10 exam-style questions with answers and explanations, straight from our 1,030-question bank. Tap an answer to check yourself. When you're ready, take the scored version in the free practice test.
The PMHS exam has 150 questions and runs 2 hours 30 minutes.
These 10 free PMHS questions are organized by exam domain, so you can see how each part of the Pediatric Primary Care Mental Health Specialist (PMHS) blueprint is tested. Reveal the answer and explanation under each question.
At a delayed well-child visit, a 20-month-old has an initial M-CHAT-R score of 5. Developmental surveillance identifies no additional concerns or loss of skills. The parent asks whether this result means the child needs an autism evaluation. What is the appropriate next step in the screening pathway?
Correct answer: C - Complete the structured follow-up interview for the items scored at risk.
'Should we stop taking her to group activities?' ask the parents of a 4-year-old who watches unfamiliar groups for about 15 minutes before joining. Once comfortable, she talks freely, plays reciprocally, and enjoys herself. She has friends and separates from her parents at preschool without ongoing distress. What guidance best fits this pattern?
Correct answer: D - Preview new situations and allow a gradual warm-up before expecting participation.
Although a 16-year-old denies personal alcohol, cannabis, or other drug use, the CRAFFT interview reveals that he sometimes rides home with a friend who has been using cannabis. He says, 'I don't use anything, so I thought I was being safe.' What counseling directly addresses the risk he has disclosed?
Correct answer: A - Make a sober-ride plan that includes a trusted backup adult.
An 11-year-old's child-report SCARED has a total score of 23 and a school-avoidance subscale score of 5. She has missed several mornings because of stomachaches that resolve when she stays home. Medical assessment has not identified an explanation. How should the screening results influence the assessment?
Correct answer: A - Explore school-related anxiety despite the total score being below its screening cutoff.
During a routine visit, a 15-year-old answers yes to an Ask Suicide-Screening Questions (ASQ) item about wishing to be dead in the past few weeks. She answers no when asked whether she is thinking about killing herself right now. She is calm and cooperative. A clinician has not yet assessed past suicidal behavior, plans, access to lethal means, or available support. Before determining where she can safely receive care, the clinician should:
Correct answer: D - Conduct a brief suicide safety assessment during this visit.
A 30-month-old hears Spanish and English daily. Across both languages, he uses approximately 15 single words and no spontaneous two-word combinations. He points to share interests, engages in pretend play, and has age-appropriate motor skills. His newborn hearing screen was normal. The family has been told that learning two languages explains the delay. Which evaluation is warranted now?
Correct answer: B - Speech-language assessment across both languages and formal audiologic evaluation.
The school requests an ADHD evaluation for a 10-year-old with declining grades and new classroom outbursts. Seven months earlier, he witnessed his father sustain life-threatening injuries in a collision. He previously functioned well. Since the crash, he has recurrent crash-related nightmares, avoids cars, blames himself, and has withdrawn from friends. He watches for danger, startles at loud noises, and struggles to concentrate. Which diagnosis best accounts for this change?
Correct answer: D - Posttraumatic stress disorder
A caregiver worries that a 9-year-old has bipolar disorder because of explosive behavior. For 18 months, the child has had developmentally disproportionate outbursts four or five times weekly at home and school. Between episodes, he is irritable most of nearly every day; there has been no symptom-free interval longer than three weeks. There have been no distinct periods of elevated mood, grandiosity, or decreased need for sleep. The pattern began at age seven and substantially disrupts family and classroom life. The most specific diagnosis is:
Correct answer: A - Disruptive mood dysregulation disorder
Parent training has helped a 4-year-8-month-old with well-established ADHD, but serious impairment remains after 16 weeks of consistent treatment and a preschool behavioral plan. He repeatedly runs from supervised areas and cannot participate in classroom activities. Sleep, development, and family circumstances have been assessed; no untreated comorbidity explains the persistent symptoms. His caregivers are willing to consider medication. Which plan is best supported for this age group?
Correct answer: B - Add low-dose methylphenidate while continuing the behavioral interventions.
A 9-year-old with separation anxiety repeatedly asks to leave school because of nausea. Medical evaluation is reassuring, and interviews identify no bullying or academic mismatch. Her parents collect her whenever she calls; the nausea resolves, but absences are increasing. She is beginning cognitive-behavioral therapy. Which school plan is most likely to improve functioning?
Correct answer: C - Use a supported, graded return to attendance while reducing anxiety-driven pickups.
The PMHS exam also covers these domains. Drill them in the full free practice test:
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