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PE6.1-12 | Adolescent Health — Practice Quiz
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A 13-year-old girl presents for a routine health check. According to WHO, the adolescent age group spans from 10 to 19 years. Which of the following best describes the CORRECT classification of early, middle, and late adolescence?
Correct. WHO defines adolescence as 10–19 years, divided into early (10–13), middle (14–16), and late (17–19) adolescence, each with characteristic developmental features.
Adolescence = 10–19 years (WHO); early 10–13, middle 14–16, late 17–19. Young people 10–24 years are sometimes termed 'youth' under broader definitions, but the clinical-programme definition for India's RKSK/AFHC programmes uses 10–19.
Adolescence per WHO is 10–19 years, subdivided into early (10–13), middle (14–16), and late (17–19). Option A correctly reflects this three-stage division used in clinical and programme contexts.
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During routine screening of a 14-year-old boy, you note testicular enlargement (>4 mL volume), sparse pubic hair, and no other pubertal changes. Using the Tanner (Sexual Maturity Rating) staging, what Tanner stage does this most likely correspond to?
Correct. Tanner Stage 2 in males is characterised by testicular enlargement (>4 mL or length >2.5 cm) with scrotal skin changes and the first appearance of sparse, slightly pigmented pubic hair — the earliest sign of puberty in boys.
The first sign of puberty in boys is testicular enlargement >4 mL (Tanner Stage 2); in girls it is thelarche (breast bud). Always assess Tanner stage systematically using both genital and pubic-hair parameters (SMR).
Testicular enlargement >4 mL with sparse pubic hair and no other changes = Tanner Stage 2. Stage 1 is prepubertal (no changes); Stage 3 adds penile length increase and darker/curlier pubic hair; Stage 4 adds penile girth and adult-type hair not yet reaching the medial thigh.
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A 15-year-old girl presents to the adolescent clinic with irregular menstruation, acne, and weight gain over the past year. During HEEADSSS screening, she discloses academic failure and peer isolation. She is at risk for which of the following systemic health problems most common in adolescence in India?
Correct. Iron-deficiency anaemia (especially in girls with menstruation) and overweight/obesity are the two most prevalent health problems in Indian adolescents. This girl's presentation — irregular periods, weight gain, acne — also raises suspicion for PCOS, itself strongly associated with overweight.
Leading adolescent health problems in India: anaemia (especially girls), overweight/obesity, reproductive health issues, mental health (depression/anxiety), substance use, and injuries. The WIFS (Weekly Iron and Folic Acid Supplementation) programme targets adolescent iron-deficiency.
The most common general health problems in Indian adolescents are nutritional anaemia (particularly in menstruating girls), overweight/obesity, and mental health issues. Rheumatic heart disease, Type 1 DM, and congenital hypothyroidism are not the leading burden-of-disease in this age group.
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During an adolescent health visit, a 16-year-old male discloses that he has had a consensual sexual encounter with a peer. He expresses concern about sexually transmitted infections (STIs). Under the principle of confidentiality for adolescents, when is it appropriate to breach this adolescent's confidentiality without consent?
Correct. Confidentiality for adolescents may be breached only when there is an immediate risk of serious harm — to the patient (e.g., suicidal intent, severe self-harm) or to another person. This is the ethical and legal standard underpinning adolescent-friendly health services.
Adolescent confidentiality is protected under AFHS principles: disclose only when there is risk of serious harm to self or others, when legally mandated (e.g., abuse), or when the adolescent consents. Document the rationale whenever confidentiality is breached.
Adolescent confidentiality is a cornerstone of adolescent-friendly care (AFHS/AFHC). It can be breached ONLY for risk of serious harm to self or others — not for parental curiosity, clinical disagreement with choices, or routine STI management (STIs are managed confidentially to encourage disclosure).
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An 18-year-old girl presents with a 6-month history of restricting food intake, fear of weight gain, and a BMI of 15.5 kg/m². She denies binge-eating or purging. She has amenorrhoea. Which DSM-5 diagnosis is most consistent with this presentation?
Correct. Anorexia Nervosa (Restrictive Type) per DSM-5: restriction of energy intake → significantly low body weight (BMI < 17.5 or age-specific equivalent), intense fear of gaining weight, distorted body image, with NO recurrent binge-purge episodes. Amenorrhoea, though removed as a criterion in DSM-5, is commonly present.
DSM-5 criteria for Anorexia Nervosa: (1) restriction leading to significantly low body weight, (2) intense fear of gaining weight, (3) disturbance in perception of body weight/shape. Amenorrhoea was removed from DSM-5 criteria but is clinically important. Early intervention improves prognosis.
Bulimia Nervosa requires recurrent binge-eating AND compensatory behaviours (purging, laxatives). Binge Eating Disorder has recurrent binges without compensation. ARFID is characterised by sensory/texture aversion or fear of choking — not body-image distortion. This case fits AN-Restrictive.
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A 17-year-old male presents following a failed examination. He reports persistent low mood for the past 3 weeks, poor sleep, loss of interest, and feelings of worthlessness. He admits to passive death wishes but denies active suicidal plans. Which screening tool is MOST appropriate for assessing suicide risk in this adolescent at a primary health facility?
Correct. Validated suicide risk screening tools — the Columbia Suicide Severity Rating Scale (C-SSRS) or the Ask Suicide-Screening Questions (ASQ) — are designed specifically to stratify suicide risk and guide triage. Depression scales measure symptom severity, not suicide risk categorisation.
Adolescent depression and suicidality must be screened using dedicated tools (ASQ, C-SSRS) at primary-care visits. Any passive death wish or suicidal ideation warrants same-day mental health review. The Mental Healthcare Act 2017 decriminalised suicide attempt in India — approach adolescents without judgment.
HAM-D, BDI, and the Zung scale measure depression severity — they do not specifically stratify suicide risk into actionable categories. For adolescent suicide risk, structured tools like ASQ (4 questions) or C-SSRS are recommended at primary-care and emergency settings.
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You are performing a routine adolescent health check-up using the HEEADSSS framework. The letter 'D' in HEEADSSS stands for two separate domains. Which of the following correctly identifies BOTH domains represented by the two D's?
Correct. HEEADSSS: Home, Education/Employment, Eating (or Exercise), Activities, Drugs, Sexuality, Suicide/Depression, Safety. The two D's are Drugs (substance use) and Depression/Suicide (mental health screening). This structured framework ensures systematic adolescent psychosocial assessment.
HEEADSSS is the structured psychosocial screening tool for adolescents: Home, Education/Employment, Eating, Activities, Drugs, Sexuality, Suicide/Depression, Safety. Begin with less sensitive domains (Home, Education) and progress to more sensitive ones (Sexuality, Drugs, Suicide) as rapport builds.
The HEEADSSS acronym expands as: H=Home, E=Education/Employment, E=Eating, A=Activities, D=Drugs, S=Sexuality, S=Suicide/Depression, S=Safety. Both D's represent: Drugs (substance use) and Safety domain is captured separately. The last domains cover Depression/Suicide explicitly.
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A 16-year-old girl from a rural area in India presents for a routine health check. She has not received iron-folic acid supplementation. The government programme that specifically provides weekly iron-folic acid supplementation (WIFS) to adolescent girls aged 10–19 years falls under which national initiative?
Correct. RKSK (Rashtriya Kishor Swasthya Karyakram), launched in 2014, is the flagship Indian adolescent health programme. It includes six service areas: nutrition (WIFS), reproductive-sexual health, substance-use prevention, mental health, non-communicable disease prevention, and injuries/violence. Adolescent Friendly Health Clinics (AFHC) are its service delivery platform.
RKSK (2014) covers 253 million adolescents aged 10–19 in India across six thematic areas. Adolescent Friendly Health Clinics (AFHC) are its dedicated service delivery points, staffed by trained counsellors (ASHA/ANM) offering services with confidentiality and youth-friendly environments.
RBSK targets children 0–18 years for birth defects and disabilities. NNAPP is an older anaemia programme not specifically for adolescents. JSY is a maternal health cash-transfer scheme. RKSK (2014) is the correct national adolescent health programme that includes WIFS as one of its six components.
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A 15-year-old obese boy (BMI for age at 98th percentile) is referred to the adolescent clinic. He has acanthosis nigricans and a family history of Type 2 diabetes. Which of the following best describes the importance of obesity in this context as a non-communicable disease (NCD) risk in adolescence?
Correct. Adolescent obesity tracks powerfully into adult obesity (tracking coefficient ~0.7) and is a major driver of early-onset metabolic syndrome, Type 2 diabetes, hypertension, dyslipidaemia, PCOS, and non-alcoholic fatty liver disease. Acanthosis nigricans in this boy signals insulin resistance.
Adolescent obesity (BMI for age ≥95th centile per IAP/WHO) is a leading NCD risk: it predicts adult obesity, metabolic syndrome, cardiovascular disease, and diabetes. Acanthosis nigricans signals insulin resistance — screen with fasting glucose/HbA1c. Use IAP growth reference charts for Indian adolescents.
Adolescent obesity has a high tracking coefficient into adulthood and drives multiple NCDs early in life. BMI for age (on WHO/IAP growth charts) is the recommended screen for adolescent overweight/obesity; waist circumference is a complementary measure of central adiposity.
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A 14-year-old girl is brought by her mother who suspects sexual abuse by a relative over the past 6 months. The girl is distressed and initially reluctant to disclose. Which of the following statements about sexual abuse recognition and management in adolescents is MOST accurate?
Correct. A normal physical examination does NOT exclude sexual abuse — most children/adolescents who disclose sexual abuse have no definitive physical findings on examination. Disclosure is the cornerstone of diagnosis. Under POCSO Act 2012, medical professionals are mandatory reporters — failure to report is an offence.
Child sexual abuse (POCSO 2012): applies to persons <18 years; mandatory reporting by all healthcare providers (Section 19); physical findings are absent in majority of cases; a trauma-informed, non-judgmental approach is essential; refer to a Child Welfare Committee/DCPO after stabilisation.
Physical findings are absent in the majority of sexual abuse cases, especially when abuse is non-penetrative or when examination is delayed. The POCSO Act 2012 applies to any person below 18 years of age — age 16+ is not exempt. Reporting to law enforcement (police/DCPO) is mandatory under POCSO for all healthcare providers.
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