Behavioral Science & Ethics USMLE Step 1 Practice Question
A 52-year-old woman presents to her primary care physician 8 weeks after her husband's death from myocardial infarction. She reports experiencing daily headaches described as a tight band around her head, occurring unpredictably without associated nausea, photophobia, or vision changes. She denies suicidal ideation, appetite changes, or sleep disturbance beyond occasional insomnia related to grief. Vital signs are normal. On examination, she becomes tearful when discussing her husband and expresses feelings that "life feels empty" and worries about managing finances alone. She states these feelings are most intense when she encounters reminders of him but she is able to attend to her job responsibilities. There is no personal or family history of psychiatric illness. Which of the following is the most appropriate next step?
Answer choices
- AProvide empathic listening, validate her grief response, and schedule a follow-up visit in 2-4 weeksCorrect answer
- BInitiate a selective serotonin reuptake inhibitor for depression
- CRefer to psychiatry for evaluation of major depressive disorder
- DPrescribe a tricyclic antidepressant for migraine prophylaxis and mood support
- ERefer for immediate neuroimaging to exclude secondary causes of headache
- FPrescribe a benzodiazepine to reduce anxiety and allow emotional expression
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