250 ) A 30 year old woman presents to your office with complaints of fatigue and headache. She reports that the headaches occur almost daily and are mild to moderate. They are not associated with nausea or vomiting and are unrelated to menstrual cycles. She also reports chronic diffuse abdominal pain and pelvic pain for the past several months for which she did not seek any medical attention. Her chart reveals that she was seen by your colleague few months ago for similar complaints. She was asked to return after few laboratory investigations but she had been non-compliant with her follow-ups. Physical examination reveals an anxious appearing woman who otherwise appears healthy. She does not make an eye contact. Abdominal and pelvic examination is benign. There are no tender points. There are no neurological deficits. The most appropriate next step in managing this patient:
A) Support and Counseling
B) Refer to Psychiatry
C) Start Selective Serotonin Reuptake Inhibitors
D) Trial of Tricyclic anti-depressants
E) Screen for Domestic Violence
screen for domestic voilence
I agree
e
Pt’s reulctance to make eye contact and multiple complaints without organic cause imply that there might be domestic abuse.
C