Behavioral Science & Ethics USMLE Step 1 Practice Question
A 42-year-old woman presents to the clinic with her husband, who reports that she has become increasingly withdrawn, tearful, and hopeless over the past 8 weeks. She has a 10-year history of systemic lupus erythematosus currently managed with prednisone 20 mg daily. On review of systems, she denies new joint pain, rashes, or constitutional symptoms beyond fatigue. Vital signs are stable. On mental status examination, she maintains adequate eye contact and denies current hallucinations or delusions. When asked about the future, she states, 'I don't know if things will ever get better. My family might be better off without me.' She denies having a specific plan to harm herself. Which of the following is the most appropriate next step in management?
Answer choices
- ADirectly ask the patient about suicidal ideation, intent, and any plan or meansCorrect answer
- BInitiate selective serotonin reuptake inhibitor therapy and schedule psychiatric follow-up in 2 weeks
- CReassure the patient that her depression is secondary to SLE and will improve with corticosteroid dose adjustment
- DArrange immediate psychiatric hospitalization given her passive suicidal ideation
- EOrder brain MRI and lumbar puncture to rule out lupus cerebritis before initiating any psychiatric treatment
- FIncrease prednisone dose to 40 mg daily, as corticosteroid-responsive depression is common in SLE
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