PE6.1-12 | Adolescent Health — Graded Quiz

Correct. Pubertal gynaecomastia affects 40–60% of boys at Tanner Stages 2–3 due to a transient imbalance between oestrogen and androgen activity. It is benign and self-limiting, typically resolving within 12–24 months. Persistent (>2 years) or marked gynaecomastia warrants investigation (Klinefelter's, testicular tumour, medications).

Pubertal (physiological) gynaecomastia occurs in up to 60% of boys, peaks at Tanner 2–3, and resolves within 24 months. Investigate for pathological causes if: onset before Tanner 2 or after Tanner 5, persistent >2 years, asymmetric/hard/tender, or associated with testicular mass, short stature, or virilisation failure.

Pubertal gynaecomastia is physiological, peaking at Tanner Stage 3. Pathological causes (Klinefelter's, testicular tumour, liver disease, medications) are excluded by the normal testicular size, normal pubertal progression, and absence of other features. Reassurance and follow-up are appropriate here.

Correct. Levonorgestrel 1.5 mg within 72 hours is effective (reduces pregnancy risk by ~85% if taken within 24 hours, ~58% at 49–72 hours). The copper IUCD inserted within 5 days is the most effective emergency contraceptive (>99%). Adolescents may access emergency contraception without mandatory parental consent under the principle of capacity-based consent for health services.

Emergency contraception: LNG 1.5 mg within 72 hours (efficacy ~85% if within 24 h, decreases with time); Cu-IUCD within 5 days (>99% efficacy, also provides ongoing contraception). Capacity-based adolescent consent is the ethical standard for reproductive health services at AFHC.

Levonorgestrel ECPs (not the Yuzpe/combined method) are preferred due to fewer side effects and higher efficacy. Emergency contraception is NOT 100% effective. The POCSO Act mandatory reporting obligation relates to disclosed sexual abuse (non-consensual), not consensual adolescent sexual activity — and capacity-based consent applies to adolescent healthcare.

Correct. Hypokalaemia (and hypomagnesaemia) from caloric restriction and/or purging reduces the repolarisation reserve of cardiac myocytes, slowing ventricular repolarisation and prolonging QTc. QTc >450 ms in anorexia nervosa is associated with sudden cardiac death risk — a medical emergency.

Anorexia Nervosa medical emergency indicators: QTc >450 ms, hypokalaemia (<3.0 mEq/L), bradycardia <50/min, hypotension, syncope, or BMI <13 kg/m². Electrolyte correction and cardiac monitoring are priorities during initial management and refeeding.

The predominant electrolyte cause of QTc prolongation in anorexia nervosa is hypokalaemia (and hypomagnesaemia), both of which delay ventricular repolarisation. Bradycardia is present but reflects autonomic adaptation; it is NOT always benign when accompanied by QTc prolongation, electrolyte disturbance, and severely low BMI.

Correct. Adolescent substance use in a HEEADSSS context requires a non-judgmental, motivational approach: assess frequency, impact on functioning (school, relationships), dependence features, and co-occurring mental health issues; provide brief motivational counselling and harm-reduction information; maintain confidentiality unless there is serious harm risk.

In HEEADSSS substance-use screening, use the CRAFFT (Car, Relax, Alone, Forget, Friends, Trouble) tool for adolescent substance use risk stratification. Brief motivational intervention is effective at reducing substance use. Confidentiality is maintained unless harm risk is identified.

Parental notification without consent violates confidentiality unless there is serious harm risk. Cannabis is not legal for adolescents in India. Immediate inpatient referral is disproportionate for non-dependent, non-harmful recreational use at this stage. Brief intervention and motivational counselling are the evidence-based first steps.

Correct. Turner Syndrome (45,X monosomy) presents with: short stature, primary (or absent) puberty (streak gonads), primary amenorrhoea, and characteristic features (webbed neck, wide-spaced nipples, cubitus valgus). Karyotype 45,X confirms the diagnosis. Bone age may be delayed.

Turner Syndrome workup: karyotype (45,X or mosaic 45,X/46,XX), echocardiogram (bicuspid aortic valve/coarctation in ~30%), renal USS, thyroid autoantibodies, and oestrogen replacement for puberty induction. Growth hormone therapy improves adult height.

CDGP typically has a family history of delayed puberty and will eventually progress spontaneously — karyotype is 46,XX. Hypothyroidism can delay puberty but does not cause the 45,X karyotype. Kallmann Syndrome involves anosmia + absent GnRH and presents with 46,XX karyotype. The 45,X karyotype is diagnostic of Turner Syndrome.

Correct. Bulimia Nervosa (DSM-5): recurrent binge eating episodes + recurrent compensatory behaviours (purging, laxatives, excessive exercise) at least once/week for 3 months + normal body weight + self-evaluation unduly influenced by body shape/weight. Parotid swelling, enamel erosion, and Russell's sign are hallmark physical features.

Physical signs of Bulimia Nervosa: parotid (salivary gland) hypertrophy, dental enamel erosion (from acid reflux/vomiting), Russell's sign (calluses/abrasions on dorsum of hand from induced vomiting), hypokaalaemia (ECG changes, muscle weakness). Screen electrolytes in all suspected eating disorder patients.

Anorexia Nervosa Binge-Purge Type requires significantly LOW body weight (BMI <17.5 or equivalent); this patient has a normal BMI. Binge Eating Disorder has recurrent binges WITHOUT compensatory behaviours. Purging Disorder is purging without binge eating. This presentation fits Bulimia Nervosa.

Correct. A structured safety assessment (C-SSRS), a written safety plan, and close scheduled follow-up are the evidence-based steps for an adolescent with moderate depression and past suicidal ideation. SSRIs (fluoxetine is the only FDA-approved SSRI for adolescent depression) are first-line pharmacotherapy but should be initiated in consultation with psychiatry.

Adolescent depression management: CBT + SSRI (fluoxetine preferred; black-box warning on increased suicidality — monitor closely in first weeks). Always create a written safety plan, include family if appropriate, and schedule close follow-up within 1 week of any suicidal ideation disclosure.

Discharging with only a leaflet is unsafe for an adolescent with moderate depression and prior suicidal ideation. TCAs are NOT first-line for adolescent depression (cardiotoxicity risk, potential for overdose). Involuntary admission is not mandated solely by past ideation without current active plan/intent.

Correct. POCSO Act 2012, Section 19, mandates that any person who has knowledge of a sexual offence against a child MUST report it to the SJPU or the local police. Failure to report is an offence. The clinician must also refer the child to the Child Welfare Committee and ensure she is in a safe environment. The duty to report overrides confidentiality in this context.

POCSO Act 2012 Section 19: mandatory reporting duty for ALL persons, including healthcare providers. Report to SJPU/police within 24 hours. The CWC (Child Welfare Committee) coordinates child protection and placement. Failure to report is punishable under Section 21. Always ensure immediate safety before the child leaves the facility.

POCSO 2012 (Protection of Children from Sexual Offences) is a mandatory reporting law — there is NO discretion. Confidentiality does not override the legal duty to report. Informing the alleged abuser first is dangerous and contrary to law. Deferring report pending psychiatric evaluation delays child protection.

Correct. This adolescent meets criteria for metabolic syndrome (central obesity + elevated BP + impaired fasting glucose — IDF paediatric criteria: waist circumference ≥90th centile, BP ≥130/85, fasting glucose ≥100 mg/dL or T2DM). Obstructive sleep apnoea (OSA) is a common and under-diagnosed comorbidity of adolescent obesity. Together, they represent the NCD burden of adolescent obesity.

IDF Paediatric Metabolic Syndrome criteria (10–16 years): central obesity (waist ≥90th centile) PLUS ≥2 of: TG ≥150 mg/dL, HDL <40 mg/dL, BP ≥130/85, FPG ≥100 mg/dL. Screen all obese adolescents for metabolic syndrome, OSA (polysomnography), fatty liver (LFTs/USG), and PCOS in girls.

Prader-Willi presents with hypotonia, hyperphagia, hypogonadism, and intellectual disability from infancy. Cushing syndrome has central obesity, striae, moon facies, and elevated cortisol. Hypothyroidism causes weight gain but primarily via reduced metabolic rate; hypertension is not a primary feature. This presentation fits metabolic syndrome + OSA secondary to obesity.

Correct. RKSK's sixth thematic area — Non-Communicable Diseases — specifically addresses obesity, hypertension, metabolic syndrome, and PCOS in adolescents. AFHC is the service delivery platform where this girl should receive counselling, weight management advice, and metabolic risk screening (lipid profile, fasting glucose, BP monitoring).

PCOS in adolescents: diagnosis requires 2 of 3 (per PCOS Society 2018 for adolescents): oligo-amenorrhoea >2 years post-menarche, hyperandrogenism, or polycystic ovarian morphology on USS. RKSK's NCD component and AFHC-based care address the metabolic comorbidities (insulin resistance, dyslipidaemia, future T2DM risk) with lifestyle counselling as first-line therapy.

JSSK is an entitlement scheme for free maternal and neonatal care. ICDS targets children 0–6 years. Routine immunisation addresses vaccine-preventable disease. RKSK's NCD component is the correct programmatic response for adolescent obesity-related NCD risk management in India.