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These 10 free CAQ questions are organized by exam domain, so you can see how each part of the Certificate of Added Qualification in Adolescent Medicine (CAQ) blueprint is tested. Reveal the answer and explanation under each question.
Domain 1: Musculoskeletal Diseases
Question 1
Three days after a soccer concussion, a 16-year-old returns for follow-up. She was removed from play immediately and has spent two days resting at home. Her headache is improving; reading causes a mild, brief increase that resolves with a break. Walking around the house does not worsen symptoms. Neurologic examination is normal, and she has no repeated vomiting, worsening headache, or focal deficit. She is worried about falling behind at school. Which recommendation belongs in her recovery plan now?
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Correct answer: B - Begin a graded return to class and light, symptom-limited aerobic exercise
Domain 2: Endocrine and Metabolism
Question 2
Pubic hair has developed, but a 15-year-old boy has had no apparent genital progression. Examination shows Tanner stage 3 pubic hair, testes measuring 2 mL bilaterally, and a prepubertal penis. Morning testosterone is low; LH and FSH are both markedly above their age-adjusted reference ranges. He takes no hormones or supplements. Which physiological interpretation accounts for the discordance between his hair development and gonadal findings?
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Correct answer: A - Primary gonadal dysfunction with preserved adrenarche
Domain 3: Nutrition and Eating Disorders
Question 3
A 16-year-old has lost 18 kg in four months by progressively restricting food and running despite fatigue. Her current BMI is 22.6 kg/m². She is intensely afraid of regaining weight and becomes lightheaded on standing. After resting supine, her daytime heart rate is 44/min; on standing it rises to 94/min and remains elevated. Blood pressure is 98/62 mm Hg. Potassium, magnesium, and phosphorus are within their reference ranges. Her mother asks whether outpatient treatment is sufficient because her weight is not low. Which disposition best addresses the risk evident today?
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Correct answer: C - Medical admission for nutritional rehabilitation with cardiac and electrolyte monitoring
Domain 4: Collagen Vascular Diseases
Question 4
A family canceled an ophthalmology appointment for their 13-year-old because her oligoarticular juvenile idiopathic arthritis is quiet. Arthritis began at age 5, and she is ANA-positive. She has no eye pain, redness, photophobia, or visual complaint; visual acuity is 20/20 in both eyes. Her parent asks whether eye follow-up is still necessary when neither the joints nor the eyes are bothering her. Which surveillance approach remains appropriate?
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Correct answer: D - Continue scheduled slit-lamp examinations despite the absence of eye symptoms
Domain 5: Mental Health
Question 5
During a routine visit, a 15-year-old's PHQ-9 total is 8, including a score of 1 on the death/self-harm item. In private, she describes wishing she would not wake up on several days after a friendship ended. She denies thoughts of killing herself right now and reports no lifetime suicide attempt. She is calm and willing to continue the interview. A suicide-focused interview has not yet been completed. The appropriate response to these findings is to:
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Correct answer: D - Complete a brief suicide safety assessment before deciding her disposition
Domain 6: Hematology/Oncology
Question 6
Heavy menstrual bleeding has occurred since menarche in a 15-year-old. Her periods last 9 days, with hourly pad changes during the heaviest flow. She also has recurrent nosebleeds and bled for many hours after a dental extraction. Her mother required treatment for postpartum hemorrhage. The patient is hemodynamically stable; hemoglobin is 9.4 g/dL, MCV 68 fL, and ferritin 5 ng/mL. Platelet count, PT, and aPTT are normal. Pregnancy testing is negative. Beyond iron replacement and menstrual control, which investigation is best supported by this history?
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Correct answer: A - Von Willebrand factor antigen, platelet-dependent activity, and factor VIII activity
Domain 9: Reproduction including Sexuality and Sexually Transmitted Diseases
Question 7
At a contraceptive visit, an 18-year-old asks for a method that does not require daily dosing and will make her heavy periods lighter. Her periods are regular, and prior evaluation found no bleeding disorder or structural cause. She has migraine with visual aura and is comfortable with IUD placement. Her normal menstrual period began three days ago, and a pregnancy test is negative. She is due for gonorrhea and chlamydia screening but has no pelvic pain, abnormal discharge, cervical inflammation, or known infected partner. What is the best choice to offer today?
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Correct answer: A - Place a levonorgestrel IUD while obtaining gonorrhea and chlamydia screening
Question 8
Pelvic pain persists in a sexually active 17-year-old whose cervical gonorrhea and chlamydia NAAT results are negative. Examination shows mucopurulent discharge, cervical-motion tenderness, and bilateral adnexal tenderness without guarding. Pregnancy testing is negative, and ultrasonography shows no adnexal mass or abscess. No alternative cause is identified. She is afebrile, tolerates oral medication, has no relevant drug allergies, and has reliable follow-up within 72 hours. Which management choice is justified by the clinical findings rather than the negative cervical tests?
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Correct answer: C - Treat as an outpatient with ceftriaxone, doxycycline, and metronidazole
Domain 11: Gastrointestinal Diseases
Question 9
The initial evaluation of a 17-year-old with chronic bloating, loose stools, and iron deficiency includes a negative tissue-transglutaminase IgA result. Total IgA is below the laboratory's detection limit. She has continued to eat bread and pasta daily and has not tried a gluten-free diet. Which change in the testing strategy corrects the principal limitation of the negative result?
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Correct answer: C - Measure tissue-transglutaminase IgG without withdrawing dietary gluten
Domain 13: Substance Abuse
Question 10
Emergency personnel bring in a 17-year-old who became unresponsive after taking a tablet sold as oxycodone. Respiratory rate is 5/min, oxygen saturation is 82%, and the pupils are pinpoint. Glucose is 96 mg/dL. Bag-mask ventilation is underway. A routine urine opiate immunoassay is negative. Which medication is most urgently indicated despite that result?