PART XIII Adolescent Medicine

QUESTIONS
HAYDER ALMUSAWI
1. Adrenal production of androgen with development of underarm odor and faint
genital hair (adrenarche) may occur as early as
A. 4 yr
B. 5 yr
C. 6 yr
D. 7 yr
E. 8 yr

2. In males, the first visible sign of puberty is testicular enlargement, beginning as early
as
A. 8.5 yr
B. 9.5 yr
C. 10.5 yr
D. 11.5 yr
E. 12.5 yr

3. Penile growth occur during SMR

A. 1
B. 2
C. 3
D. 4
E. 5

4. Peak growth occurs during SMR 4 when testis volumes reach approximately
A. 3-4 cm3
B. 5-6 cm3
C. 7-8 cm3
D. 9-10 cm3
E. 11-12 cm3

5. Sperm may be found in the urine and nocturnal emissions may be noted at SMR
A. 1
B. 2
C. 3
D. 4
E. 5

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6. The first visible sign of puberty in females is the appearance of breast buds
(thelarche) between
A. 5 and 9 yr
B. 6and 10 yr
C. 7 and 11 yr
D. 8 and 12 yr
E. 9 and 13 yr

7. Menses typically begins 2.5 yr after the onset of puberty at an average age of
A. 9.5 yr
B. 10.5 yr
C. 11.5 yr
D. 12.5 yr
E. 13.5 yr

8. The belief that major structural brain development is completed in childhood is

outdated. It is now clear that neuromaturation continues into the
A. 2nd decade
B. 3rd decade
C. 4th decade
D. 5th decade
E. 6th decade

9. Urethritis is a sexually transmitted infections syndrome characterized by

inflammation of the urethra, usually caused by an infectious etiology.
All of the following are true EXCEPT
A. urethritis may present with meatal pruritus
B. approximately 30-50% of males are asymptomatic
C. on examination, the classic finding is erythema of the urethral meatus
D. N. gonorrhoeae is one of the most commonly identified pathogen
E. noninfectious causes of urethritis include urethral trauma or foreign body

10. In assessing the seriousness of adolescent drug abuse score, which of the following
take +2 in the score?
A. female sex
B. age >15 years
C. positive family history of drug abuse
D. use before driving
E. use of hallucinogens

11. Which of the following scores regarded as serious according to the assessment of
seriousness of adolescent drug abuse score?

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 A. 0-3
B. 3-8
C. 8-13
D. 13-18
E. 18-23

12. A 13-years-old male presented with delirium and mumbling speech, tachycardia,
dry flushed skin, dilated pupils, myoclonus, slightly elevated temperature, urinary
retention, and decreased bowel sounds, later on he developed seizure and
dysrhythmia.
Of the following, the MOST likely cause is
A. antidepressant agents
B. amphetamine
C. barbiturates
D. benzodiazepines
E. edrophonium

13. Alcohol acts primarily as a central nervous system depressant. It produces all the
following EXCEPT
A. euphoria
B. impaired short-term memory
C. increased pain threshold
D. hyperthermia
E. respiratory depression

14. Smoking during pregnancy is associated with an average decrease in fetal weight by
A. 100 g
B. 200 g
C. 300 g
D. 400 g
E. 500 g

15. Exposure to smokeless tobacco increases the users risk for

A. lipoid pneumonia
B. chronic cough
C. cancers of the esophagus
D. irritability
E. decreased concentration

16. Lysergic acid diethylamide (LSD) is a very potent hallucinogen that is made from
lysergic acid found in ergot, a fungus that grows on rye and other grains.
All the following are common somatic symptoms EXCEPT

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 A. dizziness
B. miosis
C. nausea
D. flushing
E. hyperthermia

17. A 15-year-old female presented with delusions, paranoia, tachycardia,

hypertension, hyperpyrexia, diaphoresis, piloerection, mydriasis, and hyperreflexia,
later on she developed seizure, hypotension, and dysrhythmia.
Of the following, the MOST likely cause is
A. antidepressant agents
B. amphetamine
C. barbiturates
D. benzodiazepines
E. edrophonium

18. Which of the following is TRUE regarding pubertal gynecomastia?

A. occurring in up to 20% of normal adolescent males
B. onset typically is between 7 and 9 yr
C. usually regresses within 6 mo
D. surgery may be indicated in severe or persistent cases
E. medical therapies have been approved for use in adolescents

19. Evaluation for pubertal delay in female should be done if she lacks any pubertal
signs by the age of
A. 12 yr
B. 13 yr
C. 14 yr
D. 15 yr
E. 16 yr

20. The age at which an evaluation for primary amenorrhea should be undertaken is
A. 12 yr
B. 13 yr
C. 14 yr
D. 15 yr
E. 16 yr

21. Primary amenorrhea generally requires evaluation, if menstruation does not occur
within
A. 1 yr from the onset of puberty
B. 2 yr from the onset of puberty

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 C. 3 yr from the onset of puberty
D. 4 yr from the onset of puberty
E. 5 yr from the onset of puberty

22. The MOST commonly used method for contraception is

A. condom
B. withdrawal
C. oral contraceptive pill
D. spermicides
E. intrauterine device

23. The contraceptive method with the highest failure rate even with perfect use is
A. progestin releasing intra uterine device
B. progestin-only injection
C. combined oral contraceptives
D. male condom
E. spermicides

24. Depo-provera: an injectable progestin, medroxyprogesterone acetate available as a

deep intramuscular injection (150 mg) or as a subcutaneous injection (104 mg) with
typicaluse, the failure rates is 6%.
Potential adverse effect include
A. heavy menstrual bleeding
B. dysmenorrhea
C. acne
D. weight gain
E. osteoporosis

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PART XIII Adolescent Medicine
ANSWERS
HAYDER ALMUSAWI
1.(C). Adrenal production of androgen (chiefly dehydroepiandrosterone sulfate
[DHEAS]) may occur as early as 6 yr of age, with development of underarm odor and
faint genital hair (adrenarche).
2.(B), 3.(C), 4.(D), 5.(C). In males, the first visible sign of puberty and the hallmark of
SMR 2 is testicular enlargement, beginning as early as 9.5 yr, followed by the
development of pubic hair. This is followed by penile growth during SMR 3. Peak
growth occurs when testis volumes reach approximately 9-10 cm3 during SMR 4. Under
the influence of luteinizing hormone and testosterone, the seminiferous tubules,
epididymis, seminal vesicles, and prostate enlarge. Sperm may be found in the urine by
SMR 3; nocturnal emissions may be noted at this time as well.
6.(D), 7.(D). In females, typically the first visible sign of puberty and the hallmark of
SMR 2 is the appearance of breast buds (thelarche), between 8 and 12 yr of age. A
significant minority of females develops pubic hair (pubarche) prior to thelarche. Less
visible changes include enlargement of the ovaries, uterus, labia, and clitoris, and
thickening of the endometrium and vaginal mucosa. A clear vaginal discharge may be
present prior to menarche (physiologic leukorrhea). Menses typically begins 2.5 yr after
the onset of puberty, during SMR 3-4 (average age: 12.5 yr; normal range: 9-15 yr).
8.(B). This maturation is characterized by decreases in gray matter, increases in white
matter, and an apparent increase in the efficiency of communication and connectivity
between different brain regions.
9.(C). On examination, the classic finding is mucoid or purulent discharge from the
urethral meatus. If no discharge is evident on exam, providers may attempt to express
discharge by applying gentle pressure to the urethra from the base distally to the
meatus 3-4 times.
10.(D). The score consist of 0, +1 and +2.
+2 include : use of drugs alone not in group, sad before drug use, recently poor school
performance, use drugs before driving, history of accident, use drugs before and during
school day and the use of Whiskey, opiates, cocaine, barbiturates.
11.(B). 0-3 less worrisome, 3-8 serious and 8-18 very serious.
12.(A). Patient in the question presented with anticholinergic syndrome and this
syndrome can be caused by antihistamines, antiparkinsonian medication, atropine,
scopolamine, amantadine, antipsychotic agents, antidepressant agents, antispasmodic
agents, mydriatic agents, skeletal muscle relaxants, and many plants (notably jimson
weed and Amanita muscaria).
13.(D). Hypothermia.

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14.(B). Smoking during pregnancy is associated with an average decrease in fetal
weight of 200 g; this decrease, added to the already smaller size of infants born to
teenagers, increases perinatal morbidity and mortality.
15.(C). The 2 forms of smokeless tobacco (SLT) are “chew,” a leafy tobacco product sold
in pouches, and “snuff,” a finely ground tobacco product sold in tins or packets.
Exposure to SLT increases the users risk for oral cancers of the mouth, pharynx, larynx,
and esophagus, as well as gum disease and nicotine addiction.
16.(B). Mydriasis.
17.(B). Patient in the question presented with sympathomimetic syndrome and this
syndrome can be caused by cocaine, amphetamine, methamphetamine, and OTC
decongestants (phenylpropanolamine, ephedrine, and pseudoephedrine). In caffeine
and theophylline overdoses, similar findings, except for the organic psychiatric signs,
result from catecholamine release.
18.(D). Occurring in up to 60% of normal adolescent males, onset typically is between
10 and 13 yr, usually regresses within 18-24 mo, no medical therapies for gynecomastia
have been approved for use in adolescents.
19.(B).
20.(D), 21.(D). Age 15 yr is commonly considered the age at which an evaluation for
primary amenorrhea should be undertaken. Evaluation should begin sooner if 4 yr have
elapsed since the onset of puberty (breast development in most females).
22.(A). The most commonly used method is the condom, followed by withdrawal and
then the pill.
23.(E). Failure rate are as follow: Progestin releasing intra uterine device 0.2%,
progestin-only injection 0.2%, combined oral contraceptives 0.3%, male condom 2%,
spermicides 18%.
24.(E). After 1 yr of use, 50% of users develop amenorrhea, which may be an added
advantage for teens with heavy menstrual bleeding, dysmenorrhea, anemias, or blood
dyscrasias. Although concern has been directed toward the potential for loss in bone
mineral density in adolescents, thereby potentially increasing their risk for osteoporosis
later in life, subsequent studies have found that bone density is recovered after
discontinuation of the method and is considered safe for use in this population.

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