Behavioral Science & Ethics USMLE Step 1 Practice Question
A 3-year-old girl is brought to the office by her parents who express concern about their daughter's behavior. They report that she frequently refuses to comply with requests, throws 3-5 minute tantrums when frustrated, and resists bedtime routines despite requiring minimal parental assistance once she cooperates. Her preschool teacher describes her as active, talkative, and appropriately interactive with peers without being disruptive in the classroom setting. The parents note she sleeps through most nights but occasionally has episodes of enuresis. Developmental history is significant for first words at 11 months and independent ambulation at 14 months. Physical examination is unremarkable. Mental status examination reveals initial shyness that resolves within minutes; the child demonstrates age-appropriate play, 90% intelligible speech, and vocabulary consistent with her age. Vital signs are normal. Which of the following is the most appropriate next step in management?
Answer choices
- AReassurance to parents that these behaviors are developmentally normalCorrect answer
- BReferral to child psychiatry for evaluation of oppositional defiant disorder
- CInitiation of methylphenidate for suspected attention-deficit/hyperactivity disorder
- DPrescription of an enuresis alarm system for nocturnal bedwetting
- EReferral for speech-language pathology evaluation
- FTrial of selective serotonin reuptake inhibitor for anxiety
See the full explanation
Get the correct-answer rationale, why each distractor is wrong, the underlying mechanism, and high-yield associations — plus adaptive practice that targets your weak areas — with a free MedBoardPRO account.