Adolescent Medicine and Puberty Disorders MCQs

Pediatrics · 36 free questions with answers & explanations.

1. A 6-year-old girl presents with breast development (Tanner stage II), pubic hair (Tanner stage II), and accelerated growth velocity. Bone age is 9 years. GnRH stimulation test shows LH >8 IU/L (LH>FSH). MRI brain is normal. What is the MOST appropriate management?
2. A 17-year-old girl presents with primary amenorrhea, normal breast development (Tanner V), absent pubic and axillary hair, and an absent uterus on pelvic USG. Karyotype is 46, XY. Which is the MOST appropriate counseling priority?
3. A 15-year-old boy has not yet begun puberty. His height is 145 cm, weight appropriate for height, smell is absent (anosmia). LH and FSH are very low. Testosterone is prepubertal. What is the MOST likely diagnosis?
4. An obese 14-year-old adolescent female presents with oligomenorrhea since menarche 2 years ago, acne, and hirsutism. Ultrasound shows multiple small follicles in both ovaries. FSH is normal, LH is elevated (LH:FSH ratio ~2.5), testosterone mildly elevated. Which scoring system quantifies the degree of hirsutism in this patient?
5. A 7-year-old girl develops breast budding (Tanner stage II), pubic hair, and accelerated growth velocity. Bone age is 10 years. GnRH stimulation test shows LH > FSH response (LH:FSH ratio >1). What is the diagnosis and treatment?
6. A 14-year-old girl has not started menstruation. She has normal breast development (Tanner IV), normal pubic hair, but no menstruation and is found to have a blind vaginal pouch. Karyotype is 46,XY. What is the likely diagnosis?
7. A 15-year-old boy has not started pubertal development. He has anosmia, bilateral undescended testes, and normal karyotype (46,XY). FSH and LH are low. GnRH stimulation shows a blunted response. What is the diagnosis?
8. An 8-year-old girl presents with breast budding (B2), sparse pubic hair, and a bone age of 11 years. She has no neurological symptoms. FSH and LH are suppressed; estradiol is mildly elevated; GnRH stimulation test shows prepubertal LH response. DHEAS is elevated. The most likely diagnosis is:
9. A 14-year-old girl has not yet had any breast development or pubic hair (Tanner B1, PH1). Her height is at the 5th centile. FSH is markedly elevated (68 IU/L), LH elevated (35 IU/L), and estradiol is very low. Karyotype is 46,XX. Pelvic ultrasound shows a small uterus and streak gonads. The diagnosis is:
10. A 16-year-old girl with primary amenorrhea has normal breast development (B4), absent pubic and axillary hair, and a blind-ending vagina. Karyotype reveals 46,XY. LH is elevated, testosterone is in the normal male range, and FSH is normal. This is:
11. A 17-year-old girl is brought in by her mother for weight loss. BMI is 14 kg/m2. She is amenorrheic for 8 months, has lanugo hair, bradycardia (HR 48/min), hypothermia, and denies body image disturbance. The immediately life-threatening complication that must be managed before nutritional rehabilitation is:
12. A 7-year-old girl presents with pubic hair (Tanner stage 2) and breast development. Bone age is 10 years. GnRH stimulation test shows LH >5 IU/L (pubertal response). Basal LH is elevated. The most likely diagnosis and first-line treatment is:
13. A 15-year-old girl has never had a menstrual period. She has normal secondary sexual characteristics. Examination reveals a blind-ending vagina with absent uterus. Karyotype is 46,XY. The most likely diagnosis is:
14. A 13-year-old boy has Tanner stage 1 genital development, bone age of 11 years, and growth rate of 4 cm/year. His father started puberty at age 15. FSH and LH are prepubertal. Olfaction is normal. The most likely diagnosis and management is:
15. Adolescent girls are at high risk for iron deficiency anemia due to menstrual losses. The recommended daily iron supplementation for adolescent girls under the National Iron+ Initiative (NI+I) of India is:
16. An 8-year-old girl begins developing breast buds and pubic hair. Her bone age is 10 years. GnRH stimulation test shows a pubertal LH response. The most appropriate next investigation to identify the cause is:
17. A 16-year-old girl is concerned about not having started her menstrual cycles. She has normal secondary sexual characteristics (Tanner stage IV breasts and pubic hair). Pelvic exam and ultrasound show absent uterus. Karyotype is 46,XY. The most likely diagnosis is:
18. A 14-year-old boy has no signs of puberty (Tanner stage I). He has anosmia and his MRI brain is normal. Baseline LH and FSH are low. GnRH stimulation test shows minimal LH response. The diagnosis is:
19. Which Tanner stage for female breast development first denotes a secondary mound (mound-on-mound appearance)?
20. A 15-year-old female athlete presents with primary amenorrhea, stress fractures and disordered eating. This triad is best described as:
21. A 6-year-old girl presents with breast development (Tanner stage 2), pubic hair (Tanner stage 2), and a bone age of 8 years. GnRH stimulation test shows LH rise to 12 IU/L (>8 IU/L). Pelvic ultrasound shows a 2 cm follicular ovarian cyst. MRI brain is normal. What is the most appropriate management?
22. A 15-year-old boy has no testicular enlargement (testicular volume 2 mL) and no axillary or pubic hair. His height velocity is 3 cm/year. Bone age is 11 years. Baseline LH/FSH are undetectable; after GnRH stimulation, LH rises minimally. Smell is reported as absent. The most likely diagnosis is:
23. A 16-year-old girl with primary amenorrhoea has normal secondary sexual characteristics, absent uterus on ultrasound, 46,XY karyotype, and markedly elevated LH with mildly elevated testosterone (within normal female range). The most appropriate management includes:
24. A 17-year-old girl presents with secondary amenorrhoea for 8 months, lanugo on the back, bradycardia (48 bpm), hypotension, and a BMI of 14. She exercises 2 hours daily and believes she is overweight. Which electrolyte abnormality is the MOST life-threatening acute risk?
25. A 5-year-old girl presents with breast development (Tanner stage 2) and pubic hair. She has no vaginal bleeding. Bone age is 2 years advanced. GnRH stimulation test shows a pubertal LH response. Which is the MOST appropriate first-line treatment for this condition?
26. A 15-year-old girl presents with primary amenorrhea, no secondary sexual characteristics (no breast development, no pubic hair), and short stature. FSH is 85 IU/L (elevated), LH 62 IU/L (elevated), estradiol very low. Karyotype shows 46,XX. What is the MOST likely diagnosis?
27. A 14-year-old boy presents with gynecomastia (bilateral breast tissue enlargement) for 6 months. There is no galactorrhea, testicular mass, or hepatomegaly. He is Tanner stage 3 for genital development. What is the MOST likely explanation for his gynecomastia?
28. An adolescent girl with low BMI, lanugo hair, parotid enlargement, and dental erosion is found to have hypokalemic metabolic alkalosis. She denies food restriction. Which eating disorder is MOST consistent with these findings?
29. A 6-year-old girl presents with breast development (Tanner stage 2), pubic hair, and a bone age of 8 years. GnRH stimulation test shows LH response of 12 IU/L (basal LH 0.8 IU/L). She has no headache or visual symptoms. MRI brain is normal. What is the most appropriate management?
30. A 16-year-old girl presents with primary amenorrhea, normal secondary sexual characteristics (Tanner V), blind-ending vagina, and absent uterus on pelvic ultrasound. Her karyotype is 46,XY. Serum testosterone is in the adult male range. Which is the most appropriate next step?
31. A 14-year-old boy has been showing no signs of puberty (testicular volume <4 mL, no pubic hair). His bone age is 12.5 years. Father reports he himself started puberty late. Serum LH, FSH, and testosterone are all low-normal. Growth velocity is normal. What is the most likely diagnosis?
32. A 15-year-old girl with anorexia nervosa has a BMI of 13 kg/m², secondary amenorrhea for 9 months, lanugo hair, low estrogen, and an ECG showing a QTc of 510 ms. Which metabolic/electrolyte abnormality is most immediately life-threatening in this patient?
33. A 7-year-old girl presents with breast development (Tanner stage 2) and pubic hair. Bone age is advanced at 9 years. GnRH stimulation test shows LH response >5 IU/L. The MOST appropriate treatment is:
34. A 16-year-old girl has never menstruated. She has normal secondary sexual characteristics (Tanner stage 5 breasts, scant axillary and pubic hair), a blind-ending vaginal pouch, and no uterus on ultrasound. Karyotype is 46,XY. The diagnosis is:
35. A 14-year-old boy is concerned about his lack of pubertal development. He has no testicular enlargement (testicular volume 2 mL), no pubic hair, short stature, and has never experienced voice changes. His bone age is delayed at 11 years. Serum LH, FSH, and testosterone are all low. He is otherwise healthy with a normal sense of smell. The MOST likely diagnosis is:
36. In assessing pubertal development, the FIRST sign of puberty in girls is: