. M-CHAT-R

Explanation

CRAFFT is a validated adolescent substance-use screening tool. The PHQ-9 assesses depression, M-CHAT-R screens for autism, and the Vanderbilt scale assesses ADHD symptoms.

Question 20Pediatric Primary Care Mental Health Specialist

A 9-year-old with ADHD responds partially to a stimulant but continues to have impairing symptoms. Which principle best guides next steps?

  1. Reassess diagnosis, adherence, and dosing before changing medication class Correct answer.
  2. Immediately add an antipsychotic
  3. Stop all treatment and observe
  4. Add three medications simultaneously

Explanation

Partial response warrants reassessment of diagnosis, adherence, dose, and timing before escalating or switching therapy. Adding an antipsychotic, stopping treatment, or polypharmacy without reassessment is not appropriate.

Question 21Pediatric Primary Care Mental Health Specialist

A 6-year-old presents with sudden onset of refusal to attend school, clinging behavior, and nightmares about separation from parents after a family move. Which diagnosis best fits?

  1. Separation anxiety disorder Correct answer.
  2. Selective mutism
  3. Social anxiety disorder
  4. Oppositional defiant disorder

Explanation

Developmentally inappropriate and excessive fear of separation from attachment figures, with school refusal and nightmares about separation, characterizes separation anxiety disorder. Social anxiety, ODD, and selective mutism do not center on separation fears.

Question 22Pediatric Primary Care Mental Health Specialist

A 10-year-old with major depressive disorder has not responded to an adequate trial of psychotherapy. Which medication class is first-line pharmacotherapy for pediatric depression?

  1. Benzodiazepines
  2. Monoamine oxidase inhibitors
  3. Tricyclic antidepressants
  4. Selective serotonin reuptake inhibitors Correct answer.

Explanation

SSRIs, particularly fluoxetine and escitalopram, are first-line pharmacotherapy for pediatric major depressive disorder, with monitoring for suicidality. Tricyclics, MAOIs, and benzodiazepines are not first-line for pediatric depression.

Question 23Pediatric Primary Care Mental Health Specialist

A 12-year-old with autism and new-onset aggression is being considered for pharmacotherapy. Which principle best guides medication selection?

  1. Avoid monitoring for metabolic effects
  2. Prescribe medication to eliminate all autism features
  3. Use multiple antipsychotics concurrently as first step
  4. Target specific impairing symptoms with the lowest effective dose and monitor closely Correct answer.

Explanation

Pharmacotherapy in autism should target specific impairing symptoms, such as aggression, using the lowest effective dose with close monitoring for adverse effects including metabolic changes. Polypharmacy, unrealistic goals, and absent monitoring are inappropriate.

Question 24Pediatric Primary Care Mental Health Specialist

A 16-year-old with bipolar disorder on lithium presents with vomiting and tremor after a viral illness. Which concern is most relevant?

  1. Hypoglycemia
  2. Lithium toxicity exacerbated by dehydration Correct answer.
  3. Neuroleptic malignant syndrome
  4. Serotonin syndrome

Explanation

Vomiting and tremor in a patient on lithium, particularly with dehydration from illness, raise concern for lithium toxicity requiring urgent level measurement. Serotonin syndrome, neuroleptic malignant syndrome, and hypoglycemia do not fit this medication and presentation.

Question 25Pediatric Primary Care Mental Health Specialist

A 14-year-old with depression is started on an SSRI. Which monitoring plan best reflects appropriate pediatric primary care follow-up?

  1. Close follow-up within 1-2 weeks of initiation with monitoring for increased suicidality Correct answer.
  2. Discontinue monitoring after the first dose
  3. Rely solely on parent report without clinical assessment
  4. No follow-up until 6 months

Explanation

Close follow-up shortly after SSRI initiation, with monitoring for activation and increased suicidality, is recommended in pediatric depression care. Delayed or absent follow-up, or relying only on parent report, misses early adverse effects.

Question 26Pediatric Primary Care Mental Health Specialist

In pediatric primary care, which validated tool is the most widely recommended broadband screen for emotional and behavioral problems in a 9-year-old when information is gathered from both parent and child?

  1. The Pediatric Symptom Checklist (PSC-17) Correct answer.
  2. The Vanderbilt ADHD Diagnostic Rating Scale
  3. The PHQ-9 modified for adolescents
  4. The CRAFFT 2.1

Explanation

The PSC-17 is a brief broadband screener that captures internalizing, attention, and externalizing problems and can be completed by parents and youth in primary care. It is designed for general psychosocial screening rather than a single disorder.

Question 27Pediatric Primary Care Mental Health Specialist

A 7-year-old is brought in with 6 months of recurrent stomachaches and headaches that have been extensively medically evaluated with normal results. The parent reports the child worries before school and seeks constant reassurance. Which formulation best fits the presentation?

  1. A primary sleep disorder producing daytime physical complaints
  2. An emerging psychotic process with bodily hallucinations
  3. A factitious presentation maintained by caregiver attention
  4. Somatic symptoms arising from an anxiety-related process Correct answer.

Explanation

Recurrent medically unexplained physical complaints in a school-age child, paired with worry and reassurance seeking, are commonly the somatic expression of an anxiety disorder. The physical symptoms are real to the child even when medical workup is negative.

Question 28Pediatric Primary Care Mental Health Specialist

Which developmental feature most strongly supports a diagnosis of separation anxiety disorder rather than developmentally normal separation distress in a young child?

  1. The child cries briefly at daycare drop-off and settles within minutes
  2. The child has occasional nightmares after a frightening event
  3. The child prefers a parent over a familiar teacher in a new setting
  4. The fear is persistent and causes impairment beyond the expected developmental period Correct answer.

Explanation

Separation anxiety is developmentally expected in early childhood and typically fades with reassurance and routine. A diagnosis requires persistence beyond the expected age, excessive fear, and clear functional impairment.

Question 29Pediatric Primary Care Mental Health Specialist

A 15-year-old has been treated for depression for 8 weeks with good response. Which statement about discontinuation of antidepressant therapy is most appropriate to share with the family?

  1. Stopping is best timed to the start of the school year for monitoring
  2. The dose should be doubled to consolidate the response before stopping
  3. The medication can be stopped abruptly once mood has normalized for 2 weeks
  4. Medication should be continued for several months after remission before a gradual taper is considered Correct answer.

Explanation

Guidelines recommend continuing antidepressant treatment for a sustained period after remission to reduce relapse risk, followed by a gradual taper with monitoring. Abrupt discontinuation risks discontinuation symptoms and relapse.

Question 30Pediatric Primary Care Mental Health Specialist

A 12-year-old with a diagnosis of oppositional defiant disorder is being managed in primary care. Which parenting approach has the strongest evidence for reducing oppositional behavior?

  1. Consistent positive reinforcement paired with calm, predictable consequences Correct answer.
  2. Removal of all privileges until behavior fully resolves
  3. Frequent public correction to establish parental authority
  4. Allowing the child to set household rules to reduce conflict

Explanation

Behavioral parent training emphasizing positive reinforcement, clear expectations, and consistent non-punitive consequences has the strongest evidence base for oppositional behavior. Escalation and total privilege removal tend to worsen conflict.

Question 31Pediatric Primary Care Mental Health Specialist

A 10-year-old is being evaluated for ADHD. Which element is essential before applying a diagnosis of ADHD rather than attributing symptoms to another cause?

  1. Symptoms began during the current school year
  2. Symptoms are present in more than one setting and cause functional impairment Correct answer.
  3. Symptoms are reported only by the classroom teacher
  4. The child has an above-average IQ

Explanation

ADHD requires developmentally inappropriate symptoms that are present across settings and cause clear impairment. Cross-setting information is essential because context-specific behavior may reflect environment rather than disorder.

Question 32Pediatric Primary Care Mental Health Specialist

A 14-year-old with depression and a history of a prior suicide attempt is seen in primary care. Which factor most increases acute suicide risk and should prompt immediate safety planning?

  1. Recent discharge following a psychiatric hospitalization Correct answer.
  2. Participation in a school sport
  3. Reporting improved mood on an SSRI
  4. A stable two-parent household

Explanation

The period shortly after psychiatric discharge is a high-risk window for suicide, particularly with a prior attempt. Close follow-up and safety planning are essential during this transition.

Question 33Pediatric Primary Care Mental Health Specialist

A 6-year-old has nighttime fears and refuses to sleep alone after moving to a new home. Which initial approach is most appropriate in primary care?

  1. Recommend the child sleep in the parents' bed indefinitely
  2. Provide reassurance and a consistent bedtime routine with gradual return to independent sleep Correct answer.
  3. Prescribe a benzodiazepine for sleep onset
  4. Refer immediately for long-term psychoanalysis

Explanation

Transient sleep disruption after a move is common and responds to reassurance, predictable routines, and gradual shaping of independent sleep. Medication and intensive referral are not first steps for a brief adjustment reaction.

Question 34Pediatric Primary Care Mental Health Specialist

A 16-year-old is being evaluated for a possible eating disorder. Which finding most strongly warrants urgent medical assessment?

  1. Occasional skipping of breakfast before school
  2. A BMI in the 50th percentile
  3. A desire to eat more plant-based foods
  4. Systolic orthostatic drop with resting bradycardia Correct answer.

Explanation

Orthostatic hypotension and bradycardia are markers of medical instability in restrictive eating disorders and require urgent evaluation. These signs can occur even when weight appears relatively preserved.

Question 35Pediatric Primary Care Mental Health Specialist

A 13-year-old with autism spectrum disorder has new-onset agitation and sleep disruption. Which principle best guides the initial approach in primary care?

  1. Recommend hospitalization as the first step
  2. Start an antipsychotic immediately to control agitation
  3. Attribute the change to autism and defer further evaluation
  4. Evaluate for pain, constipation, infection, and environmental change before considering medication Correct answer.

Explanation

New behavioral change in a child with autism frequently reflects an undetected medical or environmental cause such as pain or constipation. A structured search for reversible triggers precedes pharmacologic escalation.

Question 36Pediatric Primary Care Mental Health Specialist

Which statement about the use of the PHQ-A (modified PHQ-9) in primary care is most accurate?

  1. It supports detection and severity tracking but does not by itself establish a diagnosis Correct answer.
  2. It is validated only for adults over 18
  3. It screens exclusively for bipolar disorder
  4. It replaces a clinical interview when the score exceeds 10

Explanation

The PHQ-A is a screening and severity-tracking instrument; a positive result requires clinical interview to confirm diagnosis and assess function and safety. Screening tools support but do not replace clinical judgment.

Question 37Pediatric Primary Care Mental Health Specialist

A 9-year-old with ADHD is started on a stimulant. Which monitoring plan best reflects appropriate pediatric primary care follow-up?

  1. Assess symptom response, appetite, sleep, and growth at each dose change and regularly thereafter Correct answer.
  2. Obtain an annual EEG to detect seizure risk
  3. Check serum drug levels monthly
  4. Recheck blood pressure only if symptoms are reported

Explanation

Stimulant monitoring focuses on symptom response, adverse effects such as appetite and sleep change, and growth parameters including height, weight, and blood pressure. Serum levels and routine EEGs are not part of standard monitoring.

Question 38Pediatric Primary Care Mental Health Specialist

A 17-year-old presents with 5 days of irritability, decreased sleep, and increased goal-directed activity after starting an SSRI for depression. Which concern is most appropriate to consider?

  1. A typical early response to the SSRI that needs no follow-up
  2. Serotonin syndrome from a single-agent SSRI at a standard dose
  3. A possible SSRI-associated activation or manic switch requiring urgent reassessment Correct answer.
  4. An expected side effect that resolves without intervention

Explanation

Irritability, reduced need for sleep, and increased goal-directed activity shortly after starting an antidepressant may represent activation or a manic switch. Urgent reassessment and consideration of medication adjustment are warranted.

Question 39Pediatric Primary Care Mental Health Specialist

A 5-year-old has frequent tantrums and defiance that occur in multiple settings and cause impairment at preschool and home. Which diagnosis is most appropriate to consider?

  1. Disruptive mood dysregulation disorder
  2. Oppositional defiant disorder Correct answer.
  3. Intermittent explosive disorder
  4. Conduct disorder

Explanation

Oppositional defiant disorder involves a persistent pattern of angry, defiant, and vindictive behavior across settings with impairment. Conduct disorder requires more severe violations of rights or rules, and DMDD requires chronic irritability with severe temper outbursts.

Question 40Pediatric Primary Care Mental Health Specialist

A 15-year-old reports using cannabis several times per week and asks about confidentiality. Which response best reflects appropriate practice?

  1. Explain the limits of confidentiality, including safety concerns, and engage the teen in a collaborative discussion Correct answer.
  2. Inform the parents of all substance use without discussing it first
  3. Guarantee complete confidentiality to build trust
  4. Decline to discuss substance use to avoid a confidentiality conflict

Explanation

Adolescents should be told the boundaries of confidentiality in advance, including exceptions for imminent safety risk. A collaborative approach that respects autonomy while addressing risk best supports engagement.

Question 41Pediatric Primary Care Mental Health Specialist

Which feature most distinguishes a panic attack from the physiologic arousal of an anxiety disorder more generally?

  1. Gradual onset over several hours
  2. Presence of depressed mood
  3. Abrupt onset reaching peak intensity within minutes Correct answer.
  4. Occurrence only during sleep

Explanation

Panic attacks are defined by an abrupt surge of fear or discomfort that peaks within minutes. Generalized anxiety involves more sustained worry rather than discrete abrupt surges.

Question 42Pediatric Primary Care Mental Health Specialist

A 12-year-old with major depressive disorder has not improved after 8 weeks of evidence-based psychotherapy. Which next step is most consistent with pediatric guidelines?

  1. Add an SSRI while continuing psychotherapy and monitor closely Correct answer.
  2. Start a benzodiazepine for mood symptoms
  3. Discontinue treatment and reassess in 6 months
  4. Switch to an antipsychotic as monotherapy

Explanation

For moderate to severe depression or inadequate response to psychotherapy, combining an SSRI with ongoing psychotherapy is recommended, with close monitoring for response and adverse effects. Antipsychotics and benzodiazepines are not first-line for depression.

Question 43Pediatric Primary Care Mental Health Specialist

A 16-year-old with a new diagnosis of generalized anxiety disorder is being counseled. Which statement about cognitive behavioral therapy (CBT) is most accurate?

  1. CBT is contraindicated in adolescents with anxiety
  2. CBT targets maladaptive thoughts and avoidance behaviors and has strong evidence in adolescents Correct answer.
  3. CBT requires hospitalization to be effective
  4. CBT is effective only when combined with medication

Explanation

CBT for anxiety focuses on identifying and modifying maladaptive thoughts and reducing avoidance through graded exposure. It has strong evidence as a first-line treatment for adolescent anxiety.

Question 44Pediatric Primary Care Mental Health Specialist

A 7-year-old with new-onset nighttime urinary incontinence and clinginess after the birth of a sibling is being evaluated. Which formulation is most appropriate?

  1. A regressive response to a family stressor that warrants reassurance and monitoring Correct answer.
  2. A sign of an emerging personality disorder
  3. An indication for immediate psychiatric hospitalization
  4. A primary enuresis requiring immediate medication

Explanation

New regressive symptoms after a major family change often reflect adjustment stress and typically respond to reassurance, routine, and monitoring. Medication and intensive intervention are not first steps.

Question 45Pediatric Primary Care Mental Health Specialist

A 14-year-old with bipolar disorder on lithium presents with vomiting, coarse tremor, and confusion after a gastrointestinal illness. Which action is most appropriate?

  1. Reassure the family that this is a common viral response
  2. Increase the lithium dose to compensate for vomiting
  3. Obtain a lithium level urgently and hold the medication pending results Correct answer.
  4. Start an SSRI to address the mood symptoms

Explanation

Vomiting, coarse tremor, and confusion suggest lithium toxicity, particularly with dehydration from illness. An urgent level and holding the medication are indicated, with evaluation for renal and volume status.

Question 46Pediatric Primary Care Mental Health Specialist

Which statement about the use of rating scales in pediatric mental health care is most accurate?

  1. They eliminate the need for collateral information
  2. They are useful only for research settings
  3. They standardize symptom measurement and support tracking but require clinical interpretation Correct answer.
  4. They provide a definitive diagnosis without interview

Explanation

Rating scales standardize symptom reporting and support severity tracking and treatment monitoring. They inform but do not replace clinical interview and collateral information.

Question 47Pediatric Primary Care Mental Health Specialist

A 10-year-old with a history of trauma presents with hypervigilance, intrusive memories, and avoidance of reminders. Which diagnosis is most appropriate to consider?

  1. Generalized anxiety disorder
  2. Posttraumatic stress disorder Correct answer.
  3. Obsessive-compulsive disorder
  4. Social anxiety disorder

Explanation

Intrusive memories, avoidance of trauma reminders, and hypervigilance after a traumatic event are core features of PTSD. The other conditions lack the trauma-linked intrusive and avoidance symptoms described.

Question 48Pediatric Primary Care Mental Health Specialist

A 16-year-old is brought in for declining grades and social withdrawal. On interview the teen describes hearing voices commenting on their behavior for the past month. Which initial step is most appropriate?

  1. Recommend increased sleep and reassess in 3 months
  2. Reassure the family that this is typical adolescent development
  3. Urgently evaluate for a psychotic disorder and coordinate with specialty mental health care Correct answer.
  4. Start a stimulant for presumed ADHD

Explanation

Auditory hallucinations with functional decline suggest a possible psychotic disorder and require urgent evaluation and coordination with specialty care. Early intervention improves outcomes.

Question 49Pediatric Primary Care Mental Health Specialist

A 13-year-old with obesity reports binge eating with loss of control several times weekly and distress about it. Which diagnosis is most appropriate to consider?

  1. Binge-eating disorder Correct answer.
  2. Anorexia nervosa
  3. Bulimia nervosa
  4. Avoidant/restrictive food intake disorder

Explanation

Recurrent binge episodes with loss of control and distress, without compensatory behaviors, characterize binge-eating disorder. Anorexia and bulimia involve weight or compensatory features not described here.

Question 50Pediatric Primary Care Mental Health Specialist

Which statement best describes the role of the primary care clinician in coordinating care for a child with significant mental health needs?

  1. The clinician should transfer all mental health care to a specialist and discontinue involvement
  2. The clinician should defer to school staff for treatment decisions
  3. The clinician maintains continuity, monitors safety and response, and coordinates with specialty and school services Correct answer.
  4. The clinician should manage all aspects independently without referral

Explanation

Primary care clinicians serve a coordinating role, maintaining continuity, monitoring safety and treatment response, and linking families with specialty and school supports. Collaboration improves outcomes and access.