MCQs on Puberty

Q1. Which of the following is the earliest clinical sign of puberty in boys ?

• A. Pubic hair development

• B. Voice deepening

• C. Testicular enlargement

• D. Penile lengthening

• E. Growth spurt

Answer explanation

Answer: C. Testicular enlargement

Explanation:
Testicular volume >4 mL due to seminiferous tubule growth is the first sign of true puberty in boys.

Q2. Menarche usually occurs at which Tanner stage ?

• A. Tanner I

• B. Tanner II

• C. Tanner III

• D. Tanner IV

• E. Tanner V

Answer explanation

Answer: D. Tanner IV

Explanation:
Menarche occurs late in puberty, typically after peak height velocity.

Q3. Which hormone is responsible for initiating puberty ?

• A. LH

• B. FSH

• C. Estradiol

• D. GnRH

• E. DHEA

Answer explanation

Answer: D. GnRH

Explanation:
Pulsatile GnRH secretion from the hypothalamus initiates the pubertal cascade.

Q4. Precocious puberty is defined as onset of secondary sexual characteristics before:

• A. 7 years in girls, 8 years in boys
  
  

• B. 8 years in girls, 9 years in boys
  
  

• C. 9 years in girls, 10 years in boys
  
  

• D. 10 years in girls, 11 years in boys
  
  

• E. 11 years in girls, 12 years in boys

Answer explanation

Answer: B. 8 years in girls, 9 years in boys

Q5. Which finding suggests central precocious puberty ?

• A. Suppressed LH after GnRH stimulation

• B. Advanced bone age with low LH

• C. Pubertal LH response to GnRH

• D. Elevated DHEAS only

• E. Normal growth velocity

Answer explanation

Answer: C. Pubertal LH response to GnRH

Explanation:
Central precocious puberty is gonadotropin-dependent and shows pubertal LH secretion.

Q6. Which condition causes gonadotropin-independent precocious puberty ?

• A. Craniopharyngioma

• B. Hypothalamic hamartoma

• C. Congenital adrenal hyperplasia

• D. Idiopathic central puberty

• E. Kallmann syndrome

Answer explanation

Answer:

C. Congenital adrenal hyperplasia

Q7. The most useful initial investigation in a child with suspected precocious puberty is:

• A. Bone age X-ray

• B. MRI brain

• C. Serum oestradiol/testosterone

• D. Pelvic ultrasound

• E. GnRH Stimulation test

Answer explanation

Answer: A. Bone age X-ray

Explanation:
Bone age helps confirm true puberty and assess progression.

Q8. The treatment of choice for central precocious puberty is:

• A. Aromatase inhibitors

• B. GnRH analogues

• C. Oestrogen blockers

• D. Corticosteroids

• E. Growth hormone

Answer explanation

Answer: B. GnRH analogues

Q9. In normal puberty, the peak height velocity occurs:

• A. Before secondary sexual characteristics

• B. At the onset of puberty in both sexes

• C. Earlier in girls than boys

• D. After menarche

• E. Only in boys

Answer explanation

Answer: C. Earlier in girls than boys

Q10. A 6-year-old girl presents with breast development and pubic hair. She is tall for age with advanced bone age. LH rises after GnRH stimulation.

Most likely diagnosis is?

• A. Premature thelarche

• B. Peripheral precocious puberty

• C. Central precocious puberty

• D. McCune-Albright syndrome

• E. Congenital adrenal hyperplasia

Answer explanation

Answer: C. Central precocious puberty