NEWEST FAMILY MEDICINE –
ADOLESCENT MEDICINE CERTIFICATION
EXAM FOR THE ABMS (AMERICAN BOARD
OF FAMILY MEDICINE) | Q&A WITH
RATIONALES
1. A 15-year-old male presents with a painless,
unilateral breast enlargement of 6 months' duration.
Examination shows a 3 cm firm, mobile subareolar
mass. No galactorrhea, testicular abnormalities, or
medication use. What is the most appropriate next
step?
A) Mammography
B) Testicular ultrasound
C) Reassurance and follow-up in 6 months
D) Serum estradiol and testosterone levels
Correct answer: C
Rationale: This is physiologic gynecomastia of
puberty, which is common (up to 65% of adolescents)
and typically resolves spontaneously within 1-2
years. No testing is needed without red flags.
,2. A 14-year-old girl has missed three consecutive
menstrual periods. She is sexually active with one
male partner and uses condoms inconsistently.
Pregnancy test is negative. She reports mild acne
and hirsutism. BMI is 32. What is the most likely
diagnosis?
A) Hypothalamic amenorrhea
B) Polycystic ovary syndrome (PCOS)
C) Primary ovarian insufficiency
D) Prolactinoma
Correct answer: B
Rationale: PCOS is the most common cause of
oligomenorrhea in adolescent females, especially
with obesity, acne, and hirsutism. Two of three
Rotterdam criteria are met after excluding
pregnancy.
3. A 16-year-old male is brought in by his parents due
to a one-week history of fever, sore throat, and
severe fatigue. Exam reveals posterior cervical
lymphadenopathy, palatal petechiae, and
splenomegaly. What is the most important
recommendation?
A) Amoxicillin 875 mg twice daily for 10 days
B) Avoid contact sports for 4-6 weeks
,C) Monospot test immediately
D) Corticosteroids for symptom relief
Correct answer: B
Rationale: Splenomegaly in infectious mononucleosis
(EBV) confers risk of splenic rupture with trauma.
Avoid contact sports for 4-6 weeks regardless of
imaging. Amoxicillin is avoided (rash risk).
4. A 17-year-old female reports heavy menstrual
bleeding lasting 10-12 days each cycle for the past 4
months. Hemoglobin is 9.8 g/dL. She is not sexually
active. Pelvic exam is normal. What is first-line
management?
A) Oral contraceptive pills (OCPs) cyclically
B) Tranexamic acid
C) Medroxyprogesterone acetate intramuscularly
D) NSAIDs alone
Correct answer: A
Rationale: Combined OCPs are first-line for
anovulatory bleeding in adolescents without
contraindications. They stabilize endometrium and
reduce blood loss. NSAIDs are adjunctive, not
monotherapy for heavy bleeding.
, **5.** A 13-year-old boy has a 2-day history of
progressive scrotal pain, nausea, and vomiting. On
exam, the left testis is tender, elevated, with an
absent cremasteric reflex. What is the most
appropriate immediate action?
A) Urgent urology consultation and scrotal
ultrasound
B) Empirical antibiotics for epididymitis
C) Ice packs and scrotal elevation
D) Urinalysis and STI testing
Correct answer: A
Rationale: Testicular torsion is a surgical emergency.
Absent cremasteric reflex is highly sensitive. Scrotal
ultrasound with Doppler is urgent, but surgery should
not be delayed if clinical suspicion is high.
**6.** Which of the following vaccines is routinely
recommended for all adolescents aged 11-12 years
regardless of prior infection history?
A) Hepatitis A
B) Meningococcal B
C) Tdap and HPV and MenACWY
D) Influenza only if high-risk
Correct answer: C
ADOLESCENT MEDICINE CERTIFICATION
EXAM FOR THE ABMS (AMERICAN BOARD
OF FAMILY MEDICINE) | Q&A WITH
RATIONALES
1. A 15-year-old male presents with a painless,
unilateral breast enlargement of 6 months' duration.
Examination shows a 3 cm firm, mobile subareolar
mass. No galactorrhea, testicular abnormalities, or
medication use. What is the most appropriate next
step?
A) Mammography
B) Testicular ultrasound
C) Reassurance and follow-up in 6 months
D) Serum estradiol and testosterone levels
Correct answer: C
Rationale: This is physiologic gynecomastia of
puberty, which is common (up to 65% of adolescents)
and typically resolves spontaneously within 1-2
years. No testing is needed without red flags.
,2. A 14-year-old girl has missed three consecutive
menstrual periods. She is sexually active with one
male partner and uses condoms inconsistently.
Pregnancy test is negative. She reports mild acne
and hirsutism. BMI is 32. What is the most likely
diagnosis?
A) Hypothalamic amenorrhea
B) Polycystic ovary syndrome (PCOS)
C) Primary ovarian insufficiency
D) Prolactinoma
Correct answer: B
Rationale: PCOS is the most common cause of
oligomenorrhea in adolescent females, especially
with obesity, acne, and hirsutism. Two of three
Rotterdam criteria are met after excluding
pregnancy.
3. A 16-year-old male is brought in by his parents due
to a one-week history of fever, sore throat, and
severe fatigue. Exam reveals posterior cervical
lymphadenopathy, palatal petechiae, and
splenomegaly. What is the most important
recommendation?
A) Amoxicillin 875 mg twice daily for 10 days
B) Avoid contact sports for 4-6 weeks
,C) Monospot test immediately
D) Corticosteroids for symptom relief
Correct answer: B
Rationale: Splenomegaly in infectious mononucleosis
(EBV) confers risk of splenic rupture with trauma.
Avoid contact sports for 4-6 weeks regardless of
imaging. Amoxicillin is avoided (rash risk).
4. A 17-year-old female reports heavy menstrual
bleeding lasting 10-12 days each cycle for the past 4
months. Hemoglobin is 9.8 g/dL. She is not sexually
active. Pelvic exam is normal. What is first-line
management?
A) Oral contraceptive pills (OCPs) cyclically
B) Tranexamic acid
C) Medroxyprogesterone acetate intramuscularly
D) NSAIDs alone
Correct answer: A
Rationale: Combined OCPs are first-line for
anovulatory bleeding in adolescents without
contraindications. They stabilize endometrium and
reduce blood loss. NSAIDs are adjunctive, not
monotherapy for heavy bleeding.
, **5.** A 13-year-old boy has a 2-day history of
progressive scrotal pain, nausea, and vomiting. On
exam, the left testis is tender, elevated, with an
absent cremasteric reflex. What is the most
appropriate immediate action?
A) Urgent urology consultation and scrotal
ultrasound
B) Empirical antibiotics for epididymitis
C) Ice packs and scrotal elevation
D) Urinalysis and STI testing
Correct answer: A
Rationale: Testicular torsion is a surgical emergency.
Absent cremasteric reflex is highly sensitive. Scrotal
ultrasound with Doppler is urgent, but surgery should
not be delayed if clinical suspicion is high.
**6.** Which of the following vaccines is routinely
recommended for all adolescents aged 11-12 years
regardless of prior infection history?
A) Hepatitis A
B) Meningococcal B
C) Tdap and HPV and MenACWY
D) Influenza only if high-risk
Correct answer: C
